What you can do to save midwifery as an independent profession in the UK.

By Ruth Weston and Emma Ashworth

Independent Midwives are in the NMC firing line, and most of the campaigning that you might see is about this. However, the NMC (Nursing and Midwifery Council), which made this decision, did so without a practicing midwife on the board, and the ramifications of the decision affects every midwife in the UK.

For instance, the NMC have stated, “A registered midwife can only attend a woman during a birth if she has appropriate indemnity cover. The midwife cannot avoid this legal requirement by attending the birth in a ‘non-midwife’ capacity… The only exception to this is when a midwife attends a birth in a personal capacity to support a family member or close friend for whom they have not previously provided midwifery services”. “Services” includes emotional and physical support, meaning that midwives are being banned from attending the births of their grandchildren, or their own babies in the case of male or lesbian midwives if they’ve so much as listened in, or supported their partner through morning sickness.

The NMC is removing the midwifery committee, which advises the NMC on midwifery matters. Its replacement will have no budget and delegatory powers and it is unclear who will be on it and what its role will be within the NMC. As the NMC – the NURSING and Midwifery Council – has overwhelming numbers of nurses compared to midwives, and the way it is now being set up means midwives will be regulated by a completely different professional – one geared to nursing sick people rather than caring for healthy women -without their own voice being heard at all.

There is a huge risk that this will toll the death knell to midwifery as an independent and autonomous profession. becoming subsumed into the nursing profession as another branch of nursing.  This is certainly the way the NMC and the Government legislation is treating midwifery at present and would mean Midwives would lose the status of being THE professional experts in the normal maternal pathway and key care provider. This is not inevitable but as a profession and as parents we must rise up and clearly and strongly oppose  the removal of the midwifery code, the midwifery committee and lack of representation for mothers and midwives at the NMC. The profession has never been in more jeopardy, and never has the care of women and their babies been so much at risk since the formation of the profession of midwifery.  It falls to us to do something about it..

What can I do?
1) There have been several petitions. The writer of this one admits that if it had been less rushed it would be better worded, however, if we want Parliament to take note of the voices of women, midwives and their families then this is a good petition to start the ball rolling, so please do support it. https://petition.parliament.uk/petitions/178561

2) Share your story of how midwives have helped and supported you. What impact will the lack of access to IMs have on you?  Share on:

Facebook, Save Independent Midwifery page: https://www.facebook.com/groups/443681876022589/

Send to Birthplace Matters who is preparing stories and letters to the NMC through  birthplacematters at yahoo.co.uk

Send them to the saveourmidwvies.co.uk website.

Don’t forget to include permission to share.

3) Tweet!  Use the #savethemidwife hashtag with your messages about how this affects you. You can  tag Jackie Smith of the NMC using @JackieSmith_nmc, and BBC Watchdog (@BBCWatchdog)

4) Write to your MP. The website saveourmidwives.co.uk has important template letters which answer the cut-and-paste responses that most MPs are sending. Find your MP here: http://www.parliament.uk/mps-lords-and-offices/mps/

5) Join IMUK, the Independent Midwives’ professional body, as a supporting member. It only costs £20: http://www.imuk.org.uk/professionals/join-imuk/

6) Make a complaint to the NMC. E-mail complaints@nmc-uk.org. They have less than 20 working days to respond. It is important to mention that it’s a formal complaint to ensure that you go straight to Stage 2 of their complaints process. If you don’t like the reply, simply respond back, say you’re not satisfied, why, and then appeal the complaint response, escalating to Stage 3.

7) Many women and Midwives across the UK are using their passion, creativity and skills to support independent midwives and to challenge midwifery regulation to do its work better.  Do what you can with the people you can, and watch this space as more developments are in the pipeline.  Thank you!

Acupuncture helped me tackle my post-partum pains

I found acupuncture for my fifth child after a talk by an acupuncturist at Bradford Choices meeting.  I had had really really bad after pains and I was dreading them coming back, for me the pain for these few days was worse than anything in labour!

