Vaginal Examinations in Labour

Vaginal examinations are often taken for granted in labour. Many women would be led to believe they could not birth a baby without having a vaginal exam, but the truth is, if a baby is going to be born vaginally, it will be born regardless of whether a vaginal exam (VE) has been performed. That said, there are some really good reasons why your midwife or obstetrician might recommend one (or more). VEs are mainly done to obtain information that is relevant to that particular labour or the circumstances of the labour. It might be suggested:

  1. To determine if a woman is in labour, because it is not helpful to the woman or her support people to spend many hours in a delivery suite when labour hasn't yet started.
  2. To confirm whether the baby is coming down bottom first or head first.
  3. To determine whether the head is engaged deeply in the pelvis, and perhaps the position of the baby (although I believe this isn't really relevant until later in labour)
  4. To assess the progress in labour, which, combined with an assessment of the position of the baby, can help midwives and obstetricians to suggest positions and movements that can be helpful for encouraging the baby to turn naturally.

A lot of information can be obtained from a VE, but that is not to say that at every VE, your midwife or obstetrician will obtain all of this information: sometimes, it is only important to know that your cervix has opened more, whereas other times it will be more important to track the position of your baby's head.

I would do a vaginal examination:

  1. If the woman asked for one, perhaps because she would feel more reassured to know that she is progressing well in labour, or if she wanted to know the exact position of her baby to guide her movements and positions in labour;
  2. To reassure her that yes, labour is progressing really well, if she is feeling that it is all too much and she is at the end of her tether (although this very rarely happens as most of my clients attend a Calmbirth (R) course);
  3. Always before providing medical forms of pain relief (except nitrous oxide gas). This is because it is important to know that a woman is in labour before giving an epidural, but it is also important to know that she is not very close to birthing her baby, as this would mean that the epidural would take full effect after the baby arrives. It is also important if morphine is used, that we know that the baby is unlikely to make an appearance shortly.

It's not my practice to do a vaginal exam:

  1. Frequently if the woman is in early labour, as it is discouraging to hear, "You're 1cm" when this was the case 12 hours before, despite contractions.
  2. If I thought the woman was fully dilated. In this case, I wait for the urge to push to intensify, so that it is present during the entire contraction and is an irresistible urge. At that time, the woman is most often fully dilated and we see the baby's head very soon. Doing vaginal exams to confirm that a woman is fully dilated can often lead to premature pushing, before the baby's head has descended deeply into the pelvis. This early pushing - often directed - can lead to more tearing. And nobody wants to tear if it can possibly be avoided!

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Predicting a healthy pregnancy?

Women have often wondered if there was a way to predict a healthy, uncomplicated pregnancy.  New research has now suggested a way that this can be done.

On average, just over 60% women studied had a normal, uncomplicated pregnancy.

The sorts of things that can predict a complicated pregnancy include:

  • Increased body mass index
  • Misuse of drugs in the first trimester of pregnancy
  • High blood pressure early in pregnancy
  • Vaginal bleeding in pregnancy
  • Family history of high blood pressure in pregnancy

The sorts of things that women can do to help have a normal pregnancy include:

  • Pre-pregnancy fruit intake of at least three pieces of fruit per day
  • Being in paid employment

This study suggests that there is a lot that women can do to increase their chance of a healthy pregnancy, including moving towards a healthy weight by exercise and good nutrition.

What to pack for your hospital bag

It can be really helpful to have a hospital bag packed by about 36 weeks, just so that it is ready to go to hospital when you are. Women planning a homebirth will also pack a hospital bag just in case a transfer is needed in labour. For the most part, women stay in hospital up to 48 hours after birth. This means that you really don't need to bring very much in the way of changes of clothes. So - what to bring?

Clothes for labour

Hospitals provide gowns, but many women prefer to wear their own clothes, or even no clothes. The best clothes to wear in labour are loose, baggy t-shirts, a dressing gown (if you are cold), tracksuit pants and so on. Nothing tight or restrictive, and nothing you can't take off quickly if you want to. It's also a good idea to wear old clothes, not your best new outfit. Bring a couple of pairs of underpants for labour.

Toiletries

Tooth brush, tooth paste, shampoo, conditioner, moisturiser, deoderant etc - whatever you normally use. You'll also need 2 packets of maternity pads. Ie, not panty liners or thin menstrual pads, but heavy-duty maternity pads.

Underwear

Breastfeeding bras, lots of dark-coloured, loose underpants.

Clothes for the hospital stay

Again, whatever feels comfortable. Nighties, singlets, buttoned tops, loose clothes, tracksuit pants etc. You're best to pack lightly, as anything that's needed can easily be brought in from home by a relative or friend. Slippers, shoes etc - whatever you normally walk comfortably in. After you have a baby, your feet often swell a bit, so loose shoes are the key. Hospitals can often be cold places, so give some thought to layers of clothes so that you can layer up or down as you need.

Things for labour

Food and drinks, massage oil, aromatherapy, homeopathics, herbal medicines, pillows, photos / visualisation aids, CDs / iPod, anything that makes you feel 'at home'.

For baby

Babies are small ... and therefore easy to pack for! The hospital will supply baby clothes while you're in hospital. Some hospitals provide nappies; others don't. Best to check with your hospital. In geberal, you'll need two outfits to take your baby home in. Why two? babies are notorious for pooing and weeing through outfits and this way you can have a change of clothes if you need them. You'll need singlets, mittens (if chosen), nappy wipes and nappies. In winter or cooler weather, you'll also need a beanie.

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Breastfeeding: Benefits for Babies

Early breast milk is called colostrum, and is rich in antibodies and nutrients that help a baby's immature immune and digestion systems. Colostrum is present in very small amounts, but this is actually perfect for babies as they have very small tummies when they are born. as your milk comes in, your breast milk changes as your baby grows and it becomes slightly more watery and plentiful, to match your baby's growing size. By the time your milk comes in, it has the right amount of fat, carbohydrate, water and protein to help your baby continue to grow. 

Breast milk is easy to digest - and hence, you'll find your breastfed baby will want to feed more often. This is a good thing, as it helps to regulate your body make enough milk.

Breast milk helps your baby fight infections. This is because any infections – such as a cold – that you may have, you will form antibodies to. These antibodies will be present in your breastmilk and will help to protect your baby.

Breastfed babies experience fewer digestive concerns such as diarrhoea and constipation.

They also experience fewer health issues such as respiratory infections, asthma, eczema, allergies, obesity and Type 2 diabetes. They are less likely to miss days from school owing to infections, so there is a social and educational benefit too.

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Ten Tips for a Normal Birth

  1. Choose a place to birth where you're most comfortable and that supports normal birth. This may be at home or in a hospital.
  2. Choose a healthcare practitioner who supports normal birth. Many women have found that care provided by midwives includes less interventions and more labor support.
  3. Don't request or agree to induction of labour unless there's a medical reason. Allowing your body to go into labour on its own is usually the best sign that your baby is ready to be born. Allow your labour to find its own pace and rhythm.
  4. Move around freely during labour. You'll be more comfortable, your labour will progress more quickly, and your baby will move through your pelvis more easily if you stay upright and respond to your labour by changing positions
  5. Think carefully about who will be ideal to support you during labour and birth
  6. Ask that your baby's heartbeat be monitored intermittently so that belts, cords and wires do not tie you to a machine or specific place.
  7. Eat and drink as your body tells you to. Drinking plenty of fluids during labor will keep you from getting dehydrated and give you energy.
  8. Use non-pharmacologic pain management strategies such as baths and showers, massage, hot packs, aromatherapy, focused breathing and other comfort measures
  9. Don't give birth on your back! All-fours and kneeling positions are more comfortable, increase the effectiveness of your contractions and enable you to work with gravity. Push when your body tells you.
  10. Keep your baby with you after birth. Skin-to-skin contact keeps your baby warm and helps to regulate your baby's heartbeat and breathing. Keeping baby with you in your room helps you to get to know your baby, respond to your baby's early feeding cues and get breastfeeding off to a good start.

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Physiological third stage

Link

No previous study has focused on true physiological third stage for women at low risk of postpartum haemorrhage. Physiological third stage is often chosen by women who birth at home or with a private midwife, however hospital policies urge active management of the third stage (injection of syntocinon, immediate clamping and cutting of the cord and then pulling the placenta out) because studies have shown that this form of management reduces bleeding. However, those studies have either a) not clearly defined physiological management or b) not managed the "physiological" third stages in a physiological manner.

This study clearly defines what is meant by physiological management and also the women who are suitable for physiological management. Some women are at a higher risk of PPH and so active management was recommended to those women in the study.

