Category Archives: labour and birth

Labour Pain

Women often ask me: Okay, so how much does labour really hurt? Well, how long is a piece of string? It depends. Labour pain seems to be unique and subjective. Every woman experiences it differently. For some women, labour pain is excruciating, especially towards the end. Others say they expected worse. It was intense, but it was manageable.

Medical researchers haven’t come up with much support for the pain threshold theory. It seems that the amount of pain you’ll experience depends not on your ‘pain threshold’, but rather on something else. Question is, on what?

If I’m asked the ‘how sore is it really’ question in my antenatal classes, I ask a question of my own. I say: “Labour is a lot like sex. The hormones and body parts involved are very similar. Is sex painful or pleasurable?” The first few women normally say that it is pleasurable. But is sex always pleasurable? What about rape? It is probably one of the most painful experiences a woman’s can experience in her life. Why? What makes it painful?

The answer I’m looking for, of course, is resistance. Sex becomes painful when a woman resists it. The same tends to be true for labour. Sure, the baby can be in a position that causes additional pain, like when he is lying posterior, but in general labour coping tools and techniques are all designed to minimise resistance.

Klaus and Kennell writes:

“Every aspect of labour support must start with the idea of reducing stress – mental, emotional and physical. The goal is to enhance the woman’s ability to relax. The body’s stress system is called the sympathetic nervous system, which produces what we call the ‘fight or flight response’. The opposite of the sympathetic nervous system is the system that creates calm and a feeling of well-being called the parasympathetic nervous system. The hormones of the sympathetic nervous system are epinephrine and norepinephrine. The parasympathetic nervous system produces a hormone called oxytocin. Reducing the stress response enhances the body’s own production of oxytocin, as well as natural opiates called endorphins.

When the woman can relax, oxytocin strengthens the contractions of the uterus. It also allows the muscles to function properly, the longitudinal muscles to expel the baby and the lower uterine muscles to relax, stretch, and open to release the baby. When a mother’s body is tense, the opposite occurs; the upper muscles of the uterus loosen and stop contracting, and the lower muscles tighten to retain the infant. This is perhaps nature’s way of stopping labour if the mother has to flee from a frightening experience … The fight-or-flight response occurs and the body gears for defense, sending blood to other organs of the body. If blood flow is reduced to the uterus, the uterine muscles constrict, causing the circular muscles of the cervix to tighten up, and dilation is impeded [and remember, the less blood flow to the uterus, the more pain]. Also, there may be less oxygen sent to the fetus. When the vertical muscles of the uterus continue their attempt to expel the baby, and the cervix resists, the baby’s head pushes against tense muscles. This causes more pain and lengthens labour.

When labour is not impeded by undue stress and fear, the woman’s own natural oxytocin is secreted from the posterior pituitary gland into the bloodstream. At the same time, her brain also secretes oxytocin to other areas within the brain itself. This has four effects. First, it markedly increases the pain threshold, so that the mother has reduced sensitivity to pain. Second, it results in drowsiness. Third, it results in some relaxation or calming, and finally, after the birth it helps the woman feel closer to the baby.” (The Doula Book, Klaus, Kennell & Klaus 2002: 70).

In other words, relaxation creates a positive feedback loop. The more relaxed the mother is, the better her secretion of oxytocin. In its turn, oxytocin leads not only to stronger and more effective contractions, but, paradoxically, also to less pain! The key to a less painful labour is increasing relaxation and reducing resistance.

But how do you reduce resistance? My top ten tips are:

