Saturday, May 11, 2019

The Sensations of Labor: Touch and Massage Techniques

We're really getting into the nitty-gritty of non-medical labor sensation coping support now! It was difficult to know how best to break down the next few posts in this series: so many of these techniques are interrelated, or can be combined to great effect! I tried to make the call based on keeping every post to a reasonable length (not a strength of mine!!), but there will inevitably be some call-backs and cross-references moving forward!

It doesn't take a rocket scientist to understand the power of touch and massage to help someone cope. As a little kid, you may have squeezed a parent's or friend's hand when getting your ears pierced, or blood drawn. A shoulder massage from a romantic partner when you have a headache is soothing whether or not the tension was the cause of the headache. Ultimately, we're social animals, and when we're scared, or in pain, touch helps us ground, and relax. Of course, some people in labor will find that when they're having a contraction, they don't want anyone touching them at all! But more often than not, for at least part of labor, touch and massage will play a key role in the coping strategies of the birthing person.

Massaging with the intention of releasing tension from the body can help the birthing person release tension built up from the last contraction before the next one, encouraging relaxation and ease, and allowing each contraction to be a fresh start, so to speak.

Generally, touch during contractions will be different than touch in between contractions. Light touches can be soothing in between, but during contractions, a firmer touch with less movement is frequently appreciated. Of course, every birthing person is different, and and communication and experimentation before labor begins is super helpful, there will always be a trial and error element to helping a person cope with labor.

When using touch and massage to support a birthing person, it's important to remember the three R's:

Rhythm: don't touch in a way that goes against a rhythm the birthing person has found in their contraction. If you can't detect a rhythmic movement or sound, try to follow the pace of their breathing.

Relaxation: patting motions, or brisk rubbing are stimulating, and unlikely to be helpful. Keep strokes long and slow. If the rhythm the birthing person has found is fast, try applying more and less pressure in that rhythm, rather than risking patting or brisk rubbing, unless of course the birthing person in question asked for that!

Ritual: if a certain pattern of touch seemed to help last time, don't reinvent the wheel. Repeating a coping strategy over and over with each contraction can make it more effective over time. Until it doesn't. Then it's time to switch it up. Don't worry, you'll know.

There are specific touch and massage techniques that help with particular situations in labor as well. Counter pressure is a great example. If you've ever stubbed your toe, or wacked your elbow, and immediately squeezed the toe or elbow in your other hand for relief, you've use counter pressure! This doesn't work super well for labor pains in the abdomen, but it can be really effective when the pain of labor is felt in the back. You can use the heels of your hands, or your fists, but I like to use the kind of balls designed for rolling out tight muscles in the body. Using proper technique is really important to allow you to use as much pressure as the birthing person likes (typically, a whole hell of a lot), to keep it up for the entire length of contractions repeatedly for as long as necessary, and so you don't feel like you were hit by a truck the next day. Extend your arms out all the way straight, and lean your body weight into the birthing person. If you're in a position to brace yourself against a wall or solid object, so much the better. Don't try to push from a bent arm position. You will be sorry, and so will the birthing person!

Another specific type of touch that's also most commonly used for back labor is the hip squeeze. In practice, this is really more of a butt squeeze. You're squeezing the bottom of the laboring person's pelvis, so the top opens slightly, like a clothespin. This is another intensive one for the support person, so it's great if there's another person you can tag out with (helloooooo, doula!). It's also a good one to practice before labor, because finding the right spot can be tricky. The birthing person will be on hands and knees on the floor. Place your palms around the widest part of the birthing person's hips. Then, slide your hands back in space (and rotate hands so your fingers point up to the sky) until you feel like you've slipped off the boney pelvis and are just squeezing butt. Now press your hands toward each other. You'll have to use a fair amount of pressure, but start gently, and gradually squeeze harder and harder until the birthing person feels their pelvis being compressed. Use their feedback to guide you to the right spot. It might take a few tries! Don't be discouraged if at first, the doula does it better. We have a lot of practice at this. ;-)

If the birthing person likes to use lotion or oil for massages, it can be helpful to use the same one they usually do, since they'll have positive associations with it already, but bring an unscented back up as well. Scents become a fraught topic during labor!

There are also massage therapists who will attend your birth and use their professional training and experience to keep you comfortable during labor. Certainly something to think about!

This is such a basic technique, I could go on about it forever, but this covers the basics. In general, practice a lot beforehand, and get a sense of the kind of touch the birthing person likes and doesn't like. Then, play it by ear.

Live Omily,