kathy fray’s motherwise kathy fray’s organic childbirth

For a more detailed labour guide, do read my OH BABY book’s Childbirth chapter. www.kathyfray.com

So very often when talking with a first-time mum-to-be about Childbirth, their focus is all about the Birth, being somewhat still unaware of the enormity that before a birth, is the Labour. That is why, as midwives, we refer to the event as Labour & Birth. (Labour is the cervix dilatating stage, and Birth is the pushing stage – and of course there is also a third stage, the AfterBirth being the Placenta.)

Labour is called Labour, because it is laborious. And for a new mum, reflecting retrospectively after the birth, there is nearly always a blown-away awesome respect of just what LABOUR entailed … a “I had no idea” reaction. And for most first-timers, Labour takes about three nights: Two overnights of Latent Labour, then the third night establishing into Active Labour. Sometimes quicker. Sometimes longer.

Bearing in mind advice from your midwife/obstetrician, Labour is about trusting your Body (and doing so can oftentimes be a real ‘first’ in a woman’s life, after years of trying to control her body). But your body has the collective history of millions of years evolving and knows how to do the primary life function of childbirth. So trust Mother Nature’s process – she has billions of women going before you.

Love & Light,

Kathy

MotherWiseP R O D U C T S

Kathy Fray’s

www.motherwise.co.nz

Bianca Duimel Photography

Organic ChildbirthUnderstanding the Secrets toNatural Labour & Normal Birth

Kathy Fray’s


1st STAGE OF CHILDBIRTH: LABOUR(Latent phase – Active phase – Transition phase)

For most first-time mums-to-be the Latent Phase takes around 8-20 hours over a couple of nights (and about 5-14 hours for second-timers). But of course there is also enormous variation too. In my experience, the Latent Phase is a time that should not be rushed – because the longer the Latent phase (of moderate contractions ripening and softening the cervix), then usually the shorter the Active phase (of strong contractions stretching the cervix fully open). You want a longish Latent phase.

For most first-time mums-to-be the early Latent phase can take just a few long hours, but typically takes an overnight of niggling contractions to soften the cervix, which you can sometimes doze through (eg 10-20 second mild-moderate contractions every 10-20mins). This is the time to stay upbeat emotionally and relaxed physically (save your energy). And expect that usually after the sun comes up, the contractions peter off. Labour is a nocturnal activity.

For most first-time mums-to-be the main Latent phase takes about 8 hours (around 5 hours for second-timers). During this period your cervix begins to ‘efface’ (thin and shorten), as the upper-segment of your uterus (top half your womb) ‘pulls’ the cervix upwards, until eventually it will be fully-effaced (thin and flat against the baby’s head at the bottom of your womb, at the top of your vagina). This can take a few hours, but typically takes another overnight of stronger and more regular contractions, which you likely can not sleep through (eg 30-second moderate-strong contractions every 5-10mins). This is the time to start to bunker down at home, and save your energy.

During the advanced Latent phase, your fully effaced (very thin cervix with no length) begins to dilatate (open by 3-4cm). This may only take a few hours of stronger contractions you definitely can not sleep through and sometimes will not be able to talk through (eg 45-sec stronger contractions every 4-5mins). This is generally not the time to travel or change your labouring environment (such as

lots of people arriving), as any hit of Adrenaline may cause your Latent Labour to pause.

Once properly establishing into Active Labour your cervix will be at least 3-4cm dilatated, and this obstetrically officially marks the beginning of actual ‘real’ labour. Depending on your geographical location, medical history and midwife/obstetrician recommendations, it is normally best to stay in your home environment for another 1-2 hours (with a first labour) to successfully establish into strong Active labour before transferring to your Birthing facility (if not having a planned homebirth), to get labour so strongly established that the adrenaline of transferring won’t slow your labour … which is the woman arriving at Birthing Suite saying “Well the contractions were much stronger before” being discharged home to finish establishing into Active Labour.


Often we talk of the 3-1-1 ‘rule’: 3-4 contractions every ten minutes, all over 1 minute long, for at least 1+ hours as being when to call your midwife/obstetrician. Obstetric literature talks of the average length for a first-time mum-to-be in the Active Phase of Labour as being around 8 hours (and 5 hours for second-timers). Usually longer if opting for an Epidural – and sometimes much, much faster with natural spontaneous labours. At this point your 3-4 contractions every ten minutes are all 60-90 seconds long, and strong, which you definitely can not talk through. Because adrenaline reduces contraction strength, so slows cervix dilatation, it makes adrenaline the ‘enemy’ of Labour. So this is when you have to start intentionally taking deliberate control of your own emotional feelings, using long inhalations and controlled exhalations, and between contractions smiling with joyful happiness. I am not kidding! Relaxed face = Relaxed vagina. And ONLY YOU can do this for You and Your Baby. Bigger the smile – shorter the Labour, seriously.

