Transferring from a homebirth to hospital

For many women, the chance of needing to transfer from a planned homebirth to hospital during labour is quite scary, and is enough to deter them from even planning a homebirth.

There are many and varied reasons for transferring from a planned homebirth to hospital, and you'll be pleased to hear that most fo those reasons actually come about during the pregnancy and well before labour starts.  This could be for reasons such as :

  • High blood pressure
  • Baby is in the breech (bottom-first) position
  • You have certain medical conditions such as a heart condition or epilepsy
  • There have been concerns about baby's growth or the health of baby during pregnancy

By and large, having started labour at home as a low-risk woman carrying a healthy baby, the chance of needing to transfer to hospital is very low.  The statistics on this vary, depending on whether we look at first-time Mums or women who have previously given birth.  The chance of needing to transfer to hospital during labour as a first-time Mum is slightly higher than that of a woman who has previously given birth.  However, the most common reason for transfer in a first-time Mum is not an emergency reason: it is simply for a labour that has gone on for a while, the woman is tired and is requesting pain relief.  This is not an emergency situation and transport to hospital would most likely be by car.  In your own time. 

The other reasons that women sometimes need to transfer are for after-birth issues such as a placenta that is not coming away or losing too much blood after the birth.  It is rare for babies to become distressed in a home birth when the pregnancy has been well and healthy, the baby has grown well and is healthy and the labour is normal and has not been stimulated artificially with drugs and medications.

What precautions do midwives take?

There are many things that homebirth midwives do to make a potential transfer safe for mother and baby.

  1. Homebirth midwives usually make a back-up booking into the local hospital, with your permission.  This means that if a transfer to hospital is needed, the necessary information (test results, ultrasound reports, health history and so on) is on file at the hospital.
  2. Homebirth midwives carry with them medication for excessive bleeding after birth and resuscitation equipment for baby.
  3. Eligible midwives work collaboratively with obstetricians, streamlining any possible transfer situations and ensuring that if medical care is needed, it is available from a doctor whom you have met previously.
  4. Your midwife may take you on a personalised tour of the birth unit so that you are able to view the rooms and ask any questions you may have.  This means that if a transfer is needed, you would be moving to a place that you have seen before.
  5. Your midwife will talk with you about any risk factors and s/he will work with you to minimsie their potential impact on your birth and baby

Overall, women who plan to birth at home have a small chance of needing to transfer to the hospital after labour has started,  Despite this, women who need to transfer usually rate their experience as being positive, even though it was not the experience that they had initially hoped for.  Evidence supports that women who plan to birth at home experience a smaller chance of complications and interventions when  compared with women who had planned all along to birth in hospital.

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.

Birthing Statistics

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When women meet me during an initial consultation, one of the questions they usually ask me is in regards to the birthing outcomes (statistics) for my practice.  They are interested to know my rate of normal birth, homebirth, epidurals and so on.  The statistics listed below are for the births I have attended at home, in birth centres and in hospitals.  They reflect the care that has been provided to the women in my care, so they may or may not represent your individual experience - however they will give you a good idea of what you can reasonably expect.

The number and type of interventions in a birth will depend on many factors:

  • Health and safety factors
  • The decisions that are made by a woman and her care provider
  • A woman's motivation and preparation in achieving the birth she desires

Statistics:

  • Normal birth (no forceps, vacuum or caesarean): 87%
  • Caesarean 8% (The World Health Organisation recommends a caesarean rate of no more than 10% - 15%)
  • Amongst low-risk women, the caesarean rate is 3%
  • Vacuum 2%
  • Forceps 3%
  • VBAC 86%
  • Episiotomy 2%
  • Intact perineum 64%
  • 5% women use an epidural for labour
  • 84% women use no medical forms of pain relief in labour
  • 15% women are induced
  • 54% women have a waterbirth
  • 35% women birth at home
  • 64% women have a physiological third stage
  • 96% babies are exclusively breastfed at 6 weeks discharge
  • Homebirth transfer rate 7%
  • Women considered to be "low risk": 39%
  • Women considered to be "high risk": 61%

Statistics for first babies:

  • Normal birth (no forceps, vacuum or caesarean): 88%
  • Caesarean 8%
  • Vacuum 2%
  • Forceps 2%

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.

