Birth in a time of Covid-19

I think most people are a bit anxious right now. There’s a lot going on and a lot to get your head around. But if you’re pregnant, it must be especially worrying. Particularly if it’s your first and you already don’t know what to expect. Pregnancy and birth keeps you on your toes at the best of times, but birth in a time of Covid-19 comes with further considerations.

You can read the Royal College of Obstetricians & Gynaecologists advice on coronavirus infection and pregnancy here.

We’ve had a couple of recent births in the BigBirthas Facebook Group. With permission, here’s a birth story from someone who just did it four days ago! Hopefully this will give a bit of information and reassurance on what to expect if you’re nearing your due date:

Kay’s birth story

I gave birth to my little legend on Friday 27th March.

Newborn baby wearing a hat and clutching at a finger. Birth in a time of covid-19

I was induced at 37+5 due to obstetric cholestasis. (OC is a liver condition which affects 1 in 140 pregnancies in the UK. It is characterised by excessive itchiness, often on the palms of your hands and/or soles of your feet. A bit of itchiness in pregnancy is normal, particularly on a stretching tummy, but always worth getting checked out. – Big Birtha)

He came at 38+1. They kept me in hospital due being high risk with OC and high BMI and the midwives were absolutely amazing. They really put my mind at rest. The consultant and the anaesthetist were pushing for a c-section because of my size, but I rejected and carried on. I knew that I could do it.

In the end I managed all but the last hour without any pain relief at all and the last hour I allowed myself some gas and air. He was born at 2.10am on the 27th weighing 7lbs 14oz and is perfect.

My advice to everyone is to not let them put time pressure on you. If you choose a c-section, that of course is your choice and I am fully supportive, but I am so glad I didn’t let them hound me into one. The ward they put me on (postnatal) I was the only one that had a natural birth. It was so hard watching everyone else struggle even picking up their newborns, whereas I was up and walking about straight away.

Birth in a time of Covid-19 – Kay’s experience

They are taking the upmost care due to current situations, and I am generally a bit of a worrier. If you’re like me don’t let it get you down, I cannot express how safe they made me feel!

The midwifes were only allowed in that section of the hospital. Birthing partners were limited to one and had to take their own food etc. Once they were on the ward they couldn’t leave and come back again. It’s reduced the risk and made everyone feel more comfortable. We all washed so much too, mums, dads, and staff.

All in all it was a very positive experience, even in the circumstances.

Good luck everyone, from one very happy mumma. 💜

*****

Thanks for taking the time out to share that Kay, and congratulations!

Birth in a time of Covid-19 – highlights from the RCOG guidance

The Royal College of Obstetricians & Gynaecologists is carefully monitoring all evidence as it’s released. So for up to date information, it is definitely best to read the advice on their page. The below is current as of 31st March 2020:

Generally, pregnant women do not appear to be more likely to be seriously unwell than other healthy adults if they develop the new coronavirus.

Based on the evidence we have so far, pregnant women are still no more likely to contract coronavirus than the general population.

What has driven the decisions made by officials to place pregnant women in the vulnerable category is caution.

It is expected the large majority of pregnant women will experience only mild or moderate cold/flu like symptoms.

If you think you may have symptoms of COVID-19 you should use the NHS 111 online service for information, or NHS 24 if in Scotland.

Our advice remains that if you feel your symptoms are worsening or if you are not getting better you should contact your maternity care team or use the NHS 111 online service / NHS 24 for further information and advice.

The most important thing to do is to follow government guidance [to reduce the risk of catching coronavirus].

It is really important that you continue to attend your scheduled routine care when you are well.

If you have any concerns, you will still be able to contact your maternity team but please note they may take longer to get back to you

There is a long FAQ section in the Royal College of Obstetricians & Gynaecologists advice so it’s likely most questions you have may be covered there.

Stay safe, and look after yourselves.

x

Big Birtha

Birth Confidence Summit

Do you have an urge to listen to BigBirthas.co.uk founder Amber Marshall talk about high BMI birth for 50 minutes? Surely you’re keen to marvel at how much I waggle my hands around when I talk (because it’s a LOT)!? Well, I’m pleased to tell you your wait is over! I recently took part in a free online Birth Confidence Summit, organised by Birth Confidence Mentor and founder of BirthEssence.co.uk Charlotte Kanyi.