With a first natural labour, it is reasonable to allow a couple of hours per 1cm of dilatation (one hour per cm for second or subsequent labours), before declaring some ‘failure to progress’ needing Oxytocin drip augmentation, or C-Section. Sometimes dilatation can ‘stall’ a little bit which is typically to do with the flexion of the baby’s head or the anxiety of the mother (or her birth support people exuding anxiety). Oftentimes, the mother changing position, and having a litre of fluids intravenously to rehydrate her, and receiving loving reassurance that everything is normal and as it should be, can altogether greatly assist. In reality, many (most) natural labours do dilatate much faster than 1cm every 2 hours.

A few hours or up to half a day later, you will enter the Advanced Active or Transitional Labour phase, once you have reached 8-9cm dilatated. This is the hardest part of Childbirth. This is when frankly most of us want to call it quits and go home. This is when the contractions can be unfathomably tumultuous, unbelievably strong and long, almost rolling on top of each other, with hardly a break between them. This is when we as women in very strong labour, need a strong midwife to look us straight in the eyes and say “You are in Transition, your cervix is almost fully dilatated, I know it’s hard, I know it’s harder than you ever imagined it could be, but we will get you through this. Now BREATHE!” This is also the time you typically start to feel pressure in your back passage as if you need to do a big poo. But that is no poo darling – that is your baby’s head pushing on your rectum. That is a fantastic sign, and that sensation is just going to get stronger, and stronger, and STRONGER.It is like, that at about 8cm dilatated, you experience strong contraction pain with a bit of rectal pressure. Then by 9cm it is feeling almost 50/50 as the pressure is starting to become hard to resist not to bear down on, but still keep breathing and blowing, breathing and blowing out … like you’re furiously blowing a cloud across the sky. Then finally once your cervix is fully 10cm dilatated, there is only PRESSURE, PRESSURE, PRESSURE! The pain as such has dwarfed. Pressure with its irresistible urge to push is all you can feel – and you absolutely cannot NOT push anymore! You have to push, even if you try not to push, your phenomenal body is pushing involuntarily.

Now my darling, my amazing extraordinary brilliant remarkable Woman, now it is time to Give Birth to your baby.


What is Normal in Latent Labour?

• Erratic or regular contractions, less than one minute long, every 4-30 minutes, that are initially period-like and mild, and eventually sharp and painful. Over hours or days, the contractions become longer, stronger and more frequent. Try not to complain that the contractions are strong – of course they are, your baby can’t be born unless they are. Say to your body “Come on, I can take it, give me your longest strongest contractions, I want to birth my baby”.

• Waters that are intact, or waters that are ruptured (broken) then leaking (a constant dribble). Clear, straw and pinky colour waters are all normal. (Call your midwife/obstetrician if waters are a green-brown colour).

• Diarrhoea and/or Vomiting – your body is emptying itself to anatomically make room for your baby to later descend.• Backache – especially if your baby’s back is pushing on your back

rather than pushing on your bellybutton. Use leaning-forward positions, or lie on your left side in the ‘recovery’ position, to encourage your baby to rotate its back to the front.

• Overwhelming feelings of utter exhaustion (or bubbling excitement). Try not to whinge about how tired you are. Your body knows it has a marathon ahead of itself, so is forcing you to conserve your energy. You simply need to listen to your body.

• Mucous-bloody “shows” (like the amount of a nose-bleed) are normal as a positive sign that your cervix is opening. (Call your midwife/obstetrician if you start to actively drip continual fresh red blood. A healthy normal woman haemorrhaging larger amounts of blood during a spontaneous natural labour is rare and requires urgent immediate hospital medical assessment.)

What should I do during Latent Labour?

Preserve and reserve your energy and stay positive! Strategy plans:• In your head try to ignore the early latent-labour contractions. Try to sleep, or just get on with your normal day.• Distract yourself: Go for a beach walk, play scrabble, binge-watch a TV series.• When you have been awake all night with early latent labour, as the contractions peter off with it being daylight, then become like

a cat and doze-&-snooze as much as possible during the daytime … you don’t know when your next long night-time sleep will be.

• Eat high-energy complex-carb food, eg grain bread, potatoes, wholemeal pasta, brown rice. (Childbirth = 50 mile hike, so keep well nutriented, well hydrated and well rested.)

• Do NOT! get frustrated at the length of your latent labour phase … remember the longer the latent phase, often the shorter the strong active phase! The more your cervix softens and ripens in latent labour, then the easier it can stretch open in active labour. Patience emotionally is the key. Trust the process.

• Once you are having regular strong contractions every 5 minutes, it is time to rally up your support crew, and time to intentionally cocoon yourself, so you can deliberately focus on your breathing. Have your birth support person(s) pull the curtains across,


light candles, put on relaxing music, use aromatherapy, turn off the phones, and disconnect from the world.

