Tag Archives: Ina May Gaskin

Birth keeper or Baby catcher?

I felt compelled to comment on a great blog my the brilliant Rebecca Wright today. It can be seen here entitled “Are you a birthkeeper? Then don’t catch babies.” She was commenting upon the language used by birth workers in a facebook post which said “because maternity care providers are not serving mothers’ needs, more doulas and non-medically trained supporters being called on to catch babies.” She made great comment about mothers being the ones who should catch their own babies and why.

I’d like to elaborate further on my comments here, as this is an interesting subject, and I didn’t want to fill Rebecca’s site with my ramblings.

I was privvy to a conversation last year about the midwife’s role, brought about by the looming end to legal independent midwifery care. One party said when Independent midwifery becomes illegal we will be doing what doulas do anyway. The other camp were vehermently defending the title of midwife and not wanting to be compared to the service a doula provides. The arguement got heated (as is the way with passionate women!), and it was mentioned that women dissatisfied with their maternity care were indeed employing doulas to attend their births. Further heated discussion about the legality of this followed.

This got me thinking about what Independent or Authentic midwives do at a birth. I’ve been very honest over the past few years, telling my clients that I won’t actually be delivering their baby, they will. In fact most of my time (between the nurturing/ loving type of things) is taken up writing notes and drinking tea. I need women to realise that its not like on telly where the doctor heroically swoops in at the last moment to pull the baby out. It is the woman’s body, love, sweat and pure determination which get the baby born.

Several years ago I noticed that some women reach down to receive their own babies at the point of birth, but some are ashamed to touch themselves “down there,” especially if they are being watched! As a student midwife I recall watching my mentor move a woman’s hand away so she herself could ‘do’ the “delivery”. I’ve never been very directive myself, and have learnt the most by observing what women do naturally. Some women need to be informed that catching their own baby is possible as the power has so often been taken away from them. Professionals sometimes forget that they are there to serve the needs of the mother and baby – and not tell her what to do! (another post brewing on the balance of power). I remember telling a friend pregnant with her second child that I thought she could catch her own baby, for a number of reasons. I had seen many women slow down the birth of their baby if it was coming quickly and others who protect their own body in this way, giving tissues time to stretch (after practicing 11+ years I have never seen anything worse than a second degree tear). My friend did catch her own baby and tells all her friends that they can too!

empowered birthI’ve been mulling over what it means to be a midwife, what Independent midwives can call themselves, and how they can still serve women after October this year. I’ve also been thinking about what difference there would be between what a doula or I could legally do at a birth. There is potential for several posts on this, so I’ll try to stick to the current theme.

As a midwife I know it is the woman’s baby and not mine. I’m sure he prefers his mothers touch to mine, and encourage women to receive their own babies. I’ve shied away from unessesary internal examinations, and refrain from telling women how, or when to push, because I have attended many births where the mother does something totally unexpected and it turns out brilliantly. I remember being present at a birth centre birth where I was the second midwife. The woman was in advanced labour and spontaneously pushing with her first baby . We were prevented from being nosey, birth coach midwives, as visibility in the room was poor. The lights were dimmed and the water was a little cloudy, so our torch light couldn’t penetrate the water. Despite our efforts with torch and mirrror we could see nothing. I was concerned that I wouldnt be able to help her prevent a tear if I couldnt see when to tell her to pant, or give smaller pushes. As she pushed she spontaneously reached down and told us that she could feel the baby advancing, and before long told us baby was emerging. She lifted the baby triumphantly to the surface knowing she had done it all herself! We examined her perineum a while later and she had no tears. I told myself that women can obvoiusly prevent tears better than I can with all my experience.

I cannot bear midwives or doulas who brag about their ‘catches’ or how many deliveries they’ve done. I’ve no idea how many births I’ve attended (although it must be several hundred by now), and feel that keeping numbers makes it into some unsavoury sort of competition (like notches on a bedpost), rather than a unique event in someone’s life! Its a shame this bad habit starts in midwifery training where students have to get 40 deliveries to qualify as a midwife. Its not about numbers, its about people. I fail to see what student midwives learn when they are shoved into rooms to deliver a baby at the last minute, without knowing the woman, just to get their numbers. It can’t be nice for the mother either.

