Though drug options are common choices for pain management in labor in the US, medication isn’t the *only* option.

<This is part 2 in a two-part series. Read Part 1 here.>

There are many reasons mothers choose to avoid medication in labor, such as the risks mentioned in part one. Others might want to experience the fullness of labor sensations in their bodies and enjoy a sense of accomplishment. Whatever a person’s reasons are for ‘going natural’ in birth, there are countless ways to support that individual. Let’s explore a number of physiologic, as opposed to pharmacologic, options that can be used to decrease pain and increase comfort during childbirth. 

Natural Comfort Measures in Labor and Delivery

• Hydrating and Nourishing: Hydrating and nourishing your body during labor helps increase energy and endurance, making it easier to work through contractions and progress labor. However, it’s common in the US for some providers or hospital policy to ‘require’ or prefer their patients not eat or drink during labor, or to only consume clear liquids. The chief reason being, there is a virtually nonexistent risk that a patient might vomit and then aspirate stomach contents into their lungs in the event of a general anesthesia cesarean. However, it is always *your* choice whether you want to eat or drink during labor. It is worth noting, the American Society of Anesthesiologists report, “Most healthy women would benefit from a light meal during labor.” The Cochrane review concluded after summarizing numerous articles on the subject, “Since the evidence shows no benefits or harms, there is no justification for the restriction of fluids and food in labour for women at low risk of complications.”

• Movement and Position Changes: While there certainly are particular positions and movements that can encourage baby to assume an ideal position for birth or promote labor progress, there is no ‘wrong’ way to move in labor – the biggest key is to move! Professionals who are experienced in physiologic birth will have the greatest awareness of those super helpful positions, some of which include: pelvic tilts, lunges, open-knee chest, and exaggerated side-lying. But for this post, we want to introduce some tools that many birth locations will have available to help!
  • Peanut Ball: Looking much like a circus peanut, this inflatable, plastic tool can be used in several different positions. The main goal of the peanut ball is to keep the pelvis open and in alternating positions during labor. Premier Birth Tools has fantastic visuals and training on the use of peanut balls.
  • Birthing Ball (Exercise Ball or Stability Ball): The popularity of birth balls has increased, and for good reason! These are wonderful to sit on during pregnancy for comfort; not to mention handy to keep around for fussy newborn days when gently bouncing on the birth ball might be just the thing to soothe everyone’s nerves. Rocking, bouncing, or swaying with the support of a ball in labor can be wonderfully relieving. Many folks find birth balls the perfect height for draping themselves over and getting much-needed rest in between contractions. 
  • Birth Stool: Talk about kicking it old school! Birth stools have been assisting birthing people in bringing forth their babies since Ancient Egypt. Shaped much like a semi-circle toilet seat, the goal of using a birth stool is to release tension in your pelvic floor and allow your baby to move through your pelvis with the least resistance possible. Stools also can easily prop your legs into a deep squat, which is one of many ideal birthing positions.

• Superficial Heat/Cold: The wonders heat and cold can provide to soothing pain is not breaking news. You’ve likely used a heating pad for an aching back or placed a pack of ice on a swollen ankle. The same principles work with labor! Typically heat works best for mild or dull pain, cold works best for more intense and sharp pain. Heat and cold can be delivered in a number of ways, including: rice socks, electric heating pads, ice packs, cold washcloths, bags of ice, or disposable plastic hot or cold packs.
• Touch/Massage: It’s very normal for a laboring person to benefit from touch and also, without warning, strongly dislike touch – all in the same birth! Attentive birth partners will be on the lookout for such cues, and not take offense if the mother’s preferences change. You might keep some coconut oil or favorite lotion on hand during birth to make massage easier.
  • Counter-pressure: This refers to firm, sustained pressure on the low back and sacral area during a contraction.
  • Hip squeezes: This refers to firm, sustained pressure on the hips and buttocks during a contraction. 
  • Massage: Most people in labor will want a firm (not forceful) and confident massage. This may be either on the hands, feet, back, or shoulders. Typically light massage is perceived as annoying amid the many sensations of labor. As always, follow your body cues and communicate your preferences!

• Deep Breathing: There’s a myth that breathing is the only form of natural pain relief in labor. (We hope this article has busted that myth!) However, deep breathing does help ease the pain of labor. There are several different techniques for breathing in labor. Although, much like movement, the biggest key to breathing is to DO IT! With each breath, focus on filling your lungs deeply and calmly. 
• Focus and Distraction: Sometimes simple distraction or refocusing of attention helps folks cope through labor!
  • Audio-analgesia (Music or Relaxation Guides): Having a birth playlist isn’t a high maintenance add-on to the birth plan, it’s an evidence-backed way to ease labor pain! Many progressive relaxation guides for labor are also readily available, and are an alternative to self-hypnosis. 
  • Self Hypnosis: There are several programs such as Hypnobabies® and HypnoBirthing® that train expectant mothers to self-hypnotize as a way to dull or eliminate labor sensations. 

