But then again too few to mention

I have been thinking vaguely about what I would have done differently.

An obvious starting point to this would be to have had a birth plan (that would help!) and to have researched the various different approaches to birth before going in. I was a bit downhearted about the whole birth plan thing because everything I wanted seemed to be forbidden by the consultants due to the monitoring I would have to be under (the tears I wept for my denied water birth) so I was in a bit of a petulant mood about it. I also thought I had plenty of time to work out what I wanted when on leave and that the NCT classes would kickstart my thinking on this – but that wasn’t to be.

Perhaps if the NHS Birth Plan Form (online editable version here) for the birth plan had been a bit clearer about which choices you should be making in advance then I might have found creating one easier. For instance, it asks you to complete the check box if “I have given my midwife my consent to give my baby vitamin K”, whereas the things you need to decide are whether you want vitamin K administered and, assuming most of us will, whether to do so via an injection or orally. And the option to delay cord clamping isn’t even mentioned! So the NHS form is a start but really you need your own version that shows your preferences more clearly.

Another limitation of the way the questions are set out is that they suggest all options are created equal and that there won’t be any pressure to do take a specific route, meaning that if you don’t want to take that route unless in extremis then you should state that on your birth plan.

The one that has been niggling at me, is the following:

“Positions for labour and birth
Find the positions you prefer and which will make labour easier for you. Try out various positions at antenatal class or at home to find out which are the most comfortable for you. You can choose as many positions as you want and vary them throughout your labour.

  • I would like to be in bed with my back propped up by pillows
  • I would like to be standing
  • I would like to be sitting
  • I would like to be kneeling
  • I would like to be kneeling on all fours
  • I would like to be squatting
  • I would like to be lying on my side
  • I am not sure yet which positions I would like to be in during labour”
  • I cannot see how you would easily answer anything but “I am not sure yet” and it gives the impression by saying “You can choose as many positions as you want and vary them throughout your labour” that this will be encouraged, but not so much in my case.

    In the hospital there was no choice given to me at the time of delivery, it felt like it had to be written down in advance if I wanted to be anything other than lying on my back. The commentary was very much “up onto the bed” as opposed to “what position do you think feels most comfortable?”. And I was not in a position to object, off with the fairies in my zen state as I was. Which makes me wish I had stated a preference for an active birth NOT lying on my back on a birth plan and directed Fred to make sure my wishes were fulfilled (in fact I think a top tip would be for the father to know the birth plan inside out including your rationalisations for your decisions so he can do just that).

    The preference for you lying on your back in the beached turtle position is one the medical establishment prefers as it is easier to strap you into monitoring equipment (for the baby’s heart rate and the mother’s contractions) and line of sight is better for the midwife.

    But there are a ton of other potential positions for giving birth, a lot of them more natural than lying on your back (a practice started because Louis XIV wanted to see his mistress give birth and didn’t fancy lying under her to get a good view!).
    20130824-070131.jpg
    Picture credit: Laboraide.com

    As virtual medical centre explains:

    ” Advantages of delivering in an upright position are not proven, but are thought to include:

  • Assistance of gravity helping passage of the baby through the birth canal;
  • Decreased compression of the blood vessels in the abdomen, improving the strength and efficiency of contractions;
  • Improved alignment of the baby with the passage through the birth canal, thus allowing the woman to ‘bear down’ in the direction of the baby’s movement; and
  • Increased width of pelvic outlet.
  • Studies comparing different birth positions are not of good quality. However, it has been found that for women without epidurals, delivering in an upright position:

  • Is less painful for the woman;
  • Is associated with fewer abnormalities in the baby’s heartbeat;
  • Results in slightly earlier delivery than non-upright positions;
  • Reduces the likelihood of assisted delivery with forceps and episiotomy;
  • Increases blood loss from the mother, though this finding may be related to the increased ease of collection of blood in an upright position; and
  • Increases the rate and severity of perineal tears.”
  • So mostly better, although higher risk of tearing…

    Luckily, because I was on the antenatal ward for so long and no one realised how quickly the labour was progressing, I was left to my own devices and did a lot of pacing and leaning – onto the table, onto Fred’s shoulders and even out the window. This wasn’t so helpful for the monitoring (I had to be coerced into sitting for that), but was much more comfortable for me.

    I also wonder if I had been in a different position whether I would have tried to close my legs so much to cover the point of pain. As Alex suggested to me, more upright might feel more like the usual position one would do on the loo – I don’t tend to try and close my legs there!

    I think the NHS has moved on from the days of the machine that goes ping, but there is still some way to go to make birth more of an act done in partnership with your midwife than directed by them.

    Hindsight is a wonderful thing and in reality it may be that I would have been advised to lie on my back any way to maintain the monitoring and view simply because of the added risks associated with Elphie being preemie, the (unproven) association between obstetric cholestasis and still birth, and the blood clotting issues. But if there is a next time, then there will be a section in my birth plan about things I want to avoid and I think I’ll elect to lean into my birth!

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