TENS machines are widely used across the pond to help women deal with labor pain. They are safe for most women* with no side effects when used properly. They don't eliminate the pain completely, but it helps a lot. What is it? Here's a description from BabyCenter's UK website: 

• TENS stands for transcutaneous electrical nerve stimulation. A maternity TENS machine consists of a hand-held controller connected by two sets of fine leads to four sticky pads. These are placed on your back. 
• The machine gives out little pulses of electrical energy that reach your skin via the leads and pads. The pulses may give you a tingling or buzzing sensation, depending on the setting. If you don't want to hold the controller, you can clip it to your clothing or attach a strap to hang it around your neck. 
• We don’t know exactly how TENS works to help you cope in labour. It may be that the electrical pulses prevent pain signals from reaching your brain. Or the pulses may stimulate your body to release natural, feel-good substances (endorphins).  http://www.babycentre.co.uk/a542581/tens
  
  

Why don't we use it here??? Well, you can! A quick search on the internet will show you a wide range of machines at affordable prices. I don't endorse any one model over any other. I would just suggest getting one with at least four reusable pads and adjustable strength controls. I have had clients use them and they really appreciated the pain relief. It didn't eliminate all the pain, but it did make it easier for them to cope with the intensity of contractions. To be safe, do read all safety precautions when you get your TENS machine. In my experience hospitals don't want you to use it while you are there, but you can use it at home and also on your way to the hospital. A huge help for those car rides. If you are having a homebirth and/or when we are home, you can use it as long as you like, as long as you are not in water!

I have completed training on the use of TENS in labor at Renew Physical Therapy with Elizabeth Isa Herrera MSPT, CSCS and Rachel Schneiderman, DPT, ATC. I can help you learn how to use your TENS and will make suggestions for placement on specific locations on your back. If you choose to incorporate a TENS machine into your birth tool kit, we can integrate it with your other coping techniques; such as directed breathing techniques, massage, positions, yoga, hypnobirthing, Bradley and more.  If you choose to get an epidural, it can help you delay getting an epidural too early. While you don't use a TENS at the same time as an epidural, it may help a mom who wants pain medication delay the introduction of an epidural into her labor. The longer we can stall getting an epidural, the less chances you will experience the possible side effects, and/or you can minimize the side effects. 

*Please check with your provider if you can use a TENS machine before using one.

This is my longest blog entry to date. This thought and the need to explain it kept me up till 4am writing it out. If shorter blog posts are more your speed, just scroll past this one as all the rest are quite short.

My greatest tool in my doula “tool box” is my ability to help you regulate your emotions. Regulation is our ability to maintain stress within a window of tolerance. Its often referred to as being calm, being connected, being present, essentially its when your body mind system is in a balanced state. When you are you are thinking clearly, you’re engaging, your interacting, because your stress is maintained within a window. We all have a window for how much stress we can handle. Once we eclipse that and our experience exceeds that window, we move into dysregulation. Commonly referred to as stressed out. When you are in a state of dysregulation, you feel irritable, withdrawn, depressed, defiant, aggressive, you can’t think clearly, your short term memory is repressed. Its the state of road rage, losing it, seeing red. We all vacillate between these two states all the time. With the right support and understanding, a person, and specifically a woman in labor, has the essential tools to regain a calm state of regulation. 

Labor can be an intensely stressful situation. Doula care is spefically intended to address the emotional needs of the laboring women to help her deal effectivly with the stress of labor. To work with her contractions, to work with however her birth unfolds, to help her have the birth experience she desires, and/or help her manage an unexpected labor that is far from what she had expected or hoped for, in a positive way.

Stress is normal to experience during your birth. But balancing that stress with calm is a vital balance to help you adjust to the huge transitions of labor and delivery. Not finding the balance can be pathologically harmful. The abstract below addresses the effects of stress on the body’s ability to function.

Chronic Stress, Immune Dysregulation, and Health


In the past 40 years, a growing body of literature has shown that chronic psychological stress can lead to immune dysregulation. Notably, these stress-induced immune changes are large enough to be clinically relevant. Chronic stress has been associated with a state of chronic low-grade inflammation, delayed wound healing, poor responses to vaccine, and increased susceptibility to infectious illnesses. Activation of neuroendocrine and sympathetic systems provides physiological pathways linking stress and these immune outcomes. Behavioral changes under conditions of chronic stress also contribute to immune dysregulation. Behavioral and pharmacological interventions may attenuate stress-induced immune dysregulation. 
(Jean-Philippe Gouin, MA, MPs, Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois  http://ajl.sagepub.com/content/5/6/476.abstract)

My role as your doula is to help you regain calm and return to regulation from state of dysregulation. 

To help someone find their calmness, you must first be calm within yourself. As a doula, a mother and a calm energy person, I stay in a deeply regulated state during your labor no matter how stressful the scene may be. I feel most calm when I am at births. Births regulate me (why? I don’t know, thats why its called a calling) and in turn, I get the privilege of helping to regulate you. In addition to bringing you my calm energy, there are additional tools to help you. These techniques interweave with hypobirthing and yoga birth and are essentially bringing about the same desired results. All of the effective childbirthing techniques are essentially just ways to practice the following principles. 


Regulating the environment. 

Dimming lights, hydrotherapy, selecting specific sounds, music, or just silence are some examples of how I help affect your environment to help support you. Also practicing and modeling a calm, slow speaking voice to partners and others present.


Directed breathing techniques are an extremely effective tool in helping laboring women regain regulation. When you create that dynamic of breath, you can bring regulation back to your system.


Touch is another amazing tool for regulation. 

Lymphatic massage is a very gentle type of massage therapy used to flow off redundant fluid from the body and build up the general performance of the lymphatic (immune) system. This type of massage is easy to learn and a great technique for partners to learn as well. It can be done on isolated body parts or on the entire body. This kind of massage helps to bring about the proper direction of the lymph flow.
(Lymphatic massage definition from: http://www.yogawiz.com/massage-therapy/lymphatic-massage-techniques.html#continued). Counter pressure is a more intense form of massage. Counter pressure is the firm application of hands and/or other hard objects such as tennis balls, massagers, etc to help alleviate the intense pains of contractions. This is most often done on the sacrum, hips and buttucks. 


Positions

Changing and suggestions positions can help a woman feel like she has choices. Some positions are for the comfort of the woman, some are for aiding progress, many of them overlap those two things. Choices in labor are a useful calming and empowering tool for her. Some positions can also bring the desired affect of centering, like child's pose. Childs pose helps a woman quiet down the outside and regain calm. It puts her in a power position with her body as well as being great for opening and widening the pelvic outlet. 


The next piece of helping a woman regain and keep regulation is hydration and nourishment. 

A women needs to be well hydrated yet not over hydrated. Dehydration will zap her energy and decrease the efficiency of her labor. Advanced dehydration is of course a very dangerous condition. Over hydration can have adverse affects as well. Beyond swelling, we don’t want to overly dilute her oxytocin either. For nourishment, I am carefully monitoring her emotions and labor progress, or lack thereof, for signs of deficiency in calories, protein, sugar, carbs and/or sodium. Preparing highly nutritious yet low volume foods that don’t require much chewing or effort to eat and beverages to the laboring woman whenever possible helps regulation and labor progress.


Speaking up in the labor room and advocacy

As your doula, I do not address your health care provider on your behalf. I cannot speak for you, nor do I desire too. My goal is for you to find your own voice. But why is it sometimes so hard for women (and many men) to find their voice? Why are doctors sometimes so intimidating? Beyond their medical expertise that may make some feel less confident to voice their opinion, there are stress hormones affecting our abilities to cope with and react to the environment as we would like to. When people don’t find their voice during their births, they can then have a sense of failure, regret and/or other negative emotions. This is not your fault or failure to be strong and assertive. It is our survival mechanism in the face of stress. The flight or flight response mechanism we all learned about, which yes inhibits oxytocin (hormone responsible for contractions) and can inhibit contractions, and then necessitate the need for augmentation, ie pitocin, is more complex than we used to understand. And stress has a different reaction in women than in men. Stress in women does necessarily not cause the “flight or fight” response we all learned about. More recent research has shown that when under stress, women “tend and befriend”. Tend and befriend is not standing up to authority. But she is protecting her young and herself. Women need to realize it is a normal response to stress and nothing to be ashamed of.

