Bump to Motherhood

Thursday, December 13, 2007

Caesarean births twice as risky as natural deliveries

Caesarean births twice as risky as natural deliveries
By Jeremy Laurance, Health Editor
Published: 31 October 2007
Women who choose a Caesarean delivery, sometimes described as "too posh to push", are increasing the risk to themselves and their baby. Surprise results from an international study of 97,000 deliveries show that a routine Caesarean puts a woman at twice the risk of illness or death compared to a vaginal birth.

And babies born by Caesarean had a 70 per cent higher risk of dying before discharge from hospital if they were lying normally head first in the womb than if delivered vaginally.

A Caesarean delivery was, however, found to be safer for babies lying in the less common and riskier breech position – feet first.

The findings are from eight randomly selected countries in Latin America, where Caesarean rates are higher than in the UK, at an average of 33 per cent of all births. Well-heeled Latin American women are more anxious about the potential effects of a vaginal birth on their sex lives and in some private hospitals the Caesarean rate is up to 60 per cent.

In Britain, the Caesarean rate has doubled in the past 20 years to 22 per cent, driven in part by the demand of some women for what is perceived as a convenient and pain-free method of delivery. Obstetricians too have seen it as safer – and as a way of reducing risks of litigation. The latest study, published online in the British Medical Journal, suggests the safety of Caesareans may have been overstated.

Jose Villar, former director of maternal health at the World Health Organisation and now a senior research fellow at the University of Oxford, who led the study, said there was no benefit from the very liberal use of Caesareans, either for mothers or babies, and they could even do harm.

Caesareans led to longer hospital stays for mothers and babies, increased the risk of readmission and increased the risk to subsequent pregnancies.

The only exception was that babies in the breech position did better and women had fewer severe vaginal complications.

Dr Villar said the findings should be applicable to Europe and the UK because of the large number of deliveries surveyed, the comparability of outcomes to those in Europe and because the overall Caesarean rate was not dissimilar.

"The message is that a woman thinking of having a Caesarean because it is safer should think again," he said. "It is a question of balancing the risks and benefits. She should sit down with her care provider and consider the options. We think this is the most comprehensive study that has been done."

In a commentary on the findings, Alison Shorten, of the School of Midwifery at the University of Wollongong, New South Wales, Australia, said an important reason why women chose Caesareans was because of worries about damage to the pelvic floor from a vaginal birth, which could lead to sex and bladder problems. "Women need to weigh up the possible but uncertain benefit of preventing urinary problems against the increased chance of problems related to surgery in themselves or their baby," she said.

Pat O'Brien, consultant obstetrician at University College Hospital, London, and a spokesman for the Royal College of Obstetricians and Gynaecologists, said: "We have always known from the mother's point of view a planned Caesarean was slightly riskier... Recent research from the US has suggested the risks of the two approaches were getting closer and closer. This latest study pushes that back a bit."

The tragic human cost of NHS baby blunders

http://www.guardian.co.uk/society/2007/sep/23/health.medicineandhealth

The tragic human cost of NHS baby blunders - Not for the faint hearted so don't read it if you are!

Errors and negligence that result in stillbirths or disabled babies are costing Britain's hospitals billions in compensation. In this investigation, The Observer reveals how staff shortages are wrecking the lives of countless parents

* Denis Campbell
* The Observer,
* Sunday September 23 2007

What began as a routine pregnancy but turned into a tragedy for one family will finally end this week in a West Midlands courtroom. The hospital charged with caring for the mother will finally agree to pay £5m in damages to the parents of a boy left in a wheelchair, unable to communicate or do anything for himself, after suffering cerebral palsy because of mistakes made by staff during his birth.

It might sound like a lot of money. But consider - it costs £120,000 a year to provide the 24-hour, all-year-round care needed by the boy, who is now 16. The imminent award also reflects the fact that he will never be able to work, and that his parents have had to move to a bungalow and had it specially adapted to cope with his needs, such as a therapy room where he tries to do gentle exercises to stop his muscles from wasting away from moving around so little.

His parents, who have asked not to be named for legal reasons, would rather it had never come to this. 'When I told the boy's father that the report into the case we had commissioned from an independent obstetrician had said that it was negligence, that someone at the hospital hadn't done their job properly and that the care was sub-standard, he began crying,' recalls the family's lawyer, Lindsay Gibb, of solicitors Irwin Mitchell in Birmingham. 'He wanted us to tell him that it was no one's fault, that it was just one of those things, so to learn that it was avoidable was very difficult for him.'

The hospital's first blunder was to send the boy's mother home after hospital staff had failed to induce the birth. An expert witness who gave evidence for the family said that, given the late stage of her labour, she should definitely have been kept in until the baby arrived, if necessary by Caesarean section. Later, when she was back in hospital again, the child became distressed while he was being delivered and suffered a sudden loss of air to his brain when meconium, the result of his first bowel movement, seeped into his lungs.

Usually, when maternity staff realise that is occurring, they suck out the meconium. But when the anxious personnel attending the woman sought advice by phone from a neonatologist, a specialist in dealing with newborn babies, the doctor seems to have failed to appreciate how serious the situation was. Her guidance meant nothing was done to tackle the baby's oxygen starvation and respiratory collapse.

Despite the large sum involved, the settlement this week is unlikely to get much publicity, because such payouts are fairly common nowadays. The going rate in compensation for a baby who suffers brain damage due to negligence during birth is £3m-£6m. When the mother dies, the payout can also run into millions. Parents of a child who is stillborn receive £50,000-£100,000. Relatively minor damage, for example to a baby's arm, brings about £45,000. Given such sums and the frequency with which such incidents occur, it is easy to see how the NHS has ended up in a position where, as The Observer reveals today, it is being sued for £4.5bn in compensation for alleged mistakes in just one area of its work, albeit a vital and difficult one: obstetrics, the branch of medicine dedicated to ensuring that women get the best possible care during pregnancy, childbirth and afterwards.

