Pregnancy

Birth place options – What are they?

Birth place options – What are they?

• Home birth – a birth that takes place in your home.

Community midwives usually provide the care for home births. A midwife will come out to you when you are in labour and will monitor both you and your baby’s wellbeing throughout the labour.

Your midwife will organise a second midwife to join her for your baby’s arrival. Ideally, two midwives should be with you when your baby is born.

OR

You can organise is private midwife and/or doula to support your birth.

ADVANTAGES OF A HOME BIRTH

• You are likely to have the same midwife/ midwives caring for you throughout the labour so will receive one to one care
• You’re able to give birth in a relaxed, familiar environment with your family close by
• There is increased likelihood of having a normal birth
• If things don’t go as planned, you will still be able to transfer to hospital
• You can recover from the birth in your own home.

DISADVANTAGES OF A HOME BIRTH

• Your midwife will offer you Entonox (gas and air)
• A home birth is not advisable if your pregnancy is considered high risk, for example, if you have had previous birth complications
• If you have problems during labour, you may have to transfer to hospital at a very late stage.

• Free birth 

Unassisted birth is often called ‘free birth’.

It means deciding to give birth at home or somewhere else without the help of a healthcare professional such as a midwife.

For more on this type of birth visit https://www.birthrights.org.uk/factsheets/unassisted-birth/

• Hospital birth – A birth that takes place in a public hospital where medicines and medical procedures are carried out.

Hospital Birth Pros

• Many hospitals have caring and supportive doctors and nurses
• The hospital has staff available to handle complications
• Clean and well-maintained hospitals
• There are often tools and equipment to support the birthing process
• A paediatrician was available to assess the baby at the hospital

Hospital Birth Cons

• Unfamiliar carers
• Higher risk of C-section
• Higher rate of drugs used during birth
• Higher risk episiotomy
• Less chance of continuity of care
• Higher risk of intervention such as ventouse, forceps
• In a shared ward (unless a private room is possible)
• More medicalised birth process which can feel unnatural
• Higher risk post-natal depression
• Higher risk traumatic birth
• Higher risk induction
• Siblings are not allowed to stay with their parents
• More difficult to advocate for birth preferences.

Where and how to give birth – What are the options?

In water – i.e. in a birthing pool. A water birth is when you spend part of your labour or delivery in a tub of warm water. Many women find being submerged relaxing during labour, and it can be a great way to manage surges.  

Benefits of Water Birth

The main benefit of labouring in warm water comes in the form of pain management, says Dekker. “You’re less likely to use pain medication, less likely to have anxiety and you’ll have better positioning of the baby in your pelvis,” she elaborates. A Cochrane review that examined eight randomised trials looking specifically at water immersion during the first stage of labour—before pushing begins—showed evidence that labouring in water reduces the use of epidurals and spinals for pain relief. It also noted that labouring in water shortened the first stage of labour by roughly 30 minutes.

There aren’t many studies that look at babies being born in water, but some key benefits of water birth noted by Evidence Based Birth include:

• Lower pain scores
• Less use of pain medication
• Shorter labours
• A higher rate of successful vaginal birth
• Lower rate of episiotomy (cutting of the vagina and perineum)

*This can be in a bath or a birth pool.

On a bed or on a ball?

While it may seem routine to birth in a bed, it isn’t necessarily the best for a seamless birth.  You don’t have to learn every available position but open your mind to a better way to birth and on your back defies gravity so it makes sense to explore another way.

Resources

https://evidencebasedbirth.com/evidence-birthing-positions/

https://www.thebump.com/a/birthing-positions

In the sea – yes even this is possible and legal but if you’re UK based the water temperature and quality could prove a problem.  There is no reason though that you can enjoy early labour (sea conditions dependent) at one with Mother Nature’s tides. 

Or anywhere in between!  Your body is brilliant and so is your baby so even if you’re caught short between your birthing pool and hospital, trust that everything will be ok because you have all the knowledge within to do it.

Scans – What do we really know about them?

