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I have been reading a fantastic book by Ina May Gaskin called 'Ina May's Guide to Childbirth'. For those that don't know, Ina May Gaskin is a world renowned midwife that lives in Southern Tennessee in the US. She and her colleagues live in a small village called "The Farm" a place that women and girls have little or no fear of childbirth. Ina May and her partners have attended births of more than 2,200 babies, most being born at home within the village or at the birth center. The first half of the book has short birth stories told by these mothers and midwives. The second half is Ina Mays guild to childbirth, what happens within the body and things she has witnessed happen such as an 'Orgasmic birth' - Yes it is physiologically possible and if you’d like to know more, take a look at the YouTube clip below.

But the chapter that really caught my attention and made so much sense to me was the chapter titled 'Sphincters Law'. Sphincter refers to a ring-shaped muscle that encircles an opening or passage in the body. We have over 50 sphincters within the human body, some microscopically small. The opening and closing of the anus is controlled by contraction and relaxation of a sphincter, as is the cervical sphincter that releases during childbirth, allowing the baby to pass through the birth canal out into the world.

                                            The basics of Sphincters law are:

  • Excretory, Cervical, and vaginal sphincters function best in an atmosphere of intimacy and privacy - I think we can all agree it would be very difficult to go to the toilet in a room full of people watching and that it is much easier to go in a bathroom with a locked door where interruption is unlikely or impossible.       
  • These Sphincters cannot be opened at will or don’t respond well to commands such as "push"
  • When a person's sphincter is in the process of opening, it may suddenly close down if that person becomes upset, frightened, humiliated, or self-conscious. - This happens because high levels of adrenaline in the bloodstream prevent the sphincter from opening. As with all mammals the body will not want to release anything, especially an offspring if it feels threatened and possibly in danger. I’m sure millions of years ago this saved many lives so you can understand why we were made this way.
  • The state of relaxation of the mouth and jaw is directly correlated to the ability of the cervix, the vagina, and the anus to open to full capacity. - It’s not easy to relax these muscles when you are straining and trying to “push”. If you find yourself in this situation either whilst on the toilet or when in labour, take a few deep breathes, let all the tension out of your mouth and relax those muscles. The proof is in the pudding as they say; you will see what a difference this makes.

Something that wasn’t mentioned here was how important relaxing is in order for these muscles to open. Some people like to read on the toilet or smoke a cigarette, this enables them to relax, take their mind off what’s happening and let the body get on with it whilst concentrating on something else. It is the same way when giving birth, Hypnobirthing mothers are taught visualisations and relaxation techniques to help them focus the mind so the body can do what it is designed to do, without the unnecessary straining.  Instead of having elevated adrenaline levels in the bloodstream, which inhibit the body’s sphincters from opening, Hypnobirthing mothers produce endorphins, the body’s natural feel good hormone allowing the cervix to open as nature intended.

To learn more about hypnobirthing click here

 
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I recently received a DVD showing 2 beautiful hypnobirthing births from a friend and fellow hypnobirthing practitioner, Rae Dingall (Birth Peacefully). Rae recently filmed theses births herself and made the DVD in the hope that others will see them and see for themselves the power of hypnobirthing. Both couples in the DVD birthed at home calmly and peacefully with the assistance of a midwife, one in water and the other on land so to speak. I will most certainly show these to expecting parents during my classes as they are another great example of how birth should and can be.

After watching the DVD and seeing how comfortable the woman were at home it got me thinking as to why I had never considered a home birth for my own son's birth over a year ago. I guess like many first time mothers I worried about the "what ifs" but to be honest I didn't really know too much about having a home birth and the only stories I had heard about were the ones that were unplanned home births. With only approx 3% of UK woman having a planned home birth it is no wonder I personally didn't know someone who had.

Obviously that has completely changed now that I am a hypnobirthing practitioner and not only do I know many women who have given birth at home, I also know many who have attended the births or who are home birth advocated. So with my new found knowledge I wanted to share some things I previously didn't know below. 

1- Having a planned home birth is just as safe as birthing in hospital (in "low risk" pregnancies) 
Some people worry that having a baby at home is risky and its best to be in hospital where you have emergency services on hand in case something goes wrong, but studies show this is not true. Being pregnant and giving birth doesn't mean you are sick or in life threatening danger. In normal "low risk" circumstances a woman could give birth just as her body was designed to do so, without any medical interventions. Research has shown that woman who are relaxed and comfortable have shorter and 'easier labours' and it goes without saying that for many woman, being at home rather than in hospital will make them feel more relaxed and comfortable.

So what are the chances of things going wrong? What happens if I need to transfer to hospital?
Probably the most comprehensive study of home birth ever undertaken in the UK was by The National Birthday Trust, they found that 40% of first time mothers that birthed at home had to transfer to hospital. Some of these transfers occurred before labour actually started, whilst others occurred during labour. The single largest reason for transfer was slow or no progress, accounting for 37.2% of transfers. Premature rupture of membranes (waters releasing) accounted for 24.8% of transfers, and most of these occurred before labour had even started. 
If the mother does need to go into hospital the midwife present will arrange for an ambulance or as in half the cases in the study above she can go by car (as you probably would in a planned hospital birth). The study also showed that planning a home birth halved the chances of mothers having assisted or caesarean births. The overall rate of these events was very low. So if you add in the reduced risks of infection, ventouse, forceps, tearing and caesarean section, you may even conclude that for some woman having a home birth is safer than having a hospital birth and what deems as an "emergency" rarely happens.

2 - In the 1950s home births were actively discouraged
The reason home births have been unfashionable for years, is mainly because in the 1950s it was actively discouraged by the health service which ran campaigns to persuade mothers to go into hospital to give birth. In post-war Britain, just as the NHS was being created, our housing conditions and general health were quite poor. For many poorer women at that time, it probably was safer to be in hospital. However, those campaigns convinced many people that home birth itself was unsafe and that hospital was always safer. This has been perpetuated by the media so that many, particularly older, people still believe that hospital is safer than home. This is not supported by the evidence, see point 1.  

3- A home birth will be attended by one or two experienced midwives
Whether the couple have hired an independent midwife* or have chosen NHS midwives to attend their home birth, only experienced midwives will be sent out. Almost all midwives love attending home births but it is unfortunate that at this current time, we have a shortage of midwives and very often a mother that has planned a home birth will be told to go into hospital as they are short staffed. This will also mean that many student midwives graduate without ever attending a home birth, something they are very keen to experience and may rarely ever do so.
Now It isn't against the law for a woman to refuse to go into hospital but many go in as they don't know that they have any other option. The hospital have an obligation to find a midwife to attend the birth. Even if this means they send out the head midwife on duty (as only midwives with home birth experience can attend). AIMS** advises any woman who is told during her pregnancy that "if we have a shortage of midwives at the time of your labour you will have to come into hospital" to write a short letter back stating that they have no intention of coming into hospital and they expect a midwife to attend when called. So far, each one has had a midwife attend at home (a sample letter for women in this situation is available on the AIMS website at the address below). If enough women exercise their right to choose their place of birth then things may start to change, the home birth rate may go up and more midwives may be employed.

* Independent Midwives are fully qualified midwives who have chosen to work outside the NHS in a self employed capacity. Traditionally one midwife would look after a woman throughout her pregnancy, giving them a chance to get to know one another, attend the birth and care for them both after the birth. www.independentmidwives.org.uk
** AIMS, Association for Improvements in the Maternity Services www.amins.org.uk

4- You can still have pain relief during a home birth
It's important to remember that women who are in control, relaxed and in their own environment and having one to one care from a midwife are much less likely to experience severe pain and less likely to ask for pain relief. However, the midwife attending the birth will carry entonox (gas and air) and may carry pethidine. A recent study by the National Birthday Trust showed that
  • 53% of women who planned a home birth used entonox compared to 72% for planned hospital birth.
  • 8% of women planning a home birth used pethidine compared to 30% for planned hospital birth.
You can use self help measures like hypnobirthing, massage and complementary therapies such as aromatherapy and homeopathy. You can hire a TENS machine and also a birthing pool. Laying in a pool full of warm water is a great way to relax and for many woman its so comfortable they give birth in the water.  

