06 Nov Preparing your own pain management kit for labour

By Anchen Verster

Being confident and well prepared is a major key to coping with labour pain. The better you understand the process of birth the better you can prepare yourself. The better prepared you are the more confident you will be with what is happening with your body. Hospitals provide medicated pain relief but mainstream care usually does not provide many alternative options. Alternative options could give you hours of manageable labour without medicated intervention. You usually need to plan your own “tool bag” for this.

Birthing a baby is a little like running the Comrades, you need to be prepared in the following ways:

• Know the route
• Be physically prepared for endurance (well it helps)
• Know how you’ll cope with the pain
• Know how you’ll prevent dehydration
• Plan to prevent glucose drops
• Have a team supporting you on the side-lines

Each of these aspects will contribute to pain management. In this article we will deal with

“tools for coping with pain” but a good Prenatal Birth Preparation course will help you with a good understanding of how labour works, time frames and making sure you are fit and healthy as far as it is in your control.

Birthing couples often expect to have a staff member (midwife or nurse) present with them most of the time during the birth but this is not usually the case unless you have booked a private midwife or doula. It is thus imperative that the two of you have a plan on how to cope with the labour.

I’ll start with massage and touch.  You may be reading this and think to yourself, “I don’t like anyone touching me so we won’t make use of that”. However, once you are in labour the amount of Oxytocin hormone circulating in your body increases and one of its “effects” is that it makes you more open to touch. So – short end of the story – you may be quite comfortable with massage during labour even if you don’t want anyone to touch you now as you are reading this.

The first principle of massage is to always keep one hand on the body while using or lifting the other hand. It is a stabilizing factor and helps the body to relax faster with massage rather than having hands on and off the body, which is confusing and unsettling to the sensory system. So, for example, one hand on the shoulder while the other hand moves firmly down the spinal cord. Some manuscripts encourage moving up the spinal column but I find in practice moving down is more calming and works in the opposite direction to the pain messages being sent to the brain. You can use a hand or massage device or foam stress balls in a sock to provide warm and deep pressure down the spinal column or in circular motion on the back muscles or sacrum. Heads-up to partners – light, back and forth touch (like tickling or frivolous patting) increases pain sensation so your massage tools need to be firm, deep, confident pressure without hurting mom. Sometimes just still hand pressure is equally comforting like a warm hand on the shoulder or sacrum or upper outer thighs just below hipbone without any hand movement. Other than moving down the spinal column in rhythmic motion you can use foam stress balls on the back in circular motion. Alternatively, you can give a shoulder massage to relieve tension that has gathered there. 

TENS stands for “Transcutaneous electrical nerve stimulation”. If you decide to make use of this for pain management, you will usually need to hire your own machine. It consists of electrical pads, which you stick onto your lower back and then choose a frequency of electrical nerve stimulation. Mothers report that it is most useful in early labour but less useful in active phase when the labour becomes more intense. However, the more tools you have to draw on and try out the better for your coping. In later labour you could use it along with massage or heat packs or cold compresses. Remember you can’t use it while in the bath.

Pressure points have been used over the centuries to encourage pain relief and stimulate healthy hormone release and labour progression. There are multiple pressure points and an acupuncturist or reflexologist could teach you many of these to use in labour or even be present during the labour to help. Here are three to start with…

1. Applying deep pressure on the skin pad/ crease between thumb and index finger. It is on the highest point of the “fat bulge” that forms when you place your thumb parallel but below your index finger. You hold your hands out in front of you – thumbs facing roof and partner crosses their arms and grips “the bulge” between the pad of his thumb and bent index finger. Pressure is firm and sustained until contraction passes.

2. Pressure to the point between the clavicle and scapula on the shoulders. At this point the bones form the border of a little “V” and pressure can be placed on the inside at the base of the “V”

3. The sacrum has multiple pressure points but is also very richly supplied with nerves. During labour there is lots of activity here. This point is halfway between dimples above buttock and lumbar spine (or index finger length above beginning of buttock crease and one thumb width laterally). It is easier to use when the labouring mother is kneeling or leaning over the bed/ tray table or against a wall.

