Pain in labour – what causes it and how can you minimise it?

May 10, 2007

By Paula Pedersen

What causes pain in labour?
During labour and birth, there are several physical processes occurring that lead to childbirth pain: the strong uterine contractions and the tension they place on supporting ligaments; pressure of the baby on the cervix, vagina, urethra, bladder, and rectum; stretching of the cervix, pelvic floor muscles, and vagina.

These processes are unavoidable, and the pain caused by them is a positive sign that labour is progressing. We don’t want to stop these processes from happening, we just have to figure out how to minimize the pain we experience as a result.

Pain-intensifying factors that we can influence:

- The stretching of the pelvic floor muscles can cause pain; it helps if you’ve been doing your Kegel exercises in advance.
– Pressure on bladder causes pain, going for a wee regularly during labour helps.
– Reduced oxygen to uterine muscle increases pain; breathing techniques help.
– Muscle tension increases pain, fear and anxiety make you more sensitive to pain; relaxation can help with these.

itf131048.jpgYour body is AMAZING! It has nurtured another human being for 40 weeks, and is beautifully well equipped to birth your baby into the world. Endorphins are natures own pain killers and are naturally released into the blood stream when the body is physically stressed beyond its normal limits (think of an athlete running a marathon!).

The endorphins increase as your labour does – so the key here is to ensure that you are mentally and physically in a state that will encourage endorphins to be released at all times. Your endorphins will modify pain, create a feeling of well-being as well as alter your perception of time and place. The endorphins peak at the transition stage, giving you that extra energy for birth and amnesic effect (forgetting about the pain afterwards). They are at their highest during the pushing stage, which then gives rise to the elation you feel after the birth and encourages bonding with your new baby.

Ways to enhance natural pain killers include:

Position
If you are free to move around and get comfortable, your labour may even speed up. Use gravity to its maximum benefit and try to remain upright as that will encourage your baby’s head to come down. Change positions every 30 minutes or so. Try standing, walking, slow dancing, lunging, sitting upright on a chair, sitting on a birth ball, kneeling, on your hands and knees, sidelying, squatting…the list is endless – find a comfy position that feels good for you.
See some great labour position suggestions in this slide show.

Support
Do not labour alone, surround yourself with positive and encouraging support people. Your partner (and a doula) will help you immensely. Anxiety increases the amount of adrenaline in your body, which in turn reduces the release of endorphins and oxytocin and will slow labour down considerably.

Avoid unnecessary procedures
Procedures with scientific evidence of benefit to you and your baby should be promoted and those without scientific evidence of benefit should be avoided. Avoid the following ‘routine procedures': pubic shaving, enemas, early artificial rupture of membranes, restriction to bed, intravenous fluids.

Safe Environment
Ideally you want to labour and give birth in a safe and non threatening environment. If you are giving birth in a hospital, make the room your own by bringing flowers, candles, music and turn the lights down or off.

Comfort measures
These include breathing and relaxation techniques to help reduce anxiety and tension. Water (bath, shower or Jacuzzi) is a very effective comfort measure and it encourages you to relax. The best time to get into a bath for pain relief is between 5-6 cm. Sit of stand in the shower and allow the jets of water to massage your back or tummy.

Heat and cold
Alternate between heat and cold to relieve pain or tension. A hot water-bottle, microwave bean bag or warm face cloth. Then try an ice pack, chilled cooldrink can or a cold cloth on your neck, back, shoulders or under your tummy – wherever you need it!

Touch & Support in labourMassage and touch
A massage can do wonders for pain. It conveys a comforting message to you that you are loved and being cared for. If you transmit pleasurable impulses (such as light, soft touch), those will reach the brain first and that can modulate, or interfere with, the pain sensations. Firm massage on your back or soft fingertips (called effleurage) over your tummy can all ease the pain of your contractions. Even a foot, hand, leg or shoulder massage can help! In general, sensory input can distract us from pain perception.

TENS machine.
T.E.N.S stands for Transcutaneous Electrical Nerve Stimulation. A TENS machine is quite a nifty little gadget. The unit consists of four flexible, band-aid-size pads connected by wires to a small battery operated generator of electric impulses. The pads stick to the mothers back alongside her lower spine. The mother can regulate the impulses during a contraction. The pulses prevent the pain signals from the contracting uterus and cervix from reaching your brain and also stimulate your body to release its own, natural “feel good” substances, (endorphins.) (Not easily available in SA though…)

Your attitude is very important in labour. Try to relax and believe in yourself and your ability to do something miraculous. Tell yourself, “I AM STRONG. MY BODY KNOWS WHAT IT NEEDS TO DO.”

If you aren’t able to cope and feel overwhelmed by the intensity of your contractions – medicated pain relief is available. You will have made your educated decision beforehand as to what type of pain relief you are willing to accept. Labour and childbirth is not an endurance test – it is a beautiful occasion when a new family is born and an event that you will remember for the rest of YOUR life.


Epidural – Pros, Cons & Considerations

April 22, 2007

Natural Childbirth versus Epidural

by Marjorie Greenfield, M.D.
(The original article is listed on the Dr Spock website)

When I talk to pregnant women about their plans for childbirth, some are very clear about what they want, while others are not so sure. The range of responses I get to my questions is amazing, from “I live in the twenty-first century. Why would I want to labor like an animal? Give me drugs!” to “Women have given birth without drugs for centuries. I don’t see why I can’t do it. I want the full experience.”

There isn’t a “right answer” to these questions, but understanding your own values and priorities, psychologically preparing for the experience, choosing and educating your helpers to support your goals, and setting the scene for success can help you towards the birth experience that you are seeking.

