The Yellow Flannel

One thing that all my experience has taught me is that every single woman is unique and experiences birth differently to the woman next to her. Yes, the physicality is broadly the same but your feelings, emotions and perceptions of pain are very unique to you and your situation.

Not long after I had qualified as a midwife, a woman turned up unannounced on the delivery suite saying that she knew that she would be going into labour in a few hours. This was an odd thing for a start for someone to say. Usually women would come in reporting having had irregular contractions or their waters breaking or some other symptom that might herald the start of labour.

This woman was from a family of travellers who had just arrived in the area and she was having her fourth child. She wasn’t distressed or appear to be in pain but I led her into a delivery room anyway because I just felt that she would have benefitted from some privacy. Her partner had left her at the door and she did not want him with her at this stage.

In the room, I introduced myself to her and asked her consent to carry out all the usual routine observations for a woman coming into the delivery suite in labour. She gave her consent but then looked me straight in the eye and said very firmly but politely:

“Yes, but I would like to tell you how I would like things to be –
First of all, I am not in labour yet so you don’t need to examine me internally to find out – in fact you won’t need to do that at all because I can tell you when I am going to birth my baby. I would like to go for a walk when you have checked me and the babies heart beat and then I will come back when I know that I am going to give birth. On asking her what she would like for pain relief, she laughed and said ‘nothing – I have a yellow flannel that I will put over my face and that will be enough’. And when I have given birth, I want you to wash me and the baby straight away and put us in clean clothes, tidy the room so there’s no blood or mess and clean sheets on the bed. Then you can get my husband to come in to see me”.

I must admit to feeling a little anxious about this because usually, when a woman is in labour and having her fourth baby, it is not wise to let them go too far away in case they birth their baby in the car park or in the road. However, I reasoned that Mrs A was not in labour, her waters hadn’t broken and all was well with her so I could see no reason to keep her in a delivery room waiting for labour to commence. I felt instinctively that she was a woman who knew her own body extremely well, having had three previous births all without complication. Also, we used to encourage women to go home and await events as it was far better for reducing their anxiety levels to be in their own environment.

It’s a known well researched fact, that women labour better where they feel safest and that coming into a hospital environment increases their anxiety levels which are already increased due to the release of adrenaline in response to the pain of the contractions. The body is finely tuned however, so that endorphins are released in response to pain which helps ease it and oxytocinon which brings on labour and continues to stimulate the womb until birth and after with the bonding and attachment process. There is a great web site explaining this:
Childbirthconnection.org/maternity-care/role-of-hormones/

She promised that she would not go far only around the hospital grounds and to the local shops and that she would come back as soon as she knew that she was going to give birth.

Two hours later, she did indeed come back looking a little flushed but calm. The first thing that she did on going into the delivery room was produce the yellow flannel which I put cold water on. She sat on the bed, put the flannel over her face and told me that she was going to give birth. Which she did – fortunately I did have time to prepare the room for a birth and managed to put on a pair of gloves.

The birth was effortless with no fuss and she produced a healthy baby within 15 minutes of being back in the room. I carried out no internal examination to confirm that the cervix was fully dilated but I did manage to listen to the baby’s heart beat which was normal. After the birth of the placenta she and the baby were washed and dressed as instructed. The room tidied, a clean sheet put on the bed, cup of tea supplied. Her husband came back into the room to find his wife looking like the queen, propped up against clean pillows and clean sheets.

He was so proud of her and so grateful to me and my care it made me feel very humble, especially as he had bought me a small box of chocolates which they could probably ill afford.

For me, this birth demonstrates how important that element of self-belief is in ourselves and the enormous trust that is placed in a relationship between woman and midwife.

Anxiety in Pregnancy

You will probably remember from my last post that evidence has shown that one in four women experience some form of mental illness during the perinatal period (this relates to the period of time before and after the birth) (Howard et al, 2018).
Most common mental health disorders are depression (11%) and anxiety (15%), but eating disorders, obsessive-compulsive disorder and post-traumatic stress are also seen.

These figures, though, do not always accurately reflect the true number of women who suffer, because a great number of mental ill health cases still do not get reported by the women themselves due to the stigma attached to them and the fear that women will be judged as being poor mothers who are unable to cope.

So, what exactly is anxiety?

Anxiety is a normal reaction to an unknown situation and many psychologists believe it is to be expected to be anxious about the unknown. However, it is the persons reaction to the stress response that needs to be addressed in order that it does not become all-consuming and colours an experience which otherwise should be an exciting and joyful time.
In other words, it is a feeling most people experience at various points in their lives but when it is constant and overwhelming and out of proportion to the situation then something needs to be done to address the anxiety.

