Gas, air and the epidural are what automatically spring to mind when you think of pain relief during labour and childbirth.

But there are a number of “natural” or non-pharmacological methods of pain relief, which many women choose to use either on their own or along with medication to make birth more manageable.

They include the Tens machine (a device which affects the way pain signals are sent to the brain), massage, water (showers and birthing pools, although for the most part pools in Ireland are available only to labour in rather than to give birth in) and a birthing ball.

Some women opt to learn a range of relaxation and breathing techniques, which generally need to be practised well in advance of the due date.

Emily McElarney from Rush, Co Dublin, used hypnobirthing for the birth of her first two babies and had such positive experiences that she began teaching it herself in 2012.

“There is no great mystery to it. A lot of people think of it as a mystical, crazy, hippy thing; it’s really not,” says McElarney.

“It’s basically using a combination of breathing techniques, visualisation and deep relaxation to increase your comfort during labour and birth.”

Visualisation

The mother of three says many women find visualisation in labour very effective.

“The toughest part of labour is, arguably, the dilating of the cervix, especially for a first-time mum because it can go on for a very long time . . . so for that part of labour visualisation is extremely useful.

“You are visualising your happy place – taking yourself onto a beach in Lanzarote or whatever, but it’s also using deep relaxation and that’s where the hypno element of it comes from. There is no pendulums or ‘look into my eyes’ or any of that stuff. It is basically just . . . teaching women how to get themselves into a deeply relaxed state against the odds.”

There is also a big focus on breathing techniques and on breathing through the contractions or “surges”.

“With hypnobirthing we don’t push our babies out, we breathe our babies out. That is a difficult thing for most women to get their heads around.”

McElarney says, when possible, it’s great to have a partner learn the techniques as well, “to prompt mum when she’s trying to relax and breathe against the odds”. Couples can do the programme at any stage of the pregnancy, but she says around 26 weeks is a good time to start as it means couples have support throughout the rest of the pregnancy.

She stresses, however, that hypnobirthing is not “a magic wand”, and that you have to put in the practice to reap the rewards. “You can’t expect to be able to relax against the odds on a whim. I meet so many women – they’re the type of women who worked really hard at school, worked really hard to get the job that they wanted, worked really hard at that and now they’re coming to have a baby and they realise that they have never relaxed in their entire life.

“That’s something that you’ve really got to put the work into.”

Not about natural birth

She is also keen to stress that hypnobirthing is not necessarily about having a “natural birth”.

“It doesn’t matter if it is a Caesarean section. It’s about the birth that a mum comes out of and says, ‘Yeah, I made decisions there, I knew what I was doing, I felt empowered, I wasn’t frightened and that was a great experience and I can’t wait to do it again’.”

Aside from a partner or family member, some women are hiring doulas as an extra person to support them through labour and to make it more manageable.

Doulas, also called birth doulas, provide support, information and companionship to expectant mothers during pregnancy, labour and delivery and sometimes after the birth.

Unlike midwives they do not deliver babies and do not perform medical tasks or give medical advice. Germaine Reidy, who lives in New Ross, Co Wexford, with her partner David Creevy and son Joshua (2), started working as a doula in the southeast of the country in 2008, having originally trained and worked as one while living in San Francisco.

“Doulas are more well known there. I used to do two or three births a month there [compared with] two or three a year here,” says Reidy, who adds that in the US it is very common for women to bring another person, aside from their partner, into the delivery suite with them, whether that’s their mother, sister or a doula.

Reidy says some women seek the services of a doula, which she describes as a “trained birth companion”, because they want to have a natural birth and they want “extra support around that”.

“A doula is with the mother throughout the labour [so they] can suggest other things [strategies] first. “Others just want someone who has seen it before,” says Reidy. “It’s just an extra support. We’re another person to make the hospital staff aware of the woman’s wishes.”

They also support birth partners throughout the process. “It’s a hard place for them, I can give suggestions [about] techniques to distract the mother . . . so he doesn’t feel he is just sitting there and not helping.”

