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.