By Penny Simkin, Janet Whalley, and Ann Keppler
Issue 95, July/August 1999
Women respond differently to labor, depending on the nature of their labors, their sense of readiness, their coping styles, and their goals and expectations. As you prepare and rehearse for labor, learn various comfort measures and then adapt them to suit you. Use this knowledge to develop your own style for labor. Think about what helps you to relax: music, massage, soothing voices, a bath or shower, meditation, prayer, chanting or humming, or thinking about or visualizing pleasant places and pleasing activities. Plan to use these familiar comfort measures to help you relax in labor as well.
Unlike most pain, which is associated with injury, illness, or stress, the pain of labor is associated with a normal healthy body function. By recognizing your labor pain as productive and positive – a part of the process that brings the baby – you can help reduce the pain to a more manageable level. To cope with your pain, you may find it most helpful to "tune into it" – focus on it, accept it, and tailor your response to it. Or you may prefer to use distraction techniques, concentrating on outside stimuli, to keep yourself from focusing on your pain.
Many women successfully employ both tuning in and distraction. For instance, in early labor they relax, breathe slowly and easily through out their contractions, close their eyes, and visualize either something very soothing and pleasant or the uterine contractions opening the cervix and pressing the baby downward.
As labor becomes more intense, some continue in this way; others lighten and speed up their breathing. Then, during late labor (transition), when contractions are very intense and close, many women find they cannot continue as before. They find they must open their eyes, focus outside (perhaps on their partner’s face), and follow outside directions (their partner guiding their breathing with verbal directions, with hand signals, or by breathing with them). Sometimes more complex breathing patterns are helpful.
The following comfort measures are based on relaxation, the key to pain control in labor. Learn and adapt them to suit yourself.
During labor contractions, it helps to focus your attention on something. Many women prefer an internal focus. They might visualize exactly what is happening – contractions of the uterine muscle pulling the cervix open, the baby pressing down and opening the cervix.
Others prefer to visualize something calming and pleasant– the beach, a mountaintop, a happy memory, or they visualize themselves as above their contractions, like a gull above a stormy sea, soaring over, but very much in touch with, the contractions.
Still others visualize each contraction as a hurdle to be overcome, for example, a steep hill to be climbed, a footrace, a wave to ride.
You might also find it helpful to look at something. This visual focus is often called an external focal point. You may wish to look at your partner’s face, a picture on the wall, a reminder of the baby (perhaps a toy), an object in the room, a flower, or even a crack in the plaster. Some women focus on the same thing for many contractions; others change focal points often. Others focus on a line, such as the edge of a window, and follow that line visually during the contraction.
Many women find it helpful to focus on touch in the form of a particular rhythmic massage stroke or pressure on one area or a tight embrace. This is called a tactile focus.
Still other women focus on sounds, an auditory focus – taped music, the soothing voice of the birth partner, a tape recording of various environmental sounds (surf, rain, a babbling brook), repeating rhythms, or other sounds.
Some women focus on a particular mental activity (a song, a poem, a chant, a mantra, Bible verses, a repeated saying, counting backward), breathing in a complex pattern, or relaxing the body step by step. Others focus on a physical activity, performing a series of particular movements (pelvic rocking, swaying, walking, dancing, effleurage, or others).
As you and your partner practice breathing and relaxing together through mock (pretend) contractions, try the attention-focusing techniques described above. You will probably discover a preference for some over others. Be ready to try more than one if a particular focus loses its appeal in labor.
Massage and Touch
Effleurage is a light, rhythmic stroking of the abdomen, back, or thighs. It can help with relaxation and pain relief when done on bare skin by you or your partner.
Some women prefer an extremely light, even "tickly" stroking, while others find a firmer touch more soothing. As you and your partner prepare for labor, try varying the pressure and rhythm of effleurage until you discover the most appealing stroke. Then practice it as part of your labor preparation. Effleurage over the lower abdomen, following the lower curve of the uterus, is most popular. Some people think of it as stroking the baby’s head. Others like to the stroke the abdomen in circles with both hands.
Many women use effleurage during contractions in labor. Use cornstarch or powder to make your hands slide more easily. Keep the massage rhythmic, pacing it with the slow breathing. If you find that your skin is becoming sensitive as the contractions intensify, you might try effleurage in a different area or discontinue it.
Other types of massage, such as firm stroking, kneading (squeezing and releasing), or rubbing, are soothing and relaxing during both pregnancy and labor. Massage of the neck, shoulders, back, thighs, feet, and hands can be very comforting. Work together in pregnancy to find out how and where massage is most helpful and plan to use it in labor.
Another helpful form of massage for labor is firm pressure, used particularly over the lower back or sacrum during contractions.
