Something that often comes up, talking to women about their plans for labour and birth, is the idea of keeping control. There is talk of birth plans, options, to have an epidural or not. For some, keeping a sense of control means planning to labour and give birth in their own homes. For many it is having access to help, knowing that the epidural is available and requesting it on arrival.
When I embarked on this journey myself, so many years ago, there just wasn’t so much talk about how difficult we might find labour so without it being stated clearly we just accepted that it would all happen (probably) and that we would cope. We covered a good deal on mechanics and the importance of staying upright, giving the pelvis that all-important extra 27 – 30% of space. I hadn’t really considered that my labour and birth wouldn’t be anything other than straightforward. In my NCT classes we learned how to breathe deeply, to surrender to our bodies, to get to understand how our bodies worked and how by switching off from the world around us we would be helping our natural instincts to kick in. Each week we would try another breathing exercise, keeping the lips loose, being taught the link between the mouth and the pelvic floor. It was all very physical. Relaxations, often lying down on the floor, were also introduced regularly as were other physical skills such as massage and instilled in us was the importance of movement. In my midwife -led clinic classes, too, I recall a lot of time was spent sitting around breathing and relaxing.
We seem to be so much more complicated these days. Life seems so much more complicated and we are bombarded with choice, or so we are led to believe. In my NCT classes we look at what choices are available and consider, if the group wish to, the pros and cons of various options. Sometimes we role-play tricky situations such as how to deal with things not going quite to plan or how to ensure women get the birth they really want.
All this requires thought. And that is where it all starts to fall apart because as soon as a woman in labour is disturbed and is asked what she thinks, she is startled out of her trance-like state, a state where her endorphin levels are at their highest, aiding the release of oxytocin. This is the magical hormone that gets the uterus contracting in order to draw up the cervix and push the baby out. Adrenaline kicks in as she realises she is back in the room and oxytocin is knocked back. Labour takes longer, she gets tired, her pain threshold is reduced and so she begins to think that actually that epidural doesn’t sound such a bad option after all, even though in her birth plan she did say she did not want to be offered it.
I am not averse to the idea of thinking things through beforehand however but no longer quite so sure that this is always the best approach for everyone. What I do accept however is that for some this is exactly what they want which is why I continue to teach my NCT classes.
So, to return to the idea of a woman in labour keeping a sense of control. She may need help with this. She needs to be treated with empathy and gentleness. Michel Odent, French obstetrician and pioneer of the use of water for labour and birth, talks of the importance of talking to a labouring woman using simple words that a child would understand. For many women silence works best of all. Whether she favours massage, deep breathing and visualisation, hypnosis methods such as Natal Hypnotherapy, or simply having a familiar face with her, the more a woman can shut herself away from the room and those in it, the more her body will respond as it knows exactly what to do, which is an amazing thought. Her body has known how to conceive, or if she had help with that, her embryo was able to be accepted and be nurtured over the weeks and months. No talk of choice, of options. No need.
Ultimately the less she tries to stay in control, the further away she is from using her logical, conscious brain, the more her body can take over and just get on with the job. Simple.