Evidence based practice to support a pain free labour - One.

Midwives today have improved the care offered to pregnant women by providing Evidence Based Practice. That is, only offering a plan of care that has been proved to be effective by research. The concept of evidence based practice was developed by Dr. Archie Cochrane in order to encourage all health care professionals to use evidence when making care decisions.
The Cochrane Library are a wealth of information when seeking research to guide our practice. They take the findings of similar research projects and amalgamate them to present an overall picture of what the researchers were hoping to discover. Their aim is to present independent high quality evidence for decision making within health care settings.
Lawrence et al (2009) examined 21 such studies which included the experiences of 3706 women. Their subject matter was Maternal Positions and Mobility During First Stage Labour.  Their findings after examining each piece of research by two independent health care specialist were:

• The first stage of labour was one hour shorter in the upright groups.
• There was less use of epidurals in the groups that remained mobile and upright.

They concluded that remaining upright and mobile during the first stage of labour was advantageous to women. They pointed out that lying down in labour should not be encouraged due to the weight of the pregnant uterus putting pressure on the abdominal blood vessels.

This blog supports staying upright during labour. This summer I visited Bonny Scotland and was amazed at how hilly it was. Walking up the hills was hard work, I would arrive at the top of a hill breathless with the muscles in my legs hurting. When women lie down in labour the uterus has to work against gravity and push the baby uphill, no wonder the uterine muscle starts to hurt, just like my legs did in Scotland. However, I had the choice of sitting down and getting my breath back at the top of the hill and so the hurt went away. Labouring women do not have this choice, of stopping the labour to relieve the hurt.

From the research available to guide my practice I can surmise that staying upright in labour will shorten the labour and make it more comfortable. I can therefore be confident that when I advise labouring women to have a little walk or adopt an upright position such as sat on a birthing ball or kneeling on a mat, my practice is evidence based.

Pain free labour for baby? Why not?

I have just read Birth Without Violence by Frederick Leboyer. It has made me think about the way we treat newborn babies within a hospitalised setting during and after they are born. Reading Leboyer is like reading a very long poem. It is very emotive and thought provoking and there are none of the usual references to back up the subject matter. The pictures within the book say it all and he has a lovely soft way about him as he takes you by the hand and guides you through birth from a newborn's perspective.
He comments on how cruel we are to new born babies comparing it to how women used to experience labour by saying:
"The same blindness that made us think women had to suffer simply because we didn't know any better. Happily we no longer believe in the old saying: 'In pain shall ye give birth'. Isn't it time to do for the child what we've been trying to do for the mother?"
What the frell? This book was first published in 1974. Here was another man telling us how to have a pain free labour, the first being my hero Grantly Dick-Read, and obviously being totally ignored, just like Dick- Read was in the 1940s.
What on earth is the matter with us. Why do we believe so blindly in the medical model of care that gives us such painful labours when we have known about pain free labours for years and years. What we need is a modern, easy to read book, that explains in detail why uterine smooth muscle was never designed to cause the sensation of pain when contracting normally. A book that tastefully mixes the funny side of labour, as seen by midwives, with advice on how to survive birth with a lovely big happy smile on your face at the end. There exists such a book, cos I wrote it, but the publishers have been contaminated by the belief system that has kept women from taking charge of their labours and passively following society's media driven model of childbirth. Ask Amy at   amy.carroll@carrollandbrown.co.uk   why she has got cold feet and is keeping women chained to the epidural trolley.
Two very eminent gentlemen in their field (one with a very sexy French accent) have told us for years that the majority of women going into labour today can achieve a pain free labour if they know the coping strategies outlined within posts in this blog. Why do we find it so difficult to believe when the advantages to ourselves and our babies are so enormous?
Don't make me chain myself to railings on a race track like the super suffragettes had to do in order to drag women out of being second class citizens during the 1800s. Cos I will. If you make me.

VBAC at Home?

