From MIDWIFERY MATTERS, Issue No.117
Olivia Lester - Yoga and Active Birth Teacher
Olivia shared this with us at the wonderful National Meeting in Sheffield in March, to the amazement of everyone present. I suggest every midwife reading this tries it out immediately; when Olivia explained it to us we all nodded politely, but when we all gave it a go there were gasps of amazement all round!
When I was newly qualified as an Active Birth teacher we had a study weekend within which an experienced teacher, Val Orrow, shared the following top tip for enhancing the effectiveness of a 'bearing down' contraction in the second stage of labour.
This would probably be used when a woman had felt she had had several 'bearing-down' contractions but wasn't sure where or how to make the most of them. The following suggestion, when used, can help a woman to work more efficiently with her second stage contractions and make clearer for her where and how to work with the expulsive effort of the body as she births her baby. It is a tried and tested confidence booster that allows a slow, controlled way of bearing down.
As she feels the contraction beginning, the woman in the second stage of labour makes a fist with her hand, inhales through her nose, opens her mouth wide, places her fist in her mouth and then exhales out over her fist. Some of her breath will escape out over her fist but the fist is very much providing a resistance to the out breath. At the very end of the out breath she pauses, relaxes and then allows the new breath to come in through her nose. The woman would need to make sure that she allows the jaw to open fully and for the fist to be well inside her mouth.
In this way, the woman would be keeping her jaw open and relaxed thus working with the corresponding softening of the pelvic floor muscles. As there is a physiological link within the body between a soft jaw and a soft pelvic floor, this enhances a physiological second stage.
The resistance to the breath provided by the obstruction of the fist triggers a bearing down of the diaphragm and the top muscles of the uterus. It is both the diaphragm and the top of the uterus that bears down to push the baby through the birth canal. The pelvic floor needs to be as relaxed as possible.
Adopting an upright birthing position also allows for the added advantages of a gravity efficient position.
I have had feedback over the years from women who have found the 'fist breath' really useful.
One woman who was birthing her first baby with a mobile epidural managed to be in an upright kneeling position, leaning over the bed head. Her midwife was able to let her know when her contraction was beginning, so she could use the fist breath during the length of the contraction and then rest in between. She birthed her baby within one and a half hours with an intact perineum.
Another friend, also expecting her first baby, was taken to theatre for a caesarean delivery. She said that as she looked at all the doctors and how young they all seemed to be, she asked for five minutes to, "Try something a friend had showed her". Two fist breaths and her 10 lb baby son was born.
After my talk to ARM members in Sheffield in March this year, I spoke to Jane Evans, independent midwife. She shared with me that she had recently been at a home VBAC birth where the mother had had a prolonged second stage. Jane said that she remembered the tip and was amazed at how effective the fist breath was for allowing the baby to finally make its way out into the world.
Given that in the majority of cases (during labour) when the second stage needs to be speeded up, for whatever reason, there are always five or ten minutes available within which to try a different birthing position or to give a few words of encouragement. You may like to suggest a fist breath ... watch how the pelvic floor releases to allow the baby to be born...
www.sheffieldhomebirthgroup.org.uk
This article was originally published in Midwifery Matters ISSUE 117, Summer 2008, p11
AH updated 18 April 2009