Birth story: Doula support, water & epidural
Ashley gave birth to her second daughter in hospital, supported by her husband, doula (Gifted Birth Support) and hospital midwives. Ashley shares this experience in her own words along with some commentary from her doula.
Birth story
A little background: My first birth was traumatic. 26 hours with contractions starting at five minutes apart and extremely intense. I had gas and two doses of pethidine which left me very out of it. I was confused, disorientated and terrified. I was coached to push for four hours (records say 2). When bubs was born all I could do was stare at her blankly. I was still very out of it and was for a couple of days afterwards. PTSD set in and the mother and baby psych unit in Melbourne was on call for me but I wouldn’t go without my husband. At four months I stopped breastfeeding due to my mental health and I slowly improved but at six months I felt like I ‘woke up’ with an infant I barely knew.
This time around I was determined to have a natural ecstatic birth. I read everything I could get my hands (or cursor) on. I was prepared, confident and very well informed. I hired a doula. I was ready.
“Doula: When I first met Ashley, it wasn’t long before I realised she was a survivor. For a young woman she had already overcome adversity, survived abuse and trauma as a child only to make it through a traumatic birth as well. A part of me was nervous about providing doula care; because I was worried I might say or do the wrong thing! But my nerves were short-lived once I learnt how self-aware and informed Ashley was about her upcoming birth and her choices.”
I had very light early labour contractions start on Sunday night/Monday morning and continue for two days. I’d had this on and off for a couple of weeks so had my fingers crossed and walked a lot of stairs while at school but just ignored it.
Monday night dtd (“did the deed”) with the hubby and they got stronger for two hours went to sleep and woke in the morning disappointed.
Tuesday night bounced on my ball and did a single leg release (spinning babies) and lots of forward leaning to try and get things going but tightening just keep continuing at the same pace.
10.00pm dtd again with the hubby not really expecting it to work. Again tightening got stronger and decided to sleep through them again.
Woke up at 2.00am needing the bathroom then I couldn’t get back to sleep. Started to think this may be it but I had already decided not to wake hubby as I thought it would be a long one. Breathing and meditating through tightening as they started to get stronger. Back and forth to the toilet constantly.
By 2.30am needed the shower which didn’t really help much just lots of squatting to get baby to move down. Hot water ran out so back to bed. At this point I jumped online to get some company as I was feeling a little lonely and worried. Instant support was amazing people from all over the world were actually cheering me on. No need for visualising imaginary women there.
“Doula: I woke at 1.00am remembering my conversation with Ashley on Monday, where we laughingly agreed a baby on Wednesday would suit us just fine! My doula bag was packed and ready to go, and as I began to drift back to sleep around 3.00am I thought I should quickly check Facebook on my phone. Lo and behold, Ashley had posted on the BWF support page and was in labour! No going back to sleep now…”
Shorty after contractions started to get hard. Around 3:15am I started to think this is going way faster than last time. 3:30 I wanted to wake hubby as labour was getting very hard and couldn’t really just breathe through them anymore, but once again I thought it was going to be ages yet (first labour was 26 hrs). So I told myself let him sleep till 4.00am. With each contraction I was willing the clock to go faster.
By 10 mins to 4 I couldn’t do it alone anymore. I woke hubby and he got up immediately. I went for the shower again. Again it wasn’t helpful really so I just knelt in the bottom and willed myself to relax and let the baby move down. Everything was starting to progress by then and I started to track of time.
Wasn’t long before i was leaning over the birth ball and moaning through contractions. At 4.20am I text my doula to let her know what was going on but didn’t think I’d need her yet. Not even five minutes later I changed my mind it was getting harder fast. Kate (my doula) said she’d get ready and come around. Somewhere around here John called our babysitter for our toddler to come.
I headed downstairs to be ready to go. Kneeling and leaning on the couch during contractions thought I was moaning very loudly but apparently was quite muffled. Kate arrived and started counter pressure on my back which helped a bit while we waited for babysitter to arrive so we could go to hospital. We realised there was no way I was going to be able to get my runners on so Kate gave me some thongs (flip flops) to wear. (Kind of giggled to myself in my mind when I saw the sparkles on the straps).
“Doula: My doula bag contains rubber thongs for when I provide support to birthing women in the showers and bath at the hospital. I hadn’t imagined they would come in handy like this, but a doula bag is meant to be full of tricks!”
Babysitter arrived and climbed in the backseat of the car kneeling and holding the headrest. Made me nervous without the seatbelt but the whole way there through contractions I was thinking why didn’t I do this last time?
Got out at the hospital and held onto John for the walk in. Had to stop for a few contractions and once to throw up. While I’m standing there puking I feel this gush. At first I wasn’t sure if my waters had broken or I’d wet myself but figured it didn’t matter as either way it was embarrassing and uncomfortable and just kept going.
Made it to the birth suite and had a contraction on the way to the room. Turns out I was allocated the same room I had my first daughter in. Found out no one was using the bath but had to wait for it to be cleaned and filled so immediately stripped and jumped in the shower for the meantime. Again the hot water offered little relief. Eventually the bath was filled and I was able to get in. They had it as hot as they could but it just wasn’t enough.
I found it difficult to fully relax as I was too buoyant and couldn’t float without my head slipping off the edge.
Started to realise around now that i wanted the epidural. I’d already given my code word well before this but Kate and John encouraged me to try different positions and to keep going as long as I could. I found it frustrating at the time but realised it was what I needed to do. I don’t remember a lot from here as there wasn’t really much activity. I switched to squatting against the edge of the bath and rocking through contractions keeping eye contact when I could to help me focus. Kate had hot water spraying on my back during contractions but it just wasn’t hot enough. I wanted scalding hot but I knew it wasn’t safe. After a while I felt myself start to lose focus like my first birth the contractions were manageable but the searing pain in my back and hips was just too much.
