Artificial Rupture of Membranes...The Least Invasive Procedure With the Least Appreciable Benefit?

Artificially rupturing your membranes (AROM) seems like such a small inconsequential intervention when you compare it to interventions like pitocin augmentation or episiotomy or forceps.  And it's true, compared to those and others, breaking your bag of waters is not quite as rife with risk, but that is not to say that it is entirely without risk either.  If your goal is a natural intervention free birth and you've already established some clear idea of your stance regarding other interventions let me encourage you to think a bit more deeply about this one.  Here is some background from what I've read and experienced:

The most often cited reason for doing an AROM is progress.  When labor is slow or arrested many times breaking your waters is suggested as a safe way to speed things up.  One time I had a client who was laboring very well and making adequate progress and then the doctor came in 5 minutes before her shift was up and suggested breaking her waters since according to her, it had cut her own labor time nearly in half.  I couldn't believe such blatant misinformation!  In this case there was no medical indication, simply a desire to speed an already well progressing labor.  My client agreed (as who wouldn't when promised a speedy delivery?!)  The unfortunate result was that the contractions intensified, causing pain my client could not keep up with prompting her to request a narcotic for the pain, which then led to her being confined to the bed, which slowed her progress down considerably and as far as I could see only increased her frustration and discomfort.  A veritable snowball of interventions that began with in my opinion an unnecessary AROM.

Another example of AROM used to speed up labor is from my own first birth.  My first birth was long but not atypically so.  I was going on a good 18 hours of labor with steady progress but not yet complete dilation.  My mood was tense and tired.  When my midwife suggested that breaking my waters might speed up my labor, I latched onto that fact with all the hope and expectation of a dying woman being offered a cure.  My husband tried to remind me of what we had learned in our Bradley childbirth classes, but I was not convinced.  Anything that might mean an end to my pain was very very welcome.  In my case I was close enough to complete dilation that it did not cause any very severe increase in pain nor necessitate my requiring any other intervention. What did happen was that I ended up feeling as if I had failed somehow in my attempt to birth.  I felt like I needed the help of my midwives in order to give birth and that my body just wasn't able to get the job done.

With my third I again accepted an AROM although I can no longer remember why (which bothers me a bit...) but anyway I was laboring well although contractions were incredibly intense.  My son's heartbeat stayed steady throughout labor but after the AROM there were significant decelerations to the point that my midwives gave me oxygen and told me to get up on the bed (I had been on the birth stool).  A significant side-effect of AROM is that cord compression is more likely to occur causing fetal distress.  Without the bulgy bag of waters for protection the baby is less protected and more subjected to the rigors and stresses of labor.  Since my son could no longer tolerate the contractions and pushing as well, I had to be up on the bed and slow things down in order to proceed safely.  If I had left my bag of waters intact would labor have continued as steadily but with less distress for my son?  It's possible...

My third and final example is from a birth where the baby was actually born in the sack.  It was my client's first birth, and everything was progressing steadily and normally.  The doctors were very gentle and patient, encouraging my client and remaining calm and steady throughout.  An ideal situation!  Whenever my client complained of pain or wondered when labor was going to end, instead of offering to "do something" i.e. break her waters to speed things up, offer pain medication, the nurses and I instead offered words of encouragement and gently helped her breathe through her contractions.  The baby's heartbeat never faltered and when pushing time came, my client pushed slowly and steadily with each contraction.  We all expected the bag of waters to break explosively on any or all of us there assisting but it never did, and in the end the baby was born, beautifully and gently with the bag intact.

Expecting labor (especially a first labor) to be slow and steady and allowing for pushing to be slow and steady as well is key.  Avoiding stress for mother and baby is also key when aiming for a natural childbirth.  Looking back, I think what I needed most towards the end of my first labor was encouragement that I was doing well and that all was proceeding normally.  To me, my labor seemed abnormally slow and painful.  I wanted/expected the AROM to be my miracle pill, dropping my baby out of me quickly.  That didn't happen and afterwards I still remember feeling that there had been something wrong or abnormal about my labor and my experience of pain.

