Some Shocking Facts About Cot Death (Sudden Infant Death Syndrome, SIDS )

cot_death_SIDS_statistics
There has been a BBC story doing the rounds on Facebook about why Finland has such a low cot death rate (also known as Sudden Infant Death Syndrome, SIDS). It got me thinking about the global statistics of SIDS and how/if it’s different for each country. I was really shocked at what I found.Below are the statistics for SIDS from a 2004 WHO report. Unfortunately I’ve not been able to find any other up to date global statistics on SIDS. Interestingly (and annoyingly) the report ranked each country by the number of deaths per year. Obviously the USA, with such a huge population, ranked as the highest place for babies to die of SIDS (China and India were not included). But when I compared the number of deaths per country by the birth rate and how many babies are born there was a completely different picture.I was totally shocked to find that New Zealand ranked number one with the highest rate of recorded SIDS in the world! In fact babies are nearly twice as likely to die in New Zealand than they are in America! What is it that this peaceful, developed country is doing that makes it so much more dangerous for babies to sleep compared to El Salvador with all their drugs and gang related problems where they have the lowest recorded SIDS rate in the whole world?

I was also really surprised to see that in 2004 the UK was the safest place for babies to sleep in the western world at a 0.004% SIDS death rate. However, according to a BBC article, in 2010 254 babies died of SIDS. That’s 222 more babies dying than just six years previously. I wonder how correct all of these statistics are?

According to the WHO statistics more than 99.8% of babies all over the world will NOT die of cot death (SIDS). I always believed the rates were high and every baby was in danger. However, looking at the statistics below I really can’t figure out what is actually making the difference. How can there be such a big difference between all these countries?

Going back to the BBC article about Finland we can see that actually in 2004 babies were six times more likely to die there than in the UK. There is such a huge difference in the size of the population so when you look just at the numbers of deaths you can be very misled about the real picture. What is it that the UK is doing so much better than all the other westernised countries?

Looking at the statistics you will also notice that the poorer the country the safer babies sleep. Could this be to do with CoSleeping, breastfeeding, vaccinations, toxins in the water, the family unit, or maybe even genetics? But maybe all or none of these?

There is still a huge debate about what causes a baby to die in their sleep. It’s possible that for every baby that dies there is some one thing that has actually caused it no matter where in the world they are. We just don’t know yet. It does seem that the UK is doing something right, maybe something as simple as lying a baby on their back will stop the trigger from causing their death. Maybe it’s something else.

If you have more up to date statistics please will you let me know as I would like to do a more recent analysis.

Take a look at the summary table below and see just how much difference there is in a country’s ranking when considering their population… What surprises you most about this?

Table of Statistics: Rate of SIDS including population and birth rates 2004 (pdf)

Rank by Birth Rate
Nationmaster.com Rank by number of deaths
Countries
Amount of Cot Deaths (SIDS) 2004 Percentage of Cot Deaths
# 1 # 15 New Zealand: 62 0.114%
=2 = 32 Latvia: 17 0.074%
=2 = 42 Belize: 6 0.074%
# 4 # 8 Chile: 144 0.064%
# 5 # 1 United States: 2,523 0.063%
# 6 # 2 Germany: 429 0.062%
# 7 = 50 Barbados: 2 0.059%
# 8 = 23 Uruguay: 26 0.057%
# 9 # 49 Luxembourg: 3 0.056%
# 10 # 16 Paraguay: 56 0.053%
# 11 = 50 Malta: 2 0.049%
# 12 = 44 Qatar: 4 0.047%
=13 # 5 Argentina: 303 0.045%
=13 = 19 Austria: 32 0.045%
# 15 # 10 Australia: 103 0.042%
# 16 = 44 Bahrain: 4 0.041%
# 17 = 29 Norway: 20 0.040%
# 18 # 9 Canada: 121 0.036%
=19 # 3 Japan: 363 0.034%
=19 # 31 Denmark: 19 0.034%
=21 # 22 Sweden: 28 0.030%
=21 # 35 Kuwait: 14 0.030%
=21 = 36 Croatia: 13 0.030%
=21 # 39 Lithuania: 10 0.030%
=25 # 21 Nicaragua: 30 0.029%
=25 = 44 Estonia: 4 0.029%
# 27 = 53 Iceland: 1 0.026%
# 28 = 13 Ecuador: 65 0.025%
# 29 = 36 Finland: 13 0.024%
# 30 # 28 Hungary: 22 0.023%
=31 # 11 Korea, South: 87 0.021%
=31 = 53 Bahamas, The: 1 0.021%
=33 # 7 South Africa: 164 0.020%
=33 # 27 Israel: 24 0.020%
=35 # 12 Spain: 70 0.017%
=35 # 34 Czech Republic: 15 0.017%
# 36 = 29 Kyrgyzstan: 20 0.016%
# 37 = 25 Netherlands: 25 0.014%
# 38 # 6 Mexico: 261 0.013%
# 39 # 41 Slovakia: 7 0.012%
=40 # 4 Brazil: 318 0.011%
=40 # 18 Poland: 43 0.011%
# 42 = 32 Dominican Republic: 17 0.010%
=43 = 42 Costa Rica: 6 0.009%
=43 = 44 Puerto Rico: 4 0.009%
=45 # 40 Cuba: 8 0.007%
=45 = 44 Moldova: 4 0.007%
=47 # 17 Colombia: 45 0.006%
=47 = 53 Slovenia: 1 0.006%
=49 = 23 Venezuela: 26 0.005%
=49 = 25 Peru: 25 0.005%
=49 # 38 Romania: 11 0.005%
=52 = 13 Egypt: 65 0.004%
=52 = 19 United Kingdom: 32 0.004%
# 54 = 50 Panama: 2 0.003%
# 55 = 53 El Salvador: 1 0.001%

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The most comfortable pregnancy sleeping position to relieve lower back & hip pain

Sleeping well is so important during pregnancy to have you feeling full of energy and refreshed for the day ahead. Most pregnant women get uncomfortable during the night and as a result find it difficult to sleep well.

TOP TIP: The pillow between the knees is an urban myth. It puts too much pressure on the bottom leg, the knee joint twists which then twists the hip joint and pulls on the lower back. Sleeping with the pillow in foetal position further pulls on the buttocks and lower back muscles and if not supported correctly makes your spine twist. The pillow between your knees also puts pressure on your bladder so more getting up in the night. You also reduce space for your baby which means more kicking.
The Mumanu pillow relieves these problems by keeping your hip, knee and foot at the same height. It’s self-inflating so you adjust it to fit you perfectly. This position allows you to fully relax, takes pressure off your bladder and gives your baby extra space to be comfortable.

The hormone Relaxin makes your joints loser during pregnancy so it’s even more important than normal to get correctly aligned and super comfortable.
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The Socially Accepted Violence Against Pregnant and Labouring Women

Birth Related Violence Against Women
By Samantha Thurlby-BrooksToday Amnesty International and One Billion Rising are campaigning together for women’s rights. They are encouraging everyone across the world to support the elimination of violence against women and girls. I think in the light of recent events, such as the horrific Delhi gang rape that happened in December 2012, this day is much needed.

We usually think of violence against a woman as being rape, beaten or emotionally abused, often by someone they are in a relationship with or someone else they know. Domestic violence is a serious issue and society is working together to find out what is going on behind closed doors and helping women in need. Sadly the prevalence of abuse specifically during pregnancy is rarely thought of yet 20% of pregnant women will suffer at the hands of their partner. This is unacceptable.

It is estimated that one in five women will be abused during pregnancy. As homicide during pregnancy now surpasses the previous leading causes of death (automobile accidents and falls), it is more important than ever that we know the signs and properly screen women for domestic violence.About.com

What I’d like to talk about here is the socially acceptable physical violence and emotional abuse pregnant and birthing women suffer. The abuse that leaves a woman feeling unworthy, incapable, doubting her abilities, fearful and physically and emotionally scarred. This is also the abuse that makes a woman feel like she deserved it, that there was something she did wrong to bring it on herself, that ‘it’s just what happens’ and brush it under the carpet to suffer in silence. It’s the socially acceptable abuse that leaves new mothers depressed and anxious or in a state of shock and numbness. Sometimes (and probably more frequently than is recorded) these women suffer post-traumatic stress disorder.

This violence I’m talking about is the way pregnant women are treated by the health profession in general and some health professionals (obstetricians and midwives). The problem is widespread because no one talks about it as being abuse and so many of the health professionals don’t even realise they are being abusive and how their words and actions affect a person. The Nocebo Effect is a term that is used when someone says something negative to a person and the person responds negatively. For instance, “your baby is measuring big” at 20 something weeks gestation sets a woman up to believe that her baby may be too big to be born vaginally. She wonders over the next few months how she would ever get a large baby out without tearing her perineum. When her healthcare provider then offers her the opportunity of an early induction or caesarean she is likely to accept.

