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20 February 2018

Surviving the Last Days of Pregnancy!

This post is dedicated to the mums whose baby's due month is February (the shortest month this year!).

Your patience is truly tested in the last days of pregnancy. You have gotten everything prepared, and created a nice cosy nest. You have stocked your fridge with plenty of frozen meals to last you several weeks after the baby is born. You have packed and re-packed your hospital bags, or checked and re-checked your home birth kit (perhaps timed how long it took you to inflate, fill up and deflate your birth pool). You have gone on loads of long walks trying to kick-start your labour. You can’t get comfortable in bed as your bump always gets in the way or you need to go to pee every 15 minutes. It takes you an age to put on your shoes and perhaps you need help from your partner as you can’t reach your foot. Every well-meaning person around you is asking “when is the baby coming?” “have you not had your baby yet?” and it makes you want to scream!

Yes, the last few days of pregnancy can be tough. This is the time that you dig in deep and find your true North, find your inner strength, trust your body to go into labour when it and your baby is ready. Let your baby choose their birthday. You are strong and powerful and your body is doing an amazing job and you can totally overcome this challenge!

Here’s a list of things you can try to pass away the time:

  1. Repeating positive phrases – “I can do this”, “I’ve totally got this”, “Each day that passes, brings me closer to meeting my baby”, "I've made a lovely home for my baby"
  2. Enjoy being fully present - go for a walk in a park or by the river (because who can sit still and be comfortable?!) and listen to the sounds around you, feel the breeze in your hair, the sunrays warming your face, or the rain drizzle on your face (because let's face it, it is winter in London after all).
  3. Go on a romantic date - enjoy some quality time with your loved one. If you have an older child, spend time with him/her and relish them with your undivided attention.
  4. Turn off phone – or put it on silent giving yourself an hour of peace and quiet
  5. Indulge yourself - go for a pregnancy massage to ease achey muscles, or reflexology treatment for relaxation or to try and kickstart the labour.
  6. Go to a pregnancy yoga class – the movements help alleviate any back pain and get your baby in a good position and more deeply engaged in your pelvis.
  7. Come and chat with us at our next Positive Birth Movement group meet-up – hear how others are coping and what they are doing. (Next meet up in on Feb 22nd)

By all means, if none of the above work then scream into a pillow or even better, beat the pillow up!

If you would like to book a relaxation or induction of labour reflexology session with me or a private yoga class tailored for labour preparation please contact me here.

 

30 January 2018

Tips for your birth partners!

Are you worried you may not get the support you want or need? Is your birth partner perhaps clueless how to best help you or worried that they will feel useless? Get your birth partner prepared before the big day by giving them a list of how they can help you in the best possible way. Perhaps print this off and pass it onto them. 

  1. Give her plenty of positive encouragement and reassurance. Please keep in mind the language used!
  2. If things seem to be getting intense and difficult to cope with maintain eye contact and remain calm
  3. Plenty of massage (if wanted - not every women likes massage)
  4. Speak quietly and gently
  5. Encourage her to breath slowly and steadily – concentrating on a long outbreath
  6. Remind her to relax her jaw, drop her shoulders and move her lower body
  7. Remind her to go to the toilet every hour and give her assistance to get there if she needs it
  8. Make her laugh and distract her or just sit with her in silence (every woman is different - ask what she prefers
  9. Give her drinks if she’s thirsty, snacks if she’s hungry
  10. Help her to reapply lip balm, face mist, moisturiser as needed
  11. Act as advocate – explain her needs (and yours) to healthcare staff and ensure they read your birth plan
  12. Remind staff to ask for her consent before they do any interventions
  13. Keep your own strength up – sandwiches, biscuits, drinks, and look after your back
  14. Just be with her and enjoy the birth together
  15. Before making any big decisions - remember the acronym:

B enefits                       

R isks                           

A lternatives                          

I nstinct                      

N othing

Feel free to add any of your own tips!

If you would like to book a private birth preparation class or attend a group antenatal preparation class with me please get in touch via the contact form.

 

23 January 2018

Induction of labour (IOL) for post-term pregnancy - what does the evidence say?
 

The following lists are not exhaustive but highlight some important points. In the UK, IOL is offered at 41+5 as it is a procedure that can last 48 hours and the aim is for your baby to be born by 42 weeks.


Some evidence against IOL for post-term pregnancy

  1. Normal length of pregnancy is thought to be longer than 280 days (40 weeks) The number 280 days was first stated by Aristotle in a time when the number 280 was considered auspicious and had celestial significance.  Therefore, pregnancy length is a moot point. The average length of pregnancy for first time mothers is 41 weeks + 1 day. So, does this mean we should be placing the yardstick for "normal" pregnancy length further away?
  2. Also, how sure are you about the date of your last menstrual period or how accurate is the scan? There may be a margin of error.
  3. Placenta insufficiency - the truth about the ageing placenta is that there is no evidence to support this. Placentas can deteriorate or not be in good shape. However, this is due to some pathological condition (for example pre-eclampsia) but not due to it age. This can lead to unnecessary intervention in some cases and possibly delay of intervention in other cases.
  4. You may have been told that stillbirth rates increase with length of pregnancy. However, most studies that investigated induction at 41 weeks found no statistical differences in poor outcomes between induction and watchful waiting. Therefore - why are we being offered induction?! When looking at evidence, the risk is far smaller than we are told, occurs later than we are told, and is not necessarily reducible by a policy of routine induction of labour at any point.

