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Breathing techniques to aid relaxation

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Evidence base for UFO positions creating more space in a woman's pelvis.

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Evidence base for UFO positions creating more space in a woman's pelvis.

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Efficacy of pregnancy and labour massage

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Efficacy of pregnancy and labour massage

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Abstract

Massage therapy has been demonstrated to be effective during pregnancy. Women who received massage therapy reported decreased depression, anxiety, and leg and back pain. Cortisol levels decreased and, in turn, excessive fetal activity decreased, and the rate of prematurity was lower in the massage group. In a study of labor pain, women who received massage therapy experienced significantly less pain, and their labors were on average 3 h shorter with less need for medication. An underlying mechanism we have been exploring is that these effects are mediated by increased vagal activity. This likely occurs by the stimulation of pressure receptors that are innervated by vagal afferent fibers, which ultimately project to the limbic system, including hypothalamic structures involved in autonomic nervous system regulation and cortisol secretion.

Keywords: alternative therapy, labor pain, postpartum depression, pregnancy massage, prematurity

Complementary and alternative therapies have become increasingly popular for pregnant women and women in labor. In one survey, the majority of pregnant women who participated (62%) and 61% of providers of prenatal healthcare reported that they used complementary and alternative therapies during pregnancy [ 1]. The most common alternative therapies recommended during pregnancy were massage therapy (61%), acupuncture (45%), relaxation (43%), yoga (41%) and chiropractic therapies (37%).

Pregnancy massage

Massage therapy has been demonstrated to be effective during pregnancy in three studies by our group [ 2- 4]. In the first study, therapists provided massage therapy for 20 min per week for 5 weeks [ 4]. The women reported decreased depression, anxiety and leg and back pain. Cortisol levels decreased and, in turn, excessive fetal activity decreased, and the rate of prematurity was lower in the massage group.

In the second study, depressed pregnant women were massaged by their significant others over a 16-week period using the same protocol (20-min massages twice weekly) [ 2]. As in the first study, significant decreases were noted in depression and anxiety, as well as cortisol levels. In addition, like the results of the first study, pregnancy outcomes were improved, including a reduction in excessive fetal movement that has been noted in fetuses of depressed women (). The most important finding was the lower incidence of prematurity (0 vs 11% in the control group).

In the third study, pregnant women diagnosed with major depression were given 12 weeks of twice weekly massage therapy by their significant other, or only standard treatment as a control group [ 3]. The massage therapy group women versus the control group women not only had reduced depression by the end of the therapy period, but they also had reduced depression and cortisol levels during the postpartum period. Their newborns were also less likely to be born prematurely (4 vs 16%) and with low birthweight (2 vs 10%), and they had lower cortisol levels and performed better on the Brazelton Neonatal Behavioral Assessment habituation, orientation and motor scales.

The higher-than-national-average prematurity and low birthweight rates for the depressed mothers in this sample were not surprising given previous reports on a greater incidence of prematurity in depressed women [ 5, 6]. The decreased depression and low back pain in the massaged women and their fewer prenatal complications, including a 75% lower prematurity rate and an 80% lower incidence of low birthweight in the massaged depressed women, were also not surprising given our previous finding of a lower prematurity rate in depressed women given pregnancy massage [ 2].

These findings were unique in that post partum depression and cortisol levels were decreased in the massaged women. The decrease in depression by week 32 of gestation in the massaged women persisted through the duration of pregnancy and the postpartum period. To have mothers less depressed during the neonatal period would likely enhance their bonding with their infants. Having more mature and more interactive newborns would also certainly enhance that process [ 7]. The fact that the newborns of the massaged mothers also had lower cortisol levels than the newborns of the control mothers may relate to the mothers' lower cortisol levels and their decreasing depression across pregnancy.

Labor massage

It is interesting that while labor is an anxiety-provoking experience, and while massage therapy has been noted to reduce anxiety in many studies, the focus of massage therapy labor studies has been almost exclusively on the alleviation of pain. In one study, massage was noted to lessen the pain intensity during phase 1 and 2 dilation, but there were no significant differences between the massage and control groups at phase 3 dilation [ 8].

In a study we conducted on labor pain, the pregnant women's partners massaged them during the first 15 min of every hour of labor [ 9]. The partners were given instructions on massaging the back and the legs (the areas of greatest pain) of the pregnant women from a side-lying position. The women experienced significantly less pain, and their labors were on average 3 h shorter with less need for medication ().

