Sharing the Skills: Supporting birth without the use of vaginal examinations

I have struggled to write this particular post for the past week or so; do I reference, don't I reference. Am I trying to be the 'expert'?  Is this formal, informal.  Argh - round and round I go!  Until a colleague reminded me this is a BLOG post, meaning it's an informal piece of my opinion (see disclaimer thingy).    and breathe........

I can still remember the first Vaginal Examination (VE) I preformed as a student midwife.  I remember two things mainly:

1. I had no idea what on earth I was feeling!

2. That this was a very invasive procedure.

Many units have a 4-hour guideline for VEs to asses the progress of labour; this routine assessment has no real evidence to support it and is still of unproven value in routine midwifery care, despite being recommended by NICE (it is important to acknowledge, that NICE states women should be offered a VE).  VE's can be a very helpful tool in understanding a labour when perhaps midwifery intervention may support the woman in keeping her labour normal, when clarity around labour progress is appropriate, and / or if it will affect the plan of care.  When used as the marker for progress in labour only, VEs can cloud the midwives understanding of what is happening in the woman's birth story and cause the woman to doubt her own body.

The art of Midwifery is the 'big picture', and it is through many different signs that a midwife may recognise where a woman is in her labour.  This awareness is not 'taught', but learnt: learnt from the women as you observe undisturbed birth, learnt from sitting and quietly absorbing the behaviours unfolding in front of you, and learnt from not starting from a place of 'knowing best'.  As a result of this, the thoughts below are not a 'check list' of progress in labour, simply prompts to help you consider the physiology of what may be unfolding before you.  Remember also that all women are different, and every woman and birth can unfold in a way that is unique for them.

Let us consider then, alternative ways of recognising a labour that is progressing:

How low can you go?
When I was a student midwife, I heard the wonderful Jane Evans speak on Breech birth.  In her talk, she described how women get 'closer the the ground' as their labour progressed.  In labour, as those powerful surges increase in intensity, the woman finds it harder to be upright and conserves her energy by moving into positions that bring her down - usually into the all fours, or leaning over a sofa etc.  As a guide, the closer she is to the ground and needs to stay 'grounded', the further along in her labour she is likely to be.

Those wonderful noises
Experienced midwives can often tell where a women is in a labour from those lovely noises she omits; Liz Nightingale wrote an excellent article in Midirs on noises in labour which is well worth getting your hands on. Women, under the influence of Oxytocin in labour, start to withdraw into themselves.  Talking and conversation dwindles (and so too should birth workers!), but the woman will naturally start to moan and groan through those surges; those noises come from deep within her and she has little control over them.

The 'purple' line
If you google this term you will find lots of excellent blogs reflecting on this phenomena, pictures on what you may see and so forth.  My favourite post is in Birth Without Fear which is beautifully written: just read that for a great explanation on the purple line.  I love the purple line; once you recognise it you can't fail to notice it.  Just wish bottoms came with a little gauge - you know, when it's this height the cervix is x-cms etc!

This is a woman who smiled
most of the way through her labour!

Sense of humour failure
When the woman is no longer smiling, then we are in serious business (except for those women who are having serene, orgasmic births - they smile a lot).  Humour can really help a woman in labour as it can ease tension.  If you follow her guide however, the more serious she becomes the less she may appreciate wise-crack jokes from her supporters, and the more likely her labour is advancing well.



It's all a bit sticky down here
Around 8-9 cms, women will discharge a sticky, blood-stained mucousy plug as the cervix really opens. Yay!  Even better still, as the cervix becomes fully open, the waters will spontaneously release if they have not done so already.  There is NO NEED to do an ARM if a women is 9 cms and membranes are intact (and yes I have seen midwives do this, because otherwise how will the baby get out?).

