Pain in Childbirth – Part 2

father in delivery room

What contributes to PAIN in labor?

Fatigue

Muscles that are stretched, hurt. The muscles of the uterus work faster, the blood and oxygen flow is lessened. When there is tension, the uterus works even harder and fatigue sets in. The tension of the surrounding muscles has created a “brick wall”. So, relax.

Tension

The stretching of the lower uterine portion and the intense contractions of the upper uterine muscle are what is thought to be the source of the pain felt. But these muscles actually have very few pain receptors. You would not feel the pain unless the muscles were forced to work in an unnatural manner. If tense and fearful the nerve endings of the muscles and tissues around the uterus send messages to the pain receptors. There is a direct correlation of tension to pain.

Tired muscles

The biochemistry of the muscle is imbalance when tired. It creates tension that sends out more electrical activity. The physiological changes will lower the point at which the muscle will hurt.

The outlet is too small, or baby too big

These actually do not need to be an issue. Usually the position of the baby or laboring mother, are the causative factor of pain. The pain messages are signaling that something isn’t right. What will help is a change of position of the mother.

Get out of the horizontal position, to a vertical one, and things will change. The baby is assisted (most of the time) to re-position him/or herself in the womb to facilitate birth without as much pain. As stated in a different hand-out, just doing this type of change in position opens the outlet by 20%.

Fear

Information is out there on all the things that “can go wrong”. We are not taught that birthing is a natural process; we women are pummeled with media and other females telling horror stories about birth.

There is a shroud over the whole process of birth, making it seem to be a great mystery. What is needed is correct information.

Your uterus is a magnificent muscle which is affected by the neuro-hormonal pathway that connects the brain, the circulatory system and the uterus. Fear causes an alteration of the pathway creating a reduction of blood and oxygen to the brain. This results in the tightening of the cervical opening of the womb.

Fear unbalances the hormones of the body. Being fearful causes the release of labor inhibiting hormones. These are the stress hormones of the adrenal glands that when in stress, we release hormones that are the fight-or-flight mechanisms. Animals also have them, and the hormones are released to stop labor allowing them to find a safe place for birthing. These then block the labor enhancing hormones . This lengthens the labor and increases the pain felt.

A well-informed, correct education about birthing will assist you. Make sure your labor supporters also have been educated so that their fear is not surrounding you when you are in labor.

Occasionally, the sensation of pain will continue, even after all the relaxation techniques are implemented. This may be due to a tightened psoas muscle or mal-aligned hip. Both can cause tension in the body, and / or problems with the baby being delivered easily. These two issues can be checked, and remedied.

The Natural Pain relieving Narcotic: Endorphins

“Circulating throughout the body are natural hormones that relax you when stressed and relieve pain when you hurt (138)”

What is sad is that most women do not know about these hormones, or that they can activate them when needed. In the 1970s studies were being done for drug addiction and the presence of these hormones in the receptor sites of the brain (for morphine-like substances). What was found was that the nerve cells that are attached to receptor sites, had chemical pain relievers that acted to dull the sensation of pain in the cells. Here is how they can work for you:

As you probably know, Endorphins are raised during exercise and well, labor is strenuous exercise!

  • When the abdomen contracts in labor, the Endorphin level is raised.
    o This is especially true in the second stage of labor.
    o They are the highest after labor, and two weeks beyond.
    Endorphins are highest during vaginal birth, not so much when labor was started but delivery was cesarean.
  • Endorphins are higher in newborns that had signs of fetal distress during their delivery.
    o Baby also receives Endorphins during birth.
  • The release of Endorphins also will stimulate the production of prolactin, the hormone that relaxes and creates the “mothering” sensation.
    o Prolactin regulates milk production, which boosts the interaction with baby and mother.
    o These hormones are what researchers think are the cause of the “birth high”.
  • Mothers who had surgical birth have lowered hormone levels, which would account for the delay in milk supply after cesarean birth.
  • Endorphin production is directly tied to a person’s emotional state.
    o So if stress and anxiety are not resolved the body increases the stress hormones, Catecholamines, which counteract the relaxation produced by Endorphins.
    o Like commercial narcotics, Endorphins may behave differently woman to woman, which is why some women may feel more pain than others.
  • Injectable narcotics give you a bit of blast of pain relief, whereas Endorphins give you a steady dose throughout labor.

