Dilation Dilemmas: Conner’s Birth Storyhttps://bornstroppy.files.wordpress.com/2013/02/alana-and-family.jpg?w=287

Here is a lovely birth story, a home water birth where the mother laboured instinctively, but, as Senior Midwife Christian Howarth reflects afterwards, one wonders how helpful it is to tell a woman how far she is dilated.  Does she need to know  when her real question is ‘how much further?’

See what you think:

My husband Chris and I had decided from quite early on in my second pregnancy that we wanted to have the baby at home. My first pregnancy, labour and birth had been fine and so was my second. At our 20 week scan we found out that our eldest son Dylan (now 3), would have a baby brother who we decided to call Conor.

I had started having BraAlana birthpoolxton Hicks a few weeks before labour started and a few false alarms! We couldn’t believe how different this was from the first time. We had arranged to hire a birth pool which we got while the Olympics were on and Dylan and I would have an evening soak in the birth pool whilst watching the highlights of the day! As I had a lot of lower back ache towards the end of the pregnancy, the birth pool was a godsend and good fun for Dylan too! We also felt it was very important for him to understand that his baby brother would be born at home in the birth pool.

I decided to go for a pregnancy massage a few days before my due date. As I was paying for the massage, I had quite a strong pain but thought nothing of it as I had been having such powerful Braxton Hicks. When I got home from having the treatment, the contractions started. It was 3pm on the Friday afternoon of the Bank Holiday weekend. I decided that I would see how regularly the contractions were coming.  They didn’t stop and so I decided to call Chris to tell him to get home. He wasn’t answering his phone so I called my mum (who had finished work that lunchtime and started two weeks of annual leave) and asked her to come. Mum was always going to come and pick our dog Sasha up and take her up to her house but at that point we didn’t realise that she would be in charge of filling the birth pool up in Chris’ absence! Because of the false alarms I had been having, I received a text from Chris explaining he was in the middle of carrying out some training for one of his clients and what was the matter! He soon set back home when he realised that the baby was coming though!

I then called my in-laws who were looking after Dylan and explained that they might want to keep Dylan at their house for the night and rang BRI to explain that I was in labour and wanting them to inform the midwives on call that I was in labour.

I had been attending pregnancy yoga and relaxation classes and so was just breathing through the contractions whilst burning jasmine and clary sage in my oil burner and staying upright. I found swaying my hips really helped and I loved the TENS machine! I knew the contractions were getting closer together and lasting for longer so I rang BRI to ask them to let the midwives know I wanted them to come out. This was about 530pm. They told me to take some paracetomol for the lower back ache which I did.

The midwives arrived about 630pm and took time to read my birth plan while they had a cup of tea. We were chatting and I was still wandering round and pausing to have contractions and resting on Chris for a good hour or so. I then felt that the contractions were getting more intense and I asked the midwife to examine me to see how dilated I was. When I was told that I was 4cms dilated I felt quite concerned and was wondering how else I could speed things up apart from keeping mobile and using the yoga positions. The midwife suggested that she carry out a bit of a stretch which was very uncomfortable as I was lying down. As soon as I was able I got straight up and restarted rocking my hips.

The midwife had definitely worked her magic as then the contractions really stepped up and I felt that I wanted to get in the birth pool. I felt pressure on my bladder which was different from my labour with Dylan and I felt like I was starting to make noises like I was getting ready to push. I kept thinking how stupid this was though as I’d only 10 or 15 minutes earlier been told I was 4 cms. This was now about 750pm.

When I got in the pool, I felt much more comfortable and was kneeling over the edge of the pool holding Chris’ hands. The sensation to push was getting more tempting and I made a joke to the midwives about how this was crazy when I was only part way towards the 10cm! They were very hands off and after a couple more contractions I realised thatAlana and family the noises, the pressure and the urge to push were getting more extreme…..I then saw both midwives putting their plastic aprons on and knew that Conor would soon be born.

After a couple more contractions and bearing down I said that I thought I could feel his head crowning. The position I was in made it very awkward for the midwives to see and they asked me if I could move to a slightly better position but I couldn’t! Instead they asked me to reach down. I did so and could feel his hair wafting about in the water. A couple more pushes and he was out. I guided him to the surface of the water, his big blue eyes looking up at me through the water blinking! It was 835pm and I’d gone from 4cms to giving birth in less than an hour!

