‘It’s better to be looking at it than for it’ as my husband tells me!

Nobody can tell you how long, or short, your labour will be. I have been asked by labouring women many times ‘How long is labour?’ and the answer is always the same……’How long is a piece of string!?!’. Some women have long, drawn out labours others have labours that are fast and furious- either way can still be a positive experience.  I concluded a long time ago that labour is 90% preparation and 10% what happens on the day. What you can do is prepare, and prepare well. Have a good read around all the methods women use to manage and cope with labour. Try not to exclude anything until you’ve tried it as you never know what might really help on the day. One thing is for certain, it is far better to have them in your tool kit and not need them than to need them and not have them! Below contains an A-Z list (perhaps not exhaustive!) of tools for labour and birth…….

A-Z of the Birth Toolbag

A is for ‘Acupuncture’ and ‘Acupressure’ too,
B stands for ‘Breathing’ which alone can get you through.
B is also for ‘Ball’, be it to sit upon or squeeze
Or perhaps to lean on while you’re down on hands and knees

C represents the ‘Cycle’ to achieve,
Calm, Controlled and Confident…let yourself believe.
D is for ‘Dancing’ your babe into position
trying for direct OA should be your bopping mission.

E is for the ‘Epidural’, never rule one out
there is a time and place for one, of that there is no doubt.
E also stands for ‘Energy’, be sure to maintain hydration
and awareness of the kicks and rolls of your unborn creation.

F is for the ‘Fragrance’ of ‘aromatherapy’
‘Gas and air’ is represented by the lovely letter G.
H stands for ‘Homeopathy’ and of course ‘Hypnobirth’
which many women have found to be of tremendous worth.

H is also for ‘Heat pack’ and ‘Hot water bottle’
I is for your ‘Intuition’ if things start to go full throttle.
J is for the ability to ‘Juggle’ each and every tool
unfortunately, there’ll never be, a ‘one fits all’ rule.

K is for your ‘Knowledge’ of the entire birth process,
ensuring that you’re well informed will lessen any stress.
L is for the ‘Lights’ to be kept turned down nice and low
M is for ‘Massage’ and ‘Music’ -fast or slow.

M also stands for ‘Midwife’, expert in all that’s normal
Call them by their first name- they don’t like to be too formal!
N is for ‘Nipple twiddling’ to keep oxytocin flowing
although there are other ways to keep your labour going.

O is for ‘Obstetrician’ who without any doubt,
specialise in abnormalities and may assist your baby out.
O is also for ‘Osteopath’ who like ‘Physios’ have a place
In opening up the pelvis, to create more room and space

P is for ‘Paracetemol’ and ‘Pethidine’ should you require
Q is for the ‘Quietness’ that many labouring women desire
R is for ‘Resting’ and of course ‘Relaxation’
It’s also for ‘Remifentanyl’, though used only on rare occasion.

S is for ‘Support’– be it partner, doula or friend
the benefits of such support not merely a modern trend.
T is for ‘T.E.N.S.’ machine, a super little device
you can never put it on too soon would be the only advice.

U is for ‘YoU’, the most important letter here,
To trust in your ability, to conquer any fear.
V is for ‘Vocalising’ and ‘Visualising’ your mission,
it is also for ‘Variety’ in posture and position.

W is for ‘Water’ be it pool or bath or shower
never underestimate its raw amazing power.
X is a letter in ‘RefleXology’,
those pressure points, can help reduce, so much anxiety.

Y is for ‘Yoga’ and perhaps ‘Pilates’ too
whichever you find useful, whatever helps you through.
Keep all your options open, you know not how things will go
And unless you try out all your tools you’ll really never know.

If one tool doesn’t help you, don’t discount the rest,
the letter Z represents, all your ‘Zeal’ and ‘Zest’!

Nadia Arthurs© www.labouroflove.ie 2016

What about evidence?

Evidence for the various methods vary greatly. Cochranes Database of Systematic Reviews is a great place to look at the evidence (where available) for some different methods. Jones et al (2012) conducted a systematic review entitled “Pain management for women in labour” and summarise the following;

“Women’s experience of pain during labour varies greatly. Some women feel little pain whilst others find the pain extremely distressing.  A woman’s position in labour, mobility, and fear and anxiety or, conversely, confidence may influence her experience of pain. Several drug and non-drug interventions are available, and in this overview we have assessed 18 systematic reviews of different interventions used to reduce pain in labour, 15 of these being Cochrane reviews.

Most of the evidence on non-drug interventions was based on just one or two studies and so the findings are not definitive.  However, we found that immersion in water, relaxation, acupuncture and massage all gave pain relief and better satisfaction with pain relief. Immersion and relaxation also gave better satisfaction with childbirth. Both relaxation and acupuncture decreased the use of forceps and ventouse, with acupuncture also decreasing the number of caesarean sections. There was insufficient evidence to make a judgement on whether or not hypnosis, biofeedback, sterile water injection, aromatherapy, and TENS are effective for pain relief in labour.

Overall, there were more studies of drug interventions. Inhaled nitrous oxide and oxygen (Entonox®) relieved pain, but some women felt drowsy, nauseous or were sick.  Non-opioid drugs (e.g. sedatives) relieved pain and some gave greater satisfaction with pain relief than placebo or no treatment, but satisfaction with pain relief was less than with opioids. Epidurals relieved pain, but increased the numbers of births needing forceps or ventouse, and the risk of low blood pressure, motor blocks (hindering leg movement), fever and urine retention. Combined spinal-epidurals gave faster pain relief but more women had itching than with epidurals alone, although urinary retention was less likely to be a problem. Local anaesthetic nerve blocks gave satisfaction but caused side effects of giddiness, sweating, tingling, and more babies had low heart rates. Parenteral opioids (injections of pethidine and related drugs) are less effective than epidural but there was insufficient evidence to make a judgement on whether or not they are more effective than other interventions for pain relief in labour.

Overall, women should feel free to choose whatever pain management they feel would help them most during labour. Women who choose non-drug pain management should feel free, if needed, to move onto a drug intervention. During pregnancy, women should be told about the benefits and potential adverse effects on themselves and their babies of the different methods of pain control. Individual studies showed considerable variation in how outcomes such as pain intensity were measured and some important outcomes were rarely or never included (for example, sense of control in labour, breastfeeding, mother and baby interaction, costs and infant outcomes). Further research is needed on the non-drug interventions for pain management in labour.”