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The System Is Broken…And It’s Breaking Women

Now, I preface this with the fact I love the NHS. I really, really do. It’s a hundred times better than any privatised, corporate system could ever be and it has some of the most dedicated people working for it I’ve ever come across.

So why am I so angry with it?

Because it’s failing women.

Just some examples, from one single class yesterday.

One woman told me her midwife had told her she wasn’t allowed to write her birth plan until she’d been to her NHS antenatal class.

Not ‘you’ll know more after you’ve been to class’. Not ‘the appointment is scheduled for X weeks and you’ll have been to your class then so we’ll discuss it together after’. Not ‘get started now and we’ll go through it together after class in case there’s anything else you want to add to it’.

Not. Allowed.

Not allowed to have an opinion about HER birth at the time of HER choosing. Not allowed to exercise her absolute right to think, plan, decision-make over one of the biggest events of her life. Not allowed to create a tool that connects her to her baby, to her birth.

Language. Fucking. Matters.

And then, a conversation about augmentation of labour. A second-time mom asked why the NHS hadn’t given her this information, the information she needed to make her decisions. This is a mother who HAD BEEN THROUGH THIS PROCESS. She’d HAD the drip and ARM. And she hadn’t known why or what might happen. She asked me why she hadn’t been told this.

She actually wanted an answer.

What could I say?

I spend 9 hours officially (12 hours realistically) talking about it and many many many hours guiding them on top of that, and I barely scratch the surface. The new NHS parentcraft programme has a 2 hour session on labour. Two hours to learn how your body works, what medical assistance there is, to learn what might help you birth your baby.

‘Why don’t they tell us that accepting things has consequences?’

I don’t know. I know they SHOULD. I know I WANT them to. I know I’m glad for each and every woman who comes to me because they get those 12 (18…20…22….24…) hours of me repeating it’s your choice, you have the control, what are the benefits, what are the risks, what might it lead to, what if you say no, it’s your choice, IT’S YOUR CHOICE over and over and over and over and sometimes some of them believe it.

Our bodies are designed to do this but we’ve created these wonderful intervention techniques that help when our bodies don’t work perfectly or our babies need help and then we hold it secret so nobody knows what it’s really about. But then nobody trusts their bodies either because if they worked we wouldn’t have all these interventions would we and so these women, these poor, poor women are left with TWO HOURS of information and then they come out the other end lost and broken and feeling like they’ve failed because how could they possibly win if they’re not even in the same race?

I’m sure the new NHS programme has merit. It sounds like it’s a huge step forward, weaving in attachment and mental health and other vitally important things. But it’s not enough. And that needs to be recognised and if there’s no money to invest in preparing women for something that can impact the rest of their lives, their attachment with their baby, their relationships with their partners, family and friends, their own wellbeing (don’t forget that maternal suicide is THE most common cause of death after childbirth), their future family plans…if there’s no money to protect all of that then why the hell are we not making it commonplace for women to get this information from alternative sources? Why are we giving out fucking Bounty bags instead of educational resources? Why are we allowing Emma’s Diary to fill the screens of antenatal clinics instead of using them to signpost women to information that could save their mental and physical health? Why are we letting down some of the most vulnerable people we have in society?

I’m so angry about it. And so sad for them. It’s a horrendous, stupid broken mess of a system and it doesn’t get any better.

I’m an antenatal teacher because of this shit. Because I desperately don’t want people to go through what I went through. Because I want to stop women being too scared to have more babies, too scared to go back into the hospital that traumatised them, too scared to even THINK about their pregnancy because after pregnancy comes birth and I’ve done my very best to block out any thought about that because of the panic attacks it makes me have. I volunteer with the NHS in two different capacities to try and work within the system, to make it better, to stop breaking women, to stop failing them. I’m not a big corporation. I’m not a profit-making business or well-known monopolising charity. God (well, HMRC) knows I don’t do this for the money, I give away too many free places to women for that! I do it because you deserve better.

How Do We Calculate Dues Dates In Pregnancy

Pretty much as soon as you find out you’re pregnant you’re on google trying to work out when your baby will arrive (no judgement, been there ), this will be confirmed at your booking in appointment based on your last menstrual period date (it might be changed again if you have a dating scan but we’ll come to that another day).

But how do we get to the due date? Here in the UK the way we calculate the estimated due date (EDD) using the principles of Naegele’s formula where we add 7 days to the LMP, take off 3 months, then add a year. Or, add 280 days to the LMP. Simple

This formula was first published in the 1700s and was based on the biblical reference of pregnancy lasting 10 lunar months. So y’know, accurate and evidence-based. OH WAIT. Boerhaave, who FIRST came up with this, helpfully published his calculations with the description ‘count one week from the last period’ without specifying whether this was the beginning or the end of the period. Thanks for the help, Boerhaave, didn’t your teacher ever tell you to show your workings?

