By Christine Lakowski
WebMD Live Events Transcript

Christine Lakowski, a nurse and certified Lamaze instructor, will discuss the Lamaze method of childbirth.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD Live's Pregnancy and Parenting Auditorium. Today we are discussing The Lamaze Method with Christine Lakowski, B.S.N, L.C.C.E.

Christine Lakowski, B.S.N, L.C.C.E., is an expert in Lamaze and pregnancy. She currently works for Kaiser Permanente in Los Angeles. She is a graduate of the prestigious UCLA Medical School.

The advice provided Christine Lakowski is hers and hers alone and does not necessarily reflect that of WebMD. If you have any medical questions about your health, you should consult with your personal physician. This event is meant for informational purposes only.

Ms. Lakowski, welcome back to WebMD Live.

Lakowski: Thank you.

Moderator: Can you tell me what are some reasons for taking a Lamaze class?

Lakowski: The most common reason that people tell me that they're there is to learn about what's coming up, and to be prepared. The coaches I always ask them, independently, why they're there. Sometimes, they get dragged in by the collar, but mostly to be as well educated for something they know little about. I have a unique group of people that are intensely interested in learning about the technique, "how can I go through labor without pain?" which isn't true. I don't provide that. They come there as if I could provide some special pain relief.

Moderator: I definitely want an epidural at my labor. Would your Lamaze class be of any value? If so, what?

Lakowski: Definitely, a Lamaze class is a plus, or a benefit to those that want to go epidural, just due to the full education in the realm of early labor, transition, birth, and the process of expulsion of the placenta. Definitely you'd have very much increased knowledge. I use The Family Way, by Debbie Amos, and it's about learning. I also offer the possibility of not having an epidural, and other tools I take very seriously in teaching you methods of relaxation, verbal and non-verbal communication skills between the coach and his/her lady. I think I've seen every great combination of coaches. Whether you have an epidural or not, the class will benefit you a lot. People have said, "Gee, we didn't go natural, but the class helped so much."

Moderator: What makes your Lamaze class different from another Lamaze class?

Lakowski: Actually, I haven't sat in on too many Lamaze classes, due to the time factor, but those that I have, or that I've shared with -- regardless of whether the coach and the partner is another female, significant partner -- but a lot of non-verbal relaxation techniques to allow her body to do what it was made to do, without expending any more energy. I do think many of my Lamaze co-workers offer this as well. I don't have anything bad to say about other educators, as long as they put in time and focus on educating and togetherness.

Moderator: What is the most important thing I must learn to have a positive experience during our labor?

Lakowski: I compare labor to a 16 mile journey. I've done several marathons, and it's very much like a marathon. It's a journey, which is a stress in and of itself. You must prepare with proper socks and walking shoes, sunblocks, canteens of water, and then take off for the journey. My class system is preparing for whatever journey this 16 mile stretch is. Some people will take a left turn and go C-section, and some will take a right turn and have something wrong with the newborn, maybe minor or major... but in educating them, I hope they'll go into having this baby educated enough to ask questions and not feel intimidated. And that at least, at Kaiser, and I do teach specifically for Kaiser members now, that our staff OB/GYN, are excellent. I have seen my doctors and midwives at work, so I feel confident at what we have at Kaiser have to offer them. They enter with some trepidation, because it's a journey that's unknown, whether it's 16 miles down the freeway, or up Mount Baldy... or whether it's rough towards the end.

Moderator: I am a single Mom with no significant "coach" in my life (a support person, male or female). Should I still take Lamaze?

Lakowski: Yes. If you can, find just a friend, male or female, that is willing to at least take this class with you, whether they can be present for your delivery or not. Having someone in class learning along with you, seems to stimulate my moms. I have had single women come into a class and out of six classes, they bring someone three times, and its very rough on them at times, because everyone at least has one coach. What happens in the group, because I teach 12 couples, is that the group takes her in. Most of my couples are due, anywhere from two weeks to five weeks, and they're all Kaiser members, so they actually network in a most unique way, and are thrilled when they see another Lamaze couple entering labor or delivery, or just in the clinic. So it's about networking, even if you come in alone.

Moderator: What is Lamaze? Who invented it?

