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a placenta & umbilical cord
forceps
What is........?
~ A brief explanation of different types of birth ~
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The purpose of this web page is to give you a general run down of some of the most common ways to give birth today. As always, we're aiming to offer-up simple, factual, research-based information so you can go on to form your own opinion.
JUMP TO:
Normal Birth
Lotus Birth
Unassisted Birth
Instrumental Birth
Caesarean Birth
We've already dedicated a page to this on our website, so to find out lots more info, click here. In our opinion, normal birth can be defined as:
“......when the mother's uterus spontaneously contracts, her cervix dilates, her baby moves through her pelvis and she gives birth,
she expels her placenta and breastfeeds her baby. She does this without any ritual or routine interference, disruption or distress caused by others. The place of birth is chosen by her and her instinctive movements are unrestricted and respected. This happens at the natural, unprovoked end of her pregnancy as part of a normal, physiological, psychological and social life process”.
(McNamara, C. (2008) Normal birth –www.birthchoices.co.uk)
In this ritual, the umbilical cord is left uncut and the baby and placenta remain attached for several days, until the entire cord and placenta naturally separate and drop off from the baby, a few days after the birth. Some believe that this allows a more gentle transition for the baby. It is believed that the benefits to the mother and baby are thought to be emotional and spiritual in nature rather than physical.
According to Wikipedia, "Lotus birth, or Umbilical Nonseverance,is the practice of leaving the umbilical cord intact following birth, allowing the physiological process of the cord substance known as Wharton's jelly to naturally seal the cord within 10-20 minutes postpartum. The umbilical cord then dries and eventually detaches from the umbilicus. Detachment usually occurs 2-3 days after birth".
Wikipedia
goes on to state that "Modern practitioners of Lotus Birth point out that those mammals with whom humans share 99% genetic material, the chimpanzees leave the umbilicus intact, neither chewing or cutting it, a fact known by primatologists. Therefore, the medical practice of immediate cord clamping and cutting, and its physiological impact is questioned by parents who choose partial or full Nonseverance".
However, we've found some information that contradicts that statement. This account of a chimpanzee birth in the Budongo Forest Reserve in Uganda 1998 states:
"At 09:22 the vagina opened widely: the infant's head was seen to come out first. The infant emerged fully at 09:23:20 and KY caught it with her left hand. She immediately pulled the infant onto her belly and hugged it. 4 sec from the birth of the infant, blood started to flow for about 5 sec. At 09:26 a juvenile male KD came close to see the newborn. KY did not pay attention to KD. At 09:40 the placenta emerged, KY moved her left hand to her vagina, collected the placenta and started to feed on it immediately. At 09:46 she finished feeding on the placenta and started licking blood from her hands. She did not eat the umbilical cord and she left it hanging. At 09:48 she grasped the umbilical cord from the distal end and started pulling it. At 09:48:30 she was seen biting the umbilical cord. At 09:49 she stopped and after 30 sec she started feeding. At 09:53 NB (adult female) and her offspring joined the group on the tree.
Discussion
This description of a live birth to a previously nulliparous female chimpanzee on a branch in a tree shows interesting features of labour and delivery, such as the eating of the placenta by the mother soon after it emerged. It is also noteworthy that this birth took place high up (30m) in a large tree, necessitating great care on the part of the mother, especially given the fact that this female had only one functional hand. Cleaning of the infant by the mother was not observed after delivery. The placenta and umbilical cord were eaten within 25 min of the birth".
And this from another source:
"During 19 years of study of chimpanzees in the Gombe National Park only one birth has been observed; this is probably the first such observation for any chimpanzee in the natural habitat. The birth took place in a nest in a tall tree during the morning. Details were recorded by Tanzanian field staff from a neighbouring tree. Labour and parturition are described as well as the mother's care of the infant immediately after birth. The mother consumed the placenta as she lay in another nest. Throughout the birth process the mother's juvenile son remained close by and watched with apparent interest. Another mother and her offspring were present during the birth and an adult male approached the mother while she was feeding on the placenta".
It's up to you to decide whether a Lotus Birth is for you. Do you regard your placenta as an amazing piece of kit that should be discarded once it's served its purpose after a birth? Or do you place a more spiritual meaning on it?
Unassisted Birth is the popular term used when talking about a woman who chooses to give birth without the attendance of a midwife or any other health professional. 'Free Birth' is an American term used to describe the same situation, as is 'Naissance Sauvage' or 'Wild Birth' in France. This is a perfectly legal choice for a woman to make in the UK - you are under no obligation in law to call a midwife or doctor when you are in labour because any mentally competant adult can decline medical help.
There is some debate as to whether 'Unassisted Birth' ought to be renamed 'Unattended Birth' as many women who experience a normal birth do so without any help - they do it 'unassisted' but with a midwife present.
