 Our speaker for today, Heidi Mayer Valentin from Denmark. She is a midwife, an author, a blogger, and a mother of three living in Copenhagen. And she's a self-proclaimed birth feminist and has been into midwifery since the birth of her first child in 2002. After giving birth to a second child abroad as an expat in Hong Kong, she worked at an international midwifery clinic and had a passion for breastfeeding and whispering babies. However, after attending her first birth back in Denmark, she realized she had a special sense of birth which resulted in the development of a pain and relaxation technique called the MAYER method. Her life is now dedicated to this passion for a better birth experience through partner interaction and the MAYER method. And it is currently under research in Denmark and will be presented at the ICM in Bali in 2021. So thank you very much to Heidi for joining us today and we are looking forward to your presentation. Is it time for me to go on now? That is my cue. Hi there. I am so excited to have this opportunity to present the MAYER method at the VIDM conference. And I know my time is limited so I'll just get straight to business. I hope you will enjoy the presentation and get some inspiration. And how to help women cope better with birth. So we all know that fear, tension and loss of control creates pain and complications in labor. The MAYER method is a big dive into that pain and grab hold of the birthing woman, helping her gain control, relax her body and promote coping. This presentation will give you the insights for you to begin working with this method as a fantastic tool to ease and promote labor. So my name is Heidi and yes, I'm a Danish midwife. I was born in 1977, so that gives me 43 years. I have been a midwife by heart since I gave birth to my first daughter, Beliba. She was born at a hospital in Copenhagen in 2002. Later on I lived abroad in the Caribbean and Hong Kong and I gave birth to my second child, William, in a public hospital in Hong Kong. And later on I worked at this international midwifery clinic, Annaly Midwives in Hong Kong. I wasn't a trained midwife at this time. I was a CBI duble and I had a lot of interest in breastfeeding, as Karen also told you. Later on I attended midwifery school and back home in Denmark. And after I was finished, trained midwife, I gave birth to my third child, Nova, at home with an amazing pain-free water birth. So later on I worked at a private midwifery clinic in Copenhagen called the Stork Nest. And I had a lot of opportunity to work on my method and write my book which I finished in 2018. And since then I have been very dedicated to my method and to promote the good birth experience by enabling mothers and fathers into coping with birth and also educating students, midwife students. So this is the Myomet. It's actually a very simple take. It's a technique where you use your hands and you make this series of calm, deep pressures down the woman's body in an asymmetrical pattern focusing on the depth and the rhythm of this series and you will promote the grounding effect. It is also possible to modulate the pain expression and send the woman into the parasympathetic state of mind which promotes the secretion of hormones. So the Myomet is a technique which you use when the woman starts her contraction. So you are on her body helping her relax and focus on these four points. So when you use the Myomet, you can less the pain perception and promote the progression of birth. So I end up developing a method. It was actually a series of events that we developed. My first birth was a very traumatic experience with particular position of the body delaying the progress and I had hours and hours of stimulation and the artificial contractions were just hailing my body and giving me no poses and just extreme pain. My mind just ran off with me and I couldn't cope with the power of the birth at all. At one point a midwife commented on my tense phase and she pressed her very cold thumb right into my forehead just above the nose to kind of ease out the tension in my forehead. And I immediately felt a relief but she was gone again and I wasn't able to ask her to continue. So I didn't actually get any more of that amazing relaxation. And so I was just left to cope with the antennas and the mask and it wasn't much of a help. It sent me off to a horrible after postnatal depression afterwards and I really had to struggle to find my path again and getting ready for my second birth. And my second birth was in a public hospital in Hong Kong and it was a totally different intense experience. They ruptured my membranes and when I had just passed my due date one day or something and right away I got intense contractions and I had really dealt with the trauma from the first birth and I had healed my fear and I felt like I was ready to trust this birth but the doctors and the midwives just kept interfering trying to make me accept medicine and intervention. So I got so confused and fearful again. At only four centimeters I was just overwhelmed by the power of my body. So I was totally also stressed out by the medical staff's interruptions. So at one point I actually pretend and at that moment when I got away from the disturbances I got in contact with myself and my own inner control just telling my body to let go and relax and I actually convinced my body to open up while I had acondition and I continued to do that over the next few contractions and I could literally just feel how my son was descending and after only five or something, five contractions I actually gave birth to a 4.25 kilo big baby. They've never seen anything like this in Hong Kong. So these two births gave me my own, gave me an understanding of how pressure points and mental focus were key concepts for coping and how you can minimize pain perception by getting in control, in this inner control. But the problem was that the way I was handled in both of my births I was actually taken out of the inner control and into an interaction with the medical staff. So this gave me a lot of inspiration and when