Now nobody planning a homebirth really wants to consider that they may need a hospital bag. I see it as having a dual purpose. Of course should you need to go to hospital for whatever reason, its there and its ready (think Girl Scout).. but also if your partner or your doula or midwife needs to get you something - having everything in one place makes it so much easier to find.Read More
News + Notes
News & Notes from Kelly Evans (The Modern Doula) on pregnancy and giving birth in Perth, Western Australia.
Filtering by Category: Birth Planning
When you are planning a Vaginal Birth After Caesarean, it’s easy to want to do absolutely everything you can - this time around. I see women posting often in online forums asking for opinions on whether it’s really worth it to hire a Doula and/or an independent midwife.
I'm not here to speak for other doulas.. but the first thing I usually do is sit down and review the first birth that ended in a Caesarean Birth the first time. To do this you need to obtain a copy of your birth records from your care provider/hospital. Often but not always, despite thinking they were making optimum choices, parents who were in fact making the best choices on the information they had available, the truth is that those choices were incongruent with an easy natural birth.
They may have done a course or two, or chosen a care provider that they trusted and expected that in itself would provide protection from the birth they didn’t want. You don’t know what you don’t know. They may have been given insufficient time, insufficient movement in labour or insufficient choice. Sometimes a Caesarean Birth was very necessary.
So here are five reasons why you need a doula for your VBAC:
1. There’s often a lot of fear. Fear can be buried deep after your first birth so you don’t have to think about it. It can be a survival mechanism after birth with a newborn to care for. The problem is if you don’t deal with it in pregnancy it can affect your next labour and birth.
2. There comes a point in a VBAC pregnancy when the doubt creeps in. Can I really do this? Should I try? Can I cope with disappointment if this ends up in surgery again? You need the support of someone who works with women having Vaginal Births After Caesarean to help you through the doubt. You can do this!
3. Without support, when you have a care provider appointment after 36 weeks and they want to book you in for a repeat Caesarean already “just in case”.
When you are told the risks of a trial of labour, and how risky this is for your baby.
When this.. When that.. When care providers can and do make statements such as 'We strongly suggest you book a repeat Caesarean Section, because the longer we leave you the risk of blah blah increases'.
you NEED someone to help you sort through the facts and the real risks.
4. Using techniques such as those found in Spinning Babies while in labour can make a huge difference. Get a birth doula who can help you with this in labour. This is more important than how big the baby measures or which way they are facing.
5. You need to have a plan at the start... to make sure that Vaginal Birth After Caesarean is for your family.. and once you have made the decision you need someone with you every step of the way.
If you would like to have a Free Chat about your upcoming VBAC in Perth, Western Australia contact me now. Don't wait until later in pregnancy when the pressure is greater and your resolve may have been weakened. Get support now!
Even when you think its too late to get doula support it really isn't.
Just like you - I have been there. I remember vividly being told that my baby needed to be born early. Which absolutely did not fit with the notion in my head that I was still 3 weeks away from 40 weeks (as you can guess mentally I wasn't ready).
I also remember feeling so confused and scared when they said it was an emergency induction and my baby needed to be born now... but then the hospital got busy and I was told I would have to wait until tomorrow. Like what the actual? I needed someone to explain why, but the staff were all quite busy. In fact I waited an hour for someone to enter my room to tell me what was going on, to reassure to me, to tell me where I could get a drink of water.. but noone.
The Confidence Game in birth is alive and well. I'm writing this blog post in response to an email from a client. Up until now this client has received total support and confidence from their caregiver regarding their ability to give birth naturally. It has always been a valid option for them.
Today when they went to a regular, scheduled hospital appointment, they faced a different person to last time. A person who through their 'counselling' instilled the first seed of doubt in their choices. A person who made it clear that they held the medical degree (and hello how many medical professionals don't ;)
Given my client's (totally valid) choice to have a natural birth, which was based on an analysis of benefits, risks, alternatives, using intuition, she wondered should she now be scared?
What were the consequences?
The consequence of this change in caregiver support meant that she had the support of midwifery care removed. She was scheduled for extra weekly and fortnightly tests. Plus she has been told she now has time limits on her labour!!!
She wrote to me to ask if this was standard practice, or just a one-off supportive Dr?
My answer is this. Welcome to the Birth Confidence Game (also referred to as the Bait and Switch).
The Bait and Switch is when you are lured in to selecting a care provider who you believe is supportive of the style of birth you aspire to, but then when you get later in pregnancy, or are in labour - your choices are no longer respected. Previously unmentioned limits are applied, you are treated differently, you are told things that make you doubt your body's ability to birth your baby safely, the seeds of doubt are sown with leading questions.
The reasons for care givers being unsupportive of you having a natural birth may be many. Sure there may be risks (but having done your research you already know about that). They may be inexperienced and scared of supporting you through something they know nothing to very little about. They may have been privvy to a bad experience in the past and still be scared by trauma. They may even have just heard bad stories from colleagues. The possible reasons are endless and irrelevant.
