Weekend babies on the NHS

 

I woke up this morning and as is my habit, tuned into LBC.  I like to keep up with what the great British public are thinking about and medicate my homesickness for London.  This mornings birth news story was repeated over and over again. A discussion began about what can make birth safer. I asked a non-birth world friend (already a parent three times over) how they would feel if they were having a baby now and they came across this article “……frightened….like I would want to do the impossible and try and keep the baby in if it was coming on the weekend……” of course – this is a reasonable response to hearing that one in six baby deaths during birth at the weekend in England could be avoided.  Tuesday is the safest day.  So what will happen now with parents?

Tuesdays will be over run and I can imagine many women deciding not to turn up at the weekend if they can avoid it and maybe if they can’t too.  Not turning up when they are worried about their baby, not wanting to have an induction on a Friday, if they burst their amniotic sac of fluid, if they would ordinarily be ready but staying home that extra night in fear.  Fear we know is an adrenalin producer. Adrenalin we know is a direct inhibitor of oxytocin which is our love hormone.  Physiologically we need oxytocin to make our cells contract to open the womb for our baby to get out.  We are designed so well – this means if something frightening happens we can stop giving birth and deal with it.  It’s troublesome to not be able to produce it in abundance because you are freaking out your baby is coming on a Saturday night.

This was no small study – it can be found in its entirety here.  Imperial college London analysed 1.3 million births and found that babies were 7% more likely to die during birth or in the first week of life if born on a Saturday or Sunday. Infections after birth were 6% higher and the chance of the baby suffering an injury was also 6% higher.  Researchers found clear evidence of poor care and this was not due to a lack of senior doctors either.

So what can we do as mothers and fathers to counterbalance this?  Carefully considering your place of birth is a really good place to start.  What will be safest for you? Where will you feel safest? What is their reputation? You can often find feedback sections for maternity units on their websites and we are also in the fortunate position that we have an independent organisation that collates figures and facts called Which? You can find them here. The Birthplace Study has found that home and birth centres are generally safest for most women – even high risk – you can read more about that here.  My experience supporting at births over the years reflects this.  At home you have two midwives dedicated to caring for you and your baby and they can go nowhere else – they are with you constantly once you call.  We imagine that labour wards with doctors, equipment, theatres and medication will solve all manner of ills and there is no doubt at all that they can be very useful when needed but with all of those technologies come a further degree of risk – seemingly we are frequently introducing this risk to women and babies without having the staff to monitor as closely as needed or indeed the capacity for surgery that is needed once those higher risks manifest.

Also thinking about who you may choose to have with you can make a real difference. Having another woman with you who has given birth before has been known to greatly reduce risk. It significantly reduces the chance of c-section, instrumental delivery, induction, epidural and ups the chances of breastfeeding – this all lowers risk considerably.  Have a look at this piece of research here. I had my sister with me for my babies but this may also be your yoga teacher or someone who does this professionally like a doula. You can read more about doulas and find one near you here.  Doulas are fantastic at lowering risk. Why? They are on constant watch to make sure you have all that you need and sometimes its the doula who spots the clinical risk when the professionals haven’t. This is a very controversial issue as it is most definitely out of their scope of practice but what are you supposed to do when you can see blood pooling under an increasingly pale woman and the midwife is tapping away on the computer in the corner? When you see your maternity notes being handed to another woman who’s going in for her antenatal appointment? When a woman is convinced she is having a stroke and no one is listening to her? (I spoke with three midwives before a doctor arrived about 45 minutes later to check out the patient) When a baby is actually coming out and both mum and dad are saying this and the midwife is still asking who the GP is whilst again tapping information into a computer while dad is shocked and trying to catch? (in this case mum was a doctor). When syntocinon (a hard-hitting synthetic version of the  hormone associated with greater risk) is clearly going into a womans tissues rather than her blood supply and her hand is swelling and swelling? These are all real life situations I have personally witnessed and I could go on before I even begin to add in all the others I have heard of as a mentor.  This isn’t an attack on midwives and doctors – I’ve seen and know many who do a fabulous job at doing their absolute best to keep everyone safe and loved.  It seems to me that these over sights are often the result of a HUGE amount of bureaucracy and policies and procedures and machinery to read and attend to before you can fully concentrate on the mother.  We know that their is a problem with listening – this article here helps you to understand that. We are currently spending millions in the NHS on the Compassionate Listening programme. Alongside serious staffing issues which are clearly much more to do with not funding enough midwifery posts to deliver the standard of care that keeps everyone safe and supported including the midwives and much less to do with a shortage of midwives.

Something needs to change. My first thoughts when I heard this headline this morning were that this would generate a whole lot of unhelpful fear and stress. With some reflection I think what it also does is open up the discussion that when we are overworked and over stressed we cannot work safely and we need to be having that discussion over and over until something changes. It’s just the human condition. Now this is out in the open we can begin walking towards change one step at a time keeping mothers, babies and staff loved, safe and happy.

nicola mahdiyyah goodall is a revert muslim who grew up with hip hop based in edinburgh, scotland and london, england. she works with women trying and mainly succeeding to build circles of knowledge and community primarily with birth. read more about her and find out how to access her services here. she is now also part of a new doula collective in london called birth in the city launching 2016 – watch this space!

she is also the director of wysewomen publishing and facilitates wysewomen workshops and red tent doula courses.