  1. Practice relaxation techniques before labour, preferably with your partner. You can take a course like Hypnobirthing or The Mama Bamba Way, you can buy CDs on the internet, or you can practice yoga, meditation and/or visualisation. These techniques will all teach you how to relax into the intense experience that is labour, instead of resisting it.
  2. Support yourself with people that you love. Research has shown over and over that a mother who is supported experiences less pain. Consider hiring a professional doula to take some of the pressure off your partner and to support him as well.
  3. Ensure that you are labouring in an atmosphere that feels safe and comforting. If you are one of those people who tense up as soon as you step into a hospital, you should consider birthing at home or in an Active Birth Unit.
  4. Use water to relax you and to relieve pain. A birth pool is probably second only to an epidural in terms of pain relief. It really can provide extremely effective pain relief.
  5. Remember that your breath is your best friend in labour. You don’t need to learn a lot of complicated breathing techniques. You just need to breathe in a natural and relaxed way: in through your nose, out through your mouth. Try to make your out-breath a little longer than your in-breath and purposefully relax and let go while breathing out.
  6. If you find labour painful, tell yourself that this is healthy pain and that you welcome it. We are so used to resisting pain, to taking pain killers and rushing to the doctor. We are used to seeing pain as a message from our bodies that something is wrong. In the case of labour, however, pain has a purpose.
  7. Take it one contraction at a time. You can handle this one contraction, can breathe through an intense minute or minute and a half. What you may not be able to do, is cope with the idea of the contractions that have gone before this one (I’ve been in labour for fourteen hours!) or with the ones that are still to come (How long is this going to take?). The moment you start thinking of the past or the future – the moment you step out of the present – you are in trouble. See each contraction as one less, not as ‘oh no, not another one!’.
  8. Keep your mouth, your neck and your shoulders soft. It is almost impossible to hold tension in your body if these areas are soft. Blow soft raspberries with your lips, roll your neck, ask your partner for a shoulder massage in between contractions. Some soft, smoochy kisses will also do the trick.
  9. Make low-pitched sounds from deep in your belly. This increases endorphin release. If you find yourself crying ‘no’ and shaking your head from side to side as a contraction starts, try doing the opposite. Chant something like ‘yes’ or ‘open’ instead. Embrace the pain instead of resisting it.
  10. Use tools that will get you out of your normal state of consciousness into a more embodied, instinctive state. Lower the lights or close your eyes. Play relaxing music and move rhythmically with it. Dance with your partner. Spiral your hips.
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Posted by on March 12, 2012 in labour and birth, Natural Birth


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From the deep recesses of sleep

Another strong, incredible woman after the birth of her second baby

I drag myself to assist at the birth

of a woman I’ve never laid eyes on.


whispered encouragement

only women in the room

reverently gathered round the bath

to worship our fair goddess of fertility.

Somewhere far from here

the baby’s father

sleeps peacefully next to his new love

just as the two children

from his old one

sleeps in the birth room next door

while their mother strains and sighs

while their grandma frets and fusses

while their auntie rubs her sister’s aching back

and snaps digital pics.

“I can’t!”

the woman cries

and four pairs of female hands

stretch towards her

to transfuse their strength.

Into the warm water

slips a chubby pink baby

onto her mother’s chest

where she turns her head

to take in all the faces

belonging to the admiring voices.

“You did it!”

we cry

our eyes wet with tears.

Two hours later

the woman walks

to her tiny white car

straps her brand new baby

into an old car seat

and makes sure that her boys

are comfortably settled

on the laps of their grandma and aunt.

As the muezzin’s mournful voice

begins his morning call to prayer

she slides behind

the steering wheel

and drives herself

and her family


The midwife and I

wave goodbye

until the battered white Corsa

disappears in the dark.

We turn to each other

shaking our heads.

“Women!” we marvel.


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What is Normal Birth?

Here is one of my favourite quotes about birth:

The question is disarmingly simple, like asking: ‘What is love?’ I open my mouth to answer quickly, then close it again, suddenly humbled by the realization that the answer is complex, emotional, elusive, rich, deep and varied.

Images flash in my mind – I see beautiful, wet babies in their mothers’ arms, I smell the birth smell and feel the holiness that hangs in the air; and I feel the wonder that rises in the presence of the wise and ancient process that is beyond human design or control.

Normal birth is the mother who stands up beside her bed where she has just given birth, faces me with her baby in her arms, her eyes flashing fire and triumphantly shouts: ‘I did it!’

Normal birth is the woman who dances the slow birth dance and sings the low birth song. It is the woman who is naked and not ashamed.

Normal birth is the woman who, though she has never been there before and did not know she knew the way, finds her path to the deep and quiet place within herself where her intuition and faith lie hidden and ready to feed her soul.

Normal birth is the woman who births in her own power, dignity, beauty, grace and strength. It is this mother and this never-seen-before baby working it out together for the first time.

Normal birth is what I trust this mother can do. It is what I believe in, cherish and humbly protect. It is the gift we give the mothers we serve and the gift they give their precious babies. It is the real life miracle I witness again and again with an ever-growing sense of privilege and joy.

