Preparation for Birth: The Complete Guide to the Lamaze Method
By Beverly Savage, Diana Simkin
One of the most profound changes that has taken place in the twentieth century concerns the manner in which women give birth. Today women are knowledgeable about the processes and procedures of childbirth. They prepare themselves mentally and physically ahead of time, and they expect to exercise a certain amount of control. Women once accepted all kinds of medication and intervention; they now assume that these measures will be taken only if medically necessary. Husbands, once banished to lonely waiting rooms, now play an active role in a joyful celebration of life.
The Lamaze method helps women in every stage of childbirth, from pregnancy to the postpartum period. You probably know that Lamaze involves certain kinds of breathing patterns, but there is more to Lamaze than learning how to pant-blow through a contraction. Lamaze's goal is to enable women to experience natural childbirth. To accomplish that, Lamaze teaches you what to expect from labor, how to cope with pain, what options are available if complications occur, and how to achieve your fantasy birth, whatever that may be. Lamaze expects you to play an active role in the management of your labor and delivery, to work hard, and to be assisted in giving birth, not delivered.
The Lamaze theory is founded on several principles. The first is that education dispels fear. The Lamaze technique educates couples about the realities of labor and delivery so that they will have an idea of what to expect. Couples are taught relaxation techniques, which are used to counteract muscular tension, the natural response to pain. In addition, the Lamaze method teaches a series of breathing exercises designed to distract a laboring woman's mind from pain. These breathing techniques work on a sensory principle called the gate theory. When attention is focused on one specific thing, such as breathing or a focal point, the transmission of pain signals is blocked. The theory is that the brain is capable of receiving only one kind of stimulation, and pain messages are stopped by the gate.
There are many pitfalls in the road to a good birth experience: long labors, intrusive hospital procedures, unsympathetic doctors, and a natural fear of giving birth. But in almost every case, the Lamaze method is helpful. The strength of the method is that it enables many women to have natural childbirth and helps those who can't to use minimal amounts of medication and accept minimal intervention.
Thirty years ago, obstetric wards were filled with women whose only positive expectation about birth was to emerge with a healthy baby. Labor was often painful and lonely and usually heavily medicated. Elective inductions were performed routinely, and many women knew in advance exactly the day their babies would be born. Childbirth itself was not particularly joyful, and it was merely a means to an end.
Consider this typical scenario: A woman in labor was dropped off at the hospital by her husband. After being admitted and sent to the labor floor, the mother-to-be was put into a hospital gown, given an enema, and subjected to a complete pubic shave. She might have been given a pill to hold under her tongue. This was Pitocin, known in this form as buccal-Pitocin, and it stimulated labor contractions. As labor intensified, she was given scopolamine, a drug nicknamed "twilight sleep" for its tendency to induce a hallucinogenic haze. She was confined to a bed, forced to use a bedpan, hooked up to an intravenous, and her hands were often restrained to prevent her from harming herself. When she was fully dilated, she was wheeled to the delivery room and tied down again. Her doctor performed an episiotomy and then delivered the baby by forceps. The baby was taken immediately to the hospital nursery without being seen or touched by his mother.
The next day this woman probably thanked the doctor profusely because scopolamine is an amnestic and she didn't remember anything. In the 1950s, most women expected to be unconscious during childbirth. The average hospital stay was about five days. Breastfeeding was discouraged, and babies spent most of their time in the hospital nursery.
How Lamaze Began
All of that began to change, however, one summer's day in 1951 when an unknown French doctor named Fernand Lamaze attended the International Congress of Obstetricians and Surgeons in Russia. Lamaze had heard about a new method of pain control used by laboring women called psychoprophylaxis, literally meaning "mind prevention." In Leningrad he was able to witness a full labor and delivery during which this technique was employed. His reaction was one of utter amazement. "I had, at the time, thirty years of experience as an obstetrician. I had never been taught anything like this. I had never seen it, nor had I ever thought it could be possible. My emotional reaction was therefore all the stronger. I made a clean sweep of all preconceived ideas and, now an elderly schoolboy of sixty, I immediately began studying this new science."
When he returned to Paris, Lamaze became a proselytizer for the psychoprophylactic method of childbirth. Interestingly, his middle-class patients were less than enthralled with his new approach and Lamaze's practice shrank. This turned out to be a blessing in disguise for it afforded him the time to refine the technique with the patients at a local metalworkers clinic where he was chief of obstetrics.
Today Lamaze's name is a household word. The psychoprophylactic method of pain control is taught in every hamlet of North America and Europe. Lamaze has become part of the rite of passage to parenthood along with decorating the nursery and choosing names.
The Lamaze theory is founded on several principles: The first is that education dispels fear. During the 1940's British obstetrician Grantly Dick-Read wrote about the fear-tension-pain syndrome in relation to childbirth. He surmised that fear caused tension which created unnecessary pain which caused more fear, then more tension and so on in a vicious cycle. The Lamaze technique prevents this syndrome by preparing couples for the realities of labor. In addition, Lamaze students are taught relaxation techniques which are used to counteract muscular tension, the natural response to pain. The Lamaze method also includes a series of breathing exercises designed to help women cope with the pain of labor.
Lamaze was popularized in the United States largely through the efforts of two women, Marjorie Karmel and Elisabeth Bing. We met with Mrs. Bing in her New York apartment and she shared with us her memories of the early days of the Lamaze movement as well as those of her deep friendship with Marjorie Karmel.
