Hazards to a pain free labour - 2

From an observational study that I have been conducting over the past two years I can safely say that rupturing your membranes is a hazard to a pain free labour.
On TV the first thing that happens when someone is about to go into labour is they look down and say "I think my waters have gone" staring at a puddle on the floor. This is not the way that most labours start.
When your waters go there is a release of hormones called prostaglandins. These hormones attach to the uterine smooth muscle and open up pathways to oxytocin. Oxytocin is a hormone secreted in the brain that causes uterine smooth muscle to contract. With more pathways open the smooth muscle lets in more oxytocin and so the contractions become stronger.
During a normal pain free labour it is much better to keep your waters intact untill you are pushing your baby out. Not only do they cushion the baby's head while he is coming down the birth canal but they continue to protect baby from bacteria or other harmful organisms that may be present there.
If you are in labour and a midwife or doctor wants to rupture your membranes then make sure they have a jolly good reason to do so. A jolly good reason would include:

• If an abnormal fetal heartbeat was picked up with a hand held doppler then a CTG machine would be offered to obtain a better picture. If all was well with the CTG trace then it could be stopped and you would go back to the hand held doppler monitoring. If the trace was not reassuring, or there is some difficulty obtaining a good trace, then you would be offered an Artificial Rupture of the Membranes (ARM) so that a clip can be attached to the baby's head to obtain the heart beat directly. Not being able to pickup the fetal heartbeat abdominally is often due to an increase in maternal habitus (too many doughnuts). 
• If a CTG trace is in progress and there is an episode of fetal distress, then you may be offered an ARM to observe the colour of the liquor. If baby has been really distressed then they may have had their bowels opened and the liquor stained with meconium (baby poo). You then need to stay on the CTG machine to ensure baby is not suffering further as a result of this distress. See the next post for coping with CTG monitoring.
• If your hospital protocols call for a progress rate of half a cm per hour, and your cervix does not comply with this estimation, then you will be offered an ARM to increase the strength of your contractions. A good long walk or sitting on a birth ball should produce the same result.
• If your labour ward is very busy then the midwife may tell you that you need an ARM in order to speed up the labour. Get you done and dusted and off the ward. The work load is their problem not yours, do not accept any artificial interventions unless a jolly, jolly good reason is given.

An ARM is almost never carried out on a midwifery led birthing unit. This is because we believe in natural labours, if they go they go but we will not interfere. If your labour slowed down then we would haul you out of your lovely comfortable birthing pool and send you for a walk that may include stairs. OK, mean, but you will thank us in the end when you have your wonderful pain free labour.


During my observational study I noted that women can still have a comfortable labour with their waters gone if they follow the relaxing regime and stay upright, but it may not be entirely pain free. Still, worth a try. Good luck. Ann xx

Hazards to a Pain Free Labour - 1

As discussed in Why Labour Hurts 2, the hard working uterus needs a good supply of oxygen whilst contracting so as not to produce lactic acid which causes pain. If you are a smoker, then every time you have a cigarette your red blood cells are filled with carbon monoxide and are unable to carry a normal amount  of oxygen. This means that you have a lot less oxygen available to your baby and, if in labour, to your hard working uterus whilst smoking a cigarette. This oxygen deprivation lasts for about an hour after finishing a cigarette.
Once you are aware that smoking can cause you to have a painful labour you can take steps to remedy the situation. During your pregnancy or for at least a few weeks before you are due to go into labour you could ask your family doctor to prescribe you some nicotine patches suitable for pregnancy. They will satisfy your craving whilst making sure the oxygen carrying capacity of your blood remains at an optimal level. See your community midwife or GP for advice on who to contact about giving up smoking.
As an ex smoker I understand how difficult it is to give up. Now, as a non-smoker, I am so glad I did.

Why labour hurts 5

The focus with our maternity units today is mainly centred on pain relief. From the moment you enter a labour ward your contractions will be called 'pains' by midwives and doctors alike. The British TV programme 'One Born Every Minute' included recently an interview with a midwife stating that women should expect to be in "agony" during their labour.
With all the social conditioning aimed at convincing us that labour WILL be painful, we are brainwashed into thinking that we cannot possibly even contemplate going into labour without intensive medical help. It is therefore not surprising that women today fear childbirth. If I was told that I had a hospital appointment next week where I would be in acute agony for hours and hours then my adrenalin levels would start rising now and accumulate on a daily basis as the dreaded day drew nearer. With pregnancy you have nine months to hone that fear. Little wonder that women present in labour shouting for an epidural before they have even got through the hospital door.
The fear of labour is so instilled into out society that it will be very difficult to overcome. Until the fear is seen for what it is - a cause of painful labour contractions - then the "agony" will continue.
A self fulfilling prophesy.
Help break the mould by spreading the word of Pain Free Labour by following the simple steps outlined in this blog and posting your outcomes for all to see. Thank you.

Why labour hurts 4

Imagine you are still a cave woman who is just so fed up with life in a damp mouldy old cave. So along with your hunky cave man you decide to go live on the hill. You look forward to waking up to a stunning view bathed in untainted primordial sunlight. Bliss.
However, there is one factor you forgot to consider. A hill. You will have to carry all your building materials up the hill to build your hut. Gravity will not be your friend. However, if you decide to build in the valley and forgo the stunning view, it will be easier to get materials down rather than up.
So working WITH gravity is easier, mmmmm.
If we lie down in labour the hard working uterus has to work even harder cos it is working against gravity, pushing baby up hill. The contractions will have to become stronger and so become painful.
If we remain in an upright position, on a chair/birthing ball or leaning forward on a bean bag etc. then the contractions are working with gravity and do not have to increase in strength. Simple.
Then why oh why do women, as soon as you show them into the labour room, make straight for the bed and lie down. We have chairs. We have birthing balls. We even have a large scrunchy bean bag. We also have a beautiful birthing pool where you can sit or kneel in relaxing warm water and labour in comfort.
Once you are aware of why labour hurts you can face labour with fresh expectations. You can make a birth plan that includes staying upright and use of the pool to relax in. You can inform your midwife and birthing partners that you need a quiet atmosphere in order to do your chosen relaxation technique.
You can have a pain free labour.
You can do it.
I did it.
Twice, so I know it works.

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.