Birth Q&A: Read the Wednesday Lunch Club chat with birth doula and natal hypnotherapy practitioner Himalee Rupesinghe

By askamum

27 February 2013

If you missed our Wednesday Lunch Club Q&A on the askamum Facebook page with birth doula and natal hypnotherapy practitioner Himalee Rupesinghe, from allaboutbirth, read the questions she was asked and her answers below.

Q: I'm 41. Although so far classed as 'low-risk' and I am healthy, fit and had no problems during my pregnancy, I am concerned my age will eventually be held against me. I really want to avoid induction ideally using the pool and believe I can give birth. Do I need to be induced because of my age? What can I do to avoid this? Where do I stand? Been really relaxed until now but this one thing I am concerned about.

A: Some hospitals do have a policy to induce women over 40 at 39 weeks, or exactly at 40 weeks (there are studies that show the risk of your placenta being less effective increases after this time if you are ‘older’) - but this varies dramatically depending on where you are booked. Equally for many women, if they are healthy, fit and with no other complications, their age hasn’t been mentioned at all as a factor for induction. In the absence of any other health queries, in most cases maternal age alone isn’t a strong case for induction. But I would encourage you to speak to your midwife and find out what the policy is where you are booked at. Remember that you cannot be ‘told’ that you will be induced. Your caregivers can advise you on all your options and the benefits and risks of each one, and it is totally your decision on what route to take. An alternative to induction is ‘expectant management’, when you go into hospital every day/every other day to be monitored and scanned to reassure that all is as it should be. Your other option would be to email or call your maternity services, and arrange to meet with the supervisor of midwives, who will be able to review your notes and discuss your wishes - including using a birth pool, and put into place a plan of action that is most likely to enable you to have a safe, satisfying and positive birth experience. Just to reassure you that I have supported many clients over 40, and all of them have laboured naturally between 39 and 41 weeks (some also had homebirths post 40 weeks), and have also had one client who did labour at 42 weeks plus 3 days. This was because we discussed options with their midwives and/or consultants and agreed on a plan that worked for them, rather than accepting general policy. I would discuss with your caregivers and find a route that feels comfortable for you, and then go back to staying calm and relaxed about the birth process. Feeling worried or stressed often affects the way we labour, and that includes pressure from being told you may be induced at a time when you should be enjoying your pregnancy!

Q: I had a 48 hour labour with my first pregnancy, and my baby was born by forceps. It was quite traumatic at the time but was quickly forgotten once the joy of holding my son took over. Now I’m six months pregnant I’ve been starting to play over my previous birth in my mind and it’s starting to worry me. Is there anything I can do to calm myself when I get these feelings of dread and panic? I know it will only be worse if I keep panicking.

A: I’m sorry to hear you had a traumatic time with your first birth. It’s really common for parents to focus completely on getting to know their little one, and then when they do fall pregnant again, start to process their first birth experience. I would say there are two parts to enjoying the rest of your pregnancy, and having a great birth this time. Firstly look at whether you fully understand what happened first time around...you could get a copy of your maternity notes from your hospital and review yourself, or some hospitals have a birth reflections service where you can discuss your notes with a midwife and get to grips with what happened, or contact a local Independent Midwife and ask if you could review with them. By understanding the reasons for your first experience, you can then start to prepare for this one. Look at what you would like to do differently from last time, for example, staying active and mobile during labour, staying nourished and well hydrated in early labour so you have the energy to birth your baby, ensuring you get plenty of rest in early labour so you don’t get too tired etc. Secondly and equally, while you may have spent a while not thinking about your first birth, our subconscious mind tends to remember everything and the way you are feeling now – dread and panic, can affect the labour process this time. It’s great thatl you are processing your first birth now, as often I find when women don’t, that processing often happens when they are in early labour with their next baby. I would encourage you to look at trying the Natal Hypnotherapy Pregnancy Relaxation CD and then from 32 weeks the Birth Preparation CD, which will help you to learn simple techniques to stay calm and relaxed throughout the rest of your pregnancy, and during labour and birth. If you are able to, try and attend a Natal Hypnotherapy workshop with your birth partner closer to your due date, where you can focus on preparing for this birth, and feel really confident about the labour process and all the conditions we need for it to happen just as it needs to. By learning simple relaxation techniques and practising them now, you can ensure you make the right decisions for you for the right reasons, rather than out of feeling dread or panic, and go on to have a great birth experience this time. I have many, many second time mums on my workshops who are determined to make this birth a very different experience and they do.

Q: I have a 21 month old & am 14 weeks pregnant. I had a great active birth with my son but had a third degree tear. I have fully healed, no incontinence issues thank goodness! I didn't tear right the way through.
My query is- advice for this time round? I really want a water birth in the midwifery led unit but am obviously scared at the thought of tearing again.

A: A previous third degree tear doesn’t mean you will definitely tear again this time, though some women do have an increased tendency to tear. And it shouldn’t mean you can’t have a waterbirth at your MLU. On a practical level, it sounds like you prepared for an active birth last time, so I would recommend you prepare in the same way, so active birth yoga/pilates so you are in tune with your body. Did you actively ‘push’ during the birth with your son? There is a greater chance of tearing if you did physically ‘push’ for longer/stronger rather than working with the power of your uterus and allowing it’s amazing fetal ejection reflex to birth your baby. Labouring in water, or using a birth pool does reduce the risk of tearing, by softening the tissues and allowing you to move into supported birthing positions – so using a birth pool would be a great idea, and you could try some perineal massage when you are closer to birthing baby. You could also look into the Gentle Birth Method Book by Gowri Motha who recommends that our diet can help our tissues to soften and be ‘birth fit’ and allow for a smooth birth. Natal Hypnotherapy can really help you release any fears you may have about tearing again, and help you to stay relaxed during the birth. Your chance of tearing is far less if you stay calm, relaxed and allow all the amazing hormones in the labour process to soften and then gently expand your cervix and perineum to allow for a smooth birth. Your labour environment also plays a strong role in how your body labours, so try and ensure you feel warm, safe, dark and private to allow those hormones to do their work.