Naegele came along in the 1800s and ballsed up the calculation again by not clarifying what conception period he was talking about so someone else finally came along and actually laid out the workings – and added 7 days to the end of the period in the formula. Thank you Professor Bedford.

This probably explains why France’s EDDs are 41 weeks not 40 weeks. Not that French uteruses are intrinsically different to British ones.

Aside from the lack of clarity from the authors of the formula, what it also doesn’t do is take into account the length of your cycle – we know women don’t always ovulate on day 14 and we know not everyone has 28 day cycles. Eek, another flaw in the plan.

But why does it matter? Well, in theory it doesn’t because in the wise words of Call The Midwife (see image), babies will be in utero until they’re ready to not be.

And yet.

Yet when you start nearing your 40 week date the world and his wife plus every Tom, Dick and till operator will start quizzing you on “isn’t your baby here YET?!” (Yes Janet, I just have a cushion shoved up my jumper so I can be harassed by people like you every day) and your mom will start texting irritatingly often.

Not to mention that you’ll start getting pressure from your medical team to induce rather than wait for spontaneous labour.

And because you’ve had that arbitrary date in your head for 40 weeks you’ll be REALLY PISSED OFF when it comes and goes without a baby. I’ve had a +19 baby, believe.

If you’re nearing that 40 week date take a breath, book yourself some nice treats, go to the cinema alone a few times (and if you spill your bucket sized Sprite you could always try saying your waters broke for free tickets?) and enjoy those last few precious moments before your world changes beyond compare.

For the technical stuff: https://obgyn.onlinelibrary.wiley.com/…/j.1471-0528.2000.tb…

Home Births

It’s interesting that this blog post popped up this morning as I had a little chat with my current class about home births yesterday. Thanks to Chilled Mama for sharing so I can pass on and Live, Love & Birth for writing.

The number one reason I hear about not wanting a home birth from those who are pregnant is that they think it will be better to be in hospital ‘just in case’. (The number one reason from dads is the mess )

The research tells us that planned home births are as safe as hospital settings in low risk, not first time pregnancies. For first time moms the chance of a serious negative outcome happening is elevated slightly but the absolute risk is still very low.

We also know that women have better outcomes the longer they stay at home and for those that stay at home for the full event there’s less chance of needing interventions, less chance of getting an infection, less chance of baby being admitted to NICU and more chance of achieving a vaginal birth after caesarean (vbac).

We know that women who feel safe, secure, loved, respected, listened to and in control birth with better outcomes and with a more positive experience than those that don’t, and we know being in a home environment provides those things in a greater capacity than a hospital.

We know that when women are able to choose the position and movements they feel best with in labour they have better outcomes. We know that in hospital women feel restricted to their rooms in labour and those rooms are often quite small (but conversely when rooms are large they feel too clinical and cold).

We know that there’s stupid rhetoric among people who have no clue whose immediate response to people discussing the idea of having a home birth is ‘ooh you’re brave’ which is neither helpful nor accurate but goes a long way in affirming the idea that home birth is risky business without any basis in fact.

There are a multitude of resources for people who are thinking about a home birth including meet ups at most of the local hospitals to discuss other people’s experiences, and the fabulous Greater Manchester Homebirth (morning tag fail, find them on Facebook!) who also run an active support group.

Ultimately, this is YOUR choice and not that of your partner, mother-in-law, Janet your work colleague, Martha on the till at Tesco, your midwife or your consultant. YOUR CHOICE, as everything to do with your care in pregnancy and birth is.

Oh, and dads and partners? There is no mess and you don’t need to clear it up anyway. Your job is to support your partner and your baby and before you even realise it everything has been cleared away. There’s probably more mess from your Friday night takeaway tbh.

*side note: when I refer to hospital I mean an along-side unit of delivery suite and birth centre, as that’s what we have here in Stockport

Risks discussed: https://www.nhs.uk/…/births-at-home-or-in-hospital-risks-e…/

And: https://www.nct.org.uk/…/giving-b…/home-births-are-they-safe

And: https://www.tommys.org/…/midwives-answ…/are-home-births-safe

babyhillfinal-27 — Photo by Hazel Hughes Photography

Dates in Labour

When you’re pregnant you (hopefully!) get given loads of information about things you can do or things that might be offered to you to help the baby on their way earthside.

But rarely do people get told about the humble date.

As well as being utterly yum, dates have special qualities which can help labour progress. Eating around 7 dates a day from around 36 weeks pregnancy until after the placenta is birthed can…

– Help ripen and dilate the cervix: higher Bishop score and entering hospital at 4cm dilated rather than 3cm.

