Our Bodies, Ourselves (88 page)

Labor and birth are intense and unpredictable, and can push us to places within ourselves that we've never been. Many of us fear the pain and wonder how we will manage.

Fortunately, many techniques are available to ease and help manage pain. These techniques range from comfort measures such as walking, touch, and submersion in water to mental strategies
such as focused breathing and hypnosis to medications such as opioids and epidurals.

In everyday life, physical pain, especially intense pain, is usually a warning that something is wrong in our bodies. But the pain of labor is not a sign of danger, nor is it a symptom of injury or illness. It is a sign that your body is working hard to birth your baby.

Labor pain is different in many ways from other kinds of pain. For one, the pain is self-limiting—it will end when the baby is born. It is also intermittent, not continuous, which means you will usually have periods of no pain between contractions. In addition, labor sensations intensify gradually over time, and this allows your body time to adapt. These differences often make labor pain easier to cope with than other kinds of pain.

Because pain and suffering often go hand in hand, we tend to think they're the same thing. But they're not. Pain is a physical sensation, while suffering is an emotional experience. We may suffer (feel helplessness, anguish, remorse, fear, panic, or loss of control) even when there is no physical sensation of pain. And we may experience physical pain without suffering. As Penny Simkin and April Bolding, longtime advocates for birthing women, write, “One can have pain coexisting with satisfaction, enjoyment, and empowerment.”
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By the same token, they say, suffering can be caused or increased by factors other than physical pain: “Loneliness, ignorance, unkind or insensitive treatment during labor, along with unresolved past psychological or physical distress, increase the chance that the woman will suffer.”

While it is commonly believed that a woman's satisfaction with her birth experience is linked to how much or how little pain she feels, this isn't typically so. Our satisfaction seems to be highest when we trust that we are getting good information, we are given opportunities to participate in decisions regarding our care, and our caregivers treat us with kindness and respect.
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Pain and pain relief seem to have less effect on our overall satisfaction than the quality of support we receive from our caregivers.

My labor felt like a marathon that lasted over two days. There were easy periods, where I sailed along (I was even able to sleep), but there were stretches when it felt like a steep, uphill climb that would never end. But just like in a marathon, you just keep putting one foot in front of the other. You don't think about reaching the end, you just think about taking the next step. Having the support of a great midwife, my husband, and a few close loved ones made all the difference. I had such a HUGE sense of accomplishment when my daughter emerged and made her first tiny sounds. I was exhilarated by meeting such a great physical (and mental) challenge and felt I had earned a marathon “crown.”

Certain strategies lay the foundation to help you cope with the pain of labor. These include working with a provider you trust; knowing ahead of time what pain relief strategies are available in your chosen birth setting and maximizing your range of safe options; and giving birth in a safe, comfortable space, surrounded by people who will provide you with good support.

Most women labor best in a calm, nurturing environment. For instance, having privacy, dim lights, quiet voices, and/or music of your choosing can contribute to your sense of ease and safety.

Some of the strategies listed below can help reduce pain, while others can help you cope better with it. Women's responses to these techniques vary; you may find that some techniques are helpful while others are not. Your support team can help you try different strategies and see what works. An experienced nurse, midwife, or doula will have suggestions for specific techniques to assist you. In some cases, there is little scientific evidence that a particular strategy is helpful, but it is included as some women find it comforting and it poses no risks.

Having the freedom to move and change positions makes labor more manageable for many women. Upright movements, such as walking, swaying, lunging, moving on a birthing ball, and dancing, can help reduce discomfort and help move the baby down into a good position for birth.
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As labor progresses, you may find yourself staying in one place or gravitating to a bed, but you are unlikely to want to lie on your back. Upright positions may be more comfortable and may open your pelvis to help the baby descend. Being on your hands and knees can help relieve back pain. Lying on your side helps you rest your legs and may help the baby to rotate into a good position for birth.

In active labor, you turn inward, and you develop a rhythm that takes you through each contraction and rest period. You may rock back and forth, moan, curl around a partner's hand during each contraction, and then want massage or total silence in between. The pattern that works for you will be uniquely yours. While the woman is in this zone, she can benefit when her support team reinforces her rhythm/ritual and keeps interruptions to a minimum.

The two things that helped me through the labor were mooing and yelling at the top of my lungs. Mooing was the only sort of deep moaning noise that made my whole body feel good, but it did not fit into my mental picture of myself as a chic, polite woman, so I kept making myself laugh. I would do these big low bellows and then burst out laughing because I was so embarrassed, but then that felt really good, so I would just keep laughing
.

