Dear Praxedes,

This is a very important topic and one that is socioculturally contextualised. Depending on the location of the world, there will be different answers. I would therefore recommend that you speak directly with mid-wives in your specific region in which you will be conducting research to inquire to what they are finding as the lack of knowledge that women/mothers have. Good luck on your work!

What’s the most challenging thing you’ve ever done? Many mothers will say it was giving birth. Knowing that, you’ll want to prepare in every way you can to make your baby’s birth a little easier. Sylvia Brody’s* idea of a good birth was one where she felt in control, with as few medical interventions as possible. Categorized as high-risk for a premature baby due to her unicornate uterus (half a uterus), Brody was determined to give herself the best possible chance of a natural, full-term birth. And last February, at 36 weeks (just a week away from term), she gave birth vaginally and without pain medication to a healthy baby girl!

We’ve all heard stories of labours that were exhausting or that required all kinds of medical assistance. Some of us, like Sylvia Brody, might have additional fears due to medical conditions.

Nevertheless, there are things you can do to increase the odds that your labour will go smoothly from the first contraction to the final push that brings your baby into the world. Brody began with the basics that encourage a healthy mom and baby throughout pregnancy: eating well, getting plenty of rest and seeing her caregiver regularly. But she didn’t stop there: “I learned from a friend’s story of her disappointing birth that I needed to be really prepared.” But what can you actually do to boost your odds for an easier labour?

DURING PREGNANCY

1. Yoga

Of all the prenatal exercise classes out there, yoga has the largest following. Janet Balaskas, a British childbirth educator and author of Active Birth, explains why: “Yoga prepares the body to be upright in labour—standing, kneeling, hands and knees and squatting—and these positions keep the pelvis loose and open for easier positioning and descent of the baby.” Balaskas’ number-one rule for labour, all the way through to pushing, is “Don’t lie in bed!”

Yoga has other benefits. “Focusing on breathing was really helpful practice for labour,” says Kate Stewart, who attended yoga classes during her first pregnancy and is back with her second. Balaskas advises, “Concentrate on the exhale, and relax after, then stay relaxed for the inhale. Learn to breathe away the tension in your body and that will help you to breathe away the pain in labour.”

2. Massage

“Regular massage helps women to breathe into areas of discomfort, relaxing tight muscles,” says Vancouver registered massage therapist Paula Jaspar, who sees mostly pregnant women in her practice. She adds that muscles made supple from regular massage relax more quickly following a contraction during labour, making the rest between contractions feel a little longer.

Is massage helpful in labour? Angela Verbrugge was so sure of it she hired Jaspar to be her doula. As it turned out, Verbrugge had intense back pain in labour. She says, “I was glad to have an expert massage therapist who knew how the muscles are connected and how to release tension.”

Other women turn to their partners for comforting touch. A partner can stroke the woman’s head, which may calm and relax her, allowing her body to get on with its work. According to research, firm touch such as holding hands (that’s all Brody wanted) or pressing firmly on the upper arms or thighs increases the production of oxytocin, encouraging labour to progress. If you’d like to learn more, consider signing up for a prenatal massage class.

3. Hypnosis

Another route to relaxation is hypnosis—not the entertainment version, where uninhibited people might quack like ducks. This is the therapeutic form that requires the same deep relaxation or trance state experienced during meditation.

Shawn Gallagher, a certified hypnotherapist and retired midwife in Toronto, says hypnosis teaches women to relax deeply, causing them to be much less uncomfortable in labour. While many who come to Gallagher’s classes do so because they desire an unmedicated birth and are looking for an effective way to cope with labour, others come because they are highly anxious about the birth.

Michelle de Braux says, “Hypnosis was recommended by my doula. I was frightened of giving birth. Also, I knew wanting a non-medicated birth was a lofty ambition.” Did hypnosis help? “It was awesome,” de Braux enthuses. “We got through a challenging birth with no medication.

4. Optimal fetal positioning

The theory here is that our sedentary lifestyles, including slouching on the couch and riding in cars, allow gravity to encourage the heaviest part of the baby—the spine—to roll to the back of the mother’s body. Optimal fetal positioning (OFP) is a concept developed by New Zealand midwife Jean Sutton, which may help get baby into the best position—facing the mother’s back—before labour begins.

If the back of a baby’s head is turned to press against the mother’s tailbone, the mother experiences intense back pain in labour and often a slower labour as well. Sometimes these posterior babies require assistance with forceps or vacuum extraction to be born. Connie Banack’s first baby was posterior and was delivered by Caesarean—part of the reason she’s an advocate of the technique.

“Spend time every day sitting upright with a slightly forward lean, or kneel on the floor while leaning forward into the couch,” suggests Banack, a childbirth educator and mother of four. One study found that being on hands and knees 10 minutes twice a day from 37 weeks’ gestation to the onset of labour did not reduce the number of babies still in a posterior position at birth. Advocates of OFP argue that women should start earlier (34 weeks) and spend longer (30 minutes twice a day) in a forward position.

