As a former labor and delivery nurse who has supported women and families through the transition to parenthood for the past 15 years, and as a mom to three daughters, I have seen a lot! When it comes to labor, I can’t help but compare it to running a marathon (despite never having run a marathon, and training for my first one this year!).
Just like you need ample time and training to finish a marathon, labor requires preparation too. The difference is that many people don’t treat labor the same way and might show up without any training or skills. Both marathons and labor demand physical and mental training.
Of course, we can’t prepare for everything, and unexpected complications arise. Just as we can’t control the weather or getting sick on the day of a marathon, there are many aspects of labor that are beyond our control. Sometimes, despite our best efforts, the outcomes aren’t what we imagined — like planning for an unmedicated vaginal birth and ending up with a C-section.
Regardless of the outcome, it is never your fault. Some things are simply out of our hands, no matter how much we read, practice, or prepare. In these moments, it’s important to remember that there are still ways to regain control, even in the most unexpected circumstances. While this article focuses on preparing for the sensations of labor and managing pain, many of these techniques also promote relaxation and reduce anxiety, helping you navigate whatever comes your way.
So how can you prepare for labor? What data-driven approaches can improve the experience of birth? Let’s talk about the skills you might find useful to learn and practice.
What does labor feel like?
When we think of labor, many people, rightly so, think of pain. When I asked parents to describe labor, I received answers like:
- “Period cramps on steroids that come and go in waves.”
- “I thought I had an upset stomach, like really bad diarrhea, cramping, and kept going to the bathroom!”
- “I felt it in my pelvis and my back like the worst charley horse you could imagine.”
- “It felt like my uterus was twisting in on itself, and the only relief was counterpressure.”
This last quote ties the physical sensation of labor to a physical intervention — counterpressure. Having tools like this to ease pain can be incredibly helpful, whether you’re planning a medicated or unmedicated birth. Even with a medicated birth, there may be times you’re uncomfortable, like when waiting for your epidural.
How can I prepare physically for labor?
There are numerous non-pharmacological ways to reduce pain during contractions, whether you are planning on a medicated or unmedicated birth, that you and your partner can use, including:
Massage: When using massage, partners can move from one spot to another with the contraction. For example, start massaging her shoulders at the beginning of a contraction, move to her upper back as the contraction builds and then to her lower back at its peak, applying firm, continuous pressure (counterpressure). As the contraction subsides, move back up to her shoulders.
Hip squeeze: The laboring mom gets on all fours on a bed or yoga mat while the support person kneels behind her. During a contraction, the support person applies firm pressure just above her hip bones. This relieves tension and discomfort in the lower back and pelvis while opening up the pelvis, giving the baby more room to move through the birth canal.
Acupressure: Acupressure promotes relaxation and eases discomfort by applying gentle pressure to specific points on the body. One example is the Large Intestine 4 point, located between the thumb and pointer finger. Apply firm, continuous pressure to this point during contractions.
These techniques can be used with tools like a bathtub, shower, birthing ball, or peanut ball, and with breathing exercises and mindfulness tools (more below). They can be helpful in early or active labor, at home or in the hospital.
How can I prepare mentally for labor?
Just like the physical sensations, labor can be mentally challenging. Parents have described it to me as:
- “I had negative self-talk and felt alone in my pain.”
- “I had a burst of happy emotions that turned to fear and anxiety after being awake for 30 hours.”
- “I felt like I blacked out and went numb as my body took over.”
- “I was focused on trying to listen to my body, and it put me in an athletic game mindset.”
- “I wish I knew how to better advocate for myself. I was too scared to ask questions.”
Mentally, the biggest hurdle is experiencing pain as a good thing. Traditionally, pain indicates a problem, but in labor, it’s a sign of progress. Training your mind to view pain this way is crucial, much like pushing through a tough stretch in a marathon.
Here are three evidence-based tools, rooted in mindfulness, to help with labor:
The Tale of the Two Arrows: There’s a Buddhist saying: “Pain is inevitable; suffering is optional.” In the tale of the two arrows, the first arrow causes initial pain (the fact), and the second arrow is our response to that pain or fact (our feelings or thoughts), causing unnecessary suffering. The first step to managing the unnecessary suffering is awareness. Catch yourself when you start down the path of the second arrow, and separate feelings from facts.
