Relaxation Practice

 Relaxing is often though of as being passive, but in labor it is something you have to do actively. No one can relax for you. You have to do this for yourself. Your partner and your birth attendants can help greatly, but it is you who must focus your attention and intention and release your muscles. To begin practicing relaxation, you and your partner must read through this information together. Then you and your partner find a comfortable position with plenty of pillows for supporting your head and your knees. Uncross your feet and let your arms lie comfortably at yourside. Make sure the room is warm and the lighting is comfortable. Then, as you practice the exercises, have your partner read them to you.

CALMING THE MIND

Sometimes your mind is racing and your emotions have you tied in knots. This may be true when you can't sleep, and it may be true in early labor when the excitement and adrenaline rush of "This is it! I'm in labor! Can I do it? Is everything ready? What about the...?" can make early labor much more strenuous than it needs to be.

A good method for calming the mind is centering on your breath. If done for 20 minutes daily until your baby is born, it can help you meet labor (or any other stressful situation) with more calm and clarity.

CENTERING USING YOUR BREATHING   Sit in a relaxed position with the spine vertical. An upright chair is fine, or you can sit on some pillows with your legs crossed. Facing a blank wall or a plain rug, leave your eyes and your mouth relaxed. Rest you hands, palms upward, on your thighs. Focus your attention on your breathing. Don't try to change your breathing, but simply watch the natural flow of the breath in and out of the body. Don't try to shut other things out of your consciousness, just choose to have your focal point be the breath. When you notice your attention drifting, simply return it to the breath. There is no need to make any special effort to suspend thoughts, although with regular practice thoughts will gradually begin to fall away. This exercise is best practiced at a regular time and place. Doing some stretching exercises and then washing your hands and face with cold water before starting will also help keep the body and mind from complaining.

This state of complete relaxation is one which you should get to know intimately, and be able to return to at will. Practice when you can't sleep, when you're sitting in the dentist's office (you don't have to be lying down), on the train or the bus when commuting to work, or the next time you have too much to do and are feeling frazzled and tense. Complete release is the key to comfort in labor.

 

CLARITY: Focus your mind by placing your attention in your body. Watch your breathing. Every emotion has a characteristic holding or altering of the breath pattern. Allow the breath to be full and deep, so that your body, your emotions, and your mind all release. Remain centered in the breath and let your thoughts fall away.

RELEASING THE BODY: The breath is also the best tool for releasing the body of tensions.

RELEASE: Let your breath deepen, so you are breathing all the way down into your belly. Let your body feel heavy, as if it were sinking into foam rubber or into warm sand at the beach. Breathe with your diaphragm, as you do during sleep.

As your breathing becomes slower, use each breath to release more fully. On the outbreath, let go of any holding or tension that may be in your body. Feel the breath flowing all the way down your backbone so there is a connection between your tailbone and the top of your head. Let the breath surround your baby and go allthe way into your vagina and anus, making sure they are both released.

WHOLE BODY RELAXATION: Now use your attention to travel throughout your body, releasing on the outbreath any tension you may find. Start with your face and eyes, cheeks and jaws. Travel down through the neck and shoulders, then the chest and belly, paying special attention to the muscles of the lower belly and upper legs. If you find any places of chronic tension which don't release with the breath, imagine the area to be warm, and imagine your outbreath flowing through it. Note these chronic places to work on with your partner.

SHARING ENERGY

Make some time with your partner, maybe some quite evenings, that you can set aside a time to share energy together. This can be done by lying in bed naked together, begin by touching one another, hugging and kissing each other. Then try to feel the totality of each other's bodies, inside and out, and feel the energy flowing between you. Allow the energy to flow, and consciously release any blocks you feel. Feel the presence of the baby, and allow energy to flow among the three of you. Welcome the baby, telling her/him you are looking forward to having her/him joining you in the exciting world of sights, smells, and touch.

It is important that this energy sharing is NOT goal-directed, not to be trying to turn each other on or to reach any particular state, but simply to be sharing what is, in a loving and friendly way. Don't be afraid to verbalize your feelings.

