The body’s physiology during labour:
It is important to know that a woman’s uterus is so strong it can deliver a baby unaided, even if the woman is unconscious. Oxytocin is the hormone that contracts the uterus. Although oxytocin is in a woman’s body all the time, during pregnancy there is an inhibitor to prevent contractions. When this inhibitor is removed, labour begins.
Once labour is underway, most women will experience the contractions of the uterus as being uncomfortable progressing to painful. The body’s response to pain is to release endorphins. Endorphins are the “natural narcotic” that the body releases during times of stress and the effects are similar to those of morphine but without the side effects. It is easy to tell when endorphins are at work as the labouring mother will have glazed eyes, flushed cheeks, may have trouble completing sentences or may slur words and will be non-communicative between contractions.
Endorphins are extremely powerful and the body releases them in increasing amounts proportionate to the release of natural oxytocin. So, as the pain of labour increases so does the “natural narcotic”. Some women worry that after hours of labour they will be too tired to push their baby out. They need not worry, the body has an answer to that too; it’s called adrenalin.
The effects of adrenalin have been seen in such cases as people requiring super human strength to save someone’s life or in completing a marathon. It is this hormone that will revive a labouring mother as the pushing stage begins. Many mothers have said that they “woke up” as the baby’s head was crowning and they were alert and excited to greet their child, whereas a few moments before they had felt “asleep”.
Everything that a woman needs to meet the challenge of labour is already in her body. It is not uncommon however, for many medical interventions to occur in the course of a “healthy, normal labour and delivery” when a woman decides to birth in hospital. This is due to the fact that hospitals view birth as a crisis waiting to happen rather than a natural process that, left alone will usually progress to completion unaided. Unfortunately, when there is one intervention it is usually the cause of another intervention. It is worthwhile to investigate when a medical intervention is actually necessary and then ascertain if there is a way to prevent those occasions from arising.
Induction
What is it?
Artificial stimulation of contractions, usually with a syntocinon I.V. Other methods include application of prostin gel to cervix, stripping the cervix membranes, rupturing the membranes also known as “breaking the waters”.
When is it needed?
When the baby is overdue. When there is a medical condition which determines that the baby is safer out of the womb than in the womb.
Why it might be viewed as undesirable.
Bringing on labour artificially can be unpredictable and can result in an intense, fast and painful labour which doesn’t prepare the mother properly either mentally, emotionally or physically. The result can be an unnecessarily traumatic birth or the administration of further medical interventions.
Ways to prevent it from occurring.
Stay healthy. Eat well. Exercise. Medical conditions need to be monitored by your doctor and you can educate yourself as to the different ways to proceed.
If the baby is overdue you can research ways to stimulate the onset of labour without drugs, however it is advisable that you proceed after consulting with your caregiver. Some methods people have tried include spicy food, a vigorous walk, drinking castor oil, making love, enema, loud movies or music, nipple stimulation, acupressure and acupuncture.
Augmention with syntocinon due to a failure to progress
What is it?
The body hinders the natural processing of oxytocin and a synthetic form called syntocinon is administered via I.V.
When is it needed?
When the cervix dilates up to a point and then stops dilating or when contractions start and then stop, start and then stop. Sometimes it is called for when the doctor would like to speed things up although everything may be progressing normally, just more slowly than they desire.
Why it might be viewed as undesirable.
Augmenting labour artificially can be unpredictable and can result in an intense, fast and painful labour which doesn’t prepare the mother properly either mentally, emotionally or physically. The result can be an unnecessarily traumatic birth or the administration of further medical interventions.
Ways to prevent it.
There are a few things that can hinder the natural release of oxytocin. Discerning what those might be and addressing them before a medical intervention can be helpful in avoiding the intervention.
Inhibitors to Oxytocin Release:
1. The labouring mother is uncomfortable with the environment
Ways to avoid this inhibitor before it arises:
Make the environment your own with familiar stuff from home such as pillows, clothes, pictures and music. Close or open the curtains and windows and dim the lights or light candles. Bring an aroma that you enjoy.
Inhibitor:
2. The labouring mother is uncomfortable with the people around her
Avoidance technique:
Ask people to leave; you or your partner can do this. Telling them this might happen beforehand will ensure there are no bad feelings. If it is medical staff and they are not able to leave at that time, then try to tune them out. Medical students should always be respectful of your requests to leave. Cranky nurses can be ignored or you can talk to the head nurse, although this situation requires a degree of delicacy.
Inhibitor:
3. The labouring mother is experiencing a fear or a situation that hasn’t been dealt with
Avoidance technique:
Animals birthing in the wilderness can stop their labour when fearing for their safety and humans are no different. There are a variety of reasons that labouring mothers may fear for their safety – They are afraid they or their baby will die, they may fear not being a good parent, not liking their child, having a bowel movement while giving birth, the loss of control, or… anything. It is normal to have fears around childbirth and parenting. Those fears, even if they are baseless can still slow or stop labour. If one of these “paper tigers” appear, looking at the problem, facing it, perhaps having a good cry or getting validation may very well get your labour back on track.
Inhibitor:
4. The labouring mother is experiencing a lot of pain
Avoidance technique:
Determine where the pain is in order to choose the most appropriate comfort technique: massage, change of position, shower, hot or cold, etc. Reassurance that the pain will not increase once she is 6 cm, that endorphins are working and she has people around to help her may be all that is needed. Trying something rhythmic often works: counting, rocking, or humming.
Epidural
What is it?
A small needle catheter is inserted into the spinal column in the area known as the “epidural space” and left there. Drugs are administered with dosages and varieties varying depending on what degree of feeling is desired.
When is it needed?
There are many reasons an epidural may be necessary (refer to Penny Simkin’s Epidural Update). For this purpose we will be talking about when the labouring mother is experiencing a great deal of pain.
Why it might be viewed as undesirable:
A labouring mother can no longer gauge her body’s readiness to birth or feel the desire to push. The hormone loop is no longer effective and if the epidural “wears off” she will experience pain more intensely. She is dependant on machines to tell her when to push and can’t move instinctively to a position that might help her deliver more easily. Epidurals can cause a maternal fever that can lead to dehydration or the mistaken presumption of illness resulting in the administration of antibiotics. Epidurals are known to affect the fetus in utero by slowing the heart rate, decreasing oxygenation, causing tachycardia and fever. Once the baby is born, epidurals are known to slow the reflexes, the ability to suckle, and the ability to self-sooth or receive consoling.
Ways to prevent it.
Endorphins are unable to be fully utilized in the body when the labouring woman is allowing fear to control her and she is “fighting” the contractions. Thus she experiences more pain. In general, when a labouring woman is relaxing and “surrendering” to the contractions, the body’s endorphins are adequate for pain management and that is why relaxation techniques can be vital in avoiding an epidural.