Bringing Back Birth

Oh what a day!

2008-07-27T15:37:00.003+09:30

I am lost for words after Friday... I received a letter that congratulated me on being nominated for the 'Midwife of the Year' Award by one of the women I worked with whilst on placement. Still in shock, I had to giggle because I didn't know what else to do... it was strange being nominated for such an award particulary as I am not quite a midwife!

In the scheme of things, I would never strive to do what I do only to receive something such as this. I do what I do only because I feel it is every womans right to have a midwife that listens and assists in the ways that are most important to her. It just made me realise that I am fulfilling my purpose in this role which has always been my ultimate goal. I am just completely taken aback that this woman has taken the time to appreciate me in this way even though it is everything that she deserved. I should be thanking her for providing me with the opportunity to do what I love doing.

Thank you so very much N. xoxo

Time and Numbers...

2008-07-22T15:51:00.003+09:30

I am not entirely sure why I called this post what I did... I guess that both of these things have become pressing in my life in recent weeks and I cannot seem to separate myself from them as much as I try to.

After stepping into this course in 2006 and thinking that 3 years would take forever to pass, I have been rudely awakened to the fact that time goes faster the further that you proceed into life. I have decisions to make, and fairly big ones at that, as to what I am going to do next year. Ideally I would love to become independent and not constrained by the system and politics but there are obviously the realities of finances and social aspects of my life that I have to consider.

I have options and I am going to keep them open because I know all too well that planning months, weeks or even days ahead is pointless as time has it that things can change and do change in an instant.

The most positive thing is that I am well on my way to completing the requirements of the course and will not be impeded in anyway by the 'numbers'. As much as I hate saying that word, it is a reality that at the end of it all, it has become about a number on a piece of paper. Nevermind that these numbers are women and families who have needs and wants and a wish to be respected. It is one of the most awkward of things to be asked - 'what number am I?' by a woman in labour and even harder to try and take away the focus of it being as such. Unfortunately, it is a result of the way this course is structured and the high demands they place on us. At the same time I whinge about it, I am glad that the numbers are higher than they have been in previous years because I am feeling better prepared and more able to step out with at least some confidence in my judgement and abilities.

And then there is the race against time... If something unforeseeable happens and I don't get my numbers its going to impact on what decision I make in the short term. Seems fitting in that the entire concept of that race is a constant element of birth and the length of time that a woman is allowed to birth. It is becoming less and less.

I cannot wait to finally be qualified, to make an impact on midwifery and more importantly on the women and families that I work with. I love what I do and I love the reality of the challenges that I am going to face however sucky the politics are going to be.

To cut or not to cut... that is the question!

2008-06-27T21:10:00.003+09:30

Further to my recent post titled 'Time stood still...' I have been thinking about the lifeline they call the umbilical cord. Initiated by the fact that the shoulder dystocia that I experienced was combined with a nuchal cord and the recent 60 minutes documentary on birth choices that had women making reference to cord around the neck as a significant complication, I am prompted to discuss my thoughts and my recent research into what should be done, if anything.

For 259-294 days (more or less!) two arteries and one vein encased in whartons jelly transport everything that a fetus needs (and doesn't need) to ensure its survival. This supply line is the umbilical cord and it is what literally bonds mother and fetus. Damage, compression or compromise of the cord is associated with fetal compromise.

So what do we do when it comes to actually severing it? Controversial issue for many but for me it seems pretty simple. LEAVE IT!!

Unfortunately in practice this very rarely happens. It is not provided as an option similarly to physiological third stage. It is just done. Research that I have undertaken is not convincing as to reasons for active third stage and the use of syntocinon or syntometrine yet its the most common birth drug used and amazingly, never formally consented to by majority.

So what is the deal with cutting the cord or even checking for cord? Seems odd to me that it would be a problem because logic would have it that if the baby is born with nuchal cord than for a reality decent amount of time previous to labour and birth, the cord was around the neck. Even more logical is the possibility of it is happening. A baby freely moving within the amniotic fluid with something resembling a jump rope, seems highly likely that it is bound to wrap around something. So as normal as it is, what is the panic?

Common responses to this have been - short cord, very very tight around the neck, impeding on the ability of the baby to be born, etc... Hmmm...

So the head has been birthed and we have nuchal cord... at which point, the only oxygen supply is still the umbilical cord as baby still has not taken its first breath. So in making the decision to cut the cord at this point for whatever reason is dicey. Not only are we cutting the lifeline and oxygen supply, in doing so there is there is poor placental transfusion of blood that is vital to facilitating the blood flow through the lungs to initiate fetal ventilation. Further to this, there is the risk of hypovolaemia, pallor, anaemia, hypotension, hypothermia, hypoxia and respiratory distress etc... in comparison to possible bruising due to a tight cord.

Any baby that has a nuchal cord is in greater need of oxygen and yet it seems that the first thing that most do is deprive them of the most effective and efficient source. I have witnessed this decision being made and in almost every case it was a decision based on panic and uncertainty and more so the preempting of resuscitation being required.

Even more frustrating for me is the realisation that the process of resuscitation that seems to be in place completely contradicts the normal and physiological resuscitation that occurs. Not only is the cord cut, the cold-crying and cold-pressor reflexes are interrupted by the warmth from the resus trolley - the process that normally constrict the blood vessels of the cord and result in the placental transfusion that initiate ventilation and assist in closing of the foramen ovale and the beginning of fetal circulation. To add to the this, the entire process is done AWAY from the mother.

Something that I also read explained a lot about the normal and natural process of birth being interrupted rudely. Why is it that women refuse to cut the cord? Morley (2002) simply states that it has everything to do with with the mothers strong inhibition to 'damaging the cord'.

Like much of what I observe, its practice based on fear rather than fact. I found this quote - More proof that science, intervention and understanding have actually caused more harm than good. In 1842 it seemed so simple and yet somehow we have made it so difficult and contoversial.

“Let the loop be loosened to enable it to be cast off over the head. … [or] by slipping it down over the shoulders. … If this seems impossible, it should be left alone; and in the great majority of cases, it will not prevent the birth from taking place, after which the cord may be cast off. … Should the child be detained by the tightness of the cord, as does rarely happen, … the funis may be cut … Under such a necessity as this, a due respect for one’s own reputation should induce him to explain, to the bystanders, the reasons which rendered so considerable a departure from the ordinary practice so indispensable. I have known an accoucheur’s capability called harshly into question upon this very point of practice. I have never felt it necessary to do it but once. … The cord should not be cut until the pulsations have ceased.”
Charles D Meigs, M.D. Professor of Midwifery Philadelphia, 1842

Update - Malaysia Placement

2008-06-27T11:45:00.003+09:30

I have now paid my deposit and all has been confirmed for me to jetset to Malaysia late September. Although still 3 months away, I am getting excited about the thought of doing something that is completely unlike me in the sense that I am homebody, a bit of loner and hate being away from my family.

I still haven't yet received my itinerary but we have been advised to organise our passports, immunisations and learn some of the native language. All a bit exciting!

I am hoping to get more info in weeks to come so stay tuned!

Jampa lagi!!

Time stood still...

2008-06-11T12:37:00.003+09:30

Yesterday was one of those days that you look back on and question whether you did everything you possibly could given the situation. So much so, that you go to bed thinking about it, dreaming about it and the next day it begins to crash down like a ton of bricks.

The morning went smoothly as I attended a Caesarean Section. I was nervous going into it because the woman had had a previous emergency and had ended up with a cerebral aneurysm and impaired sight due to the effects of the anaesthesia and a postpatrtum haemorrhage which unfortunately I am getting used to. Thankfully all went well both for mother and baby. I spent a lot of time with her postoperatively and I lost count of how many times that she asked 'why do people opt for this?' or 'why would anyone want to put themselves through this if they didn't have to?' I am not entirely sure myself.

