Grab Bags

Grab bags are a fun and interactive teaching technique that is easily adapted to a wide variety of topics. Basically, you gather up a collection of small items that symbolize each topic you want to cover – you may find these things around your house, in your kid’s toybox, at a Goodwill or a dollar store. Put them in a bag. At class, pass the bag around, and each student takes one (or each couple, depending on how many items there are). They then hold it up to show the other students, and they talk about how they think it relates to the topic, and you follow up with any additional information or discussion to add some more “meat” to the conversation.

What kinds of topics it works well for:

I use it for places where I have lots of little things I want to talk about that don’t need to come out in any special order… basically, whenever I find myself with a  lecture with 7 or more bullet points, I know that will seem like just an endless jumble of info to my students, so I start thinking about other techniques to use, and this is a great one.

I also find it works well for introducing the awkward topics. During the prenatal wellness section, when discussing all the things students “shouldn’t do”, it’s easy to turn into a nag. Here, when the candy cigarette appears, I “have to” talk about smoking but it  feels less judgmental. During postpartum, when the condom appears, it introduces the topic of sexuality after baby in a gentler way than me announcing “Sex” or writing it on the board.

However, don’t overuse it! I think it would feel gimmicky and tired if you used it multiple times in one series.

Here are examples of topics I have used it for:

Prenatal Wellness Lunchbox: I use one of my daughter’s old lunchboxes to contain this – I think it’s nice for our students to see signs that we are parents – it helps them connect. I fill  it with items that symbolize healthy choices for pregnancy, and not-so-healthy choices.

Sample items: calcium tablets, iron supplements, raisins, protein bar, tuna, caffeinated soda, a prenatal appointment reminder card, flyer for prenatal exercise class, cigarette, alcohol, Tylenol, condom, plastic baggies with “substances” in them. I label them so they know what it’s supposed to represent, and what it really is: “cocaine (baking powder)”, “marijuana (parsley)”, and so on.

Comfort items for labor: When I introduce it, I talk about how every pregnancy book has a list of items you should take to the hospital. But you often don’t need them all. For example, if it says “eye drops” and you don’t own any eye drops, you don’t need to go out and buy them! They’re not one of the comfort items you use in your life. But they are a good reminder to people who wear contacts to consider bringing contact supplies or a pair of glasses if needed. Then I say “So, this bag is just a collection of ideas about what kinds of things people find helpful for comfort in labor. Hold up your item, say how you think it would be useful in labor, and then say whether you think you would find it helpful.”

Sample items: heating pad, ice pack, massage tool, tennis ball, snack (clif bar, peanut butter crackers…), water bottle, CD (note that many students will use their smart-phone for music… the CD is a little dated, but I’m not putting my phone in the bag…), reflexology combs, toothbrush, mints, shorts, sweater, etc.

Postpartum adjustment: items that address physical, emotional, and lifestyle adjustment. Sample items: Maxi pad, peri bottle, tucks pads, stool softeners, condoms, breastmilk pads, kleenex (to symbolize baby blues), phone number for PPMD hotline, alarm clock (to represent sleep / frequent wake-ups), easy-to-eat food, phone to represent reaching out for support, red silk rose to talk about romance / relationship after baby.

A grab bag alternative… If you feel like you’re over-using the grab bag technique, but want some of the same effect, Teri Shilling from Passion for Birth has a postpartum bathrobe, where she fastens all these symbols all over a bathrobe that she wears when she presents this topic. It’s a very entertaining visual aid!

Try some experiments with grab bags. They’re always entertaining!

A note on number of items: My class size can vary from 6 couples to 14 couples. I may have 14 items in a bag. If I have 14 couples, they draw one item per couple. If I have 7 couples, they draw one item per person. But if I have ten couples, then I have two options for how to handle it. Pass the bag around once and have them take one item per couple, then pass it again, asking those who are willing to take a second so we can cover them all. Or, I can edit the bag before passing it around and only include the 10 most important items and put four others away.

