Tips to navigate the hospital system – part II
Here is Part II of our post for navigating the hospital system.
For the real deal and to best improve your chances, remember independent advice is often the best preparation. If you are interested in learning more about teaching Couples Birthing Workshops, our new Advanced Pregnancy Module for these workshops with Lisa Wilkinson, Melissa Curtis & Private Midwives Ireland (Liz Halliday) are a great opportunity to explore and learn.
Advanced Pregnancy Teacher Training starts April 27th, Individual module booking available.
Make a sign for the door or wear a T-shirt stating
“Natural Birth in progress – please do not offer any pain relief. Mum is fully aware of its availability, and will ask for it if she needs it. There may be some noise (-: Thank you”
During labour, it can be common for mothers to be frequently asked, “what are you doing for pain relief”? Probably because so many women are given it as part of the pain relief menu in antenatal classes, or all their exposure to birth is set around an epidural.
Assuming it is a necessary part of birth, many women automatically ask for it without understanding the negative side effects. Many midwives don’t get to practice their wonderful midwifery skills so it’s good to prepare them for your individual birth wishes, they will be delighted.
Sometimes caregivers change, or other staff may come in. being asked during the throws of labour about pain, relief only serves to disempower women who are coping.
Sometimes women ask for an epidural but but have progressed so far, that they are nearly at the end of dilation! A midwife and well- educated partner can normally spot this and use something else to help a mother cope; reassurance, changing positions, using hot water and many more techniques really help. Distracting from one centimeter to the next is a great art.
Ask for an attendant who is enthused by natural birth
Asking for a midwife who is experienced in natural birth can really make a difference. Many new midwives rarely experience a physiologicaly normal birth, and many experienced ones may not see them as often as they like. Due to the increased management and medicalisation of birth, the role of the midwife has changed over the last 50 years. Many midwives are unhappy about this new role they find themselves in working more as an obstetric nurse, rather than a midwife.
Any midwife should relish the opportunity to support your physiological birth and bring in her finely tuned observation skills, support techniques and experience. If after communicating your birth plan, and getting to know your caregiver, you find they are just not into what you are trying to do, ask for a change of staff.
Many midwives will be biting at the bit to assist with a physiological birth. It is a chance for them to put into practice their amazing skills.
Eat well during labour
Keeping up your energy levels at home and in the hospital by staying hydrated and nourished is one of the best ways of keeping your labour progressing and reducing exhaustion. It’s a uterine marathon you are doing after all. You need to keep the fuel coming in to keep your uterus working well.
Some hospitals still restrict food intake as part of a blanket policy. This practice is outdated and is for historical reasons only. It serves NO benefit for the mother. It stems from when many C-sections were performed under a general anaesthetic to reduce the likelihood of food aspiration (inhaling food) during anaesthetic. Aspiration is the result of poor anaesthetic technique, and general anaesthetic during labour is very very rare. Think of all those who end up in A&E – are they only allowed onto an operating table with an empty stomach? Nope.
Remember both the WHO and NICE (World Health Organisation, National Institute for Health and Clinical Excellence) recommendations clearly state women should not be deprived of food and drink during labour.
So, forget about an extremely unlikely scenario (c-section, general anaesthetic, aspiration etc) and think about the danger of labouring whilst energy depleted and exhausted. Women eat and drink at homebirths and in birthing centres freely. And so should you. If food and drink are banned in your labour rooms – sneak it in and get it out when they leave the room.
Most women I know don’t really fancy a full on meal in labour, its normally snacks they really like an copious amounts of labour aid (a great drink for labour). My rule is to offer something that has high energy but won’t be so bad if it is thrown up – curry is definitely out!
Stay upright for fetal monitoring and request to be monitored intermittently
Your baby’s heart rate is an excellent indication of how they are doing in pregnancy and labour. In your last trimester you are going to become familiar with the hand held device (Doppler) for listening into your babies heartbeat. When you start having contractions your baby’s heartbeat will at some stage start to respond to the increase in uterine pressure during a contraction which will temporarily alter the blood flow in the uterus. Your baby has a great response to this blow flow change by increasing their heart rate to maintain their oxygen levels. Fetal monitoring will pick up this healthy response.
It can also check if you are possibly compressing the cord which would be accompanied by a suggestion in a change of position. In rare circumstances if you baby is starting to get tired or is not managing the labour that well, it can pick up a heart beat that is going to fast or slow or perhaps dipping after a contraction. This would then lead to perhaps another suggestion to help the baby.
Monitoring can be done using several devices:
- Fetal stethoscope
- Pinard (hand held ear trumpet)
- Doppler – using ultrasound
- CTG – machine with two belts correlating uterine pressure with fetal heart rates
- Scalp monitor – a device attached to your babies scalp in utero that picks up their
- heart rate.
The recommendation for monitoring by WHO (world health organisation and NICE (National Institute for Health and Clinical Excellence) recommends in uncomplicated labours to use only intermittent monitoring with a hand held device.
In Irish hospitals, there is a policy of taking a baseline trace with a CTG for 20-40 minutes upon admission during labour. This trace would then serve as a record to your baby’s response to contractions and the strength and length of contractions. It may provide you with reassurance that all is progressing well.