The study compared active management which was standard at the tertiary hospital, with physiological management which was the norm at the free-standing birth centre. At the tertiary unit, 11.2% low-risk women experienced a PPH. At the midwifery-led unit, where physiological management was practiced, PPH only occurred in 2.8% women. Active management was associated with 11.5% PPHs compared with physiological management which was 1.7% PPHs. Active management was associated with a seven to eight fold increase in PPH for low-risk women.

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Cascade of intervention

A study has found that first-time mothers who have their care within the general hospital system and have their labour induced, face a greater risk of having a caesarean section than those who wait for labour to start on its own.

In the study, 44 percent women had their labour induced, and 20% of those inductions failed (ie, labour did not start) and caesareans were performed in those cases.

By definition, induction is performed before a woman's body is ready for labour, and this may point to the reason for such a high rate of failed inductions. In other cases, the reason for the induction is also the reason that the caesarean became necessary. For example, a labour may be induced because of concerns for the baby, and once in labour, the baby shows signs that it is not tolerating labour well and so a caesarean is performed.

The study does point to the issue that inductions should not be performed unless they are genuinely necessary. Up to 50% inductions are not performed for a genuine medical reason. They might be performed more for convenience, for example. However, if we limit inductions to those which really need to be done, we may lower the caesarean rate.

There are some reasons when an induction might be a good idea, such as when the woman's blood pressure is high, if the pregnancy goes to 42 weeks, if the waters have broken for many hours and labour has not started, if there are concerns for the baby and so on.

Before any induction is commenced, it's important that women are fully informed by their care provider of the reasons for the induction, the alternatives, the process and procedure, what to expect and the likely outcome.

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Swelling in pregnancy: what to do about it?

Natural therapies such as lymphatic drainage, reflexology and acupuncture can work well for swelling.

Drinking more water can help to flush through any swelling, combined with gentle exercise such as waking or swimming.  While you are resting, keeping your legs elevated will help, too.

Swelling is a normal part of pregnancy, particularly towards the end of pregnancy.  It can also occur after the baby is born, and typically takes two to six weeks to resolve.  In this time, walking is a really good way to encourage the fluid out of the legs and feet.

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Natural birth in hospital?

Here are some ideas to birth naturally in hospital: Read, read, read. Books, websites, any written info from your care provider ... read it all. You also need to know the difference between facts presented to you in an honest and unbiased way, and facts that are being filtered through hospital policy. This is where women benefit from having a private midwife by their side.

Be assertive As with most human relationships, a great deal can be resolved with a calm, respectful and firm manner. Know what you want and why you want it. Engage a private midwife to assist you with obtaining relevant and impartial information.

Listen. If you are choosing to use a hospital and an obstetrician for your birth, then you acknowledge that their presence, education and experience have some value.

Be Flexible. Understand that sometimes things don't go the way we had planned. There might be some occasions where you'll be happy to accommodate the hospital policy, and other times when you'll want to stand your ground.

Ultimately, it is true that the most important aspect of birth is safety and a healthy mother and baby. But that doesn't mean the other aspects are unimportant, and I believe you can have a great birth - and a safe birth - in any location.

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Induction of Labour

Labour induction is a controversial choice in birth.  There are concerns on the one hand that it leads to more intervention, particularly epidural and caesarean, yet these beliefs are not supported by all of the research on induction.  The other issue is that provided the induction is being recommended for sound medical reasons (ie, there is a risk to the baby in continuing the pregnancy), then other than induction, the only other safe option might be a caesarean. 

In my practice, women are very well prepared for labour, birth and the unpredictability that this brings.  With sound preparation, women respond to evolving events with flexibility and positivity.  I wonder if it is this mindset that influences the outcomes of women for whom induction was the safest choice.

Of the women who have been induced in my practice, the vast majority have gone on to have normal births, free of any form of medical pain relief.  For the most part, the only interventions have been the induction itself, and monitoring for the baby.  Waterbirth is just as common, even physiological third stage.  So my experience doesn't agree with the research that suggests that women who are induced are more likely to have an epidural and caesarean.

What sorts of situations have led me to recommend induction?

There can be many issues that arise that might make it safer for the baby to be born, rather than continuing pregnancy.  Pre-eclampsia is one condition which will worsen over time, and often at term, induction is the safest course of action.  Cholestasis is another condition which can be harmful for the baby, and induction is usually considered to be safer.  I don't normally recommend induction for women who have gone past their due date, or with waters broken, because we have good forms of monitoring (and antibiotics in the case of waters broken) that we can use instead to ensure that mother and baby are healthy. 

