Rest and be thankful

Not long ago, I saw a brilliant example of a mum instinctively using relaxation, rhythm and ritual (what Penny Simkin calls the '3 Rs of Childbirth') to cope with the strong sensations of labour. Anyone who came in the room while she was having a surge would have been forgiven for thinking that she was 'not coping', as she used all of her body and voice to show just how hard she was working. However, as soon as each contraction was over, and the muscles of her uterus relaxed, she blinked and smiled around the room and said, 'It is lovely though, the rest you get in between, it is wonderful.' She then appeared to be in a state of total bliss until the next surge came and the hard work started all over again.

Initially, to me and her birth partners, this dramatic shift between intense discomfort and absolute rest was pretty funny to observe. It was a total and immediate change, and the first time it happened, we all (including mum) got the giggles. But when she was still making this transition, with every surge, 8 hours later, it was less funny and more awe-inspiring. By drawing on her apparently natural ability to live in the moment, and, I'm sure, a wealth of juicy endorphins, she was able to feel her rest periods as keenly as her contractions, with apparently no fear of what was going to happen next. It was incredible to watch, and a great example of how you don't have to birth silently to be coping well.

Writing on Mindful Birth, Nancy Bardacke breaks down the time spent with the uterus contracting compared to the time available to rest in labour. A widely-accepted (if imperfect) definition of active labour is when a woman is having three contractions every ten minutes, with each contraction lasting a minute, and with this pattern happening for over an hour. This, in theory, means that in a text-book first stage of labour, there are seven minutes available out of every ten to rest. In an hour, that would give us a potential 42 minutes of rest! I appreciate that, in reality, it's not that simple. But it's certainly interesting to consider. 

This mum was an absolute trooper, and I was delighted when I came in the next evening and found out that, after all that work, she'd had an uncomplicated birth about an hour after handover. I wish I could bottle what she had - a kind of eau de mindfulness - and pitch it to mum's across Yorkshire. Unfortunately, I'm neither scientist nor magician. So the rest of us will just have to put in a little work, and try to master what she did naturally through regular practice in the lead up to our births!

#Birthnerd

I'm not sure anymore what this blog post - intended as my first - was originally meant to be about. Something to do with women and midwives needing to be brave or similar, I'm sure I'll get round to writing it eventually. The thing is, as I sat down at my computer, I got distracted by the fact that I couldn't think of a single catchy umbrella term for people like me who are 'into' pregnancy and birth. Like 'foodies' or 'twitchers', but to describe those of us who basically live for oxytocin. 

'Birth enthusiasts' is already in circulation and a recognised genre (according to one online book store), but it's a bit dreary. When I typed 'birthophile' into Google, it autocorrected to 'burritophile', making me think it's not really a thing.

I then spent a considerable amount of time trying to invent a term myself.  A quick look at some Collins 'birth' synonyms for inspiration threw up only: birthing, childbirth, delivery (something else altogether), accouchement (romantic but decidedly un-catchy), parturition (which reminds me of sheep) and nativity (nativists is, sadly, already a thing). 'Birthivists' is out there, but its meaning seems to be more political than the catch-all term I'm after. 

An hour on, tiring of the ambitious task I'd set myself, I started cruising the entries for the 2016 International Association of Professional Birth Photographers Image of the Year competition.  A brilliant decision that introduced me to some sensational shots of childbirth and, in particular, the work of globe-trotting doula Angela Gallo, who is at least 100% radical (if I have gained one thing from my ARM membership, it is the right to use the word 'radical' freely and with relish).

In Angela's blog on natural birth in the hospital setting, she writes, 'if you are a birth nerd like me...'  And there it was, the term I'd been looking for: BIRTH NERD. It's even works as a hashtag. 

Keen to explore just why this term was so pleasing, I did a bit more research into its meaning. 'Birth' we've already covered... but 'nerd'? 

The first, kindly, definition of 'nerd' that I found on-line was, 'A single-minded expert in a particular technical field'. Single-minded? Maybe sometimes. And expert? I'd like to think so. A less generous definition, and one we might be reluctant to identify with, was this: 'A foolish or contemptible person who lacks social skills or is boringly studious'. But, if we take a moment to think about it, proponents of natural birth are regularly subjected to ridicule and contempt. Even those of us who have a well-developed understanding of the benefits of timely medical intervention when it is needed. Think, for example, of Melissa Kite's delightful assertion, 'Natural birth enthusiasts need C-sectioning' (she blogs for the Daily Mail, I'll say no more). But do we really lack social skills? Anyone who's ever sat down to dinner with a bunch of would probably say so (we have absolutely no appreciation of when it's appropriate to talk about placentas). And are we boringly studious? Well, yes, because we have to be. We have to know our stuff if we are going to defend natural birth in a culture which is increasingly medicalised. We have to use science to convince people that we're not just a bunch of hippies, skipping around wooded glades, waiting for the woman spirit of the forest to come to deliver our babies. We - midwives, doulas, hypnobirthing teachers - have to be birth nerds if anyone is going to take us seriously. 

