Labor & Delivery: Lamaze Method Health Article

Ferdinand Lamaze, a French obstetrician, went to in the early-1950s to develop of method of pain relief based on Pavlov's training principles. Lamaze classes are structured to help women replace their negative preconceptions regarding pregnancy and the birth process with positive, learned responses and coping skills. At the same time, participants and their Lamaze partners are taught active relaxation techniques and patterned breathing to ease the discomfort of labor and birth. These skills are taught in a six-to-eight week series of classes. A variety of information is covered in each class. The following represents a typical series of Lamaze classes and information presented.

First Class

The initial Lamaze class gives an overview of the anatomical, physiological, and emotional changes that accompany pregnancy, with a focus on the third trimester changes.

Common topics in the first class include:

• Coping skills and expectations. You and your partner are encouraged to share your thoughts, fears, and feelings. You are taught to trust each other and to work together to deal with labor.
• Normal discomforts of pregnancy. You and your partner are taught to provide counter pressure for low backaches and pains by steadily pushing on your lower back. You are both encouraged to discuss discomforts you are experiencing and the instructor explores different remedies.
• The benefits of breast-feeding. Breast-feeding helps your uterus contract after childbirth. These contractions also reduce blood loss after delivery. The mother's milk immunizes the baby from childhood illnesses. The breast-feeding experience strengthens the mother-baby bond.
• Nutritional needs. You continue to require additional nutrient dense calories to build a healthy baby. Brain cells only develop in babies for a short period of time. Brain cell development occurs throughout the last trimester and up until 18 months after birth, during which time proper nutrition is very important.

Third trimester changes:

As your body grows to accommodate the growing fetus, you

• Will often feel tired;
• May cry and laugh easily;
• Will have an increase in blood volume;
• May notice generalized swelling; or
• May need to urinate frequently.

Activities

The activity session for the first class may include progressive relaxation, positive affirmations, and positive imagery. You and your partner can practice progressive relaxation. You first contract and then relax each body part in turn, starting with your feet. This process helps you recognize how your body feels when it is relaxed and to contrast it with the feelings of being tense. During labor, your cervix opens more easily if you are relaxed. You practice positive affirmations, replacing negative thoughts with positive images. One example is welcoming the contraction as you feel the pain begin. You can also visualize the work of the contraction by using positive imagery.

Second Class

During the second class, participants discuss fetal growth and development, fetal movement counting, and waking and sleeping cycles of babies. The discussion of feelings regarding labor and birth builds upon those explored in the first class. Anatomical and physiological changes during labor and birth are reviewed. Some instructors choose the second class as the time to show birthing movies to participants.

Special Place Imagery

A second relaxation sequence is taught during the activity portion of the class, consisting of the use of "special place" imagery for dealing with discomfort. You learn to picture yourself in a pleasant place and to focus on the sights, sounds, and smells of the special place. This technique helps you distract yourself from the pain and focus on positive feelings.

Third Class

You learn more about Lamaze's theory during the third class. The instructor presents and discusses the perception of pain. You may be encouraged to share what you have been told or believe regarding labor. A concrete discussion regarding the physics of birth can be helpful in demystifying the delivery process. As you understand more about the nature of birth you may begin to see it more and more as a normal event. Childbirth preparation may help you and your partner trust more in your ability to experience the birth of your baby positively and to participate in it more fully.

Another focus of the third class is the developing fetus and its transition to newborn baby:

