Well - pool is blown up (hurrah for electric pumps) and punctures mended (not ones that would let water out but ones letting air out of bottom ring so deflating it. After some research it seemed the conclusion was that ordinary garden hose would be fine for filling - just to let water run through it for a few minutes first. I also bought a new tap connector as recommended. So everything putting the water in is new and clean. There is a separate hose for removing the water which connects to a submersible pump (like you would use in a garden pond). (NCT sells pack with all these bits in.) I half filled it and added Milton to give it a good clean. I added the sieve to clean that as well - although it is new, not been used before and I will throw it away after. The bath thermometre I bought from Mothercare doesn't work which is a real pain. I hope to get a kitchen thermometer from our local hardware shop before I go into labour.
I am going to fill the pool again today - this time to get in and enjoy. I will leave it filled for the boys to enjoy after school. With my last pregnancy I did that and it started labour off. I hope that doesn't happen this time because Jenny, one of my birth partners, has a 12 shift today and the earliest she could be here is 10pm. I sort of don't want baby to come tomorrow as it is April Fool's Day - but we will have to wait and see. No signs of anything imminent. I did think it was coming last Thursday but all went quiet.
Wednesday 31 March 2010
Tuesday 30 March 2010
Midwives supporting home births
In March 2006 the Nursing and Midwifery Council issued a circular clarifying the rights of women, the responsibilities of midwifes and the obligations of Local Supervising Authorities (LSA) for home births. In brief it outlines guidelines in three areas
• As experts in normal birth midwives should be competent, and have confidence, in caring for women having home births.
• Home birth is at least as safe as hospital birth for healthy women with straightforward pregnancies. Whilst there are some clear categories of women for whom a hospital birth would be highly recommended, there are others with increased risk factors where opinion is divided. Risk is a complex issue. If a woman is legally competent to make the choice to birth at home then the midwife should support her, make a plan of care, and seek support from her supervisor. S/he should make all options and choices clear and respect the choices a woman makes.
• There should always be midwives available to cover home births. ‘Withdrawal of a home birth services is no less significant to women than withdrawal of services for a hospital birth.’ Women can contact the LSA for advice.
Hurrah! This is tremendously important for those planning homebirths. In the past six months I have known women trying to book home births who have encountered problems in all these areas: midwives who are not competent in water births, not competent in physiological third stage, not confident in normal birth and nervous about attending a home birth; there have been women with low iron, suspected big babies, previous caesarean, previous assisted birth with high blood loss; two women told no midwife was available, though one other woman was attended by a senior midwife who came out from the hospital. For all these women, and the many, many more, I am very grateful for this document. If you would like to see the full document, ask me for a copy or go to www.nmc-uk.org.uk.
Everybody should at least consider a home birth, simply because it is one of your options, and should be considered along with which hospital, what pain relief and which pram. In fact the National Institute for Health and Clinical Excellence (www.nice.org.uk - Clinical Guideline on Caesarean Section) positively recommended that you do “During their discussions about options for birth, healthy pregnant women with anticipated uncomplicated pregnancies should be informed that delivering at home reduces the likelihood of CS.”* Start at www.homebirth.org.uk or the NCT publications (home birth info sheet, £1; booklet, £2.50), or contact me
*Were you told this? The guideline also recommends that “Women should be informed that continuous support during labour from women with or without prior training reduces the likelihood of CS.”
Ref: www.nice.org.uk/CG013NICEguideline pg12
• As experts in normal birth midwives should be competent, and have confidence, in caring for women having home births.
• Home birth is at least as safe as hospital birth for healthy women with straightforward pregnancies. Whilst there are some clear categories of women for whom a hospital birth would be highly recommended, there are others with increased risk factors where opinion is divided. Risk is a complex issue. If a woman is legally competent to make the choice to birth at home then the midwife should support her, make a plan of care, and seek support from her supervisor. S/he should make all options and choices clear and respect the choices a woman makes.
• There should always be midwives available to cover home births. ‘Withdrawal of a home birth services is no less significant to women than withdrawal of services for a hospital birth.’ Women can contact the LSA for advice.
