Hindrances to Natural Birth #52 : Tickets

Image courtesy of Arvind Balaraman / FreeDigitalPhotos.net

I'm pretty sure that if I were to ask you about some of the top hindrances to natural birth, 'tickets' would not be high on your list. Pitocin, lithotomy position, hospitals, a medical model of care, our culture of fear around birth: these are all pretty obvious. But I believe some of the real hindrances to natural birth may be somewhat more banal.

Labour is a shifty thing sometimes. One of the hormones that keep labour going - oxytocin - is considered to be a 'shy' hormone. It is not easily released under pressure. It is the hormone most intricately involved in lovemaking and released during orgasm. It is also the hormone that causes 'let down' or a fast flow of milk when breastfeeding. In short, oxytocin is the hormone of love, labour and lactation. 

Couples struggling to get pregnant who have to do the 'baby dance' on a particular day or even at a particular time will often attest that being 'forced' to make love on schedule kind of kills the vibe. 

Let's take it a bit further. Imagine you are in the middle of lovemaking and someone knocks on the door, peeks around it, and switches on the main light, just to check how you're doing. Are you there yet? Shall we check to see how far you've got to go? It seems to be taking some time. If you're not done in x amount of time we may need to help you along. I'll be back shortly. As you were. Toodles! 

Vibe. Officially. Dead.

Now that sounds ridiculous when applied to lovemaking, but the same hormone, oxytocin, is what induces and keeps labour going. 

So imagine: you are at the end of your pregnancy and your mom has booked her ticket from across the country, or across the globe, for the day before your expiration due date. She only has three weeks off work. The pressure is on. The clock is ticking.   

The thing is, when a pregnant mom has a perceived time limit within the labour process, her body is far less likely to release sufficient oxytocin to keep labour going effectively. On a larger scale, when a mom feels under pressure to go into labour to begin with, it actually makes it much harder for her to do so. 

And so she starts looking at induction options. Inductions can be helpful when there is a genuine medical need for them, but often then lead to a cascade of interventions as illustrated below.

There is lots I could say about inductions that would give some evidence for the diagram above - but that is a whole other post on its own! Let's rather look at some solutions to avoiding inductions altogether. Firstly, let people know that 'estimated due dates' are just that, estimates - there is about a 4-6 week window of 'normal'. I've got another post in this series looking at the notion of due dates as a hindrance to natural birth. I'll link to it here once it's up.


I know you get better prices if you book tickets long before the time and I know grannies-to-be would love to be around at the when babies are born - but I would really encourage you to find a way to not have time pressure around the time of your birth, especially if you are aiming to have a natural or low intervention birth.

Do you have creative ideas on how to avoid time pressure around your labour day? Please share them with us!

Debra's Testimonial

This was my first experience of a private hospital as a doula. I met Debra only a few weeks before the birth on the recommendation of a mutual friend, but we connected straight away!

Debra had an unplanned Caesarean birth after attempted induction. I'll be writing my story about this soon, but here is her story:

Not sure if you can see it here,
but mom is on the ball!

From the time we conceived, my husband and I read books, watched DVDs and sought advice from close friends and family. However, since none of our family were able to make the delivery or help us adjust to life after the birth, we still felt particularly nervous about whether we were always making the best choices for our family. 

This is where the famous Leigh joined our family of 3! I had never heard of a ‘doula’ or birthing ‘servant’ but from the day I met Leigh, she played an invaluable double role as both a passionate baby specialist and devoted friend. 

Leigh spent hours with us, answering our many questions regarding different natural birth pain relief options, emergency hospital procedures, breast verse bottle feeding… All our concerns were addressed. This made us feel confident and completely supported, knowing we could make well informed decisions concerning the safety and care of our baby Mpilo.

On the 6th of September Mpilo was due to be induced. Just in case he decided to arrive early, Leigh made sure we knew where she was at all times. Even if my contractions happen to start at 2am, she guaranteed to be there for us. What commitment! 

Armed with games, snacks, massage oils, stories and a medicine ball, Leigh was ready for anything that might occur on our special day. After 6 hours of trying to prepare for a natural birth, the doctor decided to conduct a C-section birth, due to my increasing BP and the circumference of Mpilo’s head. I would have panicked if Leigh was not there to speak with the medical team, offer us sensible advice and show compassion. 

