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.

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Sphincter Law- Part 1

doula at work
In birth work, obstetricians use the Law of Three Ps:

• Passenger (baby)
• The Passage (the pelvic structure and vagina)
• And the Powers (strength of uterine contractions)

From these Ina Gaskin believes stems the misunderstood capacity of a woman’s body from both the pregnant woman and the doctors who work with them. From the misunderstood capacities are the causative factors leading to all the interventions and procedures that now create problems in birthing, such as: Cesarean sections, Forceps use, vacuum extractors, etc.

The blame is placed upon women, for what obstetricians see as “dysfunctional birth”. Women have birthed for eons without a hitch; doctors perceive having a baby as “a problem of physics rather than a millions-of-years-old physiological process (168)”.

The Basics of Sphincter Law

• They function best when the atmosphere is private, and familiar.
• They do not open “at will” and do not respond to commands such as “Push!”
• When in the process of opening (relaxing) they will suddenly close down if a person is upset, frightened, humiliated, or self-conscious. This is the reason why in most traditional cultures women assist women in birth.
• If the mouth and jaw are relaxed, there is a direct correlation to the ability of the sphincters opening in the cervical and vaginal area (or the anus, for that matter).

What are the Sphincters?

These are a grouping of muscles that surround the rectum, bladder, the cervix and vagina. Each has a function for the body. These muscles remain contracted to keep the openings of certain organs held shut until something needs to pass through.

How do they work?

They work in conjunction with the brain. The brain has two sections that directly influence the functions of the Sphincters. These sections are the neocortex and the brain stem (or “primal” brain).

The brain stem is the portion that is directly connected to hormonal functions, and more instinctual. The hormones it releases (related to birth) are oxytocin (the main ingredient in the drug Pitocin, used to induce labor), endorphins, and prolactin.

Whereas the neocortex stimulation works to inhibit the brain stem from hormone release. It is “stimulated” during labor by asking too many questions of a woman in labor, bright light, and failure to protect her privacy during birth.

The sphincters work with the brain stem (and its many hormonal excretions) by a relaxation response. They respond to emotions. A good example of this relaxation response is what happens when toilet functions are interrupted. Everything gets held in, and it takes a while to relax again, right?

~more on the “Sphincters” next week!

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.

Women with Disabilities -The Healthcare Team- Part 1

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When do you start your Search?

The search should begin as early in the pregnancy as possible. When you do a gynecological examination is the opportune time to decide if you are able to become pregnant. Hopefully, that will occur with a doctor with whom you feel comfortable.

But if the pregnancy was unexpected, or you have not found that great doctor with whom you feel comfortable, the earliest point of time is best. It is important for the baby’s sake. It has been discovered that women who receive care late in the pregnancy or have had no prenatal care at all tend to run a higher risk of infant mortality.

Finding a doctor may be a challenge. Some will immediately advise an abortion. Other doctors will become enthused by the challenges.

You need that doctor to know you well enough to understand the way the changes of pregnancy will affect you. Health issues unrelated to the disability you have will most likely need to be addressed early.

How to Find a Doctor

You could find the doctor via those with whom you trust. You may also get recommendations from the doctor who has been working with your disability.

Evaluating the Doctor’s Practice

The recommendations of friends with whom you trust can assist you in assessing the skills of the doctor. Or listening to the impressions of the patients the doctor has had in the past.

Sometimes there may be differing experiences; it’s in this instance that the opinion of an older and well-trusted doctor in the community may come in handy. There is no singular way to assess what doctor may work for you, other than knowing what you are looking for in the care administered by a doctor.

Check the office policies, by checking with the receptionist. You can ask about fees, for normal birth and caesarian section. Ask about payment and billing, insurance the doctor will accept. You will need to know what hospital the doctor is affiliated. Also check the doctor’s flexibility with requests, such as persons allowed to attend the birth, and whether the doctor will work with you on having a natural birth. Most importantly, check accessibility, if you are using a wheelchair…are the rooms and bathrooms set-up for your ease of use. The answers to these questions may narrow the choices of whom to visit.

You could ask for only a consult, rather than a visit with a full physical examination until you have decided upon which doctor you will use. Bring with you the father-to-be or an advocate. You then will have someone to share impressions and ideas with, or who would think of questions you may have not been able to think about in your nervousness.

The Vision

CHAIR STRADDLE

It has been my long-term goal, to start the work of Childbirth Education on the Rosebud Reservation, then expand the birthwork to local native women assisting families and extended family in childbirth.  This vision includes a mobile bus that would be able to reach even the most rural of communities to assist in health care for pregnant and post-partum women, and a free-standing childbirth center.  BIG dreams!

Today, I was thinking “What are the obstacles for young women who may be interested in becoming a Doula?” Well, first it would be the funding necessary to have the training as a Doula. So I set-up a scholarship funding campaign on Go Fund Me.

The campaign is designed to raise money for a minimum of 10 women. I believe that is a good start!  If you are interested in supporting my vision, here is my campaign: https://www.gofundme.com/rstdoulas

How to “Trust the Process” in Childbirth

Trust the Process

Trusting is a big word. We oftentimes say we trust others, but do not even trust our own selves. The nurturance of our babies and bonding that would be necessary in utero, assists in developing a trust between baby and mother. But before working on the baby-mother bond learn to trust your own instincts.

Science has determined that the mother-baby bond is essential after a child is born. But what about the significance of bonding while the baby is growing inside the uterus? This is the essential missing information not communicated to women in our modern times.

Due to the obsession of the over-technological world we live in, we forget to listen within. We tend to not realize important knowledge lies inside our psyches. We avoid listening to our bodies. The cues are there, we just do not stop to listen.

The pregnant body is communicating what it needs all the time, and, believe it or not, the unborn baby is, too. All we have to do as mothers is learn to listen, give ourselves permission to trust the connection, and take the time to respond (Peters & Wilson, 22).

For survival, the baby must begin to adapt to its environment while in the womb in order to survive. There are special molecules that act as messengers, to allow the mother to communicate to her baby in utero. Components such as hormones and neuro-peptides cross the placental wall, sending information to the fetus.

Emotional intelligence is taught to the fetus via this mechanism. So he or she learns the whole range of emotions via the mother. Her responses teach the fetus. She sets the tone, so-to-speak for coping within the world.

Creating the bond with the fetus is a spiritual act that transcends the normal functions of mothering. How one adjusts to life, begins during the prenatal period.

Researchers and clinicians have found that prenatal and birth experiences of the mother, effect the birthing patterns she has with her own babies. These would include cultural patterns imbedded in the lives of the family. We can prevent “life-constricting patterns (McCarty, 9)” that are developed while in utero by addressing these issues and healing our own birth traumas.

This scientific approach closely parallels the work of John Upledger in his ground-breaking work with Cranio-Sacral and Somato-Emotional Release therapies. His theory is that the body stores memories at the cellular level.

Have you ever massaged someone, or been massaged, and a small soft-tissue lump is discovered that almost feels like it “crackles”? That is a “energy cyst”. When released it creates an emotional response, and the muscular tension abates. It is thought this “cyst” holds the memory of the injury. In Unpledger’s book, he states that traumatic injury can be fully healed by the release of these “cysts”.

I have come to look upon this phenomenon as ‘tissue memory’. By this I mean that the cells and tissues of the body may actually possess their own memory capabilities. These tissue memories are not necessarily reliant upon the brain for their existence [[Upledger, 64].

I would consider this muscular and tissue intelligence. If Upledger’s theory is true [and is likely, due to hundreds of patients having experienced his work] then it is an important aspect to consider for the mother and the mother-baby bond.

There are four essential KEYS to developing the mother-baby bond, and learning to be aware of and trust your own instincts.

Being: an awareness of thoughts and feelings
Observing: a state of mindfulness
Nourishing: involves all the things women do to tend to their emotional and physical needs.
Deciding: to make an active participation in creating your own reality. A conscious agreement
to make decisions based on deep inner-listening.

Steps to making the conscious agreement are:

1. Separating ourselves from all external influences (even for a few moments in the day)

2. Get quiet and pause. A few deep breaths in order to connect to your “source”

3. Listen. What is your gut saying to you? How does your body feel? How is your body reacting? How does your baby react to what you are feeling, physically or emotionally?

4. Then decide and commit. This is when you honor your feeling and that of your baby. Make a decision that will be in harmony with the messages your intuition says.

Through this practice, then you will develop a trusting respect for your own intuitive thought process, allowing it to guide you. You have several months of your pregnancy to find your awareness of self and of your baby.

When the day comes for labor to begin you take this newly-developed self-awareness, the bond you created between you and baby, and the education you have gained about safe birthing practices to trust fully the process of labor! “Listen” to your own self, and what your baby is telling you.

Relax into labor, BE with it. OBSERVE what is transpiring within your own body, and NOURISHING your emotional / physical needs while you are in labor. Then DECIDE. Decide to trust your instincts, trust your body (which is wonderfully made!), and to trust your bond you’ve made with your baby…

COMMIT to Trusting the Process.

REFERENCES:

McCarty, Wendy Anne. Ph.D. , R.N. The Call to Reawaken and Deepen Our Communication with Babies: What Babies Are Teaching Us. International Doula. Summer 2004, Vol 12.

Tracey Wilson Peters, CCCE, C.L.D., and Laurel Wilson, IBCLC, CCCE. The Mission Piece: Consciousness and the MotherBaby Bond. Pathways to Family Wellness. Issue 31, Fall 2011

Upledger, John E., D.O., O.M.M. Your Inner Physician and You. 2nd Ed. North Atlantic Books. 1997

Effects of Tetracycline and Aspirin in Pregnancy

Tetracycline

Tetracycline is a wide-spectrum antibiotic. During pregnancy it crosses into the placenta, and goes directly to the unborn child’s teeth. It may continue in affecting the teeth of the fetus causing yellow mottling and staining.

