The medical definition of a ‘large baby’ is a baby who has macrosomia, otherwise known as a baby who is above 4.5kg in weight at birth, or above 10pd if you don’t follow the metric system. A baby who is 8-9pd/3.65-4kg is not a ‘large’ baby, and is only on the higher end of the ‘normal’ birth weight range for babies (75th-95th percentile on the baby weight charts).

In today’s modern highly medical society many women are being told that a “big” baby will die or be seriously injured if they go to term and birth their baby vaginally, some are even told that they will die or be seriously injured as well if they birth a large baby vaginally. These women are being told that there are no if’s, buts’ or maybe’s and that these things WILL happen if they attempt a vaginal birth at term or just by attempting a vaginal birth in the first place. But the truth is that regardless of how big or small your baby is the majority of the risks apply to everyone, and those risks are still very small when you put them into perspective.

It’s a catch 22, we are misinformed and scared silly with the thought that we might possibly cause our baby or ourselves harm during normal childbirth and if we ignore those scare tactics and still choose to let nature take its course by allowing labour to begin spontaneously when our body and baby are ready for it and initiate it and allow it to progress normally we also then feel guilty if we end up being one of the very small percentage of women that do experience a complication just for choosing something that put ourselves and our baby at risk of that complication. We all must make our own decisions about what risks we feel comfortable taking, and when a baby isn’t involved many of us will willingly take risks with our own lives for the thrill of it or just because we can, but when a baby IS involved we do not like to take extra risks and unfortunately when we are scared by things we have been told, when we are misinformed or coerced by a trained professional into believing that what we were physically designed to do is far too dangerous and we are as a result choosing something that we otherwise wouldn’t choose for ourselves we aren’t actually making the informed decision which is required by law, we are going along with what we have been told to do instead without knowing all of the risks that we already have or all of the new risks we will then be placing upon ourselves by blindly following a “doctors advice” without questioning things. Questioning, demanding truthful, evidence based answers and getting all the information on the risks you may currently have and comparing them to the potential risks of whatever other choices you have been offered is essential to making the informed decision that we are legally required to make prior to signing any consent forms, and once you have done that only then can you make a truly informed decision on something that will affect your whole life, if not mentally then it will affect you physically in some manner, from that moment onwards. The purpose of this blog post is to inform the ready and provide evidence based factual information. The majority of this information is from legitimate research studies, some is from my own experiences of birthing suspected macrosomic babies who turned out only to be “above average” in size between the 75th and 95th percentiles, and from information gained from conversations with my various care providers over the years.

Let’s debunk some myths about the actual, potential, perceived and implied risks of having a larger than average or macrosomic baby both vaginally and via caesarean into perspective:

Myth: My friends and my doctor all told me only big babies develop shoulder dystocia. Is this true?
FALSE: The most commonly mentioned “risk” of having a “large” or macrosomic baby by most doctors is shoulder dystocia or “sticky shoulders” where the babies shoulder becomes stuck behind the pubic bone or it’s shoulders have difficulty moving through the pelvis and become “sticky”. Contrary to popular belief, a ‘small’ baby (a baby who is under 3kg at birth) is just as likely to have shoulder dystocia or ‘sticky shoulders’ as a larger baby, it all depends on the babies position as he/she moves through the birth canal, how patient the delivery suite staff are (and how prone to panic they are too, sometimes even the most experienced staff will panic if they think that something is wrong or that something is taking too long) and the mothers position as she delivers.

