Most of the folks who come to my Confident Birthing Childbirth Classes are preparing for a natural childbirth. They hope to avoid the use of pain medications in their births. Those
not intending a drug-free birth, are usually hoping to delay the use of pain medications and that means that they would be delaying/avoiding systemic narcotics (administered through an I.V.) and/or the most common pain management used in childbirth, the regional anesthetic: epidural.
Avoiding those drugs is most often possible through non-pharmacological means like movement, touch, breathing, intention, and sounding, just to name a few. I have spent my 20+ year career helping women avoid or delay those medications through my classes and my doula services. And while it’s still possible for women, whose goal is an unmedicated birth, to achieve that through good preparation and good support, there is another option for pain management here in the Treasure Valley that is worth knowing about: Nitrous Oxide.
Used around the world for well over 100 years as a medical analgesia, Nitrous Oxide is most commonly thought of in the United States as the “laughing gas” used by dentists to help ease patient’s anxiety during dental procedures. Discovered in the late 1700’s, it was introduced to provide pain relief during childbirth in 1881 but its wide use increased in the 1930’s when an apparatus was developed for self-administration. Since that time, laboring women have been using nitrous with great satisfaction in Great Britain, Canada, Finland and Australia. However, in the United States nitrous fell out of favor in the 1970s and the US has been slow to implement this option for laboring women since.
In 2002, Childbirth Connection conducted a systematic review of the research on pain management options in childbirth. In their Executive Summary of The Nature and Management of Labor Pain, they shared that 99% of United Kingdom maternity units responding to a national survey said that nitrous was available to laboring women during childbirth. Additionally, in a national survey of women just after childbirth, 60% said they used the nitrous and, of those, 85% rated their pain relief with nitrous as “good” or “very good”. Around the same time, a US survey of pharmacological methods of pain relief did not even mention nitrous oxide. There were however, two forward-thinking (or should we say backward-thinking) hospitals that had already been using nitrous oxide – one of which, The University of California San Francisco, had been offering nitrous routinely for over 30 years!
While researching this topic, I was gob smacked to learn that the second hospital was the University of Washington because in the 11 years I practiced as a doula in Seattle, I had never seen or heard of nitrous being used there. So this might be a worthwhile moment to acknowledge that it was, in fact, my doula trainer, and long-time mentor/inspiration, DONA International, founder, and author, Penny Simkin, who suggested to the lead investigator of the review, Judith Rooks, CNM, that they include nitrous in their investigation of pain management in labor. You can read more about the systematic investigation in this Lamaze International/Science and Sensibility blog post interview with Rooks.
Later, in 2012, the Agency for HealthCare Research and Quality examined the use of nitrous oxide and compared it with other methods of pain management for intended vaginal deliveries. They determined there was very little quality data in the literature on the effectiveness of nitrous on pain management, however, satisfaction could be measured. What resulted was a thorough comparison. At that time, only 5 centers were using nitrous: UCSF and UW (as mentioned above), another hospital in Brewster, Washington, Vanderbilt Hospital in Nashville, and interestingly, St. Joseph Regional right here in Lewiston, Idaho! Finally, it was catching on and within the last 2 years, nitrous has become increasingly available as a pain relief option in US hospitals including here in the Treasure Valley.
A possible reason for the resurgence of interest in the pain relief method might also be the 2012 FDA approval of safety equipment to administer a 50% concentration of nitrous oxide with a 50% oxygen, as suggested by Catherine McGovern, RN who has written an article on the subject for DONA International’s December issue of International Doula. (available to members.)
For optimal delivery and safety, the laboring woman administers the inhaled medication herself by holding the mask over her mouth and nose. Self-administration allows the laboring woman to “time” her inhalation to her contractions and to coordinate the peak analgesic affect to about 60-90 seconds after inhalation. It also ensures safety and prevents the woman from inhaling too much nitrous which could result in her losing consciousness – a very rare occurrence since self-administration is required and a woman would become too drowsy to continue to hold the mask before she would become unconscious. For an expanded discussion on nitrous from Judith Rooks, see Our Bodies, Ourselves.
(It is important to know that this medication is defined and regulated as a prescription drug – which means doctors and midwives will need to “write for it”. Having a conversation with your care provider ahead of time to make sure that the option is a “standing order” for you is important in the moment you are trying to decide about pain management options.)
