Coping Tools for fear-free pain-free childbirth

Any time I mention the words “fear free” or “pain free” birth, I usually get a blank stare response of disbelief. Our modern culture has so over-dramatized and medicalized the tradition of childbirth, that it’s hard for most to imagine a woman in natural labor lost so deliciously deep within herself that she is feeling such words as peace, rest, excitement, pleasure, sensuality, and even euphoria! We imagine instead the movies–a woman’s water breaking on the sidewalk, cut to her screaming bloody murder in the cab on a panic drive to the hospital, cut to her looking like death, sweating and red faced, surrounded by doctors screaming push as she shrieks out her baby, sending fear into the hearts of all passers by. Walk into any coffee shop 6 months pregnant and you’re sure to be met by at least one well-meaning mama dying to tell you her traumatic childbirth story. Most assume that birth trauma is the norm, and sadly they’re right. But it absolutely doesn’t have to be! Here’s the thing though, euphoric fear-free pain-free childbirth doesn’t happen by chance, and unfortunately it is not going to be taught to you during your prenatal appointments. It is a womanly art that takes specific mental & physical training, and each woman must seek it out herself. The good news is that with the right training & tools–euphoric childbirth IS possible! I experienced a euphoric natural birth (you can read my story here) using these coping tools. My hope as a doula and a blogger is to spread the word so that more & more women rediscover the lost art of natural fear-free, pain-free childbirth as well.

As a doula, I break the coping tools down into two categories for my clients: The birthing mother’s jobs in labor & the birthing partner’s jobs in labor.


The Birthing Mother’s Jobs

A birthing mother has 3 jobs, or things she can directly control at any stage in labor. They are her mind, her breathing, and her rest.

1- Her MIND. The brain is the most powerful coping tool in a woman’s possession. One powerful brain tool is the birth mama’s labor vocabulary. Instead of using the word “contractions” which have a negative association in our society, we call them “waves.” Like ocean waves, birth waves come on like a swell with a defined peak. Once the peak of the wave has been reached (which usually happens 30 seconds into the wave), the wave dissipates more and more until it passes completely. Another powerful change in labor vocabulary is to entirely replace the word “pain” with more detailed descriptions of the physical experience. A woman is less likely to fear childbirth when she comes to understand that what she is feeling is not pain or injury, but is instead the healthy and essential sensation of “intense downward pressure,” or “sharp points of stretching” that her body is creating to safely birth its baby.  Another mind tool is to recite affirming birth mantras. You can google different birth mantras and pick which ones resonate the most with you. My favorites are “My body is calm, my body is powerful,” “This is not injury, this is birthing a baby,” and “Good work body, bring that baby down.” Lastly, we access the mind’s eye by teaching different visualization techniques. It may be helpful to visualize a lily flower blossoming in relation to the cervix & vagina opening for your baby. Or it may help to visualize the physiology of your baby’s head dropping safely & gently into the birth canal, out your vagina & into your loving arms. These kinds of visualizations help the birthing mama to remember the purpose and necessity of each wave. Some women also enjoy visualizing themselves in the ocean, surfing on top of each birth wave. While others prefer visualizing themselves diving deep beneath the wave’s powerful surge, until it passes and she emerges completely safe.

2- Her BREATHING. Slow deep breaths are one of the best techniques a woman can call upon during each wave. Not only do those deep breaths help a woman feel in control and calm (instead of overwhelmed and panicky), but they also help deliver higher doses of oxygen to her baby. I recommend beginning a slow deliberate deep breath in as soon as the wave begins to swell upon you. You’ll want to keep the controlled pace of each breath,  all the way in and all the way out, again & again the wave passes, at which point you may return to your normal breathing.

3- Her REST. The best thing a woman can do as soon as she emerges from each wave is rest! That rest will look different depending on how the woman is needing or preferring to labor at any given time, but the goal is for a woman to find a position in between waves that feels as comfortable and restful as possible. It is very common for women trained in fear-free natural labor to successfully nap in between waves. I personally napped between each wave of transition during my second labor, sometimes for up to 10 minutes at a time. Ultimately, the calmer you remain in between waves, the calmer you will remain during the waves. And the calmer you remain during waves, the more productive those waves are able to be. Also, the more you focus on resting while your body does the work to dilate, the more energy you will retain for the more draining “pushing” phase of labor. All good things!


The Birthing Partner’s Jobs

During our prenatal visits, I talk my birthing women and their partners through a list of sensory coping tools. These are the tools that the birthing partner will need to take charge of offering the birthing mama during labor so that she doesn’t have to leave her “labor land” to access their soothing powers. These sensory coping tools fall under each of our 5 senses. When used during labor, they distract a woman’s brain away from the sensation of her birth wave by introducing a pleasurable sensation caused by the tool. When using these tools in labor, the birthing mama should affirm what felt good to her once her wave has passed so that the birth partner knows which tools to go back to during the next wave. The goal is to find a rhythm between birth mama and partner so that the partner knows which tools to use and the mama can rest knowing that relief will be meeting her during the next wave. In addition to providing sensory coping tools, your birth partner should be knowledgable in positions to suggest or assist in during labor, as well as be ready to advocate for the birthing mama’s wishes to any clinicians involved.

1- TOUCH. Touch tools are the biggest sources of relief to a woman in labor. Counter pressure is the first. A rebozo scarf (fancy term for long piece of fabric) can be wrapped around a woman’s hips and pulled tight to squeeze the lower back and pelvis during a wave. It also feels good to have hands squeeze the hips in the same way the rebozo scarf would (but that can get very tiring for the birth partner). The birth partner can also use small wood bowls, soda cans, and balls of different textures (spiky, bumpy, smooth, etc) to massage deep hard pressure into the woman’s back. Then there’s cold & heat. Hot shower water can feel amazing when allowed to fall on a woman’s back or stomach (hot water falling on mother’s nipples also helps labor pick up and progress quicker in the case of a stall). A warm bath can also do the trick. Cold soda cans can be rolled hard into a woman’s back, hips, and buttocks and thighs for cooling pressure. The cans are great because they feel colder longer than a typical ice pack. Cold wash cloths feel good on a woman’s forehead and the back of her neck. Ice packs also feel amazing when rested on the back (especially when applied at the peak of the birth wave). Heat can also feel amazing on the back and hips but may be harder to come by depending on where you are laboring. If you have access to a microwave, you can bring a rice sock (just as it sounds–a sock filled with rice) and heat it anywhere from 30 sec to a minute in between waves so that it’s nice and hot when the next wave approaches. You can also mimic a heat sensation by applying a muscle relaxing menthol rub like Icy Hot or the Deep Blue rub by Doterra. That rub can feel really amazing on the back and hips as well as the stomach. Gentle sensory tools are also very beneficial during labor. You can use a hair brush to gently stroke the arms or a head scratcher to gently massage the head.

2- SIGHT. Some women like having one or several focal images to be shown during the waves. That can be a general image that evokes the idea of opening (like a flower blossoming or sun parting through the clouds) or it can be an image that inspires strength and joy like a picture of her other children. You can also provide a meditative focal tool for a woman to focus on like a flickering Woodwick candle flame (if real candles are not permitted, the battery powered LED candles can also do the trick). Another powerful visual tool is for the birthing partner to approach the birthing mama with a peaceful countenance and tell her to lock eyes with you as you guide her through deep slow breaths. Not only is this good to help her with her breathing, but it also gives her a chance to absorb your peaceful energy.

3- SOUND. Some women like to have meditative tapes playing throughout labor like the tracks provided by Hypnobirthing. Some like to have a prepared musicplaylist of calm or empowering songs to cycle through. Others (like myself) lock on to one song and request that track on repeat through the whole labor. Another aspect of sound tools is to have their birth partner affirm them directly with encouraging words and affirmations. Simply hearing “You’re a birth goddess” or “You are so powerful! You’re doing perfect” can go along way to assure a birthing mama and give her the boost she needs.

4- TASTE. It is very important that a birth mama prepare some light healthy snacks & drinks to consume throughout labor as she is able to replenish her electrolytes and give her the energy she needs to complete labor. If a mama is nauseous, ginger chews may be helpful to offer. Organic honey candies (my personal favorite during transition) or peppermints can also be nice to suck on. At some point a birthing mama may lose her taste for anything, but even if that happens it is still important to put a glass of water with a straw in front of her and frequently tell her to take a sip. You do not want a birthing mama to become dehydrated.

5- SMELL. Essential oils are so powerful–in daily life and especially in labor. You can use oils by diffusing them in the room with a cool mist diffuser, adding a few drops into almond oil for a soothing aromatherapy massage, or by simply waving the open bottle of oil directly under the woman’s nose during a wave. As with all of the tools, the birthing mama will tell you during or after the wave which scents she didn’t like and which ones she loves and wants again during the next wave. For someone new to oils, a few good basics to invest in for labor would be ginger (*my personal favorite during my own pain-free childbirth* eases nausea & is considered the oil of empowerment), peppermint (also great for easing nausea + 1 drop of peppermint in the toilet can help mom pee), clary sage (helps move labor along), lavender (great for its calming effects), wild orange (known to be a happy, motivating oil), frankincense (calming properties, good for easing pain and inflammation), and ylang ylang (positive uplifting properties, lessens tension and stress).

