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I’m going to give birth! How is my body going to do it?

Understand how your body is designed to birth your baby. 

by Sophie Fletcher

Birth we can do it
Our bodies get on with the task of quietly and painlessly growing an intricate human being.

I never really thought much about how I’d get the baby out; to be frank I’m a genuinely in the moment person, I tackle things as they happen and I don’t get scared of much, expect for missing my train and being late. It often bemuses me that women get so frightened about the birth, and that the main worry is ‘how is that going to get out of there’.  This seems especially perplexing when women aren’t often frightened by thoughts of, ‘how is that baby going to grow in me?’, ‘how is that tiny small fist sized womb going to grow and expand so my baby is going to fit in it?’. The body expanding and growing to accommodate baby is something we are largely accepting of and don’t spend too much time focusing on.

While pregnant women generally just carry on with their lives, complaining of tweaks and pressure here and there,  the more unfortunate ones may have more physical challenges such as SPD, or bad reflux as the baby grows and the stomach is pushed upwards.   However, women don’t fear these, they accept them, find ways of managing and just carry on with the pregnancy.

So why do we trust and accept that our bodies are going to expand and stretch enormousl?That our womb will grow from the size of small fist to the size of a large basketball and that all our internal organs will reorganise themselves, but we don’t accept that our body is designed to actually birth our baby?  WE GROW A BABY, with tiny hands, ears, eyes, arms, legs and a heart.  How incredibly amazing is that?  And you know what, we generally don’t think about it at all, our body just does it and we just accept it.  We don’t question that our heart gets larger, that our organs are pushed upwards and that our lung capacity gets smaller. Do we think, “oh no, I won’t be able to breath properly, I need help to expand my chest and get more oxygen in me”, no we don’t. This video shows how your internal organs are designed to reorganise themselves during pregnancy.

Grantly Dick-Reid, the man whose ideas underpin many other modern approaches to undisturbed physiological birth, understood that fear can slow labour down. He spent a good amount of time in his antenatal classes reassuring women and teaching them how their bodies were designed to birth by telling them exactly what happens as they go into labour.  His book Childbirth Without Fear is still a great book to read if you want to know more about what your body is designed to do.

Nowadays some antenatal teachers will demonstrate how our vaginas expand by pushing a doll through the neck of polo neck jumper, explaining how the muscles of your vagina relax and stretch. Others might use the example of an erection to help women understand that soft tissue in their body is designed to expand and that it’s soft tissue for a reason. When a man has an erection his penis always stretches very easily and very comfortably!  Then it always goes back to its normal size.

One midwife I know made me laugh when she said to me once, “I wish I could say in a class that your vagina is like a bucket, because it is during labour”. Many mums I know describe that second stage when baby is being born as the easiest as that’s the moment they realise that they’ve nearly done it and it’s ok.

Here are some facts about the birth that may help you understand how incredible your body is during labour as well as during pregnancy.

Relaxin:

 The hormone relaxin relaxes the body’s muscles, joints, and ligaments. Not surprisingly, the effect centers on the joints of the pelvis, allowing them to stretch during birth. It also softens and lengthens the cervix and helps relax and smooth muscles in the uterus and elsewhere throughout the body.  The vagina is like an accordion; it can stretch and return to its normal shape with the help of relaxin.

Baby’s head shape and a stretchy vagina

The baby’s head must be small and flexible to fit through the birth canal. The bones of a baby’s skull are soft and are able to mold into different positions. This is why babies that have been resting low in the pelvis waiting for delivery sometimes have pointy heads. The pieces of the skull are like a jigsaw, and can move easily to allow baby to move through the birth canal and then grow and expand over the first years of life to accommodate baby’s quickly growing brain.

To allow it to do what it’s meant to do, mum should be as relaxed as possible, this is something else we teach on our classes. Like any other tissues or muscles in our body, tension can make the job harder than it’s meant to be.

This great article explains the history of how our heads changed in utero to accommodate evolutionary changes in humans.

This one also explains the changes in your baby’s head from birth to ex-utero .

If you are worried about sex and the shape of your vagina this great little article talks about how incredible that soft tissue is.