Lisa Arnold used nitrous at the birth of her daughter, Lilli in April of 2015 at St. Luke’s in downtown Boise. She described how it helped her during labor: “It was exactly what I needed during transition. I liked how I was able to use it when I felt I needed and also take a break from it at any time. Since the mask was not attached to me, it gave me the freedom to easily move from laying down to (sitting up on) the birth ball. Needing to the hold the mask and take deep breaths gave me something to concentrate on when the pain was very intense and its effects were mild and calming allowing me to feel in control and be present at such an amazing moment in our lives.”
While movement is possible using nitrous, it stands to reason that with drowsiness a predominant side-effect, any woman wanting to use nitrous in an upright position will need more careful observation, but I have personally had clients on birth balls, birth stools, and hands & knees positions while using the mask.
To ensure the fullest delivery of the medication, she should make sure the seal of the mask is tight on her face and inhale deeply. When done correctly, a low “rumbling” sound will be heard (and a vibration felt) from the nitrous tank and hose that carries the gas.
There has been some concern that nitrous poses an occupational risk for nurses, doctors and others in the birth room, (particularly those attempting to conceive or in their first trimester of pregnancy) but those concerns diminished with the FDA approved delivery system which includes a “scavenging system” that collects 70% of the exhaled nitrous. Laboring mothers are told to exhale back into the mask so that the majority of the exhaled gas is collected and deposited into a waste system through another hose.
What is Nitrous Oxide?
Nitrous Oxide is a naturally occurring* non-flammable, odorless and colorless gas that is quickly eliminated from the body through the lungs so it doesn’t accumulate in the mother’s body and has no adverse affects on the baby. *In nature it is produced by bacterial processes of biological decay. Man-made nitrous is usually the result of burning fossil fuels.
Safe for Mother and Baby
In the spring of 2014, I asked Nurse-Midwife, Kristi Rhodes to give a presentation on nitrous oxide- which had just been approved for use by Boise’s St. Luke’s Hospital – at our local conference for doulas. Kristi shared (with several references to Rooks who has likely written the most about its use in childbirth in the past 15 years) that no studies or observations have found any adverse affects on baby – no respiratory depression or increased need for neonatal resuscitation. Newborn responsiveness, alertness and early breastfeeding appears to be unaltered with the medication. In addition, there is no extra monitoring, so mothers can use the mask and still move into positions that provide comfort and progress as long as they are close to the nitrous tank.
In addition to showing no risks to baby, there appears to be little adverse outcomes for the laboring moms since the gas is eliminated through the lungs the effects are transient. Some women experience nausea and vomiting but since that is also common in the later part of labor, it is unclear if it is truly caused by the nitrous. More commonly, a woman might feel drowsy, or light-headed. The biggest complaints I have seen from my own clients have been ones that span the range of not liking the mask (but being quite satisfied with the relief they experienced – something like a relief of anxiety – knowing the physical sensations of the contractions are still there but caring little or far less) to being unhappy with the nitrous altogether because it didn’t stop the pain. In those cases, the fact that nitrous is eliminated so quickly from the body means there is no delay in moving on to an epidural if the client so chooses.
How does Nitrous Oxide Work?
While the definitive answer has yet to be confirmed, it appears that nitrous activates endogenous (naturally occurring) opiates such as endorphins (and likely dopamine) creating a euphoria (hence the name laughing gas) and/or modulating the perception of pain in the brain (hence many women’s ability to continue with labor when they felt they could not prior to inhaling the nitrous). Dr. William Camann, the immediate-Past President of the Society for Obstetric Anesthesia and Perinatology, described what women experience as “diminished pain, or a continued awareness of pain, without feeling bothered by it”.
Understanding how nitrous works will help tremendously in making an informed choice about when/how to use it and will likely play a factor in satisfaction with the pain management option.
Certified Nurse-Midwife, Georgianna Ainslie recently posted this article on her practice’s Facebook page. I asked her what she felt most people should know when they are considering using nitrous in labor.
