Preparing for Birth

Sam Norman: After nine months of pregnancy, most women are more than ready to give birth, not least is their sore backs, swollen ankles and weak bladders; but what are the best ways to prepare for the actual birth. I'd like to welcome to the studio, Sue MacDonald, the Education and Research Manager at the Royal College of Midwives in London to answer some questions on birth preparation. Welcome Sue. Sue MacDonald: Hi! Sam Norman: Now people often do child birth classes these days and what should you look out for in one? Sue MacDonald: Well, you need to find what will suit to you as a person and as a woman and if it's your first baby, your needs are going to be different to if it's your second or third baby, where you might just need a little refresher course to catch up with any changes that have happened in maternity care. So you should checkout with your midwife and your GP, what's available locally. Sam Norman: Would these be offered to you automatically or will you have to sort of research it and ask? Sue MacDonald: They tend to be offered locally and you'll be offered really at your first interview with the midwife and then they vary from one or two classes to a set of six classes. In addition there are other classes put on by different groups, such as the National Childbirth Trust that can be very useful for moms who want more in-depth information and want to go with their partners and that sort of thing. Sam Norman: There are many types of sort of birth that you can choose on there, I mean you can have it as a one-to-one midwife or you can have through some of the options. Sue MacDonald: Okay! Well, the way maternity care is gone in the UK in the last five-ten years, it's being very exciting, certainly for midwives because it's been a change, a ton of huge change, but also for women because they are getting greater choice and they are getting more models that offer one-to-one care, so there is a variety of different models and they are called by variety of different names according to the maternity service you go to. And this can vary from what's called traditional sort of care where you book into the hospital, you have a lot of your care in the hospital with the team of midwives, and you come in labor, you have your baby and then you go home and have care from your community midwife and that's the kind of traditional model. A different model where midwives have a small group of women that they provide care from beginning to end all the way through, and the midwives will often work in a group of four or six to really work on continuity for the woman, so she gets to know not just one midwife but a group of midwives, one of whom will look after her during labor. Sam Norman: As people do tend to want the personal touch, I mean basically, you want your favorite midwife to be there when you're actually doing the business. Sue MacDonald: Well, sometimes, I mean sometimes it's not always possible to get the midwife that you know very well, but I have to say that as a midwife when you're caring for women in labor, you get a very good relationship very quickly and we're trained and tuned in to what woman need and basically once you get to know woman in half-an-hour, you get a very strong relationship with her and you'll tend to have one woman for her labor. Sam Norman: It is very intimate relationship, isn't it? Sue MacDonald: It is very intimate. It's very special, very special for a mother and midwife. Sam Norman: I had huge affection for mine. I was very lucky. And is it possible -- do you think really to prepare for birth. Sam Norman: Well, it was interesting that you are preamble about waiting till the end of nine months, because I think preparation for birth has to start much earlier if possible, because entering and everyone says that going into labor and birth is a bit like a marathon and the advantage of, if you're preparing for marathon is you know what the deal is, you know how to try and you can have the fastest run and you do it and you can kind of gear up on getting your muscles strong. Preparing for labor is not quite the same because you can't have a practice round as it were, but you can prepare physically to be in the best possible condition for that experience and that time. So things like making sure you're very fit or as fit as you can be. Sue MacDonald: And how would you do that, because you can't exercise a lot when you're pregnant, can you? Sam Norman: Well, you can't. If you haven't done rigorous exercise before, now is not the time to suddenly go off to the gym. Sue MacDonald: And running marathon. Sam Norman: For six hours a day and seven days a week, but it's the time to start doing things like walking, maybe doing things like swimming or even trying a yoga class that's specifically designed for pregnant women to really get your muscles toned up to get your energy levels really in tip-tip condition. Alongside that really making sure, you're well nourished and well rested is a huge help, because in some ways at the end of pregnancy, nature makes sure you slow down, because you're much bigger. Sam Norman: Because it's three months isn't it, I mean I always remember being so tired and as I was working really, really hard for first three months for both my pregnancies. And it just seemed -- because this is just one way around isn’t it? That's when you need to rest most. Sue MacDonald: It is, but in a way you have to rest from beginning and the end. Because at the beginning of a pregnancy it's because there’s so much going on in your body, you are very tired. The middle is probably the best time because of you full of energy, you feel good and you are not too large. Towards the end of pregnancy when your baby is quite large and you are feeling, your swollen