Labor Positions + Comfort Measures
- Chardá Bell, IBCLC, CBE, CD
- Apr 30, 2022
- 16 min read
Updated: Apr 30, 2022
Comfort isn’t the same for everyone, so that’s why as I doula, I come prepared with a plethora (like the word didn't you!) of comfort measures to help keep my clients relaxed and engaged during their birthing experience. In this blog I will cover a few of my favorites, but this isn’t my whole list, just a few easy peasy ones I know most folks will be able to do.
We will learn:
Feel free to click on the titles above to jump ahead and skip to the section you need!
Comfort measures : Techniques to keep you grounded and relaxed during birth and pregnancy
Labor positions : For a smoother delivery and optimal fetal positioning
Medical methods : Epidural + other Oral/IV medications or procedures
Birth Prep Reminders : Ways to help you and baby prepare for traveling this journey of labor
Hi, I’m Charda, a Black mom, doula, childbirth educator, prenatal/postnatal yoga instructor and lactation consultant in San Diego, California. I love teaching families how to have a more healthy and positive pregnancy, birth, parenting & breastfeeding experience! My focus is on empowering Black moms, babies and families to be resilient, informed and protected on their life journey.
What are comfort measures?
Comfort measures provide direct or indirect pain relief which can be very effective during labor and birth. Methods such as hydrotherapy, hypnobirthing, patterned breathing, relaxation, and visualization can increase the production of endogenous endorphins that bind to receptors in the brain for pain relief. Try to create a warming, private and peaceful environment for your birth to remain calm and present during this amazing experience. You can increase your own comfort by walking, slow dancing and rocking your pelvis, using pillows to position for comfort as well as sitting or swaying on a birth ball and lifting the abdomen gently and rocking while supporting the belly. These are all proven to provide some level for comfort and relief during the process of birthing. Let’s dive in deeper!
Water Therapy:
We immediately think of a birthing pool, and home birth or birth center but that’s not the only way you can use water as a form of hydrotherapy for pain relief. Having a bath, shower or warm water on parts of your body can provide the same desired effect. If you are at home this will be easier, some birth locations like UCSD Jacobs medical center in La Jolla, CA will allow you to use the tub for comfort measure relief but you will not be allowed to give birth in that tub. The tub itself however is there for your comfort during your trial of labor so try it! The water should not be warmer than your body temperature, ask a trusted member of your care team to help you get the water ready and get in to relax!
Reduces stress which allows your body to release more oxytocin
Decrease pressure on your abdominal muscles
Reduced need for an epidural
Shortens duration of labor
Lowers your blood pressure
Relaxes perineal tissues which prevents risk of tearing
Decreases risks of interventions and increases your relaxation
Hot + Cold Therapy:
Focuses on using different tools that can be heated or cold to be used throughout all stages of labor to provide relief and soothe back pain by decreasing the level of sensation felt.
Heat
Store bought heating pads (non-electric)
Gel packs
Warm water bottles
Rice sock - My Tik Tok on making your own heating pad!
Warm bath or shower
Cold
Store bought cold packs
Wrap frozen items in a thin towel or paper towel or bag
Cold or damp washcloth soaked and squeezed in ice cold water
Birthing Ball
Studies have shown that use of a birth ball can help with relief of uncomfortable sensations during labor, which gives us a sense of control over our body’s pressure, balance and coordination at a time when some of us birth givers may feel super out of control or out of body.
Birth Ball
Bounce gently on the edge of the ball
Place ball on a surface like floor or hospital bed and lean over the ball
Rock pelvis back and forth on ball
Lean over your front half while on the ball
Peanut Ball
Can use for pushing phase of labor
Use it if you have an epidural
Use it for KICO positions (Knees In Calves Out)
Mermaid pose (flying cowgirl)
Twerk it out!
This is your time to be in your feelings, emotions and spirit, you have made it to this birth!
Praise yourself and your baby, be in the moment and dance it out if all else fails. Evidence shows that dancing during the early phases of labor can decrease the duration and intensity of labor and increase your overall satisfaction of your birthing experience. As a birth worker and former professional dancer (one time super bowl dancer, ballerina, jazz, modern, gospel/praise and hip hop) I approve this message!
