What is Oxytocin?
Going into labour is like falling asleep… Labour is a different state of being, a state of being with a lot of similarities to sleep. For a start, they are both states that cannot be forced. They just happen! Sometimes when we least expect it. We cannot decide or control the moment when we fall asleep. We can also not decide or control the moment when we “fall into labour.” But we can make it difficult for both to happen easily and most effectively. Labour is like sleep because we need the same conditions to “fall into labour” as we need to “fall asleep.” We need to feel safe and warm and relaxed. We need to be in a place in which we feel comfortable, and we need to be free from pressure, anxiety or fear. Oxytocin When a woman is in labour she releases a hormone called oxytocin. Oxytocin is the hormone that makes the uterus contract during labour. It is also the hormone of love. Oxytocin is the hormone we release when we are enjoying a meal, or having a stimulating conversation. It is the hormone we release when we are making love and when we orgasm. It is the hormone that makes us feel in love, and it is the hormone that releases the milk when a mother is breastfeeding. Isn’t it amazing that it is the love hormone that brings the baby into the world? In hospitals synthetic oxytocin is often given to women. It has different names like Pitocin or Syntocinon. Synthetic oxytocin is given to make the mother’s uterus contract, which can help to birth the baby. But this synthetic oxytocin is not a love hormone. It is not like the oxytocin that is naturally secreted by the mother’s body. Synthetic oxytocin is just a hormone that contracts the uterus and helps to push the baby out. It is important that we know more about the effects and function of natural oxytocin, because when a labouring woman is under the effect of synthetic oxytocin she may have a decreased ability to produce natural oxytocin. How is synthetic oxytocin used? Synthetic oxytocin is used to induce a labour (this means starting a labour artificially) or to augment a labour (this means to speed up a labour that has stopped or slowed down). Synthetic oxytocin is also used for active management of the third stage of labour when the placenta is delivered (an injection of synthetic oxytocin is given to the mother to help deliver the placenta quickly). It is also used to stop a mother bleeding if she has a postpartum haemorrhage (when the mother’s uterus doesn’t contract after birth and she begins to bleed heavily). Induction These days it is very common for a woman to be induced to start her labour. She may be given many reasons for this: she may be over her due date, or her caregivers may be worried that her baby is getting too big, or that her baby is ill, or that she is ill. Augmentation When a woman is in labour, it is common for her labour to slow down or even to stop when she arrives in the hospital. There could be many reasons for this sudden slowing down of the labour: the lights are too bright, she is given a vaginal examination, a stranger enters the room, she is feeling watched or self-conscious, she is feeling rushed, cold or scared. Usually, if the labour doesn’t start up again after a certain amount of time, synthetic oxytocin will be used to get the labour...
Read MoreBeing on Call
Being on call… I was asked some time ago: If there was one thing you had known about becoming a midwife before you began training that you know now, would you still have chosen to become a midwife on call for home births? My answer was: “The realities of being on call.Knowing that I would be on call 24/7. That my phone would have to be charged and near me at all times!” I knew that attending home births and being on call would entail all of these when I chose to walk the path of midwifery and attending home births but the realities of it are quite different from any selfless fantasies one might have about it. Seeing the disappointed faces of my children as we turn around the moment we walk into the library or leave the beach, or miss a much loved extra-mural activity. Having to miss birthdays. Leaving for a birth on Christmas day. Missing New Year’s. Missing my very good friend’s wedding. Or feeling too tired to enjoy any of the above… And having that bloody phone so close to my head as I sleep and having to jump up and check EVERY SINGLE MESSAGE that pings its way into my world at all hours of the day. I curse at pointless emojis and kisses and notifications that I have won R500 000 from Coca-Coal via sms – I am trying to sleep! And having to check and answer every message and call even when you need to desperately sleep after two back to back births. Being on call means being available. 100% available. It means being willing, and able, to drop everything, no matter how important and valuable, to go and sit and just be at someone’s birth. If you want to practice a path of non-attachment then being an on-call midwife is it. I have had a nice break from being on call, teaching in Spain and Portugal in July. Being able to leave my phone in my caravan while I taught, or letting it die completely for a day or two was a rare treat. Now I am back in South Africa and life carries on. Being with my children. Four children. Homeschooling. Extra murals. Outings. Housework. Meetings. Teaching. Seeing clients. Walking on the beach. Life! And somehow I am supposed to drop everything and fit a birth into all of this? This busy, full, demanding life I have created for myself? And yet, somehow, when that phone rings or pings, and it is time to go – whether in the library, or the beach, or at breakfast, or more than likely, in the middle of the night, while it is raining and I am in the deepest sleep – time is somehow able suspend itself and I am able to make space for this woman birthing her baby. My mother was a midwife and her attending births was often more of a nuisance and an annoyance than fascinating to me while growing up. It meant that she would be tired and unavailable. But, it also meant, that when I fell pregnant, she dropped everything to be with me in labour and for the first time I saw how essential the work she did was for the woman in labour – her calm and presence held me through that experience and afterwards I thought, “This is the coolest job on the planet!” and wanted to be able to do just that for women in labour after that. But why do it? Why sacrifice family, children, friends? Is it worth it? It is. It really...
