Valerie Gommon Midwife’s Blog

Archive for the ‘active birth’ Category

I guess the first choice is where do you want to give birth, at home, in a birthing centre or in a hospital?  Although you may be asked this at your first appointment you can actually decide at any time, even when you are in labour (although it may be easier if you make plans earlier).

There are so many factors to take into account, but the most important thing is to give birth where you feel safest.  Labour is a very instinctive, hormonal event and if you are scared or unhappy with your environment you will not labour so easily.

Homebirth:

There are many benefits to be gained by giving birth at home.  The woman is in familiar surroundings and is therefore more relaxed allowing the birthing hormones to work properly.  Labour is usually shorter, less painful and the mother is more likely to have a normal birth (so less need for ventouse, forceps or caesareans), she is more likely to breastfeed and less likely to suffer postnatal depression and she is more likely to report that she is satisfied with her experience.  These claims are backed up by research and evidence can be found at www.nct.org.uk/about-us/what-we-do/research/roepregnancy-birth

Birth Centre/Midwifery Led Unit:

These are often seen as a half-way house between home and hospital.  They have many of the benefits of home, a more relaxed environment but if you are concerned about the privacy aspect of birth (for example if you live in a shared house, or are concerned about the neighbours) or the mess (which in reality is rarely an issue) then a birth centre may be right for you.

Birth Centres are only an option for women whose pregnancy is defined as “low risk” which means that the birth is expected to progress without complication.  Should a complication occur you will need to be transferred into a hospital where more advanced help is available.

Hospital:

Many women choose to give birth in hospital because they believe it to be the safest place.  Of course it is true that the hospital will have advanced facilities if needed however you should also bear in mind that sometimes these facilities are over-used and that just by setting foot in a hospital you increase your chance of using some of that help!  If you choose to give birth in hospital my top tip would be to stay at home as long as possible.

Waterbirth:

I think the use of water in a labour and birth can be hugely beneficial.  I recognise that not all women will want or need a waterbirth, but I would strongly recommend all women not to rule the use of water out.  It may be that you use water by having a bath or shower in labour; it can be hugely comforting to have shower water jetting onto your tummy or back whilst in labour.

As I see it, if we are achy or tense a bath is usually helpful.  It works in just the same way in labour; water is usually relaxing.  Another benefit is that women are much more mobile in labour and have their weight supported by the water making it easier to move around.  Lastly (dare I say it) if you are in a birthpool no one can interfere with you!  You are in your own space and are much more in control of what happens.

Most hospitals now have at least one birthing pool and if it is something that appeals to you I suggest you discuss it with your midwife and let the labour ward midwife know as soon as you arrive at the hospital.  For homebirths there is a considerable choice of birthpools available, for example rigid “bath” type pools that come with and without water heaters and inflatable pools.

Active birth:

Most midwives will agree that by being as active as possible you give yourself the best chance of having a normal birth.  In early labour listen to your body – if you can rest then do so, if you can eat then have something to eat and also make sure you drink plenty and pass urine frequently.  As the labour progresses keep changing position as your body directs; some women want to squat, be on all fours, pace around … most importantly change your position don’t just take to bed.  Being active and gravity will help you baby find its way through your pelvis and may well shorten your labour.

Antenatally it is helpful to prepare for the labour by undertaking gentle exercise, perhaps walking, swimming or yoga.  I wish you a lovely birth wherever you decide it should be!

No two pregnancies are the same, so it is very important that you continue to look after yourself by eating and resting as much as you possibly can.  Remember this time you are also looking after your little one(s) too.  You may feel better or more tired this time around; and certainly having a toddler is hard work.  If your toddler sleeps then you should rest and not rush around doing housework!  If you are exhausted try asking a friend if they would have your toddler for a couple of hours so you can rest.  I can’t stress enough that you need to eat a good diet – ensure that you eat plenty of protein and iron rich foods.

You may notice that you “show” earlier second time around, this is because your tummy muscles have been stretched before and is quite normal.  You may also notice baby movements a little earlier because you know what you are looking for, but don’t worry if you don’t!

Some women say that they are anxious about labour second time around; if you had a difficult labour talk to your midwife about it – ask her what happened and why it happened and what are the chances of it happening again, however second births are usually much easier and shorter.  It is usual to be a bit anxious about labour – most women are, but remember you did it last time and you can do it again!

