Perceptions of Pain

Apr18

Some time ago I wrote several posts about pain in labor, one of which addressed needing more words for pain. In the book Birthwork, there is an interesting list of possible perceptions of pain in labor:

—‘Satisfying pain‘—enjoyable labour

–‘Positive pain’–it is birthing the baby

—‘Constructive pain’–it is doing a good job

—‘Functional pain’–acceptance of the process

—‘Okay pain’–it hurts but everything is on track

—‘Intense pain’–it is a lot!

–‘Abnormal pain’–something is not right

—‘Overwhelming pain’–unable to manage alone (exacerbated by isolation, fear, exhaustion, and tension).

—‘Off the wall pain’–utterly unbearable (usually associated with intense nerve or spinal pressure).

Even though these aren’t new words for pain, I think they add to our vocabulary for describing what is going on with our birthings. Additionally, keep in mind that you can transform the language and perception of the sensations of labor even further, by not using the word pain or contractions at all–you can refer to “sensations” or “tightenings” or “pressure” or “waves” or “surges” or “intensity” and so forth.

Just Relax?

Apr17

Most approaches to birth preparation emphasize “relaxation” and being able to “relax” during contractions. Some people have noted that the word “relax” isn’t very descriptive to women in labor–or, it can irritate them (“Just relax?!”) while at the same time not really giving them anything specific  to work with. I recently finished a really incredible book called Birthwork (more about this will follow in several more posts!) and it addresses this topic as follows:

…it can be disconcerting for a mother to be told to ‘just let go and relax’ during labour without some practical guidance on how to  do this or without first acknowledging how tough it is, or how stuck or frustrated the mother may feel. Perhaps a more helpful response might be:

–‘Let’s find a way to open more.’

–‘How can I help you to let go?’

–‘Try softening here.’

–‘Sometimes this works really well. Would you like to try it?’

I particularly like the “soften here” idea. It reminds me of something else I read in The Pink Kit, which was about “directed breathing.” The idea with directed breathing is that you can direct your breath into any specific area of your body–when helping a woman in labor, you might put your hand on her lower back and ask her to “breathe into my hand.” When you practice this at home, it is fascinating to me how you actually have a sensation of “breathing” in your back, or thigh, or shoulder, or wherever–sort of a subtle feeling of expansion.

Non-verbal Communication

Apr13

Birthing women tend to enter “birth brain” while focusing during labor–this is a more primal, instinctive, intuitive, primitive part of their brain and it tends to be fairly nonverbal. I often remind fathers-to-be in my classes not to ask their partners too many questions while they focus on birthing, because questions pull women out of “birth brain” and into the more analytical, rational side of the brain that we use in day-to-day life (this “thinking” brain is not as useful during labor!) Instead, I encourage birth partners to just “do” and then pay attention to the woman’s nonverbal cues (or short, verbal cues) about whether to keep it up–an example I often use is with giving her a drink of water or juice. Instead of asking, “do you want another drink?” Just hold the straw up to her lips! If she is thirsty, she will drink, and if she is not she won’t. No words need to be exchanged. Other reactions might be that she might push the drink away, say “no,” or shake her head.

As I referenced in a prior post, I recently finished reading through The Pink Kit. It has some more related thoughts to add:

Childbirth is such intense work that sometimes a woman just can’t get a full sentence (or even a short one) out of her mouth. You can’t read her mind. However, it’s not too difficult to read her body language…During labour, it will be easier for her to push your hand away, say ‘shhhh,’ grab you and hold on, or put your hand on some part of her body, than to talk. Often a woman can THINK something so loudly, she’s certain she’s said it aloud.”

Birth as a Rite of Passage

Apr11

Part of my philosophy of birth is that it is a significant rite of passage for women, men, and families, not a medical event, emergency, or health crisis. I recently finished working through The Pink Kit and the little book that came with it had some thoughts to share on this subject in the “final word” segment of the book:

We would like to warn you against expecting a ‘perfect birth,’ or for that matter anything in particular, except that you will get through it, with your baby–just about everyone does, no matter what they know and do!

The fact is, there is no such a thing as a ‘perfect life.’ Think about what life passages you may have undergone so far–cutting teeth, starting school, menstruation, the first sexual experience, loved ones dying.

Birthing is also a rite of passage–into parenthood–and like any other passage, it comes upon us and we just have to deal with it. It’s an awe-inspiring experience, and it would be perfectly natural to want to prepare in some way. And you can do that. But to some extent the experience is still out of your control.

Giving birth is definitely the most significant and impactful rite of passage of my life–it is the the gateway to motherhood, which has been the single most life-changing role I’ve had. I believe that this significant, transitional, rite of passage is worthy of appropriate level of awe, respect, and preparation. It is a sacred passage. Accordingly, I also believe the birthing woman should be treated with reverence and respect.

