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.

Homebirth transfer rates: cause for concern?

What is a woman really asking when she asks her midwife what the midwife's transfer rate is? Women often interview several private midwives when they are choosing the right midwife for their needs. Women will ask many questions of their prospective midwife, and one of the more common questions is, "What is your transfer rate?" meaning, "what percentage of the women who book with you for homebirth, end up transferring to hospital?"

On the surface, this seems like a fair question. But what is the woman really asking? I consider that the woman is really asking, "If I book with you, what's my chance of being transferred?" and when women ask the same question of several midwives, they are most reassured by the midwife with the lowest transfer rate because they perceive that they have the lowest chance of transferring if they go with the midwife with the lowest transfer rate.

Is it a fair assumption to make, that the midwife's transfer rate, representing her previous client's outcomes, are a valid guage for the current woman's likelihood of transfer? Often I find that transfers can't be predicted at the time a woman books-in for care. If we could predict it, we'd recommend a planned hospital birth. Considering transfer rates from this perspective, a midwife's transfer rate has no bearing on the current woman sitting with her. As well as this, some transfers occur because the woman has requested it - eg a request for transfer for an epidural, but not on the advice of the midwife as the labour is actually progressing very normally. The other situation that can arise is that the midwife forsees problems occurring and makes some recommendations to avert those problems, but the woman considers the recommendations and declines to follow them. In these cases, again, the midwife's transfer rate has no bearing on each new client who interviews a midwife.

What's a "good" homebirth transfer rate?

Well, many might argue that the lowest transfer rate is the best transfer rate. You're setting out for a homebirth, right? So why go to the midwife with a "high" transfer rate?

I did some scouting around on the internet and found that transfer rates range from 10% through to 50%. The Netherlands has a transfer rate of 52%! This surprised me. In the Netherlands, 86% women start in "primary" care (midwifery care), 28% are transferred in pregnancy and 17% are transferred in labour, leaving 41% women birthing with midwifery care. Of this 41%, 30% occurred at home and 11% occurred in hospital.

The St George hospital homebirth program reported a transfer rate of 37% for its first 100 births and this was in a low-risk clientele (at the start of pregnancy). Their outcomes were excellent, however and the satisfaction of the women and midwives using / working in the service was very high.

Private midwives' transfer rates vary - anywhere from 10% to 40% in some States of Australia as well as overseas. So there's a wide fluctuation. What can we deduce from these transfer rates?

Well, with the exception of the Netherlands - which has large numbers - we can't really deduce very much at all. You never can when you're dealing with small numbers. Private midwives in Australia typically don't attend more than 25-30 births a year, and some as few as 5 births a year. One transfer in 5 births is 20%, whereas if that same midwife had attended more births without complication, perhaps the transfer rate would have only been 10%.

There are a couple of things to consider with high and low transfer rates: 1. The risk status of the women at booking 2. The midwife's adherence to safety and risk management guidelines and her outcomes.

The midwife with the lowest transfer rate might simply have a low transfer rate because she only attends very low risk women: women who have birthed without complication before, who have no health history and who have no problems in their current pregnancy.

The midwife with the high transfer rate might not be transferring willy-nilly, she might just be taking on a higher risk group of women and adopting a wait and see approach - eg, "yes, you have a family history of high blood pressure and you've had it with every pregnancy thus far, but let's try some preventative measures and see what happens this time", and continue with homebirth plans. If this woman's blood pressure went up, she would have been transferred, contributing to the midwife's "high" transfer rate. The low risk / low transfer rate midwife might not have accepted this woman for homebirth at all, hence the difference in transfer rates.

The other thing to consider with transfer rates is the midwife's commitment to safety and risk management. Some midwives may have low transfer rates because the decision to transfer is prolonged, or because risk factors are denied. Is it good to have a low transfer rate if women or babies have been compromised?

But getting back to the question, "If I book with you, what's my chance of being transferred?", this question is impossible to answer. 1. We can't tell the future. Family history and health history might shine some light on possible issues for the pregnancy, but not necessarily. We can't predict all the paths a pregnancy can follow. 2. A woman's determination to move towards - and remain in - a state of health and wellness is a life-long journey that pre-dates the pregnancy. 3. Although midwives will make recommendations with the aim of homebirth in mind, it is the woman's right to consider the advice and decline it. Declining a midwife's advice may well mean that a transfer will become necessary. 4. Midwives' statistics are only relevant to her past clients, not the client sitting with her currently. 5. For many midwives, the goal is really safety: safety for woman and baby. We strive to achieve the safest birth in the setting that can best meet the needs of our client.