Having read a post by Villagemidwife found on Twitter (yes, I do know how to tweet) I have been thinking about VBACs. That is, Vaginal Birth After Caesarian. Villagemidwife puts forward a very strong argument for allowing women wanting a VBAC to give birth at home. Within the medical contraints of hospital care offered in the UK a home birth would be strongly contraindicated and not encouraged.
If you think about it for a moment, a home birth seems the perfect place for a VBAC. In my experience, most caesarian sections are performed when a woman fails to make enough progress in labour and the baby is seen to be distressed by the long labour on the CTG monitor.

Going into hospital can be a stressful event, adrenalin will be secreted when a person in under physical or mental stress. In an earlier post I explained how adrenalin attaches itself to the uterine cervix and prevents it from opening normally. So, when stress is a factor within a labour, expected progress will not be made due to the actions of adrenalin. The contractions will have to become stronger in order to pull up on a resisting cervix. How will this help someone having a VBAC? It will make a uterine rupture much more likely.

At home however, a woman is much more likely to remain calm and in control. If she follows the advice on relaxation techniques outlined in earlier posts then she will not secrete adrenalin and the cervix will be free to dilate. The contractions will not have to become stronger as the cervix will not be resisting and so they will remain at normal contraction levels. The first stage of labour, if conducted under the methods taught in this blog, will be pain free.

When in hospital, a woman having a VBAC has to be continuously monitored to detect any early signs of uterine rupture. She will most likely be confined to a bed with only brief breaks to visit the loo. Staying upright during labour helps the uterus work with gravity so that the contractions do not have to become strong. Lying down on a CTG monitor will make the contractions become stronger and so cause pain. The fact that she is not mobile will also impact on descent of the rotating baby into the complicated anatomy of the birth canal.

At home, a woman is free to move around and relax as her body dictates. She can eat and drink anything she chooses according to her body's needs. She can remain upright and have the power of gravity helping her to labour instead of hindering. The contractions will remain normal as her environment and mental state will be in harmony with her labour, not putting obstacles in the path of normal progress.

Spot on Villagemidwife, you have put forward a brilliant argument for a VBAC at home. With the element of a pain free first stage of labour, a home birth can become a real option with all the benefits working toward encouraging normal progress. The only element that will prevent women from seeking out a pain free labour is FEAR. The fear of litigation. The fear that women are irresponsible little tykes that are all too willing to put their babies at risk. Hospitals will not support home births for VBAC. But. They may support birthing in a birth centre where pool deliveries are the norm. Water births are so nice and gentle that no extra stress will be put on the scared uterus causing it to rupture, the contractions can remain normal.

• Lying down on a CTG machine will cause the contractions to become painful as they work against gravity.
• Pain will cause stress that will hold the cervix closed that will make the contractions become stronger.
• Not moving about in labour will slow the normal rotation of the baby.
• Not eating in labour will prevent enough carbs being available to fuel a contracting uterus, labour may slow down or stop.
• If it slows down or stops a drip may be started that will put extra stress on the scared uterus.

Everything we do in hospital seems to be against helping women to achieve a VBAC. Lets start a campaign today to allow women VBACs within a birthing centre setting. Let me know what you think?

Once upon a time

Has anyone seen the fabulous new series called Once Upon A Time? It is a new take on old fairy tales, bringing them into present day. Very clever and extremely well done. However, some of their audience will be young people and the labour scene where Snow White was giving birth was so cliche that I almost cried. She was doing the usual crying and screaming and acting as if she was being tortured.
What message does this give to our young people today? It tells them that labour will be very very very painful. As soon as any of them get pregnant and start to labour they will remember all these images and they will naturally start to feel anxious. At that moment in time all hopes of a pain free labour will evaporate like fairy dust.
The midwives among us could tell that she was supposed to be in the second stage of labour and so it does get a little painful as the perineum stretches but how could the young audience know that.
Ms. White was also firmly planted onto a bed - THE WORSE PLACE TO LABOUR - as it is difficult to remain upright on a bed and the uterus will not be able to work with gravity and so the contractions become stronger and so may become painful. (see the posts - Why Labour Hurts 4)
I don't want to give the story line away but Ms. White was under threat at the time from the evil queen casting a very bad spell on her that was speeding like a huge dark swirly thing towards her and her prince. So really, she could be forgiven for having a painful labour cos who wouldn't if labouring under the same circumstances?
Her anxiety would flood her body with adrenalin which is the main cause of painful labours. (see the posts - Why Labour Hurts 2 and 3)
If pain free labours are to become an accepted part of our society then TV producers have to stop using birth as a fulcrum for drama and forcing their actresses to overact. Stop teaching young people to fear labour cos then painful labours become a self fulfilling prophesy. Change in how we perceive labour is coming, if you see a huge dark swirly thing coming towards you then don't worry, it's not the evil queen, it's the anger of all the women, who suffered in labour after being taught that the first stage of labour was meant to be painful, and then they learn the truth.

