Relaxation, patterned breathing, and comfortable labor positions are very important for coping with labor. Other tools that reduce pain perception during labor are massage, counterpressure, acupressure, laboring in water, and application of heat or cold. These latter techniques can be easily learned by the woman and her labor partner. Several additional techniques—such as transcutaneous electrical nerve stimulation, intradermal injections of sterile water, and acupuncture—require professional assistance. All these nondrug remedies should be attempted before using medication, since the risks to the woman and baby are lower. They may also reduce the need for other interventions.
Massage can be an effective tool during labor to promote relaxation, relieve stress, conserve energy, facilitate breathing, and assist in the relief of muscle cramping and pain. While some women prefer not to be touched at all during labor, others appreciate the relief it brings, as well as the loving care and support it represents.
Effleurage is a light fingertip massage. It can be performed by you or your labor partner during contractions. To do effleurage, lightly place the fingertips of both hands on your abdomen just above your pubic bone. Slowly bring the fingertips upward, still using light pressure, to point near the top of your abdomen. Then gently draw the fingertips outward, downward, and back to the beginning point. Continue drawing these circles on your abdomen for the duration of the contraction. If desired, draw the circles in rhythm with the breathing pattern.
Other massage techniques that your partner can try on you during labor are:
• Gently stroking your arms and legs using his full hand and going toward your heart.
• Gently massaging your face using light stroking of your jaw area to help relax your jaw during active labor.
• Applying pressure along the base of your skull with his fingertips in between contractions.
• Grasping and lightly holding together the first three toes (the big toes and the next two) on each foot during contractions. Grasping and releasing these toes rhythmically helps to relax the pelvic floor.
• Gently rubbing your neck and shoulders.
You may want to hire a professional massage therapist to attend your labor. Because of her knowledge and expertise, she would be able to incorporate such other techniques as reflexology and the use of pressure points.
Counterpressure can also be used to provide relief during labor. Your partner can use his fist or the heel of his hand on your back to reduce the pain if you are experiencing back labor. You will need to direct him to the exact location on both sides of your lower back and let him know the amount of pressure you desire. He can apply firm pressure during contractions. The pressure points will become lower as your labor progresses and your baby’s head descends through the pelvis.
Performing the double hip squeeze can also help to relieve back pain. To accomplish this technique, you can either stand while bending over at the waist and supporting your upper body against a chair or bed, or kneel on all fours. Standing or kneeling behind you, your partner should place his hands high on your buttocks, on the meatiest area. Using his full hands, he should then press your hips together, which opens the outlet at the pubic joint.
Another counterpressure method for relieving back pain is the nee press. For this technique, you should sit in a straight-back chair, with a small pillow or towel supporting your lower back. Your partner should kneel in front of you and place his hands on your knees. The heel of his hand should be at the lower margin of your knee, where the tibia ends. During a contraction, your partner should lean forward, pressing your upper legs toward the back of your chair.
The Russian theorists who originated the idea of psychoprophylaxis in childbirth included acupressure massage in their approach. They identified certain “pain prevention points” in the body and recommended applying pressure to these areas to aid in pain relief. This technique was omitted as a component of prepared childbirth when it became Westernized. Acupressure interferes with and alters the pain impulses as they travel to the brain (the gate theory), and it may also encourage the release of endorphins.
Acupressure, or pressure point massage, involves applying pressure, heat, or cold over certain acupressure points. It is a method of stimulating these points to provide pain relief in other specific areas. Pressure is applied with the fingertips or thumbs, either held stationary or moved in very small circles over the acupressure points, without the use of lubricants. When the point has been accurately located, the person being treated feels a tenderness or tingling sensation. If the area is very painful, it may be necessary to begin with light pressure, then to gradually increase it. Pressure should be applied for 5 to 10 seconds, and it may be repeated. Since acupressure points exist in pairs—one on each side of the body—remember to treat both sides.
Acupressure can be used along with patterned breathing to enhance the effects of both. Steady pressure works well with patterned breathing, as do circular and intermittent pressure.
You can either perform acupressure on yourself or have it done by your partner. Because the positive support and reinforcement of another person’s touch tends to have a soothing effect and promotes relaxation, having your partner do it for you may be most effective.
The following are acupressure techniques for dealing with the discomforts of labor and postpartum, as well as of pregnancy:
• To relieve headache or pain in the neck or upper back, place your fingers or thumbs on the muscles at the tops of the shoulders, slightly toward the back and in a vertical line with the nipples. Apply circular pressure.
