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Sub-Set A First Stage -
Comfort / Support / Positions /
Natural Forms of Pain Relief

NOTE: In order to respect the privacy of those parents who so generously allowed their sacred birth images to be used in this teaching resource, the actual images (apart from those above) have not been put onto this website.

Please read below, the detailed description of each photo. These short notes are included in the photo sets.

In labour, contractions come and go. During contractions, when you are in pain, it hurts! But it only lasts a short time. In between contractions you have a chance to relax deeply, which will help you to save energy and greet the next contraction more easily. (Because contractions come and go, the average length of actual pain in a 24 hour labour is only three and a half hours!) In the next 8 photos you see women DURING the contractions - working hard - and the same women BETWEEN contractions resting, waiting.

  1. Here is the face of a woman during a strong contraction. It would be easy to presume that she looks like this all the way through labour (and this is why people are afraid of labour pain). 

  2. But, between the contractions she rests, and nature provides endorphins which give her a sense of well-being.
    But then - another contraction! (repeat first photo) and then it is gone! (repeat second photo). 
    How long does a contraction last? Any guesses? Up to one and a half minutes usually. That is all. 

  3. During the contraction it hurts and she must work hard! 

  4. After the contraction, she lets go, breathes out with a loose mouth, and rests her head in her partner's loving hand. This woman is sitting on the toilet, a popular place for women in labour. 

  5. The scowl on her face lets us know that she is really challenged during the contraction. 

  6. Between contractions she relaxes, appreciating the love and support offered by her partner. 

  7. During the contraction this woman is bellowing loudly. This helps her to express herself and to get to the other side of the contraction. She is going WITH the contraction, not against it. Many women moan or bellow in labour. 

  8. Between contractions she relaxes, as she has a few sips of energy drink. She is fine.

    In most of these photos the light is low (unless they are in the daylight). Minimal lighting helps the woman to relax more easily and assists the birth hormones to work better. In many photos the women are naked. Once they are in active labour, endorphins are released, helping the woman to feel uninhibited and not self-conscious. When women in labour feel safe and supported, they are unconcerned about the people around them. They are working hard and they often take their clothes off because they are too hot or clothes feel restrictive.

  9. The woman in labour is very vulnerable. She often draws upon the strength and support from her partner. (Note: The partner is in his bathers as they have been using the shower. Pack your bathers!) 

  10. She needs to feel safe to express her vulnerability. Her partner cradles her in his loving embrace. 

  11. At times women just need to be held - this woman is kneeling over her partner's lap under the shower. There is a soft waterproof mat on the floor for her knees. 

  12. She needs to feel safe to moan and cry out, knowing that she is completely supported by her partner.

  13. She needs to feel surrounded by love, caring and total acceptance. (This is a teenage mother-to-be in the arms of her teenage sister, her mother and her best friend nearby). 

  14. Support people and partners need to be there for her, totally, during contractions. This woman needs pressure on her forehead as she moans loudly, inches away from her partner's face. 

  15. Breathing audibly with her and holding her hands lets her know she is not alone. (Often women close their eyes during contractions). She is sitting on the edge of the bed, as her partner sits on the birth ball next to her. Note: flowers and photo of her first child, to make her feel more at home.

  16. It is nice to hang baby clothes on the wall or on furniture, so that when she does look up, she is reminded of why she is there! (You can use blue tack or medical tape in hospital). 

  17. Bring lots of loving energy and encouragement to the woman in labour. (Between contractions). This is a home birth.

  18. And bring loving energy to the baby. 
    Note: Warm pack on her belly, nice dim lights. She is sitting on a birth stool with a bucket beneath, because she wanted to pee and was comfortable staying where she was. 

  19. Bring humour and joy to the experience! It can be lots of fun at times - especially between contractions! These parents are giving birth at home. 
    Homebirth is a popular choice in New Zealand and the UK, and 30% of babies are born at home in Holland. 

  20. Remember - all the hard work is about having a baby! It is a celebration! This baby is about to be born and the father can barely contain his excitement and joy.