Are you assuming that because they are ‘routine’ that there are no side effects or future implications of this technology?  Many women, particularly those that choose free birth, are choosing not to scan, some suggest it over medicalises the process and can end up with further unnecessary investigations/interventions simply because they are looking ‘for something’. However, for others the potential risk may out weight the alleviation of anxiety during pregnancy.  Whatever feels right for you, just ensure that you have explored the subject.

Resources

Book – Am I allowed? What every woman needs to know before she gives birth by Beverley Ann Lawrence Beech

Due dates – Are they accurate?

Only 3% of babies arrive on their due date, so why as a society do we get so attached? 

What if we took is as a very loose guide and thought of birth as a birthing month from 38-42 weeks?  Did you know in France that they wait until 43 weeks (37-42 +6 days is full-term in France).

It has been suggested that thinking of your baby’s arrival as a birth month rather than a ridged due date is a healthy way to approach the arrival of your new baby. By becoming attached to a particular date can induce anxiety, not least because everyone is asking you if you have had the baby yet but also because we subconsciously think that if we are overdue then we are somewhat failing which is completely untrue given that only a few even hit this inaccurate date!

‘Based on the best evidence, there is no such thing as an exact “due date,” and the estimated due date of 40 weeks is not accurate. Instead, it would be more appropriate to say that there is a normal range of time in which most people give birth. About half of all pregnant people will go into labour on their own by 40 weeks and 5 days (for first-time mothers) or 40 weeks and 3 days (for mothers who have given birth before). The other half will not.’ Evidence based birth website

Resources

https://evidencebasedbirth.com/evidence-on-due-dates/

Who can attend my birth?

Midwife, doula, birth partner, other?  Firstly, decide who you want there and this will inform where you have your baby as your choices inform your place of birth.

At home, you can have anyone, your whole family if you choose. Remember though an oxytocin rich environment is the one that will give you a seamless and calm birth.

In the hospital, following the pandemic, only one birth partner is allowed whether that is your husband, partner or doula.  This is changing often and can differ from hospital trust.

Vaginal examinations – do you need them?

Often during a hospital birth or when you are accompanied by a midwife through birth they will either offer you, or tell you that they are going to give you a vaginal examination. As stated in the birth rights, you do not have to do this if you do not feel comfortable.  Vaginal examinations can be seen as an invasion of one’s privacy and crossing of bodily autonomy.  Your body is yours and you decide if you wish to or not have this, equally if you feel ok about this, then that is ok too. 

Pregnancy conditions – What are the options for treatment?

• Gestational diabetes – What is it and what are my options?

Gestational diabetes is a type of diabetes that is first seen in a pregnant woman who did not have diabetes before she was pregnant. Some women have more than one pregnancy affected by gestational diabetes. Gestational diabetes usually shows up in the middle of pregnancy. Doctors most often test for it between 24 and 28 weeks of pregnancy.

Often gestational diabetes can be controlled through eating healthy foods and regular exercise – note: it is not caused by poor diet.

You do not have to take the test for GD if you do not wish to.

Resources

 https://www.gestationaldiabetes.co.uk/ 

• Pre-eclampsia – What is it?

Pre-eclampsia is a condition that typically occurs after 20 weeks of pregnancy. It is a combination of:

• raised blood pressure (hypertension)
• protein in your urine (proteinuria).

The exact cause of pre-eclampsia is not understood.

Often there are no symptoms and it may be picked up at your routine antenatal appointments when you have your blood pressure checked and urine tested. This is why you are asked to bring a urine sample to your appointments.

Pre-eclampsia is common, affecting between two and eight in 100 women during pregnancy. It is usually mild and normally has very little effect on pregnancy. However, it is important to know if you have the condition because, in a small number of cases, it can develop into a more serious illness. Severe pre-eclampsia can be life-threatening for both mother and baby.  Around one in 200 women (0.5%) develop severe pre-eclampsia during pregnancy. 

• Group B Strep – What is it?

Group B Streptococcus (Group B Strep, Strep B, Beta Strep, or GBS) is a type of bacteria which lives in the intestines, rectum and vagina of around 2-4 in every 10 women in the UK (20-40%). This is often referred to as ‘carrying’ or being ‘colonised with’ GBS.  Only a small number of women who have GBS in pregnancy give birth to babies who have GBS infection.

