This article first appeared in Motivate Magazine in February 2019
The lights are low, soothing music fills the air, the flicker of soft candle light illuminates her face which is aglow with perspiration. He strokes her hair and she moans gently, sinking her head in to his chest, the chest she loves. The lights are low, lavender oil scents the air. Her brain is shut off from the outside world. It is a place of mindful oblivion, safety, privacy, neocortical inhibition. He repeatedly whispers that he loves her, taking her to her safe place. She lets out a deep guttural moan as each wave overwhelms her. The midwife stands back observing her breathing and watching the labour progress.
You may be excused from imagining that the above scene was going somewhere else. The parallels between making babies and birthing babies really are that close. The ‘love hormone’, oxytocin, is in abundance during love making and is an essential component of labour, the uterus cannot contract without it. Women who fail to feel safe and loved, who fail to reach that point of neocortical inhibition, will struggle to release enough oxytocin to reach the point of orgasm or to labour successfully to the point of natural birth.
For some women, the above will resonate deeply. Some even report a state of ecstasy during childbirth which has been dubbed ‘orgasmic birth’. However, for many this is a far cry from their birth experience. Despite our irrefutably knowing that oxytocin is an essential ingredient for natural child birth, the Hollywood scenes of adrenalin fuelled birth rooms, bright lights and a team of medics yelling “PUSH” are all too prevalent. Mums groups are ablaze with women out-goring each other’s birth stories and programmes like ‘One born every minute’ convince us that your baby will either be sneezed out in the car park or will practically kill you. We are prepping our women for disaster! Tocophobia (fear of childbirth) is on the rise. Raised levels of anxiety can not only lead to a complicated birth with higher rates of intervention and C-sections, the raised cortisol levels can cause fetal growth restriction, premature or post term labour, and post natal depression. We owe it to ourselves and to our unborn babies to take the fear out of pregnancy and become love machines!
So how can we best support women to have the beautiful birth they deserve. The great obstetrician midwife and women’s advocate, Michel Odent, stresses that “One cannot actively help a woman give birth. The goal is to avoid disturbing her unnecessarily”. My mission is to enable a women find their ‘zone’, their safe place where the neo-cortex disengages and she is safe and apart from the world around her. Women describe this zone as a nirvana, a place of ecstasy , an out of body experience. It is when a woman reaches the ‘zone’ that she produces maximum oxytocin, which in turn allows the uterus to contract and enable the passage of the fetus. The moment a woman is in a state of fight or flight, when the adrenalin starts to flow, oxytocin production is inhibited. The slow down of labour in turn creates further stress and the cycle can halt labour altogether.
When we send women home from hospital in early labour, it really is not about saving the hospital money. We just know that she is more likely to enter established labour at home where she is surrounded by familiar smells and sights, her own bed, her own bath. It is an oxytocin rich environment. So often, a women will be contracting beautifully at home but the moment she arrives at hospital, the excitement / fear / anticipation has triggered a surge of adrenalin. Adrenalin is oxytocin’s nemesis. When Adrenalin flows, oxytocin goes. “But I WAS in labour!” she insists and we believe her. In the birth centre we can dim the lights and give her some privacy and love but the best remedy is often to send her home for a few more hours.
At the start of the 20th century over half of all women gave birth at home, principally assisted by women, trusting their bodies. Today the figure has dropped to around the 2% mark. As women surrender their pregnancies to the medical profession, they are losing faith in their innate abilty to give birth. Countries like the USA and Brazil, who are highly medicalised with the highest rates of intervention, also have some of the poorest maternal and infant outcomes of the entire developed world. We forget that pregnancy is not an illness. It is a natural process. Modern medicine is there to catch you but you don’t need a dental surgeon to brush your teeth at night. Michel Odent suggests that the hours spent in labour are directly proportionate to the amount of people in the room during labour.
People often ask me why we are the only animal who struggles so much with child birth. Our head to pelvis ratio certainly has something to do with the answer but why are C-section rates going through the roof? We all know of the Mamma cat who quietly excuses herself to the back of a wardrobe to birth her kittens. She does this gracefully, without fear. Her body performs as it should as her brain is not interfering with the process. Let’s go back to the opening paragraph. If I had been going somewhere else with this scene, how well would the love making have progressed if there were bright lights and a team of medics cheering the couple on!
