Undisturbing Birth.

By Rangimarie Aperahama & Madison Fredheim
May 2015

Sarah Buckley is not only a Dr at the forefront in her field, exploring the true physiology of birth. She is also a passionate advocate for home birth. As part of her ‘Undisturbing Birth’ workshop, Sarah Buckley gave our Home Birth community an opportunity to join her on the day and feedback on their experiences. We gained an incredibly enthusiastic response to our offer of seats gifted by Sarah. We could only choose two from our community to go, but as luck would have it, we found two strong voices to offer their reflections on the workshop:

Our trustee Tammi heap enjoyed her day with Sarah Buckley.

Rangimarie Aperahama gives her thoughts and reflections on the day:

I recently had the privilege of attending Sarah Buckley’s workshop “Undisturbing Birth”.

It was also a privilege to share the space with a room full of women who work in roles that support mothers, Midwives, midwifery students, birth educators, lactation consultants etc. Sarah’s respect for them was evident in her continual reference about whether the information she was presenting was consistent with their observations and practice.

The workshop began with a mihi to Sheila Kitzinger, who had passed away two days earlier. Sarah acknowledged Sheila’s contribution to the field of pregnancy and birth and to Sarah personally.

The remainder of the day was split in to three parts; the role of specific hormones in motherhood; the effect of interventions; and the hour after birth.

The four hormones covered were Oxytocin, Beta Endorphins, Catecholamines and Prolactin. As someone new to this, and having just birthed my second child, there was a lot of information of interest to me. Each hormone is required at particular times and particular levels to facilitate labour, and deviation has flow on effects to the others, for example an excessive amount of either catecholamines or beta endorphins causes a reduction in oxytocin. The hormones also play a critical role in attachment between mother and child. The mantra for this part of the day was that a birthing woman should feel “private, safe and unobserved” as this created the right environment for birth to progress and for the long term health of her and her baby.

The evidence Sarah presented demonstrated that not only do the hormones have effects on one another but that disturbance to that process by the introduction of interventions had flow on effects during labour as well as long term. The second part of the day was about the impact of three interventions, synthetic oxytocin, epidurals and caesarean section. Given their prevalence in today’s birth environment, I wish I’d informed myself better about the issues around each intervention. My recent labour was augmented with Syntocinon, a synthetic oxytocin. Once in hospital it felt like there was pressure for decisions to be made and it feels like those decisions were made with very little information about the risks. Sarah explained that while synthetic oxytocin is the same molecule it does not pulsate like the oxytocin naturally released in our brain, therefore the body’s natural response is to reduce the oxytocin receptors on cells, which actually reduces the efficiency of contractions. Synthetic oxytocin does not effectively cross the blood brain barrier, so it lacks the analgesic effects of natural oxytocin, meaning stronger contractions with less natural pain relief. This often results in women requesting epidurals. Sarah also noted that in animal studies epidurals were shown to have detrimental effects on the attachment of mother to offspring.

The hour after birth was the last section. Here Sarah talked about the ongoing role and prime conditions for the same hormones to function in the hour after the baby is born. By this stage of the day, the babies in the room were ready for a change of scene so I wasn’t able to take on as much information. The take-home message seemed to be directed to those in the room that support women during labour. “Keep the mother undisturbed, keep baby with the mother, don’t clamp the cord”.

The whole day was jam packed with evidence of the physiology of motherhood and the effects and potential effects of interventions. Quite sobering when you consider the rising prevalence of interventions in the developed world.

I was born at home in Northland in 1981.

At 2 we moved to Lumsden Maternity Hospital where mum was the lead midwife. I used to run around the hospital, and peek under the doors all the time. The sounds and sights of birth were very familiar.

I have felt very strong and capable as a woman and mother, perhaps to the point of arrogance. I didn’t seek out information about nurturing the physiology of birth or of the risks of interventions prior to becoming a mother.

At 17 I gave birth to my first child. I wanted a home birth. I was past my due date and afraid of having a hospital induction, so I used castor oil to bring on the labour. We laboured at home but after about 12 hours transferred to hospital. I went into second stage on the car trip. My daughter was born within half an hour of arrival without intervention.

