Vaginal breech birth in a birth centre

Does your hospital support vaginal breech births in the birth centre? If not, why not make 2024 to year to make this happen?

Annie West generously shares her wonderful story of this happening at The Rosie birth centre. What an incredible experience for everyone this must have been.

“I was determined to turn my baby, but he was more determined to stay breech. With the help of our Doula, Becky Talbot, I tried everything: bouncing on my ball, hunching over it while I watched TV, inversions, handstands in the pool, osteopathy, an ECV – but no luck. After the ECV, the Consultant briefly discussed our options: a planned cesarean section or vaginal breech delivery in the Delivery Unit. We scheduled a follow-up discussion with the Consultant Midwife, in ten day’s time, to finalise a plan.

I was hugely disappointed and frustrated to be in this position. Why hadn’t he turned?! I had had a straightforward vaginal delivery with my daughter, so my gut decision was for the vaginal breech delivery, but I wanted to be in the Birth Centre. I wanted a less clinical environment, with midwife led care where I could feel the most relaxed and least interrupted.

My partner and I discussed the options with Becky in preparation for our meeting. I was absolutely confident in birthing my breech baby in the Birth Centre with skilled midwives, but feared pushback because the guidelines were to be in the Delivery Unit with Consultant led care and constant monitoring.

My waters broke Friday morning, three days before our meeting with the Consultant Midwife. Becky rang The Rosie to inquire about a Birth Centre delivery while I started labouring at home. After discussions on my behalf with the Lead Midwife and Consultants to consider my history and baby’s well being – I was cleared to use the Birth Centre! They would be expecting us, under the care of one of the most experienced breech delivery midwives. I was extremely relieved and appreciative to get this news and be supported in my choices.

I laboured at home for a few hours before arriving at the Birth Centre, where everything was ready and waiting for us. A mat and birthing ball were set up in the corner, where I could labour and deliver my baby in a comfortable position for me and as recommended by the midwife. With the support of my partner, Becky and the midwife, my baby made his entrance into the world Friday afternoon – bum first! We enjoyed the golden hour and stayed the night in the Birth Centre before heading home the next morning.

My Birth Centre birthing experience was all I could have hoped for. I felt cared for, supported and safe. My birthing team approached the situation with confidence, but most importantly calmness and compassion, which helped my baby arrive without any complications or interventions. We are extremely thankful and appreciative of The Rosie team who supported our wishes to use the Birth Centre for our breech birth and hope this can be an option for other women who want to do the same.”

For information on breech training across Europe, contact Debs Rhodes via daaluzoasis@yahoo.com

Do Breastfeeding Doctors Bedshare?

A group of researchers in the USA were interested in how many doctors bedshared with their babies, and whether this affected their breastfeeding journey. Unlike the advice of professional organisations in many countries, which tend towards positivity or neutrality thanks to up to date research showing its benefits, bedsharing is still contrary to the recommendation of the American Academy of Pediatrics (AAP).

 

77% of their group of respondees were in roles where they were responsible for the care of pregnant women and people, and/or infants. This is perhaps relevant as doctors in these roles may be more aware of the AAP’s guidance than other doctors.

 

Despite this, the doctors in the survey were still likely to bedshare, with 68% reporting “some bedsharing”. Bedsharing led to an average of 4 months longer breastfeeding duration.

 

Interestingly, 52% of the doctors did not tell their own healthcare providers that they were sharing a bed with their baby. The researchers note that this could perpetuate the stigma of bedsharing, and reduce the chance of positive discussions being had, as well as the sharing of safety information about sharing a bed with a baby.

You can read the full report here…

BASIS is a great source of evidence based bed-sharing information for parents and professionals. (Click here to go to their website)

NMC – Independent Culture Review “An institutional bully of the professions it regulates”

July 2024 saw the publication of the Independent Culture Review of the NMC by Nazir Afzal OBE. The Review is a mix of quantitive data, such as employee retention, and, crucially qualititive data – the voices of the employees of the NMC and the culture within.

 

While the Review reflected some positive aspects of working for the NMC, there were many horrific reports which included bullying, racism, sexism and people considering that supporting vulnerable people is a “weakness”.

 

Over 18% of employees said that they had witnessed “discrimination, victimisation or harassment” from panel members or NMC staff. Nearly 10% of staff reported being victims themselves of the same.

 

Fitness to Practice panel staff raised issues around ethnicity. One panel member reported being told that her Indian name was “very difficult” and did they have a shorter version. Others noted that the panels were not diverse, and raised concerns about how this may affect the outcomes of NMC registrants who were facing a FTP hearing. One damning quote says, “It now makes me laugh when I hear the value of Kind being mentioned in communications – it doesn’t feel like that it is a value that is adopted – it’s just a word bandied about that makes it sound like that kindness is an embedded value – I don’t believe it is.”

