As I prepare to assist at the births of several of my doula clients, I thought it was fitting to write a post about tips and strategies for a natural labor. (I already wrote about things I will and won’t consent to during pregnancy here). I’ve gotten several questions about this lately as well, so I’m covering what I choose and some tricks I’ve found helpful in my own natural labors.
Unfortunately for me, my labors tend to be long (like 24+ hours long). This has been great for me as a doula since I have so much time to test various labor techniques. (Though I admit, I’m a teeny bit jealous when I attend a birth and the mom pushes once after laboring for two hours… c’est la vie I guess).
Why Natural Birth?
(I’d like to preface by saying that these are the options I chose after extensive research, but I do not necessarily think that they are right for every woman. My hope is that women are actually provided the information (or can find it easily) to feel empowered and make the best decisions for their own labors/births, and unfortunately, this does not always seem to be the case.)
I have some friends who look at me like I’ve grown a second head when I mention that I prefer to labor naturally, and others who experience rather pain free births and can’t even understand why coping techniques are necessary. For me personally, labor is long, hard, and a true test of both will power and surrender. I decided to labor and birth naturally (medical issues aside) after researching all of the options and deciding that this was best for baby and me.
From personal experience, I can say that the endorphin high and fast recovery of a natural birth are absolutely amazing, while my c-section was exhausting (emotionally and physically) and tough to recover from.
Labor augmentation and medical intervention can absolutely be necessary and life saving, but the majority of the time intervention isn’t necessary. As mothers, we should carefully consider any intervention, especially elective ones, as all intervention comes with some level of risk to mom or baby (or both).
Going Into Labor Naturally
The most recent statistic I’ve seen shows that almost 1/4 of all women (in the US) are induced and do not go in to labor naturally. While medical induction can be necessary, many of these cases are simply elective and induction alters the important and delicate hormones that occur during labor and birth.
Labor is often induced because a doctor may think that the baby is too big (tests determining this are often wrong), mom is tired of being pregnant, there are scheduling issues for doctor or mom, or for a genuine medical reason. Often, women are induced at 41 weeks or not allowed to go past 42 weeks based on studies that risk of maternal and infant death are higher after this time (this article explains why this research is not necessarily accurate).
This article presents some important biological happenings in the final weeks of pregnancy:
“In the last weeks of pregnancy, maternal antibodies are passed to the baby—antibodies that will help fight infections in the first days and weeks of life. The baby gains weight and strength, stores iron, and develops more coordinated sucking and swallowing abilities. His lungs mature, and he stores brown fat that will help him maintain body temperature in the first days and weeks following birth. The maturing baby and the aging placenta trigger a prostaglandin increase that softens the cervix in readiness for effacement and dilatation. A rise in estrogen and a decrease in progesterone increase the uterine sensitivity to oxytocin. The baby moves down into the pelvis. Contractions in the last weeks may start the effacement and dilation of the cervix. A burst of energy helps pregnant women make final preparations, and insomnia prepares them for the start of round-the-clock parenting.”
The Risks of Induction
This article explains some of the risks of induction (especially elective induction):
“The induction process is a fairly invasive procedure which usually involves some or all of the following (you can read more about the process of induction here). There are a number of minor side effects associated with these medications/procedures (eg. nausea, discomfort etc.) There are also some major risks:
- Prostaglandins (prostin E2 or cervidil) to ripen the cervix: hyperstimulation resulting in fetal distress and c-section.
- Rupturing the membranes: fetal distress and c-section (see previous post)
- IV syntocinon / pitocin: Mother – rupture of uterus; post partum hemorrhage; water intoxication leading to convulsions, coma and/or death. Baby – hypoxic brain damage; neonatal jaundice; neonatal retinal hemorrhage; death. There is also research suggesting that there may be a link between the use of syntocinon/pitocin for induction and ADHD (Kurth & Haussmann 2011)
The most extreme of these risks are rare but fetal distress and c-section are fairly common.”
My personal choice is simply to refuse any labor induction, augmentation, or intervention without a clear medical reason (as there was with complete placenta previa with my third, when natural birth would have been impossible).
Pain Relief In Labor
This is one area where I will definitely never judge a woman for deciding to get pain relief of some kind. In labor, I cry like a baby and sometimes even curse like a sailor… I understand the pain.