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Reflexology combs for labor pain relief

combCounter-irritants for pain relief

As a childbirth educator and doula, I wish we all talked more about “counter-irritants” as effective methods for pain relief during labor and birth. By counter-irritant, I mean the mom does something which is uncomfortable but it helps to distract her from the labor pain, such as biting on her lip, squeezing her fingernails into her palms, using a fist to thump on her thigh, pulling on her own hair. These are all things that are within the mom’s control – she can start or stop anytime she wants to – she chooses how intensely to do it so that it will bring her attention away from the contraction that is not within her control.

The issue is that some of these spontaneous techniques can cause pain or minor injury to the mom. I like to talk about these behaviors in class so partners know that if mom is doing this, it’s because it’s helpful to her. But the partner may need to help her figure out how to do it in a way that provides the pain relief but doesn’t cause harm on its own.

Sometimes it’s a simple in-the-moment fix – for the mom who’s hitting her thigh we might place a pillow there to cushion the blow. For the mom digging her fingernails into her palm, we might be able to give her a washcloth to grip tightly, or better yet, a comb or brush to squeeze.

Birth combs – How to Use Them and Why They Help

In some traditional cultures around the world, laboring women hold onto wooden combs. When a contraction comes on, the mom squeezes the comb so it presses into her palm – she squeezes as long and as hard as she finds helpful. Then she relaxes her grip between contractions, but usually chooses to continue holding the combs.

What to use: I use these reflexology combs from Mildred Carter’s Reflexology. But you could also use two plastic combs from a drugstore – be sure to get blunt tipped combs! Or if I don’t have my reflexology combs when I’m having pain, any comb or hairbrush will do.

How to hold it: the photo at the top of this post illustrates it, and the drawing on Page 9 of this booklet also shows how you would hold the comb.

There are a few theories as to why this might be helpful.

  • One is “Diffuse Noxious Inhibitory Control“. If we create pain or discomfort anywhere on the body, it causes the release of endorphins which reduce the perceived intensity of the pain. (Note: TENS and sterile water injections would also fit in this category of pain relief.)
  • One is related to Gate Control theory: Our brain can only pay attention to so many stimuli at once, so the pressure on the nerve pathways of the hand travels to the brain faster than abdominal pain, and crowds out the abdominal pain signals.
  • One is reflexology or Chinese medicine-based. There are meridians – energy pathways – that cross the palm. Pressing on trigger points there helps to release stagnant chi, allowing healing energy to flow.
  • One is psychology – because the mom is in control of the pain from the comb, it makes her feel less out of control from the labor pain.

My experience with combs for pain

I am an amputee. Which means I have phantom pain.You’ve likely heard it mentioned in studies where people rate the intensity of different kinds of pain. Broken bones, tooth abscesses, and kidney stones are pretty high on the list. But labor pain and phantom pain top the list. So, I’ll share how pain combs work on both these types of pain for me.

Although my right leg has been gone for over 30 years, any time I think about it (like as I type this sentence), I have a tingly sensation all up and down “where my leg should be.” About once every 6 weeks, I have severe pain that I can’t sleep through or work through.Over the years, I explored LOTS of ways to cope with phantom pain. (I luckily have finally found something that fixes it for me. One tylenol and one ibuprofen. If I only take one of the meds, it’s completely ineffective, no matter the dose. But together they’re really effective!)

One of the most effective pain coping tools I had found was combs. As the phantom pain intensifies, squeezing the comb helps distract me from it. It helps me feel much more in control. It significantly reduces the effects of phantom pain.

So, when I had my third baby, I brought my combs to the labor. My labor was quite fast. About 3 hours start to finish, with the 3cm – baby out portion lasting about 30 minutes. So, it was VERY intense. I was in a lot of pain with contractions, and my teenage daughter remembered the combs and suggested them. I used them through the rest of labor, and they were what made contractions bearable for me. Managing a contraction without them was very difficult, so having them was my top priority. At one point I’d gone to the bathroom and set down my crutches and my combs. When a contraction came as I was hopping toward the sink, I yelled for the combs – my husband tried to give me my crutches – which obviously would normally be a priority for me. But at that point I only wanted the combs, because I knew they were what would make the contraction manageable.

