Saturday 7 December 2013

Progresive Muscle Relaxation

The secret to pain free labour is to use relaxation techniques practiced in pregnancy as soon as labour starts in order to avoid the complications brought on by adrenalin production.
The best relaxation technique I have used is to sit in a comfortable chair with pillows or supports as necessary to give good support to your back. You then close your eyes and focus on your feet. You imagine all the tension flowing out of them and you say to yourself (in your mind, not out loud or people will think you are nuts) feet relax.
You work up the body in this fashion paying particular attention to your shoulders and neck as this is where we store a lot of our stress and tension.
This technique once practiced can be done quite quickly when in labour so you are ready for the next contraction. A relaxed person does not secrete adrenalin so the cervix is free to dilate. The contractions therefore do not have to increase above normal as you are making their work easier.
Take control and have confidence. We are women, we are built to give birth and we can be very good at it.
Let me know if you have a pain free labour as a result of this technique and help spread the word.


Saturday 23 November 2013

The lady who had a pain free labour, and then gave it away.

Whenever you tell someone that you are a midwife you get the inevitable birth stories. I love them. A young lady I met whilst out and about asked me what I did for a living and then told me her birth story.

Mum told me that she had been in the pool at her local hospital where she felt so nice and calm and relaxed that the contractions stopped causing her any pain. They were still there but were pain free.

She became upset at this as she thought that if they were not causing her any pain then they were not normal contractions and her labour had stopped.

So she got out of the pool and started walking about, becoming more and more stressed. At last the contractions began to hurt again and she was finally happy that she was once again in labour. She did not however get back in the pool as she did not want the contractions to stop hurting again.

Arrrrrrrgh. Do I have to shout it from a mountain top somewhere? UTERINE SMOOTH MUSCLE IS NOT DESIGNED TO CAUSE PAIN WHEN CONTRACTING UNDER NORMAL CONDITIONS!

OK, I feel better now.

If you are nice and comfy and relaxed and not secreting any adrenalin in the pool and your contractions stop causing pain then please stay there and enjoy the rest of your labour. As long as you can still feel your tummy going hard every 2-3 minutes then you are still in labour. Honest.


Tuesday 12 November 2013

Hazards to a Pain Free Labour - 6

By far the biggest hazard to a pain free labour is YOU. Society has taught you that labour will be painful, that the contractions will cause pain during the first stage of labour. This view of childbirth has been around for the past three hundred years. Why would the weight of all that knowledge and history be wrong?
If you want to solve a murder then you look for who will benefit from a persons death. If you want to solve the mystery of why we are taught that labour will be painful then look at who has benefited from our pain.

The international best-seller Dean Koontz captured the essence of why we accept painful labours so easily when he wrote:

  •        “Fear is the engine that drives the human animal. Humanity sees the world as a place of uncountable threats, and so the world becomes what humanity imagines it to be.”

In our dark dank past women were exploited. They were not even allowed an education so that they could say “Hey, stop exploiting me you patriarchal society you”. We have had to fight tooth and nail for our relative freedom. The only battle that has yet to be won in the civilised world is childbirth.

Fear of childbirth has been instilled in us for hundreds of years. Doctors have made money out of us by keeping us in fear so that their services are needed to provide a medical model of care to help us birth. Early midwives were burned as witches so that women would turn to the medics in their time of need.

Modern health care follows blindly the belief in painful labours as the norm. There has been no research that I know of to support this belief. Within the UK we pride ourselves on offering evidence based practice and yet there is no evidence that uterine smooth muscle is designed to cause the sensation of pain when contracting normally. Yet we continue to believe. “The world becomes what humanity imagines it to be.”

Perhaps women want painful labours. Perhaps fear is the engine that drives the human animal. Perhaps we only feel comfortable when something we believe in comes true. Any other outcome would be too hard to accept, too big a paradigm shift for us to relate to.