Best Birth Centres - The Rosie Hospital, Cambridge

Exciting news seen on the Internet - a brand new 10 roomed birthing centre has opened in Cambridge, England. Each room has a birthing pool and other essential equipment for a natural pain free first stage of labour. The essential equipment will be aimed at providing you with a comfortable environment in which to labour. A home from home. An upright position will be encouraged as previously outlined in this blog. Staying upright is important for a pain free labour as the contractions are working with gravity, so do not have to become stronger.

Relaxation will be encouraged within a calm nurturing atmosphere where you can eat and drink to your own personal needs. Taking advantage of the pools for your labour and birth is always a very good choice as warm water has been used for years to ameliorate the normal aches and discomforts of simply being pregnant. The warm water also negates the pull of gravity to some extent and so floating in the pool with a cool drink and willing birth partners in attendance will feel like being on your hols, what more could you ask.

In today's economic climate, it is wonderful to hear of an NHS trust going that extra mile to provide a choice for women in Cambridgeshire. So, if you desire a birth to be envied by all your friends, make sure you are around the Cambridge area when you go into labour. Access earlier posts within this blog for relaxation techniques. Sorted.

Welcome to pain free labour comrades

A big здравствуйте to all the Russian people who have started looking at my pain free labour blog. Я надеюсь, что погода там не также холодна. That was just a little secret message to our Russian friends.
It seems that the message is getting through regarding midwives calling contractions PAINS. More and more are recanting their ways and, at least while I am present, they are making a very concerted effort to not use the P word. It will take time. For our Russian friends, you need to call uterine activity сокращения and not боли.
The social construct that we have created and woven into our belief systems regarding painful labours is very strong, it will be difficult to erase. Midwives who are independent enough to fight against this acceptance of painful labours, and at least try to address the balance, will help women to achieve the best labour possible for them as an individual. Once we teach them how to behave in labour, and what elements are causing any discomfort, then we will be truly 'with woman'. Cos at the end of the day, that is what 'midwife' means.
See earlier posts in this blog for relaxation techniques and staying upright to achieve a pain free first stage of labour. Goodnight. Доброй ночи, я надеюсь, что Вы наслаждались этим постом.
And, for our Aussie friends - Sling another Wombat on the barbie will ya Shiela. Thankyou.

Birthing in the pool

I have just spent the weekend having two of the most amazing gentle pool births that you could ever imagine. I love it. Working on the birth centre at North Manchester General Hospital is just the perfect job for any midwife.
Both the women that I have cared for over the weekend said they coped so much better after entering our lovely birthing pools and are going to recommend them to their friends. Giving birth in nice warm water is a more natural way to birth for baby, she is already used to an aquatic environment. Heat is a universal source of comfort for all ages and being surrounded by warm water whilst giving birth seems to cocoon women in a security blanket that most do not want to leave after the birth.
Birth centres cater for low risk women, ask your community midwife if you are low risk and if so ask her to book you in at your local birth centre. Normal labour wards can still have birthing pools, though they do not get used as much. Even if you have risk factors, ask the labour ward where you are booked if you can use the pool. Always remember that you are the boss. All maternity care is offered as a service, with you as the client. When you go to the hairdressers and ask for a certain style, you would not be happy if they said that style was not available and you could only have a crew cut instead. Well, not unless you like that sort of thing. Write your birth plan before you are in labour. Have someone calm and confident with you so they can fight your corner if necessary, leaving you to focus on your relaxing. Stay upright untill you are in the pool, the water will then negate the pull of gravity and you can adopt whatever position is comfortable for you at the time. Floating has been the mode of choice this weekend. Love it.