Pain relief during labour is on most women’s minds in pregnancy. Everyone’s tolerance to pain is different, and we all have different needs for pain relief.
There are a whole range of pain relief options available to women in New Zealand – some are widely available, some you may need to seek out in advance.
It makes sense to have a ‘toolkit’ of pain relief options available before you go into labour. If you are planning for a drug-free labour, start putting your ‘toolkit’ together by combining the following items/ideas:
- Obstetric/Labour TENS Machines
- Water - birthing pool, bath, shower
- Breathing Techniques
- Birthing Aids
(Transcutaneous Electrical Nerve Stimulation)
TENS has a rapidly growing reputation as one of the safest, most effective forms of modern pain control available to women during childbirth. The treatment is widely approved and recommended by medical professionals and it allows you to experience a mobile, drug-free labour, with personal control over your pain relief.
Most women aiming for a drug-free childbirth will hire a TENS unit for their labour. If you can, pre-book your TENS unit at least 4 weeks prior to your due date.
How does TENS work?TENS units supply gentle, electrical impulses through your skin via four self-adhesive electrode pads positioned on your back.
These gentle impulses attack pain in two ways:
1. by stimulating the release of endorphins, the body’s own pain-relieving hormones
2. by stimulating the nerves to block the slower-moving pain messages coming from your cervix and womb before they reach your brain.
Benefits of Labour TENS
- No harm to baby
- Drug free pain control
- No side effects or drowsiness
- Used at home when contractions start
- Can be used with other methods /drugs
- Proven up to 80% effective for reducing labour pain
- Non invasive giving freedom to move and walk about
WATER– birthing pool, bath and/or shower
Heat has been one of the most effective ways to help control pain for thousands of years. The use of water is well-documented as a labour pain management technique. Labouring women can get in the shower and direct the water stream to specific areas of discomfort.
The main role of water is to help you get through labour by adopting a natural, instinctive position throughout the whole process of childbirth. Relaxing the muscles is truly beneficial, while the contractions are often significantly easier.
The weightlessness and buoyancy means it’s easy to change positions and float easily. In a relaxed state, your body will be producing more useful hormones facilitating a smoother, quicker progression of labour.
A birthing pool may provide you with an increased sense of privacy. Once you are in the pool you may become less aware of those around you and more able to move with your body’s primitive and instinctive urges. You are also in your own space which is unlikely to be invaded by anyone else. For most people it is very hard to remain relaxed standing in the nude, unsure who is going to walk in on you at any moment!
Pain relief – In the water, one’s perception of ‘pain’ seems to alter. It can be easier to accept the intense contractions and the resting in between contractions can be more relaxing in the pool, than on land.
Some factors regarding water births to research and discuss with your Lead Maternity Carer:
- Unable to gauge exact blood loss
- Avoiding dehydration
- Avoiding over-heating the mother
- Difficulty using monitoring equipment
- Avoiding the risk of infection
Rhythmic breathing during labour maximises the amount of oxygen available to you and your baby. Breathing techniques can also help you cope with the pain of contractions.
When you are tense and frightened, your breathing becomes shallow and rapid. Your shoulders are pulled up towards your ears and your neck and shoulder muscles feel tight and rigid. If you move into a state of panic, you start over-breathing, sucking the air into your lungs and breathing out in short, sharp gasps.
Panic breathing cuts down on the amount of oxygen you take in for yourself and for your baby. You feel light-headed and out of control. Pins and needles start in your fingers and your mouth feels numb.
Panic-breathing is a common reaction to very stressful or frightening situations. It’s normal, but your body can’t continue in this state for long without becoming exhausted. In labour, your aim is to conserve your energy as much as possible, and give your baby plenty of oxygen to help him/her cope with the stress of being born. Rhythmic breathing can help you do this.
Simple breathing techniques:
• Think of the word “relax”. It has two syllables, “re” and “lax”. Now try this exercise. As you breathe in, think “re” to yourself, and as you breathe out, think “lax”. Don’t let your mind wander away from repeating the word “relax”‘ in tune with your breathing. When you breathe out, try to let go of any tensions in your body. Focus on the muscles which you know become tense when you’re stressed. Remember, every time you breathe out: “laaaax”. The out-breath is the one to focus on: the in-breath takes care of itself!
• Or you can try counted breathing. As you breathe in, count slowly up to three or four (or whatever number seems comfortable for you) and as you breathe out, count to three or four again. You might find that it’s more comfortable to breathe in to a count of three and out to a count of four.
• Try breathing in through your nose and out through your mouth. Keep your mouth very soft as you sigh the breath out. In through your nose, and out through your mouth. Many women also find it helpful to make a sound on the out-breath, such as “oooooooh” or “aaaaaah”. In between contractions, have sips of water to prevent your mouth from becoming dry.
Support with Breathing
It can be very hard to keep your breathing rhythmical and to relax every time you breathe out when you’re having painful contractions, you’re tired, and labour seems to be endless. This is where the support of your birth partner is essential. A birthing partner can help you keep your breathing steady by breathing with you.
