Difficult Birth - a Dad's Perspective

by Mark Bullows, Birmingham West NCT

I have had seven babies in total, only one of them was a normal birth. My eldest was diagnosed with a heart condition during pregnancy. Of the five I’ve had with Claire we lost our first due to prematurity and then went on to have four more premature births with Claire spending much of her pregnancies threatening to go into labour.

There are three that really stand out on the subject of a dad's perspective, my eldest son with his heart condition, my eldest surviving baby with Claire, and our youngest daughter who was Claire’s VBA2C (that’s vaginal birth after two sections).

When my first wife was 20 weeks pregnant with our first baby we went along for the scan - excited expectant parents like everyone else. Then we had that classic silent moment, where you know something is wrong. We went round to see my wife’s consultant and he explained that they thought they had found something wrong with the heart. He told us that there wasn’t anything we could do until the birth but they would run tests to investigate the extent of the problem. 

Throughout the remainder of the pregnancy, the hospitals looking after my wife and baby couldn’t do enough to make sure we were fully informed, answered every question we had. At 38 weeks they induced my wife, scheduled a theatre and had an ambulance on standby. When our son was born she had enough time to look at him before he was rushed off. I followed behind and got to the hospital with enough time to have some paperwork thrust at me to sign before he was taken into theatre. When they brought my son out of theatre and I got to see him properly for the first time I couldn’t believe what I was seeing: he was covered in tubes and wires. Despite how awful it all was, we felt prepared and were able to cope with it. I really have nothing but praise for the hospitals. 

Three babies later and despite what we’ve been through, me with my son and losing our first daughter, Claire and I were happy expecting another daughter. She had an easy pregnancy and we had no reason to think anything would go wrong. As she got to the late 20s Claire had started to track her Braxton Hicks. She didn’t get them often but they were quite strong and regular when she did. She even had an overnight stay because of them. So at 31 weeks when Claire went off to B&Q with her dad and a notebook and pen to write her Braxton Hicks in, we didn’t really think much of it. After an hour I got a call saying to get myself ready and be waiting with her green notes. 

Claire had had a scan that morning and had been having contractions during the scan which they’d said weren’t anything worrying, so we didn’t think they’d be too worried. They sent us around to the waiting room and gave her a sample pot. After Claire cried out during a contraction, one of the midwives came around and said “was that your pain?” and she got us straight into a delivery room. Even strapped onto the monitor, with a drip set up to stop the contractions and steroids already administered we didn’t think anything would come of it. We were laughing together, I’ve never been forgiven for coming back from the shop with a coat full of chocolate and drink and opening it as (Claire describes) like a dodgy watch salesman and asking if she wanted anything followed by “Oh you can’t can you? You’re nil-by-mouth!” 

After an hour the doctor came back to examine Claire to see if anything had changed. He just calmly said “we need to get this baby out now” and suddenly the room was full of people. Claire had her nail varnish cleaned, her jewellery removed, her drip capped off, three consent forms explained to her which she had to sign and her clothes changed for theatre, all at the same time. Neither of us really knew what was going on and, as it was a crash and she was having a general anaesthetic, all I could do was sit outside with her mum. I saw our daughter in passing as she was wheeled past on her way to the neonatal unit. They took a long time to do the operation and Claire took a long time to come round but no one explained what was happening or why things had gone like they did. Really my son’s birth should have been the hardest of the two, but the lack of information in this one made it the hardest. 

Claire went on to have another section under similar circumstances but slower and things felt better having already been there. 

Then Claire got pregnant again and she decided as it would be her last she was going to get a Doula and she would try VBAC. The team that Claire was under were brilliant, they were very supportive and came up with a plan that we were all happy with. We met some lovely people along the way who agreed with our decision and Claire felt confident going into the birth. Sadly on the day we had a team who were determined she wasn’t going to get the birth she wanted. There was a lot of shouting, they forced her into stirrups which she knew was bad for her because she has pelvis issues. The midwife and doula tried to stop them but they were yelling at me to hold my wife still. It’s very difficult as a man when you see the woman you love in distress but being told by medical staff that you need to do something that is going to make her worse. I wish I had understood better before the birth why she kept saying “Mark, remember, stirrups bad” because for a long time it has been a source of guilt for me, even though Claire says it’s unnecessary. Our daughter was born APGAR 9, pink and screaming after 6 minutes of unaided pushing. 

