Category Archives: Birth

Defining Active Labour

A quick snippet here, finally it is starting to become common practice to start counting active labour as 6cm dilated, instead of the 4cm previously used as the measure of success.  Stepping aside a little from the debate over whether measuring a cervix is a helpful thing to do at all, this is a positive move for women and babies.  As early labour can take a long time for many women, and it is prone to starting and stopping for quite a few, this could make a big difference to the numbers of women who are diagnosed with stalled labours at 5cm and who end up with their labours artificially accelerated or having caesarean surgery.  This is particularly important for women panning a VBAC who may have had their primary caesarean for a stall at this point, or who got to the end and they or their babies were exhausted from an artificially hard labour.

Science and Sensibility have written a great post about it, which is here.

Instinctive pushing

This isn’t really my post, it is just a chance to share a really amazing article written by MidwifeThinking on women’s instinctive pushing behaviours and what can happen when women are given directions by anyone other than themselves.  In short, telling a woman to push, not push, that she is ready to push or not, or even telling her how to do it, disrupts the normal flow of birth and is at best unnecessary and at worst harmful to her and her baby.

I wish everyone involved with birth would read and absorb this blog, because it would really change women’s birth experiences faster than anything else I can think of.




A doula is for life, not just for birthdays…

I was very,very sad to read this lovely blog post by the very lovely doula (for she still is a doula, even if she isn’t currently supporting birthing women, because it never really leaves you) Jay Kelly.

I’m far from rolling in it either, I do what I do because my heart will not let me do anything else.  I am inordinately lucky to have a husband with a flexible job and the amazing support of not only my own amazing mum, but also of my husband’s equally amazing mum.   I supplement being a doula with a variety of jobs I can work at totally flexibly, but there is always a price to pay, so when I should be sleeping whilst someone I trust more than myself is looking after my kids, I am actually catching up on the AIMS Journal…

I am lucky too, my clients pay me what they can, which might be in cold, hard cash I can spend in Tesco or pay my bills, but it might equally be some work on my home, it might be some lovely treasure or service that makes me feel wonderful (and as a busy mum I can’t put a value on that) and enables me to carry on giving to others, it might be things my children want or need or would benefit from learning, from music lessons to party entertainers.  Payment for me is a circular process, and whatever I receive I can recycle into love somewhere else.

Women will always need the support of other women, and, paid or not, doulas and mid-wives will always be there.  It is a sad reflection on a consumer society that we have to put a price on our care, and sadder still that the lack of value our society gives to caring means many can not justify the expense of hiring that support and many more can’t afford to give the gift of care because it is a low-paid vocation.  Childcare, mothering, and care work in general is an area of society I would like to see get a much higher social and economic value, and I will continue to campaign for care to be a central part of human life.

The average wedding costs a staggering £18,000 (Telegraph).  All added up and written down in black and white, that sounds like a huge sum of money to invest in a single day.  The birth of your baby is an equally momentous day, and I would argue more important as not only do the memories last a lifetime, there are considerable health benefits for both mother and baby associated with a peaceful and empowering birth experience.  All of a sudden £500 for the services of a doula seems like a bargain!  The cost of a baby’s first year is estimated at anywhere between £1,600 and £7,200, excluding childcare costs (money advice service) and much of that is a long list of things that are nice to have, but nowhere near as important as your physical and emotional health.

So, my questions are:
•  Do you know the person who is going to be with you during your pregnancy, birth and afterwards?
•  Will the same trusted person, who knows you well, be supporting you and your partner, protecting your space, your wishes, your needs and generally taking care of you physically and emotionally before, during and after the amazing event that is the birth of your baby?
•  Can you afford not to have a doula on and at your side?

Pay what you can afford, share and swap your skills, be creative, because whilst a doula can’t wave a magic wand and guarantee you a perfect birth, the evidence is quite striking – doulas really do make a difference to the emotional and physical outcomes of birth.  Having a doula on hand to help you and to nurture you, and to do all those little things, means that instead of making time to do all the jobs, you can get on with the most important job in the world, mothering your child.

Respect for the moment of birth

Today I read a lovely article about just why it is so important to respect the moment of birth.

I would go even further, by suggesting that women are empowered and facilitated to catch their own babies, which will almost certainly also mean sharing some of this information with her so that she can see why it helps and how it works.

Intrigued?  The article, from the Journal of Perinatal Education, is here.