Reasons for IOL after 40 weeks (list is not exhaustive)

  1. You are tired and mentally drained from being pregnant - a very valid reason!
  2. Perhaps your partner works overseas and has limited time off so you want to give birth when you are sure he is around.
  3. You are having some signs that show concern for your health (eg. elevated blood pressure)
  4. There are some signs that there is concern for your baby's wellbeing (eg. reduction or change in pattern of baby's movements, or amniotic fluid around the baby has diminished, blood flow to and from the baby is not optimum)

Inducing labor is a serious decision. Work with your midwife/doctor to make the best choice for you and your baby.

If you would like to book a one-off antenatal consultation with me to fully discuss the benefits and risks of IOL and of watchful waiting (ie monitoring closely without intervening) and choices how to induce labour naturally (eg. reflexology, acupuncture) please contact me. Or if you would like to book a reflexology treatment to induce the labour please get in touch.

 

 

16 January 2018

⭐️ TRUST ⭐️

Trusting your own instincts is vital and tuning into your own body and what it is telling you has never been more important, as there are two of you to think of now.

  • You think your baby is coming NOW!

One of my pregnancy yoga students, who birthed her baby recently, told me how her labour ramped up from 0 to 10 within minutes. She had been feeling mild surges during the day, which she thought were Braxton Hicks, so she thought nothing else of it and carried on as usual. Then after a relaxing bath (with the lavender essential oil that she encountered in my classes) her waters broke, her surges grew in intensity and frequency and it all happened at once. So, she called the birth centre. However, the frequency and intensity wasn't enough for the birth centre midwives to "allow her" to come in and they advised her to stay at home for a while longer. However, something told her that this baby was ready to be born NOW, and she was almost ready to start involuntary pushing on the bathroom floor. So, she followed her INSTINCT, ignored the advice she received and went straight to the birth centre where her baby was born a mere 18 minutes after arriving!

  • Baby's movements

If you feel that your baby's movements have decreased or reduced - have it checked out. A baby's movements can be described as anything from a kick, flutter, swish or roll. The type of movement may change as your pregnancy progresses. However, it is NOT TRUE that babies move less towards the end of pregnancy. If you think your baby's movements have slowed down or stopped, contact your midwife or maternity until immediately. There's no need to feel silly if it turns out that your baby is doing just fine.

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31 December 2017

The reason why I became a midwife and what it means to be adopted

It is New Year’s Eve, the last day of 2017 – a time for reflections!

Many people tell me what a change it must be from working as a flight attendant (I worked for a Middle-eastern airline for just under 9 years) and jetting off around the world to becoming a midwife, and they ask what brought about that change – I usually tell them that after flying for over 8 years I was tired of it and felt I had had my share of adventures and wanted to settle into a more “normal” lifestyle. And also, that the biology side of it fascinated me (my first degree was in biology, albeit animal biology). All of that is true however, I’ve since dug deeper and reflected on my life and the many twists and turns it has taken me to where I am today.

 

Thinking deeper on the question of what brought about that change, I believe I had left my twenties behind and was now more mature and with it came the philosophical questions and my curiosity turned inward. Where do I come from? Who am I? What does it mean to be adopted? It makes me sad not to know how I was born, who was my birth mother, what was the pregnancy like for her, who do I look like. Having learnt about attachment theories (Bowlby, Ainsworth, Harlow etc) I know how crucial those early days are in shaping us. Studies show that separation of newborn babies from their mothers causes a high secretion of the stress hormone cortisol. The few months after birth form what birth activist, Sheila Kitzinger, calls the fourth trimester of pregnancy. These months are part of a continuum where the baby remains psychologically connected with the mother. Interruption of this continuum, Kitzinger says, has a profound effect on the child. I have no knowledge or memories what the first two months of my life was like. As a midwife, I have learnt the benefits of delayed cord clamping, the bonding that occurs during the “golden hour” after birth, and all about the fourth trimester of pregnancy. Was my cord clamped and cut straight away as was custom back in the early 80s? Did my birth mother hold me during the “golden hour”? Did she take care of me for a few days before handing me over? How often was I held as a newborn in those first two months before my adoptive parents came to get me? So many, many questions and no answers. Perhaps it is because I know next to nothing about my own birth and first two months of life that it has motivated me to learn more about pregnancy and birth and have developed a need to support others. I don’t know how much support my own birth mother had and I want to help women in any way I can.

 

Life was tough in Peru, especially in the early 80s. I was told that my birth parents were poor and there were already too many mouths to feed at home. So, they did the most selfless thing a parent could do and put me up for adoption. It is without a doubt the best decision they could have made, and even though I have many questions, I am happy where I am. My adoptive parents – the only parents I have known – are absolutely wonderful people and I love them so much. They wanted to adopt because they wanted to give girls a better chance in life (in developing countries life is tougher for girls). My parents could have their own children and they did (I have a brother who is biologically their child) but they wanted to adopt as well. I also have a younger sister. Together we make a United Nations family – all five of us born in a different country: Peru, Brazil, Spain, Netherlands and England. Makes for fun times when we sit down to cheer our teams during the World Cup or the Olympics!

What are your reflections for 2017?

 

 

19 December 2017

Natural Breastfeeding for Newborns

Compared to older babies, newborns face special breastfeeding challenges; they have large heads and weak muscles. They are somewhat like turtles, put them on their back and they will flail, place them on their front and their movements are more coordinated.
 

Natural Breastfeeding for Newborn is a method that can be like training wheels on a bicycle for newborns. It is an easy and effective way to learn to breastfeed. When you are just starting out perhaps you may find the Natural Breastfeeding position the easiest and most comfortable way to get going. After your baby starts to grow and get stronger back and neck muscles you can then take off the training wheels and go onto other methods.


