Thursday, 3 September 2015

Better Births?

It is very difficult to break away from the TV image of women lying down on beds to labour and give birth. Society has done a great injustice to women where birth is concerned by allowing programmes like One Born Every Minute where women's faith in themselves to birth their young is eroded week after week.

Research has shown us (Lawrence et al 2009) that women who remain mobile and adopt positions that they are comfortable with during labour have less analgesia and labour much quicker. The mobile elements found on most CTG machines today are not just there as a fancy add on, they are there to be used to help keep women in charge of their labour by staying off the bed. Hand on heart, how many midwives reading this can say they have ever used the mobile CTG attachments or have strived to keep women off the bed while obtaining a necessary CTG trace in labour?

If we are truly going to obtain better births for our women then we have to start with the basics, often lost when working within a busy hospital obstetric unit. Normality is often the last thought on our minds as we strive to follow all the guidelines and protocols available to 'keep women safe'. Once a woman is in labour from IOL then we have the power to stop any further interventions that may cascade her into an operative birth.

The USA have obstetric nurses in their obstetric units and they seem to be nothing like midwives. The internet is full of unhappy women who feel they have been violated by hospital care received in labour. Obstetric rape is often the cry from these women who are desperately trying to reclaim the lost art of birthing within the doctor led services available in America today. This is one model of care that we must strive to stay well away from by supporting midwives to look at their practice and reflect. Am I being truly 'with woman'?

Student midwives are our future and yet the number of students who pick up the very bad habit of calling contractions 'pains' to women really drives me crazy. I once mentored a student, well into her second year, and she had never laboured or birthed a woman off the bed. This was all she had ever seen and she was quickly becoming an obstetric nurse without her even knowing that there was a choice.

Women need knowledge. We can give them this knowledge during parent craft classes that teach them how to labour as nature intended. Relaxed and confident, giving them the choice of mobilising or simply sitting on a comfy chair or birth ball. When was the last time you even saw a birth plan, have women simply given up writing them as they learn to expect the carnage they see on TV?

Better birth is an achievable choice for most women going into labour today with the right support from their midwife. We need strong midwives, confident in the simplicity of normal birth, lets rise to the challenge and make a difference today.

Lawrence AM, Lewis L, Hofmeyr J, Dowswell T, Styles C, (2009) Maternal Positions and Mobility During the First Stage of Labour. Published online 2009. Available on the internet from: The Cochrane Collaboration and Wiley Online Library.

Wednesday, 15 April 2015

Was it in the 1950s when birth went wrong?

Just read an article posted by Orgasmic Birth and was interested in their telling of the history of childbirth and when it all went wrong.

"In the 1950s, with the new dynamic of birth being behind closed doors- women were alone, drugs and twilight sleep were given, and as a result the knowledge of how to work with our bodies in birth was lost and fear grew. I can’t even imagine what it was like for the many women who found themselves alone, in a hospital gown, put down with a wheel chair and tied to bed (yes they were tied with lambs wool). How different this was from being in your own home, in your own clothes and familiar textiles and fabrics, surrounded by those who love you. While we have had benefits of hospital birth, there is much to ponder and question of what we have lost and what we can birth forward in new ways."

They have taken birth away from women, but we can get it back. Education is the key. Real education, not gained from watching One Born Every Frelling Minute!

See my posts Why Labour Hurts (5 posts) and Hazards to a Pain Free Labour.(6 posts)

The doctors can care for high risk women such as diabetics and eclamptics. Leave the low risk women to find a better way to labour. Birth centers in England are amazing but you may still find a midwife there who calls contractions "pains". Just follow the advice for learning a relaxation technique (post-Progressive Muscle Relaxation) in pregnancy and stay sat upright on a ball or chair or couch, mobilising when you need to. Stay at home for as long as possible, scoffing lots of carbs before going to hospital, you will know when the time is right, listen to your inner voice. Better still have a home birth then the midwife will come to you.

We need to listen to our bodies and trust. WE ARE WOMEN AND WE ARE POWERFUL AND WE LOVE IT!

Pain Free Labour books now available from Amazon, cheap as chips to download.

Thursday, 19 March 2015

Picturing a Pain Free Labour.

Adapted from Susan Jeffers and taught at my parentcraft classes, I thought you would like it...

Make yourself comfortable in your chair, back straight, feet on the floor, hands comfortable on your lap. You have nothing to do but listen to my instructions and let whatever comes up for you come up. There is no right or wrong way to do a visualization. Just accept whatever comes to mind.
Now close your eyes … and keep them closed throughout the visualization. Take a deep breath … inhale all the loving energy in the universe … and exhale all your loving energy back into the universe. Once more … in … and out … And once more … in … and … out. Feel how good it feels to begin to totally relax. Begin at the bottom of your feet and work your way up to your head … relax. Let go of the muscles in your feet … feel your legs becoming heavy and relaxed … your abdomen is relaxing … your chest feels heavy, every breath feels so light and tension free … arms and hands are feeling relaxed … your shoulders suddenly give up their tension and they are feeling so heavy and soft … your neck feels relaxed … just let go of any tension in the little muscles around your eyes and then your mouth … all tention free and nice and relaxed. You have never felt so relaxed. Every breath you take eases more tention out of your body.

Just totally let go … checking out any part of your body that may still be holding tension … and release it.

Now I want you to think of a goal that you have in life … a specific goal … and you know that FEAR is keeping you from moving forward toward that goal.
Now what I'd like you to do is to imagine yourself approaching that goal “as if” you had no fear.

I want you to see yourself approaching that goal with a sense of power and confidence in yourself … confidence that it will all be all right.
What would you be doing in your visualization … if you had no fear?
See yourself … What would you be doing next … if you had no fear?
Within the visualization look at the people around you. How are you relating to them … with no fear?
How are they relating to you?

Just enjoy this sense of power and notice your ability to love … and contribute.

And know that this is a feeling always within you … always a part of you if you choose to use it.
And it is within your capability to move forward in life with that power and with that confidence.

See yourself … achieving your goal … with your power … with your confidence … with your love … and with your contribution. Imagine how good it would feel to approach your goal with utter confidence in your ability to be a success. Nothing could stop you.

And slowly … start to bring yourself back to this room … knowing that the power is available to you … as soon as you begin to act … the power you need will come forward.

Feel yourself in your chair … be present in this room … listen to the sounds around you … and when you are ready, open your eyes … no need to rush. When you are ready, open your eyes.
Stretch and just feel the deliciousness of your power. It's all there for the taking. 

Then I would ask my parents, when using this visualisation method, to imagine they are in labour. What if they approach labour with confidence and strength, imagine going into labour and feeling perfectly safe. What if you sat at home on your couch in labour, feeling the contractions and they are causing you no pain. Wonder and joy course through you and you know you can do this. Know it is within your power. What if? 

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!

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.