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Spurgeons provides support to families in Birmingham. As part of the Birmingham Forward Steps Partnership, we work with children aged 0 to 5 and our Family Hub online and in-person takes a whole family approach. So we can offer information, advice and support for families with children and young people from 0-19 years (25 with SEND). Our family hub services and children centre services wrap around families to offer help where we are needed most.

Our experienced teams are based at our children's centre venues in Erdington, Perry Barr, Sutton Coldfield and Hodge Hill districts (including our Family Hub) in partnership with Birmingham Forward steps, providing outreach services in local community venues.

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Spurgeons Birmingham Children's Centres | Birmingham Forward Steps

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At Birmingham Children's Centres and Family Hub, we deliver early years and support for families with children and young people from 0-19 years (25 with SEND).

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Feeding | Information and support for babies & toddlers | NCT

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Whether you're breastfeeding, formula-feeding or both, you'll find lots of useful articles about feeding here. Plus, tips on introducing solids when you're ready.

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Helping your child to sleep in their own bedroom

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We all know how important a good night’s sleep is – both for us and our little one. Once your child is old enough to sleep in a bed rather than a cot, you will probably be thinking about moving them into their own room, however, getting a young child used to settling down in their own bedroom every night can be difficult. In this blog, we will explore methods and tips to help your child develop healthy sleep habits and feel confident sleeping in their new bed and room.

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Close family relationships afford a person better health and well-being, as well as lower rates of depression and disease throughout a lifetime. But in many families, getting along isn't a given. The interaction between various members is at the core of these complicated dynamics. We may joke about the stereotypical sources of disharmony-the obnoxious uncle and the ne'er-do-well son-but factors like environment and sibling rivalries do emerge when considering the viability and stability of family networks.

For more on sibling bonds, visit The Sibling Relationship.

The Single-Parent Family and The Only-Child Family.

The Families We Choose.

What Is a Functional Family?

In a functional family, parents strive to create an environment in which everyone feels safe and respected. A positive home requires parents to set and uphold rules, but not resort to overly rigid regulation of any one person's behavior. In a healthy household, slights and misbehaviors are readily addressed, and boundaries are clear and consistent, all of which help avoid disharmony in the longer term. While this sounds easy, it can be hard to achieve in practice.

In a stable family, positive emotions are infectious. And in an unstable family, the anger felt by one person can reverberate throughout an entire household. In fact, negative emotions are sometimes even more contagious than positive ones. Growing up in such an environment often leads to difficulty in identifying and regulating one's emotions later in life.

Boundaries can be physical (don't hit your brother) emotional (stop blaming me) perhaps even digital (no, Mom, you cannot post that photo of me). For healthy family boundaries, every family member has a right to their privacy (stop walking in without knocking) a right to their belongings (stop borrowing my iPad) a right to their opinion (I am voting for my candidate, not yours) a right to their values (I am an atheist).

Setting limits and defining what is okay and not okay makes you feel stronger because you're standing up for yourself; it also communicates to others that you know your needs and aren't afraid to state them. As uncomfortable as setting limits may be, they are good for relationships, not bad.

To set limits, you need to know your thresholds. This starts with healthy self-awareness and what you value, both of which are important when you're dealing with young family members who are only starting to learn about themselves and their needs. Boundaries also bring out hot-button emotions, and the ability to regulate those emotions is a necessary skill.

Some therapists map genograms, which track behavior patterns across generations. They find that some children replicate the behaviors of their dysfunctional parents when they themselves become adults. Others, when grown, cultivate behavioral patterns that are the opposite of how their parents behaved; it's not uncommon to find a teetotaler who has an alcoholic parent.

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What Is a Dysfunctional Family?

Peace and harmony may be the goal for most families, but dysfunction is common and insidious, and arrives in many forms. Family quarrels, grudges and estrangement can have lasting effects, sometimes following members into old age. When one family member contends with a problem such as alcoholism, the entire household is impacted. In a dysfunctional home, there is normally no sense of unity or empathy or boundaries, and members can be highly critical of one another.

The reasons for conflict are many and varied. The dysfunction may start with something as simple as a parent who models unhealthy behavior. This is a no-brainer, if Mom allows herself to eat the entire bag of Oreos, she shouldn't bother hiding them from the kids. Another obvious reason is poor communication, unstable households rarely enjoy positive interaction. The unsteady home is not a safe place for its members. Often dysfunctional households suffer any number of problems, including domestic violence, substance abuse, neglect, or untreated mental illness.

Just one member can tilt the family dynamic into dysfunction, or worse, estrangement. Often, it is the parent who behaves destructively. The parent may have underlying personality traits that result in harmful family dynamics. The destructive parent may try to manipulate others; demand support but offer no support; remain inconsistent with rules and operate unfairly. They can also be judgmental, critical, and unaccountable. All of which harms the family unit, maybe for life or even generations.

Enmeshment is when two or more members become overly involved with and reactive to one another. Relationships that have few boundaries can become enmeshed. For example, if a mother becomes emotionally needy and dependent on her child, her role as a parent is blurred and confused. The child is afraid to separate from Mom, which would make her feel abandoned.

Enmeshment masquerades under the name of unity, family love, filial piety, or loyalty. However, enmeshment comes from fear, not love. A genuinely supportive family is one that empowers a young person to forge their own life path. The child should not be bound to conditional love at the expense of their sense of agency. They should not be their parents' only source of happiness and well-being, nor should they have to absorb their parent's emotional pain.

Family therapy addresses the entire family. Family therapists work collaboratively with parents as a team. Each family member is not just an individual, they are part of their family system. And any one member's behavior is influenced by his family-parents as well as siblings. Not every member of the family attends every session. The therapist may see the parents without a child, a parent and a child, a teenager and a sibling, or other variations. This allows the therapist to see the full picture.

Why is it so hard to change family dynamics? Discover the hidden rules that keep families stuck in harmful patterns and how to break free.

Why is it so hard to change family dynamics? Discover the hidden rules that keep families stuck in harmful patterns and how to break free.

Why is it so hard to change family dynamics? Discover the hidden rules that keep families stuck in harmful patterns and how to break free.

Why is it so hard to change family dynamics? Discover the hidden rules that keep families stuck in harmful patterns and how to break free.

Find a Family Therapy Therapist

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Close family relationships afford a person better health and well-being, as well as lower rates of depression and disease throughout a lifetime. But in many families, getting along isn't a given. The interaction between various members is at the core of these complicated dynamics.

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Ways to entertain a toddler while feeding a newborn

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Ways to entertain a toddler while feeding a newborn

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Truth be told, I wrote this post for myself.

My husband is taking a generous amount of time off work to be at home with our new addition, but soon enough he'll return and I'll be juggling the responsibilities of a toddler and a newborn on my own.
The part I'm most concerned about? Breastfeeding.
My infant daughter is still at an age where she's often nursing quite frequently, which means mama's tied to the couch for significant amounts of time-much to my energetic toddler's dismay!

So I wracked my brain and consulted the best kid bloggers I know to compile this list of 35 simple ways to entertain a toddler while breastfeeding a newborn.
I'll be referencing this list quite a bit over the next few weeks. I hope it's helpful for you, too!
(Please note that the success of the ideas and activities listed here will depend on the exact age and development of your unique toddler. You can always modify the activities-making them easier or more difficult-to be more suitable for your particular situation.

Additionally, some of these require a bit of set-up, which you can do ahead of time before your newborn starts his/her hungry cry. Others require no preparation at all!)

Ways to Entertain a Toddler While Breastfeeding a Newborn

1. Sing songs that require your toddler's participation, either through motions (think Itsy Bitsy Spider) that your toddler can do while you sing, or through words/sounds, like in Old MacDonald.

2. Set your toddler up with a box of crayons and some coloring pages-or better yet, with a giant cardboard box to decorate!

3. Puzzles! For younger toddlers, these simple DIY puzzles from Toddler Approved would work perfectly. My older toddler is onto 24 and even 48-piece puzzles, which hold his attention for almost as long as it takes my infant to eat a meal.

4. Play a round of I SPY.

5. These reusable Water Wow books from Melissa and Doug are a great learning tool for toddlers. And since they're mess-free, you don't have to worry about cleaning up after you're finished breastfeeding!

6. If appropriate, encourage your toddler to have a snack too. Keep a stash of healthy snacks in the pantry or fridge within their reach, so they can grab one and bring it over when you're nursing.

7. Set your toddler up with this simple fine motor activity from Hands on : as we grow. All your child does is put rubber bands over a can, but it really holds their attention!

8. Make this easy DIY Sticker Seek and Find game from Left Brain Craft Brain for them to play!

9. Have your toddler weave pipe cleaners either in and out of a colander, or through wiffle balls.

10. Your toddler can easily play independently with a magnetic play set. My son loves this Tangrams Mini Tin Magnet Set!

11. Set your toddler up with a pasta sorting activity, like this one from See Vanessa Craft.

12. Indeed, you can have your toddler match and sort all kinds of things. My son currently loves to match socks, so he can help with the laundry while his baby sister eats! Double win for Mommy!

13. Create a special nursing basket or nursing box -like these great examples from When at Home and Rainy Day Mum-filled with toys and treats your toddler can only use when you're breastfeeding. That adds an element of excitement, to the point where your toddler might just jump for joy the next time your infant gets hungry!

14. Read, read, read. This is especially easy if your toddler is old enough to hold the book and turn the pages while you read it aloud.

15. Play a round of Simon Says.

16. Have your toddler do a color sort with pom poms, as described on The Imagination Tree. For additional fine motor work, have your child pick the pom poms up with a set of kid-appropriate tweezers.

17. Encourage your toddler to sit beside you and snuggle too!

18. Tell your child an oral story (preferably one with him/her as the main character), as suggested by Planning with Kids.

19. Set out a set of blocks and let your toddler build independently.

20. Try this mess-free idea for painting in bags from Teaching Mama. You can tape the bags to a window or just set them on the floor or a table next to wherever you're nursing.

21. Dominoes! Scatter them on the floor before your breastfeeding session, then encourage your toddler to line them up, match the dots, or find other ways to play with them-a great idea from Hands on : as we grow!

22. Save any screen time for when you're nursing. Perhaps during one feeding per day your toddler is allowed to watch TV, play with the iPad, etc.

23. Make this awesome toddler-friendly sewing basket from Childhood 101 for your child to play with while you nurse your newborn.

24. Make your toddler a set of these Velcro Dot Craft Sticks from Powerful Mothering, then encourage them to make all kinds of shapes, letters, and designs.

25. Ask your child to fetch things for you! Toddlers love to be helpful, and most of us inevitably forget something when we sit down to breastfeed, be it our water bottle, a burp cloth, or a pillow.

26. Lacing cards are a great fine motor activity for toddlers to work on independently while you nurse. These printable DIY ones from Activity Village are super cute!

27. Have your toddler play an independent game of balloon tennis, as described by Toddler Approved. Some children may not like playing this with themselves, but I know my toddler would have no problem playing this solo while I watch and encourage.

28. For older toddlers, spread out books, cards, and other items that contain words and have them search for and find different letters. For younger toddlers, modify this to colors, shapes, or whatever your child is currently learning.

29. Set your toddler up with a shape sorter-either a store-bought one or this neat DIY version from Teaching Mama.

30. Play restaurant! If you have play food and/or a play kitchen, place your order with your toddler as you sit down to breastfeed, and let him/her pretend to prepare and serve you your meal.

31. Encourage your toddler to feed a baby doll or stuffed animal while you feed the real baby.

32. Make these reusable, dry erase funny face photo drawings from Mama Papa Bubba for your toddler to play with next to you while you nurse.

33. Instruction cards! Make a bunch of cards with fun instructions for your toddler to follow-things like make a monkey face, point to something blue, find something that's a circle, touch your nose, etc. Use your free hand to randomly draw cards and have your toddler follow the instruction.

34. Another great fine motor activity from Mama Papa Bubba that your toddler could work on independently is playing with these button-up foam craft sticks. You can make bracelets, shapes, chains, and more! (Just keep an eye out so that no button accidentally comes loose and becomes a choking hazard.)

35. Set up a tea party or picnic on the floor for your toddler's dolls and stuffed friends! No doubt the pretend play will continue throughout your nursing session.
Busy Toddler, Happy Mom: Over 280 Activities to Engage Your Toddler in Small Motor and Gross Motor Activities, Crafts, Language Development and Sensory Play The Toddler's Busy Book: 365 Creative Games and Activities to Keep Your 1.5 to 3-Year-Old Busy 99 Fine Motor Ideas for Ages 1 to 5 150+ Screen-Free Activities for Kids
Want more ideas? These great books are filled with activities you could use (or modify) to entertain a toddler while breastfeeding a newborn.

Did you ever have to entertain a toddler while breastfeeding a newborn? What's your best tip?

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35 Simple Ways to Entertain a Toddler While Breastfeeding a Newborn - Pick Any Two

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Truth be told, I wrote this post for myself. My husband is taking a generous amount of time off work to be at home with our new addition, but soon enough he'll return and I'll be juggling the responsibilities of a toddler and a newborn on my own.

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Acacia Family Support offers a range of free services including peer support to families across Birmingham experiencing pre and postnatal depression/anxiety . However you are feeling and whatever you are going through, we are here to help.

Acacia is an organisation deriving its inspiration and values from the Christian faith. Our services are open to everyone, regardless of their backgrounds, faith or beliefs. Most of our staff and volunteers have experienced maternal mental health or other mental health problems.

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postnatal support services west midlands

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Acacia Family Support | Prenatal Depression and Postnatal Depression Support Services | Birmingham

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Acacia Family Support offers a range of free services including peer support to families across Birmingham experiencing pre and postnatal depression/anxiety . However you are feeling and whatever you are going through, we are here to help. Acacia is an organisation deriving its inspiration and values from the Christian faith.

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First off, per a wise friend of mine who is a mom of five: Be creative, patient, and hold tight to your sense of humor!

What can I do to prepare my older child for a new baby?

Before baby is born, it can help to talk with your older child about what newborns are like - what they look like, that they mainly nurse and sleep and cry, and how they need to be held much of the time.

Tell stories about what your older child was like as a newborn and how you took care of him.

Discuss things that your older child can do to help with baby: talk and sing to baby, get diapers and wipes, get mom her water bottle.

Make opportunities for your children to see young babies and nursing babies (a La Leche League meeting can be a great place for this, especially if you don't know any nursing moms), and read books that show newborns and nursing babies.

If your child has weaned or was never breastfed: Explain that mom makes milk for baby, that nursing is how baby eats, and that nursing also helps baby feel better when he's sad or scared or feeling bad.

If your child is still nursing and you expect to tandem nurse: Talk to your child about how he and baby will both nurse after the baby is born. Point out that since baby can't eat other foods like your toddler can, he will need to nurse a lot. Look at pictures of tandem nursing siblings with your child. Here's more on tandem nursing.

Should breastfeeding be "hidden" from your older child or other children?

