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Archive for the ‘Birth’ Category

I have been given an award, by Geepeemum, and it gave me a lovely warm feeling.

The rules of the award are:

  1. The winner can put the logo on his/her blog.
  2. Link the person you received your award from.
  3. Nominate at least seven other blogs.
  4. Put links of those blogs on yours.
  5. Leave a message on the blogs that you’ve nominated.

7 other blogs?

Town Mouse

Punctuation

Flighty

Lisa’a Place

Cartside

Mumof4 (even if she has disappeared)

Mum of 4’s Blog

Something even more stupendous has happened though, the unasked question I’ve had wriggling around in my brain for the last 30 weeks has been answered. Big family meal yesterday and Son and DIL arrived first, complete with a beautiful bouquet of flowers for me, DIL was in need of an antenatal check-up so I went through all the ‘routine’ and as usual asked if there were any questions. There were, what did I think of TENs machines, off I went into my little chat about ‘anything’s worth a try’. Practice putting it on and how the controls work before you’re in labour, make sure that you start using it as soon as you think you may be in labour as it works by ‘tricking’ the brain and reducing the recognition of pain from contractions, it’s called the Gate theory etc. Out came my demonstration pelvis and off I went showing the reason that lying down restricts the possibilities for the joints within the pelvis to move and so allow for an increase of the internal dimensions. Have you thought of using water to help with pain-relief? I was on a roll, then DIL stopped me in my tracks, ‘ You will be there won’t you?’. After checking that they were really asking me to be with them when their first baby, and my 6th grandchild, was born I jumped-up, hugged them both, and burst into tears, so did DIL. I know that I was happy, and I think that my happiness was making her happy. Now all I’ve got to do is discuss it with the powers that be, that will be fun – not.

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“Why are you doing homebirths, and why is the government promoting them, if no one has any idea whether or not they are safe?” A question asked by Dr Amy on Homebirth Debate.
Hmmm. Well, I’m a Community MIdwife, it’s my job. Stop thinking, if I think too much I could talk myself out of a job. I mean, who in their right mind would do a job that requires them to work all day, then go home and wait all evening, all night to see if the phone rings to summon them to previously uncharted territory, to meet new people, in unknown circumstances, for an unspecified length of time and all for their usual hourly rate, plus one third and, to then go to work the next day?

My response to Dr Amy was so smarmy, real interview speak “I would rather provide women demanding homebirth with trained support than encourage UC. There will always be women who want homebirth and, if this is the case, then it must be preferable that they have care from a trained professional.”  That’s true, and I suppose it is a component of why I facilitate homebirth, although it does not explain why I promote them. I have purely anecdotal, observational ‘data’ to support my belief that homebirth is appropriate and safe for low-risk women, so from my personal perspective I see no reason not to offer homebirth as a valid option (other than a purely selfish desire not to be on-call!) so I suppose that answers that query.

That makes it sound as if I have no worries about homebirth, I do, but I also have worries about hospital birth. Statistically I have more chance of finding myself encountering a difficult labour, birth when working on the labour ward than I will at a homebirth. If things start to deviate from a clearly defined norm at home I will transfer the woman in immediately, I have absolutely no intention of increasing the chance of harm befalling the woman and baby or finding myself, deliberately, in an emergency situation. I can’t d this in the hospital. Yes, I can ask the Doctors to attend but, as the midwife providing care in labour I have to stay, provide the care the Doctor advises and sometimes be present at an extremely sad outcome.

I wrote the truth when I said that there will always be women who demand homebirth, and I believe that as the caesarian section rate rises, so will homebirth as women search for a less medicalised approach to childbirth. If we don’t provide the choice of homebirth with NHS midwives more women will feel that the only route they can take is that of unassisted childbirth, freebirthing. Obviously, if they have the money they can choose to employ an Indie (Independent Midwife), they can provide better individualised care but they are unable to acquire insurance at present so this may make them less appealing as an option.

