Questions and Answers with Milli Hill

Around a month ago you may have read my post all About The Positive Birth book. If you did it you can get a good look at it here.

The Positive Birth Book, is written by a wonderful lady called Milli Hill who is the founder of The Positive Birth Movement. The book holds all sorts of amazing advice on how women can go about giving birth with a more positive attitude by getting rid of all aspects of fear. In this book she writes all about why you don't need to be scared to give birth because you can take control of your birth. You would not believe the amount of choices and options you have to make your birth the best it can be. 

After being really inspired by her book and finding it so helpful to read I asked Milli if she would like to answer some of my readers questions. So here they are, they are really worth a read as you never know if you may have a simular thought, question or problem yourself. 

Your Questions Answered - By Milli Hill

From Myself

"My last birth I really wanted a water birth or to birth in a birthing centre rather than hospital room. I unfortunately didn’t get either and ended up on a hospital bed where I didn’t want to be which ended up causing me all sorts of problems. I would love to try and get a birthing centre next time I have a baby but worried that the same would happen. What ways can I plan as a backup incase I don’t get the birthing centre again? EG, Can I ask to stay at home and have a home birth? Can I set up the hospital room to make it seem more like a birthing suite?"

Hello Cassie! Yes, yes and yes! (said in the style of Meg Ryan!). SHOCK NEWS! You can do what you like when you have a baby! You are FREE! Yipppeeeee! Etc…

In seriousness, first of all, I’m sorry that happened the first time round. There is a real problem with birth centre availability and it has such a negative impact on women when they plan to give birth in one and then they can’t. 

So yes, one thing you could do next time, is plan a home birth. The amazing thing is, that (assuming you are ‘low risk’), as a second time mother, home (or birth centre) are both safer  than labour ward in terms of where you plan to have your baby. For more info please read the section of my book, “Is Home Birth Safe?” (it’s in the Positive Home Birth section!), which explains about a very large study called the Birthplace Study, which shows that for 2^nd time low risk mums, planning to give birth at home OR in the Midwife Led Unit is safer in terms of avoiding interventions. Caesareans, instrumental births, episiotomies, third or fourth degree tears and the need for blood transfusions and also, the very rare need for admission to intensive care, happen less frequently to women who plan a birth at home or in a MLU.

The other thing to remember about home birth is that it is very easy to change your mind ‘at the last minute’, whereas it’s not so easy to do this the other way round, ie, start laboring in hospital and then say, ‘Hang on a minute folks, I’ve decided to head home for the final fireworks.” (although you CAN do this if you want to – see SHOCK NEWS in paragraph one!)

So if you plan to be at home, you can still have a bag packed for hospital and keep an open mind, and transfer if you feel you would be happier there. 

You’re right, too, to think about ‘home birth in the hospital’ as I call it. If the stars line up to say that you are having a hospital birth, then yes, think about how you can make this a more oxytocin rich environment. Oxytocin, the ‘love hormone’, is essential to normal birth, but we tend to produce much more of it when we feel safe, warm, undisturbed, cosy, and loved. Basically, if you think of the perfect atmosphere for romantic sex, then you are not far off the best birth environment! So – take in your battery operated tealights, your fairy lights, your familiar cushion, an eye mask, photos of people you love, etc! And your partner, get loving with him in the hospital room! Get him to be in charge of keeping the space dimly lit and sexy. Ban interruptions. Move the bed to one side if you don’t want it. Make a floor nest. Get your fairy lights up. Snog! Etc!

All of these ideas and more will help you to have your ‘home birth in the hospital’. 

I hope that all helps, and I hope you get the birth you want. I know you have a copy of the Positive Birth Book, and there are so many more ideas in there! Good luck, and thanks for having me on your lovely blog! Milli x

From Abi 

I am just planning my second birth after a traumatic first labour. 

My question would be: "How do you stay positive when you have negative influences around you, for example family or friends who think it's easier to just opt for an elective c-section rather than concentrate on having a positive vaginal birth?"

Hi Abi, first of all I’m really sorry your first birth was traumatic and I hope you have had some support – it can help so much for someone to listen to your story and validate your feelings about it. Too often women feel they have to keep birth trauma to themselves and ‘enjoy their healthy baby’. Going forwards to your next birth, I think it can be really helpful to process feelings about your previous birth, and also find out why your first birth went the way it did? This can ‘put to bed’ some of your own possible worries or concerns about this next labour. 

