Why hire a doula?

Many women are afraid of the birth process. The medical model of care which dominates birth practice in Australia does little to alleviate this fear, and actually fosters the belief that pregnancy and birth are dangerous and medical assistance is required to birth safely.

In addition, many women who experience birth within this model feel out of control and are left doubting themselves. Tragically, many are also unnecessarily traumatised by their experience.

When these birth stories are relayed, expectant mothers embark on their journey with fear as the driver. This fear inadvertently hinders the progression of labour and is often the beginning of intervention and its potential downward spiral.

Utilising a doula can help women “tame the tiger” that labour can be perceived as. Doula is a term that many people are unfamiliar with, however it reclaims the positive aspects of birth support that our ancestors would have experienced along with most women in the non-industrialised world.

Historically, no woman would have embarked upon labour without the support of a female companion experienced in birth and all that it entails.

Hire a doula for caring labour and birth support in metropolitan Melbourne or country Victoria: Contact Birth By Nature

Vaginal Birth After Caesarean (VBAC)

Vaginal Birth after Caesarean (VBAC) is worthy of having its own section on my website as it is such an important topic and one that is becoming increasingly common. For many women who have had a previous caesarean, gaining as much knowledge and understanding regarding this scenario is critical. Some women who have one or more caesareans are happy to accept that they should have another one as often suggested by their caregiver. That is their choice and if it feels right for them, it is a choice they can be happy with.

However, many women would like the opportunity to attempt a vaginal birth. Depending on where you choose to have your baby will greatly impact the support you receive and your desired outcome.

Unfortunately in Australia once you have had a caesarean, it is pretty much impossible for women to choose a low risk model of care. Those which are predominantly midwifery led, such as a caseload program, a hospital funded homebirth program (which Sunshine Hospital offers) or a family birth centre will only accept women with a "low risk" title. VBAC couples are essentially told from the moment they re-enter our healthcare system that they are "high-risk". This does a lot of damage both to their resolve and confidence in their own birthing abilities. It is this factor alone that makes it so beneficial in having professional support with you throughout the journey. We always revert back to the wonderful Sarah Buckley's (Australian GP, Author, mother of four and protector of birth) acronymn BRAN. Of any given intervention or recommendation what are the benefits,risks, alternatives and what if we do nothing. With the cascade of interventions that commonly occur as routine procedure this can work well when processing new information.

Australia is lagging behind many other countries (Holland, Canada, New Zealand, Sweden, Denmark and the UK) with regard to our birth practices and increasing rates of caesarean and highly medicalised deliveries. It is the birthing consumer that will eventually change the industry by demanding different types of care that are more women centred and holistic. For example I have first hand knowledge of a birth centre in Germany (attached to a tertiary level hospital) that will accept twin births, vbacs, breech births, water births and home births. When you register you choose whether you will birth at home with 2 of their midwives or come into the birth centre. In Singapore which is considered very medicalised I have a friend working as the hypno-birthing and waterbirth co-ordinator. As far as I know in Australia there is no private hospital that will allow a water birth and very few public ones. Many women who want this experience are forced to opt for a homebirth. Unfortunately we are following scarily down the path behind the United States and their birth intervention rates make us in the birth world terrified of where this is taking us.

The most likely scenario most women take in Australia when finding out they are pregnant is to utilise the services of a large maternity hospital or a private hospital. There are also independent midwives who work with and care for women in the woman's own home and prepare for a homebirth. This is most common if women had a very traumatic birth experience the first time and are reluctant to engage back with mainstream birthing options. This can be a much more relaxed option and from my experience it is the hands down best option of working in partnership with your own midwife. In our society initially many couples fear this option, however once they explore it further and break down the fear barriers it can be very nurturing and rewarding. It is also pertinent to note the couples I have worked with who have opted for a homebirth are very normal, mainstream people who wanted a gentler way of bringing their babies into the world. They were in no way radical , alternative hippies.

Many caregivers, especially in the private hospital sector inform women that once they have had a caesarean they should opt for an additional one, however this is becoming quite uniformed and there is now good research available indicating this is not so. One such study of 45,000 participants in the USA in 2007 found it safer to attempt a vaginal birth after a caesarean in comparison to automatically performing a repeat caesarean.

Conclusions of VBAC Study
Conclusions of VBAC Study The absolute risk of catastrophic rupture with poor outcome is, in fact, quite small."Landon's study confirms that uterine rupture is the complication with the greatest risk attributable to trial of labor; however, it also shows the risk for uterine rupture is not significantly increased in women with multiple prior cesarean deliveries compared to a single prior operation. "The study has confirmed that the majority of women with multiple prior cesarean deliveries undergoing trial of labor can expect to achieve a successful vaginal birth," "About two - thirds of women who have had a previous cesarean delivery are actually candidates for VBAC," says Landon. "VBAC after multiple caesarean sections should remain an option for eligible women."

The most important factor in attempting a vbac is the place and the model of care you choose to have your baby. As you are a consumer of birth you need to get facts and figures of the hospital you are considering. Finding out their caesarean, induction and intervention rates will greatly help you in making an informed choice with regard to your caregiver.

Indicative statistics in relation to caesarean in Victoria are as follows. The public hospital caesarean rate is around 30-35% (but can fluctuate significantly from this), many of the private hospitals have rates from 50-80%. The World Health Organisation state an acceptable caesarean rate is around the 15% mark, with the remaining 85% of births to fall within the "normal" category.

This indicates how out of balance and over-medicalised birth has become in Australia.

Please click on this link to give you a guide of protocol questions you may want to consider asking your prospective caregiver.

It is worth mentioning, having a caesarean for a breech positioned baby is not always necessary. There are many chiropractors that are trained in the Webster Technique that can assist in turning babies Also a course of acupuncunture can work wonders, along with certain homeopathic remedies. There are also caregivers that are comfortable supporting women with breech births.

In Summary
While attempting a vbac we can never guarantee that it can be achieved, however what is extremely important is your role in taking control of your decision making, becoming very informed of your rights and putting a support system in place where you feel safe to birth unhindered by routine protocols and procedures. I have stood beside many women who have achieved their vaginal birth after a previous caesarean and the joy and elation experienced by them is an amazing healing experience. I have also been with women who have had to have a repeat caesarean, where disappointment is real but there is also a contentment within them that they did everything within their power to give it their best shot. When women feel like this they feel empowered and in control of their bodies and the decisions around their care. These feelings of empowerment dramatically affect how a woman recovers physically, spiritually and emotionally.

Testimonials

• Ros - Reservoir/Metcalf
• Angela - West Footscray
• Emma - Brunswick