Fundamentals of Relaxation Part 2

In this 8 part series , we are going to explore the fundamentals of relaxation, how each type works, the benefits and a little history.  We humans do not relax enough – we believe that sleeping or watching television is relaxation….nothing could be farther from the truth.  And it is so important to both mother and baby during pregnancy!

Touch Relaxation

Referred to as a natural relief for labor pain by the March of Dimes, touch relaxation begins with the expectant mother relaxed in a comfortable position.  The environment can include gentle relaxation music, dim lighting, and aromatherapy (such as a candle or incense if not in a hospital, or essential

oils diffusing).

The labor support person (LSP) touches or massages a certain group of muscles, helping her to focus relaxation on that particular muscle group.

Touch relaxation may be contraindicated when there are serious psychological issues, physical injury or a history of abuse.

How to do Touch Relaxation:

1. Start the Touch Relaxation time with a deep gentle breath in and slowly exhale.
2. Beginning at the top of the head, the LSP gently touches the scalp.  The mother takes a deep breath in and on the exhale, releases tension there.
3. Move to the temples, the LSP gently touches one side and then the other. The mother takes a deep breath in and on the exhale, releases tension there.
4. Next, one by one, comes the forehead, cheeks, chin and neck (both front and back). The mother takes a deep breath in and on the exhale, releases tension there.
5. On one side, the LSP touches the shoulder, then down the arm, to the forearm and the hands.  Repeat on the other side. The mother takes a deep breath in and on the exhale, releases tension at each spot.
6. Next comes the chest under the collar bone. The mother takes a deep breath in and on the exhale, releases tension there.
7. The LSP touches the upper abdomen near the solar plexus or diaphragm. The mother takes a deep breath in and on the exhale, releases tension there.
8. Then on one side, the LSP touches the hip, down the femur to the knee, down the calf to the ankle and foot.  Repeat on the other side.  The mother takes a deep breath in and on the exhale, releases tension at each spot.
9.  End the Touch Relaxation time with a deep gentle breath in and slowly exhale. 

A great reference for relaxation comes from Kathy Morelli LPC in her book BirthTouch: Shiatsu & Acupressure for the Childbearing Year.  You can get this book through Amazon in either paperback or Kindle version! Click here to learn more.

A very useful handout on Touch Relaxation is from Birthlore.com, click here.

Rhonda Taylor has a very nice handout also with scripting, click here

While this video only shows Touch Relaxation on the head, it will give you a good idea of how it works!

Fundamentals of Relaxation Part 1

In this 8 part series , we are going to explore the fundamentals of relaxation, how each type works, the benefits and a little history.  We humans do not relax enough – we believe that sleeping or watching television is relaxation….nothing could be farther from the truth.  And it is so important to both mother and baby during pregnancy!

"Tension is part and parcel of what we call the mind. Tension does not exist by itself, but is reflexively integrated into the total organism. The patterns in our muscles vary from moment to moment, constituting in part the modus operandi of our thinking and engage muscles variously all over our body, just as do our grossly visible movements. If a patient imagines he is rowing a boat, we see rhythmic patterns from the arms, shoulders, back and legs as he engages in this act of imagination. The movements…are miniscule".

~ Edmond Jacobson, 1927

Progressive Relaxation

The deep muscle relaxation technique of progressive relaxation was developed by Edmond Jacobson PhD, MD  around  1910.  Jacobson believed that our bodies responded to anxious thoughts and events with muscle tension.  Tension in those muscles increased the feeling of anxiety (much like the Fear-Tension-Pain Cycle).  Deep muscle relaxation reduces physiologic tension, lowers blood pressure and pulse, and produces a general sense of calm.  Researchers have noted that progressive relaxation is effective in treating general anxiety, insomnia, depression, fatigue, hypertension, and

some phobias.  It has been an integral part of prepared childbirth methods since the 1950s.  It is also part of some Yoga methods.