I know I could have done things differently to support Claire better and I think that would have helped how I felt afterwards, so here is my advice to expectant dads:

1. Take an interest, there’s a good chance she knows why she is saying what she’s wants.
2. Memorise her birth plan, get her to tell you what is non-negotiable, what you need to know about any health issues.
3. If you can, get a doula, as they’re an extra brain to remember these things and it’s their speciality anyway so it comes naturally to them. If you do get a doula, attend antenatal sessions with her too, you can work as an amazing team to support your partner if you do.
4. Don’t be scared to question the staff, if there genuinely is no time you will know it, but make sure they explain to you both afterwards. Don’t be scared to tell them no either, practice your best authoritative voice saying "She said no. She does not consent to that!" It is always the mother’s word that goes, even in birth and if she doesn’t want something done to her that’s her decision. 

I learnt a little acronym that helps: TBRAINS, it means:

• Time/ Talk: do we have time/ can we talk?
• Benefits: why do you want to do this?
• Risks: what could happen if you do that?
• Alternatives: what else can you do?
• Instinct: what does my instinct tell me (or hers, she even has the say over you, sorry)?
• Nothing: what if we do nothing and just wait to see what happens?
• Smile! It’ll help keep you calm, the staff are more likely to listen to you and calmness is good for a birthing mother as adrenaline can complicate the labour.

I highly recommend antenatal classes too. Claire dragged me to one when she was expecting our youngest. I’ve had 6 babies before, what can I learn from an antenatal class? Actually I found it really useful.

The last thing to remember, debrief afterwards, especially if the birth was particularly difficult. Whether that’s down the pub with your mates, your Doula, or you make an appointment to see a Supervisor of Midwives (amazing people, if doc says no, ask the SoM!) Don’t try to hide it from your partner either, you are in it together not separately, you don’t have to be strong for her, you need to be with her.

NCT’s Chief Executive Belinda Phipps said:
“NCT has campaigned for dads to have the choice to be with their partners at their babies’ birth. Of course they don’t have to be there – but it’s important that that they and their partners discuss this and decide what’s the best approach for them. 

“If fathers do decide to be present at the birth, they need to be prepared for it. What children learn about childbirth when growing up is inadequate at school and often misleading from the media so that it’s not surprising some men are shocked. Attending NCT classes with their partners can help dads be well informed ahead of the due date. 

“There is of course no need for birth to be shocking if parents are kept informed and well supported. But where parents are not prepared – either when not supported or as a result of today’s much increased medical intervention - there may be some trauma. Having a midwife you already know and trust is important - the NHS needs to ensure a familiar face is available to mother and father, and organise itself in a way that gives midwives time to care.”

Birth Plans - to write or not to write?

by Sarah Bernstone

To write, or not to write, that was the question.  At first it seemed obvious; this was all part of the antenatal process.   It was talked about in all the books and at all the classes (we attended NHS and Active Birth as our local NCT groups were heavily over subscribed), and it was clearly the ‘Done Thing’ to write a ‘Birth Plan’.

But wait a minute, then there were the articles in commercial magazines telling you on the one hand, Birth Plans were useful, but on the other hand giving countless experiences of mothers who had abandoned every last plan for drug free childbirth the moment the contractions hit home: "Give me drugs, give me total sensory deprivation and back up drugs" as Edina Monsoon yelled in Ab Fab!  Or mothers who had been in such a flurry that they never even looked at the plans and felt chastised by them afterwards as they felt they had somehow failed to live up to their own expectations of themselves and childbirth.  Talking to other mums at work many of them were dismissive of the value of birth plans too.

So what to do?  Would I be setting myself up for a fall with my positive birth plan, or should I simply venture off into the unknown without a ‘map’ and hope for the best?

Well, being Mrs Organised (in those days anyway) I sat down at the PC and typed up a long plan with a hundred and one provisos, and boy, am I glad I did!  With the help of the NCT book, Sheila Kitzinger's guidance, and input from both sets of antenatal classes, I put together a plan which covered all options at all stages:

• Pre-labour & induction
• Early stages of labour
• Later stages of labour
• Transition & delivery
• Third stage & post delivery

Within these areas I planned my ideal scenario - natural methods with no medical intervention - breathing, movement, aromatherapy, massage, water etc - and then acknowledged that things may not go to plan.  In these secondary scenarios I planned what courses of action I was prepared to take if intervention were required - Tens, gas & air, epidural (but NOT pethidine) - and how I would like things to happen if a Caesarean became necessary.

In the event, at three weeks overdue, having tried all the usual methods of self-induction (hot bath, sex, massage, reflexology) and a few others besides (bouncing on a trampette was recommended by one midwife!) I had to go into hospital for my induction and my plan swung into action.  After two pessaries and 12 hours I was about 2cm dilated. 

