To push not to push

•June 14, 2011 • 1 Comment

So you’re having a baby. Perhaps you’re very happy to go along with what the medics say – you don’t read much, you go with the flow, and then you go into labour and give birth. Easy peasy huh? When you get to the pushing bit, it could be that you go with your body, and it all makes sense. Or it could be that the script goes something like this:

‘OK, so when you feel the urge to push, I’d like you to take a big deep breath, and hold it, and push down into your bottom. That’s right. See if you can get three big pushes out of that pain. Really push. Come on, a bit harder. Good girl. Can you just push a tiny bit harder? That’s right, get angry with it. Get really angry with your baby. There. Well done…’

There’s a beautiful example to illustrate what I mean just here:

This is called directed pushing, or Valsalva pushing. Some call it purple pushing because the idea is you hold your breath for six seconds, and push with all your might. Your eyeballs pop and you go purple. Perhaps your head swims a bit.

But hey, you’re having a baby, and this is what you have to do to have a baby, right? You’ve never done this before, and the midwives and doctors have seen it plenty of times. They’re the experts, right?

The only thing is, in a straightforward birth, where there’s no epidural, and there’s no reason to hurry the baby out (eg the baby is not distressed), there might be another way.

Because all that coaching, all that cheerleading, is a bit contraversial, actually. Some studies suggest that it shortens the second stage of labour, but not by all that much – I have seen research quoting times from seven to 20 minutes.

Bring it on then. We all want a shorter pushing stage, don’t we?

Think again. Perhaps not, when you realise what you pay for that seven to 20 minutes, which is:

  • Increased risk of your baby becoming distressed (therefore, increased risk of forceps, ventouse, episiotomy)
  • Increased risk of damage to your bladder
  • Increased risk of damage to you pelvic floor
  • Increased risk of damage to your vagina
  • Increased risk of you become distressed

Then why is it happening? Or rather, given there might be a time and a place for it (back to that epidural or other sound medical reasons why it’s actually very sensible to hurry this baby out), why is it happening when it’s not necessary?

I have several theories on this, but I’m not a midwife, so I speak from the sidelines. It could be to do with habit, the need to do something rather than do nothing, a feeling of control. It could be to do with institutionalisation, or fear, or a lack of confidence in a woman’s body… but, to be honest, should that really be your problem when you’re in labour, and if you’re being asked to do something that you didn’t want to do?

So instead of why is it happening, perhaps the question from my standpoint as a doula and childbirth educator, and from the standpoint of the labouring woman and her partner, is to consider how best to avoid getting into a ‘valsalva’ situation in the first place, and if you do, how to make the best of the situation.

And this leads us back to the same old same old. You’re avoiding an epidural, and you’re finding ways to minimise stress to the baby during labour, through plenty of antenatal practice on breathing and relaxation, and upright, forward-leaning positions in labour. You’re also – crucially – going to have your baby in a place that celebrates, rather than fears natural birth, with supporters and professionals who feel the same.

And if despite all this, the cheerleading starts, it’s over to your birth partner. This is the point where your supporter becomes your advocate. She wants to listen to her body, they say – she doesn’t want to be coached. Perhaps they should then ask, gently and politely, without confrontation, whether there’s a sound medical reason for the coached pushing. They should perhaps suggest that they’ve heard it has a lot of side effects. Maybe they should even ask for a second opinion. Or perhaps they should just say, in the words of Mary Cronk, ‘thank you for your advice. I will let you know what I decide to do.’

To end, here’s another little story I found on a parenting forum yesterday:

‘My midwife told me about a woman giving birth. She didn’t speak English and communicating with her was hard. She was fully dilated but was terrified of pushing. So she didn’t. For the longest time the midwives just tried talking to her encouraging her to push. She didn’t. This went on for quite some time (not exactly sure how long) until the woman needed to cough. And with that cough the baby’s head came out.’

Three cheers for Chippy!

•June 2, 2011 • 2 Comments

It’s not often that, as a doula, I feel redundant. But on Monday morning I did, a little bit.

I see a doula’s job as twofold: firstly it’s supporting the woman – encouraging her to breathe, giving her techniques to relax, rubbing her back or showing her partner how best to do it. Secondly it’s to advocate for her – if she has a strong sense of what she would like out of birth, then we will have talked about that beforehand and I will do my best to ensure that that happens, however the birth is unfolding, whatever Mother Nature decides to challenge us with.

