BEING WITH THIS WOMAN

Birth Stories, motherhood

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Today is International Day of the Midwife and I couldn’t allow the day to pass without acknowledging a woman who has had such a huge impact on my life. This woman who I now consider to be a dear friend, is my wonderful midwife Natalie, who has supported me through my last two pregnancies, births and postnatal periods. When I state that having Natalie as my midwife changed my life, I don’t say that lightly. The birth experiences I have had with Natalie’s support have changed me profoundly as a woman, as a mother, have inspired my career and shaped the path my life is taking.

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Natalie was with me for the birth of my second baby, who was born at home under the twinkling lights of the Christmas tree (you can read my home birth story here). Unfortunately I ended up transferring into hospital due to losing too much blood. The decision therefore about where to give birth third time round was complicated. I loved my home birth experience but the advice and medical recommendation was for me to be on labour ward due to being at ‘high risk’ of having another bleed. I did not want to be on labour ward and so Natalie created what is known as an ‘out of guidelines care plan’ to accommodate me in the birth centre.

I went on to have the most incredible and peaceful water birth with Natalie by my side, feeling safe and supported in my choices (you can read that birth story here). In the end I lost so little blood, far less even than what is considered normal blood loss after birth. Which just goes to show that what has happened before, doesn’t necessarily happen again! However I don’t ever regret not giving birth at home third time around. The birth centre was like a spa and I loved my beautiful water birth. Mostly I’m happy knowing I listened to my intuition and I chose a birth place that felt right for me. I am forever grateful that I was given a choice and supported in my decision. I have no doubt that I would not have had the same experience had I followed recommendation and been on the labour ward under continuous monitoring.

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In the period where I was making the decision about where to give birth, I don’t think I ever considered how Natalie was feeling about things in her role as midwife, which is shameful to admit. I suppose I was naive and a bit ignorant, thinking that what I was processing and going through would not be having an effect on her. I was wrong and it turns out Natalie was feeling just as torn as me. In this wonderful piece, written by Natalie herself, it becomes clear just how heavy the weight of responsibility weighs on the shoulders of midwives. Not just their responsibility to follow guidelines and ensure a safe delivery of baby (which is big enough!) but to also consider the value of the birth experience itself for the mother, to respect and support her wishes even when they go against medical advice and to recognise the importance of mental wellbeing as well as physical, and how achieving that enormous balance can sometimes be extremely challenging, leaving midwives questioning themselves.

The world is lucky to have such wonderful midwives like Natalie in it, so on this day, International Day of the Midwife, I’m sharing these insights, in Natalie’s own words…

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To be a midwife, to be ‘with woman’, is to support her, inform her, hear her, nurture her and sometimes challenge her. There is an art to this delicate balance of support. We want women and their babies to be safe and healthy, in mind, body and spirit. None of us should ever underestimate the power that the birthing experience itself has on a woman and her state of ‘health’. What happens then, when recommendations for safe care are in conflict with a woman’s dreams?

This woman, Siobhan, will tell her story. I am the voice of her midwife and we have been through two pregnancies and births together. Siobhan had a very empowering and healing homebirth with her second son, an experience which I believe will fill her with joy for the rest of her days. But she also had her second haemorrhage at this birth and required a transfer to hospital for ongoing care. As we began her journey into her third pregnancy I knew that birth planning would be harder this time around, I knew I was going to ‘pop’ her bubble.

It is a great responsibility to be a midwife; even the language and singular words I choose to use can have a life lasting effect, good and bad. How do I begin to say, I don’t believe it’s safe for you to have your baby at home again? When I know she’s living and dreaming the experience already! Do you approach it sooner rather than later, to allow time for consideration and thought, or does that stress take away a part of their pregnancy? There is of course no easy answer to this and knowing the woman helps immensely.