Cold Feet
As the uterus continues to work beautifully, the blood circulation will move more and more towards to uterus: this is why women get cold feet as labour progresses.  A German midwife (when I was a student) also taught me that the heat will move 'up the woman's' legs.  At around 5 cms, the heat will start from just above her knees, 8 cms the thighs feel cold, at 9cms, only a small amount of heat is left at the top of her thighs.  We used to have guessing games by gently placing a hand on the woman's thighs to see 'where she was'.  It doesn't always work, but is gentle and non-invasive.  Use the back of your hand to gently asses the coolness of the legs.

Pushing on through
Why, oh why, oh why on earth do some midwives feel the need to 'confirm' the onset of second stage with a VE?  Really?  As a woman moves into second stage, she will start to make grunting / expulsive noises.  These will intensify as the baby moves further down, triggering further expulsive urges.  The woman's body will start to 'open' as the rhombus lifts.  The purple line will be highly visible and prominent.  She will probably poop.  All of this will happen either quickly (as with the foetal ejection reflex), or for the vast majority of women, s-l-o-w-l-y!  Women can tell when they are 'moving' their baby and will often remark they can feel the baby moving down.  If after a period of time of strong expulsive urges, there are no external signs of descent, then a VE may be appropriate.  That time depends on the whole clinical picture.  And No, 10 minutes is not long enough.


There are many other ways of recognising progress in labour without the use of VEs (and please do share them); these are the ones I use to help me recognise that labour is progressing without needing me to 'do' anything other then keep the mother and baby safe and hold the space for the birth.  Observing the woman in a non-invasive way (i.e. not staring at her and 'drinking tea intelligently') normally enables the midwife to sense if something is not 'quite' right and provide the appropriate care to help the mother birth her baby as she needs to.  And this is usually herself.

Midwife angela 

“There is no other organ quite like the uterus. If men had such an organ they would brag about it. So should we” ― Ina May Gaskin

New Year Pop

A few months ago, a little add popped up on my computer.  I clicked it away without a thought.  A little later it popped up again; again, I clicked it away, thinking nothing of it other than it 'being annoying'.  A few days later, sure enough the advert appeared again.... and again.... and again.  I 'quickly' clicked them away and carried on with my work.  Slowly, over time, these adverts became a regular part of my day, and I stopped really thinking about them.  Just methodically removed them and carried on with my tasks: pop - click - pop - click - pop - click (getting the picture).  (If you are wondering what this has to do with midwifery - bare with me, it will make sense.)

Two weeks ago, my computer needed an overhaul; those annoying little ads had grown so much, that I could no longer log on to my blog (hence no posts for a while), I could not move on the internet without being directed to sites I did not wish to visit  (er, no I do not need Viagra thank you) and my working time at the computer ground to a halt.

Reflecting on this (and here is the midwifery link) made me think about how small interventions in midwifery practise have become a routine part of our care.  Let's take the vaginal examination (VE) for example; these are now so routine that we no longer even see them as an intervention, and yet, they can interfere so much in a woman's birth that they can slow and grind a labour down to a halt (see what I did there?).

As midwives, we are considered 'autonomous practitioners'; this means that we work to evidence base and to the woman's needs.  There is no evidence to support routine vaginal examinations and whilst they can help understand the progress in labour, most women find them invasive and unpleasant.  Encouraging the woman to 'pop' onto the bed, the 'quick' VE, the repeat of this process at routine intervals, in my opinion, slowly interferes with the midwives care and her understanding of 'normal' progress in labour, and most significantly affects the woman's trust in her body, until eventually the labour grinds to a halt and needs an overhaul (or caesarean) - just like my computer.

This year I have been blessed to attended 15 women in labour: only 6 of those women required a VE to support plans around their labour and birth.  I promised to 'share the skills' previously, but the problems with my computer jaded my work, distracted me from writing and prevented me for being 'with computer'.  Yet it took a real crisis before I addressed and faced up to the problem: it was just easier to keep pushing the problem away.  Sound familiar?

2013 has been a year of facing up to a huge problem: the demise of Independent Midwifery.  Over the past 12 months, I have been involved in the odious task of campaigning to save IMs, to save my livelihood, to save choice for women and to save a group of midwives who believe in true autonomy.  It was a problem I did not want to face up to: it is a problem that many midwives are not facing up to, and it is a problem that the Government does not wish to face (I think they hope we will all  just go away).

