Labour can be a daunting experience, but with the right planning, aids, and support, it can be a more comfortable one. Comfort measures during labour can help alleviate pain, reduce anxiety, and promote relaxation, making for a more positive birth experience. These measures are non-pharmacological techniques that aim to enhance the birthing person’s sense of control and well-being during labour. It is also important to have a support system in place, such as a partner or doula, to help with relaxation techniques and provide emotional support.
These measures are non-pharmacological techniques that aim to enhance the birthing person’s sense of control and well-being during labour
1. Baths and Showers
Hydrotherapy is a safe and effective method of relaxation and pain relief that has been used for centuries. The warmth and buoyancy of the water in a deep bath causes a decrease in stress hormones and increase in production of oxytocin.
2. Touch and Massage
Find out what kind of touch you find comforting and use that during labour. Light touch, counter-pressure techniques, acupressure points and massage can help to release tension in muscles and promote relaxation. Massaging with oils containing scents like lavender or peppermint can also be helpful in promoting relaxation and reducing anxiety.
3. Peanut Ball
A peanut ball is an exercise ball used to help open the pelvis and increase the progress of labour. It is especially helpful for positioning and pushing with an epidural.
4. Heat and Cold
Both heat and cold can provide comfort during labour and afterwards. Heat or cold (or an alternation of the two) applied to the low back may help relieve pain. And a warm compress on the perineum can be used to relieve pain and soothe the area.
5. TENS Unit
A TENS (Transcutaneous Electrical Nerve Stimulation) unit is a battery-operated device that delivers electrical impulses through electrodes to your skin. These impulses are thought to stimulate the release of endorphins, which when used during early labour, can build up to reduce the sensation of pain.
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Things you should think about that your care provider may not mention
Giving birth is one of a person’s most transformative and profound experiences. However, it is also an intense and physically demanding process that can lead to various postpartum symptoms, including postpartum “chills.” While it is a common and expected side effect of childbirth, many women are surprised and confused when they experience it.
What are postpartum chills?
Postpartum chills, also known as postpartum tremors, are a common and temporary side effect of giving birth. It typically occurs in the hours following delivery and is characterized by uncontrollable shivering or trembling. Some women may experience mild shivering, while others may have more severe symptoms.
Why do they happen?
Several factors contribute to postpartum chills. One of the leading causes is the rapid drop in hormones that occurs after delivery. During pregnancy, the body produces high levels of hormones, such as estrogen and progesterone, which help regulate body temperature. After delivery, these hormone levels drop rapidly, which can cause a drop in body temperature and trigger the body’s natural response to generate heat through shivering. Additionally, the physical exertion of labour and delivery can cause fatigue and dehydration, contributing to shivering. Women who receive epidural anesthesia during delivery may also be more likely to experience it as a side effect of the medication.
Are these chills typical?
Yes, postpartum chills are a common and temporary side effect of giving birth. It typically lasts for a few hours or days after delivery and does not usually require treatment. However, if you are experiencing severe or prolonged shivering, it is always best to consult with your healthcare provider.
How can you manage it?
While postpartum chills are not usually a cause for concern, they can be uncomfortable and sometimes alarming. So here are a few tips to help manage them:
Dress in warm, comfortable clothing and use blankets to keep yourself warm.
Drink plenty of fluids, such as water, coconut water, electrolytes or warm tea, to help prevent dehydration.
Rest as much as possible and avoid overexerting yourself.
If you experience severe or prolonged shivering or have other symptoms such as fever or chills, it’s essential to consult your healthcare provider.
Postpartum chills are usually a common and temporary side effect of giving birth. While it can be uncomfortable, it is usually not a cause for concern. Always consult your healthcare provider if you have concerns about your postpartum symptoms. Remember to take care of yourself, rest as much as possible, and seek help and support when needed.
*There is a shift towards using the term TOLAC (Trial of labour after C-section) instead of VBAC (Vaginal Birth after C-section). In many ways this term is preferred, less emotionally loaded and less cumbersome than using VBAC. Thus, I will be using both VBAC and TOLAC interchangeably in this post.
