Showing posts with label midwifery model of care. Show all posts
Showing posts with label midwifery model of care. Show all posts

Thursday, 7 April 2016

Isaac's Birth Story - Our quick, intense, didn't-make-it-into-the-water home birth...

Announcement by Sarah-Jane Photography

Isaac Johan's Birth Story



Another great home birth with our fantastic midwife!


The last you heard from me was my pregnancy diary at 38 weeks. Since then I finished off my last few work tasks and enjoyed some fun time with the girls while they were on school holiday. We went on a picnic one morning, and to the beach another day. It was great to have a few days where my time was (mostly) my own! 

(And if you're confused because you thought his name was Johan Isaac, and now my blog says Isaac Johan, your memory is correct! That was our original order, but over the last week, we have just felt that Isaac 'sticks' better – we, parents and grandparents, just seem to be gravitating towards using Isaac as a first name, Zack for short, so we made the change.)

Source

We were kind of hoping that baby would come before Easter weekend. And considering that it was my 38th week, and baby #2 arrived at 38 weeks on the dot, it wasn't too much wishful thinking. Easter weekend just seemed an awkward time for everyone. My folks run Fever Tree Guest House in Hluhluwe, just over 3 hours' drive away, and my friend Shelley, who agreed to be my doula was going to Underberg to spend the weekend with family from Joburg. We had known there would be a clash of dates from the beginning, and all just had to be okay with the idea that things might not work out how we want them to and get on with it. 

Source

I wasn't going to stress myself out – while washing dishes on Friday morning I felt God acknowledging that I spend so much of my life accommodating the needs of others, this time I just needed to let things be for me – whether things happened soon or not, I didn't need to stress. I felt free!

A friend had the girls over the play on Friday morning so Hans and I, despite all good intentions to clean the fridge and sort the pantry, went and had brunch, just the two of us. I even got my 'push prezzie' in advance – little did we know!

After my little revelation over the dishes, I shared some other thoughts about the birth with Hans – I didn't want to be bugged with 'How far are you?' and 'How much longer do you think it will be?' questions while in labour. Asking questions of a lady in labour aren't helpful for that ideal 'labour-land' brain state so typical of true physiological birth as they activate the language centres of the brain, the 'higher' brain. 

Questions about time also add in the whole idea of pressure and performance which can also distract from the task at hand – so I gave Hans the firm instruction to field those questions and comments for me, because we did have the reality of people travelling from up to three hours away to join us. In retrospect it was odd that I felt so adamant about these things right at that moment – but maybe I knew something was going down. Pardon the pun.

I honestly hadn't had any prelabour symptoms this time – no loose stools, no 'show', no major burst of energy – and I was kind of grateful about that. With my second birth I had a rather exhausting bout with prodromal labour that I wasn't keen to repeat. I think that being diligent about getting enough magnesium in really helped prevent that!

So that afternoon I coloured in another of my birth affirmation pages – and just went on with life as usual.

Some more colouring!
At around 8pm, lying in bed watching Netflix, I had what felt like a slightly uncomfortable Braxton-Hicks (BH) contraction. Now I'm a veteran on downright painful BH contractions – I know they aren't supposed to be painful, but mine sometimes are – so I didn't stress too much. Halfway through the program I was watching, I realised I'd had three of them at seemingly regular intervals, so I half noticed the time and true as nuts, ten minutes later I had another, and then another ten minutes after that. I told hubby on Skype - 'OK!' he replied and came through to help get things ready in case.


I let the midwife know, because we both know my history, and I told her I was going to get in the bath to try calm things down so I could get some sleep – because that was what I did for a whole week before my second little one was born. I also let my birth team know – just so that if it was for real they would have some warning.

By the time my bath was over, surges were 5 minutes apart, and definitely not BH anymore!

So we gave the go-ahead for those coming from far away – Hluhluwe, Underberg and Pietermaritzburg… Our midwife Arlen was the first to arrive, then my hubby's folks. Fortunately the girls were asleep by that stage and I was directing last minute details between surges – checking we had a bucket for laundry, making sure the birth pool was ready, putting birth supplies out so they could be found easily, getting some labor-aide mixed and ready – and a myriad of other minor tasks that needed doing. It was a warm evening so I was pacing and doing my thing in my undies while all the action happened around me.

