Empowered Delivery Preparations - Natural Pain Relief Methods and Mentality

By: Aunt Doula (02/26/2023)

When most people think about labor, they think pain - screaming, life altering, worst pain of your life PAIN. Many of our societal images and depictions especially in the United States that that labor is nothing but pain to be endured. Labor however, is a rare time of purposeful pain that is a form of communication between you and your baby to help you move so they can navigate their way into this world. Typically, when we as humans experience pain, it means something is very wrong, but during labor, pain is just a communication of necessary changes to help your baby be born. It is a very different experience to witness birth in a setting where labor pain is embraced rather than shunned. This is no easy feat, and it doesn't match with our expectations, so it seems an outlier not a possibility. However, it is very much possible to reach for a pain-medication free labor when you start planning early, educating yourself fully, and trusting your body completely.

How to reoirient the ideas about labor pain with another helpful Mneumonic: P.A.I.NN – Labor Pain is:

Purposeful

Yes, labor pains are purpouseful! They are coming from stretching of ligaments, tendons and tissues, muscle cramping (contractions, build up of lactic acid), baby may be pushing on the nerve plexus (back labor), you could be nauseated, you will experience strong vaginal stretching, (when baby crowns, the feeling is often known as ‘the ring of fire’ it doesn’t last very long – try not to be scared of it!). all of which have their purpose in labor. All are keeping your body, brain and baby connected to complete the process of birth. None the least of purpose, is you have an outcome to look forward to! Labor pains have a purpose to make you move and shift to help baby get into the right position to bring them into this world. When you find a comfortable position, that means it's working for baby, too!

Anticipated

You know it's likely going to happen, but you have time to get ready for this mentally, physically and emotionally – You’re going to do great. Remember that this is a communication with a goal, not a punishment without end. Anticipating while accepting these areas of pain, not being afraid of them and embracing this process will reduce your anticipation pain significantly. Fear is a huge contributor to stalled labor, talk about your fears regularly! Being scared and being ready but apprehensive are very different. One gives you perspective, the other leaves you worried and can make you feel like you are not in control. The pain of labor can be significantly reduced when labor is understood, prepared for and as undisturbed as possible (little to no interference from hospital team)

Intermittent

Labor pains comes and go, remember that it is going to be rhythmic and you will get breaks between contractions! Use that time, however brief, to catch your breath and prepare for the next contraction. Listen to your baby by listening to your body.

Normal and Natural

On average, from beginning to birth there will be 135 contractions and each one is bringing you closer to meeting your child. 200,000 women are birthing right along with you around the world. With no interventions to impede a biological process that has continued our species for hundreds of thousands of years, trust your body to bring you through this process.

Theory's of pain and pain management

Shifting and swaying during labor is thought to cancel out pain signals through “gate theory” - like trying to hop on one foot when we stub our toes. Squeezing our partners hand, biting our tongue, holding a hair brush, etc all help us distract from a higher level of pain input. Meditation to reduce pain and use literal mind over matter does come into play. The more afraid you are, the more likely you are to have heightened pain. Preparing and educating yourself will help you feel less afraid, and when you are less afraid you will feel less pain.

Many women feel they only have two narrow options – white knuckle their way through a natural birth, or have an epidural and feel nothing. To change the dynamic, think more about your options under two umbrellas of Utilizing Natural Pain Relief and Utilizing Medicated Pain Relief. There are atleast 100 ways to naturally reduce pain throughout child birth. They are rotated and changed frequently, but they do work! Medicated pain relief is not a cop out, neither is having a c-section. In general, there is the following progression of events and available pain relief options

1) Natural options until and unless pain becomes unmanageable (or baby is delivered!)

2) Analgesic - Global Pain Relief via Narcotics

3) Epidural - Regional Pain Relief via Medication in the spine

4) C-section - Spinal epidural will be given

Natural options are expansive, adaptable and very personalized for each birthing person, especially if you have an educated family advocate, doula or dedicated birth partner who learns how to perform these methods effectively.

