Sphincter Law – Part 2

doula at work

Sphincters May Close Suddenly if the Owner is Frightened

The sudden contraction of the Sphincters is a fear-based reaction, as a part of the fight-or-flight response of adrenals. The Adrenaline/catecholamine level will rise in the bloodstream when frightened or angered.

If a female animal in the wild is in process of birth, the birth process will reverse if the animal is startled by a surprise encounter with a predator. Humans can do the same thing.

In her book, Ina May’s Guide to Childbirth, Ina describes a situation where during labor a woman developed a fever; soon it became apparent that there was a bladder infection. She was seven centimeters dilated, but stalled in labor. So Ina chose to transport her to a hospital.

The laboring woman was examined by a doctor that was rough…who stated she was only 4 centimeters. Her dilation retracted from 7 to 4 centimeters as an automatic response to the roughly-handled internal exam…a natural self-protection, evidence of the function of the sphincter function.

What Helps the Sphincters?

• Trust, comfort, familiarity and safety
• Laughter
• Slow and deep [abdominal] breathing
• Immersion in warm water which calms and relaxes
• Relaxation of the mouth and jaw
o Relax the throat and jaw by singing
o Release an audible low moaning sound (similar to the sounds of lovemaking)
o “horse-lips” similar to the tone that horses make when they make that sound with their lips flapping, or “raspberry” sound.
• Relaxed labor supporters

~This information was taken from Ina May’s Guide to Childbirth. Ina May is an internationally known Midwife, who has delivered babies and written books on Midwifery and natural childbirth. She works at THE FARM, in Tennessee.

Advertisements

Pain in Childbirth – Part 1

father in delivery room
Biological Purpose of Pain

The human body responds to pain with either the response to flee, or the response to stand and fight. Some responses are automatic, such as the immediate withdrawal of the hand when burned accidently. External pains can be avoided.

But, what is known as visceral (ves-er-al) pain cannot be escaped. These are ones from the internal organs, and the uterus is an internal organ. This is in the case of normal and natural function, not a diseased state.

Extreme hunger or excessive thirst are due to physiological imbalance. These can be painful, but satiated by eating and drinking.

How Pain is Felt

On the body surface and on the outside of various organs are nerve endings. These were heightened during man’s primitive days, as sensors when man was attacked by creatures with tooth and claw. Certain exterior areas are very sensitive such as the neck, under the arms, abdomen, and chest.

The internal organs also have receptors, but only register with pain mechanisms when the external area is severely injured. The interesting thing is “the intestines and uterus can be burnt, cauterized, handled and moved without any sensation of discomfort to the patient,…(34)”. But if either has been torn or stretched the receptors respond with pain. The question we have to ask is why only during birth is the sensation of pain felt…a normal function.

The nerves send the information to the part of the brain called the thalamus. Here the intensity of the pain is interpreted. Then they are sent to the outer cortex of the brain to be balanced and qualified. The response to the messages from the Thalamus would be dependent upon the magnitude of the message by the Thalamus. The strongest response is fear, which brings about the most motor responses.

The thing to emphasize here is that this response is recognized in the normal and uncomplicated labor. The degree of neuro-response mechanism is determined by the state of the particular woman who has the pain. One may get a sense of total agony, and feel she is in great discomfort. While another woman may sense that it is not intense agonizing pain. It depends on the mental state of the person.

For the woman in birth the first time, the pain sensation will cause tension. This tension sets the stage for a flight reaction, that causes the uterine muscles that are circumventing the lower portion of the uterus to tighten. The longitudinal muscles are then constricted.
It is the longitudinal muscles that work to assist the fetus to be expelled at birth. The circulatory muscular portion of the uterus causes the longitudinal muscles to struggle in the effort to dilate the cervix. They work in opposition rendering the lower portion of the uterus and outlet resistant to dilation. The two opposite reactions in the muscular structure is then interpreted by the brain as pain.

Therefore, the fear OF pain produces ACTUAL pain.