I spoke of it early, around 28 weeks, I knew she would need time. My hospital guidelines strongly recommended labour ward care after two haemorrhages. I would of course support her in any birth environment and it was entirely her choice to make, but in the event of another haemorrhage, which seemed more likely than the last time, was home the right place for birth? I needed her to consider all her options, do all the necessary research and then feel safe in the place she chose. I think this challenge devastated her, the home birth vision slipping away amid fears of a catastrophic bleed. I am responsible for that, rightly so I think, but it doesn’t feel good, nor does the worry that you’ve used the wrong language, biased or pressured them?

Thank goodness for birth centres ☺

It’s not home I know, it never will be, but it’s a great middle ground. A protected space to make your own, a home from home with the philosophy of care to match but with medical assistance for that higher risk woman just around the corner, should you need it. Turns out, Siobhan didn’t need it, not this time. The birth of her third son was beautiful, she was beautiful and I was honoured all over again to be her midwife. It was calm and peaceful and this woman showed once again the immense strength that she has. But it wasn’t at home, and she didn’t bleed. Was I wrong, does she wish she’d made a different choice? Only she knows……

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(All photos by Susie Fisher: http://susiefisherphotography.com/)

Another factor that played a huge role in my experiences of giving birth was my hypnobirthing practice. Hypnobirthing is a bit like the psychology of birth and nothing to do with hypnosis or hippies! You learn how birth works on a physiological level so you are informed about your body. You learn how to let go of fears you are holding on to that are detrimental to the progression of natural labour. You learn techniques you can use to make your labour more comfortable. I guarantee by the time you finish a course with me, that you will be feeling excited and looking forward to giving birth! Because it can be amazing. You can find out more about hypnobirthing and the classes I run on my website The Positive Birth Company. I teach monthly in London, Devon and Birmingham.

Preparing for Birth – The Birth Plan

Preparing for Birth

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Everyone needs a plan, right? For the big things, for the small things, for the day-to-day mundane things. I’m a big believer in a good plan. Usually my plans take the form of a list; stuff I need to get done. And yes, I’m one of those people who adds extra stuff to the list, purely for the satisfaction of ticking it off. Makes me feel productive.

So when it comes to GIVING BIRTH TO A FULL ON HUMAN BEING, of course I’m all about having a plan. Not only is a plan absolutely necessary in my mind when you’ve got two other kids and logistics to organise (like who will come mind them in the middle of the night?!) but I also believe writing a birth plan (or proposal or set of preferences) is an important and significant step in ensuring you are mentally prepared for birth.

This is because, by drawing up a plan, you are taking time out to really think hard about your birth in a focused way, for perhaps the first time in your pregnancy. It goes without saying that it’s really important to give some serious thought to your birth. Unlike day-to-day parenting, birth is not something you can wing; the more preparation you put in, the better the experience will be and the more you will get out of it. So by taking some time out to draw up your plan, you will be starting to visualise your birth and think about what you want in a really positive way. It’s not all airy-fairy either, you will have a number of things to consider and big decisions to make, from where you want to give birth and if you’d like to to use a birth pool to delayed cord clamping and whether you want a physiological third stage. You will need to research these things and understand the advantages and disadvantages of all your options so you can make informed choices. By drawing up your plan for birth, or at least outlining your preferences, you’re making important decisions for you and your baby, some of which will have a profound and long-lasting effect.

What I will say for those of you reading who like me love a plan, it’s important to realise that birth is unpredictable and doesn’t always go to plan. From when the baby will actually decide to make his/her appearance in that 5 week long period in which he/she is due (the concept of a single due day is such nonsense!) to how quickly you’ll dilate in labour, there are so many unknowns. That’s not to say your birth won’t be beautiful and amazing and empowering and positive, it’s just it might pan out differently to how you expected and you need to be prepared for this. This is why some people prefer to use the term ‘birth proposal‘ or ‘birth preferences‘.

I like the latter best and believe by drawing up my preferences I am making it clear what my first choice is, but also giving some thought to, and allowing there room for movement, if my birth takes a difference course. With this in mind I have a whole section in my birth preferences dedicated to having a caesarean section. Not because I’m planning for one or even thinking I will end up having one, but I’m taking into account it could happen and if it does, I have given thought to it and specified my wishes for how I would like it to be done. This feels empowering and means however my birth goes I will still have made my own choices and will be having the best birth for me on the day.