Potential underlying mechanisms for massage therapy effects

Some suggest that massage effects can be explained by the 'gate theory' [ 10]. This is a kind of metaphor for the pain message traveling more slowly than the pressure message from massage (i.e., the stimulation of pressure receptors). Pressure messages travel more rapidly than pain messages, reaching the brain faster and closing the gate to the pain message. A more biological explanation of the gate theory is that cells in the dorsal horn of the spinal cord act like a switch between the nerve impulses from the different fibers. Pain is carried more slowly by the less insulated (unmyelinated) C neurons, whereas massage signals are carried more rapidly by the A neurons (myelinated) that close the gate to the C impulses and allow the A signals through. In this way, the massage stimulation (A fibers) closes the gate to the pain stimulus (C fibers).

An alternative underlying mechanism we have been exploring is that these effects are mediated by increased vagal activity. Vagal activity increases immediately after massage therapy sessions and across repeated sessions of massage therapy [ 11]. In these studies, significant increases in vagal activity occurred following massage therapy. This likely happens by the stimulation of pressure receptors that are innervated by vagal afferent fibers, which ultimately project to the limbic system, including hypothalamic structures involved in autonomic nervous system regulation and cortisol secretion.

These pathways are supported by several lines of evidence. First, anatomical studies indicate that baroreceptors, and to a lesser extent, mechanoreceptors under the skin (i.e., Pacinian corpuscles) are innervated by vagal afferent fibers projecting to the vagal nucleus of the solitary tract, the predominant source of afferent inputs to the efferent neurons of the nucleus ambiguous and the dorsal motor nucleus of the vagus [ 12]. Second, functional studies indicate that electrical vagal stimulation results in reduced cortisol responses in depressed patients [ 13]. Third, as already noted, we have recently shown that moderate pressure massage (but not light pressure massage) elicits a significant increase in vagal activity in both infants and adults [ 14]. Fourth, data collected across several studies by our group and others indicate that massage therapy decreases heart rate [ 15- 17], lowers blood pressure [ 17- 19] and reduces cortisol levels [ 20, 21]. Last, a functional MRI study revealed that massage therapy increased cerebral blood flow across several brain regions involved in depression and stress regulation, including the amygdala and the hypothalamus [ 22], suggesting that massage therapy involves hypothalamic regulation of autonomic nervous system activity, cortisol secretion and limbic activity associated with emotion regulation.

Inverse relationships between vagal activity and cortisol levels have also been reported [ 23]. In addition, psychological stressors that reduce vagal activity have been noted to increase cortisol levels [ 24]. Increased vagal activity results in a slowing of physiology (decreased heart rate and blood pressure) and downregulation of cortisol [ 25]. Others have interpreted this relationship as vagal activity playing an inhibitory role in the regulation of allostatic systems [ 23]. As Thayer and Sternberg noted, the prefrontal cortex and amygdala are important CNS structures linked to the regulation of emotion and allostatic systems, including hypothalamic-pituitary-adrenal axis function [ 23].

Expert commentary

Previous reports have found that depressed women have a greater incidence of prematurity and low birthweight rates [ 5, 6]. In our studies, massage therapy has been effective during pregnancy [ 2- 4]. Depressed women given massage therapy had fewer prenatal complications, including a 75% lower prematurity rate and an 80% lower incidence of low birthweight [ 2]. They also reported decreased depression, anxiety and back pain. Surprisingly, postpartum depression and cortisol levels decreased in the massaged women. Their newborns also had lower cortisol levels than the newborns of the control mothers, which may relate to their mothers' lower cortisol levels and their decreasing depression across pregnancy. In addition, the newborns performed better on the Brazelton Neonatal Behavioral Assessment habituation, orientation and motor scales. With mothers less depressed during the neonatal period along with more mature and interactive newborns, the bonding process between them is enhanced [ 7].

In many studies massage therapy has been known for reducing anxiety. In the study we conducted on labor pain, the pregnant women's partners massaged their back and legs from a side-lying position during the first 15 min of every hour of labor [ 9]. The women experienced less pain, and their labors were on average 3 h shorter with less need for medication.