Breathing: Your breath is a great tool to bring you back to the present moment. When you feel your mind falling victim to the second arrow, use your breath to ground yourself. For example, take a deep breath in to the count of 5, notice the pause at the top of your inhale, and then slowly release your breath to the count of 5.
Mantras: Mantras can be used with other strategies or on their own. Creating a birthing mantra with your partner ensures that everyone is on the same page. Simple mantras like “I am safe, my baby is safe” or “Every contraction brings me closer to you” can be powerful during contractions.
Feeling mentally prepared for labor can not only help with pain management, and decrease your perception of pain, but can also help with promoting relaxation and reducing anxiety. This can be true in the scenario where everything is going just as you planned or imagined, or the complete opposite. So even if you find yourself in an operating room having a C-section after laboring for 36 hours, you and your partner continuing to use tools like breathwork and mantras is relevant and helpful in managing any fears or anxieties that arise in these unforeseen scenarios.
How can you learn these tools?
Try to seek out prenatal classes that teach unbiased pain management options and techniques and include your partner in the curriculum, ideally with partner-specific content. This, unfortunately, likely means looking for a class outside of the hospital at which you are delivering, as many hospital-provided courses are taught with their own preferences and policies in mind. For example, if you are delivering at a hospital without access to a bathtub, then utilizing a bathtub as a non-pharmacological way to reduce pain will likely not be taught, even though this is a tool you could use at home prior to arriving at the hospital.
The data also strongly supports hiring a doula. This paper shows that there can even be positive impacts when birthing mothers identified a female friend who was taught traditional doula supportive techniques in a two-hour class. Those birthing mothers had shortened labor, waited longer to get an epidural, had babies with higher Apgar scores at 1 and 5 minutes, and reported increased satisfaction with their hospital stay. The paper’s conclusion is to train more laypeople in doula techniques, to which I agree but also say, Why can’t we train our partner in these techniques? We need to redefine “childbirth prep” courses, to ensure that we are including such training specifically for partners (or another support person) in all childbirth prep curriculum.
Finally, you may find online resources that can help you, such as Sarah Harmon’s free “Invisible Hospital Bag” toolkit or any of our prenatal classes at NAPS.
How can you advocate for yourself?
As one mom wrote when asked what she wished she had known or done differently with her first time in labor than in subsequent pregnancies, she said, “The first time, I wish I knew how to advocate for myself better. I had complications, and was too scared to speak up and ask more questions. The second time, I shared that I wanted frequent updates and clear communication along the way.” Another mom, who had three C-sections, wrote, “The best advice is to advocate. Know your options and know that your voice is so, so important! There are choices even in the controlled setting of an OR.”
These parents, like many others, wish they had spoken up more during their first labor and birth experience. I want to be clear, as a health care provider, the blame here falls on us. Health care providers need to do a better job of explaining things to patients in understandable terms and leaving time for questions. So please do not blame yourself if you have felt this way. Instead let me give you a self-advocacy tool that is rooted in doula training to help for scenarios like this, when your health care team may fall short in their explanations or recommendations.
This tool for self-advocacy is called using your BRAIN, an acronym taught during doula trainings to help make informed decisions:
- B: What are the benefits? How might this positively impact me or my baby?
- R: What are the risks? How might this negatively impact me or my baby?
- A: What are the alternatives? Are there any other options than the one being offered?
- I: What are my instincts telling me? Is there an initial gut reaction to the recommendation being made?
- N: What if I do nothing? Can I have more time to think this through? Can this procedure be delayed? What happens if I do nothing and wait?
Using your BRAIN can help you feel more confident and informed during labor.
I want to end with a story sent to me by a NAPS client about how her preparation and self-advocacy paid off. She said:
“With our first baby, I knew labor was going to be difficult — but I also thought it would feel beautiful and profound in the moment. It did not. In reality, it was just difficult. There was so much going on, I was in so much pain, and I was so scared. In the months afterward, I felt like a bad mom for a lot of reasons … and one reason that kept eating at me was the fact that I hadn’t enjoyed labor in the ways other moms had.
