Doula Training

Exciting News for all those enthusiastic about Pregnancy, Labour, Birth, breastfeeding and Newborns! 

Here is your amazing opportunity to attend Doula Training School in Sydney with Julie Clarke and it’s about to commence very soon in Spring 2016 

Want to be able to say “I’m a trainee Doula”! 

Would you love to attend lots of awesome births and be a tremendous help and support to guide women and their partners through the experience? 

Are you perhaps considering a future career in Midwifery but want to know a lot more about the wonderful world of birthing through the experience as a trainee doula first?

Are you ready to embark on one of the most amazing adventures there is in life?   Following your true passion to be a trainee Doula?

Being empowered and informed to be able to make a real difference to other women’s experience of birth as they transform from womanhood to motherhood. 

Want to be a significant part of this incredible exciting journey through women’s wisdom? 

Only 20 places available for this awesome training.

It will be closed as soon as it’s full, which will be in about 2 weeks from now.

Important:  Prerequisites are to be a kind, caring compassionate person who simply wants to help other women in their journey to motherhood, it is not necessary to be a nurse or a midwife or any other qualification to train as a doula.

Doula training will provide you with all the birth support skills to help your family, friends and clients to have an awesome birth experience. Trainee Doulas will be able to instill confidence and empower women to birth in the way they dream of naturally by providing comfort measures, reassurance, encouragement and practical support during the process to enable a very positive experience. The new mother will be grateful and delighted to have had a Doula help her.

FAQ’s about the unique special Doula training:

Where: the tranquil venue at Julie’s lovely home at Sylvania, Sydney 20 mins south of the airport

When: 21 September to 23 November, 2016 (10 x Wednesdays)

Time: 10am start and 3.30pm finish

How: group learning, discussion, self-reflection, take home activities, self-study, reading, assessments, attending births.

Why: because Australian women really do need a lot more Doulas available

Who: all women of any age over 18, whether they are a mother or not, who are naturally very compassionate, and who truly want to make a very positive difference to women’s experiences throughout their Transition into Parenthood. Excitement, dedication, curiosity, fascination, motivation, and inspiration are all that is required to get started. There will be weekly assessments yes but no exams. There are no previous academic achievements required.

What: a thorough grounding in all pregnancy, labour, birth, newborns and breastfeeding support measures both physically and emotionally.

Yes you can even bring your own breastfed babe in arms to the training if desired. Older big kids can’t be catered for but non mobile little breastfed babes are fine. 

Excited? Yes!

Make the decision to do the Doula Course? Yes!

Three quick easy steps:

  1. Make the $2000 payment or $500 part payment
  2. Email julie@julieclarke.com.au the receipt and a quick message you want the enrollment form
  3. Fill in the enrollment form and email it back to Julie

To Book in for the Doula Course simply ring Julie 0401265530 (or)  make payment following these instructions and email Julie Clarke with your details:  julie@julieclarke.com.au  

Cost: $2,000 payable via direct deposit to
St George Bank Sylvania Southgate
Account: Transition Into Parenthood
Account number: 028 538 865
BSB: 112 879
quote reference: Doula training and your name
copy and paste receipt to julie@julieclarke.com.au

Payment plans are available 4 x $500

See website for more details www.julieclarke.com.au

Is a Doula Right for you?

The roles of doula and midwife are very different, although both work with pregnant and birthing women and their families.  Here is a quick guide to describe what it is a doula does ... and doesn't .... do.

What a doula does

  • Supports your decision-making by providing information and options, referring you to sources that can give additional information, and assisting you to formulate questions for your care providers to get the information you need.
  • Supports you in labour, offering verbal guidance, emotional reassurance and comfort, position changes, water, ice, heat packs and space as needed.
  • Helps you prepare for birth, suggesting birth education classes, birth preparation methods and providing books and DVDs
  • Helps you to create and refine your birth plan.
  • A doula understands the medical system and the best ways to navigate it.

What a doula does not do

  • Judge you for the decisions and choices you make
  • Speak for you when you are with your care provider
  • Perform any clinical care such as checking your blood pressure, position of baby, monitoring, internal exams
  • Offer any clinical / health care advice (but does give you options, pros and cons)
  • Make decisions for you

 

Top Tips for Communicating with your Midwife or Doctor

Communicating effectively is an important part of taking responsibility for your health care and taking part in the decisions that need to be made from time to time.  Communication also tells your doctor or midwife what is important for you in your pregnancy and birth care, improving their ability to work with you on your terms.

EYE CONTACT
Eye contact is an important part of communication.  As is observing body language.  Eye contact establishes trust and connection with your midwife and demonstrates that you are engaged in the conversation and are attentive. 

REMEMBER THEIR NAMES
The word that is most special to a person is their own name.  In our busy lives, we often forget people's names.  Stand out from the crowd: call your midwife or doctor by their name and you'll find they treat you as a person, more-so than a number in a busy system. When you meet them for the first time, if you try to associate their name with something about them that is unique, it will help you to remember their name.  Otherwise, repeat it back at the first chance you have and it'll be more likely to stick.

BRING YOUR BIRTH PLAN WITH YOU
Your birth plan / birth preferences / birth wishes (or whatever you're choosing to call it) documents how you'd like to be cared for by your midwife or doctor.  It helps them to focus on your needs and desires, and will help them to better help you.  An ideal birth plan is no more than two pages long; preferably one page, and arranged in headings and
bullet points.  Make it easy to read and easy for them to find the information they need.

