Birthing News
Labour Language
8/14/2008 12:00:00 AM
If only we could get the message across to everyone involved in birthing, about the ‘power of language’. If you think women are sensitive to what you say to them during pregnancy, then they are certainly ‘super-sensitive’ during labour and birth. A good rule is:- if in doubt about how or what to say during labour then keep your mouth shut! This should apply to all: from midwife, partner, doula, family, obstetrician, anaesthetist and anyone else involved. I recently supported a woman who was attending a private obstetrician and booked into a small private hospital. She had her first baby at this particular hospital and was not happy with their care. She states a midwife told her to ‘shut-up’ during labour because she was making too much noise! The midwife also insisted on monitoring the baby with the CTG, on a regular basis. This, of course, meant that she had to be in bed, which she found very uncomfortable. She also had a number of vaginal examinations which, for her, were very painful. She did not want any of this for her second birth.
Despite this experience, she booked the same private obstetrician and same private hospital for her second birth. The difference was to have an experienced doula/midwife for this birth, mainly to protect her from all the policies, protocols and politics of the hospital, but also to protect her from the staff!
Labour began around 3.00a.m. and she arrived in hospital at about 5.30a.m. I arrived about 6.00a.m. to find her having a CTG. Debbie had requested to get off the bed, as it was too uncomfortable and was sitting on a fit ball. She was still uncomfortable. Given that baby was fine and this was an unnecessary intervention that Debbie did not want, we were able to persuade the midwife to detach the CTG, so that she could get up and move around, which is what Debbie wanted to do. This very young looking midwife (graduated last year), suggested a vaginal examination as she did not think Debbie was in labour and perhaps she might like to go home. Now, on Debbie’s birth plan, there was a very clear request for NO vaginal examinations, unless medically necessary or at her request. It was also devastating to be told she was not in labour and should seriously think about going home. This was Debbie’s second labour, she felt she was in labour and definitely did not want to go home. Following this discussion, Debbie’s labour slowed considerably. The power of language!
She continued to labour slowly, throughout the day. We walked around the block a few times, she tried the bath, the shower, leaning over a bean bag. The hospital midwife again told Debbie that there was not much progress and she should consider going home. This was her assessment, following some brief appearances over the day to take her blood pressure and listen to baby’s heart rate. Not from a vaginal examination. Debbie’s labour slowed even further. Her contractions became erratic and she described them as being ‘very mild’ Debbie was upset because she felt she was in good labour when she arrived, early in the morning.
Debbie’s obstetrician, whom she liked and trusted, was away on holidays. Debbie did not like the relieving obstetrician and had already had a few altercations with him during both her pregnancies, when she had visits with him, due to her obstetrician being on holidays. In fact, he had booked her in for a Caesarean section due to a low lying placenta (noted on the 20 wk. ultrasound) – very common, and women should be reassured that most placenta’s move. When Debbie’s obstetrician returned from holidays, she cancelled the booked caesarean. Debbie had been very distressed about this.
Now mid afternoon and Debbie’s contractions were still mild and erratic. This relieving obstetrician sent a phone message via the midwife that he wanted Debbie to have a canula and intravenous antibiotics, in place, by the time he arrived, for Strep. B. He was revoking a specific order on her ante-natal card, from her own obstetrician, that read ‘no antibiotics in labour’. Debbie was very upset and wanted to discuss this with me and her partner. Debbie had discussed this at length with her own obstetrician. She had been Strep. B positive with her first pregnancy and negative with this pregnancy and they had both agreed that there was no need for antibiotics in labour. The midwife came back, after having spoken to the relieving obstetrician again, and her tone had changed. She announced that he was very, very, angry with Debbie, he demanded the antibiotics be commenced. Debbie was now in tears, and her labour stopped. It took a long time and a lot of reassurance and persuasion from her support team for labour to ‘get-going’ again. A message had been sent to the obstetrician, stating that Debbie and her partner did not want antibiotics.
