Positive Hospital Birth, with Lily Yuula

Some women choose to labour in hospital, others feel they arrive there through the course of their care. If you find yourself in a delivery suite or labour ward for your birth, this episode aims to help you feel the most comfortable and prepared to be there.

I’m speaking to Lily Yuula, a midwife who specialises in holistic care in a hospital setting, about what your expectations should be on a ward, what is in your control, and how you can make your birthing experience a positive one.

Find out more about Lily at www.yuula.co.uk or follow her on Instagram @yuulaofficial

Please subscribe, rate and review, so we can get this vital info to as many parents-to-be as we can!

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Transcript

Megan Rossiter  00:00

Ad - This episode is brought to you in partnership with iCandy. I've been using our iCandy peach pushchair almost daily for the last seven years and counting. And I've really put their five year warranty to the test using it for both my boys on muddy walks in aeroplane holes in and out of my car boot and aside from being completely filthy, my fault not theirs. It's still going strong. I can't wait to tell you more about my experience with eye candy later in the show. 

Megan Rossiter  00:29

You're listening to the Birth-ed podcast. I'm your host and founder of Birth-ed, Megan Rossiter. If you're looking for the evidence, the nuance the detail that's missing from your antenatal appointment, then I've got your back. The Birth-ed podcast is here to help you sort the facts from the advertising the instinct from the influences and the information you're looking for from the white noise of the internet. I hope you've got a cup of tea in hand and a notepad at the ready. Let's dive in. 

Megan Rossiter  00:55

Hi, everybody. Welcome back to the Birth-ed podcast. Today I am having a conversation which is a conversation that I have very, very regularly with lots of the families that we are supporting. And this is a conversation about what it is to give birth in a hospital hospital within the context of a sort of obstetric led unit rather than a birth centre or a home. We do have podcast episodes on birth centre, midwifery led care and home birth care. But a lot of people may be considering or feeling like they actually might end up giving birth within a hospital. So I am delighted to be joined today by friend and sort of colleagues that I have met through working online, Lily Brockhaus. Lily is a midwife who has supported families through their labour care for the past 10 years with a real focus on personalised care provision. Lily is also founder of Yuula, which provides birth toolkits, bringing together the tools that you can use to transform your birth experience. And Lily also supports families privately through her text midwife service, the modern midwifery service for modern lives. So Lily, thank you so much for joining me. 

Lily Yuula  02:06

Hi, thank you. I'm super excited to be invited.

Megan Rossiter  02:11

I think we've got you know, we've already been chatting a little bit ahead of the episode. And we've already got 5 million angles that we could take on this conversation. But I wonder if a helpful place to start might be just to sort of explain what we mean by sometimes it's called a labour ward. Sometimes it's called a delivery suite. Universally, it tends to be referred to as an obstetric led unit. Are you able to sort of just describe to anybody that's at the very, very beginning of the kind of where shall I have my baby conversation? What this is how it's different from some of the other places that you might give birth? And then we can kind of get into the nitty gritty of what to expect there. Because I think a lot of people sometimes into pregnancy with the assumption that this is where they're going to give birth. So can you Yeah, can you explain a little bit about what an obstetric led unit? What does that mean? 

Lily Yuula  03:04

Yeah, sure. So an obstetric led unit is a unit run by obstetricians essentially, midwives work there and midwives provide the clinical care. And but generally working under an obstetricians care plan, with the exception of if a woman could decide to go there just because it's her choice. Or if she wants an epidural, or something like that, that was only offered at say like a labour ward. It's also the place that you go to for points of contact in pregnancy, or things like reduced movement. Often the maternity triage unit will be located in the obstetric unit. So yeah, it's it's generally a busy place. There's lots going on there. Often, ladies don't necessarily feel like they've gone they're out of choice. It's more kind of where their path has led them. Often there's lots of inductions you know, medicalized care if things crop up in your pregnancy.

Megan Rossiter  04:01

Yes, I suppose anybody that requires or feels that they require that medical intervention, that doctor intervention that can only that's the main difference, isn't it between home and birth centre and a labour ward is that on a birth centre and at home, there are no doctors there during your labour birth.

Lily Yuula  04:19

It's also the only place that you can say get continuous monitoring. So if you start off on a birth unit, or at home and concerns crop up with your baby's heartbeat, you may then transfer there for those kinds of reasons too

Megan Rossiter  04:32

Okay, let's explore first I suppose, why might somebody be on a labour ward so we've mentioned already that it might be because they want an epidural. So that is the sort of most effective form of pain relief but it is not available at home and is not available in a birth centre. So it might be that somebody knows in advance that they want an epidural so they've always intended to be on a labour ward, or it might be that at some point in their labour, they change them And then they decide they won't want it and may transfer there. Can we explore some of the kind of other reasons why somebody might be told they I'm going to do this in inverted commas have to give birth on a labour ward and the kind of the realities of the half, two in inverted commas. 

Lily Yuula  05:18

So starting right at the beginning, you might have your first appointment with an obstetrician when you're say 12 weeks pregnant, and you might have something like twins, or you might have a pre existing existing medical condition, maybe like type one diabetes or something. And so right at the start, you might find out that for whatever reason, you would be recommended to birth on a labour ward. And then moving on, things might crop up in your pregnancy. So if you're having regular growth scans, your baby small, potentially if your baby's big, although that's a whole nother subject, and you could potentially go to a birth Centre for that, we could potentially go to a birth centre Friday of it. But you know, there might be things that crop up maybe gestational diabetes, or blood pressure problems, or preeclampsia, or, you know, any kind of medical conditions can crop up as things move along. And then as you move towards the end of your pregnancy, if you haven't got any sort of risk factors, as such, as they're referred to, you might be induced for post dates. Sometimes that may mean that you need to go to delivery suite, or labour ward, I'll probably use those two words interchangeably. 

