knowledge is power...

From the NZ Herald today...

The leading Auckland maternity hospital has also been advised that more women should be moved to low-tech primary birthing facilities such as Birthcare Auckland if they are expected to have a straightforward delivery.

The advice is from Dr Sally Pairman, the Midwifery Council's chairwoman and head of midwifery at Otago Polytechnic, who compared the outcomes for low-risk women at National Women's and Birthcare.

She found the rates of epidural pain relief, birth interventions and bleeding were all higher for those who initially booked into National Women's.

Advocates of a more natural approach to birth care say one intervention makes the next more likely, a "cascade" that starts with an epidural or medicine to induce labour and which ends in a caesarean.

New Zealand's caesarean rate has steadily increased from 11.7 per cent in 1988 to 23.7 per cent in 2003.

National Women's rate last year was 33.1 per cent among women of all levels of risk

Dr Pairman said that if women were admitted to a high-tech hospital such as National Women's before their labour was properly established they were at risk of staff interfering medically to speed things up.

She said that because large hospitals had such an array of medical technology and expertise they tended to use it, even when not needed. Its use then became virtually the norm. National Women's higher use of epidural pain relief might be a reflection of this. She wants more primary maternity units built, separate from base hospitals.

"Across New Zealand we should have a system where women who have normal pregnancy and birth are expecting to give birth in a primary unit. Probably a lot of our intervention rate is because we are mixing primary, secondary and tertiary services in one facility which is completely dominated by the needs of tertiary."...

INTERVENTION RATES

* Among low-risk patients who started their first birth at Birthcare Auckland last year, 80 per cent had a straightforward vaginal delivery.

* For the comparable group in National Women's at Auckland City Hospital, 55 per cent had a straightforward delivery.

* Emergency caesareans: National Women's 20 per cent; Birthcare 8 per cent.

* Epidurals: National Women's 64 per cent; Birthcare 29 per cent.

* Episiotomies: National Women's 30 per cent per cent; Birthcare 10 per cent.

* Note: All figures are for low-risk women having their first birth. All the caesareans and epidurals occurred at National Women's, including transfers of Birthcare patients.

read more here

This is one of the reasons I choose to stay far away from hospitals when given the option of where to birth!

words of encouragement

These two scriptures were significant leading up to Isaiah's birth and really encouraged me. God gave me a deep sense of his peace as I repeated them over and over to myself. Just wanted to share them and I guess record them for my own memory. Reading them again now, I think they are just as significant to me as encouragement for the days that lie ahead as I work out how to be a mummy to 3 little ones...

Psalm 139: 3 & 5
You chart the path ahead of me
and tell me where to stop and rest.
Every moment you know where I am...
You both precede and follow me,
You place your hand of blessing on my head.
Such knowledge is too wonderful for me,
too great for me to know!

Philippians 4:13
For I can do everything with the help of Christ who gives me the strength I need.

Thanks God for being here with me right now, in the days that have just passed and in the days to come. I can't do this without you...

x

Our sweet babe's arrival - my birth story

Today our newborn son is one week old. In fact as I write this and look at the clock, I'm reminded that exactly one week ago almost to the minute, we would having parking our car in the car park at birthcare (where we delivered) and heading to the birthing suite! For those who haven't caught up here are the details.

We have named him Isaiah Gary Toka te manawa (Isaiah pronounced I-say-ah, Gary after my dad, Toka te manawa - "contented" in Maori). He weighed in at 4555g or 10lb 1oz, was 57cm long with a head circumference of 36.5cm. I told you my baby was gonna be big!

As you know if you had been following my previous posts, Friday 7 Sept - Sunday 9 Sept I had been having contractions at a semi regular rate. I knew they weren't just good old Braxton-Hicks contractions because they had a bit of a bite to them. Completely manageable - just no longer pain-free. These continued through Monday and by Monday night I was semi-convinced it was all on. We decided this might be our last chance to capture the preggy belly shots, so here's one of 'em!
I texted RK (my midwife Rhondda) that contractions were regular at 10mins apart (still quite manageable) and headed to bed for an early night in preparation for what lay ahead. I was quite sure that at some point in the night I would no longer be able to sleep through it all.