After pains are when the womb contracts down to its original size after the birth –  and it has a lot of reduction to do. It is usually second and subsequent pregnancies when women experience it. Some women just feel a bit of a pull when breastfeeding and that is all, other women (and we don’t know why) can experience unbearable pain. I was told that it would get worse with subsequent pregnancies – my personal experience was that it was really bad to start with and could not and did not get worse!

The acupuncturist said that he would need to start treating me in the last few weeks of pregnancy to work with this – which he did. Acupuncture is a wonderful experience. I was struggling with fatigue and a loss of concentration: the acupuncture really sorted that out and I felt alert and good. With the sessions he taught me, and then my partner, the pressure points for easing pain in labour. It enabled us to understand why I experienced so much back pain and where to press to ease this – this particular set of points was AMAZING during birth. David’s hands ached for days after pressing so hard for so long!

The after pains started a few hours after the birth. David used the pressure points but obviously he could not do that on a permanent basis. We rang the acupuncturist who did a home visit that evening. He gave me a treatment which he said would get the womb contracting more effectively. He recommended getting a tens machine and showed us the acupuncture points to place the tens on. I had a really bad night for pain but the tens machine arrived the next morning – and what relief – by the end of the day I was fine. Just occasional boosts at the beginning of a feed. After three days I stopped wearing the tens machine at all.

In previous births I had suffered really bad pain for three days with it slowly easing after that. With acupuncture and the tens machine used as instructed I had effective pain relief within 12 hours. I think that night after the treatment my womb contracted heavily because within 24 hours it was clear that the major work had been done and the tens machine was needed less and less.

I also used acupuncture for back and pelvic girdle pain experienced post-partum which gave a lot of pain relief.

I really cannot recommend acupuncture enough and the knowledge of acupuncturists with maternity specialisms.

Hypnobirthing: a guest blog by Katharine Graves

Hypnobirthing has changed practice in birthing suites and will continue to do so.  There are many good things that have happened over the years, and all the time I am aware of improvements as we edge towards a more natural and woman-centred regime, but  nothing has made the practical difference that Hypnobirthing has.  It is very important that everyone is aware of and fully conversant with what is going on.

As yet there is little research on Hypnobirthing, though various studies point to the profound effect it has.  I hope this document will help you understand more about it.

The principle behind hypnobirthing is the fear-tension-pain premise put forward by Grantley Dick Read.  In our society, everyone ‘knows‘ that birth is painful so, however much a woman is looking forward to having a baby, which she undoubtedly is, that is the background in which she has grown up.  As long as that background is in place, she is unlikely, after she has had her baby, describe it as ‘the most wonderful and empowering experience of her life‘ which is what I frequently hear from hypnobirthing mothers.

We all know the procedures that go on with heart-breaking regularity in delivery suites.  It is wonderful that these medical procedures are available when needed, but we can’t help asking if they are needed as much as they are used today.  Hypnobirthing educates a mother, and equips her to deal with whatever turn her labour may take.  It cannot promise the perfect birth; nothing could – that would be unrealistic.  But it is amazing how often this is achieved.  Whatever the outcome, hypnobirthing makes a difference, and a very big difference too.  Hypnobirthing gives you the tools to have the best birth for you.

A hypnobirthing course is a full antenatal training.  It is based on knowledge, profound and simple logic, and information.  There is nothing new in birth, after all it has been around for a very long time, but hypnobirthing looks at the facts in a completely different way which makes a dramatic difference.  Midwives who are present at a hypnobirthing birth for the first time are amazed at the calmness of the mother and I often hear the exlamation, ‘I’ve never seen anything like it.  I couldn’t believe how calm she was.‘

A hypnobirthing course lasts for about 12 hours, either 4 or 5 evenings or 2 days, and ideally a couple do the hypnobirthing course together.  They learn:

• What hypnosis is
• What hypnobirthing is
• How the muscles of the uterus and the hormones work in a way which throws an entirely new light on this system
• The power of the mind (greatly under-estimated by most people)
• The physical aspects of birth, e.g.pelvic floor exercise, perineal massage, positions, back to back babies, breech babies.
• Breathing and visualisations that work with the body
• Relaxations to practice together
• How to apply what they have learnt when they give birth
• Common procedures in delivery suites
• How to get all the information they need in order to choose the best course for them
• How to release fear

You are also given The Hypnobirthing Book, and the Colour and Calmness Relaxation CD to play each night as you go to sleep to release fears and build a positive view of birth.  This will affect the hormones you produce, which will also affect your baby, and the efficiency and comfort with which you give birth.  You are also given a folder of handouts to continue your practice at home.

