5 min read
moKee Birth School online:
complications in labour
by Suzi Smith •
Sophie, The Infertile Midwife, explains complications during labour
Complications during labour are less frightening if you know why these complications are happening. It’s important to ask your doctor why these complications are happening and what all of your options are. Remember that the Doctors and Midwives must have your consent to do anything during labour.
Instrumental birth, or assisted birth is where you give birth vaginally but you have some help. One in eight women give birth like this, getting a bit of help with a Kiwi or with forceps which are used by a Doctor.
The Kiwi has replaced the ventouse. An assisted birth can only happen if you’re fully dilated and it’s good to know that if you’re not fully dilated the only option is to have a c section if your baby is in distress and needs delivering quickly. The reasons that you might have this is because your baby isn’t happy and needs to be delivered quickly, you might have been pushing for a long time, and for some women with medical reasons they can’t push. Your doctor should be explaining the reason why they are suggesting an assisted birth. It’s important to understand why you need forceps over a Kiwi. When a doctor is assessing the situation, they’ll be making a recommendation on what they’ve found from a vaginal examination. It’s usually to do with the position of the baby. They feel the bones on the baby’s head and figure out where the baby is.
It’s safer to use forceps if you’re baby is preterm - before 37 weeks of pregnancy. It’s important to know that having a caesarean section at fully dilated is not always considered the safest way to give birth. This is because when you are fully dilated, the baby is deep inside the birth canal. There are some manoeuvres that need to happen to dislodge the baby, if it is particularly deep.
In terms of the procedure, the doctor decides on the instrument to use and gets consent. If you don’t already have a catheter in place they’ll put it in, drain the bladder and take it out. It’s really important to have an empty bladder as it gets in the way of baby coming out and they’ll ensure that you have pain relief with either an epidural or a local anaesthetic. Midwives put your legs into the stirrups so when you’re having a contraction you still have to push and then the Doctor pulls at the same time. Usually just pulling three times until baby comes out.
The kiwi is made of plastic and the sponge goes onto the baby’s head on the back. The doctor will insert it into your vagina. They pump it up so the suction stays on the baby’s head. It’s a really small instrument but It can leave a suction mark on the baby’s head but it will go away super quickly. Because they’re soft they are more likely to fail than the forceps.
Forceps look like a big pair of spoons, a big pair of salad tongs. They go around your baby’s head and they are more effective than the Kiwi and they do go on the side of the baby’s head. They’re metal and will cause slight bruising but this will be gone in a couple of days. You are most at risk of bleeding after birth with an assisted birth so in order to prevent this, Midwives recommend active management in the third stage to deliver the placenta. After the baby has born and you’re about to deliver the placenta, we suggest having an injection into the leg to reduce risk of bleeding and to deliver the placenta.
You also have a risk of tearing so you might have an episiotomy. It is very rare to have a big tear- 4 in 100 women get a third or fourth degree tear with a kiwi, and only 8 to 12 in every 100 from a forceps. That is why you are offered an episiotomy to reduce big tearing.
C sections are a surgical procedure where the baby comes out via the lower abdomen. There are lots of reasons as to why you might have a c section. If the baby is breech - coming bottom first, then you may have a planned caesarean. If your placenta is covering the cervix the baby can’t come out naturally, so a c section has to happen. Multiple pregnancies, twins or triplets, are often delivered via c section. It might be safer for you to have a c section rather than a vaginal birth due to a medical condition.
Emergency c sections happen for a variety of reasons. If your baby isn’t very happy and you’re not fully dilated, if labour is very slow and lots of things have been tried, a c section will be offered.
A spinal is often used to numb you but if you’ve already got an epidural, they’ll give you a really big dose to make you feel numb. You’ll feel touch but no pain. You’ll have a catheter and you’ll be in an operating theatre on your back but tilted to the side. In the 3rd trimester don’t lie flat on your back because the weight of your baby sits on your big blood vessels, which will stops oxygen getting around your body as well we getting to your baby.
Midwives shave you before theatre, as they don’t want hair in the wound. You don’t need to shave or wax before but go ahead if you want to. From the time the Doctors start to the time the baby is born, it’s usually 5 minutes and then 30- 40 mins when they put you back together again. Most people are so distracted by their baby and they won’t realise the time. You will feel touch but no pain and when they are trying to deliver the baby you’ll feel like someone is doing the washing up in your tummy. You’ll feel people moving inside you. You feel a lot of pressure on your tummy just before the baby is being delivered. The midwife will check the baby once it’s delivered to ensure that it’s breathing and then they usually come straight to you for a cuddle. You can’t cut a cord but usually the Doctor’s leave it nice and long, so you can trim it down, and have that nice moment. You can do skin to skin in theatre, so just let the Midwife know that you want to. After they clean you up and you go to a recovery area and then you’ll go to the post natal ward. All of the usual post theatre care will happen; nurses will do your observations regularly.
The perineum is the bit between the vagina and anus. It is really common to sustain an injury during childbirth. 9 out of 10 first time mums will have some sort of trauma to the perineum. That could be a tiny graze which doesn’t need any stitches right up to 3/4th degree tears which are really rare. 1 in 100 will have a 3rd or 4th degree tear. Most common is the 2nd degrees tear which are little- damage to the skin and muscle. They heal really quickly but you will be sore for a few days.
It is important to wash your hands before you go to the loo as well as after when you’re post delivery. Your hands might not be clean so you need to wash your hands before you touch the wound and change your pad, which you should do regularly. Make sure the area stays really clean and dry, don’t put any lotions on it, you do not need to put anything on your tear as it can irritate them and you’ll be more prone to have an infection. Just use water when washing, no soaps. Have knicker off time too; air is good for the wound.
Make sure that you do your Pelvic floor exercises throughout pregnancy but also post birth as they are important if you’ve had a tear, they help to heal it, bringing lots of blood to the wound. If you have any discharge, or if the wound seems smelly, please tell your Midwife. Midwives should check it when they come and check up on your and baby.