Molly keeping an eye on proceedings once baby was born...
Arlen took my blood pressure when she arrived, and checked baby's heartbeat – all good. We had agreed, as with my previous births, that we wouldn't do internal checks unless necessary, so it wasn't even suggested. Internal checks can only tell you how dilated your cervix is at that moment, it gives no indication of how long it took to get there, or how long it will take to reach full dilation. I've had clients go from 6cm to baby in 45minutes, or 3-10cm in an hour, so really – to have to lie down so someone can examine your cervix via your vagina, to get information that may or may not be helpful, just felt unnecessary to me. But that's just me!

I was in labour and that was all I needed to know! Each surge was slightly more intense than the last and I absolutely had to keep moving through them – they were getting longer, stronger and closer together, so we knew things were progressing. At this stage I was doing lots of figure 8's with my hips – that felt amazing!

I honestly felt a bit like cat in labour - I was pulling all sorts of crazy stretches. Later on Arlen said she had never seen anyone in labor do stretches quite like that. If you know anything about dancing – think very slow, gentle 'bouncing' in a wide second position, knees out, body forward, back arched, left elbow on knee, right hand pushing right knee out, then lunging side to side in that position as needed. 

Actually I nearly did do that once -
this was me in labour in hospital with #1.
I'm smiling because even then
I thought all those wires were ridiculous...
If I had been birthing in a place where you are expected to stay in or on the bed, I think I might have begged for drugs of some kind. Not that there would have been time. I honestly can't imagine how women do the labour thing without being able to move about. Actually I can, because I did it with #1 - but never again!

During this time hubby and mom-in-law were filling the birth pool. If it was a 'normal' home birth, the timing was perfect for getting in to the pool, just as the surges felt like they were starting to become overwhelming, the warm water of the pool would do its endorphin thing and I would be set to go for the last stretch… but my body seemed to have other plans.

I was getting down onto the floor with each surge. The cold tiles were just what I needed as the room was quite warm. What seems crazy is that I distinctly remember checking the time to find out if he would be born on the 25th or the 26th. When I checked my phone it was 12:04am

On what must have been the next surge after checking the time, I got down on the floor again only to feel an intense downward pressure which continued with each surge following – not an urge to push, but rather a sense that my body was pushing something anyway.  Actually, it felt more like gravity had concentrated itself tenfold in the area of my pelvis, as if that part of me was being pulled down with a G-force I could do nothing to resist.  I was doing low cleansing breaths with each surge – making 'hah, hah, hah' sounds – it just seemed the right thing to do. It was distinctly uncomfortable and then pop! - my waters broke. Oddly, it felt so good!

At this stage I wasn't getting up between surges, just lying with my face down on my arms and my butt in the air because that seemed to relieve the intensity for a few seconds. Graceful mental image I know, but it felt great! At some stage we put a bright pink towel under my knees. The pool was ready, and had been ready for a short while, but there was just no way I was moving anywhere. I remember reaching a similar point in my previous labour, and having the mobility and awareness to get in the pool, and I was so glad I did, but this time seemed considerably quicker and much more intense – like a condensed version of the previous labour. So I stayed put.

My Friday afternoon colouring.
I started to feel that unique sensation of a baby navigating his way down the birth canal. I can't imagine choosing to miss this part of labour as it seems to be the moment where you and baby are both working towards the same goal as he wriggles along with the rhythmic massage of those powerful uterine surges. I remember instinctively reaching down to be there to meet him, and saying, 'Baby's coming!'

As I remember it, I would be on my hands and knees and allow the pressure and stretching, but as soon as it felt too much, I would duck my head down and put my bum up to relieve the pressure a little. I think I did that through the pushing stage (in which I didn't actually do any pushing) until his head emerged. Every now and then I felt his little head moving this way and that as we worked together to bring him through. Other than that, it was just me and my hands guiding the process – so empowering! By this stage Arlen and Hans had set up some towels and linen savers behind me on the floor, Hans on his knees, waiting to catch his son. 

Once his head was out we waited for another surge, while I felt his shoulders turn in preparation for the emergence of the rest of his body. That was somewhat more uncomfortable than his head actually as I remember saying, 'Don't pull!' No one was pulling – it was his shoulders moving through. So with a sound of rushing water and great sense of relief, our little boy made his way into the world. 12:16am, 12 minutes after I last checked the time. He took a few moments to gather himself together as we welcomed him with enfolding arms and encouraging words. I sat back as they passed him to me and wrapped us both in towels. He gave a little roar of indignation to announce his acceptance of our welcome.


