Most pregnant women will admit to being a bit anxious about childbirth. Get as much information as you can about your options before making your decision about the way you feel is right for you to approach birth. No-one else can make this choice for you. I was inspired by a book I had read called Active Birth, by Janet Balaskas, which detailed the importance of being upright in labour and talked about the consequences of drug-based pain relief in labour, including increased likelihood of further medical interventions. It all sounds very New Age, but it is surprisingly instinctive and effective — and most midwives, doctors and even obstetricians are very accustomed to women birthing this way.
Most antenatal classes will demonstrate the deep, abdominal breathing that is used in labour. If you can find a good pregnancy-specific yoga class, you will have plenty of time to practice breathing and stretching techniques to help you through your pregnancy and also in labour. Moving your body through a range of positions to help you deal with each contraction can be an effective way of managing pain. Lying on your back during labour is probably the most painful position you can adopt, even if George Clooney is in the room. Moving around, getting into positions that take the weight off your back and keeping upright so that you use gravity to help the baby descend through your pelvis are all well-documented as being effective in speeding the progress of labour as well as managing pain.
Upright positions that fully support the labouring woman might involve leaning on your partner or getting other physical support from partners, pillows, beanbags or other furniture — even those blow-up fitness balls can help. Pelvic rocking, bent knees, squatting, kneeling on all fours, the odd bit of hula dancing — all of these can be useful pain-management techniques. In most labouring women, the pain of contractions across the abdomen is accompanied by lower back pain; gentle massage, perhaps with an unscented massage oil, can be a real relief at this time.
Heat packs during labour. A hand-towel soaked in very hot water and then wrung out makes a hot compress that provides excellent pain relief either for the belly or lower back or both. Hot showers during labour. A very warm shower, with the stream of water directed onto your lower back, can bring relief during contractions. In most hospital labour wards, you can put a chair, perhaps with plastic cushion, in the shower and prop there for a while.
Many people having a home-birth will hire a small portable pool or large deep bath that can be filled with warm water; many labour wards and most birth centres have large baths. Alice had already had to fight for a home birth, being told a week before the birth that she couldn't have one, but she insisted. The community midwives who attended were very supportive and it wasn't until she gave birth that she found out the baby was back to back. She used the breathing and visualisation techniques we had practised and walked a lot, remaining very calm.
The midwife who was present couldn't believe it. She said that usually women with a baby in this position would be screaming for an epidural. What's more, the waters stayed intact. I was told once by an independent midwife that the amniotic membrane doesn't have to break before the birth; it protects the baby and cushions the baby's descent down the birth canal. Indeed, the baby of one of my couples, who gave birth at home, was born with the membrane still intact.
In Alice's case, the midwives suggesting breaking the waters so that the birth would occur sooner, as they felt she was getting tired. Ten minutes later, little though she is, she gave birth without any problem to a 9lb baby boy. I saw his head as it came out and what happened was amazing. Because the baby was the wrong way round, his head was like the cone of a rocket. But it sprang back within a second.
It you weren't watching, you would have missed it. Babies are aerodynamically designed to be born as easily as possible. It is not in their interests, or the mothers', to have a difficult birth. Well, that makes a lot of sense and you never actually hear that said. So is it the fear—tension—pain syndrome that stops it happening?
Many women today, once they have recovered from the initial euphoria of finding out they are going to have a baby, can become highly anxious about what they think the birth is going to be like. The problem is that fear and anxiety set off the flight or flight response in the body. A woman needs to feel safe and secure, just like an animal does, before she can give birth. In an animal, fear usually means that its life is in danger. So if an animal that is about to give birth feels endangered, the birthing process is suspended until it feels completely safe.
It may need to take action first to save its life. The effect of the fight or flight response during birth is to direct all the oxygenated blood to the arms and legs, away from the uterus and the baby. When nothing life endangering is actually happening, there is no action to take and the baby and the mum are both just left stressed.
If this happens at a late stage, a woman may be told that the cervix is stuck and that baby is in distress, and needs to be born quickly. That means more stress for the mum and even less oxygen for the baby — horror, trauma, screams, panic and finally an emergency caesarean. Or it can happen at an early stage. How often do we hear of women who go into labour at home and are getting along quite well and progressing nicely, and then they are advised to go into hospital.
They get there and perhaps it is a busy night so they are put into a side room and left to get on with it by themselves. It is an alien environment. The fight or flight reflex responds to this situation and the freeze part of it kicks in. The contractions suddenly stop in response to the perceived danger. Sometimes the women get sent home again or sometimes they end up being induced, to move them along, but the anxiety has already set in.
