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Your Birth Checklist

A Guest Article by Yiska Obadia,

This comfort measures checklist is based on my experience as a doula and a facebook thread
that received over 90 responses to the question “if you’ve given birth, what was one of
your favorite comfort measures during labor?”

What emerged were over 30 distinct comfort measures that I am excited to share with you here.

To start, many of these comfort measures work as a function of the Gate Control Theory of
Pain. Introduced in the 1960’s, this theory proposes that non-painful input can close the
“gates” to painful input, blocking pain sensations from traveling to the central nervous
system. In theory, a person’s nervous system can only register a certain amount of sensation
at once (painful and pleasurable alike). By saturating a woman’s nervous system receptors
with the sensations of things like counter-pressure, water, aromatherapy and even music, we
can block, in part, the sensations that might otherwise feel painful.

Additionally, you will notice a few other themes. Some comfort measures will help a laboring
woman connect with something rhythmic or consistent in nature. Rhythm, routine and
consistency are known to be calming for our nervous systems. So movements, sound, touch,
etc, that are repetitive can help to create a relaxed internal environment.

Comfort measures that support bonding are also woven throughout this list. Throughout the
animal kingdom, bonding is sought out to create a sense of comfort and safety. The hormones
of birth and the hormones of bonding are one and the same. Oxytocin is often called the “love
hormone” or bonding hormone, and its production may be supported through touch, eye
contact, and the presence of a partner, to name just a few of the comfort measures listed
below.

You’ll notice a checkbox located next to each comfort measure. Check off the ones you feel
most likely to use, or mark an ‘X’ by the ones you feel least likely to use. By the end you will
know what comfort measures you want to explore further as well as discuss with your birth
team. In the end, my hope is that this list will help you and your birth team be prepared with
the tools and resources you want to have around to support you when the special day arrives.

“Birth is one of those rare life experiences where power and vulnerability live side by side.
That is all! To touch that. To touch others who touch that, is my great pleasure and honor.”

Let’s begin!
Warm water: (tub, shower)
This one is a clear winner for top of the list. The majority of women who responded shared
just how helpful water was during labor. From the comfort of a warm shower on their backs to
full body immersion in a warm birth tub, the benefits are immense. Warmth makes your
muscles expand and relax and the buoyancy of water helps support your body weight so you
don’t have to work as hard just to hold yourself up.

Cold water: (to drink, especially through a straw for ease, and as a compress)
Temperatures tend to fluctuate during labor so while warmth may feel good at some points, a
cold compress, especially during active labor, transition and pushing can really help cool a hot
mama down when she’s working so hard. Drinking cold water can be cooling at this point as
well. Bendy straws are a perfect accessory to make sipping effortless.

Movement: (dancing to music of all kinds, rocking, pacing, etc.)
Many different forms of movement made the list because movement can help women work
with the sensations of labor. Rocking or swaying of hips, pacing, circling a birth ball, dancing
of all kinds, offer a way to self-sooth, as movements can create internal shifts that a laboring
woman may be instinctively drawn to. In my experience, a woman’s intuition is especially
heightened during labor so she often knows just what she needs to do with her body.

Movement can also facilitate the progress of labor, making it easier for a baby to make its way
through the pelvis. Lack of movement is one the biggest drawbacks to getting an epidural.

Epidural:
Many women find the use of an epidural to be an obviously powerful comfort measure. While
it may limit movement, most of the time it works unlike any other comfort measure to block
the sensations of pain, though most women will still feel pressure as the baby descends. In my
opinion, every medical intervention has an appropriate time and place. Every woman should
be trusted to determine the birth experience she wants to have and if and when she chooses to
use an epidural.

Deep breathing:
Deep breathing is another one for the top of the list. In particular, slow deep breathing sends
the message to the body that we are safe. Think of the relaxation conjured by a deep inhale
and the sound of a long slow exhale, “ahhhh!”. Some relaxation methods utilize specific deep
breathing techniques, such as imagining you’re inflating and deflating a balloon, or counting
breaths. This can give women a calming thing to focus on as they move through contractions.

Vocalization:
These are just a few of the vocalizing techniques that bring laboring women comfort. Not only
do they keep you breathing, but they can also provide a source of deep focus, and the vibration
itself can reverberate throughout the body, creating comfort and diffusing tension. And
depending on the mantra, it can help encourage supportive emotions such as confidence and
trust.

Music:
Music is often useful in labor to set a mood. Sometimes to get a mama up and active, at other
times to help her relax, whatever is needed in the moment. Many women I’ve worked with
have used music to dance during labor or even sing along at various points.

Quiet: (no chatter)
While distractions can sometimes be helpful, chatter in a birth room can be distracting in an
unsupportive way when you want to be able to focus during contractions without distraction.
Side chatter can make you lose your focus, which you may need to cope with the intensity of
contractions. Hopefully you will be encouraged to let everyone in the room know the kind of
environment you need and the people on your support team will help to enforce and respect
these wishes.

