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Three Pain-Relieving Tools that Aren’t an Epidural

by Dr. Arlene Dubier, ND, Birth Doula and Lactation Expert

When we think “pain relief” and birth, our minds typically go straight to an epidural. After all, it’s one of the most commonly used pharmaceutical pain techniques. However, it isn’t the only option for pain-relieving techniques or comfort measures. We will review three techniques that you can use either yourself or with the help of an expert


Hands-On Techniques

This is referring to massage, acupressure or counter pressure that is done by a birth partner or doula. In the early stages of labour when surges are not as intense, light-touch massage can be a wonderful tool to stimulate superficial nerve endings on the skin. This touch releases tons of endorphins, otherwise known as “feel-good” hormones.

As labour intensifies, either acupressure, counterpressure or both can be used to apply a firm hold to certain body parts in order to take the pressure off the discomfort of the surge. These are tools which can be taught to you by your doula or knowledgeable healthcare provider. The key is to hold this firm pressure for the duration of the contraction so that the pregnant person feels relief and can focus on breathing through each surge.

Water!

Water can be such a wonderful tool during early and active labour. Water is used in a multitude of ways. For example, using the warm and running water from a removable shower head can relieve back pain from back labour. For our clients who have had a slow early labour, taking baths was one of the only tools that really helped to take the edge off the more uncomfortable surges. This should ideally be done with lukewarm water, and should not exceed an hour of being submerged. The reason for this is that being in the bath confers benefits up to a certain point of time. In practice, we have seen that feeling relaxed in the bath and having the water support the belly can help pregnant people progress a little more in active labour. However, after a certain point it may almost be too relaxing where labour does not progress. In this situation if water is helpful, we suggested staying in the bath for 50-60 minutes, getting out
for some time to try different positions and then getting back into the water.

Another stage of labour in which water can be helpful is during the second stage of labour; the pushing stage. During this stage, there is a lot of natural stretching that happens to the tissues of the perineum (the area between the vagina and anus) as the baby rocks down and around the pubic bone. Having the warmth and movement from the water can again take the edge off this pressure from these stretching sensations. Yet another way water comes to the rescue!

Nitrous Oxide (Laughing Gas)


Here is a type of pain relief you may have never heard of. Nitrous oxide, or laughing gas is only used in certain environments such as certain hospitals or at the Toronto Birth Center. Nitrous oxide is a colourless, odourless gas, mixed with oxygen and is inhaled via a hand-held face mask. The benefits of this is that it can be useful to relieve anxiety as well as dull the pain sensation. Most people use nitrous during the transition phase of labour which can
be to most intense (but shortest) part as the cervix is doing its last couple centimetres of dilation. Realistically you can use nitrous during any part of labour, including postpartum if you have a perineal injury which needs to be repaired.
The benefits of this is that using nitrous allows for people to be mobile because it does not affect muscular strength. It can also be started and stopped at any time, as it works very quickly and leaves the body just as quickly. Some potential side effects of using nitrous is that people can notice dizziness, nausea or claustrophobia from having to breathe deeply and using the mask. Click here to learn more about the use of nitrous oxide in labour.


There are so many pain management alternatives, I couldn’t mention them all in this post. Speak with your OB or midwife about the alternatives that are available to you. If you are looking for even more support, specifically with hands-on techniques, you may consider including a doula in your birth experience. If this is the case, please reach out to our team and inquire about our offerings.

Wishing you all the best on your pregnancy and postpartum journey!

Dr. Arlene Dubier, ND
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Top 3 Pregnancy Reads

by Dr. Sarah Winward, ND IBCLC

Given the MILLIONS of books out there on pregnancy and childbirth, it can be hard to decide where to invest your time as you prepare for this new adventure!

Here is a list of my top 3 favourite pregnancy reads that I recommend to my clients.

The list is short & sweet but packed with great information to help you feel prepared!


1) MAGICAL BEGINNINGS, ENCHANTED LIVES: A HOLISTIC GUIDE TO PREGNANCY AND CHILDBIRTH

By: Deepak Chopra M.D.

Available on Amazon for about $21

Why I love it: This book combines the latest in evidence based medicine and the ancient wisdom of Ayurvedic medicine in a way that only Deepak Chopra can. Providing a holistic and spiritual approach to pregnancy and childbirth, including simple exercises you can do in your home to help you feel more connected and aware during all stages of your pregnancy and 4th trimester.