People come to a hypnobirthing course expecting to receive a lot of techniques to raise their pain threshold, take them to some spaced-out state so they don’t notice the pain, or not notice as the pain washes over them.  Yes, we give them breathing, visualisation and relaxation techniques, but these have been around for years, so what makes hypnobirthing so different, and so effective?  There are three things:

1. The work to release fear, so that a woman looks forward to her birth with positivity and optimism.
2. She learns to relax very deeply; much deeper than a short relaxation at the end of an antenatal class.
3. Rather than just being told to go away and practice, she is given a simple programme that she can use to continue the work at home. All the best birth reports that I have received have also said, ‘And I practised lots.‘ 

Learning hypnobirthing is completely different from preparing for any other important event in our lives.  If we are preparing for an exam, we add more and more information, we do a trial run, and the night before we really cram it in, and then we produce it on the day.

Hypnobirthing does exactly the opposite.  With each practice a woman learns to let go, and let go, of her fears, her preconceptions, so that by the time she gives birth that perfect system that is already in place in her body and mind can shine forth and work as it is designed to do, comfortably and efficiently.  It is difficult to explain.  It is something you experience.

I have written The Hypnobirthing Book which fully explains hypnobirthing. Since hypnobirthing is having such a profound effect, it is important that all women consider how it can support them in giving birth.

Here is a mother’s description of hypnobirthing:

In late December, my husband and I attended – with a considerable degree of scepticism – your Hypnobirthing course. We had absolutely no idea what to expect and were worried it would be a bit hippie for our liking. In fact, it changed our lives forever and I wanted to say a huge thank you for the epiphany you inspired in us.

On Sunday, March 2nd we welcomed to the world little Felix, who arrived at 7:04pm weighing 8lb 1oz. Felix is heavenly and we are, predictably, crazy in love. But much more significantly – just a few months ago, I was one of those ridiculously well-educated but utterly-clueless-about-birth 21st-century, 30-something professional women who assumed I would march into hospital demanding an epidural and every single drug going. In fact, Felix was born with nothing more than a few sips of water and lucozade and the bath/birth pool to get us through a fairly arduous 16 hour of back labour with literally no respite between surges… No drugs or gas & air, no interventions, no stitches, no perineal tearing.. Just a lot of breathing, TOTAL faith in my body’s ancient wisdom and the perfect system that is already in place, and the spirit of you and Grantly Dick-Read guiding us through! 

Of course I realise how lucky I was to go into labour spontaneously, four days after his ‘due’ date, and not have the pressure of the NHS induction clock bearing down on me – but I’m convinced that my utter faith & conviction that baby knows best and that nature would take the right course played a huge part in that too. I also did an NCT course to meet some local mothers, and of six young, healthy women, I was the ONLY one not to be induced or have a C-section. That must count for something!

You were absolutely instructive in making the impossible possible and inspiring me to go and read Grantly Dick-Read in the original as well as discover many other sources of enlightenment and positive thinking about birth as a miraculous natural non-medical event. So thank you from us all from the bottom of my heart.  The positive changes in mental outlook you encouraged, and the way you taught us about things like the parasympathetic nervous system and so much more, are invaluable life lessons I will take forward far beyond the birth and parenthood.

I’ve already recommended you to many of my expectant friends, some of whom recently came to your course, and there are more of my friends coming to one of your courses soon. I’ll always spread the word about the wonder of Hypnobirthing in general and you in particular.

THANK YOU.

Hypnobirthing is a method for focusing the mind on the positives of birth so that before and during the birth the mother can be calm and relaxed.  This enables the body to work efficiently in the way it has been designed to do, giving the best opportunity for a calm, easy, natural birth.  The method uses deep relaxation, information, logic and knowledge for both mother and birthing partner as a way of removing fears associated with birth and importantly providing tools for how remain calm in any circumstances which may arise during the birth, thus removing any unnecessary pre-conceived worries.

