Meet the wonderful Anna-Maria. Anna-Maria will be teaching with us at We Birth in 2018.
Blog post by Jacki Barker
It is crazy, but current obstetric practices are actually increasing the chances of causing fetal hypoxia and possible MAS or Meconium Aspiration Syndrome.
On Jan 14, 2015, Rachel Reed posted “The Curse of Meconium Stained Liquor” in Midwife Thinking. Rachel says that it is not meconium alone which is a problem, but meconium plus an asphyxiated baby that can create the possibility of MAS which may result in infection and also death in some babies.
So, is it that obstetric practice is out of date?
We are still:
- Inducing labour,
- Directing pushing to speed up labour,
- Performing artificial membrane rupture (ARM) to see if there is meconium present
It seems that we appear to be fear driven and acting upon the presence of meconium alone without considering the risks of fetal hypoxia which is linked to all of the above as stated by Rachel.
What should we be doing instead? It would seem that monitoring the baby would be essential looking out for signs of distress. Then of course act and make decisions on those babies with thick mec and showing fetal distress.
However, like Rachel suggests, we should be creating a calm environment so the mother is not frightened and we should be avoiding all obstetric interventions associated with fetal distress.
This is yet another highly positive reason to have a doula at birth ensuring the calm relaxed atmosphere that is necessary when meconium is present.
Coming soon… Emergencies in childbearing for doulas and birth workers course. Be the first to know when this course is available by registering your email address here.
“Natural caesarean section” is a term coined around a decade ago in an article called The natural caesarian: a woman-centred technique written by Smith, Plaat & Fisk (midwife, director of women’s and children’s services, anaesthetist and surgeon respectively) and published in the British journal of gynaecology.
This paper created chatter, which continues till today, where more and more often we see pictures and film, hear words of encouragement and praise, all so excited to see positive change in how women and their babies are cared for during caesarean births.
The original article/ designers marked an acknowledgement in obstetric circles that c/section, for many women, is not an experience they find “satisfactory” (this is possibly the most beige way I have heard women’s negative experiences of surgical birth described). Although there is no mention of the increased risk of death, haemorrhage, infection or any other complications, this article does focus on women post-caesarean being more likely to experience postnatal depression, bonding with their baby and breastfeeding.
And behold they found the answer:
“To improve the experience of women having uncomplicated caesareans, we have modified obstetric, midwifery and anaesthetic practice over the past 6 years to emulate as closely as practicable the woman-centred aspects of ‘natural’ vaginal birth.”
This needs to be unpacked.
What is an uncomplicated caesarean? I assume it is a planned caesarean, one where the baby is expected to be born in a reasonable condition.
How have the practices been modified? There is a bit of variance depending on where this is practised however you can find a good description here.
Having a baby born this way, slowly, with delayed cord clamping, skin to skin and free to breastfeed if wanting to. Where possible there is the woman’s choice of music, (somewhat) dimmed lights, midwifery support and partner in attendance. It is about time. With about a third of babies in Australia being born by caesarean section it has been a long time coming that we are finally listening to women who are deserving of so much more.
I have been present in theatres where women, stripped naked, alone and terrified are paralysed and ignored in the centre of a brightly lit room, where a room full of staff carrying out their preparations take the time to talk, laugh and joke, in a way that would not be out of place at any office. But this is not an office. This is a child’s birth. And this mother is an incidental element in the morning’s schedule.
So I am genuinely relieved to see this positive shift towards respectful births for women undergoing a caesarean section.
But there is nothing natural about it.
Can we call it respectful caesarean? I feel like calling it natural, in 2017, the era of kale chips and green smoothies connotes a sense of wholesomeness and implies an organic ideal. We really need to be clear, this (caesarean birth) is a completely contrived situation, albeit one that is completely necessary, acceptable and even desirable when it is used to save the lives of women and babies.
I also question how women-centred it is. I accept women want their babies close, and being supported to have a skin-to-skin contact at birth is a step in the right direction. I would argue that many of the other ‘steps’ in this style caesarean are baby focused more than women-focused.