© Judith Elaine Halek / Birth Balance

Many hospitals may restrict your movement, especially if you are alone, so try to have a support person with you and try to maintain your freedom to move during your labor. If you are encumbered with multiple attachments such as blood pressure cuffs, IVs, a bladder catheter, and electronic fetal monitoring equipment, it may be impossible to move freely. You have a right to
refuse all these monitors. If you do accept them, you can adapt by standing by your bed, sitting in a chair, swaying in your partner's arms, and so forth. If you have an epidural or have taken medicines that can make you feel dizzy, you will likely be restricted to bed.

© Judith Elaine Halek / Birth Balance

Being in water during labor can be wonderfully soothing and can help you relax. Many studies have shown water immersion during labor to be safe for both mother and baby while also reducing the mother's pain and her need for pain medication. Women who bathe or shower during labor have high satisfaction with this method.

When using a tub, work with your midwife or physician to determine when and for how long you can be in the bath, so that you can avoid any negative effects. If a woman enters the bath before she is in active labor or stays in for more than one or two hours, labor progress can be slowed.
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Drink plenty of fluids, and keep the tub water at body temperature to avoid getting dehydrated or overheated.

If a tub is not available, showers are also a good option during labor. Standing and swaying under the water or holding an extended showerhead and letting the water run over your belly can be very helpful.

Focusing on your breath, a calming and centering technique used in meditation and yoga, may help in labor as well. Classic strategies include a deep, sighing breath at the beginning and end of each contraction to release tension. During contractions, you can pay attention to your breath, letting it anchor you to the moment as your contraction begins. Or breathe along with the contraction, matching your breathing to the rise and fall of the contraction as it becomes stronger, peaks, and subsides. Repeating affirmations may also be helpful. Focusing on exhaling slowly between contractions as you relax muscles and get rid of tension can help as well.

The use of hypnosis in labor has undergone a recent renaissance. Self-hypnosis involves practicing techniques before labor begins that you can use to help trigger deep relaxation when the contractions start. You can practice these on your own or with a partner. Several kinds of prenatal classes are available to learn hypnosis for birthing.

The human touch is a powerful way to relieve pain and reduce anxiety in labor.
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Touch may range from a supportive hand placed for reassurance in one spot, such as on your arm, to light stroking on your back and arms as you have a contraction to a firm massage on your neck and shoulders between contractions. Counter-pressure is using a special kind of touch to help relieve back pain in labor. Someone places the palms of her or his hands over your lower back where the sacrum (the triangular area at the base of the spine) is and then firmly presses in and supports your back during a contraction,
holding it until the contraction is over. Another technique is squeezing in on both hips, which places pressure on the outside of your pelvic bones.

In the midst of the wildness of transition, as I was on hands and knees throwing up into a bowl, my midwife placed her hand right at the small of my back. After giving birth, I couldn't conjure up in my mind what a contraction felt like, but I will always remember just how that touch felt
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At times during labor, an ice pack on your lower back or a warm compress on your abdomen or back may be just the right thing. (Wrap an ice pack so that the ice is never directly in contact with your skin, and a warm compress should never be too hot to hold comfortably in the hand.) At other times, a cold washcloth on your forehead or on the back of your neck may feel perfect. The changing sensations can sometimes distract you from labor pain.

When I was home-birthing my baby daughter, my four-year-old son, Alex, held an ice-cold wet washcloth to my forehead during the most intense part of my labor. It was extremely soothing and also allowed me to direct my focus to a single place without distraction. It was definitely one of the best tools for birthing comfortably and calmly. Not to mention, it was a wonderful way for my son to participate in the birth of his sister!

Pain medications can be extremely helpful at certain times and in certain situations in labor. They can dramatically ease the pain of labor and can be vital in managing complicated or difficult labors. Yet, like most medical interventions, they have some risks for mothers and babies and should be used only with full knowledge of all options and alternatives as well as of the risks and benefits. Medications do not take the place of emotional support and encouragement, which are essential regardless of whether you are using medication or not. These medications are not available at outside-of-hospital births; if you are giving birth at home or in a freestanding birth clinic, you will have to transfer to a hospital if at some point you need or want them.

There are two basic ways that pain medications are used during labor: systemically, that is, affecting the entire body, and regionally, affecting a targeted area. The systemic medications are usually opioids (also known as narcotics), but they also include nitrous oxide. (See box.) Epidurals use a mixture of local anesthetic (numbing medicine) and usually add an opioid.

Opioids (also called narcotics) are the most commonly used systemic medicines given to relieve pain during labor. They include morphine (usually used only in early labor to help women get some sleep when this stage of labor is long), meperidine (Demerol or Pethidine), nalbuphine (Nubain), butorphanol (Stadol), and fentanyl (Sublimaze). Specific medicines used vary by provider and location.