Birth is difficult but shouldn't be scary.  When a laboring woman expresses pain or fear the best thing her caregivers can do for her is give her a sense of her own power to birth.  How this is done varies woman to woman.  Some need words of encouragement and praise.  Others need to do something, so suggesting position changes can be really helpful.  Others like touch, so massage or counter-pressure can give them the boost they need to keep going.  Offering to break their waters or offering any other intervention even when needed should be done carefully and considerately since it carries with it the implicit observation that whatever the woman is doing it is not working.  And equally importantly, breaking the waters should not be touted as a safe effective way to speed up labor.  It can speed things up but it is not always safe or the most effective way to do so.  The potential risks should be adequately explained and it should be suggested only after other methods have been tried.

Maternal Mortality in the U.S. a True Health Care Crisis

Studies have shown that women-centered care improves outcomes.  Women-centered care should mean that the care is focused on the women and offers consistent quality health-care while being respectful of each woman's unique needs and background.  For me personally, women-centered care means that each woman gets to choose where she gives birth, who gets to be there, and that she receives respectful and quality care from her providers.

In the United States, we may claim that we offer "women-centered care," when in fact the care most consistently delivered is sub-par with less than stellar outcomes.  How can this be, you may wonder, when we are a developed country with the most up-to-date medical technology money can buy?  To demonstrate, I will simply point to the statistics gathered from the United Nations showing that between 1990 and 2008 the vast majority of countries reduced their maternal mortality rates for a global decrease of 34 % while maternal mortality nearly doubled in the United States (Maternal Mortality in the United States: A Human Rights Failure, Association of Reproductive Health Professionals Journal, 2011).  Of the many reasons for this statistic, I would like to focus on the one that I see most often in hospitals today: the overuse of medical technology.

Studies between 1996 and 2008 show that there has been a 56% increase in surgical births, with no evidence for improved outcomes.  In fact, there have been studies showing data that the increase in medical intervention actually increases maternal and infant morbidity.  This is not to say that there haven't been losses due to the lack of medical technology; there have been.  It's just that there are far fewer of those deaths than there are preventable deaths due to in part to the overuse of medical technology than otherwise.  For example, there are countries with less life-saving medical equipment that have lost fewer mothers and babies than we do in the United States.  And the reality is that the United States ranks 50th in the world in terms of maternal mortality.  So while we like to think that we are safe and protected in our hospitals surrounded by the best technology on the planet; we may in fact be placing ourselves in far greater danger than we realize.

I don't mean to sound all gloom and doom, but I do think that an increase in awareness is called for.  The statistics are scary, yes, so rather than argue, let's do something about it!  Some states have already put in place systems to increase reporting so that we can find out more about why these deaths are on the rise and what we can do about them.  There are even a few health care models utilizing fewer medical interventions and their outcomes have been consistently good.  We are making progress, but it is slow.  And here is where I will venture into the philosophical realm.  To quote a Native American saying used most often by environmentalists, "tread lightly upon the Earth, and live in balance and harmony."

In order to improve our obstetric care in the United States we have to start treading lightly.  Birth is not something that responds to a hammer fist of intervention.  Truly, birth works best when it is left alone.  In this instance an encouraging word and a gentle touch will do far more to effect good outcomes than a mighty weapon (forceps, episiotomy) and a take charge attitude.  I've seen too many doctors enter a delivery room and take over the whole scene.  I am here now, and since I am here, I must now do something to get this baby out!  Seriously?!

Again, just to qualify, I do not mean that birth always works best when left alone.  Of course, there are times when medical intervention is called for and necessary.  But when there is no true medical need and intervention is still applied, for whatever reason, that is what I am railing against.  That is where we run into trouble.  So when a doctor says it doesn't matter how the baby is born, you have my permission to say, "Actually it does and you are not following evidence-based practices if you believe otherwise."  Medical procedures should be left for when they are truly medically necessary.  Women should be assured that medical professionals have their best interests at heart.  They should be assured that nothing will be done that might endanger their lives or the lives of their babies.

The really backwards thinking that goes on is that by doing more medical interventions, we think we are preventing complications and death, but that is just not true based on the statistics.  So, to improve care, we need to start paying attention to the data.  It does not pay to induce labor unnecessarily.  It does not pay to do routine cesareans.  Most importantly, it does not pay and it can do severe harm.  It's time we started paying attention to other countries where outcomes are better and try to adopt more women-centered practices here in the United States.

