June 14, 2000
Volume 2, Issue 24
Midwifery Today E-News
“Pain In Childbirth”
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In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Labor pain
5) Drugs in Labour
6) Check It Out!
7) Question of the Week
8) Question of the Week Responses
9) For Coming E-News Themes
10) Switchboard

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1) Quote of the Week:

"Research is showing increasingly that the things that make the most difference to improving the outcome of labor are not technological advances, but feeling comfortable about the place in which you give birth and the human support you have at the time."

- Nicky Wesson

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2) The Art of Midwifery

Baby has never known sight, smell, touch, temperature regulation, hunger, voiding, or night and day as we know them. All baby's needs had been met on a constant basis before birth. Understanding this makes it easier to help baby adjust to its new environment. For example, babies like to be swaddled. Some also prefer motion (which explains why baby wakes up when an expectant mom lies down to rest!). Perfume and other strong smells can upset them. Reminding the new mother about these things may make her transition into motherhood a little easier.

- Rain Taylor, Midwifery Today Issue 41

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3) News Flashes

A randomized controlled open clinical trial of moxibustion treatment to acupoint BL 67 to promote the version of breech babies to vertex was undertaken in Women's Hospital in Jiangxi Province and Jiujiang Women's and children's Hospital in the People's Republic of China. Two hundred and sixty primigravidas with breech presentations at 32 weeks were randomized to the moxibustion group or to be given no treatment. By the end of two weeks of either daily treatment or twice daily treatment for 15 minutes on each side, 72.4 percent of the women in the daily treatment group and 81.4 percent in the twice a day treatment group had vertex babies. There were 47.7 percent vertex presentations in the control group.

- JAMA Nov. 11, 1998

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4) Labor Pain

Pain in labour is a normal physiological reaction; it is there for a reason. Unfortunately Westerners are reluctant to accept that it is normal and they do a lot to relieve it. In a normal labour, pain can be used in a positive manner. We react against the pain by tensing and fighting it. Labour pain is positive pain that will have a positive end--the baby. It is not the same kind of pain that suggests illness or problems. The pain of each contraction will not be experienced again when it passes; each pain is a step nearer to birth.

The midwife is there to help and support the woman through her labour and through the pain... Contractions build gradually and allow the body's natural endorphins to reach their peak and allow the mind to accept the pain as it increases. Pain changes with each stage of birth. In the first stage, pain needs to increase as the contractions increase to allow the physiology of labour to progress. In the second stage the pain is different, less intense, more expulsive. When the head crowns, pain is there to tell the woman to take it slowly, to gently birth her baby, to allow the perineum to stretch. In the third stage, the pain is there for her to know when to birth the placenta. If the woman is allowed to relax and is allowed to believe that her body can birth, she is more able to accept the pain.

We all find it difficult to see a woman in pain, even at normal levels. Each woman has different reactions to pain, so pain relief should be individualised and not a routine offer from a list.

Most pain relief does not take pain away as completely as the name suggests. It makes pain easier to accept and can help a woman relax and concentrate on the birth if it is used positively. Pain relief can come in many forms. A supportive, positive midwife who believes in a woman's ability to birth can be a great form of pain relief! A comfortable position, to be able to adopt that position, mobility, feeling supported--all can be pain relievers. The midwife does not have to resort to pharmacological forms of pain relief--they often lead to a cascade of intervention. We all know of births that are going well until the epidural is sited, the pain goes, the contractions are not felt, the woman does not know when her body wants to push. She needs to be told, she needs to be "helped," she needs further intervention. Pethidine does not relieve pain; it takes the woman away from her body, out of her control and into the control of others. Pain relief can make the labour ward more manageable--contact and support for women is not needed if they are quiet. Pharmacological pain relief has its place, but it should be used wisely. The pain of labour is there for a reason. We need to understand it and accept it, and not be afraid of it.

- Helen
U.K.

