‘Fetal positioning techniques can facilitate easier, faster and safer birthing thus reducing the ever increasing number of caesarean sections performed and the amount of drugs administered. A reduction in medical intervention, and particularly caesarean sections, would reduce the necessity for aftercare; helping to cut down on post operative infections, post operative complications, and even helping to reduce the occurrence of post natal depression and post traumatic stress disorder.’
The Story So Far
1. Click here for the story behind the Campaign and find out about how I used fetal positioning techniques to have two straighforward, intervention-free labours against the odds.
2. Click here to learn more about the research we so need into fetal positioning techniques to prove they are safe and effective.
3. Click here to learn about how moving mummy helps baby to move into a better position for easier birth and how the medicalisation of birthing over the years has ignored gravity and movement.
It has now been three weeks since the launch of the MakeBirthEasierCampaignUK and with continuing support, the Campaign message – fetal positioning techniques, such as those on SpinningBabies.com, to be included in the standard training curriculum for all midwives – is reaching far and wide.
A Personal Story Shared
Laura attended a Positive Birth Movement meeting in the hopes of building her confidence for her second labour which was fast approaching. This is where I met her. I was attending the group as a speaker for fetal positioning techniques I had learnt on SpinningBabies.com. She had already taken affirmative action by joining the Daisy Foundation (empowering education and support from pregnancy to parenthood) for a course, and this meeting was her next step on the road to recovering from her first labour experience.
As Laura started telling her story, I could immediately feel her anguish as she welled up and had to pause for a second to compose herself.
Laura had had a back-to-back baby and also been very poorly at the time of going into labour. She’d not had the chance to labour fully as she’d been told she would be prepared for a caesarean section to deliver her baby.
The anaesthetist doing the epidural, for some reason vocalised what he was thinking and stated more than once that it was difficult to find a suitable injection site, and that he couldn’t get the needle in the right place.
Laura was terrified that she would be left paralysed by this procedure going wrong and felt utterly helpless to do anything about it.
Following the delivery of her baby girl by csection she found it very difficult to bond with her baby due to the traumatic circumstances she’d experienced at the birth. She was overwhelmed with negative emotions and guilt, and this only amplified her trauma.
Here she sat in front of me, three years after the experience, crying her heart out, because the birth of her first child had been taken from her. She had not been allowed to give birth vaginally. Not only that, but she had been terribly traumatised by the experience which had filled her with fear.
I’d also had a back-to-back baby, yet I’d managed to turn him around and regulate my own contractions to enable me to have a smooth, intervention and drug free birth. Why, I wondered, are women and midwives not aware of the techniques I used? Laura could have had a much more positive birth experience had she known about fetal positioning techniques. It absolutely breaks my heart to see women go through such negative birth experiences, especially when, in most cases, there are alternatives. Malposition or malpresentation do not have to automatically mean a medicalised birth.
I told the group the stories of my two very straightforward labours which, without fetal positioning techniques could have easily involved induction, augmentation, assisted delivery and/or csection. I share my stories to help people understand the possibilities available to them. They have options. If I can do this, maybe you can benefit too. You at least have a much better chance of the birth you hope for.
We talked about several different fetal positioning techniques and what they’re used for. We talked about the feelings of empowerment created by having options to choose from. Many times I’ve described it as having a toolkit from which to draw whatever tools are required for the job at hand. This to me was both empowering and calming. It seems I’m not the only one.
I Had My Little Boy
Here is the story of Laura’s second labour, in her own words…
“I had a fantastic birth experience.
I had a long early stage at home and then had my 41 week antenatal check at the hospital. I described my contractions and we agreed I would be admitted as I was 1cm and feeling like I wanted some support: I felt a little like history was repeating itself. I’d had a little wobble as it had been stop start for quite a while by then despite me being active, changing position and using all my new-found knowledge.
I pulled myself back whilst we waited for a bed on the ward. Once I’d vomited a bit, replaced some fluids and found my calm, things quickly heated up. Contractions got going and I was transferred to the labour ward. Initially the midwife was not my cup of tea and despite me telling her repeatedly that the CTG wasn’t working, she just kept saying my contractions were too weak and may as well have patted me on the head when I said they weren’t and were very strong. I checked the clock and knew it would soon be handover and ignored the silly woman when she told me off for hyperventilating. She actually made an audible snort when my partner explained the escalator breath to her.
