Better Births?

It is very difficult to break away from the TV image of women lying down on beds to labour and give birth. Society has done a great injustice to women where birth is concerned by allowing programmes like One Born Every Minute where women's faith in themselves to birth their young is eroded week after week.

Research has shown us (Lawrence et al 2009) that women who remain mobile and adopt positions that they are comfortable with during labour have less analgesia and labour much quicker. The mobile elements found on most CTG machines today are not just there as a fancy add on, they are there to be used to help keep women in charge of their labour by staying off the bed. Hand on heart, how many midwives reading this can say they have ever used the mobile CTG attachments or have strived to keep women off the bed while obtaining a necessary CTG trace in labour?

If we are truly going to obtain better births for our women then we have to start with the basics, often lost when working within a busy hospital obstetric unit. Normality is often the last thought on our minds as we strive to follow all the guidelines and protocols available to 'keep women safe'. Once a woman is in labour from IOL then we have the power to stop any further interventions that may cascade her into an operative birth.

The USA have obstetric nurses in their obstetric units and they seem to be nothing like midwives. The internet is full of unhappy women who feel they have been violated by hospital care received in labour. Obstetric rape is often the cry from these women who are desperately trying to reclaim the lost art of birthing within the doctor led services available in America today. This is one model of care that we must strive to stay well away from by supporting midwives to look at their practice and reflect. Am I being truly 'with woman'?

Student midwives are our future and yet the number of students who pick up the very bad habit of calling contractions 'pains' to women really drives me crazy. I once mentored a student, well into her second year, and she had never laboured or birthed a woman off the bed. This was all she had ever seen and she was quickly becoming an obstetric nurse without her even knowing that there was a choice.

Women need knowledge. We can give them this knowledge during parent craft classes that teach them how to labour as nature intended. Relaxed and confident, giving them the choice of mobilising or simply sitting on a comfy chair or birth ball. When was the last time you even saw a birth plan, have women simply given up writing them as they learn to expect the carnage they see on TV?

Better birth is an achievable choice for most women going into labour today with the right support from their midwife. We need strong midwives, confident in the simplicity of normal birth, lets rise to the challenge and make a difference today.

Reference:

Lawrence AM, Lewis L, Hofmeyr J, Dowswell T, Styles C, (2009) Maternal Positions and Mobility During the First Stage of Labour. Published online 2009. Available on the internet from: The Cochrane Collaboration and Wiley Online Library.

Was it in the 1950s when birth went wrong?

Just read an article posted by Orgasmic Birth and was interested in their telling of the history of childbirth and when it all went wrong.

"In the 1950s, with the new dynamic of birth being behind closed doors- women were alone, drugs and twilight sleep were given, and as a result the knowledge of how to work with our bodies in birth was lost and fear grew. I can’t even imagine what it was like for the many women who found themselves alone, in a hospital gown, put down with a wheel chair and tied to bed (yes they were tied with lambs wool). How different this was from being in your own home, in your own clothes and familiar textiles and fabrics, surrounded by those who love you. While we have had benefits of hospital birth, there is much to ponder and question of what we have lost and what we can birth forward in new ways."

They have taken birth away from women, but we can get it back. Education is the key. Real education, not gained from watching One Born Every Frelling Minute!

See my posts Why Labour Hurts (5 posts) and Hazards to a Pain Free Labour.(6 posts)

The doctors can care for high risk women such as diabetics and eclamptics. Leave the low risk women to find a better way to labour. Birth centers in England are amazing but you may still find a midwife there who calls contractions "pains". Just follow the advice for learning a relaxation technique (post-Progressive Muscle Relaxation) in pregnancy and stay sat upright on a ball or chair or couch, mobilising when you need to. Stay at home for as long as possible, scoffing lots of carbs before going to hospital, you will know when the time is right, listen to your inner voice. Better still have a home birth then the midwife will come to you.

We need to listen to our bodies and trust. WE ARE WOMEN AND WE ARE POWERFUL AND WE LOVE IT!

Pain Free Labour books now available from Amazon, cheap as chips to download.

Picturing a Pain Free Labour.

Adapted from Susan Jeffers and taught at my parentcraft classes, I thought you would like it...

Visualizations

Make yourself comfortable in your chair, back straight, feet on the floor, hands comfortable on your lap. You have nothing to do but listen to my instructions and let whatever comes up for you come up. There is no right or wrong way to do a visualization. Just accept whatever comes to mind.