Instead, it would be great if the healthcare provider didn’t comment on baby’s size or alternatively could say “Wonderful, your baby’s growing healthy and big. Just what we want. So long as you’re eating healthy foods this is great.” I had a client a couple of years ago who birthed an 11lb baby. She didn’t realise she was in labour because she wasn’t in much pain but, on a routine visit to her midwife, her midwife got suspicious and asked to do a vaginal exam. It turned out she was fully dilated and her waters had broken! She walked down to the labour ward and six pushes later her baby was born… no stitches, no tearing. It’s not the size of the baby that causes problems, it’s whether mum and baby are able to get into good positions and move together.

A client came to me for a postnatal massage a few months ago. She was feeling quite traumatised by her birth and the way she was treated. She had assumed that having a female private obstetrician would give her the best care available. Among some of the things that happened during her birth, the obstetrician, whilst stitching up her torn perineum, said she wasn’t surprised it happened as she [the mother] was overweight and probably sat around in cafes drinking coffee and eating cake. Besides the woman not being overweight at all this was horrendously inappropriate!

Pregnancy, birth and new motherhood is a time when a woman is at her most vulnerable. Her hormones for love and calm have increased since conception and during labour these hormones are peaking higher than any other situation can create. This love hormone, Oxytocin, is the creator of labour contractions. To feel the love and calmness of the hormone Oxytocin there needs to be an absence of the stress hormone Adrenaline. Adrenaline blocks Oxytocin. In otherwords, a woman must feel safe, confident and protected for Oxytocin to peek, giving her and her baby the safest and most empowering experience of birth.

Here are just a few facts about birth that are widely known;

  • A labouring woman must feel safe and relaxed
  • The safety of birth increases when a woman is continuously supported
  • A woman will birth her best where she feels safest; this can be a hospital, home or birth centre
  • Movement during labour reduces the experience of pain
  • Movement during labour helps baby position correctly for a safe, un-assisted vaginal birth
  • Lying on your back or semi-reclining during labour and birth is more painful, uses up more energy and is less effective than forward leaning, upright positions.
  • Forceful pushing can damage blood vessels in the mother’s eyes, create back pain and headaches
  • Forceful pushing won’t get a baby out if the baby’s shoulders are not in the pelvic brim… but moving around will
  • Foetal distress is frequently relieved if the labouring woman changes position (normally if she gets off her back)
  • Continuous Electronic Foetal Monitoring increases the caesarean rate (but is safer during an induction using synthetic oxytocin)
  • Inductions create more painful contractions
  • Bright lights and other distractions create more painful contractions
  • Hunger creates more painful contractions
  • Epidurals increase risk to mother and baby (lowers mother’s blood pressure, can create foetal distress, prevents baby from turning for birth, increases need for forceps, ventouse and caesarean)
  • IV fluid, necessary for epidurals, creates a bloated mother and baby and difficulty with feeding from bloated breasts, as well as diluting the mother’s blood which increases the chance of haemorrage
  • Hospital policies are largely there to protect the hospital against law suits

Even though we know all of these to be true, many health professionals still offer inductions without medical cause, offer epidurals as routine, require a woman birth on her back/semi-reclining with her feet in stirrups or more fashionably now with her feet pressed on the hip of a person on either side. If we know these things to be harder for the woman, but easier for the health professional, how can this not be abuse? How can forcing a woman to lie on her back, despite her saying no, saying she wants to be upright, saying that it hurts more, not be abuse and violence? This is an abuse of power, knocking a woman’s confidence and intuition that she knows her own body. How can doing an episiotomy (surgically cutting the perineum) or the perineum tearing because of this unfavourable position not be an act of violence against women?

Women who have suffered rape, sexual assault and other types of abuse (including emotional abuse) will agree that this creates the same feeling of helplessness, shame and guilt.

During labour, telling a woman that if she doesn’t birth her baby within two hours they will do a ceasarean is like telling a man that he has to have an orgasm within the next three minutes or they will cut the end of his penis…. except what they are threatening the woman with is major surgery. A woman doesn’t need to know what might happen while she’s in labour as this will disrupt her feelings of safety and the release of hormones that will improve her chances of a safe and easy birth.

These labour hormones are the same as the sex hormones. Imagine how each person would feel if the other said, during sex, “You’re not doing it right”, “Your penis isn’t big enough”, “Stay still”, “This isn’t about your pleasure”, “You’re no good at this because you’re too fat, too old, too sick, too tired”.

The health profession know this about birth. Doctors and midwives know that a woman must feel safe and confident and keep moving to have a good birth. However, when they don’t act for the whole good of the mother and baby, I believe they are putting themselves in the position of abuser. Hospital policies are not law yet they are pushed onto a healthy labouring woman as though they are.

Now, I’m not saying all obstetricians and midwives are abusers. I know many wonderful health professionals who do a truely amazing job at supporting women. But, having massaged over 2000 pregnant women and new mothers over the last seven years I have heard many, many wonderful and awful stories. A student of mine called me up recently feeling very upset about the way her midwife treated her during her birth. Upon arrival her midwife said she’d have to cancel her beauty appointment to be here, giving the labouring woman the strong feeling that her being in labour was such an incovenience. She was then set up for feeling guilty and also untrusting of her midwife and all that happened thereafter.

I’ve had many clients complain of painful vaginal exams during labour. Despite protests these women are often ignored, told to suck it up or reassured that it needs to be done and it’ll be over soon. How familiar this is to a child suffering sexual abuse from a person they know?Vaginal exams give very little useful information when done routinely. A cervix can dilate and contract very quickly or very slowly and still be part of a safe birth. The dilation of the cervix doesn’t tell us how soon a baby will be born… there are many other factors that affect this.

One midwife, during a birth I attended, carried out a vaginal exam during a contraction, despite it being more painful, and causing the woman’s waters to break (technically a surgical procedure). The midwife turned around and said that is was common for that to happen when doing a vaginal exam through a contraction. It is common for medical professionals to do these types of procedures ‘accidentally’ without the person’s consent, increasing the risks of birth and violating the person’s human rights of choice.

I have frequently heard of women being given Pethidene, an opiate based drug that strongly affects the mother and baby, without their permission. They weren’t told what it was or what the risks of it were before it being administered, with at least one woman being left on her own for the experience. The biggest fears humans have is to be abandoned in our time of need and to be held against our will. Labouring women are often subjected to both.

I could write a whole book about the stories I’ve heard, first hand, from women about their treatment through pregnancies and birth. About caesareans that weren’t necessary, about the terminology used by the medical profession (failure to progress is actually a successful protection of the baby, something I call the Lion Effect), the lack of scientific evidence for many diagnosed cases of cephalopelvic disproportion (baby too big for the pelvis), of women not being believed when they say how labour feels, that baby’s coming soon or that they are in labour at all. Of women, successful, well educated women, being called a ‘good girl’, of being ridiculed when she says she wants a natural, unmedicated birth, of being pressured into consenting to a procedure (often with the ‘your baby might die if we don’t do this’ threat for something that carries a very small risk).

So, yes, many midwives and obstetrician’s are wonderfully caring and supportive. But, there are equally as many who subject women to this socially approved low and high level abuse creating mothers who doubt themselves, go away feeling that birth was a trauma best forgotten, that they were ‘saved’ by a terrible experience, that their body’s don’t work and that other people know what’s best for them and their baby.

When we change the way pregnant women are treated, how society prepares women for birth and nurtures new mothers, when we train healthcare professionals and update hospital policies with the latest sound research… then we will be on our way to creating a society without violence.

Twins & Super Twin Pregnancy and Childbirth

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“You’re having twins (or more)?! Double the trouble… Boys or girls? Are they identical? Do they look the same? Were they conceived naturally?”As a twin myself these are the questions that every single person asks when they find out… without fail (except for the conception question as that is kept just for the parents). There seems to be a deep fascination with twins and multiples (triplets, quads, quines, sextuplets, septuplets and octuplets).

How it happens

There are a few ways multiples can occur. The most common way is naturally, from sexual intercourse. In recent decades reproductive drugs to stimulate ovulation or to artificially implant one or more fertilised eggs have produced twins and super twins (more than two babies).

Either a mother releases two (or more) ovum/eggs during ovulation which when fertilised produce Dizygotic (DZ) twins or fraternal/ non-identical babies or, one fertilised embryo can split into two and produce two embryos known as Monozygotic (MZ) twins or identical/paternal twins. DZ twins can either be two boys, two girls or one of each. MZ twins are always the same sex (not everyone actually knows this and even when they know they are identical will still ask if they’re a boy and girl!!) According to Pathologist Geoffrey Machin MZ twins are not necessarily genetically identical.[1] There is a third type of twin called Sesquizygotic (sesqui is Latin for one and a half) twins where one ovum splits in two and then they are each fertilised by separate sperm. It’s not clear to me why the ovum splits like this without the sperm to stimulate it but it’s certainly a fascinating combination that is rarely spoken about.

