Due to popular demand, Liz Haliday of Private Midwives Ireland and myself are running a bijou birth couples preparation day on the 22nd February. This is an Antenatal preparation course with a difference. We will bring our expertise of attending many hundreds, if not thousands, of births in hospital and home in Ireland to enable you and your partner to be fully prepared for childbirth. in addition, unlike many other childbirth preparation course this course will only have a limited number of participants enabling you (and your partner if they are coming), to ask all the questions that you need and also to formulate a good set of birth preferences. The course will also focus on your needs and any questions you have.
We will cover amongst other things
❤️ Recognising that labour has started
❤️Early labour at home: positions, comfort measures, visualisations, breathing techniques, massage techniques
❤️ When to go into hospital
❤️ How to prepare a birth preferences sheet and how to ask for what you want and need in the day
❤️ Interventions and their benefits and risks
❤️ How to have a gentle c birth if that is the best course for you and your baby
❤️ How to prepare for an induction
❤️ How to prepare for coming home and the really days of parenting
❤️ Breastfeeding and safe infant feeding
10 am – 1115 am Physiology of labour and childbirth. What is your body doing during birth and what kind of support does it need? What is your baby trying to do during labour and what support does he or she need?
1130 am – 1 pm Signs of labour Early labour at home. Pain coping techniques including breathing, visualisations and practical physical support such as massage techniques. Deciding when to go to the hospital. Practical exercises.
1 pm – 145 pm Lunch
145 pm – 315 pm Interventions benefits and risks, C birth and how to plan for a great c birth if it becomes necessary. Devising your birth preferences
330 pm – 5 pm Asking for what you need. Your rights during labour and birth. Informed consent and informed refusal. Policies and research. Coping with going over dates and an induction. Preparing for life with your new baby. Referrals and support networks.
Using homeopathy for childbirth will help you prepare for the many emotional and physical symptoms of early and established labour. Homeopathic remedies and knowing how to use them are an extremely helpful addition to any birth bag, whether you are going to have your baby in hospital or at home and whether you are planning a normal birth without interventions, a birth with pharmacological pain relief or a caesarean birth. To book click here.
How can homeopathy help in childbirth?
Homeopathy helps with the many emotional symptoms of labour, such as anxiety, fear and the feeling of being overwhelmed. These symptoms arise irrespective of what type of birth you are planning and can often arise even with established childbirth preparation techniques you have been learning. Homeopathy enables you to feel more balanced and therefore optimises your focus and your use of visualisations and breathing.
This course is primarily geared towards pregnant people and their partners. The course will look at the main homeopathic remedies that are helpful in labour birth and beyond and will cover the following topics amongst others:
Homeopathy and symptoms during labour
1. When the labour starts going very quickly and its hard to stay focused and catch your breath
2. When you feel completely exhausted because the labour has been long
3. When you feel anxious or frightened
4. When you feel overwhelmed or distressed
5. When you have the symptoms of a back labour
How do I use homeopathic remedies during labour and birth?
We will look at potency (how strong should a remedy be), dosage (how should it be given?) and repeats (how often should it be repeated within a certain time span).
At the end of the course you will have a basic idea of how homeopathy supports women during this intense time of transition and also what remedies match which symptoms.
You will also have an idea of how to use a basic homeopathic birth kit, and we will talk a bit about creating your own birth and postpartum kit. There is an online support tool for the course so participants will be able to refer to this to refresh their memories after the course is over!
This information is also available in a one to one private session, if you cannot make the course. More information here.
Perinatal and Infant Mental Health in Ireland attracts a growing body of research. It is wonderful to see the attention moving towards infants and young children, a cohort who until the last 20 years, or so, have been seen as having little to no agency or as ‘tabula rasa’ – blank slates upon whom adults can impart knowledge and the proper way to conduct oneself. Sometimes, however, the focus can get skewed and researchers can often neglect that the individuals who are conceiving, carrying and birthing these babies are living, breathing humans as well. These are people who have contributed immensely to their communities. Individuals who have changed their lives and who have made sacrifices in relation to what they eat, what they drink, how they work and how they feel in order to ensure a healthy start for their offspring. There is an abundance of research on attachment theory (different from attachment parenting) that strongly supports the nurturing of a secure and healthy emotional bond between infants and their caregivers. The evidence for this theory is particularly poignant and hopeful for families where there has been a disruption in infant-caregiver bonding, for example if a mother or parent has experienced illness, complications or trauma during pregnancy, labour or birth.
Birth Trauma and perinatal infant and mental health
Thus, when an article purporting to be scientific research on birth trauma healing opens with a line like: “Research has proven that babies born without trauma enjoy an intact capacity to love and trust”, there is some serious cause for critical analysis. Anyone reading an alleged scientific article on any subject should hear alarm bells when the phrase ‘research has proven’ is used to make a claim. Scientific rigour and the most robust research can not ensure the proof of anything. All the scientific research method can do is analyse well constructed hypotheses and carefully collated data to show support that the variables being studied are evidence of a claim, or not. Any science that declares ‘this is proof’ is not good science. Any method that is applied with the claim of being the only one that is right or the only one that works is most likely marketing, and not science.