I understand the development of this technique took 6 years, however, it is unclear how they came to choose these particular interventions? Were consumers being consulted in any formal way? Anecdotally there HAVE been stories of women describing an intense desire to be the first to touch their baby. This certainly can’t be discounted.
There are other areas that could be looked at to improve the woman-centredness of it all. Allowing doulas in the room, no separation between mother and baby in recovery, continuity of midwifery support, one to one midwifery care postnatally, antenatal expressing of colostrum to reduce delay in milk production. Are women given these options? Or are they offered only the interventions acceptable to the institutions performing caesarean sections?
We are also still lacking data that confirms these changes are making any difference to breastfeeding, maternal satisfaction, bonding and postnatal depression.
I am not the first person to recognise that most of the time when we discuss “risks” associated with birth it is the baby who is central to the discussion. Although the background risk for any woman, even a healthy, young one, to be seriously injured from birth is much much higher for women birthing via caesarean section (compared to vaginal birth) we tend to hear almost exclusively about the benefits and risks for infants.
I am concerned that as this kind of caesarean birth is glorified some advocates might forget to mention that this is actually a risky procedure. For women, they are 3x more likely to die from caesarean section than vaginal birth. This statistic is the same regardless of the lighting*.
For those who might benefit from more women birthing via caesarean here is a now a way to package and promote caesarean as the new and improved vaginal births. Just with better vaginas.
Dr Gerry Burke, Consultant Obstetrician/Gynaecologist and Clinical Director, Maternal and Child Health Directorate, UL Hospitals Group, stated that the gentle Caesarean represented “another small step in the evolution of this most ‘normal’ of all the surgical procedures”.
Unpack that. And tell me all the ways a cut in the belly is normal.
And then answer me, where does this evolution end?
*Actually I have no idea if the lighting affects the stats of maternal mortality. This is hyperbole gentle readers.
WORDS: Jen Hazi
(Originally posted on Midwif This)
Why does a doula need to learn about obstetric emergencies?
Doulas are NOT medical professionals. Clinical care of the woman and baby is directly outside of our scope of practice. Clearly defining ourselves as non-clinicians is vital to safe practice.
However, we are there on the frontline. We are with women in the dark of night as they labour at home. Women are told to stay home as long as possible so they turn to us and ask for our support and help before they present to their care provider. We know labour is predictably unpredictable and although we do everything we can to direct women to their care provider there are a few, random situations where timely intervention can save lives.
Many professions have first aid requirements, and no doubt many qualified doulas have undergone some kind of first aid training. An understanding of emergencies for doulas is important.
It is not appropriate for a doula to attend the kind of emergency training midwives, obstetric nurses and doctors attend. Their role in most emergencies is very different. Understanding a few scenarios that doulas may see might give them the insight to recognise when to call for emergency assistance.
Consider the following scenarios:
If a pregnant woman was to collapse at home in early labour what would you do? After calling for an ambulance, you may be asked to assist the ambulance officer on the phone. If you have an understanding of emergencies then you will feel more prepared to assist.
Supporting a woman in the home quickly turns into a precipitous labour and there is no time to get to the hospital. You have called for an ambulance but the baby is born stunned and not breathing. What do you do while you wait for help?
Moments after the birth of a baby the woman in your care begins to haemorrhage. Staff quickly flood the room to help her. How can you help her partner? Is there anything you can do to support the baby?
This is a course about obstetric and neonatal emergencies completely devoted to the unique needs of doulas.
Experienced doulas may have (unfortunately) come across these sorts of scenarios in the past. However, these skills need to be practised, to keep current, particularly when we don’t use them very often. If you are a newly qualified (or qualifying) doula, learning about emergencies and hearing from more experienced doulas can help equip you with ideas and skills if you ever need them in you (hopefully) long and rewarding career.
Words: Jennifer Hazi
We Birth presents a course on emergencies in childbirth for doulas. Thursday 22nd June 2017, at Oxford Falls Peace Park, Oxford Falls, in Sydney’s northern beaches. Reserve your space now.