“I would really like to share my birth story with other expectant mothers please as I feel that hypnobirthing allowed me to have the birth I never thought would be possible.”

“This time 3 weeks ago I was  searching for positive hypnobirthing induction birth stories trying to keep a positive frame of mind about my upcoming labour. I had agreed to be induced at 41+5. I am so pleased to now be able to share my own positive birth story!

In the build up to my induction date I tried to kick start my labour as naturally as possible with the usual attempts of eating spicy food, pineapple, clary Sage oil baths and massage, bouncing on my birthing ball, long walks, hypnotherapy, acupressure points- the list goes on. With no success I tried 2 sweeps over week 41 but again, no success.

I had initially started learning hypnobirthing techniques to reduce my fear and anxiety around birth, due to a spinal condition I had been told I was unable to have an epidural and that c-section may be the best method of delivery for me. My partner and I attended Fernanda’s mindful mama course in Loughborough and immediately felt the benefits of viewing pregnancy and birth in a more positive way. My partner and I both felt that Fernanda had a very calming influence on us and so, following the course I asked Fernanda to be my Doula during labour.

I went into hospital on Saturday night and had the first hormone pessary, I ended up having 2 of these over the next 24 hours because they kept on falling out. My body did respond to the hormones and surges built up and slowed back down repeatedly over 2-3 days. This was not the labour I had envisioned or planned. At one stage while being monitored my baby’s heart rate had increased and the midwives needed to find a clear baseline to establish whether or not he was distressed. Using the Mindful hypnobirthing MP3 I managed to calm the baby’s heart rate back to normal. This for me was clear evidence of how a calm mother can help to create a calm baby.

The hypnobirthing techniques I had learned helped me to stay relaxed and maintain an open mind throughout my birthing journey. Fernanda’s knowledge and experience helped us feel in control; she empowered us to make informed decisions during my time in hospital.

At 4pm on the Monday I was taken to the delivery suite and started on the hormone drip, things got intense pretty quickly. I used pregnancy and birth affirmations through headphones, a cooling eye mask to help block out my surroundings and any distractions. I also used a tens machine and gas and air to help manage the discomfort of surges. I listened to the Contraction Wave MP3 when surges became more intense. At 5.17am baby Neo made his arrival weighing 9lb 12oz, I had a natural delivery and extended skin-to-skin contact before my partner cut the cord and Neo was checked over and weighed. He is now 3 weeks old and people regularly comment on what an alert and chilled out baby he is.

As a family we cannot thank Fernanda enough for all her help and support, we now highly recommend hypnobirthing and having a Doula to anyone we know expecting a baby!”

40 weeks pregnant

Ellie’s birth

I  know mums who have had a labour induction because of medical reasons, but I also know mums who have been induced because they’ve gone over their dates and have chosen to have a labour induction rather than be monitored.  In another blog I talked about the different options around going overdue and what labour induction really means under these circumstances. But today I’m going to write about mums that have been induced for medical reasons.

Personally I’m not a big fan of labour induction if there is no medical reason for it, but when there is a medical indication then it may be the one of their few options. I speak from experience, I had a labour induction because of medical reasons at 32 weeks, but I still had choices in how I trod that journey and had a successful VBAC. So I know how, even in circumstances you may not have planned for, how being in the right headspace can make a difference.

This week I had the privilege to work as a doula with a couple who too had a labour induction for medical reasons and I saw from the other side how they were able to make choices which had a positive impact.   At one point the mother was sitting on the ball bouncing and chatting while the monitor was recording regular contractions when the doctor came in to have a long chat with us as he hadn’t seen a labour induction like this before and wanted to understand more. (scroll down to the end of the blog to see a short video)

As the contractions got stronger, the dad and I helped mum focus using deep hypnosis anchors that had been strengthened in preparation for labour and massage on her lower back.  We had her moving, not always on the bed where you often see women who have been induced but on the ball, leaning over the bed. Sometimes she did rest on the bed and we did a deep hypnosis relaxation so she could collect her emotional and physical strength.

The labour was quick, and baby was born without any other intervention and mum without any need for stiches. Afterwards the midwife who did the earlier shift popped into see the mum and sent me this message later   “I was over the moon to see she had a beautiful normal birth because I could see how the path may have been leading…with the meconium and decelerations….I went to see Charlotte the next day and she looked utterly radiant sitting and breastfeeding her baby.”

