Saturday 20 February 2016

Children at birth.

Homebirth and siblings .

As a privately practicing independent midwife in Wollongong, one of my favourite aspects of home birth is that it is a family affair.

If it is not the first baby being born, the involvement of siblings in the preparation for birth, the lead up to labour and welcoming their new baby earth side is such a wonderful learning experience and a special time that bonds the whole family, especially baby and sibling from well before baby is born.

The girls would greet me at the door screaming
 "Midwife is here!!!!"

The midwife and children develop quite the
bond of their own over months of antenatal care.

In this blog post i'd like to address a few commonly asked questions about siblings and children at birth.

1. How will they handle it?

2. Will the noises scare them?

These two are best answered together. The key here is in the preparation. As a client recently described to her friends who were concerned for her girls aged two and four watching the birth, "It's not like I just sat them in front of me and said, here watch this. The girls had months of lead up, checking the baby with the midwife each home visit, reading books and watching videos, setting up the birth space."

There are lots of age appropriate recourses to help in the preparation. One of my favourite books is Hello Baby by Jenni Overend. This book shows the home birth of a family, their midwife and the labour. It talks about the noises mummy will make and shows the baby being born.
ABC Homebirth is a great free e-book. Like these, there are many other books available, some only in e-reader format but a quick google search should produce plenty to work with.

As well as books, videos can be used to help prepare little ones for what they are about to see and hear when mummy is birthing. I would recommend mum or dad watch the videos before they are watched together.

The beautiful book Hello Baby
by Jenni Overend, Illustrated by Julie Vivas.

3. What age is best?

I believe homebirth is appropriate for all ages. I don't think you can be too young or too old; each age has different challenges and advantages.

0-2yrs - these little ones are usually oblivious to what is going on. I think it's really important to have a spare set of hands in another support person. While often this age group is clingy to mummy when labour is under way, they almost seem to sense something is going on and can be unusually content being entertained and cuddled by another care provider.

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2-4yrs - the attention span of these little ones matches their years in minutes. They'll seem captivated and inquisitive one minute and then be running away to the toybox the next. They'll have more interest in the Paw Patrol DVD they've watched a thousand times than the noises or the body that is coming out of mummy. Don't be surprised if that same attention span is displayed when they are introduced to their new brother or sister for the first time.

Big sister is captivated...
Little sister... has ice in a cup... enough said.
4-8yrs - intrigue and mystery. These guys are fascinated and don't want to miss a second of the action. Action being the important word here. Normal birth can be slow and boring so these guys will sometimes be drawn to their younger siblings Paw Patrol DVD with strict instructions to be summonsed when something interesting happens. They love the noises, they love the gross bits and feel the love as much as mum and dad when that little baby finally emerges. Most of all they love telling all their friends and family how the baby was born in a swimming pool in the lounge room and how mum pushed it out her vagina and there was blood and even a placenta. If they're lucky enough daddy will even pass the scissors when its time to cut the cord.

Beauty and normalcy of birth being
imprinted for life.

8-12yrs - boys will often fake apathy and disinterest but keeping themselves in ear and eyeshot so to make sure all is going smoothly. Girls at this age are all over it; mini-midwives who want to do it all. They're in there with the torch and mirror trying to spot the first glimpse of babies head. They're giving mum sips of water and ice, heating wheat bags and changing towels and pads.

12 + - this age, whether boys or girls, get the most out of the home birth experience. While they may not know it at the time, they are getting a serious education; mum is setting the finest example of having faith in ones body, trust in birth and how birth is just normal. I believe these concepts are being seeded in each age group, but it's this adolescent group that will have a firm grasp on what it's all about.

4. Will i wake them in the night?
You might... usually not, but you might. When little ones wake in the night to find the exciting happenings of labour and birth, they usually find it pretty anti-climatic and grow weary of it and fall back asleep or asked to be tucked back into bed. More often than not they'll sleep undisturbed and wake in the morning to catch the last bit of action or meet their new sibling.

5. Will they annoy me?
Probably just a little bit. I do think it is a good idea to have a back up plan incase you find your little ones presence too distracting, Grandma or someone else could pick them up for a sleepover or take them out for a play. Usually with the right support your midwife or doula can help keep your mind in focus and dad can tend to the child. Often mums are good at tuning that little pixie voice out and indulging guiltlessly in the surges and what ever she needs to do to get through. Ultimately its up to you and how you feel at the time.

One by one these guys all arose from their beds,
 the excitement was contagious.
"shhhh" says grandma, little giggles continued
to cheer their mum on from the side line. 

6. Who will look after them?
I would say at the majority of births I attend it's only mum and dad and myself present. Between the two of us, myself and dad manage pretty well. By the time birth comes around the children are very familiar with the midwife. the children and myself have built our own little relationship and they are quite comfortable sitting back with the midwife watching on or flicking through a story book.
Mum can anticipate how much support she may need so if she's predicting dad and midwife will be tied up helping her through each surge, having another person to be on child duty makes sense.

They all jumped for joy when they laid eyes
on their new little brother.

Having a private midwife, where your pregnancy is completely normalised and your care is carried out in your own home, is just one of the perks of home birth. Children exposed to this are so very lucky and I believe it's setting them up to make informed decisions about their bodies when it is time for them or their partners to birth. Whether they witness the birth or not is not important. The benefit is in the time spent together, learning, preparing, trusting and bonding.

Thank you mum.
You're my hero.

Until next time,

Louise x

Saturday 16 January 2016

Natural Births and Hospitals... Do they go together?

