The She Births® antenatal education program has been scrutinised in large randomised controlled trials over the last 4 years. The results were finally published in the British Medical Journal in July of this year.
The effectiveness of She Births has been shown to have a solid foundation in scientific research
The study was conducted by Western Sydney University and the National Institute of Complementary Medicine and the She Births® program was chosen because it incorporates more complementary medicine modalities than other childbirth courses with private normal birth rates shown to be high (83%).
This is the first time a study on birth education has shown such significant results. There is now great potential to positively change the way women and critically their partners prepare for birth around the world.
Our Post Birth Survey 2015 results show that:
- 70% of She Births® mums have a natural vaginal birth
- 17% have a c-section (12% emergency and 5% scheduled) compared to a national average of 33%
- 13% have an epidural compared to 34 – 43% in the public sector and 58 – 66% in the private sector
- 14% are medically induced compared to a national figure of 39% and private sector rate of 50%
The effectiveness of She Births® comes from the synergy of elements but also the unique philosophy and background of creator Nadine Richardson – prenatal yoga teacher, mother, doula and daughter to an extended family of doctors and specialists. The course is founded in Vedic or yogic wisdom and yet is made easily accessible to people from all backgrounds, professions, ethnicity and socioeconomic groups.
It incorporates a unique language and referencing to the ‘pain of childbirth’ and a sequencing that allows a deep transformation for every couple that attends. She Births® also includes a new from of self-hypnosis called BMIT – Body-Mind Integration Technique (created by Nadine Richardson and based on the ancient art of yoga nidra) and helps to dispel not only the fear of pain but also the fear of medical assistance should that be required.
“98% of She Births® mums say that our program allowed them to: Create a beautiful birth, no matter what unfolded. This is the statistic I am most proud of. The comprehensiveness of the She Births® toolkit combined with a new attitude towards birth is what creates our dramatic improvement in birth outcomes.
A reductionist approach to birth education or a course that delivers only the ‘complementary medicine tools’ in my opinion would be dangerous and prove ineffective in comparison. Women have been accessing complementary medicines for many years throughout their pregnancies but not able to ‘connect the dots’ and apply this ancient wisdom across to birth.
Through the unique She Births® process, led by an experienced teacher a deep transformation can take place within every couple, that fosters both a sense of trust in birth and a security in each other. All of these factors are critical to creating a more natural and beautiful birth experience, but also in creating the foundation for a stronger and more resilient family going forward.”
Individual techniques proven to make a difference to birth outcomes:
Proven to decrease the duration, discomforts and complications of labour.
(Chuntharapat S, Petpichetchian W, Hatthakit U. Yoga during pregnancy: effects on maternal comfort, labor pain and birth outcomes. Complementary Therapies in Clinical Practice. [Randomized Controlled Trial Research Support, Non-U.S. Gov’t]. 2008 May;14(2):105-15.)
Smith et.al. (2010) has reported in the most recent Cochrane Review of acupuncture and acupressure during labour that pharmacological analgesia was reduced in one trial of acupuncture compared with placebo, and compared with standard care. That fewer instrumental deliveries from acupressure was found compared with standard care and that pain intensity was reduced in the acupressure group compared with a placebo control and a combined control.
One of the most significant outcomes of childbirth occurring more frequently in a hospital setting, with increased emphasis on monitoring and medical management, is that women have become required to lie in a recumbent or supine position to accommodate these changes. The bed often became the focal point of the room, with little other space for walking or changing position (*Simkin PP, O’Hara M. Nonpharmacologic relief of pain during labor: systematic reviews of five methods. American Journal of Obstetrics and Gynecology. [Review]. 2002 May;186(5 Suppl Nature):S131-59.).
Much of the monitoring devices are now designed for ambulation and emersion in water, so even if a woman is being continuously monitored, she will still be able to walk, move, squat and get in the bath or shower. Roberts et.al. found thatchanging position every 30 minutes or so, was important for the promotion of efficient uterine contractions (**Roberts JE, Mendez-Bauer C, Wodell DA. The effects of maternal position on uterine contractility and efficiency. Birth. [Research Support, U.S. Gov’t, P.H.S.]. 1983 Winter;10(4):243-9.).
In a systematic review by Simkin and O’Hara, researchers found that studies reported that women who laboured in an upright position, compared with those who remained in a supine position had reduced length of first stage labour, required less augmentation and used less pharmacological pain relief (*). Additionally, the strength and efficiency of each contraction was more enhanced by the upright position (**).
A 2004 Cochrane Review found that women who laboured in an upright position had a shorter duration of labour and reported less severe pain during labour, when compared with those who laboured in a supine position.
