When to follow and when to lead.
A support person who is ready to follow your lead but who can be assertive and encouraging when the time is right is a great help. Most of the time, the support person’s job is to follow the mother’s lead – talking when she needs a soothing voice, massaging her back when she asks, wiping her forehead with a cool cloth, and responding to the changing moods and needs of labour.
For most women, however, there are intense times in labour when it’s difficult to know exactly what you want, or to remember any of the comfort measures you practised. This is the time when the support person can take the lead and make suggestions for comfort measures or position changes, remind her to keep breathing, and assure her she’s doing a great job.
Giving a massage
Your support person can help you relax by putting their hands on your body. The approach can be as simple as touching your tense muscles with warm, comforting hands and saying, “Relax into my hands.”
Your support person can also give you a massage. Massage is very helpful in distracting you from the pain of uterine contractions. Massage will help you release tension in parts of your body that do not need to be tense, and it is one way for a partner to feel included in the labour process. It is a good idea to practice the following techniques in advance.
Instructions for the labouring woman
Get into a position that will give your support person clear access to your shoulders, back, buttocks and thighs (e.g. standing and leaning forward, straddling a chair backwards, sitting on a ball leaning over the edge of the bed). You may want to use pillows for greater comfort. This will be a good opportunity for you to practice your body/breath connection while you relax and enjoy the massage. It is helpful to give your support person feedback about what you enjoy or would like changed.
Instructions for your support person
There are two things that are helpful to remember no matter what kind of a massage you are giving or what technique you are using: pressure and speed. It is important to do the massage as firmly or delicately as she would like. You could ask as you are doing it, “How is this pressure for you? Is this pressure okay?” Use the same approach for the speed of the strokes. Ask what she likes best. Try to keep the speed of the massage slow and rhythmic as this can help influence her breathing patterns.
With the labouring woman in her chosen position, step behind her and place your hands on the tops of her shoulders with thumbs ready to massage the small muscles at the base of her neck. Begin by using your thumbs in a rythmic motion and knead these two muscles. Remember pressure and speed and ask her how it feels.
Slide your hands to the outside of her shoulders and gently (if that is the pressure she desires) squeeze her shoulders when she inhales and release when she exhales. This can be hard to coordinate at first so be patient. Continue sliding your hands all the way down her arms to her wrists, gently squeezing to her inhale and releasing with her exhale, pausing a few times in each spot. It may take a minute or more to travel from the top of her shoulders to her wrists. In labour this massage might take the entire contraction to complete. Speed is not the point of the exercise. The point is to help distract her by the rhythmic movement of your touch on her skin.
Position yourself so that you can reach her hands. Apply even pressure to one of her hands with both of your hands, one on top of her hand and the other underneath her palm. This will stimulate the receptors in the palms of her hands that release endorphins, the ‘feel good’ hormones. Hold this pressure steady for about a minute, or the duration of the contraction. Repeat on the other hand. You could also use this technique on her feet .
Next take her one hand in yours and open her hand so that you can slowly ‘walk’ through her palm with your thumbs.
When finished with the palm of her hand, you can then ‘milk’ each finger. Do this by starting at the base of her finger (where it connects to her hand) and gently squeezing it all the way to the fingertip. Do each finger one at a time, as well as the thumb. When you are finished, put her hand back gently and move to the other hand.
Rest your hands on the top of her shoulders. Using the heels of your hands to apply pressure, move your hands down a path from the base of her neck and down along either side of her spine. When you get to her lower back, start again from the top, or proceed by bringing your hands around her buttocks to her hips and then along the tops of her legs ,ending at her knees. Repeat this stoke as many times as she finds helpful.
For her comfort, try to maintain contact on her body with at least one of your hands as you go back to repeat each stroke.
Counter Pressure is another comfort technique that uses touch. With her leaning forward use the heel of your hand to apply pressure to her sacrum (lower back) during a contraction. Another technique is to squeeze her hips together. Most women enjoy firm, steady counter pressure during contractions.