Q: I’m 38, and pregnant with my second child. I had my first 12 years ago, by C-section. Although I don’t think there's anything wrong with a caesarean, I would like to have a natural delivery this time around. Is my age against me? Is there anything I can do to increase my chances of a natural birth?

A: Your age shouldn’t work against you. I have supported many women in their 30s, 40s and up to 50 too. In my experience I have found the following strategy the best if you are hoping to avoid a C-section. Very briefly, research shows that hiring a doula to support you during pregnancy, labour and birth reduces your chances of having a caesarean birth by 50%. Continuous, trusted support during pregnancy, labour and birth can make a great difference to your experience by giving you birthing knowledge and support that is based on your individual circumstances. Your chances of having a caesarean also reduces if you labour in water, so using a birth pool which helps you to move into well supported, gravity effective birthing position can keep your labour progressing well, and be a good alternative to medical pain relief. Planning a homebirth lowers your chances of having a caesarean birth, so you may want to look at either your local homebirth option, or perhaps your local midwifery lead unit, where you are more likely to have a comforting, home-from-home feel which creates the conditions we need for labour to progress – safe, comforting, private etc. Finally using a relaxation technique like Natal Hypnotherapy can reduce your chances of needing a caesarean further. A survey of 50 mothers who had attended the Natal Hypnotherapy™ Workshops reported a 9% caesarean rate compared to the UK national rate of around 24%. We have a dedicated Natal Hypnotherapy Birth Preparation CD for women preparing for a Vaginal Birth After Caesarean (VBAC), and a lot of mums attending our workshops have had caesarean births first time around, but attend as they would like the knowledge and skills to have a relaxed and positive, VBAC this time. If you prepare in the right way, by learning about the amazing power of our bodies and hormones, and the conditions we need for labour to happen, you will greatly increase your chances of having a positive, natural birth experience this time. Our bodies inherently know how to birth our babies, our role is to prepare in a way that builds up that trust in our body...Happy birthing!

Q: My first labour came at 36 weeks it took 53 hours and ended in ventouse which failed then forceps and cut with stitches. I'm now 33 weeks pregnant with baby number two, what's the chances of this labour being the same?

A: Do you mean what are the chances of your birth experience being the same? Or of you going into labour at 36weeks again? Every single labour and birth is different - even for the same woman. And while you may labour early, you may also 'bake' this baby longer and go into labour closer to or over 40 weeks. There is no way to determine when you may labour. However as I mentioned, every labour is different, so once you are in labour the chances of you having the same experience is pretty small. It would be good to look at how you laboured first time around so you are aware of how you could make things different. So using upright, gravity efficient positions, resting in early labour so you don't get tired. You could request a copy of your notes so you can learn and understand any reasons behind your first birth, and that should help you to realise that it was a totally different birth, with different choices and decisions, and that this birth experience IS and WILL be a different, positive experience. I would read up on active birth, as well look into learning about how you can create all the right conditions for labour to proceed as it needs to. For labour to establish, we need the right environment, which then allows your hormones to increase accordingly and birth your baby efficiently. If we don't have the right conditions, this can slow things down. So feeling observed, lots of lights on, having strangers walking in and out of our room, feeling tense or scared, can all slow the labour process down as our bodies need to feel safe to labour. Have a read of Maggie Howell's book 'Effective Birth Preparation', and let me know if you have any questions. It should give you a really good insight into how to prepare for a positive birth, with all the right conditions.

Q: I'm four months pregnant and had a previous C-section with my little boy nearly two years ago. I’m a little unsure of what to do as I planned a natural water birth last time and after seven hours of contractions it was discovered my baby had been breech for about 4months and it hadn't been picked up on. I would like a natural birth but I’m scared it will be missed again and the positioning of baby number one I would seriously struggle having him naturally! My mum also had two breech babies. I’m really unsure of what to do! Do I play it safe and have more major surgery or take a risk that could damage me and baby?

A: It's very rare for a baby to be undiagnosed breech, as while the midwives are feeling your bump at your antenatal checks, they get a good idea of how baby is lying. You don't need to worry about it being missed again, as I'm sure your care providers will be extra vigilant for you because of your first experience, and you could ask for a presentation scan - so a scan to check which way baby was presenting - towards the end of your pregnancy for reassurance. You may want to also look at seeing a chiropractor or cranial sacrotherapist who can check if your spine is aligned well. And lots of women have had good results from seeing an acupuncturist to ensure your body is nice and balanced. There are some positions to avoid in later pregnancy to encourage your baby to lie head down, and you can get some great insight into how your baby is lying at spinningbabies website. Above all, remember how powerful your mind is, so as you think of your baby, visualise him or her being head down, and happy and relaxed - that will help too. Keep planning for your natural water birth, the more you stay happy, relaxed and trusting your body and baby to get into the right position for birth; the more likely it is to happen. Lots of women prepare for vaginal birth after caeasarean (VBAC) as recovery with an older toddler and a baby is quicker and smoother with a VBAC, than with another section.