This baby here was born ‘en caul’ which means that the baby was born still in its amniotic sac.
This is a fascinating photo and a fascinating (and rare) type of birth for the birth nerds amongst us but there’s 2 other important things to gain from looking at this photo.
1. Opposed to popular belief, this photo is evidence that waters don’t have to pop for you to be in labour. Babies can, in fact, be born with their waters still intact.
2. For most baby’s, they are not swimming in a giant balloon of amniotic fluid. If you look at the top of this baby’s head, the membranes are very close to baby’s head. If you then imagine that baby’s head tightly in a pelvis acting as a plug- you can see why some women second guess themselves on whether baby’s waters have gone or is it just a little bit of pee. Sometimes the waters trickle out, which NEVER happens in the movies, right?! Don’t always expect a flood gate and always call in if you suspect your waters have gone.
Two of my babies have been born with waters still intact when their heads were born. It was like giving birth to a little astronaut 👩🚀
Has anyone got an interesting story to share on their waters breaking?
You can read the comments and join in on the conversation here.
Photo creds @janabrasilfotografia
So what are my options when it comes to fetal monitoring in labour? Will I be able to move around? Can I use the pool? The answer is often yes!
Intermittent auscultation and continuous fetal monitoring are the two main ways in which we monitor babies during labour.
Intermittent auscultation involves using a Doppler/sonicaid to listen to your baby’s heartbeat for at least 1 minute every 15 minutes during active labour and every 5 minutes when you start pushing. It is a flexible and easy way to check in on your baby during labour and is not restrictive to you in any way. (NB. This is the device your community midwife uses to listen to your baby at your antenatal appointments.)
Continuous monitoring will involve using a cardiotocograph (CTG) machine which will be attached to your abdomen throughout labour. Like the one in the photo. One is measuring your baby’s heartbeat, the top one is measuring your contractions.
If both of these methods are not suitable for you, for example if the CTG machine is not providing your midwife with a clear enough reading of your baby’s heartbeat they may recommend using a fetal scalp electrode (FSE). These cannot be used in the pool. An FSE involves attaching a small clip onto your baby’s head to very closely monitor your baby. FSE’s ensure we are always recording your baby’s heartbeat and are not affected by external factors such as mobilising. You may notice a small scratch on your baby’s head when they’re born but don’t worry, it doesn’t hurt them and this will disappear very quickly.
The type of fetal monitoring that’s recommended for you in labour will depend on whether you and your midwife/obstetrician have deemed your pregnancy to be ‘low’ or ‘high’ risk. If there is a medical reason why your baby may need to have a closer monitoring, then you’d be advised to have a CTG throughout your birth. This may be for reasons such as prematurity, pre-eclampsia, obstetric choleostasis or an induction, to name but a few. These babies have things going on already that may mean they get more stressed out in labour. Intermittent auscultation is recommended for those of you who are considered low risk as your baby is less likely to find labour stressful.
Both a CTG and using a sonic aid for monitoring your baby in labour should not affect your ability to move around, you will still be able to access the pool (they’re waterproof) and all methods of pain relief are still available. Most women worry about being strapped down to a bed when they are offered continuous monitoring, but in Gloucester, there are no cables attaching you to the CTG machines on delivery suite so you can move around as much (or as little) as you like! If you choose to have continuous monitoring of your baby, midwives like to make sure that they do that efficiently. This may mean, adjusting them or asking you to change position so the monitors pick up your baby’s heart rate clearly.
Continuous monitoring was brought in during the 1970s to reduce the amount of baby’s effected by cerebral palsy. However, the evidence doesn’t support that it’s done this. When midwives/obstetricians look at a baby’s heart rate pattern we know that if it is showing no signs of distress then your baby is well. If your baby is showing signs of distress, then 50% of these babies will be in distress, the other 50% won’t. What happens then is that cesareans/interventions are advised. 50% of these are necessary, 50% would not have been. We are continuing to study the patterns of a baby’s heartbeat whilst they’re inside to understand them to reduce the unnecessary intervention from them. You are advised against a CTG if you are low risk for this reason- to avoid the chances of unnecessary intervention.