Myth: My doctor says my pelvis is too small to birth my baby vaginally. Is this true?
FALSE: For the vast majority of women in the western world this is false, although there are some rare exceptions. A misshapen or too small pelvis, called Cephalo-Pelvic Disproportion, is very rare and true diagnosis is confined to those with skeletal abnormalities from chromosomal or genetic disorders, those who have suffered from severe malnutrition resulting in rickets (caused by very low vitamin d levels which are essential for calcium absorption and proper bone growth), those with what is called an android pelvis (a pelvis that is shaped similar to a man’s pelvis which makes it almost impossible to birth vaginally although there are also exceptions to this) or those who have broken their pelvis at some point in their life. An incorrect diagnosis of Cephalo-Pelvic Disproportion can be given if your baby is malpositioned and doesn’t descend resulting in an emergency caesarean (and in some cases it can be given after a “failure to progress” diagnosis that resulted in an emergency caesarean to make the reason for the caesarean easier for a mother to accept) which can also be caused by a twisted pelvis that, I am pleased to say, can be fixed by a qualified chiropractor before and during subsequent pregnancies. If the mother is flat on her back during labour and birth not only will her pelvic width be reduced, making it harder for the baby to move into the birth canal, but her baby will also be fighting against gravity as it makes its way into the world and will not be able to manoeuvre as effectively as it could if mum was using gravity to help her birth her baby safely and the way nature built us to birth our children. There are various positions which can help your baby move into a better position before and during labour, if you have a doula she or he can help you with them, or you can do them with your partner and some you can even do by yourself, you can find these position by clicking on the Spinning Babies Website link located in the references section at the end of this blog post. If after trying these positions your baby is still in the same position as he or she was before you tried them then don’t despair, many babies will move on their own during labour and birth, and even when they don’t a vaginal birth is still possible in most cases with the right support behind you.

Myth: My doctor told me my baby is too large for me to birth at full term and I need to be induced early because I have a high risk of my baby getting stuck in the birth canal. Is this true and what are my chances if I go to full term?
FALSE: Your doctor has not given you all of the facts and also has not explained the actual risks to you properly, when you next see your doctor ask to see the actual research statistics on shoulder dystocia for both small and large babies. You have the same risk as everyone else wanting a vaginal birth. The chance of your baby getting shoulder dystocia is approximately 0.2% to 3% with an average of 1 in every 200 births (these percentages cover everyone regardless of if their baby is “large” or small, and are about the same as the risk of uterine rupture in a mother hoping for a Vaginal Birth/VBAC after 1, 2 and even up to 5 cesareans, just to put it into perspective for you).

Myth: My doctor told me that if I try to birth my large baby vaginally I will haemorrhage and die. I am very scared of this happening, please tell me is this true or is it a scare tactic?
FALSE: This is not exactly true so it is classed as false in this instance as you have the same risk as anyone else of haemorrhaging during birth, regardless of your babies size, and with the current medical treatments for post partum haemorrhage your risk of dying from this is very low and is the same as pretty much everyone else (apart from those with existing bleeding disorders who are at higher risk anyway and are usually encouraged to birth vaginally because of the higher risks of severe haemorrhage during a caesarean). According to the WHO (2005) approximately 11% of all live births (both vaginal and caesarean) regardless of baby’s size will result in a severe post partum haemorrhage, that is 11 out of every 100 women who will lose over 1 litre of blood after birth. The vast majority of these women who experience a severe post partum haemorrhage will survive thanks to modern medicine, so the risk of you dying from a haemorrhage is quite low.

Myth: Lots of babies are born quite large these days. It’s more common to have a large baby than a small or average sized baby/ True or False?
FALSE: This is quite simply false. According to the 2003 statistics only 1.8% of all babies born in Australia in 2003 were macrosomic (born weighing 4.5kg or more). This number may have increased slightly up to 2-4% between then and now but I have been unable to find any statistics regarding average rates of macrosomia for 2013 or 2014 at this point in time.

Myth: A large baby (suspected to be macrosomic and over 4-4.5kg) is not a common cause of induction or elective caesarean. Surely doctors wouldn’t suggest those things if they weren’t necessary? True or False?
FALSE: With an average caesarean rate of 1 in every 3 births within Australia it doesn’t surprise me that a lot of inductions and primary caesareans are as a result of a suspected macrosomic baby. If you take a look in a general pregnancy and parenting forum or similar facebook group you will see a lot of women scheduled for early induction or a caesarean because a late pregnancy ultrasound scan has measured their babies as being larger than average and therefore “too big to birth vaginally at full term or post estimated due dates”. In the US alone a suspected macrosomic baby is approximately the 4th most common reason for an induction (which has its own risks not related to birthing a macrosomic baby and makes it more likely for shoulder dystocia to occur), and approximately the 5th most common reason for an elective caesarean (which has its own risks as well not related to macrosomia or vaginal birth). These numbers are not much different within Australia.

