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Coping with Labour

There are different ways of thinking about coping with labour waves and birth.

Some people feel that in modern times, there is no point in feeling any discomfort in any process and that medical pain relief should be used for labour and birth. Other people believe that discomfort is a normal part of the labour and birth process and that with good support, you can work through labour waves. It is more helpful to think about labour as hard work that requires your full attention as opposed to suffering that needs medication. Think about each of these options, the way you feel and plan your coping mechanisms accordingly.

What do labour waves feel like
Labour waves usually begin in your back or lower pelvis and spread towards your belly button. They really are like waves, starting off slowly, peaking and then ending slowly. So, if a labour wave lasts 90 seconds, imagine the lead-up lasting thirty seconds, the peak lasting thirty seconds and the wind-down lasting thirty seconds. The time in between waves is pain-free. During the first phases of labour your waves will come every ten to fifteen minutes and last a minute or so; as your labour progresses, the waves come more often and last longer, up to about 90 seconds. Not all women experience waves in the same way - for some, they are uncomfortable but not painful, for some they are barely noticeable.
Your state of mind is very important where labour and birth are concerned - if you are expecting and preparing for a painful experience, that is likely what will happen. If you are expecting a challenging experience with peaks and rest in between, it is much easier to imagine yourself working through the process.
This pain has a purpose – to bring your baby into your arms. If you are getting augmentation the waves will be more frequent and there will be less time between them earlier on in labour, which is why many women who have augmentation use pain relief. It’s not the waves that are the problem, it’s the fact that the medication makes them come so fast and frequently, over a long time.
Without augmentation, labour waves are much easier to handle.
Being restricted to a bed and lying on your back also result in painful labour waves - this is a way of your body telling you how important it is to move during the labour process to help your baby down. Lying down also puts all the weight of your uterus on blood vessels in your belly slowing the flow of oxygen to baby and slowing the opening of your cervix. There are very few reasons to say yes to lying down during labour and birth. It’s ok to lie down to rest if you feel you need to between contractions, but when your body is telling you that lying down hurts, listen to it and move around.
Only about 8% of the time you spend in labour really hurts (the peak of your labour wave); 15% of the time is spent moving towards or away from a wave. That means that the majority of your labour - 77% (!!) is spent pain-free. Looking at it that way makes it easier to see yourself working through them. (thanks to Milli Hill, author of The Positive Birth Book, for this calculation)

Coping mechanisms that do not involve medication
To begin it is helpful to think of the gate control theory of pain. In short, this theory says that your nerves can only send a certain number of sensations to your brain at once, and that if you stimulate your nerves in a non-painful way when you are feeling pain, you can block some of the pain messages. Think about a time when you hurt your leg and then put pressure on it with your hand to make it feel better – that’s the idea.
Non-medical coping options use the gate control theory to make it easier to handle labour waves. They do not have any risks (although some may not be as effective for you as others), you can remain mobile and can be used at any time, no matter where you are labouring. Some may require the added assistance of your partner or doula (this is where a doula’s expertise and having two support people present is very helpful). Practice some of these methods in advance and see how they work for you.

Massage - light massage or a massage of your shoulders, back or hips can be done by your partner or doula. Massage can also be done with a rebozo (a special long cloth that can be used during labour).
Counter-pressure - pressure put on the place where your labour waves are most intense (often your lower back) can be helpful and can be used together with hot or cold compresses.

Hot and cold compresses - putting very warm or cold compresses on different parts of your body during a labour wave or on any part of your body you need to relax. This can help ease pressure and pain, especially when combined with counter-pressure. If a hot compress isn’t working well for you, try a cold one and vice-versa.

Hydrotherapy (shower) - a fancy word for using water to help you get through labour waves. Stand in the shower and have someone direct the flow of water from the showerhead to a place on your body where you most need it - usually your back, belly or pelvis. Play with the water pressure, temperature and flow to see what works best.

Hydrotherapy (pool or bath) - floating in water in a birthing tub can do wonders to help you get through a longer labour or to help you when you are very tired. The weightlessness, warmth and movement available in a tub of water can feel amazing. During labour waves your partner or doula can pour water over your back. You can spend part of your labour in water but choose to give birth out of the pool, or have a water birth – it’s not all or nothing.

