18 Oct

Maggie’s Birth Story

Maggie’s daughter turns 13 next week; here’s the story of her birth:

I had quite a traumatic birth experience with my son, so when I found out that I was expecting my second baby I was pleased, but partly worried that we would have to go through a similar experience again. My son’s birth had been a planned home water birth, but my blood pressure had become high in the last month of pregnancy and at the onset of labour he had become distressed, leading to an augmented labour, followed by a failed ventouse and then forceps delivery. I had the same community midwife with this second pregnancy, and at my booking-in appointment, she told me that I would have to be checked by the consultant, and strongly advised against having a home birth, given what had happened previously.

This second pregnancy went very well, until six weeks before my due date when my blood pressure went up to 130/90. At this point I started to worry about history repeating itself. Over the next six weeks, however, it stayed more or less constant at 130/90, which although high, was what it had been at my booking-in appointment, so the midwife and consultant weren’t unduly worried.

On the day after my due date I went to bed at 10pm and fell asleep very quickly. Two hours later I woke up as I realised that my waters had broken. My first labour had started the same way, but this time the fluid was clear – so far so good. An hour later we arrived at the Royal Berks Hospital. In the car, the contractions had been pretty mild, but coming about every 5 minutes. The midwife on duty gave me all the routine checks, told me I was about 1cm dilated and that everything seemed to be going normally. She just had to check on my contractions and the baby’s heartbeat and then I could go home and wait for the contractions to start in earnest.

On went the monitoring belts for the obligatory 20 minutes. At the end of this time the midwife looked worried, and told me that she wanted to leave the belts on for a bit longer and get the registrar to look at the trace. The baby’s heartbeat was apparently too steady – not enough variability, which meant that the baby was either asleep or distressed. At the end of 50 minutes the trace hadn’t changed much and the registrar was also worried. She told me that it was very likely that I would have to have a caesarean if the baby was distressed this early in labour, and even if not, they would have to speed things up with a drip. When we were asked what our feelings were about this my husband said angrily “I’m just afraid of the whole bloody thing going balls-up like it did last time”

In the meantime we were moved to a delivery room in order that they could attach a scalp electrode to the baby’s head to give a better indication of the heart rate. By now it was about 2.30am and my contractions were slowly gaining in strength and still coming regularly. Once the readings started coming through the scalp electrode the output from the monitor was faxed through to the on-duty consultant to determine whether the caesarean was required or not. The trace had improved somewhat, but was still considered suspicious. In the meantime my midwife took some blood samples from me as there was some concern regarding my blood pressure and the anaesthetic for the caesarean.

The reply from the consultant came back – no need to do a caesarean yet, but certainly augment the labour with a drip. When I was told this, I asked for an epidural to coincide with the drip going up, as I knew from my first labour that I didn’t want to have to deal with the more painful contractions that would result. However, it wasn’t possible to have either the drip or the epidural until the blood test results came back. By this time the contractions were beginning to get stronger and I was using the breathing technique to get through them, standing next to the bed and leaning on the monitoring machine. They were lasting about 45 seconds and coming every three minutes. I was beginning to think that I should have put my TENS machine on, but under the circumstances I hadn’t bothered as I’d thought I’d probably be on the operating table by now! I debated whether to use gas and air, but somehow I didn’t think I wanted it just yet as the breathing on its own was making a difference.

Eventually the blood test results came back just after 6am, they were fine, and by that time everything was set up ready for the drip to go in and the anaesthetist to do his work. Just before though, I asked for an internal examination to see how things were progressing on their own. I was 3cm dilated by this time, and having been up all night was glad to lie down on the bed for a while.

I had the epidural and up went the drip. Down went my blood pressure to about 70/40 as I reacted to the anaesthetic, felt extremely light headed and debated whether or not to be sick. This reaction passed fairly quickly, and I was pleased to discover that the anaesthetist had got the dose on the epidural spot on. It dulled the pain of the contractions, but I was able to stand up next to the bed and move around to a limited extent. My real fear was that I would end up having to lie still on the bed and give birth in that position. The midwife who had been with me all night went off duty shortly afterwards at 7.30 and another midwife took over.

After another hour and a half the registrar returned and at the same time I realised that the epidural was beginning to wear off, so I asked for a top-up. This was administered just before the registrar announced that they wanted to take blood samples from the baby’s scalp to gauge how distressed it might be. So, back on the bed I went and the registrar started to try and take the blood samples. In passing she told me that I was now 4cm dilated. In the end she had to take three samples as there wasn’t enough in the first two samples to do an accurate blood test. Once she had taken the third she told me I was now dilated to 7cm. At this point I was beginning to suspect that the top-up epidural wasn’t working as not only was I feeling uncomfortable from the internal examinations, but the contractions were getting more painful rather than less. Whilst waiting for the blood results to come back (normal again) the registrar performed a stretch and sweep and told me I was 9cm dilated – quarter of an hour after I’d been 4cm!

