Sunday, 4 August 2013

World Breastfeeding Week 2013

It’s World Breastfeeding Week! A time to celebrate the wonderful thing that is breastfeeding.

http://worldbreastfeedingweek.org/index.shtml

Breastfeeding is a natural, beautiful thing. At first, it can be hard work. Many women suffer from sore nipples, poor attachment, leaking breasts and a baby that feeds frequently. At times, I can understand Daddy giving a bottle if formula may seem very appealing. But it does get better. After 2 weeks, things are starting to settle and become easier. After 6 weeks, your supply has matched your baby’s appetite and they have learned the best way to latch. Your breasts don’t feel as full and uncomfortable before a feed and your baby can almost attach themselves. By 3 months, your baby can completely attach themselves, your breasts feel ‘normal’ again and breastfeeding is second nature. It is at this point most breastfeeding Mum’s feel sorry for Mum’s that have to wake up, get out of bed, go to the kitchen, turn on the light, make up a bottle, warm it, test it, feed it to their baby and then try to get themselves and their babies back to sleep. Snuggling your baby to your breast and dosing off again seems far easier and everyone gets more sleep. Breastfeeding may take more effort at the beginning, but in the long term is far easier.

https://www.facebook.com/pages/World-Breastfeeding-Week-2012/293327800702827

So apart from the convenience of pre-prepared, pre-packaged, pre-warmed, portable and perfect food for your baby, why else would parents choose to breastfeed?

For Baby -
▪Breastfed babies are less likely to get sick, need trips to the Doctor’s, antibiotics and admissions to hospital.
▪Provides individual nutrients and antibodies (that change each feed depending on the needs of your baby) to give baby the best possible start to life.
▪Can decrease incidence of asthma and allergies developing later in life.
▪Increases IQ.
▪Decreases incidence of obesity later in life.
▪Decreases risk of SIDS

For Mum -
▪Assists with returning your body to your pre-pregnancy state (helps to contact your uterus, minimise blood loss and decrease weight).
▪Decreases risk of Osteoporosis, Type 2 Diabetes, Breast Cancer and Ovarian Cancer later in life.

For Dad -
▪Healthy and happy Baby and Mum.
▪Cheaper – no buying formula, sterilisers or bottles.
▪Means you get more time to bond with Baby with skin-to-skin time, bathing Baby, showering together and cuddles.
▪Healthy baby/child means less sick days off work and less pharmacy bills.
▪Trips out are easier as breastfeeding comes in a very convenient package.

The current Australian recommendations for feeding babies are:
▪Exclusive breastfeeding until 6 months of age.
▪Introduction of solids at a minimum of 6 months of age with continuation of breastfeeding for at least 1-2 years (depending on which guideline you look at).

Statistics from the 2010 Australian National Infant Feeding Survey show us that 96% of babies have their first feed after birth as breastmilk but this rapidly decreases and baby gets older. About 39% of babies were exclusively breastfed at 3 months of age, with 69% receiving some breastmilk. Only 15% were exclusively breastfed to 6 months of age, with 21% receiving ‘predominantly’ breastmilk and 60% receiving some breastmilk. In the 24 hours before the survey, 40% of 1 month olds and 55% of 6 month olds received infant formula (or non-human milk).

Remember that every drop of breastmilk is beneficial and any amount of breastfeeding should be encouraged. If breastfeeding is not an option, the next best option is the mothers expressed breastmilk, then donated breastmilk and then artificial infant formula.

I need to say that I am a passionate breastfeeding advocate, but I am also a passionate advocate for women’s choices. If parents are aware of the risks and choose to formula feed then I will do everything in my power to help them. Where I think we fall short as a community, is with lack of education and support for parents. New parents are bombarded with conflicting advice from every angle: health care professionals, family, friends, the media, books and the internet. Wouldn’t it be wonderful if the information being shared was accurate and parents were nurtured and supported, regardless of their choices?

Do your research and make a choice that is right for you, your baby and your family.

~Bec





References -

Thursday, 18 July 2013

Cord Clamping

There have been a lot of articles out there recently discussing the benefits of delayed cord clamping versus early cord clamping. What exactly is the difference?  In most research papers, early cord clamping is the clamping and cutting of the umbilical cord within 60 seconds of birth. While delayed clamping, involves waiting at least 60 seconds or until pulsation ceases before clamping the cord.