So to help those who are also nearing the end of their pregnancy (although it’s never too early to start thinking about your birth and researching!!) listed below are the things I believe you need to consider and include in your birth preferences. I have also posted my own birth preferences at the bottom to help you get started, which you’re welcome to use as a template…

THINGS TO CONSIDER/INCLUDE:

* Birth partner details – name, contact number etc.
* Environment – including where you plan to give birth and how you want the space to be
* Positions for labour and birth – as it says on the tin!
* Pain relief – what you think you might want / what you don’t want
* Birth pool – whether you plan on using one for labour and / or birth
* Monitoring – preferences for sonicaid or continuous
* Second stage – how you wish to birth your baby including thoughts on assisted delivery
* Third stage – how you wish to birth your placenta e.g. physiological third stage or active management and if you want delayed cord clamping
* Placenta – state if you plan on keeping your placenta for encapsulation or another reason
* Breastfeeding – whether you plan on breastfeeding and if you’d like support with this
* Special circumstances – your preferences if your birth goes off plan and you decide to transfer in to hospital from home
* Unexpected situations – include preferences for c-section if situation arises
* Vitamin K – confirm that you wish your baby to have this or state if you do not.
* Aftercare – your wishes for afterwards e.g. whether you’d like a private room if on a ward

It’s a really good idea to involve your birth partner in devising a birth plan. Not only so they are involved in the decision making but also because it is their job on the day to ensure your preferences are known, understood and adhered to. It’s a big (and vitally important) job but near-impossible if they are not totally sure what your preferences are! Also, please make sure you do your research before making decisions/writing out your preferences so you are making informed choices that are right for you and your baby. This is most important.

NOTE: I am planning to have a water birth at home and have been practicing hypnobirthing with my birth partner. We have a birth photographer attending and I am having my placenta encapsulated. I also have a history of postpartum haemorrhage and have anaphylaxis. Obviously this is not the case for everyone! You will need to adapt this plan to make it your own and most importantly add any medical information that is relevant for yourself.
 

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Birth Preferences

We wish to have a calm, quiet, water birth at home with no intervention. We are using Hypnobirthing for our birth and therefore the environment and language is very important to us. Please note that we would appreciate it if you could avoid using the words ‘pain’ or ‘contractions’, and instead talk about ‘comfort’ and ‘surges’. I may describe the power and intensity of a surge but I do not wish to think about or feel pain, as I do not believe birth needs to be painful.

Birth Partner

My partner (insert name and phone number) will be my birth companion and we would like to be left alone whenever possible.

Environment

I would like my own choice of music to be playing (including Hypnobirthing audio tracks), candles burning and a birthing ball and aromatherapy oils to use. We would like to take photos and videos throughout and have a birth photographer booked to attend. We will also be using a birthing pool when labour is established and I have a TENS machine to use in early labour.

It is very important to me that the lighting is dimmed throughout.

Positions for Labour and Birth

I would like an active hypnobirth and to use positions that mean I am upright, forward and open which facilitate an easier and quicker birth. I’d like to remain mobile throughout. If I need to rest, I would like to use my birthing ball and lean over the sofa/bed. In the birthing pool I wish to be upright and leaning forward over the side or on all fours.

I do not wish to be lying on my back.

Pain Relief

Please do not offer any pain relief to me.

I DO NOT WISH TO HAVE AN EPIDURAL. I do not want Pethidine/Diamorphine or any other drugs. I do not like Gas and Air because it makes me sick.

***I developed Anaphylaxis to Paracetamol after giving birth previously and carry an epi-pen***

I do not want any drugs introduced during my labour or afterwards.

I have a TENS machine I can use but please do not offer this to me.

Please remind me of the tools I do have which include: my breathing techniques, visualisations (of a balloon filling as I inhale and a golden thread as I exhale), light touch massage, heat pack, cold flannel, essential oils, relaxation scripts, relaxation audio tracks, positive affirmations, the birth pool etc. These will all increase my comfort level.

Please remind me of my desire to feel and experience this birth and of my previous positive birth experience if I have a wobble.