If midwifery is to remain a strong profession, then we need midwives to have the choice to work independently.  As we enter 2014, I feel optimistic and positive that this year will herald a change for Midwifery and that midwives will reclaim their profession.  I feel confident that I will be able to continue to practise in a way that supports women without the routine use of interventions, and that working in this way will not 'grind to a halt'.  And mostly, I look forward to not campaigning anymore - but rather to getting back to what I love most.  Being 'With Woman'.

What will your 2014 pop-up for you?

Call the Midwife – or call a midwife you know and trust?

I enjoyed reading Sarah Johnson’s recent blog post on call the midwife.  I LOVE call the midwife and read the books when I was student; how I dreamed of working in that way – a local midwife, on her local patch, working with the local women, caring for them in their own homes.   

For most midwives, this way of working is a million miles away from the reality of midwifery care within the NHS; birth at home is no longer the ‘norm’, midwives work in large centralised units, women are very unlikely to be cared for by a midwife they have ever met, normal birth rates are incredibly low and the use of analgesia and the associated risks and side effects high.  Sarah suggests that birth stools are ‘standardised equipment’ in units, and women birth in up-right positions: statistics suggest otherwise, with the NCT citing in their research that less than 40% of women are encouraged to be mobile, upright and off the bed and their backs.  I myself have visited units where birth stools may be quietly gathering dust in the corner, where huge, shiney new units are built with just one ‘token gesture’  birth pool (despite NICE guidance stating that birth pools should be available to all women as an effective form of pain relief) and where one-to-one care is not always achieved for women in labour.   The NHS offers the best it can on a shrinking budget, with a hard working yet disillusioned work force, with a growing population, and with women presenting with more and more complicated pregnancies. 

My dream of practising as a 1950’s midwife might not quite have come to fruition, but I am honoured to have carved a way of working which comes as close as possible: I care for the same woman throughout her pregnancy, birth and postnatal period; I care for women and families in their own home; I attend home births (and follow the woman into hospital if plans change).  I may not have a bike (and am about to invest in a 4x4 to make work life easier), but I do carry my own equipment and have a big ‘Midwife on Call’ sign to hang on my dashboard when I am with a woman in labour! 

When a woman in my care goes into labour, they can call a midwife – they can call a midwife they know and they trust, who will be by their side until their baby is tucked up safely in their arms, who knows all about them and what is important to them.  That is Independent Midwifery – the recognised gold standard of care, a choice for women outside of the NHS.  And it is under threat.  Just as that 1950’s midwife is no longer recognisable, so too, might be Independent Midwives; EU directives, insurance issues, and a government failing to deliver on its promise to really offer choice are seeing to that.

So, women, mothers, midwives, fathers, grandparents – if you LOVE Call the Midwife like me, if you LOVE the idea of calling a midwife you know, if you LOVE the idea of care in the home being the norm, then make sure you make a call to your local MP and tell them that!

You can find out more about this issue by visiting www.northsurreymidwives.co.uk

fear + loneliness = Brave?

I have often been told that I am 'brave' for choosing to be an Independent Midwife; I wrote about this a long time ago and can honestly say I have never felt brave, or really understood why fellow midwifery colleagues consider me such.  I am just a midwife, working to support women, some courageous and strong, some needing support to find their inner strength, but all who wish to have the bulk of their care outside of the NHS system, with a midwife they know and trust.

I attended a beautiful home birth this week; I was not anticipating to be the primary midwife, but the woman's own midwife was caught in Jury service and unable to attend. I gathered myself together and headed off to the birth - I knew the woman and her family having supported them as the second midwife with their first baby.  As always, I mentally prepared myself, and drew inner strength and calmness into my being.  I was not aware that I would be doing that many times in the course of the woman's labour..........

