Structural Integration and Prepared Childbirth (reprint)

I have been asked to share my work in training classes for Prepared Childbirth. I do this with the awareness that some of you may not have a special interest in the expectant mother, but that you do have an interest in posture, muscles, awareness, structure and the like.

My work is divided into two general areas:

1. The actual physical application of Structural Integration to create the type of body balance taught by Dr. Rolf.

2. Application of the principles of Structural Integration to create what I call Movement Patterns and Exercise Forms that encourage and promote structural awareness in the body.

I wish to cover the latter area in this paper and relate how some of these ideas implement a program in the preparation of expectant mothers for pregnancy and childbirth.

The program consists of a series of ten classes for the mother and six meetings with both husband and wife. It is an emotional and physical preparation of both parents for the birth of their child. For the mother this involves:

-Body toning and conditioning exercises

-Comfort during pregnancy and labor

-Methods of relaxation

-Awareness techniques to assist the mother to cooperate with her body
during labor

-Concentration exercises

-The anatomy and physiology of labor and delivery

-Body mechanics and posture

-Post-partum exercises to promote involution

Since it would be impossible for me to do justice to the whole program I will concern myself with the awareness techniques, and show how they work together with breathing technique to promote relaxation.

Throughout all practical work sessions the addition of viewpoints from the basic premises of Structural Integration is a constant source of improvement upon what would otherwise be just another exercise class. The point of the awareness techniques is to help the mother cooperate with her body during pregnancy and labor. Structural awareness is an easy and natural process to promote in the pregnant woman, but it often comes about the hard way. It is easy and natural because her structural awareness grows as her baby grows. It comes about the hard way since, over a period of nine months, she must adapt to several shifts in her center of gravity in order to compensate for the changes taking place in her structure. During the last trimester of pregnancy she must carry around a fifteen pound weight twenty-four hours a day!

The expectant mother is often acutely aware of the changes in her dimensions. She can be troubled by them both physically and emotionally. The non-pregnant usually have an escape hatch. They can “shut off,” “pretend,” “forget,” and use any number of devices to go out of communication with their structure. Not so with the expectant. Nature requires that she adapt or pay the consequences of further discomfort. If a confrontation with the nearest mirror isn’t convincing enough, the onset of labor should make the reality clear. She is indeed well-motivated to assume a more responsible role during her pregnancy and later during her confinement.

When she can be encouraged to sense and feel and willingly experience her changing body she is better able to live with the challenges these changes will bring. As one young mother put it, “I am much more aware of being pregnant now, but in a good way. I’m more with it. I know about what to expect now, and what I can do to help. I guess what I am trying to say is I am really going to have my baby!” Somehow to me this sounds like, “Giving birth is going to be my experience, not just something that happens to me.”

Getting acquainted with her pregnant self is one of the first steps that the mother must take to promote her structural awareness. I am continually amazed at the number of women who are afraid to touch their growing abdomens! “I’m afraid I’ll hurt the baby,” is a common remark.

Early in our work both parents are encouraged to touch and feel the wife’s abdomen, and for her to experience the sensations of tightness, firmness and pressure on the abdominal wall. Throughout this we are simply suggesting that she “feel the feelings.” Move into them rather than away from them.

Most students report that prior to this exercise in awareness they had interpreted these sensations as uncomfortable, and had tended to withdraw from them. Now they could see that this had contributed to their discomfort. By this time they are beginning to entertain the notion that resistance is capable of producing discomfort.

As pregnancy advances, what we call the “practice contractions” of the uterus can be more readily felt by the mother. Once again, she is asked to “feel the feelings,” to feel the differences between the movements of the baby and the more subtle movement of the uterus itself. She follows these sensations as they develop and feels them both in the pelvis and the abdominal wall. Pierre Vellay, M.D. (Childbirth without Pain) stresses the practicality of the woman being aware of these practice contractions. I am not familiar with others who make a point of this as he does. Many childbirth educators I have talked with say, “No, we don’t teach that.” Somehow it seems too good an opportunity to miss, since the woman’s beginning labor contractions will be nearly identical. As labor progresses they change in character, becoming much stronger, much longer, and gradually closer together. This early work in experiencing practice contractions, going with them rather than against them will be very important during labor itself.

For the present, she will notice when a practice contraction begins, place her hands on her abdomen, focus her attention, and take a deep breath in and out. She will be aware of the rhythm of her breathing and of “letting go” of the muscles of the pelvic floor. When the contraction is finished she is asked to notice this.

The importance of relaxation during labor cannot be overstressed. It is one of the prime considerations in childbirth training. The expectant mother needs to know how to relax. She does this best by learning how she creates tension. I observed students trying so hard to relax that they created more tension than they had in the first place. Following along this line I concluded that an exploration of tension might well be a better way to teach relaxation. This approach is not a new one. The question, “Why do you want to relax?” is usually answered, “Because I am tense.” The student is consistently able to identify that awareness of tension precedes her recognition of the need to relax. But the effect of this awareness in creating and maintaining tension must be perceived as physical process. To this end, tension can be created a step at a time. If the student can slow down the process and experience it attentively, such perception can take place.

