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?

Becky Talbot  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.”

 

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.

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.

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)

High BMI & Guidelines for Hospital Birth Pools

First posted 25TH AUGUST 2019

How can Trusts ensure that their guidelines for hospital birth pools support women with a high BMI?

The benefits of using a birth pool for labour and birth are well documented, and yet there is a group of women who are regularly denied the chance to use this powerful form of pain relief and comfort when giving birth to their babies: women with a high BMI.

The most common reason given by Trusts for the denial of access to a birth pool for women with a high BMI is that if she were to collapse, she’d be harder to get out of the pool. Another reason is that women of high BMI might be less flexible, and less able to step out of the pool themselves. A recent article by AIMS clearly debunks both of these considerations. (See here: https://www.aims.org.uk/journal/item/waterbirth-high-bmi)

But what if women with a high BMI collapse in the birth pool?
The term “BMI” does not mean “weight”. A short women who is overweight might weigh less than a tall, slim woman, and yet the short woman may be classed as “high BMI”, and the tall woman “normal BMI”. The heavier woman would be permitted access to the hospital birth pool, whereas the shorter, lighter woman might not. This is clearly illogical as the taller woman would be heavier, and harder to lift out of the pool, despite her lower BMI.

Any woman may need to be lifted out of the birth pool, irrespective of her weight or BMI, and so appropriate equipment and guidelines should be available at all times for every person using the pool.  This should not need to be weight limited. For instance, slings which support people of all weights are commonly available through hospital suppliers.

Methods to help women out of the blow-up birth pools used at home which do NOT include slashing the pool are well known. Slashing the pool will flood the floor, and nearby electrical items, with water, and the women will “flow” out with the water in an uncontrolled way. Instead, supporting the woman to remain above the water (birth partners are always going to help with this!) while a managed removal happens is much safer. A fast deflation of the centre ring will lower the sides while containing the water and retaining the structure of the birth pool.

Women with a high BMI and mobility issues
Another reason commonly given to deny women with a high BMI access to a hospital birth pool is that these women may be less likely to be able to leave the pool without assistance. In other words, the assumption is made that larger women will have reduced mobility. Any woman may have mobility issues, so this should be a separate consideration, no matter her BMI. That said, women who may find moving on land harder, for any reason, may find that the supportive effect of water in a birth pool can help them to remain more mobile in labour, thus leading to a higher chance of a positive, straightforward birth. It therefore makes sense to do what we can to support women to access the water, even if they are limited in their ability to jump out of the pool themselves – and this has nothing to do with BMI.

There are many different considerations for Trusts when they are writing their guidelines for women who wish to labour and/or birth in water. Using BMI as a barrier to access, however, needs urgent reconsideration, in order to ensure that all women are given the opportunity to birth in the way that is right for them – and which has many benefits for the Trust as well, as a low-cost way to support normal birth and better birth outcomes.

For a full and detailed report on the issue of access to a birth pool and BMI, please read the AIMS Journal article here: https://www.aims.org.uk/journal/item/waterbirth-high-bmi