Within a few moments, I felt strong enough to get into the water and Hans joined me. It was lovely to sink into the warmth and weightlessness of the pool. We could get a good look at our newest family member without worrying about getting him getting cold, and my somewhat fatigued body could get a little rest too!

Our eldest passed out on the bed after saying hello.
Things get a little blurred after that, you would think it would be the other way around! I remember relaxing in the water together for a while, with an extra contraction or two every now and then to get the placenta moving, and I remember him rooting about looking for my breast, and latching quite strongly and decisively when he found it! Peaceful and unhurried – just beautiful. 

I remember Hans getting out the water at some stage – our girls were brought through, in a sleepy stupor, to come say hello, after which they promptly passed out on our bed. My mom-in-law came through, the photographer arrived, as did my parents and my doula – though I don't remember the order. I was grateful for the water then as it forced us to stay put and kept things warm and private. There was a great atmosphere of celebration throughout!

After over an hour in the water I was ready to get out – so the cord, now limp and white, was clamped and cut and littlest was placed in his father's arms. We delivered and checked the placenta, got me cleaned up and dressed. Arlen took all the vitals and did all the newborn checks - I was quite chuffed that after needing a few stitches with my firstborn and her 33cm head, I managed this 36cm head with nary a graze! Go me! He weighed 3.56kg - my biggest baby by nearly 300g, and was 56cm long, so also my tallest baby.

We had everyone come in for a little name announcement, beause as you know we had kept our final choice a secret until he was born. Once all that was done, I got him back on my chest, skin-to-skin, covered with a few extra blankets, where he stayed drinking for the next while, and we all went through to the lounge to have tea at nearly 2am in the morning! It was lovely!

Morning meetings...
The girls have a good cuddle with
their baby brother for the first time.
You can see the pool in the background.
The girls slept on mattresses in our room as their rooms were occupied for the night. I watched as the eldest woke up and I got to see the realisation on her face as she remembered her baby brother had been born. They just couldn't get enough cuddling and snuggling in and it seems they still can't! They argue over who gets to hold the baby next, and are already stars at collecting all the bits necessary for baths and nappy changes and the like.

I've got some other thoughts to share on the whole postpartum experience - but I'll leave that for another post.

Thanks for reading...
Please add any thoughts, questions or queries below!

Friday, 9 October 2015

Durban Doula's Pregnancy Diary - Week 14


What another one?


No, not another baby, another blog post... I know I said I was going to do one every month, but there is just too much to write, so I'll try one every two weeks and see how it goes.

Our first appointment


So I saw our midwife, Arlen, this week - and I honestly can say I'm so glad I chose this model of care. Our initial appointment was just under an hour long, we talked about the pregnancy so far, how I had recovered from the last birth, what plans were for this birth and various other bits about birthiness in general. We checked all the vitals - peestick, weight, blood pressure and belly - and heard a little heartbeat too. It was great. It felt like home. 

I also got my home birth shopping list, and contract and prices for various birthing options, and like last time, the amount I'm paying for a home birth is still less than the co-payment I would have to make for a gynae in private practice on an average hospital plan that pays 150% of medical aid rates - as many gynaes charge over 300% of medical aid rates. I can understand why, given all the insurance that needs to be paid, but that's a topic for another time. Medical aids or hospital plans on the other hand, only pay 25-35% of the cost of a home birth - R2500-R4000 of R8000-R12000, even though I'd be saving them over 30k... Patriarchal prejudiced misogynistic mumble mumble mutter mutter...

And, as much as I have reservations about the safety of non-medically required ultrasound scans, (see last diary here), I admit I am a little excited for the one we are have in about 6 weeks' time. I think we'll take the girls (4 & 6) along with us, as they seem to be more excited about this baby than anyone!

Having said that, everyone seems so excited about this baby, which is so lovely for a third child! I'm enjoying being pregnant, because I know this will probably be the last time, so even getting past the nausea was bittersweet, as crazy as that sounds!

Obligatory Fresh Produce Comparison 


You thought I had forgotten about the obligatory pregnancy diary fresh produce comparison! Porridge brain has not set in quite so severely as that...

