Monday 10 December 2012

Hannah





                                                                               




Both of Hannah's babies were overdue, by NHS standards, very overdue….even so, she trusted  her first baby to give the cue and had a positive and simple birth at 42 plus 3, with labour starting spontaneously. With her second, she chose to be induced - and went on again, to have a second positive birth experience. Here she tells why - and how.....


When I was 42 weeks and 2 days, I had an assessment scan and found my baby to be perfectly healthy, with an optimally-functioning placenta. Afterwards, I had a meeting with a consultant midwife at the hospital, to talk things through. She agreed to support my plan for expectant management - I was to go in to be monitored daily, to ensure my baby's wellbeing. She also supported my wish to give birth at home should I have gone into spontaneous labour.

A plan was also made in the event that I should choose induction. I was to be supported to give birth on the midwife-led unit, in water if I should desire, with intermittent monitoring.

As it happens, I chose induction as I personally found the wait caused me anxiety (I have suffered from anxiety issues/panic attacks in the past).

This whole process was incredibly important to me. I simply was NOT happy to be induced according to anyone's timetable but my own.

I had to request this individualised care - it was not offered. It was simply assumed that I would have 1, 2, 3 sweeps, then hey-presto: be induced at 41+5 according to hospital policy. Well my policy was different. 

I was always clear that as long as baby was healthy and I was ok, I would wait.

When I did decide to go ahead and have an induction, it was my choice, not theirs.

In the event, labour took only 3.5 hours from the first contraction after they broke my waters, until he was born. It was totally manageable and much easier than my first birth, physically.

There were some concerns about my baby's heart rate during transition and it did look at one point as if a c-section would be needed for a quick delivery. I was rushed into theatre, which was not nice. However, again my wish to avoid intervention was listened to and honoured: The obstetrician halted her theatre team (who were prepping me for a spinal), and made them hold back whilst I pushed my son out into the world.

She LISTENED to me. She WATCHED me. She OBSERVED me and what my body was doing.

I believe that it was down to my determination during that scary time, and the obstetrician's sensitivity that I avoided a c-section, and subsequently will go on to birth my future children without a scar in my uterus.

My experience was positive and that is very much down to the respect I was given by my community midwives and the consultant midwife. They didn't try to bully me, or scare me into towing the line. I was supported to make an informed choice. They listened to me, and my husband, and they accepted that the decision was ours.



There is an incredible amount to be learnt from Hannah's birth stories. There is of course always a risk with going over 42 weeks, but when midwives and doctors explain this to women in this situation, they rarely if ever quantify that risk in useful percentage terms. 

More often, women are read the riot act, or bulldozed with loaded statements like, your risk 'doubles' after 42 weeks...  which of course mathematically it does. But if women knew that the doubling was from a 1% risk of placental failure, to a 2% risk, they might not feel as scared - or as irresponsible as they are so often made to feel.

I think it would be true to say, that all round the country, pregnant women who are overdue, feel pressurised into sweeps and inductions - and genuinely believe they have no choice in the matter. Certainly it doesn't feel like choice when a medical expert implies the situation is dangerous, or that you are irresponsible - and fails to balance that information with the risks an induction will also bring.

The last woman I was doula for, declined induction at 42 weeks and while being monitored, was told by a midwife, 'you do realise your placenta is likely to pack up in labour don't you?'. She was so frightened, she couldn't stop crying. 

Of course, the maternity system needs to inform women that there are certain risks in these situations. But the key word is inform.  Given our maternity service's watchword is 'choice', shouldn't it be the case that a woman advised to have an induction, is IN THE SAME CONVERSATION told the risk of a syntocinon drip - informed of the cascade of interventions a drip is likely to trigger?

Perhaps if the risks were presented in a proper and balanced way like this - in a way that treats women like adults  - more of us would, like Hannah, feel able and empowered to make an informed choice. 

For some that would be to wait - as Hannah did with her first, and for others, that risk would still be intolerable and they would agree to induction - but as Hannah did for her second birth, on their terms. 

Such an approach is absolutely KEY to getting a good birth experience. Even if an induction ends in an emergency c-section, when a woman enters into it with this mindset - with a sense of control - she almost always comes out the other side with a sense of acceptance and satisfaction. 

The difference I see as a doula when a woman draws her own boundary, as opposed to being frogmarched or even frightened into it, is immense. The three inductions I have attended in the last two years, where the woman has done the deciding, remains the agent in her birth process, and feels respected and trusted by her caregivers,  resulted in utterly normal, spontaneous deliveries. 

As well as being informed, it is absolutely crucial that women ask for meetings, as Hannah did.  Talking to a midwife or consultant, where a woman can be heard and helped to get an appropriate plan, helps her to get OFF the obstretric conveyor belt and  create a relationship with her caregivers. It is, after all, in relationships that we get the chance to communicate, where both parties' viewpoints are seen and heard. When there is a real opportunity to air feelings/fears/wishes, and trust is built. It really is just a case of picking up the phone and asking. Hannah's meetings were the key plank to her entering her induction with confidence.  So follow suit. Turn unknown territory into something more known - and you are much more likely to have a good birth experience.