Why Dads Rock the Birth Scene

Hold tight, I'm going to get around to the topic of this post but first I need to go on a round-about to get there...

Women were designed to birth--physiologically speaking we all know this to be true.  I remember an old psychology professor of mine lecturing on how women were much stronger than men.  Although men possess the bigger muscle groups, women have the stronger immune systems.  We were designed to survive.

Following this topic, I think it interesting to note discrepancies in popular thinking.  For instance, most people would say that women, girls in particular, need to be made to feel their value and given every opportunity to be told they can do and be anything they want to be.  If you were to say the same about men, boys in particular, most people would dismiss it as unnecessary.  Aren't boys already too inclined to think themselves masters of their own destinies?  Don't they already have every advantage over their less powerful girl counterparts? 

I read a book that cited recent studies showing the reverse to be true.  Girls, for the most part in our country, do grow up feeling that they are valued and in fact are more apt to raise their hands in school and go on to higher education.  Boys, however, are less inclined to raise their hands, are blamed for more disruptive behavior in school and are nowadays less likely to go on to higher education.  So, where does all this popular thinking come from?  Or are we just operating on outdated information?

What does all this have to do with birth?  Well, I think there has been a subtle shift over the years following the Women's Right's Movement.  Again to quote my professor, whenever an extreme occurs i.e. women being treated as second class citizens, an extreme response is generally called for as a corrective.  However, on the road to finding balance it is often necessary/inevitable to swing out to the opposite extreme before you are able to settle again.

I think rather than belittling or undervaluing women, these days there seems to be more belittling/undervaluing of men going on.  Watch any television sitcom.  There is almost always a quirky/beautiful/smart woman followed by a sweet/ignorant/less capable male counterpart.  Getting back to birth...watch any show and you'll see the husband break into a cold sweat and then invariably pass out just as the baby is about to be born.  The exasperated women just rolls her eyes and gets down to the business at hand.

So, to question popular thinking.  Is this really true?  Since allowing men to be more involved in birthing, have they proven themselves to be more of a hassle than a help?  In my experience, as above, the reverse is true.  When given the right tools and support, men totally rock the birth scene.  Here's how the situation typically goes:

I (as the doula) meet with the dad-to-be and give him a rundown of events.  He tries to look interested but continues to hold with his private convictions which are that he'll be there to hold her hand and run for ice chips but he won't be doing much more than that.  I smile, because secretly I know the truth.  Once labor starts, I arrive to a scene which usually involves a very active dad running around to make sure there's food and everything packed.  Then while labor gets more intense, he stands for hours in a cramped position to keep his wife comfortable.  He gives steady counter-pressure.  Wets wash-clothes.  Holds steady as his wife hangs on to him for support.  He doesn't complain once that he needs a break or could use some food/rest whatever.  His stamina rivals his wife's...it seems to be fueled on the feeling of, "if she can do this, the least I can do is stand by her."  And he does.  The coolest part for me usually comes at the end where the dads who were most vehemently opposed to watching the baby be born (I'll be standing at the head of the bed thank you very much!) are actually the ones most excited, overwhelmed, awed by the whole process that they are right there to see their baby be born.  It is an awesome moment.

So, don't get suckered into believing popular thought without at least testing the waters first. 

When the Going Gets Tough...

Today I plan on being short and sweet.  Not only because what I have to say is brief but also because I have to be home to get dinner on for my children :)

When someone tells me it does not matter whether people give birth without intervention or not...what matters is a healthy baby, I respond, "Would you say the same thing to the mountain climber?  It doesn't matter whether you flew a helicopter to the top or spent 8 long hours on the ascent.  It's all the same because you got to the summit anyway."  The key difference being, the mountain climber has most likely trained for this by conditioning her body and getting herself psyched up for the main event.  The mountain climber was prepared and hoped to push herself to her physical limit.  The mountain climber set out to achieve a personal goal.  No one in their right mind would argue that their achievement didn't matter or mattered less just because someone else chose to ride in a helicopter.