" Human Stress Responses

The human stress response coined, "fight or flight" by Walter Cannon in 1932 is a hormonal response characterized by the release of epinephrine and norepinephrine. This hormonal cascade is caused by the activation of the sympathetic autonomic nervous system in response to a potential threat or danger. These threats can range from a predator attack to natural disasters threatening the survival of the individual and species such as earthquakes, fire, or even flooding.

Up until 1995, research investigating the fight-or-flight response had been done primarily with males, females only constituting 17% of the participants. Researchers have rationalized this inequality because of an inconsistency in the results obtained from female subjects due to fluctuations in hormone levels during menstruation cycles. Taylor et al. (2000) suggest that the primarily male based research may have caused many to overlook a unique female stress response which they term "tend-and-befriend."

Taylor et al. (2000) argue that due to differences in parental investment, females may have evolved their own stress response in order to protect themselves while they were pregnant, nursing, or caring for offspring. The male fight-or-flight response would not have been advantageous to the survival of females and their offspring because often the female would either be unable to fight or flee during pregnancy, or unable to protect their young if they were nursing or taking care of their young. Evolutionarily the tend-and-befriend stress response in females would have been selected for and the fight-or-flight response would have been selected against in females.

Unlike the fight-or-flight response which allows one to fight against a threat if overcoming the threat is likely or flee if overcoming the threat is unlikely, the tend-and-befriend response is characterized by tending to young in times of stress and befriending those around in times of stress to increase the likelihood of survival. Since a group is more likely than an individual to overcome a threat, this response is a protective mechanism for both the female and her offspring. Basically, befriending other females is inherently necessary for the protection of offspring since pregnancy and nursing make a female even more vulnerable to an outside threat. Forming a network not only allows the female to have added protection and help with the raising of offspring, but also serves to secure resources such as housing and food. Although the threats mentioned are assumed to be external to the female home environment, this female network also serves to protect the females from the males even within the home environment. Studies even show that females who emigrate and are unable to form a female network, characteristic of female befriending, are more likely to become victims of abuse than women who are able to form these ties (Taylor et al., 2000). "

(Quote from: http://www.personalityresearch.org/papers/mccarthy.html)

When women are with women, they are better able to manage the vulnerable state brought upon through the care for their offspring during and before birth. When women are under attack with their babies, they will try to deal the aggressor with kindness. It goes with the saying, ‘you can get more bees with honey’. And when you are in vulnerable state, such as having contractions, and if you are in a hospital with an incompatible staff to your expectations, and you maybe didn't have any other support, it might just be the wise decision in that moment to be nice to your care providers. So women should never feel like they failed if the didn’t stand up to a hostile person. They were surviving and protecting their young in a way that felt the most effective and safe. As your doula, I am your “other females” that help calm your nervous system from the “threat”. And that “threat” may not necessarily be your doctor. It could just be your pain of labor. Maybe the threat is that you are confused by what is being said in the room and I can put it into simple terms so that you have a genuine understanding of the options and you can make confident informed decisions. By taking away the feeling of threat, your nervous system can calm down and you can release your fear. When you release your fear you are not afraid to express yourself, you are not triggered to go into tend and befriend. You can speak up confidently without fear of attack to you or your baby.