Water immersion is found by many labouring mothers to be extremely pain relieving. Moms say it makes the pain feel far away. The water shouldn’t be more than 37.5°C otherwise your blood pressure can drop and lower oxygen supply to the baby. You can try different positions in the water. If you do not have access to a bath, a warm shower to lower back is also very soothing. Most labour wards don’t allow you to lie in a bath once your waters have broken because of an increased risk of infection. If this is the case, you may still be allowed to kneel in the bath – on folded towels – and allow warm water to spray down your lower back as long as you are not submersed in water.

Heat or cold packs are also used successfully for pain relief. A microwavable beanbag can be used on sacrum or shoulders. If you prefer cold you can use a self-activating ice pack (wrapped in cloth so that you don’t damage skin). Alternatively take ice cubes with you in a cooler bag along with an empty plastic container like a yoghurt tub. Place a few ice cubes in tub and add water. Wet a face cloth in this water and squeeze out any excess water before placing on mom’s forehead or sacrum. Warn her before you place cold or hot items on her body so that she doesn’t get a fright. As soon as the cloth has absorbed heat from her body you can re-cool it again in the ice water.

Paced Breathing can be very helpful in coping with pain. If you use breathing techniques during your regular exercise class, you can use these during a contraction. Usually the cleansing breath (slowly in through nose and out through pursed lips) helps with early labour. When the pain becomes more intense you may want to employ a breathing technique that reminds you to relax your abdominal wall (slowly in through your nose and out through your mouth making an “F” sound but at the same time as your “F” you are relaxing your abdominal wall). If you watch your abdomen you should see it push out slightly as you relax the muscles. Our natural instinct is to double over or tighten muscles with pain. Given this you want to concentrate on relaxing your abdominal wall so that the uterus within can do its work.

Finally, when the “F” breath becomes too difficult to do and you can only manage short breathing bursts you can move over to the “light intercostal breathing”. To practice this, it’s most helpful to place your hands on either side of your rib-cage. Breathing in through your nose or mouth and – with each expiration, you make a groaning noise. The type of breathing is more shallow and slightly faster than the other two breathing types and is usually most suitable when you are roughly 8-10cm dilated. Be careful here not to hyper-ventilate. Keep the pace comfortable so that you do not feel dizzy or light-headed.

Pressure Scarf or sheet. This is based on the Mexican birth support technique called “Rebozo”. Rebozo is the word used for the original Mexican woven scarf used to employ this technique. It is said to help with pain management and could be helpful in shifting a baby who is in a less than ideal position. The scarf can be used to cradle your shoulders, pelvis, trunk or abdomen. We’ll focus here on the relief it can bring to the pelvic area. Let your partner wrap the scarf around your buttocks and cross the ends of the scarf in a twist or knot in front of your pelvis. By making the twist tighter he can place more firm pressure around your hips and buttocks and then grip the knot to rock you from side-to-side. If standing is too uncomfortable and you prefer to kneel on all fours your partner can sling the scarf over your buttocks and pull each side back and forth and so place pressure on your pelvis and sacrum.

Hip pressure. This two tool helps relieve pressure in the pelvis. It is imperative that partner follows mom’s cues on whether it is comfortable or not. If it is painful or uncomfortable it is probably not helping. The hip squeeze relieves pressure at the point of the symphysis pubis (pubic bone). It should be done firmly but gently and all the time hearing and seeing how mom responds. Slowly increase pressure instead of initial deep pressure. The pressure should come from your upper arms and elbows and not at the point of your hands or fingers.

These are just a few of the support tools you can take with you to the labour ward. It is ideal to practice these in the context of an antenatal class so that your technique can be adjusted and ‘perfected’.