Life with a newborn (those first few days)

End of the world as you knew it! No really life as you knew it has changed forever, but what an amazing change has taken place. For many of us it is a total (cliché alert) rollercoaster of emotions, forgive my use of that term but at this moment in time I can think of nothing that describes it more accurately.

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CRAP (Confusion Ridicule And Pretence) Empower Families Not Disempower!!

Most who know me will know I am not a great fan of forums. In my opinion, they tend to lead to competitive parenting. The advice is often contradictory, doing nothing to give parents confidence in their own abilities. This is the reason I suggest to people coming through my classes, that if they are after advice on particular subject, to contact myself or another birth professional and ask them to point them in the direction of balanced information they can read.

Why? Simple, I believe that it is our job to empower parents, help them get the information they need, for them to be able to make an informed choice. My personal opinions on parenting are irrelevant, it is for them, as parents to trust their instincts and make best decisions for their family based upon as much information as they need. After all, all families, their lifestyles, and their needs, are different!

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Birth Plans what are they and should we have one?

I find the term birth plan misleading. It isn’t a plan of how you want your birth to go, writing one in that way can lead to disappointment, guilt and birth trauma. All births are different, choices made may change depending on how things progress, how your partner is feeling and circumstances beyond your control. I prefer to think of them as Birth Preferences. I find them a useful tool, especially for the birth partner.

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Partners Role Part II (The Advocate)

Dads, PAY ATTENTION!

In my previous blog, I talked about your role in labour as being twofold. First, you are  your partner’s ‘protector’ but secondly, and just as crucially, you have a role as her ‘advocate’. So what do I mean by advocate?

The dictionary definition is:-

n [ˈædvəkɪt -ˌkeɪt]

1. a person who upholds or defends a cause; supporter

2. a person who intercedes on behalf of another

This quite accurately defines your role, but you cannot advocate successfully if you don’t understand what your partner’s wishes are. Advocacy starts now, not just during labour! (We will focus on labour and birth here but the same rules apply during pregnancy and when baby joins you.)

In all things relating to labour and birth, you need to sit down together and talk things through. Look at what choices you might be presented with. Discuss induction, if it is offered, do you want to be induced? If not, what do you want to do instead? If you are offered induction, what methods are you willing to use? What about pain relief? Do you feel strongly about it? What types of pain relief are you willing to use if needed? What are you dead against, if any?

You should try and look at as many possible outcomes as possible, although you don’t need to discuss them all in depth and over analyse! Communicate and reach a decision which you both feel comfortable with.  I suggest you write a birth plan detailing these preferences, you can give a copy to your midwife in labour, so she knows in advance what kind of birth you would like her to help facilitate. It is also for your own benefit, having a copy you can refer to in the heat of the moment can be helpful.

You should both be happy with your decisions, but if you cannot agree, then (sorry guys) your partners wishes come first. You have to accept this, and still advocate her wishes regardless of your own feelings.  A true advocate always puts forward the viewpoint of the person they are advocating for, regardless of their own feelings on the matter. It is also crucial for the birth process that your partner has complete trust that you will honour her wishes. Preparation here is the key to successfully advocating on behalf of your partner.

So how do you do it?

Firstly, you can use your advocate role in conjunction with your protector role.

Most women when labouring, in the right environment, will zone out. During contractions they will almost go in to themselves and be focused on what they are doing. You need to protect that state. NOBODY, not you, not the midwife, no one should ask her a question during contraction. If anyone does ask her a question, you will advocate for her, NOT by speaking on her behalf, but by gently asking the person to wait a moment and re ask the question when the contraction has passed.

During labour, you partner may be offered pain relief or other interventions. Here, your role as her advocate is to ensure that the wishes that you have DISCUSSED are respected. Your partner during labour will be vulnerable, she will not generally feel in a position to argue or even refuse interventions she doesn’t want, this will be YOUR job. You will need to explain on her behalf her choices, you need ensure these are respected and she isn’t pressured in to anything you or more importantly SHE isn’t comfortable with.

