https://www.nwh.

org/patient-guides-and-forms/maternity-guide/maternity-chapter-3/comfort-
measures-during-labor-and-delivery-non-pharmacological-methods

Nonpharmacologic Pain Management During

Labor
Comfort measures that provide natural pain relief can be very effective during labor and
childbirth. Birthing techniques such as hydrotherapy, hypnobirthing, patterned
breathing, relaxation, and visualization can increase the production of endogenous
endorphins that bind to receptors in the brain for pain relief. Other methods of comfort
therapy such as effleurage (light rhythmic stroking of the abdomen), massage, emptying
the bladder, and hydrotherapy can provide pain relief and reduce the need for narcotic
analgesia or anesthesia by naturally creating competing impulses in the central nervous
system that can prevent the painful stimuli of labor contractions from reaching the
brain.

Learn more about natural birthing techniques:

 Birthing Ball
 Patterned Breathing
 Beverages
 Movement and Position Changes
 Superficial Heat and Cold
 Counter-Pressure
 Touch and Massage
 Aromatherapy
 Hydroptherapy
 Focus and Distraction
 Audio-analgesia

Birthing ball
Few labor tools are as simple, beneficial, and versatile as the birthing ball. Birthing balls
are professionally made for use in physical therapy and have been used for years to
properly exercise and rehabilitate patients. The birthing ball has now found a new home
in birthing centers and hospital obstetric departments across the country. The ball easily
withstands the pressure applied by the weight of the laboring woman.

It is safe to use the birthing ball with both the external and internal electronic fetal heart
monitor.

If your amniotic membranes are ruptured, and the baby is still quite high (meaning how
high the baby is in the pelvis, or pelvic station), depend on your nurse or care provider
(physician or midwife) to tell you if it is safe to use the ball. If the baby remains “high,”
active labor and use of the birthing ball may help to bring the baby down into the pelvis.
If you are allowed to sit in a chair or walk in the hallways, it is safe to use the birthing
ball.

When using the birthing ball, it is important to have your birth partner “spot” you at all
times. The safest way for your birth partner to spot you is to have him/her sit in a chair
with legs apart, while you sit on the birthing ball positioned in between them. Other
positions are discussed below.

Use of the birthing ball is becoming much more common. Because it is one of the
newest pieces of “birthing equipment,” substantial formal research has not been
completed which will confirm the advantages of using it as a labor aid. Still, it is
undeniable that many laboring women find the birthing ball effective as a comfort
measure during labor.

Here are just a few reasons for using the birthing ball during labor:

 Sitting on the birthing ball keeps the baby properly aligned in the pelvis
 The ball encourages pelvic mobility
 Pregnant women find it easier to get up and down from the ball than a standard
chair or sofa during labor
 The ball encourages the baby to drop down further (descend) into the pelvis by
allowing gravity to work with the laboring mother
  The ball allows the laboring woman to shift her weight, rock her pelvis, and find
comfortable positions to labor in more easily
 The ball can be used when in the hands and knees position. This decreases the
pressure and stress on the hands and wrists that traditionally affect the length of
time the position can be used.

Patterned Breathing
These breathing techniques provide comfort and focus while enhancing labor progress.
Patterned breathing enhances oxygen flow to your baby and is also vital to the
contracting uterus.

Beverages
You should stay well hydrated while laboring. Laboring women may have clear liquids
such as water, juice, broth, ice, and Popsicles.

Movement and Position Changes

You may experience less pain in some positions than in others during labor. Laboring
women tend to find upright positions most comfortable such as sitting, standing, and
walking. Many choose a lying down position as labor advances. Moving about during
labor is usually more comfortable than staying still and can help labor progress by the
simple effects of gravity and the changing shape of the pelvis. It may also relieve pain by
shifting pressure and allowing the baby to move. You may try sitting, kneeling, standing,
lying down, getting on your hands and knees, and walking.

Superficial Heat and Cold

Heat can be effective when applied by using a hot water bottle, hot moist towels, or
warm blankets. Superficial cold can come from an ice bag, washcloths soaked in ice
water, or a bag of frozen peas. Hot compresses applied to the lower abdomen, groin or
perineum, a warm blanket over the entire body and ice packs to the lower back or
perineum can help alleviate labor pain. Using heat or cold on separate parts of the body
at the same time can provide particularly effective pain relief. For example, apply a cool
cloth to the forehead with warmth on the lower back. For maximum effect, change the
heat and cold locations frequently, about every twenty minutes.
Counter-pressure
Counter-pressure consists of steady, strong force applied to one spot on the lower back
during contractions using the heel of the hand, or pressure on the side of each hip using
both hands. Counter-pressure helps alleviate back pain during labor, especially in those
women experiencing “back labor.”

