Tag: informed choice

What Do I Do If My Labour Slows Down?

Sometimes labour slows down. This might also be called stalling or “failure to progress” (bleurgh, nobody should be using that phrase if they’re giving proper personalised care). When labour slows down, contractions aren’t as effective and as efficient as they could be. Your body might need a little help increasing the frequency, duration and intensity of contractions in order for your labour to progress.

This is a checklist of things for you or your birth partner to consider if labour has slowed. Trying some or all of these might help ‘unstick’ whatever’s made labour get stuck and take a holistic view of what’s happening during the birth experience. Depending on what’s happening in your individual circumstances you may be offered medical augmentation of labour – all of these methods can be used before or as well as medical methods.

Progress Ps

Position: Are you in your preferred position? Is your position giving space for your pelvis to open, and is it using gravity to help your cervix to dilate and baby to come down the birth canal? Would moving help maximise your physiology? Do you need help and support to move?

Preferences: Has your birth plan been read and understood? Are your preferences being actively listened to? Are you being supported to work towards your preferences? Have your preferences changed?

Personal: Are your physical needs taken care of? Have you eaten and drunk to make sure your birthing muscles work effectively? Are you breathing to ensure your muscles are well oxygenated? Is your jaw (and therefore your pelvis) clenched? Have you had a wee recently – full bladders can impede baby’s progress.

Place: Is the room you’re in promoting oxytocin? Is it too hot, too cold, too cluttered to mobilise?

People: Who is present in the room with you? What are they doing? Do they make you feel safe? Do they need to be there if they’re not? Are they giving unbiased evidence based information for you to make your decisions? Are they asking consent?

Prohibitors: Are there any inhibiting factors that might be slowing your labour progress? Fear, stress, energy levels, mobility…?

Partner Potential: Is your birth partner/s doing everything they can to help labour progress? If not, what’s stopping them? Are they hungry, tired, in need of a pep talk? Do they understand what’s happening in the labour? Are they being respected in the birth room?

What The Heck Is A Gentle Caesarean Anyway (And Why Would You Want One)?

A gentle, or natural, caesarean section is a way of bringing person-centred care back to a birth when that birth is happening in a theatre. It’s common for people who are choosing caesarean births to feel like they’re ‘relinquishing control’ and that this type of birth is one that ‘happens to them’. But this shouldn’t be the case. A caesarean birth is still YOUR birth. You can still have an environment that feels comfortable for you. Utilising some of the gentle caesarean techniques can help you look back on the birth in a positive way.

The idea of a natural caesarean was first raised in 2008. Some of the things on this list are becoming more popular and embedded in caesarean births anyway. Some of these things might encounter some raised eyebrows or a flat out no from your doctor – but if you want something ask to see the evidence that prevents you from having it because unless there’s a very good reason for it not happening you should be supported in your birth choices. Some of them might be things that you have absolutely no interest in doing – and that’s ok! Your birth your choice. And in the minority of caesarean section scenarios things may move too quickly to get you or your baby safe that it’s not possible to have an in depth discussion about your personalisation of your birth.

Environment: Theatres are by their very nature, very clinical environments that need to be kept sterile. But that doesn’t mean there’s not options for you to make it a bit more oxytocin-promoting. Oxytocin is, after all, the hormone of attachment and bonding so having it in your system as you meet your baby is a good thing. You can have your own music or hypnobirthing tracks playing (or use headphones); music can help distract you, keep you calm, and there’s evidence that it reduces feelings of pain as well! You can ask staff to keep their noise to a minimum and for your voice to be the first one that your baby hears as they come into the world. I’ve also heard birth stories where the peripheral lights are dimmed, and where people have taken small objects of comfort into the birth with them. Just on the subject of the theatre environment during a c-section; sometimes the super shiny equipment can reflect your uterus while they work so if you don’t want to see ask them to give it a nudge!

Drapes: Usually a drape is set up, blocking your view of what’s happening, and remains there for the entire procedure. In gentle caesareans the drapes can be lowered or clear drapes used so you can see what’s happening – if you want to! Lowered drapes also help with facilitating immediate skin-to-skin after your baby’s born.

