PREPARATIONFOR The Complete Guide to the Lamaze Method
BeverlySavageandDianaSimkin Photographs by Mary Motley Kalergis
Illustrationsby DanaBurnsand LauraHartman Ballantine BooksNew York
To Herb,whodidsomuchformeandforeveryone.
Tomyhusband,David,withlove. D.S. Copynghl@)
1987brBeverl}'SavageandDiana Simkin
PhOlograpflscop)'right@1986b)'MaryMotleyKalergis B.S.
IIIu5{fauoruonpages70,71,113-23, 147.149.1 S9,181.219.297,and353-63
cop)'righl@1987byLauraMaestro
llIustratioruonpages74.77,78,80,81,84.85,153.156,230.261,272,277,
and29Scopyright@1987byDanaBurns
AllrighureservedunderInternationalandPan.AmericanCopyrightConventions.
PublishedIntheUniledStatesb)'BallantineBooks,a divisionof
RandomHouse, Inc.,NewYork,andsimultaneouslyinCanadabyRandomHouse of
Canada Lmlted. Toronto. Libra!")'of
CongressCatalogCardNumber85.90884 ISBNOH).)1210.9
(...overde,.ignbyRichardAquanandGc."OrgiaMorrissey Bookd e ~ l g
nbyBethTondreau ManufacturedInIheU nilcdStaIC$Q( Ametlca
FlnlEdmonFebruar)'1987 109 ACKNOWLEDGMENTS INTRODUCTION
HOWTOUSETHIS BOOK CHAPTERI: TheLamazeMetbod BeforeLamaze
HowLamazeBegan UsingLamazeforNatural Childbirth TheLamazeTeacher
TheLamazeClass TheFutureof Lamaze C HAPTER2: ChoosingYourDoctoror
Midwife ACriticalChoice SelectingaDoctor ChangingDoctors Midwives
(IIAPTER3 HOII/e,Hospital.orBirt/) Center TheImportanceof Your
Choi(e Vl/l XIV 3 4 8 10 14 20 20 23 23 28 39 .1;
,thereismuchtoenjoy Women inlabor arc encouraged to walk around, to
eat and drink lightly, andto relaxIna warmshower. Sibhngs arc
permuted to be present, and whole families are often
assembledafterthebinh forareal celebration.
Somewomendisliketheearlydischarge.Hospaalscanbeimpersonal
institutions,buttheydoprovideserviceandanopportunityforrest,
whichcan'talwaysbefoundathome. Wethinkbirthcenters aregreat
andhavesummarizedwhytheyare the perfect solution to the
home*versus-hospltal dilemma-provided you
areeligibleandhaveaccesstoone.Abirthcenter Has an establishedbackup
arrangememwitha hospitalThe facility is experienced intransferring
women with complications, You don,
havetoworryaboutcallinganambulance orrelyingonyourown car.
Frequentlyprovidesprenatal care, sothatwhenlabor beginS,there
iscomfortinthefamiliarit}'of thesurroundingsandpersonnel.
HasemergencyequipmemifyouneedIt. CostSroughlyhalf
asmuchasahospitalbirth,andmanyInsur-ance
programsarenowreimbursingforbtrth-centerdelivenes. Encourages
personalization of carcandchoice of procedure.There
arenosetroutines.
Encouragestheparticipationofwhomever}'ouwantatyourside. You are not
limited 10 a Single support person, so If youwant friends
orrelatives10joinyOll.,hat'sfine Gives youan excellent chance of
hn\'lngnatural childbirth.You can berelaxedbecauseyouknow)'ou'
re10atiafeen\'lronmentwhere
youreunlikel},toencoumerunneedt'dimerventlon. Many people believe
blfth centers arc the wave of theand even
doctorsarcbUllingthemTheNationalAssouatlonofChtldbcanng Centers
(:1trade organizat ion) is wrrcntiy considering a proposal to offer
some centcrs for franchise ownership. In [CnthomJnd babies were
/JOlllt',lIo.lpit,tI.orBirth(olter ,9 60 bh butthere 3re now enough
centers to accommodate born 10In .. asmaoy twent)'thousandbirths
annually.Byproviding an alternative
tohospitalsbirthceorersareIndirectlypressunngthemtobemore
accommodatingtothepeopletheyserve. You$hould scrutinize a birth
center asclosely asyouwould a hospital. Makesurethat ItIS
Slaffedwithexpenencedandaccrediteddoctorsand I ormid-wives.