Birth is the most formative experience of our lives and, if a mother is calm and drug-free, her baby will also be calm and drug free.  Instead of birth being a traumatic experience for both mother and baby, it will be a gentle, natural experience with fewer interventions, which mothers describe as the most wonderful and empowering experience of their lives.  The baby will arrive in the world to be greeted by a mother who is calm and alert and ready to receive it.  This is how it forms its first relationship in this world, which is the blueprint for every other relationship throughout its life, and will have an effect on it throughout its life, and indeed on everyone it meets.  Time and time again, people observe that HypnoBirthing babies are different.  It is difficult to define, but there is a calmness and an alertness about them.  They have been observed to start to put on weight straight away, instead of losing weight for a few days while they recover from the traumatic experience of birth before beginning to put on weight and move forward again.  There are often reports that they are very calm babies who sleep through the night sooner.  As the children grow up, they take life easily in their stride and remain calm and happy.

Though women come to HypnoBirthing for a more comfortable birth, which time and time again it has been shown to deliver, in the long run the benefits for the baby are of even greater, and the  significance of this cannot be over-estimated.

Katharine Graves

 kghypnobirthing.com

A Midwife I know and Trust: Why I campaign for one mother one midwife care

Over many months I have been thinking a great deal about the importance of one to one midwifery care  or personalised care as the Government calls it.  Why am I so passionate and committed to seeing one to one midwifery happening in Bradford?

I am passionate about one to one midwifery care because I know what an enormous difference it can make to the experience women have during the childbearing weeks and months.  I really don’t think it is good enough for health services to say to a woman: ‘There you are!  You and your baby are alive and reasonably  well’.  And send them off to an unsupported home environment traumatised, exhausted, barely breastfeeding and with the minimum NICE visits to look forward to.  Similarly, it is unfair to expect that many women in the deprived areas of our city and district will be able to turn up to hospital to birth a baby, maintaining the best health and wellbeing of themselves and their baby and their wider family, on the minimum and fragmented care offered by the medical led NICE guidelines.

The evidence shows us that women supported by one to one care of a midwife, are more likely to have a normal birth, experience less pain in childbirth, are more likely to breastfeeding and continue to breastfeed and are less likely to have post natal depression.  Breastfeeding babies are 5 times less likely to be hospitalised for gastroenteritis, are less likely to be obese, less likley to suffer eczema,  less likely to have heart disease or diabetes.  Not breastfeeding a baby starts cost the NHS money from 8 weeks old, and new evidence shows that cutting the investment in maternity increases drop off rates for breastfeeding.  Moreover, we now know that personalised maternity care significantly reduces the risk of premature labour, miscarriage before 24 weeks and still birth.  Having a midwife you know and trust can save your baby’s life.

My Story:

I would not class myself as a vulnerable woman but I lived for 9 years in the deprived community of Girlington and 10 years on the Allerton council estate, my husband worked away and was on a minuscule salary as an archaeology PhD student(!) and so for most of this period I was having to manage a home, up to three small children, and a baby  –  all on a very low income.  Unsurprisingly I suffered from post natal depression and so I know the difference one to one care made for me.

With my first child, 19 years ago I was not referred to midwifery care by my GP and only found a midwife late in pregnancy.  Case loading was in operation then in the local teams and so not only did I  have continuity of care from my midwife, it was likely she or a midwife I knew and knew me would be attending my birth at home.  My birth was a long and difficult one and although I had a dream baby I was traumatised by the birth, regularly having flashbacks.  I remember with gratitude the care I received from this midwifery team – but most of all the couple of hours I was able to spend with my midwife 4 weeks after the birth going through what happened and why – debriefing we would call it today.  I had a lot of emotional work to do after that – not least because I was still struggling with loss of a previous child, but it helped move me forward: I did not get stuck at the birth.