“I think that one of the big points is to be clear about what you want an intervention to do because that will impact your results. If a woman is wanting all of the pain to go away, nitrous is not the answer, but if she is looking for something to help her get her focus back, help her relax and/or give her a little assistance to ‘get over the hump’ of transition, nitrous is a good solution. I also love that it is cheap, has no long-term impact, and has very minimal requirements as far as monitoring, etc. Nitrous, of itself, does not require an IV, or extra fetal monitoring (because it has no impact on the baby). We will want to monitor Mom’s oxygenation status with a pulse-oximeter for about 10 minutes, but then that is it. I love having more options for women!” ~ Nurse Midwife, Georgianna Ainslee
As a doula, I have seen nitrous work best toward the end of labor. Interestingly I have found that my clients who use nitrous before say 7-8 cm have chosen to get an epidural after trying the nitrous oxide. I am not sure if that is because change is not happening fast enough for them to remain with this “first level” pain reliever or because they somehow expected it to relieve more pain than it does. However, those who waited and used nitrous in transition, have made it to the end without an epidural. A few have asked for the epidural while they labored with the mask but by that point their labor progressed too fast to get the fluids in that they would have needed to start an epidural. While they waited for the bag of fluids to run, they ended up becoming complete and pushing, sometimes even moving beyond the need for the nitrous because they were now pushing – experiencing the contractions in a more active and tolerable way – that they chose to leave the mask off and simply push out their babies. While that might feel overwhelming in the moment, all those moms felt so pleased they did not get the epidural and happy that they had something that could take the edges off the pain enough to get them through it.
This is great option because it is important to note that nitrous has no effect on the labor itself making it a wonderful option for many women. With epidural, there is always the risk of the adverse effects such as lowered blood pressure, slowing contractions, lengthened pushing phase, fever and perhaps a need for an assisted vaginal delivery (vacuum extractor or more rarely, forceps). Nitrous does not appear to affect contractions or to diminish the laboring woman’s own oxytocin.
Who Should Use Nitrous Oxide?
Because epidural comes with the need for IV medication and continuous fetal monitoring, nitrous, which has none of these requirements or risks, can be the perfect option for laboring mother who wants to avoid most interventions. It can also be excellent for a woman who cannot get an epidural due to a spinal injury or anomaly or whose platelets are so low she cannot get an epidural.
Nitrous is also incredibly beneficial for the woman who is experiencing significant anxiety. Heather Morgan had two out-of-hospital, unmedicated vaginal deliveries here in Idaho before moving out of state. Her first birth was unusually fast and her second, unusually long and hard. She gave birth to her third baby in Virginia, and was the first patient to use the nitrous oxide in the hospital she delivered in. She shared her experience with me:
“After having such a difficult labor with my second baby, I had a tremendous amount of anxiety and fear going into my third birth. I knew I didn’t want an epidural, but wasn’t willing to suffer the way I had with my last labor. Once I start transitioning, the fear kicked in which took my pain to a new level. I started to panic and told my husband I wanted an epidural. I was insistent. I absolutely didn’t want to go to “that place” ever again. As the anesthesiologist was discussing the risks of the epidural (and my mind was screaming: ‘don’t do this’), my midwife said, “How do you feel about nitrous?” I immediately replied “YES!” I had been reading about it and just hadn’t brought it up to her to see if it was an option. My baby came at 38 weeks so I thought we had time to discuss it. My body completely relaxed as I breathed it in and I could feel my baby coming down with every contraction. I wouldn’t say the pain was any better necessarily, but my body and MIND were able to let go completely, which is exactly what I needed. I went from 7cm to 10cm in 20 minutes. I felt no nausea from it, just relaxed and fearless. My midwife said she could see my muscles relax all over my body. I was so grateful there was a safe option for me and my baby. I needed healing from my previous birth and it was achieved largely because nitrous was an option for me.”
Who Should Not Use Nitrous?
Nitrous is not suitable (or usually necessary) when an epidural is in place or narcotic medications have been administered. Some contraindications do exist and all options should be discussed with care providers at the time of making an informed choice. A few known contraindications are: increased intracranial or intraocular pressure, bowel obstruction, pnuemothorax, emphysema, pulmonary hypertension and anyone with a current B12 deficiency and MTHFR gene mutation.
Where is Nitrous Available?
