Natural Twin birth

I had the privilege of Doulaing at the birth of twins last week.
It was a beautiful birth for many reasons, the babies were born at 40+3, in a Midwifery Led unit at Liverpool. She laboured in the pool and the birth was intermittently monitored, no cannula sited or paeds present.
We were lucky to have a fantastic Consultant midwife who drove a few hours in the early morning to be with us and support the midwives in the unit who were concerned about conducting a twin birth without constant monitoring and in the low risk area and also a lovely obstetrician who had supported the birth plan throughout the pregnancy and birth.
It was a lovely, calm and normal birth, she used a tens machine and entonox and both twins were head down. The first twin (a boy) was 7lb 2oz and the little girl was born 15 Min's later 5lb 5oz. The midwives were great, checking with two handheld Doppler's that they had two heartbeats and stabilising the little girl after her brother was born to help prevent her turning transverse.
After the birth they left us alone so she could have skin to skin, she had no tearing and I left her happily breastfeeding the babies.
This birth was calm and relaxed and normal and shows that how low risk twin birth should be!

New build Midwife led units and Birth Centers

I have been lucky enough to visit a birth Center in the South West of England and a newly built Midwifery led unit (Co-located) in the North of England, in the last few weeks.
I was looking forward to seeing what they had done with the birthing rooms, as they had a 'blank slate' (so to speak).
Sadly I was dissapointed with both centers.
Whilst the rooms were clean and bright (and I could argue that dim might be better!) they were hardly 'fit for purpose' to encourage normal labour, mobilisation etc
In the new MLU the rooms were a good size, but still had hospital delivery beds and resusitaires (I was told these were going to be moved out soon)
Its a same that even in these new builds health professionals are not being more innvative in the design.
We are currently in the process of writing up a paper for publication so will post details when this is finalised.

Arts and Health Conference

We will be presenting our work on collaberation for Maternity room design at the University of Northampton Arts and Health Conference - Inspiring Transformations on September 10th.
http://www.northampton.ac.uk/artsandhealth/

A Space to give birth in film

http://blip.tv/file/2174226/

Conference

I will be presenting my dissertation "The Incidence of Women giving birth in Liverpool in 2005-07 having a ‘Physiological Birth’ as compared to ‘Normal Births’ and ‘Cephalic Vertex Births’: Are there differences in health outcomes for mothers and babies by type of birth?"
Next wek on Friday June 12th at the Normal Labour and birth 4th Research Conference at Grange over Sands.

A Space to Give Birth in event 2

Deverra and LJMU ran another fantastic event at the Climate for Change experiment at FACT, Liverpool on May 18th.
This day focused on gathering the views of health professionals on the need for change in Maternity room design and it had a great turnout with over thirty Midwives, Managers, Architects, Designers and students from around the North West.

The day sparked off lots of interesting debates and discussions and I will posting up some of the presentations, photographs, videos and feedback from the event in the next few weeks.

The day started with a delicious breakfast of fruit and juice.

We then presented the work from the previous event and summarised some of the work we have been doing, looking at innovative maternity room design.

We showed a film with footage from the first 'A Space to give Birth in' event in March, both filmed and edited by Neringa Plange ( http://neringaplange.wordpress.com/)

We also had a presentation from the National CHildbirth Trust about their, 'Better Birth environment' campaign.

We had a really interesting talk from Aquabirths (http://www.aquabirths.co.uk/) about designing bespoke birthing pools and we were all inspired by their enthusiasm and the possibilities for new and exciting pools that could be used within UK maternity units.

During lunch we had Gafro (http://www.gafro.com/GAFRO/HOME.html) a very talented percussionist, from the Liverpool Lark Lane Drummers group, run a workshop on African drumming, he introduced us to a rhythm which is used culturally to ease childbirth and I thought it was interesting to feel the mood change as the powerful, melodic music was heard throughout the FACT building, As we played, the music also depicted the changes of rhythm that women experience in Labour, from fast to slow, relaxed, to invigorated.


It also reminded us, that for many women birthing for the first time, they are unsure, feel uncomfortable or they 'don't know how to do this' or lose their way (I think anyone joining in with the workshop could agree that we all lost the way rhythmically many times) but with a skilled and non judgemental facilitator (or musical midwife) we were able to rejoin the rhythm and enjoy the experience!