However, if you are advised to have a CTG but you’d rather not then please discuss this with your midwife. Similarly, if you’d like a CTG but are advised against it, please speak to your midwife.
If you’d like to have continuous monitoring then here are some tips for you to ensure that it doesn’t interfere with your birth…
⚡️Ask for 2 straps to tie to the fetal heartbeat monitor. This will reduce the amount of times a midwife will ask you to readjust the monitor on your abdomen. It also means that you can move around more freely without thinking about it coming loose.
⚡️ If you find the noise is causing you to feel anxious then ask for the volume to be turned down. Baby’s heartbeat in labour can drop. This can be very normal for a baby to do but can cause concerns for you to hear.
⚡️You can ask for the machine to be turned away from you, for the same reason above.
⚡️Continue to move, discuss a waterbirth if that was one of your preferences and most importantly discuss with your midwife WHY you are being advised to be on the CTG and then use your EBRAN to decide if it’s something that you’d like to go ahead with.
If you want to do some extra reading on fetal monitoring and what will be best for you and your baby in labour you can find it on NICE website. If you’re attending a class with ourselves (Mia and Beth) or Hannah we’ll be happy to delve deeper into the nitty gritty too.
Mia and Beth x
Arguably one of the best jobs in the world, sitting here now I actually can’t think of a single job that would give the same tear-jerking moments, the adrenaline rushes and the relationship ties that bind you to a couples memory for a lifetime.
To see a birth is on most peoples bucket lists, one of life’s true miracles. And yet a midwife would not only see, but be involved in hundreds in her career, for those of my colleagues who have been a midwife longer than I have been alive, those numbers would be knocking on the thousands. That in itself is a testiment to the role; once you start you stay. Today on the International Day of the Midwife, Midwives across the world will be celebrating all that they love in the role. I’m going to be throwing it back to where my love for it first began, those 8 years ago.
I will never forget the first time. It was with a couple who were having their third baby. I stood in the corner of the birthing room, aged 21, 3 months into my Midwifery degree with a wealth of waitressing experience, A- Levels and 18 months of motherhood under my belt. I had been to one birth before and I was high on gas and air at the time and definitely did not have a clear view of the business end.
The mother was lying on her side on the bed. She had beads of sweat on her cheeks and her husband had a flannel that he placed just above her brow. This woman was fierce and powerful yet so vulnerable. She looked down to the midwife who was leaning, gloved hands poised ready for the baby to arrive. “I can’t do this… I can’t do this!!!” the woman cried, eyes wide searching for reassurance. The midwife gave her a smile that calmed all in an instant, “You ARE doing it… you are ready to meet your baby.” This wasn’t the first time during her labour that the midwife had spoken encouraging words. I had watched throughout as she wiped her mascara from her eyes, rubbed the bottom of her back, wet the flannel, given a drink through a straw. Only ever leaving the room to go to the toilet herself or have a quick slurp of a cold tea. A bond had formed and as this baby was now nearly here, that trust was needed now more than any. At that moment, the midwifebelieved that the mother could do it, giving her the confidence to believe in herself. And with that, as a contraction built, the mother closed her eyes, curled herself forward whilst holding her leg behind her knee. Determination in her face as her contraction peaked and her body instinctively pushed down.
I watched in awe as this thick set of black hair started to emerge. The mother continued to push as a head was born followed quickly (in true third baby fashion) by the baby. The room erupted with love as the mother opened her eyes, reaching out for her baby, with an expression reserved only for this moment. The baby placed onto her chest now taking his first breaths of life with a cry, wrapped by her arms like a blanket. This family; mother, father and newborn all crying into each other.
Chills ran up my body, hairs standing on end as I stared in amazement of what I had just seen and without realising tears spilled out from my eyes onto my cheeks. Amazing as it was, it wasn’t the baby being born that made me feel like this, but that look of the mother and father setting their eyes on something they had only just met but already had tonnes of love for.
After a few minutes had gone by the midwife said, “ Aww look, the students crying!!” I smiled, embarrassed, the new parents looked over and laughed. The sister in charge (who was present for the birth) said without even looking up. “If the students going to shed a tear, she must leave the room.” I gnawed through my lip and rolled my eyes up, not wanting to leave the room!
We keep Mum and baby’s safety at the forefront but alongside this the midwife has many roles, mascara wiper, hair tyer, shoulder leaner (both metaphorically and quite literally) tea and toast connoisseur, cheer leader, the list goes on. All this contributes to help families get to the point where they hold their baby for the first time and I’m sure I speak for many midwives when I say, after all those years later, I still bite my lip to hold those happy tears back!
(NB. This photo taken by Chui King Li was taken at my own birth. I think it summaries the support you get in labour amazingly)
1. Pelvis and Positions
When your baby is in an OPTIMUM position – baby’s head is down in your pelvis and baby’s back is running alongside your abdomen. If you are standing up baby is looking/facing your back. When a baby is in this position the smallest part of baby’s head enters the pelvis first and your baby can navigate through the pelvis a lot more efficiently- making your labour and birth quicker and less of a chance of needing intervention.
To assist your baby into this position- there are a few things you can do… Think of the back of your baby’s head is its’ heaviest part and you want that to be swinging to the front of your abdomen, this should help you understand the correct positioning.
• When you sit down/ relax in the evening try and ensure that your pelvis (top part) is tilting forward – it’s sort of like your bum will be sticking out.
• Your knees should also be lower than your pelvis too.
• Birthing balls (blown up correctly) and straddling a chair (so backwards and leaning over the back) are great ways of sitting.
• If you do want to lie down or slouch back in a comfy sofa I would always do so on your side.
• If you do a lot of driving then you can pop a small cushion at the base of your spine to again, help you lean more forward.
These are all tips that you can adopt at any time of your pregnancy. However, it is most important from 36 WEEKS as baby will be entering (getting engaged) into your pelvis at this point. You can continue to adopt these positions in labour to keep baby in this optimum position by leaning FORWARD (on your partner, a wall, leaning on a bed- whatever is in sight) with contractions so the strength of your uterus contracting will also be working to get baby into this optimum position.
Another thing that you can do to make sure that your ball is going to come out that maze quickly is by keeping your pelvis UPRIGHT. Imagine dropping a ball through a pelvis, it’s going to come out the bottom. If you lie that pelvis down then put the ball in there- you no longer have gravity on your side. So another top tip for birth is to stay standing or walking as then gravity will be pulling from the bottom whilst your uterus is pushing from the top. Use the forces of nature to lend you a hand!
2. Protect your space
Lights, camera, no action. If anyone here is anything like me and is slighty, Instagram obsessed then I am sure you are partial to a photograph. Any avid photographers amongst us? But, have you ever noticed the most creative photo opportunity of a loved one, with perfect composition and great lighting. Only to get the camera out and they have moved from a chilled out, natural form to an uncomfortable, stiff pose? I always think of Chandler and Monica here too, Friends fan anyone? The minute the photographer goes to take a photo of the newly, engaged couple, Chandler puts on the most awkward of smiles. Anyway you get the idea.. The camera makes people act weird! Similar situations can occur during labour. It is called the ‘Fear Of Being Observed’ and it makes total sense. If you think about being in a new situation, such as birth then put your friend in the corner, or your mother in law or the postman etc. this is going to change the way you react to your tightenings. Birth is instinctual and primitive. Tightenings can make you want to squat to the floor or lean over on all fours, they are going to make you want to breathe rhythmically and sometimes noisily like you do if you are exercising. Sometimes having extra people in the birth room, such as a friend, mother in law or sometimes even your own mother (depending how close you are I suppose) can alter how you behave and this can effect the hormones in your body.
So this tip would be PROTECT your space. If you are feeling overwhelmed with birth and your surroundings, take yourself into your bathroom as it is often the only place where you can guarantee that you will be on your own for. Just until you have got back in your zone again.
