Overview

A lot of things need to come together for you to have the birth experience you want. Your birth room environment should feel safe and calm. You need methods to keep you focused and relaxed so you are not mentally depleted. You also need techniques to relieve physical symptoms during labor, like nausea, exhaustion, and pain. Labor is an intense experience, and it is a marathon. There is not one universal tool that magically works for every mother in labor. Having lots of tools in your toolbox is essential. This article overviews tools ranging from inexpensive gadgets you can buy on Amazon to free and easy evidence-based techniques for an easier labor and birth.

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Article and Resources

You have likely heard me mention that having many tools in your toolbox for labor and birth is essential. Some episodes dive deep into particular tools or techniques like a rebozo, breathing during labor, labor positions, or hypnobirthing. This article overviews tools you can utilize for labor and birth. Labor is an intense experience, and it is a marathon. Some of these tools are inexpensive items you can buy on Amazon; others are techniques you can learn and practice. You need numerous tools to get you through different stages and keep labor progressing.

Education

The number one tool you can have in your toolbox is education. With each episode of this podcast, you are educating yourself to better prepare for labor and birth. Knowledge is power. The more you learn about labor and birth and how you can utilize different tools, the more prepared you will be when you go into labor, and the better you can work through contractions and keep your labor progressing.

Birth Class

A fantastic way to educate yourself is to take a birth class. The techniques you learn are tools you can utilize during your labor. Most birth classes focus on a particular method, like hypnobirthing, the Bradley Method, Lamaze, etc. If you plan an unmedicated birth, you should take a birth class with that focus. The hospital or birth center may have a birth class available, and there are also other options in your community or online. Whether you take a class in-person or virtually, your partner should attend.

Birth Plan

One tool you should have is a birth plan. A birth plan is much more than a piece of paper you hand to your care provider. It is the process you go through to prepare for the birth experience you want. This process will lay the foundation for being ready for the scenario in which everything goes exactly as planned and for what should happen if things do not go as planned. When you create a birth plan, you enter your labor prepared and confident because you have done the work beforehand. You can focus on meeting your baby rather than analyzing the pros and cons of interventions and making decisions while laboring. When done right, you will also prepare for alternative scenarios like a transfer from home or a birth center to a hospital or an unplanned cesarean.

There are many resources from the Pregnancy Podcast to assist you in creating and writing your birth plan. Start with Your Guide to Creating Your Birth Plan.

Breathing

Controlling your breath during labor can promote relaxation and help you cope with contractions. Whether you are planning an un-medicated birth, you know you want an epidural, or even during a cesarean birth, breathing techniques can be helpful. By controlling your breathing, you may feel more in control, which can be very empowering.

When you are under stress, your sympathetic nervous system increases your heart and respiration rates, which causes your fight-or-flight response. This communication can go both ways. Breathing in short, shallow breaths can activate your sympathetic nervous system. On the other hand, breathing slowly and deeply activates your parasympathetic nervous system, which promotes relaxation and even increases endorphins. 

There isn’t a right or wrong way to breathe during labor. You will need to find what works best for you, which may change as your labor changes. The breathing that tends to be most common during labor is diaphragmatic breathing. This is also sometimes called belly breathing or abdominal breathing because as you inhale deeply, your belly expands or goes outward. Diaphragmatic breathing increases oxygen, decreases blood pressure, lowers heart rate, and activates the parasympathetic nervous system.

You usually take about 10-20 breaths per minute. With slow breathing, you want to aim closer to six. Typically, you would slowly inhale through your nose and slowly exhale through your mouth. You can imagine the air going to the bottom of your lungs and slowly filling them up. Or imagine breathing all the way down to your baby. Try this and notice your belly going out as you take deep breaths. Conversely, try short, shallow breaths and see how your chest rises rather than your belly. 

There is also a specific breathing technique you may want to use during the pushing stage of labor. One study compared one group that was instructed to take a deep breath at the start of a contraction, hold it, and push. The other group was asked to use deep breathing, to breathe out with an open mouth while pushing, and to use a method called blowing when their baby was crowning. (Picture blowing out candles on a birthday cake.)