Hurrah! This is tremendously important for those planning homebirths. In the past six months I have known women trying to book home births who have encountered problems in all these areas: midwives who are not competent in water births, not competent in physiological third stage, not confident in normal birth and nervous about attending a home birth; there have been women with low iron, suspected big babies, previous caesarean, previous assisted birth with high blood loss; two women told no midwife was available, though one other woman was attended by a senior midwife who came out from the hospital. For all these women, and the many, many more, I am very grateful for this document. If you would like to see the full document, ask me for a copy or go to www.nmc-uk.org.uk.
Everybody should at least consider a home birth, simply because it is one of your options, and should be considered along with which hospital, what pain relief and which pram. In fact the National Institute for Health and Clinical Excellence (www.nice.org.uk - Clinical Guideline on Caesarean Section) positively recommended that you do “During their discussions about options for birth, healthy pregnant women with anticipated uncomplicated pregnancies should be informed that delivering at home reduces the likelihood of CS.”* Start at www.homebirth.org.uk or the NCT publications (home birth info sheet, £1; booklet, £2.50), or contact me
*Were you told this? The guideline also recommends that “Women should be informed that continuous support during labour from women with or without prior training reduces the likelihood of CS.”
Ref: www.nice.org.uk/CG013NICEguideline pg12
Why your first is the best one to have at home
Women are often recommended (ie told) not to have their first baby at home – because you don’t know what will happen. However it is precisely because of this that planning to have your first baby at home is eminently sensible. The great thing about being booked for a home birth is that you can go to hospital at any time you choose – it is much harder to transfer out of hospital to home! On top of that first labours tend to be longer. Being at home is less tiring and more comfortable for the long haul.
Most importantly, you are more likely to have a positive birth experience at home. Things are actually less likely to ‘go wrong’ at home. Studies have shown women who have planned home births need less pain relief, less likely to tear/have episiotomy, less likely to haemorrhage, and 50% less likely to have a caesarean or assisted birth even if you transfer to hospital. The baby is less likely to need oxygen, more likely to be in a good condition at birth. All of these benefits were shown in scientific research in which women booked for a hb were matched to women with similar risk factors booked for hospital births.* In fact a government body (NICE) looking into reducing the caesarean rate recommended that all women with straightforward pregnancy should be offered a home birth.
The deputy general of the Nursing and Midwifery Council said “The vast majority of women, well in excess of 60-70%, will not have started to have complications and these women do much worse in hospital, where they are at risk of interventions.” (June 23, 2006, The Guardian)
Why are the outcomes so good at home?
Going into hospital interferes with the flow oxytocin (the hormone that keeps labour moving on) – which is why women often report labour slowing down or stopping on arriving at hospital. It’s the flow of adrenaline (caused by stress/anxiety) that affects oxytocin and also inhibits the production of endorphin (the body’s own painkiller). So being as relaxed as possible is important, and for many that means being at home.
Other aspects of being at home that positively affect the birth are being upright and being able to move around freely with many different surfaces to lean on, access to a bath for pain relief, privacy, distractions from the pain, being able to eat/drink.
What about the equipment?
At home you have the most vital piece of equipment – a midwife. Midwives at home still do all the same checks and monitoring they would do in hospital. They carry equipment to deal with emergencies. At home, however, as they are solely looking after you, they also use their higher level observation skills – noticing how you are coping, your body movements, sign of labour progressing, or not. They are able to spot problems coming and make remedies or call an ambulance. (Did you know - mws can tell that a woman is getting near pushing by the way she curls her toes!)
Of course you may need or want to be transferred to hospital care, either before, during or after labour, though this is very rarely a major emergency. The vast majority of times it is due to a risk factor arising in the final week, labour not moving on, the woman wanting more pain relief, or the midwives wanting to have the baby more closely monitored. Most of those are transferred to hospital care before labour begins. More first time women do than second timers (up to 40% though rates vary tremendously). That means 60% (or more) of first time women booked for a homebirth have a straightforward birth. This contrasts greatly to hospital.
My local hospital has a higher than national average of normal births (54% in 2005). The figure will be lower for first timers as subsequent births are likely to be easier, more straightforward and quicker. Some months the the hospital has had a c.s. rate approaching 30%, and last year’s average was 25%. Again this will be higher for first timers. Other hospitals have similar outcomes. (go to www.birthchoiceuk.com )
Women in hospital use more pain relief, including epidural, which is linked to longer labours and a higher risk of assisted birth. In hospital you are less likely to have one-to-one care from a midwife.