• Labour is always running on one of two main Hormones: Either Adrenaline (fear & anxiety = slower diltation), or Oxytocin (love & trust = faster dilatation). Your responsibility is mentally to keep your head in a great space – it shortens your labour. And Oxytocin, the hormone of labour, is a ‘shy’ hormone making labour a primal experience requiring peace and serenity and inwards focus, so order everyone in your environment to STOP TEXTING!!! It’s phones off time.

• You now need to turn deep inside yourself to find your Goddess Self that has been there since the moment you were conceived. And mentally, emotionally, spiritually, UTTERLY SURRENDER to the pain. Let it wash-over you, not take-over you. Go deep into yourself before, during and after each contraction, breathing deeply and slowly. Disengage your time-aware active-thinking brain, and engage your time-unaware zoned-out primitive brain. Know dilatation plateaus (a slowing) are not uncommon at around 4cm, 7cm and 9cm.

• Intentionally doze-off into ‘power rests’ between contractions. • Water-In, Water-Out: Sip water after every contraction, and empty your bladder

every hour. Stay well hydrated!• Sip Cinnamon tea. Chew on Ginger crystals. Eat pineapple. Use Labour

homeopathic tinctures.• Walk, rock, kneel, dance, visualise, lie on your side, relax, enjoy, be proud. • Keep your head-space emotions in an upbeat chatty positive place … giggle,

laugh or smile after every contraction … “Wow! That was a really strong one, yay!”

Note to Birth Support Person(s)

• Do chill-out and somewhat ‘underestimate’ what is going on, as chances are she still has many hours to go. Stay calm, remembering anxiety within her environment slows her labour by inhibiting dilatation.

• Do NOT take on a role of Time-Keeper noting down the frequency and length of every contraction. Instead, when you suspect strong regular contractions are all almost a minute long, and regularly 3-4 minutes apart, then discreetly time some to confirm she is nearly establishing into ‘real’ Active Labour. (Do NOT download a contraction-timer phone app – argh)

• You need to physically assist her to the toilet and shower or bath, and help with mobilising into whatever leaning-forward positions she is instinctually desiring (and they could constantly change as the baby’s head flexes and descends). Plus administer massage, reflexology and acupressure, as she does or doesn’t desire (which also can constantly change, or stay the same for hours).

• Labour is not a race, and there is no time limit. The mum-to-be needs a low-sensory environment to reduce neocortical stimulation – a space that feels devoid of time, with few words, no numbers, no clocks and only non-anxious presence.


2nd STAGE OF CHILDBIRTH: BIRTH

Now all those days of labour, and weeks of waiting, and months of pregnancy, and years of pondering motherhood, are all coming to culminate in this gloriously monumental moment of giving birth! Oh the enormity of it all – and yes it is a magnificent moment in time, every time. In a year from now this date will all be about the First Birthday Party and blowing out a candle. In 5 years from now this date will all be about starting the first day at School. In 13 years from now this date will all be about celebrating having a child who is a Teenager. In 21 years from now, this date will all be about the preparation for a brilliant 21st birthday party and sticking up two decades of photos of all those special moments in time ahead of you both – mother and child.

But right now, right today, everything is coming down to this next hour or so of pushing harder than you ever imagined you would need to, or ever imagine you could do. But you can do it. Just like I did it. Just like your grandmother did it, and her grandmother, and her grandmother, and all those millions and billions of women before you.

Birthing a first baby can take two-three hours of effective active pushing – but oftentimes half that length, and with subsequent babies often just minutes. With regular long strong contractions, and babe’s descent progressing, and the fetal heart-

rate reassuring, then it is normal to just keep going for that 2-3 hours, before declaring there being any kind of ‘failure to progress’ requiring instrumental (ventouse/forcep) delivery or C-Section surgery.

At this point it’s all up to you. The stronger you push, the sooner you’ll meet your baby: Get focused. Don’t whinge and whine. Don’t get frustrated. Have patience. Stay in control. This is you doing Birth – not birth doing you. All through the Labour dilatation, you needed to find the Goddess in you. Now you need to access the Warrior in you. Get strong. Get ferocious. And PUSH!!

Then finally your midwife/obstetrician will see “vertex peeps” (when your labias part during pushing and there is a little view of baby’s head). This is an immensely positive thing. This baby is almost definitely not being born by C-Section. So PUSH!!

Then they will start see “vertex on show” when even between contractions baby’s head is clearly visible. This is a truly awesome thing. This baby is almost definitely not being born by Instrumental delivery - and is likely to be born within minutes! Now PUSH!!