We are so conditioned to believe that childbirth must be painful. Even Hollywood’s depiction is of childbirth as a painful ordeal, showing women screaming in agony.
It does not have to be this way…

Pain in any other part of the body at any other time is an indicator or “alarm” that something is not right. In labor it is also…an indicator that you need to RELAX.

Pain in labor releases a hormone that inhibits labor.

The Vocabulary of Pain

 

father in delivery room

The following information was written in order to understand pain in childbirth. This is a preliminary to understanding what your body senses when in labor.

Pain Threshold

The definition is “the point in which an individual first perceives the presence of pain”. This could be when ice or heat no longer is affective for blocking and / or reducing pain.
Each person has their own threshold. It is thought that threshold remains the same throughout ones life. But, Childbirth educators have found that the threshold is quite flexible. It is found that when comfort measures are used that effectively reduce pain or make it easier to bear, and the woman is distracted from her comfort measures, then the comfort measures no longer are useful. It will take a stronger stimulus to then break through the pain. Nothing had changed in the strength of the pain itself, “rather, her distraction reduced her pain threshold so that less pain was necessary in order for her to notice it (162)”.

Intensity
Intensity is defined as “the quantitative measure of how strong or severe the pain is (Ibid.)”. The usual measurement is a scale of 0 to 10. O being no pain, and 10 meaning that the pain is out of control.

Character
Character is a qualitative measure, using verbal or pictorial descriptors and analogies. Pain character may be described as burning, aching, tearing, or sharp like a knife. Character is the most important aspect to consider when managing pain.

Duration
Concerning when pain is first noted, and how long it lasts, and whether it is a steady pain or sporatic. It is particularly significant in that smaller diameter nerve fibers may, after repetitive signals become more responsive to pain signals. Many management strategies that are not pharmaceutical focus on the larger nerve fibers, which respond well.

Location
It is where the pain is perceived in the body. Depending on the location, the distress level may rise and start to interfere with eating, breathing, sleep, concentration, or the ability to otherwise function normally. If she is unable to concentrate due to location or any other aspect of the pain, she will be less able to use the pain management strategies she has learned.

Sensation Threshold
It is the point where the stimulus was first perceived. When reached, it is when the client first is aware of itching, cold, pressure, pain, or any other sensation. Of these, pain is the most important in that it could signify potential or actual tearing. Other sensations that may later become concerning may eventually grow strong enough to be perceived as pain.

Pain Tolerance
Defined as the greatest severity of painful stimulation an individual is able or is willing to tolerate. “Encouraged Tolerance” is the highest level of pain a person will tolerate when encouraged to try to tolerate more”. It serves a purpose, but not for women in labor as it may lower the tolerance to pain. It actually would translate to suffering rather than just pain.

Categories of Pain

Cutaneous
Occurs at the dermal level, and is sharp, localized, and generally tonic. An example would be the prick of the needle when given an injection.

Visceral
Occurring at the organ level, could be sharp or dull. There is less localization and could either be tonic or episodic. Examples: uterine contractions, severe constipation, and intestinal gas.

Somatic
It occurs at the soft tissue level. It is dull, aching, not localized and usually tonic.

Nerve Compression
The pain results from pressure on one or more nerves. It may be localized, or be referred pain to one or more regions of the body.

Stress, Part 3

Stress

stress

Stress and Pregnancy

This is a huge transitional period for the family unit, and usually characterized as stressful. Due to new roles to learn, adjustments within the family unit, communication patterns are re-established. These shifts may trigger biologic changes, hormonal function shifts, and immune system vulnerability.

The whole family unit is thrown off it equilibrium due to restructure of family roles, adjustments to family goals, physical and emotional changes that pregnancy may bring. This is the case for the average and normal situation and pregnancy. What about other circumstances or high risk pregnancy?

If the pregnancy is from an already stressful situation such as a rape or domestic violence has occurred, the stressor of pregnancy brings additional problems. Decisions need to be made to assist the mother, if other children are involved, their safety attended to.

