Monday, 31 December 2012

Goodnight 2012. Good morning 2013.

Wow! 2012 is about to end.  

Had to happen really.  Time moves on.

So, what's ahead for 2013?  Well this year I will be doing more studying and writing.  I have a course that I'm in the middle of writing, but more of that in the New Year.  I have booked into MAMA Conference 2013 and am really looking forward to it.  This year I'm going up a day early and leaving the following day.  This will allow me to breathe and reflect on the things that I've heard and the people I've met, rather than rushing back home.  Of course one of my past clients has now booked me for a baby whose guess date is around then.  I have a fabulous back up doula on standby, but am praying that she births before I leave. 

Having seen the amazing affects of placental encapsulation, I have decided to train to become an encapsulist myself. I come at all things with a gentle sense of cynicism, and become the strongest of converts.  It will be an interesting time I think.

In May I will be attending Penny Simkin's FROM TRAUMA TO TRIUMPH: Understanding and Healing the Effects of Trauma and Sexual Abuse on Childbearing Women.  I'm looking forward to that. I wanted to go a Penny Simkin workshop a couple of years ago, but my on call status prevented me.  This time, if I'm on call, I will have to rely on a back up doula.  At the moment though, I will have just come off call.  Whatever happens, I do believe that we are at the births we are meant to be at.  

All of this study will start with a time of inspiration as I attend a You Inspire Me Community Meet up hosted by Corinna Gordon-Barnes.  A gorgeous sister doula, Maisie Hill told me about her and so I'm excited by it.

2012 was incredibly exciting for me.  I saw the physiological birth of twins, VBACs, HBACs, long slow labours and incredibly fast labours.  I'm looking forward to the births of 2013 and I'm looking forward to enhancing my knowledge and meeting more and more people within this amazing world of birth.

I wish you joy, health, happiness and laughter in 2013.  Happy New Year!

Monday, 24 December 2012

Christmas wishes

Suddenly it's Christmas again.

I've been off call for about 3 weeks now.  It's the longest I've been off call for ages.  I had two clients go into labour on the same day (back up at the ready) and the first gave birth just after 2pm and the second waited a couple more days.  Both births were what the women were hoping for.  The first a VBAC - Vaginal Birth After Caesarean, the second, a waterbirth, following a very long latent phase.  Both beautiful births.  Two happy families left behind me. Just the way I like it.

So what next for me?  Well 2012 is coming to a close.  It doesn't seem but yesterday that I was writing about my hopes for 2012.  Well, I wasn't disappointed.  I saw some amazing births.  What a privilege to be a part of them.  I know that I say that all the time, but I really really mean it.  What a privilege.  I am blessed amongst women.  I was invited to talk on blog radio with Empowered Papa.  Exciting times. 

So 2013 is knocking at the door.  And I know the wish that I have for this Christmas that I would love to see.  I want to see women have informed choice and informed consent about birth and I want them to hear the positive birth stories that are out there.  I will do my best to be a part of that grass roots birth movement.  I would love to see Agnes Gereb freed and for homebirth to be an option for all women across the world.  Human rights in childbirth is a cause close to my heart.  Well, birth is the field in which I work.  It doesn't take a genius to work out how much money would be saved if women were supported in their birthing choices, freeing up time and space for the women who need obstetric support.  We need the doctors and the specialists, but we need them for the women that need them, not every Tamsin, Dorothea and Harriet.  How can you give me the best Christmas present possible? (Why thank you very much).  Click on to the Freedom for birth link, join in the Positive Birth movement and tell your good birth story.  

And so from me and mine to you and yours... Have a wonderful Christmas and a joyous New Year

Tuesday, 18 December 2012

Time to get positive

Recently I was told that a blog post I had written was rather negative, and it wasn't an unfair comment.  So I thought that I would write something more positive.  Of course much happened between then and now and I was spurred into writing about the plight of a local birthing centre.  That wasn't full of positives, but included positive births.  So now... well I absolutely have to share that there is something amazing that is happening.  There is a grass roots movement to offer positivity about childbirth.  Yes!  About childbirth and it's via a global network of free Positive Birth groups, linked up by social media.

I adore social media.  All of it.  It's such an amazing resource.  It enabled me to link up with Empowered Papa, Joe Valley via twitter.  We chatted last night on his blog radio.  It was great fun.  We've been chatting for over a year now and talking to Joe fills me with joy.  I love hearing his passion for dads and how he wants to know all about dads and their role within childbirth as well as parenting.  It seems a simple thing, but I like simple things.

So... why positive birth?  Well why not?  There is so much negative out there.  You only need to turn on the television to see scared, screaming women.  One Born Every Minute anyone?  Then there's the press.  How did you read that article?  Did it fill you with hope or with fear?  To date the best, fictional, tv birth that I've seen had the gorgeous Chizzy Akudolu, who plays Mo Effanga in Holby City in the role of the birthing mother.  There was no screaming, but it wasn't plain sailing.  She birthed standing up.  I stood and cheered when I saw it.  Yes!!!!  Finally, a fictional birth that looked like births I have seen.  My daughter's friend is here this evening.  He asked what I did and when I explained he said "You must get your hand squeezed tight while they scream".  This is birth to a 19 year old boy.  Hand squeezing and screaming.