Group B Strep is not a sexually transmitted disease. Most women carrying GBS will have no symptoms. Carrying GBS is not harmful to you, but it can affect your baby around the time of birth.

GBS can occasionally cause serious infection in young babies and, very rarely, during pregnancy before labour.  If you carry GBS, most of the time your baby will be born safely and will not develop an infection. 

GBS Prevention

Boost vitamin C in your diet – for example eat 2 grapefruit a day, red peppers, oranges or kiwi fruit.

Drink a cup of echinacea tea or take 2 tables of echinacea every day.

Bee propolis can be taken daily.

Get extra sleep before midnight.

3 tsp of colloidal silver per day, between meals – hold liquid in mouth before swallowing.

There is also a homeopathic regime using Penicillium notatum.

There are also warming protocols for once the baby is born.

Other prevention tips

 Avoid vaginal examinations

Do not permit artificial membrane rupture

Resources

Book – Group B Strep Explained by Sara Wickham

https://gbss.org.uk/info-support/about-group-b-strep/what-is-group-b-strep/

• Anti D – What is it?

You’ll have a test for your blood group (A, B, AB or O) in your initial booking in appointment.  You do not have to have this test if you do not wish.  The blood test will also show if you’re rhesus positive (RhD-positive) or rhesus negative (RhD-negative).

About 15% of the UK population are rhesus negative and 17% of all births in England and Wales are to rhesus negative women. In about 10% of all births in England and Wales, the mum is RhD-negative and the baby has inherited RhD-positive blood from the dad.

If you are rhesus negative but have a rhesus positive baby, the baby’s blood can enter your bloodstream. The danger of that is that your immune system can develop antibodies against it that then attack the baby’s red blood cells. This is known as sensitisation.

Your baby’s blood can transfer to you during birth, or if you have a bleed, an injury like a fall or a car accident, or an  invasive medical procedure. It might also happen after a previous miscarriage or ectopic pregnancy, or very rarely during a blood transfusion.

Anti-D is a blood product that can mop up rhesus positive antigens. It’s up to you if you want to take the injections though.

After the baby has been born, their blood will be checked to see whether it is RhD-positive.  If it is, and you aren’t immune, you’ll be offered another anti-D injection.

Resources

BOOK – ‘Anti D Explained’ by Sarah Wickham

Birth

Where and how to give birth – What are the options?

Right let’s begin with giving you a brief A to Z on birth hormones – oxytocin, adrenalin and more

Oxytocin – Understanding it

Oxytocin is the main hormone for birth. It is the love hormone and the key to bonding between mother and baby.  When an oxygen rich environment is created a calm and seamless birth can take place.

What creates an oxytocin rich environment?

The same environment that created the baby (making love/through sex) are the same factors that birth a child well.  This might look like slow music, soft lighting, chocolate or food that invokes that sensuality.  Much like if someone were to barge in on love-making, the moment is ruined – this is the same as in birth so minimising people walking in and out, loud voices, strangers.  Rather like when a cat gives birth, it finds a quiet cupboard, away from prying eyes where it’s dark and safe – this is exactly what a birthing woman needs too.

If you choose a hospital birth, make note of ways that you can create an oxytocin rich space, be firm with your boundaries and your wishes. Remember it is your body and your birth so while a midwife might roll her eyes when you ask to put your fairy lights up, know exactly why it’s important and don’t be put off.

Oxytocin – The number 1 birth hormone 

Oxytocin is often known as the “hormone of love” because it is involved with lovemaking, fertility, contractions during labour and birth and the release of milk in breastfeeding. It helps us feel good, and it triggers nurturing feelings and behaviours.

Receptor cells that allow your body to respond to oxytocin increase gradually in pregnancy and then increase a lot during labour. Oxytocin stimulates powerful contractions that help to thin and open (dilate) the cervix, move the baby down and out of the birth canal, push out the placenta, and limit bleeding at the site of the placenta. During labour and birth, the pressure of the baby against your cervix, and then against tissues in the pelvic floor, stimulates oxytocin and contractions. So does a breastfeeding newborn.

Low levels of oxytocin during labour and birth can cause problems by:

• Causing contractions to stop or slow, and making labour take longer.
• Resulting in excessive bleeding at the placenta site after birth.
• Leading health care providers to respond to these problems with interventions.