A flexible coccyx

Your coccyx is designed to move out of the way as your baby’s head descends. This is why not lying on your back is important; if you have freedom of movement, it allows the coccyx freedom to move. The sacrococcygeal joint, the joint between the sacrum and the coccyx or tailbone, also softens in pregnancy; it is designed to swivel backwards to widen the outlet of the pelvis as the baby emerges.

If you can get your hands on an artificial pelvis you can see how a woman’s coccyx moves but a man’s doesn’t.

Increased discharge/amniotic fluid

As you near labour your body might be producing more discharge and it may be thicker, this is due to hormonal changes as you near labour, but also helps baby to slip out. Equally amniotic fluid can help moisten the vagina and assist baby’s descent.  Babies can sometimes be born very quickly once the head has been birthed and the midwife catches a slippery baby!

Oxytocin

Oxytocin is our best friend during labour and an incredible hormone. When we go into labour oxytocin levels go up, which increases beta-endorphins (feel good hormones) which help you body naturally manage any strong sensations in your body by producing your body’s own natural relief.

At Mindful Mamma we love oxytocin and on our classes we focus on how to make sure that you give birth in an an environment favourable to oxytocin.

Read more about oxytocin here http://bringbirthhome.com/birth-experience/role-of-oxytocin-during-childbirth/

 Baby helps itself out

Just as you know instinctively how to birth and to get into the correct positions during labour to help your baby out,  your baby knows how to help itself out. Often this is a good reason not to take drugs that can cross the placenta and make baby drowsy. An alert, unmedicated baby will help itself out by  wriggling, and moving about to help its way into the world. This little video shows how this is, and I love the little kicks the baby gives as if it were diving into the world.

 If you’re a practitioner or a mum who knows of a particularly interesting description of how birth works that may have be a lightbulb moment for you or for the people you teach, please share your descriptions. 

 

 

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White Coat Syndrome in Pregnancy.

White Coat Syndrome in Pregnancy

by Sophie Fletcher

One of my clients at the moment (I have permission to post this) is having a tough time of it and suffers badly from white coat syndrome. She is absolutely set on a homebirth, because she feels anxious in a hospital environment, but has been challenged every step of the way. Not overtly, as I’ve heard other mums being told – “it’s your first birth you can’t have a homebirth or “we’re too short staffed, you have to go into the hospital”. But her confidence is subtly being undermined by certain tests that will determine whether she is low or high risk and whether she will be ‘allowed’ to have a homebirth or not.  As she really wants a home birth these tests become a threat to her choice and consequently  the tests themselves cause anxiety, which can impact negatively on those test results.

This mum-to-be is excited about her baby’s arrival, has a wonderfully supportive husband, and is fully conscious of her connection with her little one. So it nearly broke my heart when she said last week,

“I guess I thought it would be a wonderful lovely experience and everyone working in that environment would be so full of love and positivity, its just taking me this long to realise that its just a job to most full of red tape, the ladies at Sainsburys checkout are happier and full of more love… what a shame.”

Ironically the stress being created by her treatment is probably causing more problems than if she were being treated with honesty and compassion.  Did you know that there is such a thing called white coat syndrome, which is a associated with people becoming more stressed in a clinical environment. Commonly it’s also called white coat hypertension in people with high blood pressure. Very often if someone has to go into hospital or to the doctors to have their blood pressure taken it goes up, if they take the machine home, their blood pressure can go down and be perfectly normal. The NICE guidelines on Hypertension note:

“White Coat Syndrome is reported to occur in as many as 25% of the population, especially where their BP is close to the threshold for diagnosis. It is more common in pregnancy and with increasing age. Failing to identify WCH makes inappropriate treatment for hypertension in normotensive patients a possibility. Similarly, hypertensive individuals can also exhibit WCH and may receive inappropriate dose titrations or additional antihypertensive agents. Patients have historically been enrolled in trials using clinic BP values, and these trials will almost certainly have included a proportion of patients with WCH. It is unknown whether benefits of treatment differ substantially in those with or without WCH.”

This study puts white coat syndrome as high as 32% in pregnant women.