One of the very first births I attended as a new doula was a home VBAC. The parents had taken my HypnoBirthing classes and requested me to be their doula. At the time I was just so excited to be going to a home birth that I didn’t even think about the significance of this being a TOLAC.
The mother told me her birth history and the events that had led up to her c-section – “failure to progress at 9cm”. I took all her info and simply reassured her, “every pregnancy is different and so this will be a different experience than your first one”. And it was different. Amazingly different. The labour and birth progressed just like any other normal labour and birth and the mother had her successful home VBAC!
This VBAC homebirth imprinted on me that VBACs were no big deal and they were just like any other birth.
It wasn’t until I started having more conversations with pregnant clients and doctors and reading comments in mommy forums and news articles that I would realize that VBAC’s were seen as A. BIG. DEAL. Words like “highly risky”, “uterine rupture”, “endangering baby”, “dangerous for mom”, “irresponsible” almost always accompanied the VBAC discussion. It was bad enough that women had fear of normal labour and birth itself, but having a past c-section somehow put a whole other layer of fear and worry on top of that.
So I double checked the evidence and the statistics around VBAC and risks and benefits. Contrary to the conversations, the numbers showed that a vaginal birth after a previous c-section was a reasonably safe and healthy choice for most women. The absolute risks were very low and the success rates for attempted VBACs were actually quite high. In fact, the risks for a planned repeat c-section were worse. If you’d like to learn more about the pros, cons and risks around attempting a VBAC, you can read this very excellent handout created by the Ontario Association of Midwiveshere.
Over the last several decades VBAC rates have gone up and down. According to US statistics, In the 1990’s about 30% of those who had a previous C-section attempted a VBAC. Today that number is about 13%. These numbers have fluctuated because of changes in the practice guidelines of obstetricians. VBAC births themselves did not become more dangerous, but practice guideline updates recommended more medical requirements in order to offer them. These changes influenced the perception and accessibility of attempting VBACs – OB’s became less supportive of them and the public developed a bigger fear of them. Understand that the risks and outcomes for those who attempt VBACs did not change in the last 40 years.
Being able to go through a trial of labour after C-section might be a very significant and impactful choice. For some, being able to vaginally birth helps them to heal a previous birth trauma and reclaim the birth experience for themselves. As a medical industry, we should not take the personal decision to try for a VBAC lightly and we should provide unbiased information and support for that person.
If you had a previous C-section and are now considering a VBAC for your next childbirth, here are 6 things you can do to help improve your chances of birthing your baby vaginally:
Choose a supportive provider: This might be the most important factor of all. Having a midwife improves your chances of giving birth vaginally and with fewer restrictions around VBAC. If you are not able to get a midwife, make sure your OB is VBAC supportive. How will you know if they are VBAC supportive, ask them outright:
Are you supportive of VBAC?
What is this hospital’s TOLAC rate? How many of your own patients chose TOLAC and how many of those result in VBAC?
What would be your advice around increasing my chances of achieving a VBAC?
You will get a sense of their own attitudes and biases based on how they respond to these questions.
Learn techniques so you can labour at home for as long as possible: Choose a program that includes learning and practicing breathing exercises, visualizing, releasing past fears. Our clients who have been able to VBAC took HypnoBirthing classes, listened to positive birth podcasts, read books about empowered birth by Ina May Gaskin and Penny Simkin. From our own collective experience supporting our own VBAC clients, we teach a special condensed version of our Confident Birth Prenatal Program that focuses just on the relaxation exercises and techniques to help you be calm and confident during labour.
Ensure the baby is in a good position: Head down is not enough! Baby’s position with their back on the left side so you feel kicks or the big movements on the right (referred to as LOT) or baby’s back is in the front so you don’t feel a lot of kicks or movement elsewhere (referred to as OA) are the ideal starting positions for baby. A baby in the posterior position (or OP or “sunny side up”) may have a harder time being born vaginally. Perhaps during your previous birthing the baby was in this posterior position, which can lead to slow or arrested labour.