Pain in labour: does it serve a purpose?

Yes, it does ...  though you may not realise it at the time.

There are many ways to view pain in labour, or labour sensations, as I prefer to call them. 

Labour sensations alert us to the impending arrival of the baby.  They alert us to garner support and assistance for the baby's arrival.  They signal that a major change is coming and that e need to work with our bodies to help the baby to be born.
 
The sensations of labour occur because of labour hormones (oxytocin) that make the uterus contract and the cervix soften and open.  The sensations of labour also help the release of other hormones such as endorphins and oxytocin.  After a normal birth where the woman has not received pain-relieving medications, mother and baby bond and baby usually shows interest in feeding.  Interestingly, the hormones of labour are instrumental in helping the mother bond with her baby, and in preparing the baby for feeding and newborn life.

When labour starts, the sensations are usually mild, similar to period pain.  Over time, the sensations gradually intensify, so that the contractions last longer, and come more frequently.  As long as a woman feels safe, comfortable and protected, labour will usually progress well and her labour will be short and less painful.

This is because the body responds to labour by releasing more endorphins and oxytocin.  These hormones help the woman to feel relaxed and in a deeply inward state.  In this state, a woman is usually very in tune with what her body and baby need her to do in order for the baby to be born.  Provided that she is able to move unrestricted, she will adopt the very positions that are most helpful for her and for her baby during the birthing process.

Many women in labour will naturally adopt upright and leaning forward positions.  Interestingly, in these positions, gravity can help to direct the baby into the pelvis and also help the uterus to contract more effectively.

Assuming the labour is undisturbed and that the woman feels safe, oxytocin flows well and strengthens contractions, shortening the labour.  Throughout labour, the woman also releases endorphins, so that by the end of the labour when the oxytocin levels are at their highest, the endorphin levels are high, too. 

There are many things that a woman and her support people can do during labour to promote endorphin release:

  • labouring and birthing in a warm, dark, quiet room
  • minimal talking, disruption and interruption from support people and care providers
  • labouring and birthing in an environment that feels familiar and safe
  • feeling comfortable and safe with those in the room
  • labouring and birthing in a position that feels most comfortable
  • privacy
  • being free from medical forms of pain relief as these prevent the release of endorphins

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Negotiating the care you want

For many women, the way that their baby is born is very important to them.  They want their baby to be born gently and received into loving hands, and they want to be treated with respect and dignity. 

Many women, when asking about the routine policies of the hospital, may feel quite strongly about certain policies and protocols.

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

A birth plan is an excellent tool that you can use to record your preferences 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.

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.

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Do epidurals make labour longer?

An Epidural is an effective form of pain relief in labour.  In fact, it is the most effective form of pain relief that we have available.  It makes the woman numb from the waist down and no other pain relief is needed once an epidural is effective.

However, there is one major draw back, and that is that it can lengthen the duration of labour and therefore lead to many other interventions.

There are many theories about why epidurals lengthen the duration of labour, and these range from the woman being immobile and unable to work with her body and baby to help the birthing process, to interruption in the birthing hormones that help labour to progress.  Other contributing factors include the woman's position - recumbent in bed - and the lack of gravity assistance that occurs once an epidural has been placed.

A recent study has found that epidurals are associated with an even longer second stage (pushing stage) than is generally recognised, and this can lead to further interventions in the labour and birth as we try to hurry things along.

The new study suggests that a normal second stage can take as long as 5.6 hours for women who have an epidural with their first birth, and as long as 3.3 hours for women who do not have an epidural.

For women who have given birth vaginally previously, the study found that the second stage for these women can be as long as 4.25 hours with an epidural and 1.35 hours without an epidural. 

