Divine Timing Midwifery

Normal variations only become problematic when we apply generalised expectations about labour patterns to individual women and babies.
❗️Disclaimer: Before posting an uppity knee-jerk comment, please note I am referring to physiological birth and read the full blog post: https://midwifethinking.com/2016/06/08/in-celebration-of-the-op-baby/

The 'fetal ejection reflex' is NOT the 'Ferguson reflex' (spontaneous pushing). Yet, I see the terms used incorrectly and interchangeably everywhere. I think this is a symptom of our current recirculation of surface-level misinformation in the birth culture. As a stickler for detail I twitch every time I see the term 'fetal ejection reflex' misused 🥴🤣 I usually save these types of longer rants for the Collective, but here you go...

FERGUSON REFLEX
Discussed in an article by James Kenneth Wallace Ferguson in 1941 (another female bodily function named after a man). AKA 'utero-pituitary reflex' relates to when the baby's head descends and stretches the cervix and pelvic tissues stimulating receptors in these tissues to create a feedback loop that increases oxytocin and changes the contraction pattern to stronger and more expulsive. This is the normal uncontrollable spontaneous urge to push.

FETUS EJECTION REFLEX
This term was initially coined by Newton, Foshee and Newton concerning experiments on mice. Michel Odent applied the term to physiological human birth in his article 'The Fetus Ejection Reflex'. In the article, Odent discusses his theory of physiologic fear where the fetus ejection reflex is initiated by a surge of adrenaline and catecholamines. This reflex results in an extremely fast birth ie. immediate ejection of the baby as an evolutionary survival mechanism initiated by a threat (predator) at the end of labour. In his article, Odent writes "The fetus ejection reflex must not be confused with the Ferguson reflex. The Ferguson reflex is triggered by the pressure of the presenting part on the perineal muscles–in other words, local factors–while the fetus ejection reflex can start much earlier and is not triggered by local factors."
You can find more birth-related information on my blog, podcast, YouTube, articles, books, courses and collective at www.rachelreed.website

ACM welcomes the news of a publicly funded homebirth site for women in the Sunshine Coast and looks forward to continuing to work with government and key stakeholders to continue to expand access to continuity of Midwifery care for women across the entire state of Qld. Shannon Fentiman MP Queensland Nurses and Midwives' Union
https://midwives.org.au/Web/News-media-releases/Articles/2023/23_November/Publicly_Funded_Homebirth_Qld.aspx

Home birth works!
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30063-8/fulltext

*Thanks to Sam Todd for the infographic*

https://midwifethinking.com/2013/08/14/amniotic-fluid-volume-too-much-too-little-or-who-knows/

This is my regular reminder that CTG monitoring is a choice and intermittent auscultation is a safe option, even for women considered to have a high risk pregnancy. It is your choice.

Need more information to help you choose? I have you covered.

www.birthsmalltalk.com

A woman’s birth space should feel sacred and harmonious, so this space promotes birth physiology, feels safe, supportive, and high vibrational.

Women should feel as though their birth space is private, where they feel unobserved and unrushed through this sacred milestone.

The energy and intention of those in a woman’s birth space can either help or hinder her birth experience. Being conscious of the birth space, and mindful of how each person affects this space can impact the experience each woman and baby has during the journey and transition through labour and birth.

As the birthing woman ask yourself what is most important to you in this space? Such us: -
- Lighting
- Affirmations
- Nature / plants
- Sounds of nature / music / frequency sounds
- Water / Pool / Bath / Shower
- Essential oils
- Comfortable places to flow with surges
- Heat packs
- Massage oils
- Which people are present to support you

What should the people in this space with you do, and what should this look like for you?
Your support people in this space should help protect your birth space and birth physiology by being conscious of the following: -

- Not allowing strangers into the space, and by having as few people present as possible, to keep the space private.
- Avoid unnecessary noise and keep the space as a quiet as possible.
- Keep the space safe by removing anything / anyone that makes you feel unsafe and fill the space with what promotes your feelings of safety.
- Avoid rushing in your birth space, by keeping movements slow, and limit causing any distraction.
- Protecting you from feeling observed.
- Help you feel in your power by remaining low, down to eye level or lower, so you feel respected.

Quote of the day!

"Experiences have clearly shown that an approach which 'de-medicalizes' birth, restores dignity and humanity to the process of childbirth, and returns control to the mother is also the safest approach."

- Michel Odent

Aromatherapy is an alternative option when approaching health care in pregnancy & labour.

During the latent phase of labour (known as early labour) aromatherapy can be one option to help support you through this stage of labour.

Clary sage, jasmine and lavender can help promote contractions.

Frankincense can help calm.

Chamomile can help aid rest.

Black Pepper and lavender can help for pain relief.

Homeopathic remedies to consider when breastfeeding:

Belladonna - For breast engorgement, redness, inflammation, hardness, heat/hot, throbbing, and painful breasts.

Bryonia: Similar symptoms as those for Belladonna but onset of symptoms is slower, and breasts are hard, hot and pale red. Symptoms worse from movement and heat. With mastitis - if in doubt alternate with Belladonna.