When I meet with my ladies for the first time, I tell them... try not to let people tell you their birth stories until you have your own to share, because people seem to love to share the horror stories.  Find the positive birth stories.  Listen to them.  And here, to my absolute joy and delight is someone who has has that same thought and turned it into a new birth movement (yes, I know... it shouldn't be new, but in this current climate, it is).  I could go on and on (stop it at the back... I can see you), but I won't.  I shall let The Positive Birth Movement speak for itself.   

We are a grass roots movement, spreading positivity about childbirth via a global network of free Positive Birth groups, linked up by social media.

We aim to challenge the current epidemic of negativity around childbirth by bringing women together to -

Meet Up, Link Up, and Shake Up Birth.

Meet Up - Free, and local to you, find information about regular Positive Birth groups, gatherings and meetings.

Link Up - Join our larger groups in cyberspace to build a global network of shared expertise, power and positivity.

Shake Up - Challenge the culture of fear that surrounds birth, and empower women to approach birth differently.

Here's how to get involved:

If you are Pregnant...
Find your nearest Positive Birth Group -

If you are a Doula, Midwife, Birth Worker or just passionate about Positive Birth...
Set up a Positive Birth Group -
Add an existing birth discussion group to our growing network -

Either way...
Join us on Facebook
Join us on Twitter

And shake up childbirth!

Please send any enquiries, helpful information or suggestions to

Why not join in and let's see this grow.  

Wednesday, 12 December 2012

The illusion of choice

This year I have been to some amazing births, I've been to some not so amazing ones, but one the whole... amazing!

I was filled with awe and a sense of wonder when I was at a totally physiological birth of twins within a West London hospital.  This wasn't an easy thing to achieve, but with some determination, good information and great communication, it was achieved to the joy of the parents, babies, medical staff and doula.

I've been privileged to be at the East London homebirth of a second child.  The first was born after a very long and difficult, medicalised hospital birth.  Homebirth was not on this couple's initial agenda, but made plenty of sense to them as they wanted to avoid many of the interventions they had experienced the first time.

I was recently at a VBAC (Vaginal Birth After Caesarean) in an East London where mum had held lots of anxieties, particularly after the birth of her first.  This VBAC left mum ecstatic as she had lost faith in her body's ability to birth a child.

I supported a couple through a long, slow labour that culminated in the birth of a gorgeous boy in water at a West London birth centre, staffed with the most incredibly loving midwives.

I could list all of the births that I was privileged to be at this year, but that would take some time and I would drift off into memory and not get this much neglected blog written.  I simply wanted to share that not all of the births that I attend are within hospitals.  

What has spurred me on to write today is the shocking news that the Homerton Homebirth Team has been reduced from six amazing midwives to four.  One has been removed from the team without her consent, the other is leaving and will not be replaced.  The midwife that has been removed, Angela Barry, was the reason one of my ladies (not mentioned above) had a wonderful VBAC in hospital.  Angela, who had visited her at home, talked with her about her homebirth and hospital options and been instrumental in bringing calm and banishing fear from her birth.  

Why is it shocking?  There has been no consultation process with the midwives in question, no consultation process with the women that they support, nothing mentioned at the MSLC (Maternity Liaison Services Committee) and, to date, no clear rationale as to why this very popular service has been reduced.  There is no lead in time for this and so women are suddenly left unsupported as planned through the remainder of their pregnancies and the subsequent births of their babies.  I dread to think what will happen during the postnatal period, a time where more and more women are being told to go into Children's Centres rather than have a midwife visit them at home.  Remember that this is a time when they should be resting and recovering from the birth process, not shlepping over to Children's Centres.  (Did that sound a little miffed?  Wow! I'm getting better at holding my disgust in).

I am advised that at a level of 4 team members it will be impossible for the Homerton to guarantee a 24 hour/7 days a week homebirth service. This will make a real difference to the choices available to women in Hackney and also is a likely indicator of a lack of investment by the Trust in providing choice and continuity of care to the women of Hackney, wherever they choose to give birth. It is particularly worrying in light of the homebirth team's recent statistics which show a 9% caesarean rate against approx. 26% in Homerton itself.

If this news concerns you, as it does me, I would like to ask you to help me by letting the powers that be at Homerton know that this is not acceptable. To this end I would like to invite you to :

1) Open the attached pro-forma letter outlining the situation and the concerns. Please personalise this as you wish and send to: Chief Executive Officer Tracey Fletcher: Divisional Operations Director Daniel Waldren:

3) Forward the attached letter to any contacts you have who you know would be willing to write in

4) Link to the petition via your twitter/facebook/website and encourage others to sign up

5) Send me a sentence or two, if appropriate, about what the Homerton homebirth service has meant to you and why it needs to stay as is. Let me know if you are comfortable for this to be including in any future press release to the local papers.

