FAQ Friday: Pain in Induced vs. Spontaneous Labours

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Following up on last week’s inaugural FAQ Friday post, in which I responded to the question, “how is a doula different from a midwife?“, this week I will be addressing a question that was posed to me by a reader: “what is the difference between pain experienced during a natural childbirth and during… an induction?”

A little background to start us off, in case you aren’t familiar with the term “induction”. An induction is when, instead of waiting for labour to begin on its own (or, ‘spontaneously’), measures are undertaken to force the body to go into labour. Usually when we refer to an induction we mean a medical induction, where various steps are taken by medical practitioners in order to cause labour onset.

The word induce is a verb meaning “to bring about or give rise to”. While a medical induction is certainly the most aggressive and surefire way to make labour start, there are many non-medical techniques that women have traditionally used when they want to hurry things along a little. These may include acupuncture, eating certain foods (such as spicy things or pineapple), having sexual intercourse involving both female and male orgasm, or taking homeopathic and/or herbal remedies. Castor oil is also commonly ingested to bring on labour, though many women report unpleasant side effects, so this should only be tried as a last resort (i.e. to avoid a medical induction) and with the blessing of your healthcare practitioner. A medical induction may involve three steps:

  • if the cervix is not yet ‘ripe’ (i.e. it is not yet softening, shortening or opening) a synthetic prostaglandin gel is applied to the cervix directly in order to encourage it to soften and dilate (one of the reasons that sex involving male orgasm is helpful is that semen contains prostaglandins)
  • once the cervix has dilated a little bit, an amniotomy is performed. This is more commonly known as when a doctor or midwife “breaks your water” (aka AROM – artificial rupture of membranes). This is done using an amnio-hook, which looks a little bit like a crochet hook. The hook is inserted into the opening of the cervix and the bag of waters is punctured.
  • sometimes immediately following AROM, but sometimes after a period of waiting (in which labour may start on its own), Pitocin is administered. Pitocin is the brand name for synthetic oxytocin. Oxytocin is the hormone that is secreted during labour, which causes uterine contractions (here is where the female orgasm is handy – our brains also release significant amounts of oxytocin when we have orgasms…also when we kiss, hold hands, sing in chorus…). Pitocin is administered by an IV and the amount is increased gradually until contractions are happening frequently and with enough intensity to cause the cervix to open fully.

As you can probably gather from the above description, a medical induction is a way of simulating the natural processes that typically cause spontaneous labour onset. As with almost any intervention, each stage has some risks or drawbacks, including increased likelihood of a Caesarean section, in the event that the induction fails (a Bishop’s score is a means of assessing the likelihood that an induction will succeed in advance).

One of the biggest drawbacks to inducing labour is what the original question alludes to, that is, increased contraction pain. While every birth is different and some women experience more or less pain than others (indeed, many women experience no pain at all in labour), it can be said in general that an induced labour is significantly more painful than labour that begins on its own and proceeds without augmentation (augmentation is the use of Pitocin in 1st stage labour when it is felt that labour is not progressing rapidly enough).

Why is this? There are a couple of reasons. First, because Pitocin is not your body’s naturally produced oxytocin, but a synthesized form, it affects different people (and their uteri) differently. This makes it difficult to know how much to administer from woman to woman in order to get labour going gradually they way it most often does when it occurs spontaneously. One of the reasons that women who are induced are required to wear continuous electronic foetal monitors is because of this. One monitor shows how strong the contractions are (though not always accurately) and the other shows the baby’s heart rate (again, not always accurately). This is important because babies are affected by the contractions of the uterus and if they are too intense, this can cause foetal distress.