Lakowski: I graduated from UCLA in 1982, and when I started teaching in 82, people learned things they wanted to never learn about Doctor Lamaze. Dr. Lamaze was a Russian doctor who believed in and knew quite a bit about behavior modification, so Dr. Lamaze went and watched to pick up conditioned response in the relationship of when a contraction is occurring (contractions of quality discomfort), to not necessarily do what is a natural response for us. It would be holding your breath, and tightening all voluntary muscles. Like slamming your finger into your car door -- a position of guarding. In Lamaze, other than total physiology of labor and delivery, we spend a third of all our time on the floor as well, shoes off, and identifying tension and giving oneself permission to let it go. I do a lot with relaxation, because in my opinion, relaxation doesn't come naturally to everyone, and you can tell yourself to go to sleep 100 times, but it might not happen if you're tense. With tools that I offer them, and that we practice five out of six weeks on the floor, both the coach and his/her lady, learn techniques to identify tension and permission to let it go, and focusing on music or something pleasant, like a little picture of their dog. We use all sorts of focal points to assist them on focusing on something else, and allowing the involuntary muscle of the uterus to do the work, while my female is conserving as much energy as she can, for the actual energy required pushing episode, which could be two hours, easy. So I use relaxation, education, and tools relating to verbal and non-verbal communication skills between the two, and sometimes three. Sometimes the mother of the daughter wants to be there, and I support that if the significant other is okay with it.

Moderator: What is the philosophy behind Lamaze birth?

Lakowski: That a woman's body was made to have a natural phenomenon, or a very Mother Nature type of procedure called birth. As all females birth their babies, we're equipped to birth our babies as naturally as possible. I call my Lamaze class "prepared childbirth," so we as women, are equipped to do such an awesome miracle, with as little drugs as possible. That is what the body was called to do as a female, and most of the time, it knows what to do with very little intervention by the docs. Whatever medical intervention needs to be taken, and I've seen plenty of that, which we're blessed with, but basically having the baby, Lamaze would say, "we are equipped", so let our natural method of birthing a child as natural as possible.

Moderator: With proper Lamaze training, do you think most mothers can reasonably do without an epidural?

Lakowski: The percentages, I don't know if I'd say most, but probably it's not an impossible number to say three-quarters will use an epidural. I do teach a lot about epidurals. I'm not against them, but I do know that there are other tools -- if it's not a Mount Baldy, 16 mile journey, that with the tools I can offer them, that we are looking at basically a medication-free birth in many instances.

Moderator: How can you tell if Lamaze is right for you?

Lakowski: When I speak to couples about should they take a Lamaze class or not, I only encourage it if it's right for them. They want to be educated about labor, and physically see labors in delivery, and they want to learn how to control this episode in their lives. And I sort of don't support that -- control is not the word to use, but they learn how to cope with it. So if they want -- definitely, greater education, and the possibility of new tools in their lives to handle a stressful time, and life with the baby is also very stressful, then by all means, feel free to come and join and see what there is for them to learn.

Moderator: What are some of the other prenatal childbirth methods, and what makes Lamaze different? What are its relative strengths and weaknesses?

Lakowski: There is the Bradley method, which is a fine child education course, a little different from Lamaze. In Lamaze, we do a lot of conditioned response -- if your body is in pain, hold your breath and tighten all your muscles, but that doesn't do anything with helping that uterus to contract. We use more relaxation techniques -- verbal release to touch, foot massage, back massage, and effleurage, a big word that simply means a fingertip type of massage, effleurage, which simply is firm fingertip movement to help the lady to identify tension and give herself permission to let it go.

There's also the LeBoyer that isn't supported too much anymore. That's birth of the baby -- because he/she comes from a water environment -- into a saline solution to make it as less traumatic as possible, once birth actually occurs. I've only seen a couple done that way, but I'm not sure of the benefit. I know of water being a relaxant, but the baby is no longer to be in the amniotic sack, why would we prolong it?

The purpose of Lamaze would be the education, networking within the couples, the practicing of the breathing techniques and relaxation techniques that are most beneficial. And what to expect if the unexpected occurs. I also teach about C-section, and possible other problems during the labor and delivery -- forceps, vacuum extractor, and what's it all about, so they're fairly well educated, and they all become comfortable to them. And I give them a book to read from cover to cover, and to learn the terminology, whether it be icons, toolbars, etc. So its so fun to have a group of people so excited about this new event, or second or even third event in their lives, that they're hungry for the education, relaxation, and movies.

Moderator: Are there any weakness in the Lamaze method?