Try keeping in eye contact with your birthing partner, and s/he can hold your hands or place his/her hands on your shoulders, leaning gently on them. Then you can follow his/her pattern of breathing as s/he breathes in through his/her nose and blows out softly into your face. Practise this during pregnancy.
When breathing becomes out of control, some women find breathing into a paper bag helps them gain control of their breath. Keep a paper bag handy in your hospital bag.
Breathing and Pushing
During the second stage of labour, you will be pushing your baby out into the world. Sometimes women are told to hold their breath and push for as long as possible. This is no longer recommended; there is no evidence that breathing and pushing in this way benefits you or your baby, and it may increase your risk of tearing.
Follow your urges and push as many times per contraction as feels right for you. You may find that you feel the urge to push briefly three to five times with each contraction, taking several breaths in between.
Labouring in alternative positions can help with the descent of the baby as well as provide comfort and ease pain during childbirth. Walking, pelvic rocking, positioning pillows for comfort, slow dancing with partner, sitting and swaying on a birth ball (a large physiotherapy ball), lifting up the abdomen and rocking in a rocking chair are all good options.
Lying down during childbirth can work against the labouring body. It is great for brief moments of rest and gives the mother a chance to catch her breath. But don’t stay flat for very long!
Massage can be very beneficial for women in labour but there are some tips and suggestions a birth partner should keep in mind in order to help during childbirth. In labour you go through many physical and emotional changes in a short period of time so continued support from a caring birth partner can make a huge difference in your childbirth experience.
Remind your birthing partner to always ask before beginning massage during labour. This is very important for birth partners to remember because when a woman is in the middle of a contraction it can be very disturbing to her if she is disrupted.
Wait quietly until the contraction is over and say “Would you like me to rub your belly or massage your hands?” You can let him/her know where you most need a massage at the moment.
If you are planning to have your baby in hospital or a birthing centre then it is a good idea to remain at home for as long as possible. If you feel comfortable and safe at home then keep in close contact with your Lead Maternity Carer and try to work through much of the first stage of labour in your own home. By doing this you often lessen the likelihood of medical intervention when you get to hospital. By using a TENS unit, heat, massage and shower/bath you may be able to cope with a number of hours of labour/contractions at home. In the early stages of labour distraction is also a great way to pass the time! Try watching a movie, spend time with your pets, listen to music, wonder around your garden….whatever you feel comfortable doing in-between contractions!
What is aromatherapy and how does it work?
Aromatherapy involves the use of plant oils, usually in the form of essential oils, to enhance physical and mental well-being. Oils can be used directly on the body in a carrier oil, for example in the form of massage, and are often used with an oil burner or vapouriser so that the scent is carried in the air.
Different oils have different effects on the senses. If you have previously used aromatherapy, or used the scents of lemon and ginger to counteract morning sickness earlier in pregnancy – or lavendar to help you sleep, then you will already have an idea of the impact oils can have.
Numerous oils may be beneficial during labour to help relieve stress, relax, act as a uterine tonic, stimulate circulation and so on. If you have any doubt as to the potency of essential oils then remember that doctors caution against the use of certain oils during pregnancy itself, usually because of possible effects they may have on the uterus. At its most basic, aromatherapy will clear the hospital scent that so many people find unpleasant and unsettling.When can I use aromatherapy?
There’s no technical reason for you not to be able to use aromatherapy at any stage of birth and labour. However, hospital policies may vary widely on what they allow or encourage in labour and delivery rooms, and if you’re rushed off for a c-section you won’t be taking the vapouriser with you. It’s increasingly common for hospitals to recognise the role aromatherapy can play in allowing a woman to set her own atmosphere for the labour, as well as helping her cope physically and mentally. If you’re interested in using aromatherapy then do check what the hospital or birthing centre policy is – there may even be trained aromatherapists available to assist you in some places.
If you have a home birth then you will have complete freedom as to whether and how you use aromatherapy.
You will most likely benefit from using different oils, or different combinations of oils, at different stages in your labour as your physical and emotional needs change.
What oils are recommended for use in labour and birth?
If you’re considering using aromatherapy for assistance during labour and birth then it is well worth consulting a trained aromatherapist for advice and guidance. The support of your birthing partner will also be essential as you will have other things on your mind during labour than choosing what oil you need.
The following are some oils that you may find useful:
- Lavender – You may already be familiar with lavendar as a means of promoting a good night’s sleep. The scent is well-known to aid relaxation and promote calm. The oil is also a painkiller that stimulates circulation and healing and may strengthen contractions
- Neroli – Calms and reassures as well as helping relax
- Bergamot – A generally uplifting and refreshing oil
- Chamomile – Soothing and calming, helps to reduce tensions and anxiety
- Jasmine – Acts as a uterine tonic, painkiller and anti-spasmodic. Also known to strengthen contractions and can be used in a compress to aid delivery of the placenta
- Rose – Is a uterine tonic and anti-depressant
- Geranium – Helps breathing and boosts the circulation
- Marjoram – A uterine tonic that also aids breathing and can help to lower blood pressure. It is also an effective pain reliever and antispasmodic
If you’re using an oil burner or vapouriser then use several drops of oil in the water. You can combine two or three oils in combination, but it’s best not to use more than four. If you need a strong boost with a particular oil then your birth partner can put a couple of drops on a hanky for you to hold close to your nose and inhale.