I hope I have given you some food for thought. If you are looking forward to your first, or subsequent birth, you might like to explore the option of home birth, particularly to talk to women who have had/ booked home births. You can also look at the information detailed below.
*If this all sounds too good to be true then check out www.homebirth.org.uk or look at ‘Safety in childbirth’ by M Tew, an obstetrician who set out to prove that homebirths were unsafe and found the opposite. Women have been kept in the dark.
Further info:
From NCT maternity sales (www.nctsales.co.uk)
NCT booklets (£2.50): home birth, using water in labour
NCT information sheets (£1): home birth, straightforward birth, using water for labour and birth
Birth your Way by Sheila Kitzinger
NCT My birth year
From Association for the Improvement of Maternity Services (www.aims.org.uk)
(Shane Ridley, Manor Barn, Thurloxton, Taunton, Somerset TA2 8RH
Books: Choosing a home birth, Safety in childbirth, Choosing a water birth, Birthing your baby
Websites
www.homebirth.org.uk
www.sheilakitzinger.com
www.birthchoiceuk.com
www.nice.org.uk
www.aims.org.uk
www.midwifery.org.uk
www.independentmidwives.org.uk
The NCT moderates an e-group for women and men to discuss issues related to homebirths – go to www.health.groups.yahoo.com/group/homebirthUK
Most importantly, you are more likely to have a positive birth experience at home. Things are actually less likely to ‘go wrong’ at home. Studies have shown women who have planned home births need less pain relief, less likely to tear/have episiotomy, less likely to haemorrhage, and 50% less likely to have a caesarean or assisted birth even if you transfer to hospital. The baby is less likely to need oxygen, more likely to be in a good condition at birth. All of these benefits were shown in scientific research in which women booked for a hb were matched to women with similar risk factors booked for hospital births.* In fact a government body (NICE) looking into reducing the caesarean rate recommended that all women with straightforward pregnancy should be offered a home birth.
The deputy general of the Nursing and Midwifery Council said “The vast majority of women, well in excess of 60-70%, will not have started to have complications and these women do much worse in hospital, where they are at risk of interventions.” (June 23, 2006, The Guardian)
Why are the outcomes so good at home?
Going into hospital interferes with the flow oxytocin (the hormone that keeps labour moving on) – which is why women often report labour slowing down or stopping on arriving at hospital. It’s the flow of adrenaline (caused by stress/anxiety) that affects oxytocin and also inhibits the production of endorphin (the body’s own painkiller). So being as relaxed as possible is important, and for many that means being at home.
Other aspects of being at home that positively affect the birth are being upright and being able to move around freely with many different surfaces to lean on, access to a bath for pain relief, privacy, distractions from the pain, being able to eat/drink.
What about the equipment?
At home you have the most vital piece of equipment – a midwife. Midwives at home still do all the same checks and monitoring they would do in hospital. They carry equipment to deal with emergencies. At home, however, as they are solely looking after you, they also use their higher level observation skills – noticing how you are coping, your body movements, sign of labour progressing, or not. They are able to spot problems coming and make remedies or call an ambulance. (Did you know - mws can tell that a woman is getting near pushing by the way she curls her toes!)
Of course you may need or want to be transferred to hospital care, either before, during or after labour, though this is very rarely a major emergency. The vast majority of times it is due to a risk factor arising in the final week, labour not moving on, the woman wanting more pain relief, or the midwives wanting to have the baby more closely monitored. Most of those are transferred to hospital care before labour begins. More first time women do than second timers (up to 40% though rates vary tremendously). That means 60% (or more) of first time women booked for a homebirth have a straightforward birth. This contrasts greatly to hospital.
My local hospital has a higher than national average of normal births (54% in 2005). The figure will be lower for first timers as subsequent births are likely to be easier, more straightforward and quicker. Some months the the hospital has had a c.s. rate approaching 30%, and last year’s average was 25%. Again this will be higher for first timers. Other hospitals have similar outcomes. (go to www.birthchoiceuk.com )
Women in hospital use more pain relief, including epidural, which is linked to longer labours and a higher risk of assisted birth. In hospital you are less likely to have one-to-one care from a midwife.
