Having a support person or a group of support people with you during your labour and birth can make it easier and more enjoyable.
A support person can provide emotional support and practical help during your labour. Women who have a support person during their labour and birth often:
- Cope better with labour pain.
- Use pain medications less often.
- Need less medical interventions.
- Have a shorter labour.
- See labour and birth as a positive experience.
Choose support people who you trust, make you feel comfortable, and who will be able to encourage you and advocate for you during labour.
A support person is usually someone other than a health care provider who knows you personally. A support person can be any of the following people:
- Your partner.
- A relative.
- A friend.
- A doula or other professional labour support person.
You may choose to have just one support person or you may choose to have several support people. Be clear with your family and friends who you would like to be present during your labour and birth. Let others know when they can visit after your baby is born. If you plan to give birth at a hospital or a birthing centre, learn about their labour support and visiting policies.
Do what makes you feel comfortable during labour.
There are many different options to help you cope with labour pain. Before labour, it can be helpful to review and even practice some theseÂ comfort measures to learn what may work best for you. During labour, do what makes you feel most comfortable.
Some comfort measures that may help during labour are:
- Changing positions.
- Using a birthing ball.
- Using a shower or bathtub.
- Having someone massage your back, hands, feet, or other parts of your body.
- Distraction activities such as watching television, reading, or surfing the internet.
- Listening to music.
- Meditation or visualization techniques.
- Breathing exercises.
- Sterile water injections done by your health care provider.
- Transcutaneous electrical nerve stimulation (TENS). This may require the purchase or the rental of the device in advance.
Ask questions to help you make informed choices.
Your health care provider might discuss information that you do not fully understand during labour and birth. Ask questions until you understand. This may ease any anxieties that you, your partner, and/or other support people might have. It will help you make informed decisions that are best for you and your baby. For more information about making informed choices, see the Interventions in Labour file.
Partners and other support people need to take care of their physical and emotional needs.
It can be helpful if your partner and/or other support people learn about labour and understand what you want for your labour and birth to be able to support you.
Labour can be long. It is important that your partner and other support people take care of themselves so that they can continue to support you. They need to keep hydrated, eat healthy food, and rest. If your partner is your only support person, you may consider having a relief person to fill in for short periods of time.
Learn more about labour support.
You can find out more about ways to cope with labour from the following resources. More suggestions can be found in the Resources and Links section.
- Your health care provider
- Your local public health unit 1-866-532-3161
About Labour Support
Labour is a natural, physiological process which all women go through in order to give birth vaginally.1,2,3,4 The pain associated with labour and birth is a normal part of the process. The way in which women experience and manage the pain associated with labour can vary.5,6,7
The emotional and physical support that a woman receives throughout her labour and birth can determine:7,8,9,10,11
- How well she is able to cope with the pain she experiences.
- Which coping measures she uses (either non-pharmacological or pharmacological).
- What, if any, medical interventions are needed during her labour and birth.
- How well she perceives her overall experience of labour and birth.
It is highly recommended that all women have a designated labour support person with them throughout their labour and birth.3,8,9,12
A labour support person
A labour support person is typically a non-medical person who provides support to a woman throughout labour and birth. This support is often different from that which health care providers can offer a woman during labour. Health care providers may not be able to be with the woman throughout her entire labour. They may also not know the woman on a personal level and understand what helps her cope with potentially stressful situations.3,8,12
A labour support person can provide support to a woman during labour by:2,3,6,8,9,12
- Being continually present and sharing in the overall experience with her.
- Providing her with emotional support in the form of reassurance and encouragement.
- Providing her with physical comfort as well as physical assistance with non-pharmacological coping measures.
- Helping her clarify information from health care providers and supporting her in making decisions that she feels comfortable with.
For many women, their labour support person is their partner. However, other people such as a relative, a friend, or a doula (i.e., a certified labour support person) can also serve as a support person. Additionally, a woman can find it helpful to have more than one support person present during her labour and birth.3,8,9,12
Benefits of having a labour support person
Numerous large-scale studies have shown that women who receive positive, continuous support throughout their labour are more likely to:3,6,7,8,9,12,13
- Use non-pharmacological coping measures more often throughout their labour.
- Feel more in control of their labour and birth process.
- Have more confidence in their ability to give birth.
- Use medication less often.
- Require medical interventions during labour and birth less often.
- Experience a vaginal birth.
- Have a shorter labour.
- Have a newborn with a higher Apgar score at birth (e.g., a score of 7 or more at five minutes of age).
- Experience a decreased risk of postpartum depression.
- Breastfeed for a longer duration.
- Be more satisfied with their labour and birth experience overall.
Women and their partners, if applicable, should be informed of the benefits of having a labour support person and the specific ways in which a support person can help a woman in labour. To be able to cope well with labour, a woman needs to have a strong support system.9,12
Support people in labour
The Maternity Experiences Survey (2006) found that 94.6 percent of women had their husband or partner present with them during their labour, and approximately 35.5 percent of women had a support person with them other than their husband or partner. Younger women aged 15 â 19 years and women living in a household at or below the low-income cut-off were more likely to have a support person other than their husband or partner with them during their labour and birth.14
From the results of a 2007 survey of hospitals across Canada that had at least 10 births per year, it was found that 99 percent of hospitals encouraged a womanâs partner to be involved during her labour and 80 percent of hospitals encouraged a womanâs partner plus another labour support person to be present during labour. Additionally, 60 percent of hospitals restricted the number of support people who could be in the room during labour. Of those with this policy, 78 percent of the hospitals had a restriction of two support people In Ontario, 46 percent of hospitals indicated that this policy had become more structured as a result of the severe acute respiratory syndrome (SARS) outbreak in 2003.
From the 2007 Canadian hospitals survey, it was found that doulas are not frequently utilized (at least in hospital settings). Of the hospitals surveyed, 87 percent reported that very few women received labour support from a doula;15 this may be due to the fee that most doulas charge.