There is no ‘perfect’ solution as if we ban NHS homebirths the freebirths will rise and women and babies will die unnecessarily. That’s why I assist women birthing at home.

P.S  I’m ‘on-call’ now and if the phone rings the adrenaline starts flowing.

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I always warn the Mum’s who have laboured quickly that they could find themselves quite unpopular with their new chums from antenatal classes. It’s a double-edged sword really, if a woman has a short labour other women may consider has she ‘got off lightly’ and, as she can’t hope to rival them in the traumatic, epic nature of her labour, she may be perceived as not having worked so hard to bring her baby into the world.

A quick labour is not always that fantastic though, it may be over quickly, anything under 2 hours* is classed a precipitate labour, but it comes with it’s own problems. For a labour to be completed in such a short length of time the contractions are generally almost continuous and extremely long and intense, immediately. This makes it extremely difficult for the woman to adjust to labour and find a coping strategy. Also, it makes travel to the maternity unit extremely fraught, for both the woman and her companions. In precipitate labours it is not unusual for the birth to occur before the woman has reached the maternity unit, or even a place of safety, hence the tales of babies being born down toilets. Here is the first danger associated with a rapid birth, baby taking a tumble onto a hard surface and the cord snapping in the process. There is also, for baby, the possibility of the speed of the birth leaving it shocked and slow to respond, so requiring extra stimulation to encourage her to breath. Babies born quickly will often have red faces, close inspection shows it to be lots of tiny red ‘spots’, burst blood vessels, petechiae, with the whites of the eyes having burst blood vessels, sometimes leading to the iris’ having a small ring of blood around them.

The poor woman, having been totally overwhelmed by labour, is possibly in shock as soon as her baby enters the world. Due to baby entering the world at breakneck speed severe lacerations and tears to the vagina and perineum are likely, particularly if the birth was unattended and the woman was panicking. Even though her labour has been short she is exhausted, and frequently her uterus is as well so fails to contract efficiently which means that women who experience precipitate labours are at an increased risk of retained placenta and haemorrhage.

There are other, more severe and rare, complications, associated with precipitate labour. They are extremely rare and I’m not going to mention them here, but if you are interested one can be found here and here. A piece if research conducted in the 70’s by Erkkola and Nikkanen seems to show that precipitate labour does not result in adverse outcomes for newborns.

Precipitate labour is difficult to predict in a woman having her first baby. Obviously a premature labour is more likely to be rapid; induction of labour can lead to over-stimulation of contractions so causing labour to be precipitate, really it is something that just happens to some women and babies!

* If I book a woman with a previous labour and birth of under 4 hours I make a note of this as a ‘rapid birth’ as she is at a higher risk of precipitate labour in her current pregnancy. I also discuss with her the advisability of making her way to the maternity unit as soon as she believes that labour is starting and if she believes that the birth is imminent, phone an ambulance, make sure the door is unlocked, sit or kneel and grab a towel. If her previous birth had been trouble free, no retained placenta or excess blood loss, I suggest a homebirth.

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One of the women featured in the channel 5 documentary about unassisted birth, Clio, is discussing her choice in The Mail’s “Freebirthing: Is it madness or the ideal way to give birth?”, the article has so far elicited 60 comments, the majority of which are against the idea of a woman giving birth without trained support. Obviously, as a midwife I am going to counsel against an unassisted birth, I would also advise against an unsupported pregnancy, meaning no antenatal care. I know, and have seen too much to take the attitude that Sue (one of the commentators) does ‘ If you listen to your body and you are healthy there should be no reason why you can’t have an unassisted birth, We need to go back to the old days, pregnancy and birth are not illnesses.’ She is right, pregnancy and birth are not illnesses’, but that does not exclude circumstances which are capable of changing an everyday ‘natural’ event into a life threatening emergency. I remember that fact EVERY time I am called to a homebirth and EVERY time I conduct a routine antenatal examination. Sue wants us to go back to the old days. What ‘old days’ would those be? The days when women died from eclampsia; haemorrhage; puerperal fever, ruptured uterus when babies died or were damaged by obstructed labour, cord prolapse, undiagnosed twins, locked twins? 

