Birthowl’s natural childbirth


Why Should Natural Birth Be Our Goal?
November 16, 2008, 5:48 am
Filed under: labour | Tags: , , ,

When birth is as natural as possible, when the mother is allowed to labor freely without interference from anyone, her labor will go more quickly and safely.

When human beings intervene in the birth process, they introduce elements which the body does not know how to deal with.  Drugs and medical procedures are obstacles to safe birth because they introduce variables into the birthing equation which are not part of your genetically encoded birth instructions.   Your body responds pathologically to drugs in your system, or being confined to a bed and not being allowed to eat or drink. When your body is sending you signals and you ignore them, or you can’t feel them because you have been given drugs or are too afraid to understand what your body is telling you, complications and further intervention are almost inevitable.

Any drug given to you during labor will reach the baby within a few minutes of administration.  Keep in mind that even though the dosage may be right for you, because the baby shares your blood system, the baby receives the same dosage as you do.  I’m sure you have looked at children’s pain relief or cold medications. On the package they always tell you how much to administer according to the child’s age and body weight.  When pain medication is administered to you, the mother, the dosage is administered according to your needs, not the baby’s.  They have to give you enough to numb the pain; you are getting an adult dosage which is much too much for a baby.  If that baby was out of the womb, and a doctor administered that dosage of pain medication directly to your baby, he would be cited for malpractice.  Because your baby is smaller than you, and the amount of medication in his system is too much, it takes longer for it to leave his system than it does you.  Babies of epidural mothers have more respiratory distress than other babies.  After the baby is born, if will often sleep more than normal and be lethargic.  Often these babies have no interest in breastfeeding for quite some time after birth.  They do not experience the calm, alert state that naturally born babies experience.  This quiet alert state is important to maximize postpartum bonding of mother and infant.

When your labor is induced or augmented with Pitocin, your contractions speed up and seem to occur back to back without a resting period in between.  This can cause the uterus to become exhausted and unable to contract effectively.  You may get dilated to a certain point and then make no further progress.  At that point a cesarean section becomes necessary.  Pitocin also increases the risk of uterine rupture because the contractions are much more intense.  Women often start out with Pitocin and the contractions become so painful that they cannot cope without pain medication.  So there are two drugs in your system instead of one.

Most hospitals require continuous electronic fetal monitoring.  This procedure includes strapping an ultrasound device to your belly to monitor the contractions, your heart rate, and the baby’s heart rate.  When you have this device attached, you must stay in bed.  When you have epidural anesthesia you must also stay in bed.  Lying in bed increases the length of labor, increases the pain of contractions, and reduces your ability to cope with contractions.  You MUST be able to change positions as your body tells you to.

Lying in bed often produces changes in the fetal heart beat.  Sometimes these changes represent true fetal distress, and sometimes they are interpreted as such when no danger exists.  Either way, if the mother was allowed to get out of bed and move around, these heartbeat irregularities often return to normal. Sometimes the irregularities are simply the result of the normal birth process and are not distressful at all.  Onlookers have no idea which is the case, so they always intervene.  Studies of electronic fetal monitoring have found that results are not always interpreted correctly, and that although the results may actually indicate fetal distress, other tests performed on mother and infant do not always concur that distress exists.  Where electronic fetal monitoring is used, there is always a rise in forceps deliveries and cesarean sections.  Electronic fetal monitoring has not been shown to significantly improve the outcome for mother and baby, but it does increase the amount of intervention.

In the hospital, you are often given a diagnosis of “failure to progress” if you do not dilate at least one centimeter per hour.  This diagnosis is based upon research done many years ago by a doctor named Friedman.  He kept records of many, many births, and averaged the length and progress of these labors.  He came up with what is now called “Friedman’s Curve.”  The average progression is one centimeter per hour.  If you don’t progress at least this fast, you will probably be given Pitocin.  If you still aren’t progressing with Pitocin, you will be “offered” a cesarean section.  Offered is a funny way to put it, since you will be told there is no other option.

How would you feel if you were told that the average woman is 5’4″ and that because you were 5’7″ you were abnormal?  That is essentially what is being said to those who don’t progress at least one centimeter per hour.  No one seems to realize that Friedman’s one centimeter per hour is an AVERAGE.  Averages are made up of highs, middles, and lows added together.  Some women progress in a steady manner, but many if not most labors progress in spurts.  You may make steady progress for a while, then have a resting period, and then pick up again.  Your labor is also affected by your emotional state, which is why distractions in the labor room must be avoided at all costs.  Many times, a change in the emotional climate is all that is needed to jumpstart labor again.