Here in Boise, we are lucky that both St. Luke’s and St. Alphonsus labor & delivery floors have nitrous oxide as an option for laboring women. St. Luke’s found the option to be so well-recieved that they have two machines available now and St. Alphonsus is quickly finding the same interest from laboring women. Of course, it will be used by more laboring mothers if their care providers discuss the option ahead of time. Nurse-Midwife, Amy English-Burt, with the St. Alphonsus Midwifery Group has also had wonderful experiences with her clients using nitrous oxide and shared her thoughts with me:
“It has proved helpful for so many situations and procedures including IV starts, exams, ECVs, labor, operative birth, and even laceration repair and postpartum procedures. It has quickly proven to be an asset for women who desire natural childbirth but struggle to remain focused. In short I love it!” ~ Nurse Midwife, Amy English-Burt
Here in Boise, nitrous oxide is also available out-of-hospital too. I first heard about nitrous in 2001 from a German midwife I worked with at Puget Sound Birth Center in Kirkland, WA and I understand that her midwifery practice is the first to use it out-of-hospital in Washington State. Here in Boise, nitrous oxide is available for labor at the free-standing birth center, Boise Women’s Health & Birth Center. Having nitrous oxide available in birth centers may prevent the need for transport to the hospital in some cases so it is wonderful that it is an option here for those who desire a home or birth center experience.
Other uses for Nitrous Oxide
There can be other times when asking for nitrous oxide would also be appropriate. It might be very appropriate for some people when having an IV hep/saline lock placed. In addition, nitrous can also be beneficial for use during an external version to turn a breech baby or, as Amy English-Burt mentioned above, it might be helpful after delivery as well.
From a doula’s perspective, I would add is this – if you choose to use nitrous and deliver your baby vaginally, you might consider the pros and cons of asking the nurses to keep the machine hooked up until after the delivery of your placenta and any possible repair you might need. While most women have no issues and do not need the nitrous at this point, I have seen a few instances where the option of the nitrous during these moments would have been very helpful and, in those cases, it had been broken down and removed from the room already.
So, even if you deliver with no pain medications at all, if your birthing facility has nitrous oxide, know that you may find it helpful outside of labor and delivery of your baby as well and if that is the case, don’t hesitate to ask for it!
One of the themes of Confident Birthing Childbirth Classes is the space of the couple and the role of love hormones. This beautiful natural birth was captured in Boise at St. Luke’s Hospital and is shared with the generous blessing of this couple who took the class. The photos are in chronological order allowing us to see the many times she dressed and changed clothes as needed as she followed her body to change positions and move throughout the space…both the private space of the room and the open space of the hallways as needed. It also shows how a laboring woman’s temperature fluctuates and she goes from hot to cold and back again. It shows how much love can flow between a couple when they are given space and how when she feels safe, respected and loved, a mama knows what to do to give birth.
Finally, those of us supporting them, care providers, nurses and doulas share their joy.
I tell my clients and students in my Confident Birthing Classes that my favorite position for progressing labor is almost always… the toilet.
I have no idea who said this originally: “Failure to progress is most usually failure to wait.” Folks have a hard time waiting. And normal, physiologic birth can take some time, especially in a first time motherbaby.
I say motherbaby because they are just that…one…motherbaby. And together, they have much to do get this baby out. It takes time.
Luckily, doulas (and midwives and childbirth educators) are not the only ones who get this now. We’ve been joined by obstetricians who are also beginning to get it.
This is no small feat, so it bears a little detour in this post to discuss the value of waiting in the context of some pretty game-changing events.
Here is a great summary of the (somewhat recent) joint statement from the American College of Obstetrics and Gynecologists and the Society for Maternal-Fetal Medicine
stating pretty darn clearly (and raising some hackles in the process) that women need time to give birth.
In their Obstetric Care Consensus Statement – Safe Prevention of the Primary Cesarean Section they make this remarkable statement:
“Slow but progressive labor in the first stage of labor should not be an indication for cesarean.”
So, you can be sure that nudging the labor forward is not because we are bored, in a hurry, have someplace else to be. It is because we are looking at the whole picture of this birth.
We are considering how tired this mama might be. We are thinking about whether her membranes are intact or her water broke many hours ago.
We are thinking about whether she is too nauseous to keep food down and her energy up. We are thinking about – if she has had any cervical exams –
and we know anything about her how her cervix is dilating (slowly, unevenly?) or how high baby may be in her pelvis at this moment.
And most important, we are thinking about how she is doing emotionally. With all that in consideration, as well as her desire to give birth without pain medication,
we gently, lovingly (and sometimes firmly) encourage her to try a position that may help her labor progress.
