The Benefits of Giving Birth Upright

The medical model of labour care has become so entrenched in society that it’s now become the norm for women to believe they should labour lying flat on a bed. But this was only because obstetricians and midwives wanted easier access for examinations and interventions, and this is how they were trained.

However, there is very little evidence to support the effects of this physiologically dysfunctional birthing position.

But what if women got up off the beds and used gravity and movement to help the baby out. This reduces the feelings of pain as well as the time it takes to coax the baby out. When upright, women can work with gravity and the body's natural functions in labour to help the baby’s descent.

There’s a lot more research supporting the benefits of the freedom of movement during labour. Here's a potted summary:

#1: Gravity

#2: Fewer Interventions

#3: More Efficient Contractions

#4: Less Pain

#5: Shorter Labour

#6: Improved Oxygen and Blood flow To the Baby

#7: Overall Satisfaction with the Birth

#8: Significantly Increases Pelvic Space

#9: Lying Down Means Pushing “Uphill”

Feel the fear and birth anyway

Fear = tension = pain

Knowledge breaks the cycle of pain.

Don’t judge the pain of contractions; it’s just the muscles around your uterus contracting to move your baby out of your body. Think of the waves as positive sensations bringing your baby to you.

Many women find that by simply accepting strong powerful sensations as a key part of moving the baby out and breathing with the squeezes, rather than tensing up and being scared, they are pleasantly surprised by how manageable labour can be.

Think of it as a process.

We all respond to pain differently, based on our own levels of fear and anxiety, which is also what controls our pain threshold.

Sighs and low sounds will help you let go of tension in your body. When you open your mouth and moan, you relax your birthing muscles, allowing them to open more easily. Humming, mooing, singing, but keep the sounds low to keep bringing down the pitch.

Using mind over matter and mindfulness the perception of negative can be reframed. 5 positives outweigh 1 negative. Keep telling yourself positive things.

The more positive messages you give yourself about any task, the easier it is. It helps if others around you remind you of your strength and the wonderful reason for labour—your baby!

What is pain?

P - purposeful

A - anticipated

I – intermittent

N – normal

Pain is created by the brain. There is no pain in the body unless the brain translates it as that. So if the mind is strong, the brain doesn’t translates pain into something overwhelming.

Breath is a natural pain reliever. Deep breathing can really help during contractions, concentrate on the breath and it might help. Breathe in through the nose and out through the mouth. In breath 4, out breath 8.

Several studies have shown that women who use no labour medication are the most satisfied with their birth experience.

And those who had epidurals were the least satisfied with their experiences birth (probably because of higher rates of intervention).

Giving birth can be a huge challenge but no two births are alike and no two women have the same degree of labour sensations so it mostly comes down to individual pain thresholds and a belief that you can do it! And the belief of a partner who believes in you and keeps saying: “You can do it!”

It's totally different for everybody, but knowing all the options gives women so much more control over the labour process.

It’s All About Hormones

The medicalization of birth over the last 50 years has mostly served to take away the labouring woman’s ability to tune into and surrender to the hormones in her body that guide the way for birth.
   
Instead, the catalogue of drugs that are now considered a normal part of birth are having a devastating impact on the natural symphony of hormones that left to their own devices should smoothly deliver a baby without any interference.

It all starts with estrogen and progesterone, which are the main hormones for “setting the scene” during pregnancy and organizing other hormonal systems ready for birth. Progesterone is what sustains the pregnancy for the required amount of time, and estrogen then kicks towards the end to increase the number of oxytocin receptors in the uterus to prepare it for labour contractions.
       


Other hormones of labour are endorphins, catecholamines (epinephrine/adrenaline and norepinephrine/noradrenaline) and prolactin, which I’ll write an in-depth blog post about soon.    

Scientists are also starting to understand about the hormonal messages that are sent from the baby to the mum as a signal that the lungs (the last organ to develop fully in utero) are fully formed therefore the baby is ready to be born.

Researchers at the University of Texas Southwestern Medical Centre, found that a protein within lung – surfactant - serves as the key hormone to signal that the fetal lungs are mature enough to withstand the transition from breathing through the umbilical cord to air-breathing. Surfactant sends the signal to the mother's uterus which may be the first hormonal signal for labour to begin.

There’s still many questions left unanswered but the scientists are working on those, especially trying to better understand what causes preterm labour. So far, their findings show a connection between a silent bacterial infection in the uterus and preterm labour. If you want to read more about the science, you can find all the summaries here.


These advances in medical science are showing us that the widespread policy of induction and active management of labour goes against the body’s natural hormonal process.

Induction of labour alters the process of nature’s plan in significant ways:

Induced labour is usually more painful, and women who are induced are more likely to ask for an epidural because the body’s natural pain relievers – endorphins – have not had a chance to kick in and are dampened down by each synthetic hormone put into the body.

