There was a lot of speculation about the birth, for most people centred on the boy/girl stuff and the issue of the baby’s names: but for those of us who are professional antenatal teachers, midwives, doulas, hypnobirthing teachers etc what we were really concerned about was the WAY in which the baby would be born, knowing that this over-watched birth would be a role model copied, consciously or unconsciously, by millions of women. What the Duchess did – or rather, what was done to her – will affect millions of women’s choices, whether we like it or not.
As I write now, we don’t have many facts, but we have enough to piece together some strong guesses and, more importantly, some object lessons for our clients in the future. I’d like to reflect on those object lessons here by comparing what we know with what we can guess…and looking at the obstacles which fate placed in the Duchess’s way.
Fact: The Duchess arrived at St Mary’s Hospital, Paddington, in early labour early in the morning and gave birth at 4.24pm.
Fact: SHE gave birth. Not the doctors, Marcus Setchell or Alan Farthing or any of the other medics in the room…can we get that straight please?
Guess: If she was already in labour on arrival, then we can be pretty sure labour began spontaneously rather than being induced. We may also be sure that her doctors will have insisted she go to St Mary’s at the first twinge.
Guess: So labour started naturally and moved fast. All midwives will agree that it’s no coincidence that she went into labour under a huge nearly-full summer moon. The full moon is well known to fill labour wards faster than a keg of caster oil. By the way, we do not really know what her due date was but the rumours went round last week that it had been 19 July, not 13 July as the press thought.
(Slightly Naughty Guess: One of my colleagues has suggested that the Duke of Cambridge may have played his part in bringing labour on. Steady on, Marie Coveney, that really is lese-majeste.)
Fact: We don’t really know what happened after that arrival at St Mary’s, which was done cleverly enough for NOBODY to get a photo of her in labour, and the announcement of the birth 4 hours after the birth.
BUT we DO know that Kate had been listening to NatalHypnotherapy CDs. This is a hypnobirthing course and CD set very popular in the UK, devised by a British doula, Maggie Howell. I have tons of respect for Maggie Howell and it is a lovely thought that her gentle voice might have been heard in the background as the 3rd in line to the throne popped out onto the royal inco pad.
Fact: the Lindo Wing, a private section within the NHS St Mary’s Hospital, has a 100% epidural rate.
Guess: It is unlikely Kate decided to be the first woman to birth at the Lindo Wing without an epidural. So the relative speed of the labour (less than twelve hours from arrival at hospital to birth really is pretty fast for a first time mum) is a bit of a surprise – but not unusual. Perhaps the epidural was in place quite LATE in the labour – after she was 5cm dilated for example. Experience shows us that an epidural administered toward the end of the first stage of labour is less likely to interfere with the progress.
On the other hand, it could be that the doctors decided to suggest breaking her waters, or even to offer her syntocinon along with the epidural “to speed things up”. I do hope they didn’t. I hope they were well aware of the risks. Syntocinon is a powerful drug which can cause the uterus to be overstimulated, cutting off the baby’s oxygen supply. Many legal fights for compensation from the NHS after childbirth involve the use of Syntocinon having caused brain damage to the baby. The drug is also associated with higher rates of postpartum haemorrhage – massive loss of blood.
Breaking the waters is not without risk, either, especially if the baby is still high up – the umbilical cord can get trapped between the baby’s head and the mum’s pelvis and cut off the baby’s oxygen.
I hope Mr Setchell and his crew were really, really aware of these risks. I hope he looked at the Duchess and thought, hmm, healthy mum, baby sounds fine, let’s keep her quiet and comfortable and just see what happens.
Now, I’m writing this on the day after the birth and while the indications are that the baby was born by the normal vaginal route it’s not been announced in black and white. However as the Duchess is reported to be heading off to her mum’s and dad’s tomorrow, it would be less likely that she’s had a caesarean compared with, say, having a forceps or ventouse delivery and an episiotomy requiring stitches. Possibly also she and baby Cambridge have required intravenous antibiotics: because another little-expected side-effect of epidural anaesthesia is a fever.
So…it seems likely that this slim woman gave birth, under impossible public scrutiny, to a 8lb 6oz baby without a caesarean section. Jolly well done, too. Are you surprised? I’m not, but doctors who tell women that they can’t POSSIBLY give birth to a baby over the size of 7lb should be biting their lips now, and in future, should just shut the F up.
