The reason I wrote this post is to provide expectant mothers with information they may not have access to while using mainstream maternity care. Many women may not know they can ask certain questions or why certain practices occur. I am not criticising the mainstream system; I understand how overworked and understaffed they are and how they must work in a tick-box manner. However, this method of care frequently results in women feeling disempowered, leading to birth trauma. It’s important to note that while horror stories are common, birth trauma is not normal. The over-medicalised and conveyor belt approach to birth is not designed to empower women. It serves the system, not the woman.
I want to share with you five crucial points that your midwife may not discuss with you. These are common questions I receive from women who call my helpline. If you require further assistance, you can contact us (details provided at the end of this ebook). Remember, you are the expert when it comes to your body. Listen to your instincts and take control of your experience. Everyone will have an opinion on what you should and shouldn’t do, but ultimately, it’s all about you.
1) Evidence based practice
You would hope that when you are being advised about certain things during your pregnancy and birth, that advice from your care providers would be heavily based on
evidence right? Wrong!
The researchers (named below) analysed the RCOG’s ‘Green-top Guidelines’ and found that before December 2007, only 8% of obstetric guidelines were based on high- quality medical evidence while 41% were based on low-quality evidence. After December 2007, there was no significant improvement as the figures remained at 8% and 40%, respectively.
Before December 2007, 18% of gynaecology guidelines were considered to be of high quality (grade A) while 40% were of low quality (grade D). After December 2007, there was a slight improvement as the figures changed to 13% and 42%, respectively.
Based on their analysis, the researchers concluded that the majority of RCOG guidelines are supported by clinical experience, expert opinion, or low-quality studies.
The fact that the majority of RCOG guidelines are based on opinion instead of hefty evidence raises questions about how much practitioners are relying these guidelines for best practice. Are they blindly following the guidelines as strict rules or do they even know the grading system exists? Are they discussing the quality of the evidence with mums-to-be, enabling them to make informed decisions for themselves and their babies? These questions are relevant not only to medical professionals but also to women who likely assume that what they are being told to do is based on good evidence.
It is also worth pointing out that looking closely at a study is very important. For example, how do we really understand physiological birth by studying what happens to women in hospitals? To quote the late Beverley Beech “You cannot understand the behaviour of birds by observing them in a zoo”. In other words women observed under scientific conditions ie in a hospital with bright lights and strangers is
perhaps not conducive to understanding a natural process.
The details of this study are as follows;
Prusova K, Tyler L, Churcher A and Lokugamage AU (2014) Royal College of Obstetricians and Gynaecologists guidelines: How evidence- based are they? J Obstet Gynaecol. 2014 Nov;34(8):706-11. doi: 10.3109/01443615.2014.920794
2) Vaginal Exams
The practice of vaginal exams during labour is a subject that drives me mad!.
It is commonly assumed that these exams are necessary and most women do not question their use. I urge you to consider why it is standard practice for a stranger to put their fingers inside you during one of the most intimate and sacred moments of your life. Who is this exam for? Is your cervix a crystal ball that can predict the future?
It is important to understand that a vaginal exam can only tell you the dilation of your cervix in that specific moment in time. It provides no indication of where you will be in the next few hours or even minutes. In fact, your cervix can dilate from 3 to 10 centimetres in as little as 30 minutes or as long as 8 hours. Therefore, it is crucial to ask yourself whether you truly need a vaginal exam. If you feel it will be beneficial to know your dilation, then by all means, have one. However, remember that the decision is ultimately yours. You have the right to decline an exam if you do not want one.
It is true that vaginal exams can be useful for care providers in determining the progression of labour and where to rank you in their conveyor belt system (and yes sometimes there might be a good medical reason although rare). However, it is important to note that frequent exams can increase the risk of infection and can be traumatic for some women, especially those who have suffered trauma before. Additionally, the mere act of a vaginal exam can trigger the release of adrenaline, which can inhibit the production of oxytocin, a hormone crucial to the birthing process. This is why it is vital to feel safe and comfortable during labour. Fear can make your cervix begin to close!
