Category: Pregnancy

One of the side effects of the viral gentle caesarean video I shared last week is that I have been contacted by many women wanting to find out how to have such an caesarean, and I also received many unrelated questions from anxious pregnant women.

It has been quite an eye opener for me, because normally I work with women who have chosen to have me as their antenatal educator or as their doula. This means that I rarely interact with women who have no such support in place.

I know that statistically, less than 20 % of all expectant couples attend any form of antenatal education. This includes free NHS classes.

I find this very odd, because it is a most important and one probably one of the most important transition of a couple’s life. Yet for most very little time or money is spent on preparing for it.

I wonder if this is linked to the lack of value our culture places on parenting, but, hey that’s the subject of another (or many other blog posts) altogether.

Compare to what the average British couple spends on a wedding (£20K according to Money Saving Expert…). Yet which of the two events is going to have the biggest impact on the rest of your life? I know people think of medical staff as the experts in childbirth, so they think it’s ok to just turn up and “go with the flow”. But wedding planners are the experts in weddings, and you wouldn’t just tell them “just decide everything for me”, or you wouldn’t say about your wedding “I’m just going to wing it”. Would you?

If you want what is right for YOU, you need to find out what’s out there, what the options available are, what the stats for your local hospital are (you can find that here by the way), and much more.

Imagine for a minute if expectant couples in  the UK spent only half of what they spend on their wedding on preparing for their births?  Or even a quarter? The world of childbirth would change. People would be so educated, there would be more classes, more doulas, more support, everybody would find it normal, heck even maybe the NHS would get more funding if expectant couples demanded it!

But back to the topic of this post: If you want to educate yourself about the birth (and the postnatal period too-that’s just as important), there are three main options: The DIY version (teach yourself), the group version (antenatal classes) and the one to one version (hiring a doula).

By the way, when I am talking about preparation here I am thinking both birth and preparation for postnatal life/parenthood.

1) The DIY option:

What is out there if you choose to teach yourself? Well , there are countless books, scientific and lay articles, blog posts, social media groups, and so on, on the topic of birth and parenting. You can pick and choose, read at your leisure, exchange ideas with people online, the list is endless. There is a lot to read. All you need is time and dedication. There is nothing inherently wrong from this approach, and it also complements well the other two approaches below. Coming back to the wedding analogy, “DIY” weddings can be quirky and wonderful. It’s going to be the right approach for some people. But for others, it won’t be. The tricky part with self learning is that, at least at the beginning, you might not be able to discern between what is based on facts and what is merely an opinion, or just plain untrue, or not right for you. Because you do not know what you don’t know, you might miss out on important facts that you didn’t know about, or were relevant to your particular situation (the “I wish I had known…” situation). What your friends rave about may not suit you, but you may not know that until you try it so you might end up spending  your money on books and equipment for nothing, or you could end up buying into ideas that will actually turn out to be wrong for you and your family. The opinions you’ll get from exchanging knowledge with others are also unlikely to be unbiased, because people will tell you what worked for them or what didn’t. It might not be true for you and your baby. The costs range from free (reading online, getting books from the library etc), to quite a bit if you end up buying a lot of books and equipment. You will also need to invest a lot of time-which you may not have.

2) The group approach

What about antenatal classes? These tend to be done in groups of various sizes, which means you might get a great social support network out of them (which is I believe one of the top reasons people sign up for them). There is a whole range out there, from NHS classes to various private classes like those provided by the NCT (which are free for low income couples by the way) and various other organisations. Some classes are generally birth and parenting knowledge based (a mix of physical emotional and practical knowledge), some focus more specifically on some aspects of birth preparation (like Hypnobirthing classes), and some are exercise and/or relaxation based (like pregnancy yoga). The exercise based classes also usually incorporate an element of discussion. Partners usually accompany you to the group classes. Private classes are usually facilitated by people who are knowledgeable about birth and parenting, and passionate about empowering parents. There is a chance to ask questions and find out about a whole bunch of information you didn’t know existed, and build your confidence. Coming back to the wedding analogy, this is the equivalent of booking in a venue that provides all the catering under one roof-there will be choice, but from a limited list. You just need to make sure you pick the right venue. Because the classes are group based, there may not be enough time to address your individual concerns and needs in the depth that would suit your needs. Your teacher might be available to answer your questions by email between classes , but won’t be available 24/7 when you need support. You can also book one to one antenatal classes. Prices range from free (NHS classes) to about £200 to £400 for knowledge based group classes. The time is usually something from around 6 to 16h for a course.

