Comfort Measures for Labour and Birth

The pain that a woman experiences during labour is complex and very individual.¹⁵ It's physical, mental and emotional.¹⁵ There are a variety of coping measures you can use to manage the pain you experience during labour. Comfort measures do not involve the use of medications for pain relief. They allow you to have a better sense of control, can result in a shorter labour with fewer medical interventions.¹⁵ This also provides the best foundation for breastfeeding to start out well.¹⁵ There is also no risk for you or your baby.¹⁵

Every person is different in how they will manage their labour pain. Your own response will depend on a number of things including: your individual coping style, your previous experiences with pain, how prepared you feel, how your labour unfolds, your goals and expectations and how supported you feel.

The following are non-medical ways to manage your pain during labour.

It’s important to explore a variety of comfort measures prior to your labour and birth to determine what you like and what might work best for you. You can practice some of these, such as; position changes, relaxation and breath awareness before labour begins. Involving your partner or other support persons in practicing these comfort measures will ensure that they too are familiar with how they can help the labouring woman.¹

Relaxation, Rhythm and Ritual (3Rs)⁷

When women are supported to use relaxation, rhythm and ritual throughout their labour, most will cope very well with labour pain. The following are key to healthy coping in labour and birth.

Relaxation:

Relaxation in labour is important and can be used in a number of ways throughout labour to help you cope well.¹⁵ Learn more from our relaxation webpage.

• Some women are relaxed between contractions and actively using rituals during contractions.
• Others may be active, walking or moving between contractions and relaxing during contractions.

• Some women focus inwardly and use relaxation both in between and during contractions.
• Use of breath awareness can be very helpful.  
• Preparing a safe and relaxing birth environment is very important (i.e. quiet, dark, uninterrupted, use of a familiar focal point, music, calming scents).

Rhythm:

Moving rhythmically calms the mind and allows you to work with your body. Examples of rhythmic movement:

• Breathing, moaning, or chanting in a rhythm
• Tapping or stroking something or someone rhythmically
• Rocking, swaying or slow dancing in rhythm

Ritual:

A “ritual is the repetition of a meaningful rhythmic activity during contractions.”⁷(p. 207). They may develop spontaneously throughout your labour or may be adapted from early labour coping strategies as your labour progresses. Examples of rituals:

• Attention-focusing (i.e. counting, repeating a mantra or prayer)
• Vocalizing or moaning (releases feelings of tension). Vocalization often becomes a part of your coping rhythm and ritual.
• Rocking in a chair or on a birthing ball
• Swaying or slow dancing

Download the 3R's (PDF)

Water⁶

Use of water offers effective relief from labour pain and reduces the need for epidural analgesia .^{5 15}

• Take a bath/whirlpool and/or shower. Wait until you are in active labour to take a bath as this may slow down early labour.
• Drink plenty of fluids if in the shower or bath for an extended period of time to prevent overheating.
• Make sure the water temperature is not greater than 37.5 degrees Celsius. This ensures your baby does not overheat.⁵
• Water birth: While water birth is a more familiar option internationally, in Canada not all healthcare providers feel comfortable with water births. Within Ontario, midwives are the most comfortable and skilled maternity care providers in performing water births. Water birth is safest when planned in advance with healthcare providers who are experienced in managing water births. It is important for you to discuss the possibility of having a water birth well in advance with your healthcare provider if this is something that you desire.¹

Massage⁶

Massage and reassuring touch offers relief from both pain and anxiety^{5 14 15} and reduces the need for epidural analgesia.¹⁵ Touch can cue a woman to release tension where she is touched. A support person comfortable with touch and/or massage can provide this for you. Practicing massage techniques during pregnancy has the added benefit of providing relief of discomforts at that time as well.

• Hand, foot, shoulders, back
• Effleurage (light, gentle fingertip massage)
• Double hip squeeze
• Counter-pressure (tennis ball, pop can, etc.) on lower back

Rebozo

A rebozo is a traditional Mexican woven shawl, usually 4- 5 feet in length. It has been used by Mexican midwives to bring comfort to women in pregnancy and during labour for centuries. Mothers also use it to wear their baby after birth. It can be used by women and their partners to foster relaxation, comfort, connection and strength throughout labour and birth. A large scarf, sheet of other piece of fabric can be substituted if you don’t own a rebozo. Initial research has shown that this is a promising way to provide comfort and pain relief¹¹ and possibly enhance labour progress¹². For more information about using a rebozo, discuss it with your midwife or doula.

