Sunday, 24 November 2013

Freedom for birth

Peace on earth starts with birth.  Sounds cheesy?  Sounds daft?  Surely we don't need to worry about women's rights in childbirth?  Or persecution of midwives?  Our modern obstetrics run maternity care gives us the best outcomes and women don't need to worry any more, right? Wrong.

Midwives are being persecuted for supporting women's choices, and for giving women's choices.  The Albany midwifery practice was shut down and the senior midwife suspended, despite a better safety record than the local maternity unit and for incredible outcomes for women and babies - 99% knew the midwife who attended them at birth, and for 98% of them it was their own midwife; 40% gave birth at home; over 60% gave birth without even needing gas and air, they were so supported and prepared.  After more than three years the senior midwife has been exonerated, just this summer.

This isn't the only case in the UK.

Over in Ireland one woman died because she wasn't allowed to end the pregnancy of the very sick baby inside her.  Another was denied, in court, a vaginal birth after caesarean. She came to the UK and had her baby last month.

Many women are told 'you must' have a caesarean for a breech baby; 'you're not allowed' to go past 42 weeks; 'you can't' have a home birth if its your first baby/no midwives available/high bmi etc.  None of which are true.

Why does it matter?  Babies only get one birth.  Mothers will be making decisions for their babies till they are eighteen.  They should be empowered from the beginning.  Birth does matter.  Birth works best undisturbed.  This leads to better outcomes for babies. The obstetric led model of maternity care does not get it right.  We wouldn't treat our cats and dogs in birth as we do women.  Birth sets up a mother for the post natal period.  To be happy and confident, or confused and scarred.  I have supported women who felt raped by their midwives/obstetricians as they lay naked on the bed with legs in stirrups and arms and hands and instruments entering their vagina, while they shouted 'stop' 'no'. Others so traumatised by how the birth went, and mostly, how they were treated, that it takes years before they are ready to be pregnant again, if ever.

This film highlights human rights in childbirth.  It mostly follows the case of the Hungarian obstetrician, Agnes Gereb, who, unable by Hungarian law to support women at home births, retrained to be a midwife and then was taken to court and is currently under house arrest.  A woman in premature labour had come into her clinic.  Agnes Gereb had taken the women to hospital and the baby died.  The parents know it was not Agnes Gereb's fault.  But it was enough for the authorities to arrest her.  See her powerful story, and those of women and midwives around the world.  Court ordered caesareans in the USA.  Woman denied home birth in Netherlands.  Plus hear wonderful testimony from famous midwives, obstetricians and activists at the first international conference on human rights in childbirth.  Michel Odent; Ina May Gaskin, Sheila Kitzinger, Beverley Beech, Professor Lesley Page, President of the Royal College of Midwives and Cathy Warwick, general secretary of the Royal College of Midwives.

One inspiring film; many people starting a birth revolution.

Wednesday, 2 January 2013

Let your hormones be in the driving seat in labour

Ok, hormones. Giving birth is regulated by the autonomic nervous system. This is controlled by the most primitive part of our brain, sometimes called ‘the reptilian brain’. The autonomic nervous system controls our basic functions: breathing, heart rate, body temperature, digestion, excretion – and giving birth. The autonomic nervous system has two modes of function – the sympathetic and the parasympathetic systems.

In normal daily life, especially when at rest, the parasympathetic system is to the fore and our heart rate is normal, breathing is normal, digestive functions and all the rest are normal. When we encounter stress the sympathetic system takes over as our body prepares for fight or flight. Our heart rate increases, we start to sweat, blood is diverted to our muscles and non-essential processes such as digestion and excretion shut or slow down. I am sure we can all think of times when we were under stress which made it difficult to eat or go to the loo - for example being in a strange place or insanitary conditions such as a festival.  Or becoming relaxed and everythings suddenly working: for example, arriving home from holiday the body relaxes and suddenly we need a poo!

Giving birth, because it is also controlled by the autonomic nervous system is similarly affected. We see this in wild animals – if they are disturbed or feel threatened in labour, labour stops until they feel safe again. Biologically this makes sense as it ensures both mother and baby survive. Interestingly, with animals in advanced labour who are threatened labour speeds up to get the baby out quickly so they can then get to safety.