I hope I have given you some food for thought. If you are looking forward to your first, or subsequent birth, you might like to explore the option of home birth, particularly to talk to women who have had/ booked home births. You can also look at the information detailed below.
*If this all sounds too good to be true then check out www.homebirth.org.uk or look at ‘Safety in childbirth’ by M Tew, an obstetrician who set out to prove that homebirths were unsafe and found the opposite. Women have been kept in the dark.
Further info:
From NCT maternity sales (www.nctsales.co.uk)
NCT booklets (£2.50): home birth, using water in labour
NCT information sheets (£1): home birth, straightforward birth, using water for labour and birth
Birth your Way by Sheila Kitzinger
NCT My birth year
From Association for the Improvement of Maternity Services (www.aims.org.uk)
(Shane Ridley, Manor Barn, Thurloxton, Taunton, Somerset TA2 8RH
Books: Choosing a home birth, Safety in childbirth, Choosing a water birth, Birthing your baby
Websites
www.homebirth.org.uk
www.sheilakitzinger.com
www.birthchoiceuk.com
www.nice.org.uk
www.aims.org.uk
www.midwifery.org.uk
www.independentmidwives.org.uk
The NCT moderates an e-group for women and men to discuss issues related to homebirths – go to www.health.groups.yahoo.com/group/homebirthUK
My birth plan
Thought you might like to see the birth plan I have drawn up.
Birth plan for Williams baby no 5
Just to let it happen. Let my body get on and do it.
To be supported to listen to my body and enjoy this amazing event in our family.
Four previous births have been straightforward – first in hospital, then three at home (last one in water); two babies born with me on my hands and knees, one standing and one squatting.
I have not had any pharmacological pain relief with any of my labours. I will use water, breathing, relaxation, laughter, positions, encouragement and the support of my family.
I appreciate the vigilance and support of a midwife but want to mostly be left to get on and do it by myself. I consent to regular checks of BP, temp, pulse and for the baby’s heart rate to be monitored by pinard or sonic aid. I do not want any internal vaginal examinations (I have had only one at each of my home births). Reminders to go to the loo would be useful!
I will have an inflatable birth pool up for the pain relief. I may end up giving birth there. I expect to use the whole house to labour in and will see where I end up to actually give birth.
My birth partners will be my husband Merlin, and my god-sib Jenny (was at Connor’s birth and is now a midwife in Hampshire). I expect the children will come and go. I would like them to have the option of witnessing the birth of their sibling if they wish. My sister, Becky, will be on hand to look after them. I find the presence of my family a positive influence (last time I had my brother, sister-in-law, mother-in-law, three children, husband and three midwives).
All things being well I want a natural third stage. In all my births I have had minimal blood loss. My two natural third stages have been quicker than the two managed ones and I experienced less intense after pains.
I would like a very unhurried time after the birth. I would like to pick the baby up myself, for Connor to discover the sex, and for baby to enjoy lots of skin to skin and cuddles. Weighing can wait. I would like to dress baby myself when I am ready. I will be breastfeeding.
I do not want a plastic cord clamp. I will provide a sterile cord tie.
Tom would like the option of cutting the cord (Adam did it last time); if, on the day, he doesn’t want to, then I would like Connor, Hannah or Adam to have the choice.
I do not consent to the baby being given vitamin K. I have looked into this in detail so it is my informed decision and I do not want to discuss it.
Should there need to be any deviation from this rough plan, including transfer to hospital, I expect to be fully involved in the decision. I am quite well informed in most aspects of childbirth, having run support groups, attended conferences, and read widely so have a good understanding of most of the issues. If I decide not to take your advice I will sign my notes to that effect.
Birth plan for Williams baby no 5
Just to let it happen. Let my body get on and do it.
To be supported to listen to my body and enjoy this amazing event in our family.
Four previous births have been straightforward – first in hospital, then three at home (last one in water); two babies born with me on my hands and knees, one standing and one squatting.
I have not had any pharmacological pain relief with any of my labours. I will use water, breathing, relaxation, laughter, positions, encouragement and the support of my family.
I appreciate the vigilance and support of a midwife but want to mostly be left to get on and do it by myself. I consent to regular checks of BP, temp, pulse and for the baby’s heart rate to be monitored by pinard or sonic aid. I do not want any internal vaginal examinations (I have had only one at each of my home births). Reminders to go to the loo would be useful!
