Valerie Gommon Midwife’s Blog

Archive for the ‘labour’ Category

This is a guest blog, written by one of my clients.

My name is Donna and I am a mother of three.  Two year old Grace and nine week old fraternal twin girls Olivia and Faith.

My husband Paul and I had always agreed that we didn’t want a big age gap between our children so when Grace was one year old, we decided to begin trying for baby number two.  I fell pregnant fairly quickly but unfortunately suffered a miscarriage at 5 weeks which was very upsetting.  After a few weeks we were ready to try again and as before, I fell pregnant within a couple of months.

I was very anxious during the first few weeks hoping that this time I would hold onto the baby.  At 12 weeks it was time for the scan.  I was feeling quite relaxed as the pregnancy was going well and I was feeling extremely sick which I thought was a good sign.

The last thing on my mind was the fact that I could be carrying twins.  When the ultrasonographer casually told us ‘oh, you have two in there’, we knew that our lives were going to change forever.  I didn’t know whether to laugh or cry – so I did both!  Everyone in the room was so excited for us but my husband and I were just stunned.  His face was a picture.  They told me that the reason why I had felt so sick was due to the additional hormone racing round my body. They also told us that the twins were fraternal and each had their own placenta and were in their own sac which is the safest type of twin pregnancy.

The first feeling I had once I had calmed down was that of being pregnant for the first time.  My pregnancy suddenly went from having a singleton baby and feeling confident that I had done this before so it will be ok, to all the anxieties of a first time pregnancy.

I knew that I had to do my research so as I could make some informed decisions about my pregnancy and birth.  When I told the ultrasonographer that I was planning a home birth, her reaction was ‘oh, you won’t be able to do that with twins’.  I had a fantastic pregnancy with Grace and had her at home in a birthing pool.  The thought of having to follow a medical route and have my babies in hospital filled me with dread.

As with my first pregnancy, I chose to take on an independent midwife.  This was my preference as I knew I would be less likely to end up with a hospital birth.  I made sure I looked after myself by eating well, getting plenty of rest (as much as Grace would allow me!) and exercised regularly.  I found swimming was great for keeping me fit and taking the weight off my bump.  I had regular scans to check on the twins’ development and position.  Throughout the pregnancy, Olivia (first born) remained head down and Faith was breech.  I knew that this wasn’t ideal but also knew after doing some research that as long as Olivia remained head down and although a little more risky, I could still safely deliver Faith as breech.  At 38 weeks I went for my final scan and to my surprise, Faith had done a full turn and was now head down along with Olivia.  The perfect combination for birth.

We had put together a birth plan that covered every eventuality if I needed to be transferred to hospital at any stage.  Two days after my last scan; my waters broke at 9.30pm when I was lying in bed.  I felt a pop and then a head drop down.  I walked into the bathroom and called downstairs for Paul saying ‘I think my waters have broken!’  He chased upstairs and I told him to call the midwife.  My contractions started almost immediately after my waters broke.  I spoke to my midwife and she told me to go back to bed as things may not start to happen until the morning and I would need my rest.  Olivia was not going to wait until morning.  I came downstairs and stood in the bathroom leaning over the toilet with my contractions coming fast and furious.  I tried the TENS machine but that didn’t really work for me.  Paul was in the dining room putting together the birthing pool which I got into as soon as it was ready.  The relief was immense.  I had heard that water was the most effective pain relief next to an epidural – I can well believe that.

I had four midwives looking after me and the babies and they all arrived at my house in time.  It was all happening so quickly and Olivia was born in the pool at 11.55pm.  She shot out and I heard her crying straight away.  I stood up and held my baby; I was elated and also amazed that my babies would have their own birthdays.  One of my midwives held my stomach to make sure that Faith fell and engaged in the right position.  We knew she was head down so we needed to make sure she stayed that way.  We decided to wait for my labour to progress naturally however, it slowed down.  I got out of the pool to walk around and see if I could get it started again.  Four hours passed and a decision was made to break the waters around Faith as the midwife discovered they were still intact.  As soon as the waters were broken, Faith was born on the sofa, again extremely quickly.

She cried straight away and the midwife placed her on me so as I could give her a cuddle and have skin to skin contact.  Another of the midwives was looking after Olivia.  Both my babies were born healthy and I couldn’t have been happier than I was just then.

