My Body, My Baby: By Midwives for Women

By Janelle McAlpine

As midwives, it is our duty and responsibility to provide quality education and care for women through their entire birthing experience. It is a vital aspect of what we do, but at times, it can be very challenging providing this education.
What has been provided for you here is basically what every midwife wished you knew when you walked in the door. While we cannot always give you this information in person, it is here as a guide for you to educate yourselves about anything and just about everything to do with pregnancy, labor, birth, and the next few days.

Evidence-based practice and woman-centered care are the founding principles of midwifery practice. The information provided in My Body, My Baby reflects the most up-to-date research and evidence about any particular aspect of your journey at the time of publication.

This is important, no doubt.

But what is more important is how we use this evidence in our practice and how you use this information to educate yourself. A woman who has done her homework and knows to ask her questions and who knows her rights and the meaning of informed decisions and consentthose are the women that enable us, as midwives, to provide truly woman-centered care.

Standing with a woman and developing trust and backing her up when shes vulnerable are so much more effective when she has an idea of what she does and doesnt want for herself and her baby, and in this case, the saying is so true.

Knowledge is power.

Please use this information to make sure that even in your most vulnerable state, you are working from a position of power.

After all, it is your body and your baby.

• Language: English
• Publisher: Balboa Press AU
• Release date: Jul 17, 2018
• ISBN: 9781504313490

Janelle McAlpine

Janelle McAlpine is a PhD candidate with Griffith University and holds a Master of Medical research in addition to undergraduate degrees in Midwifery and Human Bio science. She is a registered midwife with current clinical experience across the entire pregnancy, birthing and postnatal experience. In this book she brings together a unique combination of midwifery and motherhood - knowledge based on personal experience, evidence and practice. Knowledge that she, as a mother, would want for her children. After working in both urban and remote Australian locations, Janelle now lives in Brisbane with her partner. She is the mother of three adult children, each of whom makes her proud every day, and each of whom will enter parenthood better prepared than she when they were born.

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Copyright © 2016 Janelle McAlpine.

All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the author except in the case of brief quotations embodied in critical articles and reviews.

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Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

Any people depicted in stock imagery provided by Getty Images are models, and such images are being used for illustrative purposes only.

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ISBN: 978-1-5043-1348-3 (sc)

ISBN: 978-1-5043-1349-0 (e)

Balboa Press rev. date: 07/16/2018

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Reflection

I sit.

Bathed in the unflattering frequency of fluorescent light I catch a mirrored glimpse of what it means to be born, to grow and inevitably age. There is no kindness in this light. Every wrinkle, every blemish, the scars of my youth, the bags beneath my tired eyes, laid bare for all to see, and remind me of my mortality and what I consider to be my own imperfections.

I stop.

Is this the face that wild-eyed woman see when I greet them in the cold white light of the labour ward? There is no kindness in this face. With its flaws so brutally exposed and my own self-image so completely contradicted, how do I trust my senses and my instincts when what I see with my eyes and what I know in my heart to be true are completely different?

I wonder.

If here, in this my place of power I find myself questioning my own reflection, how does a woman TRUST? There is no kindness in this place. If we, with our armour and allies, question what is real in the harsh unyielding light, what is left for the women in our care but fear, and shame, and disempowerment and their dignity taken away?

I awaken.

This fear and loss is as man-made as the light that exposed my face. Its false and unnatural glow causes us to question who we are and what we know. There is no kindness in lack of faith. In times gone by we laboured in nature’s dark embrace, empowered and supported by the wisdom of those who have borne before us. We laboured without questioning the perceptions of others, or the look upon our face.

I turn out the light.

—Janelle McAlpine

ABOUT THIS BOOK

As midwives it is our duty and responsibility to provide quality education and care to women across their entire birthing experience. It is a vital aspect of what we do, but at times it can be very challenging providing this education. This is often due to the systems and limited resources we have to work with.

