Positive Health Online

Touch has always been used to help labouring women, and massage has been considered beneficial for labour for some time now (Enkin et al 1989, Nolan 1996). So it is surprising that there is no widely recognised system of massage specifically designed for use in labour. Linda Kimber, a community midwife of many years standing, has set out to remedy this deficiency, and has developed a set of simple massage techniques that require minimal specialist training, and which can be used in any setting. Ms Kimber's aim is twofold: to help the mother relax and cope with contractions, and to give the father an opportunity to be more involved in the labour. Her video is therefore aimed at couples, but can be used by any combination of mother and birthing partner and/or midwife.

This is a very easy video to watch. The presentation has been well planned, with material divided into sections that are easy to take in, linking in with an accompanying leaflet. The massage techniques are clearly explained and comprehensively demonstrated, with both mothers and massage partners in a variety of positions. Sensibly, it is acknowledged that massage can be tiring to perform, and may be needed for several hours; emphasis is accordingly placed on the partner's stance and posture, as well as the mother's. Necessary cautionary notes are sounded about proceeding with care where there are pre-existing back problems, for either mother or partner, and the need to avoid nut-based carrier oils in the case of nut allergies.

However, despite the excellence of the massage presentation, as a midwife I have some major problems with this video; a number of couples tell us how helpful the massage was, but we only see one woman actually using it in labour, and so it is her experience which makes the most impact on the viewer. Unfortunately this mother was transferred during labour from the low-risk unit of her choice, because she wanted an epidural. To use this particular woman as an illustration for a natural, soothing technique, aimed at helping women cope with their contractions, was to my mind very ill-judged, mainly because she was shown on camera, before she went into labour, saying that she didn't want an epidural. I am not suggesting that she shouldn't have had one, and I can appreciate the logistics involved in managing to record the 'right' labour; but showing this situation here reinforces our society's powerful assumption that women cannot give birth without the aid of pain-killing drugs. This cannot be helpful to women who want to give birth naturally, and who might reasonably be assumed to be a significant section of the video's target audience.

Even more seriously, the narrative and the editing of the sequence suggest that this mother needed an epidural for her own and her baby's safety, because her baby was in an occipito posterior (OP) position, i.e. the baby's spine was lying against her spine. Certainly OP labours tend to be longer, and with significantly greater backache for the mother; however, while an epidural will usually (but not always) ease the mother's pain, it does not make the situation safer; on the contrary, it can detrimentally affect both the progress and the outcome of the labour. Epidurals are associated with longer labours, a higher risk of Caesarian section - and consequently greater risks for both mother and baby - and postnatal problems (MacArthur 1994, Olofsson et al 1997, Alexander et al 1998). So if anything, epidurals add to the risks of labour; they do not contribute to its safety.

For me, these concerns seriously mar what would otherwise have been a very useful aid for parents. So while I would recommend this video to interested practitioners, I could not suggest it for parents, particularly a woman expecting her first baby, or anyone with a baby in an OP position. What a pity that the invidious nature of the covert message so detracts from the value of the excellent technique Ms Kimber has set out to promote.

References

Alexander JM, Lucas MJ, Ramin SM, and others (1998) The course of labor with and without epidural analgesia American Journal of Obstetrics and Gynecology vol 178 no 3 pp 516-520.Enkin M, Keirse MJ, Chalmers I (1989) A Guide to Effective Care in Pregnancy and Childbirth Oxford: Oxford University Press.MacArthur C (1994) More evidence against the routine use of epidurals Birth vol 21 no 3 pp 172-174.Nolan, M (1996) Being Pregnant, Giving Birth Cambridge: National Childbirth Trust Publishing.Olofsson CIJ, Ekblom AOA, Ekman-Ordeberg GE, and others (1997) Post-partum urinary retention: a comparison between two methods of epidural analgesia European Journal of Obstetrics and Gynecology and Reproductive Biology vol 71 no 1 pp 31-34.