Cathy's red tent

When is my due date?

2011-10-23T16:37:00.000+01:00

Working out yourbaby’s due date is simple – and complex! On average a pregnancy last 40 weeks from the first day of the lastmenstrual period (LMP) – or 38 weeks from conception. Length of pregnancy is counted from the LMP, so four weeks after yourLMP you would be counted as being four weeks pregnant even though you probablyonly conceived two weeks ago. If youknow when your LMP was, the easiest way to work out your due date is to gothrough the calendar counting forward in weeks till you get to forty weeks. So if your LMP was on a Tuesday, then yourdue date will be on a Tuesday. Counting38 weeks from conception is more accurate, if you know when it was, especiallyfor women who do not have regular 28 day cycles.

Health careprofessionals do not have time to count through the calendar so they use one oftwo ways to quickly calculate your due date. The first is a wheel which has dates of the year on the outer wheel andthe weeks of pregnancy on the inner wheel. By matching 0 weeks on the inner wheel to the LMP date on the outerwheel, the corresponding due date at 40 weeks can be read off. These wheels are also used to work out howmany weeks pregnant you are at check ups. These wheels are not very accurate and can be out by a day or two.

The otherway is to take the LMP and add on nine months and seven days; for example, LMP7 Jan gives a due date of 14 October. Again this is an approximate measure and can be out by a day or two: in2011 7 Jan is a Sat and 14 Oct is a Sun.

The firstscan routinely offered in the UK is a dating scan, at about 12 weeks. This is used to confirm a due date from LMPor to work one out if LMP is not known (as well as some checks forabnormalities). It does this bymeasuring the length of the femur, I believe. At this point in the pregnancy there is a good correlation between thismeasurement and predicted due date. Asthe pregnancy progresses it is harder to assess gestation in this way as babiesgrowth varies. Later scan are lessreliable in predicting size of baby too. Research has shown that due dates from dating scans are more accuratethan from LMP. If, from this first scan,the due date calculated is more than a week different from that from LMP it islikely that the health professionals will change the EDD. This can be confusing – for one of myfriends it meant that, by the scan dates, she would have conceived when her andher partner were in different countries!

How canthere be such discrepancies? Of courseshe could not conceive without a partner and scans are only approximate. It cannot be an exact science. Women have varying lengths of menstrualcycles and do not all ovulate on day fourteen of their cycle. Many women have unpredictable cycles. Sometimes events in a person’s life can causeovulation to happen earlier or later than usual. You can decline the scan. If you are sure of your dates then you do not need it to confirm this. If you do not know your LMP and would like a scan to give you a due date then you can ask them not to check for abnomalities if you don't want to know (at this scan the nuchal fold is measured which is a marker for Down's Syndrome). I had no routine scans with my last two - more about that another time - but with my last I had bleeding, at 12 weeks, that did not lead to miscarriage so I attended an Early Pregnancy Unit. I was offered a scan to confirm life but I asked for no abnormality checks to be done, including nuchal fold. This was written onto my notes and respected. With all of my pregnancies I had decided not to take any abnormality screening, including triple test - but this is purely a personal choice that every couple must make for themselves.

However adue date is calculated – by calendar, by wheel, by rough approximation, or byscan – a due date is only an approximate date for baby’s arrival; in fact it isoften written as EDD (estimated due date or estimated date of delivery). Only 4% of babies arrive on their due dateand ‘term’ is defined as any time between 37-42 weeks, so the baby could comeany time 3 weeks before that date or up to 2 weeks after and still beconsidered normal – and some babies come earlier than 37 weeks and some laterthan 42!

So does it matter?

At thebeginning of the pregnancy it is hard to imagine that one or two daysdifference in a due date matters. We alllike to have a date to consider. We alsohave a tendency to wish the pregnancy by and want the baby to come as early aspossible. However, it is worth goingwith the latest due date from one of the methods – if the date given by midwife/gp/scanis later than from counting through the calendar, then keep quiet; but if it isearlier then insist on using your date. Byhaving a later due date you give yourself a bit more time and at 41 weeks everyday will count. You will feel pressurefrom yourself and others for the baby to come. (Some women choose to tell family and friends that baby is due ‘sometimein June’ rather than give a specific day.) Also in this country it is routine to offer induction to women to startlabour off at 10 or 12 days after the due date. Induction can result in a more painful labour and is associated with a higheruse of epidural and assisted birth (forceps/ventouse). If induction methods fail to get labour goingor progressing then women will be given a caesarean. So the later your due date, the less pressureand worry on you – for a day or two – which could be all that baby needs tocome on its own. (Of course you candecline induction – you can wait and be monitored.)

