Third Time Lucky

What I learnt from two miscarriages and what midwifery qualifications can’t teach you…

It’s funny being on the other side, especially after a few false starts. Two, to be exact. Miscarriage is something that, being a midwife, I  should’ve been more realistic about, especially with 1 in 4 pregnancies resulting in miscarriage, but I thought, 26 and healthy, there would be no reason to consider the gloomy side of things.
Falling pregnant for us, was easy! 3 cycles = 3 pregnancies, which we were and are very grateful for, but getting the little rugrats to stick was the hard part for us.

Recurrent miscarriage is classified as 3 or more miscarriages, so a lot of the time investigations start after the third miscarriage…but being an impatient Gen Y’er, and lucky enough to be working with, and surrounded by midwives and obstetricians to help with the investigations, I got straight to it to see what was going on/if anything was going on…

One consult with a colleague, 18 tubes of blood later and I had been tested for every weird and wonderful anomaly+chromosomal testing you could consider, I got an ultrasound,my husband got sperm+chromosomal testing, and 3 months later when the results returned, everything was perfectly normal. This was good, but was frustrating – I was almost of the mentality, if something had been there, we could work at it and fix it, but nothing showed up….as a lot of the time it does. We put it down to environment.

I’m a stress-head and love working and keeping busy. I was working a job that required me being on call, working long shifts and keeping bizarro hours – all in all not really looking after myself. My healthy lifestyle choices would fly out the window because the reformer pilates class I was booked into, or the trip to the gym, was now kiboshed by a trip into the hospital, and once I’d returned I was buggered and we’d order takeaway.

When I was newly pregnant, the first time, I pulled a few all nighters at the hospital, and we were particularly busy. I didn’t eat any food/drink minimal water for each of the shifts and we didn’t have breaks…not that I think this was the reason for what eventuated, but it just goes to again reinforce the pace at which I was moving and the fact that I wasn’t putting myself or my pregnancy first.
A couple of days later, I started a new role at the same hospital I had been working at, and as the heaven’s would have it, my first week on the job, I had a miscarriage. Not wanting to take anytime off (group practices rely heavily on being a team player…and I would be buggered if I was going to let the team down week 1!) I worked the whole way through….and did the second time as well, this time pulling a 12 hour shift, doing home postnatal visits, returning to go to the loo and instead ended up running for emergency caesarean… craziness. I ended up in hospital that night with falling blood levels and an operation at 3am. Stupid. Stupid. Stupid.

What’s the point to this article? A lesson of hindsight and how you can learn from my stupid ways.

Things I wish I had done sooner:

Prioritised myself and my health. Working within a big organisation you can be chewed up and spat out without even really noticing it. If you need a day off, you need a day off. Take it. Don’t be a martyr. I’m getting better at this. Third time around, I knew I was pregnant by 3.5 weeks (when I started vomiting all the time)…so I took the week off and veged on the couch watching movies, and as luck would have it (if you call moving interstate and packing up a house lucky when you’re 5 weeks pregnant) I was finishing up in this role a fortnight later. So I didn’t/haven’t looked for midwifery jobs in Brissie yet, I’m studying to educate Calmbirth for the moment and doing some freelance stuff.

Find a good GP. Going to whomever that was available at the local bulk-billed place when you need the quick medical certificate or script had always served me well, but not having a regular GP when it came time to pregnancy related stuff kinda screwed me. Having to show up to get your bloods taken to confirm falling HCG levels mid miscarriages by rando Dr’s that have no bedside manner and answer questions like “do you have any kids?” rather than “are you okay?” or “this sucks” was a kick in the head, twice… Go find one you like, and stick with them.

If you’ve had a couple of miscarriages and you’re wanting to investigate sooner that what a GP would normally recommend investigating or write a referral for, do it if it’s going to give you piece of mind. Even though it was third time lucky for us, just knowing that there was nothing showing up on paper was enough of a confidence booster a few months later to try again. Worth every penny! Be “difficult” and demand it. No harm in investigating, if this is what’ll keep you sane.

