Natural Birth, Normal Birth, Ecstatic Birth
When we put together our ideas of birth from what we've seen in the media (urgent, dramatic, medical emergencies) together with stories we are told about '40 hour'. 'painful' labours it is not suprising that women feel confused and fearful about their upcoming labour. Together, these images certainly paint a picture of an event that is traumatic, medicalised and negative.
The realty is, however, that when a woman is properly supported to labour naturally, her labour hormones will reach a maximum and her labour will be more efficient, less painful (even painfree or ecstatic!) and more safe for both the mother and baby.
How is an ecstatic birth - or at least a normal birth - possible? Birth is a part of a woman's normal sexual life cycle. Just as courting (flirting), making love, birthing, breastfeeding adn bonding with your baby are. They all have a number of hormones in common - foremost oxytocin, also known as the Hormone of Love.
Why is there so much intervention in birth in Australia? Unfortunately the hospital setting is set up to deal with an emergency and to oversee the care of many women at one time which is exactly the opposite to the environment and care needed for the normal hormonal process of birth to reach its peak.
"In many traditional societies they had an intuitive knowledge of the effects of maternal emotional states on fetal development. It was well understood that the duty of the community is to protect the emotional states of pregnant women." Michel Odent
What environment is needed for Natural Birth?
For oxytocin to flow at its peak women need the following:
- a dark, cozy, warm and undistrubed environment
- to not feel like they are being watch or observed
- to feel safe and supported by people they have formed a secure relationship with
- to be free from fear or stress
Adrenalin is part of a safety mechanism for mother and baby in labour. The release of adrenalin slows down the release of oxytocin, thus slowing down the labour itself. Adrenalin is released when a labouring woman :
- is cold, excited, fearful or stressed
- feels she is being watched or observed
- is disturbed or interupted
- does not feel safe and secure
The ideal environemnt for the vast majority of women to give birth is in the comfort of their own home, or similar, supported and cared for by a midwife and family they know, trust and love (This is called continuity of care). Birth Centres are designed to create the home birth environment within the hosipital system. Doulas and Independent Midwives and Team Midwifery programmes give women the conituity of care from a trusted professional to support a woman to feel safe and relaxed during labour.
How should a woman be supported during labour and birth?
As a support person or care giver our number one job is to protect the birthing woman's emotional wellbeing and to help to create the environment. or 'hold the space', that she will be able to let go of her mind, let her body take over and birth her baby.
Find out more from Independent Midwives, Doula, Birth Centre and Team Midwifery programmes (scroll down for details).
Breathing and Yoga for birth
Nose breathing (Yogic Breathing) directs the air deep into the lower part of the lungs (the much larger part of the lungs). Receptors in this part of the lungs create a relaxation response in the body. The more your body and mind realx, the more oxytocin and other hormones are relased into the body. So breathing practiced at yoga, and various Birth Preoaration Courses (Antenatal Courses for Natural Birth)when used during labour increase the labour hormones for a more efficient, maybe even ecstatic, birth!
Find Prenatal (Pregnancy) Yoga Classes in your area
Find out more about Birth Courses available for Natural Birth Preparation
Active birth
"Active labour and the adoption of natural upright or crouching birth positions is the safest, most enjoyable, most economical and sensible way for the majority of women to give birth. There is no disruption to the normal physiology of labour, no interference with the hormonal balance, postnatal depression is rare and problems with breastfeeding and mothering are less likely" (Source).
Active Birth is a term coined by Janet Balaskas. It refers to the positions women use to birth the baby and also refers to a woman being mobile and free to follow her body during labour. The women is active in her physical movement but also in her ability to voice herself and to be heard. Edcuation, knowledge and preparation often assists and empowers a woman (and her partner) to have her 'voice' heard during labour - and for her voice to be listened to so that her care is centered around her choices and not those of others. This is true 'woman centred care'. Many of the positions that women instinctively adopt throughout their labour are variations of yoga postures, usually taught in pregnancy yoga classes.
Currently, however "Very few women in Australia now experience birth without intervention. In fact we have one of the highest invention rates in the world. We live in a society that does not honour or trust women's natural ability to birth without the assistance of technology and intervention.
The way we birth our babies has a profound and lifelong impact on both parents and child. It affects how we see ourselves and our ability to parent. It impacts on our health and well being and how we interact in the world. It resonates through our child's development and personality"(Source).
"Giving birth in ecstasy: This is our birthright and our body’s intent.
Mother Nature, in her wisdom, prescribes birthing hormones that take us
outside (ec) our usual state (stasis), so that we can be transformed on every level as we enter motherhood.
This exquisite hormonal orchestration unfolds optimally when birth is
undisturbed, enhancing safety for both mother and baby. Science is also
increasingly discovering what we realise as mothers - that our way of
birth affects us life-long, both mother and baby, and that an ecstatic
birth -- a birth that takes us beyond our self -- is the gift of a
life-time.
Four major hormonal systems are active during labor and birth. These
involve oxytocin, the hormone of love; endorphins, hormones of pleasure
and transcendence; adrenaline and noradrenaline (epinephrine and
norepinephrine), hormones of excitement; and prolactin, the mothering
hormone. These systems are common to all mammals and originate deep in
our mammalian or middle brain.