You can promote your body’s production of oxytocin during labour and birth by:

• Staying calm, comfortable and confident.
• Avoiding disturbances, such as unwelcome people or noise and uncomfortable procedures.
• Staying upright and using gravity so your baby is pressed against your cervix and then, as the baby is born, against the tissues of your pelvic floor.
• Stimulating your nipples or clitoris before birth, and giving your baby a chance to suckle (breastfeed) shortly after birth.
• Avoiding epidural analgesia.

Endorphins – Your number 2 hormone in birth

When you face stress or pain, your body produces calming and pain-relieving hormones called endorphins. You may have higher levels of endorphins near the end of pregnancy. For women who don’t use pain medication during labour, the level of endorphins continues to rise steadily and steeply through the birth of the baby. (Most studies have found a sharp drop in endorphin levels with use of epidural or opioid pain medication.)

High endorphin levels during labour and birth can produce an altered state of consciousness that can help you deal with the process of giving birth, even if it is long and challenging. High endorphin levels can make you feel alert, attentive and even euphoric (very happy) after birth, as you begin to get to know and care for your baby. In this early postpartum period, endorphins are believed to play a role in strengthening the mother-infant relationship. A drop in endorphin levels at this time may contribute to the “blues,” or postpartum depression, that many women experience for a brief time after birth.

Low levels of endorphins can cause problems in labour and birth by:

• Causing labour to be excessively painful and difficult to tolerate.
• Leading health care providers to respond to this problem with interventions.

You can enhance your body’s production of endorphins during labour and birth by:

• Staying calm, comfortable and confident.
• Avoiding disturbances, such as unwelcome people or noise and uncomfortable procedures.
• Delaying or avoiding epidural or opioids for pain relief.

Adrenaline – Your friend and Foe in birth

Adrenaline is the “fight or flight” hormone that humans produce to help ensure survival. Women who feel threatened during labour (for example, by fear or severe pain) may produce high levels of adrenaline. Adrenaline can slow labour or stop it altogether. Earlier in human evolution, this disruption helped birthing women move to a place of greater safety.

Too much adrenaline can cause problems in labour and birth by:

• Causing distress to the baby before birth.
• Causing contractions to stop, slow or have an erratic pattern, and lengthening labour.
• Creating a sense of panic and increasing pain in the mother.
• Leading health care providers to respond to these problems with cesarean surgery and other interventions.

You can keep adrenaline down during labour and birth by:

• Staying calm, comfortable and relaxed.
• Being informed and prepared.
• Having trust and confidence in your body and your capabilities as a woman.
• Having trust and confidence in your care providers and birth setting.
• Being in a calm, peaceful and private environment and avoiding conflict.
• Being with people who can provide comfort measures, good information, positive words and other support.
• Avoiding intrusive, painful, disruptive procedures.

Prolactin – The warm and fuzzy hormone

Prolactin is known as the “mothering” hormone. The role of prolactin around the time of birth has been less researched than the hormones described above. It increases during pregnancy and peaks when labour starts on its own. As has been shown in other mammals, continued prolactin production during and after labour appears to be readying a woman’s body for breastfeeding. It may also play a role in moving labour along and helping the newborn adjust to life outside the womb. Prolactin is central to breast milk production. High levels of prolactin with early breastfeeding may foster women’s care-taking behaviours and adjustment to being a mother. This hormone may also support the infant’s healthy development.

Low levels of prolactin may cause problems through:

• Poorer transition of the baby at the time of birth.
• Poorer growth and development of the baby.
• Poorer adjustment of a woman to motherhood.

You can likely promote your body’s production of prolactin by:

• Waiting for labour to start on its own.
• Minimising stress during labour and after birth.
• Keeping woman and baby together after birth.
• Breastfeeding early and thereafter on cue from the baby.

Oxytocin – Understanding it

Oxytocin is the main hormone for birth. It is the love hormone and the key to bonding between mother and baby.  When an oxygen rich environment is created a calm and seamless birth can take place.

