labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Wednesday, January 30, 2008


You see how relaxed this gorilla is? (Unfortunately, it looks like it's in a zoo... which is nothing to be relaxed about but this post isn't about how much I hate zoos). I have a point to make with this, trust me.

One mistake women who want epidurals make is ignoring the importance of relaxation and comfort techniques are for labor contractions. Seems like a logical assumption to make that if you are going to get an epidural you don't really have to deal with pain and discomfort. But I've seen many a woman quite surprised that they were left without any coping skills when they were waiting for that epidural.

I know I've mentioned before that epidurals just can't happen in the blink of an eye. This is for several reasons. One is that most anesthesiologists will not administer an epidural without a blood count with a platelet level. And your 28 or 36 week CBC doesn't count. They want it from that day. So you have to wait for the lab to be drawn and results to come back. Even a stat CBC can take 30 minutes. The other thing is that you need an IV and be hydrated with a minimum of 500mL of IV fluids to hopefully counteract the common side effect of hypotension. This can also take 30 minutes, or more given how quickly and available the nursing staff are to get that IV going.

And then there is the matter of the anesthesiologist to go over risks and benefits with you, sign a consent form, and then prepare for the epidural itself. It can take 15-30 minutes to place an epidural depending on the anesthesiologists skill and your spinal anatomy. So we are talking a minimum of 45-60 minutes from the time you walk into the labor unit to get an epidural in the best cases.

Oh, and don't forget that it takes 10-20 minutes for the epidural to take some effect once it's placed. I have seen some get instant relief, but that was perhaps 3 times that I can think of.

My point to all this is that those who plan an epidural (and this post is by no means meant to be pro- or anti-epidural) is that you need to know how you will cope with your contractions. Being prepared for contractions isn't just for those women who plan to do it sans medications.

In my childbirth ed classes, I focus on relaxation techniques. I use several different types because not everyone finds each on as effective. As an educator, I find it terribly frustrating that no one really wants to do them when I present them (and then will complain on their evaluations that there wasn't enough relaxation taught! Ah!) for whatever reason. I make everyone shut their eyes to eliminate the awkwardness and fear of others watching you deep breathe, etc but some won't even do that. But I digress....

I will share some of these techniques, which I find very easy to start, that women can do to help prepare for their contractions. I've found those who find themselves some sort of relaxation they can do early in their pregnancy and consistently practice do very well with the real thing. Hypnobirthing tapes are especially effective in my personal experience.

In both relaxation techniques I describe below, find yourself in a comfortable place. It doesn't matter if you are sitting or laying down, just make sure it's a position that you can maintain throughout the exercise. You can play soothing music or white noise, or nothing at all. Completely up to you.

One relaxation uses progressive muscle relaxation. First start with slow deep breaths, as many as it takes for you to feel your body relaxed. There should be no tension in any part of your body. If you are finding that you aren't fully relaxed, focus on relaxing that part of your body with each exhalation.

Once you feel completely relaxed, tighten up a part of your body; easiest is starting with making fists. While you hold that part of your body very tight, focus on the rest of your relaxed body. You will likely need to use some sort of rhythmic type breathing to keep your body relaxed despite the tensed part. After about 30 seconds, relax your entire body. Release all the tension while taking slow deep breaths again. Then once your entire body is relaxed and you are breathing normally, tighten something else and repeat what you did the first time.

I like the next relaxation because I feel it mimics the type of relaxation needed by using real discomfort. When I do it in my class, it usually gets people talking and finally getting involved!

Get yourself a large bowl of ice water. The bowl needs to be big enough to place your hand or hands in. You'll likely need a towel as well. Then set yourself up in a comfortable position with the bowl of ice water in a place where you can easily put your hands in it without moving your entire body. Lay the towel out in a place where you will rest your hands when they are not in the bowl.

Now, for shits and giggles, the very first time you do this I want you to just place your hand(s) in the bowl for one full minute. No cheating, either. You have to keep your hand(s) in the bowl no matter how uncomfortable it is, and make sure that all you are doing is watching the clock. No TV, no music, no one talking to you. Once you've done that, remember what you were thinking and feeling during that minute you had your hand(s) in the bowl.

