Labour is daunting for many expectant mothers, and the different pain relief options can be overwhelming. 

Although we may not be in the room with you, your maternal health physiotherapist can give you some helpful tips and tricks to try during labour. 

It is important to understand that labour is broken into 3 different phases. 

The Three Phases Of Labour

Phase 1: The commencement of uterine contractions. 

In this first phase, uterine contractions begin and cause your cervix to begin to dilate. It is broken up into 3 phases.

  1. Early labour (the latent phase) encompasses the short and irregular contractions, until the cervix it dilated to 3cm, this can last up to approx. 12 hours. 
  2. The active labour phase where the cervix dilates from 3cm to 7cm, which can last up to 5 hours. 
  3. Transitional phase continues from 7cm until the cervix is full dilated to 10cm. this can last from 30mins up until approx. 2 hours. 

Phase 2: Delivering the baby – you have reached 10cm and the baby is crowing, now it is time to PUSH!

Phase 3: Delivering the placenta and membranes

From a physiotherapy perspective, we can give you some advice during the first stage of labour and a touch on the second stage regarding

  • Positioning
  • Breathing techniques 
  • Massage 

Positioning 

The positioning for phase 1 and 2 of labour can be similar, where the main aim is to help your body do what it is already trying to do. 

There has been a greater push (pardon the pun!) in the evidence lately to labour in an upright position during the first phase of labour, compared to laying on your back with legs in stirrups. 

Below are some different positions with some pictures which may be useful during labour. Some may not be suitable particularly if you have had/planning to have an epidural or spinal block. 

  • Supported Standing/Leaning (picture below)
  • Sitting on a fit ball
  • Kneeling
  • Walking around
  • Squatting*
  • Hands and knees 
  • Fit Ball (picture below)

Being able to be in a more upright position, allows your body to use gravity to help move the baby down the birth canal. Some evidence suggests that being upright is associated with a shorted first stage of labour! 

During the second phase (the pushing), many hospitals prefer the woman to be in the bed. It is useful to check with the hospital that you are delivering at to find out what they prefer. If you are limited to being on the bed, you can still find different positions that may be more comfortable that others – eg kneeling, hands and knees or laying on your side.

*Care should be taken with squatting and birthing stools during the pushing phase as they can be associated with a higher degree of perineal tears as they place a lot of pressure down there!

Breathing Techniques 

Breathing correctly can be a very powerful pain reliever during the first stage of labour. 

Abdominal breathing of diaphragmatic breathing (which is taught in things like Pilates (LINK PILATES BLOG OR PILATES PAGE ON WEBSITE) and Yoga), has been found to alter your brainwaves in a positive way, while also 

  • Increasing your relaxation response
  • Reducing your stress hormones
  • Increasing your oxygen levels
  • Decreasing your blood pressure 

And during labour, it has been found to help release endorphins, which are the body’s natural pain-relieving hormone. 

Focussing on your breathing pattern and technique will also allow for distraction, which although will not completely hide the fact that you are having contractions, it may reduce the intensity of them. 

Massage

This is one for your birthing partner.

Massage can help provide pain relief during labour through a few different theories. 

  1. Gate Control Theory

Through this theory, gentle massage helps flood the body with pleasant sensations so the brain doesn’t perceive the painful sensations (although the painful ones during labour are very intense, it can help dull these).

  1. Diffuse Noxious Inhibitory Control

This relates to deep and intense massage. Ignoring the fancy name, the idea behind this theory is that the stimulation from the painful massage is high enough for the brain to release its own pain-relieving hormones, called endorphins. When your body is flooded with endorphins, it helps your brain perceive less pain from the contractions. 

  1. Decreasing cortisol (stress hormones)

Some other research suggests that massage helps reduce cortisol levels in your body, which increases levels of serotonin and dopamine (which affect mood and other bodily functions).

How To Perform Massage During Labour

During labour, you may experience a little or a lot of pain through your lower back and hips. Focusing massage on these areas can be useful in reducing pain. Using a flat palm, thumbs, fingers or gentle knuckles can work well. 

It is useful to use some gentle cream such as Sorbolene (check with your midwife first), as this will help reduce friction between their hands and your skin.

Below we will discuss a few different positions that may be useful during labour.

  • Supported leaning (against back of chair, wall, fit ball or bed) 

Your birthing support partner can position themselves behind you or to one side and use circular movements or long sweeping strokes to massage.

  • On hands and knees

Position yourself on your hands and knees, your birthing support partner can position themselves behind you or to one side and use circular movements or long sweeping strokes to massage. 

The video below demonstrates the type of massage strokes and hand positioning you can use. This can be replicated in most positions.  

Stretching And Movement Ideas During Stage One Of Labour 

If you are able to move, here are some ideas of movement/stretches to help get you through that first phase of labour. 

  • Use a Gym/Fit/Physio Ball.

If you have a physio ball, these things are magic! You may have already been informed by your hospital or midwife to bring one along (or they may have some to use!) to help during the first stage of labour. 

When sitting on the ball, bouncing can be useful to help the baby move down the birth canal. 

Also, try some pelvic tilts show in the video below. These are useful in helping the pelvis and pelvic canal open and allow baby to move down to prepare for the second phase of labour. 

If you are finding that you are ‘labouring in your lower back’, then some gentle mermaid stretches can be useful as shown in the video below. Time these stretches in with your breathing. Inhale, then exhale to stretch, inhale to return.

If you don’t have a ball, that is okay. For the below movement, all you will need is the back of chair, edge of your delivery bed or a wall. 

 

You can perform the pelvic tilts or rocking in this position. The video below demonstrates some pelvic rocking. These, as those above, will help with preparing the pelvis and birth canal. 

***NOTE: The above information and exercise/massage ideas are from a physiotherapist’s perspective and should always be used in conjunction with your medical team. Post by Rebecca Vial.

Please note Rebecca’s final day consulting before she heads off on maternity leave is April 9th 2020.