Well tough. Get with the plan. Pain Free Labour has begun to seep into our belief system concerning childbirth. Midwifery led birthing centers are springing up all over the UK. Women are having pain free labours during the first stage when taught how to approach labour. Relaxation techniques are being learnt in parentcraft sessions to keep women from entering the stress/pain cycle often seen in labour.

We are being allowed to learn the truth about labour now in the UK only because the strain on the NHS from medicalised care has become too much. A calm pain free labouring woman in a pool is cheap compared to a theatre full of expensive equipment and staff. The caesarian section rate has reached an all time high. We have lost faith in our innate ability to labour naturally.

If I had not experienced this phenomena of pain free labour personally then I may well have been one of the supporters of offering elective caesarian sections for maternal choice. As a midwife I have helped countless women to have a pain free labour. As an author, I have explained in detail why adrenalin, secreted when we are anxious, can cause contractions to become painful.

So, who will join me in supporting the massive shift that we need in our belief system that will enable women to labour as nature intended; with medical support on stand by if needed? Who will be brave enough to swim against the tide and face the wrath of humanity when one of their “uncountable threats” is removed leaving them uncertain and afraid? Who will take a leap of faith in order to free women from the last of societies manacles holding us down? Who, maybe you?


Friday 18 October 2013

Hazards to a Pain Free Labour - 5

There are some people who are incapable of relaxing. Coffee drinkers are adrenalin junkies, they find it difficult to sit still for five minutes let alone relax and become tension free for a whole labour. Caffeine is a psychoactive stimulant which acts on the central nervous system by promoting the release of catecholamines such as adrenalin.

Caffeine can also cause dehydration which is not a good idea in pregnancy as the blood needs to remain quite dilute in order to get in and out of the placenta easily. Your baby gets all his nourishment and oxygen from you, if your blood is too thick by you being dehydrated then your baby will suffer. Research has also shown that caffeine intake during early pregnancy can contribute to miscarriages.

Caffeine is not only found in coffee. It is also in black tea, green tea, cola and some energy drinks. If you stop your caffeine intake suddenly you may experience withdrawal symptoms, which include headache and nausea. There is a reduction in serotonin levels when caffeine input is stopped which can cause anxiety, irritability, inability to concentrate and lethargy. It would therefore be a good idea to cut down slowly on caffeine intake before becoming pregnant.

It is not only the fact that caffeine makes it difficult for people to relax and so relaxation techniques become ineffective. It is the fact that caffeine causes the body to release adrenalin. As you have seen previously, adrenalin causes all kinds of problems in labour and is to be avoided at all cost. If you are unable to kick the caffeine habit before pregnancy then try stopping caffeine intake well before labour begins. This will leave you in a calmer state of mind, ready to respond to your chosen relaxation technique in labour.


