Easy Labour Massage for Pain Relief During Childbirth

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Massage during labour can either be completely relaxing and help speed up the process, or completely irritating and make the whole event last longer. So how do you know if you’re doing it right?Labour massage is very different from the type of massage you would get on a therapy bed and rightly so. During labour a woman needs to relax and switch off her thinking, judgemental brain so her body can feel safe and open up. Massage, when done correctly, will stimulate the body’s natural feel good, relaxation and labour hormone, oxytocin. The keys to making labour massage effective are repetition, a slow steady speed, comfortable pressure and a confident masseuse.Repetition allows the thinking brain to tune out. There’s no thinking of ‘what are they going to do next’ or ‘go back to what you were doing’. If you’ve ever stroked a cat, you’ll know the effects of repetition and a slow and steady speed. Go too fast or keep changing what you’re doing and the cat will stay wide eyed and interested. Keeping a slow and steady pace just stroking down the back will have the cat purring and lying down in no time. Labouring women are the same… slow and steady repetition will have her relaxed very quickly, even through contractions.Labour massage should never be painful. The techniques used must be solely concentrating on relaxation and not trying to dig into tight muscles. If you’ve ever had a sports massage you’ll know what I mean. We tense and hold our breath when we feel pain. Tensing during labour will affect the whole body and make the pain more intense. So, labour massage needs to be inducing relaxation and pleasure to help the woman cope with strong contractions. She will be able to relax and go with her body far more easily if she is being supported in a relaxed and caring way.

Let’s look at a popular technique that I would not recommend; circling up each side of the spine. During a normal massage, this circling technique is lovely to relieve muscle tension but it makes the receiver think ‘ooh that’s a sore bit, I didn’t realise I was tense there… just a bit higher/lower/left a bit/ right a bit’. This is not the dialogue you want a labouring woman having with herself. The same is true for shoulders, hands and feet. What you’re after is repetitive, steady and comfortable techniques that don’t make her think about either helping you (lifting fingers up for you to massage the next one) or what you might do next.

And lastly, the masseuse needs to be confident in what they are doing so lots of practice before the big day is essential. The labouring woman may not want to be touched, or think she does and then change her mind. A confident masseuse will not take this personally. A masseuse who is fearful, stressed or worried will not give as soothing a massage as someone who is relaxed and confident. Having said that, massage is a great way to relax the masseuse too so it may benefit both.

Here are some good techniques I’ve had great results with during the births I’ve attended…

Effleurage
This is a very relaxing and soothing massage stoke. To do effleurage is to stroke up the back from the sacrum using the flats of your hands, around the top of the shoulders and then sweep back down the sides. If done slowly and with a positive pressure (not too hard, not too soft), the recipient will feel totally supported and soothed. Massage oil is needed for this technique unless the woman is sweaty as that will act as a lubricant.

Using oils during labour should be kept to the absolute minimum. Grape seed oil is my favourite as it has very little odour and is absorbed nicely. Sweet almond oil is too thick and greasy for labour massage, as is baby oil.

Stroking

Using one hand resting on the floor or bed (be careful not to put weight from this hand on the body) use your other hand to slowly stroke down the spine. Start from the base of the neck and keep a continuous stroke going down to the very base of the spine. This is a deeply relaxing technique that can greatly help to reduce blood pressure and anxiety. You may be wanted here for a long time!

Face Massage

During labour a woman’s jaw can become very tight and cause a lot of tension in the rest of her body. Some women may also screw up their faces creating a lot of tension around their eyes and cheeks and also in their scalp. A great way to relieve stress and tension is to gently stroke the labouring woman’s brow, stroking from her brow and through her hair. Using circular movements with the flat pads of your fingers on the temples (light pressure) can help with eyestrain and forehead tension. And likewise, circular moves all along the jaw, right up to near the ears will help the labouring mother’s jaw to loosen. This has a nock on effect to the whole body. If the forehead and jaw loosen, tension can also be released in the stomach and abdominals. Also, a loose mouth means a relaxed pelvic floor (and thus not trying to hold baby in).

Head Massage

Head massage is often deeply relaxing and can help relieve headaches. Practise this technique before the birth to find out what preferences your pregnant partner has. There are two slightly different techniques: rotate the skin of the scalp under the pads of your fingers (move the skin not your fingers), or using circular moves, rub your fingers all over the scalp helping to get the muscles loosened. The former is very relaxing, the latter can also be invigorating depending on how fast and deep you do it. It may be that an invigorating head massage will help a tired woman find the extra energy to birth her baby.

Hands & Feet

When experiencing pain and discomfort, it is a natural reaction to clench the hands and tighten the feet. It’s difficult to tense your hands and no other part of your body. The more you can release tension in the hands and feet, the more tension is relieved in all other areas of the body. Even stroking a hand as you hold it has great benefits. Never underestimate the power of holding someone’s hand, especially if you’re helping them to relax it.

Holding her hand with both your hands you can use the length of your thumbs to loosen up the tension. Using stretching movements outwards on the palm will help ease tension and remind your partner to relax. The slower the moves the more relaxation you will induce. Start from the middle with both thumbs, and move them apart.

For the feet, rubbing the heel of your hand down the sole of the foot (from the balls of the toes to the heel) while support the top of the foot with your free hand will be deeply relaxing and prevent any tickling or pain.

Neck & Shoulders

Massaging the shoulders allowing them to drop down is often much appreciated during labour (and any other time!). You can use as much pressure as is comfortable for your partner. Be careful not to pinch the shoulders causing pain (ask for feedback). And do not over work tight muscles, or dig into them. Ensuring you are using a comfortable pressure will create more relaxation. Remember you’re not trying to do a therapeutic or sports massage, you’re intending to help the birthing woman relax. Use circular movements with your thumbs across the top of the shoulders, your fingers dropping down the front of the body.

When massaging the neck, make sure the head is supported either with the other hand, or by having the birthing woman with her head on a pillow. Have your thumb sweep up one side of the neck and your fingers sweeping up the other side.

Abdominal Effleurage

Using your effleurage techniques, you can help to relieve tension in the abdominal muscles by very gently stroking a labouring woman’s belly. The uterine muscles are more than capable of squeezing out a baby without the need of the stomach muscles. In fact tensing the stomach muscles can inhibit and slow down labour. By using gentle upward strokes with the whole of your hand, or gentle circular moves up the belly with the pads of your fingers, you can help the abdominal muscles to relax. If the labour has been induced with an oxytocin drip, this technique may be very useful to help a woman’s uterus relax between contractions.

NB Remember not to poke or prod the belly. Gentle pressure is essential.

Lumbosacral Pressures

There are several techniques you can use to help ease back ache (different from back labour pains caused by a posterior baby) and uterine pains.

If sore spots are felt in the sacrum area (if you have been practising your relaxation techniques you will be more aware of locations of pains rather than all over pain), then you can use elbow, knuckle or thumb pressures to help relieve the tension. The pressure must be no more than pleasure pain and hold until the discomfort subsides (which may be a while so make sure you’re comfortable!). Do not press on the spine, but on the muscles around the buttocks and either side of the sacrum. I have found this a very supportive technique for women who have experienced slipped discs or any chronic or acute back pain.

NB the sacrum is part of the pelvis that moves outwards during labour to make more room for the baby. This can be quite painful. It’s important not to put pressure on the sacrum bones themselves during labour as they need to move out (and not be pushed back in). Working either side of the sacrum itself is an effective way to make this process more comfortable.

Cord around the neck – what parents & practitioners should know

I really love this article. I have a lot of clients who have had caesareans for failure to progress and discovered that baby had the cord around their neck. The woman is totally relieved that the caesarean ‘saved’ her baby. However, “Nuchal cords are rarely found to be the cause of adverse outcomes in studies of pregnancy and birth. Several authors have concluded nuchal cords ordinarily do no harm”

Source: Cord-Clamping.com BY KATE EMERSON ⋅ NOVEMBER 4, 2011

This article shares information about the common practice of checking for a nuchal cord during the second stage of labour, and unlooping or cutting the cord – interventions that are not evidence-based and can cause birth trauma.

********Updated Jan, 2012:

This article focuses on theories and evidence where routine interventions associated with nuchal cord may be the cause of iatrogenic harm in otherwise-normal birth. This is distinct from cases where umbilical cord entanglement or cord constriction may be the cause of pathological outcomes during gestation, development, progression/descent during labour and birth.

Jen Kamel from VBACFacts eloquently described the risks associated with nuchal cord, which despite studies showing this risk is low will be devastating to the unfortunate 0.4% – 0.6% :
“Even though nuchal cords are common and occur 25% – 35% of the time, rarely a baby’s cord will be wrapped so tightly around their body that the cord is compressed and oxygen delivery to the baby is compromised. When this occurs, a cesarean is prudent and in its absence, a stillbirth could occur. Fortunately, stillbirth from cord accidents, which include nuchal cords and nuchal knots, are rare and occur in 1.5 per 1,000 (0.15%) deliveries. If your baby does have a nuchal cord, the risk of infant death is less than 0.4% – 0.6%. Thus, even though nuchal cords occur in about one third of births, they rarely result in the death of a baby. However, this is no consolation to those who have experienced the horror of their child’s death because when you are the statistic, it doesn’t matter how rarely something occurs.”

********

It is important women are informed about nuchal cord ‘management’ in vaginal birth and how it may affect their baby. Information in this article may assist with birth planning; promote discussion with care providers and birth support; and help to avoid iatrogenic injury.

