Comfort Measures for Labour and Birth

The pain that is experienced during labour and birth is complex and very individual.¹³ It's physical, mental and emotional.¹³ There are a variety of coping measures you can use to manage the pain you experience during labour. Comfort measures do not involve the use of medications for pain relief. They allow you to have a better sense of control, and can result in a shorter labour with fewer medical interventions.¹³ This also provides the best foundation for breastfeeding to start out well.¹³ There is also no risk for you or your baby.¹³

Every person is different in how they will manage their labour pain. Your own response will depend on a number of things including: your individual coping style, your previous experiences with pain, how prepared you feel, how your labour unfolds, your goals and expectations and how supported you feel.

The following are non-medical ways to manage your pain during labour.

It’s important to explore a variety of comfort measures prior to your labour and birth to find out what you like and what might work best for you. You can practice some of these, such as; position changes, relaxation and Pam England's breath awareness² before labour begins. Involving your partner or other support persons in practicing these comfort measures will ensure that they are also familiar with how they can support you during your labour and birth.

Relaxation, Rhythm, and Ritual (3Rs)⁵

When you are supported to use childbirth educator, doula and author, Penny Simkin’s 3Rs - relaxation, rhythm and ritual throughout your labour, you will be more likely to cope well with labour pain. The following are key to healthy coping in labour and birth.

Relaxation:

Relaxation in labour is important and can be used in a number of ways throughout labour to help you cope well.¹³ Learn more from our relaxation webpage.

• Some people are relaxed between contractions and actively using rituals during contractions.
• Others may be active, walking or moving between contractions and relaxing during contractions.

• Some people focus inwardly and use relaxation both in between and during contractions.
• Use of Pam England's breath awareness² can be helpful.  
• Preparing a safe and relaxing birth environment is very important (i.e., quiet, dark, uninterrupted, use of a familiar focal point, music, calming scents).

Rhythm:

Penny describes how moving rhythmically calms the mind and allows you to work with your body. Examples of rhythmic movement:

• Breathing, moaning, or chanting in a rhythm
• Tapping or stroking something or someone rhythmically
• Rocking, swaying or slow dancing in rhythm

Ritual:

She describes a ritual as "the repetition of a meaningful rhythmic activity during contractions.”⁵(p. 207). They may develop spontaneously throughout your labour or may be adapted from early labour coping strategies as your labour progresses. Examples of rituals:

• Attention-focusing (i.e., counting, repeating a mantra or prayer)
• Vocalizing or moaning (releases feelings of tension). Vocalization often becomes a part of your coping rhythm and ritual.
• Rocking in a chair or on a birthing ball
• Swaying or slow dancing

Water⁴

Immersion in water offers effective relief from labour pain and reduces the need for epidural analgesia.^{3 13 14} People also felt more satisfied with their pain relief.¹⁴

• Take a bath/whirlpool and/or shower.
• Drink plenty of fluids if in the shower or bath for an extended period of time to prevent overheating.
• Make sure the water temperature is not greater than 37.5 degrees Celsius. This ensures your baby does not overheat.³

Water birth:

Benefits:

• Increased satisfaction with the birth experience^{15 17}
• Increased sense of control¹⁵
• Reduced pain perception^{15 17}
• Increase endorphin release¹⁷
• Enhanced relaxation^{15 17}
• Reduced need for medical pain relief¹⁷
• Allows ability to move and change positions¹⁵ leading to increased diameter of your pelvis¹⁷
• Shorter labour¹⁷
• Less perineal tearing and trauma¹⁷
• Less postpartum hemorrhage¹⁷

While water birth is a more familiar option internationally, in Canada not all healthcare providers or hospitals offer them. Within Ontario, midwives are the most skilled maternity care providers in supporting water births. It is safest when planned in advance with healthcare providers who are experienced with them. It's important for you to discuss the possibility of having a water birth well in advance of your birth with your healthcare provider if this is something that you are interested in. For more information go to: The Association of Ontario Midwives Water Birth.

Massage⁴

Massage and reassuring touch offers relief from both pain and anxiety^{3 12 13} and reduces the need for epidural analgesia.¹³ Touch can be a cue to release tension where you are touched. A support person comfortable with touch and/or massage can provide this for you. Practicing massage techniques during pregnancy has the added benefit of providing relief of discomforts during your pregnancy as well. Watch Midwife Jude’s Video Part 2 for comfort massage techniques.