During the C-section, Leigh talked me through the effects of the epidural, what the doctors were doing, how to recover from the procedure and took photographs, all while holding my hand. While I was in recovery, Leigh had already updated my husband on the success of the surgery, checked Mpilo was okay and organised for him to be exclusively breast feed.

The next day, Leigh was back to check on my recovery, to patiently answer more of my questions and help me effortlessly connect with Mpilo. Since then, Leigh continues to keep in regular contact with us. What a beautiful woman! What an amazing experience! 

Mpilo Samuel Nala, the name of our handsome baby boy, means ‘God’s desire is to give us abundant life’ (1 John 14). This is our testimony of His endless goodness to us. After sharing our baby journey with Leigh, our very own special doula, I would sincerely encourage every expecting mother to do as we did.

Did you have a doula for a caesarean birth? Would you recommend it?

Who's your midwife?

So who is your midwife?

Normalizing natural birth...

We seem to have reached a place in obstetric care where interventions, even unnecessary interventions, are so normal that they aren't even noticed. Here in South Africa, most middle to upper-class women automatically hire a gynae (pronounced guy-knee aka OB-GYN) to deliver their babies. For me, that felt like calling a paramedic when I have a cough. 

In private hospitals here, the midwives employed by the hospitals actually get into trouble if they deliver the baby as then the gynae can't collect his full fee, but they also get into trouble if they call the gynae too early, because he (sometimes she) has a busy practice to run. And they need those busy practices because of the incredible insurance they have to pay.

I digress...

Within the last week I attended two screenings of the documentary Freedom for Birth (trailer above) which is about how women's rights are being violated in childbirth  - among a host of other issues related to birth. While I will be addressing this issue again, it really struck me how natural birth needs to be re-normalized.

I am always trying to encourage women to find a caregiver who trusts that a woman's body is designed to give birth, not someone who sees a pregnant women as a emergency waiting to happen. So I chose to have a private midwife in PMB, Arlen Ege, attend the birth of my second daughter at home. When I had my daughter, she was allowed to deliver babies at the local Mediclinic, but has since received notice that this would no longer be allowed. UPDATE: Sr Arlen Ege is once again able to do water births at Mediclinic in Pietermaritzburg as they have installed an outlet pipe for her birth pool! I was able to attend the birth at which this pipe was first used, also the first birth in a while in which a doula was allowed at Mediclinic - It was a beautiful VBAC in December 2013 - Birth Story to follow! 

Why I have to be a midwife...

But, how do we normalize natural birth? How do we help women to see that over 80% of them should be able to give birth naturally, when the current caesarean rate in our private hospitals is over 70%? Because when the number of caesarean births gets too high, they actually start causing more harm than they prevent...

Which brings me to my little revelation... In the city in which I live, Durban, with a population of 3.5 million, there are two practicing private midwives that I know of. If I am mistaken, please correct me, but even if there were 10, or even 50, that would still be too few.

How do we change the tide and restore midwifery care as the norm rather than the exception?

Well, what I've decided to do as my first step, is that whenever I get into a conversation with a pregnant lady, 'Who is your gynae?' will not be one of my opening questions as it usually is among my peers. My first question will be 'Who is your midwife?', and after that perhaps 'Have you found a doula yet?' You get the idea.

Language is such a powerful thing. Doctors use it all the time when they play the big baby card, or the 'but-your-vagina-will-never-be-the-same' card, or the 'If-you-were-my-wife-I'd-recommend-a-caesarean' card. What are you going to do to help normalize natural birth?

My first Caesarean Birth

My first Caesarean Birth...

Well, it wasn't my first Caesarean birth, but the first Caesarean birth I've had the privilege of witnessing 'in the flesh' so to speak. So during my first experience at an MOU I was asked to support a lady who needed an unplanned Caesarean birth. I'm not so keen on the term 'emergency' Caesarean because that gives the impression of something along the lines of an episode of ER where everything happens STAT! Sometimes it is like that, but it can take at least half an hour, sometimes a couple of hours to get into theatre if mom and baby are doing fine otherwise.

So I waited with her for one of the operating theatres to be ready, and when there was finally a spot I went off with the midwife to put on scrubs. I felt a bit spare taking a full on pic of myself with outstretched arm, so I managed to get a discreet shot of my feet to record the moment...