Perineal massage can help prevent tears and it is good for first time mums. Start from 35 weeks and it can be useful to do after a warm bath when muscles are softer. Take your thumbs and out them inside your vagina and press down and stretch out. It should feel like you’re stretching things but not painful. Use a lubricant, such as a natural based oil, olive oil, almond oil for example and try and do it every day.
Ask your midwife for being hands on at birth to help reduce tearing. This is where the midwife will put their hand on the perineum when the baby is coming out. It helps you to have a controlled delivery. If the baby is delivered slowly you are less likely to tear.
Finally, have a warm compress on your perineum during birth. A sanitary pad with warm water on it helps draw blood to the area and then you’re less likely to have a tear.
by Suzi Smith •
moKee Birth School online:
caring for newborn
6 min read
by Suzi Smith •
Newborn babies are incredible little creatures, they come out perfectly. When you see their perfect little faces you’ll be blown away. Here are some tips from Marie Louise, known as The Modern Midwife, to help you care for your newborn.
When babies are born it’s a whole new world for them, they’ve never heard clear voices, seen bright lights, breathed before and now they have been born into a whole new environment. It’s also 15 degrees cooler. Physiologically, their bodies are also having to adapt to the new environment. For example, in pregnancy the fetal circulatory system is the opposite to us; Oxygenated blood is carried in their veins and deoxygenated blood is carried in their arteries. They need to switch over their circulatory system and learn to breathe on their own as soon as they’re born. It’s really beneficial to be aware of all of this as babies are sometimes labelled needy or you’re asked ‘if you’ve got a good baby’. All newborn babies cry and don’t really sleep in the first few weeks as they are just adjusting to being a human.
First of all to understand what you newborn baby needs to go through and to help you cut out the judgement of being a parent; babies crying and not sleeping is no reflection on you, it’s what they’re meant to do.
The second thing is that the 4th trimester is an extension of your body. They are 100% reliant on their parents in the first three months so your newborn baby is totally reliant on your body after birth. Your baby needs to be close to you. Babies gain comfort from being close to their parents. There are three main ways to calm down your baby.
Skin to skin is loved by babies; it relaxes their muscles, their breath deepens, it’s a physical communication between the two bodies. When the baby is happy, relaxed and feels safe, it is then able to go into a state of thriving rather than surviving. Babies’ need this to be able to grow and this takes energy. Oxytocin is expressed when babies are happy and calm and it helps to grow their brain and develop their body.
Warmth - when a baby is close to you, you’re keeping them warm. Get your birth partner to have skin to skin or have it with them later if you’re unable to, even six hours later or six days, being close will help your baby. Warm babies feed better, as they can spend their energy on growth rather than staying warm. Cold babies have to regulate their blood sugar levels to stay warm, so if they’re already warm, their bodies can concentrate on growing.
Sound is great for newborns. The sound of mum’s blood when in the womb is loud for a baby, rushing round your body. So, babies actually don’t like silence, they actually prefer a little bit of noise. Whooshing noises are preferred as that is what they were used to. It’s quite disturbing to put your baby in a silent room as it’s not what they’re used to. Give your baby some white background noise. Babies can also hear from inside the womb and it’s been proven that they can remember specific songs and voices. Make your baby a playlist and play it to them whilst pregnant. Then when they’re born, when they’re a little unsettled, it will remind them of a comforting time. You can also go into a place in your house where you feel relaxed, put some candles and incense on and then put on the playlist and spend that time really focusing on how you feel about your baby, thinking about meeting your baby. Your oxytocin levels will rise when you’re thinking about it. When your baby is born, they may remember that moment receiving oxytocin and lovely feelings when listening to this playlist.
Babies have never seen a face before when born, yet newborn babies are instinctively drawn to faces. A baby will spend longer looking at a face than it will spend looking at anything else. They have an innate response to want to focus on a face. They will start to recognise the people they’re around mostly within three weeks of life. Get quite close to your baby, their eyesight is not great but they’ll be able to see you. Talk to your baby and get really close to your baby regularly. Try not to have too many visitors too soon around your newborn baby. This is because they need to get familiar with you and your partner. During lockdown mums are sad that their family and friends can’t come and see their baby, but this could be viewed as a positive thing as it means that this time is so precious and beneficial for just parents and baby.
Interaction and language with newborns is vital to help them develop. Newborns are absorbing everything and some scientists describes this as a time that is unforgettable yet unmemorable. A lot of this time is shaping the brain. A high level of interaction includes talking and responding to your baby when they cry, they get used to the different words, such as nappy, sleep. This starts to build on their understanding of the words and their world. Language is one of the best ways that human interact, we express ourselves through language. Babies that heard more words in a day, remember and recall more. It’s also proven that their vocab was better when they were at schooling age.
From a clinical perspective, how do I know if my baby is well. There are few things to assess them to see if they are well. If at any point you have any concerns over your baby’s behaviour, speak to your health care provider immediately.
Midwives assess babies by firstly looking at their colour. The colour tells how well perfused they are. How well blood is going round the body. Sometimes they look yellow but this can be normal when born have a really high blood count so their body has to take time breaking this down which can turn them a bit yellow.
If the whites of their eyes are yellow, they are sleeping a lot and through feed, not interested in feeding, aren’t weeing and pooing, speak to your midwife urgently.
We also touch babies to see how warm they are. We touch the back of their neck and their stomach to see how warm they feel. Room temperature for a baby should be between 16-20 degrees. Measure the room temperature as warm babies grow and feed better.
How a baby goes to the toilet is another way to assess your baby. Are they having a wee regularly, how is their poo? At first your baby will pass something called meconium, it’s black sticky and difficult to get off – a but like marmite! Don’t worry that’s normal
Poo will start to change after a few days. If you don’t notice any change in your baby’s poo, speak to your Midwife. Baby should be weeing but generally the nappy is heaver with the wee and a slight change of colour. It’s a great way to assess how well they are.
The cord. In your tummy the baby’s cord is delivering stem cells and Oxygen rick blood and nutrients to them throughout pregnancy. When they are born we cut and clamp the cord and the cord is still attached to your baby. It looks strange after birth, it’s a bit floppy and it’s white in colour. After a couple of days it starts to dry up and it will look brown and shrivelled. If it is not smelly then you don’t need to do anything with it. Leave it alone and it will fall off between 7-10 days after birth. Make sure that you leave it outside of the nappy, so it doesn’t get wet and cause an infection.
Another way to assess your baby is to see if they are alert. Are they alert for their feeds, they should be looking around when awake and moving their body. They do sleep a lot but they shouldn’t be floppy or lethargic when awake. They should be responsive and have good muscle tone. Please phone an ambulance if you have a floppy baby immediately.
Second night syndrome is when the baby is very unsettled on night two of being born. There are two explanations for this. The first is that baby is quite tired from the birth and then the baby sleeps really well on the first night and then on the second night they realise that life as they know is over and they cry for a lot of the night. The second explanation is that babies will wake very frequently to encourage mum’s milk supply to come through. It’s an innate behaviour. Do not worry! It is not a reflection of you or your parenting, it is usually normal newborn behaviour, especially if you have chosen to breastfeed. At some point in the first week, most parents will have a very disturbed sleep and this is completely normal.
Do not leave a newborn baby to cry. Controlled crying techniques are not advised for newborn babies, it’s is up to your how you parent and what you do later on but in those early newborn days I would avoid any kind of sleep training or ignoring crying. Newborn babies are crying for a reason. You won’t be making a rod for your own back by cuddling your baby when they cry, despite what some people might say.
And finally, don’t forget to care for yourself, that is about caring for your newborn too. You are so important to your baby, so take care of yourself. Take time out to look after yourself and especially your mental health. Be honest with yourself about how you’re feeling and talk to people around you who will be able to help.
by Suzi Smith •
moKee Birth School online:
6 min read
by Suzi Smith •
The 4th session of moKee Birth School online is behind us! Sophie, The Infertile Midwife, shared her tips to helping with pain relief during childbirth.
Self help methods
Breathing exercises are a good way to manage pain but they aren’t going to take the pain away, they are all about pain management. Breathing exercises are really helpful during labour as it’s important to breathe when you’re having contractions. Your uterus squeezes down and momentarily the blood flow to the placenta is reduced. But if you’re holding your breath, there’s even less oxygen so it’s really important to breathe.
There are lots of places to learn about relaxation breathing but it’s all about breathing in through your nose for as long as you can and then out of your mouth making the breathes long and slow. This can be a great way to get through each contraction.
Hypnobirthing is not going to take the pain away but it helps to focus the energy to get through each surge. There are a lot of breathing exercises involved. It’s quite similar to mindfulness and it’s something you have to prep and practice. You have to do this towards the end of pregnancy, the more you prepare the greater rewards you reap during labour. There’s not a huge amount of studies into hypnobirthing- there are no harmful effects to you or your baby but we don’t know how well it helps with pain relief. It can really help manage adrenaline and cortisol which are stress hormones. It’s natural to have these hormones during labour but midwives don’t want it getting in the way of oxytocin, which is the happiness hormone. That’s why hypnobirthing helps- oxytocin goes up and cortisol goes down. If things deviate away from your birth plan, this can really help you ground you and calm everything down. You can attend classes which are currently online, but you can pick up a book or look online for recordings to download.
Massage is something your partner can do in labour. Some people find that the pressure is nice during the contractions but dome people don’t like to be touched. Put pressure on the lower back during the contractions, feet and shoulder rubbing all helps. Get your partner to practice a shoulder massage/foot massage ahead of labour.
Pain relief- birthing pool
These are really popular but there haven’t been a huge number of studies into birthing pool use to manage pain. The studies that have been done show that if you use a pool you’re less likely to use an epidural and you’ll usually find labour less painful. The pool needs to be between 37.5 degrees and 36.5 degrees. You want it to be around body temperature so you’re not overheating- baby needs to avoid coming out into hot or cold water. The midwife will be checking the temperature throughout. Have a thermometer to check if at home. Midwives can still listen to baby’s hearts in the pool and a wireless CTG monitor can also be used in the pool. For some hospitals it’s policy to protect the perineum as the baby is born, so that baby comes out nice and slowly. This can’t happen if you give birth in the pool, so some choose to get out of the pool to give birth. The good thing about using a pool is that it allows you to use gas and air whilst you’re in there.
It’s stands for Transcutaneous Electrical Nerve Stimulation It is a really good idea to use this in the early or latent stages of labour. Before you’re in active labour and at home, get it going. You can buy or rent the machine and it’s a handheld device with wires and sticky patches which go on your back. It sends a small impulse down the wires and it tingles on your body. That impulse goes down your nerves quicker than the pain does, so it blocks the pain signal getting to your brain. There are lots of different settings- start on the lowest stage. Press the boost button when you feel the contraction happening and turn off when the contraction is finished. You can’t use it when you’re in the pool or bath remember though.
Entonox is also called gas and air. It’s a mix of 50% nitrous oxide and 50% oxygen. You simply inhale the gas and air and it can be used in all birth settings, including home births. Only use this when you have a contraction. When it starts to build, breathe it in and then stop using when it’s over. This works immediately and it wares off when you stop breathing it in. It can make you feel a little bit sick and it can give you a dry mouth so in between have sips of water and pack a lip balm. There are no effects on the baby so this is a really safe option.
Paracetamol- use this in the early and later stages of labour, especially whist you’re at home. It’s the first choice of pain relief for women as we know it’s safe for baby and mum. Do not take if you have any allergies. Just take two tablets (1g) every 4-6 hours but no more than 4 times in 24 hours.
This is a really mild opioid so it does have similar side effects to other opioids. It’s much milder though and it’s taken orally. You can take it on its own or have a tablet mixed with paracetamol. This is good to take at the early stage of labour.
