For medical advice, please contact your healthcare provider.
Here you will find in-depth information on how to work through labor pain without medication. We cover labor rhythms, relaxation exercises, cognitive strategies, body mechanics, and gate control techniques.
This information is supplemental to the class and is intended for you to work through at your own pace.
The following information is supplemental to the class and is intended for you to work on at your own pace.
“Childbirth takes place at the intersection of time;
in all cultures it links past, present, and future.”
In the 1920s, Dr. Grantley Dick-Read, author of Childbirth Without Fear, described what has become known as the “Fear-Tension-Pain” Cycle. He suggested that fear causes a woman to become tense, and that tension increases pain. The increased pain, in turn, increases fear, and the cycle repeats. When a woman is stuck in this cycle during labor it can lead to a more difficult childbirth.
Over the next few weeks we will discuss ways to break this cycle.
Informed Consent: permission granted with full knowledge of the possible risks and benefits.
Educating yourself about what is happening during childbirth will increase your confidence and sense of safety during labor. This is the first step in reducing fear. Collaborate with your healthcare team and share in the decision-making process. Your voice and opinion matters to us. Ask questions and engage your nurses and providers in a dialogue about your care.
When a test, treatment, or intervention is recommended, learn how it works and then ask:
Benefits: What is the problem we are trying to prevent or fix? Will this fix the problem? If not, what would we do next?
Risks: What are the possible risks or side effects?
Alternatives: What are the possible alternatives? What would happen if we did nothing?
Timing: Is the situation urgent, or is it possible to wait?
It can be overwhelming to think of the right questions to ask in the moment when confronted with a healthcare issue. Download this wallet- size card to help you with informed consent.
Confronting Your Fears
The birth of a child is a momentous, life-changing experience. It is normal for both a mother and her support to have fears about this experience.
What will labor be like? Will I be able to cope? Will I lose control? Will I be able to birth my baby? Will something go wrong?
Can I cope with seeing her in pain? Will I feel helpless? Will I be a good advocate? Will something go wrong?
Will I love my baby? Will I be a good parent?
As normal as these fears are, it is important to do some work prior to labor to help tame these fears. In Birthing From Within, author Pam England uses the metaphor of a hungry tiger lurking outside to explain the effects of fear on labor. These fears may be a mother’s own, or fear that she picks up from her partner. You may be able to keep your tigers at bay during pregnancy only to find them on the prowl during labor.
Understand the possible effects of fear on labor:
- Fear tends to increase muscle tension. The more tense our bodies are, the more pain we experience.
- Fear activates adrenaline and a “fight or flight” response, increasing heart rate, blood pressure, and breathing rate.
- Adrenaline neutralizes the effect of oxytocin, the hormone which stimulates labor contractions, dilates the cervix, and brings baby down through the birth canal. If fear blocks oxytocin, it may lead to complications with labor, such as a longer labor, failure to progress, more medical intervention to move labor along, or to deliver the baby.
It does not matter whether it is a real situation, or just imagined scenarios. Our bodies may not be able to tell the difference between real and imagined “tigers”. It is important to bring your fears to conscious awareness, where you can tame, eliminate, or even harness them.
Track Your Tigers
This exercise is intended for both pregnant mother and her support partner:
- What are your tigers? Write down all of the things that you fear or hope won’t happen.
- Look your tigers directly in the eye. Be vulnerable. Let your imagination flow into the fear, explore all aspects of that fear, and imagine “what is the worst that could happen?”
- Ask yourself: What do I need to do to tame or escape each tiger? What will make my birth feel safe to me? What am I going to do if things get hard—or don’t go according to plan? What can I tap into during this experience to have compassion for myself, to allow myself to be vulnerable?
- Work through the fear! Even if you are afraid. Get help if you need it.
- Create an image of birth involving safety and strength. This can be a meditative visualization, an honest dialogue with your support partner, an artful expression. Focus on this image in the weeks prior to birth.