I would love to hear of any ideas that you might have about how we might prevent this worrying reduction of Home Birth provision in Hackney. 

We are told on one hand that every woman has the right to choose how and where she births her child.  This is not ignoring medical advice etc, this is about the human right to choose.  With postnatal services being withdrawn, Independent Midwives being forced out of work, less midwives being hired as well as home birth and birthing centre teams being deliberately understaffed... where is the choice?  Or is it just an illusion?

Friday, 26 October 2012

How the Consultant (Grinch) Stole A Perfectly Good Birth

What happens between the antenatal class and the birth?

I hear lots of conversations, comments, curses and scornful laughs about birth plans.  I once saw a twitpic (picture on Twitter) of a laminated birth plan.  The tweeter (person who tweets/posts on Twitter) said 'It's laminated so that the doula can wipe the blood off of it'.  You can imagine the joy that filled my heart at that comment!

What's wrong with having a birth plan?  Who does it threaten?  My own thought is that women write birth plans to articulate the things that they would like to have happen during their labours.  They have thought carefully about what they want to have happen and what they don't want to have happen.  A typical birth plan includes their desire to move freely in labour, to ask for pain management if they want it, to do skin to skin with their baby, to not have the umbilical cord cut prematurely.  Is that too much to ask?

I was at a meeting once where a woman, who had yet to have children, literally screamed with laughter at the 'stupid women who have airy fairy plans for their births, like they know better than anyone else'.  My heart continues to sink.

I have spent time with women who have felt let down by their Consultants.  They have had reassurance all the way through the pregnancy and then, as if a transplant has taken place, the Consultant becomes the harbinger of doom.  Suddenly everything is prophylactic.  Things must be done to prevent the chance of anything happening.  Confused?  Here's a simple example.  A mother goes beyond her EDD (estimated due date).  She hasn't given birth on the day her pregnancy reaches 40 weeks.  Clearly there is a problem.  Inductions are talked about and booked.  'Well we don't want the placenta to calcify and the baby to die.'  Dramatic?  No, just something that women are told when they question induction.

The 'dead baby' card.  That's what I think happens between the antenatal class and the birth.  The Consultant that hands over a box of tissues before saying 'my way or a dead baby'.  The refusal to explain the risks of induction and instead the reiteration of the risks of going beyond 40 weeks.  That and the 'It's twins, you'll have to have a caesarean' conversation with a low risk twin mum.  Oh wait!  There's no such thing as low risk twins.

What happens between the antenatal class and the birth?  The de-humanising of the mother.  The 'I will not allows' and the 'these are the four positions you are allowed to give birth in' conversations mid labour.  The 'asking' to perform a procedure, whilst performing said procedure (ie "I would like to break your waters" and like that the waters are broken.  No chance for mum to answer).  Am I exaggerating?  Oh I really wish I were.

Of course every Consultant is not like that, but there are days when I wonder.  Why do so many traumatic birth stories abound?  This is the point where despite all that the mum to be has learnt and researched her power is handed over.  She becomes willing to listen to and do everything that she is told.  Again I'll say, if medical intervention is needed, then get it, accept it.  I want to hear more good birth stories, stories where women keep their confidence in their bodies and their trust in their Health Care Professionals.

Wednesday, 19 September 2012

Birthing with a smile

Sometimes, just sometimes, I go to a birth that just makes me feel at peace with the world.  I seem to have had a string of women who have had to fight and fight to get normal births.  Women who have had to spend the last few months of their pregnancies arguing with consultants and registrars who aren't prepared to take their births as a unique experience.  Yes, I know that we have to look at risk factors, but if we stopped doing things because there were risks attached, well frankly we would have to be dead for there is risk attached to everything. 

Anyway.. enough of the dark thoughts.  This was a ray of sunshine in the middle of 'battle' (don't you wish birth wasn't a battle?)

In what seemed to me an act of symmetry, I was having dinner with a past client, who had just been introduced to my current client.  I laughed when I found out (a few weeks previously) that they had been introduced and slipped past client some cash to ensure a good reference.  Oh okay, I didn't.  I finished the evening early as I had a feeling that I needed an early night.  Shortly after I arrived home I received a call from dad to be.  Contractions had started at 7pm but not long and rather erractic.  They were now beginning to start properly but still not very long or close together.  I tried to sleep, failed so played with social media for a while and then closed my eyes.  At around 2am I was woken by a call to say that things were getting more intense.  I could tell that I needed to be there so suggested that I pop over.  It took me less than 10 minutes to walk over.  I do love local clients. When I arrived it was lovely to see my lady labouring beautifully in a dimly lit bedroom.  She relaxed as she saw me and I sent them to bed.  I took myself off to the sofa bed, which would have been lovely but there was a large birth pool in the room, so there would be no extending of the bed.  It's a doula's life for me. lol.

