Especially For First Time Mothers

Congratulations!

It's such an exciting time in your life. Enjoy, savour it. During no other pregnancy will you have such an opportunity to truly embrace the awe of this miracle. An active toddler or two - or several ... will put paid to that.

These times are very challenging times for the first time mama.

At no other time has the initiate to pregnancy and birth been so unsupported, so bombarded with fear and mis-information that is not evidence-based - and so inundated with information. Never before have we had so little first-hand knowledge of birth and motherhood from woman friends and relatives, and so little opportunity to witness childbirth first hand before having a go ourselves. And never before has there been such a scramble by big industry to secure a monopoly on the market of childbirth.

What this means for you, is that you have to be a canny consumer like never before. Don't look to see what is available in the maternity services on offer, and what is allowed and what is even 'legal'. Instead, look deep inside yourself, your heart. Deep down, you know what you need to give birth safely and well, with peace and confidence. Settle for nothing less.

Our life-style has brought great changes to the experience of giving birth. UK Professor Denis Walsh said in this article, "It has never been safer to have a baby, yet it appears women have never been more frightened." Given the rising rates of intervention and resulting birth trauma, no wonder.

We have better nutrition - but more junk food. We have more convenience - but more sedentary life-styles. We have more life-saving technology - but more unnecessary intervention and counter-productive control over the natural process. We have more tests - but more worry and anxiety is placed on women at a time when confidence, relaxation and trust is vital for the optimal release of birth-enhancing hormones.

In this chapter of my blog, I provide encouragement and resources for first-time mothers & fathers embarking on the amazing road to parenthood. It is still the most amazing blessing to enrich your life. There are still ways that you can optimise your health and well-being in body, soul and spirit, so that you can approach the great adventure of birth with joy and confidence.

When I was about 8 months pregnant with my first daughter, in a little town in west Ireland, a woman in the street eyed my prominent bump and asked, "And are ye lookin' forward to yer labour, dear?"

And I realised I was. I really was. I hope you will be, too.

Eat wisely to avoid complications
Our modern diet tends to be high in sugar and empty calories but low in actual nutrition. Yet nutrition is the key to avoiding many common complications. NAPSAC (National Association of Parents and Professionals for Safe Alternatives in Childbirth) states that the two factors contributing most to safety in birth are:
1. A woman's faith and confidence
2. Good nutrition.
It makes sense that a healthy diet contributes to cell health of every part of your body and the baby's body, fueling your body to work efficiently.

Staying 'Low Risk' and Healthy for Pregnancy and Birth

Pre-Eclampsia is a serious complication, more common among primips, that can de-rail your hopes for a natural birth. The Australian Action on Pre-Eclampsia website states that there is no known cause for PE and no known prevention. That's an interesting perspective. Here is the PE/PIH (pregnancy induced hypertention) page from the Gentle Birth Archives. Read and decide for yourself.

Dr. John B. Irwin, author of 'The Natural Way to a Trouble-Free Pregnancy" believes there is a connection between PE and Vitamin B1 (Thiamine) deficiency. He recommends 100 mg of B1 per day. Check your pre-natal vitamins and see how much B1 is included. One well-known 'gold' brand has 0.5mg of B1. Dr. Irwin's recommendation is 200 times more than this. Research it yourself - and make your decision.

Tips for Preventing and Managing High Blood Pressure in Pregnancy

Yes, you do need exercise
Let's face it. Most of us these days have a life-style that orients around Couch, Car and Computer. Right? Well, let's be real. Pregnancy and birth is going to require more physical activity than most of us are usually doing.
This article, Barefoot and Pregnant has some interesting observations about the benefits of an active lifestyle for child-bearing. Certainly worth considering, in our sedentary "couch-car-computer" lifestyle.

If this doula had to distill all her advice for labour and birth down to one word, it would be this:

WALK

Just that. Walk. These days, most of us walk way less than our grandmothers. I suggest go for a brisk walk for a good hour, most days during your pregnancy, right up until labour, and then in labour: WALK. This one thing alone helps so much towards a normal, uncomplicated labour and birth.

