One of the areas which takes up much of our time during pregnancy is thinking about our approaching labour and birth; we worry, read, research, plan and explore. We think about where we will give birth, how we would like to process to unfold and who will be with us. We attend ante-natal classes where we learn about the stages of labour and the various forms of pain relief available to us. We read about natural birth and may take a hospital tour to familiarise ourselves with the hospital environment, or if planning a home birth, we put up the birthing pool to learn how it all works. In the Pregnancy Yoga classes we learn how we can use our breathing and postures to work with ourselves rather than against ourselves.
Yet amidst all of these preparations, often we overlook some of the most important preparations we could make ~ and the knowledge which has the potential to greatly influence how our labour unfolds ~ the basic, physiological needs of women in labour.
Labour is a physiological process, orchestrated by our hormones, it is not something we can consciously control, but like sleep, it is something that happens. And there are factors which support and enhance this process (making labour progress well) and factors which inhibit it (making labour stall or stop). Once we learn about the basic needs of women in labour, we are much more empowered to choose where and how we give birth and create the conditions which allow our labour to flourish.
Pioneered by Obstetrician and Author Michel Odent, our basic needs as women in labour are:
To Feel Safe
We need to feel safe and secure. For oxytocin to flow; the hormone which governs labour, and birth we need to feel cared for, listened to, safe and loved. Oxytocin is a love hormone, therefore we need to feel safe, loved and listened to. If we feel frightened, exposed, scared or threatened, oxytocin (and labour) retreats and our system switches to fight/flight/freeze. If our body senses threat, it is our deep, physiological instinct to withhold the labour process until the perceived threat has passed. Our labour stops and our cervix closes with the explicit intention of keeping our baby safe inside until the danger has passed by. Mammals in the wild have this reflex too ~ if they are disturbed during labour, their labour will cease.
When considering where to give birth, and how you would like to be cared for, explore where you feel most safe? For some of us this is hospital, with care on hand, and for others of us, it is at home in our own environment with little intervention. And for many of us, we will know where we feel most safe when labour begins. We can remind our partners to tell us we are safe, and to reduce the factors which may provide a sense of fear.
We can affirm to ourselves that we are safe, that in this moment, all is well, and we can ask our partners to whisper to us that we are doing well, that we are loved and that we are safe.
The Thinking Brain ~ Our Neo-Cortex Needs To Be Switched Off
We need to drift to a deeper part of ourselves than our busy, rational mind ~ labour is orchestrated by the deeper mammalian or middle brain rather than our neo-cortex. Our mammalian brain governs the complex release of hormones which bring forth good, strong contractions and endorphins to help us deal with the intensity of the experience. This is why, when undisturbed, women in labour talk much less, seem to be in their own world, and loose all track of time and order of events. This is a good thing; for when we are asked questions, chatted to, given information and asked to make decisions, our neo-cortex is stimulated and our flow of oxytocin (and hence flowing labour) can be reduced and disrupted.
We can state on our birth plan that we would not like questions to be directed to us during labour, and our birth partners can create a setting where we are able to be quiet and protected, to go into our own world, to close our eyes and let labour unfold without interruptions and stimulation of our neo-cortex. This can make a world of difference. We can focus quietly on our breathing, we can visualise waves of energy, colour or the opening of a flower. We can connect with our baby within. We can keep our focus quiet and inwards, rather than being polite and chatty.
Not To Feel Observed
Feeling observed stimulates the neo-cortex. Similarly we are unable to let go of inhibitions and move, breathe and be as we would naturally. When we are watched, we lose our natural rhythm and flow and begin to feel inhibited and self conscious. We return to our neo-cortex and the general social conventions which govern our culture. Again this inhibits labour. We need to feel unseen, safe, hidden and protected to be able to slip back into our own inner world, to let go of feelings of threat and the eyes and clock being on us. We need to feel that everything around us is being held by someone else so we can drift away into the intensity of our contractions, to breathe through them, then rest and recover ready for the next one. Asking our midwives to settle around our kitchen table whilst I laboured in the pool in the living room and upstairs made a world of difference to the flow and build up of my labour and our third baby’s birth. Being aware of this need to be unobserved, then feeling assertive enough to communicate this need with respect to our care givers can make a real difference to the flow and progress of labour. Our birthing partner can protect the space for us, being the bridge of communication between our quiet inner space and our caregivers.
Darkness or Low Lighting
Bright lights and day light can trigger our neo-cortex. Darkness or low lighting promotes a feelings of warmth, safety and cosiness and stimulates our flow of oxytocin. We can create a birth environment where lighting is low and we feel safe, secure and unobserved. If we find ourselves in a bright, light room, we can adjust the lighting. Similarly we can go within, we can close our eyes, and create our own inner world of safety, warmth and quiet focus.
As labouring women we need to be warm. Feeling cold or chilly can inhibit oxytocin and stimulate adrenaline and our neo-cortex. A warm room, a warm bath or shower, or the warm water of a birthing pool (once we are in established labour) supports us to relax and stimulates our flow of oxytocin. Similarly, it is important for our babies to be warm as they are born. A warm, quiet room helps enormously in physiological delivery of our placenta and can prevent bleeding, as does bringing our new born baby skin to skin up to our chest and inviting her to snuggle in, nuzzle our breast and begin to feed.
Adrenaline is the hormone of flight/fight/freeze. It inhibits oxytocin release. When we feel frightened or agitated, we release adrenaline. Adrenaline supresses oxytocin therefore stalling our labour and making things feel more painful, frightening and out of our control. As labouring women, we are also highly sensitive to the hormonal experiences of others. Therefore if anyone else in the room is feeling anxious, frightened or agitated, they will be releasing adrenaline, and as labouring women we will pick up on their experience and begin to mirror their physiology.
We can talk this through with our birthing partners beforehand and remind them of the importance of them keeping calm. We can ask them to affirm to us quietly that we are safe, and that all is well. We can talk to them about creating an environment where they can be our quiet source of strength rather than adding to our panic and uncertainty.
The Valuable Role of Our Birth Partner
Many partners can feel out of their depth in the birth environment, unsure what to do, and how best they can support us. Yet when we look at our needs as women in labour, we begin to see how valuable a role our partners can play in protecting our birthing environment so we are able to feel warm, safe and unobserved. Our partners can ask for questions to be directed to them rather than us. They can remind us of our affirmations, they can massage us, quietly whisper that they love us, that we are doing well, that our baby is getting closer. They can keep the room warm and dimly lit.
Our partners can take on the role of Protector of Space ~ similar to the role of the doula, supporting us by maintaining the best possible environment for our labour to unfold unhindered and uninhibited by disturbance. Their role is valuable, more so than they realise; they have the potential to be the protectors of our space. And the more we can understand these basic needs of women in labour, the more educated and empowered we become both as individuals and a culture in bringing forth the most favourable conditions in which to labour, birth and meet our babies.