Giving Birth

Some of you reading this post will be pregnant and will be giving birth soon.

For some, this may be your first pregnancy.

I always think that maybe writing a few things down, for instance, about what you would like for pain relief or what positions you might like to adopt whilst giving birth may be useful.

Maybe some of you have thought about a waterbirth after reading how relaxing and soothing it can be?

Writing a birth plan is a good way of making you feel in control. However, you should be aware that your midwife may advise that what-ever you have written it is not necessarily a given.

For example, you may write that you do not want any pain relief.

My own advice would be to have an open mind and see how you feel on the day and not be disappointed in yourself if you do find that you need something to support you through the labour.

I remember with my third baby thinking I could manage without any pain relief. I was wrong and was eventually given some much needed Pethidine. Of course, this may not suit everyone but for me I’m happy to report that all went well and I was in a relatively relaxed state when the baby appeared not long after.

For others of you, this might be your second or third baby.

Of course, this doesn’t mean that you won’t be anxious. It is perfectly normal to feel apprehensive about forthcoming births. Perhaps, you had a difficult labour previously and are worried that this might happen again or you are contemplating whether to have a vaginal birth as you had a caesarean section before.

All these anxieties and more can be discussed with your midwife.

As part of my service, I can assist and support you with any worries or concerns that you may have and help you write a birth plan that is going to be useful to you.

If you have had a previous traumatic birth event I am able to discuss this with you and help you think of ways that will be useful towards your next birth.

I can also, of course, discuss all your pain relief options with you.

All labours and births are different for every woman and it is best not to compare yourself to other women but listen to your own body and trust in it to do what it is meant to.

“Giving birth is not a matter of success or failure, of beating records or putting on a splendid performance but of giving oneself, mind and body to a creative experience in which, literally love is made flesh” (Kitzinger 1987).

New Year’s Eve Babies

When I was a midwife working on the Delivery Suite, I had to work some night shifts to ensure that the ward was covered for twenty four hours. This is usual for all nurses and midwives.

We also had to work Christmas and New Year and we usually tried to be fair to each other to ensure that we all had some of the holiday off with our own family and friends.

I have to say that sometimes, as well as being excruciatingly busy, there was always a lovely festive atmosphere in the unit and we would all bring in non- alcoholic drinks and nibbles to snack on. This was of course in between births, completing paper work and clearing up.

Babies born on Christmas Day were given a small, wrapped present and babies born on Christmas Eve were given a stocking to leave at the end of the cot which was filled by whoever was on the night shift.

All Christmas Day babies and babies born on New Year’s Eve, were, with their parents’ permission, photographed and published in the local newspapers. This seemed to add to the festive atmosphere and feeling of excitement and joy.

One New Year’s Eve, not long after I had qualified as a midwife, I volunteered to work the night shift on New Year’s Eve. I was not really looking forward to this. Night shifts were always difficult.

We are not meant to be awake at three in the morning making decisions about people’s lives, communicating and just generally functioning as you would in the day.

However, I must admit I was excited about the prospect of maybe delivering the first baby of the new year and seeing the baby and mother in the newspaper.

Delivery suite was eerily quiet when I arrived on the shift but there was just one woman in labour who had had a baby previously, so there would be a good chance that she would have her baby before I went off shift at eight in the morning. Women who have had a baby before tend to have quicker labours and births the second time around so I was pretty sure that this would be the case with this woman.

Of course, there is always exception to the rule and this doesn’t always happen. Mercifully, this did happen in this case and the woman went on to give birth to her baby at two minutes past midnight, which was definitely the first baby of the new- year.

I was so excited and in my naivety and enthusiasm completely forgot about the woman being physically and emotionally drained after the birth and as soon as the placenta had been delivered my first response was:

“Congratulations. Would you like your photograph taken for the papers”?

I can’t write what she told me to do but it wasn’t,

“Oh yes I’d really like that – thanks”.

I felt rather deflated after that response and that was lesson learnt.

Not everyone wants to be in the paper especially the next day after giving birth.

Happy New Year.

Giving Birth Safely

It is a fundamental human right that women give birth in a place that is safe and where help is at hand to assist.

We are fortunate in this country that the maternity and midwifery services available for all women are excellent, safe and accessible.

