Gate Control Theory
There are many approaches to coping with the physical demands of labour, ranging from breathing & relaxation to the use of medical anaesthetics. Before you give birth, it is a good idea to be aware of some of these options so you will be able to make use of them during labour. The majority of people labour at home for quite a while before labour is advanced enough to warrant admission at the hospital, so even if you are planning to rely on medical forms of pain relief, most people benefit from at least a few ‘at-home’ techniques for early labour.
One such technique is broadly called the ‘Gate Control Theory’.
The Gate Control Theory explains how pain signals can be amplified or reduced before reaching the brain. Originally proposed in 1965 by Patrick Wall and Canadian Ronald Melzack, it describes a “gate” in the spinal cord that regulates incoming pain signals. Small nerve fibers carrying strong pain signals tend to open the gate, while larger fibers carrying touch and pressure signals can close it.
According to this theory, different types of nerve fibers influence whether the gate is open or closed. Small nerve fibers (associated with sharp, intense pain) tend to open the gate, allowing pain signals to pass through. In contrast, large nerve fibers (associated with touch, pressure, or vibration) can close the gate, reducing the perception of pain. This is why rubbing or massaging an injured area can sometimes lessen pain—it activates the larger fibers and helps “close” the gate. There is lots of research on this.
We’ve all experienced this in normal life. If you accidentally bang your knee or your elbow, the first thing most people do is to instinctively use a gate-control approach. This might be squeezing, rubbing, applying pressure, or shaking the sore body part. I recently accidentally shut my finger in a drawer, and I squeezed it for about 15 minutes before I was willing to let go, because the squeezing so effectively muted the pain.
Understanding how this works has important implications for pain management and treatment in general, but also specifically during labour.
During childbirth, this theory helps explain why certain coping techniques can reduce the perception of labour pain. Methods like massage, rhythmic breathing, movement, and using birthing balls stimulate large sensory nerve fibers, which can help “close” the gate and lessen pain signals from uterine contractions. It helps explain why non-drug therapies—such as massage, heat therapy, acupuncture, and transcutaneous electrical nerve stimulation (TENS)—can be effective in reducing pain.
In simple terms, it’s like if your brain is only focused on the contractions, the contractions will dominate your awareness. They will be all you feel. The effect can be very intense, sometimes overwhelming. But if your brain is also receiving the sensation of touch, or rhythmic movement, or massage, part of the brain’s attention goes to that sensation as well, which reduces our intake of the pain signals. Furthermore, the pleasant sensation changes the brain’s tendency to feel pain–as if it has a calming effect on the brain–so that the actual pain is turned down a few notches at the same time. The alternative sensation we have added muffles the pain. It distracts our brain from dwelling on the pain, but it also physically alters our perception of it.
It doesn’t take away the contractions, but we feel them less.
Pretty much any pleasant or alternative sensation can have this effect. In labour, these are some common techniques you can try.
Hand holding or squeezing
Squeezing a comb or spiky ball
Rubbing
Acupressure
Double hip-squeeze
Counter pressure
Swaying or rocking
The Gate Control Theory also shifts the understanding of pain from a purely physical process to a complex interaction between the body and the brain. After all, the brain doesn’t only process physical sensations. It also interprets them in the context of our memories, emotions, and psyche. The brain sends signals down the spinal cord that influence the gate through interpreting sensations, so that emotions, attention, and past experiences also affect how much pain you feel. It highlights the psychological component of pain, showing that factors like stress, anxiety, or distraction can amplify or dampen pain perception.
This is extremely relevant for labour and how we experience it.
It means that creating a context of calm, of trust, of safety and support, can have an enormous effect on how someone experiences labour–not just the psychological experience but the actual level of pain.
One category of approaches deals with calming oneself. This can be done in many ways:
Taking a prenatal class
Deep breathing
Visualizations
Relaxation techniques
Meditating
Positive words, affirmations, mantras
Focal points
The more relaxed you are, the more your brain interprets the contractions as benign, rather than threatening or dangerous, and the less painful they actually feel.
Other techniques fall into the category of environment. Creating a relaxing, safe-feeling, comfy-cozy, nesting environment can enormously help us get into a better psychological space, that allows our brain to shift from interpreting the pain sensations as scary and menacing, to familiar and manageable. It changes our brain’s perception so that we can distinguish functional pain from pathological pain. Labour pain does not harm or injure us, but we need our brain to realize this by creating a context of calm, safety, and trust.
Dim lighting
Familiar comfort items (blankets, pillows, slippers)
Comfy, cozy nesting environment
Music or quiet
Calm surroundings
Intimate setting (limit strangers)
Uninterrupted, undisturbed
As well as calming environments, continuous support from a partner or doula, has an outsized influence on the brain’s role in modulating pain—reducing tension and fear, and replacing them with feelings of safety and support.
Continuous support from a friend
Support from a family member
Oxytocin (love, intimacy)
A doula
This cannot be overstated–continuous support is one of the most significant ways we can reduce fear and pain during labour. This is equally true whether the continuous support is instead of pharmacological pain relief, or alongside it–an alternative or an addition. Labour can still be scary and overwhelming even with an epidural, so continuous support is always beneficial.
Continuous labour support, ideally, is provided by someone outside of your medical team, so that they have no competing priority other than your experience, and they are only beholden to you and no one else. Even though your doctor, midwives, and nurses can all be extremely supportive and knowledgeable, studies on labour support show that having someone else who never leaves your side, who is with you at home as well as in hospital, who is dedicated to supporting your experience, and who doesn’t have any medical obligations, provides a uniquely effective reduction in fear and pain.
This can be your partner, but having someone who can support both of you together through the process is even more effective. Having someone dedicated, whose job it is to support both of you, frees up your partner to be fully present for the birth as well, and also helps the birthing person relax more. This official support-person can support your partner in supporting you. You can hire a doula, or you can use a friend or family-member. Or if you prefer to just rely on your partner, that’s okay too.
The Gate Control Theory provides a scientific explanation for something we already knew about labour, which is that giving birth is a holistic experience that involves the body and the mind in a seamless and integrated way. Labour is always intense, but we can experience the intensity on a huge spectrum ranging from traumatic to ecstatic, or from very painful to uniquely pleasurable. This understanding gives us enhanced tools to support birthing families and provide physical, environmental, and emotional support throughout the process. Ultimately, it helps emphasize the importance of continuous support during labour, and elucidates how the birthing person’s perception is what most acutely colours the experience. It helps care teams understand how small changes in the environment can have big effects, and it gives birthing people a range of tools to help improve their own experience.
Stephanie Ondrack has been with The Childbearing Society since 2003. She lives in East Van with her partner, kids, cats & chickens.