The Business of Being Born

Ricki Lake has made a birth related documentary Movie called the Business of Being Born.

Synopsis
Birth: it’s a miracle. A rite of passage. A natural part of life. But more than anything, birth is a business. Compelled to find answers after a disappointing birth experience with her first child, actress Ricki Lake recruits filmmaker Abby Epstein to examine and question the way American women have babies. The film interlaces intimate birth stories with surprising historical, political and scientific insights and shocking statistics about the current maternity care system. When director Epstein discovers she is pregnant during the making of the film, the journey becomes even more personal. Should most births be viewed as a natural life process, or should every delivery be treated as a potentially catastrophic medical emergency?

Watch the trailer here:
http://www.thebusinessofbeingborn.com/trailer.htm

The below link is to watch the whole documentary for free (1h24m).
http://quicksilverscreen.com/watch?video=45525

It is about America, but it closely parallels the recent trends in SA.

Do yourself a favour and check it out for yourself. Loads of food for thought!

“The Business of Being Born is a joy to watch—engaging, funny, extremely enlightening, and yes, disturbing—just as childbirth has become so disturbing. It is a kind of film that will get through to women and men in ways others have not—perfect for our culture right now.”
Kyndal – Boise, ID

What is labour like? Useful Analogies

What is labour like? Useful Analogies
By Jane Weideman

The I am often asked by friends & clients what labour (birth) is really like. Having birthed 3 LARGE babies naturally myself, they want to know how I did it? What does it feel like? How does one cope with it? What if the baby is large? Do you have to have a super human pain threshold? How do I know if I can do it? What will happen to me afterward? Questions, questions…

It’s hard to describe something to someone when they have no frame of reference. How can you really describe a contraction to someone who has never felt one? Or to a partner who never will feel one, and possibly can’t relate to it at all?

Over time I have developed a few analogies which help to illustrate the process of labour/birth, and the experience of feeling and dealing with contractions. I hope my descriptions help to make it clearer and more understandable. As well as less intimidating and less scary, to those who have the fear of the unknown.

“Nothing in life is to be feared. It is only to be understood.”
~Marie Curie~

The best analogy I can give you for birth, and what it is like, is that is it like running a marathon or climbing a mountain.

Take Cape Town’s Table Mountain for instance, there are many different ways to get to the top. None more right or valid than the others, they are just different. And those different ways suit different people better. So the best way for one person, may not be the best (or even a good) way for someone else, depending on each person’s circumstances and motivations. So while you may want to climb it, someone else may think you are crazy for wanting to do that! Why go through all that pain, sweat & exhaustion when you could take the cable car? Someone else might think that even the cable car is risky, or a waste of time, and would rather pay to get a quick & easy helicopter trip up there. I mean the end result is being at the top right?? Doesn’t matter how you got there….

Well yes & no. Sure that’s the end goal, but for some the journey of getting there is as much part of the experience and memory as the summit, and being at the top can feel that much more of an achievement and high if you got there yourself. Plus it is healthy for you, it is exercise and fresh air!

Then of course , there are different ways of climbing, there are long slow winding paths, more steep and intense direct routes, and then even scary but exhilarating real rock-face climbing options. There are loads of options and only you would know which you would want to do, and which is right for you.

Make sense?

Birth is VERY similar.

If you choose the climb option in the analogy, it doesn’t mean the journey won’t be hard and tiring. You might even think “What the hell am I doing!? Why didn’t I just catch the cable car??”, while you are plodding along, and as it starts getting steep. But you keep going, one step at a time, you get into a rhythm, and before you know it you are there at the top. You did it, and you feel fantastic! Like you can do anything. You are proud of yourself, exhilarated and the experience has been unforgettable. And that view from the top is so worth it because you really worked for it, and earned it. Your endorphins are rushing and you have never felt as good, or moved, or emotional before. Nothing compares to that. That’s what natural birth feels like.

So what you need to work out for yourself is. What option do you really want? For YOU. No one else can, or should, make that decision for you. It is a very personal choice, and you are the one who will need to do the work, and feel the feelings and really LIVE the experience.

Do I have a high pain threshold? …. I think mine is probably average, but I think I am very logical and rational. So while I hate having a pimple squeezed. It hurts and just feels WRONG to me. But the ‘pain’ of birth is not just pain. It is a combination of factors, all of which make sense.  So I can deal with it, using my rationalisation skills. A male friend asked me about labour once and said, ‘Ok so is it like slamming your hand in the door and staying there for like 12 hours!?‘

NO!!! Firstly it’s nothing like that. It’s not ‘oh my god I am being damaged, having nerves severed and am about to die!!’ pain. It is a pressure, dull ache, muscle-working-burn kind of pain. Secondly it’s not continuous. Contractions come and go. They build up to an intense peak and then dissipate, and mostly, the gaps between them are longer than the length of the contraction itself. You have a break after and between each one.

