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

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

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.

Print and give them this handout https://www.breastfeeding.asn.au/bf-info/breastfeeding-and-work/caregivers-guide-breastfed-baby

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

https://www.breastfeeding.asn.au/breastfeeding-helpline

Congratulations of breastfeeding your precious baby and enjoy the journey.

~Bec

International Day of the Midwife - 5th May 2013

I was away with family for International Midwives Day this year so unable to post this yesterday. 

Just wanted to say that I am so very lucky to have the 2 best jobs in the world – Mum and Midwife! It is a privilege to be part of the most special part of a woman’s life and I always feel in awe of every mother, father and child at every birth. I am honoured to call these amazing strong Midwives colleagues and would like to say a huge thank you to every Midwife to everything you do.

So, what exactly is a midwife?

“A midwife is...

…a health professional who, in partnership with a woman, provides specialist care, education and support during pregnancy, birth, postnatal and the early parenting period.

Midwives believe that pregnancy and childbirth are normal and significant life events for women and their families and respect and support this transition.

Midwives work in many settings including hospitals, birth centres and the community. Midwifery care includes the detection of complications in mother and baby, the referral to other specialists as needed, and the initiation of necessary emergency care. Midwives also have an important role in health counselling and the provision of information to women, their families and the community.

Registration as a midwife is dependant upon successful completion of a recognised midwifery education program and, continuing demonstration of the necessary knowledge, skill and experience to provide safe and professional midwifery care.”

Taken from http://www.nswmidwives.com.au/AboutUs/Midwifery.aspx

Basically a Midwife is a person (usually a woman) who is an expert in normal pregnancy, labour, birth and the postnatal period. They can work with women (and their families) before conception, during pregnancy, during labour and birth, and during the first 6 weeks of their baby’s life and beyond.

Midwives work in

▪Public and Private hospitals – in Antenatal Clinics, the Antenatal Ward, the Birthing Unit, Birthing Centres, the Postnatal Ward, Midwifery at Home, Neonatal Special/Intensive Care Units, and in Caseload/Group Practise Models.

▪Independantly – providing continuity of care to their clients.

▪With Doctors – in Obstetrician and GP’s rooms.

▪In Community Health

▪And many, many more.

Midwives provide expert care to women, babies and their families and are very dedicated. We often work during all hours of the day and night, weekends, school holidays, anniversary’s, birthday’s and any other time we are needed. We work long hours often spend kneeling on the floor over the edge of a bath with a labouring woman, sitting with a woman and her baby during a breastfeed or holding a woman’s hand during a hard time. We skip meals and bathroom breaks, hurt our backs and stain our clothes. We are passionate about empowering women to have their best pregnancy, birth and early parenting experience. Our families are patient, understanding and listen to our rants. We are hardworking, lucky and in my opinion, have the best job in the world.

To become a midwife in Australia you need to complete a university course. There are several ways;

▪A Bachelor of Midwifery – a 3 year undergraduate university degree.

▪A Graduate Diploma or Masters of Midwifery – a postgraduate university course where applicants need to be a Registered Nurse. Courses range from 12 months to 2 years in duration.

▪There are also double degrees Bachelor of Nursing/Bachelor of Midwifery available.

I love my job but it isn’t always easy. To succeed you need to be passionate, patient and hard working – but it is worth it! If your interested, look at the Australian College of Midwives website for your state.

To all my colleagues, thank you for your support, dedication and passion. I hope you had a lovely day and celebrated the wonder of what we do.

http://www.internationalmidwives.org/events/idotm/international-day-midwive-2013/

♥ Bec