Physiological third stage

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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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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.

6 essential tips for a natural birth

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

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

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

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

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

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

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

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

6. Care provider

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

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

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

First time mums and homebirth

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

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

 

Continuity of care

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

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

 

Why is choosing a care provider one of the most important decisions you will make in your pregnancy?

A woman’s choice of care provider for pregnancy and birth is one of the most important decisions she will make. This decision has the most important influence on how her birth will go and how she will experience her care.

Some things to consider when deciding on a care provider are:

  • What sort of relationship would you like to have with your care provider? Are you merely looking for physical check ups in pregnancy and someone to turn up for the last few minutes of the birth? Are you wanting to be cared for by strangers who do not know you or your wishes for birth / would you like to feel nurtured? Would you like to know the person who will assist you in birth?
  • How much information do you expect to receive? Are you happy with “It’s normal” in response to your questions, or do you need more information and a better understanding of your situation and progress and health?
  • Do you wish to be actively involved in the decisions made about your care or are you happy to leave all decision-making up to others?

It may take some time and energy to find the right care provider for your pregnancy and birth. It is very helpful to interview several midwives and obstetricians before deciding on the one that is right for you.

What about place of birth?

There are three options for place of birth: home, birth centre and hospital. Midwifery care is available at all three locations. Obstetricians generally work only in hospitals, however a few will attend birth centre births. Knowing where you would like to birth your baby can help you in choosing a care provider.

What should I look out for when I am interviewing care providers?

One of the most important issues to consider really doesn’t need much consideration at all. How do you feel about your care provider at the end of the initial consultation? It’s a gut feel. You can trust your gut.

You will want to ask your care provider about his/her practices to ensure that their practices are consistent with what you’re wanting for your pregnancy and birth. If waterbirth is important to you, you need to find a place of birth and care provider who can provide this. It’s best to find this out at the initial consultation stage rather than at 38 weeks.

You will also want to explore your care provider’s philosophy on pregnancy and birth to ensure that there is a match with your own.

Are there any poor reasons for choosing a care provider?

Yes! And I hear them very often. It is not wise to choose a care provider because:

  • They are close to your home / office
  • Your mother used them
  • You feel you don’t have any other choices (there are always choices; it’s not a question of resources, it’s a question of resourcefulness)
  • They are female / they are male.
  • Your GP recommended them (unless you are sure of the basis for that recommendation and you agree that they are right for you)
  • They are cheap
  • They do an ultrasound at every visit
  • They delivered you
  • It would offend Aunt Bessie if you didn’t go to Dr X
  • Although you don’t like the person, you’re sure they’ll be fine on the day (your gut is always right)

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.

Holistic midwifery care

Holistic midwifery care is care that assesses and incorporates the needs of the pregnant woman, rather than merely focusing on her pregnancy.  A midwife who is working holistically will be interested in a woman’s family, her health and medical history, her previous births, her emotional well being, any fears that she may have around birth and parenting, her work life, and her relationships. A midwife who is working holistically will tend to see women for longer appointments, around an hour each, so that there is plenty of time to get to know each other and for the woman to feel safe and comfortable and supported.

A midwife who works holistically believes in the mind-body connection.  When we consider pregnancy and birth, a holistic midwife will understand that issues in life can impact a woman’s pregnancy, and s/he will recognise when fears, uncertainty and doubt are affecting a woman’s labour.  The midwife works with the woman through her pregnancy and birth holistically to help the woman to birth naturally, safely and calmly.

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.

Knowing Your Midwife

For many women, pregnancy can be an emotional rollercoaster.  Many women experience excitement, joy and hope, but also fear, uncertainty and even disappointment and sadness. The relationship a woman develops with her midwife is important to a woman as she journeys through her pregnancy, birthing and in the early weeks with her baby.

It has been shown that women who are cared for by one dedicated midwife for the duration of their pregnancy, birth and early newborn period find this form of care to be highly satisfying.