I became a midwife student I started using these deep pressure points to direct the women away from the pain and into this deep relaxation and right away I could tell how much difference it meant. Not only to the pain perception but also to the progress and birth. This is now 10 years ago and the technique has been my best tool ever since. So I want to get right into explaining what this technique is. It is a coping and pain relief technique based on three mechanisms as you can see on the slide right now. It mobilizes the central nervous system to induce this parasympathetic hormone flow by sending the woman into the inner control where she's really engaged in deep, deep focus. Then you have the physiological pain modulation which is enhanced by these deep pressure points. They are not acupuncture. They are not based on medians but it's based on gait control theory which I will explain later on. They are all of them a physical deep pressure which is more like a double pressure. So you will grab hold of the woman's body and then pressure her down into the bed and the ground underneath which promotes this grounding sensation. Then you also have the psychological pain modulation which is based on hypnosis. So when you use the technique you also talk to the woman at the same time directing her mind into a mental focus. So this means that this technique is a fast track into relaxation and the trance which is what I call the Maya mind. You will get a lot of help from the partner or the midwife who is using the technique on the birthing woman. The birthing woman will feel that she's not alone with the responsibility of coping and she's more able to let go of her body while somebody else is taking over her body. So she can actually just focus on the focus points, the pressures and she can feel the grounding body scanning relaxation and also this technique helps her time her contractions. So when we start the contraction we are just using our own rhythm down over the body and when we are at the feet we have used almost 30 seconds and then we're going back up again to the woman's forehead and then we help her take a deep sigh to get out of the contraction and just make a deep pressure on her shoulder to really ground her after the contraction. So the functions of the Maya mind is relaxation, pain inhibition, birth promotion because when you are this relaxed while you have a contraction the body is able to let go of the baby and then the baby will have a better contact with the uterus mouth and you will open up, dilate quicker. So it works as a grounding body scanning timer, as I just said. So why is birth painful? That's a good question and I just want to just dwell on it a little bit because we all know that fear creates tension which results in pain. That's the basic of childbirth pain. So we think about how much we actually connect birth and pain and how much this influence our perception of the birth sensation because when we integrate pain as a true story of birth we actually make a great impact on how the woman is interpreting the sensation of birth, the power and the contractions. They are actually not meant to be painful. No normal functions of our body is meant to be painful as long as we cooperate with the function of the normal process. But if we do tense up while having sex it's painful too and if we have complications bodily functions like going to the toilet can get painful too. So in childbirth we also need to separate the two concepts the normal birth and the complicated one. The normal birth has a normal progress, has breaks and pauses in between the contractions and the woman is helped by hormones to promote coping endorphins inducing the tramps and relaxation and when this happens the uterus actually gets what it needs and it doesn't have to send pain signals. If we look at the uterus it doesn't have any nerves in the whole body of the uterus only in the mouth of the uterus. So the uterus is only made of flares and it's a layer of muscle tissue going in the longitudinal way and horizontal layer of muscles and then the blood veins. And as long as the uterus gets what it needs it's actually capable of resetting in between every contraction just like the heart. The slippery muscle tissue is so beautifully capable of having a contraction and then resetting and getting ready for the next contraction and with no need of building up acid and creating pain. So what creates pain is when we don't cooperate with the normal function of the body of the uterus. So when we tense up we stop the blood flow to the uterus and then we get less oxygen, we build up lactate and then we just get acid in the uterus and then it's actually really capable of creating extreme pain. So what is really important to understand is that when we work with the normal function of the birth we actually only have three levels of contractions. So it's possible to keep the power of the birth in all, is what I would say. It's possible to control the power of the birth and not just to have this sensation of birth getting worse and worse and worse. So this is where I want to jump right into my next slide. So to show you the three concepts of why this method is working. So the most important thing is to be able to get out of the contractions. So if we talk about these four levels of contractions, which is actually more dependent on the length of the contraction than on the power. So when the contract is around one minute to one and a half minute long, you will have the maximum power of the contraction as well. And if you don't manage to get out of the contraction and resetting the contraction, if you have very, very long contractions and your breathing technique and your tension is not allowing your body to resetting, then you will just build on top of that with the next contraction. So that is what I call the pain ladder that is actually creating false pain in labor. So it's totally necessary to help the woman get to the contraction and breathing and relax. During the contractions, it's even more important to help her get out of the contraction so that