Use and availability of non-pharmacological coping measures during labour
The 2006 Maternity Experiences Survey found that among women who gave birth vaginally or who attempted to give birth vaginally, the most frequently used non-pharmacological coping measures during labour were breathing exercises and position changes. The survey showed that 74.1 percent used breathing exercises and 69.5 percent used position changes.14
Following breathing exercises and position changes, baths or showers were the most commonly used non-pharmacological coping measure and were also reported to be the most helpful coping mechanism. Over half (54.8 percent) considered baths or showers to be âvery helpfulâ during labour.14 The 2007 Canadian hospitals survey indicated that 97 percent of hospitals had a bath or shower available for women to use during labour. However, there is no data available that indicated how many women used a bath or shower during labour.15
The 2007 Canadian hospitals survey reported that 99 percent of hospitals had âambulationâ available for pain control and that 63 percent of women used ambulation for pain control during labour. Comparatively, in 1993 only 94 percent of hospitals had ambulation available for pain control and an average of 62 percent of women used it for pain control during labour.15
In 2007 in Canada, 43 percent of hospitals had transcutaneous electrical nerve stimulation (TENS) available. The TENS device was mainly available in large teaching hospitals. The number of available TENS devices has increased since 1993 when it was only available in 30 percent of Canadian hospitals.15 The report did not indicate whether the TENS units were available free of charge or if there was a fee associated with use. There were no statistics on use during labour.
In 2007 in Canada, 24 percent of hospitals had sterile water injections available for pain control. This option was mainly available in large teaching hospitals. Less than 30 percent of women used sterile water injections for pain control during labour.15
In 2007, 13 percent of Canadian hospitals had acupuncture available for pain control. This option was mainly available in large teaching hospitals only.15
In 2007, in Canada only 1.0 percent of hospitals had a policy stipulating that drinking fluids during labour was not allowed and 14 percent of hospitals had a policy stipulating that eating was not allowed by labouring women. In practice, almost all women were permitted to drink fluids during labour.15 For more information, please see the section below on Eating and drinking during labour.
Experience and satisfaction
In the results of the 2006 Maternity Experiences Survey, 53.8 percent of women reported that their overall experience of labour and birth was âvery positiveâ and 26.2 percent of women reported that the experience was âsomewhat positive.â Additionally, 78.5 percent of women reported that they were âvery satisfiedâ with the respect shown to them during labour, 72.6 percent of women reported that concern was shown for their privacy and dignity, and 65.4 percent of women reported being âvery satisfiedâ with the compassion and understanding shown to them and the information given to them.14
Who is at Risk?
A woman may be at risk of receiving poor support for her labour and birth if5,6,7,8,16
- She does not have a partner or support person.
- She has difficulty communicating with her partner or support person.
- She feels uncomfortable with her partner or support person being with her during labour and birth.
- Her partner or support person feels uncomfortable or is overly anxious concerning the process of labour and birth and their ability to provide support during labour and birth.
- During a previous experience of labour or other experience of pain, the support the woman received and the non-pharmacological coping measures that she used were insufficient to help her cope with the pain she experienced.
If a woman or her partner has any of these risk factors, they should be informed that there are resources available that can help prepare them for labour and cope with labour. Attending prenatal classes and seeking the support from an experienced labour support person such as a doula are two possible suggestions for people who are at risk of poor labour support. See Referrals below, and the Resources and Links tab section for more information.
Choosing a Support Person for Labour
When partners also actively participate in the labour and birth of their child it can be highly beneficial because it can:17,18
- Decrease feelings of loneliness or exclusion.
- Decrease feelings of stress or anxiety.
- Bring the couple closer together and result in a more enjoyable experience for them.
- Result in an easier and more successful transition to parenthood for both parents.
It is recommended that a womanâs partner be involved as much as possible in the pregnancy, labour, and birth of their child. If a womanâs partner feels overly anxious or feels that he or she will be unable to provide adequate support during labour and birth, suggest that a relative, friend, or a doula act as part of their support system. It is important to understand the expectations and possible fears that expectant parents may have to ensure that they will have the best support possible during labour and birth.3,12,17,19
Women have differing social, cultural, and physiological needs resulting in differing needs during labour.6,19 If a woman does not have a partner, her partner is unable to be there, or she chooses not to have her partner present for labour and birth, it may be advisable to explore other options for support. As well, some women may choose to have extra support in addition to their partner. In all these situations, this support could come from a relative, a friend, or a doula.
In choosing a support person, a woman should try to choose someone who:3,12,13,19
- She trusts.
- Makes her feel at ease.
- She would feel comfortable with during her labour and birth.
- Encourages her to feel more confident.
- Listens to her and respects her decisions.
Women should be encouraged to choose support people who they think will provide the best support during labour. This may include one person, or it may include several people.3 During the prenatal period, women should be advised to check at their birth setting to determine if there is a restriction on the number of support people and visitors that are allowed in the room at one time. Due to safety concerns, some settings restrict the number of people in the room.15
A doula, which in Greek means a âwoman who servesâ, is a specially trained or experienced labour support person who can provide a woman and her partner or other support person(s) with extra support during labour. Doulas generally charge a fee for their service. Although doulas do not typically have medical training, they are often able to provide a labouring couple with information about events and procedures. They are also able to provide people with useful advice in carrying out non-pharmacological coping measures based on their experience. Doulas can provide partners or other support persons with respite as well so that they can take a break during labour.6,10,12,13,19,20,21
Expectant parents who are considering involving a doula in their labour and birth, should also be encouraged to meet with more than one doula until they find someone that is right for them.
When selecting a doula, expectant parents should be encouraged to ask questions concerning:21
- The type of training or certification the person has.
- The kind of experiences with labour and birth the person has had both personally and as a doula.
- The personâs philosophy about labour and birth.
- The role the person would play in their labour and birth.
- When the person would join them for support. (Possibilities to consider: at home; at the place of birth; as soon as labour begins, or at a different time).
- The personâs work schedule and what happens if she is not available when labour begins.
- If she has a backup doula that she works with regularly, and if they can meet this person.
- The personâs fee and refund policy.
- If she provides support for early postpartum care and breastfeeding.
