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 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 MoreWhat 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...
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