informed choice - Stockport Birth Services

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

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

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.

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

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/