antenatal - Stockport Birth Services

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

Vaginal Examinations: What You Need To Consider

During your pregnancy it’s a fair bet to say that a stranger will, at some point, request to examine your vagina. What fun! A vaginal examination is a relatively quick procedure where your midwife or other caregiver will insert their fingers into your vagina to feel your cervix. As with all things birth, whether you have them or not is entirely your choice. And as with most things there’s some real pros and cons either way.

Let’s have a look at the facts.

Number one on the con list is that someone is having a thorough rummage in your vagina. It’s a physically invasive procedure, sometimes painful, often disruptive to the flow of labour and can put you into a vulnerable state. Now, hopefully you’ll have some rapport built up with your caregiver by this point in the proceedings, but they’ll still be a relative stranger in the scheme of things and what’s more likely to send your adrenaline rising and oxytocin plummeting than being put in that situation? And as we know, you need a good supply of oxytocin – the love hormone – in labour to keep your uterus contracting nice and efficiently; when something happens that makes us uncomfortable, stressed or fearful, the amygdala part of your brain triggers your fight or flight response which releases a burst of adrenalin, inhibiting both oxytocin and the endorphins which are acting as your body’s natural painkillers.

Vaginal examinations are physical, and so present an infection risk. Perhaps not a huge risk in the western world where caregivers have access to plenty of soap, water and gloves, but a risk all the same. Bacteria can be pushed up the vagina, pass through the cervix and enter the uterus. The risk increases if the amniotic sack has displaced already, and some infections can be quite serious for babies in utero. Shockingly, in one study it was found that women who have had a vaginal examination in labour have 80% greater number of different bacteria in the cervix than those who hadn’t.

When a vaginal examination is carried out they can be useful storytellers to your caregiver, telling them important information, more on that below. However, they can also give you and your caregiver misleading tales. There are few rules in labour, no definitive timings, no guarantees that they will progress in exactly the way you have planned. So what happens if you’ve been in latent labour for hours and hours and get told you’re ‘only’ at 3 centimetres dilated? What if you’ve been in active labour for half an hour and you’re told you’re at 8 centimetres dilated? Do either of these things mean that your baby will be here at a specified time? Nope…in both situations baby could still be hours away from making their arrival, or they could be here within the hour. And yet your care pathway may very well be altered to fit the story that your caregiver believes your cervix is telling them. Not only that, but your own expectations can become hinged on the number you’re told and if the story doesn’t go the way you’re expecting then your flow of labour can be interrupted and throw you off kilter. If things happen more quickly or more slowly than you anticipated you could experience panic and fear, and fear leads to pain. And don’t forget distance measuring with only fingers for guides is subjective – if more than one person carries out the examination you could be in the position where measurements are miscalculated!

So what, then, are the pros from having a vaginal examination? Well they can give your caregiver information that they can use to build a picture of what’s happening in your labour. How far dilated you are alongside other factors can give an indication (but not a guarantee!) of how close to baby’s arrival you are.

Vaginal examinations can also tell your caregiver what position your cervix is in. As the cervix dilates it moves from a backwards facing position which protects baby, to a forward-facing position allowing an easy descent down the birth canal for baby.

The examination will also assist in ensuring you know your baby’s position. Again, this isn’t unique to vaginal examinations but in certain conditions such as malpresentation it’s important to have a clear picture of the situation so appropriate care can be given.

Vaginal examinations can be really useful if things aren’t progressing quite how you’d be expecting them to be. If they seem to be taking a wee while longer than expected to make their arrival an internal examination by a midwife can check their descent and position. This will tell them if baby’s position means they might need help to come along (such as asynclitic, breech or occiput posterior). It can also tell them if an intervention such as rupturing of the membranes would be appropriate to carry out. So where does this leave you and your choices? Vaginal examinations can be an important part of your care but should be used alongside other practices from your caregiver as a diagnostic tool. How judiciously they’re used is entirely up to you and your comfort level with them.

How To Release The Fear Of Labour Before Birth

I wrote this blog post for The Daisy Foundation all about how releasing your fear in labour can help ease your pain. Fear, tension and pain are in a self-fulfilling cycle, find out how to break it.