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A study on expectations of labor pain included postpartum women who had delivered single infants at term in one of two hospitals, one in the Netherlands and one in Iowa. Within 48 hours of delivery, they were asked about their prenatal expectations of pain in labor and measures available for pain relief, and then about their memory of labor pain, and whether or not they had received pain medication. The Iowa women were significantly younger than the Dutch women (mean age 24.7 as compared to 28.9 years). The number of primiparas in each population was similar (52.2% of the Iowa group and 45.5% of the Dutch). Of both groups, 12 to 13% had had their labor induced. Neonatal data were similar. The Iowa women, in general, expected labor to be more painful than did Dutch women, and anticipated more often that they would receive medication for labor pain. In virtually the same proportion as anticipated, the Iowa women did receive analgesia. By contrast, the Dutch women did not expect labor to be painful, tended not to anticipate receiving analgesia, and usually did not receive any. When asked retrospectively to assess the painfulness of labor, both groups gave similar responses, divided roughly equally among the choices "more painful, less painful, and about as expected."

- Obstetrics and Gynecology, April 1988

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..Around the turn of the century, many of the early feminists believed the pain and problems in labor were a direct result of the commonly held belief that the female body was inherently inferior to that of the male. They heard about Indian women who were giving birth painlessly and easily and believed that with the proper mindset, they could do the same. Childbirth, then, became a way for women to prove to themselves and others that women were strong and capable of determining their own fates. Elizabeth Cady Stanton wrote: "My girlhood was spent mostly in the open air. I early imbibed the idea that a girl is just as good as a boy, and I carried it out. I would walk five miles before breakfast, or ride 10 on horseback ... I wore my clothing sensibly. ... I never compressed my body. ... When my first four children were born, I suffered very little. I then made up my mind that it was totally unnecessary for me to suffer at all; so I dressed lightly, walked every day ... And took proper care of myself. I walked three miles. The child was born without a particle of pain."

- Laura Kaplan Shanley, Love is the Heart of Labor, Midwifery Today Issue 31

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5) Drugs in Labour (excerpt) by Beverley Beech

In the human being, the period of vulnerability to central nervous system damage from exposure to drugs and chemicals lasts a long time. Even after birth, important areas of the brain are still developing and differentiating at a very rapid rate, and because of this rapid period of growth they are maximally vulnerable to damage. It has been estimated for example that the brain growth spurt in the cerebellum lasts for eighteen months after birth and in the hippocampus for about four and a half years.

Some parts of the brain are fairly well developed at the time a human being is born, but other parts are not. Some parts, particularly the cerebellum, are very underdeveloped, and the introduction of toxic substances during this period of rapid development, even for a single acute administration, can either kill cells or cause aberrations in them. When cells proliferate in the cerebellum, that's not the end of it-they have to migrate into their final position and link up with other cells. Both the rate of cell death and the patterns of migration of cells in the cerebellum have been shown to be very sensitive to the introduction of toxic substances (Brackbrill, 1979). Desmond Bardon, a respected British psychiatrist, asked what prolonged exposure to maternally administered drugs means to the later neurologic development and behaviour of the offspring. Drug-induced biochemical alterations within the brain of the about to be born or newly born infant have the potential for permanently disrupting the normal link-up of the baby's brain cells by altering the biochemical markers which guide the cells into their proper places. It is somewhat analogous to the unintentional spilling of a chemical over telephone wires that are being connected according to the colour code at the end of each wire. The chemical removes the colour from the wire ends. The technician must continue to connect the wires, not knowing exactly which wires to connect with which. The circuitry is completed: it functions, but imperfectly.

While the process of cell migration is not yet fully understood, present knowledge of neurobiology suggests that the normal biochemical message left along the pathway of the neuron by the preceding cell (as it travels to its proper place within the central nervous system) serves to direct the next brain cell into place. Drug-induced changes in the biochemical message can disrupt this vital process. Could dyslexia be the result?

To read the entire article: www.midwiferytoday.com/articles/drugsinlabour.htm

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Read all about HypnoBirthing-a painless way to birth-in Midwifery Today Issue 55, due out in September! Respected author, midwife and educator Nancy Wainer Cohen talks about this highly effective way to alleviate pain in labor.

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6) Check It Out!