Now the new leader of the 5,500 doctors working in this field has reopened a debate that stirs strong emotions by claiming that the health and safety of both pregnant women and babies are being put at risk because there are too few consultants on duty for too few hours in too many maternity units around the country, because hospitals do not employ enough of them to ensure that patients receive proper care.

Professor Sabaratnam Arulkumaran, the head of obstetrics and gynaecology at St George's hospital in south London, takes over this week as the new president of the Royal College of Obstetricians and Gynaecologists. The 60-year-old, who is widely respected following a long career both here and abroad, does not have a reputation for being outspoken. But, talking to The Observer last week in his first interview in his new post, he did not pull punches when dissecting what he sees as the failings which have left the NHS facing a £4.5bn barrage of claims.

'The staffing numbers for consultants aren't adequate at 40 to 50 per cent of hospitals in the UK, though I'm sure that will apply to midwives too. The effect will be that the quality of care will not be what the patient expects', warns Arulkumaran. 'The risk incidence must be greater at those hospitals. There's a direct connection between staffing levels and the risk for patients. We know that the main cause of risk incidence is inadequate personnel. Quality and safety need to be improved.'

He points to a National Patient Safety Agency study of 'serious critical incidents', where children or their mothers ended up being injured during birth. This showed that the three most common reasons for such a tragedy were, in order, 'delay following call for assistance', then 'busy or heavy workload' and, thirdly, 'senior staff not available'.

Arulkumaran says that there are about 1,600 consultants at the moment but that that number needs to rise to 2,100 right away, and ideally to 2,500 before too long, to ensure that every woman giving birth in the UK gets the highest standard of care possible.

The professor was the expert called in by the government to get the maternity unit at Northwick Park in north-west London back on track after 10 mothers-to-be died there between 2002 and 2005. He cites the verdict of the Healthcare Commission watchdog, that 'lack of consultant obstetrician input' was a factor in six of the 10 women's deaths, to underline his point.

Consultant obstetricians are the senior doctors whose skill, judgment and experience helps ensure that complications during childbirth are handled in a way that they do not turn into what are called 'risk incidents'. But the shortage of them means junior doctors are often left to handle tricky cases themselves. This is a situation which can leave them feeling 'threatened and exposed', says Arulkumaran, although they can seek advice by telephone from a consultant, who may come in if their in-depth knowledge is required.

When birth problems do occur, though, time can be crucial for the baby or mother's welfare, and the lack of what Arulkumaran calls 'an experienced hand' on the scene and ready to make quick decisions can be vital. An NPSA analysis of 'timings of severe fetal distress events' shows that, when a baby dies, it is most likely to be between midnight and 8am, precisely the time when there is likely to be no consultant around.

When it does all go horribly, tragically, wrong, parents often feel pushed into legal action. 'It's quite a hard job doing these cases because these people don't really want to get involved with a solicitor', says Gibb, one of a growing number of lawyers who work solely on medical negligence claims. 'Generally people come to us when they haven't been able to get answers from the hospital. Initially they want answers rather than money.

'Often if the hospital simply explained and apologised, there wouldn't be a legal claim. Especially when a baby has died, money isn't going to make much difference. But people want explanations and answers as to why something terrible has happened to them. They embark on the legal action as a fact-finding exercise.'

Gibb works in the medical law and patients' rights department of the Birmingham office of Irwin Mitchell. When she joined five years ago, she was one of five solicitors. Now there are 15, all dealing full-time with claims against the NHS for various forms of alleged medical negligence.

'This area of law has really grown. The cases just keep coming and coming', says Gibb. 'Every time we take on a new member of staff, they can quickly have 60 cases to deal with without really trying.' About 15 of her own 60 current cases involve obstetrics, and some involve very large sums of money. Maternity claims make up about 20 per cent of the total number of claims for medical negligence, but 60 per cent of the damages paid.

After five years pursuing such cases against hospitals in the West Midlands, Gibb is frustrated that the NHS does not seem to be learning from the recurring problems in its maternity units. 'You think that hospitals might have learnt their lesson after settling so many negligence cases, because each case brings a letter of apology and a financial settlement. They say that they are learning and have changed particular procedures. But they don't have enough staff, especially midwives, to stop these things happening', says Gibb. 'So you keep getting these tragic consequences over and over again, which can be devastating for families, and which could be avoided if lessons really were learnt by the NHS.'

Two mistakes lead to many of Gibb's cases. First, staff, usually a midwife, fail to properly read the traces on a cardiotochograph, the piece of equipment put over the woman's stomach to measure the baby's heartbeat during labour. 'If the trace becomes abnormal, they should call a doctor straight away. We see the cases where that hasn't happened and, when he has been called, it's a crisis and he wants to get the woman into surgery for an emergency Caesarean section to get the baby out as soon as possible', explains Gibb.

She is 28. 'As a young woman, it makes me quite scared about the idea of ever having children. It worries me that the same mistakes happen over and over again.' These days, when any of Gibb's colleagues has a baby, they monitor the cardiotochograph trace themselves, and don't rely on the midwife doing it, just to be sure.

Second, the fact that a baby is having problems in the womb can go undiagnosed. 'The mum goes to the hospital before the birth and says that she's not feeling very well and can't feel the baby moving. Maybe because they are so busy with everything else, they don't admit her, and maybe, by the time she goes back, the baby has died and they have to deliver it stillborn.'

Concern over the quality of Britain's maternity services is one of the NHS's biggest challenges. The deaths of babies and mothers during childbirth, scandals involving inadequate care in the maternity units of several hospitals, countless inquiries, and a welter of official reports have led to repeated calls for improvements. A rising birthrate partly fuelled by immigration, and the increasing frequency of complicated cases presenting themselves because of the growing number of mothers who are either older or obese, mean that an already difficult area of medical practice has recently become even more demanding for those involved. Yet few of those who work in the field believe the action taken so far is enough or that maternity services yet get the priority they deserve within the NHS.