3. DIM LIGHTS.
Having bright lights on decreases your production of melatonin (the night time hormone). This hormone directly works on the uterine muscles assisting them in contracting, so we need dim lights for lots of melatonin to be produced. Also, think of mammals, they always go into a dark space- free from distraction to birth. It is again a primitive instinct as in this environment we would have been free from predators, making a safe birthing environment. Also, most likely the reason why women often go into spontaneous labour in the night time, the darkness indicates the environment is free from predators.
Keep the lights dim in labour, either whilst you are at home or in the hospital.
4. Birth Affirmations
A POSITIVE MINDSET, is something that you will always own in all situations and I encourage you to utilise this to your advantage. Use affirmations to strengthen this mindset every day. Your mindset will be using words like CONFIDENCE, STRENGTH, RELAXED.
I make the right choices for me and my baby.
I breathe for calmness.
I feel confident about birth.
I feel relaxed about birth.
Birth is safe.
I relax my mind and my body follows.
I believe in myself.
I am strong.
I birth without fear.
(Note here that birth is ALL modes: Instrumental births, vaginal births and cesareans)
By following a positive mindset- your body will naturally align with this, without you predicting or planning what will happen.
The more you go over these affirmations and follow this positive mindset- the more your body believes that all is well and will naturally align with this. What I mean by this is there is going to be less adrenaline in your body, which is a hormone that can stop / reduce contractions. If you are feeling calm, relaxed and confident about birth then the OXYTOCIN hormone is going to be released-keeping your contractions effective and therefore reducing the need for intervention.
Your feelings surrounding birth you can control, which can influence your birth for the positive. However, to plan a birth journey, not so much.
I bet you’re thinking what has this small bit of drinking equipment got to do with birth??
Well let me tell you this drinking tool goes two fold…
Firstly let’s talk about the less obvious one… I’m going to take you back to a time where you felt a bit nervous about something maybe a presentation at work or an impending exam. The things that we notoriously do to our bodies around this time is hold tension in our shoulders, hands and jaw. Even now sitting here, reading this email be aware of your jaw are you holding tension in it? What about your shoulders? Roll your shoulders back and down and you may notice that they were tense beforehand. Ever noticed how you clench your fists when feeling stressed? Our body is connected all the way down- if we are holding tension in our jaw, hands and shoulders then the rest of our muscles in our body hold tension as our body feels as if it is under stress. If you then apply this to your cervix.. a cervix that is tense will not open as readily as one that is relaxed. Which leads me onto a STRAW… when you drink a drink through a straw your jaw is relaxed. You try drinking through a straw with a tense jaw.. it is impossible!! Therefore, with the same rule applying- if your jaw is relaxed then the rest of your body is going to follow suit, meaning that your cervix will be relaxed enough to open efficiently. You can apply this same method to your palms, ask your birth partner to stroke your palms to encourage them to remain open and relaxed. Also, to your shoulders, having your birth partner pop his hands on your shoulders and reminding you to relax them will have the same effect. An extra bonus of both these too is that TOUCH increases the birth hormone OXYTOCIN, which again will encourage contractions.
This same method can and should be used in all birth situations. If you are having a cesarean, it may not be as important what your cervix is doing, however, you are still going to want to be feeling relaxed and calm during the cesarean and when meeting your baby. Get your partner to pop his hands on your shoulders whilst the spinal anaesthetic is going into your back, ask him to hold your hands and stroke your palms during the cesarean. Get that oxytocin flowing at this point, it helps greatly post birth with breastfeeding and bonding with your baby. PLUS it makes you feel good.
Second point of the straw is HYDRATION. Your uterus is a muscle. Think about going to the gym to body bump or HIIT and not bringing your water bottle… ludicrous!! It’s exactly the same as in labour, your uterus contracting requires fluid to work effectively.
Nb. Get yourself a recyclable straw then you’ll be helping your birth and the environment all at the same time.
So that’s a wrap for your 5 POSITIVE BIRTH tips.
For more tips for pregnancy and birth and the fourth trimester come to antenatal class or hypnobirthing.
