In Support of Invisible Midwives Everywhere

Today is International Day of the Midwife. A day to honour all of the midwives who have been a part of all of our lives, after all, even those people without children of their own were born themselves once and chances are, a midwife attended their birth.

Midwives are there for women and their families on one of the most important days of their lives. Midwives nurture women in their care, guide them emotionally and physically through pregnancy, birth and early parenthood. Midwives save lives and witness daily the amazing entry into the world of new little people, quietly, confidently and with compassion. Midwives know when to sit back and be invisible, trusting women to birth their own babies and only coming to assist if the need arises.

Or at least they should.

Unfortunately the systems that midwives have to work within don’t allow them to do their job properly. They are forced to place time limits on the women in their care, to intervene unnecessarily on a regular basis and to persuade women to birth in big obstetric units if their employer is under the false impression that these units will prevent law suits from happening. The fact is that home is the safest place for women to give birth, it is also the cheapest place. Continuity of care from a trusted midwife also results in better and safer births. It’s utter madness that the system doesn’t grab hold of these facts and embrace genuine with-woman midwifery.

All over the world, women and midwives face persecution and legal action against them if they dare to step outside of that system. Agnes Gereb, Hungarian midwife and obstetrician, is currently under house arrest for attending women birthing out of hospital. Even here in the UK, NHS midwives who work with women at the centre of their care face the possibility of harassment in the workplace from their colleagues. AIMS has a Midwife Defence Fund that people can donate to, this fund helps secure legal representation and cover other costs to assist midwives facing persecution. You can donate here: http://aims.org.uk/MDF/

Independent midwifery is scheduled to become illegal as of October 2013, due to red tape. The EU has declared that IMs must have indemnity insurance, but no provider on the market is willing to insure midwives working outside the system. Therefore, by default, midwives will no longer be legally able to practice independently.

IMUK has been tirelessly searching for a solution, but there is no option available that will allow them to continue to provide care during birth for women who are anything other than “low risk”, that is, “risk” as defined by an extremely conservative legal team in charge of defining NHS protocols, which is not always the same as genuine medical risk. Even if it were, women should still have the right to choose their care provider and place of birth.

If I am ever to have another baby, I would not be able to be cared for by a skilled and experienced midwife of my choice in my own home, as I have had two previous caesareans and am therefore “high risk”. The actual risks of a home birth in my situation are tiny and I should be free to choose to birth there with a midwife of my choice. The changes in the law mean that I am extremely unlikely to ever have a third baby and if I do, I would be forced to choose between the luck of the draw NHS service, who treated myself and my husband so appallingly three years ago, or to not have a midwife present at my birth at all. Basically, I don’t want another baby at all if I can’t have the same amazing midwife that I had for the Bean’s birth.

So today, on International Day of the Midwife, I’d like to shout out my support to independent, with-woman and invisible midwives everywhere who are striving to care for women and their families despite great personal risk. You are all superstars.

Rebirth: A Second Chance

Rebirth. “A new or second birth”. A chance to start again, a chance to make new memories that heal the old ones. In terms of healing birth trauma a rebirthing might consist of re-enacting the birth in the way previously imagined or it might be a spontaneous and instinctive moment shared between mother and baby in the bath or in bed in the middle of the night.

After the Munchkin’s birth, someone suggested I try a rebirthing in order to heal emotionally from the trauma I experienced. But he was already about three months old, I wasn’t ready to let go yet and wouldn’t be for over two years, and the more time passed the less like a newborn he was and it just felt wrong to try. The very thought of getting my birth pool back out again made me burst into tears. So we never did it. I had to find healing from his birth the long, hard way and we’re finally there after some intensive therapy and an empowering second birth.

That second birth, however, was not the experience I longed for. Though it wasn’t traumatic in any way, it left me grieving. Within days of the Bean’s birth I knew I wanted to try a rebirthing. I needed to physically recover from the caesarean though and I needed to prepare in practical terms. I thought I wanted my midwife and doula to be there and was considering having the Munchkin there too, though at other times I felt I didn’t want him there. Getting everyone together at the same time looked unlikely when my doula gave birth to her own baby a few weeks after the Bean was born.

