Pregnancy: All Apples Aren't Ripe On The Same Day
In our society when it comes to baby making everything is geared towards an EDD, an estimated due date. Every woman in her heart knows that it is a yardstick not a precise piece of data. Yet I remember two weeks before my first two babies were born having acupuncture to ‘tone the uterus’ and then the next week in the case of my second child to ‘stimulate uterine contractions’. I thought this was a natural method to induce that would not affect the intensity of my labour. The reason I went for acupuncture for my first baby was because I had planned a home birth and knew that if I went too far over the EDD then I would have the threat of ‘medical induction’ overhanging me and my unborn child; that meant a hospital delivery and probable complications. If this threat had not been there I would not have considered acupuncture. The first acupuncture session during my first pregnancy worked within hours. I believe it did affect my labour and I believe that my son was born too early. My waters broke dramatically at midnight and I went into spontaneous full-blown labour and within an hour I had dilated the full 10cm and my son was ready to be born. He was born with huge amounts of vernix on his body, a probable sign of prematurity. All I remember thinking is that it was better to have acupuncture and risk slight prematurity than get into a struggle with the perceived medical wisdom over the issue of hospital methods of induction. My second son seemed to go the opposite way. I went to forty-one weeks with him. And it took two acupuncture sessions to coax him out. I’m not even sure the acupuncture worked, it may have just been fluke that my second son was born a couple of days after the second session. The labour was not intense and fast in the same way. I had less fear of induction with this baby as I had already managed one birth without the aid of the NHS and felt this was footing enough to convince them to leave me alone. So I was more emotionally calm about the whole process. I always thought I had two perfect births, both born at home, both born in pools, both managed exceedingly well. But with what I know now I know it was wrong to try and force uterine contractions.
I was first introduced to Michel Odent through a book called ‘We Are All Water Babies’ in 1995 about the time my first son was born. I knew I wanted to meet him one day and I set about contacting the lady who was photographed in the book. A lady called Lauren Heston who ran an infant water safety course called ‘Little Dippers’ – one of the first of its kind. I met Lauren through taking my son to her classes and we got on very well and she said I would make a good teacher and she offered to train me. I loved teaching the babies and Little Dippers offered me my first experience of teaching. In 1998 I moved away from teaching babies water skills to teaching children yoga. I was offered an opening at a centre in South London called The Art of Health and Yoga. By 1999 I had become a fully qualified yoga instructor and sunk myself into my new profession. I still thought about Michel Odent but I had become resigned that I would probably not meet him. Then by chance he started to give talks at the Art of Health. I desperately wanted to speak to him but found I could not within that environment. The Art closed in 2001 and I only got as far as saying ‘hello’ to Michel. In 2004 I wad carrying my third child and I had really come to specialise in prenatal yoga guided by my own wisdom and experience. I knew things had moved on regarding research on how women should give birth since my last child in 1997. I looked up Michel Odent and saw that he ran a doula course in South London. I then happened upon an old friend who said she was doing a doula course, that same course. That was a sign I should do it too. I remember my course avidly. I went armed with pen and a huge pad and I literally drank Michel’s words. He was an inspiration, tall and in his late 70’s and so articulate and philosophical. I questioned him and even argued with him at times. He was appalled to discover that I had had my first two births filmed. I told him it was important, I hoped to do good work with the films in the future. We got on very well. I remember one time on the course he caught me in the corridor, we had been speaking about the contentious issue of EDD’s, I had shared with the group that I had induced my first two babies naturally by acupuncture. Michel said to me at that point (or something along these lines), it is strange that you should think acupuncture is natural. If the baby and a rush of natural hormones released at the natural time is not responsible for the uterine contractions then it is not natural. It is no more natural than a sweep. After that I started to listen even more intensely in that course. I had always been proud of my two births but Michel had really made me think about the controlling nature of my decisions. My third son was born in his own time. I don’t know how many days over, I did not count. I just knew that he would come when he was ready. I had no pressure from the NHS as I had told them I would only call them in an emergency. At 4.30am 5 April 2005 Michel turned up at my house and although I could hardly say I was in labour his miraculous appearance was all that was needed to kick-start the release of a cocktail of natural hormones and labour. My third son was born one hour later on the living room floor. In his own time.
I am not sure how many of you heard the article on Woman’s Hour last Friday. The article began with the presenter describing the waiting for a baby to come after the estimated due date as ‘intensely frustrating and uncomfortable’ and that period after the due date when you are ‘stroppy’. A lady had started a thread on the Woman’s Hour message board asking for ideas to bring on labour. The following was advised by a number of women: Curry, Raspberry Leaf Tea, Pineapple, Sex, Walking, Hiking and Camping, Nipple Stimulation, Aubergines (advised at an ante natal class), Thyme Tea, See Saw. This lady tried a few of these but ended up posting a reply that read: 'I haven’t had a show, had a sweep, not positive, the pain of the sweep was horrendous and now labour is going to be much worse when it does come. Just seen my midwife and I have been booked in for an induction tomorrow. Completely terrified'. Someone wrote back: 'Millions of women survive to tell the tale'. Twelve days after her baby was born this lady was on the radio describing how after the induction her baby slept through the whole labour and she was ‘dragged out with forceps’. Not one woman on the message board advised the woman to do nothing but allow the baby to arrive in its own time. This is not a result of ignorance as much as misinformation and social conditioning. Each woman is encouraged from the outset to make a birth plan. But is it possible to plan a birth? When we plan a birth are we not trying to dominate nature? Modern medical obstetrics practice unnecessary intervention throughout pregnancy and birth, nurturing not mother and baby but a most basic control over a human being. There is a probability that the threat of induction for the woman who started this thread on the message board was the main cause of the baby not arriving. Adrenaline upsets the natural cocktail of hormones needed to kick-start labour. The threat of induction can act as a nocebo, that is the opposite to a placebo. It is important for a woman to understand that although modern antenatal care is based on routine care that she and her baby are not a routine case. Each mother and baby is unique and each placenta functions optimally for different periods of time depending on the baby and the mother. That means a baby may be born between 38 weeks or 44 weeks depending on these factors. It is important to remember that some babies need a longer time to mature. This highlights the problem of routinely booking a woman in for an induction at 42 weeks; it is totally non-selective. Since the advent of the Primal Health Research Centre evidence shows that there can be far reaching implications on the long- term physiological health of mother and baby due to the routine disturbance of the birth process. Our health is to a great extent shaped in the womb and by the birth process. When researchers detect what happened at birth with long-term health, it is always in the field of criminality and incapacity to love. Michel Odent believes that in terms of public health there is nothing more important than the health and well being of pregnant women. The nation already bears the scars of this not being the case in our society today. Society must try and protect the emotional state of women while pregnant. This should be the first pre-occupation of anyone in the medical profession who comes into contact with women.
