Stress Relief at Your

Finger Tips for Labor, Delivery

and Afterward
by Carol Gottesman, MEd RNC HNC

Abstract: Labor and Delivery is a time

of great emotional, physical and mental
stress. Stress triggers the mothers natural
fight or flight response and blocks her
ability to breathe, relax, problem solve
and think clearly. Emotional Stress Release (ESR) is a touch technique that can
be very effective during labor, delivery
and afterward. It normalizes breathing,
activates the calm relaxed response and
diffuses the emotional impact. It is easy
to learn and use, and it is literally at
ones fingertips. This article will explain
the ESR Technique, its benefits for mothers, fathers, babies, and recommend uses
for self-care. Examples are shared from
my experiences and those of others.
Keywords: Emotional Stress Release, Complementary and Alternative
Medicine, holistic self-care, labor pain, pain management

Our brain constantly assesses what is going on in our

lives based on our past experiences and perceptions. If
something is determined to be dangerous, the fight or flight
mechanism is triggered. Even imagining stressful thoughts
and situations triggers the fight or flight mechanism. This
mechanism is especially evident during labor and delivery.
Dick-Read (2005) proposed that the laboring woman becomes fearful and that fear activates her sympathetic nervous
system, which produces excessive tension in the uterus and
restricts the circulation of blood through the uterus. This
results in muscle tenderness and the pain of labor. Pain

intensifies the fear, which increases the tension and perpetuates the entire cycle. It alters the physiological mechanism
of childbirth; in fact it is directly responsible for many of
the unpredictable complications of otherwise normal labor
(Dick-Read, 2005, p. 65).

the relaxation response is the opposite

of the stress response
Relaxation is the ultimate stress management technique
since the relaxation response is the opposite of the stress
response. It switches off the sympathetic nervous system and
switches on the parasympathetic system. Emotional Stress
Release (ESR) accomplishes this easily and quickly. Touching the neurovascular points on the forehead brings blood
flow to the forebrain. It diffuses the emotional impact and
allows a calm scan of the situation. Objectivity is regained
and problem solving is facilitated. As tension melts away,
autonomic and psychological stability increases, a feeling of
well-being replaces the fight or flight reflex, and the mind is
more receptive to positive suggestion.
The effect of relaxation became very apparent to me
forty-seven years ago, when I used the Lamaze Method during the birth of my son. In fact, it worked so well, I had five
hours of labor, arrived at the hospital fifteen minutes before
he was born, crowning at a fifty-cent piece, and I thought I
was in false labor. Relaxation added a calming psychological benefit. I certainly felt the benefits upon arrival at the
hospital. Unfortunately, the first thing the nurse said to me
was, Dont breathe like that, youll hyperventilate. Nurses
and prenatal instructors today are better informed; they
teach and encourage the use of Lamaze and other relaxation
methods. This teaching and support can make a difference in
reducing stress and anxiety during delivery. This empowers
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Stress Relief at Your Finger Tips

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mothers to use these new tools to move forward into their
experience with confidence (Adams, 2012).
Melzack (1968) presents a concept known as the sensory, motivational and cognitive determinants of pain. The
sensory aspect deals with the intensity of the pain, and the
motivational cognitive aspect deals with our perception of
the situation. In other words, our motivational and cognitive input modulates our response to pain. Therefore, we
can change our reaction to pain by changing our perception.
This is seen in soldiers with extensive wounds who dont feel
pain due to their motivational cognitive awareness of joy at
surviving the battle (Melzack & Casey, 1968). This would
also explain why, after giving birth, women dont remember
their pain.
I find this a fascinating concept to use to explain my reaction to labor. I saw it as the most joyous experience, since
it was bringing my son into the world. In that joy I perceived
labor not as pain that would cause fear, but as pressure that
would bring my child into my arms. By breathing with the
contractions, remaining calm and peaceful between contractions, I facilitated and speeded the process. Confidence in
the ability to handle labor was the most significant predictor
of all components of pain during active labor (Lowe, 1989,
p.237).
Many women have successfully used ESR with dramatic
results during the stress of labor and delivery. One woman
who used Lamaze and ESR stated that while in labor she
became very grumpy and didnt feel like being touched by
anyone. When the nurse poked her belly and listened to the
babys heartbeat during her contractions, she became agitated and felt much more pain. Her husband held her ESR
points between contractions and she was able to calm down
again. This was so effective that they continued to use ESR at
any time when she felt nervous and between every contraction for the last forty-five minutes before she was fully dilated. They also used ESR through the pushing stage, which
for her lasted two hours. Holding these points was not only
calming, but it raised her pain threshold. In other words, she
could withstand a stronger contraction with less pain after
having her points held than she could when her husband
didnt hold the points between contractions. The calming
effect was dramatic to both her and her husband. The nurse
was also impressed and asked about what they were doing.
She felt ESR was a simple and easy technique to use under