There are ways to help encourage a baby to get into the ideal starting position for birth. Daily positional awareness, acupuncture, massage, chiropractic, osteopath and physiotherapy treatments may help.
Get your labour to start naturally: If you labour starts naturally, this will help you avoid further interventions that might increase the risks of a TOLAC. Speak with your midwife or doula about ways to start labour that are safe for those who’ve had a previous c-section.
Try to avoid an epidural: An epidural can limit movement and slow down labour (if started early in labour). If labour slows down, then artificial oxytocin will be needed to help progress the labour. But using artificial oxytocin in someone who had a C-section increases the risk of having a VBAC (ie. scar separation). This is why learning good coping techniques and having a doula can be very helpful. That said, if you need an epidural to help you have a positive birth experience, then by all means, choose that for yourself!
If you have an epidural, use a peanut ball: Even if someone has an epidural, there are tips and tricks to help increase your chance of a vaginal birth. A peanut-ball is a peanut shaped exercise ball that can be used in a variety of positions to help open up the pelvis and positively influence the positioning of the baby as it’s being born.
Beware the “VBAC calculator”! Recently, I have been hearing about care providers using a “VBAC calculator”. Different factors about the pregnant person are inputted into an algorithm that is supposed to predict the percent chance of having a vaginal birth. The use of this is a HUGE RED FLAG to me, and if this becomes part of routine OB and midwifery practice I fear that VBAC rates will decrease even further.
What is wrong with these calculators?
First, the database of information that these calculators use is from observational data of a specific patient population. The one that care providers in Toronto have been known to use is from a patient population in the United States. American birthing patients and American birth management practices are very different from the birthing patients and birth management practices in Canada. VBAC rates in the US are much lower than VBAC rates in Canada. A hospital with low VBAC rates will produce patients with low VBAC rates and vice versa. So you can already see a discrepancy in applying such a calculator on a random patient.
These calculators are not evidence based, meaning no study has been done to test the impact of using these calculators to accurately predict actual VBAC success, we also need to study how these calculators impact decision making in both the OB and the patient.
We are well aware that there is bias in the practice of obstetric medicine, meaning, if a care provider is personally biased in the management of a particular patient, it greatly influences the outcome for that patient. For example, if this VBAC calculator happens to calculate a low success rate, then that can influence the OB to assume that the patient’s attempted VBAC will end up in a c-section.
In any case, the American College of Obstetricians and Gynecologists had this to say about VBAC calculators: “… population-based statistics cannot accurately predict an individual’s VBAC success odds….It is ill-advised to use statistics as a primary indicator when making VBAC decisions.”
The role of a doula in your plan to have a TOLAC: The good news is, a doula can navigate at least 5 out of 6 of the positive factors listed. Having the presence of continuous and on-going support from a doula is supported by research to help you avoid a c-section (whether it’s your first childbirth or an attempt at a VBAC). If you are interested in learning more about how a doula could be an integral part of your VBAC team, book a free meet and greet with us today!
Dr. EeVon Ling, ND
Want to get prepared for pregnancy, birth and postpartum? Grab our free Bump to Baby Checklist! This clear and thorough guide walks you through everything to expect from your first trimester to past your 6 week postpartum check up.
What tests and screenings will be offered and when
When to sign up for prenatal education and what types to consider
Things you should think about that your care provider may not mention
Trigger warning: Discussion about vaginal birth and perineum. Discussion about perineal injury and tears.
This post will go right into the discussion of how to reduce perineal tears and injury. To learn about the 4 different types of perineal injury and read my personal account of having a 2nd degree perineal injury, first read My Childbirth Experience
Is there anything you can do to help reduce perineal injury?
YES!
The most important factor that influences your risk of a perineal injury will surprise you.
Your care provider is one of the strongest factors of having an intact perineum:
Having a homebirth with a midwife is the best way to help avoid a perineal injury. Second to this is having a birth centre birth with a midwife. The main reason is episiotomies and repairing a 3rd or 4th degree perineal tear are not within a midwives’ scope of practice, so they are skilled in helping birthing people avoid or minimize these injuries.
