Doula Say Relax – Part 1 of 2

Relaxation is an important part of birth preparation, but that statement may not be as self-explanatory as it seems. In truth, there are a variety of things that I could be referring to that are all equally important in terms of prenatal life as well as preparing for labour itself.

This article describes the important exercise of practising relaxation during the prenatal stage and provides instructions for daily relaxation practice. The focus is on the benefits of truly relaxing, through mindful meditation from a physiological perspective. Given the relationship between a pregnant woman and her growing foetus, any positive impacts on the woman’s body as a result of increasing relaxation (increased blood flow, improved oxygenation of blood, reduced blood pressure, etc.) will amount to positive impacts for the foetus as well. In addition, a healthy pregnant body is a good place to start from if your goal is a smooth and healthy labour. Studies have shown that women who practice relaxation techniques prenatally tend to have shorter and more straightforward labours.

In addition to the physical repercussions of relaxation and how prenatal relaxation practice can impact subsequent labours, there are also benefits for learning relaxation techniques prenatally (or pre-conception) so that they can be used as coping measures during labour itself. Penny Simkin frequently notes the importance of the three Rs for labour: Rhythm, Ritual, Relaxation. Rhythm and ritual tend to come naturally to women when labour begins – most begin to breathe, vocalize and/or move in a rhythmic fashion during contractions, which can help with managing pain and discomfort. Ritual can be anything that a woman relies on (and again, this is not something you need to plan for, women tend to find or create their rituals when labour begins) to get through their contractions. Some women have mantras that they repeat in their minds, some may use hand motions, some focus on an object or image either in the room or in their minds, etc. The rituals often become tied to the rhythm, so that the two things work in tandem. This is useful information for birth partners – as the woman gets deeper into her labour, especially as she approaches or enters transition (when the cervix does the last of its dilating), she may lose her rhythm as a result of fear or anxiety because of the intensity of the contractions during this stage. Helping her to find her rhythm again can make all the difference and is often not difficult for the partner who has been paying attention to the woman throughout labour.

Relaxation during labour, on the other hand, is easiest to achieve when learned and practiced prenatally and may require reminders and assistance from your support team. If you are already comfortable with a style of meditation, it will be much easier to use it during labour than if you try to use that same approach without much prior exposure or experience. It may wind up being more distracting and annoying than helpful if you have not become used to it beforehand. If you do learn and practice a meditation style ahead of time, it can be easy and quite natural to rely on it during labour.

Slow breathing during contractions is extremely helpful for managing the sensations of labour and whether or not your partner and doula are reminding you to keep it slow, it is often much easier and less distracting if you are already used to this type of deep, mindful breathing. If your preferred method of meditation or relaxation practice involves vocalization, such as an ohm or other slow, low repeated sound, that can often be soothing during a contraction. An open mouth and low sounds help the cervix to dilate and help to keep all of the tissues of your body to relax. Again, while many women are open to and successfully rely on these kinds of sounds during labour, whether or not they have used them as part of a meditation practice before, those who do practice ahead of time often find that they are more comfortable with them when they use them in labour.

Keep in mind that if you are planning a hospital birth you will be in a public place, where people you don’t know will be able to hear you. The more comfortable you are with vocalization, the less this will bother you when you are in labour. If you are nervous about the prospect of making sound during your labour, discuss this with your partner and your doula. Many women find that having someone vocalize with them removes the element of self-consciousness. I had one client who practiced a meditation style called Japa. Prenatally, she informed me of the practice and I asked to borrow the materials that she had on it (a book and a CD) so that I could familiarize myself with it during her pregnancy. I learned about the theory behind it and practiced it regularly. When she was in labour I was able to recognize what she was doing as she made the “ahhhhhh” sound of Japa meditation and I knew already that she hoped to have someone vocalize with her (because she was worried about feeling embarrassed) and was able to jump right in. When she struggled through transition, I suggested that she try using it again to help herself cope. She declined that offer and opted for a different comfort measure, but I was still happy to have been able to offer it to her as one of many tools for coping. The other benefit to using a meditation style prenatally and having your doula and/or partner vocalize with you, is that many people find the multiplication of voices to be energizing and soothing. Think of the difference between an ohm that you say alone in your bedroom and one that you share with a roomful of people in a yoga class. There is a harmony that emerges that is always beautiful and resonant.

Hypnobirthing is one way of learning to relax for labour and birth. With this method, you take classes where you and your partner learn positive birth affirmations and methods for entering a trance-like or hypnotic state and you practice them daily at home. Then, when you are in labour, you use on those affirmations and techniques to enter the hypnotic state. Women who practice hypnobirthing are able to achieve a deep level of relaxation between contractions, which affords them greater rest and prevents fear and anxiety from creeping in. They are also more suggestible when in this state, which means that the verbal encouragement given by their support people is even more effective in helping to keep their mood elevated and let their bodies open up. I can recommend Hypnobirthing instructors in Toronto – feel free to contact me if you are interested.

Relaxing during labour and during the second stage are important for letting your body do what it needs to do, without interruption from your neocortex, which may otherwise be inclined to send you messages of fear, doubt or anxiety. Those kinds of thoughts can encourage the release of catecholamines, stress hormones, which initiate a fight or flight response in all mammals. That response can slow or even stall labour. Contractions can stop and dilation can even potentially reverse. Once you are fully dilated, and entering the second stage (i.e. the pushing stage in which your baby is born), you will need to be able to relax the muscles of the pelvic floor to allow your baby to emerge while your tissues stretch. Practicing perineal massage from week 35 on not only prepares your tissues to stretch (so that they aren’t doing it for the first time when your baby’s head is coming out), but it also prepares you for the sensation of that stretching. I recommend practicing slow breathing and even vocalization while performing prenatal perineal massage so that you can learn to relax even while experiencing the stinging or burning sensations that accompany the stretching of the perineum. Partners can help with the massage and pay attention to how their partner responds – does she tense up? If so, how can you tell? Does it show in her face? In her shoulders? What words or actions help her to relax and let that tension go? You can use that information during labour and second stage to remind her to let go.

In Part Two of this post I will talk about a different kind of relaxation – that is, the process of getting comfortable with the realities of labour and birth and the terminology that accompanies it. This side of the relaxation coin is much more intellectual in nature, but it will further enhance your ability to open up and let labour flow.

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