At 6am a large contraction woke me.  I can't say that I was sorry to leave my 'bed' but it was lovely to see daylight filtering through the blinds.  My lady was in the bathroom, relaxing on the toilet.  She said that is was so wonderfully comfortable and that she had dosed for ages.  Fabulous.  Rested women labour so well.  After  a while, I suggested that she change position and move to the bedroom.  A huge projectile vomit made that moot point for a while, but as I always say (or was that my mum) 'better out than in.  Your body is just clearing out for the baby'.  Dad got busy with a mop and towels.  Mum drank some water and moved to the bedroom.  She had already ripped her TENS machine off.  It was irritating her.  I could hear that labour was intensifying and asked Dad if they had updated the midwife yet.  This was to be a homebirth (my favourite type of birth.  I get to leave them snuggled up in bed together peacefully).  The gorgeous K said that she would be about 40 minutes but to call if we needed her sooner.  Less than 5 minutes after that call I took the phone to another room and called her again.  I could see a lot of bulging in the anus and worried that this might be a BBA (Born Before Arrival).  I assured K that I would call 999 if I thought that the baby was going to arrive before her and I prayed that it wouldn't.  

There was such a spirit of peace the whole time.  Dad was busy filling the birthing pool (he got told off by the lovely K for not filling it before).  To be fair to Dad, they had spent most of the night asleep (in his case), dosing (mum and I) and things were suddenly moving at quite a pace.  Neither Dad nor I were sure that the pool would fill in time, but it did, just!  K was such an unobtrusive midwife.  She moved gently around, carried out her observations, wrote her notes and messaged the second midwife.  She had such a way with her words.  She would smile at Mum and say 'You are stretching beautifully.'  She didn't asked questions, she watched and smiled.  Then she suggested that Mum get in the pool, which she did and it was lovely to watch the feeling of peace across her face.  The doorbell rang and the second midwife entered.  Not as silent as the first but a good midwife nonetheless.  It was only a matter of minutes before we saw the beginnings of baby's head gently easing itself out into the world.  Then it slipped back inside, so I reassured Mum that her baby would be here soon.  A few contractions later, a beautiful girl glided into the world.  The cord was round her neck twice, so the beautifully slow birth was perfect as there was no tension on the cord (which could have happened with 'purple pushing').  The cord was unwrapped and mother and daughter sat gazing at one another in the water.  I'm amazed that Dad didn't burst, I could feel the oxytocin pouring from him.  

Soon the midwives had completed their checks, weighed the baby and left.  Dad emptied the pool, I made breakfast for us all and then left them all 'blissed out' together.  My abiding memory was the smile on Mum's face as her daughter was born.  

Wednesday, 29 August 2012

When breastfeeding isn't an automatic bond...

I talk to a lot of women about their pregnancies, their births, their babies and their breastfeeding experiences

They all say so many different things.  I was particularly struck by a conversation that I had with one mum recently that made me stop and think about things that others have said and things that I have felt myself.
"I have read a lot of books about breastfeeding and I don't get that bonding experience that everyone talks about..."
That stopped me in my tracks a little because it's not a comment that is commonly heard.  I wasn't shocked by it, but I was very definitely struck by how few women seem to articulate it.  There are women who are quick to jump up accuse other women of not being loving enough if they say anything less than, "This is the most wonderful experience of my life".  Now that statement is not an excuse for people to say, "Yeah, I agree, breastfeeding Nazis, etc, etc".  No.  Watch your language, please.  There are ways and ways of saying things.  Honesty is good, BUT, it is not an excuse to beat others up for whatever they believe.  Neither do I believe that it is an excuse for others to jump on board and 'attack' mum for facing her feelings honestly. 

So… What DO we say to these women?

I think that the starting point is HEARING what they say.  Some women will tell you that they hate or intensely dislike breastfeeding.  Have they then gone on to say that they are NOT breastfeeding?  The answer to that is often no.  They are trying to reconcile what they feel with what they have been told that they OUGHT to feel.  A wrong response from us could potentially see the end of this period of breastfeeding. 
Once we have heard what they have said, then we need to PAUSE.  Take a step back and think about the response that might automatically flow from you.  Is that a good response?  How much effect do you think your words will have?  Will it be the effect that you want?  Will your words give her what she needs?
One of my ladies breastfed her son for a year.  All along the way she told me that she didn't like it.  When other people challenged her decision to breastfeed:
  • "What about Dad?"
  • "What about me?"
  • "Don't you think he's too old for that now?"
She always replied that she knew the milk that she produced for him was made for him, so why use anything else? When he turned one she moved over to cows milk, because she was happier with its content than the content of artificial milk.
Think of it this way.  Some women don't enjoy being pregnant.  Some love it, some hate it, some just trundle along.  What would you say to her?  What are her choices?  Will your opinion on how she OUGHT to feel, change anything?  What about the ones who are now mothers, but don't enjoy it (at the moment, or at all)?  What would you say to them?
On a personal note, I did NOT enjoy my last pregnancy.  It was my twin pregnancy, but that wasn't why I didn't enjoy it.  I was sick.  I couldn't even keep water down very well.  Some twin mums are NEVER sick.  I shall hide my jealousy...  I had a horrible condition - ptyalism.  Mine was acute, so you can imagine the joy that that brought me(!)  It left me a couple of hours after the twins were born.  I was pretty much convinced that I had it for life.  I hated people continually telling me that all I had to do was swallow.  Swallowing made me throw up.  Not a good look.
I have talked to mothers who loved pregnancy, but hated giving birth and vice versa.  I have a friend who found that she wasn't hugely keen on her baby.  She knew that she ought to be, but she was never convinced that she loved her.  Then one day, six months in, her daughter wasn't well.  And, like THAT, it occurred to her that she loved her baby.  What would you say to a mother like that?  Would you tell her that she was unnatural?  That she was wrong to feel the way that she did?  Or would you walk alongside her and wait?
We can't always help the way that we feel.  Sometimes it's not all that it was cracked up to be, but that doesn't mean we don't just get on with the job in hand.  Who knows, maybe once it's done we'll miss it.  I know I miss the babies kicking inside me and the sickness is practically a long gone memory.