Guess: I know it’s early to say but I would say that the hypnobirthing was absolutely key to the success of the birth of the Royal Baby. Let’s look at what the positive outlook encouraged by the calm relaxed voice of my fellow-hypnobirthing teacher Maggie Howell was up against.
She was in a private hospital where there are parquet floors and satellite TV but no birthing pools, no birth balls or mats, and no midwives with the skills to support a woman having an active birth.
Hypnobirthing teaches you to make the most of your surroundings and to focus on resting and saving up your energy during labour.
She had had a couple of antenatal sessions with a recently retired antenatal teacher (not NCT or hypnobirthing) who then gave an interview about it to the Daily Telegraph saying how she had told the Duchess that labour was “ghastly”. Very positive attitude? NOT.
Hypnobirthing teaches you to block out the negative attitudes of others towards labour and birth. For example, the new Wise Hippo hypnobirthing course, which I’m starting teaching this autumn, includes an exercise in which the mother puts on an imaginary cloak protecting her from negative images of birth.
She was surrounded by a team of gynaecologists led by a man older than Kate’s own father. What’s he doing there? Gynaecologists don’t do births! The up-to-date experienced obstetrician in the room was Guy Thorpe-Beeston. Obstetricians don’t do normal births! They do births where something has gone wrong. An obstetrician hardly ever sees a normal birth so how would he know how to facilitate one?
We are not even told the names of her midwives – even if she had any – it is as though they were just faceless assistants. None of her birth companions, in short, have any experience with being by the side of a first time mum from start to finish of her birthing. Experts they might be, but they are NOT experts in normal birth.
You might as well give me a scalpel and tell me to go ahead and do a caesarean section.
Oxytocin flows best when the mother feels private and not watched, and the presence of men other than her partner can be a real hindrance. Her best labour companion is a woman who has given birth herself who is there during the whole process and a midwife experienced with normal birth.
There were, according to press reports, at least five, probably six or seven people in the room with her. Feeling watched and observed can increase a woman’s stress levels hugely.
When we see new faces in the birthing room, our subconscious starts processing the new information. Is this person safe? Can I trust them? This produces adrenaline which again inhibits the oxytocin flow.
Fact: With an epidural in place (99% certain) mobility is limited, which can make it much harder to push out a baby, especially a large one. After some hours the epidural also can result in the baby being misaligned. Fact: The epidural raises to 80% the chance of ventouse or forceps being used.
Guess: We can assume that the anaesthetist was a top man/woman who adjusted the drugs to allow the mother as much mobility as possible. Possibly Kate was even able to squat or kneel on the bed to allow gravity to help – yes, it can be done.
More likely (judging by the time she’s had to stay in hospital afterwards) the epidural led to ventouse or forceps which always means cutting the perineum so she will have had stitches and will be v v sore for a while. I hope she has her NCT valley cushion, cold gel pads, lavender oil baths, and – my favourite, yonks ago – very briny 4 inch “sitz” baths all ordered. And a big box of BRAN.
Hypnobirthing teaches strong, sustainable breathing for second stage (the “pushing bit”) so it’s easier to give birth to a larger baby. One of the films I show in classes shows a slim first time mum, not dissimilar to the Duchess in build, birthing a 8lb plus baby several days after her due date with a 20 minute second stage. She didn’t have an epidural, though, so it was easier.
And, as if that wasn’t all enough: the Duchess had the most watched pregnancy in the world. It began horribly, with a terrible personal tragedy involving a nurse at the hospital where the poor Duchess was being helped through hyperemesis gravidum. Hers was not just any old celebrity pregnancy – she was carrying a future monarch. And it ended in a rather grim Victorian building on the hottest day for decades, surrounded by hundreds of noisy media people.
And she DID IT. She had her birth and she did it really well. The Duchess of Cambridge is a star and has shown young women that a natural birth is possible, that you don’t have to be induced on your “due date” and that, in short, there is nothing to be afraid of.
I think she could do it on her own, frankly, without a roomful of fidgety men disturbing her flow: just her sweet, loving husband, a couple of experienced independent midwives and possibly a pair of quietly-spoken, encouraging doulas. Next time, she should seriously think about a home birth!
J K Rowling, the multi-millionaire Harry Potter author, chose to birth her 2nd and 3rd children at home mainly, as I understand it, because she knew this would guarantee total privacy for the whole labour and afterwards. Royal births always used to take place at home within the Palace. They have the facilities to set up a complete mini-birth centre there if they want to.
So, Kate, how about it? Come along to one of my home birth workshops and we can answer your questions! 🙂