If I ask you; "What do you know about your options of comfort measures for labour and birth?", what’s the first thing that pops to mind? If you’re thinking Gas & Air or an Epidural, then I’m guessing that like most parents who join my classes, you’ve started to gather some valuable information. But guess what! There might still be lots of other options for you to explore.
I must be honest, I do find it incredibly frustrating that birthing people aren’t always supported to use non-drug alternatives to manage their level of comfort during labour, without having to give up their sense of control, or consent to the risks attached to opioid pain-relief and epidural analgesia.
Before diving into your alternative options - for those of you who are reading this and aren't sure which method of pain relief are offered in maternity settings - here are your 'usual suspects’:
The Usual Suspects
Gas & Air (Entonox)
How it works
Entonox is a mixture of oxygen and nitrous oxide gas. You breathe it in through a mouthpiece or a mask just as your surge begins and before it gets uncomfortable. To clear your head between surges, it is recommended to stop breathing in the Entonox as soon as the surge starts to subsides.
Benefits
It is easy to use and you can control it yourself.
It takes only 15-20 seconds to work and wears off very quickly.
No known harmful side effects for you or baby.
Side Effects & Risks
Dry mouth.
Feeling lightheaded, nauseous, sleepy or unable to concentrate.
Pethidine or diamorphine
How it works
While Pethidine is a synthetic opioid, diamorphine is an opiate (substance derived from opium).
Both are administered as an injection into your muscle (generally thigh or buttock).
It takes around 20-30 minutes to work and effect last between 2 to 4 hours (not recommended close to the ‘pushing stage’).
Pethidine and diamorphine can be used in combination with Entonox (often the case).
Benefits
May reduce high levels of stress and anxiety that can sometimes inhibits the physiological process, and release tensions in the body.
May enable a birthing person to get some sleep if exhausted.
Side Effects & Risks
Feeling mentally and emotionally removed from the birthing process.
Feeling very sleepy (drowsiness).
Feeling or being sick (nausea and vomiting).
Impacts bodily functions such as digestion.
May affect baby’s breathing if given too close to the birth.
Baby may be drowsy and slow to feed.
Remifentanil
How it works
Remifentanil PCIA (patient controlled intravenous analgesia) is a short acting synthetic opioid that is administered using a self-operated pump that injects the drug into your vein through an IV cannula.
When you feel a surge starting, you simply press a button to give yourself a dose.
It can be used in combination with Entonox.
Remifentanil is not accessible in every Obstetric Units – you can ask your midwife for availability in your specific trust.
Benefits
Self-controlled.
Works quickly and wears off after a few minutes – can be used until baby is born.
Side Effects & Risks
Continuous monitoring of mum and baby - limited movement.
Feeling breathless (oxygen levels will be monitored carefully).
Feeling very sleepy (drowsiness).
Feeling itchy.
Feeling dizzy and sick.
May affect baby’s breathing.
Epidural
How it works
An epidural is a local anaesthetic that temporarily numbs the nerves carrying pain impulse from the uterus.
Because an Anaesthetist and additional monitoring are required, epidural analgesia is only available in Obstetric Units.
Epidurals can be set-up either lying on your side or in a sitting position. The Anaesthetist will numb your skin and place a fine plastic tube through a needle into your lower back. The needle is then removed leaving the plastic tube in place. It usually takes 20 minutes to put in the epidural and test it, and around 20 minutes to work.
A mixture of local anaesthetic and opioid-based pain relief is administered through the plastic tube using an epidural pump. You might be able to ask for a button controller to give your own epidural doses.
A low-dose method is likely to give good pain relief while keeping a clear head and stay fairly mobile.
Benefits
The strongest method of pain relief available.
In some cases, you can control your own doses and stay mobile – ask your care provider about protocols in your trust.
Side Effects & Risks
Blood pressure may drop (hypotension) – fluid will be given through a drip (IV canula) to help maintaining good blood pressure.
Rise in body temperature (fever).
Limited mobility: Heaviness in the legs and continuous monitoring of blood pressure and foetal heart rate can impact the birthing person's ability to support the physiological process through movement and intuitive positioning of the body.
Longer labour: the mother's contraction may become less effective and reduced sensations may result in a longer second stage (‘pushing stage’).
Increased chance of instrumental birth (forceps or ventouse).
Increased chance of additional interventions including augmentation of labour and caesarean section.
You may need a bladder catheter as you may lose the sensation to pass urine.
Severe headache (1 in 100)
Sore back (for a day or two).
Alternative options of comfort measures every Mama should know about.
Now, here are my top 12 alternative options of comfort measures (in no particular order). These can ease labour ‘pains’ directly or indirectly by relaxing you and soothing unwelcomed sensations:
1. Breathing
Slow and focused breathing is often the first go to comfort measure for birthing people.
Focused breathing works by stimulating the release of endorphins, which are your natural pain-relieving hormones. In the context of Hypnobirthing, breathing techniques are part of a body-mind training mechanism that is used to relieve stress and muscular tension, while supporting basic birth physiology and increasing comfort levels.
A calming breath technique will allow the birthing person to relax on demand and increase oxygen levels. Well oxygenated muscles work more efficiently and more comfortably - this is why athletes learn to improve their performance through breathing techniques.
2. Visualisations
Visualisations are another powerful Hypnobirthing tool for anyone who wishes to prepare for a gentle birth experience. There are many different forms of visualisations. While some will help you focusing your attention on positive feelings such as calm or comfort; others will help you to lean onto the physiological experience of birth through simple images - such as bubbles floating upwards, or a soft full-blown rose as your uterine muscles draw up, soften and open during the first stage of labour.
