A to Z of birth

I decided to write an A to Z of birth, which hopefully covers some key topics women should know in pregnancy. These are only a handful of the topics I could cover. A alone could have been antenatal classes, affirmations, and P has a multitude of birth words to choose from…. placenta, push, partner, pethidine, pessary, pelvis… so if you want to learn about more than what’s in this post, and you’re in or around Bromley, come along to one of my hypnobirthing classes where we cover a wide range of topics from pregnancy to birth.

A-Z of birth

A is for adrenaline

Adrenaline is the hormone that is released when your body feels fear. When you feel afraid, threatened or somewhere unfamiliar, your primal brain, the sympathetic nervous system, triggers freeze, fight or flight mode and secretes adrenaline. What effect does this have on birth and the birthing mother? In early labour, adrenaline can reduce the flow of blood to the uterus in favour of outer extremities, causing your uterus to tense, your heart rate to raise, make you feel anxiety and panic and stall your surges (contractions) and labour.

So how can we reduce the production of adrenaline in labour in order to prevent labour stalling and the resulting interventions such as induction to kick start labour with synthetic oxytocin? We need to switch from the freeze fight or flight state to a calm state. To do this we need quiet, dimmed lights and as little distraction and chatter as possible. There’s lots you can do to help with the natural production of oxytocin to get those surges going. A Hypnobirthing class isn’t just about breathing techniques and hypnosis. Learn about the theory and basics of birth, tactics to aide your body to birth naturally and how you can empower yourself to have a positive experience no matter where you give birth and what the circumstances are.

It does however have a place in birth, and birthing women get a rush of adrenaline at the “transition” phase of labour. Most midwives will tell you a woman transitioning will suddenly start saying she can’t do this, want to get baby out and so on, but the adrenaline actually gives the mother a huge rush of energy which is needed near the end of labour, and helps with the strong contractions needed to birth baby.

B is for Birth partner

Birth partners can be anyone you chose to have at the birth… the dad, your mum, a midwife, a doula, your best friend… but whoever you choose, it’s crucial that they understand how to support you during labour. Just as an unfamiliar hospital ward full of beeping machines and screaming women can cause adrenaline and stall labour, a panicky birth partner pumped full of adrenaline can also have the same effect!

Bringing your birth partner to hypnobirthing classes, so they too understand the basics of birth, what can help and what can hinder a labouring mother, is so important. If your birth partner understands that fluorescent lighting and too much chatter can stop the vital oxytocin that’s needed to progress labour, they can help protect your birth space, advocating on your behalf, ensuring lights are dimmed and that you birth as undisturbed as possible. If they’ve listened to the breathing techniques and relaxation tracks, they can help you through the surges. Plus, bonus points, if they’re up to speed and informed, they’re less likely to feel worried, powerless and panicked (just the same as you!). Hypnobirthing can be a powerful tool in birth, for everyone involved.

C is for Cord clamping

Cord clamping refers to the moment you clamp the umbilical cord, stopping the blood flow from the placenta to the baby. Historically this was done as soon as the baby was born, but we now realise that there are numerous benefits in delaying cord clamping until the blood in the placenta has been transferred to the baby. About 30% of baby’s blood volume is in the placenta at birth. By waiting until the cord stops pulsing and has turned white, this blood is transferred to the baby. Delayed cord clamping can mean higher red blood cells and stem cells in the newborn baby which helps with growth and immunity, and improved iron stores for up to 6 months, which has physical and mental development benefits, and a decrease in anemia. There may be instances where the cord needs to be clamped and cut quickly, such as an emergency, but it’s worth considering putting whether you want delayed cord clamping in your birth plan. More information is available here.

D is for doula

A doula is a companion who supports you (and your partner!) throughout pregnancy and labour. They’re not necessarily medically trained, like a midwife is, but they do train and can register under a professional body. Your doula is there to inform you of your choices, help you with your birth plan, emotionally and physically support you throughout pregnancy and birth, and can advocate on your behalf during labour if you so wish. Unlike midwives, who you may see many of throughout your pregnancy, a doula provides continuous support throughout pregnancy and birth and beyond, and their primary focus is you and your baby. A doula can not perform medical tasks, make decisions for you, should not try to influence your decisions in one direction or pressure you to make particular choices.

