Sample Childbirth Session #3

                                                                                                 The Art of Relaxation in Birth

 

Goal:  to help you understand how to work with your body in order to realize your full potential to give birth to your baby and also empower  you.

 Purpose of relaxing in labor.  Benefits to baby and mom:

                            Letting labor unfold in a positive direction

                           Less stress, helps mom to make good choices in “working with pain”. Avoids uterine inertia and helps prevent psychological stopping of labor.

                            Creating a more pleasant birthday for you and baby.

 Relaxation is a mental state:  How you feel about birth has a direct impact on your birth experience.

 

                        4 Keys to Natural Birth or a positive birth experience

                                                   1.  Knowledge – putting understanding in place of fear. Education rules out fear.  Know what to expect from labor and birth… stages of labor. 

                                                   2. Continuous support – Who and how

                                                   3. Surrender to the birth process – how and what does it mean?

                                                   4. Remain low risk – How:

                                                                        Get good care

                                                                        Perfect size baby (eat high protein, low carb foods the last 2 months)

                                                                        Exercise a lot… walking… walking…

                                                                        Make optimal baby positioning a priority (no posterior babies!)

                       

                     Question:   What does it mean to you….”Having a “good birth” experience?”

 Utilizing every-day skills women use, for coping with discomfort and “pain”

                      Focusing away from the pain, re-framing.  Instead of “This hurts and it’s going to get worse and never be able to give birth to this baby” with positive ones.  (Breathe in) —“I can”,  (Breathe out) —“Do this.”    “I will get through this hard part very soon.”  Keeping in the present, one contraction at a time.

                      Using different positions

                      Slow controlled breathing, as body requires for oxygen

                      Holding onto something tightly

                      Massage, pressure on hips or back

                      Warmth or cool packs

                      Distraction

                       Vocalizing

 Birth Environment:

Is your chosen birth environment ‘pro’ or ‘anti’ normal birth outcome?  

More than just a relaxing décor and feeling safe, consider social relationships in that place, and the attitudes about labor as key players in a positive birth place.

Close your eyes for a moment and relax.  Choose a room in your home that you are comfortable in.  Think about the objects you like in the room.  Now think about having a strong contraction in that room.  What would you lean on, how would you make yourself comfortable?  Do you feel safe?

 The oxytocin hormone that got us pregnant in the first place, is the same hormone that gets the baby out.

 What kinds of things in a room would help you feel relaxed during love-making?  Privacy, soft furnishings, gentle lights, music.  These sorts of things have a strong resemblance to what helps a woman relax and have a healthy laboring pattern.

             What kinds of things might make us feel uncomfortable during love-making?  People standing around talking, bright lights, TV/ Monitor on loudly, no soft furnishings, etc… 

 Encourage flexibility in terms of using a hospital or birth center room.  How can we adapt the hospital environment to keep us relaxed and able to sink down into “labor land” bringing on those beta endorphins for pain?   What can you hang on to during a contraction for security?  What puts you at ease?  Who is in the room with you, lighting, pillows and things that say “comfort?

               The challenge for hospital birth settings is to harness a nurturing attitude, that encourages laboring women to feel valued, safe and in control. 

 Human Nesting – There are many intertwined dimensions in birth: physical, emotional and spiritual.  Birth is an intense, earthy process. Being uncomfortable in an environment, or feeling uneasy, or scared, or unable to get into a pain-relieving position, creates a more difficult, longer lasting labor.

 Hospital, home or birth center?  How to tell if you have chosen the right place to birth.  Inside you feel, “Yep, this is the place I can do this.” When positive day-dreaming about birthing, you sort of go back again and again to that place.  Women just intuitively know it is the right atmosphere, they just feel secure there.  Nesting as protection and safety can be linked to the friendliness, peace and relaxation they experience on visiting that place.  Next warmth, protection, freedom to make choices, baby-friendly and safety, helped balance the stress of labor with comfort and peace.

                For some women, choosing to birth at home or in a birth center to reduce the risk of iatrogenic “or problems caused by medical intervention” is most comforting.

                For some women, the security of having hospital operating room staff available quickly in case an emergency c-section was needed is most comforting.

   Facing Fear:

             Keeping birth simple.

             Feeling concern or fear during birth? The best thing to do is to face it.  Ask the question, “What is my biggest fear right now?” (Might take some time to think or verbalize it).  During labor, usually it is enough just to speak it, but sometimes some reassurance is needed.  When fear is expressed, it begins to diminish or at least become smaller.  Be bold about addressing fear. Don’t let your mind wander.

