Rock, Roll, Rinse, Lift
Supporting a woman in labor is not rocket science. In fact, at least while you are laboring at home, and even in a hospital setting, it often isn't science at all.
I've been serving as a birth doula for 15 years, and in that time I've tried every new massage gadget that has come along and every birthing method from Bradley to Hypnobirthing to tantric birth. But when it comes to supporting women well, I keep turning back to the simplest of tools. These include patience, a nurturing and loving demeanor and many items most people already have tucked away at home: a Crockpot, rocks, a long woven scarf (rebozo) or flat sheet folded in quarters length-wise, a pillowcase with rice, a lemon or two, peppermint essence, olive oil, a large tub and a variety of kitchen gadgets.
For me, supporting a woman's labor comes down to three basic approaches:
- First aid (heat, cold, counter-pressure, water)
- Forcing her brain to multi-task by having her experience up to five different stimuli at once (for example, music, firm touch, hair brushing, heat and a visual focal point)
- Penny Simkin's "Three Rs" (rhythm, ritual and relaxation)
To learn more about these approaches, I highly recommend Simkin's classic labor support guide, The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas and All Other Labor Companions (Harvard Common Press, $19.95). The following five techniques all fall into one of those three approaches – and all are simple enough for any support person to use them. You do not need to be a doula to help a woman cope with her labor.
The Rebozo for Belly Lifting and Double Hip Squeeze
Purchase a long scarf (the best are woven rebozo scarves used by women all over South America to carry their babies). If the mother is experiencing discomfort in the lower front of her belly during a contraction, slide the scarf under her belly with the ends in your hands as you stand behind her. Lift mom's belly up and in, pulling her into you – her backside should be against your front. Then rock with mom from side to side and encourage her to keep her legs at least shoulder width apart as she rocks. This technique provides counter-pressure against the contracting muscle. The wide-legged rocking motion opens the pelvis and allows baby space to navigate down. When the contraction ends, loosen the scarf. Be sure to ask mom if the pressure feels too heavy or too soft and adjust accordingly.
If mom is experiencing discomfort in her back and hips or is experiencing "back labor" (which often means the baby's occiput or the hard back part of the head is against mom's spine), slide the scarf down and around her hips, spreading it fairly wide so that is covers her hips from above the pelvic crest to below the perineum. When the contraction begins, twist the ends of the scarf together making it tighter and tighter around her hips. Ask the mother to let you know when she feels relief.
Belly lifts can also be done while mom is on her hands and knees. Slip the rebozo around her belly, stand above her with your legs on either side and lift upward until she tells you the pressure feels right.
Crock-Pot of Rocks
Fill a Crock-Pot with palm-sized round flat rocks, which you purchase from any garden store. Then fill the pot with water to cover and heat the rocks. Spoon rocks out of water (careful of the heat). Press the heated rocks into the area of the sacrum on the lower back at the base of the spine. Place one rock on each side of the spine, and rotate pressure in a circular fashion. This loosens the gluteus muscles while heat helps mom relax her back. Hot rocks may also be used to distract mom away from the intensity she is feeling in her belly or back. Place one on her shoulder and ask her to move her attention there. Then move it to another location and ask again. Each time you move the rock you take some of her attention from the contraction at hand.
Warning: Test the heat of the rock before putting it on mom. If it's too warm, wrap it in a washcloth or other material.
A Deep Tub
Water is one of my primary tools as a doula. I bring an Aquaborn birthing tub to most labors, a 170-gallon deep tub that allows both mom to be fully submerged and a partner to be in the tub as well to provide ongoing counter-pressure support. Getting in a deep-water tub too early in labor can slow things down, but getting in during active labor often speeds things up, providing mom with deep and instant relaxation as well as internal and external counter-pressure.
If you rent a tub, the tub company will bring all the fixtures (hose, faucet adaptor, plastic sheeting for the floor). But if you purchase a tub (great for hot summer days with your baby) be sure to purchase a lead-free hose and the right adaptor for your home faucet. If you are taking a tub to the hospital, ask your local hardware store to recommend the top five most used adaptors to make sure your adaptor will work on a hospital sink. In Seattle, only Group Health Cooperative and University of Washington Medical Center allow parents to bring a birthing tub or have rental tubs brought into the hospital. But be warned, it is against hospital policy at both hospitals to allow mom to give birth in a tub.
Hint: Early in her labor mom may relax and let go of anxiety in a shower. But deep water should be reserved for when her labor truly picks up – when her contractions are regular, at least four minutes apart, and preferably when she is dilated to five centimeters or more.
Peppermint Oil and Runner's GU Energy Gel or Shot Bloks
The vast majority of women will feel nauseous at some point in their labor. Have some peppermint oil and cotton balls on hand for this event. Dab the oil on a ball and tape it to mom's shirt near her nose. Peppermint oil helps to reduce feelings of nausea. Be sure to have basins or wastebaskets readily available wherever she is – vomiting generally comes on very quickly in labor. Be sure to celebrate her nausea! It's a sign that her body is working very hard to bring her baby down.
Going through a labor is a bit like running a marathon (and many runners get nauseous at some point.) It takes energy. If mom is looking weak, tired or has been unable to keep much food down, offer her a shot of high-energy, glucose heavy GU or Clif Shot bloks to give her a boost of energy. Have her try a few flavors before labor so she has an idea of what to expect. In the same vein, push water and Recharge electrolyte drinks on her – she should be drinking so much that she needs to urinate every hour. Remind her that dehydration will make the intensity of labor greater.
Take a king-size pillowcase and fill it with rice. Tie a knot at the open end far enough up that it allows the rice to be loose. Make a big one (big enough that about an inch of rice covers mom's entire belly) and a small one just right for placing on the small of her back. Heat the rice bags for four minutes on high in a microwave or in the oven at about 150 degrees. Test the heat on mom before putting the bag on her belly or back. If it is too warm, wrap it in a towel or other cloth.
When the contraction begins, have her hold the rice bag to her lower belly and lift her belly up. Or you can do that so her body remains loose and relaxed. If she is feeling intensity in both her belly and back, place the second rice bag on her back. Keep four bags rotating on a cookie sheet in the oven or rotating through the microwave. It will be hard for mom to part with this source of warmth and comfort between contractions, but have her take the rice bag away from her belly between contractions so that she does not acclimate to the warmth, making it less effective. When mom needs to rest, have her lie on her side in bed with pillows between her knees and a rice bag both on her lower belly and back.
Hint: heat up a variety of rice types to find out which rice smells best to mom. Add cinnamon or another gentle spice to the rice to compliment the nutty smell.
Try a TENS
A TENS unit is a device often used in physical therapy settings to help people cope with chronic pain. It can be a wonderful tool in labor, especially for those moms who are experiencing intense back pain early in labor or what her provider's believce is "back labor." Back labor is generally caused by a baby whose head is in a backward position -- the occiput is facing the mother's spine. Movement, shifting baby with a rebozo, positioning are ways to get a baby to rotate into a more positive position -- that is, with his or her face toward mom's spine. The TENS unit may help mom cope during this more intense form of labor. It's easy to use. Four electrodes are placed on mom's back in an X over the spot where she feels discomfort most intensely. When teh contraction comes on, she turns on the device and short bursts of a low level electrical pulse send a new signal to the brain, hopefully lessing mom's attention toward the back pain or, in some cases, overriding that discomfort. The electrical pulse is subcutaneous -- it goes just below the skin, not through the muscle or to the baby. The rule of thumb with TENS is if you are feeling the whole contraction in your back early in labor, you likely have an OP baby and a TENS is worth the try. Check out this video on use of TENS: