SBryan

If you join Times + (ie subscribe to Timesonline) you can get 2 for 1 via Mr and Mrs Smith at Woolley Grange.....

Hi, We went to Wooley Grange last year, it was brilliant! Not cheap but you could look out for special offers; we booked through a Times deal and got 2 for 1. They have several other locations too if you don't fancy the drive to Wiltshire... http://www.woolleygrangehotel.co.uk/family_hotels_uk.html

Dear Sillywoman, I'm sorry you were so hurt by my post, it certainly wasn't intended as a personal attack, and I certainly wasn't referring to the NCT. It was a direct response to your post: "Part of what Midwives, Doula's and Antenatal teachers do is to protect the culture of birth. We only have to look across the pond to see what happens when fear of birth & fear of risk is allowed to escalate and an Obstetric, risk averse culture prevails." which I'm afraid in black and white print implies that the aforementioned professions are protecting women from obstetricians. I'm sure this isn't representative of what you think, and reflects the difficulty of discussing highly emotive matters on an anonymous internet forum. I certainly wasn't accusing you personally of not supporting women and their birth-choices, and making women feel like a failure, I was commenting on the prevailing culture. I don't think any healthcare professionals, be it midwives, doctors, or antenatal teachers make women feel like failures; they do it themselves. I see women in both the immediate postnatal period, and at 6 weeks postnatally, and the amount of guilt felt is huge (and don't forget I am a young woman most of whose friends has recently been through childbirth). Part of that guilt is due to the huge pressure we put on ourselves to have the perfect birth. I am not accusing you, or the NCT of doing this, it's a societal issue. There is, amongst a small number of people, an "us and them" culture; I know, because I face it every time I work on delivery suite; I have watched babies develop brain damage and even die due to a refusal to allow medical intervention. The culture is due to a large variety of reasons. There has been a reasonable backlash against old-fashioned patriarchal medicine, giving women back control in their births, and wanting to move away from unnecessary intervention. What people don't realise is that obstetricians are at the forefront of these changes, rather than the enemy of them; that's why many of us went into obstetrics in the first place. You only need to look at the recent publications from the RCOG to see these changes. The culture has changed; the majority of labour ward leads and head obstetricians across London are women, most of whom have had babies themselves. I can't comment on Kings, but the unit I work at is generally not defensive or patriarchal, and really has women's and their families needs and wishes at the centre of everything we do. The reality currently though is that the majority of women have obstetric involvement at some point in their antenatal period, labour, or delivery, as you can clearly see from the results of the NPEU study. At any given time on delivery suite I may have up to 14 women under my care, all of whom we are doing our best to achieve vaginal deliveries for; obstetricians will probably deliver about 40 - 50% of these. Up to 4 or 5 labouring women will be at home or on the birthing unit, with a transfer rate of 50% in first pregnancies and 10% in subsequent. So, we need to be a bit more realistic about what may happen (without frightening the life out of people, not easy!) and I'm not sure we always are. That's the fault of everyone involved in maternity, certainly not the NCT alone or any individual teachers. For example, how many of you know that if you have an induction, in your first pregnancy, because you're overdue (and were previously low risk) you have a 50% chance of needing a caesarean? Sorry, it's another long post, I'm going to bow out of the discussion at this point, but felt it important to put forward the views of a member of the medical profession as it's our low visibility that leads to a lot of misconceptions.