NUCHAL CORD

A nuchal cord is when the umbilical cord is ‘coiled’ around the baby’s neck. Most nuchal cords are single coils and loose. Less common are tight, double or multiple coils (1,2,3).

Various studies have shown nuchal cord to occur:

in 10% – 37% of all births;
more commonly in male babies;
during pregnancy or labour;
progressively with longer gestation (1,2,3,4).
Maternity care providers should expect to encounter nuchal cords regularly in their practice (2).

4xNuchal Cord
Baby Tyler born with a tight x4 nuchal cord. Babe was pink and breathing spontaneously within a minute, cord intact
Read Tyler’s birth story

NUCHAL CORD RARELY THE CAUSE OF HARM

Nuchal cords are rarely found to be the cause of adverse outcomes in studies of pregnancy and birth. Several authors have concluded nuchal cords “ordinarily do no harm” (5,6,7).

Some studies have associated nuchal cord with an increased rate of variable fetal heart rate decelerations during labour, and tight nuchal cords to a higher proportion of fetal distress and low Apgar scores. (3,4,8) However, in these retrospective studies the definition of tight nuchal cord were those ‘clamped and cut before delivery of the shoulders’ – therefore short-term morbidity was more likely caused by the interventions rather than the presence of nuchal cord (3).

(To learn more about nuchal cords, how babies can and are born with loose/tight/multiple nuchal cords, and why they are disproportionately associated with risk and adverse outcomes, please read Nuchal Cords: the perfect scapegoat.)

RITUAL AND ROUTINE

Many birth practitioners are trained to routinely ‘check’ for a nuchal cord during the second stage of labour, and if present, intervene further by pulling to unloop the cord, or clamping and cutting.

Textbook recommendations to intervene in case of nuchal cords (for normal and emergency births) are based on unevaluated medical literature and lack any references to scientific evidence – they are ‘ritualised’ practices (1).

The rituals advocated in medical textbooks are:

To conduct a vaginal examination once the baby’s head is born, to feel and check for a nuchal cord.
To pull and unloop the cord over the baby’s head before ‘delivery’ of the shoulders, if the cord is loose.
To attempt to loosen the cord or clamp and cut the cord* before ‘delivery’ of the shoulders, if the cord is tight.
* Some textbooks describe the somersault technique as preferable.

While medical literature from the 1840s onward contains cautionary advice about interfering with nuchal cords, ‘revised’ literature since the 1950s does not (1). Influential nursing and midwifery textbooks that teach nuchal cord ‘management’ also fail to include the findings of research and medico-legal reviews that associate risk, serious injury and malpractice with nuchal cord interventions (1).

Practitioners should know routinely checking, unlooping or cutting a nuchal cord is unnecessary and can have serious consequences for the baby. Women and practitioners should be aware these interventions are usually performed without consent and are contrary to the midwifery model of care (1,2,9).

VAGINAL EXAMINATION TO CHECK FOR NUCHAL CORD

A vaginal examination to check for nuchal cord occurs at a vulnerable stage for women, when the baby’s head has just been born. In most cases, women are unprepared for this vaginal exam and have not given informed consent (10,11).

Vaginal exams can be painful and distressing for women, but even more so after birthing the head may have caused pain and possible trauma to the perineum. One woman described her experience to Australian midwife researcher Rachel Reed as “fingers of broken glass digging in” (2).

Checking for a nuchal cord can also interfere with the birth, cause unnecessary stress, and shift a woman’s focus away from giving birth to the intervention being performed (1,2).

No good evidence exists to support the practice of routinely checking for the nuchal cord, yet it is a common medical birth intervention (9). Jefford and colleagues found it is customary practise in US, UK and Australian maternity units, and taught to students in the UK, US, New Zealand, Ireland, Mexico and Canada. (Interestingly, midwives from Norway and Denmark responding to a survey had not witnessed the practice of checking for nuchal cord) (9).

PULLING AND UNLOOPING A NUCHAL CORD

Pulling and looping a nuchal cord over the baby’s head during birth is a common birth intervention (12). Just like checking for nuchal cord, it is not based on evidence and there is growing evidence pulling on the cord may be harmful (4).

For example, evidence indicates that handling the cord stimulates the umbilical arteries to vasoconstrict (reducing blood flow) (13). Pulling on the umbilical cord also creates tension that can risk the cord tearing and “subsequent neonatal bleeding” (6). The effect of pulling on the cord is currently unknown and cannot be predicted– cords have snapped as a direct result this intervention, compromising the baby, mother and practitioner (2).

An Australian study has found that once midwives from USA, Australia, Ireland, New Zealand and the UK felt a nuchal cord, they “reverted to carrying out the intervention they had been taught during their training: to clamp and cut the cord” (2,9).

CLAMPING AND CUTTING A TIGHT NUCHAL CORD

There is no adequate evidence to support routinely cutting a tight nuchal cord (1,2,4,9,14). If the cord is clamped and cut before full delivery has been attempted, on what basis has the practitioner determined the cord was too short or preventing the baby from being born safely? In fact, some of the reasons stated for cutting a tight cord are completely illogical. Surgically clamping and severing the cord does not relieve cord compression or correct a low heart rate/oxygenation – it produces complete, irreversible ligation and amputates the baby from its only source of blood volume, oxygen and oxygen-carrying red blood cells.

As far back as 1842, medical advice about a cord around the neck “so closely as to strangulate the baby”, was to loosen the cord, or if possible “the cord should be left to see if the baby births” – only if the birth is prevented may cutting be required (1). The Handbook of Obstetric Nursing text from 1898 began recommending to feel for a nuchal cord but not to cut if one was found – this advice was continued in midwifery texts until 1930 (1). The 1961 edition of Williams Obstetrics still urged patience after the birth of a baby’s head for the next contractions to ‘deliver’ the shoulders (15). But from 1976 the same book introduced new ideas (without evidence) that if the umbilical cord is tight around the neck, it should be “cut between two clamps and the infant delivered promptly” (15).

When the normal birth process has been “abruptly terminated” a prompt delivery becomes crucial (15, 16). This is not always guaranteed however, and there are number of cases documented in research (Mercer et al) and medical journals where cutting the umbilical cord before delivery of the shoulders resulted in iatrogenic outcomes including cerebral palsy, Erb’s palsy, global developmental delay and death (15).

Although studies show infants may appear to tolerate cutting of a loose nuchal cord, there is clear evidence that cutting of tight nuchal cords before, or immediately after, birth can result in serious injuries and even death (1,14,15). Several writers have observed and documented adverse outcomes as a direct cause of cutting a tight nuchal cord: life-threatening hypovolemia, anemia, shock, hypoxic-ischemic encephalopathy, cerebral palsy (Chow vs Wellesley Hospital 1999) cognitive deficits and death (8,13,14,15,17,18,19,20).

Clamp and Cut Nuchal Cord
Clamping and cutting the cord before the shoulders have been born
The major risks of cutting a nuchal cord are associated with the effect of compression on the umbilical cord when the coil is tight and the possiblity of a shoulder dystocia (14). Cord constriction from a tight nuchal cord can produce a loss of blood volume in the baby and cause acid-base imbalance (due to arteries continuing to send blood away from the baby, but impeding venous return) (14). With cutting of the cord, the baby’s low blood is “fixed” with no recourse to placental transfusion to correct this dangerous condition (14). (Placental transfusion is part of the normal birth process that can reperfuse the baby with oxygenated blood once the baby has been born and compression on the cord is relieved (14)). In serious cases of late-stage cord compression/ tight nuchal cord, babies can be born exhibiting “pallor, irregular respirations, low Apgar scores, gasping, tachycardia, weak peripheral pulses, hypotension, and acidemia” (21). With the cord already severed, these babies are unable to receive placental transfusion and correction of these conditions.

In 1991, the somersault manoeuvre was first described as an option for ‘managing’ a tight nuchal cord without cutting (6). Although not an evidence-based practice, the somersault manoeuvre preserves the normal anatomy and physiological processes of birth by keeping the cord intact – which is necessary for placental transfusion during the third stage of labour/ neonatal transition and vitally important for the baby born deplete in blood volume (14).

CONCLUSION

Routine checking and intervening with nuchal cords, without evidence it is beneficial or required, is in stark contrast to the philosophy of evidence-based practice – and particularly the midwifery model of care of non-intervention in normal physiological birth.

Practitioners that respond clinically, not routinely, to a nuchal cord – and with the least intervention possible – are more likely to protect normal physiology and anatomy and avoid iatrogenic injury.

When practitioners begin to observe babies being born with a nuchal cord without intervention, they will also cease to routinely check for nuchal cord – thus sparing women the indignity, pain and distraction of a vaginal exam as their baby is being born.

Until nuchal cord ‘management’ ceases to be routine practice, women are best advised to discuss these interventions with their care providers. Women can insist upon interventions being performed only when required and where supported by evidence. Birth partners and doulas should also be aware of nuchal cord rituals and have a clear understanding of the woman’s preferences for the second and third stages of her labour.

Further reading

BIRTH STORIES

An Australian mother’s experiences of her baby’s tight, double nuchal cord being cut before birth (hospital)
An American mother’s similar experience (hospital birth)
A mother shares a birth story of her baby’s nuchal cord cut before birth and requiring specialised care
Compare these experiences with this homebirth of a baby born in the caul with x4 times nuchal cord

Umbilical cord around baby’s neck rarely causes complications – VBACfacts website – excellent article with concise summary of research evidence, as well as various heartfelt comments from parents of babies that experienced benign nuchal cords, harm from pre-birth or immediate cord cutting, harm from delay in intervention despite evidence of fetal distress, fetal loss and stillbirth.