For birth to proceed optimally, this part of the brain must take
precedence over the neocortex, or rational brain. This shift can be
helped by an atmosphere of quiet and privacy with, for example, dim
lighting and little conversation, and no expectation of rationality
from the laboring woman. Under such conditions a woman intuitively will
choose the movements, sounds, breathing, and positions that will birth
her baby most easily. This is her genetic and hormonal blueprint.
All of these systems are adversely affected by current birth practices. Hospital environments and routines are not generally conducive to the shift in consciousness that giving birth naturally requires. A woman’s hormonal physiology is further disturbed by practices such as induction, the use of pain killers and epidurals, cesarean surgery, and separation of mother and baby after birth." Ecstatic Birth - Nature's hormonal blueprint for labour © Dr Sarah J Buckley 2005
Find Birth Classes in your area
Search Books and Publications for more informationon Natural Birth Practices
Contact your local Advocacy & Support GroupsImportance of Continuity of Care
"Continuity of care by a known midwife is a special partnership which is developed between the pregnant woman and her midwife which is established during pregnancy. The woman is then attended in labour and postnatally by that same midwife in the context of trust and respect for each other" (Source).
"It is well understood that under a midwifery-led model of care [where continuity of care is the goal], women and their partners experience a higher level of satisfaction and more successful birth outcomes, better breastfeeding rates, and most importantly, lower infant and maternal morbidity, mortality and mental health complications. Obstetric argument often sites that obstetric technologies have contributed to declining maternal and infant mortality but they fail to address that [these] improvements correlate with improvements in general public health and prenatal screening. …Australian’s [high] rates of obstetric intervention do not currently meet international best practice or WHO recommendations" (Source).
To receive continuity of care during your pregnancy and birth you can:
- Hire an independent midwife or doula (to birth at home or hospital/birth centre)
- Attend a birth centre (attached to a major hospital) with a Team Midwifery program
- Attend a free standing birth centre
At a Birth Centre, your appointments will be made with various midwives who attend births so that when you arrive in labour, you would most likely have met the midwife before to increase continuity of care. However, you may not be attended by the midwife who you saw during your pregnancy check ups. Many Birth Cetnres and hospitals are now introducing Team Midwifery Programs to further improve continuity of care as the benefits for health outcomes for both mother and baby are more widely acknowledged.
Obstetricians are unable to provide this model of care. Obstetricians are surgeons who have been trained to attend high-risk women and to treat serious complications. "Their responsibilities for the management of major complications are unlikely to leave them much time to assist and support the woman and her family for the duration of normal labour and delivery" or during pregnancy and postpartum (Source).If you employ an Obstetrician's services, when in labour you will most likely be attended by Midwives you have not met before.
Models of care
"The choice of birth professional is possibly the most important choice a woman will make during her pregnancy" (Source).
A range of services are available to support women during pregnancy, birth and the post-natal period. Some use obstetricians while others opt for ‘shared care’ between their general practitioner and local MaternityHospital/BirthCentre. Alternatively, independent midwives provide continuity, caring for women during their pregnancy, labour (wherever that may be) and at home following the birth of the child.The World Health Organisation states that a "midwife is the the most appropriate primary carer in normal pregnancy and birth, including risk assessment and the recognition of complications. However, in many countries midwives are either absent or are present only in large hospitals where they are assistants to the obstetricians" (Source). Obstetricians cannot provide continuity of care, and it is continuity of care which produces the best outcomes for women and their babies.
"There will always be an element of risk in birth whatever the choice of birthplace. However, safety in childbirth is intrinsically related to the mother's emotional, psychological and physical well-being during labour. This, in turn, is influenced by the choices which are made during pregnancy, choices which should enable a woman to give birth at ease with her environment, her attendants and herself.
This most important choice of birth professional should be made after long and careful evaluation of the practitioners available. It is especially helpful to talk to as many practitioners as possible and get a clear picture of the mode of practice. Every woman gives birth in her own individual style and will feel easier if her practitioner's style suits her own" (Source).
"The model of care that you choose in pregnancy may have an impact on the options and choices that are subsequently available to you during childbirth" for your current and subsequent pregnancies (Source).
Care in normal birth: A practical guide by the World Heanth Organisation
Continuity of Care - A long-term national health strategy Homebirth Access Sydney's submission to the 2020 Summit
Birth Centres
Birth centres attached to a major hospital
There are now a number of birth centres in Sydney that are attached to major hospitals (ie. in the same grounds as the hospital). For many these provide reassurance as women can labour in a more home-like setting with the knowledge that interventions are quickly available, at the labour ward, if necessary.
People should be aware that, like the labour ward, birth centres are still subject to strict guidelines and the progress of labour is measured against ‘progress of labour’ curves such as 'Friedman's Curve'. Certain conditions that may develop during pregnancy and labour will mean automatic transfer to the labour ward. It is worth asking Centres for their rates of transfer to the labour ward and the reasons for transfer.