It is possible for DZ twins to be conceived at different times. If the hormones aren’t high enough yet a woman may ovulate a second time, even a month after the first ovum is fertilised. It isn’t uncommon for single women to get pregnant with twins as the body is not used to the stimulation of hormones in semen and will ovulate again taking the ‘rare opportunity’ when it arrives to procreate.[2]

Once the embryo(s) reach the uterus for implantation certain things can happen. The two embryos of DZ twins will implant into the uterine wall and each will produce their own placenta and their own amnions (the amniotic water chamber a baby develops in) and chorions (the outermost membrane around the developing baby). Sometimes the placenta of DZ twins can fuse to look like one. If they are the same sex it may be wrongly thought that they are identical.

With MZ twins it depends when the embryo splits as to whether you get one or two implantations. If the embryo splits early enough they will implant separately, have their own placentas and their own amnions and chorions. They may appear to be DZ twins, but a blood test once they are born will confirm. Sometimes the placenta will fuse together. Most commonly MZ twins will have one placenta, one chorion and two amnions. If the embryo splits after implantation then the two babies will share one placenta, one chorion and one amnion but this is rare.

The sharing of placentas, amnions and chorions is significant for the predicted health of the babies. A placenta each is thought to be healthier than a placenta shared as they are not sharing the blood flow. Separate amnions and chorions are safer as there is less likelihood of the babies getting tangled in each other’s umbilical cords. Also if, tragically, one baby were to die, having separate amnions will prevent the live baby from being affected.

When there are more than two babies any combination of the above can happen. Two of the babies may be MZ and the other not or all three could be from single embryos. Most commonly quadruplets are formed from separate eggs, but potentially they could be made from two MZ embryos. Quads could even come from one single embryo that splits in two and then each of those split in two again!

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Psychology and emotional aspects of having more than one baby Women carrying just one baby will often hear horror stories about pregnancy, birth and breastfeeding affecting her confidence and trust in the process. Likewise with mothers carrying multiples; they’re of even more interest to the medical profession and the general public. The size of a twin pregnancy belly is often commented on by random members of the public, more so than for singletons. Being told all that could go wrong, how labour will be medically managed is totally unhelpful and creates a mother who is worried, stressed and lacking in confidence. This is known as the nocebo effect. A woman carrying twins has enough to think about without being scared of things that may never happen. For instance, a mother of twins or more needs to think about coping day to day by herself with more than one set of nappies to change, mouths to feed, the sleep deprivation that comes with even one new born let alone more, the food requirements she needs and how she will pay for everything. Will she love each of them equally? Will she have time to give to each one? What happens if one or both cry? When will she ever be able to leave the house? (Having one baby with a dirty nappy to change just as you leave the house can then become another dirty nappy to change as you try to leave the house again.) Choosing whether to breastfeed or formula feed comes with pressure and guilt from both directions. How will having more than one baby at once affect her relationship with her partner? Will she go back to work and if she does how will she feel leaving the babies? How will she be able to afford day care or afford to stay at home?

Midwife or Obstetrician?

A midwife who is experienced with twin births may be the ideal care for a healthy pregnancy. In New Zealand we have many independent midwives who are very experienced with births in general but may not want to support a twin birth. This can sometimes be more to do with politics (their statistics) than the ability of a woman to birth twins. Also legal issues, fears of something going wrong and being sued, are a big deciding factor for many midwives/obstetricians. Sometimes it can be personal in that she’s had a bad experience with a twin birth and no longer feels suitable to provide support. Strangely enough these same health professionals can have problem births with singletons in a hospital but not change their practise in the same way. Being unable to find a supportive midwife or the idea that birthing multiples is more dangerous than singletons leads many people to choose an obstetrician as their lead maternity carer (LMC). During the birth there will always be a midwife present. If you know and trust the midwife already then you’re off to a good start. Some people opt for ‘shared care’ where the midwife is the LMC and pay a small fee for an obstetrician of their choice to attend the birth.

The key to finding someone to support you with a natural twin birth and especially a vaginal breech birth is to keep looking. Don’t take one response as the response of everyone. The benefits to mother and baby from birthing as nature intended are well documented and understood. It would be a very sad thing to steal this from a mother and her babies purely because of a ‘just in case’ attitude.

Changes in level of care

Whether you have a midwife or an obstetrician, you will be expected to have more regular visits, either to your midwife or also to a specialist hospital department, and more ultrasound scans. In New Zealand you will generally have a scan every two weeks of your pregnancy. All care is optional so if you don’t feel comfortable with lots of scans during pregnancy then you can ask not to have them. Pressure may be put on you but with the latest research showing that the increase in scans is correlated with slightly lower birth weight (something of great concern with multiples) (and also an increase in left handedness) I think you’ll be in your right to stand your ground.[3] It is important to carry on with the normal urine tests and make sure each baby is growing well.

Nutrition

“Our 2008 Tamba survey revealed that almost 9 out of 10 women (87%) received no specific nutritional advice for a multiple pregnancy, apart from vague instructions to ‘eat healthily’. Although in the USA health professionals sometimes recommend following a high calorie diet, internationally there has not been a great deal of research conducted on nutrition in multiple pregnancies and therefore we have not included this advice.”[4] Of all people – it’s even more important for women carrying multiples to receive good nutritional advice.

To produce a healthy baby a woman’s normal nutritional requirement will increase. She’ll get hungrier and want to eat more often. When carrying twins and super twins the need for extra nutrition increases the same again with each baby carried. This means that a woman will need to eat even more regularly than if she were carrying just one baby. In the last trimester, grazing is best.

It is dangerous to tell a woman with multiples to watch her weight. She needs to eat enough healthy food to keep her energised and functioning optimally as well as growing two or more little people. Eating two or more pieces of cake or having a second or third portion of chips is not going to produce healthy people even though it increases her caloric intake. Eating extra portions of good quality fruit, vegetables, nuts, eggs, fish, whole grains, meat, pulses etc. will create healthy people. Lots more protein and happy fats are required as these are the building blocks of each and every cell and fuel for healthy functioning.

If a woman does not eat enough protein mixed with other healthy calories she will run the risk of using the protein as fuel rather than building blocks to healthy development. For example, a high protein diet and low carbs will result in the protein being used ineffectively. A pregnant woman with multiples has even higher blood volume than singletons. This requires higher levels of protein to facilitate the process[5]. If her protein is being used as fuel then her blood volume will not expand appropriately which may affect how much nutrition is delivered to her babies. Many people don’t know this.

I have already written a lot on pregnancy nutrition[6] so will not cover it all again here. But it is safe to say that a woman with multiples must eat much more than those with singletons if she expects to grow healthy babies to term. If her body cannot cope with the nutritional demands of her babies then the babies may be born pre-term in order to survive or make it to term but be unhealthily underweight.

Your goal, especially in pregnancy, is to eat more complex carbohydrates in their less processed, more natural form. One-third to one half of your diet should be whole grains… Excess calories actually improve protein digestibility and an extra 700 to 1000 calories can spare protein by 30 and 50 per cent respectively… Omega-3 fatty acids are important for brain chemicals, serotonin and dopamine, that affect moods. Many women start their pregnancies already deficient in omega-3 fatty acids and each baby will deplete her stores… EFAs [essential fatty acids] are needed by every cell of your body and your babies’ bodies, especially the cell walls and for the absorption of trace minerals that activate a large number of enzymes… Selenium and iodine, like EFAs, are needed for brain development. Magnesium, calcium, and zinc are involved in the body’s use of omega-3(catalysts) and have been explored as preventative agents for preterm labour[7]

Growing babies isn’t about a bit of extra nutrition to keep you going. It’s about actually making a whole new person purely out of the food and water you eat/drink and the oxygen you breathe. If you don’t put enough in you can’t expect to grow and develop healthy babies to full term.

For more detailed information about nutrition with multiples I definitely recommend reading Elizabeth Noble’s book Having Twins & More.

Possible problems associated with multiples

The biggest problem facing a multiple pregnancy is low birth weight and pre-term labour. As spoken about above nutrition plays a very big role in the healthy size of unborn babies and deficiencies can contribute to early labour. Each baby is an individual developing in the same way as all babies do (whether they’re twins or singletons). If a singleton baby is born at 34 weeks they may have the same troubles as twin babies born at 34 weeks. However, if the twin babies’ mother hasn’t been eating enough (usually because she hasn’t been told just how much more to eat) then they could be dangerously underweight and this can create even more issues for their survival. Even though nobody knows this for sure, I believe that when multiples or even singletons aren’t getting enough nutrition, they will facilitate being born as a means of survival.

