https://www.facebook.com/stockportbirth/videos/347558405955654/?t=1
Author: stockportbirthservices
National Homebirth Day
HOMEBIRTH SAFETY
The biggest question for most people when thinking about home birth is ‘is it safe’?
Generally birth is safe in this country, especially if you’re low-risk in pregnancy.
Up until now home birth was considered a safe option for low-risk pregnancies but with a statistically significant increase in risk for first time mothers. However, a very recent study, published in August 2019 by McMaster examines the risk of death either at birth or within the first 4 weeks after birth and has found no statistically significant difference between hospital or home. The study looked at over 500,000 intended home births to come to the conclusion.
Transfer rates for first-time mothers from home are around 45% which is a significant number, *however* the transfer rate from an along-side maternity unit (like the one at Stepping Hill) is 40% so really, the numbers are quite similar when looking at the right comparator. It’s worth mentioning that, again, we’re likely looking at a significant number of women who haven’t prepared for birth and perhaps might not understand the physiological changes the body goes through while giving birth which can affect the way a person births.
Transfer rates for women who already have a baby are much lower at 12%, which again is a similar figure to those from an AMU.
While producing very similar statistics for the most serious outcomes, birthing at home significantly reduces the need for an emergency caesarean, forceps or ventouse delivery, episiotomy or epidural – all of which have their own risk factors and health consequences.
ADVANTAGES OF BEING AT HOME
Apart from the different ways that being at home can affect the health and wellbeing of you and your baby there are other significant advantages to giving birth at home.
Your own space: Being in your own space is immeasurably beneficial. You’re not confined to one room or area of the hospital, you have everything you own on hand in case you need it (without dragging 3 suitcases to hospital with you in labour), you feel safe and secure which aids the labour process, you can dress the birthing area however you want to (laminated affirmations a-go-go!). There’s also a fundamental difference in attitude as well. When you walk over the threshold of the hospital you take on the role of patient, no matter how person-centred the unit tries to be. Your attitude changes as subconsciously you hand over some of the responsibility of your labour – and for some people that’s exactly what they need but for most people your subconscious needs to fully own that autocratic decision-making. When you welcome midwives into your home they’re on your turf not you on theirs, and it makes a difference.
You labour where you birth: It’s so common for contractions to drop off a bit during that journey to hospital and the settling in session when you get there. It’s no wonder, because your oxytocin vibe is disrupted. Without that journey you can stay inside your birth bubble doing your wondrous labouring. And there’s no need to worry about petrol in the car, change for the car park or accidentally giving birth on the A6!
You’re not in hospital: Well duh. But actually it’s a really huge one, this! Tokophobia is rising, birth anxiety is rising, birth trauma is rising as well as the non-birth related fear of hospitals and doctors that some people have. For some people being in a hospital is triggering, and removing the medical element can reduce anxiety levels which helps people give birth.
Childcare is sorted: Now some families won’t want to have their children at home while they give birth regardless, but for others it solves a childcare issue or means that the whole family is around ready to welcome its new member to the household.
Your own bed: I cannot emphasise enough just how amazing this is after giving birth. Your own shower. Your own toilet. Your own bed. With only the people you choose to be there; no noisy ward neighbours, midwives or babies (apart from your own). Literally worth a million pounds.
WHAT DO I NEED AT A HOMEBIRTH?
Really you need very little. A pregnant body and that’s about it. Realistically you’ll probably want to plan to have a little bit more than that!
- Something to cover the floor, whether that’s old towels, cheap shower curtains or tarps
- Something comfortable for the floor; old bedding or towels
- Something easy to slip on and off if you get cold and hot, like a dressing gown
- Something to keep baby warm, like a towel or blanket to go over you both
- A birth pool if you want a water birth (and if you do, get a sieve)
- A head lamp or torch (although there’s some controversy over this one! The idea is that the midwife may need extra lighting to check you over afterwards but in reality I know some midwives who have never needed a miner’s lamp to do post-birth checks so…)
- Bin bags to clear up after.
The midwifery team will either bring a homebirth kit prior to you going into labour, or on the day itself, with everything they need.
And that’s pretty much it! Everything else you’ll have handy anyway, like food and drink, music, hypnobirthing tracks, more food…
WHAT ABOUT THE MESS?
Genuinely one of the most frequent questions I get about home birth is about the mess.
IT’S FINE!
Honestly. What comes out is mostly contained to one area or the pool (the previously mentioned sieve serves its purpose here!) and because you’ve protected the area it can all be wrapped up and binned or washed.
