Wednesday, 29 June 2011

Past pain free labours

Pain free labour is not a new concept. People for generations have been aware of the fact that labour contractions are not meant to cause pain.
Doctor Grantly Dick-Read was born in Britain in 1890, he studied at Cambridge University and practiced at the London Hospital. He noticed during his work that labouring women, who were not afraid of childbirth, did not require any pain relief. In his book, Childbirth Without Fear, he outlines why women feel labour contractions as painful. "Pain in an otherwise uncomplicated labour arises from the activation of the sympathetic nervous system by the emotion of fear." That is the actions of the hormone adrenalin outlined in my post: Why labour hurts 2. "A labour without disproportion or malpresentation of the baby is long because it is painful, not painful because it is long." In this statement he is referring to the cervix being held shut by adrenalin causing the contractions to become stronger and making the labour much longer as discussed in the post: Why labour hurts 3.
As you can see, during the 1940s when Dr. Dick-Read's book was first published, a pain free labour was often had at home by women who were not afraid to labour. I don't know if the good doctor recommended any relaxation techniques in order to have the best chance of experiencing a pain free labour, he does however outline hypnobirthing which must have been in its infancy during that time.
Dr. Dick-Read's book is an interesting read as a historical text book. It is however not relevant to today's women who don't want to plough through a lengthy book just to extrapolate the information you can glean just from reading my blog. Sorry Dick.

Wednesday, 22 June 2011

It was like flipping a switch.

A young woman arrived on labour ward saying that she thought she may be in labour. It was her first baby so she said that she didn't know what to expect, what labour felt like. She almost apologised for her arrival as the contractions were not causing any pain, just a little back ache, so she thought she was wasting my time.
I sat her down on a padded chair and placed my hand on her abdomen to palpate her contractions. They were coming every 3 minutes and felt moderate in strength. After examining her cervix I pronounced that she was not in fact wasting my time and that she was in labour.
It was like flipping a switch. While she thought she wasn't in labour, she was calm and collected and coping well with the contractions. As soon as labour was confirmed the fear set in. I could see it in her eyes. I tried to address her fears by saying that she had been in labour all morning and not felt any pain, so why should it become painful now? I explained about adrenalin starving the uterus of oxygen and attaching to the cervix to prevent it from opening, but it was too late.
The widely held belief that labour contractions are meant to be painful is so deeply embedded that with some women, it is impossible to erase. After she found out she was in labour she was a different person. The family were sent for and she sobbed into her mothers arms. When I explained to her mother how well she had been coping in labour beforehand, and that she could continue with her pain free labour I was told to get the anaesthetist quick for an epidural. "Can't you see that my daughter is in pain?"
Generation after generation the legacy of painful labours is passed down. How can anyone compete with that. All I can do is keep repeating the mantra - Smooth muscle is not designed to cause pain when it contracts under normal circumstances. One day the message will get through. Please help spread the word.