NICE guidelines - Home birth is a safe option

Today is a great day for all those midwives, doulas, antenatal teachers and men and women who believe that giving birth is a normal, physiological and emotional event in a woman's life and should be treated with the utmost respect, dignity and awe. It is indeed a great day - women will now finally be given a more realistic (evidence based) view of home births.

Giving Birth does not have to be a traumatic and medicalised process during which the woman feels scared, out of control and a cog in the NHS maternity system. The NICE guidelines, which were published today, have recognised that the evidence to date indicates that women who choose to have their babies in the safety and privacy of their own home under the care of a Midwife, or in a Midwifery led birthing unit have less complications and hence intervention.

But we should not forget that this day is the accumulation of years and years of hard work by some unbelievably dedicated and passionate women and men. I remember being at the launch of the Birthplace study in London and the buzz then was amazing - everyone truly felt that the tide was turning, and that was 3 years ago.  We need to keep up the momentum, support midwives in the amazing work they do, encourage our friends, sisters, daughters to believe in their bodies and to spread the word that feeling safe, positive and prepared will help all women to have better births.

10 things to say to a pregnant woman

One of things which never ceases to amaze me is how much negativity there seems to be around pregnancy and childbirth. In spite of the fact that everyone on this planet has been through the process, so many people find the whole subject more of a concern than a joy.  I understand why this has happened and why people who have found it a difficult experience, find solace in talking about their experiences to others. However if we all started promoting a sense of positivity and empowerment when talking to a pregnant woman, maybe we could break the viscous cycle. 

So I came up with my top 10 things I say to pregnant woman:-

1. You look wonderful - pregnancy obviously suits you
2. This is going to be one lucky baby
3. You and your baby will be life long best buddies
4. What are you most looking forward to?
5. What has been your favourite moment of pregnancy so far?
6. The body is simply amazing - every baby truly is a miracle
7. (If this is a second pregnancy) I’d be happy to look after your    
    child so you can have some time to yourself
8.  I am so jealous!
9.  Birth was the most amazing experience of my life
10. I am here if you need me at any time

The secret to coping with labour and birth

If you are currently pregnant or even planning to have a baby then the thought of giving birth will have crossed your mind once or twice!  From those cringe worthy sex education videos to One Born Every Minute to well-meaning neighbours, the message most women get is that birth hurts like hell, that you will be in labour for days, that you are likely to scream the place down and turn the air blue with a few choice words begging for drugs.  Is it any wonder then that 8 out of 10 women in a Mother and Baby survey were terrified of giving birth?  And yet if you were to switch over to the Discovery channel and were to watch a programme of any other mammal giving birth, she would be quiet, calm, mobile and seem to just get on with it.  We know that mammals register and feel pain, yet somehow during labour they don’t seem to show the same characteristics as women on OBEM.

So do you think that maybe there is a chance that us women could also experience labour and birth being calm, more in control and better able to deal with the pain?  More and more women, have discovered that by listening to hypnotherapy CDs, they can learn safe, simple and easy ways to stay calmer, be less fearful, be better able to cope with labour and have a more positive experience. 

So how you can turn from a potential screaming banshee to a calm, serene birthing goddess by just listening to a relaxing hypnotherapy CD?  Well, it all comes down to hormones and how you are feeling in the lead up to and during the labour.  If you are scared your body will be in a “fight or flight” mode and birth becomes tough; if you are calm, relax and breathe slowly, your body can just get on with it. To put it into context, imagine you are labouring alone out in the wild. Suppose you saw or even thought you saw a dangerous animal lurking in the shadows. What do you think would happen? Would you have a conscious choice on what happens next? Simply believing there is a wild animal in your birth space would instantly stimulate the “fight or flight” response. Your muscles would tighten, blood would flow to your limbs and contractions would slow down or stop and would not resume until you felt safe.

This fear, whether real or imagined, activates the nervous system to produce adrenaline (danger hormone), which gives you a burst of power to fight or to run away. Your cervix tightens (to prevent giving birth where it is not safe) and the increased level of adrenaline neutralises the oxytocin (the hormone responsible for your contractions) so that your body slows down or even stops labour. All this “fight or flight” preparation uses a great deal of energy and as our bodies were only designed to be in this state for a few minutes, you can imagine that staying in this state for prolonged periods of time will lead to prolonged labour, horribly painful contractions which will be extremely exhausting for both mum and baby.