I too have thought long and hard about adding to this thread, but at this point feel I must (apologies in advance for the long post). I am an obstetrician and gynaecologist in East London, and, as such, have read the study in great detail. Home-birth is a controversial subject amongst healthcare professionals, and tends to divide doctors and midwives into big pro- and anti- camps, due to the lack of robust data on the subject. The problem then is that people have to rely on their own anecdotal experiences which are highly emotive, as you can clearly see after Littlemoo's courageous post above. It is often bandied about that obstetricians are vehemently against, and midwives passionately for, whereas in reality I know as many obstetricians who have had homebirths as midwives who've opted for elective caesareans. So, this study is valuable in providing us with the evidence we can use to give women informed choice. This isn't about telling women how and where to have their babies, it's about informing them of all the relative risks and benefits, and allowing them to make their decisions based on full knowledge of these facts (however unpalatable they may be). In basic terms, it backs up what most of us have thought for a long time; that home-birth for a low-risk second or subsequent delivery is as safe as delivering in hospital, but carries increased risks if it's your first labour. The primary outcome measure of the study was neonatal outcomes: this is the one that was shown to be 4.7 /1000 in a midwifery unit and 9.3 /1000 at home for first pregnancies. The take home message about these outcomes is that, although relatively rare, they were almost all catastrophic. Death, brain damage, and nerve plexus injury. They also measured meconium aspiration, but as passgage of meconium would necessitate immediate transfer to hospital, it's unlikely this contributed significantly. The results weren't statistically significant enough to break down the individual risks of each, (ie to work out whether homebirths or hospital births result in more or less severe brain damage) so, for the time being, these are the only figures we can use. The secondary outcome of the study was intervention levels. I think this aspect of the study was less well conducted. The "low-risk" group in hospital included many groups that would have been excluded from home-births and midwifery lead birthing units(eg. high blood pressure, obesity) so I don't think the results are comparable. That said, it is well known that you are more likely to have intervention if you are on an obstetric unit even if you are low-risk; some of this (eg increased instrumental delivery rates) can be attributed to use of epidurals. This doesn't mean they are inherently evil; they are safe, effective pain relief, and for many women experiencing long, hard, difficult first labours they are a godsend. The other statistic I think it is important for all first-time mothers to be aware of is the high transfer rate into hospital; almost 50%. It's not just about needing to be transferred; it's an awareness of the fact that, once transferred, the majority need obstetric intervention in one form or another (although some just need epidurals). The other thing to point out, as people have mentioned, is the difficulty in extracting from the statistics how experienced the midwives are at home-births, or how far away they are from hospital and therefore how much this contributes. It's not true that all community midwives are experienced, with a passion for home-birth, as many people think; newly qualified midwives often have to rotate through the community, and although they are usually accompanied by a more senior midwife, this isn't necessarily the case if the services are stretched. If 2 or more home-births are happening at the same time, midwives then have to be sent out from delivery suite. What keeps coming out time and again is the safety and attractiveness of midwifery lead units for low risk women. The unit I work at has a beautiful home-from-home birthing unit, attached to the main delivery suite, but run independently, and our homebirth rate is therefore very low, despite serving a population very similar to King's. We obstetricians have nothing to do with it unless asked (or crashed) but as a continuation of the unit, neonatologists are just an emergency buzzer away. It's a fallacy to say that it's the takes the same amount of time to transfer from home to an operating theatre as from a delivery suite room; in a true "crash" emergency in a hospital or adjacent midwifery lead unit, the time from the buzzer going off to delivery of the baby can be as little as 6 minutes. A lot of things in Hackneydoula's post is nonsense, I'm afraid, particularly the assertion that birth is "safe". It isn't, and you only have to look at the statistics from the third world to back this up. We have made it safer and safer, and it's easy to forget the risks, as demonstrated from Littlemoo's poignant post. It's natural, as are bad outcomes, and the key is to manage those risks appropriately with the right level of intervention. I'm sorry, Sillywoman, but I object to your comment that antenatal teachers, midwives, and doulas protect the culture of birth, with no mention of obstetricans. I am vehemently pro women's choice, pro normal vaginal delivery, and pro low intervention, as long as mum and baby remain safe. Most obstetricians are; the days of patriarchal medicine are long gone. I'm therefore pro homebirth, (despite having delivered 3 babies that subsequently died after homebirths went wrong) as long as women and their partners are fully aware of the risks and benefits. It's comments like this that develop an "us and them" culture and makes women feel as though obstetricians are out to intervene, medicalise, and meddle, just for our own satisfaction. And that leads to women feeling like a failure if they are in the 40% of women that don't have their ideal delivery, and an obstetrician delivers them instead. The reason the rates of intervention are as high as they are, are due to pregnancies becoming more high risk; in particular obesity, higher rates of twins due to fertility treatments, more diabetes, high blood pressure, etc. The rates of intervention in truly low risk women are the lowest they've ever been, and we want to drive them lower, whilst keeping women and their babies safe, and giving women a positive birth experience. It's a difficult task, but we're trying. Littlemoo, my heartfelt condolences at your loss. COI: I had a very medicalised induction with a growth restricted baby due to severe pre-eclampisa at 35 weeks, that resulted in a forceps delivery. The day I was in labour was hideous, the 10 days afterwards in hospital bloody awful, but I cherish the fact we are both alive, well, and happy. If I'm lucky enough to be low risk in any subsequent pregnancies I'll aim to deliver in an attached midwifery lead birthing unit.