These are great pain relief options and it’s commonly called pethidene or diamorphine. They are both very similar and are usually given as an injection into your bottom or thigh and can be available at home births. It’s best given at the early stages of labour and this is because they cross the placenta and can make baby a bit drowsy. So, to avoid this the midwife assess how likely it is that you’ll give birth shortly. They work by making you feel really relaxed. Some people can even sleep during contractions. Side effects are drowsiness, nausea and vomiting. Midwifes often give an anti sickness medication too. Midwives will not allow you to get into the pool within two hours of taking the medication.
Pcpa- patient controlled xxxxx
So a PCA is a pump that is attached to a drip in your vein. You have a button to press every time you want pain relief. Usually it’s a drug called remifentanil. It’s not very common to use in labour and is often used if the women is unable to have an epidural. It is an opioid so similar side effects include sickness and feeling sleepy. It can make the baby a bit sleepy after birth so you need to be assessed before being given it.
Epidurals are only available in obstetric unit. If you do want one you have to be transferred to the unit. This is because they are more complicated than other pain reliefs and need to be administrated by an anaesthetist. You have more checks ups and you’ll need a cannula in your arm to give you fluid, so it helps to keep your blood pressure stable. To site an epidural, your anaesthetist asks you to curl up like a prawn, to push your spine out. They give you a local anaesthetic to numb your back too. Once you’re in position they pop a needle into you back and put a thin tube through the needle. They then take the needle away and the tube stays in your back. This tube allows the drugs to be administered. The anaesthetist gives you an initial does and within 30 mins you should be comfortable. You can then top up your medication if you feel uncomfortable. It has a lock out so you can’t overdose. Your legs get quite heavy. It doesn’t make first stage of labour longer but it can make the second stage of labour longer. If you do have an epidural it doesn’t increase your changes of having a c section but it does increase forceps.
You should try to be as mobile as possible. It depends how heavy your block is; some people will be able to walk, some won’t. If you can’t move about ask for a peanut ball which will help you keep your legs open. You’ll need to have a catheter if you aren’t mobile, so that you can empty your bladder and baby can descend into your pelvis.
When it’s fully functioning you’ll be able to feel touch but not pain. You’ll be aware of a contraction but you won’t feel pain. If you do end up needing a c section your anaesthetist will you a huge dose to make sure that you’re numb. Side effects are not common but so that you’re fully informed:
- You might be itchy whilst having it, feeling shivery
- It can give you a fever during labour
- One in 100 will get a severe headache after the epidural but it can be treated
- There could be a drop in blood pressure- one in 50
- Sometimes it doesn’t work first time so it might have to be done again- it is fairly common, 1-10/20 cases.
- Nerve damage- one out of 10000/20000 will get temporary never damage. One in 240000 will have permanent damage
- Meningitis- this is really rare and 1 in 100,000 women could get it
A spinal is similar but there are a few differences. A spinal is a one off injection, there is no tube that stays in your back. If you’re having a c section this is the pain relief that you usually have. You will be numb from the bottom of your breasts downwards. It’s a heavy block and they work really quickly. You won’t be able to move your legs but you might feel touch.
Lastly a general anaesthetic. Not common when in labour but this might happen if none of the other pain relief options are appropriate or if a c section needs to be done really urgently. Your partner is not allowed into theatre with you and your baby can come out sleepy. You’ll feel tied and sick when you wake up and you’ll need further pain relief. Rare side effects include breathing tubes damaging your wind pipes. There is a fairly common risk of mild affections, around 1 in 100. One risk is acid going from your stomach into your lungs and that is a 1 in 1000 chance. Doctors will give you an anti acid to stop this happening. There is also a very slight chance of brain damage- 1 or two people a year in the UK.
by Suzi Smith •
moKee Birth School online:
the induction of labour
6 min read
by Suzi Smith •
Marie Louise joins us on the moKee Birth School Online to discuss the induction of labour.
Firstly, to make you aware, induction of labour varies from hospital to hospital but generally it’s similar methods which are used with varying timescales.
At the moment in the UK around about 20% of women are induced and one of the top reasons is being overdue. There are lots of different types of inductions of labour which I’ll run through with you today.
If this is your first baby, just know that around 80% of first-time mums go overdue, so don’t get fixated on that date. In fact, up to 5% of babies are born on their due date. When we give you your due date, it’s your EDD Estimated Due Date. Please take note of estimated. Please take this date with a pinch of salt. Friends and family bombarding you with texts asking if the baby has arrived is not good for you, so make it clear to everyone that 8 in 10 women go overdue and that it’s to be expected. A good tip is to tell people a later due date to ease the stress and you will probably be overdue anyway!
There can be medical reasons for being induced too; raised blood pressure, diabetes, a smaller baby, a bigger baby. Another reason is if your waters have gone but you haven’t gone into labour within 24 hours. Some hospitals have some variations around this time frame.
If you are being offered an induction of labour, please run through everything with your health care provider- why is it being recommended. Use the BRAIN Tool which I mention in the first session. Run through what the benefits and risks are, any alternatives, what your instinct is telling you and what happens if you do nothing?
If we can’t find your cervix don’t worry, this is very common. If we do find your cervix, the aim is to trigger your body to go into labour. What that does is send messages to your cervix to say, ok let’s do something. You’ll start contracting and can then go into labour. You can have a repeat sweep 48 hours later if it doesn’t work the first time around. Sometimes they don’t work at all- just more than 50% of sweeps work. This is a little bit debatable, because there are so many variables involved though.
Have a look on the risks and benefits of having a sweep on the NHS website. It’s a low risk procedure but it can be quite uncomfortable.
If you go into labour, fantastic! That’s exactly what we want. If you don’t go into labour, sometimes a sweep can cause an irritable uterus. These tightenings don’t put your body into labour unfortunately. We don’t know who will have this or who will go into labour. It’s a conversation to have with your midwife to decide.
If you don’t get into labour at all and you’re still being recommended for an induction of labour. We then need to run through everything. In most hospitals you’ll be given a day and time to come in. Sometimes hospitals will call and change your induction time, but only if you’re low risk.
