Valerie Gommon Midwife’s Blog

Archive for the ‘birthpool’ Category

Sunday 4th October, 2 – 4.30 pm

FREE Antenatal Exhibition

For pregnant women and their birth partners to find out about all aspects of pregnancy, birth and early parenting.  Exhibitors include: midwifery, breastfeeding, waterbirth, aquanatal, yoga for pregnancy, cloth nappies, ultrasound scans, complementary therapists, childcare vouchers and much more!

Venue: Church of Christ the Cornerstone (opposite Marks and Spencer), Central Milton Keynes.

Do come along to our informal and informative exhibition, or for more information you can email info@3shiresmidwife.co.uk

Prior to labour:

Inflate pool, test for filling and ensure tap connectors are correct

Early labour:

  • Have pool up and perhaps begin to fill
  • Have calm, relaxing music
  • Lots of positive encouragement for your partner
  • Does she want any light food
  • Encourage drinking regularly
  • Encourage her to pass urine every hour or two
  • Does she want to use the birth ball
  • Does she need to rest
  • Does she want the TENS machine
  • How about a bath/shower

Also remember to eat and drink yourself!

Help by breathing together through contractions – have eye contact

Offer massage, back, tummy, hands and arms, neck, head

Remind your partner that the baby is coming, that this is all normal and positive!  Babies usually take their time!

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!

I confess that I’ve been quiet – I’ve actually been away!  As I have no babies currently due (in my Independent Midwifery Practice www.3shiresmidwife.co.uk) we took advantage and went up to the wilds of Cumbria for a week and had a great time staying at Dent railway station www.dentstation.co.uk – my husband is a train spotter!  So lots of walking, snow, eating and drinking for a week – fantastic.

Whilst away I saw a couple of interesting items in The Daily Telegraph.  One article discussed that scientists have found that young women are sensitive to babies physical appearance whereas post-menopausal women and men were less able to distinguish between babies.  The researchers believe that the difference could be a hormonal one and plan further research in relation to postnatal depression. www.telegraph.co.uk/scienceandtechnology/science/sciencenews/4306406/Women-can-distinguish-cute-babies.html

In the same newspaper there is an item discussing that early terminations of pregnancy (up to 9 weeks gestation) are to be provided in some GP surgeries www.telegraph.co.uk/health/healthnews/4306534/Abortions-in-GP-surgeries-to-be-extended..html

On a happier note, today I have been to a first birthday party – the baby was born at home a year ago.  Her mother had previously had a caesarean with her first baby but really wanted a natural birth second time around.  She laboured in a birthpool and had a relatively short and easy labour and birth second time around – wonderful!  It was lovely to visit and catch up with the family.

VBAC or vaginal birth after previous caesarean section has previously been controversial, but with better surgical procedures even doctors are keen that the majority of women attempt a vaginal birth next time as this is a safer option for both mother and baby.  Obviously it is important to review what happened during the last labour, and for some women a repeat caesarean may be the best option, but for many a vaginal birth will be possible.  Doctors and many midwives will recommend that a woman planning a VBAC give birth in hospital and that she be closely monitored, for example by having continuous external monitoring of the baby’s heart, and by having intravenous access in case of  uterine scar rupture which is a rare but very serious possibility.  Scar rupture rates are quoted at between 1:200 and 1:2000 depending upon which research you read, there is an excellent booklet discussing the subject “Birth after Caesarean” published by AIMS www.aims.org.uk/pubs3.htm However there are some who believe that by labouring at home, in a calm and relaxed environment, with no monitors or drips, will give the woman the best chance of giving birth normally.  Indeed some hospitals are now comfortable with “allowing” VBAC clients into the birthing pool for labour.  Most midwives and doctors agree that women attempting a VBAC should not have their labour “interfered” with; it can be dangerous to induce or augment a labour when a woman has a scar on her uterus.  If you are considering a VBAC I recommend that you discuss the matter carefully with your midwife or doctor and give yourself the very best chance of having a normal birth next time – many, many women are now achieving VBACs, and indeed I know of several women who achieved vaginal births after several previous caesareans so it is possible!

