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.

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.

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.

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.

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.

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.

Until next time,

Louise x

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

This is how its supposed to be....

The most recent home birth I attended was the most humbling birth I've seen yet. It’s my wish that the norm for all mums is to birth in this way, especially first time mums like the mamma here in this post. All too often it takes a horrible, traumatic birthing experience for mums to wise to the system, learn of other options, learn how different it can be... how it’s supposed to be.

Mums like this new mother never cease to amaze me, and make me proud to have met them and, better, get to know them. This mamma trusted her body from the moment her pregnancy was realised; she grew a healthy girl inside and our midwife/client relationship flourished with honesty, trust and encouragement. Mamma was all-embracing of all that was to come with labour and birth and baby.

Jack the puppy watches on..

Baby Audrey decided to come earth side on her due date. Mamma was ready after her water broke two days earlier and finally it all came together on a lovely lazy Sunday. When mamma is in the right mindset, prepared without fear, the midwife’s job is an easy one. It’s a role of observer and I like to pick up the camera and become birth photographer. Other roles often ensue too; dish washer, clothes folder, bed maker... because when it’s like this, how it’s supposed to be... birth is quite boring. Beautiful, amazing and life changing, but, blissfully boring. 

Mamma progressed gently and steadily and soon baby Audrey arrived. This birth was textbook; when people ask how it went I reply that nothing could have gone better. Mamma was left well alone, she had this all along and it was let be... this is how it’s supposed to be.

Welcome to the world Audrey Storm, Thank you mum and dad for letting me be part your most wondrous day, early weeks with baby... life. 

Until next time...

Louise x


Louise David is a Private Midwife in Wollongong and The Illawarra areas. Louise provides all types of pregnancy, birth and postnatal care, including home birth and hospital birth support.
Louise is a International Board Certified Lactation consultant and offers private lactation consultation from her home in the Wollongong area.

Sunshine, cups of tea and yellow cards.

The forgotten world of private midwifery care.

Having a baby is the most special and anticipatory time of most people's lives. The care you receive in your pregnancy is of utmost importance. Knowing that you and your baby are in the safest of hands for your prenatal care is essential to rest easy at night.

I want to talk about today, something that is not well known and understood, and even not necessarily readily available, in our culture - private midwifery care. Having your own midwife who looks after you and your baby and guides you safely on your pregnancy journey and beyond.

Here are a few misconceptions about private midwifery care:

• It's alternative, or for hippies
• It's only for if you're having a home birth
• It's very expensive
• There's no health fund or medicare rebates
• If something goes wrong you don't have a doctor or hospital available

Let me clarify...

Private midwifery care is available as an option for every woman. It's a flexible model of care that can be adapted to suit every woman no matter what their health status and intended mode and place of birth.

With recent progress with medicare, private midwifery is now more available to more women. If your midwife is a medicare eligible midwife then your care is likely to attract a medicare rebate, with some midwives completely bulk billing all ante and post natal care, add to this some health fund rebates and private midwife care is now more affordable than ever.  

Finally, a midwife, even working in a private capacity, is part of a multidisciplinary team. If difficulties arise at any stage there is a smooth process of collaboration and referral with other care providers, be it your GP or local maternity unit. Your midwife and you work together to adapt your care to your changing needs. 

Private ob v Private midwife

similarities - 

one on one individualised care

differences - 

• wait time - your midwife comes to you and you're never waiting in busy, overbooked clinics

• you really get to know and trust each other 

• you form a team together - planning, discussing and choosing every step of the way. Not just the 'pilot guiding his ship' to quote an obstetrician I know.

• ob antenatal appointment 5-10 min, midwife 45-60+ min

• There is little need for prenatal classes with private midwife care as every midwife appointment is filled with little bits of information and education, it's a pregnancy worth of prenatal education sessions. We talk about the baby to be and the role it's being born into.

Your midwife comes to you.
You get to know and trust each other over many
 relaxed friendly antenatal appointments.

Trusting, relaxed, confidant - you're in safe hands.

this is going on in the background -
No need for babysitting or dragging bubs to boring,
long wait-it-out doctors appointments.

He's learning about becoming a big brother.

Care options...

Depending on your situation your care plan is tailored to suit.

In a normal, healthy, low risk pregnancy your care is taken on by the midwife and if any need arises she works together with the multidisciplinary team to support you in your care. This care is best suited to a home birth plan, but can also be adapted for hospital birth.

Midwife shared care is a great option to get the 'best of both worlds'. This is the same as the common GP shared care model with added perks: being in your own home, no wait time, private care continued postnatally.

This model works best for women who are planning to have their baby at hospital and also for women planning a home birth if there are minor complications in their pregnancy i.e. diet controlled GDM or history of complications in previous pregnancies.

The reason it works best for these cases is the women becomes familiar with the hospital, she books in, she sees the staff obstricitan and then carries on her care with her midwife with intermittent visits back to the hospital (at 30 weeks and then from 37wks). When time to birth arrives or transfer (in case of a home birth), the hospital and woman have a relationship and the transition of care is smooth and problem free.

Postnatal care...

Probably the best thing about private midwifery care is the relationship that has been fostered and grown in the pregnancy continues through the postpartum period. Your midwife you've come to know and trust visits you as needed in the postnatal period. Postnatal care continues into the 6th week postnatally. this care is usually included in the care package and is also eligible for medicare and private health rebates. 

Hannah and Andy enjoy the perks of private midwifery care.

If you are interested in private midwifery care in the Wollongong area and its surrounds don't hesitate to contact me by Email. Remember midwife care is a valid option for every woman and care can be tailored to suit your individual needs. Lastly, it's never too late to employ the services of a midwife, if you are unhappy with the care you are receiving this pregnancy (remember it's not just pregnancy, but birth and beyond) don't wait "until next time", take action, choose the care you deserve.

until next time, Louise x

Brown paper packages tied up with string.....

These are a few of my favourite things.....

About being a midwife at a home birth.

Not being welcomed at the door... 
tippy toeing in, following the sounds...finding this.

Estimating the progress of labour, 
just by being with and watching.

just waiting...
getting close now...
secretly wishing she births in this spot where the light is amazing!

Alas... 
back to the safety, warmth, comfort of the darkened birth pool.

that cord...

The relief, when all is done, from all involved....
The idea that bed is near....

Sneaking just one with the flash ;-)

Counting 10 and 10.

Saying goodnight, you were amazing x

What a joy and privilege to be present for this families birth of their new daughter. It was on the spur of the moment when their midwife fell ill and asked me to cover her as back up until she could be back with her clients.

Lucky for everyone their midwife came good, the family had two happy midwives present (one wielding the camera). 

Birthing at 3am poses some difficulty for the birth photographer, trying to maintain the calm and darkened birth environment without compromising the quality of the pics too much.

The birth photos here are quite fuzzy and grainy from the lack of light, but they still tell the picture here so beautifully.

Thank you to this family for welcoming me in to their home for their birth and to my friend and colleague Rachele Meridith for being a support and teacher.

Until next time,

Louise x

The silent arrival of baby Lucas and the Joyous Cheers from the side line....

Louise David RM RN IBCLC

No matter how many births i see i am forever reminded of these three things...

1- Every birth is different

2- We never stop learning

3- The amazing power and strength of the birthing woman

Im going to share with you some of the precious moments of baby Lucas' birth i attended and photographed recently. This birth was so special to me as it was my first birth back as a home birth midwife. Ive recently received my medicare eligibility stauts and with this i welcome the next phase in my working life inviting more and more home birth clients, as a medicare eligible midwife. If Lucas' birth is anything to go by we've a lot of joy ahead.

The atmosphere if this birth was like no other I've attended, the children were nestled in bed and the grandmas were chatting and sipping coffee as midnight approached, revelled in calm anticipation. Pregnant mum was ready; the only bit of angst in the house was present in dad... just, if you looked hard enough, that was ok, it gave just the right amount of "buzz" to the air. 

Grandmothers

Im reminded that every woman labours differently, ill never forget this one. I remember reading some time ago that Katie Holmes was required by her Scientology faith to birth completely silently. I believed this just wasn't possible. How could there be not a grunt, a groan or a secret swear word slip out? 

Well here i stand corrected. 

As this mama laboured away the only sounds to be heard were from the sidelines...

The pitter patter of exited big brother feet down the hall...

brother waits

the whirr of the camera...

Midwife waits

more footsteps down the hall...

laughter and shushing....

learning...

the shower....

the shower....

"will it make your job difficult if she stays in the shower like this" - grandma #1

"i don't have to do anything, my job is to watch" - me

And the crowd goes wild... 

This was the happiest family affair. 

What a joy and blessing for me to bear witness to such a special moment.

Welcome baby Lucas you are one lucky little man to be born in to such great love.

Louise x

Weaning - My experience of Mother Led vs Baby Led weaning. Louise David Lactation consultant.

Weaning - mother led vs baby led

At first thought, weaning is just weaning, isn't it? To some the process appears to be very straight forward and to others it can be over complicated by stress, pressure from others and unwillingness from either part of the breastfeeding dyad. When you introduce the terms mother led and baby led it lends the idea that there are different approaches to weaning and that the two can be vastly different.

As with all things mothering, everyone's experiences are different and everyone's reasons unique. I value these differences and I share here my own experience with hope of allowing others insight into another's way. I have had two personal breastfeeding relationships with three children. I share here the stories of my weaning. I lead the weaning of my twins and I later experienced self weaning with my third child, Rhys.

Before i get into my stories i want to point out the difference between self weaning and a nursing strike or breast refusal. Breast refusal happens suddenly and can occur at any age. There is usually, but not always a reason, ie mum sick, baby sick, teething baby, mestruation returned or many other possible reasons. Self weaning is a gradual process and rarely occurs in babies under two or three years of age.

My twins were born in October of 2006 they were 9 weeks early and slowly slowly over weeks and months we learnt the art of breastfeeding. We eventually hit our stride and learned to love breastfeeding somewhere around the 8 month mark. The joys and advantages for us were so very evident, and are what made us continue without any question, if it was the right thing for us to do or not. There were things I loved and things I really didn't love about breastfeeding the twins as they became older toddlers.

Kane at 2 and a half.

The things i loved:
Feeding to sleep.
Feeding to prolong a day sleep, if they woke up after only a little while.
A boob to fix a boo boo.
A boob to fix a tantrum/fight with brother.
Extra germ protection as they entered the world of day care.
Reconnection after a long shift at work or a sleepover at grandma's.
The educational factor as they asked for a boob public.

Things I didn't like as they entered toddler hood:
They were getting so big and heavy.
I needed to be comfy to feed and that wasn't always possible.
If one wanted a boob, they both wanted one.

I had some beautiful role models around me at the time I was feeding my twins. Many of my friends were entering their third and even forth years of breastfeeding their babies. I loved the idea of this, the idea of self weaning. I wanted this for my twins and for myself. I wanted to know that my twins had acess to all that the boob was to them, for as long as they wanted. This wasn't to be.  The things I didn't like about breastfeeding toddler twins were subconsciously really bothering me. From the age of two I began to gently encourage the boys away from the breast. At the time I thought of this as self weaning. It made me feel better about it if I looked at it that way.

How I encouraged the twins off the breast:
I would ask them to feed one at a time, they didn't like this and would usually wait till they were abe to feed together, once we could sit or got back home etc.
I would only allow a quick feed, once they snuggled in I'd say ok all done and distract them off another way.
I night weaned them by age two.

Over the next few months they fed les and less, they could go off to bed with out boob If I was at work or get up and start the day with out boob if daddy got up with them.  The last weeks of feeding could go by with a boob or two only every few days. Even after I'd considered them officially weaned we would go to an ABA meeting and one or both would be inspired by the little bubbas breastfeeding and hop on for old times sake.

I managed to breastfeed the twins till they were two and a half. I'm so proud of my efforts. It was only later down the track where I'd have times I wished I let them continue and self wean, I know in my heart I did what was best for us at the time.

The twins breastfeeding at 2 and a half.

Enter little Rissole 2 years later, the twins are now nearly 5. Rhys the master educator of all things baby and breastfeeding. I'd come to realise and accept that the twins weaning was mother led, I knew I wanted different for Rhys and would try to allow him to self wean when ever he was ready. I had prepared myself for the potential of the next 4 or 5 years if breastfeeding if that's what Rhys wanted and if it was ok for my family at the time. I hadn't prepared myself for the possibility of Rhys self weaning at only 2 yrs old though.

How wrong my ideas were, when Rhys was 13 mths old his dad and I seperated, the resilience of my three boys and especially baby Rhys will always inspire me. Rhys had to very quickly learn that mummy and boob wasn't the centre of his universe anymore. Slowly over the weeks, when mummy and Rhys were ready, he had his first sleep over with daddy. Rhys and daddy coped very well, mummy coped well too.

When Rhys was at daddy's Initially I would pump, Rhys would have a bottle of milk before bed, when Rhys came home to mum he'd tap at my chest and click his tongue, and we'd reconnect with a boob.

Rhys didn't skip a beat, as months went by he could go camping with dad for four days, come home and hop straight back on where he left off.