After birth, the placenta continues to function, providing oxygen to baby and filtering off waste until the baby has transitioned to extrauterine life. As this transition occurs, the cord ceases to pulsate. Eventually, the hormones of the mother’s body kick in again, and the placenta detaches from the uterine wall and comes out the vagina. This natural process ensures the baby is assisted as much a possible into their transition into extrauterine life. It also ensures that baby received their entire required blood volume, and thus their iron stores. This also means that the placenta is less bulky so therefore easier for the uterus to contract and expel.

The intervention of clamping and cutting the cord before these processes happen has become mainstream (particularly in the Western World). It is part of most hospital policies for ‘active management of the third stage’ and ‘getting accurate cord blood gasses’ is not a good enough reason in my mind. In my experience, it is done with more haste and urgency when a baby has been compromised during the birthing process (for example the use of forceps or a non-reassuring foetal heart rate). To me, this is completely illogical. In these cases, it seems even more urgent to leave the cord intact so the mother’s body can assist in restoring acid-base balance and ease the transition into extrauterine life. Most resuscitation measures can be performed on the mothers abdomen (or at the very least in-between her legs at the foot of a bed) and it seems logical for health care professionals to work with the life support system nature made rather than against it.

There are stories of midwives in isolated areas leaving pulsating cords of very premature babies intact until help arrives some hours later. There are also stories of Doctors hanging the connected placenta above babies like an IV bag following a haemorrhage. So the physiology obviously makes sense to some.

The research tells us that babies who have ‘delayed cord clamping’ have higher haemoglobin levels between one and two days after birth and were less likely to be iron-deficient three to six months after birth.  There is a slight increase in hyperbilirubinemia (also known as jaundice) however some studies show this increase is not associated with an increase in treatment, while others show a slight increase. These babies also had a statically higher birth weight. These babies’ mothers did not show any difference in postpartum blood loss or haemoglobin levels.

So, the research backs up what nature and physiology have been telling us – not intervening and leaving the cord to cease pulsating naturally gives the best possible outcomes for babies.

If you are choosing to have active management of your third stage of labour, you are completely able to decline early cord clamping and cutting in favour of evidence-based delayed cord clamping. You are of course able to decline cord blood gasses also.

It’s your baby, your body and your birth.

Shows how much blood transfers to baby over time if the cord is left intact. This took about 15 minutes! 
Thanks to Birth Dance for the image.


~Bec



The most recent study (2013) has been published by the Cochrane Collaboration.
McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD004074. DOI: 10.1002/14651858.CD004074.pub3.


Thursday, 11 July 2013

Why do parents choose to have a Homebirth?

As a home birthing Mum myself and a midwife, I often find myself asked the question “why do women choose to have a homebirth?” There is no one or simple answer to this question. Birth in itself is a complex issue and chosen place of birth is an individual as the birthing woman herself.

Firstly, it’s probably a good idea to define exactly what I mean by the term ‘homebirth’. I mean the planned choice to labour and birth at home accompanied by a Registered Midwife. This includes women who transfer out of the home before, during or after labour.  For women who choose to birth at home unattended, the usual term is ‘freebirth’. For women who planned to birth in a hospital or birth centre and got caught short, the usual term is ‘unplanned-homebirth’ or ‘unplanned-freebirth’.

So, what are some of the most common reasons parents give for choosing to plan a homebirth?

 It’s safer. When a woman’s pregnancy is considered to be low-risk, it is statically safer to birth at home with an experienced Registered Midwife.
 Less likely to have interventions like an induction, caesarean section, epidural, forceps or episiotomy and my baby is less likely to need admission to the Special Care Nursery or have problems with breastfeeding.
 It feels more comfortable at home and I’m free to labour and birth my way.
 My husband, children, mother, sister, doula and birth photographer can be there to assist me during the labour and birth.
 Not tempted to use medical forms of pain relief.
 I can have a waterbirth if I want. I can have candles. I can use aromatherapy. I don’t have to conform to hospital policies.
 Traumatic previous birth (or hospital) experience that makes me fearful to return.
▪ Previous birth didn’t happen the way it should have (e.g. Induction as Obstetrician going on holidays, leading to a cascade of intervention, ending with an emergency caesarean section) and I want something different for this birth.
▪ I had my last baby in the car on the way to the hospital – it seems safer to stay at home and have the Midwife come to me.
▪ My private Midwife knows me, my husband, my children and my history. She spends an hour with me at each appointment and knows my pregnancy. She will be there for me and only me while I am labouring (and not have another labouring woman to care for and countless women to assess). I trust her.
▪ My husband won’t have to fight for me in the hospital; he can labour with me and trust our Midwife to tell us if we need to be concerned.
▪ I am not separated from my baby or my husband and other children. We add to our family in private, in our own home and life continues as normal.
▪ Pregnancy, labour and birth are normal. Our baby was created in private at home, and will be born in privacy at home. We believe in a woman’s ability to birth her babies.
▪ Birth is normal – if we need help, our Midwife is highly trained and experienced and comes with oxygen, syntocinon and other things needed to help us in an emergency.