Nearing to birth a doula may offer other services such as pregnancy massage, rebozo, mindfulness, reflexology, aromatherapy etc if they’re trained in it. During labour, they may provide support both to your partner (who may be going through this experience for the first time too!) as well as you. They may provide aide in terms of reassurance, protecting your birth space and ensuring your birth plan is followed, you are not unnecessarily disturbed and so on. Some doulas focus on post birth, providing breast feeding support, ensuring the mother is cared for, fed, emotionally and physically supported. They may bring nourishing food, run errands, help with the baby and generally ensure the mother is resting and recovering.

Research is not extensive, but the Cochrane report in 2017, which studied 15,000 women, showed that having continuous support can mean more chance of a vaginal birth and less medical interventions, less need for pain relief, shorter births, less complications, and reduced risk of post partum depression.

With all the money we spend on pregnancy, pregnancy clothes, classes, baby clothes, cots, fancy bouncers, toys, bottles and more, the one thing I can’t advocate to spend money on enough is a doula! One piece of advice that’s stuck with me when I was weighing my options and deciding whether to have a doula or not, is this: you will never ever regret spending the money on a doula, but you may regret not spending it on one. They really can affect and improve your birthing experience in a wonderful wonderful way. You can read more about doulas at www.doula.org.uk

E is for encapsulation

Placenta encapsulation is a process in which the placenta is either steamed and dried or dried as is, and ground and put in to pill form for consumption. The benefits of consuming your placenta are wide ranging, but not widely researched or confirmed. Benefits are said to include improved mood, prevention of baby blues and PND, increased milk supply, reduced bleeding, prevented or treated anaemia to name a few. One study was conducted in 2013 of 189 women concluded that the majority showed no negative effects from consuming their placenta, 40% reported improved mood, and 98% said they would consume their placenta again in subsequent births.

It isn’t without its risks though. Toxins and chemicals pass through the placenta, as well as bacteria due to it not being sterile. Women who smoke, or have certain infections should not consume their placenta. If you do decide to encapsulate your placenta, ensure you use a professional who is trained in encapsulation. Other remedies which can be prepared include tinctures and essence.

Research in to this is available here.

F is for fear tension pain cycle

The fear tension pain cycle was discovered by Grantly Dick-Read in the 1920’s. He noted that women who had no fear of birth felt no pain in labour, and that no other mammals in nature feel pain when giving birth, unless they’re unnaturally observed, in captivity or there is something pathologically wrong. This led him to believe that fear causes a cycle of tension, causing the uterus to tense and contractions to feel painful.

When we feel fear, our primitive response is to trigger adrenaline for fight or flight. This in turn causes muscles to tense in anticipation. Often when muscles are tense, they can be painful. The uterus is literally made up of layers of muscle, and when they tense they do not work as well, causing pain. This then creates more fear, which causes more adrenaline, and so the cycle continues.

Hypnobirthing is a wonderful tool to prevent or break the fear tension pain cycle, by firstly removing the fear of birth by removing the unknown with clear and balanced antenatal information, replacing negative associations of birth with positive ones, and by providing relaxation techniques to stop the fear and tension should a woman begin to feel fearful in labour.