Wednesday 9 October 2013

Hazards to a Pain Free Labour - 4

Cardiotocographic (CTG)  monitoring of the fetal heart rate was first introduced in Germany in 1968. It was seen as a way of reducing fetal demise and cerebral palsy rates. In practice the false positive rate for cerebral palsy is as high as 99%. That is, out of 100 non reassuring CTG traces, only one will go on to suffer from cerebral palsy or other neonatal encephalopathy. Research has also shown that use of CTG monitoring in labour is more likely to result in an instrumental or caesarian section birth.
The British National Institute for Clinical Excellence (NICE) guidelines clearly state that women who are in good health and with an uncomplicated pregnancy do not need to be monitored continuously on a CTG machine. Instead, low risk women will be offered intermittent monitoring. That is, a midwife will listen in every 15 minutes during the active first stage of labour and every 5 minutes during the second stage. The active first stage is from 5cm dilatation till your cervix is 10 cm dilated. The second stage is from 10 cm dilated till the baby has been pushed out.
Some midwives see CTG monitoring as an easy option. They only have to comment on the trace every half an hour and so it is less labour intensive.  As previously discussed in this blog, lying down in labour leads to painful contractions. In order to obtain an optimal CTG trace it is best to have the mother lying down on the bed with the back of the bed slightly raised. This position is not upright enough for a pain free labour.
A compromise can be made if you can sit on a birth ball or chair beside the monitor or a mobile monitor is available. With mobile monitors you are free to mobilise, or sit down where you are upright enough for a pain free labour. If these positions do not produce the trace that the midwife would like then that is his/her problem. They may have to press the transducer onto your abdomen in order to pick up the fetal heart, this is time consuming and only a dedicated midwife will put in the extra effort. Remember, you are the client and we are merely offering a service, you are the boss. If you do not get what you want then get your birth partner to complain. You however, have to remain calm and upright so leave the negotiating to someone you trust.
My third labour was spoiled by a midwife who forced me to lie down on a bed with a CTG running throughout the labour. I was low risk. If I had known better I would have refused the CTG and been able to sit and have my planned pain free labour. I hope you are stronger than I was and able to negotiate monitoring with a flexible midwife who has you and your baby's welfare at heart.


Sunday 22 September 2013

Hazards to a Pain Free Labour - 3

Haemoglobin or iron levels for a non-pregnant woman are 11.5 to 16 g/dl. In pregnancy, your blood is diluted to make it thinner so that it gets in and out of the placenta easier, clever. Even with this haemodilution, which is normal, your iron levels should not fall below 10.5 g/dl. Iron tablets are not routinely given in pregnancy unless there is a history of anaemia or you have symptoms (feeling very tired, breathless or dizzy). Not everyone can tolerate the tablets and often just stop taking them. This means that when you go into labour your oxygen carrying capacity is reduced and as discussed in Why labour hurts 2, this will cause the contractions to become painful.
To avoid this complication you need to keep your levels up. A blood test is taken at booking at around 12 weeks gestation, this will tell your midwife if you need iron. An alternative to the iron tablets is to have the iron in liquid form. Your doctor may not want to prescribe this as it costs more than the tabs but you have to insist, it is much easier to digest.
When I had my fourth baby I was a vegetarian, so thought I should take extra steps to ensure good iron levels before the birth for a pain free labour. From the time I found out I was pregnant I had 1 small spoonful of black strap molasses three times a day with meals. At first I found it too thick and sticky but soon got used to it and after a while really enjoyed it. My iron levels stayed at 12 throughout the pregnancy and I was able to have a wonderful pain free labour at home.
According to research, we get 90% of our iron from fruit and veg, so to optimise iron levels it would be prudent to change your diet to include extra of these for the pregnancy. We only get 10% of our iron from meat cos it is bound up in animal red blood cells so is harder to get at.
Tea and coffee stop us from absorbing the iron in our food so should never be taken with meals, orange juice or some other drink rich in vitamin C should be drunk instead. Iron supplements taken without vitamin C will not be absorbed so always take them with a fruity drink.
Ask your midwife for a check on your iron levels at 28 weeks when haemodilution is complete, the result will give you a good idea of how you have been affected. It also gives you time to get your haemoglobin to a decent level before you go into labour. Broccoli has never tasted so good.


