Non-Drug Ways to Ease Pain or Difficulty in Labor

This chart is an overview and is by no means complete, nor is it meant to be taken as specific medical advice.  It's mainly intended to be a starting point as you study and prepare for birth.

Most of the pain relief tips listed below are simple, commonsense ways to accommodate physiology rather than hinder it.  Throughout the chart, there are links to other sites where you can go for further information.

Why am I against the use of pain drugs in labor, by the way?  Here's an excellent article by a medical doctor that summarizes the reasons: Medical Risks of Epidural Anesthesia During Childbirth.

Click here for a short list of additional resources for further reading.
 

Type of Pain or Problem
Causes
 Non-Drug Solutions or Prevention
Fear, doubt, negative expectations Negative messages from the dominant culture, from friends and relatives, medical providers, or from previous birth experiences. Education, reading, seek out more naturally-minded peers and providers;  prayer and affirmations (these could be Bible-based or more general) during pregnancy and birth.
Tension
 Fear or anticipation of pain, distractions during labor and birth such as observers, noise, intrusion (e.g. medical checks), bright lights (common in hospital settings) Learn to deeply relax and breathe normally, from your abdomen (Bradley® is probably the best for this.  You'll likely need to practice the deep relaxation a lot during pregnancy, in order for it to become automatic during labor); make use of shower or tub during labor - water is a huge help.  Best place for peace and privacy during birth is at home;  next best may be at birthing center.
Medical interventions that can lead to needless pain, difficulty or complications during labor or birth.  These include but are not limited to:  confinement in bed;  routine IV and continuous external fetal monitoring (EFM);  frequent cervical checks;  induction or augmentation of labor by various means including stripping the membranes or breaking the waters, or use of Pitocin;  epidural anesthesia;  setting time limits for pregnancy, dilation or pushing;  use or insertion of instruments to monitor or remove baby;  use of lithotomy position for pushing and "delivery"; routine episiotomy;  cesarean (due to non-emegency or iatrogenic emergency). Complex historic and cultural reasons, including view of pregnancy and birth as "emergencies waiting to happen" rather than inherently safe processes;  desire to control birth and keep mom passive/quiet;  impatience or desire to make the birth conform to doctor's schedule or hospital routine;  fear of litigation;  honest belief that baby might actually be "in distress" (from overusing EFM and/or misinterpreting results);  mother demands a scheduled induction or cesarean for various reasons;  mother demands "pain relief" or doctor/staff expects that she will demand it;  doctor's training and learned mindset compel him or her to take these measures. Find a doctor/midwife and birthing site that will permit your complete freedom of movement and positioning during labor and birth.  Provider should take a supportive rather than interventionist approach to normal birth:  minimal cervical checks, use of doptone or fetoscope instead of continuous EFM during labor, no induction or gentle, natural induction methods (sex if waters intact, walking, nipple stimulation, etc.);  instead of IV, mother takes fluids and light foods throughout labor, as needed;  no time limits on pregnancy, dilation or pushing as long as mom and baby are ok;  permitting mother to assume instinctive positions such as squatting or all fours can help baby be born much more easily and eliminate "need" for episiotomy or even cesarean.

 
Painful   Contractions  
Expecting it to hurt - interpretation of the sensations as painful.  See my article on putting labor sensations into perspective - might help you.
Tension or fear, causing mother to fight the contractions See Tension, above
Mother confined to bed or in an uncomfortable position. Change positions - get up, all fours, lean on wall or partner, whatever works for you.  Slow dancing, rhythmic pelvic motions, and vocalization (singing or uttering long, low sounds) can also be great for helping you to ride out the contractions.  Water is especially helpful - birthing tub is great to use; tradeoff is that immersion in water can slow labor and make pushing more difficult.
Easily-remedied physical causes. Remember to empty your bowels if needed, and to urinate frequently.  A "stuck poo" (as my children say) or a full bladder can make contractions needlessly uncomfortable or painful.