The onus on articles, like the one above on birth trauma, is to highlight the science that supports a theory or method and to omit emotive opinions and pseudoscientific claims. Women who have recently given birth can often be vulnerable and sleep deprived and may find it more difficult to discern thescientific authenticity of an article or method from the pseudoscientific claims the author(s) are making. Claims such as ‘babies are conscious from conception’ or that any separation of a baby from its mother after birth is perceived by the baby as ‘abandonment’ are categorically false and run the risk of causing increased distress to those who are already traumatised by birth. What is equally distressing is that the article above cites no references for these claims. The only links at the bottom of the article are to sources directly related to the author(s) and to a book by Dr Arthur Janov, the creator of ‘primal scream therapy’, a method that has virtually no rigorous scientific research to support its effectiveness.
Upon further reading, the article continues with questionable statements about ‘optimal birth’, such as “The mother works with the baby to help him be born successfully…Such a child will have a life script of ‘I can succeed’”. Another claim about ‘life scripts’ declares that “babies born by elective caesarean section (sometimes necessary) may have some of the following life scripts: ‘Life is something that happens to me’ or ‘I don’t like things happening suddenly when I am not ready’. These babies have also missed out on the important stimulation of the birth contractions.” While these life scripts may be tenuously linked with cognitive psychology and schema therapy, there is no scientific basis given for any of the above assumptions. While some people may connect with these claims on an intuitive level, it can be extremely dangerous for others to read them and to internalise self-blame or guilt for experiences that were outside of their control. Particularly when these claims are egregious and false.
The rest of the article goes on to promote the work of two doctors. It appears their areas of specialty are psychotherapy and developmental psychology. This is where things can get confusing. When a person refers to themselves as a ‘doctor’ or uses any professional title, we expect them to be an expert in the field in which they are qualified. We expect certain competencies, knowledge and skills in their qualified discipline. In the last decade, there has been an agreement between various psychotherapeutic and psychological associations & societies on the international standardisation of the accreditation and registration of psychotherapists and psychologists. This is important work that addresses the vulnerability of the clients involved as well as the power dynamic and the role of mental health professionals in the assessment, treatment and diagnosis of the individuals with whom they work. For too many years, psychology and psychotherapy have suffered from the prevalence of unqualified practitioners who are often more interested in marketing a toolkit they have developed or a book they have written than in providing an ethical and professional service.
Scientifically proved versus “opinion” in pregnancy and postpartum marketing
It is hard for someone marketing a theory or product to admit that it may not work, that it requires updating or that it may not be suitable for everyone. Years may have been invested in writing, training and selling their product(s). This is where marketing veers sharply away from the scientific method. A person who is selling a self-designed birth tool or service has to believe strongly that they are offering something that no one else can offer. They have to develop a marketing language that makes their product or service appear to be more effective than the competition. The problem with this is that the language to sell a product can appear to use scientific language and terms when the theories or concepts being discussed are pseudoscience. In the above article the words: cellular, hormones, brain and nervous system appear by the second paragraph with absolutely no references to explain how these biological terms or processes relate to birth or birth trauma. This is a powerful, and sometimes disingenuous, use of language to convince people that they need something that may be entirely unnecessary or even ineffective.Current research supports the theory that using terms like ‘brain’ and ‘neuro’ in marketing or health & social sciences literature appeals to the reader so that the reader will believe what the literature says, even if it is irrelevant pseudoscience. This verges on the unethical when individuals are expected to part with money for a service or product that appears to have scientific support but when critically analysed offers no more evidence than opinions and anecdotes, which are notoriously unreliable and biased.
Treating birth trauma
Going back to the content of the above article, the ideas relating to ‘re-patterning’ (defined as “creating the birth that should have happened”) and encouraging a baby to relive their birth trauma with the alleged effect of healing are highly questionable, at best, and unethical, at worst, due to the lack of evidence to support this practice. Robust and scientifically sound therapeutic approaches to healing birth trauma will draw from the most reliable and valid psychological research and not from unsupported claims in relation to an esoteric practice such as rebirthing. In fact, the most recent research on treatment of trauma is a 3 phase approach that takes the individual being treated into account. Some will gain benefits from re-living and reprocessing a traumatic event while others will not find it helpful or may even find it harmful. If the trauma is more complex or ongoing, then different approaches will be more appropriate (http://psychcentral.com/lib/ treatment-of-ptsd/). The key here being that anyone undergoing therapeutic intervention should be assessed individually bya trained and qualified mental health professional and a treatment plan should be designed accordingly, ideally in collaboration between the individual and the professional. There is an additional ethical consideration in that the babies undergoing the interventions described in the article are not able to give their consent. This means their parents – who may be sleep deprived or suffering from PTSD – are being expected to give consent for an intervention that is based on little to no empirical evidence.