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A Web Site Update for E-News Readers

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7) Question of the Week

Q: What experience has anyone had of trisomy 18 (Edwards syndrome) in a natural birth, homebirth situation? This is what mum would prefer but has been told that possible complications may require a cesarean.

- L.T.

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Send your responses to mtensubmit@midwiferytoday.com

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8) Question of the Week Responses

Q: I'm currently 30 weeks pregnant with my third child. My first pregnancy was breech. I ended up with a c-section. My second pregnancy was vertex. I ended up with an unnecessary c-section after attempting a VBAC. This time, I am trying for VBAC with my third baby. I need your help about herbs [or other methods] to enable the baby to turn to head down. I have been using a lot of pelvic tilt, visualizations, etc. but my breech baby hasn't turned. Any suggestions or advice?

- Beth McGinnis

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There are a couple of safe ways to encourage a malpositioned baby to turn to a more favorable position. Chiropractic adjustments and craniosacral therapy can optimize the function of the body in general and pelvis in specific to allow the baby to comfortably assume the best position possible for birth ... Obviously, there are other reasons for babies turning breech and a baby with a short cord will stay persistently upside-down, but if pelvic torsions are playing a role, it is essential to address that torsion. ...As a chiropractor specializing in pregnant women and children, I have learned and used things that are often not part of an average chiropractor's care, and make a difference. When I have a mom come in with back pain, visible and palpable torsion in her uterus, spine and pelvis and am able to resolve that, what a wonderful thing for that birthing pair! Not only have we improved the "mechanical/structural" parameters of this labor and delivery, but we have improved the nerve function of mom's body as well, allowing her body to work more efficiently throughout labor and delivery.

Look for these signs in your mom: Is the posture unbalanced? shoulders, hips and ears appear uneven from the back. Does mom complain of back pain, sacral pain, pain in the top, insides of her thighs & groin? When you palpate the round ligaments on the uterus, do you feel one side spasmed? Or pain/tenderness in both? These are a few signs of an unbalanced pelvis and a baby who may be searching for a comfortable spot in a twisted uterus.
Dawn Bush, D.C.

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I am a doula and pregnancy massage therapist and have turned several babies at 32+ weeks by first of all giving the mom a full massage, special rocking technique that relaxes the whole body.

After that I go with my hands to mom's belly and touch the baby and talk to him/her mostly intuitively. I circle my hands over mom's belly (very important to get in touch with the position of the baby to know if you need to go clock wise or opposite direction). My experience is that most of the time I have to move counterclock wise.

I keep on rotating and talking to the baby and have the mother breathe deep and slow. The mother lies on her back with pillows under her legs and a towel rolled up under her side. The baby just slowly turns around. I have to say that I have plenty faith that this is exactly what is going to happen. Relaxation is the key in this experience ... The pelvic tilt exercises can only work if mom is totally relaxed and has faith that she makes space for baby to turn.

- Greta Sprenkeling
Also check: www.birthconnection.bizland.com
email consultation possible

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9) For Coming E-News Themes:

1. What about the "wife" in "midwife"? How do you maintain relationships with such a demanding career? (June 21 issue)

2. "Is the fact that midwives cut far fewer episiotomies than doctors important?" asks Marsden Wagner, M.D. in his Technology in Birth article ( www.midwiferytoday.com/articles/technologyinbirth.htm ), What do you think? (June 28 issue)

3. Premature rupture of membranes (PROM): what is your protocol? (July 5 issue)

**Take part in E-News! Sound Off-Give Advice-Share Your Knowledge!**

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10) Switchboard

Editor's Note: If you are sometimes receiving only one part of your E-News issue and you use AOL, call their number to complain! 888-346-3704.

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More on the subject of choice, the theme of Issue 2:22:

I am all for natural childbirth, breastfeeding, natural everything, but it's sad to me that those complaining about not having choices to do things naturally are the ones who want to cram their beliefs down someone else's throats! What makes them any different than the medical institution they are always bashing?