As the days turned into weeks I started to feel a bit desperate. My little newborn was rapidly developing into a strong baby and I was afraid it would get too late. So I decided to grab the opportunity as soon as the Munchkin was staying at my parents’ house for the night. Finally that moment came, 8 weeks after the Bean’s original birth.

Today, after an absolutely beautiful day out with friends to celebrate the Munchkin’s third birthday, he went home with my mum and hubby and I made our preparations. We inflated and filled the pool, lit candles and put on my birth music. I got into the pool and listened to the song that had been one of my hypnosis triggers that I used during pregnancy and labour, Chimes, a song by an unsigned band called Glow. I thought about being pregnant, remembered my blessingway and the hope and anticipation I had felt about my forthcoming birth. These memories touched some raw emotions for me and I began to cry silently.
I changed the music to the song I had wanted playing as my baby was born. I had played it on repeat for a long time during my actual labour when it seemed I would be holding my baby imminently: Firework by Katy Perry. Cheesy? Maybe, but when I first heard it I felt it was the perfect song to accompany birth. What a strong message of the power and awesomeness of a birthing woman.

Hubby got into the pool with the Bean and passed him to me under my arm and through the water. I brought him straight to my chest and held him, I told him how much I love him and explained that this was how I had wanted to meet him. The tears flowed with overwhelming sadness and joy and hubby snapped away with the camera to capture the moment.

The Bean was calm and alert, looking carefully at me and around at the strange surroundings. We spent a few minutes in the pool and then moved to the sofa, wrapped up warm, where I fed him and hubby brought me some food. It was the post-birth chill that we should have shared but were denied by the circumstances of the Bean’s original birth.

This rebirth doesn’t undo that birth, nor would I want it to. His birth was truly awesome, in so many ways, but it wasn’t joyful. Now I have new memories, the memories I had hoped to create and that does undo some of the emotional damage of his birth.

But it’s late now, so I’m signing off to go and curl up in bed with my baby.

Examining the Contract

I have been asked to write about the thought processes behind some of my birth choices. I’d love to detail every decision and all of the research behind each, however, I am a busy mum of two and do not have weeks to draft, fact check and reference such a post! What I can do is highlight a few key aspects and talk about them in general terms.

No VEs. Vaginal examinations are often thought of as an essential part of labour, few women seem to question their use and a great deal of emphasis is placed on “knowing” how dilated a woman is, both by health care providers and by many mums. The fact is that the use of routine VEs is not evidence based. Experts in normal birth agree that women do not dilate in a linear fashion and that time limits placed upon birth are unrealistic and have no place in normal birth. How dilated you are at any given examination tells you nothing about how quickly your labour will progress and some, notably Ina May Gaskin, speculate that the vagina behaves as other sphincters in the body and can actually close up upon intrusion.

For women planning a hospital birth or a water birth in or out of hospital, they will be led to expect VEs in order to assess whether they are in “established” labour or not and whether they are “allowed” to get into the pool. The whole idea of latent and established labour is undermining. It implies that women in the early stages of labour do not need or are not entitled to support and for women experiencing a long latent phase, repeated examinations with little to no progress can be extremely demoralising. As for getting into the pool, it is thought that getting in too soon can slow down labour. Well so what? If that does happen then surely she can just get back out of the pool. Besides which, what is the rush, exactly? Women birthing at home with a pool should feel free to use that resource as and when they feel the need for it. They do not need permission to use it.

An experienced midwife should be able to assess the progress of labour without these intrusive examinations, the woman’s behaviour, the noises she is making, the dark line that extends up from the anus and up the back and even the smell in the room are all signs that midwives can look for to give them an idea of how the birth is unfolding.

