Holistic Therapies during Labor - Holistic Pregnancy and Childbirth

Holistic Therapies during Labor

Labor is the period during the ninth month of pregnancy when contractions of the uterus begin opening the cervix and forcing the baby through the birth canal. During labor, a woman's uterus will contract as few as 25 times or as many as 300 times. Labor can last a few hours or as long as 36 hours. Shorter labors are normally easier for the mother and baby, and are likely to result in less complications. Most women, except those with unusually small pelvises, are usually able to deliver their babies naturally without drugs or special medical procedures.

Which women have the shortest labors with the least pain? In the Motherhood Report , Dr. Louis Genevie suggests that the best indicator is a woman's stress level during her pregnancy. Women who report more psychological stress during the third trimester of pregnancy, for example, tend to have more painful labors. Interestingly, researchers have discovered that a mother's stress level in the 32nd week is the best predictor of labor pains.

Holistic obstetrics focuses on mind/body therapies which prepare the mother psychologically and physiological for an optimum birthing experience. The following sections discuss holistic therapies which have proven clinically effective during labor.

Holistic Key: Self-Hypnosis.     How does self-hypnosis help to relieve labor pains? Several English obstetricians have suggested that it produces a natural state of anesthesia. Like biofeedback, yoga, meditation, visualizations, and positive thinking, self-hypnosis can trigger the release of endorphins, the body's natural pain killers.

Dr. Gowri Mothad, an English obstetrician who supervises a holistic “pain-free” pregnancy clinic in northeast London, uses self-hypnosis to help mothers focus exclusively on positive, peaceful thoughts during labor. Her staff also provides reflexology, massage, osteopathy, yoga, and other holistic healing methods to help women have pain-free, pleasant birthing experiences. Mothad's clinic delivers the majority of babies in water, and many of her patients labor for less than six hours.

Holistic Key: Childbirth Classes.     Both conventional and holistic medicine stress the importance of childbirth classes because numerous studies have shown that preparation classes reduce a pregnant woman's anxiety and increase her positive images about labor and delivery. The information offered in a prenatal course will help eliminate some of the doubt and fear that surrounds childbirth, as well as provide practical information on prenatal exercise and nutrition. Childbirth classes also offer a first-time mother the opportunity to discuss the safest and least invasive birthing options with childbirth educators and midwives.

Holistic Key: Responsive Caregiver.     Perhaps the most important holistic “key” to minimizing pain and complications during labor is for the mother to choose a caregiver with whom she is comfortable. Ideally, this caregiver should be he obstetrician, a nurse, or nurse-midwife. Joyce Roberts, a certified nurse-midwife, conducted a study in 1989 at the University of Colorado School of Medicine in which she and her colleagues analyzed videotapes of the labor and delivery process of hundreds of women. Roberts discovered that when mothers felt that their caregivers were “responsive,” they and their newborns were healthier after delivery. The mothers surveyed by Roberts defined a “responsive” caregiver as a person who allowed them to choose their delivery positions and to push when they felt the urge.

Penny Simkin, a birth attendant, also found that women who felt that their caregivers were sensitive to their emotional needs had shorter labors, less pain, fewer complications, and less postpartum depression than those who did not have a sensitive caregiver. Pregnant women who told Simkin that they felt in control of their childbirth also recalled more positive memories about their labor and childbirth. Simkin suggests that a positive relationship a caregiver will also increase the mother's sense of self-esteem during postpartum. She notes that mothers who had negative memories of their childbirth reported more postpartum pain and depression.

Holistic Key: Certified Nurse-Midwives.     An increasing number of American mothers now use certified nurse-midwives (CNMs) as their caregivers. The American College of Nurse-Midwives (ACNM), for example, estimates that within five years 10% of all births in the U.S. will be attended by CNMs.

