How to have a positive birth when the maternity system is on its knees

Posted by: on Jul 30, 2018 | No Comments

In 2018 you would think we would have it sussed when it comes to how we treat and educate birthing women. We’ve had a long time to figure this stuff out – millennia in fact. So why are some women still having a really hard time giving birth?

We are going to go on a little journey. It will all seem like doom and gloom for the first half of the blogpost but trust me – by the end of the journey, you’ll realise it’s anything but. Bear with me and you’ll find out why. Now back to the subject in hand….

It’s not like we don’t have information available – I mean, we live in the age of information – information about how to give birth most easily has literally never been so freely available as right now. We have the means to be connected to all kinds of people across the globe.

 

Unlike women in previous centuries, we have vast online virtual libraries we can access at our fingertips – written by midwives, doctors and all kinds of really knowledgeable experts and lay people. It’s all out there. For those who don’t do the online thing, we have enough books, midwifery journals, research papers and magazines to fill whole football fields that have been written on the subject of giving birth. Many books we can borrow from our local library, books we can pick up for pennies second hand, at shops or online, or brand spanking new, from across the globe. We could not have any more access to information about birth if we tried. Women can buy old (or not so old) copies of  midwifery journals on ebay – that’s how accessible information is to us now. So why are so many mothers still in the dark?

Even this modern maternity system with its all-singing all-dancing technology and all the millions of quid thrown at it still aren’t preventing babies born distressed, birth trauma to mothers, PTSD, postnatal depression or women feeling dehumanised or butchered.

We should be crying out “Why are such large numbers of women coming out of birth feeling broken, traumatised and even violated!” The statistics are unacceptable in such a supposedly developed country. Where are we going wrong? And why aren’t we more angry about it?

The answer to this is because birth has become another industry – run on a system of conveyor belt standardisation. Robotic. Machines and monitors and litigation and targets are slowly taking the place of the personal judgement of a highly skilled, personal midwife. We’ve taken our distrust and fear of birth and women’s knowledge to new heights, and so much of it is based on untruths. Untruths which suit people who stand to make thousands if not millions from keeping everything just the way it is. And many many good people are working within that system. Kind-hearted people, making a difference to some lucky women. The rest however, are just processing us all like cattle – on automatic mode and no longer caring like they might have once done about individual women any more – because caring hurts too much, or simply takes up too much energy and headspace in a busy day of targets when they don’t even have time to so much as go for a piss for 9 hours straight, and they just want to get their head down and do their job without getting noticed too much, or bullied for standing up for individual women wanting anything outside of protocols. I have a lot of love for these tired and good people. But I’m just saying it like it is.

Midwives are over-stretched, and undervalued. They are expected to do magic with little support from above but are harangued with threats and consequences if they make even a tiny mistake. It’s not their fault the system’s shit. It’s a system built on the principles of a masculine model of industrialisation and profit-driven interests that are driving this maternity machine.

If this all sounds doomy and gloomy, take heart. There is plenty to feel good about. There is a thriving and active counter culture working hard to help women have positive and personalised, fully human experiences – trying to change the system from within and without. I know some really good people working within the system who are dedicated and passionate and somehow surviving in the rather toxic culture that they are expected to work in. They are the rebels, the movers and shakers who refuse to let women be just another number on the conveyor belt. They are the advocates, quietly working in the background, people you’ve probably never heard of, passionately working to bring love and common sense to women’s birthing experiences. Midwifing. Facilitating gentle Caesareans. Advocating. Campaigning. Writing. Making documentaries. Speaking at conferences. Doulaing. Educating. Giving the finger to the ‘computer says no’ culture. Or just tirelessly shouting the message: “We need to treat women and their babies better than this”. Up and down the country and around the world they are meeting up in hospital meeting rooms, conference rooms, in living rooms, in online forums, at events and gatherings of all kinds, trying to do better, to find solutions for women to push back against the mass and impersonal industrialisation model. You’ve most likely never heard of many of them but they number in the thousands. I know this, because I move in these circles!

So what can you personally do to improve your own birth experience?

 

Learn how your body works and which interventions are evidence-based… or not….

