Leanna Mae's reference guide for coping with contractions

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Welcome

What brings you here? Are you a momma preparing for birth? A doula or L&D nurse learning more about how you can support and guide? I love hearing from my students what helped them.
 
This handout is made for my doula clients and my students that take the class on coping with contractions. In the class or in prenatal appointments, we go over each of these things with explanation and demonstration followed by practice. I offer in-person classes and doula services in the Dayton, Ohio area. 
 
My goal for you is to know your options and choose what is right for you. There are many pieces of wisdom gathered here that I’ve collected over the last 15 years, and we are always learning more about how to support birth. I have no pressure or push for certain choices or types of births. Each of you will have your own unique journey, and I hope that you are able to weave these pieces of wisdom into your experience as you feel fitting.
 
Download this to your phone(s) and print this out to bring alongside of you. If there are any techniques you have questions about, go over this with your doula. If you are unable to or prefer not to have a doula, a good labor nurse is an excellent help. Midwives are also full of birth wisdom.
 
Congratulations on your baby on-the-way, and I commend you for seeking education in preparing for birth. More education is available at www.LeannaMae.org

What it means to cope

What do you think of when you hear coping with contractions? Let’s talk about what it means to cope.
 
Cope
Verb (a verb is an action word)
Definition: (of a person) deal effectively with something difficult
Some synonyms:

• Manage
• Get through
• Carry on
• Handle
• Tackle
• Bear up
• Take care of
• Endure
• Withstand
• Master
• Overcome

 
Why do I call it coping with contractions? You are doing an action right now. You sought education. You’re gaining education right now. You are planning. You are preparing. You are not passive. You are not intending to do nothing or go in unprepared. You are learning how to and practicing how to cope with a contraction. Coping is a positive action. Learning how to cope is an act of preparing for this birth. Labor is hard. Having a baby is hard no matter how you do it. Actively coping means you’re doing something to work through the journey you’re walking through one contraction at a time. I’m proud of you investing the time to learn these things and practice these methods throughout the rest of your pregnancy.

Coping methods

We’re going to go over several different areas of coping with contractions.
 
Mindset and affirmations
 
Scripture and prayer
 
Distraction from the pain
 
Breathing and vocalization
 
Visualization
 
Relaxation techniques (reducing tension)
 
Hydrotherapy
 
Warmth
 
Cool down options
 
Movement and positioning
 
Counter pressure
 
Pain medication options

Your body was made for birth.
Learn how to work with your body
to bring your baby into your arms.

Techniques and options

There are many ways to cope with a contraction. You will find what works for you in that moment. These methods are simply tools in your toolbox of options.
 
You have a toolbox here. There are many tools. Some you will use and some you won’t. I want you to have everything available to you that you may want to use in the moment. We all have tools we like and others we don’t care for. And we all use these tools in our own way.
 
Choose what is right for you. You have options. You have choices. Whether you want to go all natural or you definitely want the epidural, this is for you. Keep an open mind. Practice these techniques during pregnancy. Get familiar with this handout. Have it beside you as you labor. You may prefer different coping methods at different points. Go over this with your husband/partner and your doula.
 
Take a deep breath. Look at all these options you have available. There is so much you can do. Work through labor in any of these ways. Also let yourself follow birthing instincts and work through the contractions in your own way (even if you didn’t learn it in class or heard of someone else doing that).
 
There is no right or wrong.
 
Coping with contractions is very individual.
 
You have the liberty to blend your own recipe of what works for you.
 
Now let’s talk about ways to cope, comfort measures, and techniques you can use as you ride the wave of each contraction.

Mindset and affirmations

The most powerful tool is your mindset.
 
You are strong.
You are capable.
You are a mother.
 
Many women are intimidated at the idea of labor. What will the contractions feel like? How intense will it be? Can I handle it? Here in America, epidurals have become the norm and unmedicated births have become something that seems a noble goal but not necessarily a doable goal. Society spreads fear about birth through the media and through stories women share. Yes, fear is valid. Many women struggle with fear, nervousness, and anxiety about their upcoming birth. This is common and nothing to be ashamed of. Fear is a normal human emotion, particularly when we are going to go through an experience that we can’t fully control and do not fully know what is going to happen. This is an emotion that we can process. We can work through our fears about birth, and I believe you can overcome fear. Faith over fear. You can do this.
 
