Wednesday 20 June 2012

Michel Odent Study Day Sarratt, Herts

This Article was first published on The Vegetarian Experience on 2nd July 2011

This is a bit of a different post for The Vegetarian Experience, but I felt I would like to share some thoughts from a study day I attended last Wednesday.  In case you don't know already, I am training to be an NCT Antenatal teacher and since I started training have had the privilege to attend study days from some of the most inspirational people making a difference in modern childbirth.  

An opportunity to attend a study day on my doorstep with the wonderful Michel Odent, a retired Obstetrician and childcare specialist was too good to miss.  Many women who believe in natural childbirth would normally clench and take a sharp inhalation of breath upon hearing the word "obstetrician", but Michel Odent is an obstetrician with a difference.  He is a strong believer in natural childbirth, minimum interventions, home birth and also the power of water in labour - something which in the UK would put many obstetricians out of a job.

At 81, Frenchman, Michel Odent is still going strong, touring the world speaking about his belief in the ability of the woman's body to give birth without the aid of modern technology, training and inspiring midwives, health professionals and childbirth educators alike.  Having read some of his books, I was really excited to hear what he had to say and I was not disappointed. 

Here are some of the things that Michel Odent spoke about during his study day and some of the ideas he shared.
  • Society needs to develop a new way of thinking, enter a new paradigm. At the moment we are standing at the bottom of an abyss, and we need to shift in the opposite direction to the way childbirth has been going over the last 50 years
  • There is a deep-rooted, cultural lack of understanding about birth physiology.  Cultural conditioning is in absolute opposition to what we can learn from modern physiology. Cultural conditioning is influenced by visual images.  In the modern world "natural childbirth" means being surrounded by 4 or 5 people telling you what to do - that is not natural.  A meeting in Southampton with the producers of "One Born Every Minute" and the head of midwifery at the hospital, proved what many childbirth educators were thinking - that the producers only chose the births which would make good TV viewing.  However, the midwife said that these births were representative of the natural picture in the UK. In the UK, we don't know any more what the term "normal" birth means. Normal childbirth is classed as any birth which does not end up as an assisted or Caesarean birth, but a birth after 15 hours of stimulating labour using syntometrine, with a woman on the bed in stirrups and epidural in her back can surely not be classed as "normal". 
  • Women need to release a cocktail of hormones in order to give birth, but technology gets in the way. Oxytocin is the main component of the cocktail of love hormones a woman releases to give birth. The birth process if an involuntary process - you cant stop it happening.  Women need to believe in their bodies intuition and the involuntary ability to give birth.  The number of women giving birth completely naturally with no pain relief (including gas and air) is approaching 0% in many western countries.
  • To labour effectively, women should be relaxed, so relaxed that they enter a pre-sleep state, or fall asleep.  If people interfere all the time, engage the woman in conversation or keep entering the room, the woman cannot stay relaxed and her levels of adrenaline rise.
  • Often, in order to give birth, women are told that they need energy, sugar, lucozade etc, but this is not actually the case.  Sugar fuels adrenaline. You actually only need low levels of adrenaline for birth. Introducing sugar in labour increases the risk of jaundice and neonatal hypoglycemia. Sugar also helps to stimulate the neocortex.  In order for labour to progress well, the neocortex should shut down.  Women need to stop "thinking" in labour and just let their body take over (Let your monkey do it, as Ina May Gaskin says) 
  • During labour, the point where women become dazed, start talking rubbish, or go to another planet , signals that the neocortex has shut down and the animal behaviour takes over.  A mother needs to feel protected in order to let her neocortex shut down. When in labour, a woman also need to be protected against neo-cortical stimulation - specifically, being stimulated by language. Silence is a basic need during labour.  Language and asking questions actually stimulates the neocortex. Being observed also stimulates the neocortex.
  • As well as producing oxytocin, women also need to produce melatonin.  Melatonin is the darkness hormone which shuts down the neocortex and helps us all to relax and sleep at night
  • So to recap, the four basic needs of a mother in labour are:  
  • 1) Low Lighting/darkness 
  • 2) Don't stimulate the neocortex 
  • 3) The woman should not feel that she is being observed   
  • 4) Feeling secure/protected.   
  • The prototype of the person who makes us feel safe without being observed is a mother.  Midwives should be a motherly presence.
  • The emotional state is associated with the production of adrenalin.  Our emotional state is contagious, and the release of adrenalin is contagious too - i.e, if we encounter someone who is in a bad mood, chances are, they will get our back up and make us in a bad mood too.   A midwife/partner who is annoyed, stressed, harassed, fearful, tired etc and emitting lots of adrenaline will pass that adrenaline onto the labouring woman and therefore inhibit her birth.
  • Hormones released through childbirth are water-retention hormones.  They prevent water from going into the bladder. During labour, many women are constantly reminded or encouraged to drink.  However, contrary to popular belief, you don't need to drink lots of water through labour.  You only need to drink if you are thirsty, rather than drinking because you are being coached to.  There are more studies about water intoxication in childbirth than dehydration.  Hospitals always prefer to regulate and monitor/measure the amount of water going into the body during labour, but drinking fills up the bladder, which then makes it impossible to give birth or push, as you cant with a full bladder. Excessive liquid also makes the uterine contractions weaker and so slows the labour.  Some hospitals use pulse rate as a sign of dehydration, so if they think the woman is dehydrated and make her drink more, when rehydration occurs, the labour can slow down.
  • An important discovery was made using accumulative data provided by a university in the second half of the 20th century... - this important, major discovery? - A baby needs its mother.  Something so simple had been overlooked by health care professionals for so many years. 50 years ago, no one realised that a baby's only need is its mother in the first hours/day/first few days of life.  The power of modern science separated mothers and babies. Newborn babies were kept in hospital nurseries and not with their mothers.  They were washed and dressed by midwives, fed by midwives and not encouraged to bond or have skin to skin with their mothers.
  • The Golden Hour: There is a magical period after birth known as the golden hour.  Straight after birthing the baby, women who have had a vaginal birth will generally experience a state similar to the orgasm state straight after sex. Oxytocin, is working in overdrive at this time to promote bonding between the mother and the baby. This is a very precious moment is a time which can never be recreated.  The mother must not be cold or distracted and the mother and baby should not be separated.  Skin to skin should be happening and the baby and mother should be left completely alone to bond.  There is a high probability that the baby will find the breast by itself if skin-to-skin is given in the first hour after birth.  Things should be kept quiet/dark to imitate a womb-like state.  In reality, there are many things going on after birth which inhibit bonding and the golden hour.
  • The homebirth rate in the Netherlands is 30%, compared to an average of 2.5% in the UK (Birthchoice UK), so we should be looking to the Netherlands and their model of care and move in that direction.