Analgesics affect the entire body and baby, are given through your IV or as an injection in your thigh (depending on facility and availability). They are shorter acting and if used at the right time are nice for a break sometimes, but generally you end up needing an epidural because the analgesics will affect your natural endorphin pain relief process. Analgesics also have pros and cons to mom and baby, and are usually only used early in active labor, not into transition phase. Side effects to mom are usually same as taking narcotics, you may feel loopy, dizzy, nauseated. Baby also feels these effects and that is why it is not used if you are within 2 hours of delivery so the drugs can clear baby’s system and not affect their breathing, breastfeeding and bonding with the baby

Epidurals and C-sections can be read about by clicking on either in blue.

Natural Pain Relief At Home and In Hospital

There are two main camps of how natural pain relief works in the body. One is the Gate Control Theory which is the theory that your brain can only take in so many signals, so if you can ‘drown out’ the pain signals with other stimulus, the painful signals will not get through or not be as strong. The other theory is DNIC, Diffuse Noxious Inhibitory Control and follow the theory that a noxious or painful stimulus that is less than the extremely painful signals, will attenuate the severity of the pain. The idea is to give your body a bar to compare your pain to, and in this theory it helps reduce the severe pain by showing your body a smaller level of pain to compare to. Most pain relief techniques used for labor are in the gate control catergory, though there are a few that are DNIC. Other methods such as hypnosis, meditation, relaxation and massage are working through self modulation, focus and endorphin release to reduce pain.

One of the largest catergories for natural labor pain relief is positional changes. There are a few positions that will be listed below that many women rate as the best positions to keep in rotation for pain relief during labor, but the most important thing is to keep moving and keep your positions dynamic. Staying in any one position too long isn’t likely to occur if you are empowered to direct your delivery – remember that you DO NOT have to remain in the lithotomy position to birth your baby! You may choose to lay on your back as a position, there is nothing wrong with it for short periods, however if stayed in for prolonged periods it can have many labor slowing effects and cause distress in baby.

• Hand and knees, squatting, standing, hanging from a rope or a pull bar, being supported in the ‘dance’ position by your partner, using a birth ball to keep your body moving but have weight support, sitting backward on the toilet with a pillow over the tank to rest your upper body on, or a birth stool or just leaning over your birthing bed all are popular positions. Listen to your body, try different positions like kneeling with one knee down and one knee up. Try lunges on the bed where you have the birthing bar for support. And remember the mantra to Sway your pain Away. Keep moving, even if it's hip circles and figure 8's on the yoga ball, keep moving.

• Walking is the number one way to naturlaly progress your labor! Upright positions have been proven to reduce labor time, increase satisfaction from mothers and decrease pain in 75% of women who utilize the positions throughout labor. Walk the halls, 'dance' with a labor partner, squats count as a vertical position, lunges, "curb walking" all help shift your pelvis and bring baby down to help you get into active labor.

• Water birth or water labor are up and coming in many hospitals, especially those with midwives on staff. The shower is also highly effective at pain relief and allows for more movement changes than a tub can and the directed water stream is often more soothing to some people in labor. Ask for a shower chair you can sit in facing backward so the water stream can direct at your back.

• Using a heating pad or rice pillow, using tennis ball counter pressure, getting massaged where it feels best, hip squeezes, stress balls, cold compressses on the face, yoga positions (if you feel balanced, comfortable and your partner can spot you!)

You can research and choose a birthing method such as SheBirth, Lamaze or the Bradley method, but it is not strictly necessary especially if you have an educated support team. Researching some breathing techniques from multiple methods and choosing the ones you feel best about is great, and in truth many women find their own rhythms of breathing during labor and use methods sparingly unless they have completely devoted themselves to one style. You can research ‘blissful belly breaths’ and ‘gentle birthing breaths’ on youtube as a place to start.

