Easier Labour and Birth

The Actually Useful, Very Sensible and Practical Guide to Make Birth Easier Part 1 – Introduction

An extract of this was published as a guest post on admissionsofaworkingmother.com April 2016 titled Make Birth Easier.

 

Make Birth Easiermakebirtheasier logo1 colour? Really?

Some people believe there’s not much you can really ‘do’ to make birth easier, shorter or safer.

I am not one of those people anymore.

For some women, medical intervention really is necessary, and I am all for intervention when it’s needed – it absolutely saves lives. Some women really want it – so let them have it. I just didn’t want any intervention if I could help it. Daft as it may sound to some, I was actually more scared of medical intervention than of the labour itself.

I was so terrified of labour in general (the most ‘natural’ thing that a woman can ever do?) that I realised I had to do something about it – this fear I had, I knew, wasn’t going to help me. Being an engineer, I needed to find a solution. What was it that was going to help me get through this?

So began my epic research journey into the world of labour and birth, and I have found not just one but many, super helpful things that really do (no matter how weird or basic some of them may sound) make birth easier.

I am a great believer in sharing useful information so I’ve listed my favourite techniques and tips in this three Part Guide to Make Birth Easier.   I’ve tried to stick to plain English and I’ve given some explanations/translations where I couldn’t avoid using medical language, as not all of us are medically trained.

The Guide to Make Birth Easier is NOT only for vaginal birth. If you do have intervention or even a planned caesarean section, there are some tips to help you and your baby in Part 2 and Part 3 of The Guide.

Please remember that this guide is written for birth in the UK, BUT I am sure there will be things that any mum anywhere in the world could use or find useful.

 

Nature Works – Oxytocin

I do believe that for many women intervention is suggested far too early, when, as I have discovered, many labours need no help whatsoever apart from being left a little longer (stop rushing nature!) or given a little more peace and quiet (why do you think other mammals go and find a comfortable, quiet, often dimly lit space to birth?)

Oxytocin is a naturally produced hormone essential to labour progress (effective contractions), and is also important for bonding with baby and milk production. As a response to the production of oxytocin during labour, the body releases particular endorphins (another type of hormone) which act as painkillers sometimes described as similar to morphine or pethidine.

Yes you read that right – more oxytocin means better labour progress and less pain. FACT.

Oxytocin reduces if mum is anxious or tense, because, fear in the body releases adrenaline which stops the production of oxytocin during labour.

Tension can rise if mum has to move locations or if her birth environment is not private or calm (for example bright lights or extra people coming in and out of the room). This can cause contractions to slow down or even stop, which can in turn lead to the suggestion of medical induction.

Induction drugs such as Pitocin or Syntocinon are synthetic (artificial) oxytocin which are used to induce or strengthen labour contractions, and to control bleeding after birth. Synthetic oxytocin does not behave in the same ways as the naturally produced hormone and it actually inhibits or stops the production of natural oxytocin in the body during labour. While plenty of vaginal births do happen with women who have been induced, induction is a medical intervention, which can often lead to other interventions if contractions become too strong for the baby or placenta.

Contractions during induction can be longer and stronger, without a rest between them. This can be more painful for mum (leading to epidural) and cause fetal distress/reduced oxygen to the baby (leading to csection). Synthetic oxytocin does not cross the blood – brain barrier so you  won’t release the painkilling endorphins as you would with natural oxytocin production. This is another reason contractions can become more painful for mum during induction. Add to this that induction drugs are usually given by IV drip and you are required to have constant monitoring, so you may be told you are confined to bed and not able to move around freely (you could still ask .

Many inductions are carried out to speed things up for convenience (often for care providers, sometimes for mums) and often not for medical reasons. If you’d rather avoid any intervention, you could ask your care providers if there are medical reasons that they have suggested doing it, and if not, could you wait for labour to take its course naturally. Again, cuddles with your partner, and a more relaxed, quiet and dimly lit environment help you to release more of your own oxytocin.

If labour progress does need assistance, wouldn’t it be nice if you could try some alternatives before heading down the medical intervention route? Fast acting alternatives which really work?