             Recognizing ways to help moms enter that unique “birth trance” state, where their body relaxes and a smooth birth can take place:

            “Laboring down” –  Imagine opening to 11 cm, instead of 10.  Sometimes there may be a bit of cervix that is out of reach of the gloved fingers that we don’t know about. Some women need to let that last bit melt away, before baby can move down through the cervix and into that last part of labor.

               Sometimes moms (especially first time moms) have interventions that go wrong, that are often the result of a care-giver tampering with something that simply needs time and privacy to unfold.

 

What is a Doula? – Guest Speaker:  Meeting a Doula in person!

  Ask questions!   

              Hiring a Doula versus using your husband as your sole birth partner – If you were climbing Mt Everest and had never done a hard climb like that before, your husband, who had also never climbed to the peak before would do a fine job of carrying your heavy back pack of supplies, your water bottle and giving you encouragement. But if you get lost or wonder if you are almost there, you would have been better off hiring an experience mountain guide!

 What you need to know to help you relax….before you have your baby:

                        What to do if you think labor has started when it hasn’t?

                         Some women have painful contractions that might be the start of labor in the last few weeks before they actually go into active labor.  This is the revving-up kind of labor and means that changes are taking place in preparation for labor before dilation starts.  It is a positive sign that things are softening and the cervix is thinning.  Baby’s presenting part is pushing down into the cervix.

                         Ideas to overcome anxiousness:   Put your mind on something else: read, watch a movie, get busy with a project, go out to dinner, invite friends over, go for a walk, continue with regular schedule.

                         Don’t sit and time contractions!  Soaking bath with lavender oil, then having a nice hot milk/honey drink, listen to soothing music.  Settle down with a heating pad. GET SLEEP!

 Confronting the “What-if’s…”

                         What if your water breaks before labor starts:

                                      10% of women have rupture of membranes at term and 8 out of 10 of these go into labor within 12 hours.  (Sometimes it might be up to 24 hours).  When your water breaks there may be a gush or a trickle as the bubble in front of baby’s head breaks.  Note the fluid color.  Is it stained brown or green?

                          Call your doctor or midwife so that the baby’s position can be checked.  If the baby is head down and the head is low in the pelvis, there is no possibility of the type of emergency occurring when a loop of cord slips down in front of the baby’s head.

                           Once your membranes have broken, do not put anything into your vagina or infection may be introduced. No curious vag. exams either!  The more exams, the more chance of infection.

                            If you wait around anxiously for the first contraction you will be tired out by the time your energy is really needed.

                            So, put on a pad, change it regularly and go to bed and sleep if it is bed or nap time.  Do some work around the house or garden.  Walk if it is daytime and you would like to get labor going.  Be careful about wiping after elimination. Take your temperature every 4 hours.  If there is an infection, you will become slightly feverish.  Let your caregiver know if this happens. 

                                Don’t starve yourself.  Eat now, because you may not feel like it once your labor starts in earnest.  One of the secrets to a successful labor and birth is keeping your body fueled.  Keep plenty of fluids going. Take vitamin C every few hours.  250 mg.

             

 A long, slow labor

                              It can be hard to exactly pinpoint the exact time labor starts. Although some women are suddenly aware that this is IT!  Most of us have a few hours of questioning in our minds and looking back we can say, yes, that is when it started. 

                                First time labors can last 24 hours or more… and this includes the early laboring phase.

                                Intersperse your labor with activity and rest.  Change activities frequently.  Avoid getting boredom.  Make a cake, soak in a tub, take a swim, walk, sew, knit, anything rather than just lying in bed….waiting…wondering if something is wrong.  Moving around will stimulate more contractions.

Baby’s head will come down, putting pressure on the cervix.  Rock your pelvis, go up and down stairs.  Leg lunges against the wall or on a chair.

                               Keep your bladder empty.  Go every 2 hours or so.

                               Eat food that tastes good to you and is easily digested.

                              A woman in labor welcomes quiet, calm, easy-going assurance from attendants.  There should be no pressure of time if water has not broken and it is a low risk pregnancy/labor situation. Often good to leave the woman and her partner alone.

                               Try nipple stimulation or have a cuddle with your partner.  It works.

 

Start and Stop labor

                                  Labors are different.  Some are slow in a different way.  They start and seem to stop.  The uterus contracts weakly or ceases to contract for a while.  Then starts back up with another phase or with good progress.  There may be plateaus when nothing seems to be happening.  Common reasons for labor to stop or slow down:

                                   Anxiety – arriving at birth center or hospital.  Uterus is very responsive to how we are feeling, any adrenaline.  Talking about what is bothering you and centering on mentally relaxing will help bring labor back.