The argument for epidural

An epidural generally takes away or at least diminishes the pain of contractions. When labor gets very intense in the active phase, and especially in transition, women with epidural anesthesia seem more relaxed and more “themselves.”

I have heard people say they don’t want an epidural because they don’t like the idea their legs might be weak or numb: they want to feel “in control” of their body. But if feeling in control is important to you, you may well want an epidural. The emotional experience of un-medicated labor and childbirth usually feels anything but controlled. Pushing with an epidural is sometimes pain-free and sometimes still painful, but in general, people find pushing less distressing (although sometimes more exhausting) than without anesthesia. Since pushing may be less effective with epidural, you may push longer and may be more likely to end up with an operative vaginal delivery by vacuum or forceps.

There are no martyr awards for avoiding pain medication, and the end result, a baby in your arms, happens regardless of your choice of anesthesia. In most situations, the decision is purely a personal choice.

The case for natural childbirth

Un-medicated natural childbirth is not for everyone. Many women know they have no interest in the “full, primal experience” of giving birth. Natural childbirth can be an incredibly intense experience analogous to running a marathon or climbing a mountain. Why do it?

  • Your experience can be more self-directed and less medical if you avoid epidural. Epidural requires an IV, electronic fetal monitoring and usually bedrest. Without epidural, if all is going well, you should be able to move around freely, go in the shower or tub, and you may be less likely to get pitocin, vacuum, forceps, and some other medical procedures. It is as nature intended.
  • Like climbing a mountain, if natural childbirth is a goal you have set for yourself, meeting the challenge (and becoming a mother simultaneously) is a powerful experience which often gives a tremendous sense of achievement.

Regardless of your preferences, it is a good idea to keep an open mind and prepare for what comes. Maybe your labor will be so rapid that you will arrive at the hospital with your cervix 8 centimeters dilated, and will give birth quickly. Maybe there will be numerous emergencies when you arrive on the labor and delivery unit, and anesthesia won’t be immediately available.

Or maybe you will have a long, exhausting labor. Your practitioner may get the sense that your anxiety or fatigue is playing a role in labor’s poor progress. He or she might then recommend an epidural as a treatment to try to get your labor moving. An open mind will help you to reassess the pros and cons of the options, and cope with the unexpected.

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Weighing the Pros and Cons of the Epidural
By Penny Simkin

The epidural block has been used increasingly over the past 50 years. Childbirth educators across the country are finding that more and more women plan–even demand–an epidural in order to avoid labor pain.

Why the popularity? Are there any significant disadvantages to epidurals? Are they safe enough for routine use?

Risk Versus Benefit

There is almost always a trade-off when medications and interventions are used during labor. Each woman must know and consider the potential benefits and risks and apply them to her own circumstances.

When the mother is managing her pain well and progress is normal, the risks of an epidural outweigh the benefits. If, however, she is exhausted, in extreme pain or requires painful interventions, the benefits may outweigh the risks.

Potential Benefits of Epidurals

Epidural anesthesia or analgesia provides relief or reduction of labor pain without affecting the mother’s mental state. It enables an exhausted mother to relax or sleep during labor and calms the woman who is anxious and tense because of pain. Once an epidural catheter is in place, additional medication can easily be administered as needed, providing prolonged and consistent pain relief.

Some prolonged labors, probably those slowed by anxiety, speed up with an epidural. Anxiety can cause excessive production of the mother’s stress hormones such as epinephrine and norepinephrine, which slow contractions. By allowing the mother to rest without pain, the epidural removes her anxiety and her labor progress may improve.2 If not, Pitocin may be administered painlessly. Since epidurals often lower blood pressure, this may benefit some women with pregnancy induced hypertension.3

Epidurals are also useful for cesarean births, making it possible for the mother to remain alert and involved while free from pain. They enable her to avoid general anesthesia, which is considered to carry greater risks.

Epidural narcotics reduce pain without reducing other sensations or muscle function. Women can change positions more easily than with anesthetics. They remain aware of their contractions and often continue to participate; using breathing patterns and other comfort measures. For those women who wish to remain aware of their labors, epidural narcotics are often quite acceptable.

Potential Risks

Epidural blocks carry some risks to the mother, fetus and newborn. Undesired effects tend to be greater with larger doses of medication, a longer interval during which the medication is in effect and immaturity or distress in the fetus.

Undesired effects on the mother:

  • Inadequate pain relief (up to 10%)4
  • Rise of the mother’s oral and vaginal temperature 5, beginning within one hour after administration of the epidural, which may lead to treatment of the mother and baby for non-existent infection. This effect may be dose-related. This recent finding from England is being investigated in the United States.6
  • Drop in the mother’s blood pressure treated with position changes, oxygen and possible vasopressors (less likely if a bolus of IV fluids is given before the epidural).
  • Short or long-term postpartum backache from bruising caused by the injection or from ligament strain caused by prolonged time spent in a damaging position or inappropriate movement (for example, extreme passive flexion of the mother’s trunk, hips and knees during the second stage, or sudden vigorous movements of the mother) while her muscles are relaxed and her back is numb (up to 19%). Long-term backache is almost twice as likely to occur with an epidural than without.7
  • Possible unintentional spinal block and resulting spinal headache requiring days of bed rest and a blood patch.
  • Shivering may be reduced with lower doses, by warming of the anesthetic before administration, or by adding narcotics to the anesthetic.8
  • Mild to severe itching of the skin (with narcotics)
  • Retention of urine, requiring a bladder catheter1
  • Mother feels detached from the process and becomes an observer; others may reduce emotional support. The nurse can no longer assess labor progress by observing the mother and must rely more on the monitor and vaginal exams.9
  • Problems caused by human error or maternal structural anomaly, such as inability to place catheter properly; inadvertent injection of anesthetic into a blood vessel; or too much anesthesia, affecting respiration and swallowing (rates vary with skill of the practitioner and anatomy of the mother).
  • Rare complications, such as residual numbness or weakness from needle injury to nerves (almost 1 in 10,000)10, delayed respiratory depression with epidural narcotics (up to 12 hours later)8, and brain damage and death (extremely rare).