Having a Natural Birth in Hospital - You have more choice than you think.
Louise David Private Midwife & Lactation Consultant.

louise david private midwife

If you follow me on Facebook, you'll know that I am a privately practicing (independent) midwife, and that I mostly attend home births. You'll also know that I share a lot of info about the safety and benefits of home birth over hospital birth. I share a lot of articles about how the hospital system often does a disservice to the pregnant and birthing woman and how intervention and medically managed births are the norm and poor outcomes, as far as her birthing plans and wishes, for the mother common.

This post is a little different. this post is about how achieving natural birth in hospital is possible and how you can best navigate the system to have great birth outcomes that don't just result in a healthy baby but a happy and empowered mum too.

1. Know the system and be prepared to stand your ground.

The norm in hospital is medically managed pregnancy and birth; tests are offered as routine not options, time restraints are put on labour and 3rd stage is actively managed, for example. Your birth plans may differ slightly or vastly from what is standard in the local birth unit. While I would like to point out that if you are aiming for a natural birth, your best place to achieve this is at home with a private midwife, we already know that's where I stand and this isn't what this blog is about.

Knowing that your wishes are not standard practice means you have to voice your desires and having a written plan to present to your carer is even more helpful. Your request may be met with some resistance, therefore it is important to have a thorough understanding as to why you desire what you do so that you can stand strongly and firmly in the belief that what you are choosing is the right choice for you.

At the end of the day, the issue of consent becomes very important. Know that you have the final say in all that is done to you and nothing can happen without your full and informed consent.

louise david private midwife
Having been induced 2 weeks early with her last two pregnancies, this mamma wanted to go into labour on her own this pregnancy. She waited ever so patiently. With the support of her private midwife she felt supported and confident in her choices to wait it out.
As her due date came and passed, together with her midwife she came to the decision  it was time to be induced at 40 weeks and 10 days.  The last labours were spent uncomfortably on the bed and restricted due to drips and monitors. This time, with the support of her private midwife as a guide, she was encouraged and helped to ambulate and be active. To use the shower, where she stayed to birth baby upright, something  she had not experienced before.

2. Have continuity of carer.

This means that ideally one person or one (small) group of people provide your care. Your philosophy and wishes become known and understood quite early on in your care and are carried right through out your pregnancy with no surprises at the end. For example, if you ask for a water birth when you're already in labour and it's the first time your carer has heard this request, don't be surprised if you're met with "oh no we can't offer that".

3. Have a known midwife for your birth.

Often in continuity of carer models, your care provider will follow you right through your pregnancy and also be the person who attends your birth. This is ideal and the birthing woman is secure in the fact she is with a known person she has come to trust. This is proven time and time again in the literature to result in better birthing outcomes.

louise david private midwife
With her 4 births prior to this, mum had always birthed up on the bed on her back. While she'd not had what she would call "bad" births, she wanted to not be told what to do and just do as her body  felt right. As this little one emerged, her private midwife encouraged Dad to come in and receive the baby. Her private midwife was acting in a support role only and the hospital midwives were more  than accomodating and happy to stand by and encouraged Dad also. Dad was thrilled to be able to help bring his daughter into the world. It's not something he'd planned on doing but felt he would never have been given the opportunity without the guidance from their own midwife.

4. If number 3 isn't possible have a known private midwife as a support person or hire a doula.

If it is not possible that the person caring for you in labour is someone you know and trust and someone that has previously been involved in your care, you can easily replace this void with an outside person. A private midwife who has done some or all of your antenatal care with you or a doula. The role of these people in a hospital birth environment is as a support person; someone who knows and supports your wishes and can advocate for you with the hospital staff.

louise david private midwife
Birth is beautiful no matter where it takes place.
One thing the mum and baby need is time. Mum needs time to catch her breath, to greet her babe, to rest. Baby needs to come to terms with all that just went on, to catch her breath, to find her Mum. When all is settled, Mum can be made comfy, cords can be cut and placentas birthed all of their own accord. This whole time baby has never left Mum's grasp.

5. Ask questions and trust your instinct.

One tool I used to teach in prenatal classes is the accronym BRAIN. The tool helps the user question, assess and rationalise that which is before them and come to a decision they feel at peace with.

B- what are the BENIFITS?
R- what are the RISKS?
A- what are the ALTERNATIVES?
I- what is your INTUITION telling you?
N- what if we do NOTHING?

Having the support of an educated individual beside you can help get the most out of this tool. Someone like a private midwife or a doula who can discuss the ins and outs of an intervention or a procedure and help you come to a decision that you can own.

louise david private midwife
BRAIN on having your waters broken artificially.

Benefits - Possibly speed up labour.
Risks - Intensify labour, mum has difficulty coping. Unexpected meconium stained liquor (baby has had bowels opened) leading to mum needing to be  monitored continuously. Time constraints put in place, how long membranes are ruptured is watched closely, risk now of needing IV antibiotics if goes on too long.
Alternatives - Waiting and reassessing as indicated. We can do it later, at anytime if we need to.
Intuition - My gut says everything seems to be going smoothly and I'm coping well so why would we do this now at this point?
Nothing - By doing nothing labour continues and if the need to augment the
labour presents itsself sometime soon we can still do the procedure then.

Wishing you the best of luck on your birth journey. Wherever you may be birthing, whichever birth number this is is for you, trust yourself and your body.

homebirth wollongong independent midwife wollongong
Until next time,

Louise x

All photos taken my me, Louise David private midwifelactation consultant and birth photographer.