Induction doesn't have to be the start of the cascade of intervention.  My experience is that the intervention can absolutely be limited to an induction drip and monitoring. 

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care and birth support.  Visit Melissa's website to learn more about her services.

Do obstetricians and midwives attract different clientele?

New research has suggested that women who see themselves as active participants in the birth of their first child, and prefer a collaborative role with their healthcare provider are more likely to opt for a planned home birth with a midwife. On the other hand, women who perceive their role in the birthing process more passively and are more fearful of birth are more likely to seek obstetric care for a hospital birth.

Women's answers indicated whether they perceived the Mother’s Role as active or passive, the Provider’s Role as dominant or collaborative, and the Delivery Experience as fearful and painful, or as a positive occurrence.

Women who perceived their role as active, the provider’s role as collaborative, and the delivery of the child as a positive experience, were more likely to prefer midwifery care, birth at home, a vaginal delivery and the avoidance of pain medication.

The more painful and fearful a woman expects her birth to be, the more likely she is to prefer a caesarean to a vaginal birth.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care and birth support.  Visit Melissa's website to learn more about her services.

Successful VBAC

How to have a successful VBAC?  First and foremost, I think that we really need to work to minimise the number of women who ever need to have a VBAC by minimising the number of primary caesareans.  I think that preventing the first caesarean would be the best place to start. Evidence suggests that this is best done with continuity of carer: that is where a woman is cared for by one person throughout her pregnancy, birth and new parenting experience. Ideally, a woman will have her own midwife and obstetrician so that she has complete support and confidence.

Assuming the woman is well supported and goes on to have a caesarean, in my practice, women find it really helpful to discuss exactly what happened (as best as we know) and why as this helps women to make sense of their experience. It can be helpful to draw diagrams, use a model doll and pelvis to visually show the position of the baby in the woman's pelvis, review the notes that were taken through the labour and answer all of her questions. The other really vital thing is to let her know that she can absolutely plan a vaginal birth next time, provided that there are no "absolute contraindications", ie things like a placenta praevia which make a vaginal birth very unsafe for the mother and baby. These things are rare and for the most part, women who have had a caesarean with their first baby can very safely plan a VBAC with their next pregnancy.

Now to the next pregnancy ... a planned VBAC. It's important again that the woman has continuity of carer, and preferably this care will be from one midwife and one obstetrician. It will give the woman reassurance and confidence to know that her care will be from two people who know her and understand her wishes.

I have found that women who plan a VBAC need lots of time to talk and debrief their last experience. It's not uncommon for women to feel that their body is broken, that it doesn't work, that they are incapable of birthing their baby. They may feel a range of emotions: frustration, anger, disappointment, hurt, fear, powerlessness and perhaps distrust. Talking through these emotions goes a long way to paving a clear emotional path for a successful VBAC. I always recommend to my clients that they attend a Calmbirth (R) course and that they read, read and read. The more knowledge a woman has, the more confident she feels and the more relaxed she will feel going into labour - and all of this is really important for a successful VBAC.

In labour, active birth is emphasised - upright positions, movement and so on. We use a form of monitoring that means women can still labour in the bath or the shower. It doesn't interfere. Hydration and nutrition are important for maintaining fluid and energy levels. Waterbirth is a great option, but land births are great too. I find most women birth their babies in an all-fours or kneeling position and these positions are best for helping the baby move down through the pelvis. Spontaneous pushing is preferred, where the woman pushes according to her body's cues - and I find that this reduces the chance of tearing. The baby's entrance should be smooth and gentle and straight into its Mother's arms.

Following a successful VBAC, women often feel triumphant and amazing. In time, sometimes other emotions surface - things like anger (directed at self or others), guilt (perhaps feeling that the last baby didn't experience the calm birth that the current baby has experienced), regret (if only I had done xyz ...) and so on. Sometimes it's helpful to write these feelings down and talk so someone trusted - a friend or family member for example.

And as a final note, there is no such thing as a "failed" VBAC. VBAC is not about the destination, it is about the journey. It is about the courage and determination and the innate ability of a woman to make the very best choices that she can make at the time. Sometimes a caesarean is the best way for the baby to be born safely, and we honour the journey and the wise decision making.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care and birth support.  Visit Melissa's website to learn more about her services.

