Akemi and Riana moments after birth I met Akemi only a week before she gave birth but her birth was one of the most transformative births I have attended as a doula. Here’s her story from my perspective as her doula. In the wee hours of New Year’s Day, I got the call that Akemi was in labour. So, at 3am I jumped out of bed and drove down to the Gold Coast. When I arrived Akemi was having regular, mild contractions about 10 minutes apart. So I suggested she get some rest. Later in the morning we went for a long walk on the beach which helped to bring on stronger rushes. It was also a great opportunity to talk and connect, as I hadn’t had the usual few months to get to know Akemi. The space between each rush seemed to be getting closer together, so we headed back to the apartment. After another lie down and massage, we hit the stairs. Stairs are great when you’re on the cusp of active labour. The movement in your hips jiggles the baby and brings on stronger contractions that open up the cervix. We used a sarong as a rebozo because of the heat that day Around lunchtime, the intensity picked up and Akemi was needing to concentrate and breathe through the rushes. I did some rebozo work with her as I had a feeling the baby was a little posterior (she was getting a lot of back pain and her belly button was suppressed). The movement helped ease the intensity too. Within a couple of hours, the rushes were about 3-4 minutes apart, so we talked about when they might like to go in to the hospital and we all agreed that things were moving along a great pace and that it would be okay to go in. The birth unit was by the ocean with pictures of dolphins and coral reefs on sea green walls. With the music Akemi had brought with her it was a calm and tranquil setting for her labour. My hunch about the baby’s position was confirmed by the midwife so we continued to keep Akemi active throughout the labor using the rebozo, dancing, shimmying and various different positions to encourage baby to turn into the optimal position. Akemi’s labor never halted though and she continued to make good progress. At about 10pm it seemed that Akemi was hitting that transitional stage but she didn’t yet sound pushy. It stayed like that for a while and I wondered if maybe there was a bit of a cervical lip in the way. A bit later, at the midwife’s suggestion, she agreed to a pelvic exam and the midwife said that there was, in fact, a bit of cervix still to get out of the way of the baby’s head. So we laid her on her side to ease the pressure on her cervix (so it could fully dilate without becoming swollen). About midnight, Akemi was getting a strong urge to push so we moved her around and got her dancing and lunging and using every position under the sun to open up her pelvis to maximum capacity. The descent of a baby’s head can take time. In Akemi’s case, it was slow going but with each urge to push, her baby’s head moved just that little bit further down. She did have a small issue with her bladder. The baby’s head was in the way so with a little help, that pressure was relieved and we could see more and more of the baby’s head. Now I need to tell you what was happening in the room at this point. Akemi was on the bed with her legs up around her ears. I know, doesn’t sound like a very appealing position for birth but, in this case, it was what she needed. Her baby was still posterior and on rare occasions with a posterior presentation this beetle position works really well. She was definitely making better progress this way than she was in other positions. Meanwhile, the obstetric registrar had waltzed in and demanded that something had to be done to get the baby out because Akemi had been pushing for a long time (2 hours by that time). The registrar, a woman, said she would have to do an episiotomy (didn’t ask, just stated it as fact) saying to Akemi “You’re definitely going to tear.” Then she kept going on and on about how Akemi’s last doctor has done a caesarean section because Akemi was too small to give birth and that she may need to push the baby back up the birth canal and do a caesarean section. Now, Akemi is Japanese and by this stage in labour her brain had completely shut down to English, so, fortunately for her, she didn’t understand much of what the registrar was saying. I loved it when her husband, Craig, would talk to her in Japanese in between the registrar’s rantings. I had no idea what he was saying. He could well have been saying: “this stupid woman wants to cut you again. I’ll just tell her where to go,” or he could have been saying “You’re doing great honey. I’ll get you a cup of tea when this is all over.” In any case, after each translation, he turned to the registrar, smiled and said “no thank you, not now.” At one point, Akemi, who had not complained once during her entire labour, looked at me and said, “Can you still see my baby’s head?” I smiled and said, “Yes, of course, She’s right there. She’s not going back in. I still believe you can do this Akemi.” The change on her face showed steely resolve. It was like she’d gotten the second (third, fourth, fifth) wind she needed to birth her baby. The registrar, thinking that either an assisted birth or caesarean section was going to happen, had called in her obstetric consultant (her boss) and was still talking over Akemi like she was a foolish child when the consultant walked in. The consultant, a lovely, warm woman with a beautiful Indian lilt to her voice, took one look and saw what we all saw, the baby’s head crowning. She said “Oh, you’re gonna push that baby out” and within two pushes, at about 2am January 2nd, little Riana joined her mother earthside. The registrar was mercifully speechless. A tired but happy crew after the birth of Riana! In this photo: Akemi's daughter Mia, Akemi, Riana and me! Akemi’s experience was transformative for her but also for me as a doula. I never doubted she could give birth normally but what struck me was that, during her long labor and long second stage, she never doubted it either. Most women who come to me for support with a vaginal birth after caesarean section (VBAC) spend a lot of time and energy doubting themselves and overcoming the negativity that is thrown their way during pregnancy and birth. Most of these women need a massive dose of confidence. Once women believe in themselves, they birth easily, even if the birth is not straightforward, even if they are the size of my 12 year old with a 6ft tall partner. Akemi is testament to that. Recent research by the Queensland Centre for Mother’s and Babies shows that most women have a caesarean section because they’ve been advised to by their doctor. The research also shows that only around half of the women having planned caesarean sections are fully informed before agreeing to the procedure. In Akemi’s case this was certainly true. She had her first caesarean because her doctor had told her she had to (because she was very small and her husband very tall). After that, she’d had trouble with breastfeeding and starting researching and reading about birth. That lead her to question the reason for her initial caesarean section and she choose to have a VBAC for her second baby. I’d like to thank Akemi and Craig for allowing me to share their story from my perspective. I visited them last week and all are doing well. ps: Catch the radio interview I did on this issue last week on ABC AM (Radio National) here: http://www.abc.net.au/news/2012-01-19/queensland-mums-uninformed-about-caesareans/3781916 So, you can imagine my joy at finding The Ultimate Parenting Course. Now, before I say anything else, I will say that I have become an affiliate of this course. Here’s why. Anybody who knows me, knows that I am quite passionate about parenting and will quickly tell you when I think a parenting resource is unhelpful, which many of them are. What I love about this course, other than the incredible content and the calibre of the contributors is that it is easy. There are no huge books filled with lots of boring, hard to understand or flowery text. Simply download the videos and make notes in the workbook which accompanies each video so you can easily retain and apply the wisdom from each session. The course runs over four weeks and you can view each video in your own time, when it suits you, from the comfort of your own home. There are eight essential themes in the Ultimate Parenting Course: Description from the Ultimate Parenting Course website: “Each theme contains a video (about 30 minutes each, so not too long) with a compilation of interviews from parenting experts answering questions pertaining to the theme, giving you solutions and a context for the challenges you face. The Ultimate Parenting Course Handbook contains written contributions from additional experts, plus bullet points and action exercises based on the interviews to help you integrate the material.” The content in this course is in alignment with current research on the harmful effects of outdated parenting solutions often talked about in the mainstream media. After working with this course you will feel validated and empowered to parent in a way that resonates with you. Having learned the hard way about why it’s important to parent with connection and empathy, I highly recommend this book as a resource for all soon-to-be and new parents as well as parents who have been on the journey for a while and need some encouragement and new insights to guide their parenting. Find out more about this fabulous resource here! This is not my usual kind of post. I have steered clear of birth politics over the past couple of years after being burned out by the endless and seemingly pointless game play, the long hours and the impact on my family. However, I cannot ignore what is going on at the moment in Australian birth politics. My sense of justice is too strong. So here is a letter I have sent to the Australian College of Midwives in relation to their new draft guidance for private practicing midwives. This is not just addressed to them though. I address this to everyone involved in the political push and shove that women are in the middle of (and still not being heard). So please indulge me as I get this off my chest. And if you feel like this resonates with you, please visit http://mumsmatter.good.do/mums-matter/ask-your-mp-to-prove-that-mums-matter/ and make your voice heard. My Letter I have just come home from an initial consult with a woman who wants a homebirth after a prior caesarean section. She said that she cannot find a midwife to support her and she doesn’t want to free-birth. That leaves her the choice of going to hospital to then face the barrage of doubters and doomsayers who will put pressure on her to adhere to their policies, many of which are not evidence-based, which are geared to subtly lead to her next caesarean section. In the nine years since I first became a consumer advocate, I have not felt more disgusted with our birthcare system than I do now. I am appalled that a woman cannot access proper and appropriate care in a country with first world healthcare facilities. Why is it women in Ubud, Bali get better birthcare than women in Sydney, Brisbane and Perth? Affluent Western women are enslaved in a system which takes away their freedoms, and subjects them to unnecessary interventions. We supposedly live in a free society but the very act of bringing a life into this world is subject to the whim of politicians and powerbrokers. It is shameful that educated and powerful women are treated like little children when it comes to giving birth. I recently attended a birth where the woman was patronized about her birth preferences: “just so long as you are sensible. At the end of the day we want a healthy baby…” (like that’s the last thing on her mind???) and held in an assessment room until she “complied” with having a vaginal examination (something she was incredibly reluctant to do because of a traumatic experience in a previous pregnancy). Women put themselves last in the birthroom. They can be made to feel like they are the poor cousins visiting the luxury mansion of distant relatives. The message is loud and clear: “This is our turf. Don’t even think about running a bath without our say so, but you are more than welcome to partake of our smorgasbord of interventions that may or may not be evidence-based.” Most midwives seem to spend the vast majority of their time doing paperwork and don’t even try to connect with the birthing woman. Some may think this sounds harsh but when you understand what makes it easy for a woman to birth, it seems like nothing short of abuse. In a first world country where women have equal rights, they must be entitled to bodily autonomy and they must have access to a trained and qualified healthcare provider of their choice regardless of where they choose to give birth. To take this choice away is taking away their freedom and is sending a message to all women that they are no more than chattel, no better than cattle. Is that the sort of world we want for our daughters, nieces and grand-daughters? Yours sincerely, Cas McCullough Director, Mumatopia Birth and Postnatal Doula Co-founder Caesarean Awareness Network Australia Past President of Maternity Coalition Past Editor Birth Matters Journal VBA2C mum of three One of the reasons I started Mumatopia as a social enterprise was because I can see the wisdom behind the saying “gentle birth heals mother earth” (coined by humanitarian and midwife Robin Lim from Gentle Birth Bali). My birth experiences and my experience of losing a much wanted baby and nearly losing my life in the process, have taught me how gentle beginnings can nurture a mother’s love for her baby, can create a sense of empathy and patience and a strong sense of empowerment. Reflecting on my own experiences of birth, I know that I bonded more easily with my lastborn child. The love I feel for all of my children is profound and I don’t love one any more than the other, but I do feel I developed an easier connection with my lastborn child after his birth. There was no hyper vigilance like I experienced with my first two babies (both born by caesarean). The experience of natural childbirth gave me a sense of my own strength and a passion for protecting and advocating for my children. It started the process of questioning everything that has led to dramatic philosophical and life changes. We have adopted a more sustainable lifestyle as a result. Supporting other women to have beautiful births has also confirmed for me how a gentle experience of childbirth and an undisturbed physiological third stage can ease a mother and her partner into love with their baby. If this process is disturbed it is certainly not impossible to replicate this but it just takes a bit more effort. I can’t explain it but having seen it, I can see what a gift it is to have an undisturbed birth and early bonding experience. To be able to facilitate that is one of the massive perks of my job. Everything I do under the banner of Mumatopia, whether it be supporting birthing women, running a retreat or making handmade products, is done with a view to promoting a more sustainable, healthier, more abundant and more caring community. I want to change the world. It’s not such a big thing to ask is it? My own childhood has taught me how cruel people can be. If supporting women to have empowered births leads towards a kinder, gentler earth than I feel I am meeting my goal. Ps: If you have a business or social venture and you’d like to connect and discuss how we can work together, you’re invited to come along to Business with Heart, a networking dinner featuring guest speakers Hon Rachel Nolan MP, Minister for Finance, Natural Resources and The Arts and Emma-Kate Rose, General Manager of Food Connect. Details: mumatopia.com/community/bwh. As a doula, I’ve observed that the women who give birth easily and without pharmacological pain relief are generally the ones who move, shake, shimmy, and dance their babies out. During antenatal education sessions with clients I talk about how every move a woman makes during labour helps babies get into the optimal position for birth, and ease their way out, jiggle by jiggle, into the world. Moving your body in labour is also part of the process of moving into and accepting the labour journey. It’s an amazing transition, that moment where a woman walks up and down stairs in early labour and notices that the activity makes the contractions longer and more intense. She may resist doing this knowing what it brings, but then I gently remind her that the longer the contraction, the more effectively it is working to open her up to give birth to her baby. She has a moment where she realises that she has to move through and into the intensity in order to meet her baby. Avoiding that intensity or distracting oneself from it, can make labour longer and harder. At that point in labour, women are often fearful of stepping into the pain but with the right support, they soon get into a rhythm, which helps them cope. They’re up, they’re down, they’re walking up and down stairs, then on their hands and knees. They get in the shower and out of the shower, they slow dance with their partners and they rock their pelvises with their hands braced on the kitchen bench. In established labour, they are concentrating, breathing rhythmically like a marathon runner, and using their voices to “sing” their babies out (as my midwife used to put it), all the while still shimmying, swaying, stomping and dancing. Birth is designed to be a physical, active event. And this is something that modern media never portrays. All we see on TV shows is women who’s waters break in a shopping centre, who are rushed to hospital immediately and then give birth flat on their backs with everyone yelling at them to push. In reality, if a woman is enabled to move with her body’s needs, is active and uses a variety of positions in second stage to help her baby’s head descend, it can be a much different experience, even a pleasurable experience. So what will help you prepare for the intensity? The doula’s bag of tricks Rebozos: a rebozo is a long piece of material, a shawl or wide scarf with give that can be wrapped around a woman’s pregnant belly and shuffled. Sounds weird I know but it offers a lot of relief and helps a baby move into a good position for giving birth if used regularly prior to labour. It can also be used during labour and the other way around (ie. Around the back) to provide pain relief during labour and help the baby move down. All movement helps, even if it’s just your belly doing the wiggling. Rebozos can also be used as baby carriers after the birth of a baby up into the preschool years. For more information on rebozos visit these websites: Stairs: Going up and down