Undesired effects on the labor:

  • May slow labor, requiring Pitocin; and has been found to increase the chances of a cesarean delivery in primigravidas by two or three times.12
  • Often slows second stage by reducing or eliminating the normal surge of oxytocin; and by reducing pelvic floor muscle tone, which may lead to more deep transverse arrests or persistent occiput posteriors. In addition, forceps or vacuum extractor are required more often (20-75%). Delaying pushing until the fetal head is on the perineum reduces the need for forceps. Even though this approach lengthens the second stage, it does not increase the incidence of fetal distress.13

Undesired effects on the fetus:

  • Abnormal heart rate patterns, requiring oxygen to the mother, position changes and possible cesarean delivery.
  • Increased likelihood of newborn septic workup, IV antibiotics and isolation in the nursery if the mother develops an “epidural fever” that causes fetal tachycardia or newborn fever.
  • If the fetus is already stressed greater amounts of the medication are “trapped” in the fetal circulation, leading to more pronounced newborn effects (see below).

Undesired effects on the newborn:

  • Short-term (six weeks or less) subtle neurobehavioral effects, such as irritability and inconsolability and decreased ability to track an object visually or to shut out noise, bright light.4 There are no data on potential long-term effects.
  • Possible less efficient or less organized initial rooting and suckling behavior. Nurses have reported more difficulties in feeding babies whose mothers had an epidural when compared to unmedicated babies.6
  • Decreased infant responsiveness may lead to long-term consequences for the parent-infant relationship.14 Parents should be counseled to give their babies time to recover from the birth and medication and should avoid a label of “difficult child” or “incompetent mother.”

Conclusion

The childbirth educator’s duty is to inform, not to talk women into or out of using an epidural. Many women will choose an epidural, when well informed of benefits, risks and alternatives; others will choose to avoid it if their labor allows.

When women are well informed, they will consider the information, along with other factors – such as their fears, self-perceptions, their goals for their birth experiences, their support system – and make the most suitable decision.

This article has been reproduce with permission of Penny Simkin.
Penny Simkin, a physical therapist specializing in childbirth education and labor support in Seattle, Washington, is the author of The Birth Partner: Everything You Need to Know to Help a Woman Through Childbirth and co-author of Pregnancy, Childbirth and the Newborn: A Complete Guide for Expectant Parents.


VBAC – Vaginal Birth After a Caesarean

March 13, 2007

VBAC – Vaginal Birth After a Caesarean

By Jane Weideman *

More and more women are exploring the possibility of a VBAC** (Vaginal Birth After a previous Caesarean birth), either because they feel their previous caesarian was unnecessary, or because although the previous caesarean may have been required they how have a healthy normal pregnancy and would therefore like to attempt a natural vaginal delivery.

Birth is a major life event that significantly impacts a mother’s physical and emotional well-being. A caesarean can be a life-saving procedure for a mother and/or her baby, but overall, birth by caesarean puts healthy pregnant women at risk for medical complications. Recent evidence suggests that caesarean birth, particularly if it was unexpected, may also put women at increased psychological risk.

According to the International Caesarean Awareness Network (ICAN), the risks of Caesarean section include:

  • increased risk of maternal death;
  • haemorrhage;
  • infection;
  • damage to internal organs;
  • complications caused by anaesthesia;
  • adhesions;
  • long-term pain;
  • and bladder problems.

Women who undergo caesarean sections may also be subject to increased risk of future reproductive problems including the risk of secondary infertility, scar tissue, uterine rupture, placenta previa (where the placenta is very low lying – covering the cervix) and placenta accreta (when the placenta attaches too deeply into the uterine wall) . Aside from physical risk, ICAN says a Caesarean delivery can increase emotional and psychological complications, such as clinical depression and difficulties with bonding, breastfeeding and family relationships.

The Center for Disease Control has identified caesarean section as a risk factor for the initiation of breastfeeding. Medications and procedures administered to the mother during labour affect the infant’s behaviour at the time of birth, which in turn affects the infant’s ability to suckle in an organized and effective manner at the breast.Breastfeeding has been linked to several life-long health advantages for both mothers and babies. Mothers who give birth by caesarean can initiate, establish and continue breastfeeding particularly if they are encouraged, educated and supported by breastfeeding specialists.

Every childbearing woman is a giver of life, and as such deserves our support, respect, and admiration. Every child is precious no matter how she or he is born. Based on the available information, every woman can decide with her caregiver what best meets her needs.

However, this article is not about all the risks and horrors of caesarean, and neither is it about achieving vaginal birth at all costs. It is intended to provide balanced and truthful information about VBACs allowing parents to make an informed decision about whether it is something they want to pursue. Then to provide support, guidance and encouragement for those that decide a VBAC is what they would like for themselves.

During much of the last century, a woman who had a caesarean section almost always had a planned repeat caesarean and not a VBAC for any births that followed. Doctors were concerned that the scar from the past cut in the uterus could open during labour (uterine rupture), and cause serious complications for mother or infant. The phrase ‘once a Caesar, always a Caesar’ became common, and was believed to be true.

