Tuesday, 12 June 2012

Living in a civilised society

I sometimes wonder if we know what we say when we trot out ye olde 'civilised society' line.  Now you're probably wondering why on earth I'm thinking about that.  Of course you may just be thinking about the colour to paint the spare room.  Anyhoo... the reason I'm thinking about it, is my having just read another throw away line about epidurals.

What I read was a mini 'debate' about how crazy women are not to have epidurals in a civilised society.  It was asserted that midwives had no place telling women about the side effects or spreading 'horror stories'.  Now I'm all for civilised society, I'm sure that most of you are, but what is our definition of such a place?  Is it that as long as things are done the way that I think that they should be done?  Might it be a place of informed consent?  

I'm not sure why we treat pregnant women as though their brains are absent.  We talk through the risks (by we I kinda mean the Health Care Professionals) and then we tell them again, and again...  When, however, it's a procedure that we want them to have, well then a quick whistle stop tour of the risks will do.  It's why you want to say 'Mars, enough already.  We know we need to be informed'.  

So, I'm not anti-epidural but nor am I pro-epidural.  I think that they have their place.  We need life saving measures to... um... save lives.  Perhaps what we need to inform ourselves about epidural anaesthesia and how a body responds physiologically during labour and birth.  

An epidural anesthesia may be presented as a substitute for the natural opiates (endorphins) a woman is supposed to release when giving birth. The need for epidurals is a symptom of an inappropriate hormonal balance. It is therefore highly dependent on environmental factors. It is related to the degree of privacy.

Lieberman E, Davidson K, Lee-Paritz A, Shearer E. Changes in fetal positioning during labor and their association with epidural anesthesia. Obstet Gynecol 2005; 105: 974-82

So what about these endorphins?  What do we know about them?  They are naturally produced by our bodies in response to pain.  Endorphins are neurotransmitters produced in the brain that reduce pain.

In my view, a civilised society is one which views birth as a natural and normal part of life.  Not an illness.  Not a disease.  Sometimes, just sometimes, birth needs a helping hand.  The words of Michel Odent 'we are at the bottom of the abyss' still haunt me from the MAMA Conference.  Let's give birth a helping hand when it is needed, not block our bodies and their natural responses just because we're 'civilised' and just because we can.

Sunday, 10 June 2012

The Computer Says No

My gorgeous 8 year old son (WW2) loves football.  He loves football rather obsessively, much like his older brother, Number One Son.  Unlike NOS, he has extra media with which to enjoy this obsession.  He can watch football on the television, keep track of the Premiership, Championship and various leagues on the PC and play football games on his DS.  Of course he loves playing actual football.  Today he got Player of The Day in his year group.  Apparently his smile would have made a Cheshire cat look toothless.  I wasn't there.  I was up in Sheffield watching John Simm, Colin Tierney and Ruth Gemmell in Betrayal at The Crucible.  

Some days we watch a football match on the television together.  We both love Tottenham Hotspurs (keep the hissing down at the back) and NOS loves Arsenal so the North London Derby is rather interesting in our house.  WW2 will watch the television whilst keeping an eye on the score on the computer.  The television records the live event and the computer updates a short while afterwards.  There have been many times when he says 'Mummy, they've scored a goal on the television but that can't be right.  The computer says no!'  He hasn't quite worked out that the PC is behind by a few moments and when it finally refreshes he says 'Oh it's okay now.  They have scored.  The computer says so.'.

When I support my ladies through pregnancy we talk about how things are going.  I get told about dating and sizing scans.  I get told about glucose tests and inductions.  I remember one of my ladies was sent to the midwife for obese mothers.  When she questioned the maths that they used, which when applied correctly didn't have her in the obese catergory, she was told that the figure written down was the one that they would work with.  She was labelled obstructive when she pointed out the simple error.  The computer said no.  I remember as well the women who have laboured silently and arrived at hospital knowing that their babies are imminent.  They are told that there is no way they are in proper labour because they aren't displaying expected signs ie screaming or calling out in pain.  The computer says no.  I think about and remember the ladies who are told that they need to go home because they are only 1-2cm dilated and that it will be hours yet before their babies come.  Even before they make to leave the hospital, they are holding their newborns.  The computer says no.

It's important that we inform ourselves and trust ourselves so that when the 'live' action happens we don't have to rely on machinery to tell us.

Friday, 8 June 2012

We need more midwives

It is a simple fact.  We need more midwives.

We need to take the fear out of birth.  More midwives would help.  Midwives who want to be with women, not with piles of paper and computer screens.  More midwives to be there to support birthing mothers.  More midwives to ensure that the ones we have in place don't burn out because of the heavy work load.  Not more machines, not more hi-tech gadgets that do all but make a cup of tea.  More midwives.

