Archive | September 2011

How Emotions Affect Labor and Birth – Part 1

We all know things like poor nutrition, lack of exercise, smoking, alcohol and drugs can have negative effects on the course of pregnancy and the chances of having complications in labor and birth. We’ve also been told that we should try to reduce stress levels when we’re pregnant because stress can have a negative impact on the health of the pregnancy. But just how important is your emotional health to the health of your baby? And do emotions play a significant role in whether you have a smooth or complicated birth?

This is a relatively new field of study, but it is increasingly becoming evident that health in general, and in particular, health in pregnancy, birth and post-partum is not only influenced by physical factors, but by emotional factors as well. This is an important new perspective because it means that when we’re experiencing upsetting situations, it may be detrimental to our health to just “sweep it under the carpet”. Learning how to process emotions, resolve negative issues and promote positive emotions may be as important as eating well, exercising and avoiding smoking or alcohol.

How do Emotions Affect Labor and Birth? Many professionals in the field of birth, such as French Obstetrician, Michel Odent, have observed that when laboring women feel safe, supported, and respected, they tend to experience less pain, have less complications in labor, bond more easily with their infants, have fewer problems breastfeeding, and feel more positively about themselves as mothers. Laboring women who feel anxious, stressed, unsafe or unsupported tend to experience more pain, have more problems with their labors, take longer to bond, have more difficulty breastfeeding and have less confidence in their mothering.

Yup, you heard me right. Negative emotions can cause labor pain to feel wwwwaaaaaayyyyyyyy worse!

Negative emotions can cause complications in labor. What?! Are you kidding?!

Think about it. When we’re afraid, in danger or stressed, we produce Adrenalin, the fight or flight hormone. Adrenalin inhibits or slows down body functions that are not critical for immediate survival, fighting, or running away. When mammals are in labor and a predator is in the area, the mammal mom produces adrenalin which inhibits labor. This is helpful because 1. She can run away to a safer place, and 2. She wouldn’t want to have her baby near a predator who might then eat her baby.

Fear, or similar emotions, produce adrenalin. Adrenalin can slow down labor. So fear, anxiety or feeling unsafe can slow down or stop labor. You’ve probably heard of many women who had cesareans because they’re labors “weren’t progressing”. We don’t know if one of the causes could have been anxiety. More research into this needs to be done.

A recent study, featured in the Globe and Mail, shows that women who fear childbirth are more likely to have a cesarean. Click here if you want to read the article. What the article doesn’t explain is how to resolve those fears prior to birth.

Some useful questions to ask are, what causes fear and anxiety in labor (I’m sure you have a whole list in mind), and HOW do we resolve those negative emotions and promote positive ones? You can start your list about that too. We’ll talk about that in my next post How Emotions Affect Labor and Birth – Part 2.

Speaking of positive emotions, the flip side of this anxiety-adrenalin discussion is the love-oxytocin discussion. Interestingly, oxytocin, the hormone that starts and controls contractions in labor, is called the love hormone because it is also produced when breastfeeding, bonding with infants, falling in love, making love, getting a massage, thinking about something you love, talking to your best friend and who knows what other things.

Loving feelings, relaxation, relationship bonding promote the production of oxytocin. Oxytocin is necessary for effective contractions. Therefore it makes sense, and often is the case in practice, that women who feel loved, safe and supported have smoother labors. Obviously, women find it helpful to have their partners with them in the delivery room, assuming their partners are loving and relatively calm. That may also be one of the reasons that doulas are so effective at reducing the need for interventions in labor. Doulas provide continuous support throughout labor and are focused on mom’s emotional needs so she can resolve her anxiety and enhance her feelings of support.

So if you are pregnant, use this article as an excuse to do whatever it takes to feel good 🙂 And if you are upset or anxious about something, don’t sit with that for too long. Do whatever you do to feel better. Talk to your caregiver, talk to a friend, have a bubble bath, get a massage, go for a walk or talk to your doula.

Leave your thoughts in the comments box below, or contact me at 604 809 3288 or info@prenataljourney.ca

© copyright 2011 Kaurina Danu The Prenatal Journey

I didn’t know about midwives!

“I didn’t know about midwives!” I hear it all the time. I’m always surprised that most people, in particular, expecting couples, have no idea that having a midwife be their primary caregiver is even an option. Ok, I admit, before I had kids, I had no idea either. I thought midwives only existed in the middle ages. (I’ve come a long way since then)

So let’s set the record straight now : If you have a low-risk pregnancy, you can choose to have a midwife if you want.

Across the world, and in different provinces or states, the regulations and scope of practice of midwives (called Femme Sage in French) varies so check out the rules in your area. In some countries, like in Northern Europe, midwives are the primary caregivers for the majority of pregnant women and obstetricians mainly only manage high-risk pregnancies. In some countries, what they refer to as midwives are nurse-midwives who work in the hospitals and are not the primary caregiver.

Here in BC, Canada, midwives practice independently, meaning you don’t have to have a doctor if you have a midwife. The midwife handles all prenatal appointments, birth, and care up to 6 weeks post-partum. Before 1998, midwives were not part of the Medical Services Plan (MSP) so women choosing a midwife had to pay for their services themselves. In 1998, midwives organized under the College of Midwives of British Columbia, became included under MSP. So it is now free for women to have a midwife.

They are all highly trained to attend low-risk hospital births as well as home births. They are well-integrated with the rest of the medical system so they are able order medical tests, do basic medical procedures, refer to an obstetrician for a high-risk issue, handle problems at home births and transfer easily to a hospital if a need arises.

Most midwives are booked solid, so if you want to consider a midwife, try registering ASAP. Preferably as soon as you find out you are pregnant. Despite most people not knowing about them, they are very popular amongst those who do. One of the reasons is that their prenatal visits last 45 minutes so parents have a lot of time to ask questions, discuss things going on in their lives, and build a relationship. There are many things that affect the health of moms and babies, not just medical or physical things. Stress at work, financial issues, other kids the mom has, nutrition, relationships, fears, all impact your health. Women love having a midwife because they get enough time to discuss and resolve anything that may be affecting their life while they’re pregnant.

They may also choose a midwife because midwives tend to have more skills involved with the natural birth process, and tend to use less medical interventions. Of course there are also many doctors who are skilled at supporting natural birth and only use interventions when necessary. Generally speaking, midwives follow the Midwifery Model of Care.

Many women say, “I’d rather get an obstetrician because if anything happens they’ll know what to do.” That is a reasonable statement, but it may not be totally accurate. A lot of people have the paradigm that midwives know a little, and obstetricians know a lot. It is probably more accurate to think of it this way : midwives are experts in natural and normal birth. Obstetricians are experts in dealing with complications in birth. Both fields are extremely important. If a woman has a high-risk pregnancy, and obstetrician is the best option, but if she has a low-risk pregnancy, there is no evidence that an obstetrician is the best option. Although there are some obstetricians who really understand the dynamics of how to promote natural, normal birth, many obs tend to use more interventions.

Women with low-risk pregnancies actually have three choices – midwife, family physician who does maternity care, and obstetrician. In rural areas, the physician may be the only option. We are quite lucky here to have the best of both world, so to speak, because the system is so integrated. So in the case that anything were to happen, midwives and physicians are able to include an ob on the team.

Now you know your options but in the end it always comes down to, “What do you want and what is important to you?” If you haven’t read my last post on Respecting the Mother’s Preferences for Birth you can read it. You know yourself. Is it important to you to have a natural birth as possible, or do you feel safer with an obstetrician. Do you want to interview a few physicians, obs, or midwives to see if they line up with topics that are important to you, or do you want to choose the first one you get. It’s all up to you.

Here are some links to Langley and Surrey midwives if you’d like to look into having a midwife for your birth :

Midwives in BC

Surrey – Sage Midwifery

Panorama – Village Health Midwifery

White Rock – Crescent Moon Midwifery

Walnut Grove – Grove Midwifery,  Triton Midwifery

Willowbrook – Family Health Clinic

 

What are thoughts on the subject? Add your comments below.

 

© copyright 2011 Kaurina Danu The Prenatal Journey

Respecting the Mother’s Preferences for Birth

Yesterday I did a quick review of the new internet channel about birth – http://www.oneworldbirth.net/ . After giving it more thought, I decided to add a point that I think is critically important in the debate, yet is often completely ignored. That is, what does the mom prefer for her own birth?

What does the mom prefer?! How does that matter?! Isn`t it just a question of safety and risk? Life or death?

Well, remember, in my review post I talked about most decisions in childbirth being in the grey area. What that means is there may be some risks to not using medical intervention, and some risks to using medical intervention. So caregivers and parents have to make a decision based on balancing the risks.

Because we are talking about those grey area situations right now, and not the out and out real and immediate emergencies, I would like to suggest that one critically important factor in deciding the course of action, besides weighing the risks, is knowing what the moms preferences are for her birth.

Seems simple really, but it is quite profound and has long lasting effects. Here`s why –

There are roughly 3 groups of women – Women who really don`t like medical interventions, women who do want medical interventions, and women who don`t care either way.  You may argue about which group is more common, or why they feel the way they do, but no one can deny that there are these three groups.

It`s funny because the women who really prefer natural birth simply can`t understand why some women don`t, and the women who really want a medical birth cannot fathom why anyone would want a natural birth. The point is not which is a better way. There is no such thing. The point is that different women prefer different experiences. The childbirth “Experts“ can debate all they want, but what do they women actually doing the birthing think?

Why this is so important is this : Say a woman who really wants a normal birth, goes to the hospital and has a long labor. The doctor comes in at some point and says, “Well, this has gone on for too long. I think we may as well do a cesarean.“The well-intentioned doctor may well be thinking, “No sense in letting her suffer. I`ll help her out by getting the baby out now and putting an end to her pain.“ This is an example of a grey area situation where there is no signs of distress in mother or baby. (i`m not talking about situations where there is a clear problem and a cesarean is clearly the best option.)

If the mom doesn`t have a discussion with the doctor about risks, benefits and her preferences, she may go on to have the cesarean then end up wondering for the rest of her life if it was really necessary. Besides physical effects, there can be emotional effects which can affect her self-confidence as a woman and as a mother.

If however, the woman doesn`t care either way, normal birth or cesarean, then she may be totally happy with her experience and won`t feel the same emotions as the woman who actually wanted the vaginal birth.

If the woman actually wanted a cesarean to start with, she would be so relieved and totally happy with her experience.

The thing is the doctor does not know which of these three categories of women his client is in. The doctor may not even know there are three categories. If you have a preference, it is your job to figure out what it is, and to communicate it with your doctor. It is easier to have these discussions during your prenatal visits rather than in thee middle of labor, although you can still discuss things as they arise.

That woman in the first example may still choose to go ahead with the cesarean, or she may not. But if she has a discussion with her doctor or midwife and takes into account her preference, she will feel much better about her experience, and feel more confident about herself and be more relaxed as a mom.

I hope you found this article helpful. Please leave your thoughts in the comment box. If you would like to schedule a birth consultation to clarify your preferences for birth (otherwise known as a Birth Plan) and write a list of important questions to discuss with your caregiver in prenatal visits, call 604 809 3288 or email kaurina @ prenatal journey . ca

 

© copyright 2011 Kaurina Danu The Prenatal Journey

Review of One World Birth videos

September 1st was the launch of the new internet video channel One World Birth. I decided to take a look at some of the videos.

The videos are all short clips of interviews with various experts from Europe and America discussing their views on topics around birth.  There are some well known natural birth names – Ina May Gaskin, Michel Odent, Sarah Buckley, Sheila Kitzinger and so on. It brings to awareness the polarity that sometimes exists between people who want to promote natural birth as much as possible, and people who want to promote medical intervention in birth as much as possible.

I would like to think that moms who really need medical intervention can get it, and moms who don’t really need it aren’t pressured into having it, whether cesarean, induction, pain meds, fetal monitoring, IV, episiotomy etc. But often the definition of “really needing medical intervention” is the area of debate. There are some situations in birth, although rare, where doctors or midwives all agree are serious problems which require medical intervention. There are some situations where all doctors and midwives agree no medical intervention at all. But the majority of situations in birth fall into the grey area. Different caregivers disagree on the course of action.

The videos on One World Birth begin to bring to light some of the problems in maternity care and the solutions. The Revolution in Birth is one particularly interesting video. I love what they say about how improving maternity and the way mothers and babies are cared for during this important transition in life, will improve society as a whole.

“The topic of birth should not just be a topic for doctors, midwives or pregnant women. It should be a topic for all those interested in the future of humanity.”  – Michel Odent, MD

“Natural birth has become an endangered species. And we need to save it because the future physical, emotional, mental health and well-being of our culture depends on it.”  – Sarah Buckley, GP

I also quite liked the section “60 Sec Experts” where 3 doulas only have 60 seconds to answer common questions about childbirth –

How painful is childbirth?

How to relax during birth?

How do I know if breastfeeding is working properly?

Is a doula a midwife?

What’s the difference between braxton hicks and contractions?

Is it better to tear or be cut?

 

I’m looking forward to more videos on One World Birth. It will be interesting to see the development of the topics as the film makers travel around the world.

 

 

© copyright 2011 Kaurina Danu The Prenatal Journey