Comfort Measures during Labour
The pain that a woman experiences during labour is complex and highly individualized. It involves both physiological and emotional components.5,6,7 There are a variety of coping measures a woman can use to deal with the pain she experiences during labour. Non-pharmacological coping measures do not involve the use of medications for pain relief. They are generally preferred over pharmacological coping measures as they involve little to no risk for a woman or her fetus, they allow a woman to have more control, and they can result in a shorter labour with fewer medical interventions.6,8,9,22,23
Women should be encouraged to explore a variety of non-pharmacological coping measures prior to their labour and birth to determine what they like and what might work best for them. Women can practice some of these coping measures such as position changes, breathing exercises, and meditation before labour begins. Involving their partner or other support persons in practicing these coping measures will ensure that they too are familiar with how the coping measures can help the labouring woman.6,9,22
Walking or ambulation can be helpful for women during labour especially during the early phase of labour. Walking can help distract a woman from the sensation of pain as well as help the fetus drop lower into her birth canal; this can then lead to a shorter labour.6,10 Walking with her support person during labour is safer than walking alone and can lead to a better experience overall.9,10
Women frequently change positions throughout labour. The benefits of regularly changing positions throughout labour can include:2,6,13,23,24
- Decreased feeling of pain with contractions.
- Increased blood flow to the baby.
- Widening of the pelvis to permit the baby to pass more easily through the birth canal.
- Improved descent of the baby into the birth canal due to the work of gravity and the effect of the pelvis moving around the babyâs head.
- A shorter labour.
- Less need for medical interventions.
- Less need for pharmacological coping measures.
Women and their partner or support person(s) should be encouraged to try a variety of positions at home prior to birth to determine what may be most comfortable. No position during labour is preferable over any other, but a health care provider may suggest a certain position to try in some situations.6 It is normal with any position change for there to be a temporary increase in pain for several contractions following the position change.
An upright position involves any of the following: walking, sitting, kneeling, and squatting.3,6 With an upright position, women can experience increased comfort, control, and improved circulation. With an upright position, gravity also works to help the fetus to descend further into the birth canal, which can lead to a shorter labour.8,9,24,25
Hands and knees position
The hands and knees position involves a woman kneeling on her knees and placing her hands on the surface in front of her. This position can be helpful during labour as it tends to take the pressure off the womanâs back. If a fetus is in an occipitoposterior position (i.e., face up), a woman can experience increased back pain with each contraction. Assuming the hands and knees position can relieve some of this pain for her, as well as possibly assist in turning the fetus prior to birth so that it is in an occipitoanterior position (i.e., face down).26,27
Rocking or swaying positions
Rhythmic movement such as rocking back and forth while sitting in a rocking chair or while standing during a contraction can help distract from the pain. The motion of swaying, like when slow-dancing, can also be beneficial. A woman can sway while leaning on her support person or against a wall to help her cope with the pain.6 To open up the pelvis while swaying, she can rest one of her feet on a chair and lunge toward either side.
A birthing ball or physiotherapy ball can be used by a woman while she tries a variety of labour positions. If a woman decides to use a birthing ball, it should be large enough so that when she sits on the ball her knees are bent at a 90-degree angle, and her feet are flat on the floor. Women can sit on the ball while leaning over a bed, or lean over the ball to support her upper body when in the hands and knees position. She can also place it against her lower back while leaning against a wall. It is helpful if her support person is behind her for safety and support while using the ball. The use of a birthing ball during labour can aid in relaxation as well as help to widen a womanâs pelvis in preparation for birth. Some birthing settings have birthing balls. If a woman wishes to use a birthing ball during her labour, it is advisable to check in advance to confirm that a birthing ball is available. A woman may also bring her own birthing ball. However, she should ensure that it is latex-free per many hospital policies.6,28
The following illustrations demonstrate a variety of different positions that can be encouraged during labour.
Possible Labour Positions
During labour, women may find using a shower or a bathtub, also referred to as water therapy or hydrotherapy, to be comforting. In particular, women often enjoy the warmth of the water and find that the pressure from the shower or the jets of the tub can act as a massage. Using a bathtub can also provide buoyancy, which can allow a woman to move more easily as well as feel less pressure with contractions.6,29,30,31
Prior to getting into a bathtub during labour, a health care provider will often ensure that a womanâs amniotic fluid is clear and that her vital signs, as well as the fetal heart rate, are within normal ranges. If a womanâs amniotic membrane has already ruptured, this does not mean she will be unable to use hydrotherapy. Women, however, are discouraged from getting into a bathtub if there is meconium in their amniotic fluid.6,29
There is no set time limit on how long women should remain in a shower or bathtub for pain relief during labour. If they find it beneficial, they should continue to do so for as long as they like. Some women may find that taking a break and then going back in may increase the effectiveness for them.
While use of a shower or a bathtub is highly recommended as a comfort measure for low-risk women in labour, to ensure safety, a woman should:6,29
- Take a break if her temperature exceeds 37.5Âș C. The temperature of the water should not exceed oneâs normal body temperature of 37.0Âș C.
- Drink plenty of fluids if in the shower or bath for an extended period of time to prevent overheating.
- Wear water shoes in the shower and in and around the bathtub to prevent slipping. A non-slip bath mat may also be helpful in the shower or bathtub to prevent slipping.
Many women are interested in showers and baths for pain relief during labour, and some women feel so comfortable that they consider giving birth in water. Some research has found that water births are associated with effective pain management, decreased use of interventions, less perineal trauma, and high maternal satisfaction. Risks associated with water birth such as neonatal aspiration upon birth and maternal and/or neonatal infection have not been well demonstrated.
While water birth is a more familiar option internationally, in Canada not all health care 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 in settings where there are clear protocols and health care providers who are experienced in managing water births. It is best for women to discuss the possibility of having a water birth with their health care provider if this is something that they desire.6,30,31
A woman can find simple touches comforting during labour. These touches may include hand holding, hugging, and a gentle stroking of her head, shoulder, back, hand, or foot. Light massage, referred to as effleurage, can also be relaxing for her. Touch can cue the woman to release tension where she is touched. A support person comfortable with touch and/or massage can provide this for her. Practicing massage techniques during pregnancy has the added benefit of providing relief of discomforts at that time as well.6,32,33
Women often find the application of counter pressure provides a great relief for back pain. Counter pressure involves the application of pressure using a fist or the heel of oneâs hand to a womanâs lower back, specifically her sacral area (i.e., the triangular area at the base of the spine). Tennis balls or rolling pins can also be used to apply pressure. This technique can be especially helpful for women who experience lower back pain during pregnancy and labour.
