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Information from NCT about physiological vs managed 3rd stage and delayed cord clamping

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Third stage of labour: delivering placenta and cord clamping | Labour & birth articles & support | NCT

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You’ve met your baby but there’s still work to be done. Here’s what happens during the third – and, good news, the final – stage of labour…

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Why do women give birth lying on their backs? Well, you might be surprised to learn that it seems to have much more to do with history rather than biology.
If you're pregnant, you'll have lots of questions about childbirth, especially as you get closer to your due date and start to formulate a birthing plan.

One of these - why do women give birth lying on their backs? - crops up a lot and you're not alone in questioning if it has always been this way, and if there are other positions that might make labour easier.

Knowing the history about why so many women give birth lying down might help you make a better informed decision about how you want to give birth and we asked experts for their input too:

Why do women give birth lying on their backs?

The idea of women giving birth lying on their backs on a bed wasn't actually introduced until around the 1700's, according to hypnobirthing expert Katharine Graves.

Writing in her well-known publication The Hypnobirthing Book, Katharine explains that women only began to give birth flat on their backs because King Louis XIV wanted to see his mistress give birth - not because it aided labour.

At the time, women generally laboured squatting on stools, and the midwife would usually be at floor level to meet the baby.

'But kings don't grovel on the floor, so it all had to be frightfully proper and his mistress had to lay in a bed,' Katharine writes.

Women in the King's court copied this, and midwives found they had much more difficulty getting babies out when mothers lay flat, so doctors were called in a lot more often.

Soon word spread and everyone started giving birth whilst lying down, believing that if it was done in the royal household then it must be for the best.

This trend for lying down has stuck, particularly in the Western hemisphere. Interestingly, the media often perpetuates it.

'I think the reason we see less squatting these days is because so many women now choose to birth in hospital,' says birth educator and yoga instructor Lucy Flow. 'We see in movies and on TV that women go to hospital to give birth and lay on their backs. So, a pregnant woman giving birth in hospital is likely to do what she's seen since she was little,' she explains.

'Women have only started to birth on their backs in relatively modern history,' adds women's health expert and founder of Forage Botanicals Natasha Richardson. 'When birth was an event which occurred in the home, surrounded by other women, a pregnant person was likely to move into whatever position suited them,' she says. 'Often, they'd crouch or be on all fours. This promotes a posture where gravity can do a lot of the work.'

'We continue to give birth on our backs because of the physical design of hospitals and beliefs about birth,' adds Natasha.

Is it better to give birth squatting or lying down?

Katharine, who is a leading hypnobirthing teacher and associate member of the Royal college of Midwives, claims that squatting is one of the best and most natural positions for childbirth, because "you have gravity on your side and you have the maximum pelvic capacity [in this position]."

Squatting can help to deliver a baby more swiftly. During childbirth the baby moves down towards the coccycx, which has a natural curve up. When squatting, this flexes and moves as your baby makes its way down the birth canal.

'Lying on your back whilst giving birth decreases contractions,' says Natasha. 'It makes a back-to-back birth more likely, makes gravity work against you as the baby is pushed towards your back and needs to come out over your coccyx (you're essentially pushing uphill), and it decreases the baby's pressure on the cervix and therefore decreases cervical dilation,' she argues. 'Squatting is better as it does the opposite of everything I've mentioned.'

But if lying down can make giving birth harder, why is it an option? One reason is that it can help medical staff. 'Giving birth on your back is convenient for caregivers,' explains Lucy. 'Especially if there's a medical reason for requiring a better view, such as the woman consenting to an episiotomy, a vaginal examination, or forceps.'

'Personally, I recommend women give birth in any position that opens the pelvis and uses gravity,' she continues. 'Most importantly, it should be a position the woman feels comfortable in. Sometimes that position is squatting. We are mammals. Mammals are designed to give birth upright. Evidence shows that being upright and using gravity has much better outcomes for the woman. This is not only physical. Lots of women report feeling more confident, in control, and positive about their birth experience when using upright positions.'

'If a woman wants to be on her back because she feels good there, then of course she should. Often it's more a case of her not realising the benefits of being upright,' adds Lucy.

Many women find that having a water birth allows them to move about upright more freely, but what about other positions? 'Lying on the side can let you rest without creating the same amount of pressure on the coccyx as being on your back,' says Natasha. 'While being on all fours helps the baby swing around so its back is away from your back. If the mother then rests her upper body on a surface (such as a birthing ball, £22.95, Amazon) - so her chest is above her hips - this helps the baby slide towards the cervix, increasing oxytocin and contractions,' she advises.

'Standing is also a good posture but you might find this difficult in later stages of labour,' she adds. 'Therefore, holding onto your partner's neck like you're on a dance floor may help. Essentially keeping your chest above and forwards from your hips is usually the most beneficial position.'

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Why do women give birth lying on their backs? Experts reveal all

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Why do women give birth lying on their backs? Well, you might be surprised to learn that it seems to have much more to do with history rather than biology. If you're pregnant, you'll have lots of questions about childbirth, especially as you get closer to your due date and start to formulate a birthing plan.

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Donate

If you would like to donate to the Breech Birth Network please click the button below!

CIC company number and stated purpose

11091909 (England and Wales)

The objects of the Company are to carry on activities which benefit the community and in particular (without limitation) to conduct training, research and advocacy activities for the benefit of mothers of breech-presenting babies, breech-presenting babies, their families and the professionals who attend them in pregnancy and childbirth.

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Breech Birth Network is a community interest company dedicated to increasing skills and knowledge about vaginal breech birth.

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I'm pregnant through IVF. Should I have an induction? It is very common for women and people who became pregnant through IVF to be advised to have an induction of labour, usually around 38-40 weeks, if spontaneous labour hasn't started already.

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Summary

This is a publication on maternity activity in English NHS hospitals. This report examines data relating to delivery and birth episodes in 2019-20, and the booking appointments for these deliveries. This annual publication covers the financial year ending March 2020.

Data is included from both the Hospital Episodes Statistics (HES) data warehouse and the Maternity Services Data Set (MSDS). HES contains records of all admissions, appointments and attendances for patients admitted to NHS hospitals in England. The HES data used in this publication are called 'delivery episodes'. The MSDS collects records of each stage of the maternity service care pathway in NHS-funded maternity services, and includes information not recorded in HES.

The MSDS is a maturing, national-level dataset. For data in 2019-20, the MSDS transitioned to a new version of the dataset. MSDS v2.0 is an update to the existing data set that introduces a new structure and content, including clinical terminology, in order to meet current clinical practice and incorporate new requirements. It is designed to meet requirements that resulted from the National Maternity Review, which led to the publication of the Better Births report in February 2016. This is the first publication of data from MSDS v2.0, therefore data from this year is not directly comparable to previous years.

This publication shows the number of HES delivery episodes during the period, with a number of breakdowns including by method of onset of labour, delivery method and place of delivery. It also shows the number of MSDS deliveries recorded during the period, with breakdowns including the baby's first feed type and the folic acid use.

The purpose of this publication is to inform and support strategic and policy-led processes for the benefit of patient care. This document will also be of interest to researchers, journalists and members of the public interested in NHS hospital activity in England.

Last edited: 21 December 2020 10:51 am

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NHS Maternity Statistics, England 2019-20 - NHS Digital

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This is a publication on maternity activity in English NHS hospitals. This report examines data relating to delivery and birth episodes in 2019-20, and the booking appointments for these deliveries. This annual publication covers the financial year ending March 2020. Data is included from both the Hospital Episodes Statistics (HES) data warehouse and the Maternity Services Data Set (MSDS).