You were made for this. Literally. Women were made to give birth. We are uniquely created to be the life-givers of humanity. You made this baby and are carrying this precious life inside of you. Do not doubt your ability to accomplish labor and delivery. Your abilities to bring forth life and nurture it will not disappear with contractions. On the contrary, they will increase. With each passing day, you become more capable. Your body becomes more ready. You become stronger.
 
A confident and determined mindset is the most powerful tool to navigate birth. Believe in yourself. Have faith. You’re going to overcome.
 
The contractions can’t be stronger than you because it is you. No matter what people tell you, it’s literally impossible to not be able to handle labor. You can do this. You are going to do this.
 
Mindset is powerful. A healthy, positive mindset is the most crucial method for a good birth. This is the most versatile method. It can help you achieve the kind of birth you want. It can help you overcome obstacles. It also helps with the unexpected bends in the road. The right mindset is a tool that can be used in every situation.
 
You are strong. You are capable. You are made to give birth. Women are designed for this. You can do this. You will do this. Believe in yourself.
 
Stay in the moment that you are in. It’s often said you don’t have to see the whole staircase to take the first step. This is a staircase that we never know how many steps (contractions) this birth is going to journey before they have their baby in their arms. It can be overwhelming to think about how many more steps you have to take or how many more hours you will be walking through this. Stay in the moment. Take one step at a time. If you start looking at the whole staircase and imagining how it may be, it can get overwhelming. Stay present. Focus on the contraction you’re having in that moment, and rest in between contractions.
 
Mothers often describe contractions as a wave. If you’ve ever been in a lake when a wave came around you, think about how it comes on at first and then gets stronger working up in intensity while the wave peaks, then it tapers down. The contractions are a wave preparing your body to bring your baby into your arms. The contractions will come on, intensify, peak, and taper down. Many mothers think of riding the “wave” or surge as their body works to deliver their little one. Stay in the moment. Ride this wave.
 
Work through your fears. Don’t silence them. Don’t run from them. Explore them and figure out the root issue. What will you do if that happens? What can you do to prevent it? Be at peace with doing your best.
 
You are also adaptable. You are a mother. Adapting to your children’s needs is part of parenting. Their birth may or may not go your ideal way. Know that you are strong enough to get through that, adapt, and overcome.

You are powerful. You are the authority over your maternity care. You are your own greatest advocate. You make choices, seek knowledge, and lead your health care.
 
Affirmations can be a useful tool to nurture a good mindset. I encourage you to make affirmations that speak to you.   
 
There comes a point that you have to surrender to the process. Let your body do what it needs to do. It knows how to give birth.

Scripture and prayer

For those of a Christian faith, people may want to weave their faith into how they cope with birth.
 
Reflecting on scripture that encourages you and comforts you is a wonderful way to bring your faith into your birth. Trust in the Lord. Jesus is always with you.
 
Choose scriptures to bring into your birth preparation and display in your birth space. Affirmations can also be faith-based. I encourage you to create your own with faith statements that come from within you.
 
Prayer is another way to integrate your faith into birth preparation and during birth itself. Get in the habit of praying about the upcoming birth. You can also ask your husband to pray over you. If you choose a Christian doula and/or provider (doctor or midwife), they may offer prayer as well.

Distraction from the pain

The way you manage contractions will change as labor progresses. In early labor, intentional distraction can be an effective technique.
 

• Do life – If you’re in early labor, keep doing life until the contractions are intense enough to require all your attention. Carry on with your normal day.
  

• Rest – If you’re able to get some sleep, let that be a distraction from the contraction.
  

• Conversation can offer a distraction during early labor.
  

• Singing – Sometimes people who like to sing may use that as a method to focus on something else during a contraction.
  

• Focal points – focus on a specific item or spot during a contraction.
  

• Focus on a mantra or thought or visualization.
  

• Dance or use movement. 
  

• Find your rhythm.  
  

• Wooden comb – Put a wooden comb in your hand to squeeze during a contraction.
  

• Use a TENS machine.

Breathing and vocalization

Breathing is essential. The way you breathe through contractions will change throughout the journey of labor. Each person will find their own breath throughout birth. What we don’t want is someone holding their breath, hyperventilating, or breathing/vocalizing in a way that adds tension to the body. So, let’s talk about different options for our intentional breath.
 

