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Magical Baby Moments Blog

By Christine Huntingford 18 Sep, 2017
Birth is a woman’s right and how she chooses to go through her pregnancy and how to give birth should always be in her control. If you're on your first pregnancy, no doubt you have been reading countless books, been getting advice from medical professionals and recommended by family and friends what you should do.

During pregnancy, there are tests and scans that are usually carried out, but these are all a choice. Having them is not obligatory. You can say ‘no’.

The medical professional is there to advise and inform you of your choices; however the ultimate decision should always lie with you. Here are some considerations that you might want to think about:


DURING PREGNANCY

Choice of midwife or Clinic
Your antenatal care can be provided in a number of ways. You could book your appointments at the local Children’s Clinics, you can be assigned a visiting community midwife at your local doctor’s surgery, or you may have your antenatal care directly with the hospital at which you will give birth. Find out which option would best suit you.

Dating Scan – the rigidity of it
Often women will calculate their due date based on their last menstrual cycle and their first scan, which is around 12 weeks into her pregnancy. Note that scans aren’t always accurate, with regards to the due date, and are often out between 3-5 days. If they measure the baby bigger, then this would give a mum an earlier expected date, which at the end of pregnancy means an earlier date for potential pressure for an intervention/induced birth.

It’s worth noting here that the World Health Organisation states that a baby is at full term from 37 weeks and if born at this point usually doesn’t need medical assistance. Yet it is also perfectly normal for a woman to give birth around the 42 week mark. So the rigidity of a single day is nonsense, when you think about it, as only 4 per cent of babies are born on their due date, and the majority of babies arrive after their due date.
Also be aware that having scans is not compulsory, in fact some might argue that as they don’t alter the course of pregnancy, is there really a need for them at all? For many women they provide reassurance that the pregnancy is progressing well, however for others, the results of a scan can bring unexpected news. How does this alter how the woman feels in pregnancy? If you would like to read more about Ultrasounds, I recommend the book written by the Association for Improved maternity Services (AIMS) called Ultrasound? Unsound

Gestational Diabetes test
Gestational Diabetes is a high blood sugar condition that women can get during pregnancy. Between 2 and 5 per cent of pregnant mothers develop this condition.

Only about 30 per cent of women who test positive on the glucose screen really have the condition. If you test positive on the screening, you'll need to take the glucose tolerance test (GTT) – a longer, more definitive test that confirms whether you have gestational diabetes, or not.
How will I know if I might have gestational diabetes?

A routine urine test will show a lot of sugar in your urine. If midwife observes this, she may want you to be tested for this. Even if the results are normal, you may be screened again at 24 to 28 weeks, just to check.

If you are diagnosed with Gestational Diabetes, your pregnancy will move into the ‘high risk’ category, which in turn could mean birth choices being taken away from you, such as giving birth in a birth centre or midwife-led unit. The reason for this is that with gestational diabetes babies can grow bigger than the expected range for birth and the health system would prefer to monitor you in the labour ward.

This is why it is important to maintain a healthy diet through pregnancy, so that your blood sugars remain in the normal range. Avoid sugary foods and drinks before midwife appointments to avoid unusual readings that could lead you along this path.

Where to have your baby - hospital, midwife-led unit or home birth?
In the UK, the NHS, in fairness, is trying hard to normalise birth (read about the Better Births Initiative ). While many births still take place at hospital, the NHS is working towards making it less of a medical procedure and more of the wonderful experience that it should be treated as. The NHS is investing in more birthing centres, many of which are within a hospital setting. The centre usually has a more hotel-like feel rather than the medicalised setting that a labour suite tends to have. The centres are managed only by midwives, which is why they only accept women with low-risk pregnancies.

Women who are considered high-risk would be in a labour ward, where obstetricians are available to help, should any emergencies arise.
In recent years there has been a push for home-births. In the Better Births Initiative page above it states: ‘Birthplace research shows that healthy women with planned births in midwife-led units and at home were more likely to have a normal birth as compared with obstetric units.’

Home Births are intended for women who have had low risk pregnancies and where midwifery care comes to your home to help you in giving birth to your baby.

So is where you birth really a choice? What if you did have factors that put you in the high-risk bracket…are some of those choices no longer available to you? Each woman’s circumstance is different, so speak to your midwife about your plans for birth to see how you can accommodate your preferences.

Should I take their advice for an induced labour or can I wait for labour to start spontaneously?
As your due date approaches, your midwife is likely to say to you something along these lines. ‘If baby hasn’t arrived before so-and-so date then we will book you for an induction’. Please stop her right there and simply ask the question, ‘Why? What medical concerns do you have for me or my baby?’

According to the National Institute of Clinical Negligence (NICE), an induction should only be suggested to mothers when there is a clinical justification – read the NICE guidelines . If it is simply a matter of all being well and your baby is happy where they are, this is NOT a reason for induction. However, many women just aren’t aware of this and quickly accept this offer.

Quite often women aren’t talked through what an induction really means, how this type of labour feels, compared to a spontaneous labour, and what risks are involved during an induced labour – in many cases leading to what may have been an unnecessary labour, if they may have waited for a natural labour.

Because it has become so routine in our modern society, women seem to accept this as the way it has to be, without questioning why. For those who haven’t read up on their choices, they may easily accept this information and just say to friends and family. ‘I’m going to be induced on so-and-so date.’ But what they are not told is what the medical reason is for this. The late arrival of a healthy baby, with a mother who is not presenting any medical concerns, is not a clinical justification.

Just think back to when you first fell pregnant? Did you calculate your own ‘due date’? Perhaps this date was a day, or more, later than your hospital due date… are they therefore rushing you to have your baby unnecessarily early? You, your body and your baby have done just fine for 39+weeks so why do they think that your body wouldn’t know how to go into spontaneous labour when it is ripe and ready?
So what can you do? You are fully within your rights (because how you birth is YOUR choice) to decline induction and be asked to be monitored more closely in the coming days to ensure that both you and baby continue to be well. For extra reading, look at the AIMS booklet on Inducing
Labour: Making Informed Decisions


DURING LABOUR
The choice of how your labour plays out is in your hands - it doesn't need to be totally managed by the midwife, neither do you need to be left totally alone. It can be a blend of many things. Here are some things to consider:

Consent forms
In the hospital you may be asked to sign consent forms when you are in established labour, say for example agreeing to an epidural. It may be worth discussing these options with your midwife in early labour and tell her what you are open to or not. Get those consent forms signed before you enter the bubble of established labour, when the last thing you are going to care about is admin!! You have a bigger job at hand.

