Why labour hurts 3

Imagine you are a cave woman coming toward the end of your labour when a saber toothed tiger appears at the cave door. OMG. The first thing you would do is to release adrenalin into your system so that you have extra energy to run away or stay and fight. But 'Oh No' your cervix is nearly fully dilated, if your baby is born now then the tiger will think its her birthday and celebrate with a very fresh human, covered in a tasty liquour dressing accompanied by a side order of bloody placenta. Yum.
Mother nature however has other tricks up her sleeve and has put receptor or binding sites on the cervix for adrenalin. The adrenalin secreted when we are under physical or mental stress 'sticks' to the cervix and helps to stop it from opening. Your cave baby is thus held in utero untill you can run out of the back cave door leaving your cave buddies to scare off the tiger. Sorted. Or is it?
Unfortunately mother nature has not moved with the times. Curse you evolution. In the modern world we no longer need adrenalin receptor sites on our cervix and they have become a hindrance. Todays modern woman is so afraid of going into labour that as soon as she does the adrenalin produced from the mental stress will attach itself to the cervix and hinder dilatation. The contractions will have to become stronger in order to heave the resisting cervix up and so become painful.
Howells et al (2000) was a piece of research which compared injecting the uterine cervix before surgery with adrenalin or another substance. The adrenalin worked best at reducing blood loss as it caused the cervix to become rigid. This is similar to how adrenalin performs during labour when levels are high enough to affect the cervix.
A relaxed person does not secrete adrenalin. Relaxation techniques previously discussed in this blog can be used in pregnancy and labour to prevent the cervix being restricted in its dilatation. This should make the labour shorter and easier and end all the cries of " What do you mean I'm not in labour? I've been contracting for 2 f***ing days and my cervix has still not dilated?" Oh bliss.

Why labour hurts 2

Imagine you are Buffy the vampire slayer walking through an eerie graveyard at the dead of night when suddenly, out leaps a vicious vamp looking for your blood. What is your reaction?
The first thing your body would do is to send an automated message to your adrenal glands to release adrenalin. This adrenalin would then circulate the body and make certain changes in order to maximise your chances of survival.
One of the ways it does this is to redirect blood flow from the body to the arms and legs so that you can run away very fast from the vampire or, if you really are Buffy, you can stay and fight.
Women today are scared of going into labour cos they believe they will be in agony for hours and hours, as soon as they have a few contractions the anxiety they feel starts releasing adrenalin from the adrenal glands. As with Buffy, this adrenalin sends extra blood to the arms and legs. This means that non vital organs within the body, such as the uterus, get starved of oxygen rich blood.
When a labouring uterus gets starved of oxygen it produces lactic acid, this then connects to pain receptors and sends messages to the brain of PAIN!
Running too soon after a meal has the same effect on the digestive system. The adrenalin released in response to physical exercise starves the gut of oxygen and you get a stitch. All you need do under these circumstances is to stop exercising and the stitch will go away. Unfortunately we do not have this option when going into labour.
Learning how to relax during the pregnancy so that you are ready when the big day comes  is vital for a pain free labour. A relaxed body does not secrete adrenalin so the blood flow is not sent away from the body to the arms and legs. During a normal labour with a normally presenting baby there is no reason for the contractions to hurt.
Choose a  method of relaxation that suits you best, stay upright on a comfy chair or other upright position and you will be amazed, as I was when I experienced my first pain free labour.

Why Labour Hurts 1

From the feedback I have received regarding pain free labours it seems that people are just too brainwashed by society to believe. OK, but I refuse to give up.
The uterus is basically a bag of smooth muscle. It is very similar in its design to the stomach. They both have three layers of smooth muscle each. These layers work together when contracting and relaxing. The stomach to churn up food and drink to digest it and the uterus to open the cervix and push a baby out.
Have you had anything to eat today? OMG you must be in agony if the smooth muscle in your stomach is contracting. Did you send for an ambulance and get rushed to hospital for an epidural? No. Why not? From what people have told me, when smooth muscle contracts it produces pain. If this is correct then every time you eat you must be in pain.
Smooth muscle is not designed to cause pain when it contracts under normal conditions. Simple. Then why does uterine smooth muscle seem to cause so much pain when it starts to contract with most labours?
See my next post for the answers.

After Earth, a brilliant analogy.

Went to see the new film After Earth at the weekend and the analogy to painful labours was striking.

The film is about some aliens that make a creature that can only see humans when we are afraid, they can smell the pheromones that we secrete when a big scary monster is about to kill us. Really.