Megan Rossiter  06:30

Just if you're listening, they do mean the same thing. They're not different places. 

Lily Yuula  06:34

Yeah. So you may go there for postdates. But the main thing is, is that often women feel that they are going there because it's where their path has taken them, not necessarily a conscious decision that they've made to go there. But it can be a conscious decision to go there, you can still explore other options. But if for whatever reason, you decide that going to a labour ward is right for you, then midwives will care for you there as well as obstetricians. 

Megan Rossiter  07:03

And I want to pick up on something that you've said there, because you have sort of said that if you decide I think this is the real like key message to get across, because there will be like certain circumstances in some of those things that you have listed. If somebody has got very severe preeclampsia, or like they are very, very unwell, then care from obstetricians is probably going to be an incredibly positive helpful thing for them to have in their labour, and their kind of pregnancy their postnatal care. But there is this like, quite enormous grey area isn't there. And this is why we can't we're not going to see Yeah, but we're not going to be able to, you're not going to listen to this podcast. Now, we're not going to be able to say, Well, if you have gestational diabetes, then you don't need to be there. And if you've got high blood pressure than you do need to be there like it is think of almost all of it as very, very great. There is definitely like a at both ends of that somebody that has had absolutely no complexities of pregnancy whatsoever, which I think accounts by the time we get to the end of pregnancy, it's something like 20% of women currently, it's not high. And then at the other end, you have got people that in combination with being pregnant, which is just a normal physiological process of the body also are very unwell or have developed an illness either alongside or directly related to their pregnancy or their birth. And then a really, really large proportion of people in the middle are this like fuzzy fuzzy area of do I need to be on a labour ward? Do I need obstetric lead care actually in labour? Or can we make are there actually other options kind of in there around where you might want to give birth. And I think that is something that I know you're really kind of passionate about is that actually it being your decision, and that if you're going to a labour ward is something that you have kind of,

Lily Yuula  08:55

you know, you can have your own birth preferences, and the level of care that you expect from a labour ward is different to that you get from a birth centre. So it's important to understand the difference in those. I mean, like you say, there's people that are saved, got lots of complications going on, and they will naturally feel safest on the labour ward. But there are also other people say of the back is probably a good example. And perhaps they had lots of complicated care in their first pregnancy. And they've taken some time and they've done some research. And because of that, they now know that they would like to go down a slightly different route of care, and they're looking into other options, other places, and perhaps a labour war doesn't necessarily feel the safest place for them now.

Megan Rossiter  09:37

Yeah, amazing. So I think we just wanted to make sure that that was really clear at the kind of the beginning of our conversation because the focus of this episode is going to be primarily on like, Well, what do we do if we've decided that labour ward really is the kind of safest place to be? But if you're listening to this, and you have kind of started listening with the assumption of like, well, I've told I have to give birth on a labour ward. So this episode is gonna Be helpful. Actually, the very first step, I think to having a positive labour ward experience is the choice to be there. And really feeling like that is a choice that has come from a place of like information, a place of being supported of really kind of having explored all of your options. So I think from this point forward, we are now going to make the assumption that you have done all of your research into what all of your options are. And we've got episodes on birth centre on home birth, on, like out of guidelines, care planning. So let's assume you've done all of that prep, and you have come to the decision. Yes, the right place for me to give birth is on a labour ward, or potentially this could be a transition that happens at some point in labour as well. Can you talk us through, and I know there's going to be quite a few different pathways into labour ward care. But let's start with I've gone into spontaneous labour, and I'm intending to give birth on a labour ward. What can I expect generally from my care, so I'm in, in labour at home.

Lily Yuula  11:04

Okay. So when you start to go into labour, generally, if depending on your risk factors or things going on with yourself, the obstetrician may have discussed with you before if they'd like you to come in earlier. But as a general rule, we know that the best place for women to be in early labour is at home. So once your contractions get stronger, and get longer, and get to maybe like three in 10 minutes, moving towards four in 10 minutes, when you feel ready to come in, you'll be asked to come into the triage unit at the labour ward. And you'll be greeted by a midwife who will complete a sort of initial assessment, where they'll check you over check baby over listen to your heartbeat. And on the whole generally, the expectation is that you're then offered a vaginal examination. 

Megan Rossiter  11:52

Yeah, and this is a we actually have an entire episode on vaginal examinations, where we get into lots of detail about specifically this this exact vaginal examination, which could, in some ways to be described as the kind of gatekeeping for general examination. And whether or not it is giving you as the person that is actually giving birth. Whether or not it's going to give you helpful information is a whole conversation. But what is it that you're looking for?

