‘Balloon Method’ of Induction of Labour

Sally UnderwoodUncategorized2 Comments

Written by midwife Sally Underwood…

As you will possibly be aware there are currently several different methods of induction routinely being used by health care professionals. These include a cervical sweep, a propess pessary, prostoglandin gel, an artificial rupture of membranes and then ultimately a syntocinon (artificial oxytocin) infusion. 

The most common reason for induction of labour is a prolonged pregnancy. Normal Labour (term) indicates spontaneous labour between 37 – 41 + 5 days. Research indicates that after 41 completed weeks of pregnancy, there is an increased risk of a baby developing problems as the placenta becomes less efficient. There may be other reasons which would indicate a need for an induction of labour such as diabetes or preeclampsia. These conditions can slow the growth rate of your baby in the latter stages of pregnancy, making early delivery safer than continuing the pregnancy.

A balloon induction is a rather less routine option but offers good results. A special balloon catheter is inserted into the cervix (diagram above) and inflated with normal saline to encourage dilation. 

I can remember learning about this method of induction but within all my years as a midwife…which is a lot…I have not actually seen it being used until recently on our labour ward. It apparently dates to the1860’s – where Mr Barnes used air in the balloon for pre labour dilatation and then again in 1960s when Mr Embrey realised the potential for using liquid instead. Balloon induction is mainly used for women that have previously had a caesarean section aiming for a vaginal birth. This is because it is potentially more natural and does not involve any hormones. It works as the inflated balloon rubs against and stretches the cervix causing it to produce prostaglandin. The prostaglandin causes the cervix to become shorter and soften (ripening). The balloon generally stays in place for 12 -24 hrs.

With our current rise in induction of labour rates (around 30 -40%) and the associated risk of instrumental births and caesarean section within most NHS trusts today, I think we may be seeing this method used more often.

Be interested to hear if any of you have ever experienced this method of induction?

Sally

xxx

Illustration by Alex Baker, DNA Illustrations, Inc. from https://www.contemporaryobgyn.net/view/transcervical-foley-balloon

https://www.contemporaryobgyn.net/view/transcervical-foley-balloon

The Transitional Stage of Labour

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Written by Sally Underwood

…Almost there – oh my goodness – this is it!!
Labour consists of 4 stages – 

Latent phase; when the cervix ripens, effacement takes place and you get to around 4cm dilated.

First stage; when the cervix dilates from 4cm – 10cm, with regular surges.  The surges will become stronger, longer, and more frequent – usually about every 5 minutes, lasting 40-60 seconds 

Second stage; the birth of your baby

Third stage; the separation and delivery of your placenta and control of any uterine bleeding  

The Transitional Stage of Labour occurs at the end of the first stage – before the second stage. It is a period of change –  of ‘swapping over’ – as your cervix becomes fully dilated (10cm) – of transitioning from the first stage of labouring to the second stage of birthing…. from up breathing and visualisations to down breathing and visualisations…. Exciting stuff but full on…..REALLY!

It is often described as the most dramatic/uncomfortable part of labour, as you experience the effects of a massive surge in adrenalin. As your adrenalin levels overtake your oxytocin levels – you will feel hugely different – overcome – suddenly – very aware!  

With adrenalin in control the muscles of your uterus are forced to change the way they work – remember the muscles of the uterus work in pairs; with the long muscles contracting ,during the first stage of labour and the round muscles relaxing – causing the cervix to draw up and dilate to 10 cms. Now with the onset of the second stage, these roles reverse; the round muscles squeeze baby down and out through the birth canal for birthing, whilst the long muscles relax, out of the way.

With such vast hormonal changes during this period, you will probably experience physical symptoms such as panic, shaking, nausea and vomiting.  You will feel overwhelmed and ‘out of control’.  Women often state that they cannot cope, want pain relief, and that they have had enough and are going home.

Birth partners note:  Often all the supportive techniques that you have used effectively up to now will be a source of agitation during transition.  Indeed, many women often push birth partners away and focus on themselves. I can distinctively remember finding it inconceivable to believe that anyone would ever consider putting themselves through this part of labour again – surely no one would ever opt for another child – vaginally!

Fortunately, the transitional phase is only temporary – it lasts approximately 10-15 minutes (4 or 5 surges). Midwives are aware of the signs of transition and will encourage you to try and adopt different positions to get through the stage.  It can be distressing for your birth partner to observe the transition stage so being prepared really does help. 

 Self-help Strategies for the Transitional Stage

Feelings of panic, loss of control and physical side effects are common, and the support of your birth partner is vital at this time.

  • Keep changing positions, it will be difficult to get comfortable
  • All fours/hands & knees positions help to ease an early urge to push, and reduces the pressure felt in your bottom
  • Try to concentrate on your breathing, or distraction techniques during your surges
  • Try to stay focused during your contractions, keep interruptions to a minimum, close your eyes and concentrate
  • Sips of water will help keep you hydrated and reduce the feeling of nausea
  • Reassurance and support 

Remember that every surge is doing a job and that each one indicates one less to go, and that labour doesn’t last forever. You will cope – other women do – you can and will do it!

The length of the first stage of labour varies between each woman. On average, labour will last about 8 hours for women who are having their first baby and is unlikely to last over 18 hours. For women having their second or subsequent babies this time frame will be considerably shorter – around 4 – 5 hrs.  It is considered it to be normal for the cervix to dilate around a centimetre an hour, with regular strong surges.  The position of your baby inside your uterus and the positions you adopt during labour can affect the length of your labour.

Remember:  Working with your body and adopting upright positions will encourage effective regular surges, resulting in a quicker, less painful labour. 

Your body is perfectly designed to have your baby – but I really do think each birth is amazing and cannot believe that I managed to do it 6 times!

Sally x

Positive Birth

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Ana, Chris and Alice; Our Birth Story

I was 40 weeks when my midwife offered me a sweep… I was nervous about saying yes to it but she reassured me that she would only do it if my cervix was favourable. At 40 weeks + 6 I woke up and went for a long walk with my dog and my neighbour who was also pregnant at the time. Afterwards, I went for my appointment and my midwife performed the sweep – the procedure didn’t hurt but after I left the clinic I cried all the way home overwhelmed with emotions. 