A method known as the double hip squeeze can also be helpful. For this, a support person sits or stands behind a woman, places his or her hands on the womanâs hips bones forming a W and pushes in and up. This can help push the pelvis back into a relaxed position as the baby pushes on the womanâs back during contractions.6
Rather than focus on the pain during labour, some women prefer to distract themselves from it. Distraction activities can involve doing anything that a woman enjoys such as watching television, reading, surfing the internet, or doing an activity such as knitting or playing a game. Such activities are most helpful during the early stage of labour when contraction pain is mild-to-moderate in intensity and a woman can still focus on the activity and enjoy it.6,7
Many non-pharmacological coping measures involve distracting a woman from the pain she feels. Walking, massage, showering and bathing, and listening to music are just a few of the other non-pharmacological coping measures that can preoccupy a womanâs senses to distract her from her pain. It is believed that the sensation of pain travels along nerve pathways to the brain, but only a limited number of messages can travel to the brain at one time. This is known as the gate control theory. Knowing that there is a physiological basis on which distraction activities are promoted may increase the likelihood that a woman will engage in them for pain relief.6,7
Listening to music can help labouring women relax and cope with the pain that they may experience. Women can be encouraged to prepare a music selection for themselves prior to their 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 her to be able to focus on the music and block out other sounds from her environment.6,7,34,35,36
How and what a woman thinks about during labour can have an effect on her ability to cope with labour. If a woman feels anxious during pregnancy or labour, she may find meditation helpful. Meditation involves connecting with oneâs inner self by intentionally focusing oneâs attention on bodily senses and trying to accept them in the moment without fear or anxiety. If a woman is meditating, it is helpful if she is in a comfortable position. If she focuses on a mantra, a specific word or phrase, this can also help her remain focused. A womanâs support person may be able to help her focus by reading out a script.6,37,38 Some women find that prayer has the same effect as meditation.
Visualization exercises can also help decrease anxiety. Visualization exercises involve imagining oneself somewhere else such as on a beach or in a garden, some place where worry and tension disappear. Listening to a CD or a support person talk about such a place can be helpful. If a woman is having difficulty coping with labour, it may help her to visualize her baby descending into her birth canal with each contraction. Such exercises can be most beneficial during labour if practiced during pregnancy.6,37,38 See the Resources and Links tab for examples of meditation and visualization exercises to try.
During labour, concentrating on oneâs breathing can help promote relaxation, which in turn can help decrease the intensity of pain associated with labour contractions. If a woman feels anxious during labour and begins to breathe very quickly, it can be important for her to focus on her breathing and slow it down. Hyperventilation can restrict oxygen supply for a woman and her baby. A support person can remind the woman to slow her breathing down if she is becoming anxious. The support person can also breathe with a woman to help her focus.
There are a variety of breathing techniques and practicing these prior to labour often allows a woman to be able to use them better during labour.6,39 Women should also be made aware that breathing is a physiological process. During labour, breathing patterns may change without having to consciously control them. It can, therefore, be helpful just to take note of the change in breathing patterns.
Slow breathing can be helpful when a woman is no longer able to talk through contractions or distract herself from contractions. Most women will do slow breathing instinctively, with or without the initial and ending breath frequently referred to as a cleansing breath.
To perform slow breathing, a woman:39
- Takes a deep breath in and then exhales with a sigh when a contraction is about to begin to let her partner or support person know that a contraction is beginning.
- Focuses her attention on an encouraging image, inhales slowly and quietly through her nose, and then exhales through her mouth while releasing tension in her shoulders, chest, and abdomen so that they relax. She repeats this pattern five to 12 times per minute throughout the contraction.
- Takes a deep breath and yawns or gives her partner or support person some other signal when the contraction is finished to mark its end.
Light breathing is often used when contractions are long, strong, and close together or if a woman finds that slow breathing is not working for her anymore.
To perform light breathing, a woman:39
- Takes a deep breath in and then exhales with a sigh when a contraction is about to begin to let her partner or support person know that a contraction is beginning.
- Focuses her attention on an encouraging image then inhales and exhales through her mouth making a sound on exhalation keeping her head and shoulder relaxed while she breathes.
- Lets out a long sigh when her contraction is finished.
Tip: To prevent from getting a dry mouth, women can put the tip of their tongue on the roof of their mouth as well as drink fluids in between contractions.39
Variable breathing is a type of light breathing. It involves light, shallow breathing with a longer, more pronounced exhalation. It is sometimes referred to as âpant-pant-blowâ or âhee-hee-hooâ breathing.
To perform variable breathing, a woman:39
- Takes a deep breath in and then exhales with a sigh when a contraction is about to begin to let her partner or support person know that a contraction is beginning.
- Focuses her attention on an encouraging image then inhales through her mouth and performs light, shallow breathing for two to four breaths and then, after one inhalation, exhales slowly allowing her body to go limp. She then begins a rhythm and after every second or fourth inhalation (whichever rhythm which best for her) she exhales in a longer breath and may make a âhooâ or âpuhâ sound on exhalation.
- Lets out a long sigh when her contraction is finished.
Contraction-tailored breathing can be beneficial when contractions peak slowly. To do this type of breathing, a woman begins with slow breathing as a contraction begins and then switches to light breathing when it peaks and then resumes slow breathing while it tapers off again.39
Slide breathing is a good alternative to light breathing if a woman finds light breathing uncomfortable or if she has asthma. To perform slide breathing, a woman inhales slowly and deeply through her nose as if doing slow breathing, but when she exhales she lets out three or four puffs of air.39
As opposed to engaging in breathing techniques, women may also find it helpful to moan, grunt, or make other noises to cope with the pain that they experience during labour. Women should be encouraged to say or do whatever helps them cope best. Moaning, in particular, promotes relaxation as it opens the throat instead of tightening the way it does when one cries or screams.6,7,39
Sterile water injections involve the injection of small amounts of sterile water (0.005 to 0.1mL) into four specific locations on a womanâs lower back. The injections are done with a fine needle by a trained health care professional. They are used to relieve severe back pain. A stinging sensation at the time of the injections is likely the only adverse effect.