Lois Wilson, American midwife (in Midwifery Today)


Posted by on February 25, 2012 in labour and birth, midwives, Natural Birth


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When the Flame Flickers

Burnout. Those dark days when the flame of your passion is assaulted so repeatedly by opposing winds that you doubt whether you’ll be able to keep it burning any longer. Those days when The System seems omnipotent – omnipresent – when you feel like an insect crushed beneath its ever-rolling wheel. Does anything I do make a difference, you wonder. Am I a fool to even try helping moms and babies achieve better births? An idiot to keep advocating breastfeeding when artificial feeding has become the norm worldwide? When that practice is driven by multinational companies who have billions of dollars at their disposal to find new ways to bombard parents with their products, new ways to evade the Code for the Marketing of Breastmilk Substitutes?

Anyone who works in some kind of activism will know what I’m talking about. Some days you wonder why you keep trying. Why you keep getting up in morning with the idea that you might make a difference. Why you don’t just throw in the towel and let things take their course …

This week I reached an all time low. I felt like I just didn’t have the energy to be a doula and a lactation consultant and an antenatal educator who advocates choice and informed consent anymore. I felt like I kept banging my head against a brick wall. Sometimes it seems like all I get for my passion and hard work is trouble. Criticism and anger from those who’d like to preserve the status quo. Why should it bother me that two-thirds of women are giving birth with major abdominal surgery in South Africa? Why should I care that many of the rest are having routine episiotomies – a practice that is painful and just not evidence-based? Why should I lie awake at night because most women initiate breastfeeding but then wean their babies in the first six weeks? It’s not like one doula can do anything about these sad facts, is it?

I was ready to fling myself 100 percent into my writing. I actually offered to resign as antenatal teacher. (Luckily, my boss refused to accept that resignation). When I went to bed last night, I was planning to attend only those births I’d committed to and then gently ease out of the birth world. I honestly didn’t have the heart for it anymore.

I know, I know, I was feeling really sorry for myself. But cut me some slack. You have to be on fire in order to burn out, remember? It’s those of us who care deeply who end up hurting really deeply, too.

This morning I woke up and read the comment from thebirthmuse. She described natural birth as ‘magical’. Yip, I thought, that word rings a bell. It is magical to witness empowered birth. It is magical to see a mom put her newborn to the breast the first time – the way her eyes grow wide the moment he starts sucking. “Wow,” she’ll say, “he’s drinking! He knows what to do!”

Magic is certainly part of why I do it. The memory of magic gives me the energy to get up after each knock and keep trying to assist women who want a choice in birth and in how they feed their babies. But I also do it because of the moms. And I especially do it because of the babies. Because I believe they have the right to the gentlest, safest, most loving births possible. I believe they have a right to the incredible emotional and physical benefits of breastfeeding. I believe they are the ones who will make this world a better place if only we empower them to do so. I do it for Annabelle and Nathan and Sadie and Sanmarie and all the babies that have come before them and will come after them. I do it for them, because deep down, beneath the burnt-out part of me, the embers of passion are still glowing. Deep down, I still believe we can make a difference … one tiny little baby at a time.


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The Beauty of Labour

It never ceases to amaze me how different women look from their everyday selves when they are in strong labour. If they are able to surrender themselves to the process, that is. If a woman is really into her labour, her face might take on an angelic – if exhausted – glow. Her features become softer and more natural. She starts to look, I think, more like herself. As she drops her pretences and masks, the loveliness of the creation process itself shines through her. Life itself flows through her, unhindered.

You might ask me if her appearance really alters or if she only looks different to me. This I cannot tell you, for I possess only my own eyes with which to see. And, of course, beauty is in the eye of the beholder. Love for something or someone will radically change its appearance. I would not be exaggerating if I told you that I fall in love with the labouring mothers that I attend. Not in a romantic or sentimental or weird way, but in the way you fall in love with a tree or with a poem if you are truly present to it. So present that all else drops away. One can call it a mystical or spiritual experience, I suppose. The strict borders between sacred and profane definitely soften during birth, and the everyday dissolves into the otherworldly to such an extent that it becomes impossible to separate the two. And when the baby is finally born, and fed, and when I have listened to the new mommy telling her story as she experienced it, when I step out of the room to go home, the spell is broken. Almost broken. A faint afterglow remains with me, yes, and the best way to prolong this afterglow – the best way to preserve the memory – is to write it down as soon as I can. Through writing, I can almost – almost – relive an once-in-a-lifetime experience.


Posted by on February 22, 2012 in labour and birth


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Wanna be inspired?

Check out this lovely blog: Jacquie Munro has been a doula for an astounding quarter of a century. This year she’ll attend her 1000th birth! How’s that for commitment and perseverance? I love this blog, hope you do too.