When the big day comes you will have learnt lots of things that can help you, for example you might like to have a bath or shower which can really help you to relax. Early labour will probably feel a bit like period “cramps” and bathing or a hot water bottle may well help as can taking a couple of paracetamol if you wish.

Moving around and adopting different positions is also another useful thing to do – you might find that walking, marching or crawling around on all-fours might help. It is fine to go out for a walk in early labour if you feel up to it, and it is a good idea to find something constructive to do – perhaps watching a film. If you possibly can you should also try to have a nap – you will probably be working very hard for the next 24 hours, another tip is to have something light to eat and drink plenty as you will need the energy later!

TENS which is a small, battery operated machine can help; the idea is that you put the electrodes (or sticky pads) into four specific places on your back and the machine sends an electric impulse to the pads which are placed over nerve endings. TENS works in several ways, it boosts the body’s endorphin production (endorphins are our natural pain killers), it also blocks pain messages to your brain and lastly it is a distraction! Many women find TENS helpful – the trick is to put in on fairly early in your labour – TENS machines can be hired fairly inexpensively from some supermarkets, pharmacies and even some hospitals.

Soft lighting, music and massage can be relaxing – especially massage to the lower back as many women experience backache in labour. Either using hands, a nice oil or even rolling a tennis ball around on your lower back will probably feel really helpful. This might be something that you can practice with a birth partner prior to labour.

Most women find that staying active, listening to what their body tells them, is helpful. If your body is telling you to rest, then rest, if you feel better pacing around then pace. Having a supportive birth partner (or partners) is also invaluable – having a woman who has successfully given birth before is really helpful and can allow your partner time to eat, rest or even pop to the toilet! Speaking of toilet – remember to pass urine frequently yourself, ask your partner to remind you to wee every couple of hours at least as a full bladder can hamper descent of the baby’s head.

During the labour, use any breathing/relaxation techniques you have learnt, sit on a birthing ball, practice hypnotherapy, use your TENS machine, be active, sing, chant, make a noise, use massage, visualise your baby, your cervix opening – ask your partner to encourage you and to look deep into your eyes and breathe with you or use any complementary therapies that you have prepared (homoeopathy, oils, acupuncture etc).

I would encourage you to consider not using the birthing pool until the “going gets tough” and then you have somewhere else to go, somewhere that may be blissfully relaxing.

So you can see there really is quite a lot that you can do to help yourself in labour!

If you have tried all these techniques but still need more help there are drugs that the midwife can give you, for example entonox (known as gas and air) – this is not thought to harm either mother or baby and if you don’t like it you can just stop using it at any time. Most women think entonox is really helpful – it is just a mixture of oxygen and nitrous oxide which you breathe in through a mask or mouth-piece. It can occasionally make women nauseous and may make you feel a bit drunk!

The next level of pain relief available is an injection (usually given into your leg or bottom); the type of drug varies in different areas, but is usually meptid, pethidine or diamorphine. These drugs can make you feel drunk and a bit “spaced out” – some women really find them helpful, but other women don’t like them – I guess if you are needing help at this stage the answer is to try them and see what you think. The disadvantages are that they can make you sick (they are usually given with an anti-sickness drug for this reason) and may make you feel “out of control” and the effects of the drug will last for some time. The baby will also get a dose of the drug and this may make the baby sleepy at birth and make feeding slightly harder to establish.

If you require something stronger an epidural may be the answer, this is when a local anaesthetic is injected into your back. The advantages are that this usually offers good pain relief, especially when labour is long – you can usually sleep and rest once you have an epidural. However there are also disadvantages in that you have to stay very still whilst the epidural is sited and you will need a drip and probably a catheter to help you to pass urine. Your movement will be restricted and your baby will need to be continually monitored as very occasionally the baby can become distressed. Other disadvantages are that the epidural may not be 100% effective, some women experience “break-through” pain and occasionally further complications, also because there is a lack of sensation to “push” the baby out you might be more likely to need additional help with the birth.

In summary, you can see that there are lots of things you can do to help yourself during the labour, but if you need additional help there are drugs onoffer to help you.

 


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