“Doula: During our prenatal discussions, Ashley and I had chatted about the hormones of labour and how to optimise her natural endorphins. However it did occur to me that as a trauma survivor Ashley may struggle to enter “labour land”, fearing dissociation and the inability to communicate as happened with her first birth. Sure enough, Ashley remained very aware and “in the moment” as her labour progressed and intensified. I witnessed Ashley and John lovingly connect with each other, with deep and meaningful gazes and touch. But I also suspected the pain of Ashley’s labour might be outstripping her endorphins and her wish to enjoy the birth as she had hoped.”
I could feel the anxiety creeping in and I realised if I kept going I was going to sacrifice my want of a joyful birth for a most likely fearful and traumatic natural birth. I made the decision for the epidural.
I felt I was progressing too fast to cope as I was not getting enough time to adjust in between. I have no doubt that if I had stayed in the bath bubs would have come within the next hour. Someone got the midwife.
I had to get out of the bath and couldn’t even go in the shower while I waited for the anaesthesiologist to arrive. Kate kept reminding me I could change my mind but I was determined.
I was informed and had no doubts, although I did feel some disappointment. The midwife conducted the first internal examination (the first for my whole pregnancy) and it felt extremely painful. I began screaming and crying that it was painful, as she continued the exam to feel my dilatation throughout a contraction. I’d made it to 4-5cm’s dilation.
“Doula: Before birth, Ashley had explored her options for pain relief. She definitely didn’t want pethidine or the gas-and-air due to how these made her feel out-of-control and other side effects. Her plan was to try water and movement for natural relief or an epidural if the pain was distressing. Her birth plan did state to provide extra support to avoid an epidural if she was in transition. So to honour her birth plan, I gently reminded her she could change her mind when she found the exam upsetting and before the anaesthetist inserted the first needle. But Ashley was clear in her wishes and I was very keen to support her to achieve the empowered and non-traumatic birth she longed for – and in Ashley’s case, an epidural was a very effective tool for this purpose.”
The first attempt to insert the IV needle for fluids was a failure (I was still bruised three weeks later) but thankfully she got it in on the second go. I was lying on my side and returning to my hands and knees during contractions. My legs were so tired I couldn’t stay in that position. The monitor kept going off as my pulse went up and dropped fairly frequently. They eventually turned off the alarm as it was pretty normal for my pulse to do that. Baby was coping fine. I needed to pee but just couldn’t.
Eventually I got set up for my epidural I remember thinking while the anaesthetist reeled off the list of risks off the consent form that half of the risks and side effects were not even listed. Sitting on the edge of the bed I tried to stay still which was frightening. Kate kept reminding me I could change my mind. For an instant right before the needle went in I thought ‘I don’t need this’. Then the needle was in and I realised the position they had sat me in had made bubs rise and lessened the pressure so less pain…the minute I laid down again it the intensity would have returned.
The pain of the contractions started to wear off except for one spot on my left side which according to the midwife was “weird”. I was rolled onto my left side from there and after a while it went away.
I dozed on and off for a while I could still feel pressure but the pain was just gone. After they put in the catheter the pressure on my bladder was finally relieved.
All of a sudden my waters broke with force and I couldn’t believe it when they asked if was was sure. “Oooh yeah” I was sure. Had a second’s panic when I saw they were meconium stained but midwife said it looked old and baby was doing perfectly fine on the monitors so I relaxed.
After a while I started to feel the familiar pressure on the back passage. I told the midwife I was feeling pushy but she dismissed it. A couple of contractions later I told her again there was a LOT of pressure she took a quick look (between contractions) and again dismissed me. At this point I could feel myself opening slightly with each round of pressure. After roughly 4 more contractions the pressure started to tip me further onto my side. I again told the midwife.
Finally she checked internally her finger only went in about three centimetres. She got this surprised look on her face and said “Well that baby moved down fast.” I can’t remember if I actually said “I tried to tell you” out loud or not but i was definitely thinking it.
I saw them readying the synthetic oxytocin needle in preparation for the third stage and reminded them that I didn’t want it. They said I may need it for bleeding because of the epidural and while I wasn’t really happy about it I just let go.
“Doula: At approximately 5cm dilation with regular contractions, Ashley’s contractions continued to be strong and regular after the epidural took effect. She didn’t require augmentation for the rest of her labour, but the midwife did advise Ashley she strongly recommended active management for the third stage with an epidural. The second midwife was very direct with Ashley, insisting she accept the uterotonic for the placental birth. Ashley reiterated to the midwives she wanted delayed cord clamping for the third stage.” See this link for information about physiological placental birth vs active management.
At this point I was desperately trying to get John on the phone as he’d gone downstairs for food and I didn’t want him to miss the birth! He finally appeared and I was cleared to push. (I was already breathing the baby down anyway) I needed help getting my legs up as laying on my left side had made it extremely numb and heavy. Pushing was amazing; I could still feel my baby moving down perfectly but without the pain and fear from last time. I could control exactly how fast she was coming and knew exactly where she was. Crowning was definitely an interesting feeling. I remember saying “that does not feel good”. Within four contractions (record says twenty minutes) she was out.
“Doula: Ashley’s baby girl was born gently and steadily, while she continued to smile and stay in the moment. The midwives wiped her baby’s face clear of fluids and quickly lifted her up onto Ashley’s abdomen.”
