I’ve been doing a lot of research into Hypnobirthing recently, enough that I’m drafting up a Midwifery 101 on it.
It’s currently not offered in NHS hospitals nationwide, which I think is a real shame.
But I want your opinions too, which I’ll include in it.
Have you seen hypnobirthing in practice? Or have you used it yourself? Did you find it/do you think it’s effective? How did you/the woman use it? Would you recommend it to others?
Had the nicest shift ever on delivery yesterday. Cared for the most lovely couple! Was gutted I wasn’t there to help deliver their little girl.
I did go and visit them on the ward today though, couldn’t resist meeting their gorgeous little daughter.
The dad was the most amazing birth partner I’ve ever come across, he was so tuned in to his wife and what she needed. The only time he spent on his phone was when he was using an app to record her contractions. He was on his feet for the entire 14 hour shift (and most likely the rest of the night!) rubbing her back, massaging her swollen feet, cooling her down with a damp flannel.
He talked her through every contraction, keeping her breathing controlled and steady. He encouraged her and told her how amazing she was doing after every pain.
It was so beautiful to watch, you could just see how much he loved her.
It’s shifts like that that remind me why I want to do this job. It was really magical.
A while back, I posted a link to a BBC news article about the history of fathers-to-be attending the delivery of their child.
The BBC have now posted this response, with real life stories from dads. It’s a lovely read, and very interesting.
You’re supposed to count
The counted pushing they had her doing was valsalva pushing. Evidence shows that valsalva pushing increases the chance of negative urodynamic outcomes and fetal hypoxia (suffication of the baby before birth). It also increases the risk of severe perineal tears.
So no. You’re not supposed to count. You’re supposed to go with your body, and push when you feel like it, for as little or long as you feel the urge.
Just watched an episode of 16 and Pregnant and it made me so mad!
They had the poor girl flat on her back, and I mean flat, with her legs in lithotomy position. They were making her do counted pushes. Literally counting to 10 with each push.
I just…. I can’t. What the hell.
Midwifery 101: Positions for labour with an epidural
As much as midwifery is about trying to keep things normal and natural, there are certain things that we can do that make it a little different. Not wrong, just different. One of these things is an epidural - it provides excellent pain relief, but it can make labour a little trickier. One of the down sides is that you can’t move half as much as you normally would. This midwifery 101 is going to focus on positions you can use when an epidural has limited your mobility, because it is never acceptable to be told to lie flat on your back in labour.
P.S. please excuse the appalling MS Paint diagrams…
Ok so I decided to have an epidural. Please don’t be mad…
Never let anyone tell you that your decision to have an epidural was wrong. Only you know how much pain you’re in, and whether you can cope with it without an epi.
Yes, they do come with some risks, and yes a labour without an epidural is preferable when you consider the increased risk of operative delivery. But if you need it, you need it. That is your choice, and yours alone to make.
I’ve just had my epidural and I want to move, what can I do?
When you take drugs, you expect them to float evenly around your system and distribute their effects evenly. An epidural is not like that.
Whilst it’s in the process of starting to work, you can stop it from spreading evenly across your lower body. If you tilt to the left, more will go to the left side, and you might feel some pain on the right side, and vice versa.
Wait for the pain relief to really kick in - once it’s nice and numb all over, then we can talk about moving a bit.
Scenario 1: So I can’t really move my legs that much… How can I be in different positions?
Most women with an epidural will find their mobility somewhat limited. You might be able to rotate your ankles and slightly lift your legs, but you most likely won’t be able to support your own weight.
There is one position that you flat out, 100% should NEVER adopt in labour, and that is supine. In this position, you squish the major vessels in the trunk of your body (called aortocaval compression), and this can stop adequate oxygen reaching your baby.
Fortunately, there are several positions you can try that will not need you to use your legs for weight support. They are as follows (with pictures at the bottom):
Semi-recumbant, flexed knees:
- Back of the bed is mostly upright
- Knees bent
- Your birth partner can help you to bend your knees initially if you can’t quite do it yourself
- You may find it helpful to place your hands on your thighs to hold them up, if it is comfortable
- Some beds have plastic squares that pop up near the lower-middle of the bed that you can put your feet against if you’re struggling to keep your knees flexed. Note: I do NOT mean lithotomy stirrups!
- Back of the bed mostly or fully upright.
- Most labour hospital beds will allow you to drop the foot of the bed to make a very comfortable chair.
- Great if you can’t move your legs very much, as it stops you from sliding down the bed, which can happen in the upright & legs straight position.
Left-lateral, with alternate leg positions
- Lying on your left side does not compress those vessels I mentioned, and is actually often used when the fetal heart rate is abnormal to try and improve it.
- You can bend one knee down over the other, or keep it bent upwards to open your pelvis up a little more if it is more comfortable.
Upright/semi-recumbant, legs straight
- Back of bed is mostly or fully upright
- Legs straight
- Good if you have some control over your legs - if not, you might find you slide down the bed over time.
Scenario 2: So it turns out I can move my legs pretty darn well. What else can I try?
Epidurals are very tricky things. Most of the time, they lead to your legs being very numb, and you can’t bear your own weight on them.
However, very skilled anaesthetists can often provide a “mobile epidural”. This works the same way as a normal epi, but you aren’t left with the heavy legs that are hard to move. I would still recommend you don’t get up and walk, because there is a high risk of the numbness causing you to fall, and we don’t want that!
But you can try a couple more positions, if you feel up to it. Many women also adopt these positions towards the end of their epi, when the drugs have worn off enough for them to move about.
- Back of the bed mostly or fully upright
- Lean over the back of the bed, using the top edge to support your arms
- Bed mostly or fully flat
- Rest on knees and elbows/lower arms
I didn’t include this in a diagram because for the most part, it will be too difficult for a woman with an epidural to do. But if you have sufficient support in case your legs fail (birth ropes, squat bars etc), it could be worth a try!
Calling all prospective student midwives, currently training student midwives and women who had a student midwife care for them during their pregnancy or labour!
Over the past few weeks I’ve been thinking about starting a new series (much like my midwifery 101) that is based upon the life of a student midwife.
Just as Midwifery 101 focuses on the role of the midwife and pregnancy, this series will focus on what it is like to be a student from applying to universities all the way through to finishing the course.
It will talk about emotions & feelings, mentorship issues, the application and interview process, your first few days on placement, tough situations and what the course is really like, amongst other things. It will also cover women’s experiences of being cared for by a student.
But I want your help!
I want this series to be as interactive and inclusive of your views as possible. I want to hear your experiences, whether you’re currently applying to the course, are currently training or had a student midwife care for you at some point during your pregnancy or labour. Or perhaps you’re a doula who has views on students, or even a partner or family friend who has seen one of us in action.
I’d like to read your experiences about any aspect of the student midwife, and use them in the series. This creates a much more rounded view, rather than focusing on just my own experience.
I have a submission page available on my blog for you to use.
You can write about absolutely anything to do with being a student midwife or being cared for by one. Whether it’s positive or negative. Whether it’s an event you’ve been through or just a rant about how scary applying for the course can be!
I really hope people get on board with this, I’d hate for it to just be me rambling on at you all like I usually do!