I think I’m guilty of perhaps unwittingly scaring women in the past about having labour induction. It’s true to say that it is often harder as your body is not producing it’s own oxytocin and natural painkillers, but it is still possible to choose to make that journey free of other intervention and to enjoy the experience.

It’s even more important for a mother to understand that if she is having an induction for medical reasons, or even when not, that keeping herself as calm and focused as possible will have a positive impact on the baby. I’ve often heard midwives say that babies with mums who are calmer and more focused, are less likely to become distressed.

These are the keys to making sure that you are well prepared to use hypnosis during birth

Preparing for a labour induction

If you have prepared mentally using hypnosis or hypnobirthing you are conditioning your body to respond positively to cues in your environment such as music, aromatherapy, touch.  This can be invaluable when there may be not much time to ‘think’.  A good hypnosis for birth course will put these in place and emphasise practice along with a birth preparation mp3.

Birth Attendants

Get a great midwife. Say you will be using hypnosis on your birth plan, very often if you have this on your plan you will be matched with the best midwife on the unit to support a birth with as little intervention as possible. The assumption is often if a mum has done hypnobirthing that she can’t do it with an induction, this isn’t true, hypnosis can be a brilliant adjunct to a tougher birth.

A strong, calm birth partner can make a huge difference. Think about a doula or someone, perhaps a friend, who doesn’t have to be there the whole time but who can come and step in to give dad a break.

Keep the (natural) oxytocin up and the adrenaline down

With a labour induction or any other sort of intervention the risk is that the adrenaline creeps in. Hypnosis can help you stay calm, visualisations can help increase your natural oxytocin.  Remember that the best thing you can do is to stay calm, relax your muscles and breathe deeply.   At one birth I was at I remember walking through the hospital to the shop and every single person I walked past turned and gave me a warm smile – oxytocin is amazing stuff.

Environment

People assume if you’ve had a labour induction that you’re tied to the bed, the lights have to stay on with the monitor bleeping away.  Wrong!  With an induction take even more care over your environment, you’ll have plenty of time to move the bed, turn the lights off apart from a small spot light. Turn off the lights on the resus unit (they’ll turn these on well before baby is born if they need to), turn the sound off or down on the monitor and cover the screen up with a t-shirt or something. Believe me, a monitor will have everyone in the room fixated on it rather than watching and tuning into mum, so good to keep it’s presence to a minimum.  A baby can also have variable heart rates and be fit and well, if you are untrained every dip may seem a problem and increase fear.  Get a ball in the room and make sure the leads are long enough to move off the bed.

Put some aromatherapy oils on and play some music, ideally your hypnosis mp3s.

Keep positive

Take each moment at a time, be mindful of each tightening and how it is working for you. Birth partners should use positive suggestion all the time, especially to counter any negative suggestions from the medical team.  Nobody can guess how a mother will dilate, how the baby will respond, what the outcome will be, take it one moment at a time and emphasise the positive.

Keep your strength up

In early labour or while waiting for the induction to be set up, while you can, make sure that you eat. It’s very easy to neglect to eat properly when you are waiting for a labour induction. Hanging around for the cannula to go in, then the drip, then waiting for the drip to begin to work can take a long time and it’s easy to lose track of how long it actually takes and to forget to eat. Keep some healthy snacks, sandwiches, and food nearby and keep hydrated.

Even in second stage, stay relaxed, take deep breaths and tune in to your body. 

Several antenatal classes hypnosis and otherwise, talk about learning birth breathing. In Mongan’s HypnoBirthing it’s called a J breath, I’ve also heard it spoken of as a plunger, like a coffee jar, turning the breath inwards and to your bottom.  If there has been a labour  induction because of medical reasons, the staff may want to get baby out quickly and sadly often seem to instinctively in these circumstances switch to “chin on chest, puuuuuussh” far more than allowing a mother to follow her instincts. This is known as valsalva pushing, you can read more about why this can negatively impact a baby  and is now not recommended as good practice by the Royal College of Obstetrics and Gynaecology here. If you do gravitate more to pushing hard, remember to take deep breaths in between, and to relax your jaw with each breath.