During labor, if these fears or others arise, share them with your labor support and healthcare team. Talk through your fears. Your team will help guide you toward a sense of safety and strength so your labor can move forward.
Guided Relaxation Exercise
The Three R’s of Childbirth
Penny Simkin described three characteristics of women who are coping well with the intensity of childbirth: relaxation, rhythm, and ritual.
- Ability to relax during or between contractions
- Discovery of rhythms that characterize her individual coping style
- Identification of rituals to repeat with every contraction
When these components are absent it is not uncommon for a mother to feel overwhelmed in labor.
Promoting relaxation will reduce tension a mother feels. If our bodies become tense, we will experience increased pain. As a mother’s sense of pain increases, she may become more fearful and have less ability to cope well with labor contractions.
Begin and end each contraction with a deep breath and a slow audible exhale. When you exhale, release all of your tension. Let you jaw drop, then your shoulders, then around your hips. Support partners can mark the end of a contraction with a slow audible exhale to her that the contraction is finished and she can let go.
Every labor has a rhythm. This must be understood in a broad sense, and does not mean the activity must include drums beating in the background. Rhythm has to do with the repetition of a particular motion, action, vocalization, mantra, visualization, etc. Labor rhythm is personal and spontaneous. It is your coping style. Be open to whatever way your body wants to move, whatever sounds you want to make. Learn to recognize the rhythm in your labor and continue with it through each contraction as long as it is helping you cope. Labor rhythms will change as labor progresses.
Support partners can observe a laboring mother and help her stay in her rhythm. This may include swaying with her, vocalizing with her, counting to ten repeatedly, or perhaps just being the steady hand she learns she can rely on to help her up when each contraction begins. Keep rhythm with her so that if the intensity of the contraction breaks her focus she can find her way back into rhythm by following your lead.
If a mother has rhythm in labor she is coping.
The repeated use of personally meaningful rhythmic activities should be used with every contraction. The repetition creates an opportunity for focus. It offers the mind and body an activity which is steady, consistent, and non-threatening (because it is familiar). Without a ritual, a mother is faced with having to constantly make a new decision each time a contraction begins. The ritual may evolve as the labor progresses and she needs a different pace.
Penny Simkin talks on the essence of coping in labor:
Exercise: Talk with mothers you know who have experienced labor contractions—do they remember doing anything rhythmic to cope with the discomfort? Did they have a ritual that they repeated over and over again? How did their ritual evolve as labor progressed?
Staying in the Moment
One thing that prevents mothers from relaxing during labor is being out of the moment. They are thinking ahead. It’s not that they can’t handle the moment they are in, but they are fearful they won’t be able to handle it if the discomfort get worse. That activates the fear-tension-pain cycle and prevents relaxation. You just have to do one contraction at a time. Focus and stay in the moment.
Guided Relaxation Exercise
Finding Your Voice
Vocalizing during childbirth can be a very useful way of coping with the intensity of labor. It is not uncommon for a mother to growl as she labors to delivery her baby. Practicing vocalizations during pregnancy can help reduce some of the self-consciousness that may arise with making noise during labor. It can also help you to identify which vocalizations will help labor progress, and which may increase tension in your body.
Exercise: Work through the vocalizations described in this article. As you practice each noise, pay attention to where you feel tension in your body, focusing on your perineum in particular. Which sounds help you relax your muscles, and which sounds cause you to hold tension?
Progressive muscle relaxation is a mind-body technique that involves slowly tensing and then relaxing each muscle group in your body from your head to your feet. By tensing your muscles before relaxing them, you enable yourself to relax more thoroughly after release. When practiced regularly this technique can help you identify the sensations associated with tension and through body awareness, learn to let go of physical tension.
Guided Relaxation Exercise
The way a mother experiences pain varies depending on the individual. Before we start to talk about pain there are a few things that we need to define.