• Practice taking deep breaths during pregnancy. Make it a habit to take a few minutes and do deep breathing. Sit with your partner doing this together also. Make it a routine.
  

• Breathe in through your nose and out through your mouth. Inhale for 4, exhale for 4 seconds. This is a good pattern to get started with.

 
As labor intensifies, your breathing pattern will change. That is okay.
 
When contractions are intense, feel welcome to vocalize with your breathing. Women naturally release some noise during birth.

• Some women hum during contractions. I think of it as a long, open hum.
• It’s normal to moan. It’s okay to open your jaw and release. Let out lower, deeper moans rather than high-pitched or wincing noises.
• Prolonged “Uh” and “Oh” releases are very normal. If you think of it as letters, ooooo and uuhh helps open. Eeeee and high-pitched noises close.
• Release the vibration from your chest.
• You can also try mooing (yes, really, women do this in labor).
• Some may growl or roar when those contractions are getting close to delivery.
• Grunting during delivery is also normal.

 
You do not have to be quiet. You are giving birth. You can make some noise. An open jaw can help relax your shoulders and the rest of your body as your cervix blooms and you bring your baby one squeeze closer to being in your arms.
 

• If you’re having a hard time doing the deep breathing or slow breathing, trying using the horse lips technique. 
  

• Panting is okay for a few seconds as long as momma is breathing (and not hyperventilating).
  

• End each contraction with a deep cleansing breath. Release the tension. That contraction is done. You’re one step closer.

 
There is no right technique for everyone. Breathe and vocalize in a way that works for you in the moment that you’re in.

Visualization

Some people find visualization helpful, but some do not care for it. As with all these coping techniques, utilize whatever options are right for you.
 
What relaxes you? Is it the beach? The sound of lake waters hugging the shore? The sounds of birds chirping in the mountains? Gentle windchimes on a rainy day? Close your eyes and visualize these things during the waves of contractions. If you can find a soundtrack to go with your preferred visualization, that helps with both visualization and with relaxation.
 
Women may choose to visualize in their mind their cervix opening with each surge of contraction to bring their baby closer to delivery. “Soften and open” or “Bloom like a flower” are two ways to think about it.

Relaxation techniques

Stress and fear add tension which adds to pain and makes it harder for the body to labor effectively. It is a natural reaction to tense up when we are in pain. We have to learn how to intentionally relax our muscles and try to relax our bodies during labor.
 
Relaxation techniques for labor is about reducing the tension. When contractions get intense, sometimes we tense up our whole bodies. Intentionally relax your body and release any tension that is tightening your jaw, shoulders, hands. Let your uterus contract and bloom the opening for baby. Bring calmness into your labor.
 

• Get some sleep if you can. I always recommend early labor naps.

 

• Create a safe and comfortable environment.
  • Choose your location thoughtfully.
  • Set boundaries to the number of people in the birth space. The more people there are the harder it is to relax and let your body do what it needs to do.
  • Turn off the electronics. No TV. Nothing that is overstimulating mom.
  • Dim the lights. Bright lights are overstimulating. A dark room is a good labor room. Use soft lighting. String lights are a lovely addition to the room. Salt lamps are good. Candles can be a relaxing low light option. Electric candles can be used in hospitals and birthing centers.
  • Natural lighting can also be relaxing. Bask in the sunlight.
  • Nurture calmness in the birth space.

 

• Soothing sounds
  • Meditation music
  • Nature music
  • Soft piano music
  • Any music you like that helps you relax

 

• Aromatherapy 
  • You could use essential oils for relaxation while you are at home.
  • You can also use any fragrances of your preference.

 

• Stretch or do yoga in earlier labor.

 

• Meditation or visualization

 

• Breathing with the different methods we talked about

 

• Vocalization with the different methods we talked about

 

• Intentionally relax your body as you breathe deeply.

 

• Practice progressive relaxation. Release any tension in your forehead/eyebrows, face, jaw. Release tension in your shoulders. Open your hands. Let that release flow down into your pelvis. A relaxed jaw leads to a relaxed pelvis.