You can also look into chanting during birth to help your body focus and maintain a rhythm with contractions. Preparing affirmations that you will hang up on the walls, say out loud or your partner will read to you is just another way to bring positivity into your delivery room. Before you reach the delivery room, talk about how you will communicate if you want or don’t want physical affection from your partner. It can be as simple as holding up 1 finger to say ‘I need a minute’ or two fingers to say ‘I need you to hold me’ so that if you are mid-contraction and can’t speak, your partner knows what to do and you don’t end up slapping them away because you’re in pain!

• T.E.N.S units are studied and considered safe in pregnancy, most popularly when used on the lower back. The intensity can be controlled by the wearer which gives an empowerment to feel more in control overall. A tens unit falls under the gate control theory camp, and has been shown in studies that 87% of women who used a tens unit throughout their labor never reached a “severe” level of labor pain, which indicates that you may be less likely to seek an epidural at all, or reduce the time you need an epidural.

• Your birthing facility may or may not provide sterile water injection, this would be important to call and inquire about. It is the primary DNIC pain relief method that is usually performed by a midwife who has been trained in the technique. It is an approved and endorsed method of labor pain relief, especially if you are having primarily ‘back’ labor. It is a very safe procedure much like the injections you may have had for a TB test – a small amount of sterile water is injected just below the skin in 4 places parallel to your spine two on each side. It has been showen to encourage endorphin release (natural pain relief made by our bodies) and also re-orients the bodies perception of pain (DNIC theory)

• Relaxation, meditation, guided or unguided muscle relaxation exercises or using guided imagery are all things to be practicing now so you are able to easily step into the mental space and be guided when your body is stressed. The biggest reduction from using these techniques comes from reducing the Fear-Tension-Pain-Cycle. Every one has experienced this cycle whether they realize it or not, it is our natural reaction when we anticipate pain, fear what it will be like, and that ultimately ends up causing us to feel an increase level of pain. When we can relax our bodies and our minds, keep ourselves from tensing in anticipation of pain, we have overall reduction in the levels of pain we experience.

• Music can also be an excellent way to reduce pain during labor. Some people make playlists, some use pre-made labor playlists or meditation lists on spotify or pandora. You can listen to whatever you want! If it is calming to you, helps you focus, distracts you from your pain or is just enjoyable to hear, music has a significan place in the labor process. You can bring a speaker to your delivery room, but also bring headphones so you can crank it up, or block out the world! Headphones are a great non-verbal way to communicate to your team “I’m taking 5 minutes – don’t bother me”

• There is a birth method called ‘hypnobirthing’ and it really is hypnosis during labor. Definitely worth a look to see if you might want to pursue. Other options to check into are accupuncture (facility dependant), accupressure and reflexology. Homeopathy may be offered at your facility, research is mixed of efficacy but there may be a midwife that practices it in your birth facility. Aromatherapy is also popular, but facility and training dependant to have a midwife certified in aromatherapy.

• Making sounds during labor is normal and natural! Often women find that ‘mooing’ is the most helpful sound to make, but any noise you utter is valid. The most important goal to reach when vocalizing, is to aim for low and slow so that you aren’t squeaking really high pitched and ending up holding your breath and causing tension in your body for prolonged periods. Moaning is a natural pain response and you should not be afraid to do it! Some are quiet, some are vocal, it’s up to you and you may not know if you will be a vocal laborer until you’re in the delivery room!

All of these options are things you can practice at home, look up online for ideas, find a class for birthing positions, buy a t.e.n.s unit, yoga ball, - just start reading about these options and see what you are most drawn to and put it on a list. Once you have that list, start practicing! The labor room is not where we learn how to do these positions and methods of pain relief - try to practice a new possible pain relief position or technique 2 to 3 times a week with your labor partner so you know what works, what doesn't, and how to make it work the best for both of you so it's second nature in delivery.