I'm not good at this blogging lark....

It's been a while since my last confession, I mean blog post. I'm not good at this blogging lark....

But maybe its time to get digits to keys again.

Anyway, I first wrote about my feelings regarding my son's birth about 5 years ago. 

I have since edited them a little on a couple of occasions as I continue to grow and learn. 

So I decided to revisit them again and put them out there on my blog.  

Disclaimer: These are my own personal feelings and are not to be considered 

in judgement of anyone else's or as medical advice

Caesarean feelings

• I hate that I was so naive as to expect 'Them' to guide me through labour
• I hate that 'Their' ARM was the beginning of the end, as my baby was back to back with a deflexed head and I was lying down for Foetal Scalp Electrode.
• I hated 'Them' asking me if I wanted my baby to die. (It was actually a Him)
• I hated the shivering
• I hated the vomiting afterwards, so much so that I had to ask for less effective pain relief so that I wouldn't be sick.
• I hated having to care for a baby with an abdominal scar as well as a broken wrist (broken a week before CS)
• I hate that I couldn't even look at my scar for years afterwards.
• I hate that I ended up with PND and my marriage broke down.
• I hate that I lost two years of memories. I can't really remember that much of life back then.
• I hate that 18 years on I could still cry about it
• I hate that my VBAC 12 years later was affected by the primary CS and I ended up with spinal and forceps and not feeling the birth.
• I hate my episiotemy.
• I hate that I'll never get to feel a baby being born
• I LOVE that I've become a Doula because of my childbirth journey, and a Hypnopbirthing Practitioner (The Wise Hippo Birthing Programme) and now a Complementary Therapist, offering NO HANDS Massage (including massage during pregnancy, aromatherapy, reflexology) 
• I LOVE that I've met some wonderful midwives who show me what midwifery should really be like.
• I LOVE that I now know some very wonderful people all working to make a difference in maternity services so that our daughters and their partners may not necessarily suffer birth trauma. This includes the lovely 'family' of The Wise Hippo Birthing Programme. 
• I LOVE that I found NO HANDS Massage which protects me as a therapist and provides me tools to provide a wonderful treatment.
• I LOVE that my various 'hats' all utilise the fabulous hormone Oxytocin.

I can be grateful for my primary Caesarean 22 years ago because without it 

I wouldn't be doing what I am today, I wouldn't be where I am today 

and I wouldn't be able to reflect on previous times throughout my life 

that have been challenging and see what they've taught me in quite the same way.

Are some birth quotes damaging to women?.

This is a blog post I started two years ago and got stuck with. This is why I have not really posted since June 2010.

"We have a secret in our culture, and it's not that birth is painful; it's that women are strong" - Laura Stavoe Harm

I have this quote on my Facebook profile. Let me tell you why.

I believe the fact that women are strong IS a secret and sadly it is kept secret from many of us. I did not know I was strong, I knew very little about my body, my hormones and myself. I had to reach my 40s before I began to realise. I had to have an emergency caesarean, post-natal depression, query Post Traumatic Stress?), a VBAC with spinal and forceps (so I still feel that my baby was extracted) and it was only after I began to become more holistic in my life that I began to realise. Seeing www.beautifulcervix.com  (wish I'd seen this as a teen), for example, actually listening to my instincts rather than ignoring them, etc. has helped me to realise that I am strong, and that I always was, but that my strength and feminine instinct had been subverted for so long by science and over-medicalisation.

Medical science has given us the ability to save lives but sadly the tendancy of those in the medical profession with misquided intentions to help or fear of litigation based practice, has meant that routine intervention is actually more of a risk than a help. Iatrognic birth injury may possibly be the greatest cause of mortality or morbidity but I have no statistics, just the anecdotal stories I hear time and again.

I accept that many women do feel that some quotes hurt them, but I urge them to consider that it's not that they weren't strong. They were and they are, it's just that they didn't realise and were 'not allowed'.

We do the best we can, with the information we have at our disposal, in the circumstances we find ourselves. But for too long we have been conditioned to believe that birth is dangerous, and for too long women have been subjected to this very paternalistic system. It's no wonder we don't appreciate our strengths! So yes, it does hurt to think that we must have done something wrong and that we were not strong enough. But really, it's not our fault. 

Where did it all go wrong?

Women have lost the 'knowledge', ever since midwives were persecuted as witches back in the 1600s and then when they were superceded by obstetricians in the paternalistic model of medicine.

I hope that one day we will get back to the times when women were revered as the givers of life, when women had their faith in their abilities and no fear about birth, when women were respected for their strengths balancing against the strengths that men possess.

birthtalk.org says in her blog on June 3, 2010:

"But saying to me after a birth like that, that the secret is not that birth is painful, but that women are strong would have been like a knife twisting in my chest. It says immediately to me that ‘you should have been stronger’.  And maybe also “If you were strong, your birth wouldn’t be bothering you now”.

Of course, it saddens me greatly that women are feeling such pain. I am passionate about physiological birth, and of more women getting back to this type of birthing, but preserving their mental health is even more important to me and I would defend to the death a woman's right to a caesarean birth if this is her infomed decision. Unfortunately, women are being let down by maternity practices that do not serve the interests of individuals, and this leads to women feeling a failure because they were not able to make informed choices about their body, their baby and their birth.  

