The problem with recommendations…

Photo by Martin Brosy on Unsplash…when it comes to choosing a care provider for your pregnancy and birth.

I see it all the time. Pregnant women in Facebook groups with question after question: ‘does anyone recommend an OB/GYN or hospital in X area’.

I cringe and don’t know where to start answering them. Most of the time I just read the other comments.

Because there are so many variables when asking for a recommendation of this kind.

Emotional questions like: What’s your philosophy on birth? What sort of birth do you envision? How do you want to feel during your birth?

And then more practical ones regarding whether this is your first pregnancy, whether you have any pre-existing health concerns, what hospital catchment you’re in for public hospitals.

But the emotional questions are where I want to sit for a minute.

Choosing a doctor based on the rave reviews of a few people, or one, whether they’re other members of your family, friends, or complete strangers, is generally not the best way to go about choosing your provider. They may have had a totally satisfying experience with them, but are you after the same type of birth experience? Did they have a very natural, low intervention birth and you’re wanting an epidural from the first contraction, or vice versa?

A better way to go about choosing a provider, particularly a private Obstetrician or Midwife, is to really nut out what it is that you want to achieve from your birth, beyond ‘healthy baby and intact mother’. Do you want to feel supported, understood, listened to, heard, treated with respect and dignity? Most people, regardless of their philosophy on birth in general, would say yes here.

So, first you need to do some thinking about yourself. As well as feeling supported and respected, what else do you want to feel? How would you envision your ideal birth going in terms of medical interventions, or lack of? Allow for practical considerations like whether you have an underlying health condition, you’re trying for a VBAC, or anything else that may affect your pregnancy and labour, your own or baby’s health.

Now start researching providers. Google them, read their websites, check which hospitals they’re affiliated with. Then find statistics about their intervention rates and compare that to what your preferences are.

In Victoria, an annual report called the Victorian Perinatal Services Performance Indicators is released. This provides extensive information about hospitals’ performances in key areas, like their caesarean section rates, additional care rates for babies without congenital abnormalities, breastfeeding rates, and rates of VBACs planned vs achieved. This information will help you form a picture of the hospital you’re considering attending for you birth.

The next step is to set up meetings with your preferred providers. Hopefully you’ll have at least 2 that are on your ‘wish list’. At this meeting, act like your interviewing them for the job of being your care provider. Don’t choose which one to ‘employ’ until you’ve met with all your shortlisted providers.

Once you’ve done the self-reflection, the research and the interviews, now finally it’s time to go with your gut. It’s very important that you and your care provider have a similar philosophy on birth, whether that’s a medical view or a natural one. If you’re philosophies don’t match, eventually you’ll run into conflict in some way. You also need to feel as comfortable with them as possible.

If you’re past this point and have already been with a provider for several months, know that it is never too late to change if you’re not happy. If you’re reading this and re-thinking your choice, know that I have heard of families changing providers at 37, 39, even 41 weeks because they didn’t feel their current provider was the right fit.

My above suggestions may seem like a lot of work, and they’re just one part of the process of preparing for and becoming fully informed about birth and postpartum. BUT I promise it will be worth it when you take this one step towards planning for a satisfying and empowering birth, no matter how your birth actually unfolds.

If you’d like to know the other steps I’ve come up with to help you plan for a satisfying and empowering birth and postpartum period, please get in contact.

 

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Top 6 non-birth videos to watch before baby arrives

Photo by freestocks.org on Unsplash

If you’re wanting a satisfying and empowering birth, but for whatever reason, you can’t get to an independent childbirth education class and you can’t hire and birth and postpartum doula, there are still plenty you can do to prepare for childbirth.

The internet is a treasure-trove of great information with regards to childbirth and parenting – you just need to know where to look. To that end, I’ve compiled my top six FAVOURITE videos to recommend during pregnancy, to help you gain understanding, confidence, and real expectations. This isn’t a ranking, and I’ve included the video length to help you out, but most are pretty short.  Also, NONE of these are actual birth videos.

 

1 The Performance (7 mins 30)

This is an Italian video, with Italian actors, Italian birth statistics and English subtitles. But it’s SO perfect for demonstrating how our current hospital system sabotages women in labour and prevents our perfect orchestration of hormones from doing their best work. Oxytocin is the love hormone – it’s front and centre during sex and also labour. If you wouldn’t be able to have sex in a certain environment, you won’t be able to labour smoothly. Keep that in mind when planning the spaces you’ll labour in, whether that be at home before you go to hospital, as well as once you get there. It’s also a good example of why you should stay at home for as long as you feel comfortable during early labour.

