Archive for the ‘Pain Management Techniques’ Category

A Doula For The Dying: 5 Things I Learned at My Father’s Deathbed

Monday, May 18th, 2015

5 ThingsI LearnedAlmost three years ago, I packed up my four children and drove to Oregon to help care for my father. His melanoma had metastasized to his spinal fluid, and everything that could be thrown at it to kill it, had been. There was nothing left, but to wait. Probably only weeks were left.

His decline was gradual, over the course of about three and a half months. During that time, I discovered another purpose to my doula training and work.

The end of life is much like the beginning. It is mainly about waiting, comfort and support. There isn’t anyone who can do the dying work, except the dying. Those in attendance find themselves with not much to do but wait. At the most, we bring comfort through physical touch, slow conversations, and just quietly being present. It is so much like waiting while a woman labors. The main difference being that we are on the wrong side of the veil. We do not get to see our loved one birthed into the next life. It is all darkness on this side.

I have never been so grateful for my training as a doula. Everything I learned is very nearly directly applicable to the dying process. Here are 5 things I learned while doulaing my dying father.

1. Pain can be a normal part of the process.
Granted, the pain of death was not something I believe that we were ever designed for. It is often pathological, but it is also a natural part of dying. As in labor, it is a signal that something needs to change. Perhaps a massage will alleviate it. Perhaps a dose of morphine will help the man laboring to die to rest a little easier. Pain also allows and invites loved ones to minister to the dying simply by being present, holding a hand, or stroking the hair.

2. The same comfort measures used in labor often work well for the dying.
Massage. Gate control. Supporting the five senses. Medication. Acupressure. Essential oils. Music. Bathing. Hydration. Light snacking to their level of hunger if it exists at all. The dying, much like the laboring woman, do not need much food if any. It’s important to follow their lead. All these techniques we learn in our doula training are applicable to the dying one. Of course, some causes of death render certain massage strokes unbearable, much like transition may do in a laboring woman. It’s all about trying different things, and allowing the dying to accept or refuse it without taking it personally.

3. Holding space is the foundation for dignity.
We know as doulas that a mother’s pain level, or even the kind of birth she has will have little bearing on how satisfied she is with her experience. What matters most to her is that she is the decision maker and that she feels supported throughout the process. We as doulas hold the space for that to happen. We are constantly directing attention back to the laboring mother: “How do you feel about adding Pitocin to the plan? Would you like time to talk about it?” It’s the same with the dying. They often struggle to decide, and just need the space to settle in with what they want. This gives them the dignity they deserve as a human being while they go through an undignified, and often painful process.

4. Writing an end-of-life plan is much like writing a birth plan.
It’s written before the active dying really begins, much like a birth plan is written prenatally. It outlines the dying person’s desires, wishes, and medical decisions ahead of time, so that if and when they become incapable of decision-making, those who are caring for him can use it as a guide to know what he would most likely want to do. Unlike a birth plan, it is a legal document, and only power-of-attorney can override it. The principle is the same, though. And as a doula, upholding these desires came naturally to me.

5. Dying doesn’t look at all like what is portrayed in the media.
Birth in the media is always an emergency, there is a lot of screaming and hating of husbands, and demanding of drugs. It’s almost never clinically accurate or true to life. It is the same with death in the media. Death in the movies is always grand or gory or like watching someone fall asleep. Watching my father die was none of those things. There is no way to portray the sights, smells, sounds, or the heaviness of the room where the dying man lies. There are as many ways to die as there are to give birth. As beautiful as Dad’s final moments were, as dignified and peaceful as it was, I found death itself to be ugly. Just as I find birth to be beautiful, in spite of the “mess” and the pain and the noise and the smells. Death and birth are studies in contradiction. They are each a paradox. And both are sacred.

I loved being with my dad while he lay dying. I felt honored, privileged, and blessed to witness a man’s leaving of this world to enter the next. For Dad, to live was Christ, and his death was gain. Every time I enter the sacred birthing space of another woman, I am reminded of the gravity of life, and how important it is to have dignity at both birth and death. As a doula, I now know that I have the skill and compassion I need for either. If I weren’t a doula, or pursuing midwifery, I think I would want to be a hospice nurse. But that is an entirely different post for a different day.

Thanks for sticking with me. I know this is a tough subject, but it’s close to my heart, and it was time to write about it. How have you experienced death or birth in your life? Have you seen both? Are there other parallels you noticed?

Grace & Peace,

Essential Oils in Pregnancy, Labor, & Birth: Part I ~ Safety Guidelines.