Absolutely not! Modeling nurturing behavior and breastfeeding to your children is one of the best things you can do for them.

By seeing you nurse, your child is learning that breastfeeding is the normal, healthy way to feed a child rather than a "shameful" thing that needs to be hidden away. Breastfeeding is not something that should be hidden from children ( or anyone else).

Since most everyone in our culture equates babies with bottles, it's not unusual for other children to be curious when you are breastfeeding your baby. If other children are curious when you are breastfeeding, simply tell them that you are nursing the baby and that nursing is how we feed babies. Again, you are teaching them by example that breastfeeding is the way to feed and nurture babies.

General tips

Could you use a free hand when you're nursing? While you're nursing, a pillow can help bring baby to breast level so you have a hand or two free (sometimes it takes weeks or even months to get that free hand... keep trying). If you need to support your breast with your other hand, try using a small rolled-up towel.

A sling will also free up a hand or two. Are you comfortable with using a sling and nursing baby in it? In addition to nursing while you're lying down, this is another lifesaver for many moms. It frees at least one hand and allows you to keep nursing or holding your baby while tending to and playing with another child. Also, as someone I know once mentioned, when baby is in the sling your toddler can't be pulling baby's toes, or trying to get baby out of the crib, or trying to brush baby's "teeth", or dropping toys on baby.

It can be handy to have your toddler around, as many times you can ask them to fetch things for you (a diaper, a wipe, the remote, the phone, a water bottle). I don't know how many times I got settled on the couch with my first baby, then realized I was going to have to get up again to get something I forgot - the second time around I had a helper all day long, instead of only when Dad was home from work. She couldn't hold baby while I took a shower, but it sure did help with the little things.

Activities to do with your older child while baby is nursing

Read books and snuggle and talk with your toddler while you're nursing. If you don't have a free hand, get your toddler to hold a book and turn the pages while you read.

Play games - "I Spy" and "Simon Says" are often a big hit with toddlers.

Play with your food - try counting (and eating) cheerios or raisins with your toddler.

Some toddlers like to pretend-nurse their dolls or stuffed animals (or trucks!) while mom is nursing baby.

Look at your toddler's baby book or baby pictures. Tell stories about when your toddler was a little baby. Tell stories about what your toddler can do now that he/she is bigger.

You can also set your toddler up with other activities to do while you're nursing. Drawing, coloring, puzzles, blocks or big legos, cars/trains, etc. Some moms keep a box of toys that is out only when baby is nursing. We have a play kitchen that keeps my kids interested for a long time - they bring me food to eat and fix food for their dolls and stuffed animals and plastic dinosaurs, and have tea parties. Things like playdough and painting and water play can keep kids interested for a long time, but depending upon where you can set it up and your child, this may or may not be something that works when you're nursing.

If you need a nap and your toddler doesn't

Childproof a room of the house that has:

a door or a baby gate (so your toddler can't "escape" and play in the toilet while you're resting)

a bed or comfortable spot on the floor where you can lie down and nurse

interesting toys that your toddler is likely play with without much interaction - some moms also put on a favorite video

a snack and a drink for toddler

When you want to nap (or at least rest) while baby naps, close off the door so you can lie down with baby without worrying about what your toddler is getting into. A friend says she would lie on the floor with baby and let her toddlers use mom as a "road" for their matchbox cars - rest and a massage all "rolled" into one!

What if your older child asks to nurse?

It's pretty common for a toddler, or even an older child, to ask to nurse at some point after the new baby arrives. Many just want to know whether mom will say yes - they may also want to be held like a baby or "babied" in other ways. If given the opportunity to nurse, most children will simply touch or kiss the breast, giggle, and go play. Some moms prefer not to offer, but might offer breastmilk in a cup to taste, or simply distract the child with another activity. See What if a "weaned" child asks to nurse again? for more on the subject.

Additional Resources

The New Baby by Elizabeth Pantley

First-Born Jealousy by Elizabeth Pantley

Including a Sibling When Breastfeeding by Ann Butenas

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Tips for juggling a newborn and toddler * KellyMom.com

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First off, per a wise friend of mine who is a mom of five: Be creative, patient, and hold tight to your sense of humor! Before baby is born, it can help to talk with your older child about what newborns are like - what they look like, that they mainly nurse and sleep and cry, and how they need to be held much of the time.

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Help your older child to ajust to the new baby

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Help your older child to ajust to the new baby

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It is completely natural for your child to be jealous of a new baby. In fact, I doubt there is a child in the world who has not been jealous when a new sibling arrives. Your goal is to help your child manage that jealousy so love has a chance to grow, and to win out.

Anything you can do while you're pregnant to prepare your child will be helpful. Your goal is to get her excited about the baby, and feeling connected to it, even before it is born. There is a whole article about how to prepare your child for the birth of the new baby on this website.

During the birth, you'll want to make sure your older child doesn't feel abandoned. Having mom vanish to the hospital is often traumatic for little ones, and makes it more difficult for them to welcome the new baby when mom finally shows up with him. Here's an article that should be helpful as you think through how to prepare your little one for the separation while you birth the new baby: Preparing Your Child for the Separation While You Birth the New Baby.

But, of course, your child will at some point be faced with the reality that he or she now has a sibling -- or more to the point, you now have a new baby on your lap. Nothing can really prepare them for this reality. Think of the worst break up you ever had and magnify that by a factor of 1000. So despite all your wonderful prep, you will still find yourself facing the million dollar question:

What do you do to minimize sibling rivalry -- and your older child's natural panic reaction -- once the baby is born?

1. Have dad carry the baby in the door.

Mom goes straight to the older child. Scoop him or her up into your arms, and do a lot of adoring hugging and kissing. Don't make this about the new baby yet. It's about your reunion with your darling older child (or children.)

(This presumes that Mom is the most favored source of comfort in the hierarchy of attachment. If Dad is, then Mom carries the new baby in while Dad does the hugging.)

2. Make your child the hero in the eyes of the baby (and in her own eyes.)

When you get a quiet moment with your older child, call her over to snuggle with you and the baby. (Make sure any other kids are occupied elsewhere; you should do this with each child separately.) Tell the baby that you want to introduce Big Sister, who is a wonderful girl that you hope Baby will aspire to be like. List all the wonderful things you love about Big Sister, that Baby will get to know.

3. Better living through bonding:

Then let Big Sister sit and hold the baby, helping her to support his head. Bonding experts say that babies' heads give off pheromones, and when we inhale them, we fall in love, and begin to feel protective. The more your older child snuggles the new sib, the better their relationship is likely to be.

4. Make sure each of your kids knows they still have an important role in the family.

Reinforce all the wonderful things about who they are and how they contribute to the family. "Jess, I love the way you help me like this," or "Sara, I love the way you make me laugh," which note specific contributions, help your child develop a sense of why she's still a valuable member of the family. Talk often about the fact that each member of the family is important in their own way and makes their own special contribution. The family needs each person for it to be whole.

5. Naturally your child will be testing you to be sure you still love her.

Keep your relationship with her as smooth and affectionate as possible, sidestepping power struggles and minimizing conflicts. But keep your usual limits, which will help her feel secure. (By limits, I don't mean punishment, which always backfires. Set limits, like bedtime or no hitting, and enforce them with empathy.)

6. This is not the time for asking your older child to be a big kid.

Delay potty training, making her give up her bottle or pacifier, etc. If she wakes up more often for your reassurance at night, and you can't go to her because of the baby, make sure Dad comforts her and parents her back to sleep. Expect regression. Let her be a baby as much as she wants to be without shame or guilt. Give her lots of extra love and attention.

7. Keep your kids' routines the same as they were before the baby as much as possible.

This will provide a buffer against the stress of so much change and insecurity.

8. Never leave a toddler or preschooler unsupervised with the baby.

Little ones cannot be expected to control those jealous emotions and the stakes are just too high to take a chance. Supervise closely. Try to avoid admonishing your child. If you notice him getting rough, quickly move the baby away from him. If you can, invite him to roughhouse with you a little bit: "That's a little wild for the baby. She isn't big like you. She can't handle wild play yet. But you and I can have fun together! I think I know what will make you laugh!" If you can't roughhouse at that moment, make a note to do it later to get your child laughing, which will ease his tensions. Then, distract him with a question, song or story.

9. Don't make everything about the baby.

Keep your cooing over the baby for private times. Instead of saying you're waiting for the baby to wake up before you can go out to play, say you're waiting for the laundry to finish, or the casserole to bake, or for a phone call. Instead of "When I'm done with the baby I'll help you," say "I'll be there as soon as my hands are free."

10. Read your child books on siblings with new babies.

Use these as a springboard to make observations about your child's feelings. Your goal is to give your child words for her feelings, because that helps her manage them rather than having to act them out. Encourage bonding, but allow all the negative feelings too. Be direct: "I know it's hard to have me busy with the baby when you want me." Commiserate: "Babies sure take a lot of time, don't they!" Here's a list of great books for big sibs to help with adjusting to life with the new baby.

11. Encourage empathy.

Research shows that when parents encourage the older siblings to see the baby as a real person, with feelings of his own, the siblings are more affectionate and protective with the baby. So you might say things like:

"My, he loves it when you sing to him!"
"Look how he's trying to move his mouth like yours -- he is trying to be like you!"
"I wonder if the baby recognizes Grandma yet?"
"I think the dog barking scared him."
"I wonder whether the baby likes this music?"

12. Stay connected to your older child.

Spend as much positive alone-time as possible every single day with each child. When there's another adult around, let them hold the baby while you snuggle with your toddler and/or preschooler. If your hands are busy, use your voice to stay connected with your older children. When you sit down to feed the baby, invite your older kids over for a read-a-thon. They will look forward to those times.

13. Expect grief.

Your older child needs to grieve what he's lost: his exclusive relationship with you. His status as the only child. Your concentrated time and attention. Remember, think of the worst romantic breakup you've ever had and multiply by 1000. If he's whiny and cranky, reframe the way you see him. Your child is in pain. He is mourning. He can't put into words what he is unhappy about, and he isn't upset for the reason he thinks. But he needs your help to heal. So when he acts like needy or whiny, hold him and empathize:

"Seems like you feel so sad right now. Seems like you hurt inside. You know Mommy loves you soooo much. Mommy is always here for a hug if you feel sad. Come snuggle with me while I feed the baby. Let's read your favorite books."

Allow him to cry in your arms as much as he wants. Then help him find a way to feel better. Let him see that while he can't always have what he wants, he can get something that is in some ways even better: A mother who understands and sympathizes, who accepts all of him, and who helps him to feel better. No matter what.

See this article in Czech.

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It is completely natural for your child to be jealous of a new baby. In fact, I doubt there is a child in the world who has not been jealous when a new sibling arrives. Your goal is to help your child manage that jealousy so love has a chance to grow, and to win out.

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Upright births are likely to be shorter, less painful and involve fewer interventions than recumbent births. Image from shutterstock.com

Think of childbirth and you're likely to picture a woman lying on her back on a hospital bed. That's the position most (78%) Australian women adopt to give birth birth, despite growing evidence that being upright to give birth can have better outcomes for the mother and baby.

Historical and anthropological literature shows that lying down for birth is a relatively modern phenomenon, as we have moved from a more social to a surgical model of care. As far back as written records, carvings and paintings go, women have given birth upright - whether it was using stacked bricks to create a primitive birthing stool or holding onto leaves and ropes hung from trees. A famous drawing from Egypt depicts Cleopatra (69-30 BC) kneeling to give birth.

The birthing chair or stool dates back to Babylonian times (2000 BC). In cultures where Western medicine has had less of an impact, we still see these practices today. A 1961 survey found that giving birth while laying down was the norm in just 18% of traditional cultures. These findings were similar to those of the anthropologist Engelmann nearly 100 years earlier (1882).

So what happened 300 years ago to change this?

Let's first look to France, which was the early leader in obstetric practice. In 1598, barber surgeon Jacques Guillemeau (one of the first obstetricians) advocated reclining in a bed for birth. The emergence of obstetric instruments over the next 50 years, along with the use of episiotomy (where the vaginal wall is surgically cut to assist delivery), and finally anaesthetic, facilitated this shift in birth positions.

One of the first hospitals with a maternity section, the famous Paris Hotel Dieu, used a special bed for delivery. Some scholars claim the French King Louis XIV (1637-1709) enjoyed watching women give birth (including his mistresses) and found his view obstructed on the birth stool, so encouraged the use of the lying down position.

Eucharius Rößlin, Der Swangern frawen vnd hebamme(n) roszgarte(n).

However, there were midwives challenging this practice, including the famous French midwife Louise Bourgeois (1563-1636), known as the King's midwife due to her position as midwife to the royal court:

Vertical positions are the most natural, the most instinctive; gravity seems to aid and hasten the birth...Lying high up on the bed is far less natural....

The movement of birth from home to hospital in most resource-rich countries during the 1900s altered this on a grand scale. And like most things in childbirth, no research was undertaken to see if it was good thing. In the popular King's Eclectic Obstetrics medical text book published in 1900, the following is written:

I do not think that the delivery proceeds with so much ease and rapidity, nor is it so convenient for the practitioner in every respect, as when the female is placed upon the back.

A better way to deliver

Large reviews of the evidence show labouring upright and giving birth upright have advantages for the mother and baby. Apart from the obvious benefit of gravity to help the baby descend, these include:

more efficient contractions

shorter labour

better oxygenation of the baby in the mother's uterus, as the vena cava vein and aorta are not compressed by the pregnant uterus

increased pelvic diameter, especially in positions such as squatting

less maternal pain

greater satisfaction

fewer forceps, vacuum births and episiotomies.

So why most Australian women give birth on their backs? Curious to understand this, my colleagues and I undertook an ethnographic study (using observations and interviews) looking at how women gave birth in the three different birth settings: hospitals, birth centres and at home.

We discovered that the way we have constructed the birth environment, such as putting the bed in the centre of the room and having little supportive equipment (such as birth balls, birth stools, mats and bean bags) had a major subliminal impact on both the way women and midwives acted.

When the women weren't directed by midwives or obstetricians, and the environment facilitated their moving about adopting different positions, the majority gave birth upright and forwards leaning - the total opposite to what happens when a woman gives birth on her back on a bed.

Giving women information before the birth and helping them practice different positions also helped facilitate this, as did continuity of midwifery care and creating home-like environments.

While Australia seems to be behind the times, leading international bodies such as National Institute for Health and Care Excellence NICE in the United Kingdom recommend:

Women should be discouraged from lying supine or semi-supine in the second stage of labour and should be encouraged to adopt any other position that they find most comfortable.

So, what began as a change in birth positions for the convenience of men has been shown scientifically to be an inconvenience for women and babies. It's time for Australian women to stand and deliver once again.

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Stand and deliver - upright births best for mum and bub

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Think of childbirth and you're likely to picture a woman lying on her back on a hospital bed. That's the position most (78%) Australian women adopt to give birth birth, despite growing evidence that being upright to give birth can have better outcomes for the mother and baby.

