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

Tuesday, 23 September 2014

Childbirth Unmasked 5

Chapter 4 The Womb.
This chapter looks at the anatomy and function of the uterus. Jowitt informs us that the psychology of how the uterus works is just as important as the physiology. Spot on. However, it seems that researchers are more interested in the form and function of uterine activity rather than influences from an emotional mother.
"The well established medical discipline of the science of childbirth deals almost exclusively with the physical action of the uterus. Biochemists are interested in what makes it contract and what makes it relax, and endocrinologists are interested in control of this process by the pituitary gland and hypothalamus. ...the role of emotions seems to be largely ignored.
That stance by researchers seems to be mainly the same 20 years later. No one seems interested in why labour hurts for most women when it was never designed to. The role of adrenalin in making the first stage of labour painful is totally ignored. 
This chapter goes on to explain the role of various hormones that affect the uterus at different stages of a woman's pregnancy and birth. She looks at the structure of the uterus, the 3 different layers of smooth muscle, (very similar in structure to the stomach, do you need an epidural every time you eat and your gastric smooth muscle is contracting?) and how it stretches to accommodate a growing baby.
Contractions are explained, especially for the first stage of labour when the cervix needs constant even pressure to dilate effectively.
"...the fetus and the uterus dance an intricate pas de deux which directs the fetus towards the cervix to be ideally placed for the second stage of labour...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." Exactly, when a woman is made to lie down on a bed to labour and her uterus is pushing baby uphill instead of down. Much harder work.
Jowitt warns of the consequences of allowing hospital staff to 'break your waters' as they are there to cushion the fetal head against the cervix.
"...a cushion of amniotic fluid between the baby and the uterus will be to spread the fetal force more evenly." It is now commonly known that breaking your waters releases hormones called prostaglandins which attach to uterine smooth muscle to make the contractions stronger and so painful. See the post - Hazards to a pain free labour - 2.
Finally, the wonderful Margaret Jowitt states:
"Some women go through the first stage of labour without even knowing that they are in labour. They do not feel any pain in the first stage because their brain sees no need to tell them to change either their position or their surroundings."
I have to say that with my first pain free labour I only knew that I may be in labour because my uterus was going hard every 5 minutes. But then, it was 1am and I was sat on my couch with nothing else to do except count contractions.

Pain free labour books now available from Amazon. 


 


Tuesday, 2 September 2014

Childbirth Unmasked 4

Chapter 3 Stress and reproduction. Margaret Jowitt.
Unless you have a PhD in human biology you may not quite understand this chapter. I love anatomy and physiology but I have to admit I struggled.
This chapter maps the intricate hormone dance that is present in a womans' body during pregnancy and labour. It is a very complicated dance, and you thought the foxtrot was bad.
Jowitt links high stress levels to infertility, miscarriage, reduced fetal growth and premature labour. She even says that if you are only mildly stressed toward your due date then your body will resist going into labour and you will face induction of labour for postmaturity. Even more reason to practice the relaxation techniques IN PREGNANCY AND LABOUR outlined in earlier posts within this blog or in my Pain Free Labour books available from Amazon. If you are serious about life with long term reductions in stress levels then read Susan Jeffers book 'Feel the Fear, and do it anyway'. A beautiful book to help you cope with daily stress levels that cannot be avoided and bring out in you the best of who you are. Lovely.
So, blah, blah, blah, cortisol and Beta-endorphin and progesterone and oestrogen and cholesterol and even testosterone levels which control our bodies.
The hormone that we should be most interested in is ADRENALIN simply because we know that there are receptor sites for adrenalin on the cervix. High levels 'stick' to the cervix and make it rigid, harder to open. A relaxed person does not secrete high levels of Adrenalin. I have seen many stressed women in labour who as soon as they have an epidural, relax, and even go to sleep. Suddenly there are radically reduced levels of adrenalin and their cervix can open in peace and quiet to let their baby out. Awww. If they did not get stressed up to their eye balls in the first place then they would not need an epidural to reduce adrenalin levels!
Jowitt goes on to discuss the virtues of delivering your baby in a favourable environment.
"Offspring born to mothers in safe places away from predators would be more likely to survive than those born in dangerous situations. But I suggest that it was the place of labour for the mother as well as place of birth for the child that was important in evolution. I am convinced that labour proceeds more smoothly if the mother is spared unnecessary stress. High levels of stress hormones interfere with the process of labour itself, particularly in the early stages. The mother survived childbirth to bear more children if she chose to labour in a sage place, and throughout the animal world, that place is the nest."
However, we have so lost our faith in ourselves as women to be able to birth our children that most women consider hospital to be a safe place to labour. When offered a home birth at my parentcraft classes, most women turned away in horror and refused to even consider birthing at home.
"Most people maintain that hospital is the safest place for mother and child in labour while a few, myself included are convinced that home birth is just as safe if not safer, and certainly less painful and more enjoyable".
In the end it is all about choice, women should birth where they feel safest.
PROGRESSIVE MUSCLE RELAXATION say "relax" in your head, not out loud or people will think you are nuts!



 

Wednesday, 20 August 2014

Childbirth Unmasked 3

Chapter 2 - Instinct and Stress.
Instinct as in the innate ability to birth our young. Jowitt compares how we behave in labour to how animals behave. We have been taught (wrongly) by the media and doctors how to labour where as animals do not have their own Ten Born Every Minute, they labour instinctively.
"Instinctive behaviour is behaviour motivated not by conscious rational thought, but by subconscious direction from the brain".