Women are placed into a higher risk category following induction and are more likely to have an epidural, assisted delivery (forceps or vacuum), a caesarean birth and premature babies.

Due dates aren’t an exact science, only guess dates, because every baby matures at a different rate. So the best advice is to wait until the baby’s lungs sends the signal to the mum’s hormones saying their lungs are mature enough for life.
   
Induction rates have increased dramatically in the last few decades, yet induction isn't always successful. Labour may not start, and it can be very frustrating for women in this situation, feeling already on the clock and that if induction fails, then a caesarean is more likely.
   
The impact of synthetic oxytocin, the induction and 'speed-up labour' drug, is dramatic and can lead to a cascade of intervention. It dampens down the body’s ability to cope with labour pain (endorphins), it dampens down the natural contractions of the muscles to expel the baby from the uterus (oxytocin) and it dampens down the final baby ejection reflex (adrenaline) that gets the baby born. The result is a labour that is more difficult to manage, and the fetal monitor and IV line make movement more difficult.
   
NICE guidance makes it clear that a woman’s decision about whether or not to have an induction should be respected, and that the exact timing should take into account her preferences and circumstances. Some women may take up the offer of induction because they're feeling really heavy and uncomfortable; while others may feel it's not right for them and wish to wait a few more days to let labour starts spontaneously. Medics have to respect that and can't pressure a woman into anything she doesn't give her consent for.
   
But it’s hard when the ‘experts’ are saying “your baby is getting too big” or “your blood pressure is a bit high” or “going past your due date is dangerous for the baby”.

What is recommended by the holistic birthing community is to go along with nature’s plan and let your baby set the scene, not the doctors. Make your own choices and if the doctor seems to be recommending induction but you don’t feel ready, you can simply say ‘I understand your concerns, but I feel my body will tell me when my baby is ready to come’.
   
It’s very hard to do this, but just know that you are the expert over your own body and this is your baby, your decision, your life. You are the consumer of the hospital and ultimately, it is your final decision.

It’s All About Hormones

The medicalization of birth over the last 50 years has mostly served to take away the labouring woman’s ability to tune into and surrender to the hormones in her body that guide the way for birth.
   
Instead, the catalogue of drugs that are now considered a normal part of birth are having a devastating impact on the natural symphony of hormones that left to their own devices should smoothly deliver a baby without any interference.

It all starts with estrogen and progesterone, which are the main hormones for “setting the scene” during pregnancy and organizing other hormonal systems ready for birth. Progesterone is what sustains the pregnancy for the required amount of time, and estrogen then kicks towards the end to increase the number of oxytocin receptors in the uterus to prepare it for labour contractions.
       


Other hormones of labour are endorphins, catecholamines (epinephrine/adrenaline and norepinephrine/noradrenaline) and prolactin, which I’ll write an in-depth blog post about soon.    

Scientists are also starting to understand about the hormonal messages that are sent from the baby to the mum as a signal that the lungs (the last organ to develop fully in utero) are fully formed therefore the baby is ready to be born.

Researchers at the University of Texas Southwestern Medical Centre, found that a protein within lung – surfactant - serves as the key hormone to signal that the fetal lungs are mature enough to withstand the transition from breathing through the umbilical cord to air-breathing. Surfactant sends the signal to the mother's uterus which may be the first hormonal signal for labour to begin.

There’s still many questions left unanswered but the scientists are working on those, especially trying to better understand what causes preterm labour. So far, their findings show a connection between a silent bacterial infection in the uterus and preterm labour. If you want to read more about the science, you can find all the summaries here.

These advances in medical science are showing us that the widespread policy of induction and active management of labour goes against the body’s natural hormonal process.

Induction of labour alters the process of nature’s plan in significant ways:

Induced labour is usually more painful, and women who are induced are more likely to ask for an epidural because the body’s natural pain relievers – endorphins – have not had a chance to kick in and are dampened down by each synthetic hormone put into the body.

Women are placed into a higher risk category following induction and are more likely to have an epidural, assisted delivery (forceps or vacuum), a caesarean birth and premature babies.

Due dates aren’t an exact science, only guess dates, because every baby matures at a different rate. So the best advice is to wait until the baby’s lungs sends the signal to the mum’s hormones saying their lungs are mature enough for life.
   
Induction rates have increased dramatically in the last few decades, yet induction isn't always successful. Labour may not start, and it can be very frustrating for women in this situation, feeling already on the clock and that if induction fails, then a caesarean is more likely.
   
The impact of synthetic oxytocin, the induction and 'speed-up labour' drug, is dramatic and can lead to a cascade of intervention. It dampens down the body’s ability to cope with labour pain (endorphins), it dampens down the natural contractions of the muscles to expel the baby from the uterus (oxytocin) and it dampens down the final baby ejection reflex (adrenaline) that gets the baby born. The result is a labour that is more difficult to manage, and the fetal monitor and IV line make movement more difficult.
   