Malloy ME (2011) Waiting to Inhale: How to Unhurry the Moment of Birth. The Journal of Perinatal Education20(1), 8–13.  doi:10.1891/1058-1243.20.1.8

Cord Clamps

I’ve posted links about the benefits of delayed cord clamping elsewhere, here is a quick thought on methods of clamping the cord, should you decide to do it.

Essentially your options are:

•  Clamp the cord as soon as possible after birth.  This is usually recommended for a managed third stage where a syntocinon or syntometrine injection is given as the baby is being born.  Although the evidence supporting this is far from clear, it may be that the fast rush of blood as a result of syntometrine and the side effects of the drug itself reaching your baby has the potential to be harmful.  The clamp can be released to allow a lotus birth when the placenta has delivered, or the cord can be severed at any time to suit mum, or sometimes her midwife or other member of the medical team.

Delaying Cord ClampingWith early clamping the baby can easily lose 30% of their available blood volume, which has several major health implications.  Leaving a placenta engorged with blood may also make it more difficult for it to separate from the wall of the uterus and more difficult to pass, especially if the cervix has closed under the influence of oxytocic drugs. See here for more information.

•  Clamp the cord when it has finished pulsating or after the placenta has been birthed, using the same methods as above.

Lotus Kit•  Lotus birthing – where the placenta and baby remain attached until the cord snaps or comes away from the umbilicus as healing of the site takes place.

If the cord has finished its job of transferring blood to your baby, and the placenta has come away from the uterus, the cord can actually be severed without clamping at all as it is sealed at the umbilicus (belly button) and by Wharton’s jelly along its length. The mechanism is largely the same for all mammals, although the timing of cord separation and placental release vary from species to species.

Cords do not have to be cut, as well as leaving them, they can be burned, bitten, cut with a ceremonial blade or other methods that suit you or the culture you follow.

Plastic Cord ClampIf you choose to sever the cord and wish to seal it, then there are alternatives to the traditional plastic peg type clamp.

It is possible to tie the cord with a thread, dental floss or embroidery thread ties have become popular recently.  Whist they do not have to be sterilised, parents often boil them either when they wish to use them or just prior to the birth.  Sealing in a clean bag or wrapping and freezing have been suggested as ways to keep a fabric cord tie clean.

If you do opt for a plastic clamp you can always ask for the cord stump to be left long, and then once the cord has dried you can cut it off, or you can tie a tie between baby and clamp whilst the cord is soft and remove cut the clamp off later.

CordRingAnother way to seal the cord is with a rubber ring.  Unlike bulky, scratchy cord clamps, cord rings are virtually weightless and almost invisible.  There is no clip to catch in clothes or nappies, or to dig into mum and baby whilst enjoying skin to skin.  It also makes changing your new baby easier as the clamp does not catch or snag or get stuck in clothes or nappies.

Cord TieMany mums express a firm dislike for traditional cord clip, so here is an alternative that is secure enough to reassure parents and their care teams and soft enough to avoid the common disadvantages of plastic clips.  You can also tie a cord tie over a rubber ring if you like.

The most popular are available from Cetro, as they are applied with the kind of forceps carried by midwives and do not require a specialised application tool.  You can buy them as single units here and download a printable instruction sheet here – Cord Ring Application Instructions.

Abortion, Birth, Choice – Who should get the power to decide?

There is a politician in Ohio, State Representative Jim Buchy, who is campaigning to reduce or even ban legal abortion in the state of Ohio.  He is co-sponsor of the ‘Heartbeat’ Abortion Ban.  When asked by an Al Jazeera reporter why he thought women might want an abortion he replied, ‘I’m not a woman, it is a question I’ve never even thought about.’  Yes, that’s right, he is making plans for a woman’s body and he has never even thought about why she might want that choice.

Regardless of what you think about abortion, in order to present a half-way reasonable argument it would seem vital that you consider both woman and child, that you consider carefully the reasons why women are making those choices and the pressures on them, socially, economically, physically, emotionally….  The ironic thing is, that there are some who seek to protect the life of the unborn by killing abortion providers, I’m not going to say any more about that than I can’t buy into their reasoning…

It seems obvious, doesn’t it, to ask the questions…  Yet these are the kind of thoughts I hear WAY too often in my job…

Why would a woman want an abortion? Why would she want a VBAC? Why would she want a peaceful, undisturbed birth with a carer of her choice rather than just the next medic on the rota?

