Sheena Johnson, Author at Alison Hansen Doula

All About Caesareans

As both a woman and a doula, I fundamentally believe it is the right of every woman to make informed choices about her body and the delivery of her baby, without judgement or feelings of guilt or failure.

Whether your baby is delivered vaginally, via elective or planned caesarean or emergency c-section, the important thing is mum and bub are healthy and safe.

Making a decision about the right birth for you begins with knowledge. If a caesarean looks like it might be on the cards for you, the good news is, they’ve come a long way in recent years. Let’s take a look at your potential options, and what you can expect.

Elective/Planned Caesareans

This is where having a caesarean has been discussed and planned prior to labour commencing. You might choose to have an elective caesarean for a number of reasons, including:

Pregnancy complications like pre-eclampsia or diabetes
Previous complicated or difficult delivery
Placenta praevia – where the placenta is blocking, or partially blocking the cervix

You may be advised to have a caesarean if your baby is in the wrong position for vaginal delivery—feet or bum first, or sideways. This can often be resolved by Optimal Maternal Positioning and Spinning Baby techniques which, if successful, may avoid the need for a caesarean. If you would prefer a vaginal delivery a doula trained in these techniques can give you advice on your particular circumstances.

If you are having an elective caesarean, you will likely have an epidural block to numb the lower half of your body, which will allow you to remain conscious during delivery. Your partner or support person will generally be allowed in the room with you.

Maternally Assisted Caesarean Sections

Many women report feeling excluded or distanced from the birthing process when having a caesarean. One way to avoid this is to consider a maternally assisted caesarean (MAC). This is exactly what it sounds like. In the case of planned or elective caesareans, it is possible to assist in delivering your baby via c-section, providing there are no extenuating or complicating circumstances.

Prior to the procedure your medical team will talk you through what is required. You will need to be instructed on surgical scrub procedures, and wear a sterile gown and gloves. Once the doctor has accessed the uterus, they will move the baby into a position where you can safely grasp them and bring them up onto your chest for skin-to-skin contact.

During the procedure you will be able to see what the medical team are doing. There will be blood, and sometimes getting a baby into the right position requires quite a bit of manoeuvring, so you and your partner need to be sure you won’t be distressed by this.

Your medical team will tell you if MAC is likely to be possible for you, and discuss how things may unfold in your individual circumstances.

If you feel assisting is too much, you can opt to simply have the c-section without the usual drape hiding the action, so you can watch as baby emerges from your uterus.

Emergency Caesareans

Sometimes, once labour has begun, it becomes clear a caesarean might be necessary. This may be the result of foetal or maternal distress, or stalled labour.

Having a c-section might not have been your preferred birth plan, but try and remember the only important consideration is a healthy mum and bub. How that happens is secondary, and choosing a healthy baby is not failure.

Emergency caesareans will generally mean you are not able to have skin to skin contact with your baby immediately after birth, since you will probably have had a general anaesthetic. However, once baby has been checked by the medical team, there is no reason your partner can’t have that wonderful bonding experience.

The Role of A Doula in Caesarean Sections

Whether you are having a planned c-section, or you require an emergency procedure, a doula can provide support during pregnancy, delivery and the postpartum period.

A doula will assist with keeping you and your partner calm and relaxed during birth, which can be particularly important during a c-section. They can take care of things like ensuring the music you have chosen is played or taking photos or videos. This allows you and your partner to concentrate on this wonderful experience without distractions.

If it is necessary to take baby to NICU, a doula will stay with you and provide support, while your partner goes with bub, which ensures peace of mind for everyone.

The Right Time

If you are considering an Elective Caesarean, you should think carefully about the timing of the procedure.

If medical factors allow, the optimum time is 39 weeks.[i]

The last couple of weeks of pregnancy is when your baby’s lungs fully develop, and the longer you can leave baby to develop in-utero, the better.

Whilst it is not always possible to wait, studies show baby’s delivered earlier than 39 weeks are more likely to experience respiratory problems, and may also experience learning and behavioural challenges later in life.

The wrong reason to deliver earlier than 39 weeks is because it’s more convenient for the doctor or the hospital.

The Risks

As with any medical procedure, a caesarean section, whether planned or emergent, carries risks you should be aware of. It’s important to discuss these potential risks with your medical team at some time during your pregnancy, whether or not you are planning on a caesarean.

Knowing what the potential outcomes are will help you feel in control of the process, and studies have shown that this contributes to a positive birthing experience, whether baby is delivered vaginally or via caesarean.

