There are times that birthing in water may be desired but due to various circumstances, isn’t possible. In this article, we discuss the intensity of labour and birth and ways we can cope with and mitigate some of that intensity.

Before we get to the actual methods and practical things you can do, it’s worth spending a little bit of time understanding how and why labour and birth is intense and can be painful. [Skip straight to the strategies and tools]

The uterus becomes the strongest muscle (by weight) in the human body during labour. It works hard and like any hard physical activity, feels like intense work. The uterus has several groups of muscle fibres that work in different ways as labour progresses and during birth. The following video is a great visual explanation of how those muscles work.

Now that we have an understanding of how the uterine muscles work (and that they’re doing hard work), we need to understand the role hormones play. The short explanation is that for the uterus to do it’s work, you need to feel safe and private. If you feel stressed, anxious, or even just watched, it decreases the hormones that help your uterus and, as in the video above, causes the muscles of the uterus to start working against each other. That same stress, anxiety, feeling watched, etc. increases adrenaline which pulls blood away from the uterus towards extremities. Muscles need good blood flow to work efficiently. When they can’t do this, they start to hurt! (For more information on hormones in labour and birth, see Dr Sarah Buckley’s ‘Your Hormones are your Helpers’.)

Grantly Dick-Read (Childbirth Without Fear) called this the Fear-Tension-Pain cycle.

Fear Tension Pain cycle - design by Swell Doula Service — Click/tap on this image for the complete infographic

We feel fearful, stressed, anxious, watched or we anticipate pain. That sets off adrenaline in our bodies and creates tension throughout our bodies. That tension then creates pain as we are now working against the labour and birth process.

So from this, we can understand that one of the best things we can do to avoid pain is to feel safe, secure, private and cared for. This can come in many forms and is as individual as each person. However, there are some definite strategies that you can try. You can choose one or all of them. But don’t feel locked into any one strategy – the best strategy of all is to work with your body and do whatever feels right to you in that moment. It’s OK if something doesn’t work for you. Try something else.

Midwives are also skilled at helping you accept, relax and surrender into the process as well as having a toolkit of different strategies to help you with. If you have a birth partner, they can also learn some of the below tools and strategies to help you feel relaxed and nurtured during labour and birth.

Strategies and tools (for when you don’t have a birth pool)

Note: In no particular order.

Take a shower

If your hot water cylinder is small, this might be best left until you feel like you need a break from the intensity. Otherwise you can try going in and out of the shower in cycles to help extend the hot water.

Hop in the bath

People can and do birth in the bath so this can be a realistic alternative to a birth pool. Some people find it just as good and in some instances easier. Others find it too cramped. Either way, it could be worth a try.

‘Active’ labour

Staying active in your labour by moving in ways that feels right and good to you. You can try out different positions such as in this poster. And you can also wing it and just do whatever feels good. Many people find leaning on something and hip swaying to be particularly helpful.
‘Active’ also doesn’t mean having to do lots of activity or exercise – labour is a marathon, not a race. So while things like stair walking, going for walks, dancing, etc. can feel great, don’t exhaust yourself doing them. It’s also fine to have a sleep!

Electrolytes and hydration

This may seem like a strange one, but it’s similar in principle to the blood deprivation mentioned above in the Fear-Tension-Pain cycle. Our muscles (including the uterus!) need electrolytes and good hydration to function efficiently. When electrolytes are lacking or off balance, muscles are unable to contract and relax properly. Coconut water is an easy way to get electrolytes and fluids during labour. Of course you can use any electrolyte drink, just be wary of ones that are high in sugar.
If you want a detailed explanation of the role electrolytes play, check this article out: https://firstendurance.com/essential-role-electrolytes-skeletal-muscle-contraction-just-cramp-prevention/

TENS

TENS stands for Transcutaneous Electrical Nerve Stimulation. It works on the Pain Gate Control principal whereby you stimulate nerves in your back with low voltage electrical impulses to block pain lower in your body. It is best started in early labour so that it’s effects can build over the course of your labour. Bear in mind that if you use a TENS machine, you cannot get water near it which precludes showers, bath, hot towels, etc.