There are many other reasons - feel free to leave a comment here or on my Facebook Page with yours.

For me, the most compelling reason is safety. The research is compelling and wouldn’t want the best possible chance for the safest birthing experience and the healthiest baby? Having said that, the woman MUST FEEL SAFE in her chosen place of birth.

Do your research. Look at http://www.mybirth.com.au/ for the statistics of your local hospital. Your first appointment with a care provider is for you to get to know them and ask them questions. If you don’t feel comfortable, keep interviewing until you find someone who fits.

Knowledge is power. It is your body, your birth and your baby. Trust in your body and trust yourself. Women are amazing J

~Bec



References

Thursday, 6 June 2013

International Homebirth Day - 6th June 2013

http://www.squidoo.com/the-international-homebirth-day
So today 6th June, is International Homebirth Day. I think we (midwives, women, and the community) all need reminding sometimes that birth is fundamentally a safe, natural process best left alone and quietly supported. The safest place to birth is often where the women feels safest and supported, and for a number of women this is at home.
Some women you may know that have birthed at home (or planned to) include:

▪The Queen - had 4 babies at home, aka Buckingham Palace
▪Ricki Lake – check out her documentary The Business of Being Born, which includes footage of her homebirth
▪Danni Minogue – transferred
▪Alyson Hannigan
Alanis Morrisette
Gisele B√ľndchen 
Demi Moore
Julianne Moore
Pamela Anderson
Meryl Streep
Joely Fisher
Jennifer Connelly
Cindy Crawford
Nelly Furtado
Felicity Huffman
Pink – transferred
▪Davina McCall
▪Charlotte Church

Just to name a few. Depending on your age and where your family is from, you may find your Mum, Grandmum or Great-Grandmum was born at home. 


It is our responsibility to ensure that all women have access to choose safe, homebirth care provided by an expert Midwife.

~Bec

Monday, 20 May 2013

Inductions and Caesarean Sections


I posted a flowchart on my Facebook Page showing the results from a U.S. survey-based study researching women's experiences giving birth - Listening to Mothers III: Report of the Third National U.S. Survey of Women;s Childbearing Experiences. This image compared vaginal versus caesarean section births relating to induction of laour and epidurals. 


A friend posted the comment "I'm actually surprised the percentage isn't higher for the induced mum's who have an epidural."  and I've got to say so am I. I my experience, these statistics don't seem right. So I went searching and came across a South Australian study of over 28 000 women who birthed in 2006 and 2007. Only pregnancies with a single baby, in cepalic presentation (head-down) with a gestational age of 37 completed weeks or more were included in the study.

This study quotes that "25% of births in Australia are induced". That is a scary number. The complications associated with an induction are many and I will discuss them at another time.

The study looks at inductions for "recognised maternal and fetal complications" and "non-recognised maternal and fetal complications".

"Recognized indications for induction of labor in the perinatal dataset included diabetes (both gestational and pre-existing diabetes), premature rupture of the membranes, hypertensive disorders, fetal growth restriction, isoimmunization, fetal distress, fetal death, chorioamnionitis, prolonged pregnancy, twins and antepartum hemorrhage."

All other inductions were placed in the non-recognised category.

Unfortunately, this study did not produce statistics comparable to the American study in terms of induction/epidural/caesarean section but it did produce some interesting numbers.

"Women were more likely to require epidural or spinal analgesia with induction for both recognized and non-recognized indications when compared with spontaneous onset of labor. Similarly, women were more likely to have complications following induction for non-recognized indications compared with spontaneous onset of labor. Women were least likely to achieve vaginal birth following both induction for recognized and non-recognized indication when compared with spontaneous onset of labor. Conversely, women whose labor was induced for non-recognized indications had an increased risk of cesarean birth." 

Here are the figures-

73.17% of women with a spontaneous onset of labour had a vaginal birth, compared to
66.62% of women induced for a recognized complication and only
58.89% of women induced for a non-recognized complication.

