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Month: October 2015

Just for Dads/Partners

Just for Dads/Partners

Here’s what Olympic Gold Medalist Greg Rutherford said after his Hypnobirthing Course: “Now I feel ready. Now I feel like a superhuman midwife man hero. I am here!”

Right, got your attention?

I’ll be completely honest – many partners (not all, but about 90%), dads in particular, come along to my courses because their pregnant partners want to do it and have insisted they join them!

So often I hear Dads say “I guess I’m just there to hold her hand and do whatever she wants” or “ well, let’s be honest, there’s not really much I can do.” ……. I was going to write ‘what a load of codswallop!’ – but, actually, why wouldn’t they think that?

Worth noting that, for most, their only experience of birth is what they’ve seen in films or on TV where often dads are portrayed at best as helpless bystanders and at worst hapless idiots.

As someone who has attended many births and also facilitated antenatal education for loads of couples, would you please, please take it from me that this really is codswallop?!

I absolutely promise you that, in reality, partners play a critical role in supporting mothers during pregnancy, birth and the transition to parenthood.

You’re the one she’ll want support from the most – you know her better than anyone, you love her, she loves you, you both love the baby she’s bringing into the world – no one else can compete with all that LOVE!……. without any antenatal preparation you’re already equipped with oodles of one of the most vital components required for labour to progress well – you’re a like an Oxytocin Generator! (If you’re wondering ‘Oxy-what?’ Oxytocin is the hormone that causes contractions and it’s also the hormone of love – in any facet of love, oxytocin is present.)

However, I ‘get’ that the responsibility might feel a bit scary: If you and your partner decided to visit an obscure destination somewhere in the world for the first time and you were expected to be the sole tour guide having just read a book about the place, you’d probably feel the same way…….. you may have never been to ‘Labour Land’ either, and if you’re planning on going, wouldn’t it be great to be bursting with knowledge, feeling empowered, really confident and with a ‘toolbox’ of skills to take with you? ………… of course it would!

SO much better than feeling like a spare part, right? Right!

But you don’t just have to take my word for it, here’s what two actual dads wrote to me by email, completely unprompted and with no money exchanging hands or anything:

For any father/partner who is sceptical about the whole process i would recommend at least giving it a go, take in what you can it will all become apparent during birth and will benefit all of you involved. It was one of the most magical things I’ve ever been involved with and the fact Rosie was so calm during it made it that much more special.” 

I found it a rewarding ‘pre-birth’ experience, that I would whole heatedly recommend to other expectant parents as essential.”

 All of your help has been invaluable, and I definitely feel a lot more prepared and not as anxious as I did when we first walked in on Saturday.”

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 It really is a no-brainer!

VBAC – Vaginal Birth After Caesarean

VBAC – Vaginal Birth After Caesarean

A natural birth after a caesarean is a safe choice for women, according to the Royal College of Obstetricians and Gynaecologists (RCOG)

Currently the caesarean-birth rate in England is more than 1 in 5 women, so a significant number begin their subsequent pregnancies with a decision to make regarding whether or not to attempt a VBAC or have a planned caesarean birth.

Many couples, regardless of whether they’ve had a baby before or not, have concerns about labour and birth. Those planning a VBAC often have increased anxiety and doubts.

The point that’s raised is concern over uterine rupture. It’s worth quickly mentioning that this can happen at any birth, and the risk is increased if syntocinon (synthetic oxytocin) is used to enhance contractions.

A recent UK study found that the overall risk of uterine rupture for a woman who has had a previous caesarean is 0.2% – overall meaning without considering other factors that affect an individual’s risk, such as induction of labour or syntocinon being used.

So, the risk may be lower in labours that are not induced or augmented (the statistics above are a mixture of all labours). In fact studies show an increase in rupture with these interventions.

A slight increase was found for women who had had 2 or more previous caesareans.

So, 0.2% will experience uterine rupture, but 99.8% wont!

