3_Lamaze21stCentury

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Lamaze International is determined to get the

word out that todays Lamaze is not the Lamazeo 1960. Over orty years o research and learning

rom womens experience onormal, natural birth haveprovided evidence that hasgradually but dramatically

changed Lamaze rom beinga method or giving birth toa philosophy that providesthe oundation and direction

or women as they prepare to

give birth and become moth-ers. Breathing is no longer

the hallmark o Lamaze. TheLamaze Philosophy o Birthis at the heart o Lamazeeducation. Since 1995, this

philosophy has been thedriving orce or signicantchanges in Lamaze prepara-tion or childbirth. Todays

Lamaze arms the normalcyo birth, acknowledges wom-

ens inherent ability to birththeir babies, and explores allthe ways that women indstrength and comort duringlabor and birth.

Reframing Pain

Until recently, pain has been thought o as an un-

pleasant side eect o labor contractions. In Lamazeclasses o the past, women only learned about theactors that infuence pain perception and practiced

techniques, including relaxation and breathing, thathelped diminish the perception o pain. As our under-standing o normal labor and birth has evolved, we arebeginning to have a better appreciation or the impor-

tant role pain plays in the process o normal labor andbirth. The pain o labor, like most pain, is protective.Responding to pain with movement, including walk-ing, rocking, and position changes, not only helps the

baby rotate and descend through the pelvis, but alsoprotects a womans body during the process. As thecervix stretches and dilates, oxytocin levels increase, and

Lamaze InternationalPosition PaperLamaze For the 21st Century

contractions strengthen and become more eective. As

pain increases, endorphins are released that help womencope with the demands o the stronger contractions

and the descent o the baby.Actively responding to thepain o contractions notonly promotes comort,

but promotes the progresso labor. The Lamaze Cer-tied Childbirth Educatorencourages women to work

actively with labor, nding

comort in response to whatthey are eeling.

Because the pain olabor is not associated withtrauma, but is a part o a nor-mal, physiologic process, it

is sometimes compared tothe pain associated withother challenging physicalactivities. Those who push

themselves to climb the lasthill, cross the nish line,

or conquer a challengingdance routine oten reporteelings o euphoria andincreased sel-esteem. Re-searchers have ound that

women who experience natural birth oten describesimilar eelings o exaltation and increased sel-esteem.1These eelings o accomplishment, condence, andstrength have the potential to transorm womens lives.

In many cultures, the runner who completes the longrace is admired, but it is not acknowledged that thelaboring woman may experience the same lie-altering

eelings. Lamaze helps each woman nd ways to meetthe challenges o birth condently and purposeully,and to discover her strength in birth.

Rethinking Breathing and Relaxation

Relaxation and ocusing on controlled breathing

continue to be eective ways o decreasing pain percep-tion, and are airly simple comort techniques to learn.But birth is active work, and nding comort as laborprogresses, or most women, requires more than ocused

Birth is normal, natural, and healthy.

The experience o birth prooundly aectswomen and their amilies.

Womens inner wisdom guides them throughbirth.

Womens condence and ability to give birthis either enhanced or diminished by the care

provider and place o birth.

Women have a right to give birth ree romroutine medical intervention.

Birth can saely take place in homes, birthcenters, and hospitals.

Childbirth education empowers women tomake inormed choices in health care, toassume responsibility or their health, and totrust their inner wisdom.

Lamaze Philosophy of Birth


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attention and releasing tension. In todays Lamazeclasses, women learn to respond to their contractionsand nd comort in many ways including walking,

rocking, position changes, massage, heat/cold therapy,hydrotherapy, slow dancing, and use o birth balls.These active comort strategies are important becausein providing comort, they also promote the progress

o labor.

Breathing is no longer taught or practiced to get itright. Instead, women are taught that nding a breath-

ing pattern is just one o a number o strategies thatcan be used to stay ocused during contractions. Somewomen nd that patterned breathing is a ritual, likeprayer, rocking, or other behaviors done in a methodi-

cal way, that helps them move through contractions.Lamaze educators continue to teach body awarenessand tension release, but the goal is not to expect totalrelaxation during labor. Rather, women are encouraged

to be in the moment, not earul, but actively relaxed,

rhythmically working with labor.

Retiring the Coach

Lamaze classes emphasize the importance o con-tinuous emotional and physical support in labor, but the

coach who takes charge o the birth, calling the playsand instructing the mother, has been retired. Researchsuggests that when trained in class to take on the roleo coach, ew men actually do so.2 More importantly,

women know how to give birth; thereore encourage-ment and support, rather than coaching, is required.In Lamaze classes, athers, partners, and amily learnhow to provide quiet, gentle, encouraging support, and

learn basic comort measures that help most women inlabor. They learn that their calm, ocused presence is themost important thing women need rom them. Fam-

ily members are encouraged to experience the birth othe baby in their own way. The role o the proessionaldoula is discussed, and women who will give birth in ahospital environment that does not provide continu-

ous emotional and physical support are encouraged toconsider a proessional doula. In addition to supportin the hospital, women are encouraged to make plans

or support at home in early labor, and in the days andweeks at home with the new baby.

