"The Folly of 'Fully'"

Practising Midwife May 2009

Sara Wickham's article breaks into the accepted idea of 10 centimetres exactly as the universal "fully dilated" measurement.

I have always thought 10 centimetres was a suspiciously round number. I mean, did someone at the Academie Francaise des Sciences, where the metric system now called the ISU system first saw the light of day, think hard and say, "I know, let's measure a woman's fully dilated cervix, and adopt a standard measurement exactly ten times that, and call it a metre!" I don't think so.

Indeed history tells us that the metre was originally defined as one ten-millionth of the distance from the North Pole to the Equator along the meridian which runs near Dunkirk and Barcelona. Even though you could presumably fit exactly one million fully dilated cervixes along that line, I doubt this was a test uppermost in the Academie's minds.

Wickham proposes that a normal range for "fully" or as one of my doula friends says, "fully delighted" would be more natural and more in line with the acceptance of RANGES of normality for all other measurements in childbirth.

Great birth story

Another fantastic birth story from a HypnoBirthing client today.
Her waters broke early one evening, she went briefly to hospital for a check, and within 24 hours she was having 20 second surges every five minutes (she rang me around 7pm to tell me). This intensified through the night, she managed the night with a TENS and HypnoBirthing breathing. When she got to the birth centre at 5am she was 7 centimetres dilated.
The first water leakage must have been hindwaters as as she stepped into her birthing room her forewaters went with a gush. She got straight into a birth pool and after quite a long second stage birthed her little girl. The long second stage was mainly due to the baby's having her hand up by her face.
She had no pain relief besides the TENs at first then the pool - otherwise she depended entirely on the self-relaxation and breathing techniques I had taught her in her HypnoBirthing sessions. Partner stuck her special birth pictures up around the room when they got to hospital. She listened to her HypnoBirthing affirmations throughout the second stage pushing.
In her own words she felt calm and relaxed throughout her labour!

Home Birth Safety - major study

Major study in the Netherlands shows home birth as safe as hospital for low risk mothers, reported 15 April 2009:
http://news.bbc.co.uk/2/hi/health/7998417.stm

Very stupid and annoying columnist called Melanie Reid in The Times the next day:


http://www.timesonline.co.uk/tol/comment/columnists/melanie_reid/article6101189.ece

Well, Melanie Reid, how would you like to be told you, or women like you, are "spoilt and complacent" because you insist on tying up scarce NHS resources with your expensive, consultant-delivered epidural anaesthesia and the cascade of interventions, requiring more and more medical staff to be involved in the delivery of your baby, which it often brings in its wake?
You wouldn't like it one bit. And of course no birth professional would be so purblind, mean-spirited and stupid as to describe a woman as "selfish" because she insists on the kind of high-maintenance birth environment Melanie Reid clearly thinks is essential for all women. Yet she thinks it is fine to throw this abuse at other women who want to make different choices.
How sick I am of women journalists who think that because they had a baby once, they know all there is to know about EVERYONE ELSE's labour and birth!

Euphemisms and birthing language

The language around birth is very important. With HypnoBirthing it is all-important since hypnotherapy is an entirely language-based therapy.
in this month's "Practising Midwife", the distinguished midwife Sara Wickham discusses euphemisms such as "pop" - "often preceded by the word just"..."an attempt to soften any number of clinical procedures which are routine but which individual women might not consent to if it was made explicitly clear that she had a choice"
and points out, perhaps subversively, that language which softens ie makes less frightening a procedure might not be bad. "I avoid using medical terms that I perceive as fear-filled (haemorrhage, risk factor) and choose words which I feel to be less hormonally and emotionally upsetting to women (bleeding, challenge).
She prefers calling sanitary towels bunnies - "removes the connotation of dirtiness"
She mentions Ina May Gaskin's rushes for contractions, but sadly not the HypnoBirthing surge...
She might have added that linguistically many of these "less threatening" words are of Anglo-Saxon origin instead of Latin/Greek origin.
Wickham S Euphemisms: good, bad or ugly? (2) The Practising Midwife Vol 12 Number 4 April 2009 page 35
Also refers to Nicky Leap (1992). The power of words, Nursing Times 88:60-61

Pre-labour cervix weeping

Back in October 2006 - have I really been a doula all this time? I noted with interest in this blog a midwife discussing the phenomenon of the cervix "weeping" a few days (5-7) before going into labour.
Well whaddyaknow, my current birth client seems to have had that exact experience last night, at 38 weeks exactly. It was so noticeable, with a distinct "gush" of clear fluid, that she thought it might be her waters breaking and we were on the QV all night.