Lily Yuula  12:23

little caveat in here, I say this with like an inside me because this isn't necessarily the way I practice. But I'm trying to give a real X realistic expectation of what the general rule is, you will meet midwives that do things in their own way. And the reason I want to just highlight that is because we know that vaginal examinations aren't necessarily evidence based labour isn't a linear process. And when we really strip it back, there'll be a few occasions of this. But there are things that are done on labour ward, that unpopular opinion aren't for you, therefore the system. There's things like vaginal examinations on admission. The real aim of that is to get a quick snapshot of are you in labour? Are you or not? Do they need to allocate you a midwife? That's the real crux of what's going on. Because a good midwife with good holistic skills can spend a short amount of time assessing you assessing your contractions listening to the noises you're make the way you're standing until you whether you're in labour or not.

Megan Rossiter  13:26

Yeah, and even the sort of when we're saying in labour or not, we're specifically talking about a part of labour that I suppose we would describe as established labour, because obviously, if you're experiencing contractions, and they feel like they hurt enough for you to come into hospital, you're definitely in labour. But it's the sort of is the question, I guess, is, is, is being in hospital? And because we're talking specifically talking about hospital birth, is being in hospital now, the right place for you to be? Or is that going to bring the potential for more risk or more harm by having you in too early? And actually, you would be very safe and very okay to continue out of the hospital environment? And I guess that is the kind of question, but there isn't any reliable evidence to say that a vaginal donation is going to tell us that 

Lily Yuula  14:19

it's a really tricky time because you know, you're sat at home, am I in labour? Am I not? Are they going to send me home? Oh, my goodness, Labour starting. There's lots of little anxieties creeping in. So more often than not, you will find that mums will make that journey into the hospital and things may well knock off and that's okay. It's, you might not be quite on the establishing side. Maybe it's because you've got a bit of anxiety about still being at home. But sometimes you just have to settle into the environment. So my own personal feelings and my own practice is that I just like to let women settle before I start doing anything. Because yeah, you might arrive and be about to push a baby out, or you might arrive and things just fizzle out a little bit and need a moment to build back up again. 

Megan Rossiter  15:01

So let's say then you have been through this triage area, which is often like a separate environment like a separate ward bedded Ward often with like curtains around it rather than a kind of private room. I know it does depend on the trustee specifically where I trained actually, they didn't have a triage it was all done on either in the labour ward room or the birth centre. And but it was a very small hospital, most of the big ones will have a separate triage area. And that is you would also generally go through this area if there is an attached birth centre. So the triage tends to be the same for both if they will, within the same unit 

Lily Yuula  15:37

not always no. Ours go to the two separate areas.

Megan Rossiter  15:43

Okay, fine. Yeah. Yeah. So it is worth finding out what the setup is at your local trust, because it might it does, it does differ the kind of the setup from place to place. So once you have been through this triage area, you've had your blood pressure taken your baby's been listened to, they might have had a feel of your bump, find out which way up they might be your pulse has been taken, your temperature has been taken, they might have asked you to go for a week, it can be a bit of like an interface, but not the most relaxing moment in labour. Yeah. But from here, if it has been determined that like actually, yes. Now one to one care and a private room is the next stage of your birthing process. And you move into your kind of own labour ward room, I want to explore first of all, not what like you were I would be doing in this environment. But like, what can we expect as like completely standard if we didn't have a birth plan? If we didn't ask for anything? What can we expect from our care what will be presented to us as things that are supposed to be happening? And then we can backtrack and we can explore? Like what our we've got what control we've got?

Lily Yuula  16:58

Yeah, so generally speaking, if you've moved to the labour war, then you're going to need to CTG. So you'll be hooked up to the CTG. And then your baby's heart will be continually listened to. You might discuss with your midwife if you've got any preferences of how you want things to go, you know, if you've gone there, because you would like an epidural, then now's the time to mention that. And yeah, you'll just be allowed to sort of settle into your space. Really, this is your moment to settle into the time. This is a kind of a key moment of mentioning, you know, I want to be mobile, but I have a wireless monitor. And

Megan Rossiter  17:36

Lily Lily, you're going What are we adding? What are we adding? What happens if you do nothing? You turn up right? First thing is you get put in a bed usually?

Lily Yuula  17:44

Yeah.

Megan Rossiter  17:47

Right? Lily's trying to be really balanced. Because she does work in a hospital, often you'll get in a bed and might be put on monitors. Oh, my, you might then find that you are told you have to have vaginal examinations every four hours.

Lily Yuula  18:04

Okay, okay.

Megan Rossiter  18:06

Go, let's go realistic. We can go back, we're absolutely gonna go back. We're gonna add all of this in ask you for movement and

Lily Yuula  18:15

This is like a tussle with two sides of it is basically yeah, you'll go into a room, you'll be hooked up to the monitor, you'll probably just naturally sit on a bed, it probably won't move again. And you might get a knock at the door because the doctors have come around on ward round. That's the sort of realistic Yeah, patient of what's probably going to happen. Like I say, if you want an epidural, if you've got any preferences now the times to sort of mentioned that kind of thing. But yeah, if the doctors come on ward round, then you might get sort of up to five come in the room. Generally, on a labour ward or ward round just done twice a day with the lead consultant.

Megan Rossiter  18:53

Yeah. And the room itself. It looks like a hospital room. The lights on is hospital bright lights, this machine around the room? Yeah, yes, we're going we're going general, don't worry, I'm gonna give you all the opportunity in the world to go back and we can unpick it all. And then if Labour is progressing as expected, then there's pushing that happens often that's like guided somebody telling you and it might be because you've got an epidural in so then that guided pushing might be more appropriate. But just to get like just trying to get a feel of and this doesn't this is not to say that the people that looking after you aren't also incredibly kind and incredibly welcoming and incredibly lovely. But just the general culture is very different to what goes on at home birth, for example. 