Handover 30 mins later… In walked a fantastic midwife and student midwife and things quickly changed. She changed the lead on the CTG and my contractions suddenly warranted a big gold star for mummy’s coping! Got all the lights dimmed, LED candles out, essential oils and Daisy music on.
Over the next 5 hours I progressed fantastically. Changing position: in the zone; calmly labouring. The midwives were so supportive and held the CTG in place if I wanted a position that wasn’t lending itself to the monitoring.
My waters went and things stepped up a gear further. Vaginal exam at midnight, I think, and 6cm! I was so happy and quite high on gas and air. At about 02:15 things suddenly changed and the contractions were instantly unbearable. We moved positions a couple of times. Tried a few things but with every contraction came this awful pressure and then baby’s heart rate started diving very low. We quickly got a clip on his head and had a look at what was happening. He was somehow stuck and I can’t remember much of what was said from this point, but from then on his heart was nearly stopping with each contraction. Everything slowed down and I just became very calm. I knew we were off to theatre. I smiled happily as they put the spinal in and had the most serene Cat 1 csection anyone has ever had!
His head was a very peculiar shape where he’d been squished!
I feel like I’ve had a triple victory somehow with this birth.
Firstly, my body was doing it! Gas and air, tens and breathing.
Secondly, I’ve truly healed from my daughter’s birth emotionally, and thirdly I had a spinal and a csection – two things that have brought me out in cold sweats and nausea for the past 3 years – without even a second of panic or fear. I knew it was all going to be ok.
The icing on the cake was overhearing my midwife telling another midwife about how fantastic I was and how much she enjoyed my labour!
So as I sit here feeding my handsome baby boy, I’ve come to reflect on my journey. I never knew I was so strong, I never knew I could heal my own wounds and I never knew how wonderfully positive any experience can be.
Thank you to everyone who has helped me on my journey. I am very grateful for all of the support I’ve been given and hope to give back to others in the future.
Love, a very euphoric (if a little sore) Laura xx”
Achieving a Transformative Experience
Before her second labour, I‘d sent Laura a copy of the csection birth plan I’d prepared for myself in case things didn’t go as I hoped. I asked Laura, if this birth plan had proved useful and how she’d tackled the csection. The following is her response:
“I actually went for a pretty medical csection and unusually requested that I didn’t hold my baby immediately. The reason for this was that in the lead up to birth I went through all the individual things that heightened my anxiety last time, so that I could stay as calm as possible. One of the things that terrified me with my daughter’s birth was when she was placed on my chest, I felt like I was going to drop her as the spinal block made me physically shake. I knew worrying about this could be a trigger for a panic attack so I asked that I wasn’t given her to hold until I asked, and that she went straight to my partner. This was followed to the letter. He held our little boy and bonded with him until I felt stable enough to do it.
I had a strong fear of epidural so the hospital had arranged in advance for me to have an appointment with the head anaesthetist and talk over my fears. When I had an epidural with my daughter, the man that did it mentioned a couple of times that it was going to be difficult and may take more than one attempt – I had a panic attack over this and high anxiety whenever I thought about it for the 3 years until I dealt with it.
The lady I met with was fantastic, examined me and felt my spine, as I was scared it was abnormal and therefore I would be paralysed if I had an epidural. My back is normal, and she suggested as I was so tense I may not have lengthened my spine enough and he was just speaking aloud his internal monologue rather than suggesting I could help in some way by loosening up.
The anaesthetist went through my fears one by one, and addressed all of them. She then wrote a letter for my notes telling them not to offer me an epidural (I also wrote this in my birth plan) and that in the event of an EMCS (emergency csection) I could have a spinal. This was definitely read by all concerned at the time and they were incredibly sensitive. I used my Daisy Birthing breath (in for four, out for eight) to remain calm and it all went fine.
Also, I didn’t want the screen lowered as I was scared of that.
Basically I went through everything I knew I could have and weighed up what scared me first time and how I could keep calm this time – even if that meant going against the more natural section most VBAC (vaginal birth after csection) women want. This was a time for learning from things. I tried so hard to do things “properly” last time and put too much pressure on myself. This time I listened to myself. I’d learnt so much about me, and only did what I knew I could cope with.