So how can a woman mastermind her antenatal care to the best interests of herself and her baby? First of all a woman would do well to understand the induction processes she may be offered and the reasoning behind it:
Pre-eclampsia: When you have a brain tumour you have a headache. When you have a headache it does not mean you have a brain tumour. When you have pre-eclampsia you have high blood pressure. When you have high blood pressure this does not mean pre-eclampsia. Induction may be offered because a woman is told she has pre-eclampsia. Pre-eclampsia may be a term that is bandied around when a woman just has high blood pressure. In fact high blood pressure at the end of a pregnancy can be good news. It is a good sign of placenta activity. It is a transitory physiological response. The increase in blood pressure is actually associated with an even better birth outcome. People confuse high blood pressure for pre-eclampsia. But for pre-eclampsia to be truly diagnosed a woman would have to have at least 300mg of protein in her urine for 24 hours and many metabolic disturbances. A woman can check for protein in her urine herself by urinating on ketone sticks. When doing a urine sample for protein detection a woman must ensure that she does it mid-flow because early flow can contain discharge which hold protein. This must be eradicated first. However the capacity to predict pre-eclampsia does not alter the outcome the more tests you include the more the nocebo effect.
Sweeping the membrane: A doctor may ask to do a vaginal examination when a woman is overdue. He may then separate the membranes from the cervix. This is an interpretative way to stimulate the release of prostaglandin. Often doctors and midwives do not tell a woman why they are doing this. A woman must ask if it is necessary to do an examination and she must ask that the doctor does not do a sweep.
Synthetic Prostaglandin: A doctor may use a synthetic prostaglandin made from poly-unsaturated fatty acids. It can come in a gel, pessary or oral tablet form and it is used to make the cervix ripe. Sometimes it is enough to induce labour but in too many cases it is followed by a synthetic oxytocin drip. Synthetic oxytocin suppresses the natural cocktail of hormones required to give birth and lactate. The hormones released in childbirth are released in lactation. Oxytocin is released by pulsation. Only women who give birth vaginally without drugs can release pulsating oxytocin effectively.
Acupressure, Acupuncture, Reflexology, Pre-meditated Sex: Any of the above methods are not necessarily natural. Anything that stimulates the uterine contractions beyond the baby’s decision that it is time to be born is not natural.Castor Oil: PROBABLY THE MOST DANGEROUS WAY TO INDUCE LABOUR, IT INTRODUCES DIARRHOEA.
If a woman’s baby is overdue it is necessary to explore the following: Does the woman know exactly when her baby was conceived? Pregnancy is 9 months from conception. This is a strategy a woman can use when she is reported to be overdue. Check on a day-to-day basis that the baby is in good shape.
How to check on a day to day to basis:
1) Evaluate how often the baby is kicking. Take notes of times. As long as the baby is following roughly the same rhythm then everything is OK.
2) Evaluate the size of the uterus with a tape measure. With woman lying down measure from the pubic bone to the tip of the mountain. If the uterus is smaller one day then it means that liquid is disappearing and the baby could be in danger.
3) Amnioscopy – introducing into the cervix an endoscope to see the membranes. As long as clear liquid can be seen with vernix in it then the baby is Ok. This can be done everyday.
4) A method to supersede this is the ultrasound scan. The most powerful use of ultrasound scan is in this perinatal period. This is exactly when an ultrasound scan is useful and most effective. An ultrasound scan on demand in the perinatal period should be included as standard in antenatal care. Unless a woman has made up her mind to have a medical abortion if she is given any dubious information regarding her baby’s health from earlier routine scans there is no point in them. They just act as a nocebo. Here the scan can come into its own. As it is not ‘routine’ the response of the medical staff may be one of surprise.
5) Measuring hormones in urine to check that placenta is working well. A woman can ask for a urine sample to be sent to a lab. Remember that in the UK a woman cannot be induced without giving her personal consent and that risks of post maturity are very low.
This article is written from the author’s own viewpoint supported by notes from her participation in a doula course with Michel Odent. This article was inspired by Woman’s Hour Friday 18 July 2008.
To Woman’s Hour: Your radio article did not take on board the serious implications of trying to start labour and the culture surrounding the estimated due date and how to re-educate women. Millions of women were listening to that article and have gone away thinking it is NORMAL to try to stimulate uterine contractions to the detriment of our future society. It is serious stuff that was treated too casually by unqualified individuals.