Birth works: if you follow my blog you will know that this belief is deep in my inner core.  BUT, and there is always a BUT in nature, sometimes birth changes and sometimes nature will challenge us, humble us and remind us that she is a force that we cannot always control, always predict, always guarantee.  After the baby made its way earth-side (a beautiful, calm, wonderful HVBAC), the woman's body was not (for whatever reason) willing to release the placenta; I was concerned.  Too much bleeding necessitated a decision to transfer; a serious maternal obstetric haemorrhage occurred,  a wonderful team of NHS staff worked very hard to save a very compromised mother.  And a very shaken midwife was left holding the baby...... until he was safely tucked back with his mother later on that day.

So, back to my 'bravery'; it was with a sudden clarity that I understood why people believe me to be brave - and it has nothing to do with me.  As I watched the team work around the woman (and I was in total awe of the NHS staff and so very, very grateful that when obstetric care was needed, we had access to it), as I supported her, reassured her, even prayed for her, I have never felt so alone in all my life; the safety net of the NHS is a strong one.    Perhaps this is the reason midwives do not challenge guidelines, or policies not based on evidence; perhaps this is why the vice on midwifery is so strong.  Not that I am brave, but because the 'safety' of working within the NHS is so strong - and watching that team, I think I understood why people would not want to 'risk' that.  Being the lone voice, choosing to leave that safety net, to be fully autonomous, to accept full accountability..... can be very lonely indeed.  The fear of loneliness is why people believe I am brave.

I am not 'brave' for choosing to be an Independent Midwife; it is a wonderful way of working.  It is 'the gold standard of care'.  It is rewarding, challenging, exciting, scary, bumpy, amazing, tiring.  It is working to keep birth normal - and safe. I am not brave...... but if more midwives were given the support to work outside of the NHS, if the government fully supported choice and continuity, if the RCM would acknowledge a group of midwives who work outside of the system, it might be a little less lonely.

angela xx

He who is brave is free. 

Lucius Annaeus Seneca 

Read more at http://www.brainyquote.com/quotes/quotes/l/luciusanna121145.html#vPE1uJcEvV29CUTm.99 

One Born Every Minute

Last night, for the first time in very, very long time, I sat and watched 'OBEM'.  It wasn't a concious choice - we had watched the great classic movie 'Stand by Me' (oh River Phoenix, what a loss) as a family, and when the DVD had finished the TV returned to OBEM just as it started.  And I was hooked; mesmerized; drawn-in and unable to move despite my intentions to get to bed as I am feeling quite unwell of late.  But there I was, one hour later, as the credits rolled.

There are lots of reasons I don't watch programmes such as this one; firstly, my family don't allow it.  They feel it's detrimental to my health as I am unable to watch without large amounts of steam coming from my ears.  Secondly, it reminds me of the fact that the way I practise as a midwife is at risk, and frankly the thought of returning to work in a large, consultant unit, fills me with dread and fear.

So what was wrong with last night's programme?  Let's start with the fact that both labours, both healthy, first time mothers, both considered 'low risk' (hate that phrase), ended with unnecessary intervention:

'Mother one' was already in early labour; as she was 12 days over, she requested to have her labour 'induced' and just get on with it.  "Good news", hails the midwife, "we can break your waters and get you going."  A birth that was starting physiologically is now having a helping hand with an intervention that brings it's own risks (which I did not see being discussed), or other options given (such as go home - you shouldn't be anywhere near a labour ward at present) and is presented to an audience of viewers as the norm (which it probably is on a consultant unit).  Mother one did give birth vaginally - on her back, epidural in-situ and an episiotomy.

'Mother two' arrives in spontaneous labour, but she stalls and after a few hours it is decided her labour must be accelerated.  And when I say decided, this was the conversation:
Midwife "You've been stuck at 4-5cms for a while, so I need to talk to the doctors to decide what to do"........  "The plan is the get you going and put a drip up to get some oomph behind those contractions".  Interesting use of language, a really great way of not demonstrating informed CHOICE and decision making - the mother was not even included in that, the midwife and doctor decided - and another birth that needed a 'helping hand'.  It was however really fantastic to see the mother using an 'alternative position' and standing as she birthed her baby.