Sterile water injections are believed to decrease pain for a woman in labour by causing a smaller amount of pain or irritation in an area of her body, thereby distracting her from other feelings of pain that she is experiencing. This follows the gate control theory mentioned earlier. The effect of sterile water injections lasts about one to two hours, but the injections can be repeated when the effect wears off. Sterile water injections are not effective for all women, but may be tried if desired.6,25,40,41
Sterile water injections are not commonly used.15 However, if a woman wants to try this coping method during her labour, she should discuss this with her care provider before going into labour.
Transcutaneous electrical nerve stimulation (TENS) involves the placement of a pair of electrodes on either side of the base of womanâs spine at the onset of labour. These electrodes connect to a battery-operated device that provides a mild continuous electrical current to the area. During a contraction, the woman can increase the amount of the current she receives by turning a knob on the device. She will experience a tingling or vibrating sensation that is believed to distract her from the labour pain she is experiencing. Varying degrees of pain relief have been reported with the use of TENS by women during labour, from no pain relief to mild or moderate pain relief, especially lower back pain.6,42,43,44 The use of a shower or tub is contraindicated when a woman is wearing a TENS unit.
If a woman would like to use TENS during her labour, she will need to discuss this with her health care provider. Also, she will need to obtain a TENS unit at least one month before her due date so that she can receive adequate training. If her health care provider or place of birth does not supply TENS units, she will need to rent a unit privately.
Using heat for pain relief during labour can involve a woman taking a warm bath or shower, covering up with a warm blanket, or applying hot packs to areas of her body. Some women find that applying a warm pack to their lower back or their perineum can be especially comforting for them during labour. These areas often become tense or painful as labour progresses. Warmth helps muscles to relax and increases blood flow. If a woman chooses to use heat for comfort during labour, she should be encouraged to drink extra fluids and to take breaks from the source of heat to prevent overheating. Hot packs should always be wrapped in a cloth or a towel to protect a womanâs skin from burns.6,45
As labour progresses, women tend to produce a lot of heat and may actually find that the warmth that provided relief for them before may, in fact, become uncomfortable. In this case, women can find it comforting if cool cloths or an ice pack are applied to areas of their body such as their back, chest, back of the neck, and face. As with hot packs, cold packs should be wrapped in a cloth or towel. They should never be applied to an area that is anesthetized (i.e., frozen from the use of medications) to prevent skin damage.6,8
Many women find it helpful to alternate between the use of hot and cold comfort measures during labour. Women should be encouraged to try both methods and use what provides the most relief.6,8
Acupressure involves applying pressure with oneâs fist, the heel of oneâs hand, or the pads of oneâs fingers and thumbs to specific points on the body termed tsubos, which are believed to have an abundance of nerve receptors. Areas with an abundance of nerve receptors include the shoulders, neck, lower back, hips, behind the knees, ankles, and feet. Acupressure may be able to distract a woman from the pain she feels during labour to effectively help her relax.6,46 This may not be true for all women and more studies are needed to determine the effectiveness for pain relief for women in labour.47,48
Inserting fine needles into areas of the body which are believed to have an abundance of nerve receptors is termed acupuncture. Acupuncture is a traditional Chinese method that is said to correct imbalances in qi or vital energy. This method of pain relief has been proven helpful for some women, but more studies are needed to determine its effectiveness for pain relief for women in labour.6,7,48,49 Only a certified acupuncture therapist should perform the acupuncture during labour.6
There is also some evidence that states that acupuncture during pregnancy could induce labour. Women should be cautious about using acupuncture during pregnancy until there is further evidence.
Aromatherapy involves using oils made from plants and herbs that have a pleasant smell. Certain smells can have a calming effect and aromatherapy can be beneficial for women in labour. Lavender and sage, in particular, tend to have calming effects.6,8,50 Some smells may remind people of pleasant memories.7 Aromatherapy has not been shown to be effective in pain control for all women in labour, but it still can be a part of a womanâs supportive therapy if she wishes.47,51 If a woman plans to use aromatherapy during labour, she should try using the particular oil before labour to ensure that she does not experience any adverse effects.6
Caution: Aromatherapy oils should never be applied directly to oneâs skin without first being diluted.6,50
Caution: Inhaling the vapours from some aromatherapy oils can cause headaches and nausea. Women should not use aromatherapy oils for the first time during labour.6
Please note that a woman should check at her birth setting to learn about their policy concerning scents. Many hospitals are now scent-free to protect people who have sensitivities to various scents.52
Traditionally, only clear liquids, ice chips, or nothing by mouth were recommended for women during labour to minimize their risk of complications from anesthesia if it was needed. Such complications involve the aspiration of stomach contents during general anesthesia. Women having a caesarean birth are now more often given regional in which they are awake. Therefore, as drinking and eating snacks provides women with needed energy throughout labour, this practice is now generally recommended. A care provider may only recommend otherwise in rare instances.2,36,10,53,54
In addition, women should be encouraged to try to urinate frequently, about every two hours, throughout labour as a full bladder can put increased pressure on their uterus during contractions. A full bladder can also prevent descent of the fetus into the birth canal.6,55
The overall environment for a woman in labour should be pleasing and comforting. Dim lights and minimal noise can be beneficial for women. Also, women may find comfort in having touches of home with them such as their own pillow, blanket, and clothes.
The temperature and air circulation of some birth settings can be difficult to control. Therefore, it can help to bring layers of clothing and a small fan that plugs into the wall or is hand-held and battery-operated.2,3,6,39
Making Informed Decisions
During labour, it is important for a woman and her partner to stay informed and to be involved in the decision-making process together with the health care providers. A womanâs partner and/or support person can be influential in facilitating this. It is important to ask questions and to be involved in the labour process because if a woman is fearful or feels that she is not in control of her labour, it may be difficult for her to cope with labour. Comparatively, if a partner or other support person feels fearful or unsure of something it can interfere with his or her ability to provide adequate support for the woman. Feelings of dissatisfaction with oneâs labour and birth can also affect how well new parents cope during the postpartum period and in early parenting.3,6,9,11,16,56
When asked to make a decision about preferred coping measures during labour, a woman and her partner and/or support person(s) should:3,6,57
- Ask as many questions as needed to be able to understand their options.
