Wednesday, February 23, 2011

Good Morning Birth Peeps,
Kimberly responded to Change #20 telling us about her childbirth classes, and how about five minutes is spent during each class mentioning pain-coping. This is not unique. Many parents over the years have told me that with all the other information and videos that were given, teachers simply "ran out of time" for pain-coping and either "squeezed in a bit of relaxation" at the end, or promised to do more the following week. More time is dedicated to epidural information.

Over the years, postpartum, enlightened (if not burned) parents have taught me that most of the information they learned in classes (including my classes at the time) was not useful in labor, nor could it be remembered in the haze of labor's trance and exhaustion.

The one thing parents have consistently told me--and sadly still are telling me--was that they wished they had learned more about how to embrace and cope with pain, intensity, the unknown, and surprises.

From the wisdom and pleas of unprepared parents, and from knowing (both as a midwife and a mother) what they were saying was absolutely true, I changed my classes decades ago. The Birthing From Within model is based on the wisdom of parents.

There are four beliefs that motivate me to dedicate so much time to building a pain-coping mindset in classes:
1. I believe that the one thing for certain almost every mother will face and embody throughout labor, beginning with early contractions, is an unfamiliar, growing ever stronger, physical experience of dilation (call it pain, rushes, waves or whatever you like), exhaustion, and feeling "lost" or "uncertain" from time to time. Almost every mother will tell you it was more than she expected. She deserves to mentored to meet and move with the power of labor.

2. I also begin with the knowledge that as labor progresses, women shift from rational or thinking, rapid beta brainwaves toward their maternally intuitive, imaginal, slower alpha/theta brain waves. Women labor in their body. Labor is not a concept or a plan to be followed in their mind. So, I want my classes to engage and train the part of their brain in which they will spend most of their time in labor. I want the parents to cultivate emotional and physical skills and mental concentration: things they will need in their labyrinth of birth. At most we have twelve short hours to do this!

("Side Bar:" That said, most of the Fascinating Facts parents learn in their beta-note taking-class brain will fall away in the passion of labor. This is why so many women complain or shrug their shoulders when asked about their childbirth class. They say, "It all seemed interesting at the time, but it wasn't really useful in labor. Don't think I'll do that again." Or worse, as one father told Virginia recently, their previous classes were "boring," "a waste of time," and "irrelevant." And this rap is the recommendation given to peers... which may account for the fall in childbirth class attendance.)

3. Fathers, other mothers, and birth support people also need to learn mindfullness practices--to center themselves in labor; they also need to learn mental concentration in order to support and entrain the mother's efforts in labor. They need step-by-step experience (not cliches) to build genuine confidence in pain-coping and solution-focused thinking. When a mother's support people are afraid of, or uncomfortable with, her pain, intensity, or exhaustion in labor, the mother sees this and may want to take care of them by controlling or stopping her expression of pain in any number of ways. It is imperative for the support people to be prepared--so they will not feel powerless.

Perhaps it is natural for women in labor to find their way through the pain and intensity. I believe this is often true. But, it is new for fathers/other mothers to stand by and witness someone they love "in pain," and perhaps it is natural for them to want it to stop. For this reason, 60% of my attention during pain-coping practice goes to the father/other mother/birth companion. Their confidence and personal mindfulness practice during labor may entrain the mother during labor.

4. If labor progresses quickly, normally, and the mother is well-supported with no additional surprises, she and her partner could probably get on without all this fuss and training. Lots of women/couples do--and many can not. Since we don't have a crystal ball to know what she will need, we cannot rest on the theory that labor is natural and that all (modern) women know what to do.

What Change Can We Bring To Birth in our Culture!
1. Every childbirth class begins with a pain-coping practice. At least a half hour of every two-hour class is dedicated to building a pain-coping mindset. Building a pain-coping, solution-focused mindset is not the same as learning to relax or some stylized breathing pattern or technique.

2. Parents don't just hold ice for one minute "to see how long a minute long contraction is"!! I am hearing this nonsense from many parents. They tell me that their teacher made them hold ice for a minute -- how could this gimmick possibly be helpful? Is it a bad misunderstanding or poor imitation of BFW classes?

What parents in BFW classes do is learn a pain-coping practice, then... ice is held for a one-minute "ice contraction"--for several "contractions" in a row--to experience, embody, and really learn and refine the practice. Without ice, the practices would be sweet little meditations that didn't really require concentration or focus.

3. There is so much more to building a pain-coping mindset in classes... which can't be explained in this blog. It is a major section of our Level One Introductory Trainings and it required three CDs in a set for teachers called How to Teach Pain-Coping Practices.

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So Kimberly, you still have time. Since your classes don't have enough time to prepare you in pain-coping, please write the office and ask Raquel to send you a Pain Coping Cd for Parents as a gift from me for inspiring this blog.