Pretend that the monsters are the doctors at your local maternity unit. When you arrive at the hospital in labour, if you are secreting adrenalin due to anxiety then they can smell your pheromones and will pounce.

• They will force you onto a bed so that your uterus is working against gravity and the contractions become stronger and so become painful.
• Once you are in pain they will offer you an epidural to ease the pain they have just caused. A needle will be stuck into you to introduce a drip in case the epidural drops your blood pressure and your baby is put at risk. Another needle is stuck into your back to introduce the catheter for the epidural drugs.
• Your urge to push may be compromised by the epidural so the monster, sorry doctor, will have to slice a section of your perineum with a pair of scissors to allow access to your baby via forceps or kiwi extraction. The baby is then pulled from you which may cause bruising of his head leading to an increased risk of jaundice.

OK, the monsters in the film were not as specific at their torture as the events described above but you can see the analogy, can't you?

The only way to avoid the above is to GHOST. That is to control your adrenalin output so that you do not secrete any of the tell tale pheromones that give away your fear. Easy peasy.

The only way to do this is to learn relaxation techniques outlined in this blog or available on the Kindle in the form of Pain Free Labour books. A relaxed person does not secrete adrenalin. Sorted.

After Earth only got 11% on Rotten Tomatoes, obviously they were not watching it from my slightly mad perspective.

Will Smith will always get a big intact tomato from me, he simply just gets better with age. Mmmmm.

Letter from Danielle; thank you for the pain free labour.

Hello Ann,
My name is Danielle Law, and I gave birth to a 7lb baby boy, Jake, last Friday.
I just wanted to write and thank you for reccomending your book, which I bought a week before I gave birth from Amazon for my Kindle. (no longer available)
Jake is my second child, I have a daughter, Holly, who is 4 in July. Her birth was long, traumatic, painful and left me terrified of going through childbirth again. It ended with me being too exhausted to push, an episiotomy and forceps.
When I fell pregnant with Jake I was so worried of how I would cope again.
I bought your book and read it in a day, it was great to read advice from someone with so much experience, both personal and professional.
I started having contractions at 8am on 5/4/13. I was at home with my daughter all day, with the contractions gradually getting longer and closer together. I used the tecniques I had read in your book, stayed calm, breathing through each contraction. They were so managable that I got all my cleaning done, and kept my daughter entertained all day, and without my daughter knowing that anything was wrong. At 7pm my contractions were 5 mins apart, so called my parents to come and look after my daughter. I tucked my daughter into bed and phoned the labour ward.
On the phone to a midwife at the labour ward, I was told that I had two options:- To wait at home a little longer until I was sure the contractions were 5 mins apart, or to come in and they could monitor me and the baby..I'm pretty sure that the midwife didn't believe I was really in labour or as far as I was because I wasn't screaming down the phone when she was asking me questions. I told the midwife I would like to come in now please!!
I got off the phone and my waters popped, in front of my horrified dad! We got everything together and set off for the hospital. We arrived at 7.40pm. This is when my contractions finally got painful, and I made my way (loudly) to the labour ward, got through the door, told them I needed to push..helped quickly onto a bed and Jake made his very quick entrance into the world, born at 8.20pm.
The whole labour was amazing, so easy to cope, not scary and stressful like my first. We only stayed in hospital for 5 hours, then we were home with our beautiful baby.
I just wanted to say a huge thank you to you for your book, which I have reccomended to all my pregnant friends! Without reading your book there is no way I would have been able to remain so calm. I was very sceptical at first that it was possible but i truly had a pain free labour! It was so amazing to experience a nice labour, something I never thought was possible.

Thank you again, I hope more women manage to have an easy labour like me.

Danielle Law x

Do you belive in a Pain Free Labour?

