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Articles, Coombe, Home birth, Pregnancy after miscarriage, Pregnancy Diary, Third baby, Ultrasound

Pregnancy Diary – Week 4 – Securing a home birth

Posted on April 16, 2015 at 6:55 pm by BirthToBaby / 0

I found out I was pregnant last week. I’d told myself I wouldn’t buy any pregnancy tests this month but then decided to do a pregnancy test I had left over from the previous month!

I’d been unbelievably restrained this month – in previous months, I’ve had loads of internet cheapie tests and actually run out of them before 10 dpo (days past ovulation) because I was so addicted to pregnancy tests, I’d have used them all before you could even tell whether I was pregnant or not. This seems insane to everyone except the other women who do it!

The test was positive (obviously!) – so I told my husband. We were happy, and cautiously optimistic after two previous losses – surely third time lucky?

The next task, after a decent sleep, was to secure a midwife for a home birth. There are currently just three self-employed community midwives (SECMs) covering Dublin under the HSE home birth scheme so usually you call your midwife as soon as you see those two lines. I was still very early calling though, less than 4 weeks, so I was confident that my midwife would be available and we had been keeping in touch so that I knew when she was taking holidays. But, disaster: I called, and due to a previously unforeseen family commitment, she was going to be away in October. Immediately, I had a feeling that this baby was going to be the one that made it. I’d previously not birthed with this midwife, who I had built an incredible relationship with during my last pregnancy, because I had to transfer my care to hospital at 42 weeks when I didn’t go into labour with my son within the timeframe covered by HSE home birth insurance. I was shocked, but decided to take her unavailability as a good omen, and called the other two midwives covering my area, one of whom had just started her practice as a SECM.

When both told me they’d be on holiday for a few days in October, during the period they’d have been ‘on-call’ for me, I felt even more sure this baby was a keeper! I rang two other midwives who live further away, but one wasn’t accepting clients currently and another said it was too far a distance from her to be safe. So five midwives, no one to attend me. I’m not eligible for the free home birth service provided by the Domino midwives in Holles Street because I don’t live in the catchement area, although renting an apartment in the area was a possibility. So was moving to another area of the country, such as Cork, where home births are easier to organise as there are more midwives. But with my husband in final year in college, and my daughter starting primary school, uprooting for 5 weeks or so was extremely unappealing.

Luckily, a private service called Neighbourhood Midwives set up last year in Ireland. Neighbourhood Midwives work in partnership with UK Birth Services (UKBC), who offer a full home birth service that is subject to different ‘rules’ than the SECMs are – they are not bound by the Memorandum of Understanding (MOU) that the SECMs have to sign to work as part of the HSE scheme, as they have their own insurance. The MOU dictates to the SECMs conditions under which they can and can’t attend women – anyone who is over 40, for example, needs to be ‘signed off’ by an obstetrician as suitable for home birth and you need a flexible obstetrician to sign you off if you gestate longer than 42 weeks ( I couldn’t find one for my previous birth). If you have Group B Strep, Gestational Diabetes or a previous Caesarean section (to name just a few criteria), you cannot have a home birth under the HSE scheme. UKBC, however, are able to provide service based on individual assessment by their midwifery team, rather than blanket bans, with safety for both mother and baby obviously always as the top priority. The catch? The service is expensive, although most people’s private health insurance will cover the bulk of it. I, however, don’t have private health insurance.

Not sorting this insurance when I was trying to conceive is one of the most expensive decisions I’ve ever made. At the time, when I was grappling with the demons that follow recurrent pregnancy loss, it seemed presumptuous to organise it. I’d also been keeping in contact with my midwife to confirm her availability at regular intervals and I’d booked her for the pregnancies that hadn’t lasted. Plus, a big part of the healing from losing my home birth the last time was hoping I’d have another shot at it, with her looking after me.

There was never a question, though, of the birth of this baby being anything other than a planned home birth, however it eventually goes. So after talking to the lovely Heather from Neighbourhood Midwives, I’ve booked in with UKBC and requested Gail Mackey as my midwife. Gail is someone I’ve met at home birth conferences on a number of occasions and I always thought she would be a wonderful birth attendant. Being looked after by UKBC means that I don’t need permission from an obstetrician to birth at home because of my age, and I also don’t have a 42 week deadline hanging over my head. It’s already so much more relaxing – seems I needed the universe to conspire and arrange the perfect caregiver, as I didn’t know what was good for me!

Moral of the story – if you’re thinking of another baby and considering home birth, get your health insurance, with good home birth cover, in place. I know, though, how much pleasure I’ve gotten from replaying the births of my children in my head. It might seem expensive, but if you break this birth down by pay-per-view, I know it’s going to be great value for money. In years to come, the cost will be forgotten but my birthing memories will be clear as crystal.

So the midwife is sorted, and I have a wonderful doula lined up. All I have to do now is forget about being pregnant for the next 4 or 5 weeks until my reassurance scan!

Resources
For more information on home birth in Ireland, check out the Home Birth Association website: http://www.homebirth.ie/

If you would like to know more about Neighbourhood Midwives / UKBC services, which include the only home birth after Caesarean service in Ireland, their website is: http://neighbourhoodmidwives.com/

For more information on the HSE home birth scheme, visit:
http://www.hse.ie/eng/services/list/3/maternity/homebirth.html

There is a booklet detailing the home birth service provided by the National Maternity Hospital at
http://www.nmh.ie/maternity-care-options/community-midwives.220.html#home_birth

For illuminating statistics on the outcomes of home birth in Ireland in 2012, download this booklet:
http://www.ucc.ie/en/media/research/nationalperinatalepidemiologycentre/NPECHomeBirths261113AnnualReportWebReady.pdf

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Articles, Pregnancy after miscarriage, Third baby

Loss and Rainbows

Posted on April 11, 2015 at 6:55 pm by BirthToBaby / 0

It’s 6 years since the day we found out we had lost our first baby. I was 12 weeks pregnant and, after experiencing the teeniest amount of spotting, I had an appointment in the Early Pregnancy Unit for a scan. There was a serious baby boom back then and ‘booking’ appointments were happening incredibly late – mine was at 21 weeks – so this EPU appointment felt like a chance to get a sneak peek at our baby. In our innocence, we were giggly and excited, and didn’t for a moment imagine there was anything wrong as we headed into an early morning appointment. We were back on the street a half hour later, our future changed forever after an instant of horrible stillness. Our much-loved baby had become ‘retained products’. It was 8.30am. Where to now?

Missed miscarriage wasn’t something I knew much about – but now I had to decide what to do about it. This was my pre-GentleBirth life. I wasn’t informed about hospitals or maternity services or options. I consulted Google, found a very mainstream pregnancy forum and asked advice from some wonderfully supportive and sympathetic strangers, who had had similar experiences. Everyone said the same thing: have the surgery (ERPC – Evacuation of Retained Products of Conception. Bad enough having it, and the name adds insult to injury). I rang friends – lots of sympathy, but it didn’t help me decide. My gut told me that waiting it out was right for me and my baby – even though my baby had been gone already for around 4 weeks, I instinctively felt my body would be able to take care of business. But then, fear – I had a cramp and completely freaked out at the thought of miscarrying at home. I rang the hospital and booked in for two days time, to have the ERPC.

That left a day in between and for some reason we decided that morning to go to Mount Usher Gardens in Wicklow. It’s a beautiful place and I felt as I had to be sad, I might as well be sad somewhere lovely. I think the trip may have been prompted by good weather, but I have little recollection of the day other than breaking down in the car on the way home and crying about my lost little baby for the first time. I wailed in a way that felt like it would break my body, as though I could literally break my heart.

I think the experience in the hospital is for another post – suffice to say, I was not cared for emotionally in a way befitting of the emotional pain I was going through. The weeks that followed were tough. Why is the devastation of miscarriage not spoken about, when it is so common it is almost a rite of passage as a woman? It changed me in a way I wouldn’t have thought possible and marks me still. The grief went to a place inside me I hadn’t known existed, but I know now that place is motherhood. I wanted to conceive again as soon as possible and although I don’t think my desperation was very attractive, we somehow managed to do so very quickly and, just 7 weeks after that awful day, I was pregnant again.