In high risk pregnancy situation, stress is further aggravated if hospitalization is required. “High risk” is a label given to those whom the health of the baby or mother to be is threatened.

The pregnant mother’s ability to adjust and or adapt to the situation may be in jeopardy by the excessive level of stress. The mother must understand the causative factors in being labeled high risk and accept the situation in order to have a good outcome. As well as the pregnant mother, all other family members need to assess, accept, and readjust to this prognosis.

Unfortunately, pregnancy on the reservation is almost always considered high risk. This is due to poverty, gang activity, teenage pregnancy, alcohol consumption and drug abuse.

Only YOU can change this! Change the additional stressors in your life, and then you can change the outcome of your pregnancy and delivery!

Stress

About Stress

stress

There are two types: the type that is good, making you feel satisfaction and happiness. And there is negative, which leads to fatigue and possibly, illness.

There is no singular thing to point to as a cause of the latter. But, what is known about it is that the body makes biochemical changes when it is present.

GAS or General Adaptation Syndrome, has three stages. These stages are: alarm, resistance, and exhaustion. In the alarm stage the quick initial response is lowered blood pressure and tachycardia. This is in preparation for the fight or flight response to continued stress. The body will continue to increase its production of adrenocortico-tropic hormones. Along with this is increasing heart rate and elevation in blood pressure.

If the condition becomes prolonged, to the point where the adaptation of the body is too great, vulnerability of the body occurs…and exhaustion. The body is not designed to stay in a heightened state of arousal.

If continued, the sympathetic nervous system becomes activated with vasoconstricted blood vessels, increasing blood pressure, increasing heart rate, and the secretion of adrenaline. The immune system will then become suppressed and the increasing cortisol will cause cholesterol and other lipids in the blood to increase at the same time.

Situations or “agents” that cause stress are called STRESSORS. These may include physical things such as heat, exertion, trauma, infection, or cold. Or it may be from psychological reasons such as fear, anxiety, or disappointment. Stress may be caused by external things. Examples may include poverty, inadequate housing, and certain life events.

Factors altering stress responses are called mediators. The MEDIATORS may be genetics, developmental factors, experience, and social context. Some people appear to be more resilient and cope better with stress, while others seem to be more vulnerable.

Water Birth – Part 2

THE USE OF WATER FOR LABOR

Water Birth Tub-from"Birth Pool in a Box"

Water Birth Tub-from”Birth Pool in a Box”

Some suggestions for labor:

• The temperature should be body temperature
or slightly lower.
• Be equipped with an efficient pump, heater, and
a thermostat.
• A thermometer and large plastic strainer to
clear the water.
• At least 2 feet deep, to cover the abdomen when
she is doing squats or is kneeling. In order to
encourage the “freestyle movement” it should
be a pool that is at least 5 ½ feet wide.
• Optimum time: during active labor (5-8
centimeters in dilation).
• When having back labor, get into the water. The water relaxes and acts as a counter-pressure.
• If you have previously had an active labor and then stalls once in the water, get out of the pool
and move: squat, kneel. Walk, sway hips.
• Or if the labor is stalled, get into the pool, sometimes it’s just the relaxation you need to get
things started again.

It is safe to use the pool once your membranes have ruptured. Birthing centers with experience using the pool have not had any increase in infections reported.

Don’t expect all pain sensation to cease. It will decrease the pain, but does not make it completely go away. Often it’s how you move in the water, not just the pool of water.

An advantage of using the water pool for labor in the hospital is that you can really feel a sense of privacy, allowing space to sink into your own intuitive self for labor. Anxiety and blood pressure both are lowered when in the water. The stressors of hospital atmosphere is diminished, lowering the catecholamine (stress hormones) and “the secretion of endorphins” which are the relaxants that you body naturally produces, and the hormones that produce pain relief.

WATER FOR BIRTHING

Water birth is perfectly safe.

Sears & Sears state “The school of water-birthing that practices slow emergence (baby is left under the water, SIC) can be dangerous (156).” They use the example of water mammals that birth in the water, and how these mammals assist the newly born immediately to the surface.

An additional need when doing a water birth, is some salt. Adding salt allows for the pool water to have the same salinity as the amniotic fluid of the womb. The amount necessary is a generous tablespoon of salt. Before filling the pool be sure it is cleaned with mild disinfectant, and rinsed, “unless disposable liners are provided to contain the water (Balaskas, 208)”.

If your membranes break while in the water, there is no need to change the water. The amniotic fluids and “bloody show” are both sterile.

During birth in the water, the relaxation of the sphincter muscles may cause some fecal matter to be excreted. This is when that suggested plastic strainer comes in handy. There is no “evidence to show that it contaminates the water sufficiently to contribute any risk of infection (Balaskas, 212)”
You can kneel on all fours, squat, or be in a semi-sitting position to birth. Your partner can be in the pool with you or sitting just outside the pool.

Once the baby is born, the attendant (doctor or midwife) check to be sure the cord is not around the baby’s neck, and unravel the cord if it is. The baby may float to the surface on its own, or you may gently guide the baby to the surface.

Breathing will not occur until the baby emerges to the air, the coolness of the air causing the reaction to breathe. Occasionally the baby may need suctioning to clear the air passages. The cord has not been cut yet, so there are dual sources of oxygen. “In the rare circumstance that the baby doesn’t breathe, it is wise to take baby gently out of the pool into a cooler atmosphere. This will trigger the breathing reflex (Balaskas, 214)”. If necessary oxygen can be administered.

The baby can be held in the water, at breast level. It is best to sit or kneel in a vertical position. The rooting reflex will be strong, so turn the baby to face you, yours and baby’s bellies facing, to make breastfeeding easier.

You can stay safely in the water until the placenta is expelled, which generally takes place 10 -20 minutes later. Pay attention to the cord, if the pulse decreases it means the placenta is about to be expelled. The baby can be handed to the partner, and you can stand up slowly and leave the pool. If the expulsion occurs sooner and you feel the placenta released from the body, you can still stand up slowly once you have realized it, the cord can be cut before leaving the pool.

The persons you have present to assist the birth can cover you and baby as you leave the pool. It would be important at this time to have the temperature raised in the room. If you had not expelled the placenta before leaving the pool, you can stand or squat at this juncture to deliver the placenta. Then sit upright and enjoy your baby with comfortable warm coverings.

At this point, the midwife or doctor will check both you and the baby. After their examination, you can go to your bed and “…relax with your baby tucked warmly beside you (Balaskas, 215),…”.

 

REFERENCES

Balaskas,Janet. Active Birth: the new approach to giving birth naturally, Rev. (1992) The Harvard Common Press
Sears, William and Martha Sears. The Birth Book: everything you need to know to have a safe and satisfying birth. (1994) Little, Brown and Company.

Positions for Labor-Part 2

POSITIONS FOR LABOR – PART 2

Variations of the Squat

The Supported Squat

birthing• Your partner sits or squats behind you, toboggan-like style with back against the wall or bed, or using a chair for support
• Or your partner can be in front, doing a squat, and hold your hands for balance.
Standing Supported Squat
• As you relax down into the squat, take the weight off your feet and melt into the arms and against the body of your partner.
• In this position your body will tell your mind to relax
• You then surrender your mind and body to your labor
Dangle Support Squat
• Your partner supports from behind, or two people supporting you (one on each side) helping in supporting you in the squat position.

Kneeling

image004This position is a natural extension of the squat position when the labor is too intense.

• Kneel on the floor with a pillow
• Lean against a chair
• Or get on all fours
o especially good for back labor
o to try and turn a posterior positioned baby
o or if your labor is accelerating and seems unmanageable.

Kneel-Squat Position

• Kneel with one knee while squatting with the other leg.
• Alternate between legs, or you can do a rocking and swaying motion.
Knee-Chest Position
• Your knees are on the floor, while your head and arms are on a pillow
o Slows overly intense contractions
o Counteracts an urge to push when your cervix is not fully ripened.

