by Rebecca M. Urban, AAHCC, CD (BAI)
Different methods of childbirth education teach different things when it comes to the pain of labor and how to handle it. Some methods teach "escape visualization" as a way to cope with the pain, while others advocate the use of medication. The Bradley Method does not teach that childbirth is without pain...its goal is to teach couples what normal, natural, childbirth looks like (both the emotional & physical signposts), to teach women how to "tune into their bodies" during their contractions, and to teach coaches how to provide physical and emotional support to their laboring moms.
What you think about during labor will have a direct impact on how you labor and how your body progresses during labor. If, for example, you think that you're going to split in half from the force of the contractions, you will be more likely to ask for medication. If, on the other hand, you think to yourself "My body is SO strong, it's doing what it needs to do to birth my baby," you are more likely to remain relaxed and confident. You can think to yourself "The stronger the contraction, the sooner the baby!"
There are other methods of childbirth education that teach that birth can be painless, pain is all in the mind, etc, etc. This was certainly not my experience giving birth, though I have found that the pain has been less and I have labored more effectively as I've learned to trust my body more and to truly relax through the contractions - to MELT into the contractions as opposed to "fighting them" by tensing up.
Relaxation is the key to the Bradley Method, and the key to having a natural childbirth. The midwife Ina May Gaskin has a famous quote: "The energy that got the baby in is the energy that gets the baby out." Similarly, Sheila Kitzinger says that "Ninety percent of birth, like 90 percent of sex, has to do with what is going on in your head."
We discuss in Class 4 how part of the role of the labor coach is to "set the stage" for birth - to make sure that the labor environment is as conducive to relaxation as possible. This also includes making the transition from home to hospital (when applicable) as smooth as possible. Having gas in the car, having a copy of a relaxing CD (of music both of you like) on hand, can be important things...once you've arrived at the hospital, it's your job to make sure the hospital room is as conducive to relaxation as possible...adjusting the temperature, introducing yourself, remaining friendly towards the staff, and dimming the lights are all good places to start...and that CD you had in the car...bring that into the hospital room too! (Note: Check their hook-ups beforehand - what do they offer? MP3 hook-ups, CD player, iPhone speakers, etc).
It has long been known that music has the power to affect our thoughts and feelings. Have you ever taken a car ride, popped in a CD with your favorite songs, and felt like time flew by? Music has the ability to put us in a relaxed, practically hypnotic state.
I've used the same CD for all of my own labors...it's a mix of my husband and my favorite songs...I listen to it while I'm pregnant, and I visualize myself giving birth when I'm listening to it...Who is around me? Where am I? etc, etc. Then when I'm REALLY in labor, my mind goes to that place immediately, and I am able to relax.
Some other things Coaches Can Do:
Remain CALM - Dr. Bradley often said that a well-trained husband could do more to relax his wife in labor than any amount of medication. I believe this to be true. But the opposite is also true. If dad is nervous, tense, or unsure, that will affect his wife's labor. She needs to feel safe and secure. The best way for dads to become calm and collected is to familiarize themselves with the emotional and physical signposts of natural childbirth (see labor map in student workbook on pages 68 & 69).
Don't go to the hospital too soon - most unnecessary interventions occur because people arrive at their birth places too soon. The Bradley Method teaches that if a woman is less than 5 cm dilated, it's usually too soon to be in the hospital. Familiarize yourself with the labor map on pages 68 & 69 of the student workbook. Know what to look for. If she's able to talk and walk through her contractions, it's probably too soon to go. Remember the "4-1-1" guideline. If you do arrive at the hospital and you're given the option to go home, go home!
Set the Stage - Make sure her labor room is conducive to relaxation - adjust the thermostat, dim the lights, use aromatherapy, massage, music...see to it that she's comfortable.
Remain friendly and positive with the staff - your nurse needs to be your ally - it is SHE who is supplying the information to your doctor/midwife. It's important she's on board with your birth plan. If she's not, go to the front desk, and respectfully ask for a nurse who is supportive of natural childbirth.
