Chapter 12. Aftercare and self-care
Learning outcomes
• Describe some relevant breathing and relaxation exercises
• Describe simple appropriate exercises
• Identify bodywork skills which the mother and her partner may use
Introduction
Diet and nutrition form an important aspect of aftercare, but as the focus of this book is bodywork then there is no space to cover these here. We have chosen to focus primarily on tools which are in essence an extension of the bodywork which is done in the session, namely breathing, exercise (stretches) and simple bodywork techniques which can be easily taught to the mother and her partner. Often, though, in the safe space which is created, mothers may take the opportunity to explore their emotions and feelings. It is important to give them that space, while at the same time being aware that counselling is not part of the bodywork session. However, the client can be encouraged to talk, to identify additional sources of support they may need, to consider keeping a journal, or to write down their feelings about what is going on.
Of course, some clients may not be interested in these suggestions and the therapist has to be sensitive as to how to address these issues. Often presenting self-care in the form of a relaxation position (e.g. ‘relax over a ball’) rather than an exercise (‘let’s do some all fours exercises’) can be a useful way around this. Introducing simple exercises gradually and checking the client has understood them is also important.
The primary focus is to encourage women to listen to their body and their baby and to support the work of the bodywork session. If, at any point, the client is uncomfortable doing exercises then, depending on their level of expertise, the therapist needs to suggest alternatives or stop working with that exercise. However, do bear in mind that women’s energy levels vary daily at this time. On different days they may be comfortable with different things.
It may be helpful to encourage partners to be involved in aftercare work and so suggestions are given on how to include them.
12.1. Benefits of aftercare
Pregnancy
Pregnancy, possibly more than any other time in one’s life, is a time when changes are happening in the body on an almost daily basis. In order to support these changes, and to prevent them becoming ‘problems’ as much as possible, it is vital to guide clients to look after themselves properly during pregnancy. Especially in the third trimester, good self-care may help alleviate many of the minor discomforts as well as help prepare for birth.
Birth
Postnatal
Recovering after birth and becoming fit is vital in order to support the family and the mother for the rest of her life.
12.2. Breathing and visualisation
Breathing is probably the most fundamental, and in a way the simplest, self-care exercise. It underlies all the others. It is important to include breathing with massage and exercise.
Benefits
General
• Gives a quiet focused time.
• Aids relaxation – for stress reduction and calming.
• Can be used as a tool with visualisations.
• Provides good oxygen supply to the baby and mother.
• It is a way of spending quality time with the partner.
• Is a helpful focus when exercising.
Birth
• Prepares the mother and partner for labour.
• It can provide a focus for the mother.
• It can allow the throat to open which will support the opening of the cervix.
Postnatal
• In the early days the mother often does not feel like exercising much; breathing can be done which helps focus on drawing in the abdominal exercises and pelvic floor.
• Breathing can help relax tight areas of the body, for example shoulders.
• Breathing can aid relaxation and bonding with baby and incorporating the huge changes.
What kind of breathing is most helpful?
The approach we prefer to teach is simple, the emphasis being on deep abdominal and diaphragmatic breathing. In yoga there is more of an emphasis on abdominal breathing and in pilates on diaphragmatic breathing. Both are important. Breathing can be taught while teaching exercises or can be done while the mother is lying down to receive bodywork. It can be a good way to start or finish the bodywork session. Another time to work with the breathing is during a partner session. The mother and partner can be encouraged to become more aware of their own and each other’s breathing.
Encourage the mother to focus on her out-breath and to find her own deep breathing pattern with which she is comfortable. Emphasise a long, slow out-breath, pausing until she needs to breathe in again, and then a long slow in-breath. Ideally, as the mother breathes in, her abdominal muscles should contract. However, often people breathe the ‘wrong way’.
It is of benefit to continue this during labour and to continue into the postnatal period so that the mother is not having to learn new techniques but building on a fundamental skill.
Labour
Association techniques and simple techniques which help the mother connect with her own breathing are more helpful rather than the dissociation techniques which were more popular in the past.
It is important for the partner to practice as well as the mother and can be a useful tool to help the mother and the partner connect with each other.
Basic deep breathing for mothers and partners
Once the couple are in a comfortable position, with eyes closed or open, encourage them to first observe their breathing without altering it any way. Encourage them to notice the length of the in- and out-breaths and any pauses or holding between the breaths, how deep they are breathing, and if they breathe through the mouth or the nose.