We need to shut out the noise. Programmes like ‘One born every minute’ turn birth in to drama. Normal birth just doesn’t make very scintillating TV. Stay away from horror stories and please please, stop sharing them! Where focus goes, energy flows. The brain is very adept at wiping the details of child birth so it is unlikely that you remember it quite as it was anyway. When I worked in the birth trauma clinic as a student midwife I heard several women talk about how they had nearly died during their previous birth, when their notes actually showed an unremarkable delivery. Contrarily I witnessed women being rushed to the operating room in true medical emergencies, with a post partum haemmorrhage and an infection thrown in, who hypnobirthed their way through the whole experience and loved every minute. Whatever your birth experience, and let’s face it, we are not always in control of this, you have the ability to make it a beautiful, oxytocin rich journey.
We are never going to stop the broadcast of sensational birth docudramas or Hollywood birth scenes, so we need to learn to boycott them. Seriously, avoid them like the plague. Protect your daughters. Whatever your experience of birth, the ecstasy of creating a new life is the outcome to focus on. My job as a doula and your duty to your friends, your partner, and yourself is to become an oxytocin ‘love machine’ throughout pregnancy, birth and beyond. Oxytocin is also integral to breast feeding. You can never have enough!
Throughout the pregnancy a mother needs to be allowed time to meditate, to be at one with her baby, to marvel at the life growing inside her, the tiny fingers, the tiny toes. Yoga and hypnobirthing meditation tapes can aid this and are great tools to carry forward to the birth room. There are also some beautiful Youtube visualization aids to aid meditation and to envisage the ripening and opening of the cervix and the flow of energy in the uterus. Continuity of care is also important. If you can’t get to know your birth team in advance then consider a doula or involve your birth partner from day one.
During labour, do whatever is necessary to feel safe and private. Be the Mamma cat with her kittens at the back of the wardrobe. Water birth is wonderful as it helps cut off the world and achieve neo-cortical inhibition. The truly important factors are for Mum to feel safe and empowered, whether that be in the operating room, labour ward, or home birth. Dim the lights, keep noise to an absolute minimum and escape the outside world. You may add aromatherapy, massage or reflexology. Hypnotherapy is particularly effective. Play with the above during preganancy to find your zone and it will be all the easier to go there during birth. The more enlightened you are, the more empowered you will be on D-day.
To quote Michel Odent,
“Pregnant women should not read books about pregnancy and birth. They should, rather, watch the moon and sing to their baby in the womb”
Tocophobia and anxiety around the pregnancy and birth can also lead to poorer outcomes. High levels of anxiety can cause fetal growth restriction, premature or post term delivery, complications with delivery and increased intervention or C-section. There is also an increased risk of post natal depression, breast feeding issues and maternal infant bonding. Increased adrenalin levels during labour can slow or halt labour altogether as the diagram below shows. This leads to a higher incidence of intervention as the tocophobic mother’s fears become a reality.
Programmes like ‘One born every minute’ can also raise anxiety levels. We either see women sneezing babies out in the car park or going to a point of near death in a heart-stopping voyeuristic roller coaster. As Sam Wollaston of the Guardian writes of these dramas, “Worrying about things going wrong and the potential for tragedy eclipses all the joy of procreation”
There are many wonderful things to celebrate about women’s sexual enlightenment and willingness to share every intimate moment with their girl tribe, but I can’t help but feel that comparing birth stories is not in our best interests. I have heard so many women say that they ‘nearly died’ during childbirth. In theory this is true, but no more so than ‘nearly dying’ when having a tooth abscess or strep throat. Modern medicine is there to catch you but you don’t need a dental surgeon to brush your teeth at night. We rarely remember our births as others saw them and there can be a macabre competitiveness to out-gore other women’s birth experience. This is neither helpful to yourself or others.
As a student midwife, I had the privilege of working in the ‘Birth Trauma’ clinic and also the ‘Vaginal Birth after Caesarian’ VBAC clinic. I witnessed women who were paralysed with tocophobia and who were begging for an elective C-section this time around. When asked to describe their previous birth some would describe a normal, albeit adrenalin fuelled, vaginal delivery but in their memories, they had almost died. By contrast, I saw women in the VBAC clinic who had genuinely experienced massive birth trauma followed by post partum hemorrhage with perhaps an infection and a baby in NICU thrown in. Many of these women spoke calmly of their wish to have a normal birth second time around. There was no right or wrong. This is just how these women perceived things and it was our duty to support them in their journey. What fascinated me was the source of tocophobia and how to change these client’s blueprints, rules and perception of childbirth.
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