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Should I be worried?

Watching reality birth programmes when pregnant probably isn't a good idea. They are edited to seem extra dramatic. A midwife who worked in a unit that hosted OBEM said the filming took place over six weeks, 24 hours a day; this was to give ten hours of programme, covering three or four births in each of the twelve episodes, so a maximum of 48 births. Yet in that time approximately 580 babies had been born. You don't get to see the long gentle water births, or the uneventful standard birth. And even the births they show are edited to give the dramatic highlights, or to laugh at the women or their partners. Sometimes the voice over adds unhelpful and inaccurate quips; my favourite being the 'she had to xyz' or 'now not allowed to abc'.

This week the home birth groups I belong to on facebook have been full of worry about the latest reality birth programme 'Emma Willis: Delivering Babies. (Don't get me started on the title! Pizzas are delivered; babies are born!) The woman had a cord prolapse, which is when the umbilical cord is coming down before the baby's head. This is an emergency as the cord can get squashed, cutting off the baby's blood and therefore oxygen. It is extremely rare, happening in less than 1% of births. Understandably this scenario worried the potential home birthers. Should you be worried about cord prolapse?

Cord prolapse is one of the curve balls that could happen at any birth so it is worth knowing about it but I have some reassuring information too.

There are some things that make cord more likely to happen:

  • excess amniotic fluid;

  • having your waters broken;

  • baby's head not engaged;

  • premature birth;

  • combination of these.

If your baby's head is engaged then you will not have cord prolapse. Most of these things are not relevant to a home birth. Potential cord prolapse is one of the reasons to avoid having your waters broken artificially, which rarely happens with home births. Having lots of amniotic fluid, polyhydramnios, doesn't mean home birth is not an option but you might like to read up more about it here. When your waters break cord prolapse is one of the things that midwives are alert for, especially if any of the situations given above are relevant, checking by sight, and by checking the baby's heart rate, and, if concerned, vaginal examination.

Midwives are trained to deal with cord prolapse at home, along with many other potential issues. If there is cord prolapse your midwife would get you to put your head on the floor and bum in the air. The midwife will put her hand on the baby's head to keep it away from the cord. And you would travel to hospital like that. It would be caesarean birth.

There are some amazing birth stories around of this happening to women. One in New Zealand, hadn't planned a home birth but waters went and woman felt cord, phoned midwife. Midwife told her to get in the position rushed to her house, but her hand on baby's head, transferred by ambulance and helicopter like that to hospital. Baby born fine. Another story in Australia, home birth in the outback, prolapsed cord, travelled by air ambulance for two hours. Baby born fine. Midwives are trained to deal with emergencies. Midwives know what to do.

It is worth noting that the woman in the Emma Willis programme was high risk. She had a stitch in her cervix to keep it closed after losing previous babies. The stitch was removed in hospital, while on a monitor and her waters broke/were broken. I haven't watched the programme, as it is on cable channel W, but there has been discussion of this on national home birth facebook groups.

What happened here wasn't relevant to home birth scenarios. But that hasn't stopped well meaning family and friends say to those planning home births 'what if that happened at home'. I hope you can feel confident in replying that 1. it is much less likely to happen at home; and 2. midwives are trained to deal with it if it happens at home.

Home birth is a safe and sensible choice for many many births. If you would like to read more about the safety of home birth and how we came, erroneously, to think that hospital was safer, here's an article I wrote Home birth: safe birth.

If you have any other examples from reality birth programmes that you'd like to know more about then please get in touch.

I am an antenatal teacher and doula in Bedfordshire, UK.

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