The Midwife Guide to Pain Management
A remarkable insight into the power and pleasure of labor and birth.
Midwife Guide Masterclass Series
What you'll get from the Midwife Guide To Pain Management Course
The Midwife Guide to Pain Management is is part of the larger Due Date Club Community and one of the comprehensive Courses on offer.
There are not too many women who come to my classes expecting an enjoyable birth experience – even though many of them achieve that and it is most definitely possible.
However, for as long as you associate pain with labor and use the term pain, it will naturally make you think of unpleasant and abnormal situations like toothache or a broken bone. This pain occurs as a result of something being inherently wrong, and yet everything you will feel in labor is a signal that it is right.
No matter how many people you ask, what labor feels like, the answers will fall anywhere on the spectrum of “ not nearly as bad as I expected” to “absolutely excruciating” which really does not help you at all because you will naturally focus on the latter.
In terms of preparation, think of it this way. If you woke up one morning and decided to run the London marathon, you would have to put a training program together and prepare. You would never just turn up at the start line with the wrong shoes, no water and no training. You would never consider running a marathon without knowing the route, what to expect, where the hills are or how to pace yourself.
Preparing to have your baby is much the same. By the time your labor begins, you want to be sure that you have
- Done your training and mental preparation.
- You know the route (the stages of labor)
- You accept that it is going to be challenging
- You understand the factors that are out of your control
- You know how to pace yourself
- You know how to harness the power of your mind
- You know how to use powerful breathing techniques to avoid the fear/tension/pain cycle
- You understand the impact of hormones oxytocin and endorphins and how to maximise them
In this course you will learn all of that and a whole lot more. The course is structured to give you a deep understanding of the nature of pain and, your expectations and proven tools to manage it.
The Midwife Guide to Pain Management
This course will radically change the way you think about birth by understanding the cause and function of pain and the influence of fear on your experience. It is the foundation course for birth preparation and will ensure that you go into labor feeling calm and confident.
Regular, rhythmic and strong muscular contractions are essential for your cervix to soften and open and to move your baby out. They are a wonderfully positive and encouraging sign that you baby is getting ready to make the journey to meet you.
The muscles work in two very distinct ways. The upper part, known as the fundus is the most active part. The longitudinal muscle fibres contract and gradually pull up the lower segment and cervix. They also gently nudge down on the baby, pushing him ever further into your pelvis. These movements are called surges or contractions ( I use both of these terms interchangeably throughout the course)
in order for your baby to be born, the cervix needs to change function and open to allow the baby through. Your cervix is doing what it is meant to do, and it is only a matter of time before it will soften and move more anterior. This occurs naturally towards the end of pregnancy as it starts becoming softer (called ripening) and shorter (called effacing) and this coupled with increased downward pressure of your baby moving into position will guide it to angle itself more towards the front part of your body or anterior.
A guide to understanding the normal progress of labor, knowing how to assess how far you are (without doing an internal cervical check) and the common interventions that you may be offered at different stages of labor.
Staying at home as long as possible in early labor will significantly reduce your chances of needing interventions.
Every labor is as unique as the baby who is being born. While there are predictable patterns and accepted time frames, there is no correct form for labor to take.
I refer to these as practice contractions and use the metaphor of going to the gym. The muscles of your uterus need a bit of practice for what they need to achieve during labor and they start “working out” around 25 – 28 weeks of pregnancy. Most women don’t even realise they are having them, and this is why I recommend a regular practice of sitting or lying quietly, with your hands resting on your belly, and connecting to your body and baby so highly.
You will notice sometimes that your belly becomes hard and tight and may even change shape. Often it is caused by your baby moving around which stimulates the muscles to contract. This is a Braxton Hicks contraction.
There are many changes that occurr in your body in the last weeks of pregnancy. Some oare subtle and others are more noticeable. The section will guide you to become aware of the the physical signs that indicate labor is imminent. Feeling confident that your body is getting ready will greatly assist you if you are faced with the decision to have an induction of labor for non medical reasons.
If this is your first baby, you may worry that you will not be able to recognise when you are in labor and when you should go to the hospital if you are planning a hospital birth or when to call the midwife if you are having a home birth. This section will guide you and your partner to feel confident with the signs of positive labor and know what steps to follow.
In the movies you would rush to the hospital and your baby would be born soon afterwards (usually with a lot of drama). However in real life its very different. Learn about the various times your water may break and what you need to do when it does.
Fear is another factor that can contribute to increased perception of pain. Fear is misplaced in modern childbirth because today doctors have the medical expertise and technology to solve most of the serious problems that can occur. Many women enter the delivery room in a state of terror, which only exacerbates their discomfort. The fear of pain can actually produce pain through the natural tensing up of muscles in anticipation of the pain. This is called the Fear Tension Pain cycle and knowing how it works and how to avoid it is an essential part of you managing the intensity of labor.
It is also important that you learn to differentiate between pain and pressure. The muscles and ligaments in the pelvis are richly supplied with pain and pressure receptors. A receptor is a group of cells that receives stimuli. The contraction of your uterine muscles will produce powerful pressure sensations (stimuli) of birth that may be interpreted as pain, especially if there is tension in the surrounding muscles.