For Labor Support Remember TLC or BLT

Apr10

When supporting a woman in labor, remember to use “TLC”:

Touch–this can be massage, hand-holding, foot rubs, stroking her hair, and encouraging frequent position changes. It also includes the use of water (hydrotherapy).

Listen–this is half of the emotional support in labor. Listening builds trust and meets emotional needs. Use active(reflective) listening and lots of encouragement.

Communication–there are two types in labor. One is information sharing–about her progress, her choices, ideas of things to try, interventions, complications. The second is mediation with hospital staff–this can involve reminders about mother’s wishes, and assertiveness about care.

Or, you can use “BLT”:

Breath–remind her to breathe if she is holding her breath. Model a “cleansing breath” if she is stressed. In through the nose and out through the mouth (like a sigh) can be helpful.

Language–this can be mind-body communication, internal conversation, or verbally telling, showing, or modeling (body language).

Touch–as discussed above. Large muscle massage or firm pressure usually feels better to the laboring woman than light patting, stroking,  or “tickling” at the skin or clothing level of her body.

Material on TLC is drawn from the International Journal of Childbirth Education, June 1998. Material on BLT from The Pink Kit–New Focus: Breath, Language, and Touch.

Feeling Powerful

Apr9

As I’ve mentioned before, I love collecting quotes about birth. This is a great one about power and birth from Christiane Northrup:

“Imagine what might happen if the majority of women emerged from their labor beds with a renewed sense of the strength and power of their bodies and their capacity for ecstasy through giving birth. When enough women realize that birth is a time of great opportunity to get in touch with their true power, and then they are willing to assume responsibility for this, we will reclaim the power of birth and help move technology where it belongs–-in the service of birthing women, not as their master.”

—Christiane Northrup MD

I found this on the Birthing Utopia blog.

On an unrelated note, I absolutely LOVE the glass pendants available from Family Tree Glass. I bought several of the birthy belly pendants at the LLLI conference in Chicago in 2007. Since then, the artist has started making wonderful family pendants and also slinging mama pendants that are just phenomenally beautiful. I love them so much. My birthday is coming up. Perhaps my husband will read this and take a hint…;-)

Birth Center

Apr8

There is one freestanding birth center in Missouri. It is about 1.5 hours from Rolla in Columbia. Though it can be a challenge to ride in a car while in labor, I have had quite a few clients who have chosen to birth their babies at this wonderful birth center. My own first baby was born there in 2003  (though, at the time, I lived in Jefferson City, so it was only a 30 minute drive for me).

The birth center is called Columbia Community Birth Center.  Phone (573) 447-2700 or visit their website. Phenomenal women. Wonderful place.

What to say to a woman in labor?

Mar30

I always encourage support people to speak from their hearts when being with a woman in birth–your words mean a lot when they are authentic to you! However, I also realize people would like a “head start” on some good things to say. While all women are different and have different preferences, my observation is that praise and love are good sentiments to express–“you’re doing so well, ” “you’re so beautiful,” “you’re so strong,” “I love you,” you’re amazing”–those kinds of things.

I recently came across this section in the Birthing From Within Keepsake Journal that gives some other ideas of phrases to get you started:

  • Soften around the pain (or pressure/contraction/fear)
  • You are stronger than the pain
  • Keep going
  • You ARE doing it
  • I love you
  • Breathe into it
  • See your cervix opening

I prefer “you are so strong” to the “you are stronger than the pain” suggestion. “You ARE doing it” is a very helpful response to the comments women sometimes make during labor such as “I can’t do this.”

Should You Attend Birth Classes?

Mar24

In my ideal world, there would be no need for women to take formal classes to prepare for birth—they would already feel confident and well-equipped for birth as a rite of passage.  Of course, we don’t live in an ideal world and the climate of fear and doubt surrounding birth in our culture, as well as the emphasis on medical intervention and technology, means that most women view birth with some degree of apprehension. Many women also express doubt in their own ability to give birth and fear and trepidation about the experience and their own abilities to cope with it.

Lamaze’s book Giving Birth with Confidence, recommends that you ask yourself the following questions when making the decision about whether or not to attend independent childbirth education classes:

  • Did you grow up believing that your body works beautifully? That its functions are normal, natural, and healthy in general–and in particular regarding childbirth?
  • Do you know and trust women who have given birth naturally and confidently?
  • Have you talked with a woman who had a baby with a midwife’s help?
  • Do you know other people who believe in the normalcy of birth and in women’s ability to birth naturally?
  • Will your birth site allow you freedom to respond to your body’s signals however you need to as you move through labor?

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!