Friday, January 18, 2013

A Few Key Pieces of Info You Need to Know Before Giving Birth

Realise that knowing the benefits of natural birth will be invaluable during birth. 

When you hit a wall of doubt in your ability during birth – which most women do – knowing what you're working for will give you the motivation needed to push through. Natural birth means avoiding the risks and complications associated with interventions such as induction, pethidine, epidurals, and cesareans.

Let's start with an epidural. An epidural literally slows labor, your body can no longer feel what it's doing. Natural oxytocin levels drop 1,2,3, increasing the risk of needing synthetic oxytocin, opening up a whole new set of risks associated with synthetic oxytocin such as the fetal distress, uterine rupture, hemorrhage, and cesarean.4 An epidural also restricts your own movement, it increases the risk of malpresentation of the baby 4 fold, and is associated with a 5.6 fold increase in dystocia.5,6, 7 The end result being a 4.2 fold increased risk of forceps and vacuum delivery, and a 2.4 - 3.7 fold increased risk of needing a cesarean for dystocia, each of which carry their own set of substantial risks to both mother and baby. 5, 8

It's worth researching the risks associated with these procedures so you can truly appreciate the merits of working for a natural birth. See this post for more info.

Realise that birth will be extremely intense. 

A good analogy would be that the pain will be like the worst stomach cramps you've ever felt, multiplied by five. We are talking serious pain. It will come in waves (contractions), gradually building in intensity, length, and frequency as the hours pass. Because birth comes on slow and builds over a matter of hours, you will have time to get used to the sensations. Your body will respond to the pain by gradually releasing increasing amounts of endorphins (painkilling hormone) and oxytocin (euphoric hormone) to help you cope with the sensations. 9, 10, 11

 During labor women often ask, "how much worse is the pain going to get" and "how long is it going to last". Unfortunately no one can answer that question. We can't say with certainty how much stronger your surges will get, how long they will continue for, or how well you will cope. You won't know until you get there, and that's something you need to accept and be at peace with. What we can say is that there are a host of natural pain relieving methods that do effectively reduce the sensation of pain and make the birthing process more enjoyable.

The best advice is to utilize those methods and remember to take one surge at a time.


Realise you CAN control the sensations you feel. 

No you are not completely helpless and at the mercy of the birthing process. Through consciously relaxing your mind and body you are able to effectively reduce the intensity of the surges and quicken baby's descent. Pain is interpreted in the brain once the brain decides that the sensations felt are harmful. This is where you have some element of control - by consciously telling your brain that the sensations you are feeling during birth are not harmful. You can see how positive affirmations and hypnosis that help to reframe the birthing process as positive fit into the picture.

There are a host of relaxation and natural pain relieving techniques you can utilize, some of them you can start implementing before birth even begins. You are not helpless, take charge, take responsibility for the central role in your birth. Make the surges work for you, work with your surges, don't fight them, embrace them.

Realise that you will need an extreme amount of focus and perseverance to mentally and physically cope with the surges. 

Just be aware of it and ready for it. Our natural reaction when we feel pain is to tense our muscles, especially in the area where the pain is located. However tensing your pelvic floor muscles intensifies the pain of the surge! Tense pelvic floor muscles create a wall that your uterus must try to push baby through, it's like pushing against a closed door. This will greatly slow baby's descent, reducing the efficiency of surges, serving only to tire you out. Stress during labor is known to prolong or even halt the process of labor, and reduce blood flow to both the uterus and baby – not good.
During birth a goal should be to reduce stress and counteract the tendency to tense your muscles in reaction to the pain. This can be a lot harder than it sounds, especially when the sensations get more intense. You need to continually prompt yourself to relax despite the magnitude of the stress your body is undergoing. It's a little like trying to meditate in the middle of a busy construction site, while the noisy activity around you gets louder and louder. The temptation to be distracted is strong, and gets stronger as birth progresses.

But fear not, help is at hand. Practicing cognitive reframing, positive affirmations, visualization, meditation, or hypnosis during pregnancy all help train the mind to focus and relax on cue, ready for the big day. Just be aware it takes months of daily practice to really get the full benefit. So get started now!

Realise that it's all about muscle function. 

