In our culture, many of us grew up watching tv and movies that portray labor coping as limited to a woman panting and screaming for drugs. The truth is, it doesn't have to be this way. If you do opt for pain meds, as many do, you still have choices that you can learn about and prepare for ahead of time. There are also non-pharmaceutical alternatives that can be very effective. Read on for additional information on narcotic options and the lesser-known natural coping techniques you may want to include in your birth plan.
The Drugs: Injectable Opiates vs. Epidural
Injectable Opiate Pain Meds
A lot of women don't know that IV or injectable opiate medication is often offered up first to "take the edge off". There are different opiate options available, and different risks and benefits associated with each. You can read more about them in this post from the the American Pregnancy Association.
The most common, and most effective pain medication option is the epidural, which is used to numb labor pain. This Cochrane Review concluded that:
"Epidural analgesia appears to be effective in reducing pain during labor. However, women who use this form of pain relief are at increased risk of having an instrumental delivery. Epidural analgesia had no statistically significant impact on the risk of cesarean delivery, maternal satisfaction with pain relief, or long-term backache, and did not appear to have an immediate effect on neonatal status as determined by Apgar scores. Further research may be helpful to evaluate rare but potentially severe adverse effects of epidural analgesia on women in labor and long-term neonatal outcomes."
There are two types of epidurals, as well as risks and benefits you will want to be aware of. You can read more about these, as well as questions you may want to ask your provider about epidurals in this post from the American Pregnancy Association.
If you are planning to birth at St. Mary's in Madison, an additional option became available somewhat recently- nitrous oxide. Nitrous has been used to manage pain for dental procedures since the mid 1800s, and is a common option for labor pain management in several countries, including the UK, Finland, Sweden, Canada, Australia, and New Zealand. Its use during labor is now on the rise in the US as well. Check out my blog post here on the topic, to learn more about the history of the use of "laughing gas" in labor, how it works, the benefits, the risks, and what the experts are saying.
Doula Note on Pain Meds:
It's a good idea to familiarize yourself with narcotic pain relief options, even if you don't plan to use pain medication. Your plan may change, and if that does happen, it won't be the optimal time to learn the benefits and risks associated with your options. The more you know about your options, the more choice you have and the more empowered you will feel regardless of how your birth unfolds. Every birth is different, and there is no "right" way to birth or "right" decisions to make across the board. Only you truly know what is best for you and your baby.
Medication-Free Coping Strategies
There are many reasons women may choose to plan a non-medicated birth. Some are fearful of medication or needles, some wish to avoid loss of mobility (read on for advantages of mobility) or being confined to a bed, and some want to avoid the associated risks. If you do hope to achieve a medication free birth, know that it is completely do-able, and that there are several techniques known to make a medication free birth easier and more comfortable. Most women seeking such a birth will employ a combination or progression of several of the below strategies:
Calm, Positive Environment
Never underestimate the power of your birth environment. After all, it is known that "creating an environment that helps women to feel safe and secure during birth- a private, undisturbed and dark environment, where women feel calm and safe- can promote the release of oxytocin, the hormone responsible for uterine contractions and thought to promote the release of the pain relieving hormone endorphins (Uvnas Moberg 2003). When this is not achieved, women can experience fear-tension-pain syndrome, impeding labour progress and causing increased levels of pain (Dick-Read 2013)."
Doula Note on Environment:
An ideal environment for birth often includes a supportive and skilled support team (e.g. partner and doula), soft lighting (e.g. white Christmas lights and flameless candles), and sometimes pleasant scents or essential oils (e.g. lavender, peppermint)
Deep or diaphragmatic breathing can help you to get into and stay in the "rest and relax" state, as opposed to "fight or flight". Focusing on "breathing to your baby", counting during your breaths, or adding words or mantras can help you remain calm and focused during contractions. This will help to keep you more comfortable, and your labor more productive. Check out this great video guide to breathing for labor, by Deb Flashenberg, founder of the Prenatal Yoga Center.
Women who give birth without medication will often instinctively use movement as a coping strategy through their contractions. Research has reinforced the benefit of maintaining the freedom of movement during labor. This randomized prospective study comparing an ambulent group to a recumbent group concluded that movement is a central characteristic of normal labor and that women, when given the choice, will change position an average of 7-8 times in the course of labor. The findings also showed that:
"The duration of labour was significantly shorter, the need for analgesia significantly less, and the incidence of fetal heart abnormalities significantly smaller in the ambulant group than in the recumbent group. Apgar scores at one and five minutes were also significantly greater in the ambulant group. More patients in the recumbent group required augmentations with oxytocic drugs."
