Pain Management in Labor

        Culturally, the number one concern of most women who are pregnant is the pain associated with childbirth. As a result, most women plan to use epidurals without considering the potential risks or alternatives. Although research has shown that a woman's sense of control during labor is a greater indicator of satisfaction than pain levels, coping strategies can help a woman feel more in control as well as decrease her perception of pain.

        As a ‘birth doula’, I support women and their families emotionally, physically, and informationally support during pregnancy, birth, and immediate postpartum. All of these seasons can cause varying levels of discomfort to women and I work to lessen the discomfort a mother experiences. By understanding how we perceive, process, and regulate pain, I can assist women by providing practical tools to alleviate pain.

       As I dove into this topic to prepare for this article, I realized that there are actually quite a few pain theories, but the two main pain theories utilized for the purposes I mentioned above are the Gate Control Theory and the Fear-Tension-Pain Cycle. The Gate Control Pain Theory essentially claims you can “outrace” the pain signals being sent to your brain by introducing alternative stimuli. This is often exploited with massage or effleurage, even outside of childbirth. During childbirth, you can also utilize counterpressure, warmth, water, and movement. You can also hold combs as an independent measure or address other senses, such as scent, flavor, or sound. Sometimes you can combine a few, like sucking on a dum-dum or applying a scented warm compress to your forehead. The Fear-Tension-Pain cycle hypothesizes that fear in the body causes the body to tense, which in turn causes cortisol (or stress hormones) to rise. This rise in cortisol counteracts oxytocin (the hormone that causes contractions) and also increases sensations of pain. The perception of pain then leads to more fear, and the cycle has the ability to escalate, causing the birthing mother to lose control due to the fear of pain, over the pain itself. A third theory is Descending Noxious Inhibitory Control, or DNIC. This theory hypothesizes that a heightened sensation anywhere on the body can dampen the mind’s perception of pain in other areas. It’s almost like your body is “turning down the volume” on all physical sensation perceptions. This is proposed as one reason why acupuncture, among other practices and modalities, may be so effective. A friend in a Bradley Method childbirth education class mentioned that her instructor had her use an ice pack on varying parts of the body to practice 1) breathing through intense sensations and 2) to practice for utilizing the DNIC method during labor.

        Utilizing understanding of these theories, we can introduce tools and techniques that help alleviate pain. Using the Gate Control theory of pain, you can apply massage, effleurage, heat, TENS unit or counterpressure to the belly and/or back. Utilizing understanding of the DNIC theory of pain, you can apply a cold compress to your body or utilize sterile water injections. Utilizing understanding of the Fear-Tension-Pain cycle, you can educate and have a calming, receptive, and supportive birth team present to assure you that the sensations are normal and you can relax through them. Staying calm and relaxed is really the best thing you can do in labor overall to allow your body’s natural mechanisms to work best and be able to stay mentally in control of the situation.

        In order to stay calm, it’s important that the mother be coping with pain, and not suffering through it. This distinction was initially made by Penny Simkin, an incredibly experienced doula who has her own books, website, and Youtube channel. Coping means that you’re mentally calm, able to relax between contractions, and trust your body through the labor process. Suffering is when the pain is so great that you’re internally or externally panicking, not feeling in control, and not able to relax. Women should never suffer through their labor. If a woman finds that she is suffering, additional choices should be offered to her, both medical and non-medical, until she feels restored to a calm and safe place physically and mentally.

       Not all coping mechanisms or techniques rely on the pain theories discussed specifically. Fostering a calm and comforting environment for the birthing mother goes a long way in her ability to cope well with labor itself. Dim lights, quiet music, calming candles, a comfortable room temperature, and the option for water therapy in the form or a tub or shower can help tremendously. Being surrounded by supportive family members, dear friends, and trusted members of the birth team (OB, midwife, and/or doula) also makes a huge difference. Being mindful of this during pregnancy and hand-selecting this supportive group can bring a lot of peace leading up to the big day.

    In addition to those already discussed, women can utilize hypnosis and meditation. Some women are frightened by or skeptical of these terms, but many women find great success utilizing tools like Hypnobirthing. We often experience this “altered state of mind” when we “zone out” while driving home or day dreaming, so it isn’t as uncommon or odd as we might think. In a similar vein, women can utilize visualization or imagery (like imagining contractions as waves or likening it to climbing up and down a hill). Having a focal point (real, like an ultrasound picture, or imagined, like an opening flower) can also be helpful. Having affirmation or prayer cards may help to redirect thoughts or have something to chant/focus on during the harder moments of labor. In general, finding what works organically and settling in to her own unique rhythm can really contribute to coping well with contractions. When this rhythm begins to falter in alleviating pain as needed, other methods can be introduced by your birth team until a new effective routine can be established. Even breathing patterns and techniques may be helpful to achieve calm through the peak of contractions and discomfort. Many of these techniques can be practiced during pregnancy to make them more familiar and easier to execute at the onset of labor.

       Some women may be planning on an epidural and feel there is no need to know these techniques. Although that may be the case, certain factors and unknowns in the hospital environment or the birth process itself may make these tools valuable. For instance, if birth comes on suddenly and it takes longer than expected to get to the hospital, or if you purposely choose to delay going to the hospital to avoid unnecessary interventions, it may be helpful to use these techniques at home. If you get to the hospital quickly but it takes longer than expected to have the epidural administered, or if the epidural is partially or completely ineffective (which happens in up to 15% of cases), these techniques may be super helpful. Of course, if a birthing mother is planning to avoid intervention or medicated pain relief completely, these techniques may be essential to coping with contractions.