Continuous labour support
Continuous partner support is an important component of the birth education course. While Simkin (*) describes continuous partner support in terms of a doula or other trained layperson, partners who are not trained can be empowered through education to provide this kind of support for the labouring woman.
Simkin showed that continuous labour support provides enhanced pain management, among other outcomes. The researchers found that the effects are greater for low-income women who are not accompanied by a partner or family member than among middle-class women who were thus accompanied (*). Copstick’s (1986) study noted that there was a decreased use of epidurals when women had consistent partner support throughout labour (Copstick SM, Taylor KE, Hayes R, Morris N. Partner support and the use of coping techniques in labour. Journal of Psychosomatic Research. 1986;30(4):497-503.).
Breathing, relaxation & massage
Breathing techniques, such as those used in Lamaze training were the forerunners to today’s antenatal education concepts. (***Brown ST, Douglas C, Flood LP. Women’s Evaluation of Intrapartum Nonpharmacological Pain Relief Methods Used during Labor. J Perinat Educ. 2001 Summer;10(3):1-8.). Simkin reports that the majority of classes and books demonstrate relaxation techniques combined with rhythmic breathing patterns which have the purpose of complementing the relaxation techniques or methods of distraction. Importantly, they are also used to enhance a woman’s sense of control (*). Women in the Brown study reported that breathing and relaxation were the main techniques used, and that breathing techniques were the most effective pain relieving technique during labour, followed by relaxation, acupressure, and massage (***).
In Simkin’s review, breathing techniques have the effect of decreasing anxiety and fear, while providing reassurance to the woman. It increases a woman’s sense of control, reducing pain perception and provides distraction from attention on pain. Additionally it cues rhythmic activity and rituals useful for labour (*).
In the context of obstetrics, hypnosis is found to decrease length of labour, lower pain scores and decrease use of pharmacological pain relief and instrumental deliveries (Huntley AL, Coon JT, Ernst E. Complementary and alternative medicine for labor pain: A systematic review. American Journal of Obstetrics and Gynecology. 2004;191(1):36-44.). Guided imagery for labour and childbirth aims to effect labour by reducing stress and thereby decreasing the aforementioned. Evidence based research is scarce for imagery in labour, but the effects outlined above in other areas of medicine for pain reduction is significant and generalizability is feasible and plausible.
Knowledge is one of the greatest ways to overcome fear. And the specific knowledge given to women on the hormones of birth(Buckley S. Undisturbed birth. Nature’s blueprint for ease and ecstasy. Midwifery today with international midwife. [Review]. 2002 Fall(63):19-24.) and the influence that either moderating or alleviating stress can have on enhancing the effects of labour hormones for efficient and natural birth.
Women given information about these hormones, when and how they are released, the effect they have on the body (Fear-Pain-Tension Cycle) and how to enhance their effectiveness during labour is highly important.
In general, complementary medicines known to have an effect on stress hormones have an enormous potential for reduction of stress, anxiety, tension and therefore pain during labour and birth (Hodnett ED. Pain and women’s satisfaction with the experience of childbirth: A systematic review. American Journal of Obstetrics and Gynecology. [doi: DOI: 10.1016/S0002-9378(02)70189-0]. 2002;186(5, Supplement 1):S160-S72.).
Effects of continuous labour support are positive and all women should have continuous support during labour and birth. For maximum benefit, such support is best provided by women who are not hospital employees and who can focus exclusively on support for the birthing woman. Support should ideally begin early in labour.
Analysis of 15 trials involving 12,791 women (see below for details) showed that women with continuous labour support were somewhat more likely to have a smooth vaginal birth without need for a forceps or vacuum-assisted vaginal delivery, or a caesarian section, and were less likely to use analgesia and anaesthesia. They were in general more satisfied with the birth experience and were less likely to report low level of personal control during labour and birth. In a North American trial, labour support was associated with a slight decrease in use of electronic fetal monitoring.
The women with labour companions used comparable levels of artificial oxytocin, reported comparable levels of severe labour pain, and had similar length of labour and degree of perineal trauma (damage to the muscular area between the vagina and anus) as women without labour companions. No clear differences were found for the newborn baby.
There seemed to be a dose-response effect of labour support (that is to say, labour companionship improved the labour experience most when it was of longer duration). The greatest comparative benefit was in settings where it began early in labour, when the provider was not a hospital staff member, and when epidural analgesia was not routinely available. Labour support provided by a hospital staff member was not as effective in lowering operative birth rates. (http://cam.cochrane.org/labour#position_labour)
To understand more about what is best for your birth please read the Cochrane Complementary Medicine Library of reviews and studies here: http://cam.cochrane.org/labour