5. Kegels

“Do your Kegels!” admonishes Skylar Hill-Jackson, director of Baby and Me Fitness in Toronto. “Pelvic floor exercises help many women avoid medical interventions.” She explains that the weight of the uterus creates continuous and increasing stress on the pelvic floor muscles, the hammock of muscles that support the uterus. Strengthening these muscles, by squeezing the walls of the vagina tightly together and holding for a count of as much as 20, may make pushing more efficient and prevent poor bladder control and hemorrhoids.

6. Perineal massage

Perineal massage gently stretches the tissue at the opening of the vagina. While studies are not conclusive about the value of perineal massage, some research suggests it reduces a woman’s chance of tearing when she pushes her baby into the world.

Registered massage therapist Paula Jaspar is an advocate. She argues that the perineum is made of muscle (it’s the hammock of muscles that support your growing uterus in pregnancy) and muscles need time to learn to be supple. Jaspar advises her clients to begin massaging the perineum as early as 12 weeks of pregnancy.

She explains how: Imagine the face of a clock at the opening of your vagina. The 12 points to the clitoris, the six to the anus. The area to be massaged is the lower half of the vagina, from three o’clock to nine o’clock. Women can do the massage themselves. Lubricate your thumb with olive oil. Place one thumb into the vagina to the first knuckle. Stretch the tissue at three o’clock, then four and all around the bottom of the clock, continuing to nine o’clock.

Just how far should you stretch? Jaspar says you’ll know, but describes the sensation as burning.

Another benefit of perineal massage is that it helps women learn to consciously relax the perineum, allowing for an easier passage of the baby. Massage increases the circulation of the perineal tissues, speeding healing after the birth.

https://www.todaysparent.com/pregnancy/strategies-for-an-easier-labour/

https://www.thebump.com/a/make-labor-easier

https://www.girlsgonestrong.com/blog/pregnancy/how-to-make-labor-and-delivery-easier-5-tips/

Hypnobirthing

Hypnobirthing is known to help counteract anxiety about childbirth. According to the Mayo Clinic, hypnobirthing involves using tools like self-hypnosis and relaxation to prepare for birth. Women who use this technique say they feel more prepared and focused going into their labors.

Nicole, a mother of two who lives in North Carolina, used hypnobirthing to deliver both of her children. She decided to use this approach to feel more in control of the experience.

"The idea for me was to go inward," she says.

When her labor began each time, Nicole immediately put herself "in the zone," so to speak. She popped on her headphones and blocked out distractions. Then she strived to simply be in the moment.

"[I wanted to] focus on the contraction at hand, not think about the one that has just passed or the one that was coming. It's all about surrender and not tensing with each contraction," Nicole says.

Although the techniques she learned definitely helped her face the challenges of two very different labors, one long and one short, Nicole doesn't try to pretend that giving birth is easy. When I asked her if she enjoyed her births, I could almost hear her laugh through her email.

"'Enjoyed' is definitely too strong [a word]. I mean, we're still talking about a really challenging and intense physical experience. For me, it was about intensity and endurance. Having a baby is hard work and using the technique I did allowed me to feel prepared and trust myself," she says.

Although Nicole says she would use hypnobirthing again if she has another baby, she doesn't think it's for everyone. Instead she told me, "My advice is this: do what makes you feel most at ease. The more you can do that, the less fearful and the more pleasant your experience will be."

Water Birth

Jill, a mom of two who lives in New Jersey, opted to have a water birth and a midwife for her first delivery.

"I kind of stumbled upon the whole [water] birth idea. It was something that just seemed to work for me. I was a low-risk patient with no previous births or medical issues. [Plus], midwives seemed very personable and motherly, which was very appealing to me," Jill says.

This mama definitely did her research about the water birthing process and about techniques that might help her relax. She also focused on the fact that women have been giving birth since the beginning of time, which made her feel more capable of handling the experience.

"[All of these things] helped me to not be afraid when I went into labor," she says.

Jill used her mental preparation and the water as tools to help her relax.

"[But] it definitely didn't take all the pain away," she admits.

Water imagery guided her as well: "I think of labor like the ocean. Your contractions come in waves, and you just need to ride then out till the end," she says.

Jill's advice to women who are about to give birth is simple, and it may help you.

"Surrender," she suggests. "Giving birth is going to happen no matter what, and no matter how much pain you may be in, that little baby is working so hard to twist and turn its way out. As a mother, it is your job to pull yourself together and help your child."

I should note that there is some controversy surrounding the safety of water birth right now. As reported by U.S. News & World Report, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics recently issued their findings that laboring in the water is considered safe, but delivering a baby under water may be linked to certain health risks, including breathing problems and infection. However, the debate is ongoing as to the real risks of water birth, especially in the midwife community, who maintain that it is safe.

Use of Pain Medication

According to the CDC, 61 percent of women who gave birth vaginally in 2008 received an epidural. That year, I was one of them.

Although I was afraid to get the epidural, it did help me get through my delivery immensely from a pain management standpoint, but it did nothing to dull my anxieties about pushing out a baby. If anything, getting the epidural gave me the sense of losing control over the situation, as I couldn't feel when I needed to push. It was a weird experience, but I didn't think I'd be able to endure childbirth without that help.

http://www.parenting.com/pregnancy/birth/3-approaches-to-make-giving-birth-easier

http://detoxinista.com/2016/08/7-natural-tips-for-an-easier-labor-delivery/