Myth: My doctor told me that I would either tear badly in my perineal area if I attempted a vaginal delivery or would need an episiotomy to help get my baby out. Is this true?
FALSE: This is false, an episiotomy should only ever be used as a last resort if baby needs to come out very quickly and you are fully dilated and haven’t torn naturally and baby isn’t descending properly. For the vast majority of women an episiotomy is not needed, and it is far better for the mother to tear naturally as in general a natural tear will heal quicker and cleaner than an artificial cut. You are more likely to have a small tear or only have grazing from a vaginal delivery if you and baby are left well alone, you are allowed to birth in whatever way feels comfortable to you and as long as you are both happy and healthy. You have the same risk of having a severe perineal tear during a vaginal birth with a small baby as you do with a macrosomic baby, and there is no difference in the rates of 3rd and 4th degree tears between small babies and macrosomic babies born vaginally, with your overall risk of a 3rd or 4th degree tear being between 0.2% and 0.6% according to Weissmann-Brenner et al. 2012 (notice that this general risk is the same or smaller than the risk of shoulder dystocia mentioned earlier). According to Sheiner et al. 2005, a vacuum delivery (ventouse extraction) increases your risk of a severe tear by up to 11 times (0.2-2.2%) for all women expecting small, average or macrosomic babies and your risk of a severe tear with the use of forceps increases by up to 39 times (0.2-7.8%).

Myth: My doctor told me that because my baby is measuring so big if I don’t go into labour on my own before 38/39 weeks my baby will be stillborn. Is this true?
FALSE: This information that your doctor has given you is most definitely false. While the general risk of stillbirth is slightly higher from 40 weeks gestation onwards, your risk is just as high prior to 38 weeks gestation and is lower between 39 and 41 weeks. The general risks are still low at under 3% and they are not related to baby’s size. There is no evidence that having a larger baby increases your risk of stillbirth. Your overall risk of stillbirth with a larger baby is the same as everyone else who is low risk and at the same gestation as you are.

Myth: My doctor told me that I need to be induced or book an elective caesarean early to prevent complications. Is this true?
FALSE: While there is a small risk of shoulder dystocia, severe haemorrhage (over 1 litre of blood loss post birth), stillbirth and severe perineal tear when birthing a baby vaginally regardless of size, these potential “complications” apply to everyone regardless of the size of their baby. The most common complications from having a larger baby stem from inductions and cesareans themselves, including maternal and/or fetal injury, haemorrhage (most commonly haemorrhage requiring a blood transfusion), clotting disorders, maternal infection and baby having breathing problems.

Myth: Someone told me that if my baby is measuring big on the ultrasound that I’m more likely to end up with a caesarean. Is this true?
TRUE: This is true, but not because your baby is measuring larger than average. It is because a doctor is more likely to insist on an early induction before your baby or your body are ready for labour or because your doctor will insist on an elective caesarean, especially if you have already had one or more caesareans prior to your current pregnancy. According to Blackwell et al. 2009b if a baby is suspected of being macrosomic physicians are more than twice as likely to diagnose “stalled labour” or “failure to progress” and perform a caesarean (35%) when compared to physicians supporting women who were not suspected of having a macrosomic baby (13%), also according to Sanchez-Ramos et al. 2002 if you are suspected of having a macrosomic baby and wait for labour to begin spontaneously you only have an 8% risk of needing an emergency caesarean compared to a risk of 17% if you are induced early.

Myth: I was told that my baby is measuring very big on my 37 week ultrasound. My doctor told me the weight was accurate. Is this true?
FALSE: This is false. According to Chauhan et al. 2005 ultrasound weight estimates for normal and above average are only approximately 50% accurate, meaning that 25% of in-utero baby weight estimates will be below the weight estimated, 25% will be higher than the weight estimated and only 50% of the total will be exactly or close to the estimated weight, and ultrasounds for babies estimated to weigh 4.5kg or more were only 20-30% accurate, meaning that only 20-30% of all weight estimates will be exactly or close to the baby’s birth weight and the remaining 70-80% will be either lower or higher than the estimated weight. Not good statistics when you think about it, your baby’s weight could end up being much lower than estimated, or much higher, and without an ultrasound you would never have known what it could possibly be until after your baby was born.