Recovering from a Caesarean

However you look at it, this is a surgical procedure. Recovering from a c-section takes longer than recovering from a vaginal delivery. You will need to:

Take care of the wound site until the stitches or staples are removed and incision site shows new, pink skin
Avoid driving for 4-6 weeks
Avoid lifting anything heavy, like washing baskets or older children for 4-6 weeks
Avoid heavy housework, like vacuuming for 4-6 weeks
Ensure you consume plenty of water and fibre to avoid constipation as straining can cause damage to the wound site

Since recovering from a caesarean is longer than recovery from a vaginal delivery, it’s worth considering the support of a post-natal doula to assist you with chores you can’t undertake, and provide you with advice and nourishing food designed to assist with healing.

If you required an emergency c-section, it is even more important to monitor your emotional reaction in the days and weeks after birth than following an elective c-section or vaginal delivery. A doula can provide a great sounding board for your feelings, and is trained to identify if you are approaching overload.

A Word About VBAC

VBAC stands for Vaginal Birth After Caesarean. Whilst around 76%[ii] of women who have had a c-section for their first delivery go on to have caesareans for their subsequent deliveries, it’s important to know this is not always necessary.

With the right advice and support, it is possible to have a subsequent vaginal delivery, providing there are no complications. This is something you should discuss with your medical team during your pregnancy. If they are in agreement, a doula can provide you with advice on how to prepare yourself.

If you are pregnant and have been recommended to have a caesarean, or are considering one, and would like to chat about your options, please don’t hesitate to give me a call on 0422 258 771 or contact me here.

[i] safetyandquality.gov.au/about-us/latest-news/media-releases/high-rates-early-caesarean-sections-are-putting-australian-babies-unnecessary-risk

[ii] https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies/contents/labour-and-birth/method-of-birth

Celebrating World Hypnobirthing Day – 21 March 2023

I’ve talked about the medicalisation of a childbirth before. There is no denying that medical intervention has its place, and is sometimes very necessary. However, the large majority of the time, our bodies know what they need to do. Hypnobirthing harnesses the power of the mind over the body, to help this process unfold as it was intended.

Nowhere is the link between our mindset and the response of our body as evident as it is in childbirth, because the hormones produced by our brains have a direct correlation to our body’s ability to function.

If we go into birth with knowledge, not fear, and faith in our body’s ability to successfully give birth, we increase the chances of that exponentially. So let’s take a look at how Hypnobirthing can help ensure you take a calm, empowered, positive mindset into your birthing experience.

The History of Hypnobirthing

As far back as the 1920s Dr Grantley Dick-Read began to propose the idea of a ‘natural’ birth, which he wrote about in his 1942 book Childbirth Without Fear, where he discussed breaking the fear-tension-pain syndrome.

In 1989, as a result of her own birthing experiences, Marie Mongan founded the Hypnobirthing Institute, with the belief that:

“every woman has within her the power to call upon her natural maternal instinct to birth her babies in joy and comfort in a manner that most mirrors nature.”

In her book “Hypnobirthing – A Celebration of Life” Mongan laid out her ideas and techniques for birthing in a calm, relaxed and peaceful way.

What is Hypnobirthing?

While the name suggests hypnosis, this is only one aspect of hypnobirthing. In reality, the techniques used are all aimed at creating a calm and positive mindset, which results in physiological changes in the body to improve the experience of labour.

When we are fearful or anxious, not only do our bodies become tense, but our brains produce stress hormones like adrenaline and cortisol. These hormones can increase your perception of pain. Conversely, when we are calm and relaxed, our brains produce endorphins and oxytocin, which reduce pain perception and help move labour along.

Hypnobirthing techniques assist you in turning your attention inwards, allowing you to tune out peripheral activity and concentrate on the task at hand – calmly birthing a healthy baby.

Techniques

There are a range of techniques used in hypnobirthing. You may find some work better for you than others, or that certain techniques work at certain stages of labour. These techniques include:

Breath management
Self-hypnosis
Massage
Movement
Deep relaxation techniques
Acupressure
Vocalisation & Visualisation

Benefits of Hypnobirthing – Here’s the Science…

There are lots of anecdotal and quantified studies on the benefits of Hypnobirthing. The WA Government recently conducted a pilot study, which they have since rolled out to more WA hospitals. The results included:

52% fewer caesareans

40% reduction in morphine use

32% reduction in epidurals

15% fewer inductions

In the US, where more studies have been conducted, a 2010 study found that:[i]

Hypnobirth General

Caesarean Rate 17% 32%

Required Analgesia <10% 22%

Had Epidural 20% 76%

Anecdotally, birth practitioners around the world have noted Hypnobirthing results in:

Reduced rates of intervention and the need for pain relief
Reduced rates of birth trauma and post-natal depression
Shorter labours
Higher Apgar scores*
Faster post-birth recovery for both mum and bub

An additional benefit of using Hypnobirthing techniques is they provide your partner with an active, positive role to play in the birth process, helping them feel more involved and useful.

