LABOUR SUPPORT

This is a rough outline of the various skills we covered in our clinical skills labour support workshop!

Feel free to be in touch with any questions or clarifications! hello@ruthruttan.ca

OBJECTIVES

Our objective today is to raise awareness of our impact as humans on the labour and birth experience. We'll examine our presence, communication style, language, and actions and consider how we can be supportive in a birth space.

We'll use practical tools and role-play to explore how we can support what's happening emotionally, physiologically, and anatomically for the labouring person.

Hi I’m Ruth Ruttan. I'm a doula, pre/postpartum movement specialist and dancer. You can learn more about me here - Meet Ruth

My approach to supporting labour and birth involves several lenses: as an artist, I use connection and creativity; as a movement expert, I use anatomical knowledge and understanding of movement and instruction; and as a doula, I use my training to support physiology.

Obviously, doulas come in all forms and labour support can look many ways! I'm hoping that as you support births, you can draw on your unique skills to form your comfort in the birth spaces.

I'm also hoping that by the end of our time together, whether you're experienced in the birth world or not, you'll have some tools for walking into a birth space, bringing calm and comfort, feeling comfortable, and being able to connect with your clients' natural rhythm.

It would be absurd to think we could cover everything related to support, so I've selected a few key areas for us to focus on.

Environmental and emotional support.

Communication and language.

Physical support for common discomforts and labour scenarios.

Let's make some assumptions—we are looking to support what's happening physiologically and anatomically while supporting emotional and comfort needs. Even if a birth isn't purely physiological, we can still encourage it in this manner.

You'll have limitations imposed on you by the expectations and other responsibilities given to you by your preceptor. Sometimes, you will only be able to utilize a few of the tools you’ll learn, but you can keep these in your back pocket for when an opportunity arises.

Before we begin let’s do some calm breathing together: Find a relaxed position, seated or standing, hands-on forehead, heart or belly. Eyes open or closed, breathe in through your nose for 4 counts, out through your mouth for 6 counts. (this is just one form of calm breathing there are many)

Soften your face, soften your jaw, and drop your shoulders. Sink into the surface you're sitting on and let it hold you.

A brief discussion on the environment and the scene that was unfolding as you walked int the room.

I will add a list of observations and thoughts from each group after our workshop day.

Some practical suggestions you can riff off of when you walk into a birth space:

• Before you enter, take a few breaths to centre yourself and become present to 'what is'

• Check your fears, biases and expectations at the door.

• Notice the environment and what's in it.

• Who's in it? Introduce yourself to support people, including the doula!! And what roll you have.

• Between surges, introduce yourself to the birther and what role you're in. example: I'm a student midwife. I'm here to support you and your family emotionally and physically if needed and assist your midwives.

• Check in on the support people - do they need to hydrate, eat, rest, be reassured?

• offer water, snack, other? to labouring person.

• Is there anything in the environment that could change to support physiological birth? Check the five senses and help fill them with calming elements.

• Ask questions of the support people to get a sense of why the room is as it is. If you want to change something, ask the support people and the labouring person.

• Find out about their language & birth preferences:

examples: Contractions vs. Surges, tightenings, waves or Pain vs intensity

• If you have the opportunity, stick by the doula and see what skills they are using. They typically have an existing relationship with the family and an understanding of their birth preferences. You'll either bond over being newbies and or learn from each other.

• Support their decision-making:

Ask if they feel they have enough information or offer to explain in layperson's terms.

Protect the labouring person by offering time to discuss without watching eyes.

PHYSICAL SUPPORT

these are to help a labouring person find their natural rhythm or flow & show that you are trust worthy!

Let's play detective!!

Ask to touch the labouring persons back and sacrum - this helps your assess station of baby or if there's a misalignment

Notice tension in their body? Scrunched face? Clenched hands? Shoulders up?

You may ask where they're feeling surges or discomfort/ pressure? Belly, hip(s), back, a combination of those?

What sounds are they making - deep guttural/ high pitched, screaming?

Is there bloody show?

