Blog Pijnloos bevallen, bevallen zonder pijn, samen met je partner

Painless childbirth, is that possible? | Mom & co

Painless childbirth, is that possible?

Giving birth is for most of you possibly still an unknown territory and therefore very exciting. One of you is looking forward to the birth and the other is reluctant, hesitant or perhaps even afraid. How much pain do the contractions really cause and will I be able to handle this? The promise of painless labour probably sounds very attractive, doesn’t it?

Our image of childbirth

On the social media channels these days we see a lot of “primal”, natural and sometimes painless births. That’s great, but not the reality for everyone. And if that is your image of giving birth, the chances of disappointment are high. On the other hand, there are the negative scenarios from movies or bad experience stories from your environment, but even that does not have to be your reality. Your birth is still in the future and depends on all kinds of elements, which you fortunately can influence.  So in a world full of “birthing extremes”; how do you realistically prepare for your own birth? And when you have fear of pain during birth, how do you deal with that?

The subconscious

How we as humans react to something is controlled 95% (as far as the science now stands) by our subconscious. In everyone’s subconscious there is a memory of all kinds of images and experiences about giving birth. These stored images determine how you react to the phenomenon of giving birth. Is this a positive image? Then there is a much greater chance that you will relax during childbirth. But unfortunately it also works the other way around. If there is fear and tension due to the negative associations you have about giving birth, then you can cramp up during the birth. This is hormonally controlled by the functioning of our nervous system.

The autonomic nervous system

The part of your autonomic nervous system that causes cramping is called the sympathetic nervous system. When this part is activated, the hormone adrenaline goes up. You get into a ‘fight or flight’ situation, as it were. This makes you feel unsafe.  Unexpected circumstances can trigger this in your body and challenge your mindset. Showing flexibility and moving with you from positivity and strength is something we train future parents in during our pregnancy course. Be mild to yourself, and support each other and yourself from what you have trained, and with what presents itself in the moment. You can do this, and you are going to do this together!

Birth hormones

What helps then? Relaxing. This does not mean that you relax in complete surrender as you would in a spa. No, it’s grinding hard. Giving birth is raw. But even here you can move along with the hard work that your body is doing. If you manage to find surrender and relaxation during these extremely physical challenges, the parasympathetic part of your nervous system is activated. This stimulates oxytocin (the contraction hormone) and endorphins. And these two hormones reinforce each other and put you in a positive spiral. The more relaxed you are, the more oxytocin your body produces which makes for better contractions. And when your contractions get more intense, your body starts to produce more endorphins, which cause you to feel confident and relax better. And that’s where the gold is. Endorphins are, in fact, a natural painkiller. It makes the raw edges fade, you have a changing sense of time, and you can go into a fine intoxication. Endorphins create relaxation and confidence, so learning how to stimulate this, even during huge challenges, is very valuable.

Okay, this is what you want when you go into labor. But how?

A good pregnancy course is an essential ingredient if you ask us. Research shows that having knowledge and thus realistic expectations contributes positively to the experience of childbirth. This gives you direction. It’s your body, so you decide. It is not only important that you learn the facts of childbirth during the pregnancy course, but also the combination of knowledge, technique, personal control, breathing exercises and mindset. That whatever challenge presents itself, you, with the support of your partner, can relax and create the right hormones.

What makes you relax?

Therefore it is extremely important to know where you relax. Plough this question out, involve your partner in this, how can he or she support you with this? What things can he or she say to you, for example, and what not? What often helps enormously is warmth. In any form. From a bath, shower, hot water bottle, warm hands to thick socks on your feet.

Light touch massage

There are also special massage techniques, which are also discussed in our pregnancy course, that help your body to produce more endorphins. For example the light touch massage, where you ‘massage’ the back with very gentle touch. By touching the nerves in this area, senses are ‘distracted’ and brain stem and cortex are greatly stimulated. The electrical activity in the brain stem and both hemispheres is then converted to endorphins and helps you get into that intoxication. And so you can get back into that positive spiral of relaxation and confidence.

Affirmations and visualizations

Giving birth demands a lot from your body, you can become stressed, stress causes fear and fear often causes pain. A mental tool to remind you of the fact that you can do this is therefore very nice. Visualizations and affirmations are a powerful tool for this. Because you apply these techniques already during pregnancy, you get direct access to the subconscious and can store words and images that give you strength and confidence. By practicing this often (conditioning), you change your mindset. We want to teach you with our pregnancy course to be one step ahead, through knowledge, mindset and technique.

