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We all know that labour is painful, that birth hurts and that we all scream all the way through it in a terrified daze.  Don’t we?

This seems to be the given wisdom at the moment.  Where does that wisdom come from?

Current view of birth.

Well, lets step back a little bit.  Traditionally, by the time a woman had reached child-bearing age she would have assisted at many other labours and births.  She would consider birth a normal part of life and there would be no great mystery surrounding it.  Most women would have been present during births and known that for most women it is manageable, normal and everything turns out well.  They would also have seen that sometimes it doesn’t turn out well, and that would also be considered as a normal variation.

Now, the typical western woman reaches child-bearing age having never attended, assisted or even seen another woman give birth.  Many woman have rarely even held a newborn baby, and babies and children tend to be at the peripheral of their life.  Bearing this in mind, is it any wonder that the average woman in the UK approaches her first birth unsure of what is going to happen, what the experience is like or how she will cope?  Birth is no longer a normal part of life for women, it is shrouded in mystery.

So, the experience of birth is no longer present.  What has replaced this?  Sadly, it is probably media depictions of birth.  We all know how these look.  A screaming woman, a hapless partner, a general air of panic.  Don’t worry though, they are normally saved by the hero health professional on his/her white charger.  Birth is now an agony that women need saving from.  This view of birth is all that most little girls ever know, and this continues through puberty into adulthood.  By the time that most women are pregnant the only thing they think they know about birth is that it will be really painful.  It must be, look how strong the pain relief is!

Of course, this is not helped by the fact that the second the little blue line pops up a whole plethora of women suddenly appear with their ‘horror’ stories.  And boy, do they make sure the newly pregnant woman get’s the ‘no holds barred’ version of the story!  I wish women would consider a little more carefully about this, and that women with positive and fantastic stories told them more.

Why is birth painful?

Why would something as necessary to human survival as birth be so painful that we couldn’t cope with it?  Does that make any sense at all?  Just ponder that question for a second.  It just doesn’t make sense.  So, why do so many women experience birth as too difficult to cope with?  Let’s look at the factors that impact on labour and birth.

Hormones

How do birth hormones work?  There are three main hormones at play during a labour.  They work together to make the birth as efficient as possible.  They are:

  1. Oxytocin.  The ‘hormone of love’.  This is the real driving force behind labour.  The more oxytocin that is produced the more effective the contractions are, the more efficient the uterus is.  Oxytocin is inhibited when Adrenalin is produced.
  2. Adrenalin.  If the womans body produces adrenalin during the first stage of labour it will stop or reduce the production of oxytocin which will mean she will have a ‘stop and start’ labour and labour may be slow and long.  It’s vital during second stage though.
  3. Endorphines.  These are the body’s own natural pain relief.  Endorphines build up and up through labour so that at the point of birth the woman has huge levels in her body.  This, combined with huge levels of oxytocin, ensure the mother is ready to meet and fall in love with her baby.  They also act as a memory suppressant postnatally.

Oxytocin is produced in large quantities when love-making.  The same environment that will allow a woman to orgasm during sex is the same environment that will be conducive to an efficient birth.  There are not too many women who could orgasm in a brightly lit, sterile room with a number of people watching and monitoring progress and a whole ward able to hear her.

Adrenalin is produced when a woman feels observed, when people talk to her, when she meets someone new, when she is in an unfamiliar environment, when she can hear other labouring women and knows they can hear her.  Adrenalin is normally produced at the start of 2nd stage to give the mother the energy she needs to push the baby out.  Before that, it cripples the progress of labour.

Endorphines build up gradually so that at each point in labour the mothers body is ‘just about’ coping with labour.  If the mum starts to worry about coping and becomes stuck in the pain-tension-fear cycle (see below) then this can inhibit the production and effectiveness of the endorphines.  A woman is more likely to worry about future coping ability if the labour seems long and the contractions are ineffective which is why the interplay between oxytocin and adrenalin is so important.

Unfortunately, as you can see, the environment the majority of women are placed in to give birth is not going to assist the delicate hormonal balance necessary for a quick and ‘copeable’ labour.  In fact, I would go so far as to say the environment actively hampers the possibility of a normal and easy to cope with labour.

