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Why Positive Support Matters; My Lessons on Grouse Mountain

Posted by on Aug 5, 2013 in Blog | 0 comments

Why Positive Support Matters; My Lessons on Grouse Mountain

My 7 year old son and I climbed Grouse Mountain back in June with a friend and her son. Climbing Grouse, (a.k.a. “The Grind”), for those who are not native to this area, is an almost 3 km hike up the face of the mountain.  It is most definitely not a beginner trail.  I was introduced to it back in the day as “Satan’s stair climber”.  Although some Vancouverites do the Grind as part of their daily workout routine, that was not me.  I was in the class of needing to train and get into shape in order just to make it.  I hadn’t attempted the climb in about twenty years and felt as though I was doing it for the first time.  A large part of my emotional landscape as we started the trek was excitement, mixed with some anxiety about the “not knowing”: not knowing how long it would take, how steep the climb would be, how long until the highly anticipated 1/4 way marker.  For my son, having relatively no experience with meeting a challenge such as this before, his inner narrative mirrored my own, but to a much larger degree.  And naturally looking to me for guidance, each step for the first half hour of the climb was filled with the sound of his whining voice, “Are we there yet”,  ”This sucks”, “This is so hard”, and “When are we going to be done”?.  My lovely friend, trying to get into a good zone of coping with her son (4 years older than mine, and a little more resourceful),  made the wise decision to put some space between us.  Being around pessimism is a real downer, and quite honestly makes the journey hurt more.  This got me thinking during my journey, and in my reflections back upon the event of how important a positive outlook  and support is when facing challenges of any kind, but specifically for labour.

pain-and-fmri

The Brain responds in different areas in reaction to negative or positive suggestion of the efficacy of pain relief.

In fact a 2011 study from the ” University Medical Center Hamburg-Eppendorf in Germany” looks at the effects of positive thinking on the efficacy of pain medication with some fascinating results (1).  I think that although the perspective of the study is slightly different, the findings can easily be applied to a birthing mother’s experience of pain in labour .  One aspect of the study looks at the effect a negative attitude by doctors has upon their pain treatment recipients.   The findings suggest that the attitude of doctors and care providers play a critical role in shaping the recipients attitude about pain, and therefore their actual experience of it.   MRI brain scans showed brain stimulation in areas that mediate mood and anxiety differed in response to a negative expectancy versus a positive one.  ”  “We found that positive treatment expectancy substantially enhanced – doubled – the analgesic benefit of remifentanil,”says study author Ulrike Bingel of Oxford. “In contrast, negative treatment expectancy completely abolished remifentanil’s painkilling effect.”(2)

Perhaps then, we can imagine how negative commentary will effect a labouring mother’s chosen pain coping strategy. For example, a woman managing well with labour contractions using non-pharmaceutical methods,  may second guess herself and her abilities, if insensitive or unsupportive comments are made to her by nurses, doctors, or care team.   The study suggests that when the expectations are set up negtively, women may actually begin to experience more pain.  I have personally seen situations where mothers change the course of their management strategy once the anesthetist balks about the “ineffectiveness of nitrous oxide compared with epidural”.   Talk about a mysterious shift in perception that can happen.  This is one of the reasons why I feel a family needs to consider who is part of their labour support when planning for the event from the beginning.   Who will be your care providers, and what exactly are their beliefs about birth?  Where does their perspective relate to a family’s goals?  Are they going to contribute positively to the vision, or detract from the efficacy of the chosen management strategy?  Have conversations with care providers before labour about positively supporting a mother’s endeavors, and set boundaries on the type of talk about pain management when entering the birth room.  This is a great role for partners; the guardians of the birth space.

So back to our climb, about 1/3 of the way up I took the opportunity to sit down with my son and coach him a little as we fueled up with the homemade labour-aide and bliss balls.  I had been using the same mantra over and over again in response to his pessimism throughout the first part of the climb, “Let’s try and keep it positive”.   That hadn’t worked, and  I realized that I had to help him understand the framework, give him a positive language to use, and then we together had to implement a strategy.  I recalled the suggestion a midwife had made to a labouring mother in one of my early doula experiences.  Like my son, this mom was immersed in a negative narrative that highlighted the pain and suffering that she was experiencing.  The midwife made the simple suggestion to change the narrative to a positive one for one hour, and to notice any differences.  Well the differences were immediate and powerful.  As was the change for my son.  The next third of the climb was spent in relative silence as he (and therefore I), had finally found a stride.  My little one would occasionally call back to connect with my whereabouts, as he had opened up an approximate 5 minute lead from me.