 

What Does Fetal Positioning Mean?

Have you spent time spent slouching at desks, driving, carrying a bag on one shoulder, or crossing your legs over your lifetime? Our original mammal design doesn’t account for this type of body behaviour. These repeated unnatural body positions – or even a sudden stop in an accident or during sport – create imbalances in the uterus and surrounding ligaments and muscles. This reduces space in the pelvis and baby’s alignment is affected. Some babies may even turn sideways, back to back or head up due to the imbalance in the uterus. It reminds me of trying to get comfy on a long haul flight actually!

Melman crate

Alignment is something so simple which can in many cases be so easily and gently remedied by mummy rebalancing her uterine area, allowing baby to reposition itself the way nature originally intended.

Fetal positioning techniques are specific techniques which are not only for turning posterior (back to back) or breech (head up) babies. Or transverse (sideways) or oblique (diagonal) babies for that matter. Even a labour with a baby in a seemingly ideal position (HEAD DOWN and facing mummy’s back) can be overly long, or contractions can slow down or stop. This can often be due to something as simple as baby’s head being tilted to the side slightly, the chin not being flexed (tucked in to the chest), or ligaments/muscles being too tight for baby to fit through. These things slow down progress and can make labour unnecessarily long and difficult. Square peg, round hole. Pretty logical.

I have to mention here that even though many malpresented babies (crown of the head is not down first) are sent directly for csection, this is because csection has been used so commonly in these cases, that many care providers these days no longer have the experience of delivering them vaginally. However, there are still care providers out there who are experienced and willing to deliver these babies. If you do want to birth your breech baby vaginally, you may be lucky enough to track down a care provider willing and able to help you.

So a little further explanation on the perceived ideal or so called optimal position…As mentioned above, this is for baby to be head down and facing the mother’s back (often with its back towards the mother’s left side – LOA – see medical terminology I have outlined in Part 2 of this Guide), with baby’s chin tucked in nicely to the chest and the crown (the smallest part of the head) aiming through the pelvis. For malpositioned babies (head down but not in an ideal position), usually time is given for a woman to labour and see if baby will rotate. In many cases this doesn’t work and after a long labour a csection is suggested. Despite this, some women have a pelvis shape that lends itself easily to back to back or breech position anyway. So, if you do labour with a back to back or breech baby, it may be absolutely fine.

Fetal positioning techniques, several of which were developed by chiropractors, gently relax and release tight ligaments and muscles, and balance the uterus, giving baby space to do the subtle movements it needs to and help align the smallest part of baby’s head with the pelvis so that baby’s route into the outside world is as easy and short as possible. The techniques can be fast acting, which is what happened to me in both my labours.

Part 2 of my Guide to Make Birth Easier focuses on the four fetal positioning techniques which have the widest variety of uses.

I practised the techniques  during pregnancy so that they felt easy and comfortable during labour, which is when I used them with greatest effect. These techniques can be used during labour for:

  • contractions with no progress,
  • slow progress,
  • contractions which slow down or stop completely,
  • if you know your baby is in a less than ideal position, or,
  • if you have hip or back pain, or you have swelling on your cervix.

 

You Can Change Your Labour

Some people may be, but I am not, Superwoman. I do not (very definitely do not) have a high pain threshold (at all! I’m a total wimp!) and I wasn’t just ‘lucky’. I worked hard at achieving my easier births because I kind of felt like I had to take action for my own sanity. I believed in the things I’d learnt and I trusted in the knowledge that my body really is designed to give birth (we are mammals after all). I was amazed by the results, as were many midwives and doctors I recounted my birth stories to.

I tend not to use the terms ‘normal’ or ‘natural’ birth, as birth is birth whichever way you do it. Still, this quote comes from the Royal College of Midwives Normal Birth Campaign “Effective preparation – physical, emotional and intellectual – can have a huge impact on birth outcomes. It can significantly increase the likelihood of a normal birth and a healthy baby, and it can greatly enhance the satisfaction of the mother. Good preparation helps to prepare for the unexpected and can thus enable a woman to adjust herself and her expectations if circumstances change”.