All of these durations are longer than what we currently accept in our hospitals.  In many hospitals, a first-time Mum's second stage is considered to be prolonged after one hour, and a woman who has previously given birth is considered to have a prolonged second stage once the second stage has progressed beyond 30-45 minutes.  

The study has called for a re-examination of what normal and abnormal is, and a revision of guidelines.

The research is part of a growing body of evidence that suggests that a normal second stage of labour is now longer than it was decades ago.  There is now some support for the notion that a first-time Mum with an epidural may take closer to four hours to birth her baby from the time that her cervix is fully dilated.

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Working in private practice

Someone said to me recently, "Being a private midwife is a lifestyle".  I really related to that comment.

Many of the women who see me for their care ask me at some stage what I do all day.  They see me in appointments but often wonder how the rest of my time is spent.

Midwifery work is divided loosely into appointments (antenatal and postnatal), births and attending urgent issues that come up (eg bleeding in pregnancy, concerns about baby and so on).  However, there is also a large amount of "other stuff" that needs to be attended to.  I find that my time is split between being a midwife, practice manager, receptionist, accountant, marketing manager and researcher. 

As an eligible midwife, I need to attend at least 40 hours of continuing professional development each year, as well as having up-to-date and evidence-based written policies for my practice.  Each form that I use, every educational handout I provide - has all been developed by me for the women in my care.

In my day-to-day practice, the mornings are generally spent in consultations with pregnant women and new Mums and babies, while the afternoons are spent in home visits of new Mums and babies.  I find that travel does chew up a lot of time, especially in our Sydney traffic.  I drive about 20,000km each year for work and my car needs to be in good condition and reliable all of the time.

Births and urgent issues of course take priority over everything else, so if someone is in labour, I re-schedule the appointments for the day to welcome the new baby.  Luckily, the women I care for are very understanding when this happens! 

In my practice, I'm very big on providing continuity of care from early pregnancy because I find that this gives the best outcomes.  I think that early pregnancy is a really important time for a woman and baby, and there is a lot that I can do to promote health and wellness early on that often makes a difference as the pregnancy progresses.  Consequently, I am on call for each woman for around 40 weeks (eg week 6 - 40 of pregnancy + 6 weeks postnatally). 

Between each appointment, I prepare hand-outs and other resources for the next visit, file any test results that might have come through, and attend general administration (preparing the file, storing the file after discharge, preparing paperwork for the back-up booking into the hospital and writing any referral letters or discharge summaries as needed).  So there is actually quite a lot of paperwork when you think about it.

As well as all of that .... there are things like updating statistics after each baby is born and reflecting on my practice outcomes so that I am constantly improving and providing better care.  The library is regularly updated with new books, the birth kit and midwifery supplies are checked before and after each birth to ensure that supplies are in date and that there is sufficient quantities, or else an order is placed.  There is the quarterly BAS which seems to come around too fast, and probably a multitude of other things I have not written about here.

Each day is very varied, and I never know at the start of the day exactly how it might go.  I might have a whole day of appointments planned and then postpone most of those visits for a new baby whose arrival is imminent.  I might have a day off planned but end up doing a home visit if a new mother is needing help feeding her baby.  I love the unpredictability of this work.  It keeps me on my toes, and the variety is very refreshing: in one day I might attend a birth, do a postnatal home visit and also do an antenatal visit.  I use all of my midwifery skills and get to really understand how each action impacts the ongoing journey through pregnancy and birth. 

So I hope that this has given some insight into what it is like to work as a private midwife.  It is incredibly rewarding, inspiring, beautiful and incredible, but it is also tiring (at times) and I can never make any firm arrangements because my practice is the priority always.  Would I recommend private practice?  Definitely!  It's the best way to work as a midwife and I wouldn't like to work any other way.

Giving birth at home can make labour easier and shorter

Sounds interesting?  How 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.  For most people, hospitals are associated with disease, injury, accidents, pain, operations and 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.