After this I was given the opportunity to care for another woman in labour, all was going well throughout the morning. Another induction but progress was being made. As always, there was the generalised attitude that multip=quick labour and despite a dilation of only 4cm in about 6 hours, amazingly everyone was pretty happy to let things go (Hallelujah!)

Things progressed well and next thing second stage had begun and we had baby's head on view. Again it wasn't as normal for a multip as the head took a long time to manoevure the Curve of Caris and crown but it happened just the same. It was beautiful to watch the woman instinctively work through it.

Time stood still and I awaited restitution... nothing. Contraction and nothing. The head slid back after I caught a glimpse of a cord and it was freakishly tight. Midwife made the call to cut and I made the call that we had a shoulder dystocia.

It took two to at the receiving end, two on either side trying McRoberts and me climbing onto the bed to begin with suprapubic pressure. All hope seemed lost until I felt the shoulder and manage to flick it around the symphysis pubis.

I don't think it really hit me what had happened until the midwife I was working with burst into tears. I am just glad I knew what to do at the time. Even more, of those midwives I have spoken to, many of them have gone years or decades without ever experiencing this or the extreme of PPH's and here is me, not even a registered midwife and I have been a part of both. I am taking it as a positive in the sense that experience equals knowledge and knowledge of what to do in situations like yesterday could mean everything.

More equations that don't add up

2008-06-07T10:26:00.005+09:30

Having a day off, I took myself out with the kids to do some shopping and have my coffee fix and found myself thinking about what I wrote earlier. Talk about living and breathing birth! Following on from my last post...

I made the statement that most primips, if left to gestate, will go beyond their due date. I am not yet entirely sure of all the reasons as to why this happens but I have read in places that it may have something to do with their body not ever having done it before. Obviously there is controversy as to whether or not this is true as there are many multips that go above and beyond their due date too, me being one of them. But it got me thinking anyways...

If the current trend continues, primips who reach their due date will be offered induction of labour. With or without an ideal bishop score, ripe cervix, a baby ready, the cascade will be begin. Time constraints will then impose, that is 'by this time, this will happen and if that doesn't happen then we will do this and if that fails, then we will attempt this for x amount of hours'... in the meantime, baby gets upset, distressed or completely pissed off - answer is caesarean section. If baby is happy, we continue until such time as there is some issue such as 'obstructed labour' , 'cephalopelvic disproportion' or 'failure to progress' and find our way to theatre anyways.

Or maybe its a high head, OP position or deflexed vertex, and maybe the use of forceps or a ventouse will result most likely with an episiotomy. The incline of induction rates means a greater likelihood of deviations from the norm which is inevitably going to lead to either assisted births or sections, increasing the section rate even further.

So then these primips end up with a section and when their next pregnancy comes about, they have minimal options, elective section or (cough, cough) VBAC. VBAC is certainly an option but in a system that has 'ifs' and 'buts' attached to everything, whether it remains an option will be down to whoever the woman sees on the day.

Unfortunately this is becoming the reality and women, although having an option as to what they want to do, by majority, do not realise it or believe it. And more, most place their decisions in the hands of those that do not really care about the well being or future of the particular individual but rather the convenience of booking an induction or section. It has become too difficult to give the power back to the woman and if the woman does have the power, somehow the are tainted and labelled uncooperative or radical.

Looking at it from this angle it makes sense that things are heading the way they are. What I do not understand is why women are giving into it. I know that every individual is different and varies in ideals and preferences but why is it that so few really question or seek clarification and understanding?

So here I am wanting to give the power back to women. I am confronted with a woman who by her dates is only just 40 weeks, a scan at 20 weeks suggests her dates are wrong despite her certainty. Her EDD is adjusted to suit the scan because baby is 'BIG'. On assessment, she has a bishop score of 3, head still high but nevertheless, head down, but induction is commenced regardless. What do you know, nothing happens! Discussion is had, a decision is made - C-section. Reasoning - unfavourable cervix, failed IOL, high-head, post dates (despite her only being due today based on her dates) oh and dont forget the massive baby onboard (even though she is over 6 foot and appears to have decent pelvic space). She agrees without a second thought.

Given my situation and my current role, I debate as to whether I should speak up. I realise that if there was ever time to step in and advocate for a woman it is now and I go in with the attitude that I am informing her of all her options, not just the escape route. Despite what I know, I put myself in her position and know that if someone was hanging outside of my door with choice and options, Id want them to make it known.

And so I go to her and I open her up to the options and I feel like I have fulfilled my purpose as a midwife and everything that a midwife entails...

I get shot down and feel like I am an imposition, stepping on toes and completely out of place. I walk out feeling uncomfortable not because I feel like I have said the wrong thing but because I am lost as to the reasons why anyone would not want options and choice and rather leave it in the hands of those that ''know whats best!"

I did what I felt was right and despite it not having an impact at the time, I can only hope that one day she looks back and remembers that someone was willing to stand strong and uphold her rights and autonomy. I once thought that given the opportunity to do what I did and receive the response I got, Id feel lousy, yet I feel good knowing that at least she was aware that there was a choice regardless of whether she grabbed ahold of it or not.

And so I ponder the reasons why we have become mute as humans and lack the authority and the power to make decisions based on our own choices and beliefs allowing others to abuse us and decide what is ultimately our decision.

Any comments you have in response would be thankfully accepted.

Questioning the obvious and proposing the unlikely...

2008-06-07T08:48:00.003+09:30

Despite getting used to the occurrence of getting to work and being made aware of the amount of inductions and caesarean sections, it still gets to me. I do understand that there is a time and place in which they are needed but shockingly, the facts that Michel Odent spoke of are becoming more real and evident. I have been reflecting and addressing my frustration over this and trying to formulate some plan to change this trend particularly as I am due to take the leap next year and finally drop that infamous word 'student' from my title.

I am aware of the mass opinion that I will be up against when I finally do become registered but I am hoping that I continue on the path I have laid and stand strong and make a difference. Obviously it will be a challenge given the politics and legalities of the system but given my incessant need and want to bring birth back to what it is or in todays culture, what it should be, I will fight until the bitter end.

I have grown complete and utter despise for induction and looking back on my own experience, think myself lucky that it went reasonably smoothly. Almost every induction that I seem to witness fails or causes complications that inevitably result in a section. I am close to summing it up in my head - induction = delayed c-section. I choose my words carefully because in the delay between induction and section comes intervention. I am trying to find the words to express what I am feeling in relation to the future of this rather bold and forthright equation because I am sure that amongst the mist and the clouds, there are many that are pushing for something along the lines of - induction = c-section or worse birth = c-section.

The worrying thing for me has been the encroaching nature of the beast on length of gestation. Once upon a time it seemed safe to leave a woman to bloom until 42 weeks. Four years ago, knowing very little and being as naive as I was, I had to beg the doctors to induce me at term + 12 days. They wrote on my notes - IOL for social reasons. Now compare this to what I am seeing today

IOL from the EXPECTED due date
Social induction from around 38 weeks
Failed induction due to unripe cervix (GO FIGURE!!)
Vernix covered babies at T+ gestation (hmmm)

And thats only the start of it. Although I do not like to generalise, it seems that by majority we have lost touch with our bodies and hence when pregnancy miraculously occurs, we have no idea when we conceived, when our last menstrual period was or even care. I can understand this because sometimes the last thing I want to think about is my period and how annoying it is but what I am trying to highlight is the fact that, our bodies, our cycles, our ability to produce life, sustain it and give birth to it have become second, third, fouth, etc, to higher priorities.

I am deliberately making this point to try and justify in my minds how there always appear to question marks near or around the estimated due date. Deliberately because I want to make the point that its only an ESTIMATE!!!! Normal pregnancy gestation is 37-42 weeks, look in any text or reference and this will be clearly written, yet somewhere and somehow someone decided that that wasn't good enough. We need routine, structure, a timetable!

As far as I can gather the EDC or EDD was only created to give them woman some insight as to when labour may start. I dont think it was ever meant to be THE be all and end all OR the determinant of what will or wont happen. So unfortunately this date has been manipulated in such a way that it warrants the rights of OTHERS to make a decision as to when a baby is born.