  

So, I’ve let my feelings known, now I’m going to present an example of unassisted childbirth that happened recently. The woman is at term, uncomplicated second pregnancy, apart from her requiring much debriefing about her last labour and birth and a meeting with the anaesthetist to attempt to discover why her last epidural hadn’t worked and an assurance that she would be offered an epidural as soon as she goes into hospital this time. On the day of the birth she as a ‘show’ in the morning and is experiencing slight lower, back pain. Early afternoon saw her having painful tightenings, she sent her husband off to buy a few groceries, he was gone half an hour. He returned to find her on all-fours, telling him that the baby was coming. He insisted they get into the car to go to the hospital, she describes being on the pavement, on her hands and knees, unable to move. He somehow got her into the car, and off they went on a 10 mile drive. A mile from the hospital, stopped at traffic lights in the town centre, she told him the baby was coming, her waters broke and baby’s head started to come. He pulled over, leapt out of the car, asked a group of teenagers to call an ambulance, pulled off his wife’s trousers and baby was born into her underwear. After a struggle with baby and it’s cord, which was tangled in her undies, he gave the baby to his wife. She describes how terrified she was, as initially the baby was ‘floppy’ and didn’t cry, but then she hugged it hard and he cried. They cancelled the ambulance and drove the mile to the maternity unit where Mum had a couple of stitches to a small tear, cord blood was taken, as she was rhesus negative, and they then got back into the car and drove home. When I saw them the next day they were both ‘on a high’. Basically they, especially her, view the experience as being, eventually, better than the birth of their first baby but terrifying at the time. I asked if they would deliberately have an unassisted birth. NO! Would they have a midwife attended homebirth? Not too sure as those seconds, where they thought that the baby was not breathing, made them realise how unpredictable events could be. 

Not freebirthing, in fact very much the opposite as Mylene Klass is someone who had private antenatal and birth care. Now though she is outraged at the lack of care she received after the birth of her baby . I have a few thoughts about this, many contradictory. My overall thoughts are that I can’t defend the lack of care she received from the NHS but…..why did she choose to rely on the NHS for her postnatal care having gone privately during her pregnancy and birth? Was it because her private hospital does not provide a domiciliary service, however much you pay and she would have had to go to a clinic for her and baby to be seen?

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“Following the Channel 5 programme broadcast 9 July 2008 (Extraordinary People – Outlaw Birth) featuring three women in the UK and the USA who opted to give birth unassisted at home, the NMC would like to clarify the following points.
Legal position
In the UK it is legal to give birth at home without any professional or medical help.

However, it is illegal for an unqualified, unregistered person to perform the role of a doctor or midwife during the birth.

Standards and resources
As part of their training, all midwives are taught that they must

  • Work in partnership with women to facilitate a birth environment that supports their needs.
  • Provide care that is delivered in a warm, sensitive and compassionate way.

The Midwives rules and standards states that a midwife

  • Should respect the woman’s right to refuse any advice given

The Code states that

  • You must listen to the people in your care and respond to their concerns and preferences

In addition, a recent report from the Royal College of Obstetricians and Gynaecologists (RCOG) states that

  • Women who choose a home delivery as their birth option should be supported in that choice, appropriate to the level of clinical risk.

Responsibility
In a free birth situation, the mother-to-be takes full responsibility for the birth of her baby.

The mother may choose to have any friend, partner or relative present at the birth.

They may support the mother emotionally but it is not legal for them to assist her in the birth or take any kind of responsibility for the successful outcome of the birth.

Midwives must respect a woman’s decision to have a free or unassisted birth.

The Code and NMC Midwives rules and standards require midwives to be supportive and not be judgemental or critical of this choice.

If midwives have any concerns at all about the woman’s decision, they must address them to their Supervisor of Midwives.”

