Touch is one of the most sacred and healing gifts one human being can give to another. Touch has been renowned for its healing power for thousands of years, and ancient methods of touch therapy have been in practice across the globe for millennia. Although countries like Thailand, China, Japan and India consider regular massage to be a normal part of maintaining one’s health, it is primarily seen in the modern western world as a luxury for the rich, or a series of therapies designed to help one recover from a specific injury. Most of us, however, can attest to the power of touch to ease our physical and emotional pains. A friend or loved one’s arm on our shoulder helps to ease our sadness in times of grief; fingers kneading our shoulder and neck ease the tensions of the day.
In pregnancy, the healing powers of touch become even more relevant, as the medications we may ordinarily take for back pain, neck pain, and headaches are unadvisable at this time. In some traditional cultures such as those of India and Mexico, massage is a regular part of maternity care, and pregnant women and babies are massaged as a matter of course. Dona Irene Soleto, a midwife from Morales, Mexico, begins each prenatal meeting with a neck and shoulder massage. As she releases the tension in the mother’s muscles, she releases tension in the mother’s mind, and the mother becomes free to discuss her worries and her concerns. The belly is also massaged, not only to discover the position and size of the baby, but also to promote elasticity of the skin, thereby reducing stretch marks. During birth, Dona Irene uses massage as one of her tools to help encourage good positioning of the baby, ease and speed labor, and help the mother open fully to avoid injuring herself. After birth, Dona Irene uses massage over many weeks to support the uterus and pelvic bones, to ease muscle pain, and to encourage bountiful a milk supply.
The stresses which modern women face today make massage an even more vital component to a healthy pregnancy. Increasingly common problems in our culture such as high blood pressure, muscle tension, poor blood circulation, and low energy become more pronounced, uncomfortable, and even dangerous in pregnancy. Emotional illnesses such as postpartum depression, which are non-existent among Dona Irene’s clients, are also becoming more prevalent. Because so many people today work in sedentary jobs, and the possibilities for active exercise are minimal, many women enter pregnancy with weak back and abdominal muscles. As the growth of the baby increases stress on these muscles and changes the mother’s center of balance, aches and pains that did not exist before can now become quite uncomfortable.
Regular massage therapy can help alleviate these problems. Massage increases blood circulation, thereby reducing edema, muscle cramping and tension and stretch marks. The hormones released in one’s body while receiving massage reduce blood pressure and emotional tension. Birth partners (be it husbands, mothers, sisters, friends, a nurse or a trained professional) who massage women during labor actively help the mother cope with pain. Breastfeeding, postpartum recovery and weight loss are all supported by massage. The benefits may extend even further. Women who receive massage during pregnancy are more likely to massage their own babies, thus passing the benefits of healing touch onto the next generation.
As modern western culture becomes more aware of the benefits of regular massage therapy, the benefits to pregnant and birthing women and their babies has not gone unnoticed. In the United States, an entire profession of pregnancy massage therapists has developed and many of these therapists work in close contact with doctors, midwives and other health specialists to provide comprehensive care for pregnant families.
So, pamper yourself! You will be contributing to your healthy pregnancy, birth and postpartum!
NOTE: In cultures which practice massage on pregnant women, it is understood that massage at this time is different from massage at other times in a woman’s life. The practioner must be educated and aware of each woman’s condition and must know which methods and points are beneficial and harmful for pregnant women. When you are searching for a massage therapist during your pregnancy, be sure to find out the practitioners’ qualifications. If you are experiencing any problems with your pregnancy, be sure to get your doctor’s approval and to inform your therapist before proceeding.
The idea of doulas is at once very old and very new. The word “doula” comes from the Greek, meaning “female servant or slave”. It’s modern usage conveys the idea of a trained or experienced woman (friend, relative, or health worker) who supports a birthing woman and her family physically, emotionally, and informationally throughout the childbearing year. Women have been helping women give birth perhaps since the very beginning. Whales, coyotes and pygmy chimpanzees are just a few examples from the animal world whose female members help one another during birth. In some current cultures, birth is a community event which all the women attend to celebrate and support the laboring mother. One of my favorite examples of this is an anecdote told by the oriental dancer Morocco, who was able to witness a birth in a traditional community in the country of Morocco. She describes a tent containing a circle of women dancing around the birthing mother, whose only signs of being in labor were sweat on her forehead and the occasional grunt while pushing. The women were dancing to remind the mother to move to help the baby out, to remind her of her own birth, to initiate the mother into motherhood.
The evolution of our collective birth culture is very interesting to evaluate. Not so long ago, the majority of the world’s births took place at home. The majority of those births were attended by trained or untrained midwives and other female supporters. Very quickly—at lightening speed in fact—birth at home has become the anomaly and hospital birth the standard entrance into the world for most children, especially in developed countries. Hospital birth has helped save the lives of many babies and mothers who would otherwise have been injured or worse in the home situation, and for this we must be grateful. However, because the primary function of a hospital is to treat illness and save lives, pregnancy and childbirth in the hospital has come to be regarded as a sickness rather than a natural physiologic event. It can sometimes happen even in normally progressing pregnancies, that pregnancy and birth are seen as a highly dangerous processes requiring many routine tests and interventions to be safe. This intention often brings with it an aura of fear or urgency into the experience of pregnancy and birth, sometimes even making it difficult for women to give birth under their own power. Why is this? The answer lies in our magnificently orchestrated hormones.