Listening to Music

• Listening to music can help labouring women relax and cope with the pain.^{14 15}
• Prepare a music selection prior to labour, including a variety of soft and slow music, classical music, and other sounds such as ocean waves, which have been shown to have a relaxing effect.
• Headsets may allow you to be able to focus on the music and block out other sounds from your environment.

Warm or Cold⁶

Warmth¹⁴ and cold may offer relief from labour pain.¹⁵ Try using the following:

• Warm compresses on lower abdomen
• Warm or cold packs on lower back
• Warm compresses on your perineum (area between vagina and rectum) during pushing ¹⁴
• Cool washcloth on forehead

Movement and Position Changes⁶

• Movement during labour and being in upright positions eases labour pain, helps you have more effective contractions, decreases the length of labour and reduces the need for epidural analgesia.¹⁵
• Try different positions during labour and birth.¹⁴ Listen to your body and move according to what provides you the most relief. These positions will help your labour progress as they will allow your baby and pelvis to line up in the best position for birth.
• A birthing ball (exercise ball or peanut ball) can be a very useful tool to help you find positions and movements that are more comfortable during labour. It can also help to widen the pelvis to allow the baby to descend if you are restricted to bed.

Eating and Drinking

Eating to your hunger and drinking to your thirst is important throughout your labour to keep yourself hydrated and to have the energy your body needs for the work of labour and birth. ^{8 13 14 15}

• In early labour you can eat anything that you feel you would like to eat. Listen to what your body needs.
• As labour becomes more intense, many women prefer soups/broths or small light snacks.
• Drink to your thirst throughout your labour. It’s important not to become dehydrated. As labour becomes more intense, many women prefer to suck on ice cubes or popsicles in between contractions.

Pain Relieving Measures Specifically for Back Pain⁶

For back pain in labour, some of the following measures may provide relief: 

• Positions that are forward leaning, such as, hands and knees, open knee chest position or leaning forward over the bed or head of the bed
• Side lunges
• Stair climbing
• Shower/tub
• Double hip squeeze
• Counter-pressure (tennis ball, pop can, etc.) on lower back
• Warm or cold packs on lower back
• Intracutaneous Sterile Water Injection (see below)
• Transcutaneous Electrical Nerve Stimulation (TENS) (see below)

Intracutaneous Sterile Water (ISW) Injection

• Involves injecting small amounts of sterile water into 4 spots just under the skin on the lower back, two on either side of the spine, and two just above your bottom. This forms 4 blisters.¹⁵
• This creates an irritation in another area of the body that competes for the nerve pathways to the brain with the labour pain resulting in less labour pain being perceived. It may also act by causing the release of endorphins, the body’s natural painkillers.¹⁵
• The effect of sterile water injections lasts about one to two hours, but the injections can be repeated when the effect wears off.¹⁵

Transcutaneous Electrical Nerve Stimulation (TENS)

• Consists of a battery-powered stimulator, lead wires, and four electrodes which are applied to the skin on the back. “Two of the pads are placed on either side of your spine at about bra-strap level. The other two go lower down, at about the level of the dimples in your bottom.”
• By adjusting control knobs on the stimulator the woman can start or stop the electrical impulses. She can also vary the rate and strength of the electrical impulses.
• The weak electrical current passes through the skin to muscles to stimulate these nerves. This creates an irritation in another area of the body that competes for the nerve pathways to the brain with the labour pain resulting in less labour pain being perceived. It may also act by causing the release of endorphins, the body’s natural painkillers.¹⁵
• Research has shown that there is only limited evidence of pain relief in labour. There is also no evidence of harm to mother or her baby. ¹⁰
• Units are available for purchase/rent through physiotherapy supply stores and some pharmacies. Instruction should be provided. The mother will need to bring the TENS unit with her to hospital and be knowledgeable in its use prior to labour. TENS units are NOT available at the hospital as staff are not trained to use them.