 

2 The balloon and ping pong ball demo (3 mins 30 seconds)

This one went viral a few years ago, and is a great visual for what happens to your cervix during effacement and dilation. This helps you to understand that labour is more than just the 1-10cm of your cervix. Most women assume internal vaginal exams (VE’s) are just a part of having a baby that they need to submit to. In reality, a hospital or provider that has a policy of doing VE’s every 4 (or any) hours during labour are not practicing evidence-based care. As well as being invasive and uncomfortable, these procedures increase the risk of infection for you and your baby, and don’t actually provide much useful information on the progress of your labour. Your body is doing more than just dilating in labour, and your cervix can be at 9cm and you labour for another four hours, or you can be at 4cm and have your baby in your arms 45 minutes later. An experienced midwife will be able to tell what your cervix is up to just by watching you and your behaviours.

 

3 The Essence of coping in labour (the first 4 mins 30 seconds)

The video is one of American Childbirth Education/Birth Doula legend Penny Simkin. She’s an author and researcher and has done so much to advance the low intervention childbirth movement over the last 50 years. This is one to watch with your labour support partner/s, as it’s as much for their information as yours. Penny describes the 3 R’s of coping in labour. It’ll be a reassurance for both you and your partner/s that if you’re displaying these three R’s, you’re coping with labour and should be left as undisturbed as possible.

 

4 90 Second to change the world – TEDx talk (18 minutes 40)

This is the full 18 minutes of allowable time for a TED talk, but I promise it’s worth it. It goes through the simplest and most cost-effective procedure we have available to us today that could improve infant health; optimal (aka delayed) cord clamping.

Now a little explainer. In the 1910’s, as mentioned in the video, immediate cord clamping became a thing. It spread around the world and has been the default procedure at birth in a majority of hospitals in a majority of countries ever since. But why? Because it was thought to prevent or reduce the severity of jaundice. I have heard current, Melbourne based obstetricians advise their clients that they don’t practice Optimal Cord Clamping (OCC) for this very reason, and studies do show that there is a slight increase in jaundice rates in babies receiving OCC. BUT, in our modern medical world, and in full term and otherwise healthy babies, jaundice is a minor, easily treated inconvenience which lasts for a few days or so. The benefits of OCC last the individual a lifetime. When enough babies are born and OCC is practices, the benefits to society are almost unquantifiable.

 

5 Why it’s so hard to take a shower with a newborn (5 minutes 45)

This one is a bit of fun but will also help you build realistic expectations of the first few weeks with a newborn in the house. You will struggle to get time to take a shower. You will be very tired – potentially exhausted. Even if you have an angel of a baby, it just comes with the territory. It might give you a hint as to why hiring a Postpartum Doula can be so beneficial for your own care as well as your baby’s.

 

6 The period of P.U.R.P.L.E crying (9 minutes)

Some babies just cry. A lot. This video explains that this can be a normal part of infant development. Frustrating and stressful, but normal. To accompany this video, I strongly recommend you get familiar with the concept called The Fourth Trimester. These  articles are very helpful in explaining this season of life, and helping you establish realistic expectations. The top one in particular is a must-read.

9 Strategies for an empowered 4th trimester – MUST READ

Juggling advice from health professionals with your own parenting instincts 

Let’s stick together: How to survive life with your velcro baby

The “fourth trimester” is real and here’s what it means for mums and babies

Why infants stop crying when you stand up, according to science

Why newborns hate being put down

 

Do you have any videos you tell all your pregnant friends about? I’d love to hear what you’d add to the list.

Photo by freestocks.org on Unsplash

Rachel Angelone is the founder of Your Birth Your Baby and is a Lamaze Certified Childbirth Educator and Postpartum Doula based in Melbourne. Rachel offers independent childbirth and early parenting education to pregnant families before baby arrives. Once your baby is Earth-side, she offers practical and emotional in-home support as you adjust to your new life as parents. She is also a loving wife and mother to two young girls.

Have you got your BRAIN?

Do you know that you should always use your BRAIN when making medical decisions? This includes all the decisions you make regarding medical procedures and interventions during pregnancy, labour and birth. The BRAIN questions will help you get all the information you need to make informed decisions, whether that be consent or refusal. So, what does BRAIN stand for?

Benefits – How will this benefit

  • my baby
  • me
  • my labour?

Risks – How will this affect

  • my baby
  • me
  • my labour?

Alternatives – What are the alternatives available to us?
Intuition – *internal question* What is your gut saying?

No/Nothing/Not yet/Need time – What would happen if we did nothing? What would happen if we waited a week/day/hour? I need a moment to speak with my partner/think about this decision.

brain acronym informed decision making melbourne childbirth education your birth your baby

Completing independent childbirth education is SO important. It will provide your with up-to-date, evidence-based information about all the options you’ll be presented with during pregnancy, labour and birth BEFORE you come across them, and will empower you to make the decisions that are best for you, your baby and your family.

Know your options. Be independently educated.

