Ep 124: Comfort Measures and the Benefits of Prenatal Massage with Sara Lyon

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Sara Lyon is the founder of Glow Birth & Body, a prenatal and postpartum massage therapy practice, creator of The Birth Deck, and author of You’ve Got This: Your Guide to Getting Comfortable with Labor. With more than 15 years experience serving as a doula, childbirth educator, prenatal massage therapist and mother, Sara has supported tens of thousands of families through their birthing journeys. Sara's work is grounded in her belief that quality, science-based birth education, and healthy, non-traumatic birth experiences are a human right and should be readily accessible to all.

I'm super excited to share that Sara recorded an exclusive video for students of The Birth Preparation Course going over even more comfort measures in labor! And she’s offering a special discount on her birth deck and book for Birth Preparation Course members too!

In this Episode, You’ll Learn About:

  • How Sara’s bodywork studies in Australia eventually lead to her career in prenatal massage
  • What are the benefits of prenatal massage
  • What are the risks of prenatal massage and how common are complications
  • How does prenatal massage differ from other forms of massage
  • How the birth deck can be used to comfort women during labor using four categories: movement, mindfulness, massage/touch, support
  • How small details and setting can significantly affect labor and birth

Links Mentioned in the Episode

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I want this podcast to be more than a one sided conversation. Join me on Instagram where we can connect outside of the show! Through my posts, videos, and stories, you'll get even more helpful tips to ensure you have a beautiful pregnancy and birth. You can find me on Instagram @drnicolerankins. I'll see you there!

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Ep 124: Comfort Measures and the Benefits of Prenatal Massage with Sara Lyon

Nicole: In today's podcast, you're going to learn about prenatal massage and comfort measures during labor with Sara Lyon. Welcome to the All About Pregnancy & Birth podcast. I'm Dr. Nicole Calloway Rankins, a board certified OB GYN who's been in practice for nearly 15 years. I've had the privilege of helping over 1000 babies into this world, and I'm here to help you be calm, confident, and empowered to have a beautiful pregnancy and birth. Quick note, this podcast is for educational purposes only and is not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com/disclaimer. Now let's get to it. Well hello there. Welcome to another episode of the podcast. This is episode number 124. Thank you. Thank you for being here with me today. On today's episode, we have Sara Lyon. Sara is the author of the Birth Deck and her forthcoming book.

Nicole: You've Got This: Your Guide to Getting Comfortable with Labor. She's also the founder of Glow Birth And Body, a prenatal and postpartum massage therapy practice that serves Oakland, New York City, and also Chicago. Sara has more than 15 years of experience as a doula childbirth educator and a prenatal massage therapist. She has supported thousands of families through their birthing journeys and her work is grounded in her belief that quality science-based birth education and healthy, non-traumatic birth experiences are a human right and should be readily accessible to all. Yes, to all of that. Sara and her family split their time between bustling New York City and the beautiful San Francisco bay area. Sara has a really unique background for how she came to this work. She started out being interested in menopause. Actually, she studied in Australia and you'll hear more details of that in the episode.

Nicole: And I also love how very serious she is about what she does, being a prenatal massage therapist and doula, and her education are not like casual side hobbies for her. She's very serious and committed to in depth study and science of her work. And I really enjoyed our conversation and you will too. So you're going to learn about how prenatal massage differs from other types of massage, the benefits of prenatal massage, risk of prenatal massage. And then she's going to give you some practical tips for how to be comfortable during labor. And she classifies these tips into four categories. They come from the Birth Deck, her deck of cards that she has, which I love. One is support. One is movement. One is mind, and one is massage. And again, you're going to walk away with practical tips from each of those after listening to the episode.

Nicole: Now, before we get into the episode, a couple of things, number one, I had some problems with the recording settings on my side of the audio. So the first part of the episode, my audio is going to sound a little bit off, my apologies for that. And then the second part, that's way more exciting. And that I'm delighted to share is that Sara recorded an exclusive video of more comfort measures just for students of the Birth Preparation Course. And she is also offering a special discount on her products just for students of the Birth Preparation Course. So you can find that discount in the member area, as well as those videos, they are there waiting for you. And if you're not part of the Birth Preparation Course, then come on and join us. You can check out all the details at drnicolerankins.com/enroll. And the Birth Preparation Course is my signature online childbirth education class that gets you calm, confident, and empowered to have that beautiful hospital birth by helping you prepare your mind, understand your body, your labor and birth, and then also secure the right support for your labor and birth experience. Again, check out all the details of the Birth Preparation Course at drnicolerankins.com/enroll and also check out that exclusive video and discount from Sara as well. All right. Let's get into our conversation with Sara.

Nicole: All right. So thank you so much, Sara, for agreeing to come onto the podcast. I'm excited to have you here.

Sara: So nice to be here. Thank you so much for having me, Nicole. I am Sara Lyon and I am the author of the Birth Deck and of an upcoming book called You've Got This: Your Guide to Getting Comfortable With Labor. I'm also a doula and a birth educator and the owner of Glow Birth And Body.

Nicole: It love it. Love it. And what about your family? Do you have any?

Sara: I do. I have two young kids. I have a seven-year-old and a three-year-old.

Nicole: Okay. All right. Love it. Love it. Love it. So why don't you start off by telling us about what led you to become a doula childbirth educator and also a prenatal massage therapist.

Sara: I started this journey from a research perspective in college, and as every young woman does, I went straight into studying menopause, and I was so interested in what my friends' mothers were experiencing and watching how their experience of letting us go was sort of mirroring, mirroring our experience of going out into the world and then watching them wonder what they were going to do with the rest of their lives. So I really got interested in the hormone experience that they were having, what their endocrine life was doing and how that was mirrored in society back to them and what that told them about themselves and then how that impacted them.