G is for gentle caescarean

Having a Caesarian does not have to be seen as a negative in birth. Sometimes a c section is necessary or preferred. It may be planned/elective or emergency, but there’s plenty you can do to make it a positive experience. If you wish to have a gentle caescarian (also called a family centred caescarian), there’s lots of things you can put down in your birth plan to ask for. You can request a spinal block rather than a general anaesthetic so you’re awake and aware. Your choice of music could be played in the theatre (great if you’re hypnobirthing and there’s specific tracks which you associate with calm and relaxation). You can ask that your arms are free, monitors on your back instead of your front, and your gown open so you can hold baby straight away for skin to skin and breast feeding. You can request the drape lowered so you can see baby born (I’ve even seen instances where mum helps lift baby out, or baby is left to come out with the contractions, mimicking a vaginal birth). You may request delayed cord clamping and delayed weighing and measuring in order to have that vital “golden hour” which promotes prolactin, regulates baby’s breathing and heart rate, and deepens the bond between you both. You could ask for your birth partner to be present, or birth photographer if you’re having one. You can also ask for a vaginal swab to seed baby with your microbiome. A c-section doesn’t have to mean resignation to a medical, clinical birth. It can still be positive, memorable and magical!

Below is a fantastic video describing what a gentle caescarean is.

H is for home birth

I could write a whole post on this (and probably will at some point!) but for now I’ll write a condensed version! A home birth is a much under used option for so many women. Falsely seen as a more riskier option for all, in reality a homebirth is not only a viable option for many women, but it is also statistically just as safe as giving birth in a midwife led unit for low risk pregnancies and second time mothers. A study of 65,000 women, published in 2011, found that risk of complications were the same for second time mums whether giving birth at home, in an obstetric unit or midwife led unit. They were marginally higher at home for first time mums (9.3 adverse outcomes out of 1000 births at home vs 5.3 out of 1000 in obstetric units).

A home birth can enable you to have much more control of your environment, such as keeping the birth space quiet and dark, as well as familiar (promoting the production of vital oxytocin to progress labour naturally), and significantly reduces the instance of needing pain relief, interventions such as instrumental delivery or episiotomy, and Caesarean section. You are given dedicated care with two midwives in attendance, and many trusts will do your midwife appointments at home. And you can change your mind at anytime if you decide you want to transfer to hospital. Speak to your midwife about your options, and your local home birth team. A home birth can be magical!

I is for informed consent

Informed consent is when a woman gives permission for a procedure after being given sufficient information to make an informed decision. In birth, procedures such as vaginal examinations, membrane sweeps and other interventions are NOT compulsory. Consent must be given in order to carry out such procedures, and a woman should use her B.R.A.I.N.S to make an informed decision as to whether to proceed with an intervention or not. B.R.A.I.N.S refers to Benefits, Risks, Alternatives, Instinct, Nothing, Smile. A health professional, when asking for consent to a procedure, should provide the woman with information on the benefits, risks and alternatives of the intervention. The woman can listen to her instincts, and can ask what happens if we do nothing. She is entitled to DO nothing. But if she does decide to proceed, it should be after considering her options. An intervention should never be carried out without informed consent if the woman is conscious and capable of making an informed and educated assessment of her options.

J is for joy

Yes joy! Birth doesn’t have to be fear filled, painful and something to “get through”. It can be empowering, euphoric, sensual and filled with joy. How? A hypnobirthing course will put you on the path to a joyful birth, with antenatal information in order to think about your birth plan, and plan for most eventualities in labour, tips and techniques to optimise your birthing environment so that vital oxytocin is flowing and minimise the chance of interventions, relaxation and breathing techniques, and much more. Practice practice practice and plan, and even if your birth takes a different path, it can still be filled with JOY!

K is for vitamin K

Vitamin K prevents haemorrhaging and we are naturally born with very low levels of it. As part of your birth plan, you’ll need to consider whether you wish baby to receive a vitamin K injection, orally, or not at all. vitamin K deficiency is linked to a risk of vitamin K deficiency bleeding in babies. Although the risk of this kind of bleed is rare (1 in 10,000), it can be extremely serious if it occurs. Premature babies, babies delivered instrumentally, who have prolonged jaundice or do not feed well, are at greater risk of vitamin K deficiency bleeds. Breast fed babies are also more at risk of vitamin K deficiency due to breast milk being very low in vitamin K. Formula fed babies are not as at risk due to formula containing high levels of this vitamin. The vitamin K injection is typically administered immediately after birth. The other alternative is oral drops which need to be given at birth, a week later, and at 6 weeks old, although this is not as effective as the injection.