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Articles, Birth preferences, GentleBirth workshop, Labour toolkit

Do you have a labour playlist? Why music can contribute to a more comfortable birth experience.

Posted on August 21, 2014 at 6:55 pm by / 1 Comment

Did you use music to enhance your experience of labour? Or are you working on a playlist for the big day?  You may recently have seen the videos Robbie Williams and his wife shared online, showing him playing (and singing) music to keep her distracted in labour!  While various sources have referred to his behaviour as ‘bizarre’, there is a scientific basis to using music as a pain relieving measure for labour.

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The use of music to provide comfort in labour and reduce pain perception and anxiety is backed by the findings of research studies, although these are of small scale (Phumdoung & Good 2003; Liu et al 2010).  A recent study suggests that the use of music in combination with upright positions is more effective than synthetic oxytocin (“the drip”) in shortening the active phase of labour (Phumdoung et al 2014).

While research on the effects of music in labour is scant, a growing body of research supports the use of music in a variety of clinical settings.  Studies have shown that music alleviates pain, both when used as a therapy in its own right and in conjunction with other methods.  Music has been shown to reduce stress and anxiety in patients undergoing medical procedures, and, used post-operatively, to reduce the need for pain medication.  It has both psychological and physical benefits.

So when it comes to birth, how can music help?

1.  Music that makes us feel good does us good! 
The amount of pain we perceive is linked to the emotional state we are in when we experience the stimulus (Nauert 2009).  Music that evokes positive emotions and relaxes us can decrease the amount of pain we think we are in and help us to tolerate the sensations that we are experiencing.

2. Listening to music can increase the level of our ‘good’ hormones in labour.  
Labour involves a hormone cocktail, the main ingredient of which is oxytocin. Oxytocin drives the uterus and is also a natural pain reliever. Music has been shown to increase oxytocin in the body.  In a study comparing bed rest only with bed rest and music for patients recovering from heart surgery, oxytocin levels in the music group were significantly higher the day after surgery for the music group (Nilsson 2009).   Music has also been shown to increase the release of dopamine into the bloodstream (Salimpoor et al 2011).  Dopamine makes us feel happier, which affects our experience of pain. However, it is also the main neurotransmitter involved in our perception of time. Increased dopamine levels mean that labour can feel faster, in the same way as feeling good during a night out makes it pass in a flash!

3. Music provides an alternative focus that competes with your labour sensations.
We feel more pain when our attention is focused on the source.   Music chosen by you works best (Bernatzky et. al 2011) as a point of focus, and research shows that music that is familiar to you and that hooks you in has greater pain relieving properties. So pick music that you love and gets you singing along. The more involving the music, the greater the benefit!  One study showed that the better the listeners knew the lyrics of a song, the greater was the pain reduction experienced (Mitchell et al 2009). Music that is already infused with meaning and emotion for you, such as music you may have enjoyed with your partner in the past, is an ideal choice.

4. The act of listening means the brain processes less pain.
Since the brain processes music and pain along the same neural pathways,  it is believed that music can block signals of pain at the spinal cord level, before they even reach the brain. This is the gate control theory of pain.  This means music works in a similar way to a TENS machine.

As a doula, I once supported a woman who had a very long prelabour. We spent a day in her home when she was in early labour, with her partner selecting music that he knew she loved over the course of 12 hours or so. The day passed in a flash – for me, anyway!

Most of us have already experienced these beneficial effects of music – whether it’s the electro on your headphones helping you to work out for longer, your favourite album distracting you from the cleaning or that evocative holiday tune raising your spirits on a rainy December afternoon.  So what’s on your playlist for your baby’s birthday?

Bernatzky G, Presch M, Anderson M, Panksepp J. Emotional Foundations of Music as a Non-Pharmacological Pain Management Tool in Modern Medicine. Neuroscience and Biobehavioral Review. 35:1989-99 (2011).

Cepeda, M.S. et al. (2006) Music for pain relief. Cochrane Database. Syst. Rev. 2, CD004843

Liu, Y. Chang, M. & Chen, C. (2010) Effects of music therapy on labour pain and anxiety in Taiwanese first-time mothers Journal of Clinical Nursing 19 p1065 – 1072

Mitchell, L; MacDonald, R..; Knussen, C. An investigation of the effects of music and art on pain perception.
Psychology of Aesthetics, Creativity, and the Arts, Vol 2(3), Aug 2008, 162-170.