By the time your own post-birth checks have been done and you’ve had a shower, got into clean PJs and into bed your house is back to its normal state. The only evidence that a birth has happened recently is that tiny mewling little human in your arms.
LOCAL HOMEBIRTH RESOURCES
There are regular home birth meetings across Greater Manchester run by Greater Manchester Homebirth
To find out about their upcoming planned events follow this link.
They also run the Manchester Community Birth Pool Hire Scheme and the Cheshire Community Birth Pool Hire Scheme, as well as the group Greater Manchester Homebirth Support Group. You can find all of them on Facebook.
Edit: This blog post was updated followed the publication of the McMaster study August 2019
Advanced Maternal Age and Stillbirth
This is an interesting subject to write about because nobody likes to think that they’ve crossed over into the advancing age category. Remember before we start you’re only as old as you feel (which in my case sees me hitting oldest ever living person age, especially as we’re halfway through a rainy half term!)
I’m talking here specifically about maternal age and stillbirth, but there areother things to be thinking about it you’re older than 35, including genetic risks and miscarriage. It’s also really, really, really, really, really important that when you read this or any discussion of risks, you remember that these are stats made up (usually) from studies looking at one thing. Your own individual circumstances and risk factors have a big impact, as does your own personality, values and experience to date.
One of the largest reviews of evidence happened in 2008 where Huang et al took 31 studies and largely found that there was a consistent risk of stillbirth in an older mother of 1.2-2.23 times higher than in younger mothers. There are, however, concerns that have been raised with the results including:
- What age they used as their cut off date between younger and older (some used 35, some 40)
- Categorising risk in binary ‘older’ or ‘younger’ categories, which failed to show slowly increasing risk making it look instead like a substantial jump at a particular age
- Definitions of stillbirth
- The age of the study, as medical care has changed considerably over recent years.
So this seems to be a case of yes there is an increased risk but…
In 2000, Jolly et al released the following figures as a result of their study:
- Women aged 18-34 had a stillbirth rate of 4.7/1000
- Women aged 35-40 had a stillbirth rate of 6.1/1000
- Women aged 40+ had a stillbirth rate of 8.1/1000
In 2006, Reddy et al looked at whether the increased risks were for all women over a certain age, or if it was first time mothers. They found the risks were (all out of 1000):
- Women under 35: 3.72 (first time mothers) / 29 (given birth before)
- Women between 35-39: 6.41 (first time mothers) / 99 (given birth before)
- Women aged 40+: 8.65 (first time mothers) / 29 (given birth before)
They also found that if a woman was healthy her chances of stillbirth reduced but were still higher than her comparator of a younger person.
Now, the reason I’m writing this now is because one of my clients has had a conversation with her consultant about being induced on or soon after her EDD due to her age.
Reddy et al found that there is a difference in the age of the mother, length of gestation and risk of stillbirth. But, perhaps, not one that is quite so clear cut a trajectory as you’d imagine. Their research showed that:
- The largest spike in number of stillbirths in all age groups was between 38-39 weeks pregnant, while the lowest was between 32-33 weeks
- For those aged under 39 the number of stillbirths decreased from week 40-41
- For those aged 40+ the number of stillbirths continued to rise (to 2.48)
Evidenced Based Birth found that induction rates are around 20-24% regardless of maternal age (although bear in mind that current UK induction rates are around 30-40% nationally) however caesarean rates rose from 29.5% (aged 25-29), 33% (30-34), 45.5% (40-44) to 57.1% (45+) Again, this is US data from 2014 so a slightly different climate to the UK today, where midwifery-led care can bring its own benefits and good birth outcomes.
A small UK study by Walker in 2016 looked at whether there was a rise in caesarean rates in older women who had been induced. The study found no difference in caesarean rates between induced and not-induced groups but caesareans increased with maternal age. Interestingly complication rates were similar across groups so it seems as though the caesareans happened because of maternal age rather than maternal age influencing complications which led to caesareans. All other comparators were very similar too including maternal satisfaction, birth weight and baby’s health. There’s another but coming though and that’s because the study was a really small sample and although showed some interesting things there just aren’t the numbers to get good quality evidence from.
One of the thought-to-be causes of stillbirth in women over 40 is hypoxia, which is not enough oxygen for baby (Pasupathy et al). However, one of the risks of induction of labour from an artificial oxytocin drip is hypoxia. Sara Wickham calls this a birthillogic. Induction of labour and caesareans all have their own risks associated with them so we need to loop back to the very start of these 1000 words (this was meant to be a whatsapp message to quickly answer a question, by the way. Succinct is and never has been my strong suit!) where I said this has GOT to be YOUR decision and to be able to make YOUR decision you need transparency of information. Being told your risk increases because of your age may well be true, but you can’t make a decision without understand what the risk is, how it applies to your own situation, and what the risks of action you may agree to are.