The down side was that I now had to deliver the placentae.  I was so tired but knew I had to keep going.  One of my midwives helped to keep me relaxed with hypnobirthing techniques and control my breathing.  The placentae had fused together and were not budging.  With a combination of experience from my midwives and a hot towel placed across my stomach, the placenta moved and came away.  If it hadn’t been for the determination and skill of the team of midwives, I think I would have ended up in hospital with a retained placenta and that would have been disappointing after going through the entire birth at home.

So all was well.  I was in good health and although extremely tired, felt elated and proud that I had accomplished the birth I wanted.  My husband Paul was fantastic during and after the birth and I couldn’t have asked for a more supportive birthing partner.

A home birth is not for everyone and if there had been a health issue with either myself or my babies, I would have chosen hospital care.

I wanted to share my story so as other women can see that you do have choices during pregnancy even when you are having twins and you can make decisions that are right for you.  For more information about twin and multiple pregnancies visit www.tamba.org.uk

Donna has also set up a website which offers information about homebirth; she offers a free ebook at www.happyhomebirth.com

I guess this may be more useful if you are planning to hire an Independent Midwife as with the NHS there is less choice, but you still do have a choice of midwife and should remember that if you don’t get on with your midwife you can ask the local Supervisor of Midwives (at the local maternity unit) to help you to find a new midwife.

If looking for an Independent Midwife, I would suggest that you start by looking at www.independentmidwives.org.uk where you can enter your postcode to find the midwives who live closest to you.  This website will then lead you to look at the midwives own websites and you should get a “feel” of the midwives from their websites.  The next step is to email or telephone your favourite midwife(s) to have a chat with them, again this should help you to gauge whether they might be the right midwife for you.

The midwife will want to know where you live (to ensure that she is able to travel to you), she will also want to know when your baby is due (to ensure that she is free at that time) and whether it is your first baby.  If you have had a baby/babies before I would expect her to ask about your experience.  She will also be keen to know where you plan to give birth.

Questions you may like to ask of the midwife include:

How long have you been a midwife? / An Independent Midwife?
Do you like homebirths/waterbirths?
Do you have additional skills (hypnosis training etc)?
What would happen if my baby is breech/I am expecting twins?
What is your normal birth rate?
What is your caesarean rate?
What is your breastfeeding rate?
What is your homebirth rate?
What is your transfer rate?
How much do you charge?
What can I expect from you?
Antenatal care? Labour and birth care? Postnatal care?

I would expect an Independent Midwife to outline the issue of the lack of professional indemnity insurance to you.

If you enjoy speaking to the midwife, I would suggest that the next course of action might be to arrange a consultation.  The midwife will usually be happy to come to your home to meet you and your partner to discuss things in more detail.  Many midwives make a small charge for this meeting to cover their time and petrol costs (this meeting make last a couple of hours) and will be an opportunity for you to ask any questions of the midwife and again to enable you to decide whether she is the right midwife for you.  Most midwives will deduct this fee from the final balance if you decide to book with them.

Some women do “interview” a couple of midwives, and this is perfectly acceptable and perhaps a sensible approach as it will be an important relationship.

An Independent Midwife’s fee may seem expensive, particularly when you can get a similar service for free on the NHS, but I always say to clients that you won’t have many babies and it is important to get things right!  It may be better to employ a midwife and wait a bit longer for the new car or foreign holiday!  An Independent Midwife will usually give you a lot more time than an NHS midwife is able to; she will see you more frequently and give you longer appointments.  The other main benefit is that you will see the same midwife throughout your pregnancy, birth and postnatal period.

I wish you well in your decision-making whether you choose an NHS or Independent Midwife, and if I can be of any help to you please feel free to email info@3shiresmidwife.co.uk

Homebirth

Posted on: July 17, 2010

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

The British Government policy is to encourage homebirth www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073312) and in the Netherlands 30% of babies are born at home – would they really be supportive of homebirth if it were so dangerous?  A large retrospective cohort study from the Netherlands in 2009 http://www.welbornbaby.com/images/Home%20Birth%20Netherlands.pdf confirmed that the planned place of birth was not the main factor in contributing to perinatal morbidity and Low-risk women should be encouraged to “plan their birth at the place of their preference, provided the maternity care system is well equipped to underpin women’s choice”.  Furthermore, also published in 2009 was another study, from Canada http://www.sciencedaily.com/releases/2009/08/090831130043.htm which showed that planned home birth in low risk women were comparable to hospital births.  Both these studies concur with the latest US study http://www.sciencedaily.com/releases/2010/07/100701072730.htm demonstrating that women who plan home births experienced significantly fewer medical interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative vaginal and caesarean deliveries. Likewise, women intending home deliveries had fewer infections, perineal and vaginal lacerations, haemorrhages, and retained placentas. Data also showed that planned home births are characterized by less frequent premature and low birth weight infants.