• Aromatherapy: Similar to playing music in your birth room, diffusing or breathing in appropriate scents or essential oils is not part of a ‘high maintenance’ birth plan. It’s simply an evidence-based way to soothe labor pain and create a calming effect in your birthing space.
• Hydrotherapy: The American College of Nurse Midwives notes in a position statement, “Warm water immersion hydrotherapy during labor provides comfort, supports relaxation, and is a safe and effective non-pharmacologic pain relief strategy that promotes physiologic childbirth.” (Waterbirth, in which the baby is actually born underwater, is a separate topic than water immersion for labor pain relief.) Monitoring restrictions can be a potential barrier to using water for pain relief. If continuous monitoring is medically required for your birth, like in the case of Pitocin® use, talk to your doula or care provider about how monitoring will look for your birth.
  • Shower: A shower is the most readily available option for those planning hydrotherapy, whether at home or in hospital. 
  • Birth Tub or Birth Pool: If you’ve viewed your share of birth photos, you’ve likely seen birth tubs in use! Either inflatable tubs or stationary ones at home or community birth settings work well for immersion in labor. 
• TENS (transcutaneous electrical nerve stimulator) Unit: Often used in physical therapy offices, a TENS unit is a portable, handheld device that emits mild electrical impulses through connected electrodes. It is believed TENS Units alter the perception of pain by Gate Control Theory (flooding the brain with additional stimuli so that the brain only processes a portion of the pain signals) and Diffuse Noxious Inhibitory Control (the idea that stimulating the body with an additional source of pain generates more endorphins to help the body cope with pain).

Isn’t it clear? There are MANY options for pain management and comfort during labor and delivery! If you want more information about using any of these options, you can learn more by taking a good childbirth class! The Mother Well offers a very informative childbirth class, as well as additional recommendations for in-person and virtual options. You might also check with your doula, midwife, or OB and see if they have any suggestions for informative and educational classes to take!

Doulas as Pain Relief in Labor and Delivery

We’ve walked through a number of tools you can use during labor and delivery to increase comfort and manage pain, but there’s one big one we haven’t touched on—doulas! We might be a little biased, but all of us here at The Mother Well think doulas are one of the most important tools in your tool belt to help manage pain, increase comfort, decrease anxiety, and work toward a positive birth outcome. Doulas can and do support clients who choose either drug or non-drug options (or both!) for their labor and birth experiences. Doulas often have a magic doula bag filled with all kinds of items to assist you during labor, from water and honey sticks to heat or ice packs, twinkle lights, and tennis balls (yes, really!). 

In addition to physical comfort measures, doulas can also provide emotional support for you and your partner during what is often an intense and stressful experience. In fact, research shows that birthing people matched with a doula often have better birth outcomes.

“Doulas are trained to provide physical, emotional, and informational support to women during labor, birth, and in the immediate postpartum period. With the support of doulas, many women are able to forego epidurals, avoid cesarean births, and have less stressful births. A skilled doula empowers a woman to communicate her needs and perceptions and actualize her dream of a healthy, positive birth experience.”

• Impact of Doulas on Healthy Birth Outcomes, Gruber PhD, Cupito MA, and Dobson MEd; The Journal of Perinatal Education

If you don’t already have a doula, you might consider researching doulas in your area and seeing if it might be a good option for you! The following search tools can match you with a doula in your area:

• https://www.meetyourdoula.com/ 
• https://doulamatch.net/
• https://www.hellomeela.com/ 

Give Birth YOUR Way!

However you give birth, we hope this series has been helpful to you! As a doula practice, we  want to see families meet their individual goals for birth and welcome their babies in the way that’s best for them. (If you haven’t already gotten the hint, doulas are kind of a big deal!) Follow @motherweldoula on Instagram, Facebook, and TikTok for more helpful content like this. And when you give birth, please share your story with us!

Sources:

• “Medications for Pain Relief During Labor and Delivery,” The American College of Obstetrics and Gynecology
• Why Epidurals Do Not Always Work
• Epidural and Spinal Anesthesia Use During Labor: 27-state Reporting Area, 2008
• Cochrane – Eating and drinking in labour
• Most healthy women would benefit from light meal during labor
• Cochrane – Continuous support for women during childbirth