I think it is definitely worth attending childbirth classes if you can – I had four children and I went to classes each time – it gives you time to concentrate on this pregnancy and this new baby; and a birth plan is a great idea, second time around you are better prepared as you know what to expect, you know what you want and don’t want to happen so put it down into a birth plan and if you need advice speak to your midwife.

Successive reports have called for one-to-one care in labour as all outcomes are improved, for example women are more likely to have a normal birth if they receive one-to-one care.  However, to some women this means having the same midwife from booking, through the antenatal period, labour and birth and until postnatal discharge – this type of care may not be available in your area unless you employ an Independent Midwife www.independentmidwives.org.uk.

Consider having your baby at home, there are so many benefits, women usually have shorter and easier labours and this time you will be better able to read your body and can stay at home if you feel comfortable and relaxed and you won’t have to leave your first child whilst you are in hospital.  Staying upright and active will help with the contractions and also keep the baby in the best possible position for birth, but your body will tell you what you need to do; try to relax and have faith in the birthing process.

Women generally recover quicker second time around, this is partly because labour is usually quicker and easier – and also because being an experienced mother usually helps to establish feeding more quickly.

Unfortunately, the more babies you have, the stronger the after pains usually are – this is because your uterus is having to work harder to contract.  Ask for paracetamol which will help and is perfectly safe to take.

Remember that your other child(ren) will need extra love and reassurance – your new baby is much tougher than you think, try to involve the older sibling(s) in what you are doing and have patience – it is usual for children to regress a bit when they have a new baby in the house.  Accept any help that is offered and consider staying in your pyjamas for a few days – it shows that you are not at full strength.  I think women try too hard to be superwoman, just allow yourself some time to enjoy your new baby – they aren’t babies for long, although it sometimes feels like it when you are in the thick of it!

It has occurred to me that I haven’t written about the benefits of waterbirth.

I think the use of water in a labour and birth can be hugely beneficial; I’ll start with my own personal experience/feelings about waterbirth.  When my youngest child was born, more than twenty years ago now, waterbirths were just being talked about in the press.  I remember my husband asking me whether I wanted to consider a waterbirth and I have to say that I wasn’t interested, but then I’d already had three babies and I knew that I could cope with labour.

As a midwife, I would say that my opinion of waterbirth is only positive.  I recognise that not all women will want or need a waterbirth, but I would strongly recommend all women not to rule the use of water out.  It may be that you use water by having a bath or shower in labour; it can be hugely comforting to have shower water jetting onto your tummy or back whilst in labour.

As I see it, if we are achy or tense a bath is usually helpful.  It works in just the same way in labour; water is usually relaxing.  Another benefit is that women are much more mobile in labour and have their weight supported by the water making it easier to move around.  Lastly (dare I say it) if you are in a birthpool no one can interfere with you!  You are in your own space and are much more in control of what happens.

Most hospitals now have at least one birthing pool and if it is something that appeals to you I suggest you discuss it with your midwife and let the labour ward midwife know as soon as you arrive at the hospital.

For homebirths there is a considerable choice of birthpools available, for example rigid “bath” type pools that come with and without water heaters and inflatable pools.

I think the main benefit of the rigid pool with a heater is that you can put it up in advance of the birth and treat yourself to a relaxing “wallow” in the days leading up to the birth and also not have the stress of putting up the pool once labour starts.  The negative to these pools is that because they have a water filter you will need to put chemicals into the water to keep it clean.

The inflatable pools are very good, they are also usually cheaper than hiring a rigid pool.  The pool will be brand new (although both types have a disposable liner to ensure hygiene) and can be used again, or used as a giant paddling pool or ball pool for your children.  The soft sides of the pool are also very comfortable to lean against.

Here are a selection of companies who either hire or sell waterbirth pools:

www.thegoodbirth.co.uk – quote Valerie Gommon

www.borninwater.co.uk – quote Indy Mid discount

www.gentlewater.co.uk

www.bubbatubs.com

www.aquabirth.co.uk

www.madeinwater.co.uk

http://www.timesonline.co.uk/tol/life_and_style/health/article6932530.ece

Men who panic when their partners go into labour may be rushing them into hospital too early. Professor Mary Nolan, of the University of Worcester, said that their interference could be overriding the advice from midwives and leading to greater numbers of complicated births.

Labour can last 12 to 18 hours for a woman giving birth for the first time, and the longer women are in hospital the more likely they are to receive medical interventions such as painkillers or drugs to hasten labour when they don’t need them.

