Showing posts with label Inspiration. Show all posts
Showing posts with label Inspiration. Show all posts

Sunday, April 1, 2012

Rapport & Continuity of Care

I just stumbled upon a very important reason for having a well-known, and yet skilled, attendant or companion present during your labor and birth.

I love to pet cats. I love to pet animals in general. I remember lying down next to our family dog (a "schoodle," schnauzer/poodle mix) as a child and just stroking her and trying to find the way she liked to be petted. Unfortunately, she was my mom's dog, and she didn't really like anyone else to pet her. I tried so hard to pet her in a way that she liked, so she didn't just get up and walk away (which she frequently did)! However, this was likely a foreshadowing of my desire to be a massage therapist--work that continuously challenges my ability to soothe others through touch, to find the way that feels best to that client. My senses were attuned during those early interactions with our dog.

Just now, I sat next to one of our cats, petting him in the same way I used to pet our family dog. Fortunately, our current cats love to be stroked and petted (with a few exceptions--they are cats, after all!). This particular cat loves to be rubbed. His eyes light up when I enter the room, he starts to blink, and he very subtly moves along with my strokes, often moving in such small ways that I can tell where he wants me to focus. I know he likes his lower back to be rubbed and he also frequently directs me to focus on his chin and cheeks. All without saying a word.

His purrs, body movements, and snorty-breathing tell me that he loves it. (It means he is in what we call, in HypnoBirthing, the healing room--endorphins are flowing and he feels safe and comforted.) And I respond appropriately, by following his lead.

What if your labor and birth was accompanied by someone who knew just what to do when you gave even the subtlest hint--a movement, a blink of the eye, a light murmur of approval?

This is why it is so crucial to get to know your birth attendants and companions. It is why I like to schedule massages with my doula clients, so that I know their cues, their peaks and valleys, how they respond to certain types of touch. For both of us, it foreshadows the interaction we will have during labor--the mother associates my touch with feeling good, and I know where I should be.

For the record, I am the type of person who is enormously sensitive, and I would want a sensitive person around me during such a vulnerable time, as well. Too often, birth companions and attendants take a "coach-like," bossy, or directing/managing role of a woman's labor, and they don't really listen to her subtle cues. This is often because of burnout--to many births and too much work to really have the energy to care deeply. It could also be a lack of sensitivity or empathy, and a lack of training in the subtle cues of their client/patient.

Think about that as you plan your birth. A medical provider often does not have or need these sensitive skills, as their job scope does not require it. A doula, friend, partner, or (sometimes) a nurse is more likely to fill that role.

Birth Choices

In celebration of a recent HypnoBirthing mother, in one of my recent classes, who switched providers at 38 weeks, I have some inspiration for you. Yes, you read that right--she switched at 38 weeks, and gave birth between 39 and 40 weeks. What's more, her baby was breech at 37 weeks and she was told by her previous provider that she should schedule a c-section. Well, that wasn't good enough for this mama. She worked on turning her baby with many methods, switched to a more appropriate provider and hospital, had an External Cephalic Version (ECV or "version", for short), and gave birth naturally to a perfectly healthy little girl after about 12 hours of labor. That mom feels like a million bucks right now!

So, I ask you: What is keeping you from the most incredible birth experience you can imagine? Are you settling for a provider who is cool or luke-warm about your birthing plans? Do they fail to discuss the particulars of your birth preferences, or doubt whether you can actually give birth naturally?

There ARE providers out there who are ECSTATIC about natural birth, who witness it daily, and who are passionate about letting your body follow its own natural course. But you won't know this until you interview them. And when you meet them, you'll know!

