Support for Women in Labor

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Introduction: Suzanne Tucker, PT, CIMI

•Physical Therapist and Certified Infant Massage Instructor.•Massage Therapist Instructor for the Healing Arts Center on Prenatal Massage and Infant Massage for Professionals.•Contributing author for www.mymommymanual.com as Zen Mommy.•Meetup.com organizer for new moms in St. Louis, “Babies first Playgroup” helping moms connect to themselves in their role as mother, each other and their babies.•Co-Owner of Brentwood Center of Health: Physical Therapy, Massage, Chiropractic, Acupuncture, Fitness Training, Yoga, Tai Chi, and pre and postnatal services including yogakids, yogababy and infant massage classes. Vision: Inspiring Health www.bcoh.org for more information.

…how do we already support our birthing mothers in these crucial aspects?

BODY MIND SOUL

TensionPaying Attention Too SoonLack of SleepThirst: When your body is dehydrated, your muscle output is decreased by 30%; heightens feelings of exhaustion and can elevate your temperature. If your temperature goes up, your medical team, intent on ensuring your baby is healthy, will assume this "fever" is caused by an infection and you may begin to receive antibiotics via injection or IV.HungerNeed to urinate: important to urinate frequently (every two hrs).Performance AnxietyLying on Back

Increases Pain in Childbirth

Attitude: Consider your attitudes about childbirth. Ask yourself where they came from, why do you feel the way your do? The figure out what you need to do to get your attitude right.Education: Many times fear is caused by uncertainty, other times it is caused by misinformation. Support: Who will be in the room? Hiring a doula.

Realistic Expectations: Not listening to any more "horror stories.“ Read positive birth stories.

Take Control: Explore many options for pregnant women today and help her come to know the way she would like to be with the birth of her baby; birth plan. Use words like birth and surge instead of labor and pain.

Overcoming Fear:

BODY MIND SOUL

Prenatal Exercise for: Strength Flexibility Relaxation/Meditation Breathing

Support/Sharing Circles Prenatal Yoga Guided Meditation “Home” Program

During Labor:Transcutaneous Electrical Nerve Stimulation (TENS) for early labour.

Just one of many birthing tools:AromatherapyBirth BallFrozen Water BottleHot and Cold PacksKnobby BallMassageMusicPositioning/MovementRebozoRelaxation and BreathingRolling PinRice SockTennis BallWaterWeighted Ball

TENS:

•Treatment with TENS consists of attaching pads to your back. A low voltage electric current is passed across these pads and this stimulates the body to produce it's own natural analgesic substances. •It takes about 30 minutes before an effect is felt. •The relief achieved is usually assessed as moderate. •There are no known ill effects from TENS. For some women it is of considerable value. •As labor progresses the intensity of the electrical stimulation can be increased to cope with the increased intensity of contractions.

J.T. van der Spank1, D. C. Cambier1, H.M.C. De Paepe1, L. A. G. Danneels1, E. E. Witvrouw1 and L. Beerens1 Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Faculty of Medicine & Health Sciences, University Hospital

Abstract:•To determine TENS effectiveness in providing pain relief during labor as well as its influence on the incidence of requests for epidural analgesia. •The experimental group (receiving TENS by a burst – conventional obstetric TENS-apparatus) and the control population (not receiving TENS) consisted of 24 and 35 women respectively. In the experimental group the TENS application was switched off for a period of 15 min. •The 24 women were asked to point out the intensity of their pain on a visual analogue scale before, during and after this interruption. •Two days postpartum the participant's satisfaction revealed a 96% degree of satisfaction. •During TENS application the pain scores were significantly lower (p<0.0001).•No statistically significant difference in incidence of epidural analgesia was found between the experimental group and the control group.

TENS:

•Stimulates the nerve fibers and can work to help block pain signals in labor. •Allows for moving around or assuming various labor positions.•Applied by placing four electrodes on your back. Two go above your bottom and two just before your ribs on either side of your spine.•Best if applied prior to labor for a practice session.

•Hands and knees is gravity neutral, can help turn a posterior baby.

•Walking

•Sitting on a swiss ball, chair, floor (criss cross) to allow gravity to assist.

•Squatting once baby is engaged in the pelvis encourages decent and as a birthing posture to protect the perineum and prevent tearing.

Positioning and Movement:

With feet firmly planted on the floor, lower your upper body into a slight bend; lower your bottom to the floor by bending your knees and hips.If it is difficult to balance, stand in front of a table, counter, heavy chair or another person, and hold it/them while you lower your body. To come out of a squat, lift your bottom first, then bring the upper part of your body to prevent pressure on knees.

Stretches the calves to make getting into a good pushing position easier.Stretches the lower back, relieving lower back aches.Helps to lessen constipation.To pick up objects without putting pressure on your back.To prevent unnecessary pressure on pelvic floor, allow tissue to stretch with birth to avoid episiotomy.

Squats: Before and During Labor

Stand, facing a flat wall. With your hands flat on the wall to support your weight, slowly slide one foot backwards until you feel a good stretch. As you slide your leg back, the other leg should begin to bend at the knee.

Stretching: Wall Thigh Slide

Stand next to a wall. Use your hand, or your entire forearm to support your weight by placing it on the wall. Slowly slide your foot away from the wall while the leg next to the wall bends at the knee.

Wall Inner Thigh Slide:

Sitting on the floor with your legs in front of you, extend one leg and fold the other close to your body. Slowly lean toward the extended leg, reaching for your foot.

Seated Leg Reach:

Lying on your back with your arms extended and your knees bent, feet in the air. Slowly twist your body so your knees rest on the floor to one side while your shoulders remain on the floor. To come out, slowly straighten your legs so you are lying on your back. Bring your knees back up and do the other side.

Back Twist One:

Sitting on your legs or cross-legged next to a wall, slowly twist your upper body to face the wall. Use your arms to support your body in the twist while your legs remain on the floor. Change position and do the other side.

Back Twist Two:

Stand near a chair or low table with your legs greater than hip width apart. Placing one hand on the table or chair, extend the other arm. Slowly bend towards the chair or table, bending at the abdomen and keeping your hips facing front. Change positions to do the other side.

Side Bend:

Sitting on the floor or a chair with your arms at your sides, bring one arm behind your back and try to reach up. Bring the other arm over your head and reach it behind your head so try to touch your hands together. Do this on both sides.

Arm and Chest Stretch One:

Sitting on the floor or a chair with your arms at your sides, slowly bring your hands together behind your back. Begin by touching the fingertips and as you become more stretched you can hold the hands together in a "prayer" position.

Arm and Chest Stretch Two:

On the out breath, make long, deep guteral sound like you are saying “home”. Another sound to use is “aughhhhh” really softing the jaw and between the eyes. Take in a long slow breath in the nose and move again into chaning on the out breath. Go with the sounds that work for you and your body to help soften and open the pelvis.

Chanting/Breathing

Talk to birthing mothers about how:1- Their body knows what to do .2- Their baby knows what to do and is working with them to move into this world. 3- It is OK to trust and open to their baby. 4- Their baby is working with each surge to come to them. 5- It is safe for them to listen to their body. They are safe. They can trust and open.6- They are powerful birthing warriors. Powerful like women through the ages who have birthed as they are. Help them pull strength from a connection to all women. Breathe in strength with each breath and move with each surge.

Visualization:

How can we better serve birthing women and the babies they bring into the world:•by taking a holistic approach?•by taking a team approach?•by supporting them to be the head of their health care team and to make choices?•by empowering them to heal?

Conclusions: