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.

Why hospitals need to grant pool access to bigger women

Anyone who has followed this blog for a while will know that I strongly believe hospitals need to grant pool access to women with higher BMIs.

My being denied access with my first-born is one of the reasons this blog even exists! I’d discussed it at every appointment, was promised a pool birth in the hospital (so long as the pool in the delivery suite wasn’t occupied when I needed it), taken on a tour of the pool room, but then repeatedly denied access to the pool while I was in labour until someone finally told me at 8cm dilated that I would not be allowed to use it after all. It’s also the reason I chose to have my second baby at home!

Hospitals need to grant pool access to bigger women - Big Birtha's Home Water Birth

My second labour and birth, where I did have access to a pool, confirmed everything I had suspected. The warm water was incredible at helping me manage the pain of contractions! Coupled with that, the buoyancy provided by the water meant that I could move around with ease. I was so much more comfortable and relaxed – even during contractions!

The frustrating thing is there’s no evidence to support restricting access!!

To be honest, there’s not a lot of good-quality evidence about the use of birth pools full stop. But because so few women get access to water birth there’s no data to show it’s safe for larger mums. But because there’s no data to show it’s safe, we’re denied access! Anyone see a problem here?

I’m not alone in thinking this!

It turns out that Health Care Professionals are beginning to notice this. So I’m delighted to report that the Association for Improvements in the Maternity Services asked me to write an article for their journal, complete with oodles of references for you to wave in the faces of healthcare naysayers you may meet. Enjoy!

AIMS Journal Article featuring Big Birtha

https://www.aims.org.uk/journal/item/waterbirth-high-bmi

BigBirthas PSG Research Results!

So, you’ll want to know what happened to the BigBirthas PSG research results? What did we get up to in collaboration with the Parenting Science Gang?

Well, we’re all done. We put out the initial calls to join our Facebook group back in March 2018. Thank you to everyone who joined in. 161 people joined the Facebook group, and we’re still actively discussing issues even now the research has concluded! We held dozens of expert Q&A sessions, and some of the experts sounded like they enjoyed it as much as we did!

Join our Facebook group!

The BigBirthas PSG Research Topic

Conversations within our group revealed that many of us felt our choices were unfairly limited during pregnancy and labour. Our experience suggested that a high BMI leads to health care professionals restricting the choices which are normally available. We also felt that often, there was no medical evidence to suggest that our preferences weren’t perfectly reasonable. Many of us had had very negative experiences, even when our pregnancies were otherwise uncomplicated.

We decided to research how choice is presented to mothers with a high BMI and how that affects maternity experience. Were our situations typical? Or had our negative experiences made us unaware of high-BMI women with less traumatic stories?

We recruited volunteers from anywhere and everywhere in the UK we could think to ask. We were then overwhelmed by the enthusiastic response! Almost immediately, 60+ women responded to our request for research interviewees. 20 of those swiftly completed the full-length responses we needed to do our qualitative study using thematic analysis methods.

Then we stopped asking for respondents, because 20 was about the limit we could manage! Especially with just a small group of first-time thematic analysts running the show!

But that’s the point of Parenting Science Gang; let the parents be in charge of asking the questions they want answered, and of working out how to do it!

The Full BigBirthas PSG Research Findings

Please be aware, that for some, reading other people’s stories can trigger upsetting memories of our own experiences at a time of our most intense vulnerability, so if you do read the full document, please bear this in mind.

You can read our BigBirthas PSG Research Results here: Big Birthas’ Findings

What did we find out?

We did not uncover any great surprises. Our results confirmed that the conversations our group had had were pretty typical. There were a few great stories about knowledgeable health care professionals treating mothers with dignity, but we also found clear themes of unsatisfactory treatment. Several reported observing an immediate change of tone after being weighed:

“When I’d been weighed and measured she immediately started saying things like “Oh, there will be a problem because of your weight” but wouldn’t explain what the problem was. She wasn’t as friendly then and wouldn’t explain things to me”

Language changed, and some mothers felt lectured and patronised. There were almost constant warnings about potential problems (most of which never transpired), repeated tests for conditions (many of which never developed), with some health care professionals resorting to “persuading” mothers using guilt tactics.

“I felt that I was coerced and guilted into an additional scan by one particular midwife.”

“Felt that I didn’t have a choice, I was scared into decisions.”

“I was told ‘Well you must have known the risks when you decided to get pregnant, being the weight you are.”