Pain is a physical sensation with two components: intensity and unpleasantness.
Intensity is the objective experience- how it feels.
Unpleasantness is the subjective experience- how you feel about the pain.
There is a distinction between pain and suffering that is important to recognize.
Pain associated with labor is a side effect of a normal process. There are many examples of when physical discomfort is an accepted part of life– ask anyone who has run a marathon. The intensity is high and the level of unpleasantness is acceptable. It is hard and grueling but they are working to achieve a goal. Pain can be manageable and does not have to rule the labor or overwhelm the mother.
Suffering is a sense of being overwhelmed, helpless, out of control. You can have suffering without pain (i.e., emotional suffering). If a mother crosses a line from pain into suffering this means she is no longer able to cope and needs help. The ritual needs to change.
Working with Pain
Pain can be used as a guide or feedback mechanism to help labor progress; commonly the positions and rhythms a mother choses promote good progress and help get baby into an optimal position for birth. Prepare yourself with knowledge of coping techniques. Think of this as a toolkit that you can draw from as needed to enhance labor progress.
Cognitive Strategies. Choose what to think about during labor and how to think about labor differently. Try visualizations, affirmations, or a conscious reframing of your perception.
“Each contraction brings my baby closer”
“I can birth my baby”
“I will celebrate this every year”
Visualization uses the power of the imagination to help reduce stress and set goals. This involves imagining a scene or an image as completely as you can. It does not have to be literal, but could simply be a representation of how you would like to feel, where you would be most calm and relaxed, or of goal you would like to achieve.
Place yourself in the environment. Involve all of your senses: what can you see, hear, taste, smell? What can you touch or feel? Does it smell like rain? Can you feel the warm sun? Do you hear the hum of honeybees in the trees? Take time to truly center yourself in the environment.
A visualization I used when preparing to deliver my son was of a honeybee swarm. I remembered a day when my hive swarmed and the honeybees were gathered in our apple tree. It was warm but a typical windy spring day. I shook the branch to move the swarm into a box and sat in our yard with thousands of honeybees buzzing around me. It seemed chaotic, a swarm pulled apart trying to find each other, to reconnect. But each time a gust of wind hit them you could see a perfect matrix of evenly spaced honeybees who knew exactly what their role was. Each time the wind hit there was a collective “ZZZZZZZ” as every honeybee held strong. In labor I visualized a swarm of honeybees and thought to myself that I just needed to do my part. I trusted my team and my support to do their part so I could let go, be vulnerable, birth my baby.
Find something meaningful to you.
If practicing visualizations does not come naturally to you, here is another example:
A mother may picture herself as a river flowing. Sometimes turbulent, sometimes calm, always moving forward. She may picture herself held tight by the banks of the river, supporting her momentum.
Her support may picture themselves as the banks of the river. There to hold her, see her. To hold steady or move and bend with her as needs change.
Guided Relaxation Exercise
Body mechanics. During labor, the baby descends through the pelvis, rotating to find the best position for a smooth and easy birth. If the laboring person changes their position, uses movement and massage, it can help labor to progress more quickly and less painfully.
For example, walking or using upright positions will utilize gravity to increase the work of the contractions. These are just a few actions a mother may take during labor:
- Embracing her support partner during a contraction and swaying side to side like a slow dance.
- Standing and leaning over a birth ball or the bed, allowing her partner to access her back for massage or counter pressure.
- Standing and pressing her forehead into a wall while swaying can give her a sense of feeling grounded and help relieve nausea. Keeping the knees bent slightly will allow her to alternate having her feet flat and coming up on her toes, to further mobilize the pelvis.
Each week we will share a series of balancing exercises that can be used prior to labor and supportive techniques to help labor progress or reduce discomfort. Practicing these techniques prior to delivery will help you to feel confident knowing when and how to use them.
Body Mechanics Practice Exercises
I recommend spending time at SpinningBabies.com to learn how/when to use these exercises during pregnancy and childbirth.