During the last 20-30 years, however, many health professionals, advocates, pregnant women, policy makers and researchers encouraged vaginal birth after caesarean (VBAC) in light of:

  • a change in location of the uterine cut to an area much less likely to open during a VBAC labour
  • growing body of research establishing the safety of VBAC
  • growing recognition of c-section risks.

Now the pendulum is swinging back from vaginal birth after delivery, with new calls for routine repeat caesareans. This reversal leaves many women with caesarean scars struggling to make sense of conflicting, incomplete, and sometimes misleading information about the safety of VBAC vs. repeat caesarean and about what birth plan to make this time around.

The truth is that unless your previous caesarean was a medical necessity (true in 12-15% of all births) and/or the same or another medically justified condition exists in a subsequent pregnancy, a VBAC is perfectly possible.

Many Doctors however scare parents with horrors stories of the risk of a uterine rupture. Their concern is that multiple caesareans lead to a weaker uterine scar and that risk of rupture is therefore increased. However there is a lack of research evidence to support this theory.

Uterine Rupture risks
The scar from a previous caesarean is strong. While many people fear that the scar will rupture, and cause the death of the Mother and/ or her Child, medical studies have shown that this risk is greatly overstated.

The only way that VBAC differs from other labours is the small increased risk of uterine rupture – about 0.4% (one in 250). The risk of uterine rupture prior to elective repeat caesarean is 0.2%

To put this risk into some perspective, consider that the probability of requiring a caesarean section for other emergency obstetric situations (not related to the previous caesarian section), such as acute foetal distress, cord prolapse or ante partum haemorrhage is up to 30 times higher.

Although women are often told that they can’t have a VBAC for a variety of reasons, there are very few cases where a VBAC is not a real and a reasonable option. The article Caesarean Myths Exploded deals with the issues of VBAC when you are thought to have had CPD (cephalopelvic disproportion – where the baby’s head is believed to be too big to go through your pelvis) and VBAC when you have a non LSCS (Lower Segment Caesarean Scar) such as a classical or a low vertical uterine incision.

There are many reasons women are given for not being able to have a VBAC including having had more than one caesarean (see Can I have a VBAC if I have had two or more caesareans?), having a gap between pregnancies that is considered too short (see How long after a caesarean should I wait before having another baby?), your baby is breech or you are expecting twins, you are too old, too fat; the list is endless.

Really the only reasons that you would need to have a repeat caesarean is if you had a reason in the current pregnancy that would warrant a caesarean even if you had not already had one. Ask your doctor to explain clearly why it is that you NEED to have a caesarean, if that is what you are told. (These reasons include placenta previa, true CPD (rare), toxaemia, positioning of the baby – particularly transverse, but most doctors prefer breech babies to be delivered by caesarean too, severe infant distress or growth retardation etc. The reasons are covered really well in the book Birth After Caesarean by Jenny Lesley.) Remember there are times where a caesarean really is required and is literally life-saving!

Many women are told that if they have already had two or more caesareans, that any future babies will need to be delivered by repeat caesarean. This need not be the case. Loads of women have had VBACs after 2 or 3 caesareans. Some women have even had a VBA3Cs (Vaginal Birth After 3 Caesareans) and at least one who has had a VBA4C; obviously the numbers after 1 or 2 caesareans are much much larger.

Many woman have even had successful VBACs at home, and/or water, however your caregiver may feel more comfortable for you to be in a hospital setting, for peace of mind, that should any intervention be required, it is close at hand.

How can I get a VBAC?

If you are hoping to attempt a VBAC it is important to find a primary caregiver (Doctor/ Gynaecologist/ Mid-wife) who is both supportive and trusting of and also experienced in VBAC deliveries. It is imperative that your caregiver be comfortable and confident in order for you to feel safe and trusting in them and their judgement. You may find that your regular care provider is not prepared to consider a VBAC, so you would then need to search for someone who you can work with.

Once you have a good caregiver, who is happy to work with you towards achieving a VBAC, your pregnancy and labour should progress just like any other. However as with any woman planning a vaginal birth, you will need to prepare yourself for it.

The Preparation
In addition to a supportive caregiver, several factors will increase the odds for a successful vaginal birth after caesarean.

You need to be totally committed to your desire for a VBAC. Read as much as you can on the subject, until you feel comfortable and confident about it. Particularly as you may find many people will try to scare you or discourage you from your decision. Knowledge is your best defence and ammunition here.

Some recommended books are “Silent Knife,” “The VBAC Companion” and “Birth After Cesarean: The Medical Facts.”

Be informed. Take childbirth education classes. The best classes are those that specifically address VBAC and promote birth as a natural process.

Know your rights regarding Informed Consent. Which requires that your caregiver get your consent before performing any procedures and certainly surgeries on you, and your right to refuse these, or ask for reasonable alternatives and/or at least a dialogue about it before hand.

Informed Consent Questions
Here is a list of questions to ask when interventions or unplanned procedures are proposed at any point during your pregnancy or the birth of your child:

  • Is this an emergency or do we have time to talk?
  • What are the benefits of doing this?
  • What are the risks of doing this?
  • If we do this, what other procedures or treatments might we need as a result?
  • What else can we try first or instead?
  • What would happen if we waited before doing this?
  • What would happen if we didn’t do this at all?

Keep your body fit and healthy, by following a healthy diet and lifestyle. Practising yoga is an excellent way to prepare for birth (see the Yoga articles in our archives). Relax and take time to imagine your birth and how you would like it to unfold. Use affirmations (there are some in our resources section) and read positive VBAC stories to inspire you. See some VBAC birth videos if you can (there is at least one example in our lending library ).