Further information
Free birth advice sheet [PDF]
The Code
RCOG Standards for Maternity Care
[PDF] (external website)

Well, that’s made it all very plain. I think! Support her choice, be non-judgemental, contact my Supervisor of Midwives if have any concerns about her choice. Ummm, if I’m supporting her and being non-judgemental then going to my Supervisor could be perceived by a woman as obstructive and judgemental. Oh well. All I can say is, as I said here, if you thinking about it then please don’t just read the legal stuff and DIY sites on the web, there are a lot of sites out there with enthusiastic people who mean well but can be somewhat blinkered when it comes to the nitty-gritty. Talk to your midwife, see if a compromise can be reached, most of us don’t want to be ‘in control’, we would just like to try and help you, and your baby, have a positive, safe birth.

 

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Last night was nieces 21st birthday party, at a club, in that well known hub of youthful exuberance and soulful poetry, Milton Keynes. I was really looking forward to the event as it had all the ingredients for an entertaining evening; family, music, dancing, food, with a little soupscon of adrenaline as I had to give a speech and, my sister’s 2 ex-husbands plus her partner would be there.

First, back to Thursday. I had a relaxing day planned. Little pile of ironing to wade through, whilst catching up on some daytime TV, Fern is not the bubbly personality she was since losing all that weight. Not only are her measurements smaller, her warm personality has diminished as well. Shame, she and Phillip were a great ‘cheer-you up’ team. After the ironing a dabble in baking, used up some past it’s best bread and made 2 bread puddings, love the smell of the mixed spices, and then a trip to the hairdressers to have the barnet cropped for the party last night.

Thursday tea-time my job-share phoned to update me on work happenings and issues relating to our caseload. At her clinic one of our woman, booked for a homebirth, had attended for a stretch and sweep , it was unnecessary as C’s cervix was already 5 cms dilated and the membranes were bulging! Good news, as hopefully this means that labour will start quite shortly. Job-share had told C that she would go on call for her and I told my job-share that if there were problems with 2nd midwives, or things were happening very quickly, then she could call me as I only live 5 minutes away from C.

Thursday evening Son came around, he is still having a flare-up of his ulcerative colitis and they have now started him on azathioprine which is, at the moment, not helping. This flare-up has been going on for months now, he has become really anaemic and that, combined with his recent 2 stones weight loss and the constant discomfort is making him really lethargic and quite depressed. I tried to buoy him up, the new drug takes time to work and we will just have to hope that by the time baby arrives he will be full of energy and able to fully enjoy life again. I am worried about him and so a combination of ‘maternal distress’, the old night sweats and restless legs saw me wandering the house when I should have been sleeping. I was just standing on the tiles in the kitchen, good for cooling off and alleviating restless legs, when the phone rang. As I grabbed it quickly so as not to disturb Hubby I glanced at the clock, 2.45 am. It was job-share, C was labouring but……..the doors to the hospital where the on-call equipment is kept were locked, the porter was not responding to her knocking and both the on-call midwives were out at 2 other homebirths. Having experienced difficulty in gaining access before I had the phone number for the porter so relayed that to her and told her to phone me when she needed me. I got back into bed, was just entering that lovely dream-like state which precedes sleep, when she phoned again, would I join her at the homebirth? I left a note for Hubby just in case he woke up and realised I had abandoned him, phoned labour ward and told them what was going on, grabbed my on-call equipment and nipped off down the road. It was all fairly peaceful. C was smiling between contractions, she was really happy to have 2 midwives there who she knew, her previous hospital birth had been quite traumatic as she felt that the midwives were unfriendly and unsupportive, and all progressed quite smoothly to the birth of a little boy at 6am. By the time we had waited for the placenta, it was a physiological third stage so lasted 40 minutes, tidied up all our equipment, weighed baby and checked him over and then helped C with a bath it was 8.345am before we left. I arrived home, my note was still where I left it so I added the request to wake me at 12 noon and, being shattered, I headed for bed, Hubby was just getting up. ‘Bloody hell. Who was phoning at that time?’ was his greeting. I explained who, what and why and it dawned on him that I had been, gone and returned whilst he was sleeping. ‘You’re on annual leave’ was his comment as I snuggled down and hoped I could sleep. I just love that getting into bed after a night-shift or a call-out. The naughtiness of deliberately getting into bed whilst everyone else is just starting their days activities, the knowing that when you awake it will be the same day and you will still have hours to do things in, like go to a 21st party, it’s almost like gaining extra time in your life.

