Optimising Physiological Birth: Tips from a midwife
Evony Lynch – Governance Support Midwife at Royal Cornwall Hospitals
Is there such a thing as a bit of ‘midwife magic’ to optimise the chances of a straightforward vaginal birth? Or is it actually just a melting pot of science, skills and environment?
Someone recently told me how I worked my ‘magic’ and helped women birth their occiput posterior babies gently into water. I had actually tried to help them rotate their babies, in order to ease baby into an anterior position, but it hadn’t worked! However, both women became more comfortable, swiftly laboured and birthed gently and easily in the birth pool. It was awesome! But I don’t think it’s magic.
I’ve been specialising in normal birth for many years and I believe it’s simply optimising the cocktail of hormones that promote physiological birth, implementing midwifery techniques to enhance biomechanics, listening, guiding and believing.
So here are my own top tips for optimising normal birth through the science and art of midwifery.
1. Start at the beginning
What is important to individual women during their labour? Have they attended antenatal session previously? This is your baseline to know how you’ll be guiding them during their labour. If they’ve studied hypnobirthing, put on their music. If they haven’t attended any antenatal sessions at all, then you may need to share the basics of breathing and movement in labour. One young woman I cared for recently initially declined using the pool and on further exploration it was discovered that she was scared to birth her baby in water as she’d heard that she’d have to ‘pull it out herrself’. However she did love having a bath, and with information around the analgesic effect of water, the freedom of movement and option to leave at any time she wished, she gave it a try. And loved it.
2. The birth room as a sharing knowledge space
Know active birth positions, explore them for yourself, deeply understand the hormonal basics, the use of the water and birth aids and then you can confidently explain why they may be beneficial, for women/birthing people to make truly informed choices.
3. Set the scene
You’re creating a calm, safe and cosy space to enhance the parasympathetic system, thereby optimising release of oxytocin and endogenous opioids responsible for both optimal labour progress and concurrent analgesic effect. You’re aim is to reduce adrenaline release to facilitate an unhindered flow of birth hormones and enable a women to move instinctively. Revisit the basics of the physiology of childbirth – the important connection between mind and body.
4. Darken the room
Turn down the lights. Use LED candles. Upturn a torch in the bathroom and turn the lights off. Turn the angle poise suturing lamp towards the wall and turn off overhead lights. Close the blinds even in the day.
5. Reduce any sense of vulnerability
Women need to know they are safe to do this. If the woman is naked, offer a blanket. They will be doing the most intimate act to birth their baby, so privacy is key to helping the hormones flow. Close the door. Knock before entering the room. Make a sign for the door.
6. The breath
As you show women how to slow and control their breathing; breathe with them, encouraging them to close their eyes if they feel comfortable with this. Very simple, yet many people have no concept of how the breathing cycle can induce the calm, parasympathetic response.
7. Tuning in
From the moment you step into the room, their awareness will be heightened as they start to connect with you. Your ability to tune into them, to build a relationship without disturbing the hormonal interplay is crucial. Quiet observation as checks are carried out, assessing what their needs are, whether that is a change of position, encouraging words or helping them to focus.
8. Language
Listening first to hear what they need right now, then utilising the power of positive language, affirmations and absolute belief in their ability to go through this journey to meet their baby. This may be gentle encouragement about how well they’re doing or assertive guidance on how a position change may be an effective remedy to progress their labour.
9. Presence
Being able to observe the unfolding of labour is crucial to sense what the labouring person needs at any given moment. Remaining in the room discreetly as much as possible enables me to be proactive in my care rather than reactive to a call bell. However sometimes stepping outside to enable privacy for the birthing couple can be a vital part of enhancing oxytocin response in labour.
10. Optimal physiology for all mothers and babies
Whatever kind of birth a woman has optimising the physiology between her and her baby can make a positive contribution to mother-infant attachment, and their short and long term physical and psychological health. Optimal cord clamping, skin to skin contact, early breastfeeding and zero separation of mother and baby are all important
11. Fulfilment in our work
Remember we all have the same physiology and skilled midwifery support may be even more vital within a high-tech delivery suite environment. Simple measures can be employed to increase that cocktail of hormones, and enable someone to release their power during their birth experience. Seek out supportive colleagues who have confidence in these skills. It can be very challenging to balance all the midwifery demands placed on us, especially in this environment, yet together we can share our knowledge and skills and maybe enhance that sense of fulfilment in our work.
Resources for you!
All4Maternity eLearn Module Birth Physiology
All4Maternity eLearn Module Active Birth
All4Maternity eLearn Module Birth Environment
Buckley, S., 2015. Hormonal physiology of childbearing – evidence and implications for women, babies and maternity care. [pdf] National Partnership for Women and Families. Available at: http://www.nationalpartnership.org/research-library/maternal-health/hormonal-physiology-of-childbearing.pdf [Accessed 8 March 2020]
Gaskin IM (2008) Ina May’s Guide to Childbirth. Vermilion. USA
Downe S (2008) Normal Childbirth: Evidence and Debate Churchill Livingstone
Downe S, Byrom S (2019) Squaring the Circle: Normal birth research, theory and practice in a technological age. Pinter and Martin.
Hill, M., (2017) The Positive Birth Book. Pinter and Martin.
Lothian, JA., 2004. Do Not Disturb: The Importance of Privacy in Labor. Journal of Perinatal Education, [e-journal] 13 (3), p 4-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595201 [Accessed 8 March 2020].
Meddings N (2017) How to Have a Baby: mother-gathered guidance on birth and new babies Eynham Press
Simkin P et al., (2017) The Labor Progress Handbook: early interventions to prevent and treat dystocia
Evony is a midwife and works in the Patient Safety Team at Royal Cornwall Hospital Trust and in our alongside birth unit, Truro Birth Centre whilst studying for an MSc in Advanced Midwifery Practice. Exploring ways to empower midwives to optimise birth experience and increase job satisfaction. Twitter: @cornwallmidwife
Spot illustration credit: @Laurenrebbeck on Instagram www.laurenrebbeck.co