Vaginal examinations
A vaginal examination helps the midwife establish how far your cervix has dilated. Other than that, it serves no other purpose. It is possible for the cervix to constrict in labour if a woman is feeling tense or vulnerable, so if you are not comfortable with having an examination, the cervix may react and present tighter than when you relax your body; therefore giving a misleading dilation stretch. Though not very likely, there is a slim chance that by having a vaginal examination infection and bacteria is introduced into the vagina. An expectant mother is well within her right to decline all vaginal examinations, if that is her preference.

Breaking your waters vs spontaneous rupture of the amniotic sac
In an induced labour, after the pessary has taken effect, if labour isn’t progressing as they would like, the next step would be perform an Artificial Rupture of the Membranes (ARM), also known as an amniotomy. This is usually carried out by your midwife. The membranes will be ruptured using a tool, such as an amnihook or amnicot. This is carried out in the belief that it will speed up and strengthen contractions.
In a spontaneous labour the membranes can rupture at any point in labour. In rare cases a baby is born with amniotic sac still intact, this is called ‘en caul’.

While the risks are very low, there are risks associated with ARMs. It is a blind procedure, therefore, there can be no certainty that the midwife won’t end up rupturing vessels that are part of the overall blood supply to the baby. An already compromised baby may be put at further risk by an amniotomy; as the uterus could become hyper-stimulated.

Monitoring baby
Your baby should be monitored at least every four hours in early labour and every 15 minutes in established labour. A midwife will listen in to the baby’s heart rate, either with a hand-held Doppler or with a continual fetal heart monitor and check that baby’s heart rate does not decelerate during contractions. When a baby’s heart rate dips during contractions, it is a sign that baby is in distress. They will continue to monitor you very closely and advise if alternative action necessary.

Confined to the bed vs being mobile
When a woman spends most of her labour on a bed, her movements are restricted, her body could be in the exact same position for long periods of time. If this happens to be more laying than sitting upright, she is not using gravity to her advantage and she could be slowing the labour process down without realising it.

A woman, who is active in labour, keeps mobile. Those movements encourage the bay to descend more rapidly and result in shorter labours, often without complications. Antenatal educators encourage all mothers to be active and upright in labour and only use the bed when it is absolutely necessary.

Natural vs medicalised pain relief
There are two types of pain relief; see the options below:

Natural
• TENS Machine – a TENS machine is a device that has two sets of electrode patches. These patched are placed on the woman’s back and sends out continuous mild electrical pulses that trigger the body to release endorphins (natures natural form of pain relief). During a contraction (surge) the woman presses the boost button to send more impulses through the patches. Extra relief of endorphins helps soothe the mother during labour.
• Birth Pool – women choose birth pools for relaxation and pain relief during labour. It can also be the environment in which to give birth to their baby
• Baths/Showers – the heat of the water in the bath/shower can help the mother relax, when she is relaxed the body releases the hormone oxytocin, which helps labour progress.

Medicalised
• Gas & Air (Entonox) – is a mixture of half oxygen and half nitrous oxide. It is known to take the edge off labour pain, rather than blocking it out.
• Pethidine - is a sedative and a muscle relaxant that helps take the edge off labour by making you feel drowsy. However this painkiller crosses the placenta, which can affect your baby in a number of ways leaving them feeling drowsy, which could impede breastfeeding immediately after birth
• Epidural – these are administered by anaesthetists where they insert an epidural catheter into your back. It is this catheter that allows the pain relief to be topped up during labour.

Women are encouraged to go through as much of labour with natural pain relief, so as not to interrupt the natural process of birth. However, for some women, using medical pain relief is a necessity and we are lucky to have these options available to us, should they be needed.
Some people consider hypnobirthing as a natural form of pain relief. Hypnobirthing itself doesn’t promise a pain free labour, but many women who have learnt hypnobirthing and who have practiced the techniques and worked on preparing for birth with a positive mindset have experienced wonderful births.

Giving birth; should I lie, sit or squat?
Unlike the films and soap operas, giving birth on a bed with your legs astride is not the only position to give birth. The sitting position on a bed can inhibit your baby’s entrance into the world and it can be more challenging for the mother to give birth in this position. Lying down flat, means that you are not letting gravity help you and somehow your baby has to venture into your birth canal horizontally – this isn’t very efficient.

Consider being more upright, think about adopting a squat-like pose, where you are able to bear down, allowing the birth of the baby to be smoother. This could be sitting on a birth ball with your hips higher than your knees (encouraging the upper part of your body to tip slightly forward. This helps baby’s push the frontal part of the pelvis forward potentially allowing more space.

You could also think about being on your knees and leaning across the back part of the bed (moved into a vertical position; like the back of a chair). By leaning over the bed, you are allowing your bump to tip forward and you have movement and flexibility in your hips. This position also works well if you are in the birthing pool.

Coached birthing vs mother-led birthing
You may have visions of the midwife encouraging you to ‘push’ your baby out when the time comes. Media will have you believe that labour is all about pushing, pain and panting – this is inaccurate. A mother doesn’t need to experience that to birth her baby; there are gentler ways to aid your baby into this world. Simply by listening to your body and responding accordingly; through gentle Down Breathing, as taught in KG Hypnobirthing, allows your baby to descend to the rhythm of your body.


AFTER BIRTH

Natural expulsion of the placenta or Synthetic Oxytocin injection
It is entirely up to you whether you prefer the midwives to administer Synthetic Oxytocin into your system to help aid the detachment of the placenta from the uterus wall. If you have had an unmedicalised labour up until that point, you may well choose not to accept the injection to start with. It is extremely likely that your body will do this of its own accord. If you have had an augmented labour, then your body may then need a little help in expulsing the placenta, with the help of this hormone substitute. Ask your caregiver if they feel it is necessary when the time comes, or perhaps wait to see how your body reacts after birth to decide for sure.