We are told the value of stress hormones for short term survival. How they evolved to keep us safe while in danger. The very surprising fact about this chapter is that it does not mention the receptor sites for the stress hormone adrenalin discovered on the cervix in the 1970s, well before this book was published. These adrenalin receptors are the main reason that getting stressed in labour leads to a long, painful labour.

Now I am confused, Jowitt seems to think that the heart is made up of smooth muscle. What! There are three types of muscle in the human body: Cardiac muscle is found only in the heart; Striated muscle helps us to sing and dance; Smooth muscle is mainly found around hollow organs such as the uterus, stomach and large bowel. If our hearts were made of smooth muscle then there is no way we could run the 100m in less than 10 seconds, it would take more like 10 weeks.
"Adrenaline and noradrenaline have opposite effects on different parts of the body, for example they make the smooth muscle of the heart work harder but stop the smooth muscle of the womb contracting".

If you love human anatomy and physiology then you will adore this chapter, otherwise it is a bit heavy to get through.
"The chain reaction that leads to cortisol is: CRF - ACT hormone - cortisol. CRF works by unleashing a group of hormones manufactured in a prohormone string of amino acids - pro-opiomelanocortin (POMC)".

Basically, what Margaret Jowitt is saying in this chapter is if we are to labour as nature intended then we need to radically change our approach. Stress hormones mess with your labour where as relaxation helps you to work with your labour.
"Despite the fact that childbirth is safer now than it has ever been because more of us are closer to achieving our genetic potential, professionals play on the fear instinct to coerce women into hospital birth and thus increase consumption of hospital services and safeguard their own jobs, wittingly or unwittingly. Fear of childbirth is still the biggest hurdle to be overcome..."


Pain Free Labour books available from Amazon. Cheap as chips.

Wednesday, 23 July 2014

Childbirth Unmasked 2

Chapter 1 in the amazing book by Margaret Jowitt is entitled Evolution. She starts off by explaining how evolution, over the last 20 million years, has prepared us to labour and give birth.
"...the blind process of natural selection has produced a potentially highly efficient mechanism for childbirth." And goes on to ask "...most of us are nearer our genetic ideal than ever before, so why is childbirth still painful and danagerous?" Good question.

Jowitt informs us that very early woman would have lived by the sea and entered the warm waters to give birth. This would keep her relaxed and calm and upright. Perfect. However, the ice age put paid to that little piece of birthing joy as people were forced inland to avoid the cold weather. Today you can enjoy a lovely warm water birth at your local birthing center whatever the weather.
 "Seaside women laboured and gave birth in the water which was the perfect medium for allowing freedom of movement and relieving aches and pains."

The overall message of chapter 1 is that we are women and we have been shaped and bred for millions of years to give birth, it should not be as difficult as some make out. In fact, most of the problems that we encounter in our hospitals are not from women having bad genes but from the medical model of care interfering in a natural process.
"...high-tech medicine treats the effects rather than preventing problems."
She is very scathing of obstetricians who blame women's bodies for a poor birthing performance rather than how much they have interfered.

"...the mechanism of human childbirth is not one of Mother Nature's accidents. Natural childbirth has evolved to suit the species and if mankind chooses to ignore her advice and interfere with her workings we must not complain about the consequences. We have only ourselves to blame."

Rock on Margaret!
Next chapter is called Instinct and Stress. At last, adrenalin, my favourite subject. x


Pain Free Labour books are now available from Amazon.






Thursday, 26 June 2014

Childbirth Unmasked

I have just started reading the book Childbirth Unmasked by Margaret Jowitt and it is like I have been wandering around in a dark cave and someone has just put a light on. WOW!

It is so far an amazing book. Published in 1993 it was just 3 years too late for me giving birth but must have been an inspiration for pregnant women at the time. Jowitt sets out to convince women that there is another way to give birth. That obstetric units do not understand normal birth and so do not know how to optimise a womans' experience there.
"Woman has lain down on the bed of childbirth like a lamb to the slaughter, has denied her own instincts..."
"Mothers have sold their birthright for that mess of pottage known as pain relief. It has been used as a carrot to lure them into hospital."

Like me, Jowitt has experienced both painful and pain free labours and was so enthusiastic in wanting to pass her knowledge on to the sisterhood by writing her lovely book. Sadly, very little has changed since its publication 21 years ago. Low risk women still flock to their local hospital demanding pain relief. Women are still fed lies about labour within our society, teaching them to be anxious and afraid when labour day comes.
"...the so-called pain of childbirth was invented by civilisation and reinforced by men."

Jowitt recognises that the majority of women going into labour today would have a pain free first stage of labour given the right environment and advice. She points out that women labouring at home are automatically more relaxed and have lots of furniture to help remain upright on, not to mention a kitchen stocked with goodies. Research has shown that giving birth at home avoids the cascade of intervention that can lead you from a low risk normal to a high risk CS candidate.
"I have been moved to tears at the accounts of the risks and dangers labouring women have been exposed to in the name of medical knowledge while being denied the joy of delivering their children in the safety and comfort of their own home."

The resistance that the medical profession had against home births in the past has eased a little today. The problems now are that first time mums do not want a home birth. When I was a parent craft teacher of mainly first time mums I would give them a list of subjects that they wanted me to cover, they had to put them in order of importance. Home birth was always at the bottom. When I asked why, their main objection was that they were afraid that something would go wrong.
"It makes me intensely sad that most women are denied that experience (home birth)... hoodwinked by the medical profession into doubting that the safest possible place for most children to be born is in their own home."

And that is just the first chapter! Will report back when I have a chance to read more. Painting the stairs cream at the moment and there is no rest for the wicked.

Pain free labour books available from Amazon.