Get a sense of the labour pattern if you can (ideally from a support person or time a few yourself)

Supportive Touch:

BUTT BREATHING: down-regulates the nervous system, releases tension in the body, mobilizes sacrum, creating better balance in the body and torso - anatomically promotes more space for the physiology

HOW: All fours (over a birth ball), one hand on sacrum (fingers point to head), one hand on ribs (fingers point to head).

Inhale gentle traction apart - sacral counter nutation (tuck under)

Exhale hands gently come together - sacral nutation (extends out)

WHEN: to address fear, help with mindset, nice introduction to workin g together, prodromal labour, malposition, imbalance in the labouring person's body. Can be used in so many scenarios!

OTHER TOUCH:

• Stroking down the legs, holding ankles, heat on lower/ upper back, holding ankles or feet, stroking shoulders or shoulders to arms.

• Shake the Apple Tree

• Counter pressure - sacral, pressure points in the dimple of cheeks, knees - add shifting

• Double Hip Squeeze

A note on Communicating & Language:

Your communication style and language play a huge role when supporting!

• Tone & Volume - lower your voice in tone and volume, speak between surges, limit questions to consent, keep options concise - don't offer a laundry list.

Be encouraging.

Examples of things to avoid:

•Now I'm going to... I'm going to do this... ALWAYS ask for consent

• Bad babies, misbehaving babies, gender stereotypes - “they're so stubborn and won't turn for me - must be a boy.”

Let’s investigate how the movement of our body impacts the movement of the pelvis:

With you hand(s) on your ASIS, move your legs in various directions.

With you hand on your tailbone/ sacrum, move your legs in various directions. Try raising your arms overhead.

Try these movements in various positions, All fours, supine, sidling, standing, and see what you notice about your pelvis. You should feel movement!

MOVEMENT FOR BABY'S STATION

Baby is “floating” high in the pelvis or early labour - to encouraging engagement

• Asses sacrum if possible

• Restful positions:

Flying Cowgirl, Lift & Tuck, Walchers/ hip extension

Roll Over Method - Penny Simkin. All fours, side parallel legs (bolster or pillow), extreme side lying, all fours again, continue on other side - twice through if possible

• Active:

Cat/Cow, Birth ball hip movements, leaning squats & side lunges

(use a body to demonstrate & do these together)

Mid Pelvis

ROCK THROUGH THEORY: All movement is good and can help the baby navigate the pelvis - explore alternating movement.

• Passively if there is an epidural, you move their leg, rocking in positions with peanut ball

• Roll Over Method - Penny Simkin. All fours, side parallel legs (bolster or pillow), extreme side lying, all fours again, continue on other side - twice through if possible

• Actively: Slow dancing w/ one leg elevated, lunging w/ one leg elevated, Kneeling aligned lunges (psoas stretch is a bonus), curb walking or stair stepping, standing psoas release, Dip the Hip, Glute Scoot.

Pelvic Outlet & Second Stage:

Various Positions for opening the pelvic outlet and pushing:

Typically positions with deep hip flexion, internal rotation of the femur (knees do not need to be together!) and often with the arms in flexion - reaching or pulling (the latissimus dorsi connects to the sacrum and nutates the sacrum when arms are in flexion)

Side, All fours, seated or standing squat, hanging squat, kneeling, standing one leg elevated, back with runway

SPECIAL CIRCUMSTANCES:

Prodromal labour/ startstop labour:

Labour is intense and frequent but not creating much change

Address their mindset & create balance in the body/ pelvis

Butt breathing

Standing Psoas Release/ Aligned kneeling stretch with overhead arm/ Walchers

OP/ OT/ malpositioned baby, Baby needs to Rotate:

Possibly an inversion

Sacral rocking/ release -all fours, side lying, standing

Side Lying Release (3 surges on each side) do not do with clients with SPD

Extreme side lying with rocking

Baby may be Asynclitic.

Asymmetry in the sacrum could indicate that baby is asynclitic or maybe their arm is up and in the way, the head compounded somehow

Chiropractor - can one come to the birth location?

Inversion - actual inversion or open knees to chest/ bridge

Sacral rocking/ release - all fours, side lying, standing

Asymmetrical Seated Thrown

Thank you for attending this workshop!