And then youwait ...

Of courseall of this has no bearing on when your baby will actually be born. If anyone invented a way of giving women duedates that were accurate even to a day or two then they would be rich; insteadwe have to put up with not knowing and a 5 week window, which even then isn’tdefinitive. Baby chooses the day – and frommy experience babies want you to know from the start who’s in charge – them!

Pregnant? Now what?

2011-10-23T07:53:00.000+01:00

So you’re pregnant?

Here are some things you should know straightaway...

How do you knowyou’re pregnant?

· the most obvious is that you have missed yourperiod

· feel extremely tired

· Breast changes: areola (dark area around yournipple) darkens, breasts swell, breasts are tender, glands (like spots) aroundthe edge of your areola enlarge (they are called Montgomery tubercles)

· Feel hormonal, like the start of your period;some women even feel period like aches.

· Metallic taste in mouth

· A positive pregnancy test: these are extremelyaccurate and if you have used one your gp/midwife will not do another.

What now?

Well – you could do nothing. There is no need to see anyone or do anything. If you don’t see anyone or have any checksyour baby will grow and one day you will go into labour and your baby will beborn – it’s nature, it’s what humans and cats and dogs and pigs and all othermammals have been doing for millenia. However, antenatal screening has been shown to be beneficial – but it isup to you to choose which parts of it you want for you and your baby. No test can guarantee a healthy baby, and youcan’t jinx your pregnancy by not doing a test. There are reasons for doing each test and check up, and you should weigheach up and decide.

Most people in the UK tootle off to see their GP or contacta midwife. It has become more common inrecent years to contact a midwife directly – you can get the details from yourlocal surgery or contact the maternity unit at your local hospital. There is a poster up in my local surgery andchildren’s centre with the number. Theywill just want your name and contact details and the date of the first day ofyour last period – pregnancies are measured from this date which is oftenabbreviated as LMP (last menstrual period).

If you do go to a GP: they will want to know your LMP andwill calculate your estimated due date (EDD, also known as estimated date ofdelivery). (See next blog post for howthis is done.) They may check your bloodpressure and listen to your heart. Mostly they will just fill in a form to send off to the midwife. They may ask you where you want to have thebaby. This is only so they know who tosend the paperwork to. You could askwhat the options are in the area – choice of hospitals, any birth centres? Most GPs have very little firsthandexperience of birth so you may find the midwife is the best person to askanyway. It is perfectly reasonable tosay ‘we haven’t decided yet’. You canmake a decision about place of birth, or change your mind, at anytime – evenduring labour! Bear in mind, home birthis an option for first timers – in fact the first is often the best to have athome (see my blog post, firstbaby at home). Sometimes GPs try toput women off homebirth or say it isn’t an option, but, again, they have littleexperience of birth, beyond a short time during their training. It always strikes me as bizarre to be asked whereyou’re having the baby at a time when the main worry is whether you’ll miscarry,and you know so little about what birth is like and how your pregnancy is goingto progress.

If you contact a midwife directly then you will not needthis first appointment and will go straight to a booking visit.

Booking visit

Your midwifewill contact you to arrange a booking visit. These are usually done in a woman’s own home by a community midwife, atabout 8-10 weeks, and last about an hour. There is a lot of form filling and some discussions. They will go through

Your contact details and your partners’
How and when to contact a midwife
Your medical history
Options for place of birth
Programme of antenatal checks, inc scans
Information about the benefits of breastfeedingespecially straight after birth
Healthy pregnancy – diet, exercise, what toavoid, smoking, drinking, domestic violence

They willprobably test your urine (they may give you a pot with a lid to keep so you canbring a sample of urine to each check up). Urine is tested for levels of protein and sugar which can indicatepotential problems. They may take yourblood pressure to give an early reading to compare later measurements to. They may ask to weigh you, or ask you for yourweight and your height, and thereby work out your bmi. As with all tests you choose to accept ordecline each. Even though they areroutine, there is no obligation to accept.

