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Pain Management--Using Visualizations

Posted by kate.herzel on July 13, 2012 at 11:00 PM Comments comments (1)



Finally checking back in after a looong hiatus from blogging! I was recently given some good thoughts about blogging value-added content from my favorite volunteer babywearing educator, and I'm recommitting myself to doing just that!


So let's talk about using guided visualization for pain management in labor!

Googling visualization for labor or guided imagery for labor, or some combination of the two, yields TONS of scripts that you can print off and have available during your labor. But how useful are these? For starters, most women find that if they don't PRACTICE visualization during their pregnancies (especially during times of stress and discomfort), they are rather unsuccessful for coping in the throes of labor. But that's only one leg of what I call the three-legged stool of successful visualization.

We all know that without three legs, a stool is useless...here are my three legs:
1. Practice faithfully throughout pregnancy
2. Use a script that evokes your own happy place, preferably one you have written yourself
3. Evoke all 5 senses in your imagery to give you something strong to focus on

Let's take them one at a time...

1. Practice, Practice, Practice!
If you plan to use visualization (or any form of "hypnosis"-type scripts), the usefulness of your scripts is dependent on how much you have practiced using them. When labor gets tough, it is SO hard to focus (especially during the transition time from about 7-10 cm dilation). Practicing when you are pregnant helps you wear pathways into your brain that will be easier to follow when you are in labor, rather than having to create those pathways while you are distracted. It also tells you that if you are unable to focus on these successfully when pregnant, that perhaps you should find other pain management techniques for labor! Visualization just might not be your thing, but how do you know if you haven't tried it?! 

It is best to practice under some simulated (or real) stress situations, to give your brain a mental workout while it is otherwise occupied. Practice your visualization when you are having a bad day at the office, when you are having a difficult bowel movement (hey, we've all been there!), or if you are one of the lucky non-stressed few, try holding an ice cube in your hand while you practice. Focus on breathing, not holding tension in your face, and relaxing your pelvic floor while you are working through the visualizations. 

2. Use your own script. 
I lived in Florida for a couple of years, and love the beach, so my script is about a very specific beach that I frequented there. I can visualize it very well, right down to the missing letters on the sign out front and where the big knots are in the wooden planks of the pier. My visualization is successful for me because I have actually been there, multiple times. Do you think I would do as well with a generic beach script I printed off the internet? No way! On the same note, do you think someone who is afraid of sharks and water would be successful using my script? Of course not! So write your script about an actual place you've been, and include actual landmarks from that place. It doesn't matter if your place is the beach you vacationed as a kid, the mountainside where you camp, or the mall food court where you met your husband. As long as that place is relaxing and significant to you, you are setting yourself up for success!

3. Use all 5 senses.
Just visualizing the place does not give you enough to focus on when labor really gets tough. By using strong sensory stimuli, you are able to focus, even when your visualization cannot distract you from the intensity of the sensations you are experiencing any longer. In fact, when you are off in Labor Land, sometimes it is useful for your birth team to drop the whole visualization and stick to just the sensory stimuli (and maybe add some generic ones in there, too). At the start of each contraction, your birth partner can pick one example and say it to you, "the taste of a lemon." This can be paired with massage, as well as any other coping mechanisms you have. It feels good to have something to focus on (other than the clock on the wall!), especially during transition when women often describe themselves as feeling out-of-control. You should use smell, sight, taste, sound, and touch within your guided imagery script. 

Here's a list of other strong sensory stimuli to get you thinking:
-Taste of a lemon
-Smell of freshly cut grass
-Smell of fresh bread baking
-Taste of a dill pickle
-Feel of smooth velvet
-Feel of a silk shirt
-Sound of waves breaking
-Sound of snow crunching beneath your feet
-Sight of freshly fallen snow
-Sight of a spider's web with dew on it
-Sight of a pine cone
-Feel of a pine cone

Now take away the ones that aren't relaxing to you, add some that are, and get practicing! :)

Do You Have Any Questions?

Posted by kate.herzel on February 25, 2012 at 11:00 PM Comments comments (0)

How many times has your midwife or OB asked if you have any questions, and you find yourself responding NO because you can't think of any off the top of your head?! 

It's not your fault! When we are made to feel like "patients who will be delivered" instead of "women who will birth," it is automatic for us to assume that our midwife or doctor has our best interests in mind and will guide us down the right path when it comes time for the big day. While this is somewhat true, unfortunately there are other factors pulling at a provider that can cause them to recommend things that might not be in the best interest of a (soon-to-be) mom.

Here are a few questions that I recommend you write down and take with you to your next appointment (even if you don't know what they mean just yet): 

1. When I go into labor, would you like me to call your office or just go to the hospital?
-This is a non-confrontational starter question that can give you some insights into just how hands-on your provider is. If she tells you to call the office first, it's a good sign that she wants to be a part of your labor and not just show up to catch the baby! Also, it might mean that she would like you to labor at home for awhile, and hopefully not have unneccessary interventions in your labor by showing up at the hospital very early and being put "on the clock", so to speak. Bonus points if she takes time to discuss some of the signs of labor with you. If she suggests heading straight for the hospital, you may want to start asking more questions about how she would like for you to labor. 

2. When do you consider inducing a labor? What methods of induction do you prefer?
-This is a slightly more subtle way of asking your provider if she practices a medical model of care or an expectant model of care. Many women assume that doctors are medical and midwives are expectant, but that certainly doesn't hold true with our local providers! If you are unsure of the circumstances she describes, write them down and do some research. Your childbirth class will probably explain the pros and cons of induction as it relates to some specific conditions, and your childbirth educator will be able to answer your questions about others if you have them. There are pros and cons to both the medical and expectant models of care, depending on what kind of birth you want, which will also be discussed in your class.

3. How do you handle tearing?
-This is a chance for the midwife or doctor to discuss episiotomy rates, and whether she practices supporting the perineum during pushing, or whether she uses purple pushing (nurses counting to ten while you bear down) or lets you push when you feel the urge. A good follow up question is, "in what circumstances do you find it necessary to cut an episiotomy? How often do you cut them?" if she does not bring it up specifically.

4. How do you feel about food and drink during labor?
-All the local hospitals have a "policy" that you cannot eat or drink during labor. But, your provider can override that policy. This question will help you gauge whether your provider is willing to go against the grain, or if she does things by the book. It may take some prodding because she is likely to say "the hospitals have a policy of NPO, meaning nothing by mouth," so you might have to ask more specifically if she makes exceptions or thinks it is beneficial to eat and drink during labor (research shows that it is, but old habits die hard--your childbirth educator will explain more).

5. What will you do during my labor?
-This is a pretty straightforward question. Some providers do not show up until you start pushing, and may instruct nurses to call once you are ready and keep you from pushing until they arrive. Others may be more free to come in and out during your labor or will come when you are, say, 7 cm dilated (or more, or less). This is also a good time to discuss who would attend your birth if your provider is unavailable, and whether they practice with a similar philosophy. 

Let's face it--most of us spend more time researching what digital camera to buy than who will be at our births! Hopefully these questions give you a jumping-off point for getting to know your provider better. You will learn in your childbirth classes the importance of this information, so don't worry if you don't understand it 100%. If you later learn that you are not comfortable with one of the answers, you may be able to negotiate something different. Otherwise, it is never too late to change providers if you suddenly realize that you want a type of birth that is not likely to happen with the provider you have been seeing. 

***Bonus question: Do you find that a doula is helpful to a mom during labor?
-A doula is PROVEN to be helpful to a mom during labor--I can show you the statistics from all of the studies that have been conducted!