The idea is that this slows your baby coming out, which gives your perineum more time to stretch, and your baby is emerging as a result of contractions, not as a result of your pushing. 40% of the group who used the breathing techniques had an intact perineum, meaning there was no tear, compared to 20% in the control group. The group that practiced the breathing and blowing technique had more first-degree tears but fewer 2^nd and 3rd-degree.

See this episode for more information on breathing during labor.

Hydrotherapy

Hydrotherapy can be a powerful tool to apply in labor by birthing in water or taking a bath or shower. In a study of 80 participants, 39 had warm showers during labor for 20 minutes at a time. They found that warm showers improved the birth experience and decreased labor pain. Another study that utilized 30-minute showers during active labor found that the showering group had statistically significant decreases in pain, discomfort, anxiety, and tension and a significant increase in relaxation. You can try a shower at home or at a hospital or birth center.

While water births are increasing, most births in the United States occur in hospitals where water birth may not be an option. Two central authorities on pregnancy and childbirth, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists agree on the official opinion on water births. The opinion states that immersion in water during the first stage of labor may be associated with a shorter labor and decreased use of spinal and epidural analgesia and may be offered to healthy women with uncomplicated pregnancies between 37 0/7 weeks and 41 6/7 weeks of gestation.  

They state there is insufficient data on which to draw conclusions regarding the relative benefits and risks of immersion in water during the second stage of labor and delivery. Therefore, until such data are available, it is the recommendation of the American College of Obstetricians and Gynecologists that birth occurs on land, not in water. A woman who requests to give birth while submerged in water should be informed that the maternal and perinatal benefits and risks of this choice have not been studied sufficiently to either support or discourage her request.  

Proponents of water birth claim that it is beneficial in managing discomfort from contractions, promotes relaxation, and eases stress for your baby during birth. Critics of the practice raise concerns about the safety of water births, risks associated with respiratory issues for the baby, and the risk of infection for both you and your baby. See this episode for an examination of the evidence on water birth.

If you are interested in water birth, the first step is to discuss your options with your care provider. You will need to ensure you are a good candidate, given the specifics of your pregnancy and any possible risk factors. You can advocate for yourself if you want a waterbirth and think you are a good candidate. If no permanent tub is available, you may be able to bring in an inflatable one. If your doctor or midwife is reluctant to support your birthing in the water, you can always ask why or point out that ACOG supports allowing mothers to be in the water for the first stage of labor.

Tools to Transform Your Environment

No matter where you have your baby, you can adjust your surroundings. There is evidence that the sensory environment in your labor room can impact your labor and birth. The goal is to make your birth room a calming, safe environment.

You can easily change the lighting in your environment. You can dim or turn off lights, adjust blinds or curtains, or use battery-operated candles.

Sound can be a game changer for your environment. This could include music, meditations, or even white noise or ocean sounds to drown out other noises that can be distracting. If you want specific music, create a playlist and download it to your phone to access it without Wi-Fi. Having headphones to focus and not hear other noises around you will be helpful. If your care provider uses continuous monitoring with an electronic fetal monitor, you can request to turn the volume down or off on monitors or other machines that beep or make noises.

Your olfactory system, or sense of smell, is directly connected to your brain. You have a heightened sense of smell during pregnancy. At home you can control the smells. At a birth center or hospital, you may smell cleaning products and chemicals used throughout the facility that won’t help you feel comfortable and relaxed. You can bring something from home, like a blanket that smells like home or a scented candle. Keep in mind that you may not be able to light a candle if it is against the policy of the hospital or birth center. Even an unlit candle may help fill the room with a pleasant scent.

Essential oils are another tool to change your environment’s smell. Plus, they can target specific ailments like nausea or pain during labor. Hospitals and birth centers may have a policy against using a diffuser. You can put oils on cotton balls and store them in a Ziploc bag between uses. If a particular scent is no longer helpful, it is easier to seal up a bag and open a new one than to clear the air and get a smell out of an entire room. See this episode for an examination of the evidence on the safety and effectiveness of using essential oils during labor.