I believe women ARE strong, in many different ways, but that does not meant that we can always overcome the current medicalisation of birth when it happens to us in that fragile, hormonal birth dance of labour. However, I believe that strength will carry us forward as we strive to regain balance, as we strive to return to the instinctual, mammalian model of birth that our physiology affords us. When our birthing is returned to us, when the voices of Ina May Gaskin, Michel Odent, Denis Walsh, Sarah Buckley, Gloria Lemay and many others are finally heard by the world, then... THEN we will see just how truly strong Woman is.

Wisdom Birth

During a heart bypass operation do you think it would be wise to stop the heart BEFORE switching on the bypass machine?

No?

So why is it common pactice to immediately cut the cord of a compromised baby before taking it away to be resuscitated? How many valuable minutes are lost to the baby? This practice has become commonplace over the 20th century for reasons I shall not go into here.

Dr Sheena Kinmond co-presented the lecture on 'Avoiding immediate or early cord clamping' with Dr David Hutchon and explained to us the importance of the baby receiving its full blood volume from the placenta. Cutting the cord too soon can cause up to 40% of the baby's blood to be retained back in the placenta. This can cause a dramatic reduction in blood pessure which impacts on the ability of the lungs to inflate and transition into beathing air. Thus, you have a baby who is already compromised in a situation where her ability to revive is shockingly reduced. It makes absolutely NO sense!!!

Dr Hutchon told us, with passion, that babies should NOT have their umbilical cords cut EVEN when the baby needs resuscitation. He was very tearful at the thought of his own early practice and the damage he had been unwittingly doing before he learned about the physiological benefits of waiting. But I say to him, and all parents who accepted procedures they may have doubts about now, you can ONLY do the best you can, in the situation, with the information you have at the time.  

Robin Lim talks about when the cord should be cut on this You Tube video:

I am intrigued by the BASICS trolley that has been devised and feel that it may be a useful tool. Sadly for many of the delegates, Dr Hutchon did not have a trolley to show us, or any further information about its dimensions. However, the best place to resuscitate a baby, in my opinion, is the mother. 

Dr Nils Bergman, a doctor in South Africa who specialises in Kangaroo Mother Care, says "The mother's skin is the baby's natural environment, and both physically and emotionally the healthiest place for the baby to be".

So, we need to keep ALL babies connected to their mother until long after the umbilical cord has stopped pulsating and been cut.

What is surprising, pehaps, is that this knowedge about timing of cord cutting has been known long before we had the modern scientific research to back it up.

“Another thing very injurious to the child, is the tying and cutting of the navel string too soon; which should always be left till the child has not only repeatedly breathed but till all pulsation in the cord ceases.  As otherwise the child is much weaker than it ought to be, a portion of the blood being left in the placenta, which ought to have been in the child.”

                                                                        Erasmus Darwin, Zoonomia, 1801.

It really doesn't matter if it is a healthy term baby or a compromised premature baby.... no, scap that. It matters EVEN more to the compromised premature baby. We need medical professionals to be taught how to resuscitate a baby on the mother's abdomen. We can fundraise to get BASICS trolleys in every unit and/or we can get wall mounted resus units installed with oxygen hoses that can be taken to the baby wherever the mother is resting immediately after birth. But most of all we need to ensure that resuscitation is done to baby without separation from the mother.

Again, as in my previous post, it may be that it will be a ground swell from parents that drives the change from immediate clamping to waiting until the cord stops pulsating. Many mothers are now even waiting until the cord separates from the baby naturally. This has been termed Lotus Birth.

But also, the time is long overdue for medical professionals to stop looking at procedures for short term gain. They need to look at the bigger picture and ensure that research also focuses heavily on long term outcomes.

"Everybody doing it together" - Sheena Byrom, 26/04/12 Troon in Scotland

I forgot to talk about poop!

Well........

Ina May Gaskin and me!

That. was. a. maze. ing! 

I had the great good fortune to be able to attend the MAMAconference in Troon on the 26th and 27th April 2012. Speaking were such well respected people as Michel Odent, Ina May Gaskin, Denis Walsh, Kerstin Uvnäs-Moberg, Sheena Byrom, as well as many others and amongst the delegates were some very knowledgeable and passionate midwives, doulas and obstetricians as well as many keen student midwives and birth workers.

During my self directed learning I could say that I have discovered most of what was presented and discussed over these two days, but that does not detract from the wonderful experience of sitting listening to such inspirational speakers. It is heartening to know that recent research affirms all that I believe in when it comes to physiological birth and that nothing has changed to affect my passion for birth. New advances in research and maternal medicine only serve to further benefit the understanding of how birth works. I feel justified in my beliefs about physiological birth and in the emotional and spiritual side of birth. Something which scientists will find hard to quantify.

So, what were the greatest discoveries for me from the conference?

The shocking realisation that many 'professionals' in maternity services still don't get physiological birth. This is 2012 and yet our midwifery and medical schools still don't teach enough, anything like enough, about physiological birth, it would seem. 

I have read about avoiding early cord clamping, I understand the physiology of it, I understand that the blood circulating between the baby and the placenta belongs to the baby and is separate from the mothers blood. Yet, my jaw dopped to hear from an obstetician that he knows of some other obsteticians who think that by not clamping the cord the baby will get the mother's blood!