Thereisa hospitalbackupandpropertransportationtogetthere,
shouldtransferbenecessary. tThefacilitiesarecleanandwellmaintained.
tThere isprofessional prenatal care, andreferrals to appropriate
spe-cialimwhenlOdicated. ThereLS
basicemergencyequipmentavailable,suchasbloodex-panders.resuscitationeqUIpment,andaninfantwarmer.
HOSPITALBIRTH HospitalProcedures
andhinhcentershaverecentlyreceivedmuch media aneonan, the
factremains that most births roda0.h0 l'Yccur In aOSP1-taMany women
areotcomfortable with the idea of homebirch, and for onereasonor
another do nOtwe abirthcenterOftenI (ectalddh.womenseeera n
,antenwithoutquestionfollowhimtothehospitalIf you arehlgh-nskor
have anemergencycor.. hospitalIS the only place tobeThI
duringlabor,the treatiJUwomenasifthey emIS thatmany hospitals
Hospitalstendtoviewawoman'Ibo. happen.andtheiractionsare
beasacclde.ntwaitingto lhlOklOg.Conunuous fetalrno",'.,Y
thewhatIf"schoolof m onng IS Justified j. develops.Anintravenous IS
calldr..ust In case fetal distress helorJUStIn case.. emorrhagc
occurs.Food and r"d"surgery IS reqUIredor .Iquis arc Withheld
Ct."'"Sart'anISneeded.A pubicsh,_In case an emergency PI"aveIS
performedtf0\.omycop eJustifiablyexJ>tctho.I0aCIItateanepisiot-d
splta 5to becod anp. rep.aredforInterventionbh'ncernefortheir
safety ,Utospnaistd venuonIS reqUIredby311.
entoassumethat\fller-Manycouples don't realiz.ethhh d attc Savelh
fOr,antheImcavenousarcrcall_II_ Ieenema,thefetalmoni-y aOptionald
__proccures,orderedby Preparation jorBirt" .-.\ -1 H OSPI1ALBIR "
"Our insurance covered onlya hospitaldelivery.Iwouldhavepreferred a
more gendeatmosphere." "I
thoughtitwasthesafest,bUlitprovedtobemostImpersonalandlonely,"
"Have you ever been in a happier pan of the hospital?Have you heard
the wheels
onthecarriersbringingallthebabies?!l'stheneatestsound-here comethe
babies.It wasspecial,awonderfultime." "I knew myhusband and I could
stillmalOtalOour support andrelationship, with thebackupof
professionalsif somethingwereneeded. ,. "I amalabor-roomnurse
andhaveseenhowwomen,includtngmyself.canbe
manipulatedandimimidatcdinahospital.Themedicalcommunityhasaway of
doingthingsandturningyourwishesaroundtosuittheirneedsandprac-tices.
"I was allset to butt heads the doctor andhospitalstaff about how I
wanted the birth [0 go, but I waspleasantly surprised to findthe}'
allwantedto cooperate withme." "It
wasmostimponanttometohavegreatauendingobstetricians;thesen:ing
wassecondaq' ... Home,HosP"I,JI,orBirthCeuter 61 62 DlkYI! ..
Allwentaccordingtomywishes.ThebabyhadaLeboyerbathandwasnot
separatedfromme.Myfour-year..oldandmymother were allowedinrighe
after thebabyborn." "1chose a large teaching hospitalwitha neonatal
intensive care unit, where there were expertenced personnel and
adequate staffing for both myself andthe child." "The
nursesareterrificandveryhelpful.1 lovedthehositId
rheytreatedthebab)'."pastayantheway "The atmosphere wasterrible,
andtheintrusion. lackof privacyThedOClObddswere
upsetting.Ifeltanawful rageremeandeveafb ever presentto
correctmeTh'nterInhthenurseswere .eworstpan wash'fi territory.1
seemedtohavenoh"toght foreveryinchof
affectedonlyme."automy10maklOgdecisionsthatultimately
theirparticulardOCtorTh h.'.ere arever. t: are
hospitalpolicies-standingordeonoftndlvidualdOCtorsdSteverythmgelseis
harsconcerningthecareh,aneachdoclOrleaves
ppens,however,isthatewamsforhi. Obviouslytheho.I
eachhospitalstandd5patients.What ,spltaWill,ar s of.
practices.similarlyandhrunmOStsmoothlfpractice evolve. testaff d'Y
Ieachb.. canbeume-consuminFDesnt havetomk0stetflCtan g.OrexIaeexce.
upafetalmonitorandampe,u'salotePUons,which d runItc'aSlerfor
ctachitseveraltimeshOnllOuously!ha'anUrselOset SOlatanltlSt
taredperiodically.womancanwalkaattachitand aboutandb.