Very often in private work with the Rolf Technique, the question is asked, “Why can’t you just work on my neck, that’s where all my tension is. Everything else is fine.” (It could just as well be shoulders, chest, legs, etc.) Working only on the tensions in the one area would be very much like trying to unravel a tangled ball of yarn by starting in the middle. Anyone who has done a bit of knitting knows about that! Very early in his training the Rolf Technician learns how very carefully the human body wraps, layers and interweaves myofascial strains. Fundamentally, he learns that any success in unraveling this ball of yarn will come from starting on the outside and working in, not the other way around.

This concept became the basic consideration in the exploration of -the anatomy of tension, and it was necessary to create a movement pattern in order to test some of these considerations. This proved difficult because of semantic confusion. Words like “relaxation” and “tension” meant different things to different people. We found it necessary to evolve a more basic body language since the body was the one thing we all had in common. There is a comparable point of view in Structural Integration. Dr. Rolf has found that there seems to be a basic pattern for every body which can be “understood” by that body as the body and pattern are made to coincide.

With the help of my students and by throwing away the “two dollar words” and using “two bit words” (so to speak) we were able to come up with a set of instructionsthat enabled each person to create his own tension movement pattern, to trace it, experience it by direct contact, and in turn release it (I do not imply that chronic musclecontraction can be released by this method). The student substitutes “hold on” for tension, “let go” for relaxation. We found that these were instructions that the body could understand. “Now just try and relax” is anexample of an instruction the body cannot follow easily.

BASIC DRILL INSTRUCTIONS

Contract the muscles of the right arm.

Release.

Notice how this feels.

Again.

Next time, I want you to contract the muscles by area.

Make a fist.

Now tighten to the elbow.

Now tighten to the shoulder.

Hold on.

Notice how this feels.

Let go.

Is this different from the preceding exercise?

How?

Once more. This time notice the exact order in which you tighten these muscles.

Make a fist.

Tighten to the elbow.

Tighten to the shoulder.

Hold.

This time when you let go, trace backwards and let go of the last muscle group you tightened, first. Retrace your movements exactly and slowly.

Let go.

Notice how this feels.

In what ways is this exercise different from the preceding two?

Once more, exactly as before.

Hold on with your fist.

Hold on with your lower arm.

Hold on with your elbow.

Hold on with your upper arm.

Hold on with your shoulder.

Let go.

Notice how this feels.

Most students need drill in basics to get the idea of what they are doing, and that they are doing it. The terms “melt” or “unwind” seem best to describe nearly everyone’s experience with the difference between retracing to let go and the conventional release. We allow ample time for discussion and sharing of feelings and sensations throughout, before going on to create the tension movement pattern itself.

INSTRUCTIONS FOR CREATING A TENSION MOVEMENT PATTERN

Step I

Lie down in a comfortable location and position.

Notice that you are comfortable.

Take a deep breath in and out.

Do what you need to do in order to be aware that you are here in this location and youare comfortable.

Make it real for yourself.

Notice how this feels.

I am going to ask you to do something and I want you to pay particular attention to what part(s) of your body respond to this instruction.

Decide: “I have to get out of here, but I can’t.” Make it convincing.

Notice how this feels.

Now decide: “It’s all right. I don’t have to leave.” Make this real for yourself.

Take a deep breath in and out.

Notice how this feels.

What did you find?

Was there a particular part of your body that responded to this exercise?

How did it feel?

Is this a new feeling or a familiar feeling?

Were you “holding on” with some muscles? Which ones?

Did you “let go?”

Step II

We will go through the exercise once again. This time please allow the feeling of “holding on” (most students describe this as tightness or tension) to get stronger andspread. Notice how this feels and experience it.

Step III

When we go through the exercise this time remember your basic drill in tracing and retracing. “Let go” in reverse order. Very carefully and slowly follow the tightening and allow your whole body to be involved in this. Really “turn up the volume.” Then let go and “melt” as you did in basic drill, a step at a time as you retrace back to your starting point. Notice how this feels.

Most students report that when a particular body part does respond, the feeling is a familiar one. In the three years of working with this method there are so few exceptions to this that it seems justified to state that most people do have a so-called “trigger area” in the body that will respond most readily and most rapidly to tension or stress. The tension-tightness seems to spread from this point and gradually involve more muscle areas. “Turning up” the volume is a way for the student to experience how the whole body can be involved in the tension movement pattern. She is encouraged to develop this and can at times be observed to curl up in a ball. Most students report that the release through the “melting” method can be quite relaxing. The students report various benefits in their everyday living. The increased structural awareness tends to alert them to the “trigger area” earlier and make it easier to let go of tension before it spreads to adjacent muscle areas. One woman reported that she now realized that her headaches really started with a “tight” feeling between her shoulder blades. Formerly she had not sensed this tightening prior to the headache.

