Counter-irritants for pain relief
As a childbirth educator and doula, I wish we all talked more about “counter-irritants” as effective methods for pain relief during labor and birth. By counter-irritant, I mean the person in labor does something which is uncomfortable but helps to distract her from the labor pain, such as biting on her lip, squeezing her fingernails into her palms, using a fist to thump on her thigh, or pulling on her own hair. These are all actions that are within her control – she can start or stop anytime she wants to – she chooses how intensely to do it so that it will bring her attention away from the contraction pain that is not within her control.
The issue is that some of these spontaneous techniques can cause pain or minor injury to her. I like to talk about these behaviors in class so partners know that if someone in labor is doing this, it’s because it’s helpful to her. We shouldn’t stop them form using a coping technique. But the partner may need to help her figure out how to adapt it in a way that provides the pain relief but doesn’t cause harm on its own.
Sometimes it’s a simple in-the-moment fix – for the mom who’s hitting her thigh we might place a pillow there to cushion the blow. For the mom digging her fingernails into her palm, we might be able to give her a washcloth to grip tightly, or better yet, a comb or brush to squeeze.
Birth combs – How to Use Them and Why They Help
In some traditional cultures around the world, laboring women hold onto wooden combs. When a contraction comes on, the mom squeezes the comb so it presses into her palm – she squeezes as long and as hard as she finds helpful. Then she relaxes her grip between contractions, but usually chooses to continue holding the combs.
What to use: I use reflexology combs from Mildred Carter’s Reflexology – shown in the photo at the top. Sadly, they’re no longer available… But here are some alternatives I’ve found that I believe would work well:
- Metal Comb or Aluminum Mane Comb
- Wood Comb or Wood Comb
- Hand Massage Ball and Foot Massage Ball
- Or really, any hairbrush or plastic combs from the drugstore as long as it has thick tines with blunt tips.
How to hold it: the photo at the top of this post illustrates it, and this drawing from Page 9 of this booklet on Acupuncture in Labor also shows how you would hold the comb.
There are a few theories as to why birth combs might be helpful.
- One is “Diffuse Noxious Inhibitory Control“. If we create pain or discomfort anywhere on the body, it causes the release of endorphins which reduce the perceived intensity of the pain. (Note: TENS and sterile water injections would also fit in this category of pain relief.)
- One is related to Gate Control theory: Our brain can only pay attention to so many stimuli at once, so the pressure on the nerve pathways of the hand travels to the brain faster than abdominal pain, and crowds out the abdominal pain signals.
- One is reflexology or Chinese medicine-based. There are meridians – energy pathways – that cross the palm. Pressing on trigger points there helps to release stagnant chi, allowing healing energy to flow.
- One is psychology – because the mom is in control of the pain from the comb, it makes her feel less out of control from the labor pain – more like she’s “working with labor pain.”
My experience with combs for pain
I am an amputee. Which means I have phantom pain. You may have heard it mentioned in studies where people rate the intensity of different kinds of pain. Broken bones, tooth abscesses, and kidney stones are pretty high on the list. But labor pain and phantom pain top the list as some of the most intense pain people experience. So, I’ll share how pain combs work on both these types of pain for me.
Although my right leg has been gone for over 35 years, any time I think about it (like as I type this sentence), I have a tingly sensation all up and down “where my leg should be.” About once every 6 weeks, I have pain that is severe enough that I can’t sleep through it or work through it. Over the years, I explored LOTS of ways to cope with phantom pain, including medications, massage, acupuncture, reiki and other energy medicine, etc. (I luckily have finally found something that fixes it for me. One tylenol and one ibuprofen. If I only take one of the meds, it’s completely ineffective, no matter the dose. But together they’re really effective!)
Prior to that, one of the most effective pain coping tools I had found was combs. As the phantom pain intensifies, squeezing the comb helps distract me from it. It helps me feel much more in control. It significantly reduces the effects of phantom pain, so I had used them for many years.
When I had my third baby, I brought my combs to the labor. My labor was quite fast. About 3 hours start to finish, with the 3cm – baby out portion lasting about 30 minutes. So, it was VERY intense. I was in a lot of pain with contractions, and my teenage daughter remembered the combs and suggested them. I used them through the rest of labor, and they were what made contractions bearable for me. Managing a contraction without them was very difficult, so having them was my top priority. At one point I’d gone to the bathroom and set down my crutches and my combs. When a contraction came as I was hopping toward the sink, I yelled for the combs – my partner tried to give me my crutches – which obviously would normally be a priority for me. But at that point I only wanted the combs, because I knew they were what would make the contraction manageable. In the photo below, you can see I was still holding a comb to manage the cramping contractions of third stage labor after my son was born.
So, the question is: are combs effective for people who have not used them for other pain management? (In other words, did they work for me just because they were a familiar pain coping ritual from my life, or would they work for anyone?)
I used them with two clients in labor. They both found them helpful for a portion of their labor. And here are… quotes from others who have used combs during labor
- When I would use the combs, I couldn’t feel anything compared to when I walked around without them. Tracy
- When the contractions peaked, I would squeeze my combs, and there was a big difference between “comb” contractions and “non-comb” contractions. I wouldn’t do a birth without them. Rachel
- I used two combs. They were men’s combs with the all the same size teeth, with blunt ends NOT pointed ends. I loved them. Didn’t want to let go the whole labour. Marlee
- Do not under estimate the power of a comb. The small blue plastic comb… was better then an epidural! There are pressure points in your palm that help with pain relief in labor. As a contraction built, I would squeeze my comb as tight as feasible, the teeth digging into my palm, hitting those points and providing immense relief. I couldn’t have done it without that comb! source
- I held a small black hair comb in each hand, squeezing them into my palm… I’m not sure how my labor and delivery would have been without holding them, but it actually went pretty fast. And I liked the sensation when I tried it, which is why I kept on with it. Viola
- During contractions I was sort of searching with my hands for something to grab onto, I think to feel more grounded. My doula slipped a comb into my hand and I squeezed it instantly. It was awesome! ,,, I was still very much in pain, but it definitely made a noticeable difference and provided me with a bit of instant relief. I remembered her slipping it into my hand, but I didn’t remember what ever happened to it after that. I asked Dh one day if I used it for very long, or if I just dropped it after that contraction. He said that after Ds was born he pried it out of my still tightly squeezed hand. – Jennica
Combs are a cheap tool to obtain, and small and easy to toss into a birth bag, so I recommend them for all doulas as an option to bring along and try.
To learn lots more about coping with labor pain, check out The Labor Pain Toolbox, Comfort Techniques, and other articles on this site (or listen to those episodes on my podcast) and to learn about all the other topics related to the perinatal period, check out the book I co-author: Pregnancy, Childbirth, and the Newborn: The Complete Guide