PRACTICING CONTRACTIONS & RELAXATION

When you are actually in labor there will be time between contractions for you to relax fully, talking with each other if it is early labor, being massaged, or doing whatever helps you to relax and release tensions. During contractions, you will be doing the slow, deep breathing which can help you keep yourself centered. IT can be helpful to tell your body, "Okay, this is a really strong sensation that I am feeling, but I am staying relaxed, released and open." Direct your attention to any problem areas and tell them to release. The shoulders, the lower belly, and the legs are areas that may require special attention and help.

SECOND STAGE LABOR

Second stage is said to begin once your cervix is fully dilated and ends when your baby is born. Once your cervix is fully dilated, the nature of your contractions will change. They will feel different than they did in transition, and they will be further apart (perhaps every three minutes). As the baby's head descends and pushes against your rectum you will feel as if you need to have a bowel movement. Your breath will involuntarily catch during the peak of a contraction. You are starting to feel the urge to push.

Much of the teaching you see in childbirth classes and see in films or TV shows of couples giving birth, even in a homebirth setting, often show an intensely athletic second stage. You will she her clutching her legs (even without stirrups while imitating the stirrup position). This is totally unnecessary and ridiculous. You will notice her birth attendants acting as cheerleaders, and the physician is yelling at her to "Keep Pushing! Keep the baby down! Don't let it slide back an inch!" which sounds like he is getting ready to catch a football and run with it. This approach has the woman holding her breath and pushing for the duration of each contraction from the time she is fully dilated until the head crowns (which can range from a few contractions in a multipara to 2 to 3 hours in a first birth). This is very exhausting for the mother, straining and tearing can often result since tissues are not given a chance to stretch at their own rate, and blood vessels will occasionally rupture in the mother's whites of her eyes from the intensity of forced pushing.

Despite our cultural images to the contrary, there is no need for haste in the second stage. Even prolonged second stages, 3 hours or more, show no greater incidence of hemorrhage, infection, or distress in the baby. As long as your baby's heartbeat is good (it should be checked every 10 minutes in second stage), there is no need to either to bring the head down quickly or to get it out as rapidly as possible.

A much better way of handling second stage labor, and I have seen this work very well with my own birthing clients, is not to push but to continue to breathe slowly and deeply through these contractions, even when the urge to push is there. I try to keep them breathing as much as possible, allowing the uterus to do the work that is was made to do. If the urge becomes overwhelming, then I recommend a controlled release pushing, only as much as is needed to take care of the pushing urge and then back to breathing the baby out again. These clients are able to deliver themselves instinctively with little more straining than is required in a bowel movement. This kind of second stage breathing allows the cervix to fully dilate and slip over the baby's head without damage; allows the baby's head to mold more slowly, resulting in less trauma on the baby; allows the mother's tissues to stretch slowly, resulting in less tearing and "skid marks".

WHEN TO PUSH OR NOT TO PUSH

With the controlled breathing, the problem of when to push thus disappears. You push when the urge is irresistible and is taking you with it. Occasionally you will get a strong pushing urge when you are not fully dilated, and it is important to breathe through those contractions until dilation is complete. Don't resist the pushing urge in transition; allow it to be there, but continue to breathe through it just as you breathe through the tightening sensation of the contraction. It will feel as if your body is pushing, which is involuntary and is a sensation you shouldnot run away rom, but as long as you are breathing, you are not adding any extra force to these contractions before your cervix is completely opened (actively pushing against a partially dilated cervix can result in swelling, pain, and a longer labor).

By choosing not to push until you are fully dilated and have the powerful lead of your body, you rule out the possibility of a birth attendant misjudging dilation or friends (and you) wanting things to be further along than they are. Barring any abnormalities in position or your pelvis, your baby will be born even if you give up on pushing (your uterus can push the baby out if you are relaxed and releasing your pelvic floor). If your attendant is anxious for more progress, squat during contractions, which will help bring the baby down and often increases the intensity of the pushing urge.

