Prepping for Postpartum: Food, Food, Food!
Want to prep for your own or a love one’s postpartum? Don’t know what to start cooking? Look no further! Here you will find recipes and resources to get you started!
My favourite thing to bring or have delivered to new mums is food! Firstly, because often new mums are so distracted and exhausted to even think about cooking, and secondly, because it is so important for mums to be nourished properly if they are to survive the hectic first weeks of recovery, sleep deprivation and learning to breastfeed.
Prepping your freezer for postpartum, or cooking for a loved one who has just had a baby is the best gift ever - but what should you be prepping?
A great book to get a hold of is “THE FIRST FORTY DAYS” by Heng Ou - it not only outlines why nourishment is so important but it also has a tonne of recipes, suggestions on pantry staples and some great tips for postpartum in general.
The key to an easier recovery postpartum is eating food that is easily digestible and warming, this helps mums reserve their energy for more important things. With this in mind - soups, broths, curries, slow-cooked meats and veggies are perfect. Hand-held snacks like slices, muffins, bliss balls or quiches are also great to deliver fresh or frozen.
Here are some of my favourite recipes I love making for clients!
Broths:
Beef Bone Broth - I love this adaptation, and this beautiful doula also has a shiitake broth recipe for our veg mamas too.
A great ready-made option for a quick nutrient injection is the range of bone broths from Nutraorganics or the Body Glue from Gevity RX. Perfect for a postpartum gift basket!
Mains:
Thai Pumpkin Soup - Based on this recipe by Donna Hay, replace some of the water with coconut milk and serve with a squeeze of lime, coriander, fresh or dried chilli, and roti or fresh sourdough. This can be made with vege stock for vegan mamas and is great for the freezer or a jar in the fridge.
Chicken & Corn Soup - I love to replace the stock with bone broth or any kind, and the corn flour can be skipped for a gluten free soup.
Slow Cooked Beef Lasagne - I like to replace the stock with beef bone broth for extra nourishment. Can also be made Gluten Free and freezes well.
Family Friendly Fried Rice - a hit with the whole family, and super cheap to make. Great for using up any meat you have in the fridge, freezes well and can be made meat free and gluten free.
Slow Cooked Beef Ragu - a perfect meal to pop on in the morning when everyone is in a better mood. Great for the freezer, and can be served with mash, pasta or even made into a lasagne or shepherd's pie for a revamp! Can be made with Lamb and rosemary for a twist too.
Snacks:
Peanut Butter & Honey Rice Crispies from The First Forty Days - think healthy kids treats.
Zucchini Slice by Donna Hay - perfect for a quick 2nd brekkie!
Apple Cinnamon Crumble Muffins - great for the freezer and for mini muffins!
Chia Seed Pudding - serve in jars with fresh fruit and nuts on top, perfect for vegan mums too.
Some extra tips:
🌻 Serve frozen meals in small servings so that mums can defrost one at a time.
🌻Serve soup and broth in a mug, not a bowl, as it’s easy to drink while feeding.
🌻Bring along rice pouches for easy microwaving - it means you don’t have to cook rice and portions can easily be made one-handed.
🌻If you are in need of more Tupperware or baking dishes, the op shop if a great place to look - you can get some really cheap dishes that you then don’t have to worry about collecting if you don’t want to!
🌻 Sometimes mamas won’t be up for a visit at the exact time you are dropping a meal - please don’t be offended, you never know what that beautiful woman has been through in the last few days, and how her body is recovering. The best idea is to simply leave a meal outside in a freezer bag with some ice packs, and let mama know that it’s there for her.
🌻 If you want to be promoted to favourite friend, then go one extra and set up a Meal Train for mum! You can use a Whatsapp group, a shared Google Sheets page or the free Meal Train website to get one going.
Don’t Have Time to Cook?
Then your best option is to organise a food service for at least the first couple of weeks postpartum. Most cities will have their own services - just search “Postpartum Meal Delivery in {your town}”.
Here in Perth we have a couple I always recommend -
The Baby Days - specifically formulated for postpartum nutritional needs, there is also 10% your first order when you subscribe to the newsletter!
The Postpartum Chef - beautiful mama Tara is a qualified chef and works with doulas all over Perth to nourish mums in their postpartum, as well as delivering to the Perth metro and surrounds.
Poppet’s Pantry - not specifically for postpartum but amazing hearty meals, this Nedlands based family business is nourishing mamas and their families all over Perth.
The Whole Bowl Co. - frozen meals delivered all over Australia specifically for postpartum, 10% off your first order when you subscribe to their newsletter too.
Feel free to download this information in an easy PDF right here to save on your phone!
I can’t wait to see what you make for yourself or a loved one during postpartum! Make sure you come say hi over on Facebook or Instagram!!!
Sending so much love!
Britt xxx
15 Questions You Should Ask About Medical Induction
Heard induction mentioned? Here’s an intro to induction babes… the 15 questions you can’t NOT ask when discussing induction.
Most pregnant women in Australia will be offered to book an induction of sorts at some point, whether it be for a medical indication or because it suits your practitioner’s schedule.
Here are some questions that you can ask during pregnancy (before the induction talk starts) and in the later weeks when you are faced with real pressure to book an induction….
In pregnancy:
The answers to these questions can help you firstly research what you need to research to work effectively with your hospital or doctor or help you make the choice to change birth place if you need somewhere more aligned with your values.
What are your rates of induction?
What reasons would you recommend induction?
What methods of induction do you use primarily?
What is recommended to accompany my induction if I choose to be induced? I.e. Continuous fetal monitoring, cannula insertion?
If I decide to decline induction, can I expect the same care from you?
Can I request an induction, and if so at what gestation?
When you are offered induction:
It is your right as a woman to have answers to all the questions you need before booking anything. If not medically urgent (which is extremely rare), you can even ask for a couple of days to think it over, do your own personal research and perhaps get a second opinion before you make a decision. Some great questions to ask to help you research…
7. For what reason specifically are you recommending induction? If because of a test or scans, can I please have a copy of my results?
8. Is my baby currently well? Am I currently well?
9. What are the risks of the individual forms of induction you are recommending?
10. Is there an alternative to induction?
If you are preparing for an induction:
If you choose to have an induction, there are lots of choices that you can make. Here are some great questions to ask - to know what all your options are and to find out the exact process wherever you are birthing…
11. What methods of induction do you recommend using, and in what order?
12. What does each method of induction involve, and are there time limits on each method?
13. Is there a time-limiting policy on my labour once my waters are broken?
14. Can my partner or doula stay with me during the entire induction process?
15. If I no longer want to continue the induction process, can I choose a Caesarean instead?
As medical induction is related to increased pain and a higher risk of instrumental birth, some women may choose to have a planned caesarean instead of an induction - a reason that is totally valid!
There are ways to plan a beautiful and positive induction though… by optimising your hormones and working with the methods that are being used. A doula can help you plan and support a positive induction, and help your partner get involved too!
If you want any more information about how to start planning a positive birth, contact me now babes!
Sending so much birthy love!
Britt xx
Resources & References:
Books:
Why Induction Matters by Dr Rachel Reed
In Your Own Time by Sara Wickham
The Birth Map by Catherine Bell
Research Articles:
https://midwifethinking.com/2016/07/13/induction-of-labour-balancing-risks/
https://www.sarawickham.com/articles-2/induction-of-labour/
https://www.ama.com.au/articles/maternal-decision-making-2013
5 Tips for a Positive Birth
Before you prep physically - make sure you are prepping these things first!