Being an authentic midwife means having the wisdom to not do everything you’ve been taught to do. The past 10 years of practice have been about unlearning the medical model, and learning from women. I like to think of it as a reverse Ina May Gaskin midwifery journey. A journey back to basic loving care, and being a birth keeper for the women and babies I serve.

Last word from Rebecca Wright: “Not all doulas or midwives are birthkeepers, of course, but the essence to me of this concept is exactly what you express here: service to mothers and to birth. Birthkeeping (and authentic midwifery) to me is about holding mothers and babies at the centre of their own experience, bringing with us whatever skills or talents we possess that are needed in that space, but always with humility and discernment.”

Thank you Rebecca for fueling my fire. xx

 

The Third International Breech Birth Conference. Washington DC November 2012

Robin Guy
Heads Up breech birth conference

I was lucky enough to be invited to lead a workshop at this years International Breech birth conference.

My qualifications are that I have been lucky to work with Breech birth expert Mary Cronk MBE as an Independent midwife. We attended several breech births together and thus I started to learn breech birth skills. Our midwifery clients alowed us to take photos of their births for teaching purposes, and these have further added to our knowledge as we studied the many and varied ways breech babies are born.

My workshop was entitled “Arse Backwards” as my journey to learning breech birth skills started with the most unusual births. A double footling, a foot then knee, a foot and extended leg, VBAC breech birth – all at home, were marvelous to attend and record, to share with other health professionals and women expecting breech presenting babies. Unfortunately I do not have permission to share these photos on-line which is why Mary Cronk and I travel the country (and abroad) sharing the stories and skills of breech birth.

My presentation told the story of how I learnt breechbirth skills, and how important it is to share these skills with others, to give women the option of skilled birth attendants at their breech birth. I took along video footage of Mary Cronk sharing her wisdom which was very well received.

I also learnt a tremendous amount at this conference which will aid me in the future care of women planning spontaneous breech birth.

I hope to have time to write up the highlights, but until then check out the brilliant Rixa Freeze’s blog

Association of Radical Midwives monthly discussion group.

This is a local group for the support of peaceful pregnancy, birth and parenting. Hosted by Joy Horner, radical midwife, mum, lecturer and some day writer. Inspired by the Freedom For Birth film I am determined to impart information about human rights in childbirth, facilitate discussions, and to support women on their journeys to parenthood. You don’t have to be a midwife, a radical, or a female to attend. All those with an interested in women’s rights and experiences in pregnancy and childbirth are welcomed. These stimulating monthly discussion groups are designed to encourage experience sharing and debate, accompanied by tea and cake. All welcome. Donations for refreshments welcomed as 50% given to local charity Towards Tomorrow Together.

2013 Meetings at my house 7:30pm-9:30pm:

Thursday 8th August – Birth rights and choices.

Tuessday 3rd September – Waterbirth evening.

Thursday 3rd October – Postponed due to midwifery commitments.

Thursday 7th November – Am I allowed? how to get the best from your pregnancy, birth and postnatal care experiences.

Thursday 5th December – Blissful, ecstatic or orgasmic birth?

Please phone or text 07939247462 prior to attending the meeting to confirm date and location details. I am a practicing midwife so there is a chance I would have to reschedule a meeting if attending a birth.

Please note that although children are welcome they are your responsibility at all times, as I do have free-roaming teenagers, lurcher and elderly cats.

The Association of Radical Midwives are midwives, student midwives and others in the UK committed to improving the maternity care provided by the NHS. We strongly believe that all women have the right to a service tailored more closely to their needs, and a sympathetic attitude on the part of their professional attendants.

We are primarily a support group for people having difficulty in getting or giving  sympathetic, personalised midwifery care, and those who wish to provide good care. A few of us are working independently outside the NHS, in order to offer a more woman-centred,one-to-one, style of practice, which at present is not widely available within NHS maternity services.

In the mid 70s, the majority of pregnant women in UK had labour induced by artificial rupture of membranes (ARM) around the date they were “due”. These initials were used when the group needed a name, using the dictionary definition of “radical”, (roots, origins, basics, etc.) which aptly described the basic midwifery skills which they hoped to revive.

Held in our homes in Somerset, the group meet monthly to share skills and knowlege to empower women to have the best possible maternity care experience. Phone me or e-mail me at joy@birthjoy.co.uk for details of the next meeting.