You may be asking, “what does a women giving birth in a jungle have to do with me?” This is essentially about fear – fear of pain, fear of dying, fear of tearing. Your nervous system does not know the difference between fear from real danger or imagined fear, from what you may have seen on the tele or told by friends and family and so your body will respond in the same way to both. If you go into labour feeling and being frightened, your system will respond accordingly.

So how does being relaxed and calm make a difference? By being able to relax during labour, your body responds in a very different way to the fear scenario described above. When you are relaxed, your breathing is even, ensuring a high level of oxygen is entering both you and your baby’s body, helping your baby remain calm and stable. Increased oxygen stimulates the production of oxytocin (hormone responsible for contractions) and the natural pain killer, endorphins. As the uterus has no resistance or tension from surrounding muscles, the contractions are more effective and more manageable. Other natural hormones also increase in including relaxin which allows the tissue of the birth canal to relax, soften and expand.

One of the easiest and most relaxing ways to help you shift from being anxious to being calmer, is to listen to a Natal hypnotherapy CD in the weeks leading up to the birth. Over 2000 midwives now recommend Natal Hypnotherapy as they have seen how beneficial it can be for both mum and baby. Listening to the CD is a great excuse to go and lie down for half an hour knowing you are doing something really practical and useful to prepare for the birth. My voice guides you into a deeply relaxed state using breathing techniques, guided imagery and visualisation. Once you are deeply relaxed, your conscious mind becomes quiet and you become open and receptive to positive suggestions about the birth, learning coping strategies and pain management techniques, all geared towards helping you stay calm and able to deal effectively with contractions.

As any midwife will tell you, the secret to coping with labour is to relax and breathe. By listening to the CD over and over again before labour you become brilliant at relaxing and effective breathing and are mentally familiar with the processes of giving birth, which naturally increases your confidence and reduces any fear associated with birth. The hypnotherapy techniques put you in control, so that you have all the coping strategies you need for the big day, no matter who else is there to support you. All this for just £10 – it’s a no brainer really!

A mums review of the "The Effective Birth Preparation" by Maggie Howell.

Thank you Kate for your honest and candid review of the book

"Before the Birth

This was the most useful tool in the preparation for the birth that I came across and reading it prior to doing any Yoga or NCT classes was really beneficial. In a very practical (and never patronising) way it describes what will physically happen to your body and this. Along with the practical exercises, and by understanding the process I was able to logically address my fears.  From my personal experience I am most afraid of placental abruption - so I have been able to eliminate this by understanding it as much as I can and opting for the injection to artificially deliver the placenta post birth to reduce the risk.

Real life experiences

 I was already a convert of this type of therapy as I used a similar system to give up smoking many years ago so I already have the confidence that what Margaret talks about will work but in addition I particularly like the real life stories and as my NCT friends are gradually giving birth its interesting that those who are the most prepared and calm are having the easiest experiences.

 Advice for birthing partners

 I think this is probably the most important part of the book. The bit about asking is mine or the babies life in any danger and then taking the time to consider I think will be one of the most powerful tools on our side once in the hospital environment.  Having already done a short stay at the hospital where I am having the baby I know that they are very process and procedure driven which may or may not be right for me. (Note I am a high risk pregnancy so hospital only option)

 Things that could be added

I thought this book was excellent as a whole but if Margaret had any plans to expand it - it would be really interesting to know any projects or case studies she has done in hospitals that have utilised this process and hear from the point of view of the hospitals, consultants and GPs (not the midwives). I have come across numerous midwives and birthing centres that strongly support this approach from friends, to birthing centres that run hypno birthing courses and a student midwife at my yoga class keen to learn more.... but the GPs and Consultants I have come across told me (and I quote) 'birthing plans are a waste of time I don’t understand why anyone would opt for anything than an epidural!' This is the reality of the medical system that operates and it’s the consultants and GPs (not the midwives) that make the decisions about your care all the way through the antenatal process especially if you are a high risk pregnancy- and they are supposed to be the experts so its a brave person that challenges their thinking. This is probably a bit much to put on Margaret's shoulders but it would only take a few GPs to support this system and the ball would be rolling.

