Are London Maternity Services Really That Bad?

Chris turned my eye to this article in Wednesday’s Evening Standard that showcases the inadequacies of London’s maternity services for birth and suggests growing numbers of average pregnant ladies (i.e. non “new age hippies”) now resort to DIY home births for fear of over-medicalized hospital births.

It’s a long, rambling article so to summarize:

• Mothers do not get one on one care: Soaring birth rates, a shortage of trained midwives and clinical-minded, controlling consultants result in a lack of support and choice for women (particularly older mothers). 
• The Association for Improvements in Maternity Services (AIMS) claims London has some of the most interventionist hospitals in Britain.
• A recent investigation by the Conservatives found that more than four in 10 NHS hospitals have refused to accept expectant mothers at least once last year.
• Labour’s women-centric vision of childbirth featuring choice and continuity of care have fallen down; parenting charity the NCT claims just over 7% of women in the capital give birth how and where they want.

Wow. On this basis, I’m shocked that we haven’t seen a mass exodus of pregnant women from the capital. Maybe they are all just giving birth at home instead?

I’m no “new age hippie” but I did plan for a home birth, decide to be a natural birthing warrior and criticize the ambiguity around the closure of the home birth providing Albany Midwifery Unit, cited in this article.

Yet I still feel that there is a huge middle ground between a completely natural home birth overseen by an attentive midwife and a completely medicalized and/or clinical hospital birth with little aftercare and support. This article oscillates between the two extremes. I think that’s a bit misleading.

My birth plan didn’t go to plan: I ran overdue and requested daily monitoring rather than induction; was finally induced at 2 weeks 5 days post dd when my blood pressure spiked; I had some “medical intervention” at the hands of a consultant when LLC’s heart rate fluctuated during birth. Yet I delivered a healthy baby; I felt the midwives and doctors considered my wishes; sure, they could have spent a bit more time post-birth helping me learn to breastfeed but overall, I couldn’t fault my care.

I have met many other new mums whose birth plans have not played out in reality (it seems they rarely do), who have some complaints but overall had a positive birth experience. Yet our voice is glaringly absent from this article. Not to mention the voice of the many women that prefer to give birth in a hospital and have no interest in home birth.

The article shows little discretion for how women can proactively improve their birth experience. Women must ask questions and be their own advocate when it comes to maternity care. If I hadn’t asked for daily monitoring, I would have been induced as a matter of course at 42 weeks. I learned in retrospect I could have given birth in a neighboring mid-wife led birthing unit if I had requested this even though this option was not offered to me. There are definite gaps in ante-natal service choice and information, all the more reason why women must ask or they won’t get.

The article also courts political drama. The Conservative report that women have been turned away from certain maternity units is a problem, but would it not be worse if maternity wards took women into care with no staff to accommodate them?

There may be truth in many of this article’s assertions. The issues run deep and I'm not belittling the problems that exist. But does it take it too far? Are London maternity services really that dire? Have you given birth in the capital and if so, what was your experience?

Finally.

Our little lady C (LLC) finally arrived on Wednesday evening. I am glowing – well, maybe I’m more pale, tired, sore and partially engorged – but my heart is glowing and bursting with love for Chris and my beautiful daughter.

Not surprisingly, things didn’t go as planned, but you already know that I didn’t plan on being 42 + 5 weeks pregnant when she arrived. Yes, I had hoped for a home birth; this was no longer an option after 42 weeks through the NHS. I hoped my body would commence labor unassisted; in the end, I was induced due to elevated blood pressure at my daily monitoring appointment on Tuesday afternoon.

But none of that matters. As my expectations and anticipations of labor faded into reality, conviction and flexibility proved not crashing boars but my stepping stones for bringing the little lady into the world.

The good doctor met with me on Tuesday afternoon following my daily monitoring session and decided to admit me for induction there and then. Though I had prepared myself that induction could be on the cards and had my hospital bag packed in the car, I didn’t expect an immediate admission. Chris and I had just been discussing Mexican for dinner. Everything suddenly seemed surreal, overwhelming, scary.

I spent Tuesday evening in the hospital without any “action,” as my uterus appeared to be contracting, yet I didn’t feel anything getting longer/stronger. The doctors decided to wait until the morning to re-evaluate my progress and how to commence my induction. There was talk of first a pessary, then another, then an oxytocin drip depending on my progress. The doctors suggested I consider an epidural as a therapeutic measure for my raised blood pressure. I said I hoped to avoid this but would keep an open mind. My “birth plan” faded to gray. I barely slept a wink.

Wednesday morning I moved to the labor ward. The doctor administered a pessary gel and left me with a midwife to be examined in 6 hours. As it turned out, this pessary was all my body needed to kick-start labor and no other steps of induction were needed. Within 2 hours I had dilated to 6cm and from there, things moved quickly, so much so that at first I thought I was constipated!

