The Good ol’ Thinking Brain
One of the most essential things in meeting the basic needs of a woman in labour is to ensure that her thinking brain or her neocortex is well and truly switched off and understimulated. What is the neocortex? Simply put, it is our ‘thinking brain’ and is the most newly developed part of the brain. In humans, it is very developed and makes it possible for us to do all the wonderful things that make us human. Unfortunately, it also makes it much harder for us (as opposed to other mammals) to allow labour to just happen…our thinking brain tends to stand in the way of oxytocin (the love hormone and the hormone that makes that uterus contract) flowing freely. The thinking brain needs to switch off One of the prime ingredients for shy oxytocin to take effect is that the thinking brain needs to switch off. We need to make sure that the labouring woman’s thinking brain is not stimulated. We stimulate the neocortex during labour by talking to the labouring woman about logical things, such as telling her how many centimetres dilated she is, or asking her to remember when her waters broke. We stimulate her neocortex with these observations and questions, and as a result, we slow down her release of oxytocin. A woman needs to be able to slowly fall into her labour (like falling asleep) and not be ‘woken up’ by the outside world. If she can be given the space to switch off her neocortex, oxytocin will be able to do its job. No observers Feeling observed also stimulates the neocortex, so it is important that the mother does not feel watched. Observers and unnecessary people make the mother feel observed. Cameras can also slow labour down because they can make a mother feel observed which will “wake her up.” Darkness It is important that there are no bright lights around a labouring woman. Drawn curtains, candles and other forms of dim lighting, will help to suppress the thinking brain and aid in the stimulation of oxytocin. Warmth The labouring woman needs to be warm. A fire or a heater or warm water is helpful in relaxing her body and her neocortex. In fact, immersing herself in warm water at the right time (when she is in established active labour) can relax the mother so much that her cervix will dilate completely. The ideal birth attendant The ideal birth attendant understands that talking and asking questions will stimulate the labouring mother’s neocortex. Therefore, she keeps talking to a minimum and will try to answer as many questions as possible on behalf of the labouring mother. This way the mother doesn’t need to be ‘woken up’ from her labour. The ideal birth attendant knows that bright lights stimulate the neocortex and so she makes sure that the lights are dimmed or off or that the curtains are drawn during the day. The ideal birth attendant knows that the labouring mother needs to be warm in order to relax and for her oxytocin to release and flow. She makes sure that the room is sufficiently heated and knows that a warm shower or bath can work very well as a form of pain...
Read MoreEvery Mother Matters
About a year ago a young mother, pregnant and living under a bridge, went into labour. She was a sex worker and we can only assume she stayed under the bridge to birth her baby because she was afraid to go to the hospital to birth her baby. I don’t know. Sadly, the baby got stuck and both the mother and her baby died. Dudu from SWEAT (Sex Workers Education and Advocacy Taskforce) phoned me when she and a group of other mothers were returning from their friend and colleague’s funeral. “We must do this training Ruth!” she said. I had some time ago been invited to help facilitate some of the SWEAT Mothers of the Future meetings and there we had shared our birth stories and chatted about pregnancy and other reproductive issues. Mothers shared how they were slapped and hit and shouted at by nurses and midwives for being uncooperative. They felt they were stigmatised for the work they do whilst giving birth. They often felt unsupported. Three or four mothers shared their stories of birthing at home with no assistance when labour had gone more quickly than expected and how different and empowering and different those experiences were. We talked about how the mothers in this group could be of better support for one another and we eventually decided that perhaps a doula training would be a good idea. As part the Compassionate Birth Project, we envision the option of a doula for every labouring mother and initially we thought that our job was to train doulas who could be employed by facilities so that any mother arriving in labour could gain access to a doula. But the SWEAT Mothers of the Future have decided for themselves that what they want to do is ensure that there are doulas within their own networks and communities. Fellow mothers who understand each other and who have walked similar paths. Makes total sense. Dudu is a real visionary and she has plans to roll out this doula training to sex worker mothers countrywide. I like how she thinks. Yesterday, Robyn Sheldon and I started our training with five beautiful souls who made the journey from their various dwellings, catching buses and taxis to get there. They have made the commitment to be part of this training for the next week. Yesterday one of the mothers said: “ If I understand it correctly, to be a doula I need to be able to let go of everything and to just be there for the mother. To be able to fill her with positive energy.” Couldn’t have said it better myself…the perfect definition of the...
Read MoreHello Darkness my old friend
So the uterus, amongst all the other marvellous things it does (“There is no other organ quite like the uterus. If men had such an organ they would brag about it. So should we.” – Ina May Gaskin), apparently ALSO has melatonin receptors attached to it. These receptors work in conjunction with good ol’ oxytocin, aiding the contractions of the uterus, which dilate the cervix and, if undisturbed, will elicit a foetus ejection reflex . Melatonin is the hormone that anticipates the daily onset of darkness and cannot be secreted when it is light. Which is why we need to switch off lights and screens, to fall asleep. Seems we need darkness to go into labour too…which is probably why most labours begin at night and why most call outs for midwives are during the witching hour. It is important that there are no bright lights around a labouring woman. Drawn curtains, candles and other dim lighting will help aid in the stimulation of oxytocin. How do other mammals prepare for birth? They will find a quiet, dark place, far away from anyone, somewhere where they will feel safe and secure and know that they will be undisturbed. We often forget that we humans are mammals too. We are above all of that by now aren’t we? What with all our technology and higher thinking and sophistication? But when a woman goes into labour, her body responds like every other mammal who seeks safety, comfort, protection, warmth and darkness to give birth. A birth I attended recently, saw me arriving to a woman in labour in her bedroom. Her two year old son slept on her bed while her husband sat and watched television in the next room. The bedroom light was on, a stark, white light from a naked bulb. There was no bedside light or a dimmer light available. I asked the father if he had any candles in the house and we made some makeshift candle holders using stainless steel cups and sand and set those up in the bedroom. And then we turned off the lights. It was as though the room breathed out all its tension as the room warmed with the golden glow of the flickering candle light and the mother was able to go into that mammal state that she needed to be in to birth her baby. She had a mattress on the floor and now lay down there and began to moan softly. Labour sped up.Ten minutes later her waters broke and five minutes after that I was handing her her daughter. So simple…and yet so overlooked. Isn’t it interesting the way most labour wards are still so brightly lit, and all for the convenience of the caregiver? For what other purpose does it...
Read MoreWhere you are, you Shine from Your Corner…
Where you are, you shine from your corner… Those were the words that Karen and Nomvula sang to us at the beginning and at the closing of The Cape Town Midwifery and Birth Conference. And so true. As we work away, feeling often so alone, in our little corners. Working with mothers and babies and tears and loss and birth and life and everything. It is so good to be reminded that actually we are not alone. That there are many of us who feel the same way who are doing the same work, believing the same things, in our little corner. Wow… Like an amazing birth, I think I still need to process everything that took place this last weekend. Powerful. I look forward to seeing the photos and reliving the talks through the footage we filmed. By Saturday night my face felt quite parched from all the tears I had shed. Each story shared so beautiful and courages and vulnerable and real. Thank you to everyone who came and shared and was there and held space. The people who came in buses and planes and cars from all over the country to be at this gathering of tribes. Thank you. And don’t forget: Where you are, you shine from your corner…...
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