Imagine this scenario. You have an strict gym instructor and have do a yoga-type squat/lunge for a full minute every 5 minutes for a few hours. It starts off fine. No sweat. Easy! Then after 30-seconds or so your thighs start burning and feeling tired and you want to get up. You’re not dying, but you feel uncomfortable. You can’t just stand up though, you have to stay there for a full minute. You could cry, panic, scream etc, but that wouldn’t help, it would actually just feel worse, and you would just waste energy and upset and tire yourself. What you need to do is relax, zone out, breathe slowly and deeply, and just try to forget about it. Before you know it the minute is up and you can stand up. You then have a few minutes to rest move around, breathe, have a sip of water, whatever you want to. Then you start again.

The thing is each one is bearable, but you need to prepare your mind and your attitude, that’s the main thing. You need to not panic and you need to just accept it work with it, and only think in the moment. Each one you finish is one that is gone and done, don’t dwell on it. Don’t think or worry about how many more you have, or how much worse it might feel. All there is, is here and now, and each one you finish is one step closer to the end… You can get into a rhythm and find ways which help you relax quickly and easily in between. You’ll find you can finish the minute with 4 or 5 long slow breaths. Or perhaps someone encouraging you or rubbing your back through the hardest part helps you to get through it. Or closing your eyes, or day dreaming or focusing on a spot on the floor etc, whatever you need to do. Sooner or later your endorphins kick in and suddenly it’s not so bad, you can do it, you ARE doing it.

The other way to imagine a contraction is like you are floating on the ocean and each one is a wave. As it comes you can kick and fight and try to stop it affecting you, or you can simply relax as it comes and allow yourself to be lifted up and over the wave. Ride it, don’t fight it. You can’t stop a wave in the ocean, you will exhaust yourself or be dumped by it. Work with it and just surrender to it, and then you can relax and even enjoy it.

Basically your body knows what to do, and will do it regardless. Even if you went into a coma your body would birth the baby without you. In fact it would do a pretty good job of it. So your role in the birth is actually just to not get in the way. Really. 😉 You need to learn how to relax and surrender and breathe through it, and not hold back and resist and impede the progress.

In general a vaginal birth (and particularly a natural one where mom is up and active) is much safer for the mom and baby. The ‘stress’ of natural birth is actually very good and healthy for the baby. It stimulates the baby and prepares it for life outside the womb. Far more Caesarean babies have breathing and lung difficulties (pneumonia etc) because they have not had the fluid squeezed out of their lungs by the passage through the birth canal (and the adrenaline etc they have during birth too). It’s not to say a Caesarean is a BAD way to birth, but natural birth is arguably the best way to birth.

Also even if a Caesarean birth is necessary, or selected, it is still better to allow the baby to be fully ready (not at 38 weeks) and even allow labour to start, before performing the Caesarean, and let the baby get the benefit of:
1) Being born on its actual intended birth date, when it was ready to be born and
2) The stimulation of the contractions. Labour is good for the baby (unless there are issues like with the cord or placenta etc when it’s not, but that’s what the intermittent monitoring is for, to make sure baby is fine with the labour).

Are my pelvic muscles damaged? No. Sure they are not 100% the same as they were, but they work completely fine, and honestly I am far more comfortable with my body and my sexuality now than before I had my babies. Somehow growing and birthing them really put me in touch and in awe with myself. Honestly my experiences of giving birth are some of the highlights of my life, and I regard them as my greatest achievements. I wouldn’t change that for the world.

So the choice really is yours, but I hope some of the above can help with your decision.

Remember:
The power and intensity of your contractions cannot be stronger than you, because it is you.
The contractions come from and are YOU. So they can not overwhelm, or be bigger than you, as they are only as strong as you are!

Caesarean birth generally more risky to mom & baby

This article was published in the New Zealand Herald. More clinical proof of the increased danger to mom & baby, with unnecessary Caesareans.

Caesarean births twice as risky as natural deliveries

10:00AM Wednesday October 31, 2007
By Jeremy Laurance

Women who choose a Caesarean delivery, sometimes described as “too posh to push”, are increasing the risk to themselves and their baby.

Surprise results from an international study of 97,000 deliveries show that a routine Caesarean puts a woman at twice the risk of illness or death compared to a vaginal birth.

And babies born by Caesarean had a 70 per cent higher risk of dying before discharge from hospital if they were lying normally head first in the womb than if delivered vaginally.

A Caesarean delivery was, however, found to be safer for babies lying in the less common and riskier breech position – feet first.

The findings are from eight randomly selected countries in Latin America, where Caesarean rates are higher than in the UK, at an average of 33 per cent of all births.

Well-heeled Latin American women are more anxious about the potential effects of a vaginal birth on their sex lives and in some private hospitals the Caesarean rate is up to 60 per cent.