It is crucial that you exercise your right to make decisions about your body during childbirth. You have the right to ask why an exam is necessary and whether it is compulsory. If a care provider insists on an exam without a clear medical reason, it may be wise to seek another provider who respects your autonomy and decision-making power. Remember, this is your body and your birth experience, and you have the right to make informed decisions that are in your best interest. Ask if it is compulsory. If they say anything other than ‘no’ run a mile.
3) Stretch & Sweep
Currently, in many regions, a policy has been implemented where women are offered a ‘stretch and sweep’ (a procedure where the attendant will sweep their fingers around the membranes to encourage labour) at a specific point during their pregnancy with the intention of lowering the amount of women who undergo medical induction (Another intervention that is entirely your choice) A stretch and sweep may lead to discomfort, bleeding, and long drawn out irregular contractions. Moreover, in some studies, the stretch and sweep technique only advances labour by approximately 24 hours. The Cochrane review authors concluded that the habitual use of sweeping of membranes after 38 weeks of pregnancy does not seem to offer significant clinical advantages. If employed as a method for induction of labour, the decrease in more formal induction methods must be balanced against the adverse effects and discomfort experienced by women. If you are told this procedure is benign, I can assure you it is not. There ARE side effects. Let’s also look at the term ‘natural induction’ those words are said frequently to women by their care providers when discussing a stretch and sweep. Saying anything is a ‘natural’ induction is an oxymoron. Interfering with a natural process is not natural. I am not saying decline if you are offered by any means. Some women want to and if they are making informed decisions, fantastic! All I am saying is stop and question things and go with your gut instinct. I have never in 15 years
witnessed a woman’s instinct to be wrong!
4) Overdue
n the UK, the induction rate is approaching 40%. I suspect that the true number is higher and if you go over to Kemi Johnson’s Instagram page @kemibirthjoyjohnson you will see some sobering statistics that she analyses from trust to trust. Just think about that 40% statistic for a moment. Do 40% of human beings really need drugs to be born? Have our bodies really failed us? Or is the system making us think our bodies are failing us?
So on to ‘overdue’ the most common reason our babies are evicted from our cosy wombs!
We are told going past our ‘due dates’ poses ‘risk’. The idea of “risk” in
childbirth is not ideal as it can lead to care being provided based on generalisations rather than individual needs of the birthing woman. Nevertheless, it’s an unavoidable aspect of the process and most women want to be informed about it. Risk is subjective and what one woman considers significant may not be the same for another. Life itself involves risk, so when making decisions, there is no entirely risk-free choice. Birth is certainly not inherently dangerous, nor is it inherently safe. Women can only choose the option with risks they are most comfortable with after receiving sufficient information about each option. Failing to provide adequate information could lead to legal action against healthcare providers and more importantly it can lead to trauma for women! Ultimately, whether a woman chooses induction for prolonged pregnancy or not is neither right nor wrong as long as she understands the risks involved. As a birth practitioner, my role is to support and inform women without judgement.
A normal and healthy gestation period typically lasts from 37 to 42 weeks. Beyond the due date, which is usually considered 40 weeks, a pregnancy is referred to as post-dates. If it continues beyond 42 weeks, it is referred to as post-term or prolonged pregnancy according to the World Health Organisation. However, induction is frequently offered when a pregnancy becomes post- dates to prevent it from becoming prolonged, meaning very few women experience it. Basically women using the mainstream maternity system are not ‘allowed’ to experience prolonged pregnancy. So how can we have sufficient data to conclude that this is dangerous? At WPCTS we frequently attend ‘unicorn births’ or in other words, rare! We have had several women go past 43 weeks!
You might assume that all women should carry their babies for the same amount of time, but this just isn’t true. Research by Melve and Skjaerven (2011) suggests a genetic factor related to women in that family line carrying their babies for ‘longer’ , indicating that both the mother and father can contribute. Factors such as diet (McAlpine et al., 2016) may also influence the length of gestation.