(Originally shared on Acorn Pack July 2011)

Tuesday, 21 August 2012

Be careful what you say. You don't know who may be listening.

I love being a Doula Mentor.  I really really love it. 

Tonight I met with one of my newer mentees.  The enthusiasm and the pure, unadulterated excitement makes me smile.  Every day I fall in love with doula-ing more and more, meeting the new doulas... well that just sends me into spheres of pure joy.

So let me tell you about tonight.  I'm still laughing and almost crying about it.

We met in the pub.  Most of my mentee meetings are over coffee and cake (I love cake).  This mentee is busy in the days so the evenings work better for her.  I suggested the pub.  A glass of wine and a vodka lime and soda later we were sat at a small table and we were talking about how I could support her and how she'd begun her journey.

We talked about the two births that she'd supported pre-doula days.  We talked about books that she's reading and that she'd like to read.  We talked about ways to improve her knowledge and how to build her clientele.  We talked about the fact that both of us are 'doulas with no tricks'.  And then I proceeded to talk to her about Rebozo.  Whilst I was giving a semi demonstration (standing), a guy at the table next to us asked if I was showing her some special ninja moves.  We laughed and explained what a doula is.

And this is the part that makes me cry follows.

The guy that asked the question was sat with two others, one guy, one girl.  The other guy is an expectant father, so we suggested that he look at the Doula UK website and consider hiring a doula.  We also suggested that he look at homebirth.  He was pleased (I think) to get the information but the girl at the table.  Oh dear, oh dear, oh dear.  She had been told by her gynaecologist that once past the age of 35 there was a 1 in 2 chance that the babies would be born with autism, Downs Syndrome, disabled, messed up.  Women who have babies are ruined below and that sex would no longer be good.  In her own words, birth is an unnatural process and babies are ripped, torn and cut out of you.  She had a pathological fear and hatred of birth.  Personally, I want to find that man and in the words of The Sheriff of Nottingham (Robin Hood, Prince of Thieves), I want to cut his heart out with a spoon.  Why?  Because it will hurt more!

A saving grace?  The first guy is really interested in doulas, having never heard the term before, and will hopefully talk to his partner and they may well book one.  The second guy told us the story of his wife's retained placenta.  Their first child was born 'practically perfectly' and the placenta followed quickly.  Their second child, a boy, took his sweet time.  23 hours of slow labour before he finally slipped into the world.  His placenta, didn't want to come.  Eventually the midwife administered the syntometrine injection, but to no avail.  So, she wrapped the cord around her hand and tugged.  No movement.  She went to get a doctor, he repeated the cord wrapping and tugging.  Two more doctors came in and did the same.  Then dad said 'Enough!  I know that you are interfering with something natural.  There will be no more doctors tugging.  We will wait!'.  Two hours later, the placenta separated and came out with no fuss. What a star!  The girl?  Well her sister is 4 months pregnant and had the same gynaecologist and has a lot of the same fears.  My number and website details were asked for.  Of course I had been talking to my mentee about the importance of giving out business cards, because you never know who might need it.  Oh the shame to find that there were none in my bag! lol

Be careful what you say.  Be careful and mindful of who you listen to.  You don't know who hears or what they hear.

Now... where did I put that spoon?

The gorgeous Alan Rickman as The Sheriff of Nottingham

Wednesday, 1 August 2012

And like that a victory!

Sometimes it is difficult to keep a positive outlook when it comes to clients birthing in hospital.  This was never borne out more than in a recent experience where a twin mum to be was bullied (and no I'm not being emotive) and harassed from 25 weeks pregnancy.  Which charm school do some of our Consultants, Registrars and Midwives go to?  I would be living such a carefree and monied life if I had a pound, just a single pound, for every time I hear that a pregnant woman has been told 'Do it my way or your baby(ies) will die'.  In the case of my twin mum her babies had to be delivered at 37 weeks or they would die.  At 38 weeks it was increasingly more likely that they would die.  She declined induction and caesarean section.  Her babies were happy, moving nicely, her placenta was good and her fluid levels were high.  And yet every appointment she went to, she was told 'your babies will die'. 