Delivery: This is where things really start to differ with traditional caesarean sections! After the uterine cut, your baby’s head is gently encouraged to come through the incision with the doctor remaining as hands-off as possible. Once their head has emerged they begin breathing while their body is still inside the womb and connected to the placenta. This slow emerging from your body causes pressure which replicates the pressure of the birth canal, helping to get rid of liquid in your baby’s lungs. Gently supported, your baby wiggles themselves out. They can then be passed over the drapes to you.

Skin-to-skin: Traditionally, when your baby is lifted out of your uterus they’re taken to be examined, weighed and wrapped up before being brought back to you. It’s becoming increasingly more common for your baby to be passed over the drapes and skin-to-skin as well as a first breastfeed to be facilitated in line with WHO and UNICEF guidance. However, this still isn’t something that’s the norm with some doctors refusing on the grounds of ECG and pulse oximeter equipment needing to be present. To create space the pulse oximeter can be placed on your foot so your hands are free and ECG electrodes placed on the back of your shoulders.

Delayed cord clamping: Delayed cord clamping allows your baby’s blood to transfer from the placenta back into their body and is beneficial for nearly all babies to receive. Recent research suggests there are no safety concerns with delaying cord clamping during a caesarean.

Many practices within gentle caesareans are already slowly being embedded within standard caesarean section policies but it’s worth being really explicit what you do – and don’t – want during your caesarean section. Your healthcare provider should be able to discuss the benefits and risks relating to your own individual circumstances.

15 Non-Pharmacological Pain Relief Options For You To Choose In Child Birth

For those that would prefer not to use medication, or want to try other options first, you might be wondering what on Earth is available to you. Well don’t worry, you have plenty of pain relief options!

Many of these are things that will naturally enable oxytocin and endorphins to work in your body, creating a hazy dazy birth bubble that protects you. All people respond differently to different things so it’s worth putting the work in to think about what might boost your oxytocin (the love hormone) and your endorphins (your pain relieving hormones).

The brilliant thing about these is that there are no negative side effects and you can layer them up like a little pain relieving onion, and take them away when they no longer serve you. In no particular order, I bring you 15 non-pharmacological methods of pain relief during childbirth:

Breaking the fear-tension-pain cycle: Fear leads to tension, tension leads to pain. By relieving the fear you can reduce the physical symptoms of tension, ie pain! So think about some of the things that help you reduce fear and anxiety – things like deep breathing and oxytocin boosters like aromatherapy can help, as can a big cuddle from your partner!

Concept of purposeful pain: Giving birth isn’t like breaking a bone. For a start, it usually comes on gradually and builds in intensity, unlike the sudden sharp shock of a break! It’s not a something’s wrong type of pain. Reframing the lens through which you look at labour pains and understanding that each contraction brings you one step closer to your baby can help transform the way you react to the pains. Instead of being something you fear (that fear-tension-pain cycle again!), they can become something you welcome.

Breathing: Deep breathing can help encourage your physical and emotional body into a relaxed state, promoting a healthy blood flow to the birthing muscles so they work effectively. A calm, relaxed body and mind reduces the pain you experience – yep, it’s that fear-tension-pain cycle again!

Visualisations: By creating images in your mind, especially when they’ve already been anchored in your brain to a time when you were relaxed and pain-free, can help reduce your experience of pain and give you a way to handle each contraction. Many people use the concept of a wave as your contraction during labour – the wave swells and with it so does the contraction in your body, and the wave washes away as the contraction releases; you can tie this in nicely with long deep breaths.

Hot water bottle: One of the oldest and cheapest methods of pain relief!

Laughter: Laughing produces endorphins, endorphins are your body’s pain killing hormones. Easy as that!

Bath/shower: Water promotes oxytocin and endorphins, helping that birth bubble be built around you. Being submerged in water can relieve stress hormones and muscle tension, while showers can be used to massage the sore bits.

TENS machine: These send tiny electrical impulses into your body, disrupting the pain signals that you’re experiencing from your contractions. You CANNOT use this with any pain relieving method that involves water.

Massage: Getting hands on can be a great way to reduce the pain your experiencing! Massage can relax painful muscles, relieve stress and promote oxytocin, especially if it’s someone you love doing it.

Music: Music isn’t just a good distraction in birth, it can actually disrupt your brain’s pain pathways meaning your pain is reduced! Also, when else can you listen to entirely your choice of music without someone moaning?!

