5 Steps to Better Birth Outcomes
A friend of mine recently gave birth to her second child. We had our first-born’s quite close together (in the same year not the same birthing suite) and experienced relatively similar labours and births, so we had had numerous discussions about her hopes, plans and wants for her second one.
When I received the message that her bouncing baby girl had arrived, I was first elated, and then curious as to how “everything” had gone. Not wanting to jump straight into the nitty-gritty of it all, I did the appropriate thing and gooed and gahed over what truly is a beautiful little baby – all squishy and pink with a shock of black hair. But then curiosity got the better of me, so I dropped the not so subtle “I hope everything went well for you”. She responded with something along the lines of “I couldn’t have asked for a better birth this time – very quick”. Awesome! I told her that I was so glad she had had a “healing birth”, as I was aware she had suffered some trauma during her first. And then I thought how sad it is that I had to say that; that a lot of Mum’s, especially first time Mum’s, are experiencing traumatic labours and births, to the point where they are delaying going back for another, or worse, choosing not to have any more children for fear of it happening again.
Why is this becoming the “norm”? Why, in an era of advanced medical technology, knowledge and experience, is birth not becoming easier, gentler, a more enjoyable, natural experience, the way it was intended to be? Is it our “advanced medical technology” that is the problem? Are we overthinking it?
In Australia we are lucky enough to have one of the lowest pregnancy-related mortality rates in the world. But is this really enough? Is it ok for our medical system to adopt the attitude of “if the mother and baby are alive at the end of it all – it was a success?” We say no! And so does the International Consortium for Health Outcomes Measurement who describe poor birth outcomes as low birth weight in babies, birth complications for mother or baby, low breastfeeding rates, epidurals & oxytocin augmentation, c-sections / instrumental vaginal births and stressful births. We need to go beyond survival to see more women having positive experiences during their antenatal, birth, and postnatal care.
So what then, needs to change? Well, plenty, but below are 5 basic areas that need to be addressed in order to improve birth outcomes in Australia
1. Provide access to Continuity of Midwifery Carer models of care
A recent Cochrane review determined “that women who received midwife-led continuity of care were less likely to have an epidural. In addition, fewer women had episiotomies or instrumental births. Women’s chances of a spontaneous vaginal birth were also increased and there was no difference in the number of caesarean births. Women were less likely to experience preterm birth, and they were also at a lower risk of losing their babies. In addition, women were more likely to be cared for in labour by midwives they already knew. The review identified no adverse effects compared with other models”. (Source Cochrane.org)
We also know that midwifery-led models of care empower women and lead to positive birth experiences. Midwives are able to provide emotional and physical support as well as information allowing birthing mums to make informed choices regarding their care; which is linked to reduced need for clinical procedures during labour and birth, fewer birth complications, higher breastfeeding rates and overall more satisfying experiences during the antenatal period, labour, birth and postpartum periods. Game, set, match to the midwives!
2. Access to care
Sounds basic doesn’t it. And for most of us it wouldn’t even be a consideration that we may not have access to antenatal, post-natal and childbirth care. But in regional and remote areas of Australia this is a very real issue affecting many women. Many areas simply don’t have the facilities. Or they have facilities but aren’t offered a choice in their model of care. This includes things like no water births and no option for a VBAC (Vaginal Birth After Caesarean). Ensuring women have access to maternity care in their local area is imperative to ensuring a healthy pregnancy; that women feel safe and supported in their birth environment and have on-hand post-natal care for a minimum of 6 weeks after the birth of their babies. How can we ensure this? Funding! Funding, funding, funding. Come on Malcolm Turnbull, don’t forget our regional Mums.
