Comfort Measures Tools for Labor with Katie Bertsch of Gold Coast Doulas: Podcast Episode #204
Katie Bertsch and Kristin Revere chat about the tools we use as birth doulas during labor and delivery. Some of these include hands-on support, birthing balls, birth stools, and more.
This is Kristin Revere with Ask the Doulas. I’m here today with our own advanced doula, Katie Bertsch. Welcome, Katie!
Hi. Thank you!
So happy to have you here! Our topic of the day is comfort measures and how we use them as birth doulas. Katie, what are some of your favorite tools with clients, whether they’re looking for an unmedicated birth, a home birth, a hospital birth, or the support of an epidural?
I realized quickly that my list was not tools so much as how to support a physiological birth by using positions and movement within the body to help the baby rotate and descend and help labor progress. I love physiology, anatomy, and how the body works. I love knowing that their bodies were created to do this, to birth babies. It was really fun to make this list, thinking about all the ways we can help that mama and baby get to meet each other.
As you speak about your passion for birth, can you share about why you became a birth doula and some of your related trainings over the years that have led you to that elite or advanced status that we have within Gold Coast.
Absolutely. I became a doula about six years ago. It was after I had my first son. My husband and I took all the classes. We both love to learn. He has an engineering brain and he wanted all the research. We took a lot of classes and practiced a lot of things, but it still felt like birth just took us by storm. His birth was pretty hard; we had to be induced, and nothing went by the birth plan. We quickly learned that it’s more of birth preferences and how to achieve the birth that you want, even when things need to change. But I didn’t know any of those things yet, so I just held so tightly to my plan. Nothing was going the way I wanted, and it was so hard.
Thankfully, we had an amazing nurse, and she helped bring us back down to our center. She gave us some options, and the birth was great after that. I got this bug in me – I want to know more. I want to be able to help. A lot of my friends were having babies at the same time, and I just kept hearing this theme that it felt like birth happened to them. It was like they didn’t have a voice. Things just kept happening really fast. There weren’t choices. They and their partners were just overwhelmed. And I’m just thinking: I love babies. I love birth. And that’s not the feeling that you should walk away with.
I got my training through DONA International, thankfully pre-COVID. I got to have this awesome four-day in-person training, hands on, really intensive. Since then, I’ve done a Spinning Babies training, which I will talk a lot about because it has just changed the way that I see birth.
Yes, we took it together, and it’s life changing!
Yes! So that I’ve loved and I definitely use it for every single birth. It almost changes the philosophy of how I walk into it. After having a few clients who needed Cesareans for medical reasons and then wanted a VBAC afterwards, I wanted to know how that was different for them and how to support them best. So I did a VBAC training to give them the specific care that they needed. I love to learn, so I’m still trying to build my toolbox to give clients what they need. After seeing a lot of different types of birth, I’ve seen the beauty in all the different ways, whether it’s a fully natural homebirth, whether it’s a planned Cesarean, and absolutely everything in between. There is beauty in all of it, and there are ways to get what you want and use your voice and feel empowered and calm and comfortable as you get to meet your kiddo. I’m very passionate about it. I just love talking about it. I’m excited to talk about comfort measures.
I can tell you are! I love it. What’s the first tool that you utilize as a doula?
I feel like I can’t not talk about the birth ball and the peanut ball. Those are definitely easy go-tos, especially because hospitals stock them, so it will be in every room that you birth in. I do think it’s helpful to buy a birth ball for your home. It’s important to get the right one for your height so that your hips and knees are at a 90-degree angle. It’s just so versatile; you can sit on it and do hip circles, figure 8s, side to side, back and forth – all great ways to open and loosen the pelvis, help baby rotate and descend. You can do these leading up to birth; you can do it while you’re still working, and swap it out for your office chair. You can do it as early labor begins to relax and find comfort. It’s great for during surges. It’s great for in between them. Really, it can be used whenever, and that’s just sitting on it. You can also be on all fours and lean over it to give your upper body a rest when you want to relax and melt over the ball, but you still want to be in a really positive position. And you can sit on it and have that open pelvis while you’re leaning back or leaning forward on your partner for a great moment of connection. The birthing ball is just so great.
