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.
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.
Here is a copy of the information from homebirth.org.uk. It is information well worth repeating. The original is here.
Mary Cronk’s Phrasebook
Mary Cronk is a very well-known, well-respected midwife in the UK. She is an expert in breech birth and helps to train midwives and medics in this area. Here are some comments from Mary which you might find helpful, particularly if told that you are “not allowed” to have your baby at home, or you “have to” be induced, etc. etc..
I am sure that many others will explain your absolute right to refuse any procedure for any or no reason. The law, and good practice is quite clear. A sensible person will listen carefully to any explanations to why a procedure is proposed, and then should she choose not to have XY or Z she just says no or no thank you. The “allowing” is done by YOU. An asssertive approach is worth cultivating. You may care to commit the following phrases to memory and practice them frequently in front of a mirror.
- “Thank you so much Midwife Sinister/ Mr Hi-an-my-tee, for your advice. We will consider this carefully and let you know our decision.” Sweet Smile!
This one is most useful in the antenatal stage, though it can be used in labour. It can just take a minute to consider what you either want to know, or what you decide.
- “Would you like to reconsider what you have just said!” Fierce glare.
This is useful and, for example, applies to the misuse of the word “allow”.
- “I do not believe you can have heard what I have just said. Shall I repeat myself? ”
- “I am afraid I will have to regard any further discussion as harrassment.”
This is used if the person does not respect your decision or persists in pressing the subject.
- “What is your NMC or GMC pin number?”
This is used if 4 is ineffective. If the person asks why you want their pin number, inform them that this is something they might like to consider.
- “STOP THIS AT ONCE”.
This to be used in extremis. I am delighted to tell you that this was used AGAINST me by a woman to whom I had taught it. I was doing a difficult VE and was being too persistent. I stopped at once and learnt a lesson.
Do not argue; learn the phrases and keep them or similar for use if necessary. I am informed that it is usually only necessary to be assertive once or twice to have a much more respectful attitude from the people who are actually your professional SERVANTS.
Good Luck And regards
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.
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 Education, 20(1), 8–13. doi:10.1891/1058-1243.20.1.8
A recent study has found that somewhere between 9 and 12% of RCOG guidelines are based on Grade A evidence.
If you want to read the study abstract with links to the full version, it is here: informahealthcare.com/doi/abs/10.3109/01443615.2014.920794
Language is so important, and those working to support others might be wise to remember.
Sadly so much of the fear of birth, currently being dubbed ‘birth-wars’, spirals round the whole ‘which expert is the best expert’ question. As a result of the ‘which professional, which place?’ debate amongst professionals the woman has become a bystander in birth. She might want support, she might need skills, but she does not need an expert taking control of her birth and passively (or sometimes actively) encouraging her to tune into them and not herself. Birth would be much easier and safer for all if the experts stopped the expert-wars and became skilled facilitators of instinctive processes, with the knowledge and skills to help if needed and the wisdom to stand back and blend with the wallpaper when not.
It always strikes me as odd that there is such a debate about where and how to birth, with the professionals assuming control and responsibility yet leaving the woman to live with the consequences, whatever they might be.
I found this article just fascinating! www.wired.com/2014/04/missing-microbes-antibiotic-resistance-birth
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.
With 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.
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.
If 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.
Another 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.
Many 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.
The new AIMS book Inducing Labour – making informed decisions hits the shelves this month. Superbly updated and revised by midwife, researcher, educator, author and all-round speaker of common sense Sara Wickham, this book is a must-read for anyone involved in birth in any way! Visit AIMS for more information and order your copy today.
If you want a quick guide to the induction process, Rachel Reed, Midwife Thinking, has written a short guide to the actual process of induction and a little on the process of speeding up labour.
With so many women now having caesareans for failed induction, with all the additional risks to mum and her babies that carries, careful evaluation of the process, risks and benefits can make a massive difference to the experience of birth.
I’m not going to rant on and on about induction here, the evidence largely speaks for itself. All too often women are only getting part of the story, and sometimes professionals themselves are not entirely sure what the evidence really says – another casualty of an over-stretched maternity care system.
Benefits – What are they? Are they real benefits to you?
Risks – What are they? There must be some…
Instincts – Is this what you want? Does it sit right with your views?
Alternatives – There will be some, what are they, what are their risks and benefits?
Nothing – What are the issues with doing nothing, waiting, watching, expectant management?
Have you asked what is involved with the process? Beware of anyone who guarantees you results or who describes the process as ‘gentle’, because women’s experiences simply don’t bear that out. Sometimes induction is quick, but it is very rarely less painful than a spontaneous start to labour and progress in your own time under your own finely-tuned hormonal cocktail.