I have to emphasis at this point that about six or seven hours into my second labour, all the signs pointed towards a very imminent birth. I laboured in much the same state for another twelve hours before consenting to a caesarean. So these signs are not always reliable, but I would argue that they are no less reliable than VEs and in a normally progressing birth they are probably more reliable.

On a personal note, I felt that VEs were the cause of my first caesarean. I had intended to decline them, knowing how pointless they generally are, however when I was in labour I was told that I “had to” have them every four hours and I wasn’t in a state to refuse. Had I had a doula who could have reminded me that I didn’t want them and that I was entitled to refuse then perhaps that birth would have been different. I was having a long and intense latent phase, it took me twelve hours to reach 4cm. Each examination was painful and intrusive, disrupting my labour and crushing my confidence. This was reason enough for me to decline them second time around.

I did, however, ask for them when I was in labour because I knew that something was not right and I knew that some useful information might be gathered from one, such as the baby’s position, which can be found by the feel of the skull plates. I had to work quite hard to persuade my midwife that I really did want to be examined. She knew how strong my feelings on the matter were and she, quite rightly, wanted to make absolutely sure that I wanted one. I asked her not to tell me how dilated I was, I knew this information was irrelevant, but I needed to know if there was a reason why I had been pushing for hours already and felt no closer to birthing my baby.

No induction or augmentation. As a woman with a previous caesarean under my belt, the risk of uterine rupture was a hot topic. The real risk is tiny, 0.2%, but the use of drugs to induce or accelerate labour dramatically increase that risk. Even without a uterine scar, there are risks associated with this intervention, chiefly foetal distress. There are very few good reasons to induce labour, in my opinion. As long as the pregnancy is straightforward, and even some complicating factors warrant only a watch-and-wait approach, then there is no reason to interfere. I certainly wouldn’t accept induction for going “overdue”. You can see what I think about the length of pregnancy here.

As far as I am concerned, there was no good reason to augment my labour. Either birth will unfold in its own time, or urgent assistance is needed. My first labour was augmented. I was persuaded that my body wasn’t up to the task and I needed help to “coordinate” my contractions in order for my cervix to dilate. I begged for time, I really did not want to open myself up to all of the risks associated with the use of syntocinon, but I was bullied into it, told that my body had had plenty of time already and was clearly failing.

I can see how the use of synto has become so common, it is very normal for women to not labour well in hospital, the conditions are so far removed from those needed for birth to unfold naturally. In some situations augmentation may help to undo the damage caused by transferring into hospital, but for me, planning a home birth, this was irrelevant. I was only going to be going into hospital if me or my baby were in danger and needed immediate assistance.

Leaving the cord alone. I planned and had a lotus birth. I recognise that this is an extreme most people will not be interested in, however, the principle of leaving the cord in tact at least until it stops pulsating, is one that is gaining popularity. Research now shows that babies whose cords are cut prematurely are deprived of up to half of their blood volume and are more likely to be anaemic, suffer brain damage or develop autism. In a straightforward birth there is no reason whatsoever to interfere with this process and doing so is potentially very harmful. Where my view is considered a little more radical is in the belief that even in a complicated birth, leaving the cord alone is possible and even advisable. If a baby is compromised at birth then it needs all of the blood and oxygen that it can get, cutting the cord deprives them of both. Many people seem to be under the impression that a nuchal cord, that is, when the umbilical cord is wrapped around the baby’s neck, is an emergency situation and that cutting the cord is necessary in cases when it is tightly wrapped. This simply isn’t true and this article explains why.

I’ll leave it there for now, but if there are any other aspects of my Birth Contract that you would like to know more about, please comment and I will do my best to explain my reasoning. Thanks for reading.