This same American study is often quoted by obstetric practitioners because a conclusion read that infant mortality was trebled by planning a home birth, but suggested “it was because of an increased need for resuscitation among home births and therefore, the personnel, training, and equipment available for neonatal resuscitation represent other possible contributors to the excessive neonatal mortality rate among planned home births.”  The methodology of this study has also been severely criticised www.nct.org.uk/about-us/what-we-do/policy/choiceofplaceofbirth.

In conclusion, planned home births are very safe.  It is the presence of trained midwives with correct and necessary equipment that is most important factor, rather than location, in regards to safety of mother and baby.

I have recently had a client birth her twin girls at home.  To give birth to twins at home is a rare event; it is obviously slightly more risky that a single birth.  My client carefully considered the risks and benefits of homebirth.  She had previously given birth at home and felt that for her home was the right place.  She knew she would feel safe, relaxed and that her labour could not be “interfered” with (for example many women expecting twins are encouraged to have an epidural and to give birth with the help of doctors in theatre).

Her pregnancy progressed well; an ultrasound scan showed that the twins were dichorionic, diamnionic which gives the best possible prognosis as each baby was in it’s own amniotic sack and had it’s own placenta.  My client chose to have growth scans which showed that her babies appeared to be growing well and equally she declined the option to see an obstetrician as she felt this might be undermining.

We were mindful that a woman with a twin pregnancy needs excellent nutrition to grow two babies, and to maintain her health and wellbeing and my client ensured that she ate well, especially iron rich foods, protein and extra salt (as suggested by Dr Tom Brewer).    As she experienced pelvic discomfort, she saw a chiropractor throughout her pregnancy and found this to be beneficial; she also experienced heartburn as might be expected with a twin pregnancy.

During the pregnancy we made extensive plans about how we expected the birth to progress; what we would do in the event of  problems and who we would have present at the birth.  We planned to aim for the most experienced team we could muster.  In the event we had four midwives – not because we felt we needed four, but because the midwives were keen to attend a twin birth, and my client was very happy to have them present.

On scan at 36 weeks we were surprised and pleased to learn that both babies were cephalic (head down).  Previously the second baby had been in a breech position.

My client laboured at 39+ weeks.  Her labour was fast and the first baby was born in the birth pool within two hours.  There was a bit of a delay but her second daughter was safely born in good condition and although initially tired, she has recovered well and is doing really well.

This was a fabulous outcome – I was blessed with clients who were strong, did their research and knew that they wanted to give birth at home.  They did not want a homebirth at all costs and would have transferred to hospital if I felt that there was a clinical need.

Introduction to Homoeopathy – Ursula Kraus-Harper

Thursday 17th June 8 – 9.30 pm

Talk at NCT event Medbourne Community Sports Pavilion, Pascale Drive, Medbourne

Milton Keynes Antenatal Exhibition

Sunday 20th June,

2-4.30 pm FREE entry,

Christ the Cornerstone Church, CMK opp M&S bit.ly/dBsLmL 300 Saxon Gate West, Central Milton Keynes, MK9 2ES.

FREE entry, refreshment and goody bags. An opportunity for expectant parents to gather information on all aspects of pregnancy, birth and early parenting. Exhibitors include: midwives, breastfeeding, waterbirth, cloth nappies, complementary therapies, ultrasound scan, baby massage, aquanatal and much more!

Please contact me info@3shiresmidwife.co.uk for more details.

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)

We have had two weeks of the eight week Channel 4 documentary series ‘One Born Every Minute’.  The series follows the day-to-day life in a maternity ward and was filmed over the course of a month.  The programme goes out on Tuesday evenings at 9pm.

The programme highlights the intense experience of childbirth from the perspective of both parents-to-be and also midwives and maternity ward staff. 

The programme, for me, is very interesting and also very realistic of the pressures faced by staff and women alike, however it is edited in a very dramatic style featuring women screaming, babies crying and moments of intensity and drama (of course, this is TV!).  I have had clients contact me having been quite upset by the programme.  I just hope they also show some of the lovely normality of birth, the quiet, serene, beautiful births and not just the drama.

http://lifebegins.channel4.com/


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