What has been provided for you here is basically what every midwife wished you knew when you walked in the door. While we cannot always give you this information in person, it is here as a guide – for you to educate yourselves about anything and just about everything to do with women’s health issues, pregnancy, labour, birth and the next few days.

Evidence-based practice and woman-centred care are the founding principles of midwifery practice. The information provided in My Body, My Baby reflects the most up-to-date research and evidence about any particular aspect of your journey at the time of publication.

This is important, no doubt.

But what is more important is how we use this evidence in our practice and how you use this information to educate yourself. A woman who has done her homework and knows to ask her questions; who knows her rights, and the meaning of informed decisions and consent – those are the women that enable us – as midwives – to provide truly woman-centred care.

Standing with a woman and developing trust; backing her up when she’s vulnerable, is so much more effective when she has an idea of what she does and doesn’t want for herself and her baby……and in this case the saying is so true…..

KNOWLEDGE IS POWER

Please use this information to make sure than even in your most vulnerable state YOU are working from a position of power.

After all it is YOUR BODY, and YOUR BABY.

ABOUT THE AUTHORS

All authors in the book are midwives working currently and clinically. Each of them have tertiary qualifications in Midwifery; some have degrees in more than one discipline. These include nursing, nutrition, psychology human bioscience and medical research.

Janelle McAlpine (MMRes, BA (Human Bioscience), BMid) Registered Midwife

Nikki-Lee Rossiter (BMid) Registered Midwife

Karen Milner (BSc) Registered Nurse, Registered Midwife

Janice Rowe (BSW (Hons), BMid) Registered Midwife

Hayley Moyes (BMid) Registered Midwife

Kate Sycz (BN, BMid) Registered Nurse, Registered Midwife

Sophie Schipplock (BN, MMid) Registered Nurse, Registered Midwife

Kelly Padrão West (BMid, BHSc Nut.Med) Registered Midwife, Nutritionist

Rebecca Johnson (BMid) Clinical Midwife

Jacinta Reid (BMid) Registered Midwife

Lyn Ahearn (BHScNurs, PGCertNeoNurs) Registered Nurse, Registered Midwife, International Board Certified Lactation Consultant

The editor would like to thank every author and recognise the contribution of each of them to the production of the book and associated website www.mybodymybaby.com.au. For further information and education updates please visit our website or social media.

Contents

YOUR PREGNANCY JOURNEY

SIGNS OF BEING PREGNANT

I’M PREGNANT!….NOW WHAT?

MODELS OF CARE

YOUR HEALTH CARE TEAM

DOWN BELOW

NUTRITION AND EXERCISE

YOUR BMI

WEIGHT GAIN IN PREGNANCY

DIABETES IN PREGNANCY

BLOOD PRESSURE IN PREGNANCY

ALCOHOL AND YOUR BABY

SMOKING IN PREGNANCY

DRUGS AND MEDICATIONS IN PREGNANCY

ROUTINE PREGNANCY SCREENING

PERINATAL MENTAL HEALTH

COUNTING KICKS

WHICH WAY’S UP?

COMMON DISCOMFORTS

SEX DURING PREGNANCY

THINGS THAT AREN’T NORMAL

PLANNING FOR BABY

BIRTH PLANS

YOUR GO BAG

LABOUR AND BIRTH

SIGNS OF LABOUR

STAGES OF LABOUR

LATENT PHASE (EARLY LABOUR)

FIRST STAGE

SECOND STAGE

THIRD STAGE

CLAMPING THE CORD

BIRTHING YOUR PLACENTA

FOURTH STAGE

INFORMED CONSENT

MONITORING YOUR BABY

ANTIBIOTICS IN LABOUR AND BIRTH

THE MICROBIOME

VAGINAL BIRTH AFTER CAESAREAN SECTION (VBAC)

BIRTH BY CAESAREAN SECTION

HOME BIRTH

WATER IMMERSION & WATERBIRTH

PAIN MANAGEMENT

THAT WASN’T THE PLAN….

