jeopardise the start of breathing after birth, resulting in the need to resuscitate the baby (5).
Traces sometimes remain in the baby’s system after birth so that, in addition to adjusting to life outside the womb, the baby’s system will have the added burden of detoxification (6). They can also depress the baby’s sucking reflex and because they remain in the baby’s system for several weeks they can affect the initiation of breastfeeding and mother-infant bonding (7).
Epidurals
This is known as a regional anaesthetic which is injected locally into the epidural space between two lumbar vertebrae in the lower spine. When it works effectively the result will be a blocking of pain impulses, bringing numbness from the waist through the lower body.
While the effects of the drugs used for epidurals on the baby are not the same as Pethidine, we know that they enter the baby’s circulation and brain tissues within minutes (6). Their immediate and long-term effects on the neurological development of the baby are relatively unknown and direly under-researched, despite the widespread use of this form of pain relief, worldwide.
Side effects for the mother, such as severe headaches following the birth, can occasionally occur (these are caused by accidental scratching of the membrane surrounding the spinal cord by the injection needle), and a lowering of maternal blood pressure is common.
An epidural will certainly increase the need for obstetric intervention. Of course the mother will be immobile and reclining so contractions tend to be less efficient, and labour is often much longer and may need to be artifically stimulated with an oxytocic drip.
All these factors contribute to a lessening of the blood supply to and from the uterus, so foetal distress (lack of oxygen) is far more likely. Sometimes the pelvic muscles become limp and do not help the baby to rotate in the usual way (with the added disadvantage of being without the help of gravity).
An epidural can also inhibit the mother’s ability to push her baby out spontaneously and, one way or another, the risk of a forceps delivery or a Caesarean section is increased.
When mothers give birth actively, with the help of a midwife, the forceps rate rarely rises above 5 per cent and drugs are only used in cases of unavoidable distress or to save a life. By contrast, in countries such as the USA, the incidence of forceps deliveries can be, according to Doris Haire, as high as 65 per cent in some hospitals. An unnecessary forceps delivery can be traumatic for both mother and child and can occasionally result in injury or damage to the baby (8).
Although, at times, the total freedom from pain offered by an epidural may be indispensable, it is important, for a successful outcome, to weigh this advantage against the attendant risks, which are considerable. Occasionally the price of a few hours of comfort can be a damaged baby and may very well be a complicated birth (9-12).
So, might it not be better in the long run to learn how to use your body to release, minimise and transform the pain of labour and to have access to a pool of warm water or a shower – an effective and totally harmless way to reduce pain? If an epidural is really needed, then its use can be minimal and, in this way, the attendant risks are reduced.
STIMULATING LABOUR
Induction
An induction may be used to initiate labour or to stimulate contractions once it has begun. It is usually done by introducing an intravenous drip of Syntocinon (Pitocin in USA), a powerful synthetic hormone, into a vein in the mother’s arm.
Normally, when the uterus contracts, the blood vessels which carry blood to the placenta are temporarily constricted. In between contractions, blood is stored in the placenta to keep up a constant supply to the baby during contractions. When contractions are stimulated by Syntocinon they tend to be longer, stronger and closer together than in a normal labour. The periods of constriction are therefore longer than usual so that the overall oxygen supply to the baby is reduced and foetal distress is therefore more likely. Doris Haire writes in Drugs in Labour and Birth,‘The situation is somewhat analogous to holding an infant under water and allowing the infant to come to the surface to gasp for air but not to breathe.’
The incidence of postnatal jaundice in babies who have been induced is also thought to be higher (13-14).
In addition, strong contractions usually occur as soon as the drip begins to work so the gradual build-up in intensity of a normal labour is absent. This often means that the mother cannot cope with the pain of the stronger contractions and will need pain relief, so the baby will end up with the combined effect of painkillers and the drugs used for induction.
Of course, continuous foetal monitoring will probably be necessary with all these risks and so the snowball effect continues as one intervention necessitates another.
Studies have shown that there is no evidence of any natural advantage in routinely inducing births that are ‘overdue’ and a failed induction frequently ends up as a Caesarean section (15-18).
Would it not be better to reserve this option as a last resort and discover how to change position to stimulate contractions, or how to improve the birthing environment so that the mother can secrete her own natural hormones? Learning how to allow the normal physiology to unfold without disturbance is the most effective way to ensure that the mother will secrete her own hormones.
Birth Before Obstetrics
Historical studies show the prevalent use of vertical positions – kneeling, squatting, standing or sitting postures – with many variations and as many methods of support.
There is evidence going back thousands of years of the bodily positions taken in childbirth. The head of a silver pin from Luristan in Iran, first millenium BC, depicts a squatting mother. The remains of a clay statue of 5750 BC from a shrine at Çatal Hüyük, a Copper Age (Chalcolithic) city in Turkey, shows a goddess giving birth in the same position, as does an 8½ inch Aztec stone fertility figure from Mexico. A relic of the Mound Builders of eastern Arkansas, a pre-Columbian culture of unknown date, shows a woman squatting with her hands on her thighs. The Egyptian hieroglyph meaning ‘to give birth’ shows a mother squatting.
A relief from the temple of Kom Ombo, a town on the Nile in Upper Egypt, shows a woman giving birth in the kneeling position. Birth in the same position can be seen in a marble figure from Sparta, about 500 BC. In ancient China and Japan, women customarily gave birth in the kneeling position on a straw mat. All scenes, of course, depict only the final birth, but positions used during the rest of labour can also be traced.
In the Old Testament, Exodus, chapter I, verse 16 states:
When ye do the office of a midwife to the Hebrew women, and see them upon the stools …
A Corinthian vase depicts a woman in labour seated on a birthchair. An early Greek relief and a Roman marble bas-relief both show a woman giving birth on a stool supported by two assistants. The birthstool was also recommended for uncomplicated labours by Soranus in the early part of the second century AD and by many subsequent writers. It was described as, ‘In a form like a barber’s chair but with a crescent-shaped opening in the seat through which the child may fall.’ The first birthstools may have been rocks or logs of wood, developing over time into complex, adjustable chairs with many varied devices.
There are also many examples of women giving birth without a stool using a variety of upright postures and always supported by one or more attendants while the midwife receives the baby.
From Birthchair to Bed to Delivery Table
In the Western world, the birthstool or chair remained indispensably part of the equipment of most midwives up to the middle of the eighteenth century. Each wealthy household had its own stool, whilst among the poor a stool was transported from house to house. The birthstools of royalty were carved and ornamented with jewels. Dutch, German and French sixteenth century drawings show the great use of birthstools, as do