Responding to Labor Pain: What Are Your Options? Part II
In the last blog post, we discussed the different pharmaceutical pain relief options you might have available to you in labor. This time we will focus on options that do not involve medications. Most likely, you will labor for some amount of time before having access to pharmaceutical options so it is a good idea to think about implementing some of these responses to labor pain, even if you are planning to choose to use medication later in your labor. You may also find that some methods will be helpful during one point in your labor, and will no longer work as effectively at a different time, or you might want to combine two or more of them at the same time. So you may benefit from looking into a variety of these options so you can switch around and find what works for you in the moment.
I won't go into specific risks with each option this time because the major disadvantage of non-pharmaceutical options is that none of them will completely take away the pain. But many of them might help you cope with it without any of the risks associated with the medications. So here we go.
- Relaxation: Tension and fear accentuate the perception of pain. So if you are able to relax your mind and body into the work you are doing instead of fighting against it, you will perceive the pain less. Relaxation encourages effective breathing. This, of course, increases the amount of oxygen in your body and helps the the contractions of the uterus to be more efficient. It can also increase the level of endorphins in your body, thereby lessening your perception of pain.
There are several types of relaxation including visualization techniques, meditation or prayer, self-hypnosis, focusing on breathing patterns, and focusing on your baby.
Visualization can be anything that helps you to let go and think positively about the work your body is doing. Some people like to envision a flower, slowly blooming and opening with each contraction. Some prefer to visualize their cervix opening and the baby moving down through the pelvis as they breathe through contractions. Think of things that you can visualize that help you relax now and how you might be able to adapt them to labor. Meditation can mean having your partner or doula talk you through a guided meditation or repeating a mantra that is helpful to you. You could pray throughout contractions or between them or have your partner pray aloud for you. There are a couple of hypnosis based programs that have been helpful for many women. These include Hypnobirthing, Hypnobabies, and Blissborn. Focusing on your breath can be a helpful relaxation technique, and can also be used in conjunction with any other response to pain. Deep breathing, patterned breathing, and focusing on your out breath are some basic breathing techniques.
- Vocalization: Vocalization is exactly what it sounds like -- using sound to diminish tension. This can include things like yelling, groaning, singing, moaning, humming, chanting or even cursing. Think about what you automatically do when you stub your toe or bump your head. You vocalize! There's a reason this is an instinct we have when we are in pain. Vocalizing encourages effective breathing. It can also actually help you dilate more effectively because opening and relaxing the jaw and throat can also help open the cervix. You can choose to make noise in a positive way, saying, "I can" or "yes" instead of "I can't" or "no." What you say and think about what your body can do can actually change what your body is capable of. On the other hand, simply repeating a curse word might end up relieving more tension than a positive mantra. Know yourself and allow yourself to feel free to do whatever you need to do during your labor.
- Movement: Sometimes movement and staying in upright positions during labor is referred to as "active birth." This simply means being free to move around as your body dictates and using different postures and gravity to help the baby get into a good position and move down through the pelvis. It is based on the idea that if you are able to listen to your body and get into a position in which you feel more comfortable, you will be more relaxed, perceive less pain, and birth more smoothly. This method can allow you to feel some sense of control over your labor. Gravity helps the baby descend and can sometimes shorten labor. Moving around can help with back labor and can help baby move into a more optimal position. Staying off your back can also increase oxygen flow to the baby, decreasing the risk of fetal distress. Movement can include many things, such as swaying, walking, dancing, or even bouncing on a birth ball. Upright positions can include sitting on a birth ball, squatting, hanging on your partner's neck, being on hands and knees, etc.
- Massage: Some women find massage helpful during different points in their labor. Having your partner or doula rub your back, shoulders, face, hands, belly, legs or feet can help you to relax and focus on the positive physical sensations rather than just the pain. Massage reduces tension and increases endorphin levels, especially if the person massaging you is your partner -- someone with whom you have a relationship and history.
- Hydrotherapy: Hydrotherapy just means using water to relieve pain during labor. Depending on where you give birth, and what their policies are, you can soak in the tub or sit or stand in the shower. If the tub is large enough you can use upright positions such as hands and knees or squatting as long as you are well supported. In the shower, you might want your partner to get in with you, or make sure you have something to sit on or hold on to. Some hospitals or birth centers have regulations against giving birth in the tub, while others do not. Water helps in relaxation and can alleviate some of the pressure you might feel during contractions, as the baby descends, and during pushing. Hydrotherapy might lower your blood pressure if it is too high, and can reduce stress levels. For some women the relaxation that they are able to find in the water lets the cervix dilate more quickly, therefore shortening the first stage of labor. On the other hand, during some labors the water can relax a woman so much that her labor slows down. It is always important to listen to your body and see how it is responding to what you are doing.
- Rebozo Techniques: Using a rebozo in labor can help in many ways. A rebozo is a long, woven traditional Mexican scarf. It has a rich history, and has been used by midwives in Mexico for centuries. There are many rebozo techniques that can help you relax, connect with your partner, relieve pressure on your back, and help give you leverage while laboring in upright positions. If you have a rebozo certified doula or childbirth educator she can share with you some techniques to practice during pregnancy that could become your go-to methods during labor.
- Oxytocin: So this isn't really a pain-relief method, but it is one of your best friends throughout labor and birth. Oxytocin is also known as the "love hormone." It is the hormone released by our bodies during orgasm, is the main hormone responsible for labor contractions, and is released during breastfeeding. It aides in bonding in our human relationships. Any time you are able to feel safe, relaxed, and connected to the people you love, oxytocin will flow more freely. Natural oxytocin (as opposed to pitocin, which is synthetic oxytocin and does not work in exactly the same way) increases endorphin levels, thereby reducing pain perception. There are a few simple ways to make oxytocin feel more welcome in your body and your birth. Dimming the lights increases melatonin levels, and melatonin can increase and work with oxytocin. Surrounding yourself with people who make you feel safe and comfortable and being in an environment in which you feel safe can allow oxytocin to flow more freely. Adrenaline blocks oxytocin, so anything that increases stress or creates a "flight or fight" response will decrease oxytocin. Unfortunately, some of these things are not always under our control. The best way to increase oxytocin is to connect with someone you love or feel safe with. For women who have partners, being near them, cuddling, feeling their touch, hearing their voice, looking into their eyes, even kissing during labor, can all help create a feeling of safety and bonding and increase oxytocin!
There are many things to be said about the purpose of labor pain and how it is different from other kinds of pain, and about the important role that hormones play in labor. But those are for other posts. I hope this has been a helpful discussion of some of your different options for responding to pain during labor.