No expecting parent wants to put their unborn child at risk at any cost.
So here's what you need to remember when facing the Confidence Game:
1. It's still your choice - your body, your baby, your choice - ALWAYS
Your choices are still the same as they were before - you just need to find a more supportive caregiver.
2. Everyone has their own filters.
Filters influence how they view the world. Filters say that Home Birth isn't safe, or that women with GD shouldn't birth in the tub. These are not evidence-based but learned from experiences (and I have experienced both of these so they are all possible)
3. Ask for the evidence or the policy. If a care provider is waving statistics at you, or stating that this is policy - ask for the research/policy and ask to take a copy home with you. If they can't provide you with evidence/policy refuse to budge until they do.
4. Get Independent Support. Hire a doula (you can Contact Me here), an independent midwife, or whomever will support your right to birth the way you really want (and not just take what's on offer)
Have you been affected by the Confidence Game In Birth? If so comment below and let me know.
With your first birth you may have had a 'what will be, will be' attitude (or not). This time around you find yourself like Alice in The Magicians. Alice is a magician who knows that she has the power to beat the beast. She is the only one with the power to attempt it.
She and her lover use probability magic to determine their best chance to beat the beast, and the answer is to visit Fillory. Fillory is a magical land filled with talking animals and other magical beasts. It is a land of abundance.Read More
The Three Words That Mark The Transition Into Motherhood (That No Expectant First Time Mumma Ever Wants To Say)
I can't do that' was the reply from one lovely Mumma. 'Why not?' I asked with curiosity. 'It's not what we do in our culture is it?' she said. She was so right and I was so grateful for her pointing out the obvious.
It left me on the one hand saddened, knowing that as culture we expect women to DO IT ALL. In the movies they pop on a dress, heels and cook a three course meal two days after baby is born to entertain all the guests, in a sparkling clean, spotless kitchen.Read More
If you live in the local area you will know that if you're baby is on it's way - Rockingham Hospital is the closest hospital to go to. What Are Your Odds Of Having A WaterBirth In Rockingham Hospital?
If you are a local you will have heard the rumours (yep they are true) that there is only one birth pool there (to be shared amongst the 5 labour and delivery rooms).
So to begin with you have a 20% chance of getting a waterbirth (unless they are too busy and women are labouring in other rooms - in which case your odds just dropped further). One pool... 10 women in labour (10% chance of accessing the birth pool).
Who Is Supporting You When It's Time To Push?
If you are labouring in the birth pool (because you were lucky enough to get in there), you will have a beautiful midwife with you the whole time.
However, when the time comes to push if you are in that pool in Rockingham Hospital you must:
- Hold that baby in (hah like we really have a choice)
- Climb out (have you ever tried to move with your legs spread and a watermelon inserted in your vagina)
- and push that baby out safely on land.
Those of us who are in the industry know that this is the point where women who are strong and knowledgeable and supported refuse to leave the birth pool (unless they choose to).
Who Is Supporting The Midwife?
It's far to easy to blame the midwife but we know that the hospital policy does not support her.
I have heard of midwives turning a blind eye to these women who refuse to leave the birth pool when pushing.
I have also been witness to a birth where the midwife told the woman that she would lose her job if the pushing woman didn't get out to have her baby (which may be true who knows?)..
Sadly the Hospital Policy does not support midwives to allow waterbirth.
Is This A Battle You Really Want To Fight In Labour?
My point is this is not the battlefield... when you are ready to push your baby out is no time to be having a debate about the pro's and con's of waterbirth (as opposed to immersion during labour).
Research shows that having this kind of discussion at that point in labour is counterproductive and can result in a drop in hormone levels needed to birth (due to an increase in fear hormones) and increased length of pushing stage (it's simple fight or flight stuff).
What Is The Solution?
The solution is a change in policy to allow women to BIRTH their babies in the water at Rockingham Hospital (and any other state hospital where there is a birthing pool). You can help!!!!
Please take the time to sign our petition to the Minister to get change underway now and increase the odds of having a waterbirth at Rockingham Hospital!
So, if you don't want to sit there wondering if you could have done things differently, if you want to learn what ALL your options are, and how to take charge of your birth, let's talk.
Contact me to set up a complimentary Better Birth Chat for those women who are ready to get the birth they really want.
Gestational Diabetes (also known as Gestational Diabetes Mellitus) is a type of diabetes that some women get when they are pregnant. According to Diabetes Australia "between 3% to 8% of pregnant women will develop gestational diabetes around the 24th to 28th week of pregnancy, however, some may be earlier". SCREENING FOR GESTATIONAL DIABETES
The recommended screening test for GDM is performed at 26-28 weeks' gestation (according to RANZCOG Management Guidelines) SHOULD I TAKE THE TEST?