So you’re pregnant – congratulations! Now you’ve started to share the good news, we’re willing to bet that you’ve started getting the horror stories – the failed inductions, the 3^rd degree tears, the days long labour…right? In the words of Chandler Bing could that BE less helpful?

Think about your reaction when you got the last round of grim labour stories. You winced, you grimaced, you clenched your pelvic floor and tensed your knees together? Oh yes, that’s the good old fear factor – fight or flight – setting in. Fear makes your nervous system produce adrenaline, which increases your heart rate, makes your breathing shallower, blood diverts from your non-essential organs and your muscles tense. Perfectly understandable…but now think about where your baby’s going to come from. Uh huh. Your body being tense from your belly button to your knees isn’t going to help your baby on their way, is it? Your fear leads to tension, and tension leads to pain.

When adrenaline is produced in a labouring person, it inhibits the production of two other hormones; oxytocin and endorphins. It’s these two hormones that are responsible for stimulating the contractions of the uterus, and for blocking the feelings of pain. Without these present in sufficient quantities labour will be longer, more stressful, and more painful than if we allow our bodies to limit the production of adrenaline.

So what if you were told that you can help reduce the pain of labour? Hell YEAH. Let’s start by looking at the fear aspect of the cycle. Fear of the unknown is a well-established phenomenon and it holds true in labour too. Just as each birthing person and each pregnancy is different, so too is each birth experience. For a first-time mum with no point of reference, the thought of pushing a baby out of a hole that small can be pretty terrifying. Reduce the unknown, however, and you can reduce the fear. And that’s where antenatal education comes in. A knowledgeable, informed woman is one who no longer fears the unknown. Now – no woman can plan their birth experience entirely, otherwise we’d all be having two-hour labours with no tearing or pooing (am I right?) but by becoming knowledgeable about the birth process, about the options available to you and about how you can influence the birth to be the best possible outcome on the day by playing the hand that’s dealt, then you can make it all a lot less scary. What’s more, by being so well prepared, this knowledge becomes innate and you won’t have to rouse yourself too much from your birth bubble to give consideration to anything that might need a decision from you. Coming out of that internally focussed zone allows adrenaline to creep up – not good for your oxytocin levels.

We’ve looked at how you can reduce your fear by preparing your cortex (your ‘thinking brain’, responsible for knowledge and decision making) ahead of the big day, but you can also prepare your limbic system (or ‘emotional brain’) to release fear. Now your limbic system is responsible for many things, one of which is your fight or flight reflex…yep, that again. And where knowledge and information can affect your cortex, we need a different language to speak to the emotional brain. Something that will help you exercise the part of the brain which switches on – and off – that adrenaline switch. This is where relaxations and visualisations come in. Using guided visualisations such as seeing each contraction as a wave building up in intensity, peaking and gently rippling away while in a state of pain-free relaxation can encourage your body to return to that state when anchoring itself to those visualisations in labour. Your breathing becomes easier and floods the body with oxygen, your muscles are relaxed and free of tension which makes each contraction more effective, you’re disassociated from feelings of pain which keeps oxytocin and endorphin levels high. Pretty impressive, right?

There’s another way to keep adrenaline, fear and tension out of the birthing room with you, and that’s the room itself. Imagine a stark white, brightly lit room that smells slightly of Dettol that hums with the electric lights. Now picture a dimly lit, warm room filled with your favourite scent and music. It’s unlikely you’re going to be feeling very comfortable in room number one. And if you’re not comfortable, if you don’t feel safe and secure, then your adrenaline will rise and your labour might stall. So really think about preparing your birth space to be a place where you can feel comfortable in. Many hospitals and birth centres are really accommodating at letting you take in goodies from home.

Now, I’m not saying that birth can or should be pain free. But we do know that working with our emotional and physical selves, really understanding the physiology of how our bodies work, can reduce the experience of pain. And that’s a bloody good start to giving birth isn’t it?

Antenatal Education: Why Is It Important?

The pregnancy and perinatal period is one of immense change for a woman as she gets to grips with becoming a mother, both physically and emotionally. In many regards, particularly for first-time mothers, pregnancy is a threshold which separates the known world from one that will be radically different. In this context, emotional balance is likely to be disturbed readily and substantially. Antenatal classes provide a safe space for women to explore this change and empower themselves with knowledge and confidence, while reflecting in an informed manner on the change that awaits them. As will be elucidated here, this provision of balance is achieved through the careful consideration of and respect for the relevant social, hormonal and bonding factors, as well as each mother’s own belief structures and anxieties.