It is about having one person who shares in your pregnancy, who listens as you share your fears and concerns, who shares information with you and who supports your decisions and choices.

When a woman knows and trusts her midwife, there is a shift of power towards the woman as she feels a greater sense of control over her entire experience.  She becomes aware of her choices and options, she feels confident to make her own decisions and she goes to her birth feeling confident, informed and supported.  She knows who will be caring for her on the day, and she knows that her midwife knows everything that is important to her for her birth.

There is no sense of being a number in a busy system.  There is no need to repeat yourself at every visit.  There are no lengthy waits for appointments.  Each appointment takes around an hour, so there is plenty of time to get to know one another.

Private midwifery care is an option that more and more women are asking for, although it is only accessed by a small number of women.  Yet research shows that this care model, in which a woman is cared for by one midwife from early pregnancy though to birth and post-birth care, offers numerous benefits to women and babies. These include a greater chance of a spontaneous birth without stitches, feeling in control during labour and exclusive breastfeeding with minimal chance of postnatal depression and baby blues.  Private midwifery care also means much less requirement for pain relief in labour, fewer inductions of labour and of course a much lower chance of needing a caesarean.

The care I am describing - where a woman knows and chooses her midwife – is available for both home and hospital births.  If private midwifery care is available in your area, you may decide that is what you would like.

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.

My pregnancy is high risk. Can I have a midwife?

Yes, midwifery care may well be an option for you.  Your public midwifery options may be limited as public hospitals will generally steer higher-risk women towards obstetric care.  However, private midwives can care for women of all levels of risk in consultation with an obstetrician for the issues that may need obstetric input.

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.

How do Midwives Work?

It's a common question I am asked! When people ask me what I do, I tell them I am a midwife. The next question is usually, “Oh, so you’re a nurse?”. “Not quite”, I reply, “a midwife – I care for women though pregnancy and birth and with their new baby.” Then they really look puzzled. “That's not what an obstetrician does?" “An obstetrician is a doctor who specialises in caring for women with complicated pregnancies and births. A midwife specialises in caring for women who are having healthy pregnancies and births.” By that stage they’re well and truly confused and I start to wonder what we need to do to promote midwifery as a care option for all women.

The term midwife means ‘with woman’. Midwives work in partnership with women through pregnancy, birth and the postnatal period. Midwives can provide care to women from the time that the woman discovers she is pregnant, right up until her baby is 6 weeks old. In fact, women who experience a normal, healthy pregnancy and birth may not see a doctor at all! Eligible midwives are able to order all the necessary tests and scans during pregnancy and may refer directly to an obstetrician if their services are necessary.

Midwives provide education, clinical care, assessment, planning, support, advice and information, as well as doing all the routine checks of mother and baby.  Most importantly, though, a midwife's role is to develop a relationship with the woman and her family along the pregnancy, fostering feelings of trust, respect and safety for the woman and her family.

Midwives advocate measures throughout pregnancy and birth that promote normal birth: that is a birth without interventions. Midwives and are experienced in such things as water birth, active birth, and so on.

Midwives are also specially educated to know if anything is out of the ordinary, and they can get help from obstetricians. In pregnancy, midwives see women at intervals so that any issues that may present can be dealt with before they cause any major issues.

Women who are cared for by one midwife from pregnancy through to birth have better outcomes in terms of safety, lower rates of intervention and satisfaction with their experience. Midwives too prefer to work in this way, getting to know each family individually.

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.

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 woman 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 that a birth centre midwife would employ.

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 midwives bring to homebirths?

Typically, midwives bring a range of safety equipment and supplies to a birth. These include:

  • Oxygen for mother and baby
  • Suction equipment
  • Suture material and local anaesthetic in case of any tears (generally there are no tears) 
  • Medication to stop any excessive 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, 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.

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.

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.

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.

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.

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.

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.

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.