Read Nuchal Cord Management and Nurse-Midwifery Practice (pdf)

REFERENCES

(1) Jefford E., Fahy K., Sundin D. (2009) Routine vaginal examination to check for a nuchal cord Br J Midwifery, 17(4)

(2) Reed R. (2007) Nuchal Cords: Think Before You Check, The practising midwife, 10(5), 18, 20.

(3) Lt Col G Singh, Maj K Sidhu (2008)‘Nuchal Cord: A Retrospective Analysis’, MJAFI, Vol. 64, No. 3

(4) Reed, R. Barnes, M. and Allan, J. (2009), ‘Nuchal cords: sharing the evidence with parents’, British Journal of Midwifery, February 2009, Vol 17 (2): 106-109.

(5) Cunningham FG., Leveuo J., Bloom SL., Hauth JC., Gilstrapp III LC.,Wenstrom KD. (2005) Williams Obstetrics 22nd edn. McCraw-Hill Medical Publishing Division

(6) Schorn M., Blanco J. (1991) Management of the nuchal cord. J Nurse Midwifery ;36:131–2.

(7) Steinfield J., Ludmir J., Eife S., Robbins D., Samuels P. (1992) Prenatal detection and management of quadruple nuchal cord: A case report. Journal of Reproductive Medicine 37(12): 989–91

(8) Cashmore J. Usher RH. (1973) Hypovolemia resulting from a tight nuchal cord at birth. Pediatr. Res: 7:339.

(9) Jefford E., Fahy K., Sundin D. (2009) The Nuchal Cord at Birth: What Do Midwives Think and Do? Midwifery Today 89: 44–6

(10) Coldicott Y., Pope C., Roberts C. (2003) The ethics of intimate examinations -teaching tomorrow’s doctors. BMJ 326(7380): 97–101

(11) Lewin D., Fearon B., Hemmings V., Johnson G. (2005) Women’s experiences of vaginal examinations in labour. Midwifery 21: 267–77

(12) Jackson H., Melvin C., Downe S. (2007) Midwives and the fetal nuchal cord: asurvey of practices and perceptions. J Midwifery Womens Health 52(1): 49–55

(13) Coad J. & Dunstall D. (2001). Anatomy and Physiology for Midwives, Mosby.

(14) Mercer J., Skovgaard R., Peareara-Eaves J., Bowman, T. (2005) ‘Nuchal Cord Management and Nurse-Midwifery Practice’, Journal of Midwifery & Women’s Health 4 (23): 373-79

(15) Iffy L., Varadi V. and Papp E. (2001). ‘Untoward neonatal sequelae deriving from cutting of the umbilical cord before delivery’. Med Law, 20 (4): 627-624.

(16) Wickham S., (2008) Midwifery: Best Practice Vol 5. London, UK

(17) Dhar K., Ray S., Dhall G. (1995) Significance of nuchal cord. J Indian Med Assoc;93:451–3.

(18) Shepherd A., Richardson C., Brown J. (1985) Nuchal cord as a cause of neonatal anemia. Am J Dis Child;139:71–3.

(19) Iffy L., Varadi V. (1994) Cerebral palsy following cutting of the nuchal cord before delivery. Med Law;13:323–30.

(20) Flamm M D. (1999). ‘Tight nuchal cord and shoulder dystocia: a potentially catastrophic combination’. The American College of Obstetricians and Gynecologists, 94 (5): 853.

(21) Vanhaesebrouck P., Vanneste K., De Praeter C., Van Trappen Y., Thiery M. (1987) ‘Tight nuchal cord and neonatal hypovolaemic shock’, Archives of Disease in Childhood, , 62 1276-77

Additional articles

Jackson H., Melvin C., Downe S. (2007) ‘Midwives and the fetal nuchal cord: a survey of practices and perceptions’. Journal of Midwifery and Womens Health 52: 49-55

Janet D., Larson MD., William F., Rayburn MD., Crosby RSS., Gary R., Thurnan MD. (1995) Multiple cord entanglement and intrapartum complications. Am J Obstect Gynecol 173:1228-31.

Nelson K., Grether J. (1998) Potentially asphyxiating conditions and spastic cerebral palsy in infants of normal birth weight. Am J Obstet Gynecol 1998;179:507–13

Melvin C., Downe S. (2007) Management of the nuchal cord: a summary of the evidence, Br J Midwifery 15(10) 617-21

Walsh, D., Downe, S. (2010) Evidence for Neonatal Transition and the First Hour of Life, Essential Midwifery Practice: Intrapartum Care pp. 85-89.

The Lion Effect™ During Childbirth

By Samantha Thurlby-Brooks
Humans, like any other animal who is preyed on, are sensitive to certain stimuli getting their adrenalin levels rising ready to fight or run and sometimes to freeze. I call this The Lion Effect™; when in times of stress or perceived stress a person will get themselves ready for danger to protect themselves or their young for survival.Not that long ago, in terms of natural history, us westerners were living in caves as tribes. There are many human populations who still live this way where medical care is scarce and the danger of being killed by wild animals or people from other tribes is a reality. The ability to respond to perceived danger is vital and we have, along with other animals, developed a way to respond that means we don’t have to think too much about it; it’s automatic.Our modern day, western society hasn’t actually changed this danger response but we have renamed it; ‘stress’. Because we aren’t being chased by Lions or Tigers or Bears we don’t necessarily see ourselves as living in a dangerous society but our body’s and primitive, automatic brain’s don’t know the difference between wild animals and modern society. We can make our cars with airbags but our body still feels the potential for danger… we can lock our doors at night but that strange noise outside will get our adrenaline pumping.

We can birth our babies in hospitals where society says it’s safe. But our body doesn’t recognise the difference between a lion prowling and waiting expectantly for a new born dinner than with an obstetrician telling you to birth your baby within two hours or they will cut your baby out on an operating table or pull them out with forceps. This ‘Lion Effect’ makes your body do exactly what any mother will do; stop birthing to keep your baby in your belly where it’s safe so that you can either run, hide or fight the Lion and then resume birth later on when you’re safe.

It’s amazing how your body works… Oxytocin is the hormone that produces contractions also makes you calm and relaxed and helps you to bond with your baby. Adrenaline gets your heart pumping harder taking blood and oxygen to your vital organs and muscles allowing you to run or fight, keeping you super alert and focused. These two hormones are the opposite of each other. Your body will stop producing the relaxation and birthing hormone, oxytocin, when you need to run and fight. It makes sense.

Unfortunately the uterus is not considered a vital organ (probably because the woman isn’t always pregnant) so blood and oxygen are directed elsewhere and can cause the baby distress (if this happens too much or for too long). If in the birthing room your adrenaline levels go up, your birth will slow down or even stop. (Except just before your baby makes their way into the world you’ll get a quick boost of adrenaline to make you awake, upright and ready to look after your new baby and to grab your baby and run if need be).

When we consistently have high levels of adrenaline we suffer from stress because we feel there’s nothing we can do. During pregnancy, birth and mothering (including breastfeeding) this stressed state means that we constantly perceive Lions in the general area and our body must be super alert and be prepared to fight. Our baby’s interpretation is that this world isn’t safe. The mother’s body is in a dilemma; trying to choose whether to keep them safe and run or whether to stay still, calm and relaxed so she can feed and nurture her baby. Her hormones will not allow her to do both at the same time and will always choose survival.

Things that stimulate adrenaline and other stress hormones are;

  • Hunger (if you’re hungry you need the energy to find food and eat it)
  • Feeling Cold (if you’re cold you need to find firewood or shiver to keep warm)
  • Being watched or feeling observed (we sense when someone behind us is watching us and it makes us uncomfortable/ feel threatened which then makes us change our behaviour)
  • Fear (real danger or even imaginary; the mind doesn’t know the difference)
  • Excitement (I know you’re baby’s coming but staying relaxed rather than excited will help you more)
  • Other people’s adrenaline (we’re herd animals, if one person perceives danger we all need to respond… so everyone in the birthing room or when visiting a new mother must be positive, calm and relaxed)
  • Bright lights (hence why we turn the lights off when we want to relax and go to sleep)
  • Feeling too hot (ever tried to get to sleep when you’re just too hot?)
  • Needing the toilet (ever tried to get to sleep or have sex when you need the toilet?!.. oxytocin is the same hormone that produces an orgasm)

Keeping oxytocin as high as possible by staying calm, confident, supported and relaxed is vital to birthing your baby in an empowered and positive way. Mothers will respond better and nurture their baby’s more confidently when they are relaxed and supported. It’s just what happens naturally.