Expressing emotion

Emotional issues, past and present, can be an additional challenge in labor. When you have fears and anxiety and you can express it in a healthy safe way, you can begin to let it go and move on. Simply put, it feels good to talk to a trusted friend about it. When you don’t have someone to express your feelings to, or you do have an ear but they don’t listen, understand or respect what you are expressing, it can make the feelings worse. A doula uniquely understands the stresses and emotions of labor, so that when a woman needs space to express them, we are appropriately acknowledging those emotions and fears and complaints. As your doula I am listening to you. It can be your stress of labor you need space to let go of, or it can be something else. It can body issues relating to food, abuse, losses. It can be a stressful family history, fears about becoming a mother, finances, fears about what this baby will do to your body, your relationship with your partner, your parents, and yourself. If a woman doesn’t have her fears and anxiety and feelings being heard, then the experience becomes trauma. When a woman feels heard, understood and respected, the pain may not disappear, but the fear and despair can begin to dissipate and no longer govern the experience.


How the doctor/midwife work together with the doula

We need a medical provider to safeguard the health and safety of the mother and the baby. Their mindset needs to be focused on maintaining that clinical safety while simultaneously looking out for pathology and treating it if detected. Some medical personnel work from a place of stress and fear. When caregivers have stress and fear, they are unable to help the laboring woman return to a regulated state herself.  And sometimes that kind of stress and adrenaline is a useful emotion to make sure they can activate the needed parts of their brains to think clinically and quickly to keep the woman and baby safe. But that stress energy is only beneficial on that one level. On the one hand its helping them act quickly, but if it dysregulates the woman’s emotional state, it can worsen whatever the emergency is. Even if a woman needs an emergency c-section, she and her baby will have a better outcome if she remains calm. A doula is still helpful for the emotional and clinical outcomes in that scene because she can help the mother regain calm even if the rest of the room isn’t. Keeping her breathing and regulated is also keeping the baby regulated. Which is a much better state for them to enter surgery. And before any c-section is performed, the medical staff are first trying to avoid a c-section by various means depending on the situation. If the mother is regulated and therefore helping her baby to be regulated, there is a better chance that the medical interventions to avoid a c-section will be more effective and an c-section can hopefully be avoided altogether. Professionally trained doulas work very well with doctors and midwives complementing each other helping moms have better outcomes. Some women worry that their doula’s presence may make their doctor uncomfortable. That is only true if the doula doesn’t respect understood doula boundaries. The boundaries are not limiting to a doula, but actually help a doula. Defined along clinical lines, by excluding clinical tasks from the role of the doula, she can focus on the emotional and informational needs of the laboring woman. When done right, doctors and midwives love having doulas present. I enjoy working with obstetricians and midwives and have never had conflicts because I show them respect for their importance and role in the birth. I respect their medical expertise and responsibility and at the same time I am confident in my expertise in supporting the woman in the doula role. In addition, the doula and the obstetrician may sometimes have very little interaction at all because many are rarely present in the room until the end of the pushing stage.


With this understanding of doula care and its effects on the emotional state of the laboring woman we can see how essential it is for better birth outcomes. Research has proven the benefits of doula care on birth outcomes:


Numerous clinical studies have found that a doula’s presence at birth;

• tends to result in shorter labors with fewer complications
  
  
• reduces negative feelings about one’s childbirth experience
  
  
• reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans
  
  
• reduces the mother’s request for pain medication and/or epidurals
  
  

Research shows parents who receive support can:

• Feel more secure and cared for
  
  
• Are more successful in adapting to new family dynamics
  
  
• Have greater success with breastfeeding
  
  
• Have greater self-confidence
  
  
• Have less postpartum depression
  
  
• Have lower incidence of abuse
  
  
  

(list from http://www.dona.org/mothers/why_use_a_doula.php)

After births, women often tell me they were most appreciative of my calm presence during their births. It is this calmness that helps women regain control and awareness of self and body. It is this calmness, along with an in-depth understanding of birth and the needs of laboring women, that I bring to your birth. Your birth experience is something you will be replaying over in your head for the rest of your life. I am forever honored by every family who chooses to include me on their sacred passage into parenthood!