Entering the Birth Head Space

Before Christmas I decided that I needed to start winding down towards my forthcoming birth. I started cutting back on my volunteer and support work and tried to focus on me and my family. Christmas made it easy, plenty of family distractions. Entering January brought some challenges, it has been hard to stay away from the forums and groups that I typically frequent and to keep “work” at bay. If my professional life were completely disconnected from birth and parenting then I would just keep going, keep life normal for as long as possible in order to prevent days or weeks of waiting for birth. But my “work”, such as it is, is to support other pregnant women and new mums through problems they are having with their maternity care providers. I’m a sensitive person, I am easily emotionally stirred by the experiences of others and I find it extremely difficult to turn a blind eye to the problems of others. While this is a massive bonus normally, allowing me to fight passionately on behalf of others, at this point in my pregnancy I really need to focus my emotional energy inward, on myself.

There are others like me, with passion, enthusiasm and time to provide advice and support to those who need it. Acknowledging this and trusting them to continue to do so in my absence has been challenging, it is something I absolutely must do now.

A couple of weeks ago, my tribe of wonderful women friends and my amazing mum, came together with me to celebrate my pregnancy and the new life about to be born, in the form of a blessingway. It was a truly wonderful occasion, with friends coming considerable distances to join me for this, so much thought and attention had been applied by all, especially the lovely Jo who organised it. It was a deeply spiritual ritual, tailored to me and my beliefs, but hopefully open enough for those present to share in the thought behind it even if they came from different spiritual or religious backgrounds. Together we shared our fears and hopes, channelled energy and most importantly…. ate cake!

In the moments since in which I have struggled to keep worries at bay, I have looked down at my henna belly, touched the beads strung upon the necklace made for me and imagined the women of my tribe encircling me. Feeling their energy and support around me and within me is a true blessing.

As I approach this birth, which could happen any time in the next few weeks, I will continue to remember that and draw on it for the strength I need to overcome the challenges of the end of pregnancy and to enter the head space I will need for birthing my baby.

I feel emotionally ready to enter birth, I’m prepared on a practical level too with everything we need gathered together and ready to use. We have had a trial run with the birth pool, inflating and filling it, which, of course, had to be followed by an evening spent relaxing in it by candlelight. So now it is simply a case of allowing baby to be physically ready to choose the day. This is the hard part for me, being gracious and patient, though I know and believe it to be necessary and worthwhile. I’m still a normal human woman, I am uncomfortable with my size now and not sleeping as well as I wish I could, I’m bursting out of all of my maternity clothes and constantly fending off the “When are you due?” question with my suitably accurate “Some time soon” response.

I was given some affirmations at my blessingway and have written more for myself since. I share some of them with you now.

I am a link in an endless chain of birthing women.

300,000 women will be birthing with me. Relax, breathe and do nothing else. Labour is hard work, it hurts and you can do it.

We have a secret in our culture, and it is not that birth is painful, it is that women are strong. – Laura Stavoe Harm

I am surrounded by love and support.

My baby will be born at exactly the right time.

Live every day, enjoy each moment of pregnancy, for it won’t last long.

Every day my baby grows more ready to be born.

My body knows how to grow and birth the perfect baby.

Every day my body is preparing for birth.

Use this time wisely.

“When are you due?”

It’s pretty much the first question from everyone who finds out that you’re pregnant. I think on a rational level, the vast majority of people know that you can’t really predict when babies will be born, but I suspect the majority still believe that the Estimated Due Date (EDD) is scientific and accurate at least some of the time. The truth is though, it’s an arbitrary date determined by outdated pseudo science, a best guess, based on the probable misunderstandings of ancient theories.

The theory goes that pregnancy lasts for 40 weeks (9 months + 1 week) from the first day of a woman’s last menstrual period (LMP). Where did this idea come from? It’s called Naagele’s Rule, named after German obstetrician Franz Karl Naegele (1778–1851), who devised the formula. I don’t believe that Naegele plucked this idea out of thin air, it is likely that he read Aristotle’s theory that pregnancy lasts for about 10 lunar months, and Naegele assumed that a lunar month was 28 days.