Third stage

If you have had syntocinon as part of your  labour induction you may be advised to have syntometrine to help with the delivery of the placenta. Depending on the circumstances you can still ask for skin to skin immediately, if baby is alert and breathing, even if there is merconium, baby can be put straight onto your chest.

Membrane Sweep

Shall I have a Membrane Sweep?

A membrane sweep is a common form of intervention that is routinely offered in the UK. The NICE  (National Institute of Clinical Excellence) guidelines state that every woman should be offered a membrane sweep at 41 weeks. So it is likely that this will be offered to you around then or an appointment booked in at 40 weeks for your membrane sweep at around 41 weeks.

As far as hypnobirthing is concerned this is an intervention, because the philosophy of hypnobirthing is to do nothing as nature will take its course. However, Hypnobirthing is also about making the right choice for you and your baby. Being informed helps to make the decision.  Understanding the benefits and the risks fully can help you make a choice as to whether you have one at 41 weeks or earlier, to delay it until you are nearer term at 42 weeks or to decline it. Importantly you do have a choice.

Research shows that women often go into labour within 2-3 days of having a membrane sweep, whether they were about to go into labour anyway is a possibility as women who are given a membrane sweep are expected to birth imminently. The intention of a membrane sweep is to stimulate the release of prostaglandins and oxytocin, both of which can trigger uterine contractions and labour.  Prostaglandins can be found in semen and oxytocin is a hormone associate with sex as well as labour, which is why sex is recommended to get things moving!

What happens during  a membrane sweep?

During a membrane sweep, your midwife will insert a finger into your vagina and feel for your cervix. She’ll then sweep the cervix to separate the membranes from your cervix. It can be very uncomfortable and you may bleed afterwards.

What are the benefits of a membrane sweep?

If you are nearing 42 weeks and under pressure for an induction, or just want to get things moving, a sweep can be a good way of getting things started. It can often prevent the need for other more aggressive pharmacological forms of induction, that are associated with something known as a cascade of intervention.

What are the risks of a membrane sweep?

There is the slight risk that the midwife could accidentally rupture you amniotic sac during a membrane sweep, which then means your labour may be actively managed and if you don’t go into labour after 48 – 72 hours (depending on your hospital policy) you may need to be induced.

There is also the sense of being disheartened if it doesn’t work. There is also some anecdotal evidence that women who have membrane sweeps have slightly more painful labours.

Natural Alternatives.

The aim of a membrane sweep is to trigger the release of prostaglandins and oxytocin, which stimulate contractions. Fortunately there are other ways of doing this that are more fun and much more comfortable!

•  Sex (semen contains prostaglandins and sex triggers the release of oxytocin)
• Eating spicy food (releases endorphins and oxytocin)
• Light touch massage
• Stand in a warm shower and teak your nipples until milk drips
• Have a go at reflexology or acupuncture
• Get your head in the right place, let go of the worry of labour starting in time and it probably will. Our Mp3s can help with that.
• Take yourself out of your normal environment and go for a long walk
• Clary sage and lavender baths (consult with a local aromatherapist or research the use of clary sage if this is an option for you)

 Summary

A membrane sweep  may be better closer to 42 weeks than 41 –  most women are nearing labour at this point and it is more likely to be effective the closer to going into labour you are.

If you are under pressure for an induction it can be a way of compromising and getting things moving without the pressure of further interventions. Unlike pharmacological methods of intervention, it is more unlikely to trigger the cascade of intervention that you so often hear of associated with an oxytocin drip.

If you choose to decline you will be offered regular monitoring if you go over 42 weeks to check the function of your placenta and levels of amniotic fluid.

Whatever you choose, it’s your choice – make it an informed one. This is what Hypnobirthing is all about.

Clock watching can slow labour down.

The due date countdown and friends who can’t help asking is the baby is here yet.

by Sophie Fletcher

“Have you had the baby yet?” is a question that you may here more and more as you approach your due date. As much as they love their friends and family this text or call can be one of the biggest irritants to mums-to-be as when they go past their due date.  Ironically, the worst culprits are often other women who, without thinking, feel they are being attentive to their friends and bombard them with texts, saying “just checking that you’re ok”, “oh so you haven’t had the baby yet”.   An acute example is my own mother, who phoned the hospital and was buzzed through by reception to the intercom in my room, during labour, at least twice to ask if I’d had my baby!