Ok ok I get it.. it’s not the most nicest of subjects to talk about and I’m sure you’re all crossing your legs as you read this 😵. But rather than focusing on how horrid this may be or worse still sticking your head in the sand, start thinking about what YOU are going to do about it!!! Because there’s lots of things that have been shown to lessen the tear, and with around 90% of first time mums having a tear that needs sutures, the more you know the more you can do to help reduce them. Knowledge is power after all. One of the biggest fears expectant mamas have about birth is vaginal tears so I thought I’d do a post on a few things that can be done to lessen the tear (number 6. is one that you can do from 34weeks pregnant.)
1. A warm compress. Having a midwife support the area with a warm compress can reduce tears.
2. Position. Pushing on your left side, all fours or semi- recumbent have been shown to have the lesser tears.
3. Communication- Blow and don’t push when the midwife says. This is so baby’s head can be born SLOWLY.
4. Hands on approach. Having a midwife support your perineum again, especially with a warm compress.
5. Did I mention…
6. Perineal massage- Massaging the perineum with your thumbs (or getting your partner to do it) from 34 weeks with some olive oil has been shown to lessen any tears in first time mums by 10%.
These tips are all evidence based guidelines from the RCM or from an a midwife Julie Frolich who made a care bundle which has been shown to reduce tears.
If we’re talking about tears then we need to talk about recovery and healing.
1. Change your pads regularly to reduce infection.
2. Stay hydrated. It’s concentrated urine that may sting your stitches.
3. A high fibre diet will help with that first post natal poo. That’s dates, prunes, bran, fruit and veg.
4. Tea tree in the bath can aid healing. Other than that you can wash as normal but don’t use soap on the area. And pat dry.
5. Arnica tablets can help with bruising in that area regardless of if you have a tear. Have a look in your local health shop for arnica tablets to take during labour and post birth.
Any questions…? Please comment and I’ll do my best to answer them.
It’s 11pm and I’m 3 hours into my shift as an obstetric registrar. I look up at the lady I am delivering and tell her that I’m putting the ventouse cup on – a glorified sink plunger that’ll hopefully help me get the baby out. I ask her if she’s having a contraction.
There’s a pause as she sucks deeply on her gas and air, before finally replying
“….no it’s gone.”
“Ok. No worries. With your next one I’m going to help you birth this little one.”
Her husband catches my eye. He’s exhausted – his face is full of fatigue, anxiety, anticipation. I hold his gaze and compose my face. The obstetrician’s poker face is well practised. Beep, beep, beep, the baby’s heartbeat ticks away steadily; it’s almost soothing. We wait for the next contraction. Meanwhile, Beth (the midwife) and the neonatologist (baby doctor) are present in preparation for the delivery. My concentration is momentarily interrupted by a fluttering in my belly and I’m reminded of my own passenger. I turn back to the husband.
“You know you’re the only one in the room who isn’t pregnant?”
Everyone, including the birthing lady in front of me, laughs, before our attention is rapidly recaptured by a building contraction; I am distracted from my own pregnancy because I’m managing another.
Beth asked me a shamefully long time ago to put some thoughts on paper about the experience of being a pregnant obstetrician. What insight had it given me? What could I offer my past self in terms of hints and tips? What greater understanding had I gleaned from gestating?
I suppose the first thing to say is that I have found pregnancy and motherhood a surprise. I’ve met a lot of pregnant ladies, felt a lot of bellies, scanned a lot of uteruses and delivered a lot of babies. Grandmother; eggs, I thought. Despite being immersed in all things obstetric, I was astonished by how it felt to be pregnant. Despite almost every woman telling me how tired they were when I met them in early pregnancy clinic, the degree of my knackered-ness was astonishing. I’d arrive in the car park 20 minutes early and set my phone alarm just so I could have a cheeky snooze. Then I’d leap out of the car, dry-heave on the curb for five minutes, explaining to passers-by that, no, I wasn’t still drunk, then sprint to labour ward looking wan and sheepish. Unsurprisingly, pregnancy is hard to hide when you’re surrounded by those in the know. The Eau de Vom doesn’t help either.
