Birth – Winnie Wagtail

Birth Story: Baby P

A midwife shares her complicated pregnancy journey and the lessons learnt along the way.

An old colleague of mine sent me her birth story recently. Here’s a midwife’s perspective on the birth of her beautiful baby girl.

I debated about whether to share this, but realised that sometimes it is cathartic to express yourself after going through a stressful time.

Basically, I started off with a VERY complicated pregnancy. I’m not going to go into details here, but it required hospitalisation and a lot of time off work until 20 weeks. Being a first time mum and a midwife, I found this time very hard mentally. I think many first time mums focus on the birth and concerns about that, but I was NEVER concerned about the birth. Being a Birthing Unit midwife means that I am well informed and would have been confident to make the best birthing decisions given whatever circumstances came my way! Ideally, I would have wanted a natural drug-free birth (while always being open to pain relief if I needed it), but my main concern would always have been the safety of my baby. From a midwife’s perspective of not always seeing happy stories, and a history of anxiety, I was burdened with worry from the beginning about getting through a pregnancy safely. 35 weeks + 5 days is a LONG time to be feeling constantly worried.

I had a few weeks where everything was going smoothly. I was having regular scans, and then at 29 weeks we found out that our baby had asymmetrical IUGR (intrauterine growth restriction). This means that the baby isn’t growing properly for gestation. I was at least thankful that it was the asymmetrical kind – if you have IUGR this is the one you want! It means that the placenta isn’t functioning optimally to provide nutrients, but the baby is preserving brain/head growth, resulting in other areas such as the abdominal circumference not growing well. The baby had dropped from having her abdomen growing at approx 40% to 3% in a matter of 3 weeks – so pretty drastic!

Being a full time midwife while having a complicated pregnancy is HARD. I know work is hard for anyone who is pregnant and working shift work or a physical job (or any job at all), but it is harder with complications! I was so thankful to have my manager and colleagues support me where possible. However, it is SO strange to be treating women who may have come in with a growth restricted baby and concerns about their baby’s movement. Obviously, I didn’t share my own story with them for professional reasons, but on some really busy shifts where I was on my feet all day, it was hard to deal with. I hadn’t even had the chance to know if my baby had even been moving normally on those days (which is really important in the context of IUGR).

Towards the end, the plan for my birth had been an induction at around 37 weeks. I was covered with steroids to improve baby’s lungs (thankfully – given she ended up being born early by caesarean section).

Steroids are given in 2 doses 24 hours apart. I had these on a Friday and Saturday as well as having CTG monitoring of her heart rate – both days this was absolutely textbook perfect. On the Sunday we sold our car and were meant to pick up our new one on Monday. We joked with the friend we sold it to on Sunday that we hoped we didn’t need it for anything on that one night. Well, it turns out we did. At about lunch time I realised that I hadn’t really been feeling the baby move much. I lay down and prodded and poked her myself and nothing was happening. I was thinking to myself “am I imagining things? / I don’t want to go in to hospital to be annoying,” but ended up deciding to have a large coffee. If her movement wasn’t normal in an hour, I would call my midwife to go and get checked. We ended up getting an uber into hospital sooner than an hour due to my gut instinct that something wasn’t right.

I knew as soon as I was put on the CTG that the baby’s heart rate was a lot different to the two previous days, and was abnormal. I got scanned by a doctor and she wasn’t moving on ultrasound either, despite being prodded quite vigorously. The labour ward was busy that evening and the doctors had to come in and out, but I knew what was going to happen when I was asked “when did you last eat?” by the doctor. My midwife confirmed that the doctors wanted to do a caesarean section, and asked if I was ok with that. My response was “I just want my baby out safely”. My poor husband was a bit shell shocked. I think that I subconsciously knew what the outcome would be going in that day if everything wasn’t ok, but he was completely surprised and had to very quickly wrap his head around the idea that our baby was coming!

I’m so grateful that I knew the doctors who saw me/performed my caesarean from working with them previously – it made that part a whole lot easier for me!

As soon as our baby was born it was like instant relief for me mentally – I hadn’t quite realised beforehand the extent that the pregnancy had affected me. Since her birth I’ve felt amazing. She did have to go to the nursery for 9 days because she was a tiny 2.166kg, and also needed help with her breathing for the first 4 hours. I wasn’t worried about this at all, because again from experience I knew she would be absolutely fine, and my husband got to go with her to the nursery.

I was so grateful for the amazing support I got in hospital. I was expecting to not see her until the next morning when the anaesthetic had worn off and I could walk. However, the midwife looking after me arranged for me to get taken down in my bed at about 3am when she was off the breathing support, and we got to have our first cuddle. There is truly nothing better than the first cuddle with your baby!

Take home messages:

Maternal instinct is so important! I’m even more aware of how important fetal movements are after this experience. I went in 3 times in the pregnancy with movement concerns (while being a typical midwife and second guessing myself for fear of being annoying/creating a workload). I went in first at 26 weeks, and it was at the next scan that she was found to be IUGR. The second time was at 32 weeks after I’d had a lot of vomiting. I knew the reduced movements were dehydration related, but I still needed to get checked out. The third time was when she needed to be born!

I think more can be done to support the mental health of women with early pregnancy complications. It is a really lonely and scary time being in limbo.

I think there should be a discussion about leave entitlements for working women with pregnancy complications. I have always been vocal about maternity leave rights for women before I was even pregnant. We have created a capitalist society that requires 2 incomes to service a household, and for women to also support the economy. Women don’t choose complicated pregnancies. If women do have complications, I think there should be leave entitlements that don’t require them to use annual leave or leave without pay. I don’t buy into opinions of “it’s your choice to have a baby – deal with it”. As I’ve said before, there would be riots if women went on strike and stopped having babies.

Was my birth experience positive given the circumstances? YES! I feel like I recovered really well from the caesarean. The only thing I didn’t like was the spinal anaesthetic. The actual procedure was completely fine, but it is the weirdest feeling when you go completely numb from the waist down.

Would I do it all again for our daughter? YES!!!

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!

(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

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.

References:

KEMH Policy and Guideline

POP info

LAM method

After you’ve had a baby

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

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

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