         Even after delivering a baby, sometimes there may be pain during postpartum in the form of a cesarean scar or postpartum cramping (typically more common with moms who have delivered previously). These tools may be helpful when these discomforts are more intense. After the immediate postpartum stage, these tools may be helpful during more fleeting moments of pain for yourself or others, or even when your baby gets older and has a scraped knee. For example, there’s someone in my life who struggles with injury-induced panic attacks and I have utilized many of these tools to help them cope with and overcome pain of varying intensity.

         As universally valuable as all this information may be, it can be intimidating to learn or memorize in preparation for labor, especially for a first-time mom. Fortunately, most doulas come equipped with this information and make an excellent addition to your birth team if you want and are able to hire one. If that option doesn’t work well for you, I highly recommend taking an in-depth class to help guide your learning. To make this information as digestible and accessible as possible to my immediate communtiy, I have recently released my DIY Doula Bag, which comes with nearly all of the tools I keep in my own doula bag, explanations on the techniques I use, and it includes FREE access to my pain management class ‘Managing Labor’s Intensity’. This class consolidates all the information I have gathered over the years and bring with me to every birth I support. Additionally, through the month of March, the first three people to purchase this bag will receive 10% off with the code COPEWELL. Once you’ve placed your purchase, I’ll reach out and set up a time with you to get together for the class and answer any questions you have about how to cope well on the big day! If you’d prefer, you can just take the class, which can be found here, or take my whole education series, which can be found here.

         If you have any other questions on anything discussed here or are looking for additional resources, please don’t hesitate to reach out! Helping families prepare for birth and beyond is my greatest passion and I’d love the opportunity to connect with you. Truly, you already have everything you need to bring your baby earthside in a beautiful and powerful way, but it’s a gift to be able to remind you in whatever ways I can.

All the beautiful, birth-y blessings, my loves!
Autumn Baker

'Managing Labor's Intensity' Class

$75.00

Available in-person and virtually; instructor will confirm format and location after purchase

Topics Covered:

• Benefits and Risks of Medicated Labor
• Statistics on Cesarean Births
• Explanation of Pain Theories
• Utilizing Knowledge of Pain Theories
• Difference Between Coping and Suffering
• How to Labor Alone
• Therapies to Make Labor Easier
• Techniques and Tools to Prepare for Labor During Pregnancy
• Techniques and Tools to Cope with Pain During Labor

My classes are based on 10 years of immense independent study and observation of the perinatal season as a student, as a mother, and as a doula. I am constantly adding more to this series as I earn my CBE certification and complete additional specialized courses. At the end of every class, references and resources are sent out for additional research. Informational support on additional topics may be provided upon request.

The Full Childbirth Education Series can be purchased here.

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Doula Delivered: Birth Support Kit

$200.00 - $350.00

Sold out

I believe every birthing mother deserves doula care, but sometimes funds, hospital policies, or privacy preferences can limit the availability of that option.

To bring support to as many women as possible, I am now offering my knowledge and experience as a mom and a doula in a condensed, easy-to-use format with the Doula Delivered: Birth Support Kit to bring grace and peace during the peaks.

Choose between the BASIC and DELUXE packages.

The BASIC kit comes with all items listed:

(Items included only in the DELUXE package are underlined and italicized)

Pain Relief Tools:

-Scalp Massager

-Body Massager

-Lotion

-Combs

-Rebozo

-Peanut Ball

-Reusable Heat/Cold Packs

-TENS unit

Comfort Items:

-Battery-operated Candles

-Essential Oils

-Hand Fan

-Lollipops

-Broth Packets

-Birth Affirmation Cards

Education:

-'Quick Reference' Guide

• Quick summaries included about how to use each item and different techniques to utilize during labor come in a handy guide to reference on the big day.

-'Ina May Gaskin's Guide to Childbirth' Book

• I read this book before my first birth and it powerfully changed my perspective of childbirth. I include it with this kit because I believe your mindset and view of birth will be positively affected by reading it and will lead to a more joyful birth experience overall.

-'Managing Labor's Intensity' Pain Management Virtual Class INCLUDED

• In this pre-recorded class, I teach you how to use all the tools listed above for a more empowered, more comfortable birth experience. ($70 value - FREE with DELUXE kit)

*Subject to availability of all items. I reserve the right to substitute items if an item is out of stock. I will always do my best to substitute with the most comparable item available.

Shipped via USPS. Price includes shipping for the lower 48 states. Although usually shipped 1-2 weeks, please allow 2-4 weeks shipping time in light of shipping delays and availability of contents within.

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Full Childbirth Education Series - Private Classes

$500.00

Available virtually; instructor will reach out to schedule dates after purchase

Full Series Includes the Following Classes:

• Understanding and Supporting a Healthy Pregnancy
• The Stages of Childbirth
• Managing Labor's Intensity
• Postpartum: Making Time for Healing
• The Basics of Breastfeeding
• The Basics of Newborn Care
• Developing Birth Preferences
• Birth Plan Development

Courses can also be purchased separately here.

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