Touch and Massage

Touch can convey pain-reducing messages. A hand placed on a painful spot, a pat of
reassurance, stroking the cheek in an affectionate gesture, or a tight embrace can
communicate a message of caring to the laboring woman.

Purposeful massage of the hand or other parts of the body also communicates caring.
Massage takes the form of light or firm stroking, vibration, kneading, deep circular
pressure, and continual steady pressure. Stroking or rubbing the neck, shoulders, back,
thighs, feet or hands is an effective pain-reliever. No fancy techniques are required.
Receptors in the brain receive the sensations of pleasure from the massage blocking
reception of the painful stimuli of labor. Bare skin receives the signal best and
unscented powders and lotions are helpful for massage.

Aromatherapy
Aromatherapy is the use of essential oils such as lavender, rose, camomile, and clary
sage. These can be administered in a variety of ways including in oil during a massage, in
hot water as a bath or footbath, a drop in the palm or on the forehead of the laboring
woman or a drop on a warm face cloth. Aromatherapy reduces stress and tension
during labor. Beware, however, that pregnant and laboring women are highly sensitive
to smell. Be sure that you use a scent that you enjoy. Stop any comfort measure if and
when it is no longer working for you.

Hydrotherapy
Hydrotherapy during labor (techniques using water) can be emotionally soothing and
can also help with pain relief. Many of the private bathrooms in our labor suites include
a Jacuzzi tub. The Jacuzzi can be used to recline in the bubbling water or by sitting on a
shower stool to use the hand-held shower massage during active labor. Many women
are comforted by the combination of warmth, water pressure, and the sound of the
water. Advocates of hydrotherapy even suggest that immersion in water may accelerate
labor, decrease blood pressure, and increase a laboring woman’s feeling of control over
her birth.

Focus and Distraction

Many methods of coping with pain rely on the laboring woman’s ability to focus and use
mind-diverting activities. Fear and anxiety cause the release of stress hormones. You can
ease these feelings by envisioning a pleasant scene or, at times, visualizing what is
actually happening such as the cervix opening or the baby moving down. Focusing one’s
attention is a deliberate activity and is aided by verbal coaching, visualization, self-
hypnosis, and concentration on a visual, auditory, or tactile stimulus.

Distraction is a more passive form of focusing attention by using stimuli from the
environment that will draw attention away from your pain. Attention focusing and
distraction are usually used with other strategies and may not be useful for severe pain.

These techniques are meant to help you reduce fear, anxiety, and pain, and can also be
helpful with any discomfort you may experience after the birth of your baby.

Audio-analgesia
Audio-analgesia (music, talk) are used to control pain in numerous situations including
dental work, post-operative pain, burn treatment, and childbirth. Many childbirth
educators use music in their classes to create a peaceful and relaxing environment and
they advocate for its use during labor as an aid to relaxation. Audio-analgesia for pain
relief consists of soothing music between and during contractions.

Music creates a pleasant and relaxing environment and music transmitted through
earphones can block out disturbing, distracting, or unpleasant sounds. Carefully chosen
music can also reinforce rhythmic breathing patterns, massage strokes or facilitate
focusing one’s attention. Music preferences vary widely. Feel free to choose your own
music and bring your CDs with you. Each labor room at Newton-Wellesley Hospital is
equipped with a Bose CD/Radio
https://www.pregnancybirthbaby.org.au/non-medical-pain-relief-during-labour

here are many ways to reduce pain in labour without medicines. Each method has
advantages and disadvantages. Choose one or more that suit you.

Non-medical techniques such as massage and a warm bath can help with pain during labour.

Active birth
Staying active is one of the most helpful things you can do to manage the pain of labour and birth. Moving
freely and rocking your pelvis can help you to cope with the contractions.

Massage and heat

Massage and hot packs can ease your pain in labour. Massage helps distract you from the pain. Heat
packs can help your body release its natural painkillers — endorphins.