Firstly, it’s important to acknowledge that most people’s education on birth is shockingly lacking or based on media dramatisation or disproportionately blown up fears inherited from a crappy narrative about birth and what women’s bodies are capable of. Our education system is a bit rubbish when it comes to teaching us about our bodies so it’s up to you to learn about birth physiology if you want to stack the odds in your favour for a natural birth. If you don’t understand how your body works, and if your midwife is working on outdated or non-evidence based ways of supporting you or ‘managing’ your birth because that’s what her bosses insist on, you are more likely to be nudged along the conveyor belt and end up with interventions you might not need – including a caesarean. I’d like to say I’m kidding but I’m being deadly serious.  Many caesareans that are happening today are just not medically necessary at the onset of birth but become necessary after a string of other interventions stresses the baby and makes it unsafe for them to stay in the womb and endure the process of labouring in that particular way any longer. I wish I was making this up. But I know too many birth experts who are speaking, touring, writing, documentary-making, frustrated, sad, angry, broken and passionately verbal about this very phenomenon. Taking the time to study and familiarise yourself with some midwifery slang and understanding the variations of normal gives you a better chance of being able to ask confidently and assertively when you feel you actually DO need an intervention.

Find the birth books that midwives are inspired by

Instead of reading whatever is in your local bookshop by celebrities and authors such as Gina Ford (never had babies or been a midwife so her advice is actually pretty dangerous), try reading any one of these amazing authors – Milli Hill… Natalie Meddings… Ina May Gaskin… Dr Sara Wickham… Sheila Kitzinger… Michel Odent… Mark Harris… AIMS publications… Prof. Sheena Byrom OBE… Janet Balaskas… Dr Sarah Buckley…. Penny Simkin… Kerstin Uvnas-Moberg… Becky Reed… Frederick Leboyer… Rebecca Schiller… Dr Amali Lokugamage… Prof. Soo Downe OBE… Maddie McMahon… Kicki Hansard… Pam England…. Margaret Jowitt… Mia Scotland…. Adela Stockton… Katrina Berry…  look them up – they’re all, without exception brilliant and knowledgeable authors with a absolute wealth of birth experience. Whatever you do, don’t rely on NHS information alone!

Hypnobirth your baby

It’s not a fad, and in other parts of the world they have understood the power of the mind for millennia. It works, and when taught properly, can help you even if birth takes a turn in a different direction than you hoped for, giving you coping tools for life beyond the birthroom, and beyond  plan A.

Consider an Independent Midwife

I know it’s a lot of money, but consider hiring a private midwife – it will possibly be the most important couple of grand you ever spend in your entire life. More important than fancy nursery furniture, buggies or the latest car, expensive holiday or a big wedding. The positive ripple effect on the rest of your life will far outweigh the inconvenience of paying out. Continuity of care from the same person is proven to help birthgiving women on multiple levels – it’s the gold standard which all midwives wish they could give but so often can’t because of the institutional shite they have to wade through. The one’s who stay on after their shift has ended or will come and visit you even though they’re not being paid for it are like hens teeth.

Think about hiring a doula

Doulas mother the mother. We offer continuity of care by getting to know you before you give birth, are a solid, calm, reassuring presence during labour, and stick around for the days and weeks after in a way that is so much harder for midwives to do (Not their fault). We signpost you towards evidence-based information, but equally help you to cultivate a sense of trust in following your own gut feelings – that famous mother’s intuition. Doulas offer non-judgmental and loving support to you and your partner and being independent of your usual friendship or family circle can be an advantage as it means we don’t bring any of the baggage to the birth which can sometimes happen when having other family members or friends come to your birth. We offer positivity and perspective based on what is evidence-based rather than feed you negative stories because of aunty Doris’s neighbour’s sisters awful birth story or what your sister in law saw on One Born Every Minute!

Create a circle of positivity

Pregnancy is a time to immerse yourself in positivity and listen to and read stories of women gave birth in a positive way, even if things didn’t go to plan. Sharing positive stories instead of trading horror stories will help you much more. Check out Natalie Meddings website and facebook page for her TellMeAGoodBirthStory movement. And if you want a real dose of positivity check out all things Milli Hill. She has written a great book that has just come out, sparked a movement by the same name.

