Informing yourself and opting for natural methods of pain relief during labour makes so much sense.
After having spent so much time during pregnancy agonising over only being allowed paracetamol when you are sick, there is a smorgasbord offered to you when you are in labour!
It's still really important to carefully consider medications during labour. This is because when a baby is exposed to drugs, for example pethidine (which is a narcotic and crosses the placenta freely), a baby requires so much longer to eliminate the drugs from it’s system than a fully grown adult.
Norpethidine (an active metabolite of pethidine) can accumulate in both mother and baby, and it has a half-life of around 20.5 hours! Some other studies report even longer. This can be detrimental to respiration and breastfeeding attachment.
Some pregnant women freak out after having seen scary birth DVDs during prenatal classes, or perhaps it's just the usual run of the mill of horror stories which most pregnant women (and their partners) are subjected to these days.
Rest assured, with some good support and tools, labour doesn’t have to be like that at all.
Below are some known and proven ways to help relieve pain in labour. Having these things tucked away in your labour arsenal may help you during your labour and perhaps get you through without the need for any pharmaceutical pain relief.
Natural Pain Relief Option #1: Doulas
“I found one of the best forms of pain relief during labour was definitely our doula. Whilst I may have had different techniques to help me through labour pains, my doula was the one who helped me to find the best method of drug free relief for the stage of birth I was at. The support she offered throughout also helped me to stay focused which in itself is pain relief, as stress only leads to pain and she was able to help me keep calm.”
According to many studies, women who use doulas have fewer requests for epidurals, fewer caesarean sections and are less likely to require forceps or vacuum births (amongst many other things). In a recent review of all available doula studies, it was concluded that doulas were more effective at supporting a woman than hospital staff or the woman’s friends or family. This is because she provides a trifecta of continuous (doesn’t leave your side), experienced care and is known to the woman – no other person present in the birth room can usually provide all three.
Having a doula present at your birth will make it less likely that you’ll want or ask for pharmaceutical pain relief. A doula is trained in the art of birth support, where she learns about helpful positions, support methods and tools to help labouring women feel more comfortable and feel more supported.
To read more about doulas.
Natural Pain Relief Option #2: Water
“I would have to say hot showers running on the lower back was my favourite during labour, I can’t recommend it enough! I had 6 or so showers and didn’t want to get out but, I was worried about water usage, because they had a sign up in the shower. Next time, i’m not getting out!”
Water immersion in labour offers significant benefits for the labouring woman, including pain relief, relaxation and comfort. According to a Cochrane database review:
“Water immersion during the first stage of labour significantly reduces epidural/spinal analgesia requirements and reported maternal pain, without adversely affecting labour duration, operative delivery rates, or neonatal wellbeing. Immersion in water during the second stage of labour increased women’s reported satisfaction with pushing.”
The first stage of labour is the contractions prior to pushing – pushing is second stage. Most midwives and birth attendants will recommend getting into the bath once you are in active labour, as being in a bath creates buoyancy and you want to work with gravity in early labour to make sure the labour isn’t going to stall.
Showers are also great, as you can remain upright and direct the shower head at your lower back if you have back pain. Even if you think you aren’t a shower person, in labour, many women choose to use the shower and some spend a great deal of their labours under the shower.
There are also many benefits for babies born in water. Andrew Davidson is an Obstetrician at John Flynn Hospital in Queensland who says that around 40% of women at the hospital use water immersion for labour. Birth satisfaction amongst those who waterbirth is very high.
He states: “There is a much reduced usage of analgesia in the waterbirth group with no epidurals, very few women using narcotics, while about half use nitrous oxide (gas). Waterborn babies tend to breathe quietly at first rather than cry but in our experience do not have lower Apgars or require more resuscitation.”
For more information on waterbirth, Janet Balaskas has a great book, ‘The Water Birth Book.’ Sadly not many hospitals offer waterbirth so you need to do your research. Mainly birth centres offer this option, or you can waterbirth at home with your own midwife.
“My absolute fave (natural pain relief method) is the bath – instant relief. I won’t ever birth out of one again.”
“For me it was being in the shower, not just because the warm water helps with physical pain but also from a psychological perspective being a hot shower always makes me feel safer and more relaxed. Even when I’m not in labour it’s great stress relief.”
“The bath helped me the most, especially because I had a posterior (backache) labour. I had all the pain in my back as well as my tummy. So having my belly and back submerged in the warm water really helped a lot.”
Natural Pain Relief Option #3: Calmbirthing/HypnoBirthing
Learning how to relax is so important in labour, otherwise you end up in the vicious cycle of fear → tension → pain. When you tense up and get tight (which is a natural reaction to any sort of pain) it actually makes that pain worse.