Is fear really the way to get pregnant mums to agree to hospital decisions?  What happens when that same fear that hospitals breeds cause pregnant women to hide away with their unborn babies?  What happens to those babies that actually need a doctor to help with their birth?  Scaremongering? Me?  Well surely it is the new language of birth?  I've watched bits and pieces of One Born Every Minute and then I had the misfortune to tune in to The Midwives (which is another birth reality programme) and I hate them.  I really and truly hate them.  Fear on the screen.  The air turned blue as I watched an experienced midwife, who in her own words had attended 1000s of births, tell a young woman that she felt that this would be a quick labour and then offered diamorphine.  Now when women talk through their pain management options, they are told that pethidine or diamorphine shouldn't be given in the final 4 hours of birth because it can compromise the baby.  Sure enough, the baby is whisked to the resuscitaire because of the affect of the drug.  I'm not a midwife (and frankly this wouldn't encourage me to become one) but even I know that there are other ways to help a woman manage her pain when the baby is coming fast!

So back to my twin mum.  Despite all threats of dying babies, she remained strong and waited until she went into spontaneous labour at 39 weeks and 2 days.  And man did she labour beautifully.  Not a sound.  Barely raised the level of her breathing.  At one point a consultant came in and said 'Ooh I hear you are 3cm.  I'll pop back later and get some synto up.  We don't want you still hanging about at this stage tomorrow'.  My lady declined.  No indication for rush, babies and mum perfectly happy.  Despite getting to 10cm, the birth ended with a double forceps. Twin 1 was in an awkward position and not pressing down enough on the cervix for her to push him out, plus there was some meconium.  I do wonder if the midwife breaking her waters at 9cm had anything to do with that.  So having survived weeks of bullying, one might imagine it was plain sailing from there.  I regret to say.. nope!  There was another level of bullying to come.  There's something about a smaller twin isn't there?  Just causes panic and protocol driven measures.  Blood sugars galore.  He was born under 6lbs (wonder what he would have weighed if the hospital had its way at 37 weeks) and his brother was over 7lbs.  She was told that she would have to supplement as there wasn't enough breastmilk to get his sugars up.  Mum wanted to express but was told by the midwife that it was too early to express and not worth it.  Despite all of mum's efforts to exclusively breastfeed, the pressure was on to give formula and it was constant.  When mum and dad said that they wanted to discharge themselves they were told that the police and social services would be called.  They were sufficiently frightened enough to do as the doctors wanted in order to get home.  Dad told me that he was afraid he'd never be able to bring his family home (and in fact didn't believe it until they had shut the front door behind them).

So, where is the victory I mentioned in the title?  Little twin, twin 1, struggled with breastfeeding.  Mum was breastfeeding twin 2 and feeding twin 1 expressed breastmilk in a bottle.  The victory was the first breastfeed, since birth, by twin 1.  It's not all sorted yet, but he's getting there and both boys are gaining weight.  My client has told me that she will never go to that hospital again should she become pregnant again.  I don't blame her.  They fought her till she broke.  The best time was during labour with the most gorgeous of midwives who wasn't worried that there were two babies.  Strange to think that that was the most peaceful time.

My crazy pair

Sunday, 22 July 2012

Let's hear it for the girls!

My successful Home Birth after Caesarean - Rae

This is my story of how the birth of my second daughter Elsie, at home, turned out to be a wonderful, fulfilling experience.

Quite soon after I had an emergency caesarean with my first daughter Amelie, now aged 2, I began reading widely about having a vaginal birth after caesarean.  I also met with a consultant to discuss why I had had an emergency caesarean and what this meant for any future pregnancies.  During this process I became more and more convinced that the hospital experience during my first labour ultimately led me down a path that would result in an emergency caesarean.   To this day I feel the caesarean was unnecessary and could have been avoided if I had had better midwifery support, been placed in a less clinical environment and if I had had the opportunity to have an active labour rather than being restricted to a bed, which slowed Amelie’s descent.

With my first pregnancy I was entering the world of the unknown and felt that having my baby in hospital was a ‘safe’ decision.  My labour started on my due date with a few contractions in the early hours of Saturday.  These contractions continued with long gaps in between until morning and were accompanied by a clearing out (a side effect of prostaglandins hormone release).  By mid morning the contractions had passed and I went to lunch with a friend (spare underwear and leggings in a bag) and at around 5pm the contractions slowly began again, continuing all through the night and the next day until Sunday evening at 9pm when by then they were much stronger and every 4 minutes apart. 

The pain was uncomfortable and building so we decided to call the hospital and, with a feeling of excitement and adrenalin, we were told to go in and I was found on arrival to be 2cm dilated.It was a quiet night so the midwife told us to stay to see how we progressed.  About three hours later another labouring lady joined by her partner and mother-in-law were led into the waiting room (the room you are restricted to if there are no beds or, as in my case, not in ‘active’ labour).  The lady was checked and told to go home as she was told she was neither dilated nor contracting, but she refused to leave: having had several children she knew her body and the signs.  Sure enough, five minutes later after she had paced the corridor she let out a blood-curdling scream and fell to the floor.  A team of midwives ran to her aid and announced that she was having a panic attack. It turns out, however that she was actually in labour, and shortly afterwards she gave she gave birth there on the bed next to my partner and me– much to everyone’s surprise, apart from her own.