Cutting the cord / Optimal cord clamping
In the UK today, optimal cord clamping is encouraged for all babies in all birth situations, whenever possible. Ask your midwife what the policy is in your Trust. My hope is that they will say ‘until the cord stops pulsating’. If they don’t say this, then maybe this is something that you need to have in your birth plan. Nature intends for the baby to have all the blood from the placenta after birth. When the blood has drained, the umbilical cord starts recoiling and the placenta begins to detach from the uterus wall. At most this takes a few minutes, and during this time the baby is enriched with all the stem cells and blood that belongs to him/her, that they would otherwise be deprived of, if the cord were to be cut sooner. A baby can weigh 200g more if the blood is passed from the placenta, than if the cord were to be cut immediately. This blood belongs to your baby, so ask your caregivers to ‘wait for white’ (the colour the umbilical cord will be when the blood has passed through).

Skin to Skin
It is encouraged that the baby goes directly to the mother straight after birth. Decide if you prefer to have the baby wiped down first or whether you are happy for baby to come directly to you. This is known as Skin to Skin. This period is extremely important for many reasons:
After being nine months in a warm, dark pool of water, where the sounds are all muffled. It is quite a stark contrast to come into this world. Where people are excitedly talking about the new arrival, where the lights are bright and this beautiful wet baby is starting to feel cool air on its skin. The best way to soothe the baby is to place it directly to the mother’s chest, where her body heat can warm the baby, where the sound of her heartbeat and other bodily noises can be heard again; offering comfort and where a significant part of the microbiome process can be introduced (this is a step which to colonise the gut with important bacteria from the mum and helps to build the baby’s immune system).
If for whatever reason mum is unable to do this, then the Birth Partner could do this. Isn’t it much nicer than having the baby in a cot nearby, or being held by strangers, when there is no need?

Breastfeeding
Breastfeeding is a personal decision, and from experience I know that it isn’t as easy as it seems. What your plans may have been before you baby was born, can be very different from what you actually experience. However, breastfeeding is considered beneficial for the following reasons:

• Breast milk is perfectly designed for your baby
• Breastfeeding as early as possible after birth provides the first milk known as colostrum
• Colostrum is rich in proteins, carbohydrates, fats, vitamins, minerals, and proteins
• The proteins have antibodies kick-start the immune system which in time will fight disease-causing agents such as bacteria and viruses.
• Breastfeeding provides health benefits for you
• Breastfeeding helps your uterus contract to its pre-pregnancy size
• Breast milk is available for your baby whenever your baby is hungry
• Breastfeeding can foster bonding between you and your baby
• Breastfeeding is free. No need for bottle, sterilisers, formula milk etc.

Read more from the NHS .

Partners being able to stay
This varies from hospital to hospital, but it seems crazy that when a woman who is in a vulnerable situation and who needs emotional support it not allowed to have her partner stay with her. Discuss this with your midwife, as to what the guidelines are for your hospital. Sometimes you can pay for a private room; this option may be attractive to you.

These are just some considerations to decide upon, that can help you create the right birth plan that is for you.

If you have any questions, feel free to email Magical Baby Moments at classes@magicalbabymoments.com
Magical Baby Moments offers group hypnobirthing courses in Romford and Upminster, and private courses across Essex and London. Check online at http://www.magicalbabymoments.com/classes to find out upcoming dates.
By Christine Huntingford 07 Sep, 2017

If you are anything like I was, you are probably reading books about how your pregnancy is progressing and how you can better prepare yourself for labour and birth. Perhaps you are looking into what antenatal classes are available in your area. There is a fair amount of choice today. Some parents to be attend NCT (National Childcare Trust) classes, some choose ParentCraft, offered by NHS midwives and others choose hypnobirthing. Added to that you have pregnancy yoga too.

Each have their own way of preparing you for labour and birth and offer antenatal education from slightly different angles.

Hypnobirthing is a choice that many are turning to as the all-encompassing antenatal course. It teaches expectant parents:

  1. easy-to-do, practical relaxation techniques that expectant parents can begin implementing during pregnancy, as well as reap the benefits of all that practice during labour and birth
  2. the medical side of what will happen during late pregnancy, labour and birth, as the body prepares for your baby to be born
  3. the possiblities of how labour may play out and the decisions you can make that are right for you and your baby. This is known as informed choice and much more

Why should I do a hypnobirthing course?

There are many reasons why you should do a hypnobirthing course. As a mother who has been pregnant twice, I actually did all of the courses, except for yoga. After having my children I decided to become a KG hypnobirthing teacher. Why? Because this course offered all of what I needed whereas the others only offered part of it. 

I have been teaching hypnobirthing in Essex since 2015 and this year I wrote a book explaining what a hypnobirthing course offers expectant couples. If you would like more about what Hypnobirthing Course can offer you, you can buy this introductory book: The Power of Hypnobirthing: 10 reasons why it's for you for only £5.99 (on the Kindle or in paperback *).

If you are eager to read the first chapter of the book for free, simply email power@magicalbabymoments.com

*postage charges apply

By Christine Huntingford 07 Sep, 2017

I attended the Positive Birth Conference on 20 July 2017at City University in London. Being around birthing professionals is wonderful for me as a hypnobirting teacher, as I don't get to do so very often. Feeding off their knowledge and enthusiasm is eye-opening, and this conference was no disappointment.

There was a fabulous line-up of speakers, including:

  • Cathy Warwick, Chief Executive, Royal College of Midwives
  • Professor Susan Ayers, Professor of Maternal Child Health, City, University of London
  • Octavia Wiseman, REACH
  • Ellinor Olander, Senior Lecturer, City, University of London
  • Milli Hill, Positive Birth Movement

The day centred very much on the theme of what women are looking for when it comes to their birth experience. With each speaker looking from thier professional angle how we can potentially give them a better birth experience.

So what would women like to experience?

They are looking to:

  • have a safe birth
  • be able to select the right care for them
  • have care that wraps around their preferences, without pressure to make choices that simply fit with midwifery care
  • be listened to and not categorised (high-risk vs low risk)
  • be taken seriously and to have honest discussions about risks, if they arise
  • have continuous and consistent communication with their caregivers

Where to give birth?