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.

5 myths about homebirth

1. Home birth is unsafe

Numerous studies have shown that a home birth is at least as safe as hospital birth for healthy, low-risk women, who are attended by midwives, with back-up plans in place.

2. Home birth is messy.

Many homebirths occur in water, and the birth pool is simply drained after the birth and everything stays very clean!  However, if you are birthing out of the water, your midwife will provide you with a list of homebirth supplies that you will need, and this will include such things as towels, sheets and plastic to protect floors, lounges, beds, carpet and so on. Garbage bags are always available and midwives always leave the house as they found it after the birth.

3. What if something goes wrong? "I / my baby would have died if we had had a home birth!!!"

How many times do we hear hear this?  Provided the homebirth is "low risk"and there is a midwife in attendance, the chance of things going very wrong is very very small.  The important issue is to ensure that good care has been provided in pregnancy, that there are back-up plans in place and that the woman and her baby are healthy at the start of labour.  In this group of women, homebirth is at least as safe as hospital birth, for both mother and baby.

If things take a different path in the labour, the midwife is often able to manage issues with simple measures. If more complicated measures are needed, the midwife will take the woman into hospital.  Most studies show that this happens in less than 15% of home births.

Typically, midwives bring a range of safety equipment and supplies to a birth. These include: - Oxygen - Suction equipment - Suture material and local anaesthetic for tears - Medication to stop any excess bleeding after the baby is born - Vitamin K for the baby - A doppler to monitor the baby's heart beat - Blood pressure equipment - Urinalysis sticks - Scales to weigh the baby - Resuscitation equipment for the baby - An oxygen mask for the mother - A catheter in case the mother is unable to pass urine - General equipment such as gloves, a mirror, needles and syringes, sterile water and normal saline, gauze, cotton wool, tape, cord clamps (unless the family prefer to use a cord tie) and so on. It's quite a big kit when it's all put together!

4. Only hippies have home births.

This couldn't be further from the truth! The general profile of a homebirthing family goes something like this:

- tertiary educated - in their 30s - already has one child or has been researching birth for many years - works in professional or managerial industries And many are from a health background.

5. It's expensive to have a homebirth.

Costs range from $3000 to $6000 which is very little when you consider what it covers, and the fact that it is spread over about 9 months of care.  After Medicare benefits have been claimed, the out-of-pocket cost is much lower than this. 

Care includes things such as:

  • antenatal (pregnancy) care
  • postnatal care for 6 weeks
  • labour and birth care at home or in hospital
  • your own midwife being on-call 24/7 from the time you book in until 6 weeks after your baby is born
  • access to a library of books and DVDs

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.

Pregnancy symptoms you shouldn't ignore

Most pregnancies are completely normal, and women carry healthy babies to term and give birth normally.  Sometimes, things don't quite go to plan and some warning signs might be apparent.  If any of the issues below happen, you should contact your midwife or obstetrician for advice.  In most cases, they will want to see you to assess you and your baby so that they can reassure you that all is well, or monitor you more closely.

  • Abdominal pain
  • A high temperature - above 38 degrees
  • Any visual disturbances such as seeing spots or stars, blurred or double vision
  • A severe headache that won't go away
  •  Any vaginal bleeding
  • If you think your waters have broken
  • If you are feeling unwell
  • If you are concerned that your baby is less active than normal
  • Constant vomiting or diarrhoea
  • Accidents
  • Exposure to infections such as chicken pox or rubella

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.

Packing your hospital bag

Here is a checklist of things you might like to take with you to the hospital.  You might like to have a tour of the hospital beforehand, so that you are familiar with the birth rooms, the equipment that is available and the supportive aids that your hospital provides. Paperwork

  • Your yellow card / antenatal record (it's yellow in NSW but different colours in other States)
  • Your birth plan - it's a good idea to bring 3 copies with you: one for your hospital file, one for you and your partner to keep and refer to, and a third as a spare.
  • Your Medicare card and private health insurance details.