Midwifery-led services within a larger unit in NSW
Auburn Hospital - Birth Centre
Norval Street, Auburn, 2144 ph: 02 9563 9678Bankstown-Lidcombe Hospital - Birth Centre
Eldridge Rd, Bankstown, 1885 ph: 02 9722 8000Blacktown Hospital - Birth Centre works on a team model and is attached to the Delivery Suite
Blacktown Road, Blacktown, 2148 ph: 02 9881 8286Camden Hospital - Midwifery group practice
Menangle Road, Camden, 2570 ph: 02 4634 3000Campbelltown Hospital - Birth Centre
Therry Rd, Campbelltown, 2560 ph: 02 4634 3000Fairfield Hospital - Birth Centre
Cnr Polding Street &, Prairievale Road, Prairiewood, 2176 ph: 02 9616 8111Royal Hospital for Women - Birth Centre
Barker Street, Randwick, 2031 ph: 02 9382 6111Royal North Shore Hospital - Birth Centre
Pacific Hwy, St Leonards, 2065 ph: 02 9926 7111RPA – Royal Prince Alfred Hospital - Birth Centre
Missenden Rd, Camperdown, 2050 ph: 02 9515 6111Ryde Hospital - Birth Centre
Denistone Road, Eastwood, 2122 ph: 02 9858 7549St George Hospital - Birth Centre also has caseload midwifery care and offers homebirth option
(Source)
Gray St, Kogarah, 2217 ph: 02 9350 1111
Freestanding birth centres
"A free standing birth centre is an institution that offers care to women with a straightforward pregnancy and where midwives take primary professional responsibility for care. During labour and birth medical services, including obstetric, neonatal and anaesthetic care are available should they be needed, but they may be on a separate site which may involve transfer by car or ambulance" (Source).
Women are allocated their own midwife at freestanding birth centres, while those attending birth centres attached to hospitals may see a number of different midwives during their check ups and labour.
Since freestanding birth centres provide continuity of care with a known midwife, it is not surprising that their transfer rates are lower than those for birth centres attached to hospitals. They are likely to be more flexible and adhere less to 'progress of labour' curves.
"The Ryde Midwifery Group Practice, which was launched in March 2004, is a free standing birth centre. It offers the benefits of continuity of midwifery care to low risk non-insured women who book with a named midwife at their local hospital.
Compared with Australian national data (2002), the RMGP shows a significantly higher rate of spontaneous vaginal birth, lower Caesarean section and lower instrumental birth rate. This may be associated with the lack of induction and the lack of epidurals at Ryde" (Source).
A report, Highlights: First 100 Babies Report, gives figures on pain relief, transfer rates etc for The Ryde Midwifery Group Practice in its first year of operation.
Stand alone models in NSW
Ryde Midwifery Group Practice, Ryde Hospital, Sydney - stand alone midwifery led care
Tel 02 9858 7549Belmont Birthing Service, Belmont Hospital, Newcastle - stand alone midwifery led care
Tel 02 4023 2204
Belmont Birthing Service - NSW Heath Info Sheet
Independent Midwives
The midwife in internationally recognised as "the most appropriate … type of health care provider to be assigned to the care of women in normal pregnancy and birth, including the risk assessment and the recognition of complications" (Source).
In Australia 70%-80% of all pregnant women are considered low risk and are capable of normal birth without intervention" (Source).
"However, in many developed and developing countries midwives are either absent or are present only in large hospitals where they may serve as assistants to the obstetricians" (Source). In this context continuity of care is not possible. Women in Sydney are lucky to have a number of independent midwives working outside the hospital system who are able to provide continuity of care.
Independent midwives see birth as a natural, normal, healthy life event, not as a medical condition to be managed.
"Birth is not an illness. Internationally accepted best practice standards for optimal maternity services promote care by a known midwife during pregnancy, birth, and early parenting. This is fundamental to the definition of a midwife: one who provides primary care for women throughout the pregnancy and birth, and who collaborates with other practitioners (such as obstetric specialists) when a woman requires specialist or secondary levels of care.
The focus of the midwife's care is the woman, as an individual. The wellbeing and safety of the woman and her baby are paramount, and data from Australian and international reporting support midwifery care as protecting the safety of the woman and child" (Source).
"Midwives offer a variety of different services including:
Preconception advice
Pregnancy testing
Prenatal care for the entire pregnancy
Prenatal classes
Care during labour
Birth in home, hospital or birth centre
Postnatal care at home or hospital
Care at home for up to six weeks
Lactation support" (Source).
"70%-80% of all pregnant women are considered low risk and are capable of normal birth without intervention" (Source) and so the skills of an obstetrician are unnecessary for the majority of women. Instead of using the baby bonus or your private health insurance to pay for an obstetrician whose skills you do not need, consider engaging an independent midwife who can provide continuity of care and be your advocate wherever you birth. Some health insurance companies cover independent midwifery.
It is essential to choose a midwife with whom you feel comfortable. Most "midwives collect statistics of the incidence of complications which occur within their practice, such as caesarean sections, episiotomies and tears, for on-going review of their own work" (Source). Shop around, ask questions and find someone with whom you really connect.
See Statistics - on intervention rates for pregnancy and birth.
See Guide to Choosing a Midwife by Homebirth Access Sydney (2010)
See the Natural Parenting Directory (on the left hand side of this website) for a list of independent midwives practicing in Sydney.