Lily Yuula  19:43

Yeah, so you'll probably you'll probably be told, Oh, now you've had a vaginal examination. The next one is do an X amount of time. We need to measure all of your ways. We need to measure everything you drink. We need to do your opposite. Whatever time when it comes to if you start feeling an urge to push I mean You're probably going to be told to not push until they've done a vaginal examination to confirm that. Yeah, it's a much more structured way of being cared for. And generally speaking, the staff on there are used to working in this quite structured way. You know, it's very organised.

Megan Rossiter  20:18

Yeah, it's it's much more carers much more managed on a labour ward. And there is much more of a reliance on external measures of health and well being and progress versus a slightly more holistic approach that you might get at home or in a birth. And there's so much more like, drawing of graphs, that that that kind of thing, 

Lily Yuula  20:41

actually, because there's a lot more paperwork, a lot more stuff. So your midwife will be just very busy pottering around, filling out this ticking, whatever. There's just stuff to do. And that doesn't necessarily involve the care physically.

Megan Rossiter  20:57

Yeah. And so I just wanted to kind of get to grips with like, if we're turning up, and we're doing absolutely nothing. This is the culture of labour ward care. And sometimes those measurements and things might be really helpful, particularly if you do have a really complex pregnancy and actually, monitoring your health very, very closely is really important. But what I think sometimes gets overlooked, even in people that have very, very good reason to be on a labour ward, because they really need that obstetric lead care, is that the actual process of birth is still a physiological process. And that physiology still needs supporting, even if there needs to be medical monitoring medical care alongside and sometimes it's shifting

Lily Yuula  21:45

that physical, you know, biomechanics, the positions you keep exactly that. Yeah, you still need to be mindful of all those things.

Megan Rossiter  21:53

Yeah. And we sort of haven't touched on there's a couple of other ways that you can get on to a birth centre that aren't what we mentioned already that triage way. One is if you're having an induction of labour and we won't go into tonnes of detail on this now, but sometimes that starts on an antenatal Ward and then when you are in inverted commas in labour, but when things have become more established, or you're ready for a certain point of the induction process, then you might go to this room on the labour ward, or the tram or transfer might happen from home or on a birth centre, and we explore those in the episodes on Heymann birth centre. But there they cut your other routes in I suppose to a labour ward. 

Megan Rossiter  22:34

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Megan Rossiter  23:47

So can we chat through from a kind of evidence perspective, like the risks and the benefits of being on a labour ward. And I think this is a really important thing to understand. Because when we understand the potential risks that birth and when a labour would brings, it can really go to then shape and inform the choices that we are making and the things that we are doing to hopefully improve our experience of birth on a labour ward.

Lily Yuula  24:15

Yeah, so I think this is a really important topic, because when you listen to the start of this podcast, it can seem quite scary. And if you have stories from friends and read things in the media, it can feel really intimidating. But the great news is, is that all of these things that we've mentioned are all in your control. And they're all choices that you can work through which can make a massive difference to the overall risk experiences and outcome of your care essentially. So we know that if you have a low risk pregnancy, the safest place for you to have is low risk care. And that's generally speaking, but there's also lots of other evidence, which isn't necessarily included in NHS So hospital guidelines, which also will reduce your risk if you have different sort of methods of care, for example. So for example, we know that if you have a CTG, you're at much greater risk of having a caesarean section or an instrumental. We also know there's other evidence about V backs birthing at home, for example, there's lots of other areas of care which, you know, you can unpick and address. 

Megan Rossiter  25:31

Yeah, baseline I suppose, what we know if we were comparing like for, like groups of women with uncomplicated pregnancies, there was a really good bit of research that literally just looked at kind of specific outcomes for, like real life outcomes that actually happened. So the birthplace study is a little bit old. Now. It's from 2011. But it is the most up to date research of its kind. And the information that came out of that is still totally irrelevant to the kind of care that people are getting. But just on the whole, we know that people giving birth choosing to give birth on a labour ward are more likely to have an instrumental birth, they are more likely to reach for an epidural, which can in some instances be explained by the fact that they might have chosen to be on a labour ward because they want an epidural, they're more likely to have a caesarean birth, they are more like less likely to be able to access water. So it is just really important to understand that the place of birth that you choose can impact the actual way that your baby is then born. And really importantly from this research is that it showed no difference in outcomes for the baby. So I think sometimes we can make the assumption of like, oh, but surely being in a hospital is gonna make me safer. And it doesn't necessarily because of the fact that birth itself is a process of physiology, you know, we don't go to the doctors because we need a poo we trust that our body can do a poo quite well on the toilet all by itself. So when we are getting into that labour ward environment, then the chances of needing further intervention goes up. And I've got my sort of three theories on why we see this happen. But is there anything you'd like to kind of kick us off with as to why do we see higher rates of intervention when we are in this kind of medicalized environment?

