Hazards to a Pain Free Labour - 5

There are some people who are incapable of relaxing. Coffee drinkers are adrenalin junkies, they find it difficult to sit still for five minutes let alone relax and become tension free for a whole labour. Caffeine is a psychoactive stimulant which acts on the central nervous system by promoting the release of catecholamines such as adrenalin.

Caffeine can also cause dehydration which is not a good idea in pregnancy as the blood needs to remain quite dilute in order to get in and out of the placenta easily. Your baby gets all his nourishment and oxygen from you, if your blood is too thick by you being dehydrated then your baby will suffer. Research has also shown that caffeine intake during early pregnancy can contribute to miscarriages.

Caffeine is not only found in coffee. It is also in black tea, green tea, cola and some energy drinks. If you stop your caffeine intake suddenly you may experience withdrawal symptoms, which include headache and nausea. There is a reduction in serotonin levels when caffeine input is stopped which can cause anxiety, irritability, inability to concentrate and lethargy. It would therefore be a good idea to cut down slowly on caffeine intake before becoming pregnant.

It is not only the fact that caffeine makes it difficult for people to relax and so relaxation techniques become ineffective. It is the fact that caffeine causes the body to release adrenalin. As you have seen previously, adrenalin causes all kinds of problems in labour and is to be avoided at all cost. If you are unable to kick the caffeine habit before pregnancy then try stopping caffeine intake well before labour begins. This will leave you in a calmer state of mind, ready to respond to your chosen relaxation technique in labour.

Hazards to a Pain Free Labour - 4

Cardiotocographic (CTG)  monitoring of the fetal heart rate was first introduced in Germany in 1968. It was seen as a way of reducing fetal demise and cerebral palsy rates. In practice the false positive rate for cerebral palsy is as high as 99%. That is, out of 100 non reassuring CTG traces, only one will go on to suffer from cerebral palsy or other neonatal encephalopathy. Research has also shown that use of CTG monitoring in labour is more likely to result in an instrumental or caesarian section birth.
The British National Institute for Clinical Excellence (NICE) guidelines clearly state that women who are in good health and with an uncomplicated pregnancy do not need to be monitored continuously on a CTG machine. Instead, low risk women will be offered intermittent monitoring. That is, a midwife will listen in every 15 minutes during the active first stage of labour and every 5 minutes during the second stage. The active first stage is from 5cm dilatation till your cervix is 10 cm dilated. The second stage is from 10 cm dilated till the baby has been pushed out.
Some midwives see CTG monitoring as an easy option. They only have to comment on the trace every half an hour and so it is less labour intensive.  As previously discussed in this blog, lying down in labour leads to painful contractions. In order to obtain an optimal CTG trace it is best to have the mother lying down on the bed with the back of the bed slightly raised. This position is not upright enough for a pain free labour.
A compromise can be made if you can sit on a birth ball or chair beside the monitor or a mobile monitor is available. With mobile monitors you are free to mobilise, or sit down where you are upright enough for a pain free labour. If these positions do not produce the trace that the midwife would like then that is his/her problem. They may have to press the transducer onto your abdomen in order to pick up the fetal heart, this is time consuming and only a dedicated midwife will put in the extra effort. Remember, you are the client and we are merely offering a service, you are the boss. If you do not get what you want then get your birth partner to complain. You however, have to remain calm and upright so leave the negotiating to someone you trust.
My third labour was spoiled by a midwife who forced me to lie down on a bed with a CTG running throughout the labour. I was low risk. If I had known better I would have refused the CTG and been able to sit and have my planned pain free labour. I hope you are stronger than I was and able to negotiate monitoring with a flexible midwife who has you and your baby's welfare at heart.

Hazards to a Pain Free Labour - 3

Haemoglobin or iron levels for a non-pregnant woman are 11.5 to 16 g/dl. In pregnancy, your blood is diluted to make it thinner so that it gets in and out of the placenta easier, clever. Even with this haemodilution, which is normal, your iron levels should not fall below 10.5 g/dl. Iron tablets are not routinely given in pregnancy unless there is a history of anaemia or you have symptoms (feeling very tired, breathless or dizzy). Not everyone can tolerate the tablets and often just stop taking them. This means that when you go into labour your oxygen carrying capacity is reduced and as discussed in Why labour hurts 2, this will cause the contractions to become painful.
To avoid this complication you need to keep your levels up. A blood test is taken at booking at around 12 weeks gestation, this will tell your midwife if you need iron. An alternative to the iron tablets is to have the iron in liquid form. Your doctor may not want to prescribe this as it costs more than the tabs but you have to insist, it is much easier to digest.
When I had my fourth baby I was a vegetarian, so thought I should take extra steps to ensure good iron levels before the birth for a pain free labour. From the time I found out I was pregnant I had 1 small spoonful of black strap molasses three times a day with meals. At first I found it too thick and sticky but soon got used to it and after a while really enjoyed it. My iron levels stayed at 12 throughout the pregnancy and I was able to have a wonderful pain free labour at home.
According to research, we get 90% of our iron from fruit and veg, so to optimise iron levels it would be prudent to change your diet to include extra of these for the pregnancy. We only get 10% of our iron from meat cos it is bound up in animal red blood cells so is harder to get at.
Tea and coffee stop us from absorbing the iron in our food so should never be taken with meals, orange juice or some other drink rich in vitamin C should be drunk instead. Iron supplements taken without vitamin C will not be absorbed so always take them with a fruity drink.
Ask your midwife for a check on your iron levels at 28 weeks when haemodilution is complete, the result will give you a good idea of how you have been affected. It also gives you time to get your haemoglobin to a decent level before you go into labour. Broccoli has never tasted so good.

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.