I have no idea why I chose Mount Usher on that day, but it has become a very important place to us. We had no remains returned to us after my surgery. There is no grave, no other place to associate physically with our baby. The following year, we went to Mount Usher on the anniversary of the miscarriage, to honour our lost one. It was joyous to be there with our 6 week old, having wondered the year before if we would ever have children. Each year, we go to the gardens in April, to celebrate the short life of our first baby. It’s become a very special way in which to remember, mark time, and take stock. Going there is simultaneously returning to a moment in time, where I can meet my baby by remembering that sadness, and celebrating how far we’ve traveled each year as a family.

2010 – With our 6 week old

2011 – Now 13 months and flying around the place!

2012 – 2 years old and non too impressed….

….and 39 weeks pregnant!

2013 – 11 month old’s first visit.

2013 – Proved impossible to get a decent family photo!

2014 – Now aged 4 and 2

Since the miscarriage, I have carried two healthy babies to term. Both pregnancies were emotionally challenging in the early weeks, for different reasons but physically easy, and wonderful once we got to the 20 week mark. I’ve had beautiful births, thanks to the GentleBirth programme. There is so much to be grateful for. But this year I could have been at Mount Usher again with a full term bump, or a slightly smaller one. I lost a baby last year who would have been with us within the next few weeks, and another a short while later who would have arrived this summer. They were very early losses, with no physical trauma and I was thankful that the pregnancies hadn’t struggled on, only to fail at a later stage. There being two consecutive losses was worrying – and Google didn’t help matters as it told me fertility drops off a cliff at 39 and only 1 in 4 of my eggs are likely to be of much use. The last few months have been difficult at times – being in the ‘baby business’ , I am in contact with pregnant women constantly although, strangely enough, bumps that I meet professionally don’t induce any jealousy. I have naturally enough felt pangs at seeing what sometimes seems like everyone I know becoming pregnant over the past few months. But it’s been entirely bearable – not the running-my-guts-through-a-mincer feeling that was so overwhelming after my first loss.

The day we spent in Mount Usher this year was our most memorable yet. My 5 year old, who has been extremely challenging lately, was an angel for the day. The sun came out as we arrived and, as the weather had been unpromising, it seemed we had the place to ourselves. We had a fabulous picnic, followed by a gorgeous meander that magically took us to spots we’d never been before. And the highlight…I got to see the sheer excitement on my first rainbow baby’s face as we told her, in our special place, that we will be welcoming another into our family this autumn. In time for Hallowe’en. We all agreed – this was the best day ever. Until next year….

If you are trying to conceive, recovering from pregnancy loss, or pregnant and experiencing nervousness, you can download free GentleBirth sample tracks to support you on the Free Downloads page. The tracks have helped me hugely over the past number of months. Wishing you well on your journey.

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Articles, Birth preferences, First baby, GentleBirth workshop, Placenta, Third stage of labour

Why the third stage of labour should be more than an afterthought

Posted on January 27, 2015 at 6:55 pm by BirthToBaby / 0

How many of us spend time considering birth preferences for the third stage of labour ? Very few, and yet what happens between the birth of baby and the expulsion of the placenta can have a significant impact on our birth experience. During the third stage of labour, the placenta separates from the uterine wall and the uterus contracts to expel it. As the placenta separates, there is some bleeding from the area of the uterus where it was sited. The amount of bleeding varies from woman to woman – blood loss greater than 500ml is considered a post partum haemhorrage.

Currently, the policy in all Irish maternity units is to carry out a managed third stage of labour. This involves giving an intramuscular injection, of either syntocinon or syntometrine, into the thigh. Many women will not even know they’ve had this – they are so engrossed in their newborn that it doesn’t even register. Once the injection has been given, a strong surge usually follows and the placenta is often expelled quickly. Your midwife will feel the uterus to see if the placenta is separating from the wall of the uterus and may use what is called controlled cord traction (pulling the placenta out) to hurry the process along, or may encourage you to push it out. If you have a managed third stage, your risk of a post partum haemhorrage (PPH) is reduced.

The alternative is to have a physiological third stage. The placenta is left to separate itself, without drugs to speed up the process. It should be expelled using maternal effort, rather than being pulled out. Although a managed third stage is recommended based on current research which shows it lowers the risk of PPH, a study comparing physiological third stages in settings that do not fully support that mode of birth and settings that do is not available. It has been observed by midwives that women who have a physiological third stage may bleed more immediately after birth but then bleed less post partum than those who have a managed third stage, but this is anecdotal rather than backed by evidence.

The vast majority of women will have a managed third stage, as part of the standard package of hospital based maternity care. In a home birth setting, most women will have a physiological third stage and have no problems with blood loss. In the midwifery led units (MLUs), physiological third stages are far from unusual. But how can you decide what is right for you?

Dr. Sarah J. Buckley believes that we should resist intervening in the third stage of labour, if all has been well up to that point. The birth process is driven by hormone interactions which, when disturbed by some routine hospital procedures, can have negative consequences for mothers and babies. The drug given in the third stage of labour is an oxytocic drug – it is a synthetic version of the naturally occurring oxytocin in our bodies, which is at its highest level just after the birth of our babies. Oxytocin is released as we gaze at and touch our wondrous newborn, and yet more is released if baby makes her way to the breast and nuzzles and latches on. The levels peak around the time that the placenta is expelled. So if our body already has everything it needs to do the job, why do we need an injection to help?

Midwife Rachel Reed, author of the Midwife Thinking blog, explains here why the hospital environment is not always conducive to a physiological third stage of birth. Many women arrive at the third stage after having interventions along the way – birth has not been physiological up to that point. Furthermore, the third stage of labour is a time when mother and baby should be left undisturbed, to get to know each other. Uninterrupted skin-to-skin should be facilitated, to allow oxytocin levels to reach their natural peak – no weighing or other checks that separate mother and baby should be carried out. There can also sometimes be fear in the room if staff are not used to facilitating a physiological third stage – this stress, and the time pressure (sometimes hospitals will put a limit of 1 hour on a physiological third stage) can cause adrenaline release in the mother, which can suppress oxytocin release. My own experience, as a doula in Irish hospitals, is that some staff can become nervous as the hour approaches and the mother begins to feel pressure to perform and produce the placenta – not the ideal environment.

So if a managed third stage means less chance of a post-partum haemhorrage, why would you consider a physiological third stage? Well, a recent study suggests that breastfeeding duration may be affected by administration of drugs for the third stage of labour. Women who had had oxytocic drugs for the third stage of labour were significantly less likely to be breastfeeding at 2 and 6 weeks and were more likely to have stopped due to pain or difficulty breastfeeding. More research is needed to examine why this might be the case.

Another risk is that after the administration of the drug, the uterus may clamp down and start to close, trapping the separated placenta inside. This is why controlled cord traction is used, to help the placenta be expelled quickly. If the placenta is trapped inside, it will need to be removed manually in theatre.

Some women can feel sick, dizzy and too unwell to hold their babies after administration of the third stage drug. This is generally due to syntometrine rather than syntocinon being used. Syntometrine is a combination of syntocinon and another drug called ergometrine, and while effective at preventing haemhorrages, it somes with a list of unpleasant side effects. For this reason, Irish Obstetric Guidelines for preventing PPH recommend that syntocinon be used routinely, where the woman is not at increased risk of PPH. It is worth noting that the manufacturer instructions for syntometrine state that it can “inhibit prolactin secretion and in turn suppress lactation”. If you are attending a maternity unit where syntometrine is used routinely (Waterford and National Maternity Hospital being two), then you may want to have a birth preference that requests syntocinon, should you be planning a managed third stage or in case it becomes necessary.

