A Doula’s Guide to Comfort Measures for Labor
by Victoria Macioce-Stumpf
PAIN IN LABOR
Webster's Dictionary defines pain as "physical or mental suffering". Ordinarily, pain is a message from your body to do something, a stimulus telling us that something is wrong. We tense our body instantly in preparation for action- normally, this is a healthy response to painful stimulus. Pain during childbirth, however, is an exception. It is the one time when pain is not the symptom of a problem and when muscular tension is a negative response rather than a helpful one.
VARIOUS SOURCES OF PAIN IN CHILDBIRTH:
If the uterus is short of oxygen, it may cause more cramping or pain. Any muscle aches when it is not sufficiently oxygenated. In labor, this may happen when there is not enough time between contractions for the uterus to receive plenty of oxygen to replenish the uterine muscle.
Try breathing slowly and fully between contractions, beginning and ending every
contraction with a deep cleansing breath, and breathing in an easy, relaxed
manner during contractions.
If the cervix is slow to open. The baby's head presses through the cervix as
if a tight sweater were being pulled over it. The cervix is very flexible and will
open up more and more, but this takes time and some women find the stretching
uncomfortable or painful.
The physical sensation of the baby's rotation and descent through her pelvis.
The hormones of pregnancy have a lubricating and softening effect on muscle,
tissue, ligaments and joints, which is helpful during the birth. However, some
babies are large and it takes them time to squeeze through their mother's pelvis.
Some techniques to remember: squatting, pelvic rocking, and changing positions
frequently. Keep your bladder empty so that it doesn't impair the baby's descent.
Use gravity whenever possible, and avoid laying in a prone position for long
periods of time. Remember to alternate between rest and activity. Above all, have
patience..... your baby will create the labor he or she needs to be born.
Pressure on the urethra and bladder. The pressure of the baby's presenting part~usually the head~ on your bladder can be quite painful. It is important to keep your bladder as empty as possible. You should urinate at least twice an hour to make sure that a full bladder is not contributing to the pain that you are feeling.
Lack of emotional and physical preparation. If you have not learned and practiced different ways of handling pain by yourself as well as with your partner prior to going into labor, you will be at the receiving end of strong sensations which you may feel ill-equipped to handle. Practicing relaxation, breathing, visualization and other comfort techniques for labor helps your body create a physical memory that will be helpful during labor, enabling you to focus all of your energy on the powerful work of childbirth.
The degree of pain tolerated bears a direct relation to the rate the pain increases, rather than the level of pain reached. Rapid labors, induction or augmentation of labor by artificial means are examples of situations that may affect your ability to cope with pain. In each of these situations, your partner and doula --if you have one-- can step up the physical and emotional comfort measures to help you cope.
THE EMOTIONAL SIDE OF LABOR
How the laboring woman feels emotionally about what is happening in her body is just as important as what is occurring physiologically. Negative feelings can intrude and make the labor seem more painful.
If you are not prepared for the painful sensations of labor or you are demanding a great deal of yourself, you may create a struggle to try and control your labor, which is not really in your control.
If you are extremely anxious about childbirth or about your birth setting, you may get into such a state of physical tension that the slightest touch hurts.
If your labor is very long and you are suffering from lack of sleep, you may feel sensations strongly. Labor demands energy and stamina. Lack of sleep can make you feel more frustrated, impatient, or reactive. Childbirth pain makes most women feel very vulnerable. You need love and comfort to sustain you. You need reassurance and positive affirmations from your partner. How well-rested you are when you begin labor can also affect how well you cope. It is important to stay as well-rested as possible in the final few weeks of pregnancy, since you never know when labor will begin. Try napping every day in the last month of your pregnancy.
If you are laboring in an environment you feel uncomfortable in or with people whom you do not like or trust, your feelings can intrude on the birth process. Sometimes, women feel pressured to labor according to a set time schedule or they feel as if their labor is being controlled by medical interventions and hospital personnel making decisions as to what they should or should not be doing. Your uneasiness may make you unable to relax or have difficulty utilizing some of the comfort techniques that you learned in your prepared childbirth classes, which may cause you to feel that your labor is more painful.
If you have not allowed yourself to believe that some parts of your labor may be extremely painful, you may feel overwhelmed or unable to cope. It is not unusual for a woman in labor to think "something must be wrong-this sensation is too powerful!" Your partner needs to continuously remind you that your body knows what to do; your body sets the pace and rhythm of labor. Your partner can encourage you verbally and try to help you to stay on top of each contraction with as many physical comfort measures as necessary. You also need to remember to relax fully during and in between each contraction in labor.
If you are fearful that the pain in labor may be overwhelming or have worries about your pain threshold, these worries can build up in the final weeks or months of pregnancy. In labor, fear and anxiety can trigger the release of excessive stress hormones (epinephrine and norepinephrine), which can sometimes lengthen your time spent in labor.
Cultural Influences: Attitudes and ideas presented from family members, friends, co-workers, peer groups, television and movies regarding pain during childbirth can influence your perception of pain in childbirth and cause you to doubt your tolerance for dealing with pain.
Reading up on birth stories in childbirth books (see my “Suggested Reading List”) can give you an honest perception of how birth is different for every woman, and illustrate the idea that each woman copes with pain in different ways. The library or local bookstores provide an endless resource of childbirth books, which will help you feel more knowledgeable about all aspects of birth.
FACTORS WHICH MAY DECREASE PAIN IN LABOR
✦Physical and emotional support by your Birth Partner.
✦Physical, emotional and informational support by a Birth Doula.
✦Confidence and trust in your body.
✦Knowledge of choices available to you during labor and birth.
✦A supportive birthing setting.
✦Being as well-rested as possible before labor begins.
✦Staying well-rested in early labor.
✦Relaxation techniques, the conscious release of tension in any of your muscles that are not involved in supporting your positioning during contractions in labor.
✦Breathing patterns to maintain your relaxation and focus.
✦Keeping your bladder as empty as possible: go to the bathroom twice an hour.
✦A comforting atmosphere in the birth room: dim lights, relaxing music playing quietly in the background, door kept closed for privacy.
✦The presence or support of extra family or friends, if desired.
✦Gentle touch and/or massage.
✦Hydrotherapy: utilizing the shower, bath and/or a Jacuzzi for pain relief.
✦Utilize a birth ball (65 cm physical therapy ball) for flexible, yet comfortable support. This is especially useful for back pain relief. You may sit on the ball or you can lean over the ball while standing or in a hands/knees position.
✦Frequent position changes throughout labor or as needed for comfort.
✦Staying well-hydrated and nourished.
✦Variation of heat and cold on painful areas of your body.
✦Utilizing a focal point and concentration to minimize distractions and facilitate relaxation.
✦Supportive assistance by medical caregivers.
© Copyright, 2016, Victoria Macioce-Stumpf.
Permission granted to freely reproduce with attribution.