– Help shorten the early phase of labour: 510 minutes compared to 906 minutes.

– Help you achieve a vaginal birth rather than caesarean after induction: 47% of the sample had a vaginal birth compared to 28% of the control.

– Reduce your need for induction: 20% of date eaters had an induction compared to 45% of the control.

– Reduce the frequency of augmentation of labour (speeding things up once you’re in labour): 37% compared to 50%

– Reduce postpartum blood loss significantly even compared to those who receive artificial oxytocin: total average loss 163ml to 221ml.

Be careful if you’re diabetic!

Now these studies have their limitations; they’re small and other factors weren’t controlled or looked at but (unless you’re diabetic) then eating dates are unlikely to hurt and they might do some good. Even if not in labour, they’re bound to help with that first postpartum poo.

The studies also took place outside of the UK, where the birth system may be significantly different and with women who may have had strong opinions about their care anyway – for example they may be women who would refuse induction or augmentation at all costs regardless of the date eating.

Just to help you on your way…have a date recipe! https://www.superhealthykids.com/recipes/healthy-no-bake-snack-bars/

Sweeps: How They Might Help (And Hinder) Your Birth

I’ve been talking a lot this week about cervical sweeps with different people and for different reasons.

I’ve been struggling with writing this post and how to angle it as I’m aware it could come across quite negatively yet many women will tell you they’ve had a brilliant experience with sweeps. And yet the evidence around them is insubstantial at best.

Let me tell you about some of the conversations I’ve had recently.

A woman in her first pregnancy had 15 attempted sweeps. That’s not a typo. Understandably she’s traumatised from the experience.

Another woman begging for a sweep from 35 weeks. She got one at 39 weeks. She was left crying, frustrated and defeated because it didn’t work and she’d pinned her hopes on it bringing her baby earthside.

A group of women joking about finding the midwife with the biggest hands to poke their babies out because they’re done with this pregnancy and babies are born before 40 weeks who are fine so why does it matter if theirs comes without waiting for spontaneous labour?

My first baby. Accepted a sweep even though I didn’t want one because I was told it would turn the niggles of early labour into something ‘proper’. The soreness and relinquish of control over what I really wanted set the tone for the rest of my labour and I was left traumatised.

My third baby. Accepted a sweep and on the face of it, it did what it was supposed to do and my baby was born not long after. But I was 42w5 and had been having contractions for weeks – she was coming soon. I accepted as a concession to the SOM who had to pick up the pieces of a registrar telling me my baby would die if she didn’t come out NOW in front of my 2 young children.

( I’ll digress slightly on that note. My baby was transferred from home to nicu shortly after birth to be treated for meningitis and sepsis. The amount of guilt I feel over potentially dismissing the warning signs at monitoring earlier that day will probably stay with me forever. Had the doctor actually listened to me and engaged in a meaningful, transparent conversation with me things may be different. I’ll never know because she didn’t. She will never know the impact she had but I’ll live with it forever.)

Back to sweeps. When did they become so prevalent and synonymous with birth? Why are women being offered – if you’re lucky, the ‘while I’m down here I’ll just give you a sweep’ mentality still exists – without being told they’re the first stage of the induction and intervention process? Why do we not encourage and practice patience when it comes to birthing babies?

They have their place, as all interventions do. But whenever we start interrupting the body’s physiological processes we start introducing risks.

So, let’s talk research.

They can reduce your chance of your pregnancy going over 42 weeks. For some women this is important because that’s the cut off that they’d accept induction of labour. For others who wouldn’t accept induction just for being post term then this isn’t important.

For women between 40-41 weeks of pregnancy there’s a 24% chance of your baby being born within 48 hours of the sweep being done.

They can shorten pregnancy by 1-4 days. Again, these few days might be really important for some women, whereas for others in the scheme of things it doesn’t seem worth it.

70% of women find them painful.

They can cause irritation to the cervix, bleeding and uncertain contractions.

There’s a 9% chance that your waters will break as a result of the sweep. If this happens you’re on infection watch and will be offered further interventions if your body doesn’t spontaneously go into labour within a certain timeframe.

As I said earlier, sweeps have their place. But why are they so commonplace? Why are we encouraging people as a matter of course not to trust their bodies to work as they’ve been designed to, but telling them that they need help? Why are we starting women’s pregnancies, sometimes at booking in appointments, by telling them that they need a medical procedure to go into spontaneous labour? Why is this for the many and not the few whose individual circumstances suggest it might be a good idea?

Image of cervical dilation because I didn’t think you’d want to see a picture of a sweep being carried out