Some credit the massage therapy effects with the gate theory [ 10]. This suggests that pressure messages travel more rapidly than pain messages, therefore reaching the brain faster and closing the gate to the pain message. Another underlying mechanism we have been exploring is that these massage therapy effects occur because vagal activity increases following massage therapy. In our previous studies, we have demonstrated that moderate-pressure massage and not light-pressure massage elicits a significant increase in vagal activity. According to a functional magnetic resonance imaging study, massage therapy increased cerebral flow in different brain regions involved in depression and stress regulation, including the amygdala and hypothalamus [ 22]. This implies that massage therapy engages hypothalamic regulation of autonomic nervous system activity, cortisol secretion and limbic activity related with emotional regulation. Psychological stressors that reduce vagal activity increase cortisol levels [ 24], but increased vagal activity decreases heart rate and blood pressure, as well as cortisol [ 25].

Five-year view

Like China, the USA may eventually have touch rooms in their hospitals where couples will learn the massage for both the pregnant women and the newborn. In time, the USA may come to have the low 1% rate of prematurity of China instead of the 14% rate it currently has. Additional research on underlying mechanisms for the massage effects will help to advance this field.

Key issues

Massage therapy is the most common alternative therapy recommended during pregnancy.

Massage therapy has been demonstrated to be effective during pregnancy. The women reported decreased depression, anxiety, and leg and back pain.

Depressed pregnant women given the pregnancy massage experienced fewer prenatal complications.

In our study on labor pain, the women receiving massage therapy experienced significantly less pain, and their labors were on average 3 h shorter with less need for medication.

The most important finding was the lower incidence of prematurity and low birthweight in the massaged depressed women.

Postpartum depression and cortisol levels were decreased in the massaged women. The newborns of the massaged mothers also had lower cortisol levels than the newborns of the control mothers, and performed better on the Brazelton Neonatal Behavioral Assessment habituation, orientation and motor scales. An underlying mechanism we have been exploring is that these effects are mediated by increased vagal activity.

Acknowledgements

Tiffany Field would like to thank her collaborators and Lissette Medina for assisting with this research, and the pregnant women who participated in her studies.

The studies discussed in this article were supported by NIH Senior Research Scientist Awards (MH 00331 and AT 01585) and an NIH Merit award (M 46586), NIH grants (AT1003 and HD 056036), and a March of Dimes grant (12-FY03-48) to Tiffany Field and funding from the Johnson & Johnson Pediatric Institute.

Footnotes

Financial & competing interests disclosure

The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

References

Papers of special note have been highlighted as:

** of considerable interest

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Massage therapy has been demonstrated to be effective during pregnancy. Women who received massage therapy reported decreased depression, anxiety, and leg and back pain. Cortisol levels decreased and, in turn, excessive fetal activity decreased, and the rate of prematurity was lower in the massage group.

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NCT leaflet

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from NCT.org.uk

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What is tokophobia?

Tokophobia is where women have an extreme fear of pregnancy that can lead to them avoiding childbirth altogether. The fear becomes paralysing and terrifying, and can become physically and emotionally disabling (Scollato and Lampasona, 2013).

Tokophobia or being scared of giving birth

Ask any group of pregnant women their thoughts on labour and you'll know that a fear around childbirth is understandably pretty common. But that's different to tokophobia.

About 20% to 78% of pregnant women report fears associated with the pregnancy and childbirth (Bhatia and Jhanjee, 2012). Yet only 13% of women report a fear that's overwhelming enough to make them postpone or avoid getting pregnant altogether (Bhatia and Jhanjee, 2012).

Who is likely to get tokophobia?

Fears are likely to be more common and intense in women who have never been pregnant or given birth (primary tokophobia) (Bhatia and Jhanjee, 2012). Women who have had previous pregnancies (secondary tokophobia) can also experience tokophobia.

Secondary tokophobia is a fear of childbirth developed after a previous traumatic labour or even a normal birth, miscarriage, stillbirth or termination of pregnancy. In a few cases, prenatal depression might be happening alongside tokophobia (Bhatia and Jhanjee, 2012).

Causes of tokophobia

Some reasons that people can suffer from tokophobia are:

Effects of tokophobia

The biggest effect of tokophobia is that women try to delay or avoid pregnancy, using contraception. If they do get pregnant, women might be more likely to choose an abortion or to have their baby adopted (Bhatia and Jhanjee, 2012). They may also opt for a caesarean section when it comes to giving birth (Bhatia and Jhanjee, 2012).