Constipated you ask? For me the contractions were not the intense period pains I had expected but rather a massive, unforgiving wave of downwards pressure that would culminate in an urge to push. Since I was induced they kept me on an electronic fetal monitor most of the time but let me move a bit and kneel on the bed positioned as an L and rock my hips. While you usually can’t shut me up, throughout the experience I went into myself, used my yoga breathing to get through contractions and closed my eyes in between them. Chris was amazing; he rubbed my back and stayed by my side the whole time. I didn’t have an epidural, entonox or any other form of pain relief.

Then it was time to push...the baby was still high in my pelvis when I began but after about an hour her head was visible. Though my contractions had eased, the unforgiving pressure against which I pushed felt impregnable. I now had two midwives and a doctor with me, all of whom kept telling me to push, push, push, harder, longer, stronger! I was like "I need to breathe!" Near the end I felt an immense burn and stretch but they kept yelling to push so I did as I was told. In the last minutes, LLC’s heart rate started to drop so the doctor decided to “get her out now" with a ventouse. She did an episiotomy, hooked on the ventouse, I pushed and she pulled and out she came within under a minute. I could not feel the cut.

Chris said the cord had gotten wrapped around her head but they got it off immediately and put her on me. Everything burst into color.

The Good Doctor, the Madwife and My Second Home

I feel like the hospital has become my second home. And I like my home better. On the way to my daily monitoring appointments, Chris and I scheme about what £5 purchase we can make in the Sainsburys (big supermarket for those in the US) next to the hospital in order to get our £2 parking lot fee refunded.

But then you’re spending £5 rather than £2, you ask? My math skills haven’t totally gone out the window (they were there to start with but never mind) – we decided to pare down our weekly shop so we could continue our purchases throughout the week and not throw away £2 a day on parking fees. You can see we put a lot of thought into this; our days are all too exciting.

Why do we park in Sainsburys in the first place? It’s impossible to get parked in the hospital lot and the minimum, non-refundable fee is £2 for a space. I think it’s out of order, but local government loves pay-and-display (i.e. metered parking) and there’s no break for the sick, stressed or weary.

We chose daily monitoring, however, so who am I to complain? (Even though I just did). But anyway...

The little lady appears to be thriving from her daily monitoring “trace.” Over the weekend when we were monitored on the labor ward, one of the resident doctors, aka the good doctor, decided to perform a 3D scan (sonogram) for us as a spur of the moment thing. He confirmed that all looked well with baby, had a thorough chat about our decision to hold off on induction for now, and also referred me for a full growth scan in radiology, which I was originally told was not an option. I had that second scan today.  It confirmed that the little lady is active, a healthy size with normal placenta flow and amniotic fluid levels.

Knowing that she is thriving supports our decision that nature will take its course when she's ready. I’m more uncomfortable by the day, I have lots of pressure down there, I have frequent Braxton Hicks – all signs things are moving in the right direction. Still, with each day that goes by I am conscious that I don't want to leave her in there too long.... I am booked to meet my consultant doctor for the first time tomorrow (the attending of the good doctor that I saw over the weekend), so it will be interesting to see what he says after seeing me, the scans and baby’s trace.

The good doctor again showed me that not all doctors are keen to push a strictly medical policy route. I am impressed with this aspect of my pre-natal care, as I suspected I would face more push back for policy’s sake. I haven’t. Perhaps many wouldn’t ask for monitoring in the first place, but I have, and I’m grateful that I've been supported and reviewed as an individual case.

The madwife (that’s how she introduced herself to us – haha, not really that funny) proved the one fly in the ointment of my waiting game of late. Buxom and matronly, she busted into my appointment room and interrupted my scan by the good doctor by spouting off a number of frightening statistics about post-date stillborns, crystallized placentas and over-baked babies. I may be hormonal and emotional but her bedside manner really left a lot to be desired.

Hello woman, you just don’t say that! The real kicker is I’m not even sure why she came into my appointment room in the first place since she left after this diatribe of gloom and never returned. She may have been following up for another midwife who took baby’s trace earlier – I’m not sure.

I’ve read up on post-date risks and the other midwives and doctors I’ve seen of late have discussed them with me. I may stick to my guns but I’m all ears to the medical professionals when they speak objectively and relevantly as they’ve all done but for this tactless scare-mongering madwife.

I bit my tongue during her speech but it was pretty off-putting. Its best that I didn’t see her again as I’m not sure my pregnancy hormones would have remained at bay for one more dose of her medicine!

Fortunes – In my cookie, and in blogging

My fortune cookie yesterday read: “Your wish will be granted after a long delay.” Does that mean labor will start today? I’m saving this one.

And now a word on blogging fortunes, in reference to a tag from insightful parenting blog/site Angels and Urchins in response to a Communities, cliques and a new meme. This meme asks bloggers to share three of their favourite, newly discovered blogging reads in an effort to share great content. I thought the meme was a fine idea, and made the following comment on my impressions of starting out in the blogosphere on the original post by Who’s the Mummy:

"I am also fairly new on the blogging scene. It can be overwhelming at times but I find the further I dabble the more I get to grips with how to share my own stories, discover the fantastic content of others and network in general. For me it's a gradual process. I blog because I love writing and hope others can relate/connect to my posts. I sometimes need to remind myself that there is a balance to be had between gaining traffic and worrying about how to get noticed amongst the masses when I'd rather focus on actually writing. Memes like this help create that balance - thank you."

