The type and amount of discomfort during labor and birth varies from woman to woman and changes throughout the various stages of labor. Midwives are leading experts in helping women decide how to cope with childbirth pain. Whether you wish to try strategies such as movement, massage, water immersion, or relaxation techniques, or epidural, nitrous oxide, or other medications, your midwife can help. Your midwife will also help you learn about the different options and choices available if any changes to your birth plan become necessary or if you change your mind.
Know Your Options
Most women find they need a variety of techniques to help them cope with labor. Take the time to familiarize yourself with the many options and gather your support team. Ask your support team in advance to remind you to move around, to breathe, and to ask you how they can help. If one technique doesn’t work, try something else.
Environment. Make your environment comforting. Choose soothing music and become used to relaxing to it, then play the music during labor and birth. Have your birth attendants dim the lights and adjust the temperature to suit you. Wear comfortable clothing. Ask your support team or the birth center or hospital staff to be quiet, especially during contractions.
Water immersion. A warm bath or shower can be comforting during labor and birth. Soaking your feet may be relaxing, even if you only sit at the bedside and immerse them in a basin. If you and your baby are doing fine, you may use the tub any time that you want and for as long as you want. Water will provide the most comfort and benefit if it completely covers your body and stomach up to your breasts. Learn more by reading the Share with Women handout on Using Water for Labor and Birth.
Relaxation. Practicing relaxation before labor will help you stay calm during difficult contractions. To practice, lie down in a comfortable position with pillows under all joints. Have a partner “talk you” through relaxing each muscle. Tense, and then relax, all body parts. Your support person can test your relaxation by lifting each limb, one at a time. If you are truly relaxed, the limb will drop as soon as your helper lets go. Breathing is also integral to relaxation. Deep breathing provides the best oxygenation for your baby and calms your body. Some women attend yoga classes, or practice yoga with the aid of books, tapes or videos. Vocalizing is a good release, too. Chant, hum, or moan.
Hypnosis. The goal of labor hypnosis is to reduce anxiety, facilitate labor, and relieve pain. No form of hypnosis works for everybody. Certain individuals are more susceptible to hypnosis than others. The technique should be tried and practiced before labor. Books and other resources are available to help you with self-hypnosis.
Positioning. Unless you need continuous electronic fetal monitoring, you should be able to move around. If possible, avoid lying flat on your back—it interferes with blood flow to the fetus. Use pillows to support your joints. Find out in advance if you can bring extra pillows for labor. Use the bed or your partner as a leaning post. Try the hands-and-knees position (as if you were going to crawl), but on the bed. Experiment with walking, rocking back and forth, or swaying during contractions. Change positions frequently.
Birthing balls. Birthing balls are large, inflatable rubber balls that are used in exercise classes or children’s play groups. In labor, you can sit and relax your back against the ball (with the ball supported by the wall or your partner) or lean your belly over the curve of the ball from a hands-and-knees position. Find out if you can bring a birthing ball to labor, or if one is available.
Visualization and affirmations. Visualization involves creating mental images of the body letting go, the cervix (opening of the uterus) thinning and opening, and the baby moving down in the pelvis. There are visualization tools available, some of them free downloads, or you can make your own or have your partner or somebody with a soothing voice make one for you. Talk to your body as part of the visualization, and talk to the baby. Use familiar pictures of openings—a flower, a butterfly emerging from a cocoon. You might include relaxing images or thoughts not related to labor. Imagine the baby’s smell, softness, and the noises s/he will make. Some people visualize special locations or memories, or include affirmations in their tapes or simply repeat them before and during labor, such as “I will birth my baby.” “My body is uniquely adapted for birth.” “Labor will bring my baby to me.” Create your own affirmations, using phrases with personal meaning.
Heat and cold. Some women prefer applications of heat, others prefer cold. Sometimes alternating between the 2 works best. You might try placing an ice pack on your lower back or a heating pad on your lower abdomen. However, don’t apply heat to skin that is covered with lotion or ointment—it might burn.
