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Archive for July, 2007

FIRST STAGE OF LABOUR

Sunday, July 1st, 2007

Preparing for Birth
There is a fundamental difference between a maze and a labyrinth. Both are intricately patterned winding affairs but whereas a maze is designed to get you lost, misleading you with dead-ends and pointless passages, a labyrinth will always lead you to its end. It might seem the same, but with persistence and staying power you will not get lost in a labyrinth.

Modern birth is depicted as a maze. Without the help and intervention of the medical establishment, women are led to believe they will get lost or will not cope. Birth, though natural, is presented as something complex, designed to trip us up at every twist and turn. But this is a misrepresentation. Birth is more like a labyrinth than a maze. If you trust in the process and have patience, then you will get to the end with as much or as little help as you wish.

Having faith in the process of birth, and recognising that it will have a beginning, a middle and an end is good psychological preparation for the journey of labour.

Pre-labour
Although labour is a continuum, it is useful to think of it in stages just to have some sense of where you are throughout.

Knowing the difference between pre-labour and actual established labour can be difficult for first time mothers but it will save you an unnecessarily early trip to hospital and many hours of clock-watching which is likely to make you feel dispirited. Many an account of a 24 hour labour is because the measure included pre-labour and not just established labour.

Pre-labour is, in textbook terms, the first three centimetres of dilation. In second and subsequent labours this can and often does occur in the weeks leading up to birth. For the first time mother, it is characterised by contractions that are spaced a long way apart and which are erratic. It can take a very long time but is a manageable stage of labour. A good measure of whether it is established labour or not is if you can still carry on a fairly normal conversation between contractions- of you can do so easily, it is likely that you are in pre-labour.

Coping with Pre-Labour
Carry on as normal as much as you can. Obviously its good to make sure you have everything you need if you are planning to give birth at home or your bag ready and the petrol tank topped up if you are going to hospital, but other than that just keep on as normally as is possible.

If it is during the day then keep mobile. This will help the labour and the baby who will be moving into the best position for birth, if it is not there already. Don’t be surprised if established labour doesn’t kick in until nightfall, as most births do happen at night.

Established Labour
In textbook terms this is between 3 and 8/9 cm dilation. The contractions are every five minutes and last for between 30 and 45 seconds.

You will find conversations increasingly difficult and will feel compelled to focus on nothing but your labour.

Another way of telling that you are in established labour is that the shape of the belly changes- becoming box-like- with each contraction.

Coping with Established Labour
As the momentum of the labour builds you will increasingly need to turn inwards and start to anticipate contractions. If you are able to get into a rhythm of anticipating a contraction and moving or swaying or doing whatever feels comfortable as the contraction builds then you will be on top of it when it peaks.

It is helpful to know that a contraction builds in intensity and then peaks, but as soon as it peaks, it then stops- as though it has fallen off a cliff. This means that at the point at which you think that you might not be able to deal with the contraction, it is over.

Make sure that your environment is suitable for labour- respect your own need for minimum interference, privacy, low-lighting and quiet. If you are transferring to hospital then get your partner to take care of your birth notes and answer questions so that you can remain focussed.

Remember that as the contractions build so do your body’s own endorphins which are your natural pain killer. The focus in so many books and birth preparation classes is on the contraction- few people talk about the blissful period between contractions when there is no sensation at all, but just the lovely feeling as your body is flooded with hormones and endorphins. If you stay within your labour you will give yourself the chance to enjoy this period between contractions.

As labour builds trust that your mind and body are working in tandem. If you keep going- thinking of each contraction as one less that you have to do and one step closer to meeting your baby- then you will find yourself heartened as you cope with each one. Labour is not designed to trip you up. Countless women have laboured successfully to have enabled you too to labour- a long line of mother after mother after mother- and you have the capacity to labour well. Birth is not a maze, but a labyrinth-just a journey with twists and turns and difficult bits, but a journey all the same.

Be as active as possible- this will facilitate your labour making it shorter, less painful and safer for you and for the baby. Don’t worry about what positions you adopt but simply let your instincts lead you. If you are asked to do anything that restricts your capacity to move then see if there are alternatives or mobile versions so that you can continue to labour unimpeded.

Breathe- it sounds obvious but it is essential to remember to breathe…long deep breaths and use sound if you wish. There seems to be an indirect correlation between the amount of sound a woman makes and how much pain she is in. If you hold your breath- which is a common response to something that you anticipate being overwhelming- you can make it so. If you breathe, focussing in particular on the exhalation, then you will release tension and find your capacity to cope increases hugely.

Consider using water at the end of the first stage, when the contractions increase in intensity and the space between them reduces. Water will help you cope with this more difficult part, increase the relaxation between contractions, help to hold you up and so conserve your energy and will take the peak off each contraction. It will also speed up this final stage of labour and take you through transition
and stage 2.