Consider hiring a doula, an experienced, knowledgeable woman who believes in your ability to give birth. The more support and positive influence a woman has, the greater her belief in herself and in her body’s ability to birth.

Some women who have had an extremely difficult or frightening prior birth experience or other traumatic experiences such as sexual abuse find that thinking about labour brings up such strong emotions that it interferes with their ability to make decisions. Unresolved issues can interfere with the smooth progress of labour as well. If you feel that you have unresolved emotional issues, you will want to work through them so that they don’t get in your way when planning for or experiencing your next birth. Keeping a journal, talking through the troubling events and your concerns with a friend or relative who is a good listener, or getting peer support from other women with similar experiences may help with this. Getting professional counselling from a competent mental health professional who is well-informed about maternity issues proves very helpful in resolving extremely deep fear and anxiety for many women. Your doula can help you to work through these feelings in preparation for your birth as well.

Consider, too, what you will need during this birth to feel safe and well-cared for. If you were dissatisfied with your previous care, you will want to pinpoint the sources of your dissatisfaction and plan to do things differently this time.

The odds are that you will go on the have a successful and satisfying VBAC. However if at the end of the day even if your VBAC attempt only results in a trial of labour followed by a caesarean birth your baby will still benefit greatly from being born when ready on his actual due date (as determined by the natural onset of labour) and will have benefited from all the good physiological effects of labour.

Furthermore your doula will be able to work with you to plan for the event of a repeat caesarian allowing you to make the experience as pleasant and healing as possible for you. Having a birth experience that is as much like a satisfying vaginal birth as possible and having good pain control after the surgery are keys to a satisfying caesarean birth experience. Discuss these options beforehand even if your birth plan is for VBAC.

  • Participate fully in decisions about the birth: The difficulty or ease of the birth and whether the baby was born vaginally or by caesarean have little to do with how women feel about the birth. Women are most likely to feel satisfied with their births when they feel a sense of accomplishment and personal control and when they have a good relationship with caregivers. A good relationship includes such elements as being treated with kindness and respect, getting good information, and having the opportunity to participate in decisions about care. You should feel free to question your caregiver as and when you feel it is necessary.
  • Keep your partner and any labour companions with you throughout: You can benefit from the support of your partner and any other labour companions during what may be an anxious and stressful time. This is particularly true during preparation for surgery and administration of the epidural or spinal anaesthesia, which many women find more stressful than the surgery itself. Your partner and support team will also have the opportunity to share in moment of birth and to greet the baby.
  • Keep your baby with you after the birth, in skin-to-skin contact: Unless your baby has problems at the birth that require care in the nursery — and few babies do — there is no reason not to keep your baby with you so that you and your partner can enjoy and begin to get to know your baby, and you and your baby can get breastfeeding off to a good start. Skin-to-skin contact can contribute to breastfeeding success and your early relationship.
  • Work with your caregivers to carry out your preferences: For example, you may wish to:
    • videotape the birth or the time just after the birth
    • play the music of your choice
    • not have your arms strapped down
    • have the drape that screens your view of the surgery placed low enough that the baby can be laid on your chest; if your arms are free, you can hold and touch your baby.
    • have a doctor or nurse explain what is happening throughout
    • have the drape lowered or have a mirror at the time of the delivery (your belly will be covered so you will see your baby lifted out of an opening in the sheet)
    • announce or have your partner announce the sex of the baby or be the first to speak to the baby (versus a member of the care team doing these things)
    • take the placenta home (some people bury the placenta and plant a tree or bush over the site; if of interest, bring a sealable container to contain this)
  • Have your baby and your labour companions with you in the recovery area: Holding and breastfeeding your baby soon after delivery helps both you and your baby get started on the right foot and may avoid problems with breastfeeding.
  • Have your partner able to be with your baby in the nursery: This includes the newborn intensive care nursery. If your baby must be separated from you because of concerns about the baby’s health, it will be comforting to know that your partner can provide a reassuring presence and can bring you word of your baby’s condition.
  • Begin drinking and eating again when you feel ready: Access to food and drink when you feel ready will help you feel more normal and can avoid hunger and thirst.
  • Get help with breastfeeding: Breastfeeding can be more difficult right after surgery and while your incision is healing. A knowledgeable person can help you find ways to be more comfortable during breastfeeding sessions. Your partner or others can help with switching sides, burping, and nappy (diaper) changing.

VIDEO CLIPS:

There is a lovely inspirational VBA3C photo video here.

HBAC- This is a very moving birth of a mom who had a medically managed vaginal birth with her first son, followed by a Caesarean birth with her second son. Less than a year later she had a successful home vaginal birth after a Caesarean (VBAC) with twin girls!

Feel free to Contact Us should you require more information on the doula service we can offer to a VBAC mother, as well as those caregivers we know in the Cape Town area who do provide VBAC support.

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* References and information taken from the following sources:
http://www.vbac.com/
http://www.childbirth.org/section/VBACindex.html
http://www.childbirthconnection.org/article.asp?ck=10212
http://pregnancytoday.com/reference/articles/canvbac.htm
http://www.homebirth.org.uk/vbac.htm
http://www.caesarean.org.uk/

Another great source of matter of fact and easy to digest info is :
Pushed Birth – Previous C-section?

**The term VBAC was first coined and used by Nancy Wainer Cohen author of Silent Knife:Cesarean Prevention & Vaginal Birth After Cesarean. It was chosen as the best book in the field of Health and Medicine by the American Library Association in 1983.