Then encourage them to deepen each out-breath and find their own rhythm of breathing. It can be helpful to place the hands on the lower abdomen, below the navel, while doing this and feel the muscles gently drawing the hands in on the out-breath and pushing the hands gently away on the in-breath.
Visualisation
Various images can be added to the basic deep breathing. It is important to be sensitive to each client’s needs. Some mothers like the images to be quite firmly based in reality, such as images of the particular stage of development their baby is at in the womb. Other mothers may want to connect with how their baby might be feeling, with different types of energy or sensation, colour or light. Some suggestions are given below.
Pregnancy
Connecting with the baby
From the deep state of relaxation and focus on the out-breath, they can visualise their baby in their womb at its different developmental stages.
First trimester Some women may not want to connect with their baby, due to the high rate of miscarriage. Others love to tune into what is happening. These visualisations can also be useful when working with fertility clients.
They can visualise the egg travelling down the fallopian tube into the womb and finding a place to implant on the wall of the uterus and then starting to form into the baby’s body, the amniotic sac and the placenta.
Talk the woman through the main changes, such as the development of the primitive spine, digestive system, mouth, anus. Visualise the heart beating and all the other organs developing, limb buds growing into legs and arms. Imagine the baby moving, even though the movements cannot be felt, the baby swallowing amniotic fluid and at around week 8 becoming aware of touch.
Second trimester The woman is more aware of the movements of the baby. They might feel them as a tiny flutter, like a butterfly, or like a paint brush brushing gently against the inside of the womb.
They can be encouraged to be aware of the space around their baby, the baby hiccupping, contractions, the water surrounding the baby, the baby swallowing amniotic fluid, the baby growing and becoming more aware of the space around them.
They can be aware of how their baby gradually becomes aware of sounds outside the womb. Talking and singing can become more relevant now.
They can be aware of how the placenta is nourishing the baby.
Third trimester/pre-labour This can focus on visualising the baby being in a good position for labour or readying the baby for birth.
The client can be encouraged to be aware of the position of their baby. Do they know where their baby’s spine is? Can they sense his/her arms and legs?
If their baby is in a good position, head down and back around the front, they can visualise their baby’s head gradually going deeper down into the pelvis, as s/he engages in preparation for birth. They can become aware how their baby’s time in their womb is gradually coming to an end and allow themselves to feel comfortable with the thought of letting their baby be born and moving out into the world.
If their baby is not in such a good position, head away from their pelvis or back against their back, they can visualise how their baby might be able to get into a better position. They can be encouraged to talk to the baby about why they feel comfortable in the position they are in and how, if they move, it will be easier for their journey out of their mother’s body.
Preparing for birth
The client can be encouraged to explore fears, hopes and expectations in a safe, relaxing space.
Breathing and relaxing while moving
This is an important skill to have during labour. It is also a useful to skill at any time but especially during the postnatal period when the mother may not have much time for herself. While she is holding the baby she can focus on her deep out-breath and relaxing her body.
It can be helpful for the mother and partner to try practicing this in different positions – for example all fours, sitting, standing, lying next to each other. In each position they can notice the pattern of breathing, how comfortable they are and how their baby is.
Encourage the mother to practice breathing deeply while breastfeeding.
Breathing for labour: first stage breathing
During first stage, the woman may find that all she needs to do is simply to focus on the movement of the breath, to breathe out slowly and deeply and allow the in-breath to come into her body. As the contractions get stronger and more intense, she can continue to focus on the breath, especially the out-breath. Simply by doing this, she may find a rhythm which supports first stage. If that is all she needs to do, then she does not have to feel that she has to do anything else.
Some women find that they like to use the out-breath as a focus. It can be used to:
• Help relax any tense parts of the body.
• Open up the hands or feet.
• Make open throat sounds or simply open and relax the jaw and throat.
Exploring images for first stage
Some women like to have words or images to focus on.
The wave
The wave is often an image which mothers tune in to instinctively in labour because it links into the energy of Water. The wave allows mothers to contact the Yang, dynamic, moving aspects of Water. The mother can visualise the rise and fall of a wave flowing through her body and opening up the cervix. The wave can be used as a focus for each contraction, building slowly, reaching a peak and then fading away.