Her breathing was a bit croaky so they gave her a good rub on my chest to clear her out (she was coughing up fluid for a good 24 hrs afterwards) and they cut and clamped the cord while I had a cuddle. I’ll admit I dropped the ball here as I was too ecstatic to notice what was going one but Kate said the midwives did wait a minute or two and and checked the cord for pulsations before they clamped.
Josalynn was a great colour so I figure she got most of the blood she needed. She latched on straight away and continued feeding for about 45 mins. She only got mad when the midwives touched her which I thought was funny. She did not want to be disturbed.
There was a little fuss at one stage where Josalynn was assessed to have a minor temp but I was convinced I’d just overheated her on my chest. Eventually they weighed her in and surprised us all with her being 9 pounds. I’d carried smaller then with my first child so we expected more around 8 pounds. They checked her blood sugar because of supposed LGA (large for gestational age) but it was fine. Other then extremely painful after pains (panadol, voltaren and endone as well as an anti-nausea shot later), I was fine.
I returned to school with bubby a week later to be the first student to breastfeed in class. By the end of the week she had gained past her birthweight and sleeping well.
For a little while I struggled with a feeling of failure for getting the epidural but eventually realised that this was due to peer exposure rather than actual disappointment. After my long and (mentally) traumatic birth with my first I had wanted a calm and ecstatic birth. It was only afterwards that I realised that I didn’t have to have a medication-free birth to achieve this.
I may have had an epidural, I may not have had the hospital water birth I had planned but when they handed my little girl to me I smiled, I held her, I looked in her eyes and I loved her. And at the end of the day that was all I truly wanted.
Pregnancy Counselling – GV Minds
Quick facts:
Pregnancy Counselling – Goulburn Valley area
Requirements:
- Pregnancy within one year of sessions, – Client has a Medicare Number, – GP referral (non specific – letter stating for Pregnancy Counselling made out to Pieta Shakes),
Sessions:
- Provided at the GV Minds Office, – Bulk Billed, – 40 minute session.
The following information has been provided by Pieta Shakes, local mental health nurse, new mother, and provider of important pregnancy counselling (bulk billed with GP referral) for women within 12 months of their pregnancy.
Feeling over the moon – and a little overwhelmed?!
Pregnancy and motherhood is such an amazingly, wonderful experience- from watching your belly grow, feeling your baby’s first kick, preparing the nursery, writing a birth plan right through to those expecting moments of heading to the hospital with the plan to bring home a baby! However, what those pregnancy, birth and baby books and phone app week by week’s may not let you know is that pregnancy and birth can be an emotional overload. The roller coaster of emotions and hormones required to grow and bring your baby into this world can easily send any expecting or new Mum into a world of anxieties and concerns.
As a new Mum I can recall reading many books and learning as much as possible about my baby’s development, only to end up with very unexpected twists and turns in my journey, finding myself often feeling overwhelmed, emotionally drained and isolated, not how I expected things to be. Just like other new Mum’s I often found myself blaming myself for twists and turns, for feeling inadequate and just not like the books suggest! However, with the right support I am able to reflect more realistically and enjoy each moment with my baby girl. My experience has only increased my interest in the field of perinatal mental health, and now that I am back to work I wish to support other Mums through this joyous and sometimes overwhelming time of pregnancy, childbirth and early motherhood.
I am a credentialed mental health nurse, which basically means a registered nurse with post graduate qualifications and experience within the mental health field. I hold both adult mental health and child and adolescent mental health post graduate qualifications and am currently completing my Master of Nursing (Mental Health). I have also completed education regarding perinatal mental health nursing. This past experience all comes together now by providing me the opportunity to assist other women through the journey of pregnancy, birth and early motherhood. As a registered Medicare provider I am able to provide Pregnancy Counselling to any woman who is currently pregnant or has had a pregnancy within the past 12 months of their sessions – this includes women who have delivered their baby, women who have experienced a loss or women who have had a termination of a pregnancy.
Pregnancy counselling is counselling offered around any concerns or issues the woman may have regarding her pregnancy, this may be non-directive counselling regarding decision making, providing information and support regarding pregnancy anxieties, birth anxieties, counselling following a traumatic birth (or unexpected change from the birthplan), assessing and assistance with baby blues/ post natal depression – basically anything to do with their pregnancy. Medicare entitles women up to 3 pregnancy counselling sessions with a mental health professional per pregnancy (again this could be up to 12 months after). In order to reduce barriers to accessing support I will be bulk billing all women (after all I know how money can be tight during this time!). That means NO cost for any woman referred by their GP. Of course, counselling can be provided at a cost if people so wish to skip the visit to the GP!
Appointments will be held at the GV Minds office – in The Shepparton Business Centre, 70 New Dookie Rd, Shepparton. I do plan to look into increasing options for home visits or appointments in other Goulburn Valley areas, such as Cobram, Echuca, Numurkah, however this will be a future venture, and there may be a cost associated with home visits (after all I have a baby to feed/clothe too!).
While 3 counselling sessions may not seem like enough it is a great start to feeling heard, clearing your head and walking away with information to arm yourself with steps to make your experience ever so more enjoyable and comfortable. If you do require further support I can guide you on the available local services and there may be other funded services under GV Minds of which you qualify for.
So, please don’t feel alone and certainly don’t feel inadequate if your experience isn’t matching up to the books and apps. Contact me today at GV Minds to arrange an appointment, or head to your GP for a referral letter made out to ‘Pieta Shakes’ for Pregnancy Counselling and feel supported. The first key to caring for your baby, is caring for yourself.
Happy and healthy 9 months and beautiful birth wishes for those expecting, and congratulations to those new Mums out there!
Pieta Shakes
Director - GV Minds
Credentialed Mental Health Nurse
More importantly – New Mum of a special beautiful 5 month old girl!