Lily Yuula  27:22

I think stripping it back to basics, you know, like you say, doctors you go to for, you know, pathology for when something's wrong, they don't understand really, to be honest, the physiology of birth. So when say I might be looking after a lady with an epidural who's got like an OP baby or back to back baby. And you can do really simple biomechanic techniques to help that baby rotate, a doctor would think, well, that's fine, we just need more power just need them to come lower just need the cervix to dilate because they're not necessarily considering how this baby is going to come out vaginally spontaneously, you know, a woman is going to push their own baby out, they're thinking about how they can rotate and pull the baby out themselves with forceps. So in that respect, the midwives on a labour ward are so important because they are the connecting thing, the difference in that also, there's different practices like the admission VA, the expectation of the ears, you know, you're you're entering that ticking clock, which you might not necessarily realise because you think more is more. There's things like when you come into being induced when you're offered oxytocin, especially if you're a first time mum, you hear time and time again, midwives say you should have an epidural, you have everyone has an epidural with oxytocin. But I know I've looked after lots of first time mums, who have had a baby without an epidural and had oxytocin, that is almost just expected just because of the way that things are the culture, just because it's what happens. 

Megan Rossiter  28:52

Yeah, I definitely agree that the kind of it's also just that the proximity to it, isn't it right? If labour had stalled or slow down, and you were on a birth of if you were carrying something on a birth centre? You'd be like, right? Have they been far away? Are they tired? Do they need some sugar? Do they need a nap? Do they need me to leave the room for 20 minutes so that they can kind of get their oxytocin going, and you're looking at things from a really, really holistic place, because that is all that you have available to you. And you can't just plug them into a hormone drip and off you go. Whereas on labour ward if things stall and slow down, first of all, because of the like the tick box kind of measuring that we are doing their progress, we're likely to think that things have stalled or slowed down or progress isn't happening potentially at an earlier point because we're relying so much on that external measurement. But then in order to speed things up, we're much closer to medication, so we're probably going to reach for it at a much earlier point in labour. And it's the conversations around the kind of risks and benefits of that we know that augmented labour so this is a serious concern. Tosun on drip, it's like a hormone drip that goes into your hand, it's part of the induction process, but can be offered in labour as well. When that happens, we know that the chance of baby not coping so well with Labour goes up, we know that the rate of instrumental birth goes up. And so we know that epidural use does go up. So it's really important to look at that from a kind of really holistic place. And I suppose a help, I always think a helpful question to ask is, if I wasn't on a labour board, would we be doing this now? Or is there anything else that we can try? And sometimes that just opens up that kind of slightly more holistic approach? So yeah, I would definitely agree that the kind of general culture is the first reason why we see higher rates of intervention. The next thing I think kind of goes hand in hand with that is just is the proximity to it. So the closer we are to it, not just from a care provider perspective, but from our perspective, as well. So if you hadn't planned to have an epidural and labour, and you were giving birth on a freestanding midwifery led unit, so not within the grounds of a hospital, if in labour, you decided that you wanted an epidural, you're gonna have to like transfer, you're gonna have to pack up your stuff, probably travelling an ambulance. Unless you really, if you really, really want it, you can absolutely do that. And you can go and get it. But you're only going to do it if you really, really, really want it. If it's a case of like, yeah, doing a quick baths to the anaesthetist, and they can come into your room and do it, it's way easier for us to reach for so we're much more likely they say the same with like, don't have really unhealthy snacks in your cupboard if you're trying to eat healthily, because if they're in your cupboard, delete them. And if you haven't bought them, you won't need them.

Lily Yuula  31:42

And there's two big things there, too. On a labour ward, you're probably going to have a midwife there saying children hepatorenal, do you want an epidural, whereas a home birth or an A birth centre, you're going to have a midwife this used to pulling out all the stops and whipping things out of her toolkit, just to keep you going over those extra little hurdles.

Megan Rossiter  31:58

Yeah, absolutely. So I would say that's the second is just yeah, just how close we are to things. And just to reassure everybody that is listening, that isn't the closer you are, you know, what we've said with that evidence that exists is that this is as safe to give birth in the outside of hospital environment. So it's not like, but then if it's needed, you're closer. So it's safer. That's not what the research kind of shows. And then the final thing that I think contributes to higher rates of intervention in hospital is just the actual environment that we are in and the way that that environment looks and feels, and how important our environment is to the way that Labour unfolds. Would you agree to agree 100%.

Lily Yuula  32:45

I also think there's an element as part of that, which is that a labour ward is like a well oiled machine. It's very busy. There's lots of women to get through. So whilst on a birth centre, you've got plenty of time to take these slow things slowly to move on to those wholistic measures. We've got to keep things moving on a labour ward because, you know, we've got however many other people to to waiting, or we're going to push the oxytocin, you know, faster, potentially, because there's, there's stuff to do there's things to happen. There's Do you see what I'm saying? 

Megan Rossiter  33:15

Yeah.  And these are not, these are not, I wouldn't say conscious decisions. I don't think that a doctor or a midwife is sitting there going, oh, there's somebody sat outside. But here's the Yeah, that is the the way that culture has shaped that environment is that it just feels like I remember we had I had a home birth of my second and there was a student who had come with the midwife that was looking after me. And she had had said, I think to the midwife at another time, what do you do home birth, like, it's so boring, because she just was so used to being on a labour ward, where you're like, busy, busy, something's happening all of the time. And actually, most of the time in labour, you don't like nothing really. It's not very exciting. It's quite boring, nothing actually happens.

