Coaching women during childbirth has little impact

CEG · Apr 12, 2008

hold your breath and legs, relax your pelvic floor, keep pushing, keep pushing 1, 2, 3, 4, 5, 6, (to give an idea of how long they've held their breaths)!". Then if the contraction is still there (borne out by her hard abdomen and the monitor tracing showing a raised line for the contraction), the coach immediately says "breathe in" after she has exhaled, and repeats the instructions again as long as the contraction lasts. Usually the impetus of contractions in that stage is so strong, that most women can hold their breath longer than in practise sessions,

Actually valsava (breath holding) pushing is harmful to both mother and baby- results in poor cord gases, lower APGAR scores, more fetal distress, and more perineal trauma. More effective "coaching" in second stage would be explaining to mom the mechanics of physiologic pushing and encouraging her when it is performed correctly. Whether mom pushes or not the baby will come out- it is best to avoid exhausting and harmful valsava pushing.

lamazeteacher · Apr 12, 2008

Interesting.
My most ever loving wife has recently switched departments during her young nursing career. She is now on our happy little hospital's maternity floor eagerly and anxiously learning how to deliver babies. Of course she talks about her experiences to me (respecting HIPPA, of course :chuckle). A couple of mothers, when asked, said that they had no formal birthing plan thought out. :eek: There were no formal "coaching plans" for those soon-to-be new moms. :eek: Apparently, one mother said that giving birth was "natural" and said that she would just "wing it". (It was her first birth).
O. K.
Now understand that "I don't know nothin' 'bout birthin' no babies. . . . " !!! But if I was a soon-to-be new mom, I would want a definate plan. But I'm not. Heck, I'm not even a woman. But if I was, I would at least want my husband present, reminding me to breath a certain way while I gave birth to a "watermellon" so that I could scream and yell at him.
Gratefully male,
Ted

I loved your hunor, Ted. Let's add the quote "the best laid plans of mice, men, and pregnant women.........."

Birth plans were conjured in the '80s, and a lot of childbirth educators liked the idea. To me, they're like a cook who use different ingredients than the recipe requires. When you have no idea how the labor will go, it's hard to get fulfilment from a plan. Rather, it's like many wrong answers in the final exam. If my students wanted to do one, I supported them, with cautionary admonishments that they make them flexible for the many different scenarios that can (and will) occur.

I'd much prefer that time was spent practising their techniques so that they are used smoothly, with agreement about which one to use. That can only be accomplished through "conditioning" as Dr. Lamaze described, which requires many daily rehearsals for labor with the coach(es). That's why we wait until the last half of the third trimester, to begin preparation for labor. Fear and imminence motivate practising.

A proactive, energetic coach tuned in to the needs of the laboring woman, who avoids statements like, "you're breathing wrong" and breaths as taught, following the laboring woman's lead, or if she's lost it, breathing so she can follow, is worth his/her weight in gold. Often the lack of sleep and time spent following that runaway horse called labor, makes it necessary to have a spare coach, who might be a "doula", a person trained to assist women in labor (not necessarily as medical professional). :bowingpur

lamazeteacher · Apr 12, 2008

I'd want as much of a plan as possible, consindering WHAT is coming out and WHERE it's coming out.

Rather than a "plan", knowledge of the anatomy and physiology of labor will enhance one's awareness of it, allowing informed participation rather than the common fight/flight reaction. :yeah:

lamazeteacher · Apr 12, 2008

i took childbirth classes for my 1st child.
when i went into labor, everything i had learned went right out the door.
when dh tried to coach me, i bit his wrist as well as the id band off his wrist.
i was like linda blair from the exorcist. i remember the l&d nurse saying this was the worst labor she had seen in her 23 yrs of experience. and the stupid doctor was nowhere to be found. by the time the ob was found, it was too late for an epidural. and i refused pain meds fearing it would affect the baby.
child #2 was 12 wks early so due to his size, the l&d was bearable.
child #3 i got an epidural-such sweeeeeeet relief. the only way i knew i was ready to push was from the pressure i felt. i reported the pressure, got an exam and i was 10 cm dilated and ready. i basically coughed him out.
so yeah, i can see from when the time comes, everything you've learned can go out the window.
leslie

Dear Leslie:

I'm not sure whether you had Lamaze classes or not. Dr. Lamaze taught "psychoprophylaxis" with more explicit relaxation and distracting breathing techniques, using a "focal" point to distract laboring women more. He'd learned that through his awareness of the childbirth preparation program at a Russian hospital he visited, to learn surgical methods. When he walked through the L&D there, he was nonplussed to see laboring women using patterned breathing (without coaches), who seemed almost unaware of their contractions. Unfortunately, although I've met many Russian women, they've never heard of the techniques, so it may have been a "flash in the pan" there.