Give birth together with your partner

And if you are not able to cope on your own, your partner will always be able to bring you to that resting point, with confidence. That is why it is so incredibly important that you feel well prepared together and that you are all on the same page. This is not something you learn in one day, that’s why it is important to practice with the different tools, to increase the positive vibe around giving birth and to learn to relax your body consciously.

In our (online) pregnancy courses we prepare you realistically and teach you which different tools you can use so that you can respond to the birth from positivity and strength. Even if everything goes differently than you had hoped. This can increase your natural high of endorphins, and who knows, maybe you will give birth without pain.

Blog Pijnloos bevallen, bevallen zonder pijn, samen met je partner

De eerste tekenen van de bevalling herkenne

Recognizing the first signs of childbirth | Mom & co

Recognizing the first signs of childbirth

How do I recognize the start of my labour? Good question! A question that occupies many pregnant women and their partners. When will my labor start? How does it start? Has my labor already started? Because a birth is completely unplanned, and something so big is about to happen, it makes sense that these questions run through your head. No one can predict exactly when you will give birth, but there are several signs that labor is near and/or that your body is ready for the birth of your baby.

Descent of your baby.

When a baby descends, it means that the head descends deeper into the pelvis. If the baby is in a breech position, these are the buttocks. At the end of pregnancy, most babies go into decline. One baby does this at 32 weeks, the other at 38 weeks and some even only during delivery. So it doesn’t say anything about when you will give birth, but it is a sign that your body is getting ready for the delivery.

Most mothers notice that a baby descends due to mild pain in the lower abdomen, or stitches that you can feel in your vagina. (Enjoy! ;)) During the consultation, your midwife will feel for the descent with her hands on your stomach, and tell you whether a baby is already fixed or still mobile in the pelvis. A descended baby can push your bladder quite a bit, so if you don’t already go to the bathroom 453 times a day, you often do now.

Messing around / contractions.

“I messed up a bit last night.” A well-known saying, but what does it actually mean? At the end of the pregnancy, your uterus may have some practice contractions. This is different from hard bellies. Hard bellies are painless and can be experienced a little earlier in the pregnancy, for example after a busy working day. Innocent, as long as you don’t have them too often. Front contractions feel more like a small contraction. They are often somewhat irregular and last a short time. You sometimes have to sigh them lightly and after a while they disappear again. They often make the cervix a bit soft, and can sometimes even cause a little bit of dilation. Pre-contractions do not always subside, because they can also become stronger and more regular, and eventually continue into ‘real’ contractions: good news! You are going to give birth.

If you’ve ever given birth, you usually “mess up” a bit more than someone who has never given birth. Sometimes this can make you a bit restless because you wonder ‘Is this it?’ Trust yourself and your body. When contractions become more regular, stronger, and last longer, you will feel the difference and automatically focus more on the contractions and your breathing. Read here about the five different stages of childbirth.

Expiration and softening of the cervix.

Your cervix is a round closure of your uterus that looks a bit like the nozzle of an inflated balloon. In pregnancy it is hard, stiff and 3-4 cm long. At the end of your pregnancy, it can soften somewhat, or become soft. In addition, a cervix can elongate, meaning it shortens. For some this happens during pregnancy, for others during the beginning of labour. The opening of the cervix is called dilation. You can only find out through an internal examination where the cervix is felt. Please note; it says nothing about when you are going to give birth, there are ladies who sometimes walk around for a week, or even longer, with an expired cervix that is even a bit open. That is why your midwife does not do an internal examination without reason when you are heavily pregnant, this often only causes unnecessary unrest.

Losing the mucus plug.

The word mucus plug may sound like a cute jelly-like plug, but nothing could be further from the truth. It is a thick and tough piece of mucus that is in your cervix. It forms the closure of the uterus and thus serves as a protection. You lose the mucus plug at the end of the pregnancy or during labor, and there is no reason to call your midwife. It often comes in parts, so don’t be alarmed if you occasionally find some mucus mixed with a little bit of blood in your underpants. It is normal that when you lose the mucus plug, it takes a few days or even longer before you go into labor. No worries, the membranes also protect the baby and it is completely normal!