With the publication of The Technic of Progressive Relaxation in 1924, Jacobson gave the world an answer to rising stress. His method is quite simple.  And there are many pre-written scripts available for you to use in your practice.  Below are just a few:

This beautiful handout is from Hartford Hospital in Connecticut Click here

From Baylor Univesity in Texas: click here.
From Australia: click here.

Try this one from the University of Houston at Clear Lake in Texas:  click here.

Sample this Relaxation Meditation yourself.  For some, it can be difficult to teach a technique if they have not experienced it themselves.

References: 

1. DiPietro, J. Et al. (2008) Fetal responses to induced maternal relaxation during pregnancy. Biological Psychology.  January 77(1): 11-19
2. Field, T. et al. (2004) Massage therapy effects on depressed pregnant women. Journal  of Psychosomatic Obstetrics and Gynecology. June 25(2): 115-22.
3. Fink, NS. Et al. (2011) Fetal response to abbreviated relaxation techniques. A randomized controlled study.  Early Human Development. 87(2):121-7.
4. Janke, J. (1999) The effect of relaxation therapy on preterm labor outcomes.  Journal  of Obstetrics, Gynecology and Neonatal Nursing. May –June 28(3): 255-63.
5. Lothian, J. (2011) Lamaze breathing: What every pregnant woman needs to know. Journal of Perinatal Education.  Spring 20(2):118-20.
6. Lothian J. A., DeVries C. (2010) The official Lamaze guide: Giving birth with confidence.2nd ed. Minnetonka,MN: Meadowbrook Press.
7. Smith, C. et al. (2007) A randomized comparative trial of yoga and relaxation to reduce stress and anxiety.  Complementary Theories in Medicine. June 15(2) 77-83.
8. Smith, C.A. et al. (2011) Relaxation techniques for pain management in labor.  Cochrane Summary Review retrieved 6/26/13 http://summaries.cochrane.org/CD009514/relaxation-techniques-for-pain-management-in-labour

Extreme Self-Care for the Busy Birth Professional

Usually, my blog posts are more evidence-based and researchy.  Today, I want to share with you 10 quick extreme self-care ideas.  

Not stressed?  Don't need self-care?  Sorry, I don't believe you.

Each of us has too much on our plates: family stresses, children, financial considerations, clients,

births, classes, marketing, success.....the list is endless.  And if we first don't recognize this stress, then we will become victims of the very stress hormones that we help our clients to guard against.  Stress puts stress on our bodies and lowers our immune system. Extreme stress begins to put strain on organ systems.  It can affect your hair, skin, digestive system, urinary tract, muscles and so much more.  Headaches, muscle aches and grumpy outlooks may all become part of the over-stressed menu.

Here are my top 10 go-to stress busters.  In the event of extreme stress, you may need to do ALL of these in one day!

In no particular order: 

1) First and foremost, meditate.  This is more than just sitting silently thinking or praying.  For some, it involves being in a relaxing locations or listening to relaxing meditative music.  Add a soothing scent (such as incense or lavender essential oil) for even more impact.

2) Get a massage.

3) Go sit by a body of water (lake, river, ocean).  Enjoy the sunshine and solitude of nature. Listen with intention to all of the sounds - going so far as to closing your eyes and trying to identify sounds.

4) Find a cuddly old quilt and lay on the ground and watch the clouds.

5) Have an appliance-free day - this means no TV, radio, computers, cell phone or tablet for 24 hours.

6) Do some Zentangling.

7) Relax!  Relaxing is not sleeping...it is an active form of stress release.  You may do Yoga positions to facilitate relaxation or practice what you preach in your business - progressive muscle relaxation visualization, breathing or even Tai Chi.

8) Cuddle with your partner....and if that leads to sex, then you both can benefit from the oxytocin rush!

9) Get an ice cream or coffee, preferably use a drive thru, and pay $5 towards the bill of the car behind you.

10) Take a walk through an arboretum.