2) INA MAY’S GUIDE TO CHILDBIRTH

By: Ina May Gaskin

Available on Amazon for about $20

Why I love it: Ina May Gaskin is single-handedly responsible for reviving the midwifery movement in North America, with more than 30 years of experience she is a veritable guru. This book starts with a fantastic collection of birth stories written by women from every walk of life that really help to normalize the whole process of birth and inspire incredible confidence in what a woman’s body can do. The second half of the book is full of information from Ina May on everything from inducing labour to pain management to orgasmic birth, all with an emphasis on restoring woman’s faith in their ability to navigate natural childbirth

3) THE NATURAL PREGNANCY BOOK:YOUR COMPLETE GUIDE TO A SAFE, ORGANIC PREGNANCYAND CHILDBIRTH WITH HERBS, NUTRITION AND OTHERHOLISITIC CHOICES 

By: Aviva Romm M.D.

Available on Amazon for about $20

Why I love it: As an MD with many years of experience in alternative medicine, Aviva Romm is staple in the field of holistic women’s health. This book provides a knowledgeable introduction to the world of natural remedies during pregnancy.


BONUS: MY FAVOURITE BOOK FOR BIRTH PARTNERS

THE BIRTH PARTNER: A COMPLETE GUIDE TO CHILDBIRTHFOR DADS, DOULAS, AND ALL OTHER LABOR COMPANIONS

By: Penny Simkin

Available on Amazon for about $25

Why I love it: I consider this book to be an essential read for anyone who is attending your birth. It covers every topic from how to prepare for labour right up to newborn care, in a wonderfully inclusive way. It provides invaluable information on every possible birth path including medical interventions so that you and your partner are in the know before you need to make decisions. The also has pages marked for quick reference, so it’s great to have on hand during that birth itself.

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How Can My Partner Prepare for My Birth?

by Dr. Sarah Winward, ND IBCLC


Is my partner truly prepared to help me in childbirth?

Do a quick google or amazon search on “childbirth preparation” you will get a list of results that are overwhelmingly geared towards you, the pregnant person. You might notice that there are very few books written that would help prepare your partner for childbirth.

Why is this a problem for me?

How you are cared for and supported during childbirth affects how you give birth and how you feel about it. How you feel about your birth experience can also influence how you feel about your own ability in being a mother as well as affect your chance of developing postpartum depression and anxiety. Knowing this, it’s pretty clear that ongoing emotional and physical support during the very transformative experience of birth is of the utmost importance.

What about a doula?

A doula is a person who provides continuous and on-going emotional, physical and informational support for the labouring person. It has been shown that doulas help to reduce the rates of interventions, including epidural use and c-sections and help to increase reported satisfaction in birth experience. In other words, having a doula increases the chance of having HEALTHY AND HAPPY parent and baby.

But what if I can’t have a doula?

Not everyone can access a doula. Even though having doulas would actually reduce health costs, increase positive outcomes and would be a good basic addition to any healthcare system, hiring a doula is not possible for everyone.

At the time of this writing, COVID-19 virus (simply referred to as coronavirus) is emerging as a global and local public health concern that is resulting in changes in hospital policies. Hospitals are restricting the number of people who can attend births, in some cases reducing it to only one person, usually just your partner. As a doula, when I attend births, the more support the birther can receive, the better their experience. Sometimes, in addition to their partner and me (their doula), their own mother and/ or a friend will be there too. So this change in policy can greatly impact your birth experience and well-being.

How should my partner best prepare to support me? 

Here are some tips to help your partner be your “doula”:

Communication! Be honest about your fears around childbirth and be honest about your partner’s strengths and weaknesses in handling high stress situations. Play up those strengths and how they can be best used to help you during labour and childbirth

Take a high quality prenatal class that focuses on teaching techniques and skills that your partner can use to help you during labour and childbirth. We at Your Downtown Doula offer the Confident Birth Prenatal Class for a comprehensive approach to help you feel relaxed and confident during childbirth and labour.

Labour at home for as long as possible. If the concerns around infection still exist at the time of your childbirth, then reducing your hospital stay is a good idea. Your partner can help you with relaxation, help distract you, do massage and attend to your basic needs. Doing most of your labouring at home can also reduce unnecessary interventions.

A great book for partners is Penny Simkin’s The Birth Partner. It is specific to doulas and partners and contains very comprehensive information.


Want to learn more about our Confident Birth Prenatal Program?

Click here to sign up for a complimentary virtual Meet & Greet with one of our instructors (by the way, did we mention that they’re all Naturopathic Doctors!)

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Finding Comfort During Labour

by Dr. Sarah Winward, ND IBCLC

Labour is intense, to say the least. But does it have to be painful? It can be helpful to reframe the sensations you are feeling. In the words of Ina May Gaskin “labour is an interesting sensation that requires all of your attention”. Many people prefer to refer to surges or rushes as opposed to contraction, HypnoBirthing follows this tenant as well.

Labour is an interesting sensation that requires all of your attention.