Dancing helps:
Encourages upright positioning and movement
Speeds up dilation and releases oxytocin
Helps boost your mood and puts you in good spirits
Less likely to have an epidural and overall lower pain intensity
Decreases your chance of a surgical birth
May shorten the duration of your labor
Positions to Prepare for a Smoother Birth
I highly recommend birthing folks stay as active during labor as possible by moving frequently throughout the process about every 30-60 mins until you give birth or unless you are resting for a nap, but even then a doula or partner can make sure to remind you to switch you sides in the bed while resting. It can be difficult for some to move during labor just from the heaviness of baby being low in the pelvis, ask for help when needed for position changes. Try using the bathroom once an hour to ensure you create space by keeping a relatively empty bladder and to ensure you move your body by walking to the bathroom. Sitting on the toilet also helps, I recall sitting on the toilet for almost an hour during my first birth just because it felt the best to sit with my body open in that way.
Birth positions can:
Ease your labor and contractions, waves or surges
Creates a more positive childbirth experience
Shortens the length of labor
A better sense of control over labor
Please try to avoid laying on your back for birth giving or laboring, as it will stall your labor and put the baby in a poor position for entry. If you must be lying down, keep your legs and pelvis open with a peanut ball or pillows.
Doula Magic
There are many types of doula, a birth doula is probably the most common. A doula is an individual educationally and physically trained on the process of childbirth. A doula provides a non medical approach to providing a birthing person with emotional, physical, and educational support during pregnancy, labor and birth, regardless of the type of birth. Doulas are proven to shorten the duration of labor, decrease the intensity and improve satisfaction level with overall birth experience. As a doula, my natural nurturer role is fulfilled outside of being a mother as I get to support folks like me which is awesome and rewarding.
Doulas provide:
Reduced need for painkillers or epidurals
Decreases risk of surgical birth
Reduces risk for the use of instruments like forceps or vacuums on your baby
Increases overall satisfaction of birthing experience
Black Doulas improves birth safety and comfort for Black birth givers
Reduces rate of medical or scheduled induction
Increases breastfeeding rates
Doulas love partners too! Partner support hits different:
A doula is not hired to replace a partner or spouse in the role of birth, we are a team! A partner can provide a unique level of comfort and support that we simply cannot always give depending on how long we’ve bonded with our client. When someone who we love or trust touches us, our body and brain sends a signal to our vagus nerve which slows down our central nervous system. When our CNS slowed, our body is out into a resting state which lowers the stress hormone cortisol and serotonin is released. Serotonin is a neurotransmitter that basically acts as the body’s natural antidepressant and pain reliever. Massage works similarly and decreases cortisol/stress hormones and increases serotonin and dopamine.
LOL - Laugh it out!
Laughter truly is the best medicine, it triggers the release of endorphins (the body’s natural pain relievers) and decreases the number of bad stress hormones which causes the body to relax and relieves stress and anxiety. Which all lend to having a positive and enjoyable birthing experience. Humor can reflect pain, comedians will probably tell you this, and the laugh we are looking for in order to seek relief is a good ol’ belly laugh or a hearty laugh that is genuine and felt in the eyes, face and smile. Put on your best comedy show or have a funny doula or partner get you going! Partner note: as a doula, I have to gauge when is the best time to stop the joking, usually as things progress to harder stages like pushing, that’s probably not the best time to joke but early on when birth giver is moving around and walking, dancing or chilling on the ball is a good time.
Herbal remedies for relief during birth:
As a doula I carry a small box of key essential oils and have my clients try them prior to birth to see what their preferred scent pattern will be, this can change but I like to get a general idea whether warm, clean, fresh, spicy. One oil that is great for encouraging labor and easing the process, as well as stimulating contractions which promotes oxytocin production is Clary Sage.
Clary Sage is relaxing, soothing and balancing try:
Safety Warning! Do NOT use this oil if in preterm labor or during the first trimester!