How to Maximise the role of Birth Hormones

As you can probably tell from the information above, some features of typical hospital childbirth settings, like noise or medical interventions, can interfere with your body’s natural processes. To avoid this and maximise your body’s ability to follow its natural processes, it’s a good idea to seek out a birth setting that supports this. Out-of-hospital birth settings and one-on-one continuous labour support, such as doula care, can help create conditions that enhance your body’s natural production of helpful hormones and keep disturbing hormones in check.

Drugs during Birth – What are my options?

Does medication administered to a woman in labour affect the unborn child?  

Just because drugs are administered routinely, one must understand and consider the effects on both mother, baby and the future health of your child. 

You will often be told in childbirth classes and by doctors that medications do not transfer to the baby. However, this is not true. Medications can get to the baby. Medications also change the way a mother’s body functions during labour, which alters her own hormonal balance and effects that of a newborn.

RESOURCES

 https://www.naturalbirthandbabycare.com/epidural/

There are many drug and drug-free ways to help you cope with labour pain. The benefits of some methods are better understood than others. Many women want to know about the effectiveness and downsides of specific methods of pain relief; researchers have given more attention to effectiveness and less to possible downsides.

Despite the challenges of conducting research on labour pain relief and limitations within the best available research, the following conclusions seem clear:

• A woman’s labour pain relief options depend in large measure on where and with whom she chooses to give birth.
• Receiving continuous support during labour decreases the probability of using pain medication and increases the likelihood of satisfaction with the birth experience.  
• Various non-drug techniques can offer pain relief and comfort in labour and have a low probability of causing adverse effects. They can readily be discontinued if not helpful or not appreciated.
• The epidural/spinal family has become the most common approach to labour pain relief. It is the only pain relief method that can completely abolish pain, but it also has a high profile of adverse effects, both minor and major.
• Although widely used injected narcotics appear to have little effect on pain and considerable potential for adverse effects.

Nitrous oxide can help women cope with labour pain and it leaves the mother’s bloodstream very quickly

Drugs during Birth – What are my options?

Below are the best available research on methods for relieving labour pain:

• Continuous labour support

Continuous support such as having a doula, includes emotional support, comfort measures, information and advocacy. It effectively reduces use of epidural and other pain medications and has no known side effects. Few women in the UK experience continuous support from a doula when giving birth.  However, a systematic review found that women with continuous support were less likely to use epidural and any pain medications and experienced fewer cesareans, amongst other benefits. 

• Tens machine

TENS stands for transcutaneous electrical nerve stimulation. The machine sends mild, painless electrical pulses to your body when you’re having contractions, via sticky electrode pads attached to your back. Many women find this helps reduce the pain experienced during labour.

While it’s not known exactly how a TENS machine helps to relieve pain, it’s thought that the pulses ‘distract’ the nerves that are transmitting pain. Using one may also boost your endorphin levels – your body’s natural form of pain defence.

Most TENS machines have a digital display and several settings, such as a massage setting with a lower-pulse frequency and a more intense mode with stronger pulses.

A good machine will be lightweight and come with a belt clip so you can still move around while using it – many women find that moving around during labour can help them feel more comfortable.

In a 2018 CQC survey, 13% of women reported using a TENS machine during labour and a 2014 Which? survey found that three-quarters of women who used one said that it helped them cope with the pain of contractions.

• Immersion in Water

Most women who give birth in hospitals are in bed throughout labour and birth. However, a systematic review found that immersion in water (e.g., tub or pool) during labour reduces the use of epidural and spinal pain relief. It found no evidence of negative effects on mom or baby from labouring in water. 

• Maternal positions and mobility

Most women who give birth in hospitals lie in bed throughout labour and birth. A systematic review found that women who were upright and walking in labour before the time of pushing were less likely to have an epidural and experienced fewer caesareans, among other benefits.

• Nitrous Oxide (laughing gas)

Nitrous oxide provides pain relief, but is generally less effective than epidural pain relief. However, unlike epidural (see next), nitrous oxide has no known negative effects on labour and the baby. The main side effects of nitrous oxide are possible nausea, vomiting, dizziness or drowsiness in women. Also, unlike epidural pain relief, the woman herself controls nitrous oxide with a hand-held mask, gets instant pain relief effects and can immediately discontinue use.

