Tag Archives: birth

Unnecaesarean

I must confess that I “borrowed” this clever title from a blog written by a group of mothers who are birth activists and one Obestetrician Gynaecologist in the USA. The Unnecesarean is full of birth stories and information on how to avoid unnecessary caesareans (Americans leave the ‘a’ out of caesarean). But don’t worry, just like that site doesn’t, I’m not about to start ranting about why people should never have caesareans.

I’ll even mention a couple of really good reasons why people SHOULD have caesareans; for example, when there is fetal distress (that’s when the baby’s heart rate drops), or there is a maternal complications (such as, unstable blood pressure or an epileptic fit etc.), or labour has been going for too long with no progress, or when there has been significant complications from perineal trauma from a previous birth (such as incontinence or fistula). Like I said, I’m not against caesareans.

BUT… And it’s a big but, there are many many risks that I don’t think people really take seriously enough. Just some of the risks for the mother include excessive blood loss, infection either in the uterus (in severe cases can cause infertility problems) or in the scar itself and in future pregnancies the placenta is more likely to imbed over the cervix (called placenta praevia). Not to mention the longer hospital stay and recovery time. There are also some serious risks to the baby, including respiratory distress, low apgar scores and the need for additional resuscitation methods (especially when mums need a general anaesthetic), sometimes forceps are needed to deliver the head and the doctor can sometimes accidentally “nick” the baby with the scalpel. Not to mention that in some hospitals there will be a prolonged time prior to initiation of breastfeeding and “skin to skin” time is difficult and awkward in theatre.

So, knowing that I didn’t write to give you all a lecture, the reason I did decide to write on this topic is to share my excitement about a document that the NSW Department of Health released in June last year, entitled “Towards Normal Birth“. This document arose out of concern regarding The Mother’s and Babies Report, 2006, that stated that the caesarean rate in NSW hospitals had risen by a staggering 10% from 1998 to 2006. The increase is such a concern because there is more and more evidence of increasing maternal mortality and morbidity associated with caesarean birth. Normal vaginal birth is much safer (and significantly cheaper) for mothers and babies.

I just wanted to highlight some of my favourite points in the “Towards Normal Birth” document. Under the heading “Purpose of the Action Plan” there were 7 points. Two of which particularly stood out to me:

  • reduce the use of interventions that women experience in labour, particularly augmentation of labour, analgesia and electronic fetal monitoring
  • reduce unnecessary interventions

Yay! Hopefully this means we will be working towards NOT doing continuous CTG’s(strap on baby monitor that means you can’t move further than the 1 meter cord or use shower or bath for pain relief) on such a huge number of women. The second point makes me a bit sad… shouldn’t we already be doing this? There should never be unnecessary intervention!

The document also highlights an implementation process with 10 steps to providing woman centred labour and birth care. Here are  a few of the Area Health Service requirements for adoption and implementation of the 10 steps, that I am particularly excited about:

Within Step 3

  • plan and implement strategies to enable women the option of a program of care so that the woman has known midwives providing her individualised care. Collaborative midwifery/medical programs of care, with obstetric/GP obstetric and midwifery support and leadership should be available in labour wards appropriate for the role level of the maternity service.
  • ensure midwives have opportunities to work in continuity of carer programs and provide access to professional development and skill development where needed (Excellent! More caseload programs, with more training courses to make us feel confident in our skills, ie. suturing, cannulation)

Within Step 4

  • provide women desiring a vaginal breech birth access to clinicians that will support this choice. (Yay! See my post about vaginal breech)

Within Step 5

  • develop written policy on pain relief in labour that includes: providing a leaflet for women talking positively about the use of water for pain relief and citing the evidence; encouraging women to move around and adopt positions of choice; the use of water immersion in labour and birth. (Yay! Finally there will be a written policy encouraging midwives to encourage women into water… no more being “not comfortable” with waterbirth!)

Within Step 8

  • provide access to vaginal breech and vaginal twin birth services (Yay! No longer will a woman have to fight to get the chance to birth naturally)
  • provision of training packages and networked support for obstetricians, obstetric registrars and midwives
  • provide access to opportunities for observation and clinical training in these two areas (Yay! We won’t have to be unfamiliar and scared of these variations on normal because we will be trained and supported)

All of Step 9 (massive WOO to the whole lot!)

  • change maternity unit physical environments to facilitate electronic point of care documentation – this can reduce the time that midwives spend away from women and permit accurate, timely information to be recorded
  • keep a woman’s medical record with her throughout her intrapartum care
  • implement local guidelines/protocols that discourage activities that separate midwives from the woman in labour. This includes the use of centralised monitoring systems as they discourage midwives from being with the woman in the labour room (the use of use of CTG /EFM should be in accordance with Safety Notice 004/07)

So as you can tell I’m pretty excited! Because there is a mandatory compliance requirement by 2015, I know that things are looking more positive and will definitely improve for normal birth within NSW hospitals! Good luck and let’s stay motivated!

 

 

 

 

 

My birthing experience: Part 2 (Warning: Graphic)

Leading up to the birth of my second baby, I felt more nervous and anxious than first time round. I had very mixed emotions about my first labour and birth. My hopes and dreams of a beautiful, normal, homebirth had been shattered. But, I had been fortunate enough to be transferred to a place where I felt comfortable and I was able to have a vaginal birth, albeit not completely normal (see my previous post for the full story).

I thought about it a lot, and I still could not imagine labouring and birthing anywhere but my home. It’s where I feel comfortable. It’s where my family dwell. Everything I love is there. I can be myself. So with much trepidation and nervousness I booked in once again to the St George Hospital homebirth program.

I was very blessed that my good friend and midwifery mentor and legend was able to be my caseload midwife. The same midwife that had assisted me to bring Levi into the world. It was so special and important to me that she be my midwife again. We did and still do have such a strong connection, that had only been made stronger by my first birthing experience. She understood my devastation and grief for not having achieved my homebirth goal. We had worked through it together for the last one and a half years.

While I was pregnant I did a lot of extra brainwork to ensure I would be able to manage, cope and stay calm even if the same outcome happened. This included yoga, deep breathing and relaxation, reading through the ‘Calmbirth’ course notes and seeing a psychologist to work through the reasons things didn’t go to plan. I feel like I really missed out on vital information by not doing these things during my first pregnancy. First time round I had been ready physically by exercising and doing yoga, but I had not prepared my mind adequately for the challenges of unexpected outcomes. This time I made sure I was ready.

So… The whole pregnancy I had had a feeling I was having a girl, except for the very last week. The more overdue I was, the more convinced I became that the baby was a boy. Silly unproven theory I know, but I think the feeling was deeper than just guessing. I had not enjoyed being pregnant. Sciatica, tiredness and pubic symphysis dysfunction (pregnancy hormones cause loosening of ligaments, so pubic bones rub together, excruciating!). Not to mention the exhaustion of being pregnant while looking after a toddler. Hats off to anyone who’s done it. Although pregnancy wasn’t fun, I was bursting with excitement to meet my new baby. I was also even looking forward to seeing what this labour and birth would be like.

40+5 days and 40+5 degrees, or so it felt. It was Australia Day and it was stinking hot. I had been having mild period-like pain all day but didn’t think too much of it because I had felt like that a couple of times that week already. By lunchtime though, I was pretty sure I would be having a baby soon. Levi had an especially long sleep (I think he just knew I needed time to prepare myself and rest). At 4pm we went to a friends house for a swim to cool down. It was that hot that an almost labouring woman would venture out for some watery relief. When we got home at 6pm things really heated up. The waves came every 2-3 minutes, lasting about a minute, though I wasn’t really counting. I decided it was time to get the labour plan into action. So, I tried calling my mum to pick Levi up so she could put him to bed at her house and he wouldn’t have to be disturbed halfway through the night. She wouldn’t answer. I tried her mobile. I tried her home number. I tried dad’s mobile. NO ONE ANSWERED! I was getting a bit worried now. I called my brother (who still lives with my parents) and he told me they were at an Australia Day BBQ with friends. Great. I would have to ring their friend’s house and everyone would know I was in labour. The absolutely last thing I wanted. No one knowing = no expectations. But I got over it and finally got in contact with mum.

As mum was leaving with Levi she gave me a kiss and said that this might be an Australia Day baby after all. It was about 7:30pm. I laughed and said there was no way, as there were only a few hours left of Australia Day. I thought maybe by 6am or so I might meet this baby. As I was kissing my precious only child goodbye, I felt sad. It was more than just the normal “I’ll miss you” kind of sad. It was a loss of him being my only child, my precious gift, my special one. We would all have to make room in our lives and hearts for this new creation. So with an extra big hug and kiss, my mum and my world left.

I perked up quickly at the thought that I was in labour and feeling so fine. I was getting excited! I brought in the washing and tidied the bomb site that was our house, in between pacing up and down the corridor and deep breathing/blowing through contractions. I remember one particular contraction just after going to the bathroom, I was leaning on the sink and drawing figure eights with my hips. I smiled and spoke silently to my baby, “we’re doing well, we’ll do this together, can’t wait to meet you little one”.

2 hours before birth, still with a smile on my face

At 9pm I said to hubby that I just didn’t know when to call the midwife and my sister to come. I had no idea how I was progressing, this labour felt so different to last time. So he sat down next to me and timed my contractions. After about 45 minutes he announced that I was contracting for a minute every second minute (obviously not a midwife). So we decided to call in the troops. It was now 9:50pm. After he hung up the phone, I had a huge almighty contraction. I looked up at him and said “I don’t like this anymore”. The next wave came and I heard this loud deep earthy trembling roar. I realised only after the pain eased that the roar was coming from me! I was beginning to feel the need to push. OH MY GOODNESS! I can’t be at this stage already, it’s only been a few hours, my midwife’s not here, my sister’s not here and worst of all we haven’t even started filling the pool!

My sister arrived at 10pm- record time. She knew as soon as she walked in that it wouldn’t be long. She could hear that I was pushing through my breaths. She told me later, how she thought she and hubby were going to have to catch the baby by themselves. Meanwhile I was on my hands and knees on the floor and kept looking at the pool being filled agonisingly slowly. I kept yelling “The baby’s coming, hurry up, I can’t wait, is the pool ready yet?”. My midwife arrived at 10:10pm and later she told me she could feel the stress in the air, though everyone was very calm externally, they were happy and relieved to see her face. She called her backup midwife to come (there are always 2 midwives present for the birth in this program), but knew she wouldn’t make it because she had a minimum 40 minute drive to make.

Finally at 10:20pm the birth pool was full enough for me to get in. I had absolutely no strength in my legs and it took the help of both my sister and the midwife to awkwardly drag me into the pool (hubby was still busy filling the pool with buckets so it could be deeper as it was only just deeper than my hips). The water felt amazing. The buoyancy and coolness penetrating my skin and calming me further. I hadn’t imagined a cold bath. The water had been scorching hot with Levi’s birth, but this cool sensation felt just perfect for this birth.

My midwife whispered in my ear, “you don’t have to rush this, just take your time”. This was a great reminder and made me refocus and try and breathe the baby out rather than frantically pushing. This was different to last time as I had had to push with all my might because Levi had pooed and they were worried he might become distressed. So, on my hands and knees, trying to breathe through the contractions while every fibre of my being was screaming at me to push, resulted in my blowing some serious raspberries against the plastic wall of the pool. Why hadn’t anyone told me how helpful raspberry blowing could be? It was great!

I could feel myself opening up to allow this precious being to come further down. Again it felt different to last time. Now it was a stretching, opening, releasing, groaning of my body, rather than the unbearable pressure and pain from last time. My midwife said that the baby might be born in the caul (still in the bag of waters) but as she got ready with the amnihook (like a crochet needle to pop the bag) I felt my waters pop. Suddenly that stinging sensation was there again and before I could breathe I could feel a head and body slipping gently out of me and into the water. As my husband lifted the baby out of the water he said “it’s a boy”.

I was in disbelief. I started balling my eyes out. I quickly rolled over into a sitting position so I could meet my new little man. I couldn’t fathom the experience I had just been through. “I can’t believe it’s over, oh my goodness I’ve had a baby, he’s out, I’m finished, I can’t believe it”. He was stunningly perfect. His smooth skin still totally covered in vernix (waxy cream like coating to protect the skin during a baby’s development, not usually seen in overdue babies). Cradled in my husbands arms was beautiful creamy white, angel baby. A few minutes later I gave a gentle push and out came the placenta, almost no blood at all.

Adoring our gift

I had been impatient to hold this new creation, though felt too shaky and wanted to birth the placenta first. Once I had done this, I excitedly and with an abundance of tears, lovingly enfolded my beautiful baby boy into my arms. He was much bigger than I remember Levi being. He almost immediately started to suckle. We sat there together in the water, gazing into each others eyes, I soaked him in. That’s when the back up midwife arrived. She had missed the birth by about 10 minutes. It didn’t matter. I had been hugely blessed. I was restored. I once again had faith in my body’s ability to birth a baby safely and normally. I had even managed to have an Australia day baby when I thought it would be impossible to birth that quickly. The adventure of parenting two little boys had begun!

“Children are a heritage from the Lord, offspring a reward from him.”- Psalm 127: 3.