Aristotle, however, was what I call a “well rounded wise man”. He was a philosopher, mathematician, scientist and sociologist. With his education in physics, it is extremely likely that he knew that a lunar month is not in fact 28 days, but nearly 29.5 days, making 10 lunar months 295 days, NOT 280, over 42 weeks, NOT 40. What a difference to pregnancy length that makes. What Aristotle actually wrote was:

pregnancy may be of 7 months’ duration or of 8 months or of 9 and still
more commonly of 10 (lunar) months, whilst some women go even into the
eleventh month. 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1341914/pdf/bmjcred00258-0017.pdf

Naegele’s Rule also assumes that all women have exactly 28 day cycles and that they ovulate on cycle day 14. Obviously, this is not true. There is great variation in both cycle length and ovulation timing. There is a suggested alternative formula, Parikh’s Formula, which is a date calculated by adding 9 months to a woman’s LMP, then adding the length of her average cycle, then subtracting 21 days. For example, a woman with 35 day cycles whose last period began on 1st January would do the following calculation:

1st January + 9 months = 1st October

1st October + 35 days = 4th November

4th November – 21 days = 14th October

This EDD is approximately one week later than EDD calculated by Naegele’s Rule.

A small study in 1990 by Mittendorf et al. found that the parity of the woman was a factor in the length of her pregnancy. First time mums had an average pregnancy of 41 weeks and 1 day (41+1), second and subsequent babies arrived at an average of 40+3. Some studies have also found racial variations in pregnancy length.

Normal human gestation is usually defined as 37-42 weeks, by the WHO, maternity professionals and academics, and yet the myth of the EDD persists. Midwives and obstetricians do nothing to correct this misconception, they often seem to fixate on the EDD, first calculated by LMP and then by ultrasound, the infamous “dating scan” that most pregnant women have at about 12 weeks in the UK. (My views on the reliability of ultrasound are explored in my previous post “Guess the Weight”). The dating scan has a 6 day margin for error, officially, and yet it is relied upon so strongly that a woman’s knowledge about her own body is usually dismissed in favour of what the machine says. For instance, were we using NHS maternity services for this pregnancy, the sonographer that did our early pregnancy scan (for reassurance) would have us believe that this baby was conceived 8 days prior to ovulation and 3 weeks after the last time we made an attempt to conceive, a passing familiarity with human conception will tell you that this is impossible. No, in fact, this baby was conceived when I actually ovulated and not by some freaky and convoluted miracle process of my dear husband’s swimmers breaking all records and my body releasing an egg more than a week before all the physical signs indicated the possibility.

Even so, knowing when you conceived doesn’t actually give you any particular insight into how long your pregnancy will turn out to be. Gestation is a natural process and as such, it can’t be timetabled. There is great variation and most of it is completely incomprehensible, there is no known explanation for the wide variety in gestation lengths, it’s just an organic part of life and one that I think we would all do well to accept.
People pin all of this importance on the EDD and their care providers make it worse by rushing to intervene as soon as pregnancy continues beyond 40 weeks, which it does in more than 50% of all pregnancies! In my own small way, I try to challenge this by reminding people of the “Estimated” in EDD and emphasising that normal pregnancy is 37-42 weeks. I have also refused to tell anyone the precise date that I will be 40 weeks pregnant. I know when that date is, as I know when we conceived, but it is not my EDD, to me there simply is no such thing as an EDD. Our midwife knows the 40 week date, but together we have no expectation that there is anything special about that one day. It’s a vaguely useful day to note down so that we have an idea of what 5-6 week period the baby might put in an appearance, that’s all. To all of our friends, family, neighbours and random acquaintances, we expect this baby to arrive some time in February, probably.

Switching Off and Being a “Normal Mum”

Twice in just a few days I have been in situations where it is probably best to switch off my campaign head and shut up, be a “normal mum”, whatever that might mean. The first of these was the first of two Natal Hypnotherapy workshops that hubby and I are attending in preparation for this birth and I didn’t do so well. The second was my aquanatal class today. I did better.