What defines a positive birth experience differs from woman to woman. Some women link a positive birth to the way their baby emerged, others link it to the recovery afterwards, and some to the way they were treated during their labour and birth, but all women will be able to tell you if it was a positive or a negative experience - there isn’t really an in between when it comes to birth.
I wanted to give mums some building blocks to build their birth around because I think the number of mums being traumatised after their birth experience is WAY TOO HIGH at 1 in 3. And that is just the amount that felt comfortable enough to say so - so many more women suffer in silence after their births, feeling like they “shouldn’t complain” because they “have a healthy baby”.
I’m here to tell you that this is not ok - and having a healthy mum and baby are not the only things important to a birth experience and a mum’s entrance into motherhood. Women well into old age will tell you in detail how their birth experience made them feel, it’s something you don’t ever forget!
So with that in mind, how can we as women make choices that will lead to a positive experience being more likely? Here are 5 ways I teach my clients to own their births…
Knowledge is Power
Firstly, know your rights. The AMA’s Position statement on Maternal Decision Making states as their very first point “A pregnant woman has the same rights to privacy, to bodily integrity, and to make her own informed, autonomous health care decisions as any competent individual, consistent with the legal framework of that jurisdiction.”
This means - you have the right to make a fully informed DECISION around anything that pops up during pregnancy or birth - whether that be an ultrasound, a urine test, or a vaginal exam. An informed decision is not only based on information given, it is based on having the opportunity to question the care provider and having individual circumstances taken into account.
Secondly, know the policies you are birthing under. Ask for your hospital or birth centre’s guidelines - even home birth midwives will adhere to a set of guidelines in order to be registered. Always remember that hospital guidelines are not always (rarely in fact) based on the latest evidence, they are usually based on the latest consensus in your society, it’s worth doing some research before you commit to a birthplace. You might find yourself birthing in a birth centre or at home, even though you never thought that would work for you! Trust your gut babes!
A Trustworthy Team
A study in Sweden found that: “In order to feel confident in their first childbirth, the women wanted to be confirmed and seen as unique individuals by the professionals and their partner. If professionals responded to the individual woman's needs of support, the woman more often had a positive birth experience, even if the birth was protracted or with medical complications.”
If you are told you are “not allowed” to make a choice, made to feel inferior, undignified, coerced or disrespected by your care provider, those are some clear red flags to move on to someone else.
If you have no other options for care in your area, either for lack of options or lack of financial means - then you need to rally the team that you can from your immediate circle. Can your partner do research and become your fierce supporter? Do you have a family member or friend that has had an amazing birth, trusts in the process and would be comfortable learning how to support you properly during labour?
This includes anyone that is entering your birth space - if you are birthing in a hospital this could be many people that you have never met - so how do you navigate that with a feeling of safety? By having a support team that is around you 24/7, ready to speak up for you if needed or empty the room if you need space.
Education is Key
Firstly, forget everything you think you know about birth. Then, learn everything you can about birth and your body, whether that's from books, from podcasts or from an independent childbirth education class (not a hospital one). A massive part of trusting in the physiological birth is learning how amazing it is, how to support your mind and body to function at their peak during labour, and how to work WITH your baby to bring them earthside. If you have a doula, they can usually help you prep in this way, otherwise find a birth class that focuses on physiological birth and postpartum. If you are in Perth I highly recommend Vicki Hobbs’ Back to Basics Birthing Classes (for VBAC too).
Map your Birth
Writing a “birth plan”. Cue the scoffs and eye rolls huh?
But a birth plan (or map as I like to call it), is vital for so many reasons. To make decisions, you need to have information and have conversations - not only with your partner but with your care provider. Want to labour in water, but they only have one room with a bath on the ward? Now you know! Want to have an epidural but didn’t realise that it comes with an IV drip, CTG monitoring and potentially induction medication? Now you know! You don’t know what you don’t know - so a birth map/plan helps you firstly learn WHAT you need to learn, and then can inform your decisions based on your circumstances.
I prefer to map with my clients as opposed to listing preferences, as this way you have all options laid out for the birth team and the birth support team. Together we formulate a plan for every contingency - even if you are planning to birth at home. Birth can be unpredictable but with the right support, you can navigate any turn your birth may take.
Consider Continuity of Care
I will talk about this until the cows come home!!! Continuity of care - with a known midwife (either on a hospital or home midwifery program or a private midwife with hospital admitting rights) - is a massive factor in women's positive experiences. This is because birth is a mental game, and having a bond and trust with your midwife (who is exposed to physiological birth regularly) means you go into birth feeling at home with your people. The same midwife then follows you into your postpartum, to care for you and your newborn and make sure that you are recovering well and adjusting to motherhood.
Unfortunately, not everyone has this option… so if you are in a place that doesn’t give you access to these options, a student midwife in their final year, or a doula might be your next best option. Or have both! They will both stick by your side through pregnancy, birth and postpartum - the added bonus with a doula is they will have the time to build that bond more fully.
You might have noticed I haven't mentioned ANYTHING about preparing physically or how to avoid certain outcomes. This is because usually, if women are treated respectfully, feel heard by their caregivers, and are supported in their choices, they have positive experiences. The work for birth is primarily in your mind mamas - and you CAN have a positive birth experience if you place yourself in the right care, surrounded by the right people, and with the right information.
If you want more information about how to Birth Map or find the right support in your area, contact me here.
Sending so much love babes!
Britt xx
Resources & References :
https://www.ama.com.au/articles/maternal-decision-making-2013
https://ethics.org.au/dont-throw-the-birth-plan-out-with-the-birth-water/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3793576/
https://journals.sagepub.com/doi/10.1177/10778012221140138
Can We Just Leave the Cervix Alone Already?
In labour, all anyone can talk about is your cervix and how dilated you are - but does it really matter?????
I’m going to preface this blog post by saying that I 100% do not think the cervix check is a great way to see how established or progressed your labour is - ESPECIALLY if you are in spontaneous and physiological labour. BUT, if you are birthing in a hospital (or anywhere with a medical professional really) you will be asked if you would like to have a vaginal examination to check your cervix. So firstly I’m going to go through what the cervix is, why and how it dilates, and when you might have it checked.
What is the cervix?
The Cervix is at the bottom of the uterus (womb) and forms a canal that opens into the vagina, which leads to the outside of the body. When you’re pregnant, it is closed firmly with a thick mucous plug. This mucous plug can come away and regenerate throughout pregnancy, sometimes with some pink or brown blood attached. It can mean labour is coming soonish, but not necessarily. The mucous coming away is sometimes called a “show” or a “bloody show”. Anyway, I digress - the cervix is made up of tissue that is sort of like your lips or nose (not cartilage) - firm but squishy? It’s a weird one to try to explain with words - but you can actually usually feel your cervix if you want to, just make sure your hands are clean. It’s about 2cm thick and is like a tiny firm donut cushion. If you want to look at real life pics of cervixes you can check them out here. Then you’ll know they look nothing like donuts!
How does the cervix open?
There are 2 things that happen as you progress to the end of your pregnancy - effacement (thinning) and dilation (opening). Effacement can happen without you even knowing, sometimes during braxton hicks or during practice labour. This is when your uterine muscles are pulling upwards to build an amazingly thick fundus (muscle layer) at the top of your uterus to eventually push your baby out. This fundus grows thicker with every contraction as labour progresses, and as the uterus pulls up, the cervix can’t help but open gradually.
What is a Cervical check?