If you have had a physiological or minimal intervention birth up to the third stage, then you may feel it makes sense to try for a physiological third stage. GentleBirth women often have confidence that their body, which has grown their baby from two cells and then launched it into the world with no conscious effort on their part, can finish the job on its own. The injection can be drawn up and ready to go, in the event that you begin to experience significant blood loss. This lovely article describes facilitating a relaxed third stage of labour. Midwives in Irish hospitals are thankfully now becoming more familiar with physiological third stage, as more women are deciding that this is the best option for them and their baby. As suggested in the article, maintain the ‘mood’ in the room, whether you birth at home or hospital. Leave phonecalls and texts until after the birth of the placenta. Stay together with your birth partner and supporters and marvel at the new being who has just come into your life. Examine your baby’s face, those teeny fingers and toes. Let baby crawl to your breast and familiarise herself with the new territory. Forget the clock – as long as there is no significant blood loss, the third stage of labour should not be time-limited. If there is a delay, getting into an upright position such as on the toilet can encourage the placenta to plop out. Most women will deliver their placenta within the first hour after birth, that magical period when you are getting to know the new and wonderful person you have brought safely into the world.

As with all birth preferences, there is no right or wrong answer. Being informed and having decision-making tools will mean that you can make the best possible choice for you on the day.

Further reading
Dr Sarah J Buckley on third stage physiology: http://www.birthspirit.co.nz/leaving-well-alone-third-stage-labour/
Midwife Rachel Reed discusses why a managed third stage may be the best option: http://midwifethinking.com/2012/05/05/an-actively-managed-placental-birth-might-be-the-best-option-for-most-women/
Gloria LeMay on the 30 minute third stage: http://www.glorialemay.com/blog/?p=161
How the placenta grows, functions and is birthed: http://42weeks.ie/2013/08/28/the-mysterious-placenta-and-the-third-stage-of-labour/

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Articles, Birth preferences, First baby, GentleBirth workshop, Holles Street, Induction

7 things you should know about having your waters broken

Posted on January 9, 2015 at 6:55 pm by BirthToBaby / 0

You hear it all the time – ‘I had to have my waters broken’; ‘My midwife said it was the bulging bag of waters that was holding me back’; ‘The midwife thought I’d have the baby really fast if she just broke my waters’. Sounds entirely benign, doesn’t it? Sometimes fully informed consent isn’t sought for the artificial rupture of the membranes (ARM); you may hear ‘I’ll just give your waters a nick’ as a vaginal examination is being performed. So it couldn’t be a big deal, right?

Here are 7 things you should know about ARM. If you prefer not to have it, include birth preferences refusing it as a routine procedure.

1. It doesn’t always do what it says on the tin
It’s sold to you as making labour quicker: “We’ll just nick the waters there and you’ll have your baby soon”. Yes, sometimes ARM speeds up labour but sometimes it does nothing or even slows the process down. A review of the evidence says that ARM hasn’t been shown to speed labour up – it’s not evidence based. Why would it slow it down? Well, sometimes when the waters underneath the baby’s head gush out, the baby’s head can come down in a less then ideal position, meaning direct pressure is no longer being put on the cervix to cause it to dilate. You then have to work to get baby to move into a better position and with the waters gone, this is made more difficult. Sometimes your dilation can even go backwards after ARM – if it was the bulging bag of waters that was pushing the cervix open.

2. It may increase your chances of a Caesarean delivery
Were you told this when staff offered to release your waters artificially? Evidence shows that having ARM goes hand in hand with increased likelihood of a Caesarean. The water bag is protective and cushions the cord – once that cushioning is gone, there can be times when the cord becomes compressed and this can cause a drop in the baby’s heartrate, ultimately leading to a diagnosis of foetal distress and a Caesarean birth.

3. We don’t know if it’s safe
The amniotic sac, placenta and umbilical cord are something of a mystery. There can be variations in how the umbilical cord inserts into the placenta. One of these variations is known as velamentous cord insertion (VCI). Normally, the blood vessels connecting baby to the placenta are wrapped in a substance called Wharton’s jelly and protected by this and an enclosing membrane. With a VCI, the blood vessels are not protected at the placental end and are inserting separately into the placental membranes rather than the placenta itself. They are often entwined in the foetal membranes ie. the water bag. The major risk is that one of the blood vessels could be near the cervix (this is known as vasa praevia), and therefore could be ruptured if an ARM is performed. VCI is not very common, approximately 1 in 100 pregnancies, but it’s usually undiagnosed – I didn’t find out that I had a VCI until after my daughter was born. My waters had released themselves at 10cm – clever body!

4. It can speed labour up and make it unmanageable
Yes, I said earlier that it doesn’t always speed up labour, but sometimes it does, and your labour takes off like a rocket. It can be very tempting if you are plateauing at 4cm dilation for a couple of hours to consent to an ARM in order to get things going. However, you might find yourself going suddenly from coping well with your surges to not coping, as sometimes ARM can accelerate labour and make surges longer, stronger and closer together very, very quickly. This means that you have not had the opportunity to build up endorphins in your system to deal with the sensations of the surges, nor have you gotten into the labour groove with coping mechanisms. Many women opt for an epidural after an ARM because they feel they cannot manage the intensity of labour – the epidural may then have the effect of slowing labour down! Cue the syntocinon drip to speed it up again…a classic cascade of intervention.

5. Meconium in the waters can change the course of your labour
Some babies poo before they are born – this is known as meconium. It is more common with babies who are over 40 weeks gestation and is indicative of a mature gut rather than distress, if baby’s heart rate is normal and all is well otherwise.

When meconium is found in your waters, it is generally hospital policy to use continuous monitoring, or cardiotocography (ctg), to check your baby’s heart rate from then on. However, ctg has a notoriously high rate of false positive for foetal distress, and so your chances of a Caesarean increase by around 30% once it goes on. Your movement is also somewhat limited, although you can work around this if necessary (it is not necessary to be on your back in bed if you are on ctg – you can be on your knees on the bed or floor or sitting on a birth ball, for example).

You will also be on a clock, as staff will not want a delay in delivering baby with meconium present – the time limit for labour may now be reduced.

This fascinating article looks at what happens if meconium is found in your waters, if you would like to know more.

Bottom line – if there is meconium in your waters, it is safer for baby and more desirable for your labour experience that your waters remain intact for as long as possible.

6. The water bag protects baby from infection
You may or may not have heard of Group B Strep (GBS). This is a bacteria which up to one in four of all women carry in the vagina. It doesn’t require any treatment and, for the non pregnant population, isn’t a problem. For most pregnant women, it still won’t be a problem, but in some cases, baby can become very sick if infected. Policy in some maternity units for managing labouring women with GBS is that there should be no ARM routinely – so if you don’t know your GBS status, it makes sense to leave the waters intact. You can find out more about GBS at this very informative website.

7. We just don’t know what’s going to happen next
We can’t predict what will happen after an ARM – maybe labour will fly and we’ll be holding our baby 2 hours later. Or maybe our baby will be born by c section, after going into distress following the ARM. All interventions carry risk – and ARM can lead to a number of obstetric emergencies. Our best chance at a vaginal birth is always to avoid any unnecessary intervention.

Labour is unpredictable and sometimes we depart from our birth preferences. On the day, you may feel, all things considered, that ARM is worth a throw of the dice. As long as we make informed choices and are in the driving seat, birth can be a positive experience, whatever path it takes. Guidelines from the Royal College of Midwives state that ARM should not be routine and should only be carried out after a discussion with the woman – and that this discussion should not take place just before or during a vaginal examination. When making choices, always take the time to ask any questions you have and, if you feel you need to, you can ask staff to step outside the room while you discuss your options with your birth partner. It is difficult to get into the headspace to make an informed decision when someone has their fingers inside your cervix!

For further reading, check out:

http://midwifethinking.com/2010/08/20/in-defence-of-the-amniotic-sac/
https://www.rcm.org.uk/sites/default/files/Rupturing%20Membranes.pdf
http://42weeks.ie/2013/10/02/may-i-break-your-waters-information-on-artificial-rupture-of-membranes/

Day 2 of the Your Birth GentleBirth workshop looks at standard hospital policies and procedures and birth preferences. Find out more about our workshops here.

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Articles, Reviews

What’s your baby bible?