MAMA Conference 26th and 27th April 2012

Birth Joy (C) 2011

I have just returned from the fabulous MAMA Conference in Troon, Scotland, organised by the brilliant Cassie MacNamara.

Mary Cronk MBE had been booked as a speaker but had recently suffered a bereavement, and asked me to talk on her behalf about breech birth. These are big shoes to fill! I decided I could not teach about breech birth, but could provide a presentation paying Homage to all I’ve learnt from my mentor,  and great friend Mary Cronk.

With Knees shaking and voice quaking I took to the stage. It was an emotional moment as I knew I was only there because my learned colleague was at a funeral that very same day. I paid Homage to my mentor by showing photos of breech births which have been kindly shared by families who’ve births we’ve attended. Each breech birth taught me more and more about the skills needed to safely attend breech births. I hope Mary’s wisdom and teachings shone through my presentation. It was certainly well received!

Mary Cronk MBE (right) and Joy Horner (left) 2011

Here is some of the feedback I’ve received:

Met you at the conference, and was very inspired by all you shared with us on your breech experiences!”.

It was so wonderful to hear you speak at the MAMA conference. It really was incredibly inspiring and I just know Mary would have been so proud of she could have seen you speak. Many thanks for sharing your wisdom.”

Joy I would like to send my congratulations on yesterday’s presentation. You did Mary proud, and yourself, and I am sure that you will effect change in the NHS, they are very lucky to have you!”

I must have done something right as the organisers have invited me back next year!

The highlight for me was sharing the stories privately with the wonderful Ina May Gaskin. What a privilege to speak on Mary Cronk’s behalf, and to be able to discuss breech birth with Ina May Gaskin.

Ina May Gaskin and Joy Horner 2012
 

 


The Joy of birth

Has anyone ever told you that birth can be pleasurable or even pain free? It may be a very strange concept to women bombarded with stories of painful or traumatic birth. As an Independent midwife I rarely see women needing pharmacological pain relief, the main reasons being that they feel safe, loved and respected. They know and trust their midwife and know the sensations of labour are not to be feared. When a woman feels safe and supported throughout childbirth her biological functions can work as they were designed to. Her body produces complex coctails of hormones, endorphins and oxytocin to bring forth her baby in joy and triumph.

The strong sensations of childbirth are actually signs that our body is working well. The discomfort alerts us to the start of labour so we can move to a place of safety and gather our birth supporters around us. As the baby moves through our body it instructs us how, and when to move, to paricipate in the intimate dance of birth. As sensations change they let us know that we are making progress, and to assume a birthing position. The sensations of the expulsive stage enable us to work with our body and baby to give birth. These signals are more likely to be perceived as painful if the birthing woman is unsupported, scared, disturbed, or interferred with. Most women with good support manage labour with self-help techniques, love and their own determination.

I am of course referring to healthy women, experiencing full-term spontaneous labour, with a baby in the optimum position. If a labour is induced or augmented with artificial drugs, if a baby is in a really unusual position, or if an instrumental or surgical birth is necessary, then pain can be more difficult to manage.

The secret to an enjoyable birth experience is preparation, good labour support, and Oxytocin. Oxytocin has been called the love hormone as it is produced when we fall in love, or make love. It is very important in childbirth as it makes the uterus contract, enhances maternal behaviour and enables the letdown reflex in breastfeeding. Oxytocin is a very shy hormone though. It is hard to produce oxytocin in stressful situations.

The same environment which is conducive to making love is also advantageous in childbirth. Can you imagine having to make love in hospital, with bright lights, little or no privacy, unfamiliar staff wanting to watch, examine, time and chart every move? It would be very hard to mainain that loving feeling, let alone reach orgasm.

Oxytocin production is enhanced in an environment of trust, privacy, love, tenderness, darkness and emotional and physical comfort. As normal labour progresses it is normal for a woman to become more inwardly focussed, and less inclined to commumicate. The thinking parts of her brain need to not be stimulated as she enters a different state, sometimes referred to as being in “labourland.” If a woman is disturbed during active labour the flow of oxytocin can be interrupted.

According to wikipedia “The word oxytocin was derived from Greek  oxys, and tokos, meaning “quick birth,” so you can see its advantages!

Of course, if medical management is really necessary it is still possible to give birth in joy. Loving support, being in charge of the decision making process and sending love to your baby throughout, can make all the difference.

See the films below to see how joyful birth can be.