On the day you’ll come in with all of your bits ready for your baby, because the idea is that you’ll leave the unit with your baby. The whole process takes a long time so takes lots of snacks. A tv card is a must, please ask! Take a book and be ready to wait. Sometimes it can take days….
You’ll be assessed by monitoring the baby with a CTG monitor. You’ll have the baby’s heart beat recorded and then you’ll be offered the prostaglandins - there are two types that you will be offered. One of them is Propess and this is like a little tampon that sits behind your cervix. The other one is called Prostin and is a gel. Both of them aim to soften the cervix and to ripen it. When your body isn’t used to going into labour, generally your cervix is thick and closed. We want your cervix to open up, soften and stretch into your uterus. We want a shorter cervix and slightly open. Some women go into labour just from this.
If we can’t break your waters we’ll generally suggest a hormone drip. We cant break your waters other than in a labour ward. The hormone drip is oxytocin and we pop a canular in your hand, so we need to find a vein. Sometimes it’s in your arm. It’s a tube that administers the fluids. Midwives also monitor your baby throughout this because with any drugs, we need to know that the baby is happy. It goes through quite slowly and the midwife gradually increases it. At any point that you want pain relief, ask your midwife. Make a BOSS BIRTH PLAN- see the first session on the website to see the info about pain relief.
So, the drip will continue to go through until you’re getting about 4 contractions in a ten minute period, coming nice and regularly. We’ll see them on the monitor and you’ll have one midwife continuously to look after you.
So that will run through and will hopefully help you get the right amount of contractions. We should then be able to break your waters if they haven’t already. However, you can be on the hormone drip for some time.
We’ll then get you into labour and the whole point is for you to have a vaginal birth. If the induction of labour doesn’t work then you will need to have a conversation with a senior doctor about other options. We then need to continue and so the next step is generally a c section. At the time, ask all of the questions- run through everything. it’s very rare that there are emergency c sections, so we have time to meet your requests. For example if you want some music paying during your c section, we can have a chat about it. Don’t be afraid of asking what you want.
Who to bring with you for an induction of labour. Things have changed due to Covid 19. Check with your hospital but it’s probably going to be the same as spontaneous labour but we can’t guarantee it. Your partner comes when you’re in established labour- three contractions that are lasting a minute in a ten minute period and your cervix needs to be 4cm dilated. Some hospitals will say that it’s ok for you to go home during some parts of the induction of labour process. Ask if it’s ok to go home. Once you’re in labour you need support so someone needs to be with you. I’ve picked 5 people to ensure that someone will be with me. If my partner has symptoms of Covid 19, they won’t be able to join you. So, ask a few people, just in case.
The last point is immediately after you’ve had your baby. After you’ve had your baby if you’ve had an induction you’ll be in a delivery suite. If you’ve had an epidural or a c section then you will stay in a bit longer and immediately after birth we run through all your observations and baby observations. Get your birth partner to have skin to skin if you don’t feel up to it as it’s so good for babies. A baby’s experience of birth is really unique. They are completely disoriented in this whole new world. It’s cold, light and their body has to do new things. Simply giving skin to skin with baby is comforting; they can smell you, hear you and you can keep them warm. The baby will recognise the sound of your birth partner’s voice if they’ve been around you during pregnancy.
Then we’ll check your baby over. We’ll go from top to toe. It’s my favourite thing to do and every time I think how gorgeous they are. They are so perfect. We are making sure that your baby looks healthy and well. If we detect abnormalities, we’ll call the baby doctor and they will review the baby. This is really rare. Vitamin k is an injection your baby receives. They can have it orally or not at all. It depends on what you’re comfortable with. We’ll also weigh the baby which is really exciting. I always have bets about how much they’ll weight with parents. We’ll document everything and then we’ll offer you some tea and toast. This time is so precious, we call it the golden first hour after birth. Sometimes people ask for visitors quite quickly. If you’re comfortable that’s fine, but just remember how previous this time it is for you to explore your own baby. Always put yourself first. Sometimes it can be awkward but you need to protect that bond and meeting with your baby., You’ll never get these moments back. Block out the rest of the world.
by Suzi Smith •
moKee Birth School online:
stages of labour
4 min read
by Suzi Smith •
Welcome to our second moKee Birth School online where we had Sophie Martin, The Infertile Midwife. Join us to run through the stages of labour.
First up is a bit of anatomy about the cervix. This is the neck of the womb and it opens up for the baby to be delivered. Before labour your cervix is quite firm and closed and sits high up in the vagina. The firmness is as thick as your nose. So that the baby can pass through the cervix it needs to get nice and soft and stretchy.
How Midwives and Doctors track changes to your cervix is called the Bishop’s Score- this helps to determine at what stage the labour is at. The cervix will start to shorten and thin out at around 36 weeks and continue until birth. It softens and stretches and most of the changes happen through contractions.
Early stage of labour
This is sometimes called the latent phase. This is where the softening happens and thinning and shortening. You might see a mucus plug or a show. This is a jelly-like substance which sits inside the cervix and it acts as a protective barrier stopping bacteria getting into the womb. As the cervical changes happen, the mucus plug starts to come out. It can come out in one big blob or it can come out in several smaller pieces. It looks like snot, really sticky and it can have pink and red blood through it. If you see heavy blood, call your maternity unit. Some people don’t have a show and it doesn’t necessarily mean that you’re going into labour immediately. It’s a sign that cervical changes are happening.
Braxton hicks happen in the early stages of labour when your uterus contracts and releases. Your tummy will go hard and then soft. They are uncomfortable but not painful and they are a sign that your body is getting ready for birth. They tend to be irregular and they can sometimes be stimulated through dehydration or your baby moving.
Cramping is also common during labour, similar to a period cramping, under the bump, or on the back.
Diarrhoea and vomiting are also common in the early stages of labour and are very normal. Labour uses a lot of energy, so processing like digestion isn’t a priority for your body, it gets rid of food so your body can focus on the labour. Not everyone will experience this. If you are experiencing this over a long period of time, call your maternity unit. Keep hydrated- little and often.