At 33 I gave birth to my second child. I wanted a home birth. I was past my due date and afraid of having a hospital induction, so I used castor oil to bring on the labour. We laboured at home for about 20 hours and then transferred to hospital. To my surprise I didn’t go into second stage in the car this time. We got to the hospital and someone made a comment about how different the clinical room was to where we’d come from. I had a feeling of familiarity with the room from our time in Lumsden, but I didn’t like the shift in energy, the undertone that I had lost my autonomy. The registrar came and asked what I wanted “As little intervention as possible”. He explained that if synthetic oxytocin was given that would increase the pain of the contractions which often meant women asked for epidurals. I was vaguely familiar with the cascade of intervention that potentially followed. We also had some discussion about the need for the CTG, which seemed to be the only barrier for me to stay mobile. I guess from this I deduced that there was some risk to the baby with the introduction of syntocinon. I can’t recall any other risks being discussed. I gave my consent as it seemed like “why else have we come here”. I took myself to the bathroom and my contractions seemed to be getting stronger. The registrar put the intravenous line in my hand and checked my dilation, 4cm. My midwives left and a hospital midwife, Michelle, came in to start the drip. Michelle was very responsive to my wish to stay standing. She bought the drip and the CTG machine to the end of the bed so that I could remain mobile. When the drip started, I couldn’t feel any discernible difference in the strength of contractions. After about 10 minutes Michelle came back to the machine and seemed to increase the dose. I thought she’d gone too far and that I was in trouble. I think now that my baby’s head had actually come down through my cervix. Within 5 minutes my daughter was born.

Now, having been to Sarah Buckley’s workshop “Undisturbing birth”, I have some thoughts about the way my two labours have progressed. Maybe I didn’t have enough Oxytocin receptors because I induced the labour. Maybe the place that makes me feel safe in birth is a clinical room, because of my mind’s association of birth with Lumsden hospital. Maybe I could have been more aware of my desire for privacy.

I hope the information Sarah presented creates change in the institutions and systems in which interventions are becoming more and more prevalent. More importantly I hope it, and the complementary wisdom of midwifes like Sheila Kitzinger and Joan Donley, find their way into the minds of women and helps them to feel strength in their ability and knowledge of how to nurture their physiology, so positive natural birth stories are the norm.

Nga mihi to Sarah and to homebirth Aotearoa for the opportunity.

Madison Fredheim gives as a beautiful and nuanced insight to her experience at the workshop:

Kia Ora Everyone!

My name is Madison Fredheim, a third year student midwife at Auckland’s University of Technology. First of all, I would like to say a big thank you to Sarah Buckley for her knowledge and kindness, and Home Birth Aotearoa for the opportunity to submit an article; I feel very privileged and have enjoyed writing up my account to share!

On the evening of the 13th of April at 11:30 pm or more commonly known as 2330, I was snuggling down into my scrumptious duvet and pillow, being happily consumed by them. Following this moment of blissful indulgence, naughtily I scooped up my phone off the bedside table and half read my emails.

I don’t know what I was expecting to find when tapping the email app; a Power Shop flyer, a farmers Club notification, another leaflet for the never-ending Briscoes sale. I had checked through my emails already that evening and wasn’t expecting anything of great importance. Then, my scanning eyes stopped, a title had caught my interest, I gasped, paused, and let out more well controlled “Oh My Goodness!”. Due to a series of events, I was offered the chance to attend Sarah Buckley’s Undisturbing Birth: Whole-day workshop, for free!

I couldn’t be happier! I had read Sarah Buckley’s book “Gentle Birth, Gentle Mothering” in my first year of Midwifery training and found it not only incredible, but fascinating. To think the very next day I would see her in person, hear her speak and possibly get a picture next to her made me feel as though I was a child again on Christmas Eve.

Sarah began her Workshop discussing the origin of birth from an Anthropologic perspective. It is believed that birth and placental mammals have evolved alongside one another for 65 million years!

This information for me has reinstated the purposeful belief in women’s bodies as birthing bodies. Aren’t women’s bodies clever? I found this information very encouraging. I also found it interesting that, the average human life lasts 60 years in New Zealand, and although the amount of knowledge a person may learn or discover in their whole lifetime may seem substantial, it’s really no competition when put up against the age of Mother Nature. We really do have a lot yet to discover if we want to make up for 65 million years! Furthermore, Sarah lines up the components of reproductive success as evolving for our survival (safety), efficiency (ease) and reward (pleasure). Therefore, reproduction and birth are the foundation of our survival, individually, and as a species.