Diarrhea.

Well, those intestines often make themselves heard just before you give birth, or during the start of your birth. In this way, your body clears your metabolic system so that space is released and all energy can go to the uterus. So don’t be alarmed if you have to go to the toilet a few times at the beginning of your birth, or even vomit once: tidy is neat and your body is ready for the ‘real’ work.

Break your waters.

Waters can break before you have contractions, or when you are already having contractions. There are women who feel a ‘pop’, but usually it is characterized by the fact that you continuously lose small amounts of fluid that you cannot stop. The big splash from the film occurs but is seen less often. If it happens during the day, let your midwife know. If it happens in the evening or at night, you put a maternity bandage from the maternity package (such a very large one) in your underpants and try to go to sleep further / early. You call the midwife as soon as you have regular contractions or you let them know in the morning.

The clarity of the amniotic fluid is important. Amniotic fluid that is clear as water, with white flakes, or pink in color is called clear amniotic fluid. If it is green or brown, then the baby has pooped in the amniotic fluid and you should call your midwife 24/7.

As you can see, there are a lot of signs on your body that indicate that it is ready for birth, or may even begin any moment. Keep in mind that these are all omens, and it might as well take a while. When exactly you will give birth is a question that you can only answer when you actually give birth. And that’s a good thing, because not knowing when your baby is coming is part of the magic of the whole birth process.

If your labor does not start on its own and you are about the due date, it might be interesting to read our blog about inducing the birth yourself.


These are the five different stages of childbirth | Mom & co

These are the five different stages of childbirth

It is an unknown phenomenon that childbirth consists of different phases. Some people see it as one long event, and sometimes see the delivery as “very long” while that may not always be the case. Every phase is different and they all have their own function. In this blog we take you through these different ‘birth phases’.

Phase one: the latent phase

The first stage is the latent stage. The big question that comes with this phase is: is it really going to start now? Because in most cases this phase starts with irregular contractions, only 10% of the deliveries starts with the water breaking.

What exactly is a contraction? A contraction is a contraction of the uterine muscle. The contractions often build up slowly, first about every 15, then every 8 and after a while every 5 minutes. Moreover, the latent phase can differ quite a bit in duration. There are women who have irregular contractions for hours, which we also call ‘rumbling’, and sometimes it happens that you get contractions that are already regular and fairly intense. In them, the latent phase will therefore quickly change into the active phase. There is also a difference between women who give birth for the first time and those who have given birth before.

In the latent phase, the cervix will soften and expire. This means that the cervix becomes softer and shorter. When that has happened completely, dilation can arise. In the latent phase you reach about 3 cm dilation.

What can you do best during this phase? Relax! Watch a nice series, do a relaxation exercise, take a shower or bake an apple pie for the midwife 😉 Look for as much distraction as possible when the contractions are still irregular and not so intense. If you are already fully focused on each contraction, the labor will only take longer for you. The partners are also allowed to take their rest during this phase. And if it’s nighttime, go to sleep!

Phase two: the active phase

And then you feel it changing, gradually or suddenly: it becomes more intense. The realization that it has now really started comes in slowly and ‘phew, that last contraction was pretty tough’, and exactly 5 minutes after the last one. Welcome to the active phase.

The name says it all: you are actively giving birth. At this point you are already at least three centimeters dilated, the contractions come every 3, 4 or 5 minutes and last an average of one minute. The intensity of the contractions and the dilation will increase. On average, a woman gains 1 centimeter of dilation per hour with a first child, with a second birth it will all go a bit faster.

Everything is now a bit more spicy, because your body is now going to do all kinds of things, such as the production of endorphins. This hormone has a pain-relieving effect and ensures that you get into a sedation and become more inwardly focused. Endorphins work closely with oxytocin, the hormone that causes contractions, among other things. These two hormones reinforce each other: when you make more oxytocin, you get more and better contractions, so your body produces more endorphins so you can relax more. And when you relax more, your body can make more oxytocin and you get better contractions. Isn’t this system beautiful? And your body does it all by itself.

