Disappointed in the RCM #ButNotMaternity Response

I’m disappointed and angry today. This year has been difficult for everyone, but for people accessing maternity services it has been particularly traumatic and unnecessarily anxiety inducing. When the NHS released new guidance on Wednesday, clarifying that (at last!) people should “have access to support at all times during their maternity journey“. It finally seemed like someone was listening, and some of this stress may begin to ease. But no. I’m really disappointed in the RCM response, who say “safety is being sacrificed in favour of popularity” and that they cannot support it.

We all understood the situation in March, and reluctantly accepted that lockdown restrictions were necessary. But when those restrictions relaxed, when we could visit pubs and theme parks, fly on planes and eat in restaurants, with the government encouraging us to Eat Out To Help Out, and with children returning to school, strangely we did not see much easing of restrictions in maternity services.

Pregnant Then Screwed have been raising this issue (and several others about the inequitable treatment of pregnant women and those with kids during Covid) for months.

Pregnant Then Screwed website

When still nothing had essentially changed for most people accessing maternity services by 5th November, MPs in the All Party Parliamentary Group on Baby Loss shared some very personal experiences as a call to action for NHS England and the Department of Health and Social Care.

Pregnant Then Screwed letter to the CEO of the NHS

On behalf of BigBirthas.co.uk, I was one of the signatories on this letter of 14th November;

Dear Simon Stevens (the Chief Executive of the NHS),

We are writing to you as a group of academics, healthcare professionals, politicians, charities and campaigners and MPs to ask that the NHS recognises pregnancy and birth as one of life’s most significant events and not an illness or medical procedure. We ask that you consider the evidence which shows that women have fewer complications during childbirth if they have a trusted partner with them, and we ask that you take into consideration the increased levels of stress and anxiety amongst pregnant women who are forced to go through other parts of their maternity journey without a trusted companion.

A recent survey of 15,000 pregnant women and new mothers by the charity and campaign group, Pregnant Then Screwed found that 90% of pregnant women say hospital restrictions are having a negative impact on their mental health, with 97% saying that the restrictions have increased their anxiety around childbirth. Worryingly, of the women who gave birth in a hospital which prevented partners attending until they were in established labour, 17.4% said they felt forced to have a vaginal examination and 82% cited that this felt like a requirement so that they could be reunited with their partner. This is a breach of women’s human rights when they are at their most vulnerable. The long term impact of these restrictions for new mothers and their family could be catastrophic.

We firmly believe that no-one should have to hear that their baby’s heart has stopped beating without their partner’s hand to hold. No one should be induced while their partner sleeps in a bike shed in the car park for days on end. No one should be left to look after a newborn baby whilst recovering from major abdominal surgery.

In addition to ensuring the 15 minute rapid COVID-19 tests are swiftly rolled out in maternity settings, we ask that you direct Trusts in England to treat maternity as a special case where women have the right to be supported and partners have a right to be present during each step of their maternity journey. Coronavirus has stolen so many precious moments from so many people. It doesn’t have to be this way in maternity services. Where other precautions are in place there is little evidence that partners increase the infection risk to staff or other service users. Please ensure that parents-to-be can have the birth they deserve even during the pandemic.

Yours sincerely

So, of course, I was delighted when the NHS guidance recommended partners be accommodated!

The Royal College of Midwives’ Response

Sadly, that delight didn’t last. The Royal College of Midwives chief executive Gill Walton has responded: “With more areas moving into tier-three restrictions, many will question the common sense of releasing this new guidance now.

No I don’t Gill. I question the lack of common sense and humanity in your not supporting a change in policy before now!? The RCM could have issued guidance long ago and chose not to. After all you were able to swiftly issue this public letter to all maternity staff that you don’t support the NHS position on the same day!

What’s baffling is if you read the two press statements, they both sound pretty aligned? The RCM states that they believe attendance of partners is a priority, after all. But it took several readings to realise that while the NHS guidance recommends partners should be able to attend all appointments, the RCM conspicuously mention attendance during labour and birth only, and even then, they want Trusts to retain decision making on this at a local level.

On the surface of it, the RCM say it’s ‘because the NHSE has not completely adopted all 10 of the principles’ the RCM suggested. I mean, I can’t legitimately see how the NHSE could, when two of the RCM principles say they’re the most important principle…?

Grammatical concerns aside, the RCM could have chosen more positive, supportive language. They could have reassured users of maternity services and said they support the guidance in spirit. They could have said they would hope trusts would read this guidance in conjunction with their own 10 principles, and while being mindful of local risks. I can only guess that the confrontational tone hints at some tension between the DoH and the RCM at the moment?

