The childbirth pain relief ladder

Do you know what your pain relief options are when you’re in labour? Here’s a breakdown from the non-pharmacological to the big guns…

As I’ve said before, I believe the best birth plan, is no birth plan, but an informed pregnancy – that way, you can know your options, and can tackle whatever happens as it comes.

When you’re pregnant, there are a lot of firsts and a lot of unknowns. One area in particular that women build fear and anxiety around is labour….you don’t know the extent of the pain, or how you will cope with the pain. Interestingly, pain in labour can vary, due to environment, support people (a few tips here), whether labour is spontaneous or induced and whether you’re a first time mama or not. The more you fight the pain, the worse it hurts (increasing adrenaline and decreasing oxytocin) so giving into the pain and knowing that with every contraction you’re one closer (as corny and lame as it sounds) can help in relieving pain.

75% of women use some sort of pharmacological pain relief in labour, however there are non-pharmacological options available as well, so knowing what is available, is important. Below is our “pain relief ladder”, working our way up the ladder from natural pain relief to the big guns – we’ll explain each briefly and it’s effect on both mum/and or bub.

It is important to remember, you are free to choose whatever pain relief you want – it’s your labour, body and baby. The ladder works well in a sense that for women wanting as natural a birth as possible, it allows you to incrementally increase pain relief. Speak to your midwife/obstetrician antenatally more to gain greater insight into your options.

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Breathing, Heat and Positions

Copyright Getty Images
Copyright Getty Images

How to use it?
– Heat packs (lower back, above pubic bone)
– Positions – staying active in birth is important. Gravity helps bring bub down, and helps to relieve pain and pressure, so rocking on a pregnancy ball, walking, sitting, all fours, lying on your left hand side, can help.

Safe for mum and baby?
-Yes!

Latest evidence
– According to recent research undertaken in NSW & QLD, Australia, it looked at the impact pharmacological and non-pharmacological pain relief had on labour outcomes (1835 women – link to paper at bottom of blog):
 Extract from article: “Women who used breathing techniques were more likely to have a vaginal tear, forceps/ventouse suction, initiate breast-feeding, and continue breast-feeding beyond six weeks, compared to women who did not use breathing techniques.
The women who used breathing techniques were also less likely to have their baby admitted to a special care nursery.

Massage and Water

How to use it?
– Get the support person to massage any niggles with or without oil…your choice (many birthing suites had massage oil provided)
– Hop in the bath, or shower

via Pinterest
via Pinterest

Safe for mum and baby?
– Yes!

Latest evidence
Extract: “Women who used massage were more likely to have a vaginal tear, forceps/ventouse suction, initiate breast-feeding, and continue breast-feeding beyond six weeks, compared to women who did not use massage.
Women who used bath/birthing pool/shower were more likely to have a vaginal tear, and continue breast-feeding beyond six weeks, compared to women who did not use a bath/birthing pool/shower.
The women who used bath/birthing pool/shower were also less likely to have their baby admitted to a special care nursery.”

Sterile Water Injections

Copyright of Michael Norviel
Copyright of Michael Norviel

How to use it?
This is great for persistent lower back pain. Usually injections are given in four different places in your lower back, by two midwives, just beneath the skin, raising little blips on the skin. The injections really hurt! Like a strong bee sting, but this disappears after 30 seconds. The injections can bring up to two hours of pain relief to your lower back but you will still feel the contractions, the beauty of these are that, you an have them again at any time if they wear off, as it’s only sterile water.

Safe for mum and baby?
-Yes (cannot massage where the injections were as this can make them ineffective)

Laughing Gas (Nitrous Oxide) – approximately 50% of women utilise gas

How to use it?
Administered through a nozzle/whistle mouthpiece that you breathe in and out through, with the Nitrous Oxide and Oxygen being blended (able to be increased or decreased to effect). Nitrous Oxide very quickly enters the blood stream and takes approximately 15 seconds to kick in and 15 seconds to wear off….so you begin breathing as the pain is building and cease when the contraction has gone away.
Tip: try to keep your eyes closed as you’re using the gas…it makes you feel light headed and a bit dizzy, and then the room won’t spin as much!

Safe for mum and baby?
– Yes. Nitrous oxide does cross the placenta, however doesn’t leave by-products as it isn’t broken down by the liver, like drugs such as pethidine. It is quickly eliminated from the woman’s body and from bub’s.

Evidence
Extract: “Women who required gas were more likely to have a vaginal tear and forceps/ventouse suction, compared to women who did not require gas. The women who required gas were also less likely to have their baby admitted to a special care nursery.”

Side Effects
– Laughing gas can make some women dizzy, nauseous and/or vomit. Some may not find it effective pain relief.

Morphine (systemic opioids) – approximately 22% of women use systemic opioids

How to use it?
Injection given by a healthcare professional, taking approximately 20 minutes to feel the effects of the drug.

Safe for mum and baby?
Morphine does cross the placenta, and if bub is birthed within 4 hours of the injection, they can be a little bit more drowsy than babies of women that hadn’t had opioids. Dependent on hospital policy, a paediatrician may then be present for the birth.

Evidence
Extract: “Women who used pethidine were more likely to have forceps/ventouse suction (p=0.002) and less likely to continue breast-feeding beyond six weeks (p=0.03), compared to women who did not require pethidine.”

NB: This extract specificially looked at pethidine and not morphine, however I have still included the data for an opioid reference. Morphine competes for the same central nervous system receptors that pethidine does, however they are not the same!

Epidural – approximately 29.7% of women receive an epidural

How to use it?
Anaesthetist will be present to insert the epidural catheter into the epidural space in your spine. Link here to read more about epidurals. You will lose sensation from your waist down, dependent of the efficacy of the block, and therefore will have a indwelling urinary catheter inserted and be in the bed.

Safe for mum and baby?
Click here

Evidence
-Extract “Women who required an epidural were more likely to have forceps/ventouse suction and have their baby admitted to a special care nursery, compared to women who did not require an epidural. The women who used epidural were also less likely to have a vaginal tear and less likely to continue breast-feeding beyond six weeks. In contrast, women who required an epidural were 3.38 times more likely to have their baby admitted to special care, compared to women who did not require an epidural.”

Resources:

Adams, J., Frawley, J., Steel, A., Broom, A. & Sibbritt, D. 2015,  ‘Use of pharmacological and non-pharmacological labour pain management techniques and their relationship to maternal and infant birth outcomes: Examination of a nationally representative sample of 1835 pregnant women’, Journal of Midwifery, vol 31 (458-463).

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Dear Birth Support Person…

Dear support person – you have a fabulously important role to play!

I read an article this week on The Sydney Morning Herald‘s parenting offshoot website, Essential Baby. It was written by a Dad, for Dads, about their role in birth and how best to support their partner (see article here).

