Friday, 27 February 2015

Hazards To A Pain Free Labour/Labor - 7

Reflecting on recent experiences I would like to add a hazard to the list that may interfere with your pain free first stage of labour.
A precipitate labour is a very quick labour and usually causes contraction pain. These labours are usually the result of a woman's body deciding that it really must get this baby out NOW as there is a risk factor that could damage the baby.
The contractions come much closer together than a normal labour and are quite intense and strong. This means that the uterine smooth muscle will not be able to get enough oxygen from the blood and so produce lactic acid leading to a message being sent to the brain to experience PAIN.
Women with very high blood pressure can have precipitate labours and I have noticed that women who have small for dates babies often labour very quickly as the placenta is failing.
A big help with these fast labours is entonox (gas and air). This is because it contains 50% oxygen which is 30% more than the air that we breath normally and so can help pay back the oxygen debt that is causing the contraction pain. Getting in a warm pool is also desirable but if you have risk factors then the hospital will want you to be monitored on a CTG machine.
Essential for a more comfortable labour is staying upright on a birth ball or chair or mobilising. Do not let them make you lie down on a bed in labour in order to monitor your baby's heart beat. This can easily be done in any of the positions mentioned which means the contractions will not get any stronger. In a lying down position the uterus is pushing baby uphill, very hard. In an upright position the uterus is pushing baby downhill, easy.
Never forget that whatever kind of health care you choose for your birth, you are the boss and hospital staff are there to offer you care that suits your needs. You are not there for their convenience. Never be afraid to ask for what you need to keep you more comfortable in labour.

Pain Free Labour books now available from Amazon.

 

Thursday, 22 January 2015

Childbirth Unmasked 8

Childbirth Unmasked by Margaret Jowitt
Chapter 6 Stress and Labour

In this chapter Margaret looks at how modern hospital management of labour causes stress which sets into motion the release of a cascade of hormones that interfere with normal labour, making it painful. This pain justifies the hospitals management and it is ameliorated by drugs or surgical means. The cause is therefore the cure.
Complete freedom of movement is essential in order to follow pain avoidance instincts. Curtailing movement by connecting women up to drips and fetal monitors may be counter-productive and lead to the very pain and fetal distress it is meant to avoid. Forcing women to labour on their back must have been torture (and still is today) and in itself could account for a large proportion of infant and maternal mortality.”

In this chapter the focus is on B-endorphin, a hormone that steadily rises in labour and is thought to regulate and avoid 'explosive' contractions. It seems that there is a see/saw effect between Oestrogen and B-endorphin during labour. Oestrogen apparently helps uterine smooth muscle to contract while B-endorphin works to suppress contractions. As B-endorphin is a stress hormone this could explain why women turn up at hospital with reduced contractions after contracting well at home. If you move a labouring woman before labour has established the stress hormones released, caused by the move, will halt the labour.
...the behavioural purposes of stress hormones. They are switched on in an attempt to make us change the environment to suit our needs better. Once our needs are met then stress hormones fall, and the body resumes its normal activity. The evolutionary purpose of psychologically induced stress hormones in labour is to improve the environment to make it more suitable for labour, for birth itself...”
Margaret points out that it is difficult to avoid stress, and therefore stress hormones, in a hospital setting. This is why it is so important to practice the relaxation techniques outlined in previous posts on this blog in your pregnancy so that when you start to contract you do not panic and rush straight to hospital. You simply sit down on your own comfy couch and listen to your body. Stress is like interference on a radio channel which stops you from hearing what is being said. Relaxation tunes you in properly so that your body can listen to labour in peace.

The reason that so many women attend hospital today for induction of labour is that they have gone past their ultrasound scan due date. As that date slowly approaches, women become more anxious as they believe the social construct of painful labours. This constant release of stress hormones must have an effect on the onset of labour. If women worked on their relaxation techniques leading up to labour day I am convinced that they would more readily and easily go into labour without all the stopping and starting that modern women report today. With my second labour, after a traumatic first, I went over my dates and was very stressed during that time. At term+6 I decided that I was not doing myself any favours and started doing progressive muscle relaxation that I had learned from a yoga book. I felt really well that night going to bed, as if the whole world had been lifted from my shoulders. At 1am I awoke with some irregular contractions. So that I would not mess up my labour I snuck downstairs and continued my relaxing. I listened to my body and ate and drank at will until the contractions had been regular and lasting for 50-60 seconds for at least an hour. The midwife at the hospital did not believe that I was in labour as I was still relaxing and not in any pain. On examination she found me to be fully dilated and awaiting an urge to push. I was so happy I could have cried. Just by remaining relaxed and in control I had avoided the stress and pain of my first labour. Bliss.