Home Birth as safe as hospital birth

http://news.bbc.co.uk/2/hi/health/7998417.stm

Strange that it is thought that breech birth and prolonged labour can only be dealt with in hospital.

Excellent birth story from a US HB mum

http://bebeprocawood.blogspot.com/2008/04/here-it-is-neils-birth-story.html

Home Birth: The Sunday Telegraph

Excellent and factual article about home birth in Sunday Telegraph and no scare-mongering.
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/03/09/nhomebirth109.xml

new breastfeeding helpline

A breastfeeding helpline to support new mothers has been officially launched by the Government. Public health minister Dawn Primarolo announced a £150,000 year package for the advice line to give women practical support and information. Studies have shown that babies who are breastfed are less likely to be obese in later life and gain protection against conditions like asthma, eczema and chest infections. Mothers benefit too, with studies showing a protective effect against ovarian and breast cancer. The Department of Health recommends exclusive breastfeeding up to six months, with continued breastfeeding alongside solid foods afterwards. A new report published by the Scientific Advisory Committee on Nutrition (SACN), suggests a need for more support for new mothers. It looks at the Infant Feeding Survey of 2005, which showed breast feeding rates went up from 69% in 2000 to 76% in 2005 across the UK. However, only half of women in England were still breastfeeding after six weeks. The Government cash will help support the new helpline, which will be run by two existing networks. The Breastfeeding Network and the Association of Breastfeeding Mothers, which receive around 28,000 combined calls each year on breastfeeding, will merge and run the advice line. The Government hopes the newly-created National Breastfeeding Helpline will be able to handle a far higher number of calls than either organisation on their won. The new helpline number is 0844 20 909 20. Copyright © 2008 The Press Association.

Great waterbirth

My client X asked me to be her doula for the second time, a year after I attended the waterbirth of her second child.
We had some doubts about whether this would be a straightforward labour...but as it turned out, it was totally straightforward.
X had some cervical issues that might well have given some doctors reason to refuse to support her choice of natural labour. But the hospital we were at respected her as an intelligent informed mum and agreed to support her wishes. In the event, the cervical issues made absolutely NO difference to a steady dilation speed and a strong labour which ended with a gorgeous waterbirth of a beautiful baby girl.

Nancy's HypnoBirthing home water birth

In 2006 I had the privilege of being the HypnoBirthing educator who led Nancy and her husband Tecwin through the HypnoBirthing programme. Their progress and Nancy's remarkable labour and the birth of Sid, their second son, was tracked by the series Home Grown Babies (first shown on Living TV).
Someone (don't know who yet) has put extracts from the episode on YouTube. It is an amazing story.

http://www.youtube.com/watch?v=Ks1-23fcERg&feature=PlayList&p=31717DCA62BBD447&index=0

http://www.youtube.com/watch?v=6HiljszP1FE&feature=PlayList&p=31717DCA62BBD447&index=1

(begins with a bit of an interview with me in it)

http://www.youtube.com/watch?v=M75c73A22vE&feature=PlayList&p=31717DCA62BBD447&index=2

This bit shows the birth.

Guardian letters page

Jennifer Hall says it all:

http://www.guardian.co.uk/letters/story/0,,2186472,00.html

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!"

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!"

http://www.theaustralian.news.com.au/story/0,20867,21770725-7583,00.html?from=public_rss

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.
HYPNOBIRTHING WORKS!!!!
If you are looking out for the series, which will hopefully be repeated, check out episode 9 for Nancy's story.