I was still working so I phoned my boss and told him I needed the afternoon off and went for another big walk with my neighbours, my dog and their dogs – I walked 16km that day!

The next morning I woke up at 8am feeling a slight pressure on my lower back and a sort of period-like (mild) pain. I phoned Chris, my husband, and I told him that I thought I was feeling my first surges but I wasn’t 100% sure and therefore I would call him again if it was actually the real deal. Of course, he didn’t listen to me and after 20 minutes I got a call from him saying he was heading back home from work. When he arrived we had a nice breakfast together and waited…

My surges started building up and I used the Freya app to help me focus on my breathing. At around 12pm I rang my midwife as my surges were about 4 minutes apart and 1 minute long. She told me to start packing slowly and to think about heading to the hospital. I tried moving around the house but that made my surges stronger so I sat on my pilates ball for the next hour or so… It felt really comfortable. I wanted to wait as long as possible because I didn’t want to head to the hospital too soon and be sent back, but at around 2pm my surges were 3 minutes apart so Chris decided for us, got the car and drove us to the hospital – I’m glad he did, I think I was being a bit stubborn! I realised that when I had about 3 surges trying to get from the front door to the car, which was only a few meters away!

We had our ‘hollywood movie moment’ as soon as we arrived at the hospital! I got in the lift and had a surge (quite an intense one), so I faced the wall of the lift, closed my eyes and focused on my breath… When the surge ended I looked around and I had a group of about 10 people, hospital patients, staff, doctors and nurses, holding the lift door and waiting for my surge to finish. They all started clapping and shouting “You go girl, the maternity unity is just over there, you can do this” – It was awesome, I felt like a rock star and fully energised once again!

My waters broke at triage – coolest feeling ever, like a balloon popping inside my belly! And that was when the triage midwife told me I had meconium in my waters and therefore they had to monitor the baby’s heart rate. She also gave me gas and air which I hated at first… She said I had to try it for at least 4 surges and then decide. That’s what I did… And afterwards it became “my best friend”, I really didn’t want to let go of it as apart from helping with pain management, I really thought it helped me focus on my breath.

Initially we planned on having a water birth at the MLU, but because of the meconium in my waters I was told I wasn’t allowed to, so they moved me into a room and monitored the baby’s heartbeat and my surges. I wanted to stand but the monitor on my belly kept moving so they told me I had to go on to the bed and lie down, which I really didn’t want to… So I “negotiated” with the midwife and the bed was set in a sitting position which was a lot more comfortable for me. However, the action of sitting down on the bed gave me the most intense surge I had all day and actually made me question my decision of not having an epidural: “If I can’t have a water birth, if I have to sit on this bed and barely move, why don’t I just ask for an epidural?”. But then I closed my eyes, I thought about my baby, I thought about how my body was prepared for this moment, I took a deep breath through the next surge and kept going!

At around 7.30pm, I was told I was fully dilated but because it was my first baby we were going to wait for about 2 hours before starting to push. Those 2 hours flew by, and even though I was having very long surges, very close to each other, I managed to get some rest. Chris bought all these different foods and kept telling me to eat and drink water, which really helped me build up some strength for the final stage – if it wasn’t for him, I was in such a bubble that I wouldn’t have had anything to drink the whole day!

Close to 10pm the midwife told me I was ready to start pushing, so they looked at my surges on the monitor and told me to push. I did, over and over again, with all I had, but it just didn’t feel like my body was ready for it yet. I told them this and they helped the best they could, but I think it just “wasn’t the time yet”. After 45 minutes of pushing and nothing happening I was getting pretty tired and suddenly the obstetrics doctor came in the room and told me: “If this baby isn’t out in 10 minutes I’m coming in with my nasty metals”. I think that if it wasn’t for Chris this would’ve set me in a right despair mode… But he looked at me and said: “Don’t listen to her, you are amazing, you are doing great… You can do this!”.

The head midwife came in shortly after and said that I was doing great and that she wouldn’t let the obstetrics team come in: “We are going to deliver this baby together!”. She prepared me for an episiotomy and told me to focus on her hand and push towards it… That’s when I felt my body was ready, I had a push coming from the inside, like I barely had to do anything… And Alice was born at 11.07pm, head, shoulders, legs, all in one push – healthy and amazing!

Only after Alice was born, did I realise that we were being considered a high risk birth, because she had the cord around her neck twice, and so every time I pushed her heart stopped. I didn’t notice this and I managed to stay in “my bubble” because Chris was next to me the whole time, filtering everything that was happening, paying attention to details, talking to the midwife, holding my hand and keeping me strong.

Hypnobirthing gave us the tools and information we needed to complete the first part of our journey into parenthood and we will forever be grateful to Sally and UB Academy.

Caesarean Section – Under General Anaesthetic

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Caesarean section (c/s) involves the removal of the baby from the intact uterus by abdominal operation. 

In recent years, the indications for the operation have increased considerably. In most teaching hospital trusts in the UK, the rate of c/s ranges from around 30 – 40% of the number of term births, which is a massive increase to the WHO recommendation of a 15% incidence. The main reason for having a c/s are dystocia, fetal distress, breech presentation and previous c/s. It is difficult to determine how valid these indications are, as paradoxically the c/s rate amongst private patients is always much higher! 

We believe that the objective of a c/s is to reduce perinatal mortality and morbidity – unfortunately this is not always clearly defined. The introduction of antibiotics and better techniques of anaesthesia has made the operation much safer – however it is not always the solution to all obstetric difficulties and as midwives, we need to continue to campaign for c/s rate to be kept within reasonable limits – a caesarean is a major operation that carries several risks, so it only needs to be done if it really is the safest option for you and your baby – remember – the decisions made about your pregnancy and your childbirth journey, will go on to shape your health/life for many years. 

There is so much information around currently, so many options and opinions – which aren’t always women-centred. It is crucial that you take time to consider your situation carefully and utilise the BRAINS acronym.  

Today the majority of c/s are performed as lower uterine segment sections via a bikini line incision of around 15 – 20 cms. A c/s will be performed as a planned/elective or an emergency procedure – planned caesareans are usually done from the 39th week of pregnancy. 

