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MASSAGE TECHNIQUES FOR LABOR
Article Published in: “A Midwife’s Touch,” by Elaine Stillerman. © 2008 Midwifery Today, Inc. All rights reserved.
[Editor’s note: This article first appeared in Midwifery Today Issue 84, Winter 2008. Portions of this article were taken from Prenatal Massage: a textbook of pregnancy, labor and postpartum bodywork, by Elaine Stillerman.]
As labor progresses into the active phase, a noticeable shift occurs in contraction pattern and mother’s emotional response. The midwife’s goal is to keep her calm, comfortable and focused and to encourage the normal progress of labor. Another important task is to meet her emotional needs with understanding, nurturing and respect. This will give her a greater sense of control over labor, which can lead to heightened self-esteem and a more satisfying, empowered experience.(13)
The bodywork techniques must now be adapted to the mother’s emotional and physical needs and changes. Her breathing pattern will be different and should be encouraged by breathing (or intoning, moaning, etc.) with her.
Techniques for Active Labor
As labor progresses into the transition phase of stage one, most women are no longer comfortable with long, gliding strokes. Some women may actually pull away from touch altogether as they focus on the task at hand. Hot or cold packs, or ice chips (perhaps imbued with an herbal remedy such as black cohosh, if her blood pressure is low and stable) may be welcome. Holding, rocking or swaying with her may be all the support she needs. Placing your hand on an area of tension or firmly applying pressure on her sacrum during a contraction can relieve back pain. (Don’t forget to keep her face and jaw relaxed, since a lot of women in late labor grimace in pain and lock their jaws.)
Quiet encouragement and reassurance are paramount during transition. Keeping her relaxed and calm lets her natural rhythm of labor proceed smoothly and on course.
After the short resting phase of stage two where she may enjoy a few gliding strokes on her back or belly, strong contractions resume and the urge to push becomes involuntary and compelling. Relaxation is vital to the conservation of her energy and smooth passage, particularly her pelvic floor and adductors, as any physical tension could increase pain and slow labor. Gently and quietly remind her to release tension and allow her body to open.
Helpful ways to support her include encouragement, staying calm and helping her follow patterned breathing and chosen relaxation strategies. Help her change positions and rub any tense areas—if she wants the touch. The strokes of abdominal effleurage during the active phase begin at the fundus and move toward the pubic bone in tandem with uterine contractions. Between contractions, try effleurage of the lower back, or she might prefer gentle pelvic rocking. Leg cramps or muscle spasms can be treated with active or passive stretching or appropriate light leg massage. She will most likely need assistance straightening her legs after squatting to either stand erect or sit down.
Most of the support during the baby’s birth helps to calmly remind mother to stay relaxed and conserve her energy. You can offer some physical support such as counter-pressure or perineal support and help her find a comfortable birthing position.
Expulsion of the Placenta
In the tribal world, placental birth was usually very fast because women were in good physical shape and they used efficient birthing positions. Standing and stretching can expedite placental delivery.(14) Massage was used almost exclusively to encourage expulsion of the placenta in tribal societies. Other procedures included contracting the abdominal muscle, having the woman sneeze, having the new mother bite on something very hard or having her blow into her hands or an empty bottle.(15) Heat applications were also used to effectively expel the afterbirth.
The women of Morocco soak the end of the severed umbilical cord in oil heated over hot coals. Within a few minutes of the treatment, the new mother stands and the placenta falls out.(16) The Filipinos warm the handle of a wooden rice ladle and press it against the woman’s navel. In certain regions of Mexico, a hot tortilla is placed against the mother’s right side.(17) In India, the birth attendant oils her head and rubs it against the standing mother’s belly until all the blood comes out.(18) In Tahiti, the afterbirth is expelled as mother kneads her own abdomen while bathing in the sea. Her husband presses his foot against her to stimulate further expulsion of fetal detritus.(19)
Abdominal massage from the fundus to the pubic bone, skin-to-skin contact between mother and baby (kangaroo care, nursing), nipple stimulation or oral stimulation (by the partner) promote the release of endogenous oxytocin that encourages the uterus to contract and expel the placenta. Midwives can stimulate acupuncture point Spleen 10 to release the placenta. Place the heel of your hand at the top border of the mother’s knee. Your thumb should reach the belly of the vastus medialis muscle where the point is found. Hold for a count of 10, repeating until the uterus starts to contract.(20)
If mom starts to shake, squeeze the arches of her feet to control the trembling and guide her through gentle breathing.
Many helpful bodywork and massage techniques, along with numerous comfort measures and coping strategies, can have a positive impact on the way a woman perceives and experiences her labor. These techniques also provide midwives with additional ways to keep their clients calm, comfortable and relaxed.
Elaine Stillerman, LMT, has been a New York State licensed massage therapist since 1978. She began her pioneering prenatal practice in 1980. She is the developer and instructor of the professional certification workshop “MotherMassage: Massage during Pregnancy” (www.MotherMassage.net) and the author of MotherMassage: a handbook for relieving the discomforts of pregnancy (Dell, 1992); The encyclopedia of bodywork (Facts On File, 1996); Prenatal massage: a textbook of pregnancy, labor, and postpartum bodywork (Mosby, 2008); Modalities for massage and bodywork (Mosby, publication date to be announced). She is the researcher and writer for the PBS-TV show “Real Moms, Real Stories, Real Savvy” and is proud to have helped organize the March 2008 Midwifery Today conference in Philadelphia, Pennsylvania.