Labor can be intense, but you have many alternatives to cope with pain beyond the medical options your doctor or midwife offers. You can use non-medical pain management strategies on their own if you plan to avoid medical interventions, or alongside tools like an epidural. This episode explores a range of non-medical pain relief techniques, including TENS units, breathing exercises, massage, acupressure, hydrotherapy, movement, and upright labor positions. Hear about the research on the risks, benefits, and effectiveness of each method so you can make informed decisions about which strategies to incorporate into your birth.

Listen Now

This episode is made possible with support from our sponsors. I appreciate your support for the brands that help power this podcast.

Article and Resources

Non-Pharmacological Pain Relief Options

Interventions like epidurals can offer powerful pain relief during labor, but they also come with trade-offs such as side effects, restrictions on mobility, or impacts on labor hormones. Check out this episode for a breakdown of the evidence on all the medical pain management options for labor. In addition to these, you have many non-medical options for pain relief. While the effectiveness and mechanisms of each option differ, each technique can give you a greater sense of control and empowerment during labor, which can positively shape your overall birth experience.

I encourage you to have a variety of tools in your toolbox for labor and birth. Both medical and non-medical methods can be valuable, and many parents choose to combine them. Whether you plan to utilize methods like an epidural or plan an unmedicated birth, there is value in understanding your options for non-medical pain relief and learning how you can incorporate these into your birth plan.

TENS (Transcutaneous Electrical Nerve Stimulation)

Transcutaneous electrical nerve stimulation is a non-pharmacological therapy for pain relief. This has been used as a pain-relieving technique for labor since the 1970s. A TENS unit is a handheld device with wires attached to electrodes in pads that you attach to your skin. Typically, for labor, the pads are placed on your lower back. You can control the intensity of the stimulation and may have the option of a boost button. You will feel a tingling or buzzing sensation where the electrodes are stuck on your back. This method seems most helpful early on and less effective as contractions get stronger.

There are several theories on how electrical pulses can aid during labor. The first is that they may prevent pain signals from reaching your brain. According to this theory, heat, cold, or massage would have a similar effect. Another view is that TENS stimulates the body to release endorphins, which can mediate the experience of pain.

Availability and use of TENS units vary by country. TENS are utilized more often in the U.K. and Canada than in the United States. If the venue where you have your baby does not offer TENS, you can purchase and bring your unit. These are available without a prescription at some pharmacies and online, with costs ranging from $30 to several hundred dollars. Units differ in the settings available to control the intensity of the stimulation. Some models may have a feature that boosts stimulation with the push of a button. This can be particularly helpful during contractions. Units also differ in the number and size of the pads.

Benefits of TENS

Using TENS during labor offers several potential benefits compared to other pain relief methods. Using TENS does not restrict your mobility. Since it is a handheld device that is battery-operated, you can move around, remain upright, and try different positions. A TENS unit doesn’t require a trained professional, such as a doctor, midwife, or nurse. You can use this in early labor at home, control the intensity, and start or stop at any time.

Effectiveness of TENS

The evidence is not overwhelming that TENS machines make a big difference during labor. A Cochrane Review found limited evidence that TENS reduces labor pain. Most women who used TENS said they would be willing to use it again in future labors. Researchers reported no adverse effects. Another review that looked at all available pain relief methods found insufficient evidence of TENS’ effectiveness. You will need to experiment with the intensity, frequency, and timing of stimulation that works best for you.

Risks of TENS

In reviewing research, I found no adverse effects attributed to TENS, provided the device is used as instructed. Although there are no risks, a few downsides should be considered. The electrical stimulation can interfere with electronic fetal monitoring. Your healthcare provider may ask you to discontinue using TENS while using an electronic fetal monitor. You cannot get the TENS unit or pads wet. If you plan to utilize any hydrotherapy, you need to remove the pads and then reapply once dry.

Breathing Techniques

A free and easy tool you can utilize for pain relief during your labor is controlled breathing. Controlling your breath can affect your nervous system, influencing how you cope with pain. Under stress, your sympathetic nervous system increases heart rate and respiration. This triggers your fight-or-flight response, and this communication can occur in both directions. You can also activate your sympathetic nervous system when breathing in short, shallow breaths. You can counter this with slow, deep breathing to increase oxygen, decrease blood pressure, lower heart rate, and activate the parasympathetic nervous system. Your rest and digest system is active when you are calm and relaxed.