Water immersion
Most hospitals and birthing centres will have facilities that allow you to have a bath or shower during the
first stage of labour.

Many women find that being in a warm bath is relaxing and helps them to cope with the contractions. You
might also find having a shower can help with any back pain you might be experiencing.

Having a bath or shower to ease pain during labour is not the same as having a water birth. Not all
hospitals are equipped for water birth. Your midwife and doctor need to be specially trained and they
need to be able to get you out quickly if there is a problem with the birth. Check with your hospital well in
advance to see if this option is available to you.
Relaxation
You can use different relaxation techniques to ease pain. Some people like music, some like meditation,
some like incense. Generally, relaxation techniques help ease pain in labour. Just check that the hospital
or birth centre can cope with your plans.

Aromatherapy
Essential oils are used with massage or heated over a burner. There is no evidence aromatherapy
provides pain relief, but some women find it pleasant. If you’re thinking of using aromatherapy, check that
your hospital or birth centre allow it.

Acupuncture
Acupuncture can reduce pain in labour and reduce the need to use forceps. It is not clear how it works.
There are no known side effects of acupuncture for mother or baby.

Only a trained person should perform acupuncture. Not all hospitals have an acupuncture therapist on
staff. You may need to discuss arranging your own practitioner.

TENS
A TENS machine uses two electrodes stuck to your skin. They are usually attached to your lower back.
The machine sends a small electric current through your body. It is generally safe for mother and baby.

While there is no harm is using a TENS machine, there is not a lot of evidence to show TENS works to
reduce pain, but some women find it helpful.

A TENS machine is not suitable for everyone. People with a pacemaker should not use one, and the use
of TENS before 37 weeks’ gestation should be avoided.

They can’t be used in the shower or in water. Not all hospitals or birth centres have them.

Sterile water injections

Sterile water with no medicine in it can be injected under the skin of your lower back to deal with lower
back pain.

It may sting but there are no side effects for you or your baby.

Some women have found these injections helpful. It is not clear how they work, or whether they work very
often. You may still need other pain relief.

Sources: Cochrane (Pain management for women in labour – an overview). Opens in a new window.King Edward
Memorial Hospital Obstetrics & Gynaecology (Clinical practice guideline, Pain management). Opens in a new
window.Royal Australian College of Obstetricians and Gynaecologists (Pain relief in labour and childbirth). Opens in a
new window.The Royal Women’s Hospital (Managing pain in labour). Opens in a new window.The Royal Women’s
Hospital (Active birth). Opens in a new window.The Royal Women’s Hospital (Water birth at the Women’s). Opens in a
new window.
https://www.scielo.br/scielo.php?pid=S0104-11692007000600015&script=sci_arttext

https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-019-0735-4

For many women, the pain they experience during labour and childbirth will
be the most severe form of pain they have ever experienced [1]. Pain is
considered to be a unique and individual experience. Accounts vary from
pleasurable to unbearable, with both extremes sometimes reported to occur
concurrently [2, 3]. Women’s perceptions of pain are affected by physiological
(e.g. birth position) and/or psychological issues (e.g. fear, anxiety) [4], and the
quality of the woman-provider relationship [2]. Some women cope well with
labour pain without any intervention, whereas others require pharmacological
and/or non-pharmacological methods for pain relief [5]. Effective pain
management has become an essential component of the care plan for
childbearing women.

Globally, pharmacological interventions are frequently used during labour and

childbirth.

Non-pharmacological pain relief methods associated with relaxation and

massage are referred to as mind-body interventions [5]. Relaxation methods
such as yoga, music and breathing techniques, and different forms of massage
(e.g. shiatsu, reflexology) are designed to induce calm and to distract/alleviate
pain in labouring women. Trials of relaxation techniques during labour have
reported less intense pain, increased satisfaction with pain relief and
childbirth [5], and lower rates of assisted vaginal birth [10], without any
adverse outcomes [5]. However, there was a large variation in how these
relaxation techniques were applied [11]. A Cochrane systematic review [5]
identified relaxation and massage methods as safe and non-invasive, based on
low quality evidence.
https://extranet.who.int/rhl/topics/preconception-pregnancy-childbirth-and-postpartum-care/care-
during-childbirth/care-during-labour-1st-stage/who-recommendation-manual-techniques-pain-
management-during-labour