stairs or walking up and down the street when on the cusp of established labour can help move the baby into position and progress labour more effectively but it’s important not to wear yourself out. Birth balls: Sitting on a birth ball doing a figure eight with your hips or leaning over it for support can help you keep wiggling, even when you’re resting your legs a bit. There are many more practical techniques that a doula and/or midwife can draw upon to enable a woman in labour to get her wiggle on but these are just a few examples. Disclaimer: This article shares ideas and resources to assist women preparing for childbirth. However, as always, this should in no way be construed as medical advice and a woman should always talk over her individual health concerns with her care provider. Copyright 2011, Caroline McCullough. All rights reserved. Happy mum and blissed out baby! I’m always a tad nervous calling people out of the blue but it was nice to be the bearer of good news. I was calling a new client to let her know that her work had gifted her a postnatal doula care package. She looked through the options on the website and decided on 3 visits from me to cook meals and do some light housework and 2 visits from my partner Julie Williams, from Live Organic Health to meet her postnatal therapy needs. Julie and I had only just recently started offering a combined postnatal therapy and support package so we were really excited to have our first client together. On my first day I walked up the stairs, gift hamper of mum-friendly goodies in hand, and was greeted by two excited children who wanted to know who this lady was who was going to look after their mum for the week. Once settled into the kitchen, the kids and I got to work making raspberry muffins while mum rested and fed her baby. With postnatal meals, it’s important not to include too much gluten, dairy or sugar, so I halved the sugar in the muffins and then put my Thermomix to work making pumpkin soup and mushroom and spinach risotto. While cooking, I chatted with mum Amelia about her birth and how things were going now. This baby was baby number three, so life’s been a juggle, as it often is with three small children. I left to go home to my own three hungry children just as it was getting time for dinner. A few days later, Julie phones me and tells me she’d visited our client. She’d given both mum and baby a massage and had Amelia fill out a record of her diet from the previous few days. She asked me to adjust the menu to make lunch food instead of focusing on dinners so Amelia had some easy, healthy food to eat during the day. The following day I arrived with an esky full of fresh veges, a whole chicken and a dozen eggs and set about making frittata and a pot of chicken soup. These dishes are packed full of fibre and protein, are gluten free and dairy free, just what a breastfeeding mum needs to quell the chocolate cravings. I also showed Amelia how to use a baby wrap and left one with her to try out for a few days. On my last visit today I made more frittata and soup and also made Amelia a quinoa and salmon salad for lunch with kidney beans (more protein), avocodo (unsaturated fats necessary for good milk production) and green leafy salad, grated carrot and beetroot. It was a dish that took about 2 minutes to prepare (after soaking and cooking the quinoa–a grain which is full of protein and other nutrients). I had some spare time so set about ironing some clothes (something that happens rarely at my place… my hubby raised his eyebrows when I told him I’d done ironing today) and then we took some snaps of the baby on my new camera. It’s always a bit sad to say goodbye to a family when you’ve just gotten to know them but I’m sure we’ll meet again. Amelia has one more visit with Julie for a massage next week. The service Julie and I offer is unique in that we combine both therapy and support to meet our clients’ needs. We are the only ones offering a service like this in the greater Brisbane area. Mums need more support postnatally than what is available through either the public or private system. We are so glad to be filling that need, one mum at a time. *Thanks to Amelia for permitting us to share her experience with Mumatopia readers. Well, today we saw Master 10 off at Brisbane airport. I was really teary when he left. Yes, I’m one of those emotional mothers who cries at the opening of an envelope. I can’t help it! I just love my kids so much. I know it shouldn’t be a big deal. It’s pretty safe to fly these days and the flight attendants really know how to look after kids’ needs. But it was just that lingering thought: “what if something should happen and I’m not there to protect him, comfort him?” Over the past few weeks I’ve realised that my firstborn babe is now turning into a tween. He’s curious about the world and about the changes he’ll go through in the coming years and he wants to go on adventures. I have to let go. To hold on too tight at this age would be obstructive to his growth as an individual. It’s amazing to me how paranoid our society has become about our children’s ability or lack thereof to look after themselves. When I was a child, we lived on a farm and would disappear for hours at time and go bush. We’d come home when we were hungry. When my dad took us to the beach, he’d sit on the sand and read a book and we’d pretty much be left to our own devices in the water. Now, I’m not advocating neglecting the safety of our children. I’m just pointing out that we live in a vastly different world nowadays where we are perhaps, just a little less free. I find it hard to let go much of the time but am learning to be less paranoid as the years go by. I try not to hold my breath when my five year old climbs high into a tree and I try to trust that my children know how to get to the loo and back in the shopping centre without talking to a bunch of strangers. I can’t help but wonder how I got this way, when I had so much freedom as child. 2.5 hours after we saw Master 10′s plane take off my dad called to say he’d arrived safely. I tried not to let my relief show too much. Now he’s off on an adventure with his grand parents! I can’t wait to hear all about it in 11 days time, when he flies back home. How are you with the whole “letting go” thing? Most people do not take into consideration how different models of care may impact on their perceived needs let alone their physiological needs in birth. Decisions about where to have a baby are often influenced by what friends and family feel safe with before a couple looks into further information about birth. However, if couples did their homework on birth before they were pregnant or in the early days of a pregnancy, and then sought advice and opinions of others, they’d be much more likely to make informed decisions that meet their individual needs. I am not saying this to question anybody’s decisions or how those decisions are made. I did exactly what everyone else does when I had my first baby. It took me three pregnancies to work out exactly what my needs were and to have a greater understanding of my physiological needs in birth. The reason we don’t look into our needs and options first is because, culturally, we don’t grow up around birth. Back in the day, women had their babies in the presence of local midwives, and women-folk, including daughters, sisters, mothers and grandmothers. Nowadays, women mostly birth in hospitals, away from their families and in the presence of medical staff. There are many complex reasons for the shift from birth in community to birth in institutions but the knowledge about birth physiology that was passed on from generation to generation, now has to be learned through experience because of this shift. The good news is, there are some quality resources available to assist women and their partners in gaining this knowledge before they go through the experience of childbirth. Birthtalk, based in Toowong, Brisbane, run a unique antenatal education course called Path to a Better Birth. Calmbirth Brisbane also run the Calmbirth program in the greater Brisbane area as well. Mumatopia is running a Childbirth Options workshop on December 9th which includes a unique “needs self-assessment” component for couples as well as local information on birthing options and models of care. This workshop can also be taylor-made for individual couples in the comfort of their own homes, anywhere in greater Brisbane/South-east Queensland. So if you don’t live in Brisbane’s western suburbs or in Ipswich but would be interested in Mumatopia’s workshop, please contact me on 0438 898 706 or cas@mumatopia.com. A very small percentage of mothers have babies that end up being diagnosed with a major medical condition but these days, screening tests are routine for every woman, even if they have no risk factors. Many women are unaware that ultrasound examinations are not about identifying the gender of the baby but are rather diagnostic tests to determine if there are any “markers” that may indicate the baby has a health problem. It is important to understand that these tests do not guarantee that a problem will be picked up and they only test for a limited number of medical conditions. The Australian Centre for Genetics Education has developed a fact sheet on pre-natal testing which is well worth a read. Author and International Childbirth expert, Dr Sarah Buckley has included a chapter on prenatal testing in her book Gentle Birth, Gentle Mothering and author and mum Kylie Sheffield also has a number of resources for women who face difficult news regarding their babies after ultrasound diagnostic testing, on her website Tisomy Oz Prenatal Support. Kylie wrote the most amazing book “Not compatible with life: A diary of keeping Daniel” to record her journey with her second baby Daniel, who was diagnosed with Trisomy13 during pregnancy. It is a wonderful book for any mum who is dealing with a difficult prenatal diagnosis or who has lost a baby at any time during pregnancy or at, and soon after birth. Mumatopia will be running workshops on prenatal testing and pregnancy-related grief and loss support in 2011. Become a Facebook fan or join our newsletter (see right hand column) to stay up-to-date on dates and workshop topics. Evidence suggests that a stretch and sweep (otherwise known as a membrane sweep) is a relatively safe procedure which has some benefits, particularly if a woman and her care providers may be considering an induction of labour. In such cases, a stretch and sweep can kick start labour without the need for a chemical induction of labour, which brings with it a whole new set of potential complications. However, because a stretch and sweep has become such a common procedure and because the time frame parameters for a normal gestation have narrowed over the years, clinicians sometimes fail to inform their clients of the risks associated with this procedure and some fail to inform their clients that they are doing the procedure at all. At the very least, you should be asked for your consent before such a procedure is performed. You may need to communicate your need to give informed consent to this procedure prior to any vaginal examinations from 38 weeks onwards. One of the complications associated with a membrane sweep is that it can nick the bag of waters (amniotic fluid sac that contains and cushions the baby) causing a slow leak or even the sudden breaking of the entire amniotic fluid sac. This can necessitate interventions related to premature rupture of the membranes which may involve induction or augmentation of labour and antibiotic treatment for both mum and baby. The procedure can also cause irregular contractions and prolonged labour. Lastly, a membrane sweep can be an extremely uncomfortable and even painful procedure and result in some bleeding from the cervix. There is another alternative to induction of labour, acupuncture. Acupuncture has been used to bring on labour and many women find it beneficial. There are no known side effects to this treatment, however, there is little scientific evidence to support its use. That said, many women swear by acupuncture if only for the fact that this treatment is very relaxing. Most experts agree that minor interventions such as acupuncture and a membrane sweep may not be effective unless a woman’s body is ready to go into labour. Which brings me to the final alternative—waiting for labour to start spontaneously. These days clinicians are often in a hurry to get labour going prior to week 41 and let’s face it, so are lots of women. However, the potential for complications needs to be weighed carefully on either side and the final decision should be made with clarity and a good evidence-base to back it up. Further reading: Boulvain M, Stan CM, Irion O. Membrane sweeping for induction of labour. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD000451. DOI: 10.1002/14651858.CD000451.pub2 Smith CA, Crowther CA. Acupuncture for induction of labour. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD002962. DOI: 10.1002/14651858.CD002962.pub2 When survivors give birth by Penny Simkin & Phyllis Klaus Birth is important. Regardless of how and where you give birth, birth is important. I know this because women who make very definite choices about childbirth, do so because having that choice is important. A woman who cannot bear the thought of giving birth vaginally, would be horrified if she was forced to do so against her wishes. To this woman, birth is important. And, a woman who cannot bear the thought of strangers in the room when she is in labour would be horrified if she was forced to give birth in a hospital, with midwives and doctors she didn’t know, with people walking in and out of the room unannounced. To this woman, birth is important. And having a choice of where, with whom and how to birth is fundamental to the freedom, autonomy and safety of any woman. What is right for one woman, is not necessarily right for another. Women have complex and individual needs and only they know what choices are right for them. Lately, the importance of choice in childbirth has been brought home to me more than ever. I’ve been reading a book called “When survivors give birth” by Penny Simkin and Phyllis Klaus, which is essentially a book for birth workers and health practitioners to help them understand the effects of early sexual abuse on childbearing women. Reading women’s stories contained in this book has reinforced the view that there is no “one size fits all” approach when it comes to giving birth. Again I say, women are complex, and when they are pregnant and in labour, they are vulnerable. What I find is often missing in modern maternity care is the idea of listening to women. In a hospital setting, care providers have pages of lists reminding them of what information they need about a woman to adequately care for her. Missing from this list of reminders, in the majority of cases, is “Have you listened to the woman about her needs and desires?” Why is such an essential element of maternity care so overlooked? Nobody has the right to judge another woman’s birth choices unless they have walked in her shoes. A woman who is traumatised by a previous birth experience may choose an elective caesarean or she may choose to avoid all medical technology and birth in the privacy of her own home. She may choose to hire an obstetrician or she may choose to hire a midwife. Whatever the choice, it should be her’s and her’s alone. Who are we to decide what is safest for her and her baby? Safety is one of those catch-words in healthcare that annoys me. It annoys me because it is such a relative term. Safe for whom? For the doctor? The hospital? The government? The midwife? The woman? The baby? If you view the mother as a baby-carrier then you may view safety as a physical function and focus on the baby to the exclusion of the woman. If you view the mother’s wellbeing as essential to the process of birth, progress in labour, and understand that the mother and baby are a unit, not two separate entities, you may view things differently. Personally, I hold the latter view. If a woman is so traumatised by a hospital setting that it sets her adrenalin pumping and raises her blood pressure, is that safe? The impact of fear and adrenalin in labour is well-documented in child-birth literature. Fear has no place in a birth setting and that is why choice in birth is so so important. For a woman to give birth safely, both emotionally and physically, she needs to feel safe. Unfortunately though, emotional safety is often seen as expendable in our health care system, despite a significant body of research showing that the mother’s well-being is intimately connected to a baby’s well-being post-birth. Birth is important and women need to be able to make birth choices that suit their individual needs. To take those choices away, or manipulate them to suit someone else’s needs is just another form of abuse. ***** It was a fairly typical scenario: private obstetrician recommends an early induction because of borderline pre-eclampsia symptoms. Induction ends up failing and I get rushed to theatre for an emergency caesarean. I remember feeling completely helpless when the catatonic contractions began. I wanted to use the loo but felt like nothing would come out. I got more and more upset and frustrated. My husband sat there not knowing what to do. I felt useless, like everyone around me was waiting for me to fail. By the time the operation was ordered, I had resigned myself to the reality of being sliced open. I felt like I had given it a shot but that somehow my body had let me down. No one had prepared me for what was to follow. During the operation, I felt a sudden sharp pain in my pelvis. I anxiously turned my head to the anaesthetist and said “I can feel that! I can feel pain.” He patted my shoulder and said, “it’s just a bit of tugging.” A moment later, another burst of sharp pain and I cried out, “I felt that! Please, I felt pain!” The obstetrician looked up and said, “can you feel that?”