Recently I saw a question on a pregnancy and parenting page asking about being induced at 37 weeks for a “Big Baby” (estimated to be around 9ish pounds/4-4.5kg by 40 weeks). This particular mum-to-be didn’t feel comfortable with being induced then, and did say that, but was seeking advice and support that it was the right thing to do.
I did what I usually do, I advised of the risks, the benefits, that the estimated weight was not “Big” at all and many women birth babies even bigger than that vaginally and after spontaneous labour with no issues at all, and reassured the mum-to-be to follow her heart – in that if it didn’t feel right then tell her doctor that she didn’t want to be induced and would wait until baby decided to arrive on his/her own.

This kind of question is becoming more and more common these days, women being told they are having “Big Babies” estimated to be between 9 and 10pd (which isn’t “big” as such, it is just another variation of normal size) and will be induced between 37 and 38 weeks gestation because of that. These women are apparently not being given any choice in the matter, they are being told it WILL happen, that they NEED to be induced as if they don’t their baby will get stuck (shoulder dystocia) and die because it is too big to be born vaginally.

For the record, this is not evidence based medical practice, this is fear mongering and scare tactics and outright lying by medical professionals in order to get an expectant mother to do what THEY want her to do. A 9-10pd baby is not big, 11+ pounds is “big”. 9-13pd babies are born all around the world all the time without any issues when the mother is able to move around in whatever way she finds comfortable and as a result assist the baby in manoeuvring through the birth canal. In these cases there is no respect for a mother’s decision making, no allowing the woman’s body to do what it was made to do, preventing the natural physiological process of birth from occurring when the time is truly right and making women around the world afraid of a natural body process. To add to this a small baby is just as likely to get stuck as a larger baby if baby’s position and mothers position while birthing are not ideal. There are ways to prevent it and to reduce the chances of it happening, and early induction is not one of them and has a higher chance of shoulder dystocia by preventing the mother from adopting natural birthing positions due to the CTG monitoring and in many cases an epidural as well when the induced contractions become too much for the mother to bare and increasing the chances of baby being malpositioned when artificial rupture of the membranes (amniotic sac) is done as part of the standard practice of induction, traumatic physical and emotional intervention with the use of ventouse (vacuum), episiotomy, forceps and physical pressure on the mothers abdomen, and fetal distress from the induction itself resulting in either the above mentioned interventions or an emergency cesarean occurring.

But what I've mentioned just above is not what prompted this blog post. What prompted this is the lack of up to date knowledge in obstetricians and other mothers who were “fans” of this particular page and answered this particular question.
These “fans” were promoting induction at 37 weeks with no major risk factors or true need, stating that it was “term” and “baby would be fine”. This information is incorrect, not only have the WHO and ACoG, within the last 12 months, updated their guidelines of when “term”, “full term” and “post dates” are, but an induction at 37 weeks for no reason other than an ultrasound weight estimate (proven to be inaccurate in the majority of cases) shows that baby is measuring larger than average. The new guidelines state that “term” is now from 39 weeks to 39+6 weeks after recent research showing that a lot of important brain development occurs in-utero between 37 and 39 weeks and babies who stay in longer have less physical issues than babies born before 39 weeks gestations (eg feeding issues, regulating of body temperature issues etc), “full term” is now from 40 weeks to 42 weeks gestation, and “post dates” is now from 42+1 weeks onwards.