Positions

For most of human history, a mother in labor could move around and change positions to whatever was most comfortable and suited her best at the time. It wasn’t until we made labor and birth a highly medicalized process that women began laboring on their backs in a bed. Knowing what positions are most effective will be a useful tool in labor.

In labor, you want to work with gravity, not against it. In a review of women during the first stage of labor, researchers conclude that there is clear and important evidence that walking and upright positions in the first stage of labor reduces the duration of labor, the risk of cesarean birth, the need for epidural, and does not seem to be associated with increased intervention or negative effects on mothers’ and babies’ well-being.

There is evidence that women should be encouraged to move and deliver in the most comfortable position. One study compared women giving birth in an upright position to women who labored and gave birth lying down. Women who used upright positions more than 50% of the time had more effective uterine contractions and more perineal muscle relaxation, and their births were significantly shorter. In addition, they had lower rates of requests for epidurals or other medication, fewer assisted deliveries, and fewer cesarean sections.

Any position in which you are upright, just not lying down, will keep gravity on your side and working in your favor, especially during the pushing stage. Squatting, in particular, is fantastic for the pushing stage. Squatting encourages your baby to descend downwards and increases the opening of your pelvis. A downside of this position is that it can be tiring. Thankfully, you can use some tools to make squatting easier, and we will discuss those in the next section.

Some mothers experience back labor. This can be uncomfortable as your baby puts pressure on your lower back, just above your tailbone. Getting in a position on your hands and knees takes the pressure off your spine and ease back labor. This position can also help open up your pelvis and will use gravity to help your baby move further down. You can do this on the floor at home or on a bed in a hospital or birth center. It can be helpful to put some pillows below the top half of your body to help support you.

As your needs change in labor, so should your positions. If you are trying something that is not working for you, change it. You aren’t stuck; trying different positions will help you determine what works best. Interventions like electronic fetal monitoring and IV fluids may limit your mobility, but you always have options other than lying flat on your back in a hospital bed. I urge you to trust your body. If you are uncomfortable, change positions. If your body tells you to stand up and move around or lay and rest, do that. See this episode for more information on different positions you can utilize in labor.

Positional Tools

You can use many tools to assist you in different positions in labor. These tools can help support you and allow you to remain in a position that would otherwise be difficult for an extended period. Some of these may be available at a hospital or birth center. If you know you want to utilize a particular tool, ensure the venue where you plan to give birth has it available. If they do not have it plan to bring your own.

A birthball is a large rubber exercise ball you can sit or lean on. You can sit on the ball in a squat position and benefit from opening your pelvis while the ball supports your weight. You could also kneel and lean over a birthing ball to support your weight in a hands-and-knee position. If you feel unstable on a birth ball, your partner or someone else can help support you. If you purchase a birth ball, I recommend buying the largest size, and you can always remove some air to make it smaller.

A peanut ball is similar to a birth ball but is smaller and shaped like a peanut. This is a good tool to place between your legs and keep your pelvis open while lying on your side.

Many hospitals will have a squatting bar arched over the foot of the bed. This allows you to rest between contractions, and when you feel a contraction coming, you can grab the bar and pull yourself up to a squatting position. This may not be ideal if you have an epidural and your legs are too numb to support you in a squatting position safely. In this case, you can rest your feet on the vertical supports of the bar and loop a sheet or towel over the top. During a contraction, you can pull back on the sheet as you push downward.  

You can also use a bed sheet and a door to create support for squatting. Tie a knot in one end of the sheet, hang the knot over the top of a door, and securely close the door. The knot keeps the sheet in place, and you can hold the other end as leverage to help you squat down.

Another tool you may have available at a hospital or birth center is a birthing stool. This short U-shaped seat helps support you while you are in a squatting position.