Your uterus is a giant set of smooth muscles that form a sac encasing your baby. There are three layers of uterine muscle, with the first vertical layer being the most important. During each surge these vertical muscles contract, shortening and thickening. But unlike a skeletal muscle, like for instance a bicep muscle, when the uterine muscles shorten and thicken with each surge they don't return to the same resting state they previously were. Their resting state continues to contract tighter and tighter with each surge, little by little. In this way birth can only progress forward, there is no going backwards. With each surge the muscles nudge baby down further and further, provided your cervix (the opening of the uterus into the vagina) is fully dilated (open).
So what causes the pain during a surge? Well it's similar to a having a muscle cramp – during muscle contraction the body lacks the required nutrients or blood flow to continue functioning properly, causing it to inflame, resulting in pain. Based on each person's blood flow or nutrient level, the muscle can only cope with a certain level of contraction intensity before exhausting itself. When a muscle contracts it squeezes blood out of the blood vessels running through the muscle. You can imagine that the more intense the contraction is, the more blood will be squeezed out, the more reduced blood and nutrient flow to the muscle, and the more muscle fatigue, inflammation, and pain.
So how can we reduce the pain of surges while preserving their important function of nudging baby down and out the birth canal? When you are stressed during labor you tend to tense your body, in particular your pelvic floor muscles. The problem with this is that with each surge the baby is trying to descend down through this area, but if this area is tensed and constricted it makes it a lot harder for baby to pass through. The surges will still push baby down against those muscles, and when that happens the muscles are compressed by baby's head, squeezing ever more blood out of tissue that is already lacking blood flow. This, ofcourse, results in a more intense, painful surge. The answer to reducing this over-compression? Relax your pelvic muscles ofcourse! Which is so much harder in reality than it sounds in writing. Relaxation really is a high priority during birth, if you can master that, you've got it sorted. So get to work researching and practising a range of relaxation methods in preparation for birth!

There's one more element to muscle function that is integral – nutrient supply, namely water, sugar, salt, calcium, magnesium, and potassium. Without these nutrients muscles will fatigue and cease to function. B vitamins are also crucial for energy. Ensure you have an abundant supply of these nutrients in the weeks leading up to birth, and throughout birth.

Realise that birth is extraordinarily emotional, hormonal, and even spiritual. 

Many women (who have taken acid) describe natural birth as similar to an acid trip, with the peak right at the end when baby is born. Be aware that you won't behave like your normal 'you' when you give birth, you will literally be 'high' in a way you've never been before. You'll make strange noises you've never made before, and think strange thoughts you've never thought before. You will experience a rollercoaster ride of emotions, an epic journey, a lifetime of experiences condensed into one day. Just go with it, don't hold back, and don't be afraid.

During birth your body will be brimming with hormones at heightened levels you will never experience again. As labor progresses these birthing hormones will continue to increase, helping you cope. By the time baby is born these hormones will have reached incredibly high levels, and once baby is out and the pain is gone, you'll be left with a 'birth high'. The birth high serves to imprint baby in your memory and bond the two of you together. Decades later you will still be able to recall the moment you first looked into your baby's eyes. The birth high can, however, be negatively affected by birth interventions such as synthetic oxytocin, epidurals, or cesareans. These interventions may reduce the body's ability to produce the hormones needed for naturally coping with pain, birth progression, bonding, and breastfeeding.

Remember the surges, and the sensations that go along with them, are all part of the process of building up the hormones needed for coping with pain, birth progression, bonding, and breastfeeding. As much as you might abhor them, they are VERY beneficial.

Painting by Amanda Greavette

Sources:

1. Effects of intrapartum oxytocin administration and epidural analgesia on the concentration of plasma oxytocin and prolactin, in response to suckling during the second day postpartum. Jonas K et al 2009
http://www.ncbi.nlm.nih.gov/pubmed/19210132

2. Effects of lumbar epidural analgesia on prostaglandin F2 alpha release and oxytocin secretion during labor. Behrens O et al 1993
http://www.ncbi.nlm.nih.gov/pubmed/8484013

3. Plasma oxytocin levels in women during labor with or without epidural analgesia: a prospective study. Rahm VA et al 2002
http://www.ncbi.nlm.nih.gov/pubmed/12421171

4. Pitocin Side Effects
http://www.drugs.com/sfx/pitocin-side-effects.html

5. Side Effects of Epidurals: Research Data
http://transitiontoparenthood.com/ttp/foreducators/ceinfo/Side%20Effects%202.htm

6. Changes in fetal position during labor and their association with epidural analgesia.
Lieberman E et al, 2005
http://www.ncbi.nlm.nih.gov/pubmed/15863533

7. Obstetric risk indicators for labour dystocia in nulliparous women: A multi-centre cohort study
Hanne Kjærgaard et al, 2008
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2569907/

8. Epidural analgesia and risks of cesarean and operative vaginal deliveries in nulliparous and multiparous women.
Nguyen US et al. 2010
http://www.ncbi.nlm.nih.gov/pubmed/19760498

9. Pain in Labour: Your hormones are your helpers
http://www.sarahbuckley.com/pain-in-labour-your-hormones-are-your-helpers/

10. Pain and plasma beta-endorphin level during labor.
Räisänen I et al, 1984
http://www.ncbi.nlm.nih.gov/pubmed/6095156

11. Corticotrophin-releasing hormone and beta-endorphin in labour.
McLean M et al, 1994
http://www.ncbi.nlm.nih.gov/pubmed/8075786

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