For labour and birth

  • Lip balm
  • Massage oil
  • Music
  • Pillows / a beanbag
  • Comfortable clothes for labour, such as a baggy t-shirt
  • Food and drinks to sustain you through labour - water does not sustain a labouring woman for very long.  Apple juice is good!
  • Bendy straws - it makes it easier to drink
  • Camera / video (and power / batteries)

For after the birth

  • Toiletries
  • PJs
  • Maternity pads.  Not panty liners.
  • Slippers
  • Underwear
  • Clothes - comfy, warm clothes

For your partner

  • Snacks and drinks for labour
  • Money for vending machines and parking (but not too much .... things can go missing in hospitals)

For Baby

  • Clothes to go home in x 2
  • Some nappies for the car ride home and for the hospital stay if your hospital does not provide these
  • Singlets
  • Socks / booties
  • Beanie
  • Wraps
  • A blanket for going home
  • Bunny rug
  • A car seat - it's best to have this fitted by 37 weeks

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.

Continuous care in labour

What do we mean by continuous care in labour?  Continuous care means having care one-on-one from a known and trusted midwife.  It is considered to be the "Rolls Royce" of labour care, where a woman has a midwife by her side for the duration of her labour.  Why is this form of care so beneficial? Women who access continuous care in labour are less likely to:

  • Have an epidural
  • Have any analgesia/anesthesia for labour and birth
  • Give birth with vacuum extraction or forceps
  • Give birth by caesarean
  • Have a baby with a low 5-minute APGAR score
  • Report dissatisfaction or a negative rating of their experience.

Women receiving continuous midwifery care were more likely than those who did not to have a shorter labour.

Private midwifery care provides women with continuous care from a midwife who is known to the woman and trusted by the woman. Typically, the private midwife would have provided all of the woman’s pregnancy care and then attends the labour and birth, providing continuous midwifery care. Private midwives have only one woman in labour at a time, and are able to dedicate their whole time to this woman and family.

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.

Negative Blood Groups

Everyone has a blood group, or a blood type.  The groups are O, A, B and AB.  As well as this, a person may or may not contain a protein in their blood called Rhesus factor.  A person who has the Rhesus factor is called "Rhesus positive" and a person who does not have this factor is called "Rhesus negative".  So people may be (for example) O positive, A negative, AB positive and so on.  About 85% people are Rhesus positive.  That is, they contain the Rhesus factor in their blood, so their blood group would be one of the positive ones. The other 15% of people do not have this factor in their blood.  A pregnant woman's blood group and Rhesus factor are determined by a blood test as part of the tests that are done when a woman first discovers she is pregnant. 

If a pregnant woman has a negative blood group and her partner has a positive blood group, there is a chance that the baby will also have a positive blood group.  Should any of the baby's blood get into the mother's system, her body will make antibodies to the baby's Rhesus factor.  This doesn't cause any problems in the current pregnancy, but the next time the woman falls pregnant, the antibodies can affect the baby.  The baby can be born prematurely, miscarriage is more likely, the baby may be born anaemic and the baby is more likely to experience jaundice.

Fortunately, there is something that can be done to prevent this all from happening!

Women who are a negative blood group will be offered two injections of Anti-D in pregnancy.  This prevents any antibodies from forming.  After the baby is born, the baby's blood group will be determined from blood that is in the cord, and if the baby's blood group is found to be positive, the mother will be given another dose of Anti-D. 

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 are the benefits of a water birth?

Waterbirth is a popular way to birth a baby.  I find that few women will have a waterbirth for one baby and choose a land birth for a subsequent baby, however many women will have a land birth with one baby and then opt for a waterbirth the next time.  Occasionally a woman will choose a homebirth specifically so that she can experience a waterbirth, perhaps because her local hospital may not support her in this.  Waterbirth is an effective way for a woman to manage the sensations of labour and may lead to a shorter labour.

Waterbirth results in fewer perineal tears because the water has a softening effect on the perineum and because women are better able to assume birthing positions that minimise pressure on the perineum.

Waterbirth helps a woman to be more active in her labour and birth because it helps with a sensation of weightlessness.