Karlene Davis, general secretary of the Royal College of Midwives, said: 'The service is at breaking point.' The main problem is that 'it is patchy. In some areas it's good, but in other places there aren't enough midwives and you get a service where women are dissatisfied and sometimes unsafe practices occur'.

The Department of Health insist that England has a good record on births. Gwyneth Lewis, the Department of Health's chief adviser on childbirth, says: 'Due to the skill and expertise of our midwives and doctors, England is one of the safest places to have a baby.' In a study she conducted of almost 2 million births over three years, just 50 women died 'of obstetric complications that were not managed as best as they could have been, and there is no evidence to suggest any increase in this rate since', she adds.

The NPSA, the NHS body which aims to make receiving healthcare less risky than it sometimes proves, states that: 'The vast majority of the 650,000 pregnancies a year in England and Wales are successful, with mother and baby well.' But, it adds, 'there is evidence from a variety of sources that women and their babies sometimes experience unintended harm, often as a result of problems relating to deficiencies in intrapartum care [during labour and childbirth] and problems in communication.'

Its figures show that, in the past three years, 17,676 women were injured, 1,000 seriously, in labour. However, another 2 million women delivered safely.

In a speech on 3 October on the safety of maternity care, Arulkumaran will point out that more than one of every 100 births is problematic. Of the 668,681 live births in England, Wales and Northern Ireland in 2005, 7,225 ended up being notified to the official Confidential Enquiry into Maternal and Child Health because there had been an issue involving the baby's safety. Those 7,225 cases comprised 1,193 'late fetal losses', where the baby died between 20 and 24 weeks; 3,676 stillbirths; and 2,356 neo-natal deaths, in which the baby died in its first week of life. Employ more consultants, have their expertise on hand, and those figures will come down, says Arulkumaran.

He is aghast that hospitals are being sued for such a colossal sum of money and can think of a much better use of the NHS's resources. 'The presence of a consultant increases the safety for mothers and babies; incidents happen when there aren't enough people present, especially senior doctors', he says. So why not use a proportion of the amount currently paid out in damages to hire more consultants and more midwives, he asks.

'The cases where a baby suffers lack of oxygen, which can lead to brain damage, is one or two per 1,000 births in the UK. If a hospital delivers 5,000 babies a year, it may have 10 such cases a year, each of which could cost it [at least] £3m', explains Arulkumaran. 'Even if one of those cases could be avoided by having additional staff, you are going to save £3m. Spending £1m a year would buy you two consultants and 15-20 midwives.'

His message is aimed at hospital managers, who decide on staffing levels, and the government, which sets the NHS's priorities. 'We should try expanding consultant numbers, because otherwise we are paying out taxpayers' money which could and should be better spent rather than being used to settle litigation. The quality and safety of Britain's maternity services can and must be improved.'

'I tell myself I have two lovely daughters, but I have lost my son and the pain will never go'

Vicky Gough from Telford gave birth to a stillborn baby on 4 September 2001. Doctors tried to resuscitate the baby but, after half an hour, they were forced to declare him dead. Vicky and her husband Steven received £50,000 in compensation after Shrewsbury and Telford hospital, where baby Thomas was born, admitted a series of failings in his maternity care. Here, Steven tells Amelia Hill the devastated couple's story.

'Vicky was exhausted and drugged out so she wasn't aware of what was happening but I was forced to stand there and watch all these people rushing into the room and battle to save my son's life. My brain froze and it took me ages to comprehend that something was really wrong. Then I just stood there and prayed that I would have a baby to hold; I didn't care if he had brain damage. I just wanted to be able to take my child home.

'When they told us Thomas was dead, it was completely soul-destroying. I kept repeating the words to Vicky but I could see she wasn't taking any of it in. I had to leave the room. I went out into the corridor and collapsed. I almost assumed the foetal position myself there against the wall, and just broke my heart. It was beyond description.

'They told us that Thomas had died because he'd been born with the cord twisted around his neck. We didn't think to question this until four years later when we decided to ask for the medical notes, not because we had any suspicions but because we were still deeply grieving and wanted something to hold on to.

'It was only when we started reading the notes that we realised what had really happened. It was so obvious that we were stunned. We wished so much that we'd had the confidence to speak up about things that had seemed wrong during the labour because, reading back through the doctors' accounts of what happened, it was obvious that Thomas died because of human error so total it was akin to neglect. Thomas's heartbeat was showing warnings for over 35 minutes. If they had noticed his heart was having trouble at any point during that time, he could have been born completely safely and healthy. If they hadn't noticed until later - so late we'd had to have a Caesarean - we still would have had a baby to take home, albeit a very damaged one. But the fact that no one noticed any of the warning signs at any point was just so shocking we couldn't believe it.

'The fact that the NHS trust has clearly verified that they really messed up has allowed us to achieve a certain amount of closure but we are still traumatised and unable to move on in any genuine way. I have trouble bonding with my younger daughter, born after Thomas's death.

I try telling myself I have two beautiful daughters but I have lost my only son, and that pain will never go away.'

Payouts and claims

34,497 the total number of claims for compensation which the NHS in England received between 1995 and 2006 over alleged clinical negligence by staff. Most came in surgery (13,449 claims), obstetrics and gynaecology (7,352), medicine (6,060) and A&E (3,732).

£20m thought to be the largest amount awarded to a woman injured during childbirth. Kerstin Parkin, a dancer from Surrey, was awarded a £7m lump sum and £250,000 a year for the rest of her life in 2002 for the brain damage she suffered while giving birth at the Farnborough Hospital in 1996.

18,000 pregnant women injured during childbirth, including 246 who died, according to a National Patient Safety Agency study of 60,000 maternity care mistakes between 2003-06.