This response will not have helped ease pregnant families’ anxieties. Some reports of success when waving a copy of the new NHS guidance have filtered through, but others report no change in their area, adding to further feelings of injustice.

Positives of restricting partner access?

What’s even more galling is that the RCMs own website boasted about the positives of the current restrictions, in a response to a Times article in October entitled “Covid rules have gone too far“. Rather than acknowledge the multiple genuine stories of trauma and distress experienced up and down the country, Gill Walton dismissed them out of hand as situations “few women who have given birth over the past six months would recognise” and then go on to make unsubstantiated claims that women report “benefits of fewer visitors on postnatal wards: finding it easier to start breastfeeding, and opportunities to bond with other new mothers”.

When I’m not rolling my eyes at this, I’m hearing from other sources that the rules restricting partner attendance at maternity appointments have been good, because they’ve helped victims of domestic violence to come forward and receive help. Forgive me, but it’s hard to believe that this is all done with perinatal safety as the primary concern. After all, no-one seems to be considering the long term safety implications of perinatal mental health for these families? And surely it just begs the question what lessons can be learnt from this period, without metaphorically throwing the baby out with the bathwater and banning partners altogether?

Is there another, hidden agenda?

I, and many others with close links to maternity services have heard from midwives up and down the country at all levels about how many midwives prefer the current ‘woman alone’ setup. Their jobs are much easier with fewer people to accommodate. Of course that’s also fewer people to ask questions, and fewer people to advocate for the pregnant/labouring person when there are concerns (and fewer people to argue with when they don’t want to do what you think they should). While certainly not all midwives agree, it seems plausible that could also be a factor in explaining the RCMs slowness to react.

I don’t wish to be cynical, but better support for victims of DV and RCMs boasts of ‘bonding mothers’ notwithstanding, there certainly don’t seem to be widespread better experiences for people in maternity care right now. I’m hearing too many tales of trauma, coercion from clinicians, even of people having panic attacks while being separated at the door from their trusted supporter, and having to make difficult choices between their place of birth and their own mental wellbeing.

I’m not seeing positives represented in the stats published from multiple trusts either. Poor rates of skin-to-skin & breastfeeding initiation, fewer vaginal births, and more inductions. If support and advocacy in pregnancy were ever needed, it’s clearly now.

Of course, some inductions are necessary! An obsession with ‘natural birth’ was highlighted by the media as being at the heart of poor decision making at Shrewsbury & Telford Trust in the recent review of poor care there. But there was also a lack of a culture of listening to women, and poor continuity of care. It’s a shame that the media have focused more on the ‘reluctance to perform c-sections’ and less on the lack of compassion that was a key finding in the independent review.

My call to action for Gill Walton and the RCM

Unsurprisingly, given this background, a recent study by King’s College London, who surveyed 1,754 women who were either pregnant or had given birth since the beginning of lockdown, have discovered huge increases in the numbers of families considering freebirth.

The study, and the potential reasons for the shift are covered in this excellent Guardian article:

https://www.theguardian.com/lifeandstyle/2020/dec/05/women-give-birth-alone-the-rise-of-freebirthing

So why is the RCM not responding with concern to this worrying rejection of their services in far greater numbers than ever seen before? I really hope they can swiftly recommend a solution to this problem that brings partners and supporters back into maternity services ASAP. Pleas and complaints have been ignored for too long, and there simply is no good evidence that partners increase risk to staff or other service users, and plenty of evidence that this is causing very real trauma and potentially long-lasting repercussions for families.

If Gill Walton doesn’t recognise this, and wants to continue asserting that its a situation “few women who have given birth over the past six months would recognise” I recommend she check out https://www.theysaidtome.com/ (if she’s feeling strong). The submissions to that page starkly illustrate the myriad ways in which women and birthing people report they are being poorly served by health care professionals right now, and by extrapolation, why birth partners are absolutely essential in helping return the balance of power in the birthing room.

I’m really disappointed in the RCM that instead they’re ignoring these reports and gaslighting the people who’ve experienced them. It’s worth remembering these stories are not everyone’s experience of hospital birth, but they are occurring all too often and the RCM needs to recognise and address this issue, and fast.



Nitisha’s Birth Story – Home Birth After Caesarean

I love a birthing story! I’m always excited to read about other mamas experiences in the Big Birthas Facebook group, and so I asked for permission to share this one with you. This is Nitisha’s home birth after caesarean. It actually took place in November 2019, but proving that baby brain is a lifetime condition, I completely forgot to add it until now. Sorry about that, and welcome baby Maya!

