Guide to Labor Support

Are you looking for a “cheat sheet” for labor support, to help you remember all the options for supporting someone in coping with labor pain during childbirth? Check out my free printable handout – click here to download the PDF. (Here’s the black and white version.)

Orientation to the Guide

The first page covers how to assess whether someone is coping well with labor pain (in which case, your job is to help them maintain their coping ritual) or whether they need more support. It then offers quick pointers for comfort techniques that might help.

flow chart

The second page lists all the tools in the labor support toolbox, including ways to transform the fear-tension-pain triangle into the confidence-relaxation-comfort triangle, pleasant distractions and counter-irritants to distract from the pain, positions to aid labor progress, and labor support techniques that increase oxytocin and endorphins.

labor comfort techs

If you have the Guide, and you are wondering about any of the ideas listed, or need more details on how to use any of the tools, read on for a full discussion of all the key points on the Guide. Also, all these tools are covered on my podcast and in my book Pregnancy, Childbirth, and the Newborn.

Assessment: Look for Signs that they’re Coping

Relaxation and Rhythm

The guide begins with assessing how well the laboring person is coping. A person who is coping well has Rhythm (in their breathing and movement) and is as Relaxed as they can be, given their stage in labor. When providing labor support, your best clue whether it’s working is to watch for this: if you do something (touch, turn on music, or whatever) and the person Relaxes and their Rhythm improves, it’s working, and that can be part of your Ritual for coping. If you do something and they tense up or they lose their rhythm, it’s not helping them to cope. (Learn more about Relaxation, Rhythm and Ritual in my podcast episode on Labor and Birth.)

Watch for Effects of Adrenaline or Oxytocin/Endorphins

The other thing to watch for is: do they seem to be rushing on adrenaline? The signs are: rapid breathing, tight muscles, high pitched voice, and they seem vigilant or panicky. If you see any of these signs, do anything to reduce anxiety triggers – calm down yourself, dim the lights, turn on calm music, reassure the person, talk to them about what’s making them anxious. Do all you can to help them feel safe, calm, loved, and respected. As the oxytocin and endorphins start to flow, breathing becomes slower and more rhythmic, muscles relax, the voice gets lower, and they seem calmer. (Learn more about the hormones of labor pain in my podcast episode on Labor Support or in Pathways to Birth, which is available on the Childbirth Connection website.

Avoid the Fear-Tension-Pain Triangle

If someone has Rhythm and is Relaxed, what you’re doing is working, so keep it up! We want to avoid the Fear-Tension-Pain triangle, so think about all the ways you can transform fear to confidence, tension to relaxation, and pain to physical comfort. (Learn more about these triangles in my podcast episode on Understanding Labor Pain.)

On the second page of the guide, you’ll find ideas for how to increase confidence, relaxation, and comfort. Here’s links to where you can learn more about each idea:

Building Confidence

  • Ask questions so you understand what is happening and what to expect. (You can get lots more information in advance by listening to my podcast, or, even better, taking an in-person childbirth education class. During labor, you can ask key questions about the benefits, risks, and alternatives of maternity care options.)
  • Reframe the P.A.I.N. Remember that labor pain is pain with a Purpose – it’s moving your baby down and out of your body. It’s Anticipated – you’ve prepared for it by learning coping tools in advance, and having a labor support team lined up. It’s Intermittent – try to relax as much as you can in the breaks between contractions. It’s Normal. Yes, it hurts, but that doesn’t mean something’s wrong. Ask your caregivers for reassurance that your labor is progressing in a typical way.
  • Counting, Affirmations. Prayer. Visualizations: Visualize a safe place,
    or visualize breathing in what would help, and breathing out what’s not helpful.

Increasing Relaxation

  • Tense then relax muscles; Relaxation scripts / hypnobirthing. (Learn more.)
  • Breathe: Cleansing Breath, Slow Deep Breathing, Light and Slide Breathing (breathing techniques are covered in episode 3

Physical Comfort

All the techniques for increasing physical comfort you already know! These are the kinds of things you do when you take care of a child, or help a friend or loved one when they are sick or unhappy. In this post, I cover food in labor, showers and baths. For the environment, think about what helps the person in labor to relax, and what helps to reduce her stress and increase her feelings of being cared for. Different people have different preferences for music or talking vs. being quiet, dim lights or bright lighting, solitude or company. The best way to find out might be to ask the questions in the Labor Support episode about what this person finds comforting when they are tired or sick or worried about something.

