Pro-tip Series: Comfort Measures and Coping Mechanisms for Labour

askthemidwife labourandbirth pro-tip series Nov 15, 2020

Labour and birth are nothing short of life-changing events in a couple’s life. How labour is perceived prior to the event, often affects how the event is experienced. Labour is a powerful, yet healthy force and is most commonly a normal physiological event. A woman’s ability to cope with labour can be influenced by a great number of factors as will be discussed by MyMama midwife Ms Catriona Grech in this article.

Ms Catriona Grech - Comfort Measures and Coping Mechanisms for Labour

I believe that maternal satisfaction with the birth experience is dependent on not just creating a painless labour, but rather on multiple factors, including maternal control as well as support of maternal preferences for labour and birth.

Active birth

Staying active during labour is one great way to make you feel comfortable during labour. It is vital to find the positions that feel right for you. Most often, mothers find that they develop a certain ritual of movement in order to cope with contractions by moving into a certain position, each time they feel them coming – either by rocking, vocalising and then resting when they subside. The creator behind the concept of “active birth”, Janet Balaskas (1980), suggested that it was more than just physical positions. She believed it was also a state of mind and the choice to be 'active' rather than 'passive' in the birth experience.

Support

Helping mothers to be as relaxed as possible and aware of their situation can help minimize the physical pain and emotional distress of labour and birth. This happens when women adequate care, information, comfort, support and reassurance during labour and birth. A review resulting from 22 trials involving over 15,000 women found that simply having continuous support from the same partner in labour leads to much less need for pain relief, fewer interventions and better outcomes for both mothers and babies. In addition, this continuos support was found to be most effective when that support person was not a member of the hospital staff.

Breathing exercises

Breathing calmly and deeply is surely a great way of gaining a sense of control and confidence. I believe this is important, whether you are in labour or else in a waiting room waiting for a job interview. Practicing in labour, whether a yoga or meditation class, is a good place to start. Or else you can just try some deep relaxing breaths – in through the nose and out through the mouth (inhale, exhale, repeat) – as you fall asleep each night.

How can breathing patterns during labor work to help manage pain or promote comfort?

Researchers think there are a couple of different ways that breathing might work for pain relief during labor. Focused breathing might work by interrupting the transmission of pain signals to your brain by giving you something positive to focus on. It can also work by stimulating the release of endorphins (which are the natural pain relieving hormones) by helping you reframe your thinking about labor in order to view labour as positive, productive and manageable. Using breathing techniques and focusing your attention on your breathing may activate mental processes in your brain that make labour sensations seem less unpleasant. Breathing techniques are a body-mind training mechanism that are in fact used by people around the world for stress relief.

Low lights and noise

When environments are explicitly designed to complement birth physiology, studies have found an increased likelihood of spontaneous vaginal birth, breastfeeding at six-to-eight weeks and very positive views of care. Continuous environmental noise appears to be inherent in the hospital environment and can negatively affect memory, cause increased agitation, reduce pain tolerance and increase the use of pharmacological pain relief. Sound is interpreted as a reflex action and so external noises are rapidly transmitted to brain, where pitch and volume are interpreted as either causing alarm or conveying safety. Therfore, keeping the room quite and dimly lit can allow you to keep focused.

Massage

Your partner or midwife can massage you during labour. What most women look for is usually a hard-counter pressure applied to their lower back especially during contractions. Some might make use of acupressure points to relieve pain and if you wish you can encourage your partner to make use of the 'hip press'. This involves squeezing your hip bones while you are either on all fours or standing, in order to relieve the pressure, pain and help open up the pelvis. Another technique that your partner can practice and research about is the 'labour shaking the apples' technique which is used to promote relaxation of the butt, pelvis and inner and outer thighs muscles. It is also believed to help aid in the rotation and decent of the baby during labour.

Music

Listening to music during labour and birth is not a new idea, however it is often overlooked as a coping strategy and given that it costs nothing and can work in conjunction with other types of pain relief, it is worth planning a playlist that is personal to you. Some randomised control trials show that music can lower perception of pain, help to regulate heart rate and breathing, reduce the amount of drugs needed as well as reduce anxiety, which in turn help you feel calm and in control. Your birth partner can take charge of this practical task and might also help them to focus on your mood and give them some control in an unfamiliar environment.