If this is true, then Michel Odent's thoughts that 'We are at the bottom of the abyss in childbirth' are correct. He is 82 and no longer wishes to be politically correct. He feels that we need to 'rediscover what is simple'.  I believe he is right, we can no longer afford to work quietly in the background, changing the face of birth one birth at a time, we have to act fast, and NOW!

Michel Odent with Chair of Conference Gillian Smith,
RCM Director of UK Board for Scotand

Michel was explaining more about epigenetics, which I have read a little about, and watched programmes on TV. It is my understanding that the genes that our parents give to us also have markers on them which can be primed (often during or by the process of physiological birth) to activate at different points. If I understand correctly, in relation to childbirth, this could mean that in even just one generation we can be affecting women's ability to birth. If babies are born by surgical means will their genes have markers on them which say that a vaginal birth is not necessary? It is incredibly scary to think that by interfering in birth where not necessary we could be speeding up an evolutionary process beyond our expectations. Perhaps it is not just global waming that Man has influenced! We can be affecting our future generations in many other ways we don't yet understand and it is possible that current birth practices of epidurals, synthetic oxytocin, immediate cord clamping, instrumental deliveries and Caesaeans without a valid medical reason could be having far reaching and serious health implications for future generations. Thinking about asthma, mental health issues and austism to name but a few....

As Michel says, "It is becoming serious!"

The common consensus from speakers such as Dr David Hutchon, Dr Sheena Kinmond and Denis Walsh is that there is VERY little evidence base to many current birth practices in modern facilities. We suffer from a very paternalistic approach to childbirth which has little understanding about physiological birth. But as Denis said "Some things that really count, can't be counted".  So how can obstetricians and paediatricians understand birth and newborns if they cannot do ethical research, and indeed if some of them can't seem to even grasp basic biology and physiology?

Most work to the principle that all that matters is a healthy baby. They forget to look at the emotional and spiritual side of birth, they neglect the mother. The presentations by Dr Roch Cantwell and Mia Scotland came from quite different perspectives but confirms my own beliefs that we are affecting mothers' mental health detrimentally and that a very much more holistic approach needs to be considered when caring for mothers during the antenatal, perinatal and postnatal periods.

It comes back to mothers then, listening to their instincts. Women need to stipulate in their Birth Preferences what they want for a physiological birth, and indeed for a necessary surgical birth. They need to demand that their wishes be respected, they must decline certain offers of intervention if they so wish. They must gather the strength to NOT defer to the experts. Change is ONLY going to happen from the ground up.

And there is evidence for this.

Ina May Gaskin's figures at the Farm Midwifey Centre in Tennessee actually speak for themselves. Women going to her and opting for physiological birth can expect to have one. Between 1970 and 2010 there were 2844 women planning a birth at the Farm.

• 1.7% ended in a Caesarean (compared to US 32.3%)
• 0.37% were forceps deliveries and 0.04% were vacuum extractions
• 3.5% were breech and of those 8.6% required a Caesarean
• 1.7% had a post partum haemorrhage
• 5.4% were induced, but this was by castor oil or by stretch and sweep
• 19 sets of twins were born, all vaginall7
• 1.5% epidural (compared to US 80+%)
• 99% Breastfeeding Initiation (compared to US 50%)
• 0.39% Pre-eclampsia (compared to US 7%)

I know of women who have demanded their wishes be respected in some challenging cases. Although we cannot make birth 100% safe in all cases, whether home births or Caesareans, if women take responsibility for their own bodies, their own babies, their own births then they CAN be the instrument for change.  Then perhaps the medical people will have more of a chance to see for themselves what a physiological birth looks like. 

Just chatting to, or overhearing from, student midwives made me realise that in my short time as a not very busy Doula I have seen far more physiological births than most student midwives see in 3 years training, if any! And obstetricians certainly rarely see any and so their pactice is entirely clouded by fear from only seeing the abnormal. But fear is a tangible emotion, at least by hormones, and if a woman is fearful, or someone in the room is fearful, then her very clever body stops birthing to protect her baby. This is a fundamental part of labour which many medical professionals fail to grasp. If they cannot understand the very delicate balance of hormones which drive labour then it is no wonder we have such high intervention rates. 

I call for those who understand physiological births to be given the opportunity to teach this to the upcoming medical students. This is a very important aspect that needs to be added to current medical training as it clearly is lacking at the moment.

"Oh..., I forgot to talk about poop!" - Ina May Gaskin, 27th April, Troon in Scotland.

Rainbow Holistic Therapies

Well, since my last published post I have completed a course to become a Complementary Therapist, begun working out of a wee clinic to offer treatments, taken a part time job in a supermarket in order to pay the bills while I try to build a business, embarked on a Childbirth Educators course with Nadine Edwards, met Dr Sarah Buckley, and have a blogpost unpublished which I need to revisit, update and then publish. My son has turned 18 and left home. My partner and I nearly split up but have become stronger. Humphrey is now on a raw diet, loving rabbit in particular and my daughter continues to be an effervescent whirling bundle of joy.

Tonight I have a new blogpost to write, which may take some time. Bear with me.

OMG!!!

I received an email today stating I have now been offered a place on the ITEC Complementary Therapies course and will get official notification next week. I need to arrange to get fitted for my 'uniform', and await details of where to apply for bursary etc.....