NICE guidance makes it clear that a woman’s decision about whether or not to have an induction should be respected, and that the exact timing should take into account her preferences and circumstances. Some women may take up the offer of induction because they're feeling really heavy and uncomfortable; while others may feel it's not right for them and wish to wait a few more days to let labour starts spontaneously. Medics have to respect that and can't pressure a woman into anything she doesn't give her consent for.
   
But it’s hard when the ‘experts’ are saying “your baby is getting too big” or “your blood pressure is a bit high” or “going past your due date is dangerous for the baby”.

What is recommended by the holistic birthing community is to go along with nature’s plan and let your baby set the scene, not the doctors. Make your own choices and if the doctor seems to be recommending induction but you don’t feel ready, you can simply say ‘I understand your concerns, but I feel my body will tell me when my baby is ready to come’.
   
It’s very hard to do this, but just know that you are the expert over your own body and this is your baby, your decision, your life. You are the consumer of the hospital and ultimately, it is your final decision.

Top 10 Tips for Labour and Birth

The UK's Royal College of Midwives has put together a Top 10 Tips for labour ad birth, as part of its Better Births Initiative/Campaign for Normal Birth. It's a great list, so I'm presenting an abridged version, but you can also read it in full list with more details here.


1. Labour takes time
Try not to watch the clock. Remember that each contraction is one less to go before you have your baby. Stay at home as long as possible and try and keep busy.
 
2. Create a happy birth environment
Think about how you can create warmth, comfort and privacy in your chosen birth environment. Think about changing the room temperature, lighting or position of the furniture. Think what you might take from home to make the room more comfortable for you.
 
3. Stay active
Changing position during labour and keeping active can really help. Try swaying, rocking, or wriggling your hips, walking, and going up and downstairs. Use a birth ball or other means of support, like your birth partner/s or midwife that lets you relax but helps you remain upright and mobile.
 
4. Understand all your options
Another useful tool for labour and birth is having a good understanding about what might happen and how you want to deal with it. Find out as much as you can about techniques to help you with your contractions, for instance: breathing, using water, massage, a TENS machine, complementary therapies or hypnotherapy (hypnobirthing), as well as other medical forms of pain relief and intervention.
 
5. Ask for help or reassurance
It’s very normal for women to feel that they can’t cope at some point during labour (usually towards the end) so ask for help if you need it. You could ask for some time alone with your birth partner so that he or she can soothe and encourage you and you can also remind yourself of your birth plan.

6. Make a birth plan
It can help to write a birth plan with your birth partner(s) so you both know what your preferences and plans for birth are. On the day, your birth partner(s) can help remind you of your birth plan and also update the midwife on your preferences during labour.

7. Trust your body
Women’s bodies are designed to give birth and most healthy women can do so without major medical intervention. Try to ‘let go’ and allow your body to work with you and for you.
 
8. Choose the right birth partner for you
For some women, their partner is the best person to be with them during labour and birth, while others might choose a close female friend or relative or perhaps even an independent midwife or doula. Whoever you choose, it’s important that you feel comfortable with them, that you find them calm and reassuring and that they are someone you can communicate openly with.
 
9. Stay positive
Feeling strong, happy and confident releases endorphins and a hormone called oxytocin that actually makes your uterus contract strongly and regularly. This in turn will help to relieve pain and also help you achieve a sense of well-being. You will produce more oxytocin if you try and avoid feeling afraid, anxious, embarrassed or angry, and if you remain upright and have privacy and support.
 
10. Cuddle your baby close after birth
Your baby will have strong instincts to bond and breastfeed straight after birth. Cuddling your baby on your chest skin-to-skin (without clothes, towels or blankets in the way) will help your baby stay warm and secure, begin to bond with you by gazing at your face and start to breastfeed successfully. Your baby may turn towards your nipple and open her mouth. You may like to help her find your nipple. If you have a caesarean, your midwife can still help you have skin-to-skin contact and breastfeed.

RCOM videos about positions for labour and birth
http://www.rcmnormalbirth.org.uk/birthing-positions-in-practice/short-videos-for-birthing-postions/
 

Delayed Cord Clamping Makes Stronger Babies

Numbers for sudden unexplained infant deaths, or cot deaths, have reached the lowest all-time record in England and Wales, according to new figures.

Experts have jumped in to attribute this to many factors including: fewer women smoking, warmer than average temperatures throughout the year, and a greater awareness of safer sleeping practices (back to sleep).

But another reason has been suggested by Amanda Burleigh at Optimal Cord Clamping #WaitforWhite. “Could this be a decreased incidence of immediate cord clamping perhaps?” she asks. “More babies are now getting their full quota of blood and other unknown goodies.”

