Support for Birthing Through a Health Crisis
A Short Practical Guide for Remaining Calm, Confident and In Control of your Birthing Body.
By Maureen Collins
With Thanks to Kemi Johnson, Sonia Richards and Jeanette Jones for their review and suggestions.
Wherever you are birthing at home, in hospital with your partner or alone birthing through a health crisis can be challenging. It appears that some of our basic rights are being eroded for reasons that may or may not be valid – time will tell us the answer. Some women are expressing real concerns regarding: birthing alone, some home births services, midwife led units being withdrawn and birth centre services suspended in some parts of the country; partners in some parts of the world being declined access to the birthing room to support their partner.
Wherever you are birthing this information is designed to offer you knowledge about the normality of birth to keep calm and confident through the chaos.
The environment for birth is the key and can be created at home or in hospital.
The process of birth is physiological and can be simply described. An optimal birthing environment is key to support the process. I will try to keep this as simple as possible but give you enough to empower you with the knowledge that your body and your baby know how to birth. Before we look at techniques for a comfortable birth lets go through the simple but effective process that clearly demonstrates the importance of the environment for birth.
1. Neocortex - Private, quiet environment powers down the Neocortex this is the thinking part of the brain the higher consciousness the logical brain that is connected to abilities like communicating, conscious thought etc. Its activity tends is part of the limbic system the primitive brain and when stimulated can inhibit the birth process. A quote from the amazing Michel Odent describes this perfectly:
Nature has perfected a system, through millions of years to facilitate childbirth. To understand the birthing process, one must compare it to other physiological functions. Imagine a couple making love, in a pre-orgasmic state—one of the partners suddenly says, “what do you want for dinner later”—the physiological process of making love halts. Why? Because the neocortex, or the thinking brain, is stimulated. Similarly, a birthing woman, has one need—protection. Protection from all forms of neocortical stimulation during labour—through language, lights and being observed.
2. The Autonomic Nervous System - The perfect system of defence. The Autonomic nervous system (ANS) contains two systems that control the communication network in the body. They are called the sympathetic and parasympathetic nervous systems.
The parasympathetic nervous system keeps the body and mind in the state of harmony and balance think of it as your calm room - It maintains body functioning in a state of calm, slowing heart rate, reducing stimulation keeping you are calm and relaxed. When we are calm relaxed, not watched and undisturbed our Oxytocin levels rise -– perfect for birth!
The sympathetic nervous system’s role is to act as the body’s defence and its mechanism is triggered when we are stressed or frightened. It creates the fight, flight or freeze response within the body, think of it as your stress room. When we are here in the stress room our adrenaline levels rise and our oxytocin levels fall. This response can have a profound effect on labour, causing pain and eventually slowing down or even stopping labour. Adrenaline does have it pace in birth, when the moment of birth is imminent, there is a sudden increase in levels, especially noradrenaline, which activates the natural expulsive reflex that subsequently births the baby.
3. Main Hormone for Birth - Oxytocin has many names – the altruistic, the shy, the love hormone. It is the central hormone for birth and as the many names imply oxytocin thrives in a quiet private environment – similar to the love making environment. Another quote from the famous obstetrician, Michel Odent that said "Whatever the facet of love we consider, oxytocin is involved”. The role of oxytocin is to ensure powerful uterine surges (contractions) that support the cervix to thin and open and to subsequently move the baby down to birth. Disruption or a noisy environment can decrease the flow of oxytocin and slow down or stop the process. Following birth, the uterine surges then support the birth of the placenta. Supporting Oxytocin is Beta Endorphin, this acts as your own body’s natural opiate. High endorphin levels can help you deal with the process of giving birth, even if it is long and challenging. High levels help you to transmute pain and enter the altered state of consciousness that characterises an undisturbed birth (Buckley S 2014).
4. Uterus and Pelvis - play their part. The amazing uterus that has held and nurtured your baby throughout pregnancy is a combination of muscles working together in harmony, first thinning the cervix and then opening it ready for the baby to pass through to birth. The action is called contraction and retraction. It’s important for you to remember that thinning of the cervix happens during early labour and is preparation for the opening phase of the cervix. If this is your first baby this can take a long time – 24 hours or longer. Shorter for subsequent births. An undisturbed birth will ensure good level of oxytocin which in turn will ensure powerful uterine surges to help your baby descend, flex and rotate through the pelvis to birth.
· Quiet private environment
· Neocortex off
· Mother in the Calm Room
· Good levels of Oxytocin and Endorphins.
· Uterine Muscles working in harmony together
· The baby descends, flexes and rotates through the pelvis to birth.
When you are calm, relaxed and undisturbed, your body will follow its own natural rhythm and birth your baby the way nature intended. At birth the baby will be placed direct skin to skin with mother and the cord will be left uncut – wait for white.
Techniques to remain calm wherever you birth:
We must also consider the power of the mind body connection and the importance of positivity. Where the mind goes the body follows. Going through this time of uncertainty can put you in the stress room and that in turn can reduce or slow labour, which then can lead to a cascade of intervention. We need to work on techniques to promote calm relaxation. So, let’s turn our attention away from limitations in the birth room to the wonder that is birth – today you will meet your baby – the most precious day of your life – let’s reframe and prepare for that day and make the change from negative thoughts to positive.
Change takes place in the inner- conscious mind and for change to become a habit and therefore become easier and more deeply embedded you need to - practice, practice, practice, just as you do when learning any new skill, like learning to drive, or riding a bike. At the beginning you need to focus your attention to detail, but then it all clicks into place, the habit has embedded into the inner-conscious mind, change occurs and you now can undertake these tasks automatically. The quickest way to achieve this is affirmation – belief in yourself in your ability to birth and a belief in the physiological process; Here are some affirmations for you to practice daily:
I believe in me – I believe in my body – I believe in my baby
I am empowered - I am motivated - I am focused on a calm birth
I trust my body to know how to birth
With every surge I will go deeper into relaxation
I am confident - my labour will follow the natural rhythm and flow of my body
Be creative think of your own affirmations and say them daily or as often as you can.
A great technique is to establish your Personal Anchor for Relaxation; practice this technique as much as you can prior to birth - remember change takes place at the inner-conscious level and practice is the key to success.
Think of a memory that creates a happy, safe mindset – this can be anything from a holiday to something from your childhood – we are creating your safe space, your happy place.
When you have chosen your memory:
· Put on some relaxing music
· Get comfortable and warm
· Practice slow relaxing breathing
· Create the anchor by pressing the thumb and middle finger firmly together and then start to re-live the memory – see all the colours of your environment wherever you are - green pastures in the countryside, blue sky with fluffy white clouds. Maybe you are at the seaside, see the waves gently coming to you as you breath in and away as you breath out. Accentuate the colours of your environment, hear the conversation you had, Feel how you Feel happy, relaxed, safe, then remove the anchor, take of the music and go about your day.
· Practice this technique every day so you set the anchor into the subconscious mind. The day you are in labour all you will need to do is put on the anchor to go to your safe space, feeling calm and relaxed.
Counting Down - This next technique is great for bringing you into calm relaxation particularly if you become stressed. You can use this technique on your birthday anytime you feel the need to. It can be done by your birthing partner or you may do it yourself by visualising the relaxing coloured drops of water cascading down from your head to your toes while you count down – relaxing more with every decade.
Time to relax, to forget about time and to begin to send your hormones of love, comfort and relaxation out from the brain into the body. So, start with you your slow relaxation breath. Breathing in slowly and breathing out allowing your body to become loose and relaxed. Now you can imagine your body relaxing from the top of your head to your feet or as we begin counting down from 40, see your natural relaxants spread like coloured drops of liquid into water, dispersing in different directions all over the body initiating deepening and increases comfort. So now let’s begin counting down (Richards 2018)
40 39…38…37…36…35…more relaxed…34…33…32…31 and 30 and doubling your relaxation going deeper…
…29…28…27…26…25… feeling so calm and comfortable…24…23…22…21…and 20 and doubling your relaxation again, that’s right…
At…19…18…17…16…15 even more deeply relaxed now…14…13…12…11…10 and doubling relaxation again…
Almost there now as we reach 9…and 8…7…6 and 5 letting go even more deeply…4…3…2…1…and 0 once again doubling your relaxation… Marvelous…
Now feeling ten times as deeply relaxed as you were before… as you go beyond zero even, drifting onto a cloud of bliss, safely cocooned within your protective colour and noticing how good it feels to just be and to be here… right now, resting now.
Your Birthing Day
Remember what we said above early labour is about the cervix thinning getting ready to open so for this part of labour you can stay home, carry on as normal, eat, rest, go to the loo, listen to music, watch a film take a gentle walk. Contact the hospital/midwife when you feel you need help, when your surges become longer, stronger and closer together.
Birthing at home- in hospital – with your partner or alone:
Stay calm, confident and in control of your birthing body
Use your techniques described above
Create your environment
Environment for Birth
The importance of the birthing environment has been emphasised above and can be created wherever you birth:
Oxytocin Environment - Calm & Relaxed
Environment that Inhibits Oxytocin Release - Stressed
Quiet calm atmosphere
Warm comfortable environment
Feeling secure Relaxation
Light massage and gentle touch
Being with loved ones if not face to face then virtually or through pictures, items from home.
Strangers in the room
Fear and Tension
Stimulating the neocortex - talking, answering questions
TIPS FOR CREATING A HORMONE ENVIRONMENT FOR BIRTH
· Tell your midwife that you would appreciate a calm, peaceful and private environment for birth.
· Keep talking to a minimum so you can remain focused within your birthing body
· Keep the lighting low and the room warm.
· Use your birthing or favourite colour as an anchor for relaxation – your own pillow from home
· Play your favourite music as an anchor for relaxation
· Take the mattress off the bed and put it on the floor, creating an area for you and your partner to be together.
· If you are without your partner - maybe you can connect electronically - have them on Skype/Zoom. If this is not possible take photographs with you perhaps wear their sweater or tee-shirt.
· Stay positive – this is your special birthing day.
· Protect your privacy and limit the number of care givers in the room
Use what comfort measures are available to you – use of the birthing pool if that is available; using hypnobirthing techniques including massage, breathing and relaxation techniques. Gas and Air; TENS. Also keep your blood sugar levels up – take high calorie drinks eat small snacks. The uterus needs the energy to do its job efficiently.
You will find your own natural flow for birth. Within your hormone responsive, undisturbed environment you will go within and follow your innate instincts for birth - instinctively adopting positions for labour and birth that are natural and comfortable for you. The upright position is optimal with shorter labours, freedom of movement, pressure for the baby’s head of the cervix will optimise dilation. Upright position also affords an increase in the available space in the pelvis of up to 28%. When you labour out of bed you are more likely to have a normal vaginal birth. There is also evidence to show that women who birth in an upright position are less likely to experience perineal trauma. With the progress of labour and opening of the cervix your surges will become longer – stronger and closer together.
· Trust - in yourself
· Confidence - that your body and your baby know how to birth
· Follow - your natural instinct
· Feel - rather that time your surges
· Listen - to your body to your rhythm of birth
Breathing Through Surges (contractions). The importance of this breath is that it will help you deal with your contractions, remain relaxed and work with the rhythm of your uterus.
Place your tongue behind your upper teeth, this will relax the jaw which in turn will relax your pelvic area. Allow your body to go lose and limp. The key to this breath is loose and limp and to allow the breath to work with the rise and fall and the uterus.
Slowly breathing in through the nose directing the breath from the pubic bone breath in for as high as you can go up and up - expanding the abdomen and letting your arms and legs go lose and limp, then slowly breathing down and letting go of any tension – while your body is contracting repeat – then rest.
Breathing for the birth of your baby:
Follow your body’s direction!
Take a long slow breath in through the nose. The out breath is directed toward the lower back of the throat, and then downward through the chest gaining power from the top of your uterus (the fundus) working with the power of uterus and continue down to the vaginal outlet and outward. Do Not Hold the Breath! As the surge continues, continue with the birth breath until the baby is born. Work with your birthing body it will tell you what to do. Directed pushing commands from care giver are not necessary!
To birth baby follow your natural instinct – however you breath that will be right for you.
If you find yourself at home without the support of a midwife follow the above advice but also:
· Call for assistance
· Birth companion create a positive calm environment
· Receive the baby direct to mother’s chest – skin to skin
· Keep yourself and the baby dry warm
· Do not cut the cord – do not pull on the cord wait for help.
· The baby may take a minute to take a breath relax and gently stroke her. If the baby does not start to breath try blowing in her face as the cold air can make her gasp and take a breath. If that doesn’t work briskly rub the baby’s back up and down with the towel as this can stimulate her to breathe. Familiarise yourself with neonatal CPR prior to birth - you shouldn’t need it but it’s good to be prepared; https://www.resus.org.uk/resuscitation-guidelines/resuscitation-and-support-of-transition-of-babies-at-birth/
· Breast feed as soon as you can
· If you and your baby are well you do-not need to be transferred to the hospital. If the midwife has not arrived with or just after the ambulance, she will come to check you both and then arrange to have the baby’s first neonatal examination.
This is your day - Remember this is your body, your baby, your birth, your choice - don’t give away your power. while we don’t know how your birth will play out, I hope this information will support you to achieve a strong, positive experience. When you look back on your birthing day, when you tell your story it won’t just be how you birthed through a health crisis but how you were confident and in control, how you achieved a positive birth memory for life.
REPRODUCTIVE RIGHTS ARE HUMAN RIGHTS:
Human rights are the basic rights and freedoms that belong to every person in the world, from birth until death. They apply regardless of where you are from, what you believe or how you choose to live your life and are based in a set of human rights principles’. These are sometimes called the FREDA principles - Fairness, Respect, Equality, Dignity, and Autonomy.
YOU HAVE A RIGHT:
· To safe ethical maternity care
· To self determination
· To be fully informed about your care with current evidence and research and not just hospital policy and protocol – informed consent
· To make choices that are right for you and your family
· To accept or to decline care
· To choose care outside of current policy and guidance
· To be treated with dignity, respect and free from neglect
· To privacy and family support
· To be treated equally regardless of race, disability or gender
NICE Quality Statement 7 (2012) States - Patients are made aware that they have the right to choose, accept or decline treatment and these decisions are respected and supported.
The White Ribbon Alliance state that ‘to improve maternal and new-born health is to promote self-care as a vital component of any comprehensive maternal and new-born healthcare strategy. We know that when women are equipped with information and resources, they make the best health decisions for themselves and their families’. www.whiteribbonalliance.org/self-care