Then as the baby’s head crowns with your labias being stretched wide, you will be told to stop pushing and now pant-pant-pant your baby’s head gently through that intense stretch (a ring-of-fire sensation that just lasts a few seconds), then the head is Born! Then the shoulders and the whole baby’s body.

… And finally you meet your Baby. Unreal. Surreal.You have done it! You have done it!! You have done it!!! Rapturous joy … Euphoric happiness … Ecstatic bliss


3rd STAGE OF CHILDBIRTH: AFTER-BIRTH

An empty and well-contracted womb does not bleed, but until it is empty and well-contracted there is around a 20% chance of some level of excessive blood-loss (in other words, it’s not uncommon). So as soon as a baby is born, midwives and obstetricians always naturally become hyper vigilant to monitoring your blood-loss.There are basically three ways a placenta arrives:

• PHYSIOLOGICAL BIRTH OF THE PLACENTA: This is meant to be the ‘default’ mode for all natural births, with women who have no risk factors for haemorrhaging (excessive bleeding). This is when 5-60 minutes after birth, the womb begins to contract again and expels the placenta (often once the babe starts suckling the breast).

• ACTIVE MANAGEMENT DELIVERY OF THE PLACENTA: This is generally the ‘norm’ for women with pre-existing risk factors for haemorrhaging (eg low platelets, oxytocin drip during labour, the large womb of twins, a history of post-birth haemorrhaging, etc) – and it is the method used if a woman is actively bleeding. This is when you are generally given an injection of oxytocin, then the midwife/obstetrician uses controlled traction on the cord to deliver the placenta.

• MANUAL REMOVAL OF THE PLACENTA: This needs to occur in theatre with spinal or general anaesthesia, due to the entire or part of the placenta being retained. And thank goodness for modern obstetrics – because even today in some third world countries this can be a death sentence to the mother who will eventually die of septicaemia (massive infection) – but for us, it just means the slight inconvenience of needing to go to theatre after the birth. How grateful we should be to have access to such wonderful care.

“Pizzas are delivered.Strong women give birth.”

Joan Donley, Iconic NZ Midwife


Strategies for managing the pain of Labour

FREE eg Positional techniques, Water, Massage, Heat packs, Hypnobirthing Meditative Labour.Along with a wonderfully supportive labour-birth assistant and the mother having a positive non-anxious mindset, these are the most powerful non-drug pain-management techniques I ever witness. Meditating through labour (aka Hypnobirthing) is nothing less than phenomenal – it’s about letting the contractions wash over you instead of take over you. I recommended meditating 15-20mins every day from 32-weeks onwards, to get used to finding that ‘space’ – to practice getting into your ‘zone’. Plus the hydrotherapy of using the shower in early labour, and using the pool in advanced active labour are also both excellent.

COMPLEMENTARY NATUROPATHY eg Homeopathy, Herbal Medicine, Rongoa, Aromatherapy, Ayurveda, TCM, TENS.Speak with your medical herbalist or naturopath at the local Health Store. There are great labour-birth aid remedies available. And prebook rental-hire of a TENS machine (strongly recommended for all first-time labours) – and I have found it is best not to start using it until strong contractions are 4-5 minutes apart. Do use your homeopathic drops and put Bach’s Rescue Remedy in your drinking water. Do everything. Do the lot. It all helps!

LEARNED eg Acupuncture & Acupressure.Do your research and encourage your birth support person to learn these skills.

NITROUS OXIDE (Laughing Gas Entonox).Available at the Birth Centre and Hospital. Useful for strong active labour to “take the edge off”and calm anxiety. Does not harm the baby or hinder the labour. Also useful in conjunction with the pool for advanced active labour during the Transition phase.

OPIATE (eg. Pethidine).Typically ideal for the early phases of a long induced labour. (Not suitable if birth is imminent within the next 1-2 hours, because this narcotic is also a respiratory depressant, so can cause breathing distress in a newborn.)

EPIDURALOnly available from an Anaesthetist in a secondary-care facility (ie Hospital), after approval from the on-call Obstetric doctor. It involves the insertion of a plastic tube (by way of a large hollow needle) into the epidural cavity of the spine.This spinal anaesthesia, on average, can add another 6+ hours to a labour because a common side-effect are contractions petering off, thus requiring the labour to have oxytocin augmentation. The lack of natural maternal labour positions can lead to the fetal head deflexing so malpresentating (babe hasn’t tucked his chin into his chest), subsequently increasing the need for instrumental forcep/ventouse deliveries, and/or a caesarean-section for failure to progress, (or fetal distress due to the lengthened labour). Additionally this prolonged and interventionalised labour requires continuous fetal monitoring, due to the increased risks of fetal distress. (However, there can also be certain medical complications when an Epidural may be specifically recommended such as pre-eclampsic Toxaemia to reduce blood pressure.)

© Kathy Fray

kathy fray’s motherwise kathy fray’s organic childbirth

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