In addition to dosage issues, Pitocin is a substance that is being introduced to the body from outside, rather than being released from within the body as a part of a complete system. Oxytocin is only one of the hormones produced in the body during childbirth. When labour happens on its own the body is responding to prior hormonal secretions (such as melatonin) and subsequently causing others to be released (such as endorphins). When labour begins spontaneously, it usually does so somewhat gradually. The most definite sign of ‘true’ labour is contractions that progress – that is, they become stronger, longer and closer together over time. As they become more intense, longer and more frequent, the body begins to release increasing quantities of endorphins, which allow the woman in labour to cope more easily with the contractions themselves. Endorphins can reach a potency that is significantly stronger than morphine. These hormones (melatonin, oxytocin, endorphins) have a synergistic relationship to one another – that is, they enhance each other’s effectiveness in the body. Because Pitocin is synthesized and administered artificially, the body’s ability to respond with appropriate amounts of endorphins is compromised. It can’t keep up. It is important to note, that the release of endorphins can also be compromised by the release of stress hormones – catecholamines – such as adrenaline. This means that any interruption that causes stress, fear, humiliation, etc. in a woman has a direct impact on her physiologic ability to cope with the sensations of labour. These stress hormones can also interfere with the release of oxytocin, which then may lead to augmentation with Pitocin because contractions are slowing or stalling. For many people, simply being in a hospital is a stressful thing, which may be one reason why statistically speaking, hospital labours tend to be longer and tend to lead to a greater number of interventions, such as augmentation or pain medication, even when they begin naturally.

When you look at naturally occurring contractions on a monitor, they look like hills that have a slow incline, a rounded peak and a slow decline. As labour intensifies, the slopes on either side become more extreme and the peaks get higher. Contractions caused by Pitocin on the other hand, tend not to have very gradual slopes and have much higher peaks, earlier on. They look spiky, rather than hilly. In other words, induced labour hits women much harder, faster, instead of allowing for a gradual ‘easing in’. Add to that the fact that your body’s pain ‘medications’ – endorphins – don’t work as effectively when the system is circumvented, and it’s no wonder that women who have experienced both induced labours and spontaneously occurring labours say that the former are much more painful than the latter.

Do you have a question you’d like me to answer? Maybe you’d like to know more about induction, or maybe your question is on another topic altogether. Anything goes! Leave it in the comments and I’ll be happy to tackle it next week.

photo credit: Fire Engine Red via photopin cc

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New testimonial!

I’m excited to post another lovely testimonial from a recent client!

I was initially hesitant to hire Heather due to her age and perceived lack of experience. However, after our first meeting with her and our subsequent experiences we couldn’t be happier with her expansive knowledge on not only birth coaching but everything you could ever want to know about pregnancy, labour, birth and post partum (we had her not only for our doula but also our prenatal class teacher). The enthusiasm she has for what she does is apparent in her thirst for knowledge and connection to the community. 

This being my first child I didn’t know what to expect from a doula. How could a relative stranger help me when my very own husband was unable to calm me down? As it turned out, Heather’s presence was invaluable; her cool head, confidence and pure enjoyment of the process put me in the best possible head space to have an unforgettable positive birth experience. Where I was tense and uncertain, Heather was calm. Where my husband was frazzled and scared, Heather was reassuring. She lead our fragile selves delicately and confidently through the most important and crazy moment of our lives, and for that I’m forever thankful! 

A New Tool

I recently acquired an Obi-TENS unit to use with my clients. Many women swear by these devices as an alternative to pain medications and I am really excited to begin using it in my practice! They are frequently used by physiotherapists for helping individuals manage musculoskeletal pain and to help encourage blood circulation. As for use in labour, they tend to be very popular in the UK, where many hospitals have them available. In North America you need to have a doula who has one or buy one of your own. The unit is controlled by the birthing woman, which is helpful in encouraging her to feel in control and like an active participant, rather than a passive ‘patient’. As many of you are, I’m sure, aware, research shows that a sense of control is the key factor in how women report feeling about their birth experiences days, weeks and even years later.

Check out this handy blogpost about how TENS works for labour: http://www.meghanprice.ca/2012/11/03/handheld-magic-elle-tens-machine/

Summer/Fall Prenatal Classes at the Centre for Social Innovation

If you are expecting a baby in later summer or fall of 2012 and are looking for prenatal education that works for you, you’re in luck! I am offering a full series of Prenatal Classes at the Centre for Social Innovation (Annex) from August 15th to September 19th, 2012. This is a six-week series, Wednesday evenings from 6:30-9:00 pm. People have already started registering for this series – I have, at present, room for four more couples (or singles with a support person). If you are interested in taking my summer course (May 30th to July 4th), there are still a couple of spots available in that series too.