We need more midwives because we want women to believe in the ability of their bodies to give birth.  We need more midwives because we want our daughters to be able to birth our grandchildren in a place of safety, be that at home or in hospital.

We want the promise of more midwives to be kept.  Not a number crunching exercise, but a respecting of women's rights to birth their babies.  We need more midwives because we believe in the lives of the mothers and the babies.  This isn't about them, this is about us!  

Have you signed the petition yet?  Here's a reminder as to why it is important.

Listen to what the RCM have to say

Thursday, 7 June 2012

Inducing Fear

If I say that my Spanish is rubbish, I fear I'll be overstating my competency in the language.  I have been thinking about fear in birth for a while and about induction.  Today I was pleased to read Jesusa Ricoy-Olariaga's blog "Induciendo el miedo" today.  When I say read a Spanish blog, think google translate/bing kinda read.  Oh you get the picture.  My substandard French is positively fluent in comparison.

So Jesusa has pretty much written the blog that I want to write, but I'm going to put my thoughts down anyway, because then instead of ranting and raving over it, it will be a little more measured and stop my head from exploding.

Another email about induction dropped into my inbox today.  A lovely young couple expecting twins.  Mum healthy, first twin head down, babies a good size.  She has been informed that she must be induced or have a caesarean at 37 weeks.  The reasoning? The hospital's protocol doesn't allow for twins to go beyond 38 weeks and if she doesn't book her slot now, there will be no slot for her.  I wish I could say that that were an extraordinary utterance, but I can't.  Heard exactly the same from another twin mum just a few short months ago.

When this couple first got in touch with me, they were excited about the fact that they were expecting twins.  Every communication since has included fear and worry.  I don't know how many times they've been told that the second placenta will fail.  Or how many times they've heard that twins never go to term.  One of the reasons that they booked me is because they want as 'normal' a birth as possible.  What saddens me is that 'normal' and twin birth don't seem to go hand in hand with hospitals.  Reading Lucy Symons blog about a twin vaginal birth shows that the more things change, the more they stay the same.

Why is fear the currency with which we talk to mothers?  Whose fear is really at play here?  Litigation seems to be the key word, following closely on the heels of risk management.  I was at a birth recently where a midwife was trying to shift the care of a labouring mum from the birth centre to the labour ward.  Her reasoning?  Mum had refused a canula (she had had a postpartum haemorraghe with her previous birth) and so on the advice of the risk manager - yes she used those words - Mum would need to go upstairs to labour ward.  The midwife threw a gown at her and brought in a wheelchair.  The canula had been refused because the midwife had tried to put one in earlier and caused so much pain that of course a second request was refused.  Long story short, the lead midwife examined her and couldn't get her fingers in because the head was right there.  Mum consented to the canula to keep the first midwife at bay.  It was inserted whilst she was contracting and begging to be left alone.  The baby was born within minutes and there was no bleed.

It's not just the twin mums that have fear induced births.  That 40 week Estimated Due Date is more and more seen as Delivery Day!  With no exceptions.  As a woman moves towards 40 weeks she begins to be offered sweeps and if the first sweep doesn't work, then she'll be offered another and then another.  Of course this does nothing to give her confidence in her body to birth her baby.  Heads are shaken, birth centres and home birth options begin to be withdrawn, or certainly threatened with withdrawal and induction dates are booked.  You either take your slot or you are condemned as an uncaring individual.

Jesusa says it better than me today.  I'm saddened by the continual bombardment of fear and yet... yet there is a ray of hope.  Today I'm enjoying Rebecca Schiller - The Hackney Doula's blog post about her time at the Birth Human Rights Conference in The Hague and the Initial Impressions of Dr Amali Lokugamage FRCOG.  As my gorgeous Sister Doula Maddie McMahon says "I smell change coming".

Wednesday, 6 June 2012

Teaching them that prayers aren't answered

It's funny the things that stick in my mind.  I was visiting a repeat client and we were talking about the impending birth and reminiscing about her first birth.  I remembered how supportive her husband was when the midwife ignored all that they wanted.  The way he encouraged his wife and how happy they were when they were holding their daughter.  Then she told me about the first year.

She hadn't realised that they both had very different parenting styles.  She was instinctual and wanted to hold and feed her baby, his school of thought was about not spoiling the baby.  She said that it was a long, hard year but that this time round they were both more relaxed about the whole thing.  They were together at a talk where a question about leaving babies to cry was asked.  The reply came that 'when you leave your babies to cry, you teach them that God does not answer prayers'.  Wow!