In this phase, your baby descends deeper and deeper into the pelvis, and turns with his or her head in the correct position to be born. The skull seams of the baby slide a little over each other, this is called moulage. It makes the cross-section of the head smaller and it fits better through your pelvis. A wonderful trick of nature! During this phase, and sometimes towards the end of the latent phase, you may feel nauseous or have problems with your bowels. Don’t be alarmed if you have to vomit a lot or if you get diarrhea. This is another nice trick of your body: your body works everything out so that all the attention and energy can go to your uterus.

Phase 3: the transition phase

The active phase lasts until the pressing phase starts. But just before you start pushing, you also enter a transition phase.

This phase is described by most women as the most intense phase of labor. You are about 9 cm dilated and the contractions come every 3 minutes. You may be nauseous and your lower back may be hurting because the baby is pushing on your tailbone.

Because you are now moving towards the pressing phase, your body produces the hormone adrenaline. That will give you extra power for pressing. But the adrenaline decreases the production of endorphins. You will become a bit clearer, so that your experience of pain changes   and you feel the contractions more. So it gets a little tougher.

Right now it is very important that you keep a positive mindset. And that is sometimes really difficult since you have of course worked hard for a long time. As a partner you can now really play an important role by providing continuous and positive support. This phase lasts on average a maximum of one hour and moreover: after this you can push, your baby is almost there!

Phase 4: the pressing phase

For the pressing phase you need to be 10 cm dilated, in other words, fully dilated. The cervix has been pushed back and is no longer in front of, but around the baby’s head.

From this moment on you will get contractions, also known as reflex pressure. Those are muscle contractions of your uterus that are unstoppable. It’s similar to when you have to throw up, there’s no other way! As your baby descends deeper and pushes on your rectum, the urge to push feels like you need to poop. That feeling sometimes takes some getting used to. Know that it is normal and it is a positive sign that the first real meeting with your baby is going to happen really soon.

During the pressing phase, you push along with these contractions, doubling your strength. Your uterus and you squeeze together. When you give birth for the first time, you squeeze an hour to 1.5 hours on average. If you have given birth vaginally before, this usually goes a lot faster.

You push until the head is standing, and thus almost born. This is the moment that your midwife will coach and guide you more intensively. To prevent tearing, it is important that this moment does not go too quickly. Pretty intense, but remember here again: the baby is almost here! So when you feel a burning sensation, from now on you think ‘come on baby’. Your baby will be born in the next or second contraction that follows.

Phase 5: the afterbirth phase

And then… Your baby has been born and lies comfortably on your bare chest. Then only the placenta will follow. We always have the umbilical cord knocked out, because there is still blood flow with oxygen-rich blood from the placenta to the baby. As soon as the placenta releases, this blood flow stops, the umbilical cord is cut (unless you want a *lotus delivery) and the placenta will be born with 1 or 2 more pressings.

A very nice fact is that the placenta has developed from the fertilized egg as well as a baby, and that the placenta has ensured that your baby grew and was safe. A beautiful and brilliant system.

If it takes longer for the placenta to arrive, or if there is extensive blood loss, your midwife may advise you to give synthetic oxytocin an injection in your thigh (or through the IV if you already had an IV). This ensures that your uterus can contract better, allowing the placenta to detach more easily. Synthetic oxytocin can also be used after the birth of the placenta so that the wound is closed better and you therefore have less blood loss.

What makes this final birth stage very special is that during this process you, as new parents, are falling in love with your beautiful baby.

* In a lotus delivery, the umbilical cord is not cut, but the baby remains attached to the placenta, until it falls off on its own after about a week. A half lotus delivery is also possible, where you cut an umbilical cord after the birth of the placenta at a chosen moment, for example immediately after the birth of the placenta, or a few hours later.

Written on behalf of ouders.nl.


Induce childbirth yourself | Mom & co

Induce childbirth (yourself)

You have passed 40 weeks of pregnancy, the due date seems like an eternity ago. Maybe you still feel fit and you think it’s cozy, your little one so warm in your belly. Meanwhile, your phone is overflowing with sweet intended apps (“And and and!?”). You probably totter like a penguin and break out in a sweat just thinking about a walk to the appie. But of course you are also very curious about that mini-human in your belly! It is also not surprising if it is now a bit more difficult to keep a positive mindset. How are you holding up this last period? And what if you pass 42 weeks? And finally: what tricks can you use to induce labour?