The party. Well, for all my eulogising about how wonderful losing a night’s sleep can be, I feel that age is catching-up with me and I don’t recover as well so I was possibly less energetic than I had hoped. My niece looked lovely and really, really enjoyed herself. The speeches were lovely, I did a tongue-in cheek imitation of an M & S advert, you know, using the ‘ extra-sweet, hand-dusted, steeped, traditional, 21 year-matured’ keywords, I think it was appreciated (the 3 bacardi’s and no food helped)! I did very little dancing, the music was good but really not suited to a 50 year-old trying out her moves in front of a room full of mainly 20 year olds. My Mother, the ********** , use any expletive descriptive of pure evil here, did her usual and behaved similarly to how she had at Son’s wedding, controlling and attention-seeking. Hubby ended up having to drive her home as she wouldn’t take a taxi. At one point, after being introduced to her grand-daughter’s fiancees relatives she said ‘ Well, of course R’ (her husband) ‘has bi-polar’, attempting to lighten the conversation I interjected with ‘Yes, he’s big and white with a black nose’, she rejoined with how she diagnosed his condition, instructs the doctors on the medication he requires, and then she decides regimes and dosages. Apparently, if it wasn’t for her R would be dead, if it wasn’t for her he would be mentally stable, is my observation. At the party my previous, and present brother-in-laws all behaved impeccably toward each other. One of them I hadn’t seen for about 15 years, it was good to catch-up. When there is a divorce it is an odd situation for other family members. There you are, all a family together, sharing so many parts of your lives and suddenly this quite major member of the family disappears off the radar, this huge chunk of family life disappears. (Huge chunk is not meant to imply that either of my ex-BIL’s are overweight!) We left at 12.30, Hubby was sober and in danger of being deafened by the music, I was tired, tired and tipsy. After several failed attempts, frequent muliple revolutions of roundabouts, we left Milton Keynes, headed into Bedfordshire, had a passing aquaintance with the M1, a close encounter with Whipsnade Zoo and eventually got home at 2.30am. Hubby insists that at no time did he take a wrong turning, he was just enjoying listening to Leonard Cohen

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I’ve just finished watching the channel 5 programme about unassisted childbirth and I feel many mixed emotions. As a woman I feel rather jealous of the three women shown freebirthing in the programme, especially the first one who really did appear to experience a non-traumatic, pain-free, dream of a birth, as a midwife I fnd that rather worrying. I mean, if I was swept up by the images and beauty of the concept why shouldn’t a significant number of women, who are in a position to have a go at birthing by themselves, decide that they would like to experience an unassisted birth?  Would that be a problem? Not to me, no, but it may cause them an assortment of problems, some life-threatening. I am absolutely delighted that a went well for the three women, and babies, in the progamme but that is troublesome. Although the doctors warned about a couple of complications that could occur, this will just be perceived as the medical establishment ‘shroud waving’ and there are very real and dangerous problems which may occur during childbirth.

Why are more women considering this ‘lone’ birthing as an option? There will be a few who will enter into it due to a personal belief, or as an extension of a life-style but I believe that the majority will choose free-birthing as a result of a previous birthing experience. Perhaps they believe that the attendants were not sympathetic to their needs, or their choices were dismissed or ignored, whatever it is, the maternity services, midwives, doctors have failed them. I do place some, well quite a lot, of the blame here on promises, and hence expectations, engendered by government and built-up by the media. Women and their families are told that they have choice but this is never qualified by the reality of shortage of staff, resources and amenities. Some elements of the media and pressure and user groups paint a negative picture of attended childbirth, I would include channel 5 in this group. There are many images of midwife-attended, home, birth-unit or hospital maternity care they could have used which could have shown a woman in a non-medicalised environment. Instead the images shown were of a woman semi-recumbant, on a  hospital bed, with a doctor busy setting-up an intravenous infusion, complete with an electronic pump, hardly the most tempting alternative to the impression of a pleasurable birthing experience for the three women depicted in the programme.