Your body knows exactly how to give birth.  All you must do is remove the obstacles so that your body can do what it knows how to do.  Allowing the woman to control her own birth insures that things are going just they way they are supposed to go.  Your body will not do something to sabotage your birth, unless obstacles make it impossible.  Focus on learning how to remove every obstacle possible.

http://www.unhinderedliving.com

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picture by Justin Henry



Upright positions useful for labor and birth

The laboring woman can make the most of these positions by combining them with movement, chanting, natural breathing, visualization and massage. However, she should be able to rest whenever she feels like it, particularly in early labor. Encourage her to follow her inner urges. Her instinct and intuition will guide her when she allows her body’s wisdom to take over.

Standing and Walking – Stimulates contractions. The downward force of gravity assists the baby’s head to descend which in turn helps to dilate the cervix. Will also help to increase the efficiency of contractions and lessens discomfort, particularly when she leans forward with each contraction.

Helpful in early labor when the baby is in a good position – sometimes used for most of the labor.

Sitting upright and leaning forward on a firm chair, stool or toilet seat. Can be very comfortable. Her body is well supported while upright; good downward force. A nice position for being massaged because the back is so accessible.

To relax and to be in control with minimum effort.

Kneeling – An instinctive position particular in active labor when contractions are strong. Gives a sense of being literally on top of the contractions. A way of increasing privacy and concentration. Helps to feel centered. Easy to relax forward over a pile of cushions, a beanbag or a chair; makes it easy to change into different positions like standing, half kneeling – half squatting, squatting and all fours.

Helpful when labor starts in the night or when the woman is tired, needs privacy or seeks comfort.

Induces a feeling of control and release. Can be helpful for internals.

Particularly useful for active labor or for helping a posterior baby rotate.

All fours – lessens the force of gravity, thus reducing the speed of descent while providing the baby with enough space to move on; lessens the intensity of the contractions; allows for a wide range of movement, facilitates the ability to produce low noises and helps to feel centered; helpful in rotating a posterior baby.

Induces a feeling of control, makes breathing easy and gives privacy. Good when suffering from vulval or varicose veins.

Knee – Chest – Takes pressure off the back. Slows down a violent or extremely fast birth, thus helps to cope. Helps to create a time-out when needed. Extremely valuable in helping a baby to turn to a better birth position and to heal a swelling on the cervix (4).

Least pressure. Good for focusing and privacy or to take some time out. Can relieve pressure on the baby. Best position for an anterior lip to go down.

Lying on Side – If labour is progressing well she may choose this position for comfort and a slow, gentle birth. Good resting position for a long birth. Take care that she rolls fully to the left side into the recovery position with cushions to prop up her head, right leg and under her right arm; use a small cushion as a wedge under her left hip.

Make her comfortable with big cushions in her back, to rest her arm on. Keeping her left leg long while the right leg is bent and flops right over to the left as in the recovery position, put a small wedge under her left hip.

Picture by Bolinhanic – “Theresa in Labor”



Posterior Position and the Fetus Ejection Reflex


Two facts regarding posterior  position have been authoritatively confirmed by published prospective studies.

The first fact is that worrying pregnant women about the position of their baby in the womb is useless. A large Australian randomized controlled trial involving 2547 pregnant women has eloquently demonstrated that hands and knees exercise with pelvic rocking from 37 weeks’ gestation until the onset of labor does not reduce the incidence of persistent occiput posterior position at birth.

The second fact is that fetal position changes are common during labor, with the final position established close to birth. This is the conclusion of a prospective study of 1562 women to evaluate changes in fetal position during labor by using serial ultrasound examination. Among babies who were posterior late in labor, only 20.7% appeared to be posterior at birth.
Finally, when the mother had no epidural, the overall rate of posterior position at birth was only 3.3%, although this study was conducted in conventional departments of obstetrics, where the basic needs of birthing women could not easily be met. The rate was 12.9% in the epidural group.

When taking into account these two well-documented facts, focusing on the right question becomes easy: what factors can influence the rotation process during labor?

The answer is simple: The factors that can facilitate the rotation process are those that make a typical fetus ejection reflex possible.The passage toward the fetus ejection reflex is inhibited by any interference with the state of privacy. The ejection reflex does not occur in the presence of a birth attendant who behaves like a “coach,” an observer, a helper, a guide or a “support person.”

The fetus ejection reflex can be inhibited by a vaginal exam, by an eye-to-eye contact or by the imposition of a change of environment. It does not occur if the intellect of the laboring woman is stimulated by rational language (e.g., “Now you are at complete dilation; you must push”). It does not occur if the room is not warm enough or if the lights are bright. The best situation I know for a typical fetus ejection reflex is when no one is around but an experienced, low profile, silent, motherly midwife sitting in a corner and knitting.