Treatment for tokophobia

Tokophobia can be a lot less debilitating if you have a strong support system, including partners, mothers, sisters or friends and colleagues (Bhatia and Jhanjee, 2012). One study reported a 50% reduction in caesarean birth rates when women received psychological and prenatal support (Sjogren and Thomassen, 1997).

Some other forms of treatment include cognitive behaviour therapy, psychotherapy and taking medication to help tackle your feelings. You could also try hypnobirthing techniques to see if that helps ease the anxiety (Bhatia and Jhanjee, 2012).

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Check to see if NCT have any ' Relax, stretch and breathe' or ' Yoga for pregnancy' classes in your area.

Bhatia MS, Jhanjee A. (2012) Tokophobia: A dread of pregnancy. Ind Psychiatry J. 21(2): 158-159. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24250052 [Accessed 16th March 2018].

Fisher C, Hauck Y, Fenwick J. (2006) How social context impacts on women's fears of childbirth: A Western Australian example. Soc Sci Med. (63):64-75. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16476516 [Accessed 16th March 2018].

RCOG. (2011) RCOG statement on draft NICE caesarean section guidelines. Available from: https://www.rcog.org.uk/en/news/rcog-statement-on-draft-nice-caesarean-section-guidelines/ [Accessed 16th March 2018].

Scollato A, Lampasona R. (2013) Tokophobia: When fear of childbirth prevails. Mediterranean J Clin Psychol. 1:1-18. Available from: https://core.ac.uk/download/pdf/25510068.pdf [Accessed 16th March 2018].

Sjogren B, Thomassen P. (1997) Obstetric outcome in 100 women with severe anxiety over childbirth. Acta Obstet Gynecol Scand. 76(10): 948-952. Available from https://www.ncbi.nlm.nih.gov/pubmed/9435734 [Accessed 16th March 2018].

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Tokophobia: how to get over extreme fear of giving birth

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Tokophobia is where women have an extreme fear of pregnancy that can lead to them avoiding childbirth altogether. The fear becomes paralysing and terrifying, and can become physically and emotionally disabling (Scollato and Lampasona, 2013). Ask any group of pregnant women their thoughts on labour and you'll know that a fear around childbirth is understandably pretty common.

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Good ideas for coping in labour

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NCT leaflet

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Tip and links to relaxation resources

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For women giving birth naturally, the most critical skill to master is relaxation. It may seem odd to consider relaxation a skill, but indeed it is.

Maintaining relaxation in the face of the unknown, in the midst of the emotional journey into motherhood, can be a daunting task. If negative thoughts or self-doubt creep into your mind, they can undermine your ability to turn your body over to birthing and ultimately make your birthing a painful experience.

To illustrate the skill of maintaining relaxation amidst distraction, Pam England, in her book Birthing from Within, suggests taking the "ice cube" test: holding an ice cube in your hand when you think you're completely relaxed. After a few minutes, you will most likely find that your "relaxation" has vanished.

Relaxation techniques can be applied to every aspect of your life. The benefits of relaxation for improving people's physical and mental health have been well documented.

Barriers to Relaxation

To birth your baby, your body must open. Tense, tight muscles impede that opening. If you condition your body now to stay relaxed in the face of distraction, you will be better equipped to slip into deep relaxation during labor and birth.

Different factors may impede women giving birth naturally from fully relaxing, including their perceptions of childbirth. If a woman harbors negative connotations or phobias about childbirth, these feelings can interfere with her ability to trust her body and truly relax. Any of the following techniques may be employed to learn relaxation for childbirth. Before starting them, read the guidelines for implementing relaxation techniques for childbirth.

Relaxation Techniques

There are many avenues available to learn relaxation. The key is finding what works for you. Some of the most commonly used methods include:

Relaxation Scripts

A relaxation script is a critical birthing preparation tool. These scripts can be read by a partner or alternately, you can choose a relaxation audio cd instead. Through daily practice, you will condition your body to immediately relax under any circumstances. Daily relaxation practice is the key to pain-free births.