Another cause for low birth weight and pre-term labour is Twin to Twin Transfusion Syndrome (TTTS). This rare condition (6% of multiple pregnancies) may happen when a placenta is shared, or more normally if the same circulation is shared. This is why it’s important to know if there is one or more placenta, amnion and chorion. If both babies are sharing everything then a close eye is needed to make sure they are growing at a healthy rate. Sometimes one baby can receive more nutrients and fluid creating problems for themselves as well as the other. The smaller twin may become anaemic and the bigger twin may receive too much blood putting a strain on their heart. I have seen many sets of twins where you can see the one who received better nutrition and the other compromised nutrition.

Risk factors for pre-term labour (babies born too early and need help to survive)[8]

  • Poor nutrition or inadequate hydration
  • Insufficient Omega-3’s in the diet
  • Physical trauma
  • Hard physical labour, tiring travel, standing all day at work
  • Substance abuse
  • Emotional stress and fear
  • Financial stress
  • Fear of increased body size by term
  • Fear of birthing two or more babies
  • Low pre-pregnancy weight
  • Chronic coughing
  • Placental problems
  • Toxaemia (pre-eclampsia, eclampsia etc.)
  • Infection in the genital tract
  • Congenital abnormalities and congenital heart disease/defect
  • Fibroids (benign uterine tumours)
  • Diabetes mellitus (true diabetes not gestational diabetes)
  • Insufficient or excessive amniotic fluid (oligohydramnios or polyhyrdamnios)
  • Exposure to x-rays, anaesthetic gases and lead
  • Car accident or injury
  • Severe gum disease
  • Two or more second trimester abortions

Length of gestation

A normal healthy singleton baby in a good position will normally be born around 40 week’s gestation. Having two or more babies will often bring the birth day earlier. It could be enough nutrition and oxygen for both babies is becoming harder so labour is naturally instigated. Since a woman can carry quads and octuplets I do not believe the weight or space are the factors that determine when a multiple pregnancy starts labour.

These days, because women are often not eating enough for multiples, labour may start before 38 weeks. According to an Australian study of 235 women those that carry on past 38 weeks have been found to be at higher risk of complications[9] but it is not clear from this study what the mother was eating day to day.

I believe that if it’s not ideal for a singleton to be born before 38 weeks why would it be ideal for a twin or triplet to be born so early? If we can discover why there are complications past 38 weeks we can address them rather than making sweeping statements that everyone should be induced and put them at risk of inductions and caesareans. Again, I believe it is related to the quality and amount of nutrition. I worked with a woman carrying triplets and they were birthed at 36 weeks with two weighing over five pounds and one weighing 4.8 pounds. We do know that the longer multiples can be carried in the womb, the healthier they will be.

“Multiple pregnancies are generally less likely to carry to full term (40 weeks for singleton births, 37 weeks for twin births, and 34 weeks for triplet births). In the 2008 Tamba survey, only 43% of twin pregnancies and 1.5% of triplet pregnancies lasted over 37 weeks.”[10]

I’m actually quite excited by the statistic that 43% of twins go past 37 weeks. I was born with my twin at 36 weeks and spent time in NICU before being allowed home. I’m more interested in research that looks at good nutrition of multiple pregnancies and allows births to happen spontaneously. Hopefully one day I will come across that study. At the present time most twin pregnancies are induced at 38 weeks ‘just in case’.

Special circumstances

With some pregnancies a baby isn’t healthy enough or the circumstances aren’t right and the baby dies or the pregnancy is terminated (the baby’s life is medically stopped). This is often traumatic for the mother and can be felt for a life time.

Twin pregnancies can create a different set of moral heartbreaks. For instance, if carrying two or more babies is putting each baby at risk but allowing one to die will save the life of the other then the decision needs to be made as to who will be killed. It may be clear that one baby won’t survive and needs to be killed to save the life of the other but this is still very hard to come to terms with for many people. It’s important that both parents get the correct nurturing and support when going through such an experience.

Choosing to end the life of one of the babies carries a high risk of pre-term labour (75%)[11] and also runs the risk of infection (through the injection of the poison) and also the possibility of either choosing the wrong baby or even failing to kill the baby properly.

Occasionally one twin or a super twin will die naturally. Whether the baby has had to be killed or he/she dies naturally it’s not possible to remove the dead baby early as this will put the living baby at risk. The mother is then required to carry all babies to term and give birth to one or more live and one or more dead babies. It’s often very difficult for the mother to celebrate the life of the living baby when overshadowed by the grief of losing the dead baby. This is why it is so important to address grieving in childbirth classes and to actually give women an opportunity to grieve a loss where they feels supported.

Likewise if they to full term with two or more babies and one dies during the birth it’s incredibly difficult to handle the emotions of elation with one (or more) baby and the grief of the other. Many people will brush your emotions off with “at least you still have one (or more)”. Imagine if they said that if you had two grown children and one died! It really is the same situation.

Rates of still births are low but there continues to be an increased risk for multiple births from 0.57% for singletons to 1.3% for twins, 5.1% for triplets and 10% for quads (source: ONS, 2004). Several studies have also shown the incidence of cerebral palsy to be higher in multiple births, which is mainly attributable to the higher levels of prematurity and lower birth weights in multiple births.”[12]

Although still birth is incredibly low a medical professional can still scare you by saying twins are twice as likely to be still born as singletons. What they may not tell you is that 99.43% of singletons and 98.7% of twins are born alive. It is important to focus on the positive, especially when the rate of normal birth is so high.

Labour presentation

Determining whether or not to birth your babies vaginally or by caesarean can often depend on the positioning of each baby. It’s rare these days for super twins to be born vaginally although I have heard of natural triplet deliveries.[13]

Women are often told different things by different doctors or midwives. Often if the first baby is head down a vaginal delivery is supported, although some midwives and obstetricians don’t feel safe supporting a vaginal twin delivery at all. Some obstetricians won’t deliver a breech second baby even though the risks of incomplete dilation are not an issue, but some will. If the first baby is breech and you want a vaginal birth then you will need to find a fantastic midwife and obstetrician who believe in you and will stand up to the pressure put upon them by other hospital staff. I honor those that do!

I nearly supported a double breech twin birth as a doula but unfortunately at 39 weeks during an ultrasound scan we discovered the first baby had the umbilical cord between her feet. This meant that it was unsafe to birth vaginally and a caesarean was given.

During the birth

The trouble with birth today is that it’s so routinely interrupted that we actually have very little evidence and research that shows what happens in truly natural birth situations. This is never more apparent than with the birth of multiples. Each baby comes out one at a time and interventions used carry similar risks as with singletons so I won’t talk here about birth itself but more specifically about things that arise from birthing more than one baby at a time.

For decades women have been pressured into having epidurals for twins/multiples just in case the second baby needs help e.g. is breech or a caesarean is required. We know that epidurals carry risks of further intervention, especially with breech delivery because the mother cannot move and her hormones are no longer stimulated. Continuous foetal monitoring has been shown to increase the caesarean rate[14] due to the woman being unable to move effectively. Continuous monitoring during twin births is standard hospital procedure so can we really trust any of the twin birth research to give us an accurate indication of what a woman is capable of?

In New Zealand you are within your legal rights to accept or refuse any care, to be treated respectfully, to ask for more information and to be given time to think about what you want to do.[15] Unfortunately this is not common in the USA unless the woman is giving birth at home with midwives but that is only about 1%. Pressure is often put on parents of multiples by medical professionals as well as society to go with interventions and especially to induce at 38 weeks (if babies haven’t already arrived). It is up to the parents whether or not to go with ‘just in case obstetrics’ weighing up the pros and cons of doing so or to carry on with pregnancy, eating well and having extra visits to their LMC as the days and weeks go on and wait for birth to happen spontaneously.

During labour there will always be a midwife present as you come to full dilation. During the birth itself you may have a second midwife (or third if you’re at home) or if you’re in a hospital there will be one or more obstetricians. There will be paediatricians (one for each baby) on standby either in the room or just outside ready to look each baby over once they are born. You can choose whether or not to have any students present.

The second baby may take time to get into a good position and be born. This could be minutes or hours. It is extremely rare in the USA for an obstetrician to wait for the second twin if the first has been born. Unfortunately in America most are now cesareans anyway. So long as the mother is being looked after just like a singleton mother still in labour then she will have a great chance of birthing the second (third or fourth) baby naturally. Patience; that is the key.

If you are having a caesarean then all of these people will be in the operating theatre plus an anaesthetist, nurses for the operation and obviously your partner (unless you are under general anaesthetic). So there will be a minimum of nine people, maybe more.

Most birth centres won’t allow twin births as they screen women for the likelihood of a successful vaginal delivery. Since births of multiples is considered risky by the medical profession, birth centres have a just in case attitude. However, if you don’t feel safe birthing at hospital and you’re all healthy it is possible to find a confident and experienced midwife to support you with a homebirth. Ideally you will live near a hospital. Since the place with the most twin births in the world is a small village in Nigeria with a very under equipped hospital, I would say you’re good to plan for staying at home.[16]

Remember… each baby comes out one at a time. What is required for a natural birth of singletons is also required for a natural birth of multiples.