Birthing Pool

I would like to use the birthing pool during labour and would like to give birth in the pool.

Monitoring Baby’s Heart Rate

Sonicaid please. There is no need to ask when you want to listen in. I would prefer not to be asked questions in labour unless necessary.

I wish to be as mobile as possible / in the pool so only continuously monitored if absolutely necessary. If continuous monitoring is necessary and I am therefore in hospital, I would like to use the wireless monitoring if this is available so that I can continue to move about.

Second Stage

I would like to breathe my baby down so he is born gently and calmly. I would like to follow the lead of my body rather than be coached to push.

I would like to be able to bring my baby to my chest immediately after delivery. If it is not possible for me to hold the baby then I would like the baby to have skin to skin time with James.

It is vitally important to me that the calm and intimate environment is maintained after the baby has been born as I have a tendency to lose blood, so plan to do what I can to encourage the flow of oxytocin: baby to breast, a little placenta to place against my gum, calming touch, warmth and reassurance, low lighting, relaxation track playing.

Assisted Delivery

I would rather wait longer than try to rush the process unless the baby is in obvious distress and needs to be born. I will accept assistance if there is no other option.

Third Stage

It is my preference to have a physiological third stage. I would like to birth the placenta without any drugs being introduced to my body. I would like to wait until my baby has received all of his blood before the cord is clamped and cut.

When the cord has stopped pulsating, please assist James in cutting the cord.

I would also like to place a small bit of the placenta once it has been birthed, against my gum to aid the flow of natural oxytocin and encourage my uterus to contract, as it has a tendency to relax after birth.

I am having my placenta encapsulated so please be mindful of this. It will need to be stored in a sterile container which we will provide and placed in the fridge as soon as possible and certainly within half an hour.

In the event that I experience another PPH, I accept that I will need to have the injection. Hopefully this will be enough intervention. If I continue to lose blood then I accept that I will need to transfer to hospital in order to receive syntocinon via a drip.

It is really important that my epi-pen is with me at all time if transferring to hospital and that the hospital staff are aware I have anaphylaxis to paracetamol and am allergic to latex.

Feeding the Baby

I wish for the baby to be put to my breast immediately after delivery.

I feel confident with feeding my baby and do not need assistance with breastfeeding.

Special Circumstances

If I chose to birth my baby in hospital because of special circumstances, I would like to request a private room with a birthing pool. The environment is very important to us so we would like the room to be as similar as possible to our preferences outlined for home birth. Most importantly we would like the room to be dimly lit, quiet and with as few people as possible present. We would like people to knock before entering and to speak in hushed voices. All communication is to go through James please so that I can labour undisturbed.

I do not wish for students to be present, only those who absolutely need to be there.

I do not wish to be cannulated unless it is essential to do so.

Unexpected Situations

If absolutely necessary, I give my permission for an emergency C-section to be performed.

It would be my preference to be awake for this and to receive my baby to my chest immediately after delivery, certainly before weighing him or cleaning him.

Please ensure any electrodes are placed on my back to they are not in the way and do not inhibit skin to skin time.

I wish for only those who are absolutely necessary to be present in theatre. I would like to be able to see my baby be born so would appreciate if the curtain could be lowered at this stage. I would appreciate it if the lights could be dimmed at head end so when the baby is delivered and brought to my chest, he is not subjected to bright light. I would like my choice of music/relaxation track to be playing in theatre during the birth of my baby.

If there is time beforehand, I would like to be given a pack of sterile gauze strips so that I have the opportunity to seed my baby with bacteria and stimulate microbiome development, which would happen if he were born naturally.

I would still like my placenta to be encapsulated after birth, so please bear this in mind and ensure the theatre staff are aware of my wishes. My placenta will need to be stored in a sterile container and kept cool until collected.

If my baby has to be in the Special Care Unit, then I want to be able to care for him as much as possible and to ensure he receives my breast milk. I would like help with making sure this happens.

Vitamin K

I am happy for my baby to be given Vitamin K by injection.