Now close your eyes … and keep them closed throughout the visualization. Take a deep breath … inhale all the loving energy in the universe … and exhale all your loving energy back into the universe. Once more … in … and out … And once more … in … and … out. Feel how good it feels to begin to totally relax. Begin at the bottom of your feet and work your way up to your head … relax. Let go of the muscles in your feet … feel your legs becoming heavy and relaxed … your abdomen is relaxing … your chest feels heavy, every breath feels so light and tension free … arms and hands are feeling relaxed … your shoulders suddenly give up their tension and they are feeling so heavy and soft … your neck feels relaxed … just let go of any tension in the little muscles around your eyes and then your mouth … all tention free and nice and relaxed. You have never felt so relaxed. Every breath you take eases more tention out of your body.

Just totally let go … checking out any part of your body that may still be holding tension … and release it.

Now I want you to think of a goal that you have in life … a specific goal … and you know that FEAR is keeping you from moving forward toward that goal.

Now what I'd like you to do is to imagine yourself approaching that goal “as if” you had no fear.

I want you to see yourself approaching that goal with a sense of power and confidence in yourself … confidence that it will all be all right.

What would you be doing in your visualization … if you had no fear?

See yourself … What would you be doing next … if you had no fear?

Within the visualization look at the people around you. How are you relating to them … with no fear?

How are they relating to you?

Just enjoy this sense of power and notice your ability to love … and contribute.

And know that this is a feeling always within you … always a part of you if you choose to use it.

And it is within your capability to move forward in life with that power and with that confidence.

See yourself … achieving your goal … with your power … with your confidence … with your love … and with your contribution. Imagine how good it would feel to approach your goal with utter confidence in your ability to be a success. Nothing could stop you.

And slowly … start to bring yourself back to this room … knowing that the power is available to you … as soon as you begin to act … the power you need will come forward.

Feel yourself in your chair … be present in this room … listen to the sounds around you … and when you are ready, open your eyes … no need to rush. When you are ready, open your eyes.

Stretch and just feel the deliciousness of your power. It's all there for the taking. 

Then I would ask my parents, when using this visualisation method, to imagine they are in labour. What if they approach labour with confidence and strength, imagine going into labour and feeling perfectly safe. What if you sat at home on your couch in labour, feeling the contractions and they are causing you no pain. Wonder and joy course through you and you know you can do this. Know it is within your power. What if? 

Hazards To A Pain Free Labour/Labor - 7

Reflecting on recent experiences I would like to add a hazard to the list that may interfere with your pain free first stage of labour.
A precipitate labour is a very quick labour and usually causes contraction pain. These labours are usually the result of a woman's body deciding that it really must get this baby out NOW as there is a risk factor that could damage the baby, this is usually high blood pressure.
The contractions come much closer together than a normal labour and are quite intense and strong. This means that the uterine smooth muscle will not be able to get enough oxygen from the blood and so produce lactic acid leading to a message being sent to the brain to experience PAIN.
Women with very high blood pressure can have precipitate labours and I have noticed that women who have small for dates babies often labour very quickly as the placenta is failing.
A big help with these fast labours is entonox (gas and air). This is because it contains 50% oxygen which is 30% more than the air that we breath normally and so can help pay back the oxygen debt that is causing the contraction pain. Getting in a warm pool is also desirable but if you have risk factors then the hospital will want you to be monitored on a CTG machine.
Essential for a more comfortable labour is staying upright on a birth ball or chair or mobilising. Do not let them make you lie down on a bed in labour in order to monitor your baby's heart beat. This can easily be done in any of the positions mentioned which means the contractions will not get any stronger. In a lying down position the uterus is pushing baby uphill, very hard. In an upright position the uterus is pushing baby downhill, easy.
Never forget that whatever kind of health care you choose for your birth, you are the boss and hospital staff are there to offer you care that suits your needs. You are not there for their convenience. Never be afraid to ask for what you need to keep you more comfortable in labour.

Fear of Childbirth, latest research.

 Seen on the Royal College of Midwives web page.

 ‘Fear of childbirth’ and ways of coping for pregnant women and their partners during the birthing process: a salutogenic analysis

05/09/2014 - 14:15

To explore ‘fear of childbirth’ and its impact on birth choices among women and their partners in Northern Ireland.

Jean Greer BSc, RM. Anne Lazenbatt PhD, MSc, BSc. Laura Dunne PhD, BA.