Diaphragmatic (Deep) Breathing

The type of breathing that is most common during labor is diaphragmatic breathing. That sounds complex, but it is just deep breathing. This is sometimes referred to as belly breathing or abdominal breathing because your belly expands outward as you inhale. Usually, you take about 10-20 breaths per minute. With slow breathing, aim for a rate closer to six. Typically, you would slowly inhale through your nose and slowly exhale through your mouth. You can imagine the air filling the bottom of your lungs and slowly expanding them. Or imagine breathing all the way down to your baby. Try this out, and as you take deep breaths, you will notice your belly going out. Conversely, try taking in short, shallow breaths, and you can observe your chest rising rather than your belly.

Evidence on Breathing Techniques

Many studies examining breathing during labor don’t isolate breathing. It is often used in conjunction with other methods, such as massage or visualization. One study found that breathing techniques were associated with lower anxiety levels. Another study found that deep breathing decreased the perception of pain and the duration of labor. A Cochrane review found that relaxation techniques, including breathing, may help women manage labor pain.

Practicing Breathing Techniques

Before going into labor, you can experiment with different breathing techniques. One way to do this is to set a timer for 60 seconds and hold an ice cube in your hand while practicing breathing. The idea is that holding an ice cube is uncomfortable, and you can experiment to find techniques that are most helpful in either distracting you from the discomfort of the ice or making the discomfort more bearable. You may want to incorporate techniques such as counting as you inhale or exhale into your diaphragmatic breathing. It may be helpful to add words, a mantra, or an affirmation to each breath. You can combine breathing with visualization, such as imagining waves breaking on the shore or your baby descending.

Rapid and Shallow Breathing

There may be times in your labor when deep breathing is not the most comfortable. Breathing in and out of your mouth rapidly with shallow breaths may be more helpful during the more challenging times of a contraction.

One study compared different breathing techniques used during the pushing stage of labor. Researchers instructed one group to take a deep breath at the start of a contraction, hold it, and push. They asked the other group to use deep breathing, exhale with an open mouth while pushing, and employ a method called blowing when their baby was crowning. Picture blowing as if you are trying to blow out a candle. The idea is that this slows your baby coming out. This gives your perineum more time to stretch and allows your baby to emerge as a result of contractions, not pushing. 40% of the women who used the breathing techniques had an intact perineum, compared to 20% in the control group. Overall, the group that practiced breathing had more first-degree tears but fewer 2nd and 3rd-degree tears.

Hydrotherapy Options

Another option is hydrotherapy, a broad term encompassing various treatments that utilize water’s physical properties, such as temperature and pressure. You can include hydrotherapy in labor by birthing in water or even taking a bath or shower.

Showers During Labor

In a study of 80 participants, 39 had warm showers for 20 minutes at a time during labor. 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 experienced statistically significant decreases in pain, discomfort, anxiety, and tension, as well as a significant increase in relaxation. There were no differences in the use of obstetric interventions.

You can try a shower either at home or once you are in the hospital. It is easy to instantly adjust the temperature in a shower if you prefer warmer or cooler water. The sensation of the water on your back can be soothing, especially if you have a high-power shower head. You may also want to try putting a plastic chair in the shower and sitting on it backward to feel the shower on your back. If your care provider monitors your baby with an electronic fetal monitor, you can request to remove it while in the shower. Getting in the shower at a hospital may not be an option once you get an epidural.

Water Birth Options

Waterbirth is when a baby is born to a mother laboring in a tub of water. 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.

Waterbirth may be an option for you if you are planning an unmedicated labor and are low-risk. While more hospitals are beginning to offer this as an option, most water births occur in homes or at birth centers under the care of a midwife.

Professional Opinions on Water Birth

The American College of Nurse-Midwives states warm water immersion hydrotherapy during labor provides comfort, supports relaxation, and is a safe and effective non-pharmacologic pain relief strategy that promotes physiologic childbirth. Women should be given the opportunity to remain immersed during labor and birth if they wish to do so within the context of a shared decision-making process with their healthcare providers.

The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists share a unified official opinion on water births. The opinion states immersion in water during the first stage of labor may be associated with 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 recommended 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. 

