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.