After watching the programme I am now aware of several things: Midwives are in charge and know best; women are clearly malfunctioning when it comes to labour; physiological birth doesn't work.  I am so grateful to have had those points clarified and to recognise that it must be time to change my practice as I am very outdated in my beliefs that birth is normal; that labour has it's own rhythm; that women should be involved in all aspects of the decision making; that the amniotic sac provides a safe, protective barrier in labour; that vagina's are designed to stretch to birth a baby; that facilitating a safe, warm, quiet, environment aids progress in labour.  Thank you to the powers that be (insurance companies and eu regulations) that foolish midwives like myself, or like Virginia Howes need to be tamed and brought into line and that we are wrong.

I clearly am one of those 'born every minute' that needs to be reminded on prime-time TV that birth does not work and the NHS knows best.

angela x

Home Birth is for Hippies?

This was an original article I wrote a few years ago and felt it was relevant again.....

“I’m planning a Home Birth”. It amazes me that this simple, short statement can evoke such a torrent of emotion and be an area where people feel they have the right to comment on someone else’s choices; the phrase ‘you’re so brave’ springs to mind here. Yet without doubt, the discussions and thoughts around home birth bring to mind many powerful images, not least of ‘danger and emergency’, but for some, the image that the ‘sort of woman’ who may choose home birth, as being a slightly alternative, incense burning, ‘hippie’.

Home birth is not a new concept; home, since the time of (wo)man, has been the place where women birthed their babies. In the beginning, home was most likely to have been a sheltered cave, nestled on a hill-side somewhere, and over time has developed into the style of housing that we now know in the western world. Hospital as a place of birth however, is a fairly recent development in the time line of history and yet it has been culturally accepted as the safe place to give birth, even though study after study, report after report does not uphold this notion. Now, don’t get me wrong here; the advent of technology, obstetrics and the caesarean birth have played a hugely important role in making birth safe for both mother and baby – and we now experience very low rates of maternal and infant mortality and morbidity. However, it is not exclusively through birth taking place in hospital that has lowered these rates so significantly, but the development of excellent antenatal care, drugs for the prevention of haemorrhage and infection, and the development of health professionals’ skills in recognising and managing emergency situations.

In an article in ‘The Times’ newspaper (May 09), journalist Melanie Reid launched a scathing attack on women who had or were planning home births: she labelled them as spoilt and complacent, insinuating that intelligent women choose hospital birth, and only ‘sandal-wearing' women (the hippie word again?) would choose home birth.

True? – far from it;

Factual? – indeed not;

Emotive? – yes and yes again.

Ms Reid is not alone however in voicing her opinion, and this is part of the problem for women who are considering home birth – the emotion that decision causes, the myths around home birth and the presumption of ‘safety’ deter many women from pursuing, what is in fact, a very normal, very safe choice.

I had my third baby at home; it was a well-researched, informed, intelligent decision. I met some opposition along the way, but on the whole felt well supported and confident in this decision. No, it was not my ‘first baby’, but how I wish it had been! I had never truly considered home birth an option, after all I did not know anyone who had given birth at home. I had been born in hospital and I was not a sandal-wearing hippie. Why on earth would I want a home birth? Well after experiencing two less than positive hospital births, I felt instinctively that there had to be another way. And there was, and it was fantastic – hard work – but empowering, positive, and ‘uniquely normal’.

The home birth rate in the UK is around 2%, but in parts of the UK the home birth rate is a staggering 50%! In areas where the home birth rate exceeds the average, there are some telling trends in the way maternity care is delivered: midwives actively offer home birth throughout pregnancy and discuss it in an open, friendly manner; women share positive stories of their home birth experiences - giving other women confidence in their own ability to give birth; and women are attended at home, in labour, by a midwife (they often know) and make the final decision on the big day itself! This gives them the freedom to see how they are feeling and coping, knowing that they will be well supported by the midwife, by family and birth supporters, whatever their decision. I would challenge anyone to categorise all those women as hippies.

