Saturday 16 July 2011

Getting Past the Fear

The idea of giving birth haunts a lot of women.  Our knowledge (and the lack) of it is mostly shaped either by films that show a lot of screaming and arms flailing in excruciating pain, or from friends and relatives who recount the agony to Calgary in gripping detail. Yes, the pain is definitely not for the faint-hearted.  I still get nightmares every time I think about it.  There is however, a fine difference between succumbing to pain and handling the pain. 

That is exactly what I found out when I saw this video “Everyday Miracles” from  Long before the clip ended, tears were streaming down my face.  I realized that there are just some things in life that ought to remain uncomplicated.  I was totally moved seeing how the mother handled labor – an intuitive understanding of her own body.  She gains confidence from the support and trust by her husband, family members and healthcare providers.  Indeed, the whole experience can be overwhelmingly profound if one allows it to. 

At a personal level, my older sister gave drug-free natural birth twice - to a healthy boy and girl.  So I can probably do it, right? Heck, what about the thousands of women prior to the advent of this heaven-sent (as what my doctor's secretary calls it) pain reliever called epidural.   I have to say, it does make all the difference psychologically when that leaves you with no option.   Interestingly enough, for our grandmothers and great-grandmothers who supposedly had no choice - boy, have they made so many children!
Though a childbirth educator from our prenatal class did ‘assure’ that after the 5th or so child (I wonder who’d go for that many nowadays), giving birth gets easier. Some required almost no pushing at all!  She recounted the story of a mom who was in active labor with her 5th or 6th child.  When she stood up, the baby just popped out!  Good thing she was quick enough to grab hold of the umbilical cord.  Maybe there ought to be a separate class for moms giving birth on their 5th child onwards.  Instead of teaching breathing techniques, “Enhancing Catching Reflex” perhaps would be more relevant.
Anyway as I was saying, my sister Lyn, who eventually became a childbirth educator (teaching Lamaze and advocating breastfeeding) drew me this diagram of what must be the most important information to know when in labor:

She advised me to remain as calm as possible by maintaining breathing rhythms, and most especially not to be afraid.  Fear results to stronger contractions, which leads to more pain. In consequence, you get more frightened and the vicious cycle continues.

This is explained extensively in the classic book, “Childbirth without Fear” by Dr. Grantly Dick-Read.  An English obstetrician, he came to the conclusion that “fear felt by a woman during childbirth caused blood to be filtered away from her uterus, so it could be used by the muscles that would flee the dangerous situation. As a result, the uterus was left without oxygen and could not perform its functions efficiently or without pain”.

Our body is equipped with survival instinct.  So when we are in a state of fear, messages are sent to the brain either to “fight or flee”.  Organs are drained of blood and oxygen to aid the muscle structure and give it the “adrenaline” it needs to survive.  This explains why frightened people turn “white as sheet”. In fact, Dick-Read found that the uterus of a frightened women in labor has literally gone white! Without the fuel that it needs, the uterus cannot function properly and therefore causes labor to hurt.

I remember there were moments I lost focus and panicked, the pain instantly doubled.  I was very lucky to have known the repercussions of such behavior.  I refocused, inhaled and exhaled deeply, and channeled my energy to staying calm.  This is the beauty of natural birth.  Women are in control of their own body. Maternal instinct drives you and is most rewarded when you have that baby in your arms – truly an empowering experience.

Monday 11 July 2011

What does Running and Giving Birth have in common?

The body is born for it.

Over a dinner one night, my hubby got very excited sharing a book he has just read. Entitled “Born to Run” by Christopher McDougall, it is a New York Times Bestseller that took the running world by storm.  As a marathon enthusiast himself, he recounted how the book defies popular beliefs and inspires him to go out and run more.

The author, who had trouble running due to chronic knee problems, was wary of the futile and fleeting solutions recommended by physiologists and chiropractors alike.  Not even the most expensive running shoes in the world could help.   Determined to look for answers, he turned to great runners and running experts around the world.

The fascinating discovery?  “Human beings are designed to run without shoes”. It goes back as far as Leonardo Da Vinci who “considered the human foot, with its fantastic weight-suspension system comprising one quarter of all the bones in the human body “a masterpiece of engineering and a work of art.”

Dr Hartmann, Ph.D., Irish physical therapist who serves world’s finest distance runners stated:  “Your foot’s centerpiece is the arch, the greatest weight-bearing design ever created.  The beauty of any arch is the way it gets stronger under stress; the harder you push down, the tighter its parts mesh.  No stonemason worth his trowel would ever stick a support under an arch; push up from underneath, and you weaken the whole structure.  Buttressing the foot’s arch from all sides is a high-tensile web of twenty-six bones, thirty-three joints, twelve rubbery tendons, and eighteen muscles, all stretching and flexing like an earthquake-resistant suspension bridge.”

In fact, “running shoes may be the most destructive force ever to hit the human foot.” It even goes further to purport that most of the foot and knee injuries that presently beset us are caused by people running with shoes that actually makes the feet weak. Prior to 1972, people run on thin-soled shoes, had strong feet and less knee problems.

The new Nike Free
What is even more spellbinding is that Nike knew this.  A company that spends billions on Research and Development, they also arrived at this puzzling conclusion: “the more cushioned the shoe, the less protection it provides”.   Not to be behind, they introduced the new Nike Free, a pair of shoes closest to wearing nothing with a new slogan – “Run Barefoot”.  It is rather ironic for a company who invented the modern athletic shoes.

Vibram's version of "barefoot" running
As fascinating as it sounds, I was not totally surprised.  A firm believer of natural birth, it anchors on the same ground that the body was designed to do the job it was intended for.  The woman reproductive system is designed to give birth – no interventions required.   Indeed, a labor is a “dance of hormones” between the mother and the baby.  A collaboration of three main hormones – oxytocin, endorphin and adrenaline, that naturally helps women to cope with giving birth.

The increase of oxytocin in pregnancy stimulates powerful contractions that help to thin and dilate (open) the cervix.  As the baby moves down and puts pressure on the cervix and against the tissues of pelvic floor, it sends back signal to release more oxytocin and stimulates contractions again till the baby comes out of the birth canal.  It then helps to expel placenta and limits bleeding, triggers release of milk and motherly feelings.

Working hand in hand with oxytocin is endorphin – a hormone that functions as a pain-relief.  The level of endorphins increases at the peak of labor to help cope with the rising pain.  It gives a heightened sense of awareness despite a long and challenging labor that continues even after birth.  Unfortunately, the use of epidural as a pain relief causes endorphin levels to drop and contributes to the “feeling of sadness” that mothers experience after birth and may also affect the initial mother-infant relationship.

The last but not the least – the hormone adrenaline that we know too well when we feel “pumped up” and give us that extra boost of energy.  It is the “fight or flight” hormone that humans produce to help ensure survival. 

From conception to labor, it is a complex and intricate network of signals that, just as the book “Born to Run” declares on human foot - “once you block a natural movement, you adversely affect the other.”  Nothing could be more true when it comes to giving birth. 

Mommy and Ava just after Natural Birth and supporting Daddy's Marathon

Monday 4 July 2011

We are not masochists, we just know better.

Why subject yourself to the arduous task of natural birth when clearly there is a pain-free alternative?
Many friends and colleagues have asked me this ubiquitous question. It kind of insinuates a response something along the line “I’m really a masochist, that’s why” and would have passed off as a confession.  If you do think about it, why not go for something to ease the pain right (or so it seems)?  I’d say, why not? It is a conviction that many confident moms out there feel very passionate about.
It is important to know that there has been a paradigm shift on how we look at giving birth.  Till the 1940's, giving birth was largely done at home and attended to by midwives or experienced family members.  It was perceived as a natural process and as an act of God.  Further, this was more often tied with cultural traditions and superstitious beliefs that have kept medical practitioners at bay.

As science begin to gain precedence however, women sought medical help on the belief of a safer and pain-free childbirth without risks.  Epidural, the most effective and thus most commonly used form of pain-relief, is administered by injecting a dose of anesthesia through the lower back into the epidural space. A procedure with risks and undesirable effects both for the mom and the baby.

The administration of this drug causes a series of ‘domino-like’ events.  Because of a likelihood of a drop in blood pressure that can seriously affect the flow of oxygen to the baby, the mother has to be attached to an IV drip as a safety precaution in the event an increase in blood is necessary.  She also needs a transducer strapped around her abdomen to monitor the baby’s condition and a temperature bracelet to monitor chances of fever.   Further, a catheter is placed in the bladder as the epidural makes it difficult to tell when to pass urine.

This leaves the mother confined to bed, unable to move around, helpless and feeling out of control.  If the anesthesia has not worn off at the second stage of labor, she has to rely heavily on the doctor to manage the labor.  With the abdominal muscle weakened, the voluntary muscle is unable to push effectively and thus increased the use of forceps and vacuum extractor.  Moreover, studies have shown that there is a significant link between epidural and c-section.  Risk of c-section is found to be 2-3 times more likely with epidural.

What was previously celebrated as nature’s right of passage into motherhood, childbirth has rather appeared to be an "ailment" prescribing medical procedure. Not only that, a mother (and baby) has to deal with after-birth effects – giddiness from the drugs, headaches (which can persist up to 3 months), backache, decreased milk letdown reflexes due to decrease in maternal oxytocin which might have interfered with oxytocin release after birth, and associated post-partum depression.  It doesn’t stop there, the medication permeates the placenta and subtle side effects are also seen on babies.  They are observed to have difficulty in self-soothing, self-latching and trouble suckling at the mother’s breasts.  

In my opinion, the mother and newborn are somehow deprived of an instantaneous bonding.  An otherwise poignant moment for both, have the mother been fully aware and the newborn fully alert.  These reasons are compelling enough for me to assert that the end just could not justify the means. 

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