First Pregnancies

In most cases, first-time around, mothers reported following the recommendations of health care professionals unquestioningly. This too echoed our experiences in the group. It was only after the first birth that many realised that they should have had a choice.

“I didn’t realise you could refuse induction”

“In both labours vaginal examination was presented as a non-option.”

Some mothers reported being ignored:

“I was given all the interventions including an epidural that I had refused”

“First time round I agreed to one [vaginal examination] and the midwife swept me without my consent.”

Disagreements Between Health Care Professionals

Worryingly, many mothers reported finding a great discrepancy between health care professionals, in terms of knowledge and subsequent behaviour. Sometimes mothers found that their weight was the scapegoat for everything with a few professionals, but that others didn’t agree.

“The first sonographer very harshly said that the reason she had trouble was because I was quite fat so it was harder to get a good picture. During other scans I was told that weight doesn’t necessarily come into it and it really does depend on the competency of the sonographer and the position of the baby/womb/placenta”

Many mothers received conflicting messages about risk and options from different professionals. This was both confusing and upsetting, and didn’t inspire confidence in the system to provide for their needs.

“I felt that people knew best, but when professionals are literally disagreeing about the well-being of your unborn baby, it’s a bit disheartening.”

Stress

This lack of consistency, coupled with feeling judged and unsupported had a strong effect on mothers, many of whom reported that pregnancy had been an extremely stressful time for them.

“I found it scary and confusing during my first pregnancy.”

“I left some midwife appointments afraid that I might die in labour!”

Second Pregnancies

Not unexpectedly, mothers prepared for subsequent pregnancies with care. No one mentioned losing weight, but many mothers talked about being much better informed. Many read up on guidelines and risks, were more confident in asserting their views and wishes, and challenged health care professionals to explain themselves, their actions and their recommendations.

“I had the confidence (or some might say bad attitude) to say, I’m not having all of those scans – they aren’t necessary and are a waste of my time.”

Many approached their relationships with health care professionals differently second time around. This manifested itself in their making a concerted effort to form respectful and supportive relationships from the start, either by seeking out professionals they had found supportive in their first pregnancies, or by actively avoiding certain individuals. In several cases women said they had paid for independent midwives or doulas to support and advocate for them.

Sadly, in several second pregnancies, mothers also reported avoiding health care professionals wherever possible; engaging as little as possible and refusing appointments. More than once, mothers reported needing to do this for the sake of their own mental health. This is clearly a very worrying result; it cannot be ideal for any mother, irrespective of medical needs, to be avoiding the service provided to support her. This did however, seem to be a common reaction to prior bad experiences.

Risk Presentation

We know (and I have complained many times!) that many of the risks in pregnancy are delivered in terms which make them sound excessively alarming. For example, where a risk changes in likelihood from 0.1% to 0.3%, it is often represented as “THREE TIMES THE RISK” in big, bold letters, which makes the difference seem very extreme, when it is actually still very low risk.

These alarm bells are also usually rung when the mum is already pregnant, so NOT a safe time to diet or do anything about it, and just increases the stress and feelings of guilt. This is not helpful, and given that no respondents mentioned consciously trying to lose weight between pregnancies, such an approach is clearly not serving any weight-loss motivational purpose either.

There are examples of great care, but until we are able to universally provide larger mums with a respectful and compassionate experience, ensuring they feel in control, then many more mothers will suffer from unnecessary stress during pregnancy, with the result that some will avoid health care professionals altogether, potentially putting themselves and their pregnancies at greater risk.

Thank you to the Parenting Science Gang Team!

Huge thanks to the Parenting Science Gang Team for bringing this project to fruition, for being such lovely, patient, intelligent, enthusiastic ladies, and particularly to Sophia for birthing PSG in the first place. Long may PSG continue gaining funding and doing Citizen Science into all sorts of topics, because it’s bloody ace.

Go and have a look at the Parenting Science Gang page! This link says pretty much everything I’ve said above, worded pretty similarly, but if you have a mooch around, there’s all sorts of fascinating information about the other groups and their experiments on breastmilk, baby wearing, picky eating, homeschooling and more: http://parentingsciencegang.org.uk/experiments/big-birthas-findings/

If you’d like to join us, the BigBirthas Facebook group is still going. Feel free to come and pick our collective brains, have a chat, discuss unicorns, it’s all good! We chat about all topics BigBirthas related, and anyone can post a question for the wisdom of the hivemind to respond. You’d be very welcome.

xx

Big Birtha