Pain Free Labour for International Women's Day

Everything you really need to know about labour without really trying.
Happy International Women's' day.

Remember that pain is the body's way of warning us that something is wrong. No healthy tissue within the human body is designed to cause the sensation of pain when working under normal healthy conditions. Most labours are normal and healthy so there is no reason, other than fear, that they should become painful. Dr. Grantly Dick-Read (my hero) commented in his book, Childbirth Without Fear:

“There is no physiological function in the body that gives rise to pain in the normal course of health.”

Any relaxation technique when practised regularly brings your body and mind into balance which increases energy and concentration levels. Energy levels are not being wasted, having to deal with unnecessary panic attacks throughout the day. When relaxed we have an increase in serotonin levels which make us feel well and happy, without the need to get drunk. When stress hormones are being released throughout the day they have a long term negative effect on us, we become tired and listless. Remember that in labour you can easily reach a state of utter exhaustion, if adrenalin is secreted for long periods of time. Sometimes it is not a case of being too posh to push, more a case of being much too drained.

Remember, it is vital to find a relaxation technique that appeals to your lifestyle and preferences. When you find the one that best suits you personally it can be used throughout the pregnancy so when labour begins you will not instantly go into panic mode. If you do then you can pull yourself back and start to take control by practising relaxing in a way that suits you best. Having calm people around you helps a lot. Make sure your birth partners are aware of your birth plans and are strong enough people to make it happen.

Remember to stay upright. It is very tempting to go and lie down on the nice comfy bed when you are feeling tired, but you must resist. The most dominant piece of equipment in a labour room is often the bed. When showing women into a labour room I always asked them to sit on one of the padded chairs. If I did not then they would make straight for the bed. Labour is not an illness. You don't have to lie down to labour or to give birth. In fact, lying down will make your labour painful and last a lot longer. Gravity is your friend during labour. Use her well.

Please try to stop smoking in pregnancy. I know it is hard cos I did it three times. After my third son was born I decided not to start again. When you become a mother, it is incredible just how strong a person you can be. Having a tiny baby reliant on you for everything is a life changing event. I stopped smoking because I wanted to tell my children that taking known harmful substances voluntarily into your body was not a good thing to do. Remember that there is help out there to give you the support you need to quit. Ask your GP or community midwife for advice.

Remember to ask your midwife for a blood test at around 28 weeks gestation to estimate your iron levels. A pain free labour is reliant on getting lots of oxygen to your contracting uterus. Having good iron rich blood will ensure that your uterus is not being deprived of oxygen in labour. The easiest way to take in extra iron in your diet is to eat extra fruit and vegetables in pregnancy. Anything dark has good iron in it like kiwi fruit and broccoli. These naturally also contain vitamin C, so the iron in them is automatically readily absorbed. Do not drink tea and coffee with meals as they will stop you absorbing any iron present there.

Drinking coffee in early pregnancy has been linked to an increase in spontaneous abortions. Why take the risk? Coffee is a stimulant as it contains caffeine and can become addictive. How many people do you know who simply cannot function in the morning till they have had a fix of caffeine? They are not very relaxed people. By not drinking coffee in your pregnancy you can become even better at the relaxation techniques. Remember what adrenalin, secreted after drinking caffeine drinks, does to your cervix in labour. It makes it very difficult to open. The contractions have to become stronger and stronger and eventually cause pain.

Remember not to slouch on the couch. Sitting with your back rounded for long periods of time in pregnancy will encourage your baby to adopt an OP position. Try and support your back with some cushions before spending down time on the couch. If baby does settle into an OP position then try some of the postures outlined in this book. Whilst walking try and keep your shoulders back and your head high. You will not only look good but the natural curve in your spine will discourage baby from snuggling into an OP position. In labour, contractions have to become stronger as the baby's head does not fit well in the pelvis when his back is toward your back.

Remember that most hospital staff firmly believe in painful labours and will call your contractions PAINS! You can ask them to stop. One young lady I booked for her second baby was telling me how she had got on with her first. I had previously taught her how to approach labour and she had been having pain free contractions at home. When the contractions were every 3 minutes and lasting 50 seconds she informed the hospital that she was on her way. On arrival the midwife noted her calm demeanour and apparent lack of pain and sent her home without examining her cervix or feeling her contractions. Once home she gave birth on the bathroom floor with her mum in attendance. Your midwife may not think that you are in labour if you are calm and pain free, ask for a vaginal examination before she decides to send you home.