• Hand, foot, shoulders, back
• Effleurage (light, gentle fingertip massage)
• Double hip squeeze
• Counter-pressure (tennis ball, pop can, etc.) on lower back

Rebozo

A rebozo is a traditional Mexican woven shawl.¹⁶ It has been used by Mexican midwives to bring comfort to individuals in pregnancy and during labour and birth for centuries.¹⁶ It is also used to wear their baby after birth.¹⁶ Rebozos can be used by you and your partner to foster relaxation, comfort, connection and strength throughout labour and birth.¹⁶ A large scarf, sheet of other piece of fabric can be substituted if you don’t own a rebozo.¹⁶ Initial research has shown that this is a promising way to provide comfort and pain relief⁹ and possibly enhance labour progress^{9 10 16}. For more information about using a rebozo, discuss it with your midwife or doula. Watch Midwife Jude’s Videos Part 3 for Rebozo techniques.

Listening to Music

• Listening to music can help reduce the sensation and distress of labour pain³ and help you relax and cope with the pain.^{12 13}
• Prepare a music selection prior to labour, including a variety of soft and slow music, classical music, and other sounds such as ocean waves, which have been shown to have a relaxing effect.
• Ear buds may allow you to be able to focus on the music and block out other sounds from your environment.

Warm or Cold⁴

Warmth¹² and cold may offer relief from labour pain.¹³ Try using the following:

• Warm compresses on lower abdomen
• Warm or cold packs on lower back
• Warm compresses on your perineum (area between vagina and rectum) during pushing ¹²
• Cool washcloth on forehead

Movement and Position Changes⁴

• Movement during labour and being in upright positions:
• eases labour pain,
• helps you have more effective contractions,
• decreases the length of labour, and
• reduces the need for epidural analgesia.¹³
• Try different positions during labour and birth.¹² Listen to your body and move according to what provides you the most relief. These positions may help your labour progress as they allow your baby and pelvis to line up in the best position for birth. Narrow your knees during pushing to increase the space in your pelvic outlet.
• A birthing ball (exercise ball) can be a very useful tool to help you find positions and movements that are more comfortable during labour. A peanut ball can also help to widen the pelvis to allow the baby to descend if you are restricted to bed.
• Gail Tully at Spinning Babies, offers some great resources about the baby's position and ways you can move to facilitate the baby being in the best position for birth.

Eating and Drinking

Eating to your hunger and drinking to your thirst is important throughout your labour to keep yourself hydrated and to have the energy your body needs for the work of labour and birth. ^{6 11 12 13}

• In early labour you can eat anything that you would like to eat. Listen to what your body needs.
• As labour becomes more intense, you may prefer soups/broths or small light snacks.
• Drink to your thirst throughout your labour. It’s important not to become dehydrated. As labour becomes more intense, you may prefer to suck on ice cubes or popsicles in between contractions.

Pain Relieving Measures Specifically for Back Pain⁴

For back pain in labour, some of the following measures may provide relief: 

• Positions that are forward leaning, such as, hands and knees, open knee chest position or leaning forward over the bed or head of the bed
• Side lunges
• Stair climbing
• Shower/tub
• Double hip squeeze
• Counter-pressure (tennis ball, pop can, etc.) on lower back
• Warm or cold packs on lower back
• Intracutaneous Sterile Water Injection (see below)
• Transcutaneous Electrical Nerve Stimulation (TENS) (see below)

Intracutaneous Sterile Water (ISW) Injection

• Involves injecting small amounts of sterile water into 4 spots just under the skin on the lower back, two on either side of the spine, and two just above your bottom. This forms 4 blisters.¹³
• It creates an irritation in another area of the body that competes for the nerve pathways to the brain with the labour pain resulting in less labour pain being perceived. It may also act by causing the release of endorphins, the body’s natural painkillers.¹³
• The effect of sterile water injections lasts about one to two hours, but the injections can be repeated when the effect wears off.¹³

Transcutaneous Electrical Nerve Stimulation (TENS)

• Consists of a battery-powered stimulator, lead wires, and four electrodes which are applied to the skin on the back. Two of the pads are placed on either side of your spine at about bra-strap level. The other two are placed down lower on your back, at about the level of the dimples in your bottom.
• By adjusting control knobs on the stimulator, you can start or stop the electrical impulses. You can also vary the rate and strength of the electrical impulses.
• The weak electrical current passes through the skin to muscles to stimulate these nerves. This creates an irritation in another area of the body that competes for the nerve pathways to the brain with the labour pain, resulting in less labour pain being perceived. It may also act by causing the release of endorphins, the body’s natural painkillers.¹³
• Research has shown that there is only limited evidence of pain relief in labour. There is also no evidence of harm to you or your baby. ⁸
• Units are available for purchase/rent through physiotherapy supply stores and some pharmacies. Instructions should be provided. You will need to bring the TENS unit with you to hospital and be knowledgeable in its use prior to labour. TENS units are NOT available at the hospital as staff are not trained to use them.