This came as a complete shock as I had resigned myself to the fact that I was not getting a place. I fully expected my Reserve list offer to remain in the reserves ;)

I am happy, I am healthy, I am whole, I am harmonious, I am strong, I am woman! :)

Instinctive birthing

My neighbours new kitten is about 8/9 months old and a very cute boy, so friendly and often trying to get into my house.

On Sat morning (5th June) I was talking over the fence with my neighbour's daughter, she had come to feed the cat as her mum was away till Sunday evening. As we were talking I noticed how big his tummy appeared to be, and we discussed the possibility of pregnancy.

Later the cat was visiting my garden, as he does and I notice a string of mucus from his back end. My mind goes into overdrive as I've never had a cat have kittens before.

We go out to the park for my daughter's birthday (it was her birthday midweek but we are meeting some of friends at the weekend) and when I get back the cat comes charging over, mieowing his head of and shoots in my house. I decide not to shoo him out, bearing in mind our fears that he is actually a she.

She makes for under the sofa and is purring away like a tractor, and checking her rear end, then I'm aware of the rasping of cat tongue on my carpet and I decide to call my Cats Protection League contact for guidance. She doesn't answer so I leave a message during which an almighty yelp came from mum. First kitten is born at 5.40pm! I keep peeking at her to make sure she is ok, and baby is ok. I speak to CPL contact who heard that yelp on the message! Then I see her eating the placenta. I try to move them to a box taking instructions from CPL, but she is having none of it and goes back under sofa, so I take the hint. Then there is nothing for a while, apart from occasional kitten mewing and purring from mum, Then I am aware of a second baby. Next time I check her she is curled up looking proud as punch with two kittens tucked up.

Much later there's a third kitten, again I saw mum eating the placenta... this is AMAZING!!!!! And then I realise from noises coming from under my sofa that there is now a fourth kitten. And now she's finished.

She seemed so happy, the purring is intense!!! She had a looooooooooooooong pee at 4am on Sunday, and ate little portions of food I stick under her nose. I placed water beside her too.

During Sunday I ensure she always had food, which she ate ravenously. I periodically check that all the little bodies are moving and vibrant. At 7am on Monday 7th June she finally has a poo, and it's a BIG one!!!! Now I can relax that all her bodily functions seem normal. Peeing and pooing is important in childbirth so I know it's important in having kittens too :) She has been seeing to their needs beautifully in that respect, stimulating them and clearing up after them. And she's barely out of kittenhoold herself. She gave me such a beautiful leasson in instinctive birthing and parenthood, whilst the kittens show just how well they are designed to find the breast. Cats are mammals. Human Beings are mammals and we definitely need the same kind of birthing space.

On Monday night she comes out from the sofa looking for food so I take the opportunity to give her it away from the sofa. While she is eating I take each kitten, quickly inspect it and put it into a carrier, finally she is shut into it as she follows her kittens. Her owner and I take her back over to her own house and quietly settle her into the room she had previously been nesting in. She does another ENORMOUS poo,  while we quickly look at the kittens and weigh them. Three are just over 100grams and the fourth is just under and feels much slighter than it's siblings. I keep my fingers crossed it continues to thrive. We arrange for me to take a spare key so that I can go over and check she has enough food etc during the longest part of the day when the owner is out. She is so grateful I took in and looked after her cat while she was away, as although she had come to realise her cat was pregnant, despite being told it was a boy when she got her, she hadn't realised she was going to birth so soon!!

This has been the most amazing experience! I am so happy to have been able to see first hand how instinctive birthing can be if left undisturbed. I often refer to Dr Sarah Buckley's articles and now I can relate even more to what she writes: 

"All mammals seek a safe place to give birth. This “nesting” instinct may be due to an increase in levels of prolactin, which is sometimes referred to as the nesting hormone. At this stage, as you may have observed with your cat, interference which the nest -- or more importantly with the feeling of safety -- will stall the beginning of labour." 

So now I am so proud of myself for fiercely guarding her birthing space, and of that young mama cat as she listened to her instincts.

This morning I read a blog by Dr Poppy Daniels.  

"As I type, I look over at my one-week old baby zonked out in his cradle swing and am in awe at how awesome his arrival was.  Instead of having my third c-section as scheduled, I went into labor on my own (first time in 5 tries) and delivered him (precipitously in fact), one hour before I was to arrive at the hospital for my surgery......   .....Reflecting back over my journey, I see how much the field of obstetrics has managed to contribute and sometimes outright cause complications, all the while assuming they are just keeping everyone safer.  And I see how much fear has overtaken the natural birthing process."

I feel so sad as I know what she has gone through is happening all the time. It's what led me to become a Doula. However, we now have at least one more mama who knows the truth, and who hopefully will join the increasing number of birth activists who are making a difference, one birth at a time.

Update: Having guarded her space so fiercely by instructing my kids to be quiet, not allowing my daughter to play on the family Wii in the living room, not allowing our cat Humphrey to have access to the living room, and having ensured she was quietly observed periodically around the clock with her space kept darkened and enclosed, I have been apprehensive about the transition from my house back to her own house. Today I went back over to check and she is absolutely fine!!! And the kittens are still good. So far, job's a good 'un :)

What life am I made for part 2

Well it's been a while since I last blogged.....

and a tough wee while at that :(. I failed miserably at my interview for Midwifery. Talk about verbal diahorrea when they asked me an open question?? 'Tell us about yourself", I watched from above myself as I spouted forth the biggest load of rubbish, realised, tried to fix it and only made it worse. It was horrendous. :( I was, as expected, rejected and advised to try again next year after getting help with my interview technique.