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I'm pregnant through IVF. Should I have an induction? It is very common for women and people who became pregnant through IVF to be advised to have an induction of labour, usually around 38-40 weeks, if spontaneous labour hasn't started already.

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Imagine the scene - you're a tiny baby and not long ago your home was warm and cosy, cushioned in every sense from the outside world. Suddenly you're shunted into a bright environment, noises are no longer muffled and food is no longer delivered around the clock.

But it's OK, you're snuggled up with mum and her familiar voice, her skin and now her scent help you adjust as she tends your every need. You've just settled down for a nap when out of the blue someone strips you starkers, then plonks you on a thin piece of paper, on top of cold hard plastic scale like a stranded beetle. Your startle reflex is triggered, your hands come up to your face and you let out a big shout, WTF is going on?

You might kick your legs and wave your arms, why is nobody moving me you shout? Hello! I'm letting you know I'm really not OK with this!

As a result the numbers on the display dance a Cha Cha up and down as watchful eyes wait to see where it will land (if you lay still long enough).

Why do many insist on weighing babies in this way? I don't get it, especially given we don't use analogue scales for weighing anymore.

The liquid weighs exactly the same whether it is in a suitable receptacle or not, yet one is far more practical than the other.

Applied to babies, if parents are aware their baby will be weighed why can't they dress baby in a vest and/or babygrow and/or hat depending on the weather/baby's age, and have a spare set of identical items on hand (as per multipacks)

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Stop Weighing Babies Like Stranded Beetles!

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Imagine the scene - you're a tiny baby and not long ago your home was warm and cosy, cushioned in every sense from the outside world. Suddenly you're shunted into a bright environment, noises are no longer muffled and food is no longer delivered around the clock.

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Frank, funny, factual physiotherapist, Fellow of the Chartered Society of Physiotherapy, award winning comedian, mother and recovered incontinent, Elaine Miller, wants you to learn to laugh and not leak. Find out what your pelivc floor is, what it does and why having a good one is smashing.

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When to call the midwife poster A2 final

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Physiological transition of the newborn with optimal cord clamping

Hannah Tizard - Midwife at Blackpool Teaching Hospitals NHS Foundation Trust and Midwifery Media Consultant at All4Maternity and The Practising Midwife

This blog post provides an update about the progress and validity of the #BloodtoBaby campaign. Progress is evolutionary and whilst continuing to promote optimal cord clamping for newborns, focus also considers how practice can be improved in other areas;

delayed cord clamping and cord milking at cesarean section

optimal cord clamping at instrumental deliveries

optimal cord clamping to reduce preterm mortality

resuscitation with an intact cord

Hence the new title which encompasses all of the above; physiological transition of the newborn with optimal cord clamping. Today I want to focus on optimal cord clamping at instrumental deliveries and resuscitation with an intact cord.

Continued efforts

The #BloodtoBaby campaign, facilitated by sponsor Inspiration Healthcare continues to be a huge success with over 18K resources printed and delivered free of charge, to individuals across the world, including Australia, New Zealand, Sweden, India and Palestine. The campaign has and continues to support changes to the practice of immediate cord clamping.

UK NICE guidelines now recommend delayed or optimal cord clamping, so some people question why a campaign like this is necessary. The answer is fairly straightforward:

Change to practice takes time

In February 2018 Tommy's reported on a survey completed by The Positive Birth Movement. The survey questioned over 3500 women and families which highlighted that many clinicians are not waiting for the recommended 1-5 minutes before clamping the umbilical cord, contrary to guidance from NICE and consequently

40% of UK babies are not having delayed/optimal cord clamping.

Case study example - optimal cord clamping at instrumental delivery

Student midwives continue to report that delayed/optimal cord clamping is not happening in practice.

Recently qualified midwife Gemma Dickinson used her degree dissertation module to complete 'An audit to assess the rates of deferred cord clamping in a central London Trust Hospital and to explore whether factors surrounding birth may impact on timing of cord clamping'. As a consequence she made a poster highlighting the need for practitioners to consider delayed/optimal cord clamping particularly at instrumental deliveries.

Gemma comments:

"As a 2nd year student midwife in 2016, I was captivated by Amanda Burleigh and her presentation on optimal cord clamping at King's College University. I started to become silently outraged at the endless births I witnessed with early cord clamping when on placement, especially at instrumental deliveries. Whenever I asked doctors after instrumental births why they didn't leave the cord to pulsate when the newborn didn't need resuscitation, I was greeted with rolling eyes and patronising, feeble excuses. In January 2017 we were given a Public Health assignment to create a poster to display in hospitals, reminding staff of a key issue regularly being forgotten in practice. Naturally I jumped at the idea and created this poster. After wonderful feedback from my hospital and university, I went on to do an audit on cord clamping for my 3rd year dissertation. The Hospital is keen to act upon my significant results and plans are being set in place to develop a local cord clamping guideline, change the hospital computer documentation system and arrange education for the staff! My poster is currently being copied and laminated and I can't wait to see it displayed.. more importantly I can't wait to see more and more beautiful umbilical cords left to pulsate."

Resuscitation with an intact cord

Optimal cord clamping for all babies is the fundamental aim of the #BloodtoBaby campaign and this includes those babies born needing resuscitation at birth. In clinical practice, discussion about newborn resuscitation with an intact cord is fairly infrequent, sometimes contentious, however the evidence to support it is mounting.

New study:

Delayed Cord Clamping in Newborns Born at Term at Risk for Resuscitation: A Feasibility Randomized Clinical Trial by Katheria, A., Brown, M., Faksh, A., Hassen, K., Rich, W., & Lazarus, D. et al. (2017). The Journal Of Pediatrics, 187, 313-317.e1.

Helping to expand knowledge base and understanding in this area (other studies provided as references at the end), this randomised clinical trial suggests infants may benefit if resuscitation could be provided with an intact umbilical cord. Infants identified at risk for resuscitation were randomised to 1- or 5-minute cord clamping. The 5-minute group had greater cerebral oxygenation and blood pressure. The authors acknowledge that further studies are needed to determine whether this translates into improved outcomes over the long term.

As with all change comes challenge. These need to be examined. Indeed lack of appropriate resources in an already underfunded NHS may cause frustration to those seeking to make early change in line with evidence. Bedside resuscitation trolleys such as the LifeStart are priced attractively to compete with traditional stand alone resuscitaires, however there will, for some Trusts, be a long wait for the old models to be discontinued before new improved models can be purchased.

These images are provided by © 2018 Katheria, Sorkhi, Hassen, Faksh, Ghorishi and Poeltler and demonstrate positioning of the bedside resuscitaire, which can be used in any number of positions, two shown below. Their study was focused in an obsteric led hospital setting in the US where vaginal birth is tended to by an obstetrician in lithotomy. Indeed we know that this is not optimal for the birth of the baby, but that's another issue.

The same principals can be applied to birth centre and home birth settings where a bag and mask resuscitation can occur ensuring physiological transition with an intact cord.

In respect of the clinical challenges to bedside resuscitation, practitioners describe concerns about:

Short cords

Poor access to the baby

Accessing necessary equipment

Uncomfortable with parents watching

These concerns are highlighted in

Katheria, A., Sorkhi, S., Hassen, K., Faksh, A., Ghorishi, Z., & Poeltler, D. (2018). Acceptability of Bedside Resuscitation With Intact Umbilical Cord to Clinicians and Patients' Families in the United States. Frontiers In Pediatrics, 6.

In this study about 50% of neonatal providers, including obstetricians, expressed some concerns regarding sub-optimal access to the baby and adverse impact on the delivery of care. It is postulated that these issues can be easily rectified with appropriate space design and adequate training for all clinical staff.