Most of the data I’ve looked at has come from Evidence Based Birth and any misinterpretations of the data are mine. I would encourage you to read the original as there’s loads more information there than I’ve written in this post. I’d also suggest reading Sara Wickham’s article about this, and also the RCOG guidelines for Induction of Labour At Term In Older Mothers.
Pregnancy, Maternity Leave, and Your Employment Rights
Some of you may know that my other professional hat is as an HR Manager (yes, yes, I’ve heard all the jokes). Pregnancy and HR often go hand-in-hand and as there’s been a few different conversations going on between some of my clients recently I thought I’d do a whistle-stop tour of pregnancy rights when at work.
Disclaimer up front – the world of employment legislation is never easy, and never more so when pregnancy is involved so none of this should be used for your own specific situation and you should always get your own advice if you have something you’re concerned about. Blah blah blah, legal, legal, legal.
When to tell work you’re pregnant: You MUST tell your employer you’re pregnant at least 15 weeks before the week the baby is due, so by the end of your 24th week of pregnancy. I’d always suggest informing them sooner rather than later because that way you can be kept safer. You don’t have to immediately announce it to the office as soon as you pee on a stick, but telling a few key people might ease some of the stress. It certainly helps if your colleagues know you’re pregnant if you’re running out of meetings to find the nearest vomitarium, are suddenly and surprisingly refusing cups of tea, or have developed a rather strange allergy to herbs that makes you ill…
Appointments: You have the right to paid time off for antenatal care without taking this from your annual leave allowance. Antenatal care doesn’t just mean your regular scheduled health checks either; it covers all scans and extra appointments as well as any midwife/doctor recommended antenatal/parentcraft classes. Most of these tend not to be in the working day but it gives you a bit of flex for leaving early if you need to. Your partner/the baby’s other parent is allowed time off for 2 antenatal appointments up to 6.5 hours per appt. Many employers will allow time off for all the appts but some don’t (because, y’know, heaven forbid a soon-to-be-parent tries to take an active part in their unborn’s wellbeing )
Health & Safety: Urgh, yeah, that. But it’s important when you’re pregnant that your company takes even better care of you than they normally do – after all, it’s your kid that will be paying the taxes that pay their pension You must be covered by a specific risk assessment in pregnancy that covers off all potential risks to your wellbeing. And even in office jobs there’s a lot! Your body does wonderful things when you’re pregnant but it’s at one of its most vulnerable points too. If there are risks then your employer must remove them for you. If they can’t do that they need to find suitable alternative work for you. If that’s not possible then they must put you on fully paid suspension until the risk is removed or you start maternity leave. I know you don’t want to be that guy causing a fuss but you’re you and your baby’s biggest advocate and you’re responsible for making sure you’re both healthy. Heavy stuff!
Maternity Leave & When To Take It: Maternity leave is a day 1 right, so if you’re pregnant and an employee you’re entitled to take up to 52 weeks leave. The earliest you can start maternity leave is at 29 weeks of pregnancy. You can change your maternity leave start date with 28 days notice although pragmatically this isn’t always possible.If you’re ill with a pregnancy-related illness after 36 weeks of pregnancy and you’re still working this can trigger an automatic start of your maternity leave, even if you intended to work right up to the hilt.
Maternity Leave…How Long: If you work in an office you have to take 2 weeks leave after the birth of your baby (4 weeks if your job is manual). That’s it, the end, it’s the law, no arguments. You can take up to 52 weeks and you also have your annual leave allowance including your accrued Bank Holidays to top up your leave. You can change your maternity leave return date with 8 weeks notice, if you want to (although if you decide to resign only your normal notice period would apply which may be less than 8 weeks).
Maternity Pay: Chances are you’re entitled to 39 weeks maternity pay. To qualify you have to have been an employee for 26 continuous weeks up to the 25th week of pregnancy, earn at least £118 a week and have given correct notice.If you’re not entitled you may receive Maternity Allowance direct from the government. SMP is taxable but you don’t have to pay it back, unlike company maternity pay which you may receive and may have conditions attached, such as returning for a minimum of 6 months after your leave.
Shared Leave: You might want to share your leave with your partner. Essentially you give up some of your maternity leave so they can take it as well as or instead of you. Writing about the ins and outs of the scheme would and does fill up several pages of company handbooks but suffice to say here, it exists so be aware of it while you’re planning.
