Articles about Birth

Our amazing birthing body working in total synchronicity!

“The hormones that make birth happen, also prepare us for breastfeeding and mother-infant attachment” – Dr Sarah Buckley

Our birthing hormones are critical to actually making labour and birth happen! In addition, our hormone systems prepare us in the final weeks, days and hours – for an efficient labour and birth, help with labour pain and stress, ensure a safe birth for our babies and, after it is all over, give us feelings of reward and pleasure as we meet our babies for the first time. But for all this to happen in perfect harmony – to work the most efficiently – the birthing hormones need to work together in perfect synchronicity.

So how do we achieve this perfect dance?

Our birthing hormones are made up of 4 main hormones

  • Oxytocin – the Love hormone
  • Endorphins – the Pain-relieving hormone
  • Catecholamines – the Stress hormones – the fight or flight hormones
  • Prolactin – the Mothering hormone that facilitates breastfeeding

 

Pregnancy

When we are pregnant we need to choose a kind, caring healthcare professional who will create a supportive environment for pregnancy and birth. They need to answer our questions, allay our fears, be supportive and encouraging, increasing our confidence in our own ability to grow a baby and birth it.

It is important to attend childbirth education classes where our increase of correct knowledge can allay our fears and give us the confidence to trust our bodies to birth correctly. As well as to understand this perfect dance of birthing hormones in order to achieve the best outcome for mom and baby at birth.

This kind supportive environment will decrease pregnancy stress which decreases the release of our catecholamines – our stress hormones – which cause us to fight or take flight.

Exercise during pregnancy – this prepares our body for labour as well as generating higher levels of endorphins which will lead to a shorter, less painful labour. Research also shows that regular exercise decreases the risk of needing a caesarean.

Slight increases of catecholamines in the last few weeks and days of pregnancy causes the foetal lungs to mature preparing the baby’s lungs for breathing after birth as well as maturing other foetal organs.

 

Labour

The hormones of mom and baby are interrelated and work in synchrony together to get the best outcomes for both mom and baby. What mom is exposed to during her pregnancy, labour and birth will influence what effects she experiences during this time, which goes on to effect the hormonal balance of the foetus and baby. They are totally interconnected – mom and baby can’t be separated. They promote and inhibit each other’s hormonal activity and dance.

Let labour start on its own.

Birth in a safe, private, relaxed atmosphere to keep your stress hormones and the balance of hormones dancing perfectly.

Onset of labour – increases in oxytocin and prostaglandins will cause the uterus to supply effective contractions in labour.

Endorphins prepare for pain relieving mechanisms

Increase in oxytocin prepares for breastfeeding and maternal-infant bonding

Maintain a calm, low stress, supportive environment in labour so labour isn’t slowed down by the wrong hormones interacting – lowers catecholamines.

Lower levels of stress by labour support – mom able to cope with pain, not need an epidural

Lower levels of stress – promotes uterine blood supply, improving foetal circulation and newborn well-being

Eustress – healthy levels of stress – slightly increased catecholamines let mom remain alert and focused during labour. Short term foetal catecholamines also increase in late labour – protects foetus from hypoxia (low levels of oxygen) and promotes transition of breathing, temperature and glucose levels. Also promotes newborn alertness which benefits breastfeeding and maternal-infant bonding. Too much stress – high catecholamine levels – cause blood to flow away from uterus and baby – flight response – causes labour to stall. Moms labour often stalls as she is admitted to hospital in this unfamiliar stressful environment

Use your relaxation techniques taught to you at childbirth education classes to keep you relaxed and with low stress levels. Relaxation, guided imagery and massage are wonderful tools to help keep this balance in place. Use non-pharmacological pain relieving methods like water, positions, massage – this promotes the release of endorphins – the natural pain relieving hormones.

Movement and upright posture enhance endorphin release

In late labour – Oxytocin peaks and assists with the pushing stage of labour

If stressed, the catecholamines will disrupt labour.

Stressful labour – increase of catecholamines – prolongs labour – foetal hypoxia – increases mortality and morbidity. Slow labour and foetal hypoxia are common reasons for labour interventions

 

Cascade of interventions

Mom has an epidural – Mom’s oxytocin levels drops – leads to synthetic Pitocin being given to counteract this effect. Prolonged use of Pitocin blocks the real oxytocin receptors and increases the mom’s risk of postpartum haemorrhage (excessive bleeding after birth).

Women who give birth vaginally release oxytocin more effectively and sooner than a woman who had a caesarean

Skin to skin

Promote skin to skin – increases mom and baby oxytocin levels – supports breastfeeding success – enhances maternal-infant bonding – decreases risk of postpartum haemorrhage.

Following birth, stress levels decrease – catecholamine levels decrease – increases in oxytocin and endorphins – the calming and rewarding hormones – mom views birth as more positive

Support the early initiation of breastfeeding, which also promotes the release of calming, rewarding hormones for mom and baby. The first breastfeed calms the baby after being born

Prolactin levels increase – facilitates breastfeeding

Foetal oxytocin increases with skin to skin – promotes a calm and alert state – facilitates breastfeeding

Uninterrupted skin to skin – increases oxytocin and prolactin – promotes breastfeeding

Skin to skin promotes moms vasodilation (blood vessels opening) – warms the infant

Skin to skin reduces newborn stress and stress hormones – improves energy consumption, glucose levels, breathing, crying and breastfeeding behaviours

Ongoing skin to skin during those early days and weeks benefits moms mental health via oxytocin and prolactin peaks – both stress reducing

 

When we interact with our babies – hold, carry, touch, talk to, breastfeeding – we are rewarded with the release of oxytocin, beta-endorphins and prolactin, which give us pleasure by activating the dopamine-related pleasure centres in our brains. The more pleasure we get from interacting, the more we want to be with our babies, which benefits their health and development.