Lamaze International just released this video clip about making good choices in preparation for childbirth:

Good Example of Suggestibility

In my HypnoBirthing classes, I love to talk about how suggestibility can affect the labor and birthing process. Plainly stated, suggestibility is the openness to language and predictions that is prevalent when someone is hypnotized--hypnosis is a state of being suggestible and vulnerable to others' predictions about our experiences. Since hypnosis utilizes the altered state of consciousness that is experienced by all of us throughout the day, (we are most familiar with this concept when a commercial makes us feel hungry for a certain food or when the first song we hear in the morning sticks in our heads all day long), it is a normal and natural response.

During labor, suggestibility goes hand-in-hand with the natural trance state of the laboring women. It doesn't matter if you took HypnoBirthing. You will naturally go within and become more focused on your body...and more suggestible to what others predict about your labor. In class, we talk about how laboring women often feel exactly what they are told to feel or have the labor length they are told they will have. THAT is suggestibility. And it is important to be aware of what is being said around you, during your labor, because it can have serious consequences.

As I was sitting on the couch watching TV the other night I came across this episode of Family Guy. Watch from 8:14-8:55 in particular. Summary of the clip: Brian, the dog, arrives at a woman's house and she throws a white powder on his face. He is shocked, but not bothered by this. She promptly predicts that "it's gonna burn like hell in 30 seconds," and continues to banter with him. He notices nothing else until she soon reminds him, "By the way, it's been 30 seconds..." and he suddenly responds by screaming, grabbing at his eyes in pain, and running around the room in a panic.

Interesting! Sounds like a lot of labors where mom was doing just fine, until she was told that she would feel one thing or another, or that labor would progress in a certain way--usually a negative, rather than positive, suggestion. Lo and behold, it happens. And we wonder why!

Well, some of us wonder why. Some of us are not surprised at all.

Kismet!

I had the most interesting random meeting today.

As a massage therapist, I occasionally perform fill-in work at a spa in the city of Chicago. Yesterday was one of those days. My last client proved to be a talkative one, making small talk about relaxation music, which lead to me talking about music used for hypnosis and a conversation about my involvement with hypnotherapy. This occasionally comes up in my client sessions, as clients are curious about how I got into massage therapy, how long I've worked at that location, and what I do with my life outside of massage. This time was different.

As I talked about my work with hypnotherapy, I said my main focus was working with women who were preparing to give birth. This often intrigues my clients (but not always!), and this client was intrigued, asking how it worked, etc. I said the major premise is that childbirth shouldn't be painful, as every other normal body function happens without pain, and the source of that pain is fear and tension in the mother's body. He was very, very interested and said it made sense.

The next thing I remember is my client telling me he was an anesthesiologist. I thought (and said), wow, that's interesting. I asked if he worked in Labor & Delivery. Yes, he said. The room started spinning! Automatically, I thought, this guy must be an advocate for drugs during labor, and I probably have a lot of explaining to do!! Why did I say all of that simple language about birth without even thinking about who my audience was?? I was most definitely talking down to him! The thoughts were racing.

But he was surprisingly easy to talk to and accepting of everything I said. (I also felt kinda bad that we were talking through his massage, but neither of us could resist!)

Then, the most interesting part was revealed: He works for one of Chicago's most interventive, epidural-laden, non-natural-birth-friendly, "baby factory" (I won't reveal the name to preserve privacy on this public forum, but ask me personally and I'll tell you)! Without blinking an eye, he tells me how that hospital just works on getting women in-and-out, actually using the phrase "baby factory," and he doesn't quite agree with the rushing of all of the births. After all, he said, what would happen if we just see how things progress on their own? He says (and I know this well) that so many women are given oxytocin (a.k.a., "Pitocin" or "Pit"), even without any idea of what unknown effects it has, and it is clear that he is frustrated by the machine of this hospital.

Then, he says something very interesting. He mentioned that electronic fetal monitoring (EFM) has never been shown to improve outcomes--a clear, indisputable fact from scientific literature. I was shocked that he knew this--more specifically, I was shocked that medical doctors knew this fact so well, even though it is standard procedure. Clearly, the frustration is felt by those working on the "front lines" and not just us doulas and childbirth educators!! He made it clear that malpractice was the driving force for the use of EFM. I knew this, but clearly the validation was priceless.

