Hospital Policy & Procedure

Guidelines

Absolutely fantastic to meet and listen to Shelia Byrom OBE yesterday. Shelia's talk, 'Who's decision is it anyway?', looked out how the presentation of guidelines can influence decision.

At the end of the day every pregnant women has the right to choose what should happen to her next.



 Shelia talked passionately about the word 'Allowed' - as in what women are allowed and not
 allowed to do. It is a word we would prefer not hear, instead supporting a woman to
    make her own decision.

    Clinical Guidelines are in place to assist clinicans to help patients in making their own
    decisions about appropriate care. Guidelines are never mandatory.

    So, if you are told:

•  You are not allowed to go beyond your due date.
•  You are not allowed to have a water birth.
•  You are not allowed to use the birthing centre or have a home birth. 

    And actually, the same goes for the word 'Must' - as in:

•  You must be examined.
•  You must have a c/section.
•  You must take certain drugs.

   You are perfectly within your right to challenge it, ask questions and ask to be sign posted to
   further information.

   The following document looks in detail at how guidelines, policy and procedure may be
   presented to parents in a more constructive light. To fully respect the individual and empower
   them with the ability to make a decision.

   Guidelines & Policy

Fruity Dates for Pregnancy

Dates - Reducing the need for Induction...

The Journal of Obstetrics and Gynaecology 
concludes that "the consumption of date fruit in the last 4 weeks before labour significantly reduced the need for induction and augmentation of labour, and produced a more favourable, but non-significant, delivery outcome."




Evelyn Ojeda from the Peaceful Birth Project looks at the ancient wisdom of eating dates.

Eating Dates

Kate Middleton - Pressure for Induction?

Pressure for Induction?

Imagine the pressure Kate Middleton is under at the moment to consider induction. The Queen was heard saying yesterday

 "I would very much like it to arrive. I’m going on holiday."

Not only does Kate have her family and friends to contend with, but pretty much all of the world is awaiting her news.

Following yesterday's blog 'Due Date' I found this article by Milli Hill Founder of The Positive Birth Movement:

The Dodgy Truth about Kate's Due Date.




"It might surprise you to know that due date calculation is based, not on an ultra modern piece of science, but on a bungled theory about moon cycles made up by a doctor called Naegele in 1812. Unfortunately Naegele didn't seem to be very good at maths, and his dodgy old sums mean that the length of pregnancy could be as much as 15 days longer than his '40 weeks' target. Nevertheless, 40 weeks remains the length of time we accept as accurate - and don't get excited about scan dates either – they are simply based on the same theory."

I'd never heard of Franz Naegele, but since learnt he was a German Obstetrician 1812. Wikipedia offers more information on Naegele's Rule and the way in which the medical profession use it.

 Naegele's Rule

Hill Continues:

"Research shows that the likelihood of giving birth 'on time' is exceptionally slim, and that the average first time mother has her baby 8 days 'late'. But in spite of this, and the fact that due dates are pretty widely accepted to be 'only an estimate', women still find themselves coming under all sorts of pressure once they reach them, with UK NICE guidelines suggesting that induction be offered any time from a week 'overdue'. Often, other interventions like 'sweeps' can start to be offered even before the due date, 'just to get things started'.

It's funny how there seems to be such little trust when it comes to pregnancy and birth, and a real desire to meddle and control. The fuss over due dates is a perfect example of this – our obsession with them, and the panic when they pass by, gives the message that a woman's body simply can't be trusted to have a baby by itself. This lack of trust is passed on to women, filling them with doubt and anxiety just at the time when they most need to believe in their body's abilities!"

If Kate Middleton is wanting a natural birth (as it has been reported) let's hope she is filled with the strength and faith she needs to get what she wants.

Due Date

What's your due date?

Possibly one of the most common questions you are asked when pregnant.

So much anticipation hangs on the date given at your date scan. You build yourself up for months. You feel ready to give birth. You have had Braxton Hicks (practice contractions). The date comes. And Nothing. The date goes. And you are left feeling...

Flat? Impatient? Disappointed?

Did someone suggest 'Induction'?

If birth is left to unfold naturally, most baby's will arrive when they are ready. Sometimes earlier & sometimes later than your expected due date, but rarely on the "Due Date". The NCT quote only 5% of baby's arriving "on time".

As your due date comes and goes you might start to feel pressure to consider means of induction. If this is happening to you just be aware of the implications of induction if you truly want a natural birth.

Implications of Induction

 

If birth starts naturally, as opposed to induction, it means "the baby has adequately developed pituitary and adrenal glands and is mature enough to cope with the rigours of labour and birth"
So the baby is ready to be born.

If you are hoping for a natural birth you need to be aware of the knock on effect of induction.

"The induction of labour by drugs produces a more difficult, painful, and protracted labour and is thus frequently the prelude to caesarean section. So is the artificial rupture of the membranes, which may cause a prolapsed umbilical cord....Drugs that accelerate labour may also interfere with the baby's oxygen supply, since the baby is deprived of oxygen during contractions, and artificial pitocin induced contractions are stronger and more frequent than spontaneous ones".

"Generally speaking, conventional hospital procedures - the insertion of electronic monitors, the vaginal examinations, the intravenous drips - may all inhibit women in labour. Fear stops her labour: a caesarean is judged necessary. It is alarming, but true that the more medicine gets involved with childbirth, the more complex and difficult everything becomes".

Extracts taken from Birth Reborn by Michel Odent.

So what should I do?

The due date is an estimate. Most baby's arrive between 37 and 41 weeks. Medical professionals tend to want to induce before the 42 week mark as post maturity can result in still birth. The problem for pregnant women is experts don't agree on the best time to induce.

So, what can you do if you go past your 'due date' and still want a natural birth?

As with all birthing decisions you need to make the right choice for you, your birth partner and your family.

• You could let nature take its course.
• In the days after your due date you could look into natural approaches to induction.
• You may have a Membrane Sweep (This is an internal examination where your midwife inserts her finger into the cervix to disturb membranes and hopefully trigger labour).
• Don't feel pressured into induction if you don't want it.
• Consider medical induction - explaining to your midwife that you wish to have a normal birth with as little intervention as possible.
• Whatever decision you make - know its an informed decision.

Always discuss your decisions with your midwife, who can advise the best course of action for your unique pregnancy and birth.