birth - Stockport Birth Services

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

Birth Plan Stockport Antenatal Preferences

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

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.