I think the peanut ball can be more versatile just because of its size. You can do a little bit more movement with your lower half. You can put it between your knees and feet and extend it behind you for a flying cowgirl, which is a Spinning Babies move. It’s just really great for helping baby through the inlet if they’re kind of stuck up high. You can put it under one knee that’s drawn up high if you’re doing exaggerated sidelying release. That can help them through the mid pelvis. You can kind of rest in the butterfly position with your feet together and your knees out, and you can put a peanut ball under each leg. You can put it under your left leg; you can drape it over. So many things.
It is great for rest. If you have a hospital bed, you can move it up and down and change into so many different positions. But if you’re at home in early labor or birthing at home and don’t have a peanut ball, you can just take your pillows and fold them and stick two of them in between your legs to give you that open outlet.
Yes. It creates some space in your pelvis by moving your knees apart.
Exactly. Great tips! What are your other favorite tools?
I also love the forward leaning inversion as a position that’s just really helpful. Babies get into the best position available with the space available, but that’s not always the most optimal position with the head down, facing the back, chin tucked. That’s ideal, but that’s not always what happens. Maybe that’s just based on where we hold tension on one side or what’s going on with the umbilical cord inside. We don’t always know. But we know that babies get in the best position they can. But we can help them to get into that more optimal position, and that forward leaning inversion is great for that because you lean forward and put your head down, and that gives you a reset to the uterine, sacral, and round ligaments. They stretch while you’re down in the inversion, and then as you come up, they reset. That gives baby room to float off the pelvis and then hopefully rotate, tuck their chin, and reengage into that best optimal position. And if baby is head down, you can do this daily at home after 24 weeks. You can do it during early labor or if there’s a stall in labor progression, if malposition is indicated. If any intervention is suggested, you can do this to give baby a chance to reset before you talk about doing the next thing.
For our listeners who are not familiar with the forward leaning inversion, you can check out the Spinning Babies website for those videos and tutorials. I know there are plenty of doulas who are Spinning Babies trained who have also created YouTube videos that you can search.
Yes. I am not super into the social media world, but I’ve already seen TikTok videos of it and all those good things. So it’s out there, and I love that.
For sure. What’s next?
The sidelying release is also great. This addresses 30-plus muscles that go to the pelvis, which is just incredible that one move that is very relaxing is also so productive and so great for your pelvis. This one is great to use if mom has been at it for a long time and she’s exhausted and wants to be laying down in the bed. She’s got her bottom leg straight, her hips kind of rotated so that she’s more on her belly, and her top leg is just thrown way over to the side. That’s why it’s called exaggerated. That is making amazing opening and movement to the pelvis, which gives baby a chance to rotate if they are in that nonoptimal position. And then mom can just breathe and rest while we’re supporting. It does feel a little tippy, like you might be falling off, but you’re supported. And it stretches the pelvis and the spine muscles. It opens that sacroiliac joint, frees up the sacrum, and softens the pelvic floor to help that open cervix for the uterus and baby to turn.
And if you have a doula, your doula will likely know how to do the sidelying release. But I’ve been impressed over the years at how many nurses not only were in our Spinning Babies training, but just hearing more and more from the hospitals that we work with about how their nurses are getting trained in some of these techniques. It’s very exciting.
It is. I was at the hospital this weekend, and as we were doing laps, walking around, I saw the nurses’ board. They had posters of different positions on there. They’re doing a position of the week. It’s just so encouraging that they are committed to learning these things, to help their clients. Not everyone does have a support person. If they’ve got a nurse in the room who understands this, then it’s just great for their team.
Exactly. What’s next, Katie?
Another great one is a posterior pelvic tilt, or an abdominal lift and tuck. If I can kind of describe this one, it would be flattening your back, tucking your hips and tailbone in, and then with your hands, lifting your belly during a surge. This gives baby more room and can help them reposition, especially if they’re posterior. It’s most helpful if baby is still up high, and sometimes it’s a good one to do when the nurse is in the room because then they can be doing heart tones on baby. Sometimes if there is an umbilical cord issue, this can kind of change baby’s heart rate. For the nurse to already be in there and to know, okay, it’s just the position. Baby’s doing fine. And then hopefully as they reengage, they’re going to be more optimal, and so there’s not going to be any heart issues after that.