Like heaven into my hands: a midwife story a VIDEO by Tess Colwell
Doulas
“A doula is a professionally trained birthing support partner who is there to offer emotional and physical support as well as unbiased information to the birthing mother and her partner. A doula does not replace the role of a midwife or doctor and is not there to deliver the baby. She is there to ‘hold the space’ for the woman and to be attuned to her emotional and physical needs. The World Health Organisation agrees that trained and experienced labour assistants who meet a woman’s emotional and physical needs in labour can improve maternal and infant outcomes. Studies have shown that the presence of a doula during labour reduces:
the overall caesarean rate by 45%
the length of labour by 25%
syntocin use by 50%
pain medication by 31%
need for forcep deliveries by 34%
requests for epidurals by 10 - 60%" (Source).
See the Natural Parenting Directory (on the left hand side of this website) for doulas practicing in Sydney and for services that can recommen and train doulas.
General Practitioner
Some women see their GP for check ups during their pregnancy and then birth at a birth centre or hospital. This is called 'shared care'.
A General Practitioner can prescribe conventional drugs and make referrals to specialists. The GPs listed in the Natural Parenting Directory (on the left hand side of this website) have all studied and specialise in some form of natural therapy as well as conventional medicine. They will be supportive of parent’s choice not to immunize and specialise in women’s and children’s health.
Obstetrician
Obstetricians are surgeons who have been trained to attend high-risk women and to treat serious complications. "By training and by professional attitude they may be inclined … to intervene more frequently than the midwife" (Source).
In Australia "70%-80% of all pregnant women are considered low risk and are capable of normal birth without intervention" (Source) and so the skills of an obstetrician are unnecessary for the majority of women.
Instead of using the baby bonus or your private health insurance to pay for an obstetrician whose skills you do not need, consider engaging an independent midwife who can provide continuity of care and be your advocate wherever you birth. Some health insurance companies cover independent midwifery.
Homebirth
Research shows that planned homebirth using midwives is associated with LOWER RATES of intervention, but similar intrapartum and neonatal mortality as low risk hospital birth (Source). Homebirth is SAFE!
"Some women find that having their baby in the comfort of their own home provides a very supportive environment and consequently they have an easier birth. Other women choose a homebirth, as they believe in their body’s ability to give birth and wish to decrease the chance of needing intervention in their labour. A number of different research studies have looked into the safety of homebirth and all found that for women with a low-risk pregnancy, homebirth is a safe option.
Some of the most popular reasons women choose homebirth include:
- Women have fewer complications in labour
- Decreased need for interventions during labour
- Less use of medication
- Being in comfortable and familiar surroundings
- Women have the choice of who is present at the birth
- No separation from partner or other children
- No separation from the baby
- Less risk of infection during a homebirth, as homes generally are not a haven for bacteria, unlike hospitals
- Women have the freedom to do what they want during labour, for example; dance, sing, scream, walk around the backyard or submerge in a pool or bath
- Babies have fewer problems after birth
- Increased success rates with breastfeeding
- Trusting, one-on-one relationship with independent midwife or carer which may be particularly important for persons with high personal needs, such as post traumatic stress due to sexual assault
- Ability to plan birth rituals and processes according to spiritual and cultural beliefs
- Trauma with the prospect of a hospital birth" (Source)
"I found that during my first birth in hospital fear was my enemy causing me great pain. Being amongst strangers, naked under harsh fluorescent lighting, cold from the air conditioning and shunted from room to room was very discouraging. I felt out of control and overwhelmed. I resorted to Pethadine and felt traumatized afterwards.
With the following two home waterbirths
I found courage to be the antidote. In the comfort of my own home
with the support of familiar people, feeling very safe and nurtured I
bravely faced my birthing dance. I ate when hungry, moaned
unselfconsciously through contractions, felt free to express my needs
and went wherever my instincts led me all the while managing the pain
well without drugs. They were both very peaceful births and I felt
very empowered afterwards" (Sam mother of three, two of whom were
born at home)
Locate Independent Midwives to discuss homebirth options
Find further Homebirth Information & local Support Groups
Homebirth from Sheila Kitzinger’s website
2008 The Year of Homebirth Awareness Australian Video
Articles
Homebirth An information sheetby Janet Fraser
Our Peaceful Waterbirth by Jenny Carleton (founder of NP in Sydney)
Outcomes of planned home births with certified professional midwives: large prospective study in North America by Johnson & Daviss, British Medical Journal, June 2005
Water birth
A recent study (2000) from Switzerland on 2,000 water births shows that "waterbirths demonstrate fewer episiotomies, higher rates of intact perineum, lower blood loss and lower use of painkillers. Moreover, neonatal infections do not occur more frequently"(Source).
Waterbirth from Sheila Kitzinger’s website is an excellent source of information
Labour in Water a Maternity Coalition INFOSHEET
"How you will manage pain is a decision that you need to consider in planning for spontaneous, unmedicated birth. Deep water immersion is a valuable, non-medical, drug free ‘comfort measure’ for women in labour" (Source).
Our Peaceful Waterbirth by Jenny Carleton (owner of NP in Sydney)
Unassisted birth
"Also known as UC, UB, UBAC, freebirth, earth birth, unhindered birth, DIY childbirth, and empowered birth, this is perhaps the only way that natural birth can truly occur. …
Unassisted Childbirth seems a negative term to me, like there is something 'wrong' or 'radical' or negative about choosing to birth without a medical professional in attendance. I have coined the term 'purebirth' to describe unassisted childbirth since it seems to describe unassisted birth in a more positive light.