The 3 steps with getting to grips with positioning and attaching your baby:

  1. Adjust your body
  2. Adjust your baby in relation to your body and the nipple
  3. Adjust your breast (if necessary)

When you are just starting out perhaps you may find the Natural Breastfeeding position the easiest and most comfortable way to get going. 

Adjusting the body – lie back in a reclined and comfortable position supported by pillows.

Adjust your baby – placing your baby comfortably on his front and on your body. Gravity will help keep him safe and his arms and legs are splayed out ensuring he will not roll away. You can gently hold and support your baby using her hands but your arms are not doing any of the work in holding him up, gravity is keeping him there. The baby’s feet need to be in contact with your body or a pillow. Thhis is because when the baby’s feet are touching something it helps to orientate himself and helps to trigger the reflexes in the best way. The baby can be placed lengthwise or across the body – the baby can go onto the breast from many different angles. If you have had a caesarean section, avoid your baby lying over the stitches.

Adjust your breast – you can use breast shaping by squeezing your breast gently in line with the baby’s mouth to help him get a mouthful. Imagine squeezing down a big sandwich to make it easier to take a bite. This last step is sometimes not needed - only use if your baby is having trouble getting a mouthful of breast, especially if the breast is very rounded or large.

See video on: www.naturalbreastfeeding.com

Would you be interested in attending an Infant Feeding antenatal session with me? Or perhaps your baby has already been born and you need Breastfeeding support? To book a session contact me here.

 

 

12 December 2017

Pregnancy need-to-knows: breastfeeding positions and attachment

Yesterday I saw an article in The Telegraph titled New mothers could be ‘bribed’ with £200 shopping vouchers to breastfeed children. I'm not sure I like the title. It is quite antagonistic. It seems the article is the result after a 5-year trial part-funded by Public Health England in an attempt to boost breastfeeding rates. In comparison to other countries, Britain, along with Denmark and Saudi Arabia, falls behind as one of the countries with the lowest rates of breastfeeding after 12 months (0.5%), with countries such as Senegal and The Gambia reaching a breastfeeding rate of over 98%.

The NHS recommends that mothers exclusively breastfeed their babies during the first 6 months. Research has found that breasted babies have fewer health problems and are less likely to develop diabetes when they are older. 

This scheme is attempting to reward mothers who continue to breastfeed their babies. Researchers estimate that the NHS could be saved £17million a year if breastfeeding levels are raised, because it protects babies from infections.

However, this scheme has the possibility to alienate, or even discriminate against women who cannot for medical reasons breastfeed or those who exercise their right to choose not to.

In my experience, mothers who do wish to breastfeed will give up due to being inadequately prepared to get off to a good start. This can be due to a lack of support. I know from experience how busy the postnatal ward in hospital can be and the midwives are run off their feet trying to help as much as they can. This is why learning the basics beforehand can prove to be invaluable! According to a study in the USA, 92% of first time mothers report difficulties breastfeeding within 3 days after birth! The 3 common problems reported were:

  • Nipple pain
  • Difficulty attaching
  • Concerns about inadequate milk production

However, do not worry about the above – you totally will have this. The more comfortable and calm you are - the more oxytocin will be released. Oxytocin plays an important part in milk production and the let-down reflex.

My top 3 tips before you start to breastfeed:

  1. Notice your baby’s feeding signals before she starts to cry (bringing her hand to her mouth, turning her head from side to side, opening and closing her mouth)
  2. Get yourself in a comfortable position so that your muscles can relax (no tense shoulders or neck)
  3. Have some water and snacks to hand before starting – breastfeeding is a thirsty and hungry activity

Watch this video on how to position and attach a baby optimally - Attaching Your Baby at the Breast (10 minutes).

Summary points for positioning and attachment:

  • Baby’s head, neck, shoulders and hips in line – making it easier for your baby to swallow
  • Wait for wide open mouth before attaching on the breast – so that baby takes in as much breast as possible and the nipple reaches the soft palate of her mouth
  • Baby’s chin pressed into the breast
  • Lower lip turned out
  • More aerola should be seen above the baby’s mouth
  • Baby’s cheeks should be rounded (not sucked in)
  • One or two sucks to swallow ratio

Would you be interested in doing an Infant Feeding session with me? This session will help prepare you in advance for when your newborn arrives. We will cover correct positioning and attachment; signs that baby is feeding well; weight gain and loss in the first week; manual expressing; engorgement and mastitis; bottle feeding; skin to skin; managing expectations; tongue-tie. If you would like to book this session contact me here.

 

 

5 December 2017

How do I know my baby is growing well and is healthy?

There are several ways to measure how your baby is growing:

  1. measuring your bump with tape measure
  2. measuring your bump with fingers
  3. estimating your baby's weight with an ultrasound scan
  1. Measuring your bump with tape measure

Measuring the height of your uterus helps determine if your baby is growing normally at each stage of the pregnancy. The term for measuring your uterus is called the symphysis-fundal height. This means the midwife will feel for the top of your uterus (ie the fundus) and using a tape measure will measure from the top of the fundus down to the bony part of your pubic

At about 13-14 weeks, the top of the uterus is usually just above the mother’s pubic bone. At about 20-22 weeks, the top of the uterus is usually right at the mother’s bellybutton (umbilicus). At about 36-40 weeks, the top of the uterus is almost up to the bottom of the mother’s ribs. Babies may drop lower in the weeks just before birth as they go into the pelvis and this may decrease the fundal height.