—more pain. “yes!” I cried. “I’m pressing on your pelvis,” she said nonchalantly. Then she immediately put her head down and hurried to get baby L out of me while I cried in pain. They took him out and whisked him away before I could even get a good look at him. I didn’t care about the pain at that stage. I just wanted my baby. But once they’d taken him out, they gave me a general anaesthetic. The next thing I knew, I woke up with that damn mask on my face. They brought L to me in recovery (after much insistence) and I held my baby for the first time. Wayne had taken photos of him in the humid crib for me to look at later. He was petite and round and I loved him instantly. I asked to put him to breast and he had his first suckle. He seemed to know what to do and I felt relieved. Suddenly though, I felt anxious and unable to breathe. The anaesthetist and obstetrician ordered an EKG, just in case there was anything wrong with my heart. “My heart?” I thought! “What have they done to me?” Later that night I went to sleep with L tucked under my arm. I was just glad it was all over and that I could get on with admiring this little being they had brought me and told me was mine. Within a couple of days, the aftershocks struck. A friend came by and changed his nappy. I just let her take over but something inside of me wanted to say “he’s mine, I think. Maybe I should be doing that.” But I couldn’t say it because, at that point, I felt like I had to ask everyone’s permission to do anything for him. The day after L was born, the obstetrician walked in, patted me on the leg and said “not going to have a big family then are we!” I was devastated. Childhood memories of tearing about the house with my three siblings were something I wanted for my own brood and I definitely wanted a brood, at least four! I suddenly felt robbed of that. It was as if she was saying birth was no good for me and that I should quit while I was ahead. Later on, I reflected on how much damage those words had caused and how I had to reclaim my heartfelt desire to have more children and to birth them as well. Within a couple of weeks of L’s birth, Wayne and I made the decision to pack up and head for the UK for a couple of years. That was fine by me. I wanted to get as far away from everything as possible. I felt ashamed and like I had no mothering instincts. I dared not tell anyone else how I felt lest they take L away from me. I was scared and alone and wanted to be somewhere else. So, somewhere else we went. We settled in Windsor, South West of London. There were lots of parks and lovely surroundings, plus a castle just up the road but I didn’t know anyone, nor did I know how to meet anyone. After about a month, the local health visitor came by and told me about a local group that ran at a nearby church each week. I relished the opportunity to meet other mums but, at the same time, was enjoying my isolation. It was as if I wanted to hide what was really going on—the nightmares, flashbacks and panic that had set in. I didn’t want anyone to think I was depressed or wasn’t managing but the truth has a way of declaring itself. After a couple of months I felt paralised by panic. I’d stand at the kitchen window motionless while flashbacks of the surgery replayed in my head. I’d be terrified to walk out the front door lest I ran into someone I knew or saw a pregnant woman. I didn’t want anything to do with pregnant women. I was never having another baby and didn’t want to be reminded of the fact. One day, a midwife at the clinic asked me if I’d take their postnatal depression survey. She said that I should see my GP about a referral to a counselor and a support group. I didn’t want to go to a support group though. What I was experiencing seemed removed from depression and I didn’t want to sit around listening to how sad everyone was. I opted for counseling and because they suspected I was a suicide risk, the midwife came and visited every week for eight weeks. She probably saved my life because at that point, I felt so worthless and hopeless, unworthy of my gorgeous child and long-suffering husband, that I wanted to die. I wanted the flashbacks and nightmares to be over with. When L was nearly two, we moved back to Australia and I felt obliged to have another baby, even though, inside, I really didn’t want to be pregnant again. Every bone in my body was screaming “you’re not ready yet!” As my pregnancy unfolded, I started to deal with the fallout from L’s birth. I went from being scared and overwrought at the prospect of having another baby to feeling empowered and confident. Alas, my second baby’s birth was a repeat caesarean. His birth hadn’t unfolded how I had hoped, but it was, nevertheless, an empowering experience where I felt respected. Just 10 months after D was born I found out I was pregnant once again, so whether I liked it or not, I had to deal with the issues that were still plaguing me. The stats were not in my favour: I was short, a tad plump, had a small delivery to pregnancy interval, a history of complications in previous births and had never ever actively laboured. However, I had read medical journal articles and books on the subject and decided, on balance, it was safer to go for a natural birth than a third caesarean section. I knew that I had to give it my all to have a vaginal birth, and not just a vaginal birth–a natural, ecstatic birth. I wanted to go for the fences if only to prove to myself that birth could be a good and safe experience without surgery. So I set about creating the environment I needed to optimise my chances of a natural birth. I decided that support for a vaginal birth after two caesareans would be hard to come by where I lived, so I booked in to a maternity hospital with a good VBAC rate, two hours from my home. I knew a midwife in Nambour and we arranged a deal with the local obstetrician for a shared care arrangement. I would see my midwife antenatally and she would attend the birth. The visits with my midwife were lovely. We’d spend an hour or so talking and working through issues at each session. I envisaged myself as an athlete training for a championship event. I also kept a list of my needs and fears. Each session we would go through the list. Some items were hard to write down and share but I held to the philosophy that one more thing shared prior to birth was one less thing to hold me up in labour. I didn’t have any scans as I felt the need to go within and connect with my baby on a more primal, intuitive level. My due date came and went, as I knew it would, and a couple of weeks went by. By the end of the third week I was well and truly over being pregnant. I asked my midwife if she’d do a stretch and sweep. She couldn’t reach too far in with her tiny fingers but within a day I started to lose my mucous plug so I figured something was happening. I had Acupuncture on the Monday and on the Tuesday we headed up to Nambour for another antenatal appointment. We decided to stay up there for a few days at a nearby hotel. That night, labour began. After the third rush to the toilet, I figured that this was what contractions felt like. In the morning they were bitey and closer together. I phoned my friend Jodie to come, but by the time she arrived, the regular contractions had dissipated. I felt deflated and embarrassed. Had I been wrong? It went on like this for nearly two days. In the end, I felt like I had to get away from everyone, so I booked into the maternity unit and sent Wayne back to Brisbane with the kids to find a babysitter. Shortly after they left, my waters started leaking. Progress, at last! Midwife Vicki came in while I was chatting to a woman in the opposite room and watched me through one contraction. She promptly told me to go back to my room for some quiet time. Being a talker, this was easier said than done but having some quiet time alone was exactly what I needed. I had midwife Lynne run me a bath in the birth suite and I just relaxed for a couple of hours. Wayne was on his way back and Jodie not far behind. Late that night, I felt like I’d lost the plot. Jodie gave me a massage and Wayne disappeared to get some sleep. It was going to be a long night. I sat on the toilet for ages with Midwife Vicki by my side. I was having bladder trouble and it brought back memories from my “labour” with L. After awhile, Vicki announced that my contractions were 3 minutes apart. I was euphoric. It was real now. We moved to the shower where finally, my bladder gave way and the midwives poured ice cold water over my head while the steaming jetstream belted into my lower back. The contractions were coming thick and fast now. I moved to the bath and immediately felt cooler and more serene. Midwife Lynne sat on the side of the bath, whispering words of acceptance between each contraction. I knew I just had to ride it out. At one point I started singing “Shake your groove thing” in between contractions. We all laughed until another contraction propelled me onto my knees. When it became too intense to bear, I felt I heard a voice say “I’m holding your hands.” I visualised Jesus sitting there with me. It was as if someone was giving me the strength that I lacked in that moment. For awhile I was able to breathe, to sleep again. I felt like I slept for hours but it must have only been a couple of minutes. Then I started grunting, suddenly alert. I felt my baby’s head move down and looked up at everyone in surprise. I was having this baby! It took quite a while for A’s head to come down. He went out, and in, and out and in and eventually, midwife Lynne suggested I get out of the bath. At that point his head came half-way out and then with one more push he flew out into Lynne’s hands. I stared at my precious new baby in disbelief. “I did it!” I pushed a baby out and I didn’t need surgery. The Euphoria was inexplicable! Our eyes met and we fell instantly in love but I wasn’t possessive or hyper vigilant, like I had been with L and even D. I felt relaxed in the bond we had. And it continues to this day. A’s birth gave me some incredible gifts. It somehow made me feel stronger. I no longer allow people to take my power away. Also, the memory of those first moments is very precious. It brings warmth to my heart every time I think about it. In many ways A gave his brothers a gift too, a more relaxed and at peace mother. In saying this, I know there are many women out there who have not had the experiences I have had and who believe they are somehow faulty. This makes me feel very sad when I can see so plainly now that all the interference and lack of respect for my role as chief decision-maker in my care was what caused the trauma with L’s birth. It was all so unnecessary. I would like nothing more than for all women to feel like I did the day A was born. To find yourself on the birthfront is to find out who you are and what you are made of. © 2008 Caroline McCullough. All rights reserved. About six weeks ago, I was in hospital recovering from emergency surgery for an ectopic pregnancy. I had lost more than a third of my blood supply, requiring four blood transfusions, and then developed pneumonia because my lungs had collapsed after the surgery. Next door to me was a woman who had just had an emergency caesarean. Like a fly on the wall I listened that first night as she struggled with a very unsettled baby who would not stop crying. I could hear the bewilderment in her voice as she talked with the midwives. She hadn’t expected it to be like this. In quiet conversations I heard her express disappointment about the way things had turned out, but at least she had a healthy baby, I heard some of her visitors say. What really struck me, was that starting life as a new mum while recovering from major surgery is hard. It reinforced my view that surgery should be reserved for sick people who need it, not healthy people in the prime of their lives. Sadly, this is not what happens in the real world. Australia’s caesarean section rate is currently 30.3%, and about half of all caesareans performed are repeat caesareans. Less than 17% of women who birth after caesarean have a Vaginal Birth (VBAC), and of those who do, few emerge from the experience unscathed, due to a birth care system that undermines their ability to birth normally. So today we head into the trenches, because I want to show you what women are up against, the impact of this battle on their emotional health, and the repercussions for their families. I also want to share with you my vision for a better way forward. The Context Behind the War The current situation in Australia, particularly in the private sector, is to actively or subversively encourage caesarean section and discourage VBAC, even for those women who have had only one prior transverse lower segment caesarean section (LSCS) (Fenwick et al, 2007). While the media and some medical associations would have us believe that the reason the repeat caesarean rate is so high is because women are asking for caesareans, Australian women wanting a VBAC are routinely denied access to supportive birthing programs because: The landmark US survey ‘Listening to Mothers and Babies II’ (Declercq et al, 2006) showed that only 12% of women in the survey had a VBAC despite 45% of survey participants being interested in having a VBAC. Of these, about half were denied the option of VBAC due to hospital or practitioner recommendations and policies. New research in Australia suggests the same is happening here (Staff, 2005). Other research identifies that despite a preference for vaginal birth, women tend to follow the advice of their care giver and “consent to a repeat caesarean section in the belief that it is the safest option for them and their baby (Hopkins 2000, Gamble & Creedy 2001, Potter et al. 2001, Bainbridge 2002, Donati et al. 2003, Fenwick et al. 2006, in Fenwick et al, 2007, p. 1562).” In Australia, the situation is dire. Caesarean Awareness Network Australia (CANA) has received reports of even level two hospitals denying women the opportunity to try VBAC. Women are simply not being given the option. Battle no. 1: The Big Scare Most women who enter an antenatal appointment requesting to plan VBAC, leave bewildered, frightened and anxious, with bloody images of dead babies and hysterectomies planted firmly in their minds. I know this because I have heard it from many, many women and I have also experienced it myself. At 34 weeks I was given the option of elective caesarean, stating uterine rupture as the reason. I responded: “Yes, but isn’t it only a 2% risk or something?” The reply from the registered nurse was, “Yes, but when it happens all hell breaks loose …” and other gory details. I found this unnecessary and not an objective discussion of the risks and benefits of VBAC. I was forced to obtain more accurate information myself – information which should be readily available to any pregnant mother with a prior caesarean. Fear of the mother and/or baby dying from a catastrophic uterine scar rupture casts a huge shadow over VBAC. It is argued that the uterine scar is put under immense stress from labour, which can cause it to burst open causing massive bleeding and the protrusion of the baby’s body from the uterus. However, a rare catastrophic rupture is 30 times less likely than any other rare adverse event requiring an urgent caesarean section to happen to any pregnant woman regardless of her risk factors (Enkin et al, 2000). In fact, A Guide to Effective Care in Pregnancy and Childbirth, based on a systematic review of the literature on childbirth, states that care of the VBAC woman should be “little different from that of any woman in labour (Enkin et al 2000).” World Health Organisation statistics on uterine rupture show that this rare complication is much more likely to occur in developing countries in women with no prior history of caesarean section, but where there are high levels of poverty, high birth rates, and lack of access to primary medical care. Statistics from the Australian Institute of Health and Welfare suggest that babies and mothers have more chance of dying from major car accident, heart attack or deep vein thrombosis, but we don’t drive with intravenous drips in our arms just in case. People must accept that life involves risk, and it is for women themselves to determine what constitutes ‘acceptable’ risk in the VBAC context. The job of health professionals is to give women all the information and support their choices. Medical research literature overwhelmingly supports the safety of VBAC for the majority of women with one previous LSCS (Dodd et al, 2004; Gregory et al, 2007). A recent study in Canada showed that the risk of severe morbidity or mortality in VBAC women and their babies was about 1-2%. More than 70% of women attempting VBAC who had no complications in the current pregnancy gave birth vaginally, and in the group that developed complications during pregnancy, 50% of those still had a vaginal birth (Gregory et al, 2008). The most problematic complications were those that could happen to any woman in any pregnancy and could have been due to poor management of care. Further research indicates that women who seek VBA2+C should also be supported in their choice (Enkin et al, 2000; Wood et al, 2001). And yet, women who ask for this option are actively discriminated against and undermined in our birth care system. One woman I know was a refugee from Bosnia who desperately wanted the option of VBAC for her third pregnancy. She went to a level two hospital and was told that they would reject her as a patient if she refused a repeat caesarean. When she made a complaint about this treatment to the Queensland Health Quality and Complaints Commission, she was told that the doctor was only doing what was safest for her and her baby, and that she should just accept it. There was no acknowledgement of her right to informed consent, let alone informed refusal. Nobody batted an eye at the fact this woman’s rights were completely ignored, and at a hospital with 24-hour emergency cover. For some reason, when it comes to VBAC, some people think it’s okay to badger, pester, bully and coerce. For some reason it’s okay to deny a woman her rights and to treat her with no respect whatsoever. And it’s okay to emotionally abuse her. I’m here to tell you, it is not okay! Battle no. 2: Treaty on the table, but no one’s backing down If getting someone to support you in VBAC is the first battle, the next is getting someone to support you for a normal birth, no strings attached. In Australia, the most common practice is to insist on prophylactic intravenous cannulation and continuous electronic foetal monitoring (EFM) during labour (Dodd & Crowther, 2003). However, a search of medical research database Medline reveals no evidence to support prophylactic cannulation. Furthermore, in the Royal College of Obstetrics and Gynaecology evidence-based guidelines, continuous monitoring had a poor basis in evidence, and was recommended only because: A more thorough review of the literature reveals that the benefits of continuous monitoring do not necessarily outweigh the risks (McCullough, 2008). Here is an example of standard policy on VBAC from the Royal Women’s Hospital in Melbourne, Victoria: When I had my VBAC, if I had been forced to submit to any of the above interventions, had my labour or even just my second stage been timed, I have no doubt that I would have had a repeat caesarean. I cannot help but wonder how many women’s attempts at VBAC have been foiled by restrictive