Why can’t we afford the same respect and birthing environment to a human labouring woman as we recognise as vital for any other mammal?

Pain – Fear – Tension Cycle

If something feels painful this is often followed by fear.  The natural reaction to fear is to tense up, which unfortunately heightens the experience of pain.  This can then become cyclical, and develop into a downward spiral where the fear and tension actually make the pain worse and inhibits the endorphines which can lead to the pain being too difficult to manage.

If a mother is tense because she has just had a 20 minute bumpy car drive through traffic to go to a large birth unit where she doesn’t know anybody then she is likely to be tense.  This will mean that any contractions she has will feel more painful and difficult to cope with.  Combined with the effect of adrenalin on the oxytocin production, this can mean that a mother arrives at the birth unit already overwhelmed with pain and asking for pain relief before she is even through the door.

Already she is in the cycle, and her hormonal balance has been disrupted.  Often this continues right through to the birth, where the hormones haven’t been able to work as normal and the mother then needs further assistance to birth her baby.  No wonder we all think birth is so difficult!

Make a positive change: allow yourself the optimal birth experience.

Thinking about all of the above, I hope it becomes clear that birth is not too painful to cope with unless we make it too painful to cope with.

So, how can you turn things around and allow yourself to birth normally without intervention or the necessity of pain relief?

Firstly, try to find women who have birthed normally and found birth easy to cope with.  Maybe attend home birth groups or just find friends who have found birth manageable, exhilarating and awesome.  Wallow in their stories.  Read positive birth stories online.  Go to pregnancy yoga, aquanatal, antenatal relaxation classes.  Download positive pregnancy relaxations and visualisations and make it your business to listen to them every single day.  Ignore the negative and allow the positive, coping, strong woman to come to the fore.  Indulge her.  Over the 9 months allow yourself to believe to your very core that your body is capable – more than capable! – of birthing your baby.

Secondly, take action.  The biggest intervention you will make into your birth is choosing where you give birth and who will be your birth attendant.  These two choices will make the biggest difference to your birth than anything else put together.  Ask yourself why you are considering going into hospital.  Find out about home birth.  Home birth is normal and is safer than a hospital birth for every ‘low-risk’ pregnancy, and most ‘high risk’ women.  Talk to women who have given birth at home, read up on it and allow it to become normal in your mind.

If you are unable to birth at home, consider a birth centre instead.  Birthing in a stand alone birth centre is going to create the nearest chances of a normal birth to home, a birth centre in a hospital is the next best choice.  The option that is least likely to produce a normal, manageable birth is one that takes place in a consultant unit.  This should be the last choice, only to be used when medically necessary.

I have to go to a consultant unit!  How can I have a normal birth?

If you weigh up all the information and decide to go to a consultant unit, or have medical reasons for choosing a this option then don’t despair.  You can still maximise your chances of a normal and healthy birth.  You can do everything you can to ensure you are part of the minority of women who give birth normally in this environment.

How?  There are lots of ideas.  Keep in your mind the ideal environment for birth (or sex if that’s easier to envisage!) and create that environment in your birth room.  Your birth room is yours.  You can move furniture around, put on music, bring any equipment or special items and food and clothing or whatever you need to help to create the ideal birth environment for you.

Ask for your midwife to keep her voice low, and keep at a discreet distance.  Write a good birth plan that outlines what you need to birth well, get your birth partner on board and up to speed so that they can be your advocate which will leave you freed up to birth.

Some women have even put a blanket over their head to keep the ‘outside world’ out, or used headphones with relaxations or music to ‘zone out’.  Close your eyes and you can be in your own little world.

Perhaps most important, be aware of the impact that the journey to your birth unit and settling in will have on the birth.  It may start to feel difficult to cope with, the labour could stop or contractions get less frequent.  Set up your birth room, settle down and allow yourself to relax and feel at home.  It could take a couple of hours before your body feels safe and ready to start birthing effectively again.  Don’t worry about this.  It’s a normal physiological response to moving into a strange place during birth.