I am pregnant and ready to give birth to my 6th child. I have breastfed every one of them. I totally agree with everyone, that this is the best for any infant. But if you inform a woman about her "choices" and advise her about what is right, and she chooses not to breastfeed, then she must have a good reason. Maybe she knows she is not strong enough to eat the right way or take care of herself the way she should. I don't agree with this either; I think if you take on the responsibility of getting pregnant, then that child comes first from the first moment you realize you have conceived! Unfortunately I have seen mothers who I knew were substance abusers who still nursed their baby. Or some women just don't feel "comfortable" having a baby nurse from them--very sad, but I know it can cause extreme anxiety in some women. It might transmit to the baby, maybe cause resentment toward the baby on the mother's part, also affect milk flow, therefore affecting the overall mental and physical health of mother and child. I was not breastfed and I completely love my mother. I don't feel detached from her; I have not been a chronically sick person. I still feel breastfed is extremely better....

I don't understand women who complain they are not educated by the medical institutions about choices for their bodies. Isn't it up to us as adults to be responsible for educating ourselves instead of blaming it on someone else? I know that every time I get pregnant, I read another book and when I think there is nothing left to learn, I learn one more thing I didn't know the last time! I thought it humorous that someone knew a doctor who had a sign in his office that stated "Because we care about the health of you and your baby, this office does not allow Bradley classes, birth plans or doulas." Well, did someone handcuff the women who went to him and hold a gun to their head? Thank God this is America and they had the choice to turn around and go *find another doctor*! And if they didn't and chose to stay and be angry at him, then they are more ignorant than he is! ... whether you want to believe it or not, there are two sides to every story! Anybody who is interested in knowing, feel free to ask!

- Calista

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I believe that respecting birth choices that can result in injury or death for mother or baby is playing the enabler in the classic circle of abuse: one is not above the abuse; she is a part of it. For more about this, see "A Discourse Regarding Choice" at:
www.birthlove.com/pages/bl_cols/discourse.html

- Leilah McCracken

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Regarding the question about c-section and lingering pain [Issue 2:22]:

Get yourself checked out to rule out problems with your body in relation to the c-section. If there is no detectable problem, then consider this: There are major energy centers in the body; the one corresponding to the reproductive system is sometimes called the second chakra. Even natural childbirth can disrupt and weaken this center. If you are still experiencing pain, your body may be telling you that you need to focus on more healing BEFORE you do ANY kind of strengthening exercises. Chinese medicine and acupuncture can be very helpful, as can many other alternative modalities.

Remember that whole-body medicine is not one of allopathic medicine's strong suits. There are many ways to strengthen and heal your body. You know best how to heal your body once you know what all of the options are.

- Amber

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I used massage, first light, but after, deeper massage, preferably done by another loving person, while in a relaxation state. Self massage could be used, but it requires more muscular activity.

Use osteopathy, rolfing for broken scar tissues that could cause pain. Massage oil could be evening primrose oil, alone or mixed with another vegetable oil (almond, olive, etc.) directly on the scar. Vitamin E taken internally could be useful.

Do stretching exercises, relaxation, try to find emotional scar that can cause physical pain.

- marypascal beauregard
c-sec mother of 2

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I LOVED [Lois Wilson's] article! [Issue 2:23] I am a childbirth educator, strongly in favor of not telling women when "it's time." In class, someone inevitably asks "How do you know when you're in second stage?" or "How do you know it's time to push?" and I get to get on my soap box! I had one hospital birth with an epidural and I was told "it's time" when I got to 10 cm. But I was so deadened I couldn't push at all. I asked for more time and for the drugs to be turned off. Two hours later I was still deadened, but the nurse insisted I try again. I pushed for 2-1/2 hours more and was thoroughly exhausted by the end. I'm still surprised I wasn't sectioned.

Because of the myriad things I didn't like about that first birth experience, I became a CCE and have had two subsequent homebirths. Never once was I checked and told "it's time" (nor "it's not time"). In fact, I haven't had a vaginal exam (VE) in labor since my first birth! And guess what, both those home-born babies were born in less than 30 minutes from the first urge to push!

