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Therapeutic Touch™ in Labour & Birth
By C. Stark, R.N.
Mention this to anyone who has experienced giving birth, regardless
of age, and the response will be a strong one. It may have been
the most exciting moment in a woman's life and its memory can
last a lifetime. Descriptive
words I've heard include - *incredible, unbelievable, amazing,
terrifying, exhausting, painful, nerve-wracking, awesome, wow!*
As a labour and birth nurse at St. Michael's Hospital in Toronto,
the challenges of my working day are many. Birth becomes the
long-awaited event and the pregnant woman arrives on the unit
with both emotional and physical needs. Issues
may exist that may have an impact on the patient's labour experience
and its outcome. Is she alone or with family support, married
or single? Are there unemployment or housing difficulties? Is
there evidence of abuse, alcohol or drug use? Is she a recent
immigrant or refugee with limited understanding of English or
Canadian culture? Is this an unwanted pregnancy? Is the sex
of the baby a factor? Some issues may not have been addressed
during pre-natal visits - often due to the patient's hesitancy
to say anything - so the labour nurse may be the first care-giver
to notice behavioural "cues" such as unusual fear,
anxiety, silence or excessive talking.
is usually young and in good health. When in labour, she will
show signs of coping with pain that may range from quiet, restrained
internalization to high intolerance and near hysteria.Where
does Therapeutic Touch (TT) fit into all this? I think it is
the comfort and support given to the labouring patient that
ultimately affect her feelings towards childbirth and I believe
TT to be a key element in providing such care in a positive,
reassuring, calm and gentle way.Before I enter a room, I centre
and focus on calmness in myself to help me accomplish whatever
is required. I discuss with the patient and husband their expectations
of labour e.g. if they wish for a natural childbirth. The patient
may know of some comfort measures that we can help her with,
however, I always explain and demonstrate some simple techniques.
During a contraction, have the patient breath gently in through the
nose and out through the mouth, to visualize oxygen going into the
lungs to nourish and give energy to herself and the baby. For relaxation,
as the contraction subsides, she should return to normal breathing,
physically relax the shoulders and allow her body to sink into the
bed, close her eyes and think of quietness and rest. When relaxing,
I will gently touch her ankle, knee, wrist, elbow and/or shoulder
and suggest she visualizes all her joints relaxing and letting go
of tension. Breathing and relaxation allow the patient to participate,
to keep control for herself and perhaps, to lessen her anxiety and
fear of the process of labour. The support person can help her continue
this should the nurse not be available.
During labour, a patient may have a visual point to focus on (her
husband, a photograph, something pleasant in the room) or she may
choose to close her eyes to visualize an "image" for herself,
or listen to music.Visualization can be very helpful. M. A. Alexander
RN, who also works on the unit, finds that an idea often needs to
be given to the anxious, tense patient in active labour and suggests
this type of imagery: "imagine the baby being out and in your
arms/during a contraction, breathe the baby down . . . completely
relax and see the discomfort drain out of the body and into the floor.
Labouring patients are very sensitive to touch; it may be urgently
called for or refused, all within minutes. By explaining that TT is
like a light "massage-without-touching" and that it may
help towards relaxation, the idea of TT is introduced as a gentle
option and/or complement to physical touch. The patient may not wish
to know about TT at this time; she may want immediate pain relief
and only an epidural will do. This is to be respected. While waiting
for assessment, for blood results prior to getting an epidural, or
to "locate a vein" for IV therapy, she may be willing to
receive some TT and thus verbal permission is given. Often by *giving
it a try*, the patient will want TT continued.
It only takes a breath but one may need to re-centre frequently as
there are many interruptions. While coaching the patient with breathing,
I will often breathe along with her and so centre myself as we breathe
together. When I notice the stress level rising in the room, I will
say "O.K. everyone, let's all now take in a big breath and let
it out slowly" and I visualize those in the room being calmer.
I scan the patient's field from time to time, not to identify "specifics" but to have a sense of her energy level. This is an acute care situation:
every contraction requires attention and if they occur every 2/3/4
minutes, there is little time for incorporating all the phases of
TT. Away from the bedside, I will assess the energy field in the room.