While on your back with knees up (usually with a modesty drape if in hospital/birth centre), a sterile gloved exam is done to determine the degree of cervical dilation and effacement. The measurement of cervical dilation is made by locating the cervix inside the vagina, spreading one's fingers in a 'V' shape, and estimating the distance in centimetres between the two fingers. This measurement is not always accurate and research has shown that between one care provider and then next there can be up to 50% difference in estimated measurement.
When will you be offered a Cervical check?
Before admission to a maternity ward
Every 2/4 hourly depending on the hospital policy
If asking for medical pain relief
If you request a caesarean section while in labour
If you say you feel “pushy” or pressure in your bottom
The key word here is OFFERED but I use that lightly - as most providers in our maternity system will broach the subject with a statement instead of providing risks and benefits and asking for consent. Things like - “we’re just going to check where you’re at”, or “after this contraction we’ll see if you’ve progressed”, cue glove on and ready.
That being said, you can and should say no if you don’t want a VE - to which you can expect there to be pushback or “you have to”’s in some birthing facilities. This is why I encourage all mums to map out all their decisions during pregnancy so that discussions can be had and everyone is on the same page well before you go into labour.
What risks do cervical checks have?
Cervical checks are always invasive, usually uncomfortable, and sometimes painful - some women even report being traumatised by the experience
They aren’t predictive, therefore they are not a great way to help inform your decisions
They are inconsistent between providers - sometimes by up to 50%!
They can be disempowering and disappointing - sometimes in your heart you know you are further along but if you have a number given to you that you weren’t expecting - you can start to doubt your instincts
Sometimes membranes can be accidentally ruptured when the midwife or OB does a check. This can alter the whole trajectory of a birth, and take a decision that was yours to make. When birthing in a facility, time frames are put around labouring women who have ruptured membranes, and lots of pressure can be applied to have further intervention. If you have made this call yourself knowing these risks, amazing! Many mums don’t realise these risks though, until it’s too late.
Increases the risk of infection, especially if membranes have already released.
When can cervical checks be beneficial?
In a medicalised labour (induction) to ensure that the induction method is working as needed
In a long labour (over 24 hours active labour), to check if all is well or if you want to try any new coping techniques or pain medication
If you as the birthing mum, ask for one - it’s your call mama!
With all of this in mind, you might ask - if a cervix check isn’t accurate for assessing labour progression, then what is? Well, good midwives and OB’s can tell how far you are progressing by watching you labour for even a short amount of time. They watch for the sounds you are making, the things you are saying (or how you are saying them), the positions you are instinctively moving into, the feeling of the top of your fundus and how your lower back is looking (look up Rhombus of Michaelis or “the purple line” during labour). There are so many ways! This is another reason to chat to your care provider in pregnancy if you will be declining VE’s - you might want to know if they have these skills.
The reason VE’s are offered so often is because it’s easier to measure or track a labour of many women at once if you have numbers to work with. Routine VE’s are just another indicator of our medical system trying to mechanise birth unfortunately. But we are unique HUMANS BEINGS, not man made machines - and we can’t be predicated or graphed!
My experience with VE’s
I wanted to pop my own experience with VE’s here because well… I don’t have any! After doing a lot of research during my first pregnancy and asking for the support of my private midwives, I asked how they felt about not doing VE’s and they said they absolutely didn’t need to do them. They knew they would be with me in the room for hours as I progressed through labour, and would know if labour wasn’t progressing as “normal”. I am so grateful to my first pair of lovely midwives Peta and Vanessa for teaching me about how women should be cared for in labour - they were truly “with woman” and that was the best and safest care I could have asked for. Obviously for my next 3 babies it wasn’t even a question! Even when my last baby decided to turn sunny side up while in labour - still no need for any checks! They trusted me, and I trusted myself. I think it totally would have interrupted my labour focus and had me in my thinking brain instead of my labour brain. I was so glad that once I declined in pregnancy, it wasn’t even offered - allowing me to ask if I ever felt the need.
Some extra homework for you guys is to look into cervical recoil (yep, that’s right - your cervix can recoil if you don’t feel safe!) and to listen to any of the Podcasts below… they will educate you on so much more than I can fit into a blog post
The Midwives’ Cauldon “Vaginal Examinations”
The Midwives’ Cauldron “Dr Clare Davison Interview”
The Midwives’ Cauldron “Pushing & Cervixes”
Much cervical love to you all!!!!
Britt xx
Resources & References:
https://www.sarawickham.com/topic-resources/cervical-wisdom-resources/
https://teachmeanatomy.info/pelvis/female-reproductive-tract/uterus/
https://www.sarawickham.com/original-articles/exploring-cervical-recoil/
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-10-54
https://midwifethinking.com/2017/02/03/understanding-and-assessing-labour-progress/
https://www.ingentaconnect.com/content/springer/ijc/2013/00000003/00000003/art00001
Birth in the 21st Century….
Is birth a medical event? How can you find your way through the medical system?
Why am I delving into birthing history? What does it have to do with you and your baby? History has shaped everything we think we know about birth, how the general Aussie society views birth, and how we as mums view birth and our bodies. When facing your motherhood journey, it seems poignant to know what to accept as something you wholeheartedly believe, or what to reject as something you have been conditioned to believe. Pregnancy is an amazing time to start doing this, as our brains are open and ready for learning, all whilst our instincts are on high alert…. That’s a great environment for analysing our belief system!
Let’s start with the medicalisation of birth….
Is birth a medical event?
Historically, no! Birth was like most other days, given the time and space to do it’s thing, and medical intervention was only involved if there was an actual problem. And the actual problem would be diagnosed by a midwife or birth companion who KNEW physiological birth, who KNEW you, and who KNEW when to ask for extra assistance. Now though, midwives have to train in hospitals where they see mostly invervention filled, complicated births - so they are not bringing an innate knowledge of physiological birthing behaviour to a hospital birth, because they are not surrounded by it. Of course, there are always exceptions to this, and I applaud those epic Midwives for standing up for birth in conditions that are not ideal for them or for women.
What has been lost in birth?
Connection, community and confidence.
We are taught not to trust our bodies, and so we are not connected to them. We are taught having a baby is dangerous, so we don’t connect with our baby while we grow them. We are taught only medical professionals can save us from the danger of birth, so we don’t connect with our motherly intuition. If you don’t trust your body to birth, your intuition to know what to do in labour or your connection with your baby to know when something is up, then of course how is physiological birth going to work? In saying goodbye to our connection to body, mind and baby we lose everything that is essential in birth flowing “normally”.
In most of our history, women birthed with women - wise women that had attended all the births in village, mothers and grandmothers themselves. Upon birthing our first babies, we would have witnessed several births as helpers - perhaps sisters, aunties, or neighbours. This is not a far reaching history - in most Western worlds this is only a few generations ago!
This of course would give every woman confidence in her ability to birth! Instead of scary stories or news segments about how dangerous birth is, we would have seen it for ourselves and known that it WORKS and is NORMAL. Whilst we have gained so much in the ability to save babies that come early, or women with major health issues, or the various other major risk factors - we have lost so much of what birth is. A NORMAL AND EVERYDAY OCCURRENCE.
So how can you ask for more and where can you find it?
Your care provider is the key to this. Choosing a care provider that is continually there for you through pregnancy all the way to postpartum is a massive key in getting through with connection, community and confidence. This is commonly known as Continuity of Care in the medical field, and the research shows that outcomes (physical and emotional) are far better when this type of care is experienced. Many hospitals have Midwifery programs enabling you to have care from a known midwife for care throughout your baby journey, and some women find this care in a lovely Obstetrician. OB’s that are supportive of their birth choices and are trying to not just be the surgical OB they have trained to be - in Perth we have a few amazing OB’s who are supportive of woman centred care, you just have to look hard to find them.
