What’s the APGAR Score?

During HypnoBirthing Sessions we discuss what happens once your baby is born. One of the first things that happens is that your midwife will give your baby an APGAR score.

The APGAR Test was designed by Virginia Apgar, an American anaesthesiologist, to quickly evaluate a newborn’s physical condition and to determine whether any extra medical help is required.  Conveniently for midwifery students, the word Apgar makes a handy mnemonic detailing the signs to be assessed: Appearance, Pulse, Grimace, Activity, and Respiration.

The Apgar Score is usually assessed twice: once at 1 minute after birth, and again at 5 minutes after birth. Sometimes, if there are concerns about the baby’s condition or the score at 5 minutes is low, the test may be scored for a third time at 10 minutes after birth.

Five factors are used to evaluate the baby’s condition and each factor is scored on a scale of 0 to 2, with 2 being the best score:

  1. appearance (skin coloration)
  2. pulse (heart rate)
  3. grimace response (medically known as “reflex irritability”)
  4. activity and muscle tone
  5. respiration (breathing rate and effort)

You midwife will give each of these signs a score from 0 to 2 and total them up to give your baby a score out of 10, with 10 being the best score.

HypnoBirthing Croydon Surrey London

Most mums who have had an easy calm birth and who have a clearly healthy newborn baby will want to have immediate skin to skin contact; it can be a good idea to mention on your birth preferences that you would like the APGAR score to be assessed whilst your baby remains on your chest, rather than being whisked away to a table that you can’t necessarily see. Of course instinctively, everyone is assessing whether your baby is a ‘clearly healthy newborn baby’ by looking at the signs that make up the APGAR score.

Here’s hoping your baby gets a high score in the first test of their lives!

 

 

 

One Born Every Minute

OneBornEveryMinute

Last week, one of my HypnoBirthing mums said that she had watched One Born Every Minute and had some questions about it so I felt I should watch the episode too, having managed to miss almost 2 series of it1. It proved to be quite an eye opener! I noticed that the programme is now filmed from Southmead Hospital in Bristol and a quick look at the combined 2012/13 statistics from Birth Choice for the Central Delivery Suite and the Birth Suite show that that 16.5% of mums have a caesarean, 14.4% have a ventouse or forceps delivery whilst 69.2% have ‘no help’2. So, given that this programme features 3 births, one would expect 2 of the 3 featured births to be with ‘no help’ and 1 to have some intervention. This is what we were shown:

Firstly, I want to comment on the positive language that was used through the programme. We saw one mum, Zoe, being examined and she was 1cm dilated. The midwife said, “About 1cm dilated, so not too bad”. Zoe smiled and said, “1 cm dilated, get in there!” I later jotted down comments such as, “You’re doing brilliantly” and “You’re breathing through them so beautifully”. This is just what a mum wants to hear and I was so pleased to hear the mums being supported in this way.

Secondly, we saw the relationship between patient and anaesthetist. Patients can fixate on the surgeon, the midwife, generally the person conducting the operation. For most procedures, it is the anaesthetist that the patients can see and talk to. I recommend to all of my clients who will have an anaesthetist involved to make friends with that person and we saw in #OBEM that this anaesthetist was friendly and on the mum’s side. I’m pretty sure that one of the criteria for being an anaesthetist must be to have a friendly disposition.

The first mum, Cheryl, who was with her husband Rob, and was having an elective C-Section. Cheryl’s story and strength was inspiring but I fear for anyone watching this that has an elective C-Section booked. One fear that mums have is that the spinal block /epidural won’t work. There are some stories to be found on the internet that will tell you that they don’t always work and this happened to a friend of mine, but this is incredibly rare. On the #OBEM website there is a link explaining how epidural’s work and it says, ‘if you are having a Caesarean section and have had an epidural, CSE or spinal block, you will be checked extensively by the anaesthetist before the operation takes place to ensure you are fully anaesthetised. Often, they will ‘pinch’ the skin over your abdomen to reassure you that, even though you feel some pressure, you will not sense pain.’