So, why did a homeless woman give birth before Christmas outside Trinity College in Cambridge to twins who were pre-term by about 11 weeks?

The age of viability is 24 weeks. Therefore, not only were these twins extremely early but they would be of a small birth weight and only able to make a few gasps of breath on their own before help would have been needed from the medical team. Fortunately, passers-by went to the mother’s assistance, an ambulance was called which enabled a transfer of the woman into the maternity hospital.

It is believed that the mother and babies are well. A crowd fundraising page has now been set up to support the family financially. This is of course, great and demonstrates the compassion and care that the general public show to people in dire need.

But, should this really be necessary in this day and age?

We are allegedly a developed country with all the facilities that this brings. And these facilites should be available to all and no one should have to live, give birth and die on the streets.

We, in my view appear to be returning to Victorian times.
More than anything, this country needs an honest government who really do serve the needs of all its people.

Whether we are religious or not, many of us will be familiar with the Christmas story of a mother who gave birth to her child in poverty, seeking refuge in of all places, a stable.

Not a lot appears to have changed.

What do you think?
Please leave me a comment on this post or any of my previous posts.

Men and Postnatal Depression

A considerable amount of work and research has been done on how men also can suffer from Postnatal Depression.

Like the reasons for women, it is multifactorial. Caring and supporting a partner through labour and birth can be extremely difficult for men who don’t like to see their partners suffering and in pain. They often feel helpless and try to ‘fix it’. But labour and birth are not like that. Men have their own release of male hormones in response to this. Adrenaline, testosterone to name a couple.

After the birth, there is exhaustion for them too, coupled with broken nights, worry about work, the future, guilt at watching their partners struggle with breast feeding, plus healing from the birth, all contributing to a lowering of mood in the days and weeks that follow.
The treatment for this is of course, first recognising the depression and for help with this there is a self-assessment tool on the NHS website, NHS choices. www.nhs.uk.
The National Childbirth Trust also have a lot of useful information on their website too. www.nct.org.uk
Talking Therapies is another great way of getting back on track as well as having a discussion with a General Practitioner (GP) who may prescribe a short course of anti-depressants if necessary.
The main thing is owning the sad feelings and not feeling guilty that you too (men) could be suffering from postnatal depression.

Beyond Birth Counselling offers services for partners as well.

Motherhood

The first mother mentioned in the Bible is, of course, Eve.

Genesis 3:20 says,

“The man called his wife’s name *Eve, because she was the mother of all living.”

Most of us know the rest of the story. Eve ate the apple from the forbidden tree, before giving it to her husband.

God was angry and cursed both of them saying that there would always be enmity between them. Childbirth and labour would be painful for the woman, the earth would not yield good crops and that all men and women would die.

I often reflect on the women that I have cared for over the years, both as a midwife and now as a counsellor offering therapy for depression and anxiety during the childbirth process. One thing that is very obvious to me, is that women undergo an enormous change to become mothers and this involves physical as well as emotional and psychological changes.

So, what is motherhood?

The Cambridge English Dictionary defines it as:
“The State of being a mother”

Perhaps a fuller definition would be to describe…
A Mother is a very much revered status that can bring much joy, fulfilment and laughter.

A Mother can also bring a great deal of pain, sadness, frustration and exhaustion.

A Mother’s role is multi-factoral and she is perceived as the nurturer, the teacher, the nurse, a source of comfort and a friend.

A Mother should be supportive, patient and consistent. Along with all these qualities, a Mother should love her child unconditionally.

Obviously, a Mother’s job is no easy task. There’s more…

There are no days off.

A Mother must be able to remain calm under any circumstances. Especially with smaller children. Patience is a trait that every mother must have.

A  Mother has many other perceived roles to fulfil.

Cleaner, bread winner, laundry specialist, chef, lover, friend, daughter, sister and so on.

No wonder it is a hard job and why so many women feel sad following a birth.

Not only do they have to adapt to a new and demanding role, they often have to lose some of their old lives and selves. In short, it is possible to lose sight of who they once were.