Effectiveness of Water Birth for Pain Relief

A Cochrane review found a small reduction in the risk of using an epidural for women using water immersion in the first stage of labor. A study found that water births had shorter second and third labor stages than vaginal deliveries, both with and without an epidural. The mean second stage in the water birth group was 10.9 minutes, compared to 28.3 minutes in the epidural group and 23.9 minutes in the conventional group. By shortening the time you spend in labor, you also decrease the time you experience pain.

A study of 26,684 women who gave birth at home or a birth center included 10,252 women who gave birth in water. The mothers who gave birth in water were less likely to use pain medication, significantly less likely to experience an episiotomy or laceration, and less likely to experience a fetal heart rate abnormality. The occurrence of prolonged first and second stages of labor was lower in women having a water birth. Babies born in water were less likely to be transferred to a hospital, be admitted to the NICU, or experience respiratory complications. There were no significant differences in Apgar scores, neonatal death, or newborn readmission.

Baths During Labor

Even without access to a birthing tub, you can take a bath in the early stages of labor at home. Your body is working very hard during labor, and you may already feel a bit warm. You want the temperature to be warm, but not scalding hot, so you don’t overheat. You may find a warm bath relaxing and experience some relief during contractions. There is no downside to trying a bath, and if it isn’t helpful, you can always get out.

Other Non-Pharmacological Pain Relief

In addition to the main strategies covered, many simple tools can make a real difference in how you cope with labor pain.

Heat or Cold Packs

Applying heat or cold packs during labor is an easy way to ease discomfort. Heat can relax muscles and improve blood flow. Cold can numb pain and reduce inflammation. A Cochrane review investigated the use of warm packs during labor. It found very low-quality evidence for reduced pain in labor or a shorter labor duration. Results were similar for cold packs versus usual care and for intermittent hot and cold packs versus usual care, in terms of pain intensity and length of labor. These findings are based on a handful of small studies. This is an example of a simple risk-free intervention you can try in any setting, and you can discontinue if it is not helpful.

Massage

Massage is a simple but powerful tool for managing labor pain. It works by stimulating the body to release endorphins, which are natural chemicals that ease pain and boost your mood. You can massage with hands or tools, offering flexibility as you can start, stop, or adjust it at any time. Because it requires the presence of another person, such as a partner, doula, or support person, it can also provide comfort and connection during labor.

While most research studies on massage for labor are small, the findings are promising. One study divided 40 mothers into two groups. One group received a massage with gliding and kneading strokes on their back during labor, combined with the application of essential oils, while the other group did not. Before the intervention, both groups reported similar pain levels, around 5 out of 10. Afterward, the massage group reported much lower pain scores (about 2.7 out of 10), while the control group’s pain increased to about 6.5 out of 10.

In addition to reducing pain, massage may also help alleviate anxiety during labor. A randomized controlled trial investigated the use of shiatsu massage during labor. Pain scores in the intervention group decreased from approximately 6.9 to 4.8, while in the control group, they increased from approximately 6.9 to 8.9. Anxiety scores in the intervention group dropped from about 28.5 to 20.7, while in the control group they rose from about 25.6 to 31.7.

There is also some evidence that massage can shorten labor duration. One study found that the first stage of labor was approximately 2.5 hours shorter in the massage group (average 9.0 hours vs. 11.5 hours). The second stage of labor was about 15 minutes shorter in the massage group (average 49 vs. 64 minutes). In addition, babies in the massage group had higher Apgar scores at both 1 and 5 minutes after birth.

Most studies on massage for labor pain are small and of varying quality. As a result, reviews that combine multiple studies often rate the evidence as low. A Cochrane review that included six trials of 362 women found low‐quality evidence that massage provided a greater reduction in pain intensity than usual care during the first stage of labor. Two trials reported on pain intensity during the second and third stages of labor, and there was evidence of a reduction in pain scores in favor of massage.

Acupressure and Acupuncture

Anyone can easily perform a massage. Acupressure builds on the same idea of touch but requires a bit more knowledge or practice to use effectively. Acupressure is a technique that utilizes finger or hand pressure on specific points of the body to balance the flow of energy, release natural pain-relieving endorphins, and alleviate discomfort. Acupuncture is a more complex treatment, and incorporating it during labor may not be the most convenient option, unless your acupuncturist is present.

One study found that massage is more effective than acupressure. However, the combined application of massage and acupressure is more effective than either therapy applied alone.