And for the very first time in my doula’ing career, I ended up supporting a lady at our local midwife-led unit. It’s a stand-alone unit in a cottage hospital, and it’s staffed entirely by midwives and maternity care assistants. There are no doctors and no epidurals, and unless your negotiation skills are particularly astute, you can only go there if you’re ‘low risk’. The nearest pair of forceps, episiotomy scissors, or emergency caesarean is a good 15 minute ambulance ride away.

The mother took me on because she had felt unsupported and out of control during the birth of her first baby (not at the MLU), and just couldn’t decide where to have this one baby, and was 37 weeks pregnant before she finally decided on the MLU rather than either of the two hospitals whose catchment she fell into. I was really pleased she chose it, actually – if you want a straightforward birth, my gut feeling is that you up your chances enormously by booking into a place like this rather than into a hospital, and in my area of the country we’re enormously lucky that there are three of them!

This particular one has just moved into a spanking new building where everything was purpose built. I went to the ‘launch day’ only a couple of months ago, and was shown around by excited midwives and student midwives. I made all the right noises, but I left feeling, ‘but it’s still a hospital,’ and wondering why people would go there to have their baby instead of having him or her at home.

But I changed my mind on Monday morning: this place was everything that a hospital wasn’t. The lights were dim, it was just us in the place so it was quiet and peaceful, and it was set up perfectly for everything you might need for a birth. There was a pool whose water ran at the perfect temperature, a cd player, a range of essential oils. There was a pretty bedspread and pillowcase, flowers on the windowsill, the most enormous ensuite bathroom you’ve ever seen.

And the most wonderful, wonderful midwives.

Which gets me back to my sense of redundancy. If every woman in labour was graced with a midwife like these ones, I’d be out of a job – and that would be perfect. They nurtured, they watched, they crooned and whispered and supported and did all the lovely things that a woman needs in labour, and which, unfortunately, can be less than forthcoming on a busy delivery suite. Not that most midwives don’t WANT to do it, they just sometimes are denied the chance or the time. They do their best, but it’s my impression that they’re being pulled in so many different directions at once, that it gets hard to do it.

Midwife means ‘with woman’. I have often said that I would become a midwife if I was able to continue to be a doula to the labouring women I was midwifing for. The midwives at this unit – and countless other standalone places around the country – truly manage to do that. And it was an honour to see it in action.

Remembering Stanley

•May 28, 2011 • Leave a Comment

Stanley would have been one today. Stanley should have been one today. You know what that means, don’t you. He’s not one today at all. Because in only 11 days’ time, after marking Stanley’s first birthday, his parents will be remembering the anniversary of his death.

So I’d like to spend a moment just now remembering all the babies whose parents I have worked with, who haven’t made it. There’s another Stanley. And Wilfred and Philomena and Kayleigh and Rohan. And all the other babies close to my heart – Ela and Ruth and Samuel and Alice. Some of them lived to take a breath or two – some even made it few a good few weeks, a year or more, and others were stillborn.

I have learned all sorts of things thanks to these little lives. Actually they’re not little lives – short maybe, but not little, because the baby who dies serves to teach us so much – in some ways far far more than the baby who lives.

I’ve learned that parents never forget. Even if on the surface of it, they go about normal lives after a while, and perhaps even smile again. And even make more babies – ones that live – but the memory is still there of the one that’s absent. One friend said to me, ‘there’ll always be someone missing.’ It means that questions like ‘how many children do you have?’ is fraught with complication, and makes the bereaved parent’s heart lurch when they hear it.

I’ve also learned that every parent deals with such an awful loss differently, and that it is not my place to judge their response to their bereavement. I have experienced the whole range, from not even managing to speak to the mother, to attending a funeral with several hundred others, and all manner of in-between states. And when I’ve stuck around the parents long enough, I’ve learned a bit about the journey that is coming to terms with the loss of a child.

In a clumsy way I’ve worked out how best I can cope with it – what’s best for me to say and do (and I word it that way deliberately because different people are going to best say and do different things). That it’s better to say something – anything – and risk saying the wrong thing, than to say nothing at all, avoid the subject – or even avoid the bereaved parent, as if it’s something catching. I’ve got in a muddle with which tenses to use, whether it’s appropriate to ask to see photos (I tend to, actually). I’ve crassly asked parents how they are (der! Pretty crap, obviously!).

I could go on and tell youStanley’s story here, but I won’t, because it’s not my story to tell. Suffice to say that I still feel honoured that I was among the few to meet him in his 11 days on this mortal coil, and honoured further to have shared his parents’ journey, just a little bit, in the year since that tornado struck, and everything got turned upside down in his family. But the strength, and courage, and resolve, and quiet passion that I’ve seen over the last year from one little boy’s remarkable family is an inspiration.

I will remember a tiny footprint on the order of service, tears at the graveside, a funeral full of bumps, babies and toddlers, photo albums chronicling the story, sitting in the sunshine amidst the tears. Cream cakes and laughing at the crassness of some people’s comments. Dilemmas over headstones, and a visit to the churchyard (arriving late) one wet and windy winter’s day to see it in place. Endless hugs, debriefing, story-telling, and a new sibling now on its way. And a closeness that only tragedy can bring.

Give your own babies – whatever their age – a hug today and thank them just for being there, knowing that but for the grace of Whatever / Whoever go every one of us, and if you’d like to, light a candle for Stanley because today his parents should have been lighting one for him, and singing, not crying.

‘Balanced information on the risk and the benefits’

•May 25, 2011 • Leave a Comment

On the face of it, the Birth Trauma Association should be an organisation with which I indentify. As a doula and antenatal teacher who often flirts with the idea of midwifery training, I abhor the idea of woman being traumatised by their experience of birth, particularly if (as I fear is the case frequently) this trauma could be avoidable.

Unfortunately, though, a common call from the BTA in order to remove birth trauma is ‘epidurals for all’, as if pain and trauma are two sides of the same coin. A quote I read in May’s issue of The Practising Midwife worries me: BTA’s press officer is quoted as saying ‘good, balanced information should be provided [in antenatal classes]… not horror stories and not pie in the sky stories; balanced information on the risks and benefits of pain relief.’

These are my italics, and I’ll tell you why.

When I talk about pain relief in labour, be it with doula clients antenatally, during labour, or in a variety of antenatal classes, I am sometimes accused of being biased. Of being against epidurals or pethidine. Of suggesting that the only way to give birth is the natural way. And this is just not the case.

But can you really have balanced information on the risks and benefits when, in the vast majority of cases, the risks vastly outweigh the benefits?

To offer balanced information, for every five risks of pethidine, surely I should be suggesting to my clients five benefits of pethidine? Each time I talk about one of the dangers of an epidural, I should ‘balance’ it with one of its advantages? Then I would be balanced and the BTA would applaud me. My clients would leave without fearing labour, I would no longer be accused of being biased, and all would be well.

Until my clients were in labour. Afterwards the parents whose pethidine-sleepy baby failed to breastfeed would ask me why I didn’t tell her about this. From her rubber-ring vantage point after the huge episiotomy and epidural-induced forceps, women would curse me, while wincing. And the lucky women who escaped the side effects of these powerful analgesics would sit smugly, wondering why the woman who had a waterbirth ‘put herself through all that pain’.

Because whether the BTA like it or not, there are a whole lot more risks than benefits to the strongest forms of pain relief available in labour, and if I tell it like it is to pregnant couples, then I am not offering balanced information. I can’t, because like it or not, the evidence base is not balanced. It would be like offering to teenagers the pros and cons of smoking. Or, if you prefer something a little less emotive, the pros and cons of eating five portions of fruit and veg a day, or exercising for 20 minutes three times a week, or driving at over 70mph on the motorway – or whatever other public health issue you plan to pick out of the air.

And what about this idea of ‘not horror stories and not pie-in-the-sky stories’. One woman’s horror story is another woman’s wanting to know all the facts. One woman’s pie in the sky awakens another to the possibilities of uplifting birth. These issues are subjective, must be tackled sensitively and require a delicate and tactful level of reflective practice within antenatal education be it one-to-one, or in classes, delivered in an antenatal class setting or at a midwife appointment.

The skill then lies with my presenting the evidence in a way that it doesn’t look like it’s my bias: so that people don’t leave with a sense that they have made an inferior choice. Both as a doula and as an antenatal teacher I have had plenty of clients who have chosen to have epidurals or use pethidine in labour, and I have seen the modern medical miracle first hand of transformation that an epidural can bring about.  But I have also witnessed the ancient natural miracle of a normal birth, with all the exulted, victorious joy that accompanies it – and the triumph that a mother carries with her in her first months of motherhood when she tastes that firsthand.