The midwifewill be taking your details down twice – one in a set of notes you will begiven to keep with you and bring to appointments and one kept by the midwife atthe hospital. You will be given a datefor the first scan if you decide to have it, or the midwife will make anappointment for you and contact you later. You will also be given an appointment for a blood test (or you’ll beasked to make one at your surgery).

Furtherantenatal check ups will take place either at your gp surgery, children’scentre, hospital, birth centre or at home. For more details of what is done at each check and how many to expectyou can look at the national guidelines by NICE (National Institute of Healthand Clinical Excellence www.nice.org.uk –also see their guidelines on caesareans, anti d, care in labour and more). Here is the link for the antenatalcare guidelines. They will send youa free copy of their patient copy or the professional’s version or you can viewon line.

I hope thishelps. Early accessing of maternity care(contacting a midwife and starting antenatal checks before 12 weeks) isassociated with improved outcomes. Ifyou are a first time parent then you are probably excited about the wholeprocess – as I was. By the time I waspregnant with number 3, 4 and then 5 I was much more laid back and didn’tcontact the midwife till later. Withbaby number 4 I was 17 weeks and with baby number 5 I was 16 weeks at mybooking visit – but then I didn’t want any scans and knew that my previouspregnancies had been uneventful.

Early pregnancy units

Just a quicknote before the end of this post. Mosthospitals have early pregnancy units. Ifyou think you are miscarrying you can just let nature happen. However if you are bleeding and there is nosac, or if bleeding and pain continues, or you would like to know more you canring up and make an appointment to go there. If the pregnancy is at least 14 weeks they may be able to hear a heartbeat. They also offer scans. Morepregnancies than you’d think have episodes of unexplained bleeding with no miscarriage. (See previous post for more information aboutmiscarriage and sources of support and information.)

So you’re thinking about trying for a baby?

2011-09-09T14:47:00.000+01:00

My sister attended three weddings last year of her contemporaries, two of these couples have moved houses recently, and you know what they say – new house: new baby! Anyway there are some things I think people should think about before getting pregnant and in early pregnancy, and there is some useful information out there that they might not be aware of. As I probably will not know about their pregnancies until after this stage, I thought I would write some bits down. This is not comprehensive, in fact I have tried to include information that I think is useful but is not usually available or discussed.

Pre pregnancy: Thinking about starting to try for a baby

1. Be Healthy

It will be good for you and your baby to be as fit as you can before you get pregnant. Being healthy is commonsense: eat well and exercise. See any pregnancy magazine or website for foods to avoid. Also rest. Learn to listen to your body’s needs.

The healthier you are the healthier the baby will be and the easier your pregnancy and birth. Whatever you put in your body your baby will have some too – if you have too much sugar, or fat, or alcohol, or nicotine, then so will your baby. Your body will prioritise the baby over you to give it the nutrients it needs so if you don’t eat well you will find yourself depleted – pregnancy makes you tired enough without that. You will need stamina –

To carry the extra weight of baby, amniotic fluid and placenta
To deal with the extra work your body does in growing and creating another human being from scratch
To cope with the extra strain on your body especially on your heart – by nine months, a pregnant woman’s heart – at rest – is working as hard as someone running a marathon, due to the extra blood the woman is pumping around her body and to the baby. My then the woman’s blood vessels have doubled in diameter to cope with the extra amount of blood.
To keep your strength up during labour – it is not called ‘labour’ for nothing – it is physically demanding and can last for many hours.

Being healthy before you conceive is important for both parents-to-be. A woman’s eggs all develop when she is in the womb herself but sperm is made anew so it is especially important to be healthy before trying to conceive. To-be-dads-to-be need to ditch the fags, reduce the alcohol, caffeine and fry ups.

Smoking is the biggest factor in still birth, placenta problems, premature birth and small weight babies (this is NOT a good thing – small weight babies are more vulnerable, have greater problems when born, and may have greater problems being born as they have less resilience to the stress of birth.) Smoking reduces fertility for men and women.

It seems obvious that pregnant women should stop smoking – though it can be hard, there are specialist smoking cessation midwives at every hospital – it is just as important for men to stop too – especially when trying to conceive. Smoking affects the quantity, quality and mobility of sperm so reduces the chance of conception. The placenta is formed from the division of the fertilised egg, so just as the baby is half dad, so is the placenta. The quality of the placenta is vital to the baby’s growth in the womb, it ensures the baby gets the blood, nutrients and oxygen it needs. In order to have sperm unaffected by smoking you need to quit before trying for a baby – some places say one month, some say three. Ask your gp for more information. Also, second hand smoke has been linked to the same problems for the baby as the mother smoking.