Mucous plugs, wedding ring indentation marks and encouraging mantras aside, the crux of the article, was about the importance of silent support and the safety of having a loved one by your side.

So we’re going to share with you a few birth tips as well, but firstly, a quick breakdown, hormonally of what’s happening in labour and birth.

Two hormones play a massive part in labour and birth, these being Oxytocin and Adrenaline. Oxytocin, otherwise known as the ‘love hormone’, is released in moments of bonding; hugging, kissing, breastfeeding, sex….and is also what brings on contractions, helping to dilate the cervix, move bub down the birth canal, as well as deliver the placenta.

Adrenaline on the other hand, is our ‘fight or flight hormone’, that mammals produce primally for survival. Fear produces adrenaline. And unfortunately, adrenaline inhibits oxytocin which can make labour slower, more painful, or panic the woman (and let’s face it, the partner)…potentially leading to intervention or increased pain relief?

So naturally, if you think about when Oxytocin is released, it’s at moments of intimacy; when you’re in a safe and private environment. So why would birth be any different? It’s not!  Enter dear support person – you have a fabulously important role to play!

A few tips:

  • Try to keep the room quiet (not the woman,though; trying to control her would be like trying to stop a steamroller in its tracks…not good, not good). But being mindful of phones…people coming in and out of the room and the volume of your voice (I’m particularly mindful of this, considering my boom-box voice, especially when I’m excited or stressed).
  • Keep the room dark – particularly for labour. As a woman’s cervix dilates, her pupils dilate, making her more light sensitive.
  • Touch her…not in a creepy, handsy way. You’re both in a foreign environment and and not having babies every day of the week, so it can be a bit unsettling to see her in pain, and frightening for both of you.
    Holding her hand, giving her a kiss (this is a great one – oxytocin booster, intimate, makes her feel safe, reduces adrenaline, and is a way to show her support), and massage are all ways in which to let her know you’re there.
  • When a woman is ‘transitioning’ into second stage of labour, the massages that she’s been loving…the baths that’ve been helping…the pregnancy ball rocking….the topic of conversation…the words of encouragement…ALL OF A SUDDEN, SHE MAY HATE!  When this occurs, don’t be upset or worried, see this as a sign of progress and that bub might not be too far off. Just being next to her, so when she opens her eyes she sees you there, can be all she needs in that moment in time.
  • Be her advocate. Know what pain relief she wants. If she has said 3,000,000 times in pregnancy that she doesn’t want an epidural, and someone keeps banging on about it and offering it to her, be her advocate.
    On the other hand, knowledge is key. I truly believe the best birth plan is no birth plan, but an informed pregnancy. If you both know the ladder of pain relief (blog post on this is on it’s way) then you’re able to take labour and birth as it comes, starting with non-pharmacological relief and slowly working your way up to the big guns.
  • Last but not least, know your limits. If you’re one of those people that are a bit queasy, hate needles or aren’t crash hot with blood, tell the midwife or obstetrician. Be proactive and have a chair (up the top end of the bed) ready, and sit down and support if you you start feeling giddy. No one needs you in E.D!

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(All photos published in this blog article, were taken by the talented Lindsey Kliewer)

Resources:

Do We Need Midwives? By Michel Odent (2015)

The importance of privacy in labour

Birth and Breastfeeding By Michel Odent (2003)

We must put the sex back into birth – Ted Talk, By Kate Dimpfl

The Emptiness of Loss

The story of a friend who shares how miscarriages affected her, her relationship and her journey to two miracle babies.

I stumbled across a statistic from SANDS, the Australian miscarriage, stillborn and newborn death support program a while ago. It stated that ‘Australian women are more likely to experience a miscarriage than to experience breast cancer’. Breast cancer awareness and information is everywhere and I know I’ve spoken with family and friends more about breast cancer than miscarriage. So as women, by not talking about pregnancy loss, are we making, what is statistically a horrible yet common occurrance harder?

In the past few years, I have spoken to women and been with women that have lost babies; early and late in pregnancy, but what I have found is women explain; the lead up to it happening, why it happened, how it happened, the procedure that was involved afterwards, but many do not discuss the emotional impact that it had on them and their partner. So today we’re talking about the unimaginable, yet more common that you think; grief and loss of a baby.

Finding out your pregnant is a life moment, that for many families will evoke happiness and excitement. For 1 in 4 women* in Australia, these women and their partners experience the loss of their baby early in the pregnancy. The first 12 weeks of pregnancy is when some families decide to stay tight-lipped about their newly growing addition (this being the time in pregnancy with the highest chance of miscarriage). So because the pregnancy hasn’t been announced, many couples grieve together in silence.
A less concealed grief for mothers and fathers is that of a stillbirth. 6 babies are born stillborn everyday in Australia, a statistic 10 times higher than SIDs related deaths.

Working within a maternity unit I’ve been exposed to some very sad situations, that you wouldn’t wish on anyone. My family and friends also, have not been immune to such loss.

I think many of us shy away from talking about topics like miscarriage, as well as telling people about being pregnant (within the first 12 weeks), because of how it then positions us for vulnerability. Vulnerability is an emotion that makes us human and has the ability to foster connectedness. We, as women, need to speak about the hard stuff surrounding pregnancy and not see loss as personal failure. At the end of the day, good friends only want the best for you and would move mountains to help you through the tough times.

Someone dear to me, whom will remain anonymous, has kindly written her story and the ways in which multiple miscarriages affected her, her relationship and her journey to two miracle babies.

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This is her story, “Little Miracles”:

To those who are going through or have been through a miscarriage, my heart goes out to you. I hope my story can give you hope and somehow help you heal.

To the partners who are trying to support their wives or girlfriends through pregnancy complications: know that you are doing a good job, and that the most important place you can be through all of this is with your partner, together. You are part of the equation and the difficulties of miscarriage or loss will affect you too. Make time for appointments, talk about how you are feeling, and when you can’t talk, sit in silence, and have your shoulder ready for the tears that will come.

To those who have a friend or family member experiencing pregnancy difficulties related to conceiving, miscarriage, or traumatic birth experiences: your support may go unrecognised at the time, but it is not unwelcome, and it will be appreciated.

Pregnancy. You think it’s going to be easy, but sometimes life can throw you a curve ball when you least expect it. When I was a child, I imagined my future as an adult with a good job, a nice house, a loving partner, and with children. Never did I consider how differently things could turn out, but as I learned, it’s important to expect the unexpected. I have two children, but I was pregnant eight times. We lost eight babies, as I was twice pregnant with twins. This is the story of my long journey towards motherhood and parenthood. 