City slickers vs country bumkins in the birth games

I’ve lived in two capital cities, several large country cities and a capital city satellite town in my 30 years on this earth. I have friends with a variety of backgrounds, some only from the city, some only from the country, some who have lived in both.

 

I find there’s a massive difference in attitudes towards birth depending on a person’s background. Of course this is a no-brainer; our background and life experiences shape almost everything about us. But it’s still an interesting topic to explore.

 

As I’ve mentioned before, I’ve lived and worked on a commercial horse stud. I’ve seen mammalian birth first hand many times, and noticed that animals can’t doubt their ability to give birth. There’s no fear, no anticipation. The process just starts and usually goes off without a hitch.

 

People who have grown up in or had a lot of exposure to the country, and in particular animal farming communities, usually have a more innate understanding of the process of birth. They may not know the science behind it, but they know if they go and watch a cow in labour and make her feel observed, she’s probably not going to calve very well. It has everything to do with hormones and the need for animals to feel safe in order for their birth to progress.

 

We like to think that humans are different from other mammals, but the truth is, when it comes to modern medical birth, we’re a bit dumb. We are the only mammalian species who routinely travels away from our ‘nest’ to give birth. In the West we typically travel to busy hospitals, where there are strange noises, strange people, and we’re the only ones there that are not sick or injured. It’s the opposite of what our hormones want us to do. For proper hormone choreography, mammals need to have privacy, feel unobserved and safe. If any of those needs aren’t met, our brain releases too much adrenaline, which inhibits the release of oxytocin. Oxytocin, in increasing amounts, is needed for labour to start and progress.

 

People who have always lived in the city, and don’t have close relatives or friends with a more country background, have a harder time connecting with these ideas. They’re so removed from a world where birth happens every day. Their own pregnancy may be the most exposure they’ve ever had to growing a human, their own baby may be the only one they’ve ever had more than 10 minutes contact with.

 

Regardless of whether you’ve grown up in the country or the city, you should invest in independent childbirth education, a birth doula and a postpartum doula. These three professionals (or one super-human) will assist you in making empowered, informed decisions, and in feeling calm and confident through your last weeks of pregnancy, your labour, and your first weeks of parenthood.

 

Contact me today to chat about how I can support you through this massive life event.

What do you actually NEED to buy for your new baby?

You might have heard this once or twice if you are or have been pregnant; “Oh, you HAVE to get one of THESE! It’s a life saver!!!”

Maybe it is the best thing since sliced bread, but maybe it’s one of those things that’s really good for one family, and gets used once and forgotten in another.

So, if you’re wondering what you really need to buy before baby comes, lets break it down with some psychology.

Namely, Maslow’s Hierarchy of needs.

maslow-hierachy-of-needs-min

As you can see, there are five human ‘needs’. The one above cannot be achieved if something from below is missing.

When it comes to newborn babies, we can dismiss the top two – esteem and self-actualisation – that comes late in life. Babies are only fussed with the first three needs.

If the ‘thing’ you’re considering buying doesn’t fall into one of these three categories, you probably don’t need it.

You might be thinking “ok Rach, but I came here for a list!” So here it is, accompanied by what need it satisfies.

Product Need satisfied
Clothing Physiological
Blankets Physiological
Safe sleep space (cot, co sleeper, bassinet etc) Physiological and Safety
Approved car seat Safety
Nappies* Physiological
Breastmilk (your own or donated) or formula Physiological, Love and Belonging
Safe transport device – baby carrier, baby wrap, a pram etc. Safety
Happy, healthy parents** Safety, Love and belonging

*unless you’re considering Elimination Communication.

Short list ey? But that’s it, those are the ‘having a baby’ essentials. Because mostly, babies only really need YOU and other invested caregivers to be with them, hold them when they cry, feed them and keep them warm. You could buy a lot more, and through your journey you will find there are more things you do need, but for starters, that’s it.

You’ll notice that I’ve added ‘Happy healthy parents’ as a ‘need’. Babies need parents to look after themselves as well and as much as they can during this early newborn period, and long-term into the future. You will need to plan for the support you’ll need, as much as you plan for your labour day/baby’s birth day. There are a number of ways you can do this.

Set up a roster for family and friends to take part in to help with meal and snack preparation, laundry, kitchen cleaning, grocery shopping and entertaining older children if there are any. There are some online calendars like Meal Train and Gather My Crew that help with this.

Set-up online shopping in the last few weeks of pregnancy. Delivery fees are worth the time,  hassle and stress you’ll save.

Have a ‘fill my freezer’ party with friends and family in the last few weeks of pregnancy. Also make doubles of freezable meals when you’re making them (pasta sauce, soup etc) and add the second batch to your freezer. Your future self will thank you.