The image of the “knitting midwife” should not be understood in a literal sense. Instead, it symbolizes the authentic midwife as a protective mother figure whose own level of adrenaline is maintained as low as possible.
Noticeably, when the conditions for an ejection reflex are met, most birthing women find spontaneously complex and asymmetrical bending-forward postures that probably play an important part in facilitating the rotation of the baby’s head.

Persistent posterior position at birth will become exceptionally rare on the day when the meaning of privacy is understood and authentic midwifery has been rediscovered.

– Michel Odent, MD, excerpted from “Occiput Posterior Position Should Be Exceptionally Rare at Birth”



Why is labour important?

Ina may Gaskin on “why is labour important?”

Labor is important, because during labor, both the mother’s and the baby’s body is prepared for birth. The levels of certain hormones rise and ebb during labor. For instance, the mother’s oxytocin levels rise markedly just before the baby is pushed out of her body. This protects her against postpartum hemorrhage. High oxytocin levels in the mother (which are accompanied by higher levels in the baby, too) prepare the nervous systems of both to be attuned to each other. This creates a special “sensitive” period during which these special hormones remain at high levels in undisturbed birth, and this period is best spent by mother and baby in skin-to-skin contact with each other as the baby begins to nuzzle and nick the mother’s breast or the two just look into each other’s eyes and adore each other. The euphoria that follows an unmedicated labor is a very special time for anyone who is privileged to witness it. It’s even better for those who get to experience it.

family

When the mother experiences labor, she also has higher levels than usual of beta endorphin. This hormone then triggers another hormone, prolactin, which prompts her body to get ready for milk production at the same time that it prepares the baby’s lungs for more efficient breathing.

Labor also gives the baby’s torso a good squeeze, which helps to dry out the lungs and make them ready for breathing air in the outside world. Cesarean-born babies typically have wetter lungs, which can mean a higher rate of needing breathing assistance at birth.

Photo by Ian

InaMay.com



Push the baby out?

Releasing Your Baby From Your Body

Once you are dilated to ten centimeters, and perhaps even before ten centimeters, your body may begin involuntary pushing efforts. Some women never get this urge to push at all. Whether you do or don’t, it is NOT necessary to add your own pushing efforts to that of your body. By staying totally relaxed and upright, the combination of gravity and the contractions of your uterus can birth the baby.

Women who have heart conditions are not allowed to push to birth their babies because of the strain this puts on their hearts. Yet, their bodies still birth their babies without help.

As the baby makes its way down the birth canal, this is a very intense time. Many women find that they have very primal feelings. They feel the need to make vocalizations, and some even report feeling like wild animals trying to get free. At this point, the intensity of the contractions is calling the shots. The intensity dictates your position, your breathing, everything.

As the baby’s head nears the opening of the birth canal, the perineal tissues will start to bulge. If you have remained upright and allowed gravity to bring the baby down and fan the tissues out naturally, there is very little chance you will tear. However, some women prefer to massage the tissues with oil and warm the tissues with warm, wet washcloths. A good way to keep these hand is to have two crock pots – a small potpourri size pot for the oil and a large one for water and washcloths so they can be ready any time needed. Both should be set on low.

The perineal area is the area below the vaginal opening and above the anus. As this tissue starts to bulge, the birth partner can, at the request of the woman, support the tissue with firm pressure from a hand covered with a warm washcloth. The warmth usually feels very comforting. Pressure against those tissues as the head is emerging can often prevent tearing and can guide the head gently out. However, if you have remained upright, and are giving birth in an upright position, you will probably not have a need for support and there is little chance you will tear. Birthing in the squatting position gives the baby the maximum amount of room available. The position also maximizes the pressure of the diaphragm on the top of the uterus so that the baby is literally propelled down the birth canal without extra pushing. The position pulls the tailbone out of the way so that there is no obstruction of the birth canal. The position normally provides 2 to 3 extra centimeters, which is more than enough room to birth any baby. A standing supported squat also will allow the baby’s head to fan out the birthing tissues so that there is no tearing.

As the head emerges, the perineal tissues will be stretched around the largest diameter of the baby’s head. At this point, some women experience a burning sensation that has been termed the “Ring of Fire.” This burning sensation is only momentary and passes as soon as the baby’s head moves past this point and the vaginal opening closes around the baby’s neck. Once the head is out, the body should be born within the next couple of contractions.

Once the head is out, the baby’s body must rotate so that the shoulder is released from under the pubic bone. Once the shoulder is released, the whole body is immediately born.