Thursday 29 August 2013

Hazards to a pain free labour - 2

From an observational study that I have been conducting over the past two years I can safely say that rupturing your membranes is a hazard to a pain free labour.
On TV the first thing that happens when someone is about to go into labour is they look down and say "I think my waters have gone" staring at a puddle on the floor. This is not the way that most labours start.
When your waters go there is a release of hormones called prostaglandins. These hormones attach to the uterine smooth muscle and open up pathways to oxytocin. Oxytocin is a hormone secreted in the brain that causes uterine smooth muscle to contract. With more pathways open the smooth muscle lets in more oxytocin and so the contractions become stronger.
During a normal pain free labour it is much better to keep your waters intact untill you are pushing your baby out. Not only do they cushion the baby's head while he is coming down the birth canal but they continue to protect baby from bacteria or other harmful organisms that may be present there.
If you are in labour and a midwife or doctor wants to rupture your membranes then make sure they have a jolly good reason to do so. A jolly good reason would include:
  • If an abnormal fetal heartbeat was picked up with a hand held doppler then a CTG machine would be offered to obtain a better picture. If all was well with the CTG trace then it could be stopped and you would go back to the hand held doppler monitoring. If the trace was not reassuring, or there is some difficulty obtaining a good trace, then you would be offered an Artificial Rupture of the Membranes (ARM) so that a clip can be attached to the baby's head to obtain the heart beat directly. Not being able to pickup the fetal heartbeat abdominally is often due to an increase in maternal habitus (too many doughnuts). 
  • If a CTG trace is in progress and there is an episode of fetal distress, then you may be offered an ARM to observe the colour of the liquor. If baby has been really distressed then they may have had their bowels opened and the liquor stained with meconium (baby poo). You then need to stay on the CTG machine to ensure baby is not suffering further as a result of this distress. See the next post for coping with CTG monitoring.
  • If your hospital protocols call for a progress rate of half a cm per hour, and your cervix does not comply with this estimation, then you will be offered an ARM to increase the strength of your contractions. A good long walk or sitting on a birth ball should produce the same result.
  • If your labour ward is very busy then the midwife may tell you that you need an ARM in order to speed up the labour. Get you done and dusted and off the ward. The work load is their problem not yours, do not accept any artificial interventions unless a jolly, jolly good reason is given.
An ARM is almost never carried out on a midwifery led birthing unit. This is because we believe in natural labours, if they go they go but we will not interfere. If your labour slowed down then we would haul you out of your lovely comfortable birthing pool and send you for a walk that may include stairs. OK, mean, but you will thank us in the end when you have your wonderful pain free labour.


During my observational study I noted that women can still have a comfortable labour with their waters gone if they follow the relaxing regime and stay upright, but it may not be entirely pain free. Still, worth a try. Good luck. Ann xx



Saturday 17 August 2013

Hazards to a Pain Free Labour - 1


As discussed in Why Labour Hurts 2, the hard working uterus needs a good supply of oxygen whilst contracting so as not to produce lactic acid which causes pain. If you are a smoker, then every time you have a cigarette your red blood cells are filled with carbon monoxide and are unable to carry a normal amount  of oxygen. This means that you have a lot less oxygen available to your baby and, if in labour, to your hard working uterus whilst smoking a cigarette. This oxygen deprivation lasts for about an hour after finishing a cigarette.
Once you are aware that smoking can cause you to have a painful labour you can take steps to remedy the situation. During your pregnancy or for at least a few weeks before you are due to go into labour you could ask your family doctor to prescribe you some nicotine patches suitable for pregnancy. They will satisfy your craving whilst making sure the oxygen carrying capacity of your blood remains at an optimal level. See your community midwife or GP for advice on who to contact about giving up smoking.
As an ex smoker I understand how difficult it is to give up. Now, as a non-smoker, I am so glad I did.





Tuesday 6 August 2013

Why labour hurts 5

The focus with our maternity units today is mainly centred on pain relief. From the moment you enter a labour ward your contractions will be called 'pains' by midwives and doctors alike. The British TV programme 'One Born Every Minute' included recently an interview with a midwife stating that women should expect to be in "agony" during their labour.
With all the social conditioning aimed at convincing us that labour WILL be painful, we are brainwashed into thinking that we cannot possibly even contemplate going into labour without intensive medical help. It is therefore not surprising that women today fear childbirth. If I was told that I had a hospital appointment next week where I would be in acute agony for hours and hours then my adrenalin levels would start rising now and accumulate on a daily basis as the dreaded day drew nearer. With pregnancy you have nine months to hone that fear. Little wonder that women present in labour shouting for an epidural before they have even got through the hospital door.
The fear of labour is so instilled into out society that it will be very difficult to overcome. Until the fear is seen for what it is - a cause of painful labour contractions - then the "agony" will continue.
A self fulfilling prophesy.
Help break the mould by spreading the word of Pain Free Labour by following the simple steps outlined in this blog and posting your outcomes for all to see. Thank you.