Gate Control Techniques. Pain messages pass through “gates” to reach the brain. The idea here is that you can close these gates and block the sensation of pain by focusing your attention on pleasant sensations. Try using massage, music, aromatherapy, or a warm bath to distract you from the pain.
Find a focal point. This can be something meaningful that you bring with you, or just something you discover in the room. It could be a favorite picture you printed or as simple as a large black dot drawn on an index card. When a contraction begins, give this focal point all of your attention.
Physical touch can help a mother relax during or between contractions. Be mindful that the type of massage used will depend on the woman’s comfort, what may have soothed her during pregnancy could irritate her once in labor. During contractions a mother may need more supportive counter pressure.
Counter-irritants. Create minor discomfort that you can control to distract yourself from the pain that you can’t control- like when you bite your lip to distract yourself from a painful procedure. Try gripping a finetooth comb in your hand or knocking your fist into your thigh or other surface.
Body Mechanics Practice Exercises
Pelvic Floor Relaxer (the apple shake!) is a helpful technique when a mother is having a difficult time releasing tension between contractions.
Abdominal Sifting Exercise can relieve back tension and assist with rotating a baby into an optimal position for delivery.
Body Mechanics Practice Exercises
The abdominal lift & tuck is a variation of the pelvic tilt. It can be used to open the pelvis and help the baby engage.
Lunges can help to open the pelvis, allowing baby to rotate and engage.
This video demonstrates how to incorporate hip rotation into a lunge to open the pelvis. This can also be accomplished while sitting on a birth ball.
These motions can be accomplished while sitting on a birth ball as well:
Dip the Hip is a technique that helps rotate baby to an optimal position for delivery. It is particularly helpful for rotating a baby from posterior to anterior presentation. If a mother has a difficult time with this motion her support partner can stand behind her and help guide her hips.
What might help you cope?
Labor contractions can be very intense and require a mother’s full concentration to cope effectively. Because labor rhythms are often spontaneously discovered in the moment, it can be hard to know beforehand what your personal coping style may be. This activity is designed to provide you with some discomfort so you can practice different coping techniques.
Ice Contractions- A Coping Exercise
- Bucket of Ice
- Blindfold (optional)
- Comfort measures: focal point, music, aromatherapy
Start a timer for 90 seconds. When the timer starts pick up two fistfuls of ice with your hands. This is one contraction. For each contraction use one of the comfort measures listed below. Pay attention to the way you feel tension in your body. Is this comfort measure helping you stay relaxed and distracting you from the pain? Is it making you feel more discomfort? Which contractions feel the shortest and which seem to last forever?
Give yourself at least 2-3 minutes between contractions. Remember to begin and end each contraction with a deep inhale, followed by an audible exhale. As you exhale, let go of your tension.
If you are working with a partner each person should work through contractions separately so their support person can be there to encourage and help them. You may find wearing a blindfold helps you become more in tune with your body during this exercise.
- Do nothing. Get your baseline. Rather than trying to distract yourself from the pain, be curious about it. Concentrate on the cold, burning, aching sensation of the ice.
- Use active breathing and bring full awareness to each breath.
- Use a focal point or visualization.
- Move to some music. The tempo is up to you, whatever you enjoy. I’ve seen mothers deliver their babies to anything from calm instrumental to Taylor Swift’s shake it off.
- Use aromatherapy. Any scent you enjoy is ok. I typically recommend peppermint oil as this can help with nausea during labor.
- Use a rhythmic body movement (i.e., lean your forehead into a wall and sway from side to side, slow dance with your partner, tap your foot).
- Use a rhythmic vocalization. Keep the tones low like a sigh (i.e., try growling or moaning).