You’ll notice, however, that you are not facing out as you would if you were just going to make trip to the bathroom. We want you to stay here a while so we are going to help you get comfortable. Pillows on the top of the tank of the toilet to keep you from having to put your arms across the cold porcelain, and to give you a place to rest your head, make it the perfect spot for that forward bending most mamas do instinctively when the contraction starts.
And gravity, along with the nearly squat position of the toilet make it a perfect position to help baby move down.
To stay there though, we may need to help you get even more comfortable. For example, we might need to make that seat a little softer.
And we might need to add a little lift under your feet so you can keep them flat on the floor and under your knees. This helps you keep your pelvis open and takes a little load off your thighs.
We can do this with towels, books or yoga blocks depending on how much lift you need.
OK. So we have you on the toilet and now you’re pretty comfy. You can rest your upper body and head on the pillows. You can close your eyes and sleep (between contractions).
We’ll get your partner on a stool or the birth ball behind you ready with a back massage during your rests and double hip squeeze or direct pressure during the contraction.
And we’ll likely ask you to stay here 20-30 minutes. Maybe longer. Yep. Because it makes a difference.
It’s probably clear that the toilet is a similar shape, size and height to a birth stool. So it makes sense that this is good place to hang out.
But we’re here not because you are ready to push, we’re here to either get contractions longer, stronger, and closer together or baby to move down or both.
And it seems to work. Here’s why: in addition to harnessing gravity, and getting you into a position that opens your pelvis while supporting you to rest,
the open space in the toilet seat allows you freedom of movement to rock and sway your pelvis during your contractions.
This movement makes a huge difference and can be just what is needed between lovely spells of resting to bring your baby down and progress your labor.
And let’s talk (for just a second) about how psycho-somatically, this the perfect place for your body to remember how to let your lower sphincters open. ‘Nuff said? Thought so.
But what about if you are laboring in the hospital where they have no tanks behind the toilets?
Well, we’ve got that worked out for you! You sit facing out as you would if you were going to use the toilet normally.
Partner then sits on the birth ball getting as close to the toilet as possible – with your legs open on either side.
You’ll both need one or two pillows…. two for you to put on your partner’s back to lean forward and rest comfortably and one or two for your partner to wrap forward around for support.
This is sometimes partners’ favorite position. I wonder why? But maybe your partner really needs to go lie down for a bit… we have to watch tired dads on birth balls, you know.
So, we have another option for moms in hospitals too.
We’ll wrap those pipes with pillows and we can wrap the pipes with the rebozo too, for a hand-hold.
So, I am going to wrap up with this. Every once in a while (not that often, I am afraid) this position brings a baby down quickly and sometimes you can feel an urge to push. Well, nothing gets some care providers more worked up than a mom pushing on a toilet. If you are first time mom and your urge to push is not overwhelming, you may wish to stay here for a bit. If you choose to do that, it will likely get those same care providers VERY worked up… and while I have never (in my nearly 20 years as a doula) seen a mom push a baby out INTO the toilet, I suppose that could happen. After all, I always say, just when you think you know something about birth, it humbles you. So with that in mind…I think I have a solution.
If you are just beginning to feel pushy and you can’t imagine moving yet (I say yet, because changing positions often in pushing is a good thing),
you might negotiate with that nurse, doctor or midwife by placing a bath sheet across the toilet – UNDER the seat.
Of course, if you stand up to do that…you might just change positions.
There is something about the Confident Birthing Childbirth Classes at The Lotus Tree in Boise.
The best way to describe it is to say…like everything at The Lotus Tree…
the focus is on PLAY …and learning happens naturally.
even coping becomes PLAY
and play leads to connections
we ease into the ‘work’
and the work has its own meaning
a safe space is created
and the space of the couple emerges
become parents in community
In the Confident Birthing Childbirth Class, we learn this comfort measure early and repeat it, building layer upon layer of information in several classes, so birth partners can feel not only comfortable in doing it but also clear about their intention while doing it. For some visual recognition, below are some examples of the double hip squeeze (as well as direct pressure) being practiced in class.