So, learn about all your options, non-medical and medical (looks like you’ve already made a great start if you’re reading this). Ask questions. It really did help me have intervention free births and it helped me to prepare in case I did have any interventions, which I certainly would have if I hadn’t learnt about fetal positioning. Knowing fetal positioning techniques was like having a toolkit at my disposal which I could use to solve problems during my labours. It gave me a wonderful feeling of control and something to do and focus on during times of potential anxiety.

Yup that’s right, I did quite literally change the course of my two non-starter labours using the fetal positioning techniques I have included in Part 2 of this Guide – which to me was nothing short of miraculous – so I know firsthand that these tips are not a load of rubbish. This blog is not about bragging that I had good births. It’s about sharing so that other women can also have good births. It’s about sharing the fact that good births are very definitely possible. While I can’t even begin to understand the depth of feeling for those who have experienced traumatic birth – good births do happen and they can happen for you. Not only this but (without other complications), you can make them happen… if you know how.

My first baby wasn’t engaged even after several hours of early labour. The contractions were not increasing in length, strength or frequency. That can often be called ‘Failure to Progress’ and result in intervention such as induction/augmentation drugs and possibly csection. Not for me. I used a couple of the fetal positioning techniques in Part 2 of this Guide to Make Birth Easier and within minutes my labour switched into 6th gear – Strong, long contractions increasing in frequency – fantastic progress! Within a few short hours I gave birth to my baby in the birth centre pool without any intervention or drugs of any kind.

My second baby was back to back with stop/start and very irregular contractions for a week. Using one of the fetal positioning techniques in this Guide, I turned him around in an hour and regulated my own contractions, cancelling my induction appointment with half an hour to spare (there’s nothing like a deadline to spur me into action!). My second baby was also born calmly in the pool without any intervention or drugs, this time at home.

If only some of the secrets in this guide were not so secret, many other women could also increase their chance of a straightforward, intervention free labour and birth, if that’s what they would like. Most midwives don’t know about fetal positioning techniques – YET. This is why I founded #MakeBirthEasierCampaignUK the goal of which is, one day, to have all midwives trained in fetal positioning techniques as standard and be using them in routine maternity care, including antenatally.  To achieve this we need clinical research to be done first (if any of you know researchers interested in doing a clinical trial please contact me!).  Many midwives are already using the techniques unofficially with great results.

It’s never too early to start some of the techniques – even preconception. In general the physical preparation for birth should ideally be throughout pregnancy.

Why is Relaxation Important During Labour?

How on earth can you relax during labour? It hurts! Doesn’t it?

Annoying fact here – The more anxious or tense you are in labour, the more pain you’ll feel. Why?  Fear in your body releases adrenaline which stops the release of oxytocin and therefore stops the release of painkilling endorphins into your body. There’s your smooth labour progress and natural painkillers cancelled right there. In addition to this, blood is directed away from your uterus, which is a muscle and needs blood and oxygen to function properly. The blood goes to your heart and legs instead because the human body is programmed to escape danger (fight or flight response).

 

The organs needed for running away are prioritised by a brain experiencing fear. On top of all that, the tension you are holding in your body works against contractions. Tension in your uterus, cervix, and vagina literally holds on to your baby, just like squeezing your wee muscles works to stop your wee coming out. So let go. Take your body out of reverse gear and let your baby out.

Relaxing your mind and body literally reduces pain and allows labour to progress. It’s not hippy stuff – it’s biology.

I am well known by family and friends for being VERY easily stressed, so if I can RELAX, YOU CAN too.

Refer to Part 2 of this Guide to Make Birth Easier to find out HOW you can do this. I have listed lots of relaxation techniques there for you to choose from.  I’ve also explained a little about Hypnobirthing below.

Basically find something that works for you in each stage of labour and use it, whatever it is. Everyone is different and has different preferences. You may have something else that you find helps you relax, so use that. Go with what works for you. Remember that labour is surprisingly intense and so whatever relaxation techniques you go for, have something fairly powerful up your sleeve for active labour and transition to keep you calm, focused and internalised.