Taking time for yourself fills your heart with so much positive energy!  Be ware of the temptation to short change yourself, with mental messages such as "I have too much to do - don't have time for pleasure now." or "This stuff won't work."  You must make time for you and yes this stuff does indeed work - there are plenty of evidence-based research articles that show the benefits.

Now...ready, set...RELAX!

Skin to Skin: Another Evidence-based Best Practice Ignored by Too Many

What if there was a procedure that increased exclusive breastfeeding duration, maintained infant temperature in the neutral thermal range, maintained infant blood glucose, reduced infant crying and promoted optimal maternal behaviors, plus positively affects infant self-regulation and dyadic mutuality? 


And what if this procedure took no more time or effort or FTEs for hospital staff but increased patient satisfaction? 

And what if this procedure had NO negative side effects? 

What if UNICEF, The Baby Friendly Initiative, WHO and others promote this procedure? 

And what if there was plenty of evidence based information to support this procedure? 

Wouldn’t every hospital want to implement this procedure immediately? 

Of course! But it isn’t being implemented. 

What is this procedure? Skin-to-skin contact! 

Who better to explain all of this than researcher Dr. Nils Bergman:


 

Dr. Bergman will be touring the US during the second half of 2013.  Go to http://www.skintoskincontact.com/tours.aspx for a growing list of his appearances!

Clearing the Air....and more: The Art of Smudging

Some call it New Age or VooDoo, but smudging is actually a common practice in Native American tradition and even some religions.

The use of burning aromatic herbs such as those in a smudge stick or incense plays a role in spiritual, emotional and mental clearing/purification.  It is common to smudge a new office space or living space or during a general spring or fall housecleaning.   Basically, smudging is a ceremonial way to clear out negative energy or influences that might promote bad feelings.  Smudging can also be a part of a Blessing Way for an expectant mother.

The elements used in a smudge stick or for smudging include the herbs White Sage, Cedar, Sweetgrass, Pinon,  or Lavender.  A combination of these elements are gathered and tied in a stick-like bundle and allowed to dry thoroughly.    You can also purchase premade smudge sticks from online vendors such as www.taosherb.com , www.madeinnewmexico.com or even Amazon.  Many kits are available that have a receptacle to use while burning, either terra cotta or an abalone shell.  Add sand to the receptacle to put out the lit smudge stick when finished.

Light the smudge stick with a candle or other long burning flame source.  It often takes a few minutes to thoroughly light the stick.  You do not have to use the entire smudge stick at one burning.  Having too much of the burning herb smoke may cause respiratory problems in infants/young children, pregnant women or the elderly.  And as with other flame sources, never leave a smudge stick unattended!

You can read more about Native American smudging rituals at  http://www.asunam.com/smudge_ceremony.html or http://www.nativeamericanresearch.org/smudging.html

FEAR - contributing to labor interventions and PTSD

It is called tocophobia .  

It affects 1 in 10 women.

And it seems to be ignored by maternity care literature.

Yet, an amazing study done between 2006 and 2007 in Sweden's Karolinska Institutet, shows that psychoprophylaxis does help in some cases.

What is tocophobia?  From the Greek word tokos meaning childbirth and phobos, meaning fear, tocophobia is the fear (irrational) of childbirth.  Women and men can experience tocophobia and can experience a fear of dying, fear of pain, fear of lack of pain relief and fear of deformity of the newborn.  Occasionally tocophobia is culturally associated, such as when negative feelings toward childbirth are passed from mother to daughter or after seeing a film depicting childbirth early in life with no support or educational explanation.

In the medical literature, tocophobia or severe fear of childbirth (SFOC) is seen addressed more in

psychological journals or those from Europe than in the North American continent.  Maternal confidence and self efficacy are common threads in discussions of tocophobia or SFOC.  From the Nethersole School of Nursing in Hong Kong, the author writes that the efficacy-enhancing educational intervention should be further developed and integrated into childbirth education interventions for promoting women's copying ability during childbirth. Not only did the educational intervention promote a woman's self-efficacy but also reduced their perceived pain and anxiety in the first two stages of labour.

