28 Samata Nagar, Kandivli (E), Bombay 400 101, India.
Childbirth is a normal and natural function. It is also an intense experience. In order to participate effectively in the birth of her child, the mother-to-be must be prepared for the childbirth. Otherwise, the basic response is to tense her whole body during each contraction, thus causing pain and imbalance of oxygen in the system. Over a period of time she finds herself exhuasted and out of control. When exhausted any strong sensation becomes painful and difficult to control.
There are certain physical factors in birth that may cause real pain: physical structure of the woman, the size of the baby, the quality of contractions, complications of labour, etc.
Although training helps to minimize pain factor, the aim of the training is to make childbirth a positive experience. Even if pain is present, the prepared mother regards her labour and delivery as a time of activity, concentration and confidence rather than a time of passiveness and suffering.
The Lamaze Method : The purpose of the Lamaze education is to prepare a mother for happy childbirth. Based upon Pavlov's principle of conditioned response, the theory is that the brain can be trained to accept and analyze a given stimulus and select a response to it.
Preparation for childbirth is based upon understanding and knowledge regarding the organs and skeletal structure concerned in pregnancy, labour and delivery. The area in the pelvic basin where all the activity of pregnancy, labour and delivery takes place, is the most important. The main organ is the uterus. The fertilized egg implants itself in the lining of the uterus, where its reception has been well prepared in advance. Part of the egg attaches itself to the wall of the uterus and begins to delelop into the placenta. The baby is connected to the placenta by its umbilical cord, facilitating nourishment between the mother and baby. The uterine cavity is filled with amniotic fluid which keeps the baby at an even temperature, cushions it from shock and provides a medium for its movement. The membranes are the sac that hold in the fluid. The uterus, shaped like a pear, is divided into two parts. The upper triangular part is the uterine cavity that contains the baby. The lower part, which is tube-shaped, is called the cervix. A portion of cervix projects into the vagina. The cervix is the opening of the uterus from which the baby emerges. The vagina or birth canal is the passage from the cervix to the exterior. The tissues of the vagina are extremely elastic and once the cervix opens, the baby passes through the birth canal with ease.
The following exercises are designed to build up muscle support during pregnancy and labour and contribute to more effective pushing during delivery, and provide good muscle tone after the birth of a baby. These exercises should start from sixth month onwards.
Contractions Mechanism : One of the strongest fears a woman has concerning childbirth is how can a baby pass through such an obviously small opening without causing excruciating pain. A trained woman looks forward to each contraction as a step further in the progress of the birth of her baby. A contraction is the signal to begin her active role in birth.
To understand the nature of contraction, it is most helpful to analyse the contractions that take place during eighth or ninth month of pregnancy. Place hand on top of the abdomen just as a contraction is starting, you will feel a slight hardening or tightening of the muscles, starting above the pubis, spreading towards the groin and covering the whole uterus. The uterus will become quite hard, remain tight for a few moments, then progressively become softer until it returns to its normal state. This may take 30 to 60 seconds. During labour, contractions will be similar but with three great differences: they will be stronger in intensity, longer in duration and regular in occurence.
During the first part of contraction use breathing and relaxation techniques easily. When the contraction reaches its apex work hard to maintain control. As the contraction lasts only about 60 seconds and the apex only a few seconds, about 20 to 30 seconds of conscious work is necessary for each contraction. You will get from one to five minutes of rest between contractions. Your gynaecologist may talk about three phases of labour. The first includes effacement, delatation and transition. The second phase is expulsion and the third phase is delivery of the placenta. The last needs little response on your part.
Every woman wants to know 'how long the labour lasts?'. The answer is : each woman and each pregnancy is different. The normal labour lasts usually about 8 to 12 hours, perhaps less for the woman who has had babies previously. Sometimes more for the woman who is having her first baby. The expulsion takes anywhere from half an hour to two hours.
Neuromuscular control is very essential during childbirth so as not to be a slave to your contractions but their master. Relaxation is also very essential for the same purpose. Tensing during childbirth is a natural response to the tensing of the uterus. However, tension not only causes exhaustion and a lower pain threshold but also prolongs labour physiologically.
The hormone that causes the uterus to contract is oxytocin. Adrenalin, the hormone that accompanies the tension fear syndrome, actually inhibits the effects of oxytocin and makes your contractions less effective. Hence, the more you tense during labour the longer will be your labour and the more you 0relax the shorter will be your labour.
Passive and Active Relaxation : Relaxation usually brings to your mind total lack of physical and mental activity. But passive relaxation is insufficient to control the intensity of labour contractions. The intensity of the birth experience is of a degree that precludes any possibility of passivity. Birth is active and hence must be met with active responses.
To differentiate between passive and active relaxation try this exercise. First slowly and with concentration contract the muscle of your right arm, now let it flop down in a state of limpness.
This is passive relaxation. Now for active relaxation, contract the muscle of your arm again, slowly and with concentration, but this time when you let it down slowly, release or relax the muscle with as great a concentration as when you contracted it. Feel your fingers, hand and arm, are they in the state of relaxation?
Now imagine that the muscles of your uterus are contracting with greater and greater intensity, check your arm, is it relaxed? As you imagine the uterine contractions mounting, concentrate on relaxing the muscles of your limb one by one. Are they relaxed? This is the state of relaxation you want to attain during the intense uterine contractions of labour and delivery.
Muscular Control During Delivery : The normal reaction during a contraction is to tense your body. The uterus in a sensitive state is irritable to anything working against it. The normal response of tensing is due to the traditional pain associated with childbirth. Since the uterine contractions are beyond your power to control, you will have to learn to control the other muscles of your body. You will have to work especially hard during a labour to keep the muscles of the pelvic floor in a state of controlled relaxation. If the muscles surrounding the vagina are tensed, the exit is painful. If these muscles are relaxed, the exit is much easier. You must consciously relax the abdominal muscles during labour. During delivery, however, these are the muscles you are going to use in your bearing down efforts to expel the baby.