I have lived with the knowledge that a pain free first stage of labour is achievable, for the majority of women, for more than three decades. I have tried spreading the word by telling friends and family, they were not very interested. I have become a midwife in order to teach women how to approach labour, they are too few. I have written articles for midwives magazines, they did not believe. If I had not experienced two pain free labours for myself, then maybe I would also find it difficult to believe. I am asking you to take a huge leap of faith; to try the coping strategies outlined in this book. I was so happy after my first pain free labour, I just wanted to sing and dance and spread the word. Please remember to TAKE BACK CONTROL. All it takes is to believe. The truth.

Please let me know if you use a relaxation technique (I used Progressive Muscle Relaxation for my pain free labours and there is a post in this blog to explain how to use this method) to have a more comfortable labour. We need to spread the word so that we can take back control from the medics with regards to labour. Thank you. Good luck. xxx

Belief of painfull labours (Tokophobia)

When a thing has been done a certain way for a long time, resisting change can be a reflexive instinct, and the powerful interests of the status quo are hard to move resulting in a pandemic of tokophobia.

Hi Ann,

That's so interesting that in England nurse-midwives are called obstetric nurses. I tend to agree. The dynamics in the US are pretty strange surrounding women's rights in birth. However, homebirth is not illegal in any state, but there are a few states (not the majority by far), that prohibit home births to be attended by midwives. That is a terrible law for states to have because it leaves women vulnerable to having an unassisted birth when they would've chosen otherwise or to birth in the hospital.

If I had my way I would've become a direct entry midwife (non-nurse midwife), but the career opportunities are not as stable as if I became a nurse-midwife. CNMs are legal in every state, as opposed to CPMs.

I love your blog. I will keep it as a resource. You're so right that the importance of caring for a woman so she can remain calm and relaxed is the key to keeping her labor pain free. That's also one of the main reasons why hypnobabies works. When mom is completely relaxed she no longer interprets her birthing sensations as painful. I hope that when it is my turn to be a midwife that I will live up to all I've ever wished a midwife to be for moms and babies, so that their birth will be a wholly positive experience for everyone involved.

Thanks so much for reaching out. Be well.



From RCM, research by jean greer in Ireland re the fear of childbirth.
‘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. 

‘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.

 

British Baby Box?

Why Finnish babies sleep in cardboard boxes

 

For 75 years, Finland's expectant mothers have been given a box by the state. It's like a starter kit of clothes, sheets and toys that can even be used as a bed. And some say it helped Finland achieve one of the world's lowest infant mortality rates.

It's a tradition that dates back to the 1930s and it's designed to give all children in Finland, no matter what background they're from, an equal start in life.
The maternity package - a gift from the government - is available to all expectant mothers.
It contains bodysuits, a sleeping bag, outdoor gear, bathing products for the baby, as well as nappies, bedding and a small mattress.
With the mattress in the bottom, the box becomes a baby's first bed. Many children, from all social backgrounds, have their first naps within the safety of the box's four cardboard walls.

Mothers have a choice between taking the box, or a cash grant, currently set at 140 euros, but 95% opt for the box as it's worth much more.
The tradition dates back to 1938. To begin with, the scheme was only available to families on low incomes, but that changed in 1949.
"Not only was it offered to all mothers-to-be but new legislation meant in order to get the grant, or maternity box, they had to visit a doctor or municipal pre-natal clinic before their fourth month of pregnancy," says Heidi Liesivesi, who works at Kela - the Social Insurance Institution of Finland.
So the box provided mothers with what they needed to look after their baby, but it also helped steer pregnant women into the arms of the doctors and nurses of Finland's nascent welfare state.
In the 1930s Finland was a poor country and infant mortality was high - 65 out of 1,000 babies died. But the figures improved rapidly in the decades that followed.
Mika Gissler, a professor at the National Institute for Health and Welfare in Helsinki, gives several reasons for this - the maternity box and pre-natal care for all women in the 1940s, followed in the 60s by a national health insurance system and the central hospital network.

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Contents of the box

• Mattress, mattress cover, undersheet, duvet cover, blanket, sleeping bag/quilt
• Box itself doubles as a crib
• Snowsuit, hat, insluated mittens and booties
• Light hooded suit and knitted overalls
• Socks and mittens, knitted hat and balaclava
• Bodysuits, romper suits and leggings in unisex colours and patterns
• Hooded bath towel, nail scissors, hairbrush, toothbrush, bath thermometer, nappy cream, washcloth
• Cloth nappy set and muslin squares
• Picture book and teething toy
• Bra pads, condoms

Dressing baby for the weather: Finland's official childcare advice

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At 75 years old, the box is now an established part of the Finnish rite of passage towards motherhood, uniting generations of women.

