The IVF Journey Part 9 - Morning Sickness in Thailand, Doulas and Independent Midwives

Long haul travelling during the first trimester when you are already feeling quite yucky is certainly no fun. I was 8 weeks pregnant and feeling decidedly nauseous and ever so tired at this stage.

I loved the idea of resting for twelve hours in an aeroplane seat but in reality even this was exhausting. It was challenging too simply because of the terrible aeroplane smells and the fact I couldn’t elevate my ankles. E was going through his own challenges; his back was still playing up so sitting in an air-seat for that length of time was certainly not easy for him either.

At Bangkok we had to transfer up to Chiang Mai. We’d both just settled into the seats of the smaller internal plane when E started panicking that he couldn’t find his wallet in his bag.  He’d taken it out of his pocket only minutes earlier to put through the scanner at security before we got on the plane.   He called the airhostess over and before I knew it he was leaving the plane and arranging to join me in Chiang Mai on the next flight.

Without really thinking, I quickly handed him my wallet with all my cards in it in case anything happened to him and sent him off on his way, thinking to myself how crazy that here I was now travelling up to Chiang Mai on my own, pregnant, and with no wallet.  One does silly things in the heat of the moment!

At Chiang Mai airport I was met by the driver who would be taking E and I to the house where we would later be joined by my folks and my brother and his family.  I’m not sure the driver was that delighted to hear that we now had to sit around the airport waiting for E’s plane, which was due to land within the next 2 hours, but alas there wasn’t much we could do about it. 

By then I was feeling surprisingly ok, it was like the jet lag has somehow managed to shift the sickness I had previously been feeling.  It was incredibly humid and I sat trying to read my book and feeling thankful that at least I had a bottle of water to drink because I had no money to actually buy anything – this is a really horrible feeling that makes me feel very vulnerable.

After 20 minutes or so I had cause to rummage in my bag and lo and behold there was E’s wallet.  Arghh!  My phone wasn’t working at that point so I wasn’t able to call him and let him know and I hoped that he’d still gotten on the next plane and wasn’t trawling Bangkok airport for his supposed lost wallet!

Fortunately, he arrived on the next flight from Bangkok and we both laughed at the ridiculousness of the situation.  It turned out that the kind staff at Bangkok airport had replayed the security camera footage showing E putting his wallet through the security belt so they’d been able to see that he’d popped it into my bag at the end of the belt. Crazy man with his short term memory and me completely unaware of the fact he had put his wallet into my bag, which doesn’t bode well does it, at least for personal security!

In any event all was resolved and sorted, and we were then driven the hour or so up into the hills to the house we had rented for the next 2 weeks.  The house was situated in a marvellous spot in the middle of nowhere really and had its own staff, which was pure luxury for me as it meant someone else was cooking.  However, what I hadn’t factored in was the fact that we would be eating Thai food at every meal, and that no one had thought to tell the staff that I was essentially a vegetarian so the meat dishes upon arrival were a touch challenging!

Those first twenty-four hours were relatively easy going for me.  There was a welcome outdoor swimming pool where we could all cool off from the intense humidity, and the rooms had aircon (when they were working) while the house itself was relatively cool if you did need to escape from the sun. I was beginning to think that perhaps the morning sickness had eased but after that initial twenty-four-hour period, I was left with no doubt that the morning sickness was still very much still there.

Morning sickness sucks!  Yes, I know, I should have been very grateful for the fact that I was even experiencing morning sickness because that meant I’m pregnant. And I was grateful, truly I was, and I’m quite sure that when I was having trouble conceiving, I got sick of hearing other pregnant ladies moan about their sickness and about their indigestion and tiredness and all the other stuff that pregnancy entails.

But the truth is, morning sickness is the most debilitating thing I have ever experienced.  And to be honest unless you’ve gone through it, I don’t think you can ever quite understand how absolutely awful a feeling it is. For a start, the term “morning sickness” is utterly ridiculously.  Whoever thought this one up was clearly someone who has never experienced it because yes, while I did indeed feel sick in the morning, I was also feeling sick throughout the rest of the day too.