What to do if my options are limited?
In leiu of a Midwifery Program at your local hospital or birth centre, there are also Student Midwives and/or doulas that can provide continuity of care. Something to remember is that a student midwife won’t have witnessed “normal” birth a whole lot because they are being trained in tertiary hospitals where most women choose to have intervention. Another thing to consider is perhaps feeling like a bit of a study subject when the midwives are trying to teach the student about something and talking about you right in front of you. Sometimes for first time mums this can be confronting as the midwives can sound harsh and medical terminology can sound scary. I personally didn’t feel comfortable having a student midwife present until my 4th birth, when I felt confident in my ability to halt the conversation if I didn’t want to hear it. Fortunately, my private midwife would only teach my student midwife after the session, outside my earshot. In sessions, she was taught to ask for consent and to only offer things instead of “pee in this cup”.
A doula on the other hand, is on the journey with you and for you - whilst we learn a lot from every woman we are with, it’s not the aim of our time together - which makes the time we spend together warm and encouraging and not clinical. We love researching behind the scenes and providing you with the latest evidence on any concerns that arise and always keep in contact between appointments to build a relationship with you. Both have their place, so it’s really up to you to see what fits your family the best.
What we have gained in birth being medicalised is amazing - the ability for mums to have interventions and caesareans when needed saves lives and we applaud that!! But the losses we have had in birth as a full body and mind experience are far reaching into motherhood. Blanket style care for all women has taken the heart out of birth, and it has been put in the hands of mums and their support teams to get it back. Individualised care is not the norm in our maternity system, but it can be a part of your birth if you have great people around you and a great mindset. No matter where you birth, your birth can be joyful, beautiful and even enjoyable!
More listening on this subject… Poddie by The Great Birth Rebellion
Stay tuned for my next newsletter… I’ll delve into pregnancy and birth in the Aussie maternity system, and what consent in a hospital can mean.
Sending love!!
Britt xx
The Bachie of Birth Providers… questions you should be asking before you give someone your rose!
pregnant woman with man hugging belly and love heart hands
So you’ve checked out all the available options for birth choices in your local area - free, paid, and support systems to run alongside them. Whilst money is one factor to consider when choosing a pregnancy, birth and postpartum care provider (and a vital one), there are many other questions you may like to ask your provider (but first yourself) before you commit to employing someone to look after you. Free or otherwise, the care provider is employed by you and should adhere to your family and cultural values no matter what. Here are some (but not all!) questions that can be considered before hiring someone (including free providers) to care for you during your baby journey. Most women will only give birth a couple of times in their life, so make it the best time you can have. Putting aside time to really think about what you want for your birth and introduction to becoming a mother will never be time wasted.
Here’s some suggestions for questions to ask…
What are your opinions around birth being a physiological process?
This answer to this question will give you an idea of how medicalised the obstetrician or midwife believes birth should be. This is key in finding out whether or not your values and your providers’ values match up. Trust your instincts with this question - last minute recommendations during labour will be based on how they truly feel deep down about physiological birth.
Do you think the decisions surrounding labour and childbirth rest primarily with the birthing mother?
The answer you receive to this question will tell you how involved you will be “allowed” to be. To be honest, if the word “allowed” comes into this conversation, then run a mile. Your human rights dictate that the sole decision maker in the birthing space is you and only you. If a Dr or Midwife does not practise with a consent based model then they will generally fare badly when it comes to birth outcomes - therefore again, run a mile.
What are your ultrasound/scan policies? Can I decline if I choose?
Usually Obstetricians have ultrasound machines in their offices and can offer a scan at each visit. This is on top of the regularly offered scans at 12 and 20 weeks. While scans can help reassure a mother, there is no concrete evidence that multiple scans are beneficial to outcomes, and women who have more scans open their pregnancy up to more scrutiny, even though ultrasounds are often misleading. Something to think about…
What are your policies on various prenatal testing, including Gestational Diabetes, routine urine testing and GBS swabs? Can I decline and expect the same level of care?
Most providers prefer certain tests to be done throughout pregnancy, but it is always within your rights to decline. After researching the risks and benefits of each individual test, remember before making a decision - once a test is done, you forever have those results posted on your “file”. Your provider can then choose to allocate you to a certain risk group - this doesn't have to be based on clinical guidelines or hospital policies but can be on their own risk assessment. Many of the things tested for throughout pregnancy have other symptoms that a provider should pick up with regular contact and relationship with their women. These tests can “risk you out” of many programmes, or even flag you for induction pressure - proceed with caution if a provider has a list of tests that are non-negotiable.
How long can I expect my visits to be with you? Do you have any holidays planned around my guess date?
Many obstetricians and hospital midwives can only spare 15-20 minutes per woman to go through any checks or questions you may have. Navigate towards a provider that can give you more quality time, and definitely doesn’t have any holidays booked around your due month.
Can I expect to have you present through my pregnancy, birth and postpartum periods?
This is called continuity of care, or continuity of relationship and is really important to a lot of women. Imagine having to get to know new carers continuously through your pregnancy, labour and then postpartum. It can be exhausting fostering a new relationship, and if you have to defend some decisions you make 100 times over - well let’s just say there are better ways to spend your mama energy, it can really wear you down. Try and find someone who can support you throughout your journey to motherhood. While you can get a level of continuity of care from an OB, if you are truly wanting continuity of care you may need to look at group or private midwifery care. If there is no one in your area that offers this care, then you could consider a doula to take this place of continuous support alongside your medical carer. There are mountains of research now showing that women who have continuity of care have a more positive birth experience.
Can I have a doula and partner present at both antenatal appointments and birth?
The pandemic has complicated this question, the fact remains that you have rights to have support people at your birth - whether that is family or someone employed by you. The World Health Organisation states in their Safe Childbirth Checklist that all providers should encourage a woman to have a birth companion. This is because women have better outcomes with birth companions and doulas present: Doula-assisted mothers are less likely to have a low birth weight baby, experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding.
What are your views on a pregnancy exceeding estimated due dates?
Although the WHO advises “There is insufficient evidence to recommend induction of labour for women with uncomplicated pregnancies before 41 weeks of pregnancy”, it is the norm for mums to feel “overdue” after 40 weeks. It is important for you to know how your provider is going to feel about going over 40 weeks so that you can prepare for the late stages of pregnancy.
In addition to this, EDD’s can be inaccurately calculated anyway, as the timing of ovulation of every woman is unique and each person’s gestation can be varied also. Women can birth perfectly healthy babies at 37 weeks while others birth perfectly healthy babies at 43 weeks. There is no normal when it comes to gestation and spontaneous labour.
What are your induction rates and what are your reasons for suggesting induction? If I do not consent to induction, can I expect to have the same level of care? If I do consent to an induction, can you support me to have an active birth?
A staggering 43% of first time mums are induced in Australia. Say what??? Obviously, there are some cases where an induction can be evidence based - but if being faced with the big baby or ageing placenta discussion then it’s highly likely that the obstetrician does not make recommendations based on evidence. Evidence shows that a placenta does not “age” after a specific date, nor can you tell a baby’s weight accurately until it is actually born. Another reason for induction can be to “schedule” your baby to fit a timeline of the doctor, partner or family visits. When looking into the benefits and risks of induction it is interesting to note that induction of labour for non-medical reasons is associated with higher birth interventions and more adverse outcomes. It can be quite a long, complex process and not as easy as “just getting induced”. In saying that, induction can still be a positive experience - depending on the support you have around all the other decisions that come during your induction.