Of course, this approach to second stage does not mean that you can sit back and take a vacation. Second stage contractions, although they feel different from transition contractions, are usually quite strong, and your uterus is working very hard to push the baby out. If this is a first birth, you may have contractions that push the baby against your rectum for an hour or two as the baby descends. You will need to keep breathing to stay on top of the contractions and stay relaxed and released. But you don't need to add active pushing effort, such as holding your breath and pushing with your diaphragm while bulging the pelvic floor, except when your body is involuntarily holding your breath for you. Once you are fully dilated, you can push when you feel the need or breathe with it, but let the uterus do the work without you adding extra effort except when your body is taking you with it.

There is an unconscious neuromuscular association between the vagina and the mouth, so that if your pelvic floor muscles are tense (and they are often hard to relax when the baby is pushing against them), you can help relax them by intentionally relaxing your mouth and jaw.

To demonstrate this connection, contract all the muscles of the pelvic floor, holding the vagina tightly closed. Feel your jaw, tongue and palate. You will feel that they have tension in them that can be released when you release the pelvic floor muscles. Similarly, clench your jaw, and tighten your lips and throat. Now feel your vagina and see if it is relaxed and open. Almost everyone will have unconsciously contracted both.

This is why during labor, and especially during pushing, it is important to have the lower jay dropped and the lips gently parted and loose. It is also why vomiting and laughter often increases dilation and the relaxation of the pelvic floor.

BREATHING THE BABY OUT

With a second baby the head may be visible at the vaginal opening before you ever push, so you don't need to push at all. Your body will deliver the baby. But with a first baby you may have second stage contractions for quite a while before the head is visible. This is normal, and it's important not to get discouraged. Also, the head will go back between contractions, but each time it will show a little more.

As the head descends, it feels something like a grapefruit pressing down against the rectum and rounding the arch of your pubic bone. It's an amazing sensation, one you don't feel very many times! You may think, "How am I ever ging to open up enough for the head to be born?" But with gradual stretching, the perineum does open to accommodate the head, which molds and makes itself as small as possible.

Once the baby's head can be seen, look over the curve of your belly, or have a large mirror so you can view the head as it comes further and further out. Reach down and touch it. Feel the amazing quality of the baby being both inside and outside at the same time. See and feel how strongly you need to push, and stop pushing when the perineum looks rigid and shiny or the head crowns (to minimize tearing).

As the baby's head crowns, you gradually feel yourself open up, and you may get a warm, tingling sensation (like stretching the corners of your mouth very wide). Many prepared women find the crowning intensely pleasurable and very exciting. With a second or smaller baby, it is often possible to be sensitive to each part of the baby as it emerges from the birth canal.

By the time the head crowns (when the largest part stays at the vaginal opening), you should make sure you have stopped pushing and breathe through the contractions, no matter how strong the urge to push is. The force of your uterus alone is enough to bring your baby out. Adding extra force at this point can result in tearing of your tissue and isn't particularly good for the baby, either.

 There is a tremendous feeling of release as the head slips out. Continue to breathe through the next contraction as the shoulders emerge, unless you are told by your midwife to give a gentle push. Again, if there has been no sign of fetal distress, it is not necessary to hurry this stage. Feel and savor it! Touch your baby, even bore (s)he is completely out, helping him/her to come up onto your belly once the shoulders are born.

FOCUSING DURING YOUR LAST 6 WEEKS OF PREGNANCY

Many things throughout your pregnancy contribute toward your preparation for the birth; regular exercise and good nutrition, practicing full-body relaxation when you have trouble sleeping, practicing breathing and relaxation when you're emotionally tense, massaging your partner. Making sure that you're in a good relationship with your partner affects how you feel and how you take care of yourself, as well as your experience of labor. Use visualizations as a tool in preparing for birth. Visualizations of normal labor and delivery can help your body and emotions to prepare in a way that bypasses the conscious brain. Done in a state of relaxation, they can increase your confidence in your body's knowledge and ability to give birth (just as it knows how to grow your baby). They can be valuable tools for counteracting specific concerns from previous birth experiences, for example. Many cassette tapes are available with guided visualizations, and several of the books listed on this page contain visualizations you may find helpful.