I’m not usually one for eating breakfast but in Thailand I just absolutely had to have something inside my tummy and fruit just wouldn’t do the job.  Ordinarily I give bread a wide berth as it doesn’t agree with me, but this was probably the only thing that made me feel even slightly better – tea and a piece of toast with jam and butter, two other ingredients that never usually pass my lips – and I admit to feeling guilty about this.

It’s crazy really this whole guilt thing and I know that I’m not alone in feeling it. I’m a keen fan of good nutrition and I’ve done a lot of work on myself with this in terms of discovering what works best for me in how it makes me feel – we are what we eat after all. So the fact my cravings were challenging that was actually challenging me too. While it may seem like no big deal to many, the fact I was eating bread was a big deal and I couldn’t shake the feeling that I was being unhealthy somehow.

It got worse though because about an hour after breakfast, lying by the pool, I would start feeling incredibly sick and absolutely the only thing that seemed to ease his feeling was drinking a very cold can of sparkling lemon pop which no doubt contained vast quantities of sugar, let alone all the other stuff that gets added to soft drinks.  I just couldn’t believe that a drink like this could possibly make me feel better, but amazingly it did – and this was before 10 in the morning, yikes what was going on with my body!

Now ordinarily, up until that point, I had always loved Thai food.  But lying out by the pool those first few mornings, the smell of the Thai food being prepared for lunch was enough to turn my stomach and make me feel wretched. Let alone then sitting at the dinner table and being offered a full cooked Thai meal.  In fairness even E and my folks were challenged by two Thai meals a day and it was with some relief that we agreed to prepare our own lunch and just eat one main Thai meal in the evening. 

All I really wanted to eat was bread with goat’s cheese and tomatoes.  Fortunately, the Western supermarket that we found in Chiang Mai provided all of these ingredients, so we stocked up and that pretty much kept me going at lunchtime. In the afternoon I’d get a full on fruit craving, the sweeter the better.  I recall E and I being in Chiang Mai one afternoon when it was particularly hot and all I wanted were smoothies with as much ice as possible, the colder the better, but they never seemed to be cold enough.

Late afternoon and I would experience a lull in sickness, which was a welcome relief and I would look forward to aperitif time, not for the wine, I certainly couldn’t stomach that, but for the salted nuts and crisps that were on offer.  Now all I wanted to eat was salt, washed down with ice cold sparkling water. The water I may have drunk previously but the salted nuts and crisps were always a big no, no on my list, but now I couldn’t get enough of them!

And then dinner time would come and my stomach would turn once again. I don’t know what it was but the smell of Thai food just made me feel sick.  It didn’t help that my brother’s partner developed a love of textured soya protein, so we ended up having various kinds of it as the base (if not the only constituent part) of our vegetarian meals throughout our stay, and I just absolutely could not stand it.  Even now the thought of it makes me feel sick.  Thankfully I was able to eat rice and that was really the main staple for me at those meals.

Still nausea and food aside it was a great trip. I was incredibly tired during much of it but of course I could indulge in lying by the pool and chilling out without having anyone else to think about but myself. I even managed to enjoy a few massages and I got to attend a few yoga classes in Chiang Mai, which always eased my sickness. I also joined E and the folks on a walk through a National Park, although sadly I had to give the zip wire/tree walking a miss as it wasn’t suitable for pregnant ladies.

It was whilst I was in Thailand that I started reading up on birth. A few years earlier I had trained as a pregnancy yoga teacher with a lovely lady who lived in Surrey and who was very passionate about home and vaginal delivery.  She had certainly inspired me with her tales and had directed me to a few books which she highly recommended on the subject.  One of these was called “Birthing from Within” by Pam England, which I had read previously in terms of educating myself to be able to assist my students and I had lent the book to a number of them who found it very inspiring.  Now here I was reading it for myself and I too was inspired.

I had been given another book called “Gentle Birth, Gentle Mothering” by Sarah Buckley, which was also interesting, especially in terms of the various scans and tests, which are carried out during pregnancy, and she also advocated a natural approach to delivery.  My brother’s partner is also a pregnancy yoga teacher and helps to facilitate pregnancy training courses. She is also very passionate about home birthing, having birthed my niece at home with an independent midwife and doula present, so she was keen to educate me on this too.