Hiring a birth doula costs €700-€1,000, while a post-partum doula (someone who assists mothers at home after their baby’s birth) can cost between €15 and €20 an hour.

Reidy, who is secretary of the Doula Association of Ireland which currently has 43 members, says one advantage of hiring a doula is that you know each other before the birth, whereas many women meet their midwife only when they are in established labour.

Home visits

A doula will generally offer two to three antenatal visits in the client’s own home where she meets the expectant mother and talks to her about her pregnancy and the birth.

Reidy says the doula is then on call for the birth from four to five weeks before the due date. She remains with the woman throughout the labour, regardless of its length, until after the birth.

In early labour, it is about physical comfort measures, she says. “If it’s night-time you’d be advising them to rest. I’d make sure she was staying hydrated; I would make a snack for her.

“It’s about being at her side – a continuous support.” And it means the birth partner can take a break as well, she says.

Reidy is a qualified massage therapist and uses massage techniques during the early stages of labour to aid relaxation.

“During active labour, I can work on acupressure points to release tight muscles. But some women don’t want to be touched and that’s okay too.”

Reidy has taken time out from working as a doula since the birth of her son as she could not commit to leaving him to attend a birth for 24 or 48 hours, but she intends going back to the work as soon as she can.

“Working as a doula is an amazing experience. It’s not an easy thing to do a lot of the time, but it’s rewarding. You feel like you are making a difference.”

Women who wish to have a doula present, as well as their partner, are advised to contact the hospital in advance.

Caroline Sweeney, who lives outside Midleton, Co Cork, with her husband, Raphael, and their two boys, Luka (4) and Diego (10 months), first used the services of a doula for the birth of her eldest son in Brazil.

“I found myself in a foreign country with a very interventionist birth culture and a very high C-section rate,” she says.

Sweeney was keen to avoid surgery so she hired a doula called Rachel, who worked with an obstetrician who did vaginal deliveries.

In the months before Luka’s arrival, Rachel helped Sweeney prepare for the birth and was with her throughout her labour and delivery. She says it made her “feel confident and cared for. It’s a constant, reassuring presence.

“Having had such a positive experience I always knew I would hire a doula for any subsequent children that I had.”

Sweeney promptly hired the services of Cork-based doula Mary Tighe, when she found out she was pregnant with their second son after returning to Ireland.

Tighe made three antenatal visits to their home during which she talked to Sweeney, who was planning a homebirth, about her pregnancy and her birthing preferences.

“Basically she would have always been at the end of the phone. For anything that arose during the pregnancy, I could ring her. She was always a calm and reassuring presence like a good friend.”

Brain training

Sweeney also used the Gentlebirth programme, which teaches a combination of brain-training techniques, visualisation and hypnosis to deal with labour and birth. She also did pregnancy yoga and Pilates throughout her pregnancy.

After she went into labour Sweeney contacted Mary who came to her home.

She also had an independent community midwife assisting her as part of the homebirth scheme.

“Mary was basically sitting with me, holding my hand. I really needed her there. My husband was there too as well, also reassuring me. He was delighted. He knew that she gave me great confidence.

“A doula does not take the place of your partner. A doula supports you and your partner during what can be a long labour. It’s someone [your partner] can take turns with while one person goes to the bathroom or to eat or goes for a break.

“From a practical point of view she helped my husband fill the birth pool and setting up the room.”

Sweeney ended up having to transfer by ambulance with her midwife to Cork University Maternity Hospital while her husband and Tighe followed in the car.

“I arrived at the hospital before Mary and I really felt her absence at the time. She arrived in the door with my hospital bag and all my bits and pieces.”

Diego was born about 90 minutes later. Tighe stayed with Sweeney until breastfeeding was established and visited her on two occasions at home after she was discharged from hospital.

“I think that she made my experience much more positive. Although at times the labour was very difficult, I always felt very cherished,” she says.

Sheila Wayman is back next week.