After lunch we facilitated a group discussion exploring ideas about ideal birth environments and how we can move actual maternity room design towards this ideal within the UK.

The findings from the discussion will be posted in the next few days, and make very interesting reading and have given us lots of ideas about ways to move this project forward.

Next we had a presentation from Bianca Lepori (Rome), Architect and author of ‘Architecture Inside Out’, prioritising human needs in design of spaces, she specialises in redesigning birthplaces and furniture to meet women’s psycho-physiological needs in birth.

She introduced us to the ways in which women move and inhabit space when in labour and how maternity design can facilitate this need for movement.

Marc O’ Riain (Cork), Interior designer of an award winning maternity room at Cork University Maternity Hospital presented his design process for a hospital which was designed to be 'More like a hotel than a hospital'.

I found it really interesting that the designers interviewed people about their time in hospital, their fears about the clinical feel of the space and an over riding feeling that pregnancy is not an illness!

I found it very inspiring that the designs were implemented in a functioning hospital and are currently being used by labouring women in Cork, they are truly an example of innovative design!

Findings from the day will be published in the near future, and a second film produced from the footage of this second event (massive thanks to Marc Mcdermott http://services.creativecow.net/s/596/mcmedia for his filming)

I want to thank everyone for coming, sharing your expertise and creating a thought provoking and inspiring event.

A Space to Give Birth In 2 Flier

http://groups.google.com/group/a-space-to-give-birth-in/web/flyer_sspacetobirthin2.pdf

Sensory rooms

As part of our research we visited a Multi-sensory (Snoezelen) room. These rooms are designed to deliver stimuli to various senses, using lighting effects, color, sounds, music, scents, etc.

They are usually used for children with learning difficulties and autism, but some research has recently been done on the use of Snoezelen rooms to give birth in.

This was a qualitative study, with in depth interviews of sixteen women that used Snoezelen rooms to give birth in.

The findings of the study found six themes from the data which providing insight into what a Snoezelen environment can offer a labouring woman: distraction; relaxation; comfort; environmental control; choice of complementary therapies; and safety in a home-like atmosphere.

Additional categories revealed factors that facilitated and/or detracted use of the room such as familiarity with features, being offered information and choice, timing in labour, the support person's response and working order of the room's features.

Reference

Women's experiences of using a Snoezelen room during labour in Western Australia,
Yvonne Hauck, Catherine Rivers, Kathleen Doherty, MidwiferyVolume 24, Issue 4, December 2008, Pages 460-470

A Space to Give Birth in event FACT, Liverpool May 18th

We now have confirmation of a fantastic line of speakers at our next event.

A free public event on Maternity Room design at FACT (http://www.fact.co.uk/) Liverpool on Monday May 18th 10am-4pm.
With presentations from-

LJMU Design department and Deverra- a video summary from the first ‘A Space to give birth in’ event in FACT in March 2009- a forum on requirements for women in the design of spaces for labour

National Childbirth Trust- Better Birth Environment campaign update
RORSA Designers of the award winning Cork Maternity unit birthing rooms (http://www.idi-design.ie/awards/2007/grandprix.htm)

Bianca Lepori is an anthropologically, medically and psychologically informed architect and designer living in Rome. Over the past twenty years, she has researched women’s psycho-physiological needs at birth and successfully redesigned birthplaces and furniture accordingly. Her books, articles, lectures and consultancy on this subject have contributed to attitudinal change, practice and implementation. She is a fellow of the School for Social Entrepreneurs in London.Author of: Creating Birth Space to Enable Undisturbed Birth in Birth Territory and Midwifery Guardianship(2008) by Fahy, Foureur, and Hastie (Elsevier) http://www.sheilakitzinger.com/Features/Bianca%20Lepori.htm

A few more presentations to confirm so will add a schedule ASAP

Ulster Hospital Maternity Unit

This maternity unit has a home from home area with seven rooms. This is a new unit within the Ulster Hospital. It is a midwife-led unit consisting of seven spacious rooms, all with en suite facilities and birthing pool. Opened in Summer 2007.

