Smile for Your Sphincter
What is Sphincter Law? l coined the term, so let me explain. My invention of this phrase was born out of the need I saw for new thinking in the formulation of explanations of how women’s bodies work in labour and birth. I believe that those terms that midwifery has borrowed from obstetrics often provide very little that really helps women—or those who attend their births, for that matterunderstand why so many women’s labours, especially those that take place in hospitals, fail to result in vaginal birth without some form of pharmaceutical, mechanical or surgical intervention.
According to conventional theory, the problem lies in some inadequacy in the woman, as described by the so-called Law of the Three Ps. According to this ‘law’, as explained by obstetric textbook author Derek Llewellyn-Jones as late as 1999, and by countless others, the woman’s ‘passage’ may be too small, her ‘passenger’ too large, or her ‘powers’ (the frequency and intensity of her uterine contractions) too weak, and all these shortcomings are ‘factors which can delay or prevent’ the fetus’ ability ‘to negotiate the birth canal’. To me. this language reads more like an engineering problem than a description of a biological process. This is exactly what [ believe we must overcome.
When I’m explaining labour to a midwifery student or pregnant woman, I would never mention anything related to the Law of the Three Ps. My own reluctance to refer to conventional medical theory arises because I think it explains so little in a practical sense about how birth really works. So why is the talk of sphincters relevant? My argument, of course, is based on the recognition that the cervix, like the opening of the bladder and the rectum, is a sphincter—and, thus functions in ways similar to other sphincters. Sphincters are circular muscles that surround the opening of those organs that are called upon to empty themselves at appropriate times. These openings ordinarily remain closed but have the ability to open as widely as needed when necessary. Their function and character are implicit in their name in the German language: Schliessmuskel, meaning ‘closing muscle’. Each of the organs I have referred to is able to contract rhythmically as it fills, until it reaches the point of urgency at which the sphincter relaxes enough to allow urination. defecation or birth to take place.
The basics of sphincters are worth remembering:
- Sphincters open best in conditions of privacy and intimacy.
- Sphincters don’t respond well to commands, such as ‘Push!’, ‘Poop now!’ or ‘Get ready, get set, pee!’. They are not under our voluntary control.
- Sphincters are shy. Even in the process of opening, they may suddenly close when their owner is frightened or embarrassed. This is because high levels of adrenaline in the bloodstream do not usually favour (sometimes, they actually prevent) the opening of the sphincter.
- Sphincters do respond well to praise, if it comes from a trusted intimate companion or family member accompanying the sphincter’s owner.
- Sphincters open better when their owner’s mouth and jaw are relaxed and somewhat open.
- Sphincters open better when their owner is smiling or laughing.
We all have sphincters, and comprehend in a physical way how our own minds affect our bodies’ ability to urinate or defecate according to someone’s schedule besides our own, in a different place than we are accustomed to be. I would venture to say that none of us tried to balance our cheque books while sitting on the toilet even before we began to use computers for bookkeeping. We can all imagine how easy it would be to be required to poop in the presence of a group of strangers within a certain number of minutes. For many women, the early sensation of pushing feels much like the urge to poop the biggest one of your life. Now think of trying to move a baby outside of your body under less than sympathetic conditions!
This is the challenge women face every day when they are called upon to perform what should be the most intimate act of their lives in surroundings that afford them no privacy. People yell things at them that they would never (at least, with good intent) shout at someone who was trying to relieve herself of anything other than a baby. The problem is, of course, compounded by the requirement that the mother stay in the supine position while pushing. Because there is so little understanding of Sphincter Law by those who create the policies that determine how most maternity wards function, this very real law of human physiology is constantly violated.