“Birth Matters… It matters because it is the way we all begin our lives outside of our source, our mother’s bodies. It’s the means from which we enter and feel our first impression of the wider world. For each mother, it is an event that shakes and shapes her to her innermost core. Women’s perceptions about their bodies and their babies’ capabilities will be deeply influenced by the care they receive around the time of birth.”
-Ina May Gaskin
Labor is a place between who you are and who you are becoming. A brief and vivid experience that changes your life forever. The story matters because motherhood, parenthood, is transformative. Your identity shifts as you deliver a new life.
In our culture when birth stories are shared the focus is often only on the outcome. Birth is an intense physical experience, but it also has highly emotional, psychological, and even spiritual aspects for some. I encourage you to fully embrace this experience. Pay attention to what happens, why, what you felt, who cared for you. And when you are home with your baby, spend time reflecting on your birth.
Laura Stavoe wrote “there is a secret in our culture, and it’s not that birth is painful. It’s that women are strong.” Don’t keep your birth story a secret. Write it down so that someday you can share it with your child.
Penny Simkin talks on the importance of birth memories:
Birth Story Exercise: Here are some prompts that you can work from when writing your story. You do not have to answer each of these prompts but rather use this as a jumping off point for telling your story.
- What was my pregnancy like?
- What were the joys?
- What were the challenges?
- How did my body change?
- What was I concerned about?
- What did I crave?
- How did I prepare for labor, birth, and postpartum?
- What did I learn about myself?
- How long did this stage last?
- Where was I and what was I doing when labor started?
- What did those first moments feel like?
- If induced, what was it like to make that decision? How did the process start?
- How did I cope with early labor?
- What was it like to tell my partner?
- What was it like to call my provider/ doula?
- How did I feel as we moved to our birth location?
- What was the car ride and transition to the hospital like?
- How long did this stage last?
- Who was in attendance? When did the members of my birth team join me?
- What did the contractions feel like?
- What positions did I use most?
- What comfort measures helped the most (breathing, vocalizations, movements, medications)?
- What rhythm or ritual did I during labor?
- What comfort measures didn’t work for me?
- Was labor progress quick or slow?
- What was the most physically intense part of labor?
- What was the most mentally or emotionally intense part of labor?
- How did my team encourage me?
- When did I feel most connected to my baby or partner?
- When did I rest? Eat or drink?
- What did I wear?
- How did my baby cope with labor?
Pushing and Birth
- How did pushing start? How long did this stage last?
- What did pushing feel like? Physically? Emotionally?
- What position(s) did I push in? Birth in?
- Who was present when I delivered my baby?
- How did I know my baby was close?
- What was it like to make the decision for a cesarean birth?
- How did it feel emotionally or mentally?
- What was I thinking as I prepared for surgery?
- What was the atmosphere in the OR?
- Who was present for delivery?
- What time was it when I delivered my baby?
- What was it like to meet my baby for the first time?
- What was my partner’s reaction?
- What was the first thing I said after birth or to my baby?
- Who cut the baby’s cord?
- What did my baby look like? Sound like? Smell like? Feel like? What was any skin-to-skin time like?
- If I was separated from my baby? Where did they go? What happened? Who was part of the team caring for them until we could be reunited?
- Were there any complications?
- What was it like to birth the placenta? What did it look like?
- Did I need any repairs and what was that like?
- What was it like to feed the baby for the first time?
- Who were our first visitors?
- How did I feel in this moment?
Podcasts & Videos
How to Use a Peanut Ball (YouTube)
Intuitive Bottle Feeding (YouTube)
From their website:
Irth (as in Birth, but we dropped the B for bias) helps Black and brown women and birthing people have a more safe and empowered pregnancy and parenting experience by allowing you to see how other parents of color, just like you, experienced care at a doctor or hospital. Then we turn those collective experiences into meaningful data to push for change within health systems.
PSI provides non-judgmental support, information, and connection with others. Online groups available for mothers, fathers, families for a wide range of postpartum experiences, including postpartum depression, NICU Parents, and more. You are not alone.