Childbirth has become more and more of a medicalized process. An act women have been capable of completing alone for thousands of years has turned into a major, invasive surgery in an operating room nearly 40% of the time. And though more than 98% of all births occur within hospital walls, the infant mortality rate, when stacked against 29 of the richest countries in the world, in the United States comes in ranked an embarrassing 26th. More and more mothers are putting two-and-two together and realizing that a cascade of intervention doesn’t always equal a desirable outcome, and natural birth is becoming more sought after. An estimated 30% of pregnant women, when asked before the birth of their baby, hoped to avoid the epidural. The decision to forgo the epidural, the most common form of pain relief used during labor, may be made for a plethora of reasons, including the desire to be able to freely move and position herself, as well as the want to avoid potential negative side effects, like breastfeeding difficulties, the need for instrumental delivery (such as vacuum or forceps), maternal fever, and fetal bradycardia (low heart rate). But, no one said labor was a walk in the park (hence the term labor), and I don’t think anyone would argue that childbirth can be a painful experience.
I’m now 3 months postpartum after my second medication-free birth, baby #1 was born in the hospital and baby #2 was born at home, and one of the most common questions I’m asked is how. So today, I’m compiling my top five tips for getting through the pain and difficulty of childbirth without the epidural.
Don’t be Afraid
I firmly believe that a pretty good-sized chunk of the birthing process is mental. Of course, physically you are going through a lot as well, but your mental state has quite a bit to do with how you cope. If I could use one word to describe the state of my mind during the birth of my first son, panicked quickly comes to mind. As a first time mom, I didn’t really know what to expect, but I’d been fed dozens and dozens of stories, during my pregnancy, of how painful childbirth really was. So, in the final weeks of my pregnancy, I remained nervous about the inevitable, afraid of what was to come, terrified at how much it was going to hurt. And it did. And to say I was scared would almost be an understatement, because I clearly remember a moment during labor, around 9cm dilated, when I wondered if this process would actually kill me.
All I could focus on, during the entire thing, was how can I make this pain stop. And so, I fought it and fought it, and the pain only got worse. And after he was born, I thought Oh my god, I never want to do that again. But 19 months later, I was pregnant again. About midway through the pregnancy, I started feeling that fear creep in. I began growing afraid of the baby’s entry into the world, but more than that, absolutely petrified of the pain. I mean, how was I going to do this again when I barely got through the first one? But, through conversation with my husband, reading and watching the birth stories of others, and learning all that I could about the process of labor, I made the decision not to be afraid. I accepted the fact that whatever happens, happens, and I resolved to simply take everything as it came.
For the birth of my second son, I needed to be in the most positive mindset I could. In the last month of my pregnancy, I made it a priority that my last thoughts before going to sleep at night were positive and affirming. Affirmations such as My baby knows how to be born perfectly and It’s not pain, it’s progress flooded my head, reminding me. I read birth stories, and watched a lot of videos, I took tips from other moms, but more than anything, I refused to allow myself to be afraid. When that fear would pop up, and say something like ‘What if I tear’, I would quickly follow that thought up with something like My body knows exactly what it’s doing. I made the conscious effort to keep my spirits high, and my outlook positive in those final weeks of that pregnancy.
You honestly just have to respect the process. Just as sure as your belly must grow to make room for baby, some discomfort is expected while passing a human through your body. Expect it, and accept it. Don’t fight it. Just take each wave as it comes, and remind yourself that this is a good thing. You’re not dying, nothing is wrong. It’s just the process. During my most recent birth, I embraced the contractions as they came; welcoming each one, for it only brought me closer to meeting my baby. And, during my second labor, I was calmer, more relaxed, and things were a whole lot less painful, which honestly is a surprise considering the entire labor and delivery was less than 4 hours!
Everyone who’s experienced a menstrual period, or anyone really who has had a nasty case of food poisoning, knows that abdominal cramps can be absolutely debilitating and excruciating. Oftentimes, when I’m suffering stomach pain, I can be found in the shower or soaking in a bath. I’m not sure what it is about the warm water that helps soothe my pain, but it never fails to make me feel better. Unsurprisingly, I ended up in the water while birthing both of my children (I spent most of labor in the birthing tub with my eldest, getting out of the water to push and I spent transition and delivery of my second son in our shower at home), and to say it made things more bearable would honestly be an understatement. The warm water truly brought so much relief, and helped calm both my body and mind. I honestly believe warm water was immensely helpful in helping me achieve my goal of an unmedicated birth.
And, according to science, I’m not alone in that thinking. One study recognizes that women “increasingly are seeking settings for birth that honor their ability to give birth without intervention” and that “water birth increases their chances of attaining the goal of a natural birth without intervention.” Research is showing that an intervention-free labor and delivery may not be the only advantage of utilizing water for pain relief, as studies have proven that it can also shorten length of labor, decrease chances of perineal trauma, and reduce maternal anxiety during labor.
Listen to Your Body
Childbirth is a very intricate process, a beautiful dance between a mother and her child as both make one of the biggest journeys of their lives. Hormones rushing, muscles surging, every component of the process has a purpose, down to the very aspect that many fear most: pain. In one article, Judith Lothian points out that a mother’s “movement and position change, in response to the pain facilitate the baby’s turning and moving down through the birth canal.” As the mother changes position to find comfort and relief, her movement wiggles the baby through the pelvis and into the birth canal. I moved all over the place during my deliveries, from laying on my back, to up on all fours, to squatting, I was in a new position between, like every contraction. More upright positions also have gravity on their side to help bring the baby through the birth canal. Research is even showing that women who have the freedom of movement through labor tend to have shorter labors, more efficient contractions, greater comfort, and less need for pain medication.