Screenshot of Amber Marshall - founder of BigBirthas talking to Charlotte Kanyi of BirthEssence at the Birth Confidence Summit
Amber Marshall – founder of BigBirthas – talking to Charlotte Kanyi of BirthEssence

Charlotte has interviewed 27 ‘experts’ (her title, not mine) over Skype about many different aspects of birth. Talk titles include Healing from a traumatic birth, Exploring Induction Choices, Dropping the Nice Girl Conditioning – Make Birth Better (which links with) Visibility, Birth and freeing yourself from the Good Girl Archetype, Hypnobirthing for Confidence and more.

It’s a great idea and you can access all the talks for the bargain price of free!

I talk about why I set up the site, research, the difference between absolute and relative risk, looking positively at pregnancy vs the self-fulfilling prophecy, the media, blaming and scapegoating, and a bit about my two pregnancies and births and how I felt about them.

TL:DR?

In my interview I discuss how our bodies are designed for making and birthing babies. That we’re no longer in the minority and therefore shouldn’t be treated as ‘exceptional’ or ‘problematic’, in fact, we should have the same options as anyone else! Yes, carers should monitor the risks and act accordingly, but until something negative arises (and odds are it won’t) we should stay positive! Do your research and don’t expect your doctor to know everything about your personal circumstances and what is best for you. You decide, and you can use the BRAIN acronym to help you ask the right questions.

The Birth Confidence Summit Speakers

It’s a formidable line-up! There are some great speakers here:

Charlotte Kanyi, Confidence Mentor at BirthEssence

Natalie Meddings, Author, doula and birth yoga teacher

Debs Neiger, Independent midwife at Yorkshire Storks

Rebecca Schiller, Writer, Doula and Co Founder of BirthRights Charity

Alexia Leachman, Therapeutic Coach and Host of the award winning Fear Free ChildBirth Podcast

Kemi Johnson, Independent midwife,  KG Hypnobirthing Teacher and Positive Birth Movement Facilitator

Liz Stanford, Owner of the Calm Birth School of hypnobirthing

Clare Ford, Birth Coach and Master Reiki Healer at Beautiful Souls

Mandy Rees,   Pregnancy and Postnatal Yoga Teacher

Mars Lord, Award winning Doula, Doula Trainer at Abuela Doulas and Birth Activist

Phoebe Pallotti, Practicing Midwife and Associate Professor of Midwifery

Dr. Amali Lokugamage, Consultant Obstetrician and Gynaecologist and Author

Samantha Nolan-Smith, Writer, Feminist and Founder and CEO of The School of Visibility

Simone Surgeoner, Mother of four and Journey Practitioner

Jo Bolden, Mother of one and Co founder and professional dancer at One Dance Epic

Emma Svanberg, Clinical Psychologist specialising in pregnancy birth and parenting

Dr. Rebecca Moore, Clinical Psychotherapist in Birth Trauma

Naraya Naserian, Mother of two and Journey Practitioner

Zoe Challenor, Professional Singer and Co Founder of B’Opera and Mother of Two

Lorna Phillip, ​Doula and Mizan Therapist at Birmingham Doula

Jennie Harrison, Energy Healer, Mindset Coach and Birth Trauma Specialist

Joy Horner, Independent Midwife, and facilitator of Positive Birth Movement Group

Kati Edwards, KG Hypnobirthing instructor and Doula at Birth You in Love

Nicola Goodall, Author, Founder of Red Tent Doulas and director of Wysewoman Workshops

Maddie McMahon, Breast Feeding Counsellor, Doula and Doula Trainer at Developing Doulas

Rachel Elizabeth, Mother of four and Doula at Creative Birth

Take a look and big thanks to Charlotte for organising and facilitating!

Birth Story – Twin Home Birth at 42+2

I love a good birth story. And a twin home birth story? Double the fun!

I read this one recently on Chilled Mama, and knew I wanted to share it with you. It’s not a plus-size birth story, but I do think there are some relevant messages about it being the woman who does the allowing, and about how important it is to get the right support. So thank you to Cathy from Chilled Mama, and Laura for sharing this story.

