When it comes to considering your preferences for birth you are likely to find something on a template about pain relief.
When you are in hospital there are really three main options (occasionally another one or two but not commonly); gas and air (Entonox), pethidine/diamorphine and an epidural. These can be very useful methods to use when you need them but do check out the pros and cons before you decide.
But how about earlier in labour, when you are at home? Or if you would prefer to avoid medical pain relief for as long as possible or not use it at all?
There are lots of things that you can do to make your contractions more manageable whatever stage of labour you are at.
Endorphins
Did you know your body has its own natural pain killers? Endorphins are released in response to pain and stress to create a feeling of well being as well as relieving pain. They are generally linked to feeling good – laughter, love, happiness – which is where oxytocin comes in as well. If you are feeling calm, relaxed, safe and happy your endorphins will be helping out with the pain and as labour progresses the levels will rise. Lots of these safe help methods are about boosting endorphins.
Massage
To help those endorphins you might try some massage. It is a good idea to learn and practice some techniques before the big day so your birth partner knows what you find relaxing, what relieves pressure and what is annoying! Of course, you might change your mind completely when the time comes but always good to have some ideas to try.
Massage will help relax you as well as boosting your oxytocin and endorphins. Win, win! Helping your labour progress, relieving pain, keeping you relaxed and happy and working with your partner to make this happen.
Breathing and Relaxation
I’m putting these together because they often go hand in hand. Breathing techniques can play a huge part in relaxation and being able to zone out, go into your birth bubble and let it all happen is really important.
When it comes to pain we know that pain is worse when you feel tense and often that tension comes from fear. Fear, tension, pain cycle anyone? The more fear, more tension and more pain and so on. Not the way we want to birth. Our escape is with breathing to relax. Find your breathing rhythm, let your body relax and pain is lessened.
Education and Preparing Mentally
Following on from the fear, tension, pain cycle what about the fear element? When it comes to birth fear is often about the unknown and making sure you understand birth, know how your body works, what to expect and have your coping strategies ready can make a big difference. Even if things don’t turn out quite the way you expected you will be ready to make decisions and cope with whatever comes your way.
Or maybe you prepare mentally with positive affirmations and visualisations to keep you on track. Some people spend time making beautiful affirmation cards while they are waiting for things to start. Then you can have these in your birth space to remind you how amazing you and your baby are. Or you could prepare with your partner, practice your relaxation and let your partner speak affirmations as you move, breathe and find your zone. When people think about hypnobirthing it is often these relaxation and breathing methods that they mean.
Positions and Gravity
Whenever I talk about positions for labour I say that there is no perfect, one size fits all position that you need to use. There isn’t really a ‘best’ when it comes to birth. We are all different shapes and sizes, as are our babies, and those babies all find themselves in different positions (see previous blog on baby positions). There are some things we know will help and some that probably won’t, but being free to move around and find what feels comfortable is the key.
For most people upright, mobile positions are most comfortable. Lying on your back rarely is and often women report more pain in this position. It also just so happens that these are the positions that are likely to help your labour progress better as well because you are using gravity.
Think about gravity, helping baby to descend or to turn and find a place you feel comfortable. It might be on your feet, on all fours, on a ball, kneeling on the bed, being supported by a partner, or in a supported kneeling lunge to open your pelvis. It doesn’t matter as long as you can move, you feel your labour progressing and you are comfortable. Upright, Forward, Open, UFO, will help you.
When you think about what you do when you feel pain, for example you bang your toe, chances are you jump around and shake your foot a bit. We tend to prefer movement to being still when experiencing pain and movement can help your labour progress too as movement of your hips will help your baby find the space to turn and move. You might also find rotations and sways to be calming and one of your relaxation anchors – endorphins!
Water
You might have thought about a water birth or your might have been advised it isn’t possible for you for some reason (occasionally it might not be right or more commonly it might not be available at your place of birth) or maybe you don’t like the idea. You can opt to use a pool for labour or stay in there to birth your baby, totally up to you when you get in or out.