With Calmbirth, you learn:
- To access your natural inner resources to alleviate the fear, anxiety and tension experienced during pregnancy, labour and childbirth
- Practical skills of relaxation, breathing and visualisation which are used during pregnancy, labour, childbirth and beyond
- How the mother’s body is beautifully designed to birth her baby naturally and calmly and with the right preparation, to work with the process rather than resist it
- The importance of a mother’s beliefs and attitudes about birth and how these can be one of the major differences between a positive or negative birth experience
- The importance of bonding with your baby and how this effects your baby's future life
- To be empowered to take control of your own birthing experience
Calmbirthing is an Australian method similar to the American HypnoBirthing method. For more information, visit the Calmbirth website.
Natural Pain Relief Option #4: Changing Position
“Sitting on the toilet seemed to be quite comfortable which eased my pain… as I felt more relaxed.”
Being comfortable in labour is of course going to make a huge difference in your pain tolerance. The worst position for pain during labour (and the most dysfunctional) is lying flat on your back in bed, next is semi-reclining.
Mobility is important in labour, as is position changes, especially when you are working with gravity and your body. Upright, forward leaning positions are ideal, as when your uterus contracts, it actually contracts forward. Many unrestricted women naturally lean forward with contractions. Therefore working with your body and the surges of contractions is going to be more effective and efficient, resulting in less pain for the labouring woman.
“Given my quick labours and no time for bath showers etc, the number one thing during labour was position – on my knees leaning forward with legs spread. But the very best pain relief of all was holding my baby at the end!”
For more information on active birth, check out Janet Balaskas’ book, New Active Birth.
Natural Pain Relief Option #5: Naturopathy
If you visit a naturopath before your birth, they may be able to provide some natural pain relief preparations for you, which are safe while pregnant and breastfeeding. You can get some preparations over the counter from your pharmacy, for example, Rescue Remedy, however a tailored preparation just for you is ideal.
Natural Pain Relief Option #6: Massage / Pressure
You don’t need to be a professional to provide massage in labour – loving, nurturing strokes and massage on a woman’s body in labour is all you need to provide.
Some studies have been done on pain relief and massage. One of the studies involved massage conducted by the woman’s partner. They found that the woman’s anxiety and pain was reduced and her mood improved. Another concluded that massage was a cost-effective option that could be implemented by midwives. Women perceived a reduction in their pain and anxiety levels, and found with partner involvement, they had a more positive birth experience. Yet another concluded that women who were massaged during labour were less anxious, experienced less pain, had shorter labours and experienced less postnatal depression, opposed to the control group of women who did not receive massage.
Massage can be performed by your partner or a doula, but often midwives are too busy to perform massage, so plan for your partner or a support person to do the massage.
Massage stimulates the production of endorphins which are natural pain killers and mood enhancers. In labour, massage can be given on the shoulders, head, back, feet, legs and hands. If you buy oils for massage, make sure you check that the essential oils are safe in labour. Some essential oils need to be avoided. It’s best to buy a base carrier oil, like avocado, grapeseed or almond oil and add safe oils to it if you wish. Some oils safe in labour include lavender (relaxing), geranium (relaxing), orange (uplifiting, refreshing), clary sage (strengthen contractions), but please do check the correct doses with someone who is trained in aromatherapy.
It’s important to note that some women will not like touch or massage during specific times in their labour or at all, so it’s important to plan other options for natural pain relief as well as massage. Don’t be put off if she doesn’t want to be touched and don’t be afraid of offering again if you think she would like it. Observe her movements – does she have her hand on her back, does her back ache? Is she rubbing her legs? Maybe you could do this for her.
Women with lower back pain often get more relief from pressure (press your palms into her lower back, quite firmly). Even if she doesn’t like massage, she can enjoy this quite a bit.
Another helpful tip with backache is to have the woman sitting back in a chair and her partner or a support person pushing into her knees with their hands. You really need two people to do this as a tag team or with one knee each – women often find it so helpful with lower back pain that they don’t want you to stop, and the person pushing the knees can get very sore wrists – take it from someone who thought their wrists were going to fall off!
Natural Pain Relief Option #7: Environment
The environment in which a woman gives birth can help with relaxation, hence pain relief and comfort.
- Turn the lights off or down. Help her instinctive brain kick in and her thinking brain turn off. Darkness helps with this.
- Bring familiar objects from home if in hospital, like pillows, blankets and other things that have her smell on it – the smells of familiarity, safety and home.
- Music – favourite CD’s for different moods are great, from uplifting to soothing sounds, music can groove some pain away!
- Keep it quiet. Avoid talking unnecessarily when things get serious and asking her lots of questions – her thinking brain is trying to shut down to let the instinctive part of her brain take control, hence why women can appear vague and unable to know what they want in labour. Humour can be great when appropriate, for example early labour, but it’s important not to keep engaging her thinking brain when she’s in strong labour. Encourage others to keep voices down and increase touch and encouraging words when needed.
Natural Pain Relief Option #8: Heat Pack
Another option for sore backs – a wheat pack or another form of heat pack is a great non-pharmaceutical alternative. If you are giving birth in a hospital, be sure to check the policy on heat packs, because some no longer allow you to heat up wheat packs in microwaves due to potential fires (yes it has happened before!). So you may need to choose a non-wheat heat pack, for example the gel ones which heat up in hot water, or you could find out what the hospital suggests.
