Monday, September 03, 2007

That moment when you feel you can't go on...

With all my own labours there was a moment when I thought, What WAS I thinking? Why am I doing this? I want to stop! Now! I want to give up and start again tomorrow! Likewise virtually all my birth clients have had a "dark night of the soul" moment when they felt they could not possibly, possibly carry on. This is usually the moment a woman asks for an epidural. It nearly always means that birth is very near the end.
A typical example was my recent client J. who really did not want an epidural but suddenly announced during labour that she must have one, she could not possibly endure another contraction as powerful as the past 3-5. We were in a low tech labour room where epidurals were not administered so we had to walk down the corridor to the high tec unit. The intensity of the contractions indicated that she was in "transition" (as I hate calling the phase covering the end of the cervix's dilation and the beginning of the baby's descent) and the walk really seemed to help things along! As a result she was feeling the urge to bear down within minutes of reaching the second room, the midwife quietly cancelled the anaesthetist and the baby was born not long after.
It is always difficult to explain to a woman that this moment, the moment you feel you cannot go on, is the sign to her supporters that the end, the moment she holds her baby, is almost certainly very close.
After her baby was born, J. said to me, "I am SO glad I didn't have an epidural!"

Friday, August 03, 2007

The C-Section issue: "too posh to push"

This is a very good succinct article which summarises the issues around the rise in C-sections. Author Sarah Buckley points out that most women would rather have vaginal birth; she is of the opinion that the medical establishment pushes the C-section rate up; points out how much more risky C-sections are than most mums realise; and rightly adds, "if you didn't know, the pushing can be the best part!"
This was how it was for a doula client of mine recently who said as she felt the urge to push, "I'm really enjoying this!",20867,21770725-7583,00.html?from=public_rss

Tuesday, June 26, 2007

Nancy's triumphant birth on Home Grown Babies!

My lovely HypnoBirthing client from last November, Nancy Evans, featured in the Living2 series Home Grown Babies a few days ago.
Her first labour had been a traumatic hospital experience filled with fear and confusion and at one point Nancy is seen bursting into tears at the memory.
Her birth was amazingly tranquil. She speaks during the labour of how comfortable and peaceful and safe she feels!
For the record, she went into labour about 8am, went into the pool about noon and baby Sid was born just after 2pm. The midwives were amazed by how peaceful and serene Nancy was throughout the labour. Apparently she didn't cry out or complain of pain once.
If you are looking out for the series, which will hopefully be repeated, check out episode 9 for Nancy's story.

Thursday, April 26, 2007

Home Births

Evening Standard 5 April 2007

Delivering the truth on "risky" home births

Any woman with a low risk pregnancy in London would be mad not to consider a home birth, especially if she has had a baby before.
In the capital, a transfer to hospital only takes a few minutes by ambulance. If things look dangerous, a midwife will advise a transfer long before those few minutes become critical.
Last weekend I found myself wondering yet again why humans are the only mammals who respond to birth pangs by running away from home to a huge, unfamiliar building. I am a doula, a professional birth companion. My client and I were trapped for hours in a Victorian pile with bloodstained communal toilets and broken plumbing – a Ghormenghast of a place. Not the cosy nest other mammals prepare, but the labour ward of St Mary’s Hospital, Paddington.
The hospital website boasts of “a caring and pleasant environment, excellent labour facilities with individual birthing rooms and a birthing pool”. We are wedged into a tiny room that is nearly all bed and machinery. One of the rooms opens directly onto Reception, and none have curtains screening the doors. Staff barge in frequently and interrogate my client in mid-contraction. Builder’s rubble fills the one shower stall: the ceiling has fallen in.
A labouring woman needs to be mobile to help her baby to move down – no hope of this in the few inches of space between the bed and door. Someone, somewhere, is playing pop music ceaselessly through the night. The whole building is shouting at us: “Give up! Have a C-section!”
Birth is the work of the instinctive part of our brain, which needs a familiar, private environment to function well. It is not good at accepting strange situations – and it can be very stubborn. So while the thinking part of the brain “knows” that hospital is “safe”, the primal brain is saying, “I don’t know this place or these people, I’m going into emergency mode and slowing down labour right NOW!” Fear increases tension, which increases pain.
A third of Dutch women give birth at home. Dutch women are not known for being masochists: they are known for being sensible. Doctors who gleefully recount the risks of home birth (based on statistics from rural districts in other countries) less often mention the problems of hospital interventions even in wards far more pleasant than Paddington’s Ghormenghast.
Few people realise that a midwife’s homebirth pack includes entonox and other pain relieving drugs, and resuscitation equipment. Few know that home birth in the UK died out only because Sir John Peel , the Queen’s Surgeon-gynaecologist, believed that birth would be safer in hospital than in 1960s working class homes with outside toilets.
Things are different now. We no longer live in slums, we have MRSA in hospitals. It is time to put aside Peel’s patrician scruples, and bring birth home.
Sarah Johnson

Tuesday, January 02, 2007

Ten things to know when you are having a baby

I love this list! I can't disagree with any of it, try as I might. Fiona Dill writes for the local paper in Bermuda. Suddenly I wish I'd had my babies in Bermuda.