I sat up thinking about this last night with the knowledge that primips or first time mums in general will go into labour post their due date and wondered with the understanding that we have, that being that between 41-42 weeks gestation is still safe, what would happen if we shifted the EDD to equal a gestation of 41 weeks rather than 40? Come into play politics and legalities but all that aside, what would be the outcome particularly as I am aware that 40 weeks gestation is an average gestation.

Nothing much changes. There is still an EDD, there is still that date to linger on, there is still room for manipulation. The truth of the matter is, nothing in this world is set in stone, nothing is stagnant, things change. Given that as humans we manipulate and influence so much, how can we be sure that we haven't done the same on the normal gestation of pregnancy? Its obvious we have had an enormous influence on it in a surgical, medical way but I am talking more of the physiological, psychological and environmental way. If the human race has the ability to F*#$ the planet as it has and influence global warming, seasonal shift, pump hormones into the food we consume, control life as far as messing with genes and cellular bits and pieces and possibly initiate many of the natural disasters that have occured in recent years (or months!), whats to say that we haven't done the same to pregnancy, the initiation of labour, a babies' birth??

Food for thought and my need to question...

Birth, Breastfeeding and Beyond Conference

2008-06-02T13:28:00.002+09:30

Despite it taking me almost a week to write about it, I haven't forgotten the truly inspirational stuff that I heard whilst listening to Michel Odent and the other speakers of this conference. After debating for so long as to whether or not I should go, I am glad that I made the decision to take the day off of placement and spend a little bit of money on an emotional, uplifting and motivational experience.

I knew of Michel Odent and his work but have never really had the time to sit and read his books and adding to my library has come to a halt with the amount I outlay in textbooks, travelling and uni related stuff. However, I couldn't deny myself the opportunity to meet the man himself and have him sign one of his works for me as a reminder of what my role is within the current birthing culture. And so I bought 'Birth Reborn' and have begun to read it in the very few spare moments I have. I am sure that it will initiate many posts at a later date, so stay tuned.

It was just surreal to hear him talk. Intitally I found his accent quite hard to understand but once I became so engrossed in what he had to say, I was in the zone and despite sitting in the back row, felt like I had connected with his insight into birth and breastfeeding. On a professional level it linked and correlated so much of what we know to be true in a very different way but for myself, as a mother and a soon to be midwife, it struck something else in me. His words gave meaning and justification to the love that I feel for my sons and how important their transition into this world was, not just for me or their father but for all those they will come into contact with during their lives. It was so simple an explanation of how life and love come together and yet despite its simplicity, few of us in our normal, everyday life acknowledge it.

I walked away at the end of the day wondering if the world would change if they had heard and listened to what I had. It was real awakening to our naivety as humans, to the beginning, our birth, as not only influencing a single moment in time but an entire existence.

The 'Let Down' and the Beauty of Birth!

2008-06-01T13:26:00.005+09:30

My intentions were good... I really wanted to debrief here everyday after work but it seems that baby bundles had other plans for me!! I had made the decision before I started this placement to throw myself into every possible opportunity and that I have. Monday and Tuesday were back-to-back days of 14 hours followed by an awesome encounter with Michel Odent on Wednesday at the BBB Conference backed up with two more days of 'my' midwifery! Below is a little of what happened...

Monday unfolded in a way that had me believing in myself as a midwife. Without really being aware of it at the time, I reflected on the day as awakening me to how much I knew and how far I have come. I had initially started on the ward and had completed my first round and then sat to await the influx of antenatal assessments from clinic. Fortunately for me, with this influx came the opportunity share one woman's experience of nature of birth to creep up at the most unlikely of times.

Whilst she leaned over the desk holding her belly and pointing to her appointment on her handheld record, the adrenaline started pumping. I wasn't quite sure whether to trust what I was suspecting and yet I seemed to go with it sub-consciously. Palpation further confirmed suspicions - LOA, head engaged, uterine tone, concentrated breathing. Baby??

As a formality I continued with the CTG and even with the understanding that their story of the situation isn't always a true indication, I soon had a trace in front of me that flashed 'labour', 'LABOUR', 'LABOUR'!!

Of the many opportunities I have had, it was the first I had been able to step up and take the reins in the sense that I did what I had to do as far as the politics were concerned but also in bring the elements of birth how I know it to assist and optimise this woman's experience. Despite our medicalised surroundings, I kept it simple. We utilised the floor for massage, optimised the calm with minimal light and between contractions, engaged in chit chat. As contractions intensified and second stage neared I followed to the shower that soothed the pain and empowered her with a sense of owning the moment and listening to her body. Close by but far enough away so as not to intrude in 'her' space, I directed the stream of water. When her legs became tired we moved back to the the birthing stool and she found comfort in sitting leaning against her partner whilst I took the weight of her legs on mine to assist in the squat. Position changes flowed to the beginning of second stage and the calm remained.

This mood remained for so long as second stage continued to the point where progress seem to stall despite the numerous position changes and reassurance and a completely happy baby. Given the 'time' restraints and the lingering registrar, it was found we had a case of Deep Transverse Arrest and ventouse birth soon followed.

Tuesday began with another birth and entering the room was so different to the day before. Light, people, urgency. The stage was set and a baby was had. It was beautiful in its own right.

The urgency soon dissipated and I was soon blessed with the opportunity to be with another woman. Although it was an induction, the mood was similar to the day before and I observed as she went about labour as just another part of the day. Ignoring the the syntocinon infusion and the continuous CTG monitoring (which is sometimes hard to do!) she birthed her baby like a goddess. I was fortunate to work with a midwife that was happy to hold the active third stage (query as to whether I can call it a physiological third stage or not due to the synt infusion) and I was supported in my choice to allow the cord to pulsate and the baby's need for the blood more than the blood bottles. Skin-to-skin and left to indulge in each other. Beautiful.

Wednesday - BBB Conference! I need a separate post for this. See here!

Thursday - Continuity! Postnatal care of two of these women to discharge! And showered with thankyous and gifts... I swear they are trying to make me fat - I have enough roses chocolates to feed an army!!

Friday... An absolutely fulfilling end to an amazing week! Again blessed with another birth, not just ANOTHER birth but a very special, unique and empowering experience for all involved. This woman was amazing, her husband was amazing and I was priviledged to be given the joy of being there with them. Circumstances for this woman warranted an epidural but the atmosphere was beautiful.

It was this finish to an unforgettable week that awoke me to my evergrowing intuition and my obvious distrust in it! Silly me... All signs pointed to second stage - palpation, fetal heart heard OA and early decelerations with contractions = head compression. Registrar appears. Outcome of palpation - head felt high! Response - huh? and a quick check. A show and head on view! Two pushes, no gloves, baby born, to chest, finds boob, sucks... no fuss, no rush.

SO I have explained the latter part of the title of this post and have in the best way expressed how I brought my understanding of birth and midwifery to the forefront and advocated and empowered the woman despite what was outside the bubble...

Definitely no 'let down', but plenty of 'let downs'!!! (what birth does to a breastfeeding midwife!) HOW I LOVE OXYTOCIN!!

Thought for today...

2008-05-29T18:06:00.001+09:30

I wrote this today in response to another post on our uni discussion board. For some reason it sounded good to me and reflected so much of what I have been feeling in the past two weeks and I wanted to share it...

I don't know how anyone in the position that we are as midwives, could forget how priviledged we are to be a part of the most significant moments in so many families lives. As a mother I can truly say that that single moment in your life when you birth your baby into this world and you become two separate entities, its not only the most beautiful and surreal and amazing experience (for lack of better words!!) but also the most vulnerable, scary and uncertain time because life just takes on this million mile an hour spin and in a solarity moment, your life changes forever. What happens, who is there, the things that are sad, what isn't said and everything else remains imprinted on your life, more than the actual physical act of giving birth because it seems as though we soon forget the pain and the vulnerability that we feel.