At 8.00p.m. Debbie decided, after much discussion with her partner and myself, that she would have a vaginal examination. She was becoming very tired and still had the ‘obstetricians anger’ in her head. She was 6cms. Dilated with a bag of forewaters presenting. The midwife asked Debbie if she would like her to break the waters, explaining it might ‘speed up the labour’. Debbie decided this would be a good idea. Following this examination Debbie got off the bed and as she stood, leaning over the bed, began to have one very strong contraction after the other. One hour later she had her baby in her arms. This was a very intense hour for Debbie and for her baby, as she went from 6cms. To a baby in an hour! She also had a large perineal tear, due to the intensity of the contractions and a feeling of no control.
Debbie had a beautiful baby boy, weighing 2.9kgs. The obstetrician did not make it to the hospital and Debbie birthed and caught her own baby with the help of the midwife.
Debbie found the whole experience intense, frustrating and not what she had hoped for. She was wanting to labour in the water, with no interventions and birth calmly.
My Interpretations: If you have not been happy with your first birthing experience then you need to make some changes. Firstly change your caregiver. In this case, the 2 obstetricians, who were partners, clearly did not respect or trust each others expertise. Find a continuity model of care, which can only truly be found with a midwifery model of care. Secondly, change the place where you are going to birth. Use that knowledge gained from your first birth, understand what you don’t want and shop around until you find a place to give birth that will support you in what you want. Thirdly, everyone deserves a doula BUT it is very difficult for the doula to facilitate a positive and encouraging energy when faced with the wrath of an obstetrician, who wields so much power and control in a private facility, without even showing his face. No birthing woman should have to face the issues that Debbie did. Midwives who work in private facilities are merely following doctors orders. They most certainly do not practice midwifery.
I present this story in the hope that it highlights the necessity for some diligent ‘shopping around’ for caregivers and places of birth. Find support from those who understand normal birth and who respect birthing women.
Water Birth
6/23/2008 12:00:00 AM
I have just had the privilege of supporting Ruth and David at the birth of their second daughter. We met during Ruth’s first pregnancy for some pre-natal education. Ruth was always focused on a ‘normal’ birth, with no medical intervention. She was attending a Birth Centre and as I was working with a film maker, filming as many births as we were able to, I offered this to Ruth, who had a typical ‘first-time’ reaction – I definitely don’t want to be filmed whilst giving birth!! She phoned me during her second pregnancy to REQUEST being filmed. Her reaction was very different. “I want to show women how beautiful this is, how empowering and what a difference it makes having the support of a doula, who is also a Midwife.”
Ruth had a healthy, normal and happy pregnancy. She phoned me at about 5.30a.m. – really a very civilized time! Stating she was having some regular contractions that were becoming stronger, and lasting longer and could I come over to their place. On my way over David phoned. They were on their way in to the Birth Centre and fortunately we arrived at the same time. She was labouring beautifully, clearly having strong contractions, breathing deeply throughout and very relaxed inbetween. Ruth started out on a mat on the floor, over the bean bag whilst we filled the bath. She was feeling her contractions as intense but once in the big deep bath, immediately relaxed into her labour. It was quiet, apart from some very soft music in the background, David kneeling beside the bath and holding her hand, me taking up position at the end of the bath with cool facecloth to mop her hot brow.
The Birth Centre was very busy that morning. When the Midwife appeared, Ruth, very calmly, advised her that she had done her own vaginal examination, could feel her baby’s head coming down and that it would not be much longer. It is always such a privilege to be in the presence of a woman, so powerfully birthing in her own way. There was indeed no need for any medical intervention. Ruth was in charge and felt well supported to be able to do her own thing. Over the next hour Ruth gave regular updates about the progress of baby’s head descending down the birth canal. She began to roar like a lioness as she went with the power of her contractions and gave birth to her second daughter, in water, scooping her into her arms and up near her breast for that all important skin to skin contact. Her baby was wide-eyed, very alert and gazing directly at her Mum’s face. If I could be so bold as to predict what this little person was thinking it would be ‘ so that’s what you look like!- I know what you sound like, I know taste and smell but it is wonderful to finally be in your arms’.