Nitisha's home birth after caesarean - welcome baby Maya!
Welcome baby Maya!

I got my homebirth after caesarean! 💪🏾

  • Waters broke at 36+7 naturally and so did contractions
  • 1 sweep at 37+3
  • Natural birth (no pain relief, too quick to get into my birth pool) delayed active management
  • Risks: high bmi, age, previous caesarean
  • Prep: yoga, aquanatal, positive birth company digital pack hynobirthing, saw a chiropractor, spinning babies exercises, positive birth after caesarean audio course.
  • Birth partner: Doula + hubby
  • Main sources of information: chilled mama and positive birth after caesarean.
  • Hyperemesis gravidarum (4-26wks) and pelvic girdle pain
  • I denied consultant led care after first appointment as we both agreed I was informed about the risks for a vbac and I felt there was nothing he could tell me that I didn’t already know /mythbust
  • Previous birth: induction led to fetal distress and emergency caesarean
  • Breastfed toddler throughout pregnancy
  • Toddler upstairs asleep through whole thing (rare occasion of sleeping through the night in his own bed)

After not feeling very informed in my last birth (waters broke, spontaneous start to contractions, induced before 24hrs post waters breaking) I was determined to be informed regardless of location and delivery.

This pregnancy and birth was so healing for me.

I really felt in control of my body, conversations which took place, and all options around delivery. I’d planned for hbac, hospital vbac, and caesarean, wanting to take control over any situation. I hadn’t planned for my labour starting the same way but was determined for it not to end emotionally the same way.

The VBAC consultant midwife was supportive and has changed hospital policy for midwives to use sense and monitoring birthing mums to individualise care and reduce need for vaginal exams! I had requested a meeting with her before the 36wk birth choices meeting as I didn’t want to be blindsided by policy and what they “wanted”. I had this at 32wks and planned my birth plan before of what I would accept and wanted. By the end of both meetings I was happy with my birth plan.

Home Birth After Caesarean

My waters broke 36+7. At 37 weeks I went to the Antenatal Day Assessment Unit and they confirmed my waters had broken. They checked mine and bubs stats; we were all fine so I respectfully declined any intervention for 72 hrs and said I would monitor bubs and fluid release.

Irregular contractions started within 24hrs of waters breaking. At 37+1 I went back to hospital for fetal monitoring and to check my stats and everything was fine. 37+2 – no checks, irregular contractions which increased during the night. 37+3 72hrs were up. I went back for monitoring and talk with a consultant and our stats were checked. The consultant said she thought I should be induced or have a caesarean because of my bmi being so high, I was told I only had 20% chance of giving birth vaginally.

I had a vaginal exam to assess options: cervix was 1cm thick, soft and 2cm dilated. Considered BRAIN and opted for a sweep. No contractions following sweep. Toddler wanted more feeds that night and we danced together. 37+4 still no contractions: walk with hubs, went for breakfast, chilled, massages, naps, laughs and lovin’, once toddler returned from nursery, more feeding. Rang doula to discuss plan.

I had settled that I would have an appointment at 37+5 to arrange what would happen if baby hadn’t come by 38wks. I would be induced with as little dose as possible of syntocinon. Once contractions began, turn the syntocinon off to allow body to do what it could and turn on if any stalls. The plan was also to discuss intervals of drip dosing and levels & what point I would have a caesarean section.

The contractions came back!

At 11pm, in bed, contractions came back. I was so chuffed as I felt the sweep was really invasive, made me feel uncomfortable and thought I shouldn’t have done it. I didn’t monitor, just let it happen. They became regular, so started to monitor. 1am I woke hubs and he rang doula and mother-in-law.

Just before doula arrived I went to my birthing room to relax and take in what was happening. At this point didn’t know whether we would stay at home or go hospital. Initially I was dancing to my 90s RnB club hits, but I was getting sleepy so laid down with a leg elevated to keep my sacrum free. The contractions were starting to increase and I needed my doula to push on my hips. I needed to change position, I went on my knees with my ankles out further than knees (one strong mama tip) and leaned on the sofa with my hips being pressed down during contractions.

Midwives arrived

Things progressed quickly, midwives called at 04:xx arrived 06:xx. During this time I carried on as I was, but the pain getting more intense. It felt like my whole pelvis was expanding. This is normal, I just didn’t know. I did keep checking my puppy pad for blood or meconium. At one point my hubby said I turned and growled at him.

