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Finding a way forward for the birth plan and maternal decision making: A discussion paper MidwiferyVolume 126, November 2023, 103806EditorialFinding a way forward for the birth plan and maternal decision making: A discussion paperAuthor links open overlay panelCatherine H Bell a, Hannah G Dahlen b, Deborah Davis a cShow moreShareCitehttps://doi.org/10.1016/j.midw.2023.103806Get rights an...

MAC - Maternal Assisted C-section. These are becoming more and more common, gone are the days where baby is given to your support person and separated from you until recover. No need for baby to be given to the paediatrician and then wrapped like a burrito and their face placed next to yours.
If a MAC isn’t your thing then you can have skin to skin in theatre straight after baby is born and breastfeed while being stitched. If mother and baby are well there is no need for separation at all.
- No, baby won’t get cold if they are skin to skin.
- Yes, the sterile field can be managed.
- Yes, women can have a positive experience in a surgical birth.
✔️Hospitals and obstetricians should be supporting this.

Afew people of late have been asking me about Maternal Assisted Caesarean Section. Here is a beautiful video from @drnatalieelphinstone highlighting how gentle this approach can be. . . 🎥 by @drnatalieelphinstone . . . . . #bellybirth #caesareanbirth #csection #gentlebirth #maternalassisted #caseareanoptions #birthoptions

Holy Moly, is this all RANZCOG has to say? Check out this really important research. We need to seriously rethink our maternity system.

“Many women report difficulties in accessing reliable, comprehensive, evidence-based information about the risks and associated outcomes of vaginal birth, instrumental birth and caesarean sections.

“Consequently, there is a risk of decision-making based on poor or minimal information which could contribute to adverse outcomes for both the mother and the baby.”

Dehumanised and violated: Women tell of ‘obstetric violence’ during childbirth One in 10 women who gave birth in the past five years say they were made to feel “violated, powerless or dehumanised” by health providers, a study found.

Wise words

In Australia birth trauma happens with or without a medical emergency | Rhea Dempsey Many birthing women today feel not only abandoned but actively bullied. The answer is midwifery continuity of care

The history of putting hats on newborns is an interesting read

Use Your Loaf: The Curse of the Baby Hat - The Birth Hub It’s deeply ingrained, this habit of putting hats on newborns. Search online for images of newborns and almost all of them are togged up in a woolly hat, for all the world like they are about to go outside for a snowball fight. So why do we do it? And why do so many midwives […]

This is a great visual

A complete guide to the options available when planning out your maternity care. The key is understanding your own philosophy and then fitting everything else around your care provider and location choices.

First think about where YOU sit on the medication spectrum and THEN start aligning this with your choices of care provider and location.

The further you slide across the spectrum the more medical your care becomes and the more likely you are to be exposed to unnecessary/routine interventions throughout your care. The further you move along the medicalisation spectrum the closer you are to a hospital and rapid medical attention.

If your dream birth involves early hospital admission, pharmaceutical pain relief, elective induction or caesarean and an extended stay in hospital then you might feel more comfortable with an obstetrician in hospital

if your intention is to have a vaginal birth with as few interventions as possible, midwifery care would be better suited and as far away from a hospital as you feel safe

Once you understand where you sit on the spectrum, choose a care provider and location that also aligns with your personal needs and philosophy. Choosing a care provider and location that doesn’t align with your preferences creates a barrier to you getting what you wanted from your birth. It’s your responsibility to make the choices that create the best opportunity for your needs and desires to be met…

This is a place to start when planning care that will feel most satisfying in the end.

Yup 😊

There… fixed it.

Mmm, RANZCOG seems to have missed the point. It isn’t about preparing the woman to be treated with disrespect, coercion and lack of consent and somehow this will prevent their trauma, but to avoid these things in the first place.

"In most systems in most states, women will access antenatal education, which is often run by midwives, and doctors don't often get involved in that education," Dr Khot said.

"So there is an opportunity there, because they don't get to hear from the doctors — they don't get to hear the medical side of how and what might happen in labour."

Ella says giving birth left her traumatised. Now she's trying to spare other mums the same pain Ella Porter says she was subjected to treatment against her will while she was giving birth to her son. A new program is aiming to try and lower the rate of birth trauma.

Shout out to all the amazing midwives on International Midwives Day 💗

Happy World Doula Week 💗
Attending the annual Doula Conference this year online, such an awesome lineup of birth workers

Important research

Austrian researchers analysed data from nearly a million pregnancies over more than a decade and discovered that universal screening for gestational diabetes has not led to any significant reduction in stillbirths.

Muin et al (2022) published their findings in the journal Acta Obstetricia et Gynecologica Scandinavica.