The last third of the journey was definitely the most challenging for me.  My body was fatigued, and despite the ever present flow of endorphins, every step I took was a push; I longed for the summit, and simultaneously had no idea where it was. I started to doubt my ability to finish, but at the same time knew I didn’t really have a choice.  It was here that panic could have easily settled in. Thankfully there were a couple of  significant factors that rescued me.  This climb was a “Me to We” event raising money for water wells for kids in Africa.  Thank goodness for the team of volunteers that were assigned as cheerleaders.  When I hit that last quarter mark, I was welcomed by  a wall of lovely and energetic adolescents, heartily cheering me on.   The effects of that positive energy gave me a much needed boost.  I felt drawn out of my misery, and refocused my attentions in a positive way.  I felt determined to keep going.  It was here that I began to call upon another internal coping mechanism, that of the observer.  I began relating my experience to the challenge of labour, (the inspiration of this blog).  As I became wrapped in the activity of observing my process, and drawing comparisons, it drew me out of judging my immediate experience, and out of the negativity.   I chuckled to myself as I labelled this part of the climb “transition”, and noted that had someone offered me an epidural right then and there,  I may have surely taken it!   Then behind me approached a team of  fathers with their “tween” daughters, (around 11-12 in my approximation if you aren’t familiar with the age of the “tween”).  One of the dads was providing encouragement to the girls saying that “This may be intense right now, but connect with the strength in your body, and know that this experience is making you more wise and powerful tomorrow”.  I was so inspired, and touched by such a sentiment from father to daughter.  If only our cultural faith in the experience of birth could be such. I could only imagine being gifted that sort of encouragement from my father before heading into labour!  How meaningful that would have been.

Interestingly enough, the above mentioned 2011 study cites that cultural ideas and media also have a very real effect on one’s expectations of pain management or suffering.  It is then no wonder we live in a society wrought with fear about the pain of labour.  The images that paint our collective perceptions about birth from the media illustrate a grim/comical/highly medicalized event at best.  Pregnant couples are plagued with horror stories about birth.  It is rare to have stories of powerful women in labour passed down in communities.  Many generations now have been serviced by a system which views birthing women as passive recipients in need of rescue from the potential horrors of labour.  The blueprint memories of actively engaged and powerful women in labour have become endangered.  Women who feel the deep instinctual nudges of the potential beauty of the birth experience are chastised and labelled “martyrs”, or “weirdos” for wanting to even try and forego pain medication.  I am not trying to minimize the suffering that does truly exist for many birthing women, (nor those circumstances that truly benefit from medical intervention).   Perhaps that is where the conversation comes full circle.  Many women and families are set up to suffer through their experiences of childbirth.   As the study tells us, pessimism informs and shapes our experience right from the beginning, from the images we see, the stories we hear , and the ideas we adopt as truth.  Couple that with pregnancy and labour support from medical professionals who also carry a lack of faith in a labouring woman’s body, it would be miraculous that a birthing woman could feel in her power.  Bring on the pharmaceuticals!…and even then, as the study specifically points out, they will only be as effective as the labouring woman is led to believe they will be.  That is a lot to carry.  But the good news is that birthing families have choices, and having a support team that believes in the vision and goals of the birthing family is key.

Climbing "The Grind"

My son and I 1/4 of the way up.

Being so close to the top of the summit now, having it in sight, every step felt as though my legs were made of cement.  Each breath was laborous.  I stopped as I needed, which was frequent, to rest.  The last push on was motivated almost purely by the little voice calling down the mountain to me.  My son had reached the top, and was waiting for me to arrive.  ”Come on mom, you can do it”! he called down.  And I could not wait to join him there so we could celebrate together.

 

Websites for the above mentioned study;

(1) http://www.cnn.com/2011/HEALTH/02/16/pessimistic.pain.meds/index.html

(2)http://www.smartplanet.com/blog/rethinking-healthcare/brain-imaging-reveals-pessimism-as-self-fulfilling-prophecy/3238

 

Corina Bye is a birth doula, and childbirth educator/mentor.

You can visit the Birth Blueprint website for more information about her services, and how she can be a positive support to your birth experience.  www.birthblueprint.com

 

 

 

 

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