Thank you Angels and Urchins for bringing this meme back to me. While bouncing on my birthing ball, I’ve recently been reading the following three excellent blogs:

A Day in the Life with Baby V – a beautifully written chronicle of a mother’s quest to balance motherhood, marriage, career and fitness

Young & Younger – a witty and spirited account of a first time mum to twins – her nursery photos are gorgeous too!

Single Motherhood Challenges – the honest and touching ins and outs of a young single mum and her little boy

I’d like to tag Mid-Atlantic English, Loving & Supporting Mamas and The Dotterel with this meme; their blogs are also excellent and no doubt they'll have some other blogging gems to share.

Going against the grain

Like a hesitant child, I dangle my feet in midair off the side of the hospital bed and feel slightly out of my depth. I’m not a child though; I’m 42 weeks pregnant and in keeping with my decision to go with the flow, am at the hospital for my first session of daily fetal monitoring.

I slowly take in the whir of unfamiliar bleeps, pulses and machinery and hope that I’m doing the right thing. I hope when they hook me up their not going to detect something is awry with baby, who thus far appears good as gold, just a bit too comfortable in her uterine home. I hope that maybe I’ll give birth tonight and this henceforth daily process will be restricted to today.

The midwife approaches and straps me up to two sensors; one records the little lady’s heartbeat, one records my uterine activity. I hope you’re okay with this little lady….and hmmm, I wonder if it might pick up the increased cramping and Braxton Hicks-like tightening I’ve been getting? 

I try to read my book but find my eyes keep straying to the monitor, which is printing out my “trace.” When I think trace I think CSI. Man, my mind is all over the shop. Chris has joined me for this appointment and pops his head around the bed to see how I am and to have a look at the monitor. The little lady gives me a kick; it’s comforting to hear her continual heartbeat thump thumping away.

Half an hour later, the midwife reviews my trace and confirms that I appear to have a very active and contented little baby. She also confirms that I’m having regular uterine contraction-like activity, which has got to be a positive sign. I’ll need to come in for monitoring over the weekend on the labor ward. She reminds me to phone in if I feel any decline in fetal movement, but she says all looks well.

Chris and I leave – we managed to get in and out within an hour – score! I’m on my way home for more bouncing on my ball rather than remaining in the hospital for an induction just because I’ve hit the 42 week mark.

I must reiterate that I’m not opposed to induction but have read it can be distressing for baby, particularly if my body isn’t ripe and ready for birth. We’ll have to assess our situation day by day, but I feel confident that we’ve made the right decision.

The further post date I go, the more it will play at my mind that the time is ticking, that my placenta may no longer be optimal and that maybe I should just book the induction. Still I don’t believe that because I’ve now hit 42 weeks that my body will suddenly morph into an inhospitable home for baby. This is why I’ve opted for monitoring, so we can check up on her day by day and hopefully give my body a few extra days to break up her tea party so she’ll come out and meet us.

Going with the Flow

I may feel a bit more uncomfortable by day (maybe this is a good sign??) but my mantra this week is to just "go with the flow."  I'm ignoring that I'm almost two weeks past my due date.  In a moment of weakness I asked myself if my body is hormonally defunct and not programed for birth, but then I got a grip and reminded myself that all pregnant women are designed to give birth eventually and besides being ridiculous, it was presumptuous to consider myself a special exception.  I'm not nuts, I promise you...

I've been pretty successful at not dwelling on when it's all going to kick off this week, but at the same time have done a few more things to encourage the little lady to flow on out of me.  These include:

• Another curry with Chris - we are taking advantage of our "only us" time while trying to spice up my system.  This meal - a Madras main - was spicier and tastier than the Rogan dish I had last week.
• I ate another pineapple - yum, I do love pineapple
• I went for induction acupuncture - I visited a therapist highly recommended by my yoga teacher in hopes of opening up channels of energy within....I'd never been for acupuncture and don't really understand the science behind it, but I did find the session relaxing, soothing and pleasant.  I could barely see/feel the needles, even when the therapist stimulated them throughout the session.  He explained that his induction technique is more stimulative and less relaxing than other forms of acupuncture, but he was very gentle all the same and no part of the procedure was uncomfortable.
• I went for a second membrane sweep - again, this was more uncomfortable than painful, and generated similar symptoms to my last sweep.  Unfortunately there didn't appear to be many changes down below - baby's head is engaged but not fully, cervix is soft but posterior - but the midwife said she did a thorough sweep and that things could change quickly once my body decides it's ready for birth.
  
• I busted out my high heeled boots for walking - I've been walking a lot but reverted to flats as pregnancy progressed.  With all the snow and ice of late, any type of heel was out of the question.  But now that the roads are clear, I decided some extra clunking and thumping a la heels might combine with gravity to suit my "baby please drop down further in my pelvis" purposes.  
• My butt is totally the shape of my Pilates, now birthing ball - if I'm sitting at home, I'm on that ball.  I may not have used the ball for years but with the amount of time I've clocked on it recently, it is totally worth the investment!
  