An area for improvement is to have consistent choices regarding place of birth. Not all women reported having been given choice - it some cases it was simply assumed tha they would have the baby in hospital. The crux of it is; choices are constrained by reality (e.g. in remote parts of the country the choices that are available are not the same as those of a big city; mothers being considered low risk/high risk may rule out the birth centre, for example).

The Better Birth initiative states that women should have three choices of place of birth, NICE – the National Institute for Health and Clinical Excellence – recommends four: Obstetric Unit (hospital), Alongside Maternity Unit (birth centre within a hospital), Freestanding Maternity Unit (standalone birth centre), Home. This initiative aim that all women, regardless of where they are in the country, should be able to make a choice from all offerings.

Midwives are advised not to just accept women asking for what they want, but to ask them to explain why they have made that choice. The midwife should then ensure that the potential risks and of that choice are understood by the mother, as well as making sure that all other choices have been explained in the same way. This allows the mother-to be to make choices in an informed way.

Continuity of Care

Some areas of the UK have been criticised for their lack of continuity in antenatal  and postnatal care - although this is starting to be addressed in some Trusts with the reintroduction of case-loading (seeing the same midwife/small team of midwives throughout pregnancy). It was said that more could be done to have a smoother handover from the midwives to the health visitors, so that upon the first appointment with a health visitor they are already aware of the woman's pregnancy and birth experience.

Ellinor Olander spoke about this subject and her study identified issues that women said we/weren’t important to them:

  • Location of appointments: meeting their caregivers in the same location for antenatal appointment was not important to them; however home visits after birth is appreciated.
  • Staff: When considering the handover from midwife to health visitor, face-to-face contact with health visitor in pregnancy is not required. New mums prefer not to have to repeat their medical history to the health visitor and would appreciate a better hand over from the midwife. Some said it would be helpful to have the first meeting with both professionals together - especially women who have had traumatic experiences.
    • Most respondents had a named midwife, this was not important to all of them.
    • Most had met with more than one health visitor.
  • Information: Most women wanted to receive consistent information from all the caregivers they met.

Continuity of care is especially important for women who have experienced some degree of trauma.

Professor Ayers did a presentation on Birth Trauma: Risk and Resilience in Women

She shared her research on women who have suffered some degree of trauma during labour and birth; who, as a result, have experienced Post Traumatic Stress Disorder (PTSD). Evidence shows that 4% of women experience Post Traumatic Stress Disorder in pregnancy and a further 3-4% develop PTSD as a result of birth. Most women however, who have had a traumatic birth, don’t go on to develop PTSD (55%). Risk and resilience factors have been identified during the study and medical professionals are using these findings to prevent PTSD and enhance positive outcomes going forward.

The events that occur during pregnancy and birth are important, as these are what contribute to Post Traumatic Stress Disorder and Post Natal Depression. However this is subjective based on the individual's thoughts around the events, rather than the events in themselves - some women are more acute to situations than others. It could also be that the event in isolation wasn't the trigger, but a number of factors that have contirbuted to the woman’s life experiences.

Even though it has been cited that 3-4% of women experience PTSD in pregnancy, this figure can be as high as 39% for those who have a history of abuse.

PTSD can result in:

  • Preterm birth
  • Low birth weight

If a mother is stressed during pregnancy, this carries over to the baby. Evidence shows that these babies have an increased response to stress, which carries into their lives later on.

Women who experience birth trauma and who receive support, find strength and resilience to move forward. The y find a way to give meaning to that event, which often sees them experience grow from the crisis.

Can risk be reduced?

Yes. The most common responses were by:

  1. Having better communication (39%)
  2. Being listened to more (37%)
  3. Being supported more/better, both emotionally/practically (30%)

As a result of this study, a framework has been put together to identify women who are potentially at risk, in order to customise their care across pregnancy, birth and postnatally.

With this information being fed back into the team and shared across Trusts, it will be possible to offer personalised care to women who have been identified as at risk.

Octavia Wiseman, spoke about the REACH Pregnancy Programme, which is a five year study, currently about half way through.  

This study aims to identify women who may not usually seek full antenatal care, possibly due to one of the following factors:

  • Socio economic, linguistic and cultural diversity
  • Social issues
  • Practical issues
  • Demographic issues
  • Cultural issues
  • Health issues

The aim is to find these women living within our communities and offer them the antenatal care that are entitled to.

Pregnancy Circles have been introduced - this brings together women who are at similar stages in pregnancy and who live near each other. The Pregnancy Circles offer clinical care, information-sharing and social support. They aim to provide a woman-friendly, community environment for antenatal care. These meetings are 2 hours long, rather than the 15 minute appointments expectant mums would normally receive. So far these meetings have been positively welcomed.

The final speaker of the day Milli Hill.As a co-cost of Havering’s The Positive Movement, it was wonderful to hear how she has inspired so many women to take up her movement and bring women together to look at birth positively. She centred her presentation on Carl Jung’s Shadow Theory. Jung saw quite clearly that failure to recognise, acknowledge and deal with 'shadow elements' often is the cause of problems between individuals and within groups and organisations. Hill challenged participants to consider the 'shadows' in birth, midwifery and within ourselves.

It was a thought-provoking day where I continued to learn so much from my peers. I long for the day that maternity care that is stripped of red tape; where midwives, who go into the profession wanting to be with women, can dedicate their time caring for them consistently. Continuous care is not a new thing. We all srtive for better births. These conferences help solidify our ambitions towards a positive birth experience. If only it could happen a little faster.

By Christine Huntingford 07 Sep, 2017

Why should you do a hypnobirthing course?

Book a hypnobirthing course if you are looking for an antenatal class that will not only inform you about what happens in late pregnancy, labour and birth, but you also teach you the  techniques that will enable you to feel calmer and more relaxed during labour and birth.

Doing a hypnobirthing course with Magical Baby Moments, you and your birth partner will leave the course empowered about your choices, confident that you will know how to deal with the journey of labour and you'll both have a vast toolkit to keep you focused and positive for your birth experience. Magical Baby Moments also covers key areas of how to look after a newborn. The hypnobirthing course covers a wide variety of topics: visit the classes section for full details.

