Open Letter to the NMC

open letter to NMC freedom for independent midwives

I’ve mentioned this in passing in a few posts recently, finally I’m able to sit down and write a full post about the farcical treatment of independent midwives by their governing body, the Nursing and Midwifery Council (NMC). The backstory to this goes back years. In very brief summary, in 2014, it became mandatory for all health professionals to have indemnity insurance. Prior to this, independent midwives (IMs) were practicing without insurance. Clients would simply sign a declaration stating that they understood this, myself and the husbeast signed such a document when we hired our IM in 2011.

This worked absolutely fine in the overwhelming majority of cases. For two main reasons; first, the client entered into this arrangement with full knowledge and acceptance of it. If it had been a deal-breaker for a client/couple, then they simply wouldn’t have hired the IM and would have sought midwifery services elsewhere, either through the NHS, or a private provider (note: independent and private midwives are very different. Private midwives are employed by a corporate/private maternity care provider. IMs are self employed, totally independent and traditionally free from corporate/insurance interests).

Second, it is generally recognised that IMs provide the gold standard of midwifery care, therefore adverse outcomes are extremely rare. In the exceptional circumstances where something did go wrong, AND the IM was found to be negligent, it was up to the client whether to pursue a legal case or not. With the relationship typically built up between woman and IM, it seems inconceivable that the woman would decide to bankrupt the midwife. Of course, there are a couple of cases of this happening, but it is essential to look at the big picture and assess whether broad strokes that affect nearly 100 midwives and the many thousands of women that they care for are proportionate to the tiny number of cases where lack of insurance was a serious problem.

The reason that IMs were practicing without insurance was that there wasn’t an insurance product available to them. Insurers, with no knowledge of birth or midwifery, considered it too high a (financial) risk.

In 2014, however, when IMs were left with no choice in the matter, they found a provider who was able to create a custom policy tailored to their practice. Any IM registered with IMUK was covered by this insurance. Everything seemed to be going smoothly, until late last year, when the NMC suddenly decided that the insurance they had in place was not adequate. To date, they have refused to explain in what way it is inadequate, or what additional coverage would make it adequate. There have been muddled statements about there not being enough money in the pot to make a single large payout. However, it is my understanding that this isn’t true, and that if a claim were successfully made against an IM, there would, in fact be adequate funds available by the time the payout was expected to be made.

The NMC refuse to accept this and simply forced all IMs to sign a contract, under duress, stating that they would no longer attend births. The lack of warning left hundreds of women without their midwife for their births. Apparently, the NMC found this acceptable.

Birthrights and other organisations have been working tirelessly on this issue. Below is an open letter, written by Birthplace Matters founders, Paula, Jeannette, and Anna. The complete document and correspondence history can be found here. Please feel free to share widely. Tweet the NMC @nmcnews and #savethemidwife and make your voice heard. IMs and birthing women need our support.

Open reply to the NMC from Birthplace Matters – March 2017

Dear Catherine Evans and Emma Broadbent,

Thank you for your response to our letter. It is clear that your goal is to focus on compensating mothers after the event of their birth. We wish to explore this in broader terms and discuss what really matters to the many mothers we hear from at Birthplace Matters.

It strikes us that when a woman is hiring an independent midwife, it is often done as an act of insurance, to protect herself and her baby from damage which she does not want to repeat from an earlier birth. Sadly, the damage we hear about is occurring far too often as a result of ‘routine’ or commonplace procedures which are happening every single day up and down the country.

As such, far from being a luxury lifestyle choice for a wealthy and privileged elite, a woman’s decision to hire an independent midwife is much more often an act of desperation following anxiety attacks, symptoms of PTSD, and feelings of anger and sadness following an experience of giving birth under NHS care. Often, they just want to avoid the same ‘routine’ procedures and treatment again.

Your statement that women still have the option of choosing non-IMUK midwives, fine though they may be, is not actually viable for some – since some women live too far from one for that to be a safe option for birth – especially for 2nd, 3rd, or 4th babies etc, who may come too quickly for a midwife to drive 3 hours to her. In such cases women are left facing the option of going back under NHS care, choosing to birth alone with no midwives, or, as we have been hearing more and more recently, actually choosing not to have any more children. All three of these options are unacceptable when taken as acts of desperation. Do you see now what peril women are in because of this insurance fiasco?

Without exaggeration, some stories we have heard by women describe their birth in the language that rape victims use about the violation of their bodies by strangers. Some are triggered for weeks, months and even years afterwards, often suffering silently. Even if a birth appears on paper to have been a success, with no legal category for suing a hospital, it doesn’t always mean that a woman walked away from her birth experience unscarred. There are invisible wounds which cannot be accounted for in a tick-box on an insurance claim form. Some feel too beaten down to fight anyway.