Hang out with people who uphold your dreams and visions without laughing at you or putting you down.

Birthplace Matters

Have you weighed up the risks of giving birth in hospital? Or only looked at the risks of homebirth? Setting foot in a hospital building opens you up to protocols and interventions which may otherwise be avoided at home. People often look at the benefits of hospital without considering the benefits of home too. It’s important to dig deep and look at actual benefits vs perceived benefits and actual risks vs. perceived risks. Sometimes we can be swayed away from hospital by such tiny statistics that we overlook other larger statistics which may be undesirable or compromise us and our babies if we go into a technical environment which may be offering us a false sense of safety.

Know your rights

If you don’t know what your rights are, how can you stand up for yourself with any conviction? Of course, it’s better not to have to use your voice or put your foot down, to have to refuse or rebel. It’s so much nicer and easier to be able to just let go and trust – but this needs to be in the right context. It’s certainly an easier life in the moment just going along with what you’re told to do. But, if we don’t have a basic sense of what’s what and how birth works best and easiest or the tenacity to follow our instincts even against medical advice then sometimes we can be soft-talked and tricked into things that aren’t in our (or our babies) best interests. (Many of us have been there, so if you’re reading this and nodding – you’re not alone). I strongly advise all mothers-to-be to read a copy of the AIMS book ‘Am I allowed?’. It’s a book which clearly sets out your birthing rights. I also recommend you read Rebecca Schiller’s online articles and book. She works for Birthrights, and is very knowledgeable about all things relating to this area. Sometimes it helps you have more resolve if you understand a gentler way to do a procedure which is being done elsewhere and it doesn’t hurt to ask or assert yourself to ask others to do something a new or different way.

What does this all mean?

It’s not possible to know exactly how birth will unfold, but you can be prepared and supported in ways that you might not otherwise be if you just go along with someone else’s (well-meaning) flow and you can still have an amazingly positive birth which puts you firmly in charge of all decisions even if your plan A doesn’t work out. It’s scary and it’s adulting to take on that full level of parenting responsibility and decision making but your parenting doesnt begin once the baby is born – we have to do what feels best for us and our babies even if others don’t agree. You have all the tools and knowledge you need at your fingertips and with the right team, you can have a truly beautiful and positive birth even in these strange, modern times!

How you can help women avoid birth trauma and PTSD

Posted by: on Jul 1, 2018 | No Comments

What causes birth trauma?

According to the Birth Trauma Association, it’s caused by a number of things:

  • Lengthy labour or short and very painful labour
  • Induction
  • Poor pain relief
  • Feelings of loss of control
  • High levels of medical intervention
  • Traumatic or emergency deliveries, e.g. emergency caesarean section
  • Impersonal treatment or problems with the staff attitudes
  • Not being listened to
  • Lack of information or explanation
  • Lack of privacy and dignity
  • Fear for baby’s safety
  • Stillbirth
  • Birth of a damaged baby (a disability resulting from birth trauma)
  • Baby’s stay in SCBU/NICU
  • Poor postnatal care
  • Previous trauma (for example, in childhood, with a previous birth or domestic violence)

There are some things we really can’t do much about, that as we say, are in the lap of the gods.

But whenever and wherever we can make things even a little nicer, easier, and less traumatic we really should be collectively striving for that. No matter how tired, exhausted, overworked a health professional might be, some things should be a reflex, inbuilt into our behaviour. No-one’s perfect, and we can learn from mistakes – it’s never too late to do better for our next client or service user!

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10 ways to help avoid / minimise birth trauma

1)  Point out what the protocols of your hospital are, but do not use coercive or bullying language EVER.

Make it clear what they are but always make sure women are aware that

- mothers-to-be are not legally bound to follow protocols

- there are sometimes several schools of thought around an area and that it would be wise for them to do their own research beyond the NHS leaflets to make an informed decision

- that protocols are designed for the general public, not each woman specifically or idiosyncratically

- she will often have several pathways available, some of which are not recommended but she is free to choose if she wishes, presented without emotion or persuasion – not just one you want to push on her because of your own preference.

2)  Acknowledge when you don’t know enough about a subject rather than pretending you do.