Monday 29 July 2013

Why labour hurts 4

Imagine you are still a cave woman who is just so fed up with life in a damp mouldy old cave. So along with your hunky cave man you decide to go live on the hill. You look forward to waking up to a stunning view bathed in untainted primordial sunlight. Bliss.
However, there is one factor you forgot to consider. A hill. You will have to carry all your building materials up the hill to build your hut. Gravity will not be your friend. However, if you decide to build in the valley and forgo the stunning view, it will be easier to get materials down rather than up.
So working WITH gravity is easier, mmmmm.
If we lie down in labour the hard working uterus has to work even harder cos it is working against gravity, pushing baby up hill. The contractions will have to become stronger and so become painful.
If we remain in an upright position, on a chair/birthing ball or leaning forward on a bean bag etc. then the contractions are working with gravity and do not have to increase in strength. Simple.
Then why oh why do women, as soon as you show them into the labour room, make straight for the bed and lie down. We have chairs. We have birthing balls. We even have a large scrunchy bean bag. We also have a beautiful birthing pool where you can sit or kneel in relaxing warm water and labour in comfort.
Once you are aware of why labour hurts you can face labour with fresh expectations. You can make a birth plan that includes staying upright and use of the pool to relax in. You can inform your midwife and birthing partners that you need a quiet atmosphere in order to do your chosen relaxation technique.
You can have a pain free labour.
You can do it.
I did it.
Twice, so I know it works.

Saturday 20 July 2013

Why labour hurts 3

Imagine you are a cave woman coming toward the end of your labour when a saber toothed tiger appears at the cave door. OMG. The first thing you would do is to release adrenalin into your system so that you have extra energy to run away or stay and fight. But 'Oh No' your cervix is nearly fully dilated, if your baby is born now then the tiger will think its her birthday and celebrate with a very fresh human, covered in a tasty liquour dressing accompanied by a side order of bloody placenta. Yum.
Mother nature however has other tricks up her sleeve and has put receptor or binding sites on the cervix for adrenalin. The adrenalin secreted when we are under physical or mental stress 'sticks' to the cervix and helps to stop it from opening. Your cave baby is thus held in utero untill you can run out of the back cave door leaving your cave buddies to scare off the tiger. Sorted. Or is it?
Unfortunately mother nature has not moved with the times. Curse you evolution. In the modern world we no longer need adrenalin receptor sites on our cervix and they have become a hindrance. Todays modern woman is so afraid of going into labour that as soon as she does the adrenalin produced from the mental stress will attach itself to the cervix and hinder dilatation. The contractions will have to become stronger in order to heave the resisting cervix up and so become painful.
Howells et al (2000) was a piece of research which compared injecting the uterine cervix before surgery with adrenalin or another substance. The adrenalin worked best at reducing blood loss as it caused the cervix to become rigid. This is similar to how adrenalin performs during labour when levels are high enough to affect the cervix.
A relaxed person does not secrete adrenalin. Relaxation techniques previously discussed in this blog can be used in pregnancy and labour to prevent the cervix being restricted in its dilatation. This should make the labour shorter and easier and end all the cries of " What do you mean I'm not in labour? I've been contracting for 2 f***ing days and my cervix has still not dilated?" Oh bliss.