The start of labour is believed to be caused by the baby producing surfactant protein and platelet-activating factor into the amniotic fluid as their lungs mature (Mendelson, 2009; Science Daily). This triggers an inflammatory response in the mother’s uterus, which then begins labour. Therefore, the question arises whether it is necessary to interfere with nature. I would urge every woman reading this to buy a copy of “In your own time” by Dr Sara Wickham. https://amzn.to/3MLu8MW
The idea of 40 weeks was coined by a guy called ‘Neagle” who estimated pregnancy gestation based on the Lunar calendar and we still use it today. This does not take into consideration menstrual cycle length or ‘normal’ for individuals. I know women that carry
their babies to 43 weeks and that is normal for them!
While a significant minority of babies are not born by 41 weeks gestation, induction is usually suggested during this week even though the definition of a prolonged pregnancy is 42 weeks or more. In order to make the choice that is right for them, women need to be given adequate information about the risks and benefits involved with waiting or inducing. It is important to note that neither option is risk-free, as the risk of perinatal death is extremely small for both. However, there have been cases of women losing babies in the 41st week of pregnancy or as a result of the induction process. For first-time mothers, the induction process poses particular risks for themselves and their babies. Therefore, each woman must assess and decide which set of risks she is most willing to take and be supported in her choice.
5) Meconium
Meconium is the earliest poo of a newborn baby, which is typically greenish-black and has a sticky, tar-like consistency. It is composed of materials that the baby ingested while in the uterus, including amniotic fluid, bile, and shed intestinal cells. Meconium is usually passed within the first 24-48 hours of life and is a sign that the baby’s digestive system is functioning properly. However, in some cases, meconium may be passed before birth and can be seen in your waters when they break.
Meconium refers to a blend of various components such as amniotic fluid, intestinal epithelial cells, and lanugo, among others, combined with mostly water, which accounts for about 70-80% of its composition. It is worth noting that roughly 15-20% of infants are delivered with meconium stained liquor.
There are a few main causes of meconium;
Fetal distress, which can lead to a lack of oxygen supply to the fetus (hypoxia), may or may not be linked to the presence of meconium in the amniotic fluid. There is a hypothesis that a lack of oxygen supply to the intestines (intestinal ischemia) may cause the anal sphincter to relax and increase gut movements, resulting in meconium in the amniotic fluid. However, it’s important to note that fetal distress can occur without the presence of meconium, and meconium can be present without fetal distress. During labour, the baby’s umbilical cord or head may experience compression. This is a common and natural response that can occur without any harm to the baby. As the baby’s head is compressed during the final moments of delivery, it can trigger the passing of meconium, which is why many babies are born with meconium trailing behind them.
The gastrointestinal tract has developed fully and the bowels have initiated their activity, resulting in the expulsion of meconium through peristalsis. This occurrence is prevalent among newborns, as around 15-20% of full-term infants and 30-40% of post- term babies are expected to have excreted meconium before delivery.
When a baby is in a breech position during childbirth, the pressure exerted on their abdomen as their buttocks pass through the birth canal typically results in the expulsion of meconium
During pregnancy, Intrahepatic Cholestasis (a liver condition) can lead to the production of thin meconium in the baby’s bowel. This could occur as a result of elevated flow of fluids due to bile acids.
If meconium is detected in the amniotic fluid during labour, it frequently triggers a series of interventions. The mum is usually fitted with a CTG machine, which can limit her mobility and raise the likelihood of a caesarean section or instrumental delivery. The duration of labour may also be subject to tighter time constraints, which can lead to induction , raising the chances of fetal distress and therefore a caesarean section. When a baby is born, there is a possibility that they may undergo airway suctioning, which can cause a vagal response and problems with breastfeeding.After delivery, the baby may have their umbilical cord severed early and be handed over to a paediatrician who may also perform airway suctioning. Within the first day of birth, the baby’s vital signs, such as body temperature, breathing, and heart rate, will be monitored frequently, which can cause disruptions.
This is hefty amount of drama over a bit of poo which typically does not pose any issues in the vast majority of cases. In fact, several interventions put in place due to the presence of meconium may actually lead to more complications than the meconium itself.