Signpost to robust, evidence-based sources and up-to-date information. Ask the mother how she is feeling and what her intuition is telling her to explore and research more closely. Instead of trying to look infallible, just admit ‘ this is outside of my knowledge’ and then point them towards someone more expert than you. Make a point of being open to learning things that are new and out of your current knowledge, so you can give women only what you know to be truly accurate information.

3)  Never dismiss a mother’s intuition.

If a woman has a strong feeling about something – trust her. While collecting birth stories for Birthplace Matters, I heard from so many women who had very accurate knowledge or intuition about how their baby was doing, either that everything was fine or that something was wrong, or how close they were to pushing their babies out, which was ignored. One example I hear a lot are stories from women in relation to dilation and pushing. I recently talked with a doula friend who had supported a woman who went from 6cm to having a baby in her arms in just 15 minutes. It can honestly happen.  So don’t shout at a woman not to push because she isn’t dilating according to the Friedman curve.

4)  Support women’s informed decisions

If she chooses a pathway that is outside of guidelines, try and find it in your heart to support it, without badgering her and bullying her over and over to get her to co-operate in an ‘our way or the highway’ campaign. Acknowledge she is going outside of recommendations and give her your care and loving support anyway. She is a fully grown adult not a silly child – don’t treat her like one. Her parenting right to make decisions for her baby doesn’t begin once she leaves the hospital and sets foot across the threshold of her own front door – that responsibility is hers NOW already. Make it clear to her that you understand that, without tutting, frowning, and making snide remarks please.

5)  Give statistics responsibly and talk about benefits as well as risks

Simply saying, for example that your baby’s risk of abc doubles if xyz happens is a terrifying prospect to any mother. However, if you tell her her babies risk of something doubles from 0.05 percent to 0.1 it gives woman a more realistic sense and is more helpful in making them make truly aware so they can arrive at their own carefully weighed up decisions – if there are risks to something, women need to know using maths not misleading language designed to scare them. Let them weigh up the benefits and risks of a particular pathway – NEVER make decisions for them by omission – if you are only presenting them with one option when you know damn well there might be 2, 3 or 4 options then you are forcing a pathway that isn’t chosen freely.

6)  Advocate for them even if you don’t agree with their choices and defend their human and maternal rights regardless.

Refer women to others with specialisations in supporting whatever the woman herself wants to choose, and don’t take her non-compliance as a reason to take it personally or be nasty. It’s not about you.

7)  CONSENT!

You should not be doing anything to a woman without her consent, and in order to make sure you have gained her consent, you must explain fully what you are doing or what a recommendation is. And remember it is just that – a recommendation, or suggestion.  You can’t put your gloved hand inside a woman and get consent as it is going in. You cannot break her waters without her consent. You cannot do anything at all to her or her baby, unless she gives her consent. Even if you think it’s in the best interests of the mother and/or baby. This is not your baby, your birth, or your body. She will live with the consequences of your actions so make sure she said yes and understood first!

8)  Read the birthplan

It’s completely reasonable for women to express their wishes and when something is written in black and white it should be read by staff. You are public servants to her, not vice versa. She is not there to grease the wheels and make your shift easier. Her taxes pay for you to be there assisting her and she may only give birth once or twice in her lifetime. This may be everyday work for you, but for her, this is one of the most important days of her life

9)  Gentleness costs nothing

No matter how many times you’ve stitched a vulva today, or put in an IV drip or cannula, or catheter, no matter how busy, rushed or tired you are – please remind yourself of the human in front of you who may walk away with PTSD because of your actions – this woman is not a piece of meat but a living, breathing, feeling, person with dreams, future memories, and rights.

10)  Remember why you joined this profession

If you think you can’t offer gentle care anymore, consider moving on to another career path. It doesn’t make you a bad person to admit that. It makes you a caring one who won’t let women suffer because of traumatic practices which are ingrained into the people working around you which have become so normalised they’re not even seen clearly for what they are any more..

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The links below are from the Birth Trauma Association website:   http://www.birthtraumaassociation.org.uk/about-the-bta/research

Allen, S (1998). A Qualitative Analysis of the Process, Mediating Variables and Impact of Traumatic ChildbirthJournal of Reproductive and Infact Psychology, 16: 107 – 131.

