Massage is one of the most useful tools for non-medicated pain relief I can bring to a birth. It has been credited with helping to reduce pain, anxiety, and fear by increasing endorphin levels in the body. A study reported in ‘Mental Health Update’ that “the women in a group that received physical touch (light massage and counter pressure) and emotional support, as compared to controls, had 56% fewer c-sections, an 85% reduction in the use of epidural anesthesia; 70% fewer forceps deliveries; 61% decrease in the use of oxytocin; a 25% shorter duration of labor; and a 58% drop in neonatal hospitalization” (Midwifery Today #84 Winter 2007 pg 32). Another study from the Touch Research Institute reported that “women whose partners massaged them felt less depressed, had less labor pain, and had lower stress and anxiety.” (Midwifery Today #84 Winter 2007 pg 32) These statistics are amazing!
Keep in mind: The more relaxed the body is, the less painful the contraction will seem. The more stressed the body is, the more painful the contractions will seem. There is an idea referred to as the “gate control theory”, which posits that pain is experienced not as a result of the activation of individual pain receptor neurons, but rather by the interaction between neurons, and also that pain signals can be interfered with by stimulating the periphery of the pain site. Massage, counter pressure, water pressure, heat, and ice can help to block the pain signals.
Several of the common areas that the laboring mom may enjoy having massaged are the lower back, neck, shoulders, hands, and feet. Often times I find that birth partners want to offer this kind of support but are apprehensive about how to massage and touch their partners. One need not be a trained massage therapist in order to deliver hands-on support. Rather, knowing and understanding your partner and paying attention to her verbal and body language will let you know if you are on the right track or if you need to shift gears and try something new. I do not have a specific massage I use every time, since all women experience the sensations of childbirth differently. Nor are the same techniques used throughout the whole labor. The needs of the mother will change as she moves through her labor, so the type of support you offer will also need to evolve. What feels good in early labor may not work during active labor. Some women may even find that touch is too intense during contractions but welcome in between.
Here are a few techniques to try:
Counter Pressure As the uterus is contracting, residual pain occurs in the lower back and sacrum area. Counter pressure can relieve some of this discomfort. This can be accomplished in a variety of positions: The mother can be on her side, in child’s pose, or leaning against her birth ball or a wall. Apply downward pressure to the sacrum while elongating the lumber (lower back) spine.
Counter Pressure with Heat or Cold The mother may enjoy counter pressure with the added sensation of a hot water bottle or an ice pack.
Double Hip Squeeze Locate the top of the mother’s pelvis (the iliac crest) and from there draw an imaginary line to her tailbone. Along that line, at the center of her upper buttocks, squeeze or press in and upwards during a contraction.
Long Massage Strokes I generally focus on the lower back and stroke upwards towards the mother’s shoulders. Often she has tightened her shoulders, jaw, and neck during contractions, so some time spent on these areas can be beneficial.
Bath or Shower Sometimes human touch can be too much for the mother, in which case the water pressure of a bath or shower may be ideal.
Leg Massage and Foot Massage If the mother has been walking, standing, or squatting a lot, massage can ease some of the fatigue of the legs and feet. I find leg and foot massage especially useful when a mother has opted for an epidural anesthesia, as her legs and feet often get swollen from the increased fluids. Massage can be very helpful to move the fluids which could be pooling in her lower extremities.
Besides the few that I have suggested, there are many different ways to massage your partner and help ease her discomfort during childbirth. Many yoga studios, massage therapists, and childbirth educators offer classes and workshops on partner massage. It could be a fun way for you and your partner to start to explore what may feel good during labor, as well as help alleviate some of the aches and pains of pregnancy.
I saw a screening of “The Business of Being Born” downtown at the IFC on Friday night with a few of the teachers. I had been anticipating the release of this movie for months. Within moments of the start of the film, I was already teary. The facts and images that came across the screen deeply saddened and moved me.
The film illustrates the history of birth in our country. During the 1920’s there was a shift from birthing at home to birthing in hospitals. At that time, the treatment of laboring women was horrifying. They were strapped to beds and given drugs that would prevent them from remembering the experience - but wouldn’t prevent the pain. In the 1950’s women were having their pelvises x-rayed to see if they were the ‘right size’ to deliver babies. Years later, it was discovered that x-rays are harmful to the fetus. In the 1970’s the drug thalidomide was prescribed as a sleeping pill and to treat morning sickness - until it was linked to babies being born with significant birth defects. In 1999 it was determined that the use of Cytotec, a still commonly-used induction drug, was causing uterine rupture in a significant number of women giving birth VBAC (Vaginal Birth After Cesarean). According to literature provided by a law firm which advocates for patients affected by drugs such as Cytotec, “It can be reliably estimated that between 1990 and 1999, as a result of the widespread off-label use of Cytotec for vaginal birth after Cesarean section, well over 3,000 women in the United States suffered a ruptured uterus, resulting in at least 100 dead newborn babies.” Currently, there is a frightening trend of inducing labor with the drug Pitocen. I am curious whether or not, years from now, we will find out that this drug too is harmful. The film also briefly mentioned the correlation between the rise in autism, asthma and allergies to the increase in commonly-used intervention drugs.