At the onset of labor, the hormone oxytocin is released, telling the uterus to contract and open the cervix. Oxytocin is also called the “hormone of love”, because it is also present in large quantities when eating a good meal, during breastfeeding, and most importantly, during orgasm. This gives us a clue as to why, for some women, birth is not frightening or painful, but joyful and ecstatic—under the right circumstances.
It is still not entirely understood exactly how the body receives the signal to release oxytocin, but it has recently been discovered that a hormone released by the mature baby’s lungs passes through the placenta, setting labor into motion. Along with the hormone oxytocin, endorphins are also released. These two hormones increase in relation to one another, and to signals in the body, in a juicy hormonal dance. As oxytocin increases, the sensation of the contractions increases, and the body produces more endorphins to help the woman tolerate the rising intensity. Not only tolerate, but actually move into an altered state—into “laborland”. For those who have seen women in labor, the entrance into laborland is easily recognizeable. The laboring woman is deeply focused inward, has difficulty answering logical questions, and moves and makes noise instinctively.
Let’s consider an ancient woman, thousands and thousands of years ago, before doctors, before midwives even. How did that ancient woman know what to do and how to do it?
Using her instincts, what kind of location do you imagine this ancient woman would have chosen to give birth? Warm or cold? Dim or brightly lit? Crowded or quiet? Open or protected? What would happen to that ancient woman’s labor if she senses a threat, perhaps a vicious predator prowling about? What is happening in your body now just thinking about this scenario? Perhaps you’ve noticed a tensing of muscles, a surge of adrenaline, the urge to flee—fight or flight from the dangerous situation.
Now imagine for a moment the conditions under which oxytocin is present in large quantities. Imagine the environments in which the most oxytocin will be released. Under what conditions do you most enjoy a good meal, breastfeeding, or lovemaking? Now consider the typical hospital birth environment. How do the two birth environments compare, when looking from the perspective of optimal oxytocin release? Now we begin to understand why so many modern women have difficulty birthing their babies under their own power in the typical hosptial delivery room—everything in their environment is telling their bodies to flee, even when their minds have the best of intentions.
So what does all of this have to do with the doula? Doulas can help women to reclaim their birth spaces, even in the hospital. Many women expect that the nurse or midwife or their doctor will support them and guide them in birth, but the reality is that due to modern medical practices, most caregivers do not have the time to give women the attention they need during labor. Nurses and hospital midwives unfortunately have many women to care for at one time, as well as a lot of paperwork to attend to, often preventing them from doing much more than regular checks on baby and mom’s well-being. Because the doula is not concerned with the medical aspects of the birth process, she is free to give her love and attention soley to the birthing mother and her family. Doulas can make suggestions for transforming the birth space, making it more oxytocin-friendly. Doulas offer ideas for positions, remind mothers and fathers of useful breathing practices and massage techniques, and encourage mothers to move around. Doulas help redirect mother’s and father’s attention away from the “machine that goes ping” and back onto her body, her labor, their baby. Doulas can help protect the birth space, reducing the number of uncessary interruptions and interventions.
Some couples are concerned that a doula may usurp the father’s role at the birth, but it is actually quite the opposite. The father’s job is to provide the love and presence only he can give to the mother, while being witness to the birth of his child. Many fathers have difficulty helping their wives throught the tough parts of labor, simply because they have no experience in this arena. Doulas protect the father’s birth experience by aiding him in supporting the mother, relieving him of the intense pressure having to remember everything learned in labor class. Doulas encourage the mother and father throughout the labor, empowering them to birth their child in their own way, whatever that may be. As studies by Drs. Kennell and Klaus have shown, the simple presence of a caring, relaxed person in the labor room can have a dramatic impact on the energy and mood of the labor room. It has actually been shown in multiple studies that when doulas are present at a birth, there are fewer epidurals, fewer cesarean births, and on average 2-3 hour shorter labors. The statistics are so convincing that some insurance companies in the US have begun compensating for doula fees!
The beneficial impact of doulas continues into bonding and breastfeeding, the early postpartum period, and in marital satisfaction in the years following birth. Many families report less problematic breastfeeding experiences and more extended breastfeeding relationships than women who receive no such support during and after labor. Parents’ positive relationship with and understanding of their babies’ needs also increases. Because doulas support and normalize mothers’ postpartum experiences, incidences of postpartum blues and depression are fewer. A good doula actually fosters greater closeness and understanding between mother and father, and reports of increased marital satisfaction after birth are higher with families who are assisted by a doula.