Women in labor are very aware of the natural hormone effects and describe the experience as a “natural high”.

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.

Prenatal Vitamins

PRENATAL VITAMINS

2013-03-combo[The image to the left is not an endorsement of the brand, but illustrative of a typical type of package prenatal vitamins may come in]

There is an ongoing argument about the use of vitamin supplementation whether you are pregnant or not. I would say weigh out the pros and cons of the argument.

From my nutrition studies, I learned that even when we eat very well, our bodies will often not absorb all the nutrients within the food. The cause of this can be the natural digestive make-up of the body or a particular health issue we may have. This would hold true, even if we were to eat the best of natural and organic foods.

Unfortunately, most of the American populous chose to eat lousy diets. We also do not exercise properly, nor drink enough plain old water. But, during pregnancy it is important to make sure you eat well, and that your diet is full of pure natural and organic foods.

Even with a great diet, supplementation may be a wise choice. Doctors will recommend a prenatal vitamin supplement, so be sure it contains the nutrients you need.

Look for a prenatal vitamin that includes :

• 400 micrograms (mcg) of folic acid.
• 400 IU of vitamin D.
• 200 to 300 milligrams (mg) of calcium.
• 70 mg of vitamin C.
• 3 mg of thiamine.
• 2 mg of riboflavin.
• 20 mg of niacin.
• 6 mcg of vitamin B12.
• 10 mg of vitamin E.
• 15 mg of zinc.
• 17 mg of iron.

“Keep in mind that it is possible to jeopardize your baby’s (or your own) health by taking inappropriate amounts of synthetic vitamins, so be sure your health care provider is aware of any supplements you are taking (American Pregnancy. Org).” Notice this quote discusses “synthetic vitamins”? I would recommend prenatal vitamins that are sourced from natural or organic nutrients, not a synthetic vitamin.

As with herbs containing multiple nutrients and constituents within its structure, a range of nutrients comprise the whole of the vitamin you glean from food. The same could be said of a natural or organic nutrient used in the production of a multi-vitamin.

Be sure your diet is balanced and contains the nutrients you need for good health. See my hand-outs on nutrition for the information about a healthy diet during pregnancy. “Getting your nutrients from food is generally the best route. Foods contain other compounds your body needs — such as fiber — that supplements don’t provide.

You shouldn’t use a supplement to correct a poor diet, but rather to supplement a good one (Pari-Keener)” I would liken this concept to building a house. If built on a good foundation (proper whole foods diet) an addition built onto the house, will stand a long time (supplemental vitamins/Prenatal vitamin intake = healthier baby).

Some women may experience nausea, irritated stomachs, and constipation from prenatal vitamin use. If the vitamins are taken properly, and you are eating a good diet, the effects will be greatly reduced.

Prenatal Vitamin Warnings

• Tell your doctor about unusual or allergic reactions you have had to any medications, especially to any vitamin, mineral, or iron products.
• Be sure to tell your doctor if you have ever had bone disease, liver disease, kidney disease, or stomach ulcers.
• Because prenatal vitamins may mask the symptoms of pernicious anemia, they should be used only under a doctor’s supervision.
from How Stuff Works

REFERENCES:

Consumers Guide, Eds. Prenatal Vitamins. How Stuff Works. http://health.howstuffworks.com
/wellness/food-nutrition/vitamin-supplements/define-prenatal-vitamins.htm

Maria Pari-Keener, MS, RD. (n.d.) Prenatal Vitamins Best from Food or Supplements. http://www.parents.com/pregnancy/my-body/prenatal-vitamins/

Pregnancy and Prenatal Vitamins. WebMD. http://www.webmd.com/baby/guide/prenatal-vitamins (2012). Reviewed by Trina Pagano, MD. 5-29-14

Prenatal Vitamins. American Pregnancy Association. http://americanpregnancy.org/pregnancyhealth/prenatalvitamins.html

Diapers vs. Disposables

Cloth Diapers vs. Disposables

cloth diaper“I was afraid of the smell and the grossness factor of poopy diapers”. I have heard this as the reason cloth diapers are not used, by a friend. Yes it would smell if you did not tend to the diapers by rinsing the diaper in the toilet then placing them in a pail. “My cloth-diaper pail, with water and vinegar in it, didn’t smell nearly as bad as the garbage can full of [disposable C] diapers (Shawna Cummings)”.