It is important to highlight that the challenges faced by practitioners should not be used as justification for not providing optimal cord clamping for all neonates, particularly those most at risk. Given all the evidence of the benefits of delayed cord clamping, the bedside resuscitaire seems to provide the highest standard of care in an obstetric setting.

The responses from parents were much more positive, most parents were able to see and make contact with their baby in the first few minutes of life. All parents had positive impression of both resuscitation at bedside and on a radiant warmer. No parent felt uncomfortable with neonatal interventions being provided at bedside. They also perceived that their close proximity improved communication.

Case study example - optimal cord clamping for all

Trusts such as Northumbria Specialist Emergency Care Hospital in Cramlington; a medium sized consultant led unit have been facilitating optimal clamping for all, including bedside resuscitation since 2009. Their audit review provides a leading case study example demonstrating improved neonatal outcomes, decreased need for resuscitative measures at birth and reduced admissions to the neonatal unit since implementation of delayed cord clamping for all.

Some of the secrets to the successful implementation of this included, having an experienced midwife of neonatal practitioner attend every birth to advocate for the baby and for optimal cord clamping, that allowing for normal physiological transition, most babies will resuscitate themselves. Those that do need additional support can be managed on a specially designed Lifestart resuscitaire, of which there is one in every birth room. In order to ensure the change in practice becomes embedded actions to ensure junior staff and trainee doctors are reminded at induction.

An in depth look...

David Hutchon is a retired Obstetrician and Gynaecologist. His research investigating the true effect of prematurely closing the placental circulation with a cord clamp is extensive and seminal. Please see this informative powerpoint presented at the 4th International Neonatal Conference in Poland, 2016 from Professor Hutchon.

Moving forward with the evidence

This is a perfect time to highlight that the #BloodtoBaby website has had a revamp. I have worked tirelessly on this over the past few weeks and I'm really pleased with the results. Here are some of the new features:

Over and out - Hannah x

References

Batey, N., Yoxall, C., Fawke, J., Duley, L., & Dorling, J. (2017). Fifteen-minute consultation: stabilisation of the high-risk newborn infant beside the mother. Archives Of Disease In Childhood - Education & Practice Edition, 102(5), 235-238. http://dx.doi.org/10.1136/archdischild-2016-312276

Finn, D., Roehr, C., Ryan, C., & Dempsey, E. (2017). Optimising Intravenous Volume Resuscitation of the Newborn in the Delivery Room: Practical Considerations and Gaps in Knowledge. Neonatology, 112(2), 163-171. http://dx.doi.org/10.1159/000475456

Fulton, C., Stoll, K., & Thordarson, D. (2016). Bedside resuscitation of newborns with an intact umbilical cord: Experiences of midwives from British Columbia. Midwifery, 34, 42-46. http://dx.doi.org/10.1016/j.midw.2016.01.006

Katheria, A., Brown, M., Faksh, A., Hassen, K., Rich, W., & Lazarus, D. et al. (2017). Delayed Cord Clamping in Newborns Born at Term at Risk for Resuscitation: A Feasibility Randomized Clinical Trial. The Journal Of Pediatrics, 187, 313-317.e1. http://dx.doi.org/10.1016/j.jpeds.2017.04.033

Katheria, A., Sorkhi, S., Hassen, K., Faksh, A., Ghorishi, Z., & Poeltler, D. (2018). Acceptability of Bedside Resuscitation With Intact Umbilical Cord to Clinicians and Patients' Families in the United States. Frontiers In Pediatrics, 6. http://dx.doi.org/10.3389/fped.2018.00100

Lefebvre, C., Rakza, T., Weslinck, N., Vaast, P., Houfflin-debarge, V., Mur, S., & Storme, L. (2017). Feasibility and safety of intact cord resuscitation in newborn infants with congenital diaphragmatic hernia (CDH). Resuscitation, 120, 20-25. http://dx.doi.org/10.1016/j.resuscitation.2017.08.233

Thomas, M., Yoxall, C., Weeks, A., & Duley, L. (2014). Providing newborn resuscitation at the mother's bedside: assessing the safety, usability and acceptability of a mobile trolley. BMC Pediatrics, 14(1). http://dx.doi.org/10.1186/1471-2431-14-135

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A campaign re-born: physiological transition of the newborn with optimal cord clamping

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Hannah Tizard - Midwife at Blackpool Teaching Hospitals NHS Foundation Trust and Midwifery Media Consultant at All4Maternity and The Practising Midwife This blog post provides an update about the progress and validity of the #BloodtoBaby campaign.

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When meconium is noticed in amniotic fluid during labour it often initiates a cascade of intervention. A CTG machine will often be strapped onto the woman reducing her ability to move, labour in water, and increasing her chance of having a c-section or instrumental delivery ( Alfirevic et al. 2013). Time limits for labour may be tightened up further resulting in induction or augmentation, which increases the chance of fetal distress and for first time mothers, c-section. As the baby is being born he may be subjected to airway suctioning which can cause a vagal response (heart rate deceleration) and difficulties with breastfeeding. Once born, the baby is likely to have his umbilical cord cut prematurely and be given to a paediatrician who may also suction the baby's airways. In the first 24 hours after birth the baby will be disturbed regularly to have his temperature, breathing and heart rate assessed. In some hospitals the baby will be taken away from his mother to be observed in a nursery.

This is a lot of fuss for a bit of poo which in the vast majority of cases is not a problem. Indeed many of the interventions implemented because of the meconium are more likely cause complications than the meconium itself.

This post is mostly based on two journal articles. One by obstetricians in an obstetric journal ( Unsworth & Vause 2010) and the other by a midwife in a midwifery journal ( Powell 2013). Both agree that there is very little known about meconium and whether it is a problem at all.
Meconium facts
Meconium is a mixture of mostly water (70-80%) and a number of other interesting ingredients (amniotic fluid, intestinal epithelial cells, lanugo, etc.). Around 15-20% of babies are born with meconium stained liquor.

There are three reasons (theoretically) that a baby will open his/her bowels before birth ( Unsworth & Vause 2010):

1. Because their digestive system has reached maturity and the intestine has begun working ie. moving the meconium out. This is the most common reason - 15-20% of term babies and 30-40% of post-term babies will have passed meconium in-utero.

2. Because their cord or head is being compressed (during labour) ie. a vagally mediated gastrointestinal peristalsis - the same reflex which causes variable heart rate decelerations. This is a normal physiological response and can happen without fetal distress. This may be why a lot of babies pass meconium as their head is compressed during the last minutes of birth and then arrive with a trail of poo behind them.

3. Fetal distress resulting in hypoxia. However the exact relationship between fetal distress and meconium stained liquor is uncertain. The theory is that intestinal ischaemia (lack of oxygen) relaxes the anal sphincter and increases gastrointestinal peristalsis = passage of meconium. However, fetal distress can be present without meconium, and meconium can be present without fetal distress.

Bear in mind these are theories and there is no evidence to support them. Indeed in 'animal models' the theory that hypoxia results in meconium has found to be incorrect. There are also other theories about meconium in pregnancy - that the baby continually passes it - but I think this post is confusing enough with wading into them (see the key articles for further information).