Squatting positions are fantastic for labor, but holding them for long periods without getting tired can be challenging. Without a positional tool to help you squat, you can also squat with your back against a wall or hold onto a chair. You can also ask your partner to hold your hands and help support you while you are in a squat position.

Tools of Touch

You can apply several tools that apply pressure, massage, heat, or cold. Massage tools can aid in applying pressure while requiring less strength. You can use a battery-operated massage tool, like a Theragun. Many low-cost options can save your partner’s hands and allow them to massage you longer without getting worn out. A massage roller ball is a very inexpensive option. You could even use a tennis or lacrosse ball.

A tool that can be a lifesaver if you are experiencing back labor is your partner or someone applying counterpressure. This involves someone pushing one or two hands on your lower back by your pelvis. It is helpful to lean against something sturdy so the person applying counterpressure can apply a lot of pressure while you support yourself to prevent falling forward.

Many doulas will perform a hip squeeze during labor. This is when someone places their hands with their fingers pointing towards each other, thumbs down on your hips, and squeezes them together.

Heat and cold compresses may also give you relief during labor. You can apply heat or cold with a heating pad or ice pack. You can also fill a (100% cotton) sock with rice and freeze it or heat it in the microwave for one to two minutes.

Using a rebozo as a labor tool has grown in the midwife and doula communities. A rebozo is a long rectangular shawl used in various ways during labor. The rebozo comes from teachings from traditional Mexican midwives. One way to use a rebozo is to be on your knees, leaning forward with your head near or on the floor. Your midwife, doula, or partner places the rebozo over your behind and holds it on either side. They then gently sift back and forth. Spinning Babies has a similar technique called “shake the apple tree.” You can also use a rebozo to help support your weight as someone else holds the ends of it, with the cloth supporting your belly or wrapped around your back. See this episode on the history of the rebozo and how you can use it for relaxation, support, and pain relief.

Energy

Labor is a marathon and can be both physically and emotionally exhausting. Many moms find themselves running out of energy in labor. This is why some mothers who planned for an unmedicated birth get a resting epidural. This is an epidural needed so you can rest rather than specifically for pain relief. You can do two simple things that will increase the amount of energy you have.

The first is to go into your labor well-rested. This requires that you be mindful of how much sleep you get as you get near your due date. If you have an opportunity to rest or even sleep in the earliest stages of labor, please do.

The other tool you can use to increase your energy is to eat and drink. There is an episode that examines your body’s energy and hydration requirements during labor and the evidence to support why you should eat and drink. Plus, if you decide that you want to have food or drinks at your birth, that episode covers the right things to eat and how to navigate restrictive policies. You should ask your doctor or midwife about their policies, or policies of the venue where you plan your birth, relating to eating and drinking during labor. Your body expends tremendous energy during labor. It will be even more challenging if you are dehydrated and your body doesn’t have the fuel it requires.

The Swiss Army Knife of Tools

A doula is a professional trained in childbirth who provides emotional, physical, and educational support. There is substantial growing evidence on how doulas positively impact births. A doula is a Swiss army knife of birth tools. They will have some physical tools like those discussed in this article. They also have knowledge and expertise in tools and techniques to use. Plus, they can assist you in advocating for yourself and the birth you want. See this episode for more information, including examining the research on having a doula.

Talk to Your Doctor or Midwife

Please talk to your doctor or midwife if you have questions about using the tools discussed in this article. They can assist you in navigating what tools will be available at the hospital or birth center. Your doctor or midwife will also bring their own tools to help you in labor and birth.

Packing Your Tool Box

There is not one universal tool that magically works for every mother in labor. This article covered a lot of different tools you can utilize, from inexpensive gadgets to techniques you can learn and practice now. By preparing and having many tools in your toolbox, you will feel more prepared and confident going into labor. If you are experiencing something that one tool doesn’t work for, you can try something else. It will be helpful to practice some techniques, like positions or breathing, beforehand. You should also discuss these tools with your partner so they can recall this information to support you when you are in labor.

Thank you to the amazing companies that have supported this episode.