comfort measures for med-free labor

[loving2]

I've been in L&D for almost 2 years. I'm almost embarrassed to ask this, but I need some suggestions on supporting momma's choosing med-free labor. The majority of our pts choose an epidural so it is very rare for me to care for a pt without one, unless they walk in and precip. Specifically I need comfort techniques. Unfortunately I never had this training on orientation. I could also use some suggestions on books to read. Thanks.

[bagladyrn, RN]

If your facility insists that they must be on continuous monitoring (tethered by the cords) I find that a rocking chair or birthing ball placed next to the bed with encouragement to rock with the contractions can really help. If standing is good to them raise the bed all the way up and have them lean on it while standing and rotate their pelvis with contractions (still can be monitored).

[eden]

Walking, position changes, birth ball, hydrotherapy ( tub or shower), sterile water injections, massage, counter pressure. There are so many wonderful things that can help a med free birth.

Hands and knees is an awesome position and also hot water bottles/heating pads or warm blankets are also great.

[anotherone, BSN, RN]

Not an OB nurse, nor have I ever had kids......but this topic caught my attention! From my VERY limited experience in LD clinicals, my patient who was a teen, alone and scared, who didn't get an epidural but wanted one!, reported some relief from distraction techniques, this is very memorable to me because at the time I thought the whole thing was bogus as I talked to her through it like only a student can. I still do not think they are any where near the level of even a otc pain med! I would think that if one had a strong desire to go through a med free birth she would have some idea on comfort measures? Is this correct? Maybe music, back rub ?

[futurehomebirthcnm]

A couple of good books for labor support are _The Birth Partner_ and _The Labor Progress Handbook_. The latter is more clinical. Both are by Penny Simkin.

One thing a few people touched on that isn't in the books is the peanut ball--which is kind of like a Siamese exercise/yoga ball. It's more stable than the regular ball, and it can be used in bed for moms who can't or don't want to leave the bed. Here's a link with links to more information, including a YouTube video: - Navelgazing Midwife Blog - The Miracle of Peanut Balls

[sjsa82]

A couple of good books for labor support are _The Birth Partner_ and _The Labor Progress Handbook_. The latter is more clinical. Both are by Penny Simkin.

Yes! I was just going to suggest The Birth Partner!

I would also say that you could go through a birth doula training workshop to learn more and practice some techniques hands-on. Mine was a 3day training and cost around $350, but I'm sure that varies depending on where you live.

Also, maybe check out spinningbabies.com as that can help identify and correct a malpresentation which can cause unnatural pain and prolonged labor.

Hats off to you for working to learn more and go that extra mile to help your patients!! :)

[brillohead, ADN, RN]

Check out pregnancy/labor books by Dr. William Sears, too. They are written for the patient, rather than the healthcare provider, but do an excellent job (IMO) of explaining what's going to happen, what can be done, and how each experience is individual.

[LaborLandRN]

It might be reasonable to approach the doctors, and ask for a specific order for 20 minutes of EFM/monitoring per hour, so that their patient can be more comfortable up. I ask my patients before they get into that active labor stage what they want for care, what will make their birth experience what they want it to be. When in doubt, just ask--does this feel good? Better like this or like this? (think eye doctor visit). If she is telling her hubby to shut up, then try to keep your voice calm and low, and only use short sentences infrequently, with sensitivity..."after this next contraction..." and if they don't like to be touched but the counter pressure feels good, roll up a towel and place it behind her lower back when she is lying down. I always recommend our younger nurses go to the lamaze and childbirth education courses at your hospital just as an observer--where your nurses will be teaching dads those techniques :)