To relax in pregnancy and during labour, you can choose from relaxation and breathing techniques, to visualisations, Rebozo and much more. We will teach you them all.

Classes are available on weekday evenings and also on selected weekends in Romford and Upminster, in Essex. Visit the website  for more dates and availability.

If you want to hear what other couples who have done hypnobirthing thought about the course and you want to find out what their experience was like visit the Testimonials section.

Evening Hypnobirthing Courses in Romford, Essex, generally start on the first Tuesday of the month* and run for 4 weeks. Classes start at 8pm.

Weekend Hypnobirthing Courses in Romford and Upminster take place on selected weekends. (Saturdays 10am - 4pm & Sundays 10am - 1pm)

Visit the website to find out dates or call Christine on 07764 680 215.

*check the dates in the classes section.

Magical Baby Moments Blog

By Christine Huntingford 18 Sep, 2017
Birth is a woman’s right and how she chooses to go through her pregnancy and how to give birth should always be in her control. If you're on your first pregnancy, no doubt you have been reading countless books, been getting advice from medical professionals and recommended by family and friends what you should do.

During pregnancy, there are tests and scans that are usually carried out, but these are all a choice. Having them is not obligatory. You can say ‘no’.

The medical professional is there to advise and inform you of your choices; however the ultimate decision should always lie with you. Here are some considerations that you might want to think about:


DURING PREGNANCY

Choice of midwife or Clinic
Your antenatal care can be provided in a number of ways. You could book your appointments at the local Children’s Clinics, you can be assigned a visiting community midwife at your local doctor’s surgery, or you may have your antenatal care directly with the hospital at which you will give birth. Find out which option would best suit you.

Dating Scan – the rigidity of it
Often women will calculate their due date based on their last menstrual cycle and their first scan, which is around 12 weeks into her pregnancy. Note that scans aren’t always accurate, with regards to the due date, and are often out between 3-5 days. If they measure the baby bigger, then this would give a mum an earlier expected date, which at the end of pregnancy means an earlier date for potential pressure for an intervention/induced birth.

It’s worth noting here that the World Health Organisation states that a baby is at full term from 37 weeks and if born at this point usually doesn’t need medical assistance. Yet it is also perfectly normal for a woman to give birth around the 42 week mark. So the rigidity of a single day is nonsense, when you think about it, as only 4 per cent of babies are born on their due date, and the majority of babies arrive after their due date.
Also be aware that having scans is not compulsory, in fact some might argue that as they don’t alter the course of pregnancy, is there really a need for them at all? For many women they provide reassurance that the pregnancy is progressing well, however for others, the results of a scan can bring unexpected news. How does this alter how the woman feels in pregnancy? If you would like to read more about Ultrasounds, I recommend the book written by the Association for Improved maternity Services (AIMS) called Ultrasound? Unsound

Gestational Diabetes test
Gestational Diabetes is a high blood sugar condition that women can get during pregnancy. Between 2 and 5 per cent of pregnant mothers develop this condition.

Only about 30 per cent of women who test positive on the glucose screen really have the condition. If you test positive on the screening, you'll need to take the glucose tolerance test (GTT) – a longer, more definitive test that confirms whether you have gestational diabetes, or not.
How will I know if I might have gestational diabetes?

A routine urine test will show a lot of sugar in your urine. If midwife observes this, she may want you to be tested for this. Even if the results are normal, you may be screened again at 24 to 28 weeks, just to check.

If you are diagnosed with Gestational Diabetes, your pregnancy will move into the ‘high risk’ category, which in turn could mean birth choices being taken away from you, such as giving birth in a birth centre or midwife-led unit. The reason for this is that with gestational diabetes babies can grow bigger than the expected range for birth and the health system would prefer to monitor you in the labour ward.

This is why it is important to maintain a healthy diet through pregnancy, so that your blood sugars remain in the normal range. Avoid sugary foods and drinks before midwife appointments to avoid unusual readings that could lead you along this path.

Where to have your baby - hospital, midwife-led unit or home birth?
In the UK, the NHS, in fairness, is trying hard to normalise birth (read about the Better Births Initiative ). While many births still take place at hospital, the NHS is working towards making it less of a medical procedure and more of the wonderful experience that it should be treated as. The NHS is investing in more birthing centres, many of which are within a hospital setting. The centre usually has a more hotel-like feel rather than the medicalised setting that a labour suite tends to have. The centres are managed only by midwives, which is why they only accept women with low-risk pregnancies.

Women who are considered high-risk would be in a labour ward, where obstetricians are available to help, should any emergencies arise.
In recent years there has been a push for home-births. In the Better Births Initiative page above it states: ‘Birthplace research shows that healthy women with planned births in midwife-led units and at home were more likely to have a normal birth as compared with obstetric units.’

Home Births are intended for women who have had low risk pregnancies and where midwifery care comes to your home to help you in giving birth to your baby.

So is where you birth really a choice? What if you did have factors that put you in the high-risk bracket…are some of those choices no longer available to you? Each woman’s circumstance is different, so speak to your midwife about your plans for birth to see how you can accommodate your preferences.

Should I take their advice for an induced labour or can I wait for labour to start spontaneously?
As your due date approaches, your midwife is likely to say to you something along these lines. ‘If baby hasn’t arrived before so-and-so date then we will book you for an induction’. Please stop her right there and simply ask the question, ‘Why? What medical concerns do you have for me or my baby?’

According to the National Institute of Clinical Negligence (NICE), an induction should only be suggested to mothers when there is a clinical justification – read the NICE guidelines . If it is simply a matter of all being well and your baby is happy where they are, this is NOT a reason for induction. However, many women just aren’t aware of this and quickly accept this offer.

Quite often women aren’t talked through what an induction really means, how this type of labour feels, compared to a spontaneous labour, and what risks are involved during an induced labour – in many cases leading to what may have been an unnecessary labour, if they may have waited for a natural labour.

Because it has become so routine in our modern society, women seem to accept this as the way it has to be, without questioning why. For those who haven’t read up on their choices, they may easily accept this information and just say to friends and family. ‘I’m going to be induced on so-and-so date.’ But what they are not told is what the medical reason is for this. The late arrival of a healthy baby, with a mother who is not presenting any medical concerns, is not a clinical justification.