From Laura Shanley's website 'Bornfree': "In an unassisted childbirth no one acts as a midwife. Instead, the birthing woman herself determines the course of her labor. Partners or friends may participate to varying degrees, but no one instructs the woman as to how to give birth, when to push, what position to be in, etc. Occasionally suggestions may be offered but it is assumed that the woman giving birth is the true expert on her own body".
The fundamental belief of Unassisted Birth is that a woman's body knows better than anyone else how to give birth - you don't need to be shown how to do it, your amazing body will do it for you. The thing is, at Birth Choices we completely agree. Your body is amazing & in the majority of cases, if left to get on with the job, it will grow a beautiful healthy baby & give birth to it without a hitch.
Supporters of Unassisted Birth are usually evangelical about the whole experience. At Birth Choices we have no problem with women making an informed choice to birth in this way. However, whilst websites supporting Unassisted Birth spend a great deal of time espousing its virtues, we cannot find any information or birth stories on the internet giving you a truly balanced point of view - what happened when a planned unassisted birth didn't go so smoothly? If you know of a source please do email it to us.
In order to help you make your own mind up, here are some things to think about from the 'other side' of the argument which seem to be missing from the pro-unassisted birth sites:
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According to the World Health Organisation, in the affluent West, around 10-15% of births will require a caesarean - that is, although around 85% of normal births have the potential to occur without major surgery, 10-15% of births will result in the death of the mother or baby if a caesarean is not performed.
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We don't give birth very often. Even if you've given birth 7 times, that's still only the same amount of births that a student Midwife will have witnessed within the first few months of her training. The point is, a qualified midwife sees them all the time - skilled midwifery, practiced away from a hospital setting, involves watching unobtrusively for warning signs that you may not be aware of - even if it is your 7th birth. You wouldn't know that an authentic midwife, skilled in normal birth, was actually in the room with you - if it's being observed that you (quite rightly) have a problem with. If anyone holds the belief that a midwife's job is to instruct a woman on how to give birth, then they clearly do not understand the role of an authentic midwife!
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If you are to undertake an unassisted birth, you must be prepared to take full responsibility for the consequences if something goes wrong. Think very hard about whether deep-down you can accept the possibility - however small - that your baby may not be born perfectly healthy because you chose not to give birth with the support of a midwife. There is no guarantee that a baby will be born healthy even with a midwife or any other health care professional present, but at least if they are (unobtrusively) in attendance they may be able to act quickly should the need arise. If you can live with whatever nature throws at you - fine. If you can't, are you certain you want to take the risk?
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It's not very nice to talk about, but in law, you can sue a medical professional for compensation if it is proven they were incompetant during your birth which caused you or your child harm in some way. If your baby is born with a disability because of medical negligence, you may feel you need financial compensation to help with the extra costs of raising your child. They may need special care / a wheelchair / or you may need to adapt your home to accommodate them in the future. If you gave birth unassisted and your baby was born less-than-perfect because of a complication that occured during the labour, you cannot sue yourself & nor can your child. Again, if you choose to give birth in this way, you must make sure that you can 'live' with the decision if something were to go wrong.
An instrumental birth is when the baby is born via the mother's vagina but with the aid of forceps (two interlocking metal instruments that are placed around your baby's head while in the vagina - the obstetrician then pulls on the handles to get the baby out) or a ventouse (suction cup placed on the baby's head also known as vacuum extraction). Instrumental births are carried out by Obstetricians in hospitals, not by midwives or at homebirths.
In 2006 the UK national average rate for instrumental births was 11.1%
Ventouse
This is an assisted birth using a silicone rubber or metal cup placed on the baby's head. Suction (vacuum) is then created between the cup and the baby's head to hold it firmly in place. You will be encouraged to continue pushing and at the same time the obstetrician pulls on the cup to help the baby to be born vaginally. The suction is then released and the cup removed from your baby's head. This will leave some swelling which will usually disappear within 24 hours and bruising on your baby's head which may last for a week. Very occasionally the baby's head may have a small cut on its head from the Ventouse cup.
Forceps
The obstetrician positions these around the baby's head and pulls whilst you are encouraged to push with the contraction. The doctor will make a cut into the vaginal skin and muscles (an episiotomy) to allow for the extra space that the forceps take and reduce the risks of tearing through the back passage (rectum).
Medical Indications for an instrumental birth
The obstetrician may recommend delivering your baby by Ventouse or Forceps for the following reasons:
- Because you have become exhausted or distressed during the final stages of your labour
- There are concerns about your baby's well being and the baby needs to be born quickly.
- There is a medical reason why you should avoid the exertion of pushing e.g. certain heart conditions
Ventouse /forceps – risks
In a systematic review by the Cochrane data base ‘Vacuum extraction versus forceps for assisted vaginal delivery' (Johanson RB, Menon V. Vacuum extraction versus forceps for assisted vaginal delivery. Cochrane Database of Systematic Reviews 1997, Issue 3. Art. No.: CD000224. DOI: 10.1002/14651858.CD000224) it was concluded that a ventouse birth caused the baby more physical trauma than the mother. More babies born with this method had large bruises & swelling (cephalohaematoma) on their scalps and had bleeding in their eyes than those babies born with the aid of forceps, however the mothers who had a birth where forceps were used were more likely to suffer injury.