Finally, remember that birth is partly physical and partly mental. Make sure you drink water or juice throughout labour and if you feel like it, have a snack to keep your strength up. Remain active as much as possible, moving as you feel you want to.
Allow yourself to mentally retreat, to be on another planet as Michel Odent puts it and enjoy the unique experience that this affords you. Many women find this experience, this losing yourself to the process, the most wonderful aspect of birth.
Have faith in your capacity to cope. As my midwife said to me before having my first baby, ‘You will not be sent more pain than you can handle’. You were designed to give birth and your body and mind work in wonderful synchrony in order for you to do so. You are your best guide, so respect your needs and instincts, and listen to what your body tells you. If you trust yourself whilst remaining open to possibility and to change, you will be well on the way to having a very positive birth experience.

ACTIVE BIRTH

Sunday, July 1st, 2007

Since time immemorial women have been active in labour. Myth suggests that it was Louis 14th’s desire to see his mistress give birth to his illegitimate child that prompted the fashion to lie down to give birth. More probable is that as birth moved from home to hospital and as obstetricians took over from midwives, the consequent interventions in the birth process required a woman to be immobilised. Regardless of the origin of lying down to give birth, science and anecdote have shown it to be a counter-intuitive and even a dangerous position in which to birth a baby.
Art work across the ages testifies to women birthing in upright positions- squatting, all fours, one knee up, standing holding ropes
G Engelmann did studies of tribal people in 1890s and found that most common position for birth amongst them was upright


What it means to have an active birth?

Physically An active birth is one where a woman is free to use upright and mobile positions during labour rather than lying down to give birth. There are many positions that she might adopt, though none are prescriptive. The key thing is that she is able to move as her instincts guide her, and not be instructed through her labour or inhibited by intervention, advice or cultural convention.
e.g. media representations of women women in asia accustomed to squatting, in west is not something we are necessarily physically or importantly emotionally in pictures showing active birth positions

Mentally An active birth is not simply one which involves the mother moving, but is also one in which she is an active participant in her own birth rather than a passive patient. Women report that being active in labour improves their birth experience, partly because they feel they have some control over their own birth and not simply subject to the authority of the medical establishment.
Choice, positive relationships, knowledge of the physiological needs of a birthing mother and a conducive environment are all important components in an active birth.
The history of modern childbirth has been one of women handing themselves over to be delivered of their babies- an active birth restores this balance, using obstetric intervention as and when it is necessary but respecting the natural process of birth when there is no compelling evidence to do otherwise.

Benefits of an Active Birth
1) Being upright means the mother is working with rather than against gravity. The baby’s head also exerts even and direct pressure on the cervix which sends strong signals to the mother’s brain, resulting in a more rapid first stage of labour. The spiralling descent of the baby is helped by a mother who is able to move and rotate her pelvis.
You can imagine that when lying down, baby’s head off the cervix…….labour sporadic, stop startish

2) The pelvis is up to 30 % larger when a woman is upright. The coccyx is able to move out of the way and the sacrum can expand leaving more space for the baby to pass through the pelvic canal.
Jean Sutton, OFP lady, talks about the ‘rhombus of michaelas’, this diamond shape on the back….when a woman moves into 2nd stage you can see it jutt out….in jamaica they have a saying ‘ a woman gives birth when her back opens up’ – this is what they are referring to….when lying down this can’t happen
3) There is a significantly reduced chance of a baby suffering from foetal distress when the mother upright. When a woman lies down late in pregnancy the main arteries that run from her heart to the placenta risk being compressed which reduces the oxygen flow to the baby.
Most commonly cited reason for emergency c-sections is foetal distress, more often than not if you ask woman what position she was in it was lying down……….baby and amniotic fluid, placenta etc weighs a minimum of 20 lbs at birth, huge weight, like a sack of potatoes……
4) Labour is significantly less painful than mobile and upright. During contractions the uterus tilts forward and when lying down this forward motion requires an extra exertion of energy, inevitably resulting in more pain. Anecdotes abound of women who cope with their labour until they are encouraged to lie down for an examination when they find the pain unbearable. As well as being more comfortable for the mother, a less painful birth reduces the need for pain relief and consequently reduces the possibility of a cascade of intervention arising from the administration of drugs.

Securing an Active Birth
1) Knowledge
2) Comfort, both physically and mentally in active birth positions
Includes carers and partners being comfortable too, so that their expectations don’t put mother off
3) Creating optimal conditions for birth- where environment enhances natural birth and mother feels empowered and uninhibited, thus behaving according to instinct rather than convention.
4) Respect for the process of birth. Instead of thinking of birth as something we do badly, understanding that we are designed to give birth and have been doing so successfully for centuries.