In terms of centimetres, measurement of the symphysis-fundal height will correspond to the number of weeks that you are pregnant, ie at 30 weeks pregnant your fundal height will be approx. 30 cms.

  1. Measuring your bump with fingers

Some midwives will instead of a tape measure use their fingers to measure how many fingers above the umbilicus the top of the fundus is, ie 1 finger per 1 centimetre. The limitations for this finger method is that every clinician's hands are different and this can lead to a discrepancy in measurement. Measuring with a tape measure overcomes this problem.

As healthcare professionals, we need to take into account your and the baby’s father’s genetics – taller parents will tend to mean a taller baby, and vice versa. Also important is having continuity of carer – ie the same person measuring the fundal height. Having the same person measure your bump at each appointment will mean they are best placed to pick up any discrepancies. In the hospital where I worked at, we looked at if your bump measures more than 2 cms smaller or larger than your gestation (number of weeks) then you may be referred to get an ultrasound scan.

  1. Estimating your baby's weight with an ultrasound scan

Another way you to find out how well your baby is growing is through an ultrasound scan. The sonographer will measure the femur length, head circumference amongst other measurements. This is then plotted against the average for that gestation. These measurements can be seen in your ultrasound scan report and for normal results you are looking for the black dot (•) to be anywhere along the line – like this |-----•---|. If the dot is on the left side of the lines then your baby’s growth is on the smaller side • |---------| or if it is on the right side of the lines it is on the larger side |----------| •

Using these measurements, the baby’s weight can be estimated. However, keep in mind that the further along in your pregnancy you are the more difficult it becomes for the sonographer to accurately perform measurements. This leads to overestimating a baby’s growth and can lead to unnecessary worry. According to a 2016, an analysis of the outcomes of 64,030 women shows that the practice of estimating the baby’s weight before it is born is associated with an increased chance of the woman having a caesarean section.

  • 18.5% of women who had their baby’s weight estimated by ultrasound and documented in their notes had a caesarean section
  • 13.4% of women who had their baby’s weight estimated clinically (estimation by a midwife/doctor feeling the baby with their hands) and documented in their notes had a caesarean section
  • 11.7% of women whose baby’s weight was not estimated/documented had a caesarean section

Midwife and author, Sara Wickham, states that we must not underestimate the effect that our human perceptions have on decisions. If clinicians think and see documentation that the baby might be larger than average they might be quicker to suggest a caesarean section. What concerns Sara is when women are not told about the possible risks and benefits of this type of screening (measurement) before it is performed on them and then documented in their notes.

The national guidance for the UK (NICE 2008) also suggests that ultrasound estimation of fetal size for suspected large unborn babies should not be undertaken in a low-risk population.

Sara says “given the ramifications of this screening test, not to mention the fact that our estimation of fetal weight is often not that accurate… we need to give some serious thought to whether it is justifiable to continue such a practice or whether it might be something that women should be informed about and asked about before it is performed”.

Would you prefer to be asked whether you want to know the estimated size of your baby? Would you find it helpful to know for yourself what your baby’s estimated weight is at each antenatal appointment as a routine screening? Or would you only rather know if your baby seems to be growing smaller or larger than average and then get further tests?

A baby that has static growth or is on the smaller or larger size than average for its gestation would benefit from further tests to ensure its well-being and this is when ultrasound scans are helpful. Sometimes certain factors make a pregnancy riskier and this needs to be closely monitored, with weekly check ups to ensure the baby is getting enough nutrients and is growing adequately.

 

If you would like further reassurance or information I offer one-off antenatal appointments at home where we can fully discuss your situation and your options – you can book an appointment via the contact form.

References:

Froehlich, RRJ, Sandoval, G, Bailit, JL et al, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network (2016). Association of Recorded Estimated Fetal Weight and Cesarean Delivery in Attempted Vaginal Delivery at Term. Obstetrics & Gynecology 128(3): 487-94. doi: 10.1097/AOG.0000000000001571

NICE (2008) Clinical guideline 62 – Antenatal care for uncomplicated pregnancies. National Institute for Health and Care Excellence (updated 2017)

 

 

14 November

Birth Story Part 2

When I sat down with the lovely Becs I asked a few questions on tips, that I think would be of great benefit to you, whether you already have a child or this is your first. 

Rebecca: Name 3 things that you learnt about in pregnancy that you found really useful and helped in your labour.

Becs:

  1. Breathing technique – During pregnancy and anytime I felt overwhelmed I would use these techniques: in-breath for 4 and an out-breath for 6, and mindfully relaxing every single part of your body in turn. On a few occasions, Sam helped count me in when I lost the focus, but this breathwork in the midst of surges is a deeply internal process. 
  2. Mantra of “trust” – Trust became an important mantra for me to have. Having faith in yourself is important, having faith in your beautiful baby and to also trust the midwife in supporting you.
  3. Yoga – I would be absolutely nowhere without yoga. Being able to move your body is a beautiful thing. No matter how small the movement and by acknowledging whatever it is you need on that day, make the time to move your body – every time you do this you are bringing more awareness to your body and state of emotions and this definitely helps during labour and birth. 

Rebecca: and you practiced right up until the birth?
Becs: Yes and I was practising all through the labour too. I was mainly on all fours doing hip circles and cat cow as well as wide lunges to encouraging opening of the pelvis.

Rebecca: Any tips that you’d give to other women who are expecting their first baby?
Becs:
so many things come to mind but what I found to be the one of the most helpful for the postnatal period is to cook food and freeze it. When your awareness, energy and time is completely directed at your beautiful new born, there is limited time for your own needs. Preparing nourishing and hearty meals that are easily accessible made the first few weeks a lot more manageable. 