I encourage the birthing woman to be the one to catch her own baby. Once the head is out, the woman can reach down and guide the baby out as the body is release from the birth canal. If she does not feel able, the birth partner can be the one to “catch” the baby. As soon as the baby is out, he/she should be handed directly to the mother. If the baby does not take a breath immediately, the mother should stroke the baby, rub his/her back, speak softly and gently to him/her, and soon the baby should begin to breath and his/her color should pink up.

Babies born to mothers who have remained upright throughout their labors rarely need to have nose or mouth suctioned because the fact that they have been head down the whole time means mucous has been draining from the nose and mouth throughout the entire delivery. As the baby descends through the birth canal, his chest and lungs are tightly squeezed so that any fluid or mucous is naturally expelled.

Judie C. Rall and The Center for Unhindered Living



Positions for Labor and Birth

Positions for Labor, for Back Pain, and for Pushing

Why are different positions important?

Changing positions, and moving around during labor and birth, offers several benefits. Some are obvious to the mother in labor: increased comfort / reduced pain, distraction, and an enhanced sense of control: merely having something active to do can relieve the sense of being overwhelmed and out of control.

Beyond these advantages, there are equally important effects on the baby and on the progress of labor. Changing positions during labor can change the shape and size of the pelvis, which can help the baby’s head move to the optimal position during first stage labor, and helps the baby with rotation and descent during the second stage. Swaying motions such as walking, climbing stairs, lunging, and swaying back and forth are especially helpful with this.

Movement and upright positions can help with the frequency, length, and efficiency of contractions. The effects of gravity can help the baby move down more quickly. Changing positions helps to ensure a continuous oxygen supply to the fetus, rather than causing supine hypotension (low maternal blood pressure) by lying on your back or even semi-sitting.

Changing position can reduce the length of labor. Mendez-Bauer and Newton (1986) state: “duration of labor from 3 to 10 cm cervical dilation was about 50% shorter in patients who alternated supine and standing, standing and sitting positions.”

 

Positions for First Stage Labor

For Resting:

Side-lying. Try placing pillows between your knees for comfort.

Semi-sitting, in bed, on a couch, or leaning against your partner with his arms around you.

Sitting with one foot up. Asymmetrical positions help enlarge the pelvis on one side, and change the shape of the pelvis, which helps the baby find the best position.

 

 

 

Rocking, Rhythmic Motion: In labor, it just feels better when mom rocks and sways in rhythm to her breathing. Partners sway with her, or do massage in rhythm with her breathing, or sing in rhythm.

 

Rocking Chair

Sway on ball

Slow Dancing

Dance with Belly Lift

 

 

 

Activity: Walking, climbing stairs, lunging. Activity helps baby to descend, helps baby to rotate into position for birth. In early labor, be active occasionally, but don’t exhaust yourself by walking all through early labor. Walking is more effective in active labor and transition when baby has descended far enough to put pressure on mom’s cervix and encourage the cervix to open.

 

Lunge.

Stair Climbing

Tailor Stretching

 

 

 

Positions for Back Labor  (when mom has back pain, irregular contractions, or is progressing slowly)

 

Leaning Forward: Many women, especially those with back labor, find it most relaxing to lean forward during contractions.

 

Straddle a chair (or the toilet), and rest your arms and head on the back

Leaning against a wall, or your partner, or leaning over a table. Can sway.

Raise the head of a hospital bed, then kneel on bed with arms resting on top of bed.

 

 

 

Hands and knees / kneeling. Can relieve back pain, help a posterior baby rotate, allows easy access for backrubs / counterpressure massage; makes it possible to sway side to side, rock back and forth, or do pelvic tilts to aid rotation and increase comfort. Having knee pads or kneeling on something soft will help knees. Can rest upper body on pillows, chair, or birth ball.

 

Hands and knees

By a chair

Over birth ball

Knee-Chest

 

 

 

Positions for Second Stage

For second stage, an ideal position would: open the pelvic outlet as widely as possible, provide a smooth path for the baby to descend through the birth canal, use the advantages of gravity to help the baby move down, and give the mother a sense of being safe and in control of the process.

Try out a position for a few contractions. If it works, stay with it. If not, switch to a new position in between contractions. Depending on the caregiver, they may ask you to move to a specific position just prior to the birth.

 

“Standard” positions. These can be done by anyone. These are the positions that most OB’s are used to delivering babies in.

 

 

Semi-sitting. With pillows underneath knees, arms, and back. During contractions, can wrap hands around knees and pull knees up toward shoulders (as in squatting). Most common in hospital setting. For mom and baby: some help from gravity moving the baby down; mom feels more in control than in lithotomy position. Benefits for caregivers: good view of perineum, easy access to perineum.