£3.5m-£6.5m the sum which the family of a child left with cerebral palsy, caused by lack of oxygen during birth, usually receives in compensation.

18,748 the number of 'live' claims which the NHS Litigation Authority was dealing with last year.

5,697 fresh claims for clinical negligence received by the NHSLA in 2005-06, slightly up on 5,609 the year before.

Tuesday, September 25, 2007

Homebirth recorded on a 999 call....

Absolutely amazing, listen to this....

BBC Radio 5 Live

and the transcript is here:
Guardian.co.uk

I've just blubbed my eyes out!!! it was incredible and the dad stayed so flipping calm!

It was a 20 year old operator that talked him through it and she'd only been in the job a month!!

Saturday, September 8, 2007

My Personal Birth Experiences

As part of my training I had to write up my personal birth experiences so thought I'd share them both with you all. They are both very different births. A not so great one followed by a great one. Just wanted to show really that even if you have one bad experience it doesn't mean subsequent births will the the same.

I was asked to write a) my experience, b) positive and negative feelings for each and c) how I view them now....

ps they're long so get yourself a cuppa and get comfy!

a) Jacob, my eldest was born on 16th July 1999. At the time I was a nervous but fairly confident 17 year old, single, mum-to-be.

My mum was to be my birth partner and I also wanted his dad present as although we weren’t together anymore I thought it important for their bonding. My pregnancy was an emotional roller coaster due to my circumstance of his father and I splitting up. I was young and more worried about being on my own then actual childbirth.

The night I went into labour both my parents were in Wales at my sister’s graduation! I wasn’t too upset as my other sisters (I have 3) were about and both very supportive. It was early hours when I first went to hospital, a little confused about contractions but definitely in labour (well I thought so) I was examined when I arrived and was 3cms at 3am. Because I didn’t dilate anymore by 9am they sent me home again. I went home and went to bed!! I then slept for hours and by about 3.30pm I decided I couldn’t sleep through the contractions anymore and was in quite a lot of pain. We went back off to hospital arriving around 4.30pm. They did comment how they were expecting me back at lunchtime and examined me right away. I was 9cms dilated. They broke my waters and told me an hours pushing and I’d meet my baby.

They gave me some Gas and Air and I remember feeling very floaty when I went to tell my sister and his dad how far laboured I was. The rest of the labour is quite hazey. I don’t think I let go of the G&A once and remember feeling very tired. My mum finally arrived and took over from my sister (they drove home as soon as they could from the graduation) I think I was pushing for about 2 hours and still no sign of baby. Oh I do remember them saying he was back to back and someone turning his head. I had my eyes shut through exhaustion at this point. Baby had started to get distressed and they put me on oxygen. Again it is very hazey, I was tired, my eyes were shut and this baby wasn’t coming!

Next thing I remember is someone mentioning cutting me and using forceps. I was too tired to protest and no-one even asked they just got on with it and I remember opening my eyes and seeing what felt like hundreds of doctors at the end of the bed… my legs, up and open in stirrups and lots of rushing about. I closed my eyes again and felt the most scared I had through my whole labour.

On opening my eyes again I asked my mum where Craig (the dad) was, it was apparently too much for him as they cut me, he fainted onto a chair! Moments later Jake was born. I really do have patchy memories of the first moments with Jacob, I can’t remember when I first held him, the next thing I remember is my mum bathing me and I couldn’t even sit up in a wheel chair through using every muscle in my body for 2.5 hours. I do remember coming back into the room all clean to Jake’s dad holding him in his arms with tears in his eyes. It was late now and everyone left and I was taken to the ward with my new baby, where I sat on my own feeling very lonely and wanting my mum more than ever.

When I finally got to go home, I really got time to bond with my baby. I would lay in my room (at my parents house) and just cuddle him whilst he slept. My family were really good and we agreed if my door was open they were welcome! I knew it would be too tmepting to keep comig for cuddles with a newborn in the house but I wanted time, time for me to get to know my baby properly. I did very well with breastfeeding to start with but only lasted a month. I was extremely self conscious and was made to feel awful and left mortified by some comments made by the father of my baby. Other than that I loved being a mum, I was so proud of my beautiful boy and proud of giving birth on just gas and air. I was very sore for a while but once that went I just got on with being a new mum and enjoyed every minute of it.

b) Negative feelings of the birth was feeling like I wasn’t there when it came to the staff. I felt very patronised for being young and no-one actually asked me what I wanted, how I was feeling and apart from actually giving birth it was as if I wasn’t there!

Positive feelings, I managed to give birth and without an epidural! I went in with an open mind to pain relief and was pleased to have done so well on gas and air.

c) How I view this birth now: Well writing that and recalling it in detail properly like I just have has just made me cry and feel very sad! Strange I know especially with how happy I am now with my family and my children but I just couldn’t help it. I remember the feeling of being on my own. This was something I wanted to change for my second birth 7 years later and everything I did I researched and read about so that I could experience a better and more personal birth.

Erin’s Birth

7 years on I am pregnant again, with the man I know I am spending the rest of my life with. I know he’ll be the model father as I have already seen him take Jake under his wing as his own. We planned the pregnancy and the entire thing is a whole new experience to me, an overwhelming experience of belonging and happiness.

My pregnancy did get tougher when I developed SPD and ended up hobbling around on crutches. Barely sleeping through pain but not doing it alone was an amazing feeling. Jacob was really involved all the way too. We made sure he felt included in everything. We found out the sex so that we could prepare him for the new arrival (didn’t want him thinking it was a boy as I had a “feeling” it was a girl) It was a girl! We told him what we wanted to call her and it was our family secret so although friends and family knew it was a girl, her name would be a surprise, except for the three of us. We even let him pick (out of our top 5) middle names, he was so chuffed!