Pre & Post Natal

Hypnobirthing techniques can also be used both pre and post-natally. In fact, Catherine Middleton, Princess of Wales, who famously suffered from Hyperemesis Gravidarum (extreme ongoing morning sickness) during all three of her pregnancies, used hypnobirthing techniques to help her manage her condition, as well as during labour.

These same techniques are also showing signs of success when used postnatally to assist in recovery from a traumatic birth, and from mild postnatal depression and anxiety.

How Do I Have a Hypnobirth?

There are a wide range of Hypnobirthing courses on offer through hospitals, online or in person. Hospital run courses are often very basic, and are generally aligned with hospital protocol. Private courses are more comprehensive and provide more in-depth birthing options. My personal favourites are:

Hypnobirthingaustralia.com.au

Calmbirth.com.au

Shebirths.com

If you would like to know more about how Hypnobirthing can help you achieve a calm, positive and empowered birth, I would love to chat. Give me a call on 0422 258 771. or contact me here.

*An Apgar Score is a scale on which the health of a newborn is evaluated, and it is taken at 1 and 5 minutes post-birth. It is a assessed over five criteria – skin colour, pulse, breathing, muscle tone and reflexes. Each criteria is scored out of 2, giving a maximum score of 10. A score of 7 or above is considered optimal.

[i] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4744344/#:~:text=HypnoBirthing%20(the%20Mongan%20Method)%20was,with%20Mongan's%20own%20childbirth%20experiences.

Elimination Communication

For many years it has been the commonly accepted ‘wisdom’ that babies wear nappies – either cloth or disposable – until sometime around the age or two or three. But what if that isn’t really necessary? What if, by using Elimination Communication, you can successfully ‘train’ your baby to use a potty (or any other receptacle you like) from birth?

A Little History

The history of nappies differs around the world. In colder climates, babies began to be wrapped in cloths sometime in the 1500s. These cloths were only changed every few days, and never washed, just scrapped off, dried, and used again. Thankfully, by the 1800’s squares of linen or flannel were being used, and were regularly washed.

However, in Asia, Africa and many warmer climates, babies were left naked and their parents anticipated their elimination schedule. In other words, they practiced Elimination Communication.

What is Elimination Communication

Essentially, Elimination Communication, or EC, is exactly what it sounds like. Learning to correctly interpret your baby’s communication of their need to eliminate or empty their bowel or bladder, and providing an alternative to soiling a cloth or disposable nappy.

When Should I Start?

Most proponents of EC agree the best time to start is at birth. Which, when you think about it, makes sense.

When we put a nappy on a baby, we are training them that this is the place for them to eliminate. But if we start with the idea that elimination should take place somewhere else, we eliminate – excuse the pun – the need to ‘retrain’ at a later date.

Of course, if you didn’t start at birth, that doesn’t mean you can’t try it. The process just might take a little longer.

How To Practice Elimination Communication

There are a few simple steps to take to get started.

Observation

There are two aspects to observing your baby’s elimination habits:

Timing. How long after they wake do they eliminate? How long after feeding? How often do they eliminate, and at what intervals?
Signals. Your baby will usually have a ‘tell’ that signals they need to, or are about to eliminate. This might be fidgeting and flailing, going still, grunting and straining (when needing to do a poo), squirming, fussing and unlatching during feeding.

Once you have observed your baby for a few hours, you will begin to notice a pattern. Keep a note of them. While these patterns will change over time, they will give you an indication of when baby is likely to eliminate, and you can be prepared.

Cues

When you notice baby give signals they are about to eliminate, or begin doing so, you make a noise. This might be a hissing noise for urinating and a humming noise for bowel movements. It doesn’t really matter what sound you use, as long as it is consistent and not used for any other purpose. Baby will very quickly begin to associate that noise with opening their bladder or bowel. This will allow you to help baby eliminate at optimal times, like before a bath, before bed, prior to being put in the car or pram.

Preparation

Particularly in the early stages it’s good to have a potty (or whatever you choose for baby to eliminate in) in each room so you can catch the results quickly.

Clothing

Choose clothes that are easy to remove so you act quickly. Nightgowns are a great option, even for boys, or soft leggings you can whip off easily.