The most comfortable pregnancy sleeping position

By Samantha Thurlby-Brooks
Most of my pregnant massage clients find it really hard to get comforable in bed until I teach them these great tips. Contrary to popular belief it is actually possible to get a comfortable night’s sleep when you’re pregnant. Here’s how…

  1. During pregnancy it’s important to lie on your side. This is because you have a main vein (the Vena Cava) running up the side of your spine. Lying on your back with a heavy pregnant belly will compress this vein and restrict the blood flow for you and your baby. It’s likely to make you feel sick and breathless and your baby will kick and kick trying to get a better position and telling you to move. Generally from 24 weeks onwards you’ll need to lie on your side (earlier if you’re carrying twins or more). It doesn’t matter which side you lie on (changing sides helps your blood flow and allows baby to move around to get comfortable). From 34 weeks onwards it’s ideal for your baby to have his/her spine lying on the left side of your belly as this is a much easier position to start a good, healthy labour. When baby is awake and you’re lying on your side, make sure you lie on your left.
  2. Put a pillow under your top leg but NOT between your knees. Putting a pillow between your knees puts too much pressure on your bottom leg and doesn’t correctly align you. Your lymphatic system doesn’t have it’s own pump so putting a pillow between your knees will encourage fluids to pool in your feet (oedema) as your foot drops lower than your knee and hip. The other concern is that during pregnancy you have 40% extra and 40% thicker blood (more if you’re carry twins or more) which often has a hard time getting around the body. Varicose veins in the legs and groin are very common during pregnancy so putting the pillow between your knees will make it even harder for the blood to flow.
  3. The picture above is a very thick, sturdy pillow between the knees. As you can see it still creates a twist and pull in the hips and knee. Having a thinner pillow will create even more of a twist and leave you rolling forwards onto the mattress giving baby less space to get comfortable (baby will kick a lot during the night if you’re twisting hard). The other problem with a pillow between the knees is that your lower back is pulled and your pelvis is tucked under as you try to keep your knees together. Bringing your knees up towards your belly, tucking your pelvis under or rounding your back will create pains in your lower back and prevent baby from getting his/her chin to chest for an easier birth.
  4. Keep the hip, knee and foot of your top leg at the same height. So placing your top leg on a pillow you need to make sure it’s the correct height. If your leg is too high or too low you will feel pulling in your hips and/or lower back which can be painful or just uncomfortable. The height of your leg has nothing to do with how big your belly is, this is purely about keeping your leg in alignment with your hip to stop you from twisting. This position will relieve lower back and hip pains, allowing your muscles to relax and giving you a really comfortable night’s sleep. The Mumanu pillow is the only pillow on the market that keeps you correctly aligned like this and being self-inflating you can adjust it for your own perfect fit.
  5. Support your belly. From 20 weeks onwards it’s a great idea to put a thin pillow under your belly when you sleep on your side. You have ligaments that attach from your uterus to the base of your spine and so as you get heavier these ligaments can pull creating discomfort in your sacrum (just above your bum) and a pulling feeling in your belly. A thin pillow tucked right under your belly and your leg up at the correct height will have you feeling weightless! You can buy belly wedges which are even more comfortable than normal cushions.
  6. Hug a pillow. To prevent your shoulder from pulling and to protect tender breasts, hug a pillow (or a teddy bear!). Hugging a pillow will prevent your upper body from pulling forwards and can help to relieve pains around your bra line.
  7. Keep your neck straight. If, before pregnancy, you normally lie on your front you’ll need to change your pillow while you lie on your side. Make sure the pillow is thick enough to keep your neck straight and your head aligned with your body. If your head is too high or low you may experience headaches and neck and shoulder pains.
  8. One size doesn’t fit all. Long body pillows aren’t ideal during pregnancy. If the pregnancy pillow is thin enough to support under the belly then it’s too thin to support the leg. If it’s thick enough for the leg then it’s definitely too thick for the belly (will cause twisting). Long pregnancy pillows sit in front of the belly and give little support. All the pillows need separating out. Hugging on to a pillow is great for the shoulders but it should be separate from the leg and belly pregnancy pillows so you don’t curl or twist into it. The other issue with using normal fabric stuffed pillows to support your leg is that they easily loose shape during the night. You want something that’s supportive to keep you correctly aligned and totally comfortable.

A pregnant woman who rolls onto her back in her sleep will normally wake up within minutes… because it’s uncomfortable and her baby kicks her to wake her up. A pregnancy pillow that goes around you is unlikely to prevent this from happening (depending on how thick and firm it is). The Mumanu® pregnancy pillow doesn’t need to support you behind your back because it keeps you comfortably aligned and helps you stay in one place longer. If you do wake up on your back, just roll onto your side again. Having a pillow behind you will make you even hotter and also prevents your partner from cuddling up behind you.

Buy your Mumanu Pillow online today and receive free shipping as well as a comfortable night’s sleep!
Mumanu; the only pillow endorsed by Osteopaths New Zealand

 

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How to be a great birthing partner

By Samantha Thurlby-Brooks
You’ll often find in antenatal classes that the teacher will be very confident in telling you that “the role of the birthing partner is very important”. And that’s where they often stop; no tips, no advice, just the statement that you are very important! So if you are so important, how do you know if you’re doing your ‘job’ correctly or if there is in fact a ‘job’ for you to do as your partner breathes deeply and focuses on her contractions?It is true that a birthing partner’s role is very important, but not essential. A woman can safely give birth without a ‘team’ around her and would often be much safer to give birth in privacy. If a woman decides to have you with her for the birth of her baby it is essential for the health of both mother and child that you understand and carry out your role effectively.The three main things to remember about your role as a birthing partner is to

  • stay relaxed
  • encourage and reassure her
  • hold her
  • become invisible and
  • keep the space safe

STAY RELAXED

Staying relaxed during the birth of the baby is as much the role of the birthing partner as it is for the woman in labour. If you are feeling anxious, irritable, restless, worried or aggitated, excited or even hungry you will increase your levels of adrenaline (the fight or flight hormone that raises your blood pressure and gives you a boost of energy). Adrenaline is a very contagious hormone, the effects can produce responses in those around you. During labour, if anyone has adrenaline pumping through them it can mean, for the mother, that it is not safe for her to give birth and so labour may slow down or even go backwards. Oxytocin, the hormone responsible for labour contractions, will decrease or not be released if adrenaline is in the body. It is possible for a womans’ cervix to contract from fully dilated to 7, maybe even 6cm if the situation is not safe for her and baby. Sometimes the baby will not come down the birth canal and labour suddenly stops if there’s too much tension and adrenalin in the room.

So how do you relax when you’re about to become a father, grandfather, grandmother, aunt or uncle? Read a book, try and sleep or practise meditating are all great ways to relax during childbirth. Leaving the room if you’re feeling anxious is the best way to unwind and relax. You’ll greatly benefit your partner if you are not present at times when you’re not coping with the situation so you can regain perspective and come back feeling refreshed and calm. Try and stay away from tea and coffee during the labour (especially because the smell of coffee can be very strong) as these drinks increase your adrenalin.

The first stage of labour, where the woman’s body is opening and stretching to allow the baby to come down far enough for her to start pushing, is very boring for those who are not feeling the contractions. The contractions will come and go at five to three or less minute intervals which can go on healthily for over 24 hours. If you cannot find a way to relax through this phase of labour you’re going to have a very uncomfortable wait! Childbirth is about being patient and relaxing into whatever unfolds for however long it takes. Practise relaxation and being still on a regular basis for at least four weeks before the baby is due.

BECOME INVISIBLE

Becoming invisible during the whole of the labour is essential for the birth of any mammal. Farmers and vet’s know full well that openly watching a sheep, horse or cow during the birth of their infant will cause major problems to the health and bonding of the mother and the baby both during and after the birth. The same is true for humans. All mamals need privacy during birth because an animal that is being watched during such a vulnerable time means that there is a predator around and will increase adrenaline levels in the mother allowing her to stop or slow down the labour so as to fight or run.

When in the birthing room with the labouring woman try and find a discrete corner to sit in out of the way. She will often hide her face or close her eyes which is great. Try not to interupt her or get her attention while she is doing this. Do not openly watch your partner or tell her how she looks/ sounds/ appears as this will get her brain thinking and cause her to come out of her ‘animal’, meditative state. However much you want to talk to your partner about how things are going try and refrain from doing so. The only reason you’ll be doing this is for your own good and will not help her. If she wants to talk try not to encourage her by getting into conversation with each other. Conversation will get her out of the relaxed and meditative state her body will naturally put her in to. Answer any questions with very simple positive language and a kind smile.

Sometimes during labour, a woman who’s in her ‘animal’ mind (the best way to increase the hormones and have a great and easier labour) will say and do some strange things. Making strange noises and movements are great and you can rest and relax knowing that she’s labouring really well. Remember to stay invisible and do not comment on any of this behaviour.

KEEP THE SPACE SAFE

Keeping the space safe during the labour and birth means a lot more than making sure cables are out of the way and the birthing pool water is the right temperature. Keeping the space safe means ensuring that the birth process is respected and kept uninterrupted. By being invisible and relaxed you are keeping the space safe. By ensuring the rest of the people in the birthing room are doing likewise is also keeping the space safe. Many midwives and doctors either don’t know or don’t understand the true birth process or don’t see the importance of keeping it in tact.

Interrupting the simple process of birth by watching the labouring woman, trying to get her thinking and answering questions, making comments that will make her feel self conscious, self pitying or fearful, keeping the lights bright or trying to get her to change positions and coaching her to breathe or push will all have a negative impact on the ease of the birth. Having a foetal monitor strapped to the labouring woman is also a source of observation and acts in the same way as someone sitting infront of her staring. Ask if it is possible for the midwife to use a dopler (a hand held instrument that listens to the baby’s heart beat) as this can be much less intrusive. The baby knows when it is being observed and may become distressed with a constant machine monitoring him/her.