emoO!-PreptlrllllOtljor Birtb It
ISpossibletoreceivemd'dId_IVIuaIzecareatahospital.ifyoumake
arrangcmcms 10advanceYIk. .'_.oumust tato your onetor during
anoffice VISitanddiSCUSSwithhimwh.at youWant(see chapter 8(or
adiSCUSSion of theprosandcons of
thebh.enema,puIesave,mtravenous,andfetal mOOitorlng). If he
agrees,hethenyour advocate for changing
standardandmustleaveordersconcerningyourparticular treatmentwiththe
staff.It's really quite simple.If abreakdownincom-munication
occurs, andanurse attempts to give you, say,apubic shave, yousay.
"No, I'm Dr. Smith's patient and he left orders tbat I'mnot to be
shaved."If the nurse ispersistent, youmust sayno againand askher
torechecktheorders or callthedoctor. We know we sound like
firebrands, but the idea isthat you do nm have
toallowunnecessaryprocedures.ObstetricdepartmentShavechanged
dramatically inthe last twenty years because people got angry and
asked for what they wanted. Women demanded that their husbands be
allowed tostaywiththemduringlaboranddeliveryandthattheirbabiesbe
treatedgentlyafterbirth.Therecentadditionofbirthingroomsto
obstetric wards has had a profound influence on practice, bringing
about greaterflexibilityindeliveryandmoretimeforfamiliestoenjoyone
another after birth. Many labor nurses are no""'trained in Lamaze
breath-ingtechniques andprovide compassionate support to laboring
couples.
Thesedays,hospitalshavebecomemoreflexible,butyoustillhaveto
knowwhatyouwantandyoumustaskforit. T h eHosp italTour Part of your
preparation forbirth should be a tOur of the hospital. Tours
tendtobe regularlyscheduledacouple of times eachmonth.If you're
studyingLamazeatthehospital,thetourwillprobablybepartofthe
series.If your doctOr delivers atmore than one hospital,youmaywant
to scrutinizeeachonebefore you choose.SometOursare excellent and
covereverypossiblepoint;othersarenot,andyoumustaskmany questions.
To help youmake an evaluation, we'veput together alist of
thingstolookforandaskabout:
1.Arethelaborroomsprivateorsemiprivate?Areanyofthem
equippedwithbirthingbeds?_ . .., . 2.Arewomen encouragedtobe
mobiledunng labor.It so,where cantheywalk?
3.Co1nIhavemorethanoncsupportperson? Home,Hospital,orBi,.thCellttr
64 ,hsiolo"ISI3vJllablt'31alltimes?I( nm,how 4.Isthereananc.:St eCI
_) UlCkly(anonebe"ummont.'iJ q,J'e 'ospirol's fiscaldar beglll.
sothatIrna)' gauge the I)\\'uenl..1C\ III1\ .1f
mvarn\'slandposslbl)'savesome..'money? timel.dd'
.,h.parareentrances(orthe pl)S1uons dunng laborortosquator
standwhilepushlng.tnmanywaysw(lrklOgISsimilartolab,,,;It'shardwork,ttrequ"es
c,)ncentraUOn, tthelp>,tyou ,, '\ , 112
breathe(Un.'cdy,andit'snotJlwaysenjoyable.Butlikelabor,itfeels
wonderful\\:hcnyou'redone.
\);'ehopeyou'\'ebeenexercisangthroughoutpregnancyIf I b .adI'you
haven't andarefeelingweI,)'oucaneglntay.(Snot too lated , an
thefolk,wlog(CUuneisa gentle one, gearedtothelastmomh of p reg_
nancyJust tobesafe, check with your dOCIO!or midwife before
starting theexercises.Askyour husband{Ojoin you andyou canmake It
pan of yourregularLamazepractice.Youcanstartwiththeexercisesrev'
,lew thebreathingtechniques,thenwinddownwiththerelaxation exercise
atthe end of this chapter.It shouldtake about an hour, andyou
willreel verygoodwhenyou'refinished. ________-TheExercise SITTING
SIDFSTRETCH This feelsgreatII ..ta sotonesand
Improveposturebystrength.'itrc(chcsthewaistand'bd
enmgthebackmuse!hns,anhelp,to estatsupportthespme. ToStart:
Sittallwithyo-urspmelongandstraight yourshouldersrelaxedandoped'
hdn,anyour eacenteredontopof yourspine. Exhale:
Stretchyourrightarmoveryourheadand
bendtotheleft.Relaxyourheadtotheside
andletyourleftelbowdroptowardthe
floor.Feelthestretchalongyourentire rightside. Inhale:
Trytomaintainthelengthalongyourright
sideasyouunroll(0thecenterposition. TOI(l/.
