-IBIS-1.5.0-
rx
imagery
birth complication - breech
psychospiritual approaches

definition

Visualization for prevention of complications can be very effective for a variety of presenting problems, as well as recurrent complications in past obstetrical history (repeated inductions, prematurity, etc.). The following cases are presented here in shortened form to stimulate the reader towards possibilities of application in the clinical setting.

Visualization for Breech

Jessica was a twenty-seven year old mother referred for breech presentation at thirty-two weeks gestation. She had a previous history of breech presentation with her first pregnancy, fifteen months earlier, resulting in a caesarean. She had experienced ruptured membranes with no onset of contractions, also contributing to the decision for caesarean. Other women in her family had also experienced breech presentation at term. She had been told by her previous obstetrician that she had probably inherited a pelvic shape encouraging the breech position.
In our experience, it is advisable to do a visualization for breech as soon as the diagnosis is made. Our society has such fears of the breech presentation that women can be acculturated to think of themselves as abnormal or at-risk even if the baby might spontaneously turn to vertex within several weeks. If the woman is already past thirty-two weeks, time is of the essence. The sooner she can address issues pertaining to motherhood or beliefs about the baby and birth, the more time there is for adjustment to belief change. This was particularly true for Jessica, who not only had a past history of breech presentation, but also an absence of onset of labor, both leading to her caesarean. Had she started labor on her own, she would have had the option of vaginal breech delivery in the past. Jessica is planning a vaginal birth after caesarean with her second pregnancy. A breech presentation would preclude her option for a trial of labor for vaginal birth.
The following transcript represents the exploratory part of the visualization, in which the reader can become aware of the beliefs Jessica has about the cervix which encourage a breech presentation. I worked with Jessica on this imagery, until she was able to apply the suggestions given.