This kind of childbirth does not have someone acting as a care provider, OB or midwife. There is no one present to direct how labour or birth goes for the birthing woman other than the woman herself. There is no need for procedures like timing contractions, checking dilation, checking the heart rate of the baby or the labouring woman and so on. Birth becomes simple.
The woman simply labours and gives birth in whatever ways that she feels like, trusting and knowing her body, her baby and the safety of unhindered birth. Sometimes the full extent of this freedom is only possible if a woman births alone, but others have done this with husbands, children, family or friends present as well. It all depends on the woman and the woman alone and the ways in which she may feel inhibited by having others present. It is not surprising that unassisted birth is slowly becoming more and more heard of as more women adopt this and speak out about their experiences"(Soucrce).
Websites
Australian unassisted birth websites
Unassisted Pregnancy & Childbirth in Australia
"Even if you choose to have prenatal care and birth with assistance, the information here is invaluable to you if you want to understand the influences that YOU have on your birth experience"(Source).
Joyous Birth
Unassisted Birth Information Sheet by Joyous Birth
International unassisted birth websites
Born Free - Unassisted ChildbirthUnhindered Childbirth: the online childbirth class
Empowered Childbirth
This site has links to a range of other
unassisted birth sites and other excellent birth sites.
Online forum support groups
Unassisted Pregnancy & Childbirth in Australia
Empowered Childbirth - unassisted birth
and much more
Articles
Freebirth, Every Mother a Midwife: Building a Bridge to the Future by Jeannine Parvati Baker
Maia’s Birth- a family celebration by Dr Sarah Buckley
Unassisted Childbirth Statistics - some statistics gathered on unassisted births
Kids at Birth
"Our daughter's special role in the birth of her brother was to announce his gender and count his toes" (Jenny, mother of 2 )
Kids need to be well prepared if they are attending the birth of a sibling and they need a dedicated caregiver who is there to look after them alone.
There are such lovely resources for kids at birth. We had a number of books. The best were:
Runa's Birth (available through Pregnancy, Birth & Beyond, the website of Sydney independent midwife Jane Palmer)
Hello Baby (available through Caper's online Bookstore)
My Brother Jimmi Jazz (available through the NSW author & artist, Chrissy Butler)
For the most outstanding birth resource you can't go past the DVD Siblings at
Birth, by Sydney Independent Midwife Jo Hunter, featuring her 3 home water births (available
through Homebirth Access Sydney).
Article
Siblings At Birth – Should Children Be Present At Childbirth? by Jo Hunter
The Placenta
Placental Remedy
"The traditional medicine of many indigenous cultures recognizes and
values the healing potential of the placenta. It is prepared and used
in a variety of ways to benefit both mother and child" (Source). Midwife Jane Collings and homoeopath Linlee Jordan, both of whom are based in Sydney, established the Placental Remedy site to obtain and distribute information about homoeopathic placental remedy.
Lotus Birth
"Lotus birth is the practice of leaving the umbilical cord uncut, so
that the baby remains attached to his/her placenta until the cord
naturally separates at the umbilicus- exactly as a cut cord does- at 3
to 10 days after birth. This prolonged contact can be seen as a time of
transition, allowing the baby to slowly and gently let go of his/her
attachment to the mother's body" (Source).
Lotus Birth by Lisa Schuring
See the Natural Parenting Directory (on the left hand side of this website) for a Lotus Birth Support Group.
Vaginal Birth after Caesarean (VBAC)
Preparing for a Vaginal Birth after a previous Casearean (known as a VBAC or HBAC - Homebirth after caesarean) takes a little extra research. Advice for care varies dramatically from one professional to the next. Women are often talked into, or even scared into, having another caesarean, yet this is often unnecessary - or given a 'trial of labour' which completely undermines a woman's confidence in herself. One of the greatest challenges is ignoring the myth that 'once a caesarean always a caesarean'. Preparing for a VBAC means regianing faith in your body and understanding the circumstances leading to your previous caesarean. A Dola or Midwife experienced in VBAC will be able to give you specific advice for your situation. I have personally had 3 vaginal births after my caesarean and my husband I made a film about our experience, The Birth of Aahsa.
Find other VBAC Resources and Information
Fact sheets
Births after Caesarean a Maternity Coalition INFOSHEET
"If you have already had a caesarean birth, and plan to have more pregnancies, an important decision for you to make will be whether you should plan vaginal or surgical birth. Here are some facts for you to consider in making an informed decision"(source).
Resources on VBAC and HBAC in Birthings, Homebirth Access Sydney, 2007
An excellent one page summary of books, websites and videos on VBAC and HBAC
Articles
Scarred for life? by Jodie Dearsley, Birthings, Homebirth Access Sydney, 2007
Supporting women through HBAC by Robyn Dempsey, Birthings, Homebirth Access Sydney, 2007
Interventions – be informed
Statistics – on intervention rates for pregnancy & birth
Also see Birth Assistant
Statistics on intervention rates can be helpful when deciding which health professionals or services you want assisting with your pregnancy and birth.