Sixtimestoeachside,alternatingsideseachtime. III H)OTUORK the
In)"\..lurlegsImpron"srhe(in.:ularil1n.This ('xc-fcisewillbe espe
(I3liyhelptulII rou areprone0legcrampsor If\Y;lterrerentlonIS
aproblem ToSt4rt: $11 rallwithr0urlegsstr:lIghtoutin(rontof
\'Oll,hipwidthapan. 11-1 Prepph,)ne "lis about)'ourh"Y'. C h_rU
bumpinto someonewasays,auresull rou leaverour a '". here.done about
thissituation andconsequentl)1not It ...very easyto get un .II .,
(heunexpec(edfreedom.Womenwhoareat sleepverrweor enJO}... .,Ia '
eareboundtobeupsetbecausethiSwaiting homeonmate rOlf)e'..
od.n(othe(ime(he),WIllhavela(er onw((h(hebaby.It perlIS cutting1
hduse \'our da\'s construcrivelybecausethelongeryougopast isarto."
ddthe more frequently youwillbe havmg exammanons and yourueate,
nons tresstests.It seemsthatallyoudoisanswerthephone andgo for
checkups. Yourna)'notbe feeling(00 wellphysicallyei(her,because
you're so ke),edup about experiencing the firs materna
I[hplacentaprevia,tepIIma)become bythe
also(hepossibilitythattheplacentllC.ln,uppl)orthatthe
offtht..ox}'gen baby'spresentingpart,[hm(u[ttnshebIrth(allal I bb
'dcsL'entInWt pwillprevcmthea)':> -----286 PLACENTAABRUPTIO f
teeinehemorrhagecausedbythe complete or panial ThisIS arype0u..
fthe Placenta fromthe uterine wall . IeIS,more rare and more
separation 0.. hplacenta previabecauseIt canpose anImmediatethreat
to 'l.cri(luStan the bab)"', oxygen supply, Its seventy depends on
the degree of placental t onbecauseQX)'genandcarbon dioxide canbe
adequately trans ,,,-{erredacroSSa
semidetachedplacenta.Oftenchisconditionbeginsbe-fore {he onset of
labor, but itisnot apparent untillabor begins. Be aware of
anysuddenonset of conrinuousandlocalizedpain. POSTMATURITY This
occursin4 percent of allpregnancies. The conditionisalsoknown
asplacentaldeficiencysyndromebecauseof theplacema'sinabilityto
(unCtionefficiently.Postmarurebabiesactuallyloseweightandthey
suffer from a diminished supply of oxygen, If you go past your due
date, rOUfdoctor or midwifewillprobablyperformanons tressandperhaps
a stress test to assess (he condition of the fetal-placentalunit.
(See chapter 7formoreontheseprocedures.)If
itseemsthattheplacentaisaging
andthereforenotprovidingproperfoodandoxygen,laborwillbe induced.If
inductiondoesnOtstimulate effectivelabor,acesareanwill bedone,
CORDPROLAPSE
Womencarryingbabiesinthefootlingorincompletebreechposilion
havethegreatestriskofcordprolapse.Itcanalsooccurwhenthe membranes
have ruprured and the baby isnOt well engaged in the pelvis;
thecordslipsdownintheuterusandbecomesprolapsedorwedged
betweenthebabyand[he cervicalopening.Witheach contraction, the
cordIS squeezedandthebaby'soxygensupplyisinterruptedtosome
extent.SometimesthecordwillactuallyslipOutof the cervixintothe
vagIna. Cord prolapse is an extremely dangerous condition,
requiring an emergencycesarean. MULTIPLEBIRTHS In 40to50percent of
alltwinbirths,one of thebabiespresentsinthe breech position.Babies
borninmultiplesare likelyto assume oddposj tIonsIfthefirSttw''bhd"
InIS reecanthiSISyour first pregnancy, a cesarean
maybenecessary,Butif thefirstbabyisvertex(headdown)vaginal
deltvebl' ryIS POSSIeif yourdoctorormidwifeiswilling.
PreparatifmforBirth MALPRE SENTATION
t\falprt'J0I1rt/lOflmeansanythingotherthh ._antto normal.