After the Birth

So did it work… yes!

 Although I didn’t think so at the time! My labour story is by no means the horror story that many of my poor NCT friends seemed to have suffered. There were a couple of things that swung in my favour that really helped.

 Positive events that I believe were linked to the hypno – therapy and the effective birth prep book: 

• I remained in a zone for every contraction. The 321 relax technique and turning down the dial on the pain really helped. Interestingly they helped not just with the contractions but also for the internal examinations. 
  
  
• I ended up having to get my husband to tell the hospital that I was coming in as they thought I sounded too calm on the phone. When I got there I was 5cm dilated.
  
  
• Unfortunately, when I entered the self-doubt phase I was asking for an epidural. My cervix got stuck at 9cm dilated. I had a hugely supportive midwife who had read and understood my birth plan. Between her and my husband they persuaded me to go back into my ‘zone’ I did this as some of the words from the tape came to me from nowhere. Every contraction takes you one step closer to meeting your baby’

The midwife said my labour was really inspirational.  I had a chuckle at this because it was way more painful than I had expected and calm/ inspirational would be last word I would use to describe what was going on in my head! But all in it was a positive experience. My husband said that although I had felt I was out of control compared to the other wailing women in the delivery unit I was incredibly calm! I didn’t even give a second thought to the issues with my placenta and Maia got two 9s and a 10 on her APGAR tests straight after birth and I couldn’t ask for more than that.

I would definitely recommend this book but I think it needs to be read in conjunction with other activities such as the NCT classes and the yoga classes (It does say this in the book).

Things that didn’t work for me – I went so far into my own zone that I didn’t want anyone near me! Including my husband. It wasn’t the candles and massage oil Zen like experience I had imagined but it got me through and a healthy baby."

'I'm a new mum and I had a really bad birth experience which I haven't quite got over yet- is this normal?'

I was asked this question for a mother and baby magazine:

Yes it is completely normal.  Having a traumatic experience is not something that you can just forget or sweep under the carpet – no matter how many times people tell you that you should be grateful or happy that you have a healthy baby! No one can go back and change the events of your birth, however with time, gentle support and guidance you can change how you feel about the birth, and begin to look to a time in the future when you will no longer feel this way.

Do not feel that you have to hurry to get over it or to move on. Take your time to come to terms with the fact that your experience was not as you had hoped and that you have strong emotions that need time to heal.

Steps to help yourself.

1.      Talk about your experience with someone you trust. Find someone who will simply listen and not try to give you advice or to judge your view of what happened. 

2.      Ask your maternity unit for a full debrief of your birth experience. This will help you have a better understanding of what happened and to put things in context. Some hospitals now have post birth support groups so you can talk about what happened in a safe, supportive setting. They will also have details of counsellors for you to talk to.

3.      There are several charities and support groups such as the Birth Trauma Association which have local support groups as well as a supportive closed facebook group.

4.      Write down your birth experience as you remember it now in as much detail as you can. Then put it in a sealed envelope and post it to a made up address.  Then write down 5 - 10 good things that you remember about the birth – no matter how small for example the sun was shining, the midwife had a nice smile, and put it somewhere safe to look at when you are feeling a bit down.

5.      Seek out self help books and stories on line.  It can be comforting to read about other people’s experiences and how they got through the difficult times.

6.      Use a self hypnosis CD such as “Overcome Birth Trauma” (www.overcomebirthtrauma.co.uk) which offers you a calm, gentle voice to help you cope better, especially during difficult times. It will help you take time out to relax and allows you to gently reflect on and begin to let go of the negative feelings associated with your experience. It helps build your confidence, feelings of control and acceptance of what happened, so are able to move forward with a sense of hope that you will not always feel the way you do right now. (The CD does not require to you to relive the experience at all).

By using self-help techniques, coupled with the support of sympathetic friends and family, it is completely possible to come to terms with the difficult birth you experienced, accept the feelings associated with it and rediscover your emotional balance and wellbeing.