American women may choose from an arsenal of pain relievers, from narcotics to hypnosis and everything in between! You may wonder what type of pain relief is available to the woman giving birth at home. Are epidurals or other obstetric anesthesia allowed?

Like women who give birth in a hospital, homebirthing women face many of the same questions regarding pain. They choose their home because the only option in this setting is natural, unmedicated childbirth. You may wonder how these women do it! Unbelievably, these women are not doomed to agony.

You may be surprised to discover that birth is less painful and more tolerable at home!¹ Let’s explore the reasons why this is true and then uncover the many pain relief options available to women who give birth at home.

We try to give a birthing woman freedom to find the right position for her own needs and comfort. Unfortunately, in our society we think of birthing as something done while lying down.

Women who give birth at home find that the birth process is not a mystery and their anxiety is less because they are in a familiar place surrounded by people who love them. They feel empowered, and they are able to eat and drink during labor. Furthermore, medical procedures are minimal or non-existent and the mother is able to move around and change positions often, a very important tool in pain relief and the baby is encouraged into proper position by a variety of means.

On the contrary, it is common for women who give birth in the hospital to feel that their labor is more painful and to feel out of control. This may be why that the majority of women who give birth in North Carolina do so with an epidural, making natural childbirth in the hospital rare.

The hospital birthing woman is confidently armed with the standard hospital provided childbirth classes when she enters her confined hospital birth suite. She is encouraged and sometimes forced to remain in bed where she “can rest.” She breathes through her contractions and her partner helps, but as the contractions become stronger she finds it harder and harder to cope. The nurse reminds her often that when the pain becomes unbearable she can have the anesthesiologist called in to administer an epidural. She feels as if she has no control over what is happening to her as the contractions become stronger and closer together and she tries to implement the strategies that she learned in childbirth class; she really wants a natural birth. She starts to moan and cry, her partner becomes worried and does not like to see her in pain. She wonders how worse the pain will get and she worries that she won’t be able to bear much more so she tells the nurse to call the anesthesiologist.

Because she desired a natural birth the woman may leave the hospital feeling like childbirth is impossible without an epidural and a loss in the confidence of her body. When women are conditioned by hospital provided “childbirth classes” and confined to labor on their backs in bed their labor can be tormenting. One homebirthing woman said, “The worst part of my birth was once when I thought that lying down would help. If I could only labor on my back and not be allowed to get out of bed I believe it would be very hard to resist the epidural.”

Enjoying birth, even the pain is a new concept. Sadly, American women rarely see true birth, a natural, unmedicated wonderful event! They surmise that their birth will be just as awful as the births of their mother, sister or friend. Some women are so frightened that the pain will be unbearable they wish for the days when mothers were unconscious during birth and woke to meet their newly born.

Giving birth naturally in a hospital is not impossible, but it takes proper planning and excellent skills in assertiveness. Women who give birth at home have an arsenal of pain relief far beyond the hospital-birthing woman and some are just as effective as an epidural without the side affects. According to Henci Goer, award winning medical writer, “Comfort measures are about as effective as narcotics at making labor tolerable. However, narcotics can potentially have adverse effects on you and your baby. Comfort measures do not inhibit labor and in many cases, can enhance labor progress.”

We have a secret in our culture, and it's not that birth is painful. It's that women are strong.

It’s important to remember that although you may have a grand plan of all the comfort measures you will use, you must be open minded, listen to your body and it will guide you. Here are some comfort measures that work well.

Prepare Your Home

• Prepare your birthing area in a private place in your home
  
• Set up a birth pool
  
• Dim the overhead lights or light candles. Make sure there are blinds on the windows or heavy curtains in case you labor during the day.
  
• Play your favorite music
  
• Prepare light foods and drink
  
  
  

Invite Your Helper(s)

• Choose a midwife with whom you are comfortable (but don’t wait until you’re in labor)
  
• Acquire the services of a birth doula
  
• Invite a woman or women that you trust to be at your birth. She will cheer for you during your birth and/or help with tasks like cooking, cleaning and watching after small children.
  
  
  

Move It!

• Change your position every 30 minutes!
  
• Walk
  
• Do pelvic rock exercises
  
• Slow dance with another person
  
• Sit on a birth ball
  
• Crawl on your hands and knees
  
• Lean on large appliances, like the refrigerator and washing machine
  
• Step up and down the stairs
  
• Pay a visit to the restroom often to urinate.
  