If you’re using the oils for massage then use 20 drops of oil per 100ml of carrier oil that you use. There are several carrier oils to choose from: sweet almond oil, grapeseed oil, jojoba, wheatgerm and olive oil are good examples. If you have a nut allergy then steer clear of nut-derived oils. You may prefer the light scent of one carrier oil to another, so it’s a good idea to experiment ahead of time.
Always consult with your Lead Maternity Carer before using plant and essential oils.
Birth affects, and is affected by, every sense in the body. By giving special attention to all your senses, you can bring harmony to yourself as a whole. Labour pain management techniques should address all the senses. For the visual sense, try dimming the lights or lamps to bring a soft glow to the birth environment. For the sense of smell, use aromatherapy, scented candles, or essential oils to bring calming, soothing scents. For the auditory channel, speak in low, soothing tones. Refrain from unnecessary chatter or extraneous background noise. Relaxation music, such as that used for relaxation practice during the pregnancy, can be softly played to facilitate relaxation. For the tactile sense, use counter-pressure, massage, or light touch massage, as you request. Bring soft towels, blankets or pillows to avoid rough textures.
Consider who you want with you during labour, at home or in the birthing suite. This is not a time for unwelcome visitors! Ask your birthing partner to carefully monitor who is in the room. If you prefer mobile phones to be switched off and windows to be open/closed then speak with your birthing partner about this prior to labour.
Voice is a powerful tool. You may choose to moan with your contractions. You may choose to softly sing, chant, or grunt. You should follow your body and know that whatever sounds you make are good sounds, are natural sounds. There are no apologies here; you must follow your body’s lead throughout the process of birthing.
Mental imagery is a highly-effective labour pain management technique, used frequently by professional athletes to naturally enhance their performance. You can use the same technique to visual yourself in each of the stages of birth – how you will respond to the different changes and challenges you may face. When we visualize a sequence of events as we would like them to happen, we mentally prepare ourselves to act in that situation. This reduces anxiety of the unknown in that the scene has become a familiar one, not a scary new experience. Try to visualize your cervix opening, the baby descending the birth path, or your breath as it enters and exits your body. These techniques are particularly effective when paired with an imagery relaxation script, either read by a birth companion or in audio form.
Some examples of images women use include imagining your contractions as ocean waves which, as they grow bigger, take you closer to a gentle shore where you will meet your baby … or imagining your body as a flower-bud, opening up slowly. Encouraging, goal-focused visualizations can be very helpful in labour.
This technique may not directly relieve your pain, but it helps to distract you from the anxiety of contractions and pain. If practiced correctly, hypnosis can help you to relax, control your breathing and put your body and mind in a state where you are more focused on the birth, rather than thinking about the pain.
Self-hypnosis can be taught at various hypnosis training centres, or special childbirth classes that teach the technique of repeating positive statements and concentrating on beautiful images. You can also try listening to a hypnotherapy tape to help you feel more relaxed.
There are a number of people who offer courses for pregnant women in ‘hypnobirthing;’ this is a program of deep relaxation, visualisation and self-hypnosis that teaches women to replace concepts of long, painful labour with expectations of calm, relaxed, comfortable birthing. Hypnobirthing teachers believe a lot of the pain of childbirth is caused by fear that releases hormones that constrict the birthing muscles and by teaching deep relaxation techniques, women produce more endorphins (‘feel-good’ natural pain-relieving hormones) and therefore have a shorter, far less painful birth. A book called ‘Hypnobirthing’ by Marie Mongan is a good introduction to the technique.
Reflexology is an ancient practice in which pressure is applied to specific body parts, specifically the soles of the feet, to relax other body parts. During labour, a reflexologist can help women cope with pain, and speed the process of childbirth by applying pressure and stroking specific ankle points, which are said to stimulate the pituitary glands to release pain killing hormones. If you plan to use reflexology during labour, plan ahead and find a Reflexologist in your area.
Hot and Cold Pads
Sometimes a simple heating pad may work wonders to relieve the pain you feel while giving birth. Heating pads come in all shapes and sizes and are suitable for almost all women. Either make or purchase a wheat bag and show your birthing partner how to heat it prior to labour. A hot water bottle is also a useful aid to take with you to the hospital.
Some women prefer applying cold packs such as an ice pack on the lower back and a cool cloth on the face. Remind your birthing partner of these things.Birthing Balls
Birthing balls were originally developed by physiotherapists to be used for exercise and treating orthopedic and neural disorders, but using them has been found to be equally beneficial for a pregnant woman. Using the ball throughout pregnancy can help strengthen the spinal muscles, making them less vulnerable to the back pain that continues to increase as each month passes.
During labour, a ball is a much easier place to sit, relax and move on than a bed. The natural squatting position on the ball will also help to align the foetus and provides pelvic support. Squatting has also been shown to speed up the labouring process. Gentle movement on the ball is a good way to relieve contraction pains. Some hospital and birthing suites have their own supply of birthing balls.