Delayed cord clamping is finally becoming the default practice with babies receiving a third more of their blood if the cord is left until it goes white.

More blood equals more oxygen pumping around the baby's little body, which means an increased capacity for better breathing. This means the difference of around 150ml in their little bodies from a total available blood bank amount of 450ml.

In November 2014, NICE, the UK agency that provides national healthcare guidance, recommended that hospitals defer cord clamping from 1-5 minutes - the result is that now the majority of hospitals in the UK and Ireland don’t cut cords until they stop pulsating (around 3 minutes).

Whilst there is scant evidence linking cord clamping with improved neo-natal outcomes, the body of research is growing gradually.

Recent Swedish research suggests that it helps to improve children's fine-motor and social skills by age 4 years because of the way it boosts iron levels between the critical growth spurt period of 4- to 6-months. The extra store of iron prevents iron deficiency, which has been linked to developmental problems in both motor control and mental skills.

Sudden infant death syndrome (SIDS) struck 128 times in 2014 (ONS figures only show England and Wales), compared to 165 babies who died the previous year. When ONS first started recording these numbers, that number was 207 in 2004.

Overheating is a known risk factor for cot death and during cold winters the risk of the baby getting too hot under extra clothing and blankets is increased.

Here are some of the measures parents can take to lower the risk of sudden infant deaths:
  • Always place baby on their back to sleep
  • Avoid smoking when pregnant or around the baby.
  • Place baby in a separate cot or Moses basket in the same room as you for the first six months.
  • Use a good condition, firm, flat and waterproof mattress for baby.
  • Don’t sleep on a sofa or in an armchair with your baby.
  • If you smoke, drink or take drugs or are extremely tired, don't sleep in the same bed as the baby.
  • Avoid letting the baby get too hot.
  • Don't cover baby's face or head while they are sleeping or use loose bedding.
References:
Andersson, Ola. Uppsala University, Sweden. Published in JAMA Pediatrics. (May 26)
Office for National Statistics (ONS). Birth and Death Statistcis for 2004: England and Wales. (Aug 2016)

Next 1-day Antenatal Class

SUMMER SALE
New revised price and date:
 
Sat 10 Sept
€85 for all of the below:


Sat Aug 27
10am-4pm
+ a follow-up 2 hour evening 

Here's a list of issues the class will cover:
  • Concerns about giving birth
  • Signs of labour
  • Comfort measures - things you can do to help with contractions
  • How the pelvis/uterus works to birth your baby
  • Hormones at work during childbirth
  • Informed decision making to help you communicate with medical professionals
  • Induction and interventions
  • Pain relief
  • The role of the birth partner
  • Postnatal information - delayed cord clamping, placenta, breastfeeding, safe sleeping, sling wearing, settling a baby
  • Information tailored at individual needs – small, informal group setting with time you're your questions and discussions
  • 1-Year’s Cuidiu membership included http://cuidiucork.net/
  • Interactive DVD of CUMH (optional) 
Price: €100 for the full day + a follow-up evening on a date agreed by the group 
+ a bumper pack of information-rich handouts.

Email me at totallybirth@gmail.com for more info and a booking form.

Thanks,

Amy Vickers

Next 1-day Antenatal Class

Sat Aug 27
10am-4pm
+ a follow-up 2 hour evening 

Here's a list of issues the class will cover:
  • Concerns about giving birth
  • Signs of labour
  • Comfort measures - things you can do to help with contractions
  • How the pelvis/uterus works to birth your baby
  • Hormones at work during childbirth
  • Informed decision making to help you communicate with medical professionals
  • Induction and interventions
  • Pain relief
  • The role of the birth partner
  • Postnatal information - delayed cord clamping, placenta, breastfeeding, safe sleeping, sling wearing, settling a baby
  • Information tailored at individual needs – small, informal group setting with time you're your questions and discussions
  • 1-Year’s Cuidiu membership included http://cuidiucork.net/
  • Interactive DVD of CUMH (optional) 
Price: €100 for the full day + a follow-up evening on a date agreed by the group 
+ a bumper pack of information-rich handouts.

Email me at totallybirth@gmail.com for more info and a booking form.

Thanks,

Amy Vickers

A squat a day keeps the chiropractor away

I read an article recently singing the praises of squatting.
 
It made me just think how much I used to hate squats when pregnant, and even before then when I was fit and active younger version of myself.
 
I just couldn't get anywhere near to the floor. I would always lose my balance and topple over. Then when I was pregnant (3 times), everyone would say “do squats” to open and strengthen my pelvis, but of course I found it even harder to balance with a bump.

