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Archive for the ‘Labour’ Category

Delayed cord cutting

Monday, June 14th, 2010

On the back of Third Stage of Labour Class today, this research is especially interesting.

“Delaying clamping the umbilical cord for a slightly longer period of time allows more umbilical cord blood volume to transfer from mother to infant and, with that critical period extended, many good physiological “gifts” are transferred through ‘nature’s first stem cell transplant’ occurring at birth.”

suggest researchers at the University of South Florida’s Center of Excellence for Aging and Brain Repair.

There is no reason, even in a managed third stage, why cord cutting cant be delayed until the cord has naturally stopped pulsating and the baby has got its full quota of nutritious placental blood. As increasingly women are routinely being given syntometrine, sometimes as quickly as after the delivery of the baby’s shoulders it is really important that your esearch the differneces between a physiological vs managed third stage and state clearly what you would prefer, all things being equal.

Women should endure more pain in childbirth?

Tuesday, July 14th, 2009

In Sunday’s Observer there was an article entitled ‘Its good for women to suffer the pain of a natural birth,’ says Medical Chief.  Good old journalists- we can always rely on them to throw something eye-catching, controversial and ultimately misleading into the ring. And in this case, what a red rag to a bull Dr Walsh’s comments have been.

To say that the debate has been heated since Sunday is an understatement. The column inches suggest it was Sunday months ago, not just two days ago and the debate is without doubt coloured by anger and vitriole. A trawl through websites , comments boxes and online mothers forums makes you hope that Dr Walsh is not reading. Whilst the odd woman meekly puts her hand up to say she had a drug-free birth and-god-forbid- quite enjoyed it, the vast majority are angry women who feel that they are having their choices squeezed or are being made to feel guilty for them. And if this was the case- if women were being denied choices, or we were somehow being told that childbirth is our due punishment a la Old Testament, then the outpourings might well be justified.

But misunderstandings can start wars, and I am increasingly convinced that this outcry is exactly that. A misunderstanding. No one is saying that women shouldn’t be allowed epidurals. They are available, many women’s experience with them is positive- in fact I have a friend who very proudly proclaims that she has given birth three times without ever feeling a contraction, thanks to early epidurals, and no one is condemning her. Epidurals are often described as the rolls royce of anaesthesia and they can sometimes mean the difference between a positive birth experience and a traumatic one. And for that reason alone they should be an option for all women.

But to think that we can have something for nothing is equally just short-sighted. It is essential that women recognise that to debate the pros and cons of an epidural is nothing but healthy- and that is exactly what Dr Walsh, admittedly rather big-footedly, is trying to do.

To say that there are downsides to epidurals is not to condemn the women who opt for them. It is simply to state a fact. There is that saying ‘ you cant get something for nothing’ and in the case of epidurals it is absolutely true. It is a fantastic and usually very effective form of pain relief but it has a downside that we need to acknowledge and consider.

What concerns me is that we seem very happy with understanding the risks of anything else when it comes to medicine- the pros and cons of HRT, the potential downside of an anti-cancer drug, even the possible side-effects of paracetamol, but for a doctor dares to suggest that not enough consideration has been taken of epidural downsides, he is painted as the devil incarnate.

It also ignores the again very healthy and in fact very interesting debate as to why on earth there is pain in labour and whether it is of any great benefit. In fact pain is a topic that I believe is actually undercovered in child birth classes. We talk about how to cope with it, and different forms of pain relief from aromatherapy oils to epidural, but it is never truly dissected and understood. Instead, woman’s idea of pain is simply the trauma, the extremes of it and the idea that it is the most pronounced characteristic of birth. And yet time and time again women come back to my classes after they have given birth, and speak of pain as though it were an aside. They dont deny it was painful, but emphasise that the experience was so much more than that. It is not unlike a mountaineers description of his successful attempt to reach the summit of some treacherous peak- whilst there was undoubtedly pain involved in the ascent, it does not dominate his story.