Babies who are born in water are often calmer than babies who are born on land.  Some don't cry at birth: they are pink and breathing and their cords are pulsating, but they are very calm and simply look around and take in their new surroundings.

Labouring in water has also been shown to lower a woman's blood pressure and assist with dilation of the cervix in a labour that is considered to be "slow".

In my practice, about 50% women birth their babies in water.

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 equipment do women need for a homebirth?

A while back, we looked at what equipment midwives bring to a homebirth.  But there are also a few things that women will need to supply for a homebirth.  Most of the items are inexpensive and are found around your home, so it's really just a case of gathering the supplies together.

  • Face washers
  • 3 old bed sheets: one for the bed, one for the couch and one spare
  • 15 old towels (especially if you're having a waterbirth)
  • 3 large plastic sheets (eg painter’s drop sheets or plastic shower curtains) for covering the couch, bed and for under the birth pool.
  • Plastic supermarket bags for rubbish
  • Plastic container with lid for placenta
  • Large rubbish bin for rubbish
  • Laundry basket for soiled towels
  •  Fan
  •  Candles and matches (optional)
  •  Pillows and bean bags for comfort (optional)
  •  Loose clothes and comfy socks for labour
  • 4 packets maternity pads
  • 2 packets regular pads
  • 1 box of tissues
  • Massage oil
  • Hair bands
  •  Mirror for you to see the birth
  • Music
  • Bendy straws
  •  Baby clothing, jumpsuits, singlets, etc
  • Nappies
  • Cotton wool balls
  • 6 baby wraps
  • Thermometer
  •  Birthing pool
  • Electric pump for pool
  • Hose for filling
  • Connections for hose
  • Mattress or couch to lie on that is close to the pool (cover in plastic)
  • Hand-held colander for “floaties”
  • Camera and/or video recorder
  • Snacks and drinks
  • Present from sibling/s for the new baby

All in all, most of these items are found at home, and your midwife will bring all the medical equipment that is needed.

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 can I do about leg cramps in pregnancy?

Leg cramps are quite common in pregnancy.  They often occur at night, sometimes affecting a woman's sleep.  Leg cramps might be related to certain mineral imbalances, so there is a case for magnesium supplements for leg cramps.  Dietary salt is also a good idea: not lots of salt, but just a small addition of quality salt.

Exercise that uses the muscles of the legs is also good for leg cramps, such as swimming, walking, yoga, pilates and gentle weight training (under the supervision of a personal trainer if you are new to weight training).

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.

Tips for Choosing a Midwife

When you're pregnant and choosing care for you and your baby, you want a midwife who you can trust and build a solid relationship with.  There are a few simple steps and issues to think about when you’re choosing the best midwife for your family.

  1. Employed or private practice? In Australia, most midwives work in an employed capacity.  They may either work in a private hospital or a public hospital.  Midwives may also work in private practice.  “What is the difference?” I hear you ask.  Well, the difference is that if your midwife is employed by a hospital, you will not generally be able to interview and choose your midwife; rather, you'll be cared for by whichever midwife is rostered on when you birth your baby.  However, interviewing and choosing your midwife is very much a feature of your engaging a private midwife.  The benefits of choosing to have a private midwife include: you can choose your birth setting (most private midwives attend births at home and in hospitals), an eligible midwife meets an additional registration standard, so if you choose to have care with an eligible midwife, you are assured that your midwife has been assessed and educated to a higher standard; and your midwife will provide all of your care including ordering your tests and scans and also writing any prescriptions you may need.
  2. Finding a midwife: There are various ways of finding a midwife.  A new Directory has been established that lists eligible midwives to assist you to locate an eligible midwife in your area.  You may also choose a midwife because of referral or recommendation; or because of the options of care that the midwife is also to offer you.  if you are choosing a midwife based on recommendation, it’s important to interview your midwife and maintain an open mind: there is no guarantee that another's recommendations will be suitable for you.  If you are considering midwifery for your care, it’s really important to think about finding a midwife early in your pregnancy, as many midwifery options and private midwives book out early on.  Some women prefer to interview their midwife before they become pregnant.
  3. Skills and experience:  each midwife will bring different skills and experience, however every registered midwife meets the same standards of education in order to qualify as a midwife.  Eligible midwives meet an additional standard, and this can be checked on the AHPRA website: you can search for your midwife and see that they have a “notation” to indicate that they are an eligible midwife.
  4. Convenience Of all things, this is one of the least important considerations.  You may find that you are traveling to receive the care you need, and on reflection, women who do this say that it was worthwhile to travel, rather than settle for care that was close to home, but not necessarily meeting the woman’s needs.
  5. Choice of place of birth: If your pregnancy is normal and you are healthy, you might like the option of birthing at home.  Hence, you may like to choose a midwife who offers homebirth.  However, it is also important to seek out a midwife who can attend your care in the hospital, in the role of the midwife.
  6. Method of practice:  midwives working in employed continuity models (that is, employed by a hospital but working in a model such as caseload or midwifery group practice) will book their own clients and see those women primarily.  However, they share the care of the women with the other members of the group practice.  This means that the midwife who you book-in with may not be the same midwife who provides all of your care. There are also some private group practices where you are cared for by two or more midwives throughout your care.  The other option is to see a private midwife who undertakes to attend all of your care: these will usually be midwives working in sole practice, and these midwives have a smaller caseload to ensure that they are readily available to their clients.  It is worthwhile understanding what arrangements your midwife has in place for times when they are not available, and also to ask what percentage of their booked clients’ births they actually attend.
  7. Your gut feel: It is important that you feel a sense of confidence in your midwife, and that you feel a sense of trust and comfort with her.  You should feel comfortable asking questions, and letting her know what is important to you.  In my experience, your gut feel is your best indicator.

