Comfort Measures for Labor {A Birth Circle Topic}

Believe it or not, you can actually make a positive impact on your labor prenatally by practicing healthy eating habits and proper posture. There are also a few other things you can do prenatally that promote faster, easier labor!

Yoga during pregnancy

Image Credit: Health Me Up

In particular, this pose can help relieve lower back pain in late third trimester,

View Prenatal Yoga Cat & Cow Stretch for a Pregnancy Workout on Howcast

Regular chiropractic care is beneficial for pregnancy and labor! I recommend at least once in the first and second trimester, and twice during the third trimester; additionally, if you can find a provider skilled in the Webster Technique, chiropractic care can help encourage a breech baby into a vertex presentation.

Acupuncture can also facilitate rotating a breech baby, although you may consider breech a variation of normal!  Regular balancing treatments throughout your pregnancy can enhance your health and positively influence the development of your baby. Acupuncture can also help with nausea, fatigue, anxiety, back pain and more!

Along the lines of all this information regarding fetal positioning, you might like to check out The Miles Circuit.  Many people falsely believe that fetal positioning can prevent, or rather delay labor from starting and this is simply not true, however, having optimal fetal positioning can certainly facilitate a more comfortable labor!

Don't forget, in labor, your body is working and it's working hard!! To help it out, be sure to rest as much as possible in early labor! The best early labor advice I can give you -  is go to sleep. Or if it's the middle of the day or you can't sleep, simply go about your day as normal. Pretend it's not even happening! Nourish your body with healthy foods and drinks and relax.

There was a study done that eating 6 dates a day for the last 4 weeks of your pregnancy can shorten the duration of your labor. Of course dates are also great to ease the symptoms of constipation.
And while we're on the topic of nutrition, throughout the Birth Boot Camp course we'll go over tips to boost your nutrition.

And now... for what you've been waiting for.. Comfort measures for labor.

1) A doula!

Doulas and partners work together to help you have an #amazingbirth
Posted by Guiding Angels Birth Services on Sunday, March 22, 2015

How can a doula can benefit your labor? <-- Click the link for a great read by Evidence Based Birth 

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2) Positioning. Walking and other upright positions help increase the downward compression on your cervix to aid in dilation. Many women find hands and knees to be very comfortable during labor. Birth balls can be wonderful tools to utilize. Lean in to your partner; Bradley classes teach "slow dancing" for labor. Squatting, which is also beneficial prenatally, can relieve back pressure during surges. Lie semi-prone.  Generally, lying on your back or being in a reclined sitting position are the most uncomfortable positions for labor.

3) Water. 'Nuff said!

4) Acupressure or Acupuncture during labor.

5) Birth at home! By not transferring, you maintain the highest level of endorphins and other "happy hormones" that have been triggered by an uninterrupted flow of oxytocin. By staying at home you can maintain your privacy, continue laboring in a dark, peaceful and comfortable environment. Staying at home eliminates the first of all birth interventions.

6) Realize that contractions serve a purpose and pain is not suffering. Penny Simkin's article Comfort in Labor, How You Can Help Yourself to a Normal Satisfying Childbirth is excerpted below,

Most women today are expected, even pressured, to have an epidural in labor, because they and the influential people in their lives equate labor pain with suffering. While an epidural eliminates almost all sensation, including pain, it does not address fear, worry, loneliness, helplessness, or other emotions that lead to distress, dissatisfaction, or even suffering. To prevent suffering, women need more than relief of pain; they need to recognize that labor pain is a side effect of a normal process, not a sign of damage or injury. They need a sense of mastery and well-being as they respond to their pain, but they also need humane, caring, confident people giving continuous support throughout labor. 

7) Breathe. Rythmic breathing is taught in Lamaze and other childbirth preparation courses.

8) Rythm - find yourself in a pattern. That may be rocking, swaying, groaning, or whatever best suits you.