So, what was Cheryl’sOne Born Every Minute experience? The spinal block did not fully work, which they knew before the procedure started but Cheryl wanted to go ahead in order to avoid a general anaesthetic which would mean that her husband would be unable to remain in theatre and see his son being born. It made for uncomfortable viewing. Cheryl was clearly in a lot of pain and looked like she was going to pass out. The anaesthetist was clearly concerned. Can you imagine watching that as a pregnant mum? The baby was born, cord cut immediately, taken to the side table cleaned up, packaged up in a blanket, and handed to dad. I felt so sad for mum and baby who could have had skin to skin and that fabulous oxytocin rush.

zoeanthonydanaOur second mum was Zoe who had had a long fertility journey before reaching the delivery suite. I enjoyed this birth mostly because of husband Anthony’s response to the birth. Zoe’s baby’s heart-rate went down and a forceps delivery was recommended. The doctor crouched down at Zoe’s height and explained it to her. I felt this was well done. The birth itself appeared to be relatively easy and it was joy to be part of their joy at meeting their long-awaited daughter, Dana.

Our third mum was Sarah who was with her husband Mark and her own mum. The birth seemed to be going well until the midwife said that the baby was unexpectedly breech. Suddenly the room was full because a breech birth is considered an emergency. Mums who have a breech diagnosed in advance will be steered towards an elective C-section which means that the average midwife and obstetrician hasn’t experienced that many breech births – which is why 6 members of staff were considered necessary for a vaginal breech birth. It was then confirmed that the baby (who has been called naughty for being breech) was in One Born Every Minutefact in the correct position and a normal birth could take place. However, poor Sarah still had 8 people packed tightly around her, most of them staring at her vulva. I can’t think of many things more likely to make my nether-regions clamp shut than having all those heads staring at me! Little Chloe was a very healthy sized baby, still covered in a thick layer of vernix which was allowed to stay on which was great to see.

So, we had seen 1 C-Section, 1 Ventouse and 1 ‘no help’ with quite an audience.

Exhausting stuff and I have to admit I shed a tear and felt inspired by those amazing mums and dads. I also had a very interesting HypnoBirthing class where we went through some of the events from this episode. We obviously see a heavily edited version of events in that programme and I expect my clients to leave with the skills and strategies to be able to direct their own birth and know what questions to ask so that they can avoid some of the pit-falls we viewed in that episode. Ultimately though we saw 3 healthy women have 3 healthy babies and that is what we ultimately want.

Congratulations to those mums and good luck to all those having their baby soon. x

1 I don’t recommend that the people coming to my class watch One Born Every Minute as it shows birth to be disproportionately traumatic. This will not help a mum to know that her body is perfectly designed to birth a baby.

2Figures do not add up to 100 due to rounding.

Why I’m not pro-natural birth…

I’m a HypnoBirthing Practitioner so it’s obvious that I am pro-natural birth, right?

Well actually, wrong!

Croydon Hypnobirthing birth pregnancy

If I’m pro-natural birth, I’m by default saying that those parents that do not have a natural birth must be less in some way… and that is just not the case.

If I’m pro-natural birth, I’m effectively saying that parents who do not have a natural birth must have made some poor choices.

If I’m pro-natural birth, it could be interpreted by parents who do not have a natural birth that they did something wrong, that perhaps the mum’s body wasn’t quite up to the job.

If I’m pro-natural birth, I’m telling the midwives and doctors who are there for an assisted birth that they have not assisted effectively.

And all these things would be wrong.

The reality is that most of my HypnoBirthing clients do have wholly natural births. They haven’t felt extreme pain, their babies have birthed relatively quickly and the first moments with their baby have been easy because no one is exhausted. And this pleases me greatly.

One of my favourite birth reports came from a couple who had had a previous negative birth experience. They needed the second birth to be a good one to get closure on the first one and they did everything to achieve it including planning a home water birth with an independent midwife. I was so looking forward to their birth story and it was a truly great one (brought a tear to my eye as it happens). They felt empowered, they were in control, they made all of the decisions and reflected on it extremely positively; they had their closure. They also happened to have a C-Section. It wasn’t natural, it wasn’t how they planned it, but it was the best decision in the circumstances on the day.

So, I’m not ‘pro-natural birth’. I’m ‘pro-a positive birth experience’.