WHO recommendation on manual techniques for pain management during labour

17 February 2018

 
Recommendation
Manual techniques, such as massage or application of warm packs, are
recommended for healthy pregnant women requesting pain relief during labour,
depending on a woman’s preferences.
(Recommended)
 
Publication history
First published: February 2018
Updated: No update planned
Assessed as up-to-date: February 2018 

 Most women desire some form of pharmacological or non-pharmacological

pain relief during labour, and qualitative evidence indicates that massage can
reduce labour discomfort, relieve pain and enhance the maternal birth
experience.  While the quantitative and qualitative evidence largely relates to
massage, warm packs are unlikely to be harmful and some women might
find these to be soothing.  
 Health care professionals should be aware that the care context and the type
of care provision and care provider could have a strong effect on the need
for labour pain relief, and on the kinds of choices women make in relation to
this need.  
 Non-pharmacological pain relief options can vary widely across settings and
contexts, which might favour other techniques not considered in this
guideline, such as water immersion, hypnobirthing, acupuncture, and
cultural and traditional practices that women might find soothing.  
 Health care professionals should communicate to women the options
available for pain relief in their birth facility, and discuss the advantages and
disadvantages of these options as part of antenatal care.  
 Care providers should inform women that while manual techniques for
managing pain are unlikely to be harmful, evidence of the beneficial effects is
of very low certainty.

https://www.pregnancybirthbaby.org.au/pain-relief-during-labour

Write down your wishes in your birth plan, but remember that you should keep an open mind. You may
find that you want more pain relief than you’d planned, or your doctor or midwife may suggest more
effective pain relief to help the delivery.
Ask your midwife or doctor to explain what’s available so that you can decide what’s best for you.

Whether you decide to use pain relief during labour, there are a number of techniques that will help you
be more relaxed, which can help you to cope with the pain.

 Learn about labour — this can make you feel more in control and less frightened about what’s
going to happen.
 Learn how to relax, stay calm and breathe deeply.
 Keep moving — your position can make a difference.
 Leaning forward over a beanbag or sitting back-to-front in a chair may take the pressure off your
back and abdomen.
 Bring a partner, friend or relative to support you during labour, but if you don’t have anyone, don’t
worry — your doctor or midwife will give you all the support you need.
 Ask your partner to massage you (although you may find that you don’t want to be touched).
 Have a bath.
 Place a hot water bottle or hot pack on your back or lower abdomen.

Gas (Entonox)
This is a mixture of oxygen and nitrous oxide gas. It won’t remove all the pain but it can help to reduce it
and make it more bearable. Many women like it because it’s easy to use and they control it themselves.

Find out more on using gas during labour.

TENS machine
A TENS machine is a device that delivers small pulses of electrical current that may assist in reducing
pain during labour.

Find out how TENS might work for you.

Epidural
An epidural is an injection that numbs the nerves that carry pain from the birth canal to the brain. For most
women, an epidural usually gives complete pain relief.s

Find out more on epidurals.

Pethidine
Pethidine is a strong painkiller given by injection. It helps reduce the severity of the pain but does not take
it away completely.

Non-medical pain relief

There are a number of ways of reducing labour pains without using medicine. These include massage
and water immersion. It’s important that you understand the pros and cons of each one and decide which
one might work best for you.
Find out more on non-medical pain relief during labour.

Book

Commonly used nonpharmacologic techniques for pain relief in labor are conscious relaxation,
consciously controlled breathing, effleurage, focusing, imagery, and hydrotherapy. Pg. 736

• Discuss nonpharmacologic pain techniques if the patient does not desire medication. Pg.775

Support a Woman’s Pain Management Needs. Many women plan on using nonpharmacologic pain relief
measures such as hydrotherapy (soaking in a tub of warm water or taking a warm shower), position
changes, or acupuncture during labor; ask if the woman has planned any of these and what you could do
to help her make these effective (Chaillet, Belaid, Crochetière, et al., 2014). Other women want
pharmacologic help in labor. Support whichever decision a woman has made coming into labor as well
as any change she decides on as labor progresses (see Chapter 16 for a discussion of common
nonpharmacologic as well as pharmacologic measures for labor). Some healthcare providers are
reluctant to suggest to a woman that pharmacologic pain relief is available as this might influence her to
accept an analgesic rather than continue to use nonpharmacologic methods. Part of being in control,
however, is knowing your options and feeling free to elect the one most appropriate at that time.
Because pain is subjective, only the woman knows how much pain she can endure and whether she
needs some supplemental help to make childbirth the experience she planned pg.812