                                   Physical causes:  Baby’s head is coming down in a posterior or awkward way and has become stuck.  When a baby is awkwardly positioned, the cervix will dilate, until the baby’s head does not help push it open anymore.  Try rocking hips in hoola-hoop arc,  duck-walking, going up stairs 2 at a time, pelvic tilts.  Your care provider will help you figure out which activity to try, depending on where your baby’s head is.

                                    Rest and be Thankful Stage before pushing. – There is often a natural break in the action when baby has slipped through the cervix and the muscle action is changing in the uterus.  Mom is often chatting away and comes “alive” looking after being in “labor land”.

 

You become very tired:  Labor is an intense activity.  Like a marathon in many ways.  It really pays to train ahead of time by doing a lot of walking, eating well, and getting good rest.   A woman might feel she is on a never-ending treadmill of contractions.

                             Drink something with an electrolyte balance. “Labor Aid” recipe:  1 quart water, 1/3 cup honey or maple syrup, 1/3 cup lemon juice, ½ teaspoon salt, ¼ teaspoon baking powder and two crushed calcium tablets.

                              Eat something that you can easily swallow.

                              Stop fighting the pain.  Dive right into it instead.  Welcome it as a way to get baby out.

                              Whatever is happening during contractions, make sure that you are resting completely in each interval between.  This means lying down on your side, with a pillow under your head and top knee.  Let every muscle relax and fall into the bed.  No talking in the room.   Lights down low.  Minimal activity around you. Conserve your energy.

                          

  Pushing urge before fully dilated:

                       Cause:   Some women have an urge to push before the cervix is out of the way.  The Ferguson Reflex is sensitive.  The baby is low and putting pressure on this nerve. (Same nerve you feel during a bowel movement that creates that no-going-back feeling to defecate.)

                        Change position to get pressure off of cervix while you dilate.  Side lying, on your hands and knees or even leaning slightly uphill in a bean bag chair.

                              Continue breathing smoothly.   Do not hold your breath. 

                               Pant…pa…pa…pa…pa….pa….pa

                               As soon as the urge leaves, breathe normally again.

                         If you have to push and it is O.K,  Push with an open mouth and breathing out. Let your uterus do the pushing it if wants to.

 You get no pushing urge:

                              Did you know that a woman can have a baby without deliberately pushing it out?

                              Until there is an irresistible urge to push, it stands to reason not to push.  There is no need to hold your breath in at all.  This gives your tissues a chance to smooth out smoothly before the ball of the baby’s head eases through, with no damage to ligaments, muscles or skin.  Go with your body.

                              Some pushes are short, some are long.

                              Sometimes there is only one small push with a contraction.  Even if you are unsure, your body knows how to do this.  Once again, getting your brain out of the way helps!

                              Standing, squatting, birth stool.  Just waiting.  It baby is doing well, there is no hurry.

  Baby is coming fast, or suggestions for the last part of the birth, with the head crowning.

                           Suggestions:  Make birth gentle for baby.

                           Get on all fours or lie on your side.  Do not squat or stand, if baby is coming fast.

                            Guard your perineum.  It works really well for mom to reach down and guide the baby out herself and gauge when to stop pushing.  If this is not an option for you then care-giver can guide baby’s head.

                        Breathe baby out.  Release your pelvic floor muscles, let them go limp by opening your mouth. (Practice the Kegal before hand, so you know what this feels like).  A clenched mouth, means a clenched bottom.

Drop your jaw.  Make low mama bear noises.  Avoid screaming or yelping, as that will make you tighten up.

Listen closely to your doctor or midwife.

  Primary Elements to having a good birth:

                       1.  Preparation – read and be informed. Pack your mama / baby bag at 36 weeks.

                      2. A reassuring environment – Trust care-giver, safe place to birth.  Positive place.

                      3. Freedom of Movement – Active birth concept (move position every 20 minutes), access to birth tub, ability to find your most “comfortable” place.

                      4. Ability to feel in control – natural birth or hospital birth.  You make choices to have a natural birth, to use pain medication in the hospital, to be informed.  Ask for information about things you are not sure about.

                     5.   Quiet, peaceful atmosphere – honoring birth silence as you labor and concentrate. No chatting.

                     6.  Low light – keeping the lighting low for rest and concentration 

                     7.  Continuous labor support  – A person that is able to support you physically and mentally. A person knowledgeable about your likes and dislikes.  Someone who is able to create a birth experience that is special for both partners (does not “take the place” of birth dad).

                     8.   Labor starts on its own and continues on its own – assuming pregnancy is normal and low risk.

                     9.   Gentle first breath and caresses – Baby is encouraged to breathe, kept warm, beside or on mom.

                    10.   Baby at the breast within the first 15 minutes – Reassures baby, helps placenta come out.

                    11.   Bonding and attachment period the first hour – Strongest time of oxytocin release.