Pulsatilla: For low supply with thin watery milk. Helps balance the hormones.

Sepia: For cracked ni***es; deep, sore cracks which may run across the crown of the ni**le; or when mum feels indifferent and wants to be left alone.

Consider Phytolacca for mastitis.

https://midwifethinking.com/2015/05/13/shoulder-dystocia-the-real-story/

How can you promote labour to start naturally especially if you are overdue and trying to avoid an induction due to being “At Risk”?

There are a few things you can try to promote spontaneous labour and these techniques would be recommended after 37 weeks gestation to avoid premature labour and its associated risks.

Some options to try are: -

- Cranial Osteopathy: this can stimulate the pituitary gland to produce hormones that are important in labour.

- Reflexology: This treatment is usually applied to the pituitary reflexes, which can also promote the production of hormones important in labour.

- Acupuncture: this is where needles will be inserted into acupoints that promote labour.

- Tens machine / Acupressure: Applying pressure or a tens machine to acupoints LI 4 and SP 6 (four finger widths above the ankle) can promote labour / contractions.

- Herbal Remedies: Drinking raspberry leaf tea to prepare for labour.

- Homeopathy: Consider taking Secale or Caulophyllum (as directed by a practitioner) until your contractions start. Caulophyllum should be avoided if you have a history of quick labours.

Acupressure points found in the body can have many benefits.

For pregnant women acupressure points can assist with many things such as provide pain relief in labour, help effective cervical dilation, help establish labour, help labour to progress, reduce afterbirth pains, ease nausea & vomiting, help turn a posterior baby and even help with releasing a stubborn placenta.

B.R.A.I.N

When making decisions around you and your baby's health and care, this is a handy mnemonic to use:

Benefits
What are the benefits of this intervention?

Risks
What are the risks of this intervention?

Alternatives
Are there any alternatives to this intervention?

Intuition
What is my gut feeling telling me?

Nothing
What happens if we wait or do nothing?

You can discuss these with your health care professionals for decisions aroundantenatal and postnatal care, including feeding decisions.

There is no doubt that using formula is sometimes necessary. Formula is sometimes life-saving. But it is also quite frequently suggested when it isn't necessary and when other interventions could have helped (eg breastfeeding support, skin to skin, breast compressions, hand expressing, syringe/finger feeding colostrum, switch nursing, pumping etc)

Save the post, share and tag anyone who may find it useful.

Source unknown

New books added to the borrowing library offered to clients at Divine Timing Midwifery.

Did you know?

According to the Cochrane Database of Systematic Reviews: -

There is no quality evidence available to guide us on the effects of screening for gestational diabetes, or to know what the best way is to diagnose gestational diabetes.

How can pregnant women make an informed choice if there is no quality evidence to help guide them and their care provider.

Affirmation can be powerful!

Evidence suggests there is no benefit in doing an admission CTG. Yet many hospitals offer this!

When looking at still birth or neonatal deaths in the first week of life evidence shows there is no significant difference when comparing the use of a CTG or intermittent auscultation.

When looking at cerebral palsy risk CTG monitoring has no impact on rates in term babies. However cerebral palsy is found to be 2.5 times higher in preterm infants between 26-32 weeks gestation when CTG monitoring is used, when compared to preterm infants having intermittent auscultation. Evidence therefore suggests during preterm labour intermittent auscultation provides better outcomes.

Neonatal seizure risk is halved with CTG use and results in 15 less seizures per 10,000. However, approximately 622 women would need CTG monitoring to prevent 1 neonatal seizure. Of the 622 women getting CTG monitoring the trade-off is that statistically this results in 12 women having a caesarean, and 17 women having an instrumental vaginal birth. That is 29 surgical births to prevent 1 neonatal seizure!

When looking at meconium liquor research shows that CTG use has no difference on neonatal outcomes.

General Birth Statistics:
- 3 in 10,000 intrapartum stillbirths
- 3 in 10,000 neonatal deaths during first week of life
Therefore = 6 in 10,000 perinatal mortality.
- 13 in 10,000 neonatal seizures
- 18 in 10,000 hypoxic ischemic encephalopathy
- 4 in 10,000 cerebral palsy resulting from labour
Therefore = Over 99% chance baby will be alive at the end of labour even without monitoring

The evidence suggests CTG use increases risk of caesarean and instrumental birth and has no significant difference in neonatal outcome.

When a moms goal is to exclusively breastfeed but you see her struggling, try not to say these things:

❌“Don’t be so hard on yourself, not everyone can breastfeed”
❌“The baby won’t even know the difference”
❌“Fed is best”
❌“Why don’t you just give her the bottle?”

Instead try this: ⤵️

✨”This is really hard for you, tell me more about it”
✨”How can I support you through this?”
✨”What do YOU want to do?”
✨”Can I come over and help you?”
✨”Would you like me to help you find a lactation consultant?”
✨”Do you need any help around the house so you can focus on breastfeeding?”
✨”How are you feeling?”
✨”Im so sorry you’re going through this, Is there something I can do?”