Clients often ask me whether they think they should do the test... and the answer is that is entirely up to you. However, you may want to consider it if you meet one of the risk factors that have been identified. These include:
- Previous GDM
- Previously elevated blood glucose level
- Ethnicity: south and southeast Asian, Aboriginal, Pacific Islander, Maori, Middle Eastern, non-Caucasian African
- Age ≥40 years
- Family history of diabetes mellitus (first degree relative with diabetes mellitus or a sister with GDM)
- Obesity, especially BMI >35 kg/m2
- Previous macrosomia (baby with birth weight >4 500 g or >90th percentile)
- Polycystic ovarian syndrome
- Medications: corticosteroids, antipsychotics
WHAT HAPPENS IF I HAVE GD AND I DON'T TAKE THE TEST?
According to the RANZCOG Guidelines:
Although there is no evidence that perinatal mortality is increased in pregnancies with treated GDM, some studies have shown perinatal mortality to be increased in untreated GDM.
GDM is associated with increased perinatal morbidity, the characteristics of which are the same as for infants of mothers with overt diabetes (eg, macrosomia, neonatal hypoglycaemia, hyperbilirubinaemia, respiratory distress syndrome).
Reference: Hod M, Merlob P, Friedman S, et al. Gestational diabetes mellitus: a survey of perinatal complications in the 1980s. Diabetes 1991; 40 (Suppl 2): 74-78.
WHY ARE THERE MORE WOMEN GETTING GD LATELY?
One problem that I hear a lot about lately, is mentioned here in August 2013 Australian Family Physician website: http://www.familypracticenews.com/single-view/ultrasound-diagnosis-of-fetal-macrosomia-found-inaccurate/36fa34152d.html
- that is there are currently two sets of diagnostic criteria in use for diagnosing GD. The revised guidelines will increase the number of pregnant women diagnosed with GD by a staggering 50%! This translates to the prevalence of GDM being likely to increase to around 12–14% with the new diagnostic criteria.
PREVENTING A GD DIAGNOSIS
If you are looking to prevent a GD diagnosis you might want to check out Gloria Lemay's article 'Helping your client avoid a Gestational Diabetes diagnosis': http://wisewomanwayofbirth.com/helping-your-client-avoid-a-gestational-diabetes-diagnosis/
WHAT ARE THE RECOMMENDATIONS FOR DELIVERY WHEN YOU HAVE GD?
Whilst the RANZCOG Guidelines for Timing of Delivery state:
- Delivery before full term is not indicated unless there is evidence of macrosomia, polyhydramnios, poor metabolic control or other obstetric indications (eg, pre-eclampsia or intrauterine growth retardation).
My experience has been that the few women that I have met who have been diagnosed with GD and been treated for it, were then subject to increased pressure to undergo induction and/or where told things that led them to believe that their bodies were not capable of birthing their babies (due to them being too large) and that a caesarian birth would be necessary.
If you are interested to know how an ultrasound diagnosis of big baby can be wrong - the following article may be of interest: http://www.familypracticenews.com/single-view/ultrasound-diagnosis-of-fetal-macrosomia-found-inaccurate/36fa34152d.html
For more about 'big babies' more here on Evidence Based Birth: http://evidencebasedbirth.com/does-gestational-diabetes-always-mean-a-big-baby-and-induction/
With the increased number of women being diagnosed with GD you can see the flow on effect - that an increasing number of women are being subject to a cascade of interventions, and increasingly ending up with caesarian section births.
Don't get me wrong some times c-section birth is very necessary and life saving - but for the Mum for subsequently finds out that she was bamboozled into an elective c-s that was unnecessary the impact on her mental health can be devastating. With psychiatric illness is the leading cause of maternal death in Australia - the inference is clear - we need to do everything we can to ensure that women in labour are making truly informed choices based on accurate information.
So for those women who are wanting to know whether to take the test - in the end the choice is up to you. You need to be aware of both the risks and the consequences of a positive diagnosis. You also need to be prepared that you may have a fight on your hands to achieve a natural hospital birth without fear.
For more information on GD screening, our local Community Midwifery Program has a fact sheet titled: Screening for Gestational Diabetes (http://www.cmwa.net.au/_literature_88952/CMP_Info_Sheet_-_Screening_for_Gestational_Diabetes) that provides a succinct summary of information that may help you decide. In the end it your body, your baby and your choice.
IF YOU ALREADY HAVE GESTATIONAL DIABETES
If you have already been diagnosed with GD the following articles may help:
- Gestational Diabetes FAQ: http://www.plus-size-pregnancy.org/gd/gd_index.html
and finally you need to read this: Birth without fear: The truth about gestational diabetes and why it's not your fault http://birthwithoutfearblog.com/2013/06/24/the-truth-about-gestational-diabetes-and-why-its-not-your-fault/