At the beginning of 2004, at the age of 23, my partner and I got engaged, and we decided to try to fall pregnant right away. With so much to do in preparation for the wedding, it was not until after five months of trying that I began to worry something was not quite right. I had stopped taking the pill months earlier, but I still had not had a period. My cousins had experienced problems having a baby, so I began to worry that I might find myself in a similar situation. I discussed this with my mother, who told me not to worry. She hadn’t had any problems, so why would I? I’ve always looked up to my mother and listened to her advice. I wanted to believe everything would be ok. 

After another four months, when the situation had not changed, I decided to go to see the doctor. I was surprised, but relieved, to hear that it was quite normal for your periods to be irregular after coming off the pill and so, trusting the doctor, I decided to wait a while longer before becoming too alarmed. When a year passed, we decided it was time to start investigating things further. I am not sure if it was my age or my inexperience, but at that stage, the words “gynaecologist” and “obstetrician” meant absolutely nothing to me. I was referred to a gynaecologist/obstetrician, who was chosen by my local GP. I didn’t know it at the time, but this was the person who would become an integral part of my journey and who would eventually help save my life. 

I was not exactly sure what to expect on that February morning in 2006 when we went to the appointment to discuss our infertility. Imagine our disbelief when a routine ultrasound revealed we were around seven weeks pregnant. I don’t know who was more surprised – us, or the doctor who had never seen us before. The rest of the consultation was a blur. I was so excited, I just wanted to get out of there so that we could ring everyone we knew to tell them the good news. After all, why wait? I was pregnant, and in my mind, fertility issues were about being able to fall pregnant. I wanted to tell the world!

Family and friends responded with joy and enthusiasm to the news that I was pregnant. No one was happier than my mother-in-law, who was expecting her first grandchild, and my parents, who were beginning to secretly worry that infertility might be an issue.

From the moment we knew we were pregnant, we began to plan for life with a baby. The list of discussion topics were endless, and an onlooker would have believed we were trying to make every decision about the baby’s life in the first few weeks of the pregnancy. We were so excited, why would we worry? I was a school teacher and I even told my class. It was a Friday afternoon and I was teaching when I felt that something was not quite right. I had to go to the toilet, but there were only 20 minutes left of the school day, and I had planned to go home straight after school, so I decided to wait.

 By the time I got home, I was busting and raced for the toilet. To my horror, I saw it was filled with blood. If you have ever been in that situation, you will know the feeling. It is like the world has completely stopped. You don’t want to believe what you are seeing and for a moment, you panic.

We raced to the doctor’s surgery first anyway, only to then be sent to the emergency department. It’s funny how each miscarriage brought with it the same protective maternal response: if I get to the hospital straight away, everything will be ok, the baby will be ok. I was in quite a lot of pain by then, but had visions as we were driving of the doctor telling us everything would be ok. I wish I had been right. We were left in the hospital waiting room for what felt like an eternity. People came and went and I was still waiting, bleeding quite heavily. Looking back, it is quite disgraceful that you can be made to just sit in a hospital waiting room while you are losing a life inside you. 

Finally, I was taken in to see a doctor, who told us the worst. A scan revealed the baby had passed away. I was 11 weeks pregnant. There are simply no words to describe the lonely moments soon after you realise you have miscarried a baby. You wonder what you did wrong and start to think to yourself, “If only I had or hadn’t…” about all the situations where you didn’t completely follow the rule book. 

The only people in the world I wanted, besides my husband, were my parents, who were away and out of phone reception. I wanted to curl up in a ball and never come out. All our planning came crashing down around us. All the excitement of holding our first born in our arms was ripped out from under us. Surgery was planned for later that evening, and when 8:00pm came, my husband was asked to leave. “Visiting hours are over and tell your wife she can’t use her phone,” the nasty nurse barked as she went on with her shift. I found it ridiculous that my husband was being sent home. We were both grieving. We had lost a child. I was completely empty. Surgery came and went, and when I slept that night, it was as if I was still pregnant and the frightening ordeal was behind me. 

Despite the number of miscarriages I had after that, I still believe the first was the hardest. While each additional loss brought with it the same grief and distress, the naivety from my first miscarriage had been stripped away. That first devastating loss was a wake-up call that complacency was not an option when it came to pregnancy. It was becoming more and more apparent that a magical combination, and a lot of luck, would be needed in order to conceive once again. Within a matter of months, and after taking medication for polycystic ovarian syndrome, I found out I was pregnant again. 

The end of that year brought with it a lot of excitement as we neared the 12-week mark. Things were going very well and I attributed this not only to being more relaxed at the year’s end, but also to the fact that I followed every rule in the book when it came to what to eat and how to care for myself.

Nearing the end of the first trimester, I had a feeling something was not right. As soon as I went to the toilet, I knew we were losing our second baby. Quickly, we got into the car and were on our way to the hospital again. I was in a lot of pain, and while I wasn’t left to wait in the emergency waiting room this time, I was given a bed in a corridor, where I was left to wait for hours. 

Finally, a midwife came and confirmed our worst fears. We would need a second dilation and curettage, known as a D&C, to “scrape the baby out”. I don’t know what was worse, knowing that I had lost another baby or hearing that my baby, who we had dreamed of and looked forward to meeting, would be “scraped out”. 

The moment of going into theatre was one of sheer panic. Overwhelmed with sadness and unable to speak, I would simply nod and shake my head as the nurses, doctors and specialists would come to talk to me. Once the operation was over, we drove home with barely a word. Nothing either of us could say would bring back our baby. 

While the first miscarriage was the hardest, the second brought with it a feeling of guilt and blame. As I was trying to process why this continued to happen to me, the guilt my husband and I felt began to cast a dark shadow over our marriage. We found ourselves unable to pick ourselves up out of the depression that the loss of two children had caused, and our inability to talk about how the miscarriages were affecting us individually and as a couple was having a devastating effect on our relationship. The problem was so great that talk of divorce even reared its ugly head. 

In March 2007, I decided that I would give it one more month. Barely a week later, I found out I was pregnant again. I didn’t know how to tell my husband, but I came across a little shirt with a giraffe on it that read “I’ll be this big one day”. I wrapped up the shirt and took it out one night at dinner. We hoped and prayed for nothing more than the birth of a healthy little baby at Christmas. As quickly as I had decided that divorce might be the only option, our focus once again became the baby. Planning consumed us. If only life was as simple as wishing, hoping and praying in order to achieve your dreams. I read all the books and ate everything right. We were determined nothing would go wrong. 

In late April I began to bleed again. I knew that three miscarriages was concerning; I wanted to know why this was happening to me – there had to be a medical reason. My theory was that I was miscarrying boys. I am not sure why I believed this, but probably in my frenzy of googling each time I fell pregnant, I’d somewhere read that your body can miscarry one sex. It was many years later that I learned that I had by then miscarried two girls, while the third was not tested. The late night scan revealed our worst fears.  Our baby had passed away. Another devastating miscarriage. Another heartbreaking D&C.