2. Relax and enjoy the practice!

On average it takes between six and thirty months to conceive. Stress can reduce your chance of conceiving. The more sex you have and the more you enjoy it the better the chance of getting pregnant – better pH of fluids, more blood to womb. Learn about your body: notice changes in your vaginal mucus when you are ovulating.

If you have trouble conceiving here are some useful websites:

www.zitawest.com

www.foresight-preconception.org.uk

3. Girl or boy?

There are several theories about how to increase your chance of conceiving a boy or a girl. One is based on the idea that ‘male’ sperm travels faster but ‘female’ sperm keeps going longer; so if you have sex shortly after the egg is released the sperm has further to travel so baby will more likely be a girl, but if you have sex in the days after ovulation then there is less far to travel and the faster ‘male’ sperm will get there first. How do you know when you ovulate? On average women ovulate fourteen days into the menstrual cycle, but everyone is different. Women often notice a change in discharge (like egg white). Get to know your cycle.

4. Miscarriage

Miscarriage is more common than most people realise (one in three pregnancies). Miscarriage is most common before thirteen weeks. Most of these are because although the placenta and the sac started to grow, the baby didn’t. Most miscarriages are completely spontaneous and there is no need to contact a doctor or midwife unless concerned. It is very common to grieve for the loss of your baby and the loss of the future you planned.

Bleeding does not necessarily mean miscarriage. Many women experience unexplained bleeding in early pregnancy. Most hospitals have Early Pregnancy Units which you can just ring up and usually attend that day. They may offer you a scan – either through the abdomen or the vagina. It is hard to hear the baby’s heart beat before fourteen weeks. You can decline any part of the care. Just by going along does not mean you consent to everything. You can wait it out – just like our mothers and grandmothers had to do.

www.miscarriageassociation.org.uk

Ben's birth story

2010-09-03T14:32:00.000+01:00

My sunshine baby

It seems to me that all babies give us an insight to their personalities when they are still in the womb. Connor was never still and kicked me in the ribs till I was sore – now 8 he is a mad keen sportsman. So it should have been no surprise to me that Ben would be born in glorious sunshine as I used to call him my sunshine baby as the thought of baby number five made me so happy.

Like the last two times I saw no reason to see a GP and contacted a midwife directly (which anyone can do); previously I went straight to the community midwife but I had reasons for not wanting any care from the current one so wrote to the Head of Midwifery asking to be assigned a midwife. As soon as the lovely midwife called me I felt a weight off my shoulders. From then on I had all my antenatal care with the same midwife, at home!! It is worth complaining!

Every pregnancy is different and every birth. I had had four straightforward labours and births – the first in hospital in Hampshire and the next three at home. The last had been a water birth. Again I was planning another home birth with a birth pool for pain relief and maybe for the birth – depending what I wanted on the day. I was planning to have my hubbie Merlin and my friend Jenny as my birth partners. My sister was on standby to come and look after the children (then aged 14, 12, 8 and 5) who had the choice of being around or not. I was planning on using water, breathing, relaxation and visualisation to cope with contractions as I had done with the others.

With each baby I have felt more twinges and Braxton Hick’s contractions than before, and sure enough I thought baby was on its way about half a dozen times from 37 weeks, keeping my legs crossed on the days Jenny was working. However the baby sets the day and in the early hours of 40+2 I was having twinges that were a little uncomfortable but I could sleep, waking occasionally, thinking that hurt a little. At 4am the twinges were too uncomfortable to sleep so I read. By 4.45am I could no longer read through the twinges so had to concede they might actually be contractions. At 5pm I woke Merlin and we went to the kitchen to time them – every 15-20 mins lasting 50 secs – this was it!