Lily Yuula  34:01

There's lots of listening and observing, and little quiet things that midwives do whilst they're soaking everything up. And yes, externally, it looks like they're doing nothing. But I think a really good example of what I was just trying to explain is when somebody's induced and their waters have broken, often with a first time mom, oxytocin is encouraged straightaway, generally, you're allowed to wait up till four hours, but actually, you can say, No, I want to wait longer, you know, if your waters went spontaneously at home, often, an offer of induction doesn't come until up to 24 hours. So thinking of it from an infection perspective, you could wait longer, but there's this element of when I think the obstetric team feels that they're doing things to you, you know, when things are being offered to you, they need to continue to manage that. And there's also this element of we couldn't have everybody sat here for up to 24 hours after their waters had been broken because that just would not work. 

Megan Rossiter  34:58

Yeah, yeah, and I've I've certainly looked after clients that have even been told things along the lines of well, you know, there's a room now, but there might not be in a couple of hours. So if you don't have now, now, and you're just sometimes I'm like, what? And if you don't come now what? I'm gonna give birth in the car like, it's, it's Yeah, it is, it's about being slightly selfish with your decision making you this baby once. And yes, there are system pressures and there are staffing pressures. But that's not your not your problem to be, quite frankly, 

Lily Yuula  35:34

because people are naturally people pleasers and you want to write and you want to have this care from people that don't think you're difficult. But actually, the system isn't really gonna care how you get birth in three months time, but you are going to be retelling that story for the rest of your life. So if you're going to be selfish, if you're going to do what you want to do, you know, now's the time, nobody cares about your baby more than you do. So I think it's really important to remember that, 

Megan Rossiter  36:01

yeah, I just want to go slightly back to the environment. So we know that in order for birth to work, we need to feel the four things. This is like the key message that was shared with everybody that is doing our courses, you need to feel safe, you need to feel relaxed, you need to feel unobserved, and you need to feel undisturbed. Now, hopefully, if you have chosen to be on a labour ward, it is because it has ticked the box of you feeling safe. So hopefully, that's the reason that you've ended up there is that this feels like the safest place for you to be. And as standard, it's probably not going to make you feel relaxed, it's probably not going to make you feel unobserved, and it's probably not going to make you feel undisturbed. Now, that doesn't mean that the whole of labour then has to be kind of thrown out the window. But it does mean we have to be quite forward thinking quite practical thinking about what can we do to make ourselves feel as relaxed as unobserved and as undisturbed, as possible. So let's, let's explore, right, we've got everyone picked to this, we've got a room, it is I'm in my bedroom, it's probably about the same size as a double bedroom, it's got big bed in the middle, it's got machines all around the outside, if you're lucky, it might have a window. And there's probably like bright bright hospital lights on the ceiling. If you've got monitors on there probably beeping, and you're probably attached to some kind of wire. Right? Where do we start?

Lily Yuula  37:26

So if I was going to enter a room, I would turn the lights off straight away. I always encourage people, especially often on birth centres, they have little lights and things. But on a labour ward, you can't always expect that. So to bring something yourself like a galaxy light, some kind of mood lighting so that you can really transform that form the room. No shut the curtains block the world out, that completely changes the environment, taking things like a pillow of your own. So you've got smells from home, taking familiar smells to you like some sort of aromatherapy makes such a difference to how the room feels just straight away and like the flick of the switch. Yeah, then there's practical aspects to think about. So realistically speaking, not everybody does this. So the team looking after you aren't going to necessarily expect to come in the room with the lights off. So what you could do is you could create a little sign, especially if you're Hypno birthing, maybe to pop on the door and say, I'm Hypno birthing, or please knock before you enter, please don't enter. And then that just creates that expectation that this is your zone, this is your private area. And then if say doctors come around on ward round, you may choose to invite them in. Or you may say, actually, no, thank you at the moment. I don't need to see you, you know, complete more choice. You can create your little nest.

Megan Rossiter  38:49

Yeah, absolutely. And there is I think sometimes we're like, Oh, can you really do that. And often, they're literally coming, they're going to look at a monitor that they could have often looked at from outside of the room. They'll just stare at you for a bit and they'll probably talk about you go into the room. And you're like actually put all of that have number one does it take for doctors or five? I think one of my clients the other day, said eight doctors came into the room. And she was like not there was no, there was a reason. Like there was no complexity, nothing happening. It was just the right time of day, eight people came into the room and didn't even really talk to her. Again, she was like, oh, yeah, 

Lily Yuula  39:27

you've got a plan. That's the right plan. We'll see you later. And some doctors actually literally will say no, I need to go in because I find need to come in for an instrumental she needs to have seen my face. I need to mention to her about specific things like epidural, there'll be ways that doctors work that aren't necessarily evidence or guidelines based. They just do that because they need to do that. And I have said this to doctors before when they come in the room. They'll mention things like an epidural. And what does that do to you psychologically? That they can come into the room and see puffing on the gas and air and say, Wow, you're working really hard. Well done. How amazing would that make you feel? Because just because you're puffing on the gas and air, it doesn't mean that that's anything wrong. Doctors aren't necessarily used to seeing women in physiological labour. In fact, the sounds of the doctors is probably quite freaky, because they're not used to it. Yeah. If you want to keep it that way, then just mentioned when you arrive, you know, I'd rather read, can we can we can we not just have people come in the room, and just drag those little things as and when, because it can make a real difference to your overall feeling? 