Do you (or the hospital you admit to) have time limits after admission, or after waters break (Membrane Rupture), or after a certain dilation is reached?
Putting a time limit on labour is a dangerous business, as no woman has the exact labour as another. There’s a lot of research that shows with proper care, waiting for up to 48-72 hours after the water breaks does not increase the risk of infection or death to babies who are born to mothers who meet certain criteria. While Australia says that 4cm dilation is established labour, other countries agree 6cm is the same - so while cervical dilation can be encouraging for some mothers, it's not the be all and end all of labour progression. Providers who put time limits on labour can be hard to work with during labour, as they want to either rush you along or put pressure on you if you aren’t adhering to the linear graph of a mystical labour. (PS this mystical linear labour doesn’t exist)
Do you have a policy on vaginal/cervical exams, and if I decline can I expect the same level of care?
Did you know some providers prefer to check your cervix every week from 37 weeks? Many women don’t know this, and also don’t know that there is no evidence to support any benefit to this practice. Although prenatal cervical exams may satisfy the curiosity of a provider or even yourself, a prenatal cervical exam can lead to a premature rupture of membrane (PROM). And as we have just discussed, PROM (which is an induction of labour) can lead to increased intervention and decreased outcomes.
When it comes to cervical exams in labour - the cervix can be extremely shy. There are many reports of a cervix recoiling during an exam and then dilating in a very short amount of time following this. Perhaps we just aren't supposed to have fingers up there? Either way, they can be disheartening or encouraging and they should be your choice and you should be able to expect the same level of care regardless of whether your cervix is measured or not. I can reassure you I have welcomed 4 babies into this world without a single cervical exam - so cervical dilation really shouldn't bear any worth when it comes to your birth progress.
What are your Caesarean birth rates and what are your reasons for suggesting a caesarean birth? Have you conducted a maternal led or gentle caesarean birth? If not, are you open to this if a CS is what I choose?
It’s interesting to note that the World Health Organisation estimate that the percentage of births that should require caesarean (for medical reasons and the health of mother or baby), lies between 5-15%, with a special note that any caesarean rates above 15% often result in more harm to mother and child than benefit. The CS rate in Australia is 37% and climbing. Sit with that for a minute, and decide if you would like to avoid this. If so - what can you do to avoid this? Your birth is in your hands, and every decision you make can have a positive effect on your birth outcome.
Of course, medically necessary belly births are available to those who require one due to things like placenta previa (placenta covering the cervix), birth defects or chronic health conditions. Just because you have to have a belly birth doesn’t mean that you have to forgo things like skin to skin or being involved in the birth process. In a Maternal Assisted Caesarean (MAC) mothers are actively involved in lifting their baby out of the womb and having skin to skin bonding straight away which may help breastfeeding establish and mums mental health flourish. It also can allow for delayed cord clamping, which can be vital to a baby’s first few weeks - see the blog I wrote on this.
What are your instrumental birth rates? Can you conduct an instrumental birth without an episiotomy?
Are they vacuum happy when it comes to getting the baby out? Is this based on a time schedule that they have for the baby to be out or usually a legitimate medical concern? Not only that, but did you know a skilled OB should be able to conduct an instrumental birth without an episiotomy? It’s worth asking the question to know what could pop up.
What are your episiotomy rates and opinion on episiotomies?
While routine episiotomy is a thing of the past (well I darn well hope it is!) - This is a great question to ask your OB or Midwife. An episiotomy could effect your ongoing recovery and future sexual experiences, so it’s super important to know that your provider would know where to snip if they had to. An episiotomy wound can be more painful and heals less well than a spontaneous tear, and there are other ways to encourage a baby out (i.e. changing the position to open up the pelvis) rather than widening the vaginal opening.
Do you have a policy on the 3rd stage (delivery of placenta) being actively managed in all births?
After you have birthed your baby, you will need to birth the amazing organ that you guys made together - the placenta. It detaches from your uterine wall - more easily if you have had delayed cord clamping and baby nuzzling the boob - and is delivered the same way as your baby. There are minor contractions that come with it, this closes off the blood vessels and gives the placenta a good shove out. Because it has no bones, one woman describes the birth of her placenta like birthing a squid! It’s the easier part of labour, and finishes the whole process so that you can enjoy your baby uninterrupted. Some providers or hospitals prefer to recommend “active management” - which usually involves an injection into the leg of synthetic labour hormone to hurry the placenta out. It can also mean premature cutting of the umbilical cord (before all the blood has reached your baby), and cord traction (lightly pulling the cord - which has the risk of having the cord snap). The majority of physiological births will not require an active 3rd stage management as when you breastfeed or move around after birth the placenta will make its way out on its own. In fact it is the safest option for mums who have had a physiological birth to then have a physiological third stage.
What are your policies or regular practices around optimal cord clamping?
Optimal cord clamping is waiting until the umbilical cord runs white to cut. There has never been any evidence to support the practice of cutting the cord as soon as baby is born, and the research shows that when the cord is left unclamped until it runs white (i.e. all the blood has gone from the placenta to the baby), the baby is less likely to experience anaemia, blood transfusions and other conditions. The baby will benefit from months of iron stores due to this valuable supply of blood, which contains precious cord blood and stem cells. Clinical guidelines now show that “waiting for white” should be implemented by every maternal health provider.
What is your view of skin-to-skin?
Skin to skin may seem just a lovely thing to do once your baby is born - but it actually has some really important health benefits for both you and your baby, whether you give birth vaginally or via the belly. Skin to skin involves placing a sweet little nude newborn on the mum's bare chest and covering the babe with blankets to keep it warm. Ideally, this happens immediately after birth (however that happens) and babe stays there at least until after they have nuzzled their way to the boob (possibly a couple of hours). As long as your baby is doing alright, paediatricians can even do checks while bub is snuggled in on your chest. Benefits to baby include: the heart rate, breathing, and oxygen levels were more likely to remain stable, there is a beneficial increase in blood sugar, not to mention more easily established and longer breastfeeding.
Some researchers found that skin-to-skin care provides benefits to breastfeeding after Caesarean birth as well. The mothers who had received skin-to-skin care were 22% more likely to still be breastfeeding one and four months after the birth. It’s all wins for skin to skin, and definitely something to advocate for with your health provider.
Now, here are some questions that may be unique to your situation:
What are your recommendations when it comes to:
Vaginal twin birth
Vaginal Birth After Caesarean (VBAC)
Vaginal breech birth (frank or footling)
Many OB’s are intimidated by a vaginal birth with one of the above “complexities” as it is not something that is routinely taught to them. Keep in mind that OB’s are professionals at complicated birth and birth surgery, whilst most midwives are professionals in physiological birth. A doula can help you navigate either way you would like to turn, either medical or physiological and advocate for you no matter who your provider is.
These are just questions that cover the most common things that come up during pregnancy and birth, but a doula or private midwife can help you navigate the individual questions that come up during your care also…
When you are chatting to a prospective provider, it’s likely that the reaction you receive from them will be a guide to whether you will match as a team - trust your instincts and the feels you get. It is never too late to change providers (I did it at 32 weeks!) or to bring on another team member to advocate for your birth choices - you don’t want to go into birth stressed or worried that you will have to fight to be heard, or worried that you will be coerced while you are vulnerable. The beginning of your birth story starts when forming your team during pregnancy, and I really encourage you to trust your gut when it comes to making these decisions.