A c/s will either be performed under regional or general anaesthetic. The vast majority are done via a spinal/epidural – regional block.  A general anaesthesia is usually used because it is quicker, in an emergency if there is insufficient time for a regional anaesthetic to work, where there is an immediate threat to life of mother or baby. Other reasons for its use include situations when a regional anaesthetic isn’t possible, such as a blood clotting condition, an infection or a back issue or because a woman refuses a regional technique, has an inadequate regional block, or because there are regional contraindications. A baby can be born within a few minutes following a general anaesthetic if necessary.  

Statistics from the Royal College of anaesthetists indicate that currently around 15% of emergency c/s and 5% of elective c/s surgery, is performed under a general anaesthetic. 

A c/s is performed in an operating theatre. Partners can attend for a regional procedure but not for a general anaesthetic. Strict aseptic technique is adhered to, with everyone wearing surgical gowns and masks. The theatre team consists of at least 2 obstetric doctors to perform your surgery, a scrub nurse, your midwife, an anaesthetist, and assistant and possibly a neonatal doctor. The environment is very bright, clean, and clinical but does feel extremely cold. This is because of the ventilation systems which must be in operation to keep the air fresh. Theatres have piped gases and the air needs to be constantly changing to deduce the risk of infection.    

For this little piece, I want to focus upon an emergency c/s – being done under general anaesthetic – as there appears to be little information around. It is something that you will not be planning for as such – especially not if you are planning upon using hypnobirthing techniques – whereby only concentrating on positive birth stories and a controlled water birth scenario, but will poatentially be good to read at some stage to store somewhere in you sub conscious mind – just in case – because it is good to be informed! To start with you need to remember – partners are not allowed in theatre with you – you will be alone. But your midwife will remain with you and will be there when you wake up. Obstetric maternity units have maternity theatres within their labour wards so you will not need to travel too far once the decision for theatre has been made. You will need to have an intravenous cannula to administer intravenous fluids, this is usually done via a vein in your forearm. You will have had your bloods taken – to check for such things as your blood group, for cross matching and to check your rhesus factor and your haemoglobin levels and you will also need to have a urinary catheter fitted. This is because your bladder needs to be kept emptied during surgery – your bladder lies in front of your uterus – so this is especially important. You will have a hospital gown on, a theatre hat and will have ted stockings on your legs. 

The whole atmosphere will feel electric and you will be extremely anxious, but be reassured the theatre team are a group of amazing professionals who have had much experience – as previously discussed with our contemporary rising c/s rates – ha ha! 

Your midwife will leave your partner to pack up your belongings and choose a nappy and baby outfit for your baby to wear once born.  You will be taken on a trolley to the theatre after saying goodbye… remember this is such a difficult time for partners too. They will feel so vulnerable, anxious and alone.  In some instances, an anaesthetist may allow your partner to accompany you into the theatre, however his is not the norm – in all the years of my midwifery practice I have never seen this happen. Therefore, I was so happy when I heard about Laura and Peters birth story.  

A general anaesthetic  provides a state of controlled unconsciousness. Medicines are administered by an anaesthetist to send you to sleep so that you will be unaware of surgery and cannot move or feel any pain. It is not clear exactly how it works, but it is known that all anaesthetics interrupt the passage of signals along the nerves. This means that any stimulation to the body does not get processed or recognised by the brain.

You will generally have met your anaesthetist and obstetrician before you go into theatre to discuss the procedure and which anaesthetic is most suitable for you and you will have signed a consent form – with is so important.  It is important that you and your partner understand what is going to happen and agree to what is being planned – although the situation is generally rushed/tense and you will feel completely unable to listen/understand anything. You will be having lots of things done to you and your baby all at the same time – baby monitoring/blood pressure checks/observations recorded/bloods taken/anti embolic stockings being pulled up your legs/ you may also be given a premedication – an antacid medicine.  The anaesthetist will also inform you of the complications – which include failed intubation, aspiration of gastric contents, increased blood loss, and awareness.

You may have time to discuss vaginal seeding – which refers to the practice of inoculating a cotton gauze with your vaginal fluid before your surgery. This is most generally done in cases where labour has not started so that some of your normal vaginal flora can be transferred to your baby after birth.  Research is being done to support this practice as it has been found effective in reducing the incidence of newborn allergic conditions such as childhood asthma – as it allows for the proper colonization of the fetal gut.  If you are having an urgent procedure for fetal distress – this will possibly be omitted, but if time allows – vaginal seeding is good to consider.  

You may also have time to be informed about delayed cord clamping – there have been several studies regarding this and the effect of delayed clamping in c/s. Research seems to suggest that 60 seconds is optimum or clamping as soon as pulsation stops. This practice is now widely used as a routine but something that most parents like to be aware of.  

Your anaesthetist will look at your medical history and will ask whether anyone in your family has had problems with anaesthesia. They will also ask about your general health and lifestyle, including whether you:

  • have any allergies
  • smoke or drink alcohol
  • are taking any other medicine

Your anaesthetist can answer any questions you have. Let them know if you are unsure about any part of the procedure or if you have any concerns. Ideally you would not be allowed to eat anything 6 hours before surgery – although in an emergency this is obviously not possible. 

Just before you have surgery, your anaesthetist will inject a liquid into your veins through a cannula (a thin, plastic tube that feeds into a vein, usually on the back of your hand and place an oxygen mask over your face. You will be encouraged to take some deep breaths through the mask. 

The anaesthetic should take effect very quickly. You will start feeling lightheaded, before becoming unconscious within a minute or so.

Your anaesthetist will stay with you throughout the procedure. They will make sure you continue to receive the anaesthetic and that you stay in a controlled state of unconsciousness. They will also give you painkilling medicine into your veins, so that you are as comfortable as possible when you wake up.

Recovery

After your operation, the anaesthetist will stop the anaesthetic and you will gradually wake up. You will usually wake up in the operating theatre and see your baby immediately – before being transferred to a ward. Your midwife will hold your baby next to you and try to enable skin to skin contact asap. This is sometimes not possible, depending on your situation. 