Megan Rossiter  40:39

Yeah, and that this is a really good role to give to your birth partner, if they feel confident enough. Or certainly asking your birth partner to kind of communicate with the midwife that is looking after you is that you know, you'd like them to act as the gatekeeper to your space, so that people are only coming in and out of it, if there is a genuine need for them to be, rather than it being like a completely just routine. 

Lily Yuula  41:05

You can be super, super polite about it. Just say thank you so much. I'll let you know if we need you. Or if you feel that is medically indicated, please let me know. But right now, no, thank you. 

Megan Rossiter  41:16

Yeah, absolutely. And so that really ticks the kind of the undisturbed box is definitely being like who is coming into this space. And the unobserved box, I suppose. Also, particularly with turning off the lights is such a it's such a simple thing. And I find it absolutely bizarre that that's not just standard practice on a labour ward. Like it is the most basic thing to do. Yeah. Anything. Yeah, you're like, Guys, this is so easy. It doesn't literally doesn't cost you a penny. In fact, it's saving you money, because we're not using the electricity from the lights. Turn them off.

Lily Yuula  41:49

Yeah, yeah, I completely agree. And I think, yeah, there's quite a few things like that, that when you have this epiphany and see things, you're like, What is going on? And when you look after people that have in their second babies, and they've often had this epiphany in between, it really is quite mind blowing. And then when you do things differently, and you feel the difference, it all just makes so much sense. 

Megan Rossiter  42:15

Yeah, absolutely. So definitely thinking about the environment that you're in. The other thing I suppose that can kind of come come into the environment is to do with mobilising. And the ability to kind of move around. There is like a real real focus on this bed that's in the middle of the room. Usually there's a bed in the middle, and then there's a chair next to the bed. And this is where like our subconscious plays a really, really big part in the way that we are birthing. And certainly when I was working on labour ward, and I imagine you find the same, even if people are coming in even or actually even especially if they're not actually in labour, they're coming in for another reason. Always, always, even if they weren't tired, a woman gets on the bed, the partner sits on the chair like absolutely every single time. And that is I do a really good exercise with families that I'm supporting. Right right right at the beginning. And to get them to draw a picture of or it certainly picture in their head and an image of somebody giving birth. And it's always always in unless they've already started that kind of birth prep, it is always just a person laying in a bed. And it's not when 80% of people give birth on a bed. So if that's what you've got in your kind of subconscious mind is there for good reason. That is the message that has been kind of plumbed into us. But there is 99% of the time lying on your back in bed is not going to be a position that you have kind of instinctively got into. So what can we do ask for reach for to ensure we are able to remain mobile in a labour ward environment. 

Lily Yuula  43:48

So firstly, I think it's important to know that if you've researched this in your pregnancy, and you've figured out good positions, and your midwife is potentially asking you to sit on the bed or asking you to birth on your back, they might not actually know what you know, you might be more knowledgeable about this than then they might not understand that your knees in your calves out actually opens to pelvic outlet, because they've been doing this same thing for years. And they haven't changed and they've not been challenged enough. So in your pregnancy, you can think about ways to be upright forward and open. So you could lift the bed right up and stand and lean over the bed. Or you could lift the back of the bed up and lean over the back of the bed. Or you could make the bed into like a throne position. I call it where you sit the bed right up and you move the legs down. So it's almost like a birthing stool, but you're on the bed. You can be sidelined, you can use a peanut ball earlier in labour. There's so many things that really work for physiology. And a lot of the time your instincts will be telling you to move in these ways. You might naturally want to stand on your tiptoes because that's what feels right and your body's got a plan for that, you know, it's not a coincidence.

Megan Rossiter  45:03

Yeah, certainly I always say and birth physicians is it's a really funny conversation because your birth position, I was actually looking at the NHS birth plan template yesterday. And it really made me laugh because there was a section on birth position. And basically, if I want, if I can fill it up, it basically said, like, what position would you like to give birth in, and there was a tick boxes, kneeling, sitting, standing. As though this is something that you could like, decide now while you were pregnant. And also like, as though you were just going to go, I don't think I want to try kneeling, I only, you cannot pick this stuff like this is, this is gonna come to you. And certainly, if you've got an epidural, and then making a conscious effort to try different positions and move your body, rather than just kind of laying there is important. But if you haven't got an epidural limb, ultimately, what we are trying to create, and this is what can be difficult on a labour ward is an environment in which you can behave in a way that is utterly uninhibited. So you can make whatever sound you want, you can take, adopt whatever positions you want, you can move around the space in whatever way you want. And this isn't like you cannot, you cannot tick five boxes of like, and it's not an her career, I was interviewing somebody the other day, they were like, it's not an obstacle course, like, this is not like you don't have to go right ball to stall to bed to man, like it's just creating that space. And you can say to the midwife that is looking after you This is something I always really recommend is that just, we can make an assumption, I think when you're if you're the kind of person that's already listening to these podcasts, we can make an assumption that everybody wants to give birth at a birth Centre in water, they don't like they actually don't some people want to go in, they will have an epidural, they want to be distracted, they want to chat through it, and they just want the baby to get out. And that is what they want from their birth, which is totally fine if that is what they want from their birth. But when we make the assumption that everybody wants it to be like a relaxing environment, we forget that actually, we we often need to ask for stuff. And so saying to the midwife that is looking after you, look, I wanted to be on a birth centre. Look, I was hoping to be at home, what can you do to help me make and you don't have to directly say that you get your partner to say you could write it on a bit of paper. But what can you do to help me make this environment feel better. And that's when you go, Oh, actually, we've got a bull hide at a dusty ball hiding in a cupboard that nobody's got out for 20 years. And you can go and get it or they've got a mat or they've got a birth stool, or we can move the bed out of the way. And sometimes it just takes being proactive to actually really communicate to the midwife that is looking after you. Who are you and what do you want from this care? What is most important to you?