Ok, now for the real thing. Make sure everything around you is comfortable, the room temperature, your position, your clothing, any background noise, etc that you find relaxing. Once you have everything, including your ice water and towel, set up, close your eyes and just take note of your body. Take slow deep breaths to get everything relaxed. Once you feel relaxed, put your hand(s) in the bowl. It may be helpful to have someone tell you when to put your hand(s) in and count that minute before you take it out. Or set a one minute timer that will beep every minute.

Now, when your hand is in the bowl, continue with deep rhythmic breathing or some type of visualization that keeps your entire body relaxed. Some people will do both, using the deep breathing while thinking of something they find comforting. If someone is with you, you can even have them add some massage or light touch if you want.

When that minute is up, take your hand(s) out and gently place it on the towel while keeping your body relaxed. You'll probably find that when you first take your hand out you'll need some deep cleansing type breaths to get everything relaxed.

Do this for a couple of rounds; increasing the number of rounds each time you do it.

Most people say that the minute spent with their hand in the ice while not doing anything to stay relaxed seemed longer than the minute when using use breathing and visualization.

Once you feel you've mastered this, add some background distraction, especially if you are having a hospital birth. I say this because you can't control the hospital environment like you can your house, and so you need to know you can stay relaxed when there is something trying to break your concentration. And let me tell you, most hospital units are noisy!

So back to that picture. The goal is to get you as relaxed as that gorilla between your contractions; and if possible, even during! It may seem like its a lot of work to be relaxed, but imagine the energy expended on writhing around with panic when a contraction comes along. That takes a whole lot more energy.
I've only touched on some very basic relaxation techniques. I also mentioned comfort measures, which refers to position changes, water therapy, birthing balls, and other things that can help a woman manage her contractions. I won't post about that right now, but there are a lot of things that can be done to help while waiting for that epidural. And believe it or not, I've seen some women decide that they are able to do without the epidural when using relaxation and what not. Imagine that!


Sheridan said...

THANK YOU! This is SO true. When moms say, I just want an epidural and then go on to do no preparation for birth, I worry about them. I did have a friend who said that, got to the hospital at 9cm and was told she didn't have time for the epidural. She was doing fine until they told her that... managing well... then freaked out. She said she would have pushed the baby out about 15 minutes earlier if she wasn't freaking out.

The relaxation ideas are great! I of course am a huge believer in that. I used Hypnobabies to stay relaxed and comfortable during my last birth with no drugs at all!

Hilary said...

That is the same speech that I gave my doula clients and other people about epidurals. It does not mean a labor free birth. It is always good to know what is normal and have some coping mechanisms, and to be prepared for what the hospital experience will be like.

razorbackmama said...

Relaxation has been The Key to managing my contractions for my last 3 births (I've had 6). The first 3 I used Lamaze. Lemme tell ya, all that funky breathing made for one tense uterus! But then I read about relaxation and used it with #4. WHAT A DIFFERENCE!!!

A tense abdomen is a painful abdomen, that's for sure! ;-)

mommymichael said...

what i find funny is that is all basic hypnosis. but people fear hypnosis because they think they'll be in a trance, when really... they're not!

Vanda said...

I wish I had given birth in the last couple of years than more than 40 years ago.

Oh wait, omg who would want a baby at my age? LOL.

Jay said...

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Joanne said...

Don't forget that epidurals don't always work! Imagine spending your pregnancy planning to get an epidural as early as you can in the labor, and thinking you don't need to worry about learning coping skills to deal with active labor contractions . . . then only to have an epidural that does not take, or has huge windows, or whatnot. These things have happened to women I know, and it made the situation much more difficult that it might have been if they had done some minimal preparation for labor.

Nine Texans and friends.... said...

Thanks for this post!
I don't know HOW MANY women I have tried to educate about this. All these women out there whose only answer to dealing with labor is 'I'm getting an epidural.'

The hour+ between deciding you want an epidural and receiving it the longest/hardest part of labor, even if you HAVE the coping techniques.

labortrials said...

My point to all this is that those who plan an epidural (and this post is by no means meant to be pro- or anti-epidural) is that you need to know how you will cope with your contractions. Being prepared for contractions isn't just for those women who plan to do it sans medications.

VERY good point and one I'll have to remember for my epi-wantin' friends and family members. ;)

~ Kimberly