Progressive Muscle Relaxation

Progress muscle relaxation techniques can be particularly effective for women giving birth naturally. With this technique, you learn to actively tense and then release individual muscles or muscle groups. By doing so, you learn to discriminate tense vs. relaxed muscles and ultimately maintain a relaxed state at will.

Visualization

Visualization can be a powerful tool for women giving birth. This is a technique commonly used by athletes. You learn to visualize the whole experience of birth-from early labor to delivery. In your mind, you picture all aspects of your birthing - from the smells around you to the background noises and even the lighting - and how you will react to each new development. When we see ourselves successfully giving birth naturally, we are better able to trust our bodies when actual labor begins. A guided imagery exercise in which visual imagery represents the birth process, such as picturing your body opening like the petals of a flower, can also be effective. Hypnobirthing: The Mongan Method contains several quality imagery scripts.

Music

Music speaks to people in many ways. It has such a varied impact upon people. Music can be used as a tool to evoke emotions across the spectrum-from energizing and invigorating to soothing you to sleep.

Women giving birth naturally benefit by using relaxation music as part of their relaxation routine to instill relaxation at the first strains of that familiar melody.

Whatever method or methods you choose, they will be most effective with consistent practice. So the next time you sit back and put your feet up, remember you're hard at work preparing for your birthing!

References

Smith CA, Collins CT, Cyna AM, Crowther CA. Complementary and alternative therapies for pain management in labour. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD003521. DOI: 10.1002/14651858.CD003521.pub2.

Anim-Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD000331. DOI: 10.1002/14651858.CD000331.pub2.

Hodnett ED. Continuity of caregivers for care during pregnancy and childbirth. Cochrane Database of Systematic Reviews 2000, Issue 1. Art. No.: CD000062. DOI: 10.1002/14651858.CD000062.

Cluett E R, Nikodem VC, McCandlish RE, Burns EE. Immersion in water in pregnancy, labour and birth. Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD000111. DOI: 10.1002/14651858.CD000111.pub2.
Page Last Modified by Catherine Beier, MS, CBE

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For Women Giving Birth Naturally | Relaxation Techniques

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For women giving birth naturally, the most critical skill to master is relaxation. It may seem odd to consider relaxation a skill, but indeed it is. Maintaining relaxation in the face of the unknown, in the midst of the emotional journey into motherhood, can be a daunting task.

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from NCT.org.uk

# data[].attributes.attachment_link.readable_text
What is tokophobia?

Tokophobia is where women have an extreme fear of pregnancy that can lead to them avoiding childbirth altogether. The fear becomes paralysing and terrifying, and can become physically and emotionally disabling (Scollato and Lampasona, 2013).

Tokophobia or being scared of giving birth

Ask any group of pregnant women their thoughts on labour and you'll know that a fear around childbirth is understandably pretty common. But that's different to tokophobia.

About 20% to 78% of pregnant women report fears associated with the pregnancy and childbirth (Bhatia and Jhanjee, 2012). Yet only 13% of women report a fear that's overwhelming enough to make them postpone or avoid getting pregnant altogether (Bhatia and Jhanjee, 2012).

Who is likely to get tokophobia?

Fears are likely to be more common and intense in women who have never been pregnant or given birth (primary tokophobia) (Bhatia and Jhanjee, 2012). Women who have had previous pregnancies (secondary tokophobia) can also experience tokophobia.

Secondary tokophobia is a fear of childbirth developed after a previous traumatic labour or even a normal birth, miscarriage, stillbirth or termination of pregnancy. In a few cases, prenatal depression might be happening alongside tokophobia (Bhatia and Jhanjee, 2012).

Causes of tokophobia

Some reasons that people can suffer from tokophobia are:

Effects of tokophobia

The biggest effect of tokophobia is that women try to delay or avoid pregnancy, using contraception. If they do get pregnant, women might be more likely to choose an abortion or to have their baby adopted (Bhatia and Jhanjee, 2012). They may also opt for a caesarean section when it comes to giving birth (Bhatia and Jhanjee, 2012).

Treatment for tokophobia

Tokophobia can be a lot less debilitating if you have a strong support system, including partners, mothers, sisters or friends and colleagues (Bhatia and Jhanjee, 2012). One study reported a 50% reduction in caesarean birth rates when women received psychological and prenatal support (Sjogren and Thomassen, 1997).