Hire a Postpartum Doula. These people (usually women) are essentially Fairy Godmothers who support you in-home both practically and emotionally after the arrival of you baby. They cook and prep meals and snacks, they tidy and clean the high traffic areas of your home, they keep the laundry up to date. They can also hold baby while you sleep or shower, assist with breastfeeding and general newborn questions. They know the spectrum of normal when it comes to newborn behaviour, and can be a reassuring, non-judgmental ear in many situations.

So, save the money you would have spent on unnecessary baby items, and put it towards YOUR postpartum needs. You won’t regret it.

Tell me one thing you wish you didn’t buy in preparation for the arrival of your baby, I’d love to know.

How to afford both a Birth doula and a Postpartum doula

Ok, so you’ve read the amazing statistics of improved labour and birth outcomes when using birth douas. And you’ve heard from multiple sources that having a postpartum doula in the weeks and months after birth can help you feel confident and capable while you adjust to parenthood, instead of overwhelmed and exhausted. But, how do you afford to hire them?

Well, one day governments and policy makers will recognise the value of these services and they’ll be covered by private health insurance companies and Medicare (another post for another day). But for now, let’s look at it this way.

The average cost of an Australian wedding last year (2018) was a smidge over $50,000. Eye-watering, I know. And yes, that’s the average. So there are plenty that cost WAY less. But it also means there are plenty that cost WAY more. But I wanted to show this in perspective of birth. Even if your wedding was only $10,000, that’s still a lot of money for ‘just one day’. One day that you’ll remember for the rest of your life. The birth of your child/ren is also ‘just one day’, but research shows that birth days have a much, MUCH greater impact on our emotional well-being of the parents than a wedding day. Having a doula at your birth and to help you during the early postpartum period is an investment in your own well-being and mental health.

So, now you’ve done your own research (and not just taken my word for it) and decided you’ll hire a doula or two – either one doula who offers both services or two separate doulas offering individual services.

Now what?

Of course this depends on where you’re at in your pregnancy journey. If you’re yet to conceive, you’re laughing. You can start putting a few dollars a week away until it’s needed, and by the time you’re needing to pay deposits, you’re likely to have more than enough money stashed away. But what if you’re further in to your pregnancy journey?

First, check out my other blog post on What you actually NEED to buy for baby, and then get into buying second hand stuff. This could save you hundreds if not thousands of dollars and save the planet from over-consumerism. Facebook Buy Swap Sell groups, Gumtree, eBay and many others are abound with people selling near new baby clothes, highchairs, cots, baby wearing devices and pretty much anything else you can think of. Look up the item you want from a retail baby shop, write down the price and then search for the same on a suitable site. Whatever you end up buying, if it’s less than the retail option would have been, put the difference into a ‘doula savings’ account.
Your next option is to reconsider the Pregnancy Level private health insurance (PHI) you may have bought into so you can ‘go private’ in your pregnancy and birth journey. Unless you have a specific pre-existing health condition which will complicate your pregnancy, research has shown time and time again that Midwifery led models of care produce better outcomes for both mother and baby. If you’re in the public system and develop a complication during pregnancy while in the care of midwives, you will be transferred to the care of an obstetrician if needed, still within the public system. Not paying for the extra PHI premiums for 12 months AS WELL AS the out-of-pocket costs of your private obstetrician will save you thousands. If you go through the public system and saved that money into your ‘doula savings’ account, you’ve got enough to cover the services of both a birth and postpartum doula, AND splurge on a few items to buy new instead of second hand!

But what about if you were never considering a private obstetrician care and were already buying most baby things second hand? This is where your friends and family come in. When someone asks ‘what do you need for the baby?’ you say ‘well, actually I need money to pay for my birth and postpartum doulas so I can have the best birth experience possible and feel the most capable in the first few weeks’. Hopefully they get the hint and give you a few dollars that you’ll then put straight into the ‘le ‘doula savings’ account. Planning a baby shower? Have a wishing well for Doula funds instead of asking for new clothes, nappies and blankets. Save whatever you can from your weekly pay, whether it’s $5 or $20, and over the course of your pregnancy you’ll save a surprising amount. Put all the gold coins you collect as change into a piggy bank to break open when it comes time for your doula fees to be paid, again you’ll be surprised how much is in there.

If you are experiencing genuine financial hardship, approach a doula anyway and be honest about your circumstances. They may offer alternate payment plans. Some doulas have a fund account where they ask wealthier clients to donate a little extra money which pools so they can help more disadvantaged clients. The worst thing they can do is say ‘no’.

And finally, if you meet specific circumstances and you’re living in Melbourne, there is also Birth for Humankind. They provide volunteer doula services and education to pregnant women experiencing social and economic disadvantage. Contact them to see if you qualify for their services.

However it is that you save the money for doula services, it will be worth the effort and investment. Tell me how you’ll be saving to hire your doula/s?