Further research in the literature demonstrates that prenatal anxiety was significantly related to self-efficacy for childbirth in late pregnancy, labor pain, number of hours at home in labor and admitting cervical dilation, and interventions used during the labor.


Kathy McGrath demonstrates that fear has its place in birth and new mothers can benefit from it:

Giving birth is meant to shake us right down to our roots so that we come out of it changed and ready to take on the daunting tasks of mothering a new baby. When birth goes well, from an emotional as well as a physical perspective, we come out of it empowered, awed, and humbled. When it does not go well, we can enter motherhood feeling disappointed, disillusioned, and disempowered. The stakes are high.

As childbirth educators and doulas, we need to approach this fear with caution and respect.  Not only does fear of childbirth result in extended length of labor, arrested labors, increased using of induction or augmentation, cesarean delivery, instrumental delivery but SFOC can affect mothers during the postpartum period as well with an increased risk of post-traumatic stress disorder (PTSD).  Fear and lack of control are elements contributing to PTSD.

SFOC is not addressed in the typical office visit.  Childbirth education classes are often discouraged.  Why are women's fears being ignored?  Why do we send new mothers, traumatized by a difficult birth that validated their prenatal feelings of fear, home alone with little or no support?

Give expectant mothers an atmosphere where they can feel safe in sharing their fear(s), where they feel they are heard and not judged.  Acknowledge the fear and share with them psychoprophylaxis!

What is psychoprophylaxis?  Based on a method of preparing women for childbirth with education, psychological and physical conditioning and breathing, psychoprophylaxis soon became synonymous with Lamaze, after Dr. Fernand Lamaze brought the Russian style of childbirth preparation to the West in the mid 1950s.  Quite simply, psychoprophylaxsis (psycho means mind and prophylaxsis means prevention) gives expectant mothers the educational and practical techniques to understand the careful hormonal orchestration of birth and be empowered to use simple techniques to produce effects that are not only healthy for both mother and baby but truly define self-efficacy for birth and the postpartum period.

As Barbara Hotelling so brilliantly put it: 
We once lost touch with a caring model of birth, and we are fortunate to have that knowledge and the availability of that model again. Childbirth education must evolve from the technological curriculum to a physiologic study of how well women's bodies are created, not for being delivered, but for giving birth.

With physiologic birth as our guide, we can reduce or eliminate tocophobia.


References:

Bergstrom M. et al.  Fear of childbirth in expectant fathers, subsequent childbirth experience and impact of antenatal education: subanalysis of results from a RCT.  Acta Obstetricia et Gynecologia Scandinavica 2013 Apr 16.

Harris, R., Ayers S. What makes labour and birth traumatic? A survey of intrapartum 'Hotspots'. Psychology and Health 2012; 27(10): 1166-77.

Hotelling, B. Considerations when using videos in Lamaze Classes.  Journal of Perinatal Education 2012 Summer; 21(3): 189-92.

Hotelling, B.  From Psychoprophylactic to Orgasmic Birth.  Journal of Perinatal Education 2009 Fall; 18(4): 45-48.

Ip, W et al. An educational intervention to improve women's ability to cope with childbirth.  Journal of Clinical Nursing 2009 Aug; 18(15): 2125-35.

McGrath, K. The Courage to Birth.  Journal of Perinatal Education 2012 Spring; 21(2): 72-79.

Rouhe H. et al. Obstetric outcome after intervention for severe fear of childbirth in nulliparous women, a randomized trial.  British Journal of Obstetrics and Gynecology.  2013 Jan; 120(1): 75-84. 