Contrast this with another difficult birth – my fourth child.  I had a midwife who did not really support my choice of homebirth ( when I saw her which was not often), I had one in sixty midwives on call so had to accept a complete stranger into my home and birth, there was a fiasco because I was having a water birth and she did not know  how to deal with this.  I was transferred in for bleeding with another set of midwives.  I returned home that evening unbelievably exhausted. Within a week my husband was back at work ( no paternity leave in those days) I had 2-3 perfunctory visits from 2 different midwives ( I remember just 2 visits but cannot believe this is all I had but it could have been) I was discharged at 10 days.  I had no opportunity to debrief or  talk through what had happened with the midwife who attended the birth which I desperately wanted/needed to do.  My husband started working away again at 4 weeks.  At 8 weeks both he and I were utterly exhausted and depressed.

Because of that experience, with our fifth child we took the advice of the supervisor of midwives to whom I had complained during the pregnancy of my fourth child, when I realised the level of the fragmented care that I was supposed to accept for my fourth child: we booked an independent midwife.  Better late than never! My husband was training to be a teacher at the time, the cost represented 20% of our then income and it took us 2 years to pay it off but it was worth every penny.  We were given timely information, the birth went smoothly because there was no interference.  The difference in postnatal care was enormous:  Our independent midwife kept us in check, visiting us daily until I begged her not to because I did not need it.  We were not discharged for over 2 months because they wanted to ensure we did not suffer postnatal depression – she had the knack of ringing me on the day I had done too much so she could gently remind me of my priorities and I would go to my bed and leave my job.  Michelle always said self employed women were the worst for taking too little time off around the baby!

I tell my story because I want to demonstrate in my own life – as much as others – why personalised care is so important and why I am so passionate and committed to seeing it happen on the NHS before my daughters have children.  Not every woman needs the kind of care I needed.  Different women have different social and emotional needs.  BUT women and babies NEED the investment of one to one midwifery care in order to remain healthy, to care and guide them when they are not, and to help us pick up the pieces and to carry on if it all goes horribly wrong.

Up until now whenever I have raised the possibility of case loading in Bradford I have been told it is impossible, too expensive, too difficult for midwives, women will just have to live with the (unacceptable) levels of care I faced for my fourth child.  But now we have a practising NHS midwifery team with a solid  business plan who can do it and are doing it to Tariff; and making a difference to the lives of ordinary women living at the rougher end of the Wirral.  I want this to happen for women in Bradford, especially for the women living in Girlington, Manningham, Little Horton, Barkerend where rates of infant mortality are high and many women struggle as I did to make ends meet..  It makes such a difference, SUCH A DIFFERENCE.

I know that midwives cannot wave a magic wand and give us the money to fix the car and pay the bills, they could not give my husband paternity leave or bring him home from working away.  But what they did was bridge the gaps  – of the understanding and skills I needed, give me some social and moral support so I could keep going, get me to a place where my social network could take over.

If we invest in this one mother one midwife project, if the CCGs take the needs of women seriously enough to ensure it happens, we will be investing in the health and wellbeing of not just women and babies but their families and their communities.  It makes that much of a difference.  19 years ago I was a young traumatised mum living in Girlington and my midwife was Julie Walker. Julie Walker is head of midwifery.  I have just stepped down after four years as chair the MSLC and I own an international birthpool business.  It really does make that much of a difference.

Find out what YOU can do to make a difference: http://m4m.org.uk/takeAction.php

When a Muslim Mother loses a Child

As always I am awed when I meet women and mothers who have suffered themselves and then find it in the hearts and lives to want to change things to ease the suffering of others.  Here is just such a woman, who has lost two children herself but has yet found the strength and compassion to ease the suffering of others.  I commend her story and her work to my friends.  If you are in touch with women who may need the support of Rezvanna’s charity, then feel free to contact her.

Every blessing.

Rezvana says:

Children are regarded as one of the most precious gifts for every parent to hold, love and cherish. The loss of a child is no doubt the most difficult experience for any parent to face. The pain of child loss, however, is one that may never heal as I have learnt over the years.

I lost my son Hashim 8 years ago and Haider Ali just over a year ago. However parents like myself are looking for ways in which to learn to live again and face the reality of life. The feeling of strength, courage and patience is tested daily. During the time of heartache and soul searching, spiritual guidance can be the answer to many lingering questions as I have experienced.

