3 R’s: Relaxation, Rhythm, and Ritual

Penny Simkin, P.T.Penny Simkin, P.T.

Evolution of Childbirth Empowerment

•• History of changes inHistory of changes inwomen’s role in childbirthwomen’s role in childbirth

•• Childbirth preparationChildbirth preparationmethods/philosophiesmethods/philosophies

Painless ChildbirthPainless Childbirth

•• Labor is not painful in itselfLabor is not painful in itself•• If a woman feels pain, it is because she If a woman feels pain, it is because she

is afraid and tenseis afraid and tense•• A woman can master techniques to A woman can master techniques to

prevent labor painprevent labor pain•• Women who have painWomen who have pain--free labor are to free labor are to

be admiredbe admired•• “Blame the woman” who suffers pain“Blame the woman” who suffers pain

Painless ChildbirthPainless Childbirth•• Grantly Grantly Dick ReadDick Read•• Fear tension, pain cycleFear tension, pain cycle•• Passive relaxationPassive relaxation•• Abdominal breathingAbdominal breathing•• KnowledgeKnowledge•• “Purple pushing”“Purple pushing”•• Labor supportLabor support

Painless Childbirth, cont.Painless Childbirth, cont.

•• FernandFernand LamazeLamaze•• Elisabeth Elisabeth BingBing•• Pavlov’s conditioned responsePavlov’s conditioned response•• Intricate mental activityIntricate mental activity•• Patterned breathingPatterned breathing•• “Purple pushing”“Purple pushing”•• MonitriceMonitrice

•• Robert BradleyRobert Bradley•• Read method, modified Read method, modified •• Husband as coachHusband as coach•• First North AmericanFirst North American

contribution to childbirth contribution to childbirth preparationpreparation

Painless Childbirth, cont.Painless Childbirth, cont.

Pain as a Side EffectPain as a Side EffectPain with a PurposePain with a Purpose

•• Labor pain is a side effect of a normal Labor pain is a side effect of a normal processprocess

•• Labor pain is not to be feared or Labor pain is not to be feared or avoidedavoided

•• Labor pain guides the mother to seek Labor pain guides the mother to seek movements and behaviors for comfortmovements and behaviors for comfort

Pain as a Side EffectPain as a Side EffectPain with a PurposePain with a Purpose

Sheila Sheila KitzingerKitzinger•• Body awarenessBody awareness•• Psychosexual approachPsychosexual approach•• Guided imageryGuided imagery•• “Breathe the baby out”“Breathe the baby out”•• Husband/father’s presence asHusband/father’s presence as

supportsupport

Pain as a Side EffectPain as a Side EffectPain with a Purpose, cont.Pain with a Purpose, cont.

•• Elizabeth NobleElizabeth Noble•• Birth “with insight”Birth “with insight”•• Critical of “the breathing”Critical of “the breathing”•• Breath awarenessBreath awareness•• Exhalation pushingExhalation pushing•• Alternative birth settingsAlternative birth settings

Pain as a Side EffectPain as a Side EffectPain with a Purpose, cont.Pain with a Purpose, cont.

•• Gayle PetersonGayle Peterson•• “As a woman lives, so will “As a woman lives, so will

she give birth”she give birth”•• Birth visualizationsBirth visualizations•• Psychotherapeutic approachPsychotherapeutic approach•• DeDe--emphasis on a “method”emphasis on a “method”•• Alternative birth settings.Alternative birth settings.

Emphasis on Baby’s Emphasis on Baby’s Experience of BirthExperience of Birth

•• Recognition that baby is conscious and Recognition that baby is conscious and has memoryhas memory

•• Mother’s emotions impact the babyMother’s emotions impact the baby•• Medications, interventions impact babyMedications, interventions impact baby•• The baby has ability to “help” the birthThe baby has ability to “help” the birth

Emphasis on Baby’s Emphasis on Baby’s Experience of BirthExperience of Birth

•• Frederick Frederick LeboyerLeboyer•• Gentle birthGentle birth•• Quiet room, dim lightQuiet room, dim light•• Womb to water to airWomb to water to air•• “Mother as Monster”“Mother as Monster”

Emphasis on Baby’s Emphasis on Baby’s Experience of Birth (cont.)Experience of Birth (cont.)

•• John Kennell & Marshall KlausJohn Kennell & Marshall Klaus•• “Bonding”“Bonding”•• The sensitive period (1The sensitive period (1--2 hrs. 2 hrs.

after birth) after birth) •• Immediate skinImmediate skin--toto--skin skin mothermother--

infant contact infant contact

Emphasis on EnvironmentEmphasis on Environment

•• Comfort, feelings of “safety,” familiarityComfort, feelings of “safety,” familiarity•• Home or “homelike” placeHome or “homelike” place•• Encourages spontaneity, Encourages spontaneity,

individualization in coping stylesindividualization in coping styles•• Provides for a variety of positions, Provides for a variety of positions,

movements, and coping aidsmovements, and coping aids

Emphasis on Environment, Emphasis on Environment, cont.cont.

•• Ina May GaskinIna May Gaskin•• MidwifeMidwife--attended home birthattended home birth•• Birth as a spiritual Birth as a spiritual

experienceexperience•• Women teaching and Women teaching and

learning from other womenlearning from other women

Emphasis on Environment, Emphasis on Environment, cont.cont.

