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!
'Managing Labor's Intensity' Class
Available in-person and virtually; instructor will confirm format and location after purchase
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.
DIY Doula Bag
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 many of my tips and tricks in a 'DIY Doula Bag' to bring "Grace and Peace During the Peaks".
This kit comes with*:
Pain Relief Tools:
-Reusable Heat/Cold Packs
-'Quick Reference' Guide
-'Ina May Gaskin's Guide to Childbirth' Book
-'Managing Labor's Intensity' Pain Management Virtual Class INCLUDED
*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.
Full Childbirth Education Series - Private Classes
Available virtually; instructor will reach out to schedule dates after purchase
Full Series Includes the Following Classes:
Courses can also be purchased separately here.
As a labor doula, also known as a birth doula, I support women in their pregnany, birth, and immediate postpartum with physical, emotional, and informational support. Although I am not a medical professional who can oversee your entire pregnancy and birth, I do work alongside your care team to suggest physical therapies, positions, and exercises to alleviate discomfort and support labor goals. I am hired directly by the mom and/or birth family so I have no competing allegiances to providers or birth settings. I also serve as a validating and steadfast presence continuously in labor. I am on-call through the last month of pregnancy so that I am able to quickly join mom when she goes into labor and stay through the duration of her birth. A key aspect of the assistance I provide is the informational support. I am available to help my clients discover what their options are during these seasons as well as the risks and benefits associated with those options.
In order to form a solid foundation of knowledge on these topics from which to explore related options, some women opt to take childbirth education classes with me during their pregnancy. I have a 16 hour class series that covers everything from the beginning of pregnancy to the basics of newborn care, as well as studying birth options and learning how to share and advocate for birth preferences. If women choose not to take the full course with me, I still meet with them a few times before birth to answer any questions, help them to develop birth preferences, and discover how best to share them, such as through a birth plan.
‘Birth plans’ have been birthed from necessity. Unfortunately, much of modern maternity care in the US is riddled with policies and procedures that are, at best, unnecessary, and at worst, actually harmful to mom or baby. A birth plan is the result of a family researching their options, making choices based on evidence and personal preference, and sharing those with their birth team. They come in many formats, but I typically recommend keeping them to one page, attaching the mom and partner’s names and a picture (since nurses often have many patients and may be keeping track of multiple birth plans), and utilizing visual cues to make it easy for their providers to reference. I actually offer birth plan building as an individual service for clients who want help researching their options but don’t want full doula support or childbirth education. A birth plan can be used with or without additional birth support (like a doula), but whoever is on your birth team (partner and/or provider) should be familiar with your choices before birth and be willing to advocate for them during labor and delivery.
Many women default to doing what their friends or family chose during these seasons, but it’s important that they know what other options are available to them, even if they don’t choose them. One of the first options a woman has when she discovers she’s pregnant is the type of provider she’d like to see for her perinatal care and what type of birth setting she prefers. There are two options for care providers, a midwife or an obstetrician (OB or OBGYN). A midwife is a licensed medical professional who is trained only is overseeing low-risk women during pregnancy, birth, and postpartum. They typically have a more holistic view and try to minimize interventions (like unnecessary testing during pregnancy or interventions during birth). They may offer care and deliver in your home, at a birth center, or in a hospital setting. An obstetrician is the OBGYN you are probably most familiar with. They are a licensed medical professional capable of performing surgery and specializing in overseeing and treating ‘high-risk’ pregnancy, birth, and postpartum periods. They are the most common type of provider in the US and almost always deliver in a hospital. These professionals are typically more likely to encourage and utilize interventions.
As a woman is selecting her provider, there are some questions she should ask herself to evaluate if the provider is the right fit for her. The most important thing a woman should ask herself is, “Do I trust this provider?”
Some other questions that may be helpful to ask are:
- “Does their demeanor and level of care make me feel safe?
- Do I agree with their view of pregnancy and childbirth?
- Do I feel this provider really listens to my wants and needs?
- Has this provider ever laughed at or otherwise belittled my questions, wants, or needs?
- Do I feel rushed or flustered at appointments?
- Does this provider take time to educate me about my choices?
