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/

empathy for birthkeepers

yesterday whilst a wee bit poorly and cold tucked up in my bed for one reason or another i started to think about empathy….and empathy in the birth room in particular…it’s what we all want isn’t it? to have others understand how we feel, what we are going through and what we need to heal.

when the birthkeeper puts themselves in the shoes of others her universe expands, her stress levels go down, her immune system is boosted and her brain lights up in the same way as the person she’s empathising with…there is some really amazing science that goes with this involving mirror neurons and your brains inability to reason that its not actually happening – we are born and wired to have compassion – isn’t that great? it seems like it will go a long way to making our life better.

so who’s shoes? what about mum? how is she feeling? what’s going on for her? what about her fears that you know of? perhaps that fear of doctors because of the rough vaginal exam she had as a young woman during her loss…what about that hope she has for her baby being born peacefully to heal that wound….what about the feelings of deep sadness she shared with you that her partner doesn’t find her sexually attractive whilst she’s pregnant and her great joy that she is birthing and becoming a mother which she’s dreamt of solidly for around the last ten years…and all the many thoughts and feelings you know nothing of…..what happens to you as a birthkeeper when you wear her life for a minute? you understand and you allow

what about the baby? we could write a large book on what we imagine this baby is thinking and feeling whilst birthing is taking place….how is she feeling? what’s going on for her? i’m sure there’s a whole lot of wooooaaahhh…….transitioning from one realm to the next …… flooded with chemicals at one moment high and dreamy on endorphins…loved and happy and safe full of oxytocin….rushing from adrenalin…..stressed when mum stresses…..i wonder about synthetic oxytocin and how that feels…focus goes from baby to mum continually…”we don’t want the baby to get tired”…”we’ve got to think about your pelvic floor”…what does this little soul feel when its very life is put on the line….what happens to you as a birthkeeper when you wear her life for a minute? you understand and you allow for stresses and strains and sleepy babies and babies that need a little energy or rest or time and you remember just how wise babies are….you understand

what about dad? how is he feeling? what’s going on for him? what about his fears and hopes that you know of? lets face it we know he hasn’t had sex for a long time – there must be something going on for him even if he hasn’t shared it with us…..perhaps he worries he’ll be a violent father like his own….maybe he’s looking forward to fishing trips and seeing the reflections of his grandparents in this hoped for baby…..perhaps he really didn’t want another baby….he’s concerned….at a homebirth he has jobs to do…in the hospital he may feel trapped, safe, disappointed, in the right place, in the wrong place, emasculated….maybe he’s wishing the cultural pressure was off so he didn’t have to be right there for the birth – he always thought it seemed better to be with the men folk while the women did the birthing with the support of the women in their family and circle…he’s feeling pride, the need to protect and respect at the strength of this woman thats birthing their baby…what happens to you as a birthkeeper when you wear his life for a minute? ….you understand and you allow

what about the doctor? how is she feeling? whats going on for her? what about her hopes and fears? what about the fact that she’s so far travelled her whole career not understanding the risks of synthetic oxytocin and has only had it ever presented to her as safe and useful….perhaps they’ve never been in a quiet darkened room and witnessed birth as sacred and holy and blessed…maybe last week a mother or baby died….remember her years of study, her trying so hard to be like all her mentors…her status quo ….her feelings of being a lifesaver and sometimes that actually being so….she’s tired….she’s fragile…she believes babies are dangerous and women aren’t often very good at birthing….she’s a few weeks pregnant….she’s thinking of her career…she’s getting bullied by her superior….she spent last year donating her time in a war zone…..what happens to you as a birthkeeper when you wear her life for a minute? you understand and you allow and feel a lot less judgmental ….

what about the midwife? how is she feeling? whats going on for her? she has a constant stream of registration worries…she was just reading about a colleague and her case….she has a divine calling but spends her days in front of a computer screen reading machinery not women….she’s under pressure….she’s hungry and only has coca-cola crap to eat available at night on her shift – she’s putting on weight…she’s tired – she’s on nights but it was her sons school play yesterday and she didn’t want to miss it…she knows the consultant oncall is a sexist creep and is praying he’s not coming into her work space tonight….she still vehemently believes in birth – she’s desperately trying to still believe its safe and trust it….she was just called a bitch by the last woman she was caring for…she’s training for a marathon to raise money for breast cancer…she’s quite keen on doulas….what happens to you as a birthkeeper when you wear her life for a minute? you understand and you allow ….you have compassion

what about the doula? how is she feeling? whats going on for her? what about her hopes and fears? what about the teenage daughter at home that just told her last week she was pregnant…her divorce…her trust in birth and that all will be well…what about her good intention for this family to begin their life as a family together on a healthy, happy and whole note….the fact that last week someone told her a gossipy tale of midwives at the central desk bitching about doulas even though she sacrifices so much and earns so little to do this work….she’s praying….she’s suffering watching many of the obstetric practices she believes should now be defunct….she believes she has a divine purpose…she believes that gentle birth will heal mother earth one new soul at a time…..she’s broke…..she’s delighted to be there….what happens to you as a doctor or a midwife when you wear her life for a minute? you understand and you allow for her ideals, her advocacy, her lavender oil, her prayers and you no longer see her in your way….you understand

all of the above (apart from the baby of course) is based in truth, real life that has been taking place for families over the years i’ve been a birthkeeper…one thing i’ve learnt is that empathy and compassion go a long way to making my job an awful lot easier – give it a try and let me know what happens for you.

here’s two wee films that might take you a little further

RSA animate (remember them – the really clever little animated loveliness)  – the empathic civilisation

http://www.youtube.com/watch?v=l7AWnfFRc7g

TED (come on i know you all know them) a radical experiment in empathy (this one really got me thinking)

http://www.youtube.com/watch?v=kUEGHdQO7WA

“Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around.”

Leo Buscaglia

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