When you are planning a Vaginal Birth After Caesarean (VBAC), 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.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 Trauma
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
People say nothing can prepare you for parenthood, but that's not true anymore.
Welcoming your new or next baby, or even the one who will complete your family, is a time of transformation.
Knowing how to work as a team with the changes and challenges that are common to most mamas, papas and partners can deepen your connection and strengthen the foundation you are building for your whole family.
Becoming Us prepares, guides and supports you through the first few years of parenthood so you can grow a family that thrives.Read More
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/
Birth Trauma is Real. As I sat the other day, scrolling through my Facebook Newsfeed, I came across this post from Yoni Love - Dana Laggett (pictured above). I was instantly glued. I clicked on Continue Reading, but then someone in the room was demanding my attention... but I didn't want to stop reading. Dana so succinctly put into words what so many women feel.
Her metaphor of birth trauma as like a tumor on her chest resonated with me.
Mama suddenly yelled “DON’T” or “NO” – I can’t remember which – and my heart started thumping quickly as I watched that disembodied glove continue its manipulation.
Suddenly all of the times that I had said no, and had it fall on deaf ears -all of the times that I had said “No” or “Don’t” rose from my chest to my throat and I choked on the words. My heart turned over with sickening thump.
Tears dripped onto the blanket that I clutched tightly around me as I waited for some sort of justice; surely it would be brought up in the recollection of this woman’s birth. This “birth assistant” would be spoken to, embarrassed; it would be acknowledged that both woman and infant had been violated – this would be part of the film.
But it wasn’t. And Mama felt good about her birth. There she was, a few weeks later, cheeks rosy and smile wide and honest. Her baby was bundled in her arms, perhaps breastfeeding, or simply being rocked and comforted. She told her birth story, but that word – “NO” – was left out somehow.
Her post about birth trauma is one of the reasons that I became a doula. I am pleased to say that personally I have never witnessed this happening at any birth that I have attended as a doula. It would be nice to think that I could keep my head in a bubble, and pretend that it wasn't happening in Western Australia but I know differently.
I know because sadly these events are still happening today (I hear new stories all the time - as women I talk to make a point of telling me), and yet we still don't feel like we can speak up about them in public.
I know because it happened to me. I will never forget my own birth screaming 'No' and being told
'That's right let it all out'.
Well I am speaking up! It is time that as women we reclaimed our rights. The right to birth where we feel safe! The right to be supported by safe (and qualified) caregivers! The right to have our sacred space protected (not invaded)! The right to be listened to (and heard)... The right to say No!
In the words of Dana:
'We need to stop closing our mouths and ears against these words and take back our births, for the sake of the memory of our bodies and those of our children and of their children and theirs.'
Please do take the time to read Dana's story, and if Birth Trauma is something that is affecting you - you can always call:
From the Heart WA's Helpline - 1300 726 306 (6:00am – 4:00pm WA time, Mon-Fri) or
Lifeline - 131 114 (24 hours a day, 7 days a week),
"HELD" Supporting Families after their birth experiences http://www.birthtraumaaustralia.com/
or you can read more on Sheila Kitzinger's website or the Solace For Mothers website.
Prevention And Treatment Of Traumatic Childbirth: http://pattch.org/resource-guide/traumatic-births-and-ptsd-definition-and-statistics/
If you are planning a child or pregnant, please consider having a doula present at your birth, please contact me.