Time

Whether you choose to practice Elimination Communication full time or part time is up to you. Many parents choose to use nappies at night, or when they are out, and only practice EC when they are home during the day. There is no right or wrong, just whatever works for you and your baby.

Progress

Every baby is different, and how quickly you are able to train your baby – and yourself – to know or correctly interpret when they are going to soil will differ for each baby. Of course, the more time you spend on it, the faster you should see results. But many parents find their baby can be essentially nappy-free by six months.

Advantages

It encourages a close connection between you and baby
You will save money and the environment through reduced use of either cloth or disposable nappies
It is cleaner
Baby will be more comfortable not being in a damp or soiled nappy

Disadvantages

It can be time consuming, particularly in the early stages
It can be messy until you and baby get the hang of it
Others may judge your parenting choices

Does it REALLY Work?

If you think this sounds too good to be true, I can say I recently had a client who practiced EC with their newborn baby, and yes, it really does work!

If you would like more information about Elimination Communication or any aspect of pregnancy, labour, childbirth and post-partum, I would love to chat with you. Please give me a call on 0422 258 771 or contact me here.

International Childbirth Education Week – 25-31 January

Why It’s so Important

Ever since I became a Doula in 2018, one of the things I have been most passionate about is education. Not just my own ongoing education in the support of mums and bubs, but the education of my clients. This is why I believe International Childbirth Education Week is so important.

Study after study has shown that women’s satisfaction with their labour and birthing experience impacts both their health, and their relationship with their baby. It only makes sense, then, to ensure you are armed with all the information you need to make the right choices for you.

That’s not to say everything will always go according to your plans. But the better informed you are, the more able you are to change direction if necessary, and make different decisions with purpose and power, rather than from a place of fear or uncertainty.

Benefits of Childbirth Education

Some of the key practical benefits of good childbirth education are:

Increased maternal confidence during labour, delivery and postpartum. Knowledge is power, and when a mother knows what to expect, and how she might be able to approach it, she is more confident and empowered in her choices.
Decreased fear and anxiety about childbirth. Fear and anxiety have been shown to increase complications during labour and birth.
Lower levels of medical intervention, including induction, use of analgesics and labour interventions like forceps, vacuum delivery and emergency caesareans.
Better navigation of the maternity care system. Knowing what your viable options are allows you to take control of how your labour and birth will be handled.
Increased likelihood of vaginal delivery. Whilst having a c-section is sometimes necessary, vaginal delivery has been shown to not only positively impact the health of the baby, but leads to shorter hospital stays, less likelihood of infections, and faster healing times.
Better understanding of pain management, and the impact on mother and baby, allowing for informed decision making.
Increased likelihood of breastfeeding, which has benefits for both mum and baby, not to mention the convenience it allows.

What Do I Mean Education

These days, there are an infinite number of ways you can educate yourself on just about any subject, including pregnancy, labour, birth and postpartum.

When I talk about education, I don’t just mean attending Childbirth Classes at the hospital or Baby Health Clinic. Some of the important things you need to understand include:

What happens to your body, and that of your baby, during each stage of labour, birth and the postpartum period.
The difference between the biomedical model and the humanised model of childbirth, and their relative merits.
What your options are in terms of the type of birth you would like. Gone are the days when women went to hospital and were told what to do. These days there are myriad options, from the full biomedical model, to birthing centres, home births, water births, free births and more.
Understanding your options in pain management and potential interventions.
Knowing the medical and technical terms for what is happening to your body, so you can understand what is happening and what the potential impacts may be on your labour, delivery and postpartum.
Being in a position of knowledge from which to choose the support people around you during your birth.

The most important thing is to choose reliable sources for your research. Some resources I would recommend include:

Homebirthnsw.org.au

https://calmbirth.com.au/

https://hypnobirthingaustralia.com.au/

https://shebirths.com/

https://www.rachelreed.website/childbirth-physiology-course

And there are a couple of great podcasts you can check out:

https://www.melaniethemidwife.com/podcasts/the-great-birth-rebellion

https://podcasts.apple.com/au/podcast/the-midwives-cauldron/id1523178579

The Importance of Caregivers

According to a recent study from Spain the factors most important in influencing satisfaction with the experience of childbirth are:

Personal expectations
Caregiver support
Quality of caregiver-mother relationship
Involvement in decision-making[i]

This shows how important finding the right caregivers – whether that be a doctor, midwife or doula – is to the experience of childbirth. Your caregivers should not only be experienced and qualified, but should share your philosophy on labour, birth and the postpartum experience.

So while researching childbirth, research caregivers as well, and don’t be afraid to ‘interview’ them – after all, they will have a vital role to play in one of the most important times of your life. A good place to start is professional organisations, as well as friends and family who have recently had babies.