 

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cats and doulas

I have always been a fan of Michel Odent. Primal birth was one of my first reads as a budding new doula and Birth and Breastfeeding was an inspiration when pregnant with my last and unassisted birth. There is such confidence that he exudes from his books with regards to the case for undisturbed labour resulting in pleasurable birth with excellent conditions for bonding. I had been consumed with jealousy in my second pregnancy that cats have so much more freedom than women to take themselves off on their own in the dark to birth their babies in safety.  This is a far cry from the place that most women find themselves in at the end of pregnancy and I have heard so many women saying they wished they could just go build a nest and give birth on their own. The notion that they can seems only a distant dream when well meaning midwives want to check  in on women and consultants want to monitor women’s pregnancies. Then there are the wonderful caring family members and friends consumed with excitement, so they call every 5 minutes to ask if anything is actually happening.  No wonder pregnancies get longer as women are less safe with their physiological need for privacy not being met with the constant observers.

When I found out my cat was pregnant in the summer 2014, I was a very happy surrogate grandma. I could be a doula for my cat and mother her through pregnancy and observe, albeit from a distance, how she would raise her young kittens. She was only a kitten herself at 10 months of age and we expected she would have 2 kittens from what the vets had said. I had gentle curiousity at the thought of observing a mammal from afar give birth without all the restrictions that have been put over humans since birth moved into busy hospitals. I also wondered whether her unhindered births may put me off my love for the doula, thinking that she would birth alone and need nothing being the independent mammal that she is.

On the 31st August, I went to a beautiful homebirth of a second baby. The baby was born in the water and the mama was absolutely blissed out and the Dad and husband truly in awe of his partner. I got back to a quiet house, kids in bed and a clean house. I had bought a dog cage and put it where my cat used to sit. I had covered it inside and out with fabrics so it was cave like. Much to my surprise at 2am, my cat came to sit on me in bed next to my sleeping toddler. I gave her a little pat and settled back to sleep but she started mewing like she wanted more attention. I kept stroking her and realized I could feel her contracting under my touch. She was dribbling and purring with pleasure. I knew pretty quick that she was in labour in my pitch black room on top of me in my bed. After about an hour she jumped off me next to my sleeping son and yelped. I then heard lots of licking before a shrill mewing. I had always known never to disturb a cat in labour but I didn’t want another kitten being born on my son! I moved him over and sadly aroused him enough to want milk without sleeping properly so we left her with her 3 babies by then in the dark on his cot attached to the side of the bed. At 7am there were 5 scrawny looking kittens suckling their mama as she laid out proud on my bed. She was treated every few hours with cooked fish and chicken and dried food. They nursed pretty continuously for a week so she could not really get up much and she appreciated the food and water under her chin every so often. She would only be happy with me near her nest so I protected her from my ever curious kids.

So my expectation of cat birth could not have been further from what my cat chose. She had places to be alone but she chose to be next to me and a toddler crazy as it was.

I had read a book in 2012 called ‘The Power of Pleasureable Childbirth” by Laurie Morgan. It really challenged me on why I would want a doula at a planned unassisted birth. A doula being seen as something outside of the normal family unit, so an intervention. Ever since I read this I have reflected on whether the intervention of me being at a birth has affected that natural flow of the births I have been too. I think for most of the families that I have been a doula for having the intervention of a doula was a better insurance than meeting the interventions of birth within a medicalised system. I chose to have a doula because she was someone I knew well and had been to her birth a few months earlier. Having her come with her baby was like an extension of my family really. I also wanted the emotional support of a woman as I had never received this in my relationship with my children’s father. The birth of my cat’s kittens really did highlight that there is a role for doulas to play when this is what a mother wishes. Not all women receive the nurturing from a partner that they need for giving birth. Not all male or female partners trust the mechanics of birth. Not all partners want to talk about life events after the occasion so I guess a doula fits this gap. My cat I believe picked up the scent of oxytocin from the birth I was at that very day. She came to my magical family bed, which is full of oxytocin with a breastfed toddler and she wanted me to lovingly touch her. Something that I don’t like in labour but plenty of women do like touch. Given that cats are much more intuitive than many of us humans have evolved to be, I believe my cat found it was safe being next to someone who trusted birth and mothering.

I feel very honoured to have witnessed my cat birth her babies and very honoured to have doulaed for so many families. It is wonderful to see how it all unfolds when left alone and in the case of my cat see how much pleasure is gained from acknowledging the need to be loved!

hannah robertson

hannah can be found at http://calmyorkshirebirth.co.uk/blog/

and running doula uk preparation courses in york at http://redtentdoulas.co.uk/