Contractions are when the tummy goes hard for a few seconds and then releases. They can be sporadic in early labour and they are intense and can be painful. As the labour progresses they become longer, more regular and more intense. By the time you’re in active labour, you’ll be having 3-4 contractions during this time. If you are still able to talk, it is likely that you’re experiencing braxton hicks rather than contractions. It’s not uncommon to start contractions and then to stop. Quite often people notice that they start having pains during the nights and then the next day it will stop. This is completely normal. First babies, can take quite a long time to arrive. Throughout this stage, you’ll feel your baby like usual. If your baby isn’t moving, call your maternity unit.
In this period, rest your body and this doesn’t mean sleeping. Laying on your left side with your eyes closed to help save your energy for labour. Keeping hydrated is important as dehydration can stop labour. Isotonic drinks are good with lots of electrolytes which are good for your body. Ask your birth partner to be in charge of encouraging you to drink. Remember to empty your bladder in early labour. Full bladders stop baby moving down. It can also damage your bladder if the baby keeps pressing on it.
Some people find it difficult to rest, so sometimes moving around and keeping active is good. Use a birthing ball with your knees really wide open. Rocking your hips from side to side will help to give baby lots of room to move down.
In early labour, if you’re planning on having a TENS machine, make sure that you use in the early stages. It sends mild electrical impulses and it’s great pain relief. Buy or rent them and then build up the impulses as labour progresses.
Relaxation is great for you and baby. If you’re trying hypnobirthing, get your music on. Use headphones as it will get you more in the zone rather than listening to it in the room. Breathing exercises are great and a warm bath or showers will help provide great pain relief. Sometimes this also slows the contractions down and this is very normal. It’s safe to take paracetamol in the early stages of labour too.
Nourishment is really important, snack little and often and this is a job for your birth partner to ensure that you’re fuelling your body. Fruit seeds and nuts are good as they’re high in energy. Don’t have heavy food.
Call your midwife when you’re in early labour to get reassurance or to see if you can come in for a check-up.
Active Labour is when you are over 4cm dilated and having strong regular contractions.
Contractions have to build up, so by the time you’re in active labour they’ll be really regular- 3-4 in a ten minute period lasting around 60 seconds each. Contractions can wane in early labour, in active labour they are very regular and you should feel this being more intense. Often people talk about them being painful but sometimes people describe them as really intense surges.
Don’t hold your breath when you’re having a contraction. It’s really common to clench everything and your uterus is going to squeeze down. Blood flow is temporarily reduced so we want lots of oxygen to go to the baby. It’s really important to keep breathing to give lots of oxygen to the baby. Start timing your contractions when you get more regular. A watch is fine and it doesn’t have to be exact.
When should I go to the hospital?
If you have a high-risk pregnancy you should call as soon as you have regular contractions. Also if you’re in labour and it’s less than 37 weeks. Second babies don’t hang around and the latent phase doesn’t tend to be too long. Call your midwife as soon as you start regular contractions. First babies can take a little longer so come in when you have regular contractions. Call your midwife first and you can go earlier to get extra pain relief if you need it.
If your waters break it’s important to phone your midwife. It can happen at any time, either at the beginning or at the end of labour. Waters can be a big gush or it can be a little trickle and this happens if the waters have happened at the top of your stomach. It is quite common to get a watery discharge towards the end of pregnancy but this is quite normal. If you’re having to wear a pad, and you're constantly wet, it’s more likely to be your waters breaking. Waters continue until your baby arrives.
The waters can be straw and clear colour or also pink. If they are green or a brown or an offensive smell, it’s important that you should call your midwife as it’s a sign that your baby has done a poo.
During this active stage of labour, midwives do observations- they take blood pressure, pulse, respiration rate, all at regular intervals. Vaginal examination happens when two fingers are inserted into the vagina to check how dilated the cervix is. This can also check the position of the baby. We try not to do this too often, so ask your midwife why they are recommending this.
Midwives will also use a doppler to measure the heart rate of the baby. A CTG machine might also be used and make sure that you ask for a wireless one so that you can still move about.
Midwives note how much fluid you’re taking on and off and if you’re emptying your bladder. Midwives will also look out for a purple line which appears in between your bottom cheeks when you are in advanced labour. This indicates that the baby is really low down the vaginal canal. If you want to go for a poo, this also means that your baby is soon to be born. Midwives actually get very excited about this stage!
You can request pain relief throughout your labour. Move about as much as possible, keep trying different positions. Upright positions are great as gravity is on your side. There will be lots of toys and equipment for you to use at hospital- bean bags, stools, balls. Ask if they have a peanut ball as it’s good to have between your legs during labour.
The next stage is a short transitional stage, it’s the point in when you are coming up to fully dilated. This is usually when you have a feeling of loss of control. This stage is very short. Focus on each surge as it comes. Each contraction brings you closer to meeting your baby. It means that things are cracking on! Birth affirmations really motivate you to carry on; buy or draw them and put them up in the room. For example, ‘my body knows how to birth my baby’ Warn your birth partner about this sign of labour. If they know what to expect, they will be able to support you better.
You’ll then be in the second stage. This is where you are fully dilated, and lasts until your baby is born. It involves pushing and it can take a few hours. Your cervix is fully dilated and the baby begins going down the birth canal. Contractions become more intense and you have a real urge to push, lots more pressure on your bowels. If you have an epidural, the midwife will guide you when to push. If not, your body will tell you exactly when to push. It will become so overwhelming you just have to push. Baby’s head rocks back and forth round the U bend of the birth canal. It starts to stretch the outside of the vagina and your midwife will start to verbally give instructions. Maybe asking you to pant and this is so that your baby can be born in a slow controlled way to reduce the risk of tearing. Midwives might put their hand on the perineum to protect it. Listen to your midwife so that it is a slow controlled birth.
Once the baby is born they quickly check that baby is ok and give them to you for a cuddle- congratulations!
Delivery of the placenta.
This is the third stage of labour and you have two options to deliver the placenta.