Lakowski: When they finish the six weeks and graduate, I don't promise them a rose garden. I promise that they're much better educated, and have more tools to use in handling this first time experience and episode. And the shortcoming is that even if they go C-section, that they can accept that left turn in life, because the most important goal for my docs and midwives is to have a healthy baby. They may be the one that does have to go, so I try not to figure the shortcomings, because I don't promise them anything. It's a means of simple direct communication, and a lot of hands on and appreciating whoever your coach is, to be there with you and for you, to walk and cry with you, and carry you through this awesome miracle.

Moderator: What are Lamaze classes like? What exactly do they teach?

Lakowski: I hold a series of six week classes, three hours each, and I always explain to my couples when they're looking for what I'm offering them in class, one third is didactic, where they're expected to learn and feedback, the physiology and length of the actual labor, so the greater the education, the greater the coping skills. Another third is movies and slideshows, to help them obtain the physical hands on and visualization of the pubic bone, and the journey. And the last third is actual relaxation on the floor, shoes off for both people, and they learn to do some conditioned responses with cleansing breaths and simple breathing patterns that may serve them better.

Moderator: What are some common problems that arise during labor, and how does Lamaze address them?

Lakowski: Many times, especially my first time couples, will think they're in working labor, and in fact, they go in, and they go home. They're sent home until the contractions become of greater quality, or closer, as to when to return. Other problems I don't hear about, and I hear about from 94 percent of my couples as far as I am at their birth, or they call me before they go in as to how things are going, and afterwards, they're at the facility because I work at the Kaiser Baldwin Park in the prenatal. I can't identify any flaws; sometimes, women will be disappointed that they had to use some medication, but it was their mindset. Because we cover medications very openly, and that epidural is a very good choice if needed. I don't see too much negative, because they're so positive on what they learn, and they become empowered.

Moderator: What is the man's role in Lamaze?

Lakowski: When they come in the first night of class, most coaches have been coaching all 32 weeks of her pregnancy -- by that I mean, he's made sure that she's eaten well, or that she has her prenatal vitamins, so their coaching job started long before they walked in my class. What they learn in class is that I do expect a lot from them. I do ask them to be the brains the day of the labor and delivery, because her mind isn't going to work as clearly as tonight. And that he/she, will be assisting and orchestrating positioning, possible change in focal point, possible change in breathing technique, let's get up... they are to be very empowered to say "how about if we try this?", and I do give them little "cheat sheets" and they're fans so if she does get hot, he can fan her. And they write on there the different breathing patterns, because a lady in labor is like no other -- what they know is not at the surface of the brain and able to pull it forth. So the coach is very vital in helping her to relax, and offering a breathing pattern to keep her relaxed so that the uterus does all the work.

Moderator: What are the most common misconceptions about childbirth, and in what ways are they wrong?

Lakowski: The common misconception is childbirth without pain. To the best of my knowledge, it doesn't exist. We do have a very very few labors and births within 3 to 5 hours, but that is one fallacy or misconception regarding what I can offer them. Basically my couples are very focused on wanting to learn, and wanting either a very uptight person and learn to relax, but I don't know of any other fallacies -- nothing comes to mind.

Moderator: Even with an epidural or other medication, should a mother expect pain?

Lakowski: Definitely. It's pain with a purpose, is the way I see it. It's not forever. So those are the little phrases that I empower my coaches to keep her spirits up, by reinforcing little phrases like that, which are absolutely true.

Moderator: How much of pain management is mind over matter and does Lamaze teach that?

Lakowski: I truly believe that there is a lot in hypnosis for any disorder (by that I mean, smoking, or overeating). Birth would be a very stressful time in one's life. Again it takes practice with the hypnotherapist, and the patient herself must be willing and must be comfortable with this person, who is going to take them to a subconscious level. I do believe in it quite openly. There's a seminar in the fall regarding hypnotherapy and birthing. Its not beyond the scope of what we can expect as the weeks past.

Moderator: How common is the use of hypnotherapy in birthing?

Lakowski: At Kaiser, and I come from a limited background, I don't know of any exact hypnotherapy. As my couples use a focal point and verbal breathing techniques, it truly is a form of self-hypnosis. And they know it, because the very relaxation technique allows them to let go of tension and conserve energy. As defined hypnotherapy, I don't know of any, but there could be a few out there. As far as using the tools we offer, it's truly a form of self-hypnosis. You just go deeper and deeper. If I went into it, I'd go into it with an open mind. But some people may not be able to be hypnotized.