- Ask to see written information on the topic if they feel that the verbal information that they receive is insufficient.
- Take the time to think about and to discuss the options before a decision is made, unless it is an emergency situation and decisions have to be made quickly.
Making decisions in this manner can ease anxieties a woman and her partner and/or her support person(s) may have. In addition, this allows women and their partners to make the best possible decisions for themselves and their baby.56,57 See the Interventions in Labour file for information on giving informed consent.
The Needs of Support People
Prenatal educators typically provide pregnant women and their support person with:
- Education on the process of labour and birth.
- Information on possible coping measures to try throughout labour.
- Time to practice a variety of these coping measures.
The support person can take time before labour to learn about the coping measures that work and do not work for the woman. Knowing what coping measures work and what does not work can boost the support personâs confidence in being able to support the woman during labour. During this time, a support person may also learn that they do not feel that they will be able to adequately support the woman alone during labour. It is important to know prior to the beginning of labour if the support person feels they are not able to provide adequate support so that extra support can be arranged.16,17,58
Partners and other support people can feel stress and anxiety during labour. It is not easy seeing a loved one in pain. Partners and other support people need to use strategies to cope with their feelings. This may involve communicating with the health care provider and taking part in some of the non-pharmacological coping measures mentioned in this section such as going for a walk, taking part in breathing exercises, or listening to music. Overall, partners and other support people should ensure that they take care of themselves emotionally so that they are able to support the woman the best that they can.6,17
Labour can be long and so partners and other support people need to take care of themselves physically as well. They need to drink fluids, eat healthy foods, and rest when possible. Short breaks away from the labouring woman may be considered as well. Having an extra support person for such occasions may be beneficial.6,17
Referrals for support during labour may be warranted if:
- The expectant woman does not think that she has adequate support.
- The partner and/or support person does not think that he and/or she is adequately able to support the woman during labour and birth.
- The expectant woman and/or her support person(s) require more information about coping measures during labour.
Women and/or their support person(s) who require more support and/or information about support during labour can be referred to the following sources:
- A doula or other experienced support person.
- Their primary health care provider (obstetrician, family physician, Nurse Practitioner, or midwife).
- In-person prenatal education classes, if not already enrolled.
- Their local public health unit.
- Social worker or counsellor.
Resources & Links
- Canadian Association of Midwives (CAM)
- Registered Nursesâ Association of Ontario (RNAO)
- Society of Obstetricians and Gynaecologists of Canada (SOGC)
- Association of Ontario Midwives (AOM)
- Canadian Association of Midwives (CAM)
- Childbirth and Postpartum Professional Association (CAPPA)
- International Childbirth Education Association (ICEA)
- Lamaze International
- Buckley, S. J. (2015). Hormonal physiology of childbearing: Evidence and implications for women, babies, and maternity care. Washington, DC: Childbirth Connection Programs, National Partnership for Women and Families. Retrieved from www.transform.childbirthconnection.org/reports/physiology/
- National Aboriginal Health Organization (NAHO)
- Ontario Public Health Association (OPHA)
- Public Health Agency of Canada
- Association of Ontario Doulas (AOD)
- Canadian Womenâs Health Network (CWHN)
- Lamaze International: For Parents
- Ontario Ministry of Health and Long-Term Care
Prenatal Education Provider Tools
- Best Start Resource Centre (BRSC)
- International Childbirth Education Association (ICEA)
- Penny Simkin
Client Resources and Handouts
- Best Start Resource Centre (BRSC)
- Buckley, S. J. (2008). Gentle birth, gentle mothering: A doctor’s guide to natural childbirth and gentle early parenting choices. New York, NY: Random House LLC.
- Simkin, P. (2013). The birth partner: A complete guide to childbirth for dads, doulas, and all other labor companions (4th ed). Boston, Ma: Houghton Mifflin Harcourt
- Buckley, S. J. (2015). Hormonal physiology of childbearing: Evidence and implications for women, babies, and maternity care. Washington, DC: Childbirth Connection Programs, National Partnership for Women and Families. Retrieved from http://www.childbirthconnection.org/resources/resources-q-a/advocates-and-professionals.html
- Canadian Association of Midwives. (2010). Position statement: Midwifery care and normal birth. Montreal, QC: Author. Retrieved from http://www.canadianmidwives.org/DATA/DOCUMENT/CAM_ENG_Midwifery_Care_Normal_Birth_FINAL_Nov_2010.pdf
- Health Canada. (2000). Chapter 5: Care during labour and birth. Family-centred maternity and newborn care: National guidelines (pp.5-49). Ottawa, ON: Author.
- Society of Obstetricians and Gynaecologists of Canada. (2008). Joint policy statement on normal childbirth. Journal of Obstetrics and Gynaecology Canada, 30(12), 1163-1165. Retrieved from http://www.jogc.com/
- Lowe, N. K. (2002). The nature of labor pain. American Journal of Obstetrics and Gynecology, 186(5), S16-S24. doi: 10.1016/S0002-9378(02)70179-8
- Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2013). Unit 4: Childbirth. In C. Sams & L. Keenan-Lindsay (Eds.), Maternal child nursing care in Canada (pp. 378-488). Toronto, ON: Elsevier Canada.