Myth: But ceasareans prevent permanent nerve injury from shoulder dystocia. True or False?
FALSE: This is false. According to Rouse et al. 1996, in a low risk mother with no diagnosis of diabetes, in order to prevent one permanent nerve injury in a baby from shoulder dystocia, 2,345 women suspected of carrying a macrosomic baby would need to have an elective caesarean for a suspected large baby estimated at weighing over 4kg. That’s a lot of unnecessary caesareans given that only 11.725 of those women would experience shoulder dystocia during birth, and only 3.2 of those 11.725 babies would receive permanent nerve damage leaving 8.525 babies with transient nerve damage that will heal itself, so looking at it like that your risk of it even happening at all is less than 0.0015%, or approximately 1.3 in every 1000 vaginal births. Also according to Rouse et al. 1996 it was also estimated that for every 3.2 permanent nerve injuries to a baby that were prevented by the above mentioned caesareans there would be 1 maternal death caused by complications from the surgery itself, or approximately 1 maternal death in every 7504 scheduled caesarean births that could have been prevented.

Myth: Vaginal birth is safer than a caesarean for low risk women. True or False?
TRUE: For non-diabetic women vaginal delivery of a suspected macrosomic baby is safer for them, their baby and future pregnancies than an elective caesarean section is, and for diabetic women a vaginal delivery is also the ideal, but with the added risks from potentially uncontrolled or badly controlled diabetes an early induction or elective caesarean are often recommended. However, you always have the right to refuse an early induction or elective caesarean even when you are high risk, the decision is always yours to make.

Myth: For a diabetic woman a third trimester ultrasound, usually done around 36-37 weeks gestation, is more accurate than it is for everyone else. True or False?
TRUE: This is partially true in that ultrasounds are only slightly more accurate in predicting a larger than average or macrosomic baby in diabetic women (Type 1, Type 2 and Gestational Diabetes), this is most likely due to the fact that diabetic women are more likely to have larger babies, especially if their diabetes is not well controlled. This could easily be considered false though.

Myth: Ultrasound during late pregnancy is the only way to diagnose macrosomia. True or False?
FALSE: This is false, as ultrasounds are only 20-50% accurate in the first place, and late term ultrasounds (ultrasounds conducted in the third trimester usually between gestational weeks 36 and 37) are notoriously inaccurate as the estimated weight of your baby is based on leg, arm, belly and head measurements, for example if your baby has long legs the estimated weight will be higher, or if your baby has a larger belly then the estimated weight will also be higher (baby belly measurements change day to day due to how much amniotic fluid is within the stomach, how much amniotic fluid is surrounding the baby while the measurement is being taken and how many different sonographers are measuring and their respective experience), and likewise if your babies legs and/or belly are measuring smaller your babies estimated weight will be lower as well. Because every baby, just like the rest of us, is different and has different genetic factors affecting growth, how much fat is absorbed and stored, how large they grow etc all measurements given by ultrasound are subject to error and should only be used as guidelines for measuring potential growth and only show an estimate of the growth made up to that point in time. Basically this means that your baby might stall in growth for another 2 weeks or so after the ultrasound estimating that your baby will large and over 4kg and then your baby will be born at 39-41 weeks weighing only 3.4kg, or if you are induced early shortly after your ultrasound you might find that you have birthed a 3.8kg baby who was only supposed to be measuring at 3kg according to the ultrasound!  What I am trying to say is that the only accurate way to diagnose macrosomia is to weigh the baby after delivery, anything before birth is just an estimate based on a series of measurements that are compared to a baseline series of measurements in a computer and are then calculated and converted to provide an estimated answer based on those equations and they are NOT a guarantee.

I hope this blog post has been helpful, below you can find a list of the various links used in the research of this blog post, feel free to pay them a visit and see the information and statistics for yourself. I highly recommend Evidence Based Birth for up to date information based on actual scientific research.

Jenna Edgley
Birth Doula and Placenta Encapsulator
FOOTPRINTS & RAINBOWS

References:
http://brochures.mater.org.au/Home/Brochures/Mater-Mothers-Hospital/Shoulder-dystocia
http://www.uptodate.com/contents/shoulder-dystocia-risk-factors-and-planning-delivery-of-at-risk-pregnancies
http://www.pphprevention.org/pph.php
http://www.babycenter.com.au/a1015615/macrosomia-big-baby
http://evidencebasedbirth.com/evidence-for-induction-or-c-section-for-big-baby/
http://www.spinningbabies.com

 

What Is Prelabour?
Prelabour, commonly mistaken for early labour, is the preparation stage that occurs prior to the beginning of early labour. Think of it like the test run service that car manufacturers use to determine the maximum speed, safety and efficiency of cars prior to putting them out in the market for public sale. It is your body testing itself, preparing itself and gearing itself up for the all important big show that is your labour.