So I focused on applying to college to do a year's course in Complementary Therapies and reapply for Midwifery next year. I loved the idea of Aromatherapy, Reflexology, Indian Head Massage, Hot Stones, etc. These skills would enable me to provide treatments and earn an income when I get into Uni, or if I carried on as a Doula. I intended to then specialise further and incorporate Aromatherapy in to midwifery practice, if I went down that route, or add them to my skills as a Doula. Obviously, as I am not qualified I cannot offer Aromatherapy at the moment, but I do carry 4 essential oils in my Doula bag for women who wish to use them. Peppermint oil has been so beneficial to women who have felt nausea in labour, Clary Sage is one they love to try to co-ordinate their contractions. Two ladies have requested Lavender during their labours. I also carry Tea Tree oil in case anyone feels a need to disinfect their birth space.

The 'interview' consisted of a presentation to those of us on the shortlist, and us having to fill in a form. No one-to-one interview, and I wondered how they could possibly know anything about us from a mere form. Distraught, I find myself on a Reserve list, and as it's a popular course I fear I am not likely to be called up if anyone drops out. This probably wouldn't happen until the course actually starts either so makes applying for a bursary difficult..... I hate being in limbo, not knowing where my life is going. It seems that everything I plan and work for is not panning out. So, I tell myself that the Universe has something in mind for me and I will find my path.

And then, I sat my Higher in Human Biology...... what a disaster!!! I had been hoping for a reasonable pass, perhaps a high B, if results from course work, NABS and Prelims were anything to go by. But that exam?!!! I looked at the questions and so often I knew I knew the answer but could not retrieve it to be able to put it down on paper. It was so incredibly frustrating and disheartening. I'll be lucky to scrape a low C. Family and friends tell me that's still a pass, but it's a low pass and not good enough for me. Maybe this is why I have not got onto the courses I've pinned my hopes on?

I have attended Reiki I, and hope to continue to Reiki II when the Universe calls me. I jumped when I was offered the chance to do a HypnoBirthing Practitioners course, and have my first couple booked to start in a fortnight. I have also read the Secret, and found it so inspiring as I realise so much of what I'm drawn to seems to be linked in philosophy. So I cling to these positives.

I am happy, I am healthy, I am whole, I am harmonious, I am strong, I am woman!

Precluding VBAC for all women with three or more prior caesareans may not be evidence based

 AT LAST!!! More research to add to that of Dr Mark Landon.

http://www.rcog.org.uk/news/bjog-release-do-we-need-revisit-vbac-guidelines-women-three-or-more-prior-caesareans:

Planned vaginal birth after caesarean (VBAC) refers to any woman who has experienced a prior caesarean birth who intends to try for a vaginal birth rather than to deliver by elective repeat caesarean. Although relatively low complication rates, including uterine rupture, have been demonstrated among women with two prior low-transverse caesareans who attempt vaginal birth, there are very limited data available on outcomes among women with more than two prior caesareans. Neither the American College of Obstetricians and Gynaecologists (ACOG) nor the Royal College of Obstetricians and Gynaecologists (RCOG) currently recommend planned VBAC attempt in women with three or more prior caesarean deliveries¹.

In this study, the researchers sought to estimate the rate of success and risk of maternal morbidity in women with three or more prior caesareans who attempt VBAC. The study reviewed multi-centre data from 17 tertiary and community delivery centres in the Northeastern United States from 1996 to 2000. A total of 25,005 women who had a least one prior caesarean delivery were included.

The findings indicate that women with three or more prior caesarean deliveries did not experience a difference in morbidity based on whether they attempted VBAC or elected for a repeat caesarean. The 89 women with three or more prior caesareans who attempted VBAC were as likely to be successful as women with one or two prior caesareans, 79.8% compared to 75.5% and 74.6% respectively. In addition, none of them experienced significant maternal morbidity such as uterine rupture, uterine artery laceration, and bladder or bowel injury.

The older findings of Dr Mark Landon back in 2006: 

The 19-academic center study was led by Landon and conducted through the National Institutes of Health, Maternal Fetal Medicine Units Network. Its data included more than 45,000 patients with previous cesarean section, which included almost 18,000 women undergoing a trial of labor or an attempt at VBAC.

 “This was the first large study of VBAC in which certain outcomes, such as uterine rupture, were studied prospectively,” notes Landon, who serves as vice chairman of obstetrics and gynecology at the Ohio State University Medical Center.

Landon found that the risk of uterine rupture was 0.9 percent in cases of women with a history of multiple prior cesarean deliveries undergoing a trial of labor, compared with 0.7 percent in the cases of patients who had experienced only one previous cesarean delivery. These data challenge the notion that women with more than one prior cesarean are at dramatically increased risk for uterine rupture with a VBAC attempt.

“We looked at the outcomes associated with uterine rupture, including catastrophic outcomes such as stillbirth, or hypoxic brain injury to the baby,” says Landon. “And the good news is that the vast majority of uterine ruptures fortunately are associated with healthy infants. The absolute risk of catastrophic rupture with poor outcome is, in fact, quite small.”