You can reduce the effect of the sympathetic system by relaxing and breathing calmly and the body returns to normal state with parasympathetic system in the fore.

Birth is affected by three main hormones associated with the autonomic nervous system: oxytocin, endorphins and adrenaline. Oxytocin is like the accelerator of labour. The more oxytocin your body releases the stronger and closer the contractions become. Oxytocin causes the muscles to contract. It is also known as the love hormone as it is released during cuddles, stroking, kissing, nipple stimulation and sex. During climax it is oxytocin that causes ejaculation and vaginal contractions. The release of oxytocin is inhibited by the activation of the sympathetic system due to fear or embarrassment, and also by bright lights.

Endorphins are the body’s natural pain relief, a natural opiate. They are released when we are happy and feel loved, when we are massaged or we rub a part of our body to ease a pain. They are also released when we laugh. Their release is inhibited in the same ways as oxytocin. Where oxytocin was the accelerator, endorphins are the clutch. As oxytocin is released and contractions increase, the body releases endorphins which help you cope with the contractions. This then leads to more oxytocin being released, contractions increases in strength and length as labour goes up a gear. So it goes on: oxytocin is released, contractions increase, endorphins are released, the body copes, more oxytocin is released, contractions increase, endorphins are released, the body copes etc. By the end of labour the cocktail of oxytocin and endorphins creates a natural high. Davina McColl, the presenter, who confesses to using drugs in her past, described the high at the point of birth as the biggest high she had ever experienced. Both mother and baby’s brains are flooded which aids bonding, the contraction of the uterus and breastfeeding.

By contrast, the third hormone, adrenaline is released when the sympathetic system is to the fore. Adrenaline is the brake in this analogy. It is the release of adrenaline that causes labour to slow down or stop. Adrenaline is released when we are afraid, embarrassed, feel lack of control. Remember what happens to other mammals in labour? This happens to women too. It is very common for women who have been labouring well at home to find that their contractions slow or stop when they go to hospital as the adrenaline released by the excitement and anxiety.

Just to complete the analogy: the handbrake in labour is stimulation on the neocortex. The neocortex or fore brain is the most recent part of the brain and controls language and reason. In labour the more primitive part of the brain is in control and there is little activity in the neocortex. Stimulation of the neocortex by talking, or making decisions, wakes up the neocortex which then takes over control of the body resulting in stalled labour. Left undisturbed, women are in ‘labour land’, barely able to talk by the end, or understand speech.

The last hormone to be involved in labour is prolactin. This is released at birth and encourages the placenta to come away and milk to be made.

To put this knowledge into practise think about the following situations you might find yourself in.  What could you, or your birth partner do to restore or protect the flow of positive hormones, keep the parasympathetic system to the fore and reduce the impact on interference?

1. Labouring at home, sunlight streaming in, phone ringing, workmen drilling in the road.

2. Labouring well at home, go into hospital and contractions slow down, you’re told you’re not in proper labour and to go home.

3. You are worried about childbirth, about the baby being okay, about coping with the pain. Your partner has lots of worries about childbirth, about the baby being okay, about you being okay.

4. You are in a hospital room. The lights are bright, the sun is streaming in, you can hear the midwives’ phone ringing at their desk, there are workmen drilling in the car park.

5. Labouring well but every time you have a contraction midwife approaches and puts her hand on your belly and the contractions stops.

6. Labour has been going well and contractions were getting closer and stronger but now are slowing down. Your heart rate is up. You start to worry that everything is going to go wrong.

7. Labour has been going well and contractions were getting closer and stronger. You haven’t seen a midwife in ages and partner is getting anxious. You are picking up on his anxiety.

8. Midwives are talking to you about the time, about when you last went to the loo, or what time the consultant will be around, they are asking you to make decisions about colour of cord clamp or asking you about when you are going back to work.

9. You are on an electronic fetal monitor. Everything is fine but just hearing the beeps is making you anxious. You listen out for every one to check if baby is okay.

Drop me an email and I will discuss this further.  See the next blog post to get ideas too.