One technique is called counterpressure and is especially helpful for back pain during contractions. Your partner presses a fist or the heel of a hand on a particular area of your lower back or sacrum. During labor you may want your partner to press with considerable force, so he or she should hold the front of your hipbone with his or her other hand to help you keep your balance. The exact spot for applying pressure varies from woman to woman and changes during labor, so it is difficult to know in advance which spot will be best. As long as you know the technique, you and your partner will be able to apply it during labor. You may need a surprising amount of pressure, which may be very tiring for your partner after a few hours. It is worth the effort, however, because of the relief and comfort it brings. Your partner can take turns with another support person to allow him or her to take a break.
Baths and Showers
Warm water – in the form of a lingering bath, whirlpool bath, or shower – is a marvelous comfort measure for most laboring women. Contractions are usually less painful if you are in water. You are able to relax better because of the warmth and buoyancy of the bathwater or the gentle massage provided by the shower. In the shower, lean against the wall or sit on a towel-covered stool so you can rest. Direct the spray where it helps most. In the tub, lean back against a bath pillow or folded towels and relax. Besides relieving pain, baths and showers sometimes lower elevated blood pressure and speed up slow labors. Sometimes the baby is birthed in the water because the mother is reluctant to get out of the bathtub, or because mother and caregiver have planned a water birth.
Heat and Cold
Heat, applied to the low abdomen, back, groin, or perineum, is very soothing. An electric heating pad, hot water bottle, or hot compresses are good sources of heat. Hot compresses are simply washcloths or small towels soaked in hot water, wrung out, and quickly applied wherever you need them. As they cool, they are replaced. Covering them with plastic retains their heat longer.
A cold pack – such as an ice bag, frozen wet wash cloths, a rubber glove filled with crushed ice, a bag of frozen peas, a hollow plastic rolling pin filled with ice, "instant" cold packs, or frozen gel packs (camper’s "ice" or the cold packs used for athletic injuries) – can provide a great deal of relief. Placed on the lower back for back pain during labor or on the perineum immediately after birth to reduce pain and swelling, a cold pack feels wonderful. For cold packs to bring comfort, however, you must be comfortably warm. If you are feeling chilled, the cold pack may make you uncomfortable.
Use common sense in deciding how hot or cold the compresses should be. When in labor you might easily tolerate compresses so hot or cold that they could damage your skin. Cover the cold pack with a towel to make sure your skin is protected.
Moving around during labor is yet another extremely useful comfort measure. Changing your position frequently (every 30 minutes or so) – sitting, kneeling, standing, lying down, getting on hands and knees, and walking – helps relieve pain and may speed labor by adding the benefits of gravity and changes in the shape of the pelvis. Swaying from side to side, rocking, or other rhythmic movements may be comforting. If labor is progressing slowly, walking may speed it up again. The upright position may give you a greater sense of control and active involvement than lying down.
Most laboring women lose their appetites when they begin active labor, but their need and desire for liquids continues throughout labor. In a normal labor, you can drink water, tea, or juice, or suck on Popsicles between contractions. By quenching your thirst, you are also meeting your body’s requirements for fluids. Hourly trips to the bathroom to urinate will increase your comfort during contractions. If you have a very dry mouth, you can suck on ice chips, a wet washcloth, or a sour lollipop. You may also want to refresh your mouth and teeth with cold water, a toothbrush, or mouthwash.
One of the undeniable facts about labor is that you cannot consciously control your labor or your contractions. You can, however, control how you respond to them. In a sense, then, control in labor is a matter of controlling how you will respond to your labor, not controlling the labor itself.
Women also lose control when everything is done for them. Many women want to participate in decisions about their care during labor. Feeling left out makes them feel out of control. In family-centered care, the mother is consulted and her wishes are followed.
Penny Simkin, PT, is a childbirth educator with the Childbirth Education Association of Seattle and the founder of Doulas of North America (DONA). She is the mother of four and grandmother of six. Her upcoming book from Blackwell Science is The Labor Progress Handbook: Ways to Prevent and Treat Dystocia.
Janet Whalley, RN, is administrative director of the Childbirth Education Association of Seattle. She is a lactation specialist, and childbirth and new parent educator.
Ann Keppler, RN, is coordinator of the Postpartum Care Center at Evergreen Hospital in Kirkland, Washington. She is a lactation specialist with a master’s degree in maternal-child nursing and has taught childbirth and new parent classes since 1975.
© Copyright 1991.
Text and illustrations excerpted from Pregnancy, Childbirth, and the Newborn: The Complete Guide, with the permission of its publisher, Meadowbrook Press, Minnetonka, Minnesota, USA.