• Amniotic Fluid. The fetus is surrounded by amniotic fluid within the uterus. This fluid acts as a temperature stabilizer and as a protective cushion for the fetus. The developing fetus practices breathing activities beginning in the fourth month of pregnancy. During these fetal breathing exercises, amniotic fluid washes in and out of the fetus' respiratory tract. Cells from the fetal respiratory system are carried out into the amniotic fluid, which can be analyzed to tell the maturity of the fetus' lungs if necessary. The fetus drinks the amniotic fluid and urinates back into this fluid. You should drink 2 to 3 quarts of liquid each day to maintain an adequate supply of amniotic fluid. The fetus strengthens and exercises its muscles by moving about in the amniotic fluid. You may notice periods of activity balanced with quiet periods. Even in the uterus, the fetus has waking and sleeping times.
• Sights and Sounds. The fetus begins to hear sound in the second trimester. Some studies have concluded that the fetus grows familiar with the voices and sounds of the external environment during its time in the uterus. Other researchers believe the fetus is able to recognize the voices of his parents and other family members. The pulsing of the mother's blood flow and the rumblings of intestinal activity are also present in the uterus and are heard by the developing fetus. Visual ability develops at the same time. Fiber optic photography demonstrates a "rosy" glow within the uterus when the mother's abdomen is exposed to bright light.
• Behavioral Adaptations. Most babies are alert and reactive in the first 30 minutes of life. Breast-feeding is ideally initiated while the baby is active. Inactivity alternates with reactivity as the baby again establishes sleeping and waking cycles.

Breathing Techniques

Lamaze breathing techniques teach you to pattern your breathing to decrease the pain you feel. As each contraction begins you take a deep or "cleansing" breath. This deep breath is followed by slow, deep breathing in through the nose and out through pursed lips. The focus on careful breathing distracts you and decreases your perception of discomfort. Another breathing regimen is to pant slowly while repeating "hee, hee, hee." Your partner assists you, breathing with you and encouraging you. If you feel the urge to push before the cervix is fully dilated, you may be asked to blow out more rapid, short breaths. You are encouraged to learn these breathing techniques, identifying the ones you find most useful during labor.

Fourth Class

Active Labor

Active labor is the focus of the fourth class. As the uterus repeatedly contracts, the cervix progressively dilates. During early labor the contractions are short and occur every 20 to 30 minutes. The cervix softens and thins. Early labor usually progresses slowly. You may feel a heavy tightening in your back and/or lower abdomen and cramping in your upper thighs. The mucous plug may be expelled and you may secrete streaks of blood from your vagina. When the cervix is about 4 cm dilated, active labor begins, with contractions closer together and stronger. Labor usually progresses more rapidly. You may need help in focusing and dealing with the pain at this time. As the cervix dilates to 6 to 8 cm, labor is intense, sometimes called the stage of transition. During this time you and your partner will work very hard to deal with labor. A jetted tub, rocking chair, or birthing ball may help you get more comfortable.

When the cervix is fully dilated the first stage of labor is complete. In the second stage of labor you will usually feel an urge to push as the baby descends into the birth canal. With each contraction you are encouraged to take in a breath and push the baby down and under your pubic bone. As the baby's head stretches the vaginal opening, and becomes visible, you can reach down and touch the baby's head to help you focus.

Touch Relaxation

Touch relaxation is a technique to cope with labor pains. You learn to condition yourself to relax each muscle group as your partner touches it. Your partner in turn learns to identify how you look when you are tense and to touch the tense area to help you loosen the muscles.

Fifth Class

Pushing Techniques

You may find yourself involuntarily pushing as the baby moves down the birth canal. There are various techniques to assist this natural urge:

• Take in a breath at the beginning of the contraction and slowly release the air as you push-the open glottis method.
• Take in a deep breath, hold the breath and bear down with all the force you can muster.

Back Labor

Some women feel most of the pain of labor in their back. Pelvic rocking on your hands and knees or squatting can ease this discomfort. A hot pack or an ice pack on the lower back may also be helpful. Firm counter-pressure applied to your lower back by your partner can also provide some comfort.

Postpartum Coping

You and your partner are encouraged to prepare yourselves and your homes for the arrival of a new baby. A supply of easy-to-fix, nutritious foods is helpful during this time. You should learn to accept help from friends and family. You are encouraged to nurture your sense of humor as you learn the skills of parenting and being a couple.

Sixth Class

In the sixth and final class the instructor reviews previous materials and skills and holds a dress rehearsal for the childbirth. An important aspect of the final class is to help couples understand that the birth process is a normal process.

For more information on preparing for childbirth, go to Labor & Delivery: Bradley Method and Labor & Delivery: Natural Method Without Fear.