We are hearing frequently from women who say they were ignored, laughed at and even abused by NHS staff – ironically, your actions in preventing IMs from practising is pushing some women to have to go back to the same place and potentially go through the same traumas all over again.

When we allow insurance companies, governments, and lawyers to determine the T&C’s of birth, it can be interpreted as a carte-blanche to behave appallingly, in the arrogant guise of rescuing women and protecting babies by a highly interventionist approach. The onus on deciding what is safe is therefore shifted away from the mother, where it rightfully belongs, and is assumed by her care team. When a woman is not trusted to make informed decisions, but is instead bullied, this undermines/violates her rights over her own body and her own baby.

This is why so many women seek out an independent midwife – because the word independent means just that – they know full well that whilst their midwife is insured for what is to most mothers, a reasonable and reassuring sum, these midwives are not entirely in the pocket of insurance companies so are not motivated primarily to satisfy insurance company tick boxes over and above the wishes of the mother. They often avoid the same knee-jerk interventionism that is offered within NHS settings, providing instead truly 1:1 watchful, continuous care with the time and space to be with-woman in the way that midwives in hospitals cannot due to restraints outside of their own control. Without wishing to offend individual midwives within the NHS who offer sterling care, we feel that this continuity actually makes independent midwifery a much safer model.

Even the very best NHS midwives will sometimes admit they are just too busy to truly give the full care and attention they would wish they could give to women, knowing that CTG monitors are a poor substitute for 1:1 care and have not been shown to have saved even one life. Even in those places where the NHS aspires to offer truly holistic care, it is not always consistently available for all women coming through the doors. When women are lucky enough to receive truly individualised and holistic care it is more often than not at a personal cost to a midwife’s career progression.

There are so many good NHS midwives working within the system who are being disciplined and over-ruled to satisfy bosses who are thinking of insurance and malpractice tick-boxes first and foremost. Many are leaving the system altogether due to stress and burnout in their attempt to balance gold standard care with restrictions from on high. As well as working within ever more restrictive insurance company T&C’s, it must also be said that the over-riding of mothers’ wishes within the NHS is done in a spirit of old-fashioned paternalism which is very tiring for women to have to put up with in 2017 after all the gains we have made to improve women’s rights elsewhere.

In the light of what we have discussed above, we at Birthplace Matters feel that the NMC’s definition of what it means to protect women and their babies needs to be re-evaluated. In 2017, it ought to mean so much more than a woman’s ability to claim financial reimbursement in the event of lifechanging birth complications – since no insurance company should have a monopoly on defining what those complications are. Clearly, many women are left scarred by their birth experiences in ways that are invisible, but are very real and life-changing for themselves and their babies in ways that affect whole families. Offering a wildly inflated sum like £10m is meaningless to a mother who has to drive a 10 mile detour so she doesn’t have to go past a hospital where she gave birth and who does not want to relive the trauma all over again by pursuing a legal case – especially if the hospital closes ranks and proposes what constitutes harm by their own definition only, ignoring or belittling her complaints.

The insurance cartel that is taking over birth practice is turning this very natural process into an increasingly clinical event with unhappy consequences for many mothers and babies. If such insurance-dominated practice was translating into safer and more satisfying birth it would make sense – yet the opposite seems to be true, judging by the soaring rate of inductions and other interventions which drive up the cesarean rate.

We ask that you pay attention to the voices in the #savethemidwife campaign and recognise the ridiculousness of telling independent midwives they are not insured for enough without stating what ‘enough’ is, leaving them and their clients in a state of confusion and despair. Why not let mothers decide on what level of insurance they want to choose rather than letting the insurance companies dictate whether a woman can afford an independent midwife, or not? Independent should mean just that – forcing them to fall in line with the NHS suggests you do not appreciate the difference between the two uniquely different models. They should remain separate as they have been to date, and women should rightfully be at the helm in choosing what they need.

Yours in frustration,

Paula, Jeanette and Anna – The Birthplace Matters Team

3 Top Tips for a Chilled Out Winter with A New Baby!

90338.jpgThis time five years ago, I was heavily pregnant with the Bean – wait, what? Was that really five whole years ago? Where has the time gone?! Three years before that, hubby and I moved 220 miles when I was 26 weeks pregnant. I really don’t recommend doing that! It’s been a few years since I had a tiny baby, but I remember it pretty clearly and have definitely learned a lot since then. You find that parenting is rather like being on a swing. It takes a bit of effort to get going and coordinated, but once you’re in the swing of it, you forget the effort it took and it becomes second nature. I hope that some of these tips from a wise old bird will help a few new parents this winter.