Well, baby is now about 8cm long (crown to rump) - about the size of a lemon.
He/she is growing hair, can make facial expressions, suck his or her thumb, and can even pee. Yes, baby pees in the amniotic fluid, it gets absorbed by my body and gets processed by my kidneys so I can pee it out 53 1/2 times a day. At least it's easier than nappy changes!


Irritable Uterus and the Doula Pregnancy Protocol

Peesticks, irritable uteri and
getting rid of baby pee -
Toilets are an integral part of pregnancy
Wikimedia Commons

I am currently on call for possibly my last two clients before my own baby arrives, unless I get some clients for November and December. (Any takers? Last chance! Only taking one per month!)

I'm not sure what the protocol is on doulas and maternity leave, but I feel that January is a good time for me to stop, as I'll be entering my third trimester and may not have the energy for the physical demands of doula work - staying up all night, massaging for sometimes hours on end - it can get quite demanding, and by then I think my belly may be getting a bit large to be getting in anyone's space!

I have also experienced 'irritable uterus' with my last two pregnancies - yes, that is a thing!
I can already feel reasonably strong Braxton-Hicks contractions - tightening of the uterus without downward pressure, considered to be toning up for the real thing - as I did with my first two. I haven't ever had problems with prematurity, but it was uncomfortable having strong, and sometimes even painful contractions caused by over exertion, dehydration, a full bladder, an empty bladder, touching my belly,or sometimes seemingly caused by nothing at all. 

Plant Nanny - Available on Apple,
Android and Windows devices
I'm being more diligent with making sure I get enough magnesium and drinking enough water this time around, and I'm hoping that will help, but I thinking booking clients for my third trimester would still be unwise, for me and for them!

By the by, I'm using a little app called Plant Nanny to help me remember to drink water, and it seems to be working!

After the birth I think I'll need to take about a year's break from taking on doula clients, perhaps more depending on the personality of this little sproglet. I may still be able to do some volunteer work as that usually involves a set period of time, primarily in daylight hours. Again, this is one of those bittersweet things, letting go of something I love so much for a season, but that's just what it is, a season. Ideally I'd love to be a private midwife one day, so it makes sense to have my own children sooner rather than later.

As much as I will miss doula work, I am so looking forward to newborn snuggles! I went to help a friend with breastfeeding her newborn this last week, and those teeny tiny fingers and toes always undo me!

Other birthy things I'm thinking of right now... 


  • Trying to think of how to fit three car seats in our Daihatsu Sirion
  • Sorting out the girls' playroom and unpacking all of the boxes of oddments from when we moved so it's not stressing me out when baby comes
  • Getting some newborn sized cloth nappies - a luxury I didn't have with my first two - I just started them off on regular cloth nappies and they spent their first few weeks with butternut shaped bums!
  • Realizing how many safety gates we will need for our new house (at least 3!)
One last funny thing... Even as a doula and a third time mom who had great natural births with the first two, I do still have moments of consternation centered on the question, 'This baby is coming out where?'


So I pull a doula move on myself every now and then: Women all over the world do this all the time. Our bodies are designed to give birth, and so on.

I won't be quite so glib in my encouragement in future

After seeing how much I just wrote, I think once every two weeks might be doable - not as much pressure as a weekly diary, and not as much marathon reading as a monthly one - what do you think?

If you do want to get notifications of blog posts and pregnancy diary entries in your email, please subscribe by entering your email address in the box on the right, or follow me on Twitter on @DurbanDoula

And if you have any questions about how this Durban Doula does pregnancy, ask away below and I'll address them in future posts. 

Find Week 16's diary here and week 12 here.

Tuesday, 5 May 2015

The day Kate called the Midwives...

Being the birth junkie that I am, I couldn't avoid all the press about the newest princess in the British Royal Family, especially considering that Kate Middleton is reported to have had a lovely, quick, uncomplicated birth.


We'll never know all the details. I'm assuming it would be considered untoward and most certainly inappropriate to share whether a member of the Royal Family required stitches or gave birth in water or any of the other details so savoured by those who read birth stories.

But actually, it's not those details, or the lack thereof, that inspired this blog post. So in celebration of International Day of the Midwife... Here goes!

Let's start with the good news:

Duchess Catherine chose to be attended primarily by midwives, and the midwives worked as a team with the gynaecologists and perinatologist and various other designated officials.

But, what irks me is how patriarchal ideas about birth are being perpetuated in the press surrounding the event.

I hear you sigh - 'Grouchy Feminist on the loose!'