 

Encourage them to dance

The Dance of Normal Birth

  1.  Learn the steps – birth preparation – how the body works, understanding labour
  2.  Practice – imprinting coping strategies, visualization, affirmation, confidence building, trusting the system
  3. Assign support roles – create a birth dance friendly environment , choose dance instructors – the role of support in normal birth, doulas, female support (bringing oxytocin to the birth), preparing or holding the space, carrying and lifting
  4.  Labouring (Dancing) – accepting the sensations of birth, feeling the rhythm, moving to the beat of labour, using the space, finding the path – relaxation, rhythm and ritual, preserving the natural hormonal benefits.

 

Our Amazing Birthing Body – the Perfect Dance of Birthing Hormones

Oxytocin

The Love Hormone

What does oxytocin do?

  • Decreases blood pressure
  • Decreases stress hormones; causing the tend and befriend effect
  • Fewer aches and pains (increased pain threshold)
  • Sleepiness, feeling of laziness – not wanting to jump up and do something
  • Reduces muscle tension, relaxing (less circulation to muscles)
  • Calming, less upset about big life’s problems, sense of contentment, peaceful
  • Causes more curiosity and a sense of closeness to the people nearby
  • Makes women more courageous
  • Increases openness to touch
  • Increases digestion and fat absorption and storage.  At first oxytocin reduces our appetite but when present over a long period of time, increases appetite
  • Increased skin and mucous membrane circulation
  • Causes blood vessels on the frontal side of body to dilate, thus rosy cheeks and warm chests during labour, nursing, or even just snuggling an infant
  • Facilitates learning
  • Promotes wound healing (twice as fast)

What stimulates the release of oxytocin?

  • Stress
  • Warmth
  • Stroking – especially rhythmic touch, therapeutic massage, sexual stimulation
  • Descent of the foetus (pressure against cervix, vagina and the perineal floor)
  • Good food
  • Companionship (positive emotional contact, doulas and being with women)
  • Quiet and low light
  • Positive thoughts, associations and memories, meditation and visualization
  • Suckling and baby kneading the breast
  • Pleasant smells and even sounds – as you smell your newborn baby – you have a rush of oxytocin released
  • The presence of oxytocin.  In other words we produce more oxytocin when there is oxytocin present!

Oxytocin and Nursing

  • Controls the expulsion of milk (up to 80% of milk not available if this doesn’t occur)
  • Stimulates milk production
  • Redistributes heat in the mother’s body to her front to warm her nursing young (often have rosy cheeks when done nursing – both mom and baby)
  • Helps the body release stored nutrients in order to make milk
  • Reduces blood pressure and stress hormones in the mother – breastfeeding mothers have lower stress hormone levels than bottle feeding mothers
  • Creates calm in most nursing women
  • Makes mother more interested in close relationships (probably so she’ll have help in caring for her child)
  • Induces social memory and calmness in the infant
  • May have some role in the release of dopamine and endorphins which gets us hooked on our babies, and sometimes hooked on nursing
  • In combo with Prolactin, fosters love of infant
  • Helps maintain Prolactin levels in the presence of stress

Oxytocin and Touch

  • Lower BP
  • Higher pain threshold
  • Lower level of stress hormones
  • Increased growth in both young and adult animals
  • Increased social interaction
  • Improved learning
  • “Feel” better
  • “Psychological” touch can result in the same effects
  • Effect is sustained with repetition of touch/40 beats per minute
  • Ventral stroking the most effective – HUGS.  Women whose partner hugged them more have higher oxytocin levels and were happier.
  • Dairy farmers get 25% more milk if cows are brushed and petted during milking.
  • Eating is considered an “internal massage” as the GI tract is made from the same germ layer as our skin and nerves.
  • Exercise/movement also results in the release of oxytocin (in the brain it results in calming and in the blood stream stimulates endorphin release—runners high).

Oxytocin and Relationships

  • Creates emotional bonds
  • Makes us seek out social affiliations, most often with other women, although plays a part in choosing and staying connected to male partners as well
  • Increases our willingness to trust
  • Good relationships reduce blood pressure and heart rate, cholesterol levels – lengthen life spans.

Men and Oxytocin

  • Like mothers, dads get a rush of oxytocin when they see their babies for the first time. Men’s testosterone levels tend to plummet (for a couple of months anyway) after they become dads for the first time. Even more intriguingly, some men start to produce extra oestrogen, perhaps the clearest sign of the transformative power of fatherhood. Oestrogen helps make the brain more sensitive to oxytocin, helping dads become more loving and attentive.
  • Dads oxytocin levels increase throughout their partner’s pregnancy and increase his interest in physical, but not necessarily sexual, contact with the mother.
  • Prolactin also rises in dads throughout pregnancy but rises are sharper after parenting the new infant and makes the father feel protective and a little less interested in sex.

Oxytocin is released by stimulation of sensory nerves – as a new baby crawls on its mothers chest so this activates sensory cells in the skin to produce more oxytocin

The progress of labour is inhibited by

  • Pain
  • Stress
  • Anxiety and fear
  • Decreased release of oxytocin

The progress of labour is stimulated by

  • Warmth
  • Support
  • Calm
  • Increased release of oxytocin

Changes in moms due to oxytocin release

  • Decreased levels of anxiety
  • Decreased detachment
  • Increased social interaction
  • Facilitated bonding
  • Decreased sensation of pain
  • Changed memory of labour – more positive memories

If mother and baby are separated after birth, the positive effects on other-baby interaction and the anti-stress effects normally caused by skin-to-skin contact after birth will not develop

Oxytocin released during labour is needed for sensitivity of the skin for further release of oxytocin

Consequences of medical interventions

  • Decreased oxytocin levels
  • Decreased prolactin levels
  • Inhibition of milk ejection
  • Decreased milk production
  • Increased stress levels
  • Decreased interaction between mother and baby
  • Interference with bonding and attachment

The best way to provide oxytocin is by stimulation of natural oxytocin release

  • Skin to skin contact
  • Breastfeeding
  • Social support
  • massage

By Barbara Hanrahan – SACPE course developer

Much is written on understanding pain and pain relief in labour. When new mothers are asked to describe the pain they felt in labour there are a variety of answers. Some women will depict a positive experience by saying labour was exhilarating, gave her a sense of strength and feel empowered. Others will depict a negative experience saying painful, exhausting and traumatic. Whilst some women may even say tedious, uncomfortable and manageable.

The preparations a woman makes for birth influences her birth experience. When women are taught coping techniques and choices of pain relief, they cope with pain during contractions.

“The pain is hard to explain. The contractions were intense. My body demanded my complete attention. The contractions were all my body would let me think about, just then.”

An important part of coping with pain in labour is for the woman to have the continuous support of a birth companion of her choice. Research has shown that continuous labour support reduces complications, decreases medical interventions and supports the transition the woman makes from pregnancy to being a mother. Powerful stuff!

For most women there is a plethora of preparation courses –childbirth education classes, the internet, hired doula, relaxation, books ……..

So what should a woman and her partner know about pain in labour?

 Understanding and working with the physiological process of labour and birth

When women, partners, birth companions and midwives know and respect the physiological process of labour and birth – they are better at giving comfort, encouragement, suggesting helpful positions and using comfort measures that increase oxytocin and endorphins. Thus promoting a progressive physiological labour and birth.

Pain in labour isn’t a sign of harm or injury – It’s a sign that the labour is progressing. Pain with a purpose. Women need to know that the pain in labour is temporary and normal.

Contractions are the work of the uterus in moving the baby down onto the cervix where the pressure from the foetus’ head triggers more oxytocin to be released. Thus contractions start to last longer, feel stronger and are more rhythmical. Longer, stronger and closer together is a sign of active, accelerating labour. The baby pressing on the cervix and the surge of natural oxytocin helps shorten, thin and dilate the cervix. Women and their partners need to know that THERE IS NO PAIN BETWEEN CONTRACTIONS. Relaxation between contractions helps the woman to prepare for the next contraction.

 Why labour is painful

The physical changes that contribute to pain in labour are

  • Reduced oxygen to the uterine muscle and the build up of lactic acid during contraction causes pain. As soon as the contraction is finished, the oxygen supply floods into the uterine muscle and to the foetus.
  • The stretching of the cervix as it effaces and dilates (thins out and opens) – remember that the cervix is the bottom end of the uterus so the stretching and thinning is brought about by the contractions.
  • Pressure of the baby on nerves in the cervix and vagina, as well as on the urethra, bladder and rectum. It is essential for a labouring woman to empty her bladder regularly – not just so as to avoid a full bladder impeding the descent of the foetus – but also because a full bladder increases the pain during contractions as it is squeezed and pressurised.
  • Tensing and stretching of the ligaments that support the uterus in the pelvis and the pelvic floor muscles.

 10 KEY messages about coping with pain in labour are

  1. Continuous support through the whole labour.
  2. Positioning so that the potential of the pelvis is increased by 25%. eg leaning forward against the bed – lifts the sacrum and assists in providing more room for the baby as it moves into the pelvis.
  3. Upright positions that use the force of gravity to aid the descent of the foetus.
  4. Hydration – a woman needs to drink a minimum of a cup of fluid an hour to prevent dehydration, which may cause foetal distress.
  5. Using comfort measures for coping with the pain during contractions – this reduces the pain perception at the time. eg hot pad; massage, breathing through each contraction, a focal point eg A picture that you take with you to aid coping skills, or distraction eg a visualization – such as a flower slowly opening.
  6. Involving the partner in these comfort measures – where, how and when to massage the woman’s back, ensuring the woman is sipping fluid continuously, wiping her brow with a cool cloth, fanning her during a contraction and much more. This helps the partner to “sit in the woman’s pain” without feeling that he needs to rescue her.
  7. TOUCH, TOUCH – pleasurable sensations (including smell, taste, hearing….) “race the pain to the brain” and release endogenous endorphins which assist the woman during the contractions.
  8. Create a conducive environment around you ensuring your dignity and sense of privacy.
  9. Using affirming words and terms rather than medical terminology. Giving the woman positive feedback.
  10. Honesty about pain relief options that are viewed from the risk : benefit as it specifically applies to that individual woman and her labour. It’s useful to also ask “what happens if we wait?”

Pain in labour is usually part of the physiological process and progress of labour. Suffering is not. Pain is an unpleasant physical sensation. Suffering is a debilitating emotional state. Suffering in labour comes from a perceived threat – physical or psychological; helplessness; feeling out of control; fear of dying; and fear of the baby dying.

Part of childbirth preparation is to assist the mother in identifying factors that will increase her perception of pain in labour and what she can do to remove or modify such factors.

Emotional factors

Expectations of labour and birth that don’t match up to what the woman is experiencing. Encourage her to verbalise and then assist her adaptation of expectations.

Feeling watched or judged or by being around unsupportive staff or relatives. …. Turn your  head away from the cause of this anxiety, put a light shawl over your head and shoulders to reduce visual impact.

Lack of preparation – continuous affirming support through the labour.

Misinformation about labour and birth – uncovering the woman’s core belief about labour.

Decisions or feelings that are ignored and make the woman feel disrespected.

Labour factors

Frequent and long contractions which may cause you to lose your focus and panic. Drop your lower jaw – this helps you loosen your core and pelvic floor muscles. Pain perception decreases.

Long labour that could lead to exhaustion – encourage fluids and energy nibbles, assist with relaxation techniques between contractions, affirming words and body language, periodic resting in an upright chair or on her side on the bed.

Unhelpful hospital policies – eg partner or birth companion excluded from accompanying the labouring woman; interventions that limit mobility such as a continuous blood pressure cuff or continuous electronic foetal monitoring.

When woman are encouraged to release control during labour and birth – they feel more “in control” vs trying to control the labour experience. Losing control happens when the labouring woman feels overwhelmed and helpless. The best remedy for helping a woman who feels she has lost control is continuous, affirming support and encouragement. Powerful stuff! Birth plans must be flexible with options. Helping the woman focus on one contraction at a time.

“My partner verbally celebrated the passing of each contraction with… well done, that contraction has gone, down and dusted…. Which really helped me roll from one contraction through another one at a time.”

The painful and non painful stimuli a woman perceives in labour are affected by her past experience of pain. There may be pre existing medical conditions, personality factors such as resilience, temperament, cultural or familial attitudes and beliefs, previous trauma and sexual abuse … amongst a lot of other factors that differ from women to women and in different labour settings. The answer to overcoming these influences in labour is one on one continuous affirming support. Encouragement and physical comfort can overcome the effect of these stimuli on a woman during labour.

“For personal and cultural reasons my partner was not with me during labour. I asked a good, calming friend to accompany me and she really helped feel strong and able during the labour.”

“The midwife was kind and gentle and explained what she was doing at the time. So I was able to tell her about my fears.”

It is very important to have attended childbirth education classes together, to have been taught various techniques to cope with labour. Also the crucial issue is to have communicated about both of your desires for labour so that during labour you can be her mouthpiece. Inform the staff of her desires and dreams for her labour and ensure that any issue that is important to her, she gets.

Remember guys, labour is one day in a life time – and she is the one going through the pain, so you need to do everything she asks you to do. There are practical things you can do – rearrange her pillows, cool her down with refreshing cloths, get her something to drink, help her breathe through her contractions (you will know how if you attend childbirth education classes). But most importantly, love her and be next to her encouraging and supporting her all the way, reassuring her she is doing well and coping fine, and that she will make it to the end. Also if you get to a stage where you don’t feel as though you are playing any part at all, never underestimate the sheer importance of your presence.

Seeing your baby – this is the moment you’ve been looking forward to for nine months. There’s no right or wrong thing to do or way to react. Take your time and savour the moment. This is an image you’ll be able to preserve in your mind forever. This is probably one of the most wonderful gifts you will receive in your life.

As your baby is thrust in your direction for you to hold, take him proudly. Your baby is not a china doll about to fragment into millions of pieces. Think about what this baby has just endured during labour. He is hearty and healthy and exceptionally strong. So what if his head occasionally isn’t properly supported and it flops a bit to the side – it isn’t going to fall off and go rolling down the corridor. Get involved from day one with your baby and enjoy being a Dad!

One of the scariest images for a pregnant dad is the thought of having to deliver your own baby in the car! So the second she announces she thinks she might be in labour, you want to bundle her straight into the car and get going! Seriously, don’t spoil the specialness of pregnancy with fears like this.

Waiting for that phone call!

Those last few weeks of pregnancy are torture, not wanting to make any plans in case she goes into labour. The image of an expectant father pacing outside a labour ward has been replaced by the image of him pacing around work, unable to concentrate on anything, waiting for the phone to ring. It could happen at any time (and you really hope that it does happen before the presentation you have to make to the board this afternoon). The due date was a week ago, but still the suspense is there. We’re an impatient bunch and you won’t be the first guy to ask his partner, “So when is this baby actually coming?” By this stage she will be even more desperate to have baby on the outside than you, so questioning her won’t really help the situation.

Along with her waters breaking in the middle of the supermarket, the dramatic dash to the hospital through frenetic traffic is one of the more enduring images of labour. Fathers who were denied this experience – such as those whose partners were induced or had planned caesars – talk of “feeling cheated” in some way. If you do get to live out the saying “hospital dash”, no matter how much you have gone over the route in your mind, or even in practice, actually driving in a car with a woman who is about to give birth will create an awful lot of pressure. Expect your driving to be erratic at best!

It would be a good idea to issue women who are seven months pregnant a special siren or bright pink light powered by the cigarette lighter in the car. It would be understood that anyone using said light would be on the way to hospital to give birth, giving every expectant father, for one day only the complete dominance on the road with powers that hitherto were only enjoyed by the emergency services.

Jokes aside – remember that in most situations there will be plenty of time to get to the hospital especially if this is her first baby. So make sure you drive safely and concentrate on the road!

(This article is also available in an audio format)

By Hettie Grove – Advanced midwife, SA certified perinatal educator, SA certified lactation consultant

Everything in life comes with an instruction manual or almost everything.Yes babies unfortunately don’t have a manual, nor do they have an on or off button. Moms expect to parent the way they were parented – yet there are so many different parenting styles. But what does a baby know about parenting styles and what is the babies expectations. Is it instinctive or is it learned? All babies have instincts and reflexes whether they are from China, Kenya or South Africa, and these instincts and reflexes are the same as they were thousands of years ago. Babies are born but they are not helpless. They are eager and skilled for the world that they enter and are born into. A soon as we start changing the world for them we create problems and make it difficult for them. Obviously we don’t live in caves anymore but it would help if you knew what your baby expects about how the start of life should be.

Entering Birth

Babies don’t expect to deal with drugs! All drugs / medications do affect them no matter what your birth option is. Some of these drugs can have effects for a few days after birth. Parents don’t expect this and that’s one of the reasons one should actually educate yourself before the birth. Even parents don’t always expect drugs in labour as it is a natural process. If babies are born surgically (by caesarean) that’s also okay because our goal is a safe mommy and a safe baby. Remember then that those babies didn’t go through their normal rite of passage and might need a little helping hand to aid them with some of those deep hugs they missed out on as they passed through the constricted area of the vagina during birth.

Wow world I am born.

Your baby expects to stay with you, not to be whisked away to another pair of gloved hands and a hard surface. After spending some time in his natural habitat which is his mothers own chest, getting used to all the different smells and sounds and the greatest work of breathing, he will start thinking about his very first meal. He responds to the nine instinctive stages and actually crawls his way to the breast. Remember the areola (the pigmented area around the nipple), which has darkened during pregnancy, is going to excite his visionary skills in order to get to the bulls eye. The tubercles of Montgomery – those little bumps on your areola secrete a scent that will initiate his smell senses to start his very first crawl of life. This crawl will help him to latch on and start to have his very first meal all by himself.

If he was taken away and bathed, weighed and measured, or if he was exposed to drugs, all these instinctive activities might be influenced and your own motherly instincts might be changed. Breastfeeding will work in all kinds of environments and after all kinds of birth, but this is the easiest part and it will most certainly enhance your mothering skills.

My little tummy is full what now…

Babies little tummies have a capacity of about 5 ml in the first days therefore he needs food frequently. But after this first feed he will take a deep rewarding sleep especially if he is with his mother cradled by her, close to her. This is where your baby wants to be. He expects to be with you. He was with you, heard your breathing and tummy noises, felt your warmth continuously for the last nine months, therefore his breathing, heartbeat and blood sugar will be better if he stays in touch with you.

Hospital staff might want him to drink more, wake up more, so you might fight nature a bit to encourage more frequent feedings at first. But very soon he will wake up easier, eating when he needs it like other mammals.

Is this our home Mommy?

Baby still expects to be very close to you, you are his security and his warmth. He knows you and remembers you – familiarity soothes. All mammal babies have a way of protecting themselves, they camouflage, have safety in numbers. But our little human babies protect themselves by being held. While being held he feels the safest and the calmest next to you, where no lions can eat him, nor rodents can get to him. He expects to set his own pace, eating more than you expect, he also expects you to respond quickly to his sounds and he expects not to have to cry for what he needs. His biggest expectation of life is to be near you Mommy, day and night and he will most probably sleep better if he is a bit closer to you.

Think about your baby, think about his expectations. He expects to be in your arms close to your heart, and he expects you to listen to HIM not a clock or a parenting book. If you meet his expectations life will be easier on all of you.

By Barbara Hanrahan – Nursing sister and midwife, SA certified perinatal educator course develop and facilitator, masters in midwifery

Foetal breathing movements have been identified as early as 11 weeks gestation. These movements increase in intensity and frequency until they occur 50% of the time whilst the baby is in utero. The rate varies between 30 – 70 breaths per minute. This helps develop the pliability of the foetal lungs so that once the baby breathes in oxygen at birth, the lungs are flexible and can function adequately for independent respiration. It also strengthens the diaphragm and muscles used during respiration.

The initiation of breathing by the newborn at birth is partly due to the –

  • compression of the chest during a vaginal birth and the recoil of the chest wall
  • stimulation of chemoreceptors by the reduction of oxygen and the increase of carbon dioxide in the baby’s blood
  • sensory stimulation on the skin at birth – touch, pressure, temperature
  • stimulation of the senses from lights and noise.

Physiologically the ability to initiate breathing relies on the production of surfactant in the foetal lungs during pregnancy, from 22 weeks gestation. The amount produced increases until the baby is born. There is a surge of surfactant production at 34 weeks gestation.

The function of surfactant is to reduce the surface tension of the alveoli in the lungs so that the lungs can expand easily and prevents the alveoli from collapsing at the end of each breath.

At the first successful breath at birth surfactant thins out the alveolar membrane and increases the surface of the alveolar for gas exchange. At term the surfactant creates a single layer lining within the alveoli – and this lining acts as an air-liquid interface – which prevents the alveoli from collapsing as the baby breathes out.

The surfactant in the foetal lungs can be increased in pregnancy by giving the mother corticosteroid such as Celestone, in the instance of premature labour. The labour will be suppressed by medication to give the corticosteroids an opportunity to stimulate the surfactant production in the foetus and thus ease the breathing for a premature infant and significantly reduces the breathing problems of premature infants.

The use of natural or synthetic surfactant after the birth is a significant way of assisting premature babies to reduce the time and need for assisted ventilation. Multiple doses of natural surfactant has the greatest success rate.

At term the baby’s lungs hold 25mg/kg of pulmonary fluid which is partially expelled with chest compression during a vaginal birth. The rest of the fluid in the foetal lungs is absorbed into the lymphatic and pulmonary vessels and returned into the cardiovascular system.

Why do some babies born by caesarean section struggle to breathe?

A baby born by caesarean does not go through the chest compression and recoil that a baby born by vaginal birth does. This means it is harder for the baby to move the fluids out of the lungs so that there is sufficient alveoli space to utilize oxygen effectively. This leads to TTN – transient tachypnoea of the newborn. The baby breathes fast and shallowly using extra muscles to breathe, leading to signs such as flaring of the nostrils and chest recession. These babies emit a grunting sound when breathing out.

If a baby is born by elective / planned caesarean section, the baby may well be 38 or 39 weeks gestation and thus present with a mild immaturity in producing surfactant and this also leads to difficulty in absorbing and clearing the lung fluid at birth.

Babies who have TTN are moved to high care or NICU – to a temperature-regulated environment, with the administration of oxygen, separated from the mother – which causes high maternal anxiety and prevents the initiation of early skin to skin contact between the mother and baby. A baby with TTN cannot be fed orally until the rapid breathing subsides, so they usually have a drip established. (Babies with intravenous therapy often go onto antibiotics which means they stay in the high care or NICU for 5 to 7 days. This also delays the initiation and early stimulation of breastfeeding. The baby colonises the hospital’s organisms rather than the friendly good organisms of the mother. This challenges the early immune system. All of these factors may delay early development which assists the baby’s brain growth and neuromuscular abilities. As the baby’s TTN resolves and the baby gets stronger the early infant development can kick in.

Nature designed an incredible system – aiding lifesaving first breaths with sufficient development and pliability for the lungs to work mechanically at birth. A system that prepares babies during labour for initiation of respiration. A system that secretes surfactant enabling the alveolar in the lungs to open and close efficiently for independent gaseous exchange which supports life. A system which sets up the mother’s chest as the best place for a newborn to adjust from intrauterine life to life in our world. In this era of knowledge and science we often forget to marvel at nature’s provision and wisdom.

When a caesarean is medically or obstetrically needed, it is a lifesaving procedure for both mother and baby. However there is very little evidence available on the benefits of elective routine caesarean section as the primary choice of birthing a baby. There is an astonishing primary caesarean section rate in South Africa. Doing a caesarean to avoid possible medico legal action does not sufficiently remove the risks and possible cascade of additional interventions entailed in administering anaesthesia and major abdominal surgery.

By Anchen Verster – Registered nurse, midwife, SA Certified Perinatal Educator – SACPE, wife, mother to 4 children including a set of twins

Sex sells movies, music, magazines, clothes, perfume, diets and cars! The link is sometimes very vague (perhaps even non-existent) but it emphasizes what a big role sex plays in society. Magazines are filled with tips for better sex and those articles are always featured on the cover for the very reason that it sells. It does make me suspect that we’re looking for a secret remedy to what might be quite a complex facet of life. As a childbirth educator I have become increasingly aware that women are concerned about how pregnancy and childbirth might permanently scar or damage their bodies. They are concerned that this might have a temporary or permanent affect on their sex lives. Years ago this would have been a silent fear, but with the obvious exposure and interest in society, more women are eager to discuss this fear. This article is thus by no means intended to be explicit or feed into the sex-crazy sales. Rather it addresses a very real fear with some evidence-based information and as well as women’s experiences in order to help you in your decision making about birth.

Caesarean Section has become the ‘birth of choice’ in many private hospitals across South Africa. Women and their caregivers choose this mode of delivery for a variety of reasons often in the absence of a legitimate medical indication. Although this has become a common mode of delivery it does expose the mother and baby to a set of risks (both from the surgery and the anaesthetic) – we often don’t like to admit this. These risks could be reduced or limited if the mother were allowed to give birth normally with the help of professionals within a safe birthing environment. However, it’s become much easier for us to choose a caesarean birth because it’s so common. Many women and their partners who have experienced vaginal birth believe there are more advantages to this mode than is often communicated medically.

Myth: It’s easy to assume that the “stretching” of childbirth irreparably damages your vaginal wall or perineum (area of tissue between your vagina and anus). I heard one woman ask another after natural childbirth; “So what’s it like down there? Is it all loose and hanging?” I was rather astounded by the question but I wonder if many of us don’t have similar thoughts in mind? It’s obvious then to think that a caesarean would “spare” us from such a stretch.

Truth: The vagina is designed like a concertina- draped in folds (rugae). This means that the potential for stretching is significant and it is designed to fold back again after the birth. The perineum does sometimes tear but this tear heals more easily and effectively than when the area is cut (episiotomy). The area may be protected from tearing if the mother gives birth in a more upright position instead of lying down or ‘semi-lying’. Some mothers have found it helped to care for and prepare the perineum by massaging it daily with an oil (e.g. almond or grape seed oil) during the last few weeks of pregnancy. A large Australian study published in a medical journal of Obstetrics and Gynaecology found that mothers who had an elective or emergency caesarean or a vaginal birth with vacuum extraction were more likely to suffer from painful intercourse 18 months after the birth by comparison to mothers who gave birth normally without intervention or a sutured tear. It is not uncommon for women to experience pain with sexual intercourse for months after a caesarean birth.

Myth: The damage to vagina or pelvic floor is done only by the birth and not the pregnancy.

Truth: Given the weight of 9 months (well at least the last 6 months) of pregnancy and the circulating hormones that cause a little more ‘relaxation’ in tissues and joints, it stands to reason that the pregnancy may have an effect on the changes as well as the recovery of the pelvic floor and the vaginal tone. This effect might manifest itself in urinary incontinence (passing urine when you don’t plan to), faecal incontinence (passing stool when you don’t plan to) or sexual difficulty. The difficulty in these areas during the first few months after birth (vaginal or caesarean) might be slightly higher in women who’ve had vaginal deliveries (particularly when they have had a vacuum, forceps or episiotomy), but after 6 months the statistics are similar for both groups. Strengthening your Pelvic floor with pelvic floor strengthening exercises has been shown to have a positive effect and be protective against long-term damage. This means it’s important to strengthen your pelvic floor during pregnancy and after the birth (ideally also prior to pregnancy).

Myth: Vaginal tone or lack of injury is the greatest role-player in sexual pleasure.

Truth: There are numerous aspects of sexual intercourse that may hinder or promote a satisfying experience. These are often not related to how the baby was born but may well be related to the presence of a baby in the house. There is a phase of normal adjustment that needs to take place in order to reach ‘new normal’ functioning. A few aspects that may affect intimacy after the birth of a baby: Lack of lubrication (may be related to breastfeeding); loss of libido (possibly due to change in body shape/image, sleep deprivation, fatigue, candida (thrush), emotional factors (postpartum depression, anxiety), medication or fear of pregnancy.

Myth: Partners find the change in body and tone after normal childbirth to be displeasing.

Truth: One mother told me her husband said “My inside was tighter before childbirth- but it’s not better or worse for him, just different. My sexual drive was less while breastfeeding. Orgasm comes easier after childbirth.” Other mothers (as cited by Kelly Winder on her blog) refer to their partners finding no difference after natural childbirth or some difference after the first baby but then much “tighter” after the second baby. One father of six reported that it was “as good as ever!” Many reported their intimacy being much better which their husbands loved. Some thought this was because they were so much more confident in the ability of their body.

By virtue of the nature of pregnancy and childbirth and the intensity of the initial postnatal phase; you and your partner are likely to be affected by some form of sexual difficulty or dyspareunia (pain during sexual intercourse) during the first few weeks. Whether the cause is fatigue, stress or physical in nature it is most likely a normal part of the adjustment. However, it would seem that beyond six months there is a potential for sexual intercourse to be better than prior to pregnancy particularly following vaginal childbirth by comparison to six months following a caesarean section. Another study conducted recently showed no connection between the type of delivery a women had, how many children she had and her long-term ‘sexual desire, activity and satisfaction’.

Pregnancy and childbirth is the entry into a new era that may usher in a new security in your femininity and ability as a woman. Despite some ‘flab and sag’, having a baby may well make you feel more confident which will have a positive effect on intimacy. An Australian women’s health specialist physiotherapist Allison Hilbig says the following “The result of vaginal birth is an increase in blood supply to the area. This can result in women becoming more orgasmic after vaginal birth. The effect may be reduced if the pelvic floor is weak but a women’s health physiotherapist can teach women how to correctly exercise these muscles to improve strength”.

During a study conducted last year in South Africa, women reported positive changes in their intimacy after having natural childbirth. These changes were noted 6 months or more after the birth. There is a natural adjustment phase, which can take from a few weeks to a few months after the birth. This adjustment phase may include pain during intercourse, dryness or loss of interest. It’s thus normal to expect a few hiccups in the beginning following a normal or caesarean birth, however this should improve a few months later.

Some women had the following to say when questioned about their intimacy with their partners after natural childbirth:

“I had a second-degree tear after my son was born which healed well. No issues six months or more after birth” [1 natural birth]

“Sex is a much more enjoyable experience. Penetration seems to be deeper. Stimulation seems more effective. More orgasms almost every occasion as before [childbirth] probably one in four. More relaxed time.”

“It’s less painful [than before childbirth].”

“More easily aroused and reach climax faster”

These women gave a ‘thumbs up’ for how natural childbirth has affected their sex life

Resuming sexual intercourse after a vaginal or caesarean birth may be scary for you and your partner. Some caregivers recommend waiting for 6 weeks and again others recommend waiting until you feel ready (which might be before 6 weeks). The International Childbirth Educators Association recommends first allowing the perineum to heal and waiting until the lochia (the vaginal discharge that lasts 4-6 weeks after the birth) decreases. The same organization recommends delaying sexual intercourse for 2-4 weeks after a caesarean delivery. Corresponding principles apply, waiting until the wound has mostly healed and until there is less lochia. Keep in mind that it is possible to fall pregnant during this period even if your normal cycle hasn’t restarted yet. The secret is good communication and consideration for each other. It is not uncommon to leak breastmilk during intimacy but try and be lighthearted about it.

Ultimately, choosing a caesarean on the grounds of how it may affect intimacy is not a legitimate reason. Although there are some mothers who struggle after birth, the reasons for this are diverse and might not be related to the type of birth. Knowing that some women find intimacy more pleasurable and they feel more confident with their body’s ability can be a helpful motivation to get you through the push of childbirth!

Storing your baby’s stem cells at birth is a once in a lifetime opportunity to protect your family against serious illness or disease. It is important that all families are fully informed on the benefits of storing their babies’ stem cells before making this important decision.

What are stem cells?

Stem cells are known as the master cells of the body, because they have the amazing ability to become a specialised cell such as blood, muscle or bone. For over 20 years now, families have been able to cryo-preserve cord blood stem cells for potential future medical use.

The first stem cell transplant using stem cells found in the umbilical cord blood was in 1988 for a little boy suffering from a serious blood disorder called Fanconi’s Anaemia. Since then, with the advancements in regenerative medicine, there are now over 70 blood related diseases and immune disorders being treated through stem cell therapy including leukaemia, multiple myeloma, and thalassemia.

Current research in regenerative medicine is resulting in tremendous discoveries in science, technology, health and medicine, and show great potential for improving methods to diagnose and prevent multiple diseases, as well as develop innovative treatments for injuries and illnesses. Today, there are over 4 000 clinical trials underway looking at potential future cellular therapies for diseases such as diabetes, heart disease, bone reconstruction and -neuro-degenerative diseases.

How are the stem cells collected?

Cord blood collection is a simple process and poses no risk to mother or baby. Immediately after the baby’s delivery, the umbilical cord is clamped and the baby is separated from the cord. A needle is inserted into the umbilical cord vein and drawn by gravity into the collection bag. The process of collecting cord blood is non-invasive, painless and generally takes just 3-5 minutes to complete. Once a sample is collected, it is transported to the laboratory for processing and cryo-preservation.