 

• Hydrotherapy – We’ll have a section on that next

 

• Warmth – We’ll have a section on that as well

 

• Soothing touch from your partner and support team

 

• Massage
  • Hand massage
  • Using massage tools
  • Effleurage – This is a light touch that uses fingertips or the entire hand to gently stroke

 

• Stimulating oxytocin with your partner through hugging, kissing, and intimacy

 

• Laboring on the toilet relaxes those ‘down there’ muscles. You can sit backwards with a pillow on the back of the toilet. It’s the throne of labor. (If you’re worried about accidentally delivering on the toilet, place a towel under the seat.)

 

• Rest in a comfortable position – whatever that is for you in that moment   

Hydrotherapy

• Warm water
  • Get in the tub! A lot of women love to labor in the tub. Some even deliver in the tub. It’s called a waterbirth.
    
  • The shower is wonderful during labor.
  • A hand towel soaked in hot water can help relax and comfort. You can keep a crockpot going with hot water or heat up water on the stove and keep it in an enamel dutch oven.

 

• If the laboring mother is in the tub, use a cup to gently pour water over her.
  

 

• Cold water
  • Cold washcloths on the forehead or back of the neck are a soothing comfort. You can use the sink or keep ice water in a cooler for a colder cloth.
  • Wash your face.
  • Squeeze the cold washcloth over your head and let it run down.

 

• Ice packs wrapped in cloth (so it doesn’t directly touch mom) can be placed on mom’s back or neck.
  

 
 
And, of course, stay hydrated! Drink water throughout labor. Birth is hard work. Keep a jug of water near you. Keep that ice refill coming.

Warmth

Each person is going to have their own preferences on hot and cold. The weather at that time of year may influence these preferences. If the laboring momma is comforted by warmth, you have a couple of nice options.
 

• A warm bath
  

 

• A hot water bottle to roll on her back
  

 

• Use an English hot water bottle (rubber). They stay warm for hours.
  

 

• An electric heating pad
  

 

• Corn bags 
  

 

• Rice packs
  

 

• Friction type hot packs
  

Cool down options

Labor is hard work! Birth is exercise. You may get hot working through those contractions, especially as they get closer together and more intense. Here’s a few options to help mom cool down.
 

• Strip. You do not have to stay dressed. Get comfortable. Get naked if you want. 
  

 

• Air conditioning
  

 

• An electric fan
  

 

• A fan with a mister (or use a spray bottle)
  

 

• A hand fan – You can get a traditional hand fan or wave a clipboard
  

 

• Cold, wet cloths as we discussed in the hydrotherapy section
  

 

• Ice packs on mom’s back or neck
  

 

• Drinking ice water
  

Movement and positioning

Get up and move with the waves! Lying in bed or staying on your back can be really uncomfortable during a contraction. There are so many options for movement and positioning that helps.
 

• Take a walk.
  

• Sway your hips.
  

• Rock in a rocking chair if you want to sit.
  

• Dance if you’re up for it.
  

• Find your rhythm.
  

• A birthing center may have a rope and/or hammock sling hanging from the ceiling to lean into.
  

• Use a birth ball.  
  

• Use a peanut ball. This is a great tool to open the pelvis while resting in bed.
  

• Utilize a birth scarf.  
  

• Squat – There are many ways to squat. It’s helpful to practice squatting before the birth.
  

• There are many different positions you can labor in. Follow your body’s instincts.

Counter-pressure

Counter-pressure is often a highly favored thing during labor. There isn’t only one right way to do it. If mom is comfortable and getting relief, you’re doing well. You can do this standing, leaning, kneeling, during a squat, and some techniques can be done while sitting. You can also use these techniques while the laboring woman is on a birth ball.
 

• Counter-pressure on the hips
  • Double hip squeeze – slide your palms into the groove of the hips and with your fingers pointed towards the spine press up and in.
  • You can also do the above technique with two people – one person on each side pressing one or both of their hands into the hips.
  • Find the top of the hip bones and press down with your hands pointing towards her belly.
  • Hip squeeze with a birth scarf (can use one person or two)
  • Laboring woman in chair, partner in front pressing their hips into her knees while pulling on a birth scarf to put pressure on her hips
  • Use your legs to squeeze the hips when your hands need a break.