 

 **

 

Lateral / Side-Lying. Back curved, upper leg supported by partner. Gravity neutral, good for fast second stage. May be a comfort position for mom.

 

 

Kneeling positions. These work fine if you have no pain medication, or narcotics only. [If you have epidural anesthetic: These may be possible with a light epidural. You can ask your caregiver if it would be possible to try these positions, but you will need help getting into these positions (moving the IV tubing, catheter tube, monitor wires and so on so they’re not tangled around you is a production in and of itself!). Once you are in these positions, you would need to be “spotted” (have one person on each side of you, making sure you stay balanced and stable.)]

 

 

 

 

Kneeling. Hands on the bed, and knees comfortably apart. Or one knee up. Good for reducing tears and episiotomies. May be restful for mom.

 **

 

Hands and knees. Arch your back occasionally for increased comfort. Great for back labor, big babies, posterior babies. Many find it most comfortable.

 

 

 

Upright positions / Squatting. These will not be possible if you have had an epidural, because with an epidural, you typically can not get up out of bed.

 

Sitting: On the toilet, on thighs of support person, on birthing stool/chair, on partner’s lap. Opens pelvis, gravity enhancing, natural pushing position.

  **

Squatting / Supported Squat. Opens pelvis, gravity enhancing, sense of control for mom. During squatting, the average pelvic outlet is 28% greater than in the supine position. Stand, or sit back to relax in between contractions.

 

Dangle. Gravity, no external pressure on perineum / pelvis. Feeling of being well-supported. May be difficult for mom to see or touch baby during birth.

 

Compiled by Janelle Durham. Source: The Labor Progress Handbook by Penny Simkin and Ruth Ancheta. Several other books, classes, etc.  ** Starred illustrations by Ancheta. All other illustrations, Janelle Durham.

Transition to parenthood



Turning Fear and Pain into Relaxed Focus for Birthing

When my wife became pregnant with out first daughter, we did a lot of research into my wife’s family birthing experiences and other cultures. We found that her grandmother gave birth in a Hawaiian sugar plantation by herself.

Two children were born to her in this manner. There was no pain or distress. Labor was a matter of minutes once her waters had broken, she took a day off work, and resumed work the next day with her baby strapped to her back.

To her such an outcome was unremarkable. A later birth in the local hospital was another matter. She reported that as very painful and the labor took 10 hours. She found the whole experience very unpleasant, and demeaning in how she was treated.

We found several cultures where birthing is gentle, quiet, relatively painfree, and labor is measured in minutes once the water bag has broken. (This is not to say that conditions are ideal in many other areas in these cultures. They are not.)

We decided after comparing home birth with hospital birth to have our baby at home. We found a very supportive and kind midwife and ignored the warnings of disaster and threats of prosecution for manslaughter if anything happened to either mother or child!

homebirth

When her waters broke her contractions were strong and regular and birth seemed imminent. Then as soon as the midwife and two friends arrived everything stopped. My wife was displaying symptoms of fight or flight. So I sent everyone out of the room to make tea, and as flight was impossible I got her very angry and for quite a while she pounded the pillows and mattress and shrieked her rage as loud as she could.

Once she had discharged her rage her contractions restarted and her cervix dilated, and she had a very easy birth. This experience gave me a new perspective on birth and how the birth process can be effected. From then on whenever I was called upon to attend a birth I began to suggest and apply some techniques that I had developed for mitigating or resolving chronic pain.

For a while I was quite puzzled as to why so many birthing mothers went into fight or flight when midwives, Doulas family or friends arrived or they went to a hospital. Particularly as so many these days have undergone extensive preparation for the birth with relaxation classes. Then I realised that the adrenalin rush is a primitive response designed for survival and we have probably underestimated it’s power, and while conscious training will help under some conditions, if a birthing mother unconsciously senses danger, birthing will cease until either the threat has left or the adrenalin has been discharged with violent exercise, and no amount of training will inhibit it.

We are almost certainly the only species that allows relative strangers into the birthing environment. The cultures that appear to have benign births are those where the birthing mother is attended by people who she has known all her life, or she is encouraged to give birth by herself. Even then, if the wise woman or midwife of the tribe senses a family member present who stimulates tension for the birthing mother she is asked to leave. Which brings me to a very important aspect which can have disastrous consequences for the neonate. It is to do with that we are also the only species which allows strangers into the nurturing environment before maturity.

Happy birthing and nurturing.
Rayner Garner <intuit@ncal.verio.com>

gentlebirth.org 

Photo by Madaisa