Thursday, November 8th, 2012

Welcome to Birth In Joy, and a new, short series on essential oils you can use in pregnancy, labor, and birth by my dear friend and colleague, Kim Prather.

Kim Prather is a wife to Ryan and mom of 5, learning how to use therapeutic grade essential oils to live a healthier life! Join her, as she learns more about the wonders of God’s creation and how to use essential oils in everyday life, and special situations! She is learning and sharing about Young Living Therapeutic Grade Essential Oils, and loves to help those who are interested in learning more themselves. You can contact her at Front Range Scentsabilities by clicking HERE.

Disclaimer: The essential oils described in this post refer only to therapeutic grade essential oils. I only recommend Young Living essential oils, as I am certain of their high quality. This is for informational purposes only. Different people will respond differently to the use of essential oils.

Essential Oils in Pregnancy, Labor, and Birth: Part I ~ Safety Guidelines for Essential Oils

I created this information sheet for a class that I taught recently to birth professionals. A few of the warnings at the beginning I included as I wasn’t allowed to ONLY promote Young Living, so I wanted to be sure to have my bases covered in case they tried inferior oils. I’ve added a few personal notes in here too! Please comment with questions and your stories!

Important Essential Oil Safety Rule:

Always have carrier oil or pure vegetable oil close by to wipe off essential oils if needed. Apply the pure vegetable or carrier oil to a cotton ball, tissue or handkerchief to dilute and remove the oil. Keep essential oils away from the eyes and the eye area. DO NOT rub your eyes or handle contact lenses with essential oils on your fingers.

The most common Essential Oil Safety Mistake:

If you get oil in your eye, immediately remove the oil by gently dabbing your eye with a cotton ball or tissue that has vegetable or carrier oil on it. This will help dilute the oil. Do not flush the eyes with water! Water spreads the oil and could make it worse. Oils are not water soluble.

One of the most important rules for essential oil safety is to always test an essential oil on the skin before use. Each person has their own unique body chemistry and just as foods affect people differently, so do oils. Testing the oil on the soles of the feet is the safest place. Always test here for babies and children and for those with allergies. Another location is on the inside of the arm just above the elbow. 10-15 minutes is usually sufficient. If the person you are testing is prone to allergies, or unusually sensitive, allow for 30 minutes. Testing allows you to see how their body will respond. Always ask about allergies.

The following are essential oil safety guidelines that are important for you to know:

1. Always have vegetable oil or carrier oil close by when applying essential oils. This is to dilute and remove the oil if necessary. Do not try and dilute the essential oils with water, it will spread the oil and could make it worse.

2. Certain oils should always be diluted. They can burn and injure the skin. Oils high in phenols, citrals and cinnamic aldehyde, such as Thyme, Oregano, Clove and Savory (phenols), Lemongrass (citrols), Cinnamon Bark (cinnamic aldehyde).

3. Always use a dispersing agent, such as bath gel base, when adding essential oils to bath water. Never add undiluted essential oils to bath water as they can injure or burn the skin.

4. Do not apply undiluted or neat essential oils to parts of the body that are hot, dry, or tender. Instead, use a compress that has been soaked in cold water filled with dispersed essential oils.

5. Use only therapeutic grade essential oils and oil blends. This is extremely important regarding essential oil safety. Before ingesting essential oil, or applying it to your skin, know and trust your source. Most oils contain chemicals that may be dangerous and toxic. I only recommend Young Living Essential Oils because of their purity and quality.


Really?! Fear Slows Down Labor?!

Tuesday, July 10th, 2012

It’s been awhile, birthy world! Thank you for your patience. I’ve had quite the interesting summer so far, how about you? Anyway. Today’s post.

Go ahead and go read this short article before you proceed here: Fear Makes Labor Longer, Study Finds.

Image found at

So, they’ve “discovered” that fear slows down labor. Really?

This is something women have known innately for thousands of years, and something that natural birth professionals have been preaching for decades.

We cannot make labor happen faster than it should. However, there are things we can do to slow it down – and harboring fear is one huge one. It’s called the Fear-Tension-Pain cycle. A phrase coined by Dr. Grantly Dick-Read, a pioneer in natural childbirth.

Essentially, it works like this: Mom feels the pains of her first contractions, and fear creeps in that she will not be able to cope when it gets harder. This raises her stress hormones, which ready her for flight, and she tenses up. At the peak of her contraction, her carried tension leads to a greater sensation of pain, and she again begins to fear what comes next. She fears she will not be able to cope, and the cycle begins all over again. Not much fun, I’m afraid.