Some other forms of treatment include cognitive behaviour therapy, psychotherapy and taking medication to help tackle your feelings. You could also try hypnobirthing techniques to see if that helps ease the anxiety (Bhatia and Jhanjee, 2012).

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Check to see if NCT have any ' Relax, stretch and breathe' or ' Yoga for pregnancy' classes in your area.

Bhatia MS, Jhanjee A. (2012) Tokophobia: A dread of pregnancy. Ind Psychiatry J. 21(2): 158-159. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24250052 [Accessed 16th March 2018].

Fisher C, Hauck Y, Fenwick J. (2006) How social context impacts on women's fears of childbirth: A Western Australian example. Soc Sci Med. (63):64-75. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16476516 [Accessed 16th March 2018].

RCOG. (2011) RCOG statement on draft NICE caesarean section guidelines. Available from: https://www.rcog.org.uk/en/news/rcog-statement-on-draft-nice-caesarean-section-guidelines/ [Accessed 16th March 2018].

Scollato A, Lampasona R. (2013) Tokophobia: When fear of childbirth prevails. Mediterranean J Clin Psychol. 1:1-18. Available from: https://core.ac.uk/download/pdf/25510068.pdf [Accessed 16th March 2018].

Sjogren B, Thomassen P. (1997) Obstetric outcome in 100 women with severe anxiety over childbirth. Acta Obstet Gynecol Scand. 76(10): 948-952. Available from https://www.ncbi.nlm.nih.gov/pubmed/9435734 [Accessed 16th March 2018].

# data[].attributes.attachment_link.title
Tokophobia: how to get over extreme fear of giving birth

# data[].attributes.attachment_link.description
Tokophobia is where women have an extreme fear of pregnancy that can lead to them avoiding childbirth altogether. The fear becomes paralysing and terrifying, and can become physically and emotionally disabling (Scollato and Lampasona, 2013). Ask any group of pregnant women their thoughts on labour and you'll know that a fear around childbirth is understandably pretty common.

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Massage techniques for pain relief and relaxation.

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From NCT.org.uk

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Whether it's your partner, daughter or friend due to give birth, it's an honour to be asked to be a birth partner. Yet this exciting role can also be daunting. Here we discuss some top tips to help you get ready.

You'll find a whole number of ways you can help support the mum-to-be during labour (NHS Choices, 2017a). One place to start is by talking to them in advance about their expectations of you - ask them how they'd like you to support them. This will help you both feel more prepared ahead of the birth and confident in your role as birth partner (NHS Choices, 2017b).

Watch this video for tips on how to support your partner during labour.

1. Be prepared

Birth partners should be prepared and ready. The weeks around their due date are not a good time to book an impromptu holiday or be in a meeting with your mobile phone switched off.

Talk through their birth plan (if they have one) with the mum-to-be well in advance. Attending birth classes like an NCT course together can help you learn about what to expect in labour (Which? Birth Choice, 2018). Classes will also help you write a birth plan if you want one (Which? Birth Choice, 2018).

Ask your partner if there are any specific ways they would like you to support them during labour and the birth. Also ask about any no-go areas. And know your limits too - if there are bits of the birth you prefer not to get hands on with, make it clear beforehand. For example, let her know if you don't want to help cut the baby's umbilical cord.

If you're planning to use any new kit during labour like a TENS machine, make sure you test it out ahead of time and know how to use it.

2. Be there and know what she wants

The number one thing you can do for a woman in labour is be there as continuous support for them and help them with whatever they need at the time. Research has shown that having a familiar birth partner present throughout labour can help improve the birth experience (Bohren et al, 2017).

Whether that's simply being there to hold her hand, or offering moral support and bringing some positive energy to the room (NHS, 2017b). Try to talk about what emotional, physical and practical support she would like too. Help her write down a birth plan or talk through it if she would like to. That way, you know her preferred birth choices like the back of your hand.

3. Provide company

During the early stages of labour you can help keep her company, make sure she is comfortable and help pass the time together.

You might be able to go for a walk together in the early stages of labour, watch television, listen to music or read together.

You can assist with whatever helps the mum-to-be feel comfy. She might like you to help her to bath, you could fetch her some relaxing creature comforts, or give her a hand to keep moving.

You'll also need a break. Make sure you bring some snacks for you too and wear comfy clothes to keep yourself in top form (Northern Lincolnshire and Goole NHS, 2015).