Nauert, R. (2009). Emotions Influence Perception of Pain. Psych Central. Retrieved on August 21, 2014, from http://psychcentral.com/news/2009/11/11/emotions-influence-perception-of-pain/9482.html

Nilsson, U. (2009) The effect of music intervention in stress response
to cardiac surgery in a randomized clinical trial. Heart Lung 38, 201–
207

Nilsson, U. (2008) The anxiety- and pain-reducing effects of music
interventions: a systematic review. AORN J. 87, 780–807

Phumdoung, S., Youngwanichsetha, S., Mahattanan, S., Payakkamas, T., Maneechot, K., Chanudom, B. and Ajasariyasing, T. (2014), Prince of Songkla University Cat and upright positions together with music reduces the duration of active phase of labour and labour pain in primiparous women compared to oxytocin. Focus on Alternative and Complementary Therapies, 19: 70–77.

Phumdoung S, Good M. Pain Manag Nurs. 2003.    Music reduces sensation and distress of labor pain. Jun;4(2):54-61.
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Salimpoor, V.N., Benovoy, M., Larcher, K., Dagher, A. & Zatorre, R.J. (2011). Anatomically distinct dopamine release during anticipating and experience of peak emotion to music. Nature Neuroscience, Published online 09 January 2011

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Articles, Breastfeeding

What is a breastfeeding support group like?

Posted on August 3, 2014 at 6:55 pm by / 0

 

They’re a bit militant”, said one friend, who had gone to La Leche League once, 18 years before.  “Great if you’re having problems”, said someone else. “What’s that for”, said a third, a mum of 4 breastfed children who had never been to a group. “Let’s get our tits out and chat?”

It didn’t sound like my cup of tea (I’d no frame of reference for people sitting around with their boobs out, chatting), but I thought I’d check into what was on locally.  I looked up Breastfeeding.ie to see what was on. There were no fixed locations for any of the Cuidiu or La Leche League meetings, just phone numbers of people to ring for information. I don’t do cold calling. I left it.

When my daughter was born, she was at the breast within 20 minutes and between the GentleBirth Confident Breastfeeding mp3,  Ina May Gaskin’s Guide to Breastfeeding, our instincts and the need to get the hell out of a busy postnatal ward, she was self latching by her second day of life and we were home. Bar a few seconds of toe curling burning when she’d latch on, there was no pain and none of the nipple tenderness I’d expected. She piled on weight.  I’d no breastfeeding problems, so what would I be going to a support group for?

Fast forward 14 months or so and a weekly Cuidiu Breastfeeding Support group started up in a hall a few minutes walk from my house. At this stage, I was still breastfeeding and in need of a bit of support, being now in the ‘weird breastfeeder’ category, as I was feeding a walking, talking child (it’s funny how this happens. You start off thinking it’s weird yourself and then just keep feeding your baby – and, one day at a time, they become a toddler).  Despite the World Health Organisation  and the HSE recommending feeding to two years and beyond, it’s highly unusual in Ireland and I had only ever met one person who had fed that long and she had gone home to Poland. So what did I find? A group of very lovely women, sitting around drinking tea and eating biscuits and, yes, breastfeeding.  I’ve been attending that group regularly now for over 5 years – through two more pregnancies and feeding two more babies to toddlerhood.   When I had my son, I was up at the group 6 days later, proudly showing off my newest breastfeeding expert.   My third baby is now 17 months old and I’m still a fixture at the group.

What kept me going back was the community feel of the group. I made new friends, women on the same wavelength when it came to parenting.  We shared knowledge, ideas and lots of laughs.  Often new mothers come, upset that they are having issues, perhaps worried that baby is not putting on weight, and feeling unsure of themselves. They generally leave feeling reassured, and like someone has their back as they navigate the minefield of early parenting.  Attending the group was my introduction to Cuidiu, a fantastic organization supporting all parents, regardless of feeding method and at different ages and stages.

I wish I’d known when I was pregnant that I’d be welcomed with open arms, not made to feel awkward by women who were there to chat with their boobs out. I wish I’d known that it wasn’t ‘militant’ – it’s warm and supportive. Everyone, from the group facilitator to the other mums there, wants to help you to meet your breastfeeding goals. You’ll be met where you’re at – whether you plan to breastfeed for 6 weeks, or 6 months – you aren’t expected to go in with the WHO’s two years as your goalposts. Few of us plan to end up there, it’s just something that happens. I wish I’d known that it’s a good idea to attend when pregnant. We LOVE to see bumps coming in the door – because we know that woman is more likely to meet her breastfeeding goals as she’ll be quicker to seek support when her baby is born. It’s a lot easier to get yourself to a meeting postnatally when you know the terrain – instead of handling nerves about who and what you’re going to find there as you try to grapple with motherhood (and the inevitable poopsplosion that will happen as you’re finally almost out the door), you’re going to meet new friends to show how much cuter your bump is now it’s on the outside.

It’s said that it takes a village to raise a child – sometimes, as we live in a culture where breastfeeding is attempted by a minority, we need to create our own breastfeeding village. You can do that via Cuidiu or La Leche League or, sometimes, via your local HSE breastfeeding support group.  Incidentally, when I finally rocked up to my first LLL meeting, I found it wasn’t any more ‘militant’ than Cuidiu. Just more women sitting around drinking tea – but they had healthier snacks.

 

What GentleBirth Mothers say…

“The local breastfeeding support group was my life saver. Not for breastfeeding, but to meet other new mums going through the same things. For the first few months I would just get through each week by counting how far it was to Tuesday. 6 years on and I count these women as some of my most treasured friends”. (Ruth)

“I went to the local (HSE run) group when my son was 13 days old and most weeks after that until I returned to work. I looked forward to the cuppa, biscuit and chat. Found it invaluable those first few weeks when I wasn’t very confident about breast feeding. The Public Health Nurse always answered questions and put me at ease. I don’t know if i would have kept going in the early weeks without it and I went on to feed my son for 2 years. An invaluable resource and I would highly recommended looking up local groups before baby is born so you can go either before baby is born or after”.  (Linda)

When dd was 4 weeks, I went to a local group, everyone had babies in around the same age as mine, everyone recognised each others ‘wow I’m tired/she’s been fussy all night/we’ve had a great week’ and it was just … solidarity? To know I wasn’t alone, that I wasn’t the first and wouldn’t be the last mum who reckoned she hadn’t a clue. It’s where I met some of my most important ‘mammy friends’ too”. (Gillian)

“I’ve had a good few issues with feeding – tongue tie, inverted nipples, you name it! I expressed exclusively for my first son and am combining breast and expressing now for my 8wk old. It’s sometimes hard to know where to fit in when your expressing! I assumed everyone else at the meeting would all be naturals but it turned out that loads of the mums had had to pump for various reasons, others with tongue ties, there was even a mum with inverted nipples still feeding her 2 yr old using the shields! It was so encouraging and inspiring to meet mums who didn’t necessarily have the smoothest road but were enjoying a long and successful breastfeeding journey nonetheless”. (Danielle)

“Sometimes all you need is to be sitting in a room with women going through what you’re going through, even if you don’t talk to anyone, sitting close by and feeding your baby with a group of mums is extremely therapeutic and warming”. (Aoife)

“I went to the Breastfeeding group in my local health centre, but by the time my baby was 12 weeks old he was the oldest there, and we were struggling so I really needed the support.  A while after I stopped going to the health centre group, I started going to a voluntary organisations group that was on in the afternoon so I didn’t have to get up too early! Went for the breastfeeding support, stayed for the cake, and more importantly for the social aspect of it as I didn’t have any friends or family that were around during the week for coffee or chats. It definitely normalised breastfeeding for me and helped me appreciate how boobs can solve almost any baby problem!”. (Lisa)

“On my first baby there was no way I would step foot in a local group. I lasted less than a month. This time I’ve found the local group and other breastfeeding mothers to be the biggest, most important support in my success”. (Laura)

“When you’re a first time mum, and everything in your day with a new baby is confusing and a little scary, meeting up with other mums who’ve been there and got through it and can offer practical, tested advice makes it all feel refreshingly normal!”. (Gillian)

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Articles, Birth preferences, Induction

To sweep…or not to sweep?