I was aware that I was now entering a whole new world and that there was a lot yet to learn. While I had the time, I emailed our local doula, Anita, back in Guernsey to share news of my pregnancy and to enquire into her availability for the birth and to find out more about access to independent midwives in Guernsey. Little did I know how much she would inspire me and how passionate I would become about birth.

The word doula comes from the ancient Greek meaning “a woman who serves” and is now used to refer to a woman experienced in childbirth who guides women and their partners through the process of preparing for birth, supporting them during labour and the birth, and subsequent bonding with the new-born. A birth doula recognises birth as a key experience that the mother will remember all her life.

She understands the physiology of birth and the emotional needs of a woman in labour, and assists the woman in preparing for and carrying out her plans for birth. She stays with the woman throughout her labour (if this is her choice), providing emotional support, physical comfort measures and an objective viewpoint, as well as helping the woman obtain the information she needs to make informed decisions.

She also facilitates communication between the labouring woman, her partner and her clinical care providers. She perceives her role as nurturing and protecting the woman’s memory of the birth experience and allows the woman’s partner to participate at his/her comfort level. Studies have shown that when doulas attend birth, labours are shorter with fewer complications, babies are healthier and they breastfeed more easily

She can also offer her services postpartum so that she provides companionship and non-judgmental support during the fourth trimester.  Here she can provide evidence-based information on emotional and physical recovery from birth, infant feeding, infant soothing and coping skills for new parents, as well as making appropriate referrals when necessary.  In short she is an angel and I was keen to have as many angels as I could in my life.

An independent midwife is also an angel but just in a different capacity. She is someone who has chosen to work outside the hospital service in a self-employed capacity to provide pregnancy care. The legal role of a midwife encompasses the care of women and babies during pregnancy, birth (and home birth) as well as the early weeks of motherhood. Usually one private midwife gives care to a woman and her family throughout a pregnancy.

Thus, having established a trusting relationship, the same independent midwife cares for the woman as she births her baby and supports the family afterwards. Research has shown that many women want this type of midwifery and pregnancy care, which they do not always receive from their local health care provider, and that it helps women to cope with the challenges of labour and the transition to parenthood.

The vast majority of births attended by independent midwives are home births, but they can also be present at planned hospital births too. Independent midwives have more freedom to practice individualised care compared to those working within the hospital environment, who may be restricted by guidelines and protocols.

Independent midwives are still regulated by the Nursing and Midwifery Council and they’re subject to the same supervision as those midwives working in hospitals. They’re required to keep up to date with their practice and are only allowed to act within their sphere of competence as midwives.

For me as the conception had been so medicalised, I was keen to ensure that the birth was as natural as possible. I wanted to avoid any intervention, especially as I was aware that intervention can lead to more intervention and to a potentially medicalised birthing experience. I was very aware how over time birth has become a medicalised experience and as a result of this, the emphasis has shifted from the mother to the baby, so that the mother was – and in many cases continues to be – overlooked in the whole birthing experience.

As Dr Christiane Northrup writes, “Labour and delivery often go well. Yet as a society we continue to treat the normal process of birth with hysteria. High anxiety about pregnancy and birth is partly the result of our collective unresolved birth trauma – nearly every one of us has unfinished business about her or his own birth that we keep projecting on to pregnant women. Most baby boomers, after all, were born drugged and were whisked away from their mothers to the glaring lights and sterility of the hospital nursery. The Second World War generation was born at home. Then birth became medicalised and moved into the hospital. Though the mortality rate fell we lost a great deal of birthing wisdom with this shift.

I have seen cemeteries strewn with the headstones of women who died young, surrounded by the graves of their dead children. Most of these deaths and traumas resulted from poor nutrition, overwork and lack of maternal support, not necessarily from lack of sophisticated medical intervention”.

