I want to make something very clear I make NO judgement of where or how a woman choses to birth. I think it is paramount that a woman gets to chose themselves and are appropriately supported in their decision of location and way of birth, whether in hospital (vaginal, induced or cesarean), MLU - midwife led unit or at home. I have found the acronym BRAIN very helpful while accumulating my research and I intend on using these steps while making decisions in labour just as I have used it in my choices leading up to it.
I hope my links will help any woman make the decision they feel is right for them and that they are at peace with under whatever circumstances they are in, that includes preparing for situations you hope to avoid. Please don't feel I'm trying to convince you that one things is the right or wrong necessarily, just that I want women who feel like they are being told what to do or think and how to tackle their birth to know that they are the ones that make the decisions about their birth. Birth is a very important moment in life: scaremongering and coercive behaviour towards women in a vulnerable position is abhorrent. So I'm here to hopefully make women feel they do have power and choices. Everything isn't always as black and white as some doctors and midwives will make it out to be. It seems that some think they can't be wrong because it's their profession without taking into account how important the mother's role and mental health is in all this. I also acknowledge that there are some AMAZING doctors and midwives out there who are incredibly supportive and knowledgeable, these links are here to help arm you against those that are misinformed or try to misinform you.
So without further ado let's start at the beginning: let's start with your birth rights. This is important! Both the links below have extensive information on your rights. AIMS also offers advice and help should you feel you need it.
- Birth Rights UK (Birth rights fact sheet is linked here but the whole website is helpful - particularly their information on CONSENT).
- AIMS (Association for Improvements in the Maternity Serivces) (AIMS have an abundance of information on all aspects of birth and your rights. They offer support as well if you are having issues with your care providers).
- Coercing with kindness? (The Birth Hub - feel this is a good look at the language used and another good starting point before dwelling further)
On various interventions/forms of induction/checks prior to and during labour
- Sweeps & Induction of Labour (Explained by Samantha Gadsen - Doula)
- ARM - In defence of the amniotic sac (Midwife Thinking covers Artificial Rupture of the Membranes)
- Sweeps ARE induction (Greater Manchester Doulas CIC cover sweeps and their risks)
- Membrane sweeps for induction (Cochrane Medical report on whether sweeps are an effective and safe way to induce labout)
- The curse of meconium stained liquor (Midwife Thinking covers when meconium is cause for concern if found in your amniotic fluid and when it is NOT)
- Continuous Fetal Monitoring (Cochrane medical report looking at the efficacy of Continuous cardiotocography CTG: "Overall, there was no difference in numbers of babies who died during or shortly after labour (about one in 300) (low quality evidence). Fits in babies were rare (about one in 500 births) (moderate quality evidence), but occurred less often when continuous CTG was used to monitor the baby's heart rate. There was no difference in the rate of cerebral palsy (low quality evidence); however, other possible long-term effects have not been fully assessed and need further study. Continuous monitoring was associated with significantly more deliveries by caesarean section (low quality evidence) and instrumental vaginal births (low quality evidence). Although both procedures carry risks for mothers, these were not assessed in the included studies.")
- Vaginal Examinations in labour (AIMS discuss the benefits and risks of VE, the importance of consent and that it is ok to refuse VEs. They also cover alternative ways to monitor progress in labour)
Make informed decisions before accepting induction. You may still feel induction is right for your circumstances but this list covers some things that don't have to warrant an induction.
- Do still birth rates DROP after 42 weeks (AIMS "Currently, women are being led to believe that there is a high chance that their baby will die if they continue with their pregnancy beyond 42 weeks. However, even those studies which appear to show a protective effect of induction before 42 weeks make it clear that the risks of continuing pregnancy beyond this point are extremely low; and the evidence presented in this article does not shows that women who are making the decision to continue their pregnancy beyond 42 weeks are encountering increased risk of stillbirth. It also shows that the rate of perinatal mortality is lowest at 42+ weeks.")
- Pre-Labour Rupture of Membranes: Impatience and risk (Midwife Thinking on what to do when your water breaks before your contractions have begun. When is it safe to wait a bit longer than the 24 hours hospitals push for to have started the induction process?)
- Evidence on: Premature rupture of membranes PROM (Evidence based birth, another useful source with lots of information on their website. This again looks at the 24hr clock often set once your waters have broken so it is useful to read even if your waters break after 37wks "This research shows that with proper care, waiting for up to 48-72 hours after the water breaks does not increase the risk of infection or death to babies who are born to mothers who meet certain criteria.* However, waiting means that birthing person may have a higher chance of experiencing infection themselves")
- The myth of the ageing placenta (A doula looking at the concept of the placenta by having a "best before date")
- Avoid These 15 Pitfalls For a Physiological Birth (This is a wonderful and comprehensive list of things to do (or avoid!) during ing pregnancy and birth to help you on your journey to a physiological birth, I feel the list Nadia has compiled really touches on so many important factors and many of these helped me on my journey even though I only saw this article a year after my HBAC)
Regarding VBAC/HBAC
- NICE guidelines VBAC (link to full guidelines with this quote here as a reminder that you should be supported if this is the kind of birth you hope for. NICE guidelines include that you should be supported in a VBAC up to and beyond 4 previous sections. Continuous CTG is NOT a must and neither does a cannula HAVE to be inserted as a preemptive precaution. Women desiring a VBAC should be supported in using water birth as a pain relief if they desire. There are many other things covered in the document that often isn't made clear by doctors/midwives).