- Trout, K. K. (2004). The neuromatrix theory of pain: Implications for selected nonpharmacologic methods of pain relief for labor. Journal of Midwifery & Womenâs Health, 49(6), 482-488. doi: 10.1016/S1526-9523(04)00357-5
- Simkin, P., & Bolding, A. (2004). Update on nonpharmacologic approaches to relieve labor pain and prevent suffering. Journal of Midwifery & Womenâs Health, 49(6), 489-504. doi: 10.1016/j.jmwh.2004.07.007
- Albers, L. L. (2007). The evidence for physiologic management of the active phase of the first stage of labor.Journal of Midwifery & Womenâs Health, 52(3), 207-215. doi: 10.1016/j.jmwh.2006.12.009
- El-Hamamy, E., & Arulkumaran, S. (2005). Poor progress of labour. Current Obstetrics & Gynaecology, 15(1), 1-8. http://dx.doi.org/10.1016/j.curobgyn.2004.09.001
- Simkin, P. (1991). Just another day in a woman’s life? Women’s longâterm perceptions of their first birth experience. Part Birth, 18(4), 203-210. doi: 10.1111/j.1523-536X.1991.tb00103.x
- Hodnett, E. D., Gates, S., Hofmeyr, G. J., Sakala, C., & Weston, J. (2011). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, 2(CD003766), 1-100. doi: 10.1002/14651858.CD003766.pub3
- Enkin, M., Keirse, M. J., Chalmers, , & Enkin, E. (2000). A guide to effective care in pregnancy and childbirth (3rd ed.). New York, NY: Oxford University Press.
- Public Health Agency of Canada. (2009). What mothers say: The Canadian maternity experiences survey. Ottawa, ON: Author. Retrieved from http://www.phac-aspc.gc.ca/rhs-ssg/survey-eng.php
- Public Health Agency of Canada. (2012). Canadian hospitals maternity policies and practices survey. Ottawa, ON: Author. Retrieved from http://www.phac-aspc.gc.ca/rhs-ssg/chmpps-eppmhc-2012-eng.php
- Gibbins, J., & Thomson, A. M. (2001). Women’s expectations and experiences of childbirth. Midwifery, 17(4), 302-313. doi: 10.1054/midw.2001.0263
- BĂ€ckstrĂ¶m, C., & Hertfelt Wahn, E. (2011). Support during labour: First-time fathersâ descriptions of requested and received support during the birth of their child. Midwifery, 27(1), 67-73. doi: 10.1016/j.midw.2009.07.001
- Longworth, H. L., & Kingdon, C. K. (2011). Fathers in the birth room: What are they expecting and experiencing? A phenomenological study. Midwifery, 27(5), 588-594. doi: 10.1016/j.midw.2010.06.013
- Rosen, P. (2004). Supporting women in labor: Analysis of different types of caregivers. Journal of Midwifery & Womenâs Health, 49(1), 24-31. doi: 10.1111/j.1542-2011.2004.tb04404.x
- PascaliâBonaro, D., & Kroeger, M. (2004). Continuous female companionship during childbirth: A crucial resource in times of stress or calm. Journal of Midwifery & Womenâs Health, 49(1), 19-27. doi: 10.1016/j.jmwh.2004.04.017
- Simkin, P., & Way, K. (1998). Position paper: The doula’s contribution to modern maternity care. Chicago, IL: Doulas of North America. Retrieved from http://www.dona.org/PDF/BDPositionPaper.pdf
- Escott, D., Spiby, H., Slade, P., & Fraser, R. B. (2004). The range of coping strategies women use to manage pain and anxiety prior to and during first experience of labour. Midwifery, 20(2), 144-156. doi: 10.1016/j.midw.2003.11.001
- Zwelling, E. (2010). Overcoming the challenges: Maternal movement and positioning to facilitate labor progress. MCN: The American Journal of Maternal/Child Nursing, 35(2), 72-78. doi: 10.1097/NMC.0b013e3181caeab3
- Lawrence, A., Lewis, L., Hofmeyr, G. J., Dowswell, T., & Styles, C. (2009). Maternal positions and mobility during first stage labour. Cochrane Database of Systematic Reviews, 2(CD003934), 1-67. doi: 10.1002/14651858.CD003934.pub2
- Simkin, P. P., & O’Hara, M. (2002). Nonpharmacologic relief of pain during labor: Systematic reviews of five methods. American Journal of Obstetrics and Gynecology, 186(5), S131-S159. doi: 10.1016/S0002-9378(02)70188-9
- Hunter, S., Hofmeyr, G. J., & Kulier, R. (2007). Hands and knees posture in late pregnancy or labour for fetal malposition (lateral or posterior). Cochrane Database of Systematic Reviews, 4(CD001063), 1-16. doi: 10.1002/14651858.CD001063.pub3
- Stremler, R., Hodnett, E., Petryshen, P., Stevens, B., Weston, J., & Willan, A. R. (2005). Randomized controlled trial of handsâandâknees positioning for occipitoposterior position in labor. Birth, 32(4), 243-251. doi: 10.1111/j.0730-7659.2005.00382.x
- Taavoni, S., Abdolahian, S., Haghani, H., & Neysani, L. (2011). Effect of birth ball usage on pain in the active phase of labor: A randomized controlled trial. Journal of Midwifery & Womenâs Health, 56(2), 137-140. doi: 10.1111/j.1542-2011.2010.00013.x
- British Columbia Perinatal Health Program. (2007). Obstetric guideline 4: Pain management options during labour. Vancouver, BC: Author. Retrieved from http://www.perinatalservicesbc.ca/Documents/Guidelines-Standards/Maternal/PainManagementGuideline.pdf
- Cluett, E. R., & Burns, E. (2013). Immersion in water in labour and birth. Sao Paulo Medical Journal, 131(5), 364-364. doi: 10.1002/14651858.CD000111.pub3
- College of Midwives of British Columbia. (Revised 2014). Guideline for the use of water in labour and birth. Retrieved from http://cmbc.bc.ca/standards-policies-forms/standards-policies-and-forms/
- Kimber, L., McNabb, M., Mc Court, C., Haines, A., & Brocklehurst, P. (2008). Massage or music for pain relief in labour: A pilot randomised placebo controlled trial. European Journal of Pain, 12(8), 961-969. doi: 10.1016/j.ejpain.2008.01.004
- Smith, C. A., Levett, K. M., Collins, C. T., & Jones, L. (2012). Massage, reflexology and other manual methods for pain management in labour. Cochrane Database of Systematic Reviews, 2(CD009290), 1-43. doi: 10.1002/14651858.CD009290.pub2
- Browning, C. A. (2000). Using music during childbirth. Birth, 27(4), 272-276. doi: 10.1046/j.1523-536x.2000.00272.x
- Liu, Y. H., Chang, M. Y., & Chen, C. H. (2010). Effects of music therapy on labour pain and anxiety in Taiwanese firstâtime mothers. Journal of Clinical Nursing, 19(7â8), 1065-1072. doi: 10.1111/j.1365-2702.2009.03028.x
- Phumdoung, S., & Good, M. (2003). Music reduces sensation and distress of labor pain. Pain Management Nursing, 4(2), 54-61. doi: 10.1016/S1524-9042(02)54202-8
- Beddoe, A. E., & Lee, K. A. (2008). Mindâbody interventions during pregnancy. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 37(2), 165-175. doi: 10.1111/j.1552-6909.2008.00218.x
- Davis, E. (2014). Making the most of meditative moments. Toronto, ON: Barbara Gates.