The trouble is, these days, birth often involves some form of intervention, which in many cases is probably unnecessary but sadly part of what’s accepted as normal.  For example, studies show that most of the women in the UK will have experienced at least one of the following routine medical interventions:

·      Caesarean section

·      Induction

·      Artificial rupture of membranes

·      Continuous electronic foetal monitoring

·      Epidural anaesthesia, episiotomy and recumbent birthing position.

The more I read the more I began to discover that childbirth has become an increasingly medicalised phenomenon whereby the majority of women no longer experience or have knowledge of what it is to give birth to their baby without interference. It would seem that almost all women who give birth in hospital are subjected to a cascade of medical and technological interventions throughout pregnancy and birth.

I researched a little further and discovered that since 1985, the international healthcare community has considered the ideal rate for Caesarean sections to be between 10-15% (see World Health Organisation). However, statistics collated by the NHS for 2013-14 showed that the Caesarean rate was nearer to 26.2%.

I also discovered that when medically necessary, a Caesarean section can effectively prevent maternal and new-born mortality but two new studies show that when Caesarean section rates rise towards 10% across a population, the number of maternal and new-born deaths decreases. However, when the rate goes above 10%, there is no evidence that mortality rates improve.

As Dr Christiane Northrup further writes, “The medical system participates fully in treating childbirth as an emergency needing a cure. Because of its addictive, patriarchal nature, the medical system becomes the symbolic ‘husband’ for all women crying, “Jerry, do something!” And believe me, doctors are trained in many ways to ‘do something’. Each of our doings has a price.

Some studies show, for instance, that epidural anaesthesia increase the rate of Caesarean section because this anaesthesia relaxes the pelvic floor muscles, causing the baby to engage with the head in what’s called the occiput posterior position – facing up. It’s much harder to push a baby out when she is in this position; it also slows down the process and may add to the baby’s distress. Epidurals are also a metaphor for current mind/body split approach to childbirth: ‘I want to be awake and intellectually aware, but I don’t want to feel my body”.

I researched further and found that NHS statistics for the period 2013-14 also show a continuing upward trend in induction rates, increasing by 1.7% during that year to 25%. The World Health Organisation recommends induction of labour should only be performed when there’s a clear medical indication for it and the expected benefits outweigh its potential harms.

In applying the recommendations, the World Health Organisation says that consideration must be given to the actual condition, wishes and preferences of each woman, with emphasis being placed on cervical status, the specific method of induction of labour and associated conditions such as parity and rupture of membranes. They recommend that induction of labour should only be performed with caution since the procedure carries the risk of uterine hyper-stimulation and rupture and foetal distress.

And yet it seems that induction has become common place.  I’ve lost count of the number of times I hear of women being induced and being deprived of the opportunity to connect with their body wisdom and allow their body to do what it needs to do naturally.  They are continuously monitored and in effect strapped to a bed so that they cannot move nor can they allow their bodies the opportunity to find the optimal position for birth.

Before they know it they have agreed to an epidural and then can’t feel what their body is doing, they are full of fear and the baby senses this and the medical staff are concerned about the signs of foetal distress. Hands then begin probing to check for thinning/contracting of cervix and electrodes are placed on the baby’s head.

Is it any surprise that the baby gets distressed? It’s been happy in there for 40 weeks (or whatever the term is) of its growing life safely protected by Mum and now here it is being probed before it has even entered the world. Plus of course it can sense poor Mum’s fear and the stress which accompanies this.

Thus it follows that the mother is no longer capable of birthing her baby and she is wheeled down to theatre to have her baby extracted, born into the bright lights and sterility of such an environment in front of strangers who know nothing or her and nor her of them.  Welcome to the world baby, what a way to begin!

By this stage, as the mother you’re just delighted and relieved, your baby’s arrived safely and everyone keeps telling you this. You try to put aside any concerns that there’s something wrong with your body which means that it cannot birth naturally and try not to reflect on how different things could be…the baby’s safe that’s all that matters…

But here’s the thing, of course it goes without saying that you want to birth a healthy baby, but at some point the care shifted from it being also about the Mum to just being about the baby and that’s unfortunate really. The medical model of childbirth assumes that the female body is always ready to fail.

