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Laboring Naturally
Lifespan

By Karrie Osborn

Originally published in Massage Bodywork magazine, October/November 2003.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.


Even with today's medical advances in childbirth, one simple truth remains -- a woman must eventually do most of the work herself. Understanding how to best utilize a woman's inner strength and harnessing her body's wisdom can make the process that much easier and healthier for both mother and child.


Get Out of the Way
The use of complementary therapies is one of the best ways to harness that wisdom and strength, giving a woman in labor the tools to control her fear surrounding childbirth in an instinctive and natural way.

Many believe fear is the real predication of pain during childbirth -- not the process of labor. In fact, the ability to control that fear may have more to do with the pain associated with birthing than the birth itself. "Several studies have shown that it is not the level of pain which is most significant to women in labor, but the mastery of the situation," says Nicky Wesson, author of Labor Pain: A Natural Approach to Easing Delivery. "Labor is regarded with more satisfaction if a woman feels she remained in control -- whatever that may mean for her -- rather than if it was pain-free."1 And control is largely what a "natural" birth is about.

Even though many women and their doctors may think differently, control is an irony when it comes to cesarean sections. In 2002, the national cesarean rate reached 26.1 percent -- the highest ever for the United States, according to the Centers for Disease Control. Viewing this statistic with alarm, the Coalition for Improving Maternity Services (CIMS) says even the World Health Organization can't find justification for a cesarean rate greater than 10 percent to 15 percent.

The number of optional, scheduled C-sections has become so high, in fact, that it's nearly as easy as scheduling the delivery of new furniture. CIMS reports, however, that the overuse of a cesarean section "poses considerable danger to the health and well-being of mothers and babies. Compared with vaginal birth, maternal risks include increased risk of death, surgical injury, infection, hemorrhage, deep venous clots and pulmonary embolism."2

In addition, CIMS reports that reducing the cesarean rate to an "appropriate level" would save the U.S. healthcare system more than $2 billion annually.3

Of course there are times when a C-section is the safest and best route to go for mother and child, but why are women opting for surgery over the natural process of birth? Some might say it's a woman's way of exerting her personal control over fear of the unknown. Yet the irony comes in the fact that a C-section actually eliminates a woman's control over her baby's delivery. Her involvement with the birth is reduced to virtually nothing -- strapped to an operating table, hooked up to IVs and catheters and a host of other medical procedures that fly in the face of a natural birthing process. After a C-section, most women must wait at least an hour in the recovery room before replenishing their spent bodies with fluids or having the chance to see their baby.

But even though the cesarean rate is the highest ever, most women still acknowledge that a natural birth is preferable. Peggy O'Mara, editor and publisher of Mothering magazine and author of Having a Baby Naturally, says like many pockets of social change, she sees the two extremes balancing each other out. "Midwifery is at its highest rate, complementary medicine has really been legitimized and people are picking and choosing their options," she says. "I hope that people begin to see that natural is safer and evidence-based."

What women are also struggling with is an environment that doesn't foster trust in the natural process of birth. "We have to get out of the way of our bodies," O'Mara says. It's hard to surrender to the process if you don't trust it. And how can you trust it if the pregnancy itself is perceived as a medical event, or even a disease of sorts?

"Surrendering to the physical experience is something you learn in bodywork -- getting out of the way of the process," O'Mara says. "We say birth is so dangerous, but it can't be. It has to have some integrity and safety to it or it wouldn't make sense. This is a process our bodies are equipped for. If we can surrender to the normalcy of birth, we can come back to that trusting."

And research suggests that trusting the natural process works. Continuous support from a midwife or doula during labor reduces a mother's chance of a cesarean by 50 percent, reduces the likelihood of pain medication by 60 percent, reduces the length of labor by 25 percent and reduces all other medical interventions by as much as 40 percent.4

From massage to visualization to Asian therapies, alternatives to the traditional, strictly "medical" birth environment are empowering women and helping them establish trust in the process and get out of the way of what their bodies already know how to do.


Mom's Massage
Massage is one of the best and most natural interventions to offer a woman -- before, during and after labor.

Perineal massage is something a woman and her partner can utilize during the pregnancy in preparation for childbirth. Research shows that 10 minutes a day helps avoid tearing of the perineum during labor and helps eliminate episiotomies (the surgical cutting of the perineal tissue) altogether.5 Although a 2001 study by Georgina Stamp published in the British Medical Journal discounts any significant benefit of perineal massage, her study focused entirely on the massage being performed during labor, while other successful studies focused on the preventative massage being performed daily during a woman's third trimester.

