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Natural Labour Pains

Posted on January 25th, 2013 by | 8 views
By Ilana Machover
http://homepage.ntlworld.com

There is an ongoing debate about labour pains and the use of drugs to alleviate or eliminate them. It is a controversial and fundamental issue in childbirth, arousing strong emotions, as it involves women and their partners, midwives, childbirth educators and obstetricians; and concerns the future health of mother and baby.

One writer may describe the ill effects (such as backache lasting for over a year) caused by the use of epidural anaesthesia during labour. That writer may condemn the conspiracy of silence that seems to exist regarding the negative side-effects of drugs used in our hospitals to reduce or eliminate the pain of contractions. Another, arguing against the natural childbirth movement, may imply that birth is a medical event and therefore calls for the use of the latest drug technology. Often writers who share the latter attitude compare childbirth to a visit to a dentist. However, generally speaking birth is not a medical event unless it is made to become so. Giving birth is not an illness; it is generally a normal healthy family event. On a visit to the dentist, your role is to be a passive recipient of treatment. Is this also the right attitude to childbirth? Is labour pain a pathological symptom?

Here I’d like to take another look at the whole issue of pain-killing drugs in childbirth and their influence on natural birth.

When epidural began to be used on a mass scale, it was hailed as a panacea. Many women hoped that they would be able to give birth safely without any pain. But over the years, as the negative side-effects of epidural became apparent, disappointment has set in. First we noticed that when drugs are used, further medical intervention often becomes necessary. The rate of births involving forceps and Caesarean section has soared. Later on, reports have shown that there is a link between epidural and subsequent backache. I find it quite disturbing that the revelations of the survey Health after Childbirth by the University of Birmingham’s Medical School (HMSO, 1991) are hardly ever quoted. This study showed links between health problems and some delivery procedures, notably epidural anaesthesia. Alas, it seems to have impressed only those of us who were already concerned about the consequences of these drugs.

And we have yet to mention the effects on the baby. Short-term side effects are well documented. Are there any long-term ones? There is not enough research and we do not know much; but what we do know is not exactly good news. A report from Sweden (Acta Obstet. Gynecol. Scand. 67, 1988) found that among young drug addicts there was a correlation between the drug they preferred and the drug their mothers received in childbirth. The authors suggest that this can be explained as an effect of imprinting.

Childbirth is a very finely-tuned involuntary process. It is regulated by a series of signals exchanged between the mother’s brain and the rest of her body. The contractions of the uterus are controlled by the secretion of appropriate hormones during each of the three phases of labour: dilation of the cervix, birth, and birth of the placenta. This physiological–chemical process (which also has important psychological aspects) can easily be disrupted by any outside interference. It is frequently observed and well-documented that labour, at its early stages, may halt altogether when a woman gets emotionally perturbed. This may be caused, for example, by critical whispers of her attendants, expressing disapproval of her state of body or mind, such as ‘she is not making any progress’, ‘her attitude is wrong’, ‘she is fighting too much’. A similar effect may be caused by a dramatic change in her environment, or by the psychological pressure of other people around her well-wishing relatives who are impatient for the baby to be born. Similarly, continuous monitoring of her progress also puts an enormous stress on the labouring mother. And anxiety releases the wrong hormones. Drugs can also disrupt the process by cutting off the body’s own feedback signalling.

The mother cannot directly control her autonomous nervous system and her hormonal balance. During the first stage of labour the woman does not ‘do’ anything to give birth: the dilation of the cervix happens by itself, and all she needs to ‘do’ is to allow the body to get on with a job that it seems to know how to do all by itself.

During labour it is very difficult for the unprepared woman to accept that the pain of the contractions is ‘normal’. For the majority of women, this is the most severe pain they have ever experienced. Our society does not teach us to tolerate pain and we are used to taking pain-killing drugs for the slightest discomfort.

But pain-killing drugs may derail the natural process of birth by masking the body’s signals and blocking their pathways. This explains why the use of drugs often makes further medical intervention necessary, leading to forceps or caesarean deliveries. A woman asking (or accepting) pain-killing drugs does so to eliminate her immediate pain, unaware of the unintended consequences.

In order to accept labour pain as normal, we have to understand its role: labour pain is not pathological but functional, and should therefore not be eliminated; but a woman can be psycho-physically prepared to cope with it.

This is of course no easy matter, and the availability of drugs makes it even more difficult. However let us recall that not so very long ago it was common practice for pregnant women to take a variety of drugs, ranging from tobacco to thalidomide. Nowadays when the side-effects have become known, many pregnant women are reluctant to take even the mildest drugs. Education has had a great effect here. Let us try education also in relation to labour pains. Every woman can learn to use herself well, move in a relaxed way and stay upright during labour. No athletic skill or aerobic training whatsoever is required. We need to rid ourselves of our culture-induced images of labouring women lying in bed huffing and puffing, as well as of our habit of going to bed whenever we are in pain.

Here is where the technique developed by F M Alexander at the turn of the century can be of great benefit.The Alexander Technique has long been known to actors and musicians, who use it to improve their performance, reduce stress and cope with stage fright. It has also been very effective in dealing with, and preventing, many complaints common in pregnancy. More recently Alexander teachers have been working alongside medical staff in chronic pain clinics. The Alexander Technique teaches us consciously to inhibit old tense habits of movement and to replace them by more economical patterns based on self-awareness◊a new set of ‘directions’ addressed by the brain to the body. By freeing the neck, allowing the head to go forward and up and the back to lengthen and widen, we achieve free and efficient breathing and correct positioning of the other parts and organs of the body. We learn a new body-grammar and discover the wisdom of the body and an unaccustomed freedom for it. Having this freedom, we move with maximal balance and coordination and minimal effort. My experience as an Alexander teacher and a childbirth educator shows that the same principles can be applied to pregnancy and the labour process itself. Rather than trying to eliminate labour pains altogether, we can learn to cope with them.

Where water-birth is available, women are advised not to go into the pool early in labour, because experience has shown us that this may arrest the process. The woman must wait until her cervix is dilated to about 5cm. This stage of early labour can be very difficult. Sometimes it drags on for many hours or even a few days; meanwhile you may experience severe labour pains. The Alexander Technique can teach women to cope with early labour pain rather than wear themselves out fighting against it, thinking negative thoughts and wait impatiently for the time when it is advisable to enter the pool for relief.

Women wanting an epidural often complain that they were made to feel guilty about it. Similarly, anti-smoking propaganda may perhaps cause a lot of guilt feelings in those who find it difficult to quit. But this is no reason to advocate a tolerant attitude to smoking; and the fact that smokers find smoking pleasant does not mean that we ought to recommend it. If the available evidence shows that the drugs presently used in labour can have severe negative side-effects, then it is our duty to let women know this. We have to find other ways of dealing with the problem of guilt feelings in those women who accept drugs.

If the idea of natural childbirth appeals to you, you need to prepare yourself seriously. The contrary pressure in a modern technology-dominated hospital is hard to resist without strong commitment and due physical and mental preparation.

I hope that this article will provide you with a feasible route to realizing your choice.

Copyright © Ilana Machover 1995

About Ilana Machover:

I am a teacher of the Alexander Technique, and Head of Training of the Alexander Technique School, Queen’s Park.
Ilana Machover

I trained for three years with Misha Magidov at his North London Teacher Training Course, qualifying as an AT teacher in 1984. I am a member of the Society of Teachers of the Alexander Technique (STAT) since then. From 1986 to 2003 I was an assistant at the NLTTC, training students to become AT teachers. I opened the Alexander Technique School, Queen’s Park in January 2004.

I run a private practice from my home in Queen’s Park, London. I am known locally and have had many students from my neighbourhood. I am on good terms with my local NHS clinic, and the GPs at this clinic occasionally refer to me some of their patients.

My students come from all walks of life, including many actors and musicians. Since 1984, when an AT department was established at the Royal Academy of Music, I have been a teacher in this department.

I have published extensively and conducted many workshops on the AT.

I am a childbirth educator and a doula. My eutokia classes, which are based on the Alexander Technique, prepare women for childbirth. I also run special eutokia workshops: training AT teachers to work with pregnant women and accompany them in childbirth as doulas.

I am also a qualified teacher of Medau Rhythmic Movement.

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