4. Give her practical support

You can help in lots of practical ways. You could drive the mum-to-be to the hospital, carrying her hospital bag and helping her check into the birthing suite or hospital (NHS, 2017b).

When you get there, you could do things like helping her to move around the room and change positions. She might love you to give her a back rub or get her a cup of tea.

If she is planning a home birth you can help set up everything she needs at home, whether that's a birthing pool or somewhere comfy for the mum-to-be. On the day you could offer to get the mum-to-be a hot drink and make phone calls to keep family updated.

The key here is to discuss and plan in advance what practical support she would like you to provide.

5. Provide emotional support

As the mum-to-be's labour progresses and contractions get stronger you can be her rock, comforting and reassuring her. Simple gestures like holding or squeezing her hand and giving positive words of encouragement can really help.

6. Support her physically and take care of yourself

You can encourage the mum-to-be to keep active during labour and help her move about or change positions so she feels more comfortable (NHS, 2017b). You could also offer to massage her back and shoulders, wipe her face with a cold flannel, or simply give her a reassuring hug. You might also find you need to back off a bit if she needs space. Ask what she'd prefer.

To continue to support the mum-to-be well during labour, you also need to be on top form. You might be supporting and providing comfort to her for a long time. You may even find you haven't slept all night and are extremely tired.

So take time out if you need it - whether that's going for a quick toilet break, getting a hot drink or stepping out to make a phone call. Make sure you bring snacks and wear comfy clothes (Northern Lincolnshire and Goole NHS, 2015).

7. Listen to her

Try to really listen to what she needs on the day. It can be easier said than done but you will need to be intuitive and try and understand what she needs and when. Especially if she is in too much pain to express it well herself.

Be aware that her needs might change as her labour progresses. At times during labour, the mum-to-be might like emotional and physical support. Yet there might be other times when she would like to be left alone to help her focus.

8. Be confident, encourage and motivate

If you are upbeat and confident in a woman's ability to give birth, this will help encourage and support her.

Words are powerful. You can help your partner stay motivated during labour by offering words of encouragement. Tell her how much you love her, how well she is doing. Also respect her wishes if she asks you to be quiet.

Encourage her to use any relaxation and breathing techniques you have learnt, perhaps by doing them with her. She might not be able to see what is happening as the baby is being born. So help to motivate her by telling her what is happening and when you can see the baby's head.

9. Be an advocate

You might need to express the mum-to-be's needs to the midwife or doctor (NHS, 2017b). So help to explain to the health professional what she would like. You might also need to explain to her any new information from the health professionals.

Support the mum-to-be's decisions, even if they're different from what's in her birth plan. She might want to choose a different type of pain relief, for example.

10. Be flexible

Be prepared to be flexible. No two labours are the same and, although you can prepare, you will need to adapt to whatever is working or not working during labour. It's possible that everything will go to plan but you might also find that an urgent medical situation arises and alters the course of the labour.

If this happens, tell the mum-to-be what's happening if you can and continue to encourage and reassure her. This will help her feel more in control of the situation.

You might be waiting a long time for her labour to progress, or you may have to make quick decisions based on medical advice and her best interests. Be prepared to be flexible on the day and go with the flow.

Give yourself a pat on the back too

Being a birth partner can be an incredibly rewarding experience. Yet it can also be nerve wracking and emotionally draining.

As well as congratulating the mum-to-be on their new arrival, don't forget to take some time out for yourself afterwards and talk to a friend about it. Make sure you give yourself some recognition for the part you have played in the baby's birth too.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

Find out more about NCT Doulas and how they can during labour. NCT Doulas provide women, and their partners, with skilled physical and emotional assistance during labour. They have up-to-date knowledge and information about labour and birth and help provide encouragement to woman. This helps enable them to have the type of labour and birth they would like. NCT Doulas are qualified professionals who have completed a professional Doula UK course, developed by NCT in partnership with the University of Worcester.

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Whether it's your partner, daughter or friend due to give birth, it's an honour to be asked to be a birth partner. Yet this exciting role can also be daunting. Here we discuss some top tips to help you get ready. You'll find a whole number of ways you can help support the mum-to-be during labour (NHS Choices, 2017a).

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NCT leaflet on optimal positions for labour and birth