Fast forward several years, a misaligned pelvis and thousands spent on chiropractors to fix my stress incontinence (wetting myself when I sneezed, coughed or laughed), I decided to finally bite the bullet. It was time to become a squatter.
So now I squat every day and my pelvis feels strong and flexible and my balance has improved. And believe it or not, I can now actually squat close to the floor without losing my balance.
Here’s the benefits of squatting according to the article:
  1. Increases strength and power.
  2. Improves definition in the legs and butt.
  3. Improves mobility in hips and ankles.
  4. Strengthens and tone the core. 
  5. Improves posture.
 
Some fitness gurus are even advising now to dump the kegels (pelvic floor exercises) and instead do a squat a day.

The aim is to develop an (eventual) deep squatting habit similar to how you might pee or poo while camping) to balance the pelvic floor. Modern toilets prevent us from doing this basic human movement that we used to do all the time.
I found that after 6 months of squatting (feet flat on the ground) whilst holding onto something in front of me, I was suddenly able to widen my stance and squat without having to grab something in front for balance. Success!
 
 
 
The world’s most respected midwife, Ina May Gaskin, famously once said: “Squat 300 times a day, you’re going to give birth quickly.” That is true, although realistically who has time to practice squatting 300 times a day? 

Once is better than none, right?
 
Sadly, I couldn't even contemplate a squat during birth because I didn’t have the strength in my thighs or pelvis, but I wonder what would happen now after my new squat strength? It will just have to remain a theory because I’m too old for any more babies.
The reason why squatting during birth is amazing is due to gravity and how it releases the hips, sacrum and pelvic floor muscles - which basically opens the pelvis up by 30%. Little chance of the baby getting stuck when there's that much extra space in the birth canal.
But if (like me a few years ago) you’re not a natural-born birthing squatter, there’s one other thing you can do to improve your chances of a normal birth whilst minding those pelvic floor muscles: keep upright, open and forward. Otherwise known in birthing circles as UFO, which can help birth to be quicker, faster and less painful.  
Best of luck x
 

2 Part Saturday Antenatal Session

My next 2-session Cuidiu Childbirth and Early Parenting Class is over two Saturdays and early 2016:

Part 1: Sat 30 Jan @ 10.30-3.00pm
Part 2: Sat 6 Feb @ 10.30-3.00pm

Here's a list of issues the class will cover
• Concerns about giving birth
• Signs of labour and when to go to hospital
• Comfort measures - things you can do to help with contractions
• How the pelvis/uterus works to birth your baby
• Hormones at work during childbirth
• Informed decision making to help you communicate with medical professionals
• Induction and interventions
• Interactive DVD of CUMH (optional) and loads of info about CUMH
• Pain relief options
• The role of the birth partner
• Postnatal information - delayed cord clamping, breastfeeding, safe sleeping, sling wearing, settling a baby
• Information tailored towards individual needs – small, informal group setting with time you’re your questions and discussions
• 1-Year’s Cuidiu membership included

Price: €65 for two days + a bumper pack of informative handouts for birth and beyond.

Email me at totallybirth@gmail.com for more info and a booking form.

Thanks,

Amy Vickers

Planning a Home Birth after a Caesarean

Here's a guest post by Niamh C on planning a Home Birth after Caesarean (HBAC). We wish Niamh loads and loads of good vibes and best wishes to achieve her goal of a homebirth.

My first pregnancy was a gentle surprise so hadn’t really thought about what type of care I would like; to be honest I didn’t know I had a choice. I went to my GP, had my pregnancy confirmed and asked for her advice on which hospital to attend. She told me they were all the same so I picked the one closest to my work. I decided to go semi-private so I didn’t have to wait in the public clinic for my appointments.
For the most part, until my last appointment, I was happy enough with my antenatal care. In my last appointment at 41 weeks, with some protest, I was booked in for induction at 41+4. By this point I had done some research and wanted to avoid interventions as I knew there was a higher risk of assisted delivery or c section. I had also decided that if I had more children I would consider having them at home.
My experience of the midwives and care on the induction ward was unfortunately not positive, nor was my delivery which did end up in an emergency c section. Mine and my son’s postnatal care was mixed with positive and some very negative experiences. I got home and got on with life with a newborn but as time went on realised I needed to heal from my birth trauma. As I went through this process I knew I wanted to avoid a c section for any subsequent births so started to research Vaginal Birth After Caesarean (VBAC).

My research assured me that this would be safest and best option for me. One of the main concerns for VBACs (and HBACs) is the possibility of uterine rupture due to scar separation. The research shows that in the setting of a large Irish maternity hospital with strict guidelines for a Trial Of Labour After Caesarean, the Uterine Rupture rate was 2 per 1000 (0.002%) overall, and 1 per 1000 (0.001%) for women in spontaneous labour who did not receive oxytocin augmentation (Turner et al, 2006).