Landon’s study confirms that uterine rupture is the complication with the greatest risk attributable to trial of labor; however, it also shows the risk for uterine rupture is not significantly increased in women with multiple prior cesarean deliveries compared to a single prior operation.

“The study has confirmed that the majority of women with multiple prior cesarean deliveries undergoing trial of labor can expect to achieve a successful vaginal birth,” says Landon, whose findings were published recently in the journal Obstetrics and Gynecology.

The benefits of VBAC include a faster recovery time and avoidance of the operative risks of cesarean section, which is a major operation.

“Beyond these obvious benefits, there seems to be a component that is not completely tangible,” notes Landon. “It goes along with the experience of vaginal childbirth, which certain women value, and there is probably not a price that you could put on that for a certain subgroup of women.”

Each case should be individualized, says Landon, in terms of the risks involved, the likelihood of success of VBAC, and the individual woman’s desire to proceed with attempted vaginal delivery vs. cesarean section. “Future childbearing plans are important, since the risk of cesarean complications rises dramatically after three operations,” according to Landon.

Landon advises that women should carefully research the topic of VBAC, looking for a physician who is willing to share data in an unbiased manner, who supports the concept of VBAC provided that a woman is an appropriate candidate, and who is willing to evaluate each case individually.

“About two-thirds of women who have had a previous cesarean delivery are actually candidates for VBAC,” says Landon. “VBAC after multiple cesarean sections should remain an option for eligible women.”

Sadly, childbirth can be risky, so can crossing the road. We don't ban someone from crossing the road just because they happened to have an accident once, or twice.  Sorry to be flippant! I appreciate that things can go wrong during any birth. They happen to go wrong a bit more often in birth which has interference. I recall hearing from two women within a week or two who had suffered uterine ruptures. Both had been induced, but only one had a previous scar on her uterus!

So, when women want to plan a VBAC, of any kind, it is important to support them fully. They are not selfish, wanting something for themselves, at any cost..... They are human beings who want the best birth possible for themselves and their baby. If they are fully supported during their antenatal and intrapartum periods they have the highest chance of success. If they feel listened to and respected they will then trust their caregivers, will believe that the caregivers will provide quality care with honesty and, if the birth deviates from normal, will be able to listen and make informed decisions quickly during labour. If a repeat section or assisted delivery is required then the mother will not feel violated, let down, coerced, traumatised.... she may well feel disappointment at the outcome not being as she planned for, but she will be happy that she laboured, that she was treated like a normal human being, that the assisted birth or Caesarean was for sound medical reasons and that she gave it her best shot. I also believe that morbidity and mortality will be reduced significantly as a result.

She will probably still be angry about the first Caesarean if she felt violated, let down, coerced, traumatised during that birth. She needs to be listened to, and her feelings respected. Too many women get told "you should be grateful"  No, they shouldn't!!!! Their feelings are valid and how dare anyone think that a woman would put her baby second to herself! But a mother is not much use to her baby, or anyone, when she's suffering from Postnatal Depression or, more likely, Post Traumatic Stress Disorder. Childbirth is more than just a physical process, it is also hormonal and pyschological. 

If we support a woman to have the best birth for her then she can feel good about a necessary Caesarean, but if we do not provide care and respect then even a physiological birth which sounds great on paper could leave a woman feeling traumatised.

I believe childbirth is very much a mental health issue.

Announcing Humphrey

I am pleased to announce that Humphrey Lyttelcat has joined the household. 

He is a BIG 6Kg, 3 yr old who is very loving and has been with us since 01/01/10.

So what life am I made for?

It's been an emotional week.

I'm doing a night class to get a qualification to support my application to University to study Midwifery. I love being a Doula but seven clients in twelve months is not going to fulfil me let alone give me pocket money. So with great trepidation I have begun the application process to get into University in order to get that elusive Degree. Having been brought up to study hard in order to get good qualifications, in order to get better qualifications, in order to get a good and well-paid job, I have always felt somehow unworthy that I do not have a decent well-respected qualification which would grant me access to that well-paid job. It's a long story but I've been out of school education for over 24 years. By this time in my life I imagined I would be comfortable and able to get holidays in the sun...

So, various news items over the last few days has left me wondering where my future lies.

The Albany Midwifery Practice is one practice I always hoped I would be able to arrange a placement with. They believe:

women have the right to be given evidence based information in order to make informed choices throughout pregnancy, birth and the postnatal period.

Fantastic! Just what I want. I am also fortunate in that I would get to do placement at local Maternity Units which also have this outlook, and it would be wonderful to go to the Farm too ;)

However, King's College Hospital have terminated their contract. Why? The Albany has low medical intervention rates, high home birth rates, and mothers who have birthed there appear to be passionate in their support. They like being able to make informed choices, they like being treated like sentient adults.

A baby died, this is very sad. But why the kneejerk reaction from King's to terminate the Albany's contract? Especially when apparently the investigation did not include comparative Data?

On another Blog, The F Word, Amity Reed reports on the effort to keep that Albany open and why it's so important for reproductive rights. Womens' reproductive right to choose where to give birth.