• For low-back discomfort, pelvic pain or pressure, or back labor, press firmly, in an inward direction, on either side of the spine just below waist level. Use circular pressure during contractions and either circular or intermittent pressure between contractions.
• To relieve hip or sciatic pain, alternately apply heat and cold to the upper outer quadrant of the affected buttock.
• To assist in relaxing the lower part of the body, massage the point in the center of the foot, just below the ball of the foot.
The following techniques are also effective for labor pain. They should not be used before 38 weeks of pregnancy because they can cause labor to begin. The techniques are:
• To speed up the progress of a difficult labor, apply pressure on the point at the end of the crease in between the thumb and forefinger. This relaxes the vagina and cervix.
• To aid a difficult labor, apply pressure to the point located approximately three finger widths above the inner ankle. Pressing around the whole area of the inner ankle will locate the point. The place that is the most tender is the correct spot. Use strong, steady pressure.
• For pain relief, pinch or apply pressure to the outside corners of both little toes during contractions. Press down very hard and hold for 7 to 10 seconds.
Acupressure is noninvasive, easy to learn, and effective. It is another important tool that can be added to your repertoire of pain relief techniques to be called upon the utilized as needed during labor and postpartum. For more information on acupressure and how it is used, see The Pregnant Woman’s Comfort Guide by Sherry L. M. Jimenez.
Laboring in Water
More and more birthing facilities are providing tubs or showers for laboring women. Many women find that being in warm water aids relaxation. Submersion in a tub reduces external stimuli and provides buoyancy to eliminate pressure on the joints. Pain medication is required less often, as the body is able to produce endorphins, which reduce perception of pain. Studies have shown that women who have high blood pressure experience a lowering of their blood pressure within 10 to 15 minutes after entering a tub.
Laboring in water has not been associated with any increase in complications, such as infection, even if the membranes have ruptured. The temperature of the water should not exceed 100°F, to prevent elevation of the body temperature. Since your contractions may slow if you are in early labor, wait to get into the tub until you are in active labor. A doptone can be used to monitor the baby while you are in the tub, or you may have to use the tub intermittently with electronic fetal monitoring.
If a shower is available, have the nurse place a chair in the stall so that you can rest. If the shower has a hand-held showerhead, your partner can direct the spray onto your abdomen or lower back, if desired.
The use of heat during labor can be soothing and provide pain relief. The application of heat can be accomplished through submersion in a tub or shower or by use of a hot water bottle, heat pack, or hot wet compresses. A pre-warmed blanket will also provide comfort. Heat increases skin and muscle temperature, allowing relaxation., Muscle spasms are also decreased. If you are experiencing a back labor, you can labor in water or you can alternately apply hot packs and ice packs to the lower back. The application of heat increases blood flow to the area. As the perineum stretches during pushing, the application of hot compresses helps increase elasticity and decreases the burning sensations associated with the skin stretching.
The use of cold packs can provide good pain relief, as the cold temperature provides a numbing effect. Cold works particularly well for back labor. You can use an ice bag, frozen gel packs, a rubber glove filled with crushed ice, a washcloth or small towel soaked in ice water, a cold can of soda, or even a bag of frozen vegetables (a bag of peas molds nicely). Use a layer of cloth between your skin and ice pack. If you are standing, ask the nurse to place the ice pack under the elastic strap used to secure the fetal monitor.
Transcutaneous Electrical Nerve Stimulation
Transcutaneous electrical nerve stimulation (TENS) units are most commonly used to treat chronic pain, but have been found to be helpful for some women in labor. A TENS unit is a small hand-held, battery-operated device that is connected to the skin by four electrode pads. The area is stimulated and controlled by the person wearing the device. The device provides a tingling sensation that the wearer can increase during contractions and decrease between contractions. TENS units cannot be used by women who labor in water.
Intradermal Injections of Sterile Water
The intradermal injection of sterile water is a new technique in which small amounts of sterile water are injected directly under the skin to form blisterlike bumps. The injections cause an intense stinging sensation, lasting for less than 30 seconds, followed by relief of back pain for 60 to 90 minutes. It is believed that the injections cause a release of endorphins. The technique requires knowledge about the specific injection sites and about intradermal injections.
Acupuncture involves the insertion of fine needles into specific points on the body. Stimulation of these points is believed to release endrophins. This technique requires expertise in acupuncture administration and knowledge about the specific sites. It can be used to reduce labor pain and to increase the strength of contractions. Check with your caregiver if you would like to use this technique. You would need to hire a professional who is proficient in acupuncture to attend your labor.