Shortly after this I was examined and, not surprisingly, I was no longer dilated and was told to go home. ‘That’s what you just told her’, I thought.  At 3am Monday morning, just back from the hospital and in my pyjamas, I laid down ready to sleep when my waters broke.  Another call to the hospital and we were on our way back in.  This time the contractions were a lot more painful and the car journey hellish, but again on arrival I was only a few centimetres dilated and so was made to wait in the holding room for another 11 hours whilst other labouring women came and went. 

By this time I was on the gas and air and trawling a canister behind me whilst I tiptoed through the brand new ward (which was open but not in use due to low staffing) with every contraction trying to speed things up.  On Monday at 2pm I started to panic, the midwife had been gone for hours, the pain started to feel different and I was scared the baby was coming.  I begged my partner to get the midwife over and over again but he was told she was covering someone else’s shift.  When she finally arrived she did a vaginal examination and exclaimed in a very impatient tone ‘you are ONLY 4 cm’. 

How could I go on if I was only 4 cm, I thought?  I had been at this for three days and my energy, my willingness, my strength and trust in my body had shattered.  My mum, upset at seeing me in distress, had been encouraging about an epidural and at that moment I thought why not?  If only I had read more and realised this would increase my chances of having a c section.  When I asked the midwife for an epidural she rolled her eyes and I was finally taken to my own room.Once  I was in a private space and at the thought of some pain relief I remember feeling like I could actually manage the pain.  As the surgeon put in the tube I thought ‘why am I having this? I feel in control now.’  A doctor was in the room at this point and I remember him asking the midwife why I was having an epidural?  She rolled her eyes again and he tutted, both now with their backs to me.  I wondered why I was experiencing this negativity? If the doctor and midwife thought it was a bad idea, why didn’t they say something or offer another form of pain relief first  - such as positivity and encouragement?

Now I was stuck on the bed (and so, not able to have an active labour) with a foetal monitor clipped to my baby’s scalp which, we found afterwards, had led her to bleed and bruise. The machine beeped away and every time it changed slightly my partners stress levels would peak and the midwife would jolt.  At 9pm on Monday I was found to be 10cm and the epidural was starting to wear off.  I didn’t want a top up so that I could feel to push but the midwife asked me ‘what was the point of having one?’ and promptly administered some more of the drug.  In that brief moment before the top up I had begun to feel a strong urge to push but the midwifes were changing over and I was not allowed to do anything until she read through all my notes.

Finally at 10pm I was told to push,which I did for a few contractions, then I was told to stop, as I was to have an episiotomy rather than tear followed by a ventouse.  Had I known that tearing naturally heals better, bleeds less and is less likely to get infected I would have refused the episiotomy.  We tried another three times with my legs stuck in stirrups but to no avail.  By this point I was delirious having not slept in three nights and everything started to become a blur.  Paperwork was shoved at me to sign and I was whisked into surgery for failure to progress.  My baby was born at 1am on Tuesday morning with a good APGAR score (the test used to quickly evaluate a newborn's physical condition and to determine any immediate need for extra medical or emergency care), though it felt like forever until her first cry.  I didn’t get to hold or see her for another 30 minutes, no skin to skin, and she was sent away with dad whilst I was stitched up.  When I finally had my baby in my arms and happily latched on to my breast my partner was told to leave.  I was exhausted and couldn’t keep my eyes open, falling asleep with baby in arms and with no one to help. 

That first night in hospital was terrible - my daughter screamed and screamed and I kept trying to feed her but after labouring for three days I would pass out only to be woken by a midwife shaking my arm.  I really needed more support but my partner wasn’t allowed in and the hospital couldn’t provide it. 

Four days after the labour and still at the hospital I was so annoyed and frustrated by the lack of help, given that I had just had major surgery and was expected to lift a baby on my own, that I tried to discharge myself, but I was told that I was supposed to have an iron test but no one had got round to doing it.  So, as it turned out, with seriously low iron levels I left and for at least 6 months afterwards would find myself crying to sleep feeling that I had failed my little girl.

A year later I was pregnant again leaving a 20-month gap between my first and second child and, as far as the obstetricians that I met were concerned, not a large enough gap for a successful vaginal birth after caesarean.

Having done my research I let the obstetrician know at my twelve-week scan that I wanted a home birth after caesarean.  The OB refused to support my decision and called in her manager to reiterate the risks (risks on which I was already self-informed).  Her manager stated that I would have to have my baby in hospital as that’s where the doctors and midwifes ‘felt happiest’.  When I responded that I would not be happy or calm in hospital, he retorted ‘that’s the theatre of life, darling’!

Disgusted by this attitude I immediately transferred from that well-respected central London hospital (who also wouldn’t allow me to use the birthing centre should I get moved to the labour ward as it would affect their end of year statistics) and I went back to my local east London hospital, where they did support my HBAC decision.