Posted on July 8, 2014 at 6:55 pm by / 0

When women go over their ‘guess’ date, and with some practitioners, as they approach it, they may be offered a membrane sweep, in the hope that it will get their labour started.

What is it?

A “sweep” is a non-chemical method of induction. It involves the practitioner attempting to separate the water bag (amniotic sac) from the uterus. One or two fingers are inserted into the cervix and the practitioner tries to get their fingers between the water bag and the uterus, following the cervix around and gently separating the membranes.

Afterwards, you may experience some ‘show’ (blood stained mucous) or spotting and mild cramps, regardless of whether or not labour starts.

How does it work?

It may encourage the body to produce prostaglandins, causing the cervix to soften and thin, which may get labour going within 48 hours.

What are the chances that it will work?

According to a Cochrane review in 2005, having a sweep at 40 weeks does reduce the length of pregnancy and the incidence of going beyond 41 weeks. However, in order to avoid one induction of labour, a sweep would need to be performed in 8 women.

What are the benefits?

The woman may experience a physiological onset of labour rather than a chemical induction.   A sweep increases the chances of going into labour within 48 hours and of giving birth within one week. (Keirse, 1995; McColgin et al, 1990; Weissberg and Spellacy, 1977)

What are the risks?

There is a risk that the water bag may be broken accidentally, which means that the woman will then be told she will have 24 hours to begin labour before she is chemically induced.  Although some of the evidence indicates that prelabour rupture of the membranes is not a risk of sweeps  (Boulvain et al, 2005; Wong et al, 2002), Hill et al found that there was increased risk of rupture of the membranes if the cervix was more than 1cm dilated (9% of women experienced PROM). Anecdotally, a few mothers on the GentleBirth mums group had their waters release accidentally during the procedure recently.

Some of the research indicates that infection is not an issue (NICE 2008). However, women who are Group B Strep positive should think carefully before having a sweep as GBS can cross intact membranes. As GBS testing is not routine in Ireland, few women know their GBS status and up to 25% of women are carriers of Group B Strep.

Some women may find sweeps unpleasant and uncomfortable. They may also lead to “false starts” where women have show and crampiness and think labour is on the way, but it then dies down. Some women find this to be upsetting.

 

Are sweeps recommended by NICE (UK National Institute for Clinical Excellence) guidelines?

Membrane sweeps are not recommended for routine use beyond 38 weeks in order to avoid an induction of labour. The guidelines recommend that a sweep should be offered to women who have not had a baby before at their 40 and 41 weeks antenatal visits, and to women who have had a baby before at their 41 week appointment (NICE 2008).

Why would I want a sweep?

You may want to have a sweep if:

  • There is a medical indication for induction and you want to see if a sweep will start labour, before proceeding to other induction methods.
  • You are 42 weeks pregnant.
  • You are almost 42 weeks pregnant and you are planning to have your baby at an MLU or at home under the HSE or a hospital scheme (you cannot have your baby in the MLU beyond 42 weeks and you need consultant sign off, which can be difficult to obtain, to have a HSE home birth beyond 42 weeks).

You may not want to have a sweep if:

  • There is no medical reason to induce labour.
  • You want to let labour start in its own time without any interference.
  • You have had unexplained vaginal bleeding during your pregnancy.
  • Induction is urgently required and it would be safer to start induction with medication.
  • You have Group B Strep (GBS) in your vagina.

Unfortunately, as some of the women below have experienced, non consensual sweeps sometimes happen in Irish maternity units. If you do not want a sweep, declining a vaginal examination may be your best course of action.

Women’s experiences

“I had two sweeps, at 40 weeks + 11 days and 40 weeks + 13 days.  Neither of them did much. I had some show after the second one, but that was it. I wanted to go into labour before 42 weeks because I wanted to have a home birth. I ended up being induced due to my waters going and no labour starting after 40 hours. I think the sweeps probably contributed to the waters leaking. I wouldn’t make the same decision again – I’d just book with a different maternity unit that might be more likely to sign me off for extra days”.