So actually the skill isn’t just in my presentation of this: it should be in the media’s presentation of this more broadly. It is, at the very least, naïve to suggest that satisfaction with one’s birth can be reduced to understanding a tick-box with a balanced number of pros and cons, regardless of what subject we are weighing up. (It could be pain relief, place of birth, method of birth, method of onset of labour: when to go to hospital: you chose.) It is simplistic to suggest that such a huge issue should be addressed for the first time during an antenatal class which takes place in the second, or more likely, third trimester of pregnancy. In fact these kinds of issues crop up in the media every single week, and the bias veers almost always away from the normal and towards the interventionist. And it is missing the point to suggest that birth trauma could be reduced one iota by such a tick-box approach in an antenatal class, any more than deaths by lung cancer could be reduced by secondary-school age children doing projects on ‘balanced information on the risks and benefits’ of smoking.

So come on, Birth Trauma Association. Yes, of course there will be women whose trauma would have been lessened by the administration of timely epidural. But the reasons that women are traumatised by birth lie at a far deeper level – both institutional and societal – than can be found in the controlled drugs cupboard in the labour ward, unlocked by the rescuer in green scrubs.

Knitting and birth: it’s a great combination!

•April 6, 2011 • 5 Comments

When I’m packing my bag, getting ready to be someone’s doula, I always pack my knitting. I chose something simple – something that I can put down at once if I need to, but something that keeps my hands busy and allows my mind to freewheel just enough.

And every time I’m at a birth, the midwives comment on me and my knitting. How they used to knit, how lovely it is, what I’m making. And how in the old days a midwife would always have her knitting in her bag, along with all the bits and pieces she needed for a birth.

It’s a pity it doesn’t happen more often these days, though. Because knitting is the perfect companion to a straightforward birth. I was a doula for a lady last year. Her husband was there too. They were cuddled up together; the oxytocin was flowing, as was the gas and air. She wanted him to support her and at that point I was on standby, really – not really needed other than simply my presence. So out came my knitting – I was doing a pair of pink socks at the time. I asked her whether she minded my knitting – I was slightly concerned that she was paying me to be her birth partner, and instead of ‘earning my money’ by doing something, I was bouncing gently on a giant birthing ball, knitting and purling and cabling, and watching my sock grow. I was pleased by her answer: ‘carry on, I like watching you. It’s comforting.’

That seems to be a common theme, and I found this quote on the Nomadic Midwife’s blog that sums it up:

“after a contraction, opening my eyes, and looking to see her knitting in the corner. That let me know everything was fine, I was fine, and I could do it. In fact, it was when she got up to do medical checks, I began to wonder a little bit if something could be wrong — so long as she was knitting, I knew nature and I were still on course.”

The late great Tricia Anderson talked about one of the cornerstones of midwifery being ‘intelligent tea drinking’. There is a phrase within medicine (which overlaps with midwifery, but is not a subset of it!) of ‘watchful waiting’ – and it strikes me that the knitting childbirth professional (be it doula or midwife or even grandmother of the baby) is of the same ilk: she portrays a peaceful calm suggesting that all is right, that everything is unfolding normally. There is an inference that nature knows what she’s doing here and that we don’t need to interfere.

This is just what Liz Nightingale, Independent Midwife and accomplished knitter of baby hats, says, too: ‘If the labour is nice and leisurely, I like to knit between midwifery tasks. When your midwife is knitting you know everything is going well and so you can relax and release all tension and let your baby slide down.’

But there’s more to it than that. Anyone who does anything with their hands (at all, ever), be it knitting or painting or gardening or whittling or carpentry or mechanics will understand that when the hands are engaged, the mind freewheels in a beautifully non-linear fashion. Thoughts, ideas, theories can emerge in a most satisfying fashion, conclusions are effortlessly reached about troubling or confusing issues, and there’s also the sense that time is being constructively used, not wasted. Liz Nightingale again: ‘I like to knit – it’s a satisfying activity in its own right. It also calms me and allows me to let my thoughts organise themselves inside my head. This is especially useful during birth when emerging circumstances make regular re-evaluation of plans sensible.’