How do we break that cycle?

1) Hire a doula.
I address a mother’s fears by listening to her, and helping her work through them verbally ahead of time if at all possible. This can even be done in labor. Even small fears have the potential to become big ones in the right environment, so never dismiss any fears you have as “silly.” Address it, work through it, and let it go as best you can.

2) Take an evidence-based childbirth class.
In class is where you can find all kinds of practical tips, tools, and techniques (hooray for alliteration!), for coping with any kind of pain or discomfort you may have during labor. It’s a chance for your support person to learn how to best help you, and you can prioritize ahead of time what techniques you would like to try first.

Also, the more you know about the basic anatomy and physiology of normal birth, the less likely you are to fear it. It kind of takes away all the mystery, and sheds light on an aspect of your womanhood you may never have really understood before. I know that very understanding was a huge help to me as I labored with each of my children.

3) Consider home birth.
No, really. Do it. Look into it. Especially if you have a strong aversion to hospitals and doctors normally. What better way to minimize fear than by being in your own space? Where everyone caters to your needs in labor. Where no one crosses personal boundaries “for your own/baby’s good.” Where you have the most control over the environment. Midwives almost always offer a free consultation, and it never hurts to ask questions! (Visit my home birth & midwifery link at the top of the page if you have more questions.)

4) Learn effective stress management techniques.
These don’t just work for labor – they work for life. They are practical things you can even teach your young children to do when they are feeling stressed. We all know that stress can make us sick, so learning to do this is paramount to all of us in the crazy-fast-paced world. Incidentally – many of the basic relaxation techniques taught in childbirth classes are great stress management tools!

Among many other tools, you can use prayer, physical relaxation techniques, massage, warm compresses, breathing, essential oils, and herbs.

Once the cycle is broken, and you are relaxed, your labor will progress much more quickly and bearably. You may even enjoy many parts of it! It’s not as overwhelming when you know that it is all perfectly orchestrated to bring your baby earthside as safely and effectively as possible. Eliminating fear from the equation allows a better cycle to work: Rhythm, Relaxation, & Ritual cycle (Penny Simkin).

Well, it’s not so much a cycle as it is a principle at work.When you are able to get into a groove of some kind, to find your rhythm, you are able to relax more effectively. You will create little rituals that mark time and space for you in a place where time and space mean almost nothing. It sends you to your primitive brain (a.k.a. “Labor Planet”), and helps you handle your labor as you were intended to handle it: one contraction, one rest period at a time.

When you are relaxed well, you are able to handle everything your labor brings forward. You can crest your contractions like waves, accepting them and holding realistic expectations of your own ability to continue working as long as you need to.

A woman relaxed in childbirth is a woman of power, strength, and faith.

A woman relaxed in childbirth allows her labor to work as quickly and efficiently as it was designed to. There is nothing to slow it down when fear is out of the way.

The beauty of it is that it also has a physiologic effect on your labor! Women, relaxed and uninhibited, will MOVE in labor. They will move a lot. And every movement of mother encourages the baby to move, which in turn encourages the cervix to move, which encourages mom to move, and on we go. The beautiful cycle of relaxation and courage!

Embrace it by educating yourself and taking nothing for granted.

If you have had children before, what was the one thing that helped you cope with each contraction the most? What led you to try that? What fears, if any, did you confront in your childbearing year?

Grace & Peace,
Tiffany Miller, CLD, CCCE

Do Moms Planning an Epidural Need a Doula?

Friday, May 25th, 2012

This question was posed on her facebook wall by my mentor, Desirre Andrews. I appreciate the thought that her questions provoke, and the way she challenges me to dig a little deeper and search out what my answer would be to this question.

I think, overall, there is an assumption in our country that an epidural is a panacea. The concept of labor with an epidural on board is one of passivity and a desire for separation from the experience because of fears about the process of labor. Whether those fears are well-founded or not really does depend on the individual, and is not the subject of this post. I would very much like to see a more realistic, knowledgeable view of epidurals begin to take prevalence in my community, and the world at large.

As a doula, I know that I can bring my community closer to that vision, one mother at a time. So, here is my answer to the question posed in the title of this post:

I usually tell someone that they don’t “need” a doula (if they want to get all technical), in that they can definitely have their baby without one. Yet, I would never say that a doula is a luxury, either. There is too much benefit to the presence of a doula, supported by scientific evidence, to label them luxuries. Not to mention the fact that women, for all of our world’s history, have always supported women during birth. Women need women who believe in them at their births. Period. Again – a subject for another lengthy post.