A big consideration when thinking about a woman’s changing emotional state while pregnant is that of her adaptation to her new role, either as a first-time mother or when changing the family dynamic to include more children. Both parents are understandably nervous about that which they don’t yet know and this can cause extreme challenges within the family unit and for the parent’s mental health. Cowan and Cowan argue that there is a “conspiracy of silence[1]” around the pregnancy and newborn period that can make parents feel that they’re the only ones that are struggling. One only needs to take a quick glance at the multitude of mother forums online to see a glut of ‘am I the only one…’ and ‘is this normal…’ postings by mothers who suffer from a lack of support around them. One of the big reasons that women seek out antenatal classes is to make friends with other like-minded people in a similar situation to them, and a key role for the antenatal teacher is to help facilitate friendships within the groups they teach. Having a support network of people going through similar experiences will help de-mystify their journey and ease many worries of each woman.

Classes where a woman can take some time to focus and centre herself will be beneficial to those who are dealing with pregnancy difficulties bigger than those ‘normal’ feelings and worries. Helping mothers to use techniques to have control of their own labour can help to counteract the negative impacts of health concerns that the mother may have about her own body or that of the baby. Antenatal classes help to empower women to make genuine change over their pregnancy and to benefit from the confidence this gives them. Antenatal teachers help a woman take charge of her body, filling her with self-belief by empowering her with knowledge and therefore control of her pregnancy and birth, the definition of antenatal classes according to Dick-Read who champion antenatal education to remove anxiety and dread, inhibiting fear and replacing it with confidence and increase normal labours and pregnancies[2].

There have been studies which link the level of a mother’s bonding with her child after birth to the amount of engagement with her pregnancy and the thoughts she has around it and what the baby will be like once born[3]. Benoit, Parker and Zeanah[4] linked this to the security of attachment the baby has to its parents in the first year of life. Antenatal classes encourage the mother to focus on her baby, creating a peaceful bond between them and soothing anxieties that they may not develop a strong bond. Antenatal teachers aim to anchor these bonding moments through techniques used in pregnancy which baby will recognise and be soothed by once born. Classes are spaces within which mothers can reflect on their pregnancy and learn to prepare for the future; this has substantial benefits for her emotional balance.

It is not unusual for a pregnant woman to experience feelings of stress, anxiety or depression; often this is from the usual worries and concerns a woman has when embarking on a pregnancy as seen previously, and it is important that we encourage women to let these worries go. Creating balance and harmony in her mind has a knock-on effect on her body; there are a number of studies which show various physical responses to anxiety and stress hormones in the pregnant body including reducing oxygen and calorie intake to the baby, maternal cortisol crossing the placenta and restricting foetal brain growth, growth delays, reduced levels of serotonin, reduced ‘quiet and active alert states’ when born and increased risk of hyperactivity in the long-term[7]. As Gaskin alludes to, when the mind is steadied the body can open for birth[8] and it is our aim to equip each mother with the tools to help balance her mind as well as her body.

[1] Cowan, C.P.P. and Cowan, P.A. (1993) When partners become parents: The big life change for couples. New York: Basic Books.

[2] Grantly, D.-R. (2006) Childbirth without fear the principles and practice of natural childbirth. London: Pollinger in Print, United Kingdom.

[3] http://www.refuge.org.uk/get-help-now/what-is-domestic-violence/domestic-violence-and-pregnancy/

[4] Dex, S and Joshi, H (2005) Children of the 21st Century: From Birth to Nine Months. Bristol: Policy Press

[5] Stern D (1985) The Interpersonal World of the Infant. London: Karnac Books

[6] Benoit D, Parker K and Zeanah C (1997) Mother’s representations of their infants assessed pre-natally: Stability and association with infants’ attachment classifications. Journal of Child Psychology, Psychiatry, and Allied Disciplines

[7]https://www.rc.org.uk/sites/default/files/Emotional%Wellbeng_Guide_WEB.pdf

[8] Gaskin, I.M. (2003) Ina May’s guide to childbirth. New York: Random House Publishing Group.