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After months of careful consideration, researching birthing pools and practising breathing techniques, some women are disappointed to discover that the type of birth they hoped for is simply not going to happen. Sometimes, a caesarean section is needed for babies to be born safely or for mamma to give birth safely. But that doesn't mean your preference for gentle choices can't get a look in.

In an emergency situation, gentle caesarean plans may go out the window, either completely or partially. But as long as your partner is well aware of your preferences, he or she can go into bat for you, pushing for the elements that appeal to you the most.

There is no hard and fast definition of what a mother-friendly caesarean is, however below are the requests most commonly made by women hoping to have a gentle caesarean section:

Mother-Friendly Caesarean Tip #1: Dim The Lights

Lowering the lights can help to create a more intimate, safe and comfortable environment for the mother. At homebirths, some women choose to give birth by candlelight. While this wouldn't really be practical in a surgical theatre, it is possible to lower the lights and create a more relaxed environment for the expectant couple.

Mother-Friendly Caesarean Tip #2: Hit Play

For women who may already have dedicated hours to compiling the perfect playmix for childbirth, this means you haven't wasted your time. Instead of silence, or listening to music chosen by the medical staff, you get to choose the music playing at your birth. By choosing calm and relaxing music, you can help yourself to feel more comfortable during the birth.

Mother-Friendly Caesarean Tip #3: Include Your Birth Partner

Birth partners play an important role in supporting the mother during childbirth. Some birth partners may feel overwhelmed when that birth is a caesarean, and feel unsure of how to be useful. In a mother-friendly caesarean, the birth partner is encouraged to play an active role in the birth. From reassuring the mother, to watching the baby being born, and accompanying baby to any postnatal tests, the birth partner is an important player.

Mother-Friendly Caesarean Tip #4: Bring A Doula

If you had organised a doula to support you during the birth, it still may be possible for your doula to accompany you into the operating theatre. Traditionally, surgical theatres limit the number of people allowed into the room, so doulas were often left waiting in the corridor. In a mother-friendly caesarean, however, the role of the doula is valued, and they are able to stay throughout the birth to provide support to both parents.

Mother-Friendly Caesarean Tip #5: Slow Things Down

From the procedures to the birth, caesareans are generally done with speed " but this is not the case if you have a mother-friendly caesarean. If there is no medical reason for rushing the birth, the obstetrician will be able to slow down the operation and give you chance to fully experience the birth of your baby.

The birth process helps to prepare a baby for life outside the womb. For example, the amniotic fluid that has been protecting your baby's lungs in utero is squeezed out during a vaginal birth, allowing your baby to breathe easily once in the outside world. During a traditional caesarean, the baby is lifted quickly out of the uterus, preventing the clearing of the lungs. Some babies can encounter breathing problems as a result.

During a mother-friendly caesarean, your baby will be slowly removed from the uterus. Once the baby's head is out, the surgeon may wait a few minutes before lifting the baby's body out. This extra time spent in the uterus can help the lungs to be cleared.

Mother-Friendly Caesarean Tip #6: Watch The Birth

Traditionally, caesareans are carried out behind a drape, with the mother-to-be lying flat on the table. Unfortunately this means that a mother is unable to see her baby until he or she is placed in her arms. In a gentle caesarean, the drape can be lowered to allow the mother to see her baby being born. The abdominal incision will remain hidden from view, but you will be able to see your baby being gently lifted out from your uterus. In a mother-friendly caesarean, time and care is taken to allow women to feel more involved in the birth process.

Mother-Friendly Caesarean Tip #7: Skin To Skin

Immediate skin to skin is considered to be best practice for caesarean births, but that doesn't mean it always happens. At a mother-friendly caesarean, skin to skin is a given. Where possible, this is done before any tests are done on the baby. The baby should be lifted out and immediately placed in your arms, allowing you to begin the bonding process that will last you the rest of your lives. As well as aiding with bonding, skin to skin immediately after birth has been found to regulate the baby's body temperature, and increase the likelihood of breastfeeding.

Mother-Friendly Caesarean Tip #8: Delayed Cord Clamping

Mother-friendly caesareans are all about slowing things down and allowing the mother to play an active role in the birth. If you would like to delay cord clamping, then include this in your birth plan. If there is no medical reason for clamping immediately, your healthcare provider may honour your wishes and allow you to wait until the blood has stopped pulsing between placenta and baby, before cutting the cord.

Delayed cord clamping offers your baby significant health benefits, which you can read more about here.

Mother-Friendly Caesarean Tip #9: Limited Separation

The immediate aftermath of the birth is really important for mother-baby bonding. Though in the past this may have been disregarded in a surgical environment, it is now understood to have the potential to have a lasting impact on both mother and baby. In a mother-friendly caesarean, the amount of time you spent separated from your baby will be limited. If your baby does need to leave your side for testing, your birth partner will be encouraged to accompany the baby in your absence.

Mother-Friendly Caesarean Tip #10: Breastfeeding

If you are planning to breastfeed, your healthcare provider will do all they can to ensure you are given the chance to breastfeed within the first 30 minutes of your baby's life. Breastfeeding within that first half hour increases your chances of successful breastfeeding, and is considered to be an important part of postnatal care. You are even able to breastfeed whilst still on the operating table.

Mother-Friendly Caesarean Tip #11: Dads Stick Around

If you have a caesarean, you will be expected to stay in hospital for a little while longer than you would after a natural birth. Traditionally, this has meant dads being sent home alone, only able to return during visiting hours, and the new mother left to look after the baby alone. After a mother-friendly caesarean, your healthcare provider will do all that they can to offer you a home from home experience. The father will be encouraged to stick around after the birth to bond with his baby and support you in your recovery.

Mother-Friendly Caesarean Tip #12: Quiet Time

Some hospital wards have even implemented a quiet time to give women some privacy after a caesarean. Quiet time will be a scheduled time each day (for example, 2pm until 4pm) during which medical staff will not enter your room unless requested. This gives you the chance to enjoy some privacy, bond with your baby and become more comfortable with breastfeeding. Hospitals can be hectic places, and it can be difficult to truly relax in one, but this short period of privacy each day can allow to you feel that you have your own space.

Requesting A Mother-Friendly Caesarean

If you need to have a scheduled caesarean, be sure to request a mother-friendly caesarean from your obstetrician " however do be prepared that some will say no. Don't let it put you off, because you can get a second opinion and research your options, in order to find an obstetrician who will try to work with your requests. Some obstetricians are much more open than others in helping their patients achieve a more gentle experience than others.

The more we talk about mother-friendly caesareans and share these ideas, the more demand there will be " and the more flexible obstetricians will need to become (where safe to do so). Identify the elements of a mother-friendly caesarean which most appeal to you, and ask your medical team about which of these things are possible in your hospital.

Mothers Who Have Done It

There have been several stories in the news of mothers having mother-friendly caesareans. Check out this article way back from 2007 where a mother was given the opportunity to lift her own baby up to her chest during a caesarean. The look on her face is very different to what you would normally see in other caesarean photos. Lets give mothers more experiences like that.
Source: The Age, Photo: Eamonn Mcnulty

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12 Ways To Have A Mother-Friendly Caesarean | BellyBelly

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After months of careful consideration, researching birthing pools and practising breathing techniques, some women are disappointed to discover that the type of birth they hoped for is simply not going to happen. Sometimes, a caesarean section is needed for babies to be born safely or for mamma to give birth safely.

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In modern Western culture, most women and families know about induction of labour before they even become pregnant.

They know that it is suggested when it is felt that it would be safer for the baby to be born than to stay inside its mother. Many people also know that one of the main reasons for recommending induction of labour is because pregnancy has lasted for a certain number of weeks and the baby is perceived to be 'overdue'.

Other reasons for offering induction include that the woman is older than average, that her waters have broken early and/or that she has a health problem or condition. These days, induction is often suggested where someone has a high BMI, or has been told they have gestational diabetes.

There's a big focus on telling women when they are deemed to be 'at higher risk.'

Induction is really common now. Some people think it's oversold. Some are concerned about how a lot of the 'official' information is geared to promoting induction. For instance, women and families are often told the pros of induction, but not the downsides. There are pros and cons to everything! Some are given an induction date without even being asked whether this is what they want.

But this is not the whole story. There are many other aspects to the decision that some women need to consider about whether or not to have their labour medically induced.

That's what this blog post is about. I'm not going to tell you the things that you know or have already been told. I'm here to offer a deeper perspective and cover some of the lesser-known things you might want to consider.

Hello, I'm an induction researcher

In case this is your first visit to my website, maybe I should introduce myself. My name is Sara, hello. I'm a midwife and a researcher who has been studying induction of labour for more than twenty years. That's me in the pic, speaking about induction and risk in Australia.

I have written two bestselling books about induction of labour. talks the reader through the process and the pros and cons of induction. Inducing Labour: making informed decisions In Your Own Time: how western medicine controls the start of labour and why this needs to stop explains how we got to the current situation and looks more deeply at the evidence and issues in relation to topics such as the due date, suspected big babies, and being deemed to be 'at higher risk.'

And I'm passionate about helping women and families make the decisions that are right for them.

One quick note, though. I'm not anti-induction. I've looked after lots of women whose labours were induced. I want everyone to make the decisions that are right for them. If you're fully informed and decide you want an induction, that's brilliant. But lots of women and families aren't given all the facts, so that's why I've written this blog post. In it, I share some of the evidence, issues and implications that women have told me they were less aware of but which they wish they had been able to take into account when making their decision.

And there are, of course, far more than ten things to know! That's why I've managed to fill two whole books with information that parents may find useful when considering induction. This article is intended to serve as a starting point for discussion and offer links to more info rather than to tell you everything that you might want to take into account when making your decision.

So let's dive in!

1. Induced labour isn't like spontaneous labour.

This might be obvious to some people, but I know from experience that it isn't to others. Induced labour is very different from labour that starts spontaneously. Individual women's experiences vary, of course, but there are a number of key and interwoven areas of difference that are fairly universal. First, a woman having her labour induced is given artificial hormones. These can create more pain more quickly than would occur in spontaneous labour.

Synthetic hormones don't trigger the release of a woman's own natural pain-relieving substances as her own hormones would if she were in spontaneous labour. They also come with a range of possible side effects. That means a woman whose labour is being induced needs to be monitored more closely.

The increased monitoring can lead to the woman being less able to move around. That in turn can increase her pain and stress, and this can quickly lead to a woman feeling that things have spiralled out of her control. Not everybody finds this a problem, but it is something to be aware of. Induction can also take quite a long time. Women are often waiting (usually, but not always, in a hospital ward) for two or three days before labour really gets going. This is frustrating to some women, especially when their loved ones aren't allowed to stay.

It's also worth knowing that there are many advantages to spontaneous labour. These are lost when labour is induced, so that's the first reason why it's important to look at the pros and cons of both approaches. If you'd like more on this, I wrote a whole chapter on it in In Your Own Time: how western medicine controls the start of labour and why this needs to stop.

2. Some women find induction of labour more painful.

I started to cover this already, but there is a bit more to know about this in relation to possible sources of pain.

The contractions caused by the cervical ripening methods that are the first stage of medical induction can become really sharp really quickly, but without having any measurable effect. Some women feel that this has a negative effect on women's experiences, and it is easy to become tired and/or disillusioned more quickly than if they were in spontaneous early labour.

The contractions brought on by an oxytocin drip can also be very strong. There is often less time to get used to these than when labour starts spontaneously. With induction, your body doesn't get to make the decisions about what hormones you need and when. Those decisions are made by your caregiver and/or dictated by the hospital protocol or guidelines. They may or may not work for you and your body. Which is why induction sometimes fails, as I discuss below.

In addition, the increased number of vaginal examinations and other interventions (such as the insertion of cannulas) can create additional pain or discomfort. Again, not everyone finds this a problem, but it's worth knowing about beforehand. If you decide to have your labour induced, you might want to give some thought to your pain relief decisions. And plan ahead so that you can take things that will help you cope.

More on the process of induction in Inducing Labour: making informed decisions.

3. Induction of labour is a package deal.

I am frequently asked whether women can have a physiological placental birth or decline monitoring and/or vaginal examinations if their labour is induced. The answer is usually no.

But that's not because anyone wants to prevent a woman from making the decisions that are right for her. It's because the drugs used to induce labour are powerful substances that block a woman's own hormones. They can sometimes cause side effects in the woman or baby.

It is the effect of these drugs that needs to be measured, monitored and compensated for in induced labour. If a woman is concerned that aspects of induction are not what she wants, then it might be better for her to consider whether induction is really necessary or right for her in the first place.

I have written about this in this blog post too if you want a bit more detail.

4. Stretching and sweeping isn't benign.

Nowadays, many areas have introduced a policy of offering women a ' stretch and sweep ' at a certain point in pregnancy. They do this in the hope that this will reduce the number of women who go on to have full-blown medical induction.

Even if we ignore the assumption that all of the woman who are offered induction will consent to having it, there are downsides. A stretch and sweep can cause discomfort, bleeding and irregular contractions. And it probably won't do that much. In some of the studies the stretch and sweep intervention only brings labour forward by about 24 hours, and then only in some women.

It's also important to remember that a stretch and sweep is a form of induction. Find out more about what the research on this intervention can show us here.

5. Natural induction of labour is an oxymoron.

Some people talk about 'natural induction.' But there's no such thing. Either we are awaiting spontaneous labour, or we are trying to interfere and bring it on earlier than it would otherwise have occurred.

Sometimes there is good reason to try to bring labour on. But if a woman takes castor oil or has a stretch and sweep or picks any one of the range of things that are purported to bring on labour, then she is aiming to induce her labour with non-medical means. Some holistic therapists offer to help women 'go into labour' but try to avoid using the word induction.

I am not saying there is anything wrong with trying these things, but I think it's important to be clear. Either we are letting the body and the baby do its thing spontaneously, or we are trying to induce labour.

I'm not saying this because I want to stop anyone trying bumpy car rides or having acupuncture. You do you. And I love acupuncture. But I think it's important to be clear that all the different means of induction - which include western medicine, Traditional Chinese Medicine, home remedies, holistic therapy - are still induction. The alternative to medical induction isn't necessarily to choose another form of induction. Though it can be, for some. But the alternative to induction can also be to wait and let your body and baby do their thing. It's easy to forget this in a culture which over focuses on time and continually devalues patience and women's bodily processes. More on the over focus on time in In Your Own Time.

This is another issue that I have written about elsewhere if you'd like to know more .

6. Induction of labour is NOT the law!

I was absolutely appalled to hear, part-way through writing an earlier version of my inducing labour book, what one woman had been told.

' We have to induce you twenty four hours after rupture of membranes. It's the law'.

The woman agreed to induction when she was told this. She went on to have what she felt was a very traumatic birth experience.

In most countries, including the UK, there are no laws which state what a pregnant woman must or must not do.

And any practitioner saying such a thing should be reported to their professional body.

