30 Years and Growing

When couples attend Pink Kit classes, they often ask, “Why should we be preparing for birth? We’ve made our birth plan and chosen our care provider.” What is important is that the women is driving the car, not just taking a journey by car, which can imply she is the passenger. What we’re trying to get people to understand is that developing birthing skills is a necessity just like learning to drive a car. These couples include people planning homebirths with independent midwives and people planning hospital births with continuity of care team midwives or a GP or obstetrical specialist. Common Knowledge Trust (CKT) has discovered that analogies may help answer this question.

The Journey
First, we tell them labour is like taking an unknown journey by car. Even if you’ve taken this road before, each journey is different and unknown. It can be very strenuous and demanding. It might be long. You might get tired. Someone or a few people might accompany you. Throughout this journey, others might try to help you out in order to safeguard you and make certain you reach the end safely. Some professionals might suggest that you skip the journey. Circumstances might actually require you to do that. Other professionals will encourage you to take the journey because it might become a highlight of your life.

Then we ask, what is the difference between that scenario and labour? After many responses, we tell them the real difference is that you have already learned to drive a car. If you had to take such a journey and didn’t know how to drive, would you be willing to spend eight to 12 weeks learning beforehand? Where is the birth professional in this analogy? Some are encouraging you to make the journey and others might think it’s too dangerous, or you might think you don’t need to do it, fly instead. The birth professional is usually the low or high tech mechanic.

Next, the couples talk about their relationships to the professional care provider. Their midwives are encouraging them to choose a birth plan. They have decided where to birth, and the doctors are often telling them what they need. So we present analogies to other common professional relationships. We are all passive when we go to the dentist, yet most of us take care of our teeth every day. If we took this approach to birth, we would prepare beforehand, but in the presence of the professional we would be passive. Not ideal.

Giving birth is more like learning to sing, dance, paint, throw pots or play an instrument. We probably seek a professional teacher. Yet we have to do the work to learn, as well as show the teacher our progress. If we took this approach to birth, then the birth professionals would be our musical instrument instructors, yet even midwives don’t often take that role. The Pink Kit is the driving lessons, so this analogy still doesn’t give us a clear understanding of what other similar professional relationship is like labour and being cared for.

By the time the class works through all the analogies, the couples begin to understand: only the woman is going to labour. The father, partner, friend or relative is there to help her on the journey, which will occur around and through whatever professional care they receive.

The Kit
Since The Pink Kit information developed in the U.S. in the late 1970s and 1980s, thousands of couples have used the preparation and then laboured in hospital. Having done the preparation ahead of time, the couples work together with directed breathing; they use positions that keep the woman open. There is been a great deal of ‘best positions’ that have been theoretical and not worked for women, because they didn’t know enough about their bony structure or how the muscles reacted to positions. They do hip lifts and sit-bone spreads and carry out sacral rocking so their sacrum is mobile. This developed instead of the counter pressure on the sacrum that closes the space the baby needs, although it relieves the back pain. Learning to keep the sacrum mobile, gives the baby room and the woman relieved regardless of assessments, monitoring or other procedures going on around them. They just go on working through the process of labour. Staff and doctors often comment on what a “good labour” they had. “Weren’t they lucky? One woman responded: “I wanted to grab that person by the neck and shout, ‘You don’t know how hard We worked for that good birth!’”

The Skills
When we ask couples what their mothers and fathers taught them about managing labour, most say: “Nothing,” “Not much,” or “It hurts, you’ll get through it.” If they haven’t been taught by their mothers and fathers how to manage labour, where are they getting the information, and how useful is it?

Whenever people need to accomplish a new task, it’s vitally important that they learn appropriate skills and then apply them. Because so few people have been at births, they have no idea what appropriate skills are. If a woman perceives her contractions as manageable, she will use her breath sustainably, create self-relaxation responses, get into” labour and accept the process. If she perceives them as painful or very, very painful, she will respond with ragged breathing, tensing her body and using other struggling behaviours. What CKT is teaching expectant couples (lessons they will eventually teach their own children) are the sustainable behaviours they can put into place regardless of the woman’s perception, particularly when she does feel her labour to be “painful

The fact is that these are the universal skills that any woman can use, not just another ‘theory’ or ‘technique’. People are continually saying that what they learned in ‘childbirth education’ classes went out the window, which means, to date, those skills aren’t universal enough or not useable. Why would a woman want to respond to labour with frantic behaviour? It’s the lack of appropriately learned skills.

As women learn these appropriate skills and apply them to the task, there is more consistency in how women respond to the process of labour and how their partners can help them stay on a sustainable behaviour track. Because labours are so similar, we can define, hear, see, experience, practice, model, remind, encourage, remember and know appropriate responses to the experience. A woman who is struggling with labour may hold her breath or scream, groan and moan, whereas a woman who is managing her responses to the sensations will tend to breathe in through her nose and out through either her nose or mouth in a manner that sounds “right.” Because most people have no idea what sounds right, we have to show them so they can develop the skills.

We ask fathers or the support people to look at the woman’s face and forehead when she is relaxed during labour . Usually when relaxed, a person’s forehead is smooth. When a woman wrinkles her forehead in labour, the father understands that her internal sensations are intense, and he can observe whether she is responding to them with tension. He can then help her reduce the tension using “common body language” or “common body touch.” If she is breathing more raggedly, he can model directed breathing to remind her to use breath as a focus.

If the partner sees the woman standing on her toes, with shoulders around her ears and bum muscles tight, a father working with The Pink Kit is less likely to tell her to relax, drop her shoulders or come off her toes. Using his skills and knowledge, he’ll just tell her to relax inside the pelvic clock and minnie mouse muscles (her bum muscles). She’ll know what he is talking about. She would have done that herself, except the sensations were a bit too much at the time. She still might not like the experience, but she’ll love how she managed herself. She’ll love her partner for knowing specifically what she needed to do rather than giving her a general direction that could elicit: “I’m trying to relax!” “Shut up!” or “You try!”

One woman said after her birth: “Before each contraction, I set up my directed breathing. The contractions were fine. So I thought to myself, ‘maybe the breathing has nothing to do with it,’ and I just let the next contraction happen. It was off the planet in intensity. What scared me was that it took me four to five more contractions to get it back.”

What the statistics (on our website) don’t show is how empowered both mothers and fathers feel; that the woman knew she could turn to her partner for the coaching skills; that their partnering and parenting relationships are enriched.

There is no doubt that if we had all been at 100 births, we would see and hear which mannerisms are sustainable and which indicate that a woman is struggling with her perception of the experience. But the skills haven’t been passed on generation to generation. Common Knowledge Trust wants that to change. All the couples who use these resources tell us the same thing—they will pass the knowledge on to their sons and daughters. Women will labour, whether at home, in hospital, with a midwife, with a doctor, whether having a natural or a medical birth. Skills work well in all situations.

Knowledge is power. It reduces fears, increases confidence, builds skills and encourages conscious response rather than impulsive reaction to an intense experience. It develops a strong and deeply personal sense of accomplishment for both women and men. Most important, we’ll pass it on to our children.