Don't worry, most mastitis is caused by a bug called staph aureus, which co-amoxiclav is effective at treating. Due to high levels of resistance to flucloxacillin locally, it is the first-line antibiotic in most London hospitals for any infection that gets in via the skin (including mastitis). The most important thing is to finish the course.... make sure they've given you a full 10-14 day prescription. Only if that doesn't clear it completely would I consider switching to flucloxacillin. It might be worth getting a breast feeding expert to check your latch and positioning; it can be caused by incomplete emptying or cracked nipples and they should be able to correct these things. Don't worry, only 3% of cases of mastitis go on to form abscesses, often if they've been incorrectly treated, or if treatment has been sought too late. Here's an information leaflet..... http://www.patient.co.uk/health/Mastitis-(Breast-Infection).htm Hope it gets better soon, it really is hideous. (I'm a doctor who had recurrent mastitis due to a funny position feeding overnight when I was asleep... I eventually had to stop feeding on that side at night.... I know how horrid you must feel).

Thanks for the tip, we've just got back; it was lovely, I highly recommend it!

Thanks!

Hi everyone, We've found ourselves at a loose end tomorrow. Can anyone recommend any good drop in groups for an 18 month old (and his Mum) on a Tuesday morning? All suggestions gratefully received. Thanks!

http://www.jellybellypt.com/ Kellie's classes are amazing. I can't praise her highly enough. Susie

edited

http://www.rcog.org.uk/files/rcog-corp/AirTravelandPregnancyPatientInformation.pdf

Not sure if any of you have seen it but this might be useful.... http://www.rcog.org.uk/files/rcog-corp/uploaded-files/PIVaginalBirthAfterCaesarean2008.pdf

Great, thanks!

Hi, A friend & I are planning to meet at the one o clock club today; neither of us have been there before, but I just wanted to check that it's open on Tuesdays? Can't find any info via Southwark Council. Thanks!

Hi, I'm posting this on behalf of a friend (who is a true ED-dweller, I'm just an Oval-Camberwell interloper). Her and her husband are sadly having some difficulties in their marriage. They had counselling last year through Relate with good success, but unfortunately did not complete the course of sessions as their counsellor became unwell. She is still on long-term sick leave, so they are now seeking an alternative, but having difficulty finding anyone with availability. Does anyone have a contact? Many thanks Susie

Actually, sillywoman, I didn't say it was a bad thing that antenatal classes paint a rosy picture. In fact, I attended them in my pregnancy for precisely that reason; so that my non-medical husband would hear a more positive view of childbirth to counteract all the medical horror stories he'd heard over the years. And to go into too much detail about complications would unnecessarily terrify most people. Besides, I'm not sure that any amount of theory can ever prepare anyone fo the realities of childbirth. It was more a comment about the fact that, in spite of thinking they know what may happen, a large number of women and men are understandably shell-shocked after the event. NHS classes don't have the post-natal debriefing that NCT courses do, and many women feel isolated in their feelings as a result. Which is a shame, because the stats bear out how many deliveries are complicated by an intervention of one sort or another. The c/s rate at King's is 24%. There are a wide number of factors which influence it; what proportion of women delivering there are having their first baby, the average age of the mothers, the percentage of twins delivered at the unit, the number of women wanting a c/s after having had a complication in their first birth (eg c/s or third degree tear)..... I could go on. born&brED: I'm glad to hear you're feeling more positive, and good luck with the perineal clinic.