she's able to reset and steady and keep the pain ladder away and just having what is normal bodily contractions, which is just meant to be a tightening of the uterus. But in order to do that, she has to be in control of her body and the interaction with the contraction, but also over her mind. And that's what I have tried to show you on the Maya mind picture, which is not translated. So it's a little bit difficult for you to read, but I can explain that inside of this circle you have focus, the trance, the Maya mind. This is a woman who has to be in focus, breathing, and relaxation. And then the midwife or the partner should build a safe house around this state of mind. And the midwife or the partner can help her get back into this if the woman loses control. So every time she gets out of this focus, she gets into her head, in the outer control she's up in her analytic head. And when she's in her head, the birthing woman, when she's in her head, she is sensing the birth much more painful than when she's just down in her body into this parasympathetic state of mind. Then she can just disappear away from the pain focus and into the coping focus instead. So pain actually happens when the woman loses control of her coping. And this is where I use the Maya technique to help her stay in the coping state of mind, which I call Maya mind. So as you can see on these pictures, this is a beautiful cuddle, Maria and Hans, who I helped out birthing with their second child. And Maria was extremely fearful of childbirth, but we kept her mental focus by giving her lots of Maya pressures. And you can also use the Maya pressures separately, just focusing on the pressure forehead, which is the glabella pressure. And you can also focus on hands or feet, or you can use the whole technique, which helps her time the connection. So this is a slide which just very quickly helps me take you through the understanding of the parasympathetic nervous system and the pathetic nervous system. So it's incredibly important to understand that the moment is in her sympathetic nervous system. She is in her brain. She's analyzed. And she's trying to stay informed. And she's trying to interact with the midwife and getting lots of information and all of that. But the system is not helping her promote all of these good hormones, which will help her get into the flow of the birth. So we want to help her get into the parasympathetic activity, where we can really see how much effect it has on the progress of birth and the pain perception as well. So if we talk about pain, I want to take you through a little bit of the pain theories that is describing why the Maya method is working. Because it all goes together. The more we know about pain, the better we can cope. And the less pain we will actually experience. But this is actually very new science. For 350 years, we have had a biomedical pain model up until 1977. And for that many years, we thought that pain was transcending from the, you can see on this picture, from the foot. You burn your foot and then ascending a pain signal from the bottom and up to the brain. And that's what we thought for so many years that the pain signal was dependent on how much you burned yourself or you hurt yourself. But then in 1977, they started this new understanding where they realized that the pain signal is actually coming from the brain and going down to the wounded body part. Sorry, I just have to. Hi, we've just lost Heidi for a moment. I'm just going to get her back. But hang in there, everybody. So Heidi's connection dropped there. And she'll be logging back in. So just hang on because this was just, well, it'll be wonderfully interesting. But we were just getting to the real meaty bits of understanding pain. So stay in there. And Heidi will be back any moment. Sorry. I'm just going to have you back. Disconnected. No worries. I'm just going to unmute you. I hope you can all hear me again. So I just can use the pain signs that is explaining why the Maya method is so efficient. And just getting to the describing how the brain is actually the pain mother of pain. So the brain is controlling how much pain we need actually to understand pain. We need to understand that pain is a very good mechanism in our body that helps us navigate in life and helps us to take measures that makes us not do the same mistakes again, and to stop us using an arm that is harmed. So it is a good mechanism. And the brain is there to help us learn from the pain. So when we are, I'll just do the next slide. I'll tell you about the new pain model that came in 1977. It was this biopsychosocial pain model. Understand the brain as a mother of pain. And we now understand that the, I just have to see what Karen is writing to me. OK, so we now understand that the signal comes to the brain and then the brain has to understand what kind of signal came from our body, the bio. And how do we feel about it in our psyche? What is going on in the social part of our environment? And then depending on whether the brain feels safe or vulnerable, we will create a level of pain to make us react. So that means that the brain is creating the pain. And we need to control the brain and control the body to be able to influence the pain. That's what I want to say. And I have to take care of the time here. Just quick quick take three, which is a very simple understanding that the sharp measures of pain, they travel in the narrow curves in the body. So when we stimulate the wider nerves, we can actually block the gateway to the brain because the brain can only take one action at a time. And when we stimulate the wider nerves, go faster to the brain than the narrow ones. And that means when we stimulate the body's wide nerves, we can block the pain. So when we stimulate that, it could be by touch, pressure, vibration, massage, cold and heat. We know we use all of this already just intuitively when we work with pain. But when we know that it works, we can actually enhance that effect. And that is why it's so important to go pain again. We have to understand that the more we trust