How many times have you heard this said (or said it yourself) to women during labour? We harbour this fond belief that women will know how to tune in to the rhythms and feelings within themselves during labour and birth and gently exhort them to “let yourself go” as the contractions build and the tempo increases. Do you think they know what we are talking about?
I feel sure that most women, faced with these suggestions, must feel puzzled or confused. All through their lives they have been actively encouraged to bottle up their feelings, not make a fuss, be seen and not heard and generally squash any wild and uninhibited thoughts from the time they were little girls. Suddenly “tuning in” and “letting go” in response to clearly tumultuous bodily reactions may seem to be a tall order and it may create unintended anxiety if women suddenly feel they can’t follow the instructions given by the midwife.
There are a number of ways that we can help women understand and trust the concept of surrendering during labour and much of this can be done during the prenatal program. Apart from making it a general theme that is woven throughout the discussions, it can also be addressed in some specific exercises and activities. Before you begin, take a look at the overall presentation and check that it also fits with this concept of going with the flow:
- Do you have a flexible program that enables you to address topics as they arise? Encouraging women to open up about their feelings is more successful if their concerns can be addressed immediately. It is not good practice to ask them to bottle up fears until a scheduled time in a later session. If we want women to be spontaneous during birth we must support and enable this to happen during the classes as well. If you work with large groups, offer opportunities for small group discussions around topics that around emotions and feelings as it is often easier for women and their partners to share with just a few others rather than a large group of people.
- Are you relaxed and comfortable talking about emotionally laden topics, such as sexuality (see my article in the last month’s Practising Midwife), fears for the baby, the unexpected nature of labour and birth, labour behaviours, postnatal grief reactions and dealing with less-than-helpful hospital staff? Your willingness to tackle these kinds of topics and your openness about them provides the kind of supportive atmosphere that parents need in which they can explore their own feelings and emotions.
- Are you available for one-to-one counselling if necessary? Parents desperately need a listening ear when they are worried and this is an important facet of your work. Making time either before or after class or even by phone signals your willingness to help them address important issues.
In the right kind of climate, almost any activity can be adapted to incorporate an element of “getting in touch” with innermost feelings. Ideally it can start with classes in early pregnancy, when women are facing massive adaptations going on in their bodies. Unfortunately, few caregivers actually ask or seem to care about women’s experiences of the bodily changes going on, preferring to focus instead on the scheduling of prenatal tests and interpretation of results. Many women must feel that the whole pregnancy is a series of tests and exams that must be passed to avoid dire results, rather than a time to explore the innate creativity of their own bodies.
- A small group activity where the pluses and minuses of being pregnant are compiled provides a useful opening to the concept of listening to your body. This is a good activity for separate groups of men and women as it highlights the important differences being experiences by each partner. During the feedback session, provide the physiological reason for the changes being noticed and emphasise the positive nature of them. This can help women notice and accept the many changes they are undergoing and helps to demedicalise pregnancy.
- Demonstrating, or acting out contractions can give parents a idea of the kind of behaviours that are commonly experienced during labour. This gives you a chance to let your hair down as well and indicates your willingness to “let go” in front of the group. This kind of role play works well when combined with exploring self help ideas and comfort aids for labour.
- Practising positions for labour and birth, especially if done as a problem solving exercise encourages parents to internal signals. Set up scenarios – “imagine that you have a constant back ache”, “when you feel the pushing urge, you get a strong sharp pain in your tail bone – find a position that might take some weight off that area”, “find a position that encourages the baby to turn into the best position for birth” etc.
- Talk about the trance like state induced by high levels of endorphins. Demonstrate (using roleplaying) how these signs can be recognised. Use videos to back up your message (the Dutch birth videos “Under her Own Steam” and “With Both Feet on the Ground” both offer good visuals of women full of endorphins.
- Spend time on the transitional phase of labour, as this is the most difficult time to deal with during birth. At this point it is virtually impossible for women to ignore what is happening to them, but it can feel very frightening, especially if they are unprepared. It is important for them to know that emotional outbursts are normal, vomiting, shaking and passing wind are expected and sudden demands (“get me the epidural!”) are not rational requests. Focus on the needs of the partner at this time and equip them with ideas on what they can do (see “Preparing for Birth: Fathers ” for lists of suggested remedies for various labour situations, including easing pain and managing transition).
- Equip the parents with strategies for getting around the hospital protocols so that they can labour without unnecessary restrictions. Requesting that their wishes be recorded in the notes is one way of avoiding intervention. Requests such as no vaginal examinations, no continuous electric fetal monitoring, no routine rupturing of membranes, labour and birth off the bed and extra support people are all examples that could be recorded. Another suggestion would be that that if necessary, the parents will take responsibility for the use of aids such as hot wet towels and hot packs, and encouraging them to take in various comfort aids (food, drinks, warm socks, own clothes, music, massage oil, lollies to suck etc). With these requests in place, women are more likely to feel at ease during birth and therefore more able to freely focus on what is happening within themselves.
During labour, it is also important to carry these messages through to the women in your care. Women pick up many overt and covert messages about what is “allowed” in the labour ward and quickly form and impression of how open the midwife is to supporting natural birth, with all its behavioural implications. Some of this information will be gleaned from the labour ward tour when details of the hospital policies may be explained. Many other ground rules are established during the admission processes in the labour ward. If we want women to “tune in to their bodies” we must not accidentally “tune out” to their needs at any time. After all, trust forms the basis of good births: women trusting their bodies and support people (including midwives) trusting women.