..... so that you can actually TAKE TIME in your pregnancy every day.... to follow that baby... that you need to Follow it... (refers to her having said that she needs to give herself more time with this baby before it's born)... follow it DOWN, DOWN, DOWN (voice tonality dropping) to the cervix even ... where you need to follow it... now... as you look DOWN, at the cervix down, just like that baby way up high looking DOWN at the cervix now, down toward the cervix just tell me what the cervix might look like, feel like, on the INside now, the INside of the cervix now as you look DOWN at it...
Jessica: ... looks ... warm ... inviting, pink in color...
Gayle: and the shape... what shape is it?
Jessica: .... round... almost like a.... pool, yet it's pink...
Gayle: and soft... did you say?
Jessica: No, it's not soft. It's like something that .... you dive into.
Gayle: Hmmm. It may be very helpful to know now what happens in the last months.... of pregnancy.... and on into ... labor, is that the RELAXin inCREASES, the relaxin inCREASES, and as the relaxin inCREASES into the PELVIC AREA NOW,.... the cervix begins to soften, even at thirty weeks, even at thirty-one weeks, more so at thirty-four weeks, more so at thirty-five weeks (voice gradually gains in volume and speed and then drops as softening begins)... begins to sooofften, sooften, softening... becoming very, very soft (voice drops softly) and that softness spreeaads, spreeads out outwards ... through the cervix. Just now I'd like you to go ahead and feeeel what it actually feels like on the inside... and just tell me how soft... how soft it can feel on the inside of the cervix as you look at that warm ... softness ...
Jessica: It feels... like a sponge....
Gayle: almost mushy in a way...
Jessica: No. No, it feels like a sponge that... set out to dry, and it's hard. It's.... it needs to be wet, to make it soft again...
Gayle: Uh-huh ... and you know... about the fluids on the inside of your body.... (whisper soft) .... and what is happening right NOW. And this can be very, very HELPful information to actually know what's happening physiologically on the inside... (vocal quality assumes a sing song informational tone) ... as mucus is being formed and reformed and REformed and inCREASes in the last few months towards labor ... inCREASes towards labor in FACT, the sponge would soften ... more ... and moore ... and MOORE (deep and breathy) until it almost was mushy (voice goes up very high in a hypothetical tone)... on the INside, a kind of healthy, healthy mushiness ... soft (voice softens) and spongy and wet ("T" sound emphasized) very, very wet ... so wet and so slick almost ... that, when the baby's very ready, that it is like a slide ... is like a slide that you can't even help but go right down ... can't even help but go right down, and with the waters breaking ... you can imagine what that would be like on a slide, coning right DOWN ... if you've ever been a child or seen a child go on it's stomach head first down a slide, sometimes they'll put wax paper down to make themselves go down very, very fast (slight laugh) very fast, have you ever seen that?
Jessica: Mmm hmh
Gayle: ... ever seen a child do that, or wax the slide, they do that in the park down the street. That's what the waters do with the help of the mucus, the COMBINAtion of waters and mucus is inCREDibly slippery, slick even, and just as that child goes right DOWN the slide (voice lowers, slows) children like to do that, they like to ... fly in a way, down the slide, head first even ... very slick and wet. So that just now you can begin to feel, perhaps ... a little more of what's actually happening on the inside ... the softness, the wetness ... what does it look like NOW in the cervix, what does it feel like ... as you begin to TAKE THAT INFORMATION IN, process it...
Jessica: It feels more comfortable ... it feels like ... like a ... dampness, like a lawn with dew in the mornings...
Gayle: Hmm. It might even be soft like a pillow. That's why people like to lay their heads, just like you are now, laying it on a pillow, almost soft like a pillow is ... but only it has a opening to it ... like a doughnut, (slight laugh) but that pillow ... How does that feel to you now, that cervix, does it feel...like a soft pillow?
Jessica: It feels ... soft, like to ... like to rest my head on it...
Gayle: And now, we can just go on a little bit with the physiological learnings, about labor, birth, staring labor ... sometimes with women I've worked with who have had some difficulty in the past, one woman didn't understand exactly HOW labor STARTED, it's usually some piece of information, it stimulates an even deeper adjustment in the body, as if you have the right hemispheres and the left hemispheres of the brain working together, harmonizing in a way, it can be very helpful, to just KNOW what's actually happening on the inside, the wetness, the softness, inCREDible softness, that inCREASes as the baby grows, as the relaxation continues to spread ... to become more and more dominant in your body, so that there's more mucus, more and more waters, slippery, slippery, warm and wet ... on the inside ... and as the baby grows (voice becomes louder, after having been very soft) if we take ourselves forward in time now, when the baby will be very, very READY to be born, very READY to come out into your arms, to see you, feel you on the outside ... to hear your voice on the outside, too, the baby will really, really WANT to be born. And this begins, it just begins to happen, in about the seventh month, when the baby's becoming bigger, and a little bigger, just right, and very very ready to be born, where the inside becomes less interesting, because the baby WANTS to be born, and so the outside becomes more and more (builds in volume) enticing ... and just as you move, and SETTLE INTO ... these learnings, you can even identify, in the next couple of months of what it's like when a baby just wants to be out. It no longer wants to stay inside ... it WANTS to be born, an impulse to be born, instinctive even, biologically, physiologically, ... the baby KNOWS in a physiological sense that it is time to come out, the healthiest place BECOMES the outside, it BECOMES that way, and when the baby's very, very ready to be born, it releases a hormone from it's pituitary gland, which causes a hormone to be released in your pituitary gland, which CLICKS labor into place, which STARTS the oxytocin flowing, just STARTS the oxytocin flowing (softer, but with intensity) as the waters ... break, sometimes that happens first, sometimes it doesn't, but it's a sign of beginning, that the baby's putting that hormone out, and the HEAD can come DOWN, (voice becomes heavier, slower) HEAD can come DOWN so that, I'd like you to just IMAGINE what it would be like, for a moment, to totally indulge in what it would be like if you didn't need to worry about positioning, but you just had to ... CONFRONT THE LABOR ... and deal with LABOR ... and this is something you can afford to do while you listen to the tape and at other times, you can deal with other possibilities, but right now, just as you listen to this tape, you can give yourself the total possibility to INDULGE, in what you would FEEEL like, (now, becomes a whisper) if the baby were head down right NOW ... incredible relief, which affects the lower uterine segment, incredible RELIEF ... of the baby being head down, but HOW ... how would that happen ... as the baby grows, it's head gets HEAVIER, and ... HHEAVIER HHHEAVIER ... and the hheavier and hhheavier the head gets, ... and there's so much more room down in the soft wetness (whispering gently) ATTRACTS ... DIVE right DOWN onto that pillow, right DOWN onto that cervix ... the baby can just DIVE ... just like a pear ... that's getting very, very ripe, but not dropping yet, a chemical kind of reaction has to take place in the tree, in the stem, the very STEM of the pear, it just gets ready, and ready (voice picks up speed) and it just gets hheavier and hheavier and hheavier and right, THUD (loud, then immediately returns to soft voice) right DOWN it comes to the ground ... when you're least expecting it, ... your might hear a THUD, and there's the pear on the ground if you were around the pear tree. Of course, most people won't even HEAR the THUD, it'll just happen ... and they might be aware when they eat a pear, or fruit that it happened, but they don't think about it, it's just something that's taken for granted (matter-of-fact tone) that yeah, the pear was ripe ... and ready ... to come right DOWN to the ground ... as the baby gets bigger ... it comes right DOWN, because the head is the very hheaviest, hheaviest part (softly) of the body... (now voice rises in volume, as heading towards the birthing part of the visualization)... I'd like you to take yourself forward in time now ... to when the baby will be very, very ready ... to be born, very ready to be born... (continues into birth visualization with baby assumed to be in the head down position).