The art of relaxation

Inducing labor is only possible through rest. To get your body into the right flow during that last period of pregnancy, it is important that you relax. Then the parasympathetic part of the nervous system becomes active. Your heart rate is somewhat lower, more oxygen-rich blood goes to your uterus and your body produces the hormones oxytocin and endorphins. And that is exactly what you need to prepare your body for childbirth. Let me explain this: When you are stressed, the sympathetic part of the nervous system is activated. Your body produces adrenaline and sends more oxygenated blood to your extremities. We call this the ‘fight or flight mode’, a legacy of our early ancestors. If you’re about to give birth, you’ll want to avoid that mode. So relaxing is the most important. That’s easier said than done, which is why you need to learn the art of relaxation. Be the first to realize that you can and can relax, so take advantage of this period! He is for you. Even if you think that an errand or some work is going well, make sure to relax. Empty your calendar and get a massage. Go floating or walk in the woods. Listen to a podcast or beautiful visualizations. And take naps during the day! Trust me, do it! You can only induce labor if you take enough rest.

Foot reflexology massage

Inducing childbirth can also be done by means of a foot reflexology massage. You have a number of pressure points in your body that could potentially induce contractions, including in your feet. You can therefore induce childbirth by means of a foot reflex massage. Book a foot reflex massage somewhere near you. If you want to work at home, or if you want to put your partner to work, you can massage the feet on the inside, about 2 cm below and behind your ankle. In addition to stimulating the pressure points, it is also great for relaxation. So whether it induces contractions or not, this is great anyway.

Dancing, moving, walking

Exercise is always good, both during pregnancy and during childbirth. During labour, exercise can even make labor go faster. To induce labor, go for a walk, cycle or put on some feel-good music and go dancing. Also very good for the happiness hormones!

Sex? Now?

Sex may not be the first thing that comes to mind in late pregnancy, but it just might trigger labor. Sperm contains the hormone prostaglandin, which softens the cervix and can induce contractions. It is important that you do not have sex with broken membranes, or at least do not insert anything into your vagina. A female orgasm also causes uterine contractions, which may be just that last push to induce labor.

Nipple massage

An important hormone is therefore oxytocin. It not only causes uterine contractions but also milk production. As your body is getting ready to breastfeed, it will produce oxytocin when the nipples are massaged or stimulated. So you can also try.

Stripping

No, don’t put Marvin Gaye on and undress. I really mean something else. Stripping is in this case done by the obstetrician and means loosening the amniotic membranes that are stuck to the uterine wall. The obstetrician can do this by means of a vaginal toucher in which she loosens the membranes with her fingers through the cervix between the membranes and the uterine wall. This is only possible if the cervix is ​​slightly open. Stripping is usually done after 41 weeks and is a very effective method of inducing labour.

To wait or to initiate?

It is best if labor starts on its own. When your body initiates it itself, it follows the natural path, which reduces the risk of complications. When you initiate labour, your body is not quite ready for it. The chance of medical interventions is then greater. Think of administering extra oxytocin or pain relief and possibly eventually an artificial remission. If there is no medical reason to induce labour, it is often best to wait and see. So make sure you can flip that switch and be patient. Try to enjoy those movements in your stomach, provide distraction, positive energy and let yourself be pampered a little. This is the time to be kind to yourself.

41 and 42 weeks and no baby yet

In the Netherlands, a large study (Index-trial) has been conducted into the results of induction at 41 weeks or waiting until 42 weeks. In this study of 1800 pregnant women with an uncomplicated pregnancy, hardly any difference was found between the two groups. What can you expect in these last days of pregnancy? In the 41st week an ultrasound will be made, which will look at the placenta, the amniotic fluid and the condition of the baby. If everything looks good and there is therefore no medical reason to induce labour, you can choose the next step: wait and see or induce labour. It is important that you know what the advantages and disadvantages of induction are and that you can make a well-informed decision. The midwife will often advise you to strip and follow the other tips described above to maximize the chance that your body will give birth on its own.

From 42 weeks it is often decided, in consultation with you, that an introduction is best. Good to know is that this is not mandatory. Does this not feel like the right choice for you and is there no medical need for induction? Then discuss it with your healthcare provider. If an induction is nevertheless decided on, this means that the birth will take place in the hospital under the supervision of the hospital’s obstetrician or gynaecologist.

Let’s be positive: at the end of this ride you will have a beautiful baby in your arms. Think about that, believe in yourself, trust your body and know that there is a power within you that you may not have even felt. And relax. Relax during your leave, during those last stretches, but also relax during pregnancy. you got this!