Despite this new-found support I never actually felt supported – I was called to several meetings with obstetricians where I was quizzed about my reasons for wanting a HBAC even though I had gone through the notes from my first labour with them and they saw no reason for it not to be a successful vaginal delivery. They questioned whether I was I just being obstinate with regards to my first labour as procedures had apparently improved, and they asked what made me think I could labour naturally anyway?  And then came the risks, which are centred on uterine rupture, and I was faced with comments like ‘you are risking fatality of you or your baby and you could lose your womb’. 

I wasn’t being obstinate, I had done my research on uterine rupture, I understood the risks and had gone through my the notes from my first labour with a specialist who agreed there was no reason why I shouldn’t be able to labour naturally.  If at any point the conditions of my pregnancy had changed to further complicate things I would have re-evaluated my position.

With all this negativity I focused on keeping well informed and stood my ground with consultants, doctors and midwives. I made sure that I had a plan B birthing plan should I not be able to give birth at home.  I also had the support and expertise of a wonderful Doula, Marcia, who had been through four very different births of her own.

Throughout the pregnancy I felt very isolated and found myself reading others’ VBAC and HBAC birthing stories online when I came across the Hackney home birth support group which meets monthly to share information, advice and stories.  At this get together I met a midwife from the Homebirth team who immediately stood out as highly competent and unfazed by my HBAC decision.  I called the Homerton home birth team leader days later and requested this midwife, as I wanted to ensure that I had someone with the right attitude to support my pregnancy and labour.

At 37 weeks pregnant I began to have regular cramps, which woke me up at night and eased off when I tried out different positions.  I prepared for an early labour as my first labour started on my due date.  I packed my hospital bag just in case, borrowed and tested a birthing pool, continued to listen to my hypnobirthing CD regularly and laminated my birthing plan.  However, my due date came and went, - the cramps increased but by then I ignored them and tried to continue as normal.

At 40 + 4 weeks my midwife called me to say that the hospital were concerned and that if I had not had my baby by the end of the week I would need to meet with the obstetrician who would want me to have a caesarean.  I felt sick at this news and considered having a membrane sweep despite not wanting any intervention.

A day later I spent the evening having contractions every ten minutes but by midnight they had stopped.  I knew it wouldn’t be long and sure enough the next evening, 15 minutes after I had said goodbye to a friend who had come for dinner, I had a contraction which led me to the bath and my partner started timing.  Minutes later at 10.15 my waters popped and immediately I was in immense pain, jumping out of the bath and on to the toilet to flush my system.The contractions went from 5 minutes apart to 3 minutes apart within 30 minutes and the need to bear down was uncontrollable.  The midwives and my doula arrived about an hour and a fifteen minutes later, much to the relief of my partner, and I moved to the bedroom floor with no time to set up the birthing pool (not that I wanted it as I had briefly got back in the bath and it had made me feel sick. I preferred the cold water my partner squeezed over my head). 

My doula and the midwives aided in keeping me active - moving me from all fours to a squatting position, helping the baby to descend.  In fact the baby was descending so fast that my midwife found it difficult to read the baby’s heartbeat, which was causing concern.  However, any concern she had was not shown to me, which I appreciated. 

Close to the end with more failed attempts at foetal monitoring the midwife turned to me and said ‘let’s get this baby out’ and that’s exactly what I did, squatting, held by my husband and screaming at the point of ‘ring of fire’.Baby Elsie was born weighing 8lb 6, at 1.17am, three hours after labour had started.

At no point did I feel even a twinge at the site of my caesarean scar. So, after much unfounded stress, I got everything I wanted: no intervention, pain relief or vaginal exams.  My placenta came naturally 30 minutes later and it all ended with a nice shower and a cup of tea.  Despite plans to send my daughter to her Nan's when I went into labour we didn’t even have time to call until after the birth and she slept soundly through it all, waking up the next morning to her new sister. 

It was amazing and very fast compared to my first labour and excitingly I got to see the baby slowly descending and crowning in the bedroom mirror which just happened to be opposite.  Seeing her head slowly emerge helped me get through those final moments.

If I could offer any advice to anyone considering a HBAC it would be to keep an open mind, do your research, keep informed and be prepared for things to change.  Keep communicating with the doctors and obstetricians despite the frustration you may feel at hearing ‘the risks’ for the tenth time. It was really helpful for me to understand the situation that led to my caesarean and from that to build confidence in my body and its ability to labour naturally.
One of the wonderful perks of having the home birth was that I really got to know my midwife and, unlike in a busy hospital environment, my midwife would stay with me during the labour rather than disappearing for hours covering more than one birth.

My final piece of advice would be to make sure you get the right support.  At one point I had a midwife that grunted at me when I mentioned birthing in a pool and was forceful about giving vaginal exams.  I changed midwifes and it immediately relieved the stress and got me what I wanted. 

I know the struggle and the feeling of isolation at times in the fight for a HBAC so if anyone wants to email me for a chat please do