Here in Turkey, and in much of Europe, the concept of a doula in the hospital is a new idea. However, there are doctors who are open to this very beneficial addition to the birth room. Hopefully the coming years will see a vast increase in support for birthing families, bringing into greater awareness what birth can be, what mothers and babies are capable of, and a joyous respect for the sanctity of the birth place.
Mothering the Mother: How a Doula Can Help You Have a Shorter, Easier and Healthier Birth, Marshall H. Klaus, M.D., John H. Kennell, M.D., and Phyllis H. Klaus, M.Ed., C.S.W.
The Birth Partner: Everything You Need to Know to Help a Woman Through Childbirth, Penny Simkin, P.T.
The Thinking Woman’s Guide to a Better Birth, Henci Goer
For any journey you embark on, it is a good idea to have a road map, travel plans, and the proper equipment for the terrain. The journey through birth and into becoming a breastfeeding mother is no different: preparation will make the journey more enjoyable, even if you depart from your original travel plans. So, before starting down the road, plan for the journey.
An important but often-overlooked aspect of breastfeeding is that as much as breastfeeding is a natural event, it is also a learned skill. In cultures where breastfeeding is no longer the accepted norm, or where it has skipped a generation or two, many women are lacking the necessary skills and support system for successful breastfeeding. Because breastfeeding is a learned skill, it requires observation and practice. While you are pregnant, read books, check out internet sites, watch videos, and most importantly, hang out with other moms who are successfully breastfeeding. You will learn what a “proper latch” actually looks like, have a chance to learn about common pitfalls before setting out, and establish a support group for any bumps in the road.
Choosing a good travel agent can turn even a difficult journey into a positive experience. It is important to have guidance from someone who knows the terrain well and guide you through unforseen events. However, not every travel agent has the same idea as you do about what makes a good trip. Carefully interview your doctor and pediatrician and be sure that they are on the same page when it comes to nourishing your newborn. Be wary of quick solutions involving formula or artificial nipples / breast shields—they are rarely indicated for the health of the mother or child and can actually have a negative impact on the breastfeeding relationship. Knowing that your doctor or pediatrician will support you in doing what is best for you and your child in the long term, even if it seems more difficult in the short term, will enable you to relax and enjoy the ride.
You do not need a five-star hotel in order to have a pleasant trip. The important things to look for are quality of the staff and the ability of the facilities to meet your needs. The World Health Organization has created the Baby-Friendly Initiative, which awards baby-friendly hospitals and acts as a guide for parents in finding a supportive environment for giving birth. When choosing a hospital for birthing your child, check that the staff and the administration have actively implemented these guidelines in order to make your experience as smooth as possible.
The criteria for designation as Baby-Friendly are:
1. Having a written breastfeeding policy that is routinely communicated to all health care staff.
2. Training all health care staff in skills necessary to implement this policy.
3. Informing all pregnant women about the benefits and management of breastfeeding.
4. Helping mothers initiate breastfeeding within one half-hour of birth.
5. Showing mothers how to breastfeed and maintain lactation, even if they should be separated from their infants.
6. Giving newborn infants no food or drink other than breastmilk, not even sips of water, unless medically indicated.
7. Practicing rooming in – that is, allow mothers and infants to remain together 24 hours a day.
8. Encouraging breastfeeding on demand.
9. Giving no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
10. Fostering the establishment of breastfeeding support groups and refering mothers to them on discharge from the hospital or clinic.
After your stay at the hospital, be sure to give feedback regarding the staff’s adherance to the Baby-Friendly Initiative. Only by hearing from customers will the administration be encouraged to continue in what they are doing well and make changes where they are weak.
Wear loose-fitting shirts and dresses. Allow your breasts exposure to open air as much as possible. This will prevent bacterial and fungal infections caused by constant exposure to the moist warmth of a breast pad.
Avoid tight-fitting and underwire bras. This can restrict milk flow and lead to engorgement and breast infections.
For sensitive nipples, use nipple protectors (different than breast or nipple shields). They are hard plastic cups with holes on the top and a replaceable cotton rim on the bottom to catch milk flow. It fits into the bra and provides ventilation while preventing sore nipples from rubbing against fabric. Ameda is a good brand and can be found in Turkey.
Avoid the use of breast pumps before 6 weeks while your breasts are adjusting to your baby’s needs, except under the direct guidance of a knowledgable professional. Pumping does NOT help engorement, and can actually make it worse!
Refrain from introducing bottles and pacifiers (dummies) until 6 weeks or until the breastfeeding relationship is firmly established.
Use pure lanolin or fragrance, paraben and alcohol-free vegetable-oil based nipple creams to prevent and treat sore and cracked nipples.
At the first sign of hardness or hot spots on the breast, contact your physician!
With mindful prepartation, you will be ready to hit the road. Check back next issue for the continuation of the journey!
The Womanly Art of Breastfeeding by La Leche League International
The Ultimate Breastfeeding Book of Answers by Jack Newman, M.D.
Mothering the New Mother, Women’s Feelings and Needs After Childbirth by Sally Placksin
Natural Health After Birth by Aviva Jill Romm
www.llli.org La Leche League’s website