At the time of my bereavement I was offered support by the health professionals and on a number of occasions. However I felt they did not cater for my faith beliefs therefore I declined. Sadly I did not know of any charity  out there that could cater for my beliefs. After 8 months of struggling to deal with my loss I was introduced to Children of Jannah, the only Islamic bereavment support in the UK helping to deal with child loss. Children of Jannah is a charity which aims to support parents to deal with their loss in the light of Islamic guidance. This closes a  gap in  service provision that will benefit many: as we create an environment for families to discuss their feelings and emotions.

Children of Jannah has a personal Facebook page for mothers and fathers separately where they can share their stories and experiences. It also delivers a telephone support line so that parents can speak to a trained volunteer confidentially.

The Imam of Bradford was pleased with the substantial support provided for parents by Children of Jannah, he said:

 “The Children of Jannah is a welcomed initiative that combines the offer of comfort and compassion through spiritual guidance at the time of bereavement. I would like to commend Children of Jannah charity and pray that Almighty Allah reward them for their efforts and good intentions.” Shaykh Muhammad Afzal Saeedi, President Minhaj-ul-Quran International UK

Another Imam said: “I want to congratulate Children of Jannah for producing this much needed information in a clear and accessible form. May Allah (God, the Most High) reward them for their endeavours.”    Imam Muhammad Asim MBE, Makkah Masjid, Leeds

Children of Jannah is the grief recovery charity that could help many other isolated parents deal with their grief. With their motivation and encouragement I have come to terms with my loss, and now I want to raise awareness so many other parents can receive this support. I am now the West Yorkshire Coordinator for the Children of Jannah charity and would like to talk with anyone who knows Muslim parents who may benefit, as I did, from this charity’s support.

Website: www.ChildrenofJannah.com  Email: westyorkshire@childrenofjannah.com       Mobile: 07870660035                 Charity no: 1145936

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 Braxton 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 that 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 Dangers of Uninterpreted Birth Footage

Dear all,

 

It has always been my main critique of programmes such as One Born Every Minute that they give footage without comment, analysis or context thus rendering the information it provides at best un-useful and at worst downright misleading.  For instance watching a shoulder dystosia without some discussion about its rarity, on the fact that it’s occurrence is more likely in the semi recumbent position, and the various methods of dealing with the situation, renders the footage both distressing and misleading to watchers.

 

I remember years ago a theologian, I respect immensely contended that the Bible should not be read in public without appropriate interpretation to the listeners.  He gave the example of John 21 where after the crucifixion the disciples lock themselves in an upper room ‘for fear of the Jews’.  This passage without appropriate context and interpretation had been the justification for anti semitism and violence against Jewish people over many centuries.  However contextualised, you would realise for instance, that the disciples were Jews and Jesus was a Jew – so how could they lock the door for fear of ‘the Jews’ when this was their identity also?  This phrase is actually believed to come from the context of the writer of the Gospel some decades later, a context where Gentile Christians were being persecuted by the Jewish population in that area.   So the phrase ‘for fear of the Jews’ which has caused so much strife and suffering has little to do with the Gospel story itself and much to do with the context in which the story was written down.  “This,” said my friend Dave Bowen, “Is why the Bible should always be read with appropriate interpretation.”

 

I have come to think this same rule should apply to the sharing of birth stories and especially of the televising of birth.  Editing and comment is everything in these situations: We need to have the analysis and information to really interpret what is happening in its appropriate context.  This would mean discussion from different perspectives, disagreement and comment about the practice presented, enabling viewers and readers to get a real flavour of the variety of opinions and practices that  women can receive in their birth and the opportunities for choice there are.  It would also mean of course that practitioners would have to submit their practice to the discussion and comment of their peers in a public arena – it could be a brave practitioner and a very tactful editor who could accomplish that feat.  And yet without it women are being misled and misinformed by the ‘camera that never lies’.

 

With this in mind I came to this latest birth story to cross my desk.  As I read it, questions were raised in my mind and I thought, this is a lovely birth story but there are some real questions about the practice of the carers and the way policies are implemented and practice explained.  I felt that this birth story should not be published without some pointers and questions for further discussion. 