We then talked about the specifics of epidural use. In particular, the fact that this hospital does not use "walking epidurals" (which would, essentially, give the mother more mobility and ability to work with her body--a very good thing) because of liability issues. This means that the hospital could be liable if the mother was a little unsure of her footing and slipped while walking, moving, sitting on a birth ball, etc. So, even though a lower dose of anesthetic would be helpful in so many ways, it is looked over in the name of liability by this hospital (and, I'm sure, many others).

He also described why IV narcotics are used. I won't go into that here, but he clearly stated that this type of anesthetic needs to be removed 2 hours before the birth because it can cause serious, life-threatening breathing problems in the baby--causing a need for resuscitation and intubation (and, of course, the requisite stay in the NICU, away from mom & dad).

He said his instructor was trained in the use of acupuncture and he is personally interested in alternative approaches to pain relief in the hospital--including hypnosis--in order to prevent the obvious side effects of medical anesthesia. He asked about other, less interventive hospitals and what they offered that helped mothers. I mentioned the use of water. And, not just water, but permanent tubs, like at West Suburban, since the moveable tubs seem to annoy the nurses who have to take the time to fill them (and so they often don't). He asked why water was helpful. He was truly interested and intrigued in the alternatives.

In the end, I learned a valuable lesson (one that was validated by one of the comments on my Facebook status): Even medical professionals are frustrated by the state of maternity care!! Interestingly enough, though, it takes more than just one frustrated person, even if a medical doctor, to change the state of hospital policy and procedure. In some ways, this is frustrating. In other ways, it is encouraging--because it means that those of us who are frustrated are not just daydreaming or full of fantasy about care.

Speaking of fantasy, I'm hoping to arrange an in-service where I can go and talk to the residents about the use of hypnosis during birth. In particular, I would love to emphasize the benefits of relaxation (and the Fear-Tension-Pain cycle) and the reality of hieghtened suggestibility during labor.

Saturday, March 31, 2012

Deeply Ingrained - Even for an MD

The following is a series of emails that was shared with us by Lorne Campbell, MD--you'll recognize him as the Family Physician who wrote the Foreward to our book, HypnoBirthing: The Mongan Method. He is the doctor with the "Take this hand, put it in your pocket, take this hand, put it in your other pocket, now step back and watch," method of teaching new doctors to attend births. Notice how even this well-trained doctor/mom has a hard time releasing her previous conditioning about birth.

Also notice how Mom's disbelief about the reality of labor and how thoughts about how "breathing down didn't work" are very similar to what I hear from many of YOU! It's very deeply ingrained in our culture. Very deep.

Note: Names, Dates and locations have been intentionally eliminated to allow anonymity.


This is a series of emails that IHave exchanged with X, a Family Physician in [city]. I trained her to attend at births and X taught to HypnoBirth. She had a successful HypnoBirth on Sunday.Pay attention to her language to see how dificult it is to release old beliefs that are deeply held. Remember this when working with medical people.
Lorne

[From the Mom:]

X was born Sunday August X at [time] to X and X! Labor was induced by pitocin for X's high blood pressure but there were no problems or complications. We planned for a water birth and decided to get in the tub around 8 cm, 6 pm Saturday night, but X became so relaxed in the tub with the pitocin off that labor stopped completely so we had to get out of the tub and birth on "dry land." We used hypnosis for relief of pain which was very effective, and I really only experienced a low back ache. The final half hour or so of pushing was unbelievable hard work, but the reward was great with a healthy 9 pound 7.4 ounce 20 inch baby boy! (Wow thats alot of baby).
Pictures attached.
Love,X, X & X

Campbell, Lorne wrote: Congratulations[Baby] is beautifulI posted his picture here and everybody says her looks like you. I think he looks like a baby. Now you know why I said that birth does not hurt. There was no pain relief. You just did not cause abnormal labor.
Lorne

[From the Mom]:

Youre right. It never even occured to me to ask for pain medication, and until the final pushing stage which was relatively short, I do not even recall feeling anything like a "contraction" even though they apperared on the monitor.I kept asking if the pitocin was expired. I didnt even need any cues for handling "surges" because I never felt any until the very end.