Statistics for larger hospitals (over 200 births per year) are published in the NSW Mothers and Babies Report 2005 (published in February 2007). You will need to ask smaller institutions and individuals for their statistics. If they are not given freely you may want to question why.
Questions to ask
Figures for the following vary greatly between independent midwifes, obstetricians, hospitals (public or private) and birth centres.
Some private hospitals have very high intervention rates that reflect the culture of the institution rather than the needs of the clients. If you find an independent midwife for a homebirth, for example, it’s still worth checking hospital statistics and booking into the most favorable institution, incase a transfer is needed.
Onset & argumentation of labour:
Spontaneous
Induction – with Prostaglandin (gel or tablet) or Syntocinon (synthetic oxytocin in a drip)
Induction of labour for other than defined reasons
Artificial Rupture of Membranes
Delivery:
Vaginal (normal, breech, vaginal birth after caesarean (VBAC))
Forceps
Vacuum extraction/ventouse
Caesarean (elective, emergency)
Caesarean (for failure to progress, fetal distress)
Comparison between public and private hospitals
Pain relief:
Epidural anesthetic
General anesthetic
IM narcotics (Pethidine)
Nitrous oxide (Gas)
Spinal analgesia (quick acting anesthetic used for emergency caesareans)
Birth tract:
Perineal tear (1st – 4th degree)
Episiotomy
Intact vagina (not needing surgical repair)
Infant following birth:
Resuscitation by type
Admission to special care and neonatal intensive care (all and for reasons other than congenital abnormalities)
Figures on the above questions are available in the NSW Mothers and Babies Report 2005 (for larger hospitals with over 200 births per year).
Other questions to ask
Rates of transfer to hospital for independent midwifes and birth centres, and the reasons for transfer
Fetal monitoring – continuous electronic fetal monitoring; intermittent manual monitoring; no monitoring
Is the progress of labour measured against ‘Friedman's Curve’ (See 'Progress of Labour curves' below)
Cascade of Interventions
"Every interventive obstetric technique has known side effects for mother and baby … . When help is genuinely needed the benefits of intervention may well outweigh the risks. However routine use of obstetric management tends to complicate birth unnecessarily" (Source).
Any intervention in the natural process of labour and birth increases the chance of further interventions – this chain of events is called the ‘cascade of interventions’.
Progress of Labour curves
Hospitals and birth centres are guided by diagnostic criteria which measure the progress of labour. These criteria are based on the ‘Friedman curve’, which was developed 50 years ago to measure the rate of cervical dilation and fetal descent during active labour.
"While the Friedman curve is beneficial to obstetricians for illustrating the general relationship between the duration of labour and cervical dilation, each woman often has her own pattern of labour progression. Moreover, its usefulness in clinical practice is diminished when labour deviates from the average curve...
[However] obstetricians still monitor the centimeter-by-centimetre progression in labour and utilise Friedman's definitions of labour ‘protraction’ and ‘arrest’ to guide their decision making [on when to intervene]" (Source).
For example, there is great variation in the duration of the second stage of labour (after full dilation of the cervix). Anywhere from 5 minutes to three or more hours is 'normal'. While the "average is 1.5 hours for first time moms, … physicians may encourage interventions past this point" (Source) even though everything may be fine.
With a homebirth women will not be on a time schedule for the second stage of labour the same way they are in a birth centre or hospital. They can take this time to have a break from labour, a drink or a rest, even a sleep and gather their energy until it is time to work towards the baby coming out.
Induction of Labour
A common intervention, induction of labour, artificially stimulates contractions which tend to be unnaturally strong and prolonged – these contractions decrease oxygen supply to the baby causing fetal distress. Hence continuous electronic fetal monitoring is necessary which increases the Cesarean rate by 2-3 times. Also the mother’s body does not have time to produce natural endorphins to ease labour pain and women are less likely to be able to use active birth positions as they are confined to a bed by an intravenous drip (IV) and a fetal monitor. Faced by this unbearable pain, epidural anesthesia frequently follows (Source).
The risk of hemorrhage following birth is significantly increased by induction and forceps.
Induction of Labour a Maternity Coalition INFOSHEET
Understanding what induction is, and why it may be an important and even life-saving intervention for some women, will help you to make informed decisions.
Epidural Anesthesia
"Epidurals increase the use of other medical interventions and their related risks for mothers and babies" (Source). Sometimes women are offered 'walking epidurals' however research shows that 50% of mothers cannot walk with this procedure and those who can are restricted by an IV pole, fetal monitor and catheter.
Women should ask their hospitals for their epidural and caesarean rate following induction.
Unwanted side effects
Continuous electronic fetal monitoring is necessary with epidurals (and induction which often leads to epidurals) because of the potential for epidural-induced fetal heart rate decelerations. Continuous monitoring increases the Cesarean rate by 2-3 times (without improving the baby’s outcome). A drop in heart rate adds worry and stress to labour.
When an epidural is introduced the mother’s blood pressure often drops causing fetal distress from decreased oxygen circulation. To counter this IV fluids are administered which in turn cause the mother’s feet, legs and breasts to swell. When the breasts are engorged the nipple is flattened, which makes it difficult, and sometimes impossible, for the newborn to latch on.