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Choosing where to birth your baby

Where you birth your baby is a really big decision.  Over the weekend, I met with four newly-pregnant couples who came to ask me about their options for birth and the models of care that were open to them.  I was delighted to be seeing them so early in their pregnancies: this is the best time to be asking those tougher questions.  Together, we sat and talked through the various options: public, private, which hospital, obstetric care, midwifery care, public models and so on. 

Why do we place so much emphasis on where women give birth?

This is because the type of birth a woman has often depends on where she has chosen to birth her baby, and who she has chosen to provide her care. 

Where you choose to give birth can influence:

  • the environment in which you give birth: clinical environment, home-like environment within hospital, or home
  • the options that are available to you for pain relief in labour: epidural, gas, morphine, natural methods of pain relief
  • whether you can use water for labour and / or birth (NB: this is different to the availability of baths: some facilities have lots of baths, but labouring / birthing in them is not supported by policy / practice)
  • who looks after you during your pregnancy and labour: a midwife you know, who has been chosen by you; a hospital midwife you have never met before; a group of midwives from the hospital whom you may have met during your pregnancy; a hospital doctor whom you have not met before; your own private doctor; or a private doctor whom you have not met before
  • how far you have to travel in labour: no travel at all (homebirth); intra-state / inter-state (eg if the birth options that you require are not available in your local area); some travel (eg to a hospital)
  • your chance of having medical interventions (these are very unlikely in a planned homebirth, even when transfers are included in the data)
  • whether you can access specialist medical care or facilities, anaesthetists, paediatricians, obstetricians
Water birth

Water birth

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Birth choices

I recently became aware of a fantastic new website that I wanted to share with you: Birth Choice.

It is a UK-based site that assists women to find the best place for their birth.  You can put in selections according to your preferences and needs, and after answering a few questions, it recommends the birth places that are best suited to your needs and wishes.  It's brilliant!

In the UK, it seems there is a big focus on the place of birth because the place of birth usually determines the birth outcome in terms of interventions in birth and available models of care.

In Australia, however, our birth outcomes depend less on the place of birth, and more on the care provider.  Probably the only exception (to date) is private hospitals, where currently the only available model of care is private obstetric care.  However, birthing in a pubic hospital does open up many birth options for women including standard hospital care, private obstetric care, private midwifery care, team midwifery, birth centre (in selected hospitals) and midwifery group practice.  With so many options, the actual place of birth is less important than the choice of model. 

We have some excellent research to support the notion that the important factor is the choice of care provider, rather than the place of birth.  A brand new study has explored birth outcomes within public hospitals according to choice of care provider: private obstetrician, standard hospital care and midwifery group practice.  By and large, there were differences in intervention rates according to the model of care that was chosen.  This demonstrates that even within a certain birth place, the model of care that is chosen will often determine the outcome for the woman and her baby.

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Independent childbirth education classes: a midwife's perspective

Women who book with me for care will know that I am a firm advocate of independent childbirth education classes.  Why do I feel that these classes are so important?  It’s not that I believe that women need to be taught how to give birth, because I know that women's bodies are designed to birth babies, and for the most part, women birth their babies without any help from anyone else.  Yet I still believe these classes are important ... vital, even. This is because all pregnancies and births involve choice.

And to exercise our choices responsibly, we need to have knowledge.

It is that simple.

If we do not know what choices we have, we do not have any.

If we are aware of our choices but lack any information about the implications of each path, we may not make responsible choices that lead us to a healthy birth and baby.

We have choices around care providers, place of birth, testing in pregnancy, interventions in birth, type of birth, methods of feeding a baby, postnatal care issues and early parenting choices.

Labour and birth and early parenting are not the times to be learning new information for the very first time: these are times in our lives when we are not in a state to take in new information and assimilate it.  This learning is best done in pregnancy, so that the time we get to labour, birth and baby, we are already aware of our options and our preferred choice.

Independent childbirth education classes cover more than basic hospital classes, in my opinion.  They will teach you everything from late in pregnancy to labour, birth and caring for your new baby.  They will provide all of the content of hospital-based classes and much more: more time, more resources and more attention.