 

The Association of Radical Midwives, ARM, responded to the Report with an open letter to Wes Streeting MP, Secretary of State for Health and Social Care. You can read the letter here. In it, they say:

 

“The NMC’s lawyer-driven, adversarial, punitive, destructive, and ridiculously drawn out approach to professional discipline and regulation is not in the public interest.”

 

“The charges made against [independent midwives] often result from the NMC’s complete lack of understanding of women’s reproductive rights and autonomy.”

 

“…the NMC is a contributor to the implosion of the maternity services over recent years and the unsafe environments in which women in the UK are giving birth to their children.”

 

“An institutional bully of the profession it regulates”

 

Will the NMC take note this time and make changes from within? Will the new Government recognise its failings and intervene?

 

Some midwives are fighting back. YOU can make a difference.

 

1) Contact Wes Streeting (link here) and tell him your experiences with the NMC.

2) Join the Association of Radical Midwives (ARM) Midwives’ Haven group for support and campaign ideas. You can choose what aspects of the group you would like to join in with (contact ARM here).

 

This is a great movement for change – why not be a part of it!

Supporting Stillbirth: A Guide for Doulas

Supporting a family through stillbirth is one of the most feared roles as a birth worker, and yet almost always it happens without the opportunity for us to really have had the time to consider how we can provide the best support possible. This article aims to give you some thoughts and ideas to help you to plan for this tragic possibility. If you are in need of this article right now, I am so very sorry for what you are experiencing and for your clients’ loss.

 

The doula’s role after stillbirth

As doulas, we talk a lot about holding space, and this is never more important than after the death of a baby. In the shock of the tragedy, parents will not know what to do or what is expected of them, and a doula can make a huge difference by supporting them to take their time, and reminding them that they don’t need to rush any decisions. If hospital staff are pushing for decisions to be made, you can ask what the reason for a fast answer might be, to help to work out whether it’s medically necessary, or whether it’s something that can wait for a while. Nowadays, there is usually a trained bereavement midwife, or bereavement team, so it can be helpful to ensure that they are involved with the family’s care, if that’s what they want.

 

Practical aspects of doula care

Some ways that doulas can help are with ensuring that parents are aware of things that they are unlikely to have heard of. For instance, you can find out if the parents can access a cold cot, sometimes called a cuddle cot. These are little bassinets with an integrated cooler. In between holding their baby, parents can lay him or her in the cuddle cot, which helps to preserve their baby’s body for longer, giving them more time with their baby. Sometimes, cuddle cots can be taken home so parents can still bring their baby home for up to a few days.

 

Some mothers or birthing parents will want to stop their milk supply, if they don’t already have a child that they are breastfeeding. Others may wish to donate milk to a milk bank, but few people will know that this may be an option. It isn’t an option for everyone, so it’s worth finding out where your local milk bank is, and seeing what their donor requirements are.

 

Have a list of charities that you know can be helpful for parents. For instance, SANDS offer an excellent bereavement service. Now I Lay Me Down To Sleep is a volunteer photography service, who will come to take professional photos of stillborn babies. While there are not many in their database, they have useful information for photographers which could still be helpful for parents. Little Angel Gowns make beautiful funeral gowns and outfits for newborn babies, made from donated wedding dresses which allow babies to go to rest dressed beautifully, made by volunteers who have also sometimes experienced loss.

 

Support Yourself

Supporting families through loss will be one of the hardest things you’ll ever do. Remember that you can speak to your mentor, or contact your preferred doula group to discuss your feelings and experiences. It’s ok to share what you are going through, provided you respect the family’s privacy and any details of their birth and baby, unless you have permission. Remember the circle of grief theory (if you don’t know it, read it here) and comfort in, dump out. But make sure that you do dump out. Do seek support for yourself, and take time for yourself. It’s ok for you to grieve as well.

Waterbirth and Cord Avulsion

In the biggest study done on the rates of cord avulsion (in this case defined as the cord snapping just after birth), it was found that it was slightly more common for the cord to snap during a waterbirth compared to a land birth. Looking at 17,530 waterbirths, and 17,530 land births, Bovbjerg et al. 2021 found that the rate of cord avulsion at water birth was 4.1 incidents per 1,000 waterbirths, versus 1.3 incidents per 1,000 land births.