In Britain, the Caesarean rate has doubled in the past 20 years to 22 per cent, driven in part by the demand of some women for what is perceived as a convenient and pain-free method of delivery.

Obstetricians too have seen it as safer – and as a way of reducing risks of litigation.

The latest study, published online in the British Medical Journal, suggests the safety of Caesareans may have been overstated.

Jose Villar, former director of maternal health at the World Health Organisation and now a senior research fellow at the University of Oxford, who led the study, said there was no benefit from the very liberal use of Caesareans, either for mothers or babies, and they could even do harm.

Caesareans led to longer hospital stays for mothers and babies, increased the risk of readmission and increased the risk to subsequent pregnancies.

The only exception was that babies in the breech position did better and women had fewer severe vaginal complications.

Dr Villar said the findings should be applicable to Europe and the UK because of the large number of deliveries surveyed, the comparability of outcomes to those in Europe and because the overall Caesarean rate was not dissimilar.

“The message is that a woman thinking of having a Caesarean because it is safer should think again,” he said.

“It is a question of balancing the risks and benefits. She should sit down with her care provider and consider the options. We think this is the most comprehensive study that has been done.”

In a commentary on the findings, Alison Shorten, of the School of Midwifery at the University of Wollongong, New South Wales, Australia, said an important reason why women chose Caesareans was because of worries about damage to the pelvic floor from a vaginal birth, which could lead to sex and bladder problems.

“Women need to weigh up the possible but uncertain benefit of preventing urinary problems against the increased chance of problems related to surgery in themselves or their baby,” she said.

Pat O’Brien, consultant obstetrician at University College Hospital, London, and a spokesman for the Royal College of Obstetricians and Gynaecologists, said: “We have always known from the mother’s point of view a planned Caesarean was slightly riskier…. Recent research from the US has suggested the risks of the two approaches were getting closer and closer. This latest study pushes that back a bit.”

More evidence and research findings here:
– C Sections Raise Health Risks
– Complications, Safety and Caesarian section rates
– C-section facts from the March of Dimes
– Cesarean birth in a culture of fear: a scathing indictment of the failure of technological birth in the US
– Caesarean Section Risks and Complications
– More done than ever before …C-SECTION RISKS: What Every Woman Needs to Know
– Risks of a Cesarean Procedure
– New Study Confirms Cesarean Risks

The bottom line. In most cases (i.e. other than true medically indicated Caesareans) a Caesarean IS more dangerous for you and your baby. However the choice of how YOU would like to birth remains yours. Get educated and make an informed choice for yourself, and have a happy, memorable birth expereince.

‘Pushed Birth’ – what it is, and how to avoid having one.

A fantastic new American site has launched recently called:
Pushed Birth – What to expect. Really.

It is an anti-intervention (so tending to pro-natural) site, questioning routine medical intervention in labour and birth.

The site is here: http://pushedbirth.com/

What’s a ‘Pushed Birth’? A pushed birth is one that is induced, sped up, and/or heavily medicated for no good reason, and all too often concludes with surgery, invasive instruments, an episiotomy, or a bad vaginal tear — outcomes you don’t want. Decades of research show that the healthiest birth for you and your baby — and that means your partner, your family, and your community — is a normal, vaginal birth with minimal intervention and maximum support.

This awesome website features news and articles debunking the ‘medical necessity’ of many of the pregnancy, labour and birth interventions, in a frank, slightly sarcastic & humorous, but very easy to read and digest format. It just makes sense!

It explains many of the interventions and why you should want to avoid them, and basically how and why to generally avoid having a medically ‘Pushed Birth’.

There’s a section on Previous Caesareans and VBACs here (including a summarised explanation of the recently published RCOG VBAC study risk stats in there):

If you’ve already given birth by cesarean section, you’ve probably heard the term VBAC (vee-back). It stands for, you guessed it, vaginal birth after cesarean.

And if you know that lingo, you probably know how controversial VBACs are. Your provider may be discouraging it, the hospital may not allow it, and your family and friends may be begging you not to do it.

Follow the link to find out the truth about VBAC: Previous C-section?

Another section deals with Inductions:

“It seems to make more sense in a lot of ways: your doctor or midwife may not be on call when you go into labor, your mom wants to buy her plane ticket, your office wants to plan for your absence, you’re worried about your water breaking while you’re in line at the post office. . . And now there are drugs to induce labor so that you can just set the date. Plus, maybe you’ve heard that it won’t really make a difference.”

So why not have an induction? Follow the link before now to find out: Why Not Schedule It?

Can you actually avoid Routine Medical Intervention?

Normally, women experience a host of routine medical interventions. But research shows that what a woman needs most in labor is support. Childbirth is a process that normally starts and progresses all on its own — the cervix begins to open, the uterus begins to contract, the baby begins to descend, and each of these accelerate until you can’t help but push the baby out. The body does this all by itself. Evidence-based care is essentially when the labor process is watched, supported, and protected with the least medical interference possible.

