Coping During Labor: The 3 Rs

A new approach to self-help comfort measures in labor is based on observations of the real experts — women in labor. These observations have helped the authors simplify and individualize the labor-coping techniques described in Pregnancy, Childbirth, and the Newborn.

The Three Rs: Relaxation, Rhythm, and Ritual
Despite the variety of ways that individual women cope with the demands of labor, there are some basic similarities among women who cope well. “Coping well” means that they get through their contractions without being overwhelmed. Their behavior has these three things in common: Relaxation, Rhythm, and Ritual. These Three Rs, describe the essential, universal, instinctual behaviors of women in labor.

Women who cope well in labor always use relaxation, either during or between contractions, or constantly. It is quite common for these women in early labor to allow their muscles to go limp during contractions, and to move about between contractions. Later in labor, some women may become more active during contractions (swaying, rocking) and relax and rest only between contractions. Others may remain very relaxed, still, and unresponsive to what is going on around them, both during and between contractions.

Women who cope well rely on rhythm in any number of forms. For example, they may rhythmically breathe, moan or chant. They may rhythmically tap or stroke something or someone. They may rock, sway, or even dance in rhythm. They may even curl and uncurl their toes in rhythm! Or, they may want to be talked to, stroked, or moaned with, by someone else. Rhythmic activity calms the mind; it has a lulling effect.

Although the word “ritual” is usually applied to religious or cultural activities, or to behavioral habits (such as “a morning ritual”), in this context “ritual” applies to the repetition of a meaningful rhythmic activity. Childbirth educators teach rituals for handling contractions that include relaxation, breathing, and attention-focusing. As labor progresses and becomes more intense, most women adapt or add to these learned rituals in ways that reflect their own personal coping styles and help them deal with the specific challenges of their particular labors.

If a woman is free to move (change positions, walk, sway, rock), she will usually find a spontaneous ritual (usually adapted from what she learned in childbirth classes) which she will repeat precisely the same way contraction after contraction. If a partner is a part of the ritual, that person must also consistently repeat his or her part without changing it. The partner’s role might include eye contact, holding or touching, swaying with her, saying exactly the same words over and over, or counting breaths through each contraction.

The ritual changes from time to time in labor. If a woman feels overwhelmed and unable to carry on a ritual, her partner, doula, or caregiver may help reestablish it. Such rituals show that women can adapt to the demands of labor and get through it.

Excerpt from ©Pregnancy, Childbirth, and the Newborn, c. 2001