The basic premise for perineal massage is that by making the tissue more pliable, it can stretch with the downward thrust of the emerging baby's head, thereby nearly eliminating episiotomies. Wesson recommends the expectant mother massage the perineum 15 minutes daily with a lubricant oil, and doing so after a bath when tissues are softer. Most women are not familiar with perineal massage, making massage therapists the perfect candidates to explain its benefits.

Prenatal massage is something every pregnant woman should enjoy and it has become a highly popular niche within the bodywork profession. Considered a vital element of maternity care for both mother and child, prenatal massage presents more challenges for the therapist (including a new level of contraindications and intake protocol), but offers incredible benefits to a client already structurally, muscularly and emotionally stressed. Some of those benefits include relief from nausea, decreased muscle aches and pains; increased circulation, physical and emotional relaxation; and help with edema. Maternity massage requires proper training as there are areas on the expectant mother's body which should be completely avoided, while other spots can only withstand a delicate touch to avoid miscarriage or premature labor. This client work has no room for error.

Massage during labor can help ease the excruciating pain of contractions and help pull a woman's focus away from the cyclical stress her body is undergoing. Midwives are sometimes trained in simple massage, and it's also beneficial to have a woman's partner be somewhat versed in the art of touch to help during the typically lengthy birthing process. Work on the face, neck, shoulders, hands and feet can be of great comfort during this time, and attention to the back can greatly ease the discomfort accompanied by back labor (when the pain of contractions becomes concentrated in a woman's back).

Taking it up a notch, birth assistants, or doulas, are another variant in the equation. Sandy Ventura Gordon, director and president of Bodyworkers Association for the Birthing Year (B.A.B.Y., Inc.), says her organization, among other things, takes already-trained massage therapists and gives them another avenue to pursue. A birth assistant/doula is someone who offers massage, emotional and physical support and also acts as a mediator between the birth parents and the medical caregivers.

"The amount of people requesting massage birth assistants to attend their births has grown astronomically," Gordon says. Communication, visualization, massage and other relaxation skills are what Gordon's graduates bring to a birth environment. "If a woman is completely relaxed, and you've removed her fears, then you've removed the resistance," she says. Gordon reminds us that the uterus is a muscle; if you can relax that muscle, it will be more fully oxygenated, it won't have to work as hard and there will be less perceived pain.

"I train doulas on how to educate women before they get there," Gordon says. If women can be taught these skills during their pregnancy, then their bodies will be trained and ready for the big day, too. Gordon's continuing education programs begin with prenatal massage certification, but she sees many of those students move into the massage birth assistant program once she begins educating them about the significance of pregnancy massage and how it is much more than just a physical event.

"Our whole goal is to change what's happened to pregnancy, labor and birth in the United States," Gordon says, "and you do that through knowledge." She says by educating parents, and teaching them how to use their own voice in this important process of birth, caregivers will eventually listen.

Finally, post-partum massage can help a woman reconnect with her body after the fact. With all the demands of motherhood, it's important the new mother takes time to heal herself and massage is one way to find that relief. As the new mother's body starts to revert to its pre-pregnancy status, or even undergoes additional changes brought on by surgical recoveries or breastfeeding needs, women often begin disassociating with their physical self. Massage can bring them back to their body, allowing them to begin appreciating it and the hard work it's just been through.

Massage during this time can also eliminate many of the aches and pains brought on by pregnancy and exacerbated by the traumas of childbirth. Rolfing and other forms of structural integration can greatly help "reorganize" the woman's body after birth.

Abdominal massage is a modality that has ancient roots, but new uses for the post-partum woman. Mayan women, Filipino mothers -- and even until the 20th century -- European mothers, used abdominal massage to rub the womb back into shape and even help it find its proper location within the pelvic structure. Today, abdominal massage is said to mend the wounds left by a cesarean section and bring health back to a woman's uterus.

Author and educator Rosita Arvigo says the uterus is a woman's "second brain" and the "spiritual center of her being." If the uterus is compromised by surgery, damaged uterine ligaments, long or difficult labor, or falls to the sacrum, a woman's entire health can be in jeopardy. Arvigo says by shifting the uterus back into place via massage, homeostasis is regained in the pelvis and surrounding organs, and the nutrients required to help tone tissue and balance hormones is returned to normal.


Other Bodywork Options
Massage isn't the only bodywork therapy utilized by women in the delivery room. Reflexology during labor also has its advocates. In addition to relieving nausea, increasing circulation and helping with edema, one of reflexology's main benefits for the expectant mother is to stimulate the pituitary gland, thereby releasing hormones to accelerate the labor process. Of course, you would only perform this work on a woman who is full-term and/or in active labor. Anecdotal accounts report reflexology can offer a significant reduction in pain, and move labor along as quickly as two to three hours.

