comfort measures for med-free labor

ixchel · May 15, 2012

Feel-good things for all the senses! Music, good smells, a photo of something they live or that relaxes them, a good taste, like a lollipop, massage.....stuff like that. Encouragement can go such a long, long way. Encouragement is so important! Not asking if they want pain meds, or making comments about how they should use pain meds is important. Keep stress out of their room. Make sure they urinate very frequently. Being up and walking around is huge. Showers are awesome as well.

The list could go on for ages :) Hooray you for supporting natural birth!!! If you're able to swing it, Lamaze conferences (not classes, but the actual annual conferences) count as continuing education hours and they are amazingly empowering. Attending a childbirth class would be good as well. Any naturally minded childbirth educator would be glad to have an L/D nurse there for free, especially when you are hoping to encourage moms to have more comfortable births when they labor med free. Find doulas to talk to as well for advice. Doulas are awesome :) And they are so effective at making labor faster and decreasing c/s rates that insurance companies are starting to pay for them to attend births.

melmarie23, MSN, RN · May 16, 2012

Hydrotherapy, WATER BIRTH!, walking, birth ball/peanuts, birthing stool, sacral pressure, music, dim lights and candles (you can have battery operated ones), telemetry if they have to be continuously monitored, intermittent auscultation if that is an option, no IV access if unneeded or a saline lock, doula services, effleurage, being permitted to eat and drink ad lib, aroma therapy....just to name a few. :-)

klone, MSN, RN · May 16, 2012

I agree with Melmarie's suggestions. The free ability to walk around is priceless, as well as hydrotherapy (laboring in the bathtub or shower). Wireless telemetry if it's available or intermittent auscultation if she's low risk and not being induced/augmented. Labor balls, both for sitting on/rocking, as well as for standing over (I like putting the ball on the bed and having the mom lean/drape herself over it and sway back and forth). Having someone do some really strong counter-massage on her lower back/sacral area if she's having back labor. Our midwives have a TENS unit that they use for back labor as well. They also have an aromatherapy machine and essential oils as well as battery "candles". Doulas are fabulous, and a few of our moms use hypnobirthing (some of those hypnobirthing tapes are pretty weird, though - I've been stuck in the room for hours with a few of those tapes and they've about driven me insane).

loving2 · May 16, 2012

Unfortunately we require continuous EFM so our moms are limited to how far the cords will reach (which isn't far at all). They really can't walk around except to the BR. I usually tell them to "take plenty of time in the bathroom" and walk around the room when they finish (wink, wink). We don't have birthing tubs, nor do we have balls. I've noticed some women don't like to be touched so counter-pressure doesn't work. And some women, strangely, want to stay in bed. I don't want to aggravate them by doing something they don't like I guess I'm just wondering what RNs do at the bedside while their pt is in active labor or transitioning? Do you stay quiet and just "be there"? Many (if not most) of the RNs that I work with do not spend much time at the bedside. My preceptor once told me that I needed to "get in and get out". So I never observed how to really "support" mommas.

ixchel · May 16, 2012

As you've experienced, every labor is different. Don't be afraid to ask how you can help. And make sure they know that they actually can get up, even if they are limited in movement. Just standing and rocking can be the best gift ever. I dont know how comfortable you are with this but there are studies that indicate continuous EFM is not beneficial. Perhaps you could present those studies to someone to remove that policy. Freedom of movement really can be so important to a laboring woman. I think also in your role, making sure you aren't pushy is very crucial. If a woman doesn't want EFM, don't tell her she HAS to get it. Remember she is a patient and has the right to refuse that care.I applaud you in your compassion toward your patients. I seriously could reach through the screen and hug you. The birth experience is so important each and every time it happens. The nurses that are present can play a vital role in that. I mean that in a good or a bad way. My second birth I had the worst nurse, and I remember every single detail of that birth. My third birth, each nurse I had was absolutely amazing. Worth their weight in gold, all because they supported and respected me as a person- not as a unit being processed. A laboring woman is very vulnerable no matter howany obscenities she may hurl during contractions. Your compassion will go such a long way with her!

ixchel · May 16, 2012

Boogers! Sorry for the typos. I'm on my phone and editing from it is crazy.

klone, MSN, RN · May 16, 2012

Some women don't like to be touched, but some women don't realize that counter pressure on their backs is actually a good thing and is actually helpful and soothing until you try it with them. What I always say is "Let's try this, if you decide you don't like it, just let me know and I'll stop." Also what I find is that husbands are afraid of applying pressure too hard, so they massage really lightly and it drives her crazy, but when I do it, I really dig in hard with my thumbs and she likes that, so I make sure to teach the dads how to do it the right way so he can take over.

And some women likewise don't realize, if they are trying to do it med-free, that they need to be coaxed and prodded to get out of bed and move around if they want help in dealing with the pain. You can't be passive. You need to be an active participant. You need to lead them and guide them. You need to remember that they often don't know what they're doing here, and will look to YOU as the expert.

Sometimes you literally have to pull them out of bed and get them moving (in a nice, loving way, of course). And if a mom wants to try to do it naturally, they may not realize at the time that you're doing what's best for them. And of course, if they change their mind and decide they want an epidural, then you get them an epidural. :)

ixchel · May 16, 2012

Oh! For a lesson on what not to do (and some good laughs), visit myobsaidwhat.com.

melmarie23, MSN, RN · May 16, 2012

if your hospital policy is for EFM, then you can present a case to getting some tele units so that women are not restricted adn bound by cords and can move more freely. There are a plethora of studies you can use to back you up. Being able to move/walk around is impertive in labor...not only for those desiring natural birth, but all women. She should be able to be up and moving prior to her epidural too.

destova · May 16, 2012

If you live in a large enough city to have access to an acupuncture specialist, they may be willing to teach you a few Acupressure points. I had an amazing nurse with my youngest three kids, during transition she would squeeze between my thumb and pointer finger during contractions. At first it hurt, but I couldn't say anything because of the silent mode transition put me in. Then I realized it helped. Not sure how, but when I was in labor with my next child a few years later I instinctively pushed my hand into hers once I hit the intense contractions! I'd forgotten she'd done that until I was in it again, then it was like a drug itself somehow.

For pts with back labor, put the head of the bed up and have them kneel backwards on the bed with their arms over the top. Then rub their lower back until you can't feel your arms anymore!

The main reason I was able to get through the labors without meds was the ability to move around.... from walking to swaying with my labor nurse to rocking on my hands and knees. Perhaps you could do some research and present a case to your director to change policies on continuous monitoring?

HeartsOpenWide, RN · May 16, 2012

Why do you require continuous EFM? Do your docs not know that intermittent is just as accurate? If mom is drug free, Pitocin free, and low risk; we do intermittent and Doppler monitoring, we don't even require a saline lock sometimes. We do water births, VBACs, have a low epidural rate (like 11%) and a below national average for primary cesarean sections...being able to move in a drug free birth is perhaps the most important pain control method.

"Let us bring them into harsh rooms with bright lights. Let us make them lie on their backs on hard narrow beds. Let us tether them to machines so they cannot move. Let us make them stay silent and make no noise with their pain. Let us expose their most private parts and threaten them with cold steel. Let us make them push their babies upwards, against the pull of the earth…In these conditions, labour swiftly becomes unbearable and pain relief becomes a woman’s only hope… This is not the natural cry of a woman in labour bringing a child to birth, although if you have only ever witnessed childbirth in a medicalized setting you might be forgiven for thinking so. This is the screaming plea of a tethered animal in pain. "