If you are expecting your doctor or midwife to be the one who will help you through labor, you may be surprised to find out that he/she may only visit you briefly in labor, if at all, and may not be seen again until it's time to "catch" your baby. It is your labor nurse who has ongoing contact with you. She checks your blood pressure and your baby's heart rate, makes suggestions to help you through labor, consults with your attendants, advises them of your progress in labor, and calls them to come when birth is imminent. Did you know that the way your nurse reports your progress to the doctor (often over the phone) may affect decisions about when and how he/she intervenes in your labor? Often your doctor's only view of your labor is through your nurse's eyes. A nurturing labor nurse offers more than clinical care: she's your "Guardian Angel." Countless mothers and fathers have told me that the caring, unwavering support and experience of their nurse helped create positive birth outcomes and memories. - Pam England
Remain Confident - say things like "Isn't she doing great?" Staff is much less likely to offer medication and other interventions if their patients seem like they're handling labor well.
Apply Counter-Pressure and physical support when needed (we'll demonstrate this during the labor rehearsal)
Remind her to RELAX HER JAW - when her jaw is relaxed, the rest of her body will follow
Don't underestimate the power of your presence! There will be times during her labor where you may feel a bit "lost" - (i.e. maybe she's in transition and doesn't want to be touched or spoken to)...recognize this for what it is and don't be offended - it's a GOOD sign that your baby will be born soon! Don't think you're not needed. Don't step out of the room. Your presence matters to her!
Enjoy the experience. You will remember this day for the rest of your lives. Soak it all in. Cherish it. Have someone take pictures! Happy Birth Day!
You may consider hiring a doula. A good doula will not usurp the role of the primary coach, and can act as a good mediator between mom's wishes and the staff so that you can concentrate more on assisting her through her labor. A good doula will make sure your birth plan is being followed, and will see to it that you're fully informed regarding the risks/benefits of any procedures. A good doula is like a good insurance policy!
Most moms find that during early labor, the things that they found relaxing when not in labor, work well. Examples may include:
A warm bath - try to immerse yourself up to your shoulders...if your tub is too small, put warm washcloths on your chest while you're in the tub
A shower
Watching TV or a Movie
Reading a Book or a Magazine
Having a Snack
Going for a Walk
Getting a back-rub
Sitting in a rocking chair or on a birth ball
Using the side-relaxation position in bed
Remember the average labor time for a first time mom is 15-17 hours
Some women find visual imagery to be helpful in childbirth. Below is an excerpt from Sheila Kitinger's book entitled "The Complete Book of Pregnancy and Childbirth:"
The mental images a woman has of labor and birth are vitally important: how she imagines all the intense physical sensations as they well up in her, and the meaning that these have as contractions sweep through her body and the baby's head descends. Pain may be seen as destructive and produce pictures of internal organs tearing and the baby being damaged, or be seen as purposeful, an effect of strong muscles working and the body opening. It helps to focus on creative images and to rehearse them ahead of time. Imagine being in labor, welcoming each contraction with relaxation, rhythmic breathing, and a vivid mental picture that enables you to go with the work of your birthing body instead of resisting it. These pictures inside your head may be enough for you to get in tune with your labor.
You may want an entirely internal focus and feel that anything else would be distracting, or you may prefer to concentrate on something that you can see during contractions: a photograph, painting, the pattern on your partner's shirt, a piece of pottery, a sculpture, or some intricate tiles - something that represents for you the energy and flow of birth. Sky and seascapes, a range of mountains capped with snow, a path through the forest, great trees with their branches spread wide, a waterfall cascading into a lake, a field of wheat with the wind sweeping across it, a flower opening from bud to full bloom - perhaps a water lily or a rose - are images that may be right for you.
As labor progresses and contractions get stronger and longer, you may want active images that express the extraordinary power unleashed in your body. It often helps to focus on imagined actions, and to feel that you are swimming over waves, windsurfing, climbing a hill and skiing down a slope, swinging or flying, or roller-coasting over contractions.