Moving on.

In the specific case of a mom planning an epidural, a doula can really help to optimize the use of this particular tool — maximizing its benefits, and minimizing the risks associated with it — if that’s what she wants.

A doula can help a mother stay calm through the procedure, and prepare her ahead of time to have realistic expectations of what epidurals do and do not do. Contrary to popular belief, epidurals are not a panacea. They vary in effectiveness for many women, and come with some side effects that are common enough that every woman who wants one should know about them.

A woman with a doula who has educated her ahead of time who experiences, for example, the drastic drop in blood pressure that can go along with an epidural, will know that the nurse will come in, place her on her side, put an oxygen mask on her face, and give her medication to raise her blood pressure immediately. The nurse will act, she will not ask. This prepared woman will be less susceptible to fear as the nurse takes quick action. The unprepared woman may end up scared out of her wits, and experience fear for her baby because of this process, if she did not know ahead of time that it could happen. A doula can prevent the latter circumstance. Doulas can help take fear out of the equation for women.

Along the same lines, a doula can assuage the fears of a woman’s partner, and reassure him/her that what’s going on is common, normal, and that mom and baby are likely to be okay. Partners who love these women so much often forget all they learned, as their gut takes over, and having a doula there for reassurance can really bring a sense of peace to the partners, freeing them to be fully present in their relationship to the laboring mother.

Doulas can also give women tools to cope with labor up until the time the epidural is placed. Mom is having a natural birth up to the point the epidural is in place, after all! A woman and partner equipped with basic labor coping skills and techniques will be able to handle whatever their labor throws at them up to the point the epidural can be placed.

Many moms, without the presence and preparation of a doula, may not know that the timing of an epidural is critical in avoiding some of the risks (both for herself and her baby), and maximizing its benefits. For one thing, an epidural placed too early can cause labor to slow down enough that Pitocin will be needed, beginning the lovely “Cascade of Interventions” all of us in the birth community are familiar with.

Without a doula, a mom may not have the confidence to believe she can handle labor beautifully until the time comes that an epidural would be more to her and her baby’s benefit than a risk. A doula can bring a strong sense of “I can do it” to the labor room, and help a mother to gauge when the time is right for her epidural.

Once the epidural is in, a doula will help a mother assume multiple positions that can keep it working well, keep her pelvis moving, and encourage progress. Progress in labor is directly linked to the amount of movement mom is able to do, and a doula knows this. She can help a mother and her partner work to keep an active role in her labor by maneuvering mom into alternating positions. Since epidurals are gravity-based, this also helps keep the pain relief on a more even keel, and minimizes uneven sensation.

A doula can also walk moms through what pushing with an epidural might be like, and teach them about different options for that stage. She is equipped to help them advocate for the option to “labor down” (a technique that can help preserve mom’s energy for more active pushing when baby is much further into the pelvis/birth canal), instead of beginning active, hard pushing as soon as she reaches full dilation. She can help mom assume different positions every few contractions, to maximize baby’s ability to descend and rotate well. This can also minimize the risk for forceps or vacuum extraction being needed.

After the birth, during the postpartum visits, a doula can help walk moms through any after effects she may be experiencing. She will have prepared the mother to recognize signs of a spinal headache (one possible side effect that is fairly common, but not overly so), and to get help quickly for it. She can help moms understand the back pain that may come along with it; the longer recovery time often associated with it; and – if it was on board for more than four hours – the side effects that her baby may experience. Usually, a baby might be sleepy, and have trouble latching on for the first time.

Once a mom is fully equipped with all the information about an epidural, she is equipped to take any side effects in stride, without fear. She knows that they may happen, and she accepts and owns her decision. She can come out on the other end still satisfied with her experience, even if she has experienced some negative side effects, when she is fully informed and fully supported in the way that only a doula can really do.

So, do moms planning an epidural need a doula?

You tell me.

This is just the tip of the iceberg regarding the knowledge a doula can bring to an epidural birth. If you are a birth professional, what would you add to this? If you are a mother who chose an epidural: Did you have a doula? If so, how did she help you? If not, would you want a doula the next time? What was your experience – doula or no doula?

This is a safe place for you to share – so, please do!

Grace & Peace,

Pain’s Message

Tuesday, February 7th, 2012

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“Labor will hurt. Probably a lot. But whether this is negative is another matter… A laboring woman can be in a great deal of pain, yet feel loved and supported and exhilarated by the creative forces flowing through her body and her ability to meet labor’s challenges.” ~ Henci Goer

Pain in general is not a good or bad thing, in and of itself.

