Tag Archive | childbirth education

For Labor Support Remember TLC or BLT

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.

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!

Recent Articles

Mar21

I’ve had a fun month for publications. My Birth Lessons from a Chicken essay was in Midwifery Today and my Respecting the Birth-Breastfeeding Continuum was in International Doula.

Also, the International Journal of Childbirth Education has some of their issues available online now. The September 2008 issue has my Satisfaction with Birth article beginning on page 14. The June 2008 issue has my Celebrating World Breastfeeding Week & the Birth-Breastfeeding Continuum article and my sidebar WBW: A Simple Celebration beginning on page 15.

Fears About Birth and Losing Control

Mar4

A topic that frequently arises in birth classes is about the fear of “losing control” in labor. Losing control, “losing it,” or “freaking out” are concerns expressed by women preparing to give birth. It is important to acknowledge that this is a common fear. I also like to ask parents to think about what “freaking out” or “losing it” would mean to them? I ask them to consider what benefits there may be to losing control. I also say, “What if you do freak out? Maybe, so what?! Maybe it is okay. Maybe it is good. Maybe it is helpful.” (This doesn’t come across in print quite the way it does in real life!) Surrendering to the flow and power of birthing can be of tremendous benefit. Losing it can mean letting go and letting the power BE. Letting the energy be. Letting birth carry you with it, instead of wrestling for control of it. (When discussing this topic, it is important to remain mindful that for mothers-to-be who are survivors of abuse, language about “surrender” and “letting go” can be very threatening and unhelpful.)

Thinking about “losing control” makes me think about the things that you can have over control of when it comes to your birth experience (I’ve also been reading The Big Book of Birth and it addresses this):

1. You can control who who choose as your doctor or midwife (and can choose to switch at any point in pregnancy if the match is not a good one).

2. You can control where you give birth.

3. You can control who you ask to attend your birth as support–your partner, your best friend, your mother, your sister, a doula. (Anyone who attends should be there for YOU, not because they want to “see a birth” or because you feel obligated to have them.)

4. You can control how you prepare yourself for birth and the education you seek to help you explore your options.

5. You can control the type of books you read and the information you seek about birth.

6. You can control how you care for yourself during pregnancy.

7. If you are having your baby in the hospital, you can control when you go to the hospital.

Hypnobabies rephrases the usual concept of “transition” in labor as “transformation.” This is the time in labor in which many women fear “losing control.” Women may also pass through another transformation point as they move from early labor into active labor–this is sort of a “moment of reckoning” in which it becomes clear that it is really time to DO this! Erica Lyon, who wrote The Big Book of Birth referenced above, addressed this subject really well:

“…as a mother shifts from early labor to active labor, she begins to have an awareness that the labor is getting bigger, strong, more powerful. This often translates into a feeling or idea that you are going to ‘lose it’ or ‘lose control.’ This is a temporary, transient feeling that tells you labor is progressing. It does not mean you will go running naked and screaming down the hallway of your birth facility. What is really happening is a momentary emotional state that reflects your ‘social self’ beginning to fold inward. Labor is not a rational process, it is a body function that is experienced as a gradually intensifying event. You do not think your way through it. You do it. “

Essentially, this is a point in labor when you stop fighting with the “birth power” and begin to BE it. The process of birthing becomes your entire focus. I remind and encourage people to welcome the increasing intensity of labor–and suggest taking a “make it bigger!” approach to greeting and welcoming contractions, rather than trying to avoid or minimize them.

Pam England from Birthing From Within also has a great article about “Losing It” in labor.

Other posts about fear and birth:

Birth Fear
Fear & Birth
Fathers, Fear, and Birth
Fear-Tension-Pain or Excitement-Power-Progress?
Cesarean Birth in a Culture of Fear Handout
Worry is the Work of Pregnancy
Fear Release for Birth
What If…She’s Stronger than She Knows…

Fear-Tension-Pain or Excitement-Power-Progress?

Feb14

I love re-framing traditional concepts of birthing to more positive and empowering perspectives. Recently, I was reading an older issue of the International Journal of Childbirth Education and came across a concept that I immediately loved and will incorporate into my birth classes from now on. Most childbirth educators are familiar with the Fear-Tension-Pain cycle–wherein fear raises tension in the body which leads to pain and so on. Reducing one element in the cycle leads to reductions in the others–i.e. reducing tension through relaxation techniques leads to less pain and then less fear.