I’ve always found it hard to know when to shut up and keep my opinions to myself and have probably pushed a fair few people away because of it in the course of my life. When my passions are raised they tend to spill out of me, but I’ve worked hard to get it under control and generally I think I do a better job now than ever before.

When it comes to birth, it’s a bigger challenge than most issues I’ve felt passionate about in my life. It’s such an intimate topic, birth is the single most significant physical act that a woman embarks upon and also the one fraught with the highest emotional investment too. I know that birth can be amazing and I know that all women deserve excellent maternity care. I know that there are fundamental, systemic problems with NHS maternity services that prevent the majority of women from having the births they should have. I hate seeing women being trampled on and abused by their care providers and it makes me angry and deeply saddened that I can even use the word “abused” there and know it to be no overstatement or falsehood.

Last Friday at the Natal Hypnotherapy workshop, I had to tell myself not to go to it expecting that I would know everything already and to accept any new knowledge or tools presented to me. At one point, having answered every question about hormones and birthing positions that we were asked, I actually apologised and made an effort to keep my mouth shut to give one of the others a chance to answer something. I felt a bit like Hermione Granger.

One of the other ladies on the course is also planning a VBAC and I couldn’t stop myself from making suggestions about which interventions she might wish to think more about. I don’t think I came on too strong there, but over lunch discussion turned to placentas (yes, over lunch) and I went and mentioned the fact that we’re planning a lotus birth. I think the others were mostly just intrigued, until I went a step too far and mentioned consuming the placenta as another option. I suspect I came away from lunch looking like a very weird hippy.

This afternoon was my aquanatal class, which I go to for the exercise and “me” time. After the class we sit in the café for a chat and the first time I went it was just me and the two midwives who run the class. We had a fantastic chat and I told them about what I do and which groups I’m involved in. They are lovely ladies, very keen on what they do, which is helping women keep fit and healthy in pregnancy and they have their gripes with the NHS, and so no longer work within it. However, I do suspect that they don’t see quite the same problems that I do.

Today there were others present, one lady due in a month or so and another who had a home birth a few months ago, another lady due early next year. I was very grateful for the home birthing mum’s presence, as she was able to say some of the things I would have loved to say, but in a much more palatable way than I can sometimes be guilty of. She was a normal, non-campaigning mum, a mum who only breastfed her eldest for a few months (compared to my 2.5 years) and who told us that her home birth “bloody hurt” and that she had a third degree tear and had to have a spinal afterwards while being stitched up. She was absolutely supportive of home birth and said she would do it again if she ever has another baby, but she definitely wasn’t ever going to come across as the dreaded hippy-type or militant birth campaigner. Like me.

For the most part I just nodded in agreement with her. When the nearly-due lady asked if it was possible to hire a midwife privately, as hers is so rubbish, I was able to espouse the virtues of independent midwifery and I also mentioned doulas. I think I managed to toe the line I find so difficult, that of switching off my campaigning head and just being a normal mum, talking to another normal mum and hopefully pointing her gently in a sensible direction that will help make a positive birth attainable. Maybe next week she’ll be telling us that she’s booked a home birth and hired a doula. Maybe even an IM. I hope so, for her sake.

Shopping for the Baby

So, I bought THE jeans. The Boob Jeggings. I grabbed a bargain on eBay, new with tags, and they are excellent, a little long for my average height but they fit great otherwise and do the exact job I bought them for, they may even be comfy enough and flexible enough to wear to my yoga class!

I was talking to a friend today about shopping and how my shopping behaviour has been different during this pregnancy compared to last time. In part it’s down to money, hubby and I are better off this time around than a few years ago so there is less holding me back from clicking on “Add to basket”, though we are not really as affluent as my recent shopping habits would imply and I really must try to restrain myself more. More

Previous Older Entries

Follow

Get every new post delivered to your Inbox.

Join 35 other followers