For many mothers, the fear of childbirth is synonymous with the fear of pain. But there are many ways to manage said pain, from medications to natural techniques. It is important to discuss these methods with your obstetrician beforehand and to request more information if necessary. Vaginal delivery is a combination of coping with the pain and relaxation. Pain can worsen because of:
• Tension
• Fear in relation to how your baby is coping, fear of pain itself, fear that you will not be able to cope with the labour, fear of the unknown, or fear stemming from previous experiences
• Fatigue Breathing
• When you are tense and frightened, your breathing becomes shallow and rapid (also known as panic breathing). To simulate this, breathe in and out rapidly for a few seconds – the effect will be almost immediate. The foetus may also feel this if you continue to pant during labour, consequently reducing the oxygen supply to mother and baby. As a result, you might experience light-headedness, pins and needles or a lack of control
• Your baby needs a good supply of oxygen to cope with the stress of being born. Fortunately, it has many coping mechanisms, and is especially equipped to manage the labour and delivery process, as babies can cope with fluctuations in oxygen supply. Nevertheless, it is important that your breathing is controlled during labour for both you and your baby
• Breathing techniques help you cope with the pain of contractions
• Rhythmic breathing in labour maximises the amount of oxygen for mother and baby
• Being stressed and tense during labour reduces the release of the important hormone, oxytocin, thereby increasing the likelihood of a prolonged labour Breathing in early stages
• Breathing should be effortless and rhythmic
• Close your eyes, focus on your breathing and follow your breath
• Match the length and depth of your breathing in with your breathing out
• Breathing must be steady and gradual • Inhale and exhale slowly
• Breathe in through the nose and out through the mouth
• Perform a ‘1,2,3’ count when breathing in or out
• Focus on breathing out – it can be slightly longer. Sigh out gently with every breath and relax to release the tension in the muscles Be sure to practise breathing exercises with your partner in preparation for labour.
Breathing in active stage
1. As contractions become stronger, breathing becomes shallower
2. This is acceptable as long as breathing does not rapidly increase and turn into panic breathing
3. As intensity increases, so will the quickness and shallowness of each breath
4. When contractions peak, breath in and out through the mouth as if panting to avoid bearing down
5. Pant and blow through a contraction Note that there is no correct way of breathing in labour. Experiment and experience what feels comfortable and what works for you.
Coping skills for labour
1. Breath awareness is essential
2. Focusing on breathing does not take the pain away, but rather takes the mind off the pain – as you concentrate on getting the breathing right, it will slightly distract you during the contraction
3. Hydrotherapy: Warm water soaks in the bath have shown to be the most helpful drug-free method for coping with labour – this can be done in some of our hospitals
4. Shower: Water is the second most effective analgesic; it helps with relaxation and envelops the body with a pleasant stimulation
5. As with the breathing techniques, there are different pain-coping positions – you may want to use a birthing/Pilates ball or different types of chairs. Walking around might also help
6. Effective pregnancy massages: Stimulate the release of natural painkillers (endorphins) that help you to cope with anxiety
7. Wear your own clothes and bring your own pillow if you want
8. Resting: The best you can do to help yourself cope with pain is to conserve energy by resting – in the early stages, try and rest as much as possible, as the labour becomes more intense, rest whenever an opportunity presents itself
9. Groaning and moaning: Making noise during labour is a great coping strategy
10. Play your favourite relaxation music
11. Practise meditation or pregnancy yoga
12. Relaxation, breathing and visualisation exercises reduce the awareness of pain by distraction, thereby minimising tension that increases pain
13. Constant, caring emotional support and encouragement from your birth partner, in the form of kindness, reassurance and being present, can be very beneficial. It helps to have someone alongside you who believes in you and will not panic or joke around
14. Self-talk: Think positively, e.g. ‘Every contraction brings me closer to the birth of my baby.’
15. Perform circular movements of the pelvis and rocking of the pelvis, similar to movements on a Pilates ball
16. Bringing spirituality to your birth space can be comforting and strengthening
17. Trust that your body can give birth
18. Imagine your baby moving down your pelvis with every contraction
19. Consider homeopathy: Natural remedies or favourite scents in massage oils
20. Consider reflexology: The art of relief from pressure points
Breathing while pushing
1. Breath in normally until the urge to push manifests
2. Inhale deeply and let out a small amount of air gradually as you push
3. Take a few shallow breaths to catch up
4. Follow the shallow breaths with a deep inhalation, then repeat Step 3
5. Push as many times in a contraction as you wish
Other pain-coping mechanisms:
1. Entonox gas inhalation
2. Painkiller injections
3. Epidurals: For the most effective pain relief Entonox gas Inhaled Entonox can be used in early labour to help mothers cope with pain during contractions and, if required, for uncomfortable examinations. The gas mixture allows mothers to experience the closest possible sensation of a natural birth. Mothers can adjust their intake to suit their own individual pain thresholds.
Additional information on Entonox gas:
• It is self-administered under the supervision of midwives
• It may enable a woman to avoid, postpone or limit pain medication
• It has a rapid onset and offset of action
• It can be used at any time during labour up to birth
• It does not interfere with the progress of labour
• It enables a woman to choose when to administer analgesia
• It does not affect the baby’s condition at birth Source: International Association for the Study of Pain. Obstetric pain.
September 2007 Epidural: An epidural is the injection of local anaesthetic into the epidural space – the area where the nerves supplying sensation to the uterus are located. You must have a drip in situ and will have a urine catheter placed in your bladder to drain the urine, as you will have no feeling. You will also have to stay in bed as movement from your waist down will not be possible. A very thin catheter will be placed in your back by an anaesthetist and medication will be constantly infused to keep your pain under control, which will ensure that the epidural works until you deliver. This will reduce your pain during contractions.