Your amazing uterus!

‘There is no other organ quite like the uterus. If men had such an organ they would brag about it. So should we.’ Ina May Gaskin, midwife

At the end of pregnancy the uterus is the one of the largest organs in the human body. Weighing about two pounds it is fifth after the skin, the liver, the heart, and the brain. It is the strongest muscle in power to weight ratio. Yet one week after giving birth it has already halved in size and by the end of the second week it weighs only 0.3lbs.

The uterus has a unique property, not found in any other muscle. As we all learnt in school, muscles contract and then relax, and when they relax they return to the same shape and size as before, except, that is, for the uterus in labour. In labour the muscle fibres contract and relax, but when they relax remain a little bit shorter and a little bit fatter. As labour progresses this has the effect of pulling the cervix (the neck of the uterus) up and around the baby’s head. This is the slow work of the first, and longest, part of giving birth. It also means, by the end of this stage, the muscles are concentrated towards the top of uterus, ready to push the baby down in the expulsive phase of labour.

Giving birth is muscle action!

Now you wouldn’t go and run a marathon without putting in some serious training. But guess what, that is just what your uterus does for you, automatically. From about seven weeks of pregnancy, the uterus practising contracting and relaxing several times every day. That’s what Braxton Hicks’ contractions, or practise contractions, are all about. (The inimitable Sheila Kitzinger used to point out that they may be named after Braxton Hicks but they are not his, they are yours.) Now, not everybody notices their Braxton Hicks’, and if they do they notice them at different weeks. It is not uncommon for women having their first baby not to feel any till very late, if at all. Generally the more babies you have the earlier you feel them; with my fifth I noticed them at 17 weeks. Whether you feel them or not, they are still doing the training, still growing as strong and ready for labour.

Thinking about labour as muscle action can help you cope with the waves of contractions. We all know a bit about how muscles work, and what helps them, even if we have done nothing more than watch the London marathon while eating our body weight in chocolate.

1. Be relaxed. Tight muscles don’t work so well, are more likely to be damaged, and hurt more. Athletes, singers, horse jumpers, all know their muscles work best when they are relaxed and ‘in the zone’. Be the uterus! They all have their techniques, whether it is visualising, distraction, focusing on something. In an interview marathon champion Paula Radcliffe talked about counting to sixteen over and over through last few miles. Midwife Mary Cronk recommends women ‘go saggy with the contractions’.

2. Breathe. You hear marathon runners, yoga peeps, and even weight lifters, talk about keeping their breathing slow and steady, breathing into the moment. Keeping your breathing steady, not holding your breath, nor breathing too fast, means oxygen is getting to your muscles. Muscles need oxygen, or they cramp. Marathon runners call it ‘hitting the wall’. Ouch! The simple trick of focusing on your out breath, breathing out in a rhythm, can make a huge difference to the discomfort levels. If you focus on your out breath you will automatically breathe in; but if you focus on your in breath you might hold your breath.

3. Drink. We can all picture marathon runners grabbing their drinks as they run past the tables of water. Being hydrated means the uterus can work well, with stronger and longer contractions, and be less painful. This is really important in hot hospital rooms. I have seen the difference a drink can make to women in how they are coping and to get contractions going again. This is a job for your partner, to offer you drinks regularly; and then to encourage you to go to the loo too.

4. Eat. Labour lasts a long time. Muscles need fuel. Follow your instincts. In early labour, or when you think this might be it, stock up on carbs and protein. Later on you will probably not feel like eating much so tiny mouthfuls of date energy bars, pieces of chocolate, bites of toast, or even yogurt or honey on a spoon. Again, your partner can regularly offer bits straight to your mouth. Bananas are great too, for you and for marathon runners. I always grab some on my way out to a birth. There is never a reason not to eat. Twenty years ago women were told not to eat in labour, in case they needed an emergency caesarean under general anaesthetic, and then were sick and then aspirated. Then someone point out (i.e. published research) that women were more likely to end up with a caesarean if they didn’t eat, and that aspirating during general anaesthetic was very rare, and that very few labouring women have a caesarean under general. However, women who are considered higher risk, or whose risk changes in labour, are often still advised not to eat in labour (the word ‘allow’ may be used). However it is your choice to eat or not. Withholding food against someone’s wishes is against the law. It is your risk to take, balancing it against the risk of not eating. It would be worth putting a note in your birth plan to that effect.

5. Warmth. Muscles love to be warm. Warm water soothes. With my third, I was drying my six year old daughter’s hair, and when a wave came, I found moving the hair dryer back and forth over my belly took the edge off the sensations. Just be wary of heat packs that could burn your skin.

6. Massage helps muscles to relax and work well. Massage during or between the waves can be wonderful. Partners are very useful. Practise in pregnancy so you can guide them to the speed, strength and placing of their strokes.

7. Mental prep. All athletes do mental prep whether affirmations or visualisations. It works for them, it will work for you.

8. Support. All athletes have a team around them. Giving them encouragement and practical support. As well as your partner, consider a second birth partner, your mum, sister, friend, or hire a doula.

In all the information about giving birth we’ve forgotten to talk to pregnant women about the uterus as a muscle. So much about giving birth is taught to women in terms of what can be measured from the outside, e.g. how long the waves are lasting, how many cms dilated. Combine this with the view of the woman as a passive recipient of care, and we have stopped talking about what birth feels like from the inside. Birth is seen as something ‘other’, something for which we have no experience or knowledge to bring; an ordeal to endure, or to medicate and remove ourselves from it. Yet women have knowledge about their body, about how muscles work. Their partners have skills and things they can do to help.

Labour is POWERFUL. The power of the uterus, the waves of muscles contracting, can feel overwhelming. But it comes from with in you. It can never be more than you, because it is you. The decision then, is to fight it, or to use what you know, and ride the wave. True girl power.