ankles, you are not feeling very comfortable, then is the time you need to slow down make sure you are having adequate rest, a good night sleep, which can be difficult if you are feeling huge. But having an afternoon rest, putting your feet up, making sure people on the tube are giving you a seat. You are trying that as -- Sam Norman: Well, they normally do that –- they generally I think are pretty good about that. And now can you choose anybody to be present at your birth. I mean most presumably most people have the father of their child there but -- Sue MacDonald: Yeah most people have their partner or their husband; some women have want their mom or their sister or friend. And really what most maternity units – or if you are giving birth in is not a problem at all. You could have whoever you want with you. But what you need to think about is who is going to be the best for you at that time in your life. Who is going to give you the most support, because you might worry about your partner, in case he is going to faint, or he is going to be panicky. And you need to be focusing on you, as he does or your mom does. And really talking to your midwife about who is best to be with you. And making sure that you end out with four or five people in the room with you and they are all talking to each other and not looking after you, because then you are the center of everything for this time. Sam Norman: Do men still faint at birth? Sue MacDonald: Actually very, very rarely. I think in all my years, I have only had one man who fainted and it was because it was exceedingly hot in the room and the delivery where the delivery was taking place and I think he just got beside himself and we had to move him out of the way because things were happening. But mostly men very get involved in and it's important to make sure that your partner is involved and make sure he is doing things and rubbing the small of your back or mopping your brow. Keeping you busy. Sam Norman: That's interesting, do you actually think is it important for the father of the child to be there? Sue MacDonald: I think if he wants to be there, and he is comfortable about being there, and I think that's a very important thing that you, your midwife and your partner need to talk through, because you need to find out what his previous experiences and what his expectations are because if he expects it to be horrible, or he has previous experience that was very traumatic, he may need to kind of debrief from that before he is going to be help to you. You don't want the experience to be traumatic for him or for you. You want to both be looking at it positively. Sam Norman: Because you hear people who have attended children birth and they have had strange reactions to their wives and that happens quite frequently doesn't it, so that their relationship is affected. Sue MacDonald: It can happen and that’s why it is very important to know right at the beginning if it could be a problem and also after the birth sitting down, reflecting about what happened, why it happened, how people felt, and if the couple feel that the partner isn’t the best person to be there, it's important that he doesn't feel guilty, because it’s become a big thing that the man has to be there. And some men don't want to be, or they feel forced to into it. It’s important that they are there; they have chosen to be there not that they have been kind of pushed because it's the thing to do. Sam Norman: Who do you think is the best person to have? Sue MacDonald: The best person is the one that the women wants with her, and that can be her mom, and it can be her partner. It's up to her really. Sam Norman: Now, the big day is arriving and you are sort of getting all ready, what should you have packed and prepared? Sue MacDonald: That depends if you are giving birth in your home or in a hospital, a birth center. Sam Norman: Presumably most people still give birth in hospital? Sue MacDonald: A lots of women do, that's true, though it is changing -- we developing more birth centers which are much more homely environments, and that's why I say it depends, because you need to visit the place where you are going to give birth and look at it and see what's this going to be like for me. Is it going to be comfortable, do I need some music with me? Because some women take a little tape recorder with some music that's favorite to them, that they feel will help relax them. You need things like -- a really nice comfortable nighty, or t-shirt, a huge t-shirt, some women find very useful, you get often things like gowns in maternity units but they are big -- Sam Norman: Those ones that do up at the back. Sue MacDonald: Well they never quite do up at the back. Sam Norman: They are not quite good. . Sue MacDonald: Though they are meant to be designed for full hospital use, they are not necessary -- they don't necessary fit the women. Sam Norman: Now that's a very good tip isn’t it? Using a very big t-shirt. Sue MacDonald: A great big t-shirt and one that you don't mind if it gets a bit mucky so it's best not to choose the best negligee. Because things get a bit messy sometimes, you got a bit sweaty, you get a big hot. If you want something cool, comfortable. Sam Norman: Quite nice I remember that the nicest present I got bored after I had my first child was a lovely spray sort of Eau de Cologne or something – it’s gorgeous because it's really sort of -- just crave something slightly luxurious after you see. Sue MacDonald: Yeah well also during those little water sprays which are bit expensive but those can be quite nice just to get sort of puff of cool air around you. Having things like a natural sponge that your partner or your mom can mop your brow with. Having one of those little massage bowls that