Meconium alone cannot be relied on as an indication of fetal distress: "... meconium passage, in the absence of other signs of fetal distress, is not a sign of hypoxia..."( Unsworth & Vause 2010). An abnormal heart rate is a better predictor of fetal distress; and an abnormal heart rate + meconium may provide an even better indication that a baby may be in trouble. In addition, thick meconium rather than thin meconium is associated with complications. In summary, it is important to remember that:

Most babies who are born in a poor condition do not have meconium stained liquor

Most babies with meconium stained liquor are born in good condition

Despite this, babies who are known to have passed meconium (of any variety) without any other risk factors are treated as if they are in imminent danger. I am guessing this is because if a previously unstressed baby becomes hypoxic during labour it may result in the dreaded MAS.
Meconium Aspiration Syndrome (MAS)
MAS is the major concern when meconium is floating about in the amniotic fluid. It is an extremely rare complication - around 2-5% of the 15-20% of babies with meconium stained liquor will develop MAS ( Unsworth & Vause 2010). Of the 2-5% of the 15-20%, 3-5% of babies will die. OK enough %s of %s - basically it is very rare but can be fatal. For those who like numbers if you have meconium in your amniotic fluid your baby has a 0.06% (1:1667) chance of dying from MAS. This risk will go up and down depending on individual circumstances eg. prematurity, additional labour complications, etc.

MAS occurs when the baby inhales meconium stained liquor during labour, birth or immediately following birth. Babies make shallow breathing movements during pregnancy. Breathing movements slow down in response to prostaglandins before birth. In order for a baby to gasp in-utero he must be extremely asphyxiated and have gone through a number of stages. This is unlikely to happen without anyone noticing the baby is in trouble ie. an abnormal fetal heart rate during auscultation and an abnormal labour (or induced contractions). A baby is able to maintain aerobic metabolism until oxygen levels at the 'placental blood exchange site' drop 50% below normal levels. The baby then undergoes a number of physiological compensatory responses and if the oxygen level does not improve, or worsens he will descend through hypoxaemia, hypoxia, anaerobic metabolism, metabolic acidosis, asphyxia, and then become 'unconscious' at which point his limbic system will initiate a gasp in an attempt to get oxygen.

Meconium in the lungs can cause problems with respiration and increase the risk of infection. For 3-5% of these babies it can result in death... but remember there are often other issues occurring along with the MAS eg. prematurity.

So, meconium alone is not a problem. Meconium + an asphyxiated baby = the possibility of MAS
Bizarre Practice
So you would think that the sensible thing to do if a baby has passed meconium (for whatever reason) is to create conditions that are least likely to result in asphyxia and MAS. This is where I get confused because common practice is to do things that are known to cause hypoxia, for example:

Inducing labour if the waters have broken (with meconium present) and there are no contractions or if labour is 'slow' in an attempt to get the baby out of the uterus quickly.

Performing an ARM (breaking the waters) to see if there is meconium in the waters when there are concerns about the fetal heart rate.

Creating concern and stress in the mother which can reduce the blood flow to the placenta.

Directed pushing to speed up the birth.

Having extra people in the room (paediatricians), bright lights and medical resus equipment which may stress the mother and reduce oxytocin release.

Cutting the umbilical cord before the placenta has finished supporting the transition to breathing in order to hand the baby to the paediatrician.

Suctioning the baby's airways?
I am unsure whether this is common practice or not. Evidence based clinical guidelines generally recommend NOT suctioning a baby's airways unless they are unresponsive, floppy and require resuscitation. And then only to do so using a laryngoscope so that you can see what you are doing. Guidelines: NICE guideline, Resuscitation Council UK, more guidelines. Key research: Wiswell et al. 2000, Vain et al. 2004. So, I would assume that practice would be informed by this research and guidelines.

However, on my frequent youtube birth-surfing trips I encounter suctioning of babies often (without meconium present). Both 'on the perineum' and following birth. I have seen this being done at hospital births, homebirths, and even unassisted births. You can see an extreme version of suctioning in this previous post. A more conservative method using the suction bulb pictured above seems to figure in a lot of the homebirths on youtube. So, I am guessing that this is a common routine practice in the US. Therefore, I feel obliged to reiterate why this is not only invasive and pointless but may also be detrimental. Suctioning at birth does not reduce the risk of MAS but can:

In addition I am guessing it is not a very pleasant experience/welcome for the baby. Anyway, the birth process takes care of the mucous and amniotic fluid (and meconium) in the baby's airways. As you can see from the photo below the airways clear as the head is born and while waiting for the next contraction - the chest is compressed, squeezing the fluid out and gravity helps it to drain. Babies born by c-section miss out on this and are more likely to end up with problems associated with fluid in the airways and stomach.
Suggestions
All babies deserve to have the least stressful arrival possible. It is even more important that a baby who has passed meconium does not become stressed during labour and birth because it could lead to MAS. The following suggestions apply to all births including when there is meconium stained liquor:

Avoid an ARM during labour so that any meconium present is not known about until the membranes rupture spontaneously (hopefully this will happen after much of the labour is complete). If there is meconium present it will remain well diluted and the amniotic fluid will protect the baby from compression during contractions.

Ensure that the mother knows meconium is a variation and not necessarily a complication... the practitioner needs to consider the holistic picture - a post dates baby with old meconium is very different to a 38 week baby with thick fresh meconium.

If this is a concerning scenario ie. not post dates and thick meconium... or fresh meconium occurring during labour then increased monitoring and/or medical intervention may be required.

Otherwise, create a relaxing birth environment.

Avoid any interventions that are associated with fetal distress - ARM, syntocinon/pitocin, directed pushing.

In hospital do not allow others into the room unless the mother wants them there. If there is a policy to have a paediatrician present they can wait outside the room to be called if needed.

To assist with airway clearing encourage a slow birth of the baby's head in a position that allows drainage of the airways (ie. mother not lying on her back). Do not pull the baby out - allow the mother and baby to wait for the next contraction whilst the airways clear themselves.

Once baby is born leave the umbilical cord intact until it has stopped pulsing to allow a gentle transition to breathing.

Keep baby skin to skin with mother following birth.

Encourage the mother to let you know if she is concerned about her baby in any way over the next 24 hours (eg. feeling hot, noisy breathing, etc.)

Summary
Meconium in itself is not dangerous unless it is inhaled by the baby. For some babies meconium is a sign of hypoxia and they are at risk of meconium aspiration - these babies need additional monitoring and perhaps medical intervention. For most babies ie. those who are post dates, meconium is a sign of a mature digestive system that has begun to function - in these cases the aim should be to avoid hypoxia during labour and therefore meconium aspiration.

You can listen to an interview/discussion I had with Pregnancy Birth and Beyond Radio about meconium.

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When meconium is noticed in amniotic fluid during labour it often initiates a cascade of intervention. A CTG machine will often be strapped onto the woman reducing her ability to move, labour in water, and increasing her chance of having a c-section or instrumental delivery (Alfirevic et al. 2013).

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Are you a doula? Add yourself to this directory here

Find your doula with our doula directory

This is a place to find a doula to support you to prepare for the birth of your baby, support you through labour or to help out once your baby is born. Please use the form and the tags below to find a doula in your area or who provides online doula support. If you are a Developing Doula looking for a Companion, please choose the 'companion' tag to bring up the list of Companions.

Choose the first half of your postcode to find doulas who cover your area

If you would prefer a doula who speaks your language choose one here

Here's who we found for you...

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Are you a doula? Add yourself to this directory here This is a place to find a doula to support you to prepare for the birth of your baby, support you through labour or to help out once your baby is born.

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Induction, pain relief, assisted birth and caesarean.

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A beautiful photo story of a caesarean birth

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What are the consequences of knowledge?

As midwives, we do lots of things, often simultaneously. We build relationships, gather information, determine and meet needs, offer tips, reassurance, information and advice, soothe concerns and much, much more. During an antenatal check, for example, we might do all of these things while also assessing the health of women and their babies by means of carrying out those screening tests which have become a routine part of such meetings; blood pressure, urinalysis, examining the woman's abdomen and listening to the fetal heart. Often, depending on the circumstances, we may also be talking to the woman about whether she would like to avail herself of other available screening tests such as blood and antibody checks, ultrasound, glucose tolerance testing, maternal serum screening and group B strep testing. While our activities are myriad, a fair proportion of our time is spent undertaking activities which relate to the search for knowledge that may help prevent or detect problems.