Saisto T., Halmesmäki E. Fear of childbirth: A neglected dilemma. Acta Obstetricia et Gynecologica Scandinavica, 2003 82(3), 201–208 

The Milky Way - A Breastfeeding Documentary

While the statistics show that breastfeeding rates in the US are going up, the US still has a way to go.  According to the CDC Breastfeeding Report Card 2012, Idaho leads the country in the percentage of women who ever breastfeed --> 90.8% and Mississippi is last at 47.2%.  If you look at the stats for those states who still have exclusive breastfeeding mothers at 6 months, Colorado leads with 26.6% and West Virginia is last at 9.1%.  

Part of the increase in breastfeeding rates can be attributed to the acceleration in percent of babies born in hospitals designated as Baby-Friendly, an international recognition of best practices in maternity care.  And while there are improvements statistically, the statistics also suggest that many mothers are not receiving the quality of care that will give them the best possible start to meeting their breastfeeding intentions, says the CDC.

Even with the Surgeon General's call for improved breastfeeding, the US still has not reached government goals.  The Healthy People 2020 calls for 60% of babies to breastfeed at six months and 34.1% being breastfed at 1 year.  The American Academy of Pediatrics recommends that women breastfeed their babies exclusively for six months.  The World Health Organization recommends the same, with continued breastfeeding with supplementary foods for two years and beyond.

Dr. Melissa Bartick, internal medicine physician in Massachusetts and was the 2011-2012 Chair of the Massachusetts Breastfeeding Coalition,   stated in 2011 that a study showed the then current suboptimal US breastfeeding rates cost the US economy $13 billion per year in 2007 dollars for pediatric health costs and premature deaths.  She went on to say that if 90% of mothers could comply with current medical recommendations around breastfeeding, our economy could save at least $3.7 billion in direct and indirect pediatric health costs with $10.1 billion in premature death from pediatric disease. 

Why then, with all of the known benefits, why are breastfeeding rates so low in the US?

Watch this partial "celebrity cut".....from producers Jennifer Davidson RN BSN IBCLC a pediatric nurses and lactation consultant at the pediatric practice of Dr. Jay Gordon MD in Santa Monica CA and Chantal Molnar RN MA IBCLC.

References:

Bartick, M. Breastfeeding and the US Economy. Breastfeeding Medicine: The Official Journal of the Academy of Breastfeeding Medicine. 2011 Oct: 6; 313-8.

The Academy of Breastfeeding Medicine

Academy of Breastfeeding Medicine Position Paper on Breastfeeding

The Milky Way Movie

Getting All the Ducks in a Row - Birth Plans

When you go on vacation, you map out the route.  When you go to the grocery store, you make a list.  When women are pregnant, it is logical to make a birth plan on paper.  Many expectant mothers make plans in their heads but to share their thoughts with those that will be supporting them through the process makes good sense.

According to Medline Plus, a service of the US National Library of Medicine and the National Institutes

of Health, birth plans are good tools to help expectant mothers think and learn about what might happen during the birthing process and afterwards.  As childbirth educators or doulas, we often play a vital role in assisting in information gathering and decision processing for birth plans.  Bailey stated that as a component of childbirth preparation, a birth plan can be a medium to improve patient-provider communication regarding a desired labor and birth experience and improved satisfaction with care.

Pregnant women often create birth plans to specify their preferences for the birthing process.  When nurses implement and advocate for women’s birth plans, it increases women’s autonomy and decision making in the process and can lead to greater patient satisfaction. (Anderson)

Again, satisfaction.

Yet, in many situations, birth plans are treated like a plan to fail.  Lothian points to the tension between health professionals and patients caused by birth plans and that it might reflect the larger problem with contemporary maternity care: conflicting beliefs about birth, what constitutes safe/effective care and ethical issues related to informed consent and informed refusal.  Lothian goes on to suggest that birth plans should focus on three patient-focus questions:

1. What will I do to stay confident and feel safe?
2. What will I do to find comfort in response to my contractions?
3. Who will support me through labor and what will I need from them?