  1. Excellent post Pam! Actually I went to the level one training in Seattle a year or so ago, and have been doing BFW style classes at home with my husband to get him comfortable with surprises and intensity. I'm so grateful for BFW- it really changed my mindset toward epidurals and c-sections. I used to just hate them and be scared of them, but now I can see there are beneficial times to use all of them, and I am open to needing them during my own labor.

    I love the hospital class because of the insight it has given to me on the attitudes of the nurses and the culture of birth there-and I've been pleasantly surprised overall, my only complaint is the lack of time spent on pain coping.

  2. Great post, and very timely for me.

    As a mother, because of my straight forward birth that I breathed through without learning pain-coping practices, I have de-valued teaching pain-coping practices in my classes.

    As a mentor, I have realized that not everybody has the same internal experience of labor as I did. And that learning a pain coping practice isn't so much about the technique, but of gaining self-confidence and internalizing that (pain) coping is part of labor. Sometimes I get so deep in birth work that I forget that what is normal and obvious to me, is not normal and obvious to the first time mother.

    I'm starting to really get it.

    ~Lindsey Morrow

  3. I have taught pain coping practice to ob residents and since ice wasn't a practical choice I just brought clothes pins to the session. I'd suggest they try either the tips of their nose or the lobe of their ear...which ever elicited a quicker "ouch effect" was the one we'd use.

  4. I love sharing pain coping practices with parents! These mindfulness practices are such important tools for labor, and for life. The stories we tell ourselves govern our experience. Always. Right now the story you're telling yourself about this blog is changing how fast your heart is beating, how shallow or deep your breath. It may be making you feel excited and enthusiastic, or may be pushing a button and stirring up feelings of anger, resentment, and fear. Our stories mean everything. And, when struggling through a difficult contraction, our stories can cause a huge amount of suffering! The ability to stop telling a hurtful story, and simply be present is a powerful life skill. We can change our experience if we can stop telling certain stories. Mindfulness practices give the mind that is used to storytelling constantly something else to do. Often meditation students are invited to simply stop thinking, and when a thought does come, let it go. However, some people find that when their minds are asked to simply stop thinking, it is too hard, it rebels, it "fights for its life." If that mind is given something else to do, it can relax enough to stop storytelling. Mindfulness breeds focus, concentration, stillness, aliveness, and peace. There is a wide variety of practices that over time have had repeated success at helping people experience a quiet mind. When practicing a variety of methods, parents find what works for them. Once a person has practiced each method many, many times, they have lots of "tools" in their "toolbox of ways to quiet the mind." (Even when its resisting quiet.) My meditation teacher taught me that my mind is like my foot. It is a tool. It should not be in charge. Would I give my feet control over where I go? Why should I give my mind power over when to think and when not to think? Not to mention choice around what to think, or continue thinking, or not to continue thinking. To be at the mercy of my mind is like being at the mercy of my foot.

    A couple weeks ago Nekole, founder of Tantric Birth, came to Kauai and offered an evening workshop called "More Oxytocin, Please! Increasing Intimacy in the Birth Room" We learned about the science behind oxytocin, how it is both a neurotransmitter and hormone, how it acts in the brain, and how it acts in the blood. It was a great workshop, and I connected some very interesting dots on a personal level with regards to oxytocin. One of those dots was realizing that when I practice mindfulness I have a powerful release of the neurotransmitter oxytocin! Meditation has been shown to regulate blood pressure, and promote feelings of wellness. Oxytocin has been found to regulate blood pressure, and create feelings of wellness. Isn't this exciting?!?!?! Not only do BFW's pain coping practices help to alleviate suffering through quieting the mind, but, perhaps...I dare to say... they also increase oxytocin release! Oxytocin release is very personal. What turns on the oxytocin for you, may not turn it on for me. But for those of us who feel better after meditating, it is most likely due in part to increased oxytocin in our system. I have not found any studies that have looked specifically at mindfulness and oxytocin release, but I suspect there is a correlation between the two. Below are some studies on the effects of both meditation and oxytocin on our bodies and emotions.

  5. 1. Benson, H., "The relaxation response: therapeutic effect," Science. 1997 Dec 5;278(5344):1694-5. PMID: 9411784 (Dr. Herbert Benson of the Mind-Body Medical Institute, which is affiliated with Harvard University and several Boston hospitals, reports that meditation induces a host of biochemical and physical changes in the body collectively referred to as the "relaxation response."[30] The relaxation response includes changes in metabolism, heart rate, respiration, blood pressure and brain chemistry.)
    2. Carlson LE, Ursuliak Z, Goodey E, Angen M, Speca M. (2001) The effects of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients: 6-month follow-up. Support Care Cancer. 2001 Mar;9(2):112-23.PubMed abstract PMID 11305069
    3. "How hugs can aid women's hearts". BBC News. August 8, 2005. Retrieved 2008-11-28

  6. thank you pam. for your attention to language in this article. i so appreciate seeing other mothers become more visible in the birth culture!

    much love to you!