A combination of movement, breathing, physical support, and pain relief options can make labor shorter, less painful, and more manageable. No single technique works for everyone, and most people end up using several strategies as labor progresses. Here’s what actually works, based on what the evidence shows.
Staying Upright and Moving
One of the simplest and most effective things you can do during labor is stay off your back. Standing, walking, kneeling, squatting, and getting on all fours all use gravity to your advantage. When you’re upright, your uterus tilts forward and away from major blood vessels, which makes contractions more effective and helps the baby align better in the birth canal.
The difference is measurable. In a comparative study, women who labored in upright positions had shorter first, second, and third stages of labor, reported lower pain scores, and were significantly more satisfied with their experience than women who stayed in recumbent positions like lying on their back or semi-reclining. If you have the option to move, use it. Lean on a partner, sit on a birth ball, rock your hips, walk the hallways. Changing positions every 20 to 30 minutes can also help the baby rotate into a better position when labor stalls.
Breathing Techniques
Patterned breathing is one of the few non-drug methods that remains effective deep into labor, including during the most intense final stretch. Structured breathing reduced pain scores at 4, 6, and 10 centimeters of dilation in clinical testing. That last number matters: 10 centimeters is full dilation, the point when many other comfort strategies lose their edge.
The basic approach is slow, rhythmic breathing during early labor (in through the nose, out through the mouth) and lighter, faster breathing patterns as contractions intensify. The goal isn’t distraction. Controlled breathing activates your body’s relaxation response, lowers stress hormones, and keeps oxygen flowing steadily to both you and the baby. Practicing before labor makes a real difference in your ability to use it when it counts.
Massage and Counterpressure
Targeted massage during labor significantly reduces pain, particularly in the earlier and middle phases. Massage applied to the lower back, hips, thighs, shoulders, and feet lowered pain scores at 4 and 6 centimeters of dilation, though the benefit faded in the later stages as contractions became more intense. That said, firm counterpressure on the lower back or hips during a contraction remains one of the most commonly requested comfort measures at any stage.
Your birth partner doesn’t need professional training for this to help. Steady pressure with the heel of the hand on the sacrum (the flat bone at the base of the spine) during contractions is simple and effective, especially if you’re experiencing back labor.
Water Immersion
Getting into a warm tub or shower during labor reduces pain, lowers the need for additional pain medication, and helps your body release endorphins. Women who labored in water consistently reported lower pain scores and required less medical intervention, including lower rates of labor induction and artificial rupture of membranes.
Water immersion also shortened the second and third stages of labor (the pushing phase and delivery of the placenta) compared to both conventional delivery and epidural-assisted delivery. However, it did not shorten the first stage, the longest part of labor when your cervix is dilating. The benefit of water seems to come primarily from pain relief and relaxation rather than speeding things up early on. Many hospitals and birth centers offer tubs or showers, and even a handheld showerhead directed at your lower back can provide meaningful relief.
Peanut Balls
If you have an epidural and can’t move freely, a peanut ball is one of the best tools available. It’s a large, peanut-shaped inflatable ball placed between your legs while you lie on your side. The shape opens your pelvis wider than simply lying with your legs together, giving the baby more room to descend and rotate.
A 2025 meta-analysis found that using a peanut ball during labor reduced the risk of cesarean delivery by 26%. The typical protocol involves alternating which side you lie on every 30 minutes to two hours, with the ball in place until you’re fully dilated. If you’re planning to get an epidural, ask your birth team about having a peanut ball available.
TENS Machines
A TENS (transcutaneous electrical nerve stimulation) machine delivers mild electrical pulses through sticky pads placed on your lower back. The sensation competes with pain signals traveling to your brain, and it may also encourage your body to produce endorphins. Electrodes are typically placed on either side of the spine in the lower back region.
TENS is most commonly used in early labor at home, before you head to the hospital or birth center. Many people find it helpful for taking the edge off early contractions, though it’s generally not strong enough on its own for active labor. You control the intensity with a handheld dial, boosting it during contractions and backing off between them.
Relief for Back Labor
Back labor, where intense pain concentrates in your lower back rather than your abdomen, affects a significant portion of laboring women and is often linked to the baby facing forward instead of toward your spine. Beyond counterpressure and position changes (hands and knees is particularly effective for encouraging the baby to rotate), there’s a lesser-known option: sterile water injections.
A midwife or doctor injects tiny amounts of sterile water, just 0.1 milliliters each, into four spots on the skin over the lower back in a diamond pattern around the sacrum. The injections sting sharply for about 30 seconds, but the pain relief that follows lasts up to two hours and can be repeated. The strongest effect occurs between 30 and 120 minutes after injection, though some benefit continues past three hours. This technique requires no medication, has no effect on the baby, and is available in many hospitals.
Doula Support
Having a doula, a trained non-medical support person, present during labor is one of the most well-supported interventions available. A large study published in the American Journal of Public Health, covering nearly a decade of data from Medicaid enrollees, found that women with doula support had a 47% lower risk of cesarean delivery and a 29% lower risk of preterm birth. In communities with the highest infant mortality rates, doula support was associated with a 57% reduction in cesarean risk.
Doulas provide continuous physical comfort (massage, positioning help, counterpressure), emotional reassurance, and guidance on when and how to use different coping strategies. They don’t replace your partner. They coach both of you through the process. The continuous one-on-one support is the key ingredient, since nurses and midwives typically care for multiple patients and can’t be at your side without interruption.
Nitrous Oxide
Nitrous oxide, a mix of 50% nitrous oxide and 50% oxygen inhaled through a mask, is widely used for labor pain in many countries and has become increasingly available in the United States. You hold the mask yourself and breathe it in during contractions, then set it aside between them. It doesn’t eliminate pain but dulls it and reduces anxiety, creating a sense of distance from the intensity.
Women rate their satisfaction with nitrous oxide at an average of 7.4 out of 11, placing it in the moderately high range. Side effects like nausea or dizziness are uncommon, occurring in only about 8% of users, and were rarely the reason women switched to a different method. Nitrous oxide clears your system within minutes of removing the mask and has no lasting effect on the baby.
Epidural Analgesia
An epidural remains the most effective form of labor pain relief available. It blocks pain signals from the lower body while allowing you to remain awake and alert. For many people, it transforms an overwhelming experience into a manageable one.
The tradeoff is reduced mobility (you’ll be in bed, which is where the peanut ball becomes valuable) and a longer pushing phase. Epidural use is associated with an additional 82 minutes at the 95th percentile for the second stage of labor, and it triples the rate of what’s classified as a prolonged second stage. For most people, this extended pushing time doesn’t cause problems, but it’s worth knowing that labor with an epidural typically takes longer to complete. You can still use breathing techniques, position changes with assistance, and the peanut ball to support labor progress after receiving one.
Building Your Approach
The most effective labor strategy isn’t choosing one technique. It’s layering several together and switching between them as labor changes. Early labor might look like walking, using a TENS machine, and practicing slow breathing at home. Active labor might shift to the shower or tub, counterpressure from a partner or doula, and more focused breathing patterns. If you choose an epidural later, the peanut ball and position changes with help from your support team keep labor moving forward.
Write your preferences down, share them with your birth team, and stay flexible. Labor rarely follows a script, and having multiple tools means you’re never left without options when one stops working.