Building Endurance to avoid an unwanted epidural during labour

Many well intentioned first time mums start out on their birth journeys planning to birth naturally. In current times there's an abundance of classes women can attend in preparation for birth. Unfortunately one thing that is easily overlooked during pregnancy is building physical stamina so you have the endurance for labour.

First births are often very hard work. If you've focused on building your stamina during pregnancy you're more likely to have the energy to complete cervical dilation with energy left to push out your baby unassisted.

So what can happen if we haven't worked on our stamina?

When labour goes on for an extended period of time some women become exhausted. Once exhaustion sets in contractions can become less effective. When labour gets to this point the labouring mum may simply want labour to end as she's run out of steam. If the end of labour isn't in sight an epidural may be offered as a way to help her rest and rebuild her energy. Understandably, for many mums this is a very appealing option. Unfortunately birth becomes a very different experience once an epidural is administered. Many women feel completely out of control and feel a sense of loss if they had planned a natural birth.

So what is one simple, very affordable and effective exercise you can do to build your stamina ready for labour?

WALK, WALK, and WALK. Everyone's physical capabilities are different so start out at a pace and distance that's comfortable for you. Aim to walk 3 to 4 days a week, 5 km’s each walk. Sharing the walk with a furry or not so furry friend can make it more fun. It’s important your walk is enjoyable so perhaps make the effort to walk where you enjoy the surroundings.

Please note.....building your stamina isn't critical in the first trimester when you're completely exhausted and feeling unwell. Start when you're feeling better in your second trimester.

Benefits of delayed cord clamping

Support your baby’s well-being

Working as a doula there are many hospital protocols and procedures I educate and prepare my clients for. One of the most simple procedures that is rushed at the cost of your baby’s well-being is "umbilical cord clamping”.

For many years there was no evidence as to why it was important to delay cord clamping but this is no longer the case.

One of many studies available was conducted by Erickson-Owens and this is a little of what she had to say.

"When we wait at LEAST 5 minutes to clamp the cord of healthy babies, there is a return of the infant's own blood from the placenta, up to 50 percent of the baby's iron-rich blood cells," So when the brain needs red blood cells (and iron) to make myelin, the robustness of the iron stores make a big difference,"

She goes on to say that the practice of immediate clamping of the cord is still a widespread practice in many hospitals.
I think most of us know the value of iron and how important avoiding anaemia in a newborn must be, but what is the iron connection to myelin?

Myelin is a fatty substance in the brain that wraps around all of the axons of the nerve cells. "It's an insulator and very important in the transfer of messages across the nerve cells in the brain. It's assumed that the better the myelination, the more efficient the brain processing is," "The regions of the brain affected by increased myelination are those associated with motor, sensory processing/function and visual development.

So what is the rush to clamp and cut the cord?

The cord clamp is made of either metal or plastic and is literally a clamp that once clamped tight stops the return of your baby’s blood from the placenta. My client's birth plans state, “do not clamp our baby’s cord until it's stopped pulsating and turned white”. This can sometimes take a good 15 minutes.

What’s the rush, the cord doesn’t have to be cut for the placenta to be born?

Did you know you can actually leave the cord attached to your baby for an hour or even days?. There's even a ritual known as Lotus Birth where the baby remains attached to their placenta until the cord dries and falls off. This ritual isn't for everyone but it does prove there really isn't any rush to cut the cord other than getting you cleaned up and out of the birth room ready for the next patient.

I encourage you to do what's right for you and your baby. Stay strong and communicate your wishes with your care providers. As long as all is well with you and your baby it's safe to delay cord clamping.

Your baby deserves the best start in life.

The dying art of natural physiological third stage

Grace patiently waiting for her placenta that arrived 1.5 hours after birth

THE DYING ART OF NATURAL PHYSIOLOGICAL THIRD STAGE OF BIRTH

 A physiological or natural third stage during birth means you wait for the placenta to be born naturally. After your baby's birth, your midwife will delay clamping the umbilical cord to allow oxygenated blood to pulse from the placenta to your baby. Meanwhile your uterus (womb) will contract, and the placenta will peel away from the wall of your uterus. The placenta will then drop down into your vagina, ready for you to push it out or alternatively get more upright for the placenta to fall out.

It’s very rare in hospitals in Australia to experience natural third stage unless you have pre planned and educated yourself on this subject. Third stage is routinely managed by quickly clamping and cutting the umbilical cord, administering a shot of Syntocinon (synthetic oxytocin) into the woman’s leg and pulling out the placenta quickly. This method of delivery of the placenta is considered to be the safest especially in a medical world centred around RISK MANAGEMENT.

Let’s briefly look at risk management and what it means.

Broadly defined, risk management includes any activity, process, or policy to reduce liability exposure. From both a patient safety and a financial perspective, it is vital that health centres conduct risk management activities aimed at preventing harm to patients and reducing medical malpractice claims.

 Third stage comes with potential risk primarily postpartum haemorrhage and very rarely stubborn placentas that just don’t want to be born. Hospital birth procedure is to have greater control over these issues so they use synthetic oxytocin. Unfortunately, in my experience the use of synthetic oxytocin for third stage also comes with risks if women have birthed their baby’s naturally without the use of Synthetic Oxytocin during labour. I encourage my clients to birth their placentas naturally if they've had a natural physiological birth up to the point of the placenta being born.

Natural third stage can take time. While mum is left to rest and bond with her baby the hormone oxytocin is flooding her body. The oxytocin causes the uterus to contract which in time peels the placenta off and it falls to the bottom of the uterus. Once mum is upright the placenta will often fall out into the bowl you have ready.  It's a lovely soothing feeling as the placenta leaves your body. The womb continues to contract on and off after birth. These first contractions seal off the exposed blood vessels and start the process of bringing the uterus back into its pre-pregnancy shape and size..

Hospital protocol can make the choice of a natural third stage challenging. Our local hospital permits women one hour for the placenta to be born. Like birth, every woman has her own personal experience and doesn’t always follow the textbook. I’ve had placentas arrive in 10 minutes and others take 2+ hours. As long as there’s minimal bleeding it’s safe to wait for your placenta. The calmer the environment and you remain skin to skin with your baby the more successful natural third stage will be.

 It takes more effort to navigate natural third stage in the hospital but in my experience it’s well worth the wait. You can let your midwives know you wish to wait longer if the initial first hour has past and bleeding is minimal.

 Please note, if you’ve had Syntocinon during labour it will be considered safer to use Syntocinon for your placenta as your own oxytocin receptors have been disrupted.

This photo is a client of mine waiting on her placenta which took 1.5 hours to arrive.