The cervix opening up, like a flower
Some women find it helpful to visualise the cervix opening and thinning as the contraction gets intense. They may say the words, ‘opening up, thinning out’ as they breathe out during the contraction.
Surrender
Some women like to say words with each contraction, such as ‘surrender’ as they allow their body to relax and open up.
Transition breathing
The most important thing during transition is for the woman to keep listening to her breathing and not give up. If transition is very intense, she will probably need to focus with more intensity on her breathing. It is usually best not to change what she has been doing up to that point, if it has been working for her. However, if it is not working, then she may want to try something different.
On the other hand, transition may simply be a time when the woman needs to rest and focus on her breathing in a calm way.
Second stage breathing
It is still important to focus on the out-breath, but it has a little more power about it. As the woman breathes out there is a sense of strength behind the breath, which is helping her to focus her attention down to the pelvis, cervix and perineum and help ease or push her baby out into the world. She still needs to stay relaxed as she breathes out. Often women feel that they are pushing/bearing down, but they are tensing their jaw, neck and shoulders and holding the breath in their throat. As the woman breathes, she still needs to use the open throat sounds (aaah), allowing the jaw to open and relax. As she does this, she can focus the attention of the breath down to the perineum and feel that she is using the breath to push her baby out.
Exploring images for second stage
The kind of images which may help in this stage are:
• Imagining the baby coming down the birth canal and moving out into the world.
• Visualising the perineum opening and stretching.
Some women find it helpful to physically hold on to a rope which is hanging from the ceiling. As they hold xon with their hands, they imagine feeling the strength and power of the rope moving down into theirbody.
Postnatal
It is helpful to talk the mother through remembering to continue to use breathing she may have practised during pregnancy and birth. It can be beneficial to remind her of the breathing she did with awareness of her baby and encourage her to continue to do this. She can focus on relaxed breathing while she is feeding her baby, or resting. She can be aware of her newborn’s breath.
Deep breathing
After any kind of birth, deep abdominal breathing will help venous return as well as loosen any secretions in the chest. The mother can begin this as soon as possible after birth. She can simply sit and hold her hands over her abdomen, breathing deeply.
Huffing breathing
A huffing cough is beneficial to release any mucous which may have built up during the birth or in the early postnatal period. Huffing is an outward breath forcefully using the diaphragm to expel air from the lungs, pulling in rather than pushing out the abdominal wall. Since the diaphragm is moving up in the chest, and the abdominal muscles are shortening but not tensing, pressure is decreased in the abdominal cavity. These means that if there is an incision it is not under any strain. The huffing needs to be done quickly so that some force is generated to dislodge mucus. It is rather like saying ‘ha’ but briskly and with force from the abdominal muscles. The mouth is opened wide and the jaw relaxed. Any expectorate which is generated needs to be spat into a tissue or paper cup. For women with an incision, as a comfort measure, they can support the incision area with their hands or with a pillow. However, be reassured, the stitches will not pop out.
Huffing is an ideal way of clearing the chest at any time of life. It can be especially useful in pregnancy, as coughing strains the abdominal wall and pelvic floor whereas huffing helps strengthen them (Noble 1982: 155).
Breathing to draw the abdominal muscles together
Breathing can be done to support the rehabilitation of the abdominal muscles. Initially the breathing is to focus on shortening them vertically and then to draw them together horizontally. Breathing is also vital for working with pelvic floor exercises.
Making sounds with the breath
This can be useful at different times:
• In pregnancy some women like to sing to their baby.
• Some women like to make lots of sounds with the breath during their labour, others are quieter and tend to go inside themselves.
• Open throat sounds are especially useful for relaxing the jaw and can be used during labour. The woman can be encouraged to open her mouth and relax her jaw while making an ‘aah’ sound. This may help some women breathe more deeply. They may also feel a connection between the jaw and the cervix/perineum. By letting go of the jaw, the perineum relaxes.
Ba ba, pa pa, maaa
There is a Sanskrit mantra which many women find helpful. It uses the sounds
Baaa baaa
Paaa paaa
Maaaaa.
It is interesting that these are the basic sounds that Hindus said that babies make in the womb. In most cultures they form the root of the words for:
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Ba ba: Baby
Pa pa: Father
Ma ma: Mother.
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