 

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Baking until Feb 2018

 

Pelvic Floor Exercises; no activewear required!

You don’t need activewear or a gym membership to strengthen these bad boys, just a little discipline. Here’s the 411 on why as women; before, during and post babies we should be activating our pelvic floor.

Pelvic floor exercises are something that, as women, we’re told about over and over again, but are we doing these quick and uncomfortable exercises as often as we should be…i.e. everyday?
I know I don’t, and dare I speak on behalf of women, I’m sure the majority of us aren’t doing them as often as we should be. A study conducted in the UK has shown that 66% of women didn’t know where their pelvic floor was and only 40% doing their pelvic floor exercises on a regular basis – not great stats when I’m sure 100% of us do not want to be urinary and/or faecally incontinent in the long run!

So here’s a quick 411 on all things pelvic floor and why they are important for women pre-baby, during pregnancy and post baby.

What is the pelvic floor?

Think of your pelvic floor as a sling of muscles that support the uterus, bladder and bowel. Everything that comes out from down below passes through the pelvic floor. These sling-like muscles attach at the front to your pubic bone and at the back to your tail bone, from the base of your pelvis.

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How do I do a kegel correctly?

To understand the muscles involved in pelvic floor exercises imagine needing to do a wee but not being near the toilet…that initial squeeze is the activation of your pelvic floor. How to do your pelvic floor exercises, see link below:

Continence Foundation of Australia

The Royal Women’s Hospital

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via pilatespod.co.uk
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via mutusystem.com

What’s the point pre-baby?

  • Provides bladder and sphincter control
  • Facilitates a strong foundation for when you do have a baby (think bowling ball sitting on your bladder…), to help minimise urinary incontinence
  • Can improve orgasms and sexual pleasure

What’s the point during pregnancy?

During pregnancy, the hormone progesterone softens and relaxes the muscles and ligaments within your body, enabling it to help bub manoeuvre its way through the pelvis and birth canal.

This progesterone also slows other things down in your body and a common problem during pregnancy is constipation, so drink lots or water, stay active and embrace a fibre-rich diet.

During labour and birth the pressure of bearing down and pushing may stretch and weaken the pelvic floor, so having the foundation of a strong pelvic floor can benefit the efficacy of pushing. It’s also not a bad idea to look into birthing positions, as birthing in an upright position can increase pelvic diameter by 30% …working with gravity…making more room for bub (read our article on birthing positions here)

The benefits of doing your pelvic floor exercises (excerpt via huggies.com) :

  • The risk of uterine or bladder prolapse is reduced
  • Pregnancy, delivery and recovery time can be improved
  • Post-partum discomfort from perineal swelling and haemorrhoids is reduced
  • Perineal tearing and/or need for an episiotomy is reduced
  • Urinary incontinence/leakage during pregnancy and after delivery is reduced
  • A toned pelvic floor leads to more complete emptying of the bladder and bowel
  • Helps to avoid stress incontinence after delivery – small amounts of urine leakage when laughing, sneezing, coughing or lifting something heavy

 

How do I regain strength post baby, and when should I start doing my pelvic floor exercises?

Start doing those pelvic floor exercises ASAP. Some women may find in the days post birth that doing their exercises laying down is easier and they are able to engage the right muscles more easily. Give it a go!

Before baby and during pregnancy your pelvic floor strength will have been more toned and therefore your exercises will have been stronger and longer in duration. In the early days post birth it’s important to work up to it. Aim for a few seconds each day for the first week, and build up to it slowly.