That being said, there are inherent risks with any medical pain relief options, and corresponding reasons to avoid them if possible.
Epidurals are the most common form of pain relief during labor. Over 3/4 of all women report getting an epidural during labor, and like I said, I can understand why! This article explains how an epidural works:
“In an epidural, a local anesthetic… is injected into the epidural space (the space around the tough coverings that protect the spinal cord). Epidurals block nerve signals from both the sensory and motor nerves, which provides effective pain relief but immobilizes the lower part of the recipient’s body.”
No intervention exists in a vacuum, and even epidurals carry their share of risks. This article has the most in depth discussion of risks I’ve seen. In essence, epidurals:
- Triple the risk of severe perineal tear.
- Triple the occurrence of induction with synthetic oxytocin (Pitocin).
- Quadruple the chances a baby will be persistently posterior (POP, face up) in the final stages of labor, which in turn decreases the chances of spontaneous vaginal birth (see below).
- Decrease the chances of spontaneous vaginal delivery. In 6 of 9 studies reviewed in one analysis, less than half of women who received an epidural had a spontaneous vaginal delivery.
- Increase the chances of complications from instrumental delivery. When women with an epidural had a forceps delivery, the amount of force used by the clinician was almost double that used when an epidural was not in place. This is significant because instrumental deliveries can increase the short-term risks of bruising, facial injuries, displacement of skull bones and blood clots in the scalp for babies, and of episiotomy and tears to the vagina and perineum in mothers.
- Increase the risk of pelvic floor problems (urinary, anal and sexual disorders) in mothers after birth, which rarely resolve spontaneously.”
I have only seen this mentioned by some sources, but from my own experience, my spinal with my c-section led to horrible itching all over my body for several days after, and I didn’t dare take Benadryl since it can affect milk supply. Personally, I’d rather have pain for a day than horrible itching for three if given the choice!
Epidurals pose their fair share of risks to baby too, including:
- Similar levels of epidural drugs are found in baby’s blood stream, but baby takes longer to eliminate the drugs because immune system is still developing
- Epidurals can affect fetal blood and oxygen supply, leading to the need for more intervention
- Some studies show a decrease in APGAR scores in babies whose mothers received epidurals.
- Higher risk of fever in babies whose mothers received an epidural
- Some evidence shows that mothers may have more difficulty bonding immediately when they receive an epidural
- Evidence shows an increase in difficulty breastfeeding when a mother receives an epidural
Opiate based medications are another common pain relief option in labor (though these are becoming less popular). While these allow movement, unlike an epidural, they affect the baby as well as the mother, and personally, I wouldn’t even consider using opiate medication during labor. This article from American Pregnancy explains the common risks of opiate drugs in labor.
Natural Pain Relief Options
Deciding against medical pain relief options doesn’t mean suffering though labor without any relief. There are a variety of natural pain relief options that work with a woman’s body and can also help labor progress.
These options will not provide the relief that an epidural will, but they also don’t carry the risks.
From personal experience and from working with laboring women, I’ve found that preparation and knowledge are absolutely key to having a smooth natural birth. I’m yet to meet anyone who goes in to labor with the “I’ll try and see if I can do it without drugs” mental attitude who actually goes drug free.
The Perks of Being Prepared
Labor is hard work and it is painful at times, but knowing and expecting the different stages so the fear of the unknown isn’t there can make a tremendous difference. As a personal example, with my first, I didn’t expect the vomiting/severe shaking in transition and this scared me and intensified the pain. Just fear of labor itself is often enough to intensify the pain and make contractions more difficult.
My Top Ten Pregnancy Books provide knowledge of what to expect in labor, along with detailed suggestions for natural pain relief. I’ve also benefitted from and personally recommend taking some form of natural labor classes if you plan to go natural. Some options include:
From my own experience, I wouldn’t recommend the general classes offered by some hospitals as the only childbirth preparation classes as they are often very general and cater to the majority of women who don’t plan on natural labor. (The ones I attended gave detailed practice on using a smiley face chart to rate pain… I laugh in hindsight since by the time real labor hits, I’d be more likely to throw the chart across the room!)