*** Medical disclaimer: Note that this web site is not a substitute for medical advice. The content provided here is for informational and educational purposes, and is not intended as advice or instruction. It is provided to help you to make informed choices for yourself. You should consult your primary care provider regarding your specific medical symptoms or advice. Birth Buddies is not engaged in rendering medical advice, diagnosis or treatment. Any medical decisions should be made in consultation with your caregiver or other trained medical personnel. We will not be liable for any complications, injuries, loss, or other medical problems arising from, or in connection with, the use of, or reliance upon any information or products on this web site.


Video Review: Birth As We Know It

March 4, 2007

Video Review: Birth As We Know It – Conscious Birth
by Jane Fraser (Weideman)

Whether you are already considering a natural birth or if you are undecided about whether you think a Caesarean or natural birth is the choice for you I urge you to watch Birth As We Know It .

Conscious Birth

This is from the Birth As We Know it web site:

“The Sentient Circle has released a ground breaking new film aimed at illuminating future parents on the impacts of conscious conception, pregnancy and birth. In this stunningly beautiful feature titled “Birth As We Know It” (1hr, 15 minutes), Director Elena Tonetti-Vladimirova shares her experiences as one of the co-creators of the “Conscious Birth” movement in Russia during the early 1980’s. It included a very effective birth preparation program which culminated in summer birth-camps at the Black Sea where women gave birth to their babies in warm shallow lagoons.

The movie features eleven natural births, including home birth, water birth, birth of twins, breech delivery and an astounding self-birth by Tanya Sargunas – a world renowned Spiritual Midwife and pioneer of Conscious Birth in Russia. The midwife community calls this film “the most profound and comprehensive guide to conscious birth in the world”, because it delivers a powerful transmission of what it really takes to give birth consciously and gracefully.

Also featured are informative interviews on topics rarely discussed, such as the Sexuality of Childbirth, Circumcision and Limbic Imprinting, and conveys its message in a non-intrusive, wonderfully inspirational way.

In this ground breaking new film featuring 11 births, all completely unique and all natural. This new movie from The Sentient Circle offers all a deeper insight into the nature of birth and leaves viewers in awe of its beauty.”

Giving birth with love and consciousness

Another review:

“Birth As We Know It is a treat for both the heart and mind, comfortably intertwined on a path toward realizing the full potential of birth. A new style of documentary film creates a refreshing arena for the story of Birth to unfold. A triumphant orchestration of stunning cinematography, empowering instrumentation, and a calming narrative, warms our hearts as we are reminded of the beauty of Life, and awakened to the ultimate possibilities of Birth!

BIRTH AS WE KNOW IT was initially a film for pregnant couples…..but adults and children alike are discovering that it is a heart-warming, thought provoking, life enhancing film experience.
“It is a gentle, yet powerful exploration of ourselves – at any age – reminding us of our fragile beginnings, and inspiring in us a new appreciation and understanding for the miracle of life.” …..
“Birth As We Know It is as much for birthing parents as it is for the rest of the world”

Also included on the Special Edition DVD are Additional Scenes and Interviews on unique Birthing Topics, such as:
– The Birth Of The Placenta – After Birth
– Lotus Birth – A Rite Of Passage
– Circumcision – What Every Parent Should Know
Guest Interviews And Reflections On :
– Sexuality and Birth
– Spirituality and Birth
– The Inner-Strength Of Motherhood
– Healing Birth Trauma
– Birth And Nature
– Infancy Without Diapers
– Communication and Bonding
– And More …

TOTALLING WELL OVER 3 HOURS OF VIEWING ENJOYMENT AND FASCINATION FOR THE ENTIRE FAMILY – PAST, PRESENT OR FUTURE!

Some of you will embrace this with great relief and joy, others of you may find it too confronting. Personally, this is one of the most comprehensive birth videos you could imagine, all topics covered from conception to all the issues and decisions you will need to face once you have your baby.

This will create great discussion and really get you thinking and feeling in a way that will serve you best. A great compliment to the birth classes you may be doing, but even more valuable! “

Natural Water Birth

You can view the Birth As we Know it trailer here.

This movie can be profoundly and devastatingly moving and deeply emotive to watch. It is likely to bring up a full range of emotions from joy, exhilaration, contentedness, happiness,through to sadness, distress, and even anger.

The section showing the contrast between the peaceful harmonious and natural births and the sterile almost violent and abusive clinical births can be particularly disturbing to watch, especially after viewing a the conscious births. The gentle conscious births make one feel content and warm, but the hospital ones evoke deep emotions and discord – possibly awakening deep-seated limbic memories of our own birth traumas.

This movie is recommended viewing for any pregnant mum (or someone planning on having a baby, or supporting a woman through her birth experience). It provides inspiration and will help you to prepare and to cement and affirm your desires for the birth of your precious baby.

Birth As We Know It

We have limited DVD copies of the Educational Edition available (Cape Town, South Africa). Please Contact Us if you’d like to find out more about these.


Natural Ways to Induce Labour

March 1, 2007

Natural Ways to Induce Labour
(Based on an article by Lisa Rodriguez, R.N. and Marjorie Greenfield, M.D. – edited and extended by Jane Fraser.)

As you near the end of your pregnancy, you may be ready for the entire process of carrying your baby to be over. You’ll be eager to start a whole new phase of life and finally actually meet your little miracle! But you might wonder: When is it safe to try to naturally induce labour, and how would you go about accomplishing that?

Here are some things to think about as you approach your estimated due date. Babies have their own calendar. As much as we would like to naturally induce labour as soon as “we” are ready, labour starts often unpredictably and sometimes later than what mothers would like for their own comfort. Babies will come at 38 weeks and other times will need 42 weeks. Technically you are not overdue or what is called “postdates” until 42 weeks. However, today it is more common to hear from providers that you are “overdue” even if your due date was yesterday!

