ANSWERS TO TEST YOURSELF-CHAPTER 5 1. List three main focuses of your work to prepare a woman for labor and birthing. a. Improving flexibility, particularly in the legs and pelvic joints and muscles b. Teaching her or her partner to do perineal massage to increase flexibility in the pelvic floor c. Improving her body awareness, especially her awareness about when and where she is holding tension. d. Improving her communication; help her to use simple direct statements. e. Facilitating relaxation and breathing, through autonomic sedation, breathing reeducation, and massage techniques that free the torso, neck and pectoral girdle f. Providing emotional support using active listening skills, hearing her concerns, and supporting her labor choices. 2. List the three Rs of labor support according to Penny Simkin. relaxation rhythm ritual 3. Describe three to five functions of a massage therapist attending a client’s labor. a. Physical support to reduce musculoskeletal and other pain, facilitate positioning b. Relaxation support c. Communication support d. Emotional support e. Support of the birthing “team” f. Breathing support g. Energy conservation support h. Enhancing partners’ relationship by encouraging partner’s care 4. Describe the differences in uterus contraction patterns in early and active labor. Early labor contractions tend to be subtle and gently erratic, not with a particular rhythm to them. Most women can continue through their usual activities while experiencing them. These contractions progress to become more regularly rhythmic, longer and closer together. Active labor contractions are closer together, more intense and last longer. They tend to have a rhythmic pattern occurring every 3 to 5 minutes and lasting 60 seconds or so. These are contractions that require the woman’s full attention to manage their intensity well; she will stop any activity to focus on the contraction and her breathing and movement. 5. Describe the effects of stress on uterine contractions, particularly in the first stage. During early labor stress can interfere with the normal rhythmic flow of contractions. The introduction of excess epinephrine and norepinephrine interferes with synchronized uterine muscle contractions. It may cause the layers of horizontal, circular fibers to contract so that the anxious woman’s cervix tightens against vertical muscle contractions intended to open it at this stage. Contractions then become more painful but nonproductive and this may reduce blood flow to the uterus up to 65%. Her labor often stalls, she becomes exhausted and discouraged, and interventions may be necessary for her or her baby’s safety. 6. Describe three to five strategies and/or techniques that could reduce the severity of laboring women’s back pain. a. Firm, deep sacral pressure (sacral counterpressure) b. Hands and knees position for laboring woman c. Massaging with or placing heat or ice on the sacrum d. Use of tools such as a firm tennis ball or ice filled bottle rolling on the sacrum e. Deep tissue sculpting the erector spinae, gluteus medius and maximus f. S.I. joint releases g. Gluteal squeeze or pelvic press techniques h. Pressure to Bladder-67 point on little toes i. Labor TENS unit 7. Describe the goals of massage therapy in conjunction with epidural use. Should the client receive an epidural, the massage therapist will continue to provide emotional support and physical support. Continue with body awareness support and facilitating relaxation. Continue labor support using visualization methods. Assist with managing limbs of the mother during exams and pushing. Involve and support partner, continue to support self (make sure EVERYBODY gets some rest before the pushing!!). 8. Describe three possible aspects of the massage therapist’s role with a client having a cesarean birth. In the case of a cesarean birth, the role of supporter does not end. We still provide emotional support, encouragement, and relaxation through breath and autonomic sedation techniques. If present in the surgical suite, support can be holding a hand, eye contact, encouragement, and focus on her emotional state and helping her to stay connected with her experience. In the recovery or postpartum room, verbal and physical support can resume. We can assist in the physical recovery using reflexive techniques especially on her feet. Always check in and say goodbye before leaving, and maintain a caring, unconditional, non-judgmental and supportive state of mind.