Just think back to when you first fell pregnant? Did you calculate your own ‘due date’? Perhaps this date was a day, or more, later than your hospital due date… are they therefore rushing you to have your baby unnecessarily early? You, your body and your baby have done just fine for 39+weeks so why do they think that your body wouldn’t know how to go into spontaneous labour when it is ripe and ready?
So what can you do? You are fully within your rights (because how you birth is YOUR choice) to decline induction and be asked to be monitored more closely in the coming days to ensure that both you and baby continue to be well. For extra reading, look at the AIMS booklet on Inducing
Labour: Making Informed Decisions


DURING LABOUR
The choice of how your labour plays out is in your hands - it doesn't need to be totally managed by the midwife, neither do you need to be left totally alone. It can be a blend of many things. Here are some things to consider:

Consent forms
In the hospital you may be asked to sign consent forms when you are in established labour, say for example agreeing to an epidural. It may be worth discussing these options with your midwife in early labour and tell her what you are open to or not. Get those consent forms signed before you enter the bubble of established labour, when the last thing you are going to care about is admin!! You have a bigger job at hand.

Vaginal examinations
A vaginal examination helps the midwife establish how far your cervix has dilated. Other than that, it serves no other purpose. It is possible for the cervix to constrict in labour if a woman is feeling tense or vulnerable, so if you are not comfortable with having an examination, the cervix may react and present tighter than when you relax your body; therefore giving a misleading dilation stretch. Though not very likely, there is a slim chance that by having a vaginal examination infection and bacteria is introduced into the vagina. An expectant mother is well within her right to decline all vaginal examinations, if that is her preference.

Breaking your waters vs spontaneous rupture of the amniotic sac
In an induced labour, after the pessary has taken effect, if labour isn’t progressing as they would like, the next step would be perform an Artificial Rupture of the Membranes (ARM), also known as an amniotomy. This is usually carried out by your midwife. The membranes will be ruptured using a tool, such as an amnihook or amnicot. This is carried out in the belief that it will speed up and strengthen contractions.
In a spontaneous labour the membranes can rupture at any point in labour. In rare cases a baby is born with amniotic sac still intact, this is called ‘en caul’.

While the risks are very low, there are risks associated with ARMs. It is a blind procedure, therefore, there can be no certainty that the midwife won’t end up rupturing vessels that are part of the overall blood supply to the baby. An already compromised baby may be put at further risk by an amniotomy; as the uterus could become hyper-stimulated.

Monitoring baby
Your baby should be monitored at least every four hours in early labour and every 15 minutes in established labour. A midwife will listen in to the baby’s heart rate, either with a hand-held Doppler or with a continual fetal heart monitor and check that baby’s heart rate does not decelerate during contractions. When a baby’s heart rate dips during contractions, it is a sign that baby is in distress. They will continue to monitor you very closely and advise if alternative action necessary.

Confined to the bed vs being mobile
When a woman spends most of her labour on a bed, her movements are restricted, her body could be in the exact same position for long periods of time. If this happens to be more laying than sitting upright, she is not using gravity to her advantage and she could be slowing the labour process down without realising it.

A woman, who is active in labour, keeps mobile. Those movements encourage the bay to descend more rapidly and result in shorter labours, often without complications. Antenatal educators encourage all mothers to be active and upright in labour and only use the bed when it is absolutely necessary.

Natural vs medicalised pain relief
There are two types of pain relief; see the options below:

Natural
• TENS Machine – a TENS machine is a device that has two sets of electrode patches. These patched are placed on the woman’s back and sends out continuous mild electrical pulses that trigger the body to release endorphins (natures natural form of pain relief). During a contraction (surge) the woman presses the boost button to send more impulses through the patches. Extra relief of endorphins helps soothe the mother during labour.
• Birth Pool – women choose birth pools for relaxation and pain relief during labour. It can also be the environment in which to give birth to their baby
• Baths/Showers – the heat of the water in the bath/shower can help the mother relax, when she is relaxed the body releases the hormone oxytocin, which helps labour progress.

Medicalised
• Gas & Air (Entonox) – is a mixture of half oxygen and half nitrous oxide. It is known to take the edge off labour pain, rather than blocking it out.
• Pethidine - is a sedative and a muscle relaxant that helps take the edge off labour by making you feel drowsy. However this painkiller crosses the placenta, which can affect your baby in a number of ways leaving them feeling drowsy, which could impede breastfeeding immediately after birth
• Epidural – these are administered by anaesthetists where they insert an epidural catheter into your back. It is this catheter that allows the pain relief to be topped up during labour.

Women are encouraged to go through as much of labour with natural pain relief, so as not to interrupt the natural process of birth. However, for some women, using medical pain relief is a necessity and we are lucky to have these options available to us, should they be needed.
Some people consider hypnobirthing as a natural form of pain relief. Hypnobirthing itself doesn’t promise a pain free labour, but many women who have learnt hypnobirthing and who have practiced the techniques and worked on preparing for birth with a positive mindset have experienced wonderful births.

Giving birth; should I lie, sit or squat?
Unlike the films and soap operas, giving birth on a bed with your legs astride is not the only position to give birth. The sitting position on a bed can inhibit your baby’s entrance into the world and it can be more challenging for the mother to give birth in this position. Lying down flat, means that you are not letting gravity help you and somehow your baby has to venture into your birth canal horizontally – this isn’t very efficient.

Consider being more upright, think about adopting a squat-like pose, where you are able to bear down, allowing the birth of the baby to be smoother. This could be sitting on a birth ball with your hips higher than your knees (encouraging the upper part of your body to tip slightly forward. This helps baby’s push the frontal part of the pelvis forward potentially allowing more space.

You could also think about being on your knees and leaning across the back part of the bed (moved into a vertical position; like the back of a chair). By leaning over the bed, you are allowing your bump to tip forward and you have movement and flexibility in your hips. This position also works well if you are in the birthing pool.

Coached birthing vs mother-led birthing
You may have visions of the midwife encouraging you to ‘push’ your baby out when the time comes. Media will have you believe that labour is all about pushing, pain and panting – this is inaccurate. A mother doesn’t need to experience that to birth her baby; there are gentler ways to aid your baby into this world. Simply by listening to your body and responding accordingly; through gentle Down Breathing, as taught in KG Hypnobirthing, allows your baby to descend to the rhythm of your body.