A urinary catheter is necessary with epidurals which brings the added risk of bladder infection which would need antibiotic treatment, which can lead to thrush in mother and baby (via the breasts). Also in comparison to non-epidural mothers, there is an enormous increase in urinary incontinence after an epidural – a 700% increase after three months and a 200% increase after 12 months.
Forceps or vacuum extraction are five times more likely with an epidural as they interfere with the urge to push, the effectiveness of pushing, the rotation of the baby’s head to the most favorable position, and the mother’s capacity to choose the most effective birthing position. One study found no forceps used in unmediated births but the rate was 60% with epidurals and 80% with induction and epidural.
Deep vaginal tears that extend into the rectum are three times greater with an epidural because of the related increase in episiotomy and use of forceps. Deep tears are painful and take longer to heal and may later cause fecal incontinence and chronic pain during sex.
The Caesarean birth rate is greatly increased with an epidural and the earlier the epidural the greater the likelihood of a Caesarean. This can be attributed to the following epidural-induced factors:
Fetal distress caused by drop in mother’s blood pressure, decreasing placental blood flow
Weakening, slowing or stopping of uterine contractions
Abnormal position of the baby’s head because epidural has numbed and relaxed pelvic floor muscles which prevents the baby’s head from rotating and descending normally during second stage of labour
Decreased pelvic diameter when mother is forced to lie on her back (this occurs even in a semi-reclining position)
'Epidural Fever' is the rise in temperature in most women with an epidural, caused by the body’s inability to dissipate the heat generated in the process of labour. Epidural fever does not require treatment but a rise in the mother’s temperature (from whatever cause) may result in a rise in the fetus’ as well, causing increased heart rate and possible metabolic deterioration. The medical response is: IV antibiotics, speeding up the birth (forceps, vacuum extraction, Caesar), infant to intensive care where antibiotics are administered and invasive tests done to check for infection (as infection in newborns is extremely serious). The results, which take time to come back, may show the increase in temperature was just due to Epidural Fever and not an actual infection, but the separation (which interferes with breastfeeding), pain and anxiety were necessary to avoid missing the timely diagnosis of an actual infection.
Epidurals affect the baby – it takes 48 hours for a newborn to eliminate the anesthetic from its system. These medicated babies show drugged behavior (trembling, irritability) and are drowsier which can affect the establishment of successful breastfeeding. Bonding may be affected as the impression of a difficult baby can unconsciously shape the mother’s behavior towards her newborn which will consequently shape the baby’s personality (See The Science of Attachment). Also unmedicated mothers are more responsive to their babies cries than those who had an epidural.
Birthing from within: an extra-ordinary guide to childbirth preparation by Pam England & Rob Horowitz
Medical Risks of Epidural Anesthesia During Childbirth by Dr Lewis Mehl-Madrona, & Morgaine Mehl-Madrona
Episitomy prevention
You can prepare your perineum, through Perineal Massage, to prevent grazing, tearing and the need for an episiotomy:
"There is some evidence that daily massaging and gently stretching the perineum in the last 6 weeks or so before birth can reduce the likelihood of episitomy or the need for forceps or suction" in a hospital birth (Source).
In addition to perineal massage during the last trimester, pelvic floor exercises and practicing active birthing positions can reduce the chances of a perineal tear or an episiotomy.
How to perform Perineal Massage an Information sheet by Essenture
See the Natural Parenting Directory (on the left hand side of this website) for suppliers of perineal massage cream.
Directed pushing
Whether to follow the instinctive urge of bearing down, or to have another person direct the pushing efforts, is a decision that each mother needs to consider in planning for spontaneous birth.
Bearing Down or Directed Pushing? a Maternity Coalition INFOSHEET
Skin-to-skin contact – the importance of
(Also see Carrying your baby)
All newborns benefit from skin-to-skin contact with their mothers. The benefits are even more crucial for a premature baby.
A mother and her newborn should never be separated.
Skin-to-skin contact, also known as Kangaroo Care is a "universally available and biologically sound method of care for all newborns, but in particular for premature babies, with three components:
- 1 Skin-to-skin Contact
- 2 Exclusive breastfeeding
- 3 Support to the mother infant dyad.
Skin-to-skin contact is between the baby front and the mother's chest. The more skin-to-skin contact, the better. For comfort a small nappy is fine, and for warmth a cap may be used. Skin-to-skin contact should ideally start at birth, but is helpful at any time. It should ideally be continuous day and night, but even shorter periods are still helpful.
Separation is common, but abnormal and
harmful" (Source).
A South African website, Kangaroo Mother Care Promotions, aims to promote the spread and implementation of Kangaroo Mother Care as the standard method of care for all newborn babies, both premature and full term.
The website sells a clever shirt that allows you to wear you baby against your skin. The shirt is periodically available through an Australian distributor - Capers Bookstore.
Practices used inappropriately during labour
The World Health Organisation states that "the aim of the care [by the health professional] is to achieve a healthy mother and child with the least possible level of intervention that is compatible with safety. This approach implies that in normal birth there should be a valid reason to interfere with the natural process" (Source).