KIT/SPLIT Days: While you’re on maternity leave you might want or need to get into work for a particular reason, or to keep your hand in. While on maternity leave you have 10 Keeping In Touch days to use, although your employer doesn’t have to agree to them (but likewise, you can’t be pressured into doing them). Payment needs to be agreed with your employer – some pay for the hours done, some pay for the full day regardless of how many hours you’re in but remember that even if you’re only working for half an hour, that’s one full day gone from your entitlement. If you share your leave with your partner you (and they) are also entitled to 20 additional SPLIT days. Same rules apply. (Side note – In Touch days dramatically increased when more men were given the ability to take more time off. Patriarchy, eh?)
Work While You’re On Leave: Being off on maternity leave affords you some additional rights. If changes to the business are happening while you’re off you have the right to be kept abreast of the situation. If you’re at risk of redundancy being on maternity leave can’t stop it happening, but you’re obliged to be offered any suitable alternative as a top priority. As an aside, being off on leave while all your colleagues are still working can sometimes suck big ones so make sure your workplace are supportive and respectful of you.
Discrimination: Unfortunately pregnancy discrimination still exists because sometimes organisations or people within them are dicks. Amirite?! Even more unfortunately when you’re pregnant or have just had a baby is THE worst time to stand up for your rights and a lot of the shitty behaviour never gets called out meaning organisations never have to face their truths. Those of you who have had the strength to stand your ground, I salute you! Those who have suffered but have chosen to concentrate your efforts on you and your families, I see you and I give you an awkward shoulder-pat in solidarity.
If you think something is happening that shouldn’t be these organisations can help:
ACAS – they’re the first port of call and should be ok for basic rights but they’re sometimes a bit…well, basic, in my experience. ACAS.org.uk
Maternity Action – the UK’s leading charity to fight inequality and improve the health of pregnant women, Maternityaction.org.uk
Pregnant Then Screwed – support for women who have suffered discrimination in pregnancy, including a free legal helpline. Pregnantthenscrewed.com
Whew, that pretty much covers some of the basics. Good luck!
Birth Plans (and Flow Charts)
Crack open your coloured pens, your pretty notebook and your laptop and make a start on your birth plan! Laminating is entirely optional
I’m still pretty furious that one of my clients this week was told she wasn’t allowed to write her birth plan yet. Errrr <— my actual face. Birth plans aren’t something that you write in a 10 minute appointment at 36 weeks.
The POWER of a birth plan comes from the knowledge that you and your support crew get from learning and reflecting. Of finding out what the biological norm is and what circumstances might arise that would throw you off that trajectory. Of what interventions you’d be happy to accept and in what circumstances, and which you will avoid like the plague. The piece of paper at the end is just a tiny part of the process; the really important bit is the work that’s gone into being able to write it.
Birth plans, or birth preferences, or birth flow charts (trademark pending ) come under criticism from some people (yes Adam Kay and other misogynistic folk I’m looking at you). Or rather, they’re another tool to mock and throw scorn down at a woman. As one fabulous OB said on Twitter ‘the longer the birth plan the longer caesarean scar I’ll make’. It’s funny how threatened an empowered woman can make some people feel, isn’t it? Because this is what it’s all about. When you learn and grow in confidence in your body’s abilities you start to question the autocratic policies that you’re told you have to abide by. You start to ask how it relates to you and your own unique situation. You start to ask for evidence and transparency of conversation. You start to demand that you’re treated as a person and not a statistic. And boy, does that throw the system into disarray.
Policies and procedures exist to protect hospitals and staff, and are created (often with little evidence) to give a guideline at population-level. But YOUR birth plan is just for you. It’s for YOUR situation, reflecting YOUR needs, YOUR desires, YOUR experiences, YOUR medical history. It’s the piece of paper that says ‘I am mine and my baby’s biggest advocate and I will make the decisions that I believe will keep us healthiest’. There is NOBODY who has more of a vested interest in you and your baby’s wellbeing than you. Nobody.
The biggest tip I give to pregnant people asking about birth plans – apart from booking my classes – is to read, read and read some more. It’s why my post-class emails are so link heavy! The more you read, the more scenarios you come across, the more different views you hear the more able you are to get a feel for what you’d do if that scenario happens to you in labour. Because with the best will in the world we can’t predict what’s going to happen to you on the day. But we CAN predict your reaction to it.
The second tip is to make sure your support crew know what you want. Don’t keep it secret. Get your birth partners on board, make sure they understand. Because in labour they’ll be advocating on your behalf.
A nice way of creating the final piece is a visual reminder for you and your team is the Positive Birth Movement pictures, available for free download here: http://www.pinterandmartin.com/vbp