such circumstances. Her husband experienced a great deal

of satisfaction from being able to provide so much support
and comfort. He felt like he was an integral part of the team.
Complementary or alternative methods are popular because
they involve the individuals, and work with the connection
between body, mind and the hospital environment. Involving
families in their own care can be very empowering (Tournaire
& Theau-Yonneau, 2007).

The ESR points are located on the forehead above the

eyes and halfway between the eyebrows and the hairline.
They are held lightly with just enough pressure to move the
skin, or as lightly as you would touch your eyelid if you were
wearing contact lenses. These neurovascular points have
the effect of bringing blood to the frontal lobe, turning on
the parasympathetic relaxed response and turning off the
sympathetic fight or flight response. Holding these points
normalizes breathing, activates the calm relaxed response
and diffuses the emotional impact. Objectivity is regained
and problem solving is facilitated (Thie, 2005).
Holding these points is effective for any stressful situation. I used them with a pregnant woman who was distressed
because the sonogram showed a hole in her babys heart. She
was being encouraged to have an abortion. She had decided
not to follow this advice, but was very stressed about the
possible outcome. I held her points, directed her to breathe
deeply and think through the situation from beginning to
end in her mind three times. By the end of the third time
she had relaxed completely and felt confident about her
decision. Her husband held her ESR points whenever she became stressed and also used ESR on himself. They also used
ESR on the baby after she was born. In fact many years later,
they still use ESR on their children every night before they
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Stress Relief at Your Finger Tips

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Jeanine Nicholson

go to bed, to relax and calm them and facilitate restful sleep.

Touch conveys a message that someone cares. Direct contact
with an individual has the effect of increasing their sense of
well-being (Gottesman, 1992).
This technique can be used for nursing mothers and
babies to calm and relax them. For nursing mothers stress
can inhibit the letdown reflex causing even more stress for
both the mother and hungry baby. ESR can be used to relax
the nursing mother. This will also facilitate the babys relaxation. ESR can also be used for the baby at times of stress. It
can be used for parents with the stresses of parenthood such
as all the additional responsibilities and stresses of a new
baby coupled with not sleeping all night. It can diffuse the
emotional impact, help both the mother and father to regain
objectivity and even a sense of humor plus the ability to see
things clearly and act appropriately.
Nurses and Health care professionals also experience
situations that cause stress and affect their ability to be
present for their patients and their families. They are in need
of self-care to diffuse the emotional impact and return to
a healthy state of well-being. Stress has an impact on body
physiology and, over time, manifests into physical illness.

Diffusing the emotional impact puts the body back in the

normal healing mode. Two other ways ESR can be used are
to diffuse past traumatic experiences and prepare for future
stressful situations.
Past traumatic experiences in life can affect our current
perception. This can apply to any past traumatic life experience including past birth experiences for patients and also
for staff. In these cases, ESR can be very effective, either by
holding ones hand lightly over ones own forehead or having
someone else hold the points, while thinking through the
traumatic experience from beginning to end three times. At
first the emotions may be felt in the body, but by the third
time, the emotions have usually been released from the
bodys physiology and the person has returned to the calm
relaxed response. In more traumatic situations, the process
may need to be repeated for a longer period of time. When
my mother died, my friend held my points for 45 minutes,
but the results were amazing in moving me through the
grieving process.
ESR can also be used for future situations that may be
causing stress. Follow the same procedure of holding the
ESR points while thinking through the future situation three
times, or more if needed. Visualization can give an added
boost to the process. After diffusing the emotional impact,
continue to hold the ESR points while visualizing how you
would like to see the situation materialize. The mind does
not know the difference between the real and the imagined
reality. It records the imagined reality and acts on it as if it
were real. These techniques can be used any time to promote
self-care. They can also be taught to mothers and fathers for
on-going use in parenting.
As a Psychiatric Nursing Instructor, I taught ESR to my
nursing students at the beginning of their rotation. They used
it for themselves when they got their assignments, before they
started their days rotation, at the beginning of post conference and whenever they were feeling overwhelmed after talking with their patients. They were so excited about the effects
that they experienced when they used them at State Boards,
that they want all incoming students to use them, because
it worked to relax their test taking anxiety. We also did an
experiment before their exam in class by having them check
their pulse and then hold the ESR points. Pulse rates dropped
from sixteen to thirty two points after ESR. When we are in
fight or flight we cannot think. We act automatically based
on past experiences. After using ESR they were much more
relaxed and better able to access the information.
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Stress Relief at Your Finger Tips

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Melzacks (1993) most recent model of how pain works
is related to the brain itself generating every quality of
experience, which is normally triggered by sensory input.
He says, You dont need a body to feel a body (Melzack,
1993, p.618) and is evaluating his theory through research on
phantom limb pain. He is studying the limbic system where
our emotions and affect are evaluated and acted upon. He
talks about a constant dialogue between the brain and body.
He calls this model the neuromatrix. Pert talks about the
molecules of emotion that were previously thought to be
only in the limbic system, now being found in the immune
system also. They are like gossipers telling the immune system what we are thinking (Pert, 1997). These thoughts can
make us ill or promote health, because the immune system
acts on them as if they are real. Therefore, if we can change
our thoughts to healthy positive ones, we can change the
outcome. ESR does this by changing our perceptions.
Teaching the ESR technique to the mothers and fathers
instills hope as they move from passive dependents to active
assertive participants and regain control of their own lives
(Gottesman, 1992). ESR has a positive impact on mothers in
labor and delivery, and gives fathers a supportive role in this
process. ESR is beneficial for nursing mothers, babies and
parents dealing with the stresses of parenthood. ESR is an effective self-care tool for nurses and health care professionals.
It is especially helpful in diffusing past traumatic experiences
and preparing for future stressful situations. ESR paves the
way for future experiences because the emotional impact
has been dissolved and the person enters the situation being
much more able to problem solve and be objective. ESR

is an effective, holistic stress reduction method that can

be used to reduce pain during childbirth and everyday by
parents and healthcare professionals. ESR is easy to learn and
use; it is literally at the individuals fingertips.

References
Adams, J. (2012). Massage and other CAM in Pregnancy. International
Journal of Childbirth Education, 27(3), 37- 42.
Dick-Read, G. (2005). Childbirth without fear: The principles and practice of
natural childbirth (2nd ed.). London: Pinter & Martin Publishers.
Gottesman, C. (1992). Energy balancing through touch for health. Journal of
Holistic Nursing, 10(4), 306-323.
Lowe, N. (1989). Explaining the pain of active labor: The importance of
maternal confidence. Research Nurse Health, 12, 237-245.
Melzack, R. (1993). Pain: Past, present and future. Canadian Journal of
Experimental Psychology, 47:4, 615- 629.
Melzack R., & Casey, K. L. (1968). Sensory, motivational and central control
determinants of pain: a new conceptual model. The Skin Senses, 423-443.
Pert, C. B. (1997). Molecules of Emotion: Why you feel the way you feel. New
York, NY: Simon and Schuster.
Thie, J. (2005). Touch for health, the complete edition: A practical guide to
natural health with acupressure touch and massage. Camarillo, CA: DeVorss
Publications.
Tournaire, M., & Theau-Yonneau, A. (2007). Complementary and alternative approaches to pain relief during labor. Evidence-based complementary
and alternative medicine, 4(4), 409 -417.

Carol Gottesman is certified as a psychiatric and mental health

nurse and a holistic nurse. She has been a nurse for 51 years. She
developed a psychiatric nursing program which she taught for 15
years. She has worked as a Public Health Nurse in CA and as a
Home Health Nurse in Ohio. She is a Certified Touch for Health,
Kinesiology for Learning and Pranic Healing Instructor, an Associate Certified Pranic Healer, and has been in private practice
in Creating Wellness since 1987.

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