Oh, Megan. So. Much. Fodder.

Congratulations to Megan and Harry on the arrival of their baby boy. What a lot of hoo-haa the pregnancy and birth have provided the media and society as a whole.

I thought I’d take the opportunity (like many, many others have) to write a blog about her experience, and what it means for birth in the eyes of western society.

The overarching theme of this post is that every pregnant couple should follow in Megan and Harry’s footsteps.

Headline 1: Megan reportedly hires a birth doula, attends Hypnobirthing classes, and plans a home birth.

Yes, Yes, YES!! Go Megan, getting educated about birth, the process, the pros and cons of certain interventions and pain meds, and just in general INFORMING herself so she can make INFORMED DECISIONS. Love it. You go girl!

EVERY pregnant family, whether they’re having their first or their 6th child, needs to prepare mentally for the labour and birth. It is your RESPONSIBILITY to understand the process of physiological birth, the pros and cons of pain meds and interventions, know the difference of when your care provider would like you to agree to a certain intervention verse when they are truly medically necessary. You should also learn non-drug coping strategies, and some ways to mitigate the cons of medically necessary interventions or requested pain relief. Seek out independent childbirth classes, just like Megan and Harry, whether it be Hypnobirthing, Calmbirth, Lamaze or others. Please don’t just do the hospital based classes and think you’ve ticked that box. The hospital classes provide information which is biased towards their own policies and standard practice. For example they’re not going to tell you about the massive benefits of delayed cord clamping if that’s not their standard practice. Independent educators have no agenda other than wanting you to have the most empowering, satisfying birth you can have.

Headline 2: Megan is a birth brat.

BE A BIRTH BRAT. I can not say that loudly enough. This is your birth and your baby’s birth day. You only get to do it once. You get to take the lead on how you’d like it to go. No, you can’t control everything, but if you’re well informed, have a medical team you trust, and are involved in decisions as they need to be made, then you’re more likely to feel empowered and satisfied with how it goes down. Some things to consider are:

‘No’ is a complete sentence, and you don’t need to give an explanation.

Ask questions about every decision you need to make. Let the BRAIN acronym guide you.

  • What are the Benefits to me, my baby and my labour?
  • What are the Risks to me, my baby and my labour?
  • What are the Alternatives to this course of action?
  • Where is my Intuition leaning?
  • What happens if we say No/Not now?

You do not need to ‘please’ your care providers at any point of your pregnancy or labour.

You can say ‘no’ to something you previously consented to. You can change your mind at any time. Withdrawing consent or giving consent as the situation evolves.

With private cover, consider that your care providers work for you. They need to take your lead, not the other way around. If you’re not seeing eye to eye, fire them, and get new providers.

With public care, it can be much more the luck of the draw of who you see in your prenatal appointments and have available during your labour. Being well informed, making sure your partner knows your preferences in different situations, and hiring a birth doula will help you have a team to support you know matter who is on call that day/night.

Headline 3: General outrage that the new royal baby may be ‘kept’ from the waiting media.

Umm, no. No-one (except the biological parents) have a rite to access a new baby, or a child of any age, without the parents’ consent. That includes the entire world, or just friends, distant relatives, and immediate family. If you don’t want visitors for the first 6 weeks, say so. If you want everyone to come to the hospital and then no-one to come once you get home, say so. If you want an organised roster of people coming and going all day to bring food, do laundry and hold baby while you sleep, set that up (or hire a postpartum doula *wink*). But NO ONE, no matter how close to you they are, should ‘expect’ to see the baby within a certain period of time. This is another time to be open about maybe changing your mind when you’re in the zone. You may plan on no visitors and then change your mind cause you need someone to talk to during the loooooooonnnnngggggg days of looking after a newborn. You may plan on all the visitors and then change your mind when you realise it’s winter and it seems everyone has the sniffles.  Just do what you think is best at any one time, but remember that you’re in charge.

Headline 4: Megan is whisked away to a private hospital, dashing her plans for a homebirth.

Literally 2 hours after I read of the arrival of the royal baby, I see headlines that her ‘hopes were dashed’.

First off, was it ever actually CONFIRMED by the palace that she was planning a home birth??? Or was this just a rumour everyone ran with? If it was confirmed, I missed that.

Second, if she was transferred, then she and the rest of the world can be confident there was a genuine medical reason. Some small percentage of planned home births in Australia get transferred to hospital. The families who find themselves in this situation can be confident that if the midwife they have built a relationship with during pregnancy suggests that they should go to hospital, it’s because there is a genuine medical need. You can bet that if this is the case for Megan and Harry, they were fully informed and INVOLVED in the decision, due to all the work they did to educate themselves and prepare during the pregnancy. It’s not something they’re going to walk away from and wonder ‘was that really necessary?’ A lot of families who plan to have their baby in the hospital system can’t say the same thing, particularly if they didn’t do the prep work of getting educated, informed, and setting up a support network.