The registrar then left my husband and I alone with the midwife. By this time the initial epidural had completely worn off and the top-up hadn’t done anything so I could turn round on the bed so I was kneeling and leaning against the head of the bed, and very shortly I started getting the urge to push. My new midwife was great at this point, she stood back and told me to go with my body, and do whatever felt right.

As the urge to push got stronger I went with it and started pushing. Four minutes and four contractions later at 9.30am the baby’s head appeared, followed at the next contraction by the rest of her body – a little girl! After an eleven minute third stage and some oxygen for the baby she was put to the breast to feed and stayed there for half an hour! After everything that had gone before it was an extremely positive birth experience in the end.

Three and a half hours after the birth we left hospital and brought our daughter home to meet her brother. My mum, who had been babysitting, was amazed to see us – the last update she’d had from my husband had been when we were preparing to have a c-section!

16 Oct

Book Review: The Birth Partner, by Penny Simkin

Penny Simkin is an author, doula, childbirth educator, and birth counsellor.

I was advised to read this book prior to my first job as a birth doula, and having now read it through, I will probably take it with me when I get the call. Aimed at dads, doulas and other birth companions, and packed with details of what happens before, during and after labour, it is not a small book, but its chapters are easily accessible and logically arranged.

The long section on normal labour is particularly useful. Each stage is broken down into a description, followed by what the mother feels, what a birth partner might feel, what a caregiver would be doing, and what a doula would be doing. There are suggestions for self-care and coping strategies appropriate to the challenges of each stage; it’s a real step-by-step manual.

There is a medical level of detail on pain relief, and this would need to be read and absorbed beforehand rather than at the time, but it remains a book to dip into during the process for an idea of what is happening and how to deal with it.

For when things don’t go to plan, the book covers instrumental and caesarean birth as well as other interventions. Helpfully value-free, Simkin sets out the things to take into consideration, and strategies for decision-making.

A comparatively short section at the end covers the baby’s first few days, and post-partum recovery; again with a what to expect/how to support the mother focus.

My one criticism of the book is its US-centric language, which makes me suspect that some of the procedures described may differ in the UK. But women’s bodies are the same all over the world, and ways of supporting a birthing mother are universal.

This book is a must-read for anyone working in birth, and for birth partners who prefer a lot of detailed information in a format they can refer to both before and during labour.

06 Oct

Dear Doctor

Views expressed here are my own, and do not represent the views of NCT.

This weekend, Dr Ben Goldacre stood on a stage in front of hundreds of NCT Practitioners, volunteers and staff, and told us that we “push” breastfeeding. “Because you do,” he said, with a cheeky wink. “You’re the breastfeeding nazis.”

There was a sort of silent stunned gasp, followed by a burst of laughter; it was the funniest thing, a great ironic deconstruction of the name-calling rubbish (with acknowledgement to my colleague Kerry from whom I pinched that description). It was funny the second time he said it, too. After a while I was much reminded of my eight year old son and how he repeats the joke until you have to sit him down and explain that we’re really over it now.

We were treated to Goldacre’s standard comedic romp through the Daily Mail’s war on cancer, his low opinion of Gillian McKeith, and a selection of amusing headlines that can be achieved by cherry-picking statistics. Lucky us, we got a little extra bit on research statistics, and then a worked example using Brion et al’s 2011 article entitled What are the causal effects of breastfeeding on IQ, obesity and blood pressure? This study does contain flaws, and I wondered if Goldacre had also read this commentary, though on reflection if he had read it, its conclusion might have helped him to write a conclusion of his own:

Although the collective evidence suggests that breastfeeding—initiation, longer duration or exclusivity— may very well exert a modest protective effect on childhood and adolescent obesity, it no longer appears to be a major determinant. Nevertheless, because breastfeeding also reduces infection and allergy-related outcomes and probably increases IQ, World Health Organization recommendations for 6 months of exclusive breastfeeding remain a just and justifiable policy around the world.

By the umpteenth repetition of the breastfeeding nazi joke, I had the impression that Goldacre did not quite understand what NCT does, and while I have no evidence for this assertion, I’m pretty sure he hasn’t read our excellent Infant Feeding Message Framework [pdf]. Reading through the reasons women give for stopping breastfeeding, it would appear that for mothers, the evidence itself is not the highest priority when it comes to evaluating the experience, and that is where NCT comes in, to support parents in the situation they are in: non-judgemental, respectful support where support is asked for.

Ben Goldacre told us he doesn’t care about breastfeeding, he cares about misuse of evidence, and nobody in the room would have disagreed with that. But I would have liked him to have been a bit more thorough in his own research and understanding of how NCT supports parents.