Midwife, specialising in home birth, AMA

[MidwifeAMA]

Hi :)
I'm a midwife of 15 years. I've worked in all areas of midwifery but mostly in midwife led birthing units and now specialising in home birth.

AMA

Some people have stretchier skin than others, like some of us get stench marks and some don't. Also we can reduce the chance of tearing with things like antenatal perineal massage, positioning, technique and warm compresses in labour.
It's not really the actual Caesarian section that's scary for many, it's the lead up to getting to that point- what's the reason, are we dashing there for a concern with baby, has it all come as a big rush and we feel out of control, and how well supported you are throughout.
There are some ways to encourage vaginal birth over CS, such as active birth/positioning etc. but a huge part of it is luck too though as baby's can get in a tricky position or find labour stressful unexpectedly.
It's worth preparing for CS as a common birth experience, we often look at how we can utilise Hypnobirthing type breathing and relaxation skills across all birth experiences. Many people have very relaxing, positive CS births.

Just popping on to say thank you for the wonderful work that you do. I had a horrible time birthing my firstborn, which led to postnatal mental health challenges. Several years later I chose a midwife-assisted home water birth, it was the best experience of my life, I felt empowered, strong and had a renewed confidence in my body (and my post-natal mental health was great).

How panicked/stressed do you feel when things are going wrong?
I had a home birth and haemorrhaged after delivery. To me, everyone seemed very calm (I was pretty out of it though), but DH says that after the paramedics arrived, he saw one of my midwives crying in the kitchen. I don't know whether she had something else going on, or if the situation upset her but it made me think how stressful it must be to be waiting on additional help if something isn't going well. Is there any additional stress given the current ambulance waiting times?

I love this. A healing birth

What would your recommendations be?

Have you worked with any pregnant trans identified women?

We are regularly trained in managing emergencies so we are running through a well practiced set of actions. I know I have my calm voice down to a t, so probably look and sound pretty calm on the outside while the inside is thinking "oh shit".
It is unpredictable though and we do get scared and stressed, the adrenaline pumps and afterwards the emotional response may appear, hence the crying in the kitchen.
My experience of ambulances is that if we call and give them the "bad bad things" trigger words they come really fast and in numbers.

On a side note, i read a fantastic book about a 17th C midwife that you might enjoy.
'The Gossips Choice' by Sara Read

I've not worked with any pregnant trans people yet.
I think my goal is to make every person feel valued and safe in pregnancy and birth. And if inclusive language means a transman feels more able to access care then this has to be a good thing.
We mustn't erase women or dehumanise them to body parts in the process.

I know I have my calm voice down to a t, so probably look and sound pretty calm on the outside while the inside is thinking "oh shit".

My midwives definitely had this and I am very grateful! It wasn't until maybe the next day that I really realised "oh that was quite serious.."

Thanks, I'll give it a look :)

If I had an episiotomy on my first in hospital, can I have a home birth with my second? And what if I needed the same again?

Thanks!!

Most midwives talk just a bit higher pitched when things are a bit iffy, we all seem to know what that means

Yes, it should have no impact on your future birth choices. It's very unusual to need one in subsequent births, but it's something we are able to do at home if necessary.

Sorry this is a really self centred question, but it's been bugging me.

In my second labour, they wouldn't tell me how dilated I was for ages, which I later found out was because I was only 1cm for hours and hours, but I fully felt like I was in incredible pain that I couldn't cope with, contractions were also coming every 2 minutes, they even gave me an epidural (which did nothing, maybe because I couldn't sit still) - I know they wouldn't have done that in the UK, this was in Germany. I think the only reason they didn't send me home at 1cm was that my waters had already gone.

Anyway, an hour after they gave me the epidural they examined me again and exclaimed that I was 6cm. DS2 was then born in the next hour or two but they kept having to tell me to stop pushing as I had a "lip" of cervix. This then reminded me that I'd had the same thing with DS1 ten years before, lip of cervix and everyone shouting at me not to push while I tried to explain I wasn't doing it on purpose, it was just happening.