Ruth’s main concern about being filmed was that she did not want to be conscious of having a camera ‘in her face’ – or other places! On the day, she was not even aware of Liz and her camera. She had chosen her place of birth, she had chosen her ‘support’, she had discussed what she did and did not want for her labour and birth, so she felt safe, respected and well supported to do whatever she needed to do, to birth her baby. What a wonderful welcome into the world for this little person.
Pregnant? You Deserve a Doula
6/23/2008 12:00:00 AM
Pregnant? You Deserve a Doula
A doula is a professional support for labour and birth. The doula profession is huge in the U.S.A. I attended an International Doula Conference, in St. Louis last year and was overwhelmed by the delegates – all 450 of them, from all over the world – but also the speakers and the research. So why do Australian women need a doula? Because the way women are cared for during pregnancy, labour and birth has changed over the last 3 decades. There is overwhelming research to show that for women to have a ‘normal’ birth and enjoy the birthing experience that is unique for them, one of the most important facts is they need ‘continuity of care’. Whilst many Public Hospitals do provide a number of different models of ‘continuity’ Midwifery care, this does not necessarily mean that the same Midwife will be on duty for your labour and birth. With some models of care, e.g. Team Midwifery, a woman will meet, throughout her pregnancy, a small team of Midwives. Some you will like, some you may not. Many women say ‘all the Midwives are great, but I do hope on the day I don’t get Midwife “c”, because I just don’t think we are on the same page’. Unfortunately, on the day, women don’t get a choice. Women think about this, worry about this prospect, throughout their pregnancy. This will affect your labour. The Midwife – no matter which model of care you choose - is not with you the WHOLE time.
So this leads to the question of Dad’s. What is their role exactly? What was their role, in the not so distant past? And What should it be?
There is an enormous pressure put on men these days. Most couples don’t even have a discussion around what role he would like to play. It seems to be ‘assumed’ he will be there, no matter what, he will attend pre-natal classes, he will read many books and he will embrace this pregnancy, labour and birth with the same enthusiasm as his partner. It’s not that long ago that men were ‘not allowed’ into the labour room. In the early 1970’s men were starting to infiltrate the labour rooms, at the request of women, mainly. They were unprepared, and their were many stories of men fainting, not lasting the distance and leaving before the birth. They also needed written permission from their wife’s Dr. to be present at the birth, presenting this piece of paper, on the big day, to the in-charge Midwife! Many of these Midwives did not want men in their labour rooms and felt very strongly that this was ‘women’s business’ and that men had no role to play. Over the ensuing decades it has come to be expected that men will be there and will play the role of ‘support’. I think that expectation is totally unrealistic. Of course men should be there, but only if that couple have an open discussion throughout pregnancy and explored their feelings about his role – and it does change throughout pregnancy. Dad’s should be able to enjoy the labour and birth of their baby and they also need to feel well supported.
What do Doula’s do that is different? - They provide physical, emotional and spiritual support during pregnancy, labour and birth. Women need to ‘shop around’ for a doula and employ the right person for them. This is someone who will get to know you on a different level than your caregiver. She will understand what you want during labour and birth and make sure that those wishes are respected, so that you don’t have to worry about which Midwife will be there on the day, and will you be able to explain what you want when you are in labour, will your partner be able to? If you feel safe and well supported then you will enjoy your labour and birth and welcoming your baby into the world. Dad’s also need to feel safe, to be reassured that what his partner is ‘doing’ and ‘being’ and ‘saying’ is normal. They need to be fed and watered and maybe have a ‘break/rest’, especially in a long labour. The Doula will support you at home and in hospital. Employing a Doula is the best investment you will ever make. A Doula provides space for a couple to enjoy their labour and birth, whatever role he wants to take on the day.
As a Midwife, of over 30 years experience, and a Doula I can offer a unique service. Birth Right is also a training school for doula’s – for those women who feel passionate about the importance of supporting women on this amazing journey. For the right person, this is a fantastic career move.
A breastfeeding story..