Most people automatically send a text round when baby is born; I’ve received numerous texts at 2, 3 or 4 am.  So the rule of thumb is if you haven’t received a text then baby hasn’t arrived into the world yet and if baby is on their way, and mum knows, she’s unlikely to want to text you back or chat to you.

Friends and family should fight the urge to call the mum when she is reaching her due date, she may be at the receiving end of dozens of texts from well meaning people.  At the same time mum-to-be may be under pressure for induction because she’s gone over her due date – the texts or phone calls  may become  a reminder that she’s over her due date and cause even more stress.

You may think, “I’ll switch my phone off” when I get close to my due date.  But the sound of an answer message  can just stir up the excitement even more, because if your phone is switched off everyone who calls assumes that you are in labour.

I know and you may know that you are not at term until you reach 42 weeks, and that the majority of women birth their babies before this date, but very often over their 40 week due date.  Only around 3-4% of babies come on their due date.

We also know that any stress or apprehension can stop labour from starting, as it releases stress hormones that can slow labour down, so it’s incredibly important that mum doesn’t have these reminders everywhere around her due date, and that she is able to go, stress free, into labour when she and her baby are ready.

Tips to help you minimise this disturbance as you approach your due date:

1. Don’t tell people your due date.  Tell them an approximate time, eg. The end of August, middle of September.
2. Tell your friends that you will message them straight away when baby is born.
3. Ask them not to text you, to ask “how you are”, or “if baby has arrived” after your due date but maybe a “I’m nipping to the supermarket, do you want anything” text is fine.
4. Get some lovely relaxation music to reduce stress after your due date when you may be getting anxious. Try the Mindful Mamma Mp3 on itunes.

My husband came home last night saying his work colleague, who had been on hypnobirthing classes, in central London, said that “hypnobirthing was shit” after having an epidural. Instinctively my first questions was “was she induced?” and you know what, it turns out she was. I don’t know the reasons for induction, but I do know he told me that the baby was strong and fine throughout labour. So I am guessing that she is one of the many women who are now getting to 41+ and being pressured into an induction.

So today I’m going to talk openly about induction, some of you may have read an old blog of mine which looks at the dubious methodology used to calculate due dates in the UK, but it was a while ago now and I see more and more women being unnecessarily induced so the time is ripe for a new one.

Now my job is to reduce fear, so normally I would talk about what goes right, but today I’m going to talk about the risks, as it seems that some obstetricians may be pressuring mums into induction with the threat that they are significantly increasing the risk or still birth or neonatal death if they go over 42 weeks. Statistically it’s not wrong to say that there is a 50% increase of your baby dying and this sounds frightening but it’s important to understand what this means, and I’m going to explain this in the blog. I’ve got friends and colleagues that may baulk at the word threaten, but I’m using this work because it’s what mums are hearing. Even if it’s not meant as a threat by the clinician it is most definitely being interpreted that way, mums are being frightened into having inductions, and we know that fear is not the right place to begin labour from a psychological perspective.

In a survey we recently ran, almost all mothers said that their biggest concern was something happening to the baby, so of course when they are told that going overdue could mean death, the red light goes on in their head, but what I don’t understand is why the majority of mums think that it would be safer and better for a baby to be born by induction, if they have had a normal, low risk pregnancy and everything is monitored as being well.

So today I’m going to take the opportunity to turn it inside out – I’m going to reframe induction and talk about the risk of your baby being born alive if you choose not to be induced, if you go over your dates. According to research, the risk of your baby being born alive and well at 43 weeks is 997.88 in 1000 or 97.8% compared to 98.3% at 40 weeks.

Your baby being born healthy depends on a low risk pregnancy, good placental function and levels of amniotic fluid and a spontaneous natural labour. Make no bones about it, NICE agrees that a spontaneous labour has better outcomes physically and psychologically for mother if she is low risk and the baby is well, and that fewer inductions are also a lower strain on maternity units. This is all measureable and the National Institute of Clinical Excellence writes about the choices being offered to women, note the word offered.