Monday 1 July 2013

Why labour hurts 2

Imagine you are Buffy the vampire slayer walking through an eerie graveyard at the dead of night when suddenly, out leaps a vicious vamp looking for your blood. What is your reaction?
The first thing your body would do is to send an automated message to your adrenal glands to release adrenalin. This adrenalin would then circulate the body and make certain changes in order to maximise your chances of survival.
One of the ways it does this is to redirect blood flow from the body to the arms and legs so that you can run away very fast from the vampire or, if you really are Buffy, you can stay and fight.
Women today are scared of going into labour cos they believe they will be in agony for hours and hours, as soon as they have a few contractions the anxiety they feel starts releasing adrenalin from the adrenal glands. As with Buffy, this adrenalin sends extra blood to the arms and legs. This means that non vital organs within the body, such as the uterus, get starved of oxygen rich blood.
When a labouring uterus gets starved of oxygen it produces lactic acid, this then connects to pain receptors and sends messages to the brain of PAIN!
Running too soon after a meal has the same effect on the digestive system. The adrenalin released in response to physical exercise starves the gut of oxygen and you get a stitch. All you need do under these circumstances is to stop exercising and the stitch will go away. Unfortunately we do not have this option when going into labour.
Learning how to relax during the pregnancy so that you are ready when the big day comes  is vital for a pain free labour. A relaxed body does not secrete adrenalin so the blood flow is not sent away from the body to the arms and legs. During a normal labour with a normally presenting baby there is no reason for the contractions to hurt.
Choose a  method of relaxation that suits you best, stay upright on a comfy chair or other upright position and you will be amazed, as I was when I experienced my first pain free labour.


Friday 21 June 2013

Why Labour Hurts 1

From the feedback I have received regarding pain free labours it seems that people are just too brainwashed by society to believe. OK, but I refuse to give up.
The uterus is basically a bag of smooth muscle. It is very similar in its design to the stomach. They both have three layers of smooth muscle each. These layers work together when contracting and relaxing. The stomach to churn up food and drink to digest it and the uterus to open the cervix and push a baby out.
Have you had anything to eat today? OMG you must be in agony if the smooth muscle in your stomach is contracting. Did you send for an ambulance and get rushed to hospital for an epidural? No. Why not? From what people have told me, when smooth muscle contracts it produces pain. If this is correct then every time you eat you must be in pain.
Smooth muscle is not designed to cause pain when it contracts under normal conditions. Simple. Then why does uterine smooth muscle seem to cause so much pain when it starts to contract with most labours?
See my next post for the answers.

Wednesday 12 June 2013

After Earth, a brilliant analogy.

Went to see the new film After Earth at the weekend and the analogy to painful labours was striking.

The film is about some aliens that make a creature that can only see humans when we are afraid, they can smell the pheromones that we secrete when a big scary monster is about to kill us. Really.

Pretend that the monsters are the doctors at your local maternity unit. When you arrive at the hospital in labour, if you are secreting adrenalin due to anxiety then they can smell your pheromones and will pounce.
  • They will force you onto a bed so that your uterus is working against gravity and the contractions become stronger and so become painful.
  • Once you are in pain they will offer you an epidural to ease the pain they have just caused. A needle will be stuck into you to introduce a drip in case the epidural drops your blood pressure and your baby is put at risk. Another needle is stuck into your back to introduce the catheter for the epidural drugs.
  • Your urge to push may be compromised by the epidural so the monster, sorry doctor, will have to slice a section of your perineum with a pair of scissors to allow access to your baby via forceps or kiwi extraction. The baby is then pulled from you which may cause bruising of his head leading to an increased risk of jaundice.
OK, the monsters in the film were not as specific at their torture as the events described above but you can see the analogy, can't you?

The only way to avoid the above is to GHOST. That is to control your adrenalin output so that you do not secrete any of the tell tale pheromones that give away your fear. Easy peasy.

The only way to do this is to learn relaxation techniques outlined in this blog or available on the Kindle in the form of Pain Free Labour books. A relaxed person does not secrete adrenalin. Sorted.

After Earth only got 11% on Rotten Tomatoes, obviously they were not watching it from my slightly mad perspective.