AFTER BIRTH

Natural expulsion of the placenta or Synthetic Oxytocin injection
It is entirely up to you whether you prefer the midwives to administer Synthetic Oxytocin into your system to help aid the detachment of the placenta from the uterus wall. If you have had an unmedicalised labour up until that point, you may well choose not to accept the injection to start with. It is extremely likely that your body will do this of its own accord. If you have had an augmented labour, then your body may then need a little help in expulsing the placenta, with the help of this hormone substitute. Ask your caregiver if they feel it is necessary when the time comes, or perhaps wait to see how your body reacts after birth to decide for sure.

Cutting the cord / Optimal cord clamping
In the UK today, optimal cord clamping is encouraged for all babies in all birth situations, whenever possible. Ask your midwife what the policy is in your Trust. My hope is that they will say ‘until the cord stops pulsating’. If they don’t say this, then maybe this is something that you need to have in your birth plan. Nature intends for the baby to have all the blood from the placenta after birth. When the blood has drained, the umbilical cord starts recoiling and the placenta begins to detach from the uterus wall. At most this takes a few minutes, and during this time the baby is enriched with all the stem cells and blood that belongs to him/her, that they would otherwise be deprived of, if the cord were to be cut sooner. A baby can weigh 200g more if the blood is passed from the placenta, than if the cord were to be cut immediately. This blood belongs to your baby, so ask your caregivers to ‘wait for white’ (the colour the umbilical cord will be when the blood has passed through).

Skin to Skin
It is encouraged that the baby goes directly to the mother straight after birth. Decide if you prefer to have the baby wiped down first or whether you are happy for baby to come directly to you. This is known as Skin to Skin. This period is extremely important for many reasons:
After being nine months in a warm, dark pool of water, where the sounds are all muffled. It is quite a stark contrast to come into this world. Where people are excitedly talking about the new arrival, where the lights are bright and this beautiful wet baby is starting to feel cool air on its skin. The best way to soothe the baby is to place it directly to the mother’s chest, where her body heat can warm the baby, where the sound of her heartbeat and other bodily noises can be heard again; offering comfort and where a significant part of the microbiome process can be introduced (this is a step which to colonise the gut with important bacteria from the mum and helps to build the baby’s immune system).
If for whatever reason mum is unable to do this, then the Birth Partner could do this. Isn’t it much nicer than having the baby in a cot nearby, or being held by strangers, when there is no need?

Breastfeeding
Breastfeeding is a personal decision, and from experience I know that it isn’t as easy as it seems. What your plans may have been before you baby was born, can be very different from what you actually experience. However, breastfeeding is considered beneficial for the following reasons:

• Breast milk is perfectly designed for your baby
• Breastfeeding as early as possible after birth provides the first milk known as colostrum
• Colostrum is rich in proteins, carbohydrates, fats, vitamins, minerals, and proteins
• The proteins have antibodies kick-start the immune system which in time will fight disease-causing agents such as bacteria and viruses.
• Breastfeeding provides health benefits for you
• Breastfeeding helps your uterus contract to its pre-pregnancy size
• Breast milk is available for your baby whenever your baby is hungry
• Breastfeeding can foster bonding between you and your baby
• Breastfeeding is free. No need for bottle, sterilisers, formula milk etc.

Read more from the NHS .

Partners being able to stay
This varies from hospital to hospital, but it seems crazy that when a woman who is in a vulnerable situation and who needs emotional support it not allowed to have her partner stay with her. Discuss this with your midwife, as to what the guidelines are for your hospital. Sometimes you can pay for a private room; this option may be attractive to you.

These are just some considerations to decide upon, that can help you create the right birth plan that is for you.

If you have any questions, feel free to email Magical Baby Moments at classes@magicalbabymoments.com
Magical Baby Moments offers group hypnobirthing courses in Romford and Upminster, and private courses across Essex and London. Check online at http://www.magicalbabymoments.com/classes to find out upcoming dates.
By Christine Huntingford 07 Sep, 2017

If you are anything like I was, you are probably reading books about how your pregnancy is progressing and how you can better prepare yourself for labour and birth. Perhaps you are looking into what antenatal classes are available in your area. There is a fair amount of choice today. Some parents to be attend NCT (National Childcare Trust) classes, some choose ParentCraft, offered by NHS midwives and others choose hypnobirthing. Added to that you have pregnancy yoga too.

Each have their own way of preparing you for labour and birth and offer antenatal education from slightly different angles.

Hypnobirthing is a choice that many are turning to as the all-encompassing antenatal course. It teaches expectant parents:

  1. easy-to-do, practical relaxation techniques that expectant parents can begin implementing during pregnancy, as well as reap the benefits of all that practice during labour and birth
  2. the medical side of what will happen during late pregnancy, labour and birth, as the body prepares for your baby to be born
  3. the possiblities of how labour may play out and the decisions you can make that are right for you and your baby. This is known as informed choice and much more

Why should I do a hypnobirthing course?

There are many reasons why you should do a hypnobirthing course. As a mother who has been pregnant twice, I actually did all of the courses, except for yoga. After having my children I decided to become a KG hypnobirthing teacher. Why? Because this course offered all of what I needed whereas the others only offered part of it. 

I have been teaching hypnobirthing in Essex since 2015 and this year I wrote a book explaining what a hypnobirthing course offers expectant couples. If you would like more about what Hypnobirthing Course can offer you, you can buy this introductory book: The Power of Hypnobirthing: 10 reasons why it's for you for only £5.99 (on the Kindle or in paperback *).

If you are eager to read the first chapter of the book for free, simply email power@magicalbabymoments.com

*postage charges apply

By Christine Huntingford 07 Sep, 2017

I attended the Positive Birth Conference on 20 July 2017at City University in London. Being around birthing professionals is wonderful for me as a hypnobirting teacher, as I don't get to do so very often. Feeding off their knowledge and enthusiasm is eye-opening, and this conference was no disappointment.