I once had a doula (mom of 2) audit my class. Her labors had both been very different. She said that in both of her labors she used the visual image of waves crashing upon the shore...but for her second labor, she pictured herself actually RIDING the waves...she said that it wasn't until she pictured herself RIDING the waves, that she was able to fully relax and to let her labor take over...that labor was faster and less painful for her. I love that image, because it says so much...it's not until we surrender to the "waves" and become one with them that we're truly able to open up and let our bodies do what they need to do to birth our babies.
Many women find that in order for their contractions to be most beneficial, they need to relax totally and go "loose and limp" during the contractions. This is something the coach can remind mom to do. Also, the coach can remind her to relax her jaw since relaxing the jaw helps relax the rest of the body. Other women may find that they need to "lose control" in order for their labor to really progress - they may need to get vocal - to moan, or to even yell "This hurts!" That's okay too, and women should be encouraged to do what they need to do in order to accomplish the hard work of labor. Reminding a laboring mom to relax her jaw and give you the "duh" look can be helpful.
Don't be afraid of doing it "right." It's not uncommon for laboring women to experience a type of "performance anxiety!" Pam England has some good thoughts on this...Most women start my classes with the idea (or hope) that I will help them reach their goal of being calm, confident, and controlled in labor. Unfortunately, many professionals feed into these unrealistic expectations (both prenatally and during labor itself). Because I know the difficulties created for mothers by this ideal image, I don't promise (or endorse) those results.
Imagine being in line for your first trip on the Mega-Roller Coaster. All around you terrifying tales are being told about the ride. At the same time, videos are being shown of others riding the roller coaster looking calm and composed. Instead of feeling normal excitement and anxiety as your adventure nears, you start to become pre-occupied with doing it right. You may even begin worrying whether you've got "the right stuff," and how your partner in the next seat will react if he thinks you haven't measured up!
How could there be just one right way to give birth when there are billions of women in this world?
Usually I hear a collective sigh of relief when I tell parents in my childbirth classes how for some mothers, moaning...groaning...walking...white-knuckling...and "losing control"...may actually be the key to getting their babies out naturally.
The goal of maintaining control and relaxation has been a powerful force in promoting the use of drugs in labor. If you're giving birth in a hospital, you may run into professionals who still consider drugs and anesthesia to be their only ways of helping you when you are in pain. So that's what they'll offer. It isn't just pain or well-intentioned offers of relief that steer women into using drugs they had wanted to do without. It's also their fear of "losing it" in labor, and others' judgements about that, that pushes them to say "yes" to drugs.
In her book Birthing from Within, Pam England tells the story of when she asked Suzanne Stalls, a midwife in Albuquerque, how she prepares women for labor. Seasoned by attending hundreds of women in birth, both at home and in the hospital, Suzanne has developed a sixth sense about labor. She said she tries to instill confidence in her mothers by telling them:
There are three things that are givens about labor: It's hard work, it hurts a lot, and you can do it.
Keep your eye on the prize - remember you're having your BABY! This is the day you've been waiting for! You will only get to give birth to this baby once! The pain will not last forever, and shortly, you will be holding your baby and experiencing the highest oxytocin rush you will ever have in your life. You will enter a state of bliss that is beyond words. You will have a new confidence in your body you didn't have before. You will have a new confidence in each other as a couple.
And finally, some words of wisdom from the Co-Executive Director of the American Academy of Husband-Coached Childbirth (a.k.a. The Bradley Method):
I want to suggest to you that when you are in labor, each of you appreciate that something very important is being done. Nobody else can labor for you. Nobody can give your baby what he/she needs. There are other ways, there are easier ways, but there is no better way than to labor and give birth to your baby naturally. If you think you are doing something trivial and perhaps not even doing it very well, then labor is much more difficult. If, in the back of your mind, you think you are doing this because your baby needs it, then your labor will become a joy - not easy, not necessarily painless, but extremely worthwhile and rewarding. You can't go back and give birth to this baby over again, so be prepared, dedicated, and keep your baby's needs in mind as you labor. If you could hold this baby in your arms today for one hour, get to know him, and then put him back inside, there is nothing you wouldn't do for that baby - no job too hard, no pain too intense. If you knew it was for the good of your baby...you could do anything.