Partners in healing rather than treatment from an “expert”
In Perinatal and Infant Mental Health in Ireland, there are a plethora of therapeutic tools and treatments where the person imparting the therapy or intervention implies that they are ‘the expert’ and the one being treated is the passive recipient of the intervention. This is not authentic therapy, where the quality of the therapeutic alliance is one of the biggest determinants of efficacy and the individual in therapy is facilitated to adopt healthier coping styles and to feel empowered and more confident in their ability to face life’s stressors. In the above article, one has to question: where is the facilitated care for the mother? The baby appears to have been given an intervention that the creators of the therapy claim will heal trauma for the infant. But what about the trauma affecting the mother and wider family? It is implied that once the baby is relieved of trauma then the parents can go back to parenting and a normal life, without the interference of the baby’s cries. This is far too simplistic and ignores the numerous other factors at play when it comes to birth trauma. Significant factors like: maternal morbidity, family history, prior birth trauma, socio-economic status, mental health history, expectations of childbirth, adjustment to the role of parent, and many more aspects can influence the way in which a woman and her family integrate and heal from a traumatic birth.
There is an anecdote in the above article that depicts a 15 to 20 minute intervention whereby one of the doctors cited in the article invites a woman to bring up her ‘niggling’ baby to the front of the room. It is established that the baby has been fed and wasn’t hungry but that he had endured a protracted second stage of labour. The alleged expert holds the baby’s head and then pushes on his feet until he ceases crying and this is seen as evidence that the baby has somehow re-experienced or re-patterned his birth. The idea that one single aspect of birth (long 2nd stage) is deemed the causal variable in the baby’s current discomfort and that one expert can change the trajectory of the infant-parent relationship simply by holding a baby for a few moments completely undermines the entire discipline of perinatal and infant mental health research. In addition, it reduces the role of the mother to passive participant in the care and nurturing of her child. While the power of touch has some robust evidence behind it as a way of deepening bonds and expressing and eliciting compassion, it would be far more effective to empower a mother and to encourage her to hold her own baby to facilitate and deepen the bond between them.
Promoting parental competence and confidence in parents who have experienced birth trauma
This therapeutic method neglects situations where a baby may have spent spent time in NICU or when a mother or her baby have experienced interventions or complications during pregnancy, labour and birth. Complications during birth can occur for myriad reasons and can affect the mother, the baby and the extended family to varying degrees. The methods of dealing with birth trauma in this article ignore the scientifically supported therapeutic tenets ofearly individualised family-based interventions – particularly those that promote parental competence and confidence – that reduce maternal stress and depression and increase maternal self-esteem, leading to more positive early parent-infant interactions. Assessment and treatment of an infant’s mental health involves much more than one therapist holding the baby for a few moments in the hopes of ‘re-patterning’ the baby’s birth experience. It involves the mother or caregiver, the infant and the support of an entire team.
Infant Mental Health
As an emerging discipline, Perinatal and Infant Mental Health in Ireland embraces the most current empirical research on infant-child development and its intrinsic relationship with parents and caregivers, in the early years of life. Contrary to the idea that the mother is totally separate from the infant, a recent Infant Mental Health Group Networks Evaluation (2015) document, states that a quality infant mental health model will draw on the skills and knowledge of a “network of professionals involved in providing services and support to caregivers, families and children age 0-3” (p. 5). This group will then work closely with the wider community to support primary caregivers, infants and families to achieve optimum mental health and wellbeing across the perinatal period. This requires that consideration not only be given to the physical needs but also to the psychological, social, cultural and geographical issues facing women, men, infants and families during this time.
Birth trauma does not lead to the irrevocable disruption of bonding between parent and child
In reality, if there is a disruption to the infant-parent bond due to trauma of any kind then overwhelming evidence suggests that the bond will not be irrevocably disrupted. In fact, even in cases where there has been prolonged difficulties or separation, interdisciplinary professional mental health support will take time but it will have a much more significant long term beneficial effect for the infant-parent/caregiver relationship than biased and pseudoscientific therapies. A mother, parent or caregiver should be encouraged and supported to take an active part, if they are able, in nurturing and protecting the bond with their child. If there is trauma involved, families should find great comfort in the robust evidence that in time and with evidence based support, mothers and infants can, and do, heal and go on to thrive in their relationships.
Barbara Western is a Graduate Member of the Psychological Society of Ireland (PSI) and is the Communications & PR Officer for the PSI Perinatal and Infant Mental Health Special Interest Group.
Facebook: PSI Perinatal and Infant Mental Health Special Interest Group
This weekend I got to attend a great Spinning Babies Workshop given by Spinning Baby trainer Jennifer Walker. It was a wonderful inspiring session and I would recommend it or similar to any doula.
In conservative antenatal education we are all taught to focus on the cervix as a measure of progress and change in labour. As doulas we know that the cervix is simply a symptom of the work of the fundus and all the surrounding ligaments, soft tissues and muscles and we rarely consider dilation in supporting a woman ‘s prgression in labour. Instead we look at the depth the intensity and the woman’s state. Is she still building endorphins, or has she entered into that trance like state of deep labour?
What Spinning Babies offers is an additional perspective to progression and movement (or lack of) in labour based on the baby’s position within the mother’s pelvis, rather than on cervical dilation. An understanding of optimal positioning and of the symptoms of sub optimal positioning and how these can arise over the pregnancy can offer opportunities for the doula or midwife (or both) to take action to improve the positioning and therefore improve progression towards birth.