A serious change was needed. One month is the time it took for us to find a block of land and a house to build on it. One week is the time I spent feeling sick before I decided to see a doctor. One minute is the time it took for the doctor to convince me to take a pregnancy test, while I told her, “I think I would know if I were pregnant, I have had three miscarriages”. One second is the time is took for the positive line to show up on the pregnancy test. I broke down. I didn’t want to be pregnant ever again – I couldn’t face another miscarriage. We didn’t know it at that time, but that cold day at the end of July was the beginning of what would become our official entry into parenthood, confirming my pregnancy with the little girl who would become known as T.  

We were thrilled to learn at our 18-week scan that out baby, was growing well, was a little girl. At this time, I found out I had placenta prevue, a low-lying placenta blocking the baby’s exit, which meant that T had to be born by caesarean. I was booked in to have her at 37 weeks, on March 10, 2008. 

“She is tiny,” I said to the doctors as I looked at the beautiful, perfect bundle in their hands. Weighing in at 2.4kg, T certainly was very small. I was able to hold her briefly before the paediatrician took her. The obstetrician focused his attention on the placenta. After quite a bit of prodding and poking, I could tell something was wrong. 

“What’s the matter?” I asked as he spoke quietly with the midwives. “N, don’t panic, but the placenta is not coming out quite as easily as it should”, he replied. “It has left a relatively small hole in your uterus, which could cause future miscarriages”. I was too happy to care. The problems this hole could cause was not in my foreseeable future. My daughter was finally with us.

We certainly were not expecting to fall pregnant quickly, but less that five months after T’s birth, we found out we were pregnant again. Our excitement was short-lived, and later that year, we again lost the baby we had hoped to welcome. After that miscarriage, we decided that we would have a plan for more children, but if it never happened, we would enjoy our life spoiling T and that would be enough. 

Our loss after T’s arrival was easier to deal with than the previous had been, but the miscarriages that followed were extremely traumatic and ultimately cost us our marriage. 

In December 2008, I was pregnant again, and things were going smoothly. Then, without warning, another miscarriage came on. I knew that I needed to get to hospital and I called my husband, but having been through the drill so many times before, he simply said, “I’ll come after I finish work.” It was as if he didn’t realise I needed him. I felt so scared, sad and aIone, and if it hadn’t been for my brother-in-law, who raced from work to come and meet me, I wouldn’t have been strong enough to face another daunting surgery.

The effect each heartbreaking miscarriage was having on my body, our relationship and our ability to communicate with each other, was getting worse. I fell pregnant again a little over a month after the fifth miscarriage, and by this time we both felt completely drained. Then on a trip interstate, I began to feel unwell. I was sure we had miscarried. To our surprise, we saw that I was pregnant with twins, and that there was still one heartbeat. I didn’t even know I had been carrying twins, and it was bittersweet to realise that one baby had passed away while the other little fighter still had a good chance.

“You have a very good chance of carrying this baby to term, N,” the doctor said. “To give it the best chance of survival, you should take these progesterone pessaries. I will send you a script straight away. I suggest you arrange to get them immediately.” 

I took some time off work to rest, and took the progesterone religiously, but just a month later, in April 2009, I felt that all too familiar feeling. When our worst fears were confirmed, it was decided that I would have a D&C two days later.

In the weeks that followed, I was completely and utterly grief-stricken. My husband buried himself in work and in the television; I had no concentration span and my thoughts were constantly drawn back to our lost babies.  I hit rock bottom and was so distraught that on many a night, I would lie in bed sobbing to the point of hyperventilation. I felt sad, guilty and useless for not being able to protect our innocent children. It felt like no one could understand my pain, and though a handful of people asked how I was going and encouraged me to talk about my feelings, I had no strength, no motivation and no urge to tell them how I really felt. I had many friends, but I felt like I didn’t have anyone to talk to who would really, truly listen or take the time to understand. The one thing that made me feel safe and loved was when someone would take me in an embrace and just hold me, letting me cry if I needed to.

T was a blessing, arriving after three miscarriages and just as we began to believe we might never have children. But it is S, my youngest daughter, who was a real miracle. Neither she nor I would be here without the help of expert medical care, and a lot of love and hope.

After seven pregnancies and one beautiful daughter, it became clear that a break was needed. We fell pregnant in early 2010. I knew I was pregnant instantly. It’s strange, but having been pregnant so often before, I had a feeling from very early on that I must have been pregnant, even though for weeks the tests returned negative results.

After seven hours of driving on our way to go camping, I asked my husband to stop on the side of the road. I had packed a pregnancy test and was determined to do it then and there. We were on a dirt track and it was dark, so my husband’s job was to hold his phone as a light, while mine was to ensure I didn’t miss the stick – after all, I only had one test. Sure enough, it came up straight away: two clear blue lines. I was pregnant. We got back into the car without saying a word and continued to drive. There was none of the excitement you would expect with parents so desperately wanting another child. We sat in silence, knowing we would be facing yet another uncertain time. I turned to him and said, “This time, I need you in the hospital by my side if we miscarry. I cannot do it again. I cannot take another miscarriage, so this will be the last time I will be pregnant.” Silently, he nodded.

A few weeks later, I felt that all-too familiar gush. My heart sank. The emergency department was a blur. We knew the night would be long and that yet another D&C was on the cards. Luckily though, we went for a last-minute scan. As we sat in silence, the ultrasound technician carefully examined my uterus. She could see that we had lost a baby from the bleeding and that there was no heartbeat. She was friendly enough and was sympathetic as she gave us the news. She continued to scan me as part of the routine, when all of a sudden, there was a tiny glimmer of hope. A very dull flicker on the screen, almost impossible for the naked eye to see, signalled that perhaps a baby had made it and was still alive. Sure enough, the ultrasound technician measured the heart rate: 82 beats per minute. She confirmed that I had again been pregnant with twins and that one of the babies still had a chance. Anything under 80 beats per minute would almost certainly have meant miscarriage of the second twin too, so there was no point getting our hopes up yet. Losing twins just weeks apart the year before had taught us that there was no certainty. There was nothing to do but wait.

We were referred on to the hospital’s early pregnancy unit, a section dedicated to women in the same position as me, where I went for another scan a week later. There was a dedicated nurse, sonographer and doctor, and it was the first time someone actually took the time to listen to the story of my pregnancy difficulties and acknowledged the road I had come down. It was the first time someone had stopped, looked at me and said, “Can I give you a hug? What you have been through is simply tragic,” and I knew then that I was in good hands. After telling the nurse about my history, it was time for my scan, and there was still a heartbeat, now even stronger than the previous week, at 110 beats per minute. We were still not out of the woods, but we were making progress. Two older male doctors who were in the scanning room excitedly told me that they had found a good heartbeat, and to their surprise, I burst into tears, not daring to say anything.