3. Movement
Dancing, pelvic rocking and tilting, or swaying and rotating the hips on a birth ball, etc. are all incredibly efficient ways to feel more comfortable during surges. Movement also supports birth physiology by helping baby descend and rotate. Our bodies are perfectly designed, and what feels good is also what supports basic biomechanics to birth our babies! Pretty clever don’t you think? Just tune in and your body will guide you to find the moves that feel right as labour progresses.
I always recommend creating two playlists for labour and birth. One that will make you want to shake your booty in early labour, and one with slow and relaxing tunes to accompany gentle movements as labour becomes more establish and you get in ‘your zone’.
Being active during labour is not just about physical positions – it’s also a state of mind, making the choice to be active rather than passive in the birth experience is incredibly empowering.
4. Massage, counter pressure and gentle stroking
Massage techniques and gentle strokes are wonderful tools for your birth partner to learn as you prepare together for the birth. Massage, counter pressure and gentle stroking can promote relaxation, ease painful sensations, and increase endorphin levels for greater comfort throughout labour and birth. These techniques can also improve your feeling of togetherness during the birth and strengthen your positive experience.
5. TENS
TENS stands for Transcutaneous Electrical Nerve Stimulation. A TENS machine works by sending mild electrical impulses to electrodes (sticky pads) on your lower back. TENS is thought to work as the electrical pulses stimulate nerves that run to the spinal cord and block the transmission of pain. It also stimulates the body to produce more of its own painkillers (endorphins). You can control the strength of the current yourself.
TENS might also work by providing a distraction and restoring a sense of control, both of which may lessen the anxiety that can delay the progress of labour.
TENS devices can be hired or bought. People generally describe a tingling feeling when using it. There are no known side effects associated with TENS.
6. The Comb
I must admit, I have a weak point for this one as I’ve heard some amazing feedback from mums who’ve used it as their only form of pain relief during labour.
Squeezing a comb is said to work as an acupressure technique called the ‘gate control pain theory’. This theory states that the brain can only focus on a select number of sensations. Essentially, nerve impulses that are transmitted to the spinal cord are interrupted by the feeling of the comb being tightly gripped, acting as a distraction for the brain and altering the birthing person’s perception of pain. As the comb is gently squeezed during labour, there is more of a focus on the sensation in the hand than there is on the intensity and pain of the uterine contraction. This technique will also stimulates the body to produce more endorphins.
How to use it: Grasp a comb (any comb will do) in the palm of your hand. When you feel a contraction starting, gently squeeze the comb.
7. Aromatherapy
Known by some as ‘nature’s gas and air’, clary sage is often reported as an amazing source of comfort during labour , helping women feeling more relaxed (‘floaty’).
Other essential oils that work well are lavender, citrus (orange, mandarin and lemon), frankincense and jasmine.
You can find more information about clary sage and on how to use essential oil in this post.
8. Water bliss
Whether you choose to immerse yourself in a deep bath, have your birth partner poor warm scoops over your back as you gently rest against the side of the pool, stand or sit on your birth ball in the shower, or create a playlist with sounds of the ocean, rivers and streams (if you’d rather stay on dry land)… Water has been reported to bring relief in all kinds of ways to women in labour.
“It’s the feminine element, and it’s often used to help people and even animals in pain, so it makes sense that it would work for labour.” – Milli Hill, The Positive Birth Book
9. Soothing warmth
In early labour, it’s common to feel shivery. Having a warm blanket, a thick pair of socks, and layering up clothing can really help Mamas feeling more comfortable.
Using a hot water bottle, wheat bags (heated in the microwave) or hot flannels in the lower back can also be really soothing during the latent and early stages.
10. Cold Comfort
As labour becomes established and the muscles of the uterus are working hard, Mamas tend to feel the heat in their body building. At that stage you might want to switch that hot water bottle with an ice-cold flannel.
Your birth partner can place the cold flannels on your forehead, shoulders, neck or lower back for an instant ‘aaah’. Pack flannels and maybe a bowl too so your birth partner can easily access cold water to chill the flannels without having to constantly run back and forth to the tap.
11. Rebozo
The rebozo is a traditional Mexican shawl or wrap that’s used to support and comfort pregnant women, particularly during labour and delivery. The use of the rebozo is an ancient cultural practice in Mexico (as well as Latin America) that has increased in popularity in Europe in recent years.
Here is a good website for further information and online workshops.
12. Vocalisations
Moaning, mooing, or roaring are useful responses to pain, and a natural part of labour and birth.
While low noises are generally more helpful to release tension and relieve discomfort by increasing endorphins, remember to do whatever feels right.
Key Takeaways
There are many options of comfort measures available if you wish to try for an unmedicated birth. Keep doing your research and trust the innate strength and power you already hold.
Like with everything, you’ll need to find what works best for you. Many of the alternative options I've shared will require some form of prep and practice during pregnancy. That prep and practice will most likely have a positive impact on your pregnancy though. Get your partner involved and enjoy the journey!
There are no medals for not using stronger forms of pain relief! Your body, Your baby, Your birth, Your choice!
I host regular workshops for expectant parents to learn about relaxation and comfort for pregnancy and birth in Bristol, you can check upcoming dates and book here.
For more information about my Complete Hypnobirthing Course, click here.
📷 Photos by Lindsey Eden Photography ❤️