On the surface, focusing on preventative health and undertaking screening tests seems like a jolly good idea. If we can detect potential problems at an early stage, we can put measures in place in an effort to prevent those problems being harmful to women or their babies. This rather lofty aim, however, is merely the tip of the iceberg that is screening, and a whole raft of issues is raised by this concept in practice. This is the first of a series of blog posts in which I share an article that focuses on the consequences of the knowledge that is gained by undertaking screening tests and raises questions about whether this knowledge carries risks as well as benefits.

Beginning with bloods...

Once upon a time, I shared a house with a couple of scientist friends who worked in a laboratory. At that time, I was (temporarily) vegan, they were both dedicated carnivores and we had a very friendly and very ongoing argument over our dinner most evenings. This argument was based around whether or not, as a non meat-eater, I could have a reasonable haemoglobin level. One day I invited them to draw a few millilitres of my blood and spin it in the lab so that they could check my haemoglobin for themselves and we could finally settle this argument one way or the other. This idea went down really well; one of them was also a phlebotomist and he gathered his kit and was literally just about to put the needle in when he suddenly stopped and swore quietly under his breath.

I asked him whether there was a problem and he said, "I've just realised ... I can't do an Hb independently of a full blood count".

"OK", I smiled. "Do a full blood count then, I don't mind."

"Well..." he replied. "Trouble is ... what about if I find out that you have acute lymphoblastic leukaemia? Would you want to know?"

I can't say that was the first occasion on which I ever thought about the potentially enormous consequences of the kinds of information that we gather daily and routinely, but when I am asked to speak to groups of midwives about screening I often begin with that story as an illustration of how very momentous the implications of even the simplest tests can be. In just a few decades, Western culture has embraced the notion that preventative health care and screening are beneficial tools and there has been a metaphorical explosion in the growth of technologies related to this area. Knowledge, however, can have serious consequences and simply because we can know something doesn't necessarily mean that we always should know it. Because of this, I believe that it is important to consider the consequences that can arise from the gathering of information about the human body.

You can read the next part of this article here.

A version of this article was originally published as Wickham S (2009) Screening and the consequences of knowledge. Birthspirit Midwifery Journal 2: 9-12.

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Screening and the consequences of knowledge (part one) - Dr Sara Wickham

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What are the consequences of knowledge? As midwives, we do lots of things, often simultaneously. We build relationships, gather information, determine and meet needs, offer tips, reassurance, information and advice, soothe concerns and much, much more.

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What are your rights in the perinatal period? Who makes decisions regarding your care?

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Doulas support in pregnancy, birth and in the postnatal period by providing information, advocacy, and offering practical and emotional support to the whole family.

To find a doula in your area you can search our comprehensive directory of Doula UK doula members here.

Doulas do not advise, but provide informational support to enable you to make informed decisions about your maternity care. Doulas support different kinds of births and different parenting choices. They do not take a clinical role but work alongside midwives and doctors.

Birth doulas provide continuous support through pregnancy, labour and birth and the immediate postnatal time. Postnatal doulas provide flexible practical and emotional support postnatally for families in their own homes. Some doulas work as both birth and postnatal doulas, while others work only as birth doulas or postnatal doulas. Find out more below.

Our Doula UK directory of doulas enables you to contact a few doulas in your area. Doulas usually meet with potential clients before being booked. Help with hiring a doula.

Birth doulas

Birth doulas support women, birthing people and families who are planning all kinds of birth, from planned caesarean birth or early epidural to home water birth.

Antenatally, a birth doula will usually meet with the client at least twice, and be available for phone or email support as questions or concerns arise. They will have the opportunity to talk over any concerns, work out their birth preferences and get to know their doula.

A birth doula will then go 'on call' towards the end of pregnancy (typically around 38 weeks) and will then be available 24/7. The doula will then go to their client(s) when they ask during labour, typically before they transfer to a place of birth (if planning a hospital or birth centre birth) or the midwives arrive (with a home birth).

During Labour a doula provides emotional, practical and informational support to their client(s), adapting to what is needed. The doula is able to offer help and suggestions on comfort measures such as breathing, relaxation, movement and positioning. If applicable, the doula can also encourage the partner to participate in the birth to a level at which they feel comfortable. The doula's most important role is to provide nurturing, continuous support and reassurance.

The doula will then stay with their client(s) until after baby is born and the new family are settled and happy.

Birth doulas do at least one postnatal visit with their client(s), to support them as they settle in life with a new baby, help with infant feeding as needed and allow them an opportunity to talk over the birth.

Postnatal doulas

Postnatal doulas typically start working with with a family in the first few months after birth, but some doulas do work with families with older babies too. Sometimes postnatal doulas are booked antenatally, sometimes only when a family find they are struggling or feel the need for more support. The length of time a postnatal doula spends with a family varies enormously from the initial 6-8 weeks, to years!

Just as when supporting birth clients, postnatally doulas provide emotional, practical and informational support.

The actual tasks in the practical support postnatal doulas provide varies enormously, and one of the big benefits of having a postnatal doula is that they are there to support the family, not carry out a specific task, so they do what is needed (within reason!). This can be help around the house, looking after baby while mum (and her partner) nap, helping with older siblings, making meals, helping with dinner time or the school run, helping overnight so the parents get more sleep...even walking dogs or wrapping Christmas presents. Whatever is needed to help a family relax and have a positive experience of life with a baby.

Unlike a maternity nurse, a doula is not there to take care of the baby for you. Instead, a postnatal doula supports you to be the parent you want to be.

If you choose to breastfeed, then a doula can support you with this and research shows that having a Doula UK postnatal doula means breastfeeding is more likely to be successfully established.

Postnatal doulas also provide emotional support for mothers and couples. Parents these days can feel overwhelmed by differing advice offered. A postnatal doula gives new parents the opportunity to talk things through, and just chat, knowing that they will not be dismissed or told what to do. Talking over the birth is a usual part of this, but postnatal doulas can also be there to support parents through concerns about siblings, feeding, going back to work, weaning, sleep - and what granny said she did in her day.
Now find out why you want to choose a Doula UK doula... Or find a doula near you

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Doulas support in pregnancy, birth and in the postnatal period by providing information, advocacy, and offering practical and emotional support to the whole family.To find a doula in your area you can search our comprehensive directory of Doula UK doula members here. Find A Doula

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More evidence based research on delayed cord clamping.

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Optimal Cord Clamping | Blood to Baby | England

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Information about the campaign to raise awareness about Optimal Cord Clamping and Delayed Cord Clamping, Blood to Baby

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Cord Blood Bank - NHS Blood and Transplant

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Watford General Hospital update

With much regret, after more than10years accepting cord blooddonations atWatford GeneralHospital,fromThursday 24thDecember 2020we willno longer be able to offer this service.

We will continue to accept cord blooddonations atour 3 remaininghospitalsatLuton and Dunstable Hospital,St George's Hospital andUniversity College London Hospital.

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Watford General Hospital update With much regret, after more than10years accepting cord blooddonations atWatford GeneralHospital,fromThursday 24thDecember 2020we willno longer be able to offer this service. We will continue to accept cord blooddonations atour 3 remaininghospitalsatLuton and Dunstable Hospital,St George's Hospital andUniversity College London Hospital.

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A brief overview of the latest thinking on when the baby's cord should be cut

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Babies cords are usually clamped shortly after the baby is born. For the past 50 years doctors and midwives have mostly routinely clamped and cut the cord immediately with no evidence that timing of that clamp and cut has any significant impact.