It is your job, as the birthing partner, to ensure that there are only the essential people in the birthing room; the woman in labour, a midwife (not necessarily all the time) and yourself (also not necessarily all the time). Obstetrician’s sometimes like to come in to introduce themselves. You are allowed to ask them to leave or request that they do not enter the room if everything is going fine as the more people in the room the less privacy there is and the birthing woman should be left to relax and focus on herself and the baby. The more a woman in labour is able to focus purely on herself and the baby, the quicker and easier the birth. Your role is to create the space for that to happen.

As an add on to your role, the birthing partner acts as a voice for the labouring woman. It is therefore important that you know your birthing woman’s details (e.g. postcode, date of birth, national security/health insurance details), her medical history, allergies, time difference between the contractions, her birthing wishes (natural birth or types of medication or intervention she does/doesn’t want).

So, make sure that you are well fed, well rested, calm and happy to be in the birthing room. That is your job, nothing more and nothing less. By understanding the true importance of doing very little during the whole of the birth process you will be the best partner you can be and will know that the birthing woman is having the best possible chance for a natural and enjoyable birth.

Breathing for Pain Relief During Childbirth

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By Samantha Thurlby-Brooks
It does sound a little strange to say “remember to breathe” during labour, but you’ll be surprised how often we hold our breath in day-to-day activities, let alone while giving birth.When you’re experiencing any sort of discomfort, the immediate reaction is to hold your breath. This will cause you far more discomfort, as well as making you light headed, unfocused and increase your experience of pain as well as making you stressed and irritable.

To force your breath while experiencing any discomfort or intense feeling will also create muscle tension, even if you’re trying to breathe deeply. The ideal way to breathe during labour is to focus on your breathing. You don’t need to try to change your breath, just make sure you are breathing and stay focused on that. Pay attention to what part of your body you are breathing in to; your upper chest, your belly and the sides of your belly. Once you’re focusing on your breath it will naturally and automatically start to change and become more relaxed, full and deep. Whenever your attention goes to something else, bring your focus back to your breathing.

Essentially what you’re trying to do it to empty your lungs every time you breathe. When your lungs are empty you can allow the breath to come back to you in a relaxed way. Trying to force the breath in will create tension. Letting all the air out, and then letting your body bring the air back into your lungs will bring you a deeper relaxation.

Putting your attention to your breath throughout labour will help you through the contractions and help you to rest in between. You can also practise this breathing through the second stage of labour, as your baby is coming down and out, inbetween pushing. The old fashioned teachings of panting to try and stop yourself from pushing is now out-dated. Practise panting now and see how you feel. You’re likely to become very light-headed and feel disorientated; not something you want if you’d like to get the most out of your Joyful Birth. By breathing in a relaxed, deep and focused way, as described above, you’ll reduce your experience of discomfort and increase your feelings of empowerment and control.

Practise focusing on your breathing throughout your pregnancy; both you and your baby will benefit. You’ll find that you will be more relaxed and calm and once you go into labour you’ll be well practised at breathing correctly.

Simple tips to make birth easier & safer

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  • Stay Warm
  • Darkened Room
  • Quiet
  • Relax
  • Privacy
  • Feel Unobserved
  • Breathe
  • Trust Your Body
  • Eat Nourishing Foods, Drink Plain Water

Over the past few millions of years, humans and mamals have been giving birth without the use of hospitals, doctors or epidurals, for the most part, very effectively. The female body is designed to give birth very successfully and efficiently without the need for conscious control. In fact, the more you try to control the functioning and experiences within your body as you go through labour and childbirth, the more uncomfortable, stressful and prolonged your experience will be. Here’s why…

The thinking part of your brain, called the NEOCORTEX, is responsible for your intellect. This part of the brain, when stimulated, will try to rationalise, criticise, control and generally act very ‘human’ towards a situation. The neocortex is stimulated by language, bright lights, feeling cold, feeling observed and certain forms of touch. If this part of the brain is stimulated during childbirth, it will prevent the ‘mammalian’ side of the brain from functioning effectively.

During childbirth, if a woman’s neocortex is stimulated the whole birthing process will slow down. Being asked to think (for example asking what her phone number or postcode is, how frequent her contractions are or asking her to score her pain levels), being in a room with bright lights, being watched by one or more people or being touched in an irritating rather than relaxing way, a labouring woman will be taken out of her ideal state and become self-conscious, fearful and her muscles will tighten and create pain.

Allowing a labouring woman to relax and to ‘zone out’, turning off her neocortex, will make her labour more comfortable, faster and easier. This applies to the whole of the labour, from the beginning of the first stage right through to the delivery of the placenta. Staying in a non-thinking, meditative, animal state will help you to experience the birth of your child in a more Joyful way.

By understanding the process your body will undergo to allow your baby to be born will help you to feel more confident and relaxed.

During the first stage of labour, your uterus will be stimulated by the hormone OXYTOCIN to allow the muscles to pull up and outwards. This allows your cervix to become thinner and move out of the way to allow your baby to pass through your vagina. This means your cervix is dilating. Your cervix can dilate very quickly, so even if you’ve been having contractions for a while and you’re 5cm dilated, you may become fully dilated within an hour if you’ve allowed the conditions to be right (relaxed, unobserved, dim lighting and possibly contact with water).

With each contraction, remember that you are getting closer and closer to holding your baby in your arms for the first time. This is a Joyful process and your baby is looking forward to seeing you just as much as you are of him/her. Having negative thoughts and feelings about your contractions will make them feel even more negative. Feeling positive in your thoughts and emotions will allow the experience to be easier and faster.

Once your cervix is fully dilated (about 10cm), your uterus will respond by squeezing your baby’s bottom (if they’re head down) helping to push your baby downwards and out through your vagina. The wall of your vagina will already be lubricated by a pinkish substance to help your baby slip through. Make sure you’re still focusing on relaxing your breathing at this stage as your pelvic floor muscles around the opening of your vagina will need to be relaxed to allow a more comfortable birth. If your baby is in the ‘optimum position’ (chin to chest) then at the time of birth they help themselves to be born by wiggling and turning and lifting up their chin. This is the safest, quickest and easiest way for a baby to be born.

Just before the second stage of labour starts, you’re likely to feel a mix of emotions. It is at this point that many women opt to have drugs to ease the experience. A certain amount of pain during labour is very healthy and in fact essential for a Joyful Childbirth. Once your baby has been born, both of you will have a huge cocktail of hormones running through you, one of them being an endorphin that will make you feel fantastic and help with the bonding between you and your baby. By using painkilling drugs, you are likely to disrupt this cocktail of hormones and your experience of childbirth will be hampered.

Ask your midwife/medical carers not to offer you medication throughout your labour, and to only give you medication if you ask for it (in fact I would say if you ask for it more than once, just in case you can go without it). It is standard procedure to ask a woman if she would like medication, and during labour when it gets intense, you’re likely to accept anything. Encouragement, reassurance and a positive attitude will get most women through without medical pain relief.

During labour and the ‘crowning’ of your baby, you’re likely to feel the whole region as being very warm and expansive. Your bones, joints and muscles in and around your pelvis are making way for your baby and they’ve had nine months to prepare so are more than capable of doing this job. You won’t be the first or last woman to think you’re going to explode during childbirth as your body shifts and changes. But no woman has! In fact, some women orgasm at this stage because of the stimulation of all those wonderful, sensitive parts. It’s important not to be ‘coached’ through the second stage of labour so you and your baby can listen to your body and move and respond in a safe and instinctive way.

Once your baby is born, you and your new baby will both have a huge rush of hormones running through you. Dr Michel Odent discribes these as a ‘cocktail of Love’. It is very important for you and your baby that you are not disturbed during this time. Not only will it help with breastfeeding, but also with the bonding of you and your baby and your memory of childbirth. These hormones will make you feel full of life and love even if you’ve just come through a long labour. Painkillers can often disrupt this process. Ask your midwife to leave you alone with the baby for an hour following the birth so you can focus your whole attention onto your baby (if you ask for an hour, then if you get a bit less it’s better than asking for half an hour and getting a bit less). It is very important to STAY WARM at this time to allow the hormones to release.

The birth of the placenta, according to Dr Michel Odent is not too important… the only thing that is important is to allow the placenta to release itself from the uterus walls naturally. Using a synthetic drug rather than the natural release of oxytocin increases the risk of bleeding compared to being left alone with your baby to increase your own natural oxytocin release. Synthetic oxytocin may also inhibit the natural release of oyxtocin needed for breastfeeding shortly after birth.

The hormones that are rushing around your body during pregnancy and birth will be opening your emotions as well as your body. Feeling very open and vulnerable is very healthy and normal during childbirth and gives you the opportunity to let more feelings of love run through you. So long as you feel safe and relaxed with the people you are with and the place you are in, the birth of your child can be a truely Joyful and empowering experience.

Safe & Effective Pregnancy Massage

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BENEFITSMassaging a woman from 13 weeks onwards during her pregnancy is a fantastic way to keep a mum-to-be relaxed and comfortable as her growing body accommodates the new weight. To massage a woman before 13 weeks pregnancy, you will need to be highly trained. The main benefits of regular safe and effective mama massages are:

  • Relief of pain
  • Improved circulation for mother and baby
  • Improved immune system for mother and baby
  • Better sleep
  • A more relaxed attitude towards giving birth, and thus better birth outcomes
  • Better bonding between mother and baby
  • Improved chances of carry the baby to full-term
  • A healthier and calmer baby of good weight
  • Improved skin condition
  • Relief of headaches and possibly nausea

EXTRAS YOU WILL NEED

  • A firm, steady, thick pillow (we recommend the Mumanu®) for the leg plus a towel to cover
  • A thin cushion or towel for under the belly
  • Two towels or sheets for draping
  • A pillow to hold on to

POSITIONING

A pregnant woman should NEVER lie on her stomach. This is partially for insurance reasons, but also because the weight of the uterus will pull the ligaments on the mothers’ sacrum (lower back) and cause back ache (not what we’re trying to do!)