Despite this, the routine use of interventions is standard in NSW hospitals. The World Health Organisation identifies the following practices which are frequently used inappropriately during labour:
Restriction of food and fluids during labour
Pain control by systemic agents
Pain control by epidural analgesia
Electronic foetal monitoring
Repeated or frequent vaginal examinations especially by more than one caregiver
Oxytocin augmentation
Bladder catheterization
Encouraging the woman to push when full dilatation or nearly full dilatation of the cervix has been diagnosed, before the woman feels the urge to bear down herself
Rigid adherence to a stipulated duration of the second stage of labour, such as 1 hour, if maternal and foetal conditions are good and if there is progress of labour
Operative delivery
Liberal or routine use of episiotomy (Source).
Statistics on intervention rates can be helpful when deciding which health professionals or services you want assisting with your pregnancy and birth, as figures vary greatly between independent midwifes, obstetricians, hospitals (public or private) and birth centres (See Questions to ask).
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Books & Resources
Telephone advice & Counselling
"MotherSafe is a telephone advice and counselling service for pregnant or breastfeeding women who have been exposed to chemicals, medications, radiation or infections.
Located at the Royal Hospital for Women, the state-wide service provides information to women who are planning a pregnancy, are already pregnant or breastfeeding. The service also gives advice to health care professionals" (Source).
MotherSafe by the Royal Hospital for Women, Sydney
Information Sheets by the Maternity Coalition
Maternity Coalition INFOSHEETS provide consumer information that is current, accurate, evidence based, women centred, and independent of maternity care providers. INFOSHEETS will assist women make informed decisions about their maternity care regardless of their chosen place of birth or care provider.
Maternity Coalition is an Australian national umbrella organisation committed to the advancement of best-practice maternity care for all Australian women and their families.
INFOSHEETS by the Maternity Coalition
Joyous Birth
Joyous Birth is an excellent Australian homebirth website which is now a national resource with an extensive range of online forums and resources.Pregnancy & homebirth
Breastfeeding
Parenting
Previous surgery
Fathers homebirth support
Resources include:
choosing and finding a private midwife, birth attendant or doula
locating your nearest home birth group
how to provide support to home birthing women
the latest studies into home birth worldwide
unassisted birth information.
Sheila Kitzinger
Sheila Kitzinger is one the world's most influential and outspoken advocates for women's freedom of choice in pregnancy, birth, and motherhood.
Henci Goer: Informed choices in childbirth
The award winning medical writer, Henci Goer, provides information on how to prevent interventions in birth.
Obstetric Myths Versus Research Realities
Ina May Gaskin
The 'mother of midwifery', Ina May Gaskin, established The Farm Midwifery Centre in 1970 in Tennessee in the USA, as a place for women to experience natural childbirth in a home-like setting. Of the 2,028 pregnancies from 1970-2000, 98.6% resulted in vaginal births and 1.4% were Caesarean sections. Compare this to the US national average for Caesarean sections in 2001 of 24.4% (Source).
Her seminal work, Spiritual Midwifery, is now in its 4th edition. This is the classic book on home birth. The first section details the experiences of parents and midwives during the birth experience. The second section is a technical manual for midwives, nurses, and doctors. It includes information on prenatal care and nutrition, labour, delivery-techniques, care of the new baby, and breast-feeding.
Ina May’s new book, Guide to Childbirth, inspires women to discover the proven wisdom that has guided thousands of women through childbirth with more confidence, less pain, and little or no medical intervention.
Sarah Buckley
Sarah Buckley, a Brisbane based "family physician/GP, writer and mother of four, combines the best medical evidence on pregnancy, birth and parenting with her gentle mothering wisdom". Her website includes "Sarah’s expert research on topics such as ultrasound, drugs in labour, cord clamping, and the ecstasy and inbuilt safety of natural birth. You can also share some of Sarah’s own experiences, including four natural births, and fifteen years of breastfeeding and gentle mothering" (Source).
Her 2006 book, Gentle Birth, Gentle Mothering: The wisdom and science of gentle choices in pregnancy, birth, and parenting covers a range of issues including: Enhancing natural pain-relief, Water birth, Homebirth, Breech birth, Co-sleeping and Raising babies without nappies
Birthing from Within: an extra-ordinary guide to childbirth preparation by Pam England & Rob Horowitz
"Birthing from Within should be read by every pregnant woman in the U.S, regardless of what prenatal care and what prenatal classes she may be involved in. The discussion of non-pharmacological means of pain control is outstanding and should be required reading of every obstetrical anesthesiologist in the U.S. Birthing from Within honors nature and helps a woman find her own way to go with nature and her body. This book will help women tap their resources so that their birthing will be life enhancing and empowering." (by Marsden Wagner, M.D. Perinatologist-Neonatologist, former Director Of Women's and Children's Health for the World Health Organization and author of Pursuing The Birth Machine: The Search For Appropriate Birth Technology) (Source).
This is an excellent book though its breastfeeding advice leaves a little to be desired!
Midwifery Archives
Midwifery archives are a great source of information as they are a collection of wisdom and experience on just about every subject related to pregnancy and birth.
UK Midwifery Archives from the Association of Radical Midwives
Midwife Archives from Gentlebirth.org
Unassisted Birth
See Uassisted Birth