Here are the Top Ten Things that I learnt
1. Where the baby is, is more important than dilation
A woman can be quite dilated, but if her baby is not in an optimal position to progress through the pelvis then the dilation is of no consequence, alternatively the woman can be hardly dilated at all, but once her baby gets into an optimal position, the labour can progress very quickly indeed. The position of the baby is determined by the mother and her pelvic balance.
2. Knowing the difference between passive patience and active patience
Passive patience is very high up on the doula check list in general. There is that idyllic image of the doula sitting and knitting which Michel Odent paints, and most experienced doulas will only become more hands on when the mother or her birth partner need and request more hands on support. However, in the worskshop, the point was made that whilst time is not often given to a birthing mother in our highly medicalised birth culture, continuing to simply wait and wait and wait for labour to progress can sometimes not help if the baby is not in an optimal position. Instead, if the doula and midwife can recognise the symptoms of sub optimal positioning and know exactly where in the pelvis the baby is and identify what aspect of the soft tissues, ligaments, muscles or fascia are contributing to the sub optimal positioning then action can be taken to improve the position of the baby. However its important to note that this is not some natural form of “active management of labour”, but rather an active style of waiting and supporting.
3. Balancing the pelvis, womb and everything that supports them enables good maternal position and baby’s position
Most women’s pelvis’ are not balanced. We all have previous injuries that we may have encountered along our teenage years or repetitive strains that we do on account of our job, or as part of our less than optimal posture. Also we all favour one side over the other to do certain tasks; for example writing, pulling or picking up things. All of these things accumulate and eventually we become unbalanced. When pregnancy starts we can take action to balance our pelvis’. There are exercises we can do daily and others weekly to improve pelvic balance and these are referred to as The Three Sisters, or more recently the Fantastic Four! In addition the practice of yoga and optimal sleeping positions can also be of great benefit.
4. Pelvis’ are differently shaped and shape will determine ease of the baby’s passage through it.
All women will have a slightly differently shaped pelvis. However in addition to the individual variations women have, there are generic groups of pelvis’. Some pelvis’ are more narrow in the inlet but wider in the outlet and others are wider in the inlet and narrower at the outlet. Depending which type of pelvis a woman has will determine whether the space for her baby to engage, rotate and descend is tighter or narrower or wider. It will also determine in which part of her pelvis the baby will have the narrowest fit during the journey to birth.
Pelvis’ have three parts to them, an inlet a mid pelvis and an outlet. In Ireland traditionally most women have a gynecoid pelvis, however with a greater number of women from different cultures birthing in Ireland, a wider range of pelvic shapes are now more common. It can help if the woman knows the shape of her own pelvis.
5. Often where the baby is, is dependent on the quality and balance of the soft tissues
For example the tone of the muscles, the amount of tension in the round ligaments, the alignment and symmetry of the broad ligament, the tightness of the lateral sacral ligament, the length or shortness of the muscles, notablly the psoas muscle, and the pelvic floor muscles can all affect balance and ultimately the position of the baby. Hence the importance of daily balance practices during pregnancy and body work such as yoga, and also at least one visit to the chiropractor or osteopath during late pregnancy, or if funds permit visits throughout pregnancy!
6. Every woman benefits from daily practice during pregnancy to improve balance
The three sisters of balance (now the fantastic four) are useful daily practices in pregnancy and can also be used in labour as well if imbalance is suspected. They are
7. Tips to try in early labour or just before if the baby is high and at the pelvic inlet but doesnt engage
As doulas we are generally familiar with the symptoms that this scenario presents. Mothers will have a start stop labour that may go on for several days as the baby tries to engage, the contractions may be double ones and painful but the true trance like state of labour doesn’t come on and the energy of the labour doesn’t move forwards. This can apply to early labour at home and to early labour in hospital/home.
Good tools to use here in addition to the Fantastic Four, are
Posterior pelvic tilts against a wall, as opposed to an anterior pelvic tilt (which women are often encouraged to do whilst sitting on a ball).
Abdominal lift and tuck if the mum is multparous,, this literally helps to lift the mum’s tummy into the pelvic area,
Crawling on hands and knees
Vigorous circling on the ball can be used (the analogy being an egg slipping into an egg cup if it is spun on the rim enough),
Walchers manoeuvre ie actually leaning back on the bed with the feet hanging off, or alternatively leaning backwards over the ball in a sort of half “camel” back bend for three contractions,
8. Tips to try when the baby is in the mid pelvis but not effectively rotating and so despite contractions the labour doesnt progress
The head has engaged in this case but is sitting at an angle within the pelvis in an asymmetrical way and has not completed the rotation it needs to within the pelvis in order for labour to continue. This is usually because the baby has not been able to adopt a good position, more often than not it can be due to the head not being tucked in, but being deflexed instead.