Operating out of the Shepparton Business Centre,
Suit 3, 70 New Dookie Rd, Shepparton
m 0431 323 517
f 03 5835 6605 p
PO Box 440, Numurkah 3636
info@gvminds.com
www.gvminds.com
Online petition-birth choices for Australian women
If you believe women should have equal access to funding for home, centre and hospital birth, you can sign and share this petition.
Medicare funding and indemnity insurance are important aspects of providing women equitable access to independent midwifery care for their pregnancy and birth. For many women, a private midwife is their only option to obtain woman-centred, continuity of care.
Please sign, it only takes a minute!
The Australian Senate: Provide equitable maternity funding
The Face of Birth–Shepparton Thurs 29 March
Passionate about birth and a woman’s right to choose?
Come and see the powerful new documentary – The Face Of Birth
…And bring a friend who doesn’t know anything about birth ….. It’s everyone’s right to choose – even those who don’t know it yet.
SHEPPARTON SCREENING
WHEN: Thursday 29 March 2012
TIME: 6.00pm
VENUE: Overlander Hotel Shepparton, Function Room
97 Benalla Road Shepparton
TICKETS: $18.00 per ticket, children free (cash only, ATM on site)
RSVP: 0438 298 388 or giftedbirth@gmail.com
Finger food provided from 6.00pm, drinks available at bar, screening 6.30–8.00pm
Film is rated PG and running time is 90mins
Venue has space for prams plus an indoor children’s playground
AVAILABLE TO PURCHASE AT SCREENING
| The Face of Birth DVD set X 3 filmsThe Face of Birth, Meet the Experts and Birth Stories | $60.00 (RRP $75) |
| The Face of Birth DVDYour own DVD copy of the feature film | $23.00 (RRP $28) |
| Meet the Experts – Beyond The Face of Birth DVD Over 4 hours worth of talks on one DVD, a collection of advice, opinions and shared expertise from the world’s top birth experts | $23.00 (RRP $28) |
| Birth Stories – Beyond The Face of Birth DVDThis DVD captures the complete birth stories of mothers featured in film plus others. Moving and empowering, these stories are shared in their entirety, creating a beautiful new film that shares their diverse birth journeys | $23.00 (RRP $28) |
| Birth Journeys – book by Leonie MacDonaldThe Birth Journeys book is a collection of 29 positive and inspiring birth stories from women and men around Australia | $25.00 (RRP $29.95) Orders can be taken |
The Face of Birth – where to give birth in Australia, and with whom?
RELEASE INFORMATION:
“The Face Of Birth. A film about pregnancy, childbirth and the power of choice.
Three years in the making, filmed across the globe from London to Alice Springs, The Face Of Birth is a moving documentary with vital information for anyone considering giving birth in Australia today.
In 2009 it nearly became illegal in Australia to have a homebirth. Three years later in 2012 the amount of women choosing a home birth has doubled! Who are these women and why are the government and medical establishment so against them?
Following the diverse heart warming and sometimes heart wrenching stories of a hand full of home birth mothers as they guide us through the plethora of information and opinions about where to give birth and with whom. The films helps sort out fact from fiction around the politics, risks, safety and fear in birth.
Over 25 of the world top birth experts were interviewed, including the famed Sheila Kitzinger author of over 26 books on pregnancy and childbirth, and the founder of modern midwifery in the USA; Ina May Gaskin.
We hear from Australian pro home birth obstetricians Euan Wallace and Andrew Bisits, both doctors have started up hospital run home birth pilot programs. And on the other side of the birth pool debate, Dr Rupert Sherwood, who is the president of RANZCOG ( Royal Australian and New Zealand College of Obstetricians and Gynecology) the college to which they all belong that doesn’t support home birth.
Our diverse home birth mothers include AFI award winning actress Noni Hazlehurst. She’s known by one generation from Playschool and another from City Homicide, but do her fans know why she chose a home birth?
Mother and doctor Sarah Renwick Lau, chose a home birth for her second child after her first baby was delivered by C-section at maternity hospital in Darwin where she also worked. It seems her independent midwife gave much better care than her colleagues at the hospital.
And young Aboriginal mum Tanya Kunoth, from the remote community Utopia in central Australia, who had two babies in hospital and two babies on country, she shares why it’s so important for her to be able to birth on her land, and why for her home felt safer than in hospital.
Beautifully shot and openly revealing, The Face Of Birth tells about all the things we never knew about birth and the power of choice.”
Seeking support online – pregnant with twins
Pregnant women are increasingly turning to social media for information support, especially when feeling pressure to accept medical intervention “just in case”.
This is the story of Lisa, pregnant with twins after 2 cesarean sections and one vba2c. Lisa sent a call-out for support via Facebook in the weeks and days before a booked induction date:
“I need some advice. I’ve made it to 38 weeks with mono-di twins. Not a single problem or cause for concern at all in the whole pregnancy. However, my Dr wants to induce me at 38+3 as they don’t recommend twins going much past 38 wks “just in case” the single placenta deteriorates (1:69 chance). I desperately want to avoid medical induction but don’t want to risk my babies’ lives. Any advice, info, stories, encouragement would be greatly appreciated. Thanks in advance!”
Because of her twin pregnancy, Lisa was considered high risk. Her conundrum was whether to accept the medical advice or decline the induction – but then feel solely responsible for any adverse outcome.
Lisa shares the advice she was given to accept an induction of labour with her twin pregnancy:
“There has been absolutely no problems whatsoever this pregnancy, except the fact that these twins are mono-chorionic aka “identical” (which means they share a placenta) but that appears to be functioning perfectly with no sign at all of problems. The Drs just believe that by not inducing me at their preferred time they are entering “uncharted territory” & they don’t want to take the risk that something “could” go wrong even though there is no cause for concern yet. It makes me feel very nervous to be going against medical advice but at the same time I don’t want to fall into the “cascade of interventions leading to a C-section” after getting induced. It’s a real tough call because I would hate for one of my babies to suffer or God forbid pass away because I went against the Drs advice, but at the same time I don’t want unnecessary C-section. I’m just so anxious about this but I’ll be ok I’m sure. Just have to go with my instinct and have faith.”
In Lisa’s case, she and her babies were perfectly healthy. Her assessment was that she was in a prime state for giving birth. While naturally concerned for her twins, Lisa was also worried about the risks associated with pre-emptive interventions and technological control of her labour.
Inducing twins before 39 weeks was explained by her doctor to avoid the risk of the placenta failing – Lisa quoted them as saying there was a one in 69 chance.
Virginia from Homebirth Access Sydney described the issue Lisa was facing: “It sounds like your Dr is downplaying the risks of induction (and not carrying the babies to their own natural full term) while overstating the “risk” of leaving well alone – an all too familiar story unfortunately.”
(Overstating the risk of ‘expectant management’ and understating the risks associated with ‘active management’ is a complex and important issue in maternity care)
You will be thrilled to learn Lisa went into spontaneous labour and gave birth to her twin girls – two days before the induction date.
Crystal (l) and Jasmine (r)
Lisa wrote on Facebook:
“I gave birth to our beautiful identical twin girls Wednesday 27th at 12:48pm & 1:21pm. Crystal Rose was 8 pounds even, & 52cm long, Jasmine Faith was 6 pounds 8 oz & 50.5cm long. Both safely delivered vaginally after vba2c & 2 previous c-sections. Thank you to everyone for their amazing encouragement & support! It helped more than you could ever know!”You can find Lisa’s birth story here
In the spirit of sharing information and support, Lisa was happy to share her story and the support she received online, including responses from well-known Australian midwives and researchers Rachel Reed and Carolyn Hastie.
Women expecting twins and the people supporting them may appreciate the honesty, care and encouragement in these responses too!
- I would ask the Ob for the research that says 1:69 chance of placenta deteriorating. Then when they can’t produce it, (because there isn’t any) she can just keep being pregnant. To avoid medical induction all you have to say is thank you but no thank you. I attend a few [twin births] a year and have never had a client go in for induction. They have all birthed AFTER 38 weeks with no problem. Nobody can do anything to your body that you don’t consent to. An induction means approx 65% chance of a section. Good luck
- So much fear about twin babies. Ask the woman to talk to the children heart to heart. She needs to feel safe about them both, to especially make sure she connects with the second one – that’s the baby the doctors really wave the shroud about – they are so much creating self fulfilling prophecies. I have had lots of experience with twins and even before they used ultrasound to diagnose twins – when they would pop out unannounced they know how to be born. I’m happy to talk to the woman – she can ring me
- There is probably not much info re. real risk about the alternative (ie. not inducing) because so few women avoid the pressure to [induce]. I know a mother on the Sunshine Coast who resisted and birthed full term twins without intervention. The standard approach is induction before term + epidural so that the OBs can manage any complications. Of course induction and epidural create complications for mother and baby. The risk of a twin birth alone is difficult to separate from the risks associated with the routine interventions carried out during a twin birth. If she wants to birth physiologically she will need to trust herself and have a strong birth plan + support people… or not birth in hospital.
- Lisa any medical intervention carries risk, not least when it is not medically indicated – “just in case” is not a medical indication. Inductions will at least double your chances of caesarean which carries risk in itself, for you and for your babies. You need to bear in mind that you can say no to the induction, as it is your right to make an informed choice about what happens to your body and your babies. It sounds like your Dr is downplaying the risks of induction (and not carrying the babies to their own natural full term) while overstating the “risk” of leaving well alone – an all too familiar story unfortunately. There are 2 birth stories of full term twins in our Autumn issue of Birthings “Safety & Risk”which is available to buy or download on our website. I wish you all the best.
- I don’t have any info to lend other than an old co-worker just had a c-sec on her healthy twins @ 38 weeks and they’re both still in the NICU a week later….
- Best resource I can give is a book called Having Twins and More by Elizabeth Noble. It is a hugely thick book but it was my bible for my twin pregnancy. I kept them in until I went into spontaneous labor at 40 weeks 5 days.
- I had my twins at 39 weeks at home. Labor was spontaneous, placenta was gorgeously healthy and full of life. I’m a huge proponent of letting twins go until they are ready unless there is a warranted health concern. I second the Elizabeth Noble book, she normalizes twin birth.
- One of my ladies refused an epidural [doula client]. She was told that there was a risk that she would need a crash section to get the second twin out if he went into trouble. The lack of epidural meant that she has the freedom to move about and therefore allow the babies to descend for a vaginal birth. She did it all on gas and air. She did her research about birth and decided that they were not allowed to bully her into the birth of THEIR choice.
- There is a growing body of evidence that babies born prior to 39 weeks (38 completed weeks) are more likely to have problems transitioning and need to spend some time in special care nursery. Has the OB given a reason for induction? There is no reason to treat a twin pregnancy any differently than a singleton (unless they share a placenta). [Lisa’s babies did share a placenta but this midwife was not informed of this at the time]
LINKS THAT WERE SUGGESTED BY MIDWIVES AND DOULAS:
- Romi’s empowering vaginal birth of twins (Brisbane, Australia)
- High Risk Birth – Defined by Whom by Justine Caines~ article
- Why at least 39 weeks is best for your baby~ webpage article
- Australian Multiple Birth Association~ website
- Having Twins and More – Elizabeth Noble~ book
- Natural Childbirth of Twins and Triplets~ YouTube video
- Twin Birth at Home?~ webpage from Homebirth UK website
- Mary Cronk Midwife – Guidelines for Care (natural twin birth, home or hospital) ~ webpage article
- Collection of Twin – Multiples birth stories
Natural birth in hospital–first time mother
Penny’s natural birth of Toby
This is a birth story of a first time mother that had a natural hospital birth, including natural ‘third stage’ of labour. Penny developed her birth plan with Gifted Birth Support.
