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

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