To my delight, a colleague (and now great friend) was roughly the same gestation as me, but was unfortunately having a rough ride during pregnancy. We regaled each other with tales from the pregnant trenches. I once had to flee a delivery room – to “get some equipment” – only to be so desperate to puke that I left the loo door open; the birth partner eyed me quizzically from the corridor. My craving for salty carbs was also out of control: one morning I inhaled a packet of ready-salted crisps between every patient on a morning theatre list. There were six patients that session. My friend, however, out-did me by fainting dramatically on a ward round. The consultant, ever considerate, revived her with a playful kick.
By comparison, second trimester was a delight. I stopped feeling sick – hurrah – and started relaxing into the swing of things. I even started to feel more attractive – that ‘glowing’ business didn’t seem to be all nonsense. At least, that was until I mentioned my pregnancy to a colleague.
“Oh, congratulations! Naturally, I just assumed that you’d really enjoyed Christmas.”
Great. Not fit, not ‘glowing’, just fat.
Putting my apparent gluttony aside, I waddled on unabashed.
My husband and I planned a trip to the Brecon Beacons when I was 24 weeks. We hadn’t been before and I thought it would be lovely to see it in the snow. I read avidly about ambitious hikes and told my husband that, no, pregnancy wasn’t an illness and it was him who was going to struggle to keep up with me. Yeah. Near the summit of Pen Y Fan, feeling like a breathless Weeble on ice, I came to the painful realisation that pregnancy does, indeed, c hange your exercise tolerance. A planned 6-hour jaunt spiralled into a 10-hour expedition complete with blizzard, white-out and obligatory marital spat. The conversation had become increasingly terse as our phone compass failed (I know, I know…), we got lost, and I put my foot in a deep, icy bog. He had the temerity to laugh.
My husband requested something less ambitious second time around, so, at 28 weeks, we went away for a more sedate weekend in St Ives. Pottering around shops and ‘enjoying one another’s company’ were the order of the day – it wasn’t just the pasties that were hot. I couldn’t understand why I was crippled by tightenings all weekend, and mentioned it to a senior midwife when I got back. She smiled then gave me a naughty wink. How had I not known this from my job?!
In an attempt to inhabit a more maternal, less obstetric, mental space, I booked NCT classes, and did my best to listen and not interrupt when doctors were portrayed as scalpel-wielding patriarchal butchers. I was only partially successful. Discussion turned to life after the baby, and how we would manage. It still all felt very hypothetical, despite knitted boobies, role-play and swaddling baby Resusci-Ann dolls.
Eventually, around 35 weeks, it dawned on me that this was really happening. Having refused to acknowledge that this pregnancy might actually result in a baby for months, I finally sat down to write my birth preferences. And you know what I discovered? I’m a bit of a hippy. I bought the essential oils, sat on the birth ball, made a playlist (different for 1st and 2nd stage, obvs) and expressed a wish for a normal birth, skin-to-skin, low lighting, Ina May Gaskin and Michel Odent knitting quietly in the corner. Of course, being a massive cynic, I also explained my wishes in event of a Caesarean under general anaesthetic, because failing to prepare is preparing to fail and all that.
In the event, labour was predictably unpredictable, but suffice to say it involved a dog that knew my waters had broken, a husband who was too drunk to drive, and a high-speed trip to hospital whilst alternately screaming and cracking jokes, lying across the back seats of a Mini. Well, we obstetricians do love a bit of drama…
If you had your baby in Gloucester some time between 2014 and 2016 you may notice this lovely lady in the photo (although typically looking more fresh faced in these photos! ) This Obstetric doctor may have come to visit you during your pregnancy, childbirth or even had the pleasure of helping you deliver your baby.
Whilst now on maternity leave she is continuing to provide a service to the pregnant mamas of Gloucestershire and beyond with the shoe on the other foot, with this blog about pregnancy as an obstetric doctor.… You’d think it would be teaching Grandma to suck eggs right?
So here is Dr Medland… at your cervix!