ABOUT BREECH

INDUCTION OF LABOUR

THE INTERVENTION CASCADE

INSTRUMENTAL BIRTH

WHEN BABY COMES EARLY

THE FIRST FEW DAYS

BUMPS, BRUISES AND BLUES

WHO NEEDS SLEEP?

SAFE SLEEPING

CRYING AS COMMUNICATION

SOOTHING BABY

BATH TIME

FEEDING YOUR BABY

BREASTFEEDING

BREASTFEEDING CHALLENGES

HINTS AND TIPS FOR BREASTFEEDING

EXPRESSING

FORMULA FEEDING

CHANGE TIME

SCREENING TESTS FOR BABY

JAUNDICE

THE SPECIAL CARE NURSERY

KANGAROO CARE

SUPPORT AT HOME

AND BABY MAKES 3 (OR 4, OR MORE)

SEX AFTER BABY

REFERENCES

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YOUR PREGNANCY JOURNEY

Antenatal care

‘Antenatal care’ means the care you receive throughout your pregnancy and before birth (ante = before, natal = birth). Antenatal care aims to ensure a healthy pregnancy for you and your growing baby. At your appointments we will check that you and your baby are well - problems can be picked up before they become serious, and you will have the chance to ask questions.

You may have between six and ten appointments over the course of your pregnancy. How many you have will depend on your preferences and the health of you and your baby as your pregnancy progresses. Women with complications may have more appointments, whereas women who are low risk may opt for less. You can expect to discuss aspects of your lifestyle such as diet, exercise, alcohol and drug intake, and smoking. You will be offered routine screening tests for specific conditions.

Around the world there are a variety of professionals that can provide this care for you. There are also a number of ‘models of care’. A model of care is the format by which your care is provided, and will determine which professionals you have the most contact with. Which model is appropriate for you will depend on which country you are in, where you live, what access you have to health care services, your health and pregnancy risk factors and your personal preferences.

Your first appointment

Your first appointment is usually your longest and one of the most important visits. This is when your care provider will take a thorough medical history from you (and your partner if appropriate). This visit includes recommendations for routine blood screening tests and usually takes place when you’re between eight and twelve weeks pregnant. Who you see at this visit will depend on which model you choose for your care.

A detailed history is very important to the ongoing health of you and your baby, so don’t expect to be in and out in five minutes! There’s a lot to get through. Some of the things you can expect at this visit are:

• You’ll be asked about the health of you and your family

• You may discuss options for care

• Your weight, height and blood pressure will be checked

• A sample of your urine may be tested for any underlying urinary tract infections

• Routine blood tests will be discussed and either ordered from a pathology service or taken at this appointment.

• You will be encouraged to ask questions about any concerns you may have or other general questions such as how you feel about the pregnancy as well as the physical changes in your body

• Domestic violence and living situation screening is mandatory in Australia and may be conducted at the first suitable opportunity.

Your Hand-Held Record

Some health services will provide a written record for you to carry with you. All your relevant pregnancy information is contained within your hand-held record. This is important if you experience any concerns during pregnancy and need to present to a health care facility where there are no record of your notes (e.g. if you are away on holiday). You should also take them with you to all antenatal visits and when your labour begins. If you have a birth plan it is handy to keep a copy of that with your hand-held record.

Sometimes your notes will be abbreviated or have medical language you may not understand. If you don’t understand something, or have questions, ask your health care provider to explain.

SIGNS OF BEING PREGNANT

Missed your period?

One of the first signs that you are pregnant is missing a period. While some women are really familiar with their cycles, others are not. Some women have really regular cycles and others don’t. Some women have an implantation bleed – when the fertilised egg burrows into the lining of the uterus – a little before their period is due. This can confuse the issue. There are a variety of circumstances in which you may not notice you missed your period, such as:

• Your cycle isn’t regular

• You haven’t had your first period yet

• You are breastfeeding

• You have had a baby and not had another period yet

• You have stopped hormonal contraception and haven’t had a period yet

• Have been missing periods due to low body fat

• Been manipulating periods through use of the oral contraceptive pill, or

• You really don’t keep much of an eye on when your period is due

Early pregnancy signs

Some women say they noticed signs of being pregnant before their period was due. This is sometimes the case with women who are really in tune with their body. Some signs you may notice include:

• Tender breasts

• Tiredness

• Morning sickness

• Going off some foods

• Smell sensitivity

• Feeling emotional

Pregnancy Testing

At the first signs of pregnancy many women head straight for the home pregnancy test. This tests the level of the pregnancy hormone hCG in your urine – hence the pee on a stick scenario. These are reasonably cheap and reliable, getting it right about 97% of the time from about the five week mark. Some home tests can be done a little earlier but may not be as accurate, particularly if you have an irregular cycle. Your sexual health clinic, midwife or family doctor (GP) can also arrange for this initial test. From this point it is up to you where you want to go next, depending on which model of care you choose or have access to.

Women who have a midwife as their primary caregiver in pregnancy can organise a midwife visit at a mutually agreeable time. At this visit your midwife can discuss with you any further tests including blood tests and scans ¹. These will not only confirm your pregnancy but can provide an estimated due date when performed at the right time.

Women who want or need to use their GP for their pregnancy care can organise a similar visit with their doctor’s clinic. This is also the case if you choose obstetric care or have risk factors which make obstetric care the most suitable model for you. Whichever you choose, please know that continuity of care is the best option for all women. While the midwifery continuity model is the gold standard for women without complications ², obstetricians are the experts in abnormal. If you have medical, pregnancy or birthing complications, obstetric care is highly recommended. While this does not prevent you from having care from a known midwife, legally your midwife must provide your care in consultation with, and under the advice of, your specialist.

If your pregnancy is unplanned and you wish to discuss your options please make an appointment to see your doctor who will be able to provide you with the information and support you require to make a decision.

I’M PREGNANT!….NOW WHAT?

Now that you are pregnant, whether you like it or not, you need start making decisions about your health and the health of your baby. You really don’t realise how many decisions there are to be made until you get that positive pregnancy test…..then all of a sudden they are all there to make and you are on a bit of a deadline!

Some things need to be covered now, particularly if your pregnancy is unwanted or unplanned. If you intend on continuing with your pregnancy there are a few things that need to be done now to make sure you get (or remain) healthy and have the best possible care throughout your pregnancy and birth experience.

1. Your health - If you planned this pregnancy and prepared for it well, you are off to the best possible start you can give yourself and your baby. If this is a bit of a surprise it’s not too late to make those lifestyle adjustments you need to get on track to the most healthy pregnancy and baby possible.

2. Alcohol consumption is harmful to your baby. There is no known safe level of alcohol during pregnancy at any gestation, so it is a good idea to stop now.

3. Smoking is also harmful so the sooner you start work on giving up the better.

4. Folate is vital for the prevention of neural tube defects and you should start taking folic acid supplements as soon as you find out you are pregnant if you aren’t already taking them. Pregnant women need an additional 400mcg per day, an amount which cannot be met by diet alone.

5. Your model of care - you need to decide is which model of maternity care you want to engage with. What models are available to you will depend on your local service, so do your homework. When you have decided this you will have a better idea of where to start looking for a maternity care provider.

From that point on your maternity care provider will be able to point you in the direction of the information you need to make ongoing decisions about your health or the health of your baby. While health care providers can guide you, it is ultimately up to you to educate and inform yourself about the options available to you at any and every point in your pregnancy or birth. The concept of informed decision making and consent relies on you making sure you have all your questions asked and answered before deciding on any course of action.

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MODELS OF CARE

There are a number of services and care providers that women may be able to access for their pregnancy care. The services available are known as ‘models of care’. In Australia, the National Maternity Services Review identified the range of maternity care models currently available in Australia. They reported that 92.7% of women in Australia receive care through one of four primary models: private maternity care, combined maternity care, public hospital care and shared maternity care ³.