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

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: fionadilllogic.bm

More women choosing home birth

From the Daily Mail 14/12/06


More women are choosing to give birth at home.
Figures from the Office for National Statistics showed that 17,279 UK births in 2005 took place at home, compared with 15,198 in 2004.
Analysis by the NCT showed that the biggest increase - 18.9 per cent - was in Wales, where ministers have pledged to increase the number of home births.
That figure is up on the 16.2 per cent recorded in the previous year.
Wales now has a home birth rate of 3.61 per cent - the fastest growing home birth rate in the UK, the charity said.
England meanwhile had a below UK-average rise of 13.4 per cent for the same period, with a home birth rate of 2.53 per cent.
Scotland had the second highest rise in the number of home births with an increase of 14.6 per cent over the period, the NCT said.
In Northern Ireland, the number of home births fell by 12.9 per cent, resulting in a home birth rate of 0.33 per cent.
Mary Newburn, head of policy at the NCT, said: "Wales is now leading the way in provision of home birth services and choice for women.
"It would be fantastic if England could emulate this success, but the evidence suggests this will only happen if there is a commitment to a specific health service target to increase the home birth rate.
"Currently women in many areas of the UK still find it difficult to choose a home birth.
"There is not enough balanced information available to enable them to make an informed choice about where to have their baby, and the shortage of midwives means that too often the option of a home birth is either not being offered or services end up being withdrawn at short notice."
The Government has pledged to increase women's choices when it comes to where to give birth. Ms Newburn said: "The Government's aims now need to be realised so that women are able to benefit from a real choice of where to give birth, including at home.
"We know of many low-risk women all over the UK, including Brighton, London, Liverpool and Leeds who have had straightforward pregnancies yet have been denied a home birth in the last 12 months for reasons beyond their control."
TV presenter Davina McCall, the NCT's ambassador for home birth, said: "I gave birth to all three of my children at home and it was truly amazing.
"It's great to hear that more and more mums are having the same fantastic experiences, but isn't it a shame that a lot of other women still won't have their wish to give birth at home come true this Christmas?"
but there are wide regional variations, the National Childbirth Trust (NCT) said today.

Epidural anaesthesia and breastfeeding

A study published in the International Journal of Breastfeeding has found a link between epidural anaesthesia and unsuccessful or hard-to-start breastfeeding.
This link is not new: a study in 1997 found much the same link.
This one blames the effects of fentanyl, the opoid often used in epidurals, on the baby.
To put it bluntly, the fentanyl dopes the baby up.
This is bad news as women have, in my experience, been consistently told by the medical profession that the epidural does NOT cross the placenta.

http://www.timesonline.co.uk/article/0,,2-2497626,00.html
Meanwhile in a sidebar to this report, Dr Thomas Stuttaford makes some comments which badly need scientific back up, though he does not provide such. According to him, the epidural is marvellous because it "increases bonding" between mother and baby!!!
I wonder what evidence he has for this? In my experience a mum who has had a theatre forceps delivery or emergency c-section because of the difficulties caused by her epidural finds bonding a bit more difficult than an empowered, oxytocin-sodden mum who has felt in touch with her body throughout her labour.
I've checked on PubMed and I cannot find any study which backs him up, except those which show that C-section mums find it easier to bf and bond after a local epidural anaesthetic as opposed to a general anaesthetic. Well, Duh!
I find Dr Stuttaford's lack of concern for the possibility of a baby being UNABLE TO LATCH ON PROPERLY after birth seriously worrying!!!!
In the past I have also seen him brush aside the danger of an instrumental delivery, increased by having an epidural, as an unimportant concern. (70% of primips who have an epidural end up with an instrumental delivery)
Since there is now concern for the short term effects of forceps and ventouse on a baby's comfort, I am puzzled by his very cavalier attitude to epidurals and instrumental delivery.
I seriously wonder if Dr Stuttaford has ever seen a natural birth where a woman was in a quiet, safe environment, allowed to labour in positions of her own choice, with caring, unobtrusive support?

Actor chooses home birth shock horror

Tamzin's home birth choiceTuesday, December 5, 2006
Bodies actress Tamzin Malleson has revealed that she chose to have a home birth after witnessing the horrors caused by inept gynaecologists and obstetricians in the BBC drama.
The TV star, who is mum to seven-month-old daughter Teddie with co-star Keith Allen, says she didn't want to go anywhere near a hospital when it came to her own labour.
"When I was pregnant a lot of people said they couldn't believe I was even thinking of having a baby after working on the series.
"I had a home birth, and Bodies was partly responsible for that. I didn't want to go anywhere near a hospital and I considered it safer to have a birth at home where I felt confident, relaxed and in control. I was happy at home - in agony, but perfectly happy!"
"Keith was brilliant, he was very supportive. We had an absolute disaster with the birthing pool - we live in a cottage and our water comes from a spring, and the pump chose to break.
"Keith was going up and down the hill with a wheelbarrow filling up from people's gardens in the middle of the night," she recalls, chuckling.