• Epidural

Epidurals (and their variant, combined spinal-epidural; see next section) are widely understood to offer the most effective pain relief to labouring women. However, such relief comes with important trade-offs of many increased risks and a substantial impact on the experience of labour. Epidurals involve increased use of interventions to monitor, prevent or treat side effects, keeping women in bed and attached to equipment. Most studies have compared epidural with opioids (narcotics). A systematic review found that epidurals cause increased:

• Use of “assisted” birth (vacuum extraction or forceps).
• Maternal low blood pressure (leading to use of additional drugs).
• Use of synthetic oxytocin to speed labour.
• Maternal retention of urine.
• Maternal fever (which can lead to invasive procedures in the newborn to rule out and treat suspected infection).
• Length of the pushing phase of labour.
• Caesarean section because the baby is having trouble handling labour.

The following are also routine or common with epidurals: continuous electronic foetal monitoring, intravenous lines, frequent blood pressure checks and medication for itching.

• Combined Spinal Epidural (CSE)

Both epidurals (see above) and combined spinal-epidural (CSE) are widely understood to offer the most effective pain relief to labouring women. A systematic found that the following effects were similar in both CSE and epidural:

• Maternal inability to move around and use the lower body (leading to use of bladder catheters).
• Maternal low blood pressure (leading to use of additional drugs).
• Maternal headache.

The systematic review found that combined spinal-epidural pain relief appears to have a few advantages in comparison with epidurals:

• Quicker-acting pain relief.
• Less use of added pain relief drugs.
• Less retention of urine.
• Less use of “assisted” birth (vacuum extraction or forceps).

•  Opioids (narcotics) by intravenous line (IV drip)

A systematic review of opioid (narcotic) drugs by intravenous (IV) line for labour pain relief found that they provide some pain relief and – when reported – moderate satisfaction with pain relief. The following were notable downsides:

• The need to provide additional pain relief.
• Maternal nausea, vomiting and drowsiness.

The studies were generally of poor quality and were unable to clarify possible effects on the baby and breastfeeding.

There is evidence to suggest that opioids, pethidine and epidural medication in labour can effect the health of the baby/child and are linked to teenage addictions.  It is worth fully researching this topic.

• Paracetamol

This is often suggested when labour starts however, it is worth noting that it is a prostaglandin inhibitor.  Prostaglandin is vital in softening and thinning your cervix and establishing your labour therefore the administering of paracetamol can inhibit your labours progress.

Induction – Should I or shouldn’t I?

This is a huge subject and I won’t do it justice. I ask you to read up so that you are fully informed of this topic.  Just because it is routine it does not mean that it is in the best interest of you or your baby.  It may be that this is your choice and that this is a good option for you but please ensure you understand the reality of having an induction and know the details involved. 

An induced labour is one that’s started artificially. Every year, 1 in 5 labours are induced in the UK.  Sometimes labour can be induced if your baby is overdue or there’s any risk to you or your baby’s health. Induction will usually be planned in advance. It’s your choice whether to have your labour induced or not.

 Forms of induction – what are they?

Any form of artificially encouraging the onset of labour is a form of induction including, eating a curry, lovemaking, castor oil but these ones are perhaps the less invasive forms.

• Membrane sweep Also known as a cervical sweep, to bring on labour.  To carry out a membrane sweep, your midwife or doctor sweeps their finger around your cervix during an internal examination.

This action should separate the membranes of the amniotic sac surrounding your baby from your cervix. This separation releases hormones (prostaglandins), which may start your labour.

Having a membrane sweep does not hurt but expect some discomfort or slight bleeding afterwards.  It requires to enter your vagina and can be uncomfortable. 

If labour does not start after a membrane sweep, you’ll be offered another form of induction of labour.

• Cervical Balloon catheter

Balloon induction is a mechanical form of induction of labour and is the only method used for outpatient induction of labour at present. The procedure involves a soft silicone tube also known as a catheter being inserted into the neck of your womb (cervix).  It has a balloon near the tip and when it is in place the balloon is filled with a sterile saline (salt water) fluid. The catheter stays in place for up to 24 hours, with the balloon putting gentle pressure on your cervix. The pressure should soften and open your cervix enough to start labour or to be able to break the waters around your baby.

If you are suitable for outpatient induction of labour, you can go home while the catheter is in place.

The balloon rubs against and stretches the neck of the womb (cervix) to produce a hormone called prostaglandin. The prostaglandin causes the cervix to become shorter and soften (ripening). This prepares the cervix for labour and allows your midwife or doctor to break your waters. Sometimes, the release of hormones as the cervix is stretched is enough to trigger your waters to break naturally and for labour to begin.

The balloon catheter is kept in place for up to 24 hours. It then either drops out of the cervix or is removed. At this point, it should be possible to break your waters.  Inserting the balloon into the cervix is uncomfortable, but not normally painful. There is a small risk of infection and if this is suspected you will be re-assessed and your plan of care will change.

During the time you are at home, you can do things as you would normally, for example, showering, bathing or walking. However, please avoid sexual intercourse. After going to the toilet please wash your hands and make sure the catheter is clean.

• Pessary

Contractions can be started by inserting a tablet (pessary) or gel into your vagina.  Induction of labour may take a while, particularly if the cervix (the neck of the uterus) needs to be softened with pessaries or gels.  

If you have a vaginal tablet or gel, you may be allowed to go home while you wait for it to work.  If you’ve had no contractions after 6 hours, you may be offered another tablet or gel.  If you have a controlled-release pessary inserted into your vagina, it can take 24 hours to work. If you are not having contractions after 24 hours, you may be offered another dose.

• Hormone drip

Sometimes a hormone drip is needed to speed up the labour. Once labour starts, it should proceed normally, but it can sometimes take 24 to 48 hours to get you into labour.

Induced labour is usually more painful than labour that starts on its own, and you may want to ask for an epidural.

Your pain relief options during labour are not restricted by being induced. You should have access to all the pain relief options usually available in the maternity unit.

If you are induced you’ll be more likely to have an assisted delivery, where forceps or ventouse suction are used to help the baby out.

Induction is not always successful, and labour may not start.

Your obstetrician and midwife will assess your condition and your baby’s wellbeing, and you may be offered another induction or a caesarean section.

The cascade of intervention – what is this?

Many maternity care interventions (induction) have unintended effects during labour and birth. Often these effects are new problems that are “solved” with further intervention, which may in turn create even more problems. This idea that using one intervention can lead to the need for more interventions is called a “cascade of intervention.”

Often when one embarks on agreeing to the first method of induction, it leads to a sequence of further interventions resulting in either a c-section or a very physically tiring and demanding vaginal birth with the use of instruments such as ventouse or forceps.

The maternity practices that can lead to a cascade of intervention include:

• Using various medications to induce labour.
• Artificially breaking the membranes (a sweep) surrounding the baby and releasing amniotic fluid before or during labour.
• Using synthetic oxytocin medicine (“Pitocin”) to make labour move faster.
• Giving medications for pain relief.
• Labouring in bed versus being upright and moving about.

In many instances, these practices cause problems because they disrupt the normal physiology of pregnancy, labour and birth by:

• Interfering with hormones that move labour and birth along.
• Creating opportunities for infection.
• Having undesirable effects on your baby.
• Making it harder for you to push your baby out.

When these effects happen, women may feel that their bodies have failed them, not realising that the things that went wrong could have actually been triggered by maternity practices themselves, not the inability of your body – it is very rarely that!

Unfortunately, it is impossible to predict in advance exactly what may happen during your labour and delivery, or how a given intervention may affect you or your baby. The best way to limit a cascade of intervention is to become informed, get all of your questions answered, and put plans in place in advance that will help avoid potentially harmful interventions.

Here are some tips for avoiding unnecessary interventions:

• Choose a care provider and a birth setting that have low rates of using common interventions.
• Become familiar with the best available research about interventions that are most likely to trigger a cascade of intervention, including induction of labour, epidural analgesia and other pain medications and cesarean section.
• Have an open and respectful conversation with your care provider about why you need any recommended interventions. It’s ideal to have this conversation well before you may need the intervention so you can express your wishes and discuss plans.
• Talk to your care provider about options like “watchful waiting” (doing nothing and waiting for labour to move along or for issues to resolve on their own) or using simpler, less invasive alternatives.
• Learn about the benefits of continuous labour support
• Clearly communicate your wishes to your care providers, and get the support of your spouse, partner, doula or other companions to reinforce your wishes throughout labour and delivery.
• Know that you have the right to accept or refuse procedures, drugs, tests and treatments, and to have your choices honoured.