Aristotle said, "Nature does nothing uselessly" and how true that is of giving birth. Everything that we need to give birth easily, comfortably and safely is at our disposal. Our bodies are like finely tuned instruments and, given the right frame of mind, will perform perfectly. But today, everything seems to be designed to stop us doing that. Aristotle gave us a vital clue all those years ago when he said, "The mind of a pregnant woman needs to be cared for. It is interesting that you mention the need for safety because, as we know, that is a basic human need.
And, when I heard you speak about your work, you quoted champion of natural birth Dr Michel Odent, when he said, "There is a basic need for mammalian privacy. For decades women have been told they need a guide to tell them what to do and when to do it. To give birth, women must release the hormone oxytocin, and it is a shy hormone. If there are people around it doesn't appear. In the normal scheme of things, a woman about to give birth is going to feel most safe if she can do so in private, when someone she loves and who loves her is around her and soothing her her partner, close friend or her mother , rather than a possibly previously unknown midwife fussing around with monitors or an obstetrician being very medical.
When birth is the experience it should be, it can be a very sensual experience and a woman will want to move in accord with the energy in her body. It is for this reason that, in Russia, the natural birth movement teaches belly dancing. But you don't want to be watched by strangers, however well meaning, when making those intimate kinds of movements.
So a woman is more likely to feel uncomfortable and clam up. Dr Michel Odent describes it as a cocktail of love hormones released during labour! It makes you fall in love with your baby. There is a theory that so many American children are aggressive and out of control these days because so many mothers are having caesareans. Apparently, if chemical oxytocin is given it prevents the release of natural oxytocin. So, as there is no flood of oxytocin and often mum does not get to hold baby immediately, bonding between mother and baby is a problem. Oxytocin acts on the uterine muscles and helps them work in harmony.
The ligaments soften so the pelvic bones can click out a bit to let the baby through. You could say that oxytocin allows the horizontal muscles to go floppy and stop holding baby in, while the vertical ones work to nudge baby down from behind. Now, that's important, isn't it — the way you explain to women what is happening during the birth process — words like 'imagine the baby wriggling its way down the birth path' and 'sensations'?
You never use the word 'pain'. And that is clearly a good idea — otherwise women will pattern match to pain. But midwives are taught that the vertical muscles 'squeeze' the baby out. The 'pain' of it tells them that the contractions are coming properly. And the lull between is supposed to tell them that the muscles are relaxing again. Now, that doesn't sound very comfortable!
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I say to my mums-to-be that the muscles work together in harmony to open the space to let the baby out and nudge the baby down gently. One young woman, Sarah, a second-time mum who did my course because of an awful first experience, was told she needed to be induced because she was overdue. Now that is another thing. A baby is perceived to be overdue at 42 weeks.
But scanning is not totally accurate and can be out by two weeks and weight can be under- or overestimated by 2lbs. More importantly, the due date was established years ago by a German obstetrician called Franz Karl Naegele, who used historical rather than observational data. So it doesn't take a mastermind to realise that this could do with updating. Yet many mums-to-be will be persuaded to be induced, a painful way of giving birth, when they don't need to be. This is what happened with Sarah.
She was only 22 and when you have professionals insisting they know what is best for you in the circumstances, it is hard to stand against them. The midwives put her to bed and gave her the artificial form of oxytocin that is used to start labour going. Then the ward got busy and they forgot about her. So she decided to listen to her relaxation tape and go to sleep. She felt a few twinges, thought they were Braxton Hicks [false contractions] so went back to sleep.
When she woke up eight hours later, she knew she was ready to give birth. But the midwives didn't believe her. They just insisted she couldn't be ready and they would need to get her to a delivery room first, when she was. She was ignored a few times. It was only when her mum, who was training to be a midwife herself, came to see her, had a look and saw the baby's head that she was finally taken seriously.
The midwives couldn't believe that Sarah wasn't in any pain. Tell us a little about the courses you run. As you've mentioned, certainly some of the women who attend are there because of horrendous first births and they want things to be different. Actually, most of the women who attend my courses come because of bad experiences or sky-high anxiety — or else they are first-time mums looking for a good experience.
How do you turn around those bad experiences so quickly, so that fear and tension turn to confidence? After all, as we know, some women literally are traumatised by the birth they have had and suffer post-traumatic stress symptoms. Do you need to deal with that first — for instance, by using the rewind detraumatisation technique? The course is specifically designed to help the mum- and dad-to-be understand the physiology of birth, how language and your thoughts affect you and why there is no logical reason for pain to be an automatic part of birth — if you can't change the event then the only possibility is to change your thoughts about it.