Will Smith will always get a big intact tomato from me, he simply just gets better with age. Mmmmm.

Wednesday 17 April 2013

Letter from Danielle; thank you for the pain free labour.

Hello Ann,
My name is Danielle Law, and I gave birth to a 7lb baby boy, Jake, last Friday.
I just wanted to write and thank you for reccomending your book, which I bought a week before I gave birth from Amazon for my Kindle. (no longer available)
Jake is my second child, I have a daughter, Holly, who is 4 in July. Her birth was long, traumatic, painful and left me terrified of going through childbirth again. It ended with me being too exhausted to push, an episiotomy and forceps.
When I fell pregnant with Jake I was so worried of how I would cope again.
I bought your book and read it in a day, it was great to read advice from someone with so much experience, both personal and professional.
I started having contractions at 8am on 5/4/13. I was at home with my daughter all day, with the contractions gradually getting longer and closer together. I used the tecniques I had read in your book, stayed calm, breathing through each contraction. They were so managable that I got all my cleaning done, and kept my daughter entertained all day, and without my daughter knowing that anything was wrong. At 7pm my contractions were 5 mins apart, so called my parents to come and look after my daughter. I tucked my daughter into bed and phoned the labour ward.
On the phone to a midwife at the labour ward, I was told that I had two options:- To wait at home a little longer until I was sure the contractions were 5 mins apart, or to come in and they could monitor me and the baby..I'm pretty sure that the midwife didn't believe I was really in labour or as far as I was because I wasn't screaming down the phone when she was asking me questions. I told the midwife I would like to come in now please!!
I got off the phone and my waters popped, in front of my horrified dad! We got everything together and set off for the hospital. We arrived at 7.40pm. This is when my contractions finally got painful, and I made my way (loudly) to the labour ward, got through the door, told them I needed to push..helped quickly onto a bed and Jake made his very quick entrance into the world, born at 8.20pm.
The whole labour was amazing, so easy to cope, not scary and stressful like my first. We only stayed in hospital for 5 hours, then we were home with our beautiful baby.
I just wanted to say a huge thank you to you for your book, which I have reccomended to all my pregnant friends! Without reading your book there is no way I would have been able to remain so calm. I was very sceptical at first that it was possible but i truly had a pain free labour! It was so amazing to experience a nice labour, something I never thought was possible.

Thank you again, I hope more women manage to have an easy labour like me.

Danielle Law x


Wednesday 20 March 2013

Do you belive in a Pain Free Labour?

The study of belief systems is a fascinating one. Some people will believe just about anything. Modern society today believes that labour contractions will cause pain. Why? Who does this belief system benefit? Certainly not the women in labour.
The British philosopher Jonathan Glover compares belief systems to floating boats. It is almost impossible to change them all in one go, as it would be to alter the boat significantly all at once. It has to be done slowly so as not to disrupt the stability of the boat which could cause it to sink.
Our society has known about pain free labours since the 1940s when my hero, Dr Grantley Dick-Read, first published his book Childbirth Without Fear. The hypnobirthers, who have based their teachings on Dick-Read's book, have been preaching against painful labours ever since. Yet we still will not believe. 
Religion is a belief system that is based solely on faith. There is no proof that any so called Gods exist and yet millions of people continue to believe. This is because people want to believe, they want a sense of belonging and a hope that there will be something better when our time here is done. If you believe in a Christian God then you must also believe in Allah and Zeus as there is no more evidence that one exists at the exclusion of the other. We take our comfort where we can.
The bible has been altered and translated over many years. It is unlikely that it bears any resemblance to the original script. And yet we choose to believe. If in a thousand years from now the only books left in existence are the Twilight books then people will believe in vampires, they will be watching out for the 'sparkly ones'. To be honest, I know some people in Manchester who believe firmly in 'sparkly ones' and will be seen as disciples in that distant future. You know who you are.
If women today suddenly started to believe that labour contractions were not designed to cause the sensation of pain during a normal labour then chaos would ensue. The boat would start to sink. Health services would not be prepared for women demanding a pool birth to aid their relaxation. Did you know that Oxford, England has only two birthing pools to offer where as Cambridge England has eleven. Just shows where the really clever people are.
A harmful belief that is not backed by science or logic is really not worth holding onto. If painful labours were scrutinised carefully then it would be found that uterine smooth muscle is perfectly capable of contracting without causing pain. I could not find any research into the workings of smooth muscle that proved it was designed to cause pain whilst contracting. And yet we believe. 
The only people who benefit from keeping labour painful are men. It is the last vestige of control that they have over us. It would take a really good philosopher to understand all the myriad of reasons as to why we have not yet broken free of this often crippling belief.
All it takes is to believe. The truth.