I wish we would stop comparing.  To the mountain climber, I say, "Go for it!  Believe in yourself and your body and come out stronger and more self-assured."  To the helicopter rider, I say, "Enjoy the magnificent views and celebrate your chance to participate in this life-altering experience."

Each one of us has to make our own decisions about birthing just as we do about parenting, educating, nutrition, etc...  It would be stupid to de-value or undervalue a choice that means more discipline and hard work just as it would be stupid to judge or condemn a choice to feel less pain.

When the going gets tough, in birth, and in life, we have the option typically to choose to push through or to choose another direction.  There are times when pushing through grants the deeper rewards.  There are times when pushing through starts to look more like pig-headedness and results in more frustration and emotional upset.

Life is not black and white.  Making the right choice tends to look drastically different depending on personality, temperament, situation, and surroundings.  It would be a lovely thing indeed, to allow the right choice to differ person to person.

There are a few absolutes in this life, a few black and white this is right, this is wrong scenarios.  Birth is not one of them, in my opinion.  Do not undervalue a woman's decision to labor without medication.  Do not denigrate a woman's decision to alleviate her pain in childbirth.  It seems simple, right.  Why do people get so snippy about this??

Ultimately, when the going gets tough what we all need is help and support and the freedom to do what we need to do.  Rather than snipe at each other we should rally and offer the support needed without judging and with open hearts and minds.

Thanks for letting me get up on my soapbox for a minute :)

Now on to more practical problems...what to make for dinner?!

This Doula's Recipe For A Good Birth

Today I am going to write my recipe for a good birth.  From all I have seen and experienced, these are what matter the most.

1.  Where you give birth matters.  A hospital can work, but in my opinion, it is not the safest place to give birth.  If you are healthy and your baby is healthy a birth center separate from a hospital has far better outcomes for you and your child.  Want to hear a scary statistic.  Neither do I, but here it is: The United States ranks 60 out of 180 countries, below China, even Slovakia, for goodness sake in maternal mortality!  Not to disparage China or Slovakia, but seriously we are a first world country with top medical care; this should not be so!  Of course there are many reasons why, and you could get into a very heated debate on this topic which I will not touch for the time being.  My point is that the maternal mortality rate for midwifery model care is much lower.  If you are healthy and your baby is healthy, one of the best preventative steps you can take is to give birth at a birth center with skilled professional midwives.

2. Get regular chiropractic adjustments.  I do not use a chiropractor regularly and have not when pregnant.  But from my own birth experiences (my third baby remaining very high and needing help during labor to descend versus those who've had chiropractic adjustments attesting to the fact that their babies remain quite low and engaged) I have come to the conclusion that adjustments are immensely helpful.  The body is in alignment which means the baby can descend without undue trouble which, in my opinion, really helps things along during labor.  A caveat!  Not all chiropractors are created equal.  Just like not all doctors, nurses, midwives, etc...  You get my meaning.  There are some chiropractors out there who do more harm then good.  Get a referral and make sure who you are seeing is qualified and good at what they do.

3. Eat & Distract.  The best thing you can do when labor starts is to eat a good meal and distract yourself.  Give yourself and your labor the gift of the un-watched pot.  Have a labor project planned i.e. bake something, clean something, garden, go for a walk, go out to dinner, to the movies.  When you can no longer concentrate on anything but what your body is doing, then it is time to whip out your coping mechanisms and call your support team.

4. Just say no to vaginal exams.  Aside from the initial exam upon admittance to the hospital or birth center which serves to give a baseline, there really is no need for frequent or even scheduled/regular interval exams after that.  Although you may think you want to know, it is really not helpful at all and may in fact be harmful as it increases the risk of introducing germs, not to mention the psychological effect of hearing you are not very far along!  You can tell an awful lot about where you are in labor just by watching attentively and listening.  Allow yourself to just trust the process and unless something is not going well, leave well enough alone.

