Sunday, February 20, 2011

Change #20 A Teaspoon of MIndful Pain Coping During Every Prenatal & Class

Dear Birth Peeps,

There is a common belief that if a woman believes birth is "normal," if she has a positive, confident attitude, and is committed to birthing without drugs, that her belief and attitude alone will carry her through labor. And sometimes it does!

I so want to believe that if she just believes in herself and the process it will be enough, but experience and birth stories inform me that women (and their partners) are too often surprised by the intensity of labor that is progressing normally (not to mention protracted labor), and find themselves completely unprepared to meet it. It is this shock, shame, and/or feeling of helplessness that is emotionally traumatizing to women, perhaps more so than the physical experience of it.

Today's Change is something so basic, so ordinary, so unglamorous, it is often overlooked by the most caring of birth peeps. A mother can have a dozen prenatals, meetings with her doula, even take classes, and nary a word is said about how to cope with the physical and emotional intensity of labor--except of course to reassure her that having an epidural is her choice.

It is my conviction that every mother and her partner (regardless of whether or not a an epidural is planned or will be part of her birth) need to be prepared and shown various ways to cope with emotional and physical intensity and uncertainty of being in the labyrinth of labor. (A woman/couple needs these skills because they may birth too fast to have an epidural, or the epidural might not take, and, in addition to pain-coping, a woman/couple will benefit from mindfulness skills during/after an epidural, during birth, postpartum, and parenting.)

When we learn any new skill, embodied practice makes the master! Not beliefs. Since pain, exhaustion, shaking and other sensations of labor are felt in the body, then pain-coping mindset and skills are best developed gradually, with small successes, in the body.

Beginning in the third trimester, if not sooner, I propose every prenatal visit include a five to fifteen minute pain-coping practice. This practice is absolutely done "without attachment to outcome," meaning without coercion to birth without drugs or any implication that doing so is better. Simply teach the mindful pain-coping, mind-centering practice. Then send the mother/couple home with homework: she/they must practice every day during the week or two weeks. Practice can be done during "meditation" or during periods of stress (traffic, work, etc) in her ordinary life. Each time she practices, her nervous system is learning how to respond to breath, she is learning how to quiet her mind and focus. This is nearly impossible to learn in labor.

I think it is safe to say that the majority of birth peep training, from medical or midwifery school, nursing, or childbirth education, the focus is more on epidurals (for or against) and informing mothers about tests and technology, and very little time is spent training the birth peep how to motivate parents to learn mindful coping practices. If this changed, if just four to six prenatals included mindfulness practice, the conversations between birth peeps and parents would change. And the conversations parents have in their own minds, before and during labor, will change.

We cannot leave this task to parents. How can a parent (even a mother who is a doula, nurse, or midwife herself) teach themselves to cope and be mindful in labor when they have never been in labor before? We can no longer leave this task to the majority of hospital taught childbirth classes if we know they will not learn this skill there... Maybe someday the tide will turn again and these skill will be taught as they once were!

I don't want to make this blog an info-mercial. However, if you are interested in doing this but don't know where to start, there are two Pain-Coping Practice CDs in the BFW Store: one on pain coping for parents, and the other is pain-coping for teachers. Either one would give you some ideas of how to begin.

Thank you for listening,


P.S. This posting is not meant to stir up the arguments about a woman's right to choose drugs/epidurals in labor, or what "normal" birth means, or that some women need epidurals. All of those considerations are valid, and not in contradiction to t


  1. Pam, just wondering if you will have the CDs you reference when you speak at the DoulaCARE conference in Canada this spring?

  2. Yes! I am taking the hospital prenatal course to get a feel of what our local hospital's culture and procedures are like (actually quite positive, I feel quite blessed) and we have spent about 5 minutes each night on coping techniques-and then just basic deep breathing one night and possible laboring positions the next night. We could definitely spend more time on it, but there's just so much info to cover in just six classes I don't see how we could spend more time on it-so I think it's a great idea for doulas and midwives to teach coping. Really 9 months isn't long enough to learn everything you need to know for birth-it needs to start much younger than that.

    Sorry for the long comment

  3. Mamaloo, I will bring the CDs to your conference.

  4. This exactly why I LOVE prenatal yoga, and teach it, because we practice pain coping and breathing techniques in every class, throughout the entire class. We cultivate a quite and intuitive mind, breathe deeply, hold poses until our legs are on fire, vocalize, chant and connect with other each class. This way, all the techniques we learn become part of who we are, it's in our cells. Then, when labor starts we can don't have to rely on our left brain, what we need comes very natural after practicing so much prenatal yoga.

    And....I give homework, too! ;)