Counter-pressure: (hip pressure, sacral pressure, back pressure, etc.)
You name a body part attached to the pelvis and most women will love the feeling of strong
counter-pressure in that area. Anything that squeezes or presses into the spot they need it
most will work to help dilute the intensity of the pain and pressure of labor itself. Often
women say they wouldn’t have made it through without it.

Being touched:
In addition to counter-pressure, many types of massage are a welcome comfort during labor.
Women often love having someone shake their hips and pelvis and the use of acupressure
points can also help release tension and induce a relaxed state. Besides relaxation, an added
benefit of comforting touch is the intimacy and warmth it offers.
(deep moaning, repetitive chanting of mantras (like “surrender”),
singing, praying, screaming into a pillow, etc.)

Not being touched:
Some women actually prefer not to be touched during labor. Sometimes touch feels
overwhelming or increases the intensity of what a woman is feeling. Regardless of why, touch
is simply not always welcome and it’s good to know so no one takes it personally if that turns
out to be your preference. You may still want people nearby, but the touch itself might be too
much or simply not what’s needed.

Warm compresses:
Like hot water, using a warm compress such as a heating pad or hot water bottle can be
extremely useful. Warmth relaxes tense muscles and counteract tightness in the body.

Birth ball:
Birth balls are the same as exercise balls, and many women find them to be an extremely
useful tool during labor. First, they are comfortable to sit on as they are soft and easy to move
around on. Providing a perfect seat for bouncing or making hip circles, this can help women
better manage the stronger sensations of labor as well as making space in a woman’s pelvis for
babies to descend. Birth balls are also one of the most comfortable things to lean on in labor.
If you end up not wanting to sit on it, you may just want to use it as a tall pillow! Since forward
leaning is such a helpful and comfortable position for most women in labor, having something
soft to hug while kneeling can make resting between contractions quite accessible. It is also
more supportive than putting pressure on your wrists for a hands and knees position.

Rebozo:
A rebozo is the Mexican name for a long shawl often used in childbirth. Any long and wide
scarf or even bedsheet will do the trick. There are many things you can do with this tool in
labor, many of which provide an easy way to lift up the weight and pressure of a woman’s
pregnant belly. In prenatal visits and classes, I often show people a few simple ways to use this
fabric to support a woman during labor. Rebozo videos and resources can be found online if
you look for them.

Sitting on the toilet:
Many women find sitting on the toilet to be remarkably comforting during labor. Sensations
of needing to poop during labor are common so sitting on the toilet can feel like an
appropriate place to be. People are also so used to relaxing their bottoms on the toilet that it’s
second nature to relax there in labor as well. Anything that helps you go with the sensations of
labor as opposed to fighting them is a winner.

Squatting:
This position is a very natural position for many women in labor because it has such an
opening effect on the pelvis. That is the goal after all, so women will often move into this
position naturally, especially toward the end stages of labor as they start to feel an urge to
push their baby out.

Eye contact: (with a partner and/or other members of the birth team)
For some women this kind of contact can feel reassuring and grounding. Eye contact becomes
a focal point that feels anchoring especially during contractions. Eye contact can also increase
feelings of intimacy and closeness, encouraging oxytocin production. Oxytocin, the hormone
that causes uterine contractions is also referred to as the “love hormone”. All things that
increase feelings of bonding, connection, and pleasure increase oxytocin production and as
such are wonderful for labor. Alternately, keeping eyes closed works better for some.

Positive self-talk:
During labor many women reach a point where they encounter feelings of self-doubt and lose
faith that they can keep going, that they can do it. Positive self-talk is one way to replace and
reverse a self-doubting inner dialogue. It might be something as simple as telling yourself, “I
can do this”, “I am strong”, “I am made to birth my baby”, etc.

Focused relaxation techniques:
Women who choose unmedicated childbirth often turn to mindfulness or self hypnosis
techniques to produce a state of inner calm and focus. Not all, but many of these strategies
require some practice in advance of labor to master a certain level of proficiency. Regardless,
the idea here is to help you stay open, relaxed and present to the sensations of labor without
tension or resistance. Trust of self and trust in the natural process of birth are a big part of
what these practices are designed to foster.

Mellow lighting:
Bright hospital lighting is often undesirable during labor and usually can easily be dimmed.
The message of bright lights is one of potential emergency and can trigger different hormones
than the ones that are most supportive of labor’s progress. Alternately, the tone set by mellow
lighting conveys a sense of calm and safety, both feelings that encourage an undisturbed birth
process,

Hanging onto someone for support:
From something as simple as having a hand to hold to having someone hold your whole body
weight, the act of leaning on someone and physically being supported is a tremendous
comfort.

Presence of a doula:
A doula is a member of your birth team who is there to provide continuous emotional,
physical and informational support for your birth. This person is trained and experienced to
varying degrees in the birth process and as such will help you implement many of these
strategies, as well as guide you throughout the prenatal process to prepare for the birth you
want. Time is spent prenatally to get to know your personal preferences. The evidence as well
as anecdotal accounts offer proof that doulas improve birth experiences and outcomes.

Presence of a partner:
Many of the women in this post referenced their partners as an enormous source of support.
Whether by presence alone or tireless physical support, having a loving partner present is an
obvious comfort when going through something so significant. In partnership, you’re birthing
a family as well as a child.