5. Don't break those waters!  Artificial Rupture of the Membranes (AROM) may in fact speed up your labor but it comes with a high risk guarantee.  Although labor may speed up, so will your contractions, in length and intensity.  For many that point may rocket them into a labor pattern that overwhelms them and makes them feel out of control and scared thus necessitating the need for drug intervention when perhaps it may have been avoided.  If you are going for a birth without medication, breaking your bag of waters won't help you as much as you think it will.  Plus, your baby is no longer protected by that soft cushy bag and may experience some stress as a result.

6. Don't rush pushing.  Many well-meaning doctors and nurses decide that when the time comes for pushing that they should act as the woman's cheerleaders.  It is my belief that especially without sufficient knowledge on what to expect from pushing, a woman with excited eager cheerleaders around her is more likely to feel inadequate and pressured rather than supported and encouraged.  The reason being, pushing is not an issue of strength.  Once the baby has descended, the body responds by pushing involuntarily.  The baby is then slowly, I repeat, slowly, maneuvered down the birth canal and out.  Slow is better.  The body knows this instinctively.  Contractions tends to space apart from one on top of the other or every minute or two to sometimes 4 or 5 minutes apart.  This is normal and healthy.  The baby is supposed to crown and go back in.  Pushing hard for 10 seconds is a waste of energy.  Why not just go with your body's urges and push along with your body then let yourself rest?!

One more thing on the topic of pushing...don't be coerced into pushing lying down unless you yourself feel best doing so.  It is far from ideal and will make you and your baby have to work that much harder.  And once again, it can also cause stress for the baby.  In case you didn't know, stress, or variations, decelerations in the baby's heart beat, make everybody very nervous, and with good reason!  Do what you can to avoid stress, don't have your waters broken prematurely, labor and push as much as possible in an upright position, and you will avoid the more common causes for stress.

7.  Finally, and perhaps this should be first, Just Say Yes!  Accepting your labor however it comes and however it goes, will in my mind guarantee a perfect birth for you.  When you believe in your own strength and when you let yourself do what you need to do, your labor will be perfect no matter what happens.  So, when labor starts, don't fight it, don't be scared; be courageous, be strong and say YES!!

How to Give Birth... Ancient Egyptian-Style

A few nights ago, it was story time with my daughters.  I brought out the library bag to search for a new book and came across a lovely compilation I'd grabbed earlier in the week titled, The Barefoot Book of Dance Stories.  I pulled it out and immediately both my daughters started saying, "Oh, Mama, do the one with the baby!  Do the one with the baby!"  (Now this may not seem strange to anyone with daughters since most are interested in babies, but my daughters, blessed with a doula for a mother, take their interest in babies to a whole new level.  They've heard me talk about birth often, and watched The Business of Being Born with me and the documentary, Birth Story with Ina May Gaskin, and they will often ask me to show them the births.  Like I said...a whole other level.)  I began reading the story.  It was called, The Goddess Danced.

What a beautiful story!  I loved reading it to my daughters.  I make sure when I'm talking about birth with them that I keep my tone positive and affirming.  I don't allow too much to be shown or heard that I feel is beyond their age-appropriate level.  What I am doing, is generating a history of birth stories that will allow my daughters to look forward to birth and to expect it to be hard work.  By using story, I am giving them an image of birth that will excite them not scare them.  The Goddess Danced, is a perfect example of this.  I've included a brief synopsis below:

Ra, the god of the sun, being a god, could do things that mortals could not.  He frequently fell in love with women on earth.  One time, he spied Ruditdidit, the wife of one of his priests.  She was very beautiful.  He visited her and wooed her.  Soon she became pregnant with triplets.  In order to help her have an easy pregnancy he made sure she had plenty of figs, grapes and pomegranates and he sent her earthenware jars of goat milk.  For nine months she was happy and well rested but when labor began her pains were great.  She wept and wailed and called out to Ra for help.  He heard her and sent four of his goddesses and one of his gods to help her.  They disguised themselves as street musicians (in that time street musicians were considered to be excellent midwives) and entered the house to help Ruditdidit.  The one god, Khnum, stayed outside with Ruditdidit's husband and drank barley beer.  The goddesses found Ruditdidit lying on her side in great pain.  One of the goddesses, Isis, started to dance while the others made music with their instruments.  Isis reached down and pulled Ruditdidit to her feet.  Together they swayed and danced, swinging their hips and twirling.  "Isis made Ruditdidit's stomach ripple like waves, her hips like mountains shuddering in a quake.  Ruditdidit did as Isis commanded, her belly moving back and forth, up and down until she was quite dizzy but the pain had receded.  Then, when Ruditdidit was ready for the birth, Isis stopped dancing.  She led Ruditdidit back to her bed where the woman squatted by the bedside and began to push.  Isis put her hands out, and the triplets fell into them--one, two, three."  Ruditdidit's husband, the priest Rausir, left a basket of corn as payment and went in to see his wife.  Isis flipped the basket and transformed the corn into gold coins, "but the priest, Rausir did not find that out until much, much later, for three new babies and a tired wife turned out to be a lot of work."