This is often cited as a risk of waterbirth. In fact, it appears to be a risk of insufficient training in waterbirth care rather than a risk of waterbirth itself, and can be mitigated by understanding the cause, and changing practice.

Why might the cord snap?
Some babies have umbilical cords which have developed with problems that make them less strong, so more likely to break. However, even taking this into account, we see more cases of “typical” cords snapping during waterbirth than land birth. Why might this be?

By far the most common reason for the cord to snap is the midwife or doctor pulling the baby out of the water too quickly, putting pressure on the cord and snapping it. This is more likely if the cord is unusually short. The fear of having the baby under water too long, and therefore pulling them up too quickly, is the explanation for almost all snapped cords. For this reason, changes of practice will remove this risk.

What can I do to improve my practice?
1) Understand that babies have a range of protections that stop them from inhaling water during a waterbirth. During labour, a baby’s practice breathing stops, and the instinct to not inhale liquids is triggered. This will only be over-ridden by an extremely compromised, oxygen-starved baby who is probably unconscious and who may gasp at birth, but it is very unlikely that such an unwell baby will not be recognised before they are born.

2) Of course it’s important for babies to be brought out of the water without undue delay, but this can still be a gentle movement, with great care taken to ensure that the cord isn’t pulled. Even better, supporting mothers and birthing parents to bring their own baby to the surface means that they have the feedback within their own body to not pull on and snap the cord.

3) If the cord is too short for the baby to not be brought to the surface, don’t panic, just ask the mother to stand, and if possible lower the water level.

In summary: While cord avulsion is slightly more common in waterbirth, it is still very rare, and some simple changes in practice will most likely stop it from happening any more often than in land births.

Aquabirths’ Ruth Weston: Birth Activism Book!

Changing the world of birth means giving those with the passion for activism the tools to take the plunge, or dive deeper. Who better to share these tools than the woman who has been at the leading edge of change in birth activism for over two decades? Ruth Weston shares her life experience as an activist who makes things happen, who makes things get done. Anyone, lay or professional, who is interested in making birth better, needs Born Stroppy!

If you are at the ARM National Conference, Hands Up for Midwifery at Birmingham City Hall on 16th November then you will have a chance to meet the author and see a preview of the book cover and more.  Say hello to Ruth in the market place or send her a message of support on the day (because she will be nervous!)

https://www.facebook.com/people/Ruth-Weston-Speaker-Author-Change-maker/61556828767933/

or @bornstoppy (on the former twitter)

 You can pre-order the book by emailing us at: office@aquabirths.co.uk 

Local Birth Support – Yorkshire and Manchester

UK Homebirth Support Group: Visit them on Facebook

Bradford Choices is the 2nd Tuesday of the month, beginning at 7.30pm.  Join the Facebook group for more information and the venue: https://www.facebook.com/bradfordbirthchoices

Wharfedale Birth Choices Group meets in Burley in Wharfdale, on the 3rd Saturday of the month at 10:30am. Would love to see you there, and please do help us get the word out by inviting friends and colleagues to join the group. Find them on Facebook HERE

Huddersfield and Calderdale Home Birth Support Group meet every six weeks. Find them on Facebook HERE

Ilkley Positive Birth Movement Group meets on the last Sunday of the month at Midwife Amanda’s house in Ilkley.  Please contact Amanda on 07828 315622 or visit them on Facebook.

Leeds and Bradford Caesarean and VBAC Support Group. A ‘peer’ support group for women and their partners who are considering caesarean, who have had a caesarean and want to discuss their emotions relating to their experience, for women planning another baby or already pregnant and wondering about their options and choices to birth normally next time around. Click HERE to go to their Facebook Page.

Harrogate Homebirth Support Group. The Harrogate and District  Home Birth Support Group meetings are held on the third Sunday of every month 10.30am – 12 noon at the Oatlands Community Centre, Gladstone Street, Harrogate. For further details contact: harrogate@nct.org.uk .

Leeds Choices – St. Andrews Church, Horsforth. Their Facebook page is HERE.

Manchester Homebirth Group. Visit their facebook page.

Wakefield Birth Choices is now only on Facebook.

York Home Birth Support Group meets on the first Sunday of the month from 3-5pm. See Facebook HERE

Sheffield Homebirth Group – https://www.facebook.com/sheffieldhomebirth/

Hull & East Yorkshire Home Birth group – meets third Monday of the month.
https://www.facebook.com/HEYHomeBirthGroup
http://www.hulleastyorkshomebirth.org.uk/

La Leche League Groups in Yorkshire:

Having a homebirth in Leeds – information and support from your midwives. Contact the Lotus Team on  0113 392219
There are home birth and water birth information evenings, speak to staff at the LGI for information.