Ten things everyone should know before giving birth
By Fiona Dill
1. Be well informed: Gather as much information about pregnancy and birth as you can, and try and attend childbirth education classes...Going to classes should help give you the up-to-date information to make informed choices about your birth, pain relief and other options that are available to you. The chances are that as a result, you are more likely to feel better able to cope with the prospect of labour and birth. It's also a great way to meet people who are in the same situation and make new friends.

2. Make a birth plan: Using the information you have learned from the classes and other sources you will be able to put together a plan for your birth. Flexibility is essential but it will help you to focus on what you want and help your obstetrician and the midwives caring for you to know what you are hoping for... through your childbirth education classes and discussion with your obstetrician, you should be able to discover what is important to you and what is relevant to the [local] situation, and this can be put in your own words on your plan.

3. Get good support: A supportive birth companion (aside from your midwife) is one of the most effective forms of care a woman can receive in childbirth. Research shows that it has far more influence on the way you feel about the birth afterwards than even the pain relief you opt for. Although most fathers want to be at the birth, it's not right for every man and is something that must be discussed before labour begins! If you feel close and very comfortable around your partner, able to do your own thing without feeling inhibited, then going through birth together may work well and be a very special experience for you both. Other options might be a mother, sister or close friend. You might also choose to have a doula who can relieve the pressure from the father and facilitate his participation at his own comfort level.

4. Help your baby into the best position: There is no doubt that your labour will be easier if your baby is in the optimum position for birth – head down with the back of her head towards your front. There are various things you can do that may encourage the baby into the best position … try kneeling on all fours or leaning over a exercise ball while you are watching TV, or leaning forwards slightly when you are standing (supporting your upper body on a shelf or your partner (!) and gently swaying your hips in a circular motion). Ask your obstetrician, midwife or childbirth education teacher for more details.

5. Recognise the latent phase of labour: This is a very important part of labour and is often the longest. Women often report 'niggling' contractions for days, or the contractions can stop and start which is exhausting and frustrating. If you can stay relaxed and try and get as much rest as you can during this phase and recognise you are not yet in established labour, it'll mean you are more ready when labour really 'kicks in'!

6. Relax!: Relaxation is the key to an easier birth. It is unrealistic to think you'll be able to do this in labour with no preparation so your childbirth education classes should cover it.

7. Communicate: Talk to your obstetrician and midwives. They are there to offer you support and advice during your pregnancy, labour and birth. Discuss with them your hopes and fears, find out what your options are if you go overdue, your waters break before you go into labour, different positions for the birth, what you can do if your labour slows down, choices for third stage (delivery of the placenta) and so on.

8. Don't rush to the hospital: It might be tempting as you're so excited that your labour has finally started, but many women get to the hospital before they are in established labour (ie, their cervix is 3-4cm dilated), which can mean either returning home or spending the majority of your labour in the hospital. Contractions should be strong (lasting around 60 seconds), regular and about five minutes apart. There are obvious exceptions to this: if you are GBS positive or your waters go before your labour starts. It is a good idea to discuss with your obstetrician what their preference is for when you should go in and if in doubt, ring the hospital and speak to a midwife who will be able to advise you as to the best thing to do!

9. Keep on the move: Changing position during labour is of great benefit, both in helping you deal with the contractions and in encouraging the baby through the pelvis in the best position. Women who walk around in labour or who remain upright are less likely to need pain relief and more likely to have a straightforward birth. When you first arrive at the hospital you will usually need to be monitored on the bed for ten to 20 minutes to check that all is well with the baby, but once the midwife is happy with the results then you are free to get off the bed and mobilise as you want to ... walking, leaning over onto the bed, using a birthing ball, sitting on the toilet etc. If your labour is long and you are tired you can lie on your left side on the bed or be propped up leaning over the head of the bed. Ask your midwife for some more ideas if you need some inspiration and encouragement!

10. Be positive: Arming yourself with information, getting to know your body and staying active can all help towards you achieving the birth you want. Although some women definitely need interventions for the safety of their baby or for themselves, many more women can give birth safely without them.

Fiona Dill is the mother of five children, a nurse (BSc (Hons) in Nursing Studies), a childbirth educator (Diploma in Antenatal Education), a doula and a parenting course facilitator. Her column usually appears every other week in Saturday's Weekender section. Contact: