At the Barkantine Birth Centre
In 1998, when I was pregnant with my first child, I took a look around the Royal London Hospital Maternity Ward and decided promptly on a home birth. I lived close-by and so that was my backup plan: a short walk over to the maternity unit, in case there was an emergency. As it turned out, I did not have to go into the hospital until after giving birth. A short trip by ambulance, not on foot. The ward was grim: overcrowded, unpleasant nursing staff, blood spattered in the bathrooms, filthy toilets, uncontrolled visiting hours, dreadful food. I turned down a blood transfusion, and my consultant said he did not blame me.
Fourteen years on, I am living in Whitechapel once more and the Royal London Hospital has been rebuilt. Does a new building portend a new culture? The new bright blue and silver building squats hugely in the middle of Whitechapel, resembling a Legoland fantasy plonked down by a giant toddler. Its neglected elderly relative, the poor old London Hospital, crouches in its shadow, windows boarded up; the fate of its Georgian facade undetermined. At the back of the building, the old wards are peeled open, innards blitzed and bared to the elements. Huddles of patients brave the wind tunnel effect outside the Stepney Way entrance to have a fag or a natter. What is it like to give birth there these days, I wondered. If you are inclined to natural home-style birth, you will be directed to the Barkantine Centre, an outpost of the maternity services at the Royal London Hospital which opened four years ago in a modern, purpose-built block on the Isle of Dogs.
It is a short Docklands Light Railway ride from Whitechapel and a world apart from the Royal London Maternity Unit I remember. Sarah Piller, acting Birth Centre manager and a practicing midwife, is keen to dispel my bad memories of giving birth in Tower Hamlets. She’s warm, down to earth and enthusiastic about her work, and I almost wish I were having another baby – with her on duty. She is a passionate advocate for natural and home birth, and clearly loves her career.
“It’s all very different now,” she tells me. Sarah has a bad cold on the day we meet her, but she does not grumble at all – in fact, she is apologetic. “We are part of Barts and the Royal London hospital,” she explains. It is a sizable trust, known as Barts Health, that has recently merged with Whipps Cross and Newham.
That morning, the centre is peaceful and quiet, as Sarah shows me around. Each birthing room comes with its own birth pool, soft bean bag seating, double bed for partners wishing to stay, and an en suite bathroom. The space is cocooning, yet not claustrophobic. A young mother, Jamiyla, has just given birth. She rests in a room, cocooned with her new baby, and her partner, ecstatic but exhausted.
There is a good view of the Isle of Dogs, its mix of sixties high rise flats, sleek modern buildings, divided by jigsaw shapes of water. Arcs of washing are strung between the windows of a tower block opposite, hopeful in the face of dull, still weather. Looming just beyond in the mist are those other tower blocks that dominate the skyline: Canary Wharf, CitiGroup, Morgan Stanley, HSBC.
Sarah tells me that she trained as a nurse originally, but had always wanted to be a midwife. She worked on the maternity wards at the Royal London Hospital, including the Talbot Ward – the one were I was admitted– and the Mary Northcliff; both these are post natal. “They’re very different now,” she reassures me, seeing the look on my face. “Still very busy.”
After a year, Sarah moved into community midwifery, working in Tower Hamlets and Poplar. She has been at the Barkantine Center for three and a half years, and is now a senior mid wife and acting manager. The centre’s inception was spearheaded by Alison Heron at the Trust, with a lot of input from the local women’s community.
“It’s a home from home unit,” Sarah explains, “designed for women who want an experience of giving birth at home, but want to leave their actual homes. Mums-to- be always tend to say they don’t want to give birth at home – they want to get away from all that mess of giving birth; but there isn’t much! I tell them that staying at home to have your baby is just so amazing.”
I agree with her, having gone that route myself, though I can see why you might choose a place like this, clean and calm, with the security of medical personnel on call, should you need it. “We desperately try to get the home birth rate up in London – it’s higher in rural areas,” Sarah says.