NICU

The twins/ super twins came into the world together and I firmly believe they should stay together. Parents can talk with the NICU (neonatal intensive care unit) staff about keeping babies in the same incubator/open air crib.

A premature baby hasn’t got developed heat regulating systems yet and they are prone to breathing problems and heart rate issues. The monitors that inform staff of deviations can be quite loud and startle a new born causing the problems they are trying to monitor. You can ask that conversations, monitors and alarms to be as quiet as possible.

Kangaroo care is the term given to the care of a new born baby and their mother by keeping them close together with skin to skin contact and exclusive breastfeeding/ breast milk feeding with a tube, cup or spoon if the baby is unable to latch. Research shows…

Results of two studies of the effects of 2 to 3 hours of kangaroo care (KC), one a randomized trial of 25 premature infants in open-air cribs and the other a pilot of 6 premature infants who were at least 24 hours postextubation, who were cared for in incubators are reviewed. Both studies incorporated a pre-test/post-test control group design. Heart rate and abdominal skin temperature rose for KC infants during KC. Heat loss did not occur during KC, and infants slept more during KC. Kangaroo care had a comforting effect on infants and their mothers. Apnoea and periodic breathing episodes dropped during KC for incubator infants.” [17]

Breastfeeding

Below are some tips on breastfeeding twins. If breastfeeding multiples you will find this even more relevant! Keep a stash of expressed breast milk (either your own or from a donor) in the freezer for times when more than two babies want feeding at once. Exclusively breastfeeding triplets is possible but you will need someone to help look after you (making you food, helping with burping and changing babies).

Get everyone on board. If you want to breastfeed twins or more you need the support of the people around you. You need to work on this before the babies are born and arrange for a lactation consultant to visit you regularly in the first few weeks.

You don’t need to worry about not having enough milk. The more your babies suck and empty your breasts the more milk your breasts will produce. You might need to do some breastfeeding and pumping for the first couple of weeks just to get your milk supply up.

  • Breastfeeding twins together will leave you with more time for yourself! A baby feeding schedule isn’t always possible with two babies that have different needs.
  • Get yourself a comfortable twin nursing pillow before the birth to take to the hospital with you. A good breastfeeding pillow can ease allot of the stress, because you won’t still have to struggle with getting comfortable.
  • Be prepared to breastfeed often! Keep in mind that it gets easier as time goes by
  • Get together with other women who have successfully breastfed twins. Pick up some hints, ideas and advice
  • Do not assign your babies to their own breasts; rather keep putting them on the opposite breast every time you feed. If you do this, you won’t have one breast becoming bigger than the other due to them having their own sucking patterns.” [18]

Postnatal support

Get as much support as possible! Organise your support system long before babies are born. Make lots of homemade frozen meals to eat for the first few weeks after your babies are born. Ask all friends and family that visit to help with the house work and other children you may have. Do not be ashamed to ask people to bring a meal with them for your family that evening. It will take time to get into a routine with more than one baby and the routine may change every few weeks as their needs develop.

Remember that even with one new born the sleep deprivation and demands on your attention are very exhausting. Be kind to yourself. When the babies are older they will play with each other which in some ways makes it easier than having just one baby.

Relevant support groups and resources in New Zealand

Breastfeeding Twins: www.breastfeedingtwins.org

La Leche League: www.lalecheleague.org.nz

Multiple Birth Club New Zealand: www.multiples.org.nz

Twins & Multiple Births Association (UK) www.tamba.org.uk

Find a midwife (NZ): www.homebirth.org.nz or www.midwife.org.nz/index.cfm/1,155,html

I know you’ve been thinking about writing this for a long time and here it is! Congratulations. I loved reading it and you did an excellent job. Thank you.


[1] Elizabeth Nobel, Having Twins & More p. 32

[2] Elizabeth Nobel, Having Twins & More p. 30

[3] http://www.ncrponline.org/Publications/Reports/Misc_PDFs/Ultrasound%20Summary–NCRP.pdf

[4] Healthy Multiple Pregnancy Guide (pdf) www.tamba.org.uk

[5] www.drbrewerpregnancydiet.com/id36.html

[6] www.joyfulchildbirth.co.nz/pregnancy+eating.html#.UJXD0WeS-So

[7] Elizabeth Nobel, Having Twins & More p. 166-168

[8] Elizabeth Nobel, Having Twins & More p. 113

[9] www.adelaide.edu.au/news/news53341.html

[10] Healthy Multiple Pregnancy Guide (pdf) www.tamba.org.uk

[11] Elizabeth Nobel, Having Twins & More p. 438

[12] Multiple Birth Fact Sheet, Tamba. www.tamba.org.uk

[13] www.naturalchildbirthworld.com/natural-birth-triplets/

[14] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1349387/

[15] http://www.hdc.org.nz/the-act–code/the-code-of-rights/the-code-%28full%29

[16] Elizabeth Nobel, Having Twins & More p. 438

[17] http://www.ncbi.nlm.nih.gov/pubmed/8114658

[18] www.breastfeeding-problems.com/breastfeeding-twins.html

Easy Labour Massage for Pain Relief During Childbirth

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Massage during labour can either be completely relaxing and help speed up the process, or completely irritating and make the whole event last longer. So how do you know if you’re doing it right?Labour massage is very different from the type of massage you would get on a therapy bed and rightly so. During labour a woman needs to relax and switch off her thinking, judgemental brain so her body can feel safe and open up. Massage, when done correctly, will stimulate the body’s natural feel good, relaxation and labour hormone, oxytocin. The keys to making labour massage effective are repetition, a slow steady speed, comfortable pressure and a confident masseuse.Repetition allows the thinking brain to tune out. There’s no thinking of ‘what are they going to do next’ or ‘go back to what you were doing’. If you’ve ever stroked a cat, you’ll know the effects of repetition and a slow and steady speed. Go too fast or keep changing what you’re doing and the cat will stay wide eyed and interested. Keeping a slow and steady pace just stroking down the back will have the cat purring and lying down in no time. Labouring women are the same… slow and steady repetition will have her relaxed very quickly, even through contractions.Labour massage should never be painful. The techniques used must be solely concentrating on relaxation and not trying to dig into tight muscles. If you’ve ever had a sports massage you’ll know what I mean. We tense and hold our breath when we feel pain. Tensing during labour will affect the whole body and make the pain more intense. So, labour massage needs to be inducing relaxation and pleasure to help the woman cope with strong contractions. She will be able to relax and go with her body far more easily if she is being supported in a relaxed and caring way.

Let’s look at a popular technique that I would not recommend; circling up each side of the spine. During a normal massage, this circling technique is lovely to relieve muscle tension but it makes the receiver think ‘ooh that’s a sore bit, I didn’t realise I was tense there… just a bit higher/lower/left a bit/ right a bit’. This is not the dialogue you want a labouring woman having with herself. The same is true for shoulders, hands and feet. What you’re after is repetitive, steady and comfortable techniques that don’t make her think about either helping you (lifting fingers up for you to massage the next one) or what you might do next.

And lastly, the masseuse needs to be confident in what they are doing so lots of practice before the big day is essential. The labouring woman may not want to be touched, or think she does and then change her mind. A confident masseuse will not take this personally. A masseuse who is fearful, stressed or worried will not give as soothing a massage as someone who is relaxed and confident. Having said that, massage is a great way to relax the masseuse too so it may benefit both.

Here are some good techniques I’ve had great results with during the births I’ve attended…

Effleurage
This is a very relaxing and soothing massage stoke. To do effleurage is to stroke up the back from the sacrum using the flats of your hands, around the top of the shoulders and then sweep back down the sides. If done slowly and with a positive pressure (not too hard, not too soft), the recipient will feel totally supported and soothed. Massage oil is needed for this technique unless the woman is sweaty as that will act as a lubricant.

Using oils during labour should be kept to the absolute minimum. Grape seed oil is my favourite as it has very little odour and is absorbed nicely. Sweet almond oil is too thick and greasy for labour massage, as is baby oil.

Stroking

Using one hand resting on the floor or bed (be careful not to put weight from this hand on the body) use your other hand to slowly stroke down the spine. Start from the base of the neck and keep a continuous stroke going down to the very base of the spine. This is a deeply relaxing technique that can greatly help to reduce blood pressure and anxiety. You may be wanted here for a long time!

Face Massage

During labour a woman’s jaw can become very tight and cause a lot of tension in the rest of her body. Some women may also screw up their faces creating a lot of tension around their eyes and cheeks and also in their scalp. A great way to relieve stress and tension is to gently stroke the labouring woman’s brow, stroking from her brow and through her hair. Using circular movements with the flat pads of your fingers on the temples (light pressure) can help with eyestrain and forehead tension. And likewise, circular moves all along the jaw, right up to near the ears will help the labouring mother’s jaw to loosen. This has a nock on effect to the whole body. If the forehead and jaw loosen, tension can also be released in the stomach and abdominals. Also, a loose mouth means a relaxed pelvic floor (and thus not trying to hold baby in).

