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.