Unless you are specialist trained, do not massage any woman who is less than 12 weeks pregnant due to the increase risk of miscarriage. This is through nothing you would have done, but for insurance reasons stay safe. A woman who has lost her baby following a massage is more likely to accuse and sue you and cause bad relations than someone who had a sore muscle from a strong massage.

It is possible to have a pregnant woman of 13-22 weeks lying on her back with a supportive cushion under her hips/ buttocks, but any pregnant woman who is more than 22 weeks should not lie on her back for more than 3 minutes. She may be propped up to a seated position if you need to work on her front. Lying on her back, the weight of the uterus, after 22 weeks, is too much pressure for the vena cava (main vein running up the right side of the spine) and will cause breathlessness and nausea in the mother and nutrient and oxygen restrictions to the baby.

You will find it easier and generally safer to always massage a pregnant woman in the side lying position, asking her to turn over half way through so you can massage both sides effectively.

When lying on her side, the pregnant woman should have her knee and foot on a firm and steady cushion that is high enough for her hip to be at a right angle so her leg is not pulling on her hip and lower back. Make sure the foot is supported as this creates more comfort for the mother.

If her belly is feeling like it is pulling while lying on her side, the mother-to-be will need a small cushion or towel under her belly. Let her put the cushion there so she can make herself comfortable. Any woman who is more than 22 weeks pregnant will need the belly cushion even if they initially feel comfortable… 1 hour on a couch can change things.

Ask your pregnant lady to lie on the couch with her back as close to the edge as she can… this makes it more comfortable for you to massage her so you don’t have to over reach. Make sure that the cushions under her legs are close enough to her so her back and hips are not twisting.

Once you have made sure her leg is comfortable and the blankets are neatly in place you can then give your mother-to-be a pillow to hold on to like a teddy bear so as she doesn’t put any pressure on her growing, tender breasts.

You will need two towels to drape your pregnant client. Make sure one towel covers the legs and is tucked neatly into the lady’s undies, pulling them down far enough so you can work on the hips. And drape another towel over her back so it falls across the front and back of the woman. Ask her if she’s comfortable with a blanket over her as many pregnant ladies get over heated. Ask her if she’d like her feet covered or uncovered.

Make sure your pregnant client has a pillow under their head that is not too high or too low…their neck should be in line with their spine. If the pillow is too low for her she is likely to put a hand under her head, so you’ll know if she needs extra support.

Whether a pregnant woman has a large belly or not, always use side lying when giving a mama massage.

PRESSURE

You can use as much pressure as your client wants when working on the back of a pregnant lady. The lower back and sacrum is often very sore and stiff because of bad posture so working as strong as the client likes is good to help release tight muscles. The shoulders and neck are also sore spots for pregnant women and can be massaged as strong or light as your client requires.

The only place on a pregnant body that you must NOT massage is the inside of the legs. A pregnant woman has 40% more blood in her body which is thicker and prone to clotting. This is a great design feature for giving birth in case of hemorrhaging. Normally the clots will disintegrate naturally, but if you use pressure on the inner thigh and calves, or any shaking/percussion moves on the leg you may accidentally move a clot which could cause thrombosis (dangerous restriction on blood flow) and cause problems for mother and baby.

You can safely massage a pregnant woman’s feet with as much pressure as she is comfortable with. Massaging the feet has a different intention and effect than reflexology, so is not dangerous to the mother or baby. Reflexology can safely be given to a pregnant woman from 13 weeks onwards, so long as you stay away from the reproductive area and the pituitary gland as both of these can stimulate a miscarriage or premature labour.

If your client has water retention (puffy) hands and or feet, make sure you use very light pressure on these areas.

Some women really like their belly’s being touched when their pregnant, while others hate it. Ask the mother before the start of the massage if she would like her belly touched. If she would like it to be massaged, only use gentle pressure with the flat of your hand (no pushing or poking with fingers)

PRECAUTIONS

  • No massage before 13 weeks (unless you’ve had specific training)
  • No massaging the inner leg
  • No shaking moves on the legs
  • No massage for any pregnant lady who is bleeding
  • Always ask if there has been any complications, nausea, bleeding and if all their scans and tests have come back good.
  • Always ask the client to tell you if there are any sore/painful spots… never make the massage so strong it’s painful. The baby gets the same as the mum, so if she’s in pain the baby will be also. There’s a difference between a strong massage that feels good and a strong massage that is painful but the client thinks it’s doing good.

CONCLUSION

Pregnant women deserve to be massaged… so don’t be shy! If in doubt about massaging your pregnant client, don’t do it. Seek medical or other specialist health professional advice.

If you’re looking for comprehensive training in pregnancy, labour and postnatal massage visit www.bodytherapyassociates.com

Effects of nutrition during pregnancy & birth

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If you breed what isn’t healthy, you are bound to get offspring that aren’t healthy either”1By eating healthily and getting a good level of all the nutrients before conception, during pregnancy and into motherhood, a woman can build her stores to a safe level for her and her baby to thrive. Even if she finds she has morning sickness in the first three months and is unable to eat much her stores will be high enough to support herself and her baby.

The elements of a healthy pregnancy diet & the importance of quality foods during pregnancy
Each component of a healthy diet cannot function effectively by itself. Proteins, carbohydrates, vitamins and minerals are all needed to come together to create a healthy body and a healthy baby. A yummy cake is not the ingredients separately but the outcome of the ingredients mixed and processed together. Leaving out an ingredient will totally change the cake and make it something else entirely. The same is true for humans; if we leave out a nutrient, or do not have enough of it, then the person will not reach their full capacity.

Protein is used to develop every cell in the body, every hormone, enzyme and bodily process. Protein is used for muscle development, for brain functioning and for general energy levels. It is important to increase good quality proteins in the diet during pregnancy. Proteins are made of amino acids of which there are 20. 8 amino acids are essential in our diets because our bodies cannot create these particular ones. It is essential that the pregnant diet contains high enough quantities of these essential amino acids to help mother and baby thrive.

Fats are essential to a healthy diet but only in moderation and of the right type. Each cell has a membrane made up of a fatty layer which is important for allowing nutrients, waste and messages to pass through, allowing for healthy function and cell communication.

Carbohydrates (sugars) are used by the body for energy. Refined carbohydrates have been processed and are absorbed and used by the body very quickly. These include brown and white sugar, glucose and maple syrup. These types of carb’s are ‘empty’ as they contain little nutritional value and are not needed if the diet is balanced properly with unrefined carbohydrates. Wholemeal flower, brown rice, fruits and potatoes are good sources of unrefined carbohydrates and contain other nutrients and fibre to give an even better diet.

Vitamins are essential for any healthy diet. Each vitamin has an essential role to play in bodily processes, immunity and emotional well-being. Some vitamins are stored by the body, such as vitamin A, whereas others are used and released as needed, such as vitamin C.

Minerals are needed in small quantities for a healthy, balanced diet. Iron, for example, is needed in blood to help carry oxygen to each cell as well as producing proteins and enzymes. Magnesium is essential for a healthy nervous system. Calcium and phosphorus are required for healthy bones. Iodine is essential for healthy thyroid function.

Zinc is essential for healthy growth and brain and nerve formation. It is often needed to work together with other minerals and helps produce enzymes, speeds healing and is essential for breastfeeding.

So it is important to contain all of these aspects of food, in their natural state (not in tablet form) so as to obtain the right balance and encourage the best absorption for the body to function optimally. The recommended daily intake of each of these food groups only states what is recommended to prevent illness. What we really need to eat are optimum levels of nutrition so as to maximise our full potential and have the healthiest mother and baby we can hope for.

Poor nutrition and the link to pregnancy/birth complications
Deficiencies in Zinc can cause depression, skin problems, diarrhoea, eye problems and limited growth.
Animal studies indicate that maternal zinc deficiency can upset both the sequencing and efficiency of the birth process. An increased incidence of difficult and prolonged labour, haemorrhage, uterine dystocia and placental abruption has been documented in zinc deficient animals. These effects may be mediated by the defective functioning of oestrogen via the oestrogen receptor, which contains a zinc finger protein. A review of pregnancy outcomes in women with acrodermatitis enteropathica, reported that out of every seven pregnancies, there was one abortion and two malfunctions, suggesting the human foetus is also susceptible to the teratogenic effects of severe zinc deficiency. However, a review on zinc supplementation trials during pregnancy did not report a significant effect of zinc supplementation on neonatal survival… In rats, the “first visible sign” of zinc deficiency is a decreased appetite.”2

A deficiency in iron will cause tiredness and breathlessness, and has been linked to maternal and foetal death during childbirth. 3 Pregnant iron levels indicating deficiency are much lower than non-pregnant women (because of the increase in blood volume), but they are often prescribed supplements when they may not need them. Supplements can cause problems such as constipation and knock out other nutrients such as zinc.

Folic acid is a B vitamin that has had much research and news coverage over the last few years. It has been found to be very beneficial in preventing neural tube defects (defects with the spinal cord, brain and skull development) in babies. 4 Mothers who are deficient are at a higher risk of having a miscarriage, still birth or a very sick child.

