Today I added to the site two dice game activities for childbirth classes – a ten minute small group activity to review the stages of labor, or a lengthy instructor led activity to structure either a labor rehearsal or a presentation on variations and interventions.
Note: this page is about how professionals can TEACH this concept to expectant parents. If you’re an expectant parent looking for info on labor hormones, their effect on labor pain, and what your partner can do to help you have a shorter and less painful labor, read Hormones and Labor Pain or listen to episode 5 of my podcast – Labor Support.
In my childbirth classes, and with doula clients, I want them to understand that our emotions, and the support we receive, absolutely affect labor on a physiological basis, by influencing our hormones. The big message is that fear and anxiety slow labor down and make it more painful. Support and feeling safe make labor faster and easier. I have simplified the complex details into a simple stick figure drawing that takes 5-10 minutes.
Before I talk about my teaching method, let’s start with…
A basic summary* of hormones
- What it does: Causes labor contractions that dilate cervix (i.e. helps labor progress)
- What hinders oxytocin production: Anxiety, bright light, feeling observed or judged. Pitocin (if you’re given synthetic oxytocin, you make less hormonal oxytocin)
- What increases oxytocin: Skin-to-skin contact. Nipple stimulation, making love.
- What they do: Relieve pain, reduce stress (cause euphoria and feelings of interdependency)
- What hinders endorphin production: Stress, lack of support. Narcotics (if you have an external opiate, your body will start producing less internal opiate… even after the narcotics wear off, you’ll have less endorphins)
- What increases endorphins: social contact and support from loved ones.
- What does it do: In early / active labor: slow labor down(Imagine a rabbit in a field. If it doesn’t feel safe, it wants to keep baby inside to protect it) In pushing stage: Make you and baby alert and ready for birth, give you energy to push quickly. (If the rabbit is about to have a baby, and something frightens it, it wants to get the baby out as quickly as possible so it can pick it up and run with it.)
- What increases adrenaline: Stress / anxiety / fear; Lack of control; Feeling trapped; Hunger, cold
- What increases oxytocin and endorphins and reduces adrenaline: creating an environment where the birthing parent feels private, safe, not judged, loved, respected, protected, free to move about.
Teaching about Hormones
So, in class how do I convey these ideas in just a few minutes, so it’s easy to understand and to remember?
First, I say: “In labor, our emotions and our environment effect our hormones. Our hormones have a huge effect on labor. Let’s look at a couple scenarios for labor.” [I draw two stick figures on the board.] “This one is awash in stress hormones which will make labor longer and more painful. Let’s label it adrenaline. This one is under the influence of oxytocin and endorphins. These help the laboring person shift into an altered state where labor pain is milder (less intense and less unpleasant) and also help labor progress more quickly.” [Add labels to drawings, add sad face and smiley face.]
Then I say “So, you are all probably familiar with adrenaline. What do we call it? Yes, the fight or flight hormone. This is the idea that if an individual ran into a tiger in the woods, they would choose either to fight it or to run away. Do you know what we call oxytocin? Many call it “collect and protect” or “tend and befriend.” If a tiger is coming into our village, we gather everyone together, because we are safest together.” [I add these labels to my drawing.] (I sometimes throw in the tidbit here that men who are not dads are more likely to release adrenaline during stressful situations; women and dads are more likely to release oxytocin – it’s the “gather the babies and protect them” response.)
“So, what effect do these hormones have?”
“With adrenaline, all your muscles tighten. All your energy goes to your limbs in case you need to fight or run away. So, oxytocin production drops and labor slows down. (It’s hard for your cervix to open when you feel scared…) You are also more sensitive to pain – this is useful if you’re at risk of injury – your body tells you what to move away from. But, in labor it’s not helpful – it just means labor hurts more!”
“With oxytocin and endorphins all your muscles relax. Energy is sent to the uterus and oxytocin increases. (Oxytocin is often called the love hormone, because it increases when we feel loved, and its peak levels are when we orgasm, when we birth, and when we breastfeed. It’s all about making babies, birthing babies, and feeding babies.) We also get an increased endorphin flow, which makes us less sensitive to pain, can cause euphoria, and can cause feelings of love and dependency in us… “I love you man….””