What does this mean for pregnancy and birth and going past 41 weeks gestation? Well frankly it means that every woman should now have a much higher chance of being able to go into labour naturally when their baby and body are really ready without the need to be induced, whether it is at 37 weeks that their baby decides that he or she is ready, or at 43 weeks, AS LONG AS all obstetricians and doctors follow the ACoG and WHO guidelines, which unfortunately for all of us women is not the case. Sadly most obstetricians and doctors do not follow these guidelines, they follow their own guidelines and the hospitals outdated policies on “management” of pregnancy and labour. And “management” it is, they are “managing” us like animals, inducing when they want, cutting us open when they want, giving us medication when they want, telling us what we can and can’t do, scaring us and putting the fear of death into us, only telling us what they want us to know and not what we need to know, essentially taking away our basic human rights and preventing us from making our own truly informed choices and decisions by not providing all of the information and only telling us what they want us to hear.
There are of course exceptions to this, there are some wonderful and truly amazing obstetricians and doctors out there who treat women with respect and dignity that they deserve and do everything that they can to inform women of ALL of the risks and benefits, accept a woman’s choices without trying to change her mind, support her unconditionally in those choices and go out of their way to try and give the woman the birth that she desires. They are few and far between, a dozen or so in every state, a few hundred or so in every country out of a hundred thousand or more obstetricians and doctors around the world that are trained in high risk pregnancy and birth.

“So what?” You might say, “They are trained in pregnancy and birth, they know what they are doing.” Yes, they are trained, in “HIGH RISK” pregnancy and birth, the types of pregnancies that might be dangerous for mum and/or baby. They are NOT trained in natural physiological childbirth, they are not trained in the kind of birth that does not need drugs to make it start, that does not need intervention or constant monitoring, that does not result in a mother on her back in a bed unable or "not allowed" to get up and move around and physically help her baby to get into a better position for birth, they are not trained in allowing a woman’s body to do what it was made to do and treat every woman the same as if they have the same risks as every other woman. Every woman, every body and every baby are different with different risks and different needs, we do not all fit into same mold (eg not everyone has a 12 hour or less labour just as not every woman has a very long 55+ hour labour), but obstetricians and doctors are trained to fit everyone into the same mold with the same risks regardless our own individual risk factors, body shapes, histories, abilities and needs.

How can we change this? How can we make pregnancy and birth an individual thing again? How can we make obstetricians treat us with the respect and dignity that we deserve? How can we make them respect our decisions and choices without trying to scare us or bully us into what they want us to do? The answer is that every woman and every man must make the decision to stand up for themselves and their partner, to say NO, to make obstetricians and doctors understand that it is NOT a medical professionals or hospitals decision to make on when a baby comes into the world, to make obstetricians and doctors stop scaring women with generalised risks and outright lies, to make the maternity system in whatever country you live in stop and listen and change its policies for the benefit of ALL women, to make pregnancy and birth about the woman once again and not about the medical side of things. Women everywhere need to take their bodies back, to make sure that everyone knows that SHE makes the decisions regarding HER body and HER baby, and that hospitals, obstetricians and doctors are NOT the ones to make the decisions. Even in a life or death situation the mother has the right to decide what is to be done and should be given the chance to do so, even if there is only a minute available for her to make that decision that will affect her and her family for the rest of their lives, she should be the one to decide, not someone else who doesn’t have to live with the consequences.

So there you have it. We live in a medicalised world that is slowly trying to remove all natural bodily autonomy from women, that is trying to stop women from being able to choose if she has an induction or cesarean or waits until her baby and body decide that it is the right time, a world where women are being scared and bullied into inductions and cesareans instead of being given the right information and support to make a truly informed decision over their bodies and method of birth, a world where women are ridiculed for their decisions, denied good care, denied the right support that they need and are traumatised on a regular basis when they are in the most vulnerable state and position.

Can you imagine a world where women are supported personally in a way that fits their individual needs and wants and are empowered in the process? Can you see a world where a woman is able to choose whenever she wants if she has a home birth, an unassisted birth, a hospital birth, an induction or a cesarean without being judged, ridiculed or traumatised in the process? Where she is truly informed about the risks and benefits of every procedure instead of only informed that  the medical professional feels is all she needs to know? Where she can birth however she wants without being lied to or scared by medical professionals? Where she can trust those who are caring for her and supporting her to give her the power to make her own decisions regardless of where she lives, her body shape, her previous history, or what she looks like? I can, I can see that world, our world can become that world. If we all worked together to make changes, if we all supported one another in our individual decisions regardless of what they are, we can create that world and make it ours.

