Thursday, 22 January 2015

Childbirth Unmasked 8

Childbirth Unmasked by Margaret Jowitt
Chapter 6 Stress and Labour

In this chapter Margaret looks at how modern hospital management of labour causes stress which sets into motion the release of a cascade of hormones that interfere with normal labour, making it painful. This pain justifies the hospitals management and it is ameliorated by drugs or surgical means. The cause is therefore the cure.
Complete freedom of movement is essential in order to follow pain avoidance instincts. Curtailing movement by connecting women up to drips and fetal monitors may be counter-productive and lead to the very pain and fetal distress it is meant to avoid. Forcing women to labour on their back must have been torture (and still is today) and in itself could account for a large proportion of infant and maternal mortality.”

In this chapter the focus is on B-endorphin, a hormone that steadily rises in labour and is thought to regulate and avoid 'explosive' contractions. It seems that there is a see/saw effect between Oestrogen and B-endorphin during labour. Oestrogen apparently helps uterine smooth muscle to contract while B-endorphin works to suppress contractions. As B-endorphin is a stress hormone this could explain why women turn up at hospital with reduced contractions after contracting well at home. If you move a labouring woman before labour has established the stress hormones released, caused by the move, will halt the labour.
...the behavioural purposes of stress hormones. They are switched on in an attempt to make us change the environment to suit our needs better. Once our needs are met then stress hormones fall, and the body resumes its normal activity. The evolutionary purpose of psychologically induced stress hormones in labour is to improve the environment to make it more suitable for labour, for birth itself...”
Margaret points out that it is difficult to avoid stress, and therefore stress hormones, in a hospital setting. This is why it is so important to practice the relaxation techniques outlined in previous posts on this blog in your pregnancy so that when you start to contract you do not panic and rush straight to hospital. You simply sit down on your own comfy couch and listen to your body. Stress is like interference on a radio channel which stops you from hearing what is being said. Relaxation tunes you in properly so that your body can listen to labour in peace.

The reason that so many women attend hospital today for induction of labour is that they have gone past their ultrasound scan due date. As that date slowly approaches, women become more anxious as they believe the social construct of painful labours. This constant release of stress hormones must have an effect on the onset of labour. If women worked on their relaxation techniques leading up to labour day I am convinced that they would more readily and easily go into labour without all the stopping and starting that modern women report today. With my second labour, after a traumatic first, I went over my dates and was very stressed during that time. At term+6 I decided that I was not doing myself any favours and started doing progressive muscle relaxation that I had learned from a yoga book. I felt really well that night going to bed, as if the whole world had been lifted from my shoulders. At 1am I awoke with some irregular contractions. So that I would not mess up my labour I snuck downstairs and continued my relaxing. I listened to my body and ate and drank at will until the contractions had been regular and lasting for 50-60 seconds for at least an hour. The midwife at the hospital did not believe that I was in labour as I was still relaxing and not in any pain. On examination she found me to be fully dilated and awaiting an urge to push. I was so happy I could have cried. Just by remaining relaxed and in control I had avoided the stress and pain of my first labour. Bliss.

Margaret concludes this chapter by saying:
Relaxation, breathing methods, yoga and psychoprophylaxis (you will have to google that last one) have all proven successful means of dealing with stress in labour by screening out distractions, and many mothers and midwives will testify to their efficacy. Until now, the reasons for the success of these methods have been unknown. Home birth remains the only way for a woman to be sure of retaining control over her baby's birth and I recommend it highly as an experience not to be missed unless absolutely necessary.”

However, if you have the right midwife who is willing to help keep you upright in labour and lower the lights and noise levels to keep you relaxed, then a hospital birth can be an acceptable alternative. Pool births within a hospital setting can be lovely with the right support. Practice the relaxing at home and do not come in too soon while everything remains normal. Margaret Jowitt wrote her book 20 years ago with all the information in it that women need in order to labour well and yet women today still let their fear of labour govern their reactions instead of taking control. You can change the stress/pain reaction to labour by choosing and practising your relaxation method today. Take control, I don't see why us midwives should do all the work!

A wonderful book by Susan Jeffers will teach you how to deal with stress on a daily basis, 'Feel the Fear, and do it anyway'. Also available from Amazon or ebay.
Uterine smooth muscle is only painful when deprived of oxygen, this happens when you make it work harder by lying down or taking away some of its blood supply by being anxious or afraid.

Wednesday, 7 January 2015

Childbirth Unmasked 7

Chapter 5 - Labour

"For sixty years (now 80) or more scientists have been suspending strips of animal and human uterus in various liquids in test tubes, stretching it, adding hormones, adding chemicals, measuring contractions, analysing changes, and generally trying to find out what makes uterine muscle work and what stops it working"
In this chapter Margaret Jowitt uncovers the reason that women today fear labour and so stop themselves from labouring. All the research has been carried out on medicalised abnormal labour, normal labour has been ignored so that doctors know very little about how to help women have natural labours.
"The scientists have completely ignored the mother herself and her mind. This is why obstetrics is the least scientifically based medical speciality. ...stress hormones unlock the mysteries of labour itself."

In the posts on this blog entitled 'Why Labour Hurts' I try to explain how adrenalin, secreted when we are anxious or afraid, acts in a way that causes contractions to become painful. Margaret takes this explanation a step further by comparing labour to driving a car.
"The hormonal control of labour is very complex and difficult to understand but it has certain similarities with driving a car."

Margaret goes on to describe the functions of different hormones and how they can be interfered with by adrenalin, a little like having to use your brake in an emergency in order to stop. Women have their foot firmly on the labour brake throughout by producing copious amounts of adrenalin which makes it painful and will eventually halt the labour as the body goes into total exhaustion mode. This scenario can be avoided by the relaxation techniques outlined in this blog. A relaxed person does not secrete adrenalin and so the labour can continue with the accelerator pressed instead of the brake.

Painful contractions are considered and Margaret gives a lovely explanation of what to do if you find yourself with them at any time during a normal labour.
"...pain is a motivation for the labouring woman to do something to ease her stress, whether physical or emotional. She may change her position to relieve physical stress and relax her body and mind to relieve psychological stress."
Your body uses pain to let you know that something is wrong and you have to try different things to alleviate the pain. If you are sat on your hand and it becomes painful you would not keep on sitting on it would you?

Margaret understands labour so well and is a wonderful advocate for pain free labours during the first stage. "When the woman has learnt that she must relax or change her position to avoid pain, then the uterus can get on with its work. The better she learns how to cope with contractions, to relax and follow positional instincts, the shorter will be the first stage of labour." Amen.

And yet women today still firmly believe that labour will be painful and so start pumping out adrenalin at the first sign of a contraction. We have known about pain free labours since Dr. Dick-Read put forward his fear/tension/pain theory in the 1940s and yet we seem unable to accept the simple fact that uterine smooth muscle was never designed to cause the sensation of pain during a normal contraction. We never learn, do we?

Pain Free Labour books availlable from Amazon.