The couples I have worked with over the years have been delighted with the classes they have attended, coming away feeling relaxed and calm, confident and knowledgeable.  They have helped enormously with birth planning and preparing for birth and baby, and with choices and decision-making.

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Continuity of care important in helping women to have vaginal birth after caesarean sections

A new study published in BJOG has found that there is a wide variation in the success rate of planned vaginal birth after caesarean (VBAC).

The study found that women who had chosen midwifery care for their VBAC were likely to have a successful VBAC.

Other research has found that women choosing midwifery care are more likely to give birth spontaneously with out interventions.

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Exercise in pregnancy is good for baby's brain

As well as being good for preparing for a natural birth, women who exercise in pregnancy boost the brain development of their unborn babies.  This occurs even when exercise is as little as 20m minutes, three times a week.

What types of exercise are best in pregnancy?  Swimming and walking are best for all-over exercise.

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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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Dating scans

Your midwife or obstetrician might refer you for a dating scan early in your pregnancy for a few reasons.  Dating scans are often performed between 7 and 12 weeks of pregnancy. 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
  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 midwives and obstetricians 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 41 or 42 weeks.

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How do midwives monitor the baby's heart beat in labour at a homebirth?

Midwives monitor a baby's heart beat in a home birth, as well as ensuring the health of the woman giving birth.  The usual method of monitoring a baby at a homebirth is for the midwife to use a doppler.  This portable and light-weight piece of equipment is water-proof, so the woman can be in any position and also in the bath or shower while it is in use. Current guidelines recommend that a baby's heart beat be listened to every 15 minutes in the first stage of labour, and after every contraction during the second stage of labour.

Some women are keen to avoid ultrasound, and the hand-held doppler does use ultrasound.  in lieu of this, the midwife can use a pinnards stethoscope, however this can only be used on land, so it would require the woman to leave the bath or shower so that the midwife could check on the baby's wellbeing.

If the midwife detected anything untoward in the baby's heartbeat at home, s/he would arrange for the women to be transferred to the hospital where a CTG monitor could be used to give more information abut the health of the baby.  This is the same process as what a birth centre midwife would employ.

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Tips for Choosing a Midwife

A lot has been written about the process of choosing a midwife, and many lists exist filled with questions to ask your potential midwife.  In my experience, th4ese sorts of lists have complicated matters for women who express concern that the list is “overwhelming” and that they feel unable to make sense of the information that they gain.  There are really only a few simple steps and issues you need to think about when you’re choosing your midwife.

  1. Employed or private practice? In Australia, most midwives work in an employed model.  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.  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 some are able to attend births in a hospital too), 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.
  2. Finding a midwife: There are various ways of finding a midwife.  A new list has been established to list the eligible midwives and 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 travelling 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.

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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 and a known obstetrician, 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 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

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Fish in pregnancy

Fish is a really healthy food to eat. It is rich in protein, healthy fat and minerals. It contains the sort of fat that can help to lower bad cholesterol, and increase good cholesterol.

It also contains omega-3 fatty acids which are important for the development of the baby's central nervous system.  Some women have commented that they don't like fish, and have asked if a fish oil supplement is a reasonable alternative.  I think that if it's a supplement or nothing, then a supplement is good, but there's no substitute for the real thing, so where possible, eat fish and avoid the supplements.

Although fish is a great food source, you need to be careful about which fish you choose. Bigger fish, such as shark, eat smaller fish.  They also live longer than smaller fish.  Therefore, over their lifetime, they accumulate more mercury than what a smaller fish would accumulate, and this can be harmful for the developing baby when we eat bigger fish.

Small amounts of salmon or sardines every day is very beneficial to your developing baby.  It does not need to be a large serve; the important thing is to have a steady stream of nutrients and fatty acids to your baby.

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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 hard 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.

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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.

Research suggests that leg cramps might be related to mineral imbalances, so there is a case for women taking magnesium and calcium supplements if they are experiencing leg cramps.  Dietary salt is also a good idea: not lots of salt, but just a small addition.

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).

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