Follow the link below to find out ways to reduce your risk of being pushed: Can I Avoid It?

——————————————————

Find out about what and who Pushed Birth is here: About Pushed Birth

Partners & Doulas

by Jane Weideman

Are doulas and partners mutually exclusive? Read on and then you can decide…

It is true, that the birth of your baby is a very private event, so you might be wondering if a doula will replace or exclude your partner and his (or her)* role.

I think, especially first time moms, have a concern that their birth will not be the intimate and bonding affair, they have dreamed about, if there is a doula present. However most moms having their second or more babies understand that they are actually more likely to achieve that intimate and calm birth with the help of a doula.

So while it is common for partners, and mothers-to-be, to be concerned that a doula will be a “third wheel” or will exclude the partner from sharing in the birth, in reality the opposite usually turns out to be true. A good doula knows how to support your wishes and help the two of you to maintain your physical and emotional resources to share the birth together.

The doula is not meant to sideline or replace the partner – unless no other partner is present. The role of the partner and doula are similar, but the differences are fundamental. The partner may be very emotionally attuned to the mother, but may be distressed by ‘seeing the mother in pain’ and unable to stay calm through, what is to him a new and frightening expereince. He may be well prepared and able to provide good continuous support, but typically has little actual experience in dealing with the often-subtle forces of the labour process. Even those partners who have prepared well are often surprised at the amount of work involved (more than enough for two people) – the process isn’t called “labour” for nothing! Even more important, many fathers experience the birth as an emotional journey of their own and find it hard to be objective in such a situation. Studies have shown that partners usually participate more actively during labour with the presence of a doula than without one. A responsible doula supports and encourages the partner in his support style rather than replaces him.

According to studies, rather than reducing the father’s participation in the process, a doula’s support complemented and reinforced the partner’s role. Partners felt more enthusiastic and that their contribution to the labour and birth was meaningful and helpful. Not only did partners report higher levels of satisfaction after the birth, but mothers reported feeling more satisfied with their partner’s role at birth too.

– 71% of moms were satisfied with their partner’s role in birth – with a doula present
– 30% of moms were satisfied with their partner’s role in birth – without a doula present

 

The partner and doula are complementary to one another in providing optimal support to the labouring mother. A doula can never love the labouring mom as much or in the same way as her partner can. He knows her and loves her intimately, he is the father of the baby she is working to birth, and he is one of the main figures in the event taking place – his role is vital. However, her partner has never given birth, nor is he usually very experienced in providing labour support in the same way a doula is.

Through the presence of a doula, the partner is freed from needing to remember every idea mentioned in childbirth class. The doula is able to help him to help his beloved. He can relax into experiencing his journey into parenthood, because the doula is there to support both parents. Working together, the father’s knowledge of the mother, and the doula’s knowledge of birth, can give the ultimate level of comfort and support to the labouring woman and best provide her with the opportunity for a birth experience she will remember with joy for the rest of her life.

As Penny Simkin states, “While the doula probably knows more than the partner about birth, hospitals and maternity care, the partner knows more about the woman’s personality, likes and dislikes,and needs. Moreover, he or she loves the woman more than anyone else there.”

If you and your partner feels unsure about having a doula, talk about it together. Be honest about what you are feeling. If your partner wants to be your only birth companion, he may feel that if you want a doula, it must mean you don’t think he will do a good job supporting you. Usually that’s not at all true, but it helps to talk it through. As mentioned many partners actually find they are more actively involved in the birth when an experienced professional supporter is present.

If, however, your partner feels uncomfortable about being present at the birth – he may be squeamish or just plain scared – a doula’s presence means you will have continuous support while your partner is free to respect his own limits and be as involved as he can manage, but will be free to take a break if he needs to – and you won’t have to worry whether HE is ok.

When you first meet with your prospective doula, discuss any specific expectations you have for the birth, or things you want her to do or not to do. Be clear about what you want her role to be so there are no misunderstandings on the day. This is your birth and you are paying for a service. Make sure it is what you want!

During the birth, if you see something the doula is doing that you want to be able to do — maybe massage or a pressure technique, ask her to show you how. She will gladly involve you as much or as little as you like… don’t feel timid.

Don’t be afraid to ask for some privacy if you would like, at any time during your labour. Privacy and intimacy helps labour progress! And a good doula respects your needs and won’t feel put out in the slightest.

Some of the ways that doulas can help partners:

• Stepping in to help when the partner needs a short break. Labour is hard work, not just for the woman, but for those supporting her!
• Offering suggestions, when asked, about strategies that might be comforting or helpful during labour and possibly role-modelling or demonstrating these.
• Freeing the partner to take photos, or taking photos for the couple while the partner supports mom.
• Providing reassurance to the partner as well as the woman giving birth. If a partner has never seen a woman in labour before, it can be very reassuring to have someone focused on his needs to answer questions, give an encouraging smile, and put everything into context! This is an amazing journey for partners too!
• Providing information and an objective sounding board when you have questions or decisions to make.
• and more.