Why store at birth

Currently there are no public stem cells banks on the African continent, and there is 1:100 000 change of finding an unrelated donor; which can be a lengthy and expensive process. Storing your baby’s cord blood privately, ensures that these valuable stem cells are immediately accessible for your baby and family should you need them. A baby’s umbilical cord stem cells will remain a 100% match for them and there is also a chance these stem cells could be a match for another family member. Should these cells be needed for transplant, having a 100% match reduces the risk of tissue rejection (Graft versus host disease). Stem cells found in the umbilical cord are at their purest form as they have not been exposed to any illnesses, making them the preferred source of stem cells for transplant.

Storing your baby’s stem cells at birth is a once in a lifetime opportunity to protect your family against serious illness or disease. It is important that all families are fully informed on the benefits of storing their babies’ stem cells before making this important decision.

By Jennifer Van der Laan – www.birthingnaturally.net – childbirth educator and doula

Few women go into labour realising that the strongest comfort measure is the love and encouragement of those supporting her. Let’s face it, childbirth classes are filled with charts of the baby descending and lessons on the proper way to rub a back. While these bits of information are good, they are no substitute for truly loving the labouring mom. But how do you learn how to “love” her?

Dr Gary Chapman has given us a wonderful tool to understand each other with his Five Love Languages. If you have never read his books, the basic idea that everyone has a way in which they give and receive love most powerfully, their love language. Knowing your partner’s love language allows you to focus your efforts at showing love into those areas, which communicate love to him or her most effectively. This principle holds true even through the rigors of labour.

Love Languages

Quality time

Some women feel loved when their companions CHOOSE to be with them rather than participating in another activity. For these women, the simple act of shutting off the television so you can talk with them speaks volumes about how valuable she is to you. To love this woman in labour, you must prevent yourself from becoming distracted and preoccupied by work, telephones, hospital procedures or other concerns during the labour.

Words of Affirmation

Every woman needs to be told how great she is doing, but for a woman whose love language is Words of Affirmation, your silence during labour tells her she’s alone in this. To love this woman in labour, you must remind her after every contraction how much you love her, how strong she is, how great she is handling labour, or how much you appreciate what she is doing.

Gifts

For some women, the fact that someone took the time to make or purchase something for them fills their heart with joy. Although you cannot run out to purchase gifts during the labour, you can prepare ahead of time. Putting together a small photo album, or a collection of poems even a CD with favourite songs lets this woman feel how important the labour is to you.

Acts of Service

When a labouring woman has the Acts of Service love language, everything you do to help her shows just how much you care. To love her in labour you cannot allow yourself to sit at her side while the nurses do everything. You must offer her sips of water or ice, retrieve cool or warm cloths for her face, neck and back, and be her shoulder to lean on when contractions overwhelm her.

Physical Touch

Although most women find massage of some sort comforting in labour, some women need to be touched. For these women, it isn’t just a back rub, it’s an expression of your love and devotion. If she gets to the point that touching her body is no longer comfortable, just hold her hand.

In labour, a variety of comfort measures and pain coping techniques may need to be tried. Understanding your love language allows those with you in labour to focus their efforts on the techniques that not only keep you comfortable, but also demonstrate their love to you.

(This article is also available in an audio format)

The buzz word in maternity care circles is informed choice! But how often are women exhorted to make an informed decision? How many times do these words appear in policy documents and procedure manuals within a health care institution? The reality is that this concept, of parents making truly considered decisions about their care, is a mirage! Do you want to fall in to the category of a mirage or will you truly make informed decisions about your birth?

Lamaze’s philosophy states that birth is normal, natural and healthy. The experience of birth profoundly affects women and their families. Women’s inner wisdom guides them through birth. Women’s confidence and ability to give birth is either enhanced or diminished by the core provider and place of birth. Women have their right to give

birth free from medical interventions. Birth can safely take place at home, birth centres and hospital. Childbirth education empowers women to make informed choice in health care, assume responsibility for their health and to trust their inner wisdom.

Too many times parents lack the information they need, are asked to make a decision under duress, or are presented with options in such a way that they are gently led to make decisions that fit comfortably with the caregiver’s protocols, rather than the parents expressed needs or desires.

In the past – father’s weren’t allowed into the labour ward, perineal shaving and enemas were routine procedures on entering hospital during labour, moms had to wear a hospital gown to labour in, baby’s had to stay in the nursery and not room-in with mom. These days all the above should be routine options for moms and dads.

These innovations stemmed from consumer pressure from parents who had obtained the vital facts and details from a childbirth educator or other source outside the system of direct care.

Informed choice is not a level playing field on which women can state their wishes, and if necessary, have recourse to rights to enforce these wishes. Choices are limited first and foremost by doctors and hospitals. Typical examples are

  • restrictions on the number of people the woman can have with her in labour,
  • restrictions on eating and drinking in labour,
  • unavailability of birth balls, showers and baths in labour wards
  • Not routine skin-to-skin for all babies at birth
  • Top-up feeds to all babies

Other constraints may restrict women’s access to choices that are unavailable eg. A woman’s choice of care provider and place of birth are determined by medical aids, geographical distance from alternatives to the traditional hospital, the availability of midwives, birth units or home births. Choice is further limited by the withholding of information or providing information to women that is consistent with restrictive hospital rules and obstetricians protocols rather than with evidence-based information.

The framing of information shapes choice profoundly. The “gentle steering” of midwives coaxing women to choices that the midwife is comfortable with. Subtle blackmail is another strategy used to influence choice. “If it were me …, I would do …”. Women are coerced, steered, or manipulated to choose what others want and expect them to choose.

Attend childbirth education classes but first check that you will be given all the facts, all the alternatives, so you will be able to make truly informed decisions based on the knowledge of alternatives!