Here are the top 6 laboring positions to help progress labor by getting the baby into optimal positioning as well as relieve discomfort for the laboring mama. I don’t list back reclining because the weight of your uterus compresses major blood vessels in that position, which has been known to deprive the baby of oxygen and make the laboring mama feel nauseous or light headed. In addition, a back lying position causes the baby’s head to put extra weight on pelvic nerves in the sacrum which increases discomfort during birth waves. Conversely, an upright and/or forward leaning position, like the ones listed below, reduces the pressure on your sacrum while also using gravity to keep the baby’s head bearing-down on your cervix which stimulates faster dilation. In the case of a stall in labor, it is helpful to assist mom through all the positions of “The Miles Circuit.”

Position Tools: Birth ball, Peanut ball, pillows, tub mat, yoga mat

* The Miles Circuit: This will take an hour and a half to complete start to finish.
Step 1
– Start with 5 minutes of cat/cow on all fours. Then lay forward on chest and forearms with butt in the air and knees spread wider than shoulder width apart. This position allows the baby to scoot out of the pelvis a bit and gives them room to rotate, shift their head position, etc. Stay here for 30 minutes.
Step 2- Get into an exaggerated side-lying position. Roll to your left side, bringing your top leg as high as possible and your bottom leg straight. Roll forward as much as possible, again using a lot of pillows. Sink into the bed and relax some more. If you fall asleep, great, but if not, stay here for at least another half an hour. Stay here for 30 minutes.
Step 3- Get up and moving into forward or side lunging positions. Lunge, walk stairs facing sideways, 2 at a time, (have a spotter downstairs of you!), take a walk outside with one foot on the curb and the other on the street, sit on a birth ball and hula- anything that’s upright and putting your pelvis in open, asymetrical postions.  Spend at least 30 minutes doing this one as well to give your baby a chance to move down.

1- Side-Lying: Laying on your side, you can put a pillow or peanut ball between your legs, or you can have your upper leg lifted and supported by a birth partner. | Lowers chances of tearing or need for episiotomy / good for lowering elevated blood pressure / good for resting in between birth waves / helps get oxygen to the baby / allows good access to the perineum / can slow a birth that’s moving too fast

2- Swaying: Standing upright, you can wrap your arms around your birth partner and sway your hips side to side as your partner supports most of your weight. | Uses gravity to promote rapid descent of baby / Aligns and helps open your pelvis / birth waves are often more effective and less intense feeling / may speed labor

3- Forward or side lunging: Place your leg up on a chair or stool and lean forward into a slight lunge as your partner spots you. | Helps shift baby into optimal position / opens pelvis / uses gravity to promote rapid descent of baby

4- Squatting: You can squat alone, holding on to a sturdy object or your birth partner, or by sitting on a birth stool. (Note: squatting once the baby is crowning can cause the baby to be born faster which could increase the possibility of perennial tearing.) | Helps relax perineum / uses gravity to promote rapid descent of baby/ may increase pelvic diameter by up to 2 cm / birth waves are often more effective and less intense feeling / may speed labor / increases rotation of baby / requires less bearing-down effort during pushing

5- Rocking: The difference between rocking and swaying or squatting is that rocking is typically done while seated with some kind of support (like a birth ball, peanut, chair, bed, or even the toilet) under your bottom. | Sitting on the toilet is especially good for relaxing the perineum while allowing gravity to descend the baby if you are having a hard time dilating / allows mom to rest in between birth waves / rocking on the toilet allows mom to use the bathroom freely during birth waves / aids in relaxing the body during transition

6- All Fours (aka “Hands and Knees”, “Forearms and Knees,” or “Chest and Knees”): The All Fours positions are ideal for relieving back labor as well as facilitating a slower delivery of the baby during pushing which can help prevent perennial tearing. / Helps shift and properly align baby if needed / allows mom to rest between waves / good position for birth partner to offer back comfort

I hope this helps! Please comment to share your favorite coping tools during labor that I missed! Or if you’ve used any of these coping tools before and would like to share how they helped you, I would love to hear more! We are all in this together–a sisterhood of women rediscovering the lost art of euphoric childbirth! Ooh rah mamas!

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