Thursday, 13 December 2012

Thank you NHS

I spoke to a young lady recently who I was to review her birth plan with. She told me that she wanted an epidural and episiotomy.
I was speechless.
She was low risk with normal deliveries achieved at her last births. I was told that it was normal in her culture to have an epidural and episiotomy as standard. A doctor delivers the baby and obstetric nurses care for you in labour and after the birth. Not a midwife in sight.
It took a while but I eventually persuaded mum to at least try the birthing pool at her local birth centre before opting for a medicalised birth. I described how the warm water eases away any aches and would keep her relaxed during the labour. Delivering in the pool would help her perineum to stretch naturally and she could maybe avoid any trauma to her lady bits. Baby would be listened to every 15 minutes to ensure they kept nice and happy.
She was certainly very interested in this strange way to labour and birth and eventually decided to at least give it a try.
I have spoken to lots of women who come from a culture of medicalised care in labour and when they decide to try the pool they get back to me with glowing reports. "I didn't know it could be that good, I was in the pool and no way was I getting out. My baby was born in the water and it was simply wonderful".
With the increasing number of Midwifery Led Birthing Centres opening in the UK, I feel we need to say a silent thank you to the good old National Health Service (NHS) and all the dedicated workers who strive to empower women to seek a more natural way to birth their babies.
Thank you.

Sunday, 9 December 2012

Evidence based practice to support a pain free labour - Three

It is Sunday afternoon and I have been researching smooth muscle for the past two hours. I now know all about calcium ions and calmodulin proteins which activate an enzyme called myosin light chain kinase which uses ATP to phosphorylate a portion of the myosin head. This means that the myosin head can then bind to actin and contraction can occur. I really did not need to know all this. However, what I did need to know was that SMOOTH MUSCLE IS NOT DESIGNED TO CAUSE PAIN DURING NORMAL USE.
There are three types of muscle in the human body. Cardiac muscle is found only in the heart. Striated muscle is voluntary and attached to our skeleton so that we can skip and dance. Smooth muscle is not voluntary, we have no conscious control over it. It is found in the walls of hollow viscera, airways, blood vessels, the iris and in hair follicles. There is no fourth category of muscle. If uterine smooth muscle was so different from other smooth muscle then it would be in a section of its own. If uterine smooth muscle was designed to cause pain when contracting, as many people believe, then it would be very different from the smooth muscle in your stomach. It is not.
I have read thorough Tortora and Grabowski's Principles of Anatomy and Physiology on muscle tissue and nowhere do they say that uterine smooth muscle is any different to smooth muscle in other parts of the body. In fact, I think they would turn in their penthouses if anyone suggested that their beautiful book had a major flaw, that of not recognising a fourth muscle group.
So, why do so many women today experience uterine smooth muscle contractions as painful when they go into labour?
 See earlier posts:
  • Why labour hurts.
  • Why labour hurts 2
  • Why labour hurts 3
  • Why labour hurts 4
  • Why labour hurts 5
Once you know the truth, you have the chance to choose.

Friday, 23 November 2012

Evidence based practice to support a pain free labour - Two

It has been recognised for decades that there are adrenergic receptor sites on cervical smooth muscle membranes for catecholamines. There appear to be two main receptor sites, alpha-adrenergic and beta-adrenergic. The alpha-adrenergic sites, when stimulated by adrenalin in a person's blood stream, are responsible for cervical smooth muscle contracting. The evidence to guide our practice with reference to adrenergic receptor sites is freely available on the Internet and:-

Identification of alpha-Adrenergic Receptors in Uterine Smooth
Muscle Membranes by [3H]Dihydroergocryptine Binding* 
 is one such piece of research.

Another is the research conducted to compare different local analgesia given during large loop incision to the uterine cervix by Howells et al (2000).
Lignocaine with adrenalin was found to have more side effects such as shaking but caused less blood loss. These results can be attributed to the adrenalin diffusing into the woman's general circulation and causing her blood vessels to send extra blood and energy to her arms and legs which would cause shaking. If you have ever had to stand up in front of an audience and give a speech you will know all about adrenalin and shaking! The reduced blood loss can be put down to alpha-adrenergic receptors binding with the adrenalin and causing the cervical smooth muscle to contract strongly and so cut off any damaged blood vessels and so reduce blood loss. 

So, what on earth does all that mean to a labouring pregnant woman? It means that telling women about receptor sites on the uterine cervix is evidence based and so should be allowed when offering evidence based care within midwifery services.

Society repeatedly informs women that labour contractions are meant to be painful. When women go into labour they are naturally anxious. This anxiety causes the release of adrenalin by the autonomic nervous system. The adrenalin circulates in the blood and attaches itself to receptor sites on the uterine cervix causing the smooth muscle there to contract and become rigid. The cervix should be relaxed in labour so that the uterine smooth muscle can pull it up over the baby's head. If it is being held rigid by adrenalin then it is more difficult to pull up and a longer labour can be experienced causing more stress and more release of adrenalin.