Vocalisation

Aaaaaaaaaaaah Ooooooooooooh… Don’t underestimate how helpful vocalising can be. Ina May Gaskin’s ‘Sphincter Law’ says that by opening and relaxing our mouth, we can also help relax and open our cervix. (Read more on the ‘Sphincter Law ‘ below.) Making sounds can also give us an added way to auralise working with the intensity. Feel the intensity of each contraction and verbalise it with sound. Start high and as you move through the contraction bring the sound down lower and deeper. Of course, if it feels better to hum or make no sound at all – do what feels most right to you!

Hot towels

This requires towels (regular or hand towels), thick rubber gloves, hot water and either a bucket or a slow cooker. You put hot water in the bucket or slow cooker and then add your towels. If you use a slow cooker, make sure it’s set to ‘Low’. With the bucket, you will need to regularly replace the hot water. The towels are rung out wearing the gloves (hot!) and then placed on your lower back or abdomen. It may feel most helpful during contractions or in between. As usual – whenever feels best for you.

Wheat packs and hotwater bottles are also an easy alternatives to hot towels.

Acupuncture and acupressure

Some midwives are skilled in acupuncture. Acupressure is a great alternative or used in conjunction. You can download a great booklet on acupressure here: https://acupuncture.rhizome.net.nz/download-booklet/

Orgasm

Loving touch, hugging, caress, kissing, sex, masturbation… orgasm. They all increase oxytocin (aka the hormone of love) and endorphins. Orgasm induces the second highest level of oxytocin in the body (second to birth) so not only does orgasm aid with labour but the endorphins can help with the intensity and give us a feeling of wellness (some call it feeling “high”). Penetrative sex is safe in labour so long as your waters haven’t broken. Note: Semen may intensify labour due to the prostaglandins it contains.

Aromatherapy

Essential oils have a proven reputation for helping with both the physical and mental/emotional sides of labour. Clary sage is a popular essential oil for specifically helping with the intensity. Rose, Jasmine, Rose Geranium, and Lavender are also great. Peppermint is good for nausea and vomiting. You can also purchase labour and birth mixes. It is recommended to use an electric diffuser as candle oil burners can be forgotten about and run dry. Alternately, place a few drops on a tissue or cloth to smell. Sometimes this may be preferred as it’s easy remove should you no longer want the scent.

If using essential oils as part of massage, they must be diluted in a carrier oil first. Always check the safety of essential oils first.

Massage

It’s best that a birth support person learns labour massage beforehand (it’s pretty hard to massage yourself!). While it’s not terribly complicated, a basic technique is generally more effective. This video has a couple of basic and easy to remember techniques. There are also lots of books and articles if you wish to add to your repertoire.

Sterile water injections

This involves injecting sterile saline water just under the skin of the lower back. It is particularly effective if intensity and pain is felt in the back. It is generally painful whilst being administered and has been likened to an insect sting. Not all midwives are familiar with this technique so talk to your midwife to see if they can do this for you.

Hypnobirthing, Calmbirth, Lamaze and other similar classes/techniques

These are specific courses with specific techniques such as self-hypnosis, meditation, breathing, active relaxation, etc. There are a number of providers in Aotearoa New Zealand and can be found via internet search.

Penny Simpkin’s 3 Rs

“Relaxation, Rhythm, Ritual”. From Penny Simpkin’s website:

The 3 R’s approach to childbirth preparation is a simplified approach based on observations of laboring women and how they actually cope with pain and stress in labor. Some cope well; others are overwhelmed in labor. There are three characteristics common to women who cope well:
1. They are able to relax during and/or between contractions. In early labor relaxation during contractions is a realistic and desirable goal; later in labor, however, many women cope much better if they don’t try to relax during contractions. They feel better if they move or vocalize during the contractions, or even tense parts of their bodies. It is vital, however, that they relax or be calm between contractions;
2. The use of rhythm characterizes their coping style;
3. They find and use rituals, that is, the repeated use of personally meaningful rhythmic activities with every contraction.

For more information see: https://www.pennysimkin.com/the-3-rs-in-childbirth-preparation-relaxation-rhythm-and-ritual/

It is also requested that you read this before watching the video: https://www.pennysimkin.com/three-rs/

This list is by no means exhaustive and there are many more techniques, methods, strategies, etc. out there! Have a look around and try whatever resonates most with you. Remember, there is no one ‘best’ method – go with whatever feels right and good to you in any given moment.

Alternatives to waterbirth