Reshaping the Birth Environment

The environment in which birth takes place aects

in proound ways how labor progresses, and how womenremember their birth. In the last orty years, we havelearned a great deal about both what helps and whatimpedes normal birth. All birth environments should

provide women what they need: condence, the reedomto nd comort in a variety o ways, and continuous

emotional and physical support. To be truly support-

ive, the physical environment should include a place towalk; urniture such as rocking chairs, beanbags, andbirth balls that promote upright positions; and accessto a warm pool o water.3 There should be one-to-one

continuous nursing support as advocated by the Associa-tion o Womens Health, Obstetric and Neonatal Nurses(AWHONN).4 Medical interventions, such as electronic

etal monitoring, intravenous fuids, and restrictions oneating, drinking, and movement which interere withwomens ability to actively work with their labors, shouldbe used only when medically indicated.

Research continues to document the lack o benetor harmul eect o many routine medical interventions.

Cesarean birth, with its increased risks or both mothersand babies, is at an all-time high in most hospitals. 5,6Epidural anesthesia and induction o labor are routinein many hospitals, in spite o the act that both alter the

process o labor and birth.5.7 Childbirth educators may

be rustrated in their eorts to help women developand maintain condence in their ability to give birth in

many current birth environments. In early pregnancyclasses, women are encouraged to choose birth settingsand health care providers that provide the opportunityto nd comort in a variety o ways, and provide or

continuous emotional and physical support. In Lamazeclasses women learn how to minimize the possible nega-tive eects o the birth environment and maximize theways in which they can insure a ull range o comort

and support options. In the 1960s, Lamaze educationset the stage or allowing athers in labor and delivery

rooms. Lamaze is now committed to creating birthenvironments that provide a ull range o options orbirth, including the reedom and support that womenneed to have a normal birth.

Care practices that promote normal birth

Based on recommendations o the World HealthOrganization, Lamaze International has identied six

care practices that promote normal birth:

Labor begins on its own Freedom of movement throughout labor

Continuous labor support No routine interventions Spontaneous pushing in upright or gravity-

neutral positions

No separation of mother and baby withunlimited opportunities or breasteeding

These six care practices provide the oundationor the knowledge and skills taught in todays La-maze classes and direction or women as they make

inormed decisions about their health care provider,place o birth, and the birth itsel.


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Respecting the Mother/Baby Connection

Lamaze now emphasizes the early newborn period,

viewing birth and the hours and days immediately aterbirth as important infuences on parenting.

The rst minutes and hours ater birth are criticalor mother and baby. Research supports the importance

o keeping mothers and babies together rom the mo-

ment o birth, and the importance o breasteeding ormother and baby.5 Women and babies who experiencenormal birth are primed and ready to greet each other

and breasteed eectively in the rst hours ater birth. InLamaze classes women are encouraged to keep theirbabies close rom the moment o birth; to breasteed

their babies, respond to inant cues, and understand theneeds and capabilities o the newborn.

Reclaiming Normal Birth

Ultimately, the goal o Lamaze classes is that everywoman gives birth condently, ree to nd comort in awide variety o ways, and supported by amily and health

care proessionals who trust that she has within her theability to give birth. By achieving our goal, Lamaze joinsworldwide advocacy eorts to promote, protect, andsupport normal birth. Lamaze International believes

that only when normal birth is again the standard willwomen have the opportunity o making truly inormedchoices about the birth o their babies.

Conclusion

Birth does not change, but over time the environ-ment in which birth takes place does change, and ourunderstanding o both the simplicity and the complex-ity o birth deepens. As a result, Lamaze preparation

or birth has evolved and will continue to evolve. TheLamaze Philosophy o Birth, supported by an ever-growing body o research,5 provides direction or todays

Lamaze preparation or birth. The Lamaze CertiedChildbirth Educator promotes, protects, and supportsevery womans right to give birth, condent in her ownability, ree to nd comort in a wide variety o ways,

and supported by her amily and all members o thehealth care team.

Recommended Resources

Many are available rom the Lamaze Bookstore,

website or phone (877) 952-6293.

Books:

Block, J. (2007). Pushed The painul truth aboutchildbirth and modern maternity care. Cambridge,MA: Da Capo Lie Long.

Lothian, J. & DeVries, C. (2005). The ofcial LamazeGuide Giving birth with confdence. New York, NY:Meadowbrook Press.

Nichols, F. & Humenick, S. (2000). Childbirtheducation: Practice, research, and theory (second edition).Philadelphia, PA: W.B. Saunders.

Simkin, P., & Ancheta, R. (2005). The labor progresshandbook. Malden, MA: Blackwell Science.

Walsh, D. (2007). Evidence-based care or normal

labour and birth. New York, NY: Routledge.

Six Care Practices that Promote Normal Birth:

Download papers rom the Lamaze website atwww.lamaze.org

Evidence-Based Maternity Care:

The Cochrane Library:

Videos:

Birth in the squatting position. (1979).

Celebrate birth!(2000). Boulder, CO: InJoy Videos.

Comort measures or childbirth. (1995). Seattle, WA:Comort Measures or Childbirth.

Gentle birth choices. (2005). Rochester, VT: HealingArts Press.

Giving birth and being born. (1995). Vienna: Austria:Karin Berghammer, Dr. Regine Ahner, and Pro.Dr. Husslein.

The timeless way. (1998) Boulder, CO: InJoy Videos.

Tried and true - A collection o labor techniques. (2000).Boulder, CO: InJoy Videos.

References

1. Tanzer, D. (1976). Why natural childbirth? A psycholo-gists report on the benefts to mothers, athers, and babies.New York, NY: Schocken Books.


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