As you can see they have many innovative aspects to the rooms, I love the way the wall between the pool and the bedroom can be pulled back to make one space.

They also have some equipment from the German company FEBROMED which makes equipment for birthing rooms, that I feel, could really improve the way women use the space within birthing rooms, and encourage upright positions to help babies descent and pushing in the second stage. And also to encourage partners to be involved and physically in contact with each other.

Elaine Madden (Lead Midwife, Ulster Maternity Unit,. South Eastern Trust) said that the equipment is really popular and well used and that mums love it.

Results of a survey carried out by the Healthcare Commission to find out what women think about the maternity care they have received, found in Liverpool that:

20% (England Average 14.8%) of women felt unable to move around and choose the position that made them most comfortable?

and when asked-

What position were you in when your baby was born?(Of those who had a vaginal delivery.)

8% (12% England average) were standing squatting or kneeling (as opposed to sitting, lying or in stirrups)

Considering that a recent Cochrane review also found that women who walk, sit, kneel or otherwise avoid lying in bed during early labor can shorten the first stage of labor and were less likely to seek pain relief through epidural analgesia, equipment like that used in Ulster hospital, should, I feel be in all Maternity units!

References

Lawrence A, et al. Maternal positions and mobility during first stage of labor. Cochrane Database of Systematic Reviews. Issue 2, 2009.

Interviews about birth environment from FACT Liverpool March 09

St Mary's Hospital, London

I am going to start featuring pictures and details of birthing rooms which have been designed in an innovative way to facilitate physiological birth.

I am hoping the new birthing center rooms in Liverpool (the Big Push project) will incorporate some of these ideas.

The first hospital I want to feature is St Mary's in London. The midwife-led St Mary’s birth centre opened its doors on June 4 2008 following four years of planning and preparation.

The center is open to women with low risk pregnancies.

All five bedrooms are en-suite, with a double bed, mats, birth stools and hammock as well as a TV for the whole family to relax together and welcome their new arrival. Three of the bedrooms are fitted with corner baths and the others with a birth pool and wet room.

When we interviewed women at the 'A Space to give birth in event in FACT' one of the issues that came up was the difficulty in transition from one physical space to another, having to walk down busy public corridors in the second stage of labour or transition to get in a pool.

As you can see in the picture above, St Mary's have en suite wet rooms with pools, so women can get in or out of the pool as they choose.

I also love the hammock which women can use to hang onto, this technique of 'dangling' is described on the Spinning babies website as 'allowing the pelvis to have the most mobility of any technique' and the "baby come out" position, so named by Penny Simkin.

I think the pull down double beds are a FANTASTIC idea. With the beds up, there is lots of space to move around and there is less of that sense of a bed dominating the room. The bed is also low to the ground so may feel more 'Safe' than beds which are high up off the ground, in the Cork birthing room that I mentioned in a previous post, whilst I love the decor (much more like an expensive spa than a hospital) the bed does not look as comfortable or welcoming as St Mary's!

The beds at St Mary's are also Doubles, which means there's room for Dad too! This that they are valuing fathers and the creation of the family unit.

This takes on board the recommendations of the Fatherhood Institute (The Dad Deficit: The Missing Piece of the Maternity Jigsaw)

Their research found that-

• 70% of men and women (asked) agree that dads should be able to stay overnight in hospital with their partner when their baby is born.

Sarah's Musings: Concepts of birth unit design

Sarah's Musings: Concepts of birth unit design
This is a really interesting blog from a Midwife in New Zealand who has been creating a virtual birthing center in the online world 'Second Life' based on the work of Italian architect Bianca Lepori.

Liverpool Womens hospital visit

As part of the design process for 'A Space to give birth in' We visited the Liverpool Women's hospital and photographed some of the birthing rooms.

Can you imagine walking up this corridor in labour?

I gave birth here and have also supported many births here as a Doula.

This is one of the Midwife led unit rooms, as you can see, after two years on the MSLC I managed to have the clocks moved from in front of the beds, to behind the beds!


Here's a slightly more Hi tech room.

In contrast, here is a picture of an award winning new birthing room in Cork hospital.