Movement - we mentioned already, why moving in labour is helpful to the birth process. Your birth plan should include the fact that you would like to remain mobile during labour and the type of equipment you would like to use for support and help (this will depend on what your hospital or birth centre offers). This can include pilates (birthing) balls, a birthing stool, a birthing bed that can change positions or a birthing tub. Try out any of these and see if it works for you - and don’t be afraid to change your mind and use something else.
If you love dancing and want to dance during labour, bring your favourite music with you! Your favourite music can also relax you and help you feel safe, optimising your hormonal orchestra.

Coping mechanisms that involve deep relaxation
Controlling your thoughts is another way to help you cope with your labour waves. It’s not some made-up nonsense, it’s been proven by studies on pain management. There are no negative side-effects and people who use these methods tend to use less pain medication.

Hypnotherapy - focuses your attention inward and makes you more open to suggestions, which can then be used to make you feel safe, comfortable or relaxed. This is most often done so that you take a selfhypnosis class during pregnancy that teaches you how to reach this deep state, often supported by recordings that you listen to during pregnancy. These recordings can also be used in labour and guide you into a calm, relaxed state where you perceive your labour waves differently.
Deep relaxation and breathing - can include guided or self-guided visualisation that moves your focus to something pleasant, stimulating the release of endorphins (which are your body’s natural pain relief hormones). Pain is more severe when you are feeling tense, so deep relaxation may help loosen your muscles and cope with labour waves more effectively. Doing yoga or similar exercises in pregnancy helps teach you these techniques.

Coping mechanisms that involve medication
The coping mechanisms we hear about most often are those that involve some sort of medication, but as we’ve seen these are only some of the many options that are available. Medical options have
benefits and risks for you and your baby. Babies whose mothers receive medical pain relief during labour are often less alert at birth, sleepy, are slower to start breastfeeding and as a result are more likely to have jaundice after birth. Medical pain relief options are usually only available in hospitals.

Epidural - more and more women are choosing to have epidurals during labour, and it seems as if they are being advertised as “the best” method to cope with labour waves, although as we have seen
epidurals are only one of many methods that can be used. Epidurals can only be given to women in established labour, usually from about 4 cm dilation onwards. To get an epidural an anaesthetist puts a small needle in your back with a tiny plastic tube. Drugs are put through that tube and into your back that can make your whole lower body numb or just take the edge off the pain. Epidurals lower your blood pressure and usually require you to be put on an IV of fluid, usually through your arm. So, you will likely have two tubes attached to your body - in your back and in your arm. It is also likely that you will have a blood pressure cuff put on your arm and an oxygen probe on your finger and possibly additional monitoring for your baby. You will be confined to the bed as a result.
It takes about ten minutes to set up an epidural and after that it takes about 15 minutes for you to feel it working. Epidurals do not work for everyone and if it is not working for you, let your doctors know so they can adjust the drugs they are giving you or adjust the placement of the epidural tube. Epidurals are not started if the birth is expected within 30 or 60 minutes. Keep in mind that epidurals are only available in hospitals and that not all hospitals have the staff available to give epidurals 24 hours a day, 7 days a week.
Benefits - epidurals are very helpful if you are very tired from labour and can help you get some sleep and energy. They are also effective with pain management.
Risks - studies have shown your chances for a forceps or vacuum delivery are higher if you have an epidural and so are your chances for severe tears or episiotomy. You are more likely to have a fever during labour and not be able to urinate, which means you might have a catheter put in to drain your bladder. Because epidurals slow down your labour, you are more likely to need synthetic oxytocin. Epidurals also usually cause a slower pushing phase. Epidurals are effective for 90% of women – but one in ten women get partial relief or none at all. Don’t feel like you have to get an epidural very early in labour. Try out your coping techniques and see how they work for you and then decide if you want one later on.

Pain relieving medication - different types of medication can be given for pain relief. They spread throughout your entire body to help with pain but don’t make you lose feeling in your body. Medications can be injected into your vein or muscle directly, or can be given to you through an IV. You might need an IV of fluid, usually through your arm. It is also likely that you will have a blood pressure cuff put on your arm and an oxygen probe on your finger and possibly additional monitoring for your baby. You will be confined to the bed as a result. The effects of the drugs last 60-90 minutes, and they are not given if the birth is expected in the next two hours.
Benefits - these drugs are well available and are less expensive than epidurals. They are a good option for women who want some pain relief but don’t want a continuous epidural.
Risks - They are not always very effective, can make you feel nauseous or drowsy, confused, forgetful or slowed, which can cause problems with breastfeeding after birth. For the newborn, risks include changes to heart rate before birth, slowed breathing after birth and general drowsiness after birth which can cause problems with breastfeeding. Some drugs also have more side effects on the newborn than epidurals do.