One common misconception discussed in the film is that hospitals assure a safer birth experience than homes do. When in fact “The United States has the second worst newborn death rate in the developed world” (direct quote from the film). The film went on to explore the birth practices in other countries. One of the most profound segments was about the role of midwives in birth: In the majority of developed countries, midwives attend to women for the majority of births, and OB/GYN’s are expected to step in ONLY when there is a problem. Also, the mentality abroad is that the body works perfectly fine and that the occurrence of a problem is the exception, not the rule. However, in the United States, the mentality is that we should expect a problem and treat all women as if there will be a problem - which explains why so many routine interventions have become commonplace. The film features several recognizable NYC doctors, included well-known OB/GYN Dr. Jacque Moritz who quipped “98% of obstetrics is boring, 2% is exciting”. So why are we treating every women coming through the door like a problem waiting to happen?
I fully support and encourage the viewing of this film. It provides an excellent resource for women who want to see the bigger picture of birth at this time in our country. I am not asserting that every woman should birth at home - that might not be the right choice for everyone. However, I am advocating educating women to make informed decisions about where and how they wish to birth. Women should give themselves the opportunity to hear from multiple experts, see the data, see natural birth - and then decide what is right for them. They should allow the sense of empowerment to outshine the sense of fear.
About a year ago I was attending my friend Valerie’s birth. She labored well, and after a number of hours it was time to push her baby out. When she started to push, her contractions were spaced out to about 8 minutes apart. Most women’s contractions do space out once the cervix is fully dilated and the second phase of labor starts, but 8 minutes is a bit longer then the average (4-5 minutes).
Relatively early in Valerie’s pushing experience, we were informed that the hospital’s policy is to allow the woman to push for a maximum of 3 hours. If the baby is not out at that point, she will give birth by cesarean section. I asked the nurse if there was any room to negotiate that time line, given that Valerie was getting only half the chances to push since her contractions were so far apart. The nurse seemed baffled and responded that we would wait and see. Luckily, Valerie pushed her beautiful baby out right before her ‘deadline’ for a vaginal birth.
Because situations like Valerie’s are not uncommon, I have become fanatical about teaching “The 3 Questions”: Is mom ok? Is baby ok? Can we have more time?
Some of the main issues you may encounter involving a timetable are: How far past the mother’s due date is allowed before induction? When should the mother start to push her baby out? How long can the mother push? How long can the mother labor?
How far past the mother’s due date is allowed before induction? Six Care Practices that Support Normal Birth that labor begins on its own. There are, of course, medical exceptions to this rule - which does not include, by the way, an estimation of a large baby, unless the mother has gestational diabetes. Generally, it is believed that labor should not be started artificially. Researchers now believe that when a baby is ready for life outside his mother’s uterus, his body releases a tiny amount of a substance, which signals the mother’s hormones, which begins labor.
When should the mother start to push her baby out? It is not uncommon for a woman to reach full dilation before she has the urge to push. There is no harm in waiting for her to have the urge to push. If she starts pushing before she is ready, not only will she exhaust herself for no reason, but she will start the clock on the time line alloted for the second stage of labor. The mother might be wasting an hour with ineffective pushing while she could be resting and naturally allowing her contractions to continue to help move her baby further down the birth canal. One good sign that a woman is really ready to push is that it feels better to push through the contraction than to simply breathe through it.
With women who are not using pain medication, the urge to push is very apparent. However, those women who opt for an epidural will not get the same hormonal signal telling them to push. So it is a good idea to turn the pain medication down so that she can listen to her body, follow the urge to push, and push more effectively.
How long can the mother push? Some hospitals have a preset amount of time alloted for pushing, as mentioned in the earlier situation with Valerie. However, there is no evidence supporting the use of an arbitrary time restriction if there are signs of progress and neither mother nor baby are showing signs of distress. “The time taken to complete the second stage will vary considerably between mothers; clearly it should not be allowed to continue for many hours. However, in the presence of regular contractions, good maternal and fetal condition and progressive descent, considerable flexibility in duration should be allowed.” (Myles Textbook for Midwives, 13th Ed. 1999 p.452)
There can be many reasons that labor is slow. If I am attending a birth that is slow, the first thing I consider is the baby’s position. Is the baby in a posterior position? I also check in with the mother to see if she is experiencing fear or anxiety. These emotions can keep the labor at bay. I also try to determine whether or not she is well-hydrated. However I never want to put pressure on the mother, making her think there is something wrong with how her body is working.
Should you be experiencing a slower labor, don’t panic. It might just be the way your body is working. Maybe your body needs time to get the right hormonal levels. Maybe your body needs time to allow your baby to move into the optimal fetal position. But if mom is ok and baby is ok, then whose schedule are we on anyway?
I truly believe in the intelligence of our bodies. As Midwife Ina May Gaskin said, “Our bodies must work pretty well, or there wouldn’t be so many humans on the planet.” With that in mind, allow your body and your baby the time and space needed to work through the journey of labor and birth on your own schedule.
