Cope with Labor Pains, Naturally

An unmedicated labor doesn't mean a labor without pain relief.  

Barbara had an epidural for her first birth. It was a good birth, but not quite what she'd wanted. For her second baby, Barbara chose a

midwife. When the midwife met her at the hospital, Barbara was deep into her labor, walking, holding her husband with each contraction, working hard, but coping. About an hour later, she asked for an epidural. "You may not need one," the midwife suggested, remembering that Barbara had wanted an unmedicated labor. Barbara insisted. But before the epidural was placed, the midwife examined her again and determined Barbara was ready to push.

Sure enough, Barbara was fully dilated, and agreed to bypass the epidural so that she would feel the sensations to help her push her baby out. She expressed great satisfaction afterward. "I did it," she proudly told her midwife, as she nursed her newborn son. A few years later, Barbara had a third child. With this labor, she never asked for an epidural. "For my second birth," she explained, "it was important to know the epidural was available. But once I knew I could do it, I didn't need that."

Many women feel like Barbara. They may want to avoid exposing their babies to drugs, however small the dosage. They may want to be fully present in the labor and delivery experience--to feel all its sensations. They may want the challenge, similar to the way a marathon runner wants to run the race. Experiencing an unmedicated labor and birth can give a woman the same feelings of accomplishment and exhilaration as crossing the finish line. But an unmedicated labor does not mean a labor without pain relief. There are many ways to help you cope with labor pains that do not involve drugs.

Emotional Support. Research shows that having someone to support you during labor can shorten labor and reduce the use of pain medication. Labor and delivery nurses are one source of support. A loved one can provide more emotional support by coaching or even kissing and caressing. Your physician or midwife, of course, will be another source of support. Midwives are particularly known for providing attentive and comforting labor care.

A doula (or monitrice) is another option. The doula's job is to be on call to provide support and comfort. They meet patients before labor, so they are familiar and comfortable with them before labor starts.

Relaxation. Practicing relaxation before labor pains begin will help you stay calm during the throes of 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 helper 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.

To prepare for labor, practice tensing one body part, such as an arm or leg, while the rest of the body relaxes. Include not just the muscles of the arms and legs, but the smaller muscles in your face, hands and feet. In labor, your support team can watch out for tension. During the prenatal practice sessions, you can try responding to a gentle touch or a reassuring word. In labor, if your partner sees your toes curl, for instance, he or she can whisper in your ear and touch your feet and you will immediately uncurl them.

Breathing is integral to relaxation. Deep breathing provides the best oxygenation for the fetus, and it calms the 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.

Soothing Atmosphere. Make your environment comforting. Choose soothing music and become used to relaxing to it, then bring the music to the hospital or birthing center. Have the center dim the lights and adjust the temperature to suit you. Wear comfortable clothing. Ask your support team, birthing-center staff, or hospital staff to be quiet, especially during contractions.

Movement. Unless you need continuous electronic fetal monitoring, you should be able to move around. Avoid lying flat on your back--it interferes with blood flow to the fetus and constricts the pelvis, making labor more painful. 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 will be available.

Visualization and affirmations. Visualization involves creating mental images of the body letting go, the cervix thinning and opening, the baby moving down in the pelvis. There are visualization tapes available, but you can make your own tape, 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 other than labor. Imagine the baby's smell, its softness, the noises your baby boy or baby girl will make.

Play your visualization tape during the final weeks of pregnancy. Incorporate it into relaxation sessions, use it to help you unwind at day's end, or fall asleep listening to it. Bring the tape to labor. Some people include affirmations in their tapes or simply repeat them before and during labor. "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 two 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. Effluerage 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 effluerage may be too much pressure for the uterus. Back massage is good for back labor and general relaxation. Your partner, midwife, or doula can be the massage therapist. You will need to guide them on whether you prefer light or deep strokes, or both. Deep pressure can be applied with the palms, the thumbs, or the fist.

Muscles can be kneaded between the thumb and fingers. Massage strokes should be continuous, rhythmic, and definite, going from up to down and down to up without lifting the hands. Hands may slide more easily over a thin T-shirt or nightgown than over bare skin. Lotion, powder, oil, or witch hazel can help the hands move on skin. Don't forget the neck, head, face, feet, and hands. They can tense during labor.

Water Immersion. A warm bath, a Jacuzzi or a shower is comforting. Recent research has shown that water immersion does not increase the chances of infection. But don't try getting in or out of a tub without assistance! In bed, a sponge bath may be soothing. Soaking your feet may be relaxing, even if you only sit at the bedside and immerse them in a basin.

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 before labor. Books are available to help you with self-hypnosis.

Aromatherapy. Aromatherapy uses the soothing scents of essential oils, extracted from flowers, plants, trees, roots, and fruit. Health-food stores and many 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; some women (and partners) get headaches from too strong a scent. Six 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 reaction to them.

Acupuncture and Acupressure. Acupuncture is a Chinese healing technique utilizing the placement of needles to stimulate and heal. Acupressure or shiatsu 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 labor pains. 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 four 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 ten to 15 seconds, three 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 four 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 two to three hours and can be repeated.

Most women find they need a variety of techniques to help relive labor pain. 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. With confidence, a little practice, and support, the pain of labor becomes quite bearable.

* taken from "Sweet Relief," by Ronnie Lichtman, CNM, Every Baby magazine, Issue Four.