Lily Yuula  47:58

Yeah, it gives that snapshot of what your expectation is what your ideal experience looks like going back to that picture. Yeah, it's such a key thing as well, because you can see how somebody enters a room automatically sits on a bed, and is probably sat there thinking, oh my god, I can't cope, I probably need an epidural. But actually, it could just be the position they're in. So when you've got that mindfulness to think, oh, actually, I should move. And then you realise that actually, when you're on all fours, it feels completely different. That is when things start to change and start to fall into place.

Megan Rossiter  48:29

Yeah, absolutely. So to sum up, the things that we have chatted about in this episode, first of all, is that where you are giving birth is your choice. And that is definitely the kind of the first step to having a positive birth in a labour ward environment is that you don't feel like you've been forced to be there. But it feels like you have made the choice that that feels like the safest place for you to be. Second of all, is unjust understanding the potential implications of what being on a labour ward can bring with it, question, realistic expectation. And then third of all is working out what is within our control. So this is about the way that we are communicating and the way that we are making decisions about the care and to ensure that that power still sits with us. And that is, I think the most important thing to understand from my perspective about a labour board is the power play and the power dynamic that exists in we're stepping into a system with people that are very comfortable in that environment and they spend all of that yeah, versus we feel like guests to that space and sometimes we can feel like we have to fit into it. So giving yourself if you can prepare antenatally and this is what our course is there to support you with actually to build yourself trust and your self confidence so that you can communicate what is most important to you, so that you can remain in charge of the decisions that are being made in terms of ahead of labour and in labour. And then finally, actually what can we do to transform that environment to make sure it is really supportive of the hormones that we need to ensure that we are able to mobilise to ensure that we are able to remain as, as I said, safe, relaxed, unobserved and undisturbed as we possibly possibly can throughout labour. Is there anything that you think we've missed in terms of prepping for like a good positive birth on a labour ward. Was there any other key message?

Lily Yuula  50:23

to reassure people that although it seems super scary, and I understand that it's not necessarily where you want to be, you can bring those home birth or birth centre vibes to the hospital. And when you communicate that to the people looking after you, they should respect the effort that you've gone to, to learn all these things. And you can honestly make such a big difference to your own care, you're our own outcome, your overall feeling of the experience. So, you know, please don't go along with what you think you should do if there's an instinct in you somewhere. And I think back to my first birth, I didn't know as much. And I was totally driven more on instinct than anything else. My instincts weren't wrong. So don't when you're thinking to yourself, oh, I don't know if I want to be there. I don't know if I want to sit on the bed. I don't know if I want oxytocin yet. Don't quieten those feelings, explore them, get to the root of what it is ask more questions, and really try and make sure that that gut instinct in you is happy with whatever's going to happen next. 

Megan Rossiter  51:23

Yeah, I think that's a really brilliant message to end on. That's very similar to when I was training, I was working alongside an amazing midwives sort of birth centre. And she said something to me that was very along those lines, we were supporting a woman in labour. And she was basically doing this like pushing like much, much earlier in labour than I would have imagined as a first year student. And she told me to just watch. And then basically what it was, is that baby was in a difficult position that early pushing was turning the baby. And then suddenly, everything got more straightforward. And the baby was born quite quickly after that, but it wasn't expulsive pushing, and we sort of chatted about it, she was like, well, you're gonna you know, your body doesn't lie to you in labour. And that stuck with me forever and ever and ever. And similarly, in my first birth, and I had, I gave birth in a hospital on a labour ward for my first birth, and had really, really positive experience. But that message was absolutely key in me trusting my body over what people were saying from the outside mine was that I thought the baby was coming soon. And people from the outside Well, I know, you've got ages yet. You're a first time mum Berber. But I was like, No, it's like it. It feels like it's happening. And that was it. It was trusting that and trusting your body and what your body is telling you. It's not going to be it doesn't lie. What what good, would you why would you want to lie to you? If it's telling you to do something? Lean into that? Absolutely. Thank you so, so much for joining me. And if people would like to get themselves a birth toolkit from EULA, or they would like to access your texts, midwife service, or just follow along for more kind of helpful hints, tips and information, where can they find all of those things?

Lily Yuula  53:10

Yeah, so I've got a website, www.yuula.co.uk and I've also got my Instagram. But that this is literally why I created the text, the midwife service, essentially, because it's a super accessible way to have somebody that can coach you through those little changes to bring those home birth wives to the hospital, because there's so much to learn in a pregnancy so much to do. But with the right guidance, the right tools and the right information on us today. This is just so exciting what you can achieve.

Megan Rossiter  53:39

Amazing. Well, thank you so much. And we will see you next week. Bye.

Megan Rossiter  53:50

Thank you so much for listening to today's episode of the Birth-ed podcast. It's my actual life mission to get these conversations in front of as many expensive families as possible and you can be a part of this mission. Don't worry, I'm not recruiting you into my cult. But if you leave a five star rating and review of the podcast then we creep up the charts getting more ears, change more births, change more lives and come on, you know you want to be a part of that change.