Here are just some of the positions you can do the double-hip squeeze in while in labor (or even in late pregnancy since much of the mobility of the pelvis is already felt and may be contributing some discomfort for mom). Try it! She might really appreciate a little relief from all that pregnancy pressure.
standing leaning over the birth ball
sitting, leaning forward (over the bed, the back of a chair or even the toilet)
placement of hands:
note: this is the higher placement…you may also place your hands lower and toward the middle aiming directly for the sacro-iliac joint. And your thumbs won’t wrap around through the pelvis like this either
on hands and knees
on knees leaning over ball note: laughter in labor is always nice….
until it isn’t anymore :0
below is a variation on the double hip squeeze: direct pressure applied directly over the sacrum
This week’s class was the birth rehearsal and each expectant couple arrived with pillows, birth balls and comfort measures bags in tow. From the very first class, I stress that they are not just preparing for the labor and birth; they are preparing for parenting and partnering as well. Each week, with every exercise and exploration, every comfort measure and coping skill, I try to connect its value to both the birth and beyond.
In this class, as they unpack their cars and tote in armfuls of labor “essentials”, I jokingly remind them this is practice for all the “essential” baby gear they will be soon be schlepping everywhere they go. (You know those babies…they just aren’t complete without all the accessories! More on that thought in a minute.)
Soon, they are in “labor” and the discoveries of the previous 5 weeks of class are being strung together in the context of this birthing rehearsal. In previous classes we have explored many options for how moms might work with their labor and many of them learned early on their own personal styles of relaxation and rhythm. Tonight is another opportunity for each couple to try out a few particular comfort measures they think might work for them, explore some meaning and some manner of connection and become empowered together. This is the fascinating part…to see which style works best for which woman and for each couple.
Some are “innies“. They enjoy focusing their breath, their thoughts, their BodyMind inward and often their partner becomes the container of that energy. You can feel it. There is something quite remarkable there…that “contained” focus, strength, and connection is powerful and palpable and it is easy to imagine that it remains and grows between the couple after the birth of the baby.
And then there are the “outies“. With great attention and intention, these moms place their concentration on something outside themselves, and draw great strength from the meaning and value of this focus. Here, partners open the space a bit and flexibly support her need for this extension beyond the “container of the couple”. Here is a reflection of the reality of the family…where there is movement…both toward and away from the twosome. The need of the laboring mother to find what works for her is honored. This ease of acknowledging each other’s personal needs, and holding the space for each other in it, is the true “essential” for partners who are also parents.
So which one will you be? An “innie” or an “outie”?
More than likely, you’ll be both and your labor, like your life,
will ask you to welcome both at different times.
At the end of class, as each couple loads up all their comfort measures “accessories”, and cart them all back home with them, I have to wonder: how much of the “stuff” will they use in labor? What will truly be essential? Of course, in Confident Birthing we are big on birth options, but…just like babies don’t actually need all those “accessories”, everything a laboring woman needs is pretty much standard equipment as well. And the partner who keeps her in the driver’s seat for her birth will most likely find the trip rewarding too.
Every once in a while, a baby is born before his/her parents finish their Confident Birthing Class
This was true of this little guy…whose parents, Kendra and Ryan, brought him to the last class of the session for “show and tell”
Here, dad did a great job of introducing all the still-expecting parents to 4 of the 5 S’s
The Five S’s are tried and true ways to calm a fussy baby.
While many cultures have long used these instinctive ways to soothe babies, Dr. Harvey Karp, author of Happiest Baby on the Block,
was the wise one to put them into a book, DVD and classes for the modern parent
Here Ryan talked all the dads and moms through the first four steps:
Swaddle (as in “burrito” that baby), Side/Stomach (as in hold baby on his or her side or stomach),
“SShhh” (as in make the sound), and Swing (as in gently sway or swing baby side to side)
And baby proved, with these four…maybe S #5…Sucking…isn’t even needed!
It is surprising to many people who have been through my Confident Birthing Class to learn that I am a Lamaze Certified Childbirth Educator. Having taught childbirth classes for so many years prior to becoming certified by Lamaze International, I, too, associated the name, Lamaze, with hospital-based classes teaching an outdated technique. I was very surprised, in 2005, when my class was part of the ethnographic study commissioned by Lamaze, to learn just how wrong I was about that. Once associated with “patterned breathing”, Lamaze is no longer a “technique” and breathing is no longer the hallmark of the organization.
Upon discovering the heart of the Lamaze Philosophy through their Position Paper, I found that it was so completely congruent with my own philosophy that I wanted to know more. So began my appreciation for Lamaze International.