Before you tell her why she can’t, ask yourself why she might want to.  Some days I feel like I am clashing heads with those who have not even considered that there is another side to the debate, and that is why women need support that IS up to date, confident and actually aware of not only both sides of the debate but the evidence that informs it.

When women are asking for home birth, VBAC, choice of carer or birth place, when they are declining induction, monitoring or a stranger’s hands in their vagina, instead of telling them it is for their own, or their baby’s good, just stop for a moment, and ask yourself, ‘Why might they want that choice?’

Happy Birthing

The full Al Jazeera report, The Abortion War is on YouTube, with Buchy speaking 11:47 into the film.

Uterine Rupture

I think the negativity and shroud waving is not helping women to make the decisions that are right for them, and I firmly believe that care providers who deny women choices and options are the ones who should be struck off, not those who help women to do what feels right for them. Our health care system is in such a mess and so many women are getting truly awful maternity care not because women or babies need it but because care providers are frightened of lawyers.

It is not reasonable to pretend that it is a choice between mother and baby or life and death. A woman’s ‘experience’ or her baby’s ‘life’ because the two are inextricably linked. Mothers do not willingly and knowingly put their babies at risk, but each will make a different decision based on too many factors to say what is ‘right’ because, what ever happens, the woman carries the burden and not those who cared for her or steered her decisions. For that reason it can only be the woman’s choice what is done to her body and she has to take ownership of that choice and be comfortable with it.

Care providers are so filled with fear, and that fear is affecting the women they care for, in attitude and in denial of choice. A section rate of one in three is indefensible, and at that rate is causing MUCH more harm than good.  It always strikes me as staggering that women are talked out of a VBAC by clinicians presenting the statistic that VBAC carries a 0.5% chance of rupture, and yet women who are being encouraged to accept induction are rarely told that induction carries the same 0.5% chance of creating a hole in their uterus.

It may well be that the risks of VBAC and PAR are actually MUCH lower than women are being told, and the article Uterine rupture is rarer than previously thought by Professor Marian Knight of UKOSS (UK Obstetric Surveillance System), published by NPEU (National Perinatal Epidemiology Unit, University of Oxford), would appear to back that up. If women are really re-rupturing at the rates often quoted then their ruptures are not being repaired properly.  True ruptures are rare, catastrophic ones even more so  Often the term ‘rupture’ is used to describe benign scar separations, dihesences and windows, which aren’t a risky thing for mothers or their babies, and women are left confused by what they have been told about the state of their scar or uterus.  The book Silent Knife is really a very good read for stats, descriptions and discussions of pregnancy after caesarean surgery.

So often when women are being told of the risks of VBAC uterine rupture is presented as a grave danger.  However, women are rarely told that the risk of losing their baby to amniocentesis is three times greater, and they are rarely, if ever, told about the dangers associated with repeat caesarean surgeries.  That includes the very real and present risk of problems with placental attachment.  If you want to read more about this, the great resource Science and Sensibility has done a good job of covering placenta accreta it here.

There is good research to say that tears heal better than cuts ( and so a repaired simple rupture (no healed edges to the hole, no placenta involved) should be stronger than a second planned section scar from an incision by knife.  This is clearly being taken on board, because many surgeons are now using ‘blunt extension’ techniques, which in effect means separating the uterine muscle by tearing it along its natural planes, which leads to a stronger repair and less trauma to the tissue.

I was told that a re-rupture was a certainty because my uterus would never stretch round a baby… Clearly that was a crystal-ball prediction, because it did just that and we were considerably healthier in my PAR than after either of my caesareans. That in itself has enormous benefits for the whole family!

I’m expecting that most of the re-ruptures are women who have had windows and scars that have opened during the trauma of a repeat section. We don’t worry about any other scar or injury to the same extent. I think that the ‘dead baby card‘ is just out-and-out blackmail. So few women carry a PAR (because most get a hysterectomy and the rest are told not to try again, of which a significant majority will heed that advice) that we will never have big enough studies to know what the numbers really look like.

I have been told repeatedly that no one has a baby after a rupture, well clearly I did, and I know others who have, yet it does not stop medics from telling woman that their experience is a universal truth, it isn’t, any more than mine is.  Women do have babies after uterine ruptures, yet many are told that it simply isn’t possible.