Twin home birth - Caitlyn and Evelyn
Caitlyn and Evelyn

I’ll let Cathy from Chilled Mama take over from here:

Many women are told ‘you’re not allowed to …’. Not allowed to have a home birth with twins. No water birth with twins. Not allowed to have a home birth after 42 weeks.

This birth story comes from Laura, who knows it is women who do the allowing. Supported by AIMS and local consultant midwife, to have a positive home birth previously, finding herself pregnant with twins, she knew she was the one making the decisions about their birth. Her body. Her baby.

Here’s her twin home birth story:

Upon finding out out at the 12 week scan we were expecting twins ( 2 sacs, 2 placentas) I was told ( yes told!) at the time I would be attending the twin clinic at the hospital from now on for all checks etc. This immediately set me on edge. I hate hospitals; many bad experiences including the birth of our first left me traumatised even more. When I fell pregnant with our second I went through AIMS and was put in touch with the consultant midwife, previously known as supervisor of midwives, who came out to the house to talk through everything that happened first time and put me at ease about planning a home birth. Having our little lady at home went perfectly and was so cathartic for me restoring my faith in my ability to birth. 

With twins I knew a home birth would go against the grain so back to this wonder lady I went explaining I didn’t want to have my antenatal checks at the hospital, I wanted to stay with the community team and treat this twin pregnancy as a normal pregnancy until such times as we had evidence to suggest otherwise. This was arranged and we followed the normal schedule of antenatal checks. We had the anomaly scan as normal at 20 weeks showing everything was as it should be so for the time being I declined further scans as babies now just needed to chub up. 

Roll on to November we started to prep for the home birth. We discussed how early we were prepared to stay at home, for the midwives it was 37 weeks, for me I was happy at 36 but I also knew my history was long gestations so I just had to hope we’d make it to 37… we did! Everything in place, pool up, equipment here, team on call, we were all ready to go. That was 19 Dec! 

So we waited and still no babies and carried out the normal antenatal checks at the community clinic once a week, everything always as it should be so no concerns. I was always worried how I’d cope over Christmas and new year with our older two with nursery and play groups etc being off and it was definitely hard with them in the house so much. Hubby was due back to work on 1 Jan so in the absence of babies off he went not wanting to waste his leave. Getting to 40 weeks was quite surprising but again every check showed happy babies and my health remained stable. 

At 40 weeks I did start going down to the hospital to see the consultant midwife and each time we would do a trace of the babies, check BP etc everything always perfect. At 40+3 we did a scan to check fluid levels and placental flow. We also tried a sweep in the hopes of moving them along, generally I would always decline a sweep and have in the past but felt I wanted to try something. We followed this pattern checking on the babies on a Tuesday and Friday each time to check we were safe to wait a few more days. 42 weeks came… and went!!!

At 42+1 (Wednesday) the dream team midwives were coming to the house to check on the babies and discuss next steps… one had a weekend away booked, the other had commitments on the Friday and Saturday so while medically there was no reason to do anything, should the babies not be here by the Thursday night the midwives who would come would not be those I had been working with and trusted which did make me nervous. As it was in the 10 mins before the midwives arrived I thought I had had 2 contractions… one midwife had been awake 36 hours at this stage attending the birth of her grand child so she ran off home to bed. 

Contractions didn’t come to much while seeing to our older two, by 9.30pm they were starting up again so I tried to go to bed and rest. By 11 ish I had to get up, I had a feeling the pool needed started and things organised. At 12 I messaged our doula to say no rush yet but head over, I had the pool filling and the bath so I could get some relief while waiting for the pool. Not long after this I also messaged the consultant midwife feeling terrible that she wouldn’t have had much sleep but knew I couldn’t leave it any longer.

Our doula arrived about 12.30 and just quietly sat with me in the bath as things picked up. After maybe 20 mins I asked her to call the midwife just to make sure the team were on the way, unknown to me they had snuck past the bathroom door and were getting organised. Around 1 I got into the pool at last and got the gas and air going, which felt so much better. That was me in place, I could get my earphones in and my hypnobirthing CD on and go away. 