She was very tired and a little nervous about the operation, so I was glad I was able to go with her to theatre. It was quite cramped as the larger OT (operating theatre) was being used, so I couldn't sit next to her to be on the same level with her. I had to stand next to her and take up as little space as possible. 

From my vantage point I was able to see everything that was going on. I didn't watch how they got the baby out, but just spoke to the mom. It was difficult to communicate as English is not her mother tongue, and she couldn't see me talking because of the mask, so I just tried to make my eyes look as kind as possible and tried to sound as encouraging as possible!

She had a beautiful little boy who the nurse brought to say hello once he was wrapped up. The nurse let her rub noses with him which was very touching. She was exhausted and nauseous and she didn't really want to talk, so I held her hand and was able to watch while they stitched her up. I'm not easily grossed out - so I was quite fascinated to watch how they stitched up her uterus while it was perched on her belly, and massaged it to make it contract and stop bleeding, and then did the final stitching. It was a bit odd being in scrubs, and as my 'Childbirth Companion' apron had to be left in the change room, everyone wanted to know who I was and why I was there, so I got to explain what a childbirth companion / doula does.

So when I had to leave the mom still hadn't chosen a name, but asked what my name was and said that was what she wanted to name her son. It's a good thing Leigh is a unisex name! I'm not sure if she eventually did, but I was quite touched by the thought.

Another First: Doula Experience at an MOU

My first MOU doula experience...

For the uninitiated, an MOU is a Midwife Obstetric Unit - run by midwives, sometimes attached to a hospital and designed to serve low-risk women with little or no doctor intervention. It sounds like an ideal situation, and this specific institution is quite unique in South Africa, but does have it's own set of challenges...

Image from here.

As part of our training we need to observe some births and, fortunately one of the ladies doing our course, Hayley, conducts workshops for lay doulas and those who are contemplating professional training. These workshops include an opportunity to serve underprivileged women through labour and birth, so it made sense to join her to get a chance to observe and support some births. So, myself and my friend, who was still not sure as to whether this doula thing was right for her, again made sure the littlies were taken care off, donned our aprons to identify us as childbirth companions, and made our way to meet Hayley and another trainee doula at the MOU.

I had already been at one home birth and one labour (a home birth transfer) other than my own two births before I started the doula course, but I had no experience as a doula in a hospital environment. Eeek!

The women there very seldom have partners with them, so we were welcome to help whoever needed us. One lady had already been booked for a caesarean so I was able to sit with her while we waited for the OT (operating theatre) to become available and was able to go with her into theatre. You can read more about that here.

When I got back to the ward, there was a lady who was quite close to giving birth who my other two trainee doula friends had been supporting, so I was able to join them. It seems that it is standard practise for the women to have catheters, and she also had a drip so she was on the bed for the birth. She kept wanting to reach up and grab a rail above her to pull on it. I have read that pulling on something does help to push, and lifting her weight off the bed would have helped her have more of a squat position, which would have been great, so I thought it was incredible that she knew just what her body needed, but unfortunately the rail was not designed to hold a labouring woman's weight so we let her pull on us instead...

I realized why we were advised to take rings off. The vice-like grip of a woman in the throes of transition is not to be underestimated!

She also gave birth to a boy, and you could just see how happy she was that her little one was finally in her arms! I did take a photograph but wasn't sure if I was keen to post it without asking her permission, so I will make sure I do that for future births!

After this, my friend who hadn't been sure was convinced that this was definitely something she wanted to do - and I thought she was doing a great job! It has been really lovely to have a friend to walk this journey with, I am so grateful!

The other trainee who was with us was so hyped up by the birth! I completely understood where she was coming from, and I expected to feel the same, but I felt more sobered than anything else. I think the fact that my hubby forgot to fetch my daughter from school had something to do with it, as I was awakened to the realities of dashing off to support women at unknown hours for undetermined lengths of time. Don't get me wrong, he is VERY supportive; it was an honest mistake, and my mom was nearby to help out, but mom is moving 3 hours away in the very near future to start a bed and breakfast in Hluhluwe, so it looks like childcare is a one of the bigger challenges to be overcome in this Durban Doula's journey...