Both women had had their first children in 1955: Karmel had a beautiful birth experience in Paris, using the Lamaze method with her husband, a labor coach, and Dr. Lamaze in attendance; Bing, attended only by her doctor in a New York hospital, received a spinal anesthetic, which left her with an eleven-day headache.
For the next few years Bing continued to teach preparation for childbirth at Mount Sinai Hospital, using the Grantly Dick-Read method (the earliest method of childbirth preparation and a precursor to Lamaze and Bradley). Her own experience convinced her, however, that the method was flawed, and she was casting about for a more effective technique. Karmel had her second child in America, using the Lamaze method (an induced labor), and in 1958 Harper's Bazaar published'her article, "A New Method of Painless Childbirth."
Bing kept hearing of the Lamaze method but she couldn't find anything to read about it. At last in 1958 a Cleveland doctor, Isadore Bonstein, wrote the first book in English about the technique: Painless Childbirth Through Psychoprophylaxis". Just after getting the book, 1 had a private patient come to me to prepare for her second baby," Mrs. Bing recounted to us. "I told her I had just received it and couldn't teach her the method, but I told her to take the book and read it. She did and then had her baby. A few days later, she called and said, 'It works! It works! It works!'"
The following year, in 1959, Karmel's book. Thank You, Dr. Lamaze, was published. It was immediately recommended to Bing, who read it and was very impressed. "I wrote to the publisher for Marjorie's address and found she lived just across the park (Central Park in New York). Her oldest son was a few months older than mine," Bing said, "and we became great friends."
The two women immediately began to organize a campaign to promote the Lamaze method in the United States. They geared their approach to doctors because they felt that without medical support the technique would go nowhere. They began educating people about the Lamaze technique, using a French film, Nahsance, (birth), which had to be smuggled into the United States so that it wouldn't be confiscated as pornography. The film was shown and reshown at Marjorie Karmel's apartment. Hundreds of people saw it, some of them receptive, others hostile. Many people were impressed with the film simply because they weren't used to seeing women give birth without forceps.
From the people who saw the film, a small group emerged - ten doctors, plus Karmel, Bing, and Elly Rakowitz (a mother who successfully used Lamaze) - to form the American Society for Psychoprophylaxis in Obstetrics (ASPO). Dr. Benjamin Segal was its first president, and membership was initially limited to doctors, nurses, and physiotherapists, those people who could most easily put Lamaze into practice. Elisabeth Bing and Marjorie Karmel were not happy about this organizational arrangement, but felt it was necessary if Lamaze was to be widely accepted. A year later, in 1961, the organization was restructured into its current form of three separate-but-equal divisions: one for doctors, one for childbirth educators, and another for parents.
Using Lamaze for Natural Childbirth
We define natural childbirth as birth that takes place without the influence of drugs or anesthesia (except, of course, the local anesthetic for an episiotomy).
We believe that most women, given the proper emotional support, can use the Lamaze method to have natural childbirth. Often there is confusion about the difference between "natural" and "prepared" childbirth. Prepared childbirth is an ambiguous term because it can mean preparation for just about any type of birth experience, ranging from a scheduled cesarean to homebirth.
We advocate natural childbirth because it is the ideal way to have a baby. Ever since its inception, ASPO/Lamaze has considered one of its primary goals to be decreasing the need for medication during delivery. We're not implying, however, that if you take medication during labor, you can't have a wonderful birth experience. Drugs and anesthesia have their place, and medication is sometimes the best solution to a problem in labor. The Lamaze method teaches you to make an informed choice about your options. If medication is needed, you should not allow guilt and regret to overshadow the positive emotions of childbirth.
We believe that a woman's ability to have natural childbirth is influenced by her motivation. Some women come to Lamaze class and say their goal is to handle labor until they can receive pain medication, whereas others say they want to experience birth without any drugs or anesthesia. The beauty of the Lamaze technique is that whatever your goal, you can use and benefit from the training.
We were really impressed by the women who filled out our questionnaires. Most of them said they wanted unmedicated births, and many of them accomplished this goal. Those who did have drug-free births perceived their babies to be especially alert immediately after birth and attributed this to the absence of medication or anesthesia. They also expressed great pride in giving their babies the best possible start in life. But interestingly enough, these mothers also expressed genuine understanding and compassion for women who did receive drugs and anesthesia.
One of the biggest recent changes in the Lamaze technique is its overdue recognition that childbirth can be painful. The earlier attitude stemmed in part from Dr. Lamaze's name for his method: "accouchement sans dotdeur," which means literally, "childbirth without pain." Because labor is a natural body process, just like digestion or breathing, he couldn't believe that it had to be so intensely painful. Lamaze found that women approached birth frightened by old wives' tales and general misinformation, but that after proper training and education, many of them could use the breathing techniques to avoid pain. Childbirth without pain is possible in some cases, but not in most, and usually not for first-time mothers. Lamaze no longer claims to be a technique to achieve painless childbirth, but rather an effective method for coping with the pain.
Childbirth educators do women a disservice when they avoid the word pain and substitute discomfort. Granted, there is a fine line between educating people and frightening them, but we don't think anyone will be surprised to hear that labor is painful. Besides, pain really can't be measured; it boils down to a matter of perception. A demonstrated low or high threshold for pain has little to do with the way a woman handles labor; it's attitude and support that count.
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