our body, the more secure we feel, the less pain we will feel. And in the end, we will get a lot of psychological pain if we don't trust what we feel. So let me just take you to the next one. Bio-messages on promoting focus and the safety and control by mental strategies, visualization, and deep pressure points. So what we do when we use the technique is we guide the woman's mental state. We guide by talking to her in a very easy, dominant, hypnotic way. It's just to keep her focus of pain. So we will always engage the breathing. So when I use the Maya method, I will start by pressing my thumb down into her forehead. And then I'll engage her into the breathing. So that would sound like this. I would tell her, please take a deep breath in through your nose and blow out through your mouth. Make sure that your out-breath is longer than your intake. Take a deep breath in again. And then just follow your breath down through your body, only focusing on how I'm touching you and where I'm touching you. And keep track of where I'm touching you. And just let go of your body, relaxing and trusting. And then just follow my path and rhythm down through your body. And when I get down to her feet, I will tell her maybe to wiggle her left toe and then back up to the right thumb, and then the left pinky, and then back down to the left big toe. So I'll just tell her where to focus and keep track of her mind so it doesn't run off with her. And then when we get back up to her forehead, this series of pressure points have taken have lasted one minute, so it's time to get out of the contraction. And it doesn't matter if the contraction is still there. We will gain a lot from trying to get out earlier than the contraction. So we will just tell her to take a deep breath in and then sigh out. And then keep her down, pushing on her shoulder, holding a big pause in between the breaths and then tell her to do it one more time, take a deep breath. And then let go of your body with a big sigh. And then she's reset. Actually, it's that simple. She will follow your lead and she will use the pressure points to understand how to get into that relaxation. So in order to use this technique, we need to make a partner dream. It's just a simple fond of trust in between the two working together. So when I engage in this very dumb talking, guiding of her mental state, I always make sure that we have a fallback, which is the partner agreement. So I tell her it's very difficult for me to read how you like what I'm doing because women, birthing women, they don't talk much. But they're very good at saying no. So this is what I tell her. If you don't like what I'm doing, just say no. And then actively say no. And then I will try something else. And that makes me feel more confident when I'm working this close with the woman. I can help her and I can try my things. And then if not answering, not saying anything, then it means I can call you. And then I'm trying something else. So, yeah. That's my method. It has a very baby's approach. You can try your favorite to go on my Instagram and see the videos on my YouTube. But it's very simple. I'm sure that the woman is lying here in her first position, which is this semi-prone position. No, not semi-prone, what is it called? Half sitting, half lying position. Arrange her like this and make her accept and agree to just two contractions trying to follow your lead. Then do the basic points and then use the control, the way you talk to her to enhance the relaxation of the brain. And then you are on. Trying with this technique, you can do contractions, show her how cooperation and relaxation and breathing can help her influence the pain perception. So, I guess that's it, Nina. We need some time for questions as well. Thank you so much, Heidi. That was a wonderful presentation and really interesting to midwives and birth workers and members of the public who, you know, especially pregnant moms. So, yes, thank you very, very much for that. Thank you so much, Trina. It was really fascinating and wonderful hearing the different how you came to this, you know, through your own experience as well. I'm just going through to see if there are any other questions. Angela asked to post a link to the Instagram, which I see has already been done. So, thank you so much for that. That's one of my midwife students posting it. That's so amazing. They're so dedicated to the method. It's amazing. And they're also asking if there's an English version of your book or your resources. Totally not yet. I'm working on that, but I need to get in contact with someone who can help me get the book. Do you find it easy to adapt this method to women who are not being caseloaded? What does caseloaded mean, Karen? So those who are under the hospital and who are in the hospital environment? This technique is very helpful for all environments. I think it's extremely easy to implement because you can just ask the woman if we can try this relaxation technique for just two contractions. So she only has to try it out for two minutes and then she sees the results. So I use it in a birthing clinic. I use it when I do home births and I use it a lot in the hospital because fear creates so much more pain. So in the hospital, this technique is really efficient. Absolutely. And they don't need a lot of education. What I usually do is I just introduce them to the understanding of the pain ladder and then the uterus normal bodily function. So when they understand that we just need to give the uterus what it's meant to have, they are very cooperative and they just don't know how to get there. You know, when you have a birthing woman and she's under influence of all this impact of the contractions or in her body just taking her away and when you tell her to breathe, she's like, okay, what do you think I'm trying to? And if you tell her to relax, she's like, how do I relax? I cannot even find my shoulders. I don't know where my body is in this rage of power. So when you impact her, when you touch her at the same time, then she knows where to go in her body. And a lot of women