Lisa Cook's Counter Pressure
Lisa Cook, a Labor and Delivery nurse in Washington, DC, discovered that pressing back on the pelvis in two areas seemed to help relieve pain and potentially aid rotation.
She has two ways to use counter pressure on two different matching spots.
During dilation phase when a birthing woman has back pain or the baby is shown by length of a labor stall to need help with rotation.
The red dots on the pelvis below are the specific points to press. Penny Simkin, physicial therapist, shows how to press forward on a woman's sitz bones (ischial tuberosities) while the woman is on her hands and knees. She gives this pressure with contractions and between, too, if the woman wants it. Support members can take turns as its a pretty simple technique.
Counter pressure in 2nd Stage (Fully dilated and pushing)
Lisa's counter pressure soothes when the pelvis is stretching outward creating immense feelings of Opening!
Counter-repressure on these spot on the pubic arch of the pelvis is quite helpful to relieve the pressure of birth on the pelvis in second stage.
Could it be that this counter pressure also releases tension in the pelvic floor muscles? These two, matching green spots on the pubic arch of the plastic pelvis are near the "insertion point" of the anterior pelvic floor. By pushing here, the "pull" on the pelvic floor during descent of the fetus may be lessened, soothing the pain of childbirth.
A nurse, midwife, doctor or mate of the mother might press on the pubic arch in just this way while the mother is pushing her baby out. See the green spots on a pelvic model, shown here by world-renown birth educator Penny Simkin in the photo. Read down for a testimony to Nurse Lisa Cook's technique.
Symptoms of tight pelvic floor muscles are more pain than expected with contractions, slow descent in spite of a good fetal position, an OP baby that won't rotate with maternal position changes, and pain in the pelvic girdle.
Everybody likes a testimonial:
We want write to you about our recent experience with Lisa Cook, RNC and the Cook Counter-Pressure Point methods.
On Monday, October 18, I went into labor at 5am and labored at home until 5pm with my doula. At 5 we left for GW hospital to deliver with our midwife. I was about 7-8cm dilated. At this point I was in active labor and not progressing much.
To my luck, Lisa was the delivery nurse assigned to us. My goal was to have a natural, drug free delivery, however by the time I reached the hospital I was asking repeatedly for medication. In addition to the methods my doula was using, Lisa introduced us to specific counter pressure points (sitz bones, pubic arch-pushing) that provided a lot of relief.
Unfortunately, Lisa's shift ended before delivery. However, before she left, she was able to teach these methods to my doula who was able to apply them each time I requested them. I would like to emphasize how much relief the counter pressure points provided during the delivery. I ended up having a beautiful natural birth, but it would not been possible had Lisa not been there to teach our doula these techniques.
Jenny and baby Anika
Sometimes there is a need to make more room for baby to descend. Perhaps, the baby with an asynclitic (tipped) or extended (chin up) head doesn't have room to come down. A big baby may appreciate this help to "make a little more room" or a woman with a tight or somewhat smaller pelvic outlet may benefit. Use the Facebook page or blog to report on your experiences! I'd love to add more knowledge for our greater birthing community.
Don't do this technique if
- A woman doesn't want it. Otherwise, I can't see any contra-indications.
Here's Penny Simkin turning to me at the 2013 REACHE conference to get my opinion on the technique just as I was snapping a photograph of her and her pregnant model doing the Cook Counter Pressure. Penny's gesture seems to be welcoming birth providers to give this soothing comfort measure a try!
The following excerpt is from a lovely email by developer, Lisa-Marie Cook, RNC-OB:
I’ve been an avid fan of “Spinning Babies” for several years. I’ve been teaching many your methods here at the George Washington University Hospital in Washington DC to our new Labor and Delivery nurses. We’ve had many successful birth outcomes because of the work you do in the birth world, thank you...
I would love to share a technique that we use here at George Washington University Hospital and now more on the west coast thanks to Penny Simkin. My work was published in “The Labor Progress Handbook, 3rd Edition” on pages 359-363. Specifically, the “IT” counter pressure points. ( My other counter pressure point helps, but mostly during 2nd stage, doesn’t help with rotation of baby.) It helps by relaxing those pelvic ligaments, helping decrease mom’s perception of pain (especially those with back labor) and often times, between just positioning (hand/knees) and counter pressure, it helps those baby’s to rotate! Ask Penny Simkin, she had a difficult birth that she was a doula at, she used these counter pressure points and that baby delivered beautifully…She’s a believer now and published it to get the word out to doulas and labor support people.
I used it on a laboring patient last week and she said, “this helps so much” her doula said, “I’ve never seen that technique before, where did you learn it from?” I told her that I discovered it 6 years ago and it’s been helpful for moms that are stuck or experiencing back labor.
Thank you so much for the work that you do, it is wonderful and inspiring to see how many women have been affected by your website as doulas learn methods to help women birth. I had one of my students tell me that her baby “flipped” from breech after looking at your website…Thanks from all of us.
May your journey continue to be blessed as you touch so many lives.
Lisa-Marie Cook RNC-OB, C-EFM, BSN, ICCE, CD
Birthing Basics, LLC
This is a great addition to the Spinning Babies Website. Thank you, Lisa-Marie for your care and service to birthing women- in your hospital and now, around the world! Penny Simkin, Lisa Cook, and April Bolding pose for the camera after a successful day sharing the wisdom of birth.
- A complementary technique may be the sidelying release.