The DoH has aims to increase the home birth rates for women to experience real choice within maternity services; of course this is still to be delivered and is an ongoing issue for most women.   Following the inception of the NHS it took national campaigns to persuade women to give birth in hospital, needing continual reassurances of cleanliness (hospitals were previously associated with mortality due to infection – very different from now?), and the influential offer of 10 days rest and food. The stark reality in the UK at present is that hospital birth no longer comes with the benefit of complete rest – women are encouraged to leave as quickly as possible due to the high demand for beds (at home you get your own bed); NHS trusts are stretched to capacity with midwife shortages on the labour ward (at home you get your own midwife); and the caesarean section rate is spiralling out of control (planning a home birth halves the chance of you needing a caesarean section).

Hospital is the perfect place for giving birth for the woman who may need additional obstetric care, who may need paediatric care for her new baby or who may not have the support in place to have her baby at home – and no one ever seems to feel the need to comment on those decisions. Next time someone says to you “I’m planning a home birth”, take a closer look; I expect you will find a normal woman, making a normal choice, planning to have a normal birth in the perfect place for her. And not a ‘hippie’ in sight!

Even a future Queen to be is still ‘just’ a Mother to Be.

The exciting news was announced that The Duke and Duchess of Cambridge are expecting their first baby; whilst the Duchess recovered from Hyperemesis Gravidarum (a debilitating acute from of morning sickness) and amidst all the excitement and media hype, was the devastating outcome of the ‘prank call’ and the everlasting ripples from the fall-out:  not the most positive start to a pregnancy for any couple, yet alone a couple who are prominently held in the public eye.

So what next for the Royal Couple? Well, just like any other new parents-to-be, before any of the screening, bloods, ultrasound, place of birth, type of birth choices they make, they might like to consider who they invite to care for them; they may choose to have their care with a private obstetrician, or they may choose to use their local NHS system, or they may seek a known midwife to support them in their pregnancy; but they do have a choice over all of these.   Essentially, having someone to talk to might make negotiating all those choices a little easier!

If I was Kate’s midwife (as her midwife, I would call her Kate, and she may call me Angela), I would spend time with her talking through her options; in-between appointments (that would be in her own home, and at convenient times, with appointment times that William could also come to) I would encourage her to read widely; some books I might suggest to her would include ‘Ina May's Guide to Childbirth’, Childbirth without Fear: The Principles and Practice of Natural Childbirth ’ and ‘What Every Parent Needs to Know: The incredible effects of love, nurture and play on your child's development’, as well as giving her up to date information on nutrition, screening and normal pregnancy ailments.   (I did google pregnancy books for Royalty, but it just found the Royal Free in Hampshire!)  We would drink tea together, share concerns, and build a trusting relationship, and she would feel secure in knowing that she would be well supported in her choices, and that on the big-day, someone she knew would be at her side when her baby was born.

This type of midwifery care enables women to really make choices; we also know that they are more likely to have a normal healthy pregnancy, a  normal straightforward birth, more likely to establish breastfeeding, and less likely to experience postnatal depression.   Pretty compelling reasons as to why one-to-one midwifery care is so important, and why it is essential that women know that this is the care they should receive as the norm, that they should be shouting loudly for, and that shouldn’t only be open to those whose NHS trust is forward thinking, or those who can engage an Independent Midwife like myself, and whose way of working is under threat.

The hype around the beginning of The Duke and Duchess’s pregnancy will hopefully settle and they will be able to look forward to the next 8 months or so (albeit it being very much the talk of the nation).   Expecting a baby, is for most people, a joyful, exciting event;  but every woman, whether it’s her first, second or subsequent baby, may still have the same anxieties, the same pregnancy complaints’ and may have to make some of the same choices that other mothers will – even if she is a future Queen!  

but that's just silly!......

Last week, and with my home-educating mummy hat on, I ran a 'morning with a midwife' workshop.  12 bright eyed children aged between 9 and 15 arrived at my home for a two-hour interactive workshop.

