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.