Monday, January 31, 2011

In Labour

Massage

How does massage help relieve pain?

Massage stimulates the body to release endorphins which are natural pain-killing and mood-lifting substances. Endorphins are responsible for the "feel-good" factor - the "high" you feel after a vigorous game of squash or a good laugh with your friends during your coffee-break. In labour, massage is important because it brings you close to the person who is caring for you, be this your husband or your birth companion. The touch of someone who loves you and wants to help you is very empowering when you're coping with contractions, and are perhaps tired and frightened.

One study showed that women who were massaged during labour were less anxious and experienced less pain as well as having shorter labours and less postnatal depression than a control group of women who were not massaged.

Are massage oils a good idea?

Using oil makes massage easier to carry out and more pleasant to receive. However, you have to be careful which oil you choose for labour. Essential oils are extremely powerful substances and can interfere with contractions if used wrongly. Some (qualified and certified) aroma therapists prefer just to use base oil for labour. Base oils include sweet almond and grape seed. Don't use sweet almond if you have a nut allergy or are worried about nut allergies. Just as good is grape seed and even olive oil, which is particularly well absorbed by the skin.

Shoulder massage

It's important for labouring women to keep their shoulders relaxed. Relaxed shoulders assist rhythmic breathing and rhythmic breathing maximises the oxygen available to both you and your baby. Massage is very helpful for keeping the shoulders and breathing relaxed.

Your birth companion should place his hands on your shoulders and lean lightly on them. This will help you drop your shoulders if they are already hunched because you have become stressed. Next he can stroke down from your shoulders to your elbows, maintaining a rhythmical action and applying firm pressure. Tell him whether the massage is helping you and how he could make it better.

He could also try resting his hands on top of your shoulders and using his thumbs to massage in small firm circles behind your shoulder blades. Tell him if he is pressing too hard or not hard enough, or if he is massaging too quickly. It's important for him to avoid frantic massage as this serves only to speed up your breathing when the aim is to slow it down!

Back massage

Many women feel contractions strongly in their lower back, so back massage is very useful. In early labour, your husband can use the flat of his hand to stroke down the side of your spine, from shoulder to bottom. He then uses the other hand to stroke down the other side of your spine, maintaining a rhythmical movement, with one hand constantly in contact with you. These long, slow strokes are very soothing. Make sure that he is massaging you using the whole of his hand and not just the heel. His fingers need to be in contact with your body as he tries to respond to the tensions he finds there.

In advanced labour, very firm, even pressure at the sacrum or either sides of spine can be very helpful.

Foot massage

Many people who say that they can't tolerate having their feet touched nonetheless enjoy firm, rhythmical foot massage. The massage does need to be firm, however, or it will be unbearably ticklish. If you find yourself sitting down or in bed for long periods of your labour, foot massage is ideal. Your husband can simply stroke your feet firmly from ankle to toes, or make circles with his thumbs all over the soles of your feet. You may find that your feet become very cold in labour, and a foot massage will help to warm them up. This is different from reflexology, which focuses on pressure points - note that reflexology is not recommended in labour.

Hand massage

If you have had an epidural and are lying in bed, shoulder or back massage is difficult. And if you can't feel your feet, there's no point in your husband offering you a foot massage. In these circumstances, hand massage is very soothing. Your birth companion can simply stroke each hand in turn, first on the back, then on the palm, sweeping firmly down from your wrist to your fingertips. He can make small circles all over your palm, and gently pull each finger in turn to release the tension. This is a lovely way of being close to each other and making your labour special.

Not all women like massage

If your birth companion is keen to massage you in labour, he may be very disappointed if you don't like it. However, some women simply cannot bear to be touched when they are having contractions. The contractions are so strong that even the slightest extra stimulus is more than they can cope with. Other women find massage so helpful that they want their husbands to keep rubbing their backs for hours on end! Birth companions need to be aware of these different reactions and respond accordingly.