“That Healthcare professionals should explain the following points to women being offered induction of labour:

• the reasons for induction being offered

• when, where and how induction could be carried out

• the arrangements for support and pain relief (recognising that women are likely to find induced labour more painful than spontaneous labour)

• the alternative options if the woman chooses not to have induction of labour

• the risks and benefits of induction of labour in specific circumstances and the proposed induction methods

• that induction may not be successful and what the woman’s options would be.

The guidelines also say that

“Healthcare professionals offering induction of labour should:

• allow the woman time to discuss the information with her partner before coming to a decision

• encourage the woman to look at a variety of sources of information

• invite the woman to ask questions, and encourage her to think about her options

• support the woman in whatever decision she makes.”

The guidelines look at various studies, a study in Scotland in 2005 showed that women with spontaneous labour were significantly more likely to be satisfied with their labour than the induction group. To summarise this research, the evidence statement in the NICE guidelines shows that

“evidence from four UK surveys suggested that up to 40% of women felt they were not given adequate information relating to issues about induction of labour, and induction by drug was disliked by 80% of women; overall maternal satisfaction was low”.

If you read between the lines in the guidelines, the risk associated with prolonged pregnancy and stillbirth and neonatal death are linked to babies that have special circumstances. The problem facing clinicians is that at present they are unable to identify which babies are more at risk or not. NICE quidelines interpret the available research as implying that “ that 469 women would have to be induced to prevent one perinatal death”. It quite openly states that,

“Studies should be undertaken to compare effectiveness, safety, maternal satisfaction and compliance of different expectant management protocols,” because “Although the risks of fetal compromise and stillbirth rise steeply after 42 weeks, this rise is from a low baseline. “

“Consequently, only a comparatively small proportion of that population is at particular risk. Because there is no way to precisely identify those pregnancies, delivery currently has to be recommended to all such women. If there were better methods of predicting complications in an individual pregnancy, induction of labour could be more precisely directed towards those at particular risk.”

The low baseline they talk of can been seen in the figures of this study published in the BMJ in 1999, which shows that at 40 weeks the number of still births was 1.61 per 1,000 births at 43 weeks that figure was 2.12 per 1,000 – still very low.

I also commonly hear of babies being induced because they are measuring large for their dates however again NICE guidelines state that “ a baby should not be induced in the absence of any other indications, induction of labour should not be carried out simply because a healthcare professional suspects a baby is large for gestational age.”

So what are the risks of induction?

The main risks associated with induction are uterine hyperstimulation, failed induction, and with breaking of waters, cord prolapse.

However, women should be aware that induction is also an artificial way of beginning labour often, when the body is not quite ready, we know from research when the babies lungs are fully mature that it releases a hormone that triggers labour. Even now we don’t fully understand how this intricate and incredible exchange of hormones happens between mother and baby, and if possible it should be left undisturbed to allow oxytocin to flow and the body to create its own natural rhythm, endorphins and natural anaesthetic.

By disrupting the normal process of birth with the use of artificial hormones, the theory that underpins hypnobirthing becomes to a large extent redundant, and the emphasis shifts to a pain management paradigm, so techniques using hypnosis are still absolutely effective, but with a different approach and focus on the application of dissociation, distraction and visualization rather than the view that women should not feel pain during labour. I’m not saying you can’t have a good birth while being induced, but it is often harder.

The reason why inductions can be associated with a higher rate of intervention is because they are more painful and often women end up with artificial pain relief, such as pethadine, epidurals and assisted deliveries.

I’m mindful of the fact that I’m not a Dr or a midwife, so I just interpret the evidence that’s out there the same way I would if I were in the scenario.

I’ve written this to hopefully encourage other mums to think twice, to look at the research and make an informed choice. Realise that this is a big decision, that there are risks associated with induction. If you want a hypnobirth, or a normal birth you need may wish to take this into account.

Further Reading

NICE Guidelines on Induction

To Induce or not to induce

10 Month Babies – Guardian

Overdue and homebirth on Homebirth UK. With some stories attached.

Imagine an apple tree, rich with fruit. There is one particular apple you need to get down, it looks red and juicy and ripe. You really want that apple and you want it now.

You’ve waited through winter, seen the blossom in the spring and now it’s autumn and that apple is so big and round. It looks ready. You get impatient, every day you come out to the tree to see if the apple has fallen but it hasn’t. Eventually one day you decide enough it enough, if that apple doesn’t fall today then there must be something wrong with it. If it stays up there much longer it won’t be as red and round and juicy. You have to give it a helping hand.