Anxiety is a feeling of unease…

…like a worry or fear, that can be mild or severe. Everyone feels anxious from time to time and it usually passes once the situation is over. Anxiety can also cause a myriad of physical and mental symptoms although not everyone will experience all of the symptoms all of the time. I do not intend to list all the symptoms here or how to manage your anxiety. There are plenty of web sites where you can do this, for example…

Useful websites for symptoms of anxiety and how to help your self are:
http://www.nhs.uk/ and http://www.mind.org.uk/

Talking therapies such as counselling are beneficial.  Talking through your concerns with a counsellor and therapist will help you cope with whatever is causing you to have anxious thoughts.

Pregnancy and childbirth is a time of great anxiety for some women and some of the anxiety can be expected. Your body is in an altered state physiologically so its common sense to expect your emotions and psychological health to be altered. Every woman is different and will have a different anxiety relating to herself, the baby, the labour, how they will cope and so on.

I remember one of my pregnancies feeling terrified that every time the post person delivered a letter or a parcel that it was a bomb! (This being in the 1970’s when the IRA were setting off bombs in England). Why they would want to blow me up I don’t know, but all that I do know is that I had the fear. Fortunately, I was able to tell myself that it was because I was pregnant and feeling protective of my unborn baby.

I have counselled a number of pregnant women in the past who have presented to me, saying that they are just frightened, and they could not articulate the reason why.

One woman in particular, was however able to explain that there was no way that she could give birth to her baby – the very thought of it made her physically vomit. She displayed all the signs and symptoms of sheer panic at the thought of going through labour and childbirth.

After further discussion and talking to her we decided, together, that she had a mental health condition called Tokophobia .  A rare specific phobia with an overwhelming, debilitating fear of childbirth. So much so that in some instances (not in this case) women have been known to request a termination, avoid getting pregnant or as in this case opt for a caesarean section for the birth. This mental health condition can be managed if identified and as in this case a lot of work was done with myself, the clinical psychology team and the obstetrician who supported her request for a caesarean section. Other plans were put into place to support the woman, who was able to have a positive birth experience with a good outcome.

Rosemary A Harris.

Child Birth and Mental Health

According to the literature and articles written on mental health in Pregnancy and Childbearing, it is very common for women to experience mental ill health for the first time. This is due to many reasons, but mainly it is because women feel vulnerable and anxious about what changes the pregnancy is having on them physically as well as emotionally.

Just the very physiological changes in how your body functions when pregnant is enormous and not to be taken lightly or dismissed. Therefore, it follows that some alteration in mental health follows for some women.

When I had my children in the 1970’s and early 1980’s, you weren’t allowed to display any signs of being depressed or anxious and if you did, then the thoughts that you tried to express would be very quickly dismissed with comments such as:
“Nonsense, rubbish, what’s wrong with you – you should be happy you’re not ill, you’re just having a baby etc. etc.”

As for trying to talk through your birth experience then,that too,was another big taboo.

I remember trying to explain to a dear Aunt who was a Health Visitor and Midwife, how traumatized and shell shocked I felt after giving birth to my third child. Which incidentally, was classed as a ’normal vaginal birth’ with no intervention, but to me felt like I had been run over by a bus. I also felt overawed by the whole experience, even though I had given birth twice before. When I tried to express this to my Aunt her words were:
“Never mind. It’s over. Don’t think about it any- more. Read a book and take a couple of Codeine!’

Women were also afraid to express that they might be depressed because of the fear of having the baby removed from their care or judged as being poor mothers or simply not coping with the demands of motherhood.

When I read these words back, I feel that I could almost write a thesis, un-picking how powerfully negative they are and how unhelpful it is for women to have to hear these Kafkaesque phrases trotted out by well-meaning people including some health professionals.

Just the very hormonal changes in a woman’s body alone is enough to upset the equilibrium. Add to the mix recovering from being pregnant, the labour and birth and then a few weeks of broken nights and constant demands being made, it is no wonder that some women may feel ‘down or depressed’ following the birth.

Thank goodness attitudes are now shifting to mental health.
Midwives and other health professionals over the past decade have really moved the subject into the public arena and there is much more openness about the subject than there ever was before.

In the past, the emphasis had always been on ensuring that women and babies survived child-bearing which is of course the primary concern. But when you consider that maternal suicide is the fifth most common cause of women’s deaths during pregnancy and remains the leading cause of death in the first year after birth (MBRRACE, 2018) then the care and support for women with mental ill health in pregnancy and afterwards is essential and not an optional extra.

It is also essential that we continue to talk to each other and share our feelings and not be frightened to say to your doctor, health visitor, midwife or family when you are struggling with anxiety, depression or negative thoughts about your birth experience.

Remember it’s OK to not be OK and there is an abundance of help and support out there.

Rosemary A Harris.

Watch this space for further articles.