Position isn’t the only time that unimpaired connection with your body can come in handy; it can also help prevent additional trauma to the mother’s body. During pregnancy with my oldest, I remember the first time I was introduced to the term aptly nicknamed the ring of fire. This phenomenon is a burning sensation experienced by the woman as the muscles and skin of the vagina stretches during crowning of the baby. With the delivery of both my children, by easing off on the pushing when I began to feel that tight, stretching sensation, I was able to avoid any type of perineal trauma. In fact, it’s even been determined that women who delivered via directed pushing (or instructing the woman to push without her necessarily having the urge) versus spontaneous pushing (or pushing with the urge) had a higher incidence of perineal trauma and third degree tearing.
As I approached transition during both my labors, I felt the necessary urge to vocalize during my contractions. These usually sounded like low “ohhs” and “ooos”, lasting for most of the duration of the contraction. With my eldest, these quickly turned into screams and yells as everything got stronger. The more I screamed, the tenser I became. With baby number two, I remained conscious of my efforts to keep my voice low, my body relaxed and open, and my breathing controlled. These low vocalizations can be seen in other species during labor, which suggests a sort of instinctual benefit to the act.
While not much study has been done on maternal vocalization during childbirth, it is so commonly seen in birthing mothers, childbirth experts actually suggest that mothers-to-be become aware of, and attempt to utilize it for pain relief. Some research has started touching on the topic, which is often referred to as “open glottis pushing.” Essentially, open glottis pushing is allowing the mother to push when she feels the urge, and encouraging her to emit a low tone, grunt, or deep noise while doing so. One study recognized that closed glottis pushing often resulted in “suboptimal umbilical cord gases, and fetal oxygen desaturation and acidosis (depressed oxygen).” This is an ineffective pushing style, and leads to maternal fatigue and exhaustion.
Have a Partner
My husband was my rock during the birth of both my boys. Encouragement goes so much further than you would believe during such an intense marathon like childbirth. As the pain grows, changes, and grows longer, it becomes easier to doubt your ability to finish the race. Having my husband by my side to remind my of my goals, keep my head grounded, and re-affirm my ability to get through this was absolutely priceless. Birthing a child will probably be one of the toughest things a woman does, and many are beginning to understand the sheer benefit of having that support as the demand for doulas is growing by the day. Doulas, essentially, are hired support during labor. They make the mother feel loved, cared for, and heard. They offer natural pain relief options for the mother, support for the father (or other birth partner), and mostly just be whatever the laboring mother needs at the time. Studies are proving that women offered continuous support during her labor experience, by a doula or otherwise, had significantly lower rates of medication pain relief[18, 19].
My husband spent a lot of the time reminding my of what an awesome job I was doing, reminding me that there was an end to my pain – and that it wouldn’t be much longer until it came, and offering physical support like counter-pressure, perineal compress, and massage. Some research that examined over 15,000 laboring mothers discovered that women who were offered continuous support were more likely to spontaneously give birth (birth without the use of forceps or vacuum assistance), less likely to have pain medications, less like to undergo a c-section, and be more likely to have a shorter labor.
One of the best weapons you can have in your arsenal is a birth team that is conscious and supportive of your decisions. With my hospital birth, I specifically requested that no one ask me if I wanted pain relief, because how alluring would that be in a moment of such pain? Instead, if I wanted something, I could ask for it myself. We have been told and shown for so long now that childbirth is just too painful, and honestly, that couldn’t be further from the truth. As women, our organs shift and squish to make room for our growing babies, our cervixes open to incomprehensible sizes to allow an entire human to pass, our bodies sustain life for another living being for nine months (and beyond, if you breastfeed), we were made for this.
Until next time,
1. NCBI Contributing Indications to the Rising Cesarean Delivery Rate
2. CDC Trends in Out-of-Hospital Births in the United States, 1990-2012
3. CDC International Comparisons of Infant Mortality and Related Factors: United States and Europe, 2010
4. NCBI Nulliparas’ Preferences for Epidural Analgesia: Their Effects on Actual Use in Labor
5. BMC Intrapartum Epidural Analgesia and Breastfeeding: A Prospective Cohort Study
6. NCBI Pregnancy and Birth: Epidurals and Painkillers for Labor Relief
7. NCBI Labor Epidural Analgesia and Maternal Fever
8. Springer Link Labour Analgesia and Fetal Bradycardia
9. NCBI Birth, Bath, and Beyond: The Science and Safety of Water Immersion During Labor and Birth
10. NCBI Water Birthing: Retrospective of 2625 Water Births. Contamination of Birth Pool Water and Risk of Microbial Cross-Infection
11. NCBI The Effects of Whirlpools Baths in Labor: A Randomized, Controlled Trial
12. NCBI Hydrotherapy in Labor
13. Lothian, Judith The Purpose and Power of Pain in Labor
14. NCBI Care Practice #2: Freedom of Movement Throughout Labor
15. The Royal College of Midwives Second Stage of Labour: Challenging the Use of Directed Pushing
16. Behavior Perinatal Behavior of Northern Elephant Seals and their Young
17. NCBI First Do No Harm: Interventions During Childbirth
18. University of South Carolina The Emergence of U.S. Hospital-Based Doula Programs
19. NCBI Impact of Doulas on Healthy Birth Outcomes
20. Cochrane Continuous Support for Women During Childbirth