So in essence, your due date is only a very rough target; which is why it is referred to as an EDD – estimated due date. Your own baby will likely come within a period of four weeks between 38-42 weeks. Only about 3-5% of women actually give birth on their due date not to mention that the majority of women don’t go into labour until after their estimated due date!

Rushing the last few weeks does not help you or baby. Studies have shown that if your body is not ready for labour, (i.e. cervix unripe- not dilated or effaced) and you have an induction with pitocin, you will either have a very long labour or a much greater chance of a caesarean.

So it is important to note that you shouldn’t even consider trying to begin your labour until you are at least around 40 weeks pregnant, or already overdue. That’s because your due date is only an estimate and could be inaccurate by a few weeks, so if you start your labour before 40 weeks, you might give birth to the baby before he is ready to thrive outside the womb.**

Several things can be done that might make you have contractions and kick-start your labour – but they’ll only work if your body is ready. If your body isn’t prepared to go into labour, you can try as much as your heart desires, but you will only frustrate yourself.

Please use caution when trying any of these natural methods to begin your labour, else the uterus can become hyperstimulated, meaning that it’ll get too little rest between contractions.

Visualisation
First and foremost find time to rest, relax and meditate. Connect with your baby. Make sure you feel safe and mentally, physically and emotionally ready for labour to begin. If and when you do feel ready, communicate this with your baby, either in thoughts and feelings or even verbalising it out loud. Don’t underestimate the (blocking) power of the subconscious here. Consciously surrender and give consent to yourself the universe (or whatever you believe in, and prefer) to allow the journey to begin. You could also try reading and pondering some Affirmations and Quotes to help you to prepare.

Walk
If you are having contractions but are not yet in labour, walking can help get things going. Walking allows your hips to sway side to side, which will help bring the baby into position to be born. Also, by standing upright, you’re using gravity to move the baby down into the pelvis. Another plus: It usually feels good to walk when you are contracting. And of course, even if you don’t go into full-blown labour, at least you’re getting some exercise.

Dance
Also try ‘slow-dancing’ and belly-dancing type movements. Swivel, rotate and sway your hips from side to side. Visualise the swirling of a galaxy, and the funnelling of a hurricane. Allow your focus and energy to channel inwards and and down culminating in your cervix. Doing this helps to aid gravity and can help baby to move lower into the pelvis and to to start applying pressure on the cervix which is needed to get labour established. You can make this an intimate and bonding sensual experience; possibly include candles, music, aromatherapy and massage etc. Mum & Dad sharing a sensual momentMake sure you feel safe and relaxed. This can follow on from the mediation and lead into the next suggestion. Feelings of love, safety and well-being will result in your brain releasing Oxytocin – which is the main hormone responsible in and required for labour and which makes the uterus contract. This only happens when you are relaxed and not overloaded with adrenalin and fear.

Sex
Making love can be one of the last things on a woman’s mind toward the end of her pregnancy. She probably feels clumsy and big and may be experiencing a lot of vaginal pressure. But sex is one of the main things you can do to get your labour under way. When you and your partner make love, his semen (which contains prostaglandins) can stimulate contractions. (The gel used in inductions is a prostagladin gel, so it is certainly worth trying this before going in for a medical induction). At the very least the semen will help to soften and ‘ripen’ the cervix, and every bit of progress helps. An added bonus will be if the mum can reach orgasm too. As the regular, rhythmical contractions brought on by orgasm combined with a prostaglandin may very well kick-start labour, and certainly will cause progress at the very least even if it does not result in sustained contractions.

Castor oil
For decades, women have been using castor oil to help induce labour. In fact, many old school physicians and midwives swear by it. It can provide good results if you are already in early labour. It is believed to work by causing spasms in the intestines, which surround the uterus toward the end of pregnancy. These spasms, in turn, cause the uterus to cramp, which might result in labour.

You can take 30 – 80 ml of castor oil mixed with 100 -200ml of orange juice to cut its oiliness. You’ll want to drink it quickly because of the unpleasant taste. Some practitioners suggest taking a single dose; others suggest repeated doses depending on your response. Keep in mind that castor oil usually will cause your bowels to empty within about three hours. With luck, soon after that, you will be in true labour. Warning castor oil is not only unpleasant to drink (do drink it mixed with orange juice if you really want to try this!) but it also results in near immediate diarrhoea. (Ed: I tried this at a week over due with my first son, it did give stomach cramps and diarrhoea, and emptied the bowels nicely, but no labour. Thankfully. You actually wouldn’t want to be in labour with that much bowel action – but it is a good clean out in preparation for labour.)

Mum and Dad waiting for babySpicy food
Some people swear that it was that extra-hot enchilada from their favourite Mexican restaurant that brought them face to face with their new baby. Unfortunately, the statistics are out on this one. You could try it, but if you have a full stomach when you are in labour, you might vomit and see that enchilada again–in less-than-appetizing circumstances.

Nipple stimulation
Some women massage their nipples as a way to induce labour. This stimulation brings about the release of oxytocin, which is the natural form of pitocin. Oxytocin causes contractions, which sometimes evolve into labour.

Most practitioners are not enthusiastic about this method of inducing labour, because it has been known to lead to excessively long, strong uterine contractions sometimes resulting in foetal heart rate slowing. Unless your practitioner advises it and is monitoring your progress closely, nipple stimulation is not always recommended as a means for beginning labour.

Stripping the membranes
Your practitioner may offer to “strip your membranes” to help start your labour. This procedure usually feels like a vaginal examination, although it sometimes can be painful or cause cramping. The practitioner places her gloved finger through the cervix and sweeps the amniotic membranes free of their attachment to the lower part of the uterine cavity. This process is believed to release hormone-like substances called prostaglandins, which help to ready your body for labour.