•• Michel OdentMichel Odent•• “Salle “Salle sauvagesauvage””•• Spontaneous behaviorSpontaneous behavior•• Bath available for painBath available for pain•• No disturbanceNo disturbance•• Presence of a “mother figure”Presence of a “mother figure”•• Supported squat positionSupported squat position

Emphasis on Environment, Emphasis on Environment, cont.cont.

•• Water BirthWater Birth•• Michel Odent, Barbara Michel Odent, Barbara

HarperHarper•• Controversies over effects on Controversies over effects on

labor and safety for baby now labor and safety for baby now largely resolved with largely resolved with appropriate protocolsappropriate protocols

Emphasis on Emotional Emphasis on Emotional SupportSupport

•• The woman’s emotional experience The woman’s emotional experience during birth influences outcomeduring birth influences outcome

•• When women are cared for, respected, When women are cared for, respected, and nurtured…and nurtured…–– Labor progresses more normallyLabor progresses more normally–– Satisfaction is greaterSatisfaction is greater–– MotherMother--infant relationship is improvedinfant relationship is improved–– Memories of birth are more positiveMemories of birth are more positive

Emphasis on Support for the Emphasis on Support for the Woman and PartnerWoman and Partner

•• Marshall & Phyllis Klaus,Marshall & Phyllis Klaus,John KennellJohn Kennell

•• Continuous presence ofContinuous presence ofdouladoula

•• Reassurance, guidance, Reassurance, guidance, physical comfort, physical comfort, informationinformation

•• Improved obstetrical and Improved obstetrical and psychological outcomespsychological outcomes

Emphasis on Support for the Emphasis on Support for the Woman and Partner, cont.Woman and Partner, cont.

•• Penny SimkinPenny Simkin

•• Birth as a lifelong memory Birth as a lifelong memory

•• Guide to support during laborGuide to support during labor

•• Understanding by partner or Understanding by partner or doula of woman’s experiencedoula of woman’s experience

•• Doulas of North AmericaDoulas of North America

Emphasis on Support for the Emphasis on Support for the Woman and Partner, cont.Woman and Partner, cont.

•• Polly PerezPolly Perez•• Monitrice as labor supportMonitrice as labor support•• A caring heart A caring heart ---- the essence the essence

of supportive care during of supportive care during laborlabor

•• Professional labor assistant Professional labor assistant ––change agentchange agent

Essence of CopingEssence of Coping

•• Strengthen women’s internal resources Strengthen women’s internal resources •• Look to other disciplines for innovations Look to other disciplines for innovations

in women’s coping techniquesin women’s coping techniques•• Recognize the many ways that women Recognize the many ways that women

cope well with labor pain and stresscope well with labor pain and stress•• Identify and teach qualities shared by Identify and teach qualities shared by

laboring women who are coping welllaboring women who are coping well

Essence of CopingEssence of Coping

•• Marie Marie MonganMongan•• Hypnobirthing Hypnobirthing •• Replace fear with deep Replace fear with deep

relaxation, affirmations, and relaxation, affirmations, and partner supportpartner support

Essence of Coping, contEssence of Coping, cont.•• Pam EnglandPam England•• Woman as warriorWoman as warrior•• Exploring and enhancing Exploring and enhancing

inner strengthsinner strengths•• Birth Art Birth Art •• Zen approachZen approach•• Unfocused awarenessUnfocused awareness

Essence of Coping, cont.Essence of Coping, cont.

•• Penny Simkin Penny Simkin –– The 3 The 3 RsRs--RRelaxationelaxation--RRhythm hythm --RRitualitual

•• Women who cope well exhibit Women who cope well exhibit these qualitiesthese qualities

VideotapeVideotape“Relaxation, Rhythm, & “Relaxation, Rhythm, &

Ritual: Ritual: The 3 Rs of Childbirth

Birth RapBirth Rapby Karen by Karen Miltner Miltner with Penny Simkinwith Penny Simkin

My body knows just what to doMy body knows just what to do

MyMy--body body ٠٠ ٠٠ knowsknows--justjust--what to dowhat to do

My body knows just what to doMy body knows just what to do--

MyMy--bodybody--knows knows ٠٠ ٠٠ just what to dojust what to do

Birth RapBirth Rap, , contcont

My baby grows and knowsMy baby grows and knows--how to behow to be

MyMy--baby baby ٠٠ ٠٠ growsgrows--andand--knowsknows--how to behow to be

My baby grows and knowsMy baby grows and knows--how to behow to be--

MyMy--babybaby--grows grows ٠٠ ٠٠ and knowsand knows--how to behow to be

Birth “As Nature Intended”*

• The future direction of childbirth preparation?

• Emphasizes the normal physiological process of birth

• Emphasizes the mind-body-spirit connection

• Emphasizes care that enhances the normal process

*--Judy Lothian, of Lamaze International

Conclusions• Childbirth preparation has undergone an

evolution over the past 50 years• It reflects changing times, changing

knowledge, and a changing society• It has always placed women and

partners (and more recently, babies) at the center of childbirth

• It has emphasized other influences (support, environment) as new knowledge became available.