Tales of Birth Reframed: Part 4 – The Legend of the Gate Theory

So here is a drawing of our laboring parent with a spine (no it is not to scale or exact).

Today, our laboring parent is back in labor.  What we can call early labor is just shifting into more active labor where the focus of the waves of contractions are coming in and out.  It is getting more and more difficult to cope with the intensity.  For our sake today, we will call it pain.  Now there are some painless births, but I’ve only gone to a handful of them,  but no one denied that labor isn’t intense.  

So this pain is traveling up the spine and registering in the brain.  The parent who is laboring may exclaim something like, “WOW!”  Now the endorphins may be present at this moment, or it may be in between cycles, but the doula or midwife or partner is sitting nearby and hears a calling to come help.  (How we know that is a topic for another day)

So the partner goes over and begins to give them “the best foot massage ever.”  That sensation has to travel up the leg and into the spine and up the same and similar neural networks to the brain to register.  So what once registered on a scale of sensations as only being about pain now must register as “the best foot massage ever” as well.  As they travel up the same neural networks, my theory or the legendary gate theory is that it is kind of like Southern California traffic.  Here in San Diego it kind of looks like what happens when the 805 and 5 freeway merge.  The information just doesn’t get there at the same rate.  

Now, let’s get back to the “best foot massage ever.”  Please note that it isn’t an “annoying foot massage.”   “An annoying foot massage” just might turn the intensity or pain volume up to 11 on a registration scale that really only went up to 10.

What else registers in the brain that might help with coping with this pain or intensity?  

……..

That’s right, the brain also has to register sensations that one can see, hear, feel, smell or even taste.  Now, I don’t know anyone who has used taste as a coping tool in labor.  (Ok, maybe once with salted almonds at the time of pushing, but that was an anomaly.)  Typically, other sensations are used to cope.  It might be listening to music or gazing at a candle or looking out the window or into their partner’s eyes.  These stimuli also have to register on this intensity scale and can compete with the neural networks for space.  However, if it was just about distraction, we would have disco balls in every labor and delivery room with techno music to boot.  Too much stimulus can actually increase the scale of pain similar to the annoying foot massage.  

Now, one of the things that can be provided for labor support during these intense contractions is back pressure.  I used to do a lot more back pressure when I was a doula.  I wonder about this shift in my work.  Maybe in home birth there is less of a need to have more hands-on touch because people stay in the zone.  Maybe I was a younger birth worker and less comfortable watching someone writhe in pain than I am now.  Maybe I am wiser and know that once I start with giving the back pressure, they may not want me to stop.  Maybe when it is so painful in the back I have more positioning tools to help a baby rotate and engage.  However, back pressure can still be a “go to” for coping in labor.  

Back pressure is compression around the sacral area.  Some people like it higher, but most like it lower near the sacrum.  Back pressure can help with pain or intensity in labor for several reasons.  First, the posterior ischiosacroiliac ligaments that come off of the spine and are stretched with the bulging of the sacrum are full of proprioceptors. That means that we can feel that more intensely when they are being pushed out.   Second, when a hand pushes down on this area it can also compress the nerves of the area.  It isn’t that these nerves don’t work with compression or one loses sensation.  In fact, what happens is, as in the Southern California freeway model from above, one of the lanes just gets compressed or shuts down.  

While laboring, we will go through many gates of fear, doubt, unknowing, and even sometimes what feels like terror.  How we meet those gates will vary as there are no exact directions of how to pass.  We might meet those gates with surrender or support.  We might meet them asking for help and touch or back pressure and repositioning for fetal rotation or words of encouragement.    We might even find that very seed of doubt that we have in those moments might be our biggest ally as we arrive on the other side stronger than before.  And we might find that labor support and being surrounded by love goes incredibly far in coping as we wait to pass on the way to meet our baby.  

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