Nicole: Okay, Sarah, that is not typical. I don't understand why you'd be interested in that. I love it, but it is not typical.

Sara: Not at all. It was. So I found it so interesting. And then you start looking through the medical literature. So this was all from a sociological perspective. So I was really diving deep into what the literature looked like for the previous 150 years around menopause and how the language that the medical institution and a lot of pop medical research. So you remember that book, um, I mean just before your time and certainly before my time as well, um, what is it like how to talk about sex, um, and, and like all the things you didn't want to ask and it was in the sixties and this book was so interesting and there's a line where the author literally says a woman will feel as though she is following her ovaries into oblivion. And in reality, she is. And it's like, wow. That that's like, really, it's not teeing up like a really exciting last chapter of your fertility career, you know?

Sara: Um, so I think, I thought it was just really interesting and, um, you know, so I start from that. I start from that perspective. And then, um, I'm learning about women's health through this lens. And when I decide to leave college and I'm thinking, okay, I'm going to go for a policy or a research career. I'm thinking sociology, I'm thinking public policy. I'm thinking public health really want to figure out what that's going to be. So I decided to go to massage therapy school partially as a conduit to not only paying for graduate school, but also to having sort of like, um, a clinical adjacent career where I'm working with clients and I'm able to see how their bodies are changing over the course of time from a therapeutic perspective as a massage therapist. And I went to Australia to study and they have a really different approach to medicine just generally now their allopathic medicine definitely mirrors ours, but they have a huge Asian influence in their population.

Sara: And that influence, well, I think that people talk about how it's a huge culinary influence and how it really adds to the tapestry of Australia. Um, the, the reality is it also brings all of these different therapeutics to the continent and the medical system has embraced it in a way that our system doesn't. I also think it has to do with, um, I guess it's like really a tangent, but I also think it has to do with how, uh, with having a more socialized and nationalized healthcare system where they have the, the medical system has a huge investment in prevention because the cost fully comes back to the government versus here where it's privatized. So being unwell is actually really lucrative for the systems. Um, and, and not even hating on allopathic medicine, because it almost has nothing to do with medicine. It actually has to do more with systems and organizations, right?

Sara: So, so anyways, so my, as a result of all of these little nuances, um, in the culture and in the medical system, I got this super thorough education, um, as a bodyworker, as a clinical massage therapist. And then my treatments as a massage therapist in Australia upon graduation were fully covered by insurance. So by their insurance. And so I was able to work and I was trained by osteopaths and physical therapists and, um, Bodyworkers osteopathic Bodyworkers. So I was able to, I could work in clinics. I could work in hospitals. I worked at, you know, the, one of the biggest cancer centers in Australia tested that out. And I started to get really, really interested in prenatal care and prenatal bodywork. Um, and then one of my, um, first bosses sort of took me under her wing. She was a midwife before and had started this, this retreat center called Body Freedom with her partner in downtown Melbourne, Australia. And, um, yeah, she took me under her wing and I had a few other mentors who taught me everything about birth education, birth support. And then I started going to births with clients. It was a really organic evolution. And this was in 2005, 2006. So this is, this is a long time ago. Um, and doulas were still super fringe at the time, especially in Australia. Um, and, and it was, it was cool. I, I essentially got to follow an apprenticeship model, which was so special. So that's how I got into all of this.

Nicole: Nice, nice, nice. Yeah. So I'm still, but you you're, you're born and raised in the US, but then decided to go to Australia?

Sara: That's right. I was born and raised in Southern California and then went to college in the Midwest at University of Michigan and then went to massage school in Australia. And then I ended up there for five years. I really started my practice as a bodyworker there. I started my career there.

Nicole: Gotcha. What in the world? I'm just curious. I always like hearing people's stories. Why Australia, like what led you to Australia in particular?

Sara: Really learning about international systems and medical systems and how they support women's health. Um, really again, from more of a sociological perspective. Um, and I could, there was just no doubt that, I mean, for example, I studied for two years full time and, um, that is a really intensive program. You know, I did over 2000 hours of study that is significantly more than you get in this United States as a basic program.

Nicole: Gotcha. Love it. Love it, love it. So you went through all of this training, so started on the spectrum of the menopause and then came all the way back to the other end of childbirth, which is where you still are today. Um, and do you still, I know you have also, in addition to your book and the Birth Deck, uh, prenatal massage studios, is that right?

Sara: Yes. So, because I came into this through massage therapy, right? So my, my interest in birth support, birth work, childbirth generally really came from massage therapy. And it's such a great tool for tracking something that is as, as fluid and as, um, ever-changing as a pregnancy, right? So every time you see a client they're presenting with a different physical issue, they're presenting with different emotional and endocrine issues. And all of those things you quickly learn are wrapped up into this one larger system, which is that fertility, that fertility spectrum, right? Um, and so I own prenatal and postpartum deep tissue massage therapy practices.

Nicole: So Sara, let's talk a bit about then prenatal massage. How about, what are a couple of benefits of prenatal massage?

Sara: Prenatal massage is so good for your body and for your mind, we all know how relaxing it is. And there's a reason for that. Because your body and your is going to be responding to the, not only just the touch, but the whole atmosphere of quiet, of peace, of solitude. So whether or not you already have children, or this is your first pregnancy, a prenatal massage is going to give you some time to dive in, to be quiet and to essentially get into a meditative state without having to have a meditation practice. Now that alone is really beneficial. We all know, or we've heard certainly about the research on meditation and how it can help, not just calm your mind, but then calm your entire body. So we have, um, primary benefits being, uh, an increase in oxytocin. So oxytocin is this magic hormone that governs so much of, of procreation and of the childbearing year, as your oxytocin has increased, your, the rest of your stress hormones are going to decrease.

