This is part 2 of a 3-part series on pregnancy and labor, specifically a non-medicated one since that was the route I chose.

Part 1 covered the scientific evidence around naturopathic recommendations given by midwives on what to do during pregnancy, while Part 2 is on coping mechanisms to manage the pain of a natural labor.

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It was the pain part of labor that really freaked me out. As someone who shrieked when my Dad dabbed my knee scrape with a cotton pad soaked in rubbing alcohol, I could not even imagine what giving birth would feel like.

“What was the pain like?” I would ask mothers, as if hearing the pain described in more detail would help me prepare better for it. But no one ever seemed to give me a satisfactory answer.

The responses ranged from, “Oh just imagine the worst pain ever,” to “It’s like really painful period cramps.” The majority of my survey respondents also had used epidurals, including my mother, so I had no barometer whatsoever on what natural birth pain would feel like.

When I decided I wanted to go the non-epidural route, it set me on a path of learning about pain and all the ways I could equip myself to cope with pain of labor (the findings are below are still applicable even if you do get an epidural though!)

Pain, I learned, is one of “the most complex experience a human body can have“.

According to the neuromatrix theory, pain is produced by a matrix of neural structures in the brain in response to actual or perceived threat to the tissues.

It is not just simple transmission from pain receptors to your brain, but is the complex integration of affective, cognitive and sensory constituents to help your brain respond to the threat.

It can be related to physical stimuli but also doesn’t have to be (which makes it hard to diagnose, assess or treat).

It can be affected by one’s mental state (depression/anxiety), moderated by one’s expectations of how much pain you will experience (thus the very real placebo effect when you expect the pain to reduce), and even where you direct your attention.

The mind-body connection is real, especially when dealing with pain.

While the fact that pain is hard to pin down from a purely materialist perspective may be disconcerting for some, it also offers opportunities for preparing the mind to play its role in labor.

So, with that, here are some of my findings (listed in order of what I found most effective to least) with links to the scientific studies and as always, a sprinkling of personal story.

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Side bar: Labor Induction

You might have noticed I skipped directly from pregnancy into labor itself, while you may be asking – wait, but how did you go into labor?

How to speed up the process of going into labor is a whole rabbit hole one could go down, and trust me, once you’re 39 weeks+, you’re trying everything you can to get that baby out on time (curb-walking, reflexology, pumping, spicy food, ball-bouncing – I did it all :P).

Will link in the resources a few Youtube videos I watched that I found particularly helpful during this time, although I will say, we are still very much in the dark about what actually triggers the onset of labor (interesting Science article that uses omics to track the molecular processes leading up to the start of labor!).

Once labor actually starts, however, the best pieces of advice I got was this:

1. Make sure you eat something because you need to have enough energy for what’s ahead. I thankfully scarfed down a few date-energy balls at midnight when my contractions started because I wasn’t able to get anything else down until Noah arrived at 1p.m.
2. Get as much sleep as you can. And if you can’t, make sure your husband/partner does. The beginning part of labor is totally doable on your own, so don’t wake them up if they aren’t needed, because you’re going to need them a lot more later on. I got Peter to sleep for as long as he could until I woke him up at 4 a.m. with a “Uh, I think this is actually happening..”, after which it was all hands on deck.

OK, now moving on to once things actually get going.

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Labor

(1) A support person

One of the best decisions Peter and I made leading up to the birth was to hire a doula. The costs aren’t covered in Canada (packages range from $1200 – 1600), but we figured since the birth itself was free thanks to Canada’s free healthcare, we could spend money on a doula.

The package consisted of two prenatal visits, support during labor and one postnatal checkup (here’s some good advice on questions to ask when choosing a doula).

Peter literally knew nothing of doulas when we first started (his reaction was: a doo-what?), but he was soon won over by Barbara’s winsome and gentle questions, her nods of understanding before her slow, wise answers and her indefatigable spirit the day of.

She’s like a village elder, he kept telling others, with the cumulative wisdom passed down from generations.

Over time, she became more than a doula (or village elder) to us. She was our cheerleader and coach, the person I collapsed on when I was exhausted after delivering Noah, and the one who showed up at our door with a jar of ayurvedic turmeric lactation tea when breastfeeding was tough.

Cochrane Reviews did a systematic meta-analysis across 26 trials with over 15,000 people on the interventional effect of having continuous support during labor, and found that women with a support person like a doula were more likely to have a spontaneous vaginal birth (15% increase), positive childbirth experience, and shorter labor (by 41 minutes) without the use of an epidural (10% decrease).

The review suggested 2 theoretical explanations for this effect:

• The first being that support and companionship during labor buffers the stressors of a potentially threatening and disempowering clinical birth environment, in which the woman is exposed to high rates of intervention, unfamiliar personnel, lack of privacy and institutional routines. The doula is there to provide encouragement and reassurance, thus decreasing the stress response which is known to lead to abnormal fetal heart patterns and a longer active labor phase.
• The second attributes the finding to a physical reason. The doula is trained in various comfort and coping measures, such as recommending specific maternal positions during labor to allow gravity to assist in the baby’s descent and encouraging mobility (i.e. walking, bouncing on a ball), all of which enhance the passage of the fetus through the pelvis.