Box anticipation

By Mark BosworthFinland

My partner Milla and I were living in London when we had our first child, Jasper, so we weren't eligible for a free box. But Milla's parents didn't want us to miss out, so they bought one and put it in the post.
We couldn't wait to get the lid off. There were all the clothes you would expect, with the addition of a snowsuit for Finland's icy winters. And then the box itself. I had never considered putting my baby to sleep in a cardboard box, but if it's good enough for the majority of Finns, then why not? Jasper slept in it - as you might expect - like a baby.
We now live in Helsinki and have just had our second child, Annika. She did get a free box from the Finnish state. This felt to me like evidence that someone cared, someone wanted our baby to have a good start in life. And now when I visit friends with young children it's nice to see we share some common things. It strengthens that feeling that we are all in this together.

Reija Klemetti, a 49-year-old from Helsinki, remembers going to the post office to collect a box for one of her six children.
"It was lovely and exciting to get it and somehow the first promise to the baby," she says. "My mum, friends and relatives were all eager to see what kind of things were inside and what colours they'd chosen for that year."
Her mother-in-law, aged 78, relied heavily on the box when she had the first of her four children in the 60s. At that point she had little idea what she would need, but it was all provided.
More recently, Klemetti's daughter Solja, aged 23, shared the sense of excitement that her mother had once experienced, when she took possession of the "first substantial thing" prior to the baby itself. She now has two young children.
"It's easy to know what year babies were born in, because the clothing in the box changes a little every year. It's nice to compare and think, 'Ah that kid was born in the same year as mine'," says Titta Vayrynen, a 35-year-old mother with two young boys.
For some families, the contents of the box would be unaffordable if they were not free of charge, though for Vayrynen, it was more a question of saving time than money.
She was working long hours when pregnant with her first child, and was glad to be spared the effort of comparing prices and going out shopping.
"There was a recent report saying that Finnish mums are the happiest in the world, and the box was one thing that came to my mind. We are very well taken care of, even now when some public services have been cut down a little," she says.
When she had her second boy, Ilmari, Vayrynen opted for the cash grant instead of the box and just re-used the clothes worn by her first, Aarni.
A boy can pass on clothes to a girl too, and vice versa, because the colours are deliberately gender-neutral.
The contents of the box have changed a good deal over the years, reflecting changing times.

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The story of the maternity pack

• 1938: Finnish Maternity Grants Act introduced - two-thirds of women giving birth that year eligible for cash grant, maternity pack or mixture of the two
• Pack could be used as a cot as poorest homes didn't always have a clean place for baby to sleep
• 1940s: Despite wartime shortages, scheme continued as many Finns lost homes in bombings and evacuations
• 1942-6: Paper replaced fabric for items such as swaddling wraps and mother's bedsheet
• 1949: Income testing removed, pack offered to all mothers in Finland - if they had prenatal health checks (1953 pack pictured above)
• 1957: Fabrics and sewing materials completely replaced with ready-made garments
• 1969: Disposable nappies added to the pack
• 1970s: With more women in work, easy-to-wash stretch cotton and colourful patterns replace white non-stretch garments
• 2006: Cloth nappies reintroduced, bottle left out to encourage breastfeeding

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 www.britishbabybox.com

Authentic parenting

Thursday, October 10, 2013

Pain Free Labour

Posted by Laura Schuerwegen

Written by Ann Bentley, Pain Free Labour

Hi, I am a midwife from Manchester England who is pashionate about giving women the best chance
possible for a lovely labour. I have experienced myself 4 labours, 2 very painful and 2 pain free. Society teaches women that labour will be painful, when they start to labour they become naturally anxious. It is this anxiety and the hormones secreted that cause changes in the body that lead to contraction pain.

The international best-seller Dean Koontz captured the essence of why we accept painful labours so easily when he wrote:

“Fear is the engine that drives the human animal. Humanity sees the world as a place of uncountable threats, and so the world becomes what humanity imagines it to be.”

In our dark dank past women were exploited. No surprise there then. They were not even allowed an education so that they could say “Hey, stop exploiting me you patriarchal society you”. We have had to fight tooth and nail for our relative freedom. The only battle that has yet to be won in the civilised world is childbirth.