Jenny arrived at 7.30am and my sister an hour later. As the children woke and came down it was wonderful to see the realisation dawn on their faces. I was coping by sitting on the birth pool or leaning on Merlin or the breakfast bar and focusing on my out breath with Jenny rubbing the small of my back. I rubbed a little Clary Sage and oil into my bump to help keep contractions going; be warned, it is powerful stuff. Contractions gradually became more regular – about every 10 mins - and at 9am I called the delivery suite for a midwife and she arrived at 9.30am. The lead midwife Libby used to sit on the Maternity Liaison Committee with me. The second midwife, Ursula, I hadn’t met before but had heard good things about her from the home birth group. Indeed they were both fab – quiet, supportive, followed my birth plan to the letter, even when I was so far in birth land I had forgotten.
It felt so strange labouring in the morning and the bright sunshine as my other labours had all been later in the day. I did enjoy being in the garden. By this time I was singing through contractions as for some reason this was helping! It made sense as the baby had always moved more when there was singing going on. I can honestly say that yes, the contractions were very painful but while I was relaxing, breathing out or singing, having my back rubbed and all the things that helped, it took all the pain away. As soon as I stopped doing those things it was painful. So it is possible to reduce and even eliminate the pain of contractions – just try lots of things and relax into them.

About 10.30am the contractions were stronger and about 5 mins apart, and I wanted to get into the pool. We had started filling the pool at the beginning of labour and had filled it two thirds full of hot water, so now I waited as some cold was added and then a little more hot to get the right depth and temperature. Ah bliss!!! Now I didn’t want my back rubbed but water poured on my back. I was losing heart as it was getting harder. I was getting frightened but Jenny and Merlin were so supportive and encouraging. That was probably transition – but I was still asking if I was really in labour! I did feel a ‘pop’ as if my waters had gone, but none seemed to come into the pool. Looking back we think the head was so far down it acted like a plug.

By 11.30am the pool was no longer working as well as I couldn’t find a comfortable position – and I needed the loo. Sitting on the loo was so comfortable I didn’t want to get off. I sat there for quite a few contractions till the midwives persuaded me I didn’t want to have the baby on the toilet. I still didn’t believe I was that close – I had only just started to accept that this was actually labour! I didn’t know what to do or where to go. I wandered over to the living room. I had earlier practiced a birthing position with Merlin – him sitting on the sofa with me squatting between his legs and him supporting me under the arms. However I thought it was too early to do that so I just knelt on the floor, leaning on to the sofa during contractions. I could feel what felt like a poo waiting, and as everybody seemed to be looking elsewhere I thought I would quietly push it out, but it wouldn’t come and I pushed again and the midwife said ‘There’s the head’. I looked at my friend Jenny in disbelief and said ‘Not yet?’ ‘Yes’ she laughed. I stopped my hard pushing and let my body do it slower.

At 12.10pm Ben was born with a whoosh of waters. Libby pushed him through my legs to me and he was all slippery and wet. Connor told everyone the sex and I had a long skin to skin time with a little suckling. Adam cut the cord and I had a natural third stage, pushing the placenta out while Ben was being cuddled by his siblings. He wasn’t weighed till over an hour later (7lb 12oz) and not dressed till later in the afternoon. We used a ribbon to tie the cord but later put a clamp on as the cord stump oozing. By 2pm we were all sitting on my bed eating delivered pizza, as I counted my many blessings and breast fed my fourth boy!! I asked my sister what she thought of the birth (her first to witness) ‘It’s not like it is on the TV, is it.’ I said. ‘No’ she said ‘It was so peaceful and calm’.

Ursula did all my postnatal care except for a phone call on day 4 from another midwife on the team to see if I was ok. She said she’d heard about my lovely birth as the two midwives had come buzzing in the office full of the joys of birth. ‘We do like doing homebirths’ she said. Amen to that.

Baby Ben born!

2010-04-19T19:33:00.002+01:00

Ben was born on Tuesday 13 April at 12.10 pm!!!!! It was a lovely calm and smooth home birth in the sunshine. Birth story to follow.
He is a delight and feeding and sleeping well. I am counting my many blessings.

Due date tomorrow

2010-04-10T17:45:00.001+01:00

No baby yet

39 weeks and 1 day ... and counting

2010-04-05T22:13:00.002+01:00

Well nothing happening yet. Lots of twinges, a couple of false alarms but no baby yet. I know I am not even at my due date but as my other four all came early (well one on his due date - others: 38+4, 39+1 and 39+3) I am expecting this one to be the same. Apparently shorter women tend to have shorter pregnancies and taller women, longer ones - baby triggers labour and it is thought that one of the prompts for it is the lack of room.

I did have the pool up and filled and then took it all down again. Today I have blown it up again in case anything happens tonight because the electric pump is very noisy and I have been feeling niggly - though pattern or contractions - painful or otherwise.