and unnecessarily interventionist policies like this? I often get told that a woman “had to be monitored” and “had to have a cannula just in case”, even by educated and fairly informed midwives. But evidence does not support this. There is extremely scant evidence, or no evidence in some cases, in support of artificial rupture of the membranes, starvation, time limits on first or second stage, or time limits on the pregnancy (RCOG, 2007; Zhang et al, 2002; Cesario, 2005; Watson, 1994; Zelop et al, 2001; Odent, 2004; Goer, 1999; Priddy, 2004; Clement, 1994; Enkin, 1992; Hofmeyr, 2005; Rageth et al, 1999; Leung et al, 1993; ACOG, 2002; Sheiner et al, 2000; Fraser, 1993; Fraser et al, 1997; NCT, 1989; Robson & Kumar, 1980; Donald, 1979) For women, routine interventions such as cannulation and continuous EFM which might seem benign to an obstetrician or even some midwives, suddenly take on a level of symbolism: that of failure, that of danger, that of “no one believes I can birth my baby.” So, in effect, women are filled with fear even before they reach labour, then given a double dose of it once in the labour room. Tell me, what impact do you think all this fear has on a woman in labour? These things don’t help a woman have a normal birth, which is why women who are educated about VBAC and who are motivated to achieve a normal birth take their business elsewhere, hire a doula, and stay home as long as possible, only going into hospital to push! There is no trust there, and there is no real safety either. This leads me to the next battle. Battle no. 3: Psychological Warfare! Commonly, as soon as they reveal they want a VBAC, women are met with a barrage of hostility, negativity, misinformation, and fear. And women are often surprised when initial support early in pregnancy is withdrawn at term: “My 40-week hospital appointment became my worst nightmare. The registrar started talking induction. After an exam, she told me that I wasn’t ‘favourable’ for induction and that I would need another caesarean. I was in shock. Why was she even talking induction in the first place? I wasn’t even ‘overdue’.” This from a mother (and registered nurse) who ultimately decided to stay at home during labour and birthed her baby unassisted. The victims of war: Collateral Damage In the bid to get women to comply, there is the potential to do great harm. Stress and anxiety have been shown to cause problems not only for the mother but also for the baby following birth. How we treat women antenatally and in the labour room matters. Some researchers have documented the damaging effect of anxiety and depression during pregnancy (Monk et al, 2003; Rodriguez & Waldenstrom, 2008) on the mental health of the mother and the physical and mental health of the baby, not to mention the impact on other family members. Fenwick et al (2007) found that the way women were treated in the lead up to and during childbirth “had implications for how women felt about themselves following the birth, and ultimately how they went on to interact with their newborn within the family environment (p.1566).” What will bring peace? • Respect for a woman’s right to choose to VBAC • Accessible evidence-based information (Childbirth Connection’s booklet a good resource) • Peer support (Birthtalk, BaBs, NBAC Clinic in WA, Birthrites, CARES-SA) • Respect for her right to decline routine interventions • Primary midwifery care • Time, space and encouragement to give birth normally Regarding primary midwifery models of care, there are significant flaws in current thinking including beliefs that: 1. primary midwifery care is only applicable for women who are deemed statistically to be low risk, and 2. a model of primary midwifery care operates in isolation from other care providers. The recently released Cochrane Review on midwifery-led versus other models of maternity care recommends that all women should have access to primary midwifery care regardless of their risk status (Hatem et al, 2008). The safest labour will result when there is effective communication and positive support by a skilled attendant for the labouring woman. To deny women this option puts her at greater risk of harm, not less risk. Women who have had uterine surgery, especially those planning for VBAC may need more support and attention during labour for a number of reasons. 1) Women may present with increased risks (in other words, continuity of carer in labour makes birth safer for these women). 2) They may need extra emotional support and encouragement. 3) Continuity of care enhances normal labour and reduces the need for obstetric intervention (Hatem et al, 2008; Hodnett et al, 2003; Simkin and Bolding, 2004). 4) They require care that facilitates open and honest communication and fosters an atmosphere of trust. Having a known midwife would be a distinct advantage in terms of both physical and emotional safety. In a higher needs labour such as VBAC, or in situations where a woman has had other prior uterine surgery or issues that may complicate the pregnancy or labour (such as history of child sexual abuse, a learning disability etc), continuity of carer with a midwife the woman trusts should be routine policy. In the Northern Territory, VBAC women are able to access the Darwin Homebirth Program. Fifteen VBAC women have birthed through the program, 10 of whom have had homebirths. Five were transferred, and the program has a caesarean section rate of 14.5%. While these numbers are very small, it is encouraging that the vast majority of VBAC women have been able to give birth at home. There is hope! I want to challenge each and every one of you to go back to your hospitals and take a good hard look at your VBAC policies. If they’re not evidence-based, revise them; if they are, then see them for what they are: a guide for staff, not law for the woman. The next time you care for a VBAC woman, ask her what she needs to feel comfortable and safe and give her what she needs. Don’t settle for less, because women and their babies deserve the best. © Caroline McCullough, 2008, 2009 and 2010. Please email me at cas@mumatopia.com for a full list of references. The joy of a new baby daughter was short lived when 26 years old bubbly Tasha discovered she had lost her bladder and bowel control. She struggled with feelings of failure and isolation as her bladder continued to leak and wondered if she would ever be able to chase or lift Ami. Confident, sporty Kate, a 33 year old Psychologist went from having confidence in her strong and active body, to finding she no longer liked or trusted it since the birth of her son, Harry. Her faith was shaken when she couldn’t join social activities with friends, and joked, ‘Harry has strained my wa- wa, and now I pee my pants’. Zip lock bags with pads and fresh panties were stashed in her car, nappy bag and desk at work to cope with regular accidents. Harry wasn’t the only one who needed changing through the day. Both Kate and Tasha underwent births assisted by forceps after a prolonged 2nd stage of delivery. And while studies show a higher rate of pelvic floor problems when birthing interventions are used (episiotomy, forceps, fetal monitoring, suction, heavy bearing down and poor delivery positions) any birth can be followed by pelvic floor complications. Rates of 46% for vaginal delivery and 35% for Caesarian delivery are reported for new mums experiencing incontinence and post birth pelvic organ prolapse. Kate and Tasha felt ignored and over looked by a poorly resourced health system after birthing and were advised to ‘get it fixed with surgery’. The previously supportive health system could not see the ‘Pink Elephant’ of post-natal incontinence and pelvic floor dysfunction. They persisted at home with exercises but were unable to control their pelvic floor muscles. Kate tried a biofeedback device and weeks of sitting on a magnetic wave chair without success. Tasha joined a gym only to find the exercises made her problem worse. Both women previously enjoyed a close, intimate sex life but now depression crept into their lives as their relationships were impacted. Kate said, ‘it now felt like a switch had flicked off, making everything numb’. Studies reveal 19 to 27% of women lose urine during sex along with reporting less vaginal sensation and weaker orgasms. From her Psychologists perspective, Kate wryly joked if any woman experienced prolonged sleep deprivation, loss of sexual sensation, wet pants and restricted activity (with resultant weight gain), depression was a certain outcome. Tasha agreed that her depression was related to the overwhelming changes caused by loss of bladder control and sexual problems. An Australian government report revealed 40% of all new mothers suffer with post natal depression which has long term health consequences. Yet, new mothers are not routinely questioned about incontinence or prolapse. Post natal depression questionnaires fail to take into consideration how a new mother’s mood is impacted through loss of bladder and bowel control, prolapse or sexual dysfunction. The turning point for Kate and Tasha came when they discovered they were not exercising the right muscles. Once they found, controlled and trained their pelvic floor muscles (PFMs) they quickly regained improved bladder control, and orgasmic sensation returned. Their ‘Pink Elephant’ had left the building! Their advice to other women is Pelvic Floor Physiotherapist Mary O’Dwyer, a Senior Teaching Fellow at Bond University, runs workshops teaching women, Fitness Professionals and Physiotherapists about exercise and the female pelvic floor. ‘Incontinence continues to be a wide spread problem in women of all ages with a huge personal cost and burden on the health care system. It’s difficult for many women to learn pelvic floor muscle control from a brochure so they give up or may practice the exercises incorrectly. All women should learn how to effectively control the muscles which keep them continent, assist with spinal stability and provide sexual sensation. Women’s silence surrounding the issues of pelvic organ prolapse, painful intercourse and incontinence will continue to see these problem viewed as ‘secret women’s business’, says Mary. In her books ‘Hold It Sister’ & ‘My Pelvic Flaw’ Mary addresses commonly held pelvic floor myths- The reluctance or inability to speak openly about this ‘Pink Elephant’ in the post-natal room needs to be overcome. All new mothers will benefit from understanding how they can take personal action to improve their physical symptoms and get on with re-establishing the rest of their lives and relationships.
Mary O'Dwyer Bio: Based on the Sunshine Coast, Mary is Director and Women’s Health Physiotherapist at Physiocare, a Senior Teaching Fellow at Bond University and Author . Regaining confidence with the support of other women at a Women's Retreat. About 18 months ago, I lost something precious. I didn’t really feel it at first. I was too numb from the entire experience. Too raw to feel anything, I submersed myself in work to avoid thinking about it at all. But a few months on, Angel came back to haunt me in the exuberant faces and big rounded bellies of other women who were six months pregnant with other, very precious somethings. At Christmas lunch that year, I was supposed to be sitting around on my lard-arse, contentedly rubbing my swollen belly, making my mother shift uncomfortably at the dinner table over conversations about homebirth and birthing pools. Instead I just missed my Angel. I missed him/her desperately and wished he/she was here … Tuesday, 16 September, 2008 I could feel myself slipping away. Dizziness took hold of me as I struggled to walk to the toilet, my husband Wayne on one side, a ward nurse I don’t even remember now on the other. I could feel the whiteness of my skin, the shallowness of my breath. It was a futile endeavour. I lay back down on the bed, exhausted, unable to move, in pain. The nurse came in to take my blood pressure. “That’s quite low!” he said. “I think we’d better get you in for that scan.” I had come in that morning at about 10.30 am and had been waiting all day for a scan that would tell me whether or not my baby was stuck in a fallopian tube. Why was it taking so long? He rushed out to see if he could hurry things along. I waited there alone. Wayne had left to pick up the kids from afterschool care. At about 5 pm, a friendly face came to my side. I recognised her—Natasha. We’d done a course together at Community Health. We both had sons with Autism. With the help of a nurse, Natasha tried to roll me onto my back. My body seized. I couldn’t breathe and started to panic. She quickly called for help. The nurse gave me some oxygen and put a pillow under my right side so that I wasn’t flat on my back. It was better but I still felt pain with every breath. It was easy to see that something was wrong straight away. There was no obvious baby blob in the uterus. She then did a scan of my upper right side and found a lot of excess fluid in my peritoneum and Pouch of Douglas. The pregnancy was ectopic and my right fallopian tube had ruptured. I was bleeding internally. That’s why I felt so much pain. That’s why I couldn’t breathe. That’s why the urgent phone call to Wayne and the sudden rush of activity to get me into theatre. Within a short while, Wayne and my boys had gathered around me. I reassured them that the doctor was going to make me all better. I found out later how scared my eldest was of losing his mum. I have wept many tears thinking about the unthinkable: what would have happened to them if I had died. A midwife I know came in and told Wayne she’d take the boys home with her for the night so he could stay and wait for me to come out of surgery. They rolled me onto the table gently. I felt like a beached whale, unable to breathe. The surgeon came in and a mask went onto my face. I heard conversation and felt a funny sensation. The talking didn’t stop and I thought “Why is it taking so long? It’s not working,” but quickly realised that I had simply slipped into a dreamless sleep and had just awoken in recovery. It was over. For now. The registrar came to my bedside in recovery and said, “You are a very lucky young woman. The surgery took a long time, about 1.5 hours. We tried to do keyhole surgery through your belly button but there was too much blood so we had to do a laparotomy to remove the tube and the products. The foetus was quite well developed and had a placenta …” I felt a pang of deep pain in my heart. He went on to tell me that I had been given two units of blood and would end up having more … All I could think about was my baby, and I wondered what they had done with him/her. I wished I’d asked for the ’products’ to be kept for me but I hadn’t thought about it at the time. And now I had yet another scar on my belly. The next morning, the registrar came in to check my wounds and go over the surgery with me once more. He said that given the amount of blood I’d lost, he suspected that I’d sprung a slow leak up to a week prior to the surgery … My mind raced back to the week before. Rewind to the Week Before … Driving to school one morning I had felt a sudden sharp pain in my right side but it went away, so I didn’t bother to get it checked out. I flew to Melbourne for the MC National workshop on the Friday, feeling a bit unwell and bloated. The Sunday night I left Melbourne is when things started to go really wrong. I thought I had a gastro bug. My husband had been unwell the week before and I thought that I’d caught his bug. An hour before I had to catch my plane home, I rushed to the toilet and stayed there for half an hour with cramps and diarrhoea. Something was seriously wrong with me. Somehow I made it onto the flight and home. When I arrived, I vomited everywhere and collapsed in bed. The Monday evening I phoned the midwife we had planned to hire and talked over my symptoms with her. She thought I had gastro and advised me to get plenty of rest. I had pretty much done the bare minimum that day. That night I woke up with massive cramps in my abdomen and couldn’t stop vomiting. I begged Wayne to take me to hospital. I kept saying, “This is not normal, something’s wrong.” Wayne thought I was just sick and talked me out of going to the hospital. The next morning he arranged for the boys to go to afterschool care and left me in bed, with our youngest, Adam, in front of the TV, while he went into work for a few hours. I phoned my friend Deb (who is also a midwife) and she listened while I recounted the events of the last two nights. Then she asked me if I thought it could be an ectopic pregnancy. I said I thought it was gastro or maybe kidney stones at worst. In hindsight I didn’t want to entertain the notion that I would lose my baby. After checking in with my midwife, I experienced severe pain. I phoned Deb back and told her I was calling an ambulance. She dropped everything and raced over to my house to collect Adam, arriving just as the ambos were getting me into the van. Adam retreated to his bedroom when the ambulance officers took me outside, so I was grateful that he had some support arrive at that moment. Deb arrived just as an Accident and Emergency (A&E) doctor came in to assess me. I told the doctor I was eight weeks pregnant. She asked me if I had confirmed that with a blood test. I felt exasperated. No, I had taken a home pregnancy test. She drew my blood to “make sure I was really pregnant.” Deb asked about the scan but the doctor insisted she needed my HCG levels first. A&E was busy and the blood test took a long time to come back. They had given me some morphine for the pain and medication for the nausea but the pain never subsided. My mouth was dry and I asked for some water. I hadn’t really had any all morning. They refused, saying that my chart said ‘Nil By Mouth’. I asked for some ice chips instead and Deb went looking for some, giving me little bits at a time. The doctor then came in and said she wanted to do a speculum exam to check for bleeding in my vagina. There was none, and I wondered why they weren’t just doing a scan – this all seemed like a massive waste of time. At about 2 pm, Deb had to leave to pick up her kids from school, but Wayne showed up just as she left. Throughout, Adam just sat there eating and playing. He was fantastic! I told him the Doctor House would make me all better. It was after that, that things really started to go downhill. The Aftermath… Nights were the worst. The Nursing Unit Manager for birth suites had arranged for me to have a private room in the Maternity Ward, where all the gynaecological patients also go, but there was a lot of noise which made sleep difficult. That first night, listening to babies (and some mothers) crying was awful. Every night I pretended that they weren’t actually