So the next day you shake the tree trunk with all your might, but the apple doesn’t budge. In the end you think maybe if I climbed the tree I would get it sooner.

The tree is high, and you realise that if you were to climb the tree you would be tired, it would be hard work, you legs may get scratched and there is no guarantee you would reach it safely or the apple would be easy to pick once there.

So you sit under the tree to contemplate and reflect on your apple. You see the beauty of that apple so perfect in it’s surroundings. You become still and patient under the tree, aware of the peace and quiet in this beautiful place, knowing deep down that the apple will fall from the tree when it is ready.

Then one day while you are quietly clearing the leaves from the grass around the tree the apple falls, right in front of your feet on a soft clump of moss. You bend down and lift it up, it’s perfect without a blemish. You bite into that apple and are amazed at how perfectly sweet it is, that by leaving that apple to fall from the tree when it was time you let it ripen just as nature intended.

This is a symbolic visualization about induction.

The truth is though that inductions are rising – fast. Today Aberdeen University published figures which show that inductions are increasingly and unnecessarily being offered to mothers. Published on the BBC’s website the study found that more than a quarter of cases there was no medical need for induction and that women were offered means of induction when there was no reason indicated. Sadly we also know that induced labours are associated with an increased likelihood of further medical interventions, such as caesarean section.

The researchers said that there did not seem to be a single explanation for the figures. In the study 32% of women had been given some form of induction, which is nearly a third. Do we really believe that a third of women are not able to go into labour naturally of their and the baby’s own accord?

So why is this happening?

If anyone who has been on our classes is reading this they will be familiar with my thoughts on induction, however it still amazes me (and frustrates me) when we have birth reports where mums that are educated and knowledgeable are put under such immense pressure to have inductions. In fact one client recently was booked in for a sweep at 41 weeks when she was only 21 weeks pregnant!

It seems that they are all too quick to be made aware of the risks of going overdue, but are not made aware of the risks of induction, which very often leads to further interventions, on the baby.

In the UK we use a system called Naegele’s Rule to calculate due dates. Franz Naegele was an obstetrician in the early 1800’s and made his definition of due dates based on the premise that pregnancy lasted ten lunar months from the last menstrual period. It was not based on empirical data.

In the 1980s a researcher named Mittendorf in the US noticed that birth dates for women in his practice, primarily second-generation Irish-Americans, averaged seven days past their “due dates”. He reviewed his records, then went on to review records of 17,000 births, and determined the average healthy, private-care, first time mum averaged 288 days from (last Menstrual Period) LMP to birth: 8 days longer than Naegele’s rule.

Mittendorf and other researchers have further determined several factors that affect gestational term, including ethnicity, nutrition, substance use, mother’s age, and mother’s size. To calculate your due date base don Mittendorf try this:

(LMP – 3 months) + 15* Days = Due Date

* Add 10, rather than 15, if mother is non-white, or multiparous

In a study by Odutayo“Between 4% and 14% (average 10%) of women are prepared to reach 42 weeks gestation, and 2% to 7% (average 4%) to reach 43 weeks gestation depending on the population studied.” (Odutayo) In the overwhelming majority of these pregnancies, the foetus remains healthy, as does the mother.

And, according to American College of Obstetrics and Gynecology (ACOG), 95% of babies born between 42 and 44 weeks are born safely.

There is lots of research over the years which looks at percentages of babies born at 40 weeks, 41 weeks and so forth. An example from a midwife in a unit where they don’t routinely offer induction and delivered 479 babies in a year was:

140 (29.2%) delivered between 40-41 weeks
105 (21.9%) delivered between 41-42 weeks
27 (5.6%) delivered between 42-43 weeks
1 went >43 completed weeks”

These figures were from a midwife led unit and are fairly consistent with other research that has been published, apart from the percentage over 43 weeks which is higher in controlled studies.

Impatience is sometimes the only reason for induction – coupled with fear arising from a lack of understanding of how your body works with your baby to bring on labour. Equally mums aren’t aware of how important it is to allow those natural hormones to run their course, to give you a better and easier birth.

The baby will come when it’s ready. When they do it will be wonderful and the birth will be better for it.