‘Tokophobia’ is defined as morbid fear of childbirth (Bhatia and Jhanjee, 2012), and this diagnosis has recently been endorsed within the UK as an indication for planned CS (NICE, 2011). This decision seems contrary to current trends within maternity services that focus on promoting normality in birth (Gould, 2012). However, there have been concerns for some time among midwives that the conceptualisation of fear of childbirth as a pathological process, situates the problem within the individual woman, and deflects attention from maternity care provision (Walsh, 2002).
All the women feared the pain of labour and were reassured by the availability of a 24-hour epidural service. Despite this, the majority of the women (65%) expressed hope that they could labour without an epidural, although they lacked confidence in their ability to cope and feared the pain would be too severe. Six of the primigravidas in this study (40%) had already been advised to have an epidural during labour by family or friends and all the men wanted their partner to have as much pain relief as possible during the birth: “She [her mother] said: ‘If you want my advice, you get an epidural as soon as you go into labour because you’ll never be able to cope.’ You see they all know me and know what I’m like” (W10, prim).
 Four participants (11%) identified midwife support as a resource to help them cope with birth. These were two multiparous women and partners. Recalling previous births,
they described how the midwife had reduced their fears: “...from what I could see, the midwife had everything under control and like it seemed ok... so I was pretty relaxed” (M3, third baby).
Normal birth was still very alluring for most of the women in this study. It has been reported previously that women idealise normal birth while also rejecting it as dangerous (Maier, 2010). Most women in this study (89%) aspired to a normal birth but more than half (68%) feared they would not be capable of achieving it safely without medical intervention. Gould (2012) contends that this is a consequence of the language of risk that is used when offering birthing choices to women. This perception of riskiness reduces the comprehensibility dimension for women, and increases their need for resources to help manage birth. 

See the post 'Progressive Muscle Relaxation'.

It is little wonder that women today have tokophobia as our society teaches them through the media, family, friends and health professionals that contractions WILL be painful while ignoring the simple fact that uterine smooth muscle was never designed to cause the sensation of pain during a normal first stage of labour.

It's BLOG ACTION DAY!

16/10/2014 is blog action day and OXFAM have asked bloggers around the world to take part. We are to post blogs on inequality. Inequality with regards to childbirth, don't get me started!

According to Oxfam 800 women die every day in childbirth. Just 5 of them are in high-income countries. The WHO have been saying for decades that educating local women to become midwives would put a serious dent in that awful number of losses. Making simple drugs available to these midwives like Syntometrine would help to reduce the numbers of PPH. Of course then they would need a fridge or portable cool box that I used to carry as a community midwife.

Also according to Oxfam there are 85 people who have as much wealth as half of the people on the planet combined. Who are these people? Gods? Unfortunately they did not give out names or addresses of the 85 so will have to do some more digging before I send out the begging letters.

Ironically, one of the richest nations of the world has very little in the way of equality when it comes to childbirth. The USA have a terrible record of forcing women into a medical model of care no matter what their risk factors are. They do not have midwifery led care and you have to see a doctor throughout your pregnancy and be delivered by a doctor as well. Doctors in the US seem to know nothing about normal labour and birth so how can women hope to birth normally? All they need to do is allow home births (banned in most states) and train midwives (not obstetric nurses) how to empower women to take charge of their birth and support them safely in their choices. Simple.

One young Indian lady that I booked told me that she wanted to lie down for her upcoming birth with an epidural in situ and have an episiotomy as a doctor removes her baby with forceps as this is what she went through in India at her first birth. I was speechless for a minute or two there. At the end of our hour long booking session she was so happy to be looking forward to birthing in a pool at the stunning birth center that I was working at then. Low risk women should not be given the medical model of care unless they have risk factors and even then they can labour normally with a bit of care and attention from midwives.

So, the answer to inequality within childbirth seems to be to train and pay more midwives to deliver midwifery led care for all women, whether they are rich or poor. Sorted.

HAPPY PARENTING

Basic human rights in childbirth.

The world is finally waking up to the very sad truth that many women have their human rights taken away during pregnancy and childbirth.

https://www.indiegogo.com/projects/human-rights-in-childbirth
http://birthanarchy.com/choke

Women around the globe are finally beginning to speak out against the treatment they received in labour that has stayed with them and haunted them ever since. My third labour was such a time that I was treated with cruelty and inhumanity whilst I was at my most vulnerable. My fourth was born at home and was my second pain free labour, bliss.

If more women learnt how to approach labour so that the first stage was pain free, then instead of worn out exhausted women facing their second stage, you would have strong women who would question interventions that were against their basic human rights.

Once society wakes up to the basic truth that uterine smooth muscle was never designed to cause the sensation of pain during a normal contraction then we can finally take back labour from the medical model of care. It is the way we approach labour, with anxiety leading to adrenalin production, that can cause all the problems and pain.