I will have an inflatable birth pool up for the pain relief. I may end up giving birth there. I expect to use the whole house to labour in and will see where I end up to actually give birth.
My birth partners will be my husband Merlin, and my god-sib Jenny (was at Connor’s birth and is now a midwife in Hampshire). I expect the children will come and go. I would like them to have the option of witnessing the birth of their sibling if they wish. My sister, Becky, will be on hand to look after them. I find the presence of my family a positive influence (last time I had my brother, sister-in-law, mother-in-law, three children, husband and three midwives).
All things being well I want a natural third stage. In all my births I have had minimal blood loss. My two natural third stages have been quicker than the two managed ones and I experienced less intense after pains.
I would like a very unhurried time after the birth. I would like to pick the baby up myself, for Connor to discover the sex, and for baby to enjoy lots of skin to skin and cuddles. Weighing can wait. I would like to dress baby myself when I am ready. I will be breastfeeding.
I do not want a plastic cord clamp. I will provide a sterile cord tie.
Tom would like the option of cutting the cord (Adam did it last time); if, on the day, he doesn’t want to, then I would like Connor, Hannah or Adam to have the choice.
I do not consent to the baby being given vitamin K. I have looked into this in detail so it is my informed decision and I do not want to discuss it.
Should there need to be any deviation from this rough plan, including transfer to hospital, I expect to be fully involved in the decision. I am quite well informed in most aspects of childbirth, having run support groups, attended conferences, and read widely so have a good understanding of most of the issues. If I decide not to take your advice I will sign my notes to that effect.
Monday 22 March 2010
37 weeks!
Can't believe how time has flown. I haven't written as much in this blog as I thought I would. Found working and pregnant and four children very tiring. Then once I gave up work I have been extremely tired.
Now 37 weeks and all set up for the birth - well just about. Will trial the birth pool this week. Thought baby was coming at the weekend (think baby was just moving down and engaging) - and thought would just use the bath. I have borrowed a 'birth pool in a box' from the local homebirth group. I want to give it a good clean with milton - and I need to find some info about hoses. It has come with one but that might have been used for emptying - so I think I need a new one for filling, but I believe it can't be a garden one cos of the chemicals - will have to find out. I have remembered I also need to get a thermometer. I have not bought a new liner, but I do know the pool hasn't been used for almost two years - well not for actually giving birth in - it has been borrowed (but not for a year) and was put up but not used. It has been blown up for demonstrations at the home birth group and at my children's centre.
I have been listening to the natal hypnotherapy home birth CD which is wonderful (very similar to the classes I used to run for relaxation for pregnancy and birth. I am having mixed emotions - on the one hand I am getting very impatient to meet my new little one, but on the other hand I don't want to stop being pregnant - it is such a magical time - having a baby inside wriggling about. I guess this latter emotion is probably a sign that I am not going into labour any time soon as I am not fed up of being pregnant.
Anyway - a short little post of not much content. Will keep you posted how I am doing.
Now 37 weeks and all set up for the birth - well just about. Will trial the birth pool this week. Thought baby was coming at the weekend (think baby was just moving down and engaging) - and thought would just use the bath. I have borrowed a 'birth pool in a box' from the local homebirth group. I want to give it a good clean with milton - and I need to find some info about hoses. It has come with one but that might have been used for emptying - so I think I need a new one for filling, but I believe it can't be a garden one cos of the chemicals - will have to find out. I have remembered I also need to get a thermometer. I have not bought a new liner, but I do know the pool hasn't been used for almost two years - well not for actually giving birth in - it has been borrowed (but not for a year) and was put up but not used. It has been blown up for demonstrations at the home birth group and at my children's centre.
I have been listening to the natal hypnotherapy home birth CD which is wonderful (very similar to the classes I used to run for relaxation for pregnancy and birth. I am having mixed emotions - on the one hand I am getting very impatient to meet my new little one, but on the other hand I don't want to stop being pregnant - it is such a magical time - having a baby inside wriggling about. I guess this latter emotion is probably a sign that I am not going into labour any time soon as I am not fed up of being pregnant.
Anyway - a short little post of not much content. Will keep you posted how I am doing.
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