I am not inclined to do anything to start things off as my body (and my baby) knows best when baby should come. Just resting and early nights and lots of baths. Watch this space!

Birth pool trial run

2010-03-31T10:41:00.002+01:00

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.

Midwives supporting home births

2010-03-30T18:46:00.001+01:00

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

Why your first is the best one to have at home

2010-03-30T18:45:00.001+01:00

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

My birth plan

2010-03-30T14:13:00.002+01:00

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.

37 weeks!

2010-03-22T12:28:00.004Z

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.

Myth 1: Big babies are harder to birth than small babies - False

2010-01-04T07:52:00.007Z

Back on the computer - children still sleeping so I get a chance. Baby has been moving a lot and giving me insomnia!

As I said in my last post - women can have a difficult time with a small baby, and others, an easier time with a large baby. A woman can have a long difficult labour with a 6/7 lb baby and then has a straightforward birth with a 9-10lb baby. This happened to my cousin who, after a long, difficult first birth to an average sized baby, gave birth to a 10.5 lb baby at home in the pool without a tear or even gas and air. Why does this happen?

The main factors are the position of the baby and the position of the woman. Birth tends to be longer, more difficult, and more painful if the baby has its back towards its mother's back (sometimes called: back to back, posterior, or OP). Most babies will turn in labour - but it can take time. It is more common in first time babies - though not known why - possibly because of tighter tummy muscles or more time spent lying or tipped back on settee, in car, or in office chair compared to second time more time spent on hands and knees and leaning forward positions (search 'optimal foetal positioning' for more info). Other positions that can mean longer or more difficult births are where the baby's head is not tucked in (more common with OP babies), where there is a hand or arm up by the head, or baby's head coming down at an angle (asynclitic).

The position of the mother makes a difference too (especially to birth where the baby is not in the ideal position). Moving about, walking, rocking your hips, being upright or leaning forward all help the baby and your body to do what it needs to do. The uterus tips forward in labour. Gravity helps the baby move down. Rocking and walking helps the baby move down and to move into the best position. It also making labour less painful as your body does not need to work harder, and because often pain in labour is there to get us to move and get into positions that help labour, we do it because it eases the pain and that is what our body wants us to do. I have heard of women doing strange movements, moving legs, or getting into positions instinctively - to relieve the pain - and that happens to be just what her body needed so it could birth the baby. Being in the warmth and support of water can help too.

Lying on your back or semi seated lengthens labour but also it reduces the size of the pelvis dramatically. Women's tailbones (cocix -sp?) are hinged (unlike men's)to enable them to move back in labour. The ligaments between the pelvic bones are softened in labour to allow them to move apart to make more room. Lying on a bed stops all this happening. Lying down also means your body has to work harder. The uterus is tipped forward as I said - but in a lying position that means tipped up. The action of the first stage of labour is to shorten and move the muscle fibres up towards the fundus (pulling the cervix open) - again, if you are lying down this is against gravity. The baby is not putting pressure on the cervix so it dilates slower, and possibly leaving a lip because of uneven pressure. The baby also has to move uphill and you will be pushing up hill.

Another effect of lying down is that it is more painful, which may cause you to want an epidural, or an epidural is the cause of you lying down. Epidurals relax all the muscles from waist down. This includes the pelvic floor. This may sound like a good thing but it is not. When the baby's head touches the pelvic floor muscles the pressure and firmness prompts it to turn its head to manoeuvre through the pelvic outlet. With an epidural the muscles are floppy and they do not support the head to move, which is why epidurals are associated with a greater need for forceps or ventouse assisted births. This is particulary significant with large babies.

Being relaxed, feeling supported and able to follow your instincts all help you to birth your baby - whatever the size. A wise obstetrican I met (whose wife had 3 home births) said it is counterproductive to talk about big babies as the best way for the baby to be born is vaginally and that is more likely to happen if the woman is not fearful.

There are two concerns that relate to big babies that are worth noting - but they do not contradict what has been said above.
Firstly - a big baby can be a result of diabetes. If the mother has had diabetes that can cause the baby to have more trouble stabilising its blood sugars once it is born. Women who have diabetes prior to pregnancy will receive additional care. There is some debate whether gestational diabetes (ie caused by pregnancy) exists and of the reliability of diagnosis and the value of diagnosis (ie how does it affect outcomes.) The concerns regarding gestational diabetes are two fold: the baby's control of its blood sugar when born, and difficulties of a big baby at birth (see above and below). It is worth noting that more than half of 'macrasomic' babies (over 4kg) are born to women who do not have diabetes.

