One of my favorite sayings is, “Practice makes prepared”.  We had a wonderful confirmation in class this week of why it is so important to practice and prepare for the labor you want.   

 Our relaxation session in our last class was for both the mother and the coach to make a list of positive things the mother could think about during labor.  They were then to use these ideas during our relaxation practice/labor rehearsal portion of class.  Coach had a great list going that included what he called his “secret weapon”.  It was going to be his “go to” story to tell his wife when the going got tough in labor.   

 The time for relaxation practice/labor rehearsal arrived.  We dimmed the lights, put on our relaxation music, our students got into their first “practice position” from our diagrams of labor positions.  Then we did our first “practice”.  I timed the contraction by announcing how many seconds had elapsed (I call out 15, 30, 45 and 60 seconds).  Coach started with one of the ideas his list.  Mom did not like it – the story made her laugh instead of relaxing her.   

 We did our second practice, trying out a different labor position and the same scenario with music and lighting.  I timed again and Coach went back to the verbal coaching we have been using up to this point in classes, “words of encouragement”.  Mom reported feeling much more relaxed and Coach made an “uh-oh” face.   

 I asked him what was going on since he had just coached his wife through a great minute of relaxation.  He replied that his “secret-weapon” is a story that is along the same lines as the story that made her laugh, and she prefers words of encouragement…what was he going to do?   

 We reminded our couple that this is exactly why we practice in class and we encourage them to practice at home.  We are teaching them several ways that are effective at managing the discomforts of labor so that they can fill their toolbox with several different ways of relaxing mom.  If you don’t practice before you get into the hard parts, it’s unlikely you will be able to improvise since there are so many ways to manage labor.   

 By the same token, we tell couples every labor is unique, so it’s important for a coach to have a “Top Five” list of moms’ favorites so they know what to try first.  On top of that, we remind them that the most important factor for coaching is to be flexible.  Sometimes coaches find that the things that work in class do not work in labor.  Sometimes the list of “Top Five” turns into the one thing that works.  And it has happened that none of the coping techniques the couple liked in class helped, and they pulled from some of the other relaxation techniques we had covered and that they had practiced at home “just in case”.   

 It is exactly for those reasons that home practice is vital.  Mom can review techniques on her own and create her list of favorites.  Coach can review techniques and practice scenarios in his head while he is on his own.  The most important component is to practice together for the direct feedback.  Practicing together builds the coach’s confidence that he knows what he is doing and he will do well as a labor coach.  It builds the mom’s confidence that she will be able to rely on her coach.  Our personal experience is that this sense of safety and security, which leads to the ability to complete surrender during the labor experience, is the key to allowing labor to progress to the intensity that helps us meet our baby earthside.   

 We reassured Coach to keep those stories in his toolbox because laughter is actually a great coping technique.  It’s not comfortable during a contraction because it adds tension to an already tight body part – not ideal when a mom is trying to work with her body.  However, laughter is great tool to reduce adrenaline.  This is a huge plus because adrenaline inhibits oxytocin.  Receptors in the body can only accept one or the other, not both.  The other plus to laughter is that it releases endorphins, which can act as analgesia and promote a sense of well-being – both good things for a mom in labor to welcome their child.  We encouraged Coach to bring those stories out between contractions – they definitely deserve a place of honor in their personal toolbox.   

 I don’t liken labor to a final exam because sometimes the most prepared couples end up with a birth that doesn’t go according to their wish list and I don’t want to convey to them a sense of failure.  It is true that labor will test the couple in ways that they probably have not been tested before, and the more they practice at home, the better prepared they are for their experience.  Although the weekly assignment is for twenty minutes per day, even one minute of practice is better than none to build a couple’s confidence.   

 Being prepared for this experience will definitely improve the likelihood of having the labor they have practiced for.  Whether they have a “textbook” birth or a birth with variations, our happiest couples are the ones that feel they used their information from class and worked together to choose the birth of their child as a team for a Healthy Mom, Healthy Baby outcome.   