It’s important to always remember that with your great decision making comes great responsibility. Making no decision and “going with the flow” is still a decision and still passes the responsibility to you. This is your body and your baby - and you will be amazing mama! Go forth and interview!
Britt xx
References:
https://sarahbuckley.com/ultrasound-scans-cause-for-concern/
https://midwifethinking.com/2016/07/13/induction-of-labour-balancing-risks/
https://www.sarawickham.com/research-updates/potential-harms-of-gbs-screening-outweigh-benefits/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647727/
https://www.sarawickham.com/articles-2/fixed-point-due-dates-and-wider-windows-part-1/
https://bmjopen.bmj.com/content/bmjopen/11/6/e047040.full.pdf
https://evidencebasedbirth.com/evidence-inducing-labor-water-breaks-term/
https://midwifethinking.com/2018/05/09/the-perineal-bundle-and-midwifery/
https://www.positivebirthmovement.org/everything-you-need-to-know-about-optimal-cord-clamping/
https://evidencebasedbirth.com/the-evidence-for-skin-to-skin-care-after-a-cesarean/
The Placenta: Part II
Actively manage or support physiological placenta delivery… that is the question.
So it feels like I’m banging on about the Placenta right? Well, yes I am - but with good reason! Did you know that the majority of women in Australia go through their whole pregnancy not discussing options for the third stage of labour? If it is brushed over in a quick talk, care providers can also make statements of “hospital policy” instead of going through your options. So here we are… let’s fill some gaps in information, shall we?
Physiological delivery - what happens for mum & bub
When a mother and baby are uninterrupted and given time after birth, the baby can start to bond with mum in skin to skin and starts to breathe air. As the baby’s oxygen levels increase, its lungs are activated and the placenta gets the message that its job is nearly done. Blood vessels in the baby’s lungs open up and are filled with blood from the placenta. The two arteries that send blood back to the placenta now start to constrict so that the blood is on a one way track directly to your baby. With patience, and a safe and calm environment, the baby will begin to attempt breastfeeding and this will trigger hormones that start a natural detaching of the placenta from the wall of the womb with a clot forming behind it. The mother’s body might have contractions or urges to push, and the placenta will come sliding out like a slab of jelly, sometimes with the help of a cough or standing up (gravity!). Research shows that the best prevention of a postpartum haemorrhage in a physiological birth is having the baby on the mother’s skin to keep the hormones flowing. It can take up to an hour or more for the placenta to detach, so asking for extra time would be pretty vital in choosing this option.
Active Management (usually hospital preferrence)
Active management is when a uterotonic (a synthetic version of oxytocin usually) called syntocinon is injected into the mother so that contractions start to release the placenta. Unless there is an immediate need to control a haemorrhage, this can be done at any time after the baby’s birth, meaning that you can wait for the full volume of blood to reach bub before it’s administered. This is the same drug that is given for a chemical induction, in which case another drug may need to be administered called ergometrine. This one can make mum feel a little worse for wear, so it’s important to ask which one will be administered if you choose this route.
Postpartum Haemorrhage, Breastfeeding & other things to consider
Even though the World Health Organisation recommends uterotonic management of the placenta in all births worldwide, there is research emerging that in a physiological birth (intervention & induction free) in low risk women, PPH is more common if the uterotonic is administered. Research is also well established that breastfeeding rates are affected if syntocinon is administered to mums at ANY point during labour and birth. Of course, hormonal gaps can always be filled with skin-to-skin - and it’s important to have this knowledge before you go into labour so that you can plan ahead for the outcome you want.
I want a physiological placental birth, now what?
The first thing to do is chat with your care provider during pregnancy. While most will be fine with it, or at the very least, having a “wait and see” approach, some OB’s (while not ethical) may choose to discontinue treatment if you choose a physiological placental birth, so it’s important to have this conversation during pregnancy if it’s something you really want. It’s really important to also have your birth space protected during the golden moments after birth, as it will be the safest way for you to birth your placenta. Keeping the room dark, quiet and relaxed, keeping your baby on you, and keeping everyone unnecessary out of the room (including phone calls to the outside world!) will allow your hormones to continue on their natural trajectory and work efficiently. There is plenty of time to announce your baby’s birth, and detaching from the bubble of hormones can stop your hormones from working. The birth is not “done” until the placenta is out - so take that time to soak up your new baby’s smells and sounds. If your birth team know that you want a physiological third stage they will ensure that your space is held until after you birth your placenta - one of the perks of having a doula in the hospital!
After looking at the benefits and risks of both medical management and physiological birth of your placenta or the “third stage”, you can now make an informed decision. Having these conversations with your partner and birth team during pregnancy is not only empowering for you but can help everyone feel involved and invested in the outcomes of your birth. So go ahead and keep researching and resolving all of your birth choices, mapping out a plan that you feel comfortable with. What else should you be discussing with your care provider before employing them? Stay tuned for the next blog!
Resources & further research:
Midwife Thinking - An Actively Managed Placental Birth Might Be the Best Option for Most Women
Sara Wickham - Can I have a Natural Placental Birth After Induction
My name is Brittney Blakeney and I am a Pregnancy, Childbirth and Postpartum Doula, with an emphasis on education and preparation for your birth experience as a woman and mother.
My job is to give you the most up to date research so that you can make decisions with confidence, and to give you the tools, techniques and encouragement to feel calm, safe and supported during your pregnancy, birth and postpartum journey. I aim to create villages around women to ensure they feel strong, supported and listened to as they transition to their new role.
If you don’t want to miss out on any new morsels of info, subscribe to my newsletter to be notified of the latest blogs. I am based NOR in Perth, and can be contacted by email at doula@brittneyblakeney.com.au or head to my Insta to send a direct message.
Click here for some more bloggy goodness.
Cord Clamping: The evidence & your options
Why the timing of cord clamping is so important and what options you have, no matter where or how you birth.
I really want to delve into the WHOLE third stage of labour, but I feel like I need to separate it. So here we are looking at cord clamping first. It is really so vital to know this info - especially if you have a baby pre term (before 37 weeks) and even in a caesarian birth - there are more options than you think - and care providers are not always forthcoming with their “policies”.
There are three sets of timing that are used by care providers
Early Cord Clamping
Clamping within a minute of birth. This is pretty old school, and yet it is what we see in movies and probably imagine what happens in birth. When a cord is clamped within a minute of birth, you have the potential to leave up to half of the baby’s blood volume in the placenta. It’s well known and should be common practice to wait at least 1 minute before clamping and cutting the cord, even in an emergency. If the baby is attached to the pulsing placenta they are still getting oxygen from mum - so even in resuscitation situations, this is beneficial. Adding to that, a good care provider can provide resuscitation to babies wherever they are in the small chance that this is required.
Delayed Cord Clamping:
Clamping within 1-3 minutes of birth. This is what the World Health Organisation recommends in their guidelines - stating that it should be standard in all births, even caesarean birth and preterm birth. Some benefits include: 61% reduction in severe anaemia, 59% reduction in the rate of intraventricular haemorrhage in preterm infants, 62% reduction in the rate of necrotizing enterocolitis among preterm babies, 29% reduction in the rate of neonatal sepsis for preterm infants, 52% reduction in the rate of blood transfusions for low blood pressure among preterm babies.