Moderator: Lamaze is sort of "known for" its breathing techniques. Why are breathing techniques so important in childbirth?

Lakowski: Breathing versus holding your breath, is the actual truth. When in distress, or pain, or stress... one tends to either hyperventilate, or hold their breath during an episode of breath, which of course is good for neither the mom or baby. By relaxing and breathing in a simple, different pattern in which you breath every day, it allows the mom to think about something different and to keep breathing, rather than holding her breath, screaming out, or grabbing and just hyperventilating.

Moderator: So it takes the energy away from the uterus' contractions?

Lakowski: It takes the energy of the brain to a breathing pattern, and with the coach's help, allows the voluntary muscles not to be tense and contracted. There's just a huge amount of energy wasted in tightening all the other muscles, because the uterus is an involuntary muscle that must contract and dilate, so I teach relaxation and breathing techniques for conservation of energy, because their journey could be 20 hours of labor until they get the okay to push. At that point, I want them to have plenty of energy to actively bear down and assist in the contractions of birthing their baby.

Moderator: What are some of the risks of medically-assisted childbirth? Are there risks to the use of anesthetics?

Lakowski: There's always a risk in any anesthetic, and every anesthesologist will talk to the patient about it. We are in a new millennium, and most problems have been very removed as far as any back injury or back trouble. There are no more spinal headaches because we don't give spinal anesthesia. We use the epidural, which is a different spinal area in the back. Risks in medically assisted childbirth are quite minimal, at least in my facility; forceps and vacuum extractor are used very sparingly, and never at the point where there's any compromise for the baby. As far as analgesics and pain medications, sometimes it slows down the labor. Sometimes it affects the baby's heart rate, and they all have medications to counteract the negative effects of medication that may affect the baby's heart rate.

Moderator: What are the risks associated with natural childbirth?

Lakowski: The risk of natural childbirth from my point of view, is having a perineal tear, which is one of the more common ones we see. An episiotomy may not have been performed, and may tear extensively, which takes a lot of repair and much discomfort for the mom. But it's handled, again, with great professionalism and that we are on their team, and I think most couples understand that.

Moderator: Where can I find out more information about Lamaze?

Lakowski: Lamaze International; there is an 800 number. Dydee Diaper Service still do encourage cloth diapers, and they have a list of all prenatal educators in whatever valley you're located in. In my case, its the San Gabriel valley. They encourage prepared childbirth, because we support them with cloth diapers.

Moderator: How can you find out about Lamaze classes in your area?

Lakowski: In my area, each hospital that has a birthing center has their own Lamaze educators. And Mt. San Antonio Junior College has their own educators through community services.

Moderator: Is it best to take the classes at the hospital where you will be giving birth?

Lakowski: Not necessarily. When I worked for Mt. SAC as a junior college instructor, that's the kind of homework I'd give my couples -- to go to their doctors, and find out their true epidural rate, and the education itself depends on the educators as far as time and how many hours he/she feels like running the class. The minimum is a twelve hour class, and I tend to run a 18 hour class, because of all the knowledge and fun we have in our classes.

Moderator: Childbirth in a hospital is expensive, often stressful, and sometimes possibly dangerous. What options do expectant mothers have?

Lakowski: Some midwives do home delivery, but I'm not aware of any. Ppersonal friends of mine that do home births, which would be the other option. My sister-in-law in San Francisco did deliver with a midwife in her home both times with no consequences. My own opinion is that many of our births are done by midwives, but also very close backup with an M.D. if something goes wrong, which is the way it should be.

Moderator: What are the things that every expectant mother should know, but probably doesn't?

Lakowski: To expect the unexpected. That they need to do some reading and learning about birth and birthing processes; there is some excellent material out there that can educate -- I think education is the minimal that they should do. Everything is totally new to the first time mom. So if you're clueless, then everything is the unexpected if that makes sense. At least if you know that the left and right turns exist, there's the possibility of handling it with much greater ease.

Moderator: What are some of the things that a mother should bring to the hospital?

Lakowski: Blistex. Focal point. A focal point is something special to the lady, either a smiley face that's just one of those peel off stickers, or a picture of Mammoth if they love skiing, it could be photographs of their previous baby or their cat, something to focus on as labor progresses and gets more challenging. I encourage people to bring their own boombox with whatever music is comfortable. I tend to use either harp music, and it allows them to be in a space more relaxed, which will encourage greater relaxation. Some couples bring tapes, because we do have VCRs, and I walked in on one birth, and they had Grease on. And it was perfect for this couple. It was part of the background she wanted. A couple plastic bags, produce sized, just to put ice chips in for if she has back labor A coach's lunch that doesn't have any foul smelling food which includes chocolate, peanuts, cheese or salami. We're talking about a 20 to 30 hour journey. I would encourage that. Keeping it simple works.