"What about my vagina!?" It's a perfectly valid concern for any birthing woman.
Here's how to take the best possible care of your vagina and perineum.

Get bub lined up for a straightforward birth

As first time mother, I'm sure you've already heard stories about posterior babies leading to difficulties in labour and eventual ceasareans. Well, here's what I think. The posterior position is just another variation of normal. The breech position is just another variation of normal. What is not normal is the way our system pathologises what is normal, and regards every healthy fit labouring woman as a litigation disaster waiting to happen.

If you are planning a homebirth with a midwife who trusts birth and trusts you, you can have a baby in a posterior or breech position and as long as you are motivated, well-prepared, and willing to do the work, odds are all will be well. However, in a time/money efficiency based institution, where they rarely have the patience to support the average first time mother through the birth process, they are unlikely to make any extra allowances. I've yet to see a hospital where they say, "Oh, she's a first timer and her baby is posterior, so this could take a while, we'll need to give her extra time and trust while her baby rotates."

It is vital, if you do start labour with your baby in a posterior position that you have two things in place: a careprovider who will not pathologise the posterior position, and believes you can do it, and is willing to give you the time you need to support your baby's efforts to rotate - and that you yourself understand that it is *possible* that your labour *might* take longer and need some extra endurance on your part while everyone waits for the baby to rotate. Now - you might have a quick 6 hour first time posterior labour and give birth to your baby sunny-side up - it's possible - but you need to be prepared that it *could* take 40, 50, 60 hours, and pace yourself accordingly.

Through staying fit and active throughout pregnancy, Chiropractic care and Optimal Foetal Positioning, you can optimise the chances of your baby being in an anterior position. This is worth doing if you have a careprovider or birth venue where there is no special attention paid to either first time births or first time posterior births. It can't hurt, and who knows, it could possibly help your baby get lined up for an anterior birth, which is *usually* more straightforward.

Optimal Foetal Positioning

If your baby is RIGHT anterior, you need to be aware of the theory of Rotational Positioning: that *some* right-lying babies, instead of rotating to right anterior and being born that way, like to rotate in a clock-wise direction, right through the posterior position, and round to the left anterior position, before they are born. They go the long way round! And this requires of course a great deal of patience, trust, active positioning and endurance on the part of the birth team - especially the mother.

For this reason, if your baby is right lying, I would suggest that you don't do OFP. Just get in plenty of walking and exercise, and wait to see if your baby shows signs of staying on the right or moving to the left. If s/he *does* move to the left, then start the hands-and-knees OFP. But I see no point in doing OFP with a right-lying baby. If you would like a PDF about Rotational Positining with right-lying babies, just email me and I can email it to you.

More information on foetal positioning for easier childbirth here at Spinning Babies

Your EDD - is it really 'estimated'?
The first intervention done to women, to set them up for the cascade that is to follow, is the assigning of an EDD (with zero emphasis on the 'E'). It's used like a legal edict instead of a guideline.

The commonly used Naegel's method is based on the assumption that all women have exactly the same menstrual cycle and hormonal patterns, as if we were all machines or robots. The Woods Method takes natural variations into account and can result in a more accurate "EDD". With such a strong trend towards inducing first time mothers, this information may well buy you some valuable time.

Early Labour, or "don't rush off the hospital too quick!"

Your first night of labour: denial is not just a river in Egypt!

If you know in advance that it takes a day and a night, or two days and nights, or three days and nights, to traveerse the birthing process, you're better prepared! And more careful of your sleep (whatever you can snatch) that FIRST night.

All First Timers Labour For Three Days

How can you tell how far along you are, without invasive vaginal exams?

External signs of progess - taking back ownership of your body

First-time mama birth stories 

* Listening to Rain - the story of when I had my first baby at home.

* Sarah's homebirth - as an academic, Sarah researched her options thoroughly before deciding on homebirth.

* Miranda's caesarean birth - a planned natural Family Birth Centre birth.

* Plaxy's homebirth - Plaxy was originally planning to give birth at a Family Birth Centre but changed to homebirth in order to have continuity of care.