Megan and Harry have done more to highlight that birth is a normal, natural process than any other couple in recent memory. A lot of people now know what a doula is thanks to them. Maybe more women are researching home birth because of them. Hopefully more people attend independent childbirth education because of them.

So be like Megan and Harry. Do the work, analyse the information and make an informed decision rather than just going with whatever option is presented to you, and plan for the best birth you can experience.

Megan markle

The world of risk

Risk (noun): 1 (mass noun). A situation involving exposure to danger.

  • (singular noun) The possibility that something unpleasant or unwelcome will happen.

Risk is an inherit part of life. There is risk in every thing that we do, but everyone has a different ‘tolerance’ level for it. Some people are willing to accept a certain risk, while others are not.

When it comes to risk in pregnancy and childbirth, most people become risk averse. Suddenly, there’s not just the risk to yourself, but also to your baby. You get told not to eat or drink certain things, that you must do this or must not do that, all because they can increase the risk of a negative consequence.

The threat of ‘risk’ can be used to control you and the decisions you make. Being told by a family member that planning a home birth is ‘risky’. Being told by your doctor that there’s a risk to your baby if you don’t get induced before your estimated due date. Don’t get me wrong, for some women with certain predisposing factors a home birth would be risky. And for others, there are sound medical indicators which mean they should be induced before her estimated due date. But for a majority of pregnancies, the risks of certain things happening or not happening are small. The actual numbers can help you decide for yourself which risks you’re willing to accept and which you aren’t. You may be willing to accept a risk of 3 in 10,000 but not 3 in 100.

Try not to let risk scare you. Keep pushing, keep asking questions, get actual numbers and then go away and do your own research (if time permits). You might find that this variety of information paints a picture of risk that you are willing to accept, especially if it means not compromising on other things like how your labour gets started, the comfort measures you want to use, and what policies and procedures you feel comfortable agreeing to. It also means that if you decide that you are not willing to accept a certain risk, you’ll be confident that you’re making a fully informed decision, not a fear-based one.

 

Rachel Angelone is the founder of Your Birth Your Baby and is a Lamaze Certified Childbirth Educator and Postpartum Doula based in Melbourne. Rachel offers independent childbirth and early parenting education to pregnant families before baby arrives. Once your baby is Earth-side, she offers practical and emotional in-home support as you adjust to your new life as parents. She is also a loving wife and mother to two young girls.

Graphics from The UK’s National Health Service’s (NHS) Atlas of Risk

risks leading to death in perspective-minLeading cause of death in perspective-min

What’s best for society is not necessarily what’s best for an individual

I hope that heading got your attention.

It’s a thought I heard a few weeks ago and can’t get out of my head. Read it again.

What’s best to society is not necessarily what’s best for an individual.

This concept is so important in the birth and postpartum space.

According to the World Health Organisation, as a society it’s in our best interests to reduce the caesarean surgery rates down to 10-15%, which would be most effectively done by reducing rates of other interventions like non-medical induction of labours, epidurals and continuous fetal monitoring. This will lower morbidity and mortality for both birthing parents and babies, as well as drastically reducing medical expenditure.

It’s also in society’s best interests to increase the breastfeeding rates. There are so many well researched and documented health benefits to both the breastfeeding parent and the child in receiving breastmilk until at least the first year of life, which will again reduce health spending. There would also be a modest environmental saving in the number of plastic bottles used, manufacturing of formula etc.

BUT

Those things may not be in an individual’s best interests.

The best thing for a labouring person who’s 40 hours into labour and reaching exhaustion may be an epidural. Breastmilk is best for (almost) all babies, but it might not be best for all mothers, mostly when factoring mental health.

So, what I’m getting around to, is that the onus is on you, from the minute you find out you’re pregnant, to do your own research. Don’t let any one source of information be your only source. Do the hospital-based birth childbirth education course, but do an independent one too (ie Calmbirth, Lamaze, Hynobirthing). Then do some internet research about specific topics; delayed cord clamping regardless of how baby is born, immediate and uninterrupted skin to skin regardless of how baby is born, vitamin k or no vitamin k and so many other topics.

Just because something is standard hospital policy and practice, does not mean it’s the gold standard of practice. Just because you read something in a blog or article, doesn’t mean it’s the best thing for you and your family. Just because your best friend swears by X Y Z, doesn’t mean it’s going to suit you and your unique situation.

At every decision, ask the BRAIN acronym questions in relation to 3 factors: you, your baby and your labour.  Benefits, Risks, Alternatives, Intuition and No/Not yet.

brain acronym informed decision making melbourne childbirth education your birth your baby

That way you know you’re making the best decision for you and your family. And for you to know that you’ve drawn from a solid pool of information, and to feel confident and comfortable in those decisions, that IS in society’s best interests, as well as your own.

Photo by Jens Johnsson on Unsplash

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Rachel Angelone is the founder of Your Birth Your Baby and is a Lamaze Certified Childbirth Educator, Postpartum Doula and NurtureLife Pregnancy Massage Practitioner based in Melbourne. Rachel offers independent childbirth and early parenting education to pregnant families before baby arrives. Once your baby is Earth-side, she offers practical and emotional in-home support as you adjust to your new life as parents. Along both journeys she can provide relaxing and restorative massage treatments. She is also a loving wife and mother to two young girls.

Male and child holding newborn Melbourne postpartum doula

Birth story 2 2017

If you’re still with me into this fourth blog post, cudos to you! This post is about my second birth.

There are a few things I would change about my first birth, but they’re mostly small and only really as a result of the information I now know. On the whole I felt empowered, respected and that the main elements went very smoothly. I had the low intervention, drug free vaginal birth I had always imagined.

The one thing I did want to change was the type of care I received. With my first pregnancy and birth, there was zero continuity of care from my midwives (although the care was always very good). I’d seen a different one at every appointment and on the day saw all new midwives again – I must have met at least 70% of the midwives working at the hospital for them not to have crossed over at all!

During one of the first hospital appointments with my first pregnancy, I’d been told about the Caseload Midwifery Practice that operated alongside the hospital. I had qualified to apply to them (low risk pregnancy, living within 30 minutes of the hospital) but at the time hadn’t been interested. After my disjointed care experience, one of my first questions at my first hospital appointment for my second pregnancy was, ‘how do I apply for the caseload group?’. I filled in the form then and there, asked a few more questions, and waited to hear whether I’d been accepted.

I few weeks later I got a call from Lisa, who would be my caseload midwife. I was so happy to have been accepted! I was going to be able to form a relationship with the person who would help me through labour! All of my appointments from 18 weeks to labour day were with Lisa. The added bonus was not having to go to the hospital for appointments, pay for parking, wait in a massive waiting room with heaps of other pregnant woman while trying to keep my toddler calm and contained. I met her at a small community centre not far from the hospital, we went through all the usual blood pressure checks and tummy measuring, but I was able to speak to her at length about the pros and cons of this and that. I initially decided I didn’t want to do the GBS swab test. Assuming I would be positive again, and knowing labour often goes faster the second time, I assumed I’d have the same problem of not getting the full antibiotic dose as had happened the first time. That would mean more time in the hospital than I wanted. This second time, I wanted to spend as little time there as possible, which was another thing attracting me to the midwifery group practice model of care. Because the midwife is your primary care provider, not the hospital, you have the option of home birth (I didn’t like the idea of cleaning up post-birth enough to go this way) or being discharged from hospital 4-6 hours post birth, assuming there’s no medical indication that you should stay. With a toddler at home this time and knowing that hospital is not the most relaxing place to be with a newborn, I wanted to get home as soon as possible. If I was knowingly GBS positive, that might not happen.

In the end I did end up doing the swab. I heard a story of a friend of a friend who’s baby died from a GBS infection, and me still not being the widely read, fully informed person I am today, that scared me into changing my mind. It was negative, so no need to worry anyway.

Because I’d gotten myself so convinced the first time that I wouldn’t make it to 40 weeks, this time I decided to plan like I would get to 42 weeks. I was starting to understand much more about the haphazard way we date pregnancies, and that every pregnancy and baby is an individual and need their own individual time to grow and be ready for life on the outside. Whenever anyone asked when I was due, I gave a vague ‘she’ll be here by mid-month’ rather than the exact date, and that also helped with my own mental preparation. But these kids, they’re put on this earth to mess with our plans. I was so convinced I’d go over my due date, that of course she decided to come a few days early instead. Turns out that because I had been due in the first few days of the August, I didn’t even have the right month in mind. I woke up to pee (AGAIN!!) around 1130pm one evening, and noticed that the panty liner I’d been wearing was soaked. I went to the toilet and weeing felt a little strange, and I wondered if my water had broken. I tried to go back to sleep, but my mind was racing. Instead I sat on the couch in dark silence for an hour or so, concentrating on my body. Was that a contraction, or was it nothing? I knew that if my waters had broken but labour didn’t start, I was at risk of having to be induced, and I still wanted to avoid that like the plague. I called Lisa to tell her I was pretty sure my water had broken. We had discussed during my appointments that my labour was likely to be quite fast, as it had gone from concentrating but comfortable to pushing within two hours during my first labour. Knowing I didn’t want to have bubs at home (or worse, on the side of the road on the way to the hospital) she suggested I go in and get checked over to confirm where I was at. I woke my husband and called my mother-in-law to come and stay with Miss 2yo. At this stage it was 1am. By the time MIL arrived and we drove to hospital it was 2am, and I could definitely feel some small contractions, but they were very slight. The hospital midwives did a test to confirm whether my waters had broken, and told me I was just 1cm dilated. This was actually a bit disappointing considering the first time I’d been through labour, I’d got to 2.5cm before it even began. We sat around in the observation room and I bounced on the birth ball, talked to my husband, and basically got bored. Part of me knew this was how it was last time until it ramped up at the end, and part of me was bored and wanted to go home.