Tools to help with pelvic floor instability and incontinence

If you’re one of those people that need a gadget to motivate you to do exercise, here are few to investigate:

http://www.epi-no.com.au/

http://www.kgoal.com.au/

 

 

 

 

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Birth and Bugs (the good sort)

What you need to know about seeding…

Anyone that’s had a baby, or watched “Call the Midwife” or “One born every minute” knows birth is messy…and when we say messy we mean that you don’t labour in your Camilla … there’s fluid, it’s primal, innate and magical all in one! And amongst all the vernix, amniotic fluid and blood, are microbes (good bugs), which babies born vaginally are exposed to whilst making their way through the birth canal.

This exposure to approximately 300 ‘good bugs’ from the birth canal helps to build a child’s microbiome (the army of bugs that protects us from germs, breaks down food for energy, etc.).

But what happens if you don’t have a vaginal birth, and have a caesarean? – Does this mean bub misses out on these good bugs?

Not anymore! Let’s talk seeding…

With one in three bubbas being born in Australia via caesarean, and by bypassing the birth canal, it means that they are therefore not exposed to the bugs, which is leading to the ongoing research debating the lower levels of autoimmunity of bubs born by caesar. So it’s great to hear that there are now methods out there for littlies to receive these good bugs regardless, hopefully increasing immunity for all! (Research is still pending on the efficacy of this in comparison to vaginal birth…but it can’t hurt, right?)

How is seeding done?

Seeding is carried out by inserting a sterile swab into the vagina (like a tampon), leaving it there for a little bit to absorb, then giving it a swirl and taking it out. When bub is born, this swab is put in your baby’s mouth and wiped across their little body immediately, trying to emulate a vaginal birth.

If this is something that’s of interest to you, please discuss it with your midwife or obstetrician, especially if you know you’re having a caesarean for whatever reason or thinking of going down the VBAC road.

References and Articles: (to come!)

Image via janabrasilfotografia and @birthwithoutfear

The Placenta; trash or treasure?

It’s plays one of the most important roles throughout pregnancy and then we chuck it?! What you could do with it, if you were to keep it…

Over the past 24 hours, the placenta (the organ that nourishes and oxygenates the baby whilst in utero) has been a talking point on social media. A photo published by a Brisbane photographer on Facebook (and Insty) (here) showed a little bubba still attached to the placenta, and the Maori traditions that would be practiced postnatally by his family. Which got me thinking…if this photo has received such broad recognition over something that I thought was known information, maybe the placenta and what happens to it afterwards, or ways to treasure it aren’t known?!

Let’s rewind briefly…the placenta is the huge bed of blood vessels that begins developing at implantation and imbeds itself into the uterine lining, with the umbilical cord stemming from here. Most commonly the placenta will attach to the top of side of the uterus – if you want to know where yours is out of curiosity, ask the sonographer at your next scan.
The health of your placenta is a result of lifestyle, age, nutrition, health (blood pressure, blood clotting disorders, substance abuse, smoking), etc.

After the birth of a baby, the placenta follows suit either physiologically or managed actively. Physiological management of the third stage is where the midwife and mother wait for the placenta to naturally come away from the lining of the uterus. This is method should be discussed with your midwife or doctor as there are contraindications. If you do intend to birth the placenta physiologically, a strong focus on initiating breastfeeding and skin-to-skin with baby has been documented to encourage this separation.
The other method of placental delivery is through active management (this is what is most common and implemented in Australia); whereby a mother receives an intramuscular injection with consent of a synthetic oxytocic hormone to help contract the uterus and clamp down the blood vessels…encouraging separation and minimising blood loss immediately after birth. This is the same drug that is utilised in inductions of labour to make a uterus contract.

From here the placenta, the membranes and the umbilical cord are inspected by a midwife. Unless otherwise indicated (by certain factors throughout pregnancy, birth or birth outcome) the placenta will be discarded, unless the parents want to keep it*.
*This may be something to consider antenatally if you’re thinking about going down this road. From my contact with a few hospitals, I know that they will not keep your placenta refrigerated for you whilst you are at the hospital, so organising a way in which to get it home, and keep it refrigerated until you’re ready to carry out whatever you see fit, is worth a little advanced planning.

