In this guest post, Clare Thomas, a mum of two and veteran of both a hospital birth and a home birth, considers the NICE guidance that women having their second child should be supported to have their child at home.
In May 2014, NICE began a consultation on new guidelines for birthing, which propose that women with straightforward pregnancies, and especially those having second or subsequent babies, should be supported to birth their babies at home or in midwife led units. Evidence shows that for second timers it is as safe for mother and baby to give birth at home as in hospital, with there being very similar outcomes at home for first time mums, with an increased risk of one percent, often attributed to the element of the unknown in a woman giving birth for the first time. Having experienced giving birth with lots of intervention in hospital and with none at home, I wholeheartedly welcome the proposals.
As a first time mum, I remember sitting in our NCT birth preparation class having heard about all the various births I might experience (Caesarean or not, interventions or not, medicated or not) and thinking my least favourite option, the one I was going to avoid at all costs, was an induced delivery. I was planning a natural water birth in the shiny new local midwife-led unit, influenced by feminist thinking, yoga practice and my growing maternal instinct. I had had few experiences of hospitals in my lifetime, and those I had had weren't particularly cheerful, so the idea of being effectively imprisoned in one for the birth of my child sounded anathema.
So there I was, excited but terrified, incredibly well informed and yet totally ignorant. Of course, you can guess the rest. I went over dates and was induced on a very busy labour ward complete with bright lights, stressed and cynical staff, women in all stages and varieties of labour and Jeremy Kyle blaring out of bedside television sets.
It would have been a stressful environment for someone going for a filling, let alone to go and give birth in. Honestly, it has been said that animals in our zoos have better conditions for giving birth in than many women in the UK. Of course we are fortunate to have life sustaining and saving equipment on hand should we need it, to have relative cleanliness (though I did witness some incredible lapses in this) and to have trained professionals with us. But birthing also requires the mother to be relaxed, comfortable, secure, calm, supported, fed and watered and it is these elements that we routinely fail to deliver.
In fact, the labour ward environment offers precisely the opposite of what a woman needs in order that her mind and body can work together to birth her baby. In my case, I was hanging around for two days and nights before anything much happened, at a time when I needed to be nurtured and empowered I was separated from my husband at night and infantalised in my new role as patient or ‘mum’ as everyone seemed to refer to me as!
I was in a chaotic inner city hospital with hard pressed midwifes who had little time for niceties and in some cases seemed to almost relish in bringing 'naive' women down to earth. OK, so packing my yoga mat might have been a bit daft (in my defence, my thinking had been that if I wanted to be on the floor, a bit of comforting squish might not go amiss, rather than thinking I'd knock out a few downward dogs in between contractions), but telling a woman about to give birth that 'it's not at all how you think it will be' and berating her for wearing pyjamas rather than an access-all-areas nighty is just ridiculous. Sending an anesthetist to talk to you about epidurals in the middle of the night when you are trying against the odds to squeeze in the last hours of sleep you're going to have for, well, let's just say a while, was unhelpful and just upped the fear levels to the maximum.
So unsurprisingly when I finally did get into labour I didn’t feel well placed to cope and after a very painful and demoralising cervical examination (“Only three centimetres!”) I asked for an epidural. Now! My head was spinning from the gas and air - I was basically in a great deal of pain and panic and roaring drunk at the same time. I could have kissed the anaesthetist, or had circumstances been different, a marriage proposal could have ensued. I was so relieved. I then spent a rather odd afternoon watching trains pass by my window from my hospital bed as my body birthed my baby and I made polite chit chat with the midwife. Despite my relief at having been released from my world of pain, it all felt rather disempowering and detached.
The final stages all got rather stressful and I was given 10 minutes to get the baby ‘out’, which I did thankfully. What followed over the next 24 hours was another round of disruptions, insensitivities and separations, which hampered our bonding and establishing feeding, knocked my confidence and in honesty felt like a kick in the guts.
My home birth experience
When I began to plan the birth of my second child, I initially thought I'd go for the same birth plan as last time and just hope that I'd have more luck. I am lucky to live in a closely knit community and feel supported by the wonderful women around me. I was inspired to take a hypnotherapy course and my husband and I enjoyed a mixture of deep relaxation, education about birth and practicing hypnotherapy techniques that could help us stay calm and relaxed when I gave birth.
About two thirds of the way through the course, it was clear to us that we wanted to have our baby at home this time. For my part, it was as though I had finally connected with my true feelings about giving birth, for my husband, who had visibly shrunk into the corner of the delivery room as others took control of the birth of our child first time around, it was a chance to be more closely involved and to protect me from further harm.