Though the NHS policy is to induce labor by 42 weeks, following my midwife sweep today I spoke with the doctor at hospital who agreed that as all appears well with baby/me, I can delay induction provided I come in for daily, 45 minute fetal monitoring.  That means if I don't give birth by Friday, I begin the monitoring. If the monitoring shows all is well, I can continue down this route until I give birth or decide to be induced.  The midwife/doctor answered my questions and listened to my thoughts objectively. 

Maybe something will shift before Friday, but if not I'm going to give my body and baby a few more days to go with the flow before deciding in favor of induction.

No News Unfortunately Means No News...

My recent silence unfortunately isn't down to exciting baby news - it's more to do with me trying to get out and about and keep my mind occupied with thoughts other than is labor going to start?

I've been spending a lot of time on my birthing ball (probably why I don't look overly amused on it here at 40 weeks + 9) and attempting all the old wives tales in the book alongside trying to maintain the "life as normal" mindset.  I've been moderately successful at this and when I get a little wacked out, Chris sings "Tears of a Clown" to me and that makes me feel better.  I'm soon to have a baby for goodness sake; I need to keep things in perspective.  Can I blame my moments of frustration on those pregnancy hormones?

Meanwhile Rico our dear cat has taken up residence in our Moses Basket, much to my irritation.  I love that cat but I don't want his hair all over little lady's bed.  We've covered it with a towel and a long piece of cardboard as a temporary solution.  Chris thinks once she's in it, he'll find it less appealing.

I won't say much tonight but wanted to check in....more to come tomorrow and not on the topic of labor and birth unless something does go down tonight!

Sweep, Sweep, Sweep but Still No Peep

I had my first membrane sweep today – I say first because I’m booked in for a second on Wednesday of next week. Maybe I won’t need that, but from today’s prognosis it appears that labor is not yet directly around the corner for me. As you can imagine, this was not the news I was hoping for. Let’s hope that appearances are deceiving in this instance!

Without going into TMI overload, as of this morning my cervix was still posterior and it took three attempts for a midwife to reach it to perform the sweep (though one midwife said her short fingers didn’t help the situation). On a positive note, it was also very soft and cooperative once the sweep got underway. I didn’t find the procedure painful; more uncomfortable but I never imagined that a midwife rummaging in my inners would feel like a treat.

Following the procedure I had a some show (also positive) and was sent home with instructions to eat more curry and pineapple, to bounce on my ball, walk but not tire myself and to have sex. The midwives are not shy and retiring – they tell it like it is.

I’m trying to keep my chin up. I would have loved to hear that I looked ripe and ready for labor imminently, but it sounds like I’m moving in the right direction so I need to focus on that.

I have one more week on the NHS to attempt a home birth.  Though I'd like to do this, I've always prepared myself that this plan might not come off.  What I'm struggling with more is that once I hit 42 weeks the standard NHS procedure is to induce labor.  I'm not looking to fight medical advice, but if all is well with baby at that time I can't help wondering if that's an indication that my body isn't ready.  My first priority is to bring our daughter into the world safely and I would not turn a blind eye to induction in the case of any health concerns for baby/me. Yet if all appears well, the push to induce "just because you are two weeks past your due date" when due dates are known to be a faulty science frustrates me.

I don't know if I sound like I'm losing site of the bigger picture....it's just after preparing to attempt labor as naturally as possible, induction means using intervention to kick off the very event and that's not something that appeals to me.  But we'll cross that bridge if I come to it and hopefully I won't.  As of now I am grateful that all is well with our little one.  Come on out baby - we want to meet you!

The One Where My Water's Broke

Nope, this wasn't a Friends episode, this was a My Bed episode this morning when I woke to feel something slippery in between my legs.

I couldn't believe it!  Did my water's break?  Was labor actually about to happen?  I was sure I hadn't wet myself and my leg was damp.  This could only mean one thing...

My heart started to thunder in my chest and I tentatively woke up Chris.  "Chris, I think my water's may have broken.  My leg's wet.  Feel my leg."

Chris isn't a morning person but that got him up in a flash!  "Really?" he gave me a careful look while I shoved my leg towards him.  But then his expression of half shock/half excitement faded as he examined my leg.  "I don't think your water's broke.  If they had there would probably be more fluid and there's nothing on the bed, just this little bit on your leg.  I think this is just sweat."

Say WHAT?  Sweat?!  But actually....that kind of made sense.  I hauled my body out of bed and dashed, alright waddled, down to the bathroom to explore further.   No, I wasn't damp down there.  No, there wasn't any trickle to indicate my water's were broken...just my legs, slightly sticky from rubbing together under my night dress thing.

What an anti-climax I'm telling you.....I wasn't in labor.....I'm just an uncomfortable, nearly 41 weeks pregnant lady with sweaty legs as my big body attempts to regulate its temperature in the night.  Wah.

Baby, look at all the fun you're missing!