can help because your birth partner whoever it is, will get quite tired if you are wanting him or her to be doing a lot of massage. So having one of those little massage things will help your partner not end up with aches and pains after the birth. Sam Norman: And what about I mean the sort of environments you can't really control like, I remember when I was in labor, overlooking that. And he wasn't -- I mean -- he is exactly very inspirational, but all midwives improving the sort of comfort of their patients and – Sue MacDonald: Well, certainly where possible maternity units have become a lot cozier than they used to be, a lot of efforts being made into making them more gentle places to give birth, I mean, obviously one of the best place to give birth is actually in the home if that's what you choose to do. Because you are in a familiar environment, you are comfortable. Sam Norman: People are very discouraged from doing that now, don’t they? Sue MacDonald: Well I am not sure if they are discouraged, I am not sure if women always get the chance to think about it, and think about what it would be like. I mean some areas it's not so easy to get a home birth, but it's certainly useful to talk about however with your midwife and see what is available and what is possible because for some women that's a very good option. And it's certainly very nice in the early stages of labor, when it's very tedious and lone, you could be in between your contractions, you can be doing some ironing or pottering about the house or walking about in the garden, it’s much better in some ways than maternity units are setup to be. Though some maternity units have little fountains and little gardens. Sam Norman: How nice. Sue MacDonald: It's -- things are changing for the better certainly. Sam Norman: How else are they changing? Sue MacDonald: I think the hugest thing is being continuative care for women and being able to offer different choices and different opportunities for women. And I think the other thing that has changed a huge amount is the amount of information that's accessible to women. Things like this program for example, to get more information to women. So women are asking more questions and challenging the health professionals, which is brilliant. Because they are asking us, well, why are you doing this and can I do that? Whereas maybe a few years ago, ten years ago they would get what’s a standard package of care. Now they can really tailor the care to their individual needs, where it's possible. Sam Norman: Yes, you weren’t really encouraged to question you care in past – you just sort of took what was -- speaking which is most crucial thing is pain relief, how early you have decide what form of pain relief you are going to take on? Sue MacDonald: I always say whenever I am talking to women about this that you -- the difficult thing about labor is you just know, you don't know how you are going to cope with the pain of it, whether you are going to be one of these women who just breathe through every contractions and just has a very easy birth if you like or whether you are going to be a women that goes through using Entonox, the so called Gas and Air. Sam Norman: Which doesn't work -- Sue MacDonald: And for some women it can be fantastic, because it can take the edge off of that very peak of the contraction, and they can feel very much in control because they are controlling the gas and air. So for some women it's very good, for some women they don't like the feel of it because it's a bit like being slightly tipsy and some women doesn't like that feel of going in to control. Sam Norman: No I always found it worth up to a point and then nothing could take pain away, apart from the Pethidine injection, the epidural -- Sue McDonald: We are leaving the Pethidine, that will dull the edges but it won’t take the pain away. The only thing that would take the pain away totally is an epidural and you don’t know at the beginning whether that’s what you are going to go for. The other thing is you don’t have to makeup your mind because of that. You can work your way through everything if you want or you can have one of the options and that’s the one that suits you. So you are not committed, if you decide at the beginning of the labor, I am not going to have anything except Entonox and Gas and Air you are not committed to just keeping to that because the midwife will always be checking is that feeling alright, do you need anything else – Sam Norman: -- Went up screaming for the epidural. Sue McDonald: Sometimes not always though because see there are other things that can be very useful are almost sort of taken for granted like water because going into a warm bath or if you are lucky enough to be a unit with a water pool or if you have got a water pool in your own home, that can be fantastic for women because you can lie there, the buoyancy really relieves the pain and you can feel so relaxed, it is very, very good for pain relief. Sam Norman: I think the big, obviously the big hang up for most women about birth is the pain of labor and whether they will survive it. How can you prepare yourself for that? Sue McDonald: Well, you prepare yourself by getting information I think and also and that’s every time, it is not right to the end of pregnancy. Right at the beginning of pregnancy when you have your assessment, your midwife will ask you about what is your experience of labor. If it is your first time, you might say well it is my first time I don’t know anything about labor. But one of the things about being a woman is you would get a lot of information about women giving birth and that’s drawn from your mother, your sisters, your friends and the media and things like Coronation Street or EastEnders. Sometimes those