More about laughter and endorphins: http://stress.about.com/od/stresshealth/a/laughter.htm http://en.wikipedia.org/wiki/Endorphin   

More on labor positions:

We have had a couple of students have had textbook “NAPS” in the last two classes…and since we still have several couples waiting for their babies, I thought this might be a reminder and an inspiration to them for their labors.  NAP – no, they didn’t take epic naps in labor (although I am a big advocate for sleeping in labor)…what it means is that they were very patient in their labors.   

One of the cornerstones of The Bradley Method® is a Healthy Mom, Healthy Baby outcome.  All of the discussion below only applies if Mom and Baby are not showing any signs of distress through labor.  Mom is maintaining a healthy temperature, heart rate and blood pressure, and Baby is also showing that it is doing well as per the monitoring that is being done.  If Mom or Baby are starting to demonstrate that their health is compromised, then parents are encouraged to make the best choices for their particular situation.   

The words “Failure To Progress” are the sound of doom to some of us (I say "us" because I heard this three times!).  They very often mean that interventions are going to start being suggested.  How a couple acts upon those suggestions is very individual.  Marjie Hathaway coined the phrase “Natural Alignment Plateau”, or “NAP” as an answer to the dreaded “diagnosis”: “FTP”, or “Failure To Progress”.    

Failure To Progress is based on the Friedman’s Curve*.  It looks like this: 

 As human beings, it is in our nature to see this neat, explainable graph and say, “It’s a rule!” This can have dire implications whilst in labor if you really want a natural birth.  There are no averages in the midst of a labor – each labor on is unique and individual.  

Mathematically, it’s unfair for all labors to be expected to fit the average.  That brings in another concept we teach in The Bradley Method® classes: consumerism and informed consent.  If there is time: ask questions, ask for time, and then communicate and evaluate what you have heard with your partner before you decide on a course of action.   

When a mom does not progress in dilation from one vaginal exam to the next, or between several vaginal exams, she may be diagnosed with “Failure To Progress”, and along come the string of possible interventions.  They can include any or all of the following, along with other interventions: an Amniotomy (intentional rupture of the bag of waters), augmentation of labor with Pitocin, an Epidural to take of the edge of Pitocin-induced contractions, a Cesarean.  

A cesarean may also be suggested if the care team suspects that the baby may not fit through mom's pelvis.  Diagnosed as "CPD", this is the subject for another post altogether.  For now, check the link I listed below* for more information.

Instead of accepting the words, “Failure To Progress”, Marjie decided to suggest a new phrase to her students: “Natural Alignment Plateau”.  NAP instead of FTP.  Natural Alignment Plateau is a different way of approaching that point in labor when dilation does not change.  What we teach in class and hope that our students will remember when they face this crossroads is, "Labor is much more than dilation."   

Labor can be slow to start, dilation can stop and/or contractions can slow down for many reasons.  Here are some to consider: 

If your labor has been slow to start after a spontaneous rupture of membranes, or if you are seemingly “stuck” at a measurement of dilation, it might be time to evaluate what could be going on and change tactics: 

If Mom and Baby are doing well, you can ask for time.  There is not a medical reason for an intervention if Mom and Baby are doing well in labor and your care team confirms that Mom and Baby are okay.  Here are two examples for you to consider and think about if you face a point in labor when there is no measurable progress.   

We had a mom from our Winter class go from 6 cm dilated (usually considered Active First Stage – not yet in Late First Stage) to holding her baby in 21 minutes.  Yes – you read that correctly.  She went from what most care professionals would consider mid-range in labor to holding her baby in 21 minutes…that meant she pushed within that time, too, folks.  Hers was an emotional component.  She was waiting for her mom to arrive.  Once her mom arrived at the hospital and stepped into the room where she and her husband were laboring, her baby and her body got busy.  They dilated a total of 4 cm from 6 cm to “complete” at 10 cm, then pushed, and they were holding their baby in 21 minutes.   