Presence of care providers who believe in you:
Having a care provider who believes in you and the kind of birth you want to have can make
all the difference. If you and your care provider are misaligned, you may end up having a less
than empowering or supportive birth experience. Women in labor and pregnancy can be
especially vulnerable to the opinion of a care provider, so if someone is telling you, “you CAN
push out your 9 lb. baby” and another is “concerned and doubtful”, without any evidence
based information, you can bet this will impact your confidence level! Mutual respect, shared
decision making, and evidence based care make for an ideal experience regardless of
outcome.
(hypnobirthing, hypnobabies, mindfulness practices, mental focusing on deep
relaxation, pairs well with deep breathing)

Being listened to:
An obvious offshoot of being cared for during labor is being listened to. You may find like
many women that it helps to speak out loud what’s going on inside. To be heard without
judgment or correction can be tremendously comforting. Also if reassurance and
encouragement are welcome, knowing when you are having a hard time can help your support
team know how to help. Sometimes venting what you’re feeling is just the thing that’s needed
to move through a block or challenging spot.

Reminders: (to breathe, let go, stay present, you can do it, etc.)
Anyone on the birth team can offer this one. Verbal encouragement and reminders to stay
present and not get ahead of yourself can help you remain focused on what you need to do,
one contraction at a time, to bring your baby into the world. If you lose faith or focus, your
team can remind you how well you’re doing and how close you are to meeting your baby.

Relating to baby:
Visualizing your baby descending or opening you, or remembering the purpose of the pain is
for your baby and a sign of baby coming closer, offers a helpful way to cope with the most
intense feelings of labor. Associating the pain with a purpose connected to your baby being
born helps shift perceptions away from the notion of pain associated with something being
wrong. Nothing is wrong, in fact, everything is right! Also, remembering you are not alone in
this, but your baby is going through the experience together with you can make the journey
feel less isolating and add to a sense of bonding with your baby. Finally, of course, knowing
the end is near would bolster anyone in the thick of a challenge.

Relating to the power of all women who’ve given birth before you:
This is pretty straight forward. Women draw strength from connecting with all the women
who’ve come before them who successfully crossed over into motherhood. When it gets hard,
knowing your body can do it just like them offers a tremendous boost of confidence and can
connect you with a power greater than yourself alone.

Visualization:
Whether picturing your baby’s descent, your cervix opening like a flower, or other positive
images of your birth process, visualizations can help support your ability to relax into the
sensations of labor without losing focus or hope. Seeing your progress clearly and focusing on
a well functioning process will help keep you in a positive, trusting and calm inner space.
Hypnobirthing as well as other birth preparation classes teach these mental practices in
advance of labor so any imagery you’ll want to connect with during labor is well rehearsed.

Being left alone, yet supported:
Sometimes women want to be left alone at some point during labor. The solitude can be
comforting and offers an opportunity to focus inwardly without any distraction. Still, there is a
comfort in knowing you are not alone if you need something.

Giant maxi-pad:
I love the addition of something so practical to this list. It can actually make a huge difference.
You may not realize how many fluids can come leaking out of you during labor (from amniotic
fluid to urine, mucous, and blood). This wetness can feel really uncomfortable, so simply
having large maxi-pads handy to catch any leaking fluids will relieve this discomfort.

Alcohol:
Believe it or not, alcohol can come in handy in early labor to help you relax. The goal in early
labor is to rest up so you have all your energy for when things get active. But it’s too exciting!!
Many women have a hard time relaxing enough at this stage to go to sleep. Alcohol is one way
to help you wind down so you can try to get some sleep while contractions are still spaced far
apart. It may help calm your nervous system down so labor can pick up pace on it’s own when
the time is right, undisturbed by anxiousness or restlessness. Warm water and a massage
might also be helpful for this purpose.

Aromatherapy:
Essential oils are known for their ability to generate a strong shift on a person’s energetic
state. In labor this shift in mood might help energize you or induce relaxation depending on
the oil and what you need at the time.

Permission and Freedom:
Perhaps the most important of all comforts is the permission and freedom to be you. To labor
however makes sense for you, whether it has to do with how you sound, look, move, speak, or
act. To be unfettered and empowered to make informed choices as they arise is a tremendous
comfort. No one wants to feel forced, or feel bad for how they need to behave in labor.
Hopefully everyone around you agrees not to take anything personally. Women can’t be
bothered to take care of anyone else’s needs during labor. Short, quick replies are common, so
if anyone wants to know what you need, yes and no questions are ideal. On this day, you are
the boss. After all it is your body, your baby, and your birth!

I hope you enjoyed this list. Consider me an ongoing resource on your path to birth (or
birthwork). It would be my pleasure and honor to support you anyway I can. If you have
any questions or comments, please message me at yiska@yiskaobadia.com and visit me at
http://www.yiskaobadia.com for more on bringing comfort to your birth (or birth
practice)!

 

Copyright Yiska Obadia 2017

Photograph credit Zivar Amrami @ www.zivaramrami.tumblr.com.

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