While this is still a very useful concept and I will continue to use it, the new perspective I just read about was the Excitement-Power-Progress cycle. The idea being that labor can be greeted with excitement and welcome instead of fear and anxiety. As the power of birth grows, so does the progress towards meeting your baby! So, you can greet the increased power with excitement and confidence and know that your body is making beautiful progress.

The author of the article I was reading (Stacey Scarborough), phrased it like this:

“Fear = EXCITEMENT about being labor and having a baby!

Tension = POWER, strength, or energy!

Pain = PROGRESS”

Educators as “bankers” or “midwives”

Feb10

I recently wrote on ICEA about two different approaches educators can take to presenting information (birth educators or otherwise). “Bankers” teach by “making deposits” of information into their students’ minds. “Midwife” teachers do the opposite. Instead of depositing information for the student to store, they “draw out” the information the student already has–so the student “gives birth” to their own inner wisdom.

Click here to read the whole post.

Honesty in Birth Classes

Jan14

I just wrote a quick post at ICEA regarding honesty in birth preparation. I find it a difficult line to walk sometimes—to encourage confidence, trust, and joy in childbearing, while being straightforward about the challenges couples may face when seeking a natural birth experience in a hospital. I always encourage couples to “assume good intent” from hospital staff—they offer medications because they feel like they are helping. I also remind them that routines are powerful and if the majority of births occurring at a specific hospital are induced, medicated, heavily intervened with, etc. it can be difficult to buck the trend. Again, not out of some sketchy motive from hospital staff, but simply because of routine or “this is what we always do” or “this is what mothers want from us.”

No Right Way + Fathers at Birth

Jan10

A few weeks ago, I spoke to a mother from one of my most recent birth classes. She told me something that her husband said to her in labor that I found very profound. Staff at the hospital were becoming concerned that this mother’s labor was “not progressing” and “not normal.” She, in turn, became worried that she wasn’t normal and that something was wrong. Her husband told her: “There is no normal. There is no right way. There is only your birth.”

This was so beautiful, and so true, that it brought tears into my eyes. Last week I finished reading a new book called Fathers at Birth by Rose St. John. In it, she addresses something similar:

“Of course your baby is the greatest gift of labor. but another great gift is you are pressed to your max or beyond, and you succeed. It expands who you know yourself to be…Labor is all about finding your threshold and learning you can go beyond it…If your partner feels, for whatever reason, that labor did not unfold as she had hoped, she needs your assurance. No woman should be judged or judge herself for doing whatever she has to to do to bring her baby forth into this world. And no man should be judged or judge himself for how he attends his partner or how he responds to birth. You are dealing with life on the edge. You do not know what will happen in it, and you are not in control. Together, you are participants in the mystery, and you do the best you can…On some levels, it doesn’t matter how you both get through labor. There is no prescription. No script. No right way. Its commanding power does not depend exclusively on you or your partner to do it. No matter how you get through, it alters and expands you…whether you are powerfully present, totally absent, or anywhere in between; birth deposits its power into your lives. The transformation is enduring. You can never go back.”

She also addresses the “weight” men shoulder when attending their partners in birth:

“Since men are not the ones doing the actual labor and birth, they may be embarrassed to admit how exhausted and relieved they are once it is over and all is well. they may also be reluctant to admit the amount of dedication and work it took them to attend their partner. I don’t think most women (or anyone else) realize the weight many men shoulder during labor and birth. What happens to a man’s partner and his baby, in effect, happens to him…[quote from father re: being present for his wife in labor] I don’t think anyone has any idea of the amount of effort it takes to be in a physically supportive role where you have to take action, yet be in a witness role where you have to be truly present…”

I posted more about this new book at Citizens for Midwifery:

Fathers at Birth

and More About Fathers at Birth

and also at the International Childbirth Education Association:

Fathers at Birth

Fathers’ Roles at Birth

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 Childbirth Education

Dec27

People sometimes wonder what are the benefits of childbirth education. Classes can seem expensive and they wonder what they will get out of them. The main question that researchers have examined is whether classes reduce labor pain (inconclusive). I have a book called Labor Pain that cites research indicating that classes do reduce the need for medication during labor. According to the same book, though study results do not always agree, various researchers have also found:

possible decrease in length of labor
lower levels of uterine dysfunction requiring augmentation
fewer cases of elevated blood pressure
“less maternal illness and less use of antibiotics after birth”
“more stable heart rate readings in babies during labor”
“more involvement by partners”
“more positive feelings about birth and giving birth among women attending”
less pain during labor
“less frequent use of forceps at delivery”
“greater awareness at birth”
“more enjoyment of birth for women who had attended classes than for those who had not”