The choice is yours to make but doulas and partners can and do work very well together.
*Note that this article refers to the partner as he, for simplicity sake, but the partner could of course be female too.

Technology in Birth: First Do No Harm

By Marsden Wagner, MD. Article from Midwifery Today

There is a very good, detailed article on this topic on the Midwifery today web site. Follow the links below to read more…

• How to Get the Right Technology
• Choosing Your Maternity Care Provider
• Choosing the Right Place to Give Birth
• Getting Information on the Technologies
• Why the Unnecessary Use of Technology?
• What You Can Do
• Sources of Information for Technology in Birth

© 2000 Midwifery Today, Inc. *

Excerpts:

“Caesarean section can save the life of the mother or her baby. Caesarean section can also kill a mother or her baby. How can this be? Because every single procedure or technology used during pregnancy and birth carries risks, both for mother and baby. The decision to use technology is a judgement call—it may make things either better or worse.”

“There is not a single report in the scientific literature that shows obstetricians to be safer than midwives for low-risk or normal pregnancy and birth. So if you are among the more than 75 percent of all women with a normal pregnancy, the safest birth attendant for you is not a doctor but a midwife.”

Copyright © (2007) Midwifery Today, Inc. All rights reserved.

Midwifery Today

Sensual Birth

By Anastasia Stephens

London – For Katrina Caslake, giving birth was not the terrifying, painful ordeal most women experience. Far from it. The midwife, from Wallington, south London, says she found it blissful, even orgasmic. “I found giving birth very sensual,” says Caslake, 44, who didn’t take painkillers for the birth of either of her sons, Aaron and Tomas, now 18 and 17.

“All my erogenous zones were stimulated. I was making sounds very similar to a sexual climax. And it was a very definite climax. I was doing the most feminine thing a woman can do and it felt fantastic.”

It’s a sentiment with which Frederika Deera, a PR officer at John Lewis in London, would agree. She had a similar experience giving birth to her two-year-old daughter Delphine.

‘The most indescribable euphoria’

“Giving birth filled me with the most indescribable euphoria,” says Deera, who gave birth at a midwife-led unit in Portsmouth. “Of course there was pain, but my overall sense was of peace and happiness. I was on a complete high, so much that even having a major suturing afterwards did not bother me at all.”

It was her “pleasurable experience” that led Caslake to train as a midwife. “I knew I wasn’t unique,” says Caslake, who helps run Yours Maternally, an independent midwifery service. “By encouraging other women to trust and relax in their bodies, I felt I could help them experience less painful, more pleasurable births.”

It’s an approach that’s also encouraged at the Birth Centre in south London where midwife Nathalie Mottershead actively encourages sensual birth.

“If couples are willing, nipple and clitoral massage can be used to bring on labour contractions, open the cervix and vagina and help with pain relief,” she says.

More to the point, the approach is capable of transforming birth – perceived by most women to be terrifyingly painful – into a pleasurable, even, ecstatic experience. “We work closely with women so they can give birth at home, in intimate surroundings. If mothers-to-be are open to feeling sexy, labour can be pleasurable, not painful, and it sometimes builds up to a crescendo at birth.”

‘Useful trick for pain relief’

It’s not as if the techniques used at the Birth Centre are isolated or rare.

“If a woman is comfortable enough to do nipple or clitoral stimulation during birth, it’s a useful trick for pain relief and inducing labour,” says Andrya Prescott, spokesperson for the Independent Midwives Association.

A visit to the Unassisted Childbirth Organisation’s US website confirms just how erotic childbirth can be. The site describes in graphic detail women’s fantasies in which romantic and sexual union leads to “blissful waves of pleasure”, and “cosmic orgasms” at the point of birth. More women, it seems, get turned on by birth than you’d think. When Ina May Gaskin, a US midwife, conducted a poll of 151 women, 32 reported experiencing at least one orgasmic birth. Admittedly, these were home births by women who were “open” to the experience. The plus points are pretty significant – a single orgasm is thought to be 22 times as relaxing as the average tranquilliser, while sexual arousal widens the vagina significantly.

“Women might think twice about having an epidural if they knew that, but nobody talks about these things,” points out Gaskin, a natural childbirth pioneer who was the first midwife to openly acknowledge that women could climax at birth. It almost sounds too good to be true: a touchy-feely labour followed by an earth-shattering orgasm at the moment of birth.

Unfortunately, this is very far removed from most women’s description of childbirth. A major hitch is that, as with any sexual activity, the amount of pleasure gained – for women at least – is closely related to the degree of relaxation, trust and safety she feels.

Most women anticipate with dread the “birth ordeal”, a state of mind that will make muscles contract and adrenalin levels rise before it even begins. And then, most women can only feel sexy in intimate surroundings, with people they know well. Hospitals and doctors don’t really do the trick.