So for anyone wanting to somehow use or honour the placenta (I’m aware of how hippy dippy this sounds, but I couldn’t think of another word) here are a few to consider:

Lotus Birth is where the placenta is left attached to the baby at birth until the cord falls off on its own. Sometimes being covered with salts, herbs (rosemary and sage are often used), the placenta is then wrapped up, nappy style, so it’s not intrusive (or offensive) to some guests that may want a snuggle with bub. This is the downside to a lotus birth – so both partners need to be on board with the process for it to not hinder physical interaction with bub.

Placenta Encapsulation is when the placenta is steamed and cooked at a low temperature, dried and encapsulated into what look like ground vitamins. They are tasteless and are a way of receiving nutrients that have been suggested to:
-Help balance your hormones
-Replenish depleted iron levels
-Assist involution (the uterus returning to its pre-pregnant state over the 6 weeks post birth)
-Reduce postnatal bleeding
-Increase milk production
-Decrease the chances of postpartum depression

After speaking to other midwives one shift, a few stressed the importance of seeking out well practiced and known placental encapsulators. So, make  sure you do your research beforehand and be sure to ask questions about the conditions and hygienic methods implemented throughout the process. Websites like, http://www.placentaservices.com.au/new-south-wales.html, work as directories for verified service providers.

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image via placentanetwork.com

 

Placental Burial is the burial of the placenta under a tree or in a garden. The nutrients of the placenta are said by green thumbs to make a great fertilizer too, which is a bonus! If you do intend to plant it in the garden, make sure you bury it deep in the ground…no one wants an animal on the hunt for it…not good, not good! Also, if you’re worried that you may end up moving one day, it can always be planted in a large pot. That way the placental plant can move with you.

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image via lisamckaywriting.com

 

Placenta Piccie – The name says it all really. Paint and dye are used to highlight the blood vessels to be printed onto paper. A keepsake that can be as colourful or monochromatic as you see fit.

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image via shaunaowensphotography.com

 

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In all it’s glory! Image via Pinterest

 

What did you do with your placenta? Was it trash or treasure? x

To VBAC or not to VBAC?

The benefits and risks here…

There’s been lots of VBAC discussion on our Instagram feed over the past couple of days. I wanted to have a greater handle on the recent facts and stats, so I was read an article on The Conversation by Hannah Dahlen last night on vaginal births after caesarean sections (VBAC) (read it here).

With nearly one in three women in Australia giving birth via caesarean, I feel like I am only really just now starting to hear more and more about VBAC’s. Yes, as Midwives we are taught and study this but anecdotally I hadn’t come in contact with many women asking for a VBAC, but more so of midwives asking women if they knew about a VBAC being an option and did they want to consider it.
It’s lovely to hear more women, through the channels and power of social media discussing topics like this, sharing birth stories and channelling positive empowering pregnancy energy.

It is important to mention that “most Australian women (84.4%) have a caesarean for subsequent births after a caesarean. Only 15.5% of women have a VBAC. In private hospitals, this rate is even lower, at 11% “(Hannah Dahlen)… however of the women that do attempt a VBAC, 70% of these women are successful in giving birth vaginally and do not need a repeat caesarean section. Which is nothing to sneeze at, right?

Yes, a repeat caesarean section is a decision that is solely that of the couple after an informed conversation with their health practitioner, and fabulous advancements in research now mean that babies are not separated from their mamas (health of mum and bub permitting) and there are things like seeding available for women (vaginal microbes wiped onto babies as they are born via caesarean so to simulate as best possible the antimicrobial goodness bubs receive from the birth canal) and skin-to-skin and breastfeeding support happening in theatres and recovery; facilitating the mother-infant dyad.

But if you’re a low risk, healthy mama, and want the option of a VBAC, and want to know more, continue reading!
It’s a conversation worth having antenatally with your midwife or obstetrician!

Benefits of a VBAC?