Midwives try to encourage women to stay at home as long as possible because evidence suggests that the longer a woman stays out of hospital, the more straightforward her labour. Hospitals also want to avoid women blocking beds for hours before they give birth.

But a survey of 2,400 women visiting the parenting website Babycentre.co.uk and follow-up phone interviews with new mothers found that despite the advice of midwives to stay at home during the early stages of labour, many fathers had been anxious to get to hospital quickly.

Professor Mary Nolan, from the University of Worcester, said: “Women rely on their partners to support them during labour but many first-time fathers feel that they should get their partner into hospital as quickly as possible.

“Although women are prepared to heed the advice to stay calm and remain at home until they really feel like their labour is progressing fast, the fretting of their partners drove them to go in earlier than they would otherwise have done”.

The findings come as the role of fathers before and during childbirth will be debated at the Royal College of Midwives’ Annual Conference in Manchester today.

Michel Odent, a leading French obstetrician and author, will argue that men should not be present in the delivery room when women give birth, as their anxiety can be catching and make labour longer, more painful or likely to result in a Caesarean section. Men now attend more than 90 per cent of births in the UK, a proportion that has grown significantly since the 1950s.

Dr Odent believes that the birth process had become too “masculinised” in recent years, and delivery of babies would be easier if women were left with only an experienced midwife to help them, as used to be the case.

“It is absolutely normal that men are not relaxed when their partners are giving birth, but their release of adrenaline can be contagious,” he said yesterday. “When a woman releases adrenaline she cannot release oxytocin, the main hormone involved in childbirth, which can make labour longer and more difficult.”

“We have to reconsider the political correctness of the couple giving birth together; it’s not necessarily the best way.”

Duncan Fisher, chief executive of the website Dad.Info, will oppose the motion that “Birth is no place for a father”.

“Of course, not all men are nervous and a lot of women would be even more nervous without their partner there,” he said. “Mothers want them there because it is not home.”

Professor Nolan added that the presence of a caring partner in the labour ward could be valuable to women, especially if shortages of staff meant that no midwives could provide continuous care and support during and after birth.

A poll of 3,500 new mothers for the RCM this week found that one in three were left alone and worried during labour or shortly after giving birth on the NHS.

Andy Burnham, the Health Secretary, said this week that he intends to reform the system of hospital funding to take account of patients’ satisfaction rates, starting with maternity care.

Andrew Lansley, the Shadow Health Secretary is due to announce Conservative policies today which will include “drawing in the whole family around the time of birth” and improving antenatal care. “We often do not involve the father and grandparents as much as they and the mothers would like,” a Tory spokesman said.

Cathy Warwick, the RCM’s General Secretary, commented: “We support a mother’s right to choose her birth partner during labour. There is no evidence base or research, of which we are aware, to suggest that a father’s presence impedes and interferes with the mother’s birth. We will welcome a healthy discussion of these issues during the debate at the conference.”

(Written November 2009)

Having spoken previously about “pharmacological” methods of pain relief, I thought I would mention the whole host of “natural” methods of pain relief:

Movement – Walking, pacing

Changing position – squatting, kneeling

Using a chair/birth stool/birthing ball

Having a bath or shower

Using a birthing pool

Massage – oils, talc, ball

Music

Chanting, singing, nursery rhyme

Breathing, relaxation, visualisation techniques

Encouragement

Homoeopathy

Acupuncture

Hypnotherapy

TENS – Transcutaneous Nerve Stimulation

Distraction – go for a walk, bake a cake

Having a midwife you know and trust!

Having a homebirth, or at least staying at home for as long as possible!

So you can see there are many more “natural” things to help than pharmacological, so try these first!

Send me your ideas if you have more!

What is the definition of Natural Childbirth?  A hospital might say that a woman whose labour was induced and who had an epidural was a normal birth; others might say that induction, augmentation, analgesia, episiotomies etc do not constitute a normal birth!

A more radical definition of a natural birth might be a labour that starts spontaneously between 37 and 42 weeks gestation, and progresses to a vaginal birth without any intervention or pharmacological drugs.

Natural childbirth has been given a bad press – women choosing natural childbirth have been described as “hippy types” and indeed there has been an item in the press this week about a midwife who suggested that women would do better to avoid epidurals that has caused considerable outrage!

Pregnancy and childbirth are normal life events, not medical condition; a woman’s body is perfectly designed to give birth.

Of course some pregnancies and labours will need medical help – but the vast majority of women will go through their pregnancy and birth without problems and this process works best when interference is kept to a minimum.