I support the parents that I work with to have a birth experience that they are happy with, that they can look back on and smile. You can own the birth process however it plays out and that helps in achieving a positive birth experience.

Happy New Year Baby!

HypnoBirthing Croydon

Another year has passed and I have been reflecting on what 2012 has brought with it – it has been quite  a year both professionally and personally for me, with lots of people helping me along the way, usually without even realising that they are helping me. I have been blessed to encounter so many lovely people who I have enjoyed working and studying with.

In my HypnoBirthing™ I have worked with:

  • couples who have had babies in the breech position and HypnoBirthing™ has helped the baby turn;
  • cynical dads (you know who you are!) who have really embraced HypnoBirthing™, realising that it is actually based on common sense and I’m not the hippy that they feared;
  • mums who thought an elective caesarean section might be the easier option only to end up looking forward to a natural birth after using HypnoBirthing™;Croydon HypnoBirthing
  • couples who haven’t had ‘text-book births’ but who have raved about how great their experience was because HypnoBirthing™ helped them to ‘own’ the decision making process;
  • mums who have been hospitalised during pregnancy so the HypnoBirthing™ sessions have taken place at hospital;
  • a mum who birthed her baby on 10/11/12!
  • lectured to student and registered midwives on how HypnoBirthing™ can facilitate a ‘normal birth’ and helped midwives to understand how they can best help HypnoBirthing parents.

In my BabyCalm™ work I have worked with:

  • Expectant first time parents who were nervous about what on earth wouldhow to calm a baby happen when their baby was born who went on to have lovely early days with their newborn;
  • New parents who thought that they were getting this parenting-lark wrong but actually when we talked about it in the Colic & Crying Workshop realised they were doing a great job;
  • New first-time mums who made great new friends in the Mother & Baby classes;
  • New second-time around mums who wanted to do things differently this time

Of course, bullet-pointing it like this doesn’t give scope to tell you how much I’ve enjoyed working with parents this year – with them typically arriving a little uncertain and leaving with raised self-confidence.

I’ve spent another year studying and attending some great events:

  • At the Royal College of Medicine Hypnosis in Childbirth Seminar I heard how HypnoBirthing™ is being used in the NHS and about the research being conducted by Professor Soo Downe (watch this space!)
  • At the BabyCalm Conference in London I met Michel Odent who spoke on the importance of Oxytocin in the post-natal bonding process, Naomi Stadlen who spoke on ‘What Mothers Do’ and Oliver James who spoke on ‘Love Bombing’. All very thought provoking.
  • At the HypnoBirthing™ Institute Study Day in London I heard the founder of HypnoBirthing™, Mickey Mongan, speak about the improvements being made to the HypnoBirthing™ course.
  • Exhibited at the NCT Baby Show at Trinity School, Croydon, meeting lots of expectant and new parents and meeting lots of other birth and baby professionals
  • Exhibited at the Mothercare Baby & Me Event, again meeting a cross-section of expectant parents.

I was also awarded the Gold Seal by the HypnoBirthing Institute and the HypnoBirthing UK Advisory Board nominated me as the Regional Liaison for South London.

Croydon HypnoBirthingPhew! What a year! On top of all this, I took up running this time last year (not a New Year Resolution, just happened to find a fantastic pair of running shoes) and went from being able to run about 100m (I kid you not!) to running the Croydon 10K in October in 7 minutes less than I anticipated with the 2 best supporters in the world cheering me on!

I wonder how 2013 will top that!

Another Lovely HypnoBirth

I received another lovely birth story last week. It’s a great story. Whilst the birth isn’t ‘text-book’ the techniques and confidence gained from HypnoBirthing allowed mum and dad to enjoy their amazing birth – which is what it’s all about!

So, let me introduce you to Francesca, Baydon and the delightful Frida:

HypnoBIrthing Frida

“I went into at 3am on Sunday 25th and spent the day timing surges on my iPhone app but they were pretty irregular so I was mostly watching TV and sleeping. They started off about every 7-10 mins then started to speed up to about every 4-5 mins so we went in to Croydon University Hospital at about 10pm. I was cool as a cucumber at this point. The 1st hurdle was triage when they discovered I had a really high pulse rate which meant I wouldn’t be able to go to the Birth Centre. They suggested that I was dehydrated and they said if I could bring my pulse rate down through hydration I could be transferred to the birth centre.

