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:
- 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)
- Get yourself in a comfortable position so that your muscles can relax (no tense shoulders or neck)
- 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:
- measuring your bump with tape measure
- measuring your bump with fingers
- estimating your baby's weight with an ultrasound scan
- 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.
- 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.
- 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.
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)
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.
- 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.
- 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.
- 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
- 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)
- 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:
- as a smoothie mixed in with fruit, yoghurt and/or milk
- sautéed and fried
- mixed in with ground beef in a lasagne
- dried, ground and encapsulated
- in a tincture
- 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.
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
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:
- 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.
- 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.
- 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:
- Repeating positive mantras – “I can do this”, “I’ve totally got this”, “Each day that passes, brings me closer to meeting my baby”
- 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
- Enjoy some quality time with your loved ones.
- Turn off phone – or put it on silent giving yourself an hour of peace and quiet
- Go for a pregnancy massage, or reflexology treatment – pamper yourself and relax
- Go to a pregnancy yoga class – the movements help get your baby in a good position and more deeply engaged in your pelvis.
- 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!
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.
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):
- Fairy lights or battery-operated candles
- Favourite pillow (hospital pillows are renowned to go walkabouts and in any case they are as flat as pancakes)
- Eye pillow and add some drops of lavender essential oil
- 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).
- 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.
- 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).
- Straws – so much easier to drink from than a bottle or cup!
- To help with pain relief – TENS machine, hot water bottles
- 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 of it as an intense sensation?
The second thing I teach in my yoga classes is how to overcome mind over matter during my endurance exercises. Focusing the mind on the breath or through visualisations can help overcome any pain sensations.
Having done a 10 day silent Vipassana meditation course a few months ago, I was taught to how to observe sensations (such as pain) and be equanimous. (I will write another blog on my experiences at the meditation retreat another time). I learnt to be calm and composed and notice the sensations objectively without fear, aversion. For example, during meditation, I had to sit cross-legged for a whole hour without moving at all. My knees began to hurt about 15 minutes into the hour and at first I was in agony thinking I still had 45 minutes left and I ended up stretching my legs! I was taught to observe the pain (as an intense sensation) in an objective manner and be ok with it. I had to get comfortable with being uncomfortable. Yes, my knees hurt and my legs became numb, but eventually the pain went away. Gradually over a few days it got easier to sit still for the entire hour.
Every sensation comes and goes, nothing is permanent. Think of contractions during labour (or a more positive-sounding word to use instead of contractions is waves or surges) - they come and they go. If we focus on our breath or use visualisations such as the "golden thread" or "white feather", it will help our minds deal with the intensity of the sensations.
To summarise, let's be mindful of the words we use and let's get comfortable with the uncomfortable because it won't last forever. And as one of my students pointed out; each surge will bring you closer to your baby!
22 August 2017
Recent news concerning midwives and the use of the term "normal" births
It seems really odd to me that journalists have recently picked up the change of RCM's campaign that "dropped" the term normal births. The RCM's campaign was changed to be called "Better Births" however this was old news. The misinformed articles have caused some controversy and backlash aimed at midwives who all want to do the best by the families they serve. Here are IMUK's comments on the articles in The Guardian and The Times. Click here.
22 August 2017
How to make the right decisions for a better pregnancy
Knowledge is Power!
Have you ever felt overwhelmed by the well-meaning stories from friends and family? So much so that your head is spinning and you can't make sense of anything? Or perhaps you would like more information from your doctor or midwife regarding a test? Perhaps there are too many choices and you just don't know which to pick?
I will teach you this easy way to put it all in order so that you can evaluate which approach/choice works best for you. Being a major decision-maker in your own pregnancy journey is empowering and research has proven it makes for a more positive experience.
I do so love a good acronym (who doesn't?!). So for this week's post I've got the Queen of all acronyms when it comes to making decisions for your own health. Whenever you are offered a test or intervention, remember your.....
B - BENEFITS - these obviously depend on your situation, there are some procedures that you may have wanted to avoid that are beneficial in some circumstances.