Actually, even my husband was appalled at the language used about the Duchess' birth. Let's have a look at some quotes and take it from there:

About her birth team, a headline from 'The Telegraph':

Royal baby: meet the doctors who delivered Kate Middleton's second child

Alan Farthing and Guy Thorpe-Beeston led a team of four that delivered the royal baby at St Mary's Hospital in Paddington (Ref)

This headline was followed by 11 paragraphs, or around 358 words describing their respective Curriculum Vitae and detailing how and when they met and married their wives. There was also a mention of the gynaecologist who wasn't there this time around, and even a quote by aforementioned absent gynaecologist to round things out. Interspersed in the quagmire of qualifications and dates, was one line, in the second to last paragraph:

They over saw a team of midwives looking after the Duchess in the Lindo Wing. (Ref)

Names? Qualifications? Families? Quotes? Nil. Zip. Nada. Nope.

Based in the US, the 'Boston Newstime' also published a rather extensive article detailing every aspect of the birth. In their section on the medical team, give or take 350 words are again devoted to the achievements and qualifications of the non-midwife medical team, including around 130 words about, or by, Sir Marcus Setchell, that same guy who wasn't even there. To his credit, his words did include a description of the nameless midwifery team at Prince George's birth as 'perfectly wonderful'. (Ref)

That full quote: Sir Marcus described the midwifery team as "perfectly wonderful" but added: "There are certain situations when someone is giving birth that it's important not just to have a specialist sort of available at the end of a telephone, but actually in the same room to deal with anything that's immediately going to be wrong." (Ref) (Emphasis added)

Are midwives not specialists then? Something 'that's immediately going to be wrong'? Let's give him the benefit of the doubt and assume this was just a slip of the tongue and that he didn't intrinsically see birth as an emergency waiting to happen that only someone with a Doctor's qualification could solve.


'Midwifery Team' - Names? Qualifications? No? Ok. I suppose the only qualification necessary is that the good doctor felt they were 'perfectly wonderful' - no names needed.

Princess Charlotte of Cambridge already has her own Wikipedia entry - but according the entry as it stands today (5th May 2015), there were apparently no midwives involved:
The baby was delivered by Alan Farthing, surgeon-gynaecologist to Queen Elizabeth II, and Guy Thorpe-Beeston, an expert in high-risk pregnancies and surgeon-gynaecologist of the Royal Household; both were present at the birth of the Cambridges' first child, Prince George, in 2013. (Ref)

But wait, 'The Inquisitr News', among others, reported on the 2nd of May that even though the 'suited surgeons' got most of the press coverage, they 'simply looked on to ensure that everything was going as planned ... the midwives were the ones that actually delivered both Prince George and the new Princess' (Ref)

So 'The Daily Mail' comes to our rescue, with the following headline:

Call the midwives! The calm duo who delivered the Princess after striking up close rapport with Kate

I'm so grateful they were calm. Not like those hysterical midwives you usually get...

At least here we have a mention of their qualifications:

Midwives Arona Ahmed and her boss, Jacqui Dunkley-Bent, Professor of midwifery at Imperial College Healthcare NHS Trust (Ref)

Professor of Midwifery! How delightful! 'Perfectly wonderful'! But not a 'specialist' according to the absent gynaecologist. 

The other qualifications of the midwives were summed up in the following sentence:

Both women are experienced, unflappable and have the full confidence of the obstetricians. (Ref)

Ah! There it is! You see, they had the full confidence of the obstetricians. Professor of Midwifery notwithstanding. Perfectly wonderful!

And don't get me started on how Kate was 'delivered of' her baby, as though she just lay there while someone else did all the work, or as though she was possessed rather than pregnant.

P.S. So in case you can't see what bugs me about this - it's the whole issue of gatekeeping - how is it that the men who weren't there and or didn't do anything except 'oversee' get the praise, the press and lists of qualifications and full biographies, while the midwives who did the work, whom the Duchess chose, are, on the whole, invisible, nameless and voiceless, and are qualified by the opinions of the doctors above anything else.

And then there's that line I haven't mentioned - where a number of news outlets state that Kate had opted to be seen first by midwives, and apparently a 'source' had qualified this with 'What the duchess wants, the duchess gets.' (Ref)

Like a child that wants ice-cream for breakfast.
Not like a rational adult woman with an actual choice in how she gives birth.
Perfectly wonderful!

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