To be a part of a woman, a families and a childs experience of entering this world is an honour because not one is ever the same. The circumstances are different, the people are different, the baby is different.

We have to realise how truly priviledged we are to share the beauty of life in its purest form. Its something I cherish and have at the forefront of my mind because without these women and families, I wouldn't be in love with what I do and be completely fulfilled and complete.

I have been showered with gifts and I am only into my second week of placement. I have 3 boxes of roses chocolates from women I have been with and to me, all I did was do what I felt was owed to them. My gift to them for allowing me to be a part of that special time in their lives. I should be the one thanking them, not vice versa.

Placement - Day 1

2008-05-21T12:52:00.003+09:30

It was easy to walk back in there having been there for a good four weeks over Christmas and New Year. Being a small place, most of the staff remembered me and seemed to be confident that I was right to take on responsibility of patients from the get go.

The first question I was asked was 'how long are you here for?' and when I replied with 4 weeks the response was 'Oh great! That means we dont have to do any work for the next 4 weeks!' I wasn't quite sure whether to take that as a compliment or not but throughout the day it became quite obvious that I was going to be given a great deal of opportunity not always with the greatest of assistance. On most occasions, this isn't an issue as I generally know my stuff and am confident in what I am doing but at times, I had to stop and think about what would happen if things went bad and there was no one around because so many times when I wanted to just run things past someone, there was no one around. Particularly as the lack of urgency about an emergency situation became striking clear last time I was there.

Despite that, it was a good day and I had plenty to do. We didn't have anyone in labour so I mostly faocused on postnatal and also attended to a couple of antenatal assessments which were good learning experiences.

I was a little deflated when I first got there and looked at the board... every single one of the postnatal women had had a c-section for one reason or another. Some repeats and one, supposedly a result of a deceleration which to me, really didn't look like decel at all but rather maternal pulse... hmmm...

Tomorrow I am down to work with the midwife going to theatre for yet another section and should hopefully attend to the paperwork and following through her care on Friday. As for today, I am not entirely sure where I will be and what I will be doing.

But for now I must get going!

Placement!

2008-05-19T19:21:00.004+09:30

Tomorrow I start placement again, one week of antenatal followed by 3 weeks of intrapartum. I am nervous, as always, about what I am going to encounter - experiences and people particularly as a couple of experiences I had whilst I was at this hospital last time were ones that left me questioning whether I was right for midwifery, or whether midwifery was right for me. One was a distressing and disgusting forceps birth by a consultant and the other, a postpartum haemorrhage that could have ended in disaster... for both woman and baby.

I did a lot of soul-searching, questioning and crying trying to decipher where and why things ended as they did and going back there means reliving those events mostly because the PPH was the last birth I witnessed before I finished.

Expect me back tomorrow for a debrief :)

Thought provoking reading...

2008-05-16T22:29:00.003+09:30

I ventured onto a few other midwifery related blogs tonight, one Lisa's - definitely 'the' words that highlight, empower, rejoice and celebrate the power of a woman and her ability to birth. There is not one word, phase or story that could come from Lisa's heart that could demoralise or steal from what is a woman's right. Something that inspires me to be that midwife... the one who is in every sense, 'with women'. I can say this with confidence having not only been lucky enough to have her as my midwife, but also work alongside of her and witness and be influenced by her completeness and commitment to 'true midwifery'.

After a long week of pouring my best efforts into an assignment addressing the care of women with postpartum depression and other mental health illnesses and reading tiring journal articles and reviews that seem to overlook and totally dismiss midwives and midwifery, I needed to indulge in something midwifery.

In doing so, I came across some varied opinions of what midwifery is. Despite these coming from midwives, I was quite shocked to be confronted with almost opposing opinions... that word again... After nearly 2 and a half years you would think that I would be used to the fact that some midwives have this rather strange and deranged idea of what midwifery is (my opinion... for good measure) and yet somehow it still depresses and distresses to say it nicely.

I am lost as to how you could unjustifiably denigrate midwifery to just 'a job' or a means to an end, so to speak. Anyone who has had to opportunity to witness birth, regardless of gender, role, personality or input, would be lying if they said it wasn't one of the most emotional, amazing and fulfilling experiences they have ever been a part of. Admittedly, not all can openly confess to it whilst clouded by memories of pain, choice words, vagina and blood... take these clouds away and the beauty of the birth of a child is something that can only ever be justified by witnessing it.

Maybe its a case of 'seen one, seen them all'... however birth isn't just birth in the literal sense. Birth is what makes birth. It is not just a fragment of time, there is history and future in the making, not just for one but for many. Birth is unique; not one is the same.

And whilst I am laying out my two cents for all to see, why is it that a word such as midwifery- a neutral, empowering holistic one has managed to take on such power, indifference and control, in many instances? Maybe 'with woman' would be better changed to 'with midwife' for the majority because the most of what I have experienced has not been entirely about what the woman wants. Despite the obvious time constraints, protocols and policies in the system, there is not even enough emphasis about informing and empowering women to question and discuss their options.

Two words that kept reiterating themselves during my thought process... reciprocity and autonomy. I have experienced too much 'take' and not enough 'give'. Even the most normal and simple choices such as what a woman wears and what and when they are able to eat and drink are stripped from them. And that is not to mention the lack of consideration for privacy, dignity and respect... you would think that closing a door, pulling a curtain, covering a woman, knocking before entering and ensuring the bitching done behind the nurses station doesn't echo through the corridor to be heard by all, would be common sense. If only...

Childish behaviour has some how has grown legs and left the school yard. Time and energy that could be better spent fighting for birth, for women and for their rights.

As a student, I walk on a fine line. In many situations I have found myself pressured to do exactly the opposite of what the woman wants by midwives, registrars and consultants; to me pressure that was based on little or no indication. One such instance, the words 'infiltrate' and 'episiotomy' seem to ring in the background whilst my conscience beat them down with 'consent' and 'crowning' and 'contraction'... I stood my ground until literally removed to make way for intervention. I was fortunate enough to have a supportive midwife who up until that point placed confidence and trust in me to listen to the woman.

So I end with this, a thought provoking and real statement about who or what a midwife should be... I couldn't put it better myself so will use Lisa's words

Compromising your clients wish for a great birth isn't
our role. Keeping the space is.

Another Update - Malaysia

2008-05-16T12:08:00.006+09:30

I went to the information session today and learnt a little more. Not a lot but at least more than I knew yesterday. It looks at this stage as though I am the only external midwifery student going and that most of the others are internals or nursing students, not an issue but it would have been nice to go away to a strange place at least with someone familiar!! It is most certainly going to be an opportunity for me to work on my confidence in myself as well as the nervousness that I still experience.

This trip will take place over 3 weeks, one of those will be spent at the university over there, learning about the culture and the current medical and midwifery system they have. As far as I can gather, it is very old English style midwifery and nursing as they still wear the full kit and hat. It looks very professional but says nothing about their practice at face value.

Labour suites consist of one room separated by a curtain with as many as 6 beds. Privacy is obviously minimal. The smaller of the two hospitals in Sarawak is Miri (where we will be doing our placement) and they have anywhere between 10-20 births a day. When I asked about postnatal, the response was 'there is no such thing as postnatal!' They women stay for 2 hours after they birth and are then sent home.

So 2 of the 3 weeks will be spent at this hospital which should be a culture shock for me and a true realisation of how accustomed I have come to care here in Australia. In many ways I think that maybe they have it right in a sense, in that they have minimal equpiment and send women home. Maybe the hospitals here could take note!

I am eager to see what the the birth numbers are like and I guess the numbers of sections and assisted births, if they even do them! This obviously initiates a heap of quesitons in relation to induction, augmentation, pain relief, etc etc. Is it an option over there and if it isn't, what are the statistics for birth outcomes? Obviously the health system is not as developed but maybe on the midwifery side of things, that is a good thing. All of these things I eager to learn because I do believe that knowledge (in a sense), precaution, equipment and intervention in midwifery cause more problems than they fix.