“Adrenalin inhibits sex drive and labour contractions,” says midwife Andrya Prescott. “You become tense and are more prone to feeling pain. It’s why women can have trouble with labour and birth at hospital. Surrounded by strangers, their adrenalin levels are high. They can’t relax. Even if they were open to getting aroused, at a hospital, they may as well forget it.”

Part of the problem, it seems, is the way sexuality around childbirth has been denied. In her book, Ina May’s Guide To Childbirth, Gaskin points out that doctors had to downplay female sexuality for medical men to be admitted to the birth chambers of women in the 18th and 19th centuries. This “denial” was later institutionalised when hospital births became routine.

Even today, it’s a pretty taboo subject. “Lots of women would worry they’d be seen as abnormal or deviant if they admitted to feeling sexual at birth,” says Carolyn Cowan, a yoga teacher and doula based in south London, who herself had an ecstatic birth. “It’s something lots of women feel ashamed to talk about,” she adds. “I run erotic dance classes for pregnant women to try to get rid of these inhibitions. I should know a thing or two – it took giving birth to my son to discover my G-spot.”

The tide is clearly turning. A growing number of obstetricians and midwives point out what seems pretty obvious, yet has been somehow forgotten – that since sex leads to pregnancy and birth, they’re pretty closely linked.

“When you look at sex, birth and lactation, the same hormones are involved,” says Michel Odent, the obstetrician who pioneered the use of birthing pools in the Seventies. “It seems obvious that childbirth is a part of a woman’s sexuality.”

Many parents-to-be, for example, find that making love and nipple stimulation are one of the best ways to get labour going. That’s because sexual arousal releases oxytocin, a love and bonding hormone, which triggers orgasmic and labour contractions in the uterus. Conveniently, this hormone is an endorphin, meaning it has an opiate-like effect – inducing pleasure while acting as a highly effective painkiller.

Aside from the pleasure and pain relief, the advantage of a sensual birth is less physical damage. “Women who are relaxed and feel good, undergo easier, smoother births, so suffer less tearing and bruising,” says Caslake. “Fear makes a woman more tense and this holds the baby back.”

The baby gets a pleasure hit too – bathed in “feel-good” hormones, they’re more likely to come out feeling relaxed and content.
Further reading:www.michelodent.com (for more information on love hormones); www.unassistedchildbirth.com (for more info on sensual birth); www.birthcentre.com ; www.independentmidwives.org.uk; For sensual prenatal exercises contact Carolyn Cowan ; www.mooncycles.co.uk); Yours Maternally Independent Midwives, Wallington, south London (www.yoursmaternally.co.uk )

How to have a sensual birth

Why some women achieve a “birth climax” while others endure excruciating pain is likely to be due to differences in environment, genetics, expectations, and psychological factors. Trust and the level of emotional support you feel from your husband is critical in inducing a feeling of safety and relaxation needed to get the “pleasure hormones” going.Women are generally more likely to have sensual birth experiences during home deliveries in an intimate environment.

Midwives who have witnessed women who’ve been physically aroused during childbirth believe the following techniques could make the experience more likely:Before and during childbirth, become intimate with your body. Look at yourself naked in the mirror, noticing any areas that trigger uncomfortable emotions. Send loving thoughts to that area until the difficult feelings pass. Ask your partner to look at your body and compliment you.If you feel comfortable with it, aim for a home birth.

Work closely with a doula or midwife to build up a sense of trust with her, in your body and in the birth process.Ask yourself if you can believe that your body will be doing the right thing, to the best of its ability, to give birth successfully. The more you can believe this, the more you’ll be able to trust yourself and relax.

Pick a special room or area where you want to give birth. Light candles to create atmosphere and evaporate lavender essential oil in an oil burner to induce relaxation.Learn a relaxation method such as abdominal breathing to use during childbirth to curb the release of stress hormones.

Create the expectation that childbirth could be pleasurable, even if there is pain: while pregnant, spend time imagining how it could trigger warm tingling sensations in your body along with feelings of love.

If you feel it is appropriate, ask your partner to kiss you, stroke you gently or even caress your nipples as labour contractions come on.

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

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.

Your 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!

Massage 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.

Midwifery/Doula Movie Clips

Below are links to movie clips on Doulas and Midwives:

Like Heaven into My Hands – A midwife Story
This is a beautiful orated slide show by an experienced midwife. It is well worth watching.

Quotable quote:

“I have more grey hairs after some births and I feel like I deserve at least a million dollars for being there … other births are so smooth and so beautiful and I feel like I owe them a million dollars for witnessing it”

What is a doula Movie clip

This movie clip shows moms and couples talking about their experiences with having a doula attending them at their births and discussing what a doula does and how it helps.

Home Delivery

This narrated photo movie shows midwife Nancy Harman in NC, USA, working and talking and attending a beautiful home water birth.