5am Tuesday 11 Sept
Reuben had to make the decision about whether or not to go to work. We decided he would stay home as I was still contracting.

8am
everything has pretty much stopped. Me being quite keen to get it all going decided to go for a walk around the block. So out we all headed for a 30min stroll. On return home - still pretty much zero activity. I was pretty grumpy about it all by now, so we decided to send Reuben off to work and me and the girls headed out to our usual outing at playgroup in an attempt to distract myself. Text RK and tell her its all stopped. She tells me "Don't worry, it will happen soon"

1.15pm
I arrived home at after dropping Isabella at Kindy.

1.30pm
Go to the toilet and discover I've just had a show (google it if you want details of what a show is!). Feel both nervous and excited as I never had this with the girls, and realise I must be going to be in proper labour soon enough. Text RK and she says "keep me posted"

2pmContactions start again - 10mins apart and this time they are fairly uncomfortable - I want to move every time one comes on.

2.20pm
call Reuben who decides its time to jump on a train and come home

3pm
make the 10min drive to kindy to pick up Isabella. She wants to hang around and play - so I tell her we have to go because Coco is coming out today. She gets way excited and runs to her teacher Lisa to tell her Coco is coming out today. Lisa looks way confused so I - slightly embarassed - tell her that I am in labour and we need to go. Lisa gets into a panic and starts asking if I need her to look after the kids or drive us home etc etc. I say I'm okay and go to the car. Then Lisa and another one of the teachers come out to the car and frantically try to help with getting the girls strapped in, again offering all sorts of help. I again say I am okay and drive off to get Reuben from the train. I now have a massive adrenaline rush from the drama at kindy and wonder if everything is going to stop again.

3.30pm
Arrive at train - labour hasn't stopped and I am greeted with a lovely contraction as I get out of the car to move to the passenger seat. Reuben gets his first chance to try applying pressure to my lower back - relief!

3.35pm
At home getting bags for me, girls and reuben all together and in to the car. Sort out food for the animals. Have to juggle car seats around to try and find best place for me to be. Eventually decide on me being in front seat, kneeling on floor, leaning over bean bag. Me fairly calm, Reuben a little less calm!

4pm
Begin journey to my parents to drop off girls. Contractions now 7mins apart.

4.30pm
Arrive parents. Contractions still 7mins. Reuben calls RK. We are wondering if we should get in the car and go to birthcare as rush hour is fast approaching and birthcare is 25mins away when there is NO traffic. She says to meet her at birthcare at 8pm unless things really heat up.

5.30pm
Contrations about the same. Everyone having dinner at mum and dads. For some reason I am not interested in food right now!

6.15pm
Decide to have a shower and see how that helps me cope with pain. Is awesome relief! Love the hot shower on my back - coping really well - contractions suddenly drop to 3mins apart. I stay in the shower for 15-20mins and time contrations - yip, they are still 3mins apart.

6.45pm
Out of shower and tell reuben I'm at 3mins apart. He calls RK and she says - "time to come in!"

7.00pm
Leave for birthcare. Again a "great" trip. Reuben is doing a great job timing contractions, applying pressure to my back through contractions and driving the car. I knew there was more than one reason I have had two home births previously - contractions and car rides don't mix! On the way in I decide that I want the extra support and call my friend Kristen to ask if she can come support. She is able to come in and says she will see us there.

7.30pm
Arrive at birthcare - perfectly timed as RK drives in behind us. Great fun timing getting in and out of elevators as I have contrations.

7.40pm
RK checks me and I am 6cm dilated. Feel slightly cheated and wonder how much longer this will take! The birthing pool is already full and so in I get. The water is great - but almost too hot at 40 deg c. My contractions have slowed, but as I relax they start to pick up pace again and it is not long till I am concentrating hard through each one. In between contractions we chat and laugh about all sorts of amusing topics.

8.45pm
It all becomes a bit more serious for me as I enter transition. I just want it to be over and start telling Reuben that we are not doing this again. I get a bit grumpy but find the encouragement from everyone spurs me on and helps me concentrate. RK offers me gas but I am not sure if I want it - she tells me If I am not sure that I am better not to have it.