So, Angela, thank you for introducing me to this delightful phrase. I now know that I am Julia: midwife, hypnobirthing teacher and #birthnerd. I shall be using the term liberally.

I'll take another 24 hours please...

Women have the right to make choices about what happens to their bodies in pregnancy and childbirth. The Government says so. The NMC says so. Our national clinical guidelines say so. UK law and the European Convention of Human Rights say so. Birthrights offer this simple fact sheet on human rights in maternity care for those of you who want to read a bit more.

As a final-year midwifery student, I spent months writing a dissertation on informed choice in pregnancy and childbirth - specifically, on what maternity professionals felt and thought about it. I trained at a hospital where Julie Frohlich, Consultant Midwife and passionate advocate for personalised maternity care, ran a clinic dedicated to women whose choices fell outside the guidelines (if you have access to MIDIRS, you can read one of Julie’s articles here). 

Put simply, maternal informed choice has always been ‘my thing’. So why, when I hear a story of a woman calmly and ‘successfully’ implementing her right to choose, am I still surprised?

Anna, a brilliant first-time mum called me when she was 36 weeks pregnancy to tell me that a scan had confirmed her baby was breech. Over the next couple of weeks, she sought advice from her carers and tried every safe means to turn her baby - moxibustion, yoga, hypnotherapy, external cephalic version (ECV) (when a doctor or midwife attempts to turn a baby by placing their hands on the abdomen)… All to no avail - it seemed her baby was very happy bum down.

During this time, we spoke a number of times on the phone and discussed the advice and evidence available on breech birth. While we were talking, I was struck by how neutrally she received the information I gave her. She listened, and asked more questions, but rarely responded with emotion or, more specifically, expressed any fear. For her, it seemed, this was a true information gathering exercise. Her local hospital had recommended an elective caesarean at 39 weeks; Anna requested to wait until 41 weeks to see if her labour started naturally (I had the impression that, even then, she hadn’t totally decided what she would do if it did!)

For a while, things went quiet. Then I received a text from Anna telling me that her waters had broken at 38 weeks and, after choosing to wait for 48 hours before any further intervention (apart from IV antibiotics), she had gone into labour naturally - Anna’s birth story, in her own words, can be found here.

What impressed me about Anna’s approach to the whole situation was that she really seemed to take things one calm step at a time, all the time listening to advice, gathering information, and paying attention to her own instincts. When her waters broke, she asked to wait for 24 hours to see what happened. When that time was up, after discussing things with her carers and assessing the risks, she decided to wait another 24. A plan was made for an elective caesarean if things did not progress naturally in this time - both mother and father were happy with this plan.

Now Anna is a very smart woman. But so are many of us, and we have unique insight into what we feel and want in pregnancy. So why is it so difficult for us to make our own decisions at the time of birth?

Well, firstly, let us not underestimate the power of fear. More than anything, parents want what is best for their babies - the thought that we could inadvertently put our child at risk is enough to deter many of us from questioning the advice of healthcare professionals, even when we might have good reason for doing so. The feeling is often that, if a particular course of action is recommended, it must be the right thing. However, a somewhat daunting truth about childbirth is that, sometimes, there is not one right course of action - in these instances, the best route must be determined by considering available evidence and resources and, of course, the mother’s preferences. And, often, there are practical difficulties to following a certain course - one hospital or practitioner might feel confident, for example, supporting vaginal breech birth, while another does not. By the end of a long pregnancy, many mothers are tired and more than ready for their baby to be born. Women rarely want to change Trusts at this time, or lock horns with hospital seniors, in order to pursue their choices. 

So how do we move forward? Well, in an ideal world, we work together. Just because individuals might differ in their approach to childbirth doesn’t mean that their aims are fundamentally opposed. Far from it, we all want the same thing - a healthy, happy mum and baby. 

Hypnobirthing prepares partners to help the mother communicate their wishes at the time of birth. One aim of hypnobirthing is to reduce stimulation of the labouring woman’s neocortex (the more ‘civilised’, intellectual part of the brain) so that they can turn their focus inward and not be distracted by worldly problems, such as when the next vaginal examination is due or how many centimetres dilated the cervix is. In my practice, I have seen that, sometimes, partners interpret this role as an almost combative one - they feel they must defend their loved one from the unwanted interference of midwives and doctors. This attitude is not conducive to a peaceful birth, and I cannot imagine it is at all relaxing for partners to feel that they must cram sufficient information in the lead up to the birth so that they can determine which, if any, interventions are necessary at the crucial moment. But we have already acknowledged that there is not always one *right* course of action. So how do you know what is right for you?

My advice is this: befriend your midwife! Ask questions! Be curious, not confrontational! And make your preferences absolutely clear! It is a sad truth that Midwives sometimes feel limited in the extent to which they can make you aware of your choices because of the protocol at their particular Trust. By asking what your options are, you might well make her feel bolder in supporting your informed choices. And one question that is always wise is, ‘Can we have some more time?’ If you are being asked to make an important decision, ask ‘Is it safe for us to wait another hour and see what happens?’ Or, ‘Can we just have some time alone to talk about it?’ Let there be no doubt, if it is unsafe for you to wait any longer, your carers will let you know, and sharpish! 