Getting out of the house this weekend was extremely therapeutic! After three days housebound due to my ice rink of a road, Chris and I took advantage of the weekend's slightly milder temperatures to go play in the snow. We're really just two big kids at heart - it took a lot of restraint and my burgeoning coat to remind Chris that he can't peg me (and baby) directly with snowballs! These pics were taken 2 days after my due date.

I know it's nice and warm inside me, but look at all the fun our little lady is missing out on! Not one to be left out, she continues to put in some solid kick boxes of her own. I'm also experiencing increase pelvic pressure and little zings in my groin that occasionally radiate down my leg. Nothing, however, is getting longer, stronger and closer together. For as many times as contractions are described to me, I still feel like I'm not going to know when they are actually here because of all these growing sensations. But I'm assured I will know when the show gets on the road. Let's hope it's soon. Thank you everyone for your encouragement and well wishes!

Due Date Tomorrow but No News Yet....

I just finished my second cup of raspberry leaf tea for the day. I read about its uterine stimulating qualities in one of my pregnancy updates and kept meaning to buy some. I didn’t get around to it until earlier this week, so hopefully I’m not too late to reap its supposed rewards!

I know that less than 4% or so of babies are born on their due date. Still, I can’t help the emotional and mental attachment I’ve developed about tomorrow....it has been my lighthouse on the horizon, the destination circled in red on my pregnancy map, the day that I’m expecting to meet my baby.

I’ve been known to say “never expect anything.” Now is about the time I take my own advice. I feel like a ticking bomb that could go off any moment. Hopefully this tea will help! Friends also have suggested a mix natural labor inducing activities like cuddling, hot curry, sex, walking, climbing stairs, castor oil and, ahem, ingesting semen... Suffice to say, some of these suggestions are more appealing than others! Anyone else have any others to share?

It also doesn’t help that the recent cold front has turned my road to a solid sheet of ice and left me housebound. You know I like to get out and about in some respect daily and this weather is totally cramping my style....not bringing on period-like labor cramps....grrrr. But I’m not stir crazy or anything....just a picture of calm. I’m certain the oxytocin must be flowing. I told Chris this weather will most likely secure our home birth but that he may be doing the delivery if the midwives can’t get here in time. But maybe I shouldn’t joke about such things...

Meanwhile, Chris and I are not the only ones in suspense. Calls, texts and emails are rolling in daily from family and friends wishing me well and asking about progress. Thank you everyone – I wish I had exciting news to share but as of now, I don’t. I will keep you posted, I promise.

So home alone, I chat to the little lady and encourage her to make herself known. I’ve let her know she may be real cozy in there, but that she’ll still be close to me once she comes out. In fact, LH shared this Times 2 article with me on the benefits of baby slings, which we both have and are excited about trying out. Interestingly, the article also discusses the popularity of sling movement in the USA alongside its growing popularity here in the UK. Provided Chris and I can get ours strapped on properly, I’m hoping our Sleepy Wrap (pictured) may prove soothing to our little lady. So far she’s not buying this argument but I’ll keep on trying and maybe she'll come out to play.

Birth Choice Pulled into the Political Playground

Pre-election campaigning kicked off full force in the UK as we entered 2010 and the Tories promise “real childbirth choice” as one of their political selling points.

Today the BBC reports on Conservative leader David Cameron’s bid for new maternity networks that would supposedly better link local childbirth services and better meet mothers’ needs. This feature comes as part of wider plan for improved NHS services without spending cuts.

Both Labour and the Liberal Democrats question the Tories spending promises, but without entering the full political fray, what I see as interesting is the Tories’ attempt to capture the mummy vote by promising rather ambiguous plans for improved childbirth choice as one of their campaign features. In fact the BBC article highlights the Royal College of Midwives as saying service changes were already underway and the Conservative offerings appear no drastically different.

Get ready for some questioning about this Cameron – I think mums are a bit too smart to be conned by campaign mumbo jumbo that looks sweet but lacks substance. Let’s have a bit more detail please!

"Secret Report" Leads to Axing of Home Birth Group

The home birth may be slowly growing in popularity and availability here in the UK, yet it's still considered risky taboo for many and scare stories like this highlighted by The Times don't help its case.

The Albany practice, an independent South London midwifery group specializing in home births has had its contract terminated by the NHS because of a confidential report suggesting it had ten times the normal rate of babies born with serious complications like brain damage.

Yet experts, Albany advocates and government figures alike have raised concerns over the confidentiality of this inquiry and why it was not carried out in conjunction with the Care Quality Commission, the health regulator.

King’s College Hospital commissioned this report and claims that its findings do not equate with an anti home birth stance but rather the need for closer monitoring of midwifery services. Yet details of the "serious shortcomings" identified and comparative assessment of birth rates between Albany and other midwifery practices are glaringly absent, and create a transparency gap that undermines the very nature of the report's findings.

It's crucial that NHS and contracted home birth midwives follow strict due diligence and safety protocols. When they do, it's been shown the home birth can be a fantastic experience. Shortcomings should be identified and rooted out, however the key here is identification and transparency. Axing a leading midwifery service over ambiguous failures only serves to scare and rile up the masses.