Active management- certain women will have risk factors for bleeding so this is safe for them. In this, we give an injection into your thigh and it contracts your uterus so that the placenta can move down. It risks the reduction of bleeding as it contracts all the blood vessels. Side effects such as nausea and vomiting can happen and the placenta will be delivered within 30 minutes.
The other method is physiological management which is only suitable for women who have no risk factors for bleeding. Midwives wait for the placenta to leave the body. Stand up and gravity helps push it out. If you do decide to have active management you can do this at any point.
by Suzi Smith •
moKee Birth School online:
how to prepare for the arrival of your baby
3 min read
by Suzi Smith •
Thank you to everyone who joined us on our first moKee Birth School Online session. We’ve had such fantastic feedback and we’re glad to be able to provide support and advice to you all in these uncertain times.
Marie Louise, AKA The Modern Midwife was our first guest who ran through how to prepare for the arrival of your baby; from feeling happy to what pain relief options you have, there was so much good advice which we’ve summarised here for you all.
Create your digital tribe
Now more than ever it is important to have a digital network of people you can reply on. Whether that’s someone you can text at 3 am for advice during a feed, or if it’s someone who can just provide a digital shoulder to cry on! Create a WhatsApp group and keep talking!
Get into nesting mode and we don’t just mean clearing out the house, we mean creating a relaxing space for you and baby to enjoy. Whether it’s meditation with deep breathing to calm your mind and body to send calming hormones to baby or soaking your tired feet in a hot bowl filled with fragrant lavender oil, really make the time to chill.
Boss Birth Plan
A birthing plan is not about putting together a strict schedule for exactly how you want to have your baby. A birthing plan, or as Marie Louise likes to call it, a Boss Birthing Plan, is all about putting mum in the driving seat. Get all the information so that mum can make the right decisions for her when it comes to having to make those all important decisions during labour. Once mum knows all the options, she can then work as a team with the Midwife to have the best birth possible.
Marie Louise gave us the BRAIN tool to help ask the right questions when having to make decisions during labour:
B - Benefits - what are the benefits of taking this option given by the midwife or doctor?
R - Risks- what are the risks associated of taking this option given by the Midwife?
A - Alternatives- what are the alternatives to what I’m being offered?
I - Instinct- what does my gut instinct (Mumstinct) tell me about the current situation?
N - Nothing- what happens if I just do nothing? Nothing is always an option.
What pain relief options are available?
- Oral Analgesia is a codeine-based pill which is taken orally which can be taken at home and in hospital
- Pethidine- this is an injection given in the bottom and we recommend that you don’t have this close to the arrival of baby as it can also make baby sleepy. It is an opioid based drug so there is a risk of particles crossing over into the placenta but we believe that it is a very small amount. We often given an anti-sickness drug to mums as this can make you feel sick, but you don’t have to take it if you don’t want to. Pethidine usually takes a few hours to wear off
- Gas & Air- using gas and air is best used during established labour (4 cm dilated with 3 contractions every 10 minutes with each contraction lasting 45 seconds) as it can lose its effectiveness if used for too long. The results last roughly one minute so if you don’t like the feeling, it will quickly go away. This pain relief does not cross over into the placenta too
- Epidural- administrated only in hospital by an Anaesthetist with a needle going into the spine, this will numb the pain for you and baby is then monitored closely with CGT monitoring
Marie Louise is a big fan of Hypnobirthing which is all about relaxing your body AND MIND to have a calm birth. Getting the body and mind to work in conjunction helps to reduce anxiety, sending calming hormones to baby and can be used with natural vaginal births as well as C- sections.
The hypnobirthing courses are Positive Birth Company and also The Mindful Birth Group.
Marie Louise likes to approach mums’ fears with a technique called Fear Dumping. This is where Marie asks mums where the fear has come from, the background to it and then as a team they unpick all of the fears to have all of the information about the fear. Try it with a friend or partner to get to the bottom of why you’re scared about something.
in the right position and condition for a natural vaginal birth:
- UFO- Have you been a UFO this week? This means that you are sitting Upright and not slouching, you are pushing your pelvis Forward and your hips and legs are Open- no crossed legs! This should become a habit from about 34 weeks to help open up the pelvis and help move baby so that the smallest part of baby’s head comes out first, thus helping labour progress quicker. Baby’s head should be down with their chin on their chest looking towards your spine- this is known as an OA Baby. OP babies are the opposite of this. Don’t worry if your baby is OP, it’s likely that they will move into the right position during of labour
- Pop a cushion under your bum when sitting on the sofa to help tilt the pelvis or stand and lean on a wall front ways. A birthing ball is also fantastic at helping to open up the pelvis
- Perineal massage- help reduce tearing by massaging your perineal with oil ahead of labour. Any natural oil is fine, so olive oil, coconut oil, rapeseed oil, anything with no chemicals in. You can also find massage oil made especially for your perinuem.
If you have any questions, please just drop us an email at firstname.lastname@example.org and we’ll come straight back to you!
by Suzi Smith •
Let us introduce: moKee Birth School online
3 min read
by Madlena • @wearemokee
Times are tough, but we are here for you…
It’s a challenging time to be pregnant. You should be excited to meet your baby. You should be enjoying your last weeks of being baby-free - going to the movies, shopping & having as much Italian food as you can dream of!
But nothing is quite as it should be right now. We are anxious and we are worried. The future has never been more uncertain. This is especially distressful for all mothers-to-be. It’s no long just about us - it’s all about baby now.
According to new social distancing advice, pregnant women have been placed in a vulnerable group. You should be keeping your doctor’s appointments, but you shouldn’t be undertaking any other non-essential social activities.
This means no meeting friends & no ante-natal classes. The support system you were expecting is no longer available. And the birth itself might not be quite what you had in mind – you might even be on your own.
For the past few days, we’ve been talking to many of you. And the message is clear – you are anxious, and concerned about the uncertainties ahead. To misquote the film… you no longer “know what to expect when you’re expecting”
We totally understand. And you are NOT alone in feeling this way.
