I am very excited that I can finally put my degree from the Boston Conservatory of Music to good use in my current career! Recently during class I have been focusing a lot on vocal toning and its benefits during labor and birth.
So let me back up a bit to my days as a singer. I had what I refer to as ‘Debra-isms’, which were my own special ways (read: bad habits) of dealing with a note or part of a song about which I didn’t feel confident. I would rush by that note or phrase and get very tight in my neck, throat and shoulders. To combat the problem, my teacher would ask me to move my hips around to encourage my body - especially my neck and throat - to relax. The result would be that the notes which once gave me problems would soar out with ease and beauty. So what does that have to do with birth and labor, you might ask?
Well, as I had suspected from my own experience of constriction and release, there is a strong connection between an open throat and an open pelvis. It is not a coincidence that the neck is called the cervical spine and the lower, narrow portion of the uterus is called the cervix (Latin for neck). In fact, the cervix and vocal fold tissue behave similarly when tested. For years I have humorously used the phrase open throat, open vagina! - but there really is truth to that statement. When the throat is open, this opening is reflected in the throat of the uterus, the cervix.
You may not be a professional singer, but chances are you have sung out loud with a strong and mighty voice in the shower, convinced you should be the next American Idol. Yes, I do believe some of my best vocal renditions have been in the peace and privacy of my own shower oasis. When I belt away under the warm waterfall, I am totally at ease. The water is relaxing me, and there is no concern for judgment (well, save for the neighbors) or fear of failure.
When anxiety or fear sets in, the body reacts by tightening. Fear releases adrenaline into the blood stream, causing the body to jump into the ‘fight or flight’ mode. If you’ve ever had to scream for help, you know that the voice often comes out tight, screechy and high-pitched. Being aware of the sounds of your voice may give you an indication as to your mental state, how you are breathing, and your body’s biological reaction to what is happening.
During labor, ask your partner or doula to listen to the quality of your voice and notice if it is high-pitched and constricted. If it is, have them hum, sigh or let out a gentle ‘ahhh’ sound with you. This will help you to lengthen your breath and lower the pitch. I use this technique a lot with my clients. When I hear these sounds, I know that she is breathing deeply. This conscious way of breathing promotes the function of the parasympathetic nervous system, which decreases the heart rate and blood pressure and moves the body into a state of rest and recuperation. Practicing these sounds is called vocal toning.
Vocal toning has many benefits:
* Opens the throat, which opens and relaxes the pelvis
* Ensures deep breathing
* Promotes relaxation of the mind and body, releasing stress and anxiety
* Lengthens the breath
* Serves as a productive pain management tool
* Creates vibration in the body, which can relax your muscles
* Stops the ‘fear, tension, pain’ cycle
While many women find vocal toning awkward and foreign when they try it in class, students often report back after their birth that it was a very useful tool and that they were glad they knew about it. You don’t need a degree from a music conservatory or the nod from Simon to harness the power of your own breath. Just open up, let go, and ‘ahhh’.
July 21st, 2008
I attended Andrea’s birth almost 5 years ago. I think this was the third birth in which I took the role of a doula - I was just a doula in training. Andrea had given birth naturally to her first child (almost 10 pounds if I remember correctly) and was well on her way to repeating the experience.
She was doing remarkably well, positioning her body in ways that felt productive and comfortable (well, as comfortable as one could be while moving through transition). When she reached full dilation and had the spontaneous urge to push, she was positioned on her hands and knees. For her, this seemed like the easiest, most natural way to push her baby out. To my horror, the doctor would not allow her to deliver her baby in this position. The doctor wanted her on her back. Andrea pleaded with the doctor not to make her turn around and get on her back. The doctor wouldn’t budge. So Andrea ended up flipping over onto her back - and pushing her 10 pound baby out in 7 minutes! She tore horribly. To this day, I believe Andrea pushed her baby out so quickly just to spite her doctor.
The moral of this story is that there are many positions in which to birth a baby. And research has shown that birthing on the back, although most common - is NOT the ideal way to facilitate a baby fitting through the pelvis and birth canal. In all fairness, the doctor (who was the resident on call, not Andrea’s intended doctor) probably insisted on that position because she didn’t know how to “catch” a baby in any other position. The supine position is the most convenient for the doctor and is these days the one student doctors are primarily taught. However in my experience, when a woman has been given total freedom to take a birthing position of her choice, she has NEVER chosen to go on her back. The mothers I have seen have chosen to be on all-fours, side-lying, in a partial squat, kneeling, sitting on a birth stool or upright in a seated position.
Art from many cultures throughout history shows that women have used both upright and gravity-neutral positions (such as side-lying or hands-and-knees) to give birth to their babies. Until doctors began using forceps in the 17th century, women were rarely shown giving birth in supine positions (lying on the back). The ideal position for a woman would allow for optimal opening of the pelvic outlet, use the advantage of gravity and offer a smooth path for the baby’s descent through the birth canal. When a mother births in the lithotomy (flat-on-back) or “C” position (resting on tailbone with body curled in the shape of a C), she reduces the space in the outlet of her pelvis, making it a tighter fit for the baby. The sacrum gets pushed into the birth canal, thus diminishing the space for baby to move through, and preventing the rectal space from stretching. This will, in effect, lengthen her second stage of labor (pushing). Also, the baby has to work against gravity as it heads upwards over the tailbone and under the pubic bone.
When a woman is on her hands and knees or standing, the Rhombus of Michaelis can be seen clearly because the pressure from the fetal head (which is, in fact, the chin and face as it de-flexes or extends) lifts the sacrum and coccyx out of the way. If a woman is in a well supported squat [this means with knees apart and the bottom not less than 45cm off the ground, as this allows the back to arch in the correct way] standing and leaning forwards or kneeling and leaning forwards with her arms clutching onto something higher than her waist, she will instinctively arch her back and ‘throw’ her pelvis out at this stage. Sheila Kitzinger describes in her book ‘The Experience of Childbirth’ how Jamaican peasant women believe that their backs have to ‘open up’ before their babies can be born. This is the same phenomenon. Dr. Michel Odent calls it the ‘fetal ejection reflex’.
It is not uncommon for a woman to hear that her pelvis is too small for the baby to fit through. This is called cephalo-pelvic disproportion (CPD). It does happen - but rarely. It may be that due to the baby’s size a woman needs to take a number of positions in order to push the baby out. Pioneer doula Penny Simkins explains in The Labor Progress Handbook, “Many suspected cases of CPD actually involve fetuses who are subtly malpositioned (asynclitic, deflexed, occiput transverse or posterior), who will fit well through the pelvis once the malposition has been resolved. The shape of the woman’s pelvis is also a consideration. The woman may need to try pushing in a variety of positions to find the ones that optimize descent. Resolving problems of position or fit often requires extra time. Many large fetal heads will mold and fit safely through the pelvis, but molding takes time.” It is important to allow a mother to experiment with different positions to see what is the most effective for her and her baby, especially if her baby is suspected to be large.
I highly recommend having a discussion with your doctor about how he or she feels comfortable “catching” the baby. Also, find out ahead of time if your hospital has squatting bars and birth stools. Each baby, mother and birth is different and requires individual consideration, so why are we all expected to birth in the same way?
July 1st, 2008