Skin to skin is so important as we know. We cannot imagine the shock of coming into this world but we do know that the only things a new-born baby recognises are its mothers skin, the rhythm of its mothers breathing, heartbeat, and its mothers and fathers voices and their smells. A newborn baby does not need to be wiped – following surgery a c/s will generally be clean as it will be passed by the surgeon from the abdomen to the midwife to be dried and checked, but it does need to be kept warm. Heat loss for a new-born can be very rapid and damaging. As previously alluded too, the temperature in an obstetric theatre is cold and therefore skin to skin can be challenging. It some instances your partner will be the first person to provide this, depending upon your post-operative condition. Babies can maintain their core temperature perfectly against a warm chest. This will allow for its normal responses and feeding cues initiate spontaneously. The first hour is an especially important time for a new baby.  

Depending on your circumstances, you will usually need to stay in hospital for around 2 -4 days after your c/s. you will be encouraged to wear your ted compression stocking for 6 weeks and will need to take blood thinning injections. General anaesthetics can affect your memory, concentration, and reflexes for a day or two, so it’s important for a responsible adult to stay with you for at least 24 hours after your operation, if you’re allowed to go home. You’ll also be advised to avoid driving, drinking alcohol and signing any legal documents for 24 to 48 hours.

Side effects

General anaesthetics have some common side effects. Your anaesthetist should discuss these with you before your surgery. Most side effects occur immediately after your operation and do not last long. Possible side effects include:

  • feeling sick and vomiting – this usually occurs immediately, although some people may continue to feel sick for up to a day
  • shivering and feeling cold – this may last a few minutes or hours
  • confusion and memory loss – this is more common in elderly people or those with existing memory problems; it’s usually temporary, but occasionally can be longer lasting
  • bladder problems – you may have difficulty passing urine
  • dizziness – you will be given fluids to treat this
  • bruising and soreness – this may develop in the area where you were injected or had a drip fitted; it usually heals without treatment
  • sore throat – during your operation, a tube may be inserted either into your mouth or down your throat to help you breathe; afterwards, this can cause a sore throat
  • damage to the mouth or teeth – a small proportion of people may have small cuts to their lips or tongue from the tube, and some may have damage to their teeth; you should tell your anaesthetist about any dental work you have had done. 
  • A number of more serious complications are associated with general anaesthetics, but these are rare.

Following your Caesarean Section

Adequate pain relief is very important following a c/s. You may be prescribed morphine following surgery for the first 24 hrs but generally will manage with Paracetamol and Ibuprofen – providing you take it regularly. You may be given a pain killer in the form of a suppository. It is better to take analgesia and mobilise than restrict your movement due to discomfort.

A wound infection is common, probably affecting up to 1 in 20 mothers, despite them being given a preventive dose of antibiotics at the time of delivery. For most women this is an inconvenience, but some will have more prolonged infections which delay healing. See more information below · A chest infection is also possible but more so in smokers and after general anaesthetic. 

The more serious complications include: · Surgical complications such as damage to bladder VT (blood clots in the veins of the legs) 1 in 300, as compared to 1 in every 1000 pregnant women overall. Treatment for this condition involves the use of blood thinning medication for several months after the clot is detected. · 

Pulmonary embolus (when a clot in a leg vein breaks off and then lodges in the patient’s lungs) affects 1 in every 100 patients who have had a DVT and this can be fatal. To prevent this complication women who are at a higher risk of developing blood clots are given injections of a blood thinning drug every day into the abdomen or thigh and this may continue for either 10 days or 6 weeks so will need to be continued at home.

Massive haemorrhage (bleeding) leading to blood transfusion and or hysterectomy. This happens more with mothers who have had previous abdominal surgery or those with a low lying placenta.

Most babies born by Caesarean birth are well after birth. However, a small number of babies may develop problems. In most cases, the baby will be seen by a neonatologist (baby doctor) and may need to go to the Neonatal Intensive Care Unit. 

A hat is especially important as we know babies lose heat from their heads. Your baby’s temperature will be checked by your midwife. Babies have stores of energy to use in the hours after birth. Sometimes, this energy may be used up during delivery or if the baby is cold, they may not use it properly. If the midwife is worried, she/he will test your baby’s blood sugar level by taking a drop of blood from the baby’s heel. Feeding your baby usually resolves a low sugar level. If the level is exceptionally low or your baby appears unwell in any way, he/she will be seen by a member of the neonatal team.

Your midwife will offer you help and assistance with baby care, feeding and helping you to move around. It is good for you to move your ankles and calves whilst you are in bed to prevent blood clots forming in the backs of your legs (a DVT – deep vein thrombosis). It is important to be getting out of bed and moving around gently as soon as you feel able, to reduce the risk of both DVT and chest infections delaying your recovery. Women who are at a particularly higher risk of these complications are prescribed treatment to reduce the risk of such problems. Your urinary catheter will be removed approximately 12 hours following the operation and the “drip” in your arm will be removed after you have started to eat and drink.  Your midwife will ask you to measure how much urine you are able to pass when you use the bathroom: please tell us if only small volumes are being passed – you may need to have your catheter re inserted. 

You will feel exhausted and extremely emotional following a c/s birth. It is possibly much like you are on a continuous night flight with much discomfort, an abdominal wound, backache, and vaginal bleeding. But you will have a baby your little baby to care for. 

Have a read of Laura and Peter’s amazing birth story to hear just how wonderful their recent birth experience was. They had an emergency c/s under a general anaesthetic for a pulmonary embolism, at term. She looks amazing 2 weeks following and is an inspiration to us all. Having planned extensively for a natural, drug free birth, both Laura and husband, Peter, re-routed their pathway in order to have their beautiful little son – as a matter of urgency. She relays feeling ‘in control’ and ‘confident’, despite the surrounding heightening anxiety levels, amongst the health professionals and that her birth experience was brilliant. 

My birth story could not be further from the birth I had hoped for but I came to terms with it in the days before and made we asked questions and had the confidence to make requests that were sure we wouldn’t have done without the hypnobirthing.

Due to the risk of the GA affecting him we agreed I’d remain awake in theatre for the entire prep and I’d go under right at the last moment. Pete was scrubbed and with me for all of this part and we breathed together through the cannula, catheter and prep.

The days before I felt quite bereft that I wouldn’t have any experience of our baby’s birth, not even a normal section. So I asked if photos could be taken so we could reflect afterwards. I particularly wanted a photo of him being raised out of me and it was important that I was still the first to have skin contact with him on my chest even if it was momentarily and that I wanted to have the photo to treasure…

….well our amazing team delivered and one of the wonderful midwives went full David Bailey!

We have the entire birth filmed and photographed from the incision, the waters going as he’s lifted out and the theatre wishing him happy birthday, his cord cutting and first cry, meeting daddy outside and then back to me.

And when they put him on my chest, the clever little chap actually latched on and our other amazing midwife held him there and helped him feed for 20 mins whilst they put me back together. The photos are beautiful 🥰 and I keep looking at them with such pride and awe of what my body went through and is healing from so quickly.

We came home late on Christmas Eve and we’re just finding our feet and winging it with the little chap, who is a content and lovely little time vampire. 5 day check yesterday and he’s now gained a lb over his birth weight 🍈🍈 which I’m so pleased about! I’m putting that entirely down to the skin to skin and feeding, as his latch has been perfect from day one.

Thank you again for everything – joining yoga and then hypno became a really important part of our pregnancy. I’m now looking forward to being able to come to baby yoga!!

Laura literally experienced the complete opposite birth than they had both planned for. They had an emergency procedure incorporating so much technology and intervention but because they felt involved and safe were able to enjoy and embrace their experience of childbirth.  

Thanks 

Sally x  

A note from Sally…

Sally UnderwoodUncategorizedLeave a Comment

Dear all – What a year! 

What a year it has been for us all. This time last year we would never have expected to have been subjected to such restrictions and challenges.  Sadly, for many of us, there has been heartache and huge amounts of stress. We have all been impacted in one way or another, having to change so much about the way we live and work and be us.

I for one have found it rather difficult as not really ideal circumstances for launching a new venture! Especially as I firmly believed that starting the Underwood Baby Academy was such a good idea – within our limited maternity service provision. I cannot complain though and feel that what we have done, albeit mainly virtually – apart for the amazing pregnancy yoga has been hugely beneficial to most of you.  I also feel proud to say, that, after 9 months of intense practice, I – Sally Underwood – have become quite a skilled Zoomer!

When we started within the academy, our aim was simply to make the whole birth experience better for pregnant women and their partners. The business has grown over the year and although I would personally have loved to have taught more parents face to face,  I realise that what we have provided to date has been fundamentally good and that so many couples have benefitted.

This year has certainly tested us – whilst fuelling the fire to help mothers achieve the birth they want – despite the unexpected and devasting obstacles Covid has thrown their way.

In the last few days, the NHS thankfully changed their guidelines on how NHS providers can support pregnant women during the pandemic – which you can read here. This states “a woman should have access to support from a person of her choosing at all stages of her maternity journey and that all trusts should facilitate this as quickly as possible”…Finally! Such amazing progress for mothers and their birth partners and I truly believe this will make the world of difference for parents. You can read the RCOG response to this here

Thank you all for being part of us and for joining in with our pregnancy related sessions over the past year. Next year will be so different – we hope!

Christmas wishes and all the best for 2021!

Laura and I really do look forward to seeing you all soon.

Sally Underwood

xxx

Epidurals

Sally UnderwoodUncategorized1 Comment

Written by midwife Sally Underwood

Having an Epidural – although not planned – can still be POSITIVE.

I believe that childbirth can be an empowering and positive experience that you treasure for the rest of your life. The skills and techniques you learn within our antenatal KG Hypnobirthing training programme can shorten your labour and reduce your need for pain relief, but sometimes you may well need more and have to embrace a change of plan! 

I recently spoke with a newly delivered mum and dad about their birth experience and heard how they had to do just this. Together they had prepared so well for a calm, drug free birth experience but due to an unexpected complication of late pregnancy, they had needed to amend their intended course of action to embrace hypertension, an induction of labour and consequential brow presentation.  Labour consisted of prostaglandin gels, CTG monitoring, a labour bed and also very uncomfortable uterine surges – within a brightly lit room, attended by a well-meaning attentive obstetric team. This was sooooooo not what they had envisaged – dim lights, music and a birth pool with their midwife. Therefore they had to employ plan B – which included an epidural….. but honestly, they truly needed it and were able to make the best of it. They had a mobile epidural so were able to keep active, moving around and although the birth ended up as an emergency caesarean section – it was largely still a positive experience.

An epidural provides pain management by blocking the nerves carrying pain from the womb and birth canal. This is achieved by injecting local anaesthetic into the space surrounding the spinal cord. The local anaesthetic is injected down a small plastic tube, a catheter, which passes between the bones in the lower back. You become largely pain free. 

When you have an epidural you will need to have an intravenous infusion running – this is to prevent any complications associated with a drop in your blood pressure. 

Epidurals are performed by anaesthetists – only available in obstetric led units. In order to have an epidural sited you will be asked to get into a sitting position and bend forwards. Your back is cleaned with cold fluid and the skin made numb with an injection of local anaesthetic. This stings for a few seconds. A needle is then passed between the bones in your back to find the space surrounding the spinal cord. It is very important to lie as still as possible at this stage to avoid any complications. The anaesthetist will try to work in between your surges and your midwife will help with this. A fine epidural catheter is then passed through the needle and the needle removed. Sometimes the catheter touches a nerve and causes a brief shock or “twinge” that passes into the leg. This is normal and short lasting. Finally, the catheter is taped down onto your back and is ready for use.

This is a technically difficult procedure and it usually takes about 20 minutes to insert the catheter. In people with more difficult backs, it may take longer or not be possible at all. Once the catheter is in, the local anaesthetic will take about 20 minutes to reach its full painkilling effect. 

The epidural will make your tummy feel numb and take away most of the pain of your contractions. You will be aware that you are having surges but they will not feel uncomfortable. Your legs may feel weak and heavy and for this reason you need to discuss your requirements for being as mobile as possible during your labour. A dose of local anaesthetic usually lasts for about one hour – so you can regulate it with your surges. In most women the epidural will be very effective – however, for some the epidural will not provide pain management immediately, and may require adjustment. Sometimes, it may need to be replaced.