Transition (where your cervix reaches its maximum dilation of 10cm and baby starts descending) is the time where many women have a bit of a panic and start saying things like “I can’t do it”. This is part of a hormonal switch happening and the panic feeling is normal if you are tense or in a lot of pain. The beauty of being calm is that you are much less likely to experience this panic, if at all, during the moments of transition. I was simply focusing on Hypnobirthing breathing techniques (described in Part 2 of this Guide) during my first labour, and at the moment of transition I felt the switch and calmly thought ‘wow that was it, I CAN do this’. That’s how powerful even just the breathing techniques are.

For my second labour we had got the hang of how to use the Hypnobirthing guided visualisation techniques we’d practiced. Using these I was so calm and internalised that when I felt the transition, I could sense exactly what my body was doing inside and I told my midwife matter of factly, “baby’s going to start coming down now”. Freaky but true. Her face was a picture – she was visibly startled! I still find it bizarre that I was like that. The usually easily stressed me – totally calm during the most intense moments of my life. Powerful stuff.

Hypnobirthing: It’s Not Hippy Stuff – It’s Biology

If you are reading this with a few weeks of pregnancy ahead of you I can really recommend Hypnobirthing (it’s basically relaxation techniques and birth education) as a fantastic way to help your mind and body relax during pregnancy and labour. It teaches you about the history and physiology of birth and reduces fear. It teaches breathing techniques and relaxation techniques so that your body can work the way it is designed to do. I used the Marie Mongan Method of Hypnobirthing for both of my labours with great effect. First labour I used only the breathing techniques and second labour I used the full range of Hypnobirthing techniques which I found incredibly powerful. There are a few different methods of hypnotherapy for birth out there to choose from including Hypnobabies, Natal Hypnotherapy and Wise Hippo, although I cannot make any comment about these others as I haven’t used them myself.

Check out this amazing youtube clip (Daisy’s Hypnobirth Homebirth Waterbirth) of a couple using Hypnobirthing. From about 12 minutes into the video there is a rare and wonderful example of one of the same Hypnobirthing visualisation/relaxation techniques we used for my labours. It is rare to see on video the couple counting out loud together to help mum relax. Many Hypnobirthing videos, although amazing to watch, don’t indicate what the mum is actually doing to maintain her calm, internalised state because she is so quiet. This video really shows how the visualisation technique they’ve practised together during pregnancy (which includes a whole relaxation script) instantly has an effect to help mum relax during labour. All he needs to do is count and, when she hears that counting, her body (having been programmed to relax during their practice sessions) automatically reverts to a relaxed state. Ridiculous as it sounds, and it does make me giggle every time I experience this – counting ’40, 39, 38…’ still works to immediately relax me now after more than four years – I feel all floppy!yoga pose ziva

If you don’t have time to fit in any Hypnobirthing sessions or other great birth education courses like Daisy Birthing (thedaisyfoundation.com), then breathing techniques are a serious winner in my book. Whenever I stopped working on my breathing I could feel the pain level rise. My husband cracked the whip reminding me when I lost focus, again and again, to work harder on my breathing and when I did work harder at the breathing,  I felt the pain level go down again.

Combining focused breathing with counting while blowing my tummy up like a balloon was very effective and worked wonders for me. This was something I learnt through my Hypnobirthing course.

Part 2 of this Guide to Make Birth Easier explains the breathing techniques I used and when I used them.

 No Purple Pushing Please

Tensing your whole body during contractions (‘waves’ or ‘surges’) does nothing to help you give birth. This is known as purple pushing and it will only make you very tired, very quickly.  It is also more likely to cause distress to baby (from the temporary reduced oxygen), so if you are being monitored this can lead to a vicious cycle of attendees trying to make you push even harder to get baby out or even lead to interventions due to fetal distress and mum’s exhaustion. Purple pushing also increases the risk of pelvic floor trauma.

So how are you supposed to push? Part 2 of this Guide to Make Birth Easier explains what to do.