Posted on November 1, 2014 at 6:55 pm by BirthToBaby / 0

How much do you know about babies or did you know before you had your first? Some people are lucky to be au fait with baby care if they have older siblings with children, but myself and my husband were completely clueless. When we were giving our daughter her first bath, we had to read the instructions step-by-step as we went along. It had taken me a good half hour to deal with the first meconium poo and probably the rest of the hour to get a vest and babygro on her.

So for those of you who haven’t a breeze, The Baby Book by Sears and Sears should get you up to speed.

This book is definitely on the crunchy side – Dr. Bill and nurse Martha Sears are attachment parenting advocates, and parents to eight children. But you don’t have to be planning to breastfeed, babywear and bed share with your baby in order to find this book practical. It’s a book that a lot of GentleBirth parents will relate to, as the book talks about having a safe and satisfying birth as the first step on the road to positive parenting. It is mostly aimed at those intending to breastfeed – there are a couple of chapters on breastfeeding basics and troubleshooting in the early weeks – but there is also a chapter on formula feeding.

The book is laid out by chapter subject, rather than chronologically, which makes it less goal oriented than the likes of What to Expect – The First Year (which seems to be an endless list of things your baby should be doing that you can tick off). Chapters include babywearing (carrying baby in a sling) and nighttime sleep, parenting the fussy baby, as well as chapters on feeding. There are sections on baby development from 0-6 months, 6-12 months and the second year. The chapters on the second year include dealing gently with undesirable toddler behaviour.

What I love about this book is that it encourages trusting your instincts and going with the flow – tuning into your baby and your baby’s needs as you get to know each other. It’s not prescriptive, there are no routines or schedules and while it details milestones your baby will reach during the first two years, there’s more of a range of age given for these than in some other books.

Basic stuff like nappy changing and bathing is covered, of course, for the uninitiated! Sure, at times most first time parents will probably find bits of it a little too ‘attachment’ for them. I know I did. But it all seemed completely normal by the time I had my second!

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Articles, Birth preferences, GentleBirth workshop, Labour toolkit

Do you have a labour playlist? Why music can contribute to a more comfortable birth experience.

Posted on August 21, 2014 at 6:55 pm by BirthToBaby / 1 Comment

Did you use music to enhance your experience of labour? Or are you working on a playlist for the big day? You may recently have seen the videos Robbie Williams and his wife shared online, showing him playing (and singing) music to keep her distracted in labour! While various sources have referred to his behaviour as ‘bizarre’, there is a scientific basis to using music as a pain relieving measure for labour.

The use of music to provide comfort in labour and reduce pain perception and anxiety is backed by the findings of research studies, although these are of small scale (Phumdoung & Good 2003; Liu et al 2010). A recent study suggests that the use of music in combination with upright positions is more effective than synthetic oxytocin (“the drip”) in shortening the active phase of labour (Phumdoung et al 2014).

While research on the effects of music in labour is scant, a growing body of research supports the use of music in a variety of clinical settings. Studies have shown that music alleviates pain, both when used as a therapy in its own right and in conjunction with other methods. Music has been shown to reduce stress and anxiety in patients undergoing medical procedures, and, used post-operatively, to reduce the need for pain medication. It has both psychological and physical benefits.

So when it comes to birth, how can music help?

1. Music that makes us feel good does us good!
The amount of pain we perceive is linked to the emotional state we are in when we experience the stimulus (Nauert 2009). Music that evokes positive emotions and relaxes us can decrease the amount of pain we think we are in and help us to tolerate the sensations that we are experiencing.

2. Listening to music can increase the level of our ‘good’ hormones in labour.
Labour involves a hormone cocktail, the main ingredient of which is oxytocin. Oxytocin drives the uterus and is also a natural pain reliever. Music has been shown to increase oxytocin in the body. In a study comparing bed rest only with bed rest and music for patients recovering from heart surgery, oxytocin levels in the music group were significantly higher the day after surgery for the music group (Nilsson 2009). Music has also been shown to increase the release of dopamine into the bloodstream (Salimpoor et al 2011). Dopamine makes us feel happier, which affects our experience of pain. However, it is also the main neurotransmitter involved in our perception of time. Increased dopamine levels mean that labour can feel faster, in the same way as feeling good during a night out makes it pass in a flash!

3. Music provides an alternative focus that competes with your labour sensations.
We feel more pain when our attention is focused on the source. Music chosen by you works best (Bernatzky et. al 2011) as a point of focus, and research shows that music that is familiar to you and that hooks you in has greater pain relieving properties. So pick music that you love and gets you singing along. The more involving the music, the greater the benefit! One study showed that the better the listeners knew the lyrics of a song, the greater was the pain reduction experienced (Mitchell et al 2009). Music that is already infused with meaning and emotion for you, such as music you may have enjoyed with your partner in the past, is an ideal choice.

4. The act of listening means the brain processes less pain.
Since the brain processes music and pain along the same neural pathways, it is believed that music can block signals of pain at the spinal cord level, before they even reach the brain. This is the gate control theory of pain. This means music works in a similar way to a TENS machine.

As a doula, I once supported a woman who had a very long prelabour. We spent a day in her home when she was in early labour, with her partner selecting music that he knew she loved over the course of 12 hours or so. The day passed in a flash – for me, anyway!

Most of us have already experienced these beneficial effects of music – whether it’s the electro on your headphones helping you to work out for longer, your favourite album distracting you from the cleaning or that evocative holiday tune raising your spirits on a rainy December afternoon. So what’s on your playlist for your baby’s birthday?

Bernatzky G, Presch M, Anderson M, Panksepp J. Emotional Foundations of Music as a Non-Pharmacological Pain Management Tool in Modern Medicine. Neuroscience and Biobehavioral Review. 35:1989-99 (2011).

Cepeda, M.S. et al. (2006) Music for pain relief. Cochrane Database. Syst. Rev. 2, CD004843

Liu, Y. Chang, M. & Chen, C. (2010) Effects of music therapy on labour pain and anxiety in Taiwanese first-time mothers Journal of Clinical Nursing 19 p1065 – 1072

Mitchell, L; MacDonald, R..; Knussen, C. An investigation of the effects of music and art on pain perception.
Psychology of Aesthetics, Creativity, and the Arts, Vol 2(3), Aug 2008, 162-170.

Nauert, R. (2009). Emotions Influence Perception of Pain. Psych Central. Retrieved on August 21, 2014, from http://psychcentral.com/news/2009/11/11/emotions-influence-perception-of-pain/9482.html

Nilsson, U. (2009) The effect of music intervention in stress response
to cardiac surgery in a randomized clinical trial. Heart Lung 38, 201–
207

Nilsson, U. (2008) The anxiety- and pain-reducing effects of music
interventions: a systematic review. AORN J. 87, 780–807

Phumdoung, S., Youngwanichsetha, S., Mahattanan, S., Payakkamas, T., Maneechot, K., Chanudom, B. and Ajasariyasing, T. (2014), Prince of Songkla University Cat and upright positions together with music reduces the duration of active phase of labour and labour pain in primiparous women compared to oxytocin. Focus on Alternative and Complementary Therapies, 19: 70–77.

Phumdoung S, Good M. Pain Manag Nurs. 2003. Music reduces sensation and distress of labor pain. Jun;4(2):54-61.
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Salimpoor, V.N., Benovoy, M., Larcher, K., Dagher, A. & Zatorre, R.J. (2011). Anatomically distinct dopamine release during anticipating and experience of peak emotion to music. Nature Neuroscience, Published online 09 January 2011

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Articles, Breastfeeding

What is a breastfeeding support group like?

Posted on August 3, 2014 at 6:55 pm by BirthToBaby / 0

They’re a bit militant”, said one friend, who had gone to La Leche League once, 18 years before. “Great if you’re having problems”, said someone else. “What’s that for”, said a third, a mum of 4 breastfed children who had never been to a group. “Let’s get our tits out and chat?”

It didn’t sound like my cup of tea (I’d no frame of reference for people sitting around with their boobs out, chatting), but I thought I’d check into what was on locally. I looked up Breastfeeding.ie to see what was on. There were no fixed locations for any of the Cuidiu or La Leche League meetings, just phone numbers of people to ring for information. I don’t do cold calling. I left it.