Determined to help and give me hope, the excited and optimistic nurse explained about a controversial treatment in Queensland, Australia, that I would be a candidate for. Although it would require injections twice a week of the hormones HCG and progesterone, in addition to fortnightly blood tests, the treatment had been proven to work quite well in the USA could potentially help me keep the baby safe. He was always busy, but the nurse seemed confident she could get me an appointment via another unit at the hospital.

Within an hour, I had dropped my friend home, picked up my husband and was driving to meet the man I now call “the baby doctor”. I attribute the successful continuation of this pregnancy to the early pregnancy unit, the second unit at the hospital that helped get me the appointment, and to this doctor, whose decision to give me an emergency appointment for the same afternoon was, I believe, the turning point in the pregnancy.

Fortunately, this doctor was the answer for us. In just one day at the early pregnancy unit with him, I learned more about pregnancies and miscarriages than I had in the previous six years of problems. Understanding more about progesterone’s ability to prepare the body for pregnancy and the supporting role of HCG gave us the confidence to continue, and continue we did, as a scan seven days later revealed the baby was growing and had a heart rate of 182 beats per minute.

Everything was going smoothly with the pregnancy until 2:00am on Thursday 30 September, at 30 weeks and two days, when I got sharp pains in my abdomen and through my cervix. The pains in my abdomen were quite similar to those I’d had when I was miscarrying, but the pains in my cervix were completely new. Within an hour and a half, we were at the hospital in the labour and delivery ward. The midwife and doctor decided that I was not contracting and that the baby seemed happy. I was told it was quite normal to feel the pains I described, and that it was just my ligaments stretching.

No ultrasound was performed and I was so confident the doctor was right that I accepted this explanation and went home. I was warned that if I began to bleed or to feel contractions, which I had never felt before as T had been born caesarean, I would need to go back to the hospital.

My instincts started telling me something was still not right, and two nights later, I began to bleed quite heavily. It was 1:00am and once again, my toddler and husband were fast asleep. A good friend who lived nearby was still awake and was able to come to hospital with me. Not wanting to risk driving 80km, I decided to go to a closer hospital this time, and upon arrival, I was taken immediately to the labour and delivery unit. The obstetrician on duty insisted on doing an internal examination while we waited for the sonographer on duty to come to do a scan. With clenched fists, gritted teeth and tears pouring down my face, I let them perform the examination. Internals for me represented one thing – miscarriages. Needles I did not mind, operations I could handle, but those silver shiny “salad tossers” were a completely different story – they represented the babies that I had never met. The internal revealed that my cervix was closed and the scan revealed that I had grade four placenta praevia, a condition where the placenta is low-lying and covering the cervix, preventing the baby from exiting the birth canal. From what I could find out on the Internet, this condition was highly problematic, and bleeding could signal a rupture that could very quickly prevent oxygen getting to the baby.

Bed rest in hospital is something you read about in pregnancy magazines. You wonder what it must be like to sit around in bed in your pyjamas all day long, trying to keep your baby safe. The days blended into one another and the nights became a blur. I was the only antenatal patient on bed rest over the three weeks I ended up spending there. Although I could hear cries, I rarely saw any babies or had the opportunity to speak to the new mothers who were in the rooms surrounding me.

During my time there, I quickly learned who my really close friends were. Despite their own busy lives, there were a number of people who supported me and came to keep me company. Being in hospital was also a hard time for my husband and daughter. We lived a long way away, and my husband started work at 6:30am and finished around 4:30pm. There was a fine balance that we wanted to maintain between him visiting me and caring for T.

There was a mothers group within the unit. I was encouraged to attend by the midwife and couldn’t help but accept her invitation and nervously made my way to the common room, where I was surprised to see a bunch of other pregnant women all bustling in the room, some talking, others who were new like me, shyly waiting to see what would happen next. As we sat there, I looked around, trying to guess how far along everyone was and wondering why they were stuck in the ward on bed rest. These strangers, who I might not have met or befriended at any other time in my life, would become some of my closest, most trusted friends within a matter of weeks. Little did I know that they and a handful of other people I met at subsequent meetings, would become the people who would help my post-operative journey towards recovery, both physically and emotionally. To this day, I still keep in contact with these women, some of whom had twins, others who had babies at 26 and 29 weeks.

My doctor monitored my daily, sometimes twice daily if he happened to be on the ward. Placenta praevia continued to show up on the scans, but I think it was the pelvic pains that most concerned him. I was send for an MRI. It was the 5th of November, when I received a call from him.

He told me that the scans showed placenta percreta and this was the worst form of placenta accreta, where the placenta invades the uterine wall and can attach to other organs. I had been told in the past that a caesarean hysterectomy might have been on the cards, but I was not ready for the news that this was now not simply a possibility, but a necessity, in order to save my life, due to the risk of haemorrhaging. A team of medical experts had been called in to ensure the safe delivery of S a week earlier than planned, on Tuesday 9 November, at 36 weeks. Words like “coma”, “cell saver”, “general anaesthetic” and “intensive care unit” came up again and again. S and I would each face our own set of challenges at her birth, with her prematurity and my chance of blood loss, but there was no changing the situation and no escaping it either. The nightmare possibility of a massive bleed which could lead to death or an extended period in intensive care haunted me. I sent messages to my close family and friends and let them know the exciting news that S’s birthday would be a few days later.

I don’t remember much about the surgery itself. I have flashbacks of the buzz around the room as I was being prepared, and of a midwife wiping anxious tears from her face. But everything was okay. S and I were alive and well.

Pregnancy for me represents so many things. It represents family, new life, treasured friendships, hope, pain and grief. It is a mixture of many emotions that have significantly shaped who I am today. Had I not encountered the experiences of those six years, I doubt I would be the same person I am now. It’s hard to talk to friends and family about the pregnancies and the difficulties, unless they are experiencing or have experienced similar grief, but I feel so blessed to have come out of the experience on the other side.

While the pain of the miscarriages will never be completely gone, my excitement and love for my two beautiful girls makes up for it. I am wiser for the experience – and while I wouldn’t have thought it at the time, I recognise it now – a better mother.

*Calculating the rate of miscarriage is extremely difficult, due to the fact that many miscarriages happen even before the woman knows she is pregnant. Estimates miscarriage rate according to SANDs (miscarriage, stillborn and neonatal death support) of all ‘diagnosed’ pregnancies: 25% (or roughly 1 in 4)

At different stages of the pregnancy, the loss of a baby is classified differently.
-miscarriage – first 19 weeks or <400g
-still born – after 20 weeks or >400g
-neonatal death – first 28 days of life

Resources:

SANDS

Stillbirth Foundation Australia

Postpartum Contraception

So you’ve had a baby! Contraception is probably the last thing on your mind, but it’s an important conversation to have with a healthcare provider…know your options!