Head Massage

Head massage is often deeply relaxing and can help relieve headaches. Practise this technique before the birth to find out what preferences your pregnant partner has. There are two slightly different techniques: rotate the skin of the scalp under the pads of your fingers (move the skin not your fingers), or using circular moves, rub your fingers all over the scalp helping to get the muscles loosened. The former is very relaxing, the latter can also be invigorating depending on how fast and deep you do it. It may be that an invigorating head massage will help a tired woman find the extra energy to birth her baby.

Hands & Feet

When experiencing pain and discomfort, it is a natural reaction to clench the hands and tighten the feet. It’s difficult to tense your hands and no other part of your body. The more you can release tension in the hands and feet, the more tension is relieved in all other areas of the body. Even stroking a hand as you hold it has great benefits. Never underestimate the power of holding someone’s hand, especially if you’re helping them to relax it.

Holding her hand with both your hands you can use the length of your thumbs to loosen up the tension. Using stretching movements outwards on the palm will help ease tension and remind your partner to relax. The slower the moves the more relaxation you will induce. Start from the middle with both thumbs, and move them apart.

For the feet, rubbing the heel of your hand down the sole of the foot (from the balls of the toes to the heel) while support the top of the foot with your free hand will be deeply relaxing and prevent any tickling or pain.

Neck & Shoulders

Massaging the shoulders allowing them to drop down is often much appreciated during labour (and any other time!). You can use as much pressure as is comfortable for your partner. Be careful not to pinch the shoulders causing pain (ask for feedback). And do not over work tight muscles, or dig into them. Ensuring you are using a comfortable pressure will create more relaxation. Remember you’re not trying to do a therapeutic or sports massage, you’re intending to help the birthing woman relax. Use circular movements with your thumbs across the top of the shoulders, your fingers dropping down the front of the body.

When massaging the neck, make sure the head is supported either with the other hand, or by having the birthing woman with her head on a pillow. Have your thumb sweep up one side of the neck and your fingers sweeping up the other side.

Abdominal Effleurage

Using your effleurage techniques, you can help to relieve tension in the abdominal muscles by very gently stroking a labouring woman’s belly. The uterine muscles are more than capable of squeezing out a baby without the need of the stomach muscles. In fact tensing the stomach muscles can inhibit and slow down labour. By using gentle upward strokes with the whole of your hand, or gentle circular moves up the belly with the pads of your fingers, you can help the abdominal muscles to relax. If the labour has been induced with an oxytocin drip, this technique may be very useful to help a woman’s uterus relax between contractions.

NB Remember not to poke or prod the belly. Gentle pressure is essential.

Lumbosacral Pressures

There are several techniques you can use to help ease back ache (different from back labour pains caused by a posterior baby) and uterine pains.

If sore spots are felt in the sacrum area (if you have been practising your relaxation techniques you will be more aware of locations of pains rather than all over pain), then you can use elbow, knuckle or thumb pressures to help relieve the tension. The pressure must be no more than pleasure pain and hold until the discomfort subsides (which may be a while so make sure you’re comfortable!). Do not press on the spine, but on the muscles around the buttocks and either side of the sacrum. I have found this a very supportive technique for women who have experienced slipped discs or any chronic or acute back pain.

NB the sacrum is part of the pelvis that moves outwards during labour to make more room for the baby. This can be quite painful. It’s important not to put pressure on the sacrum bones themselves during labour as they need to move out (and not be pushed back in). Working either side of the sacrum itself is an effective way to make this process more comfortable.

The Lion Effect™ During Childbirth

By Samantha Thurlby-Brooks
Humans, like any other animal who is preyed on, are sensitive to certain stimuli getting their adrenalin levels rising ready to fight or run and sometimes to freeze. I call this The Lion Effect™; when in times of stress or perceived stress a person will get themselves ready for danger to protect themselves or their young for survival.Not that long ago, in terms of natural history, us westerners were living in caves as tribes. There are many human populations who still live this way where medical care is scarce and the danger of being killed by wild animals or people from other tribes is a reality. The ability to respond to perceived danger is vital and we have, along with other animals, developed a way to respond that means we don’t have to think too much about it; it’s automatic.Our modern day, western society hasn’t actually changed this danger response but we have renamed it; ‘stress’. Because we aren’t being chased by Lions or Tigers or Bears we don’t necessarily see ourselves as living in a dangerous society but our body’s and primitive, automatic brain’s don’t know the difference between wild animals and modern society. We can make our cars with airbags but our body still feels the potential for danger… we can lock our doors at night but that strange noise outside will get our adrenaline pumping.

We can birth our babies in hospitals where society says it’s safe. But our body doesn’t recognise the difference between a lion prowling and waiting expectantly for a new born dinner than with an obstetrician telling you to birth your baby within two hours or they will cut your baby out on an operating table or pull them out with forceps. This ‘Lion Effect’ makes your body do exactly what any mother will do; stop birthing to keep your baby in your belly where it’s safe so that you can either run, hide or fight the Lion and then resume birth later on when you’re safe.

It’s amazing how your body works… Oxytocin is the hormone that produces contractions also makes you calm and relaxed and helps you to bond with your baby. Adrenaline gets your heart pumping harder taking blood and oxygen to your vital organs and muscles allowing you to run or fight, keeping you super alert and focused. These two hormones are the opposite of each other. Your body will stop producing the relaxation and birthing hormone, oxytocin, when you need to run and fight. It makes sense.

Unfortunately the uterus is not considered a vital organ (probably because the woman isn’t always pregnant) so blood and oxygen are directed elsewhere and can cause the baby distress (if this happens too much or for too long). If in the birthing room your adrenaline levels go up, your birth will slow down or even stop. (Except just before your baby makes their way into the world you’ll get a quick boost of adrenaline to make you awake, upright and ready to look after your new baby and to grab your baby and run if need be).

When we consistently have high levels of adrenaline we suffer from stress because we feel there’s nothing we can do. During pregnancy, birth and mothering (including breastfeeding) this stressed state means that we constantly perceive Lions in the general area and our body must be super alert and be prepared to fight. Our baby’s interpretation is that this world isn’t safe. The mother’s body is in a dilemma; trying to choose whether to keep them safe and run or whether to stay still, calm and relaxed so she can feed and nurture her baby. Her hormones will not allow her to do both at the same time and will always choose survival.

Things that stimulate adrenaline and other stress hormones are;

  • Hunger (if you’re hungry you need the energy to find food and eat it)
  • Feeling Cold (if you’re cold you need to find firewood or shiver to keep warm)
  • Being watched or feeling observed (we sense when someone behind us is watching us and it makes us uncomfortable/ feel threatened which then makes us change our behaviour)
  • Fear (real danger or even imaginary; the mind doesn’t know the difference)
  • Excitement (I know you’re baby’s coming but staying relaxed rather than excited will help you more)
  • Other people’s adrenaline (we’re herd animals, if one person perceives danger we all need to respond… so everyone in the birthing room or when visiting a new mother must be positive, calm and relaxed)
  • Bright lights (hence why we turn the lights off when we want to relax and go to sleep)
  • Feeling too hot (ever tried to get to sleep when you’re just too hot?)
  • Needing the toilet (ever tried to get to sleep or have sex when you need the toilet?!.. oxytocin is the same hormone that produces an orgasm)

Keeping oxytocin as high as possible by staying calm, confident, supported and relaxed is vital to birthing your baby in an empowered and positive way. Mothers will respond better and nurture their baby’s more confidently when they are relaxed and supported. It’s just what happens naturally.