babies but wild animals in the jungle. Mentally, it was the only way I could cope. I felt like that guy in I Am Legend, surrounded by a mutant mass of humanity gone wild. I was in hospital for a week and it was the longest week of my life. I needed two more blood transfusions because I was still losing a lot of excess blood. Then a cough developed into spiking fevers on the Friday night and I was sent off for an X-ray, which showed my lungs had partially collapsed (probably from the surgery, I was told). It turned into pneumonia. In the few days I had been in hospital I had been stabbed and jabbed no less than 27 times with about five recannulations. My veins weren’t coping too well with the massive amounts of antibiotics being pumped into them and the blood drawn each day to assess my haemoglobin levels. The worst was when they took blood out of my radial artery to check my blood gasses. The pain was excruciating. I just wanted to go home but they said I needed to stay another day for intravenous antibiotics. That last night on the ward I felt defeated. I thought they’d never let me out. I thought about my children who I had barely seen that past week. I missed them terribly. At that moment, one of the midwives I knew through our BaBs group walked in the door to see if I was okay. That happened a lot during my whole experience. At each moment where I felt alone or scared, someone familiar—a friend, my partner, a midwife I knew—walked through the door. I had a room full of flowers to remind me that people were thinking about me and not a day went by without several text messages and phone calls, sometimes more than I had the energy to handle. I went home on the Tuesday, exactly one week after I had gone into A&E. Going home was definitely the best medicine. I couldn’t wait to hold and kiss my beautiful boys. Five months later … I don’t know if we will try to have another baby or not. I’m still raw and hurting from the experience of losing that something precious. I’m still trying to process what happened. It didn’t feel like a miscarriage but that’s what everyone kept referring to it as, even in the SANDS brochure. There was nothing wrong with my baby—he or she was just in the wrong place. I wanted to know why this had happened to me. It turns out that I was simply unlucky. I had no risk factors predisposing me to an ectopic. What I did learn was worrying, in light of the lack of education about pregnancy and childbirth, particularly amongst younger women. I found that pelvic inflammatory disease (PID) is one of the primary causes of ectopic pregnancy. PID is mostly prevalent when women contract Chlamydia. So, the more sexually active you are (ie. The more partners you have) the more likely you are to contract PID and have an ectopic. Once you’ve experienced a tubal ectopic, you are more likely to experience another one and, the more pregnancies you’ve had, the more at risk you are. There has also been some debate about the use of internal contraceptive devices and the use of the Morning After Pill, though there is no conclusive research showing a significant relationship between these and ectopic pregnancies. Lack of access to emergency facilities is a social risk factor that is not discussed in studies, but became apparent to me when I read about a woman in rural Victoria who died recently due to an ectopic because she didn’t make it to a hospital in time. After getting so sick, I needed to regain a sense of joie de vivre. So, when an opportunity presented to go on a weekend women’s retreat with some other women, I jumped at it. It was a turning point for me. I was able to regroup and get my body moving and working again by connecting with like-minded women, doing a difficult ropes course and learning how to canoe. I’ve also planted the beginning of what will be a permaculture garden in our front yard—a living memorial to the baby we’ve named Angel Riley. Working with the soil, growing seeds and burying my pregnancy test (my only relic) with a Magnolia tree has been healing. There is still much healing to do. Maybe it will be better when my due date passes. I’m not there yet, but I’m getting there. References: Nama V, Manyonda I. (2008). Tubal ectopic pregnancy: diagnosis and management. Arch Gynecol Obstet. Jul. Sindos M, Togia A, Sergentanis TN, Kabagiannis A, Malamas F, Farfaras A, Sergentanis IN, Bassiotou V, Antoniou S. (2008). Ruptured ectopic pregnancy: risk factors for a life-threatening condition. Arch Gynecol Obstet. Sep 2. Postscript: This article was first published in Birth Matters Journal, March, 2009. The issue was on grief and loss and we sold out, it was so popular. I am happy to say that Angel’s Garden is thriving and so are we. We have decided not to have any more children now but that’s okay. I have three gorgeous boys, a wonderful husband and am trying to make the most of every day. What happened in 2008 changed me and our family forever and I can only be grateful for the blessings that have followed, even if sometimes I still feel sad and heartbroken for the little Angel we lost. In recent years, research has found that a distressing childbirth experience can trigger Post-traumatic Stress Disorder (PTSD). It is estimated between 1.5 to 6 percent of childbearing women would meet the criteria for Post Traumatic Stress Disorder, following a traumatic childbirth experience (Beck, 2004b). Cheryl Tatano Beck is one of the leaders in this field of research and below is a review of her key findings about birth trauma and PTSD. The applicability of the PTSD diagnosis has been hotly debated in relation to childbirth, primarily because childbirth is seen as a normal event in a woman’s life and the DSM-III criteria (criteria set by the American Psychiatric Association) requires that an event be outside the realm of normal experience. The DSM-IV criteria is, however, broader in its definition and states that PTSD can be triggered by “direct personal experience of an event that involves actual or threatened death or serious injury, or a threat to the physical integrity of self or others,” (APA, 1994, p.424 cited in Beck, 2004b) Traumatic episodes can be caused by a range of stressful events. Beck (2004a) identifies emergency caesarean, stillbirth, use of forceps or vacuum extraction to get the baby out of the birth canal, poor clinical and emotional care, a previous history of psychiatric care, fear of epidurals, medical emergencies requiring prompt intervention (eg. Haemorrhage), prolonged labour, rapid labour and birth and being made to feel/feeling degraded as experiences that may lead a woman to perceive her birth as traumatic. The Experience of Birth Trauma In her groundbreaking research, Beck did a phenomenological study using grounded theory to ascertain themes commonly shared between each of the participants. The research involved 38 women, the majority being from New Zealand. Her research is consistent with much of the evidence currently available on birth trauma and PTSD. In her initial study on childbirth trauma, Beck (2004a) identified four themes showing what led to traumatic childbirth experiences for the women in her study. Theme 1: To care for me: Was that too much to ask? Beck identified that a lack of a caring approach during childbirth contributed to traumatic events for some women. Responses included feeling abandoned, alone, stripped of their dignity, in some instances feeling “raped”, a lack of empathy or interest in them or their needs and lack of reassurance and support. Women also reported feeling betrayed by those who they entrusted with their care. Some described feeling like a container that the baby was extracted from. Theme 2: To communicate with me: Why was this neglected? Women reported feeling “invisible,” with clinicians speaking to each other as if the woman was not there. A failure to explain to women what was happening was also associated with women experiencing their births as traumatic events, as was a failure of staff to communicate material information about the woman’s individual circumstances, history and fears with each other. Theme 3: To provide safe care: You betrayed my trust and I felt powerless. Beck identified that most of the women interviewed believed they would receive safe care prior to giving birth and that they felt a loss of control and powerlessness when they were given poor clinical and emotional care. Another aspect that contributed towards this was ignoring what the woman was saying in her childbirth experience. Theme 4: The end justifies the means: At whose expense? At what price? Women identified that their experience of childbirth was overshadowed by the outcome if they had a live healthy baby. Women reported feeling that their experience was glossed over as their babies “took centre stage”. This was despite some reporting having “out of body experiences” and a feeling of having been “raped”. Beck stated that some women viewed the place of birth as a “battlefield” in which they were stripped of their defences and “exposed to the onslaught of birth trauma.” The aftermath of birth trauma In her followup study on the aftermath of birth trauma, Beck (2004b) identified that women’s responses to birth trauma are reflected by five distinct themes. Theme 1: Going to the movies: Please don’t make me go! Women described experiencing flashbacks and terrifying nightmares of the traumatic event. These were often described as uncontrollable scenes that replayed over and over again. This left a woman feeling “stuck in the past, unable to enjoy the present with her infant” (Beck, 2004b, p.219). Women avoided sleep in an effort to avoid the nightmares and the flashbacks and these would affect the woman’s relationship with her child, other children and her partner including sexual avoidance. Theme 2: A shadow of myself: Too numb to try and change. Women reported feeling numb and dissociated, like they were a “shadow of their former selves” (Beck, 2004b, p.220). Instances where women described out of body experiences were common in Beck’s study. Beck reported that this sense of numbness and detachment would continue after the birth. Women would report mechanically going through the motions of motherhood but not allowing emotion to surface. Theme 3: Seeking to have questions answered and wanting to talk, talk, talk. Beck reported that mothers who experienced traumatic births felt an intense need to learn the details of their experiences and get their questions answered. Women would become obsessed with understanding what happened to them and why, which would manifest itself in women making repeated appointments with clinicians to go over the birth or their records. Others read obstetric textbooks and medical journal articles to gain some clarity. Women also reported the need to talk excessively about their experiences. However, they also reported that people (care providers, family, friends) would “become tired of listening” (p.221). This would lead women to stop discussing their experiences, which Beck identified as “detrimental” to their mental health. Instead “their unasked, unanswered questions “gnawed away” at them” (p.221). Some women would take their questions and complaints about their care to high authorities only to be “retraumatised” after their concerns were dismissed. Theme 4: The dangerous trio of anger, anxiety and depression: Spiraling downward. Beck reported that women experienced anger, anxiety and depression at a “heightened level” (p.221). She states, “anger was rage; anxiety turned into panic attacks and depression left many mothers suicidal” (p.221). Anger would be directed at care providers, family, and the woman herself. Beck found, “women who had never experienced panic attacks before their birth trauma, began to be plagued by them,” (p.221) and sometimes depression would lead a woman to contemplate taking her own life. Theme 5: Isolation from the world of motherhood: Dreams shattered. Beck revealed that women felt cut off from three “lifelines into the world of motherhood” because of their traumatic experiences: the woman’s baby, the support and friendship of other mothers and hopes for any additional children (p.222). PTSD would distance mothers from their babies and from other mothers and babies. Some could not cope being around mothers that hadn’t experienced traumatic births and some could not cope with being around pregnant women. Some women in the study elected to have no more children, having tubal ligations or convincing their partners to have a vasectomy because they were terrified of childbirth. Some opted to have more children but felt a need to regain control by careful planning and choice in care providers. Of those who became pregnant again, some reported increased incidence of panic attacks, depression and terror at the prospect of having another baby. A plea to women If you view your childbirth experience as traumatic and are experiencing any of the symptoms above, you might benefit from seeking support from other women who have experienced a traumatic birth and counseling from a qualified practitioner who understands about the importance of childbirth. If you know of someone who may have experienced birth trauma, give her the room she needs to explore her experiences, talk about them and process and define them. Try to avoid using phrases like “at least you have a healthy baby” or “it might not have turned out how you hoped but you should be thankful you’re alive and your baby is alive.” These words are unhelpful and often cause the woman to feel a deep sense of pain and guilt at feeling bad about the birth of her baby. A plea to care providers If a woman feels the need to talk about her birth experience over and over again, if she seems wide-eyed and dissociated from the experience, is showing hyper-vigilant tendencies and reports having flashbacks or nightmares about the birth, there’s a strong likelihood the woman may be suffering from PTSD. It is important to refer women to peer support networks and counselors that understand the importance of childbirth, but as her care provider, it is also important to listen and understand the woman’s need to debrief and talk about her experience. Training in non-directive counseling may be beneficial to clinicians and those providing support. As Cheryl Tatano Beck points out, trauma is in the “eye of the beholder” and this is something to bear in mind when supporting a woman who has experienced what she perceived to be a traumatic birth. The woman must be given room to define her experience as she sees it so that she can move forward. Preventing symptoms of PTSD Beck advises that in the birth room, care providers need to treat every woman carefully and with sensitivity, as if she was someone who may have experienced a prior traumatic birth. Providing women with information about what is happening to them or their baby, listening to their concerns, empowering them to be part of the decision-making and just showing you care can all contribute to creating a positive experience of birth, regardless of how it unfolds. In the Antenatal period, Beck recommends care providers take a thorough history of a woman’s fears, and previous experiences and, if applicable, ask how a woman felt about prior births. When birth plans go awry, as they sometimes do, women’s disappointment and distress regarding their experiences need to be addressed with empathy by clinicians who should also keep a watchful eye out for signs and symptoms of PTSD including: a dazed look (looking past you when speaking about the birth, like a rabbit in headlights), dissociation, withdrawal, temporary amnesia and avoidance. When a woman has experienced trauma in a previous birth she may feel a real need to gain control of her labour and birth experience by seeking out the care of a known midwife or obstetrician, by electing for caesarean section or by planning a homebirth (even when clinically contraindicated) to avoid interventions that may have lead to her prior traumatic birth experience. She may show extreme fear and mistrust of healthcare providers and in some cases, being pregnant again may bring on more intense symptoms that may cause extreme emotional behaviour in either pregnancy or birth, dissociation as women psychologically escape from their current pregnancy or labour, and an intense need to control their experience of childbirth. Debriefing with a caring professional or peer support group may help to reduce trauma symptoms but women may not necessarily want to talk about their experiences right after birth. Sometimes it can take months and sometimes years. Sometimes being pregnant again can re-traumatise women and take them back to the traumatic event. Resources: Birthtalk. www.birthtalk.org. Birthtalk convenor and CANA support contact Debby Gould provides free over the phone support for women who need to talk about their births. Debby is a registered midwife and childbirth educator and has been empowering women affected by PTSD for the past seven years. Debby’s phone number is (07) 3878 7915. Trauma and Birth Stress in New Zealand (www.tabs.org.nz) provides evidence-based information and support for women who have had distressing births. Sinead McGurrell, BSSc. Qualified counselor. www.mindmassage.com.au — Australia-wide counseling available – telephone, internet or face to face in Brisbane. References: Tatano Beck, Cheryl. (2004). Birth Trauma: In the eye of the beholder. Nursing Research, January/February 53(1): 28 – 35. Tatano Beck, Cheryl (2004). Post-traumatic stress disorder due to childbirth: The aftermath. Nursing Research, July/August 53(4): 216 – 224. Note: The suggestions proffered above are based on my own experiences of healing from PTSD, my work as a Research Assistant with Dr Jenny Gamble, researcher on Birth Trauma at the School of Nursing and Midwifery, Griffith University and my experiences of attending Birthtalk: Healing from Birth sessions. It is not intended as authoritative advice, merely suggestions based on evidence-based research and experience. Caution: birthing woman on road! We’ve all been exposed to the familiar cliché of babies arriving in the back of a car and maybe those of us who have had 20+ hour labours feel a little jealous of women who just pop their babies out in no time at all, but does a fast birth necessarily mean that the woman is “lucky” and that it was a good experience? In 2008, a news story highlighted the shock and horror of a baby being born very fast in the toilet of a major Sydney hospital. The couple, Kathy and Nick Patsidis, clearly traumatised by the experience, blamed staff shortages for the incident and the hospital blamed Kathy’s fast labour. Either way, perhaps we should be wondering what underlying factors may have turned what should have been a straight forward birth, into a nightmare