Is that not the most beautiful birth story?!  I absolutely love it.  Not only does it mention diet and rest as being important during pregnancy but it also mentions music and dancing as key elements in helping ease labor pain and help labor progress.  So cool!!!  Who wouldn't love to be pregnant if they were fed figs, grapes, pomegranates and goat milk all the while resting from their work and being pampered?  Who wouldn't love to labor with their own troupe of musicians making music and dancing with you all the while encouraging your efforts?  I know I would.  Maybe they need to encourage more musicians to become doulas...  But, I'm getting sidetracked.  Back to Ruditdidit.

I didn't mention it in the story, but by the time the goddesses arrived to help Ruditdidit, she had already been laboring for more than 24 hours.  She was tired and in a lot of pain.  Now most labors will be completed within 24 hours, but every so often there are those labors that will go on for much longer or will get stuck.  (Of course, in Ruditdidit's case, she was carrying triplets and they were half-immortal, which is not a complication any of us have to worry about!)  Still, labors do get stuck sometimes and sometimes we do need to think outside the box in order to help get unstuck and move labor along.

Labors get stuck for a variety of reasons.  Sometimes the mother becomes worried or anxious.  Sometimes something happens to throw the mother out of her concentration, an interruption or some minor annoyance.  Even if it seems minor, anything that throws a mother out of concentration can really impede labor's flow.  (Why do you think wild animals birth at night where they feel completely private and safe?!)  Sometimes the mother's uterus is just plain tired and needs rest and nutrients in order for it to continue making progress.  When any of these happen, a mother may feel at a loss as to what to do next.  This is where stories can step in and help.  What did your grandmother do in her labor?  If not her, what did your friend's grandmother do? You get the point. We can learn from others' experiences.  We can learn from the birth stories we've heard.  In this case, we can learn from Ruditdidit's prolonged labor.  We just need to start dancing!

I'm not joking.  Each and every traditional culture has its own version of a birth story and I guarantee that not one of them tells of the woman lying down passively enduring labor.  Quite the contrary.  Most traditional cultures tell stories of women working until labor was imminent and only then dropping what they were doing to squat and push the baby out.  Sounds primitive, but hey, it has worked for thousands of years...

This story was probably written to serve exactly the purpose I mentioned above, to help women with prolonged and difficult labor.  This story although meant for children, most likely taught an entire culture: this is how you give birth.  Unfortunately, today we have lost most of the stories and what we've kept is a more medicalized version of what to expect.  I think we're actually doing more harm by this.  The stories are inspiring and instructional without being too scary or over-informative.  I think it is high time we revived the birth story as a means for helping prepare women to give birth.

Four Proven Pain-Management Techniques

Today I am going to write about four proven pain-management techniques to be used during labor.  We've all heard about the normal ones; movement, water, massage, positioning, but in this post I want to touch on the lesser-known but just as, if not more, effective techniques that I learned from Ina May Gaskin.  Now some of you may take issue with the word, proven.  The only "proven" pain-management is drugs, right?  Not right.

But first...

Don't skip this because it is IMPORTANT.  So often we read something, a diet plan or an advertisement for something like a cure for male-pattern baldness, and we get all excited because of the flashy promises and guaranteed results.  We try it...and it doesn't work.  What happened, we wonder?  Then we read the fine print: results not typical, or something to that effect.  Well great.  Unfortunately, in our world  of product promotion, sales, competition, big business, we, as consumers, are becoming more savvy and anything that looks like a caveat or a fine print makes us run for the hills.  We don't even need to read it to know where this is going.  It means that no matter what you assert, your product is not going to work on me.
I would like for you to suspend your instincts while I maintain that there are proven pain-management techniques for labor and there is a fine print.
Will you read on??  I hope so.