Our other story is from our Spring Class.  Mom had a slow start to labor.  She had started seeing some clear fluid on Sunday, noticed some more on Monday, and went to the hospital on Tuesday.  They tested her fluid and it was amniotic fluid.  Although they were in triage and barely 1 cm dilated, the couple was strongly encouraged to be admitted.  Now they are into the hospital and the expectations of “Friedman’s Curve.”  

This couple did a great job of asking, “Is Mom okay? Is Baby Okay?” After getting their “Yes” answers, then they followed up with, “That’s great!  Then let’s wait a couple more hours and see where we are.”  And sure enough, the next time the staff and their care provider checked in, they were a little further along in labor.  Once things got going, this mom went from being 4 cm dilated to 8 cm dilated in one hour!  Within two hours of that point, they were holding their baby.   

The great news about hitting the NAP is that once the Mom’s body and Baby “get organized”, labor seems to progress very quickly.  Again, remember what I said at the beginning – things go well when a Healthy Mom and a Healthy Baby are given the time they need.  If Mom or Baby start to indicate that “healthy” is losing out, then a family needs to make the best choice for their situation.   

What has been your experience – have you had a NAP in your labor?  What choices did you make?   

For a full explanation of Friedman’s Curve click here or enter this URL into your browser: http://allaboutbirth.net/pdfs/Failure-to-progress.pdf    

Disclaimer:  

We started seeing Dr. Ross when Bryan was breech in-utero.  His care has positively impacted my health and made our last pregnancy feel like my best one ever.  Not wanting to keep the goodness to ourselves, we invite him to come speak to our students as a free bonus class.   They hear about the many ways chiropractic care may benefit them during pregnancy, postpartum and their nursing relationship.  For more information on those topics, click here.

 

Here is the second topic in Dr. Ross’ presentation to our students: how to coach back labor.  He is also a Bradley© dad, and he knows first-hand the importance of being able to coach a mom with back labor and relieve the intense pain it can cause.  We ask him to share his tips and tricks with our student coaches.  I am so excited that we finally got some videos of him demonstrating his techniques so that people can refer to them in preparation for the birth-day.  Thank you to Erica White for volunteering to be his demo partner and for allowing me to share these on the world wide web!

 

The first video demonstrates how to find the mom’s sacrum and how to manipulate it in labor.  The idea is to open the top of the pelvis when mom and baby are trying to line up – this is great for the first stage of labor.  When baby is engaging and mom is starting to feel low-back pressure, the focus changes to opening the bottom of the pelvis to increase the size of the passageway and ease baby out.

 

This second video is a technique for every coach and doula to add to his or her “labor toolbox”. It is specifically designed to turn a posterior baby.  I have had students use this successfully and avoid a cesarean.  In their case, it correctly positioned their baby who was asynclitic, which is just a fancy way of saying the baby’s head was tilted to the side and misaligned with the birth canal.  Their baby’s position was also very painful to the mom, similar to the manner that can make back labor unbearable.

 

Dr. Ross has the moms scoot as close to the edge of the bed as they are comfortable, and he has the coaches support the moms so that they can completely relax in this position.  I included the written description of the technique below the video.

 

Alternate Positioning During Labor:

Have the patient lie on the side (whichever side feels the most comfortable to her).  Ask her to drop her top leg off of the side of the bed for as long as she’s comfortable.  This will many times take the tension out of the tissue and allow the baby to rotate into the proper position with the occiput oriented anterior instead of posterior.

     - Attribution Unkown (by me – if Dr. Ross has it I will edit)

 

Let me know if you try any of these techniques and how they work for you.  I trust and pray that their successful application will help you avoid  medical interventions. As always, I wish you the best labor possible and encourage you to make decisions that lead to a Healthy Mom, Healthy Baby outcome.

 

 

 

We are now enrolling for our Spring Series

March 5, 2012 to May 21, 2012

 

For more information or to register, please call us at 602-684-6567 or email us at [email protected]