There was a fabulous line-up of speakers, including:

  • Cathy Warwick, Chief Executive, Royal College of Midwives
  • Professor Susan Ayers, Professor of Maternal Child Health, City, University of London
  • Octavia Wiseman, REACH
  • Ellinor Olander, Senior Lecturer, City, University of London
  • Milli Hill, Positive Birth Movement

The day centred very much on the theme of what women are looking for when it comes to their birth experience. With each speaker looking from thier professional angle how we can potentially give them a better birth experience.

So what would women like to experience?

They are looking to:

  • have a safe birth
  • be able to select the right care for them
  • have care that wraps around their preferences, without pressure to make choices that simply fit with midwifery care
  • be listened to and not categorised (high-risk vs low risk)
  • be taken seriously and to have honest discussions about risks, if they arise
  • have continuous and consistent communication with their caregivers

Where to give birth?

An area for improvement is to have consistent choices regarding place of birth. Not all women reported having been given choice - it some cases it was simply assumed tha they would have the baby in hospital. The crux of it is; choices are constrained by reality (e.g. in remote parts of the country the choices that are available are not the same as those of a big city; mothers being considered low risk/high risk may rule out the birth centre, for example).

The Better Birth initiative states that women should have three choices of place of birth, NICE – the National Institute for Health and Clinical Excellence – recommends four: Obstetric Unit (hospital), Alongside Maternity Unit (birth centre within a hospital), Freestanding Maternity Unit (standalone birth centre), Home. This initiative aim that all women, regardless of where they are in the country, should be able to make a choice from all offerings.

Midwives are advised not to just accept women asking for what they want, but to ask them to explain why they have made that choice. The midwife should then ensure that the potential risks and of that choice are understood by the mother, as well as making sure that all other choices have been explained in the same way. This allows the mother-to be to make choices in an informed way.

Continuity of Care

Some areas of the UK have been criticised for their lack of continuity in antenatal  and postnatal care - although this is starting to be addressed in some Trusts with the reintroduction of case-loading (seeing the same midwife/small team of midwives throughout pregnancy). It was said that more could be done to have a smoother handover from the midwives to the health visitors, so that upon the first appointment with a health visitor they are already aware of the woman's pregnancy and birth experience.

Ellinor Olander spoke about this subject and her study identified issues that women said we/weren’t important to them:

  • Location of appointments: meeting their caregivers in the same location for antenatal appointment was not important to them; however home visits after birth is appreciated.
  • Staff: When considering the handover from midwife to health visitor, face-to-face contact with health visitor in pregnancy is not required. New mums prefer not to have to repeat their medical history to the health visitor and would appreciate a better hand over from the midwife. Some said it would be helpful to have the first meeting with both professionals together - especially women who have had traumatic experiences.
    • Most respondents had a named midwife, this was not important to all of them.
    • Most had met with more than one health visitor.
  • Information: Most women wanted to receive consistent information from all the caregivers they met.

Continuity of care is especially important for women who have experienced some degree of trauma.

Professor Ayers did a presentation on Birth Trauma: Risk and Resilience in Women

She shared her research on women who have suffered some degree of trauma during labour and birth; who, as a result, have experienced Post Traumatic Stress Disorder (PTSD). Evidence shows that 4% of women experience Post Traumatic Stress Disorder in pregnancy and a further 3-4% develop PTSD as a result of birth. Most women however, who have had a traumatic birth, don’t go on to develop PTSD (55%). Risk and resilience factors have been identified during the study and medical professionals are using these findings to prevent PTSD and enhance positive outcomes going forward.

The events that occur during pregnancy and birth are important, as these are what contribute to Post Traumatic Stress Disorder and Post Natal Depression. However this is subjective based on the individual's thoughts around the events, rather than the events in themselves - some women are more acute to situations than others. It could also be that the event in isolation wasn't the trigger, but a number of factors that have contirbuted to the woman’s life experiences.

Even though it has been cited that 3-4% of women experience PTSD in pregnancy, this figure can be as high as 39% for those who have a history of abuse.

PTSD can result in:

  • Preterm birth
  • Low birth weight

If a mother is stressed during pregnancy, this carries over to the baby. Evidence shows that these babies have an increased response to stress, which carries into their lives later on.

Women who experience birth trauma and who receive support, find strength and resilience to move forward. The y find a way to give meaning to that event, which often sees them experience grow from the crisis.

Can risk be reduced?

Yes. The most common responses were by:

  1. Having better communication (39%)
  2. Being listened to more (37%)
  3. Being supported more/better, both emotionally/practically (30%)

As a result of this study, a framework has been put together to identify women who are potentially at risk, in order to customise their care across pregnancy, birth and postnatally.

With this information being fed back into the team and shared across Trusts, it will be possible to offer personalised care to women who have been identified as at risk.

Octavia Wiseman, spoke about the REACH Pregnancy Programme, which is a five year study, currently about half way through.  

This study aims to identify women who may not usually seek full antenatal care, possibly due to one of the following factors:

  • Socio economic, linguistic and cultural diversity
  • Social issues
  • Practical issues
  • Demographic issues
  • Cultural issues
  • Health issues

The aim is to find these women living within our communities and offer them the antenatal care that are entitled to.

Pregnancy Circles have been introduced - this brings together women who are at similar stages in pregnancy and who live near each other. The Pregnancy Circles offer clinical care, information-sharing and social support. They aim to provide a woman-friendly, community environment for antenatal care. These meetings are 2 hours long, rather than the 15 minute appointments expectant mums would normally receive. So far these meetings have been positively welcomed.

The final speaker of the day Milli Hill.As a co-cost of Havering’s The Positive Movement, it was wonderful to hear how she has inspired so many women to take up her movement and bring women together to look at birth positively. She centred her presentation on Carl Jung’s Shadow Theory. Jung saw quite clearly that failure to recognise, acknowledge and deal with 'shadow elements' often is the cause of problems between individuals and within groups and organisations. Hill challenged participants to consider the 'shadows' in birth, midwifery and within ourselves.

It was a thought-provoking day where I continued to learn so much from my peers. I long for the day that maternity care that is stripped of red tape; where midwives, who go into the profession wanting to be with women, can dedicate their time caring for them consistently. Continuous care is not a new thing. We all srtive for better births. These conferences help solidify our ambitions towards a positive birth experience. If only it could happen a little faster.

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