Ina May Gaskin

The Pain-Tension-Fear Cycle

It’s very common to have fears surrounding birth. When we experience fear it releases adrenaline which in turn can cause ineffective muscle contractions around the uterus. As a result the production of oxytocin and endorphins decrease and the muscles in the uterus start working against each other. All of this restricts blood flow to your uterus and is a trigger for pain. It also lowers your pain threshold. In dangerous situations, this fear-pain-tension cycle allows for response and survival, in birth it can become a complication. Often, as the pain increases the fear increases and then the tension increases resulting in a repeating, and counter-productive, cycle. So, reducing pain really comes down to reducing tension in your body.

Breaking the Cycle

In her book “The Birth Partner” Patty Simkin discusses the 3 R’s of labour. These are Relaxation, Rhythm and Ritual. Engaging in all 3 of these brings you into the present moment and allows you to move through each contraction without being overwhelmed by them. Often rituals will arise spontaneously during the course or your labour and they can change as your labour progresses. The best rituals involve rhythm and repetition, which lead to relaxation. Things to incorporate in your rituals include: focusing on the breath, staring into someone’s eyes, “slow dancing” with your birth partner, dancing to music, or anything else that feels good to you in the moment.

Helpful hints for your birth partner

Penny Simkin’s book The Birth Partner also outlines a great tool for partners. It is called the Take-Charge routine and is outlined in detail in her book. It is great to use when the birthing person is having difficulty maintaining their ritual or is appearing to be overwhelmed or distressed.

1) Remain calm, others pick up on your energy

2) Stay close, bring your face close to theirs

3) Anchor them by calmly holding their shoulders or hands

4) Get them to look at you, eye contact itself can help to bring them back to the moment

5) Talk to them in between contractions, make suggestions of rituals to try, such as concentrating on the breath

6) Help them regain their rhythm, move your body with theirs

It may also help to remind birthing persons that they are about to meet their baby!

Tips to use in the moment

Any of the following can be helpful during labour, but remember that the right thing for you to do is whatever makes you fell calm, safe and relaxed:

  • Discuss any fears that you are experiencing with your doula, partner or care provider
  • Progressive relaxation, guided meditation or visualizations
  • Make noise and breath with sound
  • Change positions: hands and knees, on a birth ball, walking around, slow dancing
  • Acupressure
  • Use water such as a shower or birthing pool
  • Ask for assistance and allow your partner and doula to support you with hip squeezes, low back pressure, massage, etc
  • Hot or cold applications to your face, back or neck
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Nitrous Oxide – the “other” pain relief option

by Dr. EeVon Ling, ND

** At the time of this writing, COVID-19 policies have restricted the use of nitrous oxide in some birth settings. Inquire with your birth location if this option is available to you. 

What is it? 

Laughing Gas for pain relief?

Nitrous oxide (N2O). Aka “Laughing Gas”, “Gas”, “Nitrous”, “Entonox” (Brand name). 

It is a colourless and nearly odourless gas that is a chemical compound and mixture of nitrogen and oxygen. It has both analgesic and anesthetic properties – meaning it can reduce or alter pain sensation and pain perception.  You may know about nitrous oxide because of its wide use in dentistry. It is the same gas, but the concentration used during labour is much less. 

I haven’t heard much about Nitrous Oxide. Is it common in labour? 

You may be surprised to learn that N2O is the most commonly used form of analgesia in childbirth around the world. 

Historically, N2O has been in use for more than a hundred years! It was widely used in US hospitals for childbirth in the 1930’s – 1950’s. By the 1960’s, epidural use sharply overtook as the primary choice for pain relief and N20 use would pretty much disappear from labour and delivery in the US. But more recently in Canada, its popularity has increased as a pain relief option.  A survey in 2006 found that about 1 in 5, or 20%, of women who gave birth in Ontario used N2O for pain relief. In comparison, the rate of epidural use is about 50-60%. 

Is it as good as using an epidural for pain relief?  

The short answer is “no”. 

It does not replace getting an epidural in terms of pain relief. An epidural is meant to completely take away pain to the point where you usually don’t even know when you are having a contraction or not. Because N2O doesn’t take away pain like an epidural, I have noticed that OB’s and nurses don’t mention it as an option to clients, even to clients that express that they want to labour without an epidural. They don’t consider the value it may offer and in fact, I’ve heard OB’s tell my clients that nitrous oxide “does nothing”. This thinking is a result of comparing N2O with an epidural, but it is a great disservice to completely dismiss it as a useful coping tool.

The more thoughtful answer is that nitrous oxide is a “good enough pain relief”. The following are quotes from my own clients who used nitrous oxide as their main pain relief: 

“It helped take the edge off”

“It helped take the edge off” 

“It made me care less about the pain”

“Breathing through the tube helped distract me” 

“It helped me relax more and focus” 

“It helped me birth without an epidural”

“Without it, I would not have been able to have my homebirth”

“I think it made me a little giddy”**

In some cases, clients have used N2O while waiting to get an epidural or when they are receiving stitches on their perineum post birth. 

