Being mobile is key to managing pain during labor. Upright and mobile positions are associated with shorter labors, decreased pain, and higher overall satisfaction for mothers. Women often report that when laboring unmedicated, being confined to a bed is least favorable for coping, though when there is an opportunity to rest or sleep it's usually a good idea to take it!
Pain management is largely affected by mobility, and mobility is affected by the cords around you, such as fetal monitoring of heartbeat and IV fluids. Thankfully, you have options for both!
Monitoring: Continuous vs. Intermittent
First, let’s talk about the two major types of monitoring: continuous (all the time) and intermittent (periodic, in intervals such as every 15-30 min). You may be asking yourself, is continuous monitoring actually needed? Research shows and ACOG agrees that for low-risk pregnancies, continuous monitoring is usually unnecessary and can actually create situations where more interventions are performed when not necessarily needed. Continuous monitoring is recommended for 1) inductions, 2) when an epidural is used, and 3) for some specific health conditions. So, if you are receiving medication, the risk for complications is higher, and additional monitoring is needed.
In continuous monitoring, electronic fetal heart rate monitors are used to measure two things:
1) baby’s heart rate
There are two devices that do continuous electronic fetal monitoring, and they both provide a digital display and print out of both the contraction and baby heart rate.
The most common option and especially the one used during epidurals, uses two sensors that are wrapped around your abdomen and attached by a cord to a recording machine and monitor. As you can imagine, this requires you to be in or around the bed and near the machine.
A newer option that many hospitals are beginning to offer for continuous monitoring measures the same two things, but uses bluetooth to send the signals, instead of cords. The sensors are attached as patches on the abdomen. This obviously allows for more mobility, which is a goal, but keep in mind that it also continuously monitors which is not the research-based recommendation for low-risk pregnancies with unmedicated labor.
Cons to the bluetooth monitoring device:
The handheld doppler is used to listen to the baby’s heartbeat. You have likely used this device during your pregnancy at prenatal appointments with your provider when they listen for the baby’s heartbeat.
The handheld doppler provides the opportunity for the most mobility during labor and can therefore, indirectly, be a great way to increase comfort level and manage pain. The device is portable, so it can go anywhere your nurse can go and you can be in nearly any position for them to get a reading.This device is waterproof and can even be used in the tub. It does require some additional training on part of the nurse, so be sure to ask your provider and hospital if nurses are trained and ready to use the handheld doppler for intermittent monitoring.
IV During Labor
IV's can largely affect your mobility during labor. When you have an IV, the pole must trail behind you which can be an annoyance during labor. Many laboring women report that they feel restricted by it, while others don’t notice it as much. The choice is yours! Typically, IV fluids are not needed in an unmedicated, low-risk pregnancy, BUT hydration and urinating are very important.
Another Option To Consider
Some hospitals also offer the option of a hep-lock or saline. This is a port where the IV catheter is inserted into one of your veins. It serves as an easy access port to your body for IV fluids or medications. When not in use, it can be taped off! Some families choose this option as a comforting precaution in case of an emergency since it is one less thing a nurse might have to do urgently. Other low risk women choose to forgo this option all together.
Do you know which monitoring options are available at your chosen birth place? Download my Nashville Birthplace Comparison Guide to see your options. This guide compares each of these providers: Vanderbilt, St. Thomas Midtown, St. Thomas Birth Center, Baby + Company, Williamson, and Centennial.
Here are some ways to be mobile and upright during labor:
The 615 Doula Co Approach
When I am supporting families in this decision, we will discuss your risk level along with any other determining factors such as if you are planning for a medicated or unmedicated labor. Regardless, hydration (and urinating) is key! I will be right beside you offering water continuously… One less thing you have to worry about!
Sources // Evidence Based Birth
The fear of pain is the most common concern for pregnant people, especially if it is their first birth and they are unsure of what to expect. “How bad is the pain?” or “I don’t know if I will be able to go unmedicated, but I would like to...”, are both common thoughts that I hear from expecting clients who are interested in an unmedicated birth or know that they will experience some labor before an epidural.