I will be adding more photo's of birthing rooms which I think are innovative or encourage physiological birth.

We are hoping the designers of the Cork room (http://www.rorsa.ie/portfolio.php?category=2&project=87) will come to our next 'A Space to give birth in' event at FACT, Liverpool on May 18th.

I will also add some of the words from the interviews with mothers in Liverpool from the March event, I was watching them last night and they were very powerful.

Rebozo - the action shots | Homebirth: Midwife Mutiny in South Australia

Rebozo - the action shots Homebirth: Midwife Mutiny in South Australia

Fantastic post showing how to use a Rebozo to help reposition a posterior baby.

A Space to Give Birth In

On the 27th March 2009, In conjunction with Casper Jones from Liverpool John Moores university we ran a session entitled 'A Space to give birth in'

It was a very moving and inspirational day.

We set up the large room with lots of photographs of births and an example birthing room, with pool, bed, candles, flowers (even a bottle of champagne!)

We also put out lots of collage materials.

We had lots of women come to the event, a really busy, productive atmosphere in the room, with people creating collages of their vision of an ideal birth environment.

Watching Nadine Edwards film (from AIMS) 'Birth Matters' was very moving, I saw tears on many peoples faces.

We had a wonderful yoga session (thanks Jenni!) and people spoke on camera about their own birth experiences, how the environment effected them and what they think is required to help facilitate birth.

I will put up a link where you can see the footage soon.

Birth Environment

After being involved with my local hospital planning a new Maternity unit, it got me thinking about birth environment.
I went round a couple of years ago with the NCT Better Birth environment toolkit and as a Doula I have been at births in quite a few hospitals in the NW of England.
I often feel that so much more could be done to improve the environment.
Whilst I am a committed advocate for birthing at home, some women are just not ready to choose this option.
Things have improved slightly with 'Home from Home' rooms and midwife led units, but hospital is never going to be home and so often these rooms look like cheap hotel rooms
There is no real commitment to design that facilitates physiological birth or reduces fear and pain and I have felt for a long time, much more could be done than the installation of disco balls!
To this end I have organised a Design collaboration and we will be exhibiting at FACT in Liverpool in March and May-

A Space to give birth in* First of Two workshops within Climate of Change at FACT
Come to Watch - Breathe Talk + Do
There is a room made between the instinctive body and hospital practice where babies arrive. We are interested to design proposals to develop ways in which that space can help birth preparation, labour and recovery.
WATCH - Birth Matters- a Short film created by Nadine Edwards from the charity AIMS (association for improvements in Maternity services)
BREATHE- Group workshop and display of yoga, movement and breathing to facilitate birth by Doula Jenni Jones
TALK - contribute to our process by sharing your experiences or recommendations for spaces of birth
DO - Public creation of two giant collages/mood boards of 'Births - the experience and environment' - this may be an ideal or actual experience. We are a X-disciplinary team of students + health + design professionals. This is a collaboration between Deverra, Doula UK, LJMU, National Childbirth Trust, AIMS, Liverpool PCT and FACT.

See this link for more info-
http://climateforchange.fact.co.uk/discussions:childbirthtrust

I will update soon with photo's!

Home Birth

I was lucky enough to attend my first homebirth last week!
After working as a Doula for four years, it was an amazing experience.
After a previous traumatic delivery I witnessed the power of loving care. It was a privilege to be able to witness the love between this couple, the atmosphere in the room was heady with oxytocin, low lights, the pool water, massage and oils in the air.
A midwife who was willing to step back and allow this birth to happen undisturbed, I could see the fear and adrenaline kick in with any attempt to perform a vaginal exam etc so her midwife just waited in the kitchen whilst myself and her partner continued supporting and encouraging.
She was actually orgasmic (have confirmed this with her since) and just kept saying how happy she was, no pharmacological drugs and birthed a persistent posterior baby. Within two hours was tucked up in bed with her older child, husband and new baby eating tea and toast!
After running a homebirth support group for years, am so glad to see with my own eyes the difference between birth at home and in hospital!
After the birth I went straight on to the Sheffield Homebirth Conference and really enjoyed hearing Denis Walsh speak and seeing the AIMS film Birth Matters (See my next post for more on this)