What happens if I need an operation?

If for any reason you require an operation such as a caesarean section, the epidural can usually be used instead of a general Anaesthetic which is safer for you and your baby. The epidural may cause a drop in blood pressure, which may make you feel faint and nauseated which is easily treatable. Other effects include shivering or itching, which are usually short term. You may temporarily loose the sensation of a full bladder therefore your midwife will check for this at intervals, and it may be necessary to insert a small tube into the bladder to drain the urine. This is removed as soon as the bladder is empty.

Epidurals may cause temporary bruising. The likelihood of having long-term back problems after delivery is the same whether or not you have an epidural for labour.

Does and epidural effect my baby?

Epidurals have very little effect on your baby. A large drop in blood pressure may temporarily affect the baby but is easily treated. As you will no longer be aware of painful surges, the midwife will feel the strength of your contractions by laying a hand on your tummy. In addition to this, the frequency of your contractions and your baby’s heartbeat will be continuously monitored using a CTG machine. 

The total time course of labour may be prolonged. Epidurals have been associated with a higher rate of intervention but as with my couple discussed above, having an epidural offered them a chance to be able to enjoy a short time of almost normality together – being as if they were ‘low risk’ mobilising together with their relaxations – before they needed to dash for emergency surgery…… and have their little baby…abdominally… but all good. 

So despite being in unplanned territory this couple still felt empowered due to their knowledge and also they felt informed… proving you can still have a positive birth experience. And lastly…three cheers for the epidural!!!

Come and join our next Hypnobirthing Course (this is a full antenatal programme so you will not need to attend another antenatal course) so that you have the tools for a positive birth.

(Photo credit: Eva Rose Birth)

Birth Planning

Sally UnderwoodBirth Planning, UncategorizedLeave a Comment

Planning birth

The birth of your baby should be a wonderful, life-changing experience for you and for your family. It is a time of new beginnings, of fresh hopes and new dreams, of change and opportunity.

Ideally you will be able to make an informed choice re your place of birth and the options available within each setting, with your birth partner and your midwifery team – especially if you have joined one of our antenatal and hypnobirthing courses.

There are been various studies and reviews of the maternity services provided within the NHS to date. For my purpose here, I need to inform you re the Birthplace in England programme, led by researchers at Oxford University’s National Perinatal Epidemiology Unit. This was commissioned by the Department of Health in 2007, when the maternity policy stated that:

‘Every woman should be able to choose the most appropriate place and professional to attend her during childbirth based on her wishes and cultural preferences and any medical and obstetric needs she and her baby may have’.

In 2011, this cohort study published findings re the safety of births, planned in 4 different settings –

  1. At home
  2. In an obstetric unit
  3. In a free-standing midwifery led unit
  4. In an alongside midwifery led unit.

The main findings, related to healthy women with straight forward pregnancies, who met NICE intrapartum care guidelines criteria for a ‘low risk’ birth, suggested that birth itself is generally very safe and that midwifery units appear to offer benefits for mothers – risk of intervention is reduced – whilst being safer for the baby.  

You need to also be aware of the Better Births study, which took place in 2015. This was inspirational and resulted in recommendations- over a 5 year timeframe – before covid 19.  It examined maternity outcomes for all women – focussing on the huge gaps being experienced by some groups of women in specific health care settings. It aimed for choices and wanted women’s voices to be heard. This study promoted the need for personalised care and valued the concept of having continuity from a carer very highly. 

However, every pregnancy and every birth differ, so you need to trust your instincts when planning your birth….

You are focussed upon a calm and natural birth – where you are in control and feel confident. It is good to consider the following points –

  • Respect and support for hypnobirthing. A calm safe and natural place of birth
  • Birth partner to be with you throughout – be involved with decisions BRAINS
  • Soft lighting
  • Facility to play relaxations/music
  • Use of pool for labour and birth
  • Partner to cut cord following delayed cord clamping
  • Active management of third stage – or not?
  • Skin to skin contact (golden hour) – alone
  • Initiation of breast feeding
  • Availability of drugs – epidurals/opiates
  • Instrumental procedures – ventouse/forceps/caesarean section
  • Monitoring your baby during labour
  • What ifs … u need an emergency procedure/your baby is unwell at birth/during labour

What are the benefits of a water birth?

Sally UnderwoodUncategorizedLeave a Comment

Written by Midwife Sally Underwood

For many years, midwives have encouraged women to use water during pregnancy and labour because they have found it’s calming, and soothing properties really assist with progress and pain relief. I have observed over the years, that women react to pain in different ways and that although water does not give complete pain relief, it often reduces the pain women feel to a manageable level, so they do not need additional methods of pain relief during their labour. The principal being the same as using warm water to relax and unwind at the end of a hard day – a warm bath eases aches and pains and aids relaxation….. Research suggests that the warm soothing effect of the water helps the body produce endorphin hormones; these are the body’s own natural painkillers. These endorphins also act as mood uplifters and can also help to stimulate surges naturally making labour shorter.