3) The one to one approach

What about hiring a doula? A doula is like having your own birth coach. A doula will provide truly individualised support, and guide you through the maze of conflicting information, using her intuition and the information you give her so suggest links, articles, books etc which are more likely to float your boat. She will be there to hold you and your partner’s hands every step of the way, making sure you have all the information you need, all the emotional support you need (she will always be there for you-if you have a questions or a wobble, she is only an email, text or phone call away), that you and your partner feel confident and prepared for the birth and postnatal period (out of the three options above she is also the only one who can be there to support you both DURING and AFTER the birth as well as before). She will help you write your birth preferences. Your doula will meet you in the comfort of your own home at least a couple of time during your pregnancy so you get to know her and become comfortable with her, and there is no limit on email and phone support. This is truly one to one tailored to you need support in every sense of the way. In wedding analogy terms this is like hiring a wedding planner, and everything being bespoke. I have written a specific blog about that-Ten things a doula does to prepare you for the birth of your baby. What about the costs? Hiring a doula ranges from free (couples in receipt of benefit can apply for the doula UK access fund) to around £300 to £400 for a mentored (newly qualified) doula, to £600 to £2000 for a recognised doula. The time involved is usually at least 4h to 6h of antenatal face to face time, as well as unlimited email and phone support, and support throughout the whole of your labour and birth, be it 3h or 3 days long.

So there you have it-three options to prepare for birth and parenthood-they aren’t mutually exclusive either. But it’s good to know what is available, and what you get for your money 🙂

I know I’m biaised because I am a doula. And I also know I haven’t written any disadvantages of hiring a doula, but this is because I genuinely cannot think of any! I once was that pregnant mother myself, and I had a doula, and I know how much of a difference it made. It is difficult to describe with words, and often, mothers don’t really understand the full value of their doula after they have been doula’ed themselves. This is what led me on this path. I feel very strongly that every woman deserves a doula.

If you feel drawn to working with me as a doula, look here. If you are a birthworker and this resonates with you-you can find the workshops I offer here.

This week I received an invitation to a group called “save our homebirth team”.

It broke my heart, because this a campaign against the disappearance of the dedicated homebirth team in Peterborough.

Peterborough is one of the few trusts in the UK that still has a dedicated homebirth team.

This means that there is a group of midwives there who are not only confident and skilled at supporting homebirths, but when a couple books a homebirth, the team arranges for them to meet every single one of the midwives in the team. This ensures that they actually know the midwives who are going to come and support them during their birth. How awesome is that?

Nowadays in my antenatal classes, I mostly hear stories of women telling me that they rarely see the same midwife twice during their pregnancy. They say the appointments feel like box ticking exercises, and that they don’t trust the midwives they meet. Why would they? How do you trust someone you don’t know?

It didn’t used to be like this.

Ten years ago when I was pregnant with my son, Cambridge used to have a caseloading community midwifery team. During my pregnancy I saw the same midwife at every appointment (and the appointments were about 20 min long). She came to visit me at home a couple of times, and when I was in labour, as she was on call then, she came and supported me through the birth. I didn’t quite realise how lucky I had been to have this kind of continuity of care. My midwife was also very experienced, reassuring, and confident enough in her own practise to fully support my decision to refuse an induction (My son was born at home 16 days after his “due date”).

Three years later when I was pregnant with my second child, I had started my childbirth educator and doula journey and I felt I couldn’t take the risk of having a stranger turning up at my birth, so I hired independent midwives. It makes me so sad to think that not all the women who psychologically need this kind of care can afford independent midwives.