Will I get prelabour?
An active prelabour phase isn’t experienced by every woman, and occurs more commonly in women who have already given birth to one or more children, it doesn’t discriminate between women who have had prior cesareans or vaginal deliveries as it can affect women who have only had one or the other or even both and it doesn’t discriminate between woman who have experienced labour and those who haven’t. For those women who don’t notice an active prelabour phase it doesn’t mean that their bodies aren’t preparing or that their bodies are broken, it just means that their body is working efficiently and in a way that doesn’t announce what is happening inside of them physically, hormonally and mentally.

What is happening within my body during this time?
During this phase your body is getting ready for a big change and influx of different hormone levels, your baby is beginning to produce increased levels of Oxytocin (Oxytocin is a hormone essential for both effective labour contractions and breast milk production) and your uterus is creating more Oxytocin receptors on its surface which can result in an increase in contractions of the uterine muscles (usually overnight when you are more likely to be resting and relaxed and the oxytocin is able to work more effectively) due to the extra sensitivity to Oxytocin and with your Estrogen levels also beginning to increase in relation to the high levels of Progesterone (which have been present within your body since the beginning of the pregnancy to prevent uterine contractions that could expel the growing baby from the womb), it can make for some very uncomfortable and frustrating times as your body works hard to make itself ready for labour to begin. During the last few weeks or so of your pregnancy the Prostaglandin levels in your body are also increasing, these increasing levels of Prostaglandins work to soften the cervix in preparation for dilation and also work in tandem with the hormone Relaxin to soften the ligaments of the pelvis to help it open more effectively during labour and birth. This can result in aches and pains around your pelvic area (pelvic girdle pain is a good example of one of the possible side effects of this influx of hormones) and also helps the baby to descend into the pelvis or “engage” (although engagement of the baby alone is not a guarantee that labour will be starting soon and many second or subsequent babies do not engage until active labour has already begun).

How can I recognise possible prelabour?
An active prelabour phase can be recognised by irregular or regular contractions (similar to Braxton Hicks contractions only usually more noticeable and lasting longer than Braxton Hicks contractions do) that continue for an hour or more, sometimes even for 12 hours or more, and then suddenly stop or slowly decline in strength and/or regularity. These prelabour contractions can last for days, weeks or even months on end before early labour itself starts, and can often be mistaken for early labour itself resulting in a woman becoming disappointed and upset when there is very little or no progress in cervical effacement and/or dilation and can even bring on the fear of a premature delivery if they start before 37 weeks gestation. Prelabour commonly starts in the evenings and at night and tends to wane or stop during the day and is often frustrating for a mum-to-be who has been hoping that labour was finally beginning, or a huge relief for a mum who is worried about going into premature labour.

What can I do to make this period in time easier for myself?
An extended prelabour lasting days, weeks or months, can make a mum-to-be very tired and reduce energy levels considerably and it is important for the woman experiencing it to relax and rest as often as possible (a seemingly impossible thing to do when you have other children to look after as well or you are still working), eat regular high energy meals and maintain your fluid intake to prevent dehydration.
If you are responsible for other children seek help from family and/or friends who can assist in caring for your other children so that you can get adequate rest. If you do not have family or friends close to you or none of them are able to help look into day care if you can afford it or research other avenues – eg work out an agreement with a local mum that you know who can care for your children for one or two days a week while you are experiencing this in return for you caring for her child/children (if she still have any living at home with her) or offer to help her out with other things later on for the same amount of time at a later date after your baby has been born and you have settled into the new routine with your new baby. Enlist your partner, if you have one, on weekends to watch your children while you get some more sleep, arrange for your partner to take care of the children and arrange dinner in the evenings so that you can lay down for a bit or have a long soak in a warm bath. If you are a single parent look into local support groups for single parents, most large populated areas will have some kind of single parenting support group available, even if it is only on Facebook, where you can meet others going through similar things and find support that is local to you. You can ask your local maternal and child health nurse or ring your local mother and child health line for advice as well, they have a lot of information available and can advise you on places to go to for assistance. If you are religious your local church may even be able to assist in arranging in home help for you, it doesn’t hurt to ask around for help and it doesn’t make you any less of a good mother to admit that you need help either, in fact it means that you are a great mother and you will always be a great mother regardless of if you need or not.