“I had a sweep at 40 + 4, had a bit of show that evening & period cramps for the next 5 evenings before she arrived. The doctor told me I was very ready to go at the time & she thought I’d be back in that evening which I was delighted about coz I was carrying very low & was quite uncomfortable for the last 3/4 wks.  I really wanted to get things going & avoid induction. I was glad we avoided induction but I don’t think I would get it done again so early –  I think I’d hold off til nearer term + 14. It was not pleasant at all & maybe she would have arrived when she did regardless”.

“I had two sweeps desperately trying to get labour going for homebirth on my first,  but now I know full sure the hospital dates where at least a week out so they were never gonna work.  On my second,   I had a sweep at term plus 5 (my acupuncturist had already told me I was on the brink a couple of days beforehand) and went into labour a few hours later. I would do the same again as my thinking was if I declined it and went the full 14 days or more over and ended up with induction and another section then I would never have forgiven myself for not exploring every avenue of getting things started”.

“I had one but didn’t know until afterwards. The consultant said she just wanted to check how things were as they were considering keeping me in I was just due & had protein in my urine so they were concerned and wanted to see how likely I was to go. When she was done, after I asked what the story was she said ” oh yeah and I did a sweep too so hopefully that will get things going. At the time, I was just a bit surprised cos I thought they had to ask first but at the same time I was a bit relieved or excited or some mixed up emotions cos I was being kept in unexpectedly & baby might come soon. I hadn’t a clue back then, & in all the stuff I had looked up I hadn’t read anything negative about it. It’s only now I know better”.

References:

Boulvain M, Stan C, Irion O. (2005) Membrane sweeping for induction of labour. Cochrane Database of Systematic Reviews 1: CD000451.

Hill MJ, McWilliams GD, Garcia-Sur D, Chen B, Munroe M, Hoeldtke NJ. The effect of membrane sweeping on prelabor rupture of membranes: a randomized controlled trial. Obstet Gynecol. 2008 Jun;111(6):1313-9. See: http://www.ncbi.nlm.nih.gov/pubmed/18515514

Keirse MJNC. (1995) Stripping/sweeping membranes at term for induction of labour: In: Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C. (Eds.). Pregnancy and childbirth module. The Cochrane Pregnancy and Childbirth Database. The Cochrane Collaboration 2.

McColgin SW, Hampton HL, McCaul JF, Howard PR, Andrew M, Morrison JC. (1990) Stripping membranes at term: can it safely reduce the incidence of post-term pregnancies? Obstetrics and Gynaecology. 76: 678-80. Weissberg SM, Spellacy WN. (1977) Membrane stripping to induce labour. Journal of Reproductive Medicine 19(3): 125-7.

National Institute for Health and Clinical Excellence. (2008) Induction of labour. London. See: http://publications.nice.org.uk/induction-of-labour-cg70/guidance#recommended-methods-for-induction-of-labour

Wong SF, Hui SK, Choi H, Ho LC. (2002) Does sweeping of membranes beyond 40 weeks reduce the need for formal induction of labour? BJOG 109: 632-6.

Articles, Birth preferences, Breastfeeding

Preparing for breastfeeding

Posted on April 1, 2014 at 6:55 pm by / 0
You’ll have heard stories about how hard breastfeeding is, shredded nipples and non latching babies – and yet, at the same time, some will say it’s the most natural thing in the world and babies can crawl to the breast and help themselves. While having a straightforward breastfeeding experience can never be guaranteed, the more you prepare, the more natural it is likely to be. Here are some tips on how to prepare for breastfeeding – toughening up your nipples is not one of them!

1. Do your homework

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Learn about breastfeeding. Know how it works and what to expect in the early days. Invest in a copy of a good breastfeeding book such as Ina May’s Guide to Breastfeeding, or the La Leche League’s Womanly Art of Breastfeeding. Don’t be put off by the dud name and cover of the latter – this is an invaluable resource to have to hand and is organised by the age of the baby so you don’t have to read it all before baby arrives!

There are many fantastic online resources such as kellymom.com and Dr. Jack Newman’s site, where you can watch videos that show how babies latch and how you know if baby is drinking from the breast. Another excellent online resource is this series of promotional and information videos from New Zealand.  The Irish site breastfeeding.ie is a useful local resource.

You could attend a breastfeeding class with a Lactation Consultant prior to your baby’s birth, which will give you added confidence.  And don’t forget your GentleBirth mp3 for Confident Breastfeeding – I credit it as having a huge influence on the ease of my breastfeeding relationship with my first baby.