Relaxation

The benefits of relaxation in labour

In labour, relaxation performs many of the same functions as it does in everyday life:

• Relaxation prevents your muscles from becoming fatigued, especially the large muscle of the uterus (womb).

• It helps you cope better with the stresses of giving birth and manage the experience better.

• It helps conserve your energy, so you will have the strength to deliver your baby.

• It helps you communicate more effectively with your carers and understand what they are saying to you.

And equally importantly, relaxation helps your baby to cope with labour. If you are relaxed, you won't flood your baby's system with stress hormones that cause his heart rate to speed up. Staying relaxed also means that you breathe more deeply, so that your baby gets more oxygen.

Can you really relax in labour?

It's certainly not easy, but a few simple techniques can help, especially if you have the loving support of a birth companion. Being well supported in labour has repeatedly been shown to be the single most important factor in determining a positive birth experience for the woman and a positive outcome for her baby.

You might find it very hard to relax during contractions, but remember that most women are totally free of pain and discomfort in between contractions. This is the ideal time to check over your body, especially those parts that you know become tense, and relax them (see Know your body, below). Your companion can help you with massage, and with reassurance and encouragement. Focusing on your breathing both during and between contractions will help, too.

In some countries such as the UK, some women find labouring in water very relaxing. In Malaysia, this is currently available only in Pantai Medical Centre in Kuala Lumpur and Island Hospital Penang.

Create the right environment

The first step towards relaxation is to get the environment for your labour right. In the UK, women have the option of giving birth at home. Our public health delivery system and network are not set up for this, so homebirths are rare.

As such, you will most likely deliver your baby in a hospital room. You may wish to think about how to make your labour and delivery room as comfortable as possible. Consider bringing your own birth balls and pillows. Wear your own clothes for as long as possible (a loose top and elasticated jogging trousers are ideal). You may want to bring some little garments or toys for your baby and place them where you can see them.

Sheila Kitzinger, a leading UK expert on birth, says that women should deliver their babies in an environment similar to the one in which they conceived them - in other words, one that is dimly lit, cosy, comfortable and intimate. It's worth thinking about!

Know your body

During your pregnancy, whenever you become stressed, stop and think about which parts of your body are becoming tense. Do you frown when you are worried? Or grind your teeth? Or get tummy ache? Do your neck and shoulders feel tight and painful? These are all signs that your muscles are in a state of tension, causing them to become sore and tired.

Take a deep breath and, as you breathe out, let the muscles in question relax so that they feel loose and soft, rather than rigid. Practise this technique regularly - not only when you notice tension in your muscles, but before situations you know cause you stress. This way, by the time you go into labour you will automatically be able to identify areas of tension in your body and to relax them. It will also do wonders for your blood pressure.

In labour, take a deep breath at the beginning of every contraction and, as you sigh out, try to relax. Then focus on a word or phrase as a distraction technique. Hum 'ba-by' to yourself under your breath. Or repeat 're-lax' over and over again, or trying blowing out gently after taking a deep breath. Try visualising your baby as he moves down through your pelvis. Focus on the positive aspects - like the fact that you will see your baby soon!

Communicate clearly

You won't be able to relax during labour if:

• You don't know what's happening to you.

• You don't understand what the nurses and doctors are doing.

• You feel that there are conversations going on that you're not part of.

• If you are unsure about aspects of your labour.

• If you're frightened for your own or your baby's safety.

Ask to be informed about procedures and findings. Just knowing what is happening and what will happen next will be reassuring. Make sure that your birth companion understands that one of his most important roles is to keep you informed.

At one of your antenatal appointments, discuss a birth plan with your doctor, who will be able to tell you whether your wishes are realistic. Then show it to the nurses and midwives when you go into labour. Ask them to help you achieve the best possible labour for you. If they go off duty, make sure that you or your birth companion show the birth plan to the next team who cares for you. And seek their support, too.

Breathing

Breathing and over-breathing

When you are tense and frightened, your breathing becomes shallow and rapid. Your shoulders are pulled up towards your ears, and your neck and shoulder muscles feel tight and rigid. If you move into a state of panic, you start over-breathing, sucking the air into your lungs and breathing out in short, sharp gasps. You feel light-headed and out of control. Pins and needles start in your fingers and your mouth feels numb.