Sitting

CHAIR STRADDLE• Sit straddled over a low stool, toilet seat, chair or birthing bed angled like a seat
• The best of these is the sit-squat over a low stool, for the same reasons as the plain old squat position

 

Side-Lying

SIDE-LYING• Does NOT use GRAVITY in the same manner as the SQUAT.
• Best on the left side, to prevent the uterus from compressing major blood vessels that run along the right side of the backbone
• It provides a way to labor without pressure of the uterus on the back, and allows for some sleep in a long labor.
• Use pillows for your head, and pillows under the knee of the right leg, and support pillows behind your back.
o It allows you to quickly roll into the kneel or up into a squat
o Once the contraction is done you can roll back into your nest of pillows.

 

*Images from The Birth Book, Sears & Sears (1994) and internet birthing images/stock photos*

REFERENCES:

Balaskas, Janet. Active Birth: the new approach to giving birth naturally, rev. (1992) Harvard Common Press.

Dick-Read, Grantly. Childbirth Without Fear: principles and practice of natural childbirth, 2nd ed. (2013) Pinter & Marition.

Sears, William and Martha Sears. The Birth Book: everything you need to know to have a safe and satisfying birth. (1994) Little, Brown and Company.

Water Birth – Part 1

WATER BIRTH

Water Birth Tub-from"Birth Pool in a Box"

Water Birth Tub-from”Birth Pool in a Box”

In the 1960s Russia began using the Water Birth technique, and Michel Odent (a French Obstetrician) studied its use to benefit the process of birthing in the seventies and eighties. Odent shared what was discovered in the book Birth Reborn. Until the 1990s, the United States still did not use the method even though it had gained world-wide respectability.

WHY IT WORKS

Water relieves pain during labor because of “the law of buoyancy” also known as Archimedes principle. It says that when an object is placed in water, it will displace a volume of water in equivalence to its own weight.

A pregnant women feels an almost weightlessness when she is in the water which supports muscles and bones. This allows for the uterus to spare its energy. As the muscles of the abdomen, thighs and back relax…so will the birth passage.

More depth the mother has in the pool, the greater effect of weightlessness. This is especially good for back labor. As the muscles of the back relax, the internal tissues will also. It then will allow baby to maneuver, especially if positioned in the posterior direction.

Stress and anxiety causes the release of the stress hormones, which may not be the best idea for both baby and mother during labor. Stress hormones in the effort to protect will move the blood from non-vital areas of the body, which includes the uterus (considered by the natural hormonal reactions as a non-vital organ). Without the full flow of blood the uterus, the baby becomes oxygen deprived.

Water also “tricks the pain sensing system (Sears & Sears,153).” When the body of the pregnant woman is immersed it acts like a continuing body massage, and the temperature and touch-sensitive nerve receptors of the skin are stimulated. This process floods the nervous system with “pleasant sensations, virtually gridlocking the gate to painful stimuli (Ibid.)”.

WHAT THE RESEARCH SHOWS

In The Birth Book, Sears & Sears state that from 1985 to 1995 about 18,800 women used a Jacuzzi like pool at a birthing center in Upland, California. Dr. Rosenthal, the director and obstetrician stated that the women had almost always experienced shorter / easier labors, and had 1/3 the cesarean section than hospitals.

Other benefits experienced:

• Another birthing center used water birth for VBAC and had 87.5 success rate.
• Mothers labeled “high risk” because of high blood pressure which had reduced dramatically within a few moments after submersing in the pool.

Optimal Fetal Positioning

OPTIMAL FETAL POSITIONING

anterior posterior

The Anterior Position is the optimal position for birth. The head of the fetus is more round. When entering the birth canal, the crown of the head presents first, molding to the birth canal and opening more readily.

With a Posterior Position, the head is more oval. Unlike the presentation of just the crown of the fetus, the baby’s head is not as moldable. The head will have more difficulty moving into and through the birth canal.

