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 MoreLast Week we Gathered to Chat About Home Birth
We do this every three months here in Cape Town, in a lovely home in the seaside village of Muizenberg. Lana and I have been running these gatherings for the last five years. They were born out of a need and a desperation to provide support and information to those seeking direction and advice around this obscure birthing option and the gatherings have gained a momentum of their own. When we first started them we would work so hard to spread the word, posting flyers to all the midwives and interested antenatal teachers. We would arrange speakers and explore themes. We would advertise and spread the word and we would always lose money running them but loved it and loved the responses and stories we got. They were always worth it. And then something shifted. The gatherings grew. And so did the stories. And the variety and range of people who came. It has become such a safe space to listen and share. Mothers, fathers, doulas, midwives, interested parties attend and all seem to leave humbled and moved. As do we. Every time. Mothers share their birthing experiences, their eyes still glowing with oxytocin. These women, these strong strong women, share what made them feel strong and empowered. They share their vulnerable and beautiful stories to a hungry audience, an audience who needs affirmation and support in the choices they are making. “Stories teach us in ways we can remember. They teach us that each woman responds to birth in her unique way and how very wide-ranging that way can be. Sometimes they teach us about silly practices once widely held that were finally discarded. They teach us the occasional difference between accepted medical knowledge and the real bodily experiences that women have – including those that are never reported in medical textbooks nor admitted as possibilities in the medical world. They also demonstrate the mind/body connection in a way that medical studies cannot. Birth stories told by women who were active participants in giving birth often express a good deal of practical wisdom, inspiration, and information for other women. Positive stories shared by women who have had wonderful childbirth experiences are an irreplaceable way to transmit knowledge of a woman’s true capacities in pregnancy and birth.” – Ina May Gaskin I feel honoured and blessed to be part of these gatherings every three months. I do wish we could run them more often but for now, every three months will have to do. Thanks again to all who come and share....
Read MoreWaiting…
Waiting… Waiting for that baby to come…when will it come? The clock ticks. Tick tock. In this article on estimated due dates in pregnancy and induction of labour, Dr Michel Odent, likens the ‘ripening’ of the baby in the womb to the ripening of a fruit on a tree. Not all fruit ripens at the same time, and we do not expect to pick it all at the same time. We pick the ones that are ready first, and then the next and then the next. So why this hang up with the due date? Why the rush to induce and get things going so soon after this date, whether by chemical OR natural means? What is a due date anyway? The estimated due date is based on Naegele’s Rule, a system worked out by a German obstetrician called Franz Karl Naegele who lived from 1778 to 1851. He worked out that a pregnancy lasted more or less 280 days (about 40 weeks) from the start of the last menstrual period. But, as I am sure he realised, everyone is different, everyone menstruates differently, at different times, has different cycles, either short, long, irregular, heavy, mild. Every woman’s body is different. And so is her baby. And so is her pregnancy. The key words here are ‘estimated due date’ and ‘more or less.’ Only 4% of babies are born on their estimated due date, with a first-time mother birthing her babies a week or so late, and yet we set so many first-time mothers into a panic when they have not gone into labour by their due date. My first baby decided to arrive at 38 weeks gestation, I was not expecting him so soon, his clothes were not ready, and neither was I. My second baby hung in there until 9 days after her due date, and of course, from my previous experience, I assumed I would have another ‘early’ baby. By the time my daughter decided to trigger her labour, I was going pretty mad. My third labour started 15 days after my ‘due date,’ by then I had given in and decided I would certainly be pregnant forever. My fourth emerged three days after she was ‘supposed’ to. It is not an exact science. No matter how advanced the technology nowadays…we can only wait and see…as long as mother and baby are fine, all we can do is wait and watch the mother’s belly ripen. The baby, when he or she is ready to be born, will send a message that tells the mother’s body that it is ready. The mother’s body can then begin labour by slowly releasing oxytocin, the hormone of love. The mother and baby work together to bring the baby into the...
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