Penny writes:
My little baby is 5 weeks old on Saturday! How times flies. I wanted to FINALLY thank you for your help with my birth plan. Not only did you help me write a birth plan that made sense, you made it easy to read and the birth plan was followed exactly.
I couldn’t ask for more for my first birth!
Toby’s birth story
Friday 12/8 at about 9.30pm, I was lying in bed and felt something that resembled my waters breaking! I did not think much of it as I was 39+ 2 weeks and people had kept telling me first time mums go over! I had period-like cramps all night… so no sleep for me!
Saturday 13/8 at about 8.30am, I woke up and thought “yes, my waters have begun to leak.” Every time i stood up they definitely leaked some more!!!! I rang the hospital and they asked me to come in…but no rush they said!
So not wanting to be on ‘hospital time’ I didn’t go in until 1.30pm! Once there, I was hooked up to the ECG for nearly an hour (mum had to get them to come back, seems like they forgot we were there)… A midwife performed an internal to see if waters had broken. She said “no, you’re waters haven’t broken, it was just hind waters, but looks like you’re in early labour so you’ll probably give birth Monday”.
I was relieved to go home. Got home by 3.30pm and this is when things kicked in! My contractions started up straight away, so I wanted to rest and eat in case it was the real deal. Because I hadn’t really experienced Braxton Hicks contractions and the midwife estimated Monday, I was worried about getting run down.
By 5.40pm I was crying through contractions. My mum started timing and they were 40secs long and 3 mins apart! I COULD NOT do this till Monday!!! So i jumped in shower as nothing else was working! This took the pain right away, so at 6.30pm I decided to go to hospital so I could use their endless supply of hot water!!
We arrived at 7.10pm, and as I was wheeled to the ward the contractions were insane and intense! Another internal exam was done because I was told they “HAD to do it, and there is no other way to check your progress”. I had used a technique I found the xiphoid “fingerbreadth” method online for measuring dilation and progressand I estimated I was 7-8 cm using this method. The midwife told me I was 6cm, and said for a first timer I was looking at 4hrs more of dilating and 1 hr pushing.
At that point I didn’t think I would make it any longer. So they wheeled me into birth suite and straight into the shower. At this point the midwife that performed the internal check argued with me for 5 mins, telling me I was not allowed to put my undies back on because I was jumping in shower. Being in active labour and arguing, I found it very hard to explain to her that I didn’t want to be naked in front of everyone for the next 4 hours! She was rude so I decided to ignore her and got my mum to get me other undies!! OMG fighting with me in labour, not a good idea!
The midwife I was actually assigned to labour with arrived – ‘K’ she is a lovely midwife who is going independent next year! Having her take over my care was such a relief. She already had the bath running and said she had read my birth plan and wanted to get everything ready for me, so it could be followed. I was in heaven!!!
So moving from bath to shower, bath to shower, I worked through the contractions. Hours went by, or so I thought! I ended up on a birth stool in shower. Because I was told the waters hadn’t broken, when I felt something shaped like a ball coming out of me I presumed it was the waters (bulging membranes). This is when K said “oh my God, it’s your baby!” She caught him just before he hit the ground!
At 8.40pm, 1 ½ hrs after arriving at the hospital and only 15 mins of pushing/breathing my baby out, little Toby was born! The first boy in the family. I was shocked!
As planned, we waited until the cord had stopped pulsating before clamping. K asked if I wanted an injection (of artificial oxytocin) or to have natural third stage “as outlined in your birth plan.” I chose to move to the bed and wait for the placenta to come out by itself.
We had uninterrupted skin-to-skin contact from the moment he was born for 4 HOURS! Only then were the checks were done on baby and we moved to my room. But then I felt like we were forgotten again. The birth suites were busy and as I was first woman in there to give birth they took care of everyone else.
K’s shift ended at 9.30pm, and unfortunately at the shift change the midwives were rude and abusive! I am so fortunate I had K for the birth. I believe my birth would not have been so amazing without her being there!!! Mum told me later that she even ate her dinner in the room with mum while I was in bathroom as she just knew my labour would be quick.
I stayed in hospital from Saturday until the Tuesday. The whole time my mum and I were verbally abused and yelled at for silly little things. Like when I was getting checks done midwife1 told mum to take Toby out of room in his little plastic bassinet – but then midwife2 yelled at mum, accusing her of stealing him! Toby cried the whole time, mum couldn’t settle him and his tags had fallen off- they never fit in first place and he was only about 10 hrs old!
The hospital experience didn’t end there! I’ve made a complaint to hospital about this care so I will see if I get a reply! Oh and the midwife that checked my waters early on the Saturday asked me “did you get the birth you wanted or did you end up giving in to drugs like everyone else?
Mum and I proudly said, “yes I did have it the way I wanted!”
I felt like saying to her “unlike you, K believed me when I told her I thought my waters had broken!”
So in all, the birth was fantastic and just the best experience – thanks to K and my Mum.