Moderator: Are there any supplemental activities or exercises that, added to Lamaze, can make childbirth even more comfortable and painless, and speed up recovery times?

Lakowski: I encourage being physical -- to raise your heart rate, whether you just walk rapidly with your coach or alone, whether you do water aerobics which is usually recommended but to increase your cardiac output at least four times a week, 30 minutes. The one thing I do tell my couples is to monitor their heart rate no greater than 140; if you have someone that's still jogging or do the stairstepper, to make sure that they're accounting for their pulse rate. It should not go greater than 140. I do believe with being physical with ten 10-ounce glasses of water, to keep the skin well nourished and hydrated. If everyone knew how awesome just drinking water was for the body, as well as the baby... they would drink a whole lot more water.

Moderator: How does Lamaze help the baby?

Lakowski: He too is in the baby of compromise many times; that's what we do when we do a NST, to see how the baby's heart responds to the tightness and strength of the contraction.

Moderator: What are the most common misconceptions about Lamaze?

Lakowski: That I have all the answers and that they're going to have a pain free delivery.

Moderator: How many people use Lamaze? Is it growing in popularity?

Lakowski: It is at Kaiser Baldwin Park -- we have two more educators who are also working in the evenings and weekends for our couples. We have over 400 births per month, and we don't get close to that number taking Lamaze, but I always get a full class and I've been teaching there for nine years.

Moderator: What have been the most significant advances in childbirth techniques in recent history? Where does Lamaze fit into this?

Lakowski: At Kaiser, we have midwives delivering, which is in total alignment with myself as an educator. They always tell me, when my couples come in, how great they were as far as asking good questions or holding off, or being open for a suggestion from the midwife or doctor. It's not a doctor's privilege, commonly, at Kaiser to deliver a vaginal baby that has no complications. It's all done by well educated, highly skilled midwives that adore being midwives.

Moderator: If a mother isn't comfortable just having a midwife, can she have a doctor present for a delivery without complications?

Lakowski: We have always the MDs on staff, and he/she can come in and speak with her. They do have a choice; I must say that the doctors are pretty involved with high risk deliveries at that point, or emergency C-sections, so they may not in fact see a MD for long, but he/she will be called-in and speak with the patient. They're there, but they have much more complex things to minister to.

Moderator: Does the mother meet the midwife before the day she goes into labor?

Lakowski: We have midwives that see our patients in the clinic, and are on call several times a week. Their odds of getting their own midwives that they have seen prenatally are fairly good, but no promises. If the midwife is with the mother all the night, and she's ready to go home, she won't leave. Its an honorable pleasurable profession between the midwives and couples.

Moderator: And what sort of training do the midwifes have? A midwife goes to -- like USC midwifery school, and that's a two-year program, very excellent. The ones we have from all the programs, and I just know of one from USC. They go through another two-year extension, and we're thrilled with all our midwives. I could check with anyone of our midwives to see if they'd like to go online. We're right there, hand in hand, we are a team. What's nice about a midwife, is that they know their limits and so well-educated, so if there's a potential problem, the doctor is immediately called. I can always look at my couples, and say that she knows when to call for help. Whether they know her or not, they're comfortable with the professionalism. There's no question that the doctor would be there to show up, but as a rule, our doctors don't deliver non-complicated, full-term, vaginal delivery.

Moderator: In what ways is childbirth, as currently practiced, lacking? What needs to be improved?

Lakowski: I think education needs to still improve, but again, I think that we can only lead them to the many classes that Kaiser offers, and then they have to choose in. So that the team between the docs, midwives, and couple delivering, is that much more in touch with what's going on.

Moderator: What do you see in the future of childbirth?

Lakowski: That it will continue, we know that. To continue with a minimum of 18 hours of education, and possibly expanding to after the baby comes classes, and education for life with the baby.

Moderator: Dr. Lakowski, thank you for joining us.

Lakowski: Thank you.

Moderator: WebMD members, please join us every Wednesday at 1 pm Eastern here in the Pregnancy and Parenting Auditorium for our live weekly event.

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