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Pain relief in labour: An expert's A to Z of techniques to try

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Pregnant woman holding bump, pain relief in labour
We all know that, for most women, labour can be painful - but there are many options for pain relief in labour that you can try.

There are so many, in fact, that Milli Hill, author of the Positive Birth Book, has managed to come up with a whole A to Z of ideas for coping with labour pain.

Here, she talks us through 26 tips, tricks and techniques for choosing the right pain relief for you during labour - and some of them might just surprise you...

Active birth
Staying active in your labour and keeping off the bed as much as you can is one great way to feel more comfortable. Use your partner, a birth ball, yoga mats or a birth pool. Find the positions that feel right for you, and work them.

Bottle - not hot water
Heat applied to the lower back can be soothing and comforting. Try a hot water bottle with a nice soft cover or a lavender wheat bag. Others prefer ice packs or bags of frozen peas. Another technique used by some midwives involves applying hot flannels to the lower back during contractions: could this be the origin of the age-old call for 'Hot water and towels!'? Use with caution obviously as you don't want to start motherhood with first-degree burns.

Clary Sage
Known as 'nature's gas and air', some women swear that a good sniff of this essential oil on a tissue during labour can make you feel beautifully floaty. Be aware that it's not advised to use Clary Sage before you reach full term as it is said to be powerful enough to induce labour. Use in an oil burner, on a hanky, or added to plain massage oil such as olive or almond.



Doula
Don't underestimate the pain relieving effects of feeling that someone is 100% 'with' you in labour. Research has found that simply having continuous support from the same person in labour leads to less need for pain relief. And amazingly, this continuous support was found to be most effective if that support person was neither a member of hospital staff or from the woman's social network – in other words, a Doula.

Epidural
Most people have heard of this option, and it's become so strongly associated with birth that many women (and a fair few men!) hold the view that birth is not desirable, or even possible, without it. Essentially, it's a local anaesthetic that is administered using a needle which is inserted in between the bones of your lower spine. A thin plastic tube called a catheter is then fed through the hollow needle and the tube is taped to your back, allowing the dose of the drug to be topped up as necessary. You can have a 'mobile' or 'low dose' epidural, meaning the anaesthetic is mixed with Opioids allowing you more mobility, or a 'full epidural', which is a total block.

Flick the bean
Masturbation in labour is a bit of a taboo subject, but many women report that it is a great way to either get labour going or to take them to a great, sensual place during contractions. It can take a bit of a mental leap for most of us to think about labour in such positive, sexual terms. But not only will clitoral or nipple stimulation in labour get the essential birth hormone oxytocin flowing, it might actually... feel nice?! What's to lose?

Gas and air
Entonox or 'gas and air' is a mixture of half nitrous oxide (laughing gas) and half oxygen. You will be offered it to inhale through a mouthpiece and you can have it wherever you choose to give birth, and during water birth too. Because it's inhaled it's fast to enter the body and also fast to leave, so if you don't like the feeling it gives you, you won't be stuck with it for long. Some women swear by it, others dislike it intensely and say it makes them dry-mouthed, nauseous or woozy.

Hypnobirthing
Many women find it helpful to prepare for labour using this technique, which involves deep relaxation, visualisation and an appreciation of the mind-body connection. Women who use hypnobirthing often report finding labour very manageable, or even pain-free, although there are no guarantees. If you're interested you can take classes or just purchase a CD or mp3.

Inhale, exhale, repeat
Breathing in labour has become a bit of a cliché since the 70's, when women leant on their beardy husbands in antenatal classes and puffed their way through imaginary contractions. But breathing deeply is a great way of gaining a sense of calm confidence – whether you are in labour or in the waiting room for a job interview. Practice in pregnancy – a yoga class is a good place to start, or just try deep relaxing breaths as you fall asleep each night.

Joke around
A sense of humour in labour is highly recommended. It's a bit like going camping. If you think you are going to get through the experience whilst retaining your usual poise and Kardashian contouring, then you need a reality check. Like camping, giving birth involves getting down and dirty, letting go of many of the trappings of Western 21st century life, and some mild to moderate discomfort. And I'm sorry to say there's no compensatory barbequed sausages or wine in a plastic mug either. Laughing may therefore be essential for survival. It can also relieve pain by releasing beta endorphins (the brain's natural 'morphine'), perhaps why it's known as 'the best medicine'.



Kissing
Making out with your partner can be a great way to get labour going, and some women report that deep and passionate kissing can be just the thing during the intensity of contractions. Some say, 'the same energy that got the baby in, can get the baby out'. Others will tell you that the relaxed open mouth of a kiss will help your cervix to dilate effectively. Nothing to lose and everything to gain by trying this one.

Low lights, low noise
Keeping the room dimly lit and quiet will allow you to focus and let your mammalian hormones flow. This gives you the best chance of staying on top of contractions. Interruptions, bright lights, sudden noise or irritating chit chat can all make it more difficult to cope with the intensity of labour.

Massage
Your partner, doula or midwife can massage you in labour, although you are unlikely to be interested in a gentle neck rub – what most labouring women seem to want is hard counter pressure applied to their lower back during contractions. Essential oils can be part of the mix, and some midwives will use acupressure points to relieve pain or encourage labour to get moving.

Nourishment
Have a selection of drinks and food that is easy to eat such as bananas, as part of your birth bag, and keep up your intake of calories and fluid during labour. Low blood sugar or dehydration may make you feel weak and it may then be harder for you to cope.