3/31/2008 12:00:00 AM
A breastfeeding story: pregnant for the second time, Emily is very anxious. She had a very long labour at a Birth Centre with her last baby, transferred to Delivery Suite, had an epidural and much deserved rest and felt very pleased to push her baby out, unassisted. Was not happy with the care on the post-natal ward. They were very busy and no-one sat with her and helped with a breastfeed. Baby was not passing good amounts of urine and it was suggested that he be given a top-up of formula. Emily did not want her baby to have formula, but agreed because she was told that he was dehydrated. She asked to see a Lactation consultant, and had a brief meeting with her, at the lift, as she was being discharged.
Emily says the Lactation consultant handed her some leaflets and information about ‘attachment’ as she was getting in the lift. Emily found breastfeeding very painful and 3 days later was concerned because her baby was very floppy, difficult to wake and not sucking for very long. She went to her G.P. who told her it was normal for newborns to be sleepy. 24hrs. later, Emily was very concerned and went back to the hospital of birth. Her baby was very dehydrated and was admitted to an Intensive Care Unit, and given intravenous therapy. Once re-hydrated Emily took her baby home and persevered with breastfeeding. The Early Childhood Health Centre continued to be concerned that there was not sufficient weight gain. It was still very painful to breastfeed, the only comfortable position was lying down to feed. He did not seem to tolerate solid food very well, and did lots of spitting it out!
When her baby was 13 months old, Emily was visiting her Aunt, who was a Speech Pathologist. Her little boy happened to be eating a banana, which is when her Aunt discovered the problem. He had a severe tongue tie. 48 hrs. later this was corrected with Laser surgery – and changed their lives. Breastfeeding was no longer painful. He could chew and swallow solid food very well. His speech developed rapidly. Everyone was much happier. The fact that this took 13mths. To diagnose (by accident) after having been seen by so many health professionals and no-one had bothered to look in his mouth, is extraordinary. Whilst tongue tie is rare, all newborns should have a thorough examination, before discharge from hospital. Emily and her baby should not have had to go through 13mths. Of anguish. Now with her second pregnancy she has changed hospitals and caregivers and Birth Right will provide doula support. I am sure Emily will be making sure this baby has his mouth checked before leaving hospital.
A birth story..
3/18/2008 12:00:00 AM
Sharon, pregnant with her 4th baby and booked into the same Birth Centre she had used for her 3 previous births. One of those babies had been a waterbirth and the other 2 were on all fours on a mat. She had no medical intervention and no perineal trauma – no stitches with her 3 previous births. The expectation was that 4th baby should be a ‘very easy’ and enjoyable birth. On her arrival at the hospital she was 8cms. Dilated and got into the deep bath which she found very relaxing.
She quickly got to fully dilated and was pushing with her contractions. She knew the midwife on duty and liked her calm support. She had been pushing for over an hour when the midwife’s shift finished and she went off duty. Sharon had not met the next midwife, who was relatively new to the Birth Centre. Sharon feels, in retrospect, that the new midwife panicked. She stated she was not happy and requested Sharon get out of the bath. The midwife felt the baby was in a posterior position and that Sharon should have pushed the baby out by now. She then was transferred to Delivery Suite and was seen by a Registrar Dr. who used the ventouse (suction cap), unsuccessfully. Sharon found this very painful. Forceps were then applied to the baby’s head, without pain relief for Sharon.
Visiting Sharon post-natally, she feels very traumatized and confused by this experience. She did not expect her 4th birth to be this traumatic. After much discussion, Sharon feels that had she not had a change of midwife, this scenario may not have occurred.
It is very difficult when there is a staff change at that point in labour. This is where having a doula and that continuity of support may well have made a difference to the outcome of Sharon’s birth. It is impossible for a woman to be assertive at this point in labour. Sharon can’t believe she didn’t stand up for what she believed to be right – that is to have stayed in the bath in the Birth Centre. All women deserve to have the right support for their labours, no matter what number baby it is. Sharon wants to have more children, and will certainly consider a doula next time, which she says will not be for quite some time.