The hospital midwife came in and assessed my contraction at around 530am and suggested we go home. I wasn’t contracting regularly (sometimes they were 7 mins apart, sometimes 5) and I wasn’t in the least bit of discomfort. I was told to come back at 6pm even if labour had started properly, to be induced as my waters would have been broken for 18 hours by then. Again, I wasn’t confident enough to push back on hospital policy. So off we went, back home.

My MIL was watching DVD (what is it with me and labour movies?) so we sat down and watched the rest with her. I was still timing my contractions, which still weren’t completely regular, but where getting stronger. Eventually I had to sit forward in the chair and rock, or stand up and rock through contractions, though still able to hold a conversation. My daughter woke up at 730am, and I decided I was uncomfortable enough and far enough along that we should go back to hospital. I rang Lisa to say as much as 747am. She said she’d wait until the hospital rang her with an assessment of me before coming in. I almost asked her to head in anyway, but didn’t back myself (lesson learned).

We got back in the car and I was pushing the trusty TENS machine button pretty forcefully with each contraction as we drove in, parked, and walked back to the maternity unit. When we got to the nurse’ station we were told there weren’t any observation rooms available and that I would need to wait in the waiting room. We walked in a there were a few other women already there. I was starting to go very ‘within’ so my husband made the following observations about the other women in the room. One was chatting away, happy as Larry to the person she had with her (I presume her mum) the other two were alone, uncomfortable but not enough to need to actively work with pain. Then there was me. In the space of the 15 mins we were there (though it felt a lot longer!), I went from sitting still and breathing through contractions with the TENS machine button firmly pressed, to forceful rocking and breathing to telling my husband to go get me a room cause I wanted to push. Admittedly I wasn’t quite there yet, but I could tell it was coming and I knew saying that would make a room appear quickly. The midwifes suddenly appeared and ushered me into an observation room. I was given an internal and told I was 7cm. Again, I was slightly disappointed, but didn’t have much time to think about it as the next contraction showed up. It was a double – it didn’t completely go away before the next one started. I’d gotten on the bed on my back for the internal and again, I hadn’t moved and it wasn’t suggested. The room was incredibly hot (in my opinion) I and told my husband I wanted help to take my jumper off after the next contraction. I never got the chance. The next contraction came and suddenly I really did want to push. My husband yelled for the midwives to come back – I think they had been ringing Louise to update her and trying to find me a birth suite to go to. In the small observation room equipment was hurriedly bought in, it was obvious bubs was going to be born in there. A resus station appeared from the hall, a lidded plastic box with birth supplies was bought in and suddenly a small room had a lot of people and equipment. Seven minutes later, my second child was born at 847am, exactly one hour after I rung Lisa to say we were heading back to the hospital. Needless to say, she didn’t make it to be there with me. The maternity unit midwife did say I’d made her weekend by giving birth in the obs room, apparently on average it happens once a week.

In the rush from waiting room to obs room to bubs being born, the midwife obviously didn’t get a chance to read our paperwork (again). In between contractions I tried to squeak out about delayed cord cutting, but it was lost in the moment and her cord did get cut quite quickly. Interestingly I also had an undiagnosed velamentous cord insertion. If this had been found during my ultrasounds, my pregnancy and labour would have been treated as high risk.

The midwife offered to take us up to a birth suite but I didn’t see the point. Lisa arrived and came into the room and we had a laugh that she hadn’t made it in time. Bubs had her first feed and then I had the second greatest shower of my life. This time I had no need for stitches, and after my shower felt pretty much normal. Such a short labour meant my muscles felt weak but not overly strained, and I hadn’t expended much energy. I had only had a few hours sleep that night, but other than that felt great (the oxytocin high probably helped!). The uterine contractions where a lot more noticeable this time than after number 1, and they continued to be a little eye watering and require some concentration as I breastfed in the first few days. I was discharged four hours after bubs was born, and we went home with our new baby as a family of four.

 

Rachel Angelone is the founder of Your Birth Your Baby and is a Lamaze Certified Childbirth Educator and Postpartum Doula based in Melbourne. Rachel offers independent childbirth and early parenting education to pregnant families before baby arrives. Once your baby is Earth-side, she offers practical and emotional in-home support as you adjust to your new life as parents. She is also a loving wife and mother to two young girls.