I'd love a homebirth, but not for my first ....
Why not? In my experience as a doula so far, the mothers who have decided to have their first baby at home have had easier births with less unnecessary intervention. One first time mama I was doula for transferred to hospital for some extra help, which she received - an example of obstetric back-up and technology being used appropriately. This mama told me that she believes that if she had started out in the hospital, she feels sure she would have had a caesarean, but because she started her birth as a planned homebirth, this helped her towards achieving her eventual vaginal birth, with the help of obstetric technology.

This study from New Zealand shows that "Despite being cared for by the same midwives, women in the hospital-birth group were more likely to use pharmacological methods of pain management, experienced more interventions (ARM, vaginal examinations, IV hydration, active third stage management and electronic foetal monitoring) and achieved spontaneous vaginal birth less often than the women in the homebirth group. These findings strengthen the evidence that for low risk first-time mothers a choice to give birth at home can result in a greater likelihood of achieving a normal birth."

Why I had my first baby at home

 A video of  first-time mama homebirth:

What's really going on in our hospitals?
I believe that caring for primiparas (first time mothers) is a specialty science of its own. It is just not the same as working with women who have given birth before. And I think the majority of care-providers lump all women in the same category and are not paying enough attention to the special science and art of birth for primips. Basically, I think in Australia, we suck at supporting first time mothers. More and more often you hear this, ".... and so then after 22 hours of labour, I had an 'emergency' c/section." Then the majority of those first timers given caesareans are told they must have a caesarean the next time. Very few find their way to VBAC.

Australia has a 30% caesarean rate. At the moment. That doesn't sound so bad. But I am leery of statistics that do not differentiate between primips and multis. If you really want to get a picture of what your chosen location of care-provider is like with respect to supporting first time mothers to have a normal birth, ask for statistics specific to primiparas. You might get a significantly different picture.

When you are choosing your birth venue and care provider, consider asking:
What % of primips had caesareans under your care?
What % of primips had spontanous vaginal births?
What % of primips had intact perineums or minor tears not requiring suturing?
What % of primips had epidurals?
What % of primips had instrumental vaginal births with ventouse or forceps? Of these, how many were in stirrups?
What % of primips had no pharmaceutical pain relief?
What % of primips had access to deep water for pain relief during labour? (As in, a proper birth pool, not a shallow, narrow bath that does stuff-all.)
What % of primips gave birth on a bed, and what % gave birth in a position other than on a bed?

What about Family Birth Centres?
Are you planning to have your first baby in a Family Birth Centre? This can seem like a great middle road between the 'machines that go ping' - style obstetric birth and the no-frills (or machines that go 'ping') homebirth. And sometimes that's the case. We have some excellent birth centres in Melbourne.

However be aware that much as Birth Centre midwives seek to deliver something approximating the midwifery model of care to women, they are prevented from doing this fully because they must operate under strict obstetric supervision and protocols. The transfer rate out of FBC's can be as high as 50% for first time mothers. This can mean that mothers are expecting a lovely birth centre 'natural' birth and suddenly wind up in the delivery suites or operating theatre - "right this way through the double doors" - which is not what they hoped for or expected.

One reason many primips are transferred out of the FBC is because they have reached 42 weeks gestation. It is quite normal for some women to go past 42 weeks in their pregnancies, as you can read about at the '10 month mama' page. Regardless of variables such as the inaccuracy of EDDs and ultra-sounds, variations in women's menstual cycles, evidence that you, your baby and the placenta are all perfectly well, once you reach that number "42" that's it, it's all over - no more Family Birth Centre, it's straight to delivery suites: 'do-not-pass-go-do-not-collect-$200!' The pressure to be induced becomes increasingly intense.

So what to do? First - get fully informed on the subject of Estimated Due Dates and inductions.

Some suggested reading:

Induction Dangers

Alarm over rise in induced births

Second - have a back up plan. What will you do if your pregnancy goes past 42 weeks? That is perfectly normal for many women. Do you know of anyone who has still been pregnant at 43 and a half weeks pregnant? No? Have your thought about why not?

It's because the rates of induction have risen sharply in recent years. So outside of homebirth circles, pregnancies that go to 43, 44 and 45 weeks are unknown. Almost everyone you know who was still pregnant at 42 weeks would have been induced. Do you know of any exceptions?

So you need a plan in case your pregnancy does go longer than 42 weeks. Among women who have comfortable lives and are well-nourished, that's not unusual. Don't think it won't happen to you! Think ahead and have a plan.

One way to avoid the whole issue to plan a homebirth.

Another way is to hire an Independent Midwife to support you in your planned Family Birth Centre birth (instead of a doula) - and if you do reach 42 weeks and 1 day, then re-evaluate with your Midwife whether you want to
(a) go straight to delivery suites for the recommended induction, supported by your Midwife
(b) wait for labour to start naturally and have a homebirth
(c) go in for daily monitoring so all concerned have 'proof' that baby and placenta are just fine - and wait for labour to start naturally, then go to delivery suites for the birth with your midwife by your side.

Another way is to gather research until you are sure of your chosen course of action, refuse to consent to induction and negotiate with the obstetricians to play it day by day, with regular monitoring, and wait for labour to start naturally, then go to delivery suites in labour with the support of your doula. From my experience of the mental pressure and coercion couples come under to consent to induction, this is rarely successful.

It is your decision, but be aware that if you have any intention of departing from the usual obstetric policy of being induced at 42 weeks and accepting the usual cascade of intervention that follows, you will need to be thoroughly informed, very assertive, and have excellent support.

Must-reads

Pushing for First Time Mothers by Gloria Lemay

When and How to Push: Providing the Most Current Information About Second-Stage Labor to Women During Childbirth Education 2006

Basic Instruction for a Quick or Unassisted Birth by Jenny Blyth

Here are some wise words from a mother in USA, Teresa, who had three caesareans - and then a VBAC at home. I asked her, 'what advice would you give to a first time mother?' This was Teresa's reply:
“I think the most important thing for a first time mother to know is:

No one can do this but you.

You are the ONLY one who can do this.

And you CAN do it.

The strength is there, inside of you.

You have everything you need to birth your baby.

And while it will be the hardest work you have ever done, there will be nothing else that will ever come close to being as rewarding when it’s all over.

The work is worth the reward.

That’s what I wish someone had said to me.

I wish someone had just continued to reiterate to me thatI *CAN* do this, there’s no doubt about it …I was designed to birth my babies.

I don’t need a doctor to save me, or drugs to numb me, or a scalpel to cut me open.

I can birth my baby.

And so can all women.

Instead, the message I got from my care-providers was: “We are the experts on birth. You are just the mother. We know a lot more about this and about what your baby needs than you do. Just leave it all up to us and don’t question our decisions.”

Sigh.

The worst part it – I bought it.

Understanding this and finding my truth, my strength and my confidence is how, after having three caesarians, I birthed my fourth baby vaginally, normally, at home.”

You can view Teresa's inspiring birth montage here

A comprehensive birth plan from CARES
This birth plan is geared towards a VBAC birth, but it has many good ideas for any birth.

Do you know what your rights are? Choose care-
providers and a birth location where the rights of the childbearing woman will be upheld.

After the Birth
How do you want your baby treated in the critical window of bonding time immediately after birth and in the following hours and days? Know what it is important to you, and make sure this is expressed in your birth plan or at your Birth Plan Meeting.

See this video called, "Baby's First Bath" - to help you decide want you do want - and what you don't.

BOOKS
I'm sure you've got book recommendations coming out of your ears. Here's a couple I found really helpful - and by Aussie authors too.

The Down to Earth Birth Book by Jenny Blyth. No politics - just simple, common-sense birth wisdom. Practical, grounded and quite beautiful too.

Gentle Birth, Gentle Mothering by Dr. Sarah Buckley. It was reading this book that switched on a light for me with respect to understand birth hormones and how undisturbed birth supports the peak flow of those hormones - and so helps keep birth safe.