Various posts within this blog describing relaxation techniques in labour striving to stop women being anxious when going into labour and so stop the release of adrenalin. The relaxation technique I generally teach to pregnant women is called Progressive Muscle Relaxation. A relaxed person does not secrete adrenalin, which is only needed in times of stress to prevent you giving birth when there is a massive tiger at the cave door looking for a quick snack.

Practicing one of the relaxation techniques is vital in pregnancy so that when labour day arrives, you can slip easily into a relaxed frame of mind. Bliss.

Saturday, 27 October 2012

Evidence based practice to support a pain free labour - One.

Midwives today have improved the care offered to pregnant women by providing Evidence Based Practice. That is, only offering a plan of care that has been proved to be effective by research. The concept of evidence based practice was developed by Dr. Archie Cochrane in order to encourage all health care professionals to use evidence when making care decisions.
The Cochrane Library are a wealth of information when seeking research to guide our practice. They take the findings of similar research projects and amalgamate them to present an overall picture of what the researchers were hoping to discover. Their aim is to present independent high quality evidence for decision making within health care settings.
Lawrence et al (2009) examined 21 such studies which included the experiences of 3706 women. Their subject matter was Maternal Positions and Mobility During First Stage Labour.  Their findings after examining each piece of research by two independent health care specialist were:
  • The first stage of labour was one hour shorter in the upright groups.
  • There was less use of epidurals in the groups that remained mobile and upright.
They concluded that remaining upright and mobile during the first stage of labour was advantageous to women. They pointed out that lying down in labour should not be encouraged due to the weight of the pregnant uterus putting pressure on the abdominal blood vessels.

This blog supports staying upright during labour. This summer I visited Bonny Scotland and was amazed at how hilly it was. Walking up the hills was hard work, I would arrive at the top of a hill breathless with the muscles in my legs hurting. When women lie down in labour the uterus has to work against gravity and push the baby uphill, no wonder the uterine muscle starts to hurt, just like my legs did in Scotland. However, I had the choice of sitting down and getting my breath back at the top of the hill and so the hurt went away. Labouring women do not have this choice, of stopping the labour to relieve the hurt.

From the research available to guide my practice I can surmise that staying upright in labour will shorten the labour and make it more comfortable. I can therefore be confident that when I advise labouring women to have a little walk or adopt an upright position such as sat on a birthing ball or kneeling on a mat, my practice is evidence based.

Sunday, 15 July 2012

Pain free labour for baby? Why not?

I have just read Birth Without Violence by Frederick Leboyer. It has made me think about the way we treat newborn babies within a hospitalised setting during and after they are born. Reading Leboyer is like reading a very long poem. It is very emotive and thought provoking and there are none of the usual references to back up the subject matter. The pictures within the book say it all and he has a lovely soft way about him as he takes you by the hand and guides you through birth from a newborn's perspective.
He comments on how cruel we are to new born babies comparing it to how women used to experience labour by saying:
"The same blindness that made us think women had to suffer simply because we didn't know any better. Happily we no longer believe in the old saying: 'In pain shall ye give birth'. Isn't it time to do for the child what we've been trying to do for the mother?"
What the frell? This book was first published in 1974. Here was another man telling us how to have a pain free labour, the first being my hero Grantly Dick-Read, and obviously being totally ignored, just like Dick- Read was in the 1940s.
What on earth is the matter with us. Why do we believe so blindly in the medical model of care that gives us such painful labours when we have known about pain free labours for years and years. What we need is a modern, easy to read book, that explains in detail why uterine smooth muscle was never designed to cause the sensation of pain when contracting normally. A book that tastefully mixes the funny side of labour, as seen by midwives, with advice on how to survive birth with a lovely big happy smile on your face at the end. There exists such a book, cos I wrote it, but the publishers have been contaminated by the belief system that has kept women from taking charge of their labours and passively following society's media driven model of childbirth. Ask Amy at   why she has got cold feet and is keeping women chained to the epidural trolley.
Two very eminent gentlemen in their field (one with a very sexy French accent) have told us for years that the majority of women going into labour today can achieve a pain free labour if they know the coping strategies outlined within earlier posts of this blog. Why do we find it so difficult to believe when the advantages to ourselves and our babies are so enormous?
Don't make me chain myself to railings on a race track like the super suffragettes had to do in order to drag women out of being second class citizens during the 1800s. Cos I will. If you make me.

Wednesday, 2 May 2012

VBAC at Home?