First things first, it all starts with knowledge. Let’s talk about the sensation or pain you might experience in labor. It helps to memorize this acronym:
P: It is not like a charley horse or breaking a bone. It is purposeful. The contraction is doing something very purposeful and productive by opening the cervix, and the uterus muscle is spinning the baby into position, pushing the baby down and out. It is bringing you your baby!
A: The sensation is anticipated. Contractions or waves are patterned and they continue to build, so it is not like a scary surprise, but you can sense it building.
I: The pain is intermittent, not constant. Unless there is something else going on, you do not feel the sensation of pain in between contractions. These moments in between are nice breaks where you can rest, change positions, communicate, etc.
N: The discomfort of labor is normal. The discomfort felt during labor is not cause for alarm, unlike an emergency situation where you break a bone, rupture an appendix, etc. We can normalize the feeling of contractions in labor.
Once you have some knowledge around birth, your perception can begin to shift. Many like to re-frame the word “pain” or “contractions”, and prefer to use a word like “waves” or “surges”. I personally call them contractions, but feel that “waves” is a great descriptor because you can feel the contraction building up, peaking, and then falling... like a wave. It then washes away until the next one rolls in. Your only job is to ride the wave, not fight it. I also like to describe it as pure power. It is the kind of power you don’t have to will into existence, instead you have to let it be. It is pretty awe inspiring, and really opens your eyes to what your body can do.
The Evidence on Doulas
Laboring women report lower pain levels and lower anxiety levels when they are supported by a doula. There is also a decrease in requests for pain medication, and labors are on average shorter with the support of a doula.
Pain is a physical reaction. Suffering is an emotional reaction, and can be better understood by education and learning what to expect. Here is a great, short clip from Doula and Childbirth Educator, Penny Simkin, on pain versus suffering.
Whether you decide on a medicated or unmedicated birth, it’s important to understand the choices and effects of BOTH options. Below, I have included some popular medications to ease the pain during labor and birth:
The 615 Doula Co Approach
As a doula, here are some strategies that I use to reduce pain during labor:
Sources // Evidence Based Birth, National Library of Medicine
The environment of your birth space truly sets the tone for your birthing experience. First, you should ask yourself, how do I want to feel during birth? Do you want the vibe to be spa-like or a more energetic celebration? There is not a wrong answer to this question. It is totally dependent on your personal preference!
Research shows that “Creating an environment that helps women to feel safe and secure during birth can improve women's experiences and likelihood of normal birth.” (Royal College of Midwives, 2014). 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 hormones endorphins” (Uvnas Moberg, 2003). When this environment is “not achieved, women can experience fear-tension-pain syndrome, impending labour progress and causing increased levels of pain” (Dick-Read, 2013).
Here are some tips for creating a calm, spa-like environment in a hospital:
During labor and birth, focus and composure are both very important. You may not think of things like beeping, talking, or a subtle hum of a machine as distracting until you are trying to coax a tiny human out of your body 🙂
The 615 Doula Co Approach
Little things such as the vibe of your birthing environment might seem tiny in the overall birth plan, but trust me, these details are so significant in the moment. As your doula, I help walk you and/or your family through your birth space desires. We create a step-by-step plan on how we are going to achieve the vibe you want and uphold it in the actual labor space.
Sources // Royal College of Midwives, Uvnas Moberg, Dick-Read, National Library of Medicine
First, let me be clear that there is NO ROOM for us to shame or guilt anyone about C-Sections. Birth is birth. However your baby enters the world, I’m here to support!
Okay, let’s dive into the good stuff.
What is a C-Section?
A cesarean or c-section is a surgical delivery of a newborn through a series of 7 incisions through the abdomen and uterus.
C-sections can be a life saving surgery and sometimes the safest delivery method, but for low-risk pregnancies, c-sections actually pose greater risks to maternal health and life. Most pregnant people rightfully want to avoid them. The US levels for c-section are currently too high (about 32% of all births).
Did you know Doulas decrease the risk of cesarean by 39%?
The 615 Doula Co Approach
With all my clients, we sit down together and create a c-section plan in case that becomes the route for your baby to be born. Even with a c-section, you have options, and I am here to help you understand those options and feel confident in the plan that we’ve established.
Sources // CDC, Evidence Based Birth, ACOG