Pain is simply a message from our body to our brain that something needs to change. It tells me when to move my hand away from a hot surface. Pain tells me to lie down and rest for awhile. It tells me to take a bath.

In labor, pain is part of that creative process moving through my body. It does more than just tell me to get moving.

It empowers me to take what control I can in an otherwise uncontrollable event; it places me squarely on the crest of each contraction wave, where I can ride it out in some measure of peace. It tells me to seek comfort – in a warm bath, in the arms of a loved one, outside in the sun, in a dimmed room with soft music, in the motion of walking, and even in the simplest relief of emptying my bladder.

Pain signals the release of huge amounts of endorphins, bringing me to the brink of ecstasy as I feel the baby slip out of my body and into my arms.

Pain experienced in loneliness or perceived isolation is excruciating. Pain experienced in an environment of peace, comfort, and perceived safety is empowering and moving. It is life-changing and educational. It is powerful, intense, and sometimes indescribable.

The pain of labor is not suffering.

In life, as well as in labor, I find that it is often only through pain that I can experience pleasure at its fullest.

The agony and the ecstasy of labor and birth often go hand-in-hand. They are experienced in the same moments. Even at the height of a contraction, there is knowledge in my mind and heart that I will soon forget my pain at the joy of my child being born into the world. In my face, one can see unbounded joy, awe, and underlying it all – the pain of motherhood that never really goes away. We carry it with us as we agonize over every mothering decision.

Motherhood and its inherent pain is a baptism unlike any other on earth.

Being immersed to a depth we did not know we had, to emerge in the clear air of a role we somehow know without being expressly taught.

Pain in labor is what teaches us, and proves to us beyond all doubt that we have what it takes. We can rise to any challenge.

“You can’t scare me. I’ve given birth!” is our rousing, unarguable cry!

The pain of labor and birth, no matter our experience of it, or how we choose to manage it, tells us in a voice of authority: “We CAN be mothers.”

Photo from

What is/was your experience with pain in your labor(s)? How did you use the various tools available to you (everything from natural methods to medication is welcome to be mentioned here) in order to meet the challenge of your labor pain? Would you change anything about how you managed your pain? Why or why not? Did you experience a painless birth?

Grace & Peace,

Thoughts On Pain In Childbirth

Wednesday, April 21st, 2010

What is pain, exactly?

Biologically speaking, it’s simply a message our bodies send to our brains that something needs to change, and quickly. Hand on a hot curling iron? The pain message sent tells your brain to MOVE YOUR HAND NOW!!! I would say that this is a very efficient way to carry a message.

In other words, pain has a Purpose.

In labor, its purpose can be one of many things. It might be telling the mother that she needs to stand instead of sit, lie down instead of walk, or get into a tub instead of sitting on a ball. It might be telling the mother that she is tense, and needs to focus a bit more and relax. It could be saying that she needs to go to the bathroom. It could also be telling her that she has an unspoken fear lingering somewhere in the back of her mind that needs to be brought out and dealt with. The list goes on indefinitely.

The common thread running through the list is that this pain message carries the responsibility of telling the laboring woman what she needs to know in order to help her labor to progress. It encourages her to move, to find comfortable positions, to vocalize, to change her breathing in ways that will ensure that her baby can navigate her pelvic bones and pelvic floor muscles in such a way that he can meander his way through the birth canal in the most efficient way possible. Even if the baby is a little malpositioned, the pain messages mom’s brain receives will tell her what positions will be most conducive for baby to maneuver himself into a better position.

In my training as a doula, and experience birthing four babies, I have learned that a moving pelvis = moving baby = the most efficient labor progress for THIS birth. Looked at in this light, it seems that pain in childbirth might actually be a good thing.

Consider, also, that pain in childbirth is something we know is coming. It is Anticipated.

We humans, though we delight in variety, are really creatures of habit. If we know something is coming, we like to plan for it, as a general rule. I have found, too, that the more we know about something, the less we fear it. So, pain in childbirth is something right up our alley! We can learn about it, and learn how to deal with it. It is not over-powering.

While some women really do have what they describe as “pain-free” or even “ecstatic” births, most of us will experience some level of pain, discomfort, incredible pressure, or just intensity that is more than we normally deal with in everyday life, and it behooves us to prepare for it.