We know for a fact that continuity of care leads to better outcomes for mothers and babies. Beside the science backing this up, it makes sense, right? How on earth is a midwife going to know a pregnant mother is out of sorts, or more swollen than usual, or any other mental or physical signs are off, if she has never met her before?

We know that mothers prefer it, and that staff prefer it too, if they are adequately supported, with caseloads that are appropriately sized.

The trend towards team midwifery and lack of continuity of care is worrying enough, but I am now seeing a more worrying trend: the looming disappearance of homebirth services.

Kings Lynn’s hospital stopped providing a homebirth service a few years ago – this has been the object of a campaign called Birthplace Matters (the brainchild of doula Paula Cleary)  which has resulted in the Trust being criticised by the Ombudsman for its inadequate provision for choice of place of birth but has sadly not yet resulted in the reinstatement of services.

In Cambridge, where I live, we used to have a higher than average homebirth rate. When I started working as antenatal teacher in 2010 it was 6%, well above the 1% national average. In my antenatal classes, I used to have a homebirth couple in almost every class. Now it’s more like one or two per year (running monthly classes).

Since the local birth centre opened in 2012, the homebirth rate has steadily decreased to about 1%. This is partly due to the birth centre attracting potential homebirth couples, but I believe it’s also down to a lack of commitment to promoting homebirth from the local NHS trust.

Until last year we were lucky enough to have a fairly healthy homebirth service; whilst we heard stories of women being refused a homebirth in other parts of the country, it didn’t seem to happen here.

It all started to change last October, when a pilot was put in place at the local hospital. Instead of having two community midwives on call for homebirth at night, there is one, working an ordinary shift in the hospital.

Since then, several things have happened.

Couples planning homebirths have received letters telling them that the trust cannot guarantee a midwife will be available to support them at home. Whilst I understand that the hospital needs to be honest with women so they can make informed decisions, women booking hospital births are not being officially notified that the hospital may be short staffed or even closed when they go into labour.

The trust even has a statement about this on their website

“ The maternity service at the Rosie supports home births however it is acknowledged that at times this will not possible due to staffing and/or workload both within the hospital and/ or community. Should it not be possible to support a homebirth then a woman in labour will be asked to attend the Rosie(or if on divert to a neighbouring unit ) where there is a midwife available to care for her. In the event of a labouring woman being unable to make her way in or declining to attend and the unit is unable to attend the birth at home then an ambulance will be sent to facilitate transfer to a unit where a midwife is available to provide care.”

As you can imagine the recipients of this letter were very distressed, and the statement above doesn’t exactly inspire confidence to potential homebirth parents. You can read more about that here.

Since the change has happened, I have heard several stories of births for which a midwife wasn’t available and how distressing this was for the mother in labour.

In my antenatal classes, I have also heard stories of disgruntled couples who were in the birth centre, then their midwife told them she had to leave because she had to attend a homebirth. This gave parents the impression that a homebirth was more important than them.  I wish different language had been used. For example, the midwife could have explained that she was community based and if a call came from the community she may have to go.

I just do not understand the logic.

I know the NHS finances are in a terrible state, but when the Birthplace study shows us that homebirths are significantly cheaper than hospital births, (and also that homebirth is very nearly as safe for healthy first time mothers at home than in hospital, and safer for second time mothers), that homebirth are less likely to result in costly interventions, when the NICE guidelines were changed last year to reflect this, surely there should be a concerted effort to INCREASE the homebirth service and to actively promote it rather than trying to scrap it?

Yet it seems that the opposite is happening.

I am by no means trying to say that everybody should birth at home by the way. I have been in the birth field for long enough to know individual perceived safety is, and that women should birth where they feel the safest. For some it’s at home, for some in a birth centre, for others in an obstetric unit. I have no issues with that.