1Layer up! Obvious really, but this is my number one top tip. I didn’t really get it the first time around. I kept wearing the types of clothes I had worn pre-baby and was forever the wrong temperature! Nursing burns serious calories (so go ahead and let yourself have a slice of that home made cake at baby group), and in your hormonal post-partum state, you may get hot flushes. You’ll want to wrap up against the cold, but then when you arrive at your destination, be prepared to shed layers to be comfortable.

Same goes for baby, by the way! Several layers is better than one thick snowsuit, especially if baby is going to be in a car seat or be worn in a carrier (more on that in a mo). It’s super important not to put baby in anything too thick when they are in their five-point harness car seat, as if the worst should happen and you are in a collision, that padding can prevent the straps being tight enough to keep baby safely in their car seat.

When the Bean was little, I spent the extra cash on some nursing tops, rather than making do with what I had. I highly recommend Boob for fantastic tops for this time in your life. I still wear my hooded jumper from time to time. You can add layers safe in the knowledge that you can easily get to your breast to feed baby, without the discomfort of bunching up excess fabric or getting a chill from having your side/belly/chest uncovered.

Invest2 in a good carrier…. or six! I know not all parents will agree on this one, and each to their own, but I find a pram or buggy totally impractical in winter. I’ve never figured out how the parent holds an umbrella while pushing a pram, and the thought of slipping on ice and a pram rolling away down the steep hill that we live on is unthinkable! The Munchkin was in a pram a fair bit when he was little, but it was spring-summer and I hadn’t yet really discovered babywearing properly. We did have a sling, but I didn’t get on with it. It took me a while to get to a sling library and find a better carrier. He was ten months before we ditched the pram and started wearing him exclusively.12043191_1060903917277302_6469733779818377733_n

The Bean has only ever been in a buggy when we were on holiday in Florida and it was too hot to wear him. At home, I’ve never felt the need to use one with him. I got seriously into babywearing after he was born, and invested in several fantastic wraps, a ring sling, and a gorgeous custom made, Dr Seuss-themed, half-buckle mei tai by Madame GooGoo! I was wearing this in London one day, when a woman approached me from behind and told me she had seen pictures of my carrier online (sling makers often share photos of their finished products before shipping them) and long been an admirer of it, she was so surprised to see it in person. The sling world is like that, very friendly and approachable. Carriers also retain their value quite well, so can be sold on when they are no longer in use. I had to sell this carrier on last year. I often wonder where it is now and if it is still getting lots of use.

Babywearing in winter is a great way to keep each other warm and safe. Light layers, as mentioned above, are best, to avoid over-heating. I absolutely loved putting my babies in leg warmers, as in the picture above, a great compliment to babywearing and cloth nappies.

Most high street carriers are unsuitable for babywearing safely. They don’t allow for parents to follow the “TICKS” guidelines, and forward facing positions place stress on the wrong parts of a baby; chiefly their spine and crotch (these are jokingly referred to as “crotch-danglers” in the babywearing community). So, if you are going to wear your baby, make sure that your carrier enables you to wear baby in the correct position (Tight against your body, In sight at all times, Close enough to kiss, Keep the chin off the chest, and Supported back – upright, facing you,. These are the T.I.C.K.S.). Back carries are great when babies get a bit older, but newborns are best worn on the front so that the TICKS can be observed.

There is a wealth of detailed information out there for those wanting to wear their babies, so I urge you to take a good look around the net, find a local sling library, and get support. There are loads of groups on Facebook dedicated to this!

3Don’t over-do things! If you are just about to have a baby, or have recently given birth, for goodness sake, don’t try to take on too much this festive season! It’s not worth it. Take it easy. Nest, or snuggle into your “babymoon” and enjoy your new baby. Get help in for Christmas, from family or friends. Don’t feel you have to cook a huge feast for all of your extended family. Traditions are great, but they can wait until next year if they involve a lot of effort. Let yourself have this pause from the hectic hustle and bustle of the season, your body will thank you. Stock up the freezer with easy-to-heat meals; get shopping delivered instead of traipsing around a supermarket with a baby; say no to the invitations that you know you need to skip this year; keep it simple. I had the Bean at the end of January, so Christmas 5 years ago was a fairly low-key affair. I was waddling everywhere and unable to sleep comfortably due to my huge bump.

Nursing a newborn means resting and nourishing your body, rushing about trying to fit in too much won’t do either of you any good. If you have commitments that can’t be skipped or delegated, then find ways to manage them. You might have a school run to do with an older child, or a relative to care for. Of course you need to do these things, but try to have realistic expectations of yourself.

I hope some of this is helpful. If you have any more tips for the season, do please share them in the comments below. I love to hear from readers!

 

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

pregnant-beach-sunset-mother-51386

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!

Henna Belly

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.

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“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.