Comfort Measures in Labor

For all women, labor presents both emotional and physical demands. Many women in our culture have never witnessed a normal birth and often there is some degree of fear or doubt that giving birth without pharmaceutical pain relief is even possible. This is especially true when a woman is not aware of the many alternative methods of coping with the sensations of labor. In this section I will discuss the alternatives to medicinal analgesia (narcotics) and regional anesthesia (epidurals/spinals).

Choosing a care provider and place of birth in which you feel absolutely safe is the first step on the path to a satisfying birth experience. It is also crucial if you are planning a natural birth. We are mammals, and like every other mammal, we are fiercely protective of our young. This means that if we feel threatened during labor, progress may be delayed or it may stop completely. Stress hormones can also cause contractions to be more painful, creating a cycle of stress, tension, and increased pain. The ability to relax and work with your body during labor, recognizing that the powerful sensations you are experiencing are coming from within you, rather than viewing them as something you have to simply 'endure' makes you an active participant in the process and can really make a difference in your perceptions. It is also imperative that you surround yourself with caregivers who believe in your ability to give birth — even more than you might believe it yourself!

If you have no risk factors during your pregnancy, choosing to labor at home for as long as possible in early labor allows you the freedom to eat familiar foods for energy and stay well-hydrated to increase the effectiveness of uterine contractions. You will be able to rest in your own bed if your labor begins at night, or go about your daily activities if your labor begins during the day. Because you are in the privacy of your own home, you can feel free to vocalize through contractions, use your own shower or bathtub, and labor in the most comfortable positions, following your body's signals and your own intuition. If you have a doula accompanying you at home, she can offer suggestions for position changes, show your partner effective techniques for supporting you during contractions, vocalize with you, help you focus on breathing and relaxation, and help you to determine if what you are experiencing is normal. She can guide you in using tools such as the birth ball or offer soothing massage or counter-pressure for back pain. Finally, she can help you to make the decision about when to call your care provider or when to leave for the hospital or birth center.

Each woman and each labor is unique, and a technique that is useful at one stage in the process may be ineffective at another time, so it is important to be open to trying many different comfort measures during labor. It is also important to remember that it may take more than one or two contractions for a technique to be effective and that you can get through each contraction, one at a time, knowing that there is a rest period in between. The following list of comfort measures is by no means exhaustive. The most important thing to remember is that your intuition and your own innate knowledge of the process of birth will be your most effective tools.

• Remain well-hydrated — Staying hydrated by drinking frequently, between each contraction, allows your uterus to contract efficiently. If you become dehydrated it can interfere with the progress of your labor by making contractions irregular. The contractions may also be more comfortable if you stay well-hydrated.
• Continue to eat nourishing foods — Labor requires a great deal of energy and our bodies derive energy from the calories in the foods we eat. During early labor, continue to eat light snacks of nourishing foods in order to supply energy to your muscles. As labor becomes more advanced, you may experience nausea and vomiting or you simply may not have much interest in food, however continuing to take in calories in the form of juice, broth, or spoonfuls of honey is still important for labor progress.
• Get plenty of rest — In early labor, you may experience a range of emotions and the advice to "get some rest" may seem impossible to follow. Just as remaining hydrated and well-nourished will aid in the progress of labor, avoiding exhaustion is especially important. Even if you can't sleep, try making yourself as comfortable as possible in early labor. Take a warm shower, lie down with a favorite book or put on some soft music. Make the environment calm and conducive to getting some rest. You may find that you are able to nap between contractions, or even sleep through some of your early labor if it begins at night.
• Continue your regular activities — This suggestion may seem to contradict the previous one, but if your early labor begins during the day, and you are unable to nap, continue your normal activities as long as the contractions are not taking all of your attention. Once the contractions require all of your focus, try relaxing completely and resting between each one. If labor begins at night, try to sleep as much as possible.
• Change positions frequently — Once active labor is established, frequent position changes can enhance progress and make each contraction more effective. Even if you are laboring in bed, try changing sides frequently or laboring on your hands and knees, using pillows or a birth ball to support your upper body. Remaining active during labor encourages progress by allowing the uterus to work with gravity, allowing the baby to maneuver into the optimal position for birth, and giving your pelvic joints maximum flexibility to give the baby the most space to descend through your pelvis.
• Use relaxation techniques — There are many techniques that are useful in keeping your body relaxed so that all of your energy will be available for uterine contractions and the cervix dilates easily. Some techniques include focus on the breath; deep natural breathing ensures optimum oxygenation for the uterine muscles as well as for your baby. Other techniques focus on self-hypnosis, distraction, or rituals such as repeating the same phrase ("open... open...") or having a birth partner lightly touch each area where you are holding tension in your body during a contraction.
• Massage and counter-pressure — The power of touch during labor can enhance relaxation as well as help the laboring woman to feel loved and supported. It can relieve tension in her back and legs, or even in her face and hands. Some women prefer light caressing, while others need to have deep pressure and a firm touch. Counter-pressue is a special kind of massage used for women who are experiencing low back pain with or even between contractions. This is more common if the baby is in a poor position. Counter-pressure may be used in tandem with position changes to help a mother deal with pain while attempting to address the cause, and encouraging the baby to rotate. Counter-pressure is sometimes combined with heat or cold to provide additional relief.
• Hydrotherapy — The use of water for analgesia in labor is so effective that it has been referred to as "the midwife's epidural." Both showers and tubs are useful in labor, but deep water immersion especially enhances relaxation and can aid the progress of labor in the later stages. The ability to change positions with ease, combined with the relaxation of the pelvic muscles and abdomen can also aid in getting baby into the best position for birth.