Update - Malaysia Trip

2008-05-15T21:04:00.002+09:30

Well I am excited and pleased to say that this trip is definitely going ahead and I am definitely going!! Although extremely nervous about the prospect of not only stepping out of this country for the first time, but also into a country that doesn't have anywhere near as much as we do, I am ecstatic that I have this amazing opportunity.

I have looked extensively into the care of pregnancy and childbirth over there but to not much avail. The best information I have gained is from a friend who frequents there for holidays. Although he obviously hasn't spent much time in the hospitals, he did give me some great advice and his knowledge of what he believes the health system to be like there was insightful.

I am expecting it be an eye-opener and a real awakening as to how much I take for granted in my own life. The only thing that I have to compare to it, of course, is my life in Australia.

Tomorrow we have an information session which should shed some light. I guess despite the potential to read and study the culture via literature, the best understanding is most certainly going to be gained through firsthand experience.

My next task - organising a passport!!

A missed birth...

2008-05-11T11:04:00.006+09:30

I haven't been on here for awhile as a result of setting up a new laptop that my beautiful husband and my gorgeous boys bought me for Mother's Day and the fact that I haven't been well in recent weeks. I have had a couple of trips to the hospital which have found that I have ectopic heart beats, a pulse of around 40 and my blood pressure at an all time low.

As a result I missed being with one of my follow through women on Friday which I am really upset about but I do have something positive to share even though I wasn't there in body. Her first birth was with the assistance of an epidural recommended as a result of her rising blood pressure in the last weeks of her pregnancy. We had discussed this on a number of occasions and I had shared with her that I too had had an epidural with Kade. Originally she had suggested that she was going to opt for an epidural early for this labour and me being me, subtly told her about my experience of not knowing what early labour was like, how the intensity of contractions build, the feeling my baby moving downwards and the mechanism of birth that results in second stage particularly the burning sensation of crowning all because the epidural clouded my perception and my ability to remain in touch with my body.

In addition to this, I also ended up with a 3rd degree tear the first time round and as time has gone by and I have learnt more, I am tending to believe that it was because of this inability to listen to my body that it happened. I had no sense of pain and therefore continued to push regardless of whether my perineum was stretched to allow a Kade's head to come through. After having Jyrus, I am tending to believe it even more. With a head circumference 4cm greater than what Kades was, he left nothing but a slight graze and I put it down to the fact that I was in touch with what my body was telling me and in that, I listened.

I was happy to hear that my woman had taken my experience onboard and reconsidered the premature epidural and believed in her ability to work with her body rather than against it. She birthed her baby with only gas, which from my experience is a distraction rather than a true pain relief. Having spoken to her, she sounds so empowered and so proud of herself for trusting in her body and given that she had chosen the private sector, I feel so awesome that she didn't give in to temptation. If only I could have been there....

Yoga for Pregnancy

2008-04-27T16:40:00.006+09:30

One of our recent assignments involved choosing a complimentary therapy and producing a poster and powerpoint presentation that oultined the benefits of it during pregnancy, birth and beyond. I chose to look at Yoga emphasising the union of body, mind and spirit and the subsequent empowerment and understanding of oneself that a woman gains in practicising it and hence how beneficial it can be during pregnancy and labour. I have attached a link to the powerpoint that I did as a little information for anyone interested. I am hoping that once I have completed this course, I can study yoga and compliment my skills as a midwife using it throughout pregnancy, labour as well as postnatally, helping women get in touch with their inner selves and their bodies.

View my powerpoint here

To fight or conform?

2008-04-26T17:09:00.004+09:30

I have realised over the course of these two and a bit years that it would be quite easy to fall into the monotony of the system - stay quiet, do as your told, don't argue, remain oblivious to something more. And further more, I can understand why so many do. In a world where most would rather conform to the generalised way of thinking, its rare for anyone to be outspoken and question what everyone else sees as 'normal.'

As a kid I never felt I fit in anywhere and it has only become clear to me in recent years as to why... I am not one to conform... I don't take what people tell me as gospel... I question everything, even myself and until I started this course, I did not believe that making my thoughts public would have a serious influence on anyone and more, I really didn't think that I would find a real voice for the voice I have and what I have always called, my 'alternative' way of thinking!

Midwifery has given me purpose and passion and for this reason I have chosen to fight rather than conform. That is, fight for midwifery, fight for women's rights, fight for empowerment, choice and most importantly, the power, strength and ability of a woman's body to labour and birth a child.

A rare opportunity...

2008-04-26T13:34:00.005+09:30

I received an email the other day, informing us as third year students, that we have the opportunity to travel to Malaysia as part of our final semester and last placement to work with locals at the hospitals over there and experience a very different culture and birthing experiences. I had actually learned of this in first year, but at that stage, was really quite nervous about stepping out in the big bad world and making myself known, particularly as a midwife.

Now, having changed immensely due to what I have experienced in the past 2 and half years, I am a lot more confident and trusting in my abilities, not only on a personal level but I guess, professionally and when I got the email was quite excited about the prospect of actually doing something completely unlike me, and grasping the opportunity whilst it was there.

So if all goes to plan, I will be heading to Malaysia at the end of September (on my birthday actually), for 3 weeks as part of my final practicum. I am excited as I have never been anywhere out of Australia but at the same, really anxious and nervous about what I am going to experience and how I will handle being away from my family and more so, about my abilities as a midwife to actually make somewhat of an impact or difference whilst I am there.

I have no idea what I will encounter... especially in regards to their management of labour and birth but I am hoping to look into it and hopefully prepare myself somewhat for it.

I will make updates as I know more and about anything that I learn about the differences between here and there.

THE Homebirth that started it all for me :)

2008-04-19T17:21:00.003+09:30

Thank you Nikki for allowing me to add this... Mwah!!

As written in her own words...

Thoughts of a homebirth had crossed my mind for the birth of our first daughter, Eleni Clover. Ultimately we made the decision to birth with the Midwifery Group Practice in the Women’s and Children’s Hospital Birth Centre. Being our first pregnancy and not knowing how I would cope with labour pains and any potential complications, we decided we would feel more comfortable with hospital backup close at hand if it was required, and being more relaxed we would be better able to achieve our aim of a vaginal birth without drugs and any interventions. With the guidance of a marvellous midwife, Emily Daw, we achieved everything we had hoped for.

Eleni Clover was born in the water after an 8 hour labour, with no drugs, no interventions and no tearing. My husband Alex caught our darling baby, brought her to the water’s surface, we discovered her gender for ourselves after a few minutes of awed baby gazing, and he cut the cord after it had finished pulsing. It was the perfect birth for our firstborn, and we still would not change a thing.

For our second child, I wanted to do things a bit differently. I now had trust and confidence in my body and knew how it was very capable of birthing easily. I wanted to use that confidence and experience to enhance this child’s journey into the world. We researched homebirthing from early on in the pregnancy, but the financial side of it was our stumbling block. It wasn’t until I was about 25 weeks pregnant that we had explored all our options and bit the bullet in withdrawing from the MGP and hiring an independent midwife. We chose Lisa Barrett to help us in our baby’s homebirth journey. After meeting with her, we liked her professional approach to birthing. Her work was guided by factual and evidence-based information, and she had a wealth of experience behind her. We felt comfortable that we would be given unbiased information for each choice we would need to make, that our decisions would be respected and that she would be a strong advocate for us if or when required. I also felt it was important to have a student midwife with us, and we chose 1st year student Megan Castell to join us.