It is so wrong to tell women that if their babies die it will be their fault and that surgery will save everyone, because it doesn’t and it won’t.  Women have to make the choice that is right for them, it is their body, only they can decide…

If you want to read other thoughts on VBAC and rupture, have a look at birthing beautiful, there are some really good references!


Why did I choose a freebirth?

Ultimately, it is because I wanted privacy and intimacy for the birth of my babies, not dissimilar to the conditions under which they were conceived.  I firmly believe that if birth really was dangerous then the human race would not be such a successful species, or we would birth multiple babies with close spacing, as is biologically normal for those species which have a low survival rate.  I grew up round birthing animals, and knew that disturbing birth was a dangerous thing to do, and then I realised the full consequences when I had a preventable caesarean, one which was a direct result of a cascade of intervention from a whole bunch of people who I realised had no idea what an undisturbed birth looked like.  I wanted to birth like a cat under the bed, not like a goldfish in a bowl.

The more I read, the more I realised that our modern model of birth is relieving the problems of intervention and disturbance, it is not necessarily preventing danger, it is simply treating it, and that there was another way of doing it, a way which not only gave me the privacy and intimacy I craved, but also one which INCREASED the safety for me and, more importantly, for my baby.

What was it like, giving birth alone?

It was amazing, it was beautiful, it was serene, it was easier than running cross country at school!

Was I worried at any point?

Yes, I was worried that I would get unwanted intrusion, but I was not worried about the birth itself.

I had a back-up plan, to call an ambulance and put my faith in the emergency services and the emergency care the NHS is best at.  There was no half-way house for me, either it was normal and was going to be, whatever form that took, or it was the kind of emergency for which a midwife would call an ambulance, and in which case I might as well call one myself…

One of my fears what that the medical establishment is not very understanding and supportive of alternative choices.  There is a great deal of fear, and an unhealthy dose of arrogance, in those professionals who think that they know better what is good for a woman than she does herself.  If something goes wrong, ultimately the woman is the one who bears the pain for the rest of her life, not her care-givers, wherever she births, so only she can make the decisions about what risks she is and is not prepared to accept, because the only reasons that matter are the ones she can come to terms with.  Death of my baby is not the only outcome that will distress me for the rest of my life.  I have lost a baby, and it is a pain that I cannot describe, but it is not always something that technology and chemicals can prevent.  Disempowerment, feelings of having been abused, fear of death or danger in a situation which leave you feeling out of control, harsh treatment, feeling violated in the birth process all can cause trauma which will go with a woman to her grave.  Does she not deserve to feel like a goddess when she gives birth, and to be able to remember that feeling every anniversary of her child’s birth?  Every time a woman says “Birth was awful, but my baby is worth it” I feel sad that they did not have chance to have a birth that makes them say “It was the most amazing thing I have ever done, and it gave me confidence to grow into the parent I want to be.”  Parenting is hard enough without leaving women separated from their babies or with feelings of pain and trauma!

Why did you want to avoid birthing in a hospital?

I had two births in a domino unit (where your midwife gives 1:1 care and comes to the birth centre with you).  They were good experiences, but a service that is not available everywhere.  It was a compromise, we were camping in a renovation project without carpets or running water when my first child was born, and were a similar situation (different property) with my second, otherwise I would have elected to birth at home.  Then I had my third child in hospital (we moved) which led to a caesarean that would have been completely prevented had I had time and privacy to labour in my body’s own time.  As it was I was ‘timed out’ but in labour it is extremely difficult to be assertive and if I had thought it would help my baby they would have easily been able to persuade me to cut my own arm off.  It is only with hindsight that I realise that they used fear to persuade me into accepting things I never, ever wanted.  I realised that all I had known before about birth applied to humans just as much as cats and horses, and I set about my research, which was when I came to the conclusion that privacy and intimacy was the way forward…

With my 5th baby I did have an emergency, a massive bleed and pre-term labour.  Our baby was born by emergency caesarean (a direct complication of the previous caesarean) and whilst it was one of those rare life-saving surgeries it was not something I would actively seek, nor something that felt reassuring.  The hospital stay was tiring and miserable, more like trying to sleep on a bench in King’s Cross Station than a beautiful family moment!

The very last thing I wanted in my birth space was someone else’s fear of my choices, either because they did not believe it was safe, or because their supervisory structure expects stats and records.  I did not want anyone there checking and poking, I did not expect anything to go wrong that either instinct could not handle, or that would not need an ambulance anyway, so I decided that I did not want any strangers or semi-strangers in my birthspace or anywhere near it.  I did not want to be observed in birth, no matter how kind or well intentioned that person was, and I figured if I did not want checks, and I didn’t want a stranger in the house, even in the next room, then there was no point at all in having one.