I found Sarah especially captivating because as Michael Odent states, she is multi-lingual. Not only does Sarah speak from a medical background, but she can also speak the language of a mother who has birthed her four children at home. This has highlighted within me my own journey as a woman parallel, but separate to, my journey as a midwife. As a young woman, I look forward to the day I can have my own births and babies, I wonder about my birthing, what will personally resonate with me and look forward to connecting with and discovering my body. I look forward to discovering my strengths and weaknesses as a parent, and as my babies grow, loving like I have never loved before. In my travels, I have found a quote by Author Elizabeth Stone that naturally links us onto the topic of hormonal physiology and childbearing. “Making the decision to have a child is momentous. It is to decide forever to have your heart go walking around outside your body.”

Attending Sarah’s workshop enlightened me to the essential role that hormones play during labour, birth and breastfeeding. We considered the birth environment whereby the hormonal processes are enabled and supported. Sarah reinforces the importance of avoiding environmental disturbances; and feeling private, avoiding anxiety and fear; and feeling safe, and thirdly, avoiding the presence of an observer; and feeling unobserved. In short, and as was our chant on the day, “private, safe and unobserved!” were the core requirements needed to protect and promote normal physiological labour and birth.

My new understanding provided me with insight as to how everyday happenings in our current birth culture can potentially put this beautifully orchestrated balance, and therefore Mother and baby, at risk. I have reconsidered exploring how as a Midwife, I can facilitate women feeling private, safe and unobserved. Not only have I realised I needed to do more research around the subtler ways I can support the maternity female hormones, but I have also realised that there are many unrecognized and abstract ways in which the ecstatic hormones (and labour) can be disrupted.

In New Zealand today, it does not seem that many women understand the maternity female hormones or how they work to benefit the birth of their babies; nor the extent to which they can influence breastfeeding. To me, this raises the question, how well are health professionals informing New Zealand women of the short and long term risks associated with intervention in labour? And how well are health professionals educating, supporting and revealing to women their Motherly authority, true capabilities and embodied knowledge? Surely, if women knew this seemingly hormonal secret of Motherhood, they would more commonly exalt in birth instead of fear it.

The ecstatic hormonal cocktail involved in labour and birth to enhance ease, pleasure and safety consists of a great number of hormones. However, the key four focused on during Sarah’s workshop were oxytocin (the hormone of love), beta-endorphin (the hormone of pleasure and transcendence), adrenalin and nor-adrenalin (the hormones of excitement) and prolactin (the hormone of breastfeeding and bonding). These hormones increase during labour and in the minutes after birth, Sarah illustrates that mother and baby are suffused in brain and body. Postnatally, the peaks of these hormones and the behaviour they promote aids to facilitate long-term breastfeeding and attachment.

Reflecting upon Sarah’s information, I explored how it will influence my practice. I have been to one homebirth in my two and a half years of training and what I have experienced aligns with what Sarah has said. However, following my first homebirth, I couldn’t help but feel disappointed. My current lack of exposure to homebirths means I have missed out on experiencing what physiological birth looks, sounds, smells and feels like. Midwifery is a unique profession where we have the chance in New Zealand to provide good quality women centred care in the environment where the majority of women undoubtedly feel most comfortable. But how can I provide this option, promote and protect physiological birth if I don’t know what physiological or instinctual birth is? I felt primarily disappointed about my lack of exposure to homebirths because birthing at home facilitates such a safe, healthy, loving, more relaxed and personalised birthing experience for women and families.

At the birth I attended, the woman was in complete darkness, in a pool, and in a room with curtains separating her space with ours. She seemed to have felt private, safe and unobserved. I was able to hear how her labour progressed purely by the tone of her voice as she behaved instinctually to birth her baby. In my practice, finding ways in which I can prevent disturbing labour and birth firstly meant I had to understand what private, safe and unobserved meant, for women.

“Private” can be described as something belonging exclusively to the woman or to a small group of people that is not to be disclosed with others. Private is also described as a person having no official public role or position. While these descriptions helped my understanding, the synonyms were where I found the most insight; personal, one’s own, individual, confidential, secret, classified, particular, special, unofficial, not to be made public, not to be disclosed, back stage, offstage, exclusive, intimate, innermost, inward, unspoken, undeclared, unvoiced, hidden, reserved, introverted, self-contained, discreet, uncommunicative, unforthcoming, ungregarious, unsocial, withdrawn, insular, reclusive, hermit-like, secluded, quiet, concealed, remote, isolated, sequestered, undisturbed and lastly, alone.

