The lady who had a pain free labour, and then gave it away.

Whenever you tell someone that you are a midwife you get the inevitable birth stories. I love them. A young lady I met whilst out and about asked me what I did for a living and then told me her birth story.

Mum told me that she had been in the pool at her local hospital where she felt so nice and calm and relaxed that the contractions stopped causing her any pain. They were still there but were pain free.

She became upset at this as she thought that if they were not causing her any pain then they were not normal contractions and her labour had stopped.

So she got out of the pool and started walking about, becoming more and more stressed. At last the contractions began to hurt again and she was finally happy that she was once again in labour. She did not however get back in the pool as she did not want the contractions to stop hurting again.

Arrrrrrrgh. Do I have to shout it from a mountain top somewhere? UTERINE SMOOTH MUSCLE IS NOT DESIGNED TO CAUSE PAIN WHEN CONTRACTING UNDER NORMAL CONDITIONS!

OK, I feel better now.

If you are nice and comfy and relaxed and not secreting any adrenalin in the pool and your contractions stop causing pain then please stay there and enjoy the rest of your labour. As long as you can still feel your tummy going hard every 2-3 minutes then you are still in labour. Honest.

Hazards to a Pain Free Labour - 6

By far the biggest hazard to a pain free labour is YOU. Society has taught you that labour will be painful, that the contractions will cause pain during the first stage of labour. This view of childbirth has been around for the past three hundred years. Why would the weight of all that knowledge and history be wrong?
If you want to solve a murder then you look for who will benefit from a persons death. If you want to solve the mystery of why we are taught that labour will be painful then look at who has benefited from our 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. 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 belief 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 adrenalin, secreted when we are anxious, can cause contractions to become painful.

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?

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.