However, evidence now shows that there are benefits in delaying cord clamping:

Cords cut before 60 seconds after delivery are classed as early cord clamping, but in a perfect world, a cord should not be cut until it has stopped pulsating - i.e. all the blood flow from the placenta to your new baby has completed it's journey.

If the cord attached to your baby is left for as long as possible, not only will your baby receive extra blood, but it can increase birth weight, can boost your baby's blood volume by up to a third and can increase your baby's iron reserves for up to 6 months. Research shows that placental transfusion is mostly complete by 3 minutes.

Iron deficiency anaemia, the most severe form of iron deficiency, affects around a quarter of pre-school children globally and 3-7% of the population in Europe. This deficiency can go on to affect a child's brain development.

The solution is to keep the baby attached for as long as possible to make sure he or she has a good amount of iron stored up for the future.

If you allow nature to take the intended course and delay the clamping and cutting of the cord, you and your baby are still attached, therefore no one can take your baby away from you. All a midwife needs to do can be done with your baby in your arms, with their skin against yours. That is a moment no one in the world can ever take away from you. And it's doing good stuff at the same time!

Is it right for you and your baby?

There may be a reason why delayed cord clamping may NOT be an option for you and your baby. The World Health Organisation tells us that early cord clamping i.e. before the magical 60 seconds, is not recommended UNLESS resuscitation is needed. Sometimes newborns don't like being forced out of their cosy environment into a bright new world and they might need a little helping hand to come round and breathe on their own. If this is the case, then it is best to get them started and cut the cord unless there is a mini resuscitaire available, which enables resuscitation with the cord intact.

Can it be done after a Caesarean Section?

There is nothing said professionally that delayed cord clamping cannot happen after a Caesarean in theatre. Increasing numbers of hospitals have guidelines in place to permit delayed cord clamping following caesarean section. Having a Caesarean does not write off your opportunities to have delayed clamping and furthermore skin to skin contact should be every woman's right to make their birthing experience the best it can be.

In a normal delivery, once your baby has been delivered, you will then embark on the third stage of labour - either physiologically i.e. waiting for the placenta to come out naturally with no help (which can usually take up to 60 minutes before intervention is required) or, an active third stage (when your midwife will give you a little helping hand and an injection to help the placenta be delivered). Whichever one you choose, or end up having, delayed cord clamping can still be offered.

Remember, Weight can Wait! Although one of the first things new parents want to know is what the baby weighs, think of the advantages of waiting just a little bit longer for that information.

YOUR Birth Preference

You have the opportunity to make your wishes heard about how you want your birth to go and it's called a birth plan/ birth preference. Here are a few ideas you might like to consider or discuss with your midwife:

I would like delayed cord clamping, if possible

I would like immediate skin to skin contact with my baby

I want [name]to cut the cord

I would like a physiological third stage if possible

Weight can wait!

I would like an UNDISTURBED 60 minutes with my baby after birth during the third stage of labour

Special Thanks

Our sincerest appreciation to Hannah Godwin and Amanda Burleigh for writing this article.

Please visit the Blood to Baby campaign for further information.

References

Bender, S (1976). Obstetrics for Student Midwives. William Heinemann Medical Books.

Campbell, D (2013). Hospitals warned to delay cutting umbilical cords after birth. The Guardian.

Fraser, D. M. & Cooper, M. A. (Eds.) (2009). Myles Textbook for Midwives: 15th Ed. London: Elsevier.

Mehigan, S. (2014). Can I ask for a delay to my baby's cord being clamped?

Roberts, M. (2011). Delay cord clamping for baby health, say experts. BBC News.

WHO (World Health Organisation) (2012). Optimal timing of cord clamping for the prevention of iron deficiency anaemia in infants.

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Babies cords are usually clamped shortly after the baby is born. For the past 50 years doctors and midwives have mostly routinely clamped and cut the cord immediately with no evidence that timing of that clamp and cut has any significant impact. However, evidence now shows that there are benefits in delaying cord clamping: Cords ...

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NCT leaflet

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Great blog post about the second stage of labour

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Great blog post about the second stage of labour

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At some point when contemplating how this baby is going to actually come out, most of us naturally turn our minds to labour and how we might cope with the contractions. Few of us think about the second stage of labour - after all, isn't it as simple as the instruction on the door above? Once labour has unlocked the door, it's as simple as pushing the the baby through the door, right? The midwife or doctor tells us when and how to do it, don't they?

After all, almost every depiction of birth we see on TV seems to be showing us clearly that women need help, together with an awful lot of elbow grease, to push their babies out. The midwife gives instruction:

Take a deep breath, put your chin on your chest. Push down into your bottom, like you're doing a poo Now take a quick breath and push again. Push, push, push. That's it, push hard.

Sometimes, when at a birth I also see and hear:

Get angry with your baby

Or:

Push my fingers out of you. Get angry with me.

It is not surprising that many people call this "purple pushing". Mothers usually get very red in the face, their eyes bulge and sometimes even break blood vessels in their eyes. This technique for second stage (called 'valsalva' pushing in the textbooks) is firmly embedded in our cultural consciousness.
But is it the healthiest, easiest option for the mother or the baby?
If a mother and baby are healthy and un-medicated, it's not a great leap to understand that purple pushing might not be their best option. If a women holds her breath while pushing, she is not allowing that oxygen to get to her baby. Sometimes, this results in the baby getting distressed and birth needing to be hastened.

Sometimes, the mother pushes and pushes at the behest of the midwife or doctor for quite some time. The baby doesn't seem to be making any progress down the birth canal and the mother begins to run out of energy and lose heart. This can result in the the baby being born with the help of a ventouse (suction cap) or forceps - or even caesarean section.

I sometimes wonder, when I see the fear and anxiety of this kind of situation, how the baby must be feeling, too. We know that the emotions a mother is feeling have an effect on the baby so it seems logical to ask ourselves if the minutes before birth are high stress for the mother, that the baby may feel the effects, too.

Does it have to be this way? Surely the urge to expel the baby is a reflex? Telling us how and when to push our babies out feels as bizarre to me as trying to tell me how and when to sneeze.

What actually happens is that most women begin to feel a growing bearing down urge. Sometimes it starts well before full dilation - this seems not to be a problem; the mother is just making small adjustments to her baby's position, not trying to expel her baby.

As she comes up to full dilation, the urge to bear down, to expel, to push, may grow and grow, until it becomes overwhelming and undeniable. Just like the urge to sneeze builds and builds until nothing can hold it back.

Many women find that this part of labour is liberating. It can feel a huge release to be actually doing something with the contractions. Sometimes women say that the contractions become less painful or even pleasant. Others find this part of labour very challenging, both physically and emotionally. The important thing is that you have people around you supporting you, making sure you have the physical energy by offering you drinks and snacks, are warm and comfortable enough and feel as private and safe as you need.

Sometimes, a mother can reach full dilation but her body and mind need a while to re-group, her baby needs time to descend and stimulate the nerve endings that create that pushing urge. World famous midwife Ina May Gaskin calls this the 'rest and be thankful' phase of labour. I've seen this phase last up to an hour and I've heard tell of longer. The contractions can space out of even stop for a while and the mother can rest or even fall asleep.

As the urge to bear down builds, the sensations tell the mother what to do; what postures to adopt, when to bear down, how to breathe. There seems as little point telling her what to do as there would directing the sneezer or, for that matter, someone on the toilet doing a poo!