“The Lamaze Certified Childbirth Educator promotes, protects, and supports every woman’s right to give birth, confident in her own ability, free to find comfort in a wide variety of ways and supported by her family and all members of the health care team.” The emphasis on keeping birth normal while promoting, protecting and supporting women’s childbearing rights reflects my own mission of helping couples explore and identify their own definition of a satisfying birth.
Lamaze Philosophy of Birth:
Birth is normal, natural, and healthy.
The experience of birth profoundly affects women and their families.
Women’s inner wisdom guides them through birth.
Women’s confidence and ability to give birth is either enhanced or diminished
by the care provider and place of birth.
Women have a right to give birth free from routine medical intervention.
Birth can safely take place in homes, birth centers and hospitals.
Childbirth education empowers women to make informed choices in health care, to assume responsibility for their health and to trust their inner wisdom.
I tell my classes all the time…if you go into labor before the birth rehearsal class in week 6 of the series, (or, if when labor begins, you find you just can’t remember to do anything else) these four things make a huge difference in a woman’s ability to work with and move positively through her labor.
1. Move Your Hips Through Space
Moving your body by walking, rocking, and changing positions assists you in labor in several ways. Moving around can help you be better distracted with interesting activity and more easily cope with the earlier, less intense contractions. Later, as contractions get longer, stronger and closer together, movement helps you cope with the strong contractions that are needed to change the cervix and bring the baby down by allowing the pelvic bones to move apart more. Some women find that movement lessens the painful sensations of the uterus’ contractions and often, while coping becomes easier, movement seems to allow the uterus to work more efficiently.
Generally, to truly move your body (especially your knees and hips), you’ll probably want to be in an upright or semi-upright position. Working with gravity helps your uterus do its jobs of moving the baby down. Having said that, even sitting, on a birth ball, in the tub, or even on the toilet, will work just fine for many women. Any position that allows you to move your hips helps. So, rather trying to find the ideal position, keep it moving. Janet Balaskas, author of New Active Birth, says “being free to change position during labor is more important than finding a single best position.”
I also find that, in addition to changing positions for physical comfort and labor progress, changing positions also encourages a change of environment. Fresh air, (even the air of another room) makes a huge difference,especially in the case of birth that is progressing at a slower pace. These can be challenging births due to the fatigue to the mind as much as to the body. New positions, new environment, fresh air and fresh perspective is crucial. In this case…keep it all moving…BodyMind and Motherbaby.
Which brings me to this point: it so important to trust that the MotherBaby know what to do. When I say “move your hips through space” it is more of an affirmation of what I know you will do instinctively, rather than advice. As midwife, Naoli Vinaver says in her film, The Birth Day, the woman’s body who made the baby knows how to get the baby out. This instinctive movement produces the rhythmic coping that we explore in Confident Birthing in great detail. And given a comfortable, private space, you’ll find your instincts are readily accessible to you.
For more information about the benefits of movement and changing positions in labor check out Lamaze Healthy Birth Practice #2
2. Let Some Sound Out
At Confident Birthing Childbirth Class reunions, there seems to be a common theme to the things women say surprised them most about how they labored. One of these is the sounds they found themselves making. So, like moving your hips through space, this “advice” is, again, really an affirmation of what most women will find themselves doing instinctively, and yet, I find many moms just can’t imagine themselves doing it.
The explanation of this really simple…given a safe enough space, the laboring woman will instinctively use sound to cope with labor and to assist her body in progressing through labor. We explore this concept thoroughly in class, but for now let me just say…keeping your mouth, throat and jaw as lose as possible is key to your labor progressing. You can read more about this essential of labor in Ina May Gaskins’ Guide to Childbirth. This book is not required for your Confident Birthing Class, just HIGHLY recommended to every pregnant woman. Hint, hint.
3. Try the Double Hip Squeeze
If you could do only one physical comfort measure (besides loving touch), my recommendation is to try this one. While there are a few moms who don’t like it, I would say at this point in my career (15 years and 175 births), the overwhelming majority of women I have attended in labor found comfort from the firm, but gentle pressing together of their hips.
We practice this (and many other comfort measures) often in Confident Birthing, so you’ll have it mastered by the time you need it. The key is placement and then with gentle, but firm and evenly distributed pressure through your hand, you simply squeeze her hips together. If you are not in Confident Birthing…ask your doula…she’ll know.
4. Love Her
I don’t really think I need to say much more. It is afterall, the most important thing, yes?