  

Get Hot

• Submerge yourself in the warm waters of the birth pool
  
• Take a warm shower
  
• Heat a rice sock and apply it to your lower abdomen, groin and lower back
  
• Use a heating pad for your lower back
  
• Heat water in a crock-pot, wet a cloth and apply to the groin
  
  

Chill Out

• Soak cloths in ice cubes and water to apply to your forehead and neck
  
• Place ice packs on your lower back
  
• Prepare cool water to drink
  
• Suck on a Popsicle
  
  

Use Your Head

• Pray
  
• Visualize a special place or goal
  
• Focus on your breathing pattern
  
• Remain aware of everything that’s going on around you but do not focus on any one thing
  
• Focus on your partner’s voice
  
  

Accept Touch

• Get a massage
  
• Have someone apply counter pressure against your back
  
• Use acupressure
  
• Sit on a stool or toilet while your partner pushes your knees toward you
  
• Have your partner stroke your limbs while you relax each part of your body being touched
  
• Hold someone’s hand
  
  

Speak Your Mind

• Moan
  
• Groan
  
• Chant
  
• Sing
  
• Count
  
• Recite
  
  

Many or all of these comfort measures will apply to most births, however there a few more pain relief techniques available to homebirthing women.

Hypnosis

Hypnosis is the means whereby a woman is in a state of total relaxation. In this state her body is able to do its job birthing the baby while she remains alert and clear headed while at the same time releasing endorphins – nature’s anesthesia.

The woman begins this therapy during her pregnancy by training her mind to look at birth a whole new way. Terms like “contractions” are replaced with “surges” and she conditions herself to see birth as a physiological event controlled by her mind. Her goal is to easily put herself in the state of relaxation once her labor begins.

This type of pain relief works very well for many women. There are a birth hypnosis programs and classes available to women and their partners.

Back Labor

25 percent of women will experience back labor. This type of labor includes lower back pain even between contractions. Often times it prohibits a woman from relaxing which slows labor. The cause is most often from a posterior baby; the baby’s face is facing upward, also called “sunny side up.”

There are a variety of comfort measures that work well for back labor. They include:

• Pelvic rock exercises
  
• Lunges
  
• Hands and knees position
  
• Double hip squeeze
  
• Counter pressure
  
• Birth ball
  
• Counter pressure
  
• Hot and cold therapy
  
• Water: birth pool or bath
  
  

For women with 90% of their labor pain being in their lower back a sterile water papule (SWP) injection may be in order.

The procedure is simple and quick. The midwife cleans the area and then injects between 0.1 to .15cc of sterile water just under the skin in four places on the sacrum. There will be intense burning, like a wasp sting for 30 to 60 seconds and pain relief may be felt as soon as 2 to 3 minutes after the injection.2 Relief lasts up to ninety minutes and the procedure can be repeated if necessary. There are no known side effects.

SWP works by playing a trick on the brain. A-delta nerve fibers and C-fibers are thought to carry the majority of pain messages to the spinal cord. The SWP is an irritant that causes brief pain, which sends a message to the brain faster than the nerves carrying the “pain in the lower back” message. An article at Spine-Health.com demonstrates this theory another way, “After hitting one’s elbow or head, rubbing the area seems to provide some relief. This activates other sensory nerve fibers that are even “faster” than A-delta fibers, and these fibers send information about pressure and touch that reach the spinal cord and brain to override some of the pain messages carried by the A-delta and C-fibers.” This is known as the “Gate Theory.”³

“A woman giving birth to a child has pain because her time has come; but when her baby is born she forgets the anguish because of her joy that a child is born into the world.

As you can see there are a variety of pain relief techniques available to women who give birth at home. All are non-invasive, natural and they promote a healthy mother and baby.

At home you are in control and being in control means that you can utilize all the pain relief techniques available. The most important is being able to move around! You are able to keep you strength up by eating and drinking as you please and people who know how to care for you surround you. And best of all, if you’ve tried all the natural pain relief methods and you feel that you must have an epidural or other regulated pain relief you have the choice to go to the hospital.

2 Procedure for Administration Sterile water papules (SWPs) Relief of low back pain in labor. By Midwives of Washington. Found at http://www.midwivesofwa.org/procedadminofswp.htm

3 Modern Theories of Chronic Pain by Spine-Health.com
Found at http://www.spine-health.com/topics/cd/pain/chronic_pain_theories/chronic_pain_theory01.html