Sunday 6 January 2013

Avoiding PPH?

Just read a very interesting article in Midwifery Matters magazine, the Manchester issue (Winter 2012) Issue 135 P. 21. It is an article on A Novel Way to Prevent Postpartum Haemorrhage? Judy Slome Cohain, the author, puts forward a natural method of delivering the placenta without drugs and without excessive blood loss. Sounds good.
Study days attended have taught me that the 3rd stage (expulsion of the placenta) can be done in two ways:
  • Active management where an intramuscular injection of Syntometrine (if you are normotensive) or Syntocinon (if you have high blood pressure) is given into your thigh muscle immediately after the birth. The cord is clamped and cut. The injection causes the uterus to contract strongly and push the placenta away from the uterine wall. After noting signs of detachment, the midwife will then pull the placenta out by pulling on the cord. This usually takes about 10-15 minutes.
  • Physiological management where no drugs are given. The cord is left to pulsate and so give baby extra blood needed to perfuse the newly working lungs. Mum, dad and baby are settled onto a bed or other comfortable place and the midwife awaits mum feeling an urge to push the placenta out while watching for excessive blood loss. This can take up to an hour.
Judy's 3 4 5 Protocol, goes back in time to when women did not bleed excessively after giving birth. Judy explores the history of post partum haemorrhage (PPH) and how women in the past avoided it.

  • (3) Skin to skin contact is initiated immediately after the birth. The cord is left to pulsate and is not cut before 3 minutes after the birth. The midwife does not touch the cord or the uterus. After 3 minutes the cord can be clamped and cut and the baby kept with mum or given to dad.
  • (4) The new mum is asked to do "a good deep squat with her bottom almost touching the floor". This is over a low bowl or other implement to catch any blood loss or the placenta. Mum is then asked to push even if she does not feel a contraction or urge to push. 
  • (5) If the placenta has not been expelled by 5 minutes then the midwife is allowed to gently pull on the cord to lengthen it out of the vagina and reassure mum that the placenta is low and to keep pushing.
Mum stays in a low squat while she continues to push. When the placenta has been expelled, mum is made comfortable and given a maternity pad to wear and baby is returned to initiate breast feeding. It is advised to massage the uterus through the abdominal wall to expell any clots, if the pad becomes soaked during the next 5 minutes then an injection of an oxytocic is to be considered. If a woman has a history of PPH then an oxytocic can be offered after the placenta has delivered whether she is having a PPH or not. (Why not just give the injection in the first place anyway and avoid the risk of another PPH right from the start of the 3rd stage if you are going to give it anyway?)

A retained placenta is diagnosed if mum has been pushing for 25 minutes and medical assistance is advised. This method of delivering the placenta is said to avoid a placenta being trapped by the cervix closing after the birth as it should be out after 5 minutes. The baby's lungs are well perfused by the extra blood from not cutting the cord till 3 minutes have elapsed and mum keeps most of her blood by expelling the placenta quickly.

Judy is asking for maternity units to participate in a multicentre study of her protocol and can be reached at judyslome@hotmail.com