Allen S North N and Elliott P (2005) An investigation of the relationship between PTSD and PND symptoms and factors mediating the development of PTSD following traumatic labour experiences ( Paper available from Sarah Sllen Department of Psychology Southampton University SP17 1 BJ)

Andreucci CB1,2, Bussadori JC3, Pacagnella RC4, Chou D5, Filippi V6, Say L7, Cecatti JG8;Sexual life and dysfunction after maternal morbidity: a systematic review. Brazilian COMMAG Study Group; WHO Maternal Morbidity Working Group.

Ayers S Eagle A Waring H (2006) The effects of childbirth related PTSD on women and their relationship : a qualitative study. Psychol Health Med 2006 Nov 11 (4) 389-98

Ayers, S, Bond, R, Bertullies, S and Wijma, K (2016) The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework. Psychological Medicine, 46 (6). pp. 1121-34. ISSN 1469-8978

Ayers, S. & Ford, E. (2012). PTSD following childbirth. In: C. R. Martin (Ed.), Perinatal mental health: a clinical guide. (pp. 155-164). M&k Update. ISBN 1905539495

Alvarado R Perucca E Rojas M Monades J Olea E Neves E Vera A (1993) Gyneco obstetric aspects in women developing postpartum depression. Obstet Ginecol 1993;58 (3) 239-4

Ayers, S and Pickering A.D. (2001) Do Women Get Posttraumatic Stress Disorder as a Result of Childbirth? A Prospective Study of Incidence. Birth. 28 (2): 111 – 118

Ayers S Thoughts and emotions during childbirth: a qualitative study. Birth 2007 Sep 34 (3) 253-63

Ballard, C. G. et al (1995) Post-Traumatic Stress Disorder (PTSD) after Childbirth. British Journal of Psychiatry. 166: 525 – 528

Beck, C. T. (2004) Birth Trauma – In the Eye of The Beholder. Nursing Research. 53(1): 28 – 35

Beck, C.T. (2004) Post-Traumatic Stress Disorder Due To Childbirth – The Aftermath. Nursing Research. 53 (4): 216 – 224

Beck CT (2006) The anniversary of birth trauma; failure to rescue Nurs Res 2006 Nov-Dec 55(6) 381-90

Born L , Soares (2006) CN, Phillips SD, Jung M, Steiner M Women and reproductive related trauma Annexe NY Acad Sci 2006 Jul 1071:491-4

Boudou M Sejourne N Chabrol H Childbirth pain, perinatal dissociation and perinatal distress as predictors of PTS symptoms Gynec Obstet Fertili 2007 Nov 7

Callahan JL, Hynan MT Identifying mothers at risk for postnatal emotional distress: further evidence for the validity of the perinatal post traumatic stress disorder questionnaire J Pernatol 2002 Sept 22 (6) 448-54

Church, S and Scanlan, M (2002) Post-traumatic Stress Disorder After Childbirth. The Practising Midwife. 5 (6): 10 -13

Cohen et al (2004) Posttraumatic Stress Disorder after Pregnancy, Labor and Delivery, Journal of Women’s Health, 13(3): 315 – 324

Creedy, D. K (2000) Childbirth and the Development of Acute Trauma Symptoms: Incidence and Contributing Factors. Birth. 27(2): 104 – 111

Crompton, J (1996) Post-traumatic Stress Disorder and Childbirth. British Journal of Midwifery. 4 (6): 290 – 294

Crompton, J (1996) Post-traumatic Stress Disorder and Childbirth: 2, British Journal of Midwifery, 4 (7): 354 – 373

Czarnocka, J and Slade, P (2000) Prevalence and predictors of post-traumatic stress symptoms following childbirth. British Journal of Clinical Psychology. 39: 35-51.

