Balancing Guided Movement and Intuitive Laboring in Birth
by Brittany Sharpe McCollum,
CCE(BWI), CPLD, CLC, Perinatal Pelvic Biomechanics Educator
Among birth professionals, there is often a divide between those that believe in offering suggestion and those that believe in supporting instinctive birthing.
This demarcation does not have to be so bold; as highly skilled, knowledgeable, and intuitive birth companions we can support both. We can encourage our clients to develop and respect their intuition while also sharing wisdom based on knowledge, experience, and research to better ensure an experience that feels positive and empowering.
Movement is such a powerful way to support the labor process.
As an educator and doula that specializes in pelvic biomechanics and utilizing movement and positions to decrease intervention, I am biased… BUT there is a reason why I dive deeper and deeper into the relationship between the pelvis and the baby every day.
It is because understanding this complex and beautiful dance offers an opportunity to decrease interventions like augmentation, cesarean birth, instrumental assistance, and episiotomy.
It is because it offers a way to better support posterior babies in their unique journey through the pelvic space than spending hours without progress (and possibly with back pain and early rectal pressure), relying on Pitocin, manual rotation, and surgical birth.
It is because understanding this dance actually helps to support long term pelvic floor health, decreasing the likelihood of tears in labor and future incontinence and prolapse.
To have the potential to develop skills that can so positively impact people’s individual experiences yet to choose not to use them does a disservice to all birthing folks. I see it as our responsibility to develop these skills and use them to reaffirm, complement, and enhance what those in labor are already doing instinctively.
When to Jump In and When to Step Back
The question, however, is when do we gently encourage these suggestions and when do we step back and support differently?
The answer - just like the topic - is not so clear cut but depends on many factors. Some of those factors may include…
The Individual Client
Are they someone that has made it clear prenatally that they desire guided support? What are their goals in working with a doula? Do they carry anxiety or fear or past experiences in a way that could impact their ability to listen to their instincts in labor?
How Smoothly Things Are Moving
Is labor progressive and efficient or is it long and tiring? Let’s make it clear that we are not in a race to birth babies BUT we can improve outcomes for parents and babies and decrease intervention by offering suggestions that support the benefit of progress without increasing risk.
The Frequency of a Client’s Movement
Have they been laboring in the same position and/or moving in the same way through dozens of contractions? Could this signal reluctance to experience sensations in a different or more intense way? Pelvic space changes differently at different levels and different movements will allow for the space to change, which can incrementally support a baby in working their way down and out.
Pain Medication
One of the biggest myths we need to bust is that movement is not possible with an epidural. It absolutely is BUT when the person cannot feel the contractions, they are far less able to use their intuition to guide them. A skilled doula has the ability to guide movement in a way that no one else in a hospital laboring space has the time (or possibly even knowledge) to do. That skill offers a tremendous opportunity to improve both physical and emotional labor outcomes.
Providing Space So They Can Do Their Thing
Sometimes we work with people who are embracing their contractions, have little if any fear of labor, and are clearly letting go, possibly recognized in deep/breathy vocalization, rocking with contractions, moving their body often.
In this case, we may only focus on the “little” things such as offering chapstick, rubbing circles on the back in between contractions, offering a headband or hair tie, and supporting their preferences through communication and advocacy.
Our role becomes one focused on providing comfort by encouraging full enjoyment of the breaks, tending to the little things that add an element of being nurtured, and acting as a soft buffer between their labor haze and the more tangible world around them.
Providing Guidance for Working with the Process
When our clients can benefit from additional support or guidance for movement or management of discomfort, this need may be reflected in them becoming “comfortable” in one position with little intrinsic motivation to move, tightening their legs and their hips with contractions, not giving themselves permission to make deep and low sounds.
In this case, we can offer suggestions for shifting within “comfortable” positions such as changing the thigh rotation or creating asymmetry.
With gentle hands or words, we can encourage rhythmic movement with contractions and model slow intentional breath or vocalization as they sway. We can offer reminders to go to the bathroom every hour, suggest specific positions, and support different ways of rocking such as front to back shifting or hip circles.
Supporting Movement in Medicated Birth
Medicated birth is another opportunity for doulas to guide movement and encourage involvement in positioning and techniques from support people.
Too often epidurals wind up leading to movement only once an hour or so and a significant scaling back of support from partners.
In reality, epidurals offer a chance for doulas to step up their role by getting creative with safe and effective movements within stable positions. They are an opportunity for doulas to allow partners to get some rest but then make suggestions for how they can continue to nurture their loved one through hand massage, cool cloths on the face, reminders to eat and drink, and more.
Doulas can use props like the peanut ball and the squat bar and bolsters to support ideal positioning for where the baby needs space in the pelvis.
With the majority of birthing folks in the U.S. getting pain medication, it is imperative for doulas to develop their skills in guiding and supporting safe movement when medicated.
Letting Your Doula Intuition Guide You
What does all this boil down to?
In essence, it means that the degree of guidance we offer our clients has a lot to do with the individual person whom we are supporting and our ability to understand and intuit their needs in labor. It also means that the doula themselves must be able to tap into their intuition, pair it with knowledge, and then share that with clients in a way that respects their autonomy, their bodily wisdom, and the preferences they have for their experience.
Rest assured that there is a learning curve and the reality is that, as birth companions, we are still always learning and growing with every experience we have, whether it is the sixth birth or six hundredth birth we’ve attended.
Our ability to observe, reflect, and suggest are skills that are incredibly unique to our role.
When we embrace them, we better serve our clients and better serve our larger mission of encouraging healthy, positive, and empowering birth experiences for all parents.
Feel the need to deepen your understanding of effective movement in all births?
We offer opportunities for perinatal professionals to develop skills, obtain mentoring support, and participate in continuing education workshops. Learn more at Blossoming Bellies.
BIO:
Brittany Sharpe McCollum, CCE(BWI), CPLD, CLC, Perinatal Pelvic Biomechanics Educator, is owner of Blossoming Bellies Wholistic Birth Services, providing evidence based information, tools, and resources to expectant parents and birth professionals since 2007.
Brittany’s work in the childbirth field combines research based information with movement and hands-on practice to create workshops and trainings that are dynamic, energizing, and full of usable tools and techniques for supporting empowered experiences and autonomy in birthing. She facilitates educational classes and workshops for parents as well as creates and facilitates continuing education sessions for perinatal professionals. Brittany’s homebase is South Jersey where she resides with her partner and their four kids and crazy dog but you’ll find her frequently traveling to teach courses for hospital teams and doula groups as well as for conference presentations.
Learn more at www.blossomingbelliesbirth.com or on her social media @blossomingbelliesbirth.