Comments

As Jessica talked during the visualization, her experience of her cervix can be heard to be not only unrealistic to internal body processes, but uninviting to dive into. Her imagery is not congruent with labor and birth. I begin to build an image that is more yielding to the birth process, and work with her on that imagery until it becomes actually changed in her own experience. This is often necessary in order to work with a client towards changing the beliefs. It is a client's beliefs which develop the imagery that she will allow herself to experience. As a practitioner is able to work with a woman to change her imagery, she helps to change her beliefs and orientation towards her birthing. Jessica's imagery reflected beliefs that may have been reinforced by her past caesarean. However she was able to re-work her imagery of the cervix as a soft and pliable part of her body, which did become congruent with the reality of a baby diving through. The practitioner can be aware of his/her own reactions to the client's imagery, as it is not difficult to identify the incongruity of "diving "into a "hard, dry" cervix. When incongruities are identified, the direction for change (softening and moistening the cervix) is also evident.

Other issues that were significant for Jessica included the belief in the baby as delicate and the security of the womb beyond the nine month gestational period. Suggestions which address these issues can be identified in the transcript.

I was able to very briefly discuss the experience of pain in birth with Jessica, and asked her to return at a future time to talk further. We also touched on her tendency to rely on her mother, who was there at her first birth, to do the work of labor for her. She chose not to come in an additional time before birth, but to use the tape to prepare due to lack of funds.

Jessica gave birth vaginally to a healthy, full term baby boy weighing nine pounds, thirteen ounces. The baby turned to vertex the week after the visualization session. Her labor was augmented by a very slight amount of oxytocin (her obstetrician described it a "placebo") when her dilation slowed down at nine centimeters. Jessica was very joyful about her birth experience. She did report that it had been longer and more painful that she had been prepared for, never having been in labor before. As of this writing she is currently pregnant with their third child and looking forward to another vaginal birth. She came in for a visualization session early in the pregnancy for nausea and getting in touch with this baby, and plans to return to talk about the issue of pain in labor.
(Peterson and Mehl, p. 248-253)

see also:
imagery: Taueret journey
hypnotherapy: techniques of trance
imagery: birth: introductory visualization
imagery: birth: exploratory visualization
imagery: birth: birth visualization
imagery: birth: exploring phobias
imagery: birth: complication - past complications
imagery: birth: complication - fibroids


footnotes