Massaging into acupressure points
Put a few drops in your bath or shower
Smell it directly from the bottle or dab a drop on your wrist, behind ear or neck
Use it in a diffuser - I always bring this to births! I ask for consent from the birth giver before turning it on and before choosing the oils. Hospitals should not have any issue with you using it, just ask them where is the best place to plug it in.
Cannacurious?
I wrote a blog about the use of cannabis while chest/breastfeeding. I'm a supporter of the responsible use of cannabis by consenting adults who are 21 and older, particularly for parents. CBD oil is a plant compound extracted from the hemp or cannabis plant, it does not contain THC (part that gets you high). CBD mostly acts as a muscle relaxant so many have found it helpful during the early stages of labor. While it is not widely recommended that birthing folks smoke cannabis, we must acknowledge that culturally speaking small amounts of CBD oil and hemp products have been used for centuries in Middle Eastern, Indigenous, Afro-Latin and Chinese cultures to help women throughout labor.
CBD supports your body, mind and soul by:
Allowing you to access your instinctive brain
Ease unwanted sensations
Ease anxiety and depression
Ease severe vomiting or nausea
Currently the FDA regulations do not advocate for use of CBD oil during pregnancy or labor out of concerns with possible overdosing which they believe can lead to potential fetal development problems or impairment but there is little to no conclusive evidence to this point.
Medical comfort measures:
An epidural is a procedure that injects a local anesthetic into the space around the spinal nerves in your lower back, this usually blocks the pain of labor contractions and during birth very effectively, sometimes too much so. An epidural is performed by an anesthesiologist, and it is not always successful. Ask about the risks and benefits of receiving an epidural before you need one before you consider having it.
Possible reasons for an epidural:
You have been in labor for several days and are seeking relief to rest
You are too tense to relax the body after nothing else helps
Labor becomes too overwhelming or unbearable for you whether physically or emotionally or both - sometimes pitocin can be too strong and lead to the desire for an epidural, try asking to try the pitocin down and other comfort measures while you think about your epidural or wait for one to come be administered.
A few down sides of an epidural:
Increases your chances of needing synthetic or artificial hormones and a catheter
Constant monitoring of you and baby which means restriction and more anxiety
Increases chances of other interventions or instrumental use of tools in birth
Other Common Medications for Relief:
In general, there are two types of drugs for pain relief: 1) analgesics and 2) anesthetics. Analgesics lessen pain without loss of feeling or muscle movement. Anesthetics relieve pain by blocking most feeling, including pain. Pain relief medications can be either systemic, regional, or local. Systemic medications affect the entire body. Local medications affect only a small area of the body. Regional medications affect a region of the body, like the region below the waist. Systemic analgesics reduce your awareness of pain and have a calming effect. The medications used are known as opioids. These drugs will not cause you to lose consciousness. Systemic analgesics usually are given as a shot or through an intravenous (IV) line. This is a small tube that is placed into a vein through which medications or fluids are given. Side effects are minor and include itching, nausea, vomiting, feeling drowsy, or having trouble concentrating. Opioids can affect your baby’s breathing and heart rate for a short time. Your baby may be drowsy, which can make it harder for your baby to breastfeed in the first few hours after birth.
Nitrous oxide is a tasteless and odorless gas used as a labor analgesic by some hospitals. It reduces anxiety and increases a feeling of well-being so that pain is easier to deal with. Nitrous oxide is mixed with oxygen and inhaled through a mask. The birth giver must hold the mask themselves and decide when to inhale. It works best when begin inhaling 30 seconds before the start of a contraction. Nitrous oxide is safe for the birth giver and the baby. Some feel dizzy or nauseated while inhaling nitrous oxide, but these sensations go away within a few minutes.
Local anesthesia is the use of drugs to prevent pain in a small area of the body. The anesthetic drug is injected into the area around the nerves that carry feeling to the vagina, vulva, and perineum. Local anesthetics provide relief from pain in these areas. The drug also is used when an episiotomy needs to be done or when tissues need to be repaired after childbirth. When used to relieve pain during childbirth, the drug is given just before delivery. Rarely, a person may have an allergic reaction to a local anesthetic or may have nerve or heart problems if the dose given is too high. Local anesthesia rarely affects the baby.