Nausea in pregnancy

Morning sickness (all day sickness ...) is one of the most common symptoms in pregnancy.  It usually begins at around week 6 and resolves by about week 12-14, however for a few women, it remains for the whole pregnancy (and improves after the baby is born, thankfully!)

There is a lot that women can do to relieve morning sickness, and if all else fails, there are some effective and safe medications that can be prescribed by your midwife or doctor.

Some women experience nausea only, while others experience vomiting, too.  Sometimes this is only once or twice a day, however other women have a complication called hyperemesis gravidarum, which is a more severe form of vomiting that often requires hospitalisation for fluids and medications to treat the vomiting and prevent dehydration and electrolyte imbalances.

Nausea in pregnancy is actually a really positive sign, as it indicates high levels of pregnancy hormones that help to sustain and develop a healthy pregnancy.  That said, if you are fortunate to experience no morning sickness, please don't take that to be a bad sign: you probably have other pregnancy symptoms such as bloating, breast and nipple tenderness and tiredness.

Managing morning sickness day-to-day

Morning sickness can be difficult to cope with day-to-day, but there are many things that you can do to make things easier.  Most commonly, extra rest and more frequent, carbohydrate-rich snacks will be very helpful in keeping nausea and vomiting at bay.

Spicy, hot foods will make morning sickness worse, as will large, heavy meals.  Many women cannot eat protein-based foods without an increase in morning sickness, and instead prefer carbohydrate-based foods.  Go with what your body needs.

Vitamin B6 and ginger supplements can also be helpful, as can peppermint tea, homeopathic remedies, acupressure, reflexology and acupuncture.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.

Heartburn in pregnancy

Heartburn is a feeling of 'burning' or discomfort in the chest and throat, but some women experience it as nausea.  It is usually felt after eating or lying down for a few hours. 

Heartburn is very common in pregnancy, affecting more than half of pregnant women.

It is caused by the wonderful hormones of pregnancy that soften and relax us in preparation for birth.  However, one thing that gets softened is the oesophagus, so that partially-digested food can regurgitate back up the oesophagus and burn the back of the throat.  The contents of the stomach are very acidic, hence the burning.

There are some simple measures that you can try to relieve heartburn, such as:

  1. Small, frequent meals
  2. Eating in an upright position
  3. Remaining upright for at least two hours after meals
  4. A glass of milk
  5. Almonds
  6. Antacids

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Breathlessness in pregnancy

Breathlessness is very common in pregnancy, particularly towards the end of pregnancy.

Breathing changes during pregnancy for many reasons:

  1. Pregnancy hormones are at play, and usually mean that a pregnant woman will take in deeper breaths.  This is a good thing,a s she is also breathing for her baby.
  2. The woman's blood volume expands during pregnancy because the woman is also filtering the wastes for the baby.
  3. The baby and uterus lace more pressure against the diaphragm, making breathlessness more common

Shortness of breath is always something a woman should check with her midwife or doctor, because although it is very common, it can also be a sign of complications. 

There is not a lot you can do for shortness of breath during pregnancy.  It can help to sit upright and with good posture, and it does resolve after the baby arrives. 

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Care providers in labour

Care providers in labour include midwives and obstetricians. 

Around 30% women in Australia will have some of their care from a care provider who is chosen by them and known to them in the private system, be it a doctor or midwife.

Around 70% women give birth in the public system, most under the care of a midwife or doctor whom they have not met before.

Why does it matter if your care provider is known to you and chosen by you?

  • It is sometimes hard for care providers to know exactly what the woman they are caring for wants in her labour: the labour may be quite advanced at the time that the woman comes in in labour, and it might be hard for the woman or her support person to verbalise what it is that she wants
  • It can be difficult for a care provider to cater accurately to each woman's needs and expectations, especially when they have not met before.  A birth plan is a good way to communicate basic wants and needs for labour, but often the more subtle issues cannot be known without the midwife and woman knowing each other beforehand.
  • Midwives often feel that labour is not the best time to be educating a woman about her choices and the pros and cons of each option, and for good reason: when labour is well established, contractions come every 3-4 minutes, leaving little time in between to discuss choices and options and work out what will be best for the woman.

If you are cared for by a private care provider who is known to you and chosen by you, you will have the opportunity in your pregnancy to discuss with them what is important to you in your birth, and they will have the opportunity to speak with you about any concerns they may have.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

What causes a long labour?