So you’ve had a baby! Contraception is probably the last thing on your mind but, it’s an important conversation to have with a healthcare provider (Midwife, Obstetrician, GP, Family Planning Services) to discuss what will best suit you- and there’s quite the array!

If you are breastfeeding, postpartum contraception options include:

Lactational Amenorrhoea Method (LAM) – When you’re exclusively breastfeeding bub, the hormonal process can effect menstruation, halting ovulation (voila contraception!). The World Health Organisation accepts this as an effective method of contraception, and is considered 98% effective (the same efficacy as the pill) when used according to the guidelines. These guidelines should be discussed with a healthcare provider (this is very important…don’t want any surprises!)

Three criteria can be used to predict the return of your fertility.

  • Have you had a menstrual bleed? (for the purposes of LAM this is defined as any bleeding, on any two consecutive days, that occurs 2 months after the birth)
  • Are you giving regular supplementary foods or foods or fluids to your baby in addition to breastfeeding?
  • Is your infant older than 6 months of age?

If you answer no to all the above three questions, then you potentially meet the requirements for the LAM.

Progesterone only Pill (POP) – Progesterone only pills are considered safe whilst breastfeeding. POP works by thickening the cervical mucosa making it harder for sperm to penetrate. The important thing to note with the mini pill is that it needs to be taken at the same time each day (so set that alarm clock!)…because if you miss it (by 3 or more hours, that window is considered a missed pill, and extra contraceptive precaution will be needed).

Implanon® – is a progesterone implant, which may be suitable from 6 weeks. A conversation for your 6 week check up, perhaps?

Depo-Provera®/ Depo-Ralovera® – Progesterone intramuscular injection. Commence anytime from 6 weeks postpartum.

Mirena® – is an IUD. Dependent on hospital policy/doctor’s policy, the IUD may be able to be inserted within 48 hours postpartum. If this is not possible, it should be left until 4 weeks after childbirth. Its effective within 7 days, lasts 5 years and is a localised progesterone. If at any point you don’t want it anymore, it can be taken out…no 5 year lock in contract!

Note: women who have had a caesarean section should not have a IUD inserted prior to 6 weeks postpartum due to the increased risk of perforation.3

Side note: I have one of these bad boys, and they’re fab! 5 years contraception…tick…peace of mind.

Condoms – Can be used immediately.

Diaphragms – make sure size and fit is correct, and it is advised to wait 6 weeks.

Combined oral contraceptive Pill (COCP) – Not recommended to be used for the first 4-6 weeks. If breastfeeding is established, and no other methods are deemed suitable, this is an option to discuss with your GP etc.  The reason COCP is not recommended for the first 4-6 weeks, is because the combination of hormones can reek havoc with breastmilk supply establishing.

Non-breastfeeding mamas you really are spoilt for choice! All contraceptive methods are suitable. On average, for non-breastfeeding mamas, first ovulation cycle returns 45 days postpartum. 

Don’t take it lying down – evidence on birth positions

When you think of a woman having a baby and the position she assumes, what do you see? The evidence will surprise you…

When you think of a woman having a baby and the position she assumes, what do you see?
I’d always imagined what I saw portrayed in movies* and TV shows* – a woman labouring and pushing on her back. But is this the ideal birthing position?

The majority of Australian women (78%), do indeed assume this position when giving birth to bubs, but when you look at the evidence to suggest this isn’t the optimal position for labour, why the disconnect? Of course, labour and pregnancy alike are exhausting, and I love nothing more than kicking my feet up (not pregnant!) at any given moment, so I see how women gravitate towards the bed…but what does the evidence for everything but the bed, show?

In 2012, a Cochrane study, Gupta et. al was undertaken assigning 7,200 women into two groups; upright positions for birth (birthing stool, kneeling, squatting, all-fours) and non-upright positions for birth (semi-lying, lying down with bed head up, side-lying or in lithotomy (on your back, legs a part) .

When comparing the two groups, the women assigned to upright positions were:

The result of this study concluded that women, without an epidural, should be encouraged to birth in upright positions due to the decreased risk of assisted deliveries (vacuum-assisted or forceps and episiotomy).

When breaking it down logically, being in an upright position – gravity is on your side; the weight of baby and the position of baby is better applied to the cervix…stimulating contractions…helping bub descend and move through the pelvis. Hey Presto!

A midwifery professor, Hannah Dahlen, wrote an article on The Conversation a few years ago, Stand and deliver- upright births best for mum and bub, that looked into why so many women in Australia, do indeed recline to have their babies. The short and simple may indeed be birthing unit design. Like most hospital rooms, the bed takes prime position (pretty convenient for the Midwives and Doctors). To their defence, many women do receive admission CTGs…so immediately they head on over to the bed, get comfy, and then…well 78%…

Being armed with the knowledge of positions to assume in labour, to help bubs work their way down, to relieve back pain etc., is worth investigating. Again, it comes down to what you want, so why not spice things up and try a few, this way you will find out what works for you.

 

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*Movies – Knocked Up, Father of the Bride II, Nine Months, Juno, What to Expect When You’re Expecting

*TV shows – Offspring, Love Child

Vitamin K: Prophylaxis or Poppycock

The Vitamin K injection, does seem to sometimes, albeit unfairly, get lumped into the vaccination category by some people. It’s not a vaccine. More info here…

So I’m putting it out there, I’m pro-vaccination (insert horror and all things evil). I believe in herd immunity, and I believe that vaccinations against nasties such as whooping cough and chicken pox are a good thing! The Vitamin K injection, does seem to sometimes, albeit unfairly, get lumped into the vaccination category, and therefore is shoved into the evil corner by some with all the other vaccines – so this post will be about debunking the Vitamin K ‘vaccination’ and rather putting out there all things Vitamin K ‘injection’ related. It is an injection. Not a vaccination!

Vitamin K is a vitamin that naturally occurs in our bodies and is essential in helping our blood to clot and prevent serious bleeding. Babies cannot produce this for the first few months of life….so consenting to the Vitamin K injection helps bubs have enough Vitamin K to clot their blood (and prevent HDN – a rare bleeding into the brain).

There have been no reported reactions to the injection within Australia, since its implementation 25 years ago. There are two ways in which to give a baby Vitamin K:

1. Injection at birth

2. Oral doses (more complicated- a dose at birth, another 3-5 days old, and at 4 weeks).

There are some medical contraindications as to why you wouldn’t give a bubba Vitamin K… these are if they are sick, premie or if their mama took medication throughout pregnancy for certain reasons (talk to your midwife or doctor if you’re at all concerned).