Birth Plan, Check! Supple Perineum, Eeek!

My birth plan is complete! In homage to my love of lists, it’s in bullet point fashion and conveys my preferences for labor and birth while miraculously staying short and sweet. Not that I’m ever prone to loquaciousness – ha! I’m pleased it’s now sorted and not hanging over my head and tempting my tendency for doing things at the last minute. Now we’ll just need to see how this “plan” plays out in reality.

Never one to chill out entirely, I’m on to my next “to do” for this stage of late pregnancy: perineal massage. If you’re unfamiliar with the perineum, Wordnetweb defines it as “the general region between the anus and the genital organs,” i.e. the sensitive zone that bears the brunt of delivery and is prone to tearing as baby makes her entrance into the world.

Ever wondered how babies will fit out of THERE? We know they do, but they often leave their mark on the region via an episiotomy (medical cut) or natural tear to the perineum, particularly common in first timers.

Think of you perineum as a piece of tight elastic that gradually needs to stretch to accommodate a baby’s head....or perhaps as a piece of pastry that needs to be moulded and “softened” so it has give over a larger surface area. Yup, that’s what I need to do to increase the elasticity of my trusty perineum. 

BabyWorld gives an easy to follow overview and how to on perineal massage. In brief, dress clean fingers with some natural oil, slide them 2-3cm into your lower vagina and stretch/massage downwards and outwards.  It’s suggested that you start around 36 weeks pregnant and that the practice will familiarize you with the pressure, stretching and burning sensations that you may experience during birth, making you more relaxed in the moment. Perineal massage stimulates blood flow to the region, increasing its elasticity and speeding the post birth healing process.

The manoeuvre does not look sexy or feel comfortable and that’s before I consider that I’m navigating around a bump as lofty as a stalk of Swiss chard that weighs about 6 1/3 pounds.  And my arms are short!

In the end, all my efforts may be in vain. It’s not proven that perineal massage will prevent tearing. But you know what? I’ve heard tales aplenty of the crowning “ring of fire” and tears of various degrees and if I can learn to work with the burn and lessen my chances of tearing or needing an episiotomy, I’m up for some non-graceful dabbles with olive oil in my nether regions.

For those interested in water birth, check out this ultimate water birth.

Birth Plan – Oxymoron, Wish List, My Voice….All of the above?

I need to write my birth plan. But how does one “plan” for birth, the inevitable but uncontrollable event that marks the end of pregnancy?

I’ve had contractions described to me, but I don’t really know how they’ll feel and how I’ll cope with them. I’ve heard of women who want a natural birth with candles and massage for pain relief but decide to go full throttle on medical intervention when push comes to shove. I’ve heard that you need to be prepared and informed, but flexible, and that your “plan” can’t be set in stone. I’ve heard a lot of things.

It feels a little strange to put pen to paper when something as intimate as birth is the subject. Will what I write seem pedantic….or perhaps just plain mundane?

But I need to get over that. Although I know my birth plan may not go as planned, it’s my way of playing an active role in my birth and letting the midwives know Chris and my preferences, our birth wish list of sorts. At my NCT ante-natal class they suggested that where you have your baby and who you want at your birth are the two most important decisions that you can make. I know we are going to try for a home birth, and that Chris is my birthing partner, so hard job done.

So what do I know/hope for?

I know I want to try for as natural a labor as possible, full of upright positions, yoga breathing and as little intervention as possible. If I do opt for more assistance in the moment, I have ideas on what I’d like offered to me and how I’d like it discussed. I know I want skin to skin contact with baby as soon as she is born. And that I’m fine with the Vitamin K injection, but want to try for a natural third stage. Chris hopes to cut the cord. Unless I plan on having a cozy chat about this while in the throes of contractions, my birth plan along with Chris will be my voice.

Here’s a useful birth plan from the Boots Parenting Club. It’s short and sweet but provides a good outline of things to consider. I’ll let you know how I get on.

Is Labor Hereditary? Will I be late too?

Those dastardly pregnancy hormones caught me out again! Earlier this week I felt positive. Then those raging inner chemicals decided to wreak havoc on my equilibrium by bringing to the surface an occasional bad habit of mine: over-thinking. It’s like they said, “you are 34 weeks pregnant and have been calm, cool and collected for too long. You’re due for a frenzy!” 

My pregnancy newsletters and books warn that anxiousness about labor and birth, impending parenthood, finding a new life balance with baby, etc can set these hormones off and it’s totally normal. Oh good.

My hang up concerned whether I’ll be overdue with our baby like my mom was with my sister and me. Three weeks overdue to be exact. No matter that this was nearly 30 years ago and when we were ready to come out, we came out without issue. I’d heard conflicting theories on whether late labor was hereditary and I felt the need to explore this further, particularly as once you go overdue here by one week they start talking about induction, which I hope to avoid.....(This pic is of mom in labor with me!)