Sara: That's going to impact not only you, but also the fetus, right? So the baby is also going to be experiencing the oxytocin, which is going to reduce the stress chemicals in their body as well, because you guys are in, you're in a shared system, um, a shared endocrine system during gestation. So with that in mind, um, towards the end of pregnancy, it's also putting you in a better position to go into spontaneous labor and for that labor to be stronger because you, your body's already primed to release oxytocin and to turn off stress hormones. And the reason why meditation is so important for the body and for the mind is because it teaches you how to control those otherwise subconscious seemingly completely unconscious triggers, right? Th those systems in your body. So turning off your stress response system, turning on the relaxing hormones that we need in order to have those really productive contractions.

Sara: Um, so it's increasing your, your good, your happy high hormones, it's decreasing your stress hormones. So we got that. Um, in addition to that, it's going to be good for your blood pressure and for overall system health. So when I say system health, I'm really referring to the lymphatic system. So keeping your body in a, you know, people get, so they get all sorts of edema. Edema is another fancy word for swelling, and just the simple act of massaging up towards the heart, even without a lot of pressure can be really beneficial. Um, so, you know, we all know that massage therapy is going to help with our muscle tension and things like that. But I don't think as many people know that it's really great for swelling as well. And then finally, it's really great birth preparation because when you're, especially with deep tissue massage, learning how to relax into pressure and sometimes pressure that goes into discomfort and then maybe even pain in order to release something that is actually pathological for your body. So whether it's giving you sciatic pain, or it's giving you neck and shoulder tension and headaches, if we need to work into those muscles and you learn how to work with that intensity, that is again, kind of like the meditation it's training your brain to roll, to let your body relax is training your body to relax with that tension, which is something that you will, it's a skill you then carry that into your labor.

Nicole: One hundred percent. That makes perfect sense. Are there any risks of prenatal massage that you know of?

Sara: There are a few risks, but they're very minor. And the primary risk really is, um, dislodging a clot in specially in the lower leg that can travel and really it's the lower leg because that's where they're most common, right? So a deep vein thrombosis that could end up carrying through to the heart or to the brain, but that is so, I mean, incredible. I've never heard of it happening in real life to anyone. And I've been doing this work for almost 20 years.

Nicole: Gotcha. Gotcha. I know something I often see is an association or people, or like warnings about prenatal massage in the first trimester. But as I understand, there's actually no research that shows that that's really a risk. It's more a caution that someplaces take. Is that right?

Sara: That's correct. There's no research on it. I mean, there's very little research on women's health generally and on pregnancy, unfortunately, we'll get there. I mean, to be fair, I don't think that there are many pregnant women who are like volunteering for studies, you know, so I get that. It's, it's not like it's some grand, um, you know, whatever, it's fine. Yeah. Um, it's a big conspiracy. Um, but, um, yeah, there's no research on the first trimester massage, um, warning now with that said, I have a very, um, a very experienced and liberal stance on it as a result of my experience, if somebody is coming in to get massage therapy and they've been getting massage therapy throughout their lives, not super frequently, but like, you know, maybe once or twice a year or whatever, it's very unlikely that getting a massage of any kind is going to cause an issue in first trimester.

Sara: Now, what are the caveats, right. If someone's super nervous about it, they shouldn't do it or what's going to cause the issue probably more likely going to be the stress hormones than, than the, you know what I mean, the adrenaline, the cortisol than the actual massage. So that, and also you're just not going to enjoy it. So what's the point. So I would say if you're scared, don't do it. The other thing is, um, you know, I'm not going to tell somebody like, listen, your, your first trimester, you know, you've never really been a runner, but maybe you should start running. You know what I mean? Like almost virtually the same advice. There's very little research on exercise in pregnancy and exercise in first trimester. But your doctor's going to say to you, like, listen, if you're, you know, maybe you don't run first trimester.

Sara: And you know, a lot of the midwives that I know would, would generally say the first trimester is a time to sort of hold the energy, right? There's a reason why your body basically puts you down for three months. And it's because you need to build a ton of blood. You need to build up to 60% more blood volume, right. So that takes so much energy. So if you're feeling like you just want to cocoon, and if part of that cocoon process is getting a massage, then great do it. It actually will probably be quite regenerative for you, um, and restorative. But if you're not really feeling it and it's making you nervous and you've heard, you know, this sort of like pop-sci stance on, on the risk factor, then you really need to follow, um, you need to follow what your intuition is telling you in that, in that capacity.

Nicole: Yeah, absolutely. A hundred percent, a hundred percent. And then, um, how does prenatal massage differ from other types of massage?

Sara: Depending on where you're going in some places they'll put you face down in the belly hole, in a table that's crafted specifically to fit boobs and a belly, right. Breasts that have there's like breast holes and a belly hole. Now those massages part of the allure of those massages is that they aren't that different from a normal massage, right? And so women get are excited because maybe they've had bad prenatal massage experiences, or they've heard that prenatal massage is just like, aren't that great, which to be honest, can oftentimes be true. Um, and that's why we're so popular. It's because it's not true in our practice. Um, but in our practice, we do everything in the sideline position. And the reason we do that is because we want to be able to access all of the special and juicy bits of the body that are particularly stressed and strange during pregnancy.

Sara: And in fact, many of our clients come back and they choose to continue getting sideline massages along after they've actually given birth, even after maybe a C-section scar is healed and after they're no longer breastfeeding and their breasts aren't engorged or anything like that, they'll still want to be sidelined because it's so good. So we work, if you think about the, the line of the body in the sideline position, we use these big bolsters that are extra firm, so that you're not, you know, rolling in any direction you don't want to. And we have a pillow that is specially formed so that you don't get that crunchy shoulder on the bottom. And we oftentimes have clients want to buy just the head pillow for sideline sleep at home, but the system is only sold as a whole through Oak works. So you would have to buy the whole thing.

Sara: Gotcha. Um, but it's that comfortable. And so we work so that we're working specifically the hips, the lower back, we get a lot of mobility around the shoulders. We get to work all of those inner leg meridians that, and which are essentially nerve channels that are so powerful for the uterus uterine health, um, for fertility generally. So we like to work in that position if somebody is trying to conceive, um, and it just exposes all of the different parts of the body that are going to be extra, um, extra benefited by massage during pregnancy.

Nicole: Love it, love it, love it. Um, you are obviously very serious about your work. Yes, yes. A hundred percent. A hundred percent. And then the last thing I'll say before we move on to birth positions is how frequently do you recommend that women get prenatal massage?

Sara: As often as you can afford it. There we go, boom. You're not drinking wine. You're not smoking weed where available. Um, you know, and you know, what the best part is, your partner is like, honestly, whatever it's going to take for you to just chill, I'm 100% here for it. So that is the, that's the beauty of it. And it's also, it's a great gift to ask for. Um, but if for most of us, you know, once a week is not an option, right? Cause like in an ideal world, I think most of us would love to dip in for a massage once a week. But assuming that it's not possible, certainly is not for me. Um, I, I, we recommend once a month and then in the last two to four weeks of pregnancy once a week. And that's because we want to get that oxytocin really high. We want to keep your body and your mind it's really your mind. I mean, you know, that it is, it's a mental game. Labor is so much of a mental game. It's like your brain needs to go on vacation because your body's going to do the work. So it's such great training for that, you know, to just let go, let your body to experience and observe your body without being active in it is actually really powerful training for labor. So that's what I would say.

Nicole: Yeah. And I assume you recommend that people look for someone who has experience with prenatal massage.

Sara: Absolutely. I mean, honestly, I'm not worried about it being dangerous. It's just going to be boring, otherwise. Don't waste your money.

Nicole: All right. So let's talk about ways to comfort women during labor. So in the Birth Deck, which I actually have, it's lovely. And, um, you're forthcoming book. You talk about ways to comfort women in kind of four broad categories. What are those categories?

Sara: We work to the four categories that really form entirely, um, birth support. So movement, mind, or mindfulness massage, or really just touch, you know, healing touch. And then, um, our fourth category is support, which is essentially miscellaneous. And I can go more into that, but support really encompasses, you know, all the things that play on the senses that might be external to the body. So lighting, you know, making sure that mom is cool enough or warm enough, those of things.

Nicole: Gotcha. Gotcha. So, yeah, so let's get into it. Let's get folks some practical tips, um, throw from each of the strategy strategies, maybe one or two, if, if we have time, you were just talking about support. So let's talk about a couple of things that folks can do for support, whether it's themselves or the partner or, or how's it work.

Sara: So the deck is written for anybody to use who's in the labor room. Um, it's, it's deeply instructional. So the deck really has, you know, the bare minimum in terms of words. And, um, and then it, every card has an illustration or the actual dialogue that you were supposed to repeat. So in the mind category, for instance, so in support, um, something that I think a lot of people have heard about, but they don't really understand is the lighting components. So why do you turn the lights down? Right? You think like, what is this just like a mood I'm not trying to like, you know, get romantic here, which is a whole other conversation, but the reason why the lights are important is because your pupils dilate and they dilate like really, really big. And that's actually evolutionary. You're looking for danger, you're looking for light.

Sara: And most of us go into labor in the middle of the night, right. And for a first time labor, you're probably going to go into labor in the middle of the night. And you're probably going to give birth when it's dark again. Um, whether or not that's something you want to hear probably 24 hours later, you're going to be pushing a baby out. Um, and so lighting is important because your pupils are dilating to keep an eye out for danger in the environment. And danger would come in a form usually when we were evolving to give birth in the form of other humans. So it actually is to see light glinting off of somebody else's eyeballs, right? The glassy surface of an eyeball, or to see a fire of, you know, a campfire far away, um, or to see anything that's approaching that looks like it could be, um, could be endangered, you know, a danger for you.

Sara: So lighting is important because your pupils are super dilated and you're going to be super, super sensitive to that light. So when you walk into the hospital room, you'll be able to dim the lights. In most hospitals, they sort of got the memo about 10 years ago, 15 years ago. And they started building, um, dimmers into their switches. And these are the kinds of things. When you're going on your hospital tour that you want to ask about, do you guys have dim lights? Are you guys okay with us turning the lights off if we need to et cetera. So lighting is a super simple one that absolutely anything anyone can do.

Nicole: I, you know, I hate bright lights in the delivery room and I will say that, um, y'all all physicians, healthcare providers in general are often not sensitive to this. They come in the room, they flip on lights and I don't think people mean anything by it. We're just not necessarily trained to recognize it. So do not be afraid to say, can we please keep the lights low? I think it just creates a much nicer. Um, you know, in addition to the things you mentioned, like, uh, uh, say it makes you feel safer and like more, more comfortable in the room. I love like stringing up white Christmas lights to help to create like a little bit of light, but I, 100% agree, like bright lights, I don't think are the right or the best atmosphere for, for babies to, to come into the world

Sara: Signals to the brain that there's danger. And when the, when the mammal brain senses danger and labor, it cuts contractions down or off because it says this is not a safe environment in which to release this fledgling this little vulnerable baby. So. Okay, cool. Shut the process down. You know, you think about us like in a, in a former time, which it really wasn't that long ago, honestly. Um, you know, where now we have to walk to a new environment or wait for the danger to clear and then labor starts again, which if you think about it, that makes sense, right. From what you've, I'm sure seen in, in your labor rooms, right. It's like mom needs to calm down and lo and behold, the contractions come back when she's feeling safe and secure again. Right?

Nicole: Yes. And I can tell you, uh, labor will stop if you're scared and in extreme circumstances, when people are really, really scared that I have, you can give people like a bucket buckets and buckets of Pitocin, and it doesn't matter if they are scared, their body will stay shut down and labor will not happen. So a hundred percent agree. Yep.

Sara: It's so right on. That is so right on. Um, you know, it's, it's so interesting that you say that, uh, it's, it's exactly, it's exactly right. And there, so, you know, it used to be that we were afraid of all of, all of these external factors, you know, back like primal days when you're amygdala was like, you know, just really, um, tuned into your external environment. And now we're, our brain is still functioning like that, but a lot of us are actually just scared of labor itself. And so that's, what's so powerful for instance about this podcast and about all of you guys listening is starting to familiar yourself, familiarize yourself with what labor will look and sound and feel like instead of being afraid of those things, moving towards that knowledge so that when it happens, it's not so confronting to you that that in itself is instigating as is, um, you know, spurring that fear. Um, so I think that that's, that's really smart, so important.

Nicole: So let's talk about movement. What is something that folks can do with movement?

Sara: Movement is so crucial for labor. Remember, you know, I'm sitting here looking at a model of a pelvis right now in my recording area, and the pelvis has to move in order for the baby to move down through the pelvis. You have all of these bones that need to, that need to get out of the way for the baby to actually navigate that bony environment. Um, and I think a lot of us forget that, you know, we kind of feel like there's like this inert hole that the baby's coming out of. And like, that's that it's not so simple, you know, so movement is really crucial. Notw the vast majority of birthing folks are going to be in a forward-leaning position if they are left to move however they want to. So, um, one of the most important things that you can do is you can get a birth ball and start working with that at home right now.

Sara: I bet you guys have talked about that before on this podcast, you're going to get a big ball. That's like an exercise ball, a Swiss ball, and you can sit on the ball and then you can lean your upper body forward onto any surface that you want. So my favorite position for labor is called ball and bed in the Deck, and I'll just read the instructions. So you get a sense of what the instructions sound like, Sure, these cards. Um, so there's a really, really brief introduction. This position allows mama to be active during a contraction by rising onto her forearms on the bed. When she needs rest between contractions, she should relax her upper body onto the bed and pillows. So bullet points for instructions suggest that mama sit on the birth ball lean forward and rest her head and arms on the bed. Add pillows if the bed is too low. Add appropriate massage techniques, while she's in this position, like double hip squeeze, lower backstroke leg squeeze, and third eye press. So layering, these techniques is really, what's going to address multiple sensory systems at once. And that's going to bring the greatest, the greatest comfort.

Nicole: Awesome. And birth balls are not that expensive. They're just big exercise balls. I think you can get them for like 20 bucks on Amazon or something like that. They're not terribly pricey.

Sara: And you can get them blown up really quickly and for free at most sporting goods stores, they'll just take them back and blow them up from you where they work on like bikes and stuff like that. Or blow up soccer balls. Yeah,

Nicole: I did not know that, good tip. Good tip. So, yeah, and I agree movement is really crucial and even tiny millimeters of space can make a difference as to whether or not a baby's going to be able to move through the pelvis, those little bits add up and they definitely count. So movement is really, really important. And if you can start working on some of those things ahead of time, then that is great. And I would say, you know, well, I know like you, you can practice these things, but it doesn't have to be overwhelming or anything. Correct. Like, you don't feel like people need to be starting halfway through their pregnancy. And every day you gotta go through all 50 cards or like, how do you recommend sorta approaching things?

Sara: Absolutely not. Yeah. You, I mean the whole point of the deck and the reason I wrote it to begin with is because it doesn't handle a lot of ways. It almost doesn't matter if you practiced it, because again, let's go back to these hormones, right? Like adrenaline, you're going to be so excited. You're in your labor are going to be a little bit nervous. There's a lot going on, you know, you're figuring out who's going to watch your dog and who's going to watch your older kids. And it's like, you know what it means, or it feels like the house was on fire. Um, and, and so a lot of that knowledge that you've gotten through reading and through your classes are going to go out the window. Um, but if you have what I think of as like the cribs note and the crib notes, you know, like your cheat sheet, then you can always refer to those notes or to these cards, for example, to give you a reminder.

Sara: And if you start practicing around, I would say like 32 weeks, um, if gestation is usually 40, then you're going to have more than enough time to practice. And really the first thing you want to do is, you know, if you're pregnant is just go through the cards and see what even appeals to you at all. Because some of this stuff will, some of this stuff won't, you might be surprised and labor something that wasn't exciting to you when you were pregnant. It might actually be exactly what you want and need in labor. You don't always know if it's your first labor, what your body's going to do and feel like, um, but just, you know, having them around, they're also such great reminders for a nervous partner, you know, thinking about what that partner is experiencing. We so often forget that and your partner needs to feel empowered, um, in order to actually empower you in order to help you. So having something nearby that can help them feel like, okay, I didn't just sit there and not know what to do. That is by far the, the majority of the feedback we get is that it's such a great, helpful tool for the partner to remember things that they've talked about during pregnancy, or even just to bring them out for the first time ever in labor as well.

Nicole: Right. Love it. Love it. So, um, let's talk about massage. What is the massage technique? How about the double hip squeeze? How about we talk through that? Cause that's a really common one.

Sara: That's the one I've known doulas who have to carry wrist guards in their bags because they have to do so much for so long during labors. Okay. So a double hip squeeze is like the foundational support technique, and that is quite simply squeezing in at the hips in the area that I call the happy moon. So not on the bony bit, that's right on the side of your hips, but in that sort of squishy great bit. If you were to hold at a woman's proper waist, like where her jeans sit in a high-jean, high-waisted jean and then come down about one handprint, right. So right under that. And you want to get to the squishy bit that's in between the top of the pelvis, the pelvic ridge and the bone. That's the top of the leg bone on your side of your hip, which is called the greater trochanter.

Sara: And that area, right there gets a lot of intensity during labor because as the baby's moving into the pelvis, it starts to, um, oftentimes radiate pain out through just because it's pressing against the nerves in the pelvis. Um, it's, it starts to radiate pain out through the sides of the hips and the glutes. So by holding in there and providing counter pressure, it's not only really comforting, but it can alleviate a lot of that discomfort. A lot of that pain that you might be feeling through your glutes and through your hips. So you hold on and it's like, you're doing a Peck fly where you're bringing your hands straight in your palms, straight in towards one another to squeeze at the hips and you just hold there. And, you know, in labor, usually less movement is better. So less is more usually in labor for these positions that you just hold.

Nicole: Got it, got it. Got it. Okay. Um, and then let's end with the last one talking about, and I should say you also have some, um, you on Instagram, you demonstrate some of these techniques, is that correct? Or YouTube?

Sara: Yep, exactly. Both on Instagram and on YouTube. I have dozens of videos showing you guys how to do these techniques. And so you can always tune in there.

Nicole: Love it, love it. So let's talk about the last one, which I think is in many ways, the most important or foundational one, and that is the mind.

Sara: Mind is everything. So as we've harped on this entire time, this entire podcast episode, it's all about the mind. It's about what your mind is going to tell your body to do. And your mind is the computer, right? Your mind is looking around, it's taking in information and then it's sending signals out to your body. And your job is, especially if you are supporting someone in labor is to help mama feel really grounded and safe, safe, safe, safe is everything right? You want her to feel like she can do it. And like she is totally supported by everyone around her. And if you're giving birth in the hospital, it's important that you guys meet the people that are going to be caring for you. It always helps to bring some kind of a gift, Trader Joe's treats always do it, something in that amazing aisle, above the freezer section and meet everyone who's going to be helping you guys during labor. Who's employed by the hospital, give them your gratitude. And even that simple act of meeting everyone is super helpful. Then you move into the room, you start, you know, labor, maybe labor slowed a little bit as you've transitioned because you're in a new environment. You're going through the bright lights and triage and the insurance card and blah, blah, blah. And you don't worry, you don't worry. Contractions are going to come back. You know that you're going to meet the strangers around you and mom's going to be like, okay, cool. I get it. I, I, okay. I see this I'm here. We're cool. And then you can start with something as simple as affirmations. So we do have, um, hypnotherapy script and guided imagery in the deck, which are longer and more, I would say things that really need a little bit more practice if you want them to be super effective, whereas affirmations or are helpful for absolutely everyone.

Sara: So one of my favorite affirmations, but it sounds so simple. And I'll just read a couple of them, um, on the front of the card, it's where an illustration would be for an, for example, in a massage technique here, we just have the quote quietly, say, you can do this. You are so strong. You can do this. Then on the back, we simply say the sedating impact of labor's natural hormones and any narcotic used for pain medication will make mama feel extremely tired and even weak. Additionally, it's normal for women to shake or shiver at different points in labor, due to the healthy, normal labor hormones, the fatigue and the shaking can be alarming and even scary for some women reflect her strength back to her by reminding her how strong she is and that, you know, she can do it. So again, it's super simple.

Sara: You can do this. You are so strong, you can do this. And the reason why we talk about the shivering or the shaking on the back of the card is because that is really scary. Usually for the support person to watch that happen. Now we as birth workers get really excited, right? Like when, like for you, as a doctor, you see that and you're like, okay, cool. Like we're about, we're going to have a baby pretty soon. You know what I mean? Like if we're there, that means that we're at transition. And like, it's, we're about to like, get ready now for, you know, and hopefully if she's unmedicated at that point, she'd probably like drooling a little bit. Ideally, you know what I mean? Like we've got bloody show, like everything is a mess and we're so stoked to see it because that means that she's letting go and we need that process.

Sara: Right? So as the hormones shift, it's important for the, for the partner, for the support person to still be able to confidently look their partner in the eyes and say, you are, you are safe. You are healthy. This is exactly what's supposed to be happening. You are so strong, but if they don't know that those things are gonna happen, how can they know that exactly. Right. Yep. Yep. So there's like the tiniest little bit of information on the back of the cards. Whereas the book has like so much more information with that said it's still super accessible. The whole point of anything that I do is really ideally to bring knowledge in a digestible capacity so that anyone can access it. But the book will go a little bit further into why is the mind doing this? And what does it mean for the body and how can you impact that externally?

Nicole: Yup. Good. Good. Love it. Love it. Love it. All great information. I especially love the piece about, um, partners. Not, it can be, let me back up. I guess I can say it's the way that labor is depicted in our society. Like on TV in the movies is so like made up. It's just completely false. And most people don't actually get to see what labor looks like. Like back in the day, people, when people gave birth at home, like you would see your mother or your sister or whatever. So you had some idea and also partners weren't really there. So they didn't have much of a, um, a view either. But so there's lots of things where we don't see it, like what's normal. So I'm say all that to say is, it can be overwhelming when you see what it actually looks like. And for sometimes people think that we're not like not taking account of people being in pain or they're, they're, they're screaming or the way they look. Um, it can be a little bit unsetting leading because it looks like the healthcare providers are ignoring ignoring it. And we're not. It's just that we know that this is what normal labor looks like. So in order for you to have some idea of what to expect and be able to help someone through that, it's really important.

Sara: Absolutely. And research does show that a woman who feels heavily observed actually will be less efficient at labor. So women actually don't want to feel like they're being heavily watched again, go back to that primal brain, right? You want to feel like you are in isolation. If you've ever seen an animal have babies, like, you know, you were seen a cat or a dog, they will go back into like the darkest corner of the house behind the washing machine, right. Unless they're in distress. And then, and then when there's something wrong, then they'll come and find their human to help. Um, but usually if they're having a normal, you know, healthy labor, they will actually go and find isolation in order to do that. And a lot of us are the same way now. I always think it's so interesting. W exactly what you said about, you know, we don't birth in community anymore.

Sara: So the first labor we see is our own or experiences our own or our partners. And, and so we have truly no idea what, what we're walking into, whereas, you know, if you've seen it happened before I worked, when I was a young doula, I worked in a hospital in the UCSD, um, birth center, which is right in downtown San Diego, which is mere minutes away from the border of Mexico. And we had a lot of Mexican families, some of whom, um, were didn't speak any English and they would come in and they, um, and they would bring like their whole families. And it was so amazing to see like, just, I mean, I'm talking like actual literal catering. Right? Right. Like, like it's such a delight. And then they would also call in the volunteer doula. So it was like this, the more support, the better.

Sara: But then they had really specific protocols about who was in the room when and why. And, but it was all very respectful and this really well-oiled machine. And I was once helping a family. Um, and I was standing next to a little girl. And at this point again, I probably had only seen like, you know, 10 births or something like that. So I would still like, basically cry every time the baby was born, which let's be honest, like still to this day, but this was like, I couldn't help myself at that time. I'm, I'm so excited. Mom's pushing, I'm standing next to this eight or nine year old. Who's standing next to her on D and I look at this little girl and I'm like, oh my God, are you so excited? Is this your first birth? She looks at me and she goes, this is my fourth birth this year. Yeah. And it was February. I was like, you're like, oh, oh, okay. Okay. Got it. Got it, got it, got it. Got it. My bad, my bad. Right. Like such like, uh, American white woman moment or just being like, oh wait, that's so strange.

Sara: It's so eye-opening and I really, um, I don't know, like it's, I just, yeah. Birth is its own animal animal. And if you don't know it, you don't know it until you know it.

Nicole: Right. Right. So as we wrap up, what would you say is one of the most frustrating parts of your work?

Sara: Trying to, um, like trying to like package my frustration to put it mildly at how ill supported physiologic birth is in this country and then transform it into something, transform my knowledge and my understanding into something that is truly palatable because coming with straight with rage is like, not the way, um, not always, you know what I mean, there's a place for that, but that is not my way or this way. That is not my way. And I really early on recognize my place in my privilege and how I will best use it. Um, I think, you know, when it's time for when it's time for another way, I will be here for that. But, um, I would say that's the most frustrating thing it's sort of watching clients, whether it's birth education clients or massage clients or doula clients be disactively disempowered by other providers, which is why I so respect what you do here and what you do in your career broadly. Um, and have done because supporting, being supportive and being curious, you know, being curious as a provider is so crucial. And so I really respect that because it's hard for me when I see people not really having their, their needs met, um, psychologically or physically when it really, I think is there. Right.

Nicole: I agree 100%. And, um, um, you know, it definitely took me some time to really realize the, how the culture of our system was, uh, wrong. And, you know, I, I didn't get it at first, but now I do, we do not place women or birthing people at the center of that experience. And we should all kind of gather around her, um, which is not what we do, but it can be frustrating, especially when I'm sure you hear. And we can have a whole nother episode about this. People sometimes like straight up lying about stuff and just, you're like, that's just not accurate information like fear tactics and things like that. So I totally totally get that. So then on the flip side, what's the most rewarding part of your work?

Sara: Connecting with people and really helping them to change their own lives and the trajectory of how they interact with their bodies and how they then educate their kids about their own bodies. Um, and not even in like what seemingly is super radical, right? It's just like non traumatic birth. Something is like basic as non traumatic birth can be so powerful for how we think about ourselves forever and how we then talk to our kids about what they're capable of.

Nicole: Yes and, it's like, I always say, like, it's not, we're not like a building rocket ships. We're just asking that people get treated with respect and not have terrible experiences during the most than one of the most,

Sara: One of the most samples

Nicole: During one of the most important parts of their life. Like, that's like, that's it, we, I think we can do this. Like we can make this happen. It's not, it's not complicated. Like you said, it's not, um, um, huge, but it's very, very meaningful and very, very important. So I can, I can see that as well. So then last, last thing. What's your favorite piece of advice that you would give to expectant moms, dads, families, which are your favorite piece of advice?

Sara: So my biggest piece of advice is simply to get right with your partner and with yourself, confront anything that you think is going to crop up in labor, whether it has to do with postpartum, early parenthood, with birth and labor itself, are you afraid of tearing look into that, learn about it, learn about the statistics. So you understand like really what the risks are because usually the things you're scared of are something that you can either plan for. So going back to work, what does that look like? Finances are you, is our finances giving you anxiety? And is that the thing that's going to come up in your mind and labor, you know, look truly look at your life in pregnancy and think about, about how you can get as wise as possible about supporting yourself. And that does not mean face masks, you know, like really getting the work done. That's my biggest piece of advice. And obviously by the Birth Deck and buy You've Got This, which comes out on July 13th.

Nicole: There you go, there you go. So where can people find you, if they want to know more about you?

Sara: You can find me on Instagram @thebirthdeck and @glowbirthandbody, you can find us at www.glowbirthandbody.com and at thebirthdeck.com and you can buy, You've Got This: Your Guide to Getting Comfortable with Labor, which is a book that you can buy on its own. Or in addition to the Birth Deck as a full comfort measures course, you can get that on Amazon. It releases on July 13th or on our website, thebirthdeck.com or anywhere books are sold.

Nicole: Awesome. Thank you so much, Sara, for agreeing to come onto the podcast and share such great information. I love your passion and your seriousness, and your commitment to your work and serving pregnant folks.

Sara: Thank you so much for having me. It's always a pleasure to talk with other people who love labor.

Nicole: Alright. Wasn't that a great episode with tons of information I told you that you were going to enjoy it. Now, after every episode, when I have a guest on, I do something called Nicole's Notes, where I talk about my top three or four takeaways from the episode, here are my Nicole's Notes from my conversation with Sara. Number one, Sara talked about research in pregnancy and how people aren't necessarily like jumping at the bit to sign up for research. And I want to talk about that a little bit more in detail, because it has implications for what we know about how things affect pregnancy, especially medications. For instance, this is something that people ask a lot about, like, how does this medication affect my pregnancy? How does this, um, activity affect my pregnancy? And normally we get answers to questions like that from research, but research on pregnant people can be really, really challenging.

Nicole: Number one. Not a lot of people necessarily want to sign up for research because you don't want to take the chance of quote unquote, experimenting with your pregnancy and your baby. And then number two, there are actually some restrictions where pregnant people are prohibited from participating in research studies, by some government regulations. There's actually a lot of push to give pregnant people the ability to participate in research more if they want to, and not automatically just be excluded just because of pregnancy. An area that this popped up recently is with, um, research into the COVID vaccine and how that affected pregnancy. Pregnant people were excluded from all of those initial trials of the COVID vaccine in pregnancy. So now we're in this position, we, where we are gathering data based on just seeing what happens after people get vaccinated. So I say all that to say that when you think about like, what's the effects of this or that in pregnancy, sometimes it can be challenging to get that research and to get that information.

Nicole: And also when you do get information, you just have to look at it through that lens of the quality of the data as well. Because again, it's not going to be those typical, most high quality like randomized trial studies. Those are hard to come by in pregnancy, particularly for things like medications and interventions like that. Okay. My second Nicole's Notes from this episode is Sara talked about how mindset is one of the most important aspects of being prepared for your birth. And I could not agree more. Step one of my beautiful birth prep process and my beautiful birth prep process is the process that you go through the five-step process that you go through within the Birth Preparation Course to get you ready for your birth. And step one of the process is to set the tone for your birth. And by that, I mean, you need to work on your mindset and you need to get the right support, have the right people, the right types of support with you.

Nicole: The energy of your labor room needs to be on point. You can even learn about in the Birth Preparation Course, what to wear or how to manage medical students or resident physicians with your physicians in training as part of your birth and well, so I cannot agree more about that mindset piece, and you can get even more detail about that inside module one or step one of the Birth Preparation Course as well. And then the final thing that I want to say is that she mentioned how important it is for you and your partner to be on the same page with things as much as possible when you make choices and decisions about what you want to do for pregnancy birth and after the baby comes. And one of the things that's also important for you to be on the same page on childbirth education.

Nicole: I highly recommend that you and your partner both do childbirth education, it's going to make your experience go a lot better. That's one of the great things about the Birth Preparation Course is that you can do it together. It's all online. So you can do it when it's convenient for you. I have lots of folks say they like cast it to their television or, or iPad or, and just watch it together. And again, you can check out all the details of the Birth Preparation Course at drnicolerankins.com/enroll. And my third Nicole's Notes is I really appreciate how Sara talked about that you and your partner need to be on the same page with things with pregnancy birth and parenting. One of the things that's also important that you're on the same page about is childbirth education. It's really important that both you and your partner do childbirth education so that your partner understands things and can best support you.

Nicole: That is one of the great things about the Birth Preparation Course, because it's entirely online. You and your partner can easily do it together on your own time and in your own space. Check out all the details again, of the Birth Preparation Course at drnicolerankins.com/enroll. Okay. And my final Nicole's Notes is that I will respectfully disagree with Sara, that practice isn't necessary for comfort measures ahead of time. And that you'll forget everything once you're in the throes of labor. In my experience, and I've been doing this a long time, 15 years at this point, uh, those who are prepared and who have practiced ahead of time, do better in labor. Um, you may not use all of the tools that you learn and practice. You may find that some of them, you actually don't like when you're in labor, but you want to have those options there and you want to know how to easily use them if need be and not be trying to figure that out in the throes of labor.

Nicole: And that's where practice comes in and can be really important. So I recommend that you practice your comfort measures ahead of time so that you have those tools ready to go, and you can grab those tools when you need them. All right. So there you have it, be sure to subscribe to the podcast in Apple Podcast or wherever you're listening to me right now. And I would love it. If you leave an honest review on Apple Podcasts, I do shout outs from those reviews from time to time and, uh, those reviews also help the show to grow. I really, really appreciate it. And I just love hearing what you think about the show. Also, if you're not following me on Instagram, please do I'm there @drnicolerankins. I provide even more great content there about pregnancy and birth. I also do live videos and Q and A sessions from time to time.

Nicole: So do check me out there @drnicolerankins. So that's it for this episode do come on back next week. And until then, I wish you a beautiful pregnancy and birth. Thanks so much for listening to this episode of the All About Pregnancy & Birth podcast. Head to my website, drnicoleankins.com to get even more great information, including free downloadable resources on how to manage pain and labor and warning signs to look out for after birth. You'll also find information on my free online class, on How To Make A Birth Plan That Works as well as everything you need to know about my signature online childbirth education class, the Birth Preparation Course. Again, that's drnicolerankins.com and I will see you next week.