Hi, I'm glad you found the info useful. It's nice to be able to help, particularly as I'm on mat leave at the moment so just used to being Mummy. Sorry I haven't been able to reply earlier. born&brED, it sounds as though you had a long and difficult labour, and it will take a while to recover, both physically and mentally. The good news is that subsequent labours tend to be much quicker, as the body remembers what to do and how to do it, so the experience is very unlikely to be repeated. Antental perineal massage can help to prevent tears; not always(!) but its a free, easy thing to do and doesn't do any harm, so I'd certainly recommend doing it. There's a wealth of information online about it. There's no evidence that things like Mamasure are any better than pelvic floor exercises, and they're free! You do have to do them every day though, and properly. If anyone has any stress incontinence post childbirth (when you run, cough, and sneeze) then don't suffer in silence.... see your GP who should be able to refer you to a pelvic floor clinic, or classes. They're run by physiotherapists or specialist nurses (although I'm not sure about King's as I work in North London) and there's an incredible number of women attending them; you're not alone. It's good to do these things now, when you're young, as after the menopause things often get worse, by which time you've been suffering a long time. Please don't be embarrassed, gynaecologists are extremely used to seeing these problems, it's what our job is all about! And, lastly, 15=20% of women have an assisted delivery, so there are lots of people out there in the same boat, you're not alone (and 30% have a caesarean, the antenatal classes paint a very rosy picture of childbirth indeed!).

Hi there, Sorry to hear that you've had a difficult recovery time, but I want to reassure you that, as long as you don't have any other problems eg with your bladder or bowel, then things will eventually feel normal again. I had a forceps delivery (with episiotomy) 5 months ago, and felt fine from about 6 weeks onwards....... however, my big declaration of interest comes: I'm an obstetrician and gyanaecologist, so I knew all the right things to do in the immediate postnatal period to speed up my recovery. I think that sometimes this advice is lacking as all the healthcare professionals think the other is supplying it; some hospitals have physiotherapists who do the best job of all. There is also very little information provided in antenatal classes (often none), which is criminal given that over 90% of first time mothers having a vaginal delivery will need some kind of stitches. The most important thing to realise is that having had a vaginal delivery, you are very likely to have another one, and this will probably be uncomplicated, so your first experience is very unlikely to be repeated. Look away now if you don't like gory detail, but I just wanted to clear up a few misconceptions about episiotomies / tears (although Sillywoman has made some very good points above). In the old days of patriarchal medicine, every woman used to get an episiotomy in the mistaken belief that the routine use of them would prevent third and fourth degree tears..... this was found to be untrue. Thankfully, the movement went towards natural tearing instead, which is often better as the small tears don't need suturing, which episiotomies always do. However, this is in uncomplicated, normal deliveries, when the baby's head has stretched the perineum over the course of 5-10 mins pushing making the tissues more elastic and the baby's head is in the right position, and coming out on it's own (ie without baby's little hand or elbow alongside it, or a pair of forceps alongside. In second time mothers, the tissues are already more elastic, making tearing less likely. However, if an experienced midwife (and I promise, it will always be someone senior) advise you to have an episiotomy, then it's because they think it's likely to cause LESS trauma than tearing and, although it's up to you, I'd take their advice! With a forceps delivery, you have to have an episiotomy as the forceps add an additional cm to the diameter of the baby's head, and the baby comes out a lot quicker than a normal birth. Not cutting an episiotomy would cause severe trauma. With a ventouse delivery, as correctly stated, you don't have to have an episiotomy, but it depends on the circumstances surrounding the ventouse; there are a number of different procedures done for very different reasons and they're not all the same. Generally I will aim to perform them without episiotomies, but will end up with a cut in 40-50%, (rarer in second time mothers) as long as the woman is happy with it .... again because I think it will cause less trauma, and therefore better healing. Some of the worst tears I've seen have been in women who declined an episiotomy when having an instrumental and it's heartbreaking to see the subsequent suffering that might have been avoided. So, again, my advice would be to do whatever your healthcare professional advises at the time, but of course, it's up to you! And, finally, anyone who's had a baby should do their pelvic floor exercises religiously...... particularly after an instrumental, it will promote healing and prevent long term bladder problems. Right, lecture over.... hope that helps.