When Conor came to the surface, we realised that his cord was round his neck but the midwife soon unhooked it with her fingers. She asked me to give him a bit of a rub to get him to make some noise which I did. He did cry but not as loudly as Dylan had so the midwives cut the cord and then rubbed him with a towel which did the trick.

By 1030pm, the midwives had left us to it and we were sat with a glass of champagne in our lounge, our new baby boy snuggled in our arms.

Christian Howarth Senior midwifery tutor at Huddersfield University reflects:

Well I can’t really comment on the story because I wasn’t there!

Cervical dilatation is an interesting thing isn’t it?  Women seem to have been told for years that their cervix has to dilate to 10cms, magic number before the baby can come out.  It’s not surprising then that they would ask for a midwife to check dilatation.  How sad that she thought  she needed to speed things up when she found out that her cervix was four cms dilated.  That’s brilliant, that’s halfway there!

You have to look at the whole picture though. Dilatation itself isn’t a particularly good guide – it’s part of the information that may be needed.  A midwife would also have to consider how well engaged the baby’s head was, how the head was descending, how strong the contractions were, how long they were lasting, how the woman was breathing, what noises she was making …  I think I’d do all that before I thought about examining the woman.  What else can you see – any external signs of full dilatation? A show, bulging vulva, the ‘thin blue line’?  Do I really need to carry out an invasive examination? Is the woman labouring or in transition?  Is she about to give birth? Listen to the woman!

There’s always the worry that an examination will lead to further intervention.  Is it necessary to speed things up?  It seemed that this woman was in established labour, so why carry out a stretch and sweep? Again, I wasn’t there, so I can’t really comment on that.  It is not uncommon for a cervix to dilate very quickly in a second or third labour! Particularly if it’s well applied to the head (or bum). I know this, but I am always hearing stories about it!  Women feel disheartened by finding out they are ‘only’ 4cms dilated, and perhaps ask for pethidine or other analgesia – only to give birth half an hour later, doped up, and likely not to remember those first precious moments.

Hope these comments are useful.

The UK’s Agnes Gereb

” I think Becky Reed has become the UK’s Agnes Gereb, victimized for giving exemplary care to women.”

read her story below and support her cause: http://www.facebook.com/JusticeForBeckyReed

JUSTICE FOR MIDWIFE BECKY REED: WITCH HUNT OF ONE OF THE UK’S MOST RESPECTED MIDWIVES

 From 1997 to 2009 the Albany Midwifery Practice offered a unique midwifery service to the women and families of Peckham, South London.  The Practice was evaluated several times with excellent results. The outcomes for the women were recognised as outstanding, including over the first ten years a perinatal mortality rate, for an all-risk caseload, of 4.9 per 1000. This compared with a local perinatal mortality rate of 11.4 per 1000, and a national perinatal mortality rate of 7.9 per 1000 (The 2000 Women Study, 2008). The Albany midwives offered continuity of carer and choice of place of birth to the women, and the Practice achieved the highest home birth rate in the country within the NHS.

 Following an adverse outcome at a home birth in September 2009, King’s suspended Becky from duty, even though representatives of King’s subsequently told the Lambeth Health Scrutiny Committee that they had ‘no concerns in relation to individual midwives’ and had offered all of them jobs following the termination of the Albany Practice. In December 2009, King’s Healthcare Trust terminated the contract of the Practice without consultation, citing ‘safety reasons’, based on inaccurate data and statistics that have been challenged by several experts including Alison MacFarlane, Professor of Perinatal Health at City University, London.

 The unexpected closure of the Practice prompted a range of protests, including a large march and rally in London in March 2010. The ‘Reclaiming Birth’ march was called by the Albany Mums Group both to protest the closure of their valued local midwifery practice and to push for better, more women-centred approaches to childbirth.

 Becky Reed was the only midwife to have been with the Albany Practice since its inception. A very experienced and internationally respected midwife, she has written extensively about the Albany model of care and is currently co-editor of the well-respected academic journal, MIDIRS Midwifery Digest.