If the baby is in the Posterior Position, see if your support person can assist you to move the baby into LEFT Occiput position by using the Rebozo, forward leaning inversion (discussed in another handout), or have a Chiropractor do a pelvic adjustment (Jamie Zenner, specializes in this area).

The ROT (Right Occiput Transverse) position is a common position the fetus would be lying prior to the onset of labor. During birth, the fetus is most likely to rotate to Posterior Position rather than Anterior Position. The chin is usually flexed upwards, presenting first (See D, below).

Cranial Flexion

With LOP (Left Occiput Posterior) position the fetus’ back is lying opposite the mother’s liver. This position may allow the fetus to flex or curl his/her back, to tuck the chin. This would allow for an easier birth.

fetal position in relationship to the pelvis

The illustration above shows the various acronyms for the lie of a fetus, where the face of the fetus is turned towards. This will assist you in understanding what your doctor is telling you about the position of the fetus in your womb.Nearly half of the babies start out as breech babies, but turn on their own at around 34 weeks. 3 to 4 % still remain breech in presentation.

Doctors can do a maneuver to turn the baby called External Inversion. 60% of the babies will turn, but some revert back to breech presentation. Doing this maneuver may cause a premature birth.

There things that a pregnant woman can do for a breech baby without the external inversion:

  1.  Use an ironing board lain against the couch and lie with head towards the ground
    i. Be sure to use cushioning for the body, and a pillow for the head
    ii. Do this 3X a day for 20 minutes
  2. Another way is to lean forward, on your knees, butt up/head down resting on arms
    i. Do for 10 minutes, 3X a day.
    ii. Think of it ( and mentally “couch” your baby) as the position you would like to have your baby in birth
  3. Do not do either of these exercises if baby is head down, and posterior (without consulting your labor support person).

    Do not do either of these exercises if baby is head down, and posterior (without consulting your labor support person).

    If after reaching 37 weeks and these techniques have failed, try:

    1. Chiropractic Webster Maneuver with pubic symphysis aligning (see: Resource Page or class hand-out for local chiropractors)
    2. Craniosacral Therapy and Myofascial Release

How To Have a Normal Vaginal Birth

HOW TO HAVE A NORMAL VAGINAL BIRTH

baby-loading-tshirtEat Well During Pregnancy (See the post: Pregnancy Diet or Teen Pregnancy & Nutrition)

Exercise Regularly During Pregnancy (See up-coming post: Exercise during pregnancy)

Seek out the company of Other Women:

• A woman in labor needs other women or a woman to give support
• This was the old traditional way with Lakota women, as well as many other cultures!
• We learn about giving birth and about breastfeeding when in the company of other women.

Stay Home During Early Labor:

  • Early labor is not “true” labor.
  • It is what assists the thinning of the cervix in preparation for labor
  • Often it starts and stops
  • This is when you should rest
  • Your body is getting you ready for birth
  • Look at the length of the contraction itself, not the distance between each one. This will be your true indicator.
  • When you sense the early signs of excitement and nervousness, you are not ready
  • When you are concentrating and seriously working with your contractions is the second sign, but you are still not ready.
  • It is when you have been in the emotional space of the last sign, and feel aggravated when made to move…now you are getting into “real” labor.

This is IMPORTANT:

Turn your FOCUS INWARD and TRUST YOUR INSTINCTS!

  • Think comfort: Use pillows to cradle your body when resting
  • Dr. Odent states that the warm baths assists in the highest level of relaxation
  • Use soft music
  • Lower the lighting in the room
  • Walk, Rock or Sway, Dance, Squat, kneel and rock (especially for back labor)
  • There is no need to RUSH to the hospital!Final Stage / Delivery

    • Upright positioning is best for delivery of a baby. It uses gravity to assist the baby in birth.
    • If you cannot do an upright position, see if you can use a squat or kneeling position (have someone assist you)
    • Trust your body
    • See POSTS for pain management if you need to.