Massage. Effleurage is a gentle massage used during or between contractions. You or your partner can glide the tips of the fingers in an up-and-down or circular motion on the uterus. Late in labor, however, even effleurage may be too much pressure for the uterus. Back massage is good for back labor and general relaxation. Your partner or doula can give the massage. You will need to guide them about whether you prefer light or deep strokes, or both. Don’t forget the neck, head, face, feet, and hands. They can tense during labor.
Aromatherapy. Aromatherapy uses the soothing scents of essential oils, extracted from flowers, plants, trees, roots, and fruit. Many health-food stores and pharmacies sell these oils. Lavender, sandalwood, chamomile, melissa, geranium, rose, and orange oil may be relaxing or refreshing. You may not be able to bring candles to a hospital, but you can use the oils in a tub for massage or as a compress. Dilute the oils; 6 drops in a bathtub is sufficient, and half that makes a good compress. Try the oils before labor to make sure you don’t have a negative or allergic reaction to them.
Acupuncture and acupressure. Acupuncture is a healing technique utilizing the placement of needles to stimulate and heal. Acupressure is a massage technique in which the body is stimulated by touch. The Ho-ku and Spleen 6 points correspond to the uterus and cervix. Stimulating these points may relieve the pain of labor. The Ho-ku point is on the back of the hand, at the V formed by the thumb and the index finger. The Spleen 6 point is about the width of 4 fingers above the inner ankle on the shin. You press with the tip of the thumb from behind your leg, in and towards the front of the leg. Pressure is advised for 10 to 15 seconds, 3 times, with a brief rest between each application.
Transcutaneous electrical nerve stimulation (TENs). TENS is the application of small doses of electrical stimulation to nerve fibers. This is believed to cause the body to produce its own pain-relieving substances. Electrodes through which the current travels are taped to the lower back. TENS is most effective in early labor. Some hospitals have TENS machines and some childbirth centers rent them.
Sterile Water Papules. Sterile water papules are used for the relief of back labor. A midwife, a nurse, or a physician will inject a small amount of sterile water into 4 areas just under the skin of the lower back. This is thought to provide nerve stimulation that distracts you from pain. The injections sting a bit. They can provide relief for 2 to 3 hours and can be repeated.
Nitrous Oxide. Also known as “laughing gas,” nitrous oxide is often used in dental care to help patients manage pain. For labor pain, half nitrous oxide gas is mixed with half oxygen and breathed through a mask or a mouthpiece. In some countries, such as Canada and Australia and many parts of Europe, as many as 8 in 10 women use nitrous oxide to manage the discomfort of labor. Nitrous oxide is not used often in the United States, but that is changing. Learn more by reading the Share With Women handout on Nitrous Oxide.
Narcotics. Narcotics are another common type of pain medication used in US hospitals to help women manage the discomfort of labor. Sometimes these medications are available in birth centers as well. Narcotics are usually given directly into your blood stream through an IV. To learn more about the pros and cons of narcotics, read the Share With Women handout on Pain during Childbirth.
Epidural. An epidural (epidural analgesia) is a local anesthetic placed in a part of your back where it numbs the nerves that go from your pelvis and legs to your brain. This is by far the most common form of labor pain management in US hospitals. With an epidural, you get an injection into the space around the nerves in your spine that makes your body numb below the site of the injection. To learn more about how epidurals work and their associated benefits and risks, read the Share With Women handout on Epidural Analgesia.
As you approach labor and birth, you’ll hear a lot about other people’s experiences. Be aware of our culture’s tendency to give too much weight to the fear and anxiety often associated with childbirth. Your birth experience and story will be uniquely yours. As a first step to building confidence in your ability to give birth, it can be helpful to pay attention to the language you use to talk and think about childbirth. Consider using words like discomfort instead of pain and waves or rushes instead of contractions. Reframing the way you think about childbirth can go a long way towards a more positive outlook and experience. With confidence, a little practice, and support, you will get through the hard work of labor and be rewarded with your beautiful.