I teach my students to listen to their bodies and push when they feel ready. I warn them about the issues that may arise if they have a VE and tell them to think carefully about what they will do with the information they get from that exam. As long as baby is doing OK, do they really need to know? Or can they trust their bodies to tell them when "it's time"?

I also make a point of telling my students (most are giving birth in the hospital and need empowering resources even if they don't have a natural birth) that if they have an epidural and they can't feel their urge to push, then they should ask "What station is the baby at?" Since the urge to push typically occurs around +2 to +3, pushing prior to that can be a big waste of time and energy (unless of course there seems to be a medical reason to hurry the birth). And once pushing starts, at least in my area, there's often a time clock that starts ticking, and anything over 2-1/2 hours of pushing is almost a certain vacuum or cesarean. I'm all in favor of the practice of leaving women to their own instincts until real pushing begins. There's nothing like it. It's the most powerful part of birth, the most transforming, the most creative. I hate to see anyone get in the way of that awesome process. But I love to see a woman doing HER thing, birthing HER way, and feeling so energized afterward!

- Marci O'Daffer, CCE

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I found the responses regarding anterior lips [Issue 2-23] interesting. My first 3 labors included such lips. In each case my midwives were able to push it out of the way and my babies were born soon after, despite my lack of urge to push. I began to think of this as just a normal part of the way I labor. It was only after the birth of my third baby that my mother began to share the details of my own birth. She was a single teen mother, alone, frightened and in pain. She was treated horribly by the hospital staff but her labor progressed quickly. The doctor was not yet present when she felt the overwhelming need to push. A particularly brutal nurse yelled at her to stop pushing until the doctor arrived. When she continued to push, uncontrollably, the nurse crossed my mother's legs and laid across them, all the while yelling at my screaming mother to "shut up!" and to stop pushing. I could see the pain on my mother's face as she relived this experience. She had never wanted me to think that the day I was born had been anything but the most incredible day of her life!

Talking through it, though, cleared up some very powerful body memory within me. I believe the experience of birth had been ingrained upon me. Pushing had been interpreted as something bad that needed to be stalled or avoided, hence the lip and lack of pushing urge. Once I made that distinction, I was never again troubled by another lip and did gather some degree of pushing urge, albeit not incredibly strong, with my last two babies.

- Valeri Webber

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Regarding the woman who had a headache for 48 hours in early pregnancy [Issue 2:22]:
While it is useful for a woman to examine her history to see if there are obvious triggers for her headaches, pregnancy can be, and often is, the first time a woman experiences migraines due to hormonal reasons. It may not be anything requiring self-examination but rather, understanding from those around the pregnant woman.

- L.H.

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Having a headache for two days straight could very easily be structural. Has she been to a chiropractor? Try to seek out a chiropractor trained in applied kinesiology.

- Michelle Galyardt

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Two Sign Language Interpreters Needed for Midwifery Today's International Conference

Are you proficient in American Sign Language and are you involved in midwifery? FREE ATTENDANCE at Midwifery Today's international conference in New York City, Sept. 6-10, 2000 in exchange for being available all day, Sept. 6-9 (Wed.-Sat.). E-mail conference@midwiferytoday.com or phone Karen at 1-800-743-0974.

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Any suggestions for a birth enthusiast just getting started? I am 22 with no children, attempting to plan an education in midwifery. Any "If I only knew then what I know nows?" I want to relocate to where I can get the perfect education {preferably with great weather}. Where should I begin? What do you wish you learned about right away?
Reply to: rainblurb@hotmail.com

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"Paths to Becoming a Midwife: Getting an Education," compiled, edited and published by Midwifery Today, Inc., can help you fully understand what midwifery is, what kinds of midwifery are practiced in the US and the kinds of education and training each path requires. It lists and describes resources, schools, programs, standards; it charts programs and the state by state legal status of midwifery; and it includes a comprehensive chart of midwifery schools and programs. No other book has ever been published that can give you all the answers about how and why to become a midwife, from the philosophies to the realities to the training.

To learn more: www.midwiferytoday.com/books/paths.htm

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