Regional analgesia and regional anesthesia are used to lessen or block pain below the waist. They include the epidural block, spinal block, and combined spinal–epidural (CSE) block. The medication includes an anesthetic that may be mixed with an opioid analgesic. The medication may be given as a single shot or through a thin tube placed in the lower back. An epidural block (sometimes referred to as “an epidural”) is the most common type of pain relief used for childbirth in the United States. In an epidural block, medication is given through a tube placed in the lower back. For labor and vaginal delivery, a combination of analgesics and anesthetics may be used. You will have some loss of feeling in the lower areas of your body, but you remain awake and alert. You should be able to bear down and push your baby through the birth canal.
For a cesarean or belly birth, the dose of anesthetic may be increased. This causes loss of sensation in the lower half of your body. An epidural also can be used for postpartum sterilization. You can move with an epidural, but you may not be able to walk. Although an epidural block will make you more comfortable, you still may be aware of your contractions. You also may feel vaginal exams as labor progresses. When opioids are used, itching is common. This itching can be treated with another medication. Other less common side effects related to opioids include nausea, vomiting, and breathing problems.
As with systemic analgesia, use of opioids in an epidural block increases the risk that your baby will experience a change in heart rate, breathing problems, drowsiness, reduced muscle tone, and reduced breastfeeding. These effects are short term.
Less common side effects include the following:
Decrease in your blood pressure
Fever
Headache
Soreness
Serious complications with epidurals are very rare and include the following:
Injury to your spinal cord or nerves
Breathing problems if the anesthetic affects your breathing muscles
Numbness, tingling, or rapid heartbeat if the anesthetic is injected into a vein instead of a nerve
A spinal block—like an epidural block—is a form of regional anesthesia. Medication is given as a single shot into the fluid around the spinal cord. It starts to relieve pain quickly, but it lasts for only an hour or two. A spinal block is commonly used for cesarean or belly births. It has the same side effects and risks as an epidural block.
A CSE block is another form of regional anesthesia. It has the benefits of a spinal block and an epidural block. The spinal part acts quickly to relieve pain. The epidural part provides continuous pain relief. Lower doses of medication can be used with a CSE block than with an epidural block for the same level of pain relief. It has the same side effects and risks as an epidural block.
With general anesthesia, you are not awake and you do not feel pain. It can be started quickly and usually is used only for emergency situations during childbirth. It is given through an IV line or through a mask. After you are asleep, your anesthesiologist will place a breathing tube into your mouth and windpipe.
A rare but major risk is aspiration of food or liquids from the stomach into the lungs. If you have undigested food in your stomach, it can come back into the mouth and be inhaled while you are unconscious. This can cause a lung infection (pneumonia) that can be serious. General anesthesia usually requires the placement of a breathing tube into the lungs to help you breathe while you are unconscious. Difficulty placing this tube is another risk. General anesthesia can cause the newborn baby’s breathing rate to decrease. It also can make the baby less alert. In rare cases, the baby may need help breathing after birth.
Birth Prep Tips :
A few other comfort measure and labor positions I’ve discussed previously are linked in other blogs below, check them out!
Eating Dates for ripening the cervix and creating a shorter and easier birth!
Eating 6 dates a day for 4 weeks leading up to the due date has been proven to lead to spontaneous labor, higher dilation upon arrival, less likely to use pitocin or other medical cervical ripeners. It also stimulates uterine contractions, reduces your chances of postpartum hemorrhaging (bleeding out/excessive blood loss), regulates blood pressure, and reduces risk of preeclampsia. I have a blog for date recipes here!