Heat packs are also great post-natally for after birth pains, while the uterus contracts down to it’s normal size – which happens in only a few days – so it works hard!
Natural Pain Relief Option #9: Aromatherapy
Aromatherapy in labour has many great uses. If you are giving birth in hospital, it can provide a nice smell to mask the smell of the hospital, enabling you to relax a little more. While some essential oils are not advised during pregnancy and labour, it is perfectly safe to burn any oil in your burner. You might like to choose some oils suggested in the massage section above.
A point about oil burners – check to see if your hospital has one, as they will not allow you to bring in your own in case of an electrical fault and you blow up the electrical system! Naked flames are also not allowed, so you can’t bring your own oil burners that evaporate with a candle. Your options are usually a battery operated one, which I am yet to find, or a hospital one. You could always ask if it will be okay to use your own if you get your unit electrical tested.
Natural Pain Relief Option #10: Sterile Water Injections
For some women, back pain in labour (usually caused by a posterior positioned baby – where the baby’s back is against your back) is much more challenging to manage. Intradermal injections of sterile water provides a non-pharmacological pain relief option.
A small amount of sterile water is injected in four places just under the skin that covers the sacrum, the lower part of the back. Its thought that the sterile water injections stimulate the nerves which quickly send messages to the brain and interrupt the slower messages from inside the body – this has been called the ‘gate control’ theory of pain management.
Intradermal injections of sterile water have been found to stop backache for over 90% of women. For those women it works for, the relief has been immediate. The catch is that it is quite painful. It has a sharp, wasp like sting, which lasts about 20 seconds, however the vast majority of women who experienced severe backpain reported that it’s worth the sting and likely prevented them for opting for an epidural.
Sterile water injections is still fairly new and midwives need to be specially trained to use it – so you will need to check before the birth if this option is available to you. You might even suggest that they look into it if they don’t have that option. For more information, check out our article on sterile water injections.
Natural Pain Relief Option #11: TENS
A TENS machine works by attaching two strips of electrodes on your lower back – one on either side of your spine. These connect to a hand-held battery powered unit, which allows you to control the strength of the electrical impulses. The way it apparently works is that the impulses send a signal to the brain where they compete with pain impulses from the uterus, helping to block the pain.
TENS machines do help some women to cope with early contractions, but it’s effectiveness really does vary greatly from woman to woman. Feedback from both studies and by consensus from women give mixed results. Some women find TENS to be no help at all, and some swear by them. The few clients I have supported who have chosen to use TENS gave it a go until they got into water, then took it off and didn’t bother putting it back. Yet on the other hand some women I have heard from say they couldn’t have coped without it.
It is important to get some instruction on how to use TENS before labour – often places who hire out the machines do have TENS classes so if you choose to use TENS in labour, make sure you book yourself in for some lessons.
Pros Using A TENS Machine:
- You can use it from the very start of labour
- It can be used anywhere – at home, in the car or in hospital
- You can remain mobile
- Can be used with other forms of pain relief except back massage or water (shower, bath)
- Self administered and controlled
- Some women find it particularly helpful with back labour (posterior babies)
- Can be used post-birth
Cons Using A TENS Machine:
- It’s not as effective for strong labour as massage or loving care from a doula or privately-hired midwife
- You need to start using it very early in your labour to get the most out of it
- It makes you focus on the early stages of labour when it’s better to play it down and ignore it
- You cannot use it and need to take it off while being monitored, in the shower or in the bath
- You need to press the button to turn it on before each contraction, so you are effectively sitting there waiting for a contraction coming on
- It doesn’t work for all women
- Some women feel that the wires are distracting in labour
- Not to be used on broken or irritated skin
Natural Pain Relief Option #12: Keep Hydrated and Eat If Hungry
Midwife, Brenda Manning, suggests: “If you don’t think you will remember, ask your partner to remind you to drink at least 300mls of water every couple of hours to avoid dehydration, which can result in fatigue and a poorly functioning uterus. Eating and drinking during labour has been shown to reduce the total length of labour by as much as 90 minutes. Eat light, easily digested food.”
Natural Pain Relief Option #13: Acupuncture
Studies have shown that acupuncture is effective for all sorts of pain relief. In China, acupuncturists work in hospitals and provide acupuncture for patients. However in Australia (and many other western countries) no such thing exists. Some hospitals are receptive to Chinese medicine professionals treating patients (as long as you hire your own) but if you’re giving birth at home this obviously isn’t an issue.
During my client’s labours, I have worked with a good friend of mine who has helped my clients with lower back pain, labours which were slow to establish and doctors were pushing for pharmaceutical inductions, back labour (posterior babies), post birth cramping, post birth bleeding and more. My clients have been very happy with the results.
If you have a trusted acupuncturist or can locate one (make sure they specialise in fertility/pregnancy/birth, some of which have done extra training courses) then you might like to ask them if they’d be open to coming to your birth, making sure that the hospital would allow it.