Symptoms here are where the labour has stayed at more or less the same point for a long period of time and the woman is tired. The woman reports continuous pain even between the contractions. She may be advanced in terms of dilation up to of between 5cm and 8cm. There may be a premature urge to push. Options to help here include
The Fantastic Four especially the side lying release for three contractions
Open knee chest position
Shaking the apple tree with the open knee chest. This enables the baby to move out of the pelvis a tiny bit and then when the baby returns he or she may have improved flexion with the chin tucked in,
Lunges, and lifting one leg up high in a lunge using a bed or a chair or going sideways up and down the stairs
9. Tips to try when the baby is in the outlet
At this point the mother may be fully dilated and it may even be possible to see the head through the labia, but the baby’s progress may be impeded due to a high arch within the pelvis or other positional issues associated with the outlet., More than likely though progress could be impeded by the mother being asked to push in a way that makes her uncomfortable. Symptoms can include the lack of an urge to push and a cervical lip, or a lot of pressure from the care giver to do coached pushing. Options to help here in addition to the Fantastic Four include:
Squatting on a ball and leaning backwards can enable a wider opening at the pelvic arch
Putting pressure on the sacrotuberal ligaments so that they can release, even to the point of manually assisting the release if you are confident (that wouldnt be me!)
Sitting on the toilet with a straight back and bringing the knees together rather than extending them wide out
Ensuring that the mother is not curling around the baby, but is sitting or lying on her left side with her back straight, this is especially true if the baby is OP, as the baby will have a straight back and needs the mother’s straight back to get out! If she is lying on her side she will need a straight back and could use a peanut ball.
10. The importance of a tucked head in the baby
When the baby’s head is well tucked in then all the aspects of passing through the pelvis and putting appropriate pressure on the cervix can be achieved. Flexion is probably the most important aspect of baby’s position. A LOA position promotes a good head tuck whereas an ROA may do the opposite. Practising the Fantastic Four in Pregnancy and using good sleep practices and safe movement practices during pregnancy will enable a baby to be more tucked in. This includes exercises such as yoga, which naturally ensures that ligaments and muscles are well toned and the psoas is released from accumulated tension.
DISCLAIMER: These were things that I personally took from the workshop[. For guidelines and more information please either attend a Spinning Babies Workshop or consult the spinningbabies website
I was with a few women the other day and one of the topics that came up was the difficulty in coping with the gradual realisation that our own mothers may be unwell with a poor or uncertain prognosis. What does that mean for us as mothers in our own right, trying to care for our very young families and trying to be there for our mothers physically emotionally and spiritually? It means feeling over stretched, and can be especially intense when we are pregnant, And the very fact that it is our mother and not another relative makes it somehow more intense.
The small discussion that ensued made me reflect on our relationship with our mothers and mothering, and I started to see some parallels between preparing for birth and preparing for death; they are both about waves of separation. Becoming a mother and letting go of a mother seem to be somehow linked.
Journeying within our own mothers
Perhaps one of the reasons we feel differently about our mothers is that for many of us we lived inside her for 9 months! Our journey with our mother starts when we live within her during pregnancy. Some “energy workers” even point out that part of “us” existed in our mother’s eggs when she was growing inside her own mother, so perhaps in an energetic sense we know her very well, more than other relatives, we grew with her and are part of her from a long time back!
In that womb time most people would agree that in the last months of pregnancy we feel our mother’s rhythms, her wants, her heartbeat, the lilt of her walk the sound of her voice and perhaps even her smile. We know when she feels fear, or anger and when her heart is open with love. Some midwives even suggest that a breech presentation enables a baby to hear its mother’s heartbeat more strongly and perhaps breech babies need that energy of the heart more than other babies.
Birth; a time of separation
When its time to let go and leave our womb home (and our mothers), we initiate the time for birth, provided we are given the opportunity, and are not induced of course. What makes us ready as babies to “let go” and be born is unclear. I always remember my mother in “wives tale” mode saying to me that birth is a process of separation, and that sometimes that process can be painful, for the mother and sometimes for the baby. I have always been mindful of that little snippet of ancient wisdom which my mother heard from a traditional midwife who attended her mother’s own 8 home births. in my work as a doula.
Even though when we are born we do physically separate from our mothers, “mother nature” herself immediately prompts us to seek her again with all our newborn reflexes, crawling, snuffling, reaching bobbing to find that point of connection at her breast where we can hear her heartbeat once more and feel comfort and holding. We leave and we return! The instincts that prompt us to do this last well beyond the first “golden hour” and research has shown that even babies who are three months old and have only ever been artificially fed will still make an attempt to seek the breast.
Labour: a misnomer?
In English the name we give to the process which brings us to birth is “labour”. It suggests that giving birth is hard work, Your body will work hard and perform its physiological task. If birth is difficult or surgical there is often this (false) implication that maybe your body didn’t work hard enough or correctly. It implies that labour is unidimensional. Labour is anything but unidimensional of course! It is a delicate interplay of the physical, the psychological, the emotional the spiritual and the unknown. It is a transformational rite of passage which offers women an invitation to access something within them they may not have known about themselves. Strength, vulnerability, autonomy, passion, determination and instinct are a few things women sometimes cite.
In other languages however, this process of “labour” and birth is actually called “the separation”, the word “parto” means just that; letting go, to leave, to separate. It is from the Latin Parere I think. So birth is a process of separation, not simply a matter of hard work! Both mother and baby separate.
Weaning and beyond
When we wean from her breast, when we crawl and then walk away we separate more. And even for those babies that have not been breastfeed or who are not parented by their birth mother, this weaning or moving away happens. Even though as adults we live quite separate lives from our mothers, sometimes in different countries, if our relationship is good, and sometimes even if it isn’t there is still that pull, that unusual different energy reserved just for our mother(s). Perhaps it has something to do with the lesson in unconditional love a mother can give us? Perhaps its more complex.