5- Birth at home = Birth where you like, birthing pool, bedroom, hallway, kitchen....
From talking to many midwives and fellow Hypnobirthing practitioners it is my understanding that many women will give birth where they feel the safest. For some this will be in a the birthing pool after their partner lovingly fills it up with warm water and for others it will be in a part of the house they feel safest and most secure. This usually means some small, dark, cozy area of the house, like the hallway or toilet. As was the case with a friend of mine who birthed her first child at home on the upstairs landing. She said the birthing pool was all set up downstairs in the front room, she had music playing softly and candles lit around the room to give it the "relaxed" feel she had been dreaming of. She needn't have bothered because she just didn't want to move from the tiny landing and she wasn't going to move for anyone, candles and all! She stayed up there with her husband by her side and her lovely very understanding midwife, positioned on the top step of the stairs for a good few hours until she gave birth to her beautiful son. So as much as you plan for a birth you can never be sure how you will feel at the time, and where nature may take you. 


 
 

 
The misconception that laying flat on your back during labour is "the way to do it" came from Queen Victoria of England who had a male doctor for her 7th baby in 1853. She was also one of the first famous women in history to use chloroform during labour. The use of breathable pain relief by Queen Victoria set the scene for having a male doctor attending births which then became fashionable with upper class women (which were the only ones who could afford this)

Doctors would ease pain with medications and sometimes shorten the labour by using forceps. Both these interventions confined women to their beds, usually lying on their back most of the time. Being in bed also made it easier for the doctor to see what was happening and to intervene if necessary, which they frequently did. It wasn't long before these procedures spread routinely throughout the Western world and is often the scene you will see on TV and in films today.

We now know that laying flat on your back isn't the best position to birth your baby and we are very lucky that our healthcare providers support this in a normal birthing situation. Many hospitals and antenatal classes will advise against using this position and recommend alteratives, such a squatting (the optimum position) and being on all fours. The poster here provides some great illustrations of alternate positions.
 
Dr. Stuart Fischbein chuckled when he read the title of the press release: "Women with a fear of childbirth endure a longer labor."

The release was promoting a study published this week in BJOG: An International Journal of Obstetrics and Gynecology.  Researchers at Akershus University Hospital in Norway found women who feared giving birth were in labor for 1 hour and 32 minutes longer, on average, than those who had no fear.

"I'm glad there's now evidence to say that," Fischbein said, "but it's obvious."

For those of us who aren't OB/GYNs, it may seem more like a cruel joke. Women who are afraid of the pain and the possible medical complications associated with giving birth have to suffer through it longer?

Study author Dr. Samantha Salvesen Adams initially thought her team would find the prolonged labor could be explained by other factors - women who feared birth the most were first time mothers, who are known to have longer labors anyway, or obstetric interventions like epidurals. But when those factors were taken into consideration, the difference in time between the fearless and the fearful was still 47 minutes.

"Mental stress is associated with physiological arousal and release of stress hormones," Adams wrote in an e-mail. "During labour, high levels of stress hormones may weaken uterine [contractions]."

In other words, the adrenaline released when a body is stressed stops the oxytocin hormone production that makes a woman's uterus contract, slowing labor. It's a natural, biological response to fear, Fischbein said.

Fischbein, who's also a co-author of "Fearless Pregnancy," said women today are afraid of giving birth because they're surrounded by horror stories.

"We have a society where sensationalism sells. They're pounded with information [about] things that can go wrong with childbirth. Of course you develop fears."

To understand Fischbein's lack of surprise at the study results, you have to take a look at the way other mammals give birth.  For example, when cats, dogs or horses are in labor, they find dark places to have their offspring in peace.  They eat when they're hungry, pace if they're in pain and run if something comes near them.

Compare that to a hospital setting, where a woman is given ice chips, strapped to machines while laying in bed and surrounded by people who are constantly interrupting. Though the machines and medical personnel are sometimes necessary, Fischbein says the stress comes from being in an unfamiliar environment.

He recommends women find a doctor or midwife who will take the time to talk through their fears and dispense honest advice about the birthing process.


Post by: Jacque Wilson -- CNN.com writer/producer
Filed under: Living Well • Pregnancy 

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    I love babies, children and all things relating to birth. I'm
    fascinated by how the body works through pregnancy and believe that knowledge is power. Therefore I would like to share my findings with anyone who will listen in the hope that they too will learn something new.

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