Why does King's College Hospital not look to it's own backyard? After all, they can't even support their student midwives sufficiently. A midwife was found hanged after she wrongly believed she was to blame for a baby's death, an inquest just heard.

Yet in Milton Keynes a coroner has branded midwife shortages at a hospital where a newborn baby girl died as "nothing short of scandalous". And it's not the first time in Milton Keynes, and Milton Keynes is not the only hospital. Being in hospital does NOT make birthing safer. Having one to one care during labour from competent and supported midwives makes birthing safest.

All over the UK I hear from midwives who are disillsuioned and leaving the profession. Yesterday I saw a letter from respected Independent Midwife published on AIMS website and I truly wonder what I will be letting myself in for. I mean, if even the Independent Midwives feel they can no longer practise what hope does Midwifery have in the UK?

Joseph DeLee's 1915 Campaign to Eliminate the Midwife is one I was horrified to read about on Unnecesarean: The Blog. However, I don't believe this attitude has fully died out, even in the 21st Century :/

So... can I enter the lions' den? Will I be able to cope for 3 or more years in the 'system' where bullying is rife, where the type of midwife I want to be is likely to be quashed? Will I be strong enough to come out the other side and be the midwife I would want to be, the midwife others would want to care for them, the midwife who gives women evidence based information in order to make informed choices throughout pregnancy, birth and the postnatal period?

I believe that women should have the right to choose to give birth at home or in hospital, to be able to plan an unmedicated home birth or to plan an elective Caesarean section, respecting their wishes whilst considering risks rationally, and then being supported compassionately whatever the outcome of the birth. Respecting parents' informed choice is paramount, even if we sometimes disagree with it.

Being part of Doula UK means that I have support and mentoring from my fellow doulas. Doulas need to be Doula'd. In fact, as human beings we all need to be Doula'd through all stages of life. I'd like to think that midwives get mentored and supported fully but once qualified I'm not sure if they do, and I am devastated that Theresa Naish felt she had no-one to turn to.

Save the Albany
AIMS

Louis RIP

How do you tell a four year old that the cat is dead? One that has been there all her life? The other one, Ella, died just a few weeks before she was born

Well, I got books out of the library, read them to her and then explained that Louis was old and had not been well. She could easily relate to the characters in the books.

She understands that Louis is dead, she wondered if he was coming back at first but I reminded her that he was dead. She talks about him doing things in the book. I wish there was a book in the library about a cat dying but there were two about dogs and one about a bear, so I got them all out.

I dug a big hole in the front  garden this morning to bury him. Then she watched me as I dug a bit more of it out this afternoon and then we fetched his body from the back garden. I didn't have the stomach to take him out of the bin liner, in case it wasn't a pretty sight. But it would probably have been ok as it was only about 36 hours and it's been VERY cold. So he felt frozen. But I wish I'd taken him out the bag to let him go to the earth quickly.....

I was just too scared she would be traumatised even slightly by seeing his body...

Silly me.

We talked about how much we loved him, that we were sad and would miss him, but that we were happy he was off chasing mice and rabbits in Heaven, that he was no longer unwell and that we knew he was happy. He no longer needed his body so we were putting it in the ground where he would be safe and warm.

So he is buried across the path from  

Ella, RIP 18/05/05 (estimated birth date 06/05/96)

Louis RIP 03/12/09 (birth date 06/05/98)

Heaven by Nicholas Allan 

Up in Heaven by Emma Chichester Clark 

Bear's Last Journey by Udo Weigelt; Christina Kadmon 

Why we need to listen to our bodies

I was lying in bed this morning, thinking....

I was thinking back to the Race Night a few weeks back when I fell and got a couple of good bruises on my ankle and knee. The ankle bruise welled up into a huge lump, which looked very wierd and freaked me out. I immediately went to get some ice and sat with my ankle on a chair being 'soothed' by the ice pack. The swelling subsided fairly quickly and I felt good that I'd prevented my ankle from looking too deformed.

As the days and weeks passed I noticed that the discolouration of the bruise on my ankle disappeared earlier than that of the bruise on my knee. So applying an ice pack helps. As usual, I forgot to take my arnica despite often recommening it for others.

So, back to this morning. I was thinking about how we don't listen to our bodies enough these days and how I'd resolved to rely more on what my body told me and less on the secientific and medical advances we all take for granted. All part of the more holistic approach to life I want to take.

Don't get me wrong, I'm not planning on going back to the times before the Industrial Revolution. I am very grateful for living in todays' times, some of the time. I wouldn't give up my dishwasher, and I miss my car which has been off the road for too long. I am grateful that we have life saving procedures and increasing medical knowledge to improve our quality of life.

But, and it's a big BUT, I believe it needs to be balanced with the knowledge our bodies hold within us. As mammals we should have an innate instinct within us. Something I've learned in my journey as a mother and a doula. For example our hormones, far from being an annoyance once a month, are very important during childbirth. Once the roles of oxytocin, prolactin, beta-endorphin, adrenaline and noradrenaline were understood I realised how well we are designed for life. I share an article written by Dr Sarah Buckley1 about the hormones of labour with women very often. Although not a scientifice person in the least I am enjoying the Human Biology course I am taking and admiring our wonderful bodies even more. They do, indeed, know what to do.