I researched and read up as much as I could about pregnancy and birth. Someone mentioned homebirths to me and I just knew that’s what I wanted. An intimate birth with me and my man at home. He wasn’t too hot on the idea to start with but after talking it through with him he saw my reasons and went with it.

I had a false alarm on my due date, even called the mw out at 3am!! As soon as she arrived all “contractions” stopped. A couple of days later my mw looked at me with a look that gave me that sinking feeling. She said I’d got quite a lot bigger and thought it best I got checked out at the hospital, scanned and hopefully guess how big the baby would be. She even muttered the word induction! Well I blubbed as soon as she left! I really wanted a homebirth and this was shattering my plans. She tried to say not to worry but all I did was worry. James managed to calm me down and we tried to think positively.

That night James got up to open the bedroom window around 3/4am and I thought, ooh my tummy feels tense, then went back off to sleep. At about 5.45am I woke up to what felt like contractions. After my false alarm I thought I’d lay there for a bit and time them before even waking James. I had 3 contractions in 15 minutes so poked James in the arm and said “I think I’m in labour” He stirred a little and suggested I had a bath (he was clearly thinking of my false labour too!) I lay in the bath for a further 40 minutes.

As I got out, I felt surprisingly happy and well, but each contraction was starting to stop me in my tracks. I rang for the midwifes and after some confusion and my tens machine NOT working I just gave up and closed my eyes with each contraction, waiting eagerly for the midwife. I felt incredibley in tune with my own body I was happy pacing and chatting between cons and when I had a contraction I found myself half bent over, whilst stood beside the bed and my arms stretched out supporting myself on the bed, rocking and breathing very heavily through each one.

James did leave me at one point to drop Jacob at his brother’s house so he could take him to school. I was a bit worried to start with but then thought she wasn’t coming just yet and he had plenty of time.

I felt extremely relaxed and comfortable in my own home. I was downstairs by the time James was back and once the mw’s arrived. She examined me and I was 6cms. I was so pleased as I thought this was “it” and this just comfirmed it for me. Not only that I was much further than I expected to be, which empowered me with more confidence, so far I had managed to get to this point through listening to my own body and going with the flow and with no pain relief at all.

I was up and down quite a lot. It was very liberating being able to move around freely and as I pleased. I was encouraged to go to the toilet for a wee a couple of times but I’d get to the bottom of the stairs and have a contraction! I managed to get up them with a contraction stop half way! I was on the gas and air by this point but remembering the hazeyness of my birth with my son I was only using it for the height of each one. The student midwife was following me up the stairs with the cannister and I also insisted James did too. I didn’t want him to leave me at all!

As it appeared I was approaching the second stage of labour the midwife examined me again and I was 9cms. I instinctively positioned myself on my knees bent over James’s knees as he sat on the sofa, holding onto both his arms (very tightly!) I’ll never forget the intimacy of us telling each other how much we loved each other and him stroking my hair from my face. Not long after, I felt like I wanted to push…. I got to the point, you know the one where you think you can’t do it anymore and knew this was it. The 2nd midwife knelt down as I rocked back and fourth through another contraction she whispered into my ear. She gave me a little pep talk, explaining how I can do it, it was soon going to feel like it was burning like hell, while the head crowned but it’s ok I can do it etc. That made me realise, this REALLY is it, I’m finally going to meet my little girl. One of them told me her head kept appearing then going when I stopped. I actually wrote in my birth plan that I didn’t want a mirror (after being mortified when I was offered one at Jacob’s birth!) and I was now thinking…. I want to see!

I gripped onto James with every bit of strength I had and pushed. I felt the burn and pushed again. I could feel her coming but started to feel tired when all of a sudden my body just carried on pushing! I remember hearing the midwife saying to me to rest through the next contraction but I wasn’t I just kept going until her head was born.

The midwife did do a small manouver to help the shoulders out but then that was it, here she was, my little girl. She tried to pass her through my legs but they were a bit wobbley so I turned round and rested onto James’s legs while she handed me my baby. I just couldn’t believe it. Here she was, I did it, I had my baby at home!! James and I kissed each other and then stared at her while I delivered the placenta.

Once that was done they weighed her and dress her and I sat up on the sofa and put Erin to my breast for the first time. It was a 5 hour labour and an experience I will cherish as a very proud and happy memory.

After the midwives left and the gp had been to check Erin over, I bathed and settled into my own bed with James and our new baby. I just kept looking at her in disbelief. We had the curtains drawn as it was very sunny! In fact we all said she brought the sunshine with her as it had been raining for days before. She lay on my bed and in our arms and as we both gazed at her she just gazed right back at us. I couldn’t believe how wide eyed she was!

My sister picked my son up from school so we had enough time to settle and relax as Erin was born at 11.15am. When he came home to meet his new baby sister the elated look spread across his face was such a heartwarming moment. I have a picture and I don’t think I’ve ever seen his smile so big and eyes so intense!

James had 2 weeks off work and Jake was on half term the following day so we spent the whole time as a proper little family.

b) the only negative I have is to do with postnatal. I gave up bf very early this time round. I already felt very conscious of it after bad experience with my first and when I thought Erin was starving I gave in and gave her formula. I wasn’t even asked by my midwife why I’d given up or whether she could help. I feel a bit disappointed as I feel with more support I would have done so much better. I don’t regret it as I don’t believe in regrets but I am hoping to learn more through this course to enable me a better bf experience for baby number 3!!

Positive feelings… well I just want to tell everyone to have a homebirth! I couldn’t have wished for a better birth. I think next time I would want Jake at home but in another room so he could meet the baby sooner. Other than that it was a truly amazing experience. Listening to my body and doing what I felt was right and instinctively enabled me to birth the most natural and relaxing way possible. Loved it! People think I’m mad when I tell them that!

C) How I view it now: well the same as I did then, an incredible experience, that I am looking forward to doing again!