The Cascade of Intervention in Action

Epidural is a good example of the cascade of intervention. It can provide very effective pain relief during labour, but it also increases the risk of experiencing a sudden drop in blood pressure, a longer labour, difficulty moving about, difficulty urinating, difficulty pushing the baby out, fever and other negative effects.

Interventions like electronic foetal monitoring and intravenous fluids are often used with epidurals to monitor, prevent or treat these effects. And others become more likely (synthetic oxytocin to strengthen contractions, catheter to empty the bladder, vacuum extractor or forceps to help move the baby out). These in turn may have side effects that lead to the use of yet more interventions.

Babies can also be affected. For example, epidurals increase a woman’s likelihood of developing a fever, which can make doctors worry that the baby has a fever. This leads to blood tests and antibiotics for the baby after birth. They may also be observed in a special nursery, which can interfere with mother-baby bonding and breastfeeding.

Resources

BOOK – ‘In your own time’ by Sara Wickham

En Caul Birth – what is this?

En caul birth, sometimes referred to as a veiled birth, occurs when a foetus is delivered still inside an intact amniotic sac. Abdominal or cesarean en caul births may be done intentionally using surgical techniques. A vaginal en caul delivery occurs spontaneously and is thought to be rarer.

En caul birth is very rare. By some estimates, it is believed en caul births would be 1% to 2% of all vaginal births if there were no membranes that were artificially ruptured. This amounts to less than one in 80,000 births.

It is thought to be good luck when a baby is born en caul and suggested that those baby’s born this way are very psychic.

Cutting of umbilical cord – When is best?

The positive effects of delayed cord clamping (DCC) has been extensively researched. DCC means: waiting at least one minute after birth before clamping and cutting the cord or till the pulsation has stopped. With physiological clamping and cutting (PCC) the clamping and cutting can happen at the earliest after the pulsation has stopped.

Delayed cord clamping is usually 1-2minutes when blood is still in the cord.

Optimal cord clamping is usually  3-5 minutes and what most hospitals suggest. There is still blood in the cord.

Wait for White is anywhere from 10  – 90 minutes, sometimes more.  All blood has drained once it has turned white and therefore all blood has been received by baby.

Resources

BOOK Birthing your placenta by Sara Wickham

Lotus birth – what is this?

Lotus birth is the practice of umbilical cord non-severance, it involves keeping the umbilical cord intact and connected to the baby until it naturally detaches on its own, usually between postnatal day 3-10. 

Usually the placenta is washed, salted and herbs are put on 2-3h post partum. The placenta is wrapped in something that absorbs the moisture. The salting is repeated with a degreasing frequency depending on moistness of the placenta. With a Lotus birth, no clamping and cutting of the cord is done. 

Lotus birth might lead to an optimisation of the bonding and attachment with it’s gentle transition from womb to Earth.

Drugs during Birth – What are my options?

Skin-to-skin contact helps babies adjust to life outside the womb and supports mothers to initiate breastfeeding and develop close, loving relationships with their baby.

Drugs during Birth – What are my options?

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Drugs during Birth – What are my options?

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Now that you have read the education document it’s time to fill in your booking in form so that i have as much information as possible about you and where you are emotionally, physically and spiritually.  If you’re unsure of the answer, don’t worry as we will discuss these parts in our zoom call – this is just giving me a basis to meet you where you are right now so that i can help you fill in the blanks.  

Now it’s time to book your first call with me! This is where we are going to ‘get to know each other’, explore your birth plan currently, find out about your own birth story and blueprint, while digging in to your emotional self to check we are all in order there.  After this session, I will prescribe what you need to read, educate yourself on and consider ahead of birth. 

The call is 1 hour and we will do this on zoom.  You can choose from a Tuesday or Thursday time slot at 10.30am. If this doesn’t suit due your work schedule, then let’s figure one out that works for both of us.