I pushed a lot harder than is indicated in the Hypnobirthing courses or videos (birth breathing/breathing your baby down), but I made sure my breaths were directed (by my own instincts) and any pushing was focused only in the right areas. Do what you feel comfortable with.

If you feel the natural urge to push, go with it. I certainly couldn’t do anything about it when my body decided to go for it!  Some women feel this urge before they are ‘fully dilated’ (although no one will know your dilation unless someone does a vaginal exam on you at that point which is entirely unnecessary if labour is progressing). Your body knows what it is doing. There is no evidence to show your own urge to push is a problem. Some women don’t feel the urge to push yet the contractions bring baby out. Follow your instincts.

Dilation

The cervix opens like a polo neck jumper does when a head is pushing through it. It softens, thins (effacement) and opens (dilation). It also moves to the front of the vagina.

Dilation is medically charted and used as a marker for how far along you are in labour. Dilation according to medical charts should progress by a particular measure per hour. If your cervical dilation isn’t increasing according to the graph it can be the reason for suggestions of hurrying things along using interventions.

In reality, human bodies and labours are all different and regularly do not do what charts say they ‘should’ do. A woman can be 3cm dilated for days and then zoom up to 10cm over a short period. A woman could also zoom up to 8cm dilation and then stay there for ages. Being in labour for a long time or being in painful labour and being told your dilation hasn’t budged or you’re only 3cm dilated can be disheartening and can slow down a labour even more.

There is no need to constantly check your dilation or fixate on it. Instead relax, move around, and  focus on your breaths and your baby coming. The length, strength and frequency of your contractions can give an indication of whether your labour is progressing well.

If baby’s head is pressing on the cervix at a favourable angle, descending and rotating as baby wants to, then dilation is likely to happen more easily. This is why fetal positioning techniques can help so much by aligning the head correctly through the pelvis.

 

Birth Plan for Vaginal AND Cesarean Birth

Write a birth plan (or birth preferences as I prefer to call it). Even if this is only so that you have researched and you and your partner understand the different options available, medical or otherwise, and what your preferences would be in different situations. This is called making fully informed choices. Weigh up all the options when deciding how and where you would like to birth.

I’m a realist. We don’t know how things will turn out (hence the term preferences rather than plan) so I prepared for all options just in case. If you do have a csection, it is possible depending on your situation, that you could make some requests so that things are a little more how you would like them. I wrote a birth plan, not only for a vaginal birth, but also for a csection birth, just in case I needed one. This can make things more comfortable for you and can make birth easier for your baby even after the birth. There are some very simple things you can request that could make a great difference to your experience and to your baby’s health.

Part 2 makes a note on this and Part 3 of the Guide to Make Birth Easier is coming soon and explains how to write birth preferences for both vaginal and surgical births.

 

Use What You Learn

A gentle reminder here, that if you do decide you would like to try fetal positioning techniques, REMEMBER TO:

  • practise them during pregnancy (even just once or twice will help),
  • have the instructions with you to do them during labour,
  • use them during early labour at home,
  • ask your care providers if it is safe to wait while you try some fetal positioning techniques before resorting to intervention they may be suggesting.

If your labour still includes intervention and you used the techniques and tips in this Guide, know that you gave it your best shot and you really did need intervention, instead of feeling like you were rushed into something early that maybe could have been avoided. If you or your baby are ever in danger, do what your care providers advise!

 

Out now:

Part 2 – Quick Guide to Make Birth Easier

A summary of all my most useful hints and tips for easier labour – including those four key FETAL POSITIONING TECHNIQUES that could prove so helpful.

Coming Very Soon:

Part 3 – Birth Preferences

 

  • How to write your own birth preferences for vaginal birth, and
  • How to write your own birth preferences for surgical birth for a more ‘gentle caesarean section’.

 

 

So watch this space.

 

 

Blog written by Alix Fernando

 

https://www.facebook.com/MakeBirthEasier

#MakeBirthEasierCampaignUK

@makebirtheasier

 

The content of this blog is not intended, and should not be read as constituting medical advice, diagnosis or treatment. Always consult your doctor, midwife or other qualified healthcare provider before making any changes to your birth plan or recommended routine.

 

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