Tuesday, August 14, 2007

A friend's Vaginal Twin Birth Story

I was booked for induction at 37 weeks. However at 36+4 weeks in the early hours of 17th April 2006, my waters broke! I woke up my husband and got myself sorted whilst waiting for his mum to arrived.

We had to go to Dundee to have them as they were twins and that was where special care was. My contractions were every 3 minutes, lasting a minute. This was 45 minutes after my waters had gone.

At first they weren't going to let me deliver them as special care was full. After a bit of a discussion it was decided that I would be allowed to have them in Dundee as it was too risky to move me.

Was 4cms dilated by myself and started entonox. Was given the dreaded epidural and managed a little sleep. Eventually it was time to start pushing. There were 2 midwives and a medical student at this point. I had a scan to check Jamie's position as he was breech. Not any more!! He'd turned head down. After a while of pushing and having problems feeling where to push due to the epidural, something clicked and Rachel Eve was born. The hormone drip was started to get the contractions started again. It took a while to get Jamie out as I couldn't feel where to push. It got a bit scary as I could hear his heartrate dropping. At this point there were now 12 people in the room. I was threatened with the ventouse if my next push didn't work. Something clicked and out flew Jamie Alexander, 38 minutes after his sister.

After all the worry neither of them needed to go to special care.

Had a lovely wash, tea and toast, cuddles and lots of phonecalls and photos.

A friend's lovely Homebirth Story

"Ok so monday morning woke at 5 (had an hours sleep) and after reading for a bit i had a BH or so i thought. Was different to the ones i had been getting but thought it was the way i was lying.

Went down stairs and had some more. still convinced were BHs as timings were a little off.

By 7 ish i was having to ooh and aah my way through them and couldnt sit down with them so was getting up and practically mounting the computer chair.

I had the runs a few times that morning too but put that down to IBS! I was in such denial for some reason!

Woke tim at 8-30 to say i thought something may be happening but still convinced it would be BHs and would die away as it wasnt really pain just uncomfortable.

At 9 i rang Judith to say i may need her later but didnt need her right then as i thought it may be a false alarm. Sent tim to the chiropractors after he had emptied and cleaned the pool and i filled it while trying to hoover and tidy and get everything together.

Arron woke at about 10 and walked in on me having a contraction. Poor thing didnt know what to do or say. I knew then he wouldnt be able to deal with seeing me in labour so i made arrangements for him to go out for a bit.
That was the point i realised i couldnt talk through them but still didnt think they were painfull. Just before this i had gotten a little emotional and scared as i realised i was really in labour.

Still pottering around and quite happy and feeling pretty painfree really untill about 11-30 when something changed and i knew i had to ring Judith.
She got to us at 12 ish when i was in the shower (i was really conscious of how i smelt for some reason) I lost my plug on the floor as she walked in - nice!!

She did an internal at about 12-15 and i was fully expecting to be told i was 2cms and had ages to go. Before she checked she said my perineum was bulging and she discovered i was 5 cms and the cervix was very thin. She told me to take a couple of paracetamol and she left me to wander round and do what i wanted for a bit.

Within 10 minutes or so she must have noticed a change in me as she started pushing for me to get into the pool if i wanted to use it. I wanted to wait till i couldnt cope with the pain before i got in but she seemed to think that things were moving very quickly.

I think that once Judith arrived i allowed myself to let go if that makes sense.

Got in the pool and almost immediately i noticed a change. Contractions were still pretty spacey and not really regular but although i was fine between contractions, when i had one tim had to be there. He had tried putting the bedding in the dryer 4 times as i kept calling him back.

I was drinking loads of water but i kept lobbing the bottles away from me as soon as a contraction started if no one took it off me quick enough - there were bottles everywhere after i had had her lol

Within about 10 - 15 mins i was getting really awfull pushing urges but this was only half an hour or so after being told i was 5 cms so i was fighting them. Awfull feeling. I knew i was 'going' each time i had one of these and there was nothing i could do about it. But because i had had the runs that morning i got so paranoid and was fighting the pushing urge even more at first.

My waters went at about half one and was so painfull when they did as they stretched me just before they exploded. The noise of them going underwater scared the hell out of me - was like a small bomb.

By about 1-45 i couldnt be in the pool - i was uncomfortable and felt like my legs were going to cramp up so i got out and kneeled over tim as he sat on a chair.
Wasnt comfy like this either and kept saying i just wanted to lie down as i felt so tired. Judith kept trying to get me to squat and change positions but i wasnt being the most co-operative patient by this point! *blush

Eventually at around 2-30 i moved onto the settee and was lay on my left side facing the back of the settee. Now really was the time to push. I was told to hold my leg and pull it up as i was pushing.

The contractions were slowing down now they still werent massively painfull though, but the pushing urge was getting unbearable. The time between the contractions was fantastic - i lay there with my eyes closed and withdrew into myself preparing for the next one and feeling what my body was doing. Tim thought i was asleep but i was super aware of every little noise around me.

Eventually the head started to crown this was the most agony i have felt in my life. I could feel every little bit of her squeezing through from her ears to her nose and chin. I felt like i couldnt possibly stretch any further. Whilst i was pushing the head out i remember thinking if i ever do this again im going to hospital to demand all the drugs going. lol Of course things are different now and i would definately have a home birth if we were to have any more and would not want any drugs again.

Her head was born at 3-17 and i had a minute to compose myself before the body started to come. During this lull i could feel my body gently turning her and ever so slightly pushing her. Was an odd feeling.

Once i got the next contraction and started pushing the intense pain started again and i wasnt stopping pushing for anyone! I was getting her out NOW!!

She was born and passed through my legs onto my stomach and i was in awe of her immeadiately. She was so perfect and beautifull.

Unfortunately as my contractions were a little spacey a few minutes after the cord had stopped pulsing Judith decided that it would be better to give me the synto rather than wait and as everything had gone so well i agreed. The placenta came away within a couple of minutes.