The midwife we had that night and the one in the morning were both fantastic – particularly the one on the Monday who was there until the birth. On Sunday night I was still going strong with my breathing techniques and visualisation and Baydon was able to really keep me on track. It was actually amazing how any pain melts away when you relax into the surge. The Monday midwife was really familiar with HypnoBirthing and was totally respectful of all our birth preferences. She really acted as a first line of defence for us when the doctors started suggesting things.

On Monday they started talking about breaking my waters to -as you said- get things moving. The midwife gave us loads of time and options to consider. By 2.30pm we’d tried various things and I’d been going 36 hours so we decided to go for it. In hindsight I’m unsure whether this was the right decision but we know that ultimately it was our decision and no one talked us into it. My pulse rate was also still very high which was an important factor.

The surges picked up pace and intensity very quickly after that. Before we knew what was what they’d increased to the point where they were back to back which meant that I wasn’t getting the respite between surges to get my head together. Even 30 seconds would have been nice! I very quickly made the decision to have an epidural and once that was done I was absolutely elated. However, after the epidural, her heart rate dropped so they really wanted to just get her out. Our midwife was fantastic about explaining how this would affect our birth preferences and what the risks and options were. I had a ventouse delivery and ended up combining that with coughing to get her out as that was what worked! Frida had been fully engaged for 5 weeks so once they went in for her it didn’t take long at all. I did have an episiotomy although I asked not to so the obstetrician said he’d do his best. I ended up with just a small cut and a few stitches which he said would have been a lot more had I not been doing the perineal massage. They’ve completely healed now, less than 2 weeks later.

We had immediate skin to skin and as soon as the paediatrician was happy she was fine they all cleared out and left us alone in the room for a couple hours which was really lovely.

Ultimately labour was 40 hours and for 36 of those I was feeling great – I like to think HypnoBirthing on its own got me 90% of the way there! We also both felt 100% that decisions were our own and where they were dictated it was by circumstance rather than opinion. I came away feeling really quite positive about my birth.

So today she was officially registered. We’re getting out once a day and she’s gaining weight and we’re breast feeding like there’s no tomorrow! She’s an absolute treasure and doesn’t grumble too much and sleeps at night a reasonable amount. She’s totally enchanting and entertaining.

Thank you so much for all your guidance as it really helped us to have the most positive birth possible and obviously we’re totally made up with the outcome!”

Wow! What a great birth! For more testimonials, take look at this page.

Guest Blog – Who will be first?

I am hoping to welcome a series of Guest Blogs to my humble blog-site. I am looking for bloggers, parents, local therapists, and really anyone with an interest in pregnancy, birth and parenting to come and have their say here.

If you have anything you’d like to say, or you know someone else who might want to give some advice to expectant or new parents, please phone me on 020 8405 3499 or email me at helen_redfern@hotmail.com .

Later today, the first guest blogger will have their say – any guesses who it might be? Check back later to find out.

Be Prepared for the Christmas Rush

Are we in the middle of a Christmas Baby Boom?

Over the last month or so I have had a lot of enquiries for HypnoBirthing and BabyCalm courses, often from friends of mums and dads who have had calm births and now have calm babies, thanks to these courses. However, I can’t fit everyone in and it upsets me to have to turn down people who I know I could help to have easier births and a happier experience of early parenting. It hurts especially when I am unable to help people who have been referred to me by happy clients (who are like family).

So, I beseech you, do not be afraid to contact me earlier than you think is necessary. If you call me when you are 35 weeks pregnant, I may not be able to fit you into one of my classes, and if you contact me when your baby is 12 weeks old I may not be able to fit you into a BabyCalm Mother & Baby course.

Do feel free to contact me in your first or second trimester – if you’re the first to book a HypnoBirthing course of BabyCalm Antenatal Workshop I may even reschedule it to a day that suits you. By the same token, do feel free to book a BabyCalm post-natal course in the first few weeks of parenthood or even, as some do, before your baby is born. I keep my courses small so that you have chance to ask the questions you need answers to and so that you can get to know the other parents well, which has led to lots of groups of friends being made.

