Joyful
Birth
To
have a good birth experience with a favourable outcome and where you, the
birthing woman, also feel informed, capable and feel some degree of control
over your experience, you need to understand what your body is trying to do in
childbirth and the processes involved in childbirth. At your antenatal visits
and childbirth classes the hospital staff will probably give you the basics of
the stages of childbirth and the pain relief available to you at the hospital.
Here I will try to give you some more insights into what will be happening in
your body and how you can help it along.
Something to note about labour and childbirth is that during first stage labour our body does its work automatically. We don’t make labour begin; we don’t make our muscles contract; we don’t make our cervix open. We can only help our body to do its work. We do that by firstly not hindering the process. There are also things we can do which help the process, giving our bodies what they need to work properly.
Most of the work done in childbirth is muscular, so our primary considerations need to be in supporting, and not hindering, our muscular functions. As in any physical activity muscles involved in childbirth need to be well-oxygenated. They also need to be able to expel the carbon-dioxide and by-products of cellular metabolism. If these byproducts are not removed efficiently the build-up will interfere with muscle function.
Something to note about labour and childbirth is that during first stage labour our body does its work automatically. We don’t make labour begin; we don’t make our muscles contract; we don’t make our cervix open. We can only help our body to do its work. We do that by firstly not hindering the process. There are also things we can do which help the process, giving our bodies what they need to work properly.
Most of the work done in childbirth is muscular, so our primary considerations need to be in supporting, and not hindering, our muscular functions. As in any physical activity muscles involved in childbirth need to be well-oxygenated. They also need to be able to expel the carbon-dioxide and by-products of cellular metabolism. If these byproducts are not removed efficiently the build-up will interfere with muscle function.
Deep
breathing and relaxation are the best way I know to aid these processes. As
well as oxygenating the muscles and expelling toxic byproducts deep breathing
and relaxation also help to ease muscle tension. Excessive muscle tension
interferes with both the processes of oxygenation and waste removal and causes
muscle fatigue, and is therefore one of the primary causes of excessive pain in
labour.
A major cause of muscle tension and pain in childbirth is fear. We fear the pain and so we scrunch up and bend over and try to fight the pain. What that does is it constricts the flow of blood to and from our muscles and uses up a lot of energy, and this causes our muscles to fatigue. They tire and ache. This is the body’s signal to us to relax. You will find that it will hurt much less, and be quite bearable, if you can overcome your fear of the pain and do the following: For pain management during contractions breathe deeply and try to relax your tummy and pelvic floor muscles. It helped me to kind of push my tummy out to do this. To test the effectiveness of this, clam up for one contraction and note the difference in how you feel.
I have tested this. You may think while you are going through contractions that if you relax they will hurt more. During my second birth I decided to tense up during a contraction to see what would happen. I had been practising deep breathing and pushing my tummy out to avoid clenching up my abdominal and pelvic floor muscles. What a difference! I couldn’t even continue to tense up through the whole contraction. It hurt too much. To clench up and fight the pain made it hurt a whole lot worse.
As much as possible we need to relax the muscles that our body is trying to open out and pull up, so as not to hinder the process and make our body have to work even harder, take longer and hurt more. While certain muscles are trying to stretch and open up, tensing them will hinder their efforts.
During contractions your breaths in will probably be relatively short. The long breath out is when your pain will be eased. I have tended to rush the in breath during contractions in order to get to the more pain-relieving deep breaths out. Your breathing need not be even. Breathe in such a way as to ease your tension and your pain. This, along with relaxing the right muscle groups, is the best technique I know to reduce pain in labour.
Relaxing fully supported (leaning on a pile of pillows, on your spouse or support person or on whatever is comfortable) and breathing slowly between contractions will further help oxygenation and waste removal. It will also help your body rest and gather up strength for the next contraction. Having said that, some experienced and knowledgeable women advocate being up and active in labour, during and between contractions, moving about freely as they desire. Do as you feel comfortable to be most at ease in your labour.
There is another reason for the importance of deep breathing and relaxing your muscles; it helps you to remain calm and focused. You will not be able to continue your usual duties or playing cards or tending to a toddler while you are having contractions in the latter part of stage one labour. You will be consumed, and to manage the pain well and effectively you will need to stay calm and focused. Concentrating on your deep breathing and on relaxing specific muscle groups will help you to do this.
Be upright in labour, particularly as it becomes more intense, so that your body will not have to work against gravity to get the baby into the birth canal and therefore have to work harder (and therefore cause more pain and cause the process to take longer). By being upright gravity will instead be helping you. Having said that, if the labour is going too quickly and you want to slow it down, leaning back or lying can help to slow it down and ease the pressure on your perineum, if that is desired.