for the Patsidis family and for the many other parents who experience speedy births in not so ideal circumstances. Despite the hospital’s claims that the couple were not left alone, the Patsidis made it clear they did not feel like they were the highest priority for the staff on shift that night. Consider the difference it might have made to the Patsidis if they had not felt alone, abandoned and alarmed by what took place. What could have made a difference? Author and academic Dr Lareen Newman who experienced three very fast births decided to have a planned homebirth after having an unplanned homebirth with her second baby. She was so affected by her experience and the care she received by her midwife that she wrote a book titled Better Birth, published in 2006. She says: “In our culture today there seems to be a cultural belief that it is risky to have a baby without medical assistance (even if it is not needed) or outside of a major tertiary hospital.” “When most people and doctors think of homebirth they relate it to the high mortality of developing countries or of Victorian England, not homebirth in a developed country with an experienced professionally-qualified midwife and close proximity to a back-up hospital.” “My own fast birth with the second baby at home in our bathroom was an enormous shock for me. I had about 2 hours of mild niggles during early morning, followed by 30 minutes of “second stage” as ambulance officers were just coming through the front door. “It just made sense the third time to stay at home and have a midwife come to us so that it wouldn’t matter how quick the labour was. To have my own known midwife also made me feel much more reassured that we could cope with whatever happened, fast or long labour, home or hospital.” As the Patsidis’ story illustrates, the trauma and shock experienced after an unexpectedly speedy birth is not something that is acknowledged in our childbirth culture. In internet chat rooms, the length of someone’s labour is often seen as an indicator of a good birth. “Only a four hour labour! You were lucky!” Conversely, a long labour is often seen as a traumatic and horrendous experience. Canadian Researcher Catherine Rippin-Sisler examined women’s experiences of precipitate labour. The women she included in her study received standard hospital-based care (ie. fragmented care). She found that emotional reactions such as disbelief, panic, alarm and distress were common amongst the women in her study. Although her study was small, she recognised the need for care providers to provide calm, individualised care both during and after the birth and to recognise that women can experience emotional trauma as a result of a quick birth, even if the overall experience was perceived in a positive light. Rippin-Sisler said: “A woman’s labour experience is hers to define (in terms of being a positive or negative experience), and care providers would do well to listen to a woman’s description of her experience and not pre-judge that shorter means better, or that at least she had a healthy baby. “When an experience is described as negative, care providers need to explore with the woman what would have changed her perception, and as appropriate, what could be done for a future experience to improve it for her,” she said. But in a system where the vast majority of women don’t have access to known care providers to guide them through the experience, it seems the only way for women to experience calm and individualised care is if they pay for it themselves. The Cochrane Review, which offers the most authoritative source of evidence-based information on health care in the world, states that women who have continuity of care feel more supported, have better outcomes and experience a more positive start to new parenting. In New Zealand, women have the benefit of choosing a midwife as their lead maternity carer. The midwife provides all antenatal, birth and postnatal care from early pregnancy to up to six weeks postnatally. She or he spends considerable time preparing a couple for childbirth, gets to know them and their fears, follows them from home to the birth unit (if that’s where they choose to give birth) and doesn’t have to leave their side during labour to attend two or three other women labouring in rooms next door. In Australia, this type of care is not easily accessible for most women but even if it is, many public midwifery services don’t allow midwives to start labour care at the woman’s home, let alone attend a home birth (planned or otherwise). Some services are so stringent in their entry criteria, that a woman may also lose care by her midwife late in pregnancy if she develops any complications. Doulas (professional birth attendants who provide non-clinical support to birthing women and their partners) are becoming more popular in Australia mainly due to a lack of services for women who don’t fit within the narrow perimeters of “normal” for most midwifery programs. A trained doula will spend time with a couple in the lead up to a birth, attend the mum-to-be in her own home prior to established labour and will travel with the woman to a birth unit. If the woman has chosen to birth at home, the doula will work with the attending midwife to provide comfort measures and emotional support to the woman. If the woman chooses to birth her baby in a birth unit, the doula provides continuous non-clinical labour support (ie. comfort measures, emotional support, information and advocacy) regardless of whether the woman knows her clinical care providers or not. Regardless of a woman’s care scenario, a fast birth may happen prior to a midwife or doula arriving. Preparation is then key. The common obstetric response to women who are prone to precipitate labour is to recommend induction of labour at term (38 weeks) so that the woman does not have to deal with the “dangers” and “risk” of an “abnormally” fast and unexpected birth. Sydney-based midwife and researcher Hannah Dahlen says practitioners should be cautious about recommending obstetric intervention for subsequent births. “I am particularly concerned about induction of labour because one of the biggest risks for women who have very fast labours is haemorrhage and that risk is increased by induction of labour. There is also an increased risk of cord prolapse if the baby is still floating quite high in the uterus which is often the case in unexpectedly fast labours,” says Dahlen. Dahlen says that the key thing for the woman is to call for help right away if the baby comes suddenly. She says to get down on the floor rather than stay standing up as one of the most common injuries to babies comes from falling out of the birth canal. The other suggestion she makes is for the woman to lie on her side to slow things down and not to go to the toilet if she feels like passing a bowel motion. When the baby is born, Dahlen says not to sever the cord from the placenta, but place the baby on your chest skin to skin with a warm blanket over top and call an ambulance (or get your partner or someone who is there to call if possible). For women who are going to a hospital or birth centre to have their babies, she recommends they learn about recognising the signs of labour and phone the midwife at the hospital if they are at all concerned. “The midwife is often very skilled at recognising when a woman’s labour is progressing fast just by listening to the woman on the phone for a few minutes.” “Women often ask: ’What happens if my labour goes really fast?’ I just try to take the fear out of it to show that if a baby is born quickly at home, it’s really not a big deal.” Useful Sources: I nervously checked the time on the clock. This was to be Kate’s third visit to my house. She was usually late but I was feeling jittery today. The week had not gone well and I needed to talk to someone who didn’t look at me like I had two heads. At 10 minutes past ten Kate arrived on my doorstep. We did the usual, sat down with tea in hand on my living room floor with Liam playing between my legs. “So, how has your week been then?” asked Kate. “Not good.” I smiled as I said it. For the next hour I spilled every detail of how my week had unravelled onto the floor, how I had called one of the women in my playgroup seven times asking why she hadn’t called me back from an initial phone call, how I had thought about taking some pills 3 times that week, how I had brushed off my husband’s touch yet once again, how I’d fallen out with my sister-in-law (my one lifeline). In tears I recalled again the flashbacks from the caesarean surgery that were frequent visitors day and night and how just the thought of going to the post office 200 metres down the street, sent me into a panic. All the while Kate listened, and offered her support and acknowledgement. At about 11.30am Kate got up to leave, hugged me, and said “see you next week then!” I felt the weight lift as she walked out the door. Kate was a midwife and health visitor who I met at a local baby clinic while we lived in the UK. I had come into the clinic one day panic stricken and crying so the midwives gave me the Edinborough Postnatal Depression Test to take and with a score of 13, I was told that it was very likely I had Postnatal Depression. Kate wasn’t my usual case manager but I didn’t feel comfortable with the one they had assigned me, so she took me under her wing. The UK health visiting service offered weekly non-directive counselling sessions with a midwife for eight weeks after diagnosis of PND. So, for eight weeks, Kate, broad smile on face, enthusiastically had planted herself on my floor while I talked about Liam’s birth and about the way things were unfolding for me on any particular week. There was no judgement. There was no hint from her that I was an incompetent mother. During those eight weeks I felt free to tell her anything and everything. “What happened with your birth?” Kate asked at her first visit. What followed was two hours of sobbing. By the second week I had pulled myself together enough to speak coherently. “They induced me and it didn’t work. My baby went into distress and they had to do an emergency caesarean,” I explained. “While they were cutting into me I felt pain and I panicked. The anaesthetist said it was just pushing and pulling but it was painful. They just ignored me! Next thing I knew they had pulled Liam out of me and then knocked me unconscious. I woke up two hours later in recovery. The midwife said ‘I’ve never seen that happen before!’ I felt completely useless. The Dr walked in a day later, patted me on the leg and said, ‘not going to have a big family then are we.’ I was devastated. I wasn’t even capable of having a caesarean. I don’t think I want any more children. I can’t go through that again!” Each week I revealed more pieces of the story, about how the obstetrician and anaesthetist had a conversation about ski trips while I was laying there waiting for my emergency caesarean, how I didn’t feel like I could touch or care for Liam without asking someone’s permission, how I dissolved into tears just trying to buckle him into his car seat when we first left the hospital and how I suffered abdominal cramps for three weeks post-surgery because of a uterine infection. Each week more sobs and guilt over the fact I had this beautiful little boy that I felt I couldn’t fully love. Each week, Kate listened with patience and care. Of course, eight weeks weren’t enough to heal the damage in my heart but those conversations with Kate, laid the foundations for what would be many years of processing and healing. In the last few months of our time in the UK, I had convinced myself that everything was okay. I didn’t want to drag people down with my horror story and most women I knew couldn’t relate to be honest. The vast majority of them had had normal births in a low intervention maternity hospital. I didn’t want to admit weakness. So, I went through the motions of mothering and tried to get on with life but of course, when we don’t take the time to adequately deal with our emotional baggage, it has a way of resurfacing. For me, the start of a new pregnancy brought with it a resurgence of grief, anxiety and deep depression. A few weeks into the pregnancy, I started to experience invasive flashbacks again. Feeling panicky, I contacted another midwife I had read about in the newspaper. My husband had sent me a link to an article on post traumatic stress disorder following a traumatic birth. I had always thought the PND label didn’t quite fit with what I was experiencing. Yes, I was definitely depressed but there was a lot more going on than that. The newspaper article seemed to describe my experience to a tee—flashbacks, nightmares, panic, heightened anxiety, avoidance, paranoia, hyper vigilance. As I was reading the article I pondered the events that had taken place in the UK… my house was cleaner than ever, my baby well cared for but the flashbacks were pervasive. I felt trapped in a nightmare. Going to doctors appointments was the worst. I had heart palpatations even before I left my house. The stress and anxiety were crippling. I had this constant knot in my stomach and couldn’t relax. Inviting this midwife to my home was to be a turning point for me. After three long hours of talking, crying and frank discussion about the realities about what happened in Liam’s birth, I realised that if I was to get through this next pregnancy, I needed support. Shortly after that discussion I started reading voraciously about childbirth and I contacted a support group called Birthtalk. At the first meeting I went to, I discovered that there were more women out there like me. All of a sudden, instead of feeling like a crazy person, I felt normal. Other womens’ acknowledgement that what I had been through was hard and difficult gave me renewed strength to get through the next week and hope for a better experience of childbirth the next time around. Once I realised that my reaction was a normal response to an abnormal and basically crappy experience of childbirth, I realised that I wasn’t losing my mind and I wasn’t alone. Whilst the women at Birthtalk were understanding and compassionate, I didn’t find others to be so supportive. My doctor treaded a little too carefully around me and his secretary one day asked me if I had been to see a psychiatrist. I think they assumed that because I had been traumatised, I was somehow incapable of making rational decisions and treated me like I was a crazy person as a result. This just annoyed me. There were also well-meaning people who made throw away comments like “just get over it” or “at least you had a healthy baby”. These words just made me feel more anxious. After Daniel was born I realised that the events surrounding Liam’s birth, the sensation of pain etc weren’t all in my head (as I had secretly wondered). Daniel was born by caesarean but the experience was vastly different. This time there was no pain and a lot more respect. It helped me to build the confidence I needed to go into my next pregnancy with a mission to regain a sense of calm. 10 months after having Daniel I fell pregnant again and this time, I was able to thoroughly enjoy being pregnant. I was still having difficulty with doctor’s appointments but the anxiety was not as profound as it had been the second time around. Having hour long appointments with my midwife really helped me to work through my fears and address my needs. I went on to have an uncomplicated natural birth and felt elated! Birth hadn’t healed me as such, because in many ways I then felt I had to grieve over what I had been robbed of the first two times, but it confirmed to me what I was made of, very strong stuff. Thinking back to those conversations with Kate, they set the tone for that last birth. She had set me on the path to healing. If I hadn’t had that support, I don’t know what I would have done. Now 10 years have passed since Liam’s birth and whilst the flashbacks are still there, they don’t control my life. The intensity has lessened over the years but not because of time, because of the loving support of midwives and women who understood what I had been through and who helped me forge a way forward. This article was first published in Birth Matters Journal, 2009. © Caroline McCullough, 2009, 2010. Son no. 3 was born at 43.5 weeks, healthy and happy. Cas McCullough explores what it is like to have a long pregnancy and how to make informed decisions about interventions in a world where nearly every baby is born ‘on time’. My first baby, Liam, was born at 38.5 weeks gestation by emergency caesarean section so, I didn’t have any idea how long I’d be pregnant for when I became pregnant with baby number two. At 36 weeks I thought “any day now”. I just had a feeling that my baby was going to arrive early and I couldn’t wait. Thirty-eight weeks came and went and my baby had turned breech. By 39 weeks he had decided to turn around and dropped into my pelvis. My belly was so low I could practically bounce it on the pavement. By 40 weeks I was about the size of the Titanic. Well meaning old ladies would stop me in the shopping centre and say, “you’re taking quite a risk being out now”. You should have seen their faces when I told them I was due any moment. At 41 weeks I was starting to get nervous as none of the induction “tricks” I had tried were working. I had taken Evening Primrose Oil, had acupuncture, sex and went for long walks, all to no avail. When was this kid going to come out? My doctor eyed me over and said, “Well, I’ll see you in the labour ward this weekend then.” But the weekend came and went and still nothing. I was getting desperate. I knew that if I got to 42 weeks and there was no sign of a baby, I was going to be under enormous pressure. Sure enough, at 42 weeks I found myself sitting in my doctor’s office still pregnant! He said, “I think it’s time for you to have this baby.” I really wanted my baby to be born naturally if possible as my previous caesarean had been very traumatic and I knew from the research I had read that induction may be an unwise option given I’d had a caesarean already (as induction increases the risks of uterine rupture) (1). As such it was important to me to ensure that a planned caesarean was really warranted in this situation. So we went to see a Sonographer (a specialist radiologist who does ultrasounds) to check the baby’s wellbeing and were informed that due to the lack of fluid surrounding the baby, intervention would be prudent. The next morning, at nearly 43 weeks gestation, Daniel was born by elective caesarean section. In hindsight, I felt I made informed decisions about Daniel’s birth but I also felt I made informed decisions about my last baby’s birth. Adam, was born at 43.5 weeks with no complications whatsoever. Given the differences between each baby’s birth and the rarity of significant complications, I have often wondered at the wisdom of routine induction. Fifty years ago a gestation period of 10 months wouldn’t have been a predicament. At that time, most women weren’t aware of when they’d conceived and nor could they tell from test results. So, if a woman went past the 41st week everyone was none the wiser – no one panicked! The wards weren’t full of women on Tuesdays and Thursdays for scheduled inductions and babies came in their own sweet time. Nowadays it is a different story. Very few women continue with a pregnancy beyond 41 weeks and most are routinely scheduled for inductions should they reach that point. Some doctors will leave it until 42 weeks and even some until 43 or 44 weeks, but they are rarities (as are the number of women who reach that gestational age). Regardless of an obstetrician’s viewpoint on what constitutes post-dates, the one thing they seem to have in common is the idea that all pregnancies have a use-by-date. One reason for this is that a study was done in Canada which showed the risks of unexplained still-birth were increased to 1 in 500 after 42 completed weeks gestation and doubled at 43 completed weeks gestation. Therefore for every baby that may die after the 42nd week, 499 are routinely subjected to intervention which can carry its own set of risks and problems (2,3). So, once a woman reaches the magic 40 week mark she can suddenly feel pressure to perform. This pressure does not only come from doctors. It comes from partners, families, work colleagues, friends, acquaintances, neighbours and little old ladies in shopping centres. However, nobody has yet researched how the pressure put on women to birth their babies to a strict time schedule could potentially prolong pregnancies. Some have theorised that when the clock is ticking it can create enormous anxiety which can increase adrenalin levels (which can inhibit the onset or progress of labour) (4). So what is this pressure cooker like? Second Pregnancy: All of sudden, the phone won’t stop ringing. “Have you had that baby yet?” asks my well-meaning 90-year-old great aunty. “Yes, I had it and didn’t tell anyone!”… well that’s what I wanted to say. “No, I’m still here!” I would say with a smile on my face and my fist clenched. Later the phone would be found in the rubbish bin. Eventually we recorded a message informing callers the baby had not arrived and we would tell everyone when it did. Then when that didn’t stop callers we took the phone off the hook and stopped checking the email. In fact, me, an email addict – couldn’t even look at the computer. “Why won’t they just leave me alone?” Beyond the social pressure there is also an internal struggle to deal with. There is such little information available on post-date pregnancies that it is very difficult to make an informed decision about the well-being of your baby based on medical research alone. I had researched my options thoroughly during my second pregnancy but was unprepared for the anxiety that came along in those final weeks. As much as I tried not to take others’ doubts on board, I constantly questioned myself and worried about my baby. Every morning I woke up without a baby in my arms I would feel so disappointed. Then I started to get what I thought were contractions and thought “this is it” but alas, by the time I flopped into bed they would disappear. It was extremely frustrating and I was an emotional basket case by the time I reached 42 weeks. This was despite knowing that my baby was fine and that it was okay to have a baby past 42 weeks if the baby and I were well. At that stage I felt very alone. Friends told me later they thought I had lost the plot and my husband thought I was being hormonal and emotional and even accused me of wanting to put my birth experience before my baby’s well-being. I just wanted to crawl into a great big hole. It felt like everyone around me had abandoned me in my hour of need. No wonder I felt sadly relieved when we made the decision to have the caesarean. I felt battered and bruised and just wanted it to be over. 3rd Pregnancy: I made some very different choices. I chose share-care between a midwife I knew and trusted and a consultant obstetrician. I chose to decline the 18 week scan and not have any scans for the remainder of my pregnancy because I felt a need to connect with my baby more intuitively rather than judge him or her based on size, weight, expected due date and any potential “defects” that might present during an ultrasound. I chose not to tell most people when my baby was due and “locked down” for the final few weeks. I did not check the email, I did not answer the phone and just tried to relax and spend time with my family. I accepted that “what will be, will be”. I made a real effort to communicate openly with my husband, inform him as I became informed in a way that suited him, and involve him in the decision-making process. Whatever choices a woman makes it is vital she feels supported and safe. It is important to be fully informed prior to making a decision regarding a post-date pregnancy and to also trust her intuition. Caregivers that are willing to respect and support women during this time can also make an enormous difference and take the “lid off” that pressure cooker environment. Towards the end of my last pregnancy we monitored my baby’s movements carefully and had electronic foetal monitoring traces done every few days to see how he was doing. At no point was the obstetrician, the midwife or I worried that Adam wasn’t doing well. If we had been, I would have had another caesarean in a heart beat. At 43 weeks I asked my midwife to do a membrane sweep (which has been proven to help speed up the onset of labour) (5) and went and had some acupuncture. Those were the only interventions I had. After a long early labour and a very short active labour, Adam was born peacefully and naturally with no complications and a very healthy placenta. Whether you choose to continue with a pregnancy until you go into spontaneous labour, have an elective caesarean or opt for induction of labour, examine your individual needs and the benefits, risks and alternatives so you can make an informed decision that is right for you and your family. While I chose paths that might seem outside-the-box to some people, they were definitely the right paths for me and my babies. I feel confident that I weighed up all the options and the results were two empowering births with two healthy babies and a happy me. What you can do to ease the pressure if you go past 40 weeks: (1) Kayani, S., and Alfirevic, Z. (2006). Induction of labour with previous caesarean delivery: where do we stand? Current Opinion in Obstetrics and Gynecology, 18:636–641. This article was originally published in Natural Parenting Magazine in March, 2005. In their own sweet time: a journey into post-date pregnancy is © Caroline McCullough 2005, 2007 & 2010. Angel's garden in its infancy Two years ago I lost a baby in early pregnancy due to an ectopic pregnancy (where the baby develops in the fallopian tube instead of the uterus). It was the hardest and saddest experiences I’ve ever gone through and I’ve since gained a new appreciation for early pregnancy loss and also for the wonderful family I still have. It was a life changing experience in that I took stock of what I was doing with my life and in the following year made some massive life changes. One of the things I did in the year following was to establish a memorial for my lost Angel. I didn’t want to just put a plaque in the ground or plant a tree. Many of my friends had been so generous and kind to our family during that difficult time, so I also wanted to honour them and find a way to pay their kindness forward. A good friend gave me three citrus trees, so I decided to get to work on a garden. Our road curves around the ridge of the Brisbane river and most of the homes along this stretch are impressive with beautiful manicured front gardens. Not our house though. Don’t get me wrong. We are blessed to live in a lovely home but our front yard is not quite so tidy. You see, we decided to plant Angel’s garden, a permaculture garden with fruit and veges galore, smack bang in front of our house. I had two main reasons for this. The first was that the ground in that part of the garden had the best drainage, the flattest land (we live on the side of a hill) and the best soil. The second was that I had this vision of neighbours walking by and being able to help themselves to our bounty. It would be the garden that kept on giving and we’d have the opportunity to build relationships with the people we share our lives with. What better way to honour my Angel. I’ve been inviting my neighbours to collect herbs etc from the garden for months but most see it as an intrusion to ask. If anyone is walking by and I’m out in the garden, they usually go home with lots of extra goodies, including eggs from the chooks. Lately though, a few friends have been taking advantage of my offer of free herbs and veges and I couldn’t be happier. One of my friends, who lives just over the river, has harvested my lemongrass to make tea. One of my neighbours came by last night just to cut some parsley for her soup. I barter some of my excess vegetables with other friends who have vege gardens and organic food stockpiles and we keep any neighbour that happens upon us in good supply of fresh, organic eggs. Nothing goes to waste. Whatever isn’t eaten gets fed back to the chooks and the worms. They pay us back in kind with lots of natural fertiliser. You don’t have to live in the outback to experience the difficulties associated with lack of local maternity services. Many of the smaller regional hospitals around the Ipswich area no longer provide any maternity care for women in labour. So, women must travel to Ipswich from Laidley, Boonah, and other regional towns. Aside from a few lucky women who are fortunate enough to meet their midwife prior to labour, most women birth with strangers, in a busy maternity unit where the midwives are caring for multiple women at the same time. A new study has highlighted the plight of rural women in NSW who are forced to travel while in labour because their local maternity units were closed. The authors aimed to show what it was like for these women to labour, and sometimes give birth, en route to the nearest open maternity unit. Titled ‘Mind you, there’s no anaesthetist on the road’: women’s experiences of labouring en route’ the study shows that the risk of dangerous road travel is not considered by health policy makers and obstetric academics when discussing the closure of small rural maternity units. While several organisations are lobbying hard for the government to support the reopening of small rural maternity units, women who live quite a distance from a maternity unit still have the face a perilous and sometimes traumatic trip while in labour. One option for women who are forced to travel in labour is to hire a birth doula. One of the benefits of hiring a doula is that you have someone you know (and who knows you) come to your home, travel with you (if birthing in hospital) and stay with you for your entire labour and birth. Your doula provides continuous support to both you and your partner, and assists you in having an optimal birth experience. To read the full study, visit: http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=1371. Citation: Dietsch E, Shackleton P, Davies C, Alston M, McLeod M. ‘Mind you, there’s no anaesthetist on the road’: women’s experiences of labouring en route. Rural and Remote Health 10 (online), 2010: 1371. Available from: http://www.rrh.org.au A few years ago I became so thoroughly sick of using cling wrap that I decided to look for something reusuable. I looked at many different products and found a few manufacturers who were producing various types of food wraps and pouches that were made of cloth. It’s not a new idea to wrap your food in cloth and neither is it a new idea to use reusable plastic to contain food, or anything else for that matter. We regularly pull out a sheet of plastic for the kids to paint on or eat on and reusable, foldable placemats and cloth wrapped food have been around for eons. Today we have simply replaced the string and ribbon with velcro and press studs. I tried a couple of products and at first thought they were great, that was until they became worn and damaged. Family life can be brutal on everyday items. We lost some when they sneaked into the dryer on a run of wet days and one managed to get completely mangled and torn. Most of them became discoloured and looked decidedly unattractive after a year’s use. I also found the size and shape of manufactured products inadequate and I didn’t fancy paying a huge amount of money for a product that wasn’t going to last more than a few months. One day, I became fed up enough that I sat down with a piece of cloth and worked out a wrap design that suited our family, that was big enough for the bread we use (and sometimes make ourselves) and that was stylish enough for kids to want to useand for me to want to use. I found using food grade table liner was a much sturdier option than what was on offer. It is thicker than regular plastic, it doesn’t discolour after multiple use and on the odd occassions they’ve sneaked into the dryer, they’ve not been damaged (on low heat that is). I posted the piccys on Facebook and before I knew it, I had orders coming in from a dozen Facebook Friends. Although some friends have suggested I should start a wrap company (like I’d have time), I will never mass produce these wraps. Others are doing that quite successfullly to cater for a much broader market (and good on them). I simply love sewing them (especially when I can use upcycled quilt covers and dresses for the cloth) for my own family and love to use them to educate people about living a more sustainable life. Most people never even think of using something different to cling wrap. I don’t particularly mind if people feel inspired to make their own wraps, as to me, it is about inspiring people to reduce their carbon footprint, not making money. Also, I think that if we are going to market sustainable products we need to consider that our primary audience includes people who value people above things, believe in treating others with kindness and value ethical, fair behaviour. Further Info.. What are some of the benefits of using reusable wraps? What are they made of? How long will they last? What can I wrap? Care Instructions For the most part, they can just be wiped clean and reused several times without having to wash unless the covers get dirty. I usually wash them once a week. Wraps can be used in the fridge but I don’t recommend using them in the freezer. Wipe them clean with warm soapy water or just water before you use them. Guarantee Testimonials “Thanks so much for the beautiful sandwich wraps. I feel like they have been made with a lot of love and care and my kids love them. Just a tip for your buyers. I wipe them down as soon as the kids get home and then just peg them up in the kitchen window to get a bit of sun on them – it is great – am thinking of selling some of the tupperware lunch boxes on Ebay.” — Laura “They are so awesome! I made a sandwich the other day and popped it in one of your wraps. I ate it four hours later and it tasted so fresh, like I’d just made it! Not like in glad wrap, when the bread is always a bit dried out. I’ve been raving about them so am glad I have a site to share with my friends!” — Melissa “thanks for the wraps…they are awesome!”–Andrea “I’ve got these sandwich wraps and they are awesome!!!”–Christy “Today we went to our woodclub which we do every Wednesday and I used our new wrap’s. They were fantastic, plenty big enough, looked lovely and cheerful while everyone else was using cling wrap. What was also nice was that we were able to fold them over while we just took out a quarter to eat at a time, thereby keeping the bread lovely and fresh. Would certainly recommend to other people.”– Dorothy Where to purchase If you love chocolate but don’t like the calories that usually accompany chocolate cake, try this delicious recipe. It’s a great way to reduce your calorie intake while still enjoying a tempting treat. Plus, it is packed with fibre. a great choice if you’ve got fussy children. Be aware that these are likely to dissappear as soon as you get them out of the oven. Preparation time: 20 minutes Cooking time: 20 minutes Servings: 12-14 Equipment: Ingredients: Method: Preheat oven to 180 degrees celcius. place patty pans in muffin tin. Combine cup of dates with water in a saucepan (fill to just covering dates) and simmer on medium stove till reduced and soft (about 10 minutes). Once soft, puree date mixture using a bar mix or blender. Combine 1 cup water, date puree, egg whites and vanilla and beat thoroughly till blended. Combine flour, sugar, sifted cocoa and salt in another bowl and then add to liquid mixture. Divide batter between patty pans (you may need a couple of extras) and bake for about 15 minutes or until cake tester comes out clean. Cool on a rack. You can serve plain or dust with icing sugar. These cup cakes don’t really need icing as they are quite rich on their own.Your pelvis size is not the problem in birth
admin : January 22, 2012 9:03 am : Articles, Doulas, Pregnancy & Childbirth, Uncategorized, VBAC
The Ultimate Parenting Course: A Review
admin : January 18, 2012 9:05 am : Activities, Articles, Baby-friendly activities, Children, Parenting, Wellbeing
As parents, it can be really difficult to sift through all the advice that is out there. Everyone, from the expert on Youtube to the childless neighbour across the road, has an opinion on how we should parent and these days mother-guilt starts way before a child is even born.Content
An open letter to the Australian College of Midwives & the Obstetric Lobby
admin : September 22, 2011 10:06 pm : Articles, Mumatopia News, Pregnancy & Childbirth, VBAC, WomenWhy a gentle birth leads to a healthier, kinder and more sustainable earth
admin : September 16, 2011 2:31 pm : Articles, Events, Mumatopia News, Nutrition, Parenting, Pregnancy & Childbirth, Wellbeing, Women, pregnancy loss
Today I celebrate the life I never got to know. It was 3 years ago today that I lost my wee babe in an ectopic pregnancy. He or she would have been about two-years-old by now. I can’t help but wonder how different our family would be had things been different. Despite the grief of losing a baby (losing a baby at any stage of pregnancy is hard), I am feeling gratitude for all the gifts that experience gave me. For one thing, Mumatopia would likely not exist.Birth: Get your wiggle on!
