~CHOICES IN CHILDBIRTH~

TO CREATE A JOYOUS AND EMPOWERING BIRTH EXPERIENCE...UTILIZE MY "DOULA'S GUIDE TO COMFORT MEASURES FOR CHILDBIRTH"

"We have a secret in our culture, and it's not that birth is painful. 

It's that women are strong."  

Laurie Stavoe Harm

*PHYSICAL SOURCES OF PAIN IN CHILDBIRTH

*BACK PAIN RELIEF MEASURES

*FACTORS WHICH DECREASE PAIN PERCEPTION IN LABOR

*EMOTIONAL SOURCES OF PAIN IN CHILDBIRTH

*THE IMPORTANCE OF EMOTIONAL LABOR SUPPORT

PHYSICAL SOURCES OF PAIN IN CHILDBIRTH

Webster's Dictionary defines PAIN as "physical or mental suffering". Ordinarily, pain is a message from your body to do something, a stimulus telling us that something is wrong. We tense our body instantly in preparation for action- normally, this is a healthy response to painful stimulus. Pain during childbirth, however, is an exception. It is the one time when pain is not the symptom of a problem and when muscular tension is a negative response rather than a helpful one.

There are various sources of pain in childbirth:

*If the uterus is short of oxygen, it may cause more cramping or pain. Any muscle aches when it is not sufficiently oxygenated. In labor, this may happen when there is not enough time between contractions for the uterus to receive plenty of oxygen to replenish the uterine muscle.

You can correct this by: 1) breathing slowly and fully between contractions, 2) beginning and ending every contraction with a deep cleansing breath, and 3) breathing in an easy, relaxed manner during contractions.

*If the cervix is slow to open. The baby's head presses through the cervix as if a tight sweater were being pulled over it. The cervix is very flexible and will open up more and more, but this takes time and some women find the stretching uncomfortable or painful.

*The physical sensation of the baby's rotation and descent through her pelvis. The hormones of pregnancy have a lubricating and softening effect on muscle, tissue, ligaments and joints, which is helpful during the birth. However, some babies are large and it takes them time to squeeze through their mother's pelvis. Some techniques to remember: squatting, pelvic rocking, and changing positions frequently. Keep your bladder empty so that it doesn't impair the baby's descent. Use gravity whenever possible, and avoid laying in a prone position for long periods of time. Remember to alternate between rest and activity. Above all, have patience..... your baby will create the labor he or she needs to be born.

*Pressure on the urethra and bladder. The pressure of the baby's presenting part~usually the head~ on your bladder can be quite painful. It is important to keep your bladder as empty as possible. You should urinate at least twice an hour to make sure that a full bladder is not contributing to the pain that you are feeling.

*Lack of emotional and physical preparation. If you have not learned and practiced different ways of handling pain by yourself as well as with your Birth Partner prior to going into labor, you will be at the receiving end of strong sensations which you may feel ill-equipped to handle. Practicing relaxation, breathing, visualization and other comfort techniques for labor helps your body create a physical memory that will be helpful during labor, enabling you to focus all of your energy on the powerful work of childbirth.

*The degree of pain tolerated bears a direct relation to the rate the pain increases, rather than the level of pain reached. Rapid labors, induction or augmentation of labor by artificial means are examples of situations that may affect your ability to cope with pain. In each of these situations, your Birth Partner and Doula --if you have one-- can step up the physical and emotional comfort measures to help you cope.

FACTORS WHICH DECREASE PAIN PERCEPTION IN LABOR

*PHYSICAL AND EMOTIONAL SUPPORT BY YOUR BIRTH PARTNER

*EMOTIONAL, PHYSICAL AND INFORMATIONAL SUPPORT BY A BIRTH DOULA

*CONFIDENCE AND TRUST IN YOUR BODY

*KNOWLEDGE

*BEING AS WELL-RESTED AS POSSIBLE BEFORE LABOR BEGINS

*STAYING WELL-RESTED IN EARLY LABOR

*RELAXATION, CONSCIOUS RELEASE OF TENSION OF ALL MUSCLES NOT INVOLVED IN YOUR POSITION DURING A CONTRACTION

*BREATHING PATTERNS TO MAINTAIN RELAXATION AND FOCUS

*EMPTYING YOUR BLADDER TWICE AN HOUR

*RHYTHM, RITUALS OF COPING (ROCKING, TAPPING, BREATHING PATTERNS, ETC.)

*A COMFORTING ATMOSPHERE IN THE LABOR ROOM (DIM LIGHTS, RELAXING MUSIC PLAYING QUIETLY IN THE BACKGROUND, DOOR KEPT CLOSED FOR PRIVACY)

*TOUCH, MASSAGE

*VOCALIZATION DURING CONTRACTIONS (MOANING, EXHALING)

*HYDROTHERAPY--UTILIZING THE SHOWER AND/OR JACUZZI FOR PAIN RELIEF

*BIRTH BALL (65 CM. PHYSICAL THERAPY BALL) FOR FLEXIBLE YET COMFORTABLE SUPPORT

*ACUPRESSURE POINTS (ASK YOUR DOCTOR OR MIDWIFE FOR LOCATIONS)

*FREQUENT POSITION CHANGES THROUGHOUT LABOR OR AS NEEDED FOR COMFORT

*STAYING WELL-HYDRATED AND NOURISHED

*VARIATION OF HEAT AND COLD ON PAINFUL AREAS OF YOUR BODY

*UTILIZING A FOCAL POINT AND CONCENTRATION TO MINIMIZE DISTRACTIONS AND FACILITATE RELAXATION

*VERBAL ENCOURAGEMENT BY YOUR SUPPORT TEAM

*SUPPORT BY MEDICAL PERSONNEL

EMOTIONAL SOURCES OF PAIN IN CHILDBIRTH

How the laboring woman feels EMOTIONALLY about what is happening in her body is just as important as what is occurring physiologically. Negative feelings can intrude and make the labor seem more painful. For example:

*If you are not prepared for the painful sensations  of labor or you are demanding a great deal of yourself, you may create a struggle to try and control your labor, which is not really in your control.