First, it's probably worth saying that a "long" labour is subjective. What is long for one woman may be fine for another. A woman's perception of the duration of her labour will be affected by many factors such as hunger, dehydration, tiredness, support, encouragement, the environment, interventions, being cared for by one midwife who is known to the woman and trusted by the woman, her expectations of labour and birth, her preparation for labour and birth and so on. There can be many things that can cause a labour to be longer than hoped for. These include things like:

  • First baby: first babies can sometimes take longer than second and subsequent labours
  • The position of the baby: a posterior baby can sometimes (not always) mean a longer labour.
  • The positions you adopt in labour: upright positions may speed the process of labour
  • Hydration levels: if you are dehydrated, it can cause your contractions to weaken, and this can slow the labour
  • Being cared for by one midwife: continuity of carer has been shown in research to result in shorter labours
  • Birthing in the environment that feels safest to you: home or hospital, it doesn't matter. It's about where you feel safe. When you feel safe, you will labour better
  • Feeling ready for birth and motherhood

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

6 essential tips for a natural birth

Choosing a natural birth can be the most empowering and transformational experience in a woman’s life. In our culture, childbirth is viewed as a medical event and an emergency waiting to happen. We only have to turn on the TV and we witness birth being portrayed as a major emergency, and thank goodness those doctors were there to save the mother and baby. As well as this, when we ask our mothers about their births, we're bound to hear more horror stories. Forceps, stirrups, the dreaded episiotomy. Shaves, enemas, being bound to bed, not allowed to get up, let alone even sit up. Nothing to eat or drink. Husbands were not present. Is it any wonder that we are so fearful of birth?

Fear guides many birth experiences and results in the overuse of interventions and medications. As a result many women feel out of control and disempowered by their birth experience. It doesn’t have to be that way.

The following suggestions will help you prepare to have the best birth experience possible:

1. Understand the process of birth If you understand what is happening with your body during labour, you will have more confidence in the birthing process. Knowing that everything is as it should be, is the key to “letting go” and allowing birth to happen normally and naturally.

2. Good nutrition Good nutrition is essential to good health. The food we put in our mouths today will build the cells of tomorrow. In pregnancy, the food we eat also builds our baby, so we have an added responsibility to ensure that nutrition is optimal.

3. Exercise Birth is a physical event. Staying fit can minimise pregnancy discomforts and ease the birth process. Walking or swimming and prenatal yoga are very beneficial to the health of you and your baby.

4. Relax Your body instinctively knows how to birth your baby and it releases hormones that help you through birthing.  Fear, tension and anxiety can interfere with the natural process by inhibiting labour hormones and increasing fight / flight hormones.  I recommend Calmbirth to all women who plan a natural birth.

5. Address fears and concerns We are constantly bombarded with negative images and stories of childbirth. Over time these messages can become ingrained in our way of thinking. It is important to recognise our attitudes and beliefs and understand how they shape our experiences. Any negative thoughts or beliefs about childbirth can be explored prior to giving birth.

6. Care provider

Your choice of care provider has a great impact on the sort of birth you will have, despite points 1 - 5 above. Having a supportive care provider throughout pregnancy and birth is critical in positively influencing the outcome of your experience.

Birth is natural and women have done it for centuries. But in today’s society, a birth without preparation may not be the one you envisioned. You have all the resources available to help you prepare for the birth experience you desire.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

First time mums and homebirth

What a great choice!  Discuss your situation with your midwife for more advice. Generally, first babies are ideal for home births. Why? Most first births go really well with the care and support of a midwife.  In the hospital system, a first-time Mum stands a 25% chance of having a caesarean, a 25% chance of needing forceps / vacuum, and only a 50% chance of a normal birth.  Compare this with the chance of a normal birth at home with a private midwife (around 90%) and you can see why there is such a benefit to planning to birth your first baby at home.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.

 

Continuity of care

Private midwifery is the oldest form of continuity of midwifery care.  Recent research has demonstrated that this form of care – where a woman is cared for by the same midwife throughout pregnancy, birth and the postnatal period – is beneficial for women and families. It results in increased satisfaction with the birthing experience and enhanced safety.  When multiple care providers are involved in a woman’s care, the chance of errors is high because care is provided in pieces. When a woman is cared for by one midwife, she has one point of reference, no conflicting advice, she can develop trust and a sense of security and the birth will generally proceed naturally.

Melissa Maimann is an eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa offers a range of care options for women.  Visit Melissa's website to learn more about her services.