DeMier R.L. (1996) Perinatal Stressors as Predictors of Symptoms of Posttraumatic Stress in Mothers of Infants at High Risk Journal of Perinatology. 16 (4): 276 – 280

Emerson, W. R. (1998) Birth Trauma: The Psychological Effects of Obstetrical Interventions, Journal of Prenatal and Perinatal Psychology & Health”, 13 (1): 11 – 44

N. Goutaudier , N. Séjourné , C. Rousset , C. Lami  & H. Chabrol Octogone Negative emotions, childbirth pain, perinatal dissociation and self-efficacy as predictors of postpartum posttraumatic stress symptoms

Gamble, J.A. et al (2002) A Review of the Literature on Debriefing or Non-Directive Counselling to Prevent Postpartum Emotional Distress. Midwifery. 18: 72-79

Holditch-Davis, D et al (2003) Posttraumatic Stress Symptoms in Mothers of Premature Infants. Journal of Obstetric, Gynecologic, and Neonatal Nursing (JOGNN), 32 (2): 161 – 171

Hynan, M. T. (1998). The Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ). In R. W. Wood and C. P. Zalaquette (eds.) Evaluating stress: A handbook of resources, 2: 193-199. Lanham, MD: Scarecrow Press.

Joseph S Bailham D (2006) Traumatic childbirth: what we know and what we can do. RCM Midwives 2004 Jun 7 (6) 258-61

Kennedy, H.P. (2002) Altered Consciousness During Childbirth: Potential Clues to Post Traumatic Stress Disorder? Journal of Midwifery & Women’s Health. 47 (5): 380 – 382.

Menage, J. (1993) Post-Traumatic Stress Disorder in Women Who Have Undergone Obstetric and/or Gynaecological Procedures. Journal of Reproductive and Infant Psychology. 11: 221-228

Nicholls K Ayers S (2007) Chilbirth related post traumatic stress disorder in couples; a qualitative study. Br J Health Psychology Nov 2007 12 Pt 4 491-509

Parfitt, Y. & Ayers, S. (2009). The effect of postnatal symptoms of post-traumatic stress and depression on the couple’s relationship and parent-baby bond. Journal of Reproductive and Infant Psychology,stress and depression on the couple’s relationship and parent-baby bond. Journal of Reproductive and Infant Psychology, 27(2), pp. 127-142. doi: 10.1080/02646830802350831

Priest SR Henderson J Evans SF Hagan R (2003) Stress debriefing after childbirth: a randomised controlled trial. Med J Aust 2003 Jun 2 178(11) 542-5

Reynolds, J.L. (1997) Post-Traumatic Stress Disorder After Childbirth: the Phenomenon of Traumatic Birth. Canadian Medical Association Journal. 156 (6): 831 – 834

Rowan, C. Bick, D. Basots, M.H. Postnatal debriefing interventions to prevent maternal mental health problems after birth; exploring the gap between the evidence and UK policy and practice. World views Evid Based Nurs 2007 3 (2) 97-195

Sandstrom M, Wiberg B, Wikman M, Willman AK, Hogbierg U. A pilot study of EMDR for PTSD after childbirth Midwifery 2007 Jan 12 th

Soderquist J Wijma K Wijma B Traumatic stress in late pregnancy J Anxiety Disorders 2004 18(2) 127-42

Soderquist J Wijma K Wijma B Traumatic stress after childbirth; the role of obstetric variables. J Psychom Obstet Gynaecol 2002 Mar:23 (1) 31-9

Soet, J. E et al (2003) Prevalence and Predictors of Women’s Experience of Psychological Trauma During Childbirth. Birth.30 (1) 36 -46

Turton, P. et al (2001) Incidence, Correlates and Predictors of Post-Traumatic Stress Disorder in the Pregnancy After StillbirthThe British Journal of Psychiatry. 178: 556-560

Vaiva et al (2003) Immediate Treatment with Propranolol Decreases Posttraumatic Stress Disorder Two Months after Trauma, Biological Psychiatry, 54: 947 – 949

Van Pampas MG, Wolf H, Weijmar Schultz WC, Neeleman J, Aarnoudse JG

Post traumatic stress disorder following pre eclampsia and HELLP syndrome J Psychosom Obstet Gynaecol 2004 Sept – Dec 25 (3-4) 183-7

Wijma, K. et al (1997) Posttraumatic Stress Disorder After Childbirth: A Cross Sectional Study. Journal of Anxiety Disorders. 11 (6): 587 – 597