I lusted after homebirth but I knew it was against HSE policy so it would never be a reality.  Then I heard of a private midwife company that had recently entered Ireland and was supporting mums to have a Home Birth After Caesarean (HBAC). I refocused my research and started looking into the safety of HBACs.  Again, from all the evidence I trawled through it became apparent that HBACs were actually very safe for uncomplicated pregnancies and that I was much more likely to be successful in my quest for a vaginal birth with this option.

I live a ten minute or less ambulance ride from the hospital and a skilled midwife who knows you well should pick up on any issues long before they become and emergency and you would be transferred to hospital. Also repeat c sections are not without risks. So when I got pregnant I contacted the private midwife company. I asked lots of questions and decided to send my notes from my previous birth to get reviewed by their obstetrician to see if I was a good candidate for HBAC. I was given the all clear. I joined a Homebirth Facebook page and started soaking up all the information and the wonderful stories. One day I thought to ask in the Facebook group what was the best thing for you in your homebirth and below are some of the answered shared. All names given with permission. 

Not having to think about when to go to hospital, being in my own space, being able to point to exactly where my baby was born. If I moved house I think I'd cut out that piece of the floor and bring it with me – Lisa
Having the bedroom windows open looking out onto the woods by our house and breathing in the air it felt like pure freedom and space – Abigale

Everything, Continuity of outstanding care, home visits, comfort of my own bed and not leaving the older child. – Sinead
Being able to labour to the sounds of Madonna, have a home made Thai curry, showering in my own shower and finally the 3 of us falling asleep in our own bed as a new family! Bliss! – Dil Wickremasinghe

Everything - the relationship you build - it's the only set up whereby you know who your midwife will be at delivery which is so important - cuts out the panic of "I hope we have someone nice/respectful of my wishes”. Visits in your home - no need to have other kids minded and have to get to a hosp. The fact that the whole family are part of it - get to know the mw too. Not having to transfer to hospital mid labour I always hated that bit - the nerves kicked in and so did the pain. The environment is home not a clinical room. The getting into your own shower and then into bed - my [son] arrived home from Montessori to meet his new brother and still says the reason why Ted loves him so much is because he saw him first. There is no rush to get out of where you gave birth no worrying will I get a room? People can come visit you whenever you like. The aftercare is amazing. It's platinum service – Emma
So many things. What stands out most for the first birth would be being in the pool by the roaring fire and Christmas tree and so much love in the room and for the 2 births to follow nothing could compare to waking our eldest up within 20minutes of each birth and watching her hold her brother and sister and without any prompt begin to sing to them. Can't sign off without saying on top of the list would also be our midwife Kate who made us feel so empowered having made the decision to have a home birth – Mellissa

Other common themes included older siblings being present, feeling respected and powerful, continuity of care and the relationship built with your midwife, sleeping in your own bed afterwards with partner present and the post birth meal of whatever you wanted and not just tea & toast!
I’m about half way through my pregnancy now and feeling very positive for a homebirth. I’m also really excited about the labour and birth process; I’m actually looking forward to it, after my last birth I never thought that would happen.

For more information on homebirths check out www.homebirth.ie
Niamh

Just think of a bagel

Most of us know that women need their cervix to open up by 10cm to be able to give birth to babies.

I found an interesting visual a friend shared on Facebook to demonstrate the journey the cervix takes in opening, using every day spherical food objects.

Not to scale!
The comments from people included: "If only it was just a bagel I have to get out of there!" and "I was a bagel in THREE AND A HALF HOURS WITH NO PAIN RELIEF".

Hospitals are fixated with VEs - Vaginal exams - so they can write down how many cms women are dilated by during labour.

Current guidelines recommend that VEs are offered to women at regular intervals of 4 hours to assess labour progress, but they only give progress for the second that they are being done.

They are not an accurate gauge of when a woman will give birth. I had one client recently who said she went from 3cms to 9cms in 5 mins which totally took the midwife by surprise.

Vaginal exams are also not very good predictor of when labour will start as women can be 6 cms dilated for weeks before labour begins.

They can increase the risks of infection, even when done carefully and with sterile gloves because they push the normal bacteria up towards the cervix. There is also increased risk of rupturing the membranes (accidentally breaking the waters). And let's face it, nobody ever said how much they liked having one done - it's the hospital equivalent of being 'fisted'!

The upshot is there is no science behind VEs. And because every midwife has different sized fingers, the measurements can vary from midwife to midwife. So if your midwife ever says to you during labour: "You're still only 3cms" - say to yourself instead "yes, I'm dilating - I'm a slice of Banana" (see visual), because positive thinking can get you a very long way in labour.

Just remember, a bagel isn't that much bigger than a banana. And if you don't like bagels, maybe you could visualise a donut or a scone instead, yum yum!

 

What is Sphincter Law?

Well-respected midwife Ina May Gaskin describes something called Sphincter Law in her book Ina May’s Guide to Childbirth

While it may sound funny, there is much truth to this theory, especially in relation to birth. 