Opioids
Pethidine, Diamorphine, Meptid and Remifentanyl – they might sound like the Four Horsewomen of the Apocalypse, but for some women, they are knights in shining armour and represent a new dawn. All four drugs are opioids, and they work, not by actually numbing any of your pain receptors, but simply by making you 'out of it' so that you don't experience the pain in the same way. One advantage of opioids can often be that you can get some rest if your labour is long, but be aware that all four opioids cross the placenta and that, the nearer to actual delivery you are given them, the more likely you are to notice an effect in your baby, for example, they may be drowsy, and breastfeeding may be harder to establish.

Paracetamol
Some women take paracetamol in early labour, and indeed midwives often advise it. It's probably harmless, but you might like to think carefully about how helpful it might actually be, since paracetamol is known to inhibit prostaglandin synthesis. One midwife has called for an investigation into whether paracetamol use in early labour might cause longer and slower latent phases, or even be the cause of 'failure to progress'. More research needed, but meanwhile, unless you really think it's going to help, it might be best avoided.



Queen
If you ever had any ambitions for diva status, being in labour brings you a golden ticket. You really are the star of this show, so don't be afraid to behave as one, and put as many unreasonable 'riders' in your birth plan as you wish. If you only want red M&Ms in your dressing room, now is the time to say so. Asserting yourself, knowing your rights and being demanding is not only perfectly reasonable when you're birthing a brand new person, but it will also make you feel stronger and more in control, which can have real benefits in the white heat of contractions. How you are treated will directly affect how you feel and how you cope. And make the most of it: once the birth is over your royal status will be well and truly usurped by the one Sigmund Freud so aptly referred to as, 'His Majesty The Baby'.

Reframing
Ask yourself - if I'd paid fifty quid for a pill that made me feel this way, would I be enjoying it more? Or – if these sensations were occurring during an intense lovemaking session, how would I be experiencing them? This is a psychological technique known as 'reframing', seeing the same experience but through a different lens or frame. So think, 'The next contraction I will reframe as an orgasm'. When it comes, moan, rock and 'pretend' it's gorgeous. The power of your mind may surprise you.

Self belief
Do you really think you can do this? Have you prepared? Are you a tough cookie? Of course you do, of course you have, and of course you are, so please, believe in yourself. Researchers have actually found that women who go into labour feeling confident are more able to cope. The phrase, 'She believed she could, so she did', might be an overstatement: in labour, as in life, there are no guarantees. But it is true to say that your body knows what to do, so follow its lead and know that, whilst it may be tough, you can hack it.

Tens machine
This is small battery operated device with little pads that you stick on your sacrum area, where they deliver electrical impulses that feel like tingling sensations. You hold the control unit yourself and decide when to send the impulses and how strong they should be. The TENS is said to work by stimulating endorphins and reducing the number of pain signals sent to the brain. Some women love them, others don't want to be wired up to a gadget.

Urinate
Have a wee as often as you can because if you let your bladder get full this can cause not only a more painful labour but also make birth more difficult. If you really can't wee you may need a catheter. So right from the outset of labour, try to keep using the loo. In the throes of labour this can be a tough trip: one of the secret joys of water birth is that you can wee in the pool.

Vocalising
The voice is a natural form of pain relief and release. Anyone who has ever stepped on a piece of Lego in a sleeping child's bedroom will explain this phenomenon to you quite clearly. Shouting, roaring, swearing and hollering are necessary and useful responses to pain. In labour you can harness this idea but use your voice effectively – you don't want to waste energy. Moaning, chanting, singing or even mooing like a cow can feel absolutely brilliant. Keeping your noises low and sexy is generally more helpful than screaming or wailing, but do what feels right.



Water
Wallow in a deep pool, stand under a hot power shower, have your partner pour warm scoops over your back, run the taps or just stand next to a river: labouring women report that all kinds of water can help in all kinds of ways. It's the feminine element, and it's often used to help people and even animals in pain, so it makes sense that it would work for labour. Being in a water birth pool is widely reported to be bliss.

Xylophone
OK so I got a bit stuck on 'X', but this type of pain relief comes in the form of music, which can of course be played on the xylophone, although most prefer CD or Mp3. Your favourite music can uplift you, whether it's something to gyrate to in early labour or a meaningful piece that you have already enjoyed playing to your baby or listening to whilst visualising your birth. And there is a scientific basis to this: music stimulates areas of the brain and it's widely accepted it can influence our hormones and our mood. Although, even the scientists agree that Ring of Fire, the Beatles 'Help', and the theme tune from the Omen are all best avoided, (yes, even the xylophone versions).

Yoga
It's no surprise that pregnancy yoga has become such a 'thing', since the mind-body connection, focus on the breath, and attention to the power of movement that it brings can be just the ticket when it comes to coping with labour pain. Find a class that specialises in yoga for birth preparation, and allow the magic of peaceful, meditative shapes to go to work on your clumsy pregnant bod. In labour you will be able to draw on the techniques you have learnt and use them to help you cope.

Zone
Some call it Labour Land, some the Zone, some speak of a personal bubble. However you choose to name it, at some point in your labour you will withdraw to this place and, once you are there, you will be using many of the above and much much more to cope brilliantly with the roller coaster ride of labour. All of your attention will be demanded. Try to avoid anything that will take you out of the zone, for example, people you don't feel safe or comfortable with, interruptions, or being asked questions. Do not fear the Zone, many women love this place and find they feel strong and vital in it.

Milli's book, The Positive Birth Book, is available to buy from Amazon now

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Which method of pain relief did you use during labour? Let us know in the comments below!

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