Tag Archive | labor support

Just Relax?

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.”

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.

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.”

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

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

Ideas for supporting your partner in labor

Apr16

One of my favorite handouts to give in birth classes is a “Cliff’s Notes” to labor support. It is a two page handout with a variety of reminders and ideas about supporting your partner or wife during her labor. There are small illustrations as well and a review of the stages of labor. The handout is available here from the website Transition to Parenthood. This site offers a variety of useful handouts for childbirth educators and for parents-to-be and I really appreciate the educator’s generosity in making her materials available online like this!

The handout referenced focuses primarily on physical support and comfort measures of the laboring woman. Some additional, less concrete things I like to remind fathers-to-be of are:

Follow her lead. Labor is like a dance and your partner is leading the dance! Anything I say in class or anything you’ve read about is less important than what she is actually doing and you responding to her.
The most important thing you can do is just love her. This is more important than learning “techniques.” Just love her the way you love her and she will feel your love and support.
Let it happen. I encourage women to “let birth happen” and to let it flow. As her support person, you can help her by letting her let it happen (instead of hushing her or telling her to calm down or asking her to do something different than what is working for her).
Don’t interrupt a woman who is coping well with a new technique or idea–if what she is doing is working for her, encourage THAT instead of trying to introduce new ideas or tips.
Remember that as a support person you may also experience the three “emotional signposts” of labor–these are excitement, seriousness, and self-doubt and they correspond to stages of labor. A woman in early labor shows the excitement “signpost” a woman in active labor tends to be very serious and “busy working” and during transition many women show a self-doubt signpost maybe saying they “can’t do this anymore” or “I can’t do this much longer.” It is okay to let your partner know that you are experiencing excitement and seriousness, but try to keep the “self-doubt” signpost under wraps and don’t show her that you are also experiencing that one! Be as calm and supportive and confident and trusting as you can as she journeys through the sometimes challenging time of transition in her labor.

Good Foods to Eat in Labor

Feb4

Eating is important during early labor to keep up your strength and provide you with energy for your work. Many women find that they naturally no longer wish to eat once in active (serious) labor. Eat small portions of easily digested foods that you know that you like and that sound good to you at the time. Choose foods that are light and stomach-friendly. Complex carbohydrates are better choices than fatty or fried foods.

Some ideas are:

soups
crackers
graham crackers
fruits
bananas
Jello
pasta
honey sticks (plastic tube with about a TB of honey in it–good quick energy boost, especially in a birth setting with restrictions on food or drink intake. See my previous post for a discussion of the validity of withholding food and drink from laboring women).
toast
broth
yogurt
herbal tea
white grape juice
apple juice
miso soup
popsicles
fruit juice or honey-sweetened tea frozen into ice cubes
cereal
noodles
rice
cooked cereals
scrambled or boiled egg
applesauce

It is also very important to stay hydrated during your labor! Try to take a sip of something every 15-30 minutes and at least once an hour. Have one of your labor support helpers follow you around with a drink with a straw in it and hold it to your lips every so often. If you feel like sucking, you will, if you don’t, you won’t. There is no need to have a big conversation about it every time. Some women like to drink apple juice during labor, other feel it is too acidic. Orange juice is not usually recommended as it might make you feel sick or vomit. Some women choose to drink a sports drink (like Gatorade). Water is always a good choice! Other women choose hard candy to suck on during labor. Be careful choosing a flavor, because you may taste it again later and it may bother you. Avoid carbonated drinks.

What about dad?

Make sure you have snacks packed for you as well! Avoid anything that will linger unpleasantly on your breath (garlicky pasta is out!) Dads may like to have some easy to grab, quickly nutritious snacks like trail mix, granola bars, peanut butter, nuts, fruit, or an already prepared sandwich.

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Pushing the issue of pushing in labor…

Jan14

Coping with the second stage (pushing) of labor can involve several different approaches. There are many benefits to pushing according to your own body’s urging and natural rhythms. Your uterus will actually push the baby out for you without any straining from you if you are in a gravity utilizing position–upright–and following your body’s spontaneous pushing urges! Some care providers and nurses instead encourage “purple pushing”–this is often the kind of pushing you see on television portrayals of birth, prolonged breath holding and bearing down, red straining face, and directed efforts (often with loud counting to 10).

The benefits of spontaneous bearing down instead of controlled, prolonged, directed pushing, and straining include:

less strain on your perineum and consequently less chance of tearing
less incontinence later
better oxygenation for your baby (less breath holding–>more breathing–>more oxygen for baby)
less wasted effort since you are working in harmony with your uterus

If you have an epidural, delaying pushing until you feel an urge or the baby’s head is visible on your perineum is preferred as well and reduces your chance of tearing and of trying to push out a malpositioned baby.

How can your labor support person “push the issue of pushing” during labor? (i.e. support you in spontaneous pushing instead of the controlled, directed pushing common on labor & delivery units). Your labor support person–husband, partner, friend, mother, sister, doula, or other person offering you their nonmedical companionship during labor–can remind provider and nurses of your birth plan (which should specify spontaneous pushing). If directed pushing is being used anyway–i.e. loud counting–your labor support can try the counting as well once or twice and then ask you in an audible voice: “does it help you when I count like that while you push?” You can then say, “no”–this is not directly offensive to nurses, but clearly states what is helping and what isn’t and getting pushing back into your “court” which is absolutely where it belongs!

Thanks to the fabulous publication International Doula for getting me thinking about this topic (and for the catchy title)!

Comfort in Labor Handout

Dec18

Childbirth Connection also has an excellent handout titled Comfort in Labor. It is by Penny Simkin and it has TONS of great line drawings and covers a lot of labor support material in 14 pages. For partners looking for ideas of how to support women in labor, this is almost like a really quick doula training!

What is a doula?

A doula is a labor support professional trained to support birthing women physically and emotionally. She is a non-medical care provider who offers continuous one-on-one care during labor and birth.