Wow. Just wow! Something so simple as waiting a couple of minutes can have this amazing effect on a baby - care providers should be discussing this with women!
Optimal Cord Clamping:
Clamping and cutting the cord after the cord is white and clear of blood means that your baby has gotten all of the blood from the placenta. This means your baby will have all the benefits of delayed cord clamping, plus more. Babies that receive their full blood benefit also receive their full quota of stem cells, which are the building blocks for the future well-being of the infant. Cords can be clamped and cut after the placenta is delivered, or not at all. Some mothers like to have a Lotus Birth, where the placenta is birthed and kept until the cord naturally falls away from the baby. This can take up to 15 days to happen.
There is often no reason to cut the cord immediately even if you have a medically managed placenta delivery - though it is usually offered as a package. The discussion of cord clamping definitely needs to happen with your care provider during pregnancy, and make sure your birth partners know your choice as well. That way while you are busy bonding and getting to know your new baby, they can all advocate for your choices and know your reasons why. Stay tuned for the next blog: I’ll dive into your options for supporting physiology or medically managing the birth of your placenta.
Britt xx
Resources and further research:
The Midwives’ Cauldron Podcast S03 E05: Placentas & Cord Blood
https://midwifethinking.com/2016/04/13/the-placenta-essential-resuscitation-equipment/
My name is Brittney Blakeney and I am a Pregnancy, Childbirth and Postpartum Doula, with an emphasis on education and preparation for your birth experience as a woman and mother.
My job is to give you the most up to date research so that you can make decisions with confidence, and to give you the tools, techniques and encouragement to feel calm, safe and supported during your pregnancy, birth and postpartum journey. I aim to create villages around women to ensure they feel strong, supported and listened to as they transition to their new role.
If you don’t want to miss out on any new morsels of info, subscribe to my newsletter to be notified of the latest blogs. I am based NOR in Perth, and can be contacted by email at doula@brittneyblakeney.com.au or head to my Insta to send a direct message.
Click here for some more bloggy goodness.
Birth in Perth
A run down of all the birth options in Perth, Western Australia.
In a world full of options, it seems that a pregnant woman doesn’t have many when entering the Australian birth system - the GP often refers you to your nearest Public Hospital, or to your closest Private Hospital if you have private health cover. 97.5% of women in WA gave birth in a hospital in 2019 at around a 50/50 split in private and public - but is it worth looking at other options? Just because the majority choose one way to birth, are you a total hippy for even considering and researching other birth options? Do GP’s routinely offer alternative birth choices to mothers? Let’s take a closer look…
Here’s a sweet baby to get the love hormones going… Now focus!
Why research my pregnancy and birth options?
Pregnancy care and birth care go hand in hand. How you are treated during your pregnancy will 100% affect how you view and approach your birth and postpartum. The benefits of continuity of care (having the same support team throughout pregnancy and birth) have been scientifically proven for many years. A study in 2016 stated mothers who have midwife led continuity of care are “less likely to have an epidural. In addition, fewer women had episiotomies or instrumental births. Women’s chances of a spontaneous vaginal birth were also increased and there was no difference in the number of caesarean births. Women were less likely to experience preterm birth, and they were also at a lower risk of losing their babies. In addition, women were more likely to be cared for in labour by midwives they already knew”.
With that knowledge in hand, what are my options in Perth?
Private Hospital Care
The first question is, do you have private cover? If so you have a few extra options here in Perth - the choice of an obstetrician and private hospital, or possibly private rooms in a public hospital if you prefer. Depending on the care that you would like, you can interview several Obstetricians and do many hospital tours to feel out the right one for you.
Here are links to the private hospitals in Perth and their admitting obstetricians (some can admit at other hospitals so be sure to check):
Glengarry Private Hospital - OBGYN’s
St John of God Mt Lawley - OBGYN’s
St John of God Subiaco - OBGYN’s
St John of God Murdoch - OBGYN’s
When choosing private care, beware that even a pre-paid private cover does not fully cover your pregnancy and birth care - you may still be out of pocket up to $5000. You would hope this amount of money gives you the outcomes, choice and freedom of speech you deserve (that’s for another blog post). As this is a private consumer relationship, OB’s can refuse care or “bait and switch” later in pregnancy if you choose to refuse a certain procedure or test - make sure that this also enters the conversation extremely early in your relationship and weighs into your choice. There are some amazing OB’s in Perth - it’s worth interviewing a few and seeing who you like the feel of - what suits one woman may not suit the next.
Public Hospital Care
Whether you have private cover or not, there is always a public hospital available to you in your area - country or metro. The Perth metro public maternity hospitals are:
St John of God Midland Public Hospital
When choosing a hospital to attend, check their policies and their intervention rates to make sure they align with your expectations - and keep in mind that your check ups will most likely be by a different midwife every time, and birth may be with many different midwives, student midwives and attending OB’s as shifts change. Regular public hospital care does not allow for continuity of care from pregnancy to postpartum - but there are some other options in the public system.
In Perth these are GP & Hospital shared care, Family Birth Centre Midwifery Care, Community Midwife Program or the Midwife Group Practice - let’s delve into it…
GP Shared Care
If you have a GP that you love and shares your values AND you would like to birth in a hospital this is an amazing option. Your GP can be the base point for any check ups and referrals, and you can do all your own research and make your own informed choices. Care stays with GP until later in pregnancy (around 36 weeks) at which point it transfers to your local public hospital. Depending on your GP, this model of care provides an affordable option of care, although does not provide continuity of care throughout later pregnancy, birth and then immediately postpartum. Additionally it is good to note that GP’s are GENERAL PRACTITIONERS - that are amazing for family general health care, but are not pregnancy and birth professionals and are generally not updated with latest pregnancy, birth and postpartum research.
Family Birth Centre Care (FBC) - Midwifery Group Practice Care
Family birth centres at King Edward Memorial Hospital NOR and Fiona Stanley Hospital SOR, offering amazing continuity of care through a midwife led practice and relaxed birth environment. The centres have a warm, welcoming and non-clinical environment with no visible medical equipment. Its design principles support health and wellbeing by reflecting their connection to the living world. The state-of-the-art facilities assist you to have an active labour and birth in a relaxed and informal environment that encourages the support of family and friends. Primary care is provided by a midwife or a small team of midwives to ensure continuity of care for you and your family. These experienced midwives work in a team with other health professionals to ensure your pregnancy and birth are personalised. Whilst there are exclusion criteria and policies that the midwives have to adhere to and extremely limited places (get in early!), this care is one of the best continuity of care models that is fully funded by the Australian Government.
Community Midwife Program
The Community Midwifery Program (CMP) is a model of care available to Perth women experiencing a low risk pregnancy and birth who reside within a designated catchment area. The CMP philosophy is to protect and support natural birth and to provide clients with evidence based, holistic care from known midwives throughout the continuum of pregnancy, labour, birth and the postnatal period. Through this model of care you can access midwifery continuity of care for a home birth, family birth centre birth, a vbac or hospital birth with a designated midwife - all fully funded by the government. Exclusion criteria and hospital policies do apply and places are extremely limited - as with the FBC exclusion criteria and space, but this is an amazing program that the government is providing to a small group of women every year. Jump on it if you can!