admin : June 7, 2011 11:41 am : Antenatal courses, Articles, Doulas, Pregnancy, Pregnancy & Childbirth, Women
When I gave birth to my third child (the only one of my children born naturally), I was really surprised at how much I moved during labour. I had done pregnancy yoga during that pregnancy with Yogababy’s Suzanne Swann and recollect sitting in her class wondering how on earth the different yoga exercises would help me while giving birth. The truth is, I used every yogalicious trick in the book.
Shaking the thighs: This is a technique my midwives used on me and have taught me through the Better Birth Workshop. It helps relieve tension in the body, which then helps a woman work with her body and release oxytocin to help her move into her labour. You can use a rebozo to do this or you and the woman’s partner or midwife can each shake a leg.Postnatal doula care: Looking after you after birth
admin : March 22, 2011 7:40 pm : Articles, Doulas, Massage, Mumatopia Services, Nutrition, Postnatal Depression, Postnatal support, Practitioners, Pregnancy & Childbirth, Wellbeing, Women
A few weeks ago, my 10-year-old was offered the opportunity to go away with his grandparents for a week at a summer camp. My husband and I discussed it at length but we both felt that the decision was his to make. If he wanted to go, we’d support him in that. It would mean 11 days away from us and a flight to another State on his own, but he was really keen to go.What are your needs in birth?
admin : November 29, 2010 8:43 am : Antenatal courses, Articles, Events, Mumatopia Services, Pregnancy, Pregnancy & Childbirth, Women
We are all different and react differently in different circumstances. Birth is no exception. In birth, our physiological needs come to the forefront. It can be a scary, challenging and confronting experience and it can also be an exhilarating, mind-blowing, and joyful experience. Actually, birth can be all of these or any one of these or it can be somewhere in between. Every woman is unique.Testing times: Prenatal tests and diagnoses
admin : November 10, 2010 11:20 am : Articles, Pregnancy, Pregnancy & Childbirth, Support groups, pregnancy loss
During pregnancy, women undergo a number of prenatal screening and diagnostic tests including blood tests, urine tests and ultrasound. These tests are designed to provide information on the condition of the woman and her baby during pregnancy and to determine if the baby may have any major medical conditions.Sneaky interventions: What every pregnant woman should know
admin : August 20, 2010 10:46 am : Articles, Pregnancy, Pregnancy & Childbirth, Women
If you see a consultant obstetrician or registrar just prior to or on your due date the chances are you may hear these words: “I’ll just run my finger around the cervix to help get things moving.” Ever wonder what that means? Well, basically, what has become a routine procedure is effectively an intervention that may, as the clinicians say, “get things moving” but it may also cause unwanted side effects that may set off a chain of events you weren’t expecting and it is important to know what this may mean for you.Why do women need choices when it comes to giving birth?
admin : July 17, 2010 2:46 pm : Articles, Post Traumatic Stress Disorder, Postnatal Depression, Pregnancy, Pregnancy & Childbirth, Wellbeing, Women
Facing my birthfront: A birth story
admin : July 1, 2010 9:18 am : Articles, Post Traumatic Stress Disorder, Postnatal Depression, Pregnancy, Pregnancy & Childbirth, VBAC, Women
Flashback: Voices swirl. I can hear my own breathing. It’s as if I’m inside my body somewhere, hiding, listening. My eyes open and I feel the weight of heavy plastic on my face. I feel bound. Wires everywhere. “What’s going on?” I try to say but can’t because of the oxygen mask on my face. I struggle to remove it. Somebody tries to shove it back on. I tear it off anyway. “Where’s my baby?” I spit out. “Where’s my baby?”
This story was first published in: Birth Stories for the Soul: Tales from women, families and childbirth professionals, Edited by Dennis Walsh and Sheena Byrom, published by Quay Books, UK, 2009.The VBAC Wars
admin : June 16, 2010 8:49 pm : Articles, Pregnancy & Childbirth, VBAC, Women's health services
On Thursday 6 November, 2008, I gave a presentation entitled ‘The VBAC Wars’ at the Australian Midwifery Expo in Brisbane and then again at the Birth After Caesarean Internventions (BACI) Consortium Seminar at University of Technology in Sydney, NSW in April, 2009. Since then, Queensland Health as instituted a new VBAC (ie. vaginal birth after caesarean) policy which not only promotes active management of labour but shows no respect for women’s autonomy over their own bodies. Despite a huge amount of feedback detailing the flaws and issues with the draft policy by consumer groups such as Caesarean Awareness Network Australia, the International Caesarean Awareness Network, and Maternity Coalition, the new policy went ahead, unchanged. The new policy even “requires” women to give consent to plan a VBAC. To be blunt, that is like saying you need permission to go to the loo. The p0licy is rife with misinformation and biased opinions of bureaucrats and is sadly lacking sound medical evidence. The VBAC Wars are set to continue and it will become even harder for an Australian woman to plan a VBAC, especially once homebirth midwives slip underground come July 1st. As a woman who has had a VBAC after two previous caesareans, I fully support a woman’s right to choose how, where and with whom she births. I would encourage any woman planning a VBAC to disregard this policy. It is, afterall, your right to determine your own health choices, despite what Queensland Health would have you believe. Anyway, here’s what I had to say about The VBAC Wars.
The pink elephant in the room
admin : June 10, 2010 8:06 pm : Articles, Postnatal Depression, Postnatal support, Pregnancy, Pregnancy & Childbirth, Women
Guest blogger, author and Pelvic Floor Physiotherapist Mary O’Dwyer talks frankly about pelvic floor dysfunction after childbirth, giving vital information for any woman who’s had a baby. We hope you enjoy this article! Mary’s book ‘My Pelvic Flaw’ is available in book stores throughout Australia. Her revised version ‘Hold It Sister’ can be ordered on line at www.holditsister.com (RRP $24.95). For information on hosting workshops or having Mary as a speaker, contact her at mary@holditsister.com.
Losing something precious: My experience of ectopic pregnancy
admin : May 27, 2010 11:39 am : Articles, Pregnancy, Pregnancy & Childbirth, Women, pregnancy loss
The ripple effect of birth trauma
admin : May 12, 2010 7:54 pm : Articles, Post Traumatic Stress Disorder, Postnatal Depression, Pregnancy & Childbirth, VBAC, WomenIs a fast birth a good birth?
admin : May 4, 2010 12:12 pm : Articles, Doulas, Pregnancy & Childbirth, Women
Conversations with Kate
admin : April 26, 2010 9:19 am : Articles, Post Traumatic Stress Disorder, Postnatal Depression, Postnatal support, Pregnancy, Pregnancy & Childbirth, VBAC, Women
Cas McCullough shares a candid portrait of post traumatic stress disorder and postnatal depression following a traumatic birth.In their own sweet time: a journey into post-date pregnancy
admin : April 22, 2010 11:07 pm : Articles, Pregnancy, Pregnancy & Childbirth, VBAC, Women
(2) Hannah ME, Hannah WJ, Hellman J, Hewson S, Milner R, Willan A. Canadian Multicenter Post-Term Pregnancy Trial Group. Induction of Labour as compared with serial antenatal monitoring in post-term pregnancy. A randomized controlled trial. N Engl J Med 1992;326:1587-1592.
(3) Crowley P. Interventions for preventing or improving the outcome of delivery at or beyond term (Cochrane Review). In: The Cochrane Library, Issue 2, 2004. Chichester, UK: John Wiley & Sons, Ltd.
(4) Buckley, S. (2005). Gentle birth, gentle mothering. One Moon Press. Melbourne.
(5) de Miranda, E., van der Bom, J., Bonsel, G., Bleker, O., Rosendaal. F. (2006). Membrane sweeping and prevention of post-term pregnancy in low-risk pregnancies: a randomised controlled trial. British Journal of Obstetrics and Gynaecology, 113:402–408Angel's garden
admin : April 22, 2010 7:54 am : Articles, Organic gardening, Pregnancy, Wellbeing, pregnancy loss
Well, over the past two years, Angel’s garden has grown and thrived. Being close to the house, I am often out there in the early evening gathering herbs for dinner. It’s not always a pretty garden but that’s not really the point. We have five guilds in the garden at the moment and we rotate crops through each guild (a guild is simply a planting area containing a mixture of produce). I wouldn’t say I’m an expert and I definitely make lots of mistakes but I’m learning new things all the time and I’m enjoying the process of growing, planting, and harvesting. It’s a constant process of renewal.
Lately I’ve found lots of plants just springing up all over the garden… nasturtiums, borage, tomatoes, mustard greens, oak leaf lettuce, even comfrey. Mixed in with these we have lemons and limes on the cusp of ripeness, eggplants, potatoes, celery, chilli, shallots, brussel sprouts, a banana tree, lavender, arrowroot, planted organic tomatoes, pyrethrum, parsley, lemongrass and basil bushes. There’s also a magnolia tree which we planted especially to honour our lost little one. There’s so much more I want to plant and I’m really glad to be able to share the journey with others. Angel’s garden is a living reminder of the value of community.New study shares rural women’s experiences of labouring & giving birth on the road.
admin : April 16, 2010 12:58 pm : Articles, Doulas, Pregnancy & Childbirth, Women
Why wrap?
admin : April 2, 2010 8:29 am : Articles, Eco-friendly, Etsy, Fair Trade, Handmade, Madeit, Nutrition, Products
People often ask me why I started making reusuable sandwich wraps. So I thought I’d dedicate a post to the joys of wrapping.
The other issue for me was overall sustainability. It’s one of the reasons I try to buy local, second hand and handmade as much as is practical. Even if a product is eco-friendly or reusable, buying products manufactured overseas means they have to be packaged and transported to the various corners of the globe. The cost to the environment in petrol is enormous.
Below is some information regarding the wraps I make for anyone interested in purchasing some.
They keep food better contained than plastic wrap, they fit into tight spaces in eskies, it’s like openning a present everytime you have your lunch, they are washable and reusable meaning you don’t have to use cling wrap or even paper bags. they are multipurpose, they look fantastic, they are great for using on picnic tables, many schools and daycare centres and now requiring kids bring their own placemats or tea towels to use as placemats, they don’t get lost easily as each one is unique and teachers usually know who owns them, they can be easily labelled with a laundry marker.
Wraps are made of cotton/polycotton materials in a variety of colours and styles and table liner made out of food grade PVC. As much as possible I use upcycled cloth.
If you look after them, they should last a really long time and reduce the use of clingwrap and other disposable wraps.
The large wraps fit up to three sandwiches, larger rolls and blocks of cheese, the regular wraps fit 1-2 sandwiches and the snack wraps fit 3-4 cookies, small muffins or cakes or about 8 rice crackers. The wraps can also be used to wrap other items such as pencils, Lego, jewelry, make up, kids shoes if your traveling somewhere and don’t want dirty shoes all over your clean clothes in the suitcase. You name it, you can wrap it and save on the use of plastic bags and clingwrap.
They can be washed in cold water and line dried. DO NOT put in the tumble dryer or wash in hot water as this is bad for your health, bad for the environment and bad for the wraps.
These wraps are handmade in a busy household so the seams might not always be dead straight but if there are any manufacturing faults (for instance, you wash your wrap in cold water and in shrinks) I will happily replace it or fix it.
I reguarly attend The Handmade Expo in Ipswich, Queensland and some of my wraps are in the shop, Handmade Heaven, in Ipswich. You can purchase some of my wraps through the Mumatopia store on this website and some through Etsy and Madeit.
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