Fear of childbirth has been instilled in us for hundreds of years. Doctors have made money out of us by keeping us in fear so that their services are needed to provide a medical model of care to help us birth. Early midwives were burned as witches so that women would turn to the medics in their time of need.

Modern health care follows blindly the believe in painful labours as the norm. There has been no research that I know of to support this belief. Within the UK we pride ourselves on offering evidence based practice and yet there is no evidence that uterine smooth muscle is designed to cause the sensation of pain when contracting normally. Yet we continue to believe. “The world becomes what humanity imagines it to be.”

Perhaps women want painful labours. Perhaps fear is the engine that drives the human animal. Perhaps we only feel comfortable when something we believe in comes true. Any other outcome would be too hard to accept, too big a paradigm shift for us to relate to.

Well tough. Get with the plan. Pain Free Labour has begun to seep into our belief system concerning childbirth. Midwifery led birthing centers are springing up all over the UK. Women are having pain free labours during the first stage when taught how to approach labour. Relaxation techniques are being learnt in parentcraft sessions to keep women from entering the stress/pain cycle often seen in labour.

We are being allowed to learn the truth about labour now in the UK only because the strain on the NHS from medicalised care has become too much. A calm pain free labouring woman in a pool is cheap compared to a theatre full of expensive equipment and staff. The caesarian section rate has reached an all time high. We have lost faith in our innate ability to labour naturally.

If I had not experienced this phenomena of pain free labour personally then I may well have been one of the supporters of offering elective caesarian sections for maternal choice. As a midwife I have helped countless women to have a pain free labour. As an author, I have explained in detail why uterine smooth muscle was never designed to cause the sensation of pain during a normal contraction.

So, who will join me in supporting the massive shift that we need in our belief system that will enable women to labour as nature intended; with medical support on stand by if needed? Who will be brave enough to swim against the tide and face the wrath of humanity when one of their “uncountable threats” is removed leaving them uncertain and afraid? Who will take a leap of faith in order to free women from the last of societies manacles holding us down? Who, maybe you?

Ann and Mark after a pain-free labour

About the author

Midwife from Manchester trying to change the way women approach labour today. My first labour was so horrid that I set out to find a better way to labour before I had my second. My second was wonderful and the first stage was pain free. A midwife from hell made my third very painful as I was not allowed to sit up to labour. My fourth was a home birth and once again pain free. If I can do it then anyone can. Simply follow the advice in my blog and you too can discover the secret that the medics have kept from us for the past three hundred years. The first stage of labour was never designed to cause the sensation of pain. 

Labour well. 

Ann Bentley.

Modern, affluent women are really too posh to push.

A publication in the Lancet (V. 392 I. 10155 P. 1341-1348) by T. Boerma PhD et al explored global trends in outcomes of how we choose to labour with disturbing results.

169 countries were looked at with an impressive total of 98.4% of the worlds births. They found that overall the percentage of caesarean births accounted for 21.1%. The numbers have therefore doubled since 2000 when the figure was 12.1%.

Have women become rubbish at labouring in the past 18 years or is a CS birth simply becoming the norm? The highest number of CS was found to be 5 times more common in affluent societies than in poorer regions. Private hospitals had a 1-6 higher CS rate than public ones. Definitely too posh to push.

In the Dominican Republic  the CS rate was 58.1%! Closely followed by Latin America and the Caribbean at 44.3%. Areas of the world not to visit as your due date approaches!

Medicalisation of birth is of growing concern worldwide. Let us not forget that a CS is major abdominal surgery which can lead to morbidity and mortality for the mothers. It reduces your options for future births as once done your uterus has a scar on it that can rupture during following pregnancies. It is thought that babies born by CS do not have the advantage of being colonised as quickly by much needed good bacteria found in vaginal secretions. Breast feeding baby can become a challenge when mum has a much more painful recovery from the birth and is not as mobile. Not giving babies human milk for the first 6 months of life greatly impacts on their future health and well being.

Once women discover that labour need not be the negative experience that society teaches us that it will be then perhaps they will begin to take charge of their labour and not put themselves at the mercy of medicalised care. Information on having a more comfortable labour is abundant in this blog.

It would appear that women have lost faith in themselves when it comes to labour and birth. The only way we can change these perceptions is to teach women how labour really works. How to optimise their chance of a normal birth to secure the best outcome for both mother and baby. X

Labour drugs negatively affecting neonatal behaviour.

Research was conducted by Kajsa Brimdyr PhD et al into The association between common labour drugs and suckling when in skin to skin during the first hour after birth.