So, the question is: are combs effective for people who have not used them for other pain management? (In other words, did they work for me just because they were a familiar pain coping ritual from my life, or would they work for anyone?)

I used them with two clients in labor, who both found them helpful for a portion of their labor, and here’s….

Quotes from others who have used combs during labor

When I would use the combs, I couldn’t feel anything compared to when I walked around without them….” Tracy

When the contractions peaked, I would squeeze my combs, and there was a big difference between “comb” contractions and “non-comb” contractions. I wouldn’t do a birth without them. Rachel

I used two combs. They were men’s combs with the all the same size teeth, with blunt ends NOT pointed ends. I loved them. Didn’t want to let go the whole labour.  Marlee

Do not under estimate the power of a comb.  The small blue plastic comb… was better then an epidural!  There are pressure points in your palm that help with pain relief in labor.  As a contraction built, I would squeeze my comb as tight as feasible, the teeth digging into my palm, hitting those points and providing immense relief.  I couldn’t have done it without that comb! source

I held a small black hair comb in each hand, squeezing them into my palm… I’m not sure how my labor and delivery would have been without holding them, but it actually went pretty fast. And I liked the sensation when I tried it, which is why I kept on with it. Viola

During contractions I was sort of searching with my hands for something to grab onto, I think to feel more grounded. My doula slipped a comb into my hand and I squeezed it instantly. It was awesome! ,,, I was still very much in pain, but it definitely made a noticeable difference and provided me with a bit of instant relief. I remembered her slipping it into my hand, but I didn’t remember what ever happened to it after that. I asked Dh one day if I used it for very long, or if I just dropped it after that contraction. He said that after Ds was born he pried it out of my still tightly squeezed hand. – Jennica

Combs are a cheap tool to obtain, and small and easy to toss into a birth bag, so I recommend them for all doulas as an option to bring along and try.

To learn lots more about coping with labor pain and all the other topics related to the perinatal period, check out Pregnancy, Childbirth, and the Newborn: The Complete Guide.

An Icebreaker about the Postpartum Period

Today I taught about the postpartum period. I want to cover three areas under this topic – physical recovery, emotional adjustment and PPMD, and lifestyle changes / tips for coping with life with a new baby.

Over the years, I have done this as a lecture and as a grab bag exercise, I’ve had new parents visit class to talk about what the experience has been like for them, and I’ve had students read a series of quotes about the postpartum period (note: this just covered emotional stuff and lifestyle changes, not the physical recover topics).

Today, I tried something new, invented in the car as I drove to class.

I did a brief introduction, saying: “We’ll be talking about the postpartum period, after baby has arrived. I’m guessing that you have been hearing stories and advice from friends, family, and co-workers about this – probably some positive stories and some horror stories – some helpful advice and some not so helpful advice. I’m going to divide you into three small groups, and I want you to share with each other what you have heard about these topics.” Then I wrote on the board:

  • Physical recovery after birth
  • Emotional adjustment
  • Lifestyle changes – getting enough sleep, self care, juggling work and baby, housework, relationship changes

I let them talk in their small groups for about ten minutes. It was a lively discussion – this was week 3 of a class series, and we’ve been doing a lot to build community so, I knew they’d be willing to join in.

I then brought the group back together, and we talked more about each thing – what they’d heard, what they wondered, then I added more details.

If I lecture on this, it tends to take me 15 – 20 minutes, but in some ways that feels both too long a time of dumping information on them that they don’t yet know that they need, but at the same time, it feels like I skim over the basics but they don’t really connect / sink in as much as I’d like.

Today, it took ten minutes for the small group time,and about ten minutes to review together where I was able to cover all the content in a good level of detail. I felt that

  • it was a successful community building exercise that they enjoyed
  • during the discussion time, they realized that although they had lots of tidbits about the postpartum period, they didn’t really know much
  • and that realization then led them to be very engaged / interested in learning more, so they connected more with the discussion that followed – both in terms of absorbing practical information and connecting with it emotionally

Another successful classroom exercise invented on the drive to class!