*If you are extremely anxious about childbirth or about your birth setting, you may get into such a state of physical tension that the slightest touch hurts.

*If your labor is very long and you are suffering from lack of sleep, you may feel sensations strongly. Labor demands energy and stamina. Lack of sleep can make you feel more frustrated, impatient, or reactive. Childbirth pain makes most women feel very vulnerable. You need love and comfort to sustain you. You need reassurance and positive affirmations from your Birth Partner. How well-rested you are when you begin labor can also affect how well you cope. It is important to stay as well-rested as possible in the final few weeks of pregnancy, since you never know when labor will begin. Try napping every day in the last month of your pregnancy.

*If you are laboring in an environment you feel uncomfortable in or with people whom you do not like or trust, your feelings can intrude on the birth process. Sometimes, women feel pressured to labor according to a set time schedule or they feel as if their labor is being controlled by medical interventions and hospital personnel making decisions as to what they should or should not be doing. Your uneasiness may make you unable to relax or have difficulty utilizing some of the comfort techniques that you learned in your Prepared Childbirth Classes, which may cause you to feel that your labor is more painful.

*If you have not allowed yourself to believe that some parts of your labor may be extremely painful, you may feel overwhelmed or unable to cope. It is not unusual for a woman in labor to think "something must be wrong-this sensation is too powerful!" Your Birth Partner needs to continuously remind you that your body knows what to do.....your body sets the pace and rhythm of labor. Your Birth Partner should encourage you verbally, and try to help you to stay on top of each contraction with as many physical comfort measures as necessary. You also need to remember to relax fully during and in between each contraction in labor.

*Fear and Anxiety: Your fears that the pain in labor may be overwhelming, or worries about your threshold of pain tolerance can build up in the final weeks or months of pregnancy. In labor, fear and anxiety can trigger the release of excessive stress hormones (epinephrine and norepinephrine), which can sometimes lengthen your time spent in labor.

*Cultural Influences: Attitudes and ideas presented from family members, friends, co-workers, peer groups, television and movies regarding pain during childbirth can influence your perception of pain in childbirth and cause you to doubt your tolerance for dealing with pain.

Reading up on birth stories in childbirth books (see my "Suggested Reading List") can give you an honest perception of how birth is different for every woman, and illustrate the idea that each woman copes with pain in different ways. The library or local bookstores provide an endless resource of childbirth books, which will help you feel more knowledgeable about all aspects of birth.

THE IMPORTANCE OF EMOTIONAL LABOR SUPPORT

When you go through Prepared Childbirth Classes, you hear over and over again about how important it for the Birth Partner to physically assist and comfort the laboring woman throughout labor. Indeed, the classes are devoted to teaching a great many comfort techniques to help the woman in labor.

Techniques such as walking, showering, massage, touch, breathing techniques, relaxation, conscious release of tension, heat/cold variations, verbal encouragement and changing positions are invaluable. However, there is one aspect of labor support that should never be overlooked.

Emotional support is every bit as important as all of the physical support techniques for labor. Many people tend to overlook this aspect of labor, intent only upon tangible efforts to reduce the laboring woman's pain or discomfort. This can be a mistake, as I have learned from observing many labors in my work as an experienced Birth Doula.

In the Childbirth Preparation classes I teach, I try to stress the fact that in this situation, no one in the hospital setting knows the laboring woman as well as her Birth Partner, regardless of how the Birth Partner is related to the woman (married partner, boyfriend, mom, sister, aunt, friend). Nobody can love, care, cherish, support, encourage, or praise her like the Birth Partner can because her medical caregivers don't have the same relationship and bond with her. Her doctor or midwife, who has seen the expectant woman for many months during her pregnancy, cannot relate to her in the same manner because they don't know her as well as the Birth Partner after only 10-15 office visits. This intimate knowledge of her helps the Birth Partner lovingly care for her during childbirth.

Emotional support can be the  constant praise, the softly murmured words of encouragement, the sharing of excitement and worry, the determined resolve to help her through trying moments, the sharing of emotions. Emotional support is the bond that you share with her, the knowledge you will do everything in your power to help her through this physically challenging experience.

It may be helpful to hire a  Birth Doula to provide additional labor support. The Doula's role is not to replace the primary Birth Partner, but to provide additional emotional, physical and informational support during pregnancy, labor, birth and postpartum. A Doula provides explanations of medical procedures, massage and other non-pharmacological pain relief techniques, positioning suggestions for comfort and progress, help in avoiding unnecessary interventions, and support for the primary Birth Partner so that he can focus on the woman's emotional needs as well as her physical needs.

   

Lastly, practicing the skills learned in Prepared Childbirth classes together will help develop a pattern of teamwork and cooperation which will carry over into the labor. Practicing and learning together inspires confidence and trust. The Birth Partner conveys a message of caring- "This is important to me- I want to help you the best way I can." Without such support, the experience would not be as richly rewarding, powerful and satisfying as it might otherwise be.

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