30 comfort measures to ease labor pain

Comfort measures are strategies designed to help you cope with the pain of labor. A good childbirth preparation class should teach you an assortment of ways to cope, as will many books.

 What are some common comfort measures?                            

  • Environment:
    -- dim lights
    -- peaceful surroundings
    -- privacy
    -- warmth
    -- music
     
  • Physical:
    -- walking
    -- pelvic rocking
    -- positioning pillows for comfort
    -- slow dancing with partner
    -- sitting on birth ball and swaying
    -- lifting up the abdomen
     
  • Touch:
    -- massage
    -- stroking
    -- cuddling
    -- counterpressure against lower back
    -- acupressure
     
  • Heat:
    -- deep tub bath
    -- shower
    -- heated rice sock on groin or back
     
  • Cold:
    -- ice packs on lower back
    -- cool cloth to wipe face
  • Cognitive:
    -- visualization
    -- affirmation
    -- focusing on the breath
    -- structured breathing patterns
    -- non-focused awareness (paying attention to everything you see, hear, feel, smell without focusing on any)
    -- prayer
  • Aromatherapy
  • Vocalizing: moaning and groaning
  • Labor companion: The continuous presence of an experienced woman can reduce the use of pain medication in general and epidurals in particular (3). The presence of male partners, however desirable, doesn’t seem to have this effect (7).

     

    What are the benefits of using comfort measures?

    Basically, there are three ways of handling labor pain: comfort measures, narcotics (opiates) and regional analgesia, which consists of epidurals, intrathecal or spinal injections, and their combinations. Comfort measures are about as effective as narcotics at making labor tolerable. However, narcotics can potentially have adverse effects on you and your baby. And regional analgesia, while offering superior pain relief, can cause a host of problems not only for you and your baby, but for the labor as well.

    Comfort measures:

  • do not inhibit labor and in many cases, can enhance labor progress: Mobility and activities like pelvic rocking help the baby shift into the optimal position for birth. Upright postures allow gravity to help the baby open the cervix and descend into the birth canal. Strategies to relax muscles keep muscle tension from impeding the work of the uterus. Cognitive techniques reduce fear. Emotional distress, as opposed to the healthy, normal stress of labor, can interfere with labor directly through the production of stress hormones and indirectly by preventing women from paying attention to their bodies and working effectively with their labors.
  • promote a sense of mastery: Studies show that the key to a positive labor experience is the feeling that you have control over events and can cope with what is happening to you (4-5,10). Comfort measures make you the active agent in helping yourself. This is an important component of a sense of mastery.

     

  • facilitate endorphin production: During periods of intense physical demand and stress, the body produces natural pain killers called “endorphins.” In a case of “no pain, no gain,” endorphins are also responsible for the exhilaration and joy that can follow such periods (6).

     

  • enable you to postpone the use of pain medication: Medications are more likely to cause problems with repeated doses, when different types of drugs are mixed, and with prolonged use. By using comfort measures, you may need only one dose of a narcotic instead of three, you may avoid using both a narcotic and an epidural, or you may delay having an epidural.

     

  • can instantly be stopped if it doesn’t help or in the unlikely event that it causes trouble: So, for example, if the baby doesn’t like you to be in some particular position, you can simply find another one. Pain medications, once administered, cannot be rescinded, and you may need another drug or procedure to remedy the ill effects. These, in turn, introduce their own risks.

     What are the potential drawbacks?

    Comfort measures may not provide adequate pain relief. This can lead to a feeling of personal failure if you wanted an unmedicated birth. Still, this will rarely be the case where caregivers and loved ones respect and support your desire to avoid pain medication, acknowledge your efforts to do so, and validate your disappointment at not achieving that goal.

    How might comfort measures affect your birth experience and postpartum recovery?

    As with any experience that pushes you to your limits, an unmedicated labor can be a transformational event that changes how you think of yourself forever. Your pride in your achievement, the confidence in your strength and capabilities that you can gain are, perhaps, the ideal preparation for meeting the challenges of parenting. Avoiding or delaying the use of pain medication also gives you your best chance of having a complication-free labor and a healthy baby, which may mean an easier postpartum recovery.

     

     References

    1. Balaskas J. Active Birth. Boston: Harvard Common Press, 1992.
    2. England P and Horowitz R. Birthing from Within. Albuquerque: Partera Press, 1998.
    3. Hodnett ED. Caregiver support for women during childbirth (Cochrane Review). In: The Cochrane Library, Issue 1, 1999.        Oxford:      Update Software.
    4. Humenick SS and Bugen LA. Mastery: The key to childbirth satisfaction? A study. Birth 1981;8(2):84-89.
    5. Humenick SS. Mastery: The key to childbirth satisfaction? A review. Birth 1981;8(2):79-83.
    6. Jimenez S. Supportive pain management strategies. In Childbirth Education: Practice, Research, and Theory. FH Nichols and SS Humenick, eds. Philadelphia: Saunders, 1988.
    7. Klaus M et al. Maternal assistance and support in labor: father, nurse, midwife, or doula? Clin Consult Obstet Gynecol 1992;4(4):211-217.
    8. Lieberman AB. Easing Labor Pain. Boston: Harvard Common Press, 1992.
    9. Perez P. The Nurturing Touch at Birth. Katy, TX: Cutting Edge Press, 1997.
    10. Simkin P. Just another day in a woman’s life? Women’s long-term perceptions of their first birth experience. Part I. Birth 1991;18(4):203-210.
    11. Simkin P. Simkin’s Ratings of Comfort Measures for Childbirth. Waco, TX: Childbirth Graphics, 1997.
    12. Simkin P. The Birth Partner. Boston: Harvard Common Press, 1989.
    13. Simkin P, Whalley J, and Keppler A. Pregnancy, Childbirth, and the Newborn. Deephaven, MN: Meadowbrook Press, 1991.
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