This viewpoint is largely supported by two scholarly articles, one from an obstetric journal (Unsworth & Vause, 2010) and the other from a midwifery journal (Powell, 2013). Both sources concur that there is limited knowledge regarding meconium and whether it presents any problems. Meconium by itself is not a reliable indicator of fetal distress. An abnormal heart rate is a more accurate predictor of distress, and the combination of an abnormal heart rate and meconium may be an even stronger indicator of trouble. Thick meconium is more likely to lead to complications than thin meconium. Overall, it’s important to keep in mind that most babies who are born in poor condition don’t have meconium in their amniotic fluid, and most babies who do have meconium are born in good condition. If you would like to look into this further, search ‘Unsworth & Vause 2010’.
Meconium aspiration syndrome (MAS)
(MAS) is a condition that arises when a newborn inhales meconium.When meconium is present, the major concern is the development of MAS, which is a rare complication that occurs in approximately 2-5% of babies with meconium-stained liquor. Among this small percentage, 3-5% of babies may sadly pass away from MAS. While the likelihood of MAS is low, it can be a fatal condition. To put it into numerical terms, the risk of death from MAS for a baby with meconium in the amniotic fluid is 0.06% (1 in 1667). However, this risk can vary depending on factors such as prematurity, congenital abnormalities, and other complications during labour.To avoid MAS avoid any unnecessary medical intervention such as induction of labour. (Make informed choices before accepting or declining IOL)
It is important to note, there is no evidence to actually support these theories. In animal research, the hypoxia theory was actually shown to be wrong. Theories are just that! Theories. While they may be based on some evidence, they are not definitive, and we do not have all the information needed to draw conclusions about meconium risk. Again, instinct is everything. I have attended births where I saw significant meconium fairly early on in labour but mum insisted she felt baby was fine. Indeed he was. I have also attended births where very insignificant meconium was seen nearing the very end of labour but mum ‘knew’ something was not right
and indeed she was correct.
For the most part meconium is not harmful unless the baby inhales it. However, it can be a sign of hypoxia in some babies, putting them at risk of meconium aspiration. Such babies require close monitoring and medical intervention. For most babies, meconium is a sign of a mature digestive system, and the focus should be on avoiding hypoxia during labour to prevent meconium aspiration. If you want to learn more about meconium please click this link to this interview with Rachel Reed
In conclusion, I cannot stress enough the importance of making informed decisions during pregnancy and birth. The maternity system can be an overwhelmingly confusing place to be. Not to mention hearing everyone’s two pennies worth. “Don’t give birth at home it’s too dangerous” or “oh you should be induced because your baby is ‘big’ “ I would always suggest you do your own research and most importantly listen to your gut instinct. When in doubt always use this helpful acronym. B.R.A.I.N If you care provider is telling you that you do not have to accept (insert intervention here) always use this acronym to ask the following questions.
B – What are the BENEFITS?
R – What are the RIKS?
I – What is your INSTINCT?
A- What are the ALTERNATIVES?
N – What happens if we do NOTHING?
Need our support?
It is important to understand you do actually have a choice. Many women feel backed into a corner because they are being told that they must accept certain interventions against their will. Many accept under duress. You are not on trial, it is not up to you to prove your body will not fail you. It is up to them to prove it will! On the other hand you may want to accept their offer of intervention, it is entirely down to you! Just know you have a
choice and if they are insistent, you have the right to ask for evidence.
If you feel you need additional support to help you navigate the system or birth outside of it entirely please feel free to get in touch.
My organisation When Push Comes To Shove is a revolutionary maternity care structure. We provide 1-1 holistic maternity care from exceptionally well trained traditional birth attendants, advocacy services, online birth education and we even provide training if you wish to pursue a career in pregnancy and childbirth. We have birth keepers in 10 counties so get in touch to find one near you! We even have an access fund for low income families. If you are just looking for some support to learn more about a specific situation so you can advocate for yourself, you can book a 1-1
consultation with me on zoom.
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Wishing you a happy, healthy and empowering pregnancy and birth! Peace on earth begins at birth.