TAKE SOME TIME
When decisions are needing to be made, or plans are changing, or you're feeling uncertain - if its not an emergency, ask for some more time.  Take some time to formulate the questions you need to ask to get the information you need.  If you're unsure, ask.  You can ask to see the policies or evidence that is being used to inform your care.  If it's an emergency, go with what is being recommended.

USE YOUR BRAIN
Benefits: what are the benefits?
Risks: what re the risks?
Alternatives: what are the alternatives to what is being proposed / suggested?
Intuition: what does your intuition tell you?  You may need some time to tune into what your intuition is telling you.
Nothing: what if we do nothing?

The BRAIN acronym is great for many issues that occur in life.  It is the process of stopping and asking for more information that often clarifies for you what is important or the best path forward.

NEVER FORGET TO SAY THANKS!
If your midwife or doctor has gone out of their way to honour your birth plan, work with you through complications so that you still felt empowered in making decisions, and if you generally felt that they were awesome, please tell them!  Generally, midwives love chocolates with a nice thank you card.  It's a tough job, long hours and when someone says thank you, wow, it really makes their day.

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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What is a natural birth?

Natural birth.  What is it?

It seems it means different things to different people. 

For some women, natural birth means by birth any means, other than by caesarean.  "I had a natural birth" or, "I'm going to go natural" is often said as if the only other option was a caesarean.

But is this the real meaning of "natural"? 

I believe there are many ways to have a baby.  No way is necessarily right or wrong.  What's important is how you want to birth your baby and then matching your wishes to the available birth options so that you are cared for by someone who is most likely to assist you in the type of birth you desire. 

For me, a natural birth is one in which there is no intervention or interference in the normal, natural process.  For this to occur, there would be no medical forms or induction or speeding up the labour with drugs, there would be no medical forms of pain relief, no instruments used to assist the baby's birth and of course no caesarean.

Visit my website to learn more about private midwifery care and birth support.

Who said a baby was term at 37 weeks?

We have traditionally said that " term"  is anywhere between 37 and 42 weeks of pregnancy, and that a baby born anywhere in this 5-week period was at a very low risk of complications.  Babies born before 37 weeks would be considered pre-term, while babies born after 42 weeks would be considered post-term.

We are now moving to different definitions of term, and this re-definition has come about over reports that within the traditional term period, there are some important differences in outcomes. 

We now consider the early term period, which is from 37-38 weeks; term which is 39-41 weeks, and late term which is 41-42 weeks.  Babies born prior to 37 weeks would still be considered pre-term, and babies born after 42 weeks would still be considered post-term. 

It has been found that while many babies born early may look as healthy as full-term babies, sadly some of them are not.  Babies born at 37 and 38 weeks seem to have more adverse health outcomes than those born at 39 to 41 weeks.  The most significant health issues are low blood glucose levels, breathing difficulties and a need for admission to the special care nursery.

The research also showed that babies who were born by caesarean at 37-38 weeks were at an even higher risk for admission to the special care nursery when compared with caesareans that were performed on full term babies at 39-41 weeks, and this is thought to be because babies who are born by caesarean do not have the opportunity to naturally expel fluid from their lungs as occurs during a vaginal birth.

Visit my website to learn more about private midwifery care.

 

Vaginal twin birth

Exciting new research has shown that vaginal birth is as safe as caesarean for twin births.

It has long been thought that twins are best born by caesarean, with some care providers declining to offer a vaginal twin birth service.

A new Canadian study shows that, in fact, the rate of complications is no greater with vaginal birth than with caesarean, and in fact, in minimising the need for caesarean, we are minimising the risks to the woman and in her subsequent pregnancy/ies.

The research involved 1,398 women who are assigned to caesarean, and 1,406 women who were assigned to vaginal birth.  Vaginal birth only proceeded if the first twin was head-first, so in eventuality, slightly less than 50% of the vaginal birth group actually gave birth vaginally.  This represents quite a high caesarean rate (just over 50%), but with a care provider who is skilled in vaginal breech birth, there is no reason to believe that this high rate of caesarean needs to occur in practice.

The researchers found that the risk of serious complications was virtually identical in the two groups, being just over 1%.

Curiously, the risk of death was slightly higher - 0.4% - in the caesarean group.  It was 0.3% in the vaginal birth group.

Visit my website to learn more about private midwifery care and birth support.

How can fear affect labour?

A recent Norwegian study found that women who were fearful of giving birth spent an average of 8 hours in labour, versus an average of 6.5 hours for women who weren’t afraid of birth.  Women who feared childbirth were also more likely than unafraid women to need an emergency caesarean or have their birth assisted by instruments.

This might be explained by the hormonal impact of fear on labour.  When we are afraid, we release adrenaline. Adrenaline is a fight or flight hormone that prepares our bodies for action in the face of a perceived threat. Adrenaline can affect uterine contractions, making them less efficient and more painful.

We know that for labour to progress well and normally, we need very different hormones. 

The hormones we need are the endorphins and oxytocin, and these hormones are far more abundant when we are feeling calm, relaxed, confident and safe. 

Visit my website to learn more about private midwifery care.

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!

Visit my website to learn more about private midwifery care.

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.

Visit my website to learn more about private midwifery care and birth support.

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.

Visit my website to learn more about my services.

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.

Visit my website to learn more about my services.

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.