Margaret concludes this chapter by saying:
Relaxation, breathing methods, yoga and psychoprophylaxis (you will have to google that last one) have all proven successful means of dealing with stress in labour by screening out distractions, and many mothers and midwives will testify to their efficacy. Until now, the reasons for the success of these methods have been unknown. Home birth remains the only way for a woman to be sure of retaining control over her baby's birth and I recommend it highly as an experience not to be missed unless absolutely necessary.”

However, if you have the right midwife who is willing to help keep you upright in labour and lower the lights and noise levels to keep you relaxed, then a hospital birth can be an acceptable alternative. Pool births within a hospital setting can be lovely with the right support. Practice the relaxing at home and do not come in too soon while everything remains normal. Margaret Jowitt wrote her book 20 years ago with all the information in it that women need in order to labour well and yet women today still let their fear of labour govern their reactions instead of taking control. You can change the stress/pain reaction to labour by choosing and practising your relaxation method today. Take control, I don't see why us midwives should do all the work!

PAIN FREE LABOUR BOOKS NOW AVAILABLE FROM AMAZON.
A wonderful book by Susan Jeffers will teach you how to deal with stress on a daily basis, 'Feel the Fear, and do it anyway'. Also available from Amazon or ebay.
Uterine smooth muscle is only painful when deprived of oxygen, this happens when you make it work harder by lying down or taking away some of its blood supply by being anxious or afraid.






Wednesday, 7 January 2015

Childbirth Unmasked 7

Chapter 5 - Labour

"For sixty years (now 80) or more scientists have been suspending strips of animal and human uterus in various liquids in test tubes, stretching it, adding hormones, adding chemicals, measuring contractions, analysing changes, and generally trying to find out what makes uterine muscle work and what stops it working"
In this chapter Margaret Jowitt uncovers the reason that women today fear labour and so stop themselves from labouring. All the research has been carried out on medicalised abnormal labour, normal labour has been ignored so that doctors know very little about how to help women have natural labours.
"The scientists have completely ignored the mother herself and her mind. This is why obstetrics is the least scientifically based medical speciality. ...stress hormones unlock the mysteries of labour itself."

In the posts on this blog entitled 'Why Labour Hurts' I try to explain how adrenalin, secreted when we are anxious or afraid, acts in a way that causes contractions to become painful. Margaret takes this explanation a step further by comparing labour to driving a car.
"The hormonal control of labour is very complex and difficult to understand but it has certain similarities with driving a car."

Margaret goes on to describe the functions of different hormones and how they can be interfered with by adrenalin, a little like having to use your brake in an emergency in order to stop. Women have their foot firmly on the labour brake throughout by producing copious amounts of adrenalin which makes it painful and will eventually halt the labour as the body goes into total exhaustion mode. This scenario can be avoided by the relaxation techniques outlined in this blog. A relaxed person does not secrete adrenalin and so the labour can continue with the accelerator pressed instead of the brake.

Painful contractions are considered and Margaret gives a lovely explanation of what to do if you find yourself with them at any time during a normal labour.
"...pain is a motivation for the labouring woman to do something to ease her stress, whether physical or emotional. She may change her position to relieve physical stress and relax her body and mind to relieve psychological stress."
Your body uses pain to let you know that something is wrong and you have to try different things to alleviate the pain. If you are sat on your hand and it becomes painful you would not keep on sitting on it would you?

Margaret understands labour so well and is a wonderful advocate for pain free labours during the first stage. "When the woman has learnt that she must relax or change her position to avoid pain, then the uterus can get on with its work. The better she learns how to cope with contractions, to relax and follow positional instincts, the shorter will be the first stage of labour." Amen.