Private Midwifery Care
Largely known in the birth community as the “gold standard” in pregnancy, birth and postpartum care, a Private Midwife works for you and only you. Employing a private midwife in Australia means having a birth professional with you throughout your childbearing journey that is fully endorsed by the Australian College of Midwives (ACM) and Australian Health Practitioner Regulation Agency (AHPRA). Some Private Practice Midwives have hospital admitting rights (which means they slot in instead of the hospital given midwives), and all are able to attend a homebirth. Whilst the “Med-wife/Midwife” argument remains in the general hospital Australian model of care (following the US model) - a Private Practice Midwife usually still practices in the way midwives have through several centuries - hands off, experience and evidence based, learning about their women and fostering a relationship with them through pregnancy. They are on call for women to contact anytime without having to wait for an appointment, you have all appointments in your own home (or somewhere convenient), and there are always back up midwives on call as part of the package. Whilst there are Medicare rebates available for antenatal and postnatal appointments, the out of pocket expense is from $3,500.
Some amazing private midwives in Perth can be found here. I highly recommend Vanessa Butera - she was an unmoving rock through all 4 of my gorgeous home births right here in Perth and has been home birthing for many decades!
Doula Care
Whether you choose private obstetric care or to have your baby outside the system, doula care is always available and beneficial to you. In models of care where continuity of provider is not provided (i.e. private and public hospital systems) a doula can be vital in guiding you through your pregnancy journey. While many providers simply don’t have the time or resources to spend fostering a relationship with you for longer than 15 minutes per visit, a doula is available to you 24/7 (within reason). This gives you the time to research your choices, have resources on hand and have the same face supporting you through pregnancy, birth and postpartum. In the words of the World Health Organisation (WHO): “Evidence shows that birth companions can help to improve health outcomes. The presence of birth companions increases the likelihood that the mother will have a spontaneous vaginal delivery instead of a caesarean, vacuum, or forceps birth. Mothers with birth companions have also been shown to need fewer pain medications, be better satisfied with their delivery experience, and have slightly shorter labours.” The cost of having a doula ranges from around $1000 but as every woman is different, every package can be individually priced to suit particular needs.
With the majority of women opting for regular hospital care, we would hope in this gorgeous country we would all our needs met. Unfortunately this is not the case. Policy bound Obstetricians and Midwives are not easily able to practise in a woman-led way, and things like breastfeeding, attachment and long term outcomes for our babies are “soft outcomes” for hospitals - meaning they don’t have to deal with the ramifications of a any complications in birth.
They are also responsible for over half of WA birth of women having Instrumental (13.3%) or Caesarean (38.2%) Births - this is well over the amount WHO recommends is necessary.
So how can you decide on the care that suits you? Ask yourself some questions:
What are your philosophies around birth?
What type of environment would you feel safe birthing in?
What type of support would ensure you feel safe and informed throughout pregnancy and birth?
What plans can you make to have the best outcomes possible, and leave birth feeling like you want to do it again?
Dwelling on WHERE to birth would definitely be one of the most important factors to consider - as well as WHO to support you during your baby journey, and they really go hand in hand. A follow-up blog will be available soon to guide you on what to ask a potential health provider before you employ them. Stay tuned!
Britt xx
My name is Brittney Blakeney and I am a Pregnancy, Childbirth and Postpartum Doula, with an emphasis on education and preparation for your birth experience as a woman and mother.
My job is to give you the most up to date research so that you can make decisions with confidence, and to give you the tools, techniques and encouragement to feel calm, safe and supported during your pregnancy, birth and postpartum journey. I aim to create villages around women to ensure they feel strong, supported and listened to as they transition to their new role.
If you don’t want to miss out on any new morsels of info, subscribe to my newsletter to be notified of the latest blogs. I am based NOR in Perth, and can be contacted by email at doula@brittneyblakeney.com.au or head to my Insta to send a direct message.
Click here for some more bloggy goodness.
The Wonderful World of the Placenta
The very first project you work on with your sweet baby.
The wonders of pregnancy never stop surprising. The fact that our bodies MAKE, NOURISH and then BIRTH a live human is crazy. A vital part of that process is an organ called the placenta. You may have heard of it before - but what is it and why does the baby need it to survive? What does it do? What happens to the placenta once your baby is earthside? Let’s start at the beginning…
What is the Placenta?
The placenta is an organ that is created by the mum and baby together. Yep I’ll repeat that - your baby and you CREATE AN ORGAN. Pretty cool. It nestles into your uterine wall when you first become pregnant, and connects to the baby by the umbilical cord. As it grows it becomes a sort of spaceship/frisbee shape that is covered in veins and arteries.
Why Does the Baby Need a Placenta?
Well, the baby is floating in a capsule of liquid called amniotic fluid - so it can’t breathe or consume food or water. The placenta is a sort of distribution centre that receives and delivers everything that is needed by the baby.
How Does the Placenta Work?
The placenta collects blood from the mother that holds oxygen, nutrients, stem cells, antibodies and all the good stuff and then delivers it all to the baby through the two umbilical arteries which are in the umbilical cord. The baby’s waste products and carbon dioxide make the reverse travel from the baby through the umbilical vein to the placenta, and then out into the mother’s bloodstream to be removed in her urine. The umbilical cord is wrapped in a super thick coating called Wharton’s Jelly that keeps everything safe on the delivery track.
Here you can see the 2 arteries (red) delivering all the good stuff, and the one vein (blue) taking the waste away from the babe and into the placenta to be expelled by mama.
What Happens Once My Baby is Born?
Once the baby is born, the placenta is still holding about a third of the baby’s blood - this will be delivered to the baby if the cord isn’t cut immediately. This is part of the reason many mums are choosing to delay cord clamping at least a few minutes after birth if possible, or to delay cutting the cord until it has run completely white. This also helps with delivering the placenta.
I Have to Give Birth Again?
Yes, you read correctly - after you have just done the most amazing thing and birthed your baby, you will need to give birth to your baby’s placenta. Lots of mums don’t realise this - but don’t worry - it doesn’t have any bones, so it will come out with a lot less effort. The most uncomfortable part is probably when a midwife or obstetrician feels your tummy to make sure the placenta is on its way out.
Here’s a pic of one of my placentas post-birth. See the blood vessels branching out over the placenta?
What Happens Once the Placenta is Out?
If in a hospital, the staff will treat it as biohazard waste, but some mums ask to keep their placenta for encapsulation or to plant it under a tree somewhere special. It’s completely your call what you do with your baby’s placenta, but at the very least have a good look at it! It is the first masterpiece you and your baby worked on together and a true wonder. Your midwife will be able to show you the arteries and veins that we have talked about.
The placenta is a truly epic organ - a temporary organ that keeps a human alive and growing - from a mere group of cells to a fully functioning baby ready for the world. The amazingness of this organ shows how your body knows exactly what to do to grow and nourish your baby, and can give you the confidence that your body will then know what to do when it comes to bringing your baby earthside. Bask in its glory!
Britt xx
Resources:
The Midwives’ Cauldron Podcast: Placentas & Cord Blood
The Khan Academy “Meet the Placenta” Course
My name is Brittney Blakeney and I am a Pregnancy, Childbirth and Postpartum Doula, with an emphasis on education and preparation for your birth experience as a woman and mother. My job is to give you the most up to date research so that you can make decisions with confidence, and to give you the tools, techniques and encouragement to feel calm, safe and supported during your pregnancy, birth and postpartum journey. I aim to create villages around women to ensure they feel strong, supported and listened to as they transition to their new role. If you don’t want to miss out on any new morsels of info, subscribe to my newsletter (coming soon) to get the latest blogs. I am based NOR in Perth, and can be contacted by email at doula@brittneyblakeney.com.au or head to my Insta to send a direct message. Click here for some more bloggy goodness.