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	ask the experts sheila kitzinger

Sheila Kitzinger
Childbirth Education, Homebirth

Sheila Kitzinger is on a temporary leave of absence from the expert panel. She is not taking any new questions at this time.

• What kind of social support system does a pregnant and birthing woman need?
• We are planning a homebirth (attended by a midwife) for our baby due in September. My husband would prefer not to have a doula. I am wondering if there is a specific method of coaching that we should investigate so that my husband will be fully prepared to offer the support I will need?
• I have a beautiful three-year old daughter and would like to have another child. However, my first pregnancy was very difficult and included premature labor and preeclampsia, and my daughter was kept in a NICU for over a week. The birth and post-birth experiences were close to traumatic and I still can't talk about them without crying. I was told I'm at high risk for developing preeclampsia again. Is there anything you can suggest to prevent preeclampsia (and my own fears)?
• I had my first child by caesarean due to the physician not being experienced in delivering a breech position. I would like my next child to be born vaginally. What precautions do I need to take? How do I select a physician/midwife who can meet my needs?
• My friend is currently nursing her 11 month old. He has started to reach down her shirt and grab her breasts whenever he desires. My friend is distressed because she was sexually abused when she was a child and feels protective of her body. She is feeling violated, but also understands how innocent her son's actions are. Do you have any advice for her?
• Do you automatically consider someone who is in their 40's to be "high risk" for home birth?
• I was induced for my 1st child's birth and things went downhill all the way to a C-section. I was prepared to do it naturally but agreed to the induction. What can I do now to prepare for another birth to make it better? I'm scared to try a homebirth because of how badly our 1st one went even though deep down I know that the birth would not have gone that badly if it had been at home, but I have these "what if's." Where can I go to learn anything and everything about a VBAC at home and how can I get over the what ifs?
• I would strongly prefer to have a homebirth, but my insurance will not cover it, and I cannot afford it. How can I make a hospital birth as much like a homebirth as possible?
• My daughter recently weaned at 4 years and I wonder if you have any good ideas for a weaning ceremony that we could do together since, due to her age, she will remember the nursing and weaning in her conscious memory?

What kind of social support system does a pregnant and birthing woman need?

A woman needs someone who loves her, someone who believes in her, and to know that she will have people with her and a place in which she she can give birth that will enable her to behave spontaneously, and she needs to believe that she is bringing a child into the world that is safe and will allow that life to flourish. This rules out any 'war on terrorism'.

We are planning a homebirth (attended by a midwife) for our baby due in September. My husband would prefer not to have a doula. I am wondering if there is a specific method of coaching that we should investigate so that my husband will be fully prepared to offer the support I will need?

You honestly don¹t need "coaching", though I think he'll find that it gives him confidence to attend childbirth classes.

Birth is not a performance or an athletic contest. The great thing is to trust your body and welcome the power of each contraction as it sweeps through you. To do that you need to center down, and coaching often turns out to be a distraction. When Lamaze was first introduced in the US it was a drill that had to be learned and obeyed meticulously. Childbirth teachers now realise that this is a form of self-hypnosis which doesn¹t work for many women. The latest edition of my Complete Book of Pregnancy and Childbirth: Choices and Challenges (Dorling Kindersley) will hlp you both to explore how to 'go with the flow'.

It is sometimes difficult for a man to trust the birth process, because he wants to be "in charge", and is likely to be deeply emotionally involved, bringing with him to the birth all his hopes, fears and doubts. A doula can support you and your husband. She doesn¹t take over from the father of the baby and replace him. But ultimately it is entirely up to you who is with you. It¹s you having the baby, and your decision, nobody else's.

I have a beautiful three-year old daughter and would like to have another child. However, my first pregnancy was very difficult and included premature labor and preeclampsia, and my daughter was kept in a NICU for over a week. The birth and post-birth experiences were close to traumatic and I still can't talk about them without crying. I was told I'm at high risk for developing preeclampsia again. Is there anything you can suggest to prevent preeclampsia (and my own fears)?

I am so sorry to learn of your distressing birth experience. To face up to your fear, consider writing the story of your birth, the time afterwards, and your feelings about it, in the third person, as if it happened to someone else. This enables you to stand back from it a bit, and come to terms with it.

Evidence for effective prevention of pre-eclampsia is contradictory, and often based on small scale studies. It is known that the conditions for placental malfunction are laid down early in pregnancy, when placental blood vessels are rooting themselves into the uterine lining. If it doesn't happen smoothly, oxygen passing from your blood stream into the placenta is reduced.

Good nutrition, starting even before you conceive, is likely to be helpful. Do not go on a slimming diet. But research in Africa shows that an extra high protein diet increases the risk of pre-eclampsia. Some studies reveal that supplementary magnesium, and also of calcium, are useful. Fish oils and evening primrose oil may help, too, though research results are inconclusive. Studies of low dose aspirin reveal that this is helpful for some high risk women, because it makes the blood less sticky. Discuss this with your doctor or midwife. There is a good chance that your next pregnancy will be healthy.

I had my first child by caesarean due to the physician not being experienced in delivering a breech position. I would like my next child to be born vaginally. What precautions do I need to take? How do I select a physician/midwife who can meet my needs?