While some experts believe that stripping the membranes causes you to go into labour that day, the only research on this procedure was done by a group of midwives who stripped the membranes of a group of their patients at every visit to the office after 38 weeks gestation. Their findings showed that patients who had this procedure were less likely to go past their due dates. According to the study, the procedure didn’t seem to pose any complications and didn’t cause the patients’ waters to break.

Reflexology
Many people swear by this one. There are reflexology points behind the ankle (about 4 inches above the ankle bone), on the roof of the mouth sucking a spherical lolly-pop stimulates this one) and in the webbing between thumb and forefinger (the muscle just in front of the bony joint). When stimulated correctly people claim to go into labour within hours and have short and simple labour and births. (Ed: I know several people who have tried this successfully.).

Factors of success
Many of these natural labour-inducing approaches can be effective if your body is ready to deliver your baby. To be successful, most of these techniques require you to be having contractions or perhaps in early labour.

Don’t worry, though–whether one of these measures works or your body still needs more time, your little one will be joining your family soon. Try to be patient; you’ll have a lifetime together when he finally does arrive.

** Medical disclaimer: Note that this web site is not a substitute for medical advice. The content provided here is for informational and educational purposes, and is not intended as advice or instruction. It is provided to help you to make informed choices for yourself. You should consult your primary care provider regarding your specific medical symptoms or advice. Birth Buddies is not engaged in rendering medical advice, diagnosis or treatment. Any medical decisions should be made in consultation with your caregiver or other trained medical personnel. We will not be liable for any complications, injuries, loss, or other medical problems arising from, or in connection with, the use of, or reliance upon any information or products on this web site.


Birth Videos

February 22, 2007

There are some lovely birth videos on You Tube.

Birth videos can be a wonderful way to prepare yourself for birth. It helps you to desensitise to the reality that is birth, and to start becoming familiar with what is normal during birth, and what to expect.

You’ll also instinctively react to and know what you do and don’t like from each birth you see, and in that way you can get a clearer idea of what you’d like for your birth. You’ll end up with a much better idea of what it will really be like and will be able to plan and visualise your birth as you would like it.

Here are some lovely natural and gentle births*:

  • ‘Lyle’s Birth’ – mom labours and gives birth – catching the baby herself – in a birth pool at home, with dad in the pool with her. The mid-wife hasn’t even arrived yet and gets told the baby is born on the phone. Your body really does know what to do!
  • ‘Birth1′ – a very short video of a mom giving birth in water, without making any noise at all.
  • ‘Christian’ – This is the water-birth of a Spanish speaking mum. She vocalises a lot through the birth (not a BAD thing at all, it helps a lot). See how the contractions come and go and her body tells her what to do as each contraction starts and relaxes completely after each one finishes. The mid-wife helps her to birth the head slowly, so she doesn’t tear.
  • VBA3C - This is a beautiful photo video of a woman who finally gave birth to her 4th child naturally, and at home, after 3 Caesarean births.
  • Dutch Home Birth- This is a simple beautiful and calm home vaginal birth on a birthing stool. Translated into English. this one is fairly graphic with a close up of the head emerging beautifully, slowly and with control from a very calm mom. Birth doesn’t get much better than this!
  • HBAC- This is a very moving birth of a mom who had a medically managed vaginal birth with her first son, followed by a Caesarean birth with her second son. Less than a year later she had a successful home vaginal birth after a Caesarean (VBAC) with twin girls!
  • Incredible Laughing Birth – This French woman gives birth naked and completely uninhibited by herself or her birth attendants, she is in bliss and literally revels and laughs as her baby emerges slowly and wonderfully from her and is caught by the dad.

If you’d like to search yourself, try key words such as: Birth, Homebirth, Water Birth etc. There are quite a few videos to chose from (including a funny but slightly disturbing parody called ‘Snakes on a Homebirth’) ;)

Then there are also a host of other more professionally produced videos available such as:

- Birth As We Know it: Educational Edition. A profoundly moving film showing conscious, gentle birth and spiritual midwifery.**
by: Elena Tonetti-Vladimorova

- Gentle Birth Choices: Gentle and natural ways to give birth. This DVD blends interviews of midwives and physicians with footage of six different birth experiences.
by: Barbara Harper

- Kangaroo Mother Care: Rediscover the Natural Way. This video summarises research and evidence to prove that the newborn thrives best in its original rightful place – on its mother’s chest.
by: Dr Nils Bergman

Remember: You don’t fear what you understand.

** We have limited DVD copies of the Educational Edition available (Cape Town, South Africa). Please Contact Us if you’d like to find out more about how to get one of these.


Birth Buddies Introduction

December 18, 2006

Birth Buddies Logo
Welcome to Birth Buddies!

Birth Buddies is a Cape Town based birth companion (doula) service.

Please see the above tabs above for more information, or click on the links below:

    About Birth Buddies – What is a Birth Buddy? Why do I need a Birth Buddy? Who are the Birth Buddies?
    Services Offered – The labour support services available through Birth Buddies.
    Areas Serviced – The areas covered by Birth Buddies – Cape Town Metropolitan Area.
    Pricing – The current options and rates charged for the available services.
    Resources – Web Resources, Local Recommendations, Quotes & Affirmations etc to help you to prepare for your birth.
    FAQ – Frequently Asked Questions.

Doula LogoThe blog section of the site will be used to showcase articles, news and items of interest and will grow over time. So please check back often for updates.

If you have any questions, comments or suggestions, please Contact Us, we’d love to hear from you.

© Birth Buddies 2006-2007.


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