How Mobility Affects Pain Management

Continuous, wired monitoring Image via Instagram: @thefirsthello

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.  

Continuous

In continuous monitoring, electronic fetal heart rate monitors are used to measure two things:  
1) baby’s heart rate
2) contractions

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.

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Image via Instagram: @bundlebirthnurses

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: 

• Bluetooth receptions can be spotty, everyone in the room is usually advised to turn bluetooth off their phones.  
  • The range is often short and while it is waterproof, when submerged in water (bathtub) the signal can be weak. 
  • The signal can fade in and out and it can sometimes produce false data which can usually be remedied by adjusting or resetting the device.
    
    
• Sometimes they are not available because they are in use or are out for repair.
  
  

Intermittent

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:  

• Slow dance with a partner
• Sitting on a exercise ball, bouncing or doing figure 8’s
• Sitting on a birth stool
• Standing and swaying
• Walking, especially in the early stages (balance this with a need for rest and sleep in early 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