When midwives arrived I wanted to go to hospital because I didn’t know that the pelvis pain was normal, instead I had 1 vaginal exam with consent, I was 10cm and midwife could feel baby’s head. I wanted to get in the pool but couldn’t wait, one breath and baby was out! I didn’t get a chance to catch her but I did cut the cord.

During birth I didn’t think I was Hynobirthing breathing well & didn’t really work for me, I was a bit too cave-woman rather than peaceful 😂 but my doula said I was doing it at the start and to relax but the elevator breath and the final breathing the baby out was great.

Congratulations Nitisha and welcome baby Maya!

Hopefully your husband has completely forgiven you for growling at him!

You can read more birth stories here:

Sarah’s Homebirth Story

Birth in a time of Covid-19

Twin Home Birth at 42+2

Or look under ‘Birth Stories’ in the Labour and Birth menu.

Sarah’s Homebirth Story

Many people who wouldn’t normally choose home birth are considering their options right now, due to covid-19 restrictions on birthing options. I’m a huge fan of birthing at home, having had my second baby in my lounge, but I appreciate it’s not for everyone! Hearing about other people’s experiences can be helpful to give you a feel of what it could be like. Of course, everyone’s experience is as unique as they are, but it’s so lovely when we hear positive stories in the Big Birthas Facebook group, and so I asked for permission to share this one with you. This is Sarah’s homebirth story.

Homebirth story - welcome Gabriel Leonard (pictured in a rainbow babygro)
Gabriel Leonard

Welcome to the world, Gabriel Leonard!

Just wanted to announce the arrival of our gorgeous 4th baby, Gabriel Leonard, born in a pool at home on Wednesday 15th July at 07.48am, surrounded by peace, quiet and love.

I am very much a larger lady with my bmi probably in the very high 40s (I refused to be weighed), I had gestational diabetes (GDM) for which I was on 2 500mg modified release metformin tablets. I also have a medical history of gall stones, diverticulitis, and polycystic ovary syndrome (PCOS). None of those things affect me and have just been found on scans over time rather than because of emergencies. I am otherwise fit and well and still perfectly mobile (something they like to presume is fat = immobile 🙄).

This birth was slightly different from my other 3. He was my latest to arrive (38+2, 39+1, 37+6) at 39 weeks and 2 days. To be perfectly honest I was losing faith in having a natural birth. When you have GDM the word induction gets thrown around a lot regardless of how well mum and baby are getting along 🙄.

The other things that made this birth different were the fact that in my other 3 births my waters had gone first, and then my contractions started a few hours later. With this baby I started off having some slightly uncomfortable cramp. That cramp then started coming and going and increasing in intensity. I called my homebirth team and they said someone would be with me within an hour.

Early stages

Husband set about getting the pool up and my mum (who lives with us) did a great job of herding the other wild animals (ie my other 3 😂). By the time the midwife arrived I was so uncomfortable but managing to own it by breathing through (seriously ladies, get hypnobirthing!). The midwife just sat there quietly letting me do my thing, not interfering or asking me to do anything at all.

I did start to have a little wobble, being unused to my labour starting before waters breaking, I thought I was probably only 3cm and thinking “Jesus, how do I make it through the rest!?” I asked for a vaginal examination as I needed to know in my own mind what I was dealing with. The midwife was fantastic and waited until in between contractions to assess me. I was 6cm!! Knowing this really helped give me the push to continue.

Time for gas and air…

The second midwife arrived with the good stuff (gas and air) and the pool was ready at last (which meant the husband got to live on for another day!). That amazing feeling when you get into that water is indescribable. Things felt like they really ramped up. Within a few moments of being in the pool my waters went which was such a strange sensation! Probably 5-10 mins later I could feel baby start to come.

I reached down and could feel his head (something I’d never done before). In the next 2 contractions his head was out and then in the next his full body. I lifted him out of the water and onto my chest. I don’t think I have ever felt more proud of myself in that moment.

The midwife asked for the pool to be topped up with hot water and occasionally wet the towel covering baby to keep him warm. The midwives said what an amazing and calm birth it was, I didn’t make a sound other than the grunty breath noise whilst my baby came out. (My husband said our toddler makes more noise whilst having a poo 😂😂). Placenta came away nice and easily.

Baby fed like an absolute pro. My husband eventually cut the cord and the midwife helped us tie our cord tie.

Reflections

It was the blissful birth I’ve needed. Baby was absolutely perfect and weighed in at 8lb 7oz.