I would urge anyone contemplating unassisted childbirth to do more than read-up about it and watch DVDs. Please, contact your local maternity unit then, if you are still unhappy with the options or choice offered, contact your local NMC supervising authority as they are there for women who are seeking help or support concerning the provision of their midwifery care.

Women and babies can, and do, die during attended childbirth in hospital and at home but, “while many factors contribute to maternal death, one of the most effective means of preventing maternal health is to improve health systems and primary health care to ensure availability of skilled attendance at all levels and access to 24-hour emergency obstetric care” and, “Because complications of childbirth too frequently cause neonatal death, skilled assistance is recommended for all deliveries along with access to the appropriate level of neonatal care when needed.”

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I know I’ve been quiet for a couple of days but I have been reading NHS Blog Doctor and specifically his entry ‘The Independent Midwives of Kent’. I’m not the only person to have been reading it as last time I checked it had 200, yes 200, comments, obviously a provocative entry. Now, Dr Crippen is an old adversary, I like to consider it a love/hate relationship, he hates ‘madwives’ and loves to rant about them, on this occasion though he does have, more or less, my support. His entry was a comment on a birth story, Sharon’s story, published on the Independent Midwives of Kent’s website. The link is to the Google cache as, last time I checked, the original story had been removed, more on that later. I’ve read the story and, as a midwife who has a role encompassing homebirths, I have to admit that I felt quite tense at several points throughout the narrative, especially when polyhydramnios entered the equation. Polyhydramnios, basically too much fluid around the baby, may have no cause but it can be associated with several serious abnormalities in the baby, as I learned the hard way. Several years ago I was caring for a friend, J, in her second pregnancy, I had also cared for her during the first where there were no complications and she gave birth to a healthy baby girl. This first experience decided J that she would like a homebirth this time round so that is what was planned, until 32 weeks, when I was doing a routine antenatal and thought that there may be too much liquor, polyhydramnios, so I asked for a consultant opinion and ultrasound. This was done, nothing abnormal detected but due to the polyhydramnios we were no longer considering homebirth so we just prepared for baby being born in hospital. J was also a midwife and I don’t remember there even being a discussion about whether we should go ahead with the homebirth, we were both just aware of the risks associated with too much fluid; cord prolapse, haemorrhage before or after baby is born, malpresentation so the hospital would just have seemed more appropriate. J was induced at 37 weeks as she had become so huge, when the membranes were broken the room was awash with liquor, quite spectacular, but nothing untoward happened and labour progressed uneventfully. As is practice with an induction of labour J was monitored continuously, baby was a happy bunny, and so when he was born after 4 hours of labour we did not expect a problem but there was, a major problem, he couldn’t breathe. As he took his first breathe his little chest collapsed, he tried again but with the same result. Some babies will have chest recession, this is where their chests will go inwards as they try to breathe and this may be a sign of respiratory distress, but J’s baby’s chest was concave, it was an horrific sight as he battled to breathe. The paediatricians were there immediately and he was rushed round to NICU where he was X-Rayed and ventilated. I have to admit now that everything after that was a blank, according to J’s husband I was brilliant, apparently I didn’t panic, I was very calm and I just carried on delivering the placenta and helping J to wash and get ready to go round to special care to see their baby. I’m pleased I was so in control, it must have been an automatic response. When I finally left the hospital they still had no idea what was wrong with baby, I was certain that it was my fault, I must have missed warning signs, something should have alerted me during the labour. In the middle of the night J’s husband phoned me, baby had been transferred to a high level NICU, he had a severe, right-sided diaphragmatic hernia, nothing could be done, his lungs had never been able to develop, his ventilator was switched off after 48 hours. Why am I recounting this? If I was that Kent Midwife I would have gone ahead with a homebirth, the outcome would have been the same but, supposing that the hernia had not been as severe, having been born at home would certainly have jeapordised him. How would J, her husband and I felt if the same scenario had happened at home, would we ever have been able to come to terms with the sad outcome, would we not be saying ‘what if…’? An ultrasound had been performed when the polyhydramnios was discovered, the sonographer failed to see the hernia, unfortunate, but right-sided are unusual and more difficult to visualise, even so there on the report was a tick to indicate that the chest was normal, we believed that baby was fine, our only worry was the polyhydramnios causing problems, not a problem causing the polyhydramnios, the Kent midwife could have believed it just as we did. So, after tensing myself throughout her description of the labour, her only doing a vaginal examination because Sharon asked (supposing a cord or shoulder was presenting), I was relieved when baby, huge baby, was born without any problems and I relaxed, only to be bought up short by the haemorrhage and the management of it. 1500mls, that is a large bleed, not one that you just sit around observing, keeping a paramedic unit with you for 2 hours, and then finally go into hospital to ‘cover your back’. Supposing the woman had continued to bleed, there had already been one episode where “She then vomited and at the same time passed a huge amount of blood and clots”, this was after 2 previous ‘large’ bleeds’, how much more evidence of the advisability of medical support did the midwife require? All was well, thankfully, but to publish this story on the website, with such detailing of her minimising the risks, was sure to precipitate a reaction from many homebirth detractors, whilst giving them plenty of ammunition.