It feels like I’m the only one going through this, none of my friends have experienced it before, I feel like my body is broken because nothing is happening. When will it end?
Prelabour is stressful, tiring, disappointing, lonely, frustrating and can be very disheartening, but rest assured that you are not alone in experiencing it, there are many other women all around the world experiencing it with you and there are many things that you can do to help make things easier and less stressful for yourself. Remember to take time to rest during the day, eat a high energy diet to combat the energy drain that is can cause, and keep up your fluid intake to prevent dehydration, and soon you will be holding your new baby in your arms and the stress of the previous days, weeks or months will melt away and no longer matter. Your body is not broken even if there is no physical signs of progress like effacement or cervical dilation, your body is still working and changing and getting ready for labour to begin at the right time, and labour itself will start when your body and baby are both ready to be born, whether that ends up being in 24 hours time or in 4 weeks time, it will happen.

I hope this blog post has been helpful and as always feel free to share. If you wish to repost it please include the authors name and link back to this blog post.

Written by Jenna Edgley
Birth Doula and Placenta Encapsulator
FOOTPRINTS & RAINBOWS


Helpful Phone Numbers (Australia Only)

VIC
The Maternal and Child Health Line Tel: 132 229 – available 24 hours a day for the cost of a local call throughout Victoria.
Parent Line ph. 132 289
NURSE ON CALL ph. 1300 60 60 24 – for expert health advice 24/7
Victorian Aboriginal Health Service (VAHS) - 03 9419 3000
Women’s Referral and Information Exchange (WRIE) - 1300 134 130 (cost of a local call), 9am to 5pm, Monday to Friday

NSW
Healthdirect Australia and Early Childhood Services - 1800 022 222
Parentline - 1300 130 052, 24/7
Karitane -  1300 227 464 (1300 CARING) 24 hours Monday to Thursday, 10am to 4:30pm Friday to Sunday
MyChild - 1800 670 305 (freecall) or 1800 639 327 (TTY Service for hearing or speech impaired), 9am to 8pm, Monday to Friday
Tresillian Family Care Centers - (02) 9787 0855 or 1800 637 357 (free call in regional NSW), 24/7
Women’s Information and Referral Services - 1800 817 227 (free call), TTY Service 1800 673 304 (for hearing-impaired or speech-impaired callers), 9am to 5pm, Monday to Friday

QLD
Child and Baby Health Clinics - 13 HEALTH (13 43 25 84), 24/7
Parentline - 1300 301 300 (cost of a local call, 8am to 8pm, 7 days a week
Ellen Barron Family Center - (07) 3139 6500
MyChild - 1800 670 305 (freecall) or 1800 639 327 (TTY Service for hearing or speech impaired), 9am to 8pm, Monday to Friday
Women’s Infolink - 1800 177 577 (free call), 8am to 6pm, Monday to Friday

ACT
Child Health Checks - (02) 6207 9977, 8am to 5pm, Monday to Friday (except public holidays)
Healthdirect Australia - 1800 022 222
Parentline ACT - (02) 6287 3833, 9am to 9pm, Monday to Friday (except public holidays)
ACT Community Health -  (02) 6207 9977, 8am to 5pm, Monday to Friday (except public holidays)
ParentLink - 13 34 27, 8:30am to 5pm, Monday to Friday
Queen Elizabeth II Family Center - (02) 6207 9977, 8am to 5pm, Monday to Friday (except public holidays)
MyChild - 1800 670 305 (freecall) or 1800 639 327 (TTY Service for hearing or speech impaired), 9am to 8pm, Monday to Friday

NT
Maternal and Child Health - (08) 9855 6106 (in Darwin) or (08) 8922 7712 (outside Darwin), 8am to 4:30pm, Monday to Friday
Parentline - 1300 301 300 (cost of a local call), 8am to 10pm, 7 days a week
MyChild - 1800 670 305 (free call) or TTY Service 1800 639 327 (for hearing-impaired or speech-impaired callers), 9am to 8pm, Monday to Friday

SA
Child Health Checks - 1300 733 606 (cost of a local call), 9am to 4:30pm, Monday to Friday
Healthdirect Australia - 1800 022 222, 24/7
Parenting SA - (08) 8303 1660, 9am to 5pm, Monday to Friday
MyChild - 1800 670 305 (free call) or TTY Service 1800 639 327 (for hearing-impaired or speech-impaired callers), 9am to 8pm, Monday to Friday
Women’s Information Service - 1800 188 158 (free call), 9am to 5pm, Monday to Friday

WA
Healthdirect Australia - 1800 022 222, 24/7
Parenting WA - (08) 6279 1200 or 1800 654 432 (free call from regional areas), 24/7
Ngala - 08) 9368 9368 or 1800 111 546 (free call from regional areas), 8am to 8pm, 7 days a week
MyChild - 1800 670 305 (free call) or TTY Service 1800 639 327 (for hearing-impaired or speech-impaired callers), 9am to 8pm, Monday to Friday
Women’s Information Service - (08) 6217 8230 or 1800 199 174 (free call from regional areas), Interpreting Service 131 450, 9am to 5pm, Monday to Friday

TAS
Child Health Centers
·         Burnie – (03) 6434 6451
·         Devonport – (03) 6421 7800
·         Hobart – (03) 6230 7899
·         Launceston – (03) 6336 2130
The Parent Line - 1300 808 178 (cost of a local call) 24/7
My Child - 1800 670 305 (free call), or TTY Service1800 639 327 (for hearing-impaired or speech-impaired callers), 9am to 8pm Monday to Friday
Parenting Centers
·         Hobart - (03) 6233 2700, 9am to 5pm, Monday to Friday
·         Burnie - (03) 6434 6201, 9am to 5pm, Monday to Friday
·         Launceston - (03) 6326 6188, 9:15am to 2:30pm (days not specified, but most likely Monday to Friday as well)

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

Recently I've come across quite a few articles and blog posts written by disgruntled mums blaming their Doulas for things not going right.

In some cases these mums have a right to be disgruntled - a couple of those so-called "doulas" were operating well outside of our scope of practice. Very scary for the mum who has never had the support of a good doula to read, and horrifying for the doulas who do their jobs well and stay within our scope of practice.

One of the prevalent things mentioned in these particular articles and blog posts describes doulas as "Airy Fairy Hippies who promote themselves as producers of births that are so good and wonderful that they are like rainbows and unicorns" (this is my take on the statements made in these articles and blogs and not the original wording, however the words "Airy Fairy Hippies" and "Rainbows and Unicorns" to describe Doulas all come straight from the blogs and articles themselves).

The biggest issue that I've found with these articles and posts is that these mums never "shopped around" for the right doula for them. They heard from a friend that there was a "great doula" in the area and upon meeting said doula they hired her on the spot. No questions asked, no mention of "meshing" between them and the doula and then lots of complaints in the blog/article about everything that the doula "did wrong" during mums pregnancy and labour.

Now I am not everyone, but I personally shop around for things that are important to ensure that I get "the best deal" or "the best fit". This applies to a service on my husband's car, and electrician to check the wiring in our house and a plumber to check the pipes. Most recently (and currently at this point in time) we are shopping around the various real estate agents in a bid to get the best price possible for our old house back in Morwell, Victoria.
You have to do the same with Doulas as well. Not every doula will be a match for every mum who contacts her and vice versa. You need to do your research and, unless there is only 1 doula in your area or none at all, you are guaranteed to have a variety of doulas in your area who would love to have the chance to meet you and see if you are a "good fit" together.

All doulas are different, some are the equivalent of the "Airy Fairy Hippies" described in the above mentioned blog posts and articles, others are serious and studious and stick to a strict schedule in their business practices. Some are male, many are female, some are bisexual, gay, lesbian or transsexual. Some have lots of kids, some only have 1 or 2, some adopt or foster, some don't have any kids at all for various reasons that are their own.
Some are "crunchy" parents who use gentle parenting techniques, others are strict parents. Some promote and only attend drug and intervention free births, others only support women who are having an elective cesarean,  while others support families who have lost their baby in utero or who will lose their baby soon after birth. Some doulas also support people who are dying from a terminal illness (these are called Full Spectrum Doulas). Doulas are all of these and more.