Read MoreThis is Marthe and she had a Home Birth…
When Marthe was eighteen years old and newly married, she went into labour one Cape Town spring morning. She was living down the road from her Aunty Maggie and Aunty Martha’s house and the two busy body aunties came to see if the pains the expectant mother was complaining about were indeed the pains of labour, they were there to keep the nervous young husband at bay, and to send a young boy to summon the midwife. The local midwife soon arrived on her bicycle and stayed with young Marthe for three days before deciding to send the young woman off to Groote Schuur hospital. The labour was taking too long and the baby was not coming. The midwife was concerned. After three days of labour and after being transferred to the hospital, Marthe gave birth to a skinny little baby girl. The doctors were baffled as to why the tiny girl had taken so long to come. Eighteen months later, Marthe was in labour again. Again she was at home, and again the local midwife joined her. This time the labour seemed to be progressing smoothly and soon Marthe began bearing down. By some strange twist of fate, the house across the road caught alight. While Marthe easily heaved out a large ten-pound baby girl, a woman died as the house opposite burnt to the ground. (Birth and death walked side by side down that road that day…) Marthe was my grandmother and the large baby girl was my mother. Marthe was pregnant again three years later, and she gave birth easily, at home, attended by a midwife, to another girl. Smaller this time. Life went on and many things changed, especially my grandparents’ social status and when my grandmother fell pregnant in her thirties it was only natural, that this laatlammetjie(1) birth would take place in a hospital, under the care of the best doctors that money could buy. It was years later, when my grandmother was hard of hearing, and cataracts had begun to form in her eyes, that I took her along to a birth film festival I had organised in Cape Town at the Labia theatre. On the drive home, she divulged her birthing stories to me, and she admitted that giving birth at home, had been for her first prize and that paying all that money to have her baby “delivered” in a hospital had been a disappointment. After watching these beautiful birthing films that night, she had only one regret. She would have liked to have had a water birth! * (1) Afrikaans: a child born many years after his or her siblings * My grandmother died in France two years ago, whilst on holiday with my aunts. She had been quite ill and been a given a short time to live so she took herself and her daughters off on one last holiday and shopping spree before she passed away in Nice. She was cremated and has been at rest in a crematorium in Nice. This week my aunts bring her back to Cape Town where she will be buried, alongside my grandfather (who passed away over twenty years ago). Rest in Peace Jiajia, and welcome...
Read MoreEvery Mother is a Goddess
In her book Misconceptions: Truth, Lies, and the Unexpected on the Journey to Motherhood, feminist writer and mother, Naomi Wolf speaks about her experience of becoming a mother for the first time. One of the things she wrote that stood out for me was how this highly regarded intellectual, academic, writer, author, woman, suddenly found herself to be an unseen person. She was walking down the street with her infant, and one of her students walked right past her, did not recognise her, in fact, the student did not even see her. I know that before I gave birth, I did not value mothers or motherhood in the way I did after I gave birth for the first time. I loved my mother and I respected her, but I do not think that I fully valued or saw who she was and what she had done to bring me into this world. During my first labour, I remember my mother’s eyes, soft, dark, familiar, slightly concerned, loving, strong, holding me, carrying me through this experience. And I remember at one point asking her, “How the hell did you do this four times?” She smiled, then laughed softly, shook her head and said, “I don’t know…” And continued to hold me with her gentle touch and soft eyes. After I gave birth for the first time I was high, the love hormone oxytocin coursing through my entire being. The world melted away and the importance of anything beyond the little bubble of warm cosy devotion I inhabited with my newborn son, evaporated. Everything dissolved, except for my deep connection, regard, admiration, and respect for all mothers in the world. I saw mothers and motherhood in a new light and I wanted to bow at the feet of all motherhood. I could feel their sweat, their pain, their love. And any mother who had given birth more than once, was most certainly a goddess. Her work, her love, was beyond my comprehension and understanding. I was in awe. Standing on the other end of having given birth four times myself (and that lovely strong bolus of oxytocin long having left my system) and now having attended numerous births, I feel very strongly that our work as those present at births is to mother the new mother. When a woman births, not only is a baby being born, but so is a mother. How we treat her will affect how she feels about herself as a mother and as a parent. Be gentle. Be kind. Listen. She knows best. She is the mother of this child after all. Or as the mother of midwifery, Ina May Gaskin so eloquently put it: ”If a woman doesn’t look like a goddess during labor, then someone isn’t treating her right.” Happy Mother’s Day…to all the...
Read MoreI was a ‘Difficult Patient’
The women in labour must have NO STRESS placed upon her. She must be free to move about, walk, rock, go to the bathroom by herself, lie on her side or back, squat or kneel, or anything she finds comfortable, without fear of being scolded or embarrassed. Nor is there any need for her to be either ‘quiet’ or ‘good.’ What is a ‘good’ patient? One who does whatever she is told who masks all the stresses she is feeling? Why can she not cry, or laugh, or complain? – Grantly Dick-Read My mother, who was my midwife for my first birth said that it was a good thing I had not given birth in the hospital. She said that they would have knocked me over the head and ordered me to behave and shut up. I am not ‘a good patient’ in labour…no…I am what you would call ‘a difficult patient’. I moan. I complain. I shout. I scream. I sing. I stamp my feet. I demand. I swear. I growl. I froth at the mouth. I even throw things. Oh, I tried. I really did. I tried to be good. I promise. I tried those breathing techniques that are supposed to keep you calm and focused and good. And they would work for a little while. In early labour. But at some point I would have to admit defeat and throw the breathing techniques out the window. They did not help me. They hindered me and the process. I needed to let go, I needed to allow the waves of pain to drown me, I needed to howl and scream my way through labour, I needed to lose myself completely in the fire of pain. I whimpered and wailed my way through my first labour, my mother’s patient eyes and gentle touch carrying me. It was hard and the intensity of the pain was unexpected. I paced the room like a caged tiger and felt like I was a roast chicken being ripped apart by some glutton. It felt like the labour, the pains would never end. But I also felt exultant and strong, especially when I became a lion on the tip of a mountain, full of spears, bleeding, dying but still strong and powerful and roaring. I squatted and I shouted and I pushed out a 5kg baby when I knew I couldn’t. I was not a good labourer, although my midwife at my second birth whispered into my ear that I was as she rubbed soothing oils into my burning lower back. “Yeah right,” I thought, “I bet you say that to everyone…” but inside I loved those words, I needed them. I spat out the orange she had just offered me and with renewed energy, I roared as I arched my back in agonising pain. My second labour took me by surprise. They all did. All four of them. Something does make you forget the intensity and when the labour actually begins there is that moment where you go “oh shit!” and then the roller coaster ride begins and you have to hold on for the ride as you buck through the contractions. It was bloody sore but then again, it was also bloody amazing. I had not realised how strong I was and I did push ups and roared to ease the pains and was taken to a place, a white hot place on the other side of pain where pain did not exist. It was incredible. Shamanic almost. The third time I laboured my baby was ‘late’…he had spent a good...
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