Written by Aline on behalf of ouders.nl.


10 things you as a partner do not say to your wife during the birth | Mom & co

10 things you as a partner do not say to your wife during the birth

We all say awkward things in times of stress. Partners during the birth of their baby have a hand in this.

Of course they often mean well, but at times like a birth it can go just as wrong. Even if you prepare well through a pregnancy course with, for example, hypnobirthing, it is quite normal that you still have some healthy tension in your body, and maybe you say the wrong things. Well gentlemen and ladies, here’s a list of the things you absolutely must not say during childbirth.

1. There has never been one left.
Is this really still used? Of course. With only good intentions behind it. What you as a partner are actually trying to say with this is ‘this will pass’. It is simply not helpful at all during birth that millions of women have already preceded you and above all; that they have already given birth and you have not yet. Tip: adjust the pronunciation slightly, with the same good intentions. For example, ‘You’ve come a long way, you’re doing great’.

2. And this is just the beginning.
At the first resting point of Kilimanjaro you don’t say ‘the hardest kilometers are yet to come’. This makes no one happy, and it gives citizens anything but courage. ‘YES it has started, today our baby is born’ already sounds a lot more positive.

3. Pooh, how tired I am.
If the three of you want to go home together as a happy family, I would keep this one for you as a loving partner.

4. I’m going to order pizza, would you like something?
During birth, women basically eat almost nothing. In addition, they have a highly developed sense of smell. They smell eaten garlic cloves 3 days away. There is a good chance that you will be outside on the balcony with your pizza 5 minutes after receipt. So do everyone, especially your wife, a favor and spread a sandwich with cheese.

5. I will let the midwife know that you are having contractions.
Pre-contractions, the word says it all. These are the contractions at the very beginning of a labor, or even before the birth. Calling with pre-contractions doesn’t make much sense. It can then take quite a while before the birth really starts. So look for distraction and don’t focus on every cramp you feel. In addition, your midwife’s calling instructions are made for a reason. If you are not worried, you do not need to inform your midwife about pre-contractions. You may wake her up when she can’t do much for you yet. Front contractions can subside again, a shame if you then gave a false ‘green light’. In this situation you wait quietly, and possibly go back to sleep. Kisses and kind words are of course always very welcome.

6. Name your own physical complaints.
When you’re in labour, you have little empathy for your partner’s sprained ankle or stiff neck. So even if your football knee hurts or you have some back pain because you have been sitting in the same position for a long time, grab a paracetamol in silence and continue ssst..

7. Can the light be turned on?
Yes you can, in another room. Often women like dim lighting when they are in labor. This gives them a little more chance to ‘dive’ into the contractions. You weaken a sense, so you are more focused on what is happening in your body, you can turn more inward. So if you as a partner need light to complete your Sudoku puzzle, you either do that somewhere else or you save it for another time. If you need a distraction, try a gentle massage technique on your wife, because that way she makes extra endorphins to get more into her ‘birth bubble’. She will surely be very grateful to you.

8. Do you think I can go to the office tomorrow?
It is very logical that when you are not giving birth yourself, there are still all kinds of practical arrangements in your head. If you ask your girlfriend these kinds of questions while she is in labour, you have a chance that you will get her out of her ‘birth bubble’, and that is exactly what you don’t want to do. I would like to give you the answer to the question whether you can go to the office tomorrow: ‘No, you can’t go to the office tomorrow’.

9. Will it be okay again?
Jokes about a vagina are forbidden for at least a week after giving birth. The vagina itself for a bit longer, by the way. During childbirth you can imagine that there is pressure on the vagina and pelvic floor muscles, which can cause swelling. In addition, it may also be necessary to stitch. Know that a swelling subsides, and that stitches heal. So the answer to the question is, “YES, it’s going to be okay.”

10. Ajax is 2-0 behind.
The fact that you are looking for some distraction during (the beginning of) the birth does not have to be something bad for both of you. An exciting football final, on the other hand, increases adrenaline. Adrenaline inhibits oxytocin and endorphins, which are just the substances you need as a woman during childbirth. So if you would like some distraction, opt for a romantic Netflix comedy, okay, not comparable to Ajax, but good for the atmosphere during childbirth.