I wish the midwives who had attended my second birth – one warm August night, at home – had knitted. My abiding memory of the birth is looking up from a contraction to see three of them, leaning in a row against my kitchen work surface, watching me. I felt as if I had an audience, and it inhibited me. Not so badly I didn’t push out a beautiful little girl just before dawn, but it is not a pleasant memory. Liz says: ‘I offer to knit a baby hat for each baby I look after. I sometimes do sibling hats too. Parents choose what style and colours of hat they would like.’ To watch my midwives produce love in stitches for my coming baby would have warmed my heart rather than irritated me!

I wonder if I should get down the local university that trains midwives, and offer them the Hooties pattern below – or show them how to knock out a quick baby hat. Hey, I could even teach the obstetricians to knit – now there’s a plan!

Hooties!

•April 6, 2011 • 8 Comments

You will need:

Newborn size:

3mm circular needles

Yarn in two colours – one for main body of Hootie, one for sole. 4ply or fingering weight would be good

Skills: magic loop, knitting, purling, cabling, picking up stitches

For a larger size, just increase needle size and yarn weight!

c4f means slip 2 st onto cable needle and hold in front. Knit next 2 st, then knit the 2 st from the cable needle.

c4b means the same, just hold the stitches at the back.

Using A, Cast on 26 stitches.

Join in the round, placing marker and being careful not to twist. k1 p1 rib for 8 rounds

k one round

[k2tog, yo, k1] repeat to last 2 stitches, then k2tog, yo

k one round

next row – setting up for chart. Adjust stitches so the 12 stitches for the owl are all on one needle.

k6, p2, k8, p2, turn

1. k2, p8, k2, turn

2. p2, c4f, c4b, p2, turn

3. k2 p8 k2, turn

4. p2 k8 p2, turn

5. K2 p1 k2 p2 k2 p1 k2, turn

6. p2 k1 p2 k2 p2 k1 p2, turn

7. k2 p8 k2, turn

8. p2, c4f, c4b, p2, turn

9. k2 p8 k2, turn

10. p2 k8 p2, turn

11. k2 p8 k2, turn

12. p2 k8 p2, turn

13. k2 p8 k2, turn

14. p2 k8 p2, turn

15. k2 p8 k2, turn

16. p2, c4f, c4b, p2 turn

17. k2 p8 k2, turn

18. p2 k8 p2, turn

k all 12 stitches

NB If you want to give the owl sequins or similar for eyes, sew them on at this stage.

Break yarn.

Connect yarn at start of instep and pick up 10 stitches along inside edge of instep, knit along 12 instep stitches, pick up 10 stitches along other side of instep, work remaining stitches.  Work 5 rounds in stocking stitch (46 stitches)

Change to B

Set up round – k1, place marker, k21, pm, k2, pm, k21, pm, k1

Decreasing for the sole:

p1 , slip marker, p2tog, p to 2 st from next marker, p2tog, sm, p2, sm, p2tog, p to 2 st from next marker, p2tog, p1

next round: k1, sm, k2tog, k to 2 st from next marker, k2tog, sm, k2, sm, k2tog, k to 2 sti from next marker, k2tog, k1

Continue like this until total of 22 st in round.

Turn Hootie inside out and kitchener remaining stitches together.

Weave in ends. Weave in ankle tie around the ankle holes.

Make as many as you need. This is usually dictated by the number of feet owned by the baby.

NB If you’d like a pdf of this pattern, leave me a message here – I’ll see it even if it doesn’t appear, and I’ll email it to you.

Whose birth is it anyway?

•April 5, 2011 • 2 Comments

No-one forgets their experiences of giving birth, so it makes sense to do all you can to make sure it’s the most positive experience you can have – and no, that doesn’t necessarily mean a whale-song homebirth.

How many times do you think you’re going to give birth in your life? Once? Twice? And that makes it very special for you. Contrast that with the midwife’s experience of birth. In some busy hospitals, there will be an average of 50 births per midwife per year. Your ‘once-in-a-lifetime’ is her ‘everyday’.

Ask most pregnant woman what their ideal birth experience would be, and they focus on the physical. Not too much pain; not too much intervention; no scary moments or sudden surprises. But psychological research suggests that the women who come through birth feeling good about it aren’t those who escape without stitches: in fact, the actual mode of birth seems to have very little to do with it. Instead, being included in the process – that you were part of the decision-making, that you felt well supported and had established a good, trusting relationship with those caring for you – is the big one.

That’s why I’ve taken five key points that’ll help you make sure your birth is special, however it actually turns out.