One question I get asked a lot is ‘What if she changes her mind about something on the birth plan, when she is actually in labour?’ How do you know, so you can advocate for her accordingly? There is a special DaddyNatal technique for this, this is where our CODEWORD principle comes in. This technique allows mum to signal she has changed her mind about something, but leaves her to feel safe to know that her original wishes will be respected until this moment. More about this in a later blog 😉

This role does not end with the birth of your child, once your child is born you will be advocating on your partners wishes regarding the third stage of labour. If your partner has decided to have unassisted third stage, one of you needs to let the midwife know. If you see that injection being prepared without having been asked (rare, but I have known cases where this was the case) you may need to physically get in the way of the injection, until you explain she doesn’t want it!

You will have some decisions to make regarding, chord cutting, injections, examinations. You should also be aware of these choices, discuss them beforehand, and then ensure those decisions made on behalf of your partner AND baby are respected.

Both your roles during labour can feel intimidating, but being prepared is the key. TALK about the choices and possibilities beforehand. It is very difficult to advocate for someone, when you do not know what their preferences are.

I will also be writing about two key tools to use in your role in later pieces. So please, keep coming back for updates or subscribe to the blog RSS feed so you don’t miss them.

Better still book yourself onto a DaddyNatal course and learn all these tools first hand!

 

What is the partner’s role during birth? Part I

What can dad do during birth?

This is the question I am probably asked the most, normally followed with a comment such as “apart from hold mum’s hand” or worse “keep out of the way!” These comments couldn’t be further from the truth… dads can do so much during labour and really make a difference. Unfortunately no, we cannot guarantee everything will go to plan, we cannot wave a magic wand and no, we definitely can’t swap places!

So again, what can dad do during birth?

Dads role in labour is really only about two things… So dads listen up, understand your role, prepare for your role and really support you partner!

Be Her Protector

Yep, you get to be her knight in shining armour! But what are you protecting?

Everything with regard to being her protector stems from one key factor, adrenalin. In my piece “men at birth” I explain about fear. Birth professionals the world over will agree, adrenalin is an enemy in labour… adrenalin can stall labour, make labour more painful and longer.

Your role as a protector is about protecting your partner’s environment and recognising anything that may cause fear, and get that adrenalin pumping around her body.

This image is of a typical delivery room,

What in this room could cause apprehension or fear in your partner?

Simple, just about everything! Even the clock on the wall can cause both of you to watch time pass and worry how long it is taking. Then how about the blood pressure band hanging behind the bed. What about the alarm call button or the baby station? Maybe the IV tree sitting just at head of bed? All of these things can evoke anxiety in either of you, which can start the process of adrenalin production.

DON’T PANIC!!!

Simply by recognising these things can cause anxiety is first step. Now you are aware you can talk about them, understand them and accept that they are there not for you but simply because they are always there. If you spot something in your partners eye line you feel may cause a problem, move it! Think about how you can take the emphasis of the medicalised delivery room, with dimmed lights, music playing, etc.

So these are tangibles that you can spot and deal with, but also think about the walk in to the hospital, checking in, being examined. Just actually walking in to the maternity suite can be scary, as it all becomes very real for both of you. Is it any surprise that the majority of women when arriving at hospital, will state that “typical, my contractions have slowed down”? That’s caused by that surge of adrenalin… So be aware, once you get there make your partner as comfortable as possible and the environment as relaxing as possible as quickly as possible. Reassure her and follow my labour dos and don’ts.

OK, now what else was missing from the picture? Simple, people. So who will be in the room? Well, probably you, also the midwife. That will be the minimum, but depending on your circumstances there may be more.

Do you need to protect you partner from the midwife? Absolutely! But no, before the outcry, not because the midwife is bad or dangerous! Your partner just needs to feel comfortable with her midwife. To keep adrenalin down, your partner needs to feel surrounded by people she can trust and feels relaxed with.

Your role as protector does not stop there though… you also need to protect your partner against YOURSELF! During labour, your partners senses will be heightened, Mother Nature gave this as a gift to labouring women so that they can sense dangers around themselves, so they can protect themselves. During labour, your partner will sense any worries or tension coming from yourself, in a nutshell, she will smell your fear. If she senses you are afraid or worried, it will trigger her fear and thus her adrenalin. This is why YOU preparing for YOUR role during labour is so important. By being better prepared and informed, you will be calmer and more confident during labour and birth.

So focus on her, keep reassuring, use that extended vocabulary you now have prepared. Overall, trust in both of your abilities and instincts. Simply by reading this you will be better prepared. Keep preparing, and allow yourselves to enjoy the experience, as it is a truly wonderful time when you meet your child for the first time.

However, being your partners protector is only half of your role… my next blog will cover your other essential role – that of advocate.

 

An Open Letter to Kirstie Allsopp

Kirstie, I cannot quietly sit and continue to read the completely unbalanced view which has been put forward via Twitter last week, and the Telegraph article today.

Kirstie, I understand your experience of birth has been of C Section birth. I understand that you did not feel prepared or supported before or after this. I think this is appalling, and that you were terribly and unforgivably let down. You are correct, NO woman should suffer a stigma for having had a C-Section. C Section is definitely NOT an easy way out. Women who are facing having a C Section should have access to appropriate support, both to prepare and recover, both physically and emotionally.

HOWEVER, Kirstie just because this was YOUR experience, does not mean that the answer to women having better birth experiences, is implementing across the board, surgical birth education. I guarantee, if antenatal education took that direction, that our C Section rate would climb even higher.

Your standpoint is that because approximately 25% of births are now C -Sections, we should accept this statistic and start preparing and teaching parents antenatally about surgical birth, as there is a 1 in 4 chance they will have one.

Sorry Kirstie, on this you are just wrong, and doing expectant parents a huge disservice.

WHY do you not want to challenge this 1 in 4 C-Section rate? WHY are we not looking for a way to lower this, rather than accepting it & educating our expectant parents to just accept it too?! This isn’t about stigma Kirstie, this is where your arguments have gotten confused, its about safety, its about education and its about informed choice.

C-Sections SHOULD absolutely 100% be used when needed – they are an amazing medical advance which undoubtedly saves lives. That is what they are there for, and there should be absolutely no guilt, stigma or failure ever attached to this.

A C-Section should be (which even you, yourself referred to it as on Twitter) – a “life saving operation”. So, if we agree that this is the role of a C-Section, do we therefore really think that 1 in 4 of all births are so dangerous that they require a life-saving procedure?

Your comment that “Not talking C-sections during a childbirth course is like not talking Shakespeare during an English literature course” is so unbelievably misinformed. Unlike you, I believe in the ability of most women to safely birth their own baby. I believe that the majority of traditional NHS and some other antenatal classes do not teach women how to do this, therefore leading to this high rate in interventions and C-Sections. That’s right, I don’t simply blame the NHS for poor care, but I blame the quality of our antenatal education, which has a crucial role to play in the UK’s high ratio of C-Sections.

I was reading with interest some of the tweets which you received during your debate. Proud parents tweeting to say that they agreed with you that it was important they had done the full C-Section role play in class, because in their class “5 out of 9 couples ended up with C-Sections”.

So, this class which had educated and prepared its parents for C-Section, had a C Section rate of around 65%! More than twice the national average… alarm bells ringing for anyone else here??

Compare this to the classes I teach, where my average C-Section rate is around 12% – HALF the national average, and four times lower than this class. Why is this?? Maybe because I am empowering women, educating them to understand their body, understand how it works, and preparing that body to get ready for birth. These are things which are not currently adequately covered in all NHS classes or traditional classes. Perhaps Kirstie, you should attend a private natural birth class, see some of the really great practice out there and the difference it makes, and promote the good… Rather than putting us all in the same boat, and slagging us off across the board with little understanding of what we do.

I am PRO women having the most positive, easy and enjoyable birth experience they can. I am anti unnecessary medical procedures which are risky and can be highly traumatic to the whole family unit. Yes, I support woman to have natural births. By your definition Kirstie, this makes me anti C-Sections. Not the case. I teach all my ladies, that in an emergency, you trust your care provider and their medical expertise, as that is what it is there for, to back you up.

However, I work with women to make INFORMED choices. Kirstie, if I had worked with you for the birth of your second baby; I would have supported you to consider all your options, and then 100% supported whichever decision you felt was RIGHT for you. Considering all the options is not about stigma attached to any particular choice – but about the fact that decisions should be about INFORMED choice. This approach is relevant whether we are talking about C Sections, or which house we decide to buy.

I am working with two perfectly healthy pregnant women at the moment, with perfectly healthy babies, who in the last week who have been told by their medical provider, that no-one should have a water birth because “it will kill their baby”. Not all advice, just because it is offered by someone in a medical role, is unbiased, accurate or informed.

There is a reason some of us are trying to support more women to have natural births, and bring down that overall C-Section percentage, and it is nothing to do with thinking women who have C-Sections are ‘lesser than’. For a start, a vaginal birth is much safer. C Sections carry much higher risk than natural birth, to both the mum and baby. The risk of a woman dying following a C-Section is 4 times higher than following a natural birth. We are talking about major abdominal surgery here. Other reasons include the impact on the mother following the birth, which is also something clearly close to your heart too. The increase in rates of postnatal depression in C-Section mothers is not just about stigma, but also is rooted in physiological factors that are absent when baby is not born vaginally.

The women I work with who have been faced with an emergency C Section during their labour, have been able to utilise the coping and breathing techniques I teach to stay calm and involved in the decision making process. I don’t ostracise, make an example of or highlight as ‘different’ any woman who while attending my classes decides to opt for an elective section. All women learn the same coping techniques which are applicable in a variety of situations.

For those women I have worked with who have had been faced with emergency sections, do I honestly think that having ‘role played’ a C Section in advance with some playmobile will make that moment when their baby’s heart stopped beating, and they got whipped into theatre, with dad chewing his nails in the corridor, any less frightening ? No, this is probably one of the most traumatic, terrifying moments of your life. It is scary, and sometimes there are things in life which we can never be truly prepared for.

Kirstie, you absolutely deserved more support, both antenatally and postnatally, than you received.
C-Section birth should not have any stigma attached to it.
But that’s as far as I can agree with you.

The answer to addressing stigma and support is NOT adding specific surgical birth education to childbirth courses. Women do deserve better education, support and birthing experiences. I already have too many women who come to my classes who have been terrified by descriptions of epidurals or demonstrations of forceps, but no real idea of how to empower themselves to have a better birth. Let’s start to support this generation of ladies who are not “too posh to push” but rather ‘too scared to push’.

Steph
Birth & Postnatal Doula & Antenatal Educator
Bump, Birth and Beyond www.bumpbirthandbeyond.co.uk

Men at birth, good idea or not?

I was asked to write a piece on this subject by a fellow birth professional and midwife. Why I haven’t written it before I dont know, it is something I feel very passionately about.

Michel Odent was famously reported as saying men shouldn’t be at the birth, he even went as far as to blame them for the increase in Cesarean rates. At the time I was incensed by his comments. It was at the time when I was coming to the end of my training and was really passionate about supporting families, but especially in supporting men to prepare for their journey to fatherhood. I used the reflective practice I had learnt through my studies to really look at his comments and my reaction to them.

In truth, I actually found that in a lot of respects I agreed with him! The difference is that I don’t want to take dads out of the birth and I think there is another, more empowering way of looking at the issue. I want to see dads (and mums) being made more aware of the importance of the birth partner at birth, giving dads proper support and information to fulfil this role (if they wish to take it on) – after all the benefits will be far ranging and crucial for the whole family.

Dads-to-be themselves need to understand that in general their partner does wants them there, there is nobody they would rather have with them. But with this comes responsibility, responsibility to understand what is happening and to prepare to be the best support they can be. Preparation for the birth is not just the domain of the woman, and a dads role at birth is not just about being a spectator.