Several large studies have shown that when midwives assisted in the delivery of a baby, mothers were more relaxed, their labors were shorter, and they required fewer drugs or medical procedures. A five-year NIH study, for example, found that 13% of the mothers attended by a CNM used epidural anesthesia during labor, compared to 41% attended by a conventional obstetrician; 36% of CNM patients received continuous electronic fetal monitoring compared to 74% of regular patients; 32% CNM patients, compared to 59% of regular patients, received episioto-mies; and only 8% of CNM patients required Cesarean section, while 19% of regular patients received one.

These findings confirmed an earlier 1987 NIH study which found that mothers cared for by CNMs were significantly less likely to experience postpartum hemorrhage, infection, and major perineal damage than patients treated by a nonholistic physician. The study also revealed that women assisted by nurse-mid-wives fared as well as doctors' patients and were less likely to have intravenous fluids, Pitocin induction, artificially ruptured membranes, sedatives, or anesthesia.

Holistic Key: Mother-Father Intimacy.     A Mother's sense of intimacy with her partner may also influence how long she will be in labor. Several studies have shown that women who felt supported in their labor by their husband or partner have shorter labors, and fewer birth-related complications, including Cesarean sections. Psychologist Katherine Nuckolls, for example, surveyed pregnant mothers and found that those who had strong support from their partners experienced one-third fewer complications during pregnancy and childbirth. According to Nuckolls, being supported during their labor made women feel more loved, increased their self-esteem, and made them feel part of something larger than themselves.

Holistic Key: Perineal Massage.     The importance of perineal massage throughout pregnancy has already been discussed. It's particularly important to massage the perineum prior to labor to prepare it for stretching during childbirth. For some women, this reduces their need to have an episiotomy—the small surgical cut in the perineum which facilitates the emergence of the baby. Massage can also prevent the perineum from tearing or scarring, even if an episiotomy is necessary. Massage should be delayed if there are any vaginal problems, such as an active herpes sore or vaginitis. It can be resumed once the vagina is healed.

Holistic Key: Acupuncture.     Acupuncture has been used in Russia since the 1940s to relieve labor pains. There have been several Russian clinical trials in which acupuncture was effectively used as a form of reflex analgesia during labor. One clinical trial, reported by Dr. O. Oberg, investigated the effectiveness of reflex analgesia via electrical acupuncture in 46 patients with an abnormal preliminary labor periods. Oberg concludes “that acupuncture was found to effectively reduce preliminary pain sensation, to normalize central nervous function, autonomic reactions, uterine contractility, reduce the need for pharmacological agents and result in better deliveries.”

Acupuncture appears to be a less invasive pain-relieving therapy during labor than drugs. Dr. Jack Pritchard, author of “Analgesia and Anesthesia” in William's Obstetrics , cautions mothers not to indiscriminately take pain relief drugs during labor—unless they feel it is absolutely necessary—because some drugs reach the baby through the placenta. He notes that Pethidine, for example, sedates newborns to the point of disturbing their early suckling patterns and may inhibit successful breastfeeding.

Newer analgesic drugs appear to have less severe side effects. Epidural analgesia is a “local” pain medication which is injected close to the spine. The proponents of epidurals claim that in extreme cases, it can make the difference between a terrible experience and a tolerable one. They also suggest that it has few long-term effects on the mother or her baby. Holistic obstetricians, however, caution that most epidurals weaken the mother's bearing down reflex which sometimes delays the second stage of labor, and can lead to early surgical interventions, including forceps and vacuum extractions. It is important for all women to decide in advance whether they wish to have a natural labor without medications. Should complications develop, they should discuss pain relief options with their obstetrician or caregiver before they're administered.

Holistic Key: Progressive Relaxation and Imagery.     Total body relaxation helps relieve pain during labor and childbirth. The more familiar a mother is with relaxation exercises during labor, the easier it will be for her to maintain the relaxation response for longer and longer periods. If she steadily relaxes her uterus during labor, she has a better chance of having fewer and less painful contractions. Like relaxation, imagery is a skill that needs to be practiced, and becomes easier with use.