- VBAC Sabotage (Australian Doula covers 9 things that can derail your VBAC, I found it very accurate and insightful. Definitely pointed me in the right direction of what to research further)
- Uterine Rupture (VBAC) - Making a mountain out of a molehill (Midwife Thinking)
- Uterine Rupture by intended mode of delivery (PLOS Medicine - medical review on uterine rupture risks: "Although uterine rupture is associated with significant mortality and morbidity, even amongst women with a previous caesarean section planning a vaginal delivery, it is a rare occurrence.")
- Maternal and perinatal outcomes in women planning vaginal birth after caesarean (VBAC) at home (Medical study looking at success rate of VBAC if done at home: "We found that planning birth at home after a previous CS significantly increased the chances of having a vaginal birth by around 12–15% compared with planning birth in an OU. This is consistent with other analyses of the Birthplace cohort, which have shown higher rates of vaginal birth and lower rates of CS in planned home births in ‘low risk’ and ‘higher risk’ women compared with planned OU birth.")
- Continuous Fetal Monitoring (Cochrane medical report looking at the efficacy of Continuous cardiotocography CTG: "Overall, there was no difference in numbers of babies who died during or shortly after labour (about one in 300) (low quality evidence). Fits in babies were rare (about one in 500 births) (moderate quality evidence), but occurred less often when continuous CTG was used to monitor the baby's heart rate. There was no difference in the rate of cerebral palsy (low quality evidence); however, other possible long-term effects have not been fully assessed and need further study. Continuous monitoring was associated with significantly more deliveries by caesarean section (low quality evidence) and instrumental vaginal births (low quality evidence). Although both procedures carry risks for mothers, these were not assessed in the included studies.")
Home births in general
First off I can not recommend the Facebook group set up and run by Doula Samantha Gadsen: HOME BIRTH SUPPORT GROUP UK enough. There's various groups that cover the subject but this is by far the most informative and supportive I've found. Samantha has spent a lot of time setting up lots of different units that are easily accessible. So not only can you share and discuss with her, other doulas, midwives and mothers but there is also an abundance of information available and on a diverse set of topics (You'll see that I have shared a few of her own blog posts here, that are many more though with helpful information ).
- Choice of place of birth (Birth Rights)
- Booking a home birth (AIMS - who to contact if you find your midwife or consultant are trying to prevent you from birthing where you want to.)
- A homebirth transfer is NOT a Failure (Samantha Gadsen - Doula with an important reminder for those who's birth plans have to adapt.)
On Freebirthing/Unassisted birth
- Exploring Freebirth (Samantha Gadsen - Doula runs a freebirth course with a minimal fee. It covers your everything you need to know to have a safe experience - its main aim isn't to encourage freebirth, but safe birth if you chose to/can't for some reason have a midwife there. You can also access it immediately via her group FREEBIRTH & EMERGENCY CHILDBIRTH SUPPORT GROUP UK)
- Freebirth 101 (page that covers the basic essentials when it comes to an "unassisted birth". The laws regarding freebirthing in different countries vary greatly but in the UK it is perfectly legal to freebirth. I have seen posts about midwives trying to scare women by saying it is illegal. They are wrong or trying to mislead you if they say so - click HERE for a link to the Birth rights fact sheet on the subject - it is however illegal for anyone other than a registered midwife or doctor to assume the role of a midwife, you can still be supported in other ways by your partner or a doula.)
Low lying placenta - I will be covering this subject as I had a low lying, anterior placenta. I was worried about what it would mean for my VBAC and I know many other women feel the same. My understanding is that 9/10 placentas move sufficiently by 38/39 weeks. Mine had moved well clear of my cervix as well as my old C-section scar by my 32 week scan.
• Facts and Myths: Placenta Accreta - Having a section scar meant they wanted to monitor my low lying placenta extra as there's the risk of developing placenta accreta if it attached to the old scar tissue.
• Placenta Previa (NCBI research paper)
• Complete placenta previa in the second trimester Medica Journals- "Overall, 10% of placenta previa resolved before 28 weeks of gestation, 31.4% before 32 weeks and 62.9% before 36 weeks, while a small number [8 (11.4%)] resolved at or after 36 weeks."
• Placental edge to internal os distance in the late third trimester and mode of delivery in placenta praevia - This study looks at how far from your cervix your placenta needs to be for safe vaginal delivery.
Just some extra information on my own experiences: I have had two vaginal births in MLU's at hospitals, the first with an awful lot of interventions and an epidural. The second better prepared but still with interventions I know realise I had power to not agree to (I didn't know I had a voice I just thought I had to do what I was told) and that certainly added stress to me and the baby. I planned a home birth for our third but had to change to an elective section just weeks before the due date due to his dwarfism condition and the risks that came with vaginal birth. And I'm currently pregnant with number four and once again planning to be at home because to me that is the best and safest place for me to achieve a successful vbac.
What is most important is that a woman is allowed to make the most informed decision they can but that they also are NOT coerced because a staff member doesn't agree with them. I'm reading about a worrying amount of traumatic births, especially when it comes to induction and or cesareans.
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