Squatting, kneeling or being on all fours tend to be positions more conducive to giving birth. Your pelvic region will be more open which means baby will come out more easily. Sitting, while more convenient for your birth attendants, can cause your opening to become misshapen, possibly causing baby to become stuck. If a doctor is present he may opt for forceps or a caesarean at this point. To avoid such an occurrence, try squatting or kneeling to open yourself up for the baby’s descent.
Drink plenty of water and eat only easily-digestible foods, like fruit, if you feel you need to eat. As childbirth and digestion both require a great deal of energy it is best not to divert too much of the body’s energy away from the birthing process to the digestive system by eating large or heavy meals during labour.
Don’t suck on lollies for energy during labour. While they may give you a short burst of energy they may also cause a subsequent drop in blood sugar levels.
Having a fetal heart monitor strapped to your tummy can cause distress for both mother and baby. You should be cautious about letting anyone strap one to you without very good reason, or for very long. And you judge whether their reason is good enough. Take responsibility and make the decision yourself. Remember, it is your body, your baby and men, your wife. Lying on your back with a fetal heart monitor on you can be very painful. It means you are horizontal – and so you have gravity making your body have to work harder - and you are unable to move around as you please into positions that are more comfortable for you. The distress this causes the labouring mother can be transferred to the baby and cause the fetal distress that the medical staff are attempting to detect. In my opinion, fetal heart monitors are usually best left alone.
If you are well into labour and your waters have not yet broken and someone wants to break them, it is usually best not to let them. They will eventually break by themselves. And it is helpful to have them intact if, for instance, the baby is not quite in the right position to descend into the birth canal. If the baby is posterior it is possible for it to turn before it is born. You can encourage it to do this by getting down on all fours and leaning forward a little. Even if the baby is breech there are things you can do to encourage it to turn, or it may turn on its own before it is born – it has happened before. You should be able to find information in books or on the internet which can help you with this.
If your waters break and contractions don’t begin for 24 hours medical staff will probably want to induce you. The theory as I understand it, is that having the waters break very long before birth increases the risk of infection. It is not unusual for the waters to break 24 or even 48 hours or more before noticeable contractions begin, and this is not usually a problem. As for the introduction of infection, careful attention to personal hygiene is the answer here. Remember also that medical personnel themselves can introduce infection when they perform internal examinations, so it would be wise at that point to simply keep all hands off.
Do not start pushing until your body tells you to. You will know when that is. You will get an irresistible urge to push, meaning you will be unable not to push. If you try to push when your body is not telling you to your pushing will not be effective, and you will tire yourself out so that when it is time to push you may not have the energy to. You need to work with your body. Push with contractions for greatest effect and don’t push between contractions.
Learn the difference between effective and ineffective methods of pushing. Pushing harder will not necessarily help if the way you are pushing is inefficient. Merely pushing from the top of your uterus is not as effective as pushing from the top and simultaneously pulling up and open at the bottom. It’s hard to explain without a diagram. Find a diagram of the muscle groups surrounding the uterus and you will better understand the need to allow the ‘opening up’ of the muscles around the bottom of the uterus, which for eight and a half months has been holding your baby in. Practice in your months of pregnancy when having bowel movements.
Try not to push too hard or fast, so as not to tear. Pushing hard to get the baby out quickly – which I know is what most mums will want to do at this stage – can cause the perineum to tear. Pushing more gently will greatly reduce the risk of tearing. As you approach this part of labour think about easing the baby out, rather than pushing it out.
Episiotomies are rarely necessary. (I’m yet to be convinced that they are ever necessary.) They hurt an awful lot if no anesthetic is given – which thankfully is not usually the case – and the stitching and healing of the cut can be painful, particularly the injection of the anaesthetic, or the wound if it becomes infected. If the baby is not coming out quickly enough ( - by whose standard…? ) and the attendant suggests an episiotomy, it is best to refuse and try altering your method of pushing, pushing with contractions not between contractions, waiting till you get the urge to push if you’re not sure you’ve experienced that yet (you will be sure when it happens, really!) or perhaps changing position. Remember that the baby is still getting its food and oxygen from the umbilical cord, so it’s not likely that it’s suffering being stopped there for a few minutes extra while you try these things.
Do not cut the umbilical cord until it has stopped pulsating and the baby is breathing well. While the cord is pulsating the baby is still receiving fresh blood and oxygen from the placenta. This extra blood is important as it contains many nutrients from which the baby will greatly benefit. And the continued supply of oxygen can be crucial if the baby has any difficulty breathing in the minutes after birth. Cut the cord too soon and you cut off the baby’s supply of oxygen and nutrients, and reduce the total quantity of blood in the baby after the birth is all over.
After the baby has been born there will be a few more contractions as your body prepares to expel the placenta. When left to occur naturally this can take anything from a few minutes to an hour. Don’t let anyone pull on the cord to help it out as this may cause it to detach from the placenta before the placenta comes out, potentially causing excessive bleeding and the need for further intervention. If for some reason the placenta does not come out as it ought, then help may be necessary and welcomed, but always consider what ‘as it ought’ means. In hospitals they tend to administer a drug to make the placenta come out straight away. While rushing the placenta out is not usually necessary, I’m guessing a reason for this practice may be to avoid hemorrhaging. (Please read the next chapter for things you can do during your pregnancy to help avoid excessive blood loss in childbirth.)
It should be borne in mind throughout all stages of pregnancy and childbirth that all drugs are toxic in some way and should not be used unless there are problems whereby the possible benefit of the drug outweighs the ill effects it may cause.
A major cause of muscle tension and pain in childbirth is fear. We fear the pain and so we scrunch up and bend over and try to fight the pain. What that does is it constricts the flow of blood to and from our muscles and uses up a lot of energy, and this causes our muscles to fatigue. They tire and ache. This is the body’s signal to us to relax. You will find that it will hurt much less, and be quite bearable, if you can overcome your fear of the pain and do the following: For pain management during contractions breathe deeply and try to relax your tummy and pelvic floor muscles. It helped me to kind of push my tummy out to do this. To test the effectiveness of this, clam up for one contraction and note the difference in how you feel.
I have tested this. You may think while you are going through contractions that if you relax they will hurt more. During my second birth I decided to tense up during a contraction to see what would happen. I had been practising deep breathing and pushing my tummy out to avoid clenching up my abdominal and pelvic floor muscles. What a difference! I couldn’t even continue to tense up through the whole contraction. It hurt too much. To clench up and fight the pain made it hurt a whole lot worse.
As much as possible we need to relax the muscles that our body is trying to open out and pull up, so as not to hinder the process and make our body have to work even harder, take longer and hurt more. While certain muscles are trying to stretch and open up, tensing them will hinder their efforts.
During contractions your breaths in will probably be relatively short. The long breath out is when your pain will be eased. I have tended to rush the in breath during contractions in order to get to the more pain-relieving deep breaths out. Your breathing need not be even. Breathe in such a way as to ease your tension and your pain. This, along with relaxing the right muscle groups, is the best technique I know to reduce pain in labour.
Relaxing fully supported (leaning on a pile of pillows, on your spouse or support person or on whatever is comfortable) and breathing slowly between contractions will further help oxygenation and waste removal. It will also help your body rest and gather up strength for the next contraction. Having said that, some experienced and knowledgeable women advocate being up and active in labour, during and between contractions, moving about freely as they desire. Do as you feel comfortable to be most at ease in your labour.
There is another reason for the importance of deep breathing and relaxing your muscles; it helps you to remain calm and focused. You will not be able to continue your usual duties or playing cards or tending to a toddler while you are having contractions in the latter part of stage one labour. You will be consumed, and to manage the pain well and effectively you will need to stay calm and focused. Concentrating on your deep breathing and on relaxing specific muscle groups will help you to do this.
Be upright in labour, particularly as it becomes more intense, so that your body will not have to work against gravity to get the baby into the birth canal and therefore have to work harder (and therefore cause more pain and cause the process to take longer). By being upright gravity will instead be helping you. Having said that, if the labour is going too quickly and you want to slow it down, leaning back or lying can help to slow it down and ease the pressure on your perineum, if that is desired.
Squatting, kneeling or being on all fours tend to be positions more conducive to giving birth. Your pelvic region will be more open which means baby will come out more easily. Sitting, while more convenient for your birth attendants, can cause your opening to become misshapen, possibly causing baby to become stuck. If a doctor is present he may opt for forceps or a caesarean at this point. To avoid such an occurrence, try squatting or kneeling to open yourself up for the baby’s descent.
Drink plenty of water and eat only easily-digestible foods, like fruit, if you feel you need to eat. As childbirth and digestion both require a great deal of energy it is best not to divert too much of the body’s energy away from the birthing process to the digestive system by eating large or heavy meals during labour.
Don’t suck on lollies for energy during labour. While they may give you a short burst of energy they may also cause a subsequent drop in blood sugar levels.
Having a fetal heart monitor strapped to your tummy can cause distress for both mother and baby. You should be cautious about letting anyone strap one to you without very good reason, or for very long. And you judge whether their reason is good enough. Take responsibility and make the decision yourself. Remember, it is your body, your baby and men, your wife. Lying on your back with a fetal heart monitor on you can be very painful. It means you are horizontal – and so you have gravity making your body have to work harder - and you are unable to move around as you please into positions that are more comfortable for you. The distress this causes the labouring mother can be transferred to the baby and cause the fetal distress that the medical staff are attempting to detect. In my opinion, fetal heart monitors are usually best left alone.
If you are well into labour and your waters have not yet broken and someone wants to break them, it is usually best not to let them. They will eventually break by themselves. And it is helpful to have them intact if, for instance, the baby is not quite in the right position to descend into the birth canal. If the baby is posterior it is possible for it to turn before it is born. You can encourage it to do this by getting down on all fours and leaning forward a little. Even if the baby is breech there are things you can do to encourage it to turn, or it may turn on its own before it is born – it has happened before. You should be able to find information in books or on the internet which can help you with this.
If your waters break and contractions don’t begin for 24 hours medical staff will probably want to induce you. The theory as I understand it, is that having the waters break very long before birth increases the risk of infection. It is not unusual for the waters to break 24 or even 48 hours or more before noticeable contractions begin, and this is not usually a problem. As for the introduction of infection, careful attention to personal hygiene is the answer here. Remember also that medical personnel themselves can introduce infection when they perform internal examinations, so it would be wise at that point to simply keep all hands off.
Do not start pushing until your body tells you to. You will know when that is. You will get an irresistible urge to push, meaning you will be unable not to push. If you try to push when your body is not telling you to your pushing will not be effective, and you will tire yourself out so that when it is time to push you may not have the energy to. You need to work with your body. Push with contractions for greatest effect and don’t push between contractions.
Learn the difference between effective and ineffective methods of pushing. Pushing harder will not necessarily help if the way you are pushing is inefficient. Merely pushing from the top of your uterus is not as effective as pushing from the top and simultaneously pulling up and open at the bottom. It’s hard to explain without a diagram. Find a diagram of the muscle groups surrounding the uterus and you will better understand the need to allow the ‘opening up’ of the muscles around the bottom of the uterus, which for eight and a half months has been holding your baby in. Practice in your months of pregnancy when having bowel movements.
Try not to push too hard or fast, so as not to tear. Pushing hard to get the baby out quickly – which I know is what most mums will want to do at this stage – can cause the perineum to tear. Pushing more gently will greatly reduce the risk of tearing. As you approach this part of labour think about easing the baby out, rather than pushing it out.
Episiotomies are rarely necessary. (I’m yet to be convinced that they are ever necessary.) They hurt an awful lot if no anesthetic is given – which thankfully is not usually the case – and the stitching and healing of the cut can be painful, particularly the injection of the anaesthetic, or the wound if it becomes infected. If the baby is not coming out quickly enough ( - by whose standard…? ) and the attendant suggests an episiotomy, it is best to refuse and try altering your method of pushing, pushing with contractions not between contractions, waiting till you get the urge to push if you’re not sure you’ve experienced that yet (you will be sure when it happens, really!) or perhaps changing position. Remember that the baby is still getting its food and oxygen from the umbilical cord, so it’s not likely that it’s suffering being stopped there for a few minutes extra while you try these things.
Do not cut the umbilical cord until it has stopped pulsating and the baby is breathing well. While the cord is pulsating the baby is still receiving fresh blood and oxygen from the placenta. This extra blood is important as it contains many nutrients from which the baby will greatly benefit. And the continued supply of oxygen can be crucial if the baby has any difficulty breathing in the minutes after birth. Cut the cord too soon and you cut off the baby’s supply of oxygen and nutrients, and reduce the total quantity of blood in the baby after the birth is all over.
After the baby has been born there will be a few more contractions as your body prepares to expel the placenta. When left to occur naturally this can take anything from a few minutes to an hour. Don’t let anyone pull on the cord to help it out as this may cause it to detach from the placenta before the placenta comes out, potentially causing excessive bleeding and the need for further intervention. If for some reason the placenta does not come out as it ought, then help may be necessary and welcomed, but always consider what ‘as it ought’ means. In hospitals they tend to administer a drug to make the placenta come out straight away. While rushing the placenta out is not usually necessary, I’m guessing a reason for this practice may be to avoid hemorrhaging. (Please read the next chapter for things you can do during your pregnancy to help avoid excessive blood loss in childbirth.)
It should be borne in mind throughout all stages of pregnancy and childbirth that all drugs are toxic in some way and should not be used unless there are problems whereby the possible benefit of the drug outweighs the ill effects it may cause.
Educate Yourself
Joyful
Birth
