Attention-focusing and distraction
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Some women bring favourite objects such as a photograph or stuffed animal to their labour room and focus their attention on the object during contractions. Others fix their attention on some object in the labour room.
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As the contractions begin, they focus on their chosen object and start breathing techniques to reduce their perception of pain.
Imagery
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The woman focuses her attention on a pleasant scene, a place where she feels relaxed, or an activity she enjoys. She is able to breathe out any worries or tension.
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Choosing the subject for imagery and practicing the techniques during pregnancy will enhance effectiveness during labour.
These techniques coupled with feedback relaxation, help the women work with her contractions rather than against them.
Breathing techniques
In the 1 st stage of labour, breathing techniques can promote relaxation of the abdominal muscles and will increase the size of the abdominal cavity.
In the 2 nd
stage, breathing is used to increase abdominal pressure and help in expelling the fetal head.
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Instructions for simple breathing and relaxation can be given early in labour and often is surprisingly successful.
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There are various breathing techniques for controlling pain during contractions
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Simple patterns are more easily learned
Cleansing breath
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Relaxed breath in through nose and out through the mouth.
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Used at the beginning and end of each contraction.
 Start with a deep relaxing cleansing breath to “great the contraction” and end with another deep breath exhaled to “gently blow the contraction away”
Slow-paced breathing
 Approximately half the women’s normal breathing rate.

It’s initiated when the women can no longer walk or talk through contractions.

Try to keep shoulders dropped and relaxed
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IN-2-3-4/OUT-2-3-4/IN-2-3-4/OUT-2-3-4...

Modified-paced breathing
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As the contraction increase in intensity and frequency, the woman often needs to change to a more complex breathing technique.
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This is shallower and approximately twice her normal rate of breathing

This pattern requires more concentration and therefore it will block more painful stimuli than the simpler slow-paced breathing pattern

This technique conserves energy, lessens fatigue, and decreases the chance of hyperventilation.
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IN-OUT/IN-OUT/IN-OUT...
Patterned-paced breathing

The most difficult time to maintain contraction control is when the cervix dilates from 8 to 10 cm (transition phase).
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Even for a woman who has prepared for labour, concentration on breathing techniques is difficult to maintain.
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Patterned-paced breathing enhances concentration
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It may be used in a 4:1 pattern: breath, breath, breath, blow (as through you are gently blowing out a candle).
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The ration can be increased to a 6:1 or 8:1
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Watch for hyperventilation ex. Light headedness, dizziness, tingly fingers
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Panting
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Lift your chin, have mouth open slightly

Breath in and out lightly and quickly (like a dog)
Effleurage and counter pressure
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Effleurage (light massage) and counter pressure have brought relief to many women during the first stage of labour.
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Effleurage is a light stroking, usually of abdomen, in rhythm with breathing during contractions.
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It is used to distract the women from the contraction pain

As labour progressed, hyperesthesia may make effleurage uncomfortable and less effective.
Counter pressure

Pressure applied by a support person to the sacral area with the fist or heel of the hand.
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This helps the women cope with the sensation of internal pressure and pain in the lower back


Counter pressure lifts the occiput off the nerves, which helps with pain relief.
Music
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Music, recorded, or live, can enhance relaxation and lift spirits during labour.
 This helps reduce the women’s level of stress, anxiety, and perception of pain
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It can be used to promote relaxation in early labour and stimulate movement as labour progresses.
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Live music by a supportive person may help transmit energy and decrease tension and elevate mood.
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Changing tempo to coincide with rate and rhythm of each breathing technique may facilitate proper pacing.
Water therapy (hydrotherapy)

Bathing, showering, whirlpool baths with warm water can help promote comfort and relaxation.
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There are several immediate effects of using hydrotherapy: o General body relaxation and temporary relief from discomfort. o Reduces the women’s anxiety and enhances a felling of well-being. Triggers an increase in the levels of oxytocin (stimulate uterine contractions) and endorphins
(decrease pain perception)
Transcutaneous Electrical Nerve stimulation
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TENS involves pacing 2 flat electrodes on either side of the women’s thoracic and sacral spine.
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The electrodes provide continuous low-intensity electrical pulses
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During contractions, the women increases stimulation from low to high intensity
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Increase intensity should be maintained for at least 1 minute to release endorphins.
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Women describe the sensation as a tingling or buzzing, and pain relief as a good to very good.
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There are no risks to the mother or fetes by using electrical nerve stimulation
Application of Heat and Cold
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Warm blankets, warm compresses, heated rice bags, a warm shower or bath or a moist heating pad can enhance relaxation and reduce pain during labour.
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Heat application is effective for back pain caused by posterior presentation or a backache from fatigue.
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Cold application such as cool cloths or ice packs applied to the back, chest or face during labour may be effective in increasing comfort when the woman feels warm.
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You can also apply it to areas of pain


Heat and cold may be used alternatively for greater affect
Touch and Massage

Touch and massage have been an integral part of the process of labour

It is beneficial in relieving labour pain
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Touch can be as simple as holding her hand, stroking her body, or embracing her
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Touch also can involve very specialized techniques that require manipulation of the human energy field o Therapeutic Touch o Uses the concept of energy fields within the body. o Specially trained persons are trained to direct energy fields associated with pain o Research has shown the effectiveness of Therapeutic touch to enhance relaxation, reduce anxiety, and relieve pain. o Healing Touch o Is another energy-based healing modality o Combines a variety of techniques o These techniques are said to align and balance the human energy field, which enhances the body’s ability to heal itself.