Pg.815

Chaillet, N., Belaid, L., Crochetière, C., et al. (2014). Nonpharmacologic approaches for pain management
during labor compared with usual care: A meta-analysis. Birth, 41(2), 122–137
COMPLEMENTARY AND ALTERNATIVE THERAPIES Complementary and alternative therapies for pain
relief involve nonpharmacologic measures that may be used either as a woman’s total pain
management program or to complement pharmacologic interventions. Most of these interventions are
based on the gate control theory concept that distraction can be effective at preventing the brain from
processing pain sensations coming into the cortex. Many of the same techniques may help the descent
of a fetus. These may include the use of acupressure, position changes, imagery, and other relaxation
techniques. Relaxation The technique of relaxation, as discussed in Chapter 14, is taught in most
preparation for childbirth classes but can be taught in early labor as well. Relaxation keeps the
abdominal wall from becoming tense, allowing the uterus to rise with contractions without pressing
against the hard abdominal wall. It also serves as a distraction technique because, while concentrating
on relaxing, a woman cannot concentrate on pain. Asking a woman to bring favorite music or
aromatherapy with her to enjoy in the birthing room, although not evidence based, can help with
relaxation. Remember, no aromatic candles should be used because of nearby oxygen outlets. Focusing
and Imagery Concentrating intently on an object is another method of distraction, or another method of
keeping sensory input from reaching the cortex of the brain (Smith, Levett, Collins, et al., 2011). For this
technique, a woman uses a photograph of someone important to her or some setting she finds
appealing such as a beautiful sunset. She concentrates on the photo during contractions (focusing). A
woman can also concentrate on a mental image, such as waves rolling onto a beach (imagery), or chant
a word or phrase such as the new baby’s name during contractions, all of which help prevent her from
concentrating on the pain of contractions. If a woman has never used these techniques before, she may
question how effective they are. Urge her to try one of them at least for a few contractions before she
dismisses them entirely, as evidence supports their efficacy (Hodnett et al., 2013). ima Pg. 843

Spirituality For many women, prayer may be the first measure they use to relieve a stress they are facing
(Abbaspoor, Moghaddam-Banaem, Ahmadi, et al., 2014). Provide uninterrupted time as needed.
Women may bring helpful worship objects such as a Bible or Qur’an into their birthing setting to use
during prayer. Remember, these are sacred objects; be careful when changing sheets that you do not
accidentally throw such important objects away or let them fall to the floor. Breathing Techniques
Breathing patterns are taught in most preparation for childbirth classes and are well documented to
decrease pain in labor (Dick-Read & Gaskin, 2013). They are largely distraction techniques because a
woman concentrating on slow-paced breathing cannot concentrate on pain. Breathing strategies can be
taught to a woman in labor if she is not familiar with their advantages before labor (see Chapter 14).
Stay with her until she appreciates how useful slow-paced breathing can be and feels comfortable using
this technique independently. Herbal Preparations Several herbal preparations have traditionally been
used to reduce pain with dysmenorrhea or labor, although there is little evidence-based support for
their effectiveness. Examples include chamomile tea for its relaxing properties; raspberry leaf tea
(women freeze it into ice cubes to suck on), which is thought to strengthen uterine contractions;
skullcap; and catnip, which are thought to help with pain. Black cohosh (squawroot), an herb that
induces uterine contractions, is not recommended because of 844 the risk of acute toxic effects such as
cerebrovascular accident to the mother or fetus (Ulbricht & Windsor, 2015). Aromatherapy and
Essential Oils Aromatherapy is the use of aromatic oils to complement emotional and physical wellbeing.
Their use is based on the principle that the sense of smell plays a significant role in overall health. When
an essential oil is inhaled, its molecules are transported via the olfactory system to the limbic system in
the brain. The brain then responds to particular aromas with emotional responses such as relaxation.
These oils should not be applied directly to the skin to avoid irritation but are used in a mister so they
are inhaled and then carried throughout the body. The oils may be able to penetrate cell walls and
transport nutrients or oxygen to the inside of cells. The effects of aromatherapy can range from reducing
postcesarean incisional pain to reducing anxiety in the first stage of labor (Fakari, Tabatabaeichehr,
Kamali, et al., 2015; Metawie, Amasha, Abdraboo, et al., 2015; Roozbahani, Attarha, Akbari Torkestani,
et al., 2015). The evidence regarding the efficacy of aromatherapy continues to be studied with mixed
results. Pg. 844-845