The most comfortable pregnancy sleeping position

By Samantha Thurlby-Brooks
Most of my pregnant massage clients find it really hard to get comforable in bed until I teach them these great tips. Contrary to popular belief it is actually possible to get a comfortable night’s sleep when you’re pregnant. Here’s how…

  1. During pregnancy it’s important to lie on your side. This is because you have a main vein (the Vena Cava) running up the side of your spine. Lying on your back with a heavy pregnant belly will compress this vein and restrict the blood flow for you and your baby. It’s likely to make you feel sick and breathless and your baby will kick and kick trying to get a better position and telling you to move. Generally from 24 weeks onwards you’ll need to lie on your side (earlier if you’re carrying twins or more). It doesn’t matter which side you lie on (changing sides helps your blood flow and allows baby to move around to get comfortable). From 34 weeks onwards it’s ideal for your baby to have his/her spine lying on the left side of your belly as this is a much easier position to start a good, healthy labour. When baby is awake and you’re lying on your side, make sure you lie on your left.
  2. Put a pillow under your top leg but NOT between your knees. Putting a pillow between your knees puts too much pressure on your bottom leg and doesn’t correctly align you. Your lymphatic system doesn’t have it’s own pump so putting a pillow between your knees will encourage fluids to pool in your feet (oedema) as your foot drops lower than your knee and hip. The other concern is that during pregnancy you have 40% extra and 40% thicker blood (more if you’re carry twins or more) which often has a hard time getting around the body. Varicose veins in the legs and groin are very common during pregnancy so putting the pillow between your knees will make it even harder for the blood to flow.
  3. The picture above is a very thick, sturdy pillow between the knees. As you can see it still creates a twist and pull in the hips and knee. Having a thinner pillow will create even more of a twist and leave you rolling forwards onto the mattress giving baby less space to get comfortable (baby will kick a lot during the night if you’re twisting hard). The other problem with a pillow between the knees is that your lower back is pulled and your pelvis is tucked under as you try to keep your knees together. Bringing your knees up towards your belly, tucking your pelvis under or rounding your back will create pains in your lower back and prevent baby from getting his/her chin to chest for an easier birth.
  4. Keep the hip, knee and foot of your top leg at the same height. So placing your top leg on a pillow you need to make sure it’s the correct height. If your leg is too high or too low you will feel pulling in your hips and/or lower back which can be painful or just uncomfortable. The height of your leg has nothing to do with how big your belly is, this is purely about keeping your leg in alignment with your hip to stop you from twisting. This position will relieve lower back and hip pains, allowing your muscles to relax and giving you a really comfortable night’s sleep. The Mumanu pillow is the only pillow on the market that keeps you correctly aligned like this and being self-inflating you can adjust it for your own perfect fit.
  5. Support your belly. From 20 weeks onwards it’s a great idea to put a thin pillow under your belly when you sleep on your side. You have ligaments that attach from your uterus to the base of your spine and so as you get heavier these ligaments can pull creating discomfort in your sacrum (just above your bum) and a pulling feeling in your belly. A thin pillow tucked right under your belly and your leg up at the correct height will have you feeling weightless! You can buy belly wedges which are even more comfortable than normal cushions.
  6. Hug a pillow. To prevent your shoulder from pulling and to protect tender breasts, hug a pillow (or a teddy bear!). Hugging a pillow will prevent your upper body from pulling forwards and can help to relieve pains around your bra line.
  7. Keep your neck straight. If, before pregnancy, you normally lie on your front you’ll need to change your pillow while you lie on your side. Make sure the pillow is thick enough to keep your neck straight and your head aligned with your body. If your head is too high or low you may experience headaches and neck and shoulder pains.
  8. One size doesn’t fit all. Long body pillows aren’t ideal during pregnancy. If the pregnancy pillow is thin enough to support under the belly then it’s too thin to support the leg. If it’s thick enough for the leg then it’s definitely too thick for the belly (will cause twisting). Long pregnancy pillows sit in front of the belly and give little support. All the pillows need separating out. Hugging on to a pillow is great for the shoulders but it should be separate from the leg and belly pregnancy pillows so you don’t curl or twist into it. The other issue with using normal fabric stuffed pillows to support your leg is that they easily loose shape during the night. You want something that’s supportive to keep you correctly aligned and totally comfortable.

A pregnant woman who rolls onto her back in her sleep will normally wake up within minutes… because it’s uncomfortable and her baby kicks her to wake her up. A pregnancy pillow that goes around you is unlikely to prevent this from happening (depending on how thick and firm it is). The Mumanu® pregnancy pillow doesn’t need to support you behind your back because it keeps you comfortably aligned and helps you stay in one place longer. If you do wake up on your back, just roll onto your side again. Having a pillow behind you will make you even hotter and also prevents your partner from cuddling up behind you.

Buy your Mumanu Pillow online today and receive free shipping as well as a comfortable night’s sleep!
Mumanu; the only pillow endorsed by Osteopaths New Zealand

 

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How to be a great birthing partner

By Samantha Thurlby-Brooks
You’ll often find in antenatal classes that the teacher will be very confident in telling you that “the role of the birthing partner is very important”. And that’s where they often stop; no tips, no advice, just the statement that you are very important! So if you are so important, how do you know if you’re doing your ‘job’ correctly or if there is in fact a ‘job’ for you to do as your partner breathes deeply and focuses on her contractions?It is true that a birthing partner’s role is very important, but not essential. A woman can safely give birth without a ‘team’ around her and would often be much safer to give birth in privacy. If a woman decides to have you with her for the birth of her baby it is essential for the health of both mother and child that you understand and carry out your role effectively.The three main things to remember about your role as a birthing partner is to

  • stay relaxed
  • encourage and reassure her
  • hold her
  • become invisible and
  • keep the space safe

STAY RELAXED

Staying relaxed during the birth of the baby is as much the role of the birthing partner as it is for the woman in labour. If you are feeling anxious, irritable, restless, worried or aggitated, excited or even hungry you will increase your levels of adrenaline (the fight or flight hormone that raises your blood pressure and gives you a boost of energy). Adrenaline is a very contagious hormone, the effects can produce responses in those around you. During labour, if anyone has adrenaline pumping through them it can mean, for the mother, that it is not safe for her to give birth and so labour may slow down or even go backwards. Oxytocin, the hormone responsible for labour contractions, will decrease or not be released if adrenaline is in the body. It is possible for a womans’ cervix to contract from fully dilated to 7, maybe even 6cm if the situation is not safe for her and baby. Sometimes the baby will not come down the birth canal and labour suddenly stops if there’s too much tension and adrenalin in the room.

So how do you relax when you’re about to become a father, grandfather, grandmother, aunt or uncle? Read a book, try and sleep or practise meditating are all great ways to relax during childbirth. Leaving the room if you’re feeling anxious is the best way to unwind and relax. You’ll greatly benefit your partner if you are not present at times when you’re not coping with the situation so you can regain perspective and come back feeling refreshed and calm. Try and stay away from tea and coffee during the labour (especially because the smell of coffee can be very strong) as these drinks increase your adrenalin.

The first stage of labour, where the woman’s body is opening and stretching to allow the baby to come down far enough for her to start pushing, is very boring for those who are not feeling the contractions. The contractions will come and go at five to three or less minute intervals which can go on healthily for over 24 hours. If you cannot find a way to relax through this phase of labour you’re going to have a very uncomfortable wait! Childbirth is about being patient and relaxing into whatever unfolds for however long it takes. Practise relaxation and being still on a regular basis for at least four weeks before the baby is due.

BECOME INVISIBLE

Becoming invisible during the whole of the labour is essential for the birth of any mammal. Farmers and vet’s know full well that openly watching a sheep, horse or cow during the birth of their infant will cause major problems to the health and bonding of the mother and the baby both during and after the birth. The same is true for humans. All mamals need privacy during birth because an animal that is being watched during such a vulnerable time means that there is a predator around and will increase adrenaline levels in the mother allowing her to stop or slow down the labour so as to fight or run.

When in the birthing room with the labouring woman try and find a discrete corner to sit in out of the way. She will often hide her face or close her eyes which is great. Try not to interupt her or get her attention while she is doing this. Do not openly watch your partner or tell her how she looks/ sounds/ appears as this will get her brain thinking and cause her to come out of her ‘animal’, meditative state. However much you want to talk to your partner about how things are going try and refrain from doing so. The only reason you’ll be doing this is for your own good and will not help her. If she wants to talk try not to encourage her by getting into conversation with each other. Conversation will get her out of the relaxed and meditative state her body will naturally put her in to. Answer any questions with very simple positive language and a kind smile.

Sometimes during labour, a woman who’s in her ‘animal’ mind (the best way to increase the hormones and have a great and easier labour) will say and do some strange things. Making strange noises and movements are great and you can rest and relax knowing that she’s labouring really well. Remember to stay invisible and do not comment on any of this behaviour.

KEEP THE SPACE SAFE

Keeping the space safe during the labour and birth means a lot more than making sure cables are out of the way and the birthing pool water is the right temperature. Keeping the space safe means ensuring that the birth process is respected and kept uninterrupted. By being invisible and relaxed you are keeping the space safe. By ensuring the rest of the people in the birthing room are doing likewise is also keeping the space safe. Many midwives and doctors either don’t know or don’t understand the true birth process or don’t see the importance of keeping it in tact.

Interrupting the simple process of birth by watching the labouring woman, trying to get her thinking and answering questions, making comments that will make her feel self conscious, self pitying or fearful, keeping the lights bright or trying to get her to change positions and coaching her to breathe or push will all have a negative impact on the ease of the birth. Having a foetal monitor strapped to the labouring woman is also a source of observation and acts in the same way as someone sitting infront of her staring. Ask if it is possible for the midwife to use a dopler (a hand held instrument that listens to the baby’s heart beat) as this can be much less intrusive. The baby knows when it is being observed and may become distressed with a constant machine monitoring him/her.