Breech Birth: Essential Skills Training

 

By Breech Birth Midwife Debs Rhodes

From a medicalised traumatic birth, to a beautiful spontaneous surprise – this was my introduction into breech birth. I was fascinated, and I absorbed as much information from as many sources as I could find.

The history of breech birth has been a rollercoaster. Originally widely accepted as a variation of normal, at home with community midwives and family practitioner doctors in our Grandmother’s birth time, we moved to nearly 100% caesarean section birth in most industrialised countries. And now, the strong realisation that it’s time to bring back physiological breech birth, together with a rejuvenation of understanding, and a mix of old & new skills.

Where did all the breech birth skills go?? 
As the last century turned, most breech babies were already being born by caesarean. However, evidence from the Hannah et al, 2000 research showed that c-section favoured babies’ mortality outcomes over medicalised vaginal birth, putting the final nail in vaginal breech birth’s coffin. However, over the subsequent decade it was realised that there were many flaws in this trial – not least the lack of support for physiology in the vaginal birth arm of Hannah which led to iatragenic harm that could be avoided with good breech birth skills. And, critically, when the data is considered over the two years following birth, there is no difference between the outcomes of birth abdominally or vaginally (this was swept under the carpet!)

Those practitioners that understood breech birth have kept these skills alive. With mounting evidence that safety is compromised by all breeches being born via c-section. Women’s health and lives are being put at risk, future pregnancies are being affected, and with a greater focus on the overal health of the woman and child, it’s time we regained vaginal breech skills.

I’m delighted to be able to share my own experiences of practice along with my continued learning from breech experts around the world.
Whether you want to learn from new, re-skill, update, share space with like minded practitioners, offer breech support in your own practice or just be prepared for those surprise ones that come along you’ll find the latest evidence and practice techniques here.

Workshops will be in Spain, UK, France, Slovakia, Portugal & Czech Republic.
For more information, email me, Debs Rhodes, at daaluzoasis@yahoo.com.

Christmas Wishes for Maternity

If you had three wishes, three things that you could wave your Christmas Wand at and make happen within the maternity services, what would they be?

This article by Katharine Handel for AIMS shared her top three wishes: Honesty, Respect and Dignity. It’s fascinating to think that these basic foundations of care are missing from so many people’s births. We also know that they are missing from the work lives of many midwives, midwives who go to work and are not treated with honesty, respect and dignity by some of their colleagues.

How we work is often a habit, based on what we see and how people work around us. Sometimes, we may see ways of working that don’t feel right, or we may inadvertently work in ways that don’t match how we see ourselves. Some ways of working that might originally have been shocking can become normalised. Sometimes, it may not feel ok, but fighting it feels too hard, or too risky.

There is support out there. Looking forward to a new year, maybe we can all think about three wishes that we would have for the maternity services, and then consider how we can find the support to be the change we want to see.

Useful support networks:
The Association of Radical Midwives
Secret Community for Midwives in the Making (Facebook)
Say No to Bullying in Midwifery (Facebook)
Da A Luz Oasis

Biofilms and Birth Pools

 

Are biofilms a health and safety risk in hospital birth pools? What can be done to minimise the risks of biofilms in hospital birth pools? Aquabirths answers these questions and more.

What is a biofilm?

Biofilms are a collection of bacteria which have clumped together in a supportive environment, which will include the regular flow or presence of water. Biofilms are everywhere, and are likely to be the reason that we have life on earth, as the ability for bacteria to join into larger groups, rather than simply floating around as planktonic lifeforms (individual bacteria cells) appears to have been vital as part of the stepping stones from single cell to complex life (1).

When bacteria clump together into biofilms, they produce chemicals which makes them harder to destroy with normal anti-bacterial chemicals, and a combination of cleaning agents and scrubbing is necessary to remove them.

Biofilms are present in most areas of our life, and are often beneficial to our bodies, including some which reside in our gut. An example of a bodily biofilm is dental plaque, which needs to be regularly removed to avoid harm, and this is an example which clearly shows how just using an anti-bacterial mouthwash isn’t enough. Scrubbing with a toothbrush is also necessary to properly remove the bio film of dental plaque.

So, while biofilms aren’t necessarily a human health hazard, some are, so understanding how to clean them is important in all hospital environments.

Biofilms in hospitals

Biofilms can be found in many areas of hospitals (and shops, and our homes), and are likely to be present everywhere there is water. They are a natural part of the planet’s environment. The time that they may become a problem is:

  • If the bacteria that is growing in the biofilm happens to be one that can cause harm to humans
  • If this harmful bacteria is able to access the human body, eg via an open wound

For this reason, hospitals have strict policies on cleanliness, and following these policies should be enough to keep everyone safe from harmful bacteria.