Often the energy level will greet me as I open the patient's door
and I will visualize myself unruffling the whole room, asking for
gentle soothing light to enter and calm the atmosphere within.
When a contraction starts and the patient begins her visualization
and breathing, I unruffle, starting at the forehead and gently sweeping
down without stopping until well past the feet. I may unruffle once
or up to three times during each contraction and my intention is that
the patient's energy field will clear to allow the process of labour
to continue its path to a healthy, safe outcome. I also envision the
patient being calm, relaxed and able to manage her pain without anxiety
or fear. As the contraction subsides, I ground the patient by gently
touching her feet or by envisioning the energy flowing from her feet.
I may unruffle again if there is high anxiety. A times I talk quietly
with the patient while unruffling.
During relaxation (between contractions) I will stop and we "take
a moment's rest". It is during this time that the nursing work
takes priority (nursing care, assessments, monitoring, documentation),
questions can be answered, drinks and nourishment offered etc. However,
I have noticed that during relaxation a sense of peace and quiet permeates
Partnering for TT.
Although most labour units support one-on-one nursing, this is not
always possible due to unexpected emergencies. To give TT to a patient
who wishes it continued and the RN is called away, a "mini-course" in TT can be given to the support person. The husband is often willing
to learn as it allows him more opportunity to support his wife. We
try a few imagery ideas so they can both feel comfortable with a specific
one or come up with one of their own.I demonstrate unruffling, let
the husband unruffle while his wife breathes though a contraction
and during relaxation, have him sit by the bed, close to his wife,
holding her hand or massaging her. We also unruffle together. Regarding
intent, I suggest he visualize a soft mist or gentle sunshine all
around them, that everything is calm and peaceful and his wife is
managing beautifully.When I leave the room, the husband may help his
wife with visualization, breathing, physical massage and/or unruffling.
As long as there is sincere intent in the participation between the
two, then TT is being continued.
Relaxation is the most obvious effect. The patient's awareness of
relaxation may come within a few minutes of receiving TT or after
some time when she realizes she has been coping better with the contractions
(even at their most intense) and is able to fully relax and rest between
From the relaxation
effect, there come a number of benefits - decreased anxiety and fear,
a sense of peace and calm, and being able to co-operate with the process
of labour by no longer fighting against it. The atmosphere in the
room noticeably changes from high stress/tension to relaxed quietness.
After an epidural, giving TT will reduce anxiety and allow a relaxed
sleep.Does TT reduce pain, speed up the process and/or reduce complications?
Only research studies will provide affirmation to those questions.
As 'TT nurses' however, we have seen that through the relaxation effect
in labouring patients, the process of labour is allowed to travel
its journey and pain does not appear as intolerable. The progress
does seem faster in many cases and perhaps there are fewer complications.
L. Wilkinson RN,
who works at the Hamilton Health Sciences Centre, McMaster site, has
gained valuable insight from using TT with her patients over several
years. Here are some of her observations: "In my practice, I
find the use of touch and visualization very important. Even the most
active patient will benefit from a compassionate hand, stroking her
arm and having the intent to relax her. A simple visualization such
as watching her breath will help her take control and enhance the
relaxation. It is not expected that all pain will be taken away but
if the patient is in control of what she is doing and can manage her
labour, then TT has been successful."Wilkinson suggests the writing
of Carl Jones The Labouring Mind Response may help understand the
psychological, emotional and behavioural changes that occur as labour
progresses and how the left-brain orientation of logic/reasoning shifts
to right-brain functioning of creativity/intuition/instinct and the
patient becomes more open to suggestion, like touching, imagery, TT
etc.It is a privilege to be a part of childbirth! It is intensely
private and personal, the physical effort and emotional releases are
intimately shared by all involved and the experience is truly profound.
To hear the cry of a lusty, healthy newborn baby is indescribable
and to see the joy in the parents' eyes is reward indeed. A TT nurse
can share in the knowledge that Therapeutic Touch contributes towards
RN is a labour and birth nurse at St. Michael's Hospital in Toronto.
Originally from Essex, England, where she trained as a midwife, Stark
has been enthusiastically practising Therapeutic Touch™ since 1995.She
is currently investigating the effects of Therapeutic Touch™ in the
post partum phase.