Likely, both the emotional buffering from stress and the physical support measures are at play.

Not being able to blind the participant or the support person in the trial or separate out individual elements of all that the doula does makes it hard to draw neat cause and effect lines, but the evidence seems pretty clear that having a well-informed, confident support person trained in coping and comfort measures is a good thing.

If your husband falls in that category, all the power to him – and if not, a doula is a great option.

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(2) A hot bath

I was really curious about water births and signed up to deliver in the room with the water tub if it was available.

But the day I went into labor, there was a big thunderstorm, which apparently according to the midwives, always increases the number of women at the center (the scientific basis for this, not entirely sure) so that room was unavailable.

That being said, I must have spent 70% of my pre-delivery labor time in the bath, soaking in the warm water to relax my muscles.

Hydrotherapy has been used for a long time to decrease pain in labor – we know that heat increases the supply of oxygen and nutrients to tissues, which relieves pain the same way applying a hot pack eases sore muscles.

A meta-analysis of the RCTs available (n = 10) on the effectiveness of heat therapy on labor pain found that it was significantly effective in reducing pain intensity in the first stage of labor (1.31 decrease in a 1 – 10 pain scale), while shortening labor duration by an average of 32.71 min (albeit with a lot of heterogeneity between trials).

Although controversial, there is also good evidence that water births do not have any adverse outcomes for baby, while decreasing pain and the chance of C-sections for mom (read a good summary of the evidence here).

Makes me curious enough to try again for the water birth room, barring any thunderstorms.

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(3) Counterpressure

When I mentioned that counterpressure was #3 on the list, Peter commented that it should probably be moved higher, so let’s just say counterpressure and hot baths were a close tie.

During our prenatal sessions, Barbara taught him how to do 2 moves in particular: the double hip squeeze and counterpressure on the sacrum.

7 hours into labor, these were the only moves that would somewhat relieve my pain – and also the reason why I couldn’t lie on my back (because it meant no one could do counterpressure for me!)

Going back to point #1, having a doula there was crucial because Peter and her could take turns doing counterpressure (my request was constantly, harder please!)

Here’s a video for those who are curious to see it in action:

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(4) Encouragement cards

Next on the list are encouragement cards. Leading up to the day of, I wrote out a few phrases on stacks of cardboard that I wanted to remind myself of while I was laboring. While I only used the cardboard stack for a short 10 minutes, it was the sentiment embodied in the cards that helped carry me through the majority of the labor.

The cards fell into a number of categories:

1. “I am not alone or unique” – in fact, many women before me have done this. Before the advent of pharmacological interventions, this was exactly how women for generations past (and probably even now, in many third-world cultures) delivered their babies.
2. “God designed my body to do just this” – one of the most comforting facts I reminded myself of was that the pain I was experiencing was not because something was wrong with my body, but that it was designed to do exactly this. The goal was in fact to get my mind out of the way so that the body could do its work, its only function an observer on the sidelines, amazed that the body knows exactly what to do at each stage.
3. “Sink into the pain” – other variations were “let it roll over you” or “don’t run away from it, go deeper”. A technique probably borrowed from the Stoics, the aim is to realize that the pain isn’t going anywhere so you might as well lean into it vs. try to run away. If you imagine the pain as a big black hole, the imagery would be to try to burrow into the pain until it envelops you – then, counterintuitively, it no longer has power over you. Under this category were of course many Bible verses on pain, suffering and endurance (see James 1:2-4 for e.g.)
4. “Just get to the next contraction” – lastly, the pain of labor was vastly different from any other kind of pain I’ve had. In contrast to the seemingly interminable, dull ache, the pain of labor has a beginning, a rise to the peak, then a fall to no pain at all. It has its limits and an end at which point it will break forth to so much joy (more on that in part 3).

Research on self-efficacy, that is the confidence in oneself to accomplish a task, found that stronger self-efficacy beliefs were more predictive of a positive experience of labor pain and increased birth satisfaction than personality traits such as optimism, knowledge about childbirth and even social support. Although I would argue that these constructs do not operate in a vacuum (i.e. higher social support will most likely increase your sense of self-efficacy). Category 1, 2 and 4 would most likely align with this concept of self-efficacy.

A qualitative study by Whitburn et al. interviewing 19 women on their state of mind during labor suggested that a posture of mindful acceptance (Category 3) tended to be accompanied by a more positive reporting of the labor experience. This was opposed to a distracted mind that was focused on catastrophizing (“I’m so weak, I have no pain threshold…I can’t do this”) and more concerned with how much time had passed (“I’ve been laboring for a day and a half and I’m only 1.5 cm dilated!).

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(5) An “upright” position

According to Cochrane Reviews, the upright position, defined as sitting, walking, squatting, kneeling, all fours and squatting, was found to reduce labor time in the 1st stage (by 1h 22 min, p < 0.00001) as well as the rate of C-section (RR = 0.71, p < 0.19), although both effects were only found amongst women with no epidural.