He ammended the techniques he saw and began to teach them himself at his "metalworkers' clinic in Paris. A pregnant American woman, Marjorie Karmel lived in Paris and hearing of his work, she decided to partake of his instruction (husbands were not encouraged to attend the classes). He employed birth coaches (doulas) who practised frequently during the last 2 months of women's pregnancies, with the attendees of his classes, so husbands sort of stood by (like mine did) when labor occurred.

Upon returning to New York in the '60s, and pregnany again, Ms. Karmel resurrected her notes and practised the techniques with her husband, who coached her successfully through her 2nd birth (meaning they actually were able to do the techniques together, with Marjorie staying "in control" using them). Elizabeth Bing heard the drumbeat about their experience through the hospital's grapevine and questioned their MD. He told her that when he heard what they wanted to do, he said as long as they trusted his judgment and didn't insist on something that would endanger their baby, he had no opposition to their doing what they had been taught in Paris. He was so impressed by the outcome, that he became an enthusiastic proponent of Prepared Childbirth.

After their uneventful (that is uncomplicated, enhanced) labor Elizabeth Bing started to organize classes and taught the techniques in New York, starting a new movement of avid followers that spread to the west coast in 1966. I met one of those instructors in Los Angeles, asserting before attending her class, that "no woman can do 3 different breathing techniques in labor"). Afyter hearing the logic and physiological advantages of the methods, though, I proclaimed its merits to one and all, and that began my 35 year career teaching Lamaze at home, hospitals, colleges, and one year at a latge business where many employees were expecting babies, and the employer wanted a perk to retain them.

Before that, a pregnant friend of mine was reading Elizabeth Bing's book "6 Practical Lessons for an Easier (not faster) Childbirth", and although I nagged her to stop that nonsense, and do what I was teaching at the time (a la British pioneer of childbirth education, Dr. Grantly Dick-Reed's techniques). He believed that knowledge of the birth process alone would make it easier, and was somewhat charasmatic, being able to get women in labor to relax by simply saying, "Relax" (so the uterus and baby got more oxygen by not hogging it for tense maternal muscles). He also taught deep abdominal breathing, which Lamaze advocates thought caused the diaphragm to bump into the uterus, making contractions more painful.......

The competition among advocates of their own methods for preparing couples for childbirth became greater with the advent of Dr. Bradley, who wrote, you guessed it, "Husband Coached Childbirth". A folksy, traditional mid westerner, he believed that childbirth instructors needed to have had an unmedicated birth themselves, to teach others to have that. (He must have had a bad experience when someone reacted badly to medication in labor, as he was rather dogmatic about "natural" - unmedicated childbirth.)

I attended a lecture he gave, for "hens" and sent a man I knew to his concurrent one for "roosters", in the mid '60s. As we heard it, the women were instructed to remove rollers from their hair before their husbands came home from work; and the men were cautioned not to ridicule/deride pregnant women if they, in their pregnant, tired modes, hadn't removed rollers from their hair when they got home from work !??! So the medication wars raged between the educators, their followers, and the medical community..

After becoming known as a Childbirth Educator in my community for 6 years before I finally accomplished a full term pregnancy (gravida 5), I made it clear upon my admission to L&D with ruptured membranes and no contractions that I wasn't an extremist about medication, and wanted all I could get. I had the notion that my low pain threshold and extreme fear of pain motivated me to teach others how to deal with it (with medication, of course).

The way I see it, if you can control the pain with the techniques, pain medication isn't indicated. However, if the techniques "go out the window", medication is necessary; and probably it could be titrated to lower doses for prepared women. You know doctors, though. No matter the size of the patients we all get the same dose (except infants and children). I explain in my classes that adult moms get adult doses, which is far to much for small babies, which is why systemic analgesics can't be given in an effective amount within an hour of delivery, when a baby needs to be conscious enough to breathe on their own. But who can accurately predict that delivery will occur within an hour? So many women are denied needed medication for longer than it needs to be. :cry:

lamazeteacher · Apr 12, 2008

Amen Leslie :yeahthat:
I too took a 6 week childbirth class and a 6 week Lamaze class.
All straight out the window when the hard labor hit.
Liars . . all of them.
God bless the CRNA who did my epidural for my 4th child - all the rest were "natural" and hurt like he!!
And I'm a L&D nurse . .. .
I don't understand making a "plan" though - I think I knew enough from the classes that you cannot micromanage your labor and delivery.
And that is one of the things I hated so very much about labor . . . . .I hated the feeling of something else taking over my body over which I had very little control.
Just get the child out - I don't care for the "process" so much.
steph

Oh StevieLynn, now I understand you so much better! I have a hunch that thge missing element in your preparation, as in so many others who avidly attend classes, but are not told to PRACTISE, PRACTISE, PRACTISE! Onlky through "conditioning" that occurs only with at least 60 dress rehearsals, do the techniques stay with us - and even then it's important to have a coach remind us of them during labor, and do them with us.