It is your job, as the birthing partner, to ensure that there are only the essential people in the birthing room; the woman in labour, a midwife (not necessarily all the time) and yourself (also not necessarily all the time). Obstetrician’s sometimes like to come in to introduce themselves. You are allowed to ask them to leave or request that they do not enter the room if everything is going fine as the more people in the room the less privacy there is and the birthing woman should be left to relax and focus on herself and the baby. The more a woman in labour is able to focus purely on herself and the baby, the quicker and easier the birth. Your role is to create the space for that to happen.

As an add on to your role, the birthing partner acts as a voice for the labouring woman. It is therefore important that you know your birthing woman’s details (e.g. postcode, date of birth, national security/health insurance details), her medical history, allergies, time difference between the contractions, her birthing wishes (natural birth or types of medication or intervention she does/doesn’t want).

So, make sure that you are well fed, well rested, calm and happy to be in the birthing room. That is your job, nothing more and nothing less. By understanding the true importance of doing very little during the whole of the birth process you will be the best partner you can be and will know that the birthing woman is having the best possible chance for a natural and enjoyable birth.

Breathing for Pain Relief During Childbirth

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By Samantha Thurlby-Brooks
It does sound a little strange to say “remember to breathe” during labour, but you’ll be surprised how often we hold our breath in day-to-day activities, let alone while giving birth.When you’re experiencing any sort of discomfort, the immediate reaction is to hold your breath. This will cause you far more discomfort, as well as making you light headed, unfocused and increase your experience of pain as well as making you stressed and irritable.

To force your breath while experiencing any discomfort or intense feeling will also create muscle tension, even if you’re trying to breathe deeply. The ideal way to breathe during labour is to focus on your breathing. You don’t need to try to change your breath, just make sure you are breathing and stay focused on that. Pay attention to what part of your body you are breathing in to; your upper chest, your belly and the sides of your belly. Once you’re focusing on your breath it will naturally and automatically start to change and become more relaxed, full and deep. Whenever your attention goes to something else, bring your focus back to your breathing.

Essentially what you’re trying to do it to empty your lungs every time you breathe. When your lungs are empty you can allow the breath to come back to you in a relaxed way. Trying to force the breath in will create tension. Letting all the air out, and then letting your body bring the air back into your lungs will bring you a deeper relaxation.

Putting your attention to your breath throughout labour will help you through the contractions and help you to rest in between. You can also practise this breathing through the second stage of labour, as your baby is coming down and out, inbetween pushing. The old fashioned teachings of panting to try and stop yourself from pushing is now out-dated. Practise panting now and see how you feel. You’re likely to become very light-headed and feel disorientated; not something you want if you’d like to get the most out of your Joyful Birth. By breathing in a relaxed, deep and focused way, as described above, you’ll reduce your experience of discomfort and increase your feelings of empowerment and control.

Practise focusing on your breathing throughout your pregnancy; both you and your baby will benefit. You’ll find that you will be more relaxed and calm and once you go into labour you’ll be well practised at breathing correctly.

Simple tips to make birth easier & safer

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  • Stay Warm
  • Darkened Room
  • Quiet
  • Relax
  • Privacy
  • Feel Unobserved
  • Breathe
  • Trust Your Body
  • Eat Nourishing Foods, Drink Plain Water

Over the past few millions of years, humans and mamals have been giving birth without the use of hospitals, doctors or epidurals, for the most part, very effectively. The female body is designed to give birth very successfully and efficiently without the need for conscious control. In fact, the more you try to control the functioning and experiences within your body as you go through labour and childbirth, the more uncomfortable, stressful and prolonged your experience will be. Here’s why…

The thinking part of your brain, called the NEOCORTEX, is responsible for your intellect. This part of the brain, when stimulated, will try to rationalise, criticise, control and generally act very ‘human’ towards a situation. The neocortex is stimulated by language, bright lights, feeling cold, feeling observed and certain forms of touch. If this part of the brain is stimulated during childbirth, it will prevent the ‘mammalian’ side of the brain from functioning effectively.

During childbirth, if a woman’s neocortex is stimulated the whole birthing process will slow down. Being asked to think (for example asking what her phone number or postcode is, how frequent her contractions are or asking her to score her pain levels), being in a room with bright lights, being watched by one or more people or being touched in an irritating rather than relaxing way, a labouring woman will be taken out of her ideal state and become self-conscious, fearful and her muscles will tighten and create pain.

Allowing a labouring woman to relax and to ‘zone out’, turning off her neocortex, will make her labour more comfortable, faster and easier. This applies to the whole of the labour, from the beginning of the first stage right through to the delivery of the placenta. Staying in a non-thinking, meditative, animal state will help you to experience the birth of your child in a more Joyful way.

By understanding the process your body will undergo to allow your baby to be born will help you to feel more confident and relaxed.

During the first stage of labour, your uterus will be stimulated by the hormone OXYTOCIN to allow the muscles to pull up and outwards. This allows your cervix to become thinner and move out of the way to allow your baby to pass through your vagina. This means your cervix is dilating. Your cervix can dilate very quickly, so even if you’ve been having contractions for a while and you’re 5cm dilated, you may become fully dilated within an hour if you’ve allowed the conditions to be right (relaxed, unobserved, dim lighting and possibly contact with water).

With each contraction, remember that you are getting closer and closer to holding your baby in your arms for the first time. This is a Joyful process and your baby is looking forward to seeing you just as much as you are of him/her. Having negative thoughts and feelings about your contractions will make them feel even more negative. Feeling positive in your thoughts and emotions will allow the experience to be easier and faster.

Once your cervix is fully dilated (about 10cm), your uterus will respond by squeezing your baby’s bottom (if they’re head down) helping to push your baby downwards and out through your vagina. The wall of your vagina will already be lubricated by a pinkish substance to help your baby slip through. Make sure you’re still focusing on relaxing your breathing at this stage as your pelvic floor muscles around the opening of your vagina will need to be relaxed to allow a more comfortable birth. If your baby is in the ‘optimum position’ (chin to chest) then at the time of birth they help themselves to be born by wiggling and turning and lifting up their chin. This is the safest, quickest and easiest way for a baby to be born.

Just before the second stage of labour starts, you’re likely to feel a mix of emotions. It is at this point that many women opt to have drugs to ease the experience. A certain amount of pain during labour is very healthy and in fact essential for a Joyful Childbirth. Once your baby has been born, both of you will have a huge cocktail of hormones running through you, one of them being an endorphin that will make you feel fantastic and help with the bonding between you and your baby. By using painkilling drugs, you are likely to disrupt this cocktail of hormones and your experience of childbirth will be hampered.

Ask your midwife/medical carers not to offer you medication throughout your labour, and to only give you medication if you ask for it (in fact I would say if you ask for it more than once, just in case you can go without it). It is standard procedure to ask a woman if she would like medication, and during labour when it gets intense, you’re likely to accept anything. Encouragement, reassurance and a positive attitude will get most women through without medical pain relief.

During labour and the ‘crowning’ of your baby, you’re likely to feel the whole region as being very warm and expansive. Your bones, joints and muscles in and around your pelvis are making way for your baby and they’ve had nine months to prepare so are more than capable of doing this job. You won’t be the first or last woman to think you’re going to explode during childbirth as your body shifts and changes. But no woman has! In fact, some women orgasm at this stage because of the stimulation of all those wonderful, sensitive parts. It’s important not to be ‘coached’ through the second stage of labour so you and your baby can listen to your body and move and respond in a safe and instinctive way.

Once your baby is born, you and your new baby will both have a huge rush of hormones running through you. Dr Michel Odent discribes these as a ‘cocktail of Love’. It is very important for you and your baby that you are not disturbed during this time. Not only will it help with breastfeeding, but also with the bonding of you and your baby and your memory of childbirth. These hormones will make you feel full of life and love even if you’ve just come through a long labour. Painkillers can often disrupt this process. Ask your midwife to leave you alone with the baby for an hour following the birth so you can focus your whole attention onto your baby (if you ask for an hour, then if you get a bit less it’s better than asking for half an hour and getting a bit less). It is very important to STAY WARM at this time to allow the hormones to release.

The birth of the placenta, according to Dr Michel Odent is not too important… the only thing that is important is to allow the placenta to release itself from the uterus walls naturally. Using a synthetic drug rather than the natural release of oxytocin increases the risk of bleeding compared to being left alone with your baby to increase your own natural oxytocin release. Synthetic oxytocin may also inhibit the natural release of oyxtocin needed for breastfeeding shortly after birth.

The hormones that are rushing around your body during pregnancy and birth will be opening your emotions as well as your body. Feeling very open and vulnerable is very healthy and normal during childbirth and gives you the opportunity to let more feelings of love run through you. So long as you feel safe and relaxed with the people you are with and the place you are in, the birth of your child can be a truely Joyful and empowering experience.