Wednesday, August 7, 2013

Tips for Achieving an Unmedicated Birth: Strategies for Labor and Delivery (Part 3)

If you're just joining, check out Part 1: Preparing Your Mind and Part 2: Preparing Your Body.There are so many different strategies you can adopt to help ease discomfort during labor. An acronym that's helpful in organizing these techniques is PURE:

Positions. The desire to move around during labor was one of the reasons that I wanted to avoid an epidural. I think it's a good idea to familiarize yourself with different positions that can be helpful in reducing the pain of contractions, but I also believe that your body will guide you during labor. Taking a cheat sheet with you to the hospital in case you do end up needing different ideas during labor is still a good idea. An example can be found here.

Urinate. A full bladder can put additional pressure on your uterus, making contractions challenging. Go to the bathroom often.

Relax. A few ideas to help you relax during labor:
  • Visualization. This is the practice of using visual imagery of what is happening in your body to help the progression of labor and keep your body relaxed. All of my experience with visualization was through the HypnoBirthing course I took, and if this is something that you think you may find useful, I'd highly recommend reading the book and looking into taking the course because there's way too much information to discuss here.
  • Deep breathing. This was a lifesaver for me and was a huge part in helping me stay in control during labor. I'd recommend practicing deep breathing daily during your pregnancy. Simply take a few minutes to inhale and exhale, counting to 8 for each, while also focusing you filling your abdomen so that it rises on the inhale. A snippit on this from the HynoBirthing book: "When your uterus surges (contracts), it rises. Slow breathing helps you to work in concert with that upward movement of the uterus as you breathe your abdomen up to the highest possible height- like filling an inner balloon. This maximizes the wave of the vertical muscles (the outer longitudinal muscle fibers of the uterus that contract to help push the baby out), causing them to work more efficiently in drawing up the lower circular muscles (the muscles that are concentrated near the cervix that need to be relaxed in order for it to open for birth), and thinning and opening the cervix. The assist that this gives to both sets of muscles shortens the length of the surge (contraction) as well as the length of labor."
  • Massage
  • Birth ball. This is good not only for relaxation, but can also help to open up the pelvis, allowing the baby to move down. 
  • Bathtub
  • Heating pad (generally provided by the hospital)
Environment. A calm, comfortable environment is so important to staying relaxed during labor. A few ideas to creating a tranquil environment:
  • Choose a supportive doctor and birth partner. I cannot emphasize enough how important it is to choose a care provider who supports your birth preferences. Choose your doctor carefully and discuss your birth plan fully. You obviously don't have control over which nurses will be working when you're in labor, but (at least in the hospital where I had Noah) you can share your desire for an unmedicated birth while in triage and they try to assign you a nurse who prefers to work with and/or has a lot of experience with unmedicated birth. It's also important that you have a supportive birth partner. For many women, this is the father of the child, but you may also opt to hire a doula.
  • Specify your preferences for lighting and bring music you find soothing. Some women find that dim lights and relaxing music have a calming effect during labor and birth.
  • Use aromatherapy. My thought on using aromatherapy is that it will be most effective during labor if it is used in conjunction with relaxing activities during your pregnancy (meditation, yoga, a warm bath) so that there's a positive association. Lavender is an obvious favorite.
  • Bring things from home to make yourself more comfortable. This may include pillows, blankets, comfortable clothes, etc. Just make sure you're ok with them getting dirty/stained.
  • Post a sign on the door so that any staff member that enters the room is aware of the type of environment you're trying to create. We got a sign in our HypnoBirthing class that simply said, "We are a HypnoBirthing family", but yours could say something like. "Our goal is to achieve a calm, unmedicated birth". 
A few additional tips:

Make educated decisions regarding interventions. Modern medicine is amazing and sometimes so necessary. But too often, interventions are used unnecessarily and just lead to complications that require additional interventions. If an intervention is suggested, ask these questions (or have your birth partner do so. You obviously may not be in any state to be having full-blown conversations. This is another reason why it's so important to have a supportive birth partner who understands your desires exactly). Just remember the acronyn BRAIN:
  • Benefits. What are the benefits of the procedure?
  • Risks. What are the risks?
  • Alternatives. What are the alternatives?
  • Intuition. What is your intuition telling you?
  • No/Not now. What would happen if declined or said, "Not now"?
Minimize the number of cervical checks you get. I can tell you from experience that nothing is more frustrating than feeling like your body is working hard for a long time, but you're checked and haven't progressed. It took me seven hours to dilate one centimeter, and less than an hour to dilate an additional FOUR! When I was checked after that seven hours and learned that almost nothing had happened, it was so defeating and made me want to give up on my goal to have an unmedicated birth. Every body progresses at a different speed, and the information gained from a cervical check is not always an accurate representation of what's going on in your body or how much longer your labor will last. So, do yourself a favor and have as few of these as possible.

One thing that I have to emphasize is that these ideas are good for your labor toolbox, but you probably won't use all of them. You'll know what your body needs and you'll figure our very quickly what doesn't work for you. Thank you so much for reading and best of luck in achieving your birth goals! If you have any questions about anything you've read in this series, I'd love to hear from you at


  1. what neat reminders. I am 38 weeks pregnant now and have really not put a lot of thought into my birth plan. seems crazy with the amount of kids I have delivered. I need to discuss it with my husband.

  2. I did natural births 4 times. First one was an accident. After that I knew I could do it. It's almost a mind over matter situation.

  3. This was really helpful. Thank you.

    It's been a struggle for my partner and I to get clear answers from our midwife. Unfortunately since we have Kaiser, there are only two midwives available to us who also only work during banking hours and are all too ready to remind us of that. Making a birth plan has been an uphill battle even though there are midwives at the hospital who do birth (outside of banking hours) , allow birthing pools (for labor only, which is unfortunate), immediate contact with mother and delayed cord clamping. It's been a struggle to get answers about the hospital's views on interventions, and what we need to do to prepare for the birth we want (unmedicated).

    Your "BRAIN" acronym is very helpful to ready ourselves to be able to make the right decision for our family during the birth of our first child, and little things like putting a sign on the door is helpful advice. Unfortunately our midwife has been more of an obstruction than an aid to us thus far, and has made us feel like asking these questions, expressing our wishes etc.. is a joke and a waste of time, which it most certainly is not. Thank you for providing a supportive positive environment, and sharing your experience.

    -Sara, Xavier, and Ulysses

  4. Lovely and detailed sharing, esp. on the Environment part. My first delivery was smooth but I've been frightened by a screaming mum in first place. Confidence and Calm do play a big rule.

  5. Great article- thank you! I am almost 39 weeks and really want a natural VBAC this time around. I think this is the most informative article I have read

  6. I am 39 weeks pregnant and I have prepared for a homebirth with the use of a birthing pool. This is my first baby and feel confident although I'd feel defeated too if after 7 hours hardly any progress. Good reminder that I can decline the cervical checks and just trust my body. Thanks


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