Just as with maternity massage, extra care needs to be taken with the pregnant reflexology client. The main difference with this client is providing more gentle work so as not to overstress the unborn child. One technique a reflexology practitioner can utilize to speed labor, Wesson suggests, is to "stimulate the pituitary gland by putting gentle pressure on the middle of the whole of the client's thumb."

Shiatsu, acupressure and acupuncture all have their advocates when it comes to childbirth, as all are said to reduce pain, open the birth canal, create a greater energy flow within the mother and strengthen her contractions. With shiatsu, there have even been reports -- as there have been with cranial sacral work -- that prenatal sessions can turn breech babies.

Using shiatsu can help the baby descend into the birth canal, writes Connie Cox in Maternity Massage. "Massage on the lower back and buttocks can eliminate any muscle tension that may be blocking or delaying the descent of the baby's head." Cox says that instead of using direct finger pressure, practitioners can hold a point or stretch the area to release blocked energy.

Utilizing the same points and much of the same technique, both shiatsu and acupressure are potent aids during the final stages of labor. Practitioners can turn to several points to help manage pain and ease delivery. According to Cox, these include: Stomach 36, bladder 67, bladder 60 and 62, large intestine 4, spleen 6 and gall bladder 21. The gall bladder point is also good for stimulating milk production after the baby is born.

In China, acupuncture has been used in 98 percent of cesarean sections, rather than traditional epidural anesthesia. While not utilized for surgery much in the Western world, acupuncture is still finding its way into the delivery room. Many mothers are choosing acupuncture as a pain management tool, having practitioners insert smaller needles or "studs" into the relevant pain points for self-administering throughout labor. In addition to general anesthesia effects, other uses of acupuncture include stimulating a woman's contractions.


To Breathe, To See, To Say
The list of modalities being incorporated into the birthing process grows daily. Outside of bodywork, some of the more popular techniques include visualization, deep breathing, meditation, chanting, hypnotherapy and aromatherapy. While most of these methods can be self-administered by the expectant mother and her birth partner, it is helpful to have a doula/practitioner/therapist on-hand to guide the way.

Visualization is a popular and effective method for gaining control during labor. By focusing energy and attention away from the fear and pain, an expectant mother can garner greater control of the situation. Whether it be taking her mind to a favorite place, seeing her babies in a dream state, or simply focusing on a color or word, visualization is most effective when it is an individualized process.

Deep breathing is in the same family, but helps by letting a woman work through the pain. The premise requires deep breaths in through the nose and out through the mouth. It, of course, is the backbone for Lamaze, Bradley and other birthing aids.

Meditation and chanting are other avenues for refocusing the mother's attention away from the pain and into more beneficial channels. Hypnotherapy is experiencing a resurgence, and a relatively new technique called Hypnobirthing is making its way into delivery rooms with incredible anecdotal accounts being reported.

In an attempt to fight the fear of the process, many women are also turning to aromatherapy. Lavender and neroli are often recommended to calm fear, while adding rose to the combination can create a sense of inner peace. When exhaustion sets in, lavender, sage and peppermint housed in a carrier oil can be key, and when it's time to push, a woman can gather all her strength with peppermint and rosemary.6 Doulas are becoming more and more versed in this area, offering this modality of relief to expectant mothers on a frequent basis.


Here to Stay
Making inroads with the medical community will continue to prove challenging until research once and for all proves out the efficacy of complementary therapies during childbirth. Until then, however, massage therapists and others within this profession can forge relationships with the medical community and explain the importance of using labor massage, shiatsu and other alternatives during the birthing process.

Natural labor may be a less fashionable route to take today, and may even be a bit scarier than a delivery aided by medical intervention. Mothers must remember, however, that it's been only recently that birth has become a "medical procedure."

Relying on instinct and the help of those who have harnessed much of the body's wisdom is proving itself to be healthier for both mother and child. For thousands of years women have given birth without drugs and medical interventions. Why change a good thing?

Karrie Osborn is a contributing editor to Massage Bodywork magazine.

References
1 Wessons, Nicky. Labor Pain -- A natural approach to easing delivery. Vermont, 2000: Healing Arts Press. 39.

2 Press release issued by the Coalition for Improving Maternity Services, www.motherfriendly.org/news/Jul2003/high-cesarean.

3 Ibid.

4 O'Mara, Peggy. Having a Baby, Naturally. New York, 2003: Atria Trade. 70.

5 Labrecque, M., Eason, E., Marcouz, S., Lemieux, F., Pinault, J., Feldman, P. and Laperriere, L., "Randomized controlled trial of prevention of perineal trauma by perineal massage during pregnancy," American Journal of Obstetrics and Gynecology 180, 3 (March 1999).

6 www.childbirthsolutions.com/articles/birth/aromabirth/index.php.





Some options for controlling clients' labor pain from author Nicky Wesson:

- Movement -- Swaying back and forth, walking the halls or anything to keep the muscles warmed and working.