WHY Use Cloth Diapers?

For starters…consider the contents of the manufactured disposable diaper. They are made with plastics (a petroleum-based product); most brands are bleached and so would contain trace amounts of dioxin. Dioxin is a carcinogenic (cancer-producing), by product of the paper-bleaching process. Jay Bolus states that ‘Dioxins can be toxic and persistent, stick around in the environment for a long time, and accumulate in our bodies (, 58)’; they do not biodegrade easily and are persistent in leaking toxins into the soil.

Dioxins are the stuff that is stuck against your baby’s bottom, tossed in the trash and then ends up in landfills. Not only do you expose your precious child to toxins, but the diaper ends up in the soil contaminating the soil for literally generations to come!

Then there is another factor: use of natural resources and the costs for replenishing the environment and clean-up. In Sweden the conclusion was reached that “plastic diapers use three times as many natural resources as cloth (Margulis, 58).

chart for diapers

The use of plastics in the disposable diapers also exposes infants and young children to contained heat. It is bad enough for female children, but the males wind up with exposures to heat on the genitals. The male genitals are outside the body for a reason, in order to keep them cooler than the body (98.6 degrees). Obviously the heat contained cannot be healthy for a male enfant!

Cloth for Diapers

The first and foremost reason to use cloth is: NO Dioxins! When washed with natural soaps, the cloth diaper is the gentler choice. The chances of diaper rash or allergy reactions from cloth diaper use are diminished if laundered correctly.

Also, please consider the use of wash cloths instead disposable wipes. Disposable wipes are also manufactured with petroleum-based materials.

diaper pinCloth diapers are now made with a variety of materials. These materials are cotton, flannel, bamboo, and hemp. Use cloth that has not been bleached, and your baby’s bottom will thank you!
You can buy cotton diapers with no form-fitting features, or diapers that are form fitting that would need large diaper pins to keep them on baby.

You can also buy them with special fabric called “PUL” sewn on the inner layer, with closures made of Velcro or snaps. Some diapers have a removable “refill” insert. Even these should be made of natural materials.

leslie's boutique wet bags“Wet bags” are excellent for keeping soiled diapers from keeping the house or room from smelling. You can wash the bag itself every other time you wash the diapers. I would recommend the use of white vinegar in the pre-wash for odors.
If you decide to use cloth diapers, two wet bags are what I would suggest, a larger wet bag for general use around the house, and a smaller one for when you are running around town or visiting a friend. The small wet bag should be large enough to hold 2-4 diapers.
~Image is from Leslie’s Boutique Wet Bags

For cleaning the cloth diaper, consider mild soaps (preferably biodegradable if using a washer at home) and no bleach. You can purchase non-scented types of soap or scented. Non-scented is less likely to cause allergic reactions. To assist with softening and whitening cloth diapers I would recommend the use of household-grade washing soda, and hanging them on a cloths-line outside (sunlight and air are wonderful for any diaper any day).

Where Are the Cloth Diapers Sold?

Target sells regular diapers and pre-folds, as well as diaper pins

A few sites online are:

http://www.bummis.com Bummis
http://www.bumgenius.com BumGenius
http://cottonbabies.com Cotton Babies
http://smartipants.com Smartipants

If you want to make your own:

http://naturesfabrics.com Natures Fabrics [See: diaper pattern hand-out]
Join a forum to learn more: Diaper Sewing ‘N More https://groups.yahoo.com/neo/groups/Diaper_Sewing_N_More/inf

See my pinterest post at: Make your own cloth diapers

 

REFERENCES:
Mothering Magazine. No. 160 May-June 2010. The Diaper Dilemma. Jennifer Margulis.
Real Diaper Association http://realdiaperassociation.com

ProfessionalLaborSupport-Part2

mom and babyChildbirth Educator

The childbirth educator teaches and assists women in understanding the nature of childbirth, from pre-conception through the first year of baby’s life.  The information they give assists women in having a better and safer birth experience.

