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.

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.

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

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.

Non-Professional Labor Support

NON-PROFESSIONAL LABOR SUPPORT

father in delivery room

 

 

 

 


By the baby’s Father or Partner of the woman:

• Can speak for her, to interpret her needs and desires to the staff.
• Assurances, relaxation, encourage her to drink and eat snacks.
• Assistance in walking during labor, assist in getting in and out of the shower or birth tub, etc.
• If knowledgeable, help with breathing and focus in the 2nd stage of labor

Note: to work effectively, the father needs to be well informed. He needs to know what to expect. If he gets panicky he should leave the room to regain composure and then re-enter. First-time fathers especially need to be informed and may still have need of assurance. This can be assisted by his attendance at the Childbirth Education classes.

By a female relative (Grandmother, mother, aunt or sister):

• [At the hospital] Can speak for her, interpret her needs and desires to the staff.
• If they have experienced a natural birth, their assurances are “gold”. They will know what and when to do things to support the process.  If not, they need to become informed about natural childbirth.
• Assurances, relaxation, encourage her to drink and eat snacks.
• They can assist in labor as well, by walking with and supporting the laboring mother; assist her getting into and out of the shower or birth tub, etc.
• Can help with breathing and focus in the 2nd stage of labor.

RECOMMENDED POSTS To READ:

Let Your Monkey Do It
Overdue Pregnancy


FUTURE POSTS YOU WILL NEED TO READ:

Hospital VS. Midwifery Model of Care
Pain in Childbirth
Normal Vaginal Birth
Optimal Fetal Positions
Positions for Labor
Water Birth
Premature Rupture of Membranes
Fetal Distress
C-Section
VBAC

Your Birth Stories

Share your birth story! I am asking for volunteer submissions of your birth story that you wish to share on my blog.

baby-loading-tshirt

My 3rd Birth:

I was going to county hospital for checkups. I was a week over-due and they put the monitor on me. It was way too tight when I had contractions [Braxton Hicks]…so I pulled it off.

The nurse came to check it and decided there was something wrong with the baby. “The heart beat dropped during contractions”, she said. I explained what had happened, she would not hear me. They began to talk C-Section.

I said “I have my daughter with me, and would need to go home and get her to a sitter. I need arrange for the older two children’s care, and find my husband…” (no cell phone).

I went home and called my mother. I told her I was NOT going back to that hospital. They were C-Section crazy! We discussed that it was too late for a midwife (obviously) and she suggested I go into the emergency room of another hospital.

Downtown San Jose had a hospital, so I took the bus there. The doctor on call said, after I explained what happened, that he wanted to put a monitor on to be sure. I could understand his reasoning, so the monitor was placed on my abdomen. We had to wait awhile for a contraction and after four hours, he says “Baby looks fine. I will call the other hospital and explain that you will be here”…[taking off the monitor] he says “You can get up an walk around”.

At that point, I had been having regular contractions 20 minutes apart. My mom arrived just before that, so we walked the halls of the hospital.

My water broke, and the monitor was put back on. I was dilated 6 centimeters. Contractions were getting stronger, too. 2 contractions 9 minutes apart…I could feel the baby crowning.

The nurse was called in. I told her the baby was coming NOW.

“Oh no, sweetie, you couldn’t be having the baby now. Your contractions are too far apart!”

“The head is coming OUT!! I know what that feels like, I have had two babies previously…LOOK!!”

She looks under the sheet. Hits the buzzer, slaps the rails up, while saying “Oh shit, the baby IS coming!”

Not longer after, my youngest was born. No stitches, a couple tears, no complications. So much for needing a C-Section.

I am making a page that will feature birth stories. Look for it!

ProfessionalLaborSupport-Pt3

doula at workMONITRICE /MIDWIFE’S ASSISTANT

The Monitrice can assist in providing a continuity of care, from pre-pregnancy through post-partum. They are trained in all the basic skills that a midwife is trained, but without the certifications to actually “catch” the baby.

At the point of a woman going into labor, the Monitrice/Midwife’s Assistant attends the birth in the manner of a Doula. See the blog post: ProfessionalLaborSupport-Pt1 regarding how a Doula assists in childbirth.

A Monitrice/Midwife’s Assistant:

-Assists women with the pre-pregnancy and fertility issues they may have, along with natural birth control methods.

-Has knowledge of local resources

-Monitors the pregnancy with training in taking the blood pressure, FHT, and urine collection
They enter the labor room in a Doula capacity.

-Assist with neonatal care

-Supports breastfeeding of the baby

-May assist in post-partum care

-Knows alternative complimentary methods for pregnancy and childbirth

 

ProfessionalLaborSupport-Pt 1

PROFESSIONAL LABOR SUPPORT

On the average during an 8 hour shift a nurse will spend about 15 minutes offering physical comfort measures, provide emotional support, or advocate for her patients. Nursing staff are criticized during their reviews for spending too much time with patients if they DO take more time with laboring mothers.

