2 Hours per cm?

[IceCube]

Discussing labour with my midwife the other day she mentioned that they "allow" women to only dilate at a rate of 2 hours per cm before intervening.

I'm planning to argue with their protocols on some other issues but I was wondering about this one. I was under the impression that you might not dilate at a regular rate right through labour, so is the 2 hours rule based on safety or is it another rule for the sake of having rules?

I think this might be for when you are in established labour and maybe your waters ahve gone.(risk of infection if you have not delivered after 12 hours I think?) I had dilated a couple of centimetres over a weekend of sparse contractions (noted at my midwife appt.)It then took sveral more days of the same before labour really kicked in and was 6cm when I arrived at the hospital. So that was 4 com in 6 days (but no waters gone). I might be worng.

Sorry- excuse my awful spelling.

Put 'no internals' in your birth plan. That'll learn em!

My birth plan said that I am in active labour when I say I am and will be getting in the pool at some point during active labour as defined by me.

Wow!! well actually this is pretty good considering most hospital policies say 1cm per hour is "allowed"!

In my local unit, the low risk midwife led labour area policy says that half cm per hour is acceptable in established labour. Anything outside this and the midwife must inform the labour ward co-ordinator and medical staff for review. It is normal practice for vaginal examinations to be done four hourly in hospital labour wards and 6 hourly in some low risk midwife led units. It is not to say that intervention will automatically be forced at this stage but it may certainly be "suggested". You are certainly within your rights to refuse any intervention offered and also to decline to have vaginal examinations. I always advise women to use their "BRAIN"

Ask the midwife/Doctor to explain the:

Benefits
Risks
Alternatives
Intuition (what is yours telling you)
Nothing (what happens if you do nothing)

Howdie
Independent Midwife

Also cecilia the WHO recommends up to 96 hours after rupture of membranes before intervention. That is obviously monitoring temperature, refusing internal exams, taking showers not baths etc to prevent infection.

I like star1ightexpress's birth plan.

Worzel, not sure if you mean the NICE guidelines re induction of labour with ruptured membranes. They have unfortunately now amended them to say that induction should be "offered" after 24 hours (

Woops, that was meant to be a sad face on my last post and not a happy one!!

LOL: I didn't word it quite like that, but I DID mean it and was supported by a doula, and fortunately a fab mw!

Sorry Howdie I did mean the NICE guidelines. .
That is outrageous that they have amended them to 24 hours.

Ah blow it Icecube........just have a homebirth and be done with it

Worzel - actually this is a planned homebirth, but the NHS community midwife still seems to think there are lots of protocols which she would want to follow.

Cecelia - did writing the birth plan work, I'm a bit sceptical about whether the midwife who turns up on the day will read it, but I am going to do one to give DH so he can argue my corner while I groan in the background

Anyway I can be pretty bolsie when I want so I doubt I will be talked into anything I'm against, but being a first birth I want to know which battles to fight, there must be some reason they have all these guidlines, surely?!

Hmm, I was induced so might not be relevant but I went from 1cm dilated to giving birth in 2 1/2 hours. I was checked at 11:30 pm and found to be 1cm dilated, told I would be checked again at 3:30am and if I hadn't progressed would be given syntocin; but I delivered at 2am, almost by myself in the observation room - had to send DH for a mw as baby's head crowned before they arrived, and DS was born 3 mins later.

IceCube wrote: "there must be some reason they have all these guidlines, surely?! "

Yep, it's so that they can move you on and ship you out as quick as possible to free up beds and/or midwives.

I think you'll have less issues if you're at home Icecube. You'll also feel more in control of your journey and far more relaxed etc too, so dilation is unlikely to be an issue I would think.

Having a birth plan to give DH is a great idea. If you are at all concerned about needing an advocate or whether or not dh will be able to do it for you maybe investigate Doulas in your area? Trainee doulas are great and come very cheaply.

p.s. You will have a fantastic birth I am sure. My most recent HB was 12 weeks ago today (in about 45 mins to be exact), and I am still on my high.

Thanks all, some reasurring stories, and you're right it probably won't be a problem.

Howdie - if they try to kick me out of my own bed I really will argue! Guess if it's true about the "freeing up beds" then they will be happy for me to stay at home for as long as possible.

'I can be pretty bolsie when I want so I doubt I will be talked into anything I'm against'

You'd be surprised how vulnerable at at the mercy of the 'professionals' you feel. Having a doula is a great idea for many reasons, but it also sends a warning to the mw attending that things have been planned in advance and you're only open to coersion for VERY good reasons. There is also a witness/supporter without the emotional aspect.

For example: If mw says 'we NEED you to transfer in', you and your DH are unlikely to argue/enter discussion, but agree anxiously, - but your doula will question the mw on your behalf and ensure you are extremely clear of WHY and of the risks of not doing.

I wish I'd had a doula at my first.

Are douas expensive? I am very nervous about my second birth (in approx 3 mths) as my first was an induction and I feel like I did not have much of a say in what happened at all. I want a more (or lessI should say!) drug free birth this time but am getting worried about all kinds of things. Maybe a doula is for me?

I forgot to say too, that in order to give yourself the best chance of an optimal outcome you need to swtich off your consious part of your brain and give in to what your body is telling you. If you are doing this you are birthing in a very helpful way and having to break your concentration to be bolsie can affect the way your labour progresses.

hambo They can be anywhere from free to around £800 for a birth with a couple of antenatal visits and a couple of postnatal visits. The price will depend on experience, how in demand they are and possibly how much they like you and want to do it. Most doulas will take into account any financial pressure you are under and if they don't, your prolly don't want them at the birth. Compassion surely is part of the job description.

If you're looking at the lower prices, or free, you'll have to get a trainee. I paid £150 plus expenses for mine, and what she lacked in experience she made up with extreme attention to detail and enthusiasm. She was fantastic on the day!

Check out the doula uk website. Also, you could put out a request on MN. There are quite a few doulas that hang around here who have a soft spot for MNers and may give a discount.

Star1ightExpress said "and possibly how much they like you and want to do it. Most doulas will take into account any financial pressure you are under and if they don't, your prolly don't want them at the birth"

I think this is perhaps a little unfair. Yes, I am sure most doulas are compassionate women but they also have to live and eat. Trainee doulas are usually free as they have to attend X amount of births in order to be a fully qualified doula. The cost then usually depends on the area you live in and what level of support you are looking for. Most birth doulas will visit once or twice a/n and then be on call for potentially several weeks for your birth and then maybe once p/n. The on-call in itself is a HUGE committment and you are asking someone to basically put their life on hold for several weeks. The average cost where I am for a doula for this level of service is around £300, I don't think that is too bad actually.

I work as an independent midwife and the worst bit of my job is asking people for money for the work that I do. I think ALL women should be entitled to continuity of care from a known midwife and the NHS should/can provide this but choose not to in most areas. However, I also have to live/eat/pay bills etc. I am fully aware that there are people who struggle to afford my fees and I am always happy to either barter services (have had client who was a builder did work for me) or to take installments over a long period of time. However, I don't think what I charge is that expensive when you take into account the amount of hours I spend a/n (about an hour each visit) with the woman - including potentially driving for up to an hour to get to her and an hour to get home again - and then being on call from 37 weeks to....whenever she has the baby! I then see her for 28 days p/n.

I don't think that saying if a doula/midwife is not willing to reduce her fee then she's not the right person for you because you have to have the right chemistry and I think you have to value and respect the person providing the service for you.

Hambo: In your situation, having a homebirth, obviously the pressure is not to free up a bed, but more to free up a midwife who also has other women to see/clinics to run etc. I do agree with what has been said about having someone as your advocate. It doesn't even necessarily need to be someone you pay, it could just be a good friend who is on your wavelength re the type of birth you want. There is strong evidence to suggest that women who have the continuous support throughout their labour from a known female (friend/doula/midwife) will have better birth outcomes.

Howdie 'I am always happy to either barter services (have had client who was a builder did work for me) or to take installments over a long period of time'

But isn't this taking financial pressure into consideration? - as a compassionate person?