This article provides a list of other things that reduce pain in labor including (I starred the ones that work for me):
Methods of Natural Pain Relief
- Walking around*
- Sitting/rocking on a birthing (exercise) ball*
- Taking a hot shower (aimed at your low back)*
- Sitting up and rocking
- Massaging your back (well, have someone else do it)*
- Counter-pressure on the back (especially for back labor). Try tennis balls.*
- Massage oils for all-over massage*
- Chiropractic adjustment (some will make house calls)
- Focusing on the baby and “opening”
- Changing positions*
- Soothing music*
- Foot massage (pressure points; can take your mind off the pain)*
- Getting in a pool of water
- Staying hydrated*
- Eating small snacks, if you want to”
- An electrotherapy TENS machine placed on the back (this option is more popular in Europe)
As a doula, the things I most often use to help women get through labor as easily as possible are:
- Temperature changes- I bring both a microwaveable heating pad and a personal fan to help mom cope with the temp changes
- Food and drink- this is sometimes discouraged in hospitals, but I encourage mom to keep her energy up by staying nourished and hydrated (here is my recipe for a natural sports drink)
- An old soccer sock with three tennis balls tied in to it is great for counter pressure for back labor
- Natural massage oils and massage help mom relax
- Calming music
- Birthing ball for bouncing if it feels good to mom
- Guided relaxation- I often try to keep the room as quiet and dark as possible as this seems to be the most natural for woman in labor. During contractions, I will provide whatever relief mom needs, but will also touch a specific area (often the jaw) that seems to be especially tensing during the contractions and remind mom to relax here. Relaxation makes a HUGE difference during labor, so just helping a woman gently relax her jaw, arm, etc. will take her focus away from the contraction and help her return to a relaxed state
- Stress balls and focal points
- Getting mom to change position or helping her get into water (if possible)
Labor is not a time to be unprepared! Having a plan and a birth team can make a big difference. Personally, I recommend having a good birth team, including a doula, and a simple but detailed birth plan to help hospital staff support mom. Statistically, doulas can make a tremendous difference in labor outcomes including:
- 50% reduction in the cesarean rate
- 25% shorter labor
- 60% reduction in epidural requests
- 40% reduction in oxytocin use
- 30% reduction in analgesia use
- 40% reduction in forceps delivery
Most doctors and midwives I’ve talked to prefer a one-page birth plan. Even mine (I refuse a lot of stuff!) can fit on one page, so I’d encourage you to try this if possible.
(Here is a copy of my birth plan if you want an idea of a template- click to download).
A simple bulleted list is usually enough, and I also recommend using kind language. My birth plan with my first was very long and very forceful, and while it accomplished its purpose, I don’t think it made me many friends, and friends who are nurses are a good thing to have in labor! I’d also suggest printing it on a piece of colored paper so it stands out… I always add a thank you post it note to the nurses and staff as this improves the chances they read it. As a doula, I sometimes bring snacks for the nurses (they work hard!) as a thank you for their support… bonus points if you do this when you are in labor!
For moms planning to go without medication, a support system can be critical. For many women, there are times when they feel like they can’t do it, and the encouragement of a supportive team can make the difference between the ability to avoid drugs or not.
Avoid the Fear
I also learned the hard way that labor is not something that I can just “tough out.” I thought that I would just grit my teeth and get through it! The problem: one must relax to progress through labor. Ever heard stories of women who get an epidural and go from 4-10 in an hour? It is because they relax! So if you’re hoping to avoid the medication, this is what I would suggest:
- Research pregnancy, labor, and birth so you know what to expect. Fear makes labor tougher, so use those times you feel fearful as a chance to practice relaxation.
- Understand that birth is often painful, but that your body is made to get through it. All that pain will go away when the baby is born!
- Have a plan and make sure your birth team knows it too.
- Practice relaxation measures often during pregnancy.
- Unless it isn’t possible for medical reasons, stay at home as long as possible! This will help relaxation and make labor move along more smoothly.
- During contractions, focus on relaxing your jaw or on a focal point and try to avoid tensing your body. Think of contractions like a wave and accept them rather than fight them.
- Focus on the fact that the pain is temporary and a beautiful baby is at the end!
This article was medically reviewed by Dr. Betsy Greenleaf, the first board certified female urogynecologist in the United States. She is double board certified in Obstetrics and Gynecology, as well as Female Pelvic Medicine and Reconstructive Surgery. As always, this is not personal medical advice and we recommend that you talk with your doctor.
I’d love to hear your opinion on birthing options! Did you choose to go natural? Opt for medication? Any useful tips? Please share below!