The story disappeared from the web-site after about 24 hours, hence the Google cache, the midwife has now been reported to the NMC, she has done nothing to dispel the caution with which Independent Midwives are viewed and helped reinforce some commentators opinion about homebirth.

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foetus_degagement_ventouse_obstetricale_l.jpg 

Three weeks ago I gave a ‘one-on-one’ parentcraft/antenatal chat to my daughter’s friend and her husband. She had a poor experience during her first labour, little support from her husband, and they both eager to avoid a repeat experience this time around. It all went really well, it even prompted me to have my demonstration pelvis repaired, I had dropped it some time ago and it had sprung apart. I say it went well, it went so well that they both then decided on a home birth, not something that I had expected, or suggested.

Well, on Easter Sunday, term +4 days they were round at daughter’s house and C’s waters went, there were niggles but little else. The hospital were contacted and they were invited in for monitoring. All was well so they were sent home to await the onset of labour. By Monday morning nothing was happening, a community midwife went round and explained to C that if she did labour now it would be advisable that she went into hospital, as our policy is that if the membranes have been ruptured for over 18 hours then the woman should receive IV antibiotics in labour as there is a risk of infection for the baby. C phoned me up to check that this was right and see if it would be safe to avoid this advise, I advised that she should give birth in hospital, and in fact, since they really want to get 2 doses of antibiotics in not to leave going in too late as they would then pressurise her to allow blood cultures on baby and a 3 days of antibiotics IV for baby, just in case. I then asked her when she was going in to be induced, Tuesday morning. That’s 48 hours though, I know policy changes frequently but in February it had been 24 hours rupture of membranes and then induction. I decided to shed my midwives skin and just be happy for her that she would have her baby. I’m off-sick so shouldn’t be getting involved.

Tuesday morning, prior to admission she went into labour. Coped really well at home and went in when her contractions were 10 minutes apart, on admission her cervix was 4 cms dilated. All progressed well, TEN’s, birthing ball, huge amount of back pain. Eventually she couldn’t cope any longer and had an epidural, which only worked on one side. Throughout labour baby was happy, even with C pushing for an hour. Ultimately though an obstetrician came in and helped baby out with a Kiwi ventouse, at birth baby was in a occipito posterior position, basically he was facing forward rather than back. Baby well, if a trifle bruised, weighing in at a healthy 9lbs 6 ozs which was slightly less than his brother two years before. Happy family. 