images aren’t positive, so one of the very important things to do is that you unpack the women’s understanding and kind of picture what labor is going to be because if you have just seen a horrific program about childbirth where there is a woman screaming in pain and rolling around and very horrific, you can be very frightened about that and you might think is that going to be me in nine months time or be less than that -- eight months time. So it is important to see what -- to make sure you have got as much information as possible, to make sure you are in peak condition for the labor and also that you have got company with you and you have your birth partner, you will the midwife and that has been found to be really a significant thing that helps you during the labor is having somebody there. Sam Norman: As we say really, to make sure they are absolutely the right person and they are the ones who are going to give the most comfort and be useful which is necessarily your -- the father of the child, no-- Sue McDonald: No, and you can change because some women I have looked after they have had their mom and their partner and the mom is sort of been there for part of this and then they have done a sort of shift change half way through, and that’s fine, you just need to work out what suits you and be selfish and don’t be a good patient and sitting in bed and thinking, well, I have to do this because they tell me because it is very much down to what you want and this is the time and midwives will listen because we are not -- we try not to treat women as patients but as women who are going through a normal process of childbirth. Sam Norman: It must be a great job. Sue McDonald: It is fantastic. Sam Norman: There is a lot of stuff in the media about elective caesareans and people being too posh to push or too scared to push or whatever. Can you say to your daughter if you are particularly squeamish about pain, well I think I will have a caesarean, thank you? Sue McDonald: Well I think you do need to discuss it because having a caesarean section isn’t always straight forward and it has obviously got its own pain. So it is not a way of avoiding pain, finish and there are a very small number of women who psychologically are so fearful of the pain that a caesarean section is an option they should consider. But this goes back to what I was saying about -- thinking about what it is going to be like and your knowledge about what it is going to be like. If you have had a very bad experience, you need to actually debrief from that and having a caesarean section isn’t necessarily the easy answer because there are risks with any operation and cesarean section –- although it’s a very safe piece of surgery it still carries risks and it is -- still afterwards when you have got a baby, it is still a major operation and people will expect you to get on with your life and look after your baby even though you have got an abdominal wound and you are recovering from the effects of the anesthetic -- for some women that can be really hard. So it is not an easy option, but it is something you need to discuss if you wish to have that choice. Sam Norman: Right, but is it easy to make that choice? I mean, if you really are adamant and you know the risks and you are adamant that you don’t want to go through labor? Sue McDonald: Well it is. Once you have had the pros and cons and the risks and benefits of both births discussed with you, I mean, I have to say that the majority of women -- if they are coming and saying I am scared of the pain I want to have a caesarean section, once you talk it through and they realize what it is going to be like they are much more likely to say, okay, well, I think I can manage on my own. There is very, very small number of women who have cesarean sections because they have chosen to do so. Sam Norman: Well, they see other side of that, isn’t it? That sort of Alpha Female thing where people have this thing that they went through natural childbirth, they didn’t have any drugs and somehow theirs was a more noble birth and somebody who had to have an epidural or an emergency cesarean or something, how do you deal with all that and those attitudes? Sue McDonald: Well, it is difficult because if a woman has gone through the process of birth and she has done it on her own, it is a huge empowering thing for that woman and she will, she will be telling all her friends about it and she would be – Sam Norman: Oh, they do. Sue McDonald: And she would be perceiving as it makes her stronger and it is a huge, huge thing that you can see the confidence that goes -- comes in to women who have gone through that. Sam Norman: But a lot of women then feel ashamed if they have -- they wanted to go with sort of drug free labor and they have had to have intervention and they feel that their whole sort of experience has been spoiled for them. Sue McDonald: I think that’s what you really do need to come down to being realistic and being positive about all the aspects because okay, some women might need Pethidine. It is not a failure, it is just that choice of their pain management and I think that’s why it is very important for you to speak to your midwife after the birth, just go through the birth and how you feel about it because sometimes you can think I failed as a woman, I failed because I haven’t done it all on my own but actually when you talk it through with someone else, you will start to see it in a much more realistic way, in a more real way as for you because every woman is very different and if you have gone through labor, you have got a healthy, happy baby and you are healthy and happy, you have succeeded, you have achieved a huge thing. Sam Norman: Thank you very much Sue, thank you. Sue McDonald: My pleasure.