I think it’s wonderful to be able to have an idea of what to expect, and have nine whole months, give or take, to get ready for it! Independent childbirth classes are, hands-down, the best way to prepare for what your birth might look like. Since everyone is different, these classes should cover a wide range of coping mechanisms to equip birthing women and their support teams with the tools they can use to handle their particular level of pain or discomfort in labor. Everything from breathing techniques (the non-hyperventilating variety), to relaxation tools, to position changes, massage, and counter-pressure are wonderful things a woman can pull from and adapt to her own experience.

Again, her pain has the purpose of telling her which of these techniques she needs to try next, as long as she is able to turn inward and listen to her body’s signals, and has good support surrounding her, encouraging her to do so.

“This is all well and good,” you say, “but, what if my labor goes on for a Really Long Time?” Well, what if it does? Pain in childbirth is not like the suffering that comes from a badly broken bone, or a traumatic injury of some kind, where the pain doesn’t really ever abate. It is Intermittent. It comes and goes. For the majority of the time you are in labor, your body is doing no work at all, but resting.

Your uterus contracts for anywhere from thirty seconds to a minute, every three to five minutes or so (on average – keep in mind every labor is different). Even if your contractions are a full minute long, and only three minutes apart, you still get to rest twice as long as you are contracting. Heck, if they are ninety seconds long in that time frame, you’re still resting for half the time!

When people hear that my first birth was 37 hours long, they are amazed and ask how I did it. “The same way every woman does,” I reply, “One contraction at a time.” My contractions were a full five minutes apart most of the time, and only a minute long for much of it. I was resting four times as much as I was working. I was not having a giant, 37-hour contraction! I remember, during that labor, as it went on, seemingly forever, having the distinct feeling that I could handle it. “This isn’t so bad,” was my prevailing thought. Of course, I got tired. Exhausted, actually, but I found that it was totally doable! I was strong to meet this challenge, and so are you, my fellow birther. So are you.

Even transition, the time during labor where you will work more than you will rest, becomes doable when you are prepared to handle labor up to that point. You will have energy reserves left to help you get through that relatively short, intense time. You may find that you hit your wall, but that with good support and adequate tools to handle it, you will find yourself able to climb over it with strength.

Above all, the thing to remember about pain in childbirth is that it is Normal. Completely, utterly, normal. Keep in mind that if pain in childbirth were so horrendous, women would have stopped doing it as soon as we had the means to do so! In reality, many women enter labor, and realize that they can do it. That it’s not something completely insurmountable. It’s not like the movies, where a woman has one contraction, and is immediately in so much pain she can’t think straight. It’s a gradual climb, starting in hill country, moving to more mountainous routes, and finally, a wall that requires all your concentration and energy. Reaching the peak, though, is worth every agony.

All of this is why I am such an outspoken advocate for normal, unmedicated birth. I fully admit that I am strongly in favor of women being given information about the truth of pain in childbirth: It is not an evil to be avoided, but the most efficient means of communication our body has to help affect the safest, healthiest birth possible for you and your baby. I think it helps that I also understand the proper role and uses for pain medications given in labor, and see them as just one tool among the vast reserves available to birthing women. There comes a time to pull out those tools on occasion, but if women were not able to give birth without them, humanity would have died out as a species a long time ago.

So, yes, I encourage women to embrace the pain and discomforts of childbirth, because I am confident of its usefulness and purpose. It is a perfect design that draws out of us strength we never knew that we had. If it weren’t for the pain we experience, we would not know the heights of joy and thankfulness at the end of that climb. And really, when you think about it, most labors don’t take more than a single day out of our lives. What is one day of pain, compared to the lifetime of love and relationship with a human being so connected to us?

I think it’s more than worth it. But, that’s just me. I take no pride in this viewpoint – I don’t. I am just very confident in what I know to be true. I don’t condemn anyone for their use of pain meds, nor do I believe every mother who goes “au naturel” in birth deserves any kind of a medal. My point is this: to educate, inform, and equip women to do what women have been doing for millenia very successfully, and to understand that they already have what it takes to do it.

There is a quote which gets passed around the birth community, that I think sums this whole post up quite nicely:

“We have a secret in our culture, it’s not that birth is painful, it’s that women are strong. ~Laura Stavoe Harm

Weekend Birth Linkage

Friday, October 10th, 2008

Welcome to my new Birth In Joy site! Please pardon the plainness, and lack of links, as I am hoping to soon invest in a professional transferring all my content from the Blogger site to this one. I have a sluggish start ahead of me, and I hope you will be patient with me as I make this transition. Here are a few links to tide you over until the next time we meet!