There's a bit more on rights in my book 'What's Right For Me?' There are also fab organisations around the world that help women to understand their rights. I recommend that anyone who is pregnant seeks out good local sources of information.

7. It's not 'just a trickle' (or a whiff)...

I am always really concerned when I hear midwives, doctors and birth workers using language which downplays the interventions that they are recommending or discussing. I particularly dislike the terms 'trickle' and 'whiff' when used in relation to intravenous oxytocin (syntocinon).

"It's just a trickle," they'll say.

That sounds very soft and innocent, doesn't it?

But that's always not how it feels to your body or baby.

Now, syntocinon is an amazing medication. As a midwife, I am grateful for it and have seen it literally save lives.

But anything that is sometimes lifesaving is, by definition, very powerful. Syntocinon is a very powerful and very overused drug which needs to be respected as such. It can cause the baby to not cope as well with labour. In fact, in some areas the practice is to keep increasing the amount of syntocinon that women receive until the baby reacts and shows that it isn't coping well any more. It is only turned down then as it is considered that the optimal level has been found. In this situation, the 'optimal level' is the maximum dose that can be given before the baby displays signs of stress. This in itself shows you what syntocinon can do to babies' wellbeing.

But even where this is not done and the syntocinon is only increased until contractions are effective at making a woman's cervix dilate, it is still a powerful drug that needs to be given respect.

If you weigh up the pros and cons of syntocinon and decide that it is right for you, then great. That's informed decision making. But its effects should not be minimised by professionals using language that downplays those effects.

More on the pros and cons of syntocinon in Inducing Labour: making informed decisions.

8. Women don't fail. Inductions and systems do.

This one pretty much speaks for itself.

Induction doesn't always work, and this is not the fault of the woman. As I discuss in Inducing Labour: making informed decisions, we now know that some women don't respond as well to the drugs used as others because of genetic factors. There are also several other reasons why induction might not work. A key one is that the woman or baby weren't ready for labour. If they were ready, labour would have begun on its own! That's a really key thing to consider when deciding whether or not induction is right for you. And it's not a black or white decision, either. Maybe it's not right today or this week, but you might want to reconsider the decision in a couple of days, in week or two, or if a genuine problem develops.

I wish I could reassure all women who have had an induction that was unsuccessful that there was nothing wrong with them or their bodies.

This is another case where some of the language used in the maternity services really needs to be reconsidered.

9. The risks are later, lower and sometimes less preventable than people think.

In both Inducing Labour and In Your Own Time, I look at a number of studies and data sets that look at the risk of stillbirth. And whether the chance of this can be reduced by inducing women's labours.

The simple answer to this is, well it's complicated.

Sorry about that.

But there is an advantage to knowing that it's complicated. When you encounter someone who tries to make it sound as if it's a simple decision, you'll know to ask some questions.

Here's an example. In some situations, like post-term pregnancy, the increase in risk doesn't happen as early as some people believe, and it is also lower than women are often told. In fact, the outcomes experienced by women who awaited spontaneous labour and by women whose labour was induced were so similar that none of the individual studies which compared induction with non-induction were able to show a benefit to induction in their findings. It is only when all of the results for all of the studies were added together that it was possible to see a small difference. And there was still a big question mark about whether induction really made a difference because the quality of the research wasn't that high.

As I will explain further in the next point, we don't always have good evidence that sad events like stillbirth are preventable by increased intervention, such as induction of labour.

Again, I have written about this in depth in Inducing Labour: making informed decisions and In Your Own Time.

10. The risks for older women, women with suspected large babies and women who conceived via IVF aren't as clear cut as is often suggested either.

My final point relates to the women who are told that they are at greater risk of having a baby with a problem, and that they should have their labour induced because of this.

This currently includes women who are older, women who are thought to have a large baby (even though we aren't very good at estimating fetal weight, even with ultrasound), women who have a higher BMI, women who have been told they have gestational diabetes, and women who conceived by IVF. Some other groups are affected too, but it depends a bit on where you are in the world.

This is complicated, too.

Let's look at older women as an example. Some studies show a correlation between increased maternal age and an increase in certain types of complications, including stillbirth.

But ... there's a big but.

That doesn't mean that induction of labour will improve outcomes. In fact, we don't have robust evidence demonstrating that it does.

It's nice to think that it would. It's nice to think that we can control things, and prevent tragedies. That's why the offer of induction is so compelling. But sadly, in many of these situations, there's no evidence that it will help.

There are also downsides to induction, so the decision needs to be weighed up carefully by the person who it will most affect.

Women who are older or deemed to be 'at higher risk' are often offered monitoring and intervention in abundance. But this can cause complications, restrict movement, and lead to more intervention.

Older women are also more likely to have other health challenges, which is sometimes called co-morbidity. That means that it is hard to tell whether these problems and/or their age are the cause of poor outcomes.

The studies that have looked at this have not always separated these issues out, and the only papers that have done so looked at women who gave birth some years ago, and who may not be comparable to women today.

So there is a real lack of good data in this area, and unfortunately the studies that are being carried out to look further at this are tending to induce even younger women even earlier in pregnancy, so their results may not be of much use to women either.

This issue is such a big one that I devoted an entire chapter of In Your Own Time to it.

What's the take home message?

Women who are offered induction of labour need to weigh up lots of things in order to determine which path is right for them.

We need to wholeheartedly support women who want their labour to be induced, and to wholeheartedly support women who don't.

Women report variable experiences of induction of labour. Some are really happy with their experience, and others much less so.

But the overarching thing that I hear from new mothers on the topic of induction is that many women wish they had had more information.

That's why I write so much about induction.

If you'd like to find out more so that you can get informed and make the decisions that are right for you, please look at my books.

Inducing Labour: making informed decisions talks the reader through the process and the pros and cons of induction.

In Your Own Time: how western medicine controls the start of labour and why this needs to stop explains how we got to the current situation and looks more deeply at the evidence and issues in relation to topics such as the due date, suspected big babies, and being deemed to be 'at higher risk.'

I wish you well in your decision making.

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Ten things I wish every woman knew about induction of labour - Dr Sara Wickham

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In modern Western culture, most women and families know about induction of labour before they even become pregnant. They know that it is suggested when it is felt that it would be safer for the baby to be born than to stay inside its mother.

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Pregnancy and Childbirth, reality or fiction?

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Pregnancy and Childbirth, reality or fiction?

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Abstract

Background

Considerable debate surrounds the influence media have on first-time pregnant women. Much of the academic literature discusses the influence of (reality) television, which often portrays birth as risky, dramatic and painful and there is evidence that this has a negative effect on childbirth in society, through the increasing anticipation of negative outcomes. It is suggested that women seek out such programmes to help understand what could happen during the birth because there is a cultural void. However the impact that has on normal birth has not been explored.

Methods

A scoping review relating to the representation of childbirth in the mass media, particularly on television.

Results

Three key themes emerged: (a) medicalisation of childbirth; (b) women using media to learn about childbirth; and (c) birth as a missing everyday life event.

Conclusion

Media appear to influence how women engage with childbirth. The dramatic television portrayal of birth may perpetuate the medicalisation of childbirth, and last, but not least, portrayals of normal birth are often missing in the popular media. Hence midwives need to engage with television producers to improve the representation of midwifery and maternity in the media.

Background

Considerable debate surrounds the influence media has on people's perceptions and expectations of birth []. A common concern is that reality television (TV) programmes often portray birth as risky, dramatic and painful and that this effects how childbirth is perceived in society []. It has been suggested that television portrayals of birth influence decisions made by women (and their families) regarding delivery method (natural birth versus assisted birth including caesarean section), their expectations of the birth (dangerous versus serene), and best place of birth (hospital: considered safe but medicalised versus home considered natural/healthy) [-]. It is argued that these influences are in part responsible for the rising rates of interventions in childbirth.

Many high-income countries experience rising rates of childbirth intervention, without much evidence that such interventions lead to improvements in maternal or newborn outcomes []. Unnecessary interventions are associated with increased maternal and newborn morbidity. For example, a woman with an uncomplicated pregnancy who opts for a planned caesarean section rather than a vaginal birth is significantly more likely to suffer a cardiac arrest and require a hysterectomy, while her infant is significantly more likely to be admitted to intensive care []. Explanatory factors for the rise in interventions and, occasionally, the increase in maternal request for intervention include previous negative birth experiences, and the way that childbirth is portrayed by the media, the latter leading to fear and anxiety about the birth process []. Cultural perceptions and societal attitudes are known to influence women's decisions about when to enter hospital in labour [, ]. However, there has been little examination of the relationship between the media, culture and birth-related behaviour.

The literature suggests that many women in the 21 st century learn about childbirth through television, as previous generations did, perhaps to a lesser extent, from childbirth manuals []. In the United Kingdom (UK), much of this discussion comes in the form of editorials and opinion pieces highlighting the influence of media on mothers' perceptions of childbirth. These discussions point toward a misrepresentation of normal childbirth on television and in newspapers []. Unfortunately, much of this discussion is not underpinned by evidence and is based on a narrative informed by the notion of the 'media-effects' tradition, which 'assumes' that audiences do not critically engage with media messages []. Thus women are perceived to be negatively impacted by how childbirth is represented in programmes such as One Born Every Minute, A Baby Story, Call the Midwife, Pramface Babies, Underage and Pregnant and 16 and Pregnant. The media-effects theory has long been regarded as too simplistic []. Halloran suggested over forty years ago that there is an interaction between the medium and the audience, the latter approaches every media episode with a complicated filter made up not only of their past and present , but also views and hopes for the future [].

Women are exposed to a number of different viewpoints on and perceptions of childbirth that include: 1) an often stereotypical sensationalised version of the birthing process in the media; 2) stories from friends and relatives; 3) antenatal information provided by midwives, doctors, and other childbirth educators; and 4) personal experiences of giving birth. While we might be critical of women seeking out programmes that depict inaccurate representations of childbirth, we need to remember that media representations are for most women the only opportunity to see a birth [].

Reality television often presents birth as unpredictable and potentially dangerous, pointing to a steady stream of programmes depicting hypertension, postpartum bleeding, cervical cancer, mothers in preterm labour and diabetes []. The media producer needs a 'hook' or plot line to engage the viewer. Yet women, often unaware of the range of experiences, continue to watch these programmes as birth preparation, as media users actively seek information and entertainment and select from it to satisfy their needs []. It is the impact of using the media to satisfy this need that should be explored in relation to women's experiences of childbirth.

The paper was designed to determine the gaps in the literature around media and childbirth.

Methods

Scoping reviews map relevant literature in the field of interest [], including the 'grey literature'. The latter includes practitioners' journals, conference papers, unpublished dissertations, books, literature from a range of public, private and voluntary sector bodies and government publications []. Scoping reviews do not seek to limit the included literature to a certain type of study (e.g. randomised controlled trials) but instead use broad inclusion criteria []. Like a systematic review, the process is rigorous and transparent and documented in detail to enable the review to be replicated [].

The following electronic databases were searched Medline, Pubmed, NHS Evidence, Academic Search Complete, MIDIRS, Education Research Complete, CINAHL Plus, Scopus, Intute, Zetoc and Web of Knowledge. Databases were searched from their starting date until summer 2014. The following journals were hand-searched, ' Midwives (RCM)', 'Maternity & Infant Care', 'Media, Culture & Society' and BMC Pregnancy & Childbirth.

Databases were searched using the key terms; 'media representations', 'media influence', 'media effects', 'childbirth', 'labour/labor'. 'The results of searching electronic databases are measured in terms of yield, recall and precision []. However, a high yield does not necessarily result in high precision rates, example.g. 'labour/labor' yielded many studies on 'employment'.

A total of 4,014 publications were identified and the titles and abstracts (where available) of the identified publications were screened and included if they met the following inclusion criteria: -

Figure shows 56 publications met the inclusion criteria, as one was not available the full texts of 55 were reviewed, 38 were included and 17 were omitted (2 were editorials, 4 letters, 1 undergraduate essay, 2 book reviews and the remaining 8 were opinion pieces). All papers were read by two authors one with a media background (AL) and one with a health background (MC), thematic analysis was undertaken to identify the key themes through reading and re-reading the included publications. Selected papers were read by the remaining authors to help decide on disagreements between the first two readers and to verify all themes. As this is a secondary analysis of existing literature and no primary data were collected no ethical approval was required.

Characteristics of publications included in the review

The review comprises twelve qualitative and five quantitative published research studies, three unpublished research pieces and 18 elements of grey literature. The latter includes 13 papers from professional journals, two conference proceedings, two on-line discussion fora and one book chapter. Table lists the included publications, mostly from the US (United States ) ( n = 17) and the UK ( n  = 10), with four from Canada, three from Australia, and one each from New Zealand and Poland.

Results

The key themes were: 1) medicalisation of childbirth, which includes birth being depicted as risky and dangerous and hence something to fear; 2) media the dominant way for women to learn about childbirth, despite the representations being mostly negative; and 3) birth being missing as a normal "everyday" life event. These three themes are presented under the key media groupings of television, print media, new media, and books: old media. The literature revealed a difference in the way that childbirth is depicted in different countries. From the North-American perspective, medicalised childbirth is seen as the only option for mothers-to-be. In the UK, however, this discourse is only starting to emerge []. The key frame around childbirth in the UK is that midwives need to engage more with media producers to get accurate representation of childbirth and ensure the uptake of normal birth pathways []. Thus, UK media representation of childbirth not only affects a woman's view on labour, but also that of health care providers.

Medicalisation of birth

Many of the papers pointed towards a medicalization of birth within the media. As medicine in the US began to gain power and influence in the 20 th century doctors began to displace midwives as the primary provider of maternity care []. This was part of a general trend of the growing prestige of science, which started in the late 19 th century in the US. Resulting in the idea that "Giving birth made a woman a mother ... a good mother had to learn about mothering from authoritative sources" ([]: p96). Women have gone along with this medicalised model, remaining relatively passive agents in their own pregnancy; due to the television programmes they are watching and all media more generally [, ]. Prior to the 1950s, midwives played a large role in all births; however, when obstetricians began categorising births as either normal or abnormal, their role began to diminish significantly, thus paving the way for the medicalisation of childbirth [, ]. 'Abnormal' births were situated as potentially difficult, thus requiring a different set of skills that only 'formally trained and educated doctors' could perform []. Medical intervention in childbirth in the US is now the norm, with nearly half of all births being started artificially, four-fifths of women receiving intravenous fluids, three-quarters receiving epidural analgesia to reduce pain and a third of babies now born by caesarean section []. This medicalisation has created disconnect between the pregnant woman and her body. The male medical profession managed to convince middle-class women in the early 20th century to abandon the social model of care as practised by midwives and seek their services in hospitals under the promise of safer and less painful births []. Redefining childbirth as pathological helped justify doctors' authority over the birthing process, legitimised by their specialised knowledge []. By medicalising childbirth, the medical establishment rendered both women and midwives as passive agents in the birthing process. The female body, thus, was reduced to an inferior status, and childbirth was now something that was "performed" on a woman, 'rather than something women performed' [, -, ]. As the mistrust of midwives grew in the US, public opinion about midwives began to change [], and so did the modes of birth that women were offered []. The Listening to Mothers II study found that 79% of US births were attended by an obstetrician, with most mothers undergoing technology-intensive care, such as continuous electronic fetal monitoring, intravenous drips, epidurals and/or spinal analgesia, and nearly one-third had had a caesarean section [].