Having read a post by Villagemidwife found on Twitter (yes, I do know how to tweet) I have been thinking about VBACs. That is, Vaginal Birth After Caesarian. Villagemidwife puts forward a very strong argument for allowing women wanting a VBAC to give birth at home. Within the medical contraints of hospital care offered in the UK a home birth would be strongly contraindicated and not encouraged.
If you think about it for a moment, a home birth seems the perfect place for a VBAC. In my experience, most caesarian sections are performed when a woman fails to make enough progress in labour and the baby is seen to be distressed by the long labour on the CTG monitor.

Going into hospital can be a stressful event, adrenalin will be secreted when a person in under physical or mental stress. In an earlier post I explained how adrenalin attaches itself to the uterine cervix and prevents it from opening normally. So, when stress is a factor within a labour, expected progress will not be made due to the actions of adrenalin. The contractions will have to become stronger in order to pull up on a resisting cervix. How will this help someone having a VBAC? It will make a uterine rupture much more likely.

At home however, a woman is much more likely to remain calm and in control. If she follows the advice on relaxation techniques outlined in earlier posts then she will not secrete adrenalin and the cervix will be free to dilate. The contractions will not have to become stronger as the cervix will not be resisting and so they will remain at normal contraction levels. The first stage of labour, if conducted under the methods taught in this blog, will be pain free.

When in hospital, a woman having a VBAC has to be continuously monitored to detect any early signs of uterine rupture. She will most likely be confined to a bed with only brief breaks to visit the loo. Staying upright during labour helps the uterus work with gravity so that the contractions do not have to become strong. Lying down on a CTG monitor will make the contractions become stronger and so cause pain. The fact that she is not mobile will also impact on descent of the rotating baby into the complicated anatomy of the birth canal.

At home, a woman is free to move around and relax as her body dictates. She can eat and drink anything she chooses according to her body's needs. She can remain upright and have the power of gravity helping her to labour instead of hindering. The contractions will remain normal as her environment and mental state will be in harmony with her labour, not putting obstacles in the path of normal progress.

Spot on Villagemidwife, you have put forward a brilliant argument for a VBAC at home. With the element of a pain free first stage of labour, a home birth can become a real option with all the benefits working toward encouraging normal progress. The only element that will prevent women from seeking out a pain free labour is FEAR. The fear of litigation. The fear that women are irresponsible little tykes that are all too willing to put their babies at risk. Hospitals will not support home births for VBAC. But. They may support birthing in a birth centre where pool deliveries are the norm. Water births are so nice and gentle that no extra stress will be put on the scared uterus causing it to rupture, the contractions can remain normal.
  • Lying down on a CTG machine will cause the contractions to become painful as they work against gravity.
  • Pain will cause stress that will hold the cervix closed that will make the contractions become stronger.
  • Not moving about in labour will slow the normal rotation of the baby.
  • Not eating in labour will prevent enough carbs being available to fuel a contracting uterus, labour may slow down or stop.
  • If it slows down or stops a drip may be started that will put extra stress on the scared uterus.
Everything we do in hospital seems to be against helping women to achieve a VBAC. Lets start a campaign today to allow women VBACs within a birthing centre setting. Let me know what you think?

Wednesday, 18 April 2012

Once upon a time

Has anyone seen the fabulous new series called Once Upon A Time? It is a new take on old fairy tales, bringing them into present day. Very clever and extremely well done. However, some of their audience will be young people and the labour scene where Snow White was giving birth was so cliche that I almost cried. She was doing the usual crying and screaming and acting as if she was being tortured.
What message does this give to our young people today? It tells them that labour will be very very very painful. As soon as any of them get pregnant and start to labour they will remember all these images and they will naturally start to feel anxious. At that moment in time all hopes of a pain free labour will evaporate like fairy dust.
The midwives among us could tell that she was supposed to be in the second stage of labour and so it does get a little painful as the perineum stretches but how could the young audience know that.
Ms. White was also firmly planted onto a bed - THE WORSE PLACE TO LABOUR - as it is difficult to remain upright on a bed and the uterus will not be able to work with gravity and so the contractions become stronger and so may become painful. (see the posts - Why Labour Hurts 4)
I don't want to give the story line away but Ms. White was under threat at the time from the evil queen casting a very bad spell on her that was speeding like a huge dark swirly thing towards her and her prince. So really, she could be forgiven for having a painful labour cos who wouldn't if labouring under the same circumstances?
Her anxiety would flood her body with adrenalin which is the main cause of painful labours. (see the posts - Why Labour Hurts 2 and 3)
If pain free labours are to become an accepted part of our society then TV producers have to stop using birth as a fulcrum for drama and forcing their actresses to overact. Stop teaching young people to fear labour cos then painful labours become a self fulfilling prophesy. Change in how we perceive labour is coming, if you see a huge dark swirly thing coming towards you then don't worry, it's not the evil queen, it's the anger of all the women, who suffered in labour after being taught that the first stage of labour was meant to be painful, and then they learn the truth.