9.00pm
Urge to push... roll on second stage of labour. Feels good to have something to do with each contraction. I get a bit lippy and start asking RK "can you see it yet" she replies "oh yes love" I reply with a fair amount of tone, "how much". This converstions occurs at least twice more.

9.20pm
RK checks if waters have broken which they haven't. Asks me if I want her to break them. I say "no, not yet"

9.30pm
waters still haven't broken and are slowing things down. RK asks again if I want her to break them. I say "yes" and wish I had said yes earlier!

9.35pm
waters broken and I literally feel Coco come right down with next contraction

9.40pm
Head crowns and is out, shoulders are stuck. Reuben and Kristen have to help me stand up and with the next contraction I push Coco out - I am sure they heard my roar in reception! I am helped back to sitting down in the pool and handed my beautiful baby - its a second before I remember to look and there he is - my sweet baby boy. At this moment the pain is gone and Reuben and I are looking in awe at our first son - its an absolute magical moment.

welcome to the world sweet boy!

RK getting Isaiah all dressed for the first time

About an hour or two after Isaiah was born - out of the birthing suite and getting settled into "hotel" birthcare!

me and my babies - Isaiah day 1

sleeping in daddys arms - Day 2

Childbirth and fear

It never ceases to amaze me the way people hold such varied views on labour and birth. I was most prompted to write this post after reading a few different comments on Karla's blog. I guess this portays a highly medicalised, american view of the whole thing. I simply say American cause Karla is American (my best friend who is also amercian goes completely against this stereotype I have to say having trialled a homebirth with her first birth - sadly Rhys was posterior and rebelled against coming out the natural way. Her second birth resulted in a drug free natural delivery of a 10lb 2oz baby girl).

The thing that gets me the most is the intense fear that so many women seem to have towards childbirth.

• The fear of pain.
• The fear of "something" going wrong.
• The fear of being out of control
• The fear of the unknown

For an educated society there seems to be a whole lack of education about the whole process I have to say. We believe overall (as a western society) that hospital is the safest place to be to give birth. For a woman who has a normal pregnancy with no indications of potential complications, this simply isn't true. Fear leads to anxiety, leads to tension, leads to a decreased capacity to cope and an increase in pain felt, which then only perpetuates the cycle... There is such a thing called the cascade of intervention. When doctors intervene in what should be a natural process it is no wonder that more and more procedures are required to get a baby delivered.

Take this as an example. A womans labour is medically induced. It means that an IV line needs to be placed in the womans arm. It means that the baby is likely to be closely monitored involving the mother having to lie on a bed - which then means freedom to move and find the bodies most comfortable position for labouring is way limited. The drugs used to induce labour result in contractions stronger and more intense than if natural labour had occured... and this leads to a much increased likelihood of pain relief being used - in particular an epidural, which then comes with its own risks. Afterall having a needle inserted into ones spinal column has its dangers.

As a result of being confined to a bed being monitored, numb or at least partially numb from the waist down from an epidural, unable to use gravity and their own sense of where they are at with their labour, lends this woman to being at the mercy of the the judgements of the medical staff attending her - in my mind, completely disempowered. At this point the chance of having an emergency caesarean is greatly increased - not really suprising is it! And of course caesareans which we seem to view more and more as preferable to pushing, come with the risks that all major surgerys carry - we seem to forget this.

Don't get me wrong.

• childbirth IS painful (at least in my experience)
• sometimes things go wrong

but with support of a caring husband, midwife, and friends and lots of reading/knowledge of the birth process and other peoples positve experiences there doesn't need to be a fear of any of those things I listed at the top of this post. Childbirth is an amazing thing which we as women are privileged to experience (don't remind me of that comment of course when I am in labour!) It's the only painful experience I can recall that results in an amazing reward at the end.

I remain open to accepting medical assistance should that become absolutley necessary, but I look towards my impending labour and delivery and silently affirm my strength and ability as a woman to do what the billions of women before me have done.

I will now step down from my soap box...

p.s. the photo at the top of the post is just after giving birth to Isabella. She is probably minutes old.

update...

My Isabella is officially fully toilet trained - I am so excited! I won't go into details for sake of her privacy. She is a very private, sensitive little thing who insists on locking the door and being by herself on each visit to the royal room. Let me just say I am thrilled to now have only one daughter needing nappy attention during the day (at least for the next 7-9 weeks!)