Heat or Cold Application The application of heat and cold has always been used for pain relief after
injuries such as minor burns or strained muscles. It is only lately that their use has been investigated as
effective ways to help relieve the pain of labor. Women who are having back pain may find the
application of heat to the lower back by a heating pad, instant hot pack, or warm moist compress
extremely comforting. Heat applied to the perineum is proven to provide the dual benefits of soothing
and softening the perineum and decreasing the risk of perineal tears (Aasheim, Nilsen, Lukasse, et al.,
2011). Caution women if they are going to heat pads in a microwave to test the temperature of the pad
on the forearm before applying it to their perineum. Pressure anesthesia (pressure to an area of the
body that interferes with pain receptors) can dull sensation and, with an overheated pack, patients
could sustain a perineal burn without realizing it. 845 Women who become warm from the exertion of
labor find a cool washcloth to the forehead, chest, or back of the neck comforting. Sucking on ice chips
to relieve mouth dryness is also refreshing. Immediately following birth, an ice pack applied to the
perineum feels soothing, and it helps reduce edema and swelling. Cultural differences exist with
preference to heat and cold. This may be evident in dietary choices or compress application (Goyal,
2016). It is imperative that nurses to provide care that is culturally competent and respectful of the
practices of their patients. Bathing or Hydrotherapy Standing under a warm shower or soaking in a tub
of warm water, jet hydrotherapy tub, or whirlpool is another way to apply heat to help reduce the pain
of labor (Fig. 16.2) (Harper, 2014). The temperature of water used should be 37°C to prevent
hyperthermia of the woman and also the newborn at birth pg. 845-846

Remind women that plastic or porcelain tubs are slippery, so they should ask for 846 help stepping into
and out of them. Do not leave women unsupervised in a tub as they could slip and have difficulty getting
their head above water. A support person can join the woman in a tub or shower if she wishes and can
continue with back massage or other measures she finds soothing. Timing of contractions, auscultation
of fetal heart rate, and vaginal examinations can all be done without the woman needing to leave the
water. The birth environment, including the use of hydrotherapy in labor, can help support physiologic
birth (Stark, Remynse, & Zwelling, 2016). Therapeutic Touch and Massage In a classic work, Krieger
(1990) defined therapeutic touch as the laying on of hands to redirect energy fields that lead to pain. It is
based on the concept that everyone’s body contains energy fields that, when plentiful, lead to health or,
when in low supply, result in illness. Ef leurage, the technique of gentle abdominal massage often taught
with Lamaze in preparation for childbirth classes is a classic example of therapeutic touch (see Chapter
14, Fig. 14.8). Reiki can also promote healing. The term Reiki consists of two Japanese words: rei, which
means “God’s wisdom or the higher power,” and ki, which means “life force energy.” So Reiki is actually
“spiritually guided life force energy.” The technique includes “laying on of hands” and is based on the
theory that an unseen “life force energy” flows through us and is what causes us to be alive (Rakestraw,
2010). If one’s life force energy is low, then a person is more likely to get sick or feel stress. If it is high, a
person is more capable of being happy and healthy. Although the effectiveness of therapeutic touch is
not well documented, both touch and massage probably work to relieve pain by increasing the release
of endorphins. Both techniques may also work because they serve as forms of distraction. Many women
find massage, especially of the lower back or feet, helpful in the first and second stages of labor (L. Jones
et al., 2012; Smith et al., 2012). Pg. 846-847