Thursday, 5 April 2012

Best Birth Centres - The Rosie Hospital, Cambridge

Exciting news seen on the Internet - a brand new 10 roomed birthing centre has opened in Cambridge, England. Each room has a birthing pool and other essential equipment for a natural pain free first stage of labour. The essential equipment will be aimed at providing you with a comfortable environment in which to labour. A home from home. An upright position will be encouraged as previously outlined in this blog. Staying upright is important for a pain free labour as the contractions are working with gravity, so do not have to become stronger.

Relaxation will be encouraged within a calm nurturing atmosphere where you can eat and drink to your own personal needs. Taking advantage of the pools for your labour and birth is always a very good choice as warm water has been used for years to ameliorate the normal aches and discomforts of simply being pregnant. The warm water also negates the pull of gravity to some extent and so floating in the pool with a cool drink and willing birth partners in attendance will feel like being on your hols, what more could you ask.

In today's economic climate, it is wonderful to hear of an NHS trust going that extra mile to provide a choice for women in Cambridgeshire. So, if you desire a birth to be envied by all your friends, make sure you are around the Cambridge area when you go into labour. Access earlier posts within this blog for relaxation techniques. Sorted.

Pain free labour books now available on Amazon.

Friday, 16 March 2012

Welcome to pain free labour comrades

A big здравствуйте to all the Russian people who have started looking at my pain free labour blog. Я надеюсь, что погода там не также холодна. That was just a little secret message to our Russian friends.
It seems that the message is getting through regarding midwives calling contractions PAINS. More and more are recanting their ways and, at least while I am present, they are making a very concerted effort to not use the P word. It will take time. For our Russian friends, you need to call uterine activity сокращения and not боли.
The social construct that we have created and woven into our belief systems regarding painful labours is very strong, it will be difficult to erase. Midwives who are independent enough to fight against this acceptance of painful labours, and at least try to address the balance, will help women to achieve the best labour possible for them as an individual. Once we teach them how to behave in labour, and what elements are causing any discomfort, then we will be truly 'with woman'. Cos at the end of the day, that is what 'midwife' means.
See earlier posts in this blog for relaxation techniques and staying upright to achieve a pain free first stage of labour. Goodnight. Доброй ночи, я надеюсь, что Вы наслаждались этим постом.
And, for our Aussie friends - Sling another Wombat on the barbie will ya Shiela. Thankyou.

Sunday, 26 February 2012

Birthing in the pool

I have just spent the weekend having two of the most amazing gentle pool births that you could ever imagine. I love it. Working on the birth centre at North Manchester General Hospital is just the perfect job for any midwife.
Both the women that I have cared for over the weekend said they coped so much better after entering our lovely birthing pools and are going to recommend them to their friends. Giving birth in nice warm water is a more natural way to birth for baby, she is already used to an aquatic environment. Heat is a universal source of comfort for all ages and being surrounded by warm water whilst giving birth seems to cocoon women in a security blanket that most do not want to leave after the birth.
Birth centres cater for low risk women, ask your community midwife if you are low risk and if so ask her to book you in at your local birth centre. Normal labour wards can still have birthing pools, though they do not get used as much. Even if you have risk factors, ask the labour ward where you are booked if you can use the pool. Always remember that you are the boss. All maternity care is offered as a service, with you as the client. When you go to the hairdressers and ask for a certain style, you would not be happy if they said that style was not available and you could only have a crew cut instead. Well, not unless you like that sort of thing. Write your birth plan before you are in labour. Have someone calm and confident with you so they can fight your corner if necessary, leaving you to focus on your relaxing. Stay upright untill you are in the pool, the water will then negate the pull of gravity and you can adopt whatever position is comfortable for you at the time. Floating has been the mode of choice this weekend. Love it.

Friday, 10 February 2012

Birth Centres

Having just worked for 3 months at a wonderful birth centre, I am more awestruck that ever at how wonderful women are. They have been taught that childbirth will be very painful, by the society that they live in, and yet they still get pregnant and they still come back for more. Awesome. While working on the birth centre I have met some lovely people and have helped them to have a pain free first stage of labour for most. It is very difficult to teach women relaxation techniques in the middle of their labours. Relaxation really must be practised during the pregnancy as outlined in earlier posts on this blog. However, I have found that some women are capable of taking a step back from their pain and discomfort and trying the methods that I teach. Once they are upright on a chair or ball and in a more relaxed and controlled state of mind they look up at me and say "Why has no one ever told me it can be this way before?" That is a very good question. I have now been told that I have to leave the birth centre and move to another ward. They knock me down, but I get up again. I have an article to be published in Midwifery Matters in the Spring issue that aims to teach midwives how to help women labour. Please help spread the word. Thank you.