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The Mind Body Connection: Imagery for Labor and Birth

By Dr. Christine Ahmed, PhD, CD(DONA)

“Take a breath and blow it out...just see those leaves blowing, you feel calm and safe in your armchair...the wind is blowing softly and you feel relaxed and calm.” I keep her grounded with gentle touch and words as we are getting into closer contractions, more intense pam. Imagery can be a powerful tool for the midwife or doula to assist with relaxation during labor.

Those working as midwives or doulas have learned well the impact relaxation and imagery can have on the progress of labor and birth. One of the best books written on imagery during childbirth was written by Carl Jones (1987). His book, Mind Over Labor, describes the impact of the mind on labor and birth and has many suggestions for ways women can prepare mentally by using imagery. Midwives or doulas interested in using imagery to prepare for this time can still pick up a copy through Amazon.com.

Jones gives suggestions on developing a positive image of birth, relaxing the mind and body and using mental imagery during pregnancy. I have used imagery as a tool for clients that are frightened of specific events happening during labor. I offer women the opportunity to create positive images that are the opposite of this fear such as seeing themselves in a safe, warm environment, surrounded by caring people. One client did this and visualized her birthing room filled to capacity with loving family, friends and partner as well as midwife and doula! Using visualization to prepare for childbirth may be likened to mental rehearsal before an event. I encourage my clients to try different pushing positions and imagine pushing a baby out in this position. Mental rehearsal may help a laboring woman feel calm and more prepared for labor to begin. I have offered Jones’ suggestions for breech and posterior babies in pregnancy as well with my clients. He has some creative suggestions such as visualizing babies doing somersaults or cartwheels, and tumbling while in a hands and knee position to encourage rotation.

Suzanne Arms (1994) writes that imagery can be used as an aid by the midwife or doula during labor and birth to help a woman with cervical dilation and in bringing the baby down. The images of a flower opening or the sun going down are common ones that have been effective.

Some recommendations from Dr. Patricia Norris (director of biofeedback research at Menninger Cliiiic in Topeka Kansas) on
imagery used in medical regimens may apply to childbirth as well. She describes eight characteristics that may help make mental imagery effective to complement traditional medical treatment during labor and birth.
1. Visualizations are best if generated by the client, especially for pain management A familiar and relaxing scene may help the client relax during painful medical procedures or between contractions.
2. Imagery must fit with the values and ideals of the person. The doula should have visited with the client to help her match imagery with her hopes for the birth.
3. There must be a positive connotation to the imagery — no negative reinforcers such as “I am not dilating, the back pain will get worse”. Imagery should be restorative and positive such as, “Things are going well. I soon will be holding my baby.”
4. It is better if the image is somatic and kinesthetic, perhaps literally visualizing the cervix opening and the baby moving down.
5. It should be anatomically correct and accurate. We can use the symbolic figure as well as the literal one to match what needs to happen.
6. Small sessions of 15 minutes or less throughout the day may help her rather than a longer visualization.
7. Norris suggests that you use imagery as a mission accomplished. Visualize the baby coming smoothly out.
8. Include the treatment in the visualization. Norris found that cancer patients who incorporate the treatment being used in the visualization do better than those who fight it. So perhaps it's to the patient's advantage to picture medication (if used) as helping the uterus contract or to reach a state of relaxation. Norris suggests welcoming the treatment into the body.

Examples of imagery that could be suggested for women in labor are tranquil nature scenes that are familiar to the client: South sea island, lake country, ocean waves, breezes, streams, mountains, a waterfall, a sunset, clouds, an opening flower, etc. I ask the client to choose the scene and invite her to shape the scene so it feels relaxing to her. I often ask clients what place is a favorite place for them, then lead them to it during epidurals or between contractions for a short mental break.

Prearrange peaceful sensations that go with a scene may work to promote relaxation such an in a hammock, or floating in the water, walking, or resting on a dock, or swinging. I've been told later that it really helped, I know it worked for n!

Christine Ahmed teaches Health Education at the University of South Dakota. She enjoys her work as a doula in the community. She has a husband and three children and resides in Vermillion, South Dakota. She can be reached at cahmed@usd.edu

References
Arms, S. (1994). Immaculate Deception II: Myth, Magic and Birth. Berkeley, CA: Celestial Arts.
Jones, C. (1987). Mind Over Labor. New York, New York: Viking Penguin Inc.
Norris, P. (1992). Psychoneuroimmunology: Visualization and Imagery, paper presented to the Association for Applied Psychophysiology and Biofeedback, Colorado Springs, CO. March 19, 1992.
Seaward, B.L. (1997). Managing Stress. Boston, MA: Jones & Bartlett.
Simkin, P. (2001). The Birth Partner: Everything you need to know to help a woman through childbirth. Boston, MA: Harvard Common Press.