Visualisations and relaxations are perhaps even more important when you are birthing away from a familiar environment.  If you know you are going to a birth centre or hospital then practise doing your relaxations and visualisations all the way through the pregnancy so that when you arrive you are able to immediately counter the pain-fear-tension cycle and allow yourself to start labouring again more quickly.

Pain and Labour

I am hoping that this will provide you with a new perspective on pain and labour.  A new understanding of how the labouring body works, and why we have to help rather than hinder.

If we can understand how everything works and respect the environment that any labouring mammal needs to feel safe and birth easily then we can maybe banish the myth that human labour and birth is too painful for us to cope with.

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Did anybody catch the new TV series ‘Out of My Depth’?  It featured Amanda Holden ‘training’ to be a midwife and was another programme that needed lots of cushions thrown at it.

The basic premise is this:

Amanda Holden trains with student midwives. After a month of intensive on-the-job training, her mentor must decide if Amanda has learnt enough to join the delivery room team.

Oh, well… five whole weeks?  That’s Ok then.  Who knew you could be trained to be a midwife in only five weeks?  Probably only if you have a camera crew trailing along. 

A pregnant woman actually volunteered to have Amanda as her ‘lead’ (haha) midwife.  I can only assume that the side effects of this decision were not laid out clearly.  (the side effects unfolded for us all to see)

How did her birth go?  Cue image of woman lying on the bed screaming in agony, cut to midwife outside in the corridor “she’s asked for an epidural, which I think is the best decision.  She’s lost control and this will help her gain back that control”.  Next, image of Amanda Holden zooming to hospital in her chauffer-driven Merc fresh from an overnight flight back from ‘work commitments’ in the US.

Oh, how could anything possibly go wrong, you may be wondering.  What a fantastic, supportive, empowering set up.  Surely this is a normal birth waiting to happen.

Despite screaming in agony without a single helpful idea from the midwife for managing her labour (i.e. stand up, move around, have a bath, have a massage, relax, GET RID OF THE FECKING CAMERA CREW!!!) the woman did get to 8cm dilated before Amanda Holden got on the scene.

Then she was given her epidural and the baby’s heart rate dropped and didn’t recover.  Amanda Holden and camera crew then took up full-time residence in the birth room (as opposed to intermittant filming of screaming) and what on earth do you think happened then?

The woman’s very clever body sussed out that all was not right.  There were strange people in the room and thousands, if not millions, of people were watching.  She stopped dilating.  Totally understandable reaction to 1. an epidural and 2. a celebrity and camera crew suddenly appearing.

What happened?  Did her midwife act as her advocate?  Boot out the camera crew and Amanda?  Close the blinds, start massage and put on some soothing music?  Of course not!  She was wheeled off to theatre and given a very graphic ventouse – all captured on film (of course).

Why oh why do we think it’s Ok to mess with birth like this?  What an experience for that woman, what a lesson to learn for all pregnant or young women watching, what a welcome for that baby.

Sometimes…. I despair.

 

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We live in a funny old world.  We are a strange society.

A popular TV programme in this household is Harry Hill’s TV Burp (don’t ask) which is on ITV on a Saturday evening.  I was ‘lucky’ enough to catch a couple of minutes in passing this week.

He was taking the mickey out of a soap character, and she was breastfeeding her baby.  It then cut to Harry asking for a drink and being given a cup of milk and biscuit.  Supposedly the character’s breastmilk.  The audience gave the obligatory cries of disgust, and then when Harry dipped the biscuit in the milk and ate it – the uni-groan of disgust and shouts went up a notch or ten!

I just thought… isn’t it strange when the prospect of an adult human even touching breastmilk is enough to repulse us as a society?  If it was the milk of another mammalian breast the audience would not have reacted in any way whatsoever, yet even the idea of the milk coming from a human breast (clearly it was not) created such reactions of disgust.

I just thought it was a sad reflection of what a messed up place we are in at the moment about what is actually the most natural and fantastic life-giving substance. <sigh>

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UNICEF have a campaign to raise money for tetanus vaccinations in the developing world.  It is a joint campaign with pampers which does mean that in order to help you need to visit their website.  So how do you go about helping?