Delivery Method Affects Brain Response to Baby’s Cry ~ By: Tara Parker-Pope, NY Times Health

Why Babies Should Never Sleep Alone ~ A review of the co-sleeping controversy in relation to SIDS, bedsharing, and breastfeeding. By: James J. McKenna and Thomas Dade

High-Tech Interventions Deliver Huge Childbirth Bill ~ By: Rita Rubin, USA Toay. (a.k.a: One more reason to consider having a homebirth.)

Pushing Techniques & Positioning in 2nd Stage Labor

Thursday, April 24th, 2008

By: Janet Grabe, RN, BSN, ICCE, CD(DONA), CLD

Col Sylvia Wood, RN, MSN, CNM at Tripler Army Medical Center is a Co-Investigator and the Site Coordinator in a multi-site study on management of the second stage of labor. She was kind enough to share some of their knowledge with us by providing several excellent presentations on four concepts:

1. Use of upright positions throughout the 2nd stage [“pushing” stage]*.

2. Women may push when they feel the urge to push.

3. Women should non-valsalva (open-glottis) pushing [aka: “purple” pushing]*.

4. The length of the second stage of labor should not be arbitrarily limited to 2 hours.

The entire presentation was fascinating and very well supported by about 50 articles, one of which involved a study of 4,400 women that did not support the concept that the baby suffers ill effects when 2nd stage extends beyond 2 hours. Studies have shown that labor will be shorter when upright positions are used for labor, with one study finding a mean difference in length of over 2 hours (shorter) for those who labor in the upright position.

If given any choice of positions, 95% of women will choose to be upright during labor and second stage. Of these women, 75% report feeling less pain and 95% report feeling more comfort when they are upright. The upright position enhances the baby’s ability to twist and turn down through the pelvis. It also allows the mother to breathe easier and causes the most optimum blood flow to the baby. Some studies actually show more positive interactions take place when a woman delivers in an upright position.

More and more articles are describing 2nd stage as having 3 phases just as 1st stage does: latent(complete dilation without an urge to push), active (bearing down efforts with each contraction) and transition (crowning and the actual birth).

Upright positioning was described by Col Wood as: standing, sitting, squatting, and kneeling. She noted that women in the U.S.A. generally do not squat in our daily lives. She stressed the need for prenatal education to include the importance of learning and practicing the squat to build up their ability to do so for prolonged periods of time. It has been shown that squatting increases the pelvic outlet by 28%.

Studies reveal that 66% of women birthing their first baby will have some type of perineal trauma: episiotomy or lacerations. However, approximately 1,000 studies reveal that episiotomy should not be practiced routinely, and possibly not at all. It is a commonly held belief that delivering a baby over an intact perineum causes delivery of the baby 5 minutes later than cutting an episiotomy. This is something even Col Wood has done when a baby has been in distress and every minute is important. However, one recent study refutes that commonly held belief and shows that the delivery time is exactly the same, whether an episiotomy is cut or
delivery takes place over an intact perineum.

Another study shows 85% of women will have ruptured their waterbag naturally by 9 cm. This evidence pleads strongly to lessen the routine practice of artificially rupturing the waterbag.

Important concepts [for mommas]* to remember:

1. Squatting needs to be practiced. All pregnant women should receive information prenatally on the benefits of upright positions for second stage prior to labor, which include a decrease in the duration and pain of labor as well as increase in the intensity of contractions. Prenatal education can prepare women to take an active role in their labor and encourage practice of pushing positions such as squatting.

2. Encourage the pregnant woman to try different positions throughout the second stage. No single position is appropriate for all labors. Varying positions can assist the fetus to maneuver down and out the pelvis.

3. Supine positions such as lithotomy should be discouraged. The lithotomy [flat on back, legs in the air]* position causes compression of the inferior vena cava, aorta, & iliac arteries by the uterus against the mother’s spine. [This reduces the baby’s oxygen supply.]*

4. Suggested positions should include: squatting, semi-recumbent, standing, and upright kneeling. Increased intraabdominal pressure can be generated in these positions due to increased efficiency of abdominal muscle contractions in addition to the force of visceral weight.

5. Squatting should be encouraged, especially for women with narrow pelvic outlets and/or large babies. During a squat, both the antereo-posterior and transverse diameters [the baby’s head is not face down, but either sideways or partially face-up]* of the pelvic outlet increase 1-2cm. Also, the pressure of the mother’s thighs against her abdomen helps keep the baby in proper alignment.

6. The mother should be encouraged to lean forward and maintain a pelvic tilt with contractions during the first phase of 2nd stage. Leaning forward will encourage the baby to keep from resting on the sacral vertebrae, which can malalign the baby’s head and prevent it from entering the inlet. A pelvic tilt mobilizes the sacrum, enabling the baby to rotate during its descent.

7. Non-valsalva pushing should be taught and encouraged. [In other words, no “purple” pushing.]*

Expectations of staff supporting women during labor and birth are:
(Beginning May 1, 1993, these are policy and procedure at Tripler)

1. Review realistic expectations and sensations of early labor as well as the onset of 2nd stage. Learning about the range of emotions and effort involved in 2nd stage will assist the pregnant woman to prepare for the work and sensations of 2nd stage.

2. Encourage spontaneous bearing down. If baby’s head has not descended low enough in the pelvis to stimulate Ferguson’s reflex (stretch receptors in the pelvic floor) allow the mother to rest until she feels the urge to push. Refraining from instructing a mother to begin pushing prior
to the time she feels the urge to push minimizes maternal fatigue.

3. Consider fetal station and position in addition to dilation in determining a woman’s readiness for pushing. Involuntary bearing down may be encouraged if fetal station is favorable (0-1+) as well as fetal position (OT to OA) regardless of a cervix which is dilated less than 10cm (8-9cm, soft and retracting). Tearing of the cervix is extremely rare. Col Wood has not seen one for approximately 15 years, although she routinely allows her clients to push when they feel the urge, regardless of their dilation. Studies have shown that once a woman feels the urge to push, she will be completely dilated within 10-16 minutes.

4. Discourage prolonged maternal breath-holding (greater than 6 seconds) during pushing. Breath holding involves the Valsalva maneuver: increased intrathoracic pressure due to a closed glottis causes a decrease in cardiac output and blood pressure. The fall in pressure causes a decrease in placental perfusion causing fetal hypoxia. (If allowed to push any way they want, all women who choose to hold their breath usually hold it 5-6 seconds or shorter. Many women will choose not to hold their breath at all.)

5. Support rather than direct the woman’s involuntary pushing efforts. These efforts may include grunting, groaning, or exhaling during the push and/or breath holding less than 6 seconds. (This is sometimes referred to as the “Song of Labor” and is something medical professionals and support people will have to be accustomed to.) Spontaneous, involuntary bearing down efforts match the intensity of each contraction. An open glottis, as seen with grunting and exhale pushing, avoids the Valsalva maneuver and has physiological benefits for both the mother and baby.

6. Validate the normalcy of sensations and sounds the mother is voicing. Mothers and caregivers perceive low pitched groaning, sighing, and moaning to be sound of tension release which may assist her in coping with the pain of 2nd stage. (Caregivers must assist the mother to not feel self-conscious about the sounds she is making.)

7. If maternal and fetal status is satisfactory, duration of the 2nd stage should continue without time constraints. Fetal outcome may be affected more by the avoidance of sustained maternal breath holding and supine [back-lying]* position than by duration of the 2nd stage, as previously believed.


This was written by Janet after attending a presentation by Sylvia Wood in 1993, reflecting on the results of new studies that were not yet published at the time. Even though the studies are pretty old, I can find no evidence of any change since that time. If you’d like to read more, here are a few links to get you started:

  • Blackwell-Synergy: Managing Second-Stage Labour, exploring the variables during the second stage.
    Regrettably, to see the full article, this one requires a subscription…
  • The Cochrane Collaboration: Position in the second stage of labour for women without epidural anaesthesia
  • Pushing in Labor
  • *Anything in []’s was added or changed by me for clarification.

    Singing Through the Pain

    Monday, March 17th, 2008

    I saw this blog at The Birth Ecology Project, and had to share it here. It’s too beautiful…

    And it just dawned on me. I used this technique when I was in labor with my firstborn. After I’d been in labor over 24 hours, the midwife and my mom convinced me to take a walk around the block (I was at a birth center). While we were walking, I started singing “Trading My Sorrows” (my favorite worship song), and sang right through my contractions. It works. Amazingly well, as I recall. Funny. I’d forgotten about it until now.

    Anyway…here’s what I quoted:

    “Singing or toning during labor contractions is a wonderful coping technique for labor pain. Vocalization through singing or toning creates a vibration throughout the body that can assist the muscles and ligaments to relax. Singing and toning also facilitates full deep breathing which brings fresh oxygen to the mother and baby. Vocalizing can also relax the jaw which correspondingly relaxes the pelvis. Singing or toning also has emotional, mental, and spiritual benefits promoting mind-body integration, centering, and focus.

    Following is a video of one very talented birthing mama, who sings with her family to gracefully flow through her contractions.”