Informed choice is an important part of your pregnancy journey, and hypnobirthing aims to provide you with information that will help you understand the context in which you give birth, and make choices - in partnership with your carers - that are right for you. If you can, like Anna, remain calm and curious when confronted with unexpected events, ask questions and listen to the answers, there is no reason why you, too, cannot be a wise and active participant in your own care.

Flirting with the uncomfortable

There can be no doubt that each woman ‘feels’ birth differently. The pain of childbirth is talked about often and loudly; pain-free labour is considered by many to be a rarity and, by others, a myth. But, as a midwife, I can confirm that comfortable birth really does exist. And that women have tremendous resources when it comes to dealing with the uncomfortable! I still remember one young mum I looked after several years ago - between each expulsive surge, and even as her baby's head was being born, she kept saying (with apparent glee), ‘Now this is interesting!’

Hypnobirthing proposes that when you prepare the mind in advance of the birth, and release fear, you move yourself closer to the comfortable end of the birthing spectrum. However, as Nancy Bardacke (author of Mindful Birthing) reminds us, ‘A preference not to have an epidural or pain medication means that, in fact, your preference is to experience the strong sensations of childbirth...’  If we accept this, then we have a strong incentive to prepare the mind and body for these sensations, so that we can experience them without feeling overwhelmed at the time of the birth.

Recent research suggests that the minds of people who use mindful meditation techniques work differently when they encounter painful stimuli: by paying attention to pain, without fear or judgement, it seems we can effectively ease it. This makes sense, as mindful meditation encourages us to be curious about the sensations of the body while avoiding unhelpful, emotional reactions to them (you can read more about this research here).

Now I am not a Zen master, and I assume you’re not either (otherwise you probably wouldn’t be reading my blog about hypnobirthing in Sheffield). But since starting meditating, and using certain hypnobirthing techniques (in non-birthing situations), I have been pleasantly surprised by my ability to take a step back from daily discomforts and alter my response to them.

Here are a few examples of how I’ve been flirting, and dealing, with discomfort in my daily life:

  1. Cold water - letting warm skin come into contact with chilly aqua is always a good way to test your mettle; a number of birth preparation courses invite women to hold ice cubes so that they can practice 'being with' discomfort for an increasing length of time. I was recently in Spain and determined to go into the sea (for context, there was not a single Spanish person anywhere near the water, as, by local standards, it was still effectively Spring). The first time I went in, I performed all my usual antics - hopped around, hunched my shoulders, chattered my teeth, turned round to check my boyfriend was watching the whole pantomime from the beach… The second time, inspired by Nancy’s Mindful Birthing (my holiday reading), I made sure I did none of those things. Instead, I focussed on exactly what I was feeling as I moved step-by-step into the water. By doing this, I was able to establish that, step-by-step, I was actually quite comfortable. My histrionics, it turned out, were far less about what I was feeling ‘now’ and much more about what I imagined I would be feeling ‘then’, when the rest of my body was plunged into the water.
  2. Traffic - today, I had to drive my boyfriend to Meadowhall so he could get a bus to London. What should have been a forty minute round trip took me one hour and 50 minutes. Fun! As the traffic built up, my immediate reaction was to huff and puff and think, ‘This is AWFUL.’ Then, I took a mental step back and asked, ‘But, is it really?’ And it turned out, it wasn’t. After all, I had nothing in particular I needed to do when I got home, and, once I’d succeeded in directing my brain away from pissy thoughts, I found I had some useful thinking time to plan this blog.
  3. Itches - when one next happens to you, try, instead of scratching it straight away, to really feel it. See what happens, it might well go away on its own. To scratch an itch is, in fact, a choice. Who knew?
  4. Spin classes (or whatever your uncomfortable exercise of choice is) - increasingly, I’ve been using mind ‘tricks’ to get me through the tougher stretches. When my fearful brain says, ‘Can’t,’ I prompt my subjective brain to say, ‘Can.’ When my panicking brain starts screaming, ‘My legs are about to fall off,’ my calm, know-it-all brain says, ’But how’s the tip of your nose, bet that’s well rested!’ In this way, I can make it through the whole hour; occasionally, I even enjoy myself. 

I mention these examples because, for me, they represent small steps towards much bigger change. If you’re browsing hypnobirthing websites, chances are you’re pregnant (or thinking about it) and keen to do hypnobirhing (or thinking about it). If that’s the case, then now is a great time to start flirting with the moderately uncomfortable. Because whatever kind of pregnancy and birth you have, your body is going to be doing some pretty 'out there' stuff over the next few months - trust me, you are going to feel like you’ve never felt before. By engaging with harmless discomforts now, turning them over in your mind and observing your reactions to them, you can start to understand what strategies might work for you at the time of the birth. And when you’re ready, sign up to a hypnobirthing course. Because it works!