White coat syndrome can affect pregnancy in several ways. Common antenatal tests such as gestational hypertension and gestational diabetes can to respond to stress in a negative way, sometimes skewing potentially normal results and pushing women into the higher risk category and maybe unnecessary induction before baby is ready to be born (my client was told she would have to be induced at 38 weeks, despite perfectly normal readings at home and diet management).  Other conditions, especially skin conditions such the itching due to cholestasis can worsen in relation to stress. For those of you with eczema you’ll already know that stress can cause skin conditions to worsen. In addition, viruses are harder to fight off if stress levels are higher. As a hypnotherapist I work with many different types of skin conditions, which see massive improvements after reducing stress and anxiety.

Reducing stress is crucial in pregnancy to maintain the best possible health both emotionally and physically and to avoid the implications of white coat syndrome. Here are several ways to reduce stress:

  1. Take time out every day for just you, whether it’s a bath, some relaxation, reading a book. Prioritise it for you and your baby and make sure that you don’t postpone it
  2. Learn self-hypnosis and stress reduction techniques that you can use before going in for a hospital appointment. Many classes, including our Mindful Mamma class, teach this. I’ve heard of women actually being able to reduce their blood pressure when they switch into self-hypnosis and rapid relaxation techniques
  3. Ask if you are able to do any monitoring tests at home yourself so that you get a better picture of the patterns of your reading (place, time of day etc)
  4. Hire a doula, a caregiver, or a consultant or midwife you trust or feel comfortable with.  You can request a change in consultant or midwife.  You can also choose to have an independent midwife or even to have private antenatal and postnatal care with an independent midwife if you can’t afford to pay for a full package.
  5. In the absence of other symptoms, if you know you are stressed in a clinical setting having tests, talk to your doctor or midwife about monitoring in a different way
Please note, although White Coat Syndrome is common during pregnancy, and although you may think you have WHS, it’s important that you are checked and monitored by your caregiver,  but at the same time being aware of what you can do to reduce stress and anxiety around those tests. 
Further Reading:

Michel Odent on Gestational Diabetes

Heni Goer on Gestational Diabetes

False diagnosis of hypertension leads to increased rates of intervention

Impact of stress and link to diabetes

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Men around birth, is it ok? Do they help or hinder?

Men at birth
Men and birth

Men around birth, is this ok, and does it help or hinder?

This is a thinking out loud blog about something that has been bothering me since I attended the Paramana Doula training with Michel Odent about men around birth . The information from the day has settled and has started to trickle down into my practice. As the information took root I found myself questioning one of my firmest beliefs, that if a man was prepared and knew what to expect at the birth he was probably one of the best people so support his partner.  However, I found myself returning to Odent’s well-debated view more and more that a man should not be at a birth as he upsets the natural course of events.

Now anyone who knows me and knows the class, knows that I agree and disagree. I think that if the birthing partner is male, he wants to be there, his partner wants to be there and is prepared that he is probably the right person for the job. If  he doesn’t want to be there he shouldn’t.  Our classes have a big section on building confidence of men at birth, and the role of men at births and we get great feedback because of this.

Curiously over the past few weeks I’ve been much more alert to fathers and their reactions to birth and their emotions in influencing their partner’s choices around birth.  What I’ve sensed has begun to change my view and although I’m not firmly in Odent’s camp, I’m much closer to it.

The first image that really struck me was a clip on One Born Every Minute where the mum had a doula to support her and her husband. And boy I’m glad she did have a doula. The husband was of Turkish origin, men around birth isn’t culturally accepted, it’s a woman’s domain and the men stay well away. His discomfort at having to be there seemed apparent, he found it difficult to stay in the room, but thankfully because he had a doula, he was able to leave without feeling he was abandoning his wife.   Even at the end as baby was being born, the midwife called him to watch his baby emerging into the world, he declined – three times – before he was virtually dragged from where he stood, near the mother’s head, to watch baby being born.

We know that men at birth have choices too. They can choose not be there, or they can choose to be there and that choice should be respected too. They should be free to make this choice, without influence from mother, midwife or even cultural expectations.

The following week on a class I must have been subconsciously observing male reactions, some obviously felt uncomfortable watching the beautiful hypnobirth we show.  Then in an exercise I traditionally get the class to do together, I instinctively separated the men and the women to see how they responded to different environments in labour in relation to oxytocin and adrenaline – the birth hormones. I wanted to explore more closely how men around birth are hormonly influenced by their environment. Usually when we do it as a group there is majority oxytocin in the home, and majority adrenaline in hospital, but it’s always a little mixed.   The exercise aims to demonstrate where oxytocin, our labour hormone, is naturally switched on, with the familiar and the comfortable. We then teach how to make a hospital environment more oxytocin rich if that’s where you’ve chosen to go.

When I separated the groups I found that at home it was 100% oxytocin in the home for women and nearly all adrenaline for men.  The opposite happened in the hospital environment and the car, the men felt safe in control and principally oxytocin rich, whereas the women were adrenaline rich.

This made me feel uncomfortable as although I probably always knew it, the penny really started to drop and I became more consciously aware of how male partners may be influencing where women were birthing as much as the patriarchal medical system was often deciding how.

Despite the fact that they had their partner’s best interests at heart and that they wanted to protect and support their partners, they were governed by fear and their instinct was often to be in the hospital in order to protect. The mother’s instinct is often to be at home.   It may also be that the fear of the mother giving birth at home or in the car, meant, quite literally, that their partners, were often driving women into hospital too early.  We know that one of the best ways to avoid intervention is not to go into hospital too early.

I too am in the very difficult position of knowing instinctively that I would want to birth at home if I were to have any more children.  The decision was taken out of my hands with my first and my second, which was a VBAC at 32 weeks, I chose to be in hospital. But if we were to have a third despite me instinctively wanting a homebirth my choice would again to be to go into hospital, not because I want to, but because I know that my husband would be so consumed with fear that his anxiety would be contagious – so I would compromise.

This week I asked myself “why should I have to compromise?”.  As far as I am concerned the best thing for me would be to birth at home. I am the one birthing.   And suddenly I felt angry at myself for being subservient to this cultural shift of partners having to be there and frustrated that men seemed to be indirectly pushing their partners into hospital.  This quickly turned to softened to sadness that this is an unspoken and uncomfortable situation, often for men and women and I felt real empathy for both.  Men don’t want to be there all the time although society suggests that they should be, but is it really better that they are not?  Equally if a woman instinctively doesn’t want her partner there, how can she say to the person she loves “I don’t want you there”, if he does want to be there?

Setting aside their judgment and going with the birth as it is can be difficult for some men.  Very often they automatically assume their partner is in unmanageable pain and that she has to be rescued from if she makes screams, rants or groans that seem out of character.   They may feel edgy, may pace up and down (inside the room rather than outside!), feel at a loose end, try and talk her out of it, glance helplessly at the midwife.

Sometimes if I’m working privately with a client I’ll show a video of quite a powerful birth where a woman makes noise, facial gestures, is vocal and writhing in the water.  Then I say to the dad, “what did you think of that?” their response is, “she’s in so much pain”, it’s then I tell them that it’s an organismic birth.  We must learn not to judge and to impose our own fears on how we perceive a partners birth.

So all of this leaves me questioning the shift in my own thinking about men around birth.  I know that there are a great deal of men that will be and have been a real pillar of strength and security at the birth, able to set their own fears aside, recognize that their state of mind can also play a role, learning to be calm, mindful and present.   Ultimately I don’t know what I would have done without my husband at the birth, I felt I could totally rely on him on the day.

What can a birthing partner do? Listening to what the mum-to-be instinctively wants to do is so important. Yes, it’s your baby, yes it can be a shared experience, but how she feels will impact the type of birth she has and in turn how it affects your baby. If she feels frightened of going into hospital and you are frightened of being at home, what should a partner do?  If the mother feels it’s too early to go to hospital, but you are getting edgy what should you do? Can a partner find a way of facing his own fears and coming to terms with them prior to the birth? What would help him do that?  Or should he not be there at all?

Answers mammas! I’d be interested to hear people comments on this.