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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Education is key! Next prenatal course begins March 5th.

I have another upcoming prenatal series starting at the Centre for Social Innovation, in the Annex, on March 5th. This course will run Tuesday evenings from 6:30-9 pm for six weeks.

If you are expecting a baby between late April and early June, this is the class for you! I cap my courses at six couples, so that my students can get to know one another and start building those new parent networks early. This course will give you and your partner the information and skills you need to cope with labour and birth; self-advocate effectively with your healthcare providers; know how breastfeeding should look and feel; know what to expect of a newborn; and make decisions about parenting that will work for you and your family.

The course is $240 per couple. Discounts are available for doula clients. Email me for more information, or to register.

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

-pain management and coping strategies for labour

-the physiology of labour and birth

-positioning for labour and birth

-risks and benefits of common interventions

-breastfeeding

-newborn care, characteristics and abilities

-parenting options

Education is the key to having a birth experience in which you feel confident, calm and in control.

Two Prenatal Series Options!

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I will have two new prenatal education series’ starting in the new year for those expecting a baby between late February and early April, 2013. Classes at the Centre for Social Innovation (Annex) will be on Tuesday evenings, from 6:30 – 9pm, beginning January 8th. Classes at Women’s College Hospital will be on Wednesday evenings, from 6:30 – 9pm, beginning January 9th. Both courses are six weeks in length. You can choose the series that best suits you in terms of day and location.

In taking the role of prenatal instructor at Women’s College, one of my top priorities was that I would be able to use my own curriculum and that there would be no imposition of a hospital agenda upon my prenatal course content. In other words, these two courses will be identical in content and will focus on preparing for birth as a normal, healthy experience that can be anticipated and experienced without fear and in a calm an relaxed manner. We will also cover topics related to the postpartum phase and parenting.

To register for the course at CSI Annex (Tuesdays), email me at heather@socialinnovation.ca. To register for the WCH course (Wednesdays), email janelle.noel@wchospital.ca or call 416-323-6494.

For more info on topics that will be covered, hit the jump! Continue reading

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/

Prenatal Classes at Women’s College Hospital

Women's College Hospital - Health Care for Women, Revolutionized

As many of you are already aware, I was recently hired to teach prenatal education classes at Women’s College Hospital here in Toronto. I’m very excited about this opportunity as I hope that it will allow me to reach many more women and their partners, from more diverse walks of life. I firmly believe that education is a vital component of a healthy pregnancy, a positive and empowering birth experience and a strong start as new parents. Taking group classes over a six-week period gives you the opportunity to make new connections with other parents-to-be and affords you the time to absorb the wealth of information and ensure that your questions are addressed.

Another reason that I am excited about teaching at WCH is that they are permitting me to run the courses using my own curriculum – in other words, the content will be the same as  it would be in any other location where I teach. This means that my students will not have to worry about anyone else’s agenda interfering with the education they need to make informed choices. All of the content in my courses is firmly based in current, reliable evidence and respects a woman’s ability to know her body and to give birth with confidence and strength.

Unlike most other hospital prenatal classes, you do not need to be a patient at WCH. Regardless of where your midwife or doctor has privileges and whether you are planning a hospital birth or a home birth, you are welcome to register.

For more information or to register, please visit the WCH website. My courses are on Wednesday evenings at 6:30 pm (until 9). The first series begins November 14th.

New testimonial!

I received another lovely testimonial today that I wanted to share. This one is special in an unusual way, because the client is herself a doula-in-training. I am so proud of everything she’s accomplished and honoured to have been a part of her birth experience.

We couldn’t have done it without Heather! The birth of my second child didn’t go as planned. Does it ever? It didn’t go the way I had thought it would for nine months, yet I was still so happy with it. I attribute much of this happiness to Heather’s support. I went into pregnancy and labour well informed about my choices. I had read all the books, taken the classes and had personal experience. Despite all of this Heather was still able to teach me so much. She is a wealth of information, valuable resources, and an incredibly calming presence. During my labour, at the end of every painful contraction I smiled. I was made to feel secure amongst what can seem like a bit of madness. I came out of a long labour feeling strong and proud of what I had accomplished. Heather truly cares about supporting women and families. She so clearly has a passion for what she does.