The best way to take the CTG trace is to stand up whilst the monitor is attached and then stay upright during the trace. This would reduce the likelihood of any cord compression or reduced blood flow to your placenta and baby and give a more accurate trace.
There is no medical necessity for you to lie down during monitoring. If you think about it, your body is in the same position standing as it is lying down – just a different angle. And way more comfortable during a surge!
Lying down risks increasing pressure on your vena cava (blood vessel connected to the placenta) which can reduce oxygen to your baby. Or you may also compress the umbilical cord whilst lying down which can have the same affect. These reductions in oxygen may cause the baby to show fetal distress of some kind which wouldn’t have been present if you were upright in the first place.
So, don’t lie down and if you are asked to do so for monitoring just explain it is very uncomfortable and not good for the baby. Some caregivers may be used to having a women lie down for monitoring.
During labour itself if mother and baby are both doing well and there have been no previous indications from monitoring of problems, intermittent monitoring with a hand held device is the recommendation from WHO and NICE. There is no evidence that continuous monitoring for a healthy labour is of any benefit. In fact the evidence states that continuous monitoring may lead to more interventions with just the same healthy outcome as intermittent monitoring.
Bring a birth toolkit with you
If a baby is in a good position in your pelvis and you stay relaxed and focused, most women can get through birth with great support, breathing and encouragement. Sometimes, babies take a while to get into a good position or labour can be very intense. A bag of tricks can really help get you through a difficult birth. Stuff you can bring should act as a comfort aid or assist in dealing with the intensity of labour. Your independent antenatal classes should let you know what to bring, but here is a short list of essentials:
- Heat packs and towels to wring out in hot water and act as heat packs
- Food and drink (yes you can, see above)
- Cold water spray and lippy
- 4 extra pillows (hospitals contrary to belief don’t have a ready supply)
- Birth ball and mat for protecting knees
- Nice smells (oils are good but burners are not allowed in the majority of hospitals –
- fire hazard)
- Bendy straws for partners to hold drinks up to mothers lips
- Cosy blanket – hospital ones are over starched and crispy – good for sticking over
- your head and hiding underneath
- Long t-shirts and warm socks – two or three sets in case of any kind of fluids getting
- on them
- Birth plan
- Sign for the door
- Courage, open mind and sense of humour
Encourage your endorphins and oxytocin You can’t forget them. They are within you. Great news.
Oxytocin – the hormone of love will help a labour be efficient and shorter.
Think of it needing the same environment as you need for a good nights sleep:
- Familiarity with those present
- Subdued lighting
- Lowered voices
- Permission to go deep within
- No expectation of rationality – no questions that need thought, no idle chatter
- No causing a woman to feel self-conscious or under observation (how easy would it be to sleep with a stranger in a white coat prodding at your nether regions?)
Remember you have a shed load of Endorphins – our natural pain relief
Natural or alternative pain relief you might have heard it called? Some people think that just because it is natural means it isn’t as good as drugs. Not true. If you stay relaxed and focused and create the right environment in your body and mind for oxytocin to flow, your natural
endorphins will increase as your labour intensifies.
Endorphins actually mean – “morphine within”. You produce beta-endorphins in bucket loads during labour. And here it is – endorphins are stronger than morphine! How much stronger? Research points to between 100-200 times stronger.
Facing possible intervention
If mother and baby are both doing well, there is often no need for medical intervention. If there is a problem with mother or baby, the safety net of modern obstetric care is fantastic.
However, in our climate of stressed maternity services running beyond their capacity, the inclination to get a women through labour within 12 hours by actively managing her labour, is unfortunately common practice.
Sometimes of course, medical interventions are necessary, but if it is a case of your baby taking too long to arrive and you are both doing well, you may consider questioning your caregiver’s suggestions.
1. What is the problem I am trying to prevent or to fix?
2. What are the benefits of the proposed test, treatment, or procedure?
3. How is the procedure done?
4. What are the chances it will work? If it doesn’t, what next?
5. What are the possible risks and adverse effects (complications and “side effects”)?
6. What are the possible alternatives? (Repeat questions 2-5 for each alternative.)
7. Does it need to be done now, or is it possible to wait awhile?
8. What happens if we do nothing?
Remember, if you feel you are just being pressurised to speed things up you are fully entitled to refuse any intervention. Medical staff are very good at letting you know when there is a true emergency taking place.
However, midwives are often under pressure from their superiors to get a woman moving along, when in their hearts they know doing nothing is the best option for the mother. In fact, midwives are often delighted to report that a coping mother has refused an intervention although their superior may continue to put pressure on them to get you to comply. A simple smile and refusal works a treat.
If the pressure to do something gets intense, then I suggest the birth partner steps out of the room, and politely but firmly states that you both consider the intervention unnecessary at this point and would they come back in an hour or two and perhaps discuss again.
So, that is Part II – any comments or suggestions please put them in the box below. Finally, going to a birthing workshop like the ones we run, are of massive benefit to both mother and the birthing partner.