- Does this provider value consent?
- Do they ask for my permission before touching me or performing a procedure on my body?”
Women should ask themselves these questions after each appointment! If they ever feel unsafe or if they ever loose their trust in their provider, they should find a new one! It is NEVER too late to switch providers. Even during delivery, you can ask for a new nurse OR doctor OR midwife if they performed an intervention against your will or otherwise made you feel unsafe.
Once she has selected her provider, she should begin exploring other topics that will be important during pregnancy, birth, and beyond. A great way to start the exploring her options is to take a childbirth class, particularly one offered by an independent provider because they will be able to offer information on the variety of ideologies and tools available. From there, she can begin researching and developing options for interventions in birth, as well as nutrition requirements through these seasons, exercise options before and after birth, alternative therapies like chiropractic and acupuncture to help with common pregnancy ailments, postpartum care and support plans, coping strategies for labor and intervention choices during the birth, types of pushing strategies, parenting and infant care options, car seat safety information, just to name a few.
As she is exploring birth options specifically, it’s important that she familiarize herself with the name and evidence behind common hospital procedures during birth, often called ‘interventions’. Interventions are any measure, tool, or procedure during birth that exists outside of what is considered ‘unhindered’ and ‘unmedicated’ physiologic birth. Most of the time, a woman’s body is capable of birthing her baby on it’s own with little, if any, intervention. Her body can cause it’s own contractions, offer it’s own pain relief, and instinctively move and position itself to optimize this process. Interventions should ALWAYS be optional. Just because it is “standard of care” in your hospital, does not mean you are REQUIRED to accept it. It is your body, your baby, and your care. Optional interventions include an utilizing an IV for hydration (as opposed to hydrating normally), utilizing pitocin (as opposed to progressing biologically or utilizing other tools), utilizing continuous fetal monitoring (as opposed to intermittent or handheld fetal monitoring), performing artificial rupture of membranes (your provider breaking your water), performing cervical checks (unnecessary, not evidence-based, and may increase risk of infection), delivering by vacuum or forceps (position changes or tug-of-war may be used instead).
An intervention may become necessary when a woman requests it for her care or there is medical indication that she has agreed deems it necessary. One way she can evaluate if an intervention is necessary is to utilize the BRAIN tool, which is a mnemonic device that helps you remember some key questions you can ask when an intervention is suggested:
B - What are the benefits of this intervention?
R - What are the risks?
A - What are the alternatives?
I - What does my intuition/gut feeling say?
N - What happens if we do nothing?/How long do I have to make a decision?
Some times when an intervention may be medically indicated:
- if a woman’s baby is breech and her preferred provider is not experienced or comfortable delivering a breech vaginal birth, a cesarean birth may become necessary.
- if a woman planned for an unmedicated birth but changes her mind during labor and requests pharmaceutical pain relief, an epidural may become necessary.
Believe it or not, there are even more options available to a mom in her postpartum season, most of these related to continued care for her and baby. Once baby is born, if I am acting as a doula, I stay for an hour or two to help get the new family situated and support mom as she attempts her first feed (whether she’s choosing to breastfeed or bottlefeed). After that point, I leave and plan to reunite with the family once or twice through the first few weeks to answer any questions, help them discuss and process the birth experience, and sometimes gift a photo book of the big day. If the family is struggling in any way, I have an extensive resource list that I offer and a group of wonderful professionals I may refer out to. These include a postpartum app to coordinate family and friends’ emotional and practical support (called Mothership Rising), a postpartum doula (who can help parents settle in to their new life and create routines), a pelvic physical therapist (if there are any lingering pain or incontinence issues after 3 months), a newborn and family photographer (to capture those first few precious days), and others. Many of these professionals are available to meet at an annual event I coordinate called the “Bellflower Birth Boutique”, born from my passion for families to have all the specialized support they need during pregnancy, birth, and postpartum.
