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Cook Counter Pressure

This is a clever pain relief technique shared with Penny Simkin by Lisa Cook, RNC-OB, of George Washington University Hospital. Lisa gives me permission to share it with you! Use with back labor, a stall in labor, during 2nd stage or coming close to second stage. Two simple ways to ease the birth!

Lisa Cook with tuberosity counter pressure

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.

  1. 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.

Pelvic ischial-tuberosity sitz bones

The red circles on the pelvis are the area to press. Below, Penny Simkin, physical 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 it’s a pretty simple technique.

Penny Doing Lisa Cook pelvic floor counter pressure

  1. 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 spots 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?

Two 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 outside on the labia yet on the bony pubic arch while the mother is pushing her baby out. See this version illustrated at Nurse Lisa Cook’s website.

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.

Here’s 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.

Best regards, Jenny and baby Anika


Penny teaching Gail Lisa Cook Manuever

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.

A complementary technique may be the sidelying release. Don’t do this technique if a woman doesn’t want it. Otherwise, I can’t see any contra-indications.

The following excerpt is from a lovely email by developer, Lisa-Marie Cook, RNC-OB:

Dear Gail,

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

Cook Counter-pressureSM

Thank you, Lisa-Marie for your care and service to birthing women- in your hospital and now, around the world!

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