My birth story Part 1: The importance of choice and knowledge
Updated: Apr 23, 2020
Like so many I believed that the best care during pregnancy and birth was only with an obstetrician. I had paid the crazy amount to up my health insurance to cover a private hospital but I got pregnant sooner than I expected and fell just 2 weeks short of the 12 month waiting period - my insurance wasn’t going to cover it! So I started to look into my options. Even with my cover I had to still pay out of pocket the obstetrician which was about $6,000. Now with no cover, I would also need to pay for my hospital stay which was at least another $4,000 and that’s not including if I had any complications, needed any surgery, C section, etc. Besides this being a crazy amount of money that I didn’t have I also didn’t want to be in labour and be worried about how much it was going to cost should I or my son need any special care, it’s a layer of stress I didn’t need added. I did so much research to see if I could pay for an obstetrician but deliver as a public patient, it ended up as a no - obstetricians are only allocated private beds in a hospital and can not take public ones. I also wasn’t keen on the $6k for an obstetrician either. So with a brand new hospital opening up in my area I started to read up about the public system, there were lots of mums saying how bad it is but I also found these mums all went private... so how did they really know?! During all this research I found a large Australian published study that looked into women’s satisfaction of their birth experience. It stated that the key factors to determining how women felt about their experience was dependent on how much they felt heard, how much choice they had, and the amount of intervention used such as vacuum, forceps and C sections. Because of these factors, it found that the private hospitals were the worst performers and the birth centres were the best as midwives were better at meeting these key factors compared to obstetricians. As someone who has never been to hospital let alone experienced labour, this was really eye opening to me to read these statistics, but the verbatims of women in this study about what exactly made their experience either positive or negative hit home with me. The recommendations put forward was that there should be more continuity of care, more midwife lead care, more availability to water births, and of course much more respect, choice and improved bedside manner to women during labour. This gave me confidence to go public with Midwives. When making my first appointment with the midwives, I found out about the Midwife Group Practice (MGP) program, where you see the same midwife throughout your entire pregnancy instead of whoever is on that shift. Since I have read about the importance of continuity of care I was keen to get into this program. I was advised that you have to be okay with leaving the hospital within 4 hours of birth if everything is okay and that most first time mums don’t go for this. Although that sounded a little scary I still signed up for it, knowing that you can stay as long as you need if you were struggling with anything. As the MGP program is quite popular, it can be full and you miss out, so when I got the call the midwife said she can fit me in but the only catch is that she was also pregnant and due when I was. This meant that I could have her through all of my pregnancy but just not my birth. I thought it's better than the standard program as I would have her for almost all of my appointments and decided to go ahead. I soon learnt the importance of continuity of care, I had the direct mobile number of my midwife that I could call up at any point to ask and check anything between appointments and it was encouraged to do so, so I never felt like I was a burden. However continuity of care wasn’t just the main difference with MGP, they also have a much more holistic approach to pregnancy and birth. They are focused on birth being a natural experience where they learn your preferences and advocate for you when other doctors get involved. From talking to other new mums I found they were checking and teaching me things that other midwives and obstetrician don’t. They gave me a lot of information on breastfeeding, showed me how to express colostrum and explained that doing it from 36 weeks helps with not going too far over due, and told me about perianal massage to help with reducing the tearing during labour. I also learnt that while I would leave the hospital earlier, I would then have home visits every day with my midwife for 2 weeks and have also them on call 24/7, so it would end up a longer and more personalised aftercare in your own home than it would be through the standard hospital program. It was strange that no one seems to tell you this when you sign up to the program, as it is really an amazing service. A friend of mine had done her birthing classes with Calm Birth and highly recommended it to me. Calm Birth is all about not only giving you a wealth of information about the process the hospitals and doctors have but also what rights and options you have, and all of the knock on and possible disadvantages that various interventions and drugs have on you, your baby and the labour process. They give you the tools and skills to not only get through labour without any pain medication but also how to feel empowered, respected and heard. It was by far the best thing I did in my whole pregnancy journey, it totally changed my labour outcome, my health and my sons - I am deeply thankful to Janine O’Brien from iBirth for teaching us Calm Birth. Some of the eye opening things I learnt in Calm Birth that every woman should be taught in order to make an informed decision was; 1. Exactly what an epidural entailed and the side effects. I originally thought that I didn’t want one, but if I changed my mind and found it all too painful in labour that I would have it. However I learnt that it meant that you are stuck on your back in bed (the worse position to give birth in), have a spine block connected, a catheter inserted, your pushing stage of labour can be longer, you are more likely to require forceps/vacuum, more likely to need an Episiotomy as you can’t push as efficiently, and your baby is effected by the drug and more likely to have latching issues on first feed. 2. That an Induction involves pumping a synthetic version of your Oxytocin hormone to create contractions which like the epidural effects your baby’s ability to latch on first feed, it can mean the contractions jump straight to the faster and more painful ones quickly and don’t always line up with how much you are dilating meaning it can prolong your labour and stall. 3. Delayed Cord clamping. When your baby is born it has 1/3 of it’s blood in the placenta, waiting until the cord stops pulsing (under 90 secs) allows this to enter back into the baby. This means a third of their oxygen supply and a third of their iron supply is re-entered into their system - two important factors in a new baby’s life. Unfortunately western hospitals are geared to clamp the cord as soon as the baby comes out, for the only reason of making sure they tick that process off the list. Do yourself a favour and watch this to learn about it:
4. What you can say No to. I thought that the way the hospital is and what the doctors say, is what you need to conform to. I didn’t realise that you have so much more flexibility than this. You can say who you want in the room and who you don’t, you can have the lights off, move the bed, play music, have an oil infuser, ask what it means when a doctor says they need to do something, refuse the injections that your baby gets when they first come out, etc. I learnt that I truly did have all the power over what happened to me and my baby and that I could ask questions and find out alternatives instead of feeling like I need to just agree and regret it later. 5. The importance of uninterrupted skin on skin time. I learnt just how incredibly important it is to have at least 2 hours of uninterrupted skin on skin time with your baby immediately after birth, not only for the super important bonding process, but for getting a successful first feed that also helps for setting yourself up to be able to breastfeed, and to get your baby’s vitals in check - just by being on you their blood sugar level and blood pressure will come into the correct range. I learnt that you can and should say no to having your baby washed, weighed, measured, pricked, or injected until this has happened. 6. It is possible to get your labour back on track if you stall without the need for intervention. As labour is the perfect balance of sensitive hormones working in sync to correctly progress your labour, these hormones are effected by your external environment. You must feel safe and comfortable in your environment in order to progress correctly. As a hospital is not a natural environment to make you feel safe and comfortable, I learnt that you can decorate the room and have things like music and smells that help you to relax, doing things like have your partner do soft touch message, visualization and guided meditation to get you feeling good and get your contractions back on track and ramping up again.
7. Choices you can make if intervention is required. C sections and Inductions are there are as a safety net, that should the baby need to get out quickly, you have these options to ensure you and your baby remain safe. So should you find yourself in a situation where you need to do one of these, you can request things to make it as natural as possible. Request the skin on skin straight after birth, delayed cord clamping and asking for some of the fluid in your birth canal to be collected and given to your baby (Babies lick the birth canal all the way through birth as they come out and this is very important for building their microbiome and immunity.) I learnt so much more than this but I feel these basic things, all women should have the right to know so they can correctly choose what is right for them and their baby rather than being pushed into doing what the doctor or hospital finds convenient and what doesn’t get explained in full to them. So after my birthing classes I was feeling super empowered and no longer afraid of labour, I felt ready. When I spoke to my midwife about my birth plan I found out that the delayed cord clamping and uninterrupted skin on skin time is standard practice within the Midwife Group Practice. It was so nice to know that what I wanted aligned so perfectly with them.
Then my due date came and went. I was waiting and waiting!! I felt every day was the day as I could feel he was engaged. I had a couple of friends go through an induction and told me to avoid it if I can, once you are a week overdue they like to book it in as they recommend not going over 2 weeks past your due date. So I was feeling anxious to be able to go into spontaneous labour before it was too late. I bounced on my ball every day, had raspberry tea, ate spicy food, none of it worked!!