For example anything we do to interfere with this natural processes has consequences – if mother and baby are well I am suggesting that we (the medical profession) should not interfere!

One example of this is the huge number of women whose labours are induced – why?  In some areas women are induced at 41 weeks (interestingly in France a normal pregnancy is defined as 41 weeks!).

Induction is not an easy option.  It is usually quite a lengthy process which makes the mother tired.  It is also usually more painful and the mother is therefore more likely to need pain relief, possibly an epidural … the mother is then less mobile … making it harder for the baby to find a way through the pelvis and consequently she is more likely to need the help of a ventouse or forceps, or even a caesarean section.

We all know that although caesareans are very safe in this country, it is still far safer for both mother and baby if the baby is born vaginally.  A caesarean section is major abdominal surgery which will take weeks and months to fully recover from – and the mother will have a demanding baby to care for too!  Babies born by caesarean also have many more problems, and are far more likely to need to receive Special Care.  There are also implications for future pregnancies – so, although fantastic if needed, caesarean sections are far from ideal.  The World Health Organisation recommends a 5 – 10% caesarean section rate, but our rate is approaching 30%, and I believe 90% at The Portland private maternity hospital!

This interference in birth has been called a “cascade of intervention”, because we do a) we have to do b) and because we do c) d) is also necessary this is also described as “iatrogenic” or hospital induced.  Whatever we do has consequences, for example a woman with an epidural will need more careful monitoring, she will need an IV drip and also a catheter – so you can see this spiral effect, because we do this, we have to do that and so on …

I believe there are several factors that lead to this escalation of intervention in childbirth:

Our cultural conditioning, fear, poor health habits and medical intervention in normal birth (perhaps because of fear of litigation) that make birth difficult often requiring more intervention, including surgery.

With good preparation, much intervention can be avoided – women who have a midwife they know and trust are less likely to need analgesia.  With good preparation they should be in optimal health for the birth – complementary therapies they may have experienced acupuncture, homoepathy, osteopathy or any number of helpful treatments during their pregnancy which will help align their body and prepare them for birth.  They may also have practised relaxation or hypnosis techniques all of which can be hugely beneficial.  There is also much a woman can do to help herself: mobilization, relaxation, support, the use of water …

The satisfaction that a woman feels when she has successfully given birth is amazing – it is empowering and is a fantastic start to the parenting journey, and of course breastfeeding is so much easier when you haven’t got a caesarean section wound on your abdomen.

If things didn’t work out this way for you, remember that you did the very best you could at the time.  Some labours do need help and some mothers and babies wouldn’t survive without the help of our medical colleagues.  If this has raised questions or distress for you I am more than happy to speak to you please do feel free to email me info@3shiresmidwife.co.uk

A difficult or traumatic birth experience has long-lasting implications for both the mother and sometimes her child.  We don’t have many babies in our lifetime and it is important to get things as right as we possibly can!

A baby in a “posterior” position can lead to a longer and more difficult labour and also what is known as a “backache” labour.

There is lots you can do to try to turn your baby antenatally, like lying on your left side in bed, lying on the sofa on your left side with your belly hanging over the edge.  Spending time on all-fours (wash the kitchen floor!), or sit on a birth ball and ensure that when sitting your knees are lower than your hips – a great position is to sit “backwards” on a dining chair (facing the back of the chair).

Other ideas include:

1) Belly lunges – Woman needs to stand as if about to do African dancing

(ie knees loose, bum out, body forward). She needs to put her hands, cupped together, at her syphilis pubis, supporting her belly, but not lifting it. – She then needs to lunge forward – with a contraction- and finish off with a Rocky Horror style back and forth wiggle. – she won’t find it comfortable, and may not do it effectively the first attempt – but do two with each leg, and it’s often successful!

2) Walk sideways up the stairs.

3) Nest-making – Make the woman a ‘nest’ for her belly, out of  pillows/duvets. Get her lying comfortably, face down, and leave her to rest/sleep.

4) The woman can stand sideways to a wall, and lunge against it, with her arms stretched quite high.

5) Real knee-chest – i.e. thighs at right angles to shins, and chest on the floor (followed by 5 mins on each side in a darkened room).

6) Doggy thing – woman needs to be on all fours, then cock one leg up and rest it on a chair.

7) Moxibustion

8) Cranio-sacral therapist

9) Bottom jiggling (for relaxation!)

10)Alternating hot/cold towels on the back (for pain relief)

www.spinningbabies.com has lots of great ideas.


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