When we become mothers ourselves our children’s behaviours and our responses are often benchmarked against what we experienced as children from our mothers. Some of us have good experiences and some of us not so good ones. The transformational invitation of parenting enables us to parent ourselves and address some of the hurt we may feel from our own childhoods. We don’t have to do that, but the invitation is certainly there.
Finally letting go
But then the day comes, or maybe the year comes, when we realise that our time with our own mother is limited, and everything comes at once. All emotions arrive. Tiredness, uncertainty, loneliness, mortality, the unknown. Its as if we become that child again seeking the warmth and the familiar heartbeat, and we feel the terror and the panic of not finding it any more. There is no pushing away the inevitable, no stopping it however much we want to.
In that sense it is a bit like labour; we often want the intensity to stop, to to calm down, to give us a rest, but the energy of birth rolls on like a series of waves and we deal with each surge as it comes. We somehow find our own personal deep coping mechanisms and our trust. When labour is over we put our coping tools safely away to use for the next labour maybe, and even when there are no more labours, what we learnt as birthing women never leaves us. These innate lessons of birthing are available to us in every one of life’s intense transformations; they are the gifts of the birthing woman that we give to ourselves!
Birthing and dying; arriving and leaving
And so in our meeting there were comments on how similar birth is to dying. Both ask us to let go and release. Its hard to mother young children and to have time to process what we feel about letting go of our own mothers as so many emotions arise at the same time, but if we look closely we will see that the emotions and the vulnerability they expose merely offer an invitation to experience the intensity of living and loving.
Sometimes this process is hard, confusing unfamiliar and unknown, again similar words that can be used to describe birth. What is important is to find yourself time, give yourself support, surround yourself with other women who are familiar with the territory, accept all offers of help with young children,seek professional support if you need it, talk to your midwife if you are pregnant and tell her how you feel, eat well, get plenty of rest, find your reflective space where you can connect with your emotions and as ever, BREATHE.
Top 10 things I learnt at the Essence of Midwifery Conference
It was great to be invited to several events over this week in support of all the wonderful midwives who work so hard to support women during their journey to pregnancy birth and beyond in Ireland. The big day was the Essence of Midwifery conference at The Coombe. As usual they put on a great show and there were some great speakers and posters with the focus being on caesarean section and choice within it.
Maternity Strategy 2016
1. That the maternity strategy has been launched a 100 days and nothing has yet been implemented. With a government now voted in, when is the action going to start in ensuring that women have access to along side midwifery led units? The overview of the Strategy was given by Deputy Chief Nurse and Midwife Susan Kent
Caesarean Section Rate
2. That the c section rate in the North of Ireland was 36% but investment in evidenced based research, support, care pathways, informing women of their choices and in trusting women was able to reduce it to 25%. (Dr Niamh McCabe and Margaret Rogan Consultant Midwife.) There are four main reasons for c section (1) compromised baby, (2) “failure to progress”, (3) breech presentation and (4) previous caesarean section. Niamh and Margaret highlighted this last issue and the lack of informed choice surrounding VBAC in Northern Ireland that was a major factor in maintaining the high caesarean rate.
Risks of Elective Repeat Caesareans
3. .Women are rarely told the risks of Elective Repeat Caesarean Section (ERCS), instead the risks of VBAC are the primary focus of discussion. Niamh discussed some of the risks including placenta acretia and hysterectomy. Niamh pointed out that she hardly ever used to see placenta acretia when she started out in her practise and now she sees about one a month.
4. Women hoping for a VBAC are absolutely encouraged to use the water pool for labour and birth and also CTG as Niamh argued that it is almost impossible to have a uterine rupture without an abnormal CTG . However, if its a woman’s choice then she doesn’t have to have it and there are other signs that can be looked for. Niamh said that the rate of uterine rupture has increased over the years as more and more women are having c-births.
5. The increased risk of a fetal death with a VBAC is about the same risk as when you had the caesarean birth the first time round. The increased risk is perceived because in general if you had a normal birth the first time round then the chances of your second baby dying is much less than your first.
6. You are three times more likely to die with a ERCS than with a VBAC
7. The risk of a VBAC is about the same as of an IOL
8.Birth is a series of involuntary processes hindered by the interference of the neocortex
9. Melatonin and oxytocin work together to promote surges and birth. Light in the blue spectrum inhibits the production of melatonin. The most common spectrum used in delivery suite lights is blue spectrum. The light emanating from mobile phones is also in the blue end of the spectrum. Mobiles and apps are not good for connecting with your inner self and increasing oxytocin levels. Michel Odent.
Decision Making in Midwifery and Obstetrics
10. When we make decisions around pregnancy labour and birth we tend to believe that the more information we have the better decisions we will make, however what we need is sufficient information to reduce our uncertainty enough to make a decision.