We started of by covering the role of the midwife, and what kind if checks we do; they played with my sonic aid and listened to each others hear rate; they guessed if one of the mum's BP would be high or low, and they giggled as they 'explored' their own pelvis - finding their coccyx and poking around their bottoms!

Children are brilliant (well mostly brilliant, unless they are annoying or I am having a bad day), but on the whole brilliant.  They see things so clearly, and haven't been dis-illusioned by adult-hood, and are still naturally thinking out-side the box - this, I am delighted to say, made teaching them great fun.

After they had labelled up some large pregnancy charts, we looked at the physiology of how the cervix opens, how the baby descends through the vagina and how the baby rotates and fits (perfectly) through the pelvis.  Having tired of the poor messages passed to children (and adults) about birth, I used positive language: I talked about the intensity of birth, and how women cope really well with this and can rest between surges, I talked about how the baby is squeezed and 'cuddled' by the uterus with every surge, I talked about how the baby is pushed out and it feels like a huge urge to pooh!  They got it, and accepted it, and asked about it, and then there was this Eureka! moment: to help the children visualise the size and weight of a growing baby, I had created a basket with different items weighing approx weights at different gestation.  I had an orange for 20 weeks (200gms) and so forth, with the final weight of the basket about 3200g (7 1/2 pounds ish in old money).  Using the pelvis, I showed how easy it was for the orange to get through when the 'mummy' was kneeling or on all fours, then I turned the pelvis into semi-recumbent and......... the Orange just sat there.  Eureka!  

..."but that is just silly!  why would you do that?!....."

asked a 9 year old.  Why would you do that?  Why would a woman give birth in the most physiologically challenging position you could choose? Why would a woman shut her pelvis and work against gravity?  Why would we do something so silly?  Well if a 9 year old can get that, then why are the vast majority of women giving birth on their backs?  Why are student midwives qualifying having NOT supported women in 'alternative' (don't get me started on that phrase) positions? Why why why? 

One for Mr Marr!

I feel there are many reasons (sadly) why this continues; the medical mode of birth, the use of pharmacological pain relief, ease for the midwife, the images of birth that are portrayed in the media?  None of these of course make it OK, or acceptable, but I do think the latter is a huge influencing factor. It's almost as if women expect to birth in that position - the children did, as that is what they have seen - until shown otherwise.  So perhaps then, it is the Film and TV producers of the world we should be talking to?  Certainly, in the opening issue of Andrew Marrs' History of the World (a brilliant programme I might add) the ancient African homosapien is seen to birth in the 'typical' semi-recumbent position.  Historically, women birthed upright; using trees, kneeling, squatting to give birth; not sitting with their bums and vagina's in the dirt.  It would have been much cooler Mr Marrs if your production team had shown that!

Perhaps it's time to remind ourselves of the Wonderful Female Pelvis, to remind women, doctors, parents, teachers, children, and the Film Industry of how perfectly designed we are to birth and how women - when well supported - will adopt the 'alternatively brilliant' birth positions that aid birth naturally.  Perhaps it's time for a new slogan:

'don't take it lying down!'..... 'knees for ease!......'using the (all) fours of gravity!......  suggestions please!

and here is a little something to share: (catch it here too http://www.youtube.com/watch?v=MswFqXdOq2U)

Enjoy!

angela xx

Celebrating Normal Birth

I am off-call!  After attending and supporting 8 beautiful, strong, wonderful mothers since April, I am now due a short break.  I have learnt so much and had the immense honour of attending:

• a home 'land' birth
• a home VBAC in water
• a breech hospital birth
• a caesarean birth
• 4 home water births

I am taking my short sabbatical from being on-call in order to rest, reflect and regather my energy.  

In the mean-time, I am planning a workshop for Student midwives and doulas on Physiological Birth: birth is a normal process, a part of life and something that women should be well supported through.  Marsden Wagner writes eloquently and honestly about the dehumanisation of birth here - food for thought indeed. 