When my daughter was born, she was at the breast within 20 minutes and between the GentleBirth Confident Breastfeeding mp3, Ina May Gaskin’s Guide to Breastfeeding, our instincts and the need to get the hell out of a busy postnatal ward, she was self latching by her second day of life and we were home. Bar a few seconds of toe curling burning when she’d latch on, there was no pain and none of the nipple tenderness I’d expected. She piled on weight. I’d no breastfeeding problems, so what would I be going to a support group for?

Fast forward 14 months or so and a weekly Cuidiu Breastfeeding Support group started up in a hall a few minutes walk from my house. At this stage, I was still breastfeeding and in need of a bit of support, being now in the ‘weird breastfeeder’ category, as I was feeding a walking, talking child (it’s funny how this happens. You start off thinking it’s weird yourself and then just keep feeding your baby – and, one day at a time, they become a toddler). Despite the World Health Organisation and the HSE recommending feeding to two years and beyond, it’s highly unusual in Ireland and I had only ever met one person who had fed that long and she had gone home to Poland. So what did I find? A group of very lovely women, sitting around drinking tea and eating biscuits and, yes, breastfeeding. I’ve been attending that group regularly now for over 5 years – through two more pregnancies and feeding two more babies to toddlerhood. When I had my son, I was up at the group 6 days later, proudly showing off my newest breastfeeding expert. My third baby is now 17 months old and I’m still a fixture at the group.

What kept me going back was the community feel of the group. I made new friends, women on the same wavelength when it came to parenting. We shared knowledge, ideas and lots of laughs. Often new mothers come, upset that they are having issues, perhaps worried that baby is not putting on weight, and feeling unsure of themselves. They generally leave feeling reassured, and like someone has their back as they navigate the minefield of early parenting. Attending the group was my introduction to Cuidiu, a fantastic organization supporting all parents, regardless of feeding method and at different ages and stages.

I wish I’d known when I was pregnant that I’d be welcomed with open arms, not made to feel awkward by women who were there to chat with their boobs out. I wish I’d known that it wasn’t ‘militant’ – it’s warm and supportive. Everyone, from the group facilitator to the other mums there, wants to help you to meet your breastfeeding goals. You’ll be met where you’re at – whether you plan to breastfeed for 6 weeks, or 6 months – you aren’t expected to go in with the WHO’s two years as your goalposts. Few of us plan to end up there, it’s just something that happens. I wish I’d known that it’s a good idea to attend when pregnant. We LOVE to see bumps coming in the door – because we know that woman is more likely to meet her breastfeeding goals as she’ll be quicker to seek support when her baby is born. It’s a lot easier to get yourself to a meeting postnatally when you know the terrain – instead of handling nerves about who and what you’re going to find there as you try to grapple with motherhood (and the inevitable poopsplosion that will happen as you’re finally almost out the door), you’re going to meet new friends to show how much cuter your bump is now it’s on the outside.

It’s said that it takes a village to raise a child – sometimes, as we live in a culture where breastfeeding is attempted by a minority, we need to create our own breastfeeding village. You can do that via Cuidiu or La Leche League or, sometimes, via your local HSE breastfeeding support group. Incidentally, when I finally rocked up to my first LLL meeting, I found it wasn’t any more ‘militant’ than Cuidiu. Just more women sitting around drinking tea – but they had healthier snacks.

What GentleBirth Mothers say…

“The local breastfeeding support group was my life saver. Not for breastfeeding, but to meet other new mums going through the same things. For the first few months I would just get through each week by counting how far it was to Tuesday. 6 years on and I count these women as some of my most treasured friends”. (Ruth)

“I went to the local (HSE run) group when my son was 13 days old and most weeks after that until I returned to work. I looked forward to the cuppa, biscuit and chat. Found it invaluable those first few weeks when I wasn’t very confident about breast feeding. The Public Health Nurse always answered questions and put me at ease. I don’t know if i would have kept going in the early weeks without it and I went on to feed my son for 2 years. An invaluable resource and I would highly recommended looking up local groups before baby is born so you can go either before baby is born or after”. (Linda)

When dd was 4 weeks, I went to a local group, everyone had babies in around the same age as mine, everyone recognised each others ‘wow I’m tired/she’s been fussy all night/we’ve had a great week’ and it was just … solidarity? To know I wasn’t alone, that I wasn’t the first and wouldn’t be the last mum who reckoned she hadn’t a clue. It’s where I met some of my most important ‘mammy friends’ too”. (Gillian)

“I’ve had a good few issues with feeding – tongue tie, inverted nipples, you name it! I expressed exclusively for my first son and am combining breast and expressing now for my 8wk old. It’s sometimes hard to know where to fit in when your expressing! I assumed everyone else at the meeting would all be naturals but it turned out that loads of the mums had had to pump for various reasons, others with tongue ties, there was even a mum with inverted nipples still feeding her 2 yr old using the shields! It was so encouraging and inspiring to meet mums who didn’t necessarily have the smoothest road but were enjoying a long and successful breastfeeding journey nonetheless”. (Danielle)

“Sometimes all you need is to be sitting in a room with women going through what you’re going through, even if you don’t talk to anyone, sitting close by and feeding your baby with a group of mums is extremely therapeutic and warming”. (Aoife)

“I went to the Breastfeeding group in my local health centre, but by the time my baby was 12 weeks old he was the oldest there, and we were struggling so I really needed the support. A while after I stopped going to the health centre group, I started going to a voluntary organisations group that was on in the afternoon so I didn’t have to get up too early! Went for the breastfeeding support, stayed for the cake, and more importantly for the social aspect of it as I didn’t have any friends or family that were around during the week for coffee or chats. It definitely normalised breastfeeding for me and helped me appreciate how boobs can solve almost any baby problem!”. (Lisa)

“On my first baby there was no way I would step foot in a local group. I lasted less than a month. This time I’ve found the local group and other breastfeeding mothers to be the biggest, most important support in my success”. (Laura)

“When you’re a first time mum, and everything in your day with a new baby is confusing and a little scary, meeting up with other mums who’ve been there and got through it and can offer practical, tested advice makes it all feel refreshingly normal!”. (Gillian)

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Birth Stories, First baby, GentleBirth workshop, Pregnancy after miscarriage, Rotunda, Third stage of labour

Amazing first birth in the Rotunda

Posted on August 3, 2014 at 12:06 pm by BirthToBaby / 1 Comment

Cleo, my first baby, was born on 23rd February 2010, and I suppose that was the real start of my journey towards being a GentleBirth Instructor.

I really wanted to have a natural birth and used GentleBirth during my pregnancy from about 26 weeks, doing home study and attending the workshop with Tracy. My concerns were avoiding an assisted delivery or a Caesarean, but I suppose I mainly wanted a positive birth experience, and I thought that keeping things as low intervention as possible was the way to go. The only person I had ever heard describe birth as “wonderful” had had a home birth, obviously with no epidural. My mother had described my birth as great once she’d had the epidural – “like being at the hairdressers”. I didn’t want to feel like I was in the hairdressers, I wanted to experience birth in all its primal glory, if I could. I devoured Ina May Gaskin’s Guide to Childbirth and felt that, after all, I was born to birth, so I could do it. My husband was super confident that he could support me, once we attended the workshop, and assured me he’d seen hundreds of births and could probably manage the delivery himself (he’s from a dairy farm!). I had a great pregnancy and felt so well and energised as I approached my guess date and then went over it.

I went into labour at my EDD + 6 days. The surges started at 7am and were only 7 mins apart. After an hour, they were 3-5 mins apart but I knew that there was no point going to hospital yet because they were not that intense. From the first surge, I knew this was it, so told Peter there was no point in going to work. We hung out at home for the day and just chatted. From an hour or so into my labour the surges were uncomfortable enough that I had to breathe through them. The hard bit was only one breath long, in and out and I would say to myself, this will pass quickly. They were sore if I sat down, but fine if I stood and swayed so I spent many surges bending over the table or the mantelpiece, reciting that affirmation. About 10 hours of this carry on, (the time really does pass so quickly!) and I started to get impatient that things weren’t going anywhere so went for a walk. On the way back, I had a waaaay more powerful surge and looked down and there was water coming out. The same happened on the next one so I assumed the waters had gone (tip: have a sniff if this happens to you…urine smells like urine, amniotic fluid is sweet-smelling!). It was about 7pm at this stage so we had dinner and went into the hospital. As I was very calm and relaxed, I was left in the waiting room for about an hour, during which time I was able to sit quietly and listen to GB on the headphones. I was totally relaxed between surges and just closed my eyes and breathed when I had a surge.