Odds are better with a midwife. But often hospital based midwives have time constraints. You are going to do best with the support of a professional such as a Monitrice or Doula.

doula at work DOULAS

There are two different types of Doulas. A Labor Doula, who will be with you through the pregnancy, meeting with you several times, supporting you while you are in labor (if you so choose), and the first few hours after the baby is born.

There is a Post-Partum Doula, that will work with you and baby for a period of time after the baby is born.

Doulas do not “catch” babies. They will support you in labor and through delivery if you choose to have a Doula.

TheBirthDoula

It has been documented that with the support of a BIRTH (Labor) Doula:

• Lessens problems with babies born in poor condition, babies are less often admitted into special-care nurseries, the hospital stay is shorter in duration, nor are they likely to have infections.
• Women are shown to have less pain and anxiety during labor, cope better with labor, less likely to have lowered numbers of episiotomies, the use of IV Pitocin is lowered, the use of instruments during delivery is lowered and best of all: C-section rates are lower. The length of the labor is shorter.
• Breastfeeding past the 6 week mark is higher when a Doula is utilized for support.
• Also women who have had Doula support have more positive feelings towards the new baby, a better relationship with the father, and lowered postpartum depression.

A BIRTH DOULA:

• Can accompany you when you go to the doctor the first time.
• Visit with you a few times during pregnancy to:
o Assess your nutritional needs and help you stay healthy through your pregnancy.
o Assist you with good posture and exercises that will keep you strong and help in having an easier delivery.
o Before the time of labor and delivery, discuss your options and help you write up a Birth Plan.
• During labor: assist with pain measures, advocate in your behalf with hospital staff (when necessary), help coach your labor partner during labor, etc.
• Afterwards, will assist you in breastfeeding and baby care (first couple hours after delivery).
• Make a visit Post-Partum to see how you are doing, and assist where necessary.
• Do not “catch” the baby.


POST PARTUM DOULA
:

Generally, they offer some or all of the following:

• Breastfeeding Support
• Mother Care Support
• Cooking meals
• Shopping
• Cleaning
• Caring for infant while mother bathes, eats, etc..
Some also offer:
• Other childcare (not directly caring for newborn)
• Laundry

NEXT WEEK: The Childbirth Educator

Culture Part II

Cultural Perspectives on Childbirth

Achomawi mother and childMulti-cultural Beliefs (Continued)

Last week I ended with discussion about the Lakota belief in a spiritual being who assists the souls of the unborn in their journey to human existence. It is thought she “marks” them before entry into this world.  This “mark” is what the medical field calls a “Mongolian” mark.

Because of the spiritual forces in play, many indigenous cultures had and still practice rituals at the birth of a child. This is due to the understanding that childbearing and childbirth are a sacred act.

This may not necessarily be understood by present-day women within the culture, but in their soul and spirit the women do recognize that modern medicine’s “managed care” works against the traditions and ageless wisdom of their tribe. This is true whether they have a traditional spiritually based upbringing in their lives or they have adopted non-traditional religious practice. Their sense of “knowing” from their soul, speaks out against what is not natural and spiritual in the birthing process.

Western culture encourages reading and the attendance of Childbirth Education classes, along with other strategies for birthing. In traditional cultures women “…prepare more symbolically. They avoid all actions and thoughts that have anything to do with ‘getting stuck’ or ‘closing up’ and ‘letting go’…  In traditional societies, women often go to midwives to confirm the pregnancy and then again only if there are special problems… (145)” prior to childbirth.

Another aspect is that most women within many traditional cultures would have been directly involved in the childbearing and child birthing aspects from a young age. Her mother or aunts and grandmother would have taught her about the processes of childbearing and childbirth during childhood and/or adolescent years. The concepts would have “…been integrated into her maturity into adulthood (Ibid.)”. It would have come from her experiential life and stories told to her instead of a class or books.

Unfortunately, much of this kind of experiential life and tradition has been lost or no longer practiced today by local tribal women. Some of the other women will talk about this or that grandma who was a midwife, and who may have been allowed at IHS for a birth. When I have asked women, they mostly talk about a more negative experience for their childbirth if they speak up at all.

Traditionally, the birth of a baby was in the home, not a hospital. Some cultures used “a special hut [that] is constructed for that purpose ;…(Ibid)”. But today in the local area, birthing mostly takes place in a hospital setting, here on the reservation. Locally, there is the IHS. There also is Winner Regional, in Winner South Dakota (45 minutes from Mission, SD) or Cherry County Hospital in Valentine, NE.

Due to past experiences with IHS (the “Eugenics Project” of the 60s and 70s, for one), many women may opt to not have their babies unless there is an emergency. Both Winner and Valentine have doctors that have demonstrated certain biases against native women. Without midwives to deliver locally, this is what women on the Rosebud (Sicangu Oyate) Reservation face today (with the exception of one community).

Each of these three hospitals has their own regulations as to who may attend the birth. They also decide on whether a woman can have assisted births (Nurse-midwives/doulas/etc.).  My attempts to discover these policies, and the reasons for them, have been futile.

– Next week will be “Part 1 – The issues that affect Lakota Native women during pregnancy and childbirth in regards to: Racism, Sexism, and Oppression”