Pregnancy Week by Week : Week 40 (part 2) - Pain Relief without Medication, Massage for Relief, Laboring Positions

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Keep Your Options Open

An important consideration in planning for your labor and delivery is the method(s) you may use to get through the process. Will you have epidural anesthesia? Are you going to attempt a drug-free delivery? Will you need an episiotomy or an enema?

Every woman is different, and every labor is different. You don’t know what will happen and what you will need during labor and delivery for pain relief. It’s impossible to know how long labor will last—3 hours or 20 hours. It’s best to be flexible. Understand what’s available and what options you can choose during labor.

During the last 2 months of pregnancy, discuss any concerns with your healthcare provider. Know what can be provided for you at the hospital you’ve chosen. Some medications may not be available in some areas.

Pain Relief without Medication

Some women do not want medication during labor to relieve pain. They prefer to use different techniques to relieve pain.

Nondrug techniques to manage labor pain include many things, such as continuous labor support, water therapy, hypnosis and acupuncture. Continuous labor support is often provided by a nurse, midwife or doula, and includes touch, massage, application of cold or heat, and other ways to provide physical comfort. It also includes emotional support, which gives you information and helps you communicate with those caring for you.

For some women, water therapy (hydrotherapy) during labor has been shown to reduce the amount of stress hormones released in the body. It may also decrease the frequency of contractions. Some women experience less pain and more relaxation in the water. The water also softens the perineal area, so it may stretch more easily. A warm (not hot) shower can relax and massage you. Water immersion involves a warm bath during early labor and is most often used then. Birth pools may be available in some hospitals. You may have to get out of the pool to give birth.

If your labor slows down, your healthcare provider may give you oxytocin.

Hypnosis to relieve labor pain is sometimes called hypnobirthing; it may not be available everywhere. It can be effective for some women but may not be right for everyone. Visualization, relaxation and deep breathing help you enter a deep state of relaxation to help you deal with your fear of pain. However, understand that if you choose hypnotherapy to help you deal with pain, you must prepare and practice for months before baby’s birth.

Acupuncture requires an acupuncturist willing to be on call to come to the labor and delivery room. It uses needles at specific points to relieve pain. It must usually be started at the beginning of labor. Acupressure uses pressure on specific parts of the body to help relieve pain and to relax you.

Swaying from side to side, changing positions and rolling on a birthing ball (like a big exercise ball) can help ease discomfort. Because you’re upright, the force of gravity may help your labor progress. Walking also keeps you upright, which helps dilate the cervix naturally.

Aromatherapy, which consists of massage with certain aromatic oils, can be helpful for relaxation. Listening to instrumental music for at least 3 hours during early active labor may also help you deal with pain by helping you relax.

Massage for Relief

Massage is a wonderful, gentle way to help you feel better during labor. The touching and caressing of massage helps you relax and helps reduce pain. One study showed women who were massaged for 20 minutes every hour during active labor felt less anxiety and less pain.

Many parts of the body of a laboring woman can be massaged. Massaging the head, neck, back and feet can offer comfort and relaxation. The person doing the massage should pay close attention to the woman’s responses to determine correct pressure.

Different types of massage affect a woman in various ways. You and your partner may want to practice the two types of massage described below before labor.

Effleurage is light, gentle fingertip massage over the abdomen and upper thighs; it is used during early labor. Stroking is light, but doesn’t tickle, and fingertips never leave the skin. Place hands on either side of the navel. Move the hands upward and outward, and come back down to the pubic area. Then move the hands back up to the navel. Massage may extend down the thighs. It can also be done as a crosswise motion, around fetal-monitor belts. Move fingers across the abdomen from one side to the other, between the belts.

Counterpressure massage can relieve back-labor pain. Ask your labor coach to place the heel of his or her hand or the flat part of the fist (you can also use a tennis ball) against your tailbone. Firm pressure is applied in a small, circular motion.

Laboring Positions

Different laboring positions may allow you and your partner (or labor coach) to work together during labor to find relief. This interaction can help you feel closer, and it lets you share the experience. Some women say that using these methods brought them closer to their partner and made the birth experience a more joyful one.

Most women in North America and Europe give birth in bed, on their backs. However, some women are trying different positions to find relief from pain and to make the birth of their baby easier.

In the past, women often labored and gave birth in an upright position that kept the pelvis vertical. Kneeling, squatting, sitting or standing up lets the abdominal wall relax and the baby descend more rapidly. Because contractions are stronger and more regular, labor is often shorter.

Today, many women are asking to choose the birth position that is most comfortable for them. Freedom to do so can make a woman feel more confident about managing birth and labor. Women who choose their own methods may feel more satisfied with the entire experience.

If it’s important to you, discuss it with your healthcare provider. Ask about the facilities at the hospital you will use; some have special equipment, such as birthing chairs, squatting bars or birthing beds. Positions you might consider for your labor are described below.

Walking and standing are good positions to use during early labor. Walking may help you breathe more easily and relax more. Standing in a warm shower may provide relief. When walking, be sure someone is with you to offer support.

There has been some debate about walking during labor. Some believe walking helps move the baby into position more quickly, dilates the cervix faster and makes labor more pain free. Others believe walking puts the woman at risk of falling and doesn’t allow for fetal monitoring. One study of more than 1000 pregnant women showed walking had no effects. We believe the bottom line is that it’s a personal decision on your part, and you should be allowed to decide what feels best for you.

Sitting can slow labor. Sitting to rest after walking or standing is OK, but sitting can be uncomfortable during a contraction.

Tip for Week 40

If you want to use a different labor position, massage, relaxation techniques and/or hypnotherapy to relieve labor pain, don’t wait until you’re in labor to ask about it. Discuss it with your healthcare provider at one of your prenatal visits.

Kneeling on hands and knees is a good way to relieve the pain of back labor. Kneeling against a support, such as a chair or your partner, stretches your back muscles. The effects of kneeling are similar to those of walking and standing.

When you can’t stand, walk or kneel, lie on your side. If you receive pain medication, you’ll need to lie down. Lie on your left side, then turn onto your right side.

Although lying on your back is the most common position used for labor, it can slow labor. It can also make your blood pressure drop and cause your baby’s heart rate to drop. If you lie on your back, elevate the head of the bed and put a pillow under one hip so you are not flat on your back.

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