There are lots of benefits to being in water when it comes to birth. The warmth of the water helps relax and soothe your muscles, it helps you move around and find more natural positions to labour and it will help you relax mentally as well – fear, tension, pain no more!
All very well if you can use a pool when you get to hospital but what about before then. Well you can still use water at home, and if you are planning a home birth you can buy or hire a pool for home as well. If you are getting in the bath it is worth planning what you will do there, you need deep warm water to cover your bump to ease the discomfort, you might not want to just sit in the bath but leaning back to relax might not feel comfortable either.
Maybe kneeling on all four or resting on the side of the bath will feel better. Use a cushion or padding for your knees if you need to. Or you might just prefer to be in the bath with someone directing a warm shower on your tummy or your back to relax you.
One word of caution – make sure you can get out or have someone close by to help you!
TENS Machine
Have you heard of these? They are really popular as a pain relief method for labour and can be used from early on for as long as you choose. You can either rent or buy one. You pop the sticky pads (electrodes) on your back and plug in the wires to the handset and off you go. It works by sending little electrical impulses into your pads on your back which stimulate endorphins and help relieve pain. Your body can’t cope so well with more than one source of pain so adding the TENS machine acts a distraction from your contractions. As things progress you turn up the intensity and when you have a contraction you hit the boost button for a little extra stimulation. You need to start using it when you feel like this is it, labour is happening as you want to get the build up of endorphins as the contractions are starting. Once things are really intense it is hard for the machine and your body to catch up if you try to start with it now.
TENS machines can work well for as long you want, you may decide to switch to other pain relief later or you can keep it until baby arrives. Just don’t mix with water!
A Comb
What??? In the same way the TENS machine provides an alternative sensation for the brain to deal with a comb squeezed in your hand can do the same. The teeth of the comb pressing into your hand during a contraction helps distract your brain from the pain and can stimulate acupressure points to relieve pain too. The teeth need to press into your palm just below your fingers. Cheap, simple and easy to pop in your bag!
Aromatherapy
There are some oils and scents that work well to help relax you and maybe even to stimulate your labour. You can use a diffuser or have some drops on a tissue close by. Labour can be a bit like early pregnancy sometimes where smells can seem stronger so it is worth checking how you feel about it before you fill the room.
You may find that aromatherapy is offered at your hospital but it is more likely you will need to arrange it yourself. If so, make sure you do your research. Ideally find someone trained who can recommend the correct oils and how to use them safely – amount, carrier oils etc.
Acupuncture
This is something you need to think about in advance because you will, of course, need someone qualified to assist with this. If you know an acupuncturist you may be able to arrange to see them in early labour or you might find there is a midwife who is qualified. It is worth asking the questions about this in advance rather than on the day so you and they are prepared if it is something you are keen to utilise.
Painkillers
But what about a good old dose of paracetamol? If you call the hospital when you are in early labour there is a good chance you will be advised to take some paracetamol (and probably a bath). Paracetamol works best if you take it early – it works best as soon as you are aware you have a fever or headache for example– but you could be in early labour for quite a long time and would need to keep taking regular doses. If you do decide to take it make sure you don’t exceed the recommended dosage in 24 hours.
However, there is some interesting work that looks at the interaction of paracetamol with birth hormones, particularly prostaglandin. Prostaglandin is a hormone that works in early labour to soften and thin the cervix and is also involved in the oxytocin feedback loop. Specifically paracetamol hinders the production of prostaglandins which is likely to slow the early stages of labour. Frustrating and exhausting!
Before you reach for the paracetamol have a think about how you are coping and whether there is anything else you can try. A dose is unlikely to have much impact but if you are taking it repeatedly over a period of time it may well be slowing things down for you. http://undercovermidwife.blogspot.com/2015/03/paracetamol-and-labour.html?m=1
I cover lots of practical techniques for coping with labour in Birthing Classes and The Antenatal Course. If you want to find out more and practice ready for the big day, come and join us.