This Cochrane Review of 19 trials confirmed that second stage was shorter in the upright group, there were fewer assisted births, less pain, fewer abnormal heart tones, and fewer episiotomies.
Doula Note on Movement:
Women often find rhythm to be helpful in their movements, such as swaying while standing or circling their hips on a birth ball. In addition, certain position changes can be helpful in getting the baby into an ideal position for birth. Check out Spinning Babies for more on ideal positioning for birth.
Also known as hydrotherapy, water immersion during labor has been demonstrated to be effective and safe as a means to decreasing discomfort in labor. It makes sense that warm water would be relaxing and comforting, and research backs this up. For example, here is one study that found that pain and anxiety scores were significantly decreased in the hydrotherapy group as compared to the control group.
In addition, this Cochrane Review published in 2009, which included 12 trials with over 3000 women states,
"...the statistically significant reduction in rate of epidural/spinal/paracervical analgesia indicates that water immersion during the first stage of labour reduces the need for this invasive, pharmacological pain mode of analgesia, which disturbs the physiology of labour and is associated with iatrogenic interventions. We found no evidence that this was associated with poorer outcomes for neonates, longer labours or more complex births."
Doula Note on Hydrotherapy:
Another hydrotherapy option that appeals to some women would be to sit or stand in the shower, or to use a sprayer attachment in the tub to gently spray the belly during contractions. Some warn getting into the tub too soon during labor will slow or stall contractions, but there is insufficient evidence to substantiate this claim. My advice is to follow your intuition on if and when to use water. If labor seems to slow for you, you can always change it up.
The use of touch as a coping strategy may not be surprising, as most people find massage comforting and relaxing. Turns out research does support that massage is effective in making labor more comfortable. Here is one study that showed:
"massaged mothers reported a decrease in depressed mood, anxiety and pain, and showed less agitated activity and anxiety and more positive affect following the first massage during labor."
In addition, this study showed the effectiveness of acupressure, a technique used in traditional Chinese medicine where acupuncture points are stimulated by the hands, fingers, thumbs or small beads. Specifically, the study looked at the LI 4 point, found between the thumb and first finger, which reduces inflammation and pain in all parts of the body.
Heat and Cold
Use of heat and cold during labor is a safe, inexpensive, long used technique that too has been backed by research. Cool or iced washcloths can invigorate a tired, overheated woman in labor, and ice packs can help ease back pain. Hot packs are also very effective in soothing pain from back labor. Some women prefer one over the other, some prefer alternating heat and cold.
Mind over matter, the mind-body connection, and the power of positive thinking are not foreign concepts to most, but often people are skeptical that hypnosis could be an effective technique in making childbirth more comfortable. While the research support on this is admittedly scarce, it was found in this study of 60 women that the "hypnotically prepared births had shorter Stage 1 labors, less medication, higher Apgar scores, and more frequent spontaneous deliveries" than the control group. It is also difficult to dismiss the many anecdotal reports of its effectiveness, including actual film of mothers birthing under hypnosis, such as this one, and this one.
Doula Note on Hypnosis:
There are easy home study self-hypnosis programs available, such as this one, that I used during my labor. This program is considered "eyes open" hypnosis, meaning you will still be aware of your surroundings and be able to move around freely while in hypnosis. The key to success with the program is to allow enough time to thoroughly go through the modules and to follow through on listening to the tracks consistently. It's recommended that you begin by the time you are about 7 months along.
There are a multitude of choices and options during childbirth, and there is no one-size-fits-all approach. Hiring a doula can help you navigate your choices, as well as implement the coping strategies that will work best for you.
Disclaimer: The content found on this blog is meant only to provide general information and is not a substitute for professional medical advice.
See additional posts in this series: Birth Preferences (Part 1): The Importance of Informed Consent and the "Overdue" Baby, Birth Preferences (Part 2): Vaginal Exams, Birth Preferences (Part 3): Birthing Environment and Choosing a Care Provider, Birth Preferences (Part 5): Fetal Monitoring