I requested induction friday because my two best friends were in town through Sunday and I really wanted them present to support me and X while I was in labor. I am so glad I did because it made a huge difference in my ability to relax and enjoy the process. They brought music and we spent most of labor dancing to the soundtrack of Hairspray which was hilarious, and when I needed help getting to the bathoom or backrubs, they were able to help so X could get some periods of sleep, allowing him to enjoy it so much more. X was amazing, she stayed at the hospital with us from Friday night when we arrived all the way to delivery Sunday midnight and my postpartum check Sunday morning. The only thiing I would have done differently would have been to let her break my water Saturday midnight when she offered instead of waiting till Saturday 11 am, since I probably would have finished about 12 hours sooner. I did not go into active labor until she did that Saturday.

The principles of de-programming all the incorrect things I had learned in training about pain, and doing fear release was really all I needed, not the actual hypnosis. I hadnt fully released the fear of tearing, and as a result I struggled to push effectively near the end. I think "breathing down" is good but probably did not work for me because I was not fully relaxed by that point. In the last few minutes I could read the body language of my nurse and midwife. I could see without looking at the strip that there were deep decelerations on the monitor as I tried to help the baby past the symphysis pubis and she was doing scalp stim. At this point I got determined, let go of my fear of tearing, and brought out some much more effective pushes.

Had I not had the fear of tearing in my mind beginning the pushing stage it probably would have required alot less pushing altogether as my perineum would have stayed more relaxed. The most helpful thing [the doctor] said to me then was that it was not how strongly I pushed, but how long I pushed that mattered. With this I was less afraid of tearing and able to hold the push twice as long with great results. I had a very minor 2nd degree tear which took no time to sew, I didnt notice the lidocaine or sewing and was able to bond and nurse while it was done. I have had no continence issues, no discomfort with bowel movements, and have only taken motrin 2-3 times for perineal soreness. I did feel like I had the crap beat of of me the next two days. I think this was intercostal/oblique muscle soreness from my initial ineffective pushing. By day 4 I started feeling like myself again and am feeling better everyday. We are really enjoying our "babymoon". We spent almost on hour last night laughing in bed hysterically at all the faces he makes in his sleep. Leaving the phones off was the best advice also.

Thank you so much for introducing us to hypnobirthing in residency. I am already looking forward to my next birth. After delivering my almost 10 pounder, next time I want a 7 pound girl in the birthing tub ;)

Please send us your new email in the fall when you get to [city] so we can keep in touch. Hopefully we will make our way up north again in the next 2-3 years.
X

Campbell, Lorne wrote:

Next birth do a fear release around the issue of pushing. There is no need to push. It actually slows the birth down. Pushing involves the pelvic floor muscles tightening. This impedes the movement of the head along the birth path. Next time breathe the baby down. Give up all of the residual bad things you learned about birthing. You are too smart to believe the crap you were taught. I would like to forward this email to other HypnoBirth practitioners so they may learn.
Lorne

[From the Mom]:

ok. You are welcome to forward the email. I will probably type it into a 1 page story to give to X to keep for her collection of stories also. I will forward you that sometime.Thanks again.
X

Campbell, Lorne wrote :

Do Not answer my email. Get off the computer and enjoy being a mom. Happy Babymoon. Thank you
Lorne

Quote from Midwifery Today

We must relearn to trust the feminine, to trust women and their bodies as authoritative regarding the children they carry and the way they must birth them. When women and their families make their own decisions during pregnancy, when they realize their own wisdom regarding birth and its place in their lives, they have a foundation of confidence and sensitivity that will not desert them as parents.

