Pain, Power, & Accomplishment

Mar21

I love this section from Giving Birth with Confidence (Lamaze). It explores the role of pain in labor and its relationship to personal power and accomplishment:

The pain of labor, like most pain, is protective. Responding to pain with movement, including walking, rocking, and position changes, not only helps the baby rotate and descend through the pelvis, but also protects a woman’s body during the process. As the cervix stretches and dilates, oxytocin levels increase, and contractions strengthen and become more effective. As pain increases, endorphins are released that help women cope with the demands of the stronger contraction and the descent of the baby. Actively responding to the pain..then not only promotes comfort but promotes the progress of labor…Because the pain of labor is not associated with trauma, but is a part of a normal, physiologic process, it is sometimes compared to the pain associated with other challenging physical activities. Those who push themselves to climb the last hill, cross the finish line, or conquer a challenging dance routine often report feelings of euphoria and increased self-esteem. Researchers have found that women who experience natural birth often describe similar feelings of exaltation and increased self-esteem. These feelings of accomplishment, confidence, and strength have the potential to transform women’s lives. In many cultures, the runner who completes a long race is admired, but it is not acknowledged that laboring women may experience the same life-altering feelings. [Birth classes] help each woman find ways to meet the challenges of birth confidently and purposefully, and to discover her strength in birth.

The above explains very well why it is that I do what I do–I want each woman to have the chance to experience that transforming power, that sense of personal accomplishment, the increased self-esteem, and the euphoria of knowing “I did it!” I climbed my mountain, I ran my marathon…I gave birth to MY BABY!

Comfort Measures & Labor Support Strategies

Mar14

From the book Special Women by Polly Perez. I thought this was a helpful, quick review of things to try when assisting a woman in labor:

“When assessing labor pain consider the following:

Remember ‘When in doubt check it out.’

Ask the mother the following questions.

What’s going through your mind

Is there something you are afraid of?

What do you think will help?

Tell me how you feel.

Encourage the mother to empty her bladder hourly.

Make sure the mother remains well hydrated.

Encourage the mother to relax her voluntary muscles in her buttocks, thighs, abdomen, and pelvic floor.”

Also consider trying these positions during birth:

standing

swaying

lunge

squat

kneeling

leaning

side-lying

slow-dancing

hands and knees

rocking

sitting

dangle

supported squat

sitting on a birth ball

Using the right ingredients…

Feb6

I seem to be able to relate just about everything I ever read to birth. Some time ago, I read a book called Things I Learned from Knitting and in it the author recounts a story about her attempt to make her friend’s delicious stroganoff:

“The recipe was for a fantastic mushroom stroganoff that I thought was one of the yummiest things I’d ever eaten. I hurried to the grocery store to buy all of the ingredients, but there was one problem: I couldn’t afford them. I decided to make do. I bought substitutes…It called for cream; I used milk. It called for portabella and shiitake mushrooms; I used regular button mushrooms. It called for butter; I used margarine. The wine? I substituted water. I painstakingly put together my version of the stroganoff and was absolutely devastated when it was a pale (and sort of gross) imitation of the glorious dinner I had eaten at my friend’s. I explained the outcome to my mum, telling her that I must not have the skill at cooking that my friend had. I proposed that I just needed practice making the dish…’Darling, practice all you want, but you can’t make a silk purse out of a sow’s ear.'”

How does this relate to birth? When women share their stories with me in person, online, or in articles, I am struck by how often they’ve tried to make do without the “right ingredients” and then blame themselves (or nature) when their birth didn’t turn out the way they had wished. They may have gone to a hospital with a 50% cesarean rate, chosen a physician unsupportive of natural birth, spent much of their labors on their backs in beds, labored while attached to any number of restrictive pieces of technology, taken powerful medications, and so on and then grieve the loss of the beautiful birth experience they had planned.

So, what are the right ingredients? Every woman is different and each birth is different and has its own lessons to impart. However, we do know that some things are the “right ingredients” for many women if they would like to have a normal (physiologically unfolding) birth:

Labor begins on its own (no induction, no pitocin)
Freedom of movement throughout labor (no restriction to bed)
Continuous labor support (from a doula, your husband/partner, or a supportive friend)
No routine interventions (any interventions should be based on the unique needs of you and your baby, not hospital protocol or “this is what we always do”)
Spontaneous pushing in upright or gravity-neutral positions (try squatting, kneeling, hands and knees, or side-lying)
No separation of mother and baby after birth with unlimited opportunities for breastfeeding (do not have the baby taken to the nursery and breastfeed early and often!)

Another wonderful ingredient is confidence in yourself and your body’s natural ability to birth your baby.