“Safe” can be described as feeling protected from or not exposed to danger or risk; not likely to be harmed or lost. Synonyms for safe are, protected from harm/danger, shielded, sheltered, guarded, defended, secure, safe and sound, out of harm’s way, right, risk-free, riskless, unassailable, invulnerable, harmless, innocuous, non-toxic, non-poisonous, non-irritant, benign, and lastly, wholesome.

Thirdly, “Unobserved” can be described as not being observed, seen or perceived, not to view, watch or note for scientific or official purposes. Synonyms for unobserved are, undetected, not discerned, unnoticed, to keep or maintain in one’s action and not to regard with attention (especially when to see or learn something). On the contrary, antonyms for “unobserved” interestingly consisted of the need to obey, perform, comply or conform to; words that are synonymous with medicalised births.

Applying my current understanding to practice following Sarah’s workshop, has enabled new strategies to be discovered. When a woman or partner has contacted me over the phone to say labour has progressed, instead of asking to put the woman on the phone to ascertain how established labour is, it would seem more beneficial to attend her home and ‘experience’ how progressed she is. By asking a woman linear and intellectualizing questions, I would be encouraging her to focus on what I am asking her, and therefore, not on her body. As a midwife, protecting and promoting physiological birth, I want to discourage the use of her rational brain and instead allow the woman to submerge into her body via the Limbic system to facilitate hormonal processes. I could experience how she is by quietly entering the home, finding a seat respectful of the woman’s birthing space and sit and collate information whilst “not observing” her by knitting, reading one of her cook books or by resting with my eyes closed. Additionally, instead of approaching the woman to notify her of my arrival, I could leave her be and wait for her, if she should want to, approach or talk to me.

Reflecting on the role of vaginal examinations, it would be possible to encourage women to do the exam themselves. This way, they can remain in their current position, they know their own anatomy and by sensation, they can conclude a measurement being less likely to hurt themselves. This seems not only to be in most cases more accurate but empowering for women. It enables women’s womanly parts to remain precious, private and unobserved whilst in herself, safe, wholesome, effective and legitimate.

Women feeling as though they are the most informed body about their body I additionally believe, is extremely important. Since the day of each woman’s first menstrual cycle, she has been the body to attend to, care for, and nurture her body. Since the moment of conception, through nine months of pregnancy, she has been the body to keep herself well through the “minor symptoms of pregnancy”. At term, she has been the body to beautifully grow a fully functioning and complete human being from a single cell. May I emphasise, for such embodied knowledge women are employed twenty four hours a day, seven days a week for the majority of their lives. Unfortunately, the discussion around undisturbed birth in healthy women, reveals the extent to which women’s embodied knowledge and feelings of legitimacy can be undermined and undervalued by a medically orientated society.

Lastly, a seemingly unknown concept that sparked my interest, was how breastfeeding and attachment were largely emphasized upon by Sarah. She stressed that if the mother could not breastfeed her baby in the wild, the baby would not survive. If the mother was not motivated through attachment to pick her baby up and respond to its cries, like so, the baby would not survive. It became clear that the hormonal physiology of labour and birth, includes processes that ensure not only that the mother and baby survive the birth, but also to facilitate a healthy, loving and attentive breastfeeding bond. Therefore, our hormones are not only essential for the immediate here and now, but they are also purposefully and inextricably linked to provide a strong foundation for the relationship between, and the holistic wellbeing of, Mother and baby. In turn and as expected, physiological hormonal birth processes have been seen to significantly increase successful breastfeeding rates, decrease post-traumatic distress syndrome and decrease the likelihood of postnatal depression.

To conclude, Sarah’s invaluable and ground breaking research remains extremely relevant for a wide range of health professional practice, and public maternity health knowledge. As I approach the ‘half-way mark’ in my last year of midwifery training, I aim to use the amount of time left to be with a midwife who actively protects and promotes physiological birth. I rejoice as a student and believe that Sarah Buckley’s workshop has come at this time for a special reason unique to me.

Thank you, Home Birth Aotearoa and Sarah Buckley, once again for the opportunity to attend the Undisturbing Birth: Whole-day workshop. It was due to Sarah’s kind generosity and donation of two tickets to Home Birth Aotearoa, that I was able to attend.

Kindest Regards,

Madison Fredheim

Third year student midwife

Auckland University of Technology

P.S Sarah’s latest report is available as a free download from her website www.sarahbuckley.com  of which she has encouraged us to share.

Our trustee Tammi and Rachel our national coordinator enjoy some cuddle time with Sarah.