What I have issues with, however, is that women appear to be having their choices restricted.  It is paramount that these choices are respected, not just because many women prefer to birth outside the hospital but because for many women, it really is the only psychologically healthy option for them.

Asking some women to go to hospital is like asking a soldier to return to the battlefield that caused his shellshock.

I believe that women cannot make fully informed choices when they aren’t informed of all the options, their pros and cons (teaching antenatal classes for the last 5 years have showed me how many misconceptions people have about the safety of homebirth), and also being confident that the option they choose will be available.

For homebirth to become normal like it is in some countries like Holland, or even some parts of the UK where the homebirth rate is closer to 10%, there needs to be a concerted effort from the NHS to promote it as a valid choice.

Legally, where we choose to give birth in the UK doesn’t fall under the remit of maternity care, it falls under the remit of human rights.

Some countries in Europe, in particular Hungary, have banned homebirth. In 2010, a Hungarian homebirthing woman called Anna Ternovsky challenged her country in the European court of human rights, and won the case. The court ruled that meaningful choice in childbirth is a human rights issue, and that birthing women are the ultimate decision-makers regarding the circumstances in which they birth their babies. You can read more about women’s rights in childbirth on the Birthrights website.

Beside the decrease of women’s birthing options, I am also seeing a worrying trend towards disrespect of women’s choices within the health system in general. I see a lot of coercion. I hear a lot of “do as you’re told, or else”. This week I was told of a new mother who was threatened with a report to social services when she tried to discharge herself from the hospital against medical advice. Earlier this year a client of mine chose to go home to wait for labour to start on its own rather than consenting to induction, and was told by the midwife as she left “I hope you don’t have a stillbirth during the night”. Another one wanted to wait for labour too and was also told “your baby might die”.

Health professionals, I just don’t get it.

I know you want what you think is the best for the mother, but do you think for one second that the mother doesn’t have the best interests of her unborn child at heart?

Do you think there is any mother in the world who is going to put her unborn baby willingly at risk of injury or death?

Do you realise you are in breach of your own code of conduct?

The code of conduct of doctors and midwives in this country is very clear on consent. The GMC guidance states that:

” You must respect a patient’s decision to refuse an investigation or treatment, even if you think their decision is wrong or irrational. You should explain your concerns clearly to the patient and outline the possible consequences of their decision. You must not, however, put pressure on a patient to accept your advice.”

Very clear right? Only I wish I witnessed it more often. From time to time I meet a refreshing doctor or midwife who really gets it. But they are a minority. It’s so unusual that I am in awe of them. I always mention it to the person in question how impressed I am by their bedside manner. What I see, most of the time, are various shades of coercion. Sometimes it’s gentle and well meaning, but it’s still coercion. What I believe happens is that most patients are compliant with medical advice and do not question things. Therefore I assume that medical professionals are used to this behaviour, and few get to hone and practise informed decision making on a regular basis. I also believe that the fear of judgement from peers and the fear of litigation, has a lot to answer for.

The other problem is that clinical guidelines and hospital policies are based on a population. They have to be. But you, an individual pregnant mother, are not the population. You are an individual, and as such you deserve an individualised plan of care.

I appreciate the words above are potentially upsetting. I am not writing this to cause upset.

I am writing this because I hope expectant and new mothers read this  and that it helps them make more informed decisions.

I am writing this because I hope more expectant and new mothers can receive nurturing, individualised care.

I am writing this because I want to see more respect and kindness within maternity services.

I do not believe the system will change through people like me. I have been trying to make positive change happen for the last 5 years, by being a lay member of my local maternity liaison service committee and bending the ear of every health professional who will listen, with little results.

What I have seen however, is system changes happening when the people who use it (pregnant and new mothers) demanded it.

If you are pregnant, attend antenatal education, inform yourself about your birth and postnatal options, reach out to other mothers and to birthworkers and build up your knowledge so you can make the truly informed decisions that are right for YOU.

If you work with expectant parents, help them feel empowered enough to challenge the decisions that don’t feel right for them.

The more people challenge things, the faster it will change.