9) Low, deep sounds. Work with your body and "moan out" your surges.

10) Massage and other touches. I enjoy massaging my clients with a 1% dilution of lavender essential oil in grapeseed or fractionated coconut oil.

11) Hot and cold compresses.

12) Counterpressure and double hip squeeze; especially useful for back labor.

13) Many people find positive mantras and music to be helpful during labor. Guided mediation, as taught by hypnobirthing, is amazing!!

14) Surrender

15) TENS Unit or transcutaneous electrical nerve stimulation, can act as a "gatekeeper" to block pain messages to the brain and cause the body to release natural endorphins.

Understand that there may be times when intervention is very appropriate, such as in a very long labor, or perhaps your body needs some relaxation. At these times, women may consider an epidural or IV narcotics. Hopefully someday a combination of gas and air may be available in the United States.
Below you'll see a video on how an epidural is administered and I encourage you to take the time and read The Big Bad Epidural that has links to risks of the epidural but also talks about when an epidural can be a blessing to the mother! And more information at Childbirth Connection.

As mentioned, IV narcotics are another option. Some women describe these as taking the edge off, others dislike them due to the neurological effects.

Keep up to date with YC Birth Circle to join us the next time we cover this and other great topics or find a childbirth preparation course near you to practice some of the comfort measures we covered!

Past Birth Circle Topics:

• Share The Love
• Fertility Awareness
• Meet The Photog
• What's A Birth Circle
• Frequently Un-Asked Questions
• Childbirth In Pop Culture
• Nutrition in Pregnancy
• Essential Oils
• Homeoprophylaxis   
• Birth Stories

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Aquadural

I attended a water birth presentation and listened to numerous stories of how relieving and peaceful labor was for mothers who used water; I would share them but couldn't begin to do justice to their beauty! Is water birth right for you?? If you enjoy baths to de-stress, if warm showers relax you, if you like to swim or just love water in general the answer may be yes!  Do you have to birth in the water in order to benefit from it? No- water is an amazing tool throughout labor; when it comes time to push women will quite often just not want to get out.

Benefits for babe

Babies who are born in the water experience a smoother transition into the world; they are born from the water into the water.  When you labor in the water there tends to be less stress on the baby due less pressure on the umbilical cord during contractions.  The sacred space provided for the mother by the birthing tub also results in a sacred space for the baby- tubs put a bit of distance from everyone else allowing for more intimate bonding while still being accessible enough for assessing their health and assisting in birth if desired.  Being born in the tub may make it more possible for mom or dad to 'catch the baby.' 

Benefits for mom

Pain relief- moms describe getting into the water as instant relief.  The Water decreases the pressure of the contractions and provides relaxation, even decreasing the length of your labor.  Some women describe this natural form of pain relief as an "aquadural."  Mom's who labor in the water are not only more relaxed but they have better mobility due to the buoyancy.  The water provides a natural lubricant and decreases the pressure on the perineum, resulting in less tearing. There is a decrease in the risk of infection because the water holds a sort of sacred space for them resulting in less vaginal exams and intrusions; home births in general have less chance of infection because you are in your own environment.

Benefits for midwife

I was reading an article about water births in Midwifery today about the relaxing warmth and whole body support of water; the best part of the whole article was the Q & A which I must share with you:
Q: Why do you prefer waterbirth?
A: Aside from easing mamas in labor and allowing them the freedom to move about, to control their own space and to catch their own babies, there is the prized easy clean-up you don’t get with a land birth!
--Charlie Rae Young of Barefoot Birth
Do you have a water birth testimonial?  Share your experiences on this Journey of Life with laboring and/or birthing in water here.

Doula Without Guilt

This blog is in response to a book published in 2011 Epidural Without Guilt.
Below the author addresses "epidural myths" and attempts to dispute them.  Quite often he avoids the real truth and topic at hand, so I've taken each issue and readdressed it.