If you have any other questions on any of these topics, please reach out to me. You can select ‘contact’ from the menu at the top of the page to schedule a complimentary meeting with me to explore mine and other services available to you in our community. You can also find me on business Instagram and FB page @gracepeacebirth. You can also email me at firstname.lastname@example.org. If you are local to Bellflower, I host a “Meet the Doula” night on the first Tuesday of every month at SteelCraft on Bellflower Blvd form 6-7pm. You are welcome to come ask questions and grab something to eat, there are a ton of great vendors to purchase from but I also bring cookies to share. Lastly, if you are interested in taking my childbirth education series, I am offering it for free at Bethany Baptist Church in Bellflower starting January 31, 2022 for 8 weeks. you can find out more about any of these events and register for that class on my ‘events’ page (in the menu above). You’ll also have the option to add their email to receive updates about services and upcoming events to your inbox.
Sending all the beautiful birth-y blessings your way,
It's important to know what providers and resources are available locally and virtually to support your pregnancy, birth, and parenting goals. I've compiled this list to benefit you and your family! Please let me know if you have any questions or are in need of additional resources that aren't listed.
Teen Pregnancy Mentorship
Registry for Services (Doulas, CBE, Lactation Support, etc.)
Natural Birth-friendly OBs
Natural Birth-friendly Hospital-based Midwives
Home Birth Midwives
Other Care Providers
Tongue and Lip Ties
Breast Milk Solutions
Local Public Services & Non-Profits
Regional Public Services & Non-Profits
Local Food Resources
Regional Food Resources
It is of utmost importance that every woman has access to the support she wants and needs during her pregnancy, birth, and postpartum periods. I am grateful to have the opportunity to spend much of my time and effort connecting women to the resources they need during these seasons, but sometimes there can still be formidable challenges in accessing these resources, such as prohibiting cost.
The cost associated with hiring a doula for labor support can be daunting. Unfortunately, our current climate in maternity care is not very accommodating to best practice or services that are considered "standard" in other parts of the world. Thankfully, there are some new ways that families can receive the support they desire and they will be covered here.
The first way to potentially relieve the financial burden of labor support is to call your insurance provider and ask if any doula coverage exists. Recently, insurance companies are taking notice of the financial benefits of doula care and beginning to provide coverage. Doula support can decrease interventions, lead to a quicker labor, improve newborn outcomes and potentially decrease hospital stay lengths and lead to fewer postpartum complications which all decrease associated maternity care costs that insurance companies are responsible for. Some of these coming changes in coverage include:
Creating a Registry
A company called Be Her Village™ allows you to create a registry and customize monetary donations needed for the provision of doula care, childbirth education, and even lactation support services. As with any other registry, the link can be shared with family and friends so that they can contribute not just to your material needs of your Amazon or BabyList registry, but also to the practical support that is so often lacking in this exciting but taxing season. You can create learn more and create a profile here. If you'd like to add my services to your registry, you can find them here.
Volunteer Doula Programs
Some hospitals and communities have a volunteer doula program that you may be able to utilize. Call the hospital where you plan to deliver to ask about their services. In Los Angeles County, these are some of the programs you may qualify for:If you plan to utilize such a program, be sure to ask what doula support through their organization looks like. Sometimes doulas work for "shifts" and then switch out, meaning you may have to transition to another doula during your labor process. Evaluate your comfort with this possibility before relying on this type of support.
Occasionally, a doula who is in the process of certifying will offer a reduced fee or no fee at all. Additionally, some doulas are able to offer a sliding scale to their clients. You can explore your options and the cost of doulas in your area here.
Your Birthing Facility's COVID Policy
Before completing the process of hiring a doula through any of the above means, please reach out to your birthing facility and ask what their current COVID policy is regarding visitors and doula support during labor, delivery, and postpartum. Some hospitals are restricting access for all doulas, while others may have certain requirements of the doulas who attend births in their facilities (needing certification through particular institutions or requiring vaccination). Be clear on what your birthing facility's expectations are so you know what to look for and ask during the interview of any doula you are considering.
If all else fails, please reach out to me. I would love to the opportunity to serve you and would do my best to advocate or find a solution for your particular situation. You can contact me here to set up an appointment.
Sending beautiful birth-y blessings your way,
Autumn Baker is a doula, childbirth educator, wife, and mother of three who seeks to elevate the quality of maternity care in Los Angeles, CA by connecting local families to the education, support, and resources available to them.