Do I think all women should consider freebirthing?

Yes, if only to know that it is definitely not what they want.  It is not right for everyone, some women want to birth surrounded by others, some women want others to take responsibility for them, even with the same information we will not all make the same choices.  That is a good thing.  I no more want every woman to have a freebirth than I do for every woman to plan caesarean surgery.  I do want every woman to have a complete choice of where she gives birth and who is with her.

And the risks?

Do you know the risks of birthing in a busy hospital?  If not, then it is hard to compare the safety of home birth with a midwife, home birth without, or birth in a medical establishment.  Information is the key.  For all those who are adamant that medical care saves women and babies, it is important to remember that for healthy women and healthy babies, birth does not kill, infection does, malnutrition does, hip malformation due to rickets makes birthing a baby dangerous, disturbance makes birth dangerous because your body can not produce adrenaline and oxytocin together.  To make birth safe you have a choice, either protect your own oxytocin or make sure you have medics on standby to bail you out when your adrenaline pathway takes over running your body.  It is the area in-between that is the most dangerous way to birth a baby, and that happens in hospitals more often than it does at home.  Birth at home is as safe for babies and safer for mothers than birth in a hospital, and babies need well mothers to keep them healthy and safe!  It is not an ‘either/or’ it is as safe a choice as any other.  It might be an idea to look at the stats, birth in California is no safer than birth in Bosnia…

 And the mess?

For those worried about the ‘mess’, all I can say is ‘heck, you are about to have a child, birth is the least messy, and least painful, bit of the job of being a parent.’

Would I recommend it to anyone else?

No, it is a choice a woman must come to for herself.  I can say how it was for me, and the best bit was the privacy.  The special time, the lack of intervention.  If you could have good sex whilst someone is taking your temperature, listening to your heart-rate, telling you when to thrust and when to pant, then go for it, but for me that was so very disturbing and distracting that ultimately it increased the danger to both of us, because making a baby and birthing a baby require a very similar hormonal symphony.

Why is freebirthing becoming more popular?

I don’t think it is, I think women have become more open to talking about it, and the media has become more critical of those who make alternative choices and so it has become a recent target.  My first freebirth was in 2005 and I got a great deal of support from other women who had birthed their babies unassisted or were planning it.  The internet has made it easier for women to gain support from each other, and to talk openly about it with others who understand their choices and will not pass judgement. It is easy to blame the failings of an NHS to stretched to provide women with 1:1 care from a midwife they know, or to blame the crisis facing independent midwifery, which both undoubtedly deny women care and choice, but it seems that most women make the decision to freebirth from a position of choice and empowerment rather than from a place of fear or no alternative.  It is important to distinguish between those women who wanted to freebirth (and are happy with that choice) and those women who wanted support that was not there or did not turn up in time and they were left feeling afraid and abandoned.  There are, of course, those women for whom freebirth was an accident who then realise just what it was that others were trying to describe, who are eternally grateful that their support was too late.  They are often amongst the most vocal supporters, because their choices are ‘acceptable to the masses’ and yet the got the kind of birth that so many women crave, and they are most able to speak about it without feeling harshly judged for their choices, or risk being told that their decisions somehow mark them as dangerous or uncaring, which is a criticism regularly (and unfairly) levelled at women who make choices outside of the mainstream.

What did my partner think?

He knew that what felt safe for me was safe for me.  He trusts me completely to know what my body needs, and so fear was not part of his equation.  He tells everyone how wonderful it was.

If you want to know more, please do ask, I am happy to talk about it.



Here is a Sample Birth Plan for Freebirth and Transfer

So what, your baby doesn’t know the date…

If it ain’t broke, don’t try to fix it.

Your body and baby work just fine, despite your baby not yet being able to read a calendar or calculate an average…

When the time is right your baby will be born. Nature knows. Few people comment that the daffodils or the roses are late in anything other than an ‘expectant waiting’ kind of way, and they don’t often erect greenhouses or pull off the petals to make them bloom faster.

There is no need to pull the petals (or do a sweep, or break you waters) just because your baby is a few days over 40 weeks – which is a daft goal in itself, as the average length of a first pregnancy is 41 weeks and a day (or 40+8).