She is changing so rapidly and this has been even more evident since she started kindy. Everything is replied to with a "why mummy?" Incredibly inquisitve and follows up with some very intelligent comments and questions...

My Hannah is such a darling, and comes out with hilarious comments and facials. One of the ones that make me laugh the most are when I put her ear drops in or wipe her butt (at nappy time) with a cold cloth... she puts on this funny face, shivers and says "dats weally told mama" (translation - that's really cold mama). The other one is after she fills her nappy, she comes up to either me or Reuben and says... "I done poooooos".

I wanted to pop in this pic of Reuben and the girls, cause its cute and they have so much fun together...












This one here is when we had a sleep out in the lounge a couple of weeks back. We toasted marshmellows in the fireplace and then put the girls to bed on mattresses on the floor in sleeping bags. Sadly they actually didn't last the night out there and we had to transfer them both back to bed at about 10pm. Kind of cool having a wee family night though...

The other exciting thing for me recently was being at my close friend Kristens birth - at least at her daughter Raegans birth. It was quick and intense and drug free. There is something amazing about seeing a new life being born, you can never really get over the mystery of it I don't think. It all brought it a bit closer to home for me though. In 7-9wks that's me! Thinking positive thoughts right now cause I know I can do it - again!

thats all for now - seeing Rhondda tomorrow (midwife) so maybe an update will follow...

eating the apple & epidurals

So... I had part of a conversation a couple of days ago and would love to know what you think...

It went like this..

OTHER: "did you know epidurals take away all the pain so giving birth doesn't hurt"

ME: "yeah, but the pain has a purpose"

OTHER: "whatever, the pain is because adam and eve ate the apple"

the conversation continued with me giving my opinion of why I don't like epidurals as a standard form of pain relief. (don't do a knee jerk - I realise sometimes they are necessary...)

God intended birth to be pain free, (or at least different to how we experience it) but as a result of the fall, it is not. Therefore, is having an epidural (and therefore reduced labour pains, simply experiencing birth as God intended???

theres a thought...

Lets get excited

A special friend of mine is due to have her baby on my birthday. There is something extra special for me about this awaited delivery, as she has asked me to be her 2nd support person as she labours and gives birth - something I am really looking forward to doing. We hung out yesterday and she showed me the babies room and we chatted about the final things she needed to buy and then went shopping at baby factory.

There seems to be something really special about 1st babies. Its the first for the mum and dad, and the first junior for friends and family to enjoy. We found people came out of the woodwork and showered us with gifts and well wishes before and after Isabella was born. Some people we recieved cards and gifts from I hadn't even met. Seemed kind of strange at the time. Lovely all the same.

When Hannah came along there were still well wishes and lovely gifts, but a noticeable difference from baby no. 1's arrival. Having only 17mths gap between them also brought varied comments. Not such the jubilant celebration as when we announced Isabellas imminent arrival. There were a few kind of rude comments actually... Having only a 17mth gap is apparently not a good decision according to some.

Another of my friends whose two children are the same age as Isabella & Hannah, is expecting her third. She will for a few weeks have 3 under 3. This gets me to the point of the post.

She is almost out of her 1st trimester, and has not told many people that she is expecting. This isn't because she is trying to keep it a secret. Its actually because she is avoiding the awful, hurtful comments that seem to flow from many friends and family when they hear the news. Their issue? In their opinion 3 kids is too many... the gap is too close... its going to be too difficult.

In truth it took her a few days to get used to the idea. She is finding it hard going being pregnant and having two littlies to care for - I don't imagine it will get alot easier in the short term either. The point is though, this is a new life, a perhaps unexpected yet now welcomed addition to their family. Why should she feel ashamed to tell people about being pregnant? She's not asking for anyone else to step in and look after her kids for her.

I guess I just relate cause I can imagine the comments that would come if I were walking in her shoes. So what am I trying to say?

• Every baby is special regardless of whether its a 1st, 2nd, 3rd, 4th...
• Why not celebrate news of an expected baby and therefore be offering support to the parents to be.
  
• hold back on the judgemental comments.