[As you talk, write the notes, and draw on the figures like this to show effects…]
[If you teach the 3R’s method for coping with labor pain – relaxation, rhythm, and ritual, you can also add in here: If you’ve got oxytocin and endorphins flowing, you may also have more rhythm – you may rock, moan or sway rhythmically. If your partner helps to reinforce your ritual, it will help build your oxytocin and endorphins.]
“So, what causes adrenaline rushes? Fear, anxiety, feeling watched or judged, feeling like you have no control over your situation, being hungry or cold.”
“How can we tell a person in labor is rushing adrenaline? They act vigilant or panicky, have lots of muscle tension, and a high pitched voice.”
“What causes oxytocin and endorphins to flow? Feeling safe, loved, protected, having privacy, having support, eye contact, skin-to-skin contact, and love making.”
“How can we tell if someone is in an endorphin / oxytocin high? They seem open and trusting, their muscles are relaxed, and their voices are low-pitched and husky.”
[Add notes about causes and signs to your picture.]
“So, partners, what’s the big picture summary?”
“If you remember nothing else from this class, remember this: If a person in labor feels safe, loved, and supported, her labor will be faster and less painful. If in doubt about what to do, always return to this! Anything that helps her relax, gain her rhythm and feel cared for will help her.”
* If you want a great overview of hormones in labor, read Pathways to Birth. If you want all the details on hormones in labor, read Hormonal Physiology of Childbearing. You can find them both at: http://transform.childbirthconnection.org/reports/physiology/.
Find more thoughts about teaching on my blog for childbirth educators. Check out ideas for interactive activities for childbirth classes. To learn more about any topic related to the perinatal period, check out our book Pregnancy, Childbirth, and the Newborn: The Complete Guide
In classes, we talk about the Pain Medication Preference Scale from Pregnancy, Childbirth, and the Newborn. We have the expectant parents look at it together, and then encourage the pregnant parent to choose the number that best represents their preferences, and the support partner to choose what they WISH the pregnant parent would choose.
Then we have them discuss. Often they align, but not always. Sometimes there is a pregnant parent who is hoping for an un-medicated labor who has a partner who can’t bear the idea of seeing them in pain. Sometimes a pregnant parent wants medication, but the partner has concerns about side effects on them or the baby. I would much rather this issue come up during pregnancy when they can resolve it rather than arising without warning in labor.
I have designed a new worksheet that asks more questions about labor coping preferences that they can fill out separately, then discuss, to further illuminate these issues and enhance the discussion they can have about goals and preferences before labor begins. You can see the Pain Preferences Worksheet here – feel free to print and use in class.
When making choices about medical care, are you a maximalist or a minimalist? A maximalist may use lots of tools to prevent and treat problems. A minimalist may try to use as few tools as possible, letting things run their natural course. What kinds of medical tools do you use? Natural remedies and self-help techniques or medicine and technology? A maximalist naturalist might prepare for birth by attending prenatal yoga, drinking raspberry leaf tea, and frequent love-making to get her oxytocin flowing. A minimalist technologist might choose a hospital birth with an OB, but ask for as few interventions as possible.
Helping your students or clients understand their medical mindset may help them in choosing care providers and birth places, and may also help them explain their decision making in labor to their partners and care givers. There are a few tools you can use to learn more and help your clients to understand this idea.
Jerome Groopman has written a book on Your Medical Mind: How to Decide What is Right for You. (He also wrote How Doctors Think and some other great books.) You can read an article which summarizes it here: http://news.harvard.edu/gazette/story/2012/02/%E2%80%98your-medical-mind%E2%80%99-explored/ or watch a video here that presents the idea to medical professionals: http://practicalbioethics.tv/2012/06/11/jerome-groopman-pamela-hartzband/when-experts-disagree.html
Kim James and Laurie Levy discuss this in their childbirth classes and with doula clients. They designed a worksheet you can find here: http://kimjames.net/Data/Sites/3/groopmanspectrumsforlamaze2012landscape9.24.12.pdf
I liked their idea, but found the worksheet complicated and a little dense on information for my client population, so I made a simplified version of the worksheet. Click here for the PDF. If I were using this in a class, I might give one copy to the pregnant parent, and one to the support person to fill out separately, then compare and discuss.
[Added on 7/28/15: a 2-page version of the handout that looks at more factors that affect decision-making. Find it here.]
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.
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!