A meta-analysis of 22 studies showed that acupressure decreased labor pain. The most commonly used acupressure points were SP6 (inner lower leg) or LI4 (hand). On average, women who received acupressure rated their pain about 1.7 points lower on a ten-point pain scale. Similar results were found in a study that tested whether pressing on three specific acupressure points (LI4 on the hand, He-7 on the wrist, and SP6 on the leg) could help women in labor manage pain and anxiety. Forty-three first-time mothers were randomized to either receive real acupressure or a fake version. The results showed that women who received real acupressure had less pain and anxiety compared to the control group. The researchers concluded that acupressure on these points is a safe, inexpensive, and effective way to reduce both pain and anxiety during labor.

A review of 28 studies involving 3,960 women examined acupuncture and acupressure during labor. Results were unclear on whether either method was effective in reducing pain or reducing the need for medication. Overall, both might have some benefits, but the studies are inconsistent and the quality of the evidence is generally low. This is common with reviews of meta-analyses of small studies.

Movement and Labor Positions

Movement is another free, easy, and powerful tool. Walking, swaying, or changing positions can help labor progress and ease discomfort. There is considerable evidence in support of laboring in an upright position. A review of women during the first stage of labor concluded that there is clear and important evidence that walking and upright positions in the first stage of labor reduce labor duration, the risk of cesarean birth, and the need for an epidural. Another study compared women giving birth upright 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, more perineal muscle relaxation, shorter births, lower rates of requests for epidurals or other medication, fewer assisted deliveries, and fewer cesarean sections.

You will need to try different positions throughout labor to find what works best for you. No matter what interventions you use or where you give birth, you have options regarding the positions you are in. Even limited to a hospital bed, you can sit upright and use support from your partner, a doula, or nursing staff.

Your Labor Environment

You can also modify your environment to help manage pain in labor. Research shows that women reported nearly 50% lower pain scores in sensory rooms designed with calming elements, such as soothing lights, sounds, and scents. In recent years, there has been increased attention to modifying hospital rooms to make them more comfortable spaces. We are also seeing more sensory rooms incorporated into hospitals. These rooms focus on elements that make the environment more relaxing and help patients manage pain. In any environment, you can adjust lighting, music, and smell to make your space more comfortable and supportive during labor. For more on this topic, see this article.

Visualization and Meditation

There is also value in mind-body practices such as visualization and meditation. A Cochrane review evaluated various relaxation techniques, including guided imagery, progressive muscle relaxation, breathing techniques, yoga, and meditation. In early labor, relaxation lowered pain scores by about 1 point on a 0–10 scale compared to usual care. In active labor, the results were mixed. Some evidence suggested that women using relaxation techniques were more satisfied with their pain relief. One trial evaluating mindfulness versus usual care found an increase in sense of control for the mindfulness group. Feeling like you have a sense of control can make a huge difference in your birth experience.

Hypnobirthing

Hypnobirthing is a method that uses relaxation, breathing techniques, visualization, and positive affirmations to help reduce fear and tension during labor. Calming the mind and body can lower stress hormones, promote the release of endorphins, and make contractions feel more manageable.

A systematic review of seven randomized controlled trials found that hypnobirthing reduced fear and pain during labor and overall improved the childbirth experience. A Cochrane Review of nine trials, including 2,954 women, concluded that hypnosis may reduce the overall use of pain medications during labor, but not epidural use. Researchers found no clear differences between women in the hypnosis group and those in the control group for satisfaction with pain relief or sense of coping with labor.

Doula

One tool that is like a Swiss Army knife for anything you could encounter during labor is a doula. A review involving over 15,000 women found that having continuous support during birth significantly impacted birth outcomes, including decreasing the likelihood of using pain medications and reducing the length of labor. The best way to ensure you have continuous support is to include a doula on your birth team. If you want a better idea of what a doula is and how they support you during labor, check out this episode.

You Always Have Options

When it comes to pain relief during labor, you have many options, and there is no one-size-fits-all approach. You can mix and match medical and non-medical techniques, using them in different ways throughout your labor depending on how you feel and how your birth unfolds. Consider these strategies as tools you can incorporate into your labor toolbox. You may not use all of them, and you are free to start, stop, or switch tools at any time. With knowledge and preparation, you can approach labor with confidence, knowing you have the necessary tools and support. If you have questions about what is available at your birth setting or how to incorporate different options, talk with your doctor or midwife.

Thank you to the brands that help power this podcast.