[This story from The Guardian is about another promising application of presence; the discussion toward the end about the best types of virtual environment for this context is particularly interesting. The original article includes more pictures. –Matthew]
[Image: Erin Martucci and her daughter. Photograph: Mary Bratton]
Can virtual reality help women cope with childbirth?
Erin Martucci is believed to be the first to use a virtual reality headset to manage her pain during labor, and doctors hope more women will follow
Friday 9 December 2016
Erin Martucci had been enjoying the beach vista and gazing at a flock of birds overhead when something shook her view. The voice of Ralph Anderson, her gynecologist, broke through the sound of the waterfall next to her.
“We’re ready to push!” he said, gently taking Martucci’s virtual reality headset off and bringing her back to a hospital room at Orange Regional Medical Center in Middletown, New York. Martucci, 40, looked around at her husband and mother, their voices swirling excitedly around her: “She’s crowning! She’s ready!”
“I was like, ‘Wait, what are you doing?’. I thought I needed the goggles to push!,” Martucci says. She had been so engrossed in her virtual beachside hideaway, she hadn’t realised that her baby’s head was starting to show. It was time to take off the goggles.
Martucci is believed to be the first woman to use virtual reality (VR) for pain management during labor. With more women moving away from scheduled C-sections – which accounted for 32% of US births in 2015 – VR might offer another drug-free pain option during birth.
“I was on a beach, and there was a fire going,” Martucci recalls. “Wherever you moved, the scene moved with you. If I looked up, I saw the galaxy and the sun setting. On the right, there was a waterfall and a lot of movement with birds,” Martucci says. From time to time, a woman with an English accent peppered Martucci’s virtual world with guidance.
“You wanted to listen to her,” she says. “I remember her focusing on the breathing and your body tensing and relaxing, and tensing and relaxing. She kept saying ‘Focus on the birds,’” says Martucci. “It was really very calming. She would teach me how to breathe and be really in touch with your body.”
‘It made me feel I’m OK here’
Martucci had declined an epidural earlier in the day when she started to think her labor contractions were becoming too painful to manage on her own, but she was open to Anderson’s suggestion to try a pre-programmed VR headset.
While Martucci wore the device, Anderson monitored her contractions remotely and check on her in between seeing other patients. “You could tell she was having pain the whole time, but she was breathing through all of it,” Anderson says. Near the end of the two hours, Anderson saw Martucci was reacting more to her contractions, and her pain had intensified. She let out some guttural sounds and writhed a bit. He sensed that it was time to check whether she was ready to push.
“Obviously, I know I was going through some of the contractions, and eventually I knew my body was telling me I’m ready, but I never anticipated that I wore the machine for that long. It definitely calmed me down and helped me breathe and really focus on getting through the labor,” Martucci says. “There was something about it that made me feel, ‘I’m OK here.’”
Within minutes of taking off the device, Martucci gave birth to her second child, a girl.
Getting women on board with virtual reality
Anderson’s medical practice wants to improve patient safety by reducing the use of opiate and narcotic pain medications and anesthesia, and is exploring alternative pain treatments during labor, including jacuzzi baths and nitrous oxide, or laughing gas.
Since the summer, Anderson, who is also the chairperson of the robotic surgery steering committee at Orange Regional Medical Center, has been using a Samsung Gear VR headset to help calm his patients before and during minor procedures, such as biopsies of the cervix.
He had only offered it to a small number of women during early-stage, passive labor, and wasn’t sure his patients would be open to using it during late-stage, active labor when contractions are at their strongest and most women want to focus on their breathing. During active labor, women are prone to ask for epidurals, where pain relief is injected into the spine.
Martucci seemed open to managing her pain without medication, so was a good candidate for the headset. “The patient has to be a little bit motivated and not someone who is going to be that scared of the pain,” Anderson says. “You have to put the device on at the right time, because if that pain is that intense, you’re not going to catch up.”
Later that day, Anderson offered the device to another woman who was going into labor with her fourth child, and who chose VR to distract herself during an uncomfortable pelvic exam and induction. She gave birth shortly after removing the headset. “She was so interested, and was writing down the details, wanting to know where she could get her own.” says Anderson.
VR for pain
The company that created the virtual environment and supplied the headset Anderson uses, AppliedVR, has partnered with Cedars-Sinai Medical Center in Los Angeles for clinical studies. The trials will explore using VR to manage acute pain, mainly through coaching and distraction. Other hospitals, including Boston Children’s Hospital and UCLA, also have planned trials with AppliedVR.
Using VR in this way is still rare, but there is some evidence that this technique of being immersed in an different sensorial environment can temporarily relieve pain. According to a report in the Psychology of Consciousness medical journal in September 2015, adults using VR while experiencing pain reported an average 82% reduction compared to those who do not. The researchers found that adults benefited more than children, though it remains unclear how virtual reality could alter chronic, persistent pain.
Some hospitals and doctors have begun to use VR to train surgeons before they operate on real patients, while others are exploring how to use it to aid diagnosis, allowing multiple, complex 3D scans to be examined in a virtual environment.
In the limited VR trials for childbirth, Anderson found that AppliedVR’s technology can help women take their mind off the pain, but also keeps their eyes open and engaged – rather than closing their eyes and clenching their firsts. Prenatal professionals encourage women to concentrate on a focal point to keep them relaxed and concentrated on their breathing.
Natural birthing proponents point to the increasing medicalization of birth since the Victorian era, and to discussion of birth that focuses on pain and fear. Using VR during labour could encourage women to give birth naturally and without drugs, but might also mean that they aren’t fully present during one of the most important moments of their lives.
“I can imagine that for some women, looking at the sky or at the birds or flowers can be more relaxing than focusing on the body,” says Beatrijs Smulders, a Dutch midwife and author of Safe Birth. “But from my experience, any distraction from focusing on your body inhibits the birth.” She has attended to more than 4,000 births in her 40-year career in the Netherlands, a country known to promote home and natural births and with a C-section rate of 7.7%, according to a 2015 study.
Too much stimulation during labor can stimulate cortisol, the stress hormone, which inhibits the other hormones the body needs to quickly and successfully push the labor along, including oxytocin, endorphins, and prolactin. Smulders recommends laboring women seek darker, quieter spaces and give full attention to their bodies.
Women are capable of internalizing the pain, Smulder says, and using it to make the body respond to labor. “It’s the body that does the work. You have to go down into your body and leave all the activities in your brain alone.”
But for Martucci, using virtual reality felt like a simple and powerful way to deal with the intensity and discomfort of her labor.
“Having that voice take me through the breathing and being in touch with your body and that focal point helped so much more,” says Martucci, who recounts her birth story at every opportunity. “I thought it was great. And we have this healthy, beautiful baby girl.”