My pregnancy was much easier this time. A small amount of spotting at 8 weeks was worrying but resolved without any problems. I still had morning sickness, but it eased by the beginning of the 2nd trimester, and the early tiredness wasn’t as bad. It may have felt easier due to my caring for Eleni, as opposed to being totally focused on my pregnancy and every little sensation the first time, or it may simply have just been a case of different pregnancy & therefore different symptoms. However, I became convinced the differences meant I was carrying a boy, but Alex was convinced it would be another darling daughter. Our 19 week morphology ultrasound showed our lovely baby growing well, but also the presence of choroid plexus cysts on its brain. The absence of other abnormalities meant it was not a concern for our carers, but it remained a niggle in the back of my mind throughout the remainder of my pregnancy. Once the morning sickness disappeared I felt fit, healthy and strong, and this feeling dominated until the end. At 28 weeks I chose to have the Glucose Tolerance Test, and my results came back within 'acceptable' limits. My iron levels were slightly below the recommended level for pregnancy, but supplementing with liquid Floradix remedied that. Each appointment with Lisa and Megan was quite uneventful as I felt so good and there were no pregnancy complications. As the pregnancy went on, our baby decided it really was quite comfortable being breech, and showed no signs of wanting to turn cephalic.

Around 34 weeks we decided to try changing his/her mind, and I began the nightly ritual of lying upside down on an ironing board tilted at a 45 degree angle. This was a challenging position to get in and out of, some days I could stay there for the full recommended 15 minutes, other days I could only last 5 minutes before the blood rushed to my head and the weight of the baby and my stomach contents got too much. Just before 36 weeks, Alex set up the board a bit differently, and as I got on, our cheapie chipboard ironing board snapped. At our appointment with Lisa the next day, we discovered the baby had turned cephalic, so thankfully the days of being upside down on the ironing board were over and the broken board didn’t matter. Or so we thought…

On a Saturday morning at 37+3 weeks I woke up and realised I had not felt the baby move since early the night before. Much poking, prodding, walking around, and drinking cold orange juice couldn’t produce even a ripple of movement, so we rushed off to the W&CH in tears and panic. I was hooked up to a CTG machine, which showed a good heartbeat, but not much movement, so I stayed connected for a further 20 minutes to ensure baby was ok, and its movement picked up to a more reassuring amount in this time. The attending midwife however was not convinced the baby was still cephalic, so we had a quick ultrasound to confirm the position. Sure enough, our baby had once again decided that being breech was better, that it needed to be close to my heartbeat again.

I had researched my options for breech births when baby was breech the first time, and had decided that I would still attempt a vaginal birth at home, especially as Lisa had the necessary experience to facilitate it safely. When the baby turned cephalic, I put breech thoughts out of my head, and now I needed to confront them again. After much thinking, I decided that this baby was trying to teach me something, and I believe it was to trust in my baby and body, to stop trying to control a process that I really can’t control, and to accept whatever happens even if it isn’t what I had planned. I also believe that my baby stopped moving deliberately so that I would find out it was breech and learn my lessons in time.

With those lessons in mind, I decided I would give myself and my baby the best chance of having a cephalic birth, and once again go on the ironing board, try acupressure and moxibustion, and attempt an External Cephalic Version before 38 weeks. If those attempts did not work, I would accept that this baby needed to be breech for some reason, and birth it at home provided its bum engaged. If its bum had not engaged by the time labour had started, I would bypass any pharmaceutical ways of forcing that and would accept a caesarean section. Once I had decided that, I felt very peaceful and open to whatever my baby had planned for us.

I had the ECV booked for 37+6 days, and with my support team of Alex, my mother and Eleni, plus Lisa and Megan, I admitted myself to the W&CH labour ward. The CTG showed a good heartbeat and movement rate, I had blood taken ready to receive anti-D afterwards, and was ready to receive salbutamol via IV to relax my uterus to make the turning easier, all that was left was to wait for Dr Chris Wilkinson to arrive. He did, and on palpation he was certain my baby was still breech. He still needed to check the exact position by ultrasound though, and much to everyone’s surprise found our baby had turned cephalic. In hindsight, that must have happened a couple of nights beforehand, the baby kept me awake for several hours with very vigorous movements which must have been it turning again. Even though the baby was once again 3/5 engaged, I prepared myself for both a cephalic and a breech birth, knowing that it still had lots of fluid and room to turn again, and quite possibly we would not know for certain which way the baby was until it was actually being born, and I was ok with this.

With the baby most likely being cephalic, being 3/5 engaged, the strength and frequency of Braxton Hicks contractions, the fact that Eleni had been born one day early, and that I was still breastfeeding, it all led us to believe that this baby would be born before the due date. I now stepped up the pace in finishing off projects in case this did happen, and had everyone on standby from 38 weeks onwards. Again, my baby had a lesson for me - patience. My due date came and went, with no real signs of labour being close. I now started to think about my options in going ‘overdue’, and decided that anything up to 40+7 would be very gentle and non-invasive. I wanted this baby to choose its own birth day, however, I was not comfortable with going past 40+14. With Lisa, I planned that at 40+9 weeks I would have acupuncture to try induce labour, and if that didn’t work, I would have a stretch and sweep at 40+12 weeks. If that too failed, at 14 days overdue I would reassess everything with Lisa. In the meantime, I burned clary sage oil, had sex every day (Alex was happy with that!!), and started taking 2000mg Evening Primrose Oil tablets daily.

Each night I would go to sleep wondering if the next day would be the day, and each morning I would wake up and somehow know it wouldn’t happen that day. After thinking I would go early, making it to 40 weeks and beyond frustrated me. I still felt extremely good, was sleeping well, and was still enjoying being pregnant, but I was very much looking forward to experiencing labour again, having our much longed-for homebirth and meeting our new little family member.

I was extremely excited about birthing at home. I wanted Eleni to be at the birth, even if she slept through the labour, and had asked my mother to be her support person in case she got bored, distressed or was too distracting for me. My midwife had taken photos during Eleni’s birth, and I very much wanted this birth to be filmed, so I asked my brother Nigel to be the videographer. I envisioned the birth pool set up in the corner of our lounge room, near a window for natural light, but with walls on two sides of the pool I could face in case I needed to block everything and everyone out. I wanted our screen of our wedding photos and a little table of meaningful nick-knacks in the corner behind the pool to give me something to focus on, the oil burner on and my lava lamp going for softer light, and a range of music from Paul Kelly to Mental As Anything as a distraction. We had stocked up on snacks and drinks to have on our kitchen table, celebratory champagne in the fridge, and had DVDs to keep our support team occupied during any boring parts. Alex would decide at the time if he wanted to jump in the pool with me or to stay on the outside of it, but he would catch our baby and place him or her in my arms. We would discover and announce the baby’s gender ourselves, wait for the cord to stop pulsing before he cut it, and would have a physiological third stage regardless of how long it took. I had it all organised and ready to go, we were just waiting for our baby to choose its birth day.

I turned over in bed at 4.30am on Tuesday 29 August, six days overdue, and feeling a gushing sensation thought I had wet myself slightly. I hobbled down to the toilet to discover lots of clear mucous, not urine or amniotic fluid. It was exactly like the fertile mucous I was watching for when we conceived our baby, and I had the thought my body was trying to make a new baby before it had evicted the current tenant! I had assumed the mucous plug would be the same as it was in my first pregnancy, but even though it was quite different I knew it was part (or all) of the plug. I put on a pad, and went back to bed but couldn’t sleep. The baby had become very active, wriggling around quite vigorously, and I lay there wondering if it was turning breech yet again. (In hindsight, it was the baby moving into the anterior birth position from its almost posterior lie facing my left side.) I could feel more mucous coming away, and around 5am some irregular, strong but painless Braxton Hicks contractions started up. I didn’t take much notice as I’d felt them since 16 weeks, but by 6.15am I had an inkling that today would be the day.

I SMSed Lisa and Megan to give them a heads up so they could organise their day, and my mother and brother so they could also get organised. I told my mum she’d still be able to keep her dentist appointment at 9.30am, but should pick up my brother from the other side of town beforehand just in case.