So now came the first difficult bit. I was examined and was only 2cm (felt like punching someone after 14 hours or so of labour!) and it seemed the waters hadn’t gone at all – I had probably peed myself (I now think her head engaged at this point). But the midwife was insisting I stayed there and be admitted to the prelabour ward, while they’d send Peter home because it was out of hours. It made far more sense to us to go home and keep on as we were, when there was no medical reason for us to stay – especially when she said that my labour might slow down and they’d have to speed it up with drugs. Which was the reason I didn’t want to be admitted in the first place! We were most definitely going home! She said no, we said yes, eventually she got a doctor down who scanned me and told us there was no problem if we wanted to go. She said she worked in England where people were a bit more vocal about their wishes so it seemed pretty normal to her for me to want to be at home and I’d be better off. I was so proud of Peter as there was no way he was going to budge and be convinced to stay there, we were going home, and that was that.

All that lying around getting the trace on the heartbeat and being scanned threw out my focus though and when we got home I could feel things were harder to cope with. After about an hour, the surges were 4 long breaths out and in at the peak and very little break between them. They were radiating from front to back and it felt like my pelvis was going to explode. I got a bit panicky and I started to feel like I really needed the epidural and I wasn’t coping. So back to the hospital, this time I wasn’t very calm and couldn’t sit in the waiting room, could only lean over the reception desk, but was examined very quickly and was 6cm. I got the gas and air at this point as I couldn’t lie down for them to do the trace on the baby without it. Then went straight to delivery and got the gas again. The gas was like being really drunk, you can still feel everything but you don’t give a sh*t! Plus it helps focus your breathing. Was great because it meant I could lie down and rest and just flake out between surges which was a godsend because I’d been on my feet most of the day.

It was a quiet night in the Rotunda and there were two midwives in my room plus a senior midwife popping in and out, as well as a medical student. When I was admitted, I asked about the epidural and the senior midwife looked at my birth preferences and said I was doing brilliant, that it was absolutely amazing to be admitted at 6cm on your first baby, and that I still had time for the epidural if I wanted it so to see how I got on. Was hilarious when they asked me if I had birth preferences and moaned, ‘Yes, but I don’t think I want to stick with them!’. They just told me to hand them over, helped me out of my clothes and handed me the gas.

The whole time I was in the delivery room, I listened to my GB tracks on my ipod over and over (just as well, as there was a good bit of chat from the others. If I had my time again, I’d tell them all to STFU and stop polluting my birthing space with their shite talk).

All of a sudden, a bit more than an hour after we arrived, I could feel myself lifting up and turning over onto all fours like it wasn’t me doing it (poltergeist!) and the midwife looked and said, there go the waters, your baby will be here soon. I gave up the gas as I couldn’t use it on all fours and I just had to be on all fours to be comfortable. My body started pushing the baby out and it was like throwing up after waaaaay too much drink, really really forceful but it was throwing down instead of up! In between surges, I just flopped, listening to my GB and when a surge came, I just let my monkey do it and allowed my body to completely take over. Totally switched off the intellect. I could feel her head coming down and it just felt so hard, like a little cannonball. Eventually I just knew I had to get out of the bed and stand up and I did and then she was really coming. As she crowned, it stung like billy-o and I saw my sex life flash before my eyes and felt fear….and just thought, this can be over now. So for the first time, I listened to the midwife telling me to push and I pushed…..and out she came! The perfect birth!

Straight away the midwife said, oh look, it’s a velamentous cord insertion. And she said the cord wasn’t pulsating when we tried to stop her cutting it – and she cut it. So when my baby was passed to me, she was passed from the side, sort of enter stage right rather than up through my legs, which made it a little strange. She was also mostly pink and had her eyes open, wasn’t crying and looked for all the world like she was taking it all in. She was the most beautiful little thing – I just exclaimed “Oh my God, she’s gorgeous”. But I have to say I didn’t feel a rush of love – amazement, awe, relief, pride, strength, empowerment……. The love came after I sat down on the bed and had a good rest! It was less than 3 hours after we arrived back at the hospital.

I was so wrecked as I lost “more blood than normal” – have discovered since the birth of baby no 2 that I seem to bleed quite a bit at the birth but have very little lochia afterwards. My bleeding both times was pretty much done after day 3. So I was given syntometrine to stop the bleeding and deliver the placenta. However, as the midwife was carrying out controlled cord traction, she snapped the cord (she shouldn’t have been pulling it at all due to the fact it wasn’t a “normal” cord), said “oh shit” and that’s where the fun started. The world and his wife came down to try to retrieve the placenta and when they couldn’t I had to be brought to theatre, where I was given a spinal and had it removed manually. I was also stitched while I was there as pushing through the crowning meant I had a second degree tear (which was very minor, and healed brilliantly and very quickly and mostly painlessly).

The funny thing is that while all of that was going on, I was fine. I breastfed my daughter and then when I was separated from her for an hour and a half, I was on such a high, I laughed and chatted to the staff in theatre. I felt like superwoman!!!!

The memory of feeling my daughter enter to world, to feel her come down and out of me is so special. I am so glad that I got to birth her actively, my way, as really all the midwife did was catch her.

Although it didn’t end well, I still look back on the whole thing as amazing – because up until the placenta fiasco it was the perfect birth. And I think the affirmation “I accept whatever path my birthing takes” helped me stay super relaxed when it all happened – when I look back, I just can’t believe how calm and happy I was while it was all going on. It was much worse for Peter who was left holding a newborn and wondering if I would come back….

Cleo was a very easy baby and fed well from the start. Amazed all the staff in hospital with her expert breast crawling! No sore nipples, no milk supply issues, just baby bliss. We took Early Transfer Home from hospital so I was home within 30 hours of giving birth. The ETH team were fab, but I can’t say they they were great with breastfeeding help because we really didn’t need any. It felt completely natural, I think due to confidence from the breastfeeding mp3.

Despite the turn it took at the end, I had a wonderful, empowering birth that for me was transformative. When we get in touch with our primitive selves, we are powerful and all conquering 🙂

Download the GentleBirth app today – there is a free week of full access when you register. https://www.gentlebirth.com/

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Birth preferences, Birth Stories, GentleBirth workshop, Home birth, Induction, Labour toolkit, Placenta, Second baby

A GentleBirth – however and wherever it happens

Posted on July 11, 2014 at 6:55 pm by BirthToBaby / 2 Comments

As my baby boy was due just before the legendary Ina May Gaskin’s appearance at the Home Birth Association conference in 2012, I was hoping he would be four or more days late. My daughter was born 6 days after her EDD, so I fully expected to reach 41 weeks or so of pregnancy. Although her birth had been a positive and empowering experience in hospital, helped by using the GentleBirth programme, I knew I wanted a home birth next time. I had found the transfer to hospital the most difficult part of the whole thing, particularly the admissions process.

When I found out I was pregnant again, I rang and booked in with a Self Employed Community Midwife. From 11 weeks into my pregnancy, she visited every 3 weeks or so, long visits during which we discussed every aspect of pregnancy, labour and birth. Over these many, many hours, my midwife and I built a relationship and I was so happy i would be sharing my birth experience with her. I used the GentleBirth programme both to prepare for birth and to cope with any worries that arose along the way. I found great support at Home Birth Association meetings and through a breastfeeding support Facebook group. My “mind movie” of how I hoped the birth would go involved me going into labour in the afternoon, nursing my daughter to sleep at bedtime, then going downstairs, getting into the birth pool and giving birth around midnight. I gave no thought to the possibility of being transferred to hospital as I felt this was remote and I have a personal philosophy of not worrying about things that might never happen.