Yesterday I saw Dad at Amy’s nursery and asked how things were going, I hadn’t spoken to them since the birth. If I’m honest I felt as if I had let them down in some way. Not sure how, or why, but that’s a midwife for you, always blaming yourself. Anyway, he was really happy with everything and was really grateful for the chat we had, he felt it had helped. He told me he was worried about baby’s cord as it was smelly, wet and the cotton wool was stuck firm. I didn’t really pick up on the cotton wool comment, I just assumed they had been cleaning it with that and so some fibres were left behind. Since I was going to be near them when I dropped Amy back to her Mummy I asked if he wanted me to drop some swabs round so they could give it a good clean up, he said that would be great as they weren’t seeing a midwife until Thursday. Round I went, admired baby and smelt what he meant about the cord, it was rank. I offered to give it a clean and was amazed when I took the baby’s nappy off to expose the cord area, it had a strip of cotton wool wound around the stump. So that’s what he meant about the cotton wool being stuck. As I disentangled the offending material from the cord I asked how it had ended up there. Apparently, when they attended the ‘drop-in’ postnatal clinic on Sunday, the midwife they saw recommended this as the way to care for the cord. I have searched and I cannot find any recommendation for this. Everyone seems to be united on the care of the cord, clean if necessary, and avoid dry cotton wool as it sticks (!). I just wonder of they misinterpreted what the midwife was saying, I hope so as her advise was not good. Once I had talked through what they should be doing with the cord I asked C about her birthing experience. She was really happy with everything. Full of praise for all the staff, impressed by how much better it had been than last time and had felt ‘in control’. Apparently her husband had been fantastic, really supportive and they put it all down to our chat. C said that it had made a huge difference just being able to ask as many questions as they wanted and being given ‘down to earth’ advice. Her husband then went on to suggest that I start doing it privately and be paid for it as before they had attended private childbirth classes which were useless and that my chat was more informative and realistic.

So, now I’m pondering. I can’t afford to give up work but I could suppliment my income by running classes. I have all the teaching aids as I bought my own for conducting NHS classes because that equipment was so decrepit. I live in an area where there is a demand for private childbirth classes. I have the qualifications. Right, contact the NMC, our regulatory body, to check if there is a problem with me setting up privately and running them from my own home. Bloody answerphone, unable to take my call. I know me, I run with an idea but lose my energy if I can’t start acting on it. At the moment my head is buzzing with ideas for content (loads), structure (minimal), advertising (local amenities & the paper, perhaps even a website, with e-mail). Oh come on NMC, speak to me, I want to deliver but I can’t without your assistance.

(Don’t suggest I speak to my SOM (supervisor of midwives), she is in the pay of the Trust and therefore any advice from her on personal schemes is going to be tainted by Trust concerns.) 

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God bless him, my favourite G.P is once again goading midwives, this time those who attend homebirths, in his offering ‘Midwives and home births: the truth’. I can’t seem to discover any ‘truth’ a la Dr Crippen in this, which I find surprising as he says that this Guardian article, concerning the journalist’s recent experience of his wife’s home birth and including an interview with one of the midwives, ‘sums it all up’, and he then concludes by advising ‘make sure that there is a doctor close by when you have your baby’. I’m not sure why, or how the article supports this advice but if I take the title of Dr C’s entry at face value, then I can only conclude that the good doctor has finally decided that there is a place within the maternity services for homebirth!

It will be sad to stop the debate but soon there should be a definitive answer to the question of where is the safest, best place to give birth, so then Drs C and T will either have the last say or, have to eat their words. A study, Birthplace, by The National Perinatal Epidemiology Unit is underway. The study will answer questions about wellbeing, safety and quality, women’s experience of care, the process of transfer from planned place of birth, and the cost-effectiveness of different systems for care. The study will reach it’s conclusions in 2009 so, within 18 months we should have an answer to the perennial question of how safe is home birth?

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