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Posted by on February 15, 2012 in birth support, doulas, labour and birth


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If you want to be a doula

If you want to be a doula, you need strong hands, a strong heart and a strong bladder. And you need patience. Lots and lots of patience. You need to be able to sit with a labouring woman enduring the most intense experience of her life (and often the most painful, too) for fifteen, twenty, perhaps thirty hours – for as long as it takes her to birth that baby. To birth herself as a mother.

While you are sitting there, wiping her face and breathing along with her, you cannot afford to be asking yourself: “How long is this going to take?” For you are modelling to the mom exactly how to stay in the present; how to take each contraction as it comes without telling herself stories about how long she has suffered or about how much longer it could go on. You need to be in that birth room, patiently and wholeheartedly, as if there exists no other reality under the sun. Yes, you may be worrying about your three-year-old who has a fever, or about whether you’ll be done here in time to take your daughter to her ballet lesson, but you have to learn the discipline to keep bringing yourself back to this very moment – to this very mother that is counting on you to be strong when she needs to be vulnerable and filled with doubt.

Now, don’t get me wrong, I am no patron saint of patience! In fact, in the real world, I have precious little. Just ask my family! Much to my shame, I am your classical Type A personality, trying to get places as fast as humanly possible and to cram every moment so full of activity that there is little time to breathe. I overuse (okay, abuse) my hooter and have earned more than my share of speeding tickets – and not only en route to births! Boredom drives me bonkers: I never leave home without at least one book and some writing materials; I won’t allow a single minute to pass unused. I admit to having tried to read at red lights in the past, but have now given up on that dangerous practice. Returning calls on my cell phone is much more productive – at least I don’t need to stop talking every time the light turns green!

Still, when I enter a room with a labouring woman I deliberately shake off my impatience. This has become second nature: I do it instantly, instinctively – impatiently! – the way a dog rids himself of excess moisture. Calm descends upon me and time takes on a completely new – a much slower – rhythm.

I make a small ritual of removing my wristwatch whenever I enter a birth room. It is only when the mom asks me about the time that I will remember to lift my gaze to the omnipresent clock on the wall. Contrary to what you might imagine, I don’t even partake in the timing of contractions, that strange ritual that accompanies birth in Western culture. If timing gives the dad a feeling of usefulness and purpose, I do not discourage it. It keeps him occupied. But instead of watching the clock, I prefer to watch the mommy. I listen to her breathing, to every sound she makes. I hear each word she utters not only with my heart, but with my innermost being – trying to understand it with my brain but also with every fibre of my body. I strive to listen with the complete neutrality of compassion, a compassion in which a whispered ‘thank you’ is no sweeter than a yelled swear word. With the greatest of interest I watch the emotions that play out across each woman’s tired face: the sweat that glistens like diamonds on her forehead, the hair that sticks in clammy strings to her face, the frown that digs its way down between her eyebrows. I note the places her hands flee during contractions so I can rub where it really hurts. I watch her toes to see if they are curling, her belly to ascertain if it is sinking lower. My hands feel for the bulging of her sacrum under my palms as I press them deeply into her back. I observe her so closely to try and anticipate her every need, to try and read each gesture cognitively as well as intuitively.

Although the stillness of prayer and formal sitting meditation has always called to me, attending births and writing have become my truest spiritual practices instead. Being present at a labour is the ultimate experience of being in the moment for me. Time stands still, ego falls away, and I feel compassion in the deepest possible sense. When things get really intense, even the woman’s personal identity is emptied out. I know this sounds strange, but sometimes, when I have followed the mom really deeply into the woods of Labourland, a strange disorientation possesses me. If I have to venture out of the birthing room in that state, perhaps to fetch some ice or a cold drink for the mom, I tend to forget who I am attending. If the receptionist, comes across me and asks who is in labour, I often find my mind a blank. I stumble over my words and have to think very hard. I have to pull myself out of the altered state of consciousness far enough to remember everyday distinctions. For that woman has become Everywoman to me – an universal labouring mother. Perhaps you think that this lessens my compassion, that losing the sense of a woman’s unique individuality is the opposite of being totally present to her. Believe me when I tell you that it actually increases it. For when the mother I am attending to ceases to be Mia or Helen or Precious, my individual likes and dislikes, my all-too-human prejudices and judgements, cease to operate. I become empty, scooped out, a vehicle of pure compassion. The labouring mother becomes the centre – the very axis – of my entire universe. Nothing matters but holding the space for her, the space that will allow her body to birth this baby.

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Posted by on February 15, 2012 in birth support, doulas, labour and birth


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