Alternatively, if you have a group of friends in a similar position as you i.e. pregnant or a new parent, I may be able to schedule a course for your group – you can but ask!

I hope this helps anyone considering booking a course. I am already taking bookings for 2013 courses so do contact me if you think you’d like to make a future booking.

HypnoBirthing: If Carlsberg did labours…

Last week one of my HypnoBirthing couples had their first baby. The mum recovered so well that she emailed me less than 90 minutes after to tell me that the birth was,

‘less than 8 hours labour, no drugs, natural placenta delivery, and no stitches’.

That sounds pretty good doesn’t it? Today she sent me the full story:

Julia, Stuart and Baby Alexi’s birth story:

‘I decided to do HypnoBirthing after a recommendation from a friend who found it fantastic. Although I was a little sceptical and my husband was very sceptical I thought it would be worth giving anything a go for an easier labour.

Using HypnoBirthing I ended up having the dream labour. Contractions started at midnight. We arrived at hospital about 4 o’clock 5 cm dilated. I was in the birthing pool by 6 AM and to the surprise of my midwives gave birth at 7:23 AM with no drugs required not even gas and air. I would describe the pain as uncomfortable, but my birthing plan indicated that the midwives not offer me pain relief unless I asked, and the uncomfortable feeling was not significant enough for it to cross my mind to ask. Clearly HypnoBirthing had a big part to play in achieving this. Additionally I did not tear at all and have not been sore since. I put this down to the perineal massage suggested by HypnoBirthing.

Helen the Certified HypnoBirthing Practitioner I chose to have the lessons with was superb. She had a great calm but no messing manner and handled my highly sceptical husband well. I would thoroughly recommend her.

My husband is saying to his mates “If Carlsberg did labours ….”

If you are reading this wondering if it is worth the money, with no guarantee you will have a labour like mine, I would say if it gives you a chance you could have a birth like mine, then it is worth every penny.’

Julia hasn’t mentioned in her testimonial that Alexi was born ‘in the caul’ i.e. in the amniotic sac. This is considered to be very lucky. It is also a sign that Julia was very relaxed and that her midwife allowed the birth to play out naturally.

If you are pregnant and like the sound of a HypnoBirth, contact me on 0208 405 3499 or at helen_redfern@hotmail.com

One Born Every Minute

I often advise my HypnoBirthing parents to refrain from watching Channel 4’s One Born Every Minute until after their birth experience. HypnoBirthing helps parents to have easier, calmer births. I suspect viewing the types of birth that make great television drama may not help in building their confidence in the great birth they are going to experience.  However, I also suspect that quite a few of the mums ignore my advice and I watch it myself in case I need to address a point raised in a future class. Last night’s episode really struck me so I am going to raise my head above the parapet and comment on it. In doing so I also include a disclaimer here that of course the programme is heavily edited so assumptions made may be wholly inaccurate.

We saw 2 births. One was the birth of Baby Freya. Her parents, Donna and Shaun, were a supportive couple. Donna went into hospital with a relaxed frame of mind and Shaun was on hand to say and do the right thing. Added to this, their midwives were fantastic.  I’m afraid I cried like the proverbial baby when they showed her birth. I’ve included a clip here:

Donna, Shaun and Freya – Channel 4’s One Born Every Minute

The second birth really struck me though and has been a ‘popular’ discussion point on various forms of social media. Kurt (aged 20) and Beth (aged 18) had a baby boy. Their experience was less positive and made uncomfortable viewing. Beth was doing really well and Kurt was being reasonably supportive. The portrayal saw her reach full dilation fairly quickly and without too much discomfort but then it seemed that her body needed a rest. Instead it seemed that a lot of pushing took place that required a high level of coaching and breath-holding. Now I have to admit I was in the process of taking down my Christmas tree so I may have missed something but I didn’t understand why Beth couldn’t just take a rest and there didn’t seem to be enough explanation as to why forceps were required at that point. Most forceps delivery take place in theatre and it seemed that Beth could only take one person in to theatre; she chose her mum. At this point the story is shown from two perspectives:

Channel 4’s One Born Every Minute

Beth’s son was delivered, slightly blue and not breathing. The cord was immediately clamped, he was taken to the resuscitation table and it took 3 minutes for him to breath. Beth meanwhile did not see her son and didn’t seem to be kept informed. She was however told that her larger than average baby was ‘a monster’. I didn’t understand why the umbilical cord, that was providing the baby with oxygen, was so hastily clamped, neither did I understand why Beth and her now breathing baby, could not enjoy some skin-to-skin time before he was taken away for observation.