If you’re seeking more info, it’s a great topic to bring up antenatally with your partner, midwife, obstetrician or GP. Of course at the end of the day, it’s your baby, your call!

For adults wanting to increase their Vitamin K stores within the body, as it is great for bone health (Vit. K helps calcium absorption) eating varied leafy green veggies should do the trick; think spinach, kale, celery as well as carrots, blackberries, raspberries, blueberries, sundried tomatoes….

For more information on Vitamin K please click resources and blog references below:

Vitamin K Royal Hospital For Women NSW

18 Foods high in Vitamin K for stronger bones

Vitamin K in neonates: facts and myths

Vitamin K for newborn babies Australian Government

image via theberry.com
image via theberry.com

The impact of 90 seconds on Bub

1/3 of a baby’s blood it outside of its body at birth. By waiting 90 seconds before cutting the umbilical cord, it has the ability to….

Delayed cord clamping was something I knew nothing about before studying midwifery. I thought, baby comes out…baby goes onto Mum’s chest…the cord gets clamped and cut. But there’s so much more to it!

Delayed cord clamping (waiting 1-3 minutes after birth) is recommended for all births of well babies, not requiring resuscitation, according to the World Health Organisation (WHO) guidelines (2012). This is something that can be carried out for both vaginal and caesarean births. Simply put, it’s waiting until the cord stops pulsing and blood transfusing to the baby is somewhat completed. WHO reported that 29% of all newborn deaths around the planet, are a result of babies not getting enough oxygen at birth (birth asphyxia). So if you consider the ability to increase your baby’s blood supply…increasing its oxygen carrying components (red blood cells)….it’s something to consider.

1/3 of a baby’s blood is outside of its body at birth- the rest is still inside the umbilical cord and the placenta, the way in which Bub has been receiving its oxygen and nutrients for 9 months. By delaying cutting and clamping the umbilical cord by 90 seconds it allows iron-rich, oxygen-rich, stem cell-fuelled blood to enter Bub’s little body. This has the ability to:

  • give your baby 30% more blood
  • give it a natural iron supplement – minimising childhood anaemia risks
  • increase their oxygen carrying cells – whilst they’re transitioning to life outside
  • 60% more red blood cells
  • transfuse stem cells – which prevent and repair damage throughout the body
  • improve systemic blood pressure
  • reduce the chance of baby needing a blood transfusion

Some people are worried that by delaying clamping, you’re giving baby “too much blood”, and there have been reports that delayed cord clamping causes jaundice. The fact of the matter is that since 1980, according to Mercer and Erikson-Owen’s, there has not been a randomised controlled study to show statistically significant findings in a link between increased jaundice levels and symptomatic polycythemia with delayed cord clamped Bubs.

So why isn’t delayed cord clamping happening all the time?! Personally, I believe the reason behind slow reimplementation of it is personal habit of practitioners as well as ‘patience versus intervention’. Living within a fast paced society, sometimes the hardest thing to do, is not much at all. We, as people living in 2015, are all trained for intervention. No one wanders lost (we have GPS and iPhones), we tap cards to pay for just about everything and have access to information (sometimes too much!) at our fingertips. We’re all about what’s next, what’s easiest, what’s faster, what’s quicker… but what if slowing down Bub’s first few moments, and allowing them the time to take a second to soak up as much nutrients as possible, before they’re officially their own little unit, is the first decision you have to make as new parents? It’s something worth reading up on, and making an informed decision about – and let your midwife of doctor know your view. After all, life is fast paced, should it have to start out that way?

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Image via journeyofparenthood

References:

http://www.who.int/elena/titles/full_recommendations/cord_clamping/en/

Alan Greene’s Ted Talk: //www.youtube.com/watch?v=Cw53X98EvLQ

Mayri Sagadi Leslie, 2015, “Perspectives on implementing delayed cord clamping, http://nwh.awhonn.org

Exercising Pregnant

Is it safe? How intensely can I exercise? What exercise in pregnancy friendly? We’ve got all the answers here!

Working out with a Bub on board boils down to the fact that exercise, whether you feel like it or not, is good for you (and Bub).

Research has shown that exercising throughout pregnancy helps to reduce headaches, anxiety, constipation, back pain, pelvic pain as well as increase your energy levels throughout pregnancy, plus it’s likely to wear you out, hopefully allowing you to sleep better during the night…meaning, more rest before Bub arrives…who doesn’t want that?!

Of course, there are going to be days where you just want to vege out on the couch, and that’s totally fine – try and plan out your week with some exercise in mind and stick to it. You’ll feel better off for it!

Below I’ve answered some of the common questions I hear antenatally from women about exercise.

Is it safe? Yes! For the majority of women exercise is safe in pregnancy, it’s actually encouraged. The Journal of Midwifery & Women’s Health (2014) suggests daily exercise may reduce chances of problems cropping up in your pregnancy. Speaking to your health care provider (Midwife, ObGyn, GP) about what’s best for you, is your best bet.

How intensely should I exercise and for how long? Ideally, it’s to a point where you increase your heart rate and begin to sweat. You should still be able to talk whilst exercising (moderate exercise for 30 mins, is fab!) If you’ve never been one to exercise, take it slow and steady…and make sure you warm up. Walking before you get into whatever exercise you are doing that day is really important- no pulling any muscles please, your body is doing enough already! Oh, and take a water bottle- if you’re thirsty, Bub is too.

What sort of exercise is pro pregnancy?

– Walking
– Low impact aerobics
– Prenatal Yoga (make sure you’re in a class with small numbers, it’s important that you are in a class where your movements can be observed clearly by the instructor)
– Swimming is ideal in pregnancy, and you can totally practice your nice long deep breaths (great for labour!) …and it’s no impact- bonus!
– Dancing is not only great for the soul, but a great and fun way to exercise whilst pregnant. Zumba anyone?!
– Weights (light weights- and make sure you’re supervised!)
– Later in pregnancy, rowing machines and bikes at the gym can be a great option.

What to keep in mind If you’re not feeling 100% or something in your gut is saying, “take it easy today”, then take it easy- no one is going to judge you. You’re growing a human- it’s hard work!

What exercise should you steer clear of? Contact sports are a no go. These exercises put you and Bub at risk:

– Skiing
– Hockey
– Anything involving horses
– Altitude training as well as scuba diving
– Heavy weight lifting

It really is a common sense thing. If you’re at all confused or not sure whether a type of exercise is a good idea, ask a health professional that knows your pregnancy history.

When shouldn’t I exercise? If you’ve been advised not to or have pre-existing conditions that make exercising more risky. If in doubt, speak to a healthcare professional.