Protein, antioxidant and fatty acid deficiencies have been linked with pre-eclampsia and eclampsia (toxaemia). Low protein causes water to leak out into the tissues from the blood circulation 5 , causing water retention (oedema) and high blood pressure. In her book Ina May Gaskin cites her statistics for The Farm’s toxaemia levels. Out of 775 women, only one had toxaemia 6 . She puts this down to the healthy vegetarian diet, specifically high in protein. Her 0.1% rate of toxaemia is in significant contrast to the standard USA rate of 14-20% of first time mothers and 6-7% of women who already have babies.

By measuring the serum osmotic pressure of 65 pregnant women, all at seven months gestation, Strauss [Am J Med Sci 190, 1935] demonstrated that the pressure was directly related to protein intake. Serum osmotic pressure, serum albumin, and dietary protein were highest among the 35 non-toxemic women in the study, second highest among the 20 women who had non-convulsive toxemia, and lowest among the 10 women who had eclampsia.” 7

Weight gain
There is new research that suggests that;
Individuals who experience a poor diet in the womb are less able to store fats correctly in later life. Storing fats in the right areas of the body is important because otherwise they can accumulate in places like the liver and muscle where they are more likely to lead to disease.

“Professor Anne Willis of the MRC Toxicology Unit at the University of Leicester explains “One of the ways that our bodies cope with a rich modern western diet is by storing excess calories in fat cells. When these cells aren’t able to absorb the excess then fats get deposited in other places, like the liver, where they are much more dangerous and can lead to type 2 diabetes.

“The team found that this process is controlled by a molecule called miR-483-3p. They found that miR-483-3p was produced at higher levels in individuals who had experienced a poor diet in their mother’s wombs than those who were better nourished.

“When pregnant rats were fed low protein diets their offspring had higher levels of miR-483-3p. This led to them developing smaller fat cells and left them less able to store fats in adulthood. These rats were less likely to get fat when fed a high calorie diet but were at a higher risk of developing diabetes. Rats are known to be a good model for studying human dietary diseases and the team also found that miR-483-3p was present in elevated levels in a group of people who were born with a low birth weight.” 8

Weight gain during pregnancy is a very shady topic. In the ‘80’s women were told they were eating for two. This lead to a lot of unhealthy weight gain as women were eating two pieces of cake and filling up far too much. This has led many health professionals to restrict the diets of pregnant women and stop them from gaining too much. This in turn can have damaging effects.

A small baby does not need the diet of a grown adult. However, they do need extra nutrition so a pregnant woman should be encouraged to eat more (healthy food) than she would before pregnancy.

Oxytocin, the hormone of relaxation, love and bonding, increases during pregnancy. There are oxytocin receptors in the digestive tract which helps with the absorption of nutrition. This increase will help the pregnant woman absorb more to feed her baby. She may not be used to these higher hormone levels and may store fats that she wouldn’t normally on the same diet (being stressed will inhibit oxytocin… a common condition of today’s busy person).

Several studies have demonstrated the negative effects of obesity on various physiological pathways. Such outcomes resulting from excessive weight gain during pregnancy include increased risk of developing breast cancer, increased birth weights in offspring, augmented probability of developing obesity or metabolic syndrome in their lifetime, development of gestational diabetes, and the possibility of delayed lactogenesis (failure to lactate for more than 72 hours postpartum).” 9

When reading reports such as this, it’s important to keep in mind the types of people they were researching and the limitations of the research. These are rarely discussed in media articles. It could be that the women who had problems had a very unhealthy diet and lifestyle. Other women may keep putting weight on but they are eating healthy foods and taking exercise. It is also very difficult to attribute maternal weight with breastfeeding issues since there are so many factors that can prevent a woman from confidently feeding her baby that have nothing to do with her weight. Given the low rate of breastfeeding across the ‘developed’ world I do not think we can put the blame on something like weight gain.

The current thinking about salt intake and pregnancy
The recommended daily intake of salt is around 1 teaspoon. Salt (sodium) is found in many foods such as Okra, celery, strawberries, apples, milk, cheese and other foods that have salt added such as bread, processed meats and canned vegetables. Sodium helps to keep the stomach wall alkaline to secrete enough hydrochloric acid for digestion.

The typical American diet will have 1-3 teaspoons of salt daily. High salt levels have been linked with high blood pressure, heart failure, water retention, kidney stones, breathing difficulties, gastric ulcers and hormone imbalances.

So, naturally, when thinking of pregnancy, medical professionals have had a tendency to restrict salt intake with the belief that it could cause all of the above.
However, pregnant women have a different physiology from the rest of the population. Salt restriction during pregnancy restricts the normal expansion of blood volume causing problems to the placenta’s development such as dead tissue that reduces nutrients to the baby. Sometimes the placenta may separate from the uterine wall. When salt levels are low the kidneys release a hormone called Rennin into the bloodstream, influencing other hormones that cause the small arteries to constrict. This in turn raises the blood pressure even higher. 10

Reducing salt may affect the pregnant woman’s appetite as food tastes different. This may lead to lower food consumption and deficiencies in other food groups. The kidneys will excrete less water to conserve salt levels which can lead to water retention/oedema. Sodium helps fluid balance for the mother and for the amniotic fluid for the baby.

Salt should be eaten to taste in healthy diets. Diets with lots of processed and canned foods should not need more salt.

Sugar and caffeine
Sugar is very addictive and the more you have the more you want. This may also be true for babies; the more sugar a pregnant woman eats, the more the baby will ask for. The fear is that the more sugar a woman eats, the more likely she will get gestational diabetes and cause her baby to be overweight. Henci Goer is very dubious as to the reality of gestational diabetes and its risks, and even more dubious about the treatment for it (restricted diet and/or insulin injections).

The standard GD diet is a good one; adequate calories, limit simple sugars, moderate fat intake, eat whole grains and plenty of fruits and vegetables and eat smaller meals more frequently. Also beneficial is the advice to engage in moderate, regular exercise. If that was all that happened, identification as a gestational diabetic would be a good thing. Some tracking of blood sugars to make sure they aren’t drifting into the true diabetic range is probably also a good thing, as is identifying the one in a thousand women who has or will develop glucose values in that range. However, most women will find themselves caught up in frequent doctor visits, multiple daily blood tests, restrictive diets, possibly insulin injections, repeated foetal surveillance tests and a considerable chance of a labour induction or caesarean section.” 11

I’ve had women come for massages who have been diagnosed with gestational diabetes, they’ve been put on a restricted diet (more restricted than Henci’s suggestions above) and now have a baby who is under weight for gestational age and she is also losing weight. She wasn’t even particularly big in the first place.

During pregnancy the woman’s insulin levels need to be able to fluctuate according to what her baby is asking for. She needs sugar in her blood to be able to feed her baby. However, sometimes this may look like diabetic blood because of the high volumes of sugar, but at a different time of day, or different point in pregnancy, things are back to normal. A pregnant woman’s insulin levels are rarely broken, they’re just different from the non-pregnant body.

I found this article about research done with rats and the effects of caffeine on the unborn baby with the conclusion;
“...Thus, it seems that early caffeine exposure, even at quite low doses, is able to induce a wide variety of neurochemical changes. These deficits concern both constitutive material such as proteins, DNA and RNA, and functional material such as neurotransmitters and ions.
“Offspring of female rats exposed to 60 or 100 mg/kg caffeine in their drinking water throughout gestation have reduced learning capacities as adults in a novel environment. In an open field, these animals also spend less time grooming, playing, and touching new objects. The authors concluded that the behavioural effects induced by prenatal caffeine exposure could be related to the “hyperactive” children syndrome
(Sinton, C. M. et. al., 1981).” 12

I read a blog post a while ago about a woman whose unborn baby was thought to be in distress on a routine medical check. The baby’s heart rate was unusually fast so they took her to hospital where she was then sent to another hospital with more equipment for testing. With each change in location the baby’s heart rate became more normal. It wasn’t until a clever doctor asked the mother what she had been eating/drinking shortly before the visit that they discovered that she had eaten a large amount of chocolate. They found that the baby was sensitive to the caffeine and was responding to its stimulation with a fast heart rate. I can’t find the blog anymore, but I remember the woman being very grateful that the baby was going to be ok and they weren’t going to induce her so she could go home and wait for labour and have her planned homebirth.

Vitamin supplementation
Folic acid supplementation for one month pre-conception until 12 weeks of gestation is recommended for preventing neural tube defects.
If a diet is healthy and balanced with fresh foods as close to their natural state and there is plenty eaten regularly, then there should be no need for the average person to take supplements.

In the past 100 years we’ve seen different fashions for dieting, restrictions on certain foods and general confusion with what constitutes a healthy diet. Fast food, foods that contain unmarked ingredients and processed foods that have not been tested properly will all contribute to deficiencies and health/emotional issues. Many people find it very difficult to change their diet and so for those with poor eating habits who are not prepared to change, vitamin supplementation would be advised.

Depending on the supplement, how it was produced and what it contains will determine how useful it is, how the body absorbs it and whether or not it is causing more damage than good. It’s always advisable to get supplements from a nutritionist or naturopath who can recommend the correct supplements for the individual.