Although women have several birthing options, the way that reality television constructs birth is contrived as its needs to have entertainment value and hence predominantly promoting a medical model of birth []. Murray and Ouellette remind us, that we are aware that reality TV is constructed and partly fictional and still such portrayal whets our desire for the authentic []. Similarly, Clement concluded that the images of childbirth viewers see are not an accurate reflection of labour and delivery in Britain [].

Kitzinger and Kitzinger make the transatlantic link as television has produced a powerful mythology of birth, since a number of television programmes aired in Europe are from North America, and with it the medical model is slowly seeping into the public sphere []. Typically on TV doctors deliver babies, whilst in England, midwives are responsible for nearly 57% of all deliveries, rising to nearly 90% for spontaneous deliveries [].

Absence of normal birth in the media

What is missing from the public discourse is a conversation about the nature of 'normal' birth []. What this scoping review has found is that while researchers recognised television programmes as fictional or constructed in a particular way for a viewing audience, they questioned why TV producers present information in this way []. Their argument, coming from a 'behavioural-effects' stance, is that women make decisions about childbirth based on what they see on these programmes [, , , , ] hence the representations need to be more realistic. However, (reality) television is as a genre known to stretch the truth. This medium requires drama, danger, crises and unusual events such as unpredictable and fast deliveries and doctors as heroes, hence a typical birth with a normal slow and lengthy labour without interventions and pain relief and attended by a midwife is less likely to be shown [].

This stretching of the truth results in a 'disconnect' in understanding the media and the role it can play in people's lives [, ]. Some identify a role for midwives in engaging with programme producers and educating them to avoid misrepresentations and allow a more factual portrayal of childbirth and labour [, ].

Television

The literature suggests that many pregnant women find reality television helps them to understand what could happen during childbirth [, , , , ]. Reality TV programmes on pregnancy and labour seek to demystify childbirth, and many first-time mothers find it helpful to see inside maternity wards so they know what to expect []. Holdsworth-Taylor goes one step further adding that Canadian women seek out reality television to add to their knowledge [], because there is a cultural void []. Barker recommends that UK midwives should watch reality television so they can speak to pregnant mothers when they have questions partly based on unrealistic scenarios presented on reality television and soap operas []. Haken believes that a woman, who is already disengaged from the medicalised birthing process, is even further removed by watching unrealistic scenes on television [].

The literature suggests that media portrayal may narrow the options for many women focusing their attention on having a 'safe' birth. The media remind us that childbirth is a potentially dangerous condition leaving a woman with no alternative than to 'choose' heroic health professionals (mainly doctors) to save them and their babies, and hence accept medical control and interventions [, ]. Bak regarded: '...these fictional representations of birth act as a filler for the firsthand experience women are denied the opportunity to accumulate. This results in women viewing labour pain as a negative element rather than accepting it as a guide to optimal positioning and a vital element in the physiological feedback that releases additional endorphins and oxytocin, as the body requires' ([], p.45).

As women turn to television to learn how others feel and cope with childbirth, birth is no longer a natural experience that women own, rather generations of women have never seen a real-life birth before they themselves experience it []. This makes the absence of low-risk undramatic or 'uneventful' childbirth on television even more worrying.

Printed media

What is underreported in the literature is the role newspapers and magazines play in the childbirth experience. Bor found that positive newspaper reports of the first television portrayal of pregnancy in the 'I Love Lucy' sitcom in the 1950s, influenced positive audience reception to pregnancy being portrayed on television [].

Robotham commented anecdotally on UK newspaper headlines such as The Daily Express' headline 'Terror of giving birth in Britain today', The Times' headline, 'Childbirth is about pain' and The Independent's story on the 'conveyor belt of childbirth' []. While she did not conduct primary research, she highlighted that such sensationalistic headlines could influence women to avoid seeking a midwife, and instead choose a medicalised birth []. A recent review of British newspapers highlights a distorted view of birth focusing on risk, which, MacLean argues, prompts a vicious cycle of intervention that starts with fear [].

Two print-media-based studies were reported in Australia [, ]. The first paper studied the role magazines play in expectant mothers' lives and determined that these are authoritative sources of knowledge and that childbearing is represented in Australian magazines continues the discourse of the medicalisation of childbirth []. The second study of one particular national newspaper suggested the general public in Australia may be too worried of the consequences to consider a move away from reliance on traditional medical-led maternity care []. Whilst magazines in New Zealand framed pregnancy as an unusual event requiring time, vigilance, and consumption of information, goods and services to successfully perform []. More research is needed to look at newspaper and magazine representations of childbirth and the influence they may have.

New media

Women are increasingly seeking information on the Internet to support/complement what they are watching on television [, , , ]. Literature addressing the Internet's role in women's perception of childbirth, however, fails to engage with newer theories of audience reception to help women cope better with what still seems to remain a mystery: 'regardless of an individual woman's situation, the experiences of pregnancy and childbirth engender expectations, desires and concerns; thus women seek advice, guidance and care from others with experience and knowledge of the contingencies of these processes' ([], p.20). Theroux found that most American women used the Internet at least ten times during their pregnancy, with as most frequent search topic 'complications of pregnancy' []. The recent Listening to Mothers III study revealed that two-in-three pregnant women received regular email updates with information about pregnancy and childbirth []. A new finding was that first-time mothers also turned to 'apps' for pregnancy and childbirth information-56% rating them as 'very valuable' []. While US mothers in Listening to Mothers III sought out information for themselves, Australia women turned to the Internet for information to discuss with their doctor []. US women discussed issues with their doctor's first, and then turned to the Internet []. As yet, there is no study that looks at how British pregnant women engage with the Internet.

Much of the research around usage of the Internet and pregnancy comes from the US. The literature suggests women seek out information on the Internet to get social networking support to have more control over their pregnancy, e.g. '... 83% wanted to have more control over decisions affecting their pregnancy and almost two-thirds of women... used the information they obtained from the Internet to help them make decisions about their pregnancy and birth and how their childbirth should be managed' ([], p.87).

Women use the Internet to understand what a normal childbirth experience should look like. Song and colleagues note that women have a strong desire for reassurance that what they were experiencing in their pregnancy is 'normal' []. With the move of birth from the home to hospital, childbirth is missing from everyday life. It has been relegated to something that should be kept from view (unless dramatised within television accounts), as a consequence women have a difficult time in understanding the process of childbirth. Schmid comments that our current lifestyle is too removed from natural experiences []. Schmid further notes that: 'Social messages support the view that birth needs to be medicalised and depersonalized (because of the emphasis only on survival) and these social messages about birth also condition women's views and beliefs. Therefore interventions in promoting normal birth need to focus on women's personal lifestyles and wishes as well as on the wider social context of birth and on what needs to be changed in this context to make normal birth possible' ([], p.144).

The Internet, more than any other media space creates a cultural ideal for what it means to be a 'good' mother. The discourse that emerges online about childbirth is that it is 'an important event in a woman's life when she needs to be introspective, focused completely on the labour process and on ensuring her baby's safe passage into the world' ([], p.47). Other research concurs: ' ...the Internet allows women to educate themselves ... it also works to institutionalise a new set of expectations and standards of competence to which women must adhere in order to be considered savvy informed patients and, at the same time, capable mothers' ([], p.785).

This moral ideal of a 'good' mother dictates that it is important to be seen both online and offline as doing one's pregnancy 'right', and that 'love, tenderness and care' are the driving factors [].

Books: the old media

Moffat showed how discourses around childbirth and the media that mothers seek out for information have changed over the last 30 years []. Books were the main source of information in the 1980s in the US, with television, newspapers and radios being the least used to find out about childbirth. Surprisingly, what has not changed since is the notion of what it means to be a 'good' mother, 'by reaching out for the latest findings and most helpful information available' ([], p.67). Even today, many new mothers cited impersonal sources (e.g. books, internet) as their prime source of information about birth []. Therefore, women and health professionals should both assess these information resources and together discuss implications for childbirth [].

Discussion

Much of the literature in this scoping review fell into a category of media-effects research that suggests that audiences do not critically engage []. This 'hypodermic needle approach' to media research is based on behavioural-effects theory that tends to rely on a basic understanding of cause-and-effect and assumes that all media audiences are passive. Such studies frequently utilize strongly challenged, if not discredited, theories of direct or causal media effects, which can be problematic because they fail to take into consideration more recent and critical approaches to audience research. One key issue with audience reception is that is not easily observable, except in fragmentary or indirect ways []. McQuail also reminds us that audiences are a product of social context and media provision, meaning that an audience can be defined in overlapping ways, and media use reflecting wider patterns of lifestyle, daily routines and time allocation []. It would be naive to suggest that women are not influenced by TV programmes; however there are larger, more complicated issues at play in the choices that pregnant women are making. It is this literature that is missing from our body of knowledge and hence the current review.

The research conducted thus far fails to take into consideration that the relationship between cause and effect is not one way. There are many external influences that need to be considered: socioeconomic and environmental factors, fear of childbirth and lack of first-hand knowledge of childbirth. Media representations of childbirth and labour merely reflect the ideologies of society. Ideology refers to an integrated set of frames of reference through which we sees the world and to which all of us adjust our actions []. Ideology controls what we see as natural or obvious and colours what we see a particular birth, or a midwifery consultation or our antenatal visit []. Temple relying heavily on effects-research argues: 'different people use the same media in different ways and for different purposes, making it likely that a newspaper will have different effects on different people. People have a well-developed capacity to suppress, forget, distort or misinterpret messages to fit their view of the world' [].

Medical/social model of childbirth

The debates about media portrayal link to the two paradigms of childbirth: the 'social' or 'midwifery' and the 'medical' model [, ]. Proponents of the social model adhere to the notion of a physiological labour and a vaginal birth with little or no external intervention [] as being a normal and therefore a 'good thing' in itself; a model traditionally championed by midwives. The medical model, the dominant discourse, encourages women to make use of medical technology, such as monitoring and anesthesia to help reduce the perceived risks and fears associated with giving birth, and in the process move away from labour and birth as physiological processes. Proponents of the medical model argue that childbirth is only safe in retrospect [], encouraging us to see childbirth as inherently risky for mother and baby. To reduce this perceived risk, a medical birth tends to occur in hospital with electronic fetal monitoring as well as a range of interventions such as forceps or caesarean sections, and typically supervised by a doctor [].

Media representations often portray technology and interventions as contributing to the medical profession's success in reducing the risk and uncertainty associated with childbirth []. The problem with the promotion of interventions is that there is a paucity of evidence around the routine use of many such childbirth interventions. Leading women to believe that maternity care is designed to 'manage' or avert the risks for mother and baby, but often risk management is merely 'covering' the hospital/staff in case of litigation [, , , ].

It is important to take into consideration the societal ideological viewpoints of childbirth and labour, for instance, in the US, the predominant approach is the medical model; whilst in the UK both models have currency although the medical model is dominant. Some argue that UK midwives are working in a 'blame culture' that propagates the medical model []. Changing this ideology, starting with its portrayal in the media can only be accomplished if midwives engage with popular discourses about the risks and dangers of childbirth that appear on popular reality and fictional television shows. One example of active midwifery input into fictional television is that of Terri Coates, the midwifery advisor on the BBC's successful television drama Call the Midwife, and more recently advisor on a midwifery television drama in Bangladesh [].

What needs to be taken into consideration is the notion of natural versus medicalised childbirth. Some argue that women prioritise their baby and their own safety, worry about losing control, prefer services that offer, 'high rates of straightforward birth with guaranteed midwifery support throughout labour and a low need to admit babies to special care baby units' and want good postnatal and breastfeeding support; thus, suggesting that a medicalised childbirth on television, might not carry over into real life ([], p. 894). In the US, 'nonmedicalised representations of pregnancy and birth [on television] would be largely absent and marginalized when they were presented, thereby being hidden from, or distorted in public discourse' []. This discourse is merely a replication of US social views that having a baby with the aid of a doctor is safer than with a midwife [, ]. During the 1990s US midwives tended to be depicted as self- involved, disengaged, unhelpful, and generally mean 'caregivers' antagonistic to a woman's family and friends []. Shallow states: '... the media has consistently caricatured birth as a horrendous and frightening process that anyone in their right mind would want to avoid at all cost. So who can blame women when terrified, they come to the hospital asking for an elective caesarean section' []. Fear surrounding birth, and particularly the fear of birthing outside the 'safety' of a hospital, may be responsible for early labour admission and the subsequent cascade of intervention [, , ].

Handfield et al. concur that childbirth in Australia has also been portrayed on television as frightening, overrepresenting deaths and dramatic life-threatening complications []. It could be argued that the medical establishment puts forth a medicalised discourse, such as the one that causes fear in women, to maintain power and control over how and where women give birth. Robotham on contacting the BBC after watching particularly concerning scenes on television programmes, Casualty and Holby City, learnt that there were nurse and medical advisers, but midwifery input was lacking []. This reinforces that the discourses surrounding midwifery in the media are not dominant and that seeking out a doctor is the safest way to deliver and prove that one is a 'good' mother. Hence midwives must engage more with media producers to ensure normal birth has a place in British-created television programming.

This review has shown that depictions of childbirth and labour indicate that women face social anxieties around their pregnancy. By watching reality television to gain an understanding of what childbirth might be like, viewers must: 'reflect on ways they themselves must conform to the cultural institutions that surround them. People must submit themselves to the power carried within prescriptions to think and behave in normalized and normalizing ways' [], p 194.

The most commonly watched shows tend to dramatize pregnancy and birth and over represent obstetric complications and the need for interventions []. Women who watch reality TV about childbirth, learn how they should and should not react, i.e. they are socialized into a particular model of childbirth. The latter process is not unique to childbirth, as Kingdon found in the study of representation of depression in the media []. Whilst Lupton studying the portrayal of infants in popular media in Australia highlighted this inevitably creates unrealistic expectations of infants in real life [].

Television can act as a bridge when a life change or transition is occurring, alleviating women's social anxieties about childbirth []. However, fear of birth scores were highest amongst Canadian students who attitudes were shaped by the media []. It is clear from our review that women are watching television to learn what to expect during birth, to reassure themselves that they are doing their pregnancy 'right'.

Underlying all of this is the societal discourse that suggests that it is safer for women to participate in medicalised childbirth, rather than risk a midwife-led birth (in US) or labouring/ birthing at home (in UK). To offset the encroachment of the medicalised model of childbirth, midwives must watch reality and fictional television where childbirth is the focus to be in a position to alleviate fears and answer questions posed by pregnant women. Secondly, midwives and childbirth educators must engage with media producers to create more realistic portrayals of childbirth and labour.