However I DO believe that in certain cases affordability can often be more about priorities than actual cash-flow, and it would be unfair for you to be barttered down so that someone could upgrade their sky+ imo.

I think one of the problems people may resent your fees has nothing to do with you or that you aren't good value, but because you are providing a service that people feel entitled to for free from the NHS, - ditto doulas.

In my experience from interviewing doulas, that the 'package' cost less from the doula I clicked with the most, and most from the doula I clicked with the least. Perhaps it doesn't work like this, but if I personally thought that I could do without working for a particular client but they insisted they wanted me, MY fees would be higher than one who I WANTED to work for iyswim. But, perhaps this is a little bit of a crude way of putting it.

Thank you Star and Howdie, I will look up the web site.

I think it sounds like they are worth every penny

Star1ightExpress said "But isn't this taking financial pressure into consideration? - as a compassionate person?"

Yes, I suppose you're right. I think I presumed you were saying that if a doula/midwife refused to lower their fees to take account of a person's financial circumstances that they were not compassionate.

You're right about people resenting having to pay for something they get for free but in the case of independent midwives they are not paying for something they can get for free because there is nowhere in the NHS that you get all a/n in your own home with each appt lasting an hour and to 99.9% guarantee that you know which midwife is going to attend your birth. It is usually the 2nd/+ time mums that understand more the difference in the service they receive, However, interestingly enough, most of my clients have been first time mums. Similarly you could ask a friend to be a "doula" for you for free but doulas have undergone a certain level of training in understanding the birth process so you are paying for that knowledge.

I am SOOO with you about priorities of cash flow. For some women, having a doula/ind mw is more important to them than upgrading their car or going on an expensive foreign holiday because their birth experience is something that will stay with them for the rest of their life.

Howdie Sorry, I didn't mean they should lower their fees, rather 'work something out' iyswim.

'there is nowhere in the NHS that you get all a/n in your own home with each appt lasting an hour and to 99.9% guarantee that you know which midwife is going to attend your birth.'

No, you don't, but why would a first time mum think this was needed, or that there could ever be an instance when an NHS midwife would do anything other than that which is in her best interest (knowingly or unknowingly due to resource issues)?

The first time, you probably feel like you 'wouldn't' need an IM/doula, the second time you probably feel like you 'shouldn't', so when it comes to fees there may be some resentment iyswim, not that YOU deserve to bear the brunt of it of course.

Do you know how many of your clients book you because they want a gold star service, and how many book you because they just want to avoid a sub-standard, risky service!? Is there a difference. It is the latter that I am referring to above wrt resentment.

Good question SLE. I would say that the majority of 1st time mums book with me because they have experienced poor care in their current pregnancy from their midwives ie, they find the service very "conveyor belt", never see the same midwife twice, very short appointments, no time to ask questions etc or that they have been told they cannot have a homebirth purely because they are having their first baby.

In the 2nd/+ mums category it is mainly because they have a "risk" factor which means the NHS will not support a homebirth, eg VBAC, 8th baby etc but also because they have perhaps had a traumatic "normal" birth first time around and want to know the midwife caring for them.

"there is nowhere in the NHS that you get all a/n in your own home with each appt lasting an hour and to 99.9% guarantee that you know which midwife is going to attend your birth.'

No, you don't, but why would a first time mum think this was needed, or that there could ever be an instance when an NHS midwife would do anything other than that which is in her best interest (knowingly or unknowingly due to resource issues)?"

Just to confirm what Howdie has said - as a first time mother I would love to hire an independent midwife, because I have recieved shockingly bad care from my community midwife. It is not something I would have considered if she had been competent as far as antenatal care goes. I can't think of anyone I would less like to have attend my baby's birth. Although the two other NHS midwives I have had brief contact with at the hospital here have seemed very lovely and very able, this has made me question the wisdom of having an NHS home birth. I hate the idea that someone like my community midwife might show up at my door.

I can't afford an independent midwife but I will now hire a doula to provide support, which I would not otherwise have done.