This generally has the desired effect, although I have used the rewind technique on a woman who had been through a particularly traumatic caesarean, and I do what all good human givens counsellors do — I give women hope in the very first session that things can be different. The dads-to-be or birthing partners are an integral part of the course. What we aim for is the best and safest birth possible, according to individual circumstances. I would never promise a pain-free birth and I am very clear about that; the emphasis is on explaining how the muscles of the body work, changing the language and changing the focus so that the expectations are of being in control and having a more comfortable relaxing experience.
We never want to set up unrealistic expectations. For this reason part of the course covers what to do in 'special circumstances' — complications to everyone else.
Koru Self Development - Hypnobirthing
What I teach, in line with what Grantly Dick-Read taught, is that, if pain is not caused by fear and anxiety, then something is wrong and needs to be taken care of. Sometimes medical intervention is necessary and so we look at how to make the right choices in those situations. Caesareans can and do happen but mum and baby can still remain relaxed. One mum had a caesarean because she was told the midwives weren't experienced enough to attend a breech birth. But she recovered much more quickly than other mothers who had had caesareans because she remained calm and her baby was very relaxed.
I saw her and her daughter a month ago and everyone says what a calm, contented, happy one-year-old the daughter is. So what is the first thing you do to start to change women's minds about the expectation of pain? I explain the fear—tension—pain connection.
Labour day primer: Your guide to giving birth
I explain how the fight or flight response diverts blood to the wrong places — to the arms and legs so that they can take 'survival' action — instead of to the uterus, which needs it for the job in hand. And the women all relate to the idea that labour can come to a halt on arrival in hospital, either because they have been through it themselves or know someone who has — it is so common. I tell them a bit of the history of childbirth, as much as I've told you, and how a natural process was medicalised and made painful. And then we start to change the language.
If you tell a woman that birth doesn't have to be painful, she equates this with feeling nothing, as with an epidural, — and that is not true. So we talk about the labour 'sensations' she will feel, such as pressure or tightening, and describe contractions as 'surges' or 'waves'. I talk about other sensations in our bodies that we are used to feeling and responding to on a daily basis. We instinctively know how to do what is right.
When we feel hungry, we eat — it can be a pleasant sensation when we know we can have food but an unpleasant one when we can't. Similarly, when we need to empty our bodies of waste products, we just go to the toilet — and feel uncomfortable only if we can't. In human givens terms, we 'normalise' and 'reframe'. When women understand how their bodies work — the role of the uterine muscles, for instance — they can help the contractions along, making them shorter and more effective. When they stay attuned to their bodies and the sensations they are experiencing, they know instinctively which way to breathe at the different stages.
Same principle, yes, but I have women breathe in to a count of 4 and out to a count of 8. That teaches them to relax — which they have often never done before. But when birth is imminent, a woman will want to breathe in a different way — it is what is called 'birth-breathing'. They do this by directing their energy and their breathing behind the baby. Oh, we don't do pushing! Did you know that, if you push, you actually close the cervix, instead of opening it? Pushing causes tension, is hard work and uses a lot of energy.
It is a matter of changing the breathing to achieve the same effect. They go with their body sensations and they are relieved to relax and surrender, rather than struggle to control. Birth movements and birth positions come naturally in the course of a surrendered birth. And post-natal depression is very unlikely after this sort of birth. The amount of endorphins released and the sense of achievement, in such circumstances, keep new mothers on a high for a long time afterwards. I have personally seen all this, at home births and on DVDs and I just wish I could have experienced it for myself!
Unfortunately, when I gave birth, it was when you were still shaved and given an enema, then told to have a shower, and then made to lie on your back and give birth uphill. I had been fine at home but I absolutely lost it once in hospital; they took my control away and I nearly ended up with a caesarean. But I had always known my births could have been different, which is why I was drawn to run these courses. As I mentioned, I was luckier and, as a health journalist, I had written a lot about natural birth so that, by the time I got pregnant, that was what I hoped for — and luckily got, although it was certainly by no means pain free either time.
I didn't expect it to be, come to think of it, because I had never received the message that it would be. But I did know of people who did think that they would float through it all, if they diligently learned their breathing techniques and practised their squatting. Then, when their contractions started, they were suddenly completely overwhelmed and, because this was contrary to their expectations, were even less able to cope.
They lost it completely and often had the works, in terms of anaesthesia. Well, what you focus on is what you get and what you have in your mind transfers itself to what is going on in the body. Just because you have a healthy body doesn't mean that you automatically know how to give birth and, with all the negative images, it is no surprise that women end up in pain.
Also, because of words like 'labour pains' they are still focused on pain. So, immediately there is struggle. And then there is the hidden anxiety: Well, interestingly, part of the course addresses the fears and anxieties of both the mum- and dad-to-be. At the end of the second session they are asked to go away and write down any fears or anxieties they have about the pregnancy, the birth or after baby has arrived.