I myself never had a Doula for my own births, although now I wish I had, it would have made my births be much better experiences.
The picture at the top of this post is of me and my youngest child just minutes after she was born - my 2nd VBAC delivery after 55 hours of labour that could have been much shorter and far less traumatic if I'd had a Doula there to bolster my confidence and help me to find my voice. I look at this picture and I am filled with a mixture of happiness that my baby girl arrived safely, and sadness at how I was treated in the process of bringing her into the world and that I didn't have the extra support that I needed. Don't get me wrong, my husband was a fantastic support to me during labour, but there was only so much that he could do and he would have benefited from extra support as well.
As you can see I am a normal mum. I don't see myself as a "crunchy" mum or a strict mum. I am somewhere in the middle, I have to be with a child who has extra needs. I live my life day to day and plan ahead when needed. While I love the idea of natural drug and intervention free birth I know that that is not for everyone - I have not experienced it for myself either - and what worked for me won't necessarily work for everyone else. I devote my entire being to my clients, if they need me I am there ASAP to the point where I can leave my whole family in the lurch (lucky they support me wholeheartedly in my chosen profession and my kids are always excited to hear a new baby has been born). What I want out of your birth doesn't matter, all that matters is that you have the best birthing experience possible and I will support you and your decisions with my whole being. I cannot speak for you, but I can reassure you and tell you that you are doing an amazing job, whatever the outcome may be.

So as you can see we (including myself) are many and varied, but the one thing that brings us all together is the desire to provide extra emotional, physical and mental support to people going through the most important stages of our lives, whether it be bringing new life into the world or helping others on their journey out of this world. It is a very demanding job - we don't do this just for the money, we don't make millions of dollar's and many of us barely manage to put food on the table from what we earn once all of our expenses have been paid for - and not just anyone can do it. Quite often we burn out from everything that we put into our work and need to take reasonably regular breaks to rest and recharge before getting back into it again. We regularly attend marathon labours that last for over 24 hours (and in the case of the last birth I attended it was 53 hours lol and I only managed 3 hours of broken sleep somewhere in the middle because the adrenalin was still pumping). We are passionate, we love birth, we love being able to support people and feel blessed and honoured to be able to do this as a job. We are drawn to it like moths are drawn to a flame. Many of us (myself included) feel that we were born to do this and only this and anything that we did beforehand was only a stopgap measure until we found our true calling. Sometimes we end up with 2 or more clients going into labour at the same time. We cannot predict or control this, and on the rare occasions that it does happen we do everything that we can to either be at all births for as long as possible (sometimes we end up having to drive from one birth on the east side of the city/town to another birth on the west side, or north and south sides of the city/town, it is not ideal but we try to make it work) and if all else fails we try to arrange a back up doula to attend in our stead. This isn't ideal, but sometimes it has to happen.

What I am trying to say is that, no matter how much a friend or someone you know extols the benefits of a doula that they have personally hired or if they know somene who has hired a particular doula, you should always look around and make sure you mesh well with the doula that you decide to hire. This can sometimes mean having an interview meeting with 10 or more different doulas before you find the one that suits you the best. It will be worth it in the end as with the right doula even the most traumatic of labours can become something beautiful and special and be worth all of the pain that was involved at the time.

I have been lucky, I have become good friends with all of my clients, and they all had good outcomes even with things that came up during labour/birth, and we still talk regularly and share what our children are up to. We meshed so well that we were able to take the "client-doula" relationship further and will most likely remain friends for life. The best part is that we probably would never have met if they hadn't contacted me to ask if I could be their doula, and because of that I am truly blessed.
I know that in future I will be faced with clients who I don't mesh with or who don't mesh with me even if I do mesh with them, and that is OK.  It is part of the learning process and it is why I insist on an introductory meeting first to discuss things and see how well we get along. So please, please do your research before hiring a Doula! It will be more beneficial for you if you do.

As always, feel free to share :)

Jenna Edgley
Student Doula
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