The study of belief systems is a fascinating one. Some people will believe just about anything. Modern society today believes that labour contractions will cause pain. Why? Who does this belief system benefit? Certainly not the women in labour.
The British philosopher Jonathan Glover compares belief systems to floating boats. It is almost impossible to change them all in one go, as it would be to alter the boat significantly all at once. It has to be done slowly so as not to disrupt the stability of the boat which could cause it to sink.
Our society has known about pain free labours since the 1940s when my hero, Dr Grantley Dick-Read, first published his book Childbirth Without Fear. The hypnobirthers, who have based their teachings on Dick-Read's book, have been preaching against painful labours ever since. Yet we still will not believe. 
Religion is a belief system that is based solely on faith. There is no proof that any so called Gods exist and yet millions of people continue to believe. This is because people want to believe, they want a sense of belonging and a hope that there will be something better when our time here is done. If you believe in a Christian God then you must also believe in Allah and Zeus as there is no more evidence that one exists at the exclusion of the other. We take our comfort where we can.
The bible has been altered and translated over many years. It is unlikely that it bears any resemblance to the original script. And yet we choose to believe. If in a thousand years from now the only books left in existence are the Twilight books then people will believe in vampires, they will be watching out for the 'sparkly ones'. To be honest, I know some people in Manchester who believe firmly in 'sparkly ones' and will be seen as disciples in that distant future. You know who you are.
If women today suddenly started to believe that labour contractions were not designed to cause the sensation of pain during a normal labour then chaos would ensue. The boat would start to sink. Health services would not be prepared for women demanding a pool birth to aid their relaxation. Did you know that Oxford, England has only two birthing pools to offer where as Cambridge England has eleven. Just shows where the really clever people are.
A harmful belief that is not backed by science or logic is really not worth holding onto. If painful labours were scrutinised carefully then it would be found that uterine smooth muscle is perfectly capable of contracting without causing pain. I could not find any research into the workings of smooth muscle that proved it was designed to cause pain whilst contracting. And yet we believe. 
The only people who benefit from keeping labour painful are men. It is the last vestige of control that they have over us. It would take a really good philosopher to understand all the myriad of reasons as to why we have not yet broken free of this often crippling belief.
All it takes is to believe. The truth.

Avoiding PPH?

Just read a very interesting article in Midwifery Matters magazine, the Manchester issue (Winter 2012) Issue 135 P. 21. It is an article on A Novel Way to Prevent Postpartum Haemorrhage? Judy Slome Cohain, the author, puts forward a natural method of delivering the placenta without drugs and without excessive blood loss. Sounds good.
Study days attended have taught me that the 3rd stage (expulsion of the placenta) can be done in two ways:

• Active management where an intramuscular injection of Syntometrine (if you are normotensive) or Syntocinon (if you have high blood pressure) is given into your thigh muscle immediately after the birth. The cord is clamped and cut. The injection causes the uterus to contract strongly and push the placenta away from the uterine wall. After noting signs of detachment, the midwife will then pull the placenta out by pulling on the cord. This usually takes about 10-15 minutes.
• Physiological management where no drugs are given. The cord is left to pulsate and so give baby extra blood needed to perfuse the newly working lungs. Mum, dad and baby are settled onto a bed or other comfortable place and the midwife awaits mum feeling an urge to push the placenta out while watching for excessive blood loss. This can take up to an hour.

Judy's 3 4 5 Protocol, goes back in time to when women did not bleed excessively after giving birth. Judy explores the history of post partum haemorrhage (PPH) and how women in the past avoided it.

• (3) Skin to skin contact is initiated immediately after the birth. The cord is left to pulsate and is not cut before 3 minutes after the birth. The midwife does not touch the cord or the uterus. After 3 minutes the cord can be clamped and cut and the baby kept with mum or given to dad.
• (4) The new mum is asked to do "a good deep squat with her bottom almost touching the floor". This is over a low bowl or other implement to catch any blood loss or the placenta. Mum is then asked to push even if she does not feel a contraction or urge to push. 
• (5) If the placenta has not been expelled by 5 minutes then the midwife is allowed to gently pull on the cord to lengthen it out of the vagina and reassure mum that the placenta is low and to keep pushing.

Mum stays in a low squat while she continues to push. When the placenta has been expelled, mum is made comfortable and given a maternity pad to wear and baby is returned to initiate breast feeding. It is advised to massage the uterus through the abdominal wall to expell any clots, if the pad becomes soaked during the next 5 minutes then an injection of an oxytocic is to be considered. If a woman has a history of PPH then an oxytocic can be offered after the placenta has delivered whether she is having a PPH or not. (Why not just give the injection in the first place anyway and avoid the risk of another PPH right from the start of the 3rd stage if you are going to give it anyway?)

A retained placenta is diagnosed if mum has been pushing for 25 minutes and medical assistance is advised. This method of delivering the placenta is said to avoid a placenta being trapped by the cervix closing after the birth as it should be out after 5 minutes. The baby's lungs are well perfused by the extra blood from not cutting the cord till 3 minutes have elapsed and mum keeps most of her blood by expelling the placenta quickly.

Judy is asking for maternity units to participate in a multicentre study of her protocol and can be reached at judyslome@hotmail.com