Tag Archives: Mary Cronk

Unplanned Cesarean Birth. A warrior’s path.

tor-019.jpgCaesarean birth is not everyones first choice when planning the type of birth we’d like. For many women it is the very last type of birth they’d opt for. So when we are faced with our least favourite choice, the thing we’d worked so hard to avoid, our worst fear, what do we do? How can we cope with the disappointment of a birth that’s so far away from the birth that we’d dreamed of that it resembles a nightmare? What went so dreadfully wrong, and who can we blame for this travesty? As a midwife and mother who’s first baby was born by unplanned caesarean I’d like to explore these questions further.

A less than ideal birth?

Why does a less than ideal birth have to mean less-than? Could our less than ideal birth leave us feeling less than complete? If our bodies apparently failed to give birth, or we didn’t get to do the things we’d planned to do when greeting our babies, is there a sense of failure? I certainly remember feeling that my body had failed to birth my first child, and that I’d somehow failed to be there for her immediately after birth. These are very common but totally irrational thoughts as we try to make sense of how our plans went so wrong. There must be someone to blame, and that someone must be me. But our brains must be so confused at this time, as I was obviously not slacking by needing a life-saving caesarean, then haemorrhaging and being unconscious for hours after. Where does that self-blame come from? Wherever it comes from it is misplaced in the case of unplanned caesarean.

How can we even think that we are to blame for things going wrong? I can joke about it now, as it’s approaching 23 years since my baby and I nearly died. I can see rationally that my caesarean was a life-saving measure, and that my daughter shows no signs of the early neglect she may have suffered. But do you know what? It still hurts to think of those lost hours when we were not together.

Best laid plans

Like many women I’d prepared for a homebirth, but of course I knew as a midwife that anything could happen. It just wouldn’t happen to me, as I was so well prepared. I watched all my plans evaporate when labour didn’t progress and I transferred to hospital for analgesia and augmentation. A catalogue of nightmarish scenarios ensued, and my baby was found to be presenting by the brow (forehead, instead of the back of the head coming down first). Of course trying to force a malpositioned baby through a pelvis for hours is never a good idea, so my body haemorrhaged after my caesarean and I was returned to surgery. Postnatal depression inevitably ensued, marring a majority of our first year together. It just didn’t make sense. I’d done everything so right. How could it go so wrong?

 Are birth plans worth the paper they’re written on?

I’m not sure one can actually plan a birth, knowing that birth is inherently unpredictable. I think writing a birth plan is a good exercise in looking at and discussing your birth preferences with your birth partner. It can also be a useful communication aid for your midwife to read whilst you are busy birthing and not able to fully express your wishes. Beyond this it is of very limited value. If you do write your birth preferences down please just write on just one side of A4 paper, use bullet points, and try not to be too outcome orientated. What I mean by this is do not write “I am having a homebirth, vaginal birth” etc as these are never guaranteed. Its fine to write “I hope I’ll have a homebirth” or “I’d prefer x to y if I require pain relief” or how you’d like to spend the first moments with your baby if possible. Please do keep it short though, as I’ve heard doctors joke that women with long, inflexible birthplans are bound to need medical interventions! So plan all you like, but your baby may have an entirely different plan of it’s own. I do believe that all babies do their best to come out the way we have planned, but some get stuck, some run out of energy, and if left to a natural conclusion some babies and women would not survive the birth process. Nature doesn’t always get it right despite our best efforts, and timely caesarean surgery saves lives.

Less of a birth=less than a woman?

Why should we feel “less than” if we’ve accepted life saving surgery, albeit unwillingly? As a midwife I see so many different types of birth, and not one has more worth than another. All women are strong, beautiful and powerful in their birthing. This transformational state has equal value whether it is long or short, painful or ecstatic, vaginal or abdominal, surgical or physiological. Each birth brings forth a baby as well as the birth of new parents who need to start their parenting journey in an empowered way. It is a true rite of passage, where we are presented with obstacles and challenges, so we can discover how courageous and strong we really are. When women are well supported in their births they get to see their strengths and triumphs, and start their journey to parenthood in a joyful way. Without support and explanation they may be left feeling disappointed or even traumatised by such an unplanned outcome.

So how can we lessen the impact of unplanned caesareans and enable women to feel strong and empowered in their birthing? It’s important to have continuity of midwife, or a doula if possible. Research has shown that continuity of carer leads to better outcomes. Women can empower themselves by learning assertiveness phrases and asking for everything to be explained, so they are in charge of the decision making. They can organise 2 good birth supporters, who will support their choices, and be able to help practically as well as emotionally after an unplanned outcome. Women will need opportunity to debrief their birth with their care provider after unplanned caesarean. And as care providers we have a duty to help women understand and integrate their birth experiences. Unfortunately most women don’t have continuity of midwifery care, but all midwives and doulas can help a woman after unplanned caesarean birth. We can do this by listening, by witnessing their story without interrupting, then by answering their questions. We can believe them and validate their experiences, letting them know they made the best choices possible (being a professional means putting aside our personal opinions). We can congratulate them on their intuition, bravery, endurance etc, for giving it everything they had and then some, because of course every woman does. Don’t forget to mention her beauty and dignity in birthing, her graceful acceptance of the inevitable, and big up her support team too.