A comb being held in the Lao Gong pressure point, located at the center of the palm where the tip of the middle finger touches the palm when you make a fist, can send a signal to your brain to compute only one sensation at a time which in turn helps alleviate the intense sensation of contractions you may be experiencing. More coping techniques at my blog here:
Affirmations, Guided Visualization and Breathwork are all great free tools to use as comfort measures for your birth! These methods are powerful and rooted in clinical and psychological theories. Particularly, for Black birth givers, we can maintain our sense of self and bodily autonomy by affirming what we manifest, we protect ourselves and our baby/family from the threats of strengthening our resilience. Guided imagery can reduce stress and anxiety which release oxytocin and endorphins that block pain receptors. Stress has the ability to worsen our perception of pain. Calm the mind and body to cope with the mental, emotional and physical parts of birth. Focused breathing interrupts the transmission of pain signals to the brain by stimulating the release of endorphins. Breathwork als decreases your blood pressure and increases your oxygen levels. You can try breathwork anytime, anywhere during any phase of pregnancy or labor and birth.
Summary:
Comfort Measures and Position changes in birth:
Pros:
Offer lots of possibilities for relieving labor pain.
Can be combined with each other and with other techniques to suit your needs.
Usually don’t require much planning time; if you decide to use a comfort measure, you can pretty much do it right away.
Don’t interfere with the labor progress and often may help it along.
Help you feel a sense of accomplishment and confidence, which can help relieve pain.
Won’t make you unconscious, unstable or groggy.
Can help you delay or avoid labor pain medications and their possible adverse effects.
Unlike epidural and narcotic pain medications, you can stop comfort measures at any point.
Cons:
May not provide enough pain relief.
May require equipment that is not available or too expensive.
Now that we have learned all of that, you made it through this blog and quick childbirth education lesson! Take a deep diaphragmatic breath through your nose and release it with a controlled breath out of your mouth. Enjoy your pregnancy, birth and baby for what your experience is and remember you ARE doing it, you got it and if not you’ll get it, we always do!
Resources + Citations:
As always, take what you want and leave the rest. Until next time, happy birthing!
Glossary
Analgesics: Drugs that relieve pain without loss of muscle function.
Anesthetics: Drugs that relieve pain by loss of sensation.
Cesarean Delivery: Delivery of a baby through surgical incisions made in the mother’s abdomen and uterus.
Combined Spinal–Epidural (CSE) Block: A form of regional anesthesia or analgesia in which pain medications are administered into the spinal fluid (spinal block) as well as through a thin tube into the epidural space (epidural block).
Epidural Block: A type of regional anesthesia or analgesia in which pain medications are given through a tube placed in the space at the base of the spine
Episiotomy: A surgical incision made into the perineum (the region between the vagina and the anus) to widen the vaginal opening for delivery.
General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.
Local Anesthesia: The use of drugs that prevent pain in a part of the body.
Nitrous Oxide: A gas with no odor that is commonly known as “laughing gas.” When people inhale this gas, they feel relaxed and calm.
Opioids: Medications that blunt how you perceive pain and your emotional response to it.
Perineum: The area between the vagina and the anus.
Postpartum Sterilization: A permanent procedure that prevents a woman from becoming pregnant, performed soon after the birth of a child.
Regional Analgesia: The use of drugs to relieve pain in a region of the body.
Regional Anesthesia: The use of drugs to block sensation in a region of the body.
Spinal Block: A type of regional anesthesia or analgesia in which pain medications are administered into the spinal fluid.
Systemic Analgesics: Drugs that provide pain relief over the entire body without causing loss of consciousness.
Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.
Vulva: The external female genital area.
DISCLAIMER
All content and information in this video is for informational and educational purposes only, does not constitute medical, psychological or health advice of any kind and I do not warrant that the information presented herein is free of any errors or omissions. I am not providing medical, health care, nutrition therapy or coaching services to diagnose, treat, prevent or cure any kind of physical ailment, mental or medical condition.
Although I strive to provide accurate general information, the information presented here is not a substitute for any kind of professional advice, and you should not rely solely on this information. Always consult a professional in the medical and health area for your particular needs and circumstances prior to making any medical or health related decisions. For your health related questions, please seek the advice of a licensed physician or any other qualified health care provider immediately.
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