R - RISKS - healthcare providers generally inform you of major known risks, however you may need to do some of your own research. Also care providers' own beliefs and experiences based on their personal and professional backgrounds may affect how they talk about the relative benefits and risks.
A - ALTERNATIVES - formal research into alternatives therapies are hard to come by due to lack of funding (there's no money to be gained by pharmacological companies!). Midwives are experts in normal births whereas doctors are experts in complicated births.
I - INTUITION - call this your gut instinct. Deep down there's a voice or a feeling telling you what decision feels best for you, listen to this voice. It deserves to be heard.
N - NOTHING - ask yourself, what if you do nothing? This can be a valid alternative at times. Choosing nothing can also be helpful in giving you more space to consider your options. You may want to check if it is possible to changer your mind at a later stage. Your healthcare providers should uphold the right of their patients/clients to make a polite "informed refusal" of an intervention.
Let's use an example.
Deciding whether to have a medical induction of labour for going over your due date (bearing in mind a normal pregnancy is between 37-42 weeks, most doctors/midwives will start talking about induction when you reach 40 weeks)
Benefits - You may get to meet your baby sooner rather than later. If you are tired of being pregnant and looking forward to meeting your baby, having an induction can sort this out.
Risks - Studies show that a medical induction tend to have a higher rate of the birth ending up with epidural (due to the more intense contractions that the medicines produce), inability to move around, ending up with instrumental delivery due to baby not being positioned well or with caesarean section and possibly higher rate of perineal tears if instruments are involved. Please note a medical induction is a procedure that can take up to 48hours until your baby is born.
Alternatives - include: reflexology, acupuncture, osteopathic/chiropractic treatment, massage with clary sage oil, drinking castor oil, raspberry leaf tea, eating dates.
Intuition - you may feel it in your gut that your baby is not ready yet but will come in a few more days.
Nothing - Perhaps you may like to wait a while before deciding what to do. You can always change your mind. Another alternative is to do the "wait and see" approach which involves extra scans and getting baby's heart rate checked every couple of days and awaiting for events to naturally take place.
Obviously the above example is for a normal healthy term pregnancy. If there are medical conditions affecting you or your baby then medical induction may be strongly recommended and this still remains your decision. As a woman of sound mind, it is your body, your pregnancy, your baby, and you remain the person that needs to give consent or refusal.
Please do your own research and decide what is right for you. Take back some control. Pregnancy and birth should not be something that happens to you. If you know your options then can you make a true "informed choice" or an "informed decision".
You're not the passenger but the driver and you can ask for directions from your passengers or outsiders along the way, which you can weigh up for pros and cons and then make your own decision which route to take.
16 May 2017
Launching new website
We are thrilled about the launch of the new Midwife Rebecca website which has had a much-needed overhaul and a fresh new look! We would like to give a massive thank you to all the families who have given permission to use their beautiful photos, empowering stories and testimonials to describe their experience when hiring Rebecca for their care. This website has a new Blog page where Rebecca will regularly be posting birth stories, book reviews, articles on anything to do with yoga, pregnancy, birth and life with a newborn - so stay tuned!
The first blog post is an empowering birth story where Rebecca was one of the midwives looking after Hayley's labour and birth. Hayley hired independent midwives for her home birth and Rebecca came as the second midwife. She was privileged to help care for Hayley and be a part of baby Indy's journey into this world.
16 May 2017
Hayley's Birth Story
I know how many negative/scary birth stories people insisted on telling us during my pregnancy, so I just thought I'd share our positive birth story! I feel like it's really important to tell women that they can have a very positive birth experience, and exactly how it happened for me so they aren't scared or worried.
I woke up on 1st June, nine days before my due date, just before 6am. I had a mild sensation in my lower back, a sort of ache that wasn't unpleasant. The sensation faded quite quickly and I thought nothing of it. Half an hour or so later the feeling came back, it faded again and it crossed my mind that this could be the start of labour. I got up, made breakfast for me and my husband Steve, then the ache returned - I told Steve and said it was such a 'nice' ache that I thought it couldn't be a contraction. I said he shouldn't worry and to go to work.
Read the rest of Hayley's story