The trusty toilet

We don’t often talk about ‘toilet birth’, but it happens more than you might think!

If there is one thing that midwives tend to have in common, it is their love of talking about midwifery, sharing birth stories and collecting snippets of wisdom from others. With this in mind, and in view of the passion midwives have for promoting normal birth, I once polled a variety of midwife colleagues and friends to ask them what, in their experience, were the essential ingredients for normal birth. The topic – and tool – which was mentioned the most: the all-important loo!

This often unloved piece of furniture is quite universal, does not have to be hauled around in the back of anybody’s car and it transcends location. By this I mean that it is equally available in homes, hospitals and birth centres, and sometimes even in the more unusual places that women occasionally give birth, such as supermarkets and aeroplanes (although admittedly not often in taxis).

Toilets, which were described by one midwife as, “a place of total privacy and where you let yourself go” have their uses in every stage of labour:

“They are great for sitting on in first stage, either way around. I sometimes put rolled up towels on the seat to make it more comfy and suggest to women that they sit on it backwards and rest their arms and head on a pillow on the cistern. I think it helps the baby descend and gets the woman’s anatomy into a good alignment.”

“I often get women to push on the toilet. Somehow, it helps because that is a place where people are used to straining and ‘letting go.’”

“You can put a woman on the toilet to push and birth the placenta, especially if you are aiming for a physiological third stage in a hospital and time is working against you.”

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Midwives have ways of making women feel safer on the toilet; one of the tricks I learned a long time ago was to lift the seat, put a towel over the toilet and then replace the seat. When the women sits on it, her weight holds the towel in place and she can be reassured that her baby won’t fall into the pan. (The fact that most of us can attest to the fact that the majority of those babies who have to be fished out of the toilet by their midwife suffer no ill consequences does not always seem to help women relax!) Another less messy option for the third stage is to use something that doesn’t need washing afterwards:

“One brilliant trick which I learned recently from an independent midwife and I used at my friend’s birth was to use a bin liner to line the toilet. My friend then sat on the toilet for the third stage and, lo and behold, the placenta and membranes popped out seemingly effortlessly and very tidily!! I was charmed!”

The one ‘toilet trick’ that really impressed me was the following story from a midwife who developed this technique while working on a labour ward which had fairly strict protocols for putting women in the lithotomy position and giving intravenous syntocinon if they were deemed to be progressing slowly:

“When time is of the essence and the vertex is visible but just not advancing, I would always suggest to the woman that before the synto is sited and her legs are put in lithotomy (to ‘aid descent’ of course) it would be a good idea to go to the loo to empty her bladder. Once the woman is off the bed you link arms with her and run the gauntlet of colleagues who stare, frown and ‘tut’ to see a woman who is about to give birth in anything but the horizontal. At this point, to have a truly astonishing result, you have to leave the woman on her own with the door pushed to for her to fully relax. At the first shout, come flying in, arms extended, ready to cradle the baby’s head, and with the next push, lift it up to its mother’s arms. Be prepared to have everyone talk about you for a few weeks!”

Since I first published a version of this article, I’ve heard from a number of other people who have successfully tried a variation of this!

It is also important to think about the potential pitfalls, and the downsides of using the toilet which were mentioned include that:

“Of course, there is usually not much room to manoeuvre in your average bathroom, although I remember as a student midwife I caught a baby in a bathroom which, as well as the women, was also filled with her other three children, her partner, my midwife mentor and the local GP who loved home births and could never bear to miss out! I have to say it is not always the easiest place to move in, especially with that kind of crowd!”

“In a home birth, if there is only one loo, then you do have to hope that you don’t need a wee yourself! I have been known, when desperate, to nip out into the garden!”

Is there no end to what we midwives will do to facilitate women giving birth where, when and how they choose?!

Huge thanks to the midwives who shared their experiences with me, including Helen Eatherton, Mary Stewart, Sarah Stewart and a few who wanted to remain anonymous!