And yet women today still firmly believe that labour will be painful and so start pumping out adrenalin at the first sign of a contraction. We have known about pain free labours since Dr. Dick-Read put forward his fear/tension/pain theory in the 1940s and yet we seem unable to accept the simple fact that uterine smooth muscle was never designed to cause the sensation of pain during a normal contraction. We never learn, do we?

Pain Free Labour books availlable from Amazon.

Sunday, 30 November 2014

Beautiful birth video.

Thank you Rebecca Blech founder of Syntonic Birth for this inspirational birth video. OK this is not this young lady's first baby, which usually take longer to push out, but her lovely family and calm demeanour are inspirational to all women. Lovely.

https://www.youtube.com/watch?v=V0OZb5Smrek&feature=share

Pain Free Labour Books are now available from Amazon, cheap as chips.

Tuesday, 25 November 2014

Fear of Childbirth, latest research.

 Seen on the Royal College of Midwives web page.

 ‘Fear of childbirth’ and ways of coping for pregnant women and their partners during the birthing process: a salutogenic analysis
05/09/2014 - 14:15
To explore ‘fear of childbirth’ and its impact on birth choices among women and their partners in Northern Ireland.
Jean Greer BSc, RM. Anne Lazenbatt PhD, MSc, BSc. Laura Dunne PhD, BA.


‘Tokophobia’ is defined as morbid fear of childbirth (Bhatia and Jhanjee, 2012), and this diagnosis has recently been endorsed within the UK as an indication for planned CS (NICE, 2011). This decision seems contrary to current trends within maternity services that focus on promoting normality in birth (Gould, 2012). However, there have been concerns for some time among midwives that the conceptualisation of fear of childbirth as a pathological process, situates the problem within the individual woman, and deflects attention from maternity care provision (Walsh, 2002).
All the women feared the pain of labour and were reassured by the availability of a 24-hour epidural service. Despite this, the majority of the women (65%) expressed hope that they could labour without an epidural, although they lacked confidence in their ability to cope and feared the pain would be too severe. Six of the primigravidas in this study (40%) had already been advised to have an epidural during labour by family or friends and all the men wanted their partner to have as much pain relief as possible during the birth“She [her mother] said: ‘If you want my advice, you get an epidural as soon as you go into labour because you’ll never be able to cope.’ You see they all know me and know what I’m like” (W10, prim).
 Four participants (11%) identified midwife support as a resource to help them cope with birth. These were two multiparous women and partners. Recalling previous births,
they described how the midwife had reduced their fears: “...from what I could see, the midwife had everything under control and like it seemed ok... so I was pretty relaxed” (M3, third baby).
Normal birth was still very alluring for most of the women in this study. It has been reported previously that women idealise normal birth while also rejecting it as dangerous (Maier, 2010). Most women in this study (89%) aspired to a normal birth but more than half (68%) feared they would not be capable of achieving it safely without medical intervention. Gould (2012) contends that this is a consequence of the language of risk that is used when offering birthing choices to women. This perception of riskiness reduces the comprehensibility dimension for women, and increases their need for resources to help manage birth. 
See the post 'Progressive Muscle Relaxation'.
It is little wonder that women today have tokophobia as our society teaches them through the media, family, friends and health professionals that contractions WILL be painful while ignoring the simple fact that uterine smooth muscle was never designed to cause the sensation of pain during a normal first stage of labour.

Pain Free Labour books now available from Amazon.

 

Thursday, 13 November 2014

Childbirth Unmasked 6

Chapter 4 The Womb

The womb, otherwise known as the uterus. A truly wonderful organ as it grows from the size of a pear to the size of a large melon in just 9 months. In this chapter Margaret Jowitt explores the form and function of the uterus as well as how it responds to stress hormones.
"...to provide a safe environment for a growing fetus for nine months and to expel its contents at the end of that time safely and efficiently."

The uterus is mainly a bag of smooth muscle. This type of muscle is not under our direct control and is also found in the stomach, urinary bladder and surrounding most blood vessels. It was never designed by nature to cause pain when it is contracting normally. So why does it? Margaret quite rightly points her finger at  stress hormones as the main culprits.
"Since we cannot make smooth muscle work by an act of will, the only way of influencing it is to use indirect, psychological means - changing our state of mind and thus altering the secretion of stress hormones."
Thank you Margaret, I have been teaching pregnant women in this blog how to use relaxation techniques in pregnancy and labour in order to reduce stress hormones so that women's bodies can labour without hindrance. It is thought that many women go into spontaneous labour at night when they are asleep as there are no stress hormones around at that time.