"* Epidurals will slow down my labor

This is a commonly believed myth, but in fact is not true. Since 2005, there have been four scientific studies published on this issue. Three of the studies found that instead of slowing down labor, pregnancy epidurals and spinal epidurals actually speed labor up – especially when pregnancy epidurals are given before the cervix is 4 cm dilated. The fourth (and largest) of the studies showed no difference in how long labor lasted, whether or not a pregnancy epidural was used. So pregnancy epidurals do not slow labor down – they may even speed it up."

If a woman has been in labor for a long time (whatever she deems as long) an epidural can indeed relax her enough and provide her with much needed rest to continue and even speed up her labor.  Until you get it, you don’t know how you’ll respond to it, therefore a better option may be to hire a doula and take childbirth education classes that teach you natural coping methods.  There are plenty of natural techniques and tools for relaxation; water and breathing to name a couple.  Ina May’s sphincter law explains why relaxation is so essential. 

The problem with receiving an epidural before 4 cm dilated lies in the increased risk for baby going to NICU.    Quite commonly when a woman has had an epidural she will develop a fever; medical personnel have no way to determine whether or not this is due to an infection and therefore baby will be sent to NICU “just in case.”  The longer a woman has an epidural the higher her temperature may be.

An epidural comes with an I.V., a blood pressure cuff, continuous fetal monitoring (which since began has not shown a decrease in infant mortality but an increase in cesarean rates) and the inability to move.  This limit to mobility is what results in a slower labor and increased risk for a cesarean.  A better option would be to keep your mobility.  Use your doula to help you find a rhythm.  Trust your body to birth and you’ll naturally find the positions best suited to work with your labor.  Doula’s are experienced in labor and can help with suggestions for comfort and assist in helping baby into the best position resulting in a more efficient labor.

"* Epidurals will increase the chance that I will need a cesarean

This is an old myth will not go away, even though many studies from different parts of the world have found that pregnancy epidurals do NOT increase the chance of needing a cesarean. So why all the confusion despite solid scientific evidence? It’s because pregnancy epidurals are associated with cesareans, but they don’t cause cesareans. What do I mean by this? Well, women who have difficult, painful labors are more likely to need a cesarean. And these are the SAME women who are more likely to ask for a labor epidural – so there is an association between labor epidurals and cesareans. But the labor epidural does NOT make a cesarean more likely."

On the side of medical interventions, what an epidural does negatively interfere with is pushing; resulting in the increased use of vacuum or forceps extraction and an increased risk for tearing. 

Cesarean rates are increased for women receiving an epidural accompanied with induction or augmentation.  When Pitocin is administered contractions are more erratic and forceful, due to this most of those women receive an epidural.  Pitocin will gradually be increased throughout labor based on physician direction and other medical protocol.  Once the epidural is administered, the woman no longer feels the pain of the contractions and therefore will not direct stopping the drip.  The epidural has cut off this(pain) necessary means of communication.  Meanwhile, though contractions weren’t feeling stronger for mom, they were becoming increasingly stressful on baby.  The only way baby communicates stress is a drop in the heart rate.  Once this happens, even if Pitocin is turned off its affects can still be felt for an hour, which is far too long for a decreased heart rate in baby, resulting in a c-section.  Pitocin and Epidural do a dance together, as they each have opposite effect.  One relaxes and one stresses and therefore as you give one you necessitate the other.  The real problem of the two being pitocin.

Doulas are beneficial no matter what type of birth you plan on having.  Studies show that using a doula decreases the incidence of cesarean!

"* Epidurals will cause backache

It turns out that backache is very common during pregnancy and after pregnancy. In fact many women experience backaches after they deliver that can last for many months. Scientific studies of backache after delivery have found that the chance of having a long-lasting backache is the same whether or not the mom got a labor epidural."