There are lots of opinions about pushing. Some think the only way to gently birth is to 'breathe the baby out' and that this means denying the urge to push and to just keep breathing slowly and deeply. I think this is a misunderstanding of the techniques, like hypnobirthing, that many woman practice. It is not about trying not to push but merely about allowing your body to show you the way - moving, breathing, pushing as your body dictates. This is usually, in a woman who is undisturbed and un-self-conscious, a 'breathing down', a grunting push, a low moan or even a silent bearing down. A woman may find she needs to push, and push hard, to birth her baby. Someone else may find her baby slipping out with hardly a grunt. Each birth is different and perfect in its own way. My only suggestion is another one from Ina May - try to keep your vocalisations low and your jaw and lips loose. There is a direct connection between your throat and jaw and your pelvic floor and vagina. Any singing teacher can tell you about this connection.

Talking of the toilet, it would be remiss of me not to mention some women's greatest fear: pooing while pushing. It would be terrible of me not to take this fear seriously. We doulas meet many women who are mortified by the very idea. Here are some thoughts which might help:

Labour often begins with a 'good clear out' - this is nature's way of making room for your baby and making sure that you push baby, not anything else, into the room.

When the baby's head gets very low, it passes by the rectum. If there is something in there, it might be squeezed out. This is a GOOD sign. Midwives say that if a little something appears, the baby is right behind. I know it sounds crazy - and we probably are - but doulas and midwives get excited about poo. Far from being disgusted or appalled, we are actually totally chuffed and think you're dead clever. So rather then feel embarrassed, how about you feel proud of yourself - you're about to birth your baby!

Most women are completely unaware of anything 'happening'. Midwives and doulas aim is to maintain your dignity. We are there to 'mother the mother' - just as we care for our children through their bodily functions with love and without disgust, so we care for you.

So what if you have an epidural? Obviously when a mother's body is numb, she may not get all the feedback her baby is giving her. However, I am convinced I have seen mothers with an epidural who are ready to begin pushing their babies out. They wriggle on the bed, ask to sit more upright, say that they think something has changed or ask to be examined. All too often, these signals are ignored because the protocol says that vaginal exams should only be performed every 4 hours and then an hour given for the baby to descend before active pushing is commenced. I do wonder whether sometimes that natural urge that the mother is feeling, despite the epidural, is ignored and is somehow then 'missed'. I would love other doulas' and midwives' thoughts on this.

Even with an epidural, once a woman is pushing, more upright, 'active' positions can be achieved. She can be helped up onto her sitz bones or even an all-fours posture, especially if there are two support people - one on either side of the bed - to stabilize her. I have been lucky enough to work with some midwives who have been keen to help a woman with an epidural become a more active participant in her 2nd stage, rather than lying on her back and pushing up-hill.

Sometimes a epidural can divorce a woman from her pelvic floor. It can be difficult to work out what muscles are needed. A doula tip is to 'fist blow' - this means putting your fist in your mouth so that your lips make a seal around your hand. Then blow hard. Try it - your pelvic floor will bulge outward.

The other common fear is tearing. This can happen either as the baby's head crowns or his shoulders are born. Many believe that valsalva or coached pushing increases the risk of tearing. If this is the case, this is another reason to listen to the cues your body is giving you. A baby often descends slowly - coming down and then going back a little, especially a first baby. This is to make sure the tissues of your vagina stretch gently open. This stage can be helped by remembering you are designed to open perfectly to let your baby out.

As your perineum stretches around your baby's head as he crowns, the sensations you have may naturally stop you pushing. Your midwife may remind you to pant or blow at this point, just to allow your baby to crown slowly and gently. You can open very wide - and in the past, all young girls were taught how amazing the female body is.

So do you have a choice in the way your baby enters the world? Well I believe that under normal circumstances then, yes; yes you do. Consider finding your position of choice as your body dictates. This might be kneeling, squatting, all fours, 'the running start', sitting on the loo (put a towel under the seat so you're not worried about birthing the baby down the toilet!) or sit on your partner's parted knees or ask your support people to help you into a supported squat. Or use the buoyancy of the water in the birthing tub to help you into any position you need. Ask that you are not hurried and coached. Ask that your birth supporters trust you. Trust yourself and trust your baby - you both know what to do.

I love your comments so please tell me what you think - if you're a midwife or doula, what are your favourite pearls of wisdom about the 2nd stage of labour? As a mother, what helped you when pushing your baby out? If you're pregnant for the first time, what intrigues, scares or interests you most about this very special part of labour?

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Thoughts and tips for the second stage of labour.

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At some point when contemplating how this baby is going to actually come out, most of us naturally turn our minds to labour and how we might cope with the contractions. Few of us think about the second stage of labour - after all, isn't it as simple as the instruction on the door above?

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How to encourage your baby into a good position for a straightforward birth.

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Parenthood Starts with Pregnancy

You and your baby are working together! Your job is to dilate, baby's job is to rotate. Empower yourselves with our daily activities, body balancing techniques, and smart birth positions for a more comfortable, confident birth.

Proactive Preparation for Easier Birth

Join others who are enthusiastic for your life-giving year! Find a Spinning Babies ® Certified Parent Educator to start using techniques for comfort in pregnancy and smoother progress in labor through our unique approach to physiological birth.

Help Change Birth on Earth

Find Spinning Babies ® Workshops and events near you to start helping parents experience a more confident and comfortable birthing process for both themselves and their baby.

For additional education to even further enhance your pregnancy and labor preparation, shop our extensive collection of digital downloads, videos, DVDs, workbooks, and more.

Daily Essentials can be practiced daily throughout pregnancy to help bring balance and comfort - and an easier, shorter birth.

Spinning Babies® Parent Class

Spinning Babies® Parent Class provides clear instructions on how to use Spinning Babies® for a more comfortable and confident pregnancy and labor.

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Spinning Babies - Comfort in Pregnancy and Easier Birth

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Parenthood Starts with Pregnancy You and your baby are working together! Your job is to dilate, baby's job is to rotate. Empower yourselves with our daily activities, body balancing techniques, and smart birth positions for a more comfortable, confident birth. Proactive Preparation for Easier Birth Join others who are enthusiastic for your life-giving year!

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The NCT's guide to what to expect during labour

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Thinking about how, what happens and where to give birth? We're here to help you feel more confident. We've got information and tips on everything you need to know.

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- the complete resource for fathers to be -

Birthing4Blokes supports you to be the very best that you can be
on the day that she gives birth to your baby.

The confidence to understand her needs and calls for help!

My main worries were: "Could I be the person my partner needed when she needs it?" and "How will I cope with her changing moods?". I didn't understand the changes she was feeling both physically and mentally. How was I going to cope with the run up to labour and the birthing process?

The Online Course actually gave me an insight into how women think and how my actions can help stimulate oxytocin and the positive effects of doing that.

Working through the program gave me the confidence to understand her needs more fully and the ability to hear what were calls for help when she felt alone. I became more able to help her know that I was going to be the person she needed when it came to the labour and birth of our baby.

I realised that I could be an incredibly positive influence in supporting her, as she went into the natural state she felt she need to be in for giving birth. She seemed to grow in faith and trust that she was in a safe place and that her needs were being met.

My belief and self confidence have gone through the roof.

Marks program and book is helping our ongoing relationship as well, I now have a better understanding regarding the 'natural dance' of relationships. It is helping me to be a better partner and father. Learning these things is still impacting our relationship, she seems more secure and often says she feels loved and valued by me, the growing bond with our baby is being deeply benefited.

I have really valued the program and will promote it amongst my friends both female and male.

Thanks Mark, you're a hero!

This On line training was priced at £97

NOW available fo FREE .

You DO NOT need a code.

Copyright 2017 by Birthing4Blokes.

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Birthing4Blokes - Everything a 'Father to be' needs to know

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the complete resource for fathers to be - Birthing4Blokes supports you to be the very best that you can be on the day that she gives birth to your baby. The confidence to understand her needs and calls for help! My main worries were: "Could I be the person my partner needed when she needs it?"