Having given that my best shot, we were happy for the midwife to break my waters to speed things up.  I managed 2½ hours of movement and breathing to cope with the intense contractions which resulted (as well as wearing the Tens machine), before caving in and screaming for an epidural!  Having read my plan, the midwife offered me entonox as an interim solution, but I didn't like that & was still determined to go for the epidural.  An examination once that was in place showed a mere 4.5cm dilation, so I was glad I had made the decision.  Eventually, 18 hours later, and 35 hours after the first pessary, the surgeon recommended a Caesarean. We asked for 10 minutes alone to consider this, then half an hour later our beautiful baby daughter, Ella Phoebe, was born by Caesarean Section. 

The best thing about my birth plan was that even though things did not ever reach my ideal scenario, we always felt in control as we had planned for all the "what if's…" and the hospital had followed our requests.  My top tips for all new mums-to-be are:

• do make a birth plan
• consider all scenarios and plan for them
• share your birth plan with your antenatal team in advance
• ‘learn’ it in case there is no time to refer to it specifically on the day
• revisit it afterwards and congratulate yourself on such great planning and execution!

Remember, birth can be an exciting or harrowing event - but if your planning is in place, you have the power to feel confident and in control, which is the key to a positive childbirth experience.

Any plans for your birth….?

Sourced from Sarah’s Active Birth class notes and Mother & Baby 2000

Planning your birth starts the moment you find the thin blue line on the pregnancy test – do you want home or hospital?  Which hospital?  Water or not?  Drugs or alternative therapies?  Natural or caesarean?  Many of your early thoughts may change through the coming months, but then plans should always be flexible.

Your birth plan can be written or memorised, a short note, a form from the hospital or a list of your priorities.  The most important thing is to say that you and your partner should be consulted and remain informed at all times – whatever else you decide to include is entirely up to you.

The best time to pull together a formal plan is after your antenatal classes (NHS or NCT or both) when you have had time to discuss and learn about all the options open to you – but preferably at least a month prior to your estimated due date or else you might just run out of time!

When you have formulated your plan, make sure you discuss this with your midwife or consultant, that your plan is practical and that you have planned for all contingencies.

Here are some things you may like to consider when drafting your plan:

Induction & Acceleration – when, why, how soon and what methods?  

Early labour – at home?  Midwife in attendance?  When to go into hospital?  

In hospital – how many people can attend?  Do you want your partner, sister, mum, a friend, a doula?  Are you happy to be observed by medical students?  Privacy?  

Environment – what are in the rooms already – beanbags, balls, birthing pools, cushions, private toilet/bath/shower etc?  Can you bring in your own props?  Are candles allowed, aromatherapy, music?  Do they allow homoeopathy, hypnotherapy, acupuncture, massage?

Mobility & position – do they expect you to lie still and be monitored constant  Can you use a birthing stool?  Give birth in a pool?  
ly, or can you move, stand, squat, lean over?

Monitoring – how often and how long?  Belt monitoring or internal monitoring? Can vaginal examinations be kept to a minimum?  Will they check your dilation before administering drugs or an epidural (at 8cm the pain may be unbearable but you will probably be on stage 2 before the drugs kick in, so it may be best to hang on in there)?

Food & Drink – what can you bring?  What is available – think of your partner too!  What is allowed?  

Pain relief – what is your order of preference – Tens, entonox then epidural?  Is there anything you want to avoid?  If you prefer to try not to use drugs, you can ask the hospital not to offer them but to have them available in case you ask for them.

Second & Third stage – are there time limits – can you negotiate longer times before intervention?  How long would you like?  Are episiotomies routine or is tearing accepted?  Is syntometrine routinely given?  What positions would you prefer to try/are you allowed?  Can your partner cut the cord?  Can you look at or even keep the placenta?  Who stitches up the perineum and how experienced are they – hold out for the best!

Intervention – forceps?  Ventouse?  Caesarean Section?  Epidural or general anaesthetic (GA)?  Can your partner attend?  If you have a GA, can your partner look after the baby until you come round?  If possible, parents should have time to discuss any interventions alone and may request more time to decide.

Baby – will it be delivered onto your stomach or taken away and cleaned & wrapped?  Which would you prefer?  Can you find out the sex before they announce it?  Can the baby stay with mother, or father if mother needs treatment?  Breastfeeding straight away?

Intensive Care – can you breastfeed or express?  Can you get a bed nearby?  Can your partner stay?

Feeding – is there full breastfeeding support?  Are milk or water ever given without asking – if you are concerned you can put a notice on the crib: ‘mother’s breastmilk only’.