Other things I put in my birth plan were also respected, such as lowering of the lights, listening to my Daisy music, using lavender and clary sage spray in the room near me and -most importantly for me – not to be offered pain relief or for the word pain to be used. My midwife was fantastic!
I didn’t use Spinning Babies in the end but used the “rotate to dilate” movements I’d learnt with Lorna Brown at Daisy. I used pelvic tilts and the “camel walk” to engage him.
I spent a lot of my labour on all fours, gently circling my hips clockwise with each contraction and breathing. I later heard my midwife telling a colleague (when she didn’t know I was in earshot) how incredible I was and how peaceful and calm it was.
Another fab thing that happened was that I later saw the anaesthetist on her rounds (who’d given me the talk) and she recognised me. She was over the moon to hear that she really had helped and was noticeably touched that she’d made such a difference.
Near enough every health professional I came into contact with listened to and respected my views and I believe largely because I was so informed but also as I am naturally a gentle negotiator, and tend to get my own way with knowing how to strike the right balance between being firm and being gentle. It seems to work for me!
My enthusiasm seemed to rub off on people. I know I was lucky though, as I do hear a lot of consultants can push their own agenda onto mothers.
I cannot praise the hospital enough for the support they gave me.”
The positive experience Laura had with her son’s birth was helped a huge amount by the kind and thoughtful treatment she received from the medical staff involved in her labour and the way they responded to her birth plans. Communication and kindness go a very, very long way towards a positive maternal experience!
Empower Yourself with Knowledge and Preparation
I wanted to include Laura’s story in my blog for several reasons.
It has been an incredible journey for her from the way she felt about her first birth, to her second which was a hugely transformative experience. From negative to positive because she took control the second time. She empowered herself with knowledge, preparing herself for different eventualities. She worked at making it her own birth and finally, with a csection she was at peace because she knew she’d put in her best effort and the section was a medical necessity for the health of her baby boy. Her birth was not taken away from her this time. It was hers and powerful and positive. This changed her emotional response dramatically and she bonded well immediately.
**Inherent in my campaign is the concept of helping to empower women in their births so that, regardless of how their baby is eventually delivered, they know they were informed. They were aware of the array of options available and made use of them – this can make a huge difference to the birth experience postnatally.**
The positivity in Laura’s story I hope will speak volumes and it’s a wonderful and amazing example of what this campaign is trying to achieve. Her journey has really touched me.
Saving Pain and Money
In this blog I wanted to highlight ways of helping to reduce the number of women going through negative birth experiences and thereby reducing aftercare required, both psychologically and physically.
So many women are affected by post natal depression (PND) and post traumatic stress disorder (PTSD) due to their negative birth experience and the physical recovery they endure postnatally. Time and time again I hear stories similar to that of Laura’s first birth: stories of fear, pain, loss of control to a medicalised system and emergency csection. Women wondering if they could have birthed their baby differently if they’d known x, y, z , or been ‘allowed’ more time (a woman’s informed choice in all this is a subject which I think needs discssing in its own right, so I won’t go into it here).
If midwives are trained to recognise signs of fetal malposition and can support a labouring woman by applying specific fetal positioning techniques to resolve these malpositions, the 25% csection rate in the UK (yes that’s 1 in 4 women) could be reduced to a more acceptable 10-15%, as recommended by the World Health Organisation back in 1985 and again in 2015. This lower more acceptable will remain because – regardless of balance, movement and specific positioning techniques – sometimes, csection is the safest and sometimes the only option for the health of mother and baby. Fetal positioning techniques are not a guarantee in any labour, but they do give a much better chance of minimising interventions.
Csections increase the length of time spent in hospital in general and increase the risk of admission to the Intensive Care Unit for baby and also for mum.
Caesarean section is not an easy option. It is major abdominal surgery with its own inherent risks and associated fears. It is higher risk than a vaginal birth, with complications including post operative infections, blood clots and postpartum haemorrhage amongst others, and a range of side effects from the epidural or general anaesthetic such as nausea (for which anti-sickness drugs can be administered), low blood pressure (for which blood pressure medication can be provided), allergic reactions, chest infections, and in rarer and more serious cases, damage to nerves or the surrounding tissues at the epidural site.