Yoga and Meditation Yoga, a term derived from the Sanskrit word for “union,” describes a series of
exercises 847 that were originally designed to bring people closer to a divine power. It offers a
significant variety of proven health benefits, including increasing the efficiency of the heart, slowing the
respiratory rate, improving fitness, lowering blood pressure, promoting relaxation, reducing stress, and
allaying anxiety. Exercises consist of deep breathing exercises, body postures to stretch and strengthen
muscles, and meditation to focus the mind and relax the body. It may be helpful in reducing the pain of
labor through its ability to relax the body and possibly through the release of endorphins. Mothers who
engage in yoga prenatally have been shown to have a greater sense of selfefficacy and may experience
fewer episodes of antenatal depression (Battle, Uebelacker, Magee, et al., 2015; Schwartz, Toohill,
Creedy, et al., 2015). Meditation is a self-directed practice for relaxing the body and calming the mind.
Mindfulness-based stress reduction (MBSR), an 8-week intervention program developed by Dr. John
Kabat Zinn for patients dealing with issues of chronic pain, is based on the cultivation of intentional
awareness of experiences in the present moment. Transcendental meditation (TM) is a simple, natural,
and effortless activity done while resting comfortably with the eyes closed. Using one of these
techniques, an individual experiences a state of deep rest that can change physical and emotional
responses to stress (Chan, 2016). Women can meditate in any position. Do not interrupt a woman using
meditation as a pain relief technique if at all possible in order to not break her concentration.
Reflexology Reflexology is the practice of stimulating the hands, feet, and ears as a form of therapy
(Smith, Levett, Collins, et al., 2012). Professional reflexologists apply pressure to specific areas of the
hands, feet, and ears to alleviate common ailments such as headache, back pain, sinus colds, and stress.
The theory behind reflexology holds that the body is divided into 10 zones that run in longitudinal lines
from the top of the head to the tips of the toes. Each of the body’s organs and glands is linked to
corresponding areas of the hands and feet. Application of pressure to a specific area aims to restore
energy to the body and improve the overall condition. The point that corresponds to the uterus is
located on the inside ankle about halfway between the ankle bone (malleolus) and the heel. Massaging
this area is believed to begin labor or hurry labor, thus creating less pain. Hypnosis Hypnosis is yet
another method that can be used for pain relief in labor. A woman who wants to use this modality
needs to meet with her hypnotherapist during pregnancy. At these visits, she is evaluated for and
conditioned for susceptibility to hypnotic suggestion. Close to her last weeks of pregnancy, she is given a
posthypnotic suggestion that she will experience a reduction in or absence of pain during labor. Fully
awake and able to participate in labor, the woman who is susceptible to hypnotic suggestion may 848
find this may provide a very satisfactory and drug-free method of pain relief (Streibert, Reinhard, Yuan,
et al., 2015). A woman who wants to use this system but began labor before the posthypnotic
suggestion was given may be very disappointed to find herself in labor without the help she envisioned.
Some hypnotists may visit during labor or supply the suggestion over the telephone so a woman can still
use the method. Further research is needed to determine the effectiveness of the effects of hypnosis on
pain relief in labor (Madden, Middleton, Cyna, et al., 2016). Biofeedback Biofeedback is based on the
belief that people have control and can regulate internal events such as heart rate and pain responses.
Women who are interested in using biofeedback for pain relief in labor must attend several sessions
during pregnancy to condition themselves to regulate their pain response. During these sessions, a
biofeedback apparatus is used to measure muscle tone or the woman’s ability to relax. Evidence is
continuing to emerge that shows biofeedback is an effective method for reducing the pain of labor
(Janula & Mahipal, 2015). Pg.849-848

Acupuncture and Acupressure Acupuncture is based on the concept that illness results from an
imbalance of energy. To correct the imbalance, needles are inserted into the skin at designated
susceptible body points (tsubos) located along meridians that course throughout the body to supply the
organs of the body with energy. Activation of these points (which are not necessarily near the affected
organ) results in a release of endorphins, which makes this system helpful, especially in the first stage of
labor (Ozgoli, Mobarakabadi, Heshmat, et al., 2016). Acupuncture may also decrease the duration of
labor (Asadi, Maharlouei, Khalili, et al., 2015). Acupressure is the application of pressure or massage at
these same points. It seems to be most effective for low back pain. A common point used for women in
labor is Co4 (Hoku or Hegu point), which is located between the first finger and thumb on the back of
the hand. Women may report their contractions feel lighter when a support person holds and squeezes
their hand because the support person is accidentally triggering this point. Acupressure can reduce
maternal anxiety as well as the length of labor when specific pressure points are used (Akbarzadeh,
Masoudi, Zare, et al., 2015). Pg.850

http://www.midwife.org/acnm/files/ccLibraryFiles/Filename/000000004048/Hydrotherapy-During-
Labor-and-Birth-April-2014.pdf ACNM 2014