13.86% of women with a spontaneous onset of labour had an emergency caesarean section, compared to
17.98% of women induced for a recognized complication and
26.10% of women induced for a non-recognized complication.

This tell us what we already know, that an induction increases your chance of having a caesarean section by at least 50% (67% of the induction is for a non-recognized reason)!

There are risks for baby too.

"Induction of labor for non-recognized indications significantly increased the chance of the infant requiring level 2 nursery care or treatment when compared with the spontaneous onset of labor." 

Here are the figures-

8.19% of babies born following a spontaneous onset of labour required level 2 nursery care, compared to
9.13% of babies born following an induction for a recognized comlication and
14.03% of babies born following an induction for a non-recogniszd complication.

Wow! That's almost a 50% increased risk for baby with an induction for a non-recognized complication - and that's just those babies requiring level 2 nursery care.

This is going back to basics. If we interfere with nature when it is not medically indicated, we cause big problems. Of course, sometimes in induction is medically necessary, and obviously if the induction is for a compromised baby, then you are more likely to find a pathological CTG (or fetal distress) prompting a caesarean section. Induction can be a wonderful tool when medically needed (and risk-wise far better than going straight for a caesarean section) The point is, for those inductions that are not medically indicated, the risks are large and far reaching.

Have a look at the report and see the other findings for yourself.

When planning where to have your baby and who your caregiver will be, do some research. Ask them their statistics on induction of labour (is it over the average 25%?). Places like My Birth have statistics for various hospitals, birth centres and care providers all over the country. For example, in 2009 the hospital with the highest induction rate in NSW was Inverell at 44% - a sobering statistic for the women of Inverell (who are more than an hour away from the next hospital with maternity services).

Educate and empower yourself.

~Bec




Tuesday, 14 May 2013

Mothers Day Australia - 12th May 2013

On Sunday in Australia, it was Mothers Day. You may think it's just another day picked out by greeting card companies for commercial gain (and it may well be) but you don't necessarily have to think of it that way.

As a Mum, I am so looking forward to the day when me excited daughter comes home from school, bursting with pride as she presents me with a card that the has painstakingly made, glued, glittered, drawn, scissored and written on. Seeing her this year come running towards me with a huge grin and a box of chocolates made my heart melt. Isn't this what Mother's Day is all about? Personally, I don't care about presents. I wouldn't want a store bought present when my little girl has made me something with love - and I will display it with pride.

As a daughter, I don't need an excuse to tell my Mum I love her or how amazing she is. I appreciate the sacrifices she made for me every day, and I am thankful to call her my Mum every day. On Mothers Day, I get a fantastic excuse to spoil her (and tell her to sit down and stop helping). I get an excuse to write a letter to tell her how lucky I am to have her as my Mum and that's why I like Mothers Day.

Don't go commercially nuts on Mothers Day or boycott it completely. Take the day to thank your Mum for all she has done for you and tell her how much you appreciate her sacrifices. If you are a Mum, look into your children's eyes and thank them for what they have done for you. Remember fondly the cuddles, hugs and kisses and display all those pasta-necklaces, handmade cards and hand-picked 'flowers' (aka weeds from the garden) with pride.

Thanks for the graphic of one of my favourite quotes - https://www.facebook.com/KnowYourMidwife?fref=ts



~Bec

Friday, 10 May 2013

Breastfeeding and Returning to Work


This has to be the most juggling a woman can do – working while breastfeeding. Some women are lucky enough to have their babies brought into the work place or work from home for them to continue breastfeeding. Some women need to express to continue giving their child breastmilk while at work. However you work out our day, know that by persevering and continuing to breastfeed your child you are providing them (and yourself) with so many benefits – well done Mummy!

Firstly, supply=demand. As your baby feeds at your breast he/she is telling your body to make more. So it follows, that if baby doesn’t suck at the breast as often, your supply will decrease. This is where expressing comes in. Not only will whatever you yield be able to be given to your baby in your absence, but expressing will tell your body to continue making milk.

So how do you express?

First, if you are going back to work and expressing you will need to invest in a good quality, electric breastpump. A double pump is better as you can express both breasts at the same time. You can also rent breastpumps from theAustralian Breastfeeding Association, some pharmacies and some companies. When expressing, you need to pump for at least 20 minutes to get the hormone response for a good yield (if this is not possible, any time is better than none). Not every woman responds well to a pump, and a pump will never give you as much as your baby is getting.