Breathing Techniques : Between the lungs and the abdomen there is a thin, disklike muscle called the diaphragm. As you breathe out it comes up. When you are in labour you should be interested in keeping the pressure of the diaphragm off the uterus. You can do this by keeping your lungs only partially filled with air - by light chest breathing. When you are in delivery you will keep your lungs as full as possible using the pressure of the diaphragm as an aid in expelling the baby.
First Stage Breathing : Your first breathing response to your contractions will be comfortable, relaxed, deep chest breathing. Take a deep relaxed breath in through your nose. As you look down at your chest, you should see it gently rising and falling. As your contraction will last upto 60 seconds, you will practise your deep chest breathing for that length of time. You must find your own rate of speed but remember that the faster you breathe, the more exhausted you become. A slow, steady natural pace would do you good. Also, intake and output of air should be equal.
Second Stage of Breathing : The contractions during dilation are concerned with opening the cervix and may last from one to three minutes. The duration of this phase is anywhere from five to nine hours for the first baby and two to five hours for succeeding births. Your response to contractions of increasing intensity will be a shallow accelerated type of breathing. Shallow breathing to keep the diaphragm up and accelerated to match the mounting intensity of the contractions.
Third Stage Breathing : The purpose of the contractions during transition is to finish opening cervix and to begin expelling phase. These contractions are extremely strong and difficult to manage. They may last 60 to 90 seconds and have shorter intensity between them.
Transition breathing is like the second stage shallow breathing, but with forced blowing out at intervals. The blowing out is useful in two ways. First it empties your lungs and puffs up your diaphragm; your back is pressed against the bed and your pubic area is pulled up, thus relieving the pressure from the uterus.
During the transition contractions you may experience a desire to push the baby out. Your baby has descended and is presssing against your rectum. However, your cervix is not dilated to the extent desirable. As such, pushing is not advisable. Blowing out helps keep pushing urge under control.
Expulsion Breathing : Your baby is ready to be born. The cervix is opened and the baby's head is far down the birth canal, now you must push to expel your baby. The contractions continue but their intensity has decreased and at last you will begin your active work. The fact that the birth of the baby is near makes this the most fulfilling part of the labour.
To push most effectively, you fill your lungs with air (diaphragm down), bear down with your abdominal muscles and relaxing the pelvic area, push the baby out through the vaginal opening. You should push only during a contraction. Between contractions you should relax and recuperate as much as possible.
Your first few pushes will produce a small patch of hair visible at the opening. With succeeding pushes the baby's head will emerge. To prevent tearing of the delicate tissues between the vagina and rectum, you should stop pushing at the crowning, relax your legs, lie back, open your mouth wide and begin the exhaling and inhaling deeply. And lo and behold your child is born-without labour inducers, pushing, pulling by forceps (a dangerous practice) and painful episitiomy.
Some General Hints : Pregnancy is an enriching experience. It is not a disease and you should not allow yourself to be treated as sick patient. Here are some general hints to make childbirth a pleasant experience.
Dote on plenty of fresh fruits and vegetables to help in kidney flushings and to avoid constipation, piles, varicose veins, pregnancy diabetes and hypertension. Do some regular walking or light yogic exercise as shown. Entertain yourself to keep the spirit high.
Do not smoke or drink alcohol or take drugs, all of which are not only harmful to you but to your baby too. Sleep well. Take gentle massage on legs for cramps. Drink lots of water, fruit juices, coconut water, fresh buttermilk, kanji (rice water) to stay healthy and look beautiful after delivery.
Do not undergo unnecessary medical tests. Take only non-toxic, safer ayurvedic, herbal, flower remedies or homoeopathic medicines.
POSTURE : Good posture cannot be over-emphasised. It relieves backaches and makes you feel and look better. Tuck in buttocks, tilt pelvis forward to align spine, shoulders gently back, arms relaxed, head erect and chin in. This posture should be maintained at all times.
PELVIC FLOOR MUSCLES: Good all around exercise. Position : Lie on back. Legs straight, crossed at ankles. Contract buttocks and hold still contracting buttocks, squeeze legs together and contract thigh muscles and hold. Next contract pelvic floor muscles (urethra, vagina and rectum). Hold all muscles contracted and then release. Practice five times twice daily.
KEGAL EXERCISE : Excellent for strengthening vaginal muscles. Position : Standing, sitting or lying down. Push as if urinating and then contract muscles as if to stop the flow. Do it atleast 50 times, twice daily.
Stretching Exercise: Position : Sit on the floor cross-legged. Place your hands on the knees and gently press them towards the floor. Practice 10 times twice daily.
STANDING EXERCISES : Stand comfortably and go on tip toes, hands on hips, walk around the room on tip toes taking 40 steps. Now go on your heels and walk another 40 steps on your heels. Practice twice daily. Standing comfortably, hands on hips, swing your right leg forward and backward five times. Repeat the same with left leg. Practise twice daily.
PELVIC ROCK : Very good for aching backs. Position : Lie on back, legs bent, feet flat on the floor. Imagine your hips as swivel point; contract buttocks, flatten back firmly against the floor, and tilt pelvis towards you by contracting abdominal muscles, release. Repeat five times, twice daily.
BLOWING OUT : Very good for strengthening abdominal muscles. Position : Lie on back, pillow under the head, legs bent, feet flat on floor. Take a deep breath and let it out naturally, without taking another breath; purse your lips and continue blowing. Keep blowing until you feel as if there is no more air and then blow some more. You will begin to feel the abdominal muscles contracting. Release. Practise 10 times, twice daily.