Network with other women in your area who have had babies recently, to see if you can discover any who have experienced a breech vaginal birth, and find out who their obstetricians or midwives were. You can probably do this through local Lamaze and Bradley classes. You could also contact the Birth Center Association to enquire whether there is a local midwife-run birth center:www.maternity.wise.org

Then discuss with any prospective care-giver ways of facilitating vaginal birth (e.g. movement, upright posture) if the next baby is breech too.

The most effective way of avoiding a Cesarean is to have a baby turned from breech to vertex by external cephalic rotation at or after 38 weeks. This can even be done at term or early in the first stage of labor if there is still room. Some babies turn back again, but most stay snugly head down.

My friend is currently nursing her 11 month old. He has started to reach down her shirt and grab her breasts whenever he desires. My friend is distressed because she was sexually abused when she was a child and feels protective of her body. She is feeling violated, but also understands how innocent her son's actions are. Do you have any advice for her?

It must be very difficult for her. She probably feels torn in two. I think she needs to be gentle, firm, and consistent with her little boy. Every time he reaches for the breast she can take his hand, place it against her cheek, and reassure him lovingly that he can feed soon. She should offer him the breast at the first opportunity. This is teaching him to 'sign' as part of the on-going non-verbal communication between them. It will be easiest if she is willing to feed him unselfconsciously whenever he asks, and in front of other people. As he develops language, she can also teach him a word that signifies 'breastfeed' which has a private meaning just for the two of them.

Do you automatically consider someone who is in their 40's to be "high risk" for home birth?

It sounds rather a loaded question, for of course nothing should be "automatic". A woman who is healthy and who has a straightforward pregnancy and good midwife care is less "at risk" in her forties than one who is not fit, has a pregnancy that gives cause for concern, and who is cared for by a team of professionals who don't really know her, and who may misinterpret the results of tests. There is nothing about being over forty that makes birth more dangerous, though the chances of being transferred from home to hospital, either before or during labor, are increased. You and whoever is going to be your birth companion should seek out good childbirth classes too. Prepare yourself to be upright, active and moving in labor. And I think my own books may help you, too.

I was induced for my 1st child's birth and things went downhill all the way to a C-section. I was prepared to do it naturally but agreed to the induction. What can I do now to prepare for another birth to make it better? I'm scared to try a homebirth because of how badly our 1st one went even though deep down I know that the birth would not have gone that badly if it had been at home, but I have these "what if's." Where can I go to learn anything and everything about a VBAC at home and how can I get over the what ifs?

Self-confidence and feeling secure in the place you have chosen, and the people you have chosen to help you, is the key to a happy birth, whatever happens. It would be a good idea to avoid induction next time. You don¹t say why your labor was induced, but simply being past your "due date" is not an indication for an induction if cardiotographic tests show that the baby is okay, and you can feel vigorous fetal movements. I suggest that you visit the ICAN website www.ICAN-online.org.

If you can get good midwife care recommended by other mothers, home birth might be the best option. But you will need to feel very positive about the birth, too. A doula would be a good idea whereever you decide to have the baby. You will need strong emotional and practical support. Have a look at my book Birth Your Way: Choosing Birth at Home or in a Birth Center, Dorling Kindersley 2000. I hope that it helps you feel far happier and more excited about the forthcoming birth.

I would strongly prefer to have a homebirth, but my insurance will not cover it, and I cannot afford it. How can I make a hospital birth as much like a homebirth as possible?

Find a doula to be with you - very important in an alien environment. Visit the web-site: www.doula.com

See if you can get care from a professional whom you already know.

Take in things that will help you feel more at home: your own T-shirt or other clothing, pictures, candles, even a sculpture, on which you can focus during contractions, candles, aromatherapy oils and a burner, music that you rehearse relaxing with during pregnancy,.

Ask your care providers to wheel the bed to the wall or out into the corridor. Make it clear that you want to be upright and moving around. A birthing ball to perch on or large floor cushions to be propped against or lean over are a good idea.

Cover the clock on the wall and the peep-hole in the door, if there is one, with cloths, and turn off over-head lights.

This is your birth space - your birth, no-one else's.

My daughter recently weaned at 4 years and I wonder if you have any good ideas for a weaning ceremony that we could do together since, due to her age, she will remember the nursing and weaning in her conscious memory?

I think this is a lovely idea! Maybe she can contribute some thoughts about what she would like to do. The obvious thing is to plant a tree together. But my daughter who breastfed one of her own children for four years, too, suggests that you might adopt a goat in a needy rural community in Africa or Afghanistan! Sounds hilarious - but it would be really useful.

Weaning from the breast is a time of danger for children in impoverished communities. A child who flourished on mother's milk is suddenly exposed to pollutants, bacteria and infectious diseases. Commercial baby milk is expensive. It is diluted to make it go further, and where there is no refrigeration cannot be stored safely. There may be no access to clean water, and women often have to carry for great distances all the water for the household on their heads or backs. Children get gastro-enteritis, catch infections and may suffer protein deficiency disease.

If the family keep goat there is a ready supply of clean milk. So this is an opportunity to enable your daughter to learn about the lives of children in the rest of the world and do something to help them. The web-site that will give you information about how to do this is www.sendacow.org.uk