Their results showed that gestational diabetes screening may be of benefit to women who are deemed to be “at high risk,” although the number needed to screen is very high (880).

But universal screening (that is, screening all pregnant women) is not associated with any significant reduction in stillbirths.

As the researchers discuss, there are other reasons that screening for GDM is offered, and it is always important to weigh up the pros and cons for you as an individual, but this is an important finding.

One reason it’s important to weigh up whether or not to have screening is that gestational diabetes screening and the label that this can lead to carry risks of their own.

For example, more and more women are being told that they have gestational diabetes and then being offered induction of labour as a result. I will be blogging about this issue later this week, so look at for more on that at www.sarawickham.com

So it's always important to get informed about the issues so you can make the decisions that are right for you.

The reference for this study is: Muin DA, Pfeifer B, Helmer H, et al (2022). Universal gestational diabetes screening and antepartum stillbirth rates in Austria—A population-based study. Acta Obstet Gynecol Scand. 2022: 00: 1– 9. doi: 10.1111/aogs.14334

If you’d like more information, my website offers more than 500 pages of evidence-based birth information.

I also have a range of books which help women and families make the decisions that are right for them.

Find out more at www.sarawickham.com

Important information.

This trial validates the ongoing concerns expressed by many practitioners regarding the introduction of the one‐step approach to the diagnosis of GDM. The new criteria were introduced without evidence of benefit, with significant risks of harms and considerable burdens to women and health care systems. About 25% of pregnancies diagnosed with gestational diabetes in Australia are affected by this change in the diagnostic criteria.7 We believe that the results of the American trial1 require an urgent need to revisit the diagnostic criteria used for GDM in Australia.

A large trial of screening for gestational diabetes mellitus in the United States highlights the need to revisit the Australian diagnostic criteria Click on the article title to read more.

The term breech trial was a randomised trial published in 2000. The aim of the trail was to determine if vaginal or caesarean birth was the safest approach to breech births. The study concluded that ‘planned cesarean section is better than planned vaginal birth for term babies in the breech presentation’. After publishing these findings, practices changed dramatically and the routine use of cesarean for breech cascaded… the problem is, that the trial was so poorly done that it’s since been repeatedly discredited.
The consensus now is that we should have never made changes to clinical practice based on the term breech trial, but the damage has already been done.
This paper cited here by Glezerman in 2005 concluded that the trial conclusions should be withdrawn and that ‘almost immediately, the conclusions of the trial were accepted by the medical community. Rarely in medical history have the results of a single research project so profoundly and so ubiquitously changed medical practice…’.
Bottom line- the trial should be discounted in decision making around breech birth management and women should be able to choose if they want to be supported to birth vaginally or by cesarean for breech babies.
Both outcomes are equivalent.

Yep

Pregnancy is not put on pause in the COVID-19 pandemic, and neither are fundamental human rights. All women have the right to a safe and positive pregnancy and childbirth experience, with high-quality, respectful maternity care.

Have you heard about the Perineal Bundle? Here is a great article that goes through the evidence.

Perineal ‘Bundles’ and Midwifery Updated: August 2020 I’ve tried to avoid tackling this issue for months now but it won’t go away. It seems that the ‘bundle’ is one of the main topics of concern amongst mid…

DOULAS ARE NOT VISITORS

‘Despite this, women still seek to “find their tribe” and gather around them people who will support them on their journey. This includes partners, extended family, health providers and even doulas and birth photographers.’

Covid restrictions on women giving birth are causing heartbreak. We need to be more humane | Hannah Dahlen I’ve been studying the effects of restrictions on pregnant women since last year. Some are too harsh

Happy International Day of the Midwife 💗💗

There has been a lot of discussion over recent years around decreased fetal movements, this study suggests there is no association with stillbirth. Worth a read.

Evaluation of Pregnancy Outcomes Among Women With Decreased Fetal Movements This cohort study evaluates the association of decreased fetal movements with odds of stillbirth in an Australian tertiary care center.

No surprise that induction and epidural are the leading reasons for c-section in first time mothers in Australia (Qld), good to see research that puts this in to black and white. It really is important that women are informed about these interventions so they can make clear decisions.

The two most common reasons women have a first caesarean section - Transforming Maternity Care Collaborative New Queensland research shows the top two reasons for birth by caesarean section and the two common contributing interventions. Strategies that prevent the overuse of synthetic oxytocin (to start or speed up labour) and epidural for pain relief are urgently needed to tackle rising rates of caesarean...

This years Doula Conference has fantastic speakers, if you haven’t already signed up there are only a few weeks left.

We are SUPER excited to have finally finalised the program with SO many speakers and topics.
Visit the incredible line-up here:
https://www.doulaconference.com.au/program.html