Strengths and limitations of this research

This review searched and assessed the literature on the effects of the media on childbirth perceptions. The evidence of media influence generally was of low quality. This scoping review only used a selection of the poorly graded evidence to illustrate the key issues. In brief, Consequently many assertions put forward in the academic literature about media influence on perceptions of childbirth are unproven since few studies have measured the impact that such representations have on women and health professionals.

Conclusion

This review offers insight into current research on the portrayal of childbirth in the media and identifies where gaps exist. It is important to look from an ideological perspective, taking into account issues such as ethnicity, gender and socioeconomic status; none of which were mentioned or considered in the literature included in this scoping review. Future research needs to explore women's understandings of normal versus risky childbirth, independent of what they watch on television, or what they seek out on the Internet or read in newspapers or magazines. Further research needs to be conducted on where women are getting their information about childbirth and labour. With newer online platforms (Twitter, Facebook, Pinterest, MumsNet) growing rapidly, it is important that researchers understand the role social networking now plays in a woman's decisions about pregnancy. However as the recent study by Maclean highlighted; UK newspapers have an interest in horror stories and a tendency to suggest that an absence of obstetricians is dangerous, something that she has termed a 'hierarchy of safety' []. As printed media is still a major part of the mass media, it is imperative that researchers determine if the discourses put forth in the printed press replicate those broadcasted and online. Lastly, it is important to investigate what media producers know about childbirth and labour and their views on the impact that the current representations may be having on women. It is important for midwives to engage with media producers to help improve the representation of childbirth on television, in the same way that midwives should be encouraged to work more with the press [].

Declarations

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.

Competing interests

Authors' contributions

VH, EvT, HC, CA, AL conceived the study and participated in its design and coordination. MC conducted the electronic searching, MC, AL and EvT conducted the hand-searching of journals. AL and MC produced the first draft. All authors read and edited several draft versions and all approved the final manuscript.

The authors declare that they have no competing interests.

Authors' Affiliations

Faculty of Media & Communication, Bournemouth University, Poole, UK

Health & Wellbeing Community, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK

Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK

NMAHP Research Unit, School of Health Science, University of Stirling, Stirling, UK

References

1. EURO-PERISTAT Project. European Perinatal Health Report: The health and care of pregnant women and their babies in 2010. Paris: Inserm; 2013. Web address: http://www.europeristat.com/reports/european-perinatal-health-report-2010.html .

2. Declercq ER, Sakala C, Corry MP, Applebaum S. Listening to Mothers II: Report of the Second National U.S. Survey of Women's Childbearing Experiences. New York: Childbirth Connection; 2006. Available at: www.childbirthconnection.org/listeningtomothers/ . Accessed Feb 2016.

3. Bak C. Cultural lack of birth experience empowers media representations, not women. Midwifery Today. 2004;Winter(72):44-45 & 65.

4. Stoll K, Hall W. Vicarious birth experiences and childbirth fear: Does it matter how young Canadian women learn about birth. J Perinat Educ. 2013;22(4):226-33.

5. Wlodarczyk J. Cross-Cultural Delivery: The American Influence on Representations of Birth in Polish Popular Culture. Genders On-Line J. 2013;58:Fall.

6. McIntyre MJ, Francis K, Chapman Y. Shaping public opinion on the issue of childbirth; a critical analysis of articles published in an Australian newspaper. BMC Pregnancy Childbirth. 2011;11(1):47.

7. Declercq ER, Sakala C, Corry MP, Applebaum S, Herrlich A. Listening to Mothers III: Report of the Third National U.S. Survey of Women's Childbearing Experiences. New York: Childbirth Connection; 2013. http://transform.childbirthconnection.org/wp-content/uploads/2013/06/LTM-III_Pregnancy-and-Birth.pdf .

8. Lothian JA. Risk, Safety and Choice in Childbirth. J Perinat Educ. 2012;21(1):45-7.

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"Is it realistic?" the portrayal of pregnancy and childbirth in the media

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Considerable debate surrounds the influence media have on first-time pregnant women. Much of the academic literature discusses the influence of (reality) television, which often portrays birth as risky, dramatic and painful and there is evidence that this has a negative effect on childbirth in society, through the increasing anticipation of negative outcomes.

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For several years, I ran Recipes for Normal Birth workshops and spend a lot of time analysing the research on what helps keep birth normal. Yes, I know that the word 'normal' is very loaded and needs debating. For today. I'm going to focus on another aspect of the discussion. Because, as I've looked at the research on what helps facilitate straightforward birth, there's one tip in particular that I would like to share with women.
Stay at home as long as possible in labour.
That is, in my humble but - if I may say so myself - reasonably informed and evidence-based opinion, one of the most important things that a woman can do in order to help give herself the best chance of a straightforward normal birth with as little intervention as possible. Because time and time again, research shows us that, the sooner a labouring woman who is planning a hospital birth enters the hospital, the more likely she is to end up with lots of intervention which may lead down the road to a more medicalised operative or instrumental birth.

Here's some data...

One recent study which illustrates this really well was conducted by Wood et al (2015). They analysed data from 2033 women who went into spontaneous labour at term with a single baby, focusing on the relationship between how dilated their cervix was on admission to hospital and the likelihood that the woman would have a caesarean section.

The results were really clear. Women who went to hospital earlier were more likely to have a caesarean section compared with those who went later. If you want the numbers, then the cut-off point was 6cm, although please bear in mind the two important caveats here. One, midwives have long been stressing that dilation is only one element of labour progress, so I don't want to emphasise the measurement element of this more than is appropriate. Particularly because, two, most women can't or don't wish to do vaginal examinations themselves, so they can't possibly know whether their cervixes are 1cm, 5cm or 7cm dilated. The numbers aren't the important bit in the translation of this into our conversations with women.

The important bit is the message that staying at home for as long as she is comfortable doing so is one of the most important things a woman can do if she wants to maximise her chances of having a straightforward, normal birth.

What needs to happen?

There are a number of things that those of us who work with women can do to help this, and I am acutely aware that simply telling this to women may not make a difference. For a start, women receive mixed messages about when to come into hospital. Not to mention years of undermining about who is the expert on their body and baby. There is also a good bit of work to be done in the area of making time before labour to consider what needs to happen to make sure that everybody is comfortable with staying at home. By everybody, I mean the woman herself, her partner, any other relatives or birth partners and birth attendants.

Partners and families are key. If the woman can't relax because her partner can't relax, then she's not likely to get to 6cm in a reasonable timespan, and she may end up transferring in for partner's distress. But yes, birth attendants' comfort levels are another important element. Sadly, some women transfer for caregiver's distress as well, and that's something which needs to be addressed. But these are not insurmountable, and helping women and their partners and families to develop strategies for staying at home as long as possible, even if they are planning a hospital birth, is a really simple way in which we can help reduce the caesarean section rate.

Wood AM, Frey HA, Tuuli MG et al (2015). Optimal Admission Cervical Dilation in Spontaneously Laboring Women.Amer J Perinatol. DOI: 10.1055/s-0035-1563711

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The most important thing women can do for themselves in the quest for a normal birth? - Dr Sara Wickham

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For several years, I ran Recipes for Normal Birth workshops and spend a lot of time analysing the research on what helps keep birth normal. Yes, I know that the word 'normal' is very loaded and needs debating. For today. I'm going to focus on another aspect of the discussion.

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Sprogcast is a monthly independent podcast in which Karen Hall and Mark Harris explore all sorts of interesting topics around pregnancy, birth and early parenthood.

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Sprogcast is presented by Mark Harris and Karen Hall, and is a lively chat about all things to do with pregnancy, birth and early parenthood.

Sprogcast's tracks

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Sprogcast is presented by Mark Harris and Karen Hall, and is a lively chat about all things to do with pregnancy, birth and early parenthood.

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AIMS Journal, 2011, Vol 23 No 4 Sarah Buckley shows us what is stopping birth working
In modern Western countries, including Australia and the UK, rates of obstetric intervention have reached extreme levels, such that very few mothers and babies experience labour and birth without drugs and procedures to assist or hasten the process. This has led to the erroneous belief that human birth is an intrinsically faulty system, and that modern women have lost the ability to give birth.

However, our women's bodies have their own wisdom, and our innate system of birth, refined over one hundred thousand generations, is not so easily overpowered. This system, which I am calling undisturbed birth, has the evolutionary stamp of approval not only because it is safe and efficient for the vast majority of mothers and babies, but also because it incorporates our hormonal blueprint for ecstasy in birth. When birth is undisturbed, our birthing hormones can take us into ecstasy - outside (ec) our usual state (stasis) - so that we enter motherhood awakened and transformed. This is not just a good feeling; the post-birth hormones that suffuse the brains of a new mother and her baby also catalyse profound neurological changes. These changes give the new mother personal empowerment, physical strength, and an intuitive sense of her baby's needs, and they prepare both partners for the pleasurable mutual dependency that will ensure a mother's care and protection and her baby's survival.

Undisturbed birth represents the smoothest hormonal orchestration of the birth process, and therefore the easiest transition possible; physiologically, hormonally, psychologically, and emotionally, from pregnancy and birth to new motherhood and lactation, for each woman. When a mother's hormonal orchestration is undisturbed, her baby's safety is also enhanced, not only during labour and birth, but also in the critical postnatal transition from womb to world. Furthermore, the optimal expression of a woman's motherhood hormones, including the fierce protectiveness of her young, will ensure that her growing child is protected and well nurtured, adding another layer of evolutionary fitness to the process of undisturbed birth.

The hormones of birth

There are many hormones involved in mammalian birth, and our understanding of their complex orchestration is limited. This article focuses on the hormones oxytocin; beta-endorphin; the catecholamines (adrenaline and noradrenaline); and prolactin. As the hormones of love, pleasure and transcendence, excitement, and tender mothering, respectively, these form the major components of an ecstatic cocktail of hormones that nature prescribes to aid birthing mothers of all mammalian species. An optimal hormonal orchestration provides ease, pleasure, and safety during this time for mother and baby. Conversely, interference with this process will disrupt this delicate hormonal orchestration, making birth more difficult and painful, and potentially less safe. All of these hormones are produced primarily in the middle or mammalian brain, also called the limbic system or emotional brain. For birth to proceed optimally, this more primitive part of the brain needs to take precedence over our neocortex - our 'new' or higher brain - which is the seat of our rational mind. This shift in consciousness, which some have called 'going to another planet', is aided by (and also aids) the release of birthing hormones such as beta-endorphin, and is inhibited by circumstances that increase alertness, such as bright lighting, conversation, and expectations of rationality.

Mother Nature's pragmatic and efficient principles dictate that these hormones should also help the baby at birth, and this is being increasingly confirmed by scientific research. This hormonal interdependence contradicts the common medical response to natural birth as the mother's prizing of her own experience over her baby's safety, and underlines the mutual dependency of mother and baby, even as they begin their physical separation.

Oxytocin

Oxytocin has been called the hormone of love because of its connection with sexual activity, orgasm, birth, and breastfeeding. In addition, oxytocin is produced in social situations such as sharing a meal, making it a hormone of altruism or, as Michel Odent regularly suggests, of 'forgetting oneself '.

Oxytocin is also the most powerful uterotonic (contraction-causing) hormone, and its release is associated with the contractions of labour and birth in all mammalian species. Oxytocin is made in the hypothalamus, deep in the middle brain, and is released in pulses from the posterior pituitary into the bloodstream every three to five minutes during early labour, becoming more frequent as labour progresses.

The number of oxytocin receptors in a pregnant woman's uterus increases substantially late in pregnancy, increasing her sensitivity to oxytocin. Oxytocin has also been shown to have a painkilling effect in rats and mice. Oxytocin catalyses the final powerful uterine contractions that help the mother to birth her baby quickly and easily. At this time, the baby's descending head stimulates stretch receptors in a woman's lower vagina, which trigger oxytocin release from her pituitary. This oxytocin release causes more contractions that promote more fetal descent, inducing more stretchreceptor stimulation and therefore even more release of pituitary oxytocin. This 'positive feedback loop' is also known as the Ferguson reflex.

After the birth, ongoing high levels of oxytocin, augmented by more pulses released as the baby touches, licks, and nuzzles the mother's breast, help to keep her uterus contracted and so protect her against postpartum haemorrhage. Skin-to-skin and eye-to-eye contact between mother and baby also help to optimise oxytocin release. Blood oxytocin levels peak at around thirty minutes postpartum and subside towards the end of the first hour. Oxytocin levels in the brain, which switch on instinctive maternal behaviour, may be elevated for substantially longer.

Newborn oxytocin levels also peak at around thirty minutes after birth so that during the first hour after birth, both mother and baby are saturated with high levels of oxytocin, the hormone of love. Newborn babies have elevated levels of oxytocin for at least four days after birth, and oxytocin is also present in breastmilk.

During breastfeeding, oxytocin mediates the milkejection, or letdown, reflex and is released in pulses as the baby suckles. During the months and years of lactation, oxytocin continues to act to keep the mother relaxed and well nourished, by enhancing the efficiency of her digestion. Other studies indicate that oxytocin is also involved in cognition, tolerance, and adaptation, and researchers have recently found that oxytocin also acts as a cardiovascular hormone, with effects such as slowing the heart rate and reducing blood pressure.

Uvnas-Moberg describes a 'relaxation and growth response' to oxytocin release, which reflects its ability to turn on the parasympathetic nervous system, which is involved with digestion and growth, and to reduce activity in the sympathetic 'fight-or-flight' system. Malfunctions of the oxytocin system have been implicated in conditions such as schizophrenia, autism, cardiovascular disease, and drug dependency, and it has been suggested that oxytocin may mediate the antidepressant effect of drugs such as Prozac.

Beta-endorphin

Beta-endorphin is one of a group of naturally occurring opiates (drugs derived from the opium poppy), with properties similar to pethidine, morphine, and fentanyl, and has been shown to work on the same receptors of the brain. It is secreted from the pituitary gland under conditions of pain and stress, when it acts to restore homeostasis (physiological balance); for example, by acting as a natural painkiller. Beta-endorphin also activates the powerful mesocorticolimbic dopamine reward system, producing reward and pleasure in association with important reproductive activities including mating, birth, and breastfeeding. Beta-endorphin is also released during episodes of social and physical contact, reinforcing pro-social behaviours among all mammals.

Like the addictive opiates, beta-endorphin reduces the effects of stress and induces feelings of pleasure, euphoria, and dependency. Beta-endorphin levels, as measured in the mother's bloodstream, increase throughout labour, peaking at the time of birth, and subsiding in the first one to three hours. Levels in the new mother's limbic system are elevated for much longer, as beta-endorphin takes more than twenty-one hours to break down within the brain and cerebrospinal fluid (CSF).

