A guiding STARR

One of the most challenging situations during birth is when something unexpected happens that necessitates a radical re-think of approach. I have heard so many examples of this in birth stories – and the way in which labouring women and their partners are able to negotiate these twists and turns in the birth journey seems to have a significant impact on their birth experience, both in the moment and in their memories of the event.

I’m not just talking about the big dramatic denouements – the unexpected breech baby who prompts a dilemma about c-section versus vaginal breech birth – the very quick labour with a baby who arrives before the midwife does – the labour that starts spontaneously hours before a planned c-section. It’s also the seemingly smaller events that nonetheless change the course of a labour, or introduce elements the mother wasn’t expecting – a birth pool that can’t be filled for some reason, meaning the mother must seek alternative sources of comfort – a labour that is proceeding so quickly and smoothly as to make a planned epidural pointless – a partner stuck in traffic on the way home from work – a chosen birth centre that happens to be full on the night.

Almost anything could happen – and most probably won’t. It would be impossible and even counter-productive to try to prepare for every possible situation, and perhaps what is more useful is the ability to stay flexible with the unfolding of events, adapting to the circumstances as they arise in the moment while staying true to the spirit of our wishes for this birth. In Mindful Mamma courses we do a visualisation based on the idea of a tree, which represents a woman’s wishes for her birth experience – firmly rooted in well-practised mindful hypnobirthing techniques, able to bend and sway with whatever the weather happens to be on the day, but remaining its essential self.

What can help us to harness this mental flexibility when it’s most needed? I’ve been thinking about a way to capture the steps involved in this kind of mental manoeuvre that’s practical and easy to remember. Maybe what we need when everything is at sea – when we seem to be pulled away from familiar shores on tides we didn’t know were there – is a guiding star: something we can re-set our co-ordinates by, a light in the fog.

This approach is loosely based on the RAIN acronym, suggested by various mindfulness teachers for dealing with difficult emotions (explained here by Tara Brach). But these steps are specific to a mindful hypnobirth, and expressed as STARR.

Stop – the first step is to stop and acknowledge the situation – step outside it for a second to recognize that in this moment, something unexpected is happening. It can be tempting in such moments to rush forward with some kind of action. Instead, take a moment to press pause, and label the situation as an event we weren’t expecting but still have a choice in how to respond. This step might also involve asking others who are involved to press pause – for example asking the midwife or obstetrician for some time, to let this turn of events sink in, before you continue the discussion.

Techniques – use your practised techniques to calm your body and mind. Unexpected events often create anxiety, but any decision is better faced from a place of calm and focus. Perhaps 321 Relax, the lengthening breath, or the shoulder anchor.

Allow – accept that this situation, whether we like it or not, is happening right now. As Tara Brach puts it, “allow life to be exactly the way it is” – because it’s already that way. When we allow a situation we can bring our full attention to it, seeing clearly how best to respond.

Re-plan – it’s time for plan B. How can you adapt your birth preferences in light of what’s happening now? You may well find that many of your wishes can be carried out in a slightly different way. Even in the most medical of birth scenarios there is room for negotiation and choice. Small changes to the atmosphere in the birth room (lighting, sounds, the way people speak or stay quiet, how the baby is greeted and welcomed once born) can make a big difference to the parents’ experience of their baby’s birth. This is the moment for BRAINS – you may need to gather more information (for example to make a decision on a suggested intervention) and for re-planning. If you could summarise your key birth preferences in one or two bullet points, what would they be? Now express that to the people who can help you achieve them. As Sophie Fletcher writes in Mindful Hypnobirthing (p.195), it can help to clarify the following three points (and write them down if possible): ‘1. These are the facts I was given. 2. This is the choice I made. 3. These are the reasons I made that choice.’

Relax – use your mindful hypnobirthing practice to help you through this twist in the journey. What techniques will work in harmony with any interventions you choose to accept? What techniques can you use in place of something you’d planned that is no longer available to you? Using your skills can help you stay calm and focused, enabling you to get the best you can out of any situation.

Women deep in the zone of labour probably won’t be thinking about what all the letters of an acronym represent. This one’s for birth partners – as the labouring woman’s supporter you’re ideally placed to pull this out of your back pocket if it turns out it’s needed. ‘Ok – let’s do STARR’ – you can guide your birthing woman through each step.

There is little point spending a pregnancy preparing for all sorts of birth scenarios that are unlikely to happen to you. But some forethought on the steps you would go through in any situation that requires a change of tack is time well spent.