Joking around

A sense of humour in labour is highly recommended and I believe it is essential. It is believed to relieve pain, by releasing beta endorphins, referred to as the brain's natural 'morphine'. In addition, laughter helps your body release tension. Not only does tensing your muscles during labor tire your body more quickly, but being tense can actually increase your pain level. This is why it’s important to keep your muscles as loose and relaxed as possible. If you’re finding it difficult to laugh – and those moments may certainly come – focus on releasing tension from your jaw and hands; the rest of your body will follow.

Vocalising

The voice is believed to be a natural form of pain relief and release. Practicing making low earthy sounds can help you feel more relaxed and uninhibited. Moaning, chanting, singing or even mooing (like a cow) can feel absolutely fantastic. Keeping your noises low is generally more helpful, rather than screaming, but I suggest you do what feels right for you.

Visualisation and affirmation

Visualisation can have a powerful effect on the capabilities of your body, and the more you practise it, the better you can get. An effective way to tailor a visualisation to your labour would be to address the specific concerns you have. Research shows visualisation is more effective when we’re in a relaxed state, so practising your visualisation in the morning just before you get up, or at night, when you've wound down, can be a good idea - playing relaxing music can help get you in the ‘zone’, too.
Creating some positive affirmations about your labour – similar to your visualisation, centred around any concerns or struggles you anticipate, can be an effective way to actively lead the outcome of your pregnancy. Athletes do this most of the time, keeping in mind the words “I beat you!” while in competition, or “I’m strong” when they’re training. For example, if you fear the pain aspect of childbirth, you can repeat a statement such as “I am strong, focussed and powerful.” Or, if you fear labour complications - “My body has an inner wisdom better than anything I can control.” I believe affirmations are simply a way for you to take control of your thoughts, and therefore have a huge effect on the way you feel and the experiences you have.

Nourishment

Labor and birth require an extraordinary amount of energy. Providing your body with the nourishment and energy it needs during labour is just as important now as it was when you were creating and growing this baby during pregnancy. Be prepared in advance – have a selection of good quality food and beverages as part of your birth bag, that will help you run labor and birth with strength and power. It is good to remember that low blood sugar or dehydration may make you feel weak and may be harder for you to cope.

Water

Labouring women report that water can help in all kinds of ways. It is often used to help people and even animals in pain, so it makes sense that it would work for labour. The buoyancy of water enables a woman to move more easily. This can assist by relieving pain, and potentially optimising the progress of labour. Water immersion may be associated with improved uterine perfusion, less painful contractions, and a shorter labour with fewer interventions.

Hot water bottle

Heat applied to the lower back can be quite soothing and comforting. We advise to wrap the bottle with a towel or soft cover before using it. Using the heat from a hot water bottle is actually a really good way of encouraging your muscles to relax. Another technique that we like to use is applying hot flannels or towels to the lower back during contractions. It is important to be cautious so as not to end up with a first-degree burn. Furthermore, do not use heat on skin that does not have a feeling, such as areas that are numbed from an epidural. This can cause you to burn yourself accidentally. Please remember that the same warning goes for a mother with a fever during labour, as heat is not appropriate.

Tens Machine

This is a small battery-operated handheld device with pads that you stick onto your lower back. These pads deliver electrical impulses that feel like tingling, buzzing or prickling sensations. The good thing about this device is that you hold the control unit yourself and decide when to send impulses as well as how strong they should be. TENS can be used in combination with other non-pharmacological drug and pharmacological methods of pain relief – except with hydrotherapy, or water immersion. It is also not supposed to be used together with heat. TENS therapy can be stopped at any time, and does not have any residual effects. The TENS is said to work by sending electrical nerve stimulation through these electrodes; it doesn't take away the sensation of contractions, but essentially interrupts the pain signals your brain is receiving, possibly reducing your awareness of them and producing endorphins that allow you to cope better. In fact, t's a common comfort measure used in many physical and occupational therapy, especially by people who suffer from chronic pain. You can hire or buy a TENS machine, so you have it ready at the start of labour. It is best to try it out before you go into labour so you can learn how it works. For the best results, start using it early in your labour.

Entonox

This is a mixture of oxygen and nitrous oxide gas, also called the laughing gas. You will be offered to inhale through a mouthpiece, which you hold yourself. Because it is inhaled, it enters the body quickly, but also leaves the body quickly, so if you don't really like the feeling it gives you, you won't be stuck with it for long. The gas takes about 15-20 seconds to work, so it is best to breathe it in just as a contraction begins. It works best if you take slow, deep breaths. As such, there are no harmful side effects for you or the baby but it can make you feel lightheaded, dry-mouthed, nauseous, sleepy or unable to concentrate. However, if you feel that entonox does not give you enough pain relief, you can ask for further pain relief.