As for family and friends, it depends who they are and why they feel this way? If it’s just busybody neighbours etc, I would just ignore them. However, if it is your partner, then perhaps they were with you for your first birth and are also traumatised? People who love you are not going to want to see you go through such a difficult experience twice, so their concerns are understandable. Perhaps they might also benefit from some time to talk through the first birth with a professional, either a midwife who can go through the notes with you, or a counselor with skills in this area?

It’s also worth explaining to family / friends (and possibly also reminding yourself), that there are not just 2 options here: scary traumatic vaginal birth or elective caesarean. There is a 3^rd option, a really positive vaginal birth, which is exactly what you want! Get some really good support in place, for example a doula, and find out about all the different choices you can make to maximise your chances of this happening. For example, in my book you can read about the wonders of the birth hormone oxytocin, and how to create an environment where you are most likely to produce this. Consider, too (also in the book) declining routine vaginal exams and asking your carers to give you as much of a ‘hands off’ experience as possible (if this is what you feel you want – and many women who have had traumatic births prefer this – but not all – obviously it’s up to you.) 

Ironically, although you are being pressured to opt for a caesarean, the place you are most likely to get the kind of birth you want, is at home, which would probably fill your concerned friends and family with horror! But it’s actually true – unless you have complicating factors that make your birth ‘high risk’, then as a 2^nd time mum, home birth has been shown by extensive research to be the safest choice for both you and your baby. (NB I’m assuming you are in the UK here, the research I am talking about is UK based evidence and home birth safety differs if you are in different parts of the world.)

Another option to consider is the birth centre if you have one in your area. This is also safer for you than Labour Ward in the obstetric unit. 

I hope this helps – please do get in touch with me if I can help you any more, Milli x

From Georgina 

"I am planning my second labour and concentrating on remaining positive attempting a VBAC but also plans of how to stay calm should I need to have another emergency c-section. It was very traumatic first time round".

Hi Georgina, some of what I have said in my answer to Abi might also be helpful for you. 

As well as this, I would suggest that first of all it’s good to focus on the maximizing your chances of this VBAC! I would highly recommend seeking out a doula and finding out about your local birth centre. A more woman centred, homely environment, hopefully with a pool, will be brilliant for you and help you to ‘get in the zone’. As I said to Abi, learn about oxytocin, and perhaps also experiment with some relaxation techniques, such as meditation, yoga, visualization, or hypnobirthing. Make sure you have really good support for this birth, and read lots of positive stories. There is a facebook group VBAC Support Group UK where you might be able to find stories, and information specific to VBAC. 

I would also recommend making what I call a BPC Plan. This stands for Best Possible Caesarean. I’m pretty certain you will have a beautiful vaginal birth, but even if the chance is only really slim that you will end up in theatre again, it is worth making a really clear plan for exactly how you want things to be done, this time round. 

There is lots of information in my book about ‘woman centred caesarean’, and also there are special icons that accompany the birth plan section of the book that you can download for free here: www.pinterandmartin.com/vbp, and use to make plans for every kind of birth, including your BPC! 

One of the first things to talk to your care providers about is the stage at which you want to go to theatre. Many women who had traumatic first births find it comforting to make it known that they wish to go to theatre at the very first sign of any issues. Without talking to you I don’t know if this idea may be helpful, but it’s good to know that you can voice your wishes about exactly how you want things to be. Should you transfer for a caesarean, you may still find meditation, visualization or hypnobirthing techniques helpful to you in theatre. And with your BPC plan, you can make your wishes known about other details of the birth, such as music being played, or having immediate skin to skin with your baby. No matter how you give birth, there are always options and you are the key decision maker. 

I hope you have a brilliant birth, no matter how it unfolds, with love, Milli x

From Lianne 

"I would love to know if there is an option to be induced at all? I had a really traumatic labour that ended up with my back locking with every contraction which may have been related to my prolapsed disc and was induced after 55 hours and once that happened it was easier to handle. If I could be induced it would put mine and Hubby's mind at ease for next time."

Hi Lianne, I’d love to know more info here, for example, have you looked into the issues with your back and is there anything you can do in this pregnancy to help with them? Did you have an epidural last time, and at what point? What kind of induction were you given? When you say, 55 hours – were you in active labour with regular contractions all that time? But above everything else, the most important point to make here is that being induced towards the end of a very long labour is absolutely not comparable in any way to being induced before your labour starts. 