If you would like more information about how a doula can help you gain the knowledge you need to make informed choices about your labour, birth and postpartum journey, I would love to chat. Give me a call on 0422 258 771, or contact me here.

[i] Hodnett, E. Pain and women’s satisfaction with the experience of childbirth: a systematic review.

Surviving Christmas – A Guide for the Pregnant and Postpartum

Christmas is, for some, a joyous time of year. For others it’s a frantic race to keep up with the demands of friends and family. And for some it’s a time of stress and tension. Whatever Christmas usually means for you, being pregnant or having a newborn changes things.

So with Christmas fast coming up, here are some tips on how to cope with the silly season. If you plan it right, this could just be the best Christmas season ever.

Pregnancy Christmas

Whether you are struggling through the tiredness and nausea of the first trimester, or you’re struggling to move with the weight of a baby on your bladder in the third trimester, Christmas will probably require some rethinking.

Take care of you. Right now, you’re doing the single most important thing you can do – growing a human. So don’t be afraid to say no to invitations if you don’t feel up to it, or to cancel plans if you need to. And don’t let anyone make you feel guilty for getting the rest you need.
Make it easy on yourself. Whether that means buying gift vouchers online rather than braving the crowds, or picking up a deli salad for that BBQ, do it.
Watch the heat. Even if it’s not sunny, Christmas in Australia can get very steamy. So make sure you drink plenty of water.
Consider your invitations. If there’s going to be lots of standing around, maybe an event where you can sit will be more enjoyable for you. Better yet, BBQ at a house with a pool – perfect!
Eat what you want. Being pregnant is probably the only time you don’t have to worry about busting a button, so indulge. Leaving out the alcohol and excluded foods of course.

Postpartum

The months after you give birth are not only precious, but they’re probably the most important time to take care of yourself, not to mention your precious new baby.

First and foremost – remember what’s important. The health and happiness of you and your baby. Nothing else will matter in the long run, so any decisions you make should have that priority front and centre.
Baby brain is real. So be like Santa and make lists. This will not only give you a feeling of satisfaction when you cross things off, you will have the peace of mind of knowing you haven’t forgotten anything.
The internet and gift vouchers are your friends. You may well be the person known in your family for thoughtful and special gifts, but if you can get away with phoning it in any year, it’s this one. And there are not recorded cases of death as a result of receiving a gift voucher for Christmas.
Adjust your expectations. Whether you have been the family go-to for organising Christmas lunch, group presents, or family BBQs, this is your opportunity to hand all that over to someone else. For this year at least.
Adjust the expectations of others. Christmas lunch is always at your place? Maybe someone else can take it on this year. Be clear with your message, and do it early.
Be selective. If an event doesn’t fit with your schedule, or is too far away, or you just plain don’t want to go, say so.
Set boundaries. Newborns are delicate creatures, and we are living in a time where there are lots of unpleasant viruses afoot. So decide if you are happy for people to hold your baby, or you want them to wear a mask, or wash their hands, and stick to it. Don’t be afraid to advocate for the health of your baby
Make it easy on yourself. If you still want to have Christmas (or whatever celebration your family has) at your place, ask for help. Get people to bring a plate. Order deli salads. Buy bakery desserts.
Put away the guilt. If all of the above is giving you guilt-hives, stop. The most important thing is enjoying your first Christmas with baby, even if they are too young to remember.
Relax and enjoy it. Because next year you will be chasing around a toddler (or crawler) so there will be no relaxation for you!

Ask Your Partner

If you have demanding family and friends, now is the time to lean on your partner for support. It’s really important that you be on the same page in relation to what invitations you accept, what you’re prepared to do, and how others are able to interact with your baby. So have a discussion well in advance. And if you need to, ask your partner to be the one to break potentially bad news. If you can take pregnancy and childbirth, they can take a couple of uncomfortable conversations!

A Little Help (not from Santa)

No matter how much you try and divest yourself of responsibilities, there will always be a lot going on at this time of year. So if you want to completely bow out of Christmas this year, don’t feel bad about it. Embrace the slow postpartum period, nurture yourself and your baby (whether baby is in utero or in a crib) and embrace this magical time. Christmas will come again next year. And you’ll have a baby just old enough to enjoy it by then.

If you feel the Christmas season might be too much for you and would like the support of a doula in helping you get through this tough time, I would love to chat. Give me a call on 0422 258 771, or contact me here.

Let me take this opportunity to wish all the mums, present and future, out there a wonderful holiday season. May 2023 bring all of us happiness, health and joy.

Best wishes,

Alison