My EDD came and went, and I was at the HBA conference to hear Ina May’s words of wisdom. It was a wonderful day and the perfect note on which to go into labour. I felt sure labour would start in the next few days. But by 41 weeks, the home birth deadline of 42 weeks loomed. I tried all the usual methods to encourage labour to start – walking, sex, hot curry, hot bath, reflexology, acupuncture and more.

By 12 days over, I was anxious and upset. I was to be scanned in the Rotunda the next day and expected to come under some pressure to set a date for induction. Having had such relaxed antenatal care, I dreaded going into hospital and dealing with obstetricians who would likely not be supportive of my decision to wait for the onset of spontaneous labour. My midwife called to me and her presence was an amazing comfort and calmed me. She performed a sweep and said my cervix was soft and favourable so labour could be imminent. I used my GentleBirth to stay as relaxed as possible and managed a good night’s sleep.

I found myself amazingly calm going to hospital to be scanned the next day. All was well with the baby although the obstetrician who saw me was shocked to see someone 13 days past their EDD! We discussed options with a consultant and I agreed to come in again 2 days later to be reassessed but refused an induction appointment.

Day term + 14 dawned – the last day on which I could have my homebirth. My midwife visited and again performed a sweep. We spent the day quietly at home. By the evening, it seemed certain that I would not have my longed-for home birth. I decided to focus on having a positive birth experience, wherever it happened and let go of any upset about not having a home birth for the moment.

Day term + 15. I attended the follow up appointment at the hospital, knowing more pressure to be induced would be applied this time. A consultant performed a scan and was happy with what he saw but still advised induction. We smiled politely and refused an induction appointment. He noted that the date on my booking form for the hospital was 27th April which made me 13 days over. When I rang my midwife that evening to tell her how things had gone, we realised that this meant that her insurance covered us till the following day when I would be, by these dates, term + 14. Surely my baby would arrive before then? I felt like I’d been granted a reprieve. I got a sudden burst of energy and ran around the house tidying, then bounced on my birth ball for a while and got up and danced to a song with my two year old.

Suddenly, I felt a gush – the waters had released! I was ecstatic. My home birth was going to happen after all! I rang my midwife to let her know and went for a walk to deal with the excitement. The regular Braxton Hicks I’d had for weeks intensified and I could feel more water releasing. I went home, put my daughter to bed and waited for labour to kick in, texting Krysia from the HBA for advice on homeopathic remedies to get things moving. I stuck on Dirty Dancing for a bit of nostalgia and for music to gyrate on the ball to. But by 11pm, nothing had happened. I was disappointed but went to bed, listened to my hypno tracks and fell asleep.

My midwife called the next afternoon and we decided we had to make a plan. As the waters had now gone, there was a risk of infection to the baby so induction the following day seemed the sensible option. We rang the Rotunda and I was booked in for the following morning. It was a scary proposition. I spent the day in communication with Krysia from the HBA and Tracy from GentleBirth for moral support and encouragement. I focused on the belief that, by having the rest of the waters released, my labour would kick off and I tried not to think beyond that. I packed my bag and went to bed early. In the middle of the night, my daughter woke, and I brought her into our bed so we spent our last night as a family of three snuggled up together.

Next morning, my parents arrived early and we set off for the hospital. It was a beautiful sunny day. As second timers are expected to progress quickly, I was brought straight to a delivery room on admission. I was put on a trace while we waited for the obstetrician, and myself and my midwife chatted. Immediately, I could tell that she understood what sort of birth I wanted. There was no issue with any of the birth preferences we discussed. The doctor came at 8.50 am and examined me, then released the rest of the waters, which were copious. By 9.20 am, I had had my first surge. The midwife in charge came in and told me that, in the event that I had to go on the syntocinon drip and continuous monitoring, that they would do everything they could to let me be in whatever position was comfortable. I wouldn’t be confined to bed, so not to worry about that.

We decided on a walk outside, with the idea to go for a coffee. I really wanted a chocolate twist from the Paris bakery. I also wanted to buy some underwear and slippers, as my hospital bag had had to be so hastily packed, and some Lego for my daughter. In the toy shop, I had to breathe through a surge for the first time. I was delighted that things were ramping up and labour was finally here! We went across to Penney’s and after paying for my undies, I got a massive surge and realised coffee was definitely off the agenda and we should get back to the delivery room quickly.

We arrived back at 10am and within a very short time, surges were coming every two minutes and lasting around 90 seconds. They were strong and the thought of the epidural crossed my mind as I leaned over the ball and gyrated and moaned through them, amazed at how quickly labour had intensified. I knew that if I was thinking about the epidural, then I was almost there, but couldn’t believe that could be the case after about half an hour of real labour! My husband was behind me using the double hip squeeze technique we had learned in the GentleBirth workshop although he kept taking his hands off between surges which meant he wasn’t getting started right at the beginning of a surge, making it less effective (I later learned this was because he was eating a sandwich to keep his strength up!). I was using the affirmation “I can do this” between surges as I was finding the lack of recovery time in between them very challenging. On my first birth, at it’s most intense, I still had at least 1 minutes rest time to flake out between surges and flake out I did. This time, there was no flaking, just pure hard work. The most difficult part was that I couldn’t speak during surges and in between there was not enough time to think and communicate with my husband as to what comfort measures would be helpful. But he was amazing, and thanks to our preparation, had a few ideas up his sleeve.

After some time, I decided I needed the gas and air but went to the loo first. I managed to get there, but once there, had no idea how I was ever going to be able to get off! My husband started doing acupressure, as it had just occurred to him, and pressed my shoulders – but he was pushing me down into the toilet. So although it gave immense relief from the surges, it actually hurt the backs of my thighs! I didn’t have time to think that he should just choose a different point. I could barely think at all. The surges were changing and in this upright position were pushing down. The midwife came in and encouraged me to move as she didn’t want me to have the baby on the toilet! I asked her if she wanted to check me and she said there was no need, that I’d be pushing the baby out in no time. I was not examined at all which was fantastic. At this point, she was carrying my ball and the midwife in charge had the mat as they were going to let me set up where I was. Talk about being woman-led!!

So I managed to get back to the room and I knelt on the bed, dangling my arms over the bedstead and using the gas and air, which made all well with the world. I no longer thought about the previous or the next surge – I no longer thought at all! After about 15 minutes, I felt the baby move down and told the midwife who had to take off my pyjamas. It had happened so quickly that I was still fully dressed! Half an hour later, baby began to crown. The midwife did a fantastic job of warning me when it was going to happen and then coaching me to hold back which took a superhuman effort. My husband was also telling me to relax my jaw as he had forgotten to do this the first time. My baby emerged slowly and gently, with no tear, at 12.06pm, just 2 hours after we had arrived back from our excursion. He weighed 4kg (8lb 14oz) and came out roaring, marking his territory by weeing all over me! Welcome to the world of little boys!

The cord was clamped and cut after about 15 minutes and I put my baby on to my chest, where he stayed for the day. I had wanted a natural third stage, but lost quite a bit of blood and after 50 minutes was fed up and agreed with the midwife that I should have drugs to help deliver it. She gave me syntocinon, not the dreaded syntometrine that had contributed to me having a retained placenta on my first baby. The placenta came about 3 minutes after the drug was administered, so she reckoned the placenta had already separated anyway. She asked me if I wanted to take it home, and I had planned to, but after all of that, I was glad to see the back of it! I could not be happier with the care I received in the Rotunda. They were all genuinely sorry for me that I had been transferred and did everything they could to give me the closest possible experience to my home birth. It was amazing!!!

After two hours, we transferred to the postnatal ward which was thankfully very peaceful. It was actually lovely to be with my husband and new son and no distractions. However, I was desperate to be home and have all my family together. I had a bit of wrangling with the hospital as they said I had had a Post Partum Haemhorrage (it was just above the borderline). But my home birth midwife was fine when I told her the estimated blood loss so I told them I was discharging myself. I got “the talk” from an obs and then they rang my midwife to make sure she was taking over my care, which was lovely of them. We eventually left at around 9pm and brought our boy home to meet his sister and grandparents. My midwife called on us as soon as we got home and then every day for a few days after so I still had all of that wonderful postnatal care.