What I took away is how important the birth environment is and how crucial it is for you to communicate with your birth partner on how they can help you! I hope you find these tips useful and contact me if there are any other tips that you think would be of help to new mums.

 

7 November 2017

Birth Story: Becs and Marley Part 1

Becs begins by telling me how the events unfolded on a Sunday afternoon when she felt her waters break. What follows is her birth story as told by her to me. I have full consent to share her story.

There was a lot of expectation of having the birth at the birth centre... And everything I’d been studying, reading, and working towards was going to be encompassed at the birth centre.

Becs went to the birth centre where the midwives confirmed her waters had broken. However, since she was not having any contractions/surges, she was told she couldn’t use the birth centre.

That was the first moment I realised that everything was going to go very differently to plan. People keep telling you to stay open to things not going your way, and in that moment, my whole world came crashing down.

After reviewing her options, she chose to opt for expectant management – waiting for labour to start naturally. Most women (90%) will go into labour naturally within 48 hours of the waters breaking.

She decided to wait for things to start naturally and in the meantime monitor for signs of infection. Throughout Monday she tried all sorts of things to kick-start the labour – from eating pineapple, long walks, yoga, raspberry leaf tea. Becs had already started to feel sporadic tightenings and felt like mentally retreating inwards. By Tuesday morning, her surges had ramped up and she felt the need to use a TENS machine to help. By midday, the surges came every 2 minutes, and she started to feel intense pressure down below. So she got ready to go to hospital.

It was quite hard to get into the car, and to try and find a comfortable position … I had my pregnancy pillow and was lying on my left side with my head out the window. So, the looks people were giving us when we stopped at traffic lights and I was surging hard! We had one guy roll down his window, clapped and said, “go on, go on, you can do it!”

Once in hospital, Becs was examined and found to be 6cm dilated! In the labour ward she was looked after by one midwife and her student. Becs chose to use a birth pool and experienced a huge relief from the warm water – “pure feelings of surrender, and floating felt incredible”. She used her breathing techniques to help ride through the surges. The midwives attending her encouraged her to listen to her body and push if she needed to. After 1 hour of being in the water, Marley was born and brought up to her chest.

What a feeling! Your attention is diverted to something so much greater and what you have in your arms. I first sniffed his head – that beautiful baby smell!

One aspect that Becs found she was not prepared for is the checks that happen after the baby is born, ie checking for perineal tears, which felt very invasive. The gas and air really helped during this part. Both Becs and her partner are huge Bob Marley fans.

Bob Marley playing in background really helped. The midwives were singing along whilst doing the check-ups.

All in all, it was an amazing experience not only for the new parents but also for the midwives. This was the first water birth that the student had witnessed! Both the student and the experienced midwife felt privileged and commented how it gave them hope that birth doesn’t always have to be completely medicalised.

 

 

6 November 2017

Induction of labour process

An induction of labour is when labour is started artificially using pharmaceutical, mechanically or by complementary methods. Today we will focus on pharmaceutical and mechanical methods which is what is done in a hospital setting.

Every year 1 in 5 labours are induced in the UK. For labour to progress, the cervix needs to soften and shorten (called effacement) before it can start to dilate.

Membrane stretch & sweep

  • During a vaginal examination, the midwife inserts one finger into the cervix and sweeps it around the inside of the cervix giving it a stretch - attempting to separate the membranes from the sticking to the inside of the uterus above the cervix. 
  • This is thought to promote the body to release prostaglandins
  • Can only be done if cervix is slightly dilated (1cm or more) and angled towards the front so it is in easy reach of the fingers
  • Can be uncomfortable and doesn't always work result in labour, sometimes it induces a stop-start labour
  • Can inadvertently break the membranes (release the waters) and may introduce infection

Propess pessary

  • Looks like a mini tampon with a string that sits outside the vagina
  • Inserted during a vaginal examination
  • Releases prostaglandins which helps to soften and shorten the cervix
  • Usually first choice if membranes still intact
  • Can easily be removed if you start contracting more than 5 surges in 10 minutes (hyperstimulation of the uterus)

Prostin gel

  • Syringe with gel is released next to the cervix during a vaginal examination
  • Contains prostaglandins to help soften and shorten the cervix
  • Usually done if your waters have broken
  • Cannot be easily removed if hyperstimulation occurs – in this case you need to be given medicine

ARM (Artificial Rupture of Membranes)

  • Done if cervix is at least 2cm dilated
  • Long, thin plastic stick with a miniature hook (amnihook) at the end is used to break the membranes
  • Amnihook is inserted during a vaginal examination
  • Works by letting baby's head press directly on your cervix to promote more and stronger surges

Syntocinon hormone drip

  • Artificially-made hormone like our own body's natural oxytocin
  • A cannula (plastic thin tube) is inserted in your arm and a drip attached.
  • Syntocinon aims to promote regular surges and help with dilation
  • Drip is set at minimum value and dosage is increased every 30 min until your body achieves 4 surges in a 10 minute time-frame.
  • Any more than 5 surges in 10 minutes is too much for your baby and your body to cope with, and the drip should be stopped.
  • Continuous electronic monitoring of your baby's heart rate is recommended to see how the baby tolerates the drip.

To recap, the propess and the prostin gel work to efface the cervix. Once the cervix has effaced then the syntocinon drip works to dilate the cervix. Depending on how your body reacts to the drugs and whether your body is already ready for labour, the induction can take anywhere between a couple hours up to 48 hours, and you might need the whole menu of interventions to get you into labour or perhaps just the aperitif.