 

French woman enjoying giving birth – one of the best films of enjoyable birth I’ve ever seen.

Ecstatic birth –  shows the heights of pleasure some women can experience in labour.

Elephant birth – rather dramatic but worth watching just to see the power of birth and maternal instinct. Continue reading The Joy of birth

“Am I allowed?”

A woman this week asked me one of the things that make me want to get on my soapbox about assertiveness and women’s rights.  What she said was “are you allowed to give birth to a breech baby?” My response, as ever, to this type of question is “it you who allows or disallows your care providers to do anything to you or your baby. Nothing can be done to you or your baby at home or in a hospital setting, without your consent. You are a mentally competent adult making rational decisions about your care, and you, more than anyone, has the best interests of your baby at the foremost in your mind”.

The Nursing and Midwifery Council (NMC), that govern all practicing midwives, provide information to midwives and nurses on the issue of consent:

“Legally, a competent adult can either give or refuse consent to treatment, even if that refusal may result in harm or death to him or herself. Nurses and midwives must respect their refusal just as much as they would their consent”.

The problem may lie with the allocation of power and responsibility in maternity care. Midwives and doctors are in a uniquely privileged position to be able to serve women at such a vulnerable time in their lives. We train long and hard to amass knowledge to help those we care for, but we should not use this to control or coerce women into what we think they should do. We are after all “Professional Servants” (Mary Cronk). We are there to serve the families we care for, but it is also our professional duty to inform them of any risks associated with their choices. The Nursing and Midwifery council (which regulates all midwives and nurses) has rules and codes of conduct advising us how to support our clients such as:

1. You must treat people as individuals and respect their dignity

2. You must not discriminate in any way against those in your care

3. You must treat people kindly and considerately

4. You must act as an advocate for those in your care, helping them to access relevant health and social care, information and support

5. You must respect people’s right to confidentiality.

6. You must ensure people are informed about how and why information is shared by those who will be providing their care.

7. You must disclose information if you believe someone may be at risk of harm, in line with the law of the country in which you are practising.

8. You must listen to the people in your care and respond to their concerns and preferences.

9. You must support people in caring for themselves to improve and maintain their health

10. You must recognise and respect the contribution that people make to their own care and wellbeing.

11. You must make arrangements to meet people’s language and communication needs.

12. You must share with people, in a way they can understand, the information they want or need to know about their health.

Point number 2 was obviously not read or understood by midwives who attended a woman’s home birth. The woman was from a particular religious group and her partner was from a different ethnic group. The woman phoned me as a result of midwife harassment in her current pregnancy, and in telling me her previous birth experiences said the midwives at one of her previous births had made racist remarks! I was livid and asked if she had complained – no she hadn’t! this is so wrong on so many levels I don’t know where to start! Harassing heavily pregnant women, and going against their wishes in labour is not acceptable but racism from a so called professional is a disciplinary offence. I gave the woman information and advice to make written complaints about current and previous problems, and gave her AIMS contact details.

Another part of our rules concerns consent:

13. You must ensure that you gain consent before you begin any treatment or care.

14. You must respect and support people’s rights to accept or decline treatment and care.

15. You must uphold people’s rights to be fully involved in decisions about their care. 

16. You must be aware of the legislation regarding mental capacity, ensuring that people who lack capacity remain at the centre of decision making and are fully safeguarded.

17. You must be able to demonstrate that you have acted in someone’s best interests if you have provided care in an emergency.

Whether your care provider will like or dislike your choices should be no concern of yours. I personally don’t like junk food, but understand that some people know the risks of consuming it, and still chose to do so. I may offer education about the risks, but wouldn’t dream of telling people not to do it just because I don’t like it myself. This applies to many areas of midwifery care, for example if you are told you are not allowed to give birth at home it would be good to ask if there are specific risks you need to be aware of, before thanking your health professional for their opinion, informing them that you will consider what they’ve said very carefully and let them know you will let them know your decision in due course (Taken from Mary Cronk’s assertiveness phrases). Consider how your care provider would actually be able to force you to do anything against your will (sadly, women have informed me of social services being used as a threat in some circumstances!).

REMEMBER: You do not have to ask permission to do anything which concerns your own body or your baby. Politely question your caregivers, do your own research then take responsibility for your choices! Your body, your baby, your choice!