The set up here allows partners to stay, something that simply was not possible at the old Royal London, where beds were squeezed and space sorely limited. “It’s much stricter with the visiting hours there now,” she tells me, “no children allowed to visit, and only one or two visitors at a time.”
Prospective mothers come to the Barkantine Centre at around thirty-six weeks, for a risk assessment. About half of the women booked in to give birth here will subsequently be removed from the list – given their high risk factor. There is a high proportion of Bangladeshi women in the community, a sizable number of whom make use of the centre to give birth. “We get a lot of second and third time mothers,” Sarah goes on. “First time mothers are sometimes a bit skeptical, because there are no doctors on site.” So at first, the take up rate was low, but after a determined effort to promote the centre’s work, by word of mouth, and publicity at mosques and community centres, that has changed. It is really popular.
After seven years of living in New York, where birth is a much more medicalised business, I find the prospect of no medical expertise on site is slightly alarming. I was much more gung ho about deciding on a home birth for my first child.
Sarah laughs when I say this to her, pointing out that the mothers who eventually give birth here fall into the low risk category. The transfer rates to hospital are around 19/20% – lower than the national average of around 30%.
I want to know what is actually distinctive about giving birth naturally, beyond the obvious upside of being in a peaceful, calm blue painted space like this.
Sarah pauses to reflect for a moment. “It’s so amazing, after having gone through the hospital experience, working in a place like this,” she says, with feeling. “you can actually work closely with the women giving birth, guiding them with advice on what position to take, what to eat, how to move.”
It sounds almost blissful. Sometimes they use aromatherapy, listen to any music you fancy and lately, hypnotherapy birthing has been gaining popularity. I had never heard of the latter as a method, which involves a form of hypnosis to bring the birth along. Apparently, a baby can arrive a mere hour or two afterwards, which definitely sounds appealing.
Given the diversity of the East End community – women from Bangladesh, Russia, Eastern Europe, to name just a few locations – I wonder how the language barrier is tackled. The idea of giving birth in a foreign language seems daunting to me, but Sarah is quick to point out that most of the Bangladeshi women speak English, and limited English is fine for those who are less fluent. There are also many health professionals who speak other languages and can help with translation.
Every room has a birthing pool. Making use of one in labour speeds up the birth, and reduces the likelihood of transfer to hospital. Is it popular? Is it really safe? I gave birth at home in a water pool, and the first midwife that came along seemed out of her depth with what was happening. Sarah points out that the midwives in the Barkantine Centre are all water birth trained – it is compulsory.
“It’s just about birth awareness, the training,” Sarah explains, “keeping the pool warm and clean, knowing what to look out for, signs of labour not progressing, baby defecating in the water, needing to know if the mother needs to get out of the pool for any reason.”
The mothers are told to bring their own mirror with them, so that the midwives can observe the baby. The pools are deep and the women are on their knees usually, making it hard to see anything.
Something I did not know at the time I gave birth in water: water birth must be hands off, as the baby can start breathing if there is human contact from the outside world. The procedure is straightforward, in theory: the mother pushes the baby into the water, at which point, the midwife will lift the baby out.
That simple? I remember my body was covered in bruises – a result of grabbing onto my own arms and thighs, when I was standing up. I used gas and air, AKA Nitrous Oxide, which Sarah says they offer at the centre, or Pethidine, if that is preferred. No epidurals, though; they do not have the medical set up for that.
“It isn’t rocket science,” says Sarah cheerily, “doing water births, but there’s a lot to consider and some people get quite panicky. It’s a great way for a woman to give birth.”
I agree. If only this place had existed when I gave birth in water to my two daughters.
Jamiyla and Damian with baby Tennessee
Isabel and Kenneth with their baby son
Shamina with baby Areeba and brother Akif
Midwife Sarah Piller
Photographs copyright © Sarah Ainslie