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.

Dating scans

Your midwife or obstetrician may suggest a dating scan early in your pregnancy for a few reasons.  Dating scans are often performed between 7 and 12 weeks of pregnancy and there are a few good reasons for having a dating scan:

  1. You may see your baby's heartbeat, and this can be very reassuring to see and hear
  2. The scan can determine if the pregnancy is in your uterus, or in your fallopian tubes
  3. You can see that the placenta is starting to form
  4. You can tell if you are carrying twins (!)
  5. Also, a scan early in your pregnancy can more accurately date your pregnancy than using your period date alone.

Research has shown that when we use a due date that has been assessed from an early scan, women are much less likely to need to be induced for going beyond 42 weeks.  It also helps with more accurately timing other tests and of course telling the age of a baby who may be born prematurely.  As with all tests and scans in pregnancy, a dating scan is your choice.

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.

Giving birth at home can make labour easier and shorter

Sounds interesting?  Can it be possible that simply birthing at home can make labour easier?

It's well-known that women labour best where they feel safest and with whom they feel safest.  For most people, hospitals are associated with disease, injury, accidents, pain, operations and even death.  Some people find that hospitals have a particular sterile smell to them, or that they feel clinical, cold and devoid of positive emotions. Our homes are totally the opposite.  They are our safe haven, the place we go to for comfort, peace and pleasure.

So when it comes to birthing in a hospital, for many women, the associations with disease, injury and accidents are quite strong.  When we are feeling scared and anxious and we are not in our own comfortable surroundings, the hormones of labour that assist the contractions to be strong and powerful (effective, yet less painful) are disrupted by the release of adrenaline.  Adrenaline can impact the ability of the uterus to contract well by affecting the hormones of labour.

Being at home can reduce your need for medical forms of pain relief because being at home can help you to feel more relaxed, which in turn allows labour to progress more smoothly and with less pain.

For many women, using water in labour and birth is a very helpful tool to aid a natural labour.  Yet, in many hospitals, baths are either not available at all for labour and birth, or else their use or access is restricted (eg hospital policy or availability of rooms with baths in them).  When you are at home, you have your own bath or birth pool, so there is no chance of it not being available for you when you need it.

By choosing to birth at home, statistically you are much less likely to need or use any interventions, regardless of where you actually end up giving birth.

In addition, homebirth means being cared for by your own chosen midwife with whom you would have formed a close relationship throughout your pregnancy.  This feeling of trust, connection and openness can lead to feelings of safety and security, also contributing to a shorter labour.

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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.

Negotiating the care you want

For many women, the way that their baby is born is very important.  They want their baby to be born gently and received into loving hands, and they want to be treated with respect and dignity and kindness by a known and trusted midwife or doctor. 