ThemostcommonvanationIS breech (hvertexposition. seecapter7 ,fII
lionof thevarretiesof breechandtheStddror audescrip+
anar5lornormaldr AnotheroddpositionistranJltrltIttinh- hhe Ivery).
f .wIC tebabyIS stretchd acroSStheuterusat aonyfive+toninety-dIe
h..egree ang etothemother's spmalcolumn.IntIS
Instance,cesareansection'd'd .IS aVise,because {he
shoulderusuallyentersthecerviX,blockingth' .epassagelor{herestof
thebody.Babiesalsodemonstrate a brOil'prtJtntalto'l.inwhichthe
headisnottuckedIntothechest,ora farepmmtalum,inwhichthe
headisextendedandthefaceisforcedtoenterthebinhcanalfirst. Someof
these. necessitatea cesarean,butfrequentlythey
areaccompamedbycomphcallons,suchasfailuretoprogressor fetal
distress. PREMATURERUPTUREOF THEMEMBRANES(PROM) Thisisacommon
complication of pregnancy andit does not necessarily
requireacesarean.Afterthemembranesrupture,thereisincreased chanceof
infection.Tominimizerisk,manydoctorspreferdeliveryto occur within
twentyfour hours. If your water breaks andlabor does om start on
its own, your doctor mayinsist on performing aninduction, and if
[hatfails,acesarean.We considerthistobe anaggressiveapproach
andwouldprefertoallowlaborto startnarurallywithscrupulouscare paid
to hygiene in order to prevent infection. (For a complete
discussion of PROM,seechapter 8,) TOXEMIAORPREECLAMPSIA ,I
'dangerousandsomewhat Toxemiaalsoknownaspreec ampsla,IS a .'_ .y
timeduringpregnanc)'.but mystenouscondmonthatcanoccur atan. ,' d
'It 'sheraldedbya (flO mostcommonlyappears10the{hlrtrimester.I.
'ntheunneandedema ofsymptOms'highbloodpressure,protemII
..Th.unknown. but many peep e (swelling from water retennon).e
cause IS beliedbl' ,' Id' acanoftencootro
believeitislinkedtodiet.lvl1[Qxeml..If Ifntreated h rIS
del1\'ery.e{U' medication andbed rest.Its cure,oweve,I- whichcan
._d"knownasec ampSl3. toxemiacanprogressIntOaconiliondhIf the
disease does not II .comaor eveneat. cause maternaconvu
Slons,'flibeinducedora respondtomoreconservativemeasures.labor"I
cesareanwillbeperformed. 2HH DIABETES'd' d .
1....,.mustbl'(JrefullynlnnltorCliunngpregnant)'10 t,
nothingelsematteredexcepttobeabletopushandgivebinh
Inthedeliveryroom,mySplfltSzoomedhigherInashnnlime,I
wouldhavemybab)'andbeable!Oholdherorhim).Aile,what seemed like
athousandpushes and a thousand breathing corrections, my babywasbo
rn.Diditever feelfantastic!She'sa girl.Shewasbornat
11:04A.M.andweighedeightpoundselevenouncesandwasrv,:emy twa inches
long. She was so beautiful to myhusband andme.Never had I
seensomuch emotion on myhusband's face.Tears of joywere
sueam-ingdownhisface,andhesaid,"Iwouldn'thavemissedthisforthe
world." S hewokeupabout1:30'"themorning3ndsaid,'Ithinksome thing's
coming.I'm gotngintothelivingroom,but v:hydoo'[you
stayasleep?"ThenIwokeupat5 A.M.andshewasstillourthere.
makingachart.Her contractionswere about sevenmioU[esapart.She
atealittletOastandsome orangejuice.butthatwasabou[all.
Herwaterbrokeinthecab.andwewerestuck00[heBrook!)'n Bridge.\Vhenwe
gottothehospital.[he),didJcheckandsaidromy
wife,"Youknow,)'ouarefullydilatedandyou',eready'" go."And I
hd..ood'I aJUS!finishedunpackingall10)'lude gles The nurse was
terrifi cJ' usther in Jvery nice way 't\'hen the ,_..hbe
dOClorcouldn't andIdldn'!knowwhatposi"on or brea!hmgmig! neddh1 55
fnuhlt'OIngIII ee.LamazemadeitmucheasierItmOlecoL.d,- .',- s
wereo't \'t'n' ';Irong, knowwhatweweredoing. 10say found pushtng
difficult.The contrJi.IIOn. .'-. ad- - hbabyw;lSOt(\.lmIO!'
ntheywerefourorfiveminutesapart.!Illte.- ...red'and did",nJ