I was even discussing this with my favourite vet yesterday. He treats the human owners as compassionately as he does the animals, very important. So, he was showing me round the building as part of an open day and it was interesting to see all the equipment on site. I remarked that James Herriot would have been envious but then thought that it would be such a shame if the instinct vets have was lost. This vet agreed that it would be, as when training many years ago he had been impressed with a mentor who could diagnose with a good 'feel' of the animal. Nowadays, sometimes it might be that, rather than do a good investigation by sight and touch, vets would forego that for a routine x-ray, hardly handling the animal at all. It's not just humans that might be suffering as a result of over medicalisation but I've not even looked into that side of things yet...

So, if my ankle swelled up after that disastrous attempt at a three-legged race was it because it needed to? Our bodies know how to heal themselves and do so in the most remarkable way. If I 'help' my ankle by preventing or minimising bruising and swelling, am I in fact hindering it? I'm glad that my bruise healed well but wonder if I should have left it to do it's own devices. If it had been badly swollen and painful I might have been forced to take it easier for a few days. Rest would have been a good thing at that moment in time and as it happens, 36 hours after that fall I did indeed end up in my bed for a day with a migraine.

So my body did find a way to get some down-time after all..... :o)

References:

Pain in Labour: Your hormones are your helpers - © Dr Sarah J Buckley 2005 www.sarahjbuckley.com

Chocolate can be dangerous

So....

I was eating my favourite chocolate of choice, Minstrels, which have a shell coating. And, as sometimes happens, a little piece of this shell seemed to get stuck in the flesh in my throat and was seriously irritating me. The coughing was implusive and I could not stop, it felt a little like choking even.

I was coughing so hard and trying to make my way to the kitchen to get a glass of water but it was taking a long time. You just can't walk and cough/wretch at the same time.

Eventually the coughing was so hard it made me vomit.

Not once, all over the carpet.

Not twice, in the sink

But three times, had to stop it till I got back to the sink....

Should have stuck to the lovely fruit scones I'd made earlier. However, I thought that eating a fourth was too much.... and that the Minstrels would be better.

Well, you know what thought did, don't you?

Crochet.... just for old ladies?

I don't think so!

I'm itching to do more but have to feed the kids, and study, and stuff... can't think what really ;)

I've knitted a jumper and a cardigan but couldn't be bothered with a pattern so just did them, I referred to a pattern to get started with the crochet hats but then abandoned their goobledeegook instructions to go by instinct.

Instinct

How many of us listen to our instinct?

I mean, really listen and tune out the wonders of modern technology?

There are many times I 'know' things and later find out I was correct, but doubted myself at the time, or allowed doubt to prevent me from saying what I thought.

I was on-call as back up for a fellow Doula, and we hadn't gotten around to me going to visit the mum. We had merely talked by email so that I was clear on her birth preferences, and I had given some information that might be useful. However, I kept thinking how much I would like for my fellow Doula to have this experience as it would be her first. I couldn't shake that I would never meet this mum....

So, I am elated to have heard the joy and buzz in my fellow doula's voice as she quickly called me to say I was no longer needed on call. I can't wait to hear all about it and help her debrief :)

There have been previous times in my life where the 'knowing' was really strong. When I was pregnant with my first child I was never happier in my own body. So much so that I walked past an office being refurbished and 'knew' that an accquaintance was never going to start the job she had been offered. I spoke to her about two weeks later and she told me her job offer had been withdrawn. There were many more occassions like this during that pregnancy and I began to realise that being totally in tune with myself allowed me to tune in to other senses we don't normally recognise in today's world.

It's taken many more years to start listening more and to learn to have faith in myself and my body. I am becoming more and more holistic in my approach to life, whilst remaining grateful to the scientific advances of the last 150 or so years. My own childbirth journey, as well as the journey I have travelled to become a Doula, has led me back to instinct, and the fact that women have innate, animal instinct we have suppressed for far too long. 

I'd like to share with you one of my favourite brands - Faith In Nature very reasonably priced, smell gorgeous and have wonderful customer service so far. I feel really good getting out of the shower knowing that I'm not putting man-made ingredients on my skin. It's a little thing but it's made me feel good. As most mums reading this will appreciate we usually put ourselves at the bottom of the priority list but I'm inisiting on having these lovely products.

Cooking is not my forte but we do try not to buy any processed foods, and if there is anything remotely pre-prepared that it has the purest of ingredients. I'm not totaly organic, but try my best to use the best foods I can. And now I'm thinking about the medications we put in or on our bodies. I am very concerned about the ingredients contained in vaccines and all over the internet we can see both sides putting forward their arguments. Both my children have had all their immunisations to date, mainly because I did not have access to the information I do now and because with each injection neither of my children suffered much of a reaction. We all seem to cope well with them. But I can't help feel guilty that their cells may now have undesirable chemicals attached to them. Sixteen years ago my instinct was very concerned about putting 3 immunisations into my little baby's body at once, but back then the average person didn't have access to the internet like we do today. It's hard to find unbiased information, so I'm going to listen to my instinct on this topic as well as with the rest of life.

Instinct, and research-based evidence.

Here goes nothing............

Hi, I am going to try to empty my head of all the stuff that goes around and around in it, and put it all here. This means that there will be quite an eclectic mix of randomness but should contain my thoughts on childbirth, cats and crochet plus lots of other useless useful tidbits.