I dragged my husband to 2 series of classes too, one which was given by a French maternity nurse who kept saying with a thick French accent, "the baby's head brooms the perineum" as it is born". I asked her what that meant, and she explained that it was like cleaning the floor. Finally I got that she meant it "sweeps over the perineum in an upward "cardinal movement". She taught that tilting the pelvis as that happens avoids tearing the perineum toward the orifice.

I think shear cussedness kept my husband glued to his chair as I struggled to stay in control through "back" labor. However I was so thoroughly conditioned, that I was able to continue doing the techniques like the Russian women Dr. Lamaze saw (told in a previous post). I was too petrified to stop doing them, and when an examination revealed complete dilation I was told that I could push, and I refused, saying "it isn't time". "Why?" asked my nurse. I replied, "because I haven't asked for medication yet! Do you think I can do this without it?"

The nurse warmly encouraged me, and I am still so proud! Pushing hurt, yet it was another way to stay in control and my husband finally rose to his roll. Tilting my pelvis not only avoided additional sutures, but it facilitated the turning of my baby's ROP head, and I got that 8#12oz. baby boy out, in less than a half hour. He's now 36 years old, and maternal amnesia hasn't happened yet. To make a pun, it was my "crowning" moment! I wish everyone could experience the joy I had, in achieving what I'd thought was impossible (also I was a gravida 5).

The following year I did BSE and found a tiny lump in my left breast. Breast cancer was found on biopsy, and the time for giving birth was over. :cry:

I embrace the "doulas" training, as some guys just aren't cut out to coach their women in labor.

lamazeteacher · Apr 12, 2008

When I was pregnant, here was my philosophy:
Ignorance is bliss.
I didn't want to attend a chlidbirth class so I could hear all of the horror stories about everything that could possibly go wrong, long labors, epidurals that wear off, etc.
I personally thought that a few episodes of "A baby story" Discovery health was education enough.
I was planning on giving birth in a hospital, and to me, that was sufficient...I pretty much assumed that someone would be there that knew what to do.
I had a plan alright...my plan was NO PLAN.
Everyone that I knew at the time that had a baby recently, all had a plan, that got thrown out the window.
I packed my bag when I was 7 1/2 months along...people thought I was nuts, "way too early" I was told. They just thought I was being an overly-excited first time Mom.
The very next week I was admitted with preeclampsia, which was not manageable. Twins born by c-section 3 days after admission.
...sometimes I wonder if my "motherly instinct" kicked in early.

As you probably know, twins often come early. It's not known why labor starts, whether the baby's condition nudges the pituitary or vice versa. You were at least 30 weeks along, so I imagine your twins are doing well.

While it is well established that there is a "mind-body connection, I believe that physiology played a greater part in your premature birth. :uhoh3:

lamazeteacher · Apr 12, 2008

What an igmo!!!!
I have given birth to three babies and had multiple kidney stones. Kidney stones were a breeze to pass compared to an 8 lb 11 1/2 oz baby with shoulder dystocia, even WITH an epidural.
I'm GLAD you kicked him!!!!!!!!!:chuckle
And so far as coaching, I had decided with my first one, that I would go "natural", no drugs, I just knew it was a beautiful experience, blah blah blah. Not to deride anyone else, but all those weeks of Lamaze class went right out the window once those contractions got hard and fast and stayed that way for 15 hours of the 19 hour labor!!!! BRING ON THE EPIDURAL, BABY!!!!! With my next two kids, I wanted the epidural at the beginning of the ninth month!! The nurses did coaching, my exDH was pretty useless, although he at least managed to NOT pass out.

Thanks for sharing your experience with both labor and kidney stones. I'd been teaching that too, actually saying that passing kidney stones hurt more than labor. As you found out, it depends on the size and position of the stone/baby. With kidney stones, you can be zonked out of your mind with analgesics, not so with birth (although when they work, epidurals are great).

I'm sad that instructors of childbirth preparation aren't advocating practising enough, and expectant mothers aren't "conditioned" enough to use their techniques in labor.

I was a stickler for practising many years ago, and when I saw that a woman attending the 3rs of a series of 6 classes couldn't remember techniques from the last class at the next one, I told her she was wasting her time coming to class, if she didn't practise. After that class, she and her husband described their poor living conditions since their house burned down after the first class.

Of course I felt terrible for getting on their case, apologizing profusely. They did practise a lot more after that, and had a wonderful birth experience, which is, after all, one of the most important goals, after having A HEALTHY MOM AND BABY. As long as that happens, everything else is gravy!