For tailored information on induction of labour and how to fit your birth plan around it please contact Rebecca for a consultation.

 

24 October 2017

Placentophagy - a weird fad or delicious and nutritious?

There is a growing trend in consuming your own placenta for health benefits – this is called placentophagy. You may have heard of some people eating their own placenta and raving about the benefits. Or you may get squeamish at the thought of eating an organ that your body has made.

One can consume their own placenta (or someone else’s) in various forms:

  1. as a smoothie mixed in with fruit, yoghurt and/or milk
  2. sautéed and fried
  3. mixed in with ground beef in a lasagne
  4. dried, ground and encapsulated
  5. in a tincture
  6. if you are feeling brave – have it raw (but washed)

For humans, this practice is fairly recent. However, animals have been eating their own placenta forever and they eat it raw straight after the birth. It is thought they eat it so they get rid of any smell that will attracts predators – so it is a preservation thing.

In humans, the first record of placentophagy are tied to the natural birth and home birth movement in the US during the 60s. However, it is only in the last 10 years that it was become a well-known practice. The recent popularity is mainly due to greater awareness in the media. A number of doula and midwives advocate this practice. During my years working as a midwife I rarely came across it whilst working in the NHS, however, it was very common practice amongst my clients as an independent midwife. Again, this can be attributed to number of home births I did and perhaps with women wanting to explore alternative treatments for a healthier lifestyle.

So, what are the benefits? It is thought to:

  • boost milk production
  • fight postpartum depression
  • reduce pain in recovery
  • increase energy
  • increase iron-intake

Unfortunately, not much research has been done on the amounts of nutrients in a placenta and if the cooking/dehydrating process degrades the beneficial hormones and nutrients.

After the birth, the midwife will check the placenta and cord for any abnormalities – this forms part of the clinical care of the mother and baby. If there are abnormalities it is recommended your placenta be sent for analysis. Ask her to show you what she is looking out for. I’ve had plenty of clients ask me to show them their placenta and how it functions and they are all in awe that their body made this organ! It is fascinating (I think)! If the placenta is ok, then feel free to ask to keep it. This is your organ and therefore you have the right to decide what to do with your own placenta.

If you are interested in tasting your own placenta but are too squeamish to eat it in its original form, you can have it dried, ground up into powder and encapsulated. I can recommend some local doulas that offer this service. Please contact me (via contact form) if you’d like to do this.

Options on what to do with your placenta is one of the things I cover during a Birth Prefernces writing session - if you are interested send me an enquiry via the contact form.

 

 

17 October 2017

5 tips for your recovery and life with a newborn

I've been preparing for a Mothercare Expectant Parent event today, where I've been asked to give a talk. I’ll be speaking about the benefits of doing pregnancy yoga to have a healthier and easier pregnancy and birth, and also what to expect in the early days after your baby is born. You will suffer from lack of sleep, hormone imbalance, getting to know your new baby, recovering from the birth – all of this can be quite overwhelming.... becoming a parent is a huge deal!

1.    Be kind to yourself – it is ok if you have not taken out the rubbish, if you have a mountain of laundry piling up, or if you have spent several days in the same clothes!

2.    Prepare in advance – start stockpiling your freezer. Enjoy preparing your favourite recipes of delicious and healthy meals in the last few weeks of pregnancy and have at least 2-weeks' worth of frozen meals in the freezer. Perhaps get a subscription for online food shopping to be delivered to your door.

3.    Ask for help – Ask any visitors to bring something when they come over (food shopping, home-made dish) or they can take the rubbish/recycling out. Also get visitors to help themselves to a cup of tea/coffee and to make one for you. Ask family to help with cleaning or arrange a cleaner to keep your home clean and tidy.

4.    Be patient with yourself – you and your baby are in the process of getting to know each other - it is ok not to know what exactly your baby wants. Try feeding, changing nappy, winding him, cuddling him, soothing or swaddling him, singing or talking to him. And repeat. You are doing an awesome job so give yourself a break.

5.    Have zero expectations – when it comes to a sleeping or feeding pattern. These tend to vary over time. Eat when you can and rest when you can. The more you rest and the healthier you eat, the quicker you will recover.

 

Come and see me at the Mothercare Kew event today at 6:30pm and avail from an exclusive 15% discount on my postnatal care packages and other discounts on my pregnancy yoga classes. There will also be in store discounts for Mothercare products. Here’s the link to book your free space!

 

10 October 2017

Meconium-stained waters

Picking up where I left off last week – let’s talk about meconium. So, what is meconium? Meconium is the baby’s first poo. Meconium is made of a mixture of water (70-80%) and several other ingredients (30-20%) such as amniotic fluid, lanugo, intestinal epithelial cells.

According to a 2010 study by Unsworth & Vause, there are 3 reasons that a baby will open his/her bowels whilst inside your bump:

  1. The most common reason is that your baby’s digestive system has developed fully and the intestine has started to work by moving the meconium out. Around 15-20% of term babies and 30-40% of post-term babies will have passed meconium whilst inside your uterus.
  2. During labour, your baby’s cord or head is being squeezed. This causes a reflex that can both lead to heart decelerations and the gut to begin to work. This can be a normal physiological response which can happen without fetal distress such as when babies pass meconium in the last part of labour when their head is being squeezed in the birth canal, and they arrive with a trail of poo behind them.
  3. There could be fetal distress which results in hypoxia. It is thought that the lack of oxygen causes the anal sphincter to relax and intestinal movement resulting in the passage of meconium.