The story looks different again when you consider that the vast majority (94%) of the 0.2% of scar ruptures don’t cause major problems for mum or baby – serious complications are very rare.

Another way to look at it is this: All labours (like life) carry risks: For all women the risk of cord prolapse is around 1% (so more than double that of caesarean scar rupture) but that’s not a risk that’s emphasised to all pregnant mums – in fact most women will go through pregnancy, labour and birth without even hearing this risk being mentioned from care givers.

Most information and guidelines compare the risks of uterine rupture between VBAC and a planned caesarean. Planned caesarean wins hands-down here with a 2 in 10,000 rate compared with the 20 in 10,000 mentioned here earlier. But, of course, it’s not that straightforward when we consider all the risks associated with a caesarean and their higher occurrence rate.

When supporting a woman planning a VBAC, the issues that require addressing are:

. these women have often found their previous birth experience to be traumatic. Recognising this and giving her the opportunity to de-brief that birth is helpful to her, and also to understand what she’ll need during labour. Also, If the reason for her previous caesarean was a non-recurrent cause, once it has been talked through she can put that birth to one side and separate it from this different baby and birth.

. they are labelled ‘high risk’ and with that comes an implied ‘disaster-waiting-to-happen’ tag – not just from care providers but from their partners, friends and family. They’re dealing with everyone else’s worries as well as their own. Best to discuss and contextualise risks with mum and partner and provide them with evidence-based information so that they can make informed decisions.

. Usually women planning a VBAC have already begun arming themselves with the above information and done extensive research, which is great, but it’s really important to encourage them to also seek out positive VBAC stories from other parents, and I can put them in touch with my previous clients who’ve had a vaginal birth after a caesarean to hear their experiences

. make sure that parents understand what actually happens if the uterus ruptures rather than leaving it to their imaginations which may be filling their minds with all sorts of horrific visions.

. She needs to take pressure off herself to ‘succeed’ and there’s no need for her to tell everyone she’s planning a VBAC, she can just tell friends etc. that she’s going to go to hospital and see how it goes. Appreciating that a repeat caesarean may have nothing to do with the previous one is important, and really understanding what she can do to increase her chances of a successful VBAC, for example avoiding induction, having belief in her body’s ability to birth her baby and surrounding herself with others who do too.

. making sure that parents are aware that most women who choose a VBAC do go on to have a vaginal birth. The rate varies between hospitals but most record VBAC rates of 70-90%

. hospital policies – what they are locally, what she’s happy to accept, what she’s not and how to reduce any impact they may have on birth unfolding naturally. For example she may decide that she will go to hospital as soon as labour begins, that doesn’t mean that she’ll have to accept further interventions, it just means that she needs to be prepared to politely decline them. Her and her partner might need the reassurance of the continuous monitoring that will be recommended, that doesn’t mean that she’ll be immobile. And, if hospital protocol dictates that her labour is ‘taking too long’ but she and her baby are well a discussion can be had, she doesn’t have to accept all procedures suggested.

On the subject of continuous monitoring in labour – NICE guidelines suggest that this should be offered, although this isn’t based on firm evidence as there have been no reliable studies to discover if it makes VBAC safer and a Cochrane review found that it is no more effective in detecting distress in babies than intermittent monitoring

Numerous clinical studies have found that women who have the support of a doula during labour tend to have shorter labours and fewer interventions and almost everywhere I’ve looked for suggestions on increasing your chances of a successful VBAC, that continuous presence of a trained, experienced supporter is highlighted as being key

Here’s a link to the research I mentioned http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001184

And here are links to other places where you can find evidence-based research and information on VBAC:

http://www.rcog.org.uk/womens-health/clinical-guidance/birth-after-previous-caesarean-information-you

http://www.childbirthconnection.org/article.asp?ClickedLink=293&ck=10212&area=27

http://www.nct.org.uk/birth/vaginal-birth-after-caesarean-vbac