Now, you may be asking yourself, “why would I pay for independent prenatal classes when I can just attend the free ones at the hospital?” This is a great question and there are a number of excellent reasons. Continue reading

Birth Tool Review: The Kaya Birth Stool in Action

I recently had the opportunity to try out my brand spankin’ new Kaya Birth Stool while supporting a client throughout her labour and birth. I have been really psyched about the stool ever since I first saw the design on Toronto designer Kara Springer’s website, and I was itching to give it a whirl.

I’ve already written about the stool, in terms of how, theoretically, it could be useful during labour and I am excited to report that it really, really was! Continue reading

Summer Prenatal Classes at the Centre for Social Innovation

If you are expecting a baby in later summer or fall of 2012 and are looking for prenatal education that works for you, you’re in luck! I am offering a full series of Prenatal Classes at the Centre for Social Innovation (Annex) from May 30th to July 4th, 2012. This is a six-week series, Wednesday evenings from 7:00-9:30 pm. This series is already half-full – I have, at present, room for three more couples (or singles with a support person).

Now, you may be asking yourself, “why would I pay for independent prenatal classes when I can just attend the free ones at the hospital?” This is a great question and there are a number of excellent reasons.

1. While the information provided by public health prenatal classes is useful, these courses often omit a large quantity of information that is considered “alternative” or that is not routine at that particular hospital. For example, while my prenatal classes cover labour coping techniques ranging from massage and acupressure, to breathing and vocalizations,to hydrotherapy and heat, to epidurals and other forms of pain medications, a hospital class will generally only cover the epidural with any depth. Even if you plan to have an epidural, there are still many useful options available to you that won’t be explored in a standard hospital course. This is just an example of how hospitals tend to teach to the norm, rather than to what is possible. It’s understandable given the number of people they have to teach, but not exactly desirable if you want your birth experience to be as satisfying and positive as possible.

2. Public health courses tend to be two-day “crash courses”. This may seem ideal – get it all done with in one weekend! – but a course that is drawn out over a number of weeks will give you the chance to really get to know other couples in the class (start building up that new-parent social network now, before the baby arrives) and also opens up the possibilities for asking the questions that matter to you, even if they don’t occur to you until four days after class. You’ll also retain more of the information, as you’ll only need to digest two hours of material at a time, with time to reflect in between each class. I also cap my attendance at twelve people so that there is time for more questions and to facilitate group interaction.

3. Many people report being frightened or discouraged by the content/approach of hospital prenatal classes. It is vital that you understand all of your options and what is happening to your/your partner’s body during labour and birth, but it is not helpful to hear horror stories or to be inundated with negative information. My classes provide clear and detailed, evidence-based information while focusing on the positives – helping you to feel informed and fully prepared, but also excited and optimistic, not afraid.

4. I tailor my courses to the participants in them. Upon registration I’ll send you a questionnaire that asks you about your pregnancy, your current level of knowledge, your interests and your hopes for the course. That way I can focus on areas of particular interest and reduce coverage of topics that people already understand.

Prenatal education is the first step to an empowering birth experience. Feeling like an active, informed decision-maker prior to and during your labour and childbirth is the key to birth satisfaction. Knowledge is essential for confidence and self-advocacy.

The cost for the entire series is $240.00 per couple. If you are interested in hiring a doula and would like to talk to me about the doula services I offer, I also provide package deals for doula clients who enrol in my prenatal classes.

Topics for the series include (but are not limited to):

-pain management and coping strategies for labour

-relationships and sexuality during pregnancy and in the postpartum period

-the physiology of labour and birth

-positioning for labour and birth

-risks and benefits of common interventions

-breastfeeding

-newborn care and characteristics

-nutrition and exercise

This course is ideal for people expecting to give birth between late July and September of 2012. Email me at heather@socialinnovation.ca to register or if you have any questions.

Doula Say Relax – Part 2 of 2

In addition to learning to relax your body and quiet your mind prenatally so that those skills will be ready-at-hand when labour begins, there is another aspect of relaxation, or maybe comfort, that is more intellectual in nature. Becoming comfortable with the realities of labour, getting to know terminology and feeling good about your ability to get information and use it productively will make you feel more at ease as labour progresses. If you don’t have a certain degree of comfort with the practical side of things, you’ll be less likely to be able to let go and allow your relaxation techniques do their thing. Continue reading