Also decisions are often based on heuristic pattern recognition. Once we see a pattern it is difficult to erase it from our minds so even though what we are seeing is marginally different from the pattern we know, we will recognise it as the same. Situations that are similar to ones we recognise can fool us into making quick decisions based on faulty recognition. On the other hand we like using patterns to make decisions because it enables us to make decisions more quickly. Until we recognise a pattern we have to work things out from first principles, and that takes time which most HCPs dont have. Prof Maskery.
Top 5 things I enjoyed
1. The company of being with midwives and women
2. The Japanese water blessing offered in honour of the day
3. The student midwife discourse “keep it going keep it going keep it going keep it going keep it going . . . keep it going keep it going” “Exactly how long is a breath?”
4. The poster presentations. My favourite was the poster looking at caring for same sex couples
Today, January 27th 2016, the Minister for Health Mr Leo Varadkar launched Ireland’s first Maternity Strategy. This is a big first for the country, as until now maternity service have developed in an ad hoc basis without any overall direction or unified goals. This has resulted in a “geographic lottery” in terms of women’s choices and developments with some parts of the country offering midwifery led care, birth pools, home birth services, open doula policies, anomaly scans, early transfer home, DOMINO care and other parts of the country offering nothing beyond an obstetric led service.
The Maternity Strategy was prompted by a variety of reports including those by HIQA into the baby deaths in Port Laoise hospital and Savita Halappanavar, and Roisin Molloy and Shauma Keyes whose babies both died in Port Laoise sat on the Maternity Strategy Committee, as did I representing AIMSI and the generic women’s voice.
The Chair’s preview summarises the input of Roisin and Shauna
“Finally, and most particularly, I would like to acknowledge the considerable input to this Strategy of Roisin Molloy and Shauna Keyes, two mothers who have experienced both joy and heartache within our maternity services. Their presence on the Group served to ground us in reality, and I thank them for that. Savita Halappanavar was also ever present with us in our thoughts and we hope that the outcome of our work will be of some comfort to her husband and family.” Sylda Langford Chair
The committee also consisted of many midwives, HSE managers, representatives from the Department of Health and Children, obstetricians and paediatricians. Furthermore the committee sought guidance from maternity strategies in Northern Ireland and Wales and also carried out a public consultation which many of you will have taken part in.
What are the key terms of reference of the strategy?
Women and babies have access to safe, high quality care in a setting that is most appropriate to their needs;
Women and families are placed at the centre of all services, and are treated with dignity, respect and compassion;
Parents are supported before, during and after pregnancy to allow them give their child the best possible start in life.
What are the four strategic priorities that the strategy addresses?
Health and Wellbeing approach is adopted to ensure that babies get the best start in life. Mothers and families are supported and empowered to improve their own health and wellbeing;
Women have access to safe, high quality, nationally consistent, woman-centred maternity care;
Pregnancy and birth is recognised as a normal physiological process, and insofar as it is safe to do so, a woman’s choice is facilitated;
Maternity services are appropriately resourced, underpinned by strong and effective leadership, management and governance arrangements, and delivered by a skilled and competent workforce, in partnership with women.
How will safety and risk be addressed?
The Strategy classifies pregnant women/babies into three risk groups; normal-risk, medium-risk (requiring a higher level of oversight), and high-risk (requiring a more intensive level of care, either throughout or at particular stage of care). Across all risk levels there is the potential need for an increased level of care and the importance of smooth transfer between pathways of care is recognised.
What pathways of care will be available to the three groups?
A choice of pathway of maternity care will be available based on this risk profile. A woman will be supported to make an informed choice with regard to her care pathway and will have her care delivered by a particular team. All care pathways should support the normalisation of pregnancy and birth. The pathways are:
1. Supported Care: This care pathway is intended for normal-risk mothers and babies, with midwives leading and delivering care within a multi-disciplinary framework.
2. Assisted Care: This care pathway is intended for mothers and babies considered to be at medium risk, and for normal risk women who choose an obstetric service. Care will be led by a named obstetrician and delivered by obstetricians and midwives, as part of a multidisciplinary team.
3. Specialised Care This care pathway is intended for high-risk mothers and babies and will be led by a named obstetrician, and will be delivered by obstetricians and midwives, as part of a multi-disciplinary team.
Where will women give birth?
Women in the Supported Care pathway will give birth in an Alongside Birth Centre; women in this care pathway may also choose a homebirth.
Women in the Assisted Care or Specialised Care pathways will give birth in a Specialised Birth Centre.
What are along side birth centres and specialised birth centres?
“An Alongside Birth Centre should ideally be situated immediately alongside and contiguous to a Specialised Birth Centre (current labour ward). These will provide comfortable, low tech birth rooms; labour aids such as birthing balls and pools and complementary therapy will be welcome alongside natural coping strategies. If epidural analgesia, electronic foetal monitoring or syntocinon is required, transfer to the Specialised Birth Centre will be organised and where possible the same midwife will continue the women’s care. In an emergency, the necessary critical services will be brought to the woman in the Alongside Birth Centre. ” National Maternity Strategy 2016
“For all care pathways, the physical infrastructure should be of a high standard, providing a homely environment and respecting the woman’s dignity and need for privacy during childbirth. While it is recognised that more medical equipment is required in a Specialised Birth Centre, as far as possible, all birth centres should be conducive to providing a calm and relaxing environment, such that it can best support a physiological process. Modern facilities including, where appropriate, birthing aids and birthing pools should be available.” National Maternity Strategy 2016
When will these setting be provided?