So there you go. Sorry its so long but my memory of it is so clear and so unlike Arrons birth. It felt amazing to feel every part of my daughter being born. I have the most amazing pictures and video of the birth and everyone is going to hear about this till they are sick to the back teeth of it! lol

I am so proud of myself and my body and still cant quite beleive i did it."

Tuesday, August 7, 2007

Breastfeeding & Formula on BBC

Not sure if anyone saw it this morning on the BBC News but it was very interesting to see.

They are campaigning for fomula adverts to be banned as currently they are able to advertise for babies from 6 months. I thought it was 12 months so was a bit shocked to hear it!

There was a lady representing the NCT and a midwife that is doing a study into breastfeeding and why 3 in 4 women start off BF but give up in the first few weeks. Interesting that the MW discovered, although not set out to examine positioning of bf mothers, that most could not position correctly, therefore uncomfortable, tired and often caused the babies not to latch on.

Sian Williams does go down in my estimations each time they do a report on babies and parenting. There was that awful talk on Baby Led Weaning that made me shout at the tv and now she is arguing against the NCT woman about breastfeeding. Yes we do all know that breast is best and yes a lot of us couldn't do it. The point is, most of us couldn't do it because we didn't get the support we needed not like Sian was saying because we weren't physically able. The NCT lady pointed out very very little women can actually physically not bf, she said something like 1% can't.

I thought I couldn't BF with Erin but on reflection I now know that with some guidance and support I could have got there in the end. I wasn't even asked why I switched to formula by my mw or hv or whether they could help.

Instead of fluffing up the fact that so many of us give up (and yes I am one of them) and putting it down to not being "able" why not help, show and support us how to bf efficiently. As natural as it is, it doesn't always come naturally and it's a shame that in today's society people are more scared of making women feel like a failure by showing them the right way (formula is offered far to easily in hospitals) that the mothers and babies are both missing out in the long run. Why is advice taken as a critism these days?

Wednesday, July 25, 2007

Vaginal Twin Birth

I was really moved by a twin birth on a programme yesterday. She really wanted a vaginal birth and twin one was head down so it was looking very promising. I think they said something like 50% of twin births are done by caesarean section in the UK. I guess it's much harder to get 2 babies to co-operate!!

The woman looked completely in control and barely broke a sweat! Twin 1 was born and within 2 minutes (yes 2 minutes!!) she had pushed out twin 2! They were healthy weights and simply adorable. Their big sister came in soon after their birth and loved them!!

Absolutely incredible. I am very fascinated by twins in general so was very pleased to see that birth on tv yesterday! I would be overjoyed to experience one as a doula.

For more information on twin pregnancy, birth and post natal visit Tamba - Twins & Multiple Births Association

Monday, July 23, 2007

Which book first????

I ordered 2 books to read and they arrived this morning. I'm quandry as to which one to start with! lol!

Birth Reborn, What childbirth should be like by Michel Odent

"Combining the roles of romatic, philosopher, surgeon and obstetrician as only a frenchman coul... many of (Michel Odent's) theories have changed the way childbirth is viewed and conducted" The Times

"This is the man who has made childbirth a delightful, natural experience for so many women." Nursery World.

OR

The New Experience of Childbirth by Sheila Kitzinger

"A woman of remarkable insight, with a sharp and often very witty tongue" Leslie Kenton, Harpers & Queen

"She is the Earth Mother, or Birth Mother of the nation. If Britain is now one of the most progressive countries in obstetric practice, it is largely due to her" Polly Toynbee, Guardian

To be honest I am intrigued by the idea of a man writing a book about the rebirth of birth so I think I may read that one first!

My Homebirth Montage

We only have a few photos from our homebirth, think we were caught up in the moment of it all... next time I will have a doula taking me pictures ;o)

I thought I'd put together this little montage to try and show how relaxed, comfortable and enjoyable my homebirth experience was.

Friday, July 20, 2007

Breastfeeding & Support (or lack of)

When I last visited my friend in Surrey I met her mum who is a midwife. It took her about 5 minutes to ask me why I didnt BF! (it was the first time i'd met her in person and she lived in Aus for ages, in fact going back forever once she sells the house)

The thing is I have already been thinking about it more and more the last few months of how crap I did with it and how crap the support was. Even watching discovery home and health I see that if half the things said on there were said to me I would have done so much better! I already know that I would do better next time (if there is a next time) just from watching tv!

My friends mum is starting an antenatal bf class to promote bf more.

I actually feel quite sad about it now. Because the support I got was crap... well i didn't get any support. I think the only thing my mw said to me was my nipples were prefect on day 2 i think it was. that's it. Not even when I swapped to formula did she ask why or offer help or advice on how to bf properly/efficiently and I look back now and realise what a shame it is. I know it's not their fault. There's not enough midwifes, they're stressed and over worked.

I was already completely put off bf after bfing jake, it wasn't easy and the fact I was 17 and scared didn't help. His dad was a completely useless and made me feel quite crap about the whole thing. God knows how I managed to do it for a month with all what happened happening iykwim.

With these bad memories in mind I wasn't overly keen on the idea of bf Erin but said I would try and see how I got on... which again was crap.

So the biggest problem from what I've read so far is the aftercare oh and the lack of talk post-baby too. I was watching the programme earlier on H&H and the lady was saying all sorts that if I'd have known back then I think I could have struggled through. Also if my mw or hv even asked me how bf was going or offer advice... should we have to ask them for it? I don't think so, it's a nerve wracking time not to mention tiring I think they should talk things through with you more as part and parcel iykwim.

I'm looking forward to learning more about breast feeding in my training, hopefully it will arm me to succeed for longer with baby number 3 ;o) and not to mention the support I can offer other mums who have struggled as I did.

Wednesday, July 18, 2007

Pre-course Module

My pre-course module arrived yesterday from Nuturing Birth, the people I am doing my doula training with in September. It has got me really thinking and studying some more, I love it!