During labor, the tension movement pattern can be useful should tension develop between contractions. It is most helpful in promoting an understanding of the experience of tension and relaxation. No two students seem to develop exactly identical movement patterns. There is a great deal of variety. Interestingly enough, the experience of direct contact which the individual pattern provides seems to promote a feeling of responsibility for the tension.

Labor is a stress situation. When the mother goes into active labor there is no real reason to expect that she will respond too differently than she does to stress in other areas of her life. Rather, tension will appear in her body in a pattern which is habitual for her. If she has already become familiar with it, she will be better able to come with the stresses of labor. Her structure will respond more quickly to the basic body language she has been working with in class.

When her husband says to her, “Honey, let go,” these words will have a basis of feeling and experience in her body that is real for her. Once the expectant mother learns how to “hold on” and now to “let go” she can contribute to her coming experience in a much more positive manner.

As mentioned earlier, the pregnant woman has fewer “escape hatches.” Labor is an inevitable process. The normal termination of a healthy pregnancy is the birth of the baby. Once labor begins it will not stop until this is accomplished. There is nothing the mother can do to stop this process, but there is a great deal she can do to interfere with it. These are the basic “facts” in every pregnant woman’s life. Through her work in experiencing her practice contractions, “feeling the feeling” and understanding how she creates tension, she can examine the roots of resistance as she expresses it in her body. This is valuable experience. If she tries to get away from the uterine contractions she will generate the same body response that she initiates in the tension movement pattern. This can interfere with the process of labor, since this tension does transfer to the muscles of the pelvic floor.

It is not a passive role the mother takes. The decision to stay, to confront her discomforts and to prepare herself to deal with them is an active responsibility in her experience. She learns various breathing patterns to use as the uterine contractions become stronger. There are times during labor when it is appropriate to “let go,” and times when it is appropriate to “hold on.” We want her to know what to do at the right time, in order to cooperate with her body. For example, during the first stage of labor we want her to “let go” of (relax) the muscles of the pelvic floor. In this way she can help the uterus to dilate the cervix. During the second stage of labor we want her to “hold on” to (contract) certain muscles and help the uterus expel the baby. She may even be expected to contract one muscle group while relaxing another.

The expectant mother learns that through her respiration pattern she has one more key to relaxation. She learns four basic movement patterns that she can combine in a number of different ways to help her during labor.

Breathing has been going on for so many million years now that we tend to forget that it is a simple rhythm of holding on and letting go and that there is in effect a diaphragm in the pelvic floor too.

Take a quick deep breath and hold it. Now put your attention into the pelvic floor, “the seat of your pants” so to speak. See if you can let go of the muscles there while continuing to hold your breath. Now breathe out and observe what happens to these same muscles. The expectant mother learns that she lets go of any tension she may sense in her structure with every exhalation.

The Rolf Technician is taught that a relaxed body is a light body. This is contrary to many methods of relaxation currently taught in this country. Browsing through the literature reveals much emphasis on instructions which suggest to the student “feel yourself getting heavier and heavier, or “imagine you are sinking deeper and deeper into the bed.” One set of instructions suggested cultivating the feeling of having lead weights on the arms and legs. Now this may be the ideal state of affairs for the hypno therapist to begin work, but given a choice, my expectants choose lightness every time, and I prefer it as well.

If a student reports she feels so light that she is hardly aware of her body for an instant I feel I am making progress. I haven’t lost a student yet!

The Line is another concept from Dr. Rolf’s teaching which has proved very useful in my work with preparation for childbirth. Lines are good basic body language. They are the basis of instructions the body can follow. They promote structural awareness, and simplify any bodily muscular activity. I add lines to exercises to create the exercise forms used in classes in structural awareness as well as with my prenatal classes. Lines are basic in nearly all of the movement patterns that I work with, only one of which has been presented in this paper. I venture to say that any handbook of “ordinary, old-fashioned” exercises can be brought up to date with the addition of lines, even Isometrics! We use lines in our breathing techniques for basic relaxation. The expectant is acquainted with her UP line. For her it’s doubly important.

The rewards of Prepared Childbirth are many. I am certain that an expectant mother enrolled in any well-conducted program of this type would benefit. The class work I offer is not greatly different from the content of other programs. The difference seems to be that in emphasizing a structural awareness we do just a little more than prepare for childbirth. The ability to enter one’s experience, communicate with feelings and sensations is a risk that many do not take. Pregnant or not! In effect our mother may be better prepared to live with the child she bears.