Here are some of the basics of her Sphincter Law:
  • Sphincters function best in an atmosphere of intimacy and privacy, for example, a bathroom with a locked door or a bedroom where interruption is unlikely or impossible.
  • These sphincters don't open at will and do not respond well to commands (such as Push! or Relax!).
  • When a person’s sphincter is in the process of opening, it may suddenly close down if that person becomes upset, frightened, humiliated, or self-conscious. Why? High levels of adrenaline in the bloodstream can actually prevent the opening of the sphincters. This inhibition factor is one important reason why midwives are the favoured global professional of choice for assisting women in labour. 
  • The sphincter muscles are more likely to open if the woman feels positive about herself; and feels inspired and enjoys the birth process. The uterus responds to emotions, so find support partners in birth who support you emotionally.
  • Sphincter muscles may suddenly close even if they have already dilated, if the woman feels threatened in any way.

One way we can help a woman adhere to the rules of the Sphincter Law is to allow her to have a sense of privacy with as little distraction as possible. Keep the lights low, the traffic in and out of the room to a minimum, and try not to stimulate the neocortex (the ‘thinking mind’) with unnecessary questions. 

When the woman is feeling safe and cared for, her body will respond. The sphincters will open, and her baby will come out more easily, with less stress for all involved. 

So what does the sphincter law tell us about the emotional state of the labouring woman? If the mother is feeling shy, judged about her birth choices, or embarrassed about the sounds she is making or the way she moves her body, she will not open up. If the mother is feeling pressured, she will not open up. 

For these reasons, it is very important for the woman to consider who will be with her during her labor. Labour and birth is a personal experience that can be hindered or helped depending on who is involved. 

Try to recreate the atmosphere that got your baby into your belly in your first place - the same love, oxytocin and endorphins is what is needed to help the body surrender to the process of birth. 

As Ina May describes, in order for the body to successfully open, it has to feel safe and comfortable, not scrutinised and pressured. 

It is unfortunate if the woman has a midwife she does not like, and if she is not getting along with her midwife, she can ask for a new midwife or at least she ask for student midwives to leave the room if she wants more privacy.

Be wise about who you invite into your sacred space. It is not a time to worry about hurting someone’s feelings. Enclose yourself with people who support you unconditionally and who give you the least amount of disruption and disturbance as possible. 

Create a sacred space and think of birth as your baby's rite of passage. I've seen people take fairy lights into hospitals so that they can turn off the bright lights and have pretty subtle lighting. People also take aromatherapy infusers and relaxing music or guided meditations. Massage and encouraging words from a support partner can also be great to help women to open up, and lots of water (baths or showers) to sooth and relax your muscles. 




Two-part Sunday Cuidiu Antenatal Class

I'm running my next two-part Cuidiu Childbirth and Early Parenting Class, beginning on Sunday 29th of November and winding up the following Sunday.

Part 1: Sun 29 November @ 10.30-2.30pm
Part 2: Sun 6 Dec @ 10.30-2.30pm


Here's a list of things classes cover:

• Concerns about giving birth
• Signs of labour
• Comfort measures - things you can do to help deal with contractions
• How the pelvis/uterus works to birth your baby
• Hormones at work during labour
• Informed decision making to help you communicate with medical professionals
• Induction - cascade of intervention
• Interactive tour of CUMH
• Pain relief
• The role of the birth partner
• Postnatal tips - delayed cord clamping, placenta, breastfeeding, sleeping, settling a baby
• Information tailored at individual needs – small, informal group setting with timeyou’re your questions and discussions
• 1-Year’s Cuidiu membership included


Ideal from 25 weeks of pregnancy.

Price: Special Half Price discounted rate of €40 for the 2 sessions. You also get a FREE bumper pack of invaluable handouts for birth and beyond.

Located in central location on Midleton Main street.

Email Amy @ totallybirth@gmail.com for more info, or check out the Facebook event, thanks: https://www.facebook.com/events/686815691452804/

Thanks,

Amy Vickers


 

6 Things You Can Do To Make Your Labour Easier:

  • Let labour begin on its own
  • Trust your inner wisdom
  • Move around freely throughout labour
  • Demand continuous empathy and support
  • Find comfort measures that help work for you
  • Push on your own terms in an upright position

If birth is feeling alien to you, remember UFO

Upright
Forward
Open

That gives you 30% extra space in your pelvis to ease your baby out into the world.
 

The Best Advert for Natural Birth

How does she do it? She makes childbirth look easy - even down to the light coloured dress, tan tights and high heels worn less than 10 hours after pushing out a baby.

If there ever was an advert for natural birth, Kate Middleton is it. She glowed, smiled and looked relaxed whilst holding her brand new baby in her arms just hours after giving birth.