By 6.30am I was bored of lying in bed – the baby had stopped moving by then but the BH were getting more intense, even though they were still not proper contractions – so I decided to have a shower. As soon as I got out they changed in sensation, becoming regular and much more intense and painful but still well within my comfort levels. I knew then that my labour had just started, so woke Alex to help me time them. They were coming roughly every 2 minutes, lasting 30-45 seconds. Because they weren’t lasting long I thought I had plenty of time and we dawdled around. Lisa called at about 7am to check how I was doing, I told her I was ok, but wasn’t sure at what point to ask her to come out, knowing she had a 45-60 minute drive depending on traffic, and I didn’t want to ask her out too early and waste her time. We decided that she would drop her son off at kindy and she’d head out here after that, as I still thought I had plenty of time. I called Megan at 7.10 and told her Lisa was heading out soon and we thought it would be a good idea if she headed here soon too. At 7.15am the contractions stepped up another notch, and I needed to be silent through them and concentrate on my breathing and pelvic rocking. Lisa called back shortly after to suggest we start filling the birth pool as it takes 2-3 hours to fill, and I had a contraction while I was on the phone with her. She heard something in my voice and breathing that suggested that she didn’t have time after all to drop her son at kindy and said she was on her way and she’d be here by 8.15, 8.30 at the latest. I felt relief at that thought, as my contractions were so close together and I hadn’t expected that to happen so soon. As I continued to have contractions every 1.5-2 minutes, Alex spurred into action, moving furniture and setting up the frame of the pool.

Between contractions I helped get the canvas lining in place, and Alex was trying to connect the hose to the laundry taps as my mother and brother arrived at 7.25am. As Eleni was still asleep, they both got stuck straight into helping Alex to start filling the pool with cold water, and Nigel also started filming me and asking questions about how it had started earlier. The pool filled quite quickly to 1/3 full of cold water, and we could now start adding hot water. (We needed to add the hot water later to help keep the pool temperature as hot as possible.) Unfortunately we only have a small hot water heater and the hot water ran out quickly, so Alex, mum and Nigel set to work boiling water in kettles and in saucepans on the stovetop. In the meantime I set up the oil burner with lavender, clary sage and orange oils, but didn’t really get a chance to do anything else between contractions. The pool was set up where I wanted it, the photo screen of our wedding photos was in the corner, the oil burner and the lava lamp were on, but that was about as far as I got with what I had envisioned the set up to be.

One of my few concerns was that in my first labour I had no strong physical urge to push, it was more of a mental urge, and for a while I was pushing unknowingly against a stubborn cervical lip. I wasn’t sure if I would know when to push this time either, or if I’d get a cervical lip again, plus I knew if it did turn out the baby was breech it was advised I resist the urge to push for an hour to ensure my cervix was fully dilated. As it turned out, just before 8am, I first felt the urgent need to push. It was immensely strong, like a freight train rushing through my body, and there was no mistaking it. I was concerned that Lisa was still at least 20 minutes away, and did not want to push without her there in case the baby was breech or I had a cervical lip. While Alex, mum and Nigel were starting to sense the need to rush and were frantically trying to fill the pool to a high enough level and warm enough temperature, I knew the pool would be nowhere near ready as I was ready to give birth there and then, and needed to have an alternative place to birth. I set up a drop sheet and towel in front of a lounge chair, and fell to my knees leaning over the seat of the chair in yet another contraction. The frequency and strength of the contractions were so unexpected, I was having trouble focusing and gathering my thoughts and concentration between them. I felt almost like I was drowning in them, though they were never unbearable. I felt hot, and stripped off my jeans and top, leaving only my bra and knickers. With each contraction, by now every minute, the urge to push was so strong, and I was roaring with it and resisting it at the same time. On the video, it is striking that even at this point, I was able to hold a conversation with someone, but glazed over and roared through a contraction before picking up the sentence exactly where I left off. I now feel the need to go to the toilet, and Alex helps me. Once there, I can feel a huge soft bulge coming out of my vagina, and ask Alex what he can see. He says it looks like a big whitish balloon, and with a resisted push I feel a pop and a small gush, which is my waters partly breaking. The urge to poo eases, so I just take my knickers off and make my way back to my chair. Eleni has woken up while I was in the toilet, and my mum and Nigel have entertained her and gotten her dressed.

Megan arrives shortly after, around 8.10am. More resisted urges to push come and go. I say to Alex that I’m not sure if I need to do a crap or have a baby, he laughs and says probably both. On the video you can see part of the membranes hanging out of me. I can feel what I think is the head (not a bum!) descending, and I wish Lisa would hurry up or she’s going to miss it all! Lisa finally arrives around 8.20am while I am in the middle of a contraction, I am aware she has walked in the door but I am unable to acknowledge her until the contraction has passed. By this point I am not really paying much attention to what she and Megan are doing, I am trying to focus to avoid the drowning feeling. Alex has sat down on my lounge chair, and I am leaning into him and continuing with the pelvic rocking and deep breathing. On the video Lisa gets straight into it, leaning down to see what is happening (what a view she must get!), and must realise how close I am to giving birth as she and Megan immediately get the oxygen and other equipment ready in a hurry. The oxygen tank blasts out a noisy shot of oxygen quite close to my head, and I barely jump. I come out of a contraction enough to yell at my mother and brother to stop filling the pool! it’s too late! the baby’s about to come! and Lisa also says to stop, and tells my brother to get into position as the head is about to crown. Nigel barely has enough time to do that when another huge urge to push hits me, but I feel safe to go with it now that Lisa is here.

I instinctively start panting, and with barely any effort on my part, the head appears. The video shows the head coming out quite quickly and easily, and as the head is fully born you can see the membranes are still over the baby’s face, trapping amniotic fluid under it. You can see the baby’s eyes are open, looking upwards at the faces looking back in awe. Lisa announces what is happening, and that she is pulling the membranes free of the face, releasing the fluid, but I am not aware of what she has said. You see the fluid running off the baby’s face, it is squinting, and twice spits out a fountain of amniotic fluid from its mouth with a little squelching sound. I come out of that contraction, and ask Alex if he still wants to catch our baby. He rushes around behind me, not realising just how quickly it is all happening, and gets into position. Another wave hits, and I am vaguely aware of Lisa telling me to push slowly and gently. I hear her saying something else, but I don’t know what. The video shows she is telling Alex how to bring the baby out and up, and giving me additional guidance. With the next contraction, the baby doesn’t turn easily by itself, so Lisa guides its body to turn. With a pop the shoulders and arms are born followed by the rest of its body. I feel the stretching more intensely than my previous labour in the water, but it is not unbearable. I am focused on breathing and half pushing the baby out, and the different sensations as the different body parts are born. The video shows Lisa quickly and calmly pulling the cord over the baby’s head where it was wrapped around its neck, and neither Alex nor myself are aware of this until a few days later when we watch it.

It is relief when the baby is out but I am not with it yet, and don’t quite click that our baby is now here earthside with us. The time is 8.26am. The remaining amniotic fluid gushes out warmly onto the towel I am kneeling on. I do hear someone say “it’s a girl!”, on the video it is Alex saying that, and he passes our daughter to me through my legs. I feel stunned and dazed and in awe of this lovely creature I am now holding. I blow gently on her face to encourage her to start breathing, and she lets out a healthy cry. I see her colour go from purple to pink, and note she has quite a bit of vernix on her head and face, and wrinkly hands and feet. I am given a towel to wrap around the parts of her body that aren’t in contact with mine, to help keep her warm, and I can’t take my eyes off her face. She is beautiful, and I think she looks very much like Eleni did except I think she is smaller. Alex and I look at each other, and silently agree that yes, of all our chosen names, she looks like a Sasha Daisy, and we introduce her to everyone.