Rebozo: Rebozo sifting is a really gentle way to move muscles and joints, bringing relief from any pain stored up in them. It’s not a very well known concept in the UK but one that people tend to love if they do use it.

Movement: Keeping mobile helps you move and sway into contractions, relieving your body of tension, stiffness and soreness as you go. Being able to choose which position you get into and move around helps reduce your experience of pain, as well as increasing the self-efficacy you have. Choosing upright positions can help wiggle your baby down into the cervix, helping trigger oxytocin to be released into your body and stimulating effective contractions. Win win!

Acupressure: Certain acupressure points can reduce pain intensity. One of the increasingly common ways of using acupressure is to hold a comb in your hand with the teeth pointing just below where your fingers meet your palm.

Aromatherapy: Olfactory stimulation can result in pain reduction. It can also be used to promote oxytocin and reduce stress. Some essential oils are contraindicated in pregnancy/birth so do check what you’re using with someone qualified.

Personalised oxytocin boosters: We’re all individuals and respond to different things in different ways. Have a think about what makes you feel loved up, joyful, ecstatic and on a natural high as they might be just the thing to help you in labour!

(And to finish off, if you do choose pharmacological pain relief then that’s perfectly ok! You can choose to do your birth any way you want! <3 )

Where Can You Give Birth: Your Birth Place Options

Women and birthing people are supposed to be informed of their choices about where they can give birth and, crucially, are supposed to be supported in their choice. But we know this doesn’t always happen – according to the CQC Maternity Survey Results published in January 2023 a fifth of women said they were not offered any choices about where they can have their baby. Even if they are, the choices are often presented as a list rather than a proper discussion about them. How can you pick something as important as where to birth your baby if you don’t know what each option means?!

Read on for an overview of your choices of where you can give birth.

Home Birth

A home birth is exactly what it says – you give birth at home. Midwives come to you when you’re in labour and stay until you’ve given birth. They examine you post birth, help you with a shower, feeding, and tuck you into bed and go on their merry way. There is NOTHING like getting in to your own bed after giving birth and not sharing a postnatal ward with several other mums, partners and babies.  

You’re supposed to be told that home birth is a good choice for ‘low-risk’ women as there’s a lower intervention rate and the outcomes for mums and babies is no different to in a hospital setting – there’s lots of evidence for this. You’re also supposed to be supported in a home birth if you’re ‘high risk’. You can choose to birth at home whether you’re low or high risk.

To hear more about what I’ve got to say about home birth, click here or here.

Birth Centre / Midwife Led Unit

Midwife Led Units (MLUs) are generally called Birth Centres. They come in two variations:

Alongside Midwifery Unit (AMU) – these are alongside the obstetric unit, ie on the same hospital site. Because they’re on the same site if you need extra support such as certain types of pain relief or necessary interventions, it’s a short trip usually taking a matter of minutes in order to receive it (and doctors do also have legs and can come to you if it’s really necessary!).

Freestanding Midwifery Unit (FMU) – these are on a separate site to the obstetric unit. Because they’re not in the same place it will take more time to receive extra help. If you needed that support you would need to be transferred to the local obstetric unit.

Midwifery Led Units are, as the name suggests, led by midwives rather than care being shared between midwives and doctors. They tend to be a little bit more ‘home from home’ like than labour wards and often have birth pools, twinkly lights and pretty murals on the wall. If it’s a particularly well-equipped one you might even find birth ropes, birth stools and other exciting birth equipment.

You have the right to choose to give birth at a Birth Centre if you wish, however sometimes this may involve a negotiation as your trust literally hold the keys and may encourage you to believe that it’s ‘not allowed’.

Labour Ward / Delivery Suite / Obstetric Unit

On Labour Wards care is shared between doctors and midwives. This is generally where those who are expected to have a complicated birth are recommended to give birth, however sometimes your definition of “expected to” may differ from your caregiver’s definition! It’s also where caesarean births take place.

The environment tends to be more clinical looking and less oxytocin-promoting than at home or in Birth Centres, which is a bit silly because people having complicated births are arguably more in need of oxytocin promotion! There is access to more significant pharmacological pain relief such as opiates and epidurals if you want them. By definition, more interventions happen here – because they can’t take place at home or on the Birth Centre.

