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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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Beginner’s Mind

“But I’ve never done this before”

Says a dad in the second row

From the back.

The big one with the brown beard

who secretly reminds me

of a friendly bear

with thick reading glasses.

“How will I know what she needs?

How will know how to support her?”

That’s why you need a doula,

I want to say.

Someone who has been there before.

But I don’t

Because I sense

That a dad brave enough to ask these questions

In front of the whole antenatal class

Is probably a dad

Who will understand

the secrets

of supporting

a woman in labour.

So I sway a little

On the big yellow birth ball

I like to sit on

When I teach

I think a little

About what it takes

To be with a woman

During birth.

“You will know what to do”

I tell him

“If you are really there

truly present

Each moment

In that room.

Do not think about

The breakfast you never had

Do not think about

That meeting you’re gonna miss

Above all

Do not think about

The rugby

The cricket

Or anything involving balls.

Take off your shoes

For the ground on which you’re standing

Is women’s holy turf.

Switch off your cell phone

and let that room

let that woman

become your entire universe.

Watch her closely

And you will know what to do

Listen to her

With more than your ears

And you won’t say

Stupid things

That’ll get you in trouble.

No, don’t write it down!

Just listen

Practice with me

Practice being present

In this moment.

Do not think

That your lack of experience

Is a handicap.

I am not a better doula

Hundred births down the line.

In fact, I might be worse.

For beginner’s mind

Is a shimmering pearl

Of magnificent value.

Not knowing

Being open

To things as they unfold

Are way more precious

Than tools

Tricks

And techniques.

You cannot go wrong

If you love her

You cannot go wrong

If your intentions are pure.

Leave your expectations

At the door of the labour ward

And enter the birth room

With your cup empty as a beggar’s.

When it is all over

And your back and shoulders ache

As if you’ve carried her

Belly and all

The entire way

Across the desert

She will turn to you and say

‘I couldn’t have done it without you’

And you will answer

‘But I did nothing

My love

You did it all.’

Trust me,

Nothing

Will be more than enough.”

The dad looks at me

Bemused

Befuddled

His mouth opens and closes

Like a goldfish

Flapping his fins

On the dry threadbare carpet.

He never finds his voice.

But Thabo

From the front row

who is not shy

his hand goes up.

“That was some speech

That was inspiring

Now I was just wondering:

Would all of that

Be in the notes?”

 

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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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What a Professional Doula Can Do for You

“I was pregnant and totally overwhelmed – delighted of course – but overwhelmed none the less. There were so many choices and responsibilities. It was bad enough choosing a pram, and picking out a name, let alone important stuff such as choosing a caregiver, birth facility, type of birth and pain relief. Having a doula helped us to make sense of it all, and to make the birth of our first baby a very special and memorable event. I especially appreciated the level of care from our doula, Marie-Louise, and our midwives at the Active Birth Unit at Femina. During the birth, Marie-Louise was the very much needed extra pair of hands, and with a bag full of remedies, heat pads and good advice, she never left my side. This left my husband free to also experience the birth, and having someone around that we came to know and trust, took a lot of stress and responsibility away from him. Not only did we have the perfect birth, we have the most perfect baby to show for it, and pictures of our first moments together, to always remember this special day” (Corrie Swanepoel, Pretoria).

The Role of the Doula                                        

The word doula comes from a Greek word meaning ‘woman caregiver’ or ‘one who serves women’. It is a new term – a modern profession – for an age-old practice. Throughout history, birthing women have been supported by experienced mothers from their community. The role of the doula is based on an ancient pearl of childbearing wisdom: a woman who is loved and supported throughout her labour experiences more pleasure and less pain.

Numerous research studies on the benefits of doulas have confirmed this. Research has found that women with doulas:

  • Have shorter labours;
  • Report less pain and require less pain relief;
  • Need less intervention like instrument births and cesarean sections;
  • Are happier with their birth experiences and their babies;
  • Breastfeed more successfully, and
  • Adapt better to life with a baby.

But what about Dad?                  

The doula does not take the place of the father. Instead, she supports both mother and father during and after labour. Often, pregnant couples are afraid that a doula might come between them, that she might intrude on an intimate experience and rob the dad of the chance to deepen his bond with his partner and baby. Some dads feel threatened by their partners’ wish to employ a doula – as if their partners do not trust them to provide the necessary emotional and physical support.

However, in reality most dads need support, too. Labour is an intense experience and many dads feel helpless and ill-prepared when seeing their partners in pain. To quote the authors of The Doula Book: “In asking fathers to be the main support, our society may have created a very difficult expectation for them to meet. This is like asking fathers to play a professional football game after several lectures but without any training or practice games.”[i]

When I hear a mom say that her partner is going to be her doula, I feel sad for the both of them. Sad because they are robbing themselves of valuable support and because they are adding even more stress to the birth for the both of them. Pam England, author of Birthing from Within, compares a mom who wants her partner to act as doula to a woman who wants to climb Mount Everest with her inexperienced partner as her Sherpa. Birth is foreign territory to dads, too, and the intensity of it becomes much easier for them to handle with the presence of a knowledgeable birth partner. It comes as no surprise that research has found that doula support leads to a better relationship between parents after the birth compared to couples who birthed without a doula.

Helena McLeod writes: “A doula was fundamental in assisting me and my husband in my swift, sacred, drug free labour. Marie-Louise came to visit us at our house twice before the birth to help us think through our perfect labour and how to prepare ourselves mentally and physically. She came to the house once I was in active labour and used pressure and massage to help relieve pain during the contractions. She continued to help me control the pain throughout the labour, coming with us to the birthing centre. My little boy Tariq arrived after 4-6 hours of active labour. I didn’t once consider requesting painkillers and I’m sure our doula’s pain relieving help played an important role in this. After the birth Marie-Louise came to our house and helped us through the initial challenge of breastfeeding. Having a doula provided us with enormous emotional support, wisdom and confidence in our birth and breastfeeding experience.”


[i] Klaus, Marshall H., Kennell, John H., and Klaus, Phyllis H. The Doula Book. 2nd edition. Da Capo: 2002.

 
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Posted by on February 13, 2012 in Articles, doulas

 

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