Next is massage. Just kind of doing a light touch on their jaws, shoulders, forehead. This can really relaxing, and it can also be a good, quiet reminder. Sometimes if you’re feeling that tension of a surge, you’re lifting your shoulders up to your ears and your face is tensing and you’ve got a furrowed brow. And if you’re tensing up there, you’re probably tensing down low, too. What you want is to open and relax and allow baby to move. So a light touch on the forehead, jaw, cheeks, shoulders to help relax and bring that down can be really helpful. It can be a great way for the partner to engage with soft touch to bump up oxytocin. Lower back massage can relieve tension after surges. There’s also the light touch and jiggle. Jiggle is such a funny word, but it’s exactly what you’re doing. With soft hands, you’re just shaking the back, hips, thighs, hamstrings, bottom. And this helps release the fascia in that area, which in turn releases the tendons and ligaments and just provides more room for baby to shift and descend. And it’s incredibly relaxing. It can help mama move more into that parasympathetic nervous system. We want her to feel slow, steady, restful; not in the sympathetic where she’s in fight or flight. So it’s very relaxing.
Excellent. One of my favorite tools is coming up – Rebozo.
The Rebozo is long and kind of like a scarf. You can even use a hospital sheet, and that’s usually what I do. With the mama on hands and knees, you can wrap it around their tummy. You’re standing behind them and just lifting and holding their belly during a surge. You’re acting as the broad ligament, instead of their broad ligament pulling in their tummy and working really hard. You’re doing it for them, and that adds comfort and relieves pressure. It takes the load off for them, literally. And then in between the surge, you can slowly let belly back down and then sift it, which is just small movements, bringing your hands back and forth, which is kind of jiggling that tummy. Shake the apple tree is my favorite one, and I love that this one is becoming more common in the hospitals. The nurses talk about it, midwives, OBs, everyone, because it’s magical.
Yes! I learned it from Gina Kirby herself. When I had my Sacred Pregnancy instructor training, she was there. I learned about so many different techniques, including relaxation and partner bonding. Shake the apple tree is one of my favorites.
It’s a funny name, but as mom is on hands and knees or on knees with her hands up on the top of the bed, it is taking the Rebozo or sheet and fully covering from lower back to midthigh and then creating almost handles on the side. With those handles in a firm grip, you’re going to shimmy back and forth, making the whole low back, bottom, legs, jiggle. And this again is just great for helping baby out of mid-pelvis. It is that myofascial release. It’s good for repositioning baby, for relaxing mom. It feels amazing. It usually brings on some laughter for both mom and partner, which is a great sensation to have during labor. It’s a fun one.
And the doula or partner can do it alone. In some births, I’ve done it with a nurse, or with the partner on one side. So two people can be involved. It just depends on how many resources you have and how often you’re doing it, because it can be tiring if you’re doing it for every contraction for a baby who needs to turn.
Yes, we definitely get our upper body workout during these births!
With that Rebozo or sheet, you can also just tie a knot in one end, toss it over the door, and shut the door and that gives you some support to do a deep squat. You’re holding onto that while you’re squatting really low. It’s great for pelvic positioning. And I don’t think we’d be doulas without the hip squeeze or the counterpressure, so I’ll talk about those ones next. Again, that upper body – really good workout.
It is a great workout!
I was at a birth this weekend, and the husband and I kept taking turns because it was 17 hours of hip squeezes. So the two of us did some together; he’d take a few, I’d take a few. And it was great. She was supported. He was connected. We were sore, but it was good. That double hip squeeze is really effective when they’re sitting, they’re kneeling, they’re standing, they’re dancing. You can do it at any time, so it doesn’t matter what position she feels the most comfortable in; you can still get access if you can reach the hips. And it brings relief as you squeeze in and rotate up during the entire duration of the surge, and that opens the pelvis to give the baby more room. It takes the pressure off a ton.
It does. I even utilize the hip squeeze with an epidural, so it can be effective if they’re still in any discomfort in the hips.
Especially if they’re still feeling it on one hip. And then the counterpressure – and sometimes mamas want the hip squeeze, and then as baby gets lower, they want the counterpressure. Sometimes they want them intermittently. But that counterpressure is just that steady, firm press on the lower back with your palm for the entire duration of the surge. And that brings relief, especially if they’re having back labor.
That’s the main time that I use that. In my Comfort Measures for Labor class, when I do some of those demonstrations, I explain to partners that they’re most likely going to be using the hip squeeze, unless there’s an issue with back labor and position and nothing feels good but that solid, firm counterpressure.
Yeah, and I like to show them that one during their prenatal, too, because that can be really helpful at home if right away when the onset of surges start, they feel like they need support, but they’re not ready to go in and they’re not ready for me to come. Then their partner can do all of those hip squeezes or counterpressure. It’s a good teamwork between the two of them.