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Neonatal death and stillbirth - the MBRRACE report

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Neonatal death and stillbirth - the MBRRACE report

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The role of hormones and how you can maximise their effectiveness in helping you to achieve a straightforward birth.

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Hormones, labour and birth: an introduction

You know your hormones are going to be working hard at this time but you might not know exactly what they're doing. You'll in fact have four major hormonal systems active when you're in labour and giving birth. These hormones are:

oxytocin (the love hormone)

beta-endorphins (the hormones of pleasure and transcendence)

epinephrine and norepinephrine (the hormones of excitement)

prolactin (the mothering hormone).

(Buckley, 2002)

Here's what impact all four will have on you...

Oxytocin or the love hormone

Oxytocin is the love hormone, which is why it's released during sex, orgasm, birth and breastfeeding (Odent, 1999; Buckley, 2002).

Oxytocin will make you feel more affectionate and selfless, and its main function in labour is to bring on contractions (Dawood et al, 1978). You'll get a surge of oxytocin in the final stage, so if you're having a vaginal birth it will help you along with pushing.

Oxytocin reduces stress, calms you down and helps with pain during labour (Buckley, 2015). Impressively, your baby will also produce oxytocin before and during labour (Chard et al, 1971).

Oxytocin hangs around after birth too, helping you feel more relaxed, well-nourished and bonded with your baby (Buckley 2002, Buckley 2015). It helps with the let-down reflex during breastfeeding and protects you against postpartum haemorrhage (Buckley, 2002).

Beta-endorphins or the pleasure hormones

Endorphins are naturally occurring opiates, similar to morphine and heroin. Like oxytocin, they mostly appear during sex, pregnancy, birth and breastfeeding. Beta-endorphins reduce pain and suppress the immune system, which is important so that it doesn't act 'against' your baby (Buckley, 2002, 2015).

If you're stressed during labour, that can make you release excessive beta-endorphins, which may inhibit oxytocin and slow things down (Buckley 2015). That's why keeping things as calm as possible is a great thing in labour.

Beta-endorphin also helps with the release of prolactin during labour, preparing your breasts for feeding (Rivier et al, 1976).

And one more thing: it helps in the final phase of your baby's developing lungs too (Buckley 2015).

Epinephrine and norepinephrine or fight or flight hormones

You might have heard these two referred to as fight-or-flight hormones but their proper names are epinephrine and norepinephrine (adrenaline and noradrenaline). They are produced during stresses like fright, anxiety, hunger or cold and also when you're excited (Buckley 2015).

You're likely to get a high level of these hormones if you don't feel private, calm, safe and undisturbed and they can then inhibit oxytocin (Buckley 2015). Yet in the late-labour stage if you perceive danger or stress, they may paradoxically stimulate contractions so you give birth more quickly (Buckley 2015).

A rise in epinephrine when you're in the later stages of labour increases your levels of prostaglandin and cortisol to help with contractions. This will make you feel a sudden rush of energy and will cause several strong contractions and will help you push (Buckley, 2002, 2015).

These hormones help your baby too by protecting them against a lack of oxygen (Buckley, 2002). Your baby will have high levels of these hormones during birth but they'll drop quickly once you sooth them afterwards (Lagercrantz and Bistoletti 1977; Buckley, 2002).

Prolactin or the mothering hormone

Prolactin is the mothering hormone. And it's the major hormone for breastfeeding.

Prolactin starts to increase during pregnancy and peaks at birth (Buckley, 2002). Your baby produces prolactin in the womb too (Daniels and Martin, 1994).

Hormones and your feelings after birth

Lots of women get the baby blues during the first week after birth of her baby days (NHS Choices, 2018). You might feel down or depressed, emotional or irritated and likely to burst into tears at any second.

Don't despair though: these symptoms are totally normal. They're due to the sudden hormonal and chemical changes that happen after you give birth.

If you feel like you are suffering from something more extreme and it isn't going away though, talk to your GP or midwife. You might be suffering from postnatal depression and should get some support or help right away.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Buckley SJ. (2015) Hormonal physiology of childbearing: Evidence and implications for women, babies, and maternity care. Washington, D.C.: Childbirth Connection Programs, National Partnership for Women and Families. Available from: http://www.nationalpartnership.org/research-library/maternal-health/hor... [Accessed 25th April 2018]

Buckley SJ. (2002) Ecstatic birth: The hormonal blueprint of labor. Available from: http://www.dancingstarbirth.ca/Handouts/Ecstatic_Birth.pdf [Accessed 25th April 2018]

Chard T, Hudson CN, Edwards CR, Boyd NR. (1971)Release of oxytocin and vasopressin by the human fetus during labour. Nature. 234:352-354. Available from: https://www.ncbi.nlm.nih.gov/pubmed/4944487 [Accessed 25th April 2018]

Daniels G, Martin J. (1994) Neuroendocrine regulation and diseases of the anterior pituitary and hypothalamus, In Harrison's Principles of Internal Medicine, 13th edition. New York: McGraw- Hill. [Accessed 25th April 2018]

Dawood MY, Raghavan KS, Pociask C, Fuchs F. (1978) Oxytocin in human pregnancy and partrurition. Obstetrics and Gynecology. 1978; (51):138-143. Available from: https://www.ncbi.nlm.nih.gov/pubmed/622223 [Accessed 25th April 2018]
Lagercrantz H and Bistoletti H. (1977) Catecholamine release in the newborn infant at birth. Pediatric Research. 8:889-893. Available from: https://www.ncbi.nlm.nih.gov/pubmed/887309 [Accessed 25th April 2018]

NHS Choices. (2018) Feeling depressed after childbirth. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/feeling-depressed-afte... [Accessed 25th April 2018]

Odent M. (1999) The Scientification of Love. London. Free Association Press.

Rivier C, Vale W, Ling N, Brown M, Guillemin R.(1976) Stimulation in vivo of the secretion of prolactin and growth hormone by beta-endorphin. Endocrinology. 100:238-241. Available from: https://www.ncbi.nlm.nih.gov/pubmed/187406 [Accessed 25th April 2018]

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Hormones in labour: oxytocin and the others - how they work

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You know your hormones are going to be working hard at this time but you might not know exactly what they're doing. You'll in fact have four major hormonal systems active when you're in labour and giving birth.

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Compare your local units with the national picture.

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This page shows results for all measures together per site or per trust/board. If a result is missing, this is because the site or trust/board did not pass our quality checks for this measure. Please refer to the NMPA Measures Technical Specification for exact definitions of the measures.

For 2017/18 results, Data quality and completeness limited the number of English trusts that could be included in this report. Therefore, it is not possible to report a mean that is representative of the three countries combined (the GB mean). The NMPA therefore asks audiences to refrain from interpreting that aggregate trust and board mean as being representative of a GB mean. Further information is available in the full report.

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Spine charts are useful to view results for measures in the context of other relevant measures at a selected site or trust/board, rather than in isolation.

Spine charts show the rates of all measures for the site or trust/board you have selected, and how these compare to the average of all sites or trusts/boards included in each measure. They also give an idea of the overall distributions of rates, and if the rates of the selected site or trust/board fall outside of the expected range. They are essentially slices of the funnel plot for each measure at the point of the site or trust/board you have selected.

Please use the buttons below to choose either site or trust/board level overview, and then select a maternity unit or trust/health board from the dropdown list in order to view a spine chart of its results across all measures compared to the national average.

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This page shows results for all measures together per site or per trust/board. If a result is missing, this is because the site or trust/board did not pass our quality checks for this measure. Please refer to the NMPA Measures Technical Specification for exact definitions of the measures.

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