  21. Find positions of comfort and rest when possible. Sitting back to back (with or without a pillow) is useful, especially in early or slow labour. The baby's heartbeat can be checked easily in most positions. 

  22. Usually women lose their appetites in labour, but if she is hungry, offer easily digestible, high energy, nutritious foods such as bananas, toast, cereals or soup. This mother is enjoying a rice cake with avocado during a lull in the contractions. 
    You may help keep up the labouring woman's energy and hydration - water, sports drinks and fruit juice are good fluids to drink throughout, especially when the labour is long. (But not citrus juice - it can be too acidic in labour). Be sure to alternate water with sweet drinks. 
    This young mother's nightgown has been 'pegged' up so that when warm, wet towels are put on her back, the nightgown won't get wet. 
    You can see yellow and red massage balls - great for the lower back. Like many women having an active birth, she is leaning over the bed, but is not actually lying down on it.

  23. When drinking on all fours and in other active positions in labour, a bendable straw or drink bottle is useful 
    Note: Bring your own pillows- it is good to have the familiar smells and sights from home. 
    Hot pack on her back. Mirror and flashlight to see the baby's head. Fan because she has been getting very hot during her pushing stage. Good upright positions using lots of pillows and bean bags. This is in a hospital family birth centre. 

  24. Make the hospital room more homely. Use sarongs or scarves to cover up unused medical equipment, and especially to cover the clock. 
    The pain is much greater if a woman lies on her back in labour. Instead, lean over the bed (don't get up onto it or you may get stuck there!). 
    The woman's mother is applying a hot pack to her back. Her best friend is having a picnic up on the bed. Familiar people help her to feel safe. 

  25. In a 'high-tech' environment, turn the lights down really low. Bring flowers from home. Play relaxing or familiar music. Here the baby clothes are draped on a side table. The labouring woman is standing and is not in the hospital bed.

  26. There are usually padded mats available to put on the floor in labour wards. Again, this woman is not IN the bed, instead she is semi-squatting, leaning OVER the bed. Hot pack on her back.
    Overhead light has been pointed into the corner to create a dim light. Her partner is right there for her, holding her hands. She is in the pushing stage. 

    Notice how most of these local pain relief options are being applied to the lower back, or belly, where the pain is usually felt because of the opening cervix and movement of baby as it descends into the pelvis. The whole belly gets tight but it is normally only sore down below. 

  27. Touch and massage. Often women need their lower back massaged. Bring some oil (sweet almond oil is good). 
    If you wish to use aromatherapy oils, research good ones for labour beforehand and be mindful that some people are allergic to essential oils. 
    Her partner rubs her lower back as she leans forward instinctively during a contraction. Her mother places a loving hand on her upper back. This is in a birth centre.

  28. In this upright position, leaning over bean bag and several pillows, she can conserve her energy while having her back accessible for massage. 
    Note: pillows behind her knees so as not to compress her legs too much. 

  29. Be creative! Feet can be used very effectively! Straddling the toilet with pillows to lean on is comfortable. Pressure on her lower back helps. 

  30. Tennis balls or rubber massage balls are very effective on the lower back. Towels have been used as cushions to help both partners to be more comfortable. 
    A cold face washer is behind her neck, and a bowl of ice chips is nearby to chew on between contractions. 

  31. Heat and wet warmth work wonders. Folded hot wet nappies feel wonderful on the lower back. Note how pillows have been placed behind her knees, and over the ball to create a comfortable upright resting place. (Colourful sarong has been draped over the hospital bed). 

  32. Hot nappies can be placed on the belly, on the back and between the legs - this creates a 'nappy of heat' which penetrates in three directions and is very effective. Use of bean bag, hospital pillows and woman's pillows from home to create upright resting position. 

  33. This woman is comfortable sitting on the toilet (a common place for labouring women to want to sit - makes an excellent birth stool and the body automatically 'opens up' and 'lets go' there). 
    She has a hot nappy on her belly and one spread over her back.

    To do the nappies you need a bucket with a lid, large, sturdy rubber gloves, 4-6 towelling nappies (baby diapers) or hand towels and very hot water (hotter than tap water). The nappies need to be changed just before each contraction starts. Make sure you test them against your own face before putting them on the woman and if they are too hot, flap them briefly to reduce heat. If they are only warm, they are not hot enough.