See also:

Mary Cronk’s assertiveness comments on Angela Horn’s great homebirth website

AIMS the Association for the Improvement in Marternity Services has a great website and provides telephone support for anyone having trouble finding good maternity care. Please consider becoming a member or making a donation to their good work. x

All rights reserved. Copyright Birth Joy 2011 (C)


Breech Birth

Breech birthBreech birth is a very complex subject which needs in depth discussion with your care provider. I am lucky to have worked with one of the UK’s most experienced breech birth midwives, Mary Cronk, learning what I can about these unusual, but not abnormal  presentations. I have attended several breech births and taught alongside Mary Cronk, and Shawn Walker. I am happy to provide information and birth support for those carrying a breech presenting baby.

The Breech Birth Network run study days for health professionals and others wishing to learn more about spontaneous breech birth. This is a different set of skills to those needed to “Deliver” a breech baby which is a hands-on medical technique. Spontaneous breech birth is a hands off birth which can be facilitated by experienced midwives. The Royal College of Midwives consider this a normal type of birth.

Although breech is a normal presentation it carries additional risks compared with a head down birth. Breech babies are often born swiftly and spontaneously, but sometimes manouvers or surgery are needed to ensure baby is born safely. For this reason I recommend hospital birth with experienced care providers for breech presenting babies.

There are many things you can do to encourage a breech baby to turn see the brilliant spinning babies  website or the very funny pregnant chicken blog. The majority of babies who present as breech in pregnancy will turn head down by 36/37 weeks. If baby has not turned by 36/37 weeks of pregnancy you may be offered an External Cephalic Version (ECV) in hospital.

This ECV video  shows the technique used. The success rates (aprox 50%) vary with practitioner, whether it is your first baby, type of breech, how much fluid, size of baby etc. There is a small risk (1 in 200) of the baby becoming distressed during the procedure and needing immediate delivery by caesarean. More information is available here.

Breech babies can of course be born vaginally, but some doctors recommend caesarean surgery to deliver breech babies. Those doctors are probably basing their recommendation on the flawed Hannah trial (also called the Term Breech Trial or TBT) results. The TBT study seemed to indicate that babies born vaginally had worse outcomes than those born by caesarean, but when the outcomes were looked at 2 years later there were no differences in outcomes for the babies, but there are differences for the mother recovering from abdominal surgery. There have been many studies since, such as the PREMODA study (reported on at the 2012 breech birth conference) which show no differences in outcomes for breech babies born vaginally or by caesarean section. It is very important that you have a skilled midwife or doctor caring for you whichever type of birth you have.

The information and criteria which doctors use to determine who is a good candidate for sucessful vaginal birth can be found here. Please bear in mind that this green top guideline was published in 2006 and there has been lots of research done since then! I attended the International Breech Birth Conference in Washington DC in November 2012 and am eagerly awaiting the data soon to be published by Dr Frank Louven and his team in Frankfurt. See more information from the conference in Dr Rixa Freeze’s fantastic blog here.

See beautiful breech birth videos here:

A first baby born Frank Breech at home. Attended by a gentle doctor, this is a good illustration of spontaneous breech birth. The doctor does use a manouvre to help the baby’s head be born, and the baby doesn’t breathe immediately (this is fairly typical of breech born babies). You will notice how the doctor wisely does not cut the umbilical cord and how baby just requires stimulation to start breathing within a minute. Click here

A wonderful video of breech birth at home in water. It is the woman’s 4th baby and I can’t help wondering if baby would have got herself out sooner if the mother was in the supine position so buoyancy would have lifted baby’s body? The reverse of dry land breech birth, when the mother is on all fours and the baby descends aided by gravity. Anyway it’s a beautiful birth and a lesson to midwives that babies play an active part in the birth process.  You tube beautiful breech waterbirth

Another you tube film of planned breech birth at home clearly illustrating baby lifting her legs to flex her head (necessary for birth of the aftercoming head). It also shows how quickly breech babies can be born (this is the woman’s third baby), the midwife makes a very good catch of this little one! click on link Breech homebirth

There is also a lovely DVD you can buy which tells one woman’s story of deciding which birth was right for her and her baby. its called A Breech in The System. See the trailer here  and order your copy here

Of course I’m not saying all babies can, or should be born vaginally, but many can, and women should be given balanced information so they can make informed decisions about their care.