That woman is a birth warrior, she has done battle with nature and her worst fears, she has bravely laid her body down on the theatre table and has said “cut me open for the sake of my child’ risking her own life to save her unborn baby. She then returns from her battle triumphantly holding her reward, her baby, and should be welcomed home as a returning Hero. How can this warrior’s birth ever be seen as less than?

Conclusion

As a midwife I’ve had the pleasure to see empowering and ecstatic, planned and unplanned caesareans. I have personally had a vbac so also know the joy of vaginal birthing too. All births are great opportunities for us to grow and become more than we ever thought possible. This is a process of growth not lessening, so let’s treat it as such, and celebrate all birthing women as the birthing Goddesses they are.

Radical Midwifery on the Road

?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????According to the Association of Radical Midwives (ARM)  “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.”

In this spirit I offer a grass roots midwifery information service to women. I am an Independent Midwife, and as such I provide total midwifery care for women and their families, but the numbers I care for are small, and every woman needs good information. I’ve always served women by giving free information by telephone, and running a local ARM group, but again the numbers are limited, and so is my time. But I feel a huge need to pass on my knowledge of maternity rights and choices to women who may not even know that they have a choice.

Am I saying that the NHS is not giving women enough information or choice? No.

Am I saying women are unable to find out this information for themselves?  Certainly not.

Pregnant women just don’t know what they don’t know. First – time mums may, or may not have read widely, they may, or may not have a relationship with a known NHS midwife, and the midwife may be too short of time, experience or knowledge herself to be able to help each individual.  Without adequate information about choices in pregnancy the woman may feel she has no choice, and if things don’t go to plan, she may feel things were done to her without her fully informed consent. Feeling disempowered or not understanding why things were done to you in childbirth, can contribute to postnatal depression. After a poor experience women often look for further information and support to prevent the same happening in subsequent pregnancies.

2541987300_7cf0e2543a_mAs an Independent midwife many of my clients come seeking truly unbiased midwifery information, so they can feel empowered in their current pregnancy. Some have suffered previous birth trauma and wish to avoid similar happening again. But why wait until the second or subsequent pregnancy to get a positive birth experience? The first experience of birth is likely to be the most challenging, so it is important that we as midwives know how to serve you best. Unless you tell us what would help, or hinder you in labour, we will not know. Unless you know your rights and the choices available to you, you will not be able to instruct us in providing the right kind of care for you.

This is where writing birth preferences comes in useful. As an NHS midwife I would meet someone (often for the first time) in labour, and have to discuss all the pros and cons of different birth choices. I  don’t mind explaining at all, but Labour is not the right time to be engaging the thinking part of a woman’s brain!

  • Educate yourselves, know your rights and choices before labour starts.
  • Write your birth preferences down. Discuss them with your birth supporters before labour, and share them with your midwife when labour is underway.
  • If you don’t know why a course of treatment or an intervention is being suggested then please ask.
  • If you don’t understand or don’t like the answer then ask someone else.

The Association for the Improvement in Maternity Services (AIMS) are a great resource for anyone having difficulty getting support for their birth choices. AIMS have a booklet entitled “Am I Allowed?” and all over it’s cover it has the word YES. Nothing can be done to you without your informed consent. If it has not been explained to you fully, you cannot make an informed choice. Please buy this book if nothing else (order from website, under “publications”).

Read also Mary Cronk’s assertiveness phrases and practice them in front of a mirror.

Birth Rights is a new organisation founded by a human rights lawyer. The website contains useful fact sheets on rights in childbirth.

The birth bus
The birth bus

 

If you live local to me then find out when I am next holding a midwifery clinic in my Birth Bus (campervan). I park at various locations locally, to give information and answer queries about rights and choices. Just text or email me for dates and venues. These do vary according to my midwifery caseload.

Remember that knowledge is power, and you don’t know what you don’t know- BUT you can always find out and ask WHY?

 

 

 

Mary Cronk’s Assertiveness Phrases

Following on from my “Am I Allowed post” I phoned my dear friend and former colleague Mary Cronk. As well as a good chat with each other, I obtained her permission to post her assertiveness phrases. She re-quoted the phrases that I know by heart, and have recommended to many women. I had the pleasure of working with Mary Cronk for 5 years as an Independent Midwife, and a further 2 as co-teacher of “Once More Unto The Breech” workshops. She is a true Midwife and has spent her life helping women achieve positive birth experiences.

joy and mary307710_251788671525311_932911360_nMary Cronk is an expert in breech birth who has shared the skills of breech birth with midwives and doctors across the United kingdom. She was awarded a MBE for her services to women.

See Mary in action here: Mary

You may find these phrases useful, particularly if told that you are “not allowed” to have your baby at home, or you “have to” be induced, etc.

“I am sure that many others will explain your absolute right to refuse any procedure for any or no reason. The law, and good practice is quite clear. A sensible person will listen carefully to any explanations to why a procedure is proposed, and then should she choose not to have XY or Z she just says no or no thank you. The “allowing” is done by YOU. An asssertive approach is worth cultivating. You may care to commit the following phrases to memory and practice them frequently in front of a mirror. Continue reading Mary Cronk’s Assertiveness Phrases

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

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
 

 


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.