Third childbirth class.

[rivka]

Class was amazing last night.

The entire session focused on labor pain and how to cope with it. Michele organized the discussion around a handy acronym: labor pain is Purposeful, Anticipated, Intermittent, and Normal. Compared to other kinds of pain (such as a broken bone), she said, these factors make labor pain more manageable. But she also reviewed other things which will influence how much pain we'll experience: the mother's pelvis, the baby's size, the baby's positioning (here there was a long discursion into "back labor," how it happens, why it hurts, how to cope, and how to turn the baby), how we care for ourselves and are cared for during labor, and then various emotional factors.

She wants us to start thinking about how we deal with pain and hospitals, and to discuss those things with our partners, because personal history is a major factor in coping with labor pain. One of the guys in the class volunteered that his main experience of hospitals was going, as a child, with his mortician father to pick up "removals." He's now struggling to develop a more positive context for the hospital where his baby will be born. I mentioned my surgical history, and said that although I feel very secure in my ability to handle pain, people keep telling me that labor pain will be "different" - so I'm not sure whether I'm being overconfident.

She did a nice presentation about the pain gate theory, which I'm familiar with from my behavioral medicine courses. The basic idea is that the experience of pain can be reduced or blocked by flooding the nerve pathways with competing sensations. (This is why, when you hit your funnybone, it helps to rub it - you're providing a strong competing stimulus. It's also why you can slam your head against the headboard during sex and barely even notice - because your sensory neurons are busy. Not that she used that second example.) A lot of labor coping techniques involve rhythmic movements, hot or cold sensations, and massage, which are all efforts to exploit the pain gate mechanism by providing competing stimulation.

Then we watched a video. A very different video. She told us that she'd started us off with "mild" videos, because none of us had any experience observing labor and delivery. This one was a simple presentation of, essentially, home movie clips of women in labor, with none of the sounds or sights edited out, and no music or voiceover added on to help us keep our distance. She warned us that laboring women tend to make a lot of noises - what she described as "work" noises, not screaming - and that we might be uncomfortable hearing them. And then she rolled the tape, and, yeah.

I had a hard time with it. Part of me was doing what I was supposed to - taking mental notes about how they got through contractions using the "3 R's" of relaxation, rhythm, and ritual - and part of me was being overwhelmed by the similarity to, um, people with severe autism or mental retardation. The repetitive, rhythmic moans, the inward attention, the stereotyped movements (tapping, rocking)... yeah. Disturbing. Now I know what I need to get over before labor. Although maybe it feels different when it's you?

We talked about our reactions to the video for a few minutes. (I wasn't the only one who found it hard to watch.) We were briefly sidetracked by a conversation about what you wear during labor (nothing you want to keep, apparently) and why they put the baby directly on the mother's naked abdomen. And then it was time for what we'd all been waiting for: explanation and practice of various labor coping tools. Some of them were presented verbally (for example, positive affirmations). Some of them we've already been practicing (for example, relaxation exercises). For the rest, she set up five stations around the downstairs of her house, and we rotated through practicing each one: lunges, using a birth ball, heat and cold and counterpressure, specific pelvic and spinal pressure techniques individually taught by Michelle, and back pain relief measures.

I don't remember everything we got to try, but I did make notes immediately afterward about what worked well for me:

Counterpressure: having Michael put firm pressure on my lower back and just lean.

Heat: she gave us instructions on how to make a "rice sock," which is exactly what it sounds like: a rice-filled sock that can be heated in the microwave and then used to provide heat and/or pressure. We barely tried out cold, because it was already a cold day, but I made a mental note to get an additional bag of frozen soybeans (our default household ice pack) so that we can use one while the other is chilling.

Lunges with a footstool: lunges apparently help with hip pain by opening up the pelvis to the side. You put one foot on a low stool, point that toe at a 90-degree angle from your body, and lean out to the side. It felt good, and I could see how it would help my pelvis open up, but it was also immediately obvious that I need to start practicing it now if I'm going to want to do it in labor. I got tired very quickly when I tried to lunge on my right (weaker) leg. It was especially pleasant to do the lunges with Michael holding my hand and swaying back and forth in the same rhythm.

Rocking on the birth ball: sitting on a birth ball is more or less the functional equivalent of squatting, and far more comfortable. She also encouraged us to practice rocking our pelvis back and forth on the ball. It felt like a useful thing to do.

Kneeling on the birth ball: well, kneeling on the floor with my upper body draped over the birth ball, and sort of rolling back and forth. This felt great, especially when Michael put firm pressure on my lower back.

Leaning over the birth ball while it was on the couch: like the previous one, but it was easier to breathe because I was less bent over.

Slow dancing: standing face to face with our arms around each other, rocking from side to side. This was lovely. I felt very warm and supported.

Sitting with Michael kneeling: I sat in a chair with my legs apart, leaned forward and rested my arms around Michael's shoulders as he knelt in front of me. Then we rocked from side to side. Also very nice.

Kneeling with Michael sitting: he sat in the chair, and I got down on my knees and rested my head in his lap. He could stroke my hair as I rocked back and forth, which felt great.

Double hip squeeze: this is one that we almost didn't try, and boy am I glad that we did. We had a careful conversation with Michele about my pelvic architecture, and then she showed Michael how to do this thing. He'll have to describe it, because of course I couldn't see anything - I leaned against the kitchen counter, and she showed him how to apply pressure to specific points on my sacrum. Whatever it was, it felt great.

Some miscellaneous notes for labor prep:
- we'll want to make sure that there are plenty of pillows or whatever to kneel on, because both of us spent a lot of time on our knees.
- a lot of the positions that felt good to me involved leaning, which might lead to back strain because of my uneven arm lengths. We need to figure out something to prop up my right arm when I lean, so that my back stays straight. Michael will also try to keep track of my posture and notice if my back is twisting.
- I need to start practicing lunges and pelvic rocking now. That stuff is tiring.
- Michael is absolutely phenomenal at encouraging me, calming me, responding to my feedback, and cooperatively working out coping stuff with me. I knew that, but this was a good time to be reminded. I have no fears that he won't be a good birth partner - just fears that I'm going to annoy the hell out of him.

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[rivka.livejournal.com]

I stopped physical therapy before I should have, because the Christmas holidays intervened. I keep meaning to get back over there. But the pain is nowhere near what it was - it's an occasional bothersome ache, instead of an impossible-to-ignore fierce burning agony.