Opiods

Pethidine injection is administered via an injection in either your thigh or buttocks to relieve pain. It does not actually numb any of your pain receptors but women actually describe it as it makes you feel 'out of it' so you don't experience the pain in the same way. One advantage of pethidine is that it helps you to relax and that you can get some rest if your labour is long. However, you need to bear in mind that if you don't like the feeling of it, you will have to wait for it to wear off. It takes about 20 minutes to work after the injection is given. Its effects last between 2 and 4 hours, so we don't recommend it if you're getting close to the second stage of labour. This is because pethidine crosses the placenta and it may affect the baby's breathing and can interfere with the baby's first feed.

Epidural

This is a type of local anaesthetic that is administered by an anaesthetist. It numbs the nerves that carry the pain impulses from the birth canal to the brain. For most women, an epidural gives complete pain relief. It can be helpful for women who are having a long or particularly painful labour. It is important to keep in mind that although an epidural can provide very good pain relief, it's not always 100% effective in labour.

The drawback of an epidural is that you'll be needing a urinary catheter to help you urinate. You may also have reduced sensation of your baby being born and sometimes you will end up giving birth on your back on the bed, as you might be limited to mobilise.

Any concerns or questions that arise regarding any pharmacological pain relief, can always be discussed with your midwife during labour. However, in the meantime, if you require any additional information on this topic, you can reach out to our team of midwives at MyMama.

Diva Status and Self-belief

Last but not least, I believe you really are the star of this life-changing event – so don't be afraid to behave like one! Being assertive, knowing your rights and being demanding is not only reasonable, when birthing a brand new person. It will also make you feel in control and stronger during the contractions. How you are treated will directly affect how you feel and how you cope overall. Make the most out of this, as once the birth is over, your diva status will be automatically taken by 'His majesty, the Baby'! In addition, it is important to remember to believe in yourself. Many researchers have actually found that women who go into labour feeling overall confident, are more likely to cope. Your body knows what to do, so always follow its lead. While it may be tough, just remember that YOU CAN DO IT!

References

Cluett, E.R. & Burns, E. (2009). Immersion in water in labour and birth. Cochrane Database of systematic Reviews, 15(2).
Evidence based birth (2018). Reterieved October 12, 2020
from https://evidencebasedbirth.com/breathing-for-pain-relief-during-labor/
Garlovk, A.E., Arthurs, J.B. & Bass, R.J. (2017). Effects of Comfort Education on Maternal Comfort and Labor Pain. Journal of Perinatal education, 26(2), 96-104.
Hill, M. (2017). The Positive Birth Book. Pinter & Martin: London.
Lin, H.H., Chang, Y.C, Chou, H.H., Chang, C.P., Huang, M.Y., Liu, S.H., Tsai, C.H., Lei, W.T. & Yeh, T.L. (2019). Effect of music interventions on anxiety during labor: a systematic review and meta-analysis of randomized controlled trials. Peer Journal, 7, 6945.
Lin, H.H., Chang, Y.C., Chang, Y.H., Hsaio, Y.H., Lin, H.H., Liu, S.J., Chao, C.A., Wang, H. & Yeh, L.Y. (2019). Music Interventions for Anxiety in Pregnant Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of Clinical Medicine, 8(11), 1884.
NHS (2020). Pain relief in labour: Your pregnancy and baby guide. Retrieved October 30, 2020 from https://www.nhs.uk/conditions/pregnancy-and-baby/pain-relief-labour/
Obstetric Anaesthetists’ Association (2018). Retrieved October 30, 2020
from https://www.oaaanaes.ac.uk/home.
Tommy's (2020). Pain relief in labour and birth. Retrieved October 30, 2020
from https://www.tommys.org/pregnancy-information/labour-birth/pain-relief-labour-and-birth
Obstetric Anaesthetists’ Association (2020). LabourPains.com – Reliable information from doctors, midwives & mothers on pain relief and anaesthesia choices for your baby's birth. Retrieved October 30, 2020 from https://www.labourpains.com/home

Ms Catriona Grech is offering online consultations to pregnant women and new mums via this platform. Book an appointment with her should you need expert support and information relating to pregnancy, birth and parenthood preparation (nutrition, pain relief, infant care, infant feeding, self-care, local services) and any specific questions that you might have.