In fact, what you are talking about in your first labour is not ‘induction’ at all – but ‘augmentation’. Induction is when your labour has not started at all and various methods are used to encourage it to start. Augmentation, which happens to a lot of women, is when similar methods are used during labour to speed you up and get things going. 

The difference, if you like, is that with augmentation, your body has already signed on the dotted line and agreed to be in labour! We don’t fully understand the process that a woman’s body goes through when it does this. We don’t know what exactly makes a body decide to begin the birth process. So when we offer induction to women, the body still has to sign on that dotted line and agree! Sometimes, if you were already close to starting labour naturally, the body is very compliant and allows the induction to work and it can be very straightforward and not too different from starting labour naturally. Other times, if your body is less in the mood to get going and have a baby, then the induction may take several days and can be difficult, or lead to other interventions that you were not hoping for. 

So I think my advice would be that it would be wrong to assume that it was the augmentation that helped last time, and that therefore being induced would make things better / easier this time. A better approach would be to think about what was working against you last time (ie why did it take 55 hours and augmentation?), and think about ways to make labour easier this time without those factors that worked against you.

I would also highly recommend water birth, it’s brilliant for everyone but in particular for women with mobility or back issues. 

Let me know if you want to unpick your first birth a bit more and work this all out, happy to chat, love for now, Milli x

From Jade 

"Hi, I'm due my third baby in November and since last year I have suffered with tachycardia. All ECHO's and ECG's have been normal and heart looks to be on perfect condition. This will be my first birth on the consultant led ward as my tachycardia started about 6 months after the birth of my second. Consultants have been less than accommodating and didn't act on advice from cardiologists. My normal heart rate is between 100 and 160bpm and they have given me a limit of 120bpm to let me on the midwifery led ward when cardiologist said he would be happy with up to 150bpm. I've had second opinions etc and consultants are not reassuring at all. I suffer with really bad SPD and currently on crutches so I guess I just want reassurance that i can still have a normal birth (like my previous 2) without them interfering too soon and proposing a c-section. Baby is also breech at the moment and I'm adamant that i want to try a normal birth if he doesn't turn back before labour."

This sounds complicated Jade and I’m not able to give medical advice. Just your baby being breech alone would make it tough for you to have a straightforward birth (but not impossible!). Personally, if the breech issue resolves, I would push to be on the MLU unless there are health concerns in which case it’s important to listen to the doctors who are experts in pathology ie things not being right, as opposed to midwives who are experts in normality. Good luck and let me know if I can support you further, Milli x

From Georgina G

"My last pregnancy was high risk because my baby was IUGR, my first baby was SGA. We are planning on another baby within the next year or two and the likelihood of this happening again is high. Both labours I was induced and strapped to monitors most of the time. I felt unable to relax at all and spent the entire time panicking about every little thing that could go wrong and didn't get a chance to enjoy labour at all and felt coping pain wise so much harder strapped to CTG machines. How would you suggest I could feel more positive and in control of my birth with a high risk pregnancy?"

Hi Georgina, I’m sorry your previous labours have been so tough. There are lots of choices available to you with this third baby. First of all, I guess we all need to be open minded to the thought that you might not be ‘high risk’ this time?! Also high risk is a very wide ‘label’, so, even if you do fall into this category, we need to start thinking of you as an individual, not just as this ‘label’. Once you are pregnant, if you are told that you are high risk again, ask lots of questions and find out what this specifically means as it applies to you, your health history, and the fact that this is your third baby. Ask what the risks actually are! Once you’ve got this information, find out what options are considered safe for a woman in your exact position. Perhaps things might be different and you might be able to go into labour spontaneously, or labour without continuous monitoring? If you absolutely need to be monitored, could you have a wireless monitor, known as telemetry? Or could your care providers help you find ways to move and stay more mobile even with the ‘belt’ style monitor? Alternatively, would an elective, gentle, woman centred caesarean feel like a better option for you this time? Whatever happens, you remain the key decision maker, and asking questions and encouraging your care providers to treat you as a very specific individual case, will help you to feel more in control. Please do ping me a message when you are pregnant if you need any more support, Milli x

From Victoria

"After my first birth, the gynaecologist said I should have cs for the next one (had a bad tear that healed leaving a 17mm gap still). I'm now expecting but I would really like to try a vaginal birth. Is it something that is enforced or do I still have choice?"

Hi Victoria. Nothing can ever be enforced, only recommended. For example, if your long lost brother needed a kidney, and you were the only match, you could not be forced to undergo surgery and give him your kidney, even if this were the only hope to save his life. Pregnancy is no different. You have absolute autonomy over your body and nobody can make you do anything without your express consent. 