Biofilms and birth pools

There are three areas that biofilms can grow on birth pools:

  • Plumbing into the pool (taps and pipes to the taps)
  • The pool itself
  • The birth pool’s drainage system

Biofilms can grow in any pipe through which water runs, including if the water is clean and chlorinated. Of course, the chlorination is likely to significantly control any pathogen build up. There is nothing that needs to be considered in the birth pool that isn’t already considered in the use of fresh water elsewhere in the hospital. For instance, there is no additional risk from the birth pool water intake than there is for the water used in scrubbing up for obstetric or other surgical procedures.

Running the water for two minutes before starting to fill the pool (so with the drain open) will ensure that any loose bacteria that might be in the intake pipes or taps will be washed away. This will also safely wash away any loose bacteria around the drain.

The second area to consider is the birth pool itself. Clearly, the infection control policies which relate to the cleaning of the pool include both anti-bacterial cleaning agents, and scrubbing, which if done correctly are sufficient to ensure that the pool is clean and safe. ALWAYS ensure that any cleaning products are non-scratch. Abrasive cleaning agents must NEVER be used – including the cleaning cloth or pad, and the chemical used. Scratches on the pool caused by abrasive cleaning chemicals or cloths/pads can be harder to clean than a smooth surface, so in theory could make complete pool cleansing harder.

Finally, the drain needs to be kept clean. Birth pools should not have an overflow, as these are very hard to clean, and if the water level in the pool rises above the overflow it is theoretically possible that the water may be contaminated from this outlet.

The drainage area (plug hole) should be kept clean as per the guidelines provided by Aquabirths (2), or as defined by local hospital policies. There are a number of options to plug the waste outlet, and hospitals can choose what they feel happiest with.

A plug with a chain should never be used as the chain is very hard to thoroughly clean. Some pools have a traditional plug (without a chain) which can be removed by hand, but this means putting an arm through the water after it has been used for a birth, so long gauntlets would be recommended. Plugs do provide a seal between the birth pool and the drain, creating a strong physical barrier between the birth pool water and the drains, so some units choose this option and provide gauntlets for removal.

However, other plug options are available. The most commonly used waste option has a valve below a grated plug hole which can be opened and closed from a system that is outside of the birth pool (no gauntlets required!). To clean the waste area, close the valve and pour sanitising solution into the waste until it comes up above the plug hole, and leave it to stand per cleansing regime guidelines. Below this waste system is a waterless trap which can be removed for cleaning if required, and being waterless it is far less likely to develop biofilm matter (remember that biofilm needs water to thrive). Some other brands of birth pools use traditional U-bend traps which are a breeding ground for bacteria. These should be removed where possible. It is possible to use a traditional plug together with the valve if a physical barrier above the entire drain is preferred – but remember that a well-cleaned waste area, together with the good practice of running water for two minutes with the waste open before filling the pool – is already an excellent way to ensure that possible bacteria build up does not contaminate the pool.

Pop-up wastes are not recommended because they slow drainage in an emergency (although in the case of maternal collapse it is recommended to ADD water to the birth pool, as the buoyancy of the water helps when lifting her out). They also inhibit the flow of pool contaminants, and a prone to collect ‘debris’.

Should we be concerned about birth pools and biofilms?

Properly cleaning birth pools is vital to ensure the safety of the pool, which is exactly the same as any other area of the hospital, including “land birth” equipment, beds, etc. While biofilms require water to form and thrive, and therefore it might be incorrectly assumed that birth pools are a higher risk than other equipment, the amount of liquid required to form a biofilm is microscopic. Therefore, any spray of body fluid (from a sneeze, for instance, or a drop of blood) can support the growth of biofilm, including on stainless steel surfaces such as bed rails. And of course, all of us are walking biofilm hosts!

Therefore, birth pools do not lead to any greater risk of biofilm formation, provided that infection control procedures are undertaken – which of course is absolutely essential in all areas of the hospital, not just birth pools! And, in reality, evidence looking at the safety of birth pools versus land birth repeatedly shows that there is no increased risk of infection from using the pool. This means that birth pools can confidently be offered as an excellent form of pain relief and comfort in labour, and as with any other area of the hospital, we simply need to follow proper infection control procedures.

 

References

  • Is biofilm formation intrinsic to the origin of life?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10086821/

  • Aquabirths’ Baths for Labour and Birth Cleaning Guidance (link)