 

For instance:

• Where does the 24 hour deadline for induction after waters breaking come from?  Where is the risk/benefit analysis of this policy?
• Fantastic way to spend your early labour: on the allotment and walking the dog! Not worrying about progress or lack of it.
• Could the midwife have avoided that devastating moment for the mother by giving her positive information that would encourage her efforts rather than dishearten? How could she have encouraged a woman making slow progress with her birth?  Is giving the information ‘1cm dilated’ as unhelpful as uninterpreted  birth footage? What about effacement? What about not giving a number but simply saying progress is being made but there is a way to go yet? What would a caring midwife say to a woman in this situation?
• The most glaring question in this story is: if the TENS was not working and the pains were so strong – why did the mother wait so long to get in the pool? – particularly when it clearly gave so much relief?  Was she waiting for permission from the midwife? Why did she need it?

 

With these questions I hand you over to the Mother’s tale:

The arrival of Albert Oliver, 7^th March 2012.

My waters broke when I woke up at 8.30am on Tuesday 6^th March.  After getting in the shower I decided that they really had gone, and that I wasn’t just suffering from late pregnancy incontinence!  I rang my husband, Tony, who was already at work, and he headed home to be with me.  I also rang the delivery suite who rang the community midwife on call.  San came round at about 9.30am and confirmed my waters had gone.  She told me that I needed to ring them again when my contractions were 5 mins apart, and that should labour not begin within the next 24 hours, I was booked in for induction at 8.30am the next morning.

I spent the day with Tony and another friend, Carol.  Carol had arranged to visit that day anyway and help me rotovate my allotment. Poor Tony got roped in too.  I kept moving (light allotmenting jobs) throughout the day.  At 4pm Carol left, taking our dog with her.  Another friend called in, and we went for a walk, and had an evening meal at about 6ish.

Throughout the day I had been having contractions, and at about 7ish these became stronger and more regular.  I’d put my TENS machine on early in the day, as soon as I started feeling mild contractions. A bit after 8pm I rang the delivery suite again, as we were recording my contractions as coming every 2 to 5 mins.

Cat arrived at about 8.30pm, and after observing me, we decided that I would have an internal examination to see where we were up to.  I was really very nervous about this, as I hadn’t had any internal prodding so far in my pregnancy.  It was absolutely fine however, nowhere near as intrusive as I thought it would be.  However, the examination revealed I was only 1cm dilated at this point, and Cat commented that my contractions weren’t either consistent or long enough for me to be in established labour.

I was understandably devastated at this news (as it REALLY hurt by this point!).  Cat left, saying that I needed to call her when my contractions were every 2 minutes and lasting a full 60 seconds.   The next 2 and a half hours were not fun, and I caved in at 11.30pm and asked Tony to ring delivery suite.  Cat arrived by midnight and examined me again.  At this point I was 9cm dilated, and was incredibly relieved to hear it (as it REALLY REALLY hurt and the TENS machine by this point just didn’t seem to be cutting the mustard).

I finally got into the pool at about 12.30. We’d filled it around 6pm, so Tony needed to boil some kettles to get it back to temperature.  It felt amazing as soon as I got in, and made a massive difference to my pain management (the gas and air was making me too sick so I didn’t bother with it).  The second midwife dealt with further kettles after I got in the pool, as I didn’t want to let go of Tony’s hand.

Albert arrived at 1.39am, so I was only in the pool an hour or so.  I picked him up (with help from the midwife) and cuddled him in the pool, but had to get out to deliver the placenta (as I was bleeding).  Albert was wrapped up and given to his dad to hold, so Tony had loads of time with him immediately while the midwives dealt with my third stage.

I would recommend a pool birth to anyone, whether at home or in hospital, it made a huge difference to my labour experience – as soon as I got in the pool, the pain seemed manageable, and Albert seemed to arrive quite quickly.  We now have a perfect, happy little boy!”

A happy ending to a good birth story.  But as practitioners and as stroppy mothers and midwives, that cannot be enough – we have to ask the questions too.