Can you comment on the role of adrenaline in 2nd stage labour?
  • The role of adrenalin in 2nd stage. Just as it is impossible to make love in a dangerous situation, if adrenaline occurs during 2nd stage, then it is unlikely the baby will be born smoothly.  Oxytocin  - a key hormone in sex and also lactation initiation, is needed to help the baby to be born. In rare situations, if the woman is really relaxed, the neo-cortex has shut down and if the woman completely trusts the people in the room and feels protected, then "Fetus Ejection Reflex" may occur. This means that there will be a sudden release of hormones, an irresistible contraction and a sudden urge to push, and the baby will be born without the woman consciously doing anything.
Is there ever a good time to ARM (Break the woman's waters)
  • There is never a good reason to ARM.  There are many side effects including introducing the risk of cord prolapse, infection, the baby passing meconium and cascade of interventions.  The main cause of cord prolapse is ARM.  Stronger contractions facilitate the release of prostoglandins which makes more powerful contractions. Sometimes, the midwife may do it just to reassure herself that all is well or labour is progressing. Odent believes that there is a simple way to check whether the amniotic fluid (waters) are clear by reinventing amnioscopy.
What is the role of the father/partner in the birth room?
  • In 1953, no one imagined that the baby's father would be present during labour and birth.  Birth was women's work, and the men would appear only at the last minute when the baby was about to arrive.  The introduction of men in the birth room coincided with the rise of the nuclear family, government social welfare and the economic independence of the working classes, meaning that they could now live in their own home rather than with extended family. As the family became smaller, women lost the knowledge passed down to them through older female members of the family and so came to rely on their husband/partner as the main birth supporter.  Some men can be a distracting state in during labour and birth. Some women are having unnecessary epidurals/interventions just because their partner says they should, or they don't want their partner to see them in pain - not because they genuinely need it. Odent believes that the man should be kept busy whilst his partner is in labour.  Men seeing their partner give birth influences the sex life of the couple and can sometimes lead to men getting post partum depression after the birth. Its also important for couples to look after each other in the early days to prevent either person entering into a depressive state
Can you tell us a bit about Childbirth in Plastics (new book)
  • Drips are the most common intervention in childbirth.  Syntocinon can easily cross the placenta in both direction and enter the fetal blood stream. There is a chance that the syntocinon also goes directly into the babies brain.  The widespread use of syntocinon might explain the difficulties of childbirth.  A study in China showed a link of the use of syntocinon to developmental outcomes, length of breastfeeding and autism.  In this study, 6000 children all born in the same year were assessed over birth.  The findings were split into children who had a normal birth, homebirth,emergency caesarean and planned caesarean.  The children whose mothers had a planned caesarean were the only group who did not show signs of concentration. developmental difficulties or autism.  They were also the only group who were not exposed to syntocinon during labour. 
What do you think about induction?
  • There are 2 trains of thought for induction - 1) follow protocol and induce or 2) a selective attitude which takes into account each biological case individually. Count the baby's movements, take notes, palpate, watch, monitor the baby, use amnioscopy to look at the fluid, use ultrasound to assess the fluid levels, position of the baby etc. The endocrinic gland is also useful to assess whether to induce depending on the amount of placental hormones.  Nice guidelines 2008 suggest that if a woman doesn't want to be induced, you should repeat an ultrasound scan to assess whether to induce.  The baby gives signals to say that it is ready to come through the onset of contractions.  When induction occurs, you precede the signals and start the cascade of interventions.
Is Caesarean always the safest option for breech?
  • In 2000, the Lancet published two articles saying that caesarean is always the safest option for a breech baby at term, however, Odent believes that the first stage of labour could be used as a trial of labour for health professionals to then assess whether to perform a Caesarean. Don't induce or interfere, create the best environment for the woman - darkness, shutting down neocortex, woman feels protected etc. If the 1st stage goes fast, then a breech birth might be successful. If the 1st stage is difficult, then a caesarean is probably best.  Some situations will always require a caesaresan.  Don't try and have a natural breech birth in the presence of a scared midwife or doctor. Also think of the baby, don't birth a breech baby unassisted.
I hope that's useful - what are your thoughts on Odents theories? - I would love to hear them!

Finally: Not strictly Michel Odent, as this video was recommended by Ina May Gaskin, but I believe it relates to the womans belief in her body's ability to get birth and shows that all mammals have intuituion - humans and elephants included!

Elephant birth :  (warning - contains scenes of birth and blood).

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