" ...uterine sympathetic nerves become more sensitive in pregnancy... This implies an important physiological role for nervous input during labour. One biological role of pain is to promote instinctive pain-avoidance behaviour."
Remember the saber toothed tiger in my post Why Labour Hurts 3? It appears at the cave door of our lovely cave woman who is in labour. OMG. The first thing she would do is to release adrenalin into her system so that she would have extra energy to run away or stay and fight. But 'Oh No' her cervix is nearly fully dilated, if her baby is born now then the tiger will think its her birthday and celebrate with a very fresh human, covered in a tasty liquor dressing accompanied by a side order of bloody placenta. Yum.Well, Margaret's uterine sympathetic nerves are at work here by reacting to our cave woman's fear by secreting stress hormones that allow mum to escape while preventing her cervix from fully opening, allowing adrenalin to attach itself to receptor sites on the human cervix making it rigid, harder to open.

In my post Why Labour Hurts 4, I try to impart to women the importance of not lying down in labour.
"During the first stage of labour the fetus and the uterus dance an intricate pas de deux which directs the fetus towards the cervix... the mother should be allowed freedom of movement in order to give full rein to these directed contractions. I suggest that painful contractions occur when the uterus is prevented from working as it should... Freedom of movement is a cornerstone of instinctive childbirth. Immobility is a recipe for obstetric disaster..."

Thank you Margaret for explaining in far more detail than I could ever manage about why I was able to have my two pain free labours. My third labour was spoiled by being forced to lie down on a hospital bed for the duration, and I was in agony. I just wish that your book had been around for me to read at the time. I look forward to reading chapter 5.

Pain Free Labour books are available from Amazon to download or in paper form. xx
Ever wondered why animals seem to have labour contractions that cause them no pain?

Thursday, 16 October 2014

It's BLOG ACTION DAY!

16/10/2014 is blog action day and OXFAM have asked bloggers around the world to take part. We are to post blogs on inequality. Inequality with regards to childbirth, don't get me started!

According to Oxfam 800 women die every day in childbirth. Just 5 of them are in high-income countries. The WHO have been saying for decades that educating local women to become midwives would put a serious dent in that awful number of losses. Making simple drugs available to these midwives like Syntometrine would help to reduce the numbers of PPH. Of course then they would need a fridge or portable cool box that I used to carry as a community midwife.

Also according to Oxfam there are 85 people who have as much wealth as half of the people on the planet combined. Who are these people? Gods? Unfortunately they did not give out names or addresses of the 85 so will have to do some more digging before I send out the begging letters.

Ironically, one of the richest nations of the world has very little in the way of equality when it comes to childbirth. The USA have a terrible record of forcing women into a medical model of care no matter what their risk factors are. They do not have midwifery led care and you have to see a doctor throughout your pregnancy and be delivered by a doctor as well. Doctors in the US seem to know nothing about normal labour and birth so how can women hope to birth normally? All they need to do is allow home births (banned in most states) and train midwives (not obstetric nurses) how to empower women to take charge of their birth and support them safely in their choices. Simple.

One young Indian lady that I booked told me that she wanted to lie down for her upcoming birth with an epidural in situ and have an episiotomy as a doctor removes her baby with forceps as this is what she went through in India at her first birth. I was speechless for a minute or two there. At the end of our hour long booking session she was so happy to be looking forward to birthing in a pool at the stunning birth center that I was working at then. Low risk women should not be given the medical model of care unless they have risk factors and even then they can labour normally with a bit of care and attention from midwives.

So, the answer to inequality within childbirth seems to be to train and pay more midwives to deliver midwifery led care for all women, whether they are rich or poor. Sorted.

Pain Free Labour books now available from Amazon to download (very cheap) if you are rich and have a kindle or in print if you are poor with no posh phone, kindle or PC (print books are more expensive). IS THAT INEQUALITY OR WHAT!
HAPPY PARENTING