So why should men be there if they can?

The biggest enemy at any birth is fear; fear causes the production of adrenalin. This can slow the production of oxytocin and in turn this can slow or even stop contractions, which is often referred to as failure to progress. So logically, having someone in the birth room who makes the mum feel secure and safe is really important, and with the right preparation, arguably there could be no better support than having the person she loves and chooses to go through the ups and downs of life with, to support her. There is nobody she would rather have there, nobody that knows her better or she feels safer with.

Another reason for the man’s presence is in his role as an advocate for his family. A key part of his role can be to make sure his partner’s wishes and desires are listened to. Sometimes in the intensity of moment, mum can lose sight of these or be in a vulnerable position unable to advocate for what she really wishes, so the man’s role is to do this, so she can focus on the work of birthing and stay in the zone.

By being present at the birth, a man will almost always feel an immediate bond with his baby. Bonding with the unborn child is quite difficult for men, often it doesn’t occur until after the birth, and this bond can sometimes be harder to achieve if they are not there to witness and participate in the birth. This bond is crucial to the family in the first weeks and months following the birth, so certainly where men want to be present, telling them they shouldn’t be is not going to be helpful to what follows.

Are there any risks to the man being at the birth?

Unfortunately yes, the support that can be so important and desired can be undermined by dad’s own anxieties during the birth. This is partially what Odent was referring to when he made his claims. An anxious father who is fretting and worrying will cause mum to be fearful that something may be wrong (this is often subconscious but has a very real impact). This fear which mum picks up on can cause her body to increase her adrenalin production, inhibit oxytocin, and as described earlier, therefore start the chain of events that potentially will lead to a stalled labour. Unfortunately stalled labour is the most common reason for the cascade of interventions to begin, as soon as interventions start the likelihood of them escalating increases.

There is also the risk from the man’s “fix it” instinct. If the man is not understanding of the birth process he is in danger of overriding his partner’s wishes or doing something detrimental to the natural processes of birth. For example, if a man believes his partner is in pain, he will want to stop her being in pain; at this point he may suggest and even promote interventions. However, the reality may be that his partner is coping well and just making the normal sounds of birthing… but if he suggests she needs pain relief, it can bring in a seed of doubt and lead again to that negative cycle of fear. Dad’s in the birth space need to control this natural ‘fix it’ instinct, but this can only be done through first being aware of it, and then having the ability and tools to control it… This is crucial to making sure he is not one of the reasons that interventions are being suggested!

So dads listen up, if you want to be there and your partner wants you to be there, you need to put in some effort and be the best birth partner you can be. You have the potential to truly affect the whole experience and outcome, and with understanding and support you can reduce the need for interventions. Your presence WILL impact on the birth experience one way or another!

Finally, it is a helpful idea to discuss as a couple the role of the birth partner. You and your partner may decide you are not best person to act as a solo birth supporter. This is absolutely fine, it is not a requirement that you HAVE to be the only birth partner (or that you even need to be there at all, if it doesn’t feel right for you and your family).  You could both consider another family member also being there, or using the services of a doula. Doulas are professionally trained as support for expectant parents, and they can act as a birth supporter alongside dad, or instead of dad – whatever suits you as a family. I would always suggest interviewing a couple of doulas to help you find the person who is right for your family. ANYONE in the birth space can have positive or negative impact depending on how they make you feel, so it is imperative that you are comfortable with them and they are also comfortable with you.

But please, can we empower families to decide what THEY want for their birth, and to allow mums AND dads to prepare, rather than be telling them who should and shouldnt be at their birth. Anyone can bring good and bad into the birth space, men/fathers are not by default ‘poor’ birth partners, and a bit more support and encouragement would go a long way.

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Dean Beaumont is a leading expert in working with fathers and founder of antenatal programme DaddyNatal which supports fathers-to-be to prepare for birth and parenthood.

He is also author of The Expectant Dad’s Handbook published by Random House.