I feel that I have come to terms with the turn of events, although I will always be sad I didn’t have the birth in my mind movie and be slightly envious when I hear of others who had similar births. But, at the same time, I’m happy with the birth I had. There will always be the regret that the amazing midwife I built up such a relationship with over the course of my pregnancy was not with me when I delivered my baby. It would have been wonderful had she been allowed to accompany me for support during my labour. How much I relied on her during my pregnancy was brought home to me after her last visit when my baby was 2 weeks old. I cried on and off for the next two days, so sad that someone who had become such an important figure in my life was now leaving it. I even irrationally wondered how quickly I could become pregnant again so I could get her back!

So, not the home birth I hoped and planned for, and yet it was a good birth. While I didn’t birth at home, I feel I still had a “home birth experience”. The antenatal and postnatal care count for so much. To feel nurtured and listened to during and after pregnancy is something all women should experience. I’m thankful I did, and who knows – I may have the beautiful home water birth of my mind movie one day.

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Articles, Birth preferences, Induction

To sweep…or not to sweep?

Posted on July 8, 2014 at 6:55 pm by BirthToBaby / 0

When women go over their ‘guess’ date, and with some practitioners, as they approach it, they may be offered a membrane sweep, in the hope that it will get their labour started.

What is it?

A “sweep” is a non-chemical method of induction. It involves the practitioner attempting to separate the water bag (amniotic sac) from the uterus. One or two fingers are inserted into the cervix and the practitioner tries to get their fingers between the water bag and the uterus, following the cervix around and gently separating the membranes.

Afterwards, you may experience some ‘show’ (blood stained mucous) or spotting and mild cramps, regardless of whether or not labour starts.

How does it work?

It may encourage the body to produce prostaglandins, causing the cervix to soften and thin, which may get labour going within 48 hours.

What are the chances that it will work?

According to a Cochrane review in 2005, having a sweep at 40 weeks does reduce the length of pregnancy and the incidence of going beyond 41 weeks. However, in order to avoid one induction of labour, a sweep would need to be performed in 8 women.

What are the benefits?

The woman may experience a physiological onset of labour rather than a chemical induction. A sweep increases the chances of going into labour within 48 hours and of giving birth within one week. (Keirse, 1995; McColgin et al, 1990; Weissberg and Spellacy, 1977)

What are the risks?

There is a risk that the water bag may be broken accidentally, which means that the woman will then be told she will have 24 hours to begin labour before she is chemically induced. Although some of the evidence indicates that prelabour rupture of the membranes is not a risk of sweeps (Boulvain et al, 2005; Wong et al, 2002), Hill et al found that there was increased risk of rupture of the membranes if the cervix was more than 1cm dilated (9% of women experienced PROM). Anecdotally, a few mothers on the GentleBirth mums group had their waters release accidentally during the procedure recently.

Some of the research indicates that infection is not an issue (NICE 2008). However, women who are Group B Strep positive should think carefully before having a sweep as GBS can cross intact membranes. As GBS testing is not routine in Ireland, few women know their GBS status and up to 25% of women are carriers of Group B Strep.

Some women may find sweeps unpleasant and uncomfortable. They may also lead to “false starts” where women have show and crampiness and think labour is on the way, but it then dies down. Some women find this to be upsetting.

Are sweeps recommended by NICE (UK National Institute for Clinical Excellence) guidelines?

Membrane sweeps are not recommended for routine use beyond 38 weeks in order to avoid an induction of labour. The guidelines recommend that a sweep should be offered to women who have not had a baby before at their 40 and 41 weeks antenatal visits, and to women who have had a baby before at their 41 week appointment (NICE 2008).

Why would I want a sweep?

You may want to have a sweep if:

There is a medical indication for induction and you want to see if a sweep will start labour, before proceeding to other induction methods.
You are 42 weeks pregnant.
You are almost 42 weeks pregnant and you are planning to have your baby at an MLU or at home under the HSE or a hospital scheme (you cannot have your baby in the MLU beyond 42 weeks and you need consultant sign off, which can be difficult to obtain, to have a HSE home birth beyond 42 weeks).

You may not want to have a sweep if:

There is no medical reason to induce labour.
You want to let labour start in its own time without any interference.
You have had unexplained vaginal bleeding during your pregnancy.
Induction is urgently required and it would be safer to start induction with medication.
You have Group B Strep (GBS) in your vagina.

Unfortunately, as some of the women below have experienced, non consensual sweeps sometimes happen in Irish maternity units. If you do not want a sweep, declining a vaginal examination may be your best course of action.

Women’s experiences

“I had two sweeps, at 40 weeks + 11 days and 40 weeks + 13 days. Neither of them did much. I had some show after the second one, but that was it. I wanted to go into labour before 42 weeks because I wanted to have a home birth. I ended up being induced due to my waters going and no labour starting after 40 hours. I think the sweeps probably contributed to the waters leaking. I wouldn’t make the same decision again – I’d just book with a different maternity unit that might be more likely to sign me off for extra days”.

“I had a sweep at 40 + 4, had a bit of show that evening & period cramps for the next 5 evenings before she arrived. The doctor told me I was very ready to go at the time & she thought I’d be back in that evening which I was delighted about coz I was carrying very low & was quite uncomfortable for the last 3/4 wks. I really wanted to get things going & avoid induction. I was glad we avoided induction but I don’t think I would get it done again so early – I think I’d hold off til nearer term + 14. It was not pleasant at all & maybe she would have arrived when she did regardless”.

“I had two sweeps desperately trying to get labour going for homebirth on my first, but now I know full sure the hospital dates where at least a week out so they were never gonna work. On my second, I had a sweep at term plus 5 (my acupuncturist had already told me I was on the brink a couple of days beforehand) and went into labour a few hours later. I would do the same again as my thinking was if I declined it and went the full 14 days or more over and ended up with induction and another section then I would never have forgiven myself for not exploring every avenue of getting things started”.

“I had one but didn’t know until afterwards. The consultant said she just wanted to check how things were as they were considering keeping me in I was just due & had protein in my urine so they were concerned and wanted to see how likely I was to go. When she was done, after I asked what the story was she said ” oh yeah and I did a sweep too so hopefully that will get things going. At the time, I was just a bit surprised cos I thought they had to ask first but at the same time I was a bit relieved or excited or some mixed up emotions cos I was being kept in unexpectedly & baby might come soon. I hadn’t a clue back then, & in all the stuff I had looked up I hadn’t read anything negative about it. It’s only now I know better”.

References:

Boulvain M, Stan C, Irion O. (2005) Membrane sweeping for induction of labour. Cochrane Database of Systematic Reviews 1: CD000451.

Hill MJ, McWilliams GD, Garcia-Sur D, Chen B, Munroe M, Hoeldtke NJ. The effect of membrane sweeping on prelabor rupture of membranes: a randomized controlled trial. Obstet Gynecol. 2008 Jun;111(6):1313-9. See: http://www.ncbi.nlm.nih.gov/pubmed/18515514

Keirse MJNC. (1995) Stripping/sweeping membranes at term for induction of labour: In: Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C. (Eds.). Pregnancy and childbirth module. The Cochrane Pregnancy and Childbirth Database. The Cochrane Collaboration 2.

McColgin SW, Hampton HL, McCaul JF, Howard PR, Andrew M, Morrison JC. (1990) Stripping membranes at term: can it safely reduce the incidence of post-term pregnancies? Obstetrics and Gynaecology. 76: 678-80. Weissberg SM, Spellacy WN. (1977) Membrane stripping to induce labour. Journal of Reproductive Medicine 19(3): 125-7.

National Institute for Health and Clinical Excellence. (2008) Induction of labour. London. See: http://publications.nice.org.uk/induction-of-labour-cg70/guidance#recommended-methods-for-induction-of-labour

Wong SF, Hui SK, Choi H, Ho LC. (2002) Does sweeping of membranes beyond 40 weeks reduce the need for formal induction of labour? BJOG 109: 632-6.

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