3. Change the Language
The way we speak to people in our day-to-day lives is important. Tone and body language are also important. We teach our kids this; we practice it ourselves in our marriages, with our friends, even with the person scanning our groceries. So why then, in a medical setting, are there certain individuals who feel its ok to drop the niceties? While having coffee with a friend recently, we were reminiscing about the births of our firsts, and basically singing the praises of the midwives. She was saying how, after 12 hours of labour, her primary midwife was relieved and a second midwife came in. Except she didn’t just come in. She knocked on the birth suite door and asked if it was ok if she came in, making the semi-naked, vulnerable, labouring mum feel respected and comfortable. Let us make one thing clear, bullying, coercion, and disrespect are not ok! The number of stories I have heard about birthing mum’s being “told” they will be given an epidural, or an internal exam or even just being spoken to in a tone that conveys direction rather than options, is quite frankly astounding. When my second child was born I refused to have the identification tape stuck to her spine. Have you ever tried to get that off new soft baby skin? It’s cruel! But you should have seen the look on the NICU nurse’s face when she turned up without it. Without saying a word she clearly communicated to me that she didn’t approve. Using many words I clearly communicated to her that it wasn’t her decision to make. Take a breath folks, and be aware than when you enter our birth suite, you are walking in on the biggest moment of our lives. Say please and thank you, ask our permission to carry out medical exams, explain the procedure and its pros and cons. Let us discuss it with our partners and make a decision. Answer our questions. Seriously, if the girl who gives me a brazilian once a month can knock and ask if I’m ready to go, so can you!
4. Stop over-medicalizing it and back off!
Birth has become way too over-medicalized, leading to unnecessary medical procedures and high PTSD and PND rates. Whilst we acknowledge that there are situations and births that don’t go to plan and medical assistance is needed (notice my use of language – I didn’t say “fail” or “intervention”), sometimes women just need time and space to let labour progress naturally. Labour often takes TIME, something society seems to have forgotten. Let’s look at being “overdue” and undergoing an induction, for example. Firstly, what is a due date? Every woman and child are different, therefore, how can anyone assume to predict an exact due date. As I saw recently posted to Facebook, there are no due dates in nature. No-one says “oh, my cat was due to have her kittens yesterday so I am taking her to the vet for an induction”. And every child develops differently after they are born, and as Mum’s we are encouraged to embrace this, so why are we expecting them to be the same before they are born? 40 weeks is a guide only – an average – an estimate. And the side-effects and poor outcomes associated with an induction or augmented labour are staggering.
A recent study showed that synthetic Oxytocin (Pitocin, Syntocinon) is linked to postpartum depression and anxiety. A woman with a history of depression or anxiety prior to pregnancy had an increased risk of 36%, whereas a woman with no history had an increased risk of 32%. Secondly, synthetic oxytocin does not act like the body’s own oxytocin. Labour surges can occur almost on top of each other, causing the resting tone of the uterus to increase. Such overstimulation can deprive the baby of necessary blood and oxygen supplies, causing foetal distress leading to emergency caesareans. Obviously these side-effects do not always occur, and often this form of medical assistance is required. My first labour was augmented after it came to a standstill after 28 hours and a stuck baby. Actually, the fact that I had the Synto drip is probably the reason I didn’t have a caesarean. My second birth was all Synto from go to whoa. My little cherub was “failing to thrive” and had to come out pronto. Sometimes it is necessary. Sometimes. And sometimes time and space is all we need. Sometimes when an expectant Mother who is “overdue” is left alone to relax, visualize and prepare will go into spontaneous labour and go on to have an empowering experience.
5. Remove the fear
There is so much fear and negativity surrounding birth these days. The minute you fall pregnant everybody has a horror story. Everybody has an opinion. Even people who have never experienced it themselves will tell you a horror story about their best friend’s first wife’s second cousin who had a terrible birth. And ladies, we all know that some of us wear our bad experiences like a badge of honour. Like we are somehow better Mum’s because we laboured for 19,000 hours and the chick from the gym only laboured for 4. And the medical professionals do it too. They tend to focus on what could go wrong - not what the norm is and how well it goes for so many women.
Fear is the enemy of the birthing woman. It’s the kryptonite to the powerful and essential oxytocin (love hormone) that we need to birth our babies. We know women need to feel safe and comfortable in order to labour normally. We’ve known this forever. This is true for all mammals. Why do we, as a society, insist on going against this knowledge and subjecting women to horror stories and mistruths about what birth is “really” like? Education and support is what will remove fear from the equation and allow a woman to feel safe and just do her thing.
So tell your friends, your family and your younger counterparts who haven’t been there yet just how wonderful and empowering birth can be; is. Women’s bodies are amazing. WE MAKE HUMANS. This is no mean feat, and don’t let anyone tell you otherwise. Birthing your baby really is lovely. Your body is designed to do it; your body can do it. The hormonal changes that happen in a woman’s body during labour and birth is mind-blowing. We do not need to be afraid of this. Trust your body, know your choices & rights and choose a care provider who will support you.