Techniques for Managing Labor Pain
The below techniques can help you move through the stages of labor with more calm and confidence, and less pain. If labor contractions are like waves, “you can’t stop the waves, but you can learn to surf”. A few general notes:
Review and discuss with your partner and/or doula, as they can help remind you of options to try once you’re actually in labor
If you want to “practice” using any of these techniques, some people find that holding freezing ice cubes can be a useful way to simulate pain (though of course it doesn’t have intensity nor the rising & receding nature of labor pain)
You can also practice utilizing them with any pain that arises organically during pregnancy (e.g. back pain, heartburn, etc)
You may naturally gravitate towards the techniques that have worked for you in the past in other contexts, or that feel the most natural. For example, if you love music, consider incorporating it, but if it’s not your thing, don’t feel like you need to. Don’t “should” on yourself!
Don’t feel wedded to particular techniques - maybe you initially have a vision that you’re going to love spending lots of early labor in the bathtub, but when it’s actually happening that doesn’t seem appealing to you anymore. Don’t force it, try something else!
Breathing
There are various breathing techniques out there that can be helpful in the first stage of labor. Here’s a simplified summary:
Deep & Slow: deep inhales through nose, deep exhales through mouth (“smell the cake, blow out the candles”); breathe from your belly, not your chest
Do this exclusively for as long as you’re able; this brings lots of oxygen to you and your baby
Try counting your breaths during a contraction - this helps focus your attention and can be especially helpful once you know that your current contractions only last X number of breaths
Shallow & Accelerated: light, rapid breaths in and out of mouth; coming from chest
If things intensify, switch to this breath as the contraction peaks, then return to deep breaths
Patterned Breathing: any kind of rhythmic breathing, for instance “pant-pant-blow” - take a deep inhale and then 2-3 short pants followed by a longer blow. Or the opposite - 3-5 quick inhales for every 1 long exhale
There are infinite varieties here and you may naturally find yourself falling into a certain pattern. As long as it’s working for you, continue doing it; otherwise, switch it up.
You don’t need to decide your breathing technique in advance, but there is value in practicing a little to familiarize with the options
Your partner or doula can play a critical role here by reminding you to breathe and even breathing alongside you to help you keep rhythm, especially if you are doing patterned breathing
You may also find yourself producing other sounds like low groans as you deal with contractions. It can sometimes make you feel less awkward if you’re not the only one making noises - having your partner groan alongside you can free you to vocalize with less inhibition.
Visualization
It can be helpful to pair a visualization with your breathing. Below are some of the most common visualizations, but really it can anything that works for you.
Breath moving: Simply picture the air traveling through your body. It can be an accurate vision of it moving through your nostrils, down your windpipe, into your lungs and towards your baby, and then back out the same way. Or you can imagine the inhalation begins at fingers, moves through arms and up to head, and then the exhalation goes down to baby and out through your legs and feet.
Waves: Pick your favorite beach in the world and visualize the waves, watching them build and recede with each contraction. This is the most direct metaphor, because contractions really do surge like a wave. Just like in surfing, you will overcome each contraction wave by riding with it, not fighting against it.
Flowers opening: another classic image that may be helpful to hold in your mind is that of a flower blooming. Every breath you take is helping your cervix open up to reveal your baby to the world.
Music
Another tool that can help you remain steady with your breathing, or at least create a calming atmosphere
You’ll find many thematic, pump-up labor playlists online where the content of the song seems relevant (e.g. “Push It” ,“Under Pressure”). While fun and silly, I don’t think this kind of music is actually helpful too helpful for actual labor.
Instead, I’d optimize for one of the following characteristics:
Calming: Spotify’s Calm Classical or Instrumental Jazz are great options. Here’s my own Classical Labor playlist.
Rhythmic/Hypnotic: I listed to this album of African strings on repeat to really get in a rhythm; electronic music with a great beat is also helpful for keeping your breath pacing - here’s my Electronic Downtempo for Labor playlist. And here’s my Hypnotic Piano for Labor playlist.
Any songs that have personal meaning or poignance to you!
Meditations & Mantras
In the weeks leading up to birth, and during early labor itself, it can be helpful to listen to pregnancy oriented meditations. I’ve created affirmation meditations for each trimester, early labor and postpartum that are available on Spotify and YouTube.
I recommend listening to the below “Early Labor” meditation in the days (or even weeks) leading up to your due date, in addition to during early labor itself. This can help train your mind to approach labor with more positivity and ease; given the mind-body connection, this may also result in real physical benefits for your labor experience.
The app Expectful also has meditations of varying lengths for different pregnancy (and later, motherhood) related topics
I recommend picking 2-3 short phrases that could become “mantras” you repeat in your mind during labor. Some examples:
“I’m ready to meet my baby”
[while breathing in] “In for me”, [while breathing out] “Out for <Baby-Name>”
“One breath at a time” or “One more breath”
“Trust the unfolding” or “I trust my body”
“I can do anything for 30 seconds” (kind of like psyching yourself up for just one more rep during a high intensity workout!)
Counterpressure
This is one of the best comfort measures your partner or doula can provide during contractions, especially if you’re experiencing lots of labor pain in your back
Two most popular types of counterpressure:
Double Hip Squeeze: hands on the top of each hip, squeezing inwards towards center
Sacral Pressure - palm of hands or two fists at the sacrum (bottom of the spine), pushing down. Partner should use his or her body weight.
May take a little experimenting to find the precise best spot to apply pressure, but once you have it, your partner should put his or her full weight into it and sustain the pressure consistently throughout the contraction (unlike a massage, where you move around)
Another nice technique that can help relax the butt and pelvis, especially during early labor before contractions are intense or in between contractions, is to use a shawl to “shake the apple tree” - put a shawl around the hips and jiggle back and forth. This also just feels good towards the end of pregnancy
Worth practicing these moves once or twice before labor, so that there’s some familiarity before the more emotional real deal. Obviously it won’t feel as good when you don’t yet have the labor pain, but it will give your partner a sense.
Your partner must be in a comfortable position that they could potentially hold for many hours
Partners should avoid asking you too many questions (e.g. “does this feel okay?”) because it can be difficult to talk when you’re in the zone. Instead, look for body language and assume lack of response means to keep doing what you’re doing - she will tell you if she wants you to stop or change it, usually with curt one-word commands. Know not to take this personally, she is just in a more primal state where there isn’t room for niceties!
Unclenching and Changing Positions
If your partner observes you holding tension in any part of your body, especially your face, they should encourage you to relax it (either with words or gentle downward touch)
Releasing tension in the face can also release it in the rest of the body, encouraging the cervix to open up
If you’ve been laboring in a particular position for a long time, your partner should encourage you to try something new (say every 30 minutes or so). Shifts in movement can often help a stuck labor to progress.
You’ll want to move during the rest period between contractions.
It can feel scary and daunting to change positions but you can always go back
Standing, hand-and-knees, sitting, kneeling, and squatting are all great positions for allowing gravity to help bring baby down the pelvis
An exercise ball can help keep your pelvis open and be used for many different laboring positions and motions - rolling/rocking your hips, sitting and gently bouncing, kneeling and leaning over the ball (this may also prove useful later on for bouncing a fussy baby)
Partner Connection & Massage
The key hormone in labor is oxytocin, which is released when you feel love and connection. If labor is stalled, it can be helpful to try to amp up your natural oxytocin before jumping to Pitocin, which is synthetic oxytocin. Pleasant sensations can also help distract from painful ones.
Can be something as simple as holding your partner’s hand, having them kiss or stroke your face or hair, or any kind of touch that you love
Strong downward massage strokes, especially on sacrum and hips, can feel really good. You can try this while you are in child’s pose, or while you are standing and leaning against a wall.
Another stroke to try is a very light touch, where your partner sits behind you and uses the back of their fingernails to sweep gently along your back and arms, as if trying to induce goosebumps. This is thought to increase both oxytocin and endorphin levels.
Water, Heat and Electricity
Taking a warm bath or shower during labor can be extremely calming and reduce labor pain- evidence suggests it can shorten length of labor and decrease use of epidural anesthesia
Just like throughout your pregnancy, the temperature of the bath shouldn’t exceed 98 degrees
You can take a bath/shower at home during early labor, and/or at the hospital during more active labor since most hospitals have at least a shower
I am not suggesting you actually give birth in the tub, though some people do! (no data to support benefits of this, though)
Heat from an electric heating pad can also be very comforting on your back during labor
Some people find relief from electric simulation, particular in the lower back. TENS machine is a small device that uses electrodes to deliver low voltage electric current. You can find low cost options on Amazon, or look into renting a higher cost option from a local birth center (in SF, Natural Resources does rentals)
Shifting your Perspective
Every first-time pregnant mom feels some degree of fear and anxiety about childbirth pain - this is normal and understandable
The goal is to avoid getting trapped in what’s called the Fear-Tension-Pain cycle. This is a phenomenon where psychological fear can have very real physical consequences (tightening of muscles, shortening of breath, oxygen sent away from vital organs, decreases in oxytocin) that can actually increase the pain you experience and slow down labor. Mind/Body connection is real, people!
Many ways to combat this fear and decrease your suffering:
Education: Learning about what to expect in birth is a huge step towards diminishing fear. The fact that you are taking time now to read and think about these topics is already a step in that direction. Even just being familiar with the terminology that doctors might use will help make it less scary in the moment.
The IG account EmpoweredBirthProject has lots of birth content (including quite graphic) that can help normalize birth for you
Naming it: there’s a saying in mindfulness “if you can name it, you can tame it”. Talk with loved ones about what specifically you are most scared of - is it tearing? Needing a C-section? Feeling out of control? Fears about the health of the baby? This can be more productive than having a general amorphous fear swirling in your mind.
Common Humanity: childbirth - and all the emotions wrapped up in it - has been part of the human experience as long as there have been humans (duh! but also, crazy to think about!). It can be powerful to think about all the mothers who came before you, and all the ones right now, who are feeling the same excitement and fear. You might feel a little less alone that way.
Positivity: surround yourself with good vibes and examples of positive birth stories, not just horror stories. Think carefully about who you want with you in the L&D room - if you know that your mother runs anxious and may bring a fearful energy, may be unhelpful to have her there, as much as you love her.
Staying in the Present: Fear is often about the future (e.g. “How the f@ck am I going to keep doing this for hours longer?”), so trying to stay present-oriented during labor can help you take each contraction or push one-at-a-time. Try to just feel/observe the sensations you are experiencing without doing so much thinking about them (maybe even avoiding labeling them as “pain”).
Another concept that may be helpful here is to remember that labor pain is a unique type of pain. The differences are captured in the PAIN acronym:
P - Purposeful: the pain of each contraction is serving the purpose of bringing you closer and closer to meeting your baby
A - Anticipated: unlike the unexpected pain of illness or injury, this is pain you know is coming, even if you don’t know exactly when labor will begin or how it will feel
I - Intermittent: in between bursts of pain, you will have moments of almost complete relief and ease. It is really important to take advantage of these breaks between contractions and try to relax as deeply as possible. Some women are even able to sleep in between contractions in early labor, when they are farther apart.
N - Normal: part of what makes other experiences of pain scary is you may worry that there is something wrong with you, whereas with labor pain, it is a completely normal part of the process