For Kate, I reckon it’s because of all the support she got during pregnancy, labour and her positive attitude to birth. After her 1st birth she apparently told friends about her 'perfect, natural birth’ and it was suggested that she had used hypnobirthing (positive affirmations and deep relaxations).

Media reports have suggested that Kate had a natural birth, which means no epidural, no doctors - just two strong, independent midwives tuning into the needs of a woman and her body. How else could she feel capable enough to transfer home so soon after giving birth?



If I had to guess, she laboured at home as long as possible – supported by her midwives - then moved to hospital when she was around 5cm and labour was fully established. That way the adrenaline of going into hospital didn’t stall the labour. Once ready to push, all that the midwives had to do then was catch the Royal baby. It is even believed she gave birth upright, much like her late mother-in-law Diana (as revealed by Sheila Kitzinger in A Passion For Birth), co-incidentally in the same London hospital.

It just goes to show that all you need is good preparation and a midwife. Oh and if you’re a princess, perhaps a hairdresser!

Kate enlisted midwife Arona Ahmed and Professor of Midwifery at Imperial College, Jacqui Dunkley-Bent, to be by her side. They were the same midwives who assisted in the birth of Prince George and probably among the most qualified and well-respected midwives in the UK.

But apart from having good support, Kate is also said to have educated herself well about giving birth and written out a full birth plan of her preferences for a hands-off labour. This means that she controlled the birth herself, and knew instinctively what to do. Education about birth gives you power and leads to less medical interventions it gives you the confidence to say “I need more time” or “I do not consent to that”. These two simple phrases often mean that caregivers leave you to find your own groove during birth which helps you to feel more in control of the situation.

The cornerstone of Cuidiú antenatal classes is informed decision making, which encourages people to become informed, ask questions, and then make their own decisions, even if this is contrary to hospital policy on inductions and interventions.

We use an acronym tool called BRAIN (see box) as a way of empowering women to have a voice in labouring suites when hospital policy puts them on the clock to dilate by 1cm every hour. If their body doesn’t comply with this extremely fast rate of progress, they are given the damaging label of ‘failure to progress’, which can often lead to a traumatic use of forceps or c-birth.


Using your B-R-A-I-N during labour:
Benefits: how will this help me, my baby & my labour?
Risks: what risks to me, my baby & my labour?
Alternatives: what are my other options?
Instinct: what does my gut tell me?
Need time: what if I do nothing right now? I would like to wait for now.

The increasingly medicalisation of birth has led to an increase in feelings of dissatisfaction with birth and a rise in the number of women suffering birth trauma, post-traumatic shock and post-natal depression. Studies show that it’s not just about holding a baby in your arms at the end of it, it’s about how you feel, because it can haunt you for years and affect you deeply.



A survey from the Birth Trauma Association in 2010 found that nearly 70 per cent of women did not have the birth experience they wanted. A third said they were not treated with dignity and respect, and were not given proper information and/or explanations during their labour. Many cited ‘loss of control’ and ‘lack of communication’ as key factors in their negative experiences, and some said they felt ‘bullied’, ‘ignored’ or ‘dismissed’ by overstretched staff.

Sometimes a birth does not go according to plan. Babies can be positioned unfavourably, or various complications can occur which mean the baby needs to be taken out quickly. Not everyone can have such a seemingly straight-forward birth as Kate Middleton. But quick birth can be traumatic too, given that it doesn’t give the mind and body enough time to process what’s going on, and can lead to giving birth in unplanned locations, which can contribute to shock.

No birth is ever easy and we don’t really know the truth of Kate’s birth or how she’s feeling because she never reveals anything personal. Fair play to her for putting on such a public display of looking flawless in pale clothes just 10 hours after the birth. That’s the last thing I ever felt like doing after I squeezed a baby out after my exhausting labours. I just wanted to take to my bed and sleep for a week and cuddle and feed my baby.

The upshot is preparation, preparation, and more preparation. The more you know about what could happen will give you confidence, strength and arm you for any discussion you might need to have the birth both you and your baby deserves.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 


Amy Vickers is a recently trained Cuidiú antenatal teacher running new classes packed full of up-to-date, evidence-based information to empower you for a satisfactory and normal birth. If you wish to join Amy’s low-cost Cuidiú 1-day weekend classes in Midleton, east Cork, please get in touch.




References:

The Birth Trauma Association Survey. 2010. Available online: http://www.birthtraumaassociation.org.uk/newsletters/winter2010.pdf

Hodnett, Gates, et al. 2012. Continuous support for women during childbirth. Cochrane database of systematic reviews.
Kitzinger, Sheila. 2015. A Passion for Birth: My Life: Anthropology, Family and Feminism. Pinter & Martin. London.

Korte, Diana & Roberta Scaer. 1992. A Good Birth, A Safe Birth. Harvard Common Press, 3rd ed.