Here are 8 facts I wanted to share with you…

  1. There are several different pools available for birthing today. Most midwife led units have static pools within their birthing rooms , whilst others have inflatable ones available. If you are opting for a home birth then you will be able to hire a pool – which will be delivered to your home when you reach 37 weeks gestation. I would advise you to practice filling and emptying your pool – as some take a while, and require tap adapters –  you will need to be proficient for your big day and will not need any extra stress.
  2. The position you adopt once in your pool will obviously depend upon its size etc. You can kneel or lean on the side of the pool, you can squat, holding onto the sides of the pool, you can use floats under your arms for support or you can float on your back with your arms holding the sides and your head supported on a waterproof pillow. You can also float on your stomach with your head turned sideways, resting on a pillow. If your partner is in the water with you, sit with your back against them or with your arms around their neck. There are lots of different options to try out.
  3. You will need to keep hydrated in water because you will be using up energy and sweating so you’ll need to replace fluids. Drinking through a straw might be easier. But be prepared to empty your bladder regularly during labour so your baby has as much space as possible in your pelvis. You will be encouraged to leave the pool for short toilet breaks while you are in the birthing pool.
  4. Your midwife will carry out observations on you and your baby to ensure you remain well and safe.  She’ll keep the temperature of the water between 36 ºC and 37.5 ºC at all times.  It is important not to have the water too warm or you’ll overheat, causing distress to your baby and increased discomfort for you.  The midwife will check your temperature, pulse and blood pressure are within healthy ranges, will monitor your baby and check how often your surges are coming. Your baby’s heart rate can be monitored while you’re in the water using a water proof hand-held Doppler. You can use Entonox (gas and air) whilst you are in the pool but will be advised to get out by your midwife, if you decide to have diamorphine/pethidine. 
  5. There are clinical reasons why you might be asked to get out of the pool. These are all to do with either you or your baby’s safety. This is one of the reasons the midwife will undertake observations on both you and your baby in labour. The midwife will keep you fully informed of how both you and your baby are doing. 
  6. It is not dangerous for your baby to be born under the water, although you can use the pool to labour then get out for the birth. A baby’s breathing reflex only starts when it comes into contact with air. The reason the midwife will ensure the pool water is kept at a regulated temperature is that being born into water that is the same temperature as your body will not stimulate your baby to breathe.   Your baby will not take its first breath until he or she senses a change in temperature and has the feeling of air on their skin. Your baby will still receive oxygen during this period of time through the umbilical cord. You or your midwife can bring the baby to the surface of the pool face first as soon as they are born. You can then have skin-to-skin contact with your baby in the pool, with the baby kept warm by keeping their body under the warm water while you cuddle them. Babies born under water can be calmer following birth than babies born in air and may not cry or move vigorously. This is normal and no reason for worry. Your midwife will carefully observe you and your baby following birth, giving you any guidance and support needed.
  7. A water birth may not be suitable for everyone. However, for healthy women who have had an uncomplicated pregnancy, using water is generally considered to be safe. Women who have any complications in their pregnancy and do not fit the inclusion criteria for a midwife led birth, would need to have a discussion with their named consultant and midwife before they would be considered as suitable for a water birth.
  8. Despite the fact I have had 6 normal births – I sadly never tried a water birth…. Such a shame!

Group B Strep and a Caesarean Section…was Hypnobirthing really necessary?

Sally Underwoodhypnobirthing, UncategorizedLeave a Comment

Written by UB Academy Midwife Sally Underwood and a Mothers account by Emily Blake.

YES IT WAS!!!

We constantly inform women that Hypnobirthing can be used for all births, whether that’s at home, in the birth centre, or even a caesarean section. The tools and information you will learn really do provide such a huge amount of knowledge…remembering KNOWLEDGE IS POWER!

The lovely Emily attended our Hypnobirthing course in the summer, pregnant with her second baby and keen to have a more positive birth this time round. Emily and her husband loved the course and began practising all the techniques, enabling them both to feel excited and prepared for the arrival of their baby. 

Emily has kindly written an account of her birth story below…

 The delivery wasn’t what I planned. But I am so glad I had done the Hypnobirthing! Not once was I in a panicky state. I was calm throughout.

It’s a very long story but will try to keep it short haha! On Thursday (24th) my waters broke, it wasn’t a lot, it felt like I had just wet myself. I had my midwife appointment that day so left it until then, I honestly didn’t think it was my waters at all. I got to the appointment and got sent straight to triage! There they found out it was my waters and soon took tests to see if it was an infection etc.

I got moved onto the antenatal ward and was there until the 29th. They kept me in due to a high blood pressure. They continued to do tests just incase anything else showed up. Which it finally did on the 29th, showing I had GBS (Group B Strep). Then they discussed how we were going to deliver baby, which looking back, I can’t believe how calm I was! I opted for the hormone drip, which was the one thing I was terrified of from my last labour, but I did it and was surprised at how well this time round I managed all of the surges!! Due to having a cesarean with Noah they wouldn’t let me go too long on the drip. I went through 7 hours of the drip before the rechecked me and I had got a only 1cm…So then they told me it was to be another caesarean.

Of course I was gutted about it but I thought I’ve given it my all. I’ve tried my hardest. I’ve over come my fear of the hormone drip! I did all of it with the help from the Hypno birthing techniques and with God watching over me too!

In theatre I felt so at ease and calm and actually was able to enjoy it and be in the moment.  Even after when Eli got rushed off to intensive care, I was in a panicky state but I felt able to ask my midwife what was going on, in such a calm way, that she answered back and explained everything to me.

In all i want to say thank you!!! I honestly would of had another horrible experience if it wasn’t down to the yoga and Hypnobirthing! I actually got complemented on how calm I was! And the midwives started sending mums to my joint room for me to help calm them down 😅.

I just want to show everyone that even though your labour/birth story may look bad on paper. It doesn’t mean it has to be. I honestly can not thank you both enough! It has been a whirlwind but I’m so glad I was about to keep a clear head and made the choices that I made.

Think you will agree with me that Emily did such an amazing job, proving knowledge really is power. Hypnobirthing provides magic for ALL BIRTHS.

As you have read in Emilys account, her baby Eli was born 5 weeks early, due to her waters breaking resulting in an induction. She was also found to be Group B Strep positive (GBS).

GBS is a common and usually harmless type of bacteria but it can sometimes cause serious disease in new-born babies. Many pregnant women are offered screening and prevention treatments for GBS but there various advantages and disadvantages to this, as the main preventative treatments involve antibiotics. Dr Sara Wickham’s book – ‘Group B Strep Explained’, pulls together most of the most recent evidence surrounding this persistent infection. It is simple to read and describes the various choices open to women currently negotiating a GBS positive pregnancy.

1. Most pregnant women who carry group B streptococcus (GBS) bacteria have healthy babies. But there is a small risk that GBS can pass to the baby during childbirth.

2. Most babies who become infected can be treated successfully and will make a full recovery.

3. Even with the best medical care, the infection can sometimes cause life-threatening complications. Rarely, GBS can cause infection in the mother – for example, in the womb or urinary tract or, more seriously, an infection that spreads through the blood, causing symptoms to develop throughout the whole body (sepsis).

