While You Were Away…

parenting-word cloudAs some people may have gathered from my last post, something’s stirring over here at Spirited Mama!

I am indeed, still alive and still as spirited as ever. I decided that it was time to dust off this blog and breathe some life back into it. My life moved away from blogging for a while, I didn’t feel I had much to say and was focused on writing my fiction. But my mama bear is stirring and has things to say again.

It’s funny how life is this constantly shifting current, taking us from one place to another, often seemingly without us controlling it at all. There is definitely an ebb and flow to energy and that changes the course of our lives.

beach1So what happened while I was away? The Munchkin is now 6 years old and the Bean is 3. How did that happen? I’m also now a single mum. Both kids spent some time at a Montessori nursery, but are now both at home full time, so you can expect to see lots of posts about home education and parenting in general. I’m still nursing the Bean, and am a vocal advocate of full term breastfeeding, so that might come up from time to time too. I don’t have as much to do with supporting women and families with their births, but still admin a VBAC support group online and keep half an eye on the state of birth in the UK, so if something catches my eye I’ll probably mention it here. I want this blog to continue to be a resource for those with birth choices to make, even if that isn’t my primary focus these days.

Aside from parenting, what else has happened in the last few years? I’ve published two novels and a short story in the Echoes of the Past series, with novel number three due out this summer. I’m currently running a crowdfunder to raise funds for my publishing costs, so if anyone would like to contribute and help out this single mama trying to earn a living from her passion, then do please hop over to my Pubslush page and chip in what you can. But this blog isn’t about my books really, so I won’t be bombarding you with promos and the like, don’t worry. You might see a few book reviews of kids’ books though!

I’ve also really embraced Twitter, hence the title for this post. It’s become my favourite social media platform in many ways. It’s not great for holding conversations, but I love it for connecting with other people and keeping up with their news. Sometimes it is like shouting into a crowded room though, so I try to engage with people to make it meaningful to be there. Follow me via the link below!

I think that’s all from me for now. Check out my social media links below and hit the “follow” button to keep up to date with new posts here. I’m really looking forward to jumping back in to this crazy world of #pblogging with you all!

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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.

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.

A Healing Birth Can Still Hurt

It’s a secret no one will tell you. My dear friend, and fellow blogger, Chloe, wrote about this recently. For those of us who have had traumatic births, we sometimes place a lot of hope on a subsequent birth, it becomes a lifeline out of the pit of that trauma. So what happens when that lifeline snaps? What happens when you don’t get the amazing birth you were planning? What happens when, like me, you get a birth that is far removed from the one you wanted but one that was not traumatic, in which you were completely respected and had your contingency plans followed to the letter?

My recent birth genuinely was healing and empowering. It was a positive experience, by and large. I was incredibly well supported, I was respected and listened to. I had all of my wishes listened to and accommodated where at all possible. I came out of it feeling elated that I had done something so rare and thrilled that people were talking about it. It might make a very real and positive difference for other women. My relationship with the Munchkin has improved massively. I can say with absolute sincerity, finally, that I gave birth to him. For years I could not say that, he was surgically removed from me, my caesarean wasn’t the same as giving birth. Now I feel differently and because the Bean’s birth followed such a similar pattern to the Munchkin’s, I can also speculate now that no amount of support would have resulted in a vaginal birth with him either. For years I was carrying this heavy weight around my neck: what if we had just done x, y or z? Well this time we did do x, y and z and it still didn’t result in a normal birth.

But there is a dark side to that realisation. For the first few weeks after the Bean’s birth I felt lighter. I felt relieved. But as time passed I realised the consequence… if nothing I could have done would have made any difference then why did my births both end in caesareans? If it was nothing to do with the support that I had, nothing to do with my antenatal preparation, nothing to do with the external conditions of my labour, then what is wrong with me? Because that is where my mind wanders, towards a reason. I’m not the sort of person who can just accept that “these things just happen”. Maybe once they do, but twice? Twice the same thing happened to me and my babies. To me that means something. To me that means that there is some sort of problem with me.

That’s a dark place to be. No matter how much those around me bent over backwards to make my birth as positive as it could be, no matter how close my bonds are with my children, I am still left aching emotionally. I am grieving for the birth I did not get. Again.

I know there will be people who think, and indeed, say, that I should shut up and be grateful that my babies are alive. I’ve heard it before, I’ve been told that I have “lost sight of what is really important” and to them I say: I matter. My mental health matters. My scarred uterus matters. My obstetric future matters. I don’t intend on having any more children, two has long been my theoretical limit, so right now I’m trying to come to terms with the idea that I will never, ever have a vaginal birth of any kind, never mind the beautiful home birth of my dreams.

There are three little words that I have read dozens of times in VBAC birth stories, three little words that carry such depth of feeling that I don’t think many people could fail to be moved by them and I expected to be uttering them myself: “I did it”. I will never say those words and that hurts.

So to all those wonderful, Very Brave And Courageous women out there who didn’t get their VBAC, or whose births have not taken them on the journey that they expected or wanted: I love you, I am crying with you and it is OK to cry, to grieve.