Unfortunately, medical staff all believe in pain in labour and all suggest, expect and presume pain is present or imminent. I get so frustrated when I have spent hours teaching my clients to work with sensations of labor rather than pain, and the moment they step through the hospital doors, every suggestion, question and comment refers to pain. This suggestion of pain will consciously and unconsciously be conveyed and will be perceived by you through facial expression, actions for relief of ‘suffering” and preparation for prevention of pain.
These are all powerful stimuli for the expectation of and experience of pain.
Comments such as “Be Brave,” or “ Don’t worry” and questions such as “How strong are your pains?” all suggest pain and can easily disturb what was previously a peaceful but intense process that you were managing quietly in your own way.
Another factor that will strongly influence the way that you perceive and respond to intense sensations is physical and mental exhaustion. Imagine staying awake and experiencing intense waves of sensation every 5 minutes for over 24 hours? Even the strongest among you would be exhausted and despondent. It would be easy to just want to give up and give in.
Learn how to manage the stages of labor to conserve your energy as well the importance of correct physical and mental preparation.
The ANS Inhibition Theory suggests that with hypnosis, the sympathetic branch can be controlled by the parasympathetic or relaxation side. In other words, the relaxation response can inhibit or ameliorate pain stimuli. With deep relaxation, pain can be interpreted as pressure by the mind.
The Control Gate theory postulates that pain impulses traveling to the mind must pass through a control gate or valve before teaching a command center in the left brain. This command center or switchboard analyzes the information and then channels the pain stimuli to appropriate pain response centers that instigate a physiological response.
When the left brain or conscious side of the mind has a narrowed focus or span of attention, the control gate allows only wanted or selected pain impulses to enter and trigger a physiological response, ie, the sensation of pain.
Medicinal anesthesia breaks the cycle at the point of pain; hypnosis breaks the cycle at the fear-tension point, before the body experiences pain.
Researchers do not fully understand the biochemistry of what happens during hypnosis and childbirth. Some believe that hypnosis encourages the natural release of mood-enhancing chemicals that change the way the body perceives pain. Other researchers believe that hypnosis somehow causes the frontal limbic system of the brain, which regulates body functions, to inhibit pain impulses from the thalamus (the sensory relay center of the brain) to the cortex (the part of the brain that handles the perception of sensory information.) Hypnosis, therefore, actually alters the way the brain experiences pain, allowing childbirth to unfold without pain. Under hypnosis a woman experiences the sensations of labour and delivery but she does not interpret them as pain.
One of the main characteristics of physiological labor is its rhythmic nature. Rhythm is made of highs and lows, of acceleration and deceleration. Above all, it is individual. This means that it is solely determined by the personality and experiences of the woman giving birth. It is, therefore, highly unpredictable. The aspect of childbirth in which the nature of rhythm is best represented is pain. Pain in childbirth is intermittent. It is worth spending a minute to consider the meaning of this concept in physiology, as in intermittency lies one of the biggest secrets of physiological laboring.
One of the most emotionally challenging tasks of giving birth is the necessity of separating from your baby. Your baby is perceived both as an individual and as a part of you. Separating from a part of ourselves or from someone very close to us is always a difficult and painful process.
Facing great physical and psychological pain creates fear and anxiety. To endure it for so many hours represents a huge challenge to your strength and is often represented as the transition stage of labor.
This moment usually corresponds to “surrender,” a moment when you think,” I cannot do this any longer.” Yet it is this moment that you become capable of abandoning yourself to the strong energies running through your body.
Surrender, in this case, translates into going beyond one’s personal limits; it represents the last step in the progress of labor and birth, while at the same time it activates new resources and equips you with the necessary attributes to be a parent and a guide to your child.
Adrenaline increases attention and alertness. High levels will inhibit labour and reduce oxytocin by diverting the blood supply to parts of the body needed for flight or fight, and reducing circulation to the uterus and baby.
3 reasons that correct breathing is necessary during labor and birth
- During contractions/surges/waves, the blood flow to your baby and your muscles is restricted. By using DEEP breathing or BELLY breathing, you will ensure that both your baby and your muscles stay well oxygenated. This reduces fetal distress and pain sensations.
- The space between contractions/surges/waves is as important as the contractions themselves. By using EASY breathing you will be able to rest, recover and prepare for the next one, and conserve your energy for when you need it in active labor or when you have the urge to bear down.
- At the end of your labor when you feel the urge to bear down, you will use the BIRTH breath to avoid purple pushing. By practicing this during pregnancy it becomes an instinctive response to pressure and will help you to protect your pelvic floor and avoid an episiotomy. You will also feel more in control.
- Movement and position
- Water birth
- Tens machine
- Counter pressure
- Counter irritants
- Double Hip Squeeze
- Breathing Techniques
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You will understand common complications that arise in labor and what you can
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The Midwife Guide to Pain Management
This course will radically change the way you think about birth by understanding the
cause and function of pain and the influence of fear on your experience.
It is the foundation course for birth preparation and will ensure that you go
into labor feeling calm and confident.
View Full Course info