My “babies” are older now…and while I may no longer be their dandelion or their dinner,
I will always be their praying hands and open arms – the finish line to a welcome home.
Much thanks to my friend, “Jorjah B” for sharing her photos here.
We have mutual friends, she and I, all with straps around our necks, cameras dangling from the ends.
We met online when she was newly pregnant with this sweet little “B-Boy”. I admired “how she sees things” and she was taken by the images of birth I captured as she was preparing for that journey herself.
Today, I found myself back at her blog and was so moved by these photos above taken by “papa B” and reminded why I loved visiting and reading her journal entries, written so lovingly for baby B.
I invite you to spend some time and check out just how she sees things.
This family was prepared! Healthy Whole Grain Muffins straight from the oven, cooling on the counter!
But what is this about not be allowed to eat in labor? Robin Elise Weiss, at About.com does a lovely job of explaining the history of why hospitals restrict eating during childbirth.
It is clear that the approach of restricted food and drink is based on the assumption that all laboring women might end up in the operating room giving birth by cesarean section,
under general anesthesia.
Robin’s article also points out very well that women often experience the benefits of being allowed to eat and drink as desired…(slightly shorter labors, less stress to mother).
Midwives understand the importance of eating and drinking in labor and encourage women (and their partners) to stay well-hydrated and nourished through the labor.
So what to eat during your labor and birth? What are some other great options for what to eat during labor besides healthy muffins and fruit? Easily digestible, nutritious foods such as yogurt, cheese, eggs, toast, and even warm soups are often recommended.
Once in active labor, keeping your energy up by eating a bite or two every 30-45 minutes or so is essential. Eating during childbirth can be hard for some women…I have found that laboring women will eat until their body tells them it is too busy focusing on labor, but it is so important to keep the calories/energy for the labor going in
even if she has some trouble keeping it down.
When that happens, there are other options like 100% fruit juice popsicles (if you find you simply cannot keep those other things down).
Hydration is also essential in childbirth.
St. Luke’s and St. Alphonsus make drinking water easy in these HUGE water bottles you will take home with you.
Coconut Waters are making an appearance now in labor and delivery but not all are created equal. Consumer labs did a comparison and only Zico lived up to its claims.
Thank you, Kam Taylor, for taking the photos of our “got oxytocin?” baby tee shirts
Confident Birthing is an oxytocin-promoting environment.
This special time of preparing for your birth amd welcoming your baby
is also the perfect time for...
and caring for your relationship
Everything we do in Confident Birthing to prepare for the birth and the baby
is also a preparation for your partnership in parenting
OK. So I know you are all wondering… “what kind of class IS this, anyway?”… or “what is up with the blind-folded lady with the guitar?” I can assure you Guitar Hero is not a common occurence in Confident Birthing Childbirth Class, however… on this particular day, in this particular class, this soon-to-be-a mama’s husband, who was guiding her on a blind-folded journey (exploring trust and healthy dependence) sat her on this birth ball and placed this guitar in her hands.
The smile on her face says it all. And, because the time couples spend together preparing to welcome their baby should be fun, I am happy to say smiling and laughing IS a common occurence in Confident Birthing!
Much thanks to Lindy English for catching this wonderful moment in class.
When I first heard about a “birth ball” it was 1995 and I was attending my DONA birth doula training. I couldn’t wait to see what it was and I imagined all kinds of contraptions so when my doula trainers showed me the “birth ball” I was both disappointed and excited. Excited because, as a licensed massage therapist I already had several “physio balls” (which is what I knew it to be called) and disappointed that there wasn’t something a lot more special about it.
Well, it didn’t take me long to learn that this simple tool could be considered the swiss army knife of pregnancy/baby paraphernalia to expectant and new parents.
Pregnant women soon discover that the birth ball is often the most comfortable seat they can find.
See what I mean?
Now don’t think this ball is just for sitting… there are many more ways we use the birth ball in pregnancy, labor and the postpartum period. I am not kidding when I say it really can become the go-to tool for expectant and laboring moms (ask any doula), and lest you think I was kidding about the swiss army knife analogy…
I always tell dads… since you can’t lactate… you better get yourself a birth ball! Babies love to be bounced and a birth ball makes the bouncing easy. So, dads, the next time you find yourself needing some assitance soothing your baby, try out the birth ball…if you are like the dads I hear from, this will be the “tool” you can’t imagine being without.