Thats really it I think - We are not expecting baby no.3 (as far as we are aware!). But when we are we will look forward to it, so please, be excited for us, as I am for both of my friends above...

the wonderful sacrum...

I started this post as a comment to Franks blog and then decided just to post it on my own blog as it was getting a little lengthy... Being a physio who has worked with clients who are pregnant and having taught part of antenatal classes i just couldn't help myself... sorry.

So I'd love to know exactly what Franks childbirth educator said about the wonderful sacrum.

Here goes the anatomy lesson. The spine is divided into different sections - Cervical (basically the neck), Thoracic (ribs attach to these 12 vertebrae), Lumbar (low back), Sacrum (base of the spine) and coccyx (tailbone). The Sacrum attaches on each side to the ilium, or pelvis. You can work out where this is by checking for the two dimples at the top of your butt.These two joints are called your sacroiliac joints (SIJ). The pelvis joins again at the front which is called the pubic symphysis joint. These three joints are pretty much the strongest joints in your body - have to be really!

As far as I'm aware, it is actually the coccyx (tailbone) that does most of the flexing and moving during birth. So by adopting different positions (I can hear Frank giggling ;o) the baby passes through the pelvis more easily. The SI Joints and pubic symphysis joints are softened during pregnancy by the hormone relaxin. This allows for the pelvis itself to stretch and give a little to assist with allowing the babies head through the pelvic outlet. So although the sacrum is a big part of all of this, it isn't the main event (so to speak).

As a side issue, my main personal pregnancy issue with Isabella & Hannah has been as a result of those softened pelvic joints. Dysfunction with these joints can cause lots of pain with walking, rolling in bed, getting up out of chairs, wallking up stairs etc etc... and it can take a while to come right. I still can't go for a short run without suffering the consequences afterwards... thats 10mths later...

advocating for homebirth

interesting article in the NZ herald today about Britian urging mothers-to-be to give birth at home. Caught my eye...

midwives & the media

Have been thinking about the way midwives are getting trashed in the media at the moment in NZ. I was pretty frustrated after watching 60 minutes on TV3 last monday at the biased & factually incorrect information that was being relayed to mr & ms general public. They had two tragic cases of babies who had died during childbirth and whom had midwives as their LMC's (that's lead maternity carers). 60mins angle was that midwifery care is insufficient, unsafe and that women should be birthing in hospitals with obstetricians (that's baby/mum doctors) running the show. Sad how the tragic, isolated cases call into question the whole system. I guess it is the longing to be able to place blame at the foot of someone or something. Completely understandable although possibly misguided. Just as my experience shouldn't dictate how others should choose to birth, neither should theirs. The program talked about how by medicalising birth (think early 20th century) they made it so much safer for women and how perhaps we should revisit doctors having control over pregnancy, labour and birth. (see note at the bottom...)

During my first pregnancy, i did a whole lot of reading about labour etc trying to get myself prepared. (check out http://www.homebirth.org.uk/) What I found is a whole lot of evidence that giving birth in hospital is not necessarily safer (for someone sho has a normal healthy pregnancy) and can actually be less safe than birthing at home! (yes I know, heresy isn't it!) We (me and Reuben) meet our midwife Rhonda when we were 24wks pregnant (had to dump the first one as it just wasn't working, but that's another story). As the weeks passed and we got to know her, we become more and more confident in her ability to care for us as a family and most importantly to ensure a healthy baby & mummy at the end of it all. She gave me confidence in my ability to do what billions of women before me have done.

And yes, we did it - twice now! Without the need for doctors, drugs & sterile rooms. So here's to midwives, who work long unreliable hours, who are on call 24/7 and who on the whole do an amazing job.

note... when we started telling people we were considering home birth, naturally we had significant numbers of less than favourable opinions handed to us, including from my mother and grandmother. not that suprising given their birth experiences. Both experienced highly medicalised births. My mums 5 deliveries (1970's & 80's) including high forceps x 2, caesareans x 2, epidurals, inductions, being shaved, enemas etc, nice... My Grandmas 3 births (1950's) under general anaesthetic (one can only imagine how they got those babies out!). The funny thing was when Grandma realised that her mother (my gt grandma) who gave birth in the 1920's had two successful births at... home - with a midwife! oh how things come about...