Pain free labour is an achievable goal for the majority of women with a normal first stage of labour. Women are taught from an early age to fear going into labour. When they do they start secreting adrenalin, this causes changes in the body which cause labour contractions to feel painful. You can reduce adrenalin output by using relaxation techniques in pregnancy and labour. Once you know the truth, you have a chance to choose.
Research in Canada shows that water births are safer for mum and baby than land births.
Water Birth, Maternal and Neonatal Outcomes, Among Midwifery Clients in Alberta, Canada. 2014 - 2017.
A retrospective study by S. Jacoby RM and R.D. Wilson MD found a significant difference in the amount of perineal damage between water and dry births. Water births reduced the number of tears and also produced less severe tears such as third and fourth degree despite larger babies born to the water birth group. I have noticed this on the birth centre and put it down to the fact that warm water softens the perineum and helps it stretch for the birth.
There was also less bleeding after the birth as the placenta is detaching from the uterine wall. Plus a reduction in babies having a low APGAR score at birth (<7 at 5 minutes). Less babies were admitted to NICU after a water birth. All other criteria were too similar to determine a significant link.
So, book yourself in for a water birth. Practice one of the relaxation methods outlined in this blog. Get ready for an awesome birth. xx
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
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 LazenbattPhD, MSc, BSc. Laura DunnePhD, BA.
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.
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.
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
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.
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
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.
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)
Relaxation - baby becomes still. (this behaviour is often noted after pool births when a baby will calmly look around taking in their new surroundings)
Awakening - baby starts to move limbs.
Activity - baby uses larger movements, head is lifted, eyes remain open.
Resting - baby rests between bouts of activity.
Crawling - toward the nipple using limbs and head bobbing.
Familiarization - nipple found baby licks, tastes and touches area around nipple. (this makes the nipple more erect so baby can find it easier)
Suckling - baby self attaches to the nipple and starts sucking.
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