You have the right to choose to give birth in a Labour Ward either vaginally or by planned caesarean section if you want to. However, you should be advised that unnecessary intervention is more likely to happen on a Labour Ward than either at home or Birth Centres.

So there’s your whistle stop tour of where you can give birth. Where you choose to give birth to your baby is a really important decision because even planning to give birth in one place but actually giving birth in another can change your birth outcomes. So make sure you really consider it and don’t dismiss any of the places until you’ve thought about them properly. And remember, you can change your mind at any point before your baby arrives!

Vitamin K & The Newborn

V I T A M I N  K  A N D  T H E  N E W B O R N

Babies are born with proportionally low vitamin K. We don’t know why yet, although there’s a few theories that it could be due to babies being born without all their systems fully functioning, or some kind of residual consequence of some other mother-baby mechanism. As mothers need to be intaking high doses of vitamin K for it to pass through breastmilk in sufficient quantities to protect their baby it seems unlikely to be an evolutionary response although my anthropological days were left behind at uni so, I may well be wrong.

Vitamin K helps blood to clot and prevent uncontrolled bleeding. Due to low vitamin K in babies, they’re at risk of something called ‘Vitamin K Deficiency Bleeding’ or VKDB. Some of these at risk babies have known risk factor but about a third don’t. This includes what type of birth the baby experienced, as it had been mooted at one point that assisted deliveries and caesareans increased the risk.

We started giving babies vitamin K after a Swedish study in 1944 was released which showed a 5 times reduction in newborn deaths of 2-8 day old babies due to uncontrolled bleeding. Manufacturing and commerciality interests pushed the dose given higher which triggered their own problems in the baby, so the dose was reduced back down and remains at 1mg although this is still twice as much as was given in the original study. At this time it was only being given to babies with suspected risk factors of bleeding, however in 1978 a study was released which discovered that late onset VKDB was a problem for exclusively breastfed babies and very quickly it became policy to universally offer to administer vitamin K. A small study did indicate that parents who refused to give their babies a vitamin K dose could raise the levels of vitamin K sufficiently to pass through breastmilk at protective quantities by the mother taking a supplement of at least 5mg daily.

Vitamin K is usually given via one injection within 24 hours of birth, although parents have the option to have oral doses given instead. If given orally this is done over the course of 3 doses, 2 of which are normally given to the parents to give at home. Side effects of the injection are a potential allergic reaction to the ingredients, or a small reaction at the site of the injection, plus of course a small amount of pain when carrying out the injection itself. The oral dose isn’t quite as effective at minimising the risk of VKDB and there’s the potential for further doses to be forgotten to be given in the sometimes chaotic environment of a newborn household.

One of the concerns some parents have about vitamin K doses is that a 1992 study was released that indicated an increased risk of cancer in children. Helpfully most UK health authorities and authoritative bodies made no official statements to help families make their decisions but instead fence-sat and passed the buck spectacularly to parents. Further studies showed that the risk of tumours remained the same whether children received vitamin K or not, however remained unclear about the increased risk of developing leukaemia. However, the most recent studies and reviews have concluded categorically that there are no links between vitamin K and an increase of cancer of any types.

So what are the actual statistical risks we’re looking at? The most recent studies show the numbers as follows:

  • Untreated babies risk of developing VKDB: 4.4-10.5 per 100,000
  • Oral treatment: 1.4-6.4 per 100,000
  • Intramuscular treatment: 0-0.62 per 100,000

Although small risks anyway, by choosing vitamin K to be given by injection the risks are all but eliminated.

If you choose to decline vitamin K there are things that you should watch out for in your baby. These are:

  • Active bleeding from the nose, mouth, gums, umbilical stump or any treatment site (heel prick test for example)
  • Blood present in urine, faeces, or vomit
  • Unexplained bruising or bigger than expected bruising (at a vaccination site for example)
  • – The fontanelle (soft spot of the head) appearing different to normal (which could indicate bleeding on the brain)
  • If baby starts acting differently; although this is a particularly difficult one as baby’s not been around long enough to have a ‘norm’.

As an aside, some trusts will refuse to divide a tongue tie if your baby hasn’t received vitamin K, so something to bear in mind.

As ever, this is my interpretation of what I’ve read and understood, and so any mistakes are my own only. My resources for this topic are below.

NICE Guidelines

Evidence Based Birth

Article with paediatrician E Hey in BMJ