Many women, when asking about the routine policies of the hospital, may feel quite strongly about certain policies and protocols and have very clear ideas about how they wish to be treated in certain circumstances.  Issues can arise when the wishes of the woman conflict with the policies of the hospital, for example with regards to continuous monitoring or vaginal breech birth or vaginal birth following a previous caesarean section birth.

If this is the case, you may need to discuss your wishes with the midwives and doctors who are caring for you throughout your pregnancy, and maybe even negotiate to get the birth you want ahead of time.

A birth plan is an excellent tool that you can use to record your preferences and intentions for your birth.  It is a written document that you can develop with the staff and then present it to the midwives and doctors who are caring for you, rather than having to re-state your points to each person you meet.  Your birth plan can be placed in your file so that it is on hand when it is needed.  Your birth plan is not rigid and for many reasons, you may change your mind during labour.  Your birth plan simply records and communicates your wishes at a certain point in time.

Whatever decision is reached and decided, all women deserve to be treated with respect for their choices.  Women can expect to feel listened to and that their feelings and concerns matter.  Women have the right to receive full and impartial information about all proposed interventions - and also about not intervening.

Many women feel more informed and empowered after attending independent childbirth education classes and there are some excellent books and web resources that can assist in providing information about options and choices.

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.

Top 3 myths about waterbirth

Waterbirth is a great way to birth, and about half of the women who birth within my practice choose to birth in water.  But when I'm out and about, I come across some interesting ideas about waterbirth ... I thought I'd sharer some.

1. Babies may drown during waterbirths

So long as the baby is brought to the surface after birth, they do not drown during water births.  They live in amniotic fluid in the uterus before birth, so being born into water is thought to be a gentler birth for the baby.

2. The midwife has to get in the tub to deliver the baby

The idea here is that the midwife gets in the tub and "pulls" the baby out, wearing gumboots and long-sleeved gloves.  However, midwives don't "pull" babies out; women either push their babies out, or breathe their babies out.  So we don't actually get in the bath tub / birth pool and pull.  Rather, we guide and catch, or the mother guides and catches, or the partner guides and catches.  And the baby is brought to the surface.  The only part of the midwife that goes in the pool is her hands and arms which are gloved.

3. Waterbirth causes infection

Research has shown this not to be the case.

All in all, waterbirth is a great way to give birth and has many benefits for mother and baby.

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.

Physiological (natural) third stage

The third stage of labour begins once the baby has been born, and ends with the birth of the placenta. Many women are now requesting a physiological (natural) birth of their placenta, especially following a natural birth.  A safe physiological third stage requires oxytocin to be produced by the mother to stimulate the uterus to contract and expel the placenta.  Generally, this requires:

  • Natural birth: without medication to induce or augment (speed up) the labour, without an epidural, without forceps, vacuum or caesarean.  So, in other words, a labour that starts on its own, progresses on its own, where the mother does not use medical forms of pain relief, and where she breathes out or pushes out her baby unassisted by forceps or a vacuum (or caesarean).  This is because these natural processes prime the woman's body to release lots of oxytocin once the baby is born, to stimulate the uterus to contract to expel the placenta.
  • An environment that supports oxytocin release: this would be a private, dark, calm, warm, quiet environment with a known and trusted care provider.  Not the hustle and bustle of a busy delivery suite, but perhaps a water birth setting, home birth setting, or a birth centre setting.
  • No distractions: the mother and baby should be left (but observed by a midwife) for uninterrupted skin-to-skin contact, bonding time and breastfeeding if the baby is ready for this.
  • Leave the cord!  No-one should be fiddling with the cord, checking pulsations or pulling on the cord.  So long as the bleeding is not excessive, the woman should be left and observed.

In time, the placenta will emerge.  Often the woman feels more contractions and an urge to push.  If she is upright (eg squatting, sitting on the toilet, standing or kneeling) the placenta will come on its own, or perhaps with a gentle push.  It can be supported as it emerges and collected into a bowl, ice cream container (sans ice cream) or other receptacle.  The midwife would then check the placenta and membranes to ensure that they are complete.

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.

Normal Birth in NSW?