3D Medical Animation of Normal Vaginal Birth (Childbirth)

This animated movie clip shows the anatomy and physiology of a normal vaginal childbirth – how the cervix effaces (thin) and the dilates (opens) and then how the baby moves down and rotates to emerge to be born. The design is incredible and always fascinating to see!

We’ll add more midwife and doula movie clips here as we find them, if you know of any feel free to let us know, we’d love to link to them!

Epidural – Pros, Cons & Considerations

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.

Yoga in Pregnancy – Part 3 – More Advanced Postures

Following on from Part 1 and Part 2.

Practising Yoga during pregnancy – Part 3 – More Advanced Postures

Compiled by Jane Fraser (Weideman)

This is the third article in a series about yoga in pregnancy.

This article follows on from the first which introduced the benefits of yoga during pregnancy, and the second which examined some simple poses for relaxation.

Before you start remember that in general, you want to avoid any strain, compressing and twisting in the belly or abdomen. Also avoid most inverted poses (headstands, handstands, shoulder stands) unless you are experienced in and very comfortable doing them. Absolutely no breath retention or breath of fire should be attempted. Above all … listen to your body! Your body and baby will let you know what you need and what poses are uncomfortable. And please … don’t practice yoga to the point where you’re exhausted.

Foreword: As with any exercise program it is best to consult your doctor before beginning. However, with the exception of not lying directly on your back or stomach after the fourth month, and avoiding what doesn’t feel right to you, there is very little yoga that would be a problem during pregnancy.

Modifications for yoga during Pregnancy

The Basic Rule: The more your belly grows, the more challenging balance poses become (due to your shifting centre of gravity) so avoid postures that are uncomfortable, or feel to unstable or cause doubt. Or alternately use the wall!

Pregnant women are generally told not to lie on their backs after the first trimester in order to prevent Vena Cava Syndrome (a lowering of blood pressure due to the baby pressing on the vena cava artery). Use common sense and listen to your body. It varies amongst different body types. Ed’s note: You will know if this is a problem for you – as you will feel feint and light headed when lying on your back for any length of time. If you feel fine – you are.

Bolsters and cushions can make a big difference and make postures more comfortable. During deep relaxation you can bend your knees or lie on your side with cushions under your neck, baby and between your legs. During the second and third trimester, do not lie on your stomach.

Note that pregnant woman are subjected to the hormone relaxin. The purpose of this natural hormone is to facilitate the pelvis and hips to gracefully shift during pregnancy and child birth providing an easier passage way for the baby’s arrival. Due to the softening effect of relaxin on all joints and ligaments pregnant woman need more support when they are stretching to ensure they don’t over stretch and strain.

Good Form
Breathe through your nose, relaxing your jaw and drawing air deeply into your belly.Move with intention, allowing each move to follow the flow and rhythm of your breath.Do not overexert yourself. Remain calm and relaxed during the routine.Wear loose, comfortable cotton clothing and drink water before, during and after your practice.

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Breathing Basics
While in labour, you can rely on “ujai pranayama,” an ancient breathing technique, to help you relax through contractions. Keep your jaw and face relaxed and eyes closed, place the top of your tongue on the roof of your mouth, and hands on your belly. Breathe in slowly and deeply through your nose and imagine drawing the breath into the crown of your head and the deepest part of your belly. Then exhale through your nose, drawing the belly gently in to empty all the air out. (It can help to imagine the complete relaxation you feel and deep breathing you do just as you are drifting off to sleep. Ujai breathing is similar to this.)

On to the poses…

You may want to use the poses described in the second article as part of your warm up and cool down to your yoga work-out…

Standing Mountain Stand with your feet hip-width apart, knees soft and toes pointed straight ahead, your palms touching at “heart center” (in front of your chest). Close your eyes and breathe deeply. Inhale and sweep your arms out and overhead, bending back slightly. Exhale and stand upright, returning hands to heart center. Repeat for 10 full breaths. The continuous flow warms up your body and prepares you for the rest of the program.

Supported Triangle Stand with your feet about 2x shoulder-width apart, toes facing front, hands on hips. Turn your right toes in and left toes out. Bend left leg, placing your left hand on the thigh, eyes looking down. Inhale, then exhale as you lift your right arm above your shoulder and turn your head, eyes looking up. Place your left arm on your thigh for support. Hold for 1 full breath as you lower your right arm and straighten leg. Return to starting position, then repeat for 5 full breaths. Reverse feet and repeat sequence on the other side. Strengthens and stretches the entire body and helps prepare you for labour.