I just wanted to say the homebirth team were sensational and never once did I hear “no”, “but”, “maybe”. From first visit they believed in me and my baby.

I also had a private midwife to do my antenatal and postnatal observations. She came a few hours after Gabriel arrived. She was so full of joy and happiness for us that we got the birth we needed. After doing the first set of bloods on baby (in GDM, blood sugars are done on newborns to ensure there isn’t hypoglycemia), she did a few other checks on us both, had some celebratory chocolate (it had been soooooo long without chocolate!) and left us to it.

My mum set about emptying the pool whilst the hubby child herded. I just sat there in my own living room in utter bliss eating toast and feeding my baby.

I did his second set of bloods which were also absolutely fine so no further bloods needed.

Still on a massive euphoric high.

So ladies listen to YOUR BODY, YOUR BABY. Do not accept no for an answer. There are still people in the profession that see beyond your weight and believe in you as a woman and as a mother. It’s taken me 4 babies to find that very special team of women.

Sarah pictured with newborn and toddler - homebirth story
Huge congratulations to Sarah!

Would you like to share your homebirth story? Or hospital birth story? Or wherever it happened to take place story?

We love hearing about births. Even if it didn’t go exactly as you hoped, or if all your plans went completely out the window! Huge congratulations to Sarah, and thanks so much for sharing your very special homebirth story. It just goes to show that GDM and other health conditions need not be a bar to homebirthing, if it’s what you would like.

Welcome to the world, Gabriel!

Homebirth Midwife

Look what Deborah Neiger has just brought onto the market! It’s your very own homebirth midwife doll and accessories!!

Ha ha, not really. This IS homebirth midwife Deborah Neiger, plus all her kit laid out in all its glory. So, if you’ve ever wondered what’s in a homebirth midwife’s magic toolkit – here it is. We’ve come on a bit since the days of Call The Midwife!

Or maybe not! In reality, Deborah says that at most births all she uses is the Doppler (14), the incontinence pads (3), the scissors (31), the gauze (6), the scales (20) & baby weighing sling (12) – plus the wonderful midwife (1), obviously!

Homebirth Midwife and kit -Deborah Neiger

Second thing to note is that Deborah says the list isn’t exhaustive, and it’s not listed in order of importance.

The Kit

  1. A kind and sensitive *known to you* midwife
  2. Rebozo for comfort measures or to help fetal positioning
  3. Lots of incontinence pads to soak up birth goo
  4. Catheter if passing urine is difficult or a full bladder is causing excessive bleeding
  5. Cord tie
  6. Gauze Swabs, mostly used to check the perineum for damage after birth if desired, or for microbiome seeding
  7. Placenta bag if parents want it disposing of
  8. Fetoscope
  9. Penguin suction, NEVER used as routine, only as part of resuscitation should it become necessary
  10. Gloves
  11. Pinard
  12. Baby weighing sling
  13. Stainless steel mirror for pool use
  14. Doppler
  15. Transducer gel for doppler
  16. Birth pack, only carry it for the unlikely possibility we ever need the Spencer Wells clamps and super sharp episiotomy scissors in it, though it actually has never happened
  17. Some needles and syringes to administer emergency drugs or vitamin K to the baby, if needed/wanted
  18. Cord Clamp
  19. Lube in case of vaginal examination, also not routine ever
  20. Hanging scales
  21. Sphygmomanometer to take blood pressures
  22. Giving set and tubing for Entonox
  23. Vomit/emesis bags (or as Deborah likes to call them – puke tubes!)
  24. Stethoscope
  25. Entonox tank
  26. Urinalysis sticks
  27. Infrared thermometer
  28. Emergency drugs to control excessive bloodloss (Syntometrine, Syntocinon, Ergometrine) and vitamin K if desired by parents
  29. Tongue depressor, for use during insertion of Guedel airway during baby resuscitation if necessary
  30. Bag and Mask for baby resuscitation
  31. Sterile scissors to cord eventually once fully white or placenta birthed, unless Lotusing
  32. Sharps bin

Addendum, not in photo!

  1. Phone! This is useful when you need to look up things, if ever in doubt, and to summon help.
  2. Torch. To huddle and write notes when in a dark room, check heads emerging in darkness if there are concerns, check perineums.

Thanks for sharing, Deborah! I had no idea my lovely homebirth midwife most likely had all this stuff nearby when I gave birth to my second!

If you’re interested to find out more about Deborah and her work, you can follow the link to her original Facebook post here.

You can also find support at the Big Birthas Facebook Group here.