The sensations had familiarity this time and I could feel as the first baby came through my cervix and felt able to pull back and let it come slowly. Baby crowned relatively easily and again I felt able to hold and breathe while she turned. One final surge and there she was… at 01.35 such an incredibly tiny baby! I don’t think I’ll ever forget or forgive the midwife’s next statement… “Don’t tell me we have undiagnosed triplets!!!” 

One thing was for sure though, this was no overdue baby! Immediately I was so glad I’d stuck to my guns and declined induction, this wee one looked like she needed a few more weeks in the oven. 

As it was we got very little time to dwell as contractions started up again within about 4/5 minutes, seemed like no time at all. I tried to leave baby with her cord and bless them the midwives tried to hold her to me as the contractions were full on straight away but I just couldn’t cope with her there, I was worried I was going to squash or drop her. Quickly we got her cord cut and she went off for cuddles with daddy. 

I could feel the midwife trying to feel for twin 2 position, we knew it had been head down but also that it now had a lot of space to play. As it was the contractions were just coming too fast and I heard her say we’ll just need to be surprised. Again I could feel baby coming down and again tried to hold back and let it come slowly. At 02.10 we had another little lady… who behaved impeccably and stayed head down, born in her caul no one even realised she was out until I sat back and got her out the water. Obviously much bigger than her twin, she was the carbon copy of her older brother and sister, daddy has genes of steel! Again with little time to dwell contractions came back with a vengeance for the placentas.

Again I tried to hold on to baby but these were massive surges that took all my focus and again we had to cut her cord tho I think she got about 5 minutes with it. I always said I wouldn’t want a managed third stage but I did feel after maybe 10/15 mins that I was just so wiped I just wanted it done. Asking the midwife for the injection she was a bit taken back knowing I hate needles but got it sorted quickly and thankfully it was over. I have honestly never felt so depleted I couldn’t even open my eyes.

Soon after the midwife started to get a bit anxious saying she could smell the iron in the room and was concerned over blood loss and wanted me out the pool so I made it out and set up camp on the sofa. At this stage I think I downed two bottles of Lucozade in an attempt to get myself back up. The after pains were also horrific and I was sucking on the gas and air as much as I had done through their births. However after a while I really wanted a bath and the lead midwife started to look like she was hitting a wall she must have been so tired now part of me was keen to show her I was okay to give her the peace of mind to be able to go home. Sadly this is where I’d went a bit haywire….

I got up and made it through to the bathroom but was starting to feel faint so sat down in the toilet seat thinking I’ll be fine in a minute. Sadly I wasn’t, my blood pressure dropped dramatically and I blacked out… the next thing I knew I was aware of a phone call for an ambulance and they were getting me on to the floor to stabilise me.

By the time the paramedics arrived and they exchanged the information needed I was feeling a bit better again, I think lying on the cold floor actually helped me. So much so the midwives were actually saying they didn’t think it was a medical event, more a lack of sleep, not eaten and yes a little more blood loss than ideal but I had stopped actively bleeding so she said if I wanted to stay at home she was happy for me to do so as long as I could make it up to pee as my bladder was really full. However as soon as I tried to get up again I could feel how weak I was and even though I hate hospitals, even I said I think I should go in. So off we went…. two babies, daddy, 3 midwives and our doula.. we were quite the cavalcade!

Thankfully in the end all they really had to do was feed me and give me some stronger pain killers. They checked my iron levels which had dropped 3 points so they said to start taking the iron tablets again but otherwise I’d be fine with time and chance. Again the consultant midwife had made sure I was looked after and had a room to myself and all the midwives on the ward had been asked to leave me alone unless I called to give me a chance to rest. By mid afternoon I felt strong enough to make it home so it wasn’t too bad in the end. It was more of a visit to hospital rather than delivering there which I would have struggled to cope with. 

So that’s how it came to pass that we had our twins delivered at home at 42 weeks and 2 days. I’m forever indebted to the consultant midwife who could not have done more to support me and orchestrate everything to make sure my wishes were carried out right to the last. And all from a supposedly failing NHS…. it just goes to show what patient centred, evidence based care can achieve. 

Laura, Caitlyn and Evelyn

I’m in complete agreement with Cathy here. I love this story because it shows what is possible. You have to ask for it. You may have to talk to the right people. But it is possible. It also shows the value of patient centred evidence based care, as Laura says.