don't want to be touched during childbirth and they don't want to lie down. They want to walk around and just go very lonely. But what they realize is that I can help them cope and I can actually help them lie down and relax so that they can sleep in between the contractions and then their body will work much better because they can rest and gain power later on Absolutely. Just that ability to be able to rest. And somebody is asking if there's any contraindication for using this method? Well, it's only working on natural relief and relaxation and breathing. So I don't think there's any harm possible. But I do underline the importance of the position which I don't remember what it's called in English. Somebody actually wrote it somewhere, a recombinant position, the semi-recombinant position because if she's trying to flat on her back, you can actually feel the same effect as the epidural. So when you have a very tense, she gets in this kind of relaxation while she's contracting, the bruise can kind of get heavy on the veins in the back and she can have this vena cava symptom. So of course it's very important that she's lying with her back raised a little bit so that the blood is compromised. Now there's another question here from Natalie asking if you find that in the hospital birthing environment that the other medrives and medical staff are positive in giving you the space to work with women using this technique. So what has your experience of that been? I find that I get a lot of support towards this technique. And then Mark, it's the interest in my technique has been increasing. I developed this technique and I used it throughout the years so much just for myself and until I realized I could give it all the power. And then I understood that this was a very easy and universal technique which is easy to take on. So it's just basic cycle prophylax but it's made so easy to apply to the woman and to the partner. So I find that it's helping me a lot to promote the natural birth and to prevent interventions. I don't often have pain medication and augmentation of my birth because I can help the woman understand the birth easier by using this technique. So you mentioned talking about the normal birth by this. Yes, but you mentioned cycle prophylax and that's actually one of the questions asking if there's any difference between cycle prophylax and the Mayo method, that's one of the questions. Or is cycle prophylax just a term that's used to describe these different modalities that are included? Yeah, it's actually a really good question because I saw this once before by an older midwife and she was like, what is the difference because it's just cycle prophylax and I was like, okay, how do you explain cycle prophylax to the partner and how do you make it engage into this? And this is where this technique is so simple and easy to apply and it's also a very efficient kind of cycle prophylax because you are using the three mechanisms the biopsychosocial mechanisms at the same time. So you're setting in on the pain and perception by making the body and the mind cooperate with the partner or the midwife at the same time so the woman doesn't feel alone in coping. And so I would say that this technique is different because it's also using the gait control very efficiently. So when you are using these Maya pressures, these double pressures, you are actually really grabbing hold of the woman's attention and really grounding her in a dominant way. So it's a very hands on cycle prophylax. That's what I will say. That explains it. Thank you so much. One last question and then we will have to wrap up and that was just because it was asked a while ago and I'm not sure if you're going to be able to answer this really in a short space of time but they're asking if you can juggle the Maya method and documentation as well as other hospital policies. It actually gives me more time to juggle what is it called? The document and the policies. The documentation because when I use this technique I use it only for a few minutes to engage the partner and then I get more time to document as well. So sometimes I have spent hours working on the woman because she's getting so dependent on this help because it's so efficient. But then I can still write my notes in the breaks because she's much more efficiently getting breaks pauses in between the contractions where she's actually sleeping and resting. I often see that when you have a storm of contractions just hailing in over the woman when I use this technique I get her back into a normal pattern of contractions which gets much more efficient and then I have time to document and stuff. In Denmark we have a lot of amazing fathers to be who actually really wants to have a space in birth where they can do something. For me this is my best tool to let them have this amazing experience with being together on birth. Will you be offering a course to teach the Maya method or do you offer a course? I do. I do right now in my private clients here and I also do an age... I'm working on making an online English course but I don't think it will be ready until maybe within a few months maybe. Wonderful. One last question and we will be closing up but somebody looked at your Instagram and saw images of using it on babies. So if you can just answer that question. It's amazing. You should just try it. You will feel how grounding you will get by just one minute. One of my friends that I tried it on she's been using a lot of mindfulness and meditation to cope with stress and anxiety and I gave her this technique in one minute and she was like, wow, you just got me in the same place as 20 minutes of meditation does. This is just a very calm and nice technique and you can use it on babies and children too in a less powerful way to just enhance relaxation as a sleep association and they just love it. When you introduce this they get a sense of their whole body which grounds them and they get more relaxed and can easily accept going into sleep. So I use it on everybody who allows me. So. Heidi, that's absolutely wonderful.