I felt most uncomfortable about the treatment and portrayal of Kurt. Only one additional person was allowed in theatre and Beth chose her mum. Kurt immediately indicated that he really didn’t mind but it was clear that he was upset. Bethany was wheeled out of the room, leaving Kurt frightened and excluded from the birth of his child. His initial external reaction was one of indifference which soon became anger and some aggression. He was portrayed as a bit of a meat head and that is why I found it such uncomfortable viewing. He wasn’t kept informed of what was happening, he had no idea his son had been born or that Beth and their child were not together. However it was a joy to see how calm and tender he was when he finally saw his baby; he really had just wanted to be a part of his son’s birth.

The portrayal of Kurt’s reaction to being excluded was unnecessarily sensationalist and voyeuristic for me.

I have been considering how this might come up in a future HypnoBirthing class. I will reassure the parents that the skills they learn are going to help them to manage their births better. The mums will know when they are ready for the baby to be born and when that time comes they will breathe their baby down, perhaps resting if necessary, rather than being coached when and how to push. More importantly, the dads are going to fully understand their role in the process. They will know how they can help their partner, how to ask questions so that they know what is going on, how to accept what is going on if events take an unexpected turn and how to be the man who ensures that all three of them enjoy beautiful bonding time.

Birth is an amazing experience. I know it would make poor television to show an easy calm birth but perhaps the television participants should be given a little more consideration too.

I’d really like to hear what you felt of the births shown. What thought did it raise for you?

When’s my baby due?

I’m sure that one of the first things that you did when you found out that you were pregnant is try to work out the estimated due date (“EDD”); it’s also probably the first question that people ask when you tell them that your pregnant.

When is my baby due?

So, how accurate is the EDD?

Well first off, remember that the EDD is just an estimate. Your midwife will ask you when your last period started, count back 3 months and add seven days. This calculation assumes that you happen to be someone who scrupulously notes down your period dates and who has a ‘normal’ 28 day cycle; most of the HypnoBirthing mums I work with don’t match that description. It’s easy to see how using such a starting point and adding about 282 days to it may not give an accurate EDD.

Where does 282 days come from?

The gestation period for 95% of the population falls between 265 to 300 days. 282 days is simply the average of these 2 figures. You’ll probably find that your hospital will amend your EDD at least once during your pregnancy as the size of your baby is compared to the average foetal size. Most mums I work with consider that the EDD gets closer to the date that they intuitively feel is the right date. However, I don’t think any of my HypnoBirthing mums have birthed their baby on their EDD.

So, how many babies do arrive on their due date?

Only 5% of babies are actually born on their due date. How crazy is that? So it’s really not a good use of anyone’s nervous energy to focus on the due date that you’ve been given. Research shows that the average first baby is born at 41 weeks and 3 days, i.e. 10 days after their due date. Can you imagine how annoying, and pressurising it would be to have friends an dfamily calling and texting to know if you’ve had the baby yet as soon as the magical EDD arrives? Therefore, it’s more important to focus on that range of 265 days to 300 days. So, if you were due on December 15th, it would be fair to assume that the baby would be due sometime in December. My first baby was due on the 13th. Being keen to manage everyone else’s expectations and avoid any pressure, I told friends and family that the EDD was  towards the end of the month.

Is the EDD that important?

The importance of not focussing too much on the EDD is not just about avoiding other people’s expectations but allowing yourself not to worry about when the baby is born. As long as you and your baby are both in good health and there are no complications, you should enjoy these last few days of pregnancy rather than feel pressured to consider being induced. You and your baby know when it’s time to get things started. Once artificial intervention is introduced you’re moving away from what your body and baby know what to do.

In my next post I’ll be talking about how you can help things along naturally if your do go past 42 weeks.