Backache is the least of your worries if you are faced with PDPH, better known as Postdural puncture headache.  When signing the informed consent form, most women are not told that it is a blind procedure and that every woman is different!  Due to this and the precise location the medication needs to be administered into, it is not uncommon that the needle goes a bit too far causing a leak in spinal fluid.  What happens then is your brain is compressed heavily against your skull and no longer cushioned by the fluid resulting in an extreme headache when in any position besides lying flat.  The best fix for this problem being the epidural blood patch.

Due to not being able to feel when pushing, it is not uncommon that women overstrain themselves, therefore resulting in more of a backache than they may have had.  Pushing with an epidural can take longer because the woman may not be pushing as effectively as she could be.  Women pushing with epidurals are generally pushing as directed.  There are numerous benefits to pushing on instinct that are hindered by epidurals.  You’ll never know, so why not take the more natural approach and use a doula to help with coping during labor.  If you don’t have an epidural you can (ideally) push in any position you’d like.  More optimum pushing positions result in more effective pushing and less strain.  Listen to your body and trust birth!

"*Epidurals are dangerous for my baby

This is a particularly wicked myth, because it makes women feel guilty for wanting to their pain relieved. Although there are certain problems with labor epidurals that could be bad for babies, for example, a significant lowering of the woman’s blood pressure – most effects of labor epidurals are actually helpful for the baby. An example of this is the labor epidural lowering the woman’s stress level and thus getting more blood flow and oxygen to the baby during labor and delivery."

I feel this completely is avoiding the topic at hand- that epidurals are derived of cocaine.  No matter how you spell it, drugs cross the placental barrier and baby is receiving the drug as well.  The bonding between mom and baby is threatened from an epidural in that it reduces the suckling desire, causes baby to be drowsy and increases the risk of baby being sent to NICU resulting in a loss of that precious bonding time.  The safest bet for baby and bonding is a natural labor allowing the amazing hormones of pregnancy to do their thing.  Epidurals interfere with the natural flow of hormones that are so important for bonding.

Using a doula reduces the likelihood of requesting an epidural.  Doulas can help you relax and manage the sensations of labor without drugs.  A doula is there to help you have your ideal birth; if you plan on using pain medication and doula can most definitely support you in that as well. 

"*Epidurals will prevent me from breastfeeding my baby

I hear this myth repeated all the time, but the scientific evidence is scanty, at best. Modern pregnancy epidurals and spinal epidurals use such low doses of medication that it’s hard to imagine a negative effect on breast-feeding the newborn. In fact, pain after delivery can be bad for breast-feeding. Pain reduces the amount of milk a new mother produces. And a new mom in pain may be less likely to want to interact with her new baby. So I suggest something that isn’t usually considered: think about using a very low-dose labor epidural after a difficult vaginal delivery, and certainly after cesarean. It’s the best way we have to make the mom comfortable without being drowsy."

It has been proven that women who receive epidurals are more likely to have pain once it has worn off because they have not received the necessary hormones that flow in a natural labor and they have possibly strained more than necessary while pushing.  When a woman uses natural coping methods and allows the natural flow of hormones she experiences elation after the birth of her baby, experiencing the unsurpassed “birth high.”  She is able to get up and walk around, without pain and bond with her baby as nature intended.  A doula can help a new mother begin breastfeeding.  A baby who has not received epidural drugs will root for the nipple and latch on its own.   

After birth, a woman feels “after-pains” which is the uterus contracting to return to its original size and place.  This is a necessary part of birth that does become more intense after each child.  These after-pains can be felt for days after birth; it took nine months for your uterus to expand, it needs sometime to return to its original shape and size!  Oxytocin is the hormone that stimulates the uterus to contract and is released while breastfeeding.  Your milk, which won’t come in until a few days postpartum, will not be hindered by this as the paragraph in the book seems to be suggesting! 

Whether you have the epidural or not, your doula will be there to help you start breastfeeding; lean on her again to relax and breathe through the after-pains.  However you do it, do it without guilt; this amazing part of the Journey of Life.