Who should I speak to about exercise? Your midwife, ObGyn or GP

Happy Exercising! xx

References:

Exercise in Pregnancy- The Australian Family Physician 2014

Exercise in Pregnancy- The Journal of Midwifery and Women’s Health

Fertility 411

Here are the ‘Top 5 Fertility Factors’…

There are many fertility myths flying around as fact out there! When it comes down to it though, every woman is different and will find certain things work better for her and her partner than others. But so this article isn’t a total cop out; we’ve done some research on the “Top 5 Fertility Factors” according to The Fertility Site of Australia YourFertility and medical journals (references below)..

1. Age

There isn’t a nice way to put it, the older you are…statistically, the trickier it makes things. This is considered the single most important factor in conception.

Conceiving naturally (without the help of say, IVF) statistics say:

  • From age 32, the odds of conceiving naturally begin to decrease gradually (but significantly).
  • From age 35, natural conception decline speeds up
  • By age 40, fertility has been reduced by half (at 30, the chance of conceiving each month is approximately 20%. At 40 it’s approximately 5%)

Not to make it all about the female biological clock…and you do hear time and time again, “oh he can have kids whenever, women have the biological clock…”… it may seem that men do to. Research has found that:

  • The average time to pregnancy for men 25 and under is a little over 4.5 months. Men at 40 it’s around 2 years (if the woman is under 25).
  • For men over 45 years, there’s a five-fold increase in time to pregnancy.
  • For couples travelling down the IVF route, if the male partner is 41 or over, then your chance of not falling pregnant is 5 times higher than men younger than them.
  • The volume of a man’s semen and their motility- their ability to move towards the egg, decreases continually between the ages of 20 and 80.
  • Miscarriage is twice as high for women that are with partners over 45 (and they themselves are under 25).

2. Weight

Parents to be, both sides of the parenting partnership, to better your odds at fertility, you should be within a healthy weight range.

Diet and exercise, not only for personal health gain, but in shaping healthy lifestyle habits to share with your to-be-bubs is worth taking incredibly seriously! Check out the following links to help you assess where you sit health wise, and access to some good tips re food choices.

Conversely, being underweight makes falling pregnant tricky too!

Check out your BMI here:  Better Health Channel

3. Smoking

We all know smoking is bad, so it shouldn’t come as a surprise that it’s not crash hot for fertility, either! Smokers may be at twice the risk of infertility than non-smokers and are 1.5 times more likely to take more than a year to conceive. Partners that smoke may also contribute to infertility.

Something I hadn’t considered was passive smoking and the effect is has on fertility. Research shows that actively smoking is only marginally worse than passive smoking, when it comes to fertility. Female passive smokers are more likely to take over a year to fall pregnant than women from non-smoking houses.

QuitPacks are fabulous, and midwives are trained in helping mama’s and their family members make short term and long term goals to either cut back, or kick the habit altogether!

Keep in mind, smoking does affect your baby, in more ways than one. See here for more information.

4. Alcohol

In a nutshell, heavy drinking will reduce your chances of falling pregnant. Of course, once pregnant, because we are unable to gauge a safe amount of alcohol, to reduce chances of Fetal Alcohol Syndrome, it is recommended that women do not drink throughout pregnancy. Please speak further to your midwife or obstetrician if you have further questions regarding alcohol in pregnancy.

Need help to reduce or stop drinking? Visit the Australian Drug Information Network for a list of national and state services in Australia.

Unsure what’s classified as “a standard drink”? Visit DrinkWise Australia.

5. Timing

Rather than trying to reword this, I’m doing the sneaky, and borrowing all words from ‘The Women’s guide to Fertility and Timing’, from YourFertility. See below:

Pregnancy is technically only possible during the five days before ovulation through to the day of ovulation. These six days are the ‘fertile window’ in a woman’s cycle, and reflect the lifespan of sperm (5 days) and the lifespan of the ovum (24 hours).

If a woman has sex six or more days before she ovulates, the chance she will get pregnant is virtually zero. If she has sex five days before she ovulates, her probability of pregnancy is about 10%. The probability of pregnancy rises steadily until the two days before and including the day of ovulation.

At the end of the ‘fertile window’, the probability of pregnancy declines rapidly and by 12-24 hours after she ovulates, a woman is no longer able to get pregnant during that cycle.

For those women who are not aware of their ‘fertile window’ or when they ovulate, sexual intercourse is recommended every 2 to 3 days to help optimise their chance of conceiving.

YourFertility

***A couple of extra things – I get asked a stack of questions about certain foods, in particular Soy. There seems to be conflicting conclusions drawn on the relationship between soy and infertility in studies found online. I personally have an opinion, however want some cold hard evidence to back it up. I’m in and out of hospitals this week, so I will keep you posted after some discussions with colleagues.

imageImage: static.businessinsider.com

Resources and Fact Sheets:

QuitNow

YourFertility

The role of exercise in improving fertility, quality of life and emotional well-being

– The role of complementary therapies and medicines to improve fertility and emotional well-being

Effects of caffeine, alcohol and smoking on fertility

Pre-conception checklist for women

Five Factors of Fertility

Breastfeeding Mamas

It’s important to be mindful of how nutrient rich your diet is. Keep W.I.I.Z. in mind!

Breastfeeding is a calorie burner, which is awesome for post bub weight loss…but because your body is working hard to produce milk for bub, it’s important to be mindful of how nutrient rich your diet is. Keep W.I.I.Z in mind – and add an extra 2-3 mindful snacks to your everyday diet.

Wine Water No.1 thirst quencher. Water unfortunately does not increase your milk production, but breastfeeding is hard work so keeping hydrated is important. Aim for: a glass of water with each meal, a glass of water whilst feeding.

Iodine plays a key role in helping your bubs brain become Einsteinlike. The iodine requirements of a new mum are almost double the norm! Meeting these requirements can be solely diet related, supplement related or a combo of both. If you are using supplements, before use please speak to your doctor. Good Food Sources containing Iodine: bread, iodised salt, seafood, eggs and dairy.

Iron plays a part in transporting oxygen around the body. If you’re low in iron, you begin to feel sluggish, fatigued and are susceptible to a weakened immune system. Good Food Sources containing Iron: red meat, chicken and fish (these all also contain protein and zinc). Green leafy vegetables and legumes contain iron.

Hot tip: If you’re wanting to up your iron levels and help your body absorb iron more easily, squeezing citrus fruits on your greens and vegetables, allows the body to absorb the iron more easily!

Zinc is a warrior for healthy skin, good immunity and reproductive health. Good Food Sources containing Zinc: meats, cereals, brightly coloured veggies and fruit.

Image via @KauailifeImage: @kauailife

Resource: Thanks to #thehealthymummy for all their fab info and recipes available online! x

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