- Warm baths, showers or whirlpools -- Soothe the muscles and release tension.

- Mental distraction -- In the early stages of labor, walk around the park, go shopping, call friends or pamper the mother-to-be with a facial scrub.


Client Resources

- B.A.B.Y., Inc. -- 877/793-2229, www.babyinc.org,

- The Coalition for Improving Maternity Services -- www.motherfriendly.org

- Doulas of North America -- www.dona.org (check out their lengthy list of relevant links)

- www.childbirth.org

- www.parentsplace.com/pregnancy/articles

- Birthing From Within by Pam England and Rob Horowitz (Partera Press)

- Having a Baby Naturally by Peggy O'Mara (Atria Books)

- Labor Pain -- A natural approach to easing delivery by Nicky Wesson, (Healing Arts Press)

- Mothering the Mother by Klaus, Kennell and Klaus (Perseus Publishing)

- Women's Bodies, Women's Wisdom by Christiane Northrup, M.D. (Bantam)

- "Touch Therapy: Working with the tiniest of clients and their mothers brings both joy and sorrow," Carolyn Guenther Molloy, Massage Bodywork, December/January 2001, page 12.

- "Women Gathered at Birth: The massage birth assistant," Shirley Vanderbilt, Massage Bodywork, December/January 2001, page 24.

- "The Homestretch: Easing into delivery with perineal massage," Shirley Vanderbilt, Massage Bodywork, December/January 2001, page 110.



It's funny how things always seem to work out for the best. That was my experience when I gave birth to Marlee Ann and Dylan Jacob this past January.

New to the parenting gig, I wanted to make sure my husband and I were fully prepared for what might happen in the delivery room when the twins' arrival finally came.

For months I had been watching the Discovery health channel, studying delivery after delivery as captured by the television cameras. I wanted to see the good, the bad and the ugly (so to speak) so that nothing would shock me. As is common with twins, I knew there was a good chance a C-section would be in my future.Yet, I also knew I wanted to proceed with a natural, vaginal birth if at all possible. I had to be prepared for both scenarios.

In addition to what I had already read (including a text on the Bradley method) and learned, I signed up for Lamaze training as well. As fate would have it, and to add more stress to a pregnancy that included bedrest, the class was cancelled for lack of participation. My due date came ever closer, and I was concerned I wouldn't be prepared. I signed up for the next possible class, Jan. 11. But my babies chose not to wait and arrived five weeks early, and a day before my birthing class -- Jan. 10.

With my husband hurrying us to the hospital that morning after my water broke, I thought, "Oh no. What do we do now?" How was I going to get through this labor without that important knowledge and training almost all women go through in birthing classes?

The answer was something I had learned and embraced during my time within the massage and bodywork profession -- do what comes naturally.

I fortunately didn't need any formal lessons on how to breathe or how to manage my stress. The body truly knows exactly how to do it; it's innate within all of us. The only training necessary was in how to find my own natural rhythm during labor. In addition to deep breathing, part of that rhythm and relief was found in massage and visualization, each powerful allies in delivering my babies.

Settling into a birthing room and already well into labor upon arrival, I was able to utilize one of the hospital-provided doulas. Her contributions were paramount. She not only helped me find my natural breathing rhythm to work through the contractions, but she brought lavender oil and soothing CDs to help calm my mind and spirit. Her greatest contribution, however, was in the gentle massage she offered during contractions and the cheerleading she did when my labor pains became excruciating as they moved into my back.

On top of all that, she also was a comforting presence in the birthing room, even though I had the utmost support from my husband. It's often said a doula brings a calmness to the experience that can't be replicated by a husband, birthing partner or family member -- it's quite simply what her role is.

Halfway through my 191#8260;2 hours of labor, I opted for an epidural. I made the decision not because of pain (which was being managed beautifully with massage, visualization and breathing techniques), but in an attempt to ensure I would be conscious during the second baby's delivery. We knew my daughter could be delivered vaginally, but my son was breech and if the doctors could not turn him after the first birth, he would have to come out through a C-section. I wanted to make sure I was witness to both births, hence my decision for the epidural. Without it, I would be put under general anesthesia for the second delivery and not only wouldn't see the birth, but wouldn't wake for hours. As it turns out, my son had the umbilical cord wrapped twice around his neck and no amount of maneuvering by the doctor would allow him to turn. After 30 minutes, we went quickly into surgical mode and my son was born with me fully conscious.

When it came down to it, instinct, coupled with everything I had learned about the body during my previous tenure as editor of Massage Bodywork magazine, made the birthing process a wonderful, fear-free experience, despite everything that could have gone wrong.

Sometimes, things just turn out the way they were meant to.

-- Karrie Osborn






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