Long Term Care Columnist / Guide · Apr 12, 2008

I took Lamaze classes for my first childbirth experience some 26 years ago, and I can tell you this from my personal experience: Two hours into pitocin-induced labor, I was screaming for pain meds. My instructor had never once used the word "pain" to describe labor..........she used terms like "discomfort", and "contractions", and "pressure". It would've been so much easier if she had just been honest about what labor actually feels like, because PAIN is what I felt, and I wound up needing multiple Demerol shots and two paracervical blocks before it was over.

To say the least, I was bitterly disappointed, and when I became pregnant again, I said "No way" to Lamaze. Instead, a friend of mine who was also a hypnotherapist taught me how to use guided imagery during labor..........when the time came, I spent the entire labor lying on a sunset beach, allowing the "waves" (contractions) to wash over me while I relaxed and "felt" the sand under me, smelled the salty air, even heard seagulls squawking overhead. My friend coached me through it all as my nightshift-working spouse napped in the chair nearby, and she did such a good job that I never became anxious or overwhelmed. Once I heard my nurse whispering to another as she looked in on me: "I don't know what they're doing in there, but I'm going to let 'em keep doing it---she's QUIET!"

Let me tell you, this was a completely different situation from my first birth. Of course, it helped to have a little experience under my belt---at least I knew this time what I was in for, and I also knew I could survive it. But I never even needed so much as a Tylenol during the whole labor.......then I delivered an 8-pound, 2-ounce boy, in full makeup, without even breaking a sweat, and was up walking the halls two hours after the birth.

I'm sure a lot has changed in Lamaze childbirth preparation over the two and a half decades since I lay on a conference-room floor trying to memorize the different breathing techniques while some other woman's joker of a spouse made waterfowl sounds during our practice sessions! But if I had it to do over, I'd go with guided imagery all the way.

lamazeteacher · Apr 12, 2008

I took Lamaze classes for my first childbirth experience some 26 years ago, and I can tell you this from my personal experience: Two hours into pitocin-induced labor, I was screaming for pain meds. My instructor had never once used the word "pain" to describe labor..........she used terms like "discomfort", and "contractions", and "pressure". It would've been so much easier if she had just been honest about what labor actually feels like, because PAIN is what I felt, and I wound up needing multiple Demerol shots and two paracervical blocks before it was over.
To say the least, I was bitterly disappointed, and when I became pregnant again, I said "No way" to Lamaze. Instead, a friend of mine who was also a hypnotherapist taught me how to use guided imagery during labor..........when the time came, I spent the entire labor lying on a sunset beach, allowing the "waves" (contractions) to wash over me while I relaxed and "felt" the sand under me, smelled the salty air, even heard seagulls squawking overhead. My friend coached me through it all as my nightshift-working spouse napped in the chair nearby, and she did such a good job that I never became anxious or overwhelmed. Once I heard my nurse whispering to another as she looked in on me: "I don't know what they're doing in there, but I'm going to let 'em keep doing it---she's QUIET!"
Let me tell you, this was a completely different situation from my first birth. Of course, it helped to have a little experience under my belt---at least I knew this time what I was in for, and I also knew I could survive it. But I never even needed so much as a Tylenol during the whole labor.......then I delivered an 8-pound, 2-ounce boy, in full makeup, without even breaking a sweat, and was up walking the halls two hours after the birth.
I'm sure a lot has changed in Lamaze childbirth preparation over the two and a half decades since I lay on a conference-room floor trying to memorize the different breathing techniques while some other woman's joker of a spouse made waterfowl sounds during our practice sessions! But if I had it to do over, I'd go with guided imagery all the way.

I use guided imagery for beginning the relaxation technique, and people often tell me their coach repeated the words soothingly that I used, as they labored. Some women who had no coach, taped my (hypnotic) voice to use in labor. However, I go on to have women clench a fist or leg, foot, etc., to realize that they can relax while the uterus contracts (similar to the clenched fist, etc.). It also aids the coach's recognition of tense muscles in her body, and in labor when the coach sees tension in her body, he/she can soothingly stroke that contracted area to get it to relax, as they practised it.:redbeathe

allnurses Guide · Apr 12, 2008

But I never even needed so much as a Tylenol during the whole labor.......then I delivered an 8-pound, 2-ounce boy, in full makeup, without even breaking a sweat, and was up walking the halls two hours after the birth.

:rolleyes: Liar liar pants on fire . . . . .

steph

Long Term Care Columnist / Guide · Apr 12, 2008

Well, I couldn't believe I did it either, Steph, but it's the truth. Of course, it was probably easier because this particular baby was my "runt" (all the others were over 9 pounds, and my last one closer to 11). But considering that this was a VBAC (after 2 cesareans!), I was lucky indeed to have a good labor and birth experience.

allnurses Guide · Apr 12, 2008

I'm teasing . . . .

My home, when I had #2 child, had a long steep metal stairway and people were amazed I could walk up the stairs. :saint:

steph