In labour, such high levels help the labouring woman to transcend pain, as she enters the altered state of consciousness that characterises an undisturbed birth. In the hours after birth, elevated beta-endorphin levels reward and reinforce mother-baby interactions, including physical contact and breastfeeding, as well as contributing to intensely pleasurable, even ecstatic, feelings for both.

Beta-endorphin is also important in breastfeeding. Levels peak in the mother twenty minutes after commencement, and beta-endorphin is also present in breastmilk. Researchers have found higher levels, at four days postpartum, in the breastmilk of mothers who have had a normal birth, compared with caesarean mothers; they speculate that this extra dose of beta-endorphin is designed to help the newborn with the stressful transition to life outside the womb.

Beta-endorphin, as a component of ongoing motherbaby interactions, induces a pleasurable mutual dependency for both partners, reinforcing and rewarding behaviours such as breastfeeding and physical contact that are associated with long-term well-being and survival.

Catecholamines

The fight-or-flight hormones adrenaline and noradrenaline (epinephrine and norepinephrine in US literature) are part of the group of hormones known as catecholamines (CAs) and are produced by the body in response to stresses such as hunger, fear, and cold, as well as excitement. Together they stimulate the sympathetic nervous system for fight or flight.

During labour, maternal CA levels slowly and gradually rise, peaking around transition. However, high adrenaline levels in early labour, which reflect activation of the woman's fight-or-flight system in response to fear or a perception of danger, have been shown to inhibit uterine contractions, therefore slowing or even stopping labour. Noradrenaline also acts to reduce blood flow to the uterus and placenta and therefore to the baby.

This reflex makes sense for mammals birthing in the wild, where the presence of danger would activate the fight-or-flight response, inhibiting labour and diverting blood to the major muscle groups so the mother can fight or, more likely, flee to safety. In humans, high levels of adrenaline have been associated with longer labour and adverse fetal heart rate (FHR) patterns, which indicate that the baby is low in oxygen (hypoxic), consistent with CA-mediated reductions in uterine blood flow.

Research has also shown that very high CA levels can paradoxically stimulate uterine contractions, which may contribute to the fetus ejection reflex. According to Odent, this reflex occurs at transition, or perhaps even earlier in labour, and almost always follows an undisturbed birth, perhaps because low CA levels in early labour are necessary for its full expression. The mother experiences a sudden and enormous increase in CA levels, giving her a rush of energy and strength; she will be upright and alert, with a dry mouth and shallow breathing and perhaps the urge to grasp something. She may express fear, anger, or excitement, and the CA surge will produce, in concert with high oxytocin levels (associated with the Ferguson reflex), several very strong and irresistible contractions that will birth her baby quickly and easily.

After the birth, the new mother's CA levels drop steeply. If she is not helped to warm up, the cold-related stress will keep her CA levels high, which will inhibit her uterine contractions and therefore increase her risk of postpartum haemorrhage.

For the baby also, labour is an exciting and stressful event, reflected in increasing CA levels. In labour these hormones have a very beneficial effect, protecting the baby from the effects of hypoxia (lack of oxygen) and subsequent acidosis by redistributing cardiac output (blood supply) and by increasing the capacity for anaerobic glycolysis (metabolism of glucose at low oxygen levels).

The baby experiences a marked surge in CA hormones, especially noradrenaline, close to the time of birth, probably triggered by pressure on the head. This surge plays a very important role in the baby's adaptation to extrauterine life. It aids newborn metabolism by increasing levels of glucose and free fatty acids, which protect the newborn's brain from the low blood sugar that can occur in the early newborn period when the baby loses the placental supplies of glucose.

In addition, catecholamines enhance respiratory adaptation to life outside the womb by increasing the absorption of amniotic fluid from the lungs and stimulating surfactant release. Surfactant is essential for smooth inflation of the newborn lungs. CAs also assist with the necessary newborn shift to nonshivering thermogenesis (heat production), increase cardiac contractility, stimulate breathing, and enhance responsiveness and tone in the newborn.

High CA levels at birth also ensure that the baby is wide-eyed and alert at first contact with the mother. The baby's CA levels also drop steeply after an undisturbed birth, being soothed by contact with the mother, but noradrenaline levels remain elevated above normal for the first twelve hours. High newborn noradrenaline levels, triggered by a normal birth, have been shown to enhance olfactory learning during this period, helping the newborn to learn the mother's smell.

Prolactin

Prolactin, known as the mothering or nesting hormone, is released from the pituitary gland during pregnancy and lactation. Prolactin is named for its well-known prolactation effects, preparing a pregnant woman's breasts for lactation and acting postnatally as the major hormone of breastmilk synthesis.

Prolactin levels increase throughout pregnancy, helping to organise the expectant mother's brain for maternity. Prolactin's lactogenic (milk-producing) effect is blocked during pregnancy by high levels of progesterone, produced by the baby's placenta. When progesterone levels drop with the birth of the placenta, prolactin can begin stimulating milk production.

Prolactin levels decline during labour, reaching the lowest point when the labouring woman's cervix is fully dilated. Prolactin then rises again steeply in the moments after birth, perhaps due to stimulation of the mother's cervix during birth, reaching peak levels in the following two to three hours. After this, levels decline again slowly and reach another nadir from nine to twenty-four hours postpartum.

This postpartum maternal surge in prolactin provides maximum levels, available to brain and body, in the hour or so after birth. This elevation may be important in optimising maternal behaviours at this time, as well as ensuring successful lactation.

Animal studies show that prolactin release is also increased by carrying infants, and its association with paternal nurturing (including in humans) has earned it the added title 'the hormone of paternity.' Human studies have shown that just before the birth, fathers-to-be have elevated prolactin levels, which parallel the rise of prolactin in their partners. New fathers with higher prolactin levels are more responsive to newborn cries.

In summary

Mother Nature's superb design is hard-wired into our female bodies, providing an elaborate orchestration of hormones to enhance ease, pleasure and safety in labour, birth and postpartum. These hormones also ensure an ideal start to, and ongoing pleasure and reward from, breastfeeding and attachment, optimising well-being and survival for mother and offspring in the medium and long terms.

The full expression of these labouring hormones requires specific conditions: that the labouring mother feels private, safe and unobserved. This basic need is recognised by traditional systems of maternity care, which prioritise the emotional well-being of the labouring woman and ensure that she is cared for in a familiar place with known and trusted helpers. These factors will keep her as calm and relaxed as possible, and her adrenaline levels low.

Conversely, if she is not feeling private, safe and unobserved in labour, her adrenaline levels will increase, slowing labour and decreasing blood and oxygen supply to the baby and leading to fetal distress for vulnerable babies. Our current maternity care system does not done for slow labour and fetal distress. Interventions used for these indications such as synthetic oxytocin and caesarean surgery can further interfere with the hormonal orchestration for mother and baby, creating a cascade of intervention and depriving both of the ideal start that Mother Nature intends.

As Professor Kloosterman states so eloquently: 'Spontaneous labour in a normal woman is an event marked by a number of processes so complicated and so perfectly attuned to each other that any interference will only detract from the optimal character. The only thing required from the bystanders is that they show respect for this awe-inspiring process by complying with the first rule of medicine - nil nocere [do no harm].'

Following her recent UK seminars (recorded and available on DVD) Sarah adapted Chapter 6, Undisturbed Birth: Mother Nature's Blueprint for Safety, Ease, and Ecstasy, of her book Gentle Birth, Gentle Mothering, to produce this article for AIMS. Sarah's books, DVDs and articles are available at www.sarahbuckley.com
References
1. Buckley, SJ (2009) Gentle Birth, Gentle Mothering. Celestial Arts Buckley, SJ (2009) Gentle Birth, Gentle Mothering. Celestial Arts
2. Uvnas-Moberg, K (2011) The Oxytocin Factor : Tapping the Hormone of Calm, Love and Healing. 2nd edition. Pinter & Martin Ltd.

Further references and additional reading suggestions are available at www.sarahbuckley.com/undisturbed-birth-aims-reference

AIMS supports all maternity service users to navigate the system as it exists, and campaigns for a system which truly meets the needs of all. AIMS does not give medical advice, but instead we focus on helping women to find the information that they need to make informed decisions about what is right for them, and support them to have their decisions respected by their health care providers. The AIMS Helpline volunteers will be happy to provide further information and support. Please email helpline@aims.org.uk or ring 0300 365 0663.

Published on 1st December 2011

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AIMS Journal, 2011, Vol 23 No 4 Sarah Buckley shows us what is stopping birth working In modern Western countries, including Australia and the UK, rates of obstetric intervention have reached extreme levels, such that very few mothers and babies experience labour and birth without drugs and procedures to assist or hasten the process.

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Hormones, labour and birth: an introduction

You know your hormones are going to be working hard at this time but you might not know exactly what they're doing. You'll in fact have four major hormonal systems active when you're in labour and giving birth. These hormones are:

oxytocin (the love hormone)

beta-endorphins (the hormones of pleasure and transcendence)

epinephrine and norepinephrine (the hormones of excitement)

prolactin (the mothering hormone).

(Buckley, 2002)

Here's what impact all four will have on you...

Oxytocin or the love hormone

Oxytocin is the love hormone, which is why it's released during sex, orgasm, birth and breastfeeding (Odent, 1999; Buckley, 2002).

Oxytocin will make you feel more affectionate and selfless, and its main function in labour is to bring on contractions (Dawood et al, 1978). You'll get a surge of oxytocin in the final stage, so if you're having a vaginal birth it will help you along with pushing.

Oxytocin reduces stress, calms you down and helps with pain during labour (Buckley, 2015). Impressively, your baby will also produce oxytocin before and during labour (Chard et al, 1971).

Oxytocin hangs around after birth too, helping you feel more relaxed, well-nourished and bonded with your baby (Buckley 2002, Buckley 2015). It helps with the let-down reflex during breastfeeding and protects you against postpartum haemorrhage (Buckley, 2002).

Beta-endorphins or the pleasure hormones

Endorphins are naturally occurring opiates, similar to morphine and heroin. Like oxytocin, they mostly appear during sex, pregnancy, birth and breastfeeding. Beta-endorphins reduce pain and suppress the immune system, which is important so that it doesn't act 'against' your baby (Buckley, 2002, 2015).

If you're stressed during labour, that can make you release excessive beta-endorphins, which may inhibit oxytocin and slow things down (Buckley 2015). That's why keeping things as calm as possible is a great thing in labour.

Beta-endorphin also helps with the release of prolactin during labour, preparing your breasts for feeding (Rivier et al, 1976).

And one more thing: it helps in the final phase of your baby's developing lungs too (Buckley 2015).

Epinephrine and norepinephrine or fight or flight hormones

You might have heard these two referred to as fight-or-flight hormones but their proper names are epinephrine and norepinephrine (adrenaline and noradrenaline). They are produced during stresses like fright, anxiety, hunger or cold and also when you're excited (Buckley 2015).

You're likely to get a high level of these hormones if you don't feel private, calm, safe and undisturbed and they can then inhibit oxytocin (Buckley 2015). Yet in the late-labour stage if you perceive danger or stress, they may paradoxically stimulate contractions so you give birth more quickly (Buckley 2015).

A rise in epinephrine when you're in the later stages of labour increases your levels of prostaglandin and cortisol to help with contractions. This will make you feel a sudden rush of energy and will cause several strong contractions and will help you push (Buckley, 2002, 2015).

These hormones help your baby too by protecting them against a lack of oxygen (Buckley, 2002). Your baby will have high levels of these hormones during birth but they'll drop quickly once you sooth them afterwards (Lagercrantz and Bistoletti 1977; Buckley, 2002).

Prolactin or the mothering hormone

Prolactin is the mothering hormone. And it's the major hormone for breastfeeding.

Prolactin starts to increase during pregnancy and peaks at birth (Buckley, 2002). Your baby produces prolactin in the womb too (Daniels and Martin, 1994).

Hormones and your feelings after birth

Lots of women get the baby blues during the first week after birth of her baby days (NHS Choices, 2018). You might feel down or depressed, emotional or irritated and likely to burst into tears at any second.

Don't despair though: these symptoms are totally normal. They're due to the sudden hormonal and chemical changes that happen after you give birth.

If you feel like you are suffering from something more extreme and it isn't going away though, talk to your GP or midwife. You might be suffering from postnatal depression and should get some support or help right away.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Buckley SJ. (2015) Hormonal physiology of childbearing: Evidence and implications for women, babies, and maternity care. Washington, D.C.: Childbirth Connection Programs, National Partnership for Women and Families. Available from: http://www.nationalpartnership.org/research-library/maternal-health/hor... [Accessed 25th April 2018]

Buckley SJ. (2002) Ecstatic birth: The hormonal blueprint of labor. Available from: http://www.dancingstarbirth.ca/Handouts/Ecstatic_Birth.pdf [Accessed 25th April 2018]

Chard T, Hudson CN, Edwards CR, Boyd NR. (1971)Release of oxytocin and vasopressin by the human fetus during labour. Nature. 234:352-354. Available from: https://www.ncbi.nlm.nih.gov/pubmed/4944487 [Accessed 25th April 2018]

Daniels G, Martin J. (1994) Neuroendocrine regulation and diseases of the anterior pituitary and hypothalamus, In Harrison's Principles of Internal Medicine, 13th edition. New York: McGraw- Hill. [Accessed 25th April 2018]

Dawood MY, Raghavan KS, Pociask C, Fuchs F. (1978) Oxytocin in human pregnancy and partrurition. Obstetrics and Gynecology. 1978; (51):138-143. Available from: https://www.ncbi.nlm.nih.gov/pubmed/622223 [Accessed 25th April 2018]
Lagercrantz H and Bistoletti H. (1977) Catecholamine release in the newborn infant at birth. Pediatric Research. 8:889-893. Available from: https://www.ncbi.nlm.nih.gov/pubmed/887309 [Accessed 25th April 2018]

NHS Choices. (2018) Feeling depressed after childbirth. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/feeling-depressed-afte... [Accessed 25th April 2018]

Odent M. (1999) The Scientification of Love. London. Free Association Press.

Rivier C, Vale W, Ling N, Brown M, Guillemin R.(1976) Stimulation in vivo of the secretion of prolactin and growth hormone by beta-endorphin. Endocrinology. 100:238-241. Available from: https://www.ncbi.nlm.nih.gov/pubmed/187406 [Accessed 25th April 2018]

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Hormones in labour: oxytocin and the others - how they work

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You know your hormones are going to be working hard at this time but you might not know exactly what they're doing. You'll in fact have four major hormonal systems active when you're in labour and giving birth.

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The term "sibling" refers to children who are related and living in the same family. Sibling rivalry has occurred as long as families have existed. Think back to biblical times and Joseph's problems with his brothers or of Disney's "Cinderella" and the dreadful experience she had with her step-sisters!

It seems strange that whenever the word "sibling" comes up, "rivalry" seems sure to follow despite the fact that there are many solid sibling relationships in families (brothers and sisters who genuinely like and enjoy one another). However, it is typically rivalry that gets the most attention.