At this point I had my new midwife and she did a stretch and sweep to find I was 2cm dilated but also found she was feeling a bum not a head.. he was breech!!! I was in shock as my previous midwife had checked and felt a head down in my pelvis, now we know she was feeling his hips instead! I was 5 days overdue and there I was getting rushed off to an ultra sound to confirm his position - yep he was breech. The doctor who was on duty came in and began to tell me that I had 3 options which boiled down to 1 very quickly. Firstly you can try to turn the baby but he was too big to do it now and he had his bum engaged, he was too low and ready to go. Then she explained I could deliver breech however I can’t at this hospital as it’s not taught and it’s very dangerous, and thirdly I could have a C section that very day. She made the effort to explain all the risks and downfalls for the first two options but when it came to a C section she said there was no risks, no disadvantages. Which I had learnt from Calm Birth just isn’t true. She just kept talking and talking and I could feel my eyes well up, I really didn’t want a C section if I didn’t have to for many different reasons. She didn’t even respond to how I was feeling and tried to get me to agree then and there to a C section that afternoon, pushing me by making it my only choice. My new midwife Lucy interrupted and asked the doctor to give me a moment to have a think about it. I am so thankful she gave me the opportunity to take a breath. But then Lucy explained that she knows of a doctor who delivers breech at Randwick and is known as the best in Australia. She explained that she could see if I could go see him and then I can at least get his opinion and make an informed choice. I felt relieved to be able to at least take some time to find out more about a breech birth before I sign up to a C section as only an hour before I had not idea about a breech birth. Lucy then organised everything for me, she called the doctor and got me an appointment that afternoon, transferred all my documents and got me a full scan ready for the doctor. Not only did I have someone on my side advocating for me but also going above and beyond to make it so easy for my husband and I. So off we went to Randwick to see Dr Bistis. In the car I decided to call Janine, who ran my calm birth course to get her option on what I should do. She knew Dr Bisits very well and said that she wholeheartedly trusts him. That he would assess me and know whether it was a good option for me. She said that he is very honest, so if he thinks I can, that I should go for it. I didn’t know what to expect but he is this very calm and relaxed man that instantly put me at ease. After my experience with the previous doctor it was like chalk and cheese. He went through the entire breech birth process in detail with me, he gave me all the pros and all the cons of it. He confirmed that I was the perfect candidate for a breech delivery as my baby was bum first not feet first, he was not too big or too small, and I was young and healthy. He explained that it must be an active labour, no epidural - I was glad that I did my calm birth course! He then gave me the website of the latest medical study done on breech births and told my husband and I to go off and read it then come back and let him know what we decide. I was ready to say yes to trying a vaginal breech birth with him then and there but he wouldn’t let me, he wanted us to take the time to read the unbiased findings before deciding, what a breath of fresh air after the last doctor. The study confirmed that it must be an active labour, usually delivering on all fours or a birthing stool, which from my course I had learnt is the best way to deliver. The risk was that for a head first delivery 1-2 births out of 100 have complications, and breech it’s 2 out of 100. It also detailed the importance of if its a mother's first baby or not. As opting for a C section on your first child will mean that you will most likely have to have C sections for all other children that you have and that it was an important factor in the decision. My husband and I concluded that we wanted to give breech a go, we felt that we were in the best hands. So we went back in to see him and I said that so long as he will put my son’s and I safety first that I want to give it a go, that if anything seems off that he can make the call for a C section and keep us safe. He instantly confirmed that of course, like any other birth, if things change we will get the baby out safely. I also said that if he feels confident doing it, that it doesn’t seem risky to him that we want to do it. He almost laughed, he said he is more than comfortable with it and said he knew from when he first saw me that I would be up for birthing this baby vaginally and that I can do it. I then checked if I now see him for appointments instead of my midwife, it was a Friday night and he said that I wasn’t going to make it to Monday, that this baby was coming this weekend! He gave me his mobile number and told me to ring him not the hospital when I start contractions. I later found out that he had the day off but came in just to see me. That he has a reputation of making an effort to be available to give the option of a vaginal birth to any breech women and that’s why he works in the public sector. This actually makes my heart melt and I am so grateful to him for giving me choice and allowing me to bring my boy into the world in the most natural way possible. Well Dr Bisits was right, my boy came that weekend! Read part 2 to see how it all went down! AK xx