Pregnancy can be an anxious time, as you ponder how on earth you’re going to get that baby out (never mind all that parenting business that comes afterwards… FOREVER). So, we thought we’d treat Supermushers to some advice and reassurance from midwife Lisa-Marie South, who runs Nicostra Midwifery.
Lisa-Marie was on hand yesterday to answer questions from Supermushers – VIP Mush users who subscribe to the app to get expert advice, personalised content and access to exclusive live chats (you can give it a whirl here). Here are a few highlights. We don’t know about you, but we feel a lot calmer already….
Q: I would love to have a home birth but my doctor says I’m not allowed. What can I do?
Lisa-Marie: You have a human right to make the choice about what happens to you during labour and birth, that includes where you give birth. If you are under the care of an obstetrician they may be very uncomfortable with your choice to birth at home but they cannot stop you. They may say that your choice is “against medical advice”, but please know that midwives have a legal obligation to attend your birth.
Therefore, it is vital you have an informed discussion with your midwife and obstetrician – this means that they MUST give you a balanced and unbiased point of view, based on the evidence and apply that to your personal circumstances. If you do not feel that your choices are being supported in a way that you can realistically plan for a homebirth, you can take this higher to a consultant midwife or the head of midwifery. Midwives are supposed to be your advocates.
It can be emotionally challenging when you are not supported by you health providers to have the birth that you know is right for you and your baby. Some women choose to birth outside the NHS (i.e. with a private midwife) for this very reason and some will hire a doula or private midwife to advocate on their behalf. You have the right to choose the NHS trust that cares for you, but you may be restricted by the locality that midwives will travel to. You may wish to contact an organisation for personalised advice and guidance such as www.aims.org.uk or www.birthrights.org.uk.
If you haven’t yet started thinking about how your existing medical conditions or complications associated with pregnancy could impact your place of birth planning, this link is a great place to start: www.homebirth.org.uk
Q: I have been told I must have continuous monitoring of my baby’s heart but I am worried I will be ‘strapped to to the bed’. Do you have any advice?
Lisa-Marie: Firstly, it is your right to make a decision about ANY monitoring of your baby during pregnancy and labour. Continuous monitoring is conducted by a machine with two palm sized monitors attached by wires which are strapped onto your abdomen – one monitoring baby’s heart rate and the other monitoring the frequency and strength of your contractions.
There is also a wireless and waterproof version called telemetry, normally only one or two of these machines are available in a hospital. Occasionally you may be offered a Fetal Scalp Electrode (FSE), which is a small monitor on a tiny spiral wire that pierces into the skin on your baby’s scalp.
The first question to ask is “do I need continuous monitoring?”. It gives an understanding of how your baby’s heart is coping with the added pressure of labour, but that is only necessary if there is already a concern for your baby’s wellbeing. You may choose to have intermittent monitoring instead, or a mixture of the two. Whatever you choose, be sure you understand the benefits and potential complications for you and your baby. The NICE guidelines are very clear that after an informed discussion the doctors must respect your decision.
The second question is “how can I stay mobile?” I mentioned telemetry, which would be the first choice for staying mobile, especially if you plan to use the water. If you are on the wired machine you will be more restricted but the wires are long. You can sit on a birth ball next to the machine, stand, sway, dance. I suggest pushing the bed into the corner of the room, raising it high and using it to lean on. Ask for mats/pillows so you can kneel on the floor on all fours. Take your own music to encourage you to dance/sway. Consider a rebozo [a special woven cloth] so your birth partner can support you. If you find yourself wanting to lie down, adopt a position on your side to allow your pelvis to open, or as upright and open as possible (padded out with pillows). If all else fails and the monitors cannot get a reading of your baby’s heart rate when you are moving around, you could opt for the FSE.
Q: My baby is breech – what are my options for birth?
Lisa-Marie: Having a breech baby is quite common, especially in the latter weeks of pregnancy. When you are approaching 35-37 weeks of pregnancy, this is the point where there is a big emphasis on your baby being ‘head down’.
You should be offered the opportunity for a doctor to attempt to turn your baby – this is known as an External Cephalic Version (ECV) and is done at 37 weeks using a drug that relaxes the uterine muscle. From the outside of your abdomen the doctor physically tries to turn the baby. You can read more about the ECV, its likelihood of success and the associated complications here.
You may choose a less medicalised approach to turning your baby such as acupuncture or reflexology. Another option is using your own body to position yourself in a way that encourages your baby to turn – you can read more about this here.
If your baby remains breech, or you choose not to have an intervention, you generally have the following choices:
1.vaginal birth at home
2. vaginal birth in hospital
3. planned caesarean section
There are only one or two birth centres in the UK that will actively support vaginal breech birth. If you were previously under midwifery care it is very likely you will be referred to an obstetrician and, as always, they should give you unbiased and personalised information to help you reach a decision.
If you choose to have a vaginal breech birth either at home or in hospital I recommend you have a skilled midwife to support you – all midwives are trained to support an undiagnosed breech birth, but some are more experienced at the physiological needs of a breech baby. Your NHS Trust may not support you to have a vaginal breech birth at home, so please refer to question 1 if you find yourself in this position.
You can of course choose to be cared for by any NHS Trust, so you may wish to contact the head of midwifery at an alternative hospital to discuss your options. This includes for vaginal breech birth in hospital, in a birth centre or a planned caesarean section.
Every Monday night we do a live chat for Supermushers with an expert (and a few special guests you might have heard of) on the topics that are keeping you awake at night (sometimes literally…). Find out more and sign up here.