  • Greater chance of uncomplicated births in the future
  • Recovery is a lot quicker – due to no abdominal surgery
  • Reduced risk of blot clots
  • Skin-to-skin, mother-infant bonding, breastfeeding etc. may be established quicker.
  • Shorter stay in hospital

Risks of a VBAC?

  •  uterine rupture may occur. Statistics are about 1 in 200 VBAC’s there will be a uterine rupture (the scale of which varies drastically from slight rupture to the uterus opening up completely…which is very much cause for concern and can have dire outcomes).
  • “In terms of the baby’s safety, guidelines on VBAC just released by the United Kingdom’s Royal College of Obstetricians and Gynaecologists (RCOG) state that the risk of a baby dying during labour and birth is extremely low and is similar to the risk for women having their first baby”(Hannah Dahlen).

Do VBAC outcomes differ based on hospital setting?

Some hospitals in Australia offer VBAC programs for mothers that have had 1 caesarean section…other hospitals have programs that offer women the option of a VBAC after 2 caesarean sections.

Does a VBAC mean I have to labour differently?

Continuous cardiotocograph monitoring (CTG) may be implemented to keep a close eye of the wellbeing of bub. Protocols may vary from hospital, state, obstetrician etc., so this is a good question to ask your midwife of doctor so you know what to expect.

So if you’ve had a previous caesarean section and are unsure as to your personal situation and your options, asking lots of questions to you midwife or obstetrician,  and regardless of whether you choose to try for a VBAC or choose an elective caesarean, just asking questions helps to make informed decisions.

Image via Hannah Tallo of a VBAC mama
Resource: hyperlinked article (first paragraph) The Conversation, Hannah Dahlen

 

 

Birth Perceptions; the power of language

Language carries weight and power. We have a question for you…

It could be argued that the time in a woman’s life where she will seek, question and be influenced by information the most is during pregnancy. Pepper in hormones, lack of sleep and a tiny touch of anxiety about the impending birth and you have a woman that is susceptible to the weight and power of language.

We know that words have the ability to empower us, and also destroy our confidence. Statistically, we are more likely to say stuff we regret or that might be less thought out when we are under pressure, feel out of our depth, are in an unfamiliar environment or anxious (welcome to a birthing room).
As midwives throughout our training we focus on woman-centred language, and ways in which to support and empower women giving birth, including ways in which to make the birthing environment feel safe and reassuring. This is all well and good, but reassurance from a loved one, and/or support partner is invaluable, and may hold more weight physically and emotionally for some women.

So….we’re throwing this one out to you guys….what words of empowerment; from either your midwife, doula, obstetrician, loved one, or support partner, got you across the line? What do you remember most vividly?  Keeping in mind that language is not always verbal. Physical language is also telling.

Sharing is caring! We’d love for you to comment below (short and sweet, or long and lengthy, you pick) and share in the positivity and empowerment of birthing language.

 

 

Image source : @birthwithoutfear  @southcoastmidwifery @kassandranicole

 

The year that was, and the year ahead

For all the lovebirds contemplating or expecting a bub next year, have a squiz at the Chinese gender calendar. Are you having a boy or a girl?

Just a quick shoutout to all the gorgeous peeps that have been along for the Winnie Wagtail ride for the past 5 months. We’re thrilled the whirlwind that was 2015 is coming to an end and can’t wait for 2016!

Whilst we contemplate New Years resolutions, and get stuck into the bubbly, for all the lovebirds contemplating a bub for next year (the year of the monkey) have a squiz at the Chinese gender calendar. This is not evidence-based, but said to have been discovered in a tomb over 700 years ago, it is supposedly over 90% accurate. My husband and I backtracked friends, family and siblings, and only twice was it incorrect from our experience. It’s a bit of fun for guessing your baby’s gender, or planning ahead (with 50/50 odds, and this supposedly higher, you can’t really go wrong!)

Link to calendar here

 

 

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