  1. Visit the Pampers home page.
  2. Ignore all their gumph and forums if you find the whole thing offensive or irritating.
  3. Click on the little balloon that pops up to download a FREE song.
  4. This will immediately donate money toward the UNICEF fund.
  5. Make sure you wait for confirmation!

I know that both vaccinations and disposable nappies are contentious issues, but I think in this case it is worth knowing about this campaign.

If I lived in a developing country at risk of tetanus and with a poor health care  system I would want this for my children, currently hundreds of thousands die of tetanus annually and it is highly preventable.

Worth considering.

 

 

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Q: I am 37 weeks pregnant.  I had a Caesarean birth with my first child due to Pre-eclampsia and am hoping for a vaginal birth with my second.  Do you have any tips?pregnant mother

Firstly I must point you in the direction of the very informative homebirth website which has a page specifically about Vaginal Birth After Caesarean (VBAC).  Although it is a homebirth website, the information is equally as valid for a hospital birth.

An interesting fact is that VBAC is stastically safer for mum and baby than an elective caesarean, especially in a situation like this where the initial caesarean was performed for something like PE where there was no problem with the birth canal or pelvis which may recur.  (though something like this actually happening is vanishingly rare in the developed world anyway).

I don’t know if you have considered a home VBAC.  Information on the homebirth website specifically related to a HBAC is interesting and presents all current research.  I think that if you are considering a HBAC then due to patchy support from the NHS midwives, you may have much more success with an independent midwife.

An independent midwife or experienced doula would be a fantastic idea whether you are intending to birth at home or hospital.  Support from an objective, experienced advocate could make the difference between a repeat caesarean and a VBAC.  Even a supportive and well informed partner will be consumed by their own emotions and concerns, whereas a more objective advocate who knows you and your wishes well can advocate much more successfully often.

Apart from these points any tips on achieving a vaginal birth are the same for any woman about to give birth.

Any kind of induction is likely to lead to more intervention and a Caesarean.  Think really hard about this, and what you will do if you are offered one.

Environment is a huge factor.  If you feel uncomfortable or unsafe in hospital then it will affect the progress of labour.  You may also feel uncomfortable or unsafe opting for a homebirth and feel like you are stuck.  Giving birth in hospital – it is important to remember that your birth room is your room.  Move furniture around, close curtains, turn off lights, put on music, bring balls and bags and mats and whatever will make you feel like you own this room and this environment.

Practise relaxations and visualisations.  Being able to ‘zone out’ and go into yourself will be really important.  It will also allow you to break the pain-fear-tension cycle which is vital if you are at all anxious about the birth.  Gradual body relaxations are good, especially simple ones that don’t have a long and complicated ‘script’ to follow.  Visualising the cervix and birth canal ‘opening’ up will help.

Of course you will be doing your pelvic floor exercises regularly (ahem) but during the third trimester you should be practising releasing the pelvic floor and visualising the pelvic floor relaxing and opening, instead of doing the tensing or holding in type of exercise.

Think seriously about accepting continuous foetal monitoring.  It is more likely to lead to increased intervention and a caesarean.  As you are opting for a VBAC you should have a midwife with you continually – one to one care – so continuous monitoring should not be necessary.  Regular intermittant monitoring should suffice unless a problem arises.  Again, this might be something you feel unable to push for without an experienced advocate to do that for you.

The more medical pain relief you have (epidural, pethedine etc) the more likely you are to need more interventions and an assisted birth.  Using water, relaxations and massage can really help here.

Practise massage beforehand with your partner so you don’t feel like a couple of eejit’s when you get into the birth room.  Or choose a doula/ independent midwife who is also an experienced masseuse and won’t feel like an eejit!  🙂

Overall, try not to be too anxious.  Try to relax, and believe that your body is capable of birthing your baby and give yourself everything you need to achieve this.  A supportive birth partner, an experienced advocate, a homely environment and minimal interruption to the delicate birthing process are all things that can help you get the birth you want!

Good luck.

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Positive and informative statement from UNICEF which has been seen and approved by the authors of the study.