It is important to bear in mind, that fetal distress can be present without meconium and meconium to be present without fetal distress. The main thing is to look at the bigger picture.

In my antenatal one-to-one appointments I will counsel you about your options and what to avoid if you have meconium-stained waters to have a safe and positive birth. Contact me to book your antenatal appointment.

 

 

3 October 2017

Amniotic Fluid - your baby's bath water!

Did you know that when your baby is near term (fully developed) his daily urine contributes about 500ml to the total amniotic fluid volume? Your baby also swallows an estimated 400ml of your waters. This fluid passes through your baby’s circulation and any waste products are removed and passes via your placenta to your circulation system where your body removes it.

Functions of the amniotic fluid:

  • space for growth and movement of your baby, helping muscular development of his arms and legs
  • development of your baby’s lungs
  • works as an “airbag” cushioning your baby during contractions or surges
  • prevents compression of the umbilical cord during your baby’s movements and surges
  • protects the baby's head as it is descending and moulding in your pelvis during labour

At each appointment, your midwife should check the amount of fluid during palpation (the process of using her hands to examine your bump). The fluid level can be estimated to be reduced (oligohydramnios) or increased (polyhydramnios). Both these conditions, if suspected, need to be checked via an ultrasound scan which can measure the levels accurately, as in some cases may indicate a fetal abnormality or can be associated with maternal condition.

If ‘your waters break’ (known clinically as ‘rupture of membranes') at term, you should make a note of the time at which it happened, and the colour of the fluid. It is easiest to see the colour if you place a sanitary pad in your underwear. A normal colour can be clear, pale straw, or lightly blood-stained. It's not always a gush of water - sometimes it can be a slow and continuous trickle.

You could also have some “show”. This is also known as your ‘mucous plug’ and has the consistency of jelly. It can be clear-coloured or blood-stained, and could indicate that your cervix is softening and starting to dilate. If you have a show it doesn’t necessarily mean that labour is imminent - some women have it a week before going into labour, and others only right before the birth itself.

Sometimes your waters break before you have surges or contractions, and sometimes your waters never break and your baby is born in an intact membrane sac. This is called to be born ‘en caul’ – it is very rare and is thought to be extremely lucky!

If your waters break before 37 weeks, or the colour of your waters is greenish, brownish or bright red with fresh blood you should consult your hospital. Green or brown/black waters indicate the presence of ‘meconium’ which is your baby’s first poo. I will write more about meconium in next week’s post.

If you’d like to keep updated whenever a new blog post comes out then sign up to my newsletter. If you would like to book an antenatal one-off appointment with me to go over your options and more in-depth information please contact me here. These appointments last between 1-2 hours until all your questions are answered.

 

 

25 September 2017

Finding Your True North and Surviving the Last Days of Pregnancy!

I spent my Saturday volunteering at the first Wanderlust yoga event in London! The festival consisted of a mindful triathlon: a 5-km run, followed by a 90-minute yoga class and a 30-minute meditation. The work was non-stop, but it was such an awesome day, and I made some real connections with some amazing and fun people.

The reason I'm telling you about my Wanderlust adventure is that the theme of the event is “Find Your True North”, which is rather cheesy. However, I really like the notion of a bit of soul-searching, finding that inner reserve within you to pursue your dreams, life goals and overcome any challenges. I think this theme lends itself well to pregnancy and childbirth.

For most, pregnancy and starting a family is very much wanted and life dreams to start a family. For some women, the pregnancy itself can be a struggle and they find it physically and/or mentally. It is a hard slog at times, especially if you are not well supported.

Your patience is truly tested in that last days of pregnancy. You have gotten everything prepared, and created a nice cosy nest. You have stocked your fridge with plenty of frozen meals to last you several weeks after the baby is born. You have packed and re-packed your hospital bags, or checked and re-checked your home birth kit (perhaps timed how long it took you to inflate, fill up and deflate your birth pool). You have gone on loads of long walks trying to kick-start your labour. You can’t get comfortable in bed as your bump always gets in the way or you need to go to pee every 15 minutes. It takes you an age to put on your shoes and perhaps you need help from your partner as you can’t reach your foot. Every well-meaning person around you is asking “when is the baby coming?” “have you not had your baby yet?” and it makes you want to scream!

Yes, the last few days of pregnancy can be tough. This is the time that you dig in deep and find your true North, find your inner strength, trust your body to go into labour when it and your baby is ready. Let your baby choose her birthday. You are strong and powerful and your body is doing an amazing job and you can totally overcome this challenge!

Here’s a list of things you can try to pass away the time:

  1. Repeating positive mantras – “I can do this”, “I’ve totally got this”, “Each day that passes, brings me closer to meeting my baby”
  2. Meditation – go on walks in a park or by the river (because who can sit still and be comfortable?!) and listen to the sounds around you, feel the breeze in your hair, the sunrays warming your face, or the rain drizzle on your face
  3. Enjoy some quality time with your loved ones.
  4. Turn off phone – or put it on silent giving yourself an hour of peace and quiet
  5. Go for a pregnancy massage, or reflexology treatment – pamper yourself and relax
  6. Go to a pregnancy yoga class – the movements help get your baby in a good position and more deeply engaged in your pelvis.
  7. Come and chat with us at our next Positive Birth Movement group meet-up – hear how others are coping and what they are doing.

By all means, if none of the above work then scream into a pillow or even better, beat the pillow up!

If you would like to book a relaxation reflexology session with me or a private yoga class tailored for labour preparation please contact me here.