Aftercare

If in hospital, I wish to request a private room if one is available.

 

Thank you for taking the time to read my birth preferences. I am looking forward to the birth of my baby and planning for a positive and empowering birth experience where my baby is born safely and calmly. I believe this is possible however my birth story pans out.

Thank you for supporting us at this very special time in our lives. We will be sure to appreciate all you do for us, now and for the rest of time.

Siobhan and James.

 

Preparing for Birth – Hypnobirthing

Preparing for Birth

Today is a VERY exciting day on the blog because it is the launch of the brand new ‘Preparing for Birth‘ series!  I will be posting a new blog post every Monday in the lead up to the birth of my baby (and possibly beyond) covering all things from breathing techniques for labour to packing birth bags to booking babymoons! I’m super excited about this series, (and the fact that I will be having a another baby in a matter of weeks!!) and I really hope you enjoy reading the posts and find them useful as you also prepare for the births of your babies!

So today’s post to kick things off is all about Hypnobirthing and more specifically the breathing techniques you learn in Hypnobirthing which are so valuable in labour. Breathing, in my opinion, is the single most important thing you can do in labour to help yourself and your baby. It really is that good. So that’s why I have chosen to focus on it and why I’ve even made a tw*t out of myself on camera in an attempt to show you all how to do it! That’s right! My first ever vlog. It was painfully embarrassing to do so please make me feel better about the whole thing by watching it and at least pretending that it’s useful…

Finally, as most of you know, I’m a massive Hypnobirthing advocate having had an amazing hypnobirth myself,  after a relatively stressful induction first time round. I subsequently trained as a Hypnobirthing teacher and have recently founded The Positive Birth Company which is based in SW London. So if you would like to chat more about Hypnobirthing or book classes then please do get in touch!!

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Ok, sales pitch over. Here’s the blog…

If you’re in the latter stages of pregnancy, especially if this is your first pregnancy you’ll no doubt have shopping lists coming out of your ears. You’ll be needing stuff for the baby like clothes and blankets and nappies, stuff for the nursery like a moses basket and/or cot, stuff for feeding like bottles and a steriliser and maybe a breast pump, equipment like a car seat and buggy, stuff for your hospital/birth bag like granny pants, arnica and big fat pads and then there’s all the DIY stuff you want to get done before baby’s arrival… It’s overwhelming, not to mention wallet-wreckingly expensive. So it’s no wonder at all that preparing for the actual birth of the baby can be overlooked and even forgotten about.

So today  I’m going to be talking about what I think you should be doing in the lead up to birth to ensure you have a positive and empowering birth experience however and wherever you choose to birth your baby. There is no doubt that giving birth is a huge and important day for both mother and baby (and birth partner!). Becoming a parent is such an enormous life event and the actual act of giving birth, besides being mind-blowingly miraculous, can be quite a scary thought because we hear so many horror stories and because there are so many unknowns. In our lives where we have so much control over everything we do, it’s hard when it comes to birth because we do not know when the baby will come or how the baby will come and if you’re a first time Mum what it will even feel like. The best thing we can do is allow events to unfold naturally in their own time, trusting that our babies and bodies know best, whilst ensuring we are fully informed so that whatever happens we can navigate our births feeling empowered and positive.

The best way of doing this in my opinion is to attend Hypnobirthing classes where both the mother and birth partner learn about the physiology and psychology of birth (it really is quite scientific and not much to do with hypnosis at all!). Mother and birth partner, once they understand how the muscles and hormones work perfectly in labour, then learn how they can help the process so that labour is allowed to progress efficiently and comfortably. Hynobirthing equips mother and birth partner will a range of tools they can use in pregnancy and birth to remain calm and relaxed, which is so very important. There are many many reasons (and benefits for mother and baby) as to why it’s important to be relaxed in labour but one simple reason is that relaxed muscles will work and open far more easily than tense muscles. In Hypnobirthing classes you also learn about inductions, caesareans etc. Even if you’re planning for a natural birth it’s good to be informed because knowledge is power! And if these things come up, you’ll be in a position to make an informed decision as to whether you accept or decline the various interventions on offer. It’s always important to know the benefits and risks of doing and not doing.