  34. This woman has pain in her hips as well as her lower belly. The hot nappies are a great help. 
    She is wearing a belt monitor and is well propped up on the bed as she rests her legs. 
    Note: fresh flowers nearby.

  35. This woman is using a hot pack - wheat pack/gel pack/hotwater bottle wrapped in a cloth. 
    Usually women want heat on their belly low down and/or on their lower back. She is enjoying a shoulder rub between contractions. 
    Often women get very hot and tear off their clothes in labour. But sometimes their feet get cold so socks are useful to have. Sitting on the ball is very comfortable for many women. 

  36. Gel or wheat packs are easy to take if she goes for a walk.
    This teenage mother-to-be is being helped by her younger brother holding the hot pack against her lower back as she squats down during contractions. 

  37. The shower is an excellent soother of pain. There is a waterproof soft mat for the floor (or towels may be used), a bar to hang from and something for her partner to sit on. Women often spend many hours in the shower. 

  38. If you are lucky, the shower hose reaches the toilet in the same bathroom. Straddling the toilet helps to 'open everything up'.
    (Note: Cold face washer on the back of her neck because she is getting hot). 

  39. The birth ball is very useful in the shower. Notice how the water is always pointing to the lower back. 
    (Partners - bring your bathers!). 

  40. This woman is half in and half out of the shower and kneeling leaning over the ball with a cool face washer on her neck. 
    Note: You can see clearly the contraction in her belly. 
    Her partner will have a sore back if he continues in this posture. Partners need to look after themselves during labour too. 

  41. It is very common for women to want to be on all fours during a contraction. 
    There is no plug used in this bath, and towels are beneath her knees for comfort. 
    Note the hot shower on her back, cold face washer on her neck, folded towels for her forehead. 
    (Bring hair combs to keep her hair out of her face.) 

  42. Between contractions the same woman is curled up in a foetal position in the tub and has a rest, holding the shower nozzle to her belly. 
    Note folded towel under her head. Always find ways to help her be as comfortable as possible ie, folded towels / pillows / cool face washers.

  43. When things get really tough, if all else fails, using gas (nitrous oxide) may be all that is needed to get her through a difficult time and avoid more invasive pain relief options. She can use gas with or without a mask. Notice how this woman has instinctively chosen a position with one leg lifted. 

  44. The gas can be transportable. This woman chooses not to use the mask. Her partner is holding the gas for her. She is helped greatly by being in the bath, with a hot wet nappy on her back. Note the bendy straw and juice drink to keep her hydrated. (Note the fresh flowers in the background, the sonicaid and gel). 

  45. At times, things get tough for partners - one or two breaths of the gas might help them too!

  46. Some women find T.E.N.S. to be useful. But make sure that you have lots of other strategies planned in case it doesn't work. It cannot be used in the shower or tub and must be planned for ahead of time. 


  47. Find positions of REST where she doesn't have to work to be there. This is an excellent 'flop' position straddling the back of a chair - her own pillow from home is under her head and the hospital pillow is under her bottom (for obvious reasons!). 
    Note: the vomit bowl easily accessible. 

  48. Flopping forward over a bed (or could be a sofa or chair) in a birth centre. Her partner is patiently sitting next to her. She is sleeping between contractions and a mirror is on the floor because she is in the pushing stage. 

  49. Lying on her side, propped up with beanbags and pillows, and pillow between her knees for comfort. Her partner is having a rest too (between contractions!). 

  50. Flopping in the bath - the warmth and weightlessness really help! 

  51. The bath is a wonderful source of pain relief. She lies back and floats between contractions and sits up during them.

  52. Some mothers just want to completely submerge themselves in water. A snorkel is excellent in this situation! She is totally relaxed and deeply in touch with her breath. She uses the snorkel as she floats between contractions. Some women use the snorkel during the contractions.
    Although it may seem strange, anything that helps is worth doing! The bigger and deeper the bath, the better. This tub at home is large enough for her to be completely submerged on all fours 

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