Any other easily-remedied causes that should be listed here? Let me know!
Lower back pain
Back labor (baby in posterior position), or mom's back already hurting due to injury prior to labor. Here are some tips for encouraging a posterior baby to turn prior to and during labor.  The "belly lifting" maneuver they refer to is described in detail in the book  Back Labor No More!!  This do-it-yourself technique relieves the pain or pressure, helps baby to turn, and completes dilation very quickly and easily.  Your doctor or midwife should be told in advance of your using this maneuver, however, because it can speed things up so much.  This technique can be helpful for both back labor and simple back pain during labor. 
**Safety note:  My guess is that there are probably situations in which this technique should NOT be used;  consult your doctor or midwife.
**For more tips on turning a posterior baby during, or better yet, before labor, see the article Optimum Foetal Positioning.
Pain in birth canal
Usually because baby is in a weird position, as, shoulders stuck, or arm is up by baby's head.  The all fours position is a good one for mom to try, as this can help baby turn and be born (also gives midwife more room to help baby).  Here's a good article about this.
Pain at crowning ("ring of fire")
The "ring of fire" sensation is perfectly normal and fades away once baby is fully crowned and mom's bottom is naturally numbed.  However, rarely, the problem is that mom's bottom is not stretching enough.  Possible causes of this include:  mother not relaxed enough (try relaxing your face during pushing, and don't push so hard);  previous episiotomy scar(s) can be resistant to stretching;  mother in position that puts a strain on perineum. Perineal massage during late pregnancy, using olive oil or other food-grade oil.  Labor in warm water to help loosen up.  Or, warm moist compresses during second stage can help a lot.  Pushing while standing (aka "supported standing squat"), on all fours or side-lying relieves undue stretching of perineum.  Also, your and baby's condition permitting, don't resort to hurried, forced, breath-holding pushing, but let your uterus do most of the work so that your perineum has time to stretch naturally.  For more information, see Perineal Protection.
Birth is prolonged and exhausting
Poor physical conditioning, malpositioning of mother, especially lying down too much, too soon;  mother not adequately hydrated or nourished before or during labor. Keep fit during pregnancy.  Have an active birth;  don't go to bed unless you are truly tired and your instincts are guiding you to rest.  Getting into bed tends to slow labor down (unless they put you on Pitocin).  Keep taking clear fluids and light, nourishing foods as needed during labor (toward the end of first stage, you'll probably only want ice chips or frozen Gatorade chips).
Mother is tensing up and "holding back" instead of completely relaxing and surrendering to the birth process. See Tension above. 
This is a first-time labor - cervix has never been opened before, so uterus has to work harder to open it. I don't know if I buy this one, but it's a common argument.  I suspect that the true cause for many a prolonged first birth is mental (fear/tension), not physical ("resistant cervix").
Posterior baby is taking awhile to turn (note that some posteriors never turn before entering the birth canal, but are just born that way "sunny side up").  See Lower back pain above, for ideas for turning baby.  It is possible to birth a posterior baby, but it's usually much easier if baby turns to anterior first.
This is "one big baby", and mom just has to wait longer and/or work harder to give birth. I don't have any quick cure for this one!  You might want to visit Charity's site to read how she got through her long homebirths.
Rarely, malpositioning of baby (e.g. head tipped back and not engaged, or transverse lie). If baby is not positioned right, try to help him reposition (scroll to middle and bottom of linked page for transverse tips) before labor.  If this doesn't help, baby may reposition on his or her own before or during labor;  otherwise, manual assistance or cesarean may be necessary, depending on baby's position. 
Pushing is very difficult due to poor positioning (that is, mother is in the standard, aka supine or lithotomy, pushing position). If mother and baby's condition permits, mother should ideally get up out of bed and stay upright, weight off of her tailbone.  Depending on labor specifics like baby's position, mom's instinctual leadings, and her body's signals (what "feels right"), the squat or one of its variations (supported standing squat, half squat, or kneeling squat) can be an excellent position to permit baby's easy birth.  The squat positions take advantage of gravity to help baby be born.  They also make unnatural, strenuous pushing much less "necessary".  Other good "pushing" positions are side-lying and all fours.  "Except for being hanged by the feet, the supine position is the worst conceivable position for labor and delivery" - Caldeyro-Barcia, quoted in Davis-Floyd, p. 122.

 
 


 

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