4. Extremely rarely, GBS infection during pregnancy can also cause miscarriage, early (premature) labour or stillbirth.

Having said al that, GBS is one of many bacteria that can be present in our bodies. To emphasise, it does not usually cause any harm. When this happens, it’s called ‘Carrying GBS’, or being colonised with GBS. Research indicates that around 20% of pregnant women in the UK carry GBS in their digestive system or vagina. Around the time of labour and birth, many babies come into contact with GBS and are colonised by the bacteria. Most are unaffected, but a small number can become infected. The Royal College of Obstetricians and Gynaecologists (RCOG) has published guidance for preventing early-onset GBS infection. For more information, see Is my baby at risk of early-onset GBS infection? We do not routinely screen pregnant women for GBS within the UK. In other countries – USA/Canada/ and much of Europe, routine screening is caried out towards the later part of pregnancy as standard – this equates to around a quarter of all women requiring antibiotics therapy. We only offer women routine antibiotic treatment whose babies are considered to be high risk. – eg preterm babies or women with prolonged ruptured membranes/ or women who have previously had a baby with GBS. The RCOG states that universal screening will not be considered – ‘until it is clear that A/N screening for GBS carriage does more good than harm and that the benefits are cost effective’ (RCOG green top guidance 2016).

If a GBS bacteria is found in a urine specimen or HVS carried out during pregnancy, then the abx policy is adopted. Sarah Wickham’s book provides a great Q and A conclusion. She answers a multitude of general questions which are well worth reading re birthing choices for women with GBS. We cover some of these during out UBA antenatal programme and make reference to the importance of making informed choices and employing your BRAINS for all of the decisions you need to make during your pregnancy.

Big thank you to Emily for sharing her Cesarean birth story.

Sally

Photo credit: Eva Rose Birth on Instagram

Alcohol and Pregnancy

Sally UnderwoodUncategorizedLeave a Comment

A midwife’s point of view, by Sally Underwood

Harsh habit – Cheers – or NOT?

Alcohol and pregnancy really do not mix. Advice from the Royal college of Obstetricians (RCOG) suggests that is safest to avoid alcohol during your whole pregnancy. This is because alcohol passes through the placenta to your little baby. The more you drink – the risk of harm increases BUT what if, like me when I was having at least 3 of my children, I drank alcohol before I actually realised I was with child? One cannot turn back time, but I was fortunately ok. As soon I had had each of my pregnancies confirmed I quickly reverted to tee total status. The good thing being that placental function is very quick to revert to normality as soon as the alcohol consumption is halted. 

Research indicates that alcohol will increase your chance of miscarriage, affect your baby’s development – physically and mentally, will increase your risk of stillbirth and make you more likely to have a premature birth. It will also affect your new baby during infancy – it will be more vulnerable and prone to infection – for  more information re this look up www.nofas-uk.org(national organisation for fetal alcohol syndrome). 

As a midwife myself, I have routinely been responsible for alerting women of the dangers of alcohol consumption during pregnancy and discouraged its use. It has for several decades been questioned at booking by all health professionals and documented in women’s maternity records. In my practice I believe that most women have listened to our well-meaning advice and believe that they are usually honest – as they really do want the very best for their babies and really hear what we who are ‘with women’ recommend. This is why I found the headlines published in the Telegraph – 16/09/20 slightly troubling- 

‘A single drink – even before the mum knows she is pregnant – will be documented – even without consent……….’ 

It appears the NICE (National Institute of Clinical Evidence) are planning to record drinking habits – not only within maternity records but within her child’s health records – without her consent. The British Pregnancy Advice service is questioning this, as I am, suggesting that this may present barriers between health professionals, and women. Women could become fearful of being honest regarding habits and confidentiality issues will follow. 

We are currently surrounded by so much uncertainty. The Covid pandemic and isolation have been instrumental in triggering heightened anxiety levels amongst us all. These alongside hormonal changes and general pregnancy complications are possibly a reason why more women could be tempted towards the ‘bottle’ today during their pregnancies and alcohol is so readily available.

If you would like to talk to someone about drinking please do talk to us your midwives, your obstetric team or your GP or health visitor. 

However, I do believe that we need to maintain confidentiality and ensure women feel safe to confide with us – without the fear of harsh headlines – which could be hugely harmful….. for years.

Once we know that you have been drinking we can signpost you accordingly. There is so much help and support available today. A problem shared …. And all that does make it better. Promise. 

Probs not Cheers though eh!  

We are in strange and isolating times at present during the Covid pandemic, but please remember support is still out there for you. We are seeing a bigger uptake than ever before in holistic therapies, with a huge focus on self care. For example Yoga for Preganancy is one of the many ways you can learn tools to help relax, feel in control, ease anxiety and reduce fear.

At UB Acadademy we are also proud to offer all of our members a free video in mindfulness created for us by Emma at ‘Made Up Mom’. Her passion for mindfulness is contagious even for the biggest cynics…add on yoga and our Hypnobirthing course and you are on to a winner!

Remember knowledge is power. Invest in yourself, find your support network. Help is out there, don’t be afraid or embarrased to reach for it. You are not alone.

You can read more about Alcohol and Pregnancy on the NHS website and also on the RCOG. 

(The following information is taken from https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-alcohol-and-pregnancy.pdf)

Support for you:

There are a number of reasons why women might drink too much alcohol while they are pregnant: 

-they might not know they are pregnant
-they might feel under pressure to drink when with friends
-they might be trying to cope with problems and stress
-they might not be aware of the risks of drinking alcohol during pregnancy. 

If you would like to talk to someone about your drinking, you can speak to your midwife, obstetrician, practice nurse, GP or health visitor. Once they know how you are feeling and why you are drinking, the person you tell will be in a better position to offer you the right help and information. 

Further support and reading available…

UK Chief Medical Officers’ Low Risk Drinking Guidelines (Department of Health, 2016), which is available at: www.gov.uk/government/publications/alcohol-consumption-advice-on-low-risk-drinking 

Drinkline is the national alcohol helpline: if you’re worried about your own or someone else’s drinking, you can call this free helpline, in complete confidence; call 03001231110 (weekdays 9am to 8pm, or weekends 11am to 4pm) 

NOFAS-UK (National Organisation for Foetal Alcohol Syndrome-UK): www.nofas-uk.org The FASD Trust: www.fasdtrust.co.uk