Looking back, I think deep down I had wanted a home birth first time around, but was just too afraid of not being able to cope with the pain and too firmly conditioned by society's expectations of birth. I had also held a certain image in my mind of a home birther. A feisty, tough, physically very strong woman - and that didn't seem to be me. I've never been particularly physically strong or brave. And although with my first labour I might have been willing to accept a marginal amount of increased risk, I knew family members would be sceptical and that meant that I ruled it out early on. This time I simply decided to keep my home birthing plans quiet so as to not put pressure on myself or to invite too much (misinformed) comment.
How different it was second time around to be at home the night before our baby was born, tucking into a curry and laughing at the pastry based dramas in that week’s Bake Off. And when I woke up realising I was in labour, to be able to just doze in bed and lie in the bath with candles burning and relaxing music or affirmations playing. Later, when I had a wobbly moment, when something changed and I couldn’t quite get comfortable, how lucky I was not to have to try to negotiate what I needed with a member of staff or get in a car and head for hospital.
It was amazing to experience my waters breaking with a delightful pop rather than with a needle under anesthetic. How comforting that when I felt I needed a sugar burst and something refreshing, my husband could nip to the freezer for the ice lolly that was all I fancied. In between surges I was able to rest and relax - I was in my own cosy place after all. Three hours after the midwife arrived and without the need of any examinations, pain relief or interventions our second daughter was born and I experienced total euphoria.
She and I then had the most beautiful time of lying naked under a blanket together, she nuzzled my breast straight away and did an incredible wee and poo all over us to announce her arrival! My daughter who had been playing at a friend’s house for the afternoon was relaxed and happy to meet her baby sister before my husband tucked her up in bed. With dim lighting and some lullabies we shared the most blissful first minutes unaware of time or the rest of the world. She did not leave my arms for a couple of hours until the midwife had to put her in the scales, and I was very surprised to learn she weighed nine pounds, eleven ounces, a big baby which some consultants would advise you to have in hospital. How encouraging to think that perhaps more women carrying bigger babies could be supported to birth them at home or at the birth centre.
She was back in my arms in seconds, skin to skin under a blanket. We didn't wipe her too much or wash her, the midwife commenting that the minerals with which she was smeared were good for her skin, and no doubt good for our bonding process. So different to the hospital experience when our firstborn was washed and swaddled with no reference to our birth preferences and left on a brightly lit table until I asked to have her back. This time the midwife left, my husband went to the corner shop to buy something for our dinner, after which we tucked up in bed and dozed through the night in a state of bliss. It was a kind of everyday wonder. Totally unfussy and uncomplicated and yet extraordinary and the greatest high imaginable.
A birth of your choice
It is of course very difficult to know which outcomes would have been different in a birth centre or hospital. The fact that the birth was shorter, that I didn't need any pain relief, that I endured very little physical damage and I recovered much more quickly, that I had much less to process mentally this time, that our baby fed straight away and with ease, and is a cheerful and contented soul - we will never know whether these things are because of the birth experience, her character or the fact she is our second baby. In truth it is probably a mixture of all three. In addition to the things I could control, I was also very lucky in something I couldn't in that there was a midwife on call who totally shared our approach to birth and supported us during and after in every way.
I’m aware that for some people, being closer to a hospital makes them feel secure and therefore that’s the right choice for them because its where they will feel more relaxed. As someone once said to me, hospitals are nice places, it’s where babies are born! I think women should, of course have the choice of where they give birth, and feel positive and supported about their choice. I just wish that wherever they are, they can have an environment that is conducive to birthing!
So I wholeheartedly welcome NICE's proposal and hope that it will not only encourage many more women to feel confident to give birth at home or at a birth centre but that it will also catalyse a sea change in cultural attitudes to pregnancy and birth, to the benefit of all women, babies and their partners and families, no matter where and how they give birth.
If widely adopted, it would reposition birthing as a normal bodily function that most women are very well placed to undertake without medical intervention, given the right environment and support. Having reclaimed this ground I believe it could reeducate the leaders of hospital services to work harder to ensure that labour wards (hopefully renamed!) for those that want and need to use them, more closely mirror the home from home environments of birth centres, even in simple ways such as encouraging birth partners to stay, turning the lighting down and using positive affirming language. It is also to be hoped that if things don't go according to a woman's birth plan, and of course, that is often the case, that because one intervention occurs it doesn't mean all of her birth preferences, including the all important after care should be forgotten. I hope if and when my daughters give birth to their children this is the standard of care to which all women can look forward to at this most intimate, vulnerable and precious time.
Clare studied Drama and Theatre Arts at Goldsmiths College, University of London, where her feminist instincts were articulated for the first time. She went on to work in children's theatre and disability arts, most recently as Deputy Chief Executive of award winning learning disability organisation, Heart n Soul. She is currently working within the home raising the next generation of feminists!
Where did you feel safe giving birth? Labour ward, theatre, birth centre, home? Let's be frank, lots of babies are born in the car park or the lift! Where you feel relaxed, calm and in control is different for everyone, would be great to hear your experiences!