In large urban centers such as Toronto, Montreal, New York or Los Angeles, the use of epidurals for pain management during labour is staggeringly high. Toronto alone boasts an 80-90% epidural rate at most hospitals for obstetrical care. And while having medical pain relief during your labour is your own personal choice, its important to remember that there will be a portion of your time spent labouring where you will be at home.
Most hospitals are delaying your admission, until you are in an active labour pattern, contracting 3 to 5 minutes apart or are at least 5-6 centimetres dilated. As a result, it will be important for you to look into some non-medical pain relief to help you cope until you are able to get to the hospital and get an epidural. Or perhaps these options can help get you to the very end where you may end up not needing any medical pain relief at all or very little.
The use of water in birth is very common in European countries and it's certainly possible that some hospitals will allow you to birth your baby in water. For labour, warm water is helpful in easing the discomfort of strong contractions. In a nice warm tub, your body can relax. Easing tension in your body can decrease the intensity of your contractions and it may even speed your labour up if you are having a slow or prodromal labour, which is a labour that starts and stops over several days and never seems to be able to get traction and fully dilate your cervix.
Subsequently, if you are having practice labour or Braxton hicks contractions that are keeping you awake at night, a nice warm bath or shower can stop them so you can get some sleep. Hydrotherapy doesn't have to be just a hot bath, a warm shower with the spray concentrated on your back or belly can also help ease the discomfort of strong labour contractions.
Be careful, however, that the water isn't too hot. During labour, the birthing parent becomes hypersensitive to touch and temperature and what was hot for you before going into labour can actually be quite scalding while you are labouring. Always test the temperature before getting into a hot bath or shower.
Touch and massage in labour can be very comforting. When light touch or light pressure massage is used it can release endorphins into your system which helps you to relax and endorphins have been found to be significant in reducing pain felt during labour.
Your birthing team doesn't need to include a registered massage therapist to give you a good relaxing touch during your labour. Also, it will be important to start the massage early so that you can maximize the benefits. If you start when labour is in full swing it will take longer to relax into it and get the benefits. Practicing massage in the weeks leading up to labour beginning can help your partner get things right as far as what you need quickly if you have already been working on it.
Finally, ensure you are massaging over clothing or using a friction reducer like an unscented oil or lotion. As mentioned your skin becomes hyper-sensitive during labour so a massage by your birth support person may end up rubbing your raw unintentionally.
Laying down in bed for your labour is commonly seen on television and in movies. However, you may find that laying down is not what your body wants to do. Listen to what your body wants. Using upright, forward-leaning positions throughout your labour can be helpful for keeping labour going and keep baby moving down and in a better position for pushing.
Having said that, there will be a time when you need to rest, when moving and standing is becoming tiring. You absolutely can lay down in the bed, but try to lay on your side and possibly with something between your knees like a pillow or better yet, a peanut ball, which is an exercise ball shaped like a giant shelled peanut, which can help promote space for baby to move down and encourage the progress of labour.
It also works well when you have chosen to have an epidural and can't get out of bed. Ask your hospital if they have one or if you can bring your own.
Breathing for labour doesn't have to be complicated but controlled, focused deep breathing in and out using your diaphragm to fill up your lungs and create space in your abdomen for your uterus to complete a full range of motion during the contractions can make the contractions more efficient, thus needing less of them. Also, deep, focused breathing can give you something other than the contraction to fixate on and the best part, deep breathing will release endorphins in your system. And we know how important they are for pain relief.
Most hospitals will allow you to have more than one support person during your labour. And in most hospitals, your assigned nurse will not be with you the whole time or be able to spend much time making a suggestion or assisting in your comfort.
Today's labour and delivery nurses are working harder and with less time to commit to your comfort. Therefore having a second support person is a good idea. Your second support person may also be able to support you at home so that you won't need to rush to the hospital too soon. Remember though, your support people should be there to support your choices and help you through it all, so choose wisely.
If having a family member or friend is not going to give you the birth you want or they are going to stress you out or have you more worried about their comfort than your own, consider hiring a Doula. A Doula is a professional support person who can offer suggestions and information on comfort measures and the process of the birth itself. They can also give your partner a break for eating, drinking and going to the bathroom, or just getting some fresh air if they need. You can learn more about Doulas and if they may be a good option for you.
So whether you are planning for medical pain management or hoping to go as long as possible without it, make sure you are trying some or all of the above suggestions to make your labour a little more comfortable.