Women who have a Ventouse birth experience less damage to the muscles and skin of the vagina and perineum, and also report less severe pain in the early postnatal period than forceps births. Mothers that have forceps will have an episiotomy. Both groups may have significant bruising and discomfort. Instrumental births also increase the risk of post partum haemorrhage for the mother
Babies born by Ventouse tend to have more bruising on their heads and in their eyes, but babies born by forceps can have more bruising and marks on their faces. Both are more at risk of becoming ‘irritable', having low blood sugar or not maintaining their body temperature in the first 24 hours. It is important to establish feeding soon after birth. If the baby seems to be in a lot of pain and is very fractious then you can ask for a paediatrician to check baby over and prescribe some pain relief for baby if necessary.
The position of the baby's head and the clinical judgement of the doctor will determine which method is most suitable in individual circumstances - sometimes it would be more appropriate to use forceps, sometimes a ventouse. The obstetrician should advise you of which method they are recommending and why - this can be done when they are preparing for the procedure and you can of course decline either or both, this is for you to decide based on the information you are given at the time.
A Caesarean section is major abdominal surgery & research has shown that it:
- doubles the risks of maternal mortality
- increases the risk of damage to other internal organs and blood vessels
- carries a risk of infection, which may prolong a hospital stay
- interferes with the establishment of breastfeeding
- can produce harmful side effects according to which anaesthetic is used
- lowers fertility rates in women
- increases the incidents of post natal depression
- can adversely effect the baby because of the anaesthetic used
- can accidentally cut the baby as the incision is made
- produces babies who are less likely to breastfeed
- results in babies with breathing difficulties because they haven't received the benefits of being squeezed through the vaginal canal
- increases the likelihood of your baby going to special care in the first 24/48 hours after birth
- increases the risk of miscarriage
- increases the risks of a stillbirth in subsequent pregnancies
- produces a greater risk of childhood asthma
- results in a greater risk of Sudden Infant Death Syndrome
- increases the risk of retained placenta in subsequent pregnancies
- increase the likelihood of a hysterectomy in the future
- mothers who have had a caesarean birth a twice as likely to have no more children in the future
The World Health Organisation says that the caesarean section rate in any population - even 'high risk' ones - should be
between 10 - 15%.
In 2006 23.9% of all births in the UK were by caesarean section
(birthchoiceuk.com)
The national averages range from over 33% in some hospitals to 16% in others, please look at birthchoiceuk.com to find the rates in your local hospital.
Used in the right circumstances (10-15% of all births) they are life-saving rescue operations – however we believe that unnecessary major abdominal surgery that is performed on women on a daily basis because of the fear of litigation or hospital convenience is unacceptable.
What are the implications for a population whose caesarean section rate is constantly increasing?
This can only be speculation because it hasn't happened yet, but the possibilities might be:
- A higher maternal mortality rate
- More incidents of serious post-operative infections
- Less Breastfeeding than the current low rate
- More problems with fertility
- An increase in postnatal depression (which currently stands at a whopping 20%)
- A greater incidence of miscarriage
- An increase in childhood asthma
- An increase in Sudden Infant Death Syndrome
What can we do?
Every single one of us has the power to change the over-medicalisation of childbirth. If we don't do something now, and the caesarean rate contnues to grow at its current pace, it will take only one more generation before over 50% of our daughters born today are giving birth by caesarean section.
If you don't think the increasing caesarean rate is a good idea, here are some practical suggestions of how you can go about trying to change childbirth for the better:
• Get informed – find out about birth from lots of different sources, not just your local NHS Parent education classes who follow a specific hospital-based agenda. Research & then make decisions suited to your individual needs based on factual information.
• Complain – the best way to let the NHS know that their current system isn't working is to keep pointing out where it's going wrong. You don't have to be bolshy, just factually correct. Utilise the Patient Opinion website or ask to see a Supervisor of Midwives & discuss your options or problems with her. From the very minor complaint to the major – we must start making our voices heard.
• Spread the word – Most women do not know they have choices when it comes to their maternity care. Often, they get fed into a system & are processed along the conveyor belt without questioning what's happening to them. Let people know that they have choices in birth. If you've had a good normal birth, talk about it – it will make a refreshing change for most people to hear as opposed to the usual horror stories women take such great pleasure in scaring each other with.
• Get together – Nothing's going to change because one person does or says something – it has to be a collaborative effort between mothers, midwives & other health professionals.
• We believe that mothers must lead the way in demanding the service that they need
• Lobby Parliament – we know it's not going to be a popular choice because it takes a little extra effort, but a quick moan to your local MP / MSP / AM via email will at least start to raise the profile of the problems women face when they give birth. You can obtain their email addresses from the relevant parliamentary websites:
UK Parliament ~ Scottish Parliament ~ Welsh Assembly