What causes sibling rivalry? Think about it. Siblings don't choose the family they are born into, nor do they choose each other. They may be of different genders, are probably of different ages and temperaments, and worst of all, they have to share the one or two people they want most for themselves: their parents. Other factors which may cause sibling rivalry include:

Position in the family. For example, the oldest child may be burdened with responsibilities for the younger children or the younger child spends his life trying to catch up with an older sibling.

Gender. For instance, a son may resent his sister because his father seems more gentle with her. On the other hand, a daughter may wish she could go on the hunting trip with her father and brother.

Age. A five and an eight-year-old can play some games together but when they become ten and thirteen, they will likely have very different interests.

The most important factor, however, is a parent's attitude. Parents have been taught that they must be impartial with their kids, but this can be extremely difficult. It's inevitable that parents will feel differently about children who have their own personalities with varying needs, dispositions, and places in the family. Picture the age-old conflict of the young child whining: "It's not fair. Why can't I stay up until nine-thirty like Johnny?" Fairness has nothing to do with it. Susie is younger and needs more sleep. It's as simple as that, and parents are advised never to give in to the old "it's not fair" strategy. Besides, when Susie is finally allowed to stay up until nine-thirty, it will feel like a privilege to her.

Many parents feel that in order to be fair, they must treat their children equally. It's simply not possible, and it can be dehumanizing if a mother feels that when she hugs one child, she must stop and hug all of her children. Hugs will eventually become somewhat meaningless in that family. When Susie has a birthday or is ill, she is the one who merits the special attention and presents. You can be sure that no matter what they may say, the other children in the family recognize the inherent "fairness" of the situation.

Ever since we decided that sibling rivalry is a normal occurrence in a family system, we've had a terrible time figuring out what to do about it. Here are some do's and don'ts that may be helpful in reducing conflicts as well as the negative effects of sibling rivalry:

Don't make comparisons. (e.g., "I don't understand it. When Johnny was his age, he could already tie his shoes.") Each child feels he is unique and rightly so; he is his own person and resents being evaluated only in relation to someone else. Instead of comparison, each child in the family should be given his own goals and levels of expectation that relate only to him.

Don't dismiss or suppress your children's resentment or angry feelings. Contrary to what many people think, anger is not something we should try to avoid at all costs. It's an entirely normal part of being human, and it's certainly normal for siblings to get angry with each other and have the impulse to physically fight. They need the adults in their lives to assure them that mothers and fathers get angry too, but have learned self-control and that angry feelings do not give license to behave in cruel and dangerous ways. This is the time to sit down, acknowledge the anger (e.g., "I know you hate David right now but you cannot hit him with a stick."), and talk it through.

Try to avoid situations that promote guilt in siblings. First, we must teach children that feelings and actions are not synonymous. It may be normal to want to hit the baby on the head, but parents must stop a child from doing it. The guilt that follows doing something mean is a lot worse than the guilt of merely feeling mean. In situations like this, parental intervention must be quick and decisive.

Whenever possible, let brothers and sisters settle their own differences. While it may sound good, it can be terribly unfair in practice. Parents have to judge when it is time to step in and mediate, especially in a contest of unequals in terms of strength and eloquence (no hitting below the belt, literally or figuratively). Some long-lasting grudges among grown siblings have resulted when their minority rights were not protected.

For additional help see Helping Your Child With Socialization.

When One Sibling is Disabled

Quite different considerations must come into play when there is a disabled child in the family, especially if it is a child who requires a lot of extra services both in and out of the home. In this case, non-disabled siblings can be resentful of the time spent on their brother or sister; they sense the parent's preoccupation. They often feel they are receiving only "surface attention," and that the parent is not really alert to their needs.

There is one critical point that should be made and emphasized in all such cases. Whatever time and effort are spent with the disabled child, it is done with the goal of improvement: making the child better able to function independently over time. As he improves his skills, the demands on his parents will decrease commensurately, freeing them to devote more time to other members of the family. It actually boils down to, "Come on, let's everyone help, and ultimately everyone will benefit."

There are other measures to be taken to lessen sibling rivalry and tension in families with a disabled child. Every child deserves a certain amount of quality time with a parent. It needn't be long but it should be undivided. Maybe a short quiet chat before bedtime, or lunch at a special restaurant. Additionally, when one of the non-disabled siblings is involved in a school or community function, the parents should make every effort to be there, no matter how much advance planning is required. Should the disabled child go, too? Take your cue from the child who is involved in the function - it's his night. Sometimes yes. Sometimes no.

When One Sibling Is Gifted

Different people, including gifted children, have abilities and talents in different areas. Talk openly about this reality with your children so they can begin to develop appropriate expectations for themselves. You can do this by comparing your own strengths with those of your husband/wife or other family members or friends. There are two important points to be emphasized:

1. Don't expect to be great in everything.

2. Recognize and develop those areas of strength you do have. Help your children make similar comparisons among themselves in the hope that they will have a greater understanding and respect for each other (e.g., "My brother gets all A's in school but he can't hit a baseball.").

It's also okay to mention your weaknesses. This can be especially effective if there is something you don't do as well as your non-gifted child (e.g.,"I wish I could make brownies as well as yours.").

Above all, honesty and acceptance are the greatest consideration you can give your children when the ways in which they are like and unlike one another come under discussion.

Some Useful Sibling Conflict Resolution Strategies

Common Mistakes Parents Make in Managing Sibling Rivalry

Taking sides, such as attempting to punish the child who is at fault, (usually the one seen pounding on the other child). How long has this child put up with the taunting of the other child before taking drastic measures?

Ignoring appropriate behavior. Parents often ignore their children when they are playing nicely. They only pay attention when a problem arises. Behavior Mod 101 teaches that behaviors that are ignored (go unrewarded) decrease while behaviors that receive attention (are rewarded) increase.

Simple Parenting Techniques That Work

1. When the sibling rivalry progresses to excessive physical or verbal violence OR when the number of incidents of rivalry becomes excessive, take action. (Action does speak louder than words). Talk with your children about what is going on. Provide suggestions on how they can handle the situation when it occurs, such as:

Ignoring the teasing.

Simply agreeing (in a kidding way) that whatever the teaser is saying is true.

Telling the teaser that enough is enough.

When these measures aren't working, ask the person in charge (parent, babysitter) for help.

2. When the above does not work, introduce a family plan to help with the situation that provides negative and positive consequences for all concerned, such as:

When there is any fighting or shouting, all involved will have a consequence such as a timeout or the temporary removal of screentime.

However, when we can go the whole day or afternoon or evening (whatever makes sense for your situation) without fighting, everyone will earn a privilege such as (1) you can have a snack, (2) I will read you a story, (3) we will all play a game together, (4) I will play outside with you (catch, etc.) or (5) you can stay up later. (Note that several of these provide parental attention for appropriate behavior).

3. Develop a system for evenly distributing coveted privileges. In other words, a system for taking turns for such things as:

Who gets to ride "shotgun" in the car. (It's amazing how many teenagers and young adult siblings still make this an important issue).

Who gets to push the button in the elevator.

Who gets to choose where to go to eat lunch or dinner.

Who gets to chose the television show.

Who does the dishes or takes out the trash (rotate on a weekly or monthly basis).

For more parenting techniques visit Parenting 101. For help in improving your ability to cope with the rigors of parenting, we suggest Stress Management For Parents.

Yes, siblings can create certain stresses, but if they are overcome successfully, they will give your children resources that will serve them well later in life. Siblings learn how to share, how to come face to face with jealousy, and how to accept their individual strengths and weaknesses.

Best of all, as they watch you handle sibling rivalry with equanimity and fairness, they will be gaining knowledge that will be valuable when they, too, become parents.

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The term "sibling" refers to children who are related and living in the same family. Sibling rivalry has occurred as long as families have existed. Think back to biblical times and Joseph's problems with his brothers or of Disney's "Cinderella" and the dreadful experience she had with her step-sisters!

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The Lullaby Trust raises awareness of sudden infant death syndrome (SIDS), provides expert advice on safer sleep for babies and offers emotional support for bereaved families

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When you discovered you were pregnant with another child, your first thoughts probably focused on the benefits a brother or sister would bring to your firstborn - not scenes of sibling rivalry. But tug-of-war toy spats, backseat pinching, and dinner table bickering often go hand in hand with having two or more children.

Helping siblings to get along as they grow up is one of the toughest tasks mums and dads face. To help your children develop close bonds that will last a lifetime follow these six steps to sibling serenity.

Let your children care for one another

Encourage your children to nurture one another: let your older child read a bedtime story to his little sister or ask your toddler if she wants to rub her brother's back before his afternoon nap. Or suggest that your younger child give your older child a kiss when she's crying because she's fallen and hurt herself.

Whenever possible, take a step back and allow them to look after each other. If your three-year-old accidentally kicks his baby sister, rather than run to comfort your crying infant, let your toddler try (assuming she isn't hurt). This way, your toddler will see himself as a compassionate person rather than a troublemaker. And your baby will be able to perceive her big brother as a gentle, caring person.

See each child as an individual

It's not unusual for your kids to ask who you love the most. While it's tempting to tell them you love them equally, the truth is children don't want to hear that - they want to be loved uniquely.

Instead, you might say something like: "You are my only Amy. In the whole, wide world there is no one quite like you."

Another way to help each child feel valued as an individual is to be specific in your praise: "You ate your cereal very well"; "You tidied up your toys like a big boy"; "You were very kind when you shared your cake with your sister".

But be careful not to compare. Nothing breeds resentment like piling on praise at the expense of another child: "Why can't you be tidy like your sister?" or, "Your baby brother has better table manners than you, and you're three!"

Even complimentary comparisons risk stirring up hostility. Your intentions may be good when you tell your toddler: "You're such a big boy dressing yourself - not like the baby." But your older child may become so interested in outperforming his sibling that he'll feel threatened when your baby grows into a toddler who can dress herself.

And try to avoid pigeonholing your children into certain roles, such as the Brain, the Beauty, the Nice One, the Difficult One. Growing children need to experiment with lots of different roles, and you risk ensuring that the Troublemaker becomes forever just that and resents the siblings whose roles he wishes he could try.

Make time for your toddler

A newborn can be all-absorbing, but try to find time when you can be alone with your firstborn - even if it's just a few minutes at bedtime or taking the time to really listen when he's talking to you.

Think of ways you can help your older child not feel left out when you're caring for the baby. If you're about to breastfeed, you might say, "I'm going to feed the baby now. Do you want me to read to you or do you want to rest?" Let your child know you're thinking of his needs, too.

And don't forget to put your older child first from time to time. Once in a while, when the baby is crying, instead of saying, "The baby is making a fuss, hold on," try saying, "Hold on, baby. I have to tie Charlie's shoes." The baby can wait a few more minutes and your older child will see that sometimes he's your top priority.

Embrace conflict

Some sibling rivalry is an inevitable fact of family life when you have more than one child. It's probably unrealistic to expect your children to love and support each other all of the time. Some experts say that sibling conflict is an opportunity for your children to learn the skills they will need in their future relationships.

Help your children understand that it's normal to feel frustrated and upset, sometimes even with the people you love, but it doesn't mean you care about them less. Then you can start to help them find positive ways to express their feelings and work out their differences.

Listen to grievances, acknowledge concerns

Listen to your child's grievances against a sibling rather than dismiss them, and encourage them to listen to one another.

You'll be tempted to play the part of judge ("You're always being mean to your little sister!"), jury ("I take Emily's side because you steal all her toys"), and jailer ("Until you can share your robot with James, go to your room"). But sometimes it's best not to solve the conflict for them.

If you simply listen when your child says how jealous, angry or hurt he's feeling because of a sibling, he'll feel supported by you, which in turn will reduce his resentment toward his brother. You don't have to agree with him. Your role is to be a calm mediator who listens to each child's side of the story so they both feel heard and understood.

Go from conflict to conciliation

Help your children identify their feelings ("You two sound so cross with each other!"), or wishes ("Henry, you really want to play with the fire engine - Sam, you wish you could play with it, too"). Then you can guide them towards a peaceful resolution ("Do you want to pretend there's a fire and play with it together? Or do you want to take turns?").

For your toddler who is stomping his feet and screaming with rage, you can help by voicing what he's feeling, such as: "It made you really angry when the baby knocked down your blocks. Let's find a safe place to play with them so it won't happen again."

If the fighting has already come to blows, separate them and give them a chance to cool off. Then help them begin to start expressing their frustration in a more positive way - through talking, listening and deciding on a compromise.

Last reviewed: April 2008

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Helping siblings to get along as they grow up is one of the toughest tasks mums and dads face. To help your children develop close bonds that will last a lifetime follow these seven steps to sibling serenity. - BabyCentre UK

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How to introduce a newborn baby to a toddler

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How to introduce a newborn baby to a toddler

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Watch parents talk about how they introduced their new baby to their toddler.

Heather: We sort of had been really hyped up like, "Oh, how are we going to introduce them?". We put Iris in her Moses basket and said, "April, there's someone waiting for you in the bedroom", and she walked in and went, "Oh, the baby's here" and walked out again.

Ian: As we got into the hospital we had a present at the bedside, all wrapped up for the girls ready, from the baby. And they were made up, saying, "Oh thank you, thank you", kissing the baby on the head and it was a good gelling point just to begin with really.

Heather: April was two when Iris was born and I think that was one of the things that she didn't quite understand what was going on so it was difficult teaching her, "No you can't just come and scratch the baby." But she learned relatively, well, incredibly quickly really, that the baby was quite precious and just to be really gentle.

Sophia: I think I was quite surprised by Will and Bella's reaction with her actually because I think they thought she was going to be a baby that was crawling around and doing stuff, you know, immediately, and I think that it's been a bit of a shock for them to sort of realise that actually, she kind of just feeds and sleeps and doesn't really do anything else.

Ian: When the youngster was in the cot or the crib sleeping, they used to walk over and poke him, just to get a reaction, even if it was just a cry, it was just a poke to see what's happening.

Natasha: I had trouble with that at first as well, with Izzy always wanting to wake the baby to play and I explained to her many, many times that the more awake the baby was the less time she had with Mummy or Daddy and really drilled that in: "If you let the baby sleep, we can do things like read stories or have games together" and now she's quite good at leaving him alone when he's having his naps.

Sophia: My daughter's had a real wobble of not having the attention of being the youngest and really kind of insecure: "Mummy I want you to cuddle me, you don't cuddle me any more", and "She's always feeding, all she does is feed, she's just going to get fat", and we've had to sort of give her lots and lots and lots of extra attention and just doing things with me and her and, you know, her and Daddy, and really kind of trying to focus on her really, and making her feel secure again."

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How do I introduce my new baby to my toddler? (Video)

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Watch parents talk about how they introduced their new baby to their toddler. Heather: We sort of had been really hyped up like, "Oh, how are we going to introduce them?". We put Iris in her Moses basket and said, "April, there's someone waiting for you in the bedroom", and she walked in and went, "Oh, the baby's here" and walked out again.