Please do not be afraid to seek out a care provider and a birth setting that recognizes the importance of the right ingredients and who will do everything possible to help you use those ingredients to “cook” up a healthy, rewarding, normal birth for you and your baby!

For more information about Six Care Practices that Promote Normal Birth, visit the Lamaze site.

What Does Coping Well Mean?

Jan7

“I believe with all my heart that women’s birth noises are often the seat of their power. It’s like a primal birth song, meeting the pain with sound, singing their babies forth. I’ve had my eardrums roared out on occasions, but I love it. Every time. Never let anyone tell you not to make noise in labor. Roar your babies out, Mamas. Roar.” –Louisa Wales

Occasionally, I hear people telling birth stories and emphasizing not making noise as an indicator, or “proof,” of how well they coped with birthing–“I didn’t make any noise at all,” or “she did really well, she only made noise towards the end…” Women also come to classes looking for ways to stay “in control” and to “relaxed.”

This has caused me to do some thinking. Though relaxation is very important and helpful, to me, the goal of “laboring well” is not necessarily “staying in control” or “staying relaxed” or “not making any noises.” Instead, I view “laboring well” as involving: listening to yourself; respecting your own needs and acting on them; working with your body; finding your rhythm; trusting your instincts; following your body’s urges/signals; accessing your inner wisdom; finding your unique way along the path; journeying with openness, curiosity, acceptance, excitement and joy; and responding to coping strategies that spontaneously arise from within.

I have been reading Penny Simkin’s The Labor Progress Handbook and she addresses this subject as well:

“Childbirth education programs first emerged in the 1940s, when much less was known about the powerful, multisensory ways in which women spontaneously cope with labor. Much has been learned since then, but older ideas have left their stamp on Western culture…Many people still think that ‘coping well’ means that the woman remains silent and does not move during contractions. Often, caregivers, partners, and the women themselves believe that women who are physically active and vocal are coping poorly, and may strive to help these women to be quiet. However, we now know that women with kinesthetic and vocal coping styles often find much more effective relief from pain and stress when they move and make sounds, than when they try to use the quiet, still techniques of early childbirth methods.”

During my own births I found movement and sound to be of tremendous importance. With my first baby, I felt more inhibited and primarily coped by humming. I spent a lot of time kneeling on the ground with my head on the bed. With my second, I was alone with my husband for most of the time and was much more vocal–“talking” myself through contractions. I also moved around a great deal and found it very important. Talking (well, really rhythmic word repetition) and moving, for me, are parts of “surrendering” to the power, process, and intensity of giving birth. This fits with my personality as well as in “normal” life I talk a lot (talk-to-think) and I also have a lot of physical energy that leads to my “buzzing” around the room a lot or stepping back-and-forth as I speak.

Edited to add that the Feminist Childbirth Studies blog linked to this post with an interesting and insightful further development/exploration of this subject in the post characteristics of a ‘good’ labor and birth experience?

I revisited this topic in a later post: The Power of Noise in Labor

Birth art sculpture depicting pushing the baby out. Roar, mama, roar!

Benefits of Active Birth

Feb29

From Janet Balaskas’ classic book, Active Birth:

“When birth is active–

There is less need for drugs.
Discomfort and pain are less.
The uterus functions better, so artificial stimulants are not usually necessary.
Labors are shorter.
The supply of oxygen to the baby is improved.
There is less need for forceps or vacuum extraction.
The secretion of hormones that regulate the whole process is not disrupted.”

Make sure to talk to your care provider about your plan for an active birth. You may have to introduce your attendant to the concept and be assertive about your right to have an active, normal birth.

Waiting before pushing…

Feb16

Your uterus is a powerful muscle and will actually push your baby out without conscious or forced effort from you–at some point following complete dilation your body will begin involuntarily pushing the baby out. Many women experience the unmistakable urge to push as an “uncontrollable urge”–but, in order to feel that uncontrollable urge, you often have to wait a little while! Though some care providers and nurses encourage you to begin pushing as soon as you are fully dilated there is often a natural lull in labor before your body’s own pushing urge begins. Some people refer to this lull as the “rest and be thankful” stage. It gives your body a chance to relax and prepare to do a different type of work (in labor the muscles of your uterus are working to draw your cervix up and open. During pushing, the muscles of your uterus change functions and begin to push down instead of pull up). If you wait to push until you really need to, you will often find that your pushing stage is shorter and progresses more smoothly that pushing before you feel the urge.

I’m reviewing a copy of the wonderful new pregnancy book from Our Bodies, Ourselves and they shared the following about this issue:

“Research suggests that the length of time before the baby is born is the same if you allow one hour of ‘passive descent’ of the baby (when you relax and don’t consciously try to push) or you start pushing immediately after you are fully dilated.”