Apparently, once you have the epidural, the position you assume does not have an effect on your labor time/chance of C-section.

My midwife and doula got me to try a whole variety of positions throughout the course of the labor – side lying release, the jiggle, birthing stool, hands and knees (read more on the Spinning Babies website on all the positions they recommend).

I’m pretty convinced that me not being on my back helped move my labor along, although I’m not entirely sure how much the different positions helped my pain.

The hands and knees position was the best in helping me handle the pain, largely due to the fact that it allowed for the best counterpressure (see point #3).

But I don’t think there is any evidence on exactly which position is best, so if you are without an epidural, feel free to assume any of the upright positions, or just whatever position feels best to you.

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(6) Deep breathing

For all the classes that supposedly teach you the “proper way to breathe”, I was quite underwhelmed with its effectiveness. Some swear by Lamaze breathing which is a slow deep inhalation through the nose before an exhalation through the mouth.

I watched a few breathing technique videos (although nothing revolutionary, if you’ve taken basic singing lessons, you also would have learned diaphragmatic breathing), and even got a little coaching session from a pelvic physiotherapist on how to breathe during pushing.

“Just imagine pushing all the air out of you, releasing all the muscle tension,” was the general gist.

During the 1st stage of labor when you’re still thinking straight, the slow deep breathing is amazing, but let me tell you, during the pushing stage, you’re doing anything you can to get the baby out and proper breathing is the last thing you’re thinking about.

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(7) Distraction/focus techniques

The research on this is related to what we know about how attention modulates pain.

A 1989 study by Miron et al. found that focusing your attention on pain causes you to perceive it as more intense and unpleasant than directing it elsewhere.

This knowledge was the basis of a study ran in 2019 that specifically looked at using distraction techniques such as solving puzzles, listening to music, talking about personal interests on outcomes such as pain intensity, duration of labor and stress.

According to Amiri et al., the biggest significant finding was how the use of distraction was correlated with a decrease in labor pain severity (from 7.5 to 6.2 out of 10, p < 0.001).

While distraction may be useful in the 1st stage of labor (for me, that was the 1st 7 hours or so), I found that I needed to switch techniques from distraction where one’s focus is outward, to more of an inward focus where the self-efficacy/mindful acceptance I talked about in Point #4 took centre stage. 

The principle of distraction during labor was this: Don’t think about the pain for as long as you can so you save up your “mind energy” for when it’s needed the most.

The night I went into labor and couldn’t sleep also happened to be the night I was driven to finish up the last few chapters of “If we were villains”, the latest book club read.

So me being engrossed in the book, between episodes of bouncing on the birth ball during a contraction, probably helped speed the 7 hours along.

As labor went on, I switched from distraction to focus.

I had watched videos of moms recommending focusing on random sensory things during contractions to help them get through it.

It could be a picture on the wall, the sensation of squeezing a comb or even just staring at a hole on their husband’s shirt.

And aside from reminding myself of the thoughts I had mentioned in point #4, I too found my own mental imagery to focus on.

As Barbara told me to imagine my cervix opening, I pictured the bed of sunflowers on our garden patio that had just begun to bloom that week.

Over and over again, the bright tangerine-colored petals unfurled in my mind.

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(8) Worship music / Christian Hypnobirthing

So similar to the last 2 tactics, listening to worship music or the hypnobirthing tracks might have been more helpful in the earlier stages of labor, but at a certain point, it was difficult (and even annoying) to pay attention to them.

It was a bit of a bummer considering I had made an entire “baby” playlist in preparation, and paid the $4.99/month for the Christian Hypnobirthing subscription. But then again, you’re never sure what is going to work best.

The only memory I had of my “baby” worship playlist was kneeling in the back row of the car, my elbows and forehead pressed against the polyester cushion, as Peter played “Battle Belongs” by Phil Wickham.

“So when I fight, I’ll fight on my knees, with my hands lifted high, Oh God, the battle belongs to you.”

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And there you have it, my strategies for coping with labor pain rated from most to least effective.

Again, as I stated in my previous post, the scientific evidence for the effectiveness of the strategies is low to moderate, at best, because of the difficulty of isolating variables in a process as holistic and complex as birth.

In a way, I think it’s a grace that after all these years, the process of birth still continues to elude us in its mystery.

In fact, I believe its elusiveness is why we are still filled with awe and wonder whenever we see a baby cross the boundary from womb to world.

As my midwife put it, “I can see why you believe in God; it really is a miracle.”

But more on that in the third and final installation of the series 😉

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Resources

• How to use a birthing ball to induce labor, Care about Little Ones
• How to induce labor at home, Fearless Momma Birth
• How to engage baby head in pelvis to speed up labor, Pregnancy and Postpartum TV
• Miles Circuit – get into active labor, Bridget Teyler
• Breathing techniques for an easier labor, Bridget Teyler
• 5 best labor massages for pain management, Fearless Momma Birth