Night time – do you want the baby in your bed, a crib or in a nursery so you can rest?  What nursing/midwife cover is available overnight?

Whatever you do, make sure your birth plan shows not only your ideal choices, but in the event that things do not go to plan, ensure that you have covered all other options.  This way, if you end up having a less than perfect birth, you can still feel informed and more in control.  In the words of Chris Salvage, midwife, “Being flexible in the initial approach will help alleviate any feelings of disappointment afterwards.”  She also recommends a full debriefing with your midwife afterwards to discuss what happened and why.  Read your delivery notes, ask lots of questions and ensure you understand your own personal experience.

Did you write a birth plan? Did it go to plan? Do you have any advice on writing birth plans? Let us know by commenting below:

Young Bumps - Antenatal Classes for the Under 21's

Nicky Srahan

NCT’s visionary strategy aims to reach and support 20 million parents by 2020.  To this end, NCT has been in touch with all Children’s Centres and NHS hospitals about increasing partnership working.  As of last year, there were 124 contracts formed with Children’s Centres countrywide.

We agreed to pilot an antenatal course with Ely Children’s Centre last year; the success of this has led to two more courses being commissioned this year for ‘Young Bumps’ antenatal classes – for under 21 year olds. The classes are free to the participants as the contract is agreed between the Children’s Centres and NCT.  Local midwives refer all pregnant women under 19 years to Lisa Langley, Young Parent Support Worker at Ely Children’s Centre (includes Littleport and Sutton Children’s Centres); she works closely with all these young people, trying hard to encourage them to attend the classes. 

The courses have all varied in format and duration as we have adapted to the parents’ needs.  I taught five antenatal classes of eight in the first course, and local health visitors contributed to three weeks of parenting issues.  There was a regular core group of four young people who came every week; they were able to bring birth partners, friends or parents with them, and this varied widely, but the contribution of several different people was valuable and enjoyable.  Several other young people attended sporadically.  Although I had developed a course plan, the agenda was negotiable depending on people’s needs. 

We had two young mums on the second course; one came with her dad, mum or school friend each week, and the other brought her boyfriend or mum; the session when both mums were together was lovely!  Owing to quite a wide gap in due dates between these two, we shortened the course to six weeks.

I am now in the middle of my third course; we’ve changed the plan again because all the potential young women are between 15 and 18 weeks pregnant now, so a little early for a full-blown antenatal course.  For that reason, we have just had two sessions thinking about the early days of pregnancy, looking after themselves and their babies, and thinking ahead to hopes and dreams for their babies and feeding.  Evidence suggests that women have usually decided how they are going to feed their babies before they reach 20 weeks pregnant, so it was important for me to have an early discussion about breastfeeding.  Encouragingly, they are all keen to breastfeed.  After Easter, we are re-joining for a more standard six week antenatal and parenting course.

Tips that I have learnt from working with young parents:

·       Treat young people as equals and examine assumptions, in the same way as I would older parents.  Young parents often get a bad press, but becoming a parent can be a strong, stabilising and positive influence in a young parent’s life.  (Professor Simon Duncan at Bradford University is a controversial academic who writes about challenging the problems that people may have with teenage parenthood.)

·       Congratulate them!  They may not have heard too many words of congratulations.

·       Venue and timing. Afternoon sessions are easier; they are unlikely to attend in the morning.  The Children’s Centre organises local taxis to collect them and take them home.

·       Group dynamics. Although this is crucial in any class, a group relationship is important for the success of the sessions. Ice breakers are very important for strengthening a group – as long as they are right!

·       Varied teaching methods.  I have developed many more visual activities for these groups.  I am keen that these sessions are not thought of as conventional education, or school, as some people’s experiences have been poor of school. Sophie King-Hill, an NCT teacher and experienced youth worker, suggests that sometimes we may have to go back to how they got pregnant, periods etc, as school sex education can be so poor!

·       Be flexible and laid back.  Be prepared to respond to the young people’s needs and not stick to a plan!

·       Work with anyone who comes!  If a young person brings a new companion each week, welcome them and work with their knowledge and contribution.  Value everyone’s support.

Research suggests that engaging young people antenatally increases the likelihood of them continuing that engagement postnatally.  Young people are traditionally reticent about attending local mother and baby groups, but the Children’s Centre offer ‘Little Monkeys’ and PEEP for babies and toddlers; all of which are well attended by young parents. 

Although this work can be challenging, it is also very rewarding and refreshing.  There are differences between working with young people and older parents, but many of the issues, worries and concerns are the same for every age group.  The love they feel for their children is the same as mine.