A recent newspaper article has sparked much discussion and debate.  It centres around the release of data gathered from five years of statistical data around intervention rates in NSW following the implementation of a NSW Health policy directive around normal birth (Towards Normal Birth).  The basic outcome has not been achieved, that of increasing rates of normal vaginal birth and reducing caesarean section rates through NSW.  Many ideas have been suggested as to why these targets have not been achieved.  Overall, intervention rates have increased drastically within the system of private obstetric care, and despite the implementation of public hospital caseload midwifery models of care during the past few years, rates of intervention have not reduced significantly.  We have also not seen any expansion in birth centres or birth centre care which is so popular amongst women.  The only model of care that has been demonstrated over time to result in significant reductions in intervention rates such as caesareans, inductions and epidurals, is independent / private midwifery.  However, as a non-standard care option, it is seldom offered to women and is generally only available to a self-selecting group of women who seek it out.

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.

Early pregnancy: what you may feel

I am often asked by women what they might expect to experience in early pregnancy.  Here's a guide below.  The symptoms below are some of the more common symptoms that women experience.  It's always best that women contact their midwife or GP early in pregnancy to arrange for a pregnancy test and a dating scan if needed.  Eligible midwives are able to order all of the necessary tests and scans and no referral is needed.

Late period This is a common sign of pregnancy, and it is the one that it most often found first.

Morning sickness Some women experience this, while other women do not. Some experience it as a later sign of pregnancy.

Sore, tingly breasts This can also be one of the earlier signs of pregnancy and it can feel similar to premenstrual breast tenderness.

Tiredness Tiredness is a common pregnancy symptom in early pregnancy.

Changed tastes or strange tastes and off-putting smells Some women will have a strange taste in their mouth, like / dislike food that was previously disliked / liked, and may be put off by smells that were previously quite ok.

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.  Visit Melissa's website to learn more about her services.

Energy, Food and Fluids in Labour

Eating and drinking are really important in labour.  Labour is an intense physical experience, and our bodies need fuel and fluids for this in the same way that an athlete needs fuel for their workouts.  Eating and drinking in labour will keep up your strength and provide you with energy and hydration.

How much to eat in labour?

In labour, small portions of easily-digestible food is the key.  It's also good to note that when labour is established, contractions come every 3-4 minutes and last for about a minute, therefore food that is very chewy or crunchy will not be as helpful as food that is quick and easy to eat.

Carbohydrates are usually better choices for labour instead of sugary, fatty or fried foods.  In early labour, protein will provide sustained energy for labour.  Scrambled eggs are perfect for early labour, as are omelets.

It's important to eat and drink in labour

Restricting food intake during can cause dehydration and can also cause the body to break down fat.  This can cause nausea, vomiting, lack of energy, exhaustion, a slower labour and possibly lead to fetal distress and greater pain.

Foods that I recommend for labour

  • Fruit
  • Smoothies
  • Yoghurt
  • Stewed fruit
  • Diluted fruit juice
  • Soup
  • Frozen fruit

Drinking in labour

I recommend women drink an additional one-to-two litres of fluid while they are in labour.  Dehydration can set in quickly and can be difficult to reverse without resorting to intravenous fluids (via a drip).

Partners and support people can help by offering a drink after every contraction. Bendy straws are really helpful.

Diluted fruit juice (not orange juice), water and sports drinks, are fine, but cordial and fizzy drinks should be avoided.

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.

Feeling tired?

A woman's body works exceptionally hard in pregnancy, growing a new little being.

It's no surprise the woman may feel tied through this process!  Virtually every body system undergoes change during pregnancy, both to help grow the baby and also to accommodate the changes that need to take place in pregnancy.  Briefly:

  • The woman's blood volume increases
  • Breasts develop
  • The uterus grows
  • The placenta develops
  • The baby grows and develops
  • Hormones are firing

So it's no surprise that pregnant women are often more tired than usual.

What can be done about tiredness in pregnancy?

The best - and most obvious - thing to do is to rest!  Get as much rest as you can, as often as you can.  Where ever possible, delegate tasks that others can do for you and structure your day so that you are not physically and mentally overwhelmed.  Get to sleep early at night and allow at least 1-2 days per week for a 'sleep-in'.  Afternoon naps may also need to be considered, especially in the first and third trimesters when energy levels are particularly low.  Daily exercise may actually increase energy levels, along with a  healthy and nutritious eating plan.

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.