If you have a birth story you’d like to share with the Big Birthas audience, we’d love to hear it! You can contact Big Birtha here.

Accessing research documents for free

I’ve read quite a bit of research while writing articles for this site. But accessing research documents for free can be an issue. I understand that the publications and authors deserve remuneration for their work, of course I do, but the simple fact is if you’re trying to research your birth and maternity care options, most individuals don’t have the budget to pay for journal access. Even if we did, every article that might be worth reading seems to be in a different journal!

A friendly librarian pointed me in the direction of an article she’d written with tips and tricks to access this information for free, so here is the benefit of her wisdom:

Get The Research.org

Get The Research owl logo

gettheresearch.org is a search engine that makes academic information both discoverable and easier to digest. You can use it instead of Google.

Get The Research flags each article with its “level of evidence” when they know it. Is the article just a report about a single incident (a “case study”) or a more trustworthy analysis combining the results of many studies (a “meta-analysis”)? Click on the tags above the article titles to learn more. They rank articles with higher levels of evidence higher in the search results to make them easier to find.

Advantages:

  • user friendly interface
  • evidence based quick overviews

Disadvantages:

  • new so there’s likely some bugs to iron out
  • it’s not clear what information is updated automatically

Open Knowledge Maps.org

Open Knowledge Maps logo

Open Knowledge Maps describes itself as “a charitable non-profit organisation dedicated to improving the visibility of scientific knowledge for science and society.”

It provides a visualisation tool, demonstrating topics and the relationships between them. Use it to get an overview of the most relevant areas of a topic and papers related to those concepts.

Advantages:

  • generates visualisations for your search terms
  • it has an option to visualise results of searches just from PubMed

Disadvantages:

  • still in development
  • it only analyses the first 100 papers based on relevance ranking

Open Access Button.org

Open Access Button logo - - accessing research documents for free

openaccessbutton.org allows you to search for an Open Access version of a paper using it’s URL (web address), DOI (permanent Digital Object Identifier) or title. It’s helpful with accessing research documents for free as you can use it when you’ve found a journal article you want to read, but the publisher tries to charge you to access it.

Advantages:

  • easy to use
  • no installing or configuring, unlike Unpaywall

Disadvantages:

  • it relies on academics submitting a copy of the article

Core.ac.uk

Core Logo

Core.ac.uk is a not-for-profit service delivered by The Open University and Jisc. Institutions store publications created by their academics and CORE allows these to be simultaneously searchable through a single interface. It can be used when you have a keyword search and want a more in-depth, systematic overview of a topic or problem.

Advantages:

  • search a lot of credible information, fast
  • there’s an API for text mining

Disadvantages:

  • you aren’t searching ALL the repositories that exist in the world. It’s possible you will miss a source

Directory of Open Access Journals

Directory of Open Access Journals logo

DOAJ is a community-curated online directory that indexes and provides access to high quality, open access, peer-reviewed journals. DOAJ is independent, and all DOAJ services are free of charge including being indexed in DOAJ. All data is freely available. It’s searchable by title or article. Can be used to follow a specific journal that consistently produces articles about a topic of interest.

Advantages:

  • all of the journals included are Open Access — no paywalls

Disadvantages:

  • there is a small chance of encountering a predatory (scam) journal – however, each journal does undergo over 40 checks before it is listed.

Directory of Open Access Books

Directory of Open Access Books Logo

All books listed in DOAB are freely accessible and therefore free to read, but this does not mean readers are free to do anything they like with these books. The usage rights of the books in DOAB are determined by the license. Please check the license if you want to re-use the contents of a book. Generally speaking, all books listed in DOAB are free to read and share for non-commercial use.

Advantages:

  • avoid annoying previews, this is the whole textbook, for free!

Disadvantages:

  • the idea of Open Access textbooks is still a fairly new movement, so there’s a limited selection.
  • you will have to buy the book if you want to own a complete physical copy of the material. Printing could infringe UK copyright law.

I’m sure this won’t always work to get you access to the article you want to read, but hopefully it will bring more research info easily within reach than before!

x Big Birtha

with thanks to Sheldon Korpet who wrote the article “How to access academic papers online, for free!” on which this post is based. Licensed under CC BY-NC 3.0.