Jenna Edgley
Student Birth Doula
Placenta Encapsulator
FOOTPRINTS & RAINBOWS

Planning on having another baby but not sure what to do to increase your chances of a happy, relaxed, and healthy pregnancy and labour? Take these 11 things into consideration.
They are also good for every day life as well :)

1) Start exercising, even if it's only for 30 minutes a day, moderate exercise not only increases blood flow but also helps you to stay fit, increases your stamina (really good for during an unexpectedly long labour and also great for those sleepless nights with a newborn), increases oxygenation of your blood and makes you feel better too (once you get past the sore and tiring stage in the beginning anyway lol).

2) Eat a healthy, varied and balanced diet, if you are eating too much reduce your portion sizes and eat more fruits, nuts, seeds and vegetables. If you are overweight this can also help you to either loose weight or be healthier in general even if you don't lose any weight.

3) Increase your protein intake. Protein is needed to keep your muscles healthy and strong and to help them to grow, the uterus is a bunch of muscles in 3 layers and it needs protein to stay strong and healthy too. This is extremely important if you have previously had surgery involving your uterus, whether it was for a uterine rupture/tear, the removal of a fibroid, a D&C, a previous cesarean section or other uterine surgery.

4) Start drinking red raspberry leaf tea for 6 months prior to trying to become pregnant, not only does it contain trace vitamins and minerals that are very good for you but it also tones the muscles of the uterus which helps the uterus to be stronger and healthier during pregnancy and helps the uterine muscles to be more effective during labour, and the tea also helps to improve digestion of food, the absorption of essential vitamins and minerals and can help reduce the severity of PMT/PMS symptoms. If you don't have any risk factors or prior history of premature labour then you can continue drinking it throughout pregnancy to keep your uterus toned and strong.

5) Do your kegels to strengthen your pelvic floor muscles. If you don't do this already then start doing it now! Your pelvic floor is needed to help your baby move through your pelvis and down the birth canal when you are pushing, and a weak pelvic floor can (not always) result in weak and ineffective pushing which can lead to interventions like forceps or ventouse/vacuum delivery and cesarean section.

6) Research your options for pregnancy and birth, from which doctor/obstetrician who will support you to achieve the birth you want to the hospital you want to deliver at (if you have more than one hospital in your area), pain relief (or lack of it if you decide to go all natural), Doula's, Independant or student Midwives and how you want to give birth eg. at home, in a birthing center, in a hospital, in a birthing pool, in the bath, standing up or sitting down, lying down etc or wherever/whatever else you can think of.

7) Start putting together notes for your birth plan. Don't finish it now as things may change when you are pregnant but you can put together a rough draft of what you want it to be like, type it up on the computer (if you have one) so that you can edit it as things change. This will also help you to find a supportive care provider as you can use it as a guide when asking questions.

8) Start working on your household budget, do up one for your current circumstances, do one for emergency circumstances and do another one for the future taking into account another baby and the expenses involved in caring for another child. If you feel the need to save up some money just in case then implement the future budget and put what you would be spending on another child in future into a savings account (for example the ANZ bank have a Progress Saver account where for every $10+ you deposit one transaction each month without any withdrawals you get 10% interest on that deposit for that month, other banks will have something similar and possibly even better so shop around for the best deal).

9) Plan ahead. This is similar to #7 but for physical/practical things. Start implementing a weekly/fortnightly meal plan if you don't have one already. Do a weekly bulk cook up - spend one day a week cooking up 7 days worth of meals, this will save you time, especially once you are pregnant or have a newborn, and once you are pregnant you can then cook extra and freeze it for a later date (really good for when you get home from hospital and are too tired or too busy with your new baby to cook). Also start putting together lists of the things you will need for a new baby, if it has been a few years since you last had a baby or you haven't had a baby yet this can be really helpful, you can start buying a few things in the lead up to trying to get pregnant, a few packs of wipes (they are also great for wiping up spills and cleaning bench tops), some baby socks, some blankets, sheets, wraps etc, you can also start pricing car seats, prams, nursery furniture and nappies (disposable or cloth) and this will help you to find out what you really want/need and if you write it all down now you can compare prices when you are pregnant and know if you are getting real value for money.