One other simple one is just walking or dancing. Think about how you can use your body, how you can use gravity to help baby descend and progress labor, whether that’s because it hasn’t started yet and you’re past your due date and you’re just really hoping to bring it on. Going for a nice, long walk keeps everything loose, and it can help bring on labor if your body is ready. It’s great for early labor, during labor if there’s a stall to just help things move along. And it keeps your body really fluid. You want to avoid freezing into one position because that can just build up tension. So it’s a great way to keep moving. Dancing together can bring the oxytocin, which you just want to keep flowing through the whole labor.
Yes, and as you mentioned, walking the halls. There’s railings you can hold on to during contractions or surges. Movement is so helpful.
Another thing to work on is the breath. Hopefully, they’ve done a lot of work to control their breath and hone in to their breath during pregnancy, but sometimes in the heat of labor, they kind of forget, and you’ll hear their breath change. Maybe they get a little panicky. As the doula, I can emphasize my breath to help her refocus. You don’t even need to say or do anything; just loudly next to her – and then you see her like, oh, right, and then she starts breathing and she gets that control back. You can even do that same thing during transition or during the pushing stage. If the breath or vocalization has started to become really high and screamy – and it is perfectly okay and really positive to make a lot of noise during labor, but that high noise usually means that you are tensing. And if you are tensing up top, you are probably tensing your pelvic floor, as well, and that is not what you want. Just kind of moaning or groaning or even mooing next to her to remind her to bring it down and low. You don’t have to break her rhythm or say anything; you can just do it and watch her follow suit, or have the partner do it.
Also, practicing that destressor breath – in for four, out for six. That’s a great one to be doing while warming up for labor at home just to practice. It can be great to recenter yourself during your labor. Your breath is so, so important.
It is; it’s everything. It’s the number one tool. We don’t want our clients or students to hyperventilate. Talking about that with a partner is key.
What’s next, Katie?
The birth stool – not all places have this, but it is helpful for physiological upright birth. Your position during labor helps provide balance and support. Similarly, you can using the toilet, instead, just because your body knows exactly what to do on the toilet. It knows to open, relax, release. And then with the birth stool position or the toilet position, you can be sitting on it and then putting one foot up on a stool for a few surges and then switch. This is just shifting your pelvis and helping baby rotate and turn.
Exactly. I’ve seen the traditional birth stool used more at home births, but now hospitals have a new tool, which is very exciting.
They do; the CUB, which stands for Comfortable Upright Birth. I know that Gold Coast was instrumental in getting one of those in a hospital nearby.
We actually donated three to Trinity Health.
That’s awesome. It looks like an inflated C, and it’s quite large. You can sit on it with one leg on each of the arms, basically, or you can kneel and lean over it, resting your body. It can help with posterior pelvic pain or coccyx pain. Their website has some amazing stats I want to share. They’re truly amazing. It says that it increases the available space in the pelvis by 30%. It can make surges more effective. You’re 23% less likely to need medical assistance. Baby is 54% less likely to become distressed. It can decrease the length of labor, so shorter labors. There’s also a 29% reduced rate in emergency Cesareans and a 21% reduced rate in episiotomies and reduced rate for epidural. So you’re thinking that you’re just sitting on this; you’re leaning over it; you’re using it. But it’s doing so much for your pelvis and your positioning; it can do all of those amazing things to progress your labor.
And it’s not just for sitting. As you mentioned, you can do the kneeling and the leaning into it. You can rotate your hips and do hands and knees supported on the CUB. There’s so many ways you can use it. I’m a huge fan of the CUB.
Yes, it’s definitely one to look up and look at pictures for it because it’s a really cool tool.
And I’m happy to see even some of the smaller hospitals have recently gotten them. It’s very exciting.
It is. We’re seeing a lot of movement towards that more physiological birth and letting her body do what it’s supposed to do.
A few simple things, but using stairs or doing lunges or curb walking. These are great things to shift the pelvis, to assist with an asymmetric or an OP baby. We’re just trying to really move the pelvis and shift it and jiggle it up so that baby can get out of maybe a stuck position or just get into a more optimal position.