When the newborn fog finally lifted, I was able to reflect on the experience with more clarity. Although labor hadn’t felt profound or beautiful to me in the moment, in retrospect I knew that what my body had accomplished was profound and beautiful. And when my body had felt like it couldn’t continue, my brain had convinced it to keep going. It was like I’d finished a marathon without any training. When I thought about it that way, I finally began to feel proud of myself.
For our second child, I went into labor with a totally different mindset. I approached it like an athletic event: and this time I had been training for it. I knew it was going to suck, but I also knew I could do it. I was going to push my body to the limit to do something incredible … again. I communicated this mindset shift to my husband and he brought the exact energy I needed. For our first baby, he supported me in such a gentle, sweet way. But for our second? He cheered me on like I was Rocky Balboa. He really was just like a coach in a boxing movie: ignoring my (metaphorical) black eyes and broken nose and telling me I could take the guy if I just got back out in that ring!
When our second baby burst into the world, the entire delivery room cheered. They placed him on my chest and it felt like they were putting a gold medal around my neck. I did it, and here was our incredible reward. And that moment felt profound and beautiful, just like I’d imagined it would.”
How did you plan for your birth experience? What was it like for you physically and emotionally? Leave a comment below!
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I’ll echo everything about doulas with the caveat that it is so important to have a doula that you feel a connection with!! (In my opinion) I felt very rushed to choose a doula and ended up picking one that I didn’t feel very in sync with. It was still great to have one but I found myself holding my tongue a few times during the birthing process.
Yes! I also didn’t quite connect with my doula, but convinced myself that I did. The result was I spent a lot of labor and delivery worried about her energy and wellbeing instead of my own. I actually let myself be uncomfy so she could sleep. If I give birth again, I will select more carefully
These comments are great. They really show the variety of preferences/experiences. Counterpressure for me was amazing…hip squeezes got me through laboring at home.
I’ll also add another vote for having a doula. I had a hospital birth, and I credit my doula for providing the tools and words of encouragement that allowed me to advocate for the birth I wanted. Also, her strength and endurance was inspiring. Providing hip squeezes for hours on end is physically demanding on the support person. The doula had this incredible strength and was able to step in when he was getting fatigued. Dream team.
My spouse and I did a great zoom Lamaze class with a slightly wacky instructor. I had no idea what else was out there – this was just free through work. It covered most of what is discussed here, including putting the majority of responsibility on my husband and emphasizing pain management through distracting other senses (breathing, focusing on a special object, effleurage, scents if you can get them into the room). It may have backfired a bit in that my pain was always so well-managed the hospital kept telling me to wait at home. Then suddenly I felt the need to start pushing, we rushed (through 30 mins of traffic) to the hospital, and my son was b about 20 mins after pulling up outside. No time for drugs or even a gown. This was a terrifying experience. But not due to physical pain …
I planned by hiring a doula, attending their classes, reading about meditation and hypnobirthing, and making a birth plan with our preferences. In the end, pretty much all of it was for naught, since I needed an emergency C-section before I had dilated more than 1 centimeter during a 24+ hour induction at 41+3 weeks…the doula didn’t even make it to the hospital before the birth, and everything in my birth plan down to the delayed cord clamping went out the window. I did use some pain management techniques during the insertion of the Foley balloon, which was good since the birth happened only an hour later and narcotics would have still been in the baby’s system…but otherwise my main takeaway was to not expect anything of birth.
Big advocate for having a doula! For my first I just remember being so grateful that someone I know who had experience with labor was in the room with me and my partner all the time. She had great resources and new things to ask for that I wouldn’t have even known about. I went unmedicated until 6 or 7cm, and even once I had an epidural she was such a valuable resource. Positioning ideas, ways to save strength during pushing (all 4 hours 😵💫), and talking to my partner about what’s going on. Her presence was such an asset and I’m glad she’ll be with us for our second due this fall.
Excellent article Very concise with great information!
Counterpressure really did not work for me. It hurt more!!
The best advice we got before labor came from a hospital class. We got to arrange a bunch of cards with the side up reflecting our preferences: epidural/not, visitors/none, etc. Then the instructor came and randomly flipped a couple cards the other side up. The lesson was that you can have your preferences but likely won’t get all of them and you can’t know in advance which ones won’t go your way. We still talk about that class a decade later.