Add the above complications, all requiring medical treatment, to the many occurrences of PND and PTSD requiring psychological evaluation and treatment such as Cognitive Behavioural Therapy, and there is already quite a list.
Research now shows that babies born via csection may miss out on an immensely important part of vaginal birth – seeding the baby’s microbiome. This is where the baby is exposed to the mother’s own bacteria within the birth canal, during immediate skin to skin contact with the mother and breastfeeding, helping the baby’s immune system to develop to its full potential, and providing the infant with a reduced risk of developing one or more serious diseases later in life.
There has also been a stark warning recently by Dr Michel Odent that increased induction/ augmentation (use of synthetic hormones to start or increase strength/frequency of contractions) rates are suppressing the naturally occurring hormone oxytocin, which could affect the natural release in the body and have adverse effects on birth and breastfeeding.
Speaking from a business perspective, collectively reducing the occurrence of the above complications by eliminating a significant percentage of augmentation, csections and negative birth experiences, this could save a huge amount of money for the NHS and help ease pressure on midwives in so many ways. The range of aftercare for birth, particularly births that end in csection, is huge and is very costly to the already overstretched NHS. More importantly, reducing these would save a lot of pain for women!
I’m sure the NHS would like to see a positive difference in the number of women leaving the labour ward with a happier, easier outcome.
The Next Step
Step 1: Generate interest and support from mums and the midwife community. This bit is continuing well and the campaign is being followed by more people each day.
Step 2: Generate interest and support from the research community. The interest we received into doing research into fetal positioning is still keen and the facility is open to doing a study…with, as I suspected, a couple of hurdles standing in the way – hurdles which I have already covered in previous blogs. This facility needs an evidence base with actual data behind it first to show that it’s safe and it actually works before doing a larger trial: fair enough really. So we’re back to the following (click to refer to my second and third blog posts which cover these in more detail):
• Case reports – observational data on volunteering patients – tracking labour and delivery outcomes, safety, any adverse effects and compare with a control group.
• Cohort/small pilot study into safety/efficacy, again with consenting individuals.
• Pending results from the first two studies, a randomised trial could be done.
It may be unrealistic to expect to generate direct evidence of the impact of fetal positioning techniques on labour outcomes, due to the number of compounding factors. However we would hope such studies could support a trend towards improved outcomes.
I imagine there would need to be an obstetrician involved at some point?
Finding a willing researcher is a great step for the #MakeBirthEasierCampaignUK in such a short time – there’s still a very long way to go. With continued support to raise awareness about fetal positioning by sharing the campaign message, we hope this first step becomes one of many.
Step 3: Generate interest and support from the obstetric community. I have received some support here which I believe to be crucial to these techniques being accepted into mainstream care.
Step 4: Generate interest and support from the medical press. I’ve begun tweeting the medical press and can tentatively say I’ve had a couple of journalists and editors follow @MakeBirthEasier.
This is such a complex and dynamic subject. Any advice or guidance you clued up people out there (researchers, midwives, obstetricians, gynaecologists, scientists, anyone in the know!) can offer on any of these questions would be very welcome. All comments which have come my way so far have been valuable and I would like to thank all of you who’ve been in touch!
If I can use fetal positioning techniques myself for both my births with such impressive results (see my first blog post MakeBirthEasierCampaignUK dated 11 May 2015), imagine what trained midwives could achieve using them every day. Women in this country would have a better chance of an easier, uncomplicated, intervention free birth if midwives and other health care providers had training in fetal positioning techniques. To reach that goal, we need evidence and support.
This is a huge opportunity to invest in a more positive future for maternal care in the UK. I am hopeful that I have your support.
For health professionals and others interested in being part of this opportunity, please leave comments / advice / guidance / offers of funding / offers of research team & research facility (!!) on this blog page.
You can also contact me via my page at https://www.facebook.com/MakeBirthEasier (particularly if you would like to message me privately)
The Campaign is also on Twitter @MakeBirthEasier, #MakeBirthEasierCampaignUK
Blog written by Alix Fernando
The content of this blog is not intended, and should not be read as constituting medical advice, diagnosis or treatment. Always consult your doctor, midwife or other qualified healthcare provider before making any changes to your birth plan or recommended routine.