Eleni is curious, but a bit hesitant. She doesn’t like the look of the blood on and around me, but approaches to give me a big hug and a kiss, before retreating to the background where she is content to sit with her Nana and Uncle Nigel. I feel like I sit there for hours staring at Sasha before I feel another contraction to birth the placenta, but in reality it’s only about 10 minutes. The first post-baby contraction dies away, but the placenta comes out easily with the next contraction. Alex cuts the cord, and Eleni whimpers when she sees the scissors. We have taught her that scissors are sharp, and she is scared we are hurting Sasha. We give her another hug and reassure her. I now move up off the floor and onto the lounge where our baby and I am wrapped in more towels and blankets to keep us both warm. I put her to my breast, and she starts to feed straight away. She is a natural. Her feeding brings on some afterpains, and maybe because I am sitting still, they oddly feel more uncomfortable than my labour contractions. Even though I am holding our daughter, and have fallen in love with her immediately, I feel so dazed by the speed of it all, and have trouble absorbing the fact that I have given birth in such a short space of time.

My labour was 1 hour and 50 minutes, and if I had gone with the urge to push when I first felt it, it would have been closer to 1 hour 15 minutes. I think to ask Lisa if I tore, as I didn’t get the skin softening benefits of the water, she and Alex agree that I didn’t. Later examination confirms that I had no tears, but 2 grazes so superficial that they are barely there.

After sitting on the lounge for a while, I start to get cold. The birth pool is too cold for me to get into, so we get our normal bath filled with some pool water topped up with boiling water from the stove. Before I get into the bath, Lisa checks Sasha over. Her head circumference is 34.5cm and her length is 52cm. To weigh Sasha, Lisa places her in one of our green shopping bags and hangs the bag from a fish scale. She weighs in at 3.74kg, or 8lb 4oz, to my surprise she is heavier than Eleni though I still think she looks much smaller. We then dress Sasha, and Nana has her first hold. Alex helps me to the bath, though I feel surprisingly strong. The warm water feels good, but I am quick, I want to get back to my newest daughter. Back in the lounge again, everyone is euphoric at the ease of the birth and surprised by the quickness of it all. I also feel a bit lost.

I am lucky that I really enjoy being in labour and birthing, if I could do it over and over again I would. I love the anticipation of it, being in the thick of it and feeling all the sensations of labour and birth, and the joy of meeting a new human being of Alex and my creation. I had waited excitedly for so long for our homebirth. We anticipated maybe a 4-6 hour labour, and I thought that was the perfect length of time - long enough for me to enjoy the process, short enough not to get overwhelming. When it all happened so quickly, my mind couldn’t quite keep up with my body and I was left feeling like I had missed something. Later someone said to me that I would probably prefer a quick labour like Sasha’s to Eleni’s 8 hour labour or even longer. I don’t actually have a preference; both were equally good, just different. Eleni’s was longer, but I had time to gather my thoughts between contractions and always felt in control. Sasha’s was short and sweet but with the contractions coming so close together I felt somewhat overwhelmed.

We spent the rest of that day getting to know our daughter, and introducing her to a steady stream of our immediate family visiting. In the days following her birth, she has slipped easily into our lives and hearts. She is a natural feeder, and is very calm and happy. She is almost the spitting image of Eleni at the same age, except she has a bit more hair that is slightly darker. I am already in love with her. I love her funny little crossed eyed gaze as she tries to work out who I am. I love the gurgles and snorts she makes in her sleep. I love the little kink in her hair at the nape of her neck, her facial expressions as she fills her nappy, her baby smell, how she looks and feels as I hold her over my shoulder to burp her, and how she’s so keen for a feed that she tries to ‘help’ stuff my nipple in her mouth and ends up with both her hands in her mouth instead.

I am ecstatic we achieved our dream of a homebirth. Alex is a bit disappointed that he let his tiny reservations stop him from getting as excited as I did in the lead up, as once it was over he realised how much he really enjoyed it all. He now cannot imagine anything other than a homebirth with Lisa again for any future additions to our family. Lisa jokes that next time she is camping out at our house from a week before my due date, otherwise she has no hope of making it in time and I’ll end up free-birthing! I have recovered so quickly, and my postnatal visits with Lisa and Megan are probably very boring for them as there’s nothing to do! After the initial hesitation on Sasha’s birth day, Eleni has taken to her extremely well and is very protective and loving towards her. She loves to hold and kiss Sasha, and her face lights up when Sasha looks at her. I am not sure how much Eleni enjoyed the birth, but I think it was more the sight of my blood that unsettled her, not the birth itself or the sudden appearance of a new baby, and it definitely hasn’t had a lasting effect on their relationship.

I am also extremely happy I had the birth filmed. So much detail was captured, a lot of which I wasn’t aware of at the time, and the birth scenes themselves are so fabulous I wish I could show it to everyone, but I can’t because of its private nature. I highly recommend to anyone considering filming their birth to do it, even if you don’t have it at the ‘business’ end. Even just capturing your reactions and those of your support people is worth seeing, and there is so much you don’t notice when you are the one in labour. In the days and weeks following Sasha’s birth, I have found myself watching the video over and over, or thinking about how it all happened a lot, and I always have a smile on my face. It was such a relaxed, intimate, empowering, and exhilarating birth, and to me is exactly how a birth and the memories it creates should be.Thanks to midwife Lisa Barrett, student midwife Megan Castell, my mum Maxine Koop, my videographer brother Nigel Koop, and especially to my husband and daughters, Alex, Eleni and Sasha Cook for making it all happen with me.

Jyrus 28-09-07 - Homemade :)

2008-04-15T11:07:00.004+09:30

My story without words... the pictures below say it all...

Good, Better, Best

2008-04-14T21:42:00.004+09:30

Another part of our requirements is following 40 women through their pregnancy and birth which is a great way of building rapport and advocating for women. As well as this, it assists with our birth numbers but unfortunately has resulted in picking and choosing of follow throughs who are more likely to have a normal birth.

In my opinion, any woman that is happy to have me follow her through is a blessing and I would not, not follow them through if their intention was to have a caesarean or there was an increased risk of having one because I believe all women should be supported. It does not mean that I advocate for caesareans that may not be needed or do not attempt to suggest to the woman that a Vaginal Birth After Caesarean (VBAC) is a possibility, but I do not feel that a woman should be denied support and continuity just because there is a 30% chance they may end up in theatre.

It does not teach us anything about 'being with women'; it ignores the true meaning of midwifery. It may seem contradictory to my advocacy of homebirth but where training remains limited to the system and the highly likely result of a caesarean or assisted birth, I don't believe it should be treated as any less significant particularly because it seems that of all women, these are provided with the least choice of all.

A want to practice what they teach...

2008-04-14T21:38:00.003+09:30

Despite being of the understanding and opinion that birth is normal and natural and that a woman's physiology was intended for the purpose of supporting and bearing life and being taught this, I am frustrated by the lack of normality that I have witnessed as a student. Our requirements to register include being primary carer of 40 women having a normal vaginal birth... that means no forceps, no ventouse and definitely no caesareans... Here fellow students and myself face a dilemma. Current figures suggest that the caesarean rate is encroaching on 30% or more of births and even higher rates in the private sector, and thats independent of assisted births. Lets for arguments sake say that 50% of all births are either by caesarean or assistance (the current trend suggests this) and that of the 'normal' births include those with intervention such as induction, augmentation, epidural, active third stage ( acascade that increases the risk of caesarean or assistance), what hope is there for us to firstly meet these requirements and secondly, witness anything close to the normality of birth?

The year I began this course, there was not yet any restrictions on us attending homebirths, well not for the university that I am studying at anyways and hence the reason why I was lucky enough to witness and be with a woman who birthed her bubs at home. It was the most amazing experience and having been a part of it, I couldn't think of any other way to have my next baby when the time came. Shortly after I attended this homebirth, we received an email from the university saying that we were no longer allowed to be present at them for insurance reasons... and there went out opportunity to experience a truly physiological birth. Having now had a homebirth and comparing that with the hospital experience I had with my first and that which I have witnessed on the other side of things, I know that I will only ever see a 'normal physiological birth' with a woman birthing at home.

Myself and others have attempted to try and change this but it seems that everyone we approached passed the buck on to someone who would also pass it and so we went round in circles, without getting any answers.

Another reason why I want to bring birth back to what it is in its rawest form and practice what we are taught... and I guess, naming this blog what I have.