 

• Counter-pressure on the sacrum – this is arranged from most gentle to most firm (many women like the firmer pressure)
  • “Walk” the sides of the sacrum with your thumbs
  • Use two thumbs to press into the acupressure points.
  • Use two fists on the sides of the sacrum.
  • Place one hand horizontally and flat. This is a gentle counter pressure technique.
  • Use the palm of one hand to press into the sacrum.
  • Use two hands pressed flat together to apply pressure on the sacrum.
  • Use two hands in the shape of a V (thumbs touching, fingers semi-spread) to apply pressure on the sacrum.
  • Use the palm of one hand with the other hand on top of it (CPR style) to press firmly on the sacrum.
  • Press your knuckles into the sacrum. 

 
When you are using one hand to put pressure on the sacrum, you can use your other hand to hold her hip for stability.
 
You may want to avoid pressure on the sacrum close to delivery because it needs to move back while the body makes space in the pelvis. 
 

• Counter-pressure on the sitz bones
  • Use the palms of your hands, your thumbs, or tennis balls
    
    

Note: If your hands get sore, you can also use a tennis ball to apply pressure on the lower back and sacrum.

Pain medication options

• Sterile water injections into the lower back 
  

 

• Nitrous oxide (laughing gas)
  

 

• Analgesics (pain medicine)
  • IV meds

 

• Anesthesia 
  • Epidural 
  • Also be familiar with an anesthesia method called a spinal

 
 
Sterile water injections are typically only used by midwives, but you can ask a hospital if they have it available. 
 
Nitrous oxide is available in select locations. It’s been a popular choice in England for some time now. It’s starting to be offered in more hospitals and birthing centers in America.
 
If you want something to take the edge off but you don’t want an epidural, pain meds can be given through an IV. Pain medicine through an IV can be a satisfactory pain relief. They do have to be cautious about when they give IV pain meds because it does get to the baby and can make them sleepy. It’s not a safe idea to take that when delivery is going to be soon.
 
Epidurals are a wonderful pain relief. There is no shame in choosing to use it if that is what’s right for you. The goal with an epidural is 90% pain relief. Do not expect 100% pain free with no discomfort. It’s important to know that you have to qualify for an epidural and get a few things done before you can get it. There will be some blood tests to do to make sure it’s safe to use the medicine in it. You also need to have IV fluids before. Depending on your hospital and obstetrician, you will have to be dilated to a certain point (example: 4 centimeters) before qualifying for the epidural. Keep in mind your delivery location and what kind of resources they have. A city hospital will have 24/7 anesthesia to do epidurals any time day or night. A rural hospital may not have that. They may have to call in the anesthesiologist. It’s important to let your nurse know as soon as you feel ready for it. Once you qualify, it does take a little time to get the doctor in there and get everything set up and done. Once it’s in, it takes effect in about 20 minutes. To recap: You have to be in labor enough to be admitted to the hospital, make it to the dilation required by that hospital and doctor, possibly have blood work done, get IV fluids, and wait for anesthesiology to get there and get set up before you can get an epidural. Expect there to be a good chunk of time go by before you get it. You cannot get it as soon as labor starts. Because of that, I encourage women who plan on getting the epidural to still get familiar with the natural coping techniques because you will go through a lot of contractions (expect hours) before you’re to the point of getting an epidural. You can still get the epidural and also plan for natural labor management. It doesn’t have to be one or the other. Know your options. Choose what’s right for you. Have a backup plan.
 
The reason I want you to be familiar with a spinal is in case of c-section in someone who does not have an epidural. They may recommend what is called a spinal.
 
Be informed of potential risk to these options as well. As with all medications, getting an epidural or taking pain meds for labor does have side effects and risks. These medications do get to the baby. There are some downsides to epidurals including longer labor times, longer delivery times, higher need for interventions, more breastfeeding difficulties, and higher rates of fetal distress and NICU admission.

Use the techniques that are right for you

This is your birth. Do what works for you.
 
There is no right or wrong.
 
Coping with contractions is very individual.
 
You have the liberty to blend your own recipe of what works for you.
 
Listen to your birthing instincts. Your body knows what to do.
 
Each person has their own preferences. What one person likes another person doesn’t. That’s okay. How one person copes may be different than how another person copes. That’s okay. Some women want a lot of hands-on support; others do not want to be touched. Some women want a lot of emotional support; others prefer minimal people and minimal talking. All of that is okay. What you like and what is working may change throughout the process of birth. 
 
Communicate with your care team and don’t hesitate to tell your support people what you need. This is all about helping you navigate each contraction and cope through the journey of labor.

Tell me your favorite coping methods in the comments!

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