The other phenonomen that I have observed not only in myself but other women and mothers I have cared for, is how raw their feelings can be following birth and how much emotional pain can be felt for other people. I want to quote Annie Lennox who sums Motherhood up beautifully and succinctly.

annie lennox

“Motherhood was the great equaliser for me; I started to identify with everybody….as a mother, you have that impulse to wish that no child should ever be hurt, or abused, or go hungry, or not have opportunities in life”.

Perhaps this is also the kind of pain that ‘God’ refers to in Genesis in the bible, who knows.

I think that it is OK to feel different after giving birth and it’s OK to feel sad for a while.

It’s only when that sadness goes on and on and there is no joy, that maybe counselling and therapy or just talking to someone is necessary.

J.D. Salinger in the book Catcher in the Rye suggests that “Mothers are all slightly insane”. I agree that some women and mothers are possibly aat risk of losing their minds, but at the same time are finding them.

I end with the words of Margaret Sanger who said…

“No woman can call herself free until she can choose consciously whether she will or will not be a mother.”

*”Eve” means life or living

Postnatal Depression

I was watching an interesting programme on BBC 2 last night, ‘The Baby has landed’. It was a documentary following six very different couples, during the later stages of pregnancy, the birth and then the time following the birth which as commonly known as the postnatal period.

It was striking to note how the different couples on the programme were coping and adapting to having a new baby and a new addition to a family.

My heart went out to all of them but the one couple that struck me the most was the couple having their first baby after a long labour resulting in a caesarean section for the birth. As is the norm now, they were home after a couple of days and settling back into life with a loving extended family.

Initially, as is fairly common, all was well. As time went on however, the baby became unsettled. Mum and dad became increasingly tired with broken nights sleep and then a downward spiral into the mum feeling that she was failing because she could not settle the baby. The grandmother was supportive and the partner was trying to be but he too was beginning to feel that he was doing it wrong and all this against a backdrop of advice, from well- meaning relatives.

The mum was doing all the right things, but it was easy to see that she was becoming too hard on herself and forgetting that not only had she been through labour, but had, had a major operation for the birth. I think women underestimate just how difficult those early weeks can be.

The Mother now had another life to care for as well as herself.

The baby is growing even after day 1 and will be demanding more food but also, babies cry for all kinds of other reasons such as loneliness and need reassurance. They have been so used to being in the womb for 9 months and now they are having to adapt to a new environment.
That is why skin to skin contact is so important. It actually physically affects the baby’s heart rate and breathing. It calms and soothes the baby and they are a perfect temperature close to your body. You don’t have to be breast feeding to do this and Dads can do it too.

Another couple had just had their fifth baby handled it well. Mum and Dad were back running guides and scouts after a week after the birth. It made me feel tired just watching the activity within the household. I was also a bit sad because every woman is different post birth and yet they measure their progress alongside, other women who make it look so easy. The women who make it look easy tend to be in the minority, but the woman with her fifth baby said that she liked to keep busy to stop her wanting to have another baby! This could be a trick played by the levels of Oxytocinon (necessary for bonding) in the body. The levels are so high for some women after giving birth, that they can make you believe that having another baby would be a good idea.

Also, it is this cocktail of hormones or lack of them, in particular Progesterone and emotions post birth that can contribute to some women developing post-natal depression.

Postnatal depression (PND) is the most common perinatal mental health disorder women experience in the first year after having a baby. Between 10% and 20% of women have depression and anxiety in pregnancy and after birth. PND is an illness and will get better in time. The reasons for this are multifactorial and the symptoms are many and varied.

There are lots of excellent websites that explain PND and perinatal health disorders. One being the NCT.org.uk/ and the NHS website who have a self- assessment depression screening tool that you can complete if you are not sure that this is what you are suffering from.

New mothers need to care for themselves as well as their baby and it is common sense to delegate as many of the household chores as is possible and use a good 2 weeks to rest and recuperate.

In the old days (not so long ago) the 2 weeks following the birth was known as the ‘lying in period’. Women were kept in bed and only allowed to look after the baby and themselves. This of course, contributed to a higher risk of developing a thrombosis (blood clot) or chest infection because the clotting factors in the blood become thicker and it takes a while for the blood to return to pre-pregnancy state.

Nowadays, postnatal exercises are encouraged including gentle walking and if there are any other risk factors for a blood clot, then medication and anti-embolic stockings (like flight socks) are advised.

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.