10) Take some time out for you. Whether this is just time to read a good book, a massage, manicure/pedicure etc, it is essential that you are happy and stress free when you are trying for a baby. This extends to pregnancy and labour, and post birth as well. Oxytocin is the happy hormone, it is also the predominant thing that kick starts dilation and labour and gets contractions going, and it also starts breastmilk production (baby is the other thing, if baby isn't ready to be born and isn't releasing the birth/labour hormones then labour won't start without medical intervention). A happy mum also makes a happy baby as they pick up on our moods and react to them accordingly, so start working on things that make you happy and stress free now so that you have plenty of practice for once you are pregnant and after baby is here.

11) Research, Research, Research. I can't stress how important this is, and I have mentioned it subtly in the above points. Whether it is the prices of baby items or the method of birth you would like always do your research. If a doctor tells you something during pregnancy that concerns/worries you then research it and get 2nd/3rd/4th opinions until you are 100% satisfied that there are no other options or that you have chosen the right option. Medical professionals aren't God's, they are human and they don't know everything, and like any human they can and will use their personal opinions to influence you to do something that you wouldn't otherwise do, most notably in women who have had a previous cesarean and are thinking of having a VBAC the "dead baby" card is often brought into play to scare women into having a repeat cesarean, and in women with gestational diabetes the "big baby" card is thrown around and those mums are told that their babies will be too big for them to push out their vagina which means an early induction before baby is ready or a cesarean. Not only are these two things wrong in general but they also go against current evidence based research and ACOG and WHO guidelines. Women have birthed big babies (10 pounds +) for millennia with few or no complications, so why in this day and age is it more dangerous to deliver a larger baby than a small baby vaginally? This is why you need to research, and also why you need to research labour and birthing positions if you are given the "big baby" card.

I hope this post has been helpful. Feel free to share it.
Jenna
Student Birth Doula

This is just a short and sweet blog entry.

I stayed up late last night to follow a VBAC mumma as she had a healing and empowering homebirth right here in Australia!

We (the whole VBAC support group) were kept up to date as she waited for the midwife to arrive while going through transition, when she started pushing, as she managed through a rough patch where while fully dilated a cervical lip remained, and ending with the announcement that her precioius baby girl had been been born at home into her excited (and tired) parents arms shortly before 12:30 am this morning.

This amazing and beautiful event brings home just how safe and beautiful a homebirth can be, and goes against the scaremongering that the world's media, many obstetricians and even many other bloggers put into place when talking about homebirth.
The truth is that if this amazing mumma had been in a hospital to give birth the chances of her being successful in her VBAC attempt would have been very low. Not only would she have been subjected to constant monitoring with straps tightly done up around her belly, but she would have been confined either solely to the bed or within a very small area around the bed. She would have been given a time limit, usually no more than 6-12 hours, in which she could labour before a cesarean was arranged without her consent, and the chances are highly likely that she would not have been able to labour in a birthing pool (which she was able to do at home).

The media portrays homebirths as dangerous, as selfish on behalf of the mother and deadly on behalf of the child. The truth however is that hospital birth for many of these mumma's is far more dangerous to them and their babies, and the risks of maternal and fetal death in a hospital are much higher than they are in a planned homebirth with the support of a fully qualified midwife.
These women who homebirth are a true inspiration and should be given the respect that they deserve for all the research that they do in preparation and for recognising the safest way FOR THEM to birth their precious babies.

Jenna
Student Birth Doula
FOOTPRINTS & RAINBOWS Birth Doula Services