Use tried-and-tested decision-making techniques from the very beginning

If you were buying a new car, or choosing a holiday you’d be making subconscious decisions from the very start of the process. What do you want it for? What’s important to you about this experience and what isn’t? Having a baby can be viewed as no different. We often get swept along in a tide of health professionals who don’t always offer us a choice, and we go along with it, because we’re told that’s the way it is. However, the NHS is getting bigger and bigger on the concept of ‘informed choice’, and your brain is there to be used. That’s an acronym:

  • What are the Benefits?
  • What are the Risks?
  • What are the Alternatives?
  • What does my Intuition say?
  • What if we do Nothing?

Get yourself a good birth partner

Dads are a common site on labour ward these days, but professional labour companions, known as doulas, are also becoming more popular. A doula has had some training but is not a midwife: ‘The key thing is that the doula is chosen by the woman and her partner, so she’s not part of The System, and that she’s there really 100% for the woman and her partner. Her support of the partner is important as well – then he can support the woman better too,’ says doula Adela Stockton. You will get to know your doula in pregnancy, she remains on call for your birth, and you’ll see her a couple more times postnatally as well.

Anecdotes that a doula improves your birth experience is backed up by research, which cites fewer caesareans, easier experiences of breastfeeding and lower incidences of postnatal depression among women who have chosen to have doulas. Kate’s story confirms this: ‘I knew when I went into hospital I wouldn’t be cared for by a midwife I’d ever met before,’ she says, ‘but I had had four hour-long get-togethers with my doula before the birth, and it was so lovely to have her there. She feels like a special friend now. The worst point in my labour was when she left the room to go for a wee, and I remember shouting out, “I want Alison!” several times! She really was magic.’

Make the birth environment your own

The health secretary has said she wants home births to be available to all; midwife-led units are all the rage, and there’s always a good old-fashioned hospital with all the emergency equipment available.

But wherever you chose to give birth, you can go a long way to keeping the experience unique by personalizing the environment. Easy peasy if you’re at home, but if you’re in a birth centre or hospital, it might need some forethought. Adela recommends, ‘Think carefully about how to make your environment feel familiar and comfortable, because it makes a huge difference to how your hormones work. Bring in your own pillows and cushions. Stick pictures up on the wall. And try to control as much as you can who is in the room.’ Elaine, mum to Tim, 3, and Katie, 6 weeks, says, ‘I practiced a lot of relaxation before the birth, and always lay on a special blanket while I did it. The blanket came to hospital with me and it really helped me feel relaxed!’

Make a flexible birth plan

How many times have you heard women – and midwives – rolling their eyes when you talk about birth plans? Midwife Sarah Montagu suggests you have a plan A – your ideal birth – and a plan B, which would consider which parts of your plan you could retain even if things don’t go smoothly. ‘It makes you feel like you haven’t lost control of all the proceedings,’ she explains. ‘Simple things can make all the difference to someone’s birth,’ she says, ‘like finding out the sex for yourself. You can have the most pearshaped birth in the world, but there’s no reason why the surgeons in a caesarean would have to announce that.’ Adela’s take on birth plans focuses on the ‘feeling’ of the birth ‘Think about the environment, whether you want a busy atmosphere, that sort of thing. And keep it short. By all means mention interventions, too, though.’

In my antenatal classes I do an exercise which focuses on the two aspects of birth that are closest to their hearts. For some couples that might something physical like avoiding forceps, for example – for others more emotional, like the levels of support. It varies enormously. So I would encourage people to establish those points first, then to think through how best to achieve those aims.

Do your homework – books and classes

There is a huge amount of books and classes on the market, yet obstetrician (and author!) Michel Odent believes that pregnant women should keep their reading to a minimum, as it encourages intellectual activity, and birth is a primal, animal experience, not an intellectual one!

The little research that has been carried out into effectiveness of antenatal education always connects it with birth outcome, and the conclusions tend to be that it doesn’t make any difference. However, it may improve your level of satisfaction, particularly if you have learned decision-making techniques such as BRAINS. Anecdotally, women report that making a close group of friends – such as offered within traditional antenatal formats – makes an enormous difference to their experience of the postnatal period.

Ask around for the right book for you – there are huge numbers of books out there, and what gets one mum-to-be excited will send another screaming for the first epidural she can! Many local NCT branches hold a library of books relating to pregnancy and birth, so save your cash and ask them first, or visit your local library.