The hospital stay, on the other hand, was the worst! I have never been more stressed, anxious in my life! As soon as we got home, baby and I were instantly relaxed and happy and we could finally sleep. I don’t recommend staying in the hospital so long – being a first time mum and with a 24:7 nurse button I had assumed the staff would be friendly and keen to help. My experience was the complete opposite, unfortunately.
I believe that if I didn’t have such a great birth plan, supportive mum and amazing midwife, my birth probably would not have gone as smoothly as it did!
And I also credit not using any drugs, my research on natural birth and trust in my body to give birth to having such a great experience and being able to remember every little detail about Saturday the 13th!
And I really believe Toby is more content and alert because I didn’t allow anyone to “inject” him or alter his natural journey into the world.
It was so fantastic and reassuring to have K quoting my birth plan and making sure I still wanted my wishes constantly through the night!
Thank you so much again for helping me with my birth planning!!
Penny
Toby – born 8.40pm | Sat 13 Aug 2011 | 3565g | 52cm
Guidelines for health care professionals supporting families experiencing a perinatal loss
This informative article covers miscarriage, stillbirth and loss.
While written for clinical care givers, it contains valuable information for anyone who may encounter loss and grief.
Doula’s and other birth support may find the information valuable also.
Guidelines for health care professionals supporting families experiencing a perinatal loss
Newborn blood, truth & advertising
Today I received an email asking me to choose between banking or storing my baby’s ‘cord blood’, after recently subscribing to an Australian parenting website.
This email plus my Facebook newsfeed has directed me to articles with advice about cord blood collection along with reassuring quotes from private blood bank employees.
So why aren’t these articles identified as advertising, given that private blood banks profit from this procedure? If they’re not advertising, why aren’t the claims about ‘cord blood’ collection backed up with evidence?
It looks to me like the advertising dollar and pre-prepared ‘advertorial’ is the reason why several Australian magazines and websites are promoting (simultaneously) ‘banking or storage’ as the only two options other than ‘waste’.
Unlike advertorial, an independently researched piece may have at least described the biological function of the umbilical cord and birth where the blood is not ‘wasted’.
Cosmopolitan Pregnancy Australia is featuring an article titled Should you store or donate your baby’s cord blood, where the author describes the umbilical cord as a “slimy, weird-looking thing” that contains a “small amount of blood”. I doubt you will be surprised the article quotes a manager from a private blood bank.
This subtle denigration of the umbilical cord is done to minimise the truth about the importance of the intact cord before, during and many minutes after birth.
An Australian parenting site, the Bub Hub, is promoting their new online ‘hub’ about cord blood to help inform parents. While the amazing properties of ‘cord blood’ are explained there is no mention of the purpose of the blood, stem cells, and immune cells to the baby. The blood is typically described as waste, then quickly followed up by the ‘reassuring’ comment that the waste can now ‘serve a purpose’ for research and medical treatment.
Quoting the articles from the Bub Hub:
“Collecting umbilical cord blood is not harmful to the baby or mother and if you don’t choose to store your baby’s cord blood, it would normally be discarded as medical waste after the birth.”
No mention is made of the true purpose of the blood that is prevented from reaching the baby by the clamp.
The Bub Hub provides content from the private blood banks about how cord blood ‘should be be collected’:
“Immediately after the birth of your baby, the umbilical cord is clamped and cut, separating your baby from the placenta and mother…The procedure is painless and risk-free to both mother and baby. It takes about three minutes and does not alter the birthing process in any way…Collection can only take place at the time of delivery and should be done as soon after the birth as possible. The longer you wait to collect the blood, the less blood you will be able to collect, which means fewer stem cells. To maximise the volume of cord blood collected the umbilical cord should be clamped and cut as soon as possible after the delivery of the baby. The cord should be clamped and cut as close to the baby as practical.”
This same article is also seeking to reassure parents there is no harm or risk:
“Are there any risks?
No. The cord blood is collected after your baby has been born and the umbilical cord has been clamped and cut. The cord blood that is being collected is blood that would routinely be thrown away. The procedure is painless and risk-free to both mother and baby. It takes about 3 minutes and does not alter the birthing process in any way.”
Both the Bub Hub and Cosmopolitan Pregnancy Australia are regurgitating content from the private blood bank Cell Care Australia’s website (and most probably receiving advertising dollars for doing so). There is an advertisement on the Bub Hub website by Cell Care that “celebrates the launch of the Bub Hub’s new cord blood info hub”.
So what are the truths about ‘cord blood’?
The truth and science surrounding physiological birth, placental transfusion and cord clamping still has some way to go before many clinicians cease clamping the umbilical cord at birth.
It is a no-brainer really, but ritual, commercial interests and false assumptions are still in the way of true understanding and change. So in the meantime, I offer to share my truths:
-Human beings are placental mammals, sharing in many millions of years of evolution that never required a surgical clamp for the umbilical cord.
The baby’s transition to ‘adult’ respiration and circulation at birth is complicated to explain, but the umbilical cord makes it simple – leave the baby attached to the mother until the cord ceases to pulse, until the placenta is delivered, until the mother and baby are ready.
-The umbilical cord is not weird or slimy – it is wondrous and the function of the umbilical cord is of vital importance to the baby before and after birth.
-The blood in the umbilical cord is not ‘cord blood’ or ‘waste product’ at all – it is the baby’s blood.
Studies have shown (for a long time) that up to 30-60% of the baby’s blood can be in the placenta at birth. This is because the placenta performs the exchange of oxygen/carbon dioxide until the baby transitions to breathing – the baby then needs this blood in their body to perfuse the lungs and meet the increased organ function of ‘adult’ respiration (compared to placental).