 

12 September 2017

Breathing Techniques during Labour

Whilst teaching a client my “Coping Techniques for Labour and Birth” workshop we discussed the benefits of hypnobirthing and the importance of breathing techniques. Generally, the breathing techniques that I teach, I get you to completely focus and place emphasis on your exhale. I do this by getting you to visualise a white feather floating in front of your face or a golden thread coming out of your slightly-parted lips. The aim is to blow away the white feather or gold thread further and further away from you during a contraction/surge/wave.

Perhaps you have heard of Ina May Gaskin and her theory that the more the jaw is soft and relaxed the more the cervix can dilate. Therefore, by keeping your focus on your exhale and making it longer than your inhale, you help your jaw to relax and soften.

This reminded me of a conversation I had with one of my friends. She commented on how her labour was helped by whistling throughout her contractions. I thought that was fascinating at the time and did some research. I found that some hypnobirthing techniques encourage women to make a noise during the exhale which could be a “sshhh” noise or a loud sigh. Indeed, my friend used a whistling technique. I think that having this added sound can help you to focus your mind on something other than the intensity of the labour sensations. Making a noise during the out breath can also work to lengthen it and relax the muscles in the face and jaw.

If you are a practiced yogi you may find it useful to use your Ujjayi breathing. This is another way to create sound during the exhale. This breathing technique is sometimes called "the ocean breath". It works by slightly narrowing the back of the throat which constricts the passage of air. It’s important never to hold your breath during labour as your body and your baby needs oxygenated blood. However, by narrowing your throat you create an ocean-like sound when air passes out.

Another breathing technique to lengthen the exhale is by counting. Inhale to the count of 4 and exhale to the count of 4 initially, but then gradually lengthen the exhale to the count of 5, 6, 7 and finally 8. You can count in your head or get your birth partner to help you count out loud. Alternatively, instead of counting perhaps try focussing feeling the sensation of cold air coming in through the nostrils and warm air leaving your nose and mouth.

During my pregnancy yoga classes part of the class is dedicated to breathing techniques – if you’d like to sign up to my yoga classes or sign up to my one-to-one Coping Techniques for Labour and Birth classes you can contact me here.

 

 

05 September2017

How to create your birth space

To create a positive experience in a hospital labour ward or birth centre setting, you can start by making your birthing space as comfortable as possible. Making a space less clinical-looking can make all the difference! These are some useful items that you can bring (this list is by no means exhaustive):

  1. Fairy lights or battery-operated candles
  2. Favourite pillow (hospital pillows are renowned to go walkabouts and in any case they are as flat as pancakes)
  3. Eye pillow and add some drops of lavender essential oil
  4. Essential oils (I use doTERRA oils) – check my Facebook page for a video and instructions on how to safely use these oils as written by Jennifer Hautman from www.hautmanhomeopathy.com
    • Balance (creates a sense of calmness and well-being, eases anxiety, creates a soothing and calming environment)
    • Wild Orange (helps you to be grounded and focused on the present, eases anxiety)
    • Serenity (lessens feelings of tension, calms the mind & emotions and soothes the senses)
    • Clary Sage (can be used to increase contractions, if needed, and / or to help expel the placenta after birth)
    • Frankincense (when inhaled or diffused, promotes feelings of peace, relaxation, satisfaction, and overall wellness).
  5. To pass the time while things get going – magazines, ipad/laptop with comedies (laughter helps bring out oxytocin), card games, make a playlist or use hypnobirthing tracks and bring headphones.
  6. Snacks and drinks – something that’s easily digested and nutritious. Perhaps even get takeaway in the early stages, or get someone to bring you a home cooked meal (much nicer than hospital food).
  7. Straws – so much easier to drink from than a bottle or cup!
  8. To help with pain relief – TENS machine, hot water bottles
  9. Get moving – bring a birthing ball, let loose with some dancing or yoga exercises to ease any discomfort and help focus on your breathing anytime you feel anxious or during contractions/surges.

So, there’s plenty of things you can bring in from home or do to pass the time to make your hospital stay as comfortable as possible. The more comfortable and relaxed you are, the greater the chance that you will have a positive experience!

Subscribe to my weekly newsletter (see form on the right) for more information on pregnancy news and pregnancy yoga tips and class schedule or contact me to enquire about my services.

Jennifer Hautman has more information on her page about essential oils for pregnancy and birth. Read here.

 

29 August 2017

Positive Birth Movement August Theme - Pain

I haven't been to a PBM meeting since May as I was either teaching or on holidays (lucky me!). This month the theme is - Pain which is quite an unusual topic for a positive movement group, seeing that the word pain has negative connotations. However, I feel that it is important to think about this word, as it often comes up in pregnancy/birth conversations - usually from well-meaning family and friends. "Aren't you worried it will be painful?" "How will you cope with the pain?" "I couldn't handle the pain.... "

Pain is a negative sensation that we dislike and want to avoid. But how to avoid pain? Basically, we cannot avoid the physiological process that we will encounter at many points in our lives. Indeed, there is a reason we feel pain. Usually it is our body's way of communicating that something is wrong or dangerous (eg. when you burn your hand on a stove, without pain we wouldn't remove our hand from the heat). However, when dealing with a process which we need to go through (such as labour) it is best we change our mindsets to become more resilient.

During my yoga classes I often mention to my students to be mindful of the impact words can have on them. A way we can help ourselves is to change the wording or terminology. In my weekly newsletter, I incorporated a table of clinical negative sounding words and their positive-sounding counterparts. A lot of this is taught in hypnobirthing courses. So how about we change the word pain and instead think

Hayley and baby Indy
Hayley and baby Indy

 

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