There is an inverse relationship between the amount of technology used in a woman's birth and her subsequent self-esteem: The greater the number of interventions, the less well she regards herself postpartum. On the other hand, women happy with themselves in birth eagerly go on to embrace the responsibilities of mothering. The triumph of birthing on their own terms leads to new depths of self-love and self-respect, emotions readily translated to their babies.

— Elizabeth DavisExcerpted from "Autonomy at Work: Woman-Centered Birth and Midwifery," Midwifery Today, Issue 42

Forwarded to me by:
Jennifer West, LM,CPM,HBCE,TBMP,CST,CH, www.tubsntea.com, Albuquerque, NM

"In Support of Baby's Choice"

Thanks to Marie Mongan, who found this excerpt taken from “Emergency Childbirth”, a manual written for Chicago’s fire and police departments, by Dr. Gregory White:

Note: Italicized text indicates a note or emphasis by Marie Mongan.

Perhaps the most important thing for the lay assistant to know is that labor and the delivery of a child are normal functions, which Nature always tends to complete successfully. Statistics show a loss of less than one mother in three-thousand, less than one baby in a hundred—and these statistics are for all deliveries, including those in large hospitals, and, therefore, include mothers who have been ill for years and premature babies too tiny to live. An attendant without medical training, called upon suddenly to assist at a birth, should have results at least as good, if not better, as those of the hospitals because he/she is usually dealing with the least complicated cases. Mothers who have been ill for some time are ordinarily hospitalized.

The women who deliver in taxicabs, ambulances, and police squad cars (or, unexpectedly at home) are usually those with short labors, and these are nearly always easy, normal deliveries. Since the babies in these circumstances are not suffering from the effect of anesthetics or pain-relieving drugs given to the mother, they rarely require resuscitation.

Generally speaking, mechanical assistance is rarely needed, but psychological or emotional support to the mother is almost always in order. This is usually given by means of a calm and confident manner and the frequent assurance that all is going well. Such moral support is given to the mother, not just because she is a fellow human being undergoing a trying experience—worthy as that reason is—but because calmness on her part and confidence in Nature, in herself, and in her attendant make it possible for her to do her part of the job better. Giving birth, at its best , is something a mother does, not merely something which happens to her (or is done to her).

Reassurance and moral support are actually the major contribution of the attendant in most cases. This point should be stressed. (Complications) must be considered here (in the manual) because they sometimes occur in emergency childbirths. But they are rare—very rare. In over 95 percent of the cases of emergency childbirth, the emergency attendant will be overwhelmed with gratitude and widely praised as a hero or heroine, he or she can smile within themselves at the knowledge that their simple tasks could have been performed by any bright eight year old.

On Birthing Phase of Labor
The Second stage is Easier: When the mouth of the womb is completely open, the baby begins to slide into the birth canal. The mother begins to feel heavy pressure on the rectum, as though she were about to have a large bowel movement.

The mother appears to be markedly indifferent to and withdrawn from what is going on around her, although she is not unconscious; she hears everything that is said. Usually, the mother is calmer and more purposeful during the second stage. She feels the progress. . .of the baby’s moving. . .and she becomes more satisfied that she is accomplishing something. (This is the amnesiac state that we refer to. She remains in a comfortable, quiet state and just gently breathes her baby down.)

At this point, the mother desires to help along by bearing down. . .and she should be allowed, but, not in the normal case, urged to do so. She should begin this work only when she feels she must, not because she or the attendant thinks it is a good idea.

While not painful, the feeling of tightness around the external genital, or vulva, can make her tend to hold back. . . .if she is intense with fears about the birth, she may become distressed at this time more by the fear of the imminent birth rather than by pain, which has actually decreased. The chief role of the attendant is to make the mother as comfortable as possible, physically and mentally. The latter is accomplished by his/her calm cheerfulness and by frequent encouraging words, such as, “Everything is fine;” “You’re doing a good job.”