A higher amount of blood may be in the placenta at birth due to compression/ cord compression during the second stage, which can block venous return to the baby. The transfusion of blood back to the baby is especially important in this instance– a prior decision to immediately clamp can have grave outcomes for the baby with a very low blood volume at birth.
-Clamping of the cord is a surgical intervention that is ‘ritual’ and unfortunately upheld by those who will not cease interrupting a placental mammal birth in progress unless a random controlled trial tells them to.
-Despite what the advertising is claiming, there is clear evidence that “immediate cord clamping to collect as much blood as possible” is a harmful intervention – more harmful for some babies than others.
It absolutely does disrupt and interfere with the normal birth process and the baby’s transition (to breathing, to meet demand for increased organ function).
Associate Professor Judith Mercer explained in 2002 that “early clamping of the umbilical cord at birth, a practice developed without adequate evidence, causes neonatal blood volume to vary 25% to 40%. Such a massive change occurs at no other time in one’s life without serious consequences, even death. Early cord clamping may impede a successful transition and contribute to hypovolemic and hypoxic damage in vulnerable newborns.”
-Despite what the advertising is claiming, immediate cord clamping is not risk-free and does disrupt the birthing process, in many ways.
All disruptions to the physiological birth process pose risks to mother and baby. We know that immediate cord clamping causes and risks hypoxia, hypovolemia, hypoglycaemia, respiratory distress, and reduced red blood cells in the newborn. Infant anaemia from reduced red blood cells may not sound that serious but it is linked to cognitive deficits – low IQ and developmental delay.
Given the known side effects of cord clamping, we can refute the claim by private blood banks that collecting the baby’s blood will not disturb the birthing process in anyway (like the Bub Hub/Cell Care are claiming). If the early clamping does produce the results Judith Mercer describes (impeding the baby’s transition to breathing and creating pathologies) the baby may require resuscitation, artificial warming, monitoring for respiratory distress, treatment and observation for low blood sugar levels etc…all of these procedures separate the mother and baby at birth and subject them to untold stress and anxiety.
Something else for women to consider is that immediate cord clamping leaves the placenta unnaturally engorged, which can complicate or risk the safety of the ‘third stage’ of labour. This is yet another way the collection of ‘cord blood’ can interfere with the natural birth process.
-Despite the excitement about stem cells and their application in research and healing, we don’t yet fully understand the impact of depriving newborns of their own blood and stem cell/immune cell transplant at birth. Many aspects of human childbirth are not yet understood which makes it impossible to measure the true impact of intervening and altering its processes.
-The truth for some families is the decision to disrupt the physiology of placental transfusion and collect the baby’s blood in the cord may be made on compassionate grounds for a gravely ill family member. But for all of these families and anyone else contemplating banking/storing, it is vitally important they have all the information about the natural purpose and function of this blood.
Informed decision-making cannot be made based on false claims that collecting the blood is risk-free and an altruistic act using medical waste only. This surgical intervention/procedure deserves the same careful consideration and disclosure of other bodily donations (like bone marrow and organs).
-Ask your friendly equine veterinarian about placental transfusion!
Care providers that work with other placental mammals know the life or death importance of not disturbing placental transfusion at time of birth. Observing animals giving birth, if done properly, is designed to not disrupt the mother to ensure the baby receives their full volume of blood in the minutes after birth. Homebirth midwives and other progressive care providers know this is just as important for human beings too.
(L) umbilical cord engorged with the baby's blood (R) natural cord closure after placental transfusion is complete
To expand further on my own ‘truths’, I can provide a clear example where the medical community concurs that immediate cord clamping alters the birth process and is not risk-free.
In 2009 the Royal College of Obstetricians and Gynaecologists released an Opinion Paper about Clamping of the umbilical cord and placental transfusion.
The Opinion Paper states:
“Immediate cord clamping became routine practice without rigorous evaluation. There is now a body of evidence suggesting that immediate, rather than deferred, clamping may be harmful for both term and preterm births.”
“Infants who have immediate cord clamping have lower iron stores for up to 6 months after birth. The potential implications of the reduced iron status in early childhood have not been adequately investigated. Iron deficiency in the first few months of life is associated with neurodevelopmental delay, which may be irreversible.”
“The suggestion that, for preterm babies, immediate clamping may increase the risk of intraventricular haemorrhage is of particular concern and merits rigorous and prompt evaluation in randomised trials. Possible mechanisms for this increase are hypovolaemia or increased fluctuation in blood pressure during the abrupt transition from fetal to neonatal circulation.”
“Current guidance on the collection of umbilical cord blood for stem cell banks does not state when the cord should be clamped. It would be reasonable to advise parents of the advantages and disadvantages of placental transfusion when they are considering cord blood banking. (emphasis mine)
In summary, while researchers and advocates for safe birth are trying to educate parents about cord clamping, wealthy blood banks are targeting parents via magazines and websites.
The content that trusted parenting websites are hosting should be clearly labelled as advertising, otherwise it should disclose ALL the information about placental transfusion, neonatal transition and the risks of immediate cord clamping for the baby and mother.
Gifted Birth Support 2011
References are hyperlinked within this article.
This article contains opinion and does not constitute medical advice. Please research your own medical decisions thoroughly and in consultation with a clinical care provider.
Twins – Multiple Birth
The following is a collection of links and resources for women expecting twins and more!
Please feel free to suggest additions
- Australian Multiple Birth Association ~ website
- Having Twins and More – Elizabeth Noble ~ book (available in GiftedBirthSupport library)
- Natural Childbirth of Twins and Triplets ~ YouTube video
- Twin Birth at Home? ~ webpage with articles for and against – plus birth stories (Homebirth UK website)
- Guidleines for twin birth UK Independent Midwife Mary Cronk, MBE