I have just bought 2 books from Amazon
Birth Reborn by Michel Odent and
The New Experience of Childbirth by Sheila Kitzinger

Can't wait for them to arrive so I can get reading. In the meantime I best get on with my module :o)

Has anyone read these books? what did you think? Any other good books you can suggest... I'm going to start a collection for me and my clients!

Thursday, July 12, 2007

Volunteer Doula Work

I had already read on the Doula UK site about the hardship fund and it had got me thinking about working with the under privileged. Having been young single mum years ago, I know how hard and confusing such a time can be. I'd love to be able to share what I know now with mums in a similar situation to help them have a better birth and enjoy their newborn.

Then this week as I was again "researching" lol (that's what I tell James!!) I found a Sure Start site that was offering something that in my opinion is a great project! The Newland Doulas have developed a pioneering project to recruit, train and match up volunteer Doulas with pregnant women who need support at what can be a lonely and difficult time. How fantastic is that?!?!

I have been in contact with Heather but at the moment they are the only sure start doing it. They will be broadening across the UK over the next year or so. Watch this space!

Wednesday, July 11, 2007

Caesarean Statistics

I was watching a birth programme this morning and heard the narrator say that 1in 5 births are done by caesarean today compared with 1 in 10 in 1980.

I couldn't help thinking how high that was so conducted a bit of research myself lol. This is due to the rise in elective caesareans. I found this article in The Observer "The increase in Caesareans has coincided with a growing shortage of midwives in the UK"

I personally don't undertstand why some people would elect a caesarean with no medical factors. I would support anyone that wanted to but personally think caesareans should be saved for emergencies, after all giving birth is what our amazing bodies were made to do.

I do know that many women have an emergency caesarean with their first child and go on to an elective caesarean for any subsequent babies. Years ago I thought this was a necessity but since my growing interest in birth I have read so much about VBAC - Vaginal Birth After Caesarean. It is possible and many women do it. There is more information on VBAC here - VBAC on Babycentre

What ever women decide, they should remember that they have a choice either way. Never be forced into doing something you're unsure of or uncomfortable with. Ask questions!!

Monday, July 9, 2007

Doula - D.O.U.L.A!

9 times out of 10 I have to firstly spell out then explain what a Doula is to friends and family when I am telling them about what I want to do.

I got a pleasant suprise this weekend at a friends birthday party... Said it to a friend and she said "oh I know a Doula!" Hoorah! We then chatted about having babies (she's not had any yet) and childbirth and all sorts.

Wednesday, July 4, 2007

Why I'm Going to be a Doula

Thought it would be a good idea to explain my passion for bumps, births, babies, motherhood and doulas!

I had my son when I was 17, it wasn't planned and his dad left me about 1/2 way through my pregnancy. To say it was tough would be an understatement but I struggled on and did my best. My birth wasn't the best, although I slept through the worst of the boring wait, when it came to the nitty gritty it went from bad to worse. At the time I was young and scared. Although my mum was there (just! she had to travel back from Wales - my sister's graduation!!) I didn't know what was happening or what I wanted. None of the staff spoke to me or talked me through it and I spent most of it sucking on the gas and air to try and block out the pain. I was tired and the baby was getting distressed. The ruputured my waters, oxygen, episiotimy and forceps later, Jake was born weighing 8lb 2oz.

Years later I met James and we started trying for a baby. I was ready for a baby and planning it made it so much more relaxed! I couldn't believe the difference! I researched quite a lot to get pregnant and whilst I was pregnant. Someone mentioned homebirths on a forum I used. I really liked the sound of it. The personal touch to giving birth. After lots of talking and research with James we decided to go for it.

The experience of a relaxed, well-informed birth was simply amazing. I never ever thought it would be quite like that. We were fully prepared and I truly believe this made it the experience it should be, one of a lifetime. Unfortunately with the stretched nhs, over-worked and underpaid midwife's the personal and one to one care can be lost, through no fault of their own I might add. Knowing what I know now, I want to share it with other mums to be, help them on their journey and give them the chance to enjoy both their pregnancy and birth, as well as their first few weeks as a mother. Every birth will grow my knowledge and every day I talk more, read more, learn more and once I have completed my training course I will also be attended further seminars and training days.

A friend told me a while back that I would make a great doula after I helped her with her and other friend's babies. I also started up my own website helping mums with weaning www.babybanana.biz dedicated to Baby Led Weaning.

I looked into it some more and more. I found the nuturing birth website and called and spoke to Valerie at length about my passion of become a doula. The nearest and soonest course to me is in september so that is the one I have booked. There aren't many Doulas in Northampton, especially compared to the high demand in the south. I'm hoping that with word of mouth and good birth-doula stories more and more women will know about the option of having the emotional and physical support of a doula.

I will be training as an antenatal, birth and postnatal doula.

Discovery Home & Health!

I think I watched too much of it yesterday!! I had a dream I gave birth last night... It brought the pain back!!!

I do love watching portland babies and student midwives but I think I may need to watch some more between now and September as I cry everytime the baby is born! It's so emotional! I also find myself panting and holding my breath as they start to push... thinking "come on push" in my head!

I was supposed to be my sister's birth partner years ago but unfortunately I was called away from the hospital by my sons dad at the time so missed it! I was there for all the labouring and contractions but missed the birth of my nephew.

I can't wait to be there for other mums now.

Tuesday, July 3, 2007

Hello

Well I decided to start a blog to try and keep me occupied until september!

I have just signed up for the nuturing birth doula training course and I am more than excited about it!

It's taken me all evening to chose a name (which will also be my website name) and to set up the blog! So I shall post more about it in the coming days.

I have my lovely fiance to thank for my cool name!! I love it and him as we spent ages thrashing some ideas about!!

and so the Doula Mamma is born!