What can I expect if I use N2O? 

Begin use at the beginning of a contraction

Where available, it is used in a hospital or birth centre setting, and occasionally some midwife groups have it available for home births (check with your midwife or birth location for availability). It is administered through a tube with a face mask attached. When you are in labour, you hold the mask to your face and deeply breathe in the N2O at the very beginning of or in anticipation of a contraction. The maximum concentration is reached within 60 seconds so you continue to breathe the N2O gas until the contraction ends. Once the contraction is over you take the mask off of your face. Repeat this for each contraction if you continue to use it. If you’ve learned breathing exercises for labour (which I highly recommend that you do, either through a comprehensive prenatal program, HypnoBirthing or through our own Confident Birth Prenatal program), the deep breathing that you’ve been practicing is perfect for using with N2O. 

It is quick acting with the effects felt almost immediately. As described above, N2O does have the ability to alter the way you perceive and feel pain. It doesn’t take away pain like an epidural, but it can help increase your ability to cope with it. 

At the biochemical level, N2O alters levels of certain brain chemicals. It reduces those neurochemicals that activate pain (N-methyl-D-aspartate, NMDA for short) and increases neurochemicals that increase endorphins and make us feel good (dopamine, norepinephrine, endogenous opioids). It has the ability to produce a sense of euphoria and occasionally psychedelic effects. (**Yes, I’ve observed a couple clients get a little “high” while using N2O, all to their benefit)

You are able to remain alert and have full control of your body (no numbing effects). You don’t need an IV or continuous fetal monitoring, you can move freely and use the washroom, and you can eat and drink as normal. 

If you don’t think the N2O is helpful, or if you start to feel drowsy or dizzy, you simply stop using it and it leaves the body within 30 seconds.  Being able to fully control how and when you use N2O is seen as a big benefit to using this option. 

Studies of thousands of people who used N2O during labour (compared to placebo) report 

N2O helps by increasing endorphins
  • Decrease in pain perception
  • Decreased anxiety
  • Increased sense of control
  • Increased satisfaction

That said, when compared to epidural use, women were much less likely to rate N2O as effective pain management compared to those who used an epidural. But when compared with no pain relief or placebo, there was better pain relief reported with N2O use. Reported levels of satisfaction were about the same among epidural users and N2O users. And most N2O users said they would have used it again. Again, highlighting that N2O doesn’t replace using an epidural, but it may still be a very useful measure for those who want to birth without an epidural. 

Is it safe for my baby? What are the side effects? 

Some nitrous oxide does cross the placenta, however, it is safe for both you and baby when used in labour in a full-term pregnancy. It is not recommended in preterm labour as there is increased risk of brain hemorrhage for the preemie baby. Care providers may recommend using N2O only when you are in active labour (cervix is dilated 6cm or more) to reduce excess exposure to the gas. 

N2O is safe for baby when used in active labour

Otherwise, the use of N2O has not been found to affect APGAR scores in babies (the initial assessment of well-being for the newborn) and does not slow down labour or increase risks (such as interventions or c-sections) for the pregnant parent. That said, no long term studies of nitrous oxide on both the parent or baby have been conducted (in fact, no long term studies of many interventions in birth exist). From a biochemical point of view, N2O exposure can decrease levels of vitamin B12. Vitamin B12 is an essential nutrient for blood, nervous system and metabolic functions. It is found in animal-based foods such as meat, eggs and usually included in prenatal vitamins. If levels of vitamin B12 is a concern, this is something that can be addressed post birth with your naturopathic doctor. 

Potential side effects (from most common): 

  • Nausea 
  • Vomiting
  • Dizziness
  • Drowsy
  • Reduced sense of awareness
  • Reduce feelings of being present; Increases feeling detached from situation 
  • “Mask phobia” from using the mask on their face

Bottom-line: 

Nitrous oxide, if available, can be helpful during labour. It can be used as your main coping strategy (along with massage, relaxation exercises and breathing techniques) or be a helpful tool as you wait for an epidural or even be used immediately post birth if you need to receive stitches for your perineum. 

We at Your Downtown Doula are fully supportive of your choices in birth. We act as your source of information so that you are fully aware of the options so that you can make good decisions for yourself and your baby in labour. We have attended births where parents chose N2O, epidurals or other means to cope and in the end, positive births can happen no matter how you decide to journey towards parenthood. 

Want to learn more about how a doula can be a valuable support to you during pregnancy, labour, childbirth and beyond? Book a free 15 min meet and greet with one of our Naturopathic doctors and doulas today! 

Dr. EeVon Ling, ND

Resources: 

https://www.contemporaryobgyn.net/view/nitrous-oxides-revival-childbirth

https://evidencebasedbirth.com/nitrous-oxide-during-labor/