More in part two - shoulder distocia.

Nappy New Year!

2010-01-01T10:37:00.002Z

The start of a new year! This time last year I did not expect to be expecting! 2009 was a year of ups and downs. As I transferred all the birthdays on my new calender I noticed there were no births of close friends or family. Two cousins had babies. However I lost my uncle (cancer) and my friend lost her baby (at 17 weeks pregnant). And M and I found ourselves pregnant.

Despite my stretching stomach and the alien wriggles from inside I still cannot believe I am pregnant and going to have another child. It is so hard to equate the bump with the four individual human beings that are my children. With each of them it has felt a true miracle to look at this whole human that grew inside me.

I have finally conceded and bought some maternity trousers - and was grateful to find some under the bump ones. I am now a little more comfortable around the waist. This is not going to be a small baby - not that any of mine have been small. However I cannot believe I have another 3 months to go. My innards are feeling very squashed - I have terrible heartburn and indigestion and can only eat small meals. I am already getting kicked in the ribs! Mind you I don't want to complain about having a growing, healthy, active baby.

I am not concerned about having a bigger baby (my largest was no 3 at 9lb 1oz). Big babies help themselves out and down the birth canal plus they have big stomachs and can go longer between feeds. The position of the baby and the position of the mother make more of a difference. Getting chucked off the computer by child ... to be continued ...

Another footballer?

2009-12-17T06:13:00.002Z

Well I am now 23 and a bit weeks. I have got past the difficult bit where you stop feeling tired and sick but can't feel the baby move yet. You have to trust and be patient. Unfortunately at this time a dear friend who was due on the same day as me lost her baby (17 weeks). It is so hard to see anyone go through this - especially as she had an another interuterine death at 18 weeks last year as well. My heart breaks for her. I am worried how it will be for her as my bump gets bigger and bigger.

Some people are buying sonic aid/dopplers to use at home to listen for baby's heart beat. This worries me because they often get them in early pregnancy when it is too early for a trained midwife to find the heart beat with one. I think it will give more anxiety than the reassurance they are looking for. Later on, I wonder if it stops women tuning in to their baby and its movements, as they trust the machine more than their own body. My other concern is that there is no research into the long term affects of frequent use of these. Sonic aids/dopplers use ultra sound technology. With hospitals all sonic aids and ultrasound machines have to be checked yearly. Research has shown that repeated ultrasounds are linked to lower weight babies and an increased risk of premature birth. See www.aims.org.uk 'Ultrasound/Unsound'.

Now I am getting big kicks and movements so I am reassured that bubba is growing strong and healthy. I told my seven year old son that I thought it might be a footballer like him as it is kicking so much. He asked if that meant it was a boy - he already has two brothers but they are not football mad like him and he is the only one who would like baby to be a boy - the others want to even it out. I would like to give my daughter a sister. I know they will be 14 years apart but I am 10 years older than my sister and though we were not close growing up (I left home when she was 8)we are extremely close now and I am so grateful to have a sister, especially since our mum died. We can be mum to each other.

Pregnant?!!!!!

2009-10-24T16:10:00.003+01:00

Well, here I am pregnant again! A bit of a surprise but a lovely surprise. After getting over the 'I can't believe it' and the shocked reactions of other people, I have started to really look forward to the joy of another child. I am also relishing the thought of feeling a baby moving around inside me and of breastfeeding - which I enjoyed so much. I am also looking forward to the amazing experience of giving birth again (with a little trepidation to be truly honest - it is a powerful and extremely physical experience and each one is different).

I am now 16 weeks and have just been in touch with a midwife for the first time. You do get more laid back, after all what is the hurry? I am not having any routine scans nor blood tests so there is no deadline. I am relatively healthy and not in poverty; I don't smoke and don't have premature or low birth weight babies; I do not have a history of complications. All of which means the chance of needing any help is minute.

I have not seen a gp either. There is no need to see a doctor - you can go straight to a midwife. (UK government made that very clear in 2004 - giving all trusts the obligation of publicising contact details for women to make direct contact with a midwife.) All they do is write a letter to the midwife anyway. Some do a few general health checks. The worst they can do is use their ignorance and prejudice to put the frighteners up you. It is not unknown for gps to advise against home births in often graphic persuasive language even though the national advisory body, NICE, recommends all women having straightforward pregnancies should be told that having a home birth reduces their chance of having a caesarean.