Tree Pose This pose helps strengthen your thighs, calves, ankles and back. It can also increase the flexibility of your hips and groin. Your balance and concentration can also be improved with constant practice. This Yoga Pose is recommended for people who have Sciatica and flat feet. Start with the Mountain Pose (see above), as you exhale, place your left foot on the inside part of your right leg, close to the groin area, with the toes pointing downward. As you inhale, stretch your arms sideways to form a T, palms facing down. As you exhale, bring your palms together in prayer position. Raise your arms overhead, keeping your palms in prayer position. To maintain balance, it helps to focus your eyes on one point in front of you and keep on breathing through the belly. In the beginning, you may use a back brace against a wall to help you keep yourself steady.

Half or Full Squat Stand with your feet 2x hip-width apart, with a stack of pillows on the floor behind you. Bend knees to lower hips into a deep squat (sitting onto the pillows for support if you need to). Place your palms together at heart centre (shown). Close your eyes and breathe deeply through your nose as you relax your pelvic floor (the muscles surrounding the vagina). Hold for 10 full breaths, then go onto hands and knees for next move. In a healthy pregnancy this is an excellent pose to practise, as it strengthens the thighs and teaches you to relax the pelvic floor, preparing you for labour.

Ed’s Tip: You can also practise your labour breathing techniques while holding this pose! Breathe through the burning sensations in your thighs as you feel them working and try to hold for 60-90 seconds – which is about as long as a contraction lasts.

Note: This pose is not recommended if you are experiencing any signs of premature labour.

Moving Cat Sequence Kneel on all fours, abdominals drawn in. Inhale and gently arch your back, tipping your tail-bone up, eyes looking up. Exhale and round your back as you tuck your chin in toward your chest. Sit back on your heels into Child’s Pose and relax for 1 breath. Repeat sequence 10 times. Remain in Child’s Pose for 5 slow breaths to cool down. Builds stamina and strength in the arms, back and abs, and teaches you to relax and let go.

Warrior Pose II ( Warrior Pose I is tricky in pregnancy as stretches and places strain on the stomach and requires a lot of balance. Warrior II which still strenuous is probably a safer option for most people.) This posture strengthens your legs, back, shoulders, and arms, building stamina. It opens your hips and chest, and improves balance. Start with the Mountain Pose (as above). Step your legs open so that your feet are around four feet apart. Raise both arms parallel to the floor. Turn your head to the left. Turn your left foot 90 degrees to the left and bend your left knee. Keep the hips in the same angle (180 degrees) as for the arms. Stay in this position for 30 seconds to one minute. This is a powerful Standing Pose which provides numerous benefits such as increase in stamina and improved strength in the legs and ankles.

Side Stretch This side stretch will increase the flexibility of your spine, arms, and rib cage as it stimulates the liver, kidney, and spleen functions. Furthermore, the Yoga Pose will also help realign your spinal column and will aid the lungs to take in more oxygen. Start with the Mountain Pose (shown above) and establish a smooth flowing breath. As you inhale, raise your left arm, making a line from your left foot to the fingertips. Place your right hand on your right hip. As you exhale, bend your upper body to the right. Hold for several breaths. Inhale, and bring the body back to the original position. Repeat the pose on the other side. If it is too strong for you to do this standing, you can try a seated variation.

Full Butterfly Sit with legs outstretched. Bend the knees and bring the soles of the feet together, keeping the heels as close to the body as possible. Fully relax the inner thighs. Clasp the feet with both hands. Gently bounce the knees up and down, using the elbows as levers to press the legs down. Do not use any force. Repeat up to 20-30 times. Straighten the legs and relax. This pose helps to open the hips and relieves tension in the inner thigh muscles. Removes tiredness from legs.

Reverse table top Sit tall with your legs bent, palms down and behind hips, shoulders back and down, chest lifted. Pressing into your hands and keeping shoulders back and down, inhale, then exhale as you lift your hips to a comfortable position, keeping neck in line with your spine. Hold for 1 full breath, then lower hips to starting position and repeat 5–10 times. Strengthens upper back, shoulders, buttocks and abs, improving overall balance and coordination.

Bridge Strengthens the spine, opens the chest, improves spinal flexibility, stimulates the thyroid. Lie on the back. Bend the knees, bringing the soles of the feet parallel on the mat close to the buttocks. Lift the hips up towards the ceiling. Interlace the fingers behind your back and straighten the arms, pressing them down into the mat. Roll one shoulder under and then the other. Lift the hips higher. Draw the chest toward the chin, but do not move the chin toward the chest. Make sure the feet stay parallel. Release the hands and bring the upper, middle, and then lower back down. Rest , allowing the knees to knock together.

To be completed soon.

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Below is attached a very useful Great Pregnancy Yoga Poses document beautifully illustrating the various pregnancy poses (with variations):

– Great Pregnancy Yoga Poses .pdf document (right click to download, or click to access directly).

For some listings of recommended local (Cape Town) Yoga teachers experienced in Prenatal Yoga. See our Local Recommendations section.

There are also some very good Yoga for Pregnancy Books available. We have several in our Lending Library.

** 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.

VBAC – Vaginal Birth After a Caesarean

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.