Obviously this document is just a Strategy and will need to be implemented. An implementation committee will be set up and some changes will take longer to put in place than others. Here is what the Strategy has to say on the lead in period: It is recommended that the The National Women & Infants Health Programme will, “within six months of the date of publication of this Strategy, develop a detailed implementation plan and timetable for the delivery of this Strategy, including the assignment of responsibility for required actions.” National Maternity Strategy 2016.
“Each maternity network will be required to prepare a plan to provide Alongside Birth Centres across their network. In determining the priority for implementation, each maternity network will have regard to the need to ensure a reasonable geographic spread of such birth centres across the network. Pending the development of Alongside Birth Centres, or where it is determined that, given the small size of a maternity unit, a discrete Alongside Birth Centre cannot be justified, it is recommended that a designated space is established within a Specialised Birth Centre, with an appropriate environment and processes to ensure that, as far as possible, the normal risk woman will be provided with a natural childbirth experience.” National Maternity Strategy 2016.
So in other word in small units or until alongside birth centres can be built a DOMINO style situation is expected to exist, not too dissimilar to the DOMINO service in the NMH at present.
What else that we do not have now will the strategy provide?
The Strategy recommends more resources for perinatal mental health. The strategy recommends that to perinatal psychiatry and psychology services will be standardised, and as a minimum provided on a maternity network basis.
The Strategy recommends more resources to support breastfeeding including that all maternity service adhere to the Baby Friendly Hospital Initiative.
The Strategy recommends improved appointment scheduling
The Strategy recommends the development and implementation of National Clinical Guidelines and National Clinical Audit. The NCEC will prioritise and quality assure National Clinical Audit and a set of National Clinical Guidelines for maternity services; guidelines on Intrapartum Care are a priority.
The Strategy recommends improved clinical audit of the maternity services. An annual survey of womens’ experience in maternity services will be undertaken by HIQA in partnership with the HSE.
The Strategy recommends geographic uniformity in terms of choice and care settings and other services
The Strategy recommends a new community midwifery service available to all women for antenatal and post natal care
The Strategy recommends home births be made available in all hospital groups. “Women in the Supported Care pathway should, where feasible, have the option to birth at home, with care provided by the community midwifery team and the lead healthcare professional. Thus, homebirth services will be integrated with the community midwifery and the wider maternity service as part of the maternity network. Care will be provided in line with agreed national standards, with clear care pathways identified for any change in the woman’s risk profile.” 184.108.40.206
The Strategy recommends the development of an on-line resource for maternity services, to act as a one-stop shop for all maternity-related information.
The Strategy recommends that mother-baby bonding will be facilitated and supported at all times, and as such, every effort will be made to keep the mother and baby together, if clinically appropriate.
The Strategy recommends that additional support will be available for women who have experienced traumatic birth or the loss of a baby.
What is not in the strategy?
The Strategy makes no provision for free standing birth centres, despite the public consultation being overwhelmingly in favour of this and despite the evidence for the safety of free standing birth centres being stronger than for homebirths.
The woman’s choice of care provider and setting overriding her risk status. The Strategy makes no clear provision for a woman to choose a model of care that is not deemed suitable for her risk status. The Strategy makes reference to the National Consent Policy and the 8th amendment to the Constitution of Ireland as being a barrier to following through on this.
Tonight, the 31st January is Bridget’s eve. It is rumoured that the goddess Bridget will gift the land of Erin with her blessing. As she wanders over the land, offering her fertility and the energy to birth a new Spring, her cloak will touch the fields, the trees, the water, the forests, the rushes and the grass. Everything it touches will be blessed and in the early morning we see evidence of that blessing in the form Bridget s Day dew.
The goddess Bridget has three faces; the face of the poet, the face of the smithy and the face of the midwife. Historically, Bridget was held in awe by midwives. Her place in the Celtic calendar is tied to the first day of Spring, and so as birth brings new life; she fills the earth with the new life and light of the coming Spring.
Bridget was often called upon to ease the fears of a diffticult birth or to help with a mother who was fearful of labour and birth.Traditionally midwives and doulas and all who work with the coming of life would have a shawl or piece of red cloth that they would cover the woman with in times of need or distress. The shawl represented Bridget’s holding, and the protection of the goddess. Any such shawl received its potency or its power from being laid out on Bridget’s Eve to receive the blessing of the goddess in the from of the dew from her cloak s she roamed the land on Bridget’s Eve..
I learned about this many years ago, and so each Bridget’s Eve, I take my Bridget’s shawl; a red square of fabric with a Bridget’s cross woven into it, and I place it on the grass to receive its blessing. I also put out the red yarn I will use in Mother Blessing s over the coming year. If I am attending our birth this year, you will see my Bridget’s shawl there in my doula basket ready and waiting to bring the spirit of one of Ireland’s greatest goddesses to your birth if it is needed!
If you are pregnant or even if not and you want a reminder of Bridget s healing power, then you too can put a piece of red cloth out to catch the magic of Bridget’s dew tonight!