 In January 2010 Becky was referred, without her knowledge, to the Nursing and Midwifery Council (NMC) by the Head of Midwifery at King’s, Katie Yiannouzis. The referral cited seven cases, spanning a period of over three years, dating back to July 2006.  Becky was primary midwife in only two of the cases.  Katie Yiannouzis had been Becky’s midwifery supervisor until February 2009 and had raised no concerns with Becky about her practice.

 In September 2010, following an Interim Order hearing, Becky was given a Conditions of Practice order by the NMC, requiring her to undertake 450 hours of supervised practice (the maximum). She successfully completed this at Barnet and Chase Farm Hospitals, and in April 2011 an Interim Order Review hearing took place where, on the basis of reports from her supervised practice and many testimonials from women and practitioners, the Conditions of Practice were revoked in their entirety and she was deemed fit to practise.

 Unbelievably, the NMC investigation continues.

 In March 2012 Becky was sent draft charges by the NMC relating to five cases out of the original seven (two of the cases had been mysteriously dropped). In three of the remaining five cases, Becky was the second midwife.  The primary midwives have not been referred to the NMC. N.B. In the two cases for which Becky was primary midwife, she has successfully completed supervised practice (and been deemed fit to practise by the NMC itself).

 On 20 December 2012 Becky was given notice of an NMC hearing which is scheduled to commence at 9 am on Monday 11th March 2013 and continue until Friday 22 March. For each of the cases the charges are introduced as follows: When providing care for Mother XX and baby you: failed to comply with or practice within the Kings College Hospital Clinical protocols in labour and / or nationally recognised clinical guidance from the Royal College of Obstetricians and Gynaecologists and / or National Institute for Clinical Excellence.

 The Midwives Rules (Rule 5) direct the midwife to ‘work in partnership with the woman and her family, providing safe, compassionate care’. Clinical guidelines, therefore, should be considered an important aid to clinical decision-making, but not as rules to be followed in every case.

 There is no question that the public needs protection should there be midwives who are dangerous and negligent. This investigation, however, is nothing to do with protection of the public, but symptomatic of an entrenched medicalised and rule bound culture at the NMC. Becky is certainly not the first woman-centred, skilled and dedicated midwife to undergo bullying and victimisation. For Becky, one of the UK’s most respected midwives, to be treated in this way constitutes an attack on midwifery autonomy.  If she is ultimately sanctioned, it will make it more difficult in the future for midwives to confidently support women’s birth choices.

 It will be obvious on reading this that the NMC, which was described last July as ‘failing at every level’ by its own regulator, has completely mishandled this case. For Becky, this process has lasted for well over three years – she and her family have suffered both financially and emotionally. We, Becky’s support group, will be asking (if you live in the UK) whether you could spare some time to come along to a session of the hearing during the 2 weeks commencing 11th March. Visible support will indicate the strength of feeling women and midwives have about Becky’s mistreatment, as well as highlight the wider issues raised by Becky’s case.

 If you are able to come along, you will need to book your place online at http://www.nmc-uk.org/Hearings/Attending-a-hearing/#emailbooking. We would be grateful if you could also email Vicky at thebirthiwant@gmail.com<mailto:thebirthiwant@gmail.com> with details of the day/time you book so we can ensure every session is covered.

 We also plan to hold a peaceful protest gathering outside the NMC offices at the Old Bailey during the 2 weeks, probably on the first day. We will send further details of this nearer the time.

 Please email messages of support to thebirthiwant@gmail.com<mailto:thebirthiwant@gmail.com> or post them at the Facebook site Justice for Midwife Becky Reed http://www.facebook.com/JusticeForBeckyReed

 If you would like further information please email Vicky at  thebirthiwant@gmail.com<mailto:thebirthiwant@gmail.com>, or Sarah at sd889759@gmail.com<mailto:sd889759@gmail.com>

 With best wishes

 Sarah Davies, Vicky Garner, Nadine Edwards (Vice Chair of the Association for Improvements in the Maternity Services- AIMS), Beverley Beech ( Chair of AIMS) and members of the Justice for Becky Reed group.