Mothers and midwives we need to reclaim birth, we need to honour the strength and courage of all women and we need to do it now.  A fantastic new website has been created for women to share their experiences of birth and midwifery - and to campaign to improve the care that women receive.  Take the time to visit the site and make your own entry....   birth is 'uniquely normal' and we need to celebrate this!

First 2012 Baby....

Last week saw the arrival of my first baby of the year!  A bouncing baby boy arrived on Thursday morning after a very long labour.  Fantastically proud parents and a new mummy who was so amazing in labour and made it look easy for most of the time.

I did (of course) cry when he was born; we had transferred in from a planned home water birth as contractions were quite spaced out and mum was getting quite tired, despite all her best efforts to get energy on board and to rest where possible, it felt like the right decision to visit our local unit.  We had good care and baby arrived a few hours later.  Getting home again was more tricky; I am puzzled with my NHS colleagues obsession with testing blood sugars on a baby.  Really?  A well, term baby with quite a lot of fat to spare (did I mention he was a 'bouncing' boy), who had a good birth really should not need to have so many holes in his feet.  Poor thing resembled a pin cushion once they had finished with him and by all accounts this would have continued until a strong-minded midwife realised it was nonsense and they stopped.

Hurrah for stroppy midwives.

Baby your a Firework!

This week has been incredibly busy with bookings and enquiries; must be something in the water! I was also privileged to attend a home water birth on Bon Fire Night. Instead of watching the local fireworks display, a beautiful little girl entered the world very quickly and swiftly much to her parents surprise and delight; this time we did make it into the pool but only just!

Welcome to the world baby girl.

Angela x

Revealing the Lioness!

I have been very fortunate over the past few weeks to have attended two wonderful home births. The women who let me into their homes and hearts both had personal challenges and fears to overcome in order to face and meet their labours and births; both needed to regain belief and confidence in their bodies, and to trust in the power of birth.


As I watched these amazing women dig deep, bare their souls, and allow nature to release it's full force, I couldn't help but feel I was part of something more than the birth of a baby; I was also present at the birth of a mother..... and the birth of a strong, fearsome Lioness!


I haven't cried at a home birth for a while; of course I shed tears of joy, but during both these births I shed soul tears for the courage, love and bravery that unfolded before me, and I was reminded that Women really are incredibly amazing. Wow!

Is having a home birth selfish?

This was a question posted on the popular 'Mumsnet' website and caused a lot of response. I have thought about this question a lot (insomnia gives you time to think!), and I guess my response to that would be that there are many decisions we have to make as parents that are life changing, for example:

• is it selfish to vaccinate / not-vaccinate?
• is it selfish to place a child in full-time nursery care / be a full-time parent?
• is it selfish to home-educate / use state schooling?
• is it selfish to have one child / have 4+ children?

All of the decisions we make as parents are difficult ones: all we can hope to do is make the best decision, based on the information and evidence we have, at that time. Choosing to give birth at home does involve risks, but so does choosing to give birth in hospital and contrary to popular belief; hospital does not guarantee a safe outcome.

Planning a home birth based on the evidence available, is shown to be a safe, normal choice and is nothing new; Women have birthed, and will continue to birth in the place that feels right for them. The question of being selfish is therefore an unnecessary and judgemental one to pose. We are all individuals who have to make choices - as with the examples above they may not be the same choices that other parents may make, but they are no less valuable or 'right'. Birth and parenting is not 'black & white' but is made up of many shades, and every day brings new challenges and choices. I know I don't always get it right, but when it comes to important, life influencing decisions, I try to make the best decision I can at that time!

Selfishness aside, having a baby is a unique, life-changing experience; for some women they will need all the interventions that high-tech birth can offer, for some women they will choose to give birth in their local hospital, and for some women they will choose to give birth in the comfort of their own home. All choices should be respected, all women should receive the best care they can, and all women should feel supported in the decision they have made, rather than bullied, coerced or belittled into doing something that is not right for them.