Tran’s fats and foetal brain development
Hydrogenated fats are the unhealthy, tran’s fats that increase health problems such as obesity, heart disease, depression and ME. Here’s how…
Each and every cell in the body has a fatty membrane that protects the cell as well as allowing nutrients, waste and messages to pass through, keeping the cell and the person healthy. This membrane is a double fat layer. Each fat molecule looks a bit like this O~ and so in the cell’s membrane they look like this O~~O The wiggly part of the fat molecule is where the messages and nutrients are passed through. When a fat is heated it picks up hydrogen atoms. This creates a tran’s fat, or hydrogenated fat. These new fats molecules are hard and make the membrane look a bit like this O=O and make it a lot more difficult for nutrients and waste to pass through. When a cell has a membrane like this, healthy fats (O~) are not able to join and so they are deposited around the body as fat stores, increasing body weight and straining the body.

Every nerve cell contains a fatty membrane. The brain contains millions of cells, each requiring a fatty membrane.
Myelin, the protective sheath that covers communicating neurons, is composed of 30% protein and 70% fat. One of the most common fatty acids in myelin is oleic acid, which is also the most abundant fatty acid in human milk and in our diet.
“Monosaturated oleic acid is the main component of olive oil as well as the oils from almonds, pecans, macadamias, peanuts, and avocados.
” 13

When a diet is high in hydrogenated fats (margarines, ingredients in many pastries and readymade foods), the cells get a hard fatty membrane and are unable to communicate with each other effectively. If a pregnant woman is eating lots of hydrogenated fats then her baby will be growing cells with in-efficient membranes, their brain formation as well as cognitive and emotional capacity will be impaired and they may gain excessive weight.

Healthy, natural fats produce healthy, happy people.

Importance of water
Given that we are made of 70% water, it’s not surprising a pregnant woman will need to increase her water intake. With the increase in blood volume (by 40% or more depending on how many babies she’s carrying), the need for amniotic fluid and the water required to grow a baby, a pregnant woman will need to drink at least 2 litres of water a day.

Drinking plenty of water helps to keep the blood pressure balanced, keep the amniotic fluid at a healthy level and helps with concentration. Water is used in all of the body’s processes so it’s essential to have enough clean water for optimum health.

Amniotic fluid is essential for proper foetal development and provides your baby with protection and buoyancy. The effect of oligohydramnios [not enough amniotic fluid] on the baby depends on the cause, the stage of pregnancy during which it occurs, and how little fluid there is.
If it occurs in the first half of the pregnancy, oligohydramnios can cause foetal abnormalities of the lungs and limbs, poor foetal growth, and increases the risk of miscarriage, preterm birth and stillbirth. Your baby “breathes” the fluid into its lungs and swallows it, promoting healthy growth of his or her lungs and gastrointestinal tract. Too little fluid for a prolonged period may cause abnormal or incomplete lung development, called pulmonary hypoplasia. The amniotic fluid also promotes normal development of muscle and bone by allowing your baby to move around within the uterus.
” 14

So it’s really important to drink plenty of water, and reduce dehydrating drinks such as those with caffeine and/or sugar.

How emotions and food are related
Getting a healthy intake of food during pregnancy is important for the mother and baby’s wellbeing. The way we live our lives teaches children how to live theirs. If a mother does not eat healthily during pregnancy she is teaching her unborn baby to eat unhealthily. The effects of poor nutrition go beyond low energy as the resulting emotional and psychological imbalances created also teach the baby how to respond to life.

Good nutrition affects how we eat, sleep, act and think. It affects everything about us- our work, our moods, our ability to relax, our sex lives, our patience with our children- everything. It affects how well we grow our babies and how well our uteri contract. It affects the elasticity of our cervix, and our stamina during labour.” 15

Oxytocin, the hormone of relaxation, love and bonding, increases during pregnancy. There are oxytocin receptors in the digestive tract which helps with the absorption of nutrition. If we are stressed or upset our oxytocin levels go down and our stress hormones go up. This means we cannot absorb as much nutrition and we suffer deficiencies as a result.

The body doesn’t know the difference between reality and imagination, so even watching something stressful on television will reduce oxytocin and cause stress on the digestive system.

The most important facts about good nutrition to include in a class
I often say to my massage clients, would you feed that to your baby and expect them to be healthy on it? I think this is the key to good pregnancy nutrition. You wouldn’t feed your baby a cup of coffee, a glass of wine or a can of coke. You would want your baby eating lots of fruit and vegetables and quality protein.
This doesn’t mean you’re not allowed a piece of cake now and then or a coffee occasionally. It’s about creating balance with optimum nutrition to create a person that is the healthiest they can be. Everything you eat goes towards making this new person, you are literally building them through the food you put into your stomach.

Eat plenty of protein, unrefined carbohydrates, natural fats, vitamins and minerals all as close to their natural food state as possible.

Advice for vegetarians
Women who are vegetarian may have different nutritional balances than meat eaters. So long as she has been a vegetarian for a very long time her iron, B vitamin and zinc levels will be normal for her even if they are considered low for most other people. She will still be able to function well and produce a healthy baby. If she has been vegetarian since adulthood, it is believed that her baby is in more risk of these deficiency problems because she is not used to the lower levels of iron, B vitamin and zinc than when she was a meat eater.

So long as a pregnant woman gets all of the important food groups, vitamins and minerals, proteins and carbohydrates, fats and oils, she will produce a healthy baby.

Concept of holistic nutrition
Holistic nutrition is about all the elements that are taken into the body, not just about food, but about the emotional, social and psychological information that the body receives each day. Focusing on negative situations such as watching the news, complaining about people, working in an environment that is depressing, listening to other people criticising, watching scary films etc., will inhibit the optimum functioning of the mind, the body and the spirit.

References

1. Wainer Cohen, N & Estner, L.J (1983) Silent Knife; Cesarean Prevention & Vaginal Birth After Cesarean. Bergin & Garvey p.125

5. Nobel, E. (2003) Having Twins & More. P.130

6. Gaskin, I M, (2003) Ina May’s Guide to Childbirth. P.187

10. Nobel, E. (2003) Having Twins & More. P.179

15. Wainer Cohen, N & Estner, L.J (1983) Silent Knife; Cesarean Prevention & Vaginal Birth After Cesarean. Bergin & Garvey. P.125

Why & How to Relax During Childbirth

Relax… your body knows what it’s doing so you don’t need to do a thing! You don’t need to think about what comes next or what position you should or shouldn’t be in, or whether you’ve left the iron on! You’re having a baby and your body loves it.When your baby is ready to be born it will signal to your brain that large pulses of oxytocin is needed to start the process of birth. Oxytocin is a hormone of Love according to Dr Michel Odent and has been well documented and studied as such. Not only is it released during childbirth, but this wonderful hormone is also released by both men and women during orgasm, when looking into the eyes of a loved one, when sharing a candlelit meal and basically whenever doing anything that makes you feel love and bonding. It is interesting then that at a time when it is released in its highest doses (during childbirth) we relate the experience to pain and suffering. Surely if this hormone of love can create euphoria during orgasm, it can create feelings of Joy during childbirth.

The key to this is the ability to relax. During sex, if you had the lights on full, had a cold draught breezing over you, were trying to have an intelligent conversation and had a couple of people staring at you, it’s highly unlikely you’ll manage to orgasm from the experience! I suppose it depends on your sexual preference… but most people, men and women, would agree on this issue. So then, given that huge amounts of this hormone are needed during childbirth it is even more essential to turn the lights down low, switch off your thinking brain, stay warm and have some privacy.

Oxytocin is inhibited (blocked) by the release of the hormone Adrenalin. Adrenalin is the famous ‘fight or flight’ hormone that is released in times of stress and fear. It gives the body a boost of energy, increases awareness and allows the muscles to tense and the breathing to quicken so as to run or fight. Pretty much the opposite of the Love hormone Oxytocin. When Adrenalin is released during labour the body thinks it is in a dangerous situation and will often slow the labour down so as the woman can either fight or run and protect her unborn child.

During childbirth, any form of stress and tension the labouring woman is exposed to will slow down the whole process. A labouring woman must feel safe in her surroundings and with the people she is with in this situation in order to relax enough for adrenalin to stop being released. Other causes of adrenalin release, besides feeling unsafe, are; feeling cold, eating/drinking sugar, other people releasing adrenalin (it is a contagious hormone) and moving around too much.

The best way to relax during childbirth is to breathe. No matter where you are, who is around or what birth stories you’ve heard in the past, breathing will help you through the contractions and allow you to stay focused and calm.

Top tips to stay relaxed:

  • Keep Warm
  • Breathe
  • Trust your body
  • Keep your feelings positive

The more you practise feeling positive before labour, the easier it will be to feel positively during labour. Having positive feelings will make the whole event seem quicker and more enjoyable, rather than a struggle. If anyone around you expresses themselves in a negative way, either ask them to leave, change their attitude or turn their negativity into a source of determination and inspiration.

For example, “you’re only 5cm dilated” can make a woman feel like she’s failing, having done so much hard work and her body still isn’t ready. On the other hand, you could turn the statement around and say/think/imagine “I’m 5cm dilated, let’s imagine my cervix as 10cm dilated”. You’ll be surprised how changing your thoughts, images and statements will have a direct impact on your experience of childbirth and can even make physical changes very quickly.

You’re having a baby! This is the last time you and your baby will be so intimate with each other, so relish in every moment. Each contraction brings your baby closer to your arms and will make you a mother. Bring your baby into the world as you would like to be brought into the world. Allow yourself to be born as a mother as you wish to carry on as a mother.