Having an OB with a high 3rd or 4th degree perineal injury rate or has a high rate of episiotomy use will have the highest risk of developing a perineal injury.
If you want to give birth in a hospital, get a midwife to help reduce your chance of a perineal injury.
If you don’t have access to a midwife, ask your OB what their 3rd and 4th degree rate is (it should be 3% or less, if it is much more, it means they are not taking preventative measures). Ask your OB how often they are doing episiotomy, or under what circumstance they are doing this. Fortunately, hospitals in the GTA have a no routine episiotomy policy, meaning, the OB should not be doing them as just a matter of routine. Ask your care provider if they obtain consent from the client first if they are considering to do an episiotomy
Other tips to help reduce severe (3rd and 4th degree) perineal tearing:
Be in an upright birth position (If you have no epidural)
Be in a side lying birth position with delayed pushing (If you have an epidural)
Warm compress against the perineum (Done by your care provider – this helps reduce severe tears and reduce pain)
Perineal massage by the care provider might help lower your risk of a severe perineal trauma, increase your chance of having an intact perineum, or it might make no difference (They need your consent first!)
These other factors that can increase your risk: (Unfortunately, these factors are less under your control)
Size of baby (the bigger the baby, the bigger the risk)
Position of baby at birth (if baby is “sunny side up”, OP or face up at birth)
Very long or very short 2nd stage (pushing time)
Shoulder dystocia (difficulty with birthing the shoulders)
Use of forceps or vacuum
Family history of severe perineal tears
Among the research, there was a particular group of midwives with an amazing 73% intact rate! What did these expert midwives do differently?
They performed slow, calm and controlled delivery of the baby’s head
They guided with non-valsalva pushing
They delivered the baby’s head between contractions
Additional tips from these expert midwives:
When the baby is crowning, they warn clients to blow instead of push
Avoid coaching to push
Avoid pushing during crowning
Encourage hands and knees position
Allow the baby’s head to remain on the perineum for a number of contractions
Wait until baby has rotated before trying to birth shoulders
What about doing perineal massage?
Studies conducted have shown that doing a minimal amount of perineal massage (1-2 times/week, 10 minutes each time, starting from 34 weeks of pregnancy) can help reduce the chance of perineal injury for people birthing for the first time. People who are birthing after the first time generally have a lower chance of perineal injury, and doing perineal massage has not shown to reduce the rate further. However, doing perineal massage has been shown to help reduce perineal pain from childbirth. Interestingly, there is no added benefit in doing more than the minimum amount.
Also, no study showed that perineal massage made it worse for perineal health. Thus, I always recommend that you do some perineal massage to help prepare physically as well as mentally for childbirth (learn to relax and practice breathing exercises while doing it).
Injury to the perineum is cited as one of the most common fears that people have about giving birth. The fear is strong enough to influence people to not have children. It is the unseen and unspoken part of birth. We don’t properly educate the public on the ways that help reduce perineal trauma, leaving the power and decision making to the care provider. I hope that in sharing these evidence-based tips and my own personal experience that you feel more empowered to gain control of this part of the birthing experience.
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Find out what kind of touch you find comforting and use that during labour. Light touch,
A peanut ball is an exercise ball used to help open the pelvis and increase the progress of
Both heat and cold can provide comfort during labour and afterwards. Heat or cold (or an
Several factors contribute to postpartum chills. One of the leading causes is the rapid drop in hormones that occurs after delivery. During pregnancy, the body produces high levels of hormones, such as estrogen and progesterone, which help regulate body temperature. After delivery, these hormone levels drop rapidly, which can cause a drop in body temperature and trigger the body’s natural response to generate heat through shivering. Additionally, the physical exertion of labour and delivery can cause fatigue and dehydration, contributing to shivering. Women who receive epidural anesthesia during delivery may also be more likely to experience it as a side effect of the medication.