To me it seems a waste of a gp appointment - let someone else who needs the appointment more have it. I did not see a gp last time. My community midwife who was ignorant of the situation, wouldn't take a direct referral from me, so I wrote to my gp and he referred me on.

This time I wrote to the head of midwifery at the local hospital and asked for a midwife to be assigned to me as I did not want any care from my local community midwife (not the same as last time). some of my friends had complained about her in the past and I had heard some less than favourable reports, so I have no faith or trust in her. This was sorted out within days and I have been given a named midwife who will do all my antenatal check ups at home.

So now it is all steam ahead towards baby number 5! At least I don't have to hold my stomach in anymore!!

I know some secrets - will you listen?

2009-02-18T21:24:00.003Z

I was at an NCT home birth group meeting a couple of days ago. It was very exciting to be with a couple who were planning to birth their first baby at home. They had done lots of reading and research. Why, asked the expectant woman, why is home birth not the default option? Why indeed!

I have been to many birth and home birth conferences, listened to many learned midwives (and a few obstetricians), read many books, conference reports, government guidelines, and journal articles, and I have supported women and listened to their stories. This couple and myself have come to the same conclusion - we are not medically trained, but everything we have learnt about birth points to home as the best place for birth to go well. It doesn't seem to be rocket science - just hormones, physics and an understanding of birth as what a woman's body does. Yet so often our learned physicians (and sometimes our dear midwives) set up things to get in the way of the birthing body.

The simple knowledge of birth and the power of being at home to do it have become great secrets in our society. They have become so secret that no one believes you when you tell them.

That is how I feel most of the time. "Let me tell you the secrets of birth", I want to tell everyone. Some listen; many don't. Then, occasionally, I meet someone, like this woman, who has discovered the secret herself - and it feels so wonderful. Our home birth groups can buzz with this feeling.

I know secrets - about birth - will you listen?

Follow your instincts

2008-12-30T18:39:00.002Z

I was listening to an amazing birth story where the woman knew exactly what she needed to do and I was reminded of the two steps to a straightforward birth:

Step 1: Follow your instincts

Step 2: Go to step 1!!!

Love your midwife!!

2008-09-12T21:42:00.002+01:00

Having just read the latest AIMS Journal (from Assoc for Improvements to Maternity Services) which featured articles from midwives and childbirth campaigners across Europe describing maternity care in their country, in many of which midwives are sidelined and birth is conducted in cold, clinical environments with practices decades behind the UK (episiotomy rates: Greece 80%, Spain 90%, Bosnia (first time mums) 100%!) and I have to say 'thank goodness for our midwives'.

Hoorah for the midwife who keeps the focus on the normal: patiently watching; forever supporting. Of course, there are those midwives who have been worn down by working in busy obstetric units, or who find it hard to shrug off the hierarchy, or who've not had their eyes opened. However there are many many more working quietly with the women they care for, willing her on, subverting the doctor's strict instructions, or standing between woman and obstetrician; midwives who encourage the woman to 'do what your body tells you', holding her up, rubbing her back, or showing the woman's partner how to do it, whilst shooting them a strong 'we can do' smile. We are lucky that these traditional birth attendants, now highly trained whilst maintaining that 'with woman' essence, are part of our very establishment. We must do all we can to make sure that in this increasingly medicalised maternity care true midwifery skills are kept alive and strong, and not lost to become merely obstetric nursing.

Being a midwife is both a privilege and a tremendous responsibility, especially for those in the community and those in independent practice, so love your midwife. And if you're planning a home birth - don't forget the chocolate biscuits.

Welcome

2008-09-04T11:23:00.000+01:00

Hi! Welcome to my blog. I'm passionate about the importance of birth to women, babies, their families and the whole community. A good birth where the woman is in control throughout, where she is allowed to birth in peace and dignity is an empowering start to her role as a mother and for the family unit. Strong women create strong families and strong communties around them. Women who have given birth their way, being supported not overrun, feel they could move mountains. Women who have terrifying out of control births that seem like living nightmares come out broken and full of self doubt. Even women whose births seem to go well but for whom everything is done without their involvement are missing out on the empowerment that can make a real difference to their lives.

I look forward to sharing views with you.
your sister-in-birth