The AIMS Guide to Giving Birth to Your Placenta, principal author Emma Ashworth, is available from AIMS and costs £8. Rachel Quickenden, Nurturing Birth doula shares her thoughts on this new book
Like many doulas, I came to birth work after giving birth myself. My first birth, un unplanned hospital birth, ended with a retained placenta – something that I hadn’t even known was possible before it happened to me. My antenatal education presented it as “injection or no injection, your choice!” – and that was it! Ever since that experience, I have always had a particular interest in the birthing of the placenta, so I jumped at the chance to review this book (which I knew I’d be reading at some point anyway!)
At exactly 100 pages, it really does read like a handy little guidebook. It’s easy to navigate and covers all the things you’d expect a book about birthing your placenta to include.
Penned by Emma Ashworth, it definitely has her hallmark of autonomy and informed decision-making! I loved the regular reminders that everything is “always your decision” – from the ‘big’ decisions around physiological vs active management of the placenta, through to what might be seen as small things, like whether to get out of a birthing pool to birth the placenta.
In my view, she gets the balance just right in that the book is full of the evidence and statistics that you need to make decisions (and that are great for me as an antenatal educator!) whilst still being simple and to the point. My copy is highlighted and circled, page after page – partly because I found it amazing just how little the evidence actually supports the routine use of uterotonic drugs in birthing the placenta.
One of my big light-bulb moments was how the use of uterotonic drugs have been seen as a way of leap-frogging over all the essential factors that are needed to birth the placenta, reduce bleeding and aid bonding and recovery. The introduction of these drugs hailed the start of an era where hospitals started to treat the third stage as something that could now be dispensed with much more quickly. A mere inconvenience at the end of the birth…done and dusted – next woman in. And therein lies the problem! As a result, the maternity system has largely lost sight of the importance of environment, calm, and mother and baby remaining together and undisturbed in the minutes and hours after birth. Requests such as optimal cord clamping are now viewed as a deviation from the norm, and this book has the great suggestion that where this is requested, it is worth referring to the risks of immediate cord clamping rather than just the benefits of delayed or optimal cord clamping. As the author points out: “…re-frame the latter as the norm, because it is.”
The 2010 study of Fahy et al used the term “psychophysiological care” to reflect the holistic care offered to women in a midwife-led unit. That study compared two groups of women: the first received this holistic care at a midwife led unit, and the second received conventional hospital care in a nearby hospital. The findings were that 11.2% of the people birthing in the obstetric unit with active management had a post-partum haemorrhage, compared to 2.8% of of the people in the midwife-led unit who had psychophysiological care. This study highlights that the decision around the third stage is not just a case of “drugs or no drugs”. The environment in which the birth takes place, the way the birth has unfolded, and the type of care provided in the immediate post-partum heavily influences how things unfold.
This book is also brilliant at asking the wider questions and looking more long-term. In considering whether uterotonic drugs pose any harm to the baby, it refers to Bell et al (2013) which looked at the effect on babies’ pre-feeding cues. This research only included mothers whose babies were given syntocinon in labour (not after birth – we have no information on that) however the results were remarkable. The study found that 44% of babies exposed to syntocinon in labour displayed low levels of feeding cues compared to 0% of unexposed babies. It also found that only 25% of exposed babies showed strong pre-feeding cues compared to 64% of unexposed babies. As a postnatal doula providing breastfeeding support to new parents, I found this statistic staggering – particularly given that induction rates are now higher than ever. The book also cites studies showing syntocinon leading to higher rates of postnatal depression.
It goes without saying that there are instances where uterotonic drugs are vitally important – life saving even. However this book, even as a short read, is very effective at giving pause for thought at how routine these drugs have become despite their known risks. Where uterotonic drugs are opted for, this book gives handy checklists for things to consider in optimizing environment and atmosphere for mother and baby alongside those drugs. I will be keeping this book handy on my book case and will be recommending it to clients in the future!
To find out more about Rachel, a doula based in Tonbridge, Kent visit her Nurturing Birth Directory profile – https://nurturingbirthdirectory.com/doulas/rachel-quickenden/