Childbirth is now seen as a highly risky business. The majority of women who give birth in hospital do so because they assume that a hospital birth is safest. However, all the research evidence that exists demonstrates that, for a healthy woman with a normal pregnancy, a planned home birth is as safe as a hospital birth (BirthChoiceUK, 2005). In spite of this research evidence, not everybody agrees, and many health care professionals insist on claiming that a medicalised hospital birth is still the safest option.

Reactions to the medicalisation of birth have been various. For some women, the technology and surveillance that is brought to bear on the birthing body is welcomed as a comforting presence to help ensure that the baby remains safe and well.

Whilst it is essential that this is recognised, one has to question the underlying reason for the practice, in terms of litigation and making life easier for medical staff. For example, a reason women are encouraged to birth on their backs, even though this makes no sense physiologically and will only serve to make the whole process much more challenging and much more painful, is because it makes it easier for medical staff to see what’s going on.

As Dr Christiane Northrup writes, “During my training, when foetal monitoring came in and the Caesarean section rate began to soar, I remember thinking, “How can it be that 25% of women aren’t able to go through a normal physiological event without the aid of anaesthesia and major surgery? How could the human race have possibly survived if this many women really need major surgery to give birth. What is going wrong here?

I was taught that I must treat everyone as though she was going to have a potential complication, as if normal labour could turn into crisis at a moment’s notice. Whenever a woman arrived in labour, we immediately put in an intravenous drip, took blood, ruptured her membranes – broke the amniotic sac (‘bag of waters’) surrounding the baby – screwed a foetal scalp electrode into the baby’s head and threaded a catheter into the mother’s uterus to measure intra-uterine pressure on the foetal monitor. Then she and her family, the doctors and the nurses all fixed their gazes on the monitor and pretty much relied on it to tell us what to do next. The women was asked to labour in a position that gave the best monitor tracing – not the one that felt best to her…

…later, studies would show that foetal monitoring did not actually improve perinatal outcome when compared with a nurse listening to the heart rate periodically. What it did do was increase Caesarean section rates – a great example of technology ‘catching on’ before all the data were in. Monitoring has its place – I’m not against it. It simply is not a substitute for caring, human interaction, though it is often used as one….

 Unfortunately, the beliefs that support hospital procedures are often so pervasive that even those women who enter hospital wanting natural childbirth often end up with some kind of intervention. This is because a woman in labour is highly vulnerable. If she is not supported in her labour process by people who truly trust labour and see it as normal, she can be talked in to just about anything”.

Taking this all into consideration, it wasn’t perhaps surprising that that I was keen to do all I could to promote a straightforward homebirth with people around me who supported me and believed in the wisdom and power of my body. I imagined birthing at home in the peace and quiet of my own spiritual space, providing me with the opportunity to truly tap into my body’s innate wisdom and trust in that.

I felt that to have the chance of achieving this I would benefit from employing the services of an independent and intuitive midwife with whom I could establish a close and indeed trusting relationship and a doula who would be able to attend to my needs before, during and after birth. Anita was my chosen doula and she was delighted to take on that role.

Unfortunately, we don’t have an independent midwife living on Guernsey so I knew that I would need to engage the services of an independent midwife from England. Anita kindly put me in contact with an independent midwife who certainly sounded ideal but I quickly realised that it was going to cost us a lot of money, not least in terms of her fee for the delivery itself (quite understandable incidentally) but in terms of the fact we would need to establish a relationship which would mean paying for flights backwards and forwards between the UK and Guernsey. 

Furthermore, the independent midwife would need to be on the Island well in advance of the due date and we would need to provide her with accommodation during this period at our expense. I discussed the matter with E but he was not keen.  I must admit the thought of having someone in our space for the weeks leading up to the birth didn’t resonate with me as I am very precious about my need for space and especially at home.

Furthermore, we didn’t feel that we could justify the expense of the independent midwife.  My mind however was absolutely set on Anita as my doula and while E was a little resistant due to the fact he wasn’t sure of the role he would play, I was keen to make sure I was booked up and could be assured of her presence on D-day!! So that was that decided while we were away!