So I ventured onto My Best Birth and posted this query on the group forum in search of further insight.  Women responded with a mix of thoughts and experiences; some had similar labors to their moms, others didn’t; one thought labor could be linked between sisters, another found this not to be the case. Others suggested I should not compare myself to anyone else but instead relax and let nature take its course.

I came away with the impression that there is no clear rhyme or reason to the hereditary labor theory and that I needed to stop thinking, comparing, wondering and just chill out. It was just the advice I needed to snap out of my over-thinking rut. Relevantly, CD sent me this very interesting post on research she completed into the inaccuracy of estimated due dates. Her site is well worth exploring for wisdoms on getting the best out of your birth experience.

(Longstanding followers may remember I haven’t always been a fan of community forums because of the many acronyms and worrying suggestions that can come with them. While the acronyms still don’t appeal, I’ve learned to avoid scare-story posts that set off the sinister elements of my imagination in exchange for obtaining advice/opinions on topics of interest and sharing my own thoughts. I’ve since posted on a few different community forums and found the exchanges insightful, as above. So I retract that community boards are not for me – just to be used in moderation with focus so I don’t get lost on or freaked out by them!)

Pregnancy Courts Debate

Pregnancy is smitten by debate. Pregnancy is a sucker for debate. Pregnancy just can’t get enough of debate.

And that’s usually okay with me, for as pregnancy courts debate I am encouraged to think laterally and broaden my perspective. Only occasionally when the debate in question concerns copious baby retail options (i.e. what are the relative merits of baby mattress types?....gag me and fast!) or the sweeping scythe of the nanny state do I want to bang my head against a wall and renounce all deliberation as painful and/or confusing and/or insane.

Today debate was so “hot to trot” that pregnancy managed to finagle two dates. I’d like to share the details and my take:

Debate #1: A Council in Wales hands out pink badges to heavily pregnant ladies so they can bag favourable parking spaces. An online news blogger decries this as yet another policy that will be abused. 

My father-in-law brought my attention this afternoon’s BBC Radio 2 report. I can’t find anything in print on this story, so please let me know if you can. Without more information it’s hard to pass judgement, but my gut instinct is that walking an extra 50 extra feet might do a pregnant woman good. Badges like this most likely would be abused unless monitored, which I don’t see as the best use of Council resources.

Debate #2: Are Doula’s “helping hands or stepping on toes?” The BBC today reports anaesthetist Dr Abhijoy Chakladar’s view that the increasing trend of women hiring doulas (birth assistants that offer emotional support before, during labour and postnatally) is a side effect of lapses in midwifery care that often hinders clinical decisions by disturbing the relationship between the mother and medical team.
 
I beg your pardon? My understanding is that doulas offer mothers and their birthing partners emotional support and encouragement in preparation for and through birth, as well as during the early days of parenthood. Doulas are not medically trained and unlike midwives, are not responsible for the physical care of the woman through her birth. While it’s important that doulas don’t overstep this boundary (and perhaps some do), to suggest that their presence upsets the clinical side of birth wreaks of practitioner speak to me! Many women hire doulas to develop firm emotional support and coping strategies that help them approach labor as naturally as possible and don’t want a clinical birth. Doulas should not be berated for helping women participate actively in their birthing experience - having said that, should medical care be needed, it is not their place to argue with practitioners but to support their client through whatever shape the birthing experience takes.

Dads in the Delivery Room: Delightful or Disastrous?

Today the BBC brings to light French obstetrician Michel Ordent’s view that dads should NOT be in the delivery room during the birth of their children as they are likely to be more of a hindrance than a help in the birthing process. The French doc shuns the notion championed by US doctor Robert Bradley that a husband’s presence during labor provides his wife with much needed support and solidarity. He even suggests that an anxious male partner will make a women tenser and increase her likelihood of ending up with an emergency Caesarean section!

Oh ye of little faith Dr Ordent! While not all men want to be present at the birth of junior (celeb chef Gordon Ramsay for example) there are loads out there who want to actively participate in the life changing experience that is birth to the extent that they can. And although the c-section rate has risen over the last several decades, this is more likely a side effect of our increasingly litigious and medicalized society that features older moms and women who struggle with obesity.

On Babyworld, midwife Catharine Parker-Little suggests that women talk openly with their partners during pregnancy to gauge their true opinions about attending the birth - and not to lay on a guilt trip if they decline. I couldn’t agree more. Rather than make sweeping generalizations about whether men should be in delivery rooms, we need to talk it out with our guys. Do they want to be there? If so, do they want to be down “the business end?” If not, who can better offer moms support?

Chris can’t wait to be there for the birth of our daughter – look at him with Rico – he’s a natural! But since I’m one to lay things on the table, we’ve had the birthing “talk” to different degrees over the course of my pregnancy. I’ve tried to condition him to the idea that he’ll see me in pain, that we’ll both ride an emotional rollercoaster, that he may be subjected to some grim and gore like blood, poop, placenta and stitches.