For DS3, a similar thing happened. They said I was 4cm when I got into hospital but then every time they examined me after that it was still 4cm, 4cm, 4cm for ages, eventually 4.5 I got in a pool at that point and zenned out for a bit but then got fed up and asked for gas and air, when I got out (have to get out and be on three different monitors for this in Germany 🙄) I remember not long after this having that same urge to push and they said no you can't as you're only 6cm! Luckily I remembered the tricks this time but had also been listening to a podcast where they had discussed this stopping women pushing thing and they had concluded that they'd never seen anything bad happen from pushing too soon so I at least wasn't terrified of what my body was doing this time.

Now I don't know what my cervix was doing with DS1 because I didn't have any checks between 4cm (transferred in from planned home birth due to wanting pain relief) and pushing because I was so excited to be 4cm I said never mind about pain relief, get me the pool. But the beginning of that labour also went on for days where they kept saying I was only 1-2cm yet I was climbing the walls. But is it common to get stuck at a particular stage? I was taught in antenatal classes that once you're in active labour it's roughly 1cm an hour and my body doesn't seem to do that, it has 3-4 states, I would be 1cm, 4cm, 6cm or ready to go and I never got anything in between. Is that common or is my cervix just really weird? And why do I get such ridiculous pain levels at 1cm dilated, maybe I'm just a wuss

I just wanted to say how much I loved my home birth too. It was such a calm, empowering experience with midwives who listened to me, let me trust my body and were absolutely fantastic throughout (and didn't kill my DH who spent the entire day telling them he had a headache!)

Sounds like this is normal for you, you gave birth to your babies, but the medical model tried to tap your square peg pattern if labour into a round hole of expectation.
The whole 1cm an hour thing is impractical, we know cervix don't open in a linear way. What really we want is ongoing progress, but not all progress is a numbers victory.
The long latent phase is normal but to be so uncomfortable with it is less common. Maybe it's related to the shape of your pelvis for instance. Maybe you have lots of work of getting baby lined up and in the pelvis before baby suddenly drops onto the cervix and makes it open quickly.
The "don't push on a lip" thing is outdated rubbish advice, the docs used to think that pushing on a bit of cervix would make it swell up and cause more issues. What we really know is that spontaneous bearing down following instincts isn't going to cause you problems and trying to stop someone pushing with the urge is hideous.
In summary: it's not you, it's them!

Oh dear, a headache, poor thing
Glad you have a good experience.

How do you deal with midwives who are very anti homebirth? Or rather how should the woman deal with it if one is attending a homebirth?

And I'm talking about very low risk situations where they are obviousoy uncomfortable. Like the baby is out and healthy and there's no bleeding and an ambulance is present. And they turn up and just stand around discussing how they don't know what they're doing, and they never attend homebirths, and how it's all soo much better with floodlights and stirrups. At that point obviously all trust has gone.

I'd really hope no one would be so obviously unprofessional. Most midwives, even those who are a bit wary of homebirths, usually feel the joy after a successful birth.
In the situation described I'd complain via PALS.

I think midwives are just amazing . And brave as it must be hard when things turn risky.
i did wonder fleetingly whether our baby would have been ok if he’d been born at home as I was low risk with our 3rd so considered it but ended up with a cord prolapse . I had a category 1 Csection under a general within minutes and he needed some resuscitation . (Our hospital was incredible and is half an hour from our house).
how long can one keep the pressure up to keep baby from pressing on the cord I wonder with a Cord prolapse as it was very uncomfortable, and must be for the midwife too I would think.
I am so incredibly grateful to ours for her quick reactions and calm action and care and still in touch !

Thank you that’s really interesting.

Thank you for your answers!

I had my second baby at home 15 months ago. It was the most incredible experience of my life and I recommend it to everyone I know that is pregnant.

Im now really considering training in midwifery as I would absolutely love to be a homebirth midwife. Im 27. Currently at SAHM and really need to decide what I want to do for me and my career.
Would you recommend your job?

Please can I ask your experiences of second births after a first forceps birth? Do they generally go smoothly? (Nervous laugh!)

I love it, absolutely love it, but I think you have to be pretty resilient to consider it. The working conditions are challenging, you regularly work over your hours, miss breaks, have to work Christmas day etc
For me I would definitely do it all again but midwives are leaving in their droves so I know not everyone feels the same.