2. Create your village

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Have you heard the saying ‘It takes a village to raise a child’? Breastfeeding is instinctual, but women have traditionally had help and support with breastfeeding from their mothers, sisters, neighbours and birth attendants. However, in Ireland, where little more than 1 in 2 women initiate breastfeeding, that help and support is something we often have to seek out for ourselves.  Surrounding yourself with those who are positive and supportive about breastfeeding may involve a little work on your part. 

Take note of which friends and family members may be good sources of breastfeeding information when you’ve had your baby. 

Get along to a breastfeeding support meeting while you are pregnant, perhaps at the start of your maternity leave. Pregnant women are always welcome and it’s much easier to motivate yourself to get along to a meeting post partum if you already know some of the people there. The groups are fantastic, not only if you have problems, but also for combating some of the unhelpful breastfeeding advice you can get from well-meaning family members – often from those who haven’t breastfed!  It’s a great way to connect with other mothers living near you. You can find a list of support groups in your area on breastfeeding.ie.

Put the number of a local Cuidiu breastfeeding counsellor or a La Leche League leader in your phone, so you can call if there are any problems.

If you are involved in online forums and Facebook groups, join one where there are experienced breastfeeding mums who can offer guidance and support and normalise the breastfeeding experience for you.

3. Get your partner on board

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A supportive partner has a positive influence on breastfeeding success. If you’re attending a breastfeeding class, do so as a couple.

Make sure your partner knows how time-consuming breastfeeding a newborn might be.  Discuss what your expectations are around housework, particularly during the time he takes off after the baby is born. If possible, he should be doing the cooking, cleaning, laundry and nappy changing while you focus on getting feeding well-established and sleeping when you can.  It’s a team effort!  

If your partner is not able to take time off after the birth, then call in favours from other family members. You could also consider hiring a postnatal doula who could help you with breastfeeding, as well as household chores. 

 

4. Write birth preferences that support getting off to a good start

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Babies who get skin-to-skin contact with their mothers for the first hour after birth are more likely to successfully latch without any help.  The vast majority of babies can have skin-to-skin with their mother directly after the birth – weighing and other hospital procedures can be postponed until later. Writing birth preferences around this to give to your caregiver can ensure that you get this time together.

Even if you have had a c-section, you should still be able to have this skin-to-skin contact, so discuss this with your caregiver antenatally and write c-section birth preferences.

We know that birth interventions affect breastfeeding so preparing for as undisturbed a birth as possible, by using the GentleBirth programme, will give you the best chance of getting breastfeeding off to a good start.

5. Plan on being laidback

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Laidback breastfeeding or the biological nurturing position, as it is also called, allows you both to lie back and get comfortable and stimulates baby’s natural feeding reflexes. It often means that baby self-latches, making for a better and more comfortable latch. The use of a reclined or semi-reclined position means that you get to rest as much as possible, too!

5.  Remember what you’ve learned!

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You’ve gone to the breastfeeding class, read all the books, watched the videos..but now you have a newborn who hasn’t fed yet, you had a long labour and haven’t slept for a couple of nights and you’re wondering if your baby is hungry…what did the book say about that again?

Remember that….
…a newborn’s stomach is tiny and can only hold 5 – 7 ml of colostrum on the first day of life. 

..if there is a need to supplement your baby, the first choice should not be formula, but your own expressed colostrum, fed from either a syringe, spoon or cup, rather than a bottle, so as not to confuse the baby’s suck pattern.  The Lactation Consultant in the hospital or your midwife can show you how.
..if in doubt, contact your Cuidiu breastfeeding counsellor or LLL Leader for support. 

6. Expect success!

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Use your Breastfeeding Confidence mp3, which is part of the GentleBirth Complete Box Set, to boost your confidence during pregnancy. Motivation is increased if we expect success, meaning that we put more work into preparation if we think it will be rewarded – which, in turn, increases our chances of success! 

7. Get your box sets and munchies organised

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Breastfeeding every couple of hours is of course demanding – but it also gives you a free pass to sit on the couch watching box sets and eating biscuits all day – while burning calories. What’s not to like?!
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Phone: +353 87 6181008

Email: melanie@birthtobaby.ie  

 
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