The Fine Print:
There are no short-cuts.  There, I said it.  No matter which way you look at it, these pain-management techniques will not in any way resemble a pill or a shot or a quick fix of any kind.  In order for you to be able to manage your pain effectively, you are going to have to work for it.
Not your typical advertising claim, now is it?!
But, if you think you can handle that kind of fine print, then keep reading.  It only gets better from here :)

Pain-Management Techniques:

#1  Keep Calm and Carry On:
Surround yourself with people who are calm about the birth process.  This may not seem like a lot of work or even important enough to rank first in the list, but trust me, the importance of this simple step cannot be overstated.  At your birth, you need to have people who are going to look lovingly at you and say, "yes, this is normal," and "you are doing a perfect job," or "those are wonderful sounds you're making right now."  Basically, you want people who will encourage your efforts, bolster your confidence and lesson your fear and anxiety.  This may require un-inviting people to your birth (most definitely not an easy thing to do) or switching providers (even less easy), or taking that extra step to seek out a doula or someone who you know will provide that positive, calm support.

#2  Laugh:
Expect to laugh.  Try to laugh.  Erase whatever image of birth you may have that tells you that birth should be a solemn, serious event.  It can be.  But that wouldn't be much fun, now would it?  Seriously, though, if you can laugh or even smile, however tiny, you will be amazed at how your body will respond.

#3  Kiss:
Forgive me if this is TMI, but it should be said, and I love Ina May Gaskin for saying it.  What happens when you kiss a guy?  Blood rushes from his head to his you-know-what, and what happens?  It gets bigger.  We don't talk about it much, but the same thing happens to women.  When we kiss, we get bigger too.  Why?  Hormones.  It's a beautiful thing.  And, by the way, I'm not talking about close-mouth, puritan-style kisses either (I hope you know what I'm talking about).  Make everyone leave the room and enjoy some snuggle time, just you and your partner.  It not only helps ease your pain but boy can it get things moving!

#4  Attitude Adjustment:
Try to observe your attitude.  If you notice that the pain is getting unbearable, take a peek at your thoughts and what their tone is like.  Are you succumbing to the temptation to wonder, "how much longer?"  Are you approaching each contraction with the thought, "dear God, I can't take much more of this!"  Any negative attitude regarding birth and the process will increase your pain.  Although we may think this is out of our purview; it is not.  Let me reiterate, IT IS NOT!!!  This, more than any other area is entirely, firmly, completely within your grasp.  Fake it, till you make it if you have to.  Even if you don't believe yourself; know that you can change your attitude merely by acting like it. Your body will respond.
The next time a contraction comes, change your thoughts, or even better, start talking out-loud and say something like, "Yes!" or "I got this!" or anything that spontaneously comes to you that will help you reverse those negative thoughts and transform them into positive body-affirming truths.

Final Consideration Points:
These techniques, unlike the more commonly-known techniques of movement, water, massage, etc...require practice, habit-building, in order for you to be able to draw upon them when labor begins.  Don't we, when stressed, tend to revert back to a more basic, and base, version of ourselves?  Our pretensions are stripped away and we are left with our own naked vulnerability.  Quite a scary thought.
Unless you have forged habits to draw on.  Habits like staying calm when you most feel like blowing your top; laughing instead of crying when the unexpected happens; kissing, especially when you least feel like it; and training your thoughts to focus on the positive.  The more we practice these techniques in our everyday lives the better we will be able to "switch them on" when labor begins.

Results Are Typical:
Again, to run counter to your typical marketing outcomes, I will maintain that when you use the above techniques you can expect your pain to be manageable, and sometimes even exciting or exhilarating.
Birth is normal.  Our bodies are designed for birthing.  We can birth.  It is possible to feel pain and ride it.  You will have to work harder than you have worked ever before and possibly after.  That's why how we birth matters.  That's what makes it so good.