While the mother is taking the antibiotic, it can slow or stop the growth of bone in the unborn fetus. It should not be taken during pregnancy.

aspirin

Aspirin

In general, aspirin or Ibuprofen are not recommended during pregnancy. Aspirin can interfere with the blood’s clotting action. Aspirin can also cause the premature closure of the vessel in the baby’s heart leading to high pressure (pulmonary hypertension).

If you have a headache, a few low-doses will not be detrimental. You should always ask your doctor first. If your headache persists, see your doctor.

If taking Aspirin in the days leading up to birthing Aspirin can cause some problems. It can produce difficulty in blood clotting in both the pregnant woman and the baby. It also can cause neonatal jaundice.

REFERENCES:

Kitzinger, Sheila. The Complete Book of Pregnancy and Childbirth. (1996) Alfred A. Knopf.

Lowdermilk, Deitra Leonard and Shannon E. Perry. Maternity and Women’s Health Care. 9th Ed. (2007) Mosby/elsevier

Sexually Transmitted Infections – Part 1

Chlamydia Trachomatis

This is a highly transmittable disease. It is difficult to diagnose, and the symptoms are nonspecific. It is very expensive to culture.

It is important to identify this disease early. Without doing so and not getting treatment, it can lead to salpingitis or pelvic inflammatory disease.

It increases the risk of ectopic pregnancy and tubal factor infertility. If this disease has infected the cervix, it can cause a cervical inflammation leading to ulcerations…increasing the risk of HIV infection.
Women under the age of 20 are at highest risk for infection. They are 2 to 3 times more likely to have it.

Risk Factors:

Multiple partners
Not using barrier methods of birth control

Cervical cultures should be taken at the first prenatal visit. The use of silver nitrate on the newborn may not be sufficient to prevent the transmission of this disease from mother to infant. Early culture and treatment is a must.

Treatment

For cervical, urethral, and rectal infections: doxycycline or azithromycin.
If the woman is pregnant: erythromycin or amoxicillin.
If she has HIV, treatment would be the same as those without.

Midwife Model of Care VS Hospital Model – Part 2

doula at work

Conclusions

The Medical model of care has been dominant for a century in the northern century. “By the 1920s the United States and Canada became the first societies in human history to do away with midwifery (186)”, only to learn decades later that women still wanted midwives and some would reinvent midwifery if necessary.

In the United States – our present times, only 10% of the babies delivered are born with the assistance of midwives. Whereas, in Western Europe and the rest of the world midwives attend the majority of the births. These nations have the lowest rates of maternal and newborn deaths.

There are some variances within the models of care. Some doctors now will practice according to the midwifery model of care. Some midwives, are employed by large hospital practices where the technological-medical model of care is the rule. They use the midwives for those women who desire midwifery care but the midwives in the medical model are pressured to work in the technological-medical model of care.
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.

Midwife Model of Care VS Hospital Model – Part 1

doula at work

The Midwifery Model of Care

This ancient form of birthing care approaches the idea of birth as more holistic way of care-giving, recognizing the female power of creation. It also acknowledges the holistic view with a seamless unity of mind, body, and spirit; that mother and baby are inseparable units, birth is a normal healthy process.

Visits are much longer. The Midwife is attentive to the pregnant woman, answering her questions. Care-giving, education, counseling are all a part of the Midwife Model of care.

Nutrition is emphasized as the means for a healthy pregnancy, good birth, and strong thriving babies. Companionship during labor is considered important to minimize the use of technology to intervene in the process of birth.

The Midwifery Model has not time-constraint on the process of birth. Labor has its on rhythm, “…it can start and then stop, speed up or slow down and still be normal (Gaskin, 184)”. Midwives give continuous assistance throughout the duration of labor and delivery, and postpartum support after the baby is born. Women can move freely and eat freely throughout the process of labor.

Medical Hospital Model of Care

A product of the industrial revolution, and male derived, its basis is technology and medicine. It is assumed that the body is machine-like, full of short-comings or defects (some has stated child-birth as “pathological”). Pregnancy and labor are viewed as an illness, and that to prevent harm to the mother and baby, must be treated with drugs and/or medical equipment. Also, birth MUST take place within 24 hours.

Mind and body are separate entities. Women are consigned to the bed in a supine position, hooked up to electronic fetal monitors, intravenous tubes, and blood-pressure machines. Eating and drinking, after a certain point in the labor process, are not allowed. Analgesia is administered to ease labor pains since the Medical Model of Care deems pain as unacceptable.

Office visits during pregnancy are short, and questions are discouraged. The mother must take the back seat in her concerns during pregnancy, and passive role during labor. Women are treated homogeneously, with individuality considered unimportant.