Managing Pain During 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.

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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:

• Epidural (see previous post breaking down the pros and cons of epidurals here)
  
• Nitrous Oxide or “laughing gas” - doesn’t pass the barrier to the baby, dissipates quickly, often described as anxiety relieving or calming and sort of a distraction from painful sensations
• IV or inject-able medications - narcotics that do reach the baby, can cause reactions common in opioids like nausea, itching, or drowsiness, least safe for baby of the medicated routes, but for some that cannot have an epidural this can be helpful

The 615 Doula Co Approach
As a doula, here are some strategies that I use to reduce pain during labor:

• Knowledge - demystify the birth process and develop an understanding of what your body is doing
• Perception - affirmations are a favorite (see previous post on affirmations here)
• Encouragement and assurance of what is normal and acknowledging progress
• Breathing - 
  • Slowing your breath to bring a calming response
  • Lengthening your breath to provide your body and baby with the oxygen it needs to power forward
  • Syncing your breath with contractions
  • Panting or using short, shallow breaths when baby is crowning to reduce tearing 
• Water -
  • The shower is a great place for early labor or even transition. Bathrooms often offer a more private space where lights can be dimmed and the environment more controlled. Some birth places have additional sprayers that can be nice for targeting certain areas of the body like lower back or abdomen. The birth ball and stools can provide other opportunities for positioning whether it is a restful sit, bouncing, on hands and knees, or using it to prop one leg up.  
  • The bathtub can help to soothe your body and many mamas comment that the floating feeling is helpful. In the tub you can float on your stomach or back, squat, kneel, or get on hands and knees.  Some of the birthing tools can also go into the bathtub, such as knee pads or towels to soften the edge as you lean over.  
• Massage - The lower back is a common request, but your neck, hands, or legs can also feel nice. This is another great way to feel the presence and support of your partner.  
• Counter Pressure - Oh the glorious hip squeeze! This perfect spot really varies by woman and by labor.  Some love the squeeze on the sides, others directly on the sacrum and some even like it on the sides of the lower abdomen as contractions come. We try a few to see which works best for what you are experiencing.  
• Acupressure - There are two main points, one in the hand and one on the leg. There are other lesser known points such as on the bottom of the foot and at the sacrum on your lower back.  
• Heat - Heating pad or warm, moist towels.  I actually tote in a sterilized crockpot, which feels a little nutty, but hey, my clients rave (and laugh) about it.    
• Position changes - Most positions last about a half hour and then it is usually a good idea to switch to another one to make sure that the body is staying mobile, you are staying comfortable, and the time flows more quickly. The possibilities for positions are endless from standing and swaying to hands and knees or squatting on a labor bar with a rebozo.  
• Movement Techniques - During labor I am attuned and collecting data in my mind about where your baby is in the process and how you are responding to each stage and position. If you are coping well, then I follow your flow and support you. If you are struggling to find your rhythm or cope, then I step in with some suggestions. I often assist you in performing some balancing exercises like sifting with a rebozo while you are on hands and knees. I might support you in bouncing on an exercise ball with hip swirls, doing what Spinning Babies calls “shake the apples”, or to simply rest smartly.
  
  

Sources // Evidence Based Birth, National Library of Medicine