The findings are not very surprising. Women today are subjected to constant unnecessary medicalised treatments during pregnancy and birth that cannot help but have negative outcomes for both mother and baby. Society often forgets that pregnancy and birth are normal physiological events and not illnesses to be treated by doctors

Drugs used in labour such as Fentanyl (epidural) and Oxytocin (induction of labour with a drip) were previously studied with conflicting results. Brimdyr set out to define how these drugs impact on neonatal behaviour after birth.

The results found a strong inverse correlation between the amount of drugs given during labour compared to Widstrom's  9 stages of newborn behaviour. Especially focusing on no. 8 which is suckling during the first hour after a vaginal birth.

There was an increase in babies not being able to suckle effectively at birth while in skin to skin. Putting a newborn in skin to skin at birth regulates their heartrate, breathing, temperature and normally stimulates them to find food. This was not the case after prolonged amounts of Fentanul and oxytocin were being used in labour. Fentanyl use was found to lower neurobehavioral scores after birth and breastfeeding rates were much lower at 6 weeks post partum.

This outcome is very sad. There are simply too many women suffering from being given these drugs in labour. Babies are the ultimate victims as they are being denied the best start in life by being unable to suckle at the breast.

Research constantly shows that giving babies human milk instead of cow milk increases their intelligence and immune system. Human fed children are much less likely to have eczema, asthma and obesity. Cow fed babies on the other hand do not get these benefits. We are breeding generations of Cow people due to how we treat women during their labour.

Widstom's 9 Instinctive Stages of Neonatal Behaviour During Skin to Skin after Birth.

1. Birth cry - expanding lungs. (this is not necessary as a calm baby after a calm birth simply starts breathing and does not need to cry)
2. Relaxation - baby becomes still. (this behaviour is often noted after pool births when a baby will calmly look around taking in their new surroundings)
3. Awakening - baby starts to move limbs.
4. Activity - baby uses larger movements, head is lifted, eyes remain open.
5. Resting - baby rests between bouts of activity.
6. Crawling - toward the nipple using limbs and head bobbing.
7. Familiarization - nipple found baby licks, tastes and touches area around nipple. (this makes the nipple more erect so baby can find it easier)
8. Suckling - baby self attaches to the nipple and starts sucking.
9. Sleeping - an involuntary action lasting 1 and a half to 2 hours after birth.

Posts in this blog aim to teach women how to approach labour so that their chances of having a medicalised birth is reduced. Read the post on avoiding induction of labour and posts on using relaxation in labour to avoid use of pain relief. See post on not lying down in labour even if you are on a CTG machine to monitor fetal heartrate. Get off the bed and sit on a chair! Good luck. x

Allergies and breast milk.

Remember in the post:-

Breast Feeding - giving baby more than you thought.

       I reported that research had found oligosacharides in breast milk that were only there to feed certain bacteria in the baby's guts, in exchange they  produced compounds that sealed the stomach so that bacteria couldn't get through infecting baby with gastroenteritis, and developed the brain so that your child could become the person they were always meant to be.

New research has now found that the milk of mothers who eat known allergy foods (nuts, eggs, wheat, shellfish) in pregnancy and while breastfeeding protect their babies from those very allergies. This is of course as long as the mother does not already have an allergy to these foods herself!

Not so long ago women were advised not to eat peanuts in pregnancy in case this is what was causing the rise in children with dangerous nut allergies. This turns out to be the wrong advice and children could have been protected if mothers had eaten nuts in the pregnancy and then continued whilst breastfeeding.

It was found that the immunity from allergies was not fully passed on if the mother did not breastfeed. But when a baby is breastfed, immunity is given. When a nursing mother is exposed to a food protein, her milk contains complexes of the food protein combined with her antibodies, which are transferred to the baby through breastfeeding. Aided by a protein in the baby's gut lining and some immune cells, the food protein-antibody complexes are taken up and introduced to the baby's developing immune system triggering the production of protective cells that suppress allergic reactions to the food. This protection persists after the baby is weaned from breast milk on to a more varied diet at six months.

Now that we understand a little better just how good human milk is for our babies we should be shouting it from the rooftops. Imagine if you, and only you, could not only make your baby's brain develop so that they have a higher IQ, protect them from stomach bugs in their vulnerable early months, but also ensure that they do not develop allergies that could endanger their very lives. WOW. Such power.

And yet UK breastfeeding rates are the lowest in Europe. I often wonder why.