The professional Childbirth Educator trained at Birth Arts International adheres to the “Midwifery Model” of care, as outlined by MANA. This is where I am training (and near completion of).

Here are some things that may be covered:

  • Nutrition – preparation to conceive, during pregnancy, and post-partum
  • Pre-natal tests: What is required and why
  • Exercise: for optimal health, and to tone muscles in preparation for birth, as well as post-partum exercises
  • Stages of labor
  • Interventions
  • C-sections and VBAC
  • Neonatal care (newborn baby care)
  • Breastfeeding

Even second-time mommies can benefit from classes.  It helps you to have a better / safer birth to review information.

Childbirth Educators can assist in labor, in a much similar way that a Doula would.  They can answer your questions and assist after the baby is born.

 Part 3: Midwifery

Issues Part 3

What are the issues that affect Lakota Native women during pregnancy and childbirth in regards to: Racism, Sexism, and Oppression – Part 3

After years of encroachment upon traditional healing practices, the stage was set for an Eugenics movement. This movement “… in the 20th century began as a means of controlling the perceived increase in ‘degenerate’ population and maintaining or protecting hereditarily ‘fit’ members in society from being overrun by the genetically ‘unfit.’ (Forbes, 2)” or groups that were marginalized, such as Native Americans.

Initially, the population targeted was those with low intelligence and those with physical disabilities. But, soon it expanded to “ a program to implement ‘racial hygiene’ in the United States, eugenics essentially entailed taking the principle of natural selection and enforcing it by employing allegedly ‘scientific’ means (Forbes, 2)” The concern was that the white populace were being degraded by the influx of people with racial differences. The classifications included socio-economic, class, status and race.

…policies founded on eugenic theories (sic) started to emerge, forcing procedural sterilizations and other means of population control upon people believed to be unfit (Forbes, 2-3)”. In the late 60s and through the 70s the target was Native American people. Indian Health Services began a systematic sterilization policy.

Women would go to the I.H.S. hospital, told they needed a cesarean section (for a variety of reasons), anesthetized; and when they awoke, these women found they had been given a hysterectomy, which is what happened to my friend. She stated that she was not informed of the need for a hysterectomy. She had gone to deliver her baby, the doctors examined her and stated that she needed an emergency cesarean section. She awoke, finding that she had her uterus removed. My friend’s experience was not uncommon, “…in 1975 alone, some 25,000 Native American women were permanently sterilized – many after being coerced, misinformed, or threatened .

In 1990, a former nurse at I.H.S. reported that tubal ligations were used on women who did not want the surgical procedure. Birth control also was forced upon unsuspecting females such as Depo-Provera, without informed consent, and prior to the FDA having given its approval (this would include the mentally retarded ).

Health risks of the drug Depo-Provera are high in native populations due to Diabetes, obesity, and cigarette smoking. Many who were forced to have it or Norplant administered were not informed of the risk. A secondary aspect is the cultural issues. Irregular bleeding that is caused by these drugs can prevented participation in traditional spiritual practices.

In my own research of the issues of native women in the child-bearing years I was shocked by the high numbers of cesarean sections done on this sector of women. The rate of C-Sections nation-wide is 32.8%; whereas South Dakota is around 25.3%. But, I.H.S. rates are higher than the state average, last internet search showed it at 34%.

Why is this of concern? The health risks of women in the child-bearing years due to unnecessary surgery being conducted. Childbirth is treated by the modern medical doctors as though the baby a ‘disease’ that needs to be cut-out, rather than a natural biological reproductive process. Had the traditional practices of midwifery had been continued within the native culture, allowed to flourish, there would have been very few cesarean sections necessary in our modern times.

Other Factors Regarding Childbirth in Indian Country

Next below the black woman, the native woman is recorded as 2nd to the highest in infant mortality rates . This is due to living in rural areas with poor access to proper care during pregnancy. “Poverty is an important risk factor for poor health outcomes ”.

Compounding the issues mentioned above are those of teen and pre-teen births. A female who is younger than 18 or 19 years of age are not fully developed, in other words are still growing themselves. Teenagers tend to eat poorly, are more prone to drink alcohol, smoke, and take drugs during pregnancy.

Next: What are the issues that affect Lakota Native women during pregnancy and childbirth in regards to: Racism, Sexism, and Oppression – Part 4