- International Childbirth Education Association. (2011). The ICEA guide to pregnancy and birth. Raleigh, NC: Author.
- Derry, S., Straube, S., Moore, R. A., Hancock, H., & Collins, S. L. (2012). Intracutaneous or subcutaneous sterile water injection compared with blinded controls for pain management in labour. Cochrane Database of Systematic Reviews, 1(CD009107), 1-38. doi: 10.1002/14651858.CD009107.pub2.
- MĂ„rtensson, L., & Wallin, G. (2008). Sterile water injections as treatment for lowâback pain during labour: A review. Australian and New Zealand Journal of Obstetrics and Gynaecology, 48(4), 369-374. doi: 10.1111/j.1479-828X.2008.00856.x
- Chao, A. S., Chao, A., Wang, T. H., Chang, Y. C., Peng, H. H., Chang, S. D., . . . Wong, A. M. (2007). Pain relief by applying transcutaneous electrical nerve stimulation (TENS) on acupuncture points during the first stage of labor: A randomized double-blind placebo-controlled trial. Pain, 127(3), 214-220. doi: 10.1016/j.pain.2006.08.016
- Dowswell, T., Bedwell, C., Lavender, T., & Neilson, J. P. (2009). Transcutaneous electrical nerve stimulation (TENS) for pain management in labour. Cochrane Database of Systematic Reviews, 2(CD007214), 1-72. doi: 10.1002/14651858.CD007214.pub2
- Sluka, K. A., & Walsh, D. (2003). Transcutaneous electrical nerve stimulation: basic science mechanisms and clinical effectiveness. The Journal of Pain, 4(3), 109-121. doi: 10.1054/jpai.2003.434
- Dahlen, H. G., Homer, C. S., Cooke, M., Upton, A. M., Nunn, R. A., & Brodrick, B. S. (2009). âSoothing the ring of fireâ: Australian women’s and midwivesâ experiences of using perineal warm packs in the second stage of labour. Midwifery, 25(2), e39-e48. doi: 10.1016/j.midw.2007.08.002
- Lee, M. K., Chang, S. B., & Kang, D. H. (2004). Effects of SP6 acupressure on labor pain and length of delivery time in women during labor. Journal of Alternative & Complementary Medicine, 10(6), 959-965. doi: 10.1089/acm.2004.10.959.
- Smith, C. A., Collins, C. T., Cyna, A. M., & Crowther, C. A. (2006). Complementary and alternative therapies for pain management in labour. Cochrane Database of Systematic Reviews, 4(CD003521), 1-51. doi: 10.1002/14651858.CD003521.pub2
- Smith, C. A., Collins, C. T., Crowther, C. A., & Levett, K. M. (2011). Acupuncture or acupressure for pain management in labour. Cochrane Database of Systematic Reviews, 7(CD009232). doi: 10.1002/14651858.CD009232
- Cho, S. H., Lee, H., & Ernst, E. (2010). Acupuncture for pain relief in labour: A systematic review and metaâanalysis. BJOG: An International Journal of Obstetrics & Gynaecology, 117(8), 907-920. doi: 10.1111/j.1471-0528.2010.02570.x
- Bharkatiya, M., Nema, R. K., Rathore, K. S., & Panchawat, S. (2008). Aromatherapy: Short overview. International Journal of Green Pharmacy, 2(1), 13-16. Retrieved from http://www.stikeskarsahusada.ac.id/files/IntJGreenPharm211-3367213_092112.pdf
- Burns, E. E., Blamey, C., Ersser, S. J., Barnetson, L., & Lloyd, A. J. (2000). An investigation into the use of aromatherapy in intrapartum midwifery practice. The Journal of Alternative and Complementary Medicine, 6(2), 141-147. doi: 10.1089/acm.2000.6.141
- Senger, E. (2011). Scent-free policies generally unjustified. Canadian Medical Association Journal, 183(6), E315-E316. doi: 10.1503/cmaj.109-3800
- American College of Midwives. (2008). Providing oral nutrition to women in labour. Journal of Midwifery and Womenâs Health, 53(3), 276-283. doi: 10.1016/j.jmwh.2008.03.006
- Singata, M., Tranmer, J., & Gyte, G. M. (2010). Restricting oral fluid and food intake during labour. Cochrane Database of Systematic Reviews, 1(CD003930), 1-89. doi: 10.1002/14651858.CD003930.pub2
- Caton, D., Corry, M. P., Frigoletto, F. D., Hopkins, D. P., Lieberman, E., Mayberry, L., . . . Young, D. (2002). The nature and management of labor pain: Executive summary. American Journal of Obstetrics and Gynecology, 186(5), S1-S15. doi: 10.1067/mob.2002.123102
- Bylund, C. L. (2005). Mothers’ involvement in decision making during the birthing process: A quantitative analysis of women’s online birth stories. Health Communication, 18(1), 23-39. doi: 10.1207/s15327027hc1801_2
- Dugas, M., Shorten, A., DubĂ©, E., Wassef, M., Bujold, E., & Chaillet, N. (2012). Decision aid tools to support women’s decision making in pregnancy and birth: A systematic review and meta-analysis. Social Science & Medicine, 74(12), 1968-1978. doi: 10.1016/j.socscimed.2012.01.041
- Escott, D., Slade, P., & Spiby, H. (2009). Preparation for pain management during childbirth: The psychological aspects of coping strategy development in antenatal education. Clinical Psychology Review, 29(7), 617-622. doi: 10.1016/j.cpr.2009.07.002