This is why we have created moKee Birth School online, as a part of the moKee's helping mums programme. The school will be led by the hugely knowledgeable and experienced midwives - Marie Louise, known as The Modern Midwife, Sophie Martin, known as The Infertile Midwife and other specialists. It will be exactly what a birth school should be, but online - thus safe. We will cover all the basic topics concerning pregnancy and birth. We will discuss newborn care & breastfeeding. We will give you the support from professionals and also from your fellow expectant parents.
Classes will take place twice a week, but you will be able to discuss any subject on the moKee helping mums Facebook group we have created, anytime. You will also be able to listen back to each session on our moKee Birth School Podcast. Because sometimes it’s late at night when the worries set in, and they just won’t wait.When this happens, be sure to reach out and ask for support. We will be there, other mums will be there and Marie Louise will be there also to comfort and advise.
If you would like to join the moKee Birth School online, please register HERE.
First classes will start on Thursday, 16th of April at 4pm and we will send you the email invitation! If you have any questions - please reach out to us at email@example.com.
moKee behind the scenes:
working from home
3 min read
by Daria • @wearemokee
At moKee most of the time we work remotely from different locations, e. g. Fuerteventura, France, United Kingdom or Poland. Being a part of an online brand, we have to be flexible and available despite the circumstances. Although we really appreciate the possibility of working from home, there is nothing better than meeting together and creating new projects while discussing them lively at our office. Especially that we have decorated our new place a while ago!
After all, some things never change, and here we are - working from our homes and trying to adapt to the new reality that has a lot of challenges! So... take a look at how it is to be a part of moKee team!
Michal, data specialist, and Suzi, PR specialist, got little helpers to complete all the important tasks. Well, we always say at moKee: all hands on board!
While Becca, moKee's blogger, decided to put... legs on board! We can't blame here because we know how comfy is Mini Sofa. Once you sit on it, you never want to get up again!
We are a group of nursery design freaks but some of us are also parents. On a daily basis, we try to combine homeschooling, child care and work.
If in the latest days you've received a kind of incomprehensible email, now you know who wrote it! It's Hirek, the youngest son of Madlena, content and e-commerce manager. He just wanted to buy a few sleeping bags for himself...
Meet Magda, French translator & customer support member, with her son, Billy! Magda answers to your emails every day while she's stuck on Fuerteventura. Although we're still debating if "stuck" is the right word because Fuerteventura seems like a paradise to live in!
Wiktoria, also customer support member, replies to your questions with a smile every day. She makes sure your orders are shipped on time and your moKee experience is excellent!
Staying home for a while isn't a problem... What we struggle with is there are businesses that can't work remotely while we need them so much! Rohan and Artur, moKee's directors, have the same trouble! Their opticians don't work online...
Oh sorry, there's one person in our team who really struggles with staying home! Daria, marketing & communication manager, is ready for her another trip but unfortunately, the farthest she can travel now is her balcony...
Mateusz, HR & administration specialist, got the same idea and while processing a million of documents daily, he's getting a little bit of tan!
While Daria and Mateusz are enjoying a warm weather, Rafał, member of logistics centre, is working hard to ship your orders on time! The more packages he has to pack, the happier he is!
And there is Yogesh, finance director, who is probably not the happiest that instead of working, we took some time off to show you our #stayhome reality... ;)
Let us know how you're spending your time at home and share your picture with #wearemokee on Instagram! We would love to see it!
Finding the perfect gift for a newborn
3 min read
by Becca Smith • @beccasmith_tomlins
Tiny newborn babies get a huge amount of stuff when they’re welcomed into the world. Family and friends love to shower babies with gifts and love! But what do you buy a tiny baby who seems to have everything it needs already?!
For me I really loved getting gifts that I certainly wouldn’t buy. My friends bought beautiful clothes that were super cute and sometimes impractical. A bright white Babygro with ridiculous but cute pom poms on was one which I adored- it’s not practical but so nice to have something special for your baby. In fact the items I now treasure are the gifts that my babies were given. So, take a look at some ideas for newborns
Newborns get through a lot of clothes. The constant sick and poo means there are accidents so multiple outfits a day is the norm. Clothing is therefore a great gift. I found it useful when friends bought clothing that was a larger size, something my baby would grow into in a few months time. Some beautiful clothing stores include, Lilly and Sid and Aidie London have some beautiful baby shoes (totally impractical but a must!)
It’s nice to give baby a bit of luxury so why not give them a super soft bath robe? My first born received this one from The White Company and it was such a loved present- super soft and lasts forever.
We Are Pop have some really lovely toys – I particularly like their pull along sausage dog – this will keep your child entertained for years, not just during their first year.
moKee has a super useful Baby Play Gym – it comes with a cute slide (that doubles up as storage) and the hanging black and white toys are perfect for young babies who are learning coordination and wanting to grasp.
GIFTS TO REMEMBER
What is so cute about babies is that they’re so tiny- the tiny hands and feet! Well it’s worth trying to capture that memory and a great gift is with a kit like this from John Lewis. The ink pad captures their tiny hands and feet and it comes with a stylish frame to treasure the memory forever.
I received a lot of children’s books for my sons and I can’t think of a better gift. Lots of friends gave me books that they loved as children. A personal favourite is Stick Man by Julia Donaldson.
It’s lovely to receive personalised gifts and now you can get personalised books. Check out this super sweet book with Beatrix Potter’s Peter Rabbit.
It’s always nice to get some practical gifts sometimes. I received some super useful muslins – you can never have too many and at moKee you'll find three different sizes & colours to choose from.
moKee also has some very clever sleeping bags - Baby Sleeping Bag includes two detachable and replaceable front covers, ideal for both warm and cooler months. The Sleeping Bag also features a handy opening for car seat belts and pram straps. Double plastic zip fastening for easy fastening and all day comfort. The front and back layers are fully detachable with popper buttons - convenient for those unpredictable nappy change moments.
One thing I have learnt as a parent is that teething can only be helped by Sophie La Giraffe! She’s every baby’s essential during those teething years (and yes it can take years!). My son had many Sophie’s which he adored!
Happy shopping! x