All these are common reactions to very stressful or frightening situations. They're normal, but the body can't continue in this state for long without becoming exhausted. In labour, your aim is to conserve your energy as much as possible. You also want to give your baby plenty of oxygen to help him cope with the stress of being born. Panic breathing cuts down on the amount of oxygen you take in for yourself and for your baby.

Breathing patterns for labour

Close your eyes for a moment now and focus on your breathing.

Notice how rhythmical it is. You breathe in, then there's a slight pause before you breathe out. Your out-breath matches you’re in-breath in length and depth. You pause slightly before your lungs draw the next breath in.

In labour, you want to keep your breathing rhythmical. Don't let the in-breath become longer than the out-breath. If anything, you’re out-breath should be longer than your in-breath. It's inevitable that when you are having very strong contractions, your breathing will become shallower. There's nothing wrong with this as long as your breathing doesn't start to get faster and faster and turn into panic-breathing.

Simple breathing techniques

• Think of the word "RELAX". It has two syllables, "RE" and "LAX". Now try this exercise. As you breathe in, think "RE" to yourself, and as you breathe out, think "LAX". Don't let your mind wander away from repeating the word "RELAX"' in tune with your breathing. When you breathe out, try to let go of any tensions in your body. Focus on the muscles which you know always becomes tense when you're stressed. Remember, every time you breathe out: "LAAAAAX". The out breath is the one to focus on: the in-breath takes care of itself!

• Or you can try counted breathing. As you breathe in, count slowly up to three or four (or whatever number seems comfortable for you) and as you breathe out, count to three or four again. You might find that it's more comfortable to breathe in to a count of three and out to a count of four.

• Try breathing in through your nose and out through your mouth. Keep your mouth very soft as you sigh the breath out. In through your nose, and out through your mouth. Many women also find it helpful to make a sound on the out-breath, such as "Oooooooh" or "Aaaaaah". In between contractions, have sips of water to prevent your mouth from becoming dry.

Support with breathing

It can be very hard to keep your breathing rhythmical and to relax every time you breathe out when you're having painful contractions, you're tired and labour seems to be endless. This is where the support of your birth companion is essential. He can help you keep your breathing steady by breathing with you. You need to be in eye-contact with him, and he should hold your hands or place his hands on your shoulders, leaning gently on them. Then you can follow his pattern of breathing as he breathes in through his nose and blows out softly into your face. Practise this during pregnancy. It feels strange to begin with and both of you may be rather self-conscious. However, co-breathing is wonderful when you're in labour and you think you just can't go on any more.

Breathing and pushing

During the second stage of labour, you will be pushing your baby out into the world. Many women want to hold their breath when they push. This is fine as long as you push down in between your legs, rather than into the back of your throat.

It may be better to take a deep breath when you feel your contraction starting, and then breathe or blow slowly out as you bear down. This will prevent you from damaging your throat, ensure that you maintain a healthy breathing pattern, and result in effective pushing. If you have had an epidural, and can't really feel where you are meant to be pushing, take a deep breath when your midwife or doctor tells you there is a contraction beginning, and as you blow out, let your mind travel down your body to your baby's head between your legs, and push.

Sometimes women are told to hold their breath and push for as long as possible. This is not a good idea. You will deprive yourself and your baby of oxygen, and you'll quickly exhaust yourself. Push as many times per contraction as feels right for you. Four or five pushes for every contraction is about right.

Breathing and not pushing

Sometimes women get the urge to push before their cervix is fully dilated. In this case, your doctor will ask you not to push to give your cervix more time to open. This can be extremely difficult! You can help by kneeling on all fours with your bottom in the air and your cheek resting on the ground. When a contraction arrives give four short pants, then a quick in-breath, followed by four more short pants and so on. You can also repeat the phrase "I must not push" in your head as you pant. Breathe normally between contractions.

No comments: