THE ALEXANDER TECHNIQUE IN NATURAL CHILDBIRTH
by Ilana Machover
Childbirth is a very finely-tuned involuntary process. It is regulated by a series of signals exchanged between the mother's brain and the rest of her body. The contractions of the uterus are controlled by the secretion of appropriate hormones during each of the three phases of labour: dilation of the cervix, birth, and birth of the placenta. This physiological-chemical process (which also has important psychological aspects) can easily be disrupted by any outside interference. It is frequently observed and well documented that labour may halt altogether when a woman gets emotionally disturbed.
This may be caused, for example, by critical whispers in the presence of the mother, expressing disapproval of her state of body or mind, such as "she is not making any progress", "her attitude is wrong", "she is fighting too much". A similar effect may be caused by a dramatic change in her environment, or by the psychological pressure of other people around her--well-wishing relatives who are impatient for the baby to be born. Similarly, continuous monitoring of her progress also put an enormous stress on the labouring mother. And anxiety releases the wrong hormones.
The mother cannot directly control her autonomous nervous system or her hormonal balance and any attempt to do this will be self-defeating. During the first stage of labour the woman does not "do" anything to give birth: the dilation of the cervix happens by itself, and all she needs to "do" is to allow the process to proceed. With each contraction, she should just move in a relaxed way, agree to accept the pain, and help herself to cope with it.
During labour it is very difficult for the unprepared woman to accept that the pain of the contractions is "normal". For the majority of women, this is the most severe pain they have ever experienced. Our society does not teach us to tolerate pain and we are used to taking painkilling drugs for the slightest discomfort. But painkilling drugs derail the natural process of birth by masking the body's signals and blocking their pathways; this often makes further medical intervention necessary, leading to forceps or caesarian deliveries. In order to accept labour pain as normal, we have to understand its role: Labour pain is not pathological but functional, and should therefore not be eliminated. But a woman can be psycho-physically prepared to cope with it.
In this the Alexander Technique can be of enormous help: we can teach the woman how to cope with labour pain rather than wishing to eliminate it. Through inhibition and direction (these are both Alexander Technique teaching terms) we can stop our habitual reaction to pain. Instead of flexing, tensing and pulling our heads back and down (followed by other symptoms of panic attack) we can consciously and voluntary undo the involuntary muscle tension. We can learn to exercise conscious control over our posture and movement. This, in turn, gives us an indirect conscious way of affecting the hormonal balance.
This is far from easy, since the startle reflex is activated in us many times during our daily life. We acquire the habit of going into this startle mode whenever we are stimulated to movement. Consequently, there is a lot of unnecessary muscle tension in most of us most of the time, especially during movement. It takes time to re-educate the body and replace habitual patterns of tension with those of release. But having learnt to move in her daily life without interfering with the primary control, a woman in labour can apply this skill during contraction. There is no need to be athletic or be able to perform all sort of complicated positions or exercises. In any case, most of these only enhance patterns of tension and misuse.
Of course we cannot expect a woman in labour to undo the harmful habits of a lifetime without previous careful preparation. During our lessons with pregnant women we can also prepare them for childbirth. It is now widely accepted that a woman should move freely and stay upright during her labour.
The Alexander Technique teaches us that it is not just a matter of what we do--staying upright and moving--but how we do it: using inhibition and direction. In fact, it transpires that our "monkey"(an Alexander Technique term for a standing position in which the knees are bent and the torso is tilted forward from the hips) is one of the best stances during pregnancy and is particularly advantageous during labour. In "monkey", as the mother leans forwards, her abdominal wall becomes a kind of hammock for the baby, while the tilt of her pelvis makes more space for the baby's head to enter the pelvic brim; thus the baby is encouraged to move into the optimal position for birth. At the same time, the force of gravity--the weight of the baby--aids contractions and makes them stronger and more efficient.
In order to soothe the pain, it is of paramount importance to move freely, so during labour this position of mechanical advantage ought to be used in a dynamic way: the woman can maintain her primary control while shifting her weight from one leg to the other, either on her own or supported by her partner.
Since many women find it helpful to go on all fours during labour, I looked for a way of making this stance more dynamic and integrating it with the principles of the Alexander Technique. I devised what I call the "pear movement": the woman is on all fours and, with her head leading, her body describes the shape of a pear parallel to the floor. Incidentally, this shape also echoes the outline of the uterus. The pear movement is useful in encouraging her to free her joints and prevent tension from accumulating, especially in the shoulders, arms and lower back. With her neck free and her head leading the movement, her back lengthens and widens, so that it does not sag and create tension in the lumbar area.
One of the means towards achieving a relaxed state of body and mind is salivation. The body of woman in labour gets a signal that a contraction is about to begin. At this moment she can choose not to adopt the pattern of the startle reflex but instead give herself directions: she should first think of a smile and allow her mouth to become wet. You may recall that one of FM Alexander’s instruction for the practice of the "whispered ah" (a vocalization procedure sometimes used in teaching the Alexander Technique) is: "think of something funny". A smile, or even the thought of a smile, releases the tension in the jaws and face; this loosens the pressure on the salivary glands and causes them to secrete. This is a preventive measure, so that the mouth does not become dry. Note that dryness of the mouth is one of the symptoms of a panic attack.
As I have mentioned, the body's mode in reaction to pain is very similar to that in a panic attack, exhibiting all the physiological symptoms such as dry mouth, palpitations, trembling and shaking. By allowing the mouth to become wet, we break the chain of symptoms, and the brain gets a message that everything is in order and there is no need for anxiety. This is one indirect way in which we can influence hormonal secretion. If at the onset of contraction, or rather a split second before, the mother allows her mouth to be wet, whispers "ah'", and starts to do the pear movement (or a dynamic form of "monkey") her whole attention is directed to the movement.
Her conscious awareness is engaged with the process rather than striving for an end - the birth - which in any case is beyond her direct control. In other words, she is only concerned with the means whereby, and no endgaining attitude is involved.
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Although the idea of natural childbirth has gained some popularity, it is still not easy to achieve in our technological Western society. The Alexander Technique can provide a feasible route to what many women are seeking.
This article is adapted from a presentation to the Fifth International Congress of the F M Alexander Technique, Jerusalem, 1996
Ilana Machover is a childbirth educator, a qualified teacher of the Alexander Technique and of Medau Rhythmic Movement. She assists at Misha Magidov's training school for Alexander Technique teachers in London, England and also teaches at the Royal Academy of Music. As part of her private practice, she runs special Eutokia classes for pregnant women and attends births as a doula. She has also conducted many workshops for midwives, childbirth educators and AT teachers on the application of the Technique to childbirth. Currently, she is running courses for Alexander Teachers who wish to accompany women to labour as doulas. She has published a number of articles on the subject. Together with Angela and Jonathan Drake, she wrote The Alexander Technique Birth Book, published in 1993. Ilana has two children and four grandchildren. Email: moshe.machover@kcl.ac.uk
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