“We define toxic positivity as the excessive and ineffective overgeneralization of a happy, optimistic state across all situations. The process of toxic positivity results in the denial, minimization, and invalidation of the
authentic human emotional experience.
- Samara Quintero, LMFT, CHT and Jamie Long, PsyD

Breastfeeding can be realllly hard. It does not come naturally for everyone. Some moms (and babies) need more time, and support to get through the challenging few weeks/months.

The last thing a new mom who wants to breastfeed needs is some sprinkled with rainbows 🌈 toxic positivity.. because for most, this doesn’t make them feel better, nor does it actually support them through breastfeeding.

What toxic positivity have you experienced regarding breastfeeding that frustrates you the most?

Quote of the day!

"...one cannot actively help a woman to give birth. The goal is to avoid disturbing her unnecessarily."

"There is a generally accepted clinical impression that amniotomy stimulates labor in progress. The experimental evidence to support this contention just does not exist. Nevertheless, the conviction with which it is held is almost unshakable." - Friedman
This is yet another example of how 'evidence' only makes it into practice if it aligns with cultural beliefs. Friedman's curve still underpins labour progress timeframes (despite being thoroughly debunked). Yet his findings on amniotomy are ignored (despite being supported by recent research).

A study done by Zhang et al in 2010 researched contemporary patterns of spontaneous labour with normal neonatal outcomes in over 62,000 women.
It was found that Labour may take more than 6 hours to progress from 4 to 5 cm and more than 3 hours to progress from 5 to 6cm dilated.

That is only 2 cm dilation in over 9 hours!!

It was found irrespective of a woman being nulliparous or multiparous progress in labour happened at a similar pace before 6cm dilated. However, after 6cm dilated labour accelerated much faster in multiparous women.

Imagine the shift in maternity care if this 9-hour window on dilation was acknowledged and respected better throughout all maternity models of care.

👶🏾 Congenital Dermal Melanocytosis (Mongolian Spots)👶🏾

Congenital Dermal Melanocytosis are what happens when skin pigmentation gets "trapped" in the deeper layers of skin during the infant's development. When the pigment does not reach the surface, it appears as a gray, greenish, blue, or black mark.

👶🏽 They are not a cause for alarm. No one knows why some babies get them and why some don’t. They cannot be prevented. It’s just a birthmark. They , in and of themselves, do not pose any health risks. Most babies who have them will outgrow them and do not have any health effects from them.

👶🏿 They typically appear on baby’s skin at birth. Sometimes they appear a few week after birth.

👶🏾 when you notice them. Make sure your doctor documents them. Sometimes they are mistaken for bruises.

👶🏾 While no one knows for sure what causes them , some infants are more likely to get them than others; particularly those with darker .

👶🏿They usually occur on the back and buttock area

👶🏽The marks are flat and smooth and may look like bruises. But, unlike bruises, they do not cause pain and are not a result of an injury.

👶🏿The AAP identify Congenital Dermal Melanocytosis in 9.5 percent of Caucasian babies, 46.3 percent of Hispanic babies, and 96.5 percent of black babies.

Iron deficiency in pregnancy is when there are insufficient iron stores in the body, a reliance on current iron stores, and/or insufficient iron is being transported in the body.
When iron deficiency is left unmanaged it can then progress into iron deficiency anemia (IDA) which is when there are also insufficient red blood cells in the body, this is usually the last stage of iron deficiency.

Symptoms of IDA include headaches, increased heart rate, tiredness, fatigue, restless legs, breathlessness, depression, dizziness, brain fog, irritability, insomnia, craving ice, poor appetite.

What does IDA cause?

For the mother: -
Reduced oxygen carrying capacity of the blood.
Reduced resistance to infection.
Increased risk of antepartum or postpartum haemorrhage.
Reduced ability for the body to compensate if haemorrhage occurred.

For the developing baby: -
Not enough iron supplied to the fetus.
Associated with increased risk of fetal death, perinatal mortality, preterm delivery, and low birth weight.
Can result in lower cognition and motor development.
Baby is more likely to have low iron stores.
Can cause growth restriction.

Managing iron deficiency in the early stages is important to avoid these potential complications.

Did you know your body needs 3X more iron when you are pregnant?

What can you do?
Eat foods high in iron. Animal food sources are absorbed better by the body.
Eat foods high in other nutrients that support iron absorption and red blood cell production. Such as vitamin B12, folate, vitamin C, magnesium, vitamin B2, vitamin A, vitamin E, copper.
Avoid foods that block iron absorption especially during mealtimes when iron needs to absorb. Such as coffee, tea, cocoa rich food, calcium rich foods like dairy, grapes, legumes, nuts, and whole grains

If your iron is abnormally low and diet changes are not increasing iron stores an iron supplement may be recommended.

During labour there are things you and your partner can consider doing to help cope with labour at home. Some great techniques to help cope with labour pain are: -

Counter Pressure – often the lower back
Swaying / Rocking
Water – water immersion, hot shower, bath
Hypnobirthing
Birth Affirmation
Massage
Focused Breathing
Aromatherapy

These techniques are not only helpful during a homebirth, but also for labour at home leading up to heading into hospital, and even labour while attending a hospital.