Yesterday we went to our NHS Labor and Birth ante-natal class that featured a short film showing a labouring woman taking gas and air on a birthing ball. Afterwards one of the husbands admitted that the image made him feel nauseous, and that he was “going to take some quiet times to come to terms with all that labor may entail.” We shared a laugh about this, but props to that guy and his wife for preparing for birth as a unit. He might decide to attend his child’s birth, he might not, but they were in the learning together.

From our chats, Chris is on board and prepared to be my labor partner, coach, advocate and rock. He hopes to cut the cord and be as active a participant as possible, partly why we’ve opted to attempt a home birth.

Tonight we had our first couples NCT class, which also featured the first stage of labor, including the need for a woman to relax and let her oxytocin (hormone of “love” that causes uterine contractions) flow while in labor. As a birth partner, the man is instrumental to this process; if he gets in a flap, it’s likely to kick off his wife’s adrenaline, which counteracts oxytocin production and slows labor. I hope Chris is by my side throughout labor, but learning like this helps us both recognize that it depends how he feels in the moment and if he’s able to give off positive energy in the face of his own apprehensions. If it all gets too much and he needs a breather, we accept that.

So Dr Ordent, you can take your study and shove it! Whether a dad is a birth partner should be an individual choice – not a given but not ruled out either. It’s up to couples to do their research and make the best decision for them.

Sweet Dream, More Like Beautiful Nightmare...

The only thing beautiful about my dream last night was our baby’s birth at the end of it.

I dreamt that I had an early show and visited my American gynaecologist to tell her that I thought I was in labor. She doesn’t even know I’m pregnant by the way. I caught her on her way out the door (where from, I don’t know) and convinced her to overcome her scepticism and examine me. She did, and sure enough, our baby was on her way out. I wasn’t in any pain, but the next thing I knew she had me on an operating table and was performing a caesarean and then, poof, our tiny baby came into the world! I watched this scene removed from my own body, and when I looked back at myself on the operating table I was an old woman, cackling away and wrinkled. Then I woke up.

My brain must have been decompressing the advice I read earlier yesterday in What to Expect When You’re Expecting about how bizarre dreams are common in pregnancy. Always a sucker for weird suggestion, my subconscious jumped right on the bizarre dream bandwagon and churned this disturbing one out for me last night.

I hope I don’t have to have a caesarean so maybe that was my mind’s way of coming to terms that in labor, anything is possible? Maybe I have “latent fears” of delivering early in the wake of my rectal pressure incident this weekend? But how did I turn into a crazy old woman? Anyone else care to analyze?

What to Pack Should Be the Least of My Concerns

I've got a little over 9 weeks to go until DD-Day.  Earlier today I started pondering what should be included in and when I should pack my infamous hospital bag.  Yes, I'm still planning a home birth, but packing a hospital bag is like a right of passage for pregnant women.  Even if you plan for a home birth, a hospital bag should still be at the ready just in case.  It's an acknowledgement that your baby is almost in town.  It's a sanity guard for when you're in the heat of labor and need to bust a move for the hospital.

I felt a little bizarre thinking about my hospital bag this early but it's my first time, I have pregnancy on the brain and I want to be prepared. 

Fast forward two hours and I was standing in Boots (aka CVS) grimacing over an aisle of pads and adult diapers.  I saw some Depends but I'm pretty sure that's not what I'm after.....I'm certain that they make specific maternity pads for after the birth, right?  If anyone has any advice here please share.  All the diapers and pads started to blur and then I lost the will, quickly exiting Boots and rolling my eyes that maternity pad shopping is now on my radar.

When I travel Chris usually audits my suitcase to stop me bringing too many things.  He says I like to take my clothes on vacation.  I'm not a fussy dresser, I just like options and tend to be indecisive.  That doesn't bode well for packing a maternity bag that I probably, hopefully, may not need.  Was this going to get stressful?

No!  Leave it to me to create unnecessary stress.  I'm going to stay strong; there are lots of check lists (yay, lists!) out there about what to include in hospital bags and on my walk home from Boots I promised myself that I'm going to take a minimalist approach....I'll tell you how I get on once I actually pack the bag.  Aside from working out where I can get some maternity pads and finding out what the heck arnica actually is, I have most of the things I need and ample time to get organized.

I've also stumbled across a not-so-surprising US/UK difference in hospital bag advice: In the USA diapers and maternity pads are usually provided; in the UK they are not and need to be packed (ahh, the differences of private, pricey healthcare versus NHS no frills).

Aside from the usual suspect advice and items to bring for mama, baby and birthing partner included on most hospital bag lists, here are a few other gems that I've heard.  If you have any other tips, please add a comment!

• Pack 2 small bags - one for labor and one for your hospital stay - this may help you stay better organized
• Remember to pack your glasses; even if you wear contacts, you may not want to wear them through labor
• Pack a pair of flip flops for the shower; if you're a clean freak like me who wears flip flops to the gym pool, this advice was a real winner!
• Bring along some baby wipes or cotton wool for changing your baby; these are not provided by the NHS
• Pack baby nail clippers or an emery board in case your little one has long nails that need trimming
• Pack your Baby Book to jot down all your baby's birth information