In 2007, the majority of Australian women gave birth in the conventional hospital setting, with a small percentage accessing birth centres or opting for a planned homebirth. There was also a small number who birthed before they reached hospital. Of the women birthing in the hospital setting 7/10 chose the public system³. Continuity of care is very important for women. In recognition of this, the demand for the midwifery continuity model has been increasing. However, there are also a large number of women who choose continuity of care from general practitioners (GPs) and specialist obstetricians. Regardless of who provides this care, continuity is still recognised to be the most beneficial option.

Midwifery Care

Standard Midwifery Care – You will have most antenatal visits with a hospital-based midwife, however some of these may be in your community. A midwife will care for you in labour. You will then go to the postnatal ward where you will have one midwife each shift caring for you as well as a number of other women and babies. A midwife will still be there to support you and your family throughout your journey. However, this care can be fragmented.

Continuity of Midwifery Care – You will have the same midwife (or team) throughout pregnancy, birth, and the postnatal period. You can access this through a hospital (may have inclusion/exclusion criteria), or an eligible privately practicing midwife. These midwives practice independently but usually have agreements in place if their client wishes to birth in hospital or needs to transfer from home to hospital during labour. Medicare* reimburses most of the fees that apply. Continuity of care is known to be the gold standard of care, lowering the rates of caesarean section, induction of labour, and improving newborn outcomes and the satisfaction of women with their care when compared to other models of care ⁴,⁵,⁶ .

*Please note Medicare is the Australian equivalent of universal healthcare, so this role may differ from country to country.

Obstetric Led Care

Private – If your health insurance covers it, you can hire a private obstetrician. Your obstetrician will care for you during your pregnancy, be called in to attend your birth and check on you after your baby is born. Fees are involved.

Public – An obstetrician will need to be responsible for your care during pregnancy if you have pre-existing complications or develop complications in your pregnancy. You will often have the option of additional visits with a hospital midwife to ensure all aspects of your care are covered. Fees do not apply in this case.

GP Shared Care

Some women have a good, longstanding relationship with their family doctor, and would like this relationship to extend into their pregnancy. Your GP will look after most of your antenatal care, with some appointments with the doctors and midwives at your local hospital. You can ask your hospital for extra midwifery appointments. This way you can ensure you receive all of the information and support you need.

Choosing where to give birth

You can give birth at home, in hospital, or in a birth centre. These places may have guidelines and criteria as to who would provide care to you.

Public Hospital

Midwife-led unit (including hospital based birth centres) – Staffed by midwives (core staff and continuity of care midwives) with a focus on normalising childbirth. However, there are emergency facilities available if required. Obstetric doctors are often available 24/7 and will be close by if they are needed.

Obstetric-led unit – Midwives will care for you for you labour and birth, however there will be obstetric doctors on call and on the birthing unit floor. They will look at each labouring woman’s history and labour progress and intervene if necessary. Women who are deemed ‘high risk’ usually give birth in this type of unit.

Private hospital

This is where you will likely give birth if you are receiving private obstetric care. A midwife will likely care for you in labour, and will call your obstetrician when you are close to birthing. You will pay for what you receive (e.g. epidural) along with a flat rate for care.

At home

Your options for homebirth will vary greatly depending on where you live, access to a skilled midwife, whether your local hospital will provide this care, and fees. Research suggests that for low risk women cared for by trained midwives, homebirth is as safe as giving birth in a hospital and can reduce the unnecessary interventions ⁷. This is providing there are strategies in place in case of emergency, including equipment and medications, and a nearby hospital.

Free-Standing Birth Centre/Community Maternity Unit

These are centres located on their own – separate to the hospital. Some countries don’t have them, whilst these are the main places of birth for other countries. The centres are set up to mimic a home environment that promotes natural birth. Midwives staff these centres and transfer to hospital is available if complications arise.

YOUR HEALTH CARE TEAM

Pregnancy and birth is an event worthy of a team effort. Who is in your health care team will depend on your model of care.