So who are these women? Are they super-human, smug, lucky or plain stupid?

No, they are just normal women, like any other, but with a caveat. They are normal women who’s cultural perception of birth has been supersceded by something else. They are almost always well mentally and physically prepared for birth, they have been bolstered in confidence and in their sense of what birth entails, and are suitably convinced of the place of pain in labour to give it a go. They also labour under good conditions - those conducive to a physiological birth ( see  Primitive Brain at this link ), usually with outstanding one-to-one midwifery care, and sometimes with the luxury of having a doula.

To try to bring down epidural rates without recourse to anything else is foolhardy to say the least. It is no different to trying to cap elective c-section rates without recognising that their rising is a product not of a weakness in women but an inherent problem in our cultural perception of birth and more importantly, the system in which women in this country are pregnant and labour. Women have access to unprecedented levels of information- books, websites and endless forums. And yet most of them are more unprepared and crucially more fightened than any generation of women before them. Our interventionist system, which promotes electronic foetal monitoring and unexplained hospital protocols,  induction and intervention makes contemplating a natural birth nigh on impossible for many women. And the fact that we have too few midwives, whose ideology and caring gets swept away in a plethora of rules and the madness of overwork means that women are simply not cared for enough during their pregnancy or throughout their labours. The single biggest emotional state to ensure a woman copes with labour, and might experience the pain without the suffering ( for the two are potentially mutually exclusive) is confidence, and until we find practical ways to instill this in the next generation of mothers, we need to offer them the next best thing, and very often that is an epidural.

A helping hand

Wednesday, February 27th, 2008

When dolphins give birth, the mother is surrounded by a small group of females who swim in circles around her whilst she births her calf. A little further away, the rest of the pod’s female contingency form another circle, and then outside of them, the males provide a final protective layer. In this way the whole community works to protect the mother, providing a safe place for her to give birth. They have not been taught this but know from instinct that birth requires a female to be protected.

Human mothers need the same treatment, yet all too often this is sadly lacking. Instead of forming a protective circle, a labouring woman is often subject to overt scrutiny, surrounded by an army of strangers all trying to control her experience. Instead of feeling private and secure as she should do, a woman often feels observed and unsupported, with machines left to do the work that should be undertaken by a loving birth partner.

Yet as so often is the case, science proves animal instinct right. We are, for the purposes of birth, less removed from our mammalian roots than we think. Studies show that if a woman is continually cared for by someone - even a stranger- her birth tends to be shorter ( often up to 25% shorter), she has significantly less need for pain relief, her chances of having a caesarean are dramatically reduced ( in 7 trials by 60%) and her experience of labour is much more positive. Additionally, babies tend to be born in better condition, success at breastfeeding is higher and bonding is improved.

For many women, the baby’s father is the perfect birth partner. He can act as the buffer between a woman and her environment, shielding her physically and emotionally so that she can lose herself to the process of birth. It is also an extraordinary time for a man, whi is becoming a father and many men truly want to be by their partner and babies side. But just because our culture now expects fathers to be there, doesn’t mean that they are the only option, nor that they should be. All too often a reticent father is in the delivery room when he would rather be in the pub! And a reticent father is worse than no one at all.

If a father is unsure that he wants to be there, or even if a couple simply feels the need for extra support then a doula is a wonderful option. Doula’s are experienced and qualified birth partners who stay by the woman’s side throughout the entirety of her birth. They can work in any environment - birth, home or both- and have the necessary experience and understanding to make a fundamental difference to a woman’s experience of labour. She needn’t take a father’s place, but can be alongside him, freeing him up from responsibility and allowing him to simply be a part of the process of becoming a family. All the evidence is that a doula has a positively transformative effect on a woman’s labour and womn who have laboured with doula’s report to having been more relaxed throughout the course of their labours. One woman went so far as to proclaim her doula the equivalent to a guardian angel. For more information or to find a doula in your area go to www.doula.org.uk