A childbirth educator’s guidance in birth plan preparation is key.  In searching the Internet, web-based birth plans typically do not give adequate (if any) explanation of terms or options.  They  lack the depth to explore the Ripple Effect™ of interventions, nor do they include what Lothian called informed refusal conditions.   Multiple pages in length, web-based birth plans often are too long for hospital staff to read and may evoke feelings that the laboring women is trying to tell them how to do their job.  Wagner and Gunning suggest that a birth plan is an approach to labor, rather than a term for a specific kind of outcome.  Childbirth educators, counseling expectant mothers, can ensure this flexibility.

A vital piece to understanding of birth plans by the expectant mother is the concept of informed consent and the five questions that should be asked/answered.  These five questions can provide a memory hook by the acronym BRAIN.  Asking these five questions when there are exceptions to be made to the birth plan can also ease flexibility.

For the complete article with references, click here

Blending Childbirth Education and eLearning--> Dreams to Reality

Just a few short years ago, I took an impromptu "study" in my childbirth education class to see where parents went for their information.  In 2008, information resources ranked like this: (1) Friends; (2) Family; (3) Books; (4) Internet; and (5) Careprovider.  Now while this was very far from being a scientific study, educators are finding out today that the internet has moved up to #2 if not #1 in the rank of pregnancy/parenting information gathering resources.  I will be speaking on this topic at the 2013 Lamaze International Conference in New Orleans in October.  What remains important as the paradigm shifts more toward elearning is evidence based information.  Guest blogger Dianne Moran RN, LCCE, ICD from Customized Communications shares about blazing this very important new trail!

Have you ever seen the movie, The Field of Dreams? In the movie, the lead character is walking through a cornfield and he hears a voice telling him “If you build it, they will come.”

The premise was if he cleared this cornfield to build a baseball ball diamond, he’d be able to host baseball’s greatest players and people would flock from everywhere to pay for a seat to watch a game. Today, more people are familiar with this phrase because it is commonly used in the world of business. It implies that if you offer a product, the customer will magically appear and want to pay you for it.

Well, that is a dream.

Most of us know success isn’t simply attained because you’ve built something. You have to position it to attract an audience and then tell them that you have what they need and most importantly why they need it from you. That requires a bit more creative finesse.

With the latest developments in healthcare reform, our clients are faced with adapting to an ever-changing landscape in hospital healthcare. Hospitals and health systems realize now more than ever that it’s simply not enough to exist as a brick and mortar establishment. They have to strategize effectively to draw the community closer and market the most comprehensive procedure they have; the patient experience. This is a great challenge because this experience doesn’t simply begin the moment they see a nurse.

The patient experience begins at home. Right now a pregnant woman is online, searching for answers to her questions about childbirth and preparing to make a monumental decision; where to have her baby.

This is where cycle of influential healthcare starts and for hospitals, the prenatal period is a prime opportunity to reach that prospective patient. At CCI, we are consistently exploring ways to help our clients use patient education to position themselves within their communities to:

• ·         Keep the hospital’s brand of healthcare highly visible and distinguishable above all the rest
• ·         Engage and educate the expectant community
• ·         Use the momentum of a positive birth outcome as a catalyst for more growth and more success

In 2008, we began cultivating our own Field of Dreams when we set out to revolutionize the way patients and hospitals connect. We started by carefully calibrating each program within our Mother-Baby library into a resource hospitals could position on their website. The goal of our eLearning was to connect the expectant patient with the nurses and educators at her hospital by offering her access to educational programs 24/7.

It’s been five years now and our dream of building a dynamic pathway between the patient and the hospital has become a reality. eLearning has quickly become one of the most innovative tools we can offer a hospital.

So where that guy heard a voice in the middle of a cornfield, we hear that mama’s voice somewhere within your community saying “If you teach me, I will come” This is the voice of expectant parents in your community, and eLearning is just one of the many ways, you can reach her and her family now and in the years to come.

Dianne Moran, RN, LCCE, ICD

Customized Communications, Inc.