The best way to a better birth
Why do celebrities flock to see the independent midwife Zita West for their antenatal care? Maybe, she tells Harriet Griffey, it's because she provides the kind of care the NHS no longer offers
15 December 2003
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Zita West, campaigner and the midwife to Sophie Wessex and countless celebrities, is recalling her introduction to childbirth. "I trained as a midwife in 1976, but it was going out to the Middle East to work that really gave me the midwifery experience. I did a lot of deliveries in the car park - women came in fully dilated - labour was often very quick. What I really benefited from was that working there, I saw the patterns of behaviour that women went through in normal labour.
"I had my first baby in the same hospital, as I hadn't wanted to travel back to the UK at 30 weeks, like most ex-pats, and leave my husband. My waters went in the afternoon, I got on the bed two or three hours later, and delivered in the same room as 40 other women shortly afterwards. Afterwards I was with the two women I had delivered the day before, who were next to me in the ward. My husband wasn't allowed in, because it was a Muslim country, but a midwife friend was with me throughout and I felt very supported, and could let go and just get on with the business of having my baby. It was a very good experience."
To many who have laboured, attached to drips and fetal heart monitors, anxious and fearful, this seems like Nirvana - except for the audience of 40, perhaps. But essentially it was this sort of woman-centred care that was advocated 10 years ago in the Government's Changing Childbirth Report. Now, with Caesarean rates and all their complications - a recent report suggested that women who'd had C-Sections were statistically more likely to have a stillbirth next time round - rising to around 1 in 4 births in some areas, the report seems to have made little difference in 10 years, which exasperates West no end.
"The changing way in which midwives are trained now, with less hands-on experience, means that the ability just to be with someone, seeing them through their labour with confidence, is a skill that isn't perhaps valued as much as being able to set up an epidural. Understanding the patterns of behaviour in labour, how fear can slow down a labour, and not getting caught up in the time restraints modern obstetric practice tends to impose, is also important - and those are skills learnt through lots of hands-on experience. I know, and for a lot of midwives like myself, that on a one-to-one basis I can get any woman through normal labour. The epidural rate is crazy. But there's a huge midwife shortage, and who'd be a midwife? The money they receive is appalling and shows no respect for their skills. So their morale is low."
Partly for reasons like this, West set up her own clinic, in order to provide women with the service she feels they deserve. She is known, not only for this, but increasingly for those she cares for at the Zita West Clinic in Harley Street - Sophie Wessex, Kate Winslet, Cate Blanchett, Gaby Roslin and Davina McCall (who had successful home deliveries for both her children) - to name a few. She is, as one might expect, infuriatingly discreet. When I make mention of Cate Blanchett's second pregnancy, recently revealed in the press, she asks with alarm how I know - fearful perhaps she has let something slip. She hasn't of course. She even removed the photographs of Kate and Cate from view while the photographer was there, but the women themselves are keen to sing her praises.
"Zita is often called a fertility and pregnancy guru," says Kate Winslet - now pregnant with her second child by the director Sam Mendes - in her recommendation of West. "And I'm definitely one of her followers. The guidance and support she has given me through both my pregnancies has helped me to stay healthy and positive and to relax and enjoy the whole experience - at least most of the time!"
Tentatively I ask West, who visited her while in hospital, how the Countess of Wessex is. She is polite but brief. "Sophie is fine. She had a bad time, but the care she received was fantastic; it was the NHS at its best. I've known her for eight or nine years now, and I'm delighted that she and her baby are both doing well. But my friendship with Sophie is very private."
West's new book, just out, is on fertility and conception, an area of enormous concern to many couples. Given that most women spend most of their early sexual lives believing they will get pregnant at the flick of a knicker's elastic, why the hysteria later? Is there really a problem?
"Well, a lot of women do leave it until later, and fertility does decline with age. And the hard thing for couples today is often not being able to have what they want, unlike just about everything else, when they want it. They find it hard to accept that it can take up to a year to get pregnant - and that's normal. Then, particularly with older couples, there's the panic about IVF and they can get fast-tracked into it when it's not essential."
She is also emphatic that male fertility, often sidelined, can be the problem. "Male infertility is an increasing problem, and most fertility clinics are run by gynaecologists and obstetricians, not urologists. There is a decline in the general sperm count, in addition to which a standard sperm test only looks at numbers and general mobility, which isn't really good enough. We use a test that looks more closely, at things like DNA fragmentation, which gives a better insight. A lot of recurrent miscarriages are to do with the man rather than the woman. His dodgy DNA might get him through conception and implantation, but it's not good enough for the pregnancy to continue. But the great thing about sperm is that it is produced over a 72-day cycle, so you can really make a huge difference to its quality - through lifestyle changes, nutrition and supplementation - and that can make pregnancy viable."
West is nothing if not straightforward, and critical of those fertility clinics which fail to ask detailed enough questions on some of the basic requirements for pregnancy. Like sex? She rolls her eyes. "One of the commonest problem with couples is not enough sex, and even if they think they are having sex that is regular and OK for them, it might not be enough to get pregnant. Swinging from the chandelier every Thursday night is absolutely fine, but if you've ovulated the previous Wednesday morning, you are not going to get pregnant that month. And a lot of women I see have been on the pill for years, and have no idea what their normal cycle is, what their pattern of fertility is, the different secretions that herald ovulation - they have no idea, so education is essential.
"There's no point peeing on what I call the 'evil pee sticks' obsessively if you don't know what your cycle is. Many think their cycle is 28 days, and you ovulate on day 14. Well, not that many of us have a uniform 28-day cycle, and if yours is long - say, 32 days - you're going to be ovulating on day 18, not day 14. Conversely, if you have a shorter, 25-day cycle, you'll be ovulating around day 11."
Simple stuff, you'd think, but it's this sort of straightforward advice, backed up by a clinical team of nutritionists and other specialists, that makes her the fertility guru that she is. She's also hugely sympathetic to those couples who work 12-hour days, eat foods that may not be conducive to enhancing fertility, drink a little too much to relax, smoke. All sorts of things make a difference, she says, from the lubricating gel that will block 70 per cent of sperm to the use of cannabis or cocaine. Only at weekends? Recreationally? Sorry, that will have to go. In addition, she counsels balance: know the facts, make the changes that matter, then relax - the occasional glass of wine won't stop you having a baby.
On one area she is very clear. While nutritional adjustments and weight management can make a big difference in conception, faddy diets for both men and women are out. The Atkins diet gets some serious stick here for couples trying to conceive. "The worst weight-loss diet for someone, male or female, who's trying for a baby is the Atkins diet. It's high protein, which disturbs the body's electrolyte balance. Its high fat content upsets the hormone balance. It causes ketosis, which is toxic. And although this is anecdotal, some of the men I've seen on the Atkins diet have terrible sperm counts, I think because of the acidosis. For conception the body needs to be alkaline, the vaginal secretions need to be alkaline. So I wouldn't encourage anyone to do the Atkins diet, and certainly not those trying for a baby."
Alternative therapies, where appropriate, are also part of West's arsenal. She is an experienced acupuncturist and uses it with clients to help balance hormonal cycles, and create better possibilities for ovulation and conception.
Research has shown that acupuncture has good results with regulating cycles. It helps with endorphin release, and the research that's been done on the pituitary axis, boosting FSH (follicle stimulating hormone) has shown very good results. Hypnotherapy can be useful for some - fear of labour, guilt about past terminations, lack of confidence about becoming a mother, fear of not being able to provide enough materially for a baby - you name it. "What we do here is to tailor-make and focus on what an individual couple needs, that gets back to basics, and provides an holistic approach within the western medical model."
So if the alternative is being fast-tracked down the expensive, and often unrewarding assisted fertility route, then her approach smacks of the sort of common sense that could make the difference between getting pregnant, and not.
'Fertility and Conception: The complete guide to getting pregnant' by Zita West is published by Dorling Kindersley (£14.99). See website at
www.zitawest.com
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