There are many statistical analysis of what happens when we leave our babies to cry, but you may have noticed I don't post a lot of statistical stuff.  Rather than think of it by number, I like to think of it as relating to each baby.  I get many calls from my ladies (and/or their partners), but mainly my ladies.  Grandma, Dad, some self-appointed guru, the media or the stranger in the street has criticised something that they are doing.  Suddenly, all that they know is in question. I'm not sure what's worse, that or coming into parenting with all the myths and 'correct' things already established in their minds.  Oh don't imagine that I don't point that finger back at myself.  I was laughed at for having my son in my bed.  Told that I was mad to continue breastfeeding as long as I did.  Made to feel stupid for thinking I could fully breastfeed my twins.  Despite all of this (and that was only some of it) I could feel this instinctual pull towards my babies.  It didn't make sense that they slept apart from me or that I didn't hold them.  I put my babies in slings before I knew what wearing a baby was about.  My regret is that I didn't know about wrap slings and that it was possible to wear the Wee Weapons..  They did, at least, share an undivided buggy and so snuggled with each other.

So when my ladies call, I ask the questions 'what do you think?' 'what does your instinct say?'.  I can't parent these babies for them.  I don't presume to.  I can offer helpful pointers, but mostly I direct their question back at them.  "My mum says that I mustn't rush to the baby each time she cries, it will spoil her'.  'What do you want to do?' I ask.  'Go to my baby'.  'Then go to your baby!  The one who parents her best is you.  She's your baby.'

Saturday, 2 June 2012

Pizza and Pink Champagne

Last week I had the privilege of being invited to the Islington branch of the Women's Institute.  It was nothing like I was expecting.  I admit it, I was thinking there would be floral pinnies and cupcake bunting.  Instead I found pizza and red wine.  Well, there's nothing wrong with that.  One happy Doula in the house.  

Actually, it wasn't a particular calm and peaceful journey to visit the Islington WI.  I set off with an idea of where it was in my head.  My Smart phone wasn't being smart, so there was no satnav and my printer was broken, so I was relying on my memory.  Being geographically challenged, it wasn't ever going to be easy.  I arrived at Angel and knew it was a short walk.  I checked with a black cab driver who sent me miles off of course.  I was finally rescued by another black cab who muttered about the 'new ones that don't seem to know The Knowledge'. Whilst walking around Islington like a lost child, my beautiful new shoes took umbrage with being a part of my outfit and both, yes both, broke.  Not a happy Doula.  Lots of breathing exercises were done.  I won't mention the cursing of unknowledgeable black cab drivers.  I have always believed two things.  When lost in London you can't go wrong if you ask a policeman or a black cab driver.  I won't get into the depth of how crushed I was to discover that is no longer true.  Actually, what bothered me almost as much as being late, for by now I was very late, was the fact that my beautiful shoes would have to be returned as unfit for purpose.

Finally, I arrived and the WI were mid debate.  They were debating whether or not the UK needed more midwives.  Well that was a no brainer for me, but I was there to join the debate and, as it turns out, I arrived at just the right moment.  Two of the gorgeous ladies talked about the bad experiences of their friends.  Neither of them had any children as yet but the level of misinformation and myth caused me to catch my breath and the lovely Sheena Byrom stroked my arm and whispered gently, which allowed my blood pressure to go back down.  At this point, I should mention that Sheena was the main invitee and that she asked me to go along.  The N1 WI were lovely and extended their invitation to me.  

The gorgeous Sheena Byrom

Oh yes, my rising blood pressure.  I was so frustrated at the level of myth and misinformation.  It wasn't the ladies that caused that, but it hasn't been helped the media and the way birth is now handled.  These have only increased the fear of birth.  I couldn't help myself.  My hand shot up and I was allowed a moment to speak.  In brief, and you know I don't do brief, my answer was as follows:

  • We need more midwives so that women can talk through their birth hopes and fears from the beginning of their pregnancy
  • We need more midwives so that women can have dedicated and known carers throughout their pregnancy and birth
  • We need more midwives so that a woman's birthing place is filled with trust and not fear
  • We need more midwives so that midwives can give the time, care and attention that they want to give
  • Doulas now do a lot of what midwives originally signed up for - we are 'with woman'

After the debate there was a vote which went in favour of the UK having more midwives.  I was glad to see that this was reflected the next day when the National Federation of Women's Institutes voted in favour by 96%.  This means that the glorious WI will be backing the campaign for more midwives.

Sheena and I headed back to her nephew's home where his lovely wife was waiting.  Paul, gorgeous husband of Sheena, did a sterling job of keeping my champagne glass refilled with delicious pink champagne.  So the evening may have started with me in a bit of a tizz, but ended with some lovely fizz (did you see what I did there? :D)