What if they Need More Support?

Sometimes when you assess someone’s coping you see signs that they need more support. They may be tensed up and not able to Relax during a contraction. They may be having a hard time keeping a Rhythm. It’s important that you’ve talked prior to this point about what this person’s preferences are for pain medication. (Learn about the Pain Medication preference scale and about options for Pain Medication.) This preference will guide you in how to respond when a laboring person tells you they need more support.

If they wanted pain medications, you can ask the care provider if those are available at this time. If they hoped to delay pain medications for as long as possible, then I suggest some new comfort techniques we could try. I suggest trying something for five contractions. (Learn more about this approach in the Toolbox episode.) I don’t really expect anything to work well on contraction 1, but if we stick with it, it starts to help on contraction 2, and if we’re lucky, by contraction #5, we’ve found a new ritual. If not, we try something else. It helps to be familiar with lots of ideas from:

The Labor Pain Toolbox

Gate Control and Counter-Irritants

When we focus our attention on something other than pain, then our brain simply has less attention to give to the pain, and this will reduce the intensity of the pain and the unpleasantness. (Learn about intensity and unpleasantness concept here.) The Gate Control idea is for the laboring person to pay attention to any sensation that they find pleasant. So, the labor support person might try: turning on music, speaking encouraging words, holding hands or massage, aromatherapy, offering food or drink, suggesting a walk or a movie for distraction. (Learn about Gate Control.)

Counter-irritants are when the laboring person chooses something uncomfortable to focus on instead of paying attention to the pain. This could be squeezing birth combs, or it could be a spontaneous ritual like biting their lip, or pounding their fist on their thigh. (Learn about these and other counter-irritants, including TENS, acupressure, and more.)

Positions and Movement

During labor, the baby will need to rotate through the pelvis and descend in order to be born. (Learn more.) If the laboring person is Upright, leaning Forward, and moving in ways that Open the pelvis to give baby more room to descend, labor will progress more quickly and with less pain. Positions are covered in episode 4, and you can find pictures of labor positions in Pregnancy, Childbirth, and the Newborn.

Oxytocin and Endorphins

Whether the person in labor is coping well, needs more support, or is really struggling, it helps a great deal for the person providing labor support to understand the roles that hormones play in labor and labor pain, and how to influence that. If someone is feeling stressed, judged, alone, worried, cold, or hungry, they will feel the effects of adrenaline – their muscles are tense, their sensitivity to pain is increased, and labor slows. If they are wrapped up in a cozy environment that’s just right for them, and have lots of support, and feel safe and loved, they will feel the effects of oxytocin and endorphins – they’ll have frequent, strong contractions which will help labor to progress, but the endorphins will reduce the intensity of the pain, their muscles will relax, and they’ll find their rhythm. A key role of labor support is to reduce the stressors that cause adrenaline to flow, and increase this sense of well-being. Learn more about labor support.

What if they’re Suffering

Someone can be working really hard with their labor pain but not be suffering – you can tell this is the case if they are somewhat relaxed, they have some rhythm, and they tell you it’s hard, but they don’t tell you it’s completely overwhelming them. But sometimes labor pain is more than that, and a person hits a point where they are suffering. If they had planned on pain meds in labor then they probably opted to get them before reaching this point or will do so at this time. If they had hoped to avoid pain medication, then we need to find a new plan for how to cope at this time. Sometimes, that is to choose pain medication, even if that wasn’t originally in the plans. (Learn about the code word as a way to indicate this time may have come.) Or, you may just kick into high gear with Comfort Techniques – trying new options for 5 contractions each till you find that magic combination that is enough to help her work with the pain and not feel as though she is suffering. You may also use the Take Charge technique.

Labor Support After Epidural

Although epidurals are usually quite effective at reducing labor pain, that doesn’t mean that there’s no need for labor support after an epidural takes effect. A person in labor will still need emotional support and reassurance, they will still appreciate assistance with comfort, such as warm blankets or cool cloths for their forehead, and they can use assistance with changing positions to help labor progress. Learn more about labor support after an epidural.

Labor Support During Second Stage

As labor moves from first stage (opening of the cervix) to second stage (the birth of the baby), labor support changes. The person in labor will benefit from encouragement, emotional support, comforting gestures like cool cloths and sips of water, and support with positions for pushing. Learn more about labor support during second stage and support with baby’s first hour.