I could talk (or write) for hours on the subject but in short, the best thing you can do if you’re pregnant to prepare for birth is to GO TO HYPNOBIRTHING CLASSES! You will not regret it. In fact I’d go as far as saying it will be the best money you will ever spend.

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A key tool you learn in Hypnobirthing is a breathing technique that you can use through surges (a nicer and more accurate word for contractions). We call this breathing ‘up breathing’ because it is used during the ‘up stage’ of labour. The up stage of labour is also the first stage of labour and it is where the muscles of the uterus are lifting up and the cervix is relaxing and opening to 10cm dilated. This stage is most commonly the longest stage of labour.

I have posted this little video on my YouTube channel where you can learn more about Up breathing and how to do it. When preparing for birth, it is so important that you practice this breath so it comes naturally to you in labour. Make time, even just 5 minutes, to practice it every day.

This breathing technique not only helps you remain calm and therefore allows your muscles to work more easily and comfortably because they are not tense and tight, but it also ensures that you are filling your body with oxygen which we know all muscles need to work effectively. If you hold your breath through your surges, then you are denying the muscles of your uterus this much needed oxygen which will only make it more difficult for them to work efficiently. Finally, if you’re filling your body with oxygen and sending it all to the uterus, guess who else is benefiting? Yes! Baby! Which means you’re a lot less likely to experience foetal distress which can happen if baby’s oxygen is reduced over a long period of time.


Then there is the down breathing which we use in the down stage of labour. The down stage of labour is the second stage of labour, where the baby moves down the birth canal and is born. So up breathing is for up stage where the uterus muscles lift up and the cervix opens and down breathing is for the down stage of labour where the baby moves down and is born. Makes sense, right?

The benefits of using this breathing technique to birth your baby rather than following the instructions of a midwife or doctor to push, are numerous. For one the baby will be born more gently rather than forcibly ejected. That’s why many hypno babies are born asleep or still in their sac, because their delivery has been so gentle and calm. Secondly rather than force and push the baby out of a cervix/vagina that is not ready, breathing the baby down will mean the baby’s head slowly kneads the cervix open until it can pass through. This means the mother is a lot less likely to suffer any trauma to the perineum or vagina and is a lot less likely to tear.

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Again it is important to practice beforehand! Best place to practice the down breathing is on the toilet when you need to go for a… you guessed it! Especially if you suffer with constipation in pregnancy, you might find this actually really helps! So I will be posting a little video on my YouTube channel soon (probably not whilst on the toilet) showing you how to do this so please have a watch and give it a go!

Now this is not intended to replace attending a Hypnobirthing course because you will learn a lot more than just breathing but this is just to give you an idea of the kind of tools you will learn to help you in labour. The most important thing to remember when preparing for birth is to practice. I can’t stress this enough. It’s very simple but very true: the more you put in, the more you will get out of it.

The thing I hate to hear most is when people say ‘oh I tried Hypnobirthing and it didn’t work for me’ or ‘I tried the breathing thing but it didn’t work so I had to have an epidural’… just before it transpires that they did little or no practice. If someone showed you how to play an instrument one time, or drive a car, you couldn’t then go and perform or drive like an expert. It’s exactly the same. Of course it will not work if you do not practice. That’s not to say it won’t or can’t work. The key thing is practice, practice, practice and it’s so worth it! Not only will mother benefit and have the most amazing, positive empowering birth experience but so will baby who will be born gently and calmly to a mother who is happy and fully present, ready to meet them.

Finally when I say practice, I mean literally just taking a few minutes in the morning and a few minutes at night to practice this breathing technique so it becomes second nature. I’m not saying you need to find hours every day. And the down breathing is something you can do on the loo! So that’s just a matter of multi-tasking and we all know women are experts at that 🙂

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I hope you’ve found this little bit of Hypnobirthing knowledge useful (and had a good LOL at my first video!). Please do get in contact if you have any questions and make sure you check out the video on my YouTube channel and then give it a go!

GOOD LUCK!
X