Regarding the tear, I would suggest researching this in more detail and talking to people who have ‘been there, done that’. There is a facebook group for women who have experienced severe tears here: https://www.facebook.com/groups/506595522875980/. I would start there and see what other women say about the types of tears they had and the choices they made. 

If you decide to have a vaginal birth, there is lots of information in my book about preventing tears. Water birth is helpful, as is being active, and ‘non-directed pushing’ ie listening to your body and pushing when you feel compelled to, rather than when a midwife instructs you to. Very best with it! Milli x

From Elizabeth

"We hope to have another sometime in the future if my body allows (suffer from PCOS so have some fertility issues). With both of my previous births the midwives wanted me to be monitored from when I first arrived at the labour ward which I found restricting. First pregnancy I had gestational diabetes but second I did not (had to GTT and did not have it much to consultants surprise) but both high BMI. As such it was highly suggested to have a hospital birth and I found along with the monitoring the hospital environment was daunting and contractions slowed once I arrived at hospital as I was tense and felt uneasy. If I was to have another which would likely be a hospital birth how can I have a relaxing and enjoyable birth especially if I had to be monitored again? Also due to childcare issues there is a chance I'd have to birth without my partner, what tips can you suggest for having a relaxing, positive birth alone?"

Hi Elizabeth, I’m sorry you were made to feel that your options were restricted so much by your high BMI. There is a good website here http://bigbirthas.co.uk/ for women with high BMI with lots of evidence based information and research. 

Might you be able to use a birth centre? There are restrictions on this for BMI but it depends how high your BMI is really, and what your overall health is like. If you are well otherwise, and only on the borderline of their ‘cut off point’, then it is very much worth pushing / begging for them to let you birth in the birth centre!

I can’t tell from your message why you had to be monitored? It’s worth exploring this a bit more and, as with any recommendation from a health care provider, finding out the reasons, any specific risks involved and on what evidence your care providers are making their decision. 

So – look at the options. If ‘worst case scenario’ is continuous monitoring in hospital, then see above to Georgina’s answer for ideas like wireless telemetry or a more active birth with the monitors on. 

If you think you might be alone, I would get a doula. This can be incredibly cheap (considering they are on call for 4-5 weeks around your due date and will stay with you for your entire labour and birth, no matter what!). A trainee doula will usually charge around £500, but if this is out of reach, you can apply for support through the Doula UK Access Fund. More info here: https://doula.org.uk/. I hope you have a great pregnancy and birth and do get in touch with me if I can help any more, Milli x

From Margaret about a family member

"After a traumatic birth what is the best way to put someone's mind at rest, It's got to the point where she's paranoid about another baby but always wanted a big family?"

Hi Margaret. This is so complicated. I think the first thing that’s really important is that you and the other people around her really listen and honour her feelings about her previous birth. I think we have some big cultural problems with any kind of ‘big feelings’ sometimes! And birth trauma is no different. Often women are told, ‘Oh, you’ll soon forget, enjoy your healthy baby!”, and this can make them feel guilty for raising the subject, as if by complaining about their birth they are somehow implying they are ungrateful for their baby or do not fully love them, which is of course not the case. 

If you family member is willing, she may want to go over her birth, including the notes, with a midwife. She can ask for this service at the hospital where she had her baby, it’s sometimes called, ‘Birth reflections’ or ‘Birth afterthoughts’. Alternatively she can hire an Independent Midwife (via www.imuk.org.uk) to go over her notes with her, if she would prefer someone separate from the hospital. 

It’s possible she is suffering from PTSD, and if so, she could be referred by her GP for counseling, or she can seek a specialist in birth trauma if she wishes to go privately. Sometimes PTSD is misdiagnosed as Post Natal Depression, so this is something to be aware of. If she is not clinically depressed, then she does not need anti-depressant medication. 

There is online birth trauma support including a great Facebook group here: https://www.facebook.com/groups/TheBTA/

The key thing here is to help your family member find the right path to process and come to terms with what happened to her. Only then will she able to move on and think about whether she can give birth again, and if so, what her options for a better second birth might be. I hope that helps, Milli x

I really want to say a great big thank you to Milli Hill for answering these questions. I hope that they provided great help to all involved. Please do head to the Positive Birth Movement Website and also follow The Positive Birth Movement on facebook to see more positive advice.