Another one is the bath. The bath is amazing. That water – it does give you some buoyancy. It can relieve pressure and feel great. A lot of my clients say that it feels like a natural epidural. We see a huge shift in their presence, their calmness, their control, their ability to handle the next surge. It’s so great. You go in there, and it’s warm. You keep the lights down or off. Maybe it’s just you and your partner. It’s calming; it resets; it allows connection. And you can go in as much as you want. You can stay in as long as you want, as long as you’re not overheating. In the last birth, she used it four times. That was her tool; it’s what she wanted, to breathe and float. And just watching her move her body and use her own instincts for what felt right – it was amazing. The water is awesome.
It is. A lot of hospitals have jets, and I like to take the showerhead and use that. Clients can get in different positions in the tub. Of course, not all hospitals have tubs. Some have waterfall showers or a standard shower as an option. Water in general can be calming, as you said, and just a great reset and can keep any discomfort off your back by having the flow of water.
Yes, and the sensation and the noise, if you just have the bath running the whole time, that white noise. Like you said, bringing the showerhead down and having that hot water either hitting one spot or kind of a fluid motion up the entire length of the back can sometimes feel really nice.
For those of you who plan to have a home birth or who have given birth at home before, there are the inflatable tubs. I’ve also attended home births where my clients had a bigger tub of their own, and they just delivered in their own tub versus an inflatable. There are lots of options.
Yeah, and it can be great in early labor just to relax when you don’t want to be focusing on the labor too much. It can be great for during transition. It has many uses throughout the entire duration. If you’re doing a homebirth, maybe being able to push baby and catch baby while you’re in the water.
Yes. The water births are an option for many individuals, depending on the state requirements for midwives, but certainly in Michigan, you can. In our hospitals, you can labor in water, and you can even have a walking monitor and be monitored while you’re in the water. But you are not able to deliver your baby in water, so then you move to land to have your baby. But again, movement is helpful.
Yeah, and that is a point you talked about, wireless monitoring. Just asking for that, to be able to keep moving. You can use wireless, and they can put the bands on. Or they’ve got intermittent Doppler monitoring, if you and baby are doing well. It gives you that freedom to move and get in the water and to not feel stuck.
What other tools do you have?
The last one on my list is just using the squat bar. This is a metal bar that attaches to the hospital bed. Most hospitals have them in every room. It allows for a supported squat so that if you’re feeling a little shaky and your legs don’t feel like they can hold you, then just being able to be in bed and pull yourself up on this, to have that supported squat, which increases the pelvic opening and helps with the descent of baby. You can do that during the pushing stage. You can tie a towel or sheet to the squat bar and kind of do this tug of war motion, which can really help with pushing, because you’re giving this push-pull motivation in your brain. You can have your partner or a nurse or a doula hold it and go back and forth; as you’re pushing down low, you’re also pulling, and it’s just a great counteraction in your body. You can also rest your feet on it. If you don’t want to rest your feet in the stirrups, you can rest your feet on it. I’ve had a few clients who’ve had trigger things with the stirrups, but they loved the squat bar, so they were very happy to put their feet on the squat bar, but they wanted nothing to do with the stirrups. Just having lots of options to move the bed, use different things, just creating space and creating movement.
Depending on the strength of the epidural, I’ve had clients use the squat bar even with the support of an epidural, if they have some movement in their legs. It’s a great tool.
Well, thank you for sharing all of our amazing tips with our listeners. Any final suggestions or comments?
I think just believing in your body’s capability to do this. I’ve been fascinated to learn just what the body does on its own, the physiological aspect of it and how your anatomy works with you to help birth this baby. So just believe in the power that you have, the support that you have, and just trusting in that and reminding yourself of that. I am safe; I can do this. I am supported. Our bodies are amazing. As a doula, it’s a privilege to get to be in that room and help you know that, help you feel that so deeply. You’re doing this, girl.
It is a privilege. It never gets old. Every birth and every person is so unique, so it’s not like anything is routine for us as doulas, which I love.
I do, too. No births are the same. It helps us to hone our skills because we’re on our toes the whole time. It shows the beauty of it.
It’s so beautiful! Well, I appreciate you so much, Katie. We’re very lucky to have you on the Gold Coast team.
If you aren’t planning to hire a doula, then check out our Comfort Measures for Labor class. That’s part of our Saturday series. We also offer HypnoBirthing, which is a five-week comprehensive childbirth class. It is very partner-involved, and it involves a lot of visualization and focuses on breathwork and understanding the physiology of what your body is doing at each stage in labor.
Thanks so much, Katie!
Thanks for having me!