Interesting comment in The Guardian yesterday who picked up the mis-reporting issues and the fact that the authors of the study are not happy with how the press have been picking it up.

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Once again the ‘risks’ of bed-sharing and SIDS is all over the news.  I am so tired of seeing

co-sleeping

co-sleeping

mis-reporting and poor methodology in these studies that I have taken some time to look over current evidence and advice.

“Over half of cot deaths occur whilst co-sleeping”

Or so says the study that is currently being used to scaremonger.  This is a retrospective study by a team from Warwick and Bristol Universities.  They looked at the evidence for 80 babies who died of SIDS in the SW region.  The BBC report that ‘sharing a bed is a factor in more than 50% of cases’ followed confusingly by the statement that ‘many of the deaths occurred when parent and infant slept together on a sofa’.  Hmmm.

So what did the study find? That in 43 out of the 80 deaths the parents were co-sleeping.  But in 7.31 (?) of those cases they were on a sofa.  In 13.3 of those cases the parents had consumed drugs or alcohol.   A further 16 out of the total of 80 babies were on a pillow or swaddled and the authors state that these risk factors were the same in either group  so we can assume that 8 babies were on a pillow or swaddled.  So around 28-29 of those 43 cases were definately not safely bed-sharing or bed-sharing at all.

The study makes no reference as to whether the parents were smoking – a contributing factor in the vast majority of cot deaths.  And there is no reference to breastfeeding – a protective factor in the vast majority of cases.

So what does this study really tell us?  That without the important information about smoking and breastfeeding 15 out of 80 of the babies who died of SIDS were sharing a bed with a parent who was not drunk or on drugs.  This doesn’t tell us very much.  I have contacted the team who authored the study asking for clarification about smoking and breastfeeding and will update the blog if I hear back from them.

Other Evidence

Moving away from this specific study, what other evidence abounds about bed sharing and SIDS?  The number of studies is huge.  To enable results that can be considered rigerous and therefore actually truthful:

UNICEF further recommends that all future research into infant death and sleeping environments should unambiguously record data on … the baby’s sleep surface, maternal and paternal smoking status, alcohol and drug consumption and infant feeding method. These factors should be recorded at the time of infant death (rather than relying on data for other periods such as feeding method at delivery or smoking status during pregnancy) and the results adjusted to control for them.

However it is very difficult to come across any study that actually takes into account these recommendations, let alone reports it’s findings within these guidelines and separates out the evidence as stated above.

The nearest I have found is a study published in the British Medical Journal entitled Babies sleeping with parents: case-control study of factors influencing the risk of sudden infant death syndrome. The study was part of the CESDI (Confidential Enquiry into Stillbirth and Death in Infancy) carried out annually in the UK.

This study was published in 1999.  It was a three year, population based case-control study.  The authors studied all cases within a population of 470,000 births.  During the three year study the authors examined 325 SIDS cases, and also those of 1300 ‘control’ infants matched for age, locality and time of sleep.  They interviewed all parents.

Findings initially showed an increased risk for infants sharing the parental bed for the whole sleep, babies sleeping in their own bedrooms and infants who shared a sofa.

However, the risk for infants sharing the parental bed was found to be not significant for older infants >14wks or any infant whose parents did not smoke.

The authors concluded that :

There is no evidence that bed sharing is hazardous for infants of parents who do not smoke.

This study found that if parents don’t smoke and BED share (rather than sofa share) they are no more likely to suffer from SIDS than babies in a cot in their non-smoking parents bedroom.   However babies in their own rooms are at more risk of SIDS than babies in a cot in their non-smoking parents bedroom.  So, why is this fact so under-reported?

More information and analysis of this study can be found at the Mothering Magazine website.

Conclusion?

Given that bed-sharing has been shown to be crucial in establishing a successful breastfeeding relationship, is practised safely worldwide and is practised in the UK and ‘developed’ world by the majority of parents it is about time that it stopped being demonised by the authorities and the media.

There is no rigourous evidence that safe bed-sharing is related to an increased rate of cot death.  FACT.

Find out how to bed-share safely with the information from UNICEF or Dr Sarah Buckley.

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