Here are some tips to increase the amount you are expressing and to continuing your breastfeeding relationship beyond your return to work:

▪Pump in the morning. Your hormones mean your milk supply is at its greatest from 2am to 6am. While waking up at 2am when your baby is asleep may seem ridiculous, you will get more by expressing at that time. Another option (as a lovely Mummy on my Facebook page Bellies, Births and Babies suggested) is to pump the left side while feeding your baby from the right for the first feed of the day. This advice is excellent as it works two-fold. Not only does it involve expressing in the morning when your supply is at its highest, but you are taking advantage of all those lovely breastfeeding hormones released by feeding your baby to express more from the other side.

▪Pump when your baby would usually feed.  If your baby would usually feed at 2pm and you are at work, try to fit in an expressing session then.

▪Breastfeed more when you can. It is logical that is your baby is getting most of their breastfeeds in while you are available, then he/she will ask for milk less when you are absent. So when you get home, feed and feed and feed. Feed before work and feed when you get home. Give your baby unlimited access to your breast particularly at night and on your days off. Many mothers find that bed sharing with their babies gives them all the rest their body needs, whilst allowing their baby to feed frequently throughout the night, thus asking for less milk during the day. Look here for advise on safe bed sharing practices http://safebedsharing.org/safetyguidelines.html

▪Keep your baby close. Lots of skin-to-skin, baby wearing and taking baths together. This is signalling to your body to keep making milk. Bed sharing or co-sleeping (where bub is in their own bed in your room, near your bad) also keeps your baby close.

▪Take baby with you when you pump. This may seem illogical, but what I mean is take things that remind you of your baby when you express. Take yesterday’s wrap and drape it over yourself. The smell will help you to express (if you put it over your head it can help you block out external stimuli and relax). Look at some photos on your phone. Take a video on your phone of your baby breastfeeding, or making their adorable “I’m Hungry Mum” noises and play it while expressing. Play music when you breastfeed your baby and repeat the same music when expressing.

▪Make sure your pump works for you. If the flange is too small or too big, if won’t work as effectively. Start off with the let-down function (short, rapid bursts) for a minute or two, and then switch to the long, drawn out function. You may need to do this a few times during a session. The suction should be comfortable and NOT painful. Obviously, you need to feel the pull, but it should always be comfortable. It may take some experimenting to find which setting works best for you.

▪Try breast compressions while expressing – this can increase your yield. 

▪Make sure you are comfortable. This may seem obvious, but trying to relax and be calm whilst reclining in a comfy chair will go a long way to helping you express.

▪See a naturopath, chiropractor or acupuncturist. Natural therapies (particularly a naturopath) will go a long way towards maintaining your supply. There are tonics available online which are good, but a customised tonic from your naturopath will be better. Be careful with online products as not all herbs used to increase supply are considered safe to use during pregnancy, so if you are pregnant or planning a pregnancy be cautious.

▪Get your boss on board. Try to get your employer interested in becoming accredited as a Breastfeeding Friendly Workplace. It may seem like a trivial thing, but your employer is more likely to attract women of childbearing years to their company and retain their employment with accreditation. Women are more likely to return to the workforce when they know their parenting commitments are respected and supported. Win-win!

▪Ensure you know about the safe collection, storage and transportation of breastmilk. You pump and bottles need to be cleaned thoroughly using hot, soapy water, and then rinsed with clean hot water. Store in a container cleaned with the same method. You do not need to ‘sterilise’ your breastpump – although can if you really want to.

The Australian Breastfeeding Association has great information about storage and transport for healthy babies (for babies in the Neonatal Intensive Care Unit, refer to their hospitals guidelines). https://www.breastfeeding.asn.au/bf-info/breastfeeding-and-work/expressing-and-storing-breastmilk

▪Make sure your baby’s carer (whether it be Dad, Grandma or a day care centre) knows how to handle and use breastmilk safely. It is liquid gold, and should be treated accordingly. To ensure they don’t waste your precious milk (or put unused milk back in the fridge for later) it might be an idea to send bags with small amounts of 20mL’s so careers can simply heat up what bub needs without wasting the rest. This also helps ensure careers don’t overfeed your baby (with the continuous flow from a bottle and the mentality that he/she must finish the bottle this is a real possibility) as you want your baby taking most of his/her milk feeds from your breasts.


▪Ask for help. Your partner, midwife, mother, sister, friend, work colleagues and the Australian Breastfeeding Association are all able to help and support you.

Breastfeeding Helpline 1800 686 268
https://www.breastfeeding.asn.au/breastfeeding-helpline

Congratulations of breastfeeding your precious baby and enjoy the journey.

~Bec