Midwives support mothers in managing labour pain

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When Marina Dempster gave birth, she knew ahead of time that she didn’t want drugs, and she worked with her midwife to find several ways to manage the intensity of labour. Dempster gave birth to daughter Paloma six months ago attended by midwives in Toronto.

“I had a great birth preparation class together with my partner which helped me to understand what would be happening to me physically as the baby made her way out,” she says. “I was encouraged by the fact that your body produces good endorphins in tandem with contraction-producing oxytocin. I also listened to hypno-birthing meditations before going to sleep for a week before my due date. So it was definitely hard work but I felt I was armed with tools to deal with the pain naturally.”

Pain relief in childbirth comes in many forms. Midwives are qualified by the College of Midwives of Ontario to monitor clients with epidurals, but look to their clients as the decision-makers regarding how they want to handle pain while offering suggestions and support during the process.

“I find that many of my clients don’t want or need labour drugs,” says Lisa Weston, a Registered Midwife with Sages-Femmes Rouge Valley Midwives. “Using natural methods such as breathing, relaxation, position change and water are unlikely to interfere with labour and can work very well. When additional help is needed, other methods such as narcotics, an epidural or nitrous oxide can be accessed by the mother. But these may have side effects and may have an impact on the progress of labour.”

In order to manage the process of labour, midwives might suggest massage and counter-pressure, which can be provided by the midwife or the father or another support person. Water therapy such as a hand-held shower or bath is popular. Heat and cold packs also offer relief. “Getting into the bath was the best thing in the world,” says Dempster. “I felt supported by the tub and could grip the sides or press my feet on it, or hold the hand of a friend beside me. The heat was wonderful and the water somehow made everything less intense. I spent a large part of my labour in the bath. I also recommend low groaning – and lots of it!”

Staying mobile and changing positions can be key to the progress of labour and management of pain. Midwives might suggest walking during early labour, rocking or swaying on a chair or birth ball or leaning against another person for support. Squatting while holding a partner’s hands or a special bed support, leaning forwards on hands and knees or even just sitting backwards on a chair can all help the baby continue through the birth canal.

Midwifery clients tend to have a low rate of epidural use, likely due in part to the continuous support from midwives while using alternate methods of pain relief. “Sometimes there are cases where an epidural is appropriate care,” says Weston. “If the woman is exhausted and labour is not progressing normally, there are many things midwives can help clients do. And if non-medical interventions are not helping, then we look at what medical tools are available, such as use of drugs.”

Midwives are experts in normal pregnancy, birth and infant care and offer a choice of home or hospital birth. In Ontario, midwives are paid by the Ministry of Health and Long-Term Care, which means care is free to clients. Midwives are available by phone 24 hours a day, seven days a week. There are over 400 Registered Midwives in Ontario and over 85,000 babies have been born under midwifery care since 1994, including over 20,000 births at home. To find a midwife in your community, visit www.aom.on.ca.

“I would absolutely do it this way again,” says Dempster. “When I was in labour with Paloma I could move around wherever was comfortable and my midwives were absolutely fantastic. I felt so positive, so strong, so empowered.”