Initially my supply coped well. I'd pump when he would normally feed when he wasn't with me. Soon though I noticed I was pumping less and less, he was getting more and more active and busier with his brothers and naturally feeding less anyway.

Rhys 15 months.

There was a point around him being 15 mths old or so when there could be 24 hours between a boob, I decided to wean one breast and from there on he only fed on the left breast. This allowed the one breast to be emptied more frequently. My breasts involuted and my supply was minimal that I wouldn't be uncomfortable even after Rhys being away for a weekend camping.

Rhys was unphased by all the going ones around him, he was unphased by the low supply, the one breast, he just needed the comfort and security that one little breast provided and he had free access to that.

Rhys thrived in his new life between mums and dads, soon he didn't need that boob the second he walked through the door. He was beginning to wean himself.

I'd offer boob, he'd think about it, might even make mouth to boob, but whatever he was doing would win over. The difference when the twins asked for a boob at this age, I'd reluctantly oblighe or try to encourage them away.

Don't offer don't refuse... 

I believe this statement to be the whole basis of self weaning, it allows the child to have free access to the breast which in turn, allows for baby to regulate the milk supply. 

Don't refuse, however, in my opinion, does not mean never saying no. For example, if Mr 2 year old requests boob in the que at the supermarket, when mum is paying and her hands are full, it's only commons sense. I would say something like "you can have a boob in a minute when mummy has free hands", "let's go find a nice spot to sit down and have a boob together", "we'll be home soon and you can have all the boob you like then".

It wasn't untill I really examined this theory that I realised I actually led the weaning of my twins and not them. With the twins, I found myself not only not offering a feed, but I was frequently refusing feeds. "No honey, later....(insert any excuse and distraction)". It is here in the distinction between the two methods really becomes clear. 


Rhys, baby lead, came and went as he pleased. He really didn't ask much for me to refuse anyway. While the months leading up to Rhys weaning around his 2nd birthday were much like the twins last months of feeding, they were with much less resentment. I enjoyed feeding more with baby lead weaning. Maybe because the pressure was off me making the right or wrong decision? Maybe because he wasn't my first baby? Maybe because it was likely to be my last breastfeeding relationship? Maybe because I was truly prepared to breastfeed for many more years? 

How ever your breastfeeding relationship comes to a close it is natural to have mixed emotions about it. It is so very normal to experience feelings of relief and sadness, both at the same time. If a baby is weaning long before  mum is ready to stop feelings of sadness and rejection, even, can be felt. Some mothers go through a period of mourning for sometime after the breastfeeding relationship has ended.

Emotions i felt with weaning:
Mother lead- 
relief
guilt
unsure

baby lead-
unsure
desire to breastfeed longer
relief




I hope you are enjoying the breastfeeding journey you are on and the teachings your babies are offering you everyday. Above all else, listen to your gut. Do what is right for you and your family. As with all things breastfeeding, there are NO rules. You can't ruin your baby because you decided to wean him or because you decided to let him choose when he is ready to wean weather thats at age 2 or 5 or more.

Thanks for reading...

Louise x

Lactation Consultant Wollongong - Louise David

Dreaming of breastfeeding ~ 

Im dedicated to my profession, thats for sure.

I share my passion and respect for all things breastfeeding and birth with my sons daily.

Every evening we talk about our favourite and least favourite things from that day, cuddling a new babe or seeing a babe take to the breast after some difficult time often tops my list.

Last night i dreamt that the children were given a passage of writing to analyse for their homework, they had to read it and share with the class what it was about. I was proud of my boys because they were so familiar with the scene that they were almost bored with it. The rest of the class were in fits of giggles and disbelief, how sad that my boys beliefs would be challenged by their reactions.

I always have the most vivid of dreams and i remember them with great detail. I write here the passage as i see it in my dream from a print out the teacher pasted in their homework book....

"Jamie looked intently, pink flesh against bulbous white. Warmth radiating he could feel it from across the mattress. The noises were familiar, but from some time ago.

He didn't know how to name the feeling he felt or even why he did. 

He wanted to shoo the little creature out of the way and take its place.

Soon enough his mamma invited him to her embrace.

As the warm flow of love reached the depth of his stomach that little ball of angst melted away.

Jamie was home, he is happy. "Happy birthday Jamie" his mamma said. Jamie is 5 today"

My boys that inspire me xxx

Way to go dream land.... where will i go next.

Happy days,

Louise x