Articles

Thoughts on birth

• Birth is normal, natural and healthy
• Women are made to birth
• The experience of birth profoundly affects women and their families
• Create good birthing experiences the memories are with you forever
• Women’s inner wisdom guides them through birth
• Women’s confidence and ability to give birth are either enhance or diminished by the care provider and place of birth so choose them carefully
• Women have a right to give birth free from routine medical interventions
• Birth can safely take place in birthing units and homes
• Childbirth education empowers women to make informed choices in health care, to assume responsibility for their health and to trust their inner wisdom
• Enjoy the privilege of giving birth
   

Choosing your childbirth educator

There should be no doubt in your mind that to attend childbirth education classes is essential. Now lets ensure that you choose the correct classes for you. Since expectant parents have different needs, choosing a childbirth education program that suits your needs is what is important.

Childbirth educators are important sources of information, skills and support for parents in today’s technological world.

The childbirth educator acts as :

·        a teacher who provides

·        information about the physiology, psychology and sociology of pregnancy, childbirth, postpartum(the 6 weeks after you have had your baby), and early parenthood

·        skills to assist women and their support persons to cope with pregnancy, childbirth, postpartum and early parenthood.                         

·        a facilitator who helps pregnant couples better understand and value their experience of the transition to parenthood

·        a communication link between the pregnant woman and other members of the health care circle

·        an advocate for pregnant women, their partners, infants and new families

 The philosophy of the childbirth educator should be freedom of choice based on the knowledge of alternatives

 Some important questions to ask the educator are :

·        what are her qualifications?

·        does she attend regular Childbirth Educators Professional Forum updates?

·        is she a mother herself?

·        what are her ideals of labour - do they match your ideals and expectations (desires) for your labour?

·        do partners attend all the classes or only a select few?

·        are there practical sessions on breathing, positions for labour, massage, relaxation and visualisation?

·        which birthing methods are included in her course?

·        Which birthing method does she put her emphasis on during her teaching? - It is very important that her emphasis should be the birth you are striving for, but she should cover all birthing options

·        length of course

·        cost of course

The childbirth educator - a person you cannot possibly be without during your pregnancy - make sure you find your childbirth educator today - what a benefit she will be to you! Consult the directory from page 96 or phone the childbirth educators hotline on 072 351 0051 to find the educators in your region.
 

Childbirth Education Classes

Labour is one of the most precious and memorable days in a lifetime and enormous preparation and planning should go into it.

Childbirth education classes should be geared not only to the pregnant mom, but her partner as well. The intricacies of pregnancy and labour can be learnt together - stimulating discussion between you as a couple, helping you to work through problem areas and finding better solutions to make this life long journey of parenting the exciting path in life that it should be.

The philosophy that should be taught at classes - is one of “informed choice through the knowledge of alternatives” - in other words the teaching should cover the pros and cons of all your options for the birthing process, and once the mom has heard and understood all the different methods available to her - she now has the knowledge to make her decision.

 The classes are a place where long term friends are made, where you can compare labour methods, and encourage each other in the trying times of early parenting, swapping tried and tested tips on every available subject.

So what exactly do you learn at these classes - typically the course is an 6 - 8 week course - held one evening a week. In that time being taught about the changes that have occurred in the mother’s body during pregnancy - which gives the dads an enormous amount of insight about what has been happening during the past few months - it all begins to fall into place. From there, one starts to look at what labour is all about - how it starts and then when to go to the hospital - but one of the most practical and beneficial evenings is learning coping skills - skills for coping with the pain of labour but equally so the ways to cope with the everyday stresses of life. The normal natural process of labour is covered. Then onto the possibilities of birthing not progressing totally normally.  The most important issue is to come out of labour and be able to say, “That was a fantastic birthing experience.”

Practical advice is also discussed - how to bath your baby, breastfeeding, handling your baby in general.

The classes combine a fun-filled time with important information gained in your life at the same time
 

Choosing a birth place and caregiver

By Barbara Hanrahan – midwife and educator

 Most women already have a gynaecologist by the time they fall pregnant. The question is do you know what you want from your birth experience? This is a sensitive area as your gynae may work at a hospital with limited birth options. So the first step is really to find out what YOU want and which setting will best offer you the birth options you are looking for.  

1. Birthplace

Choosing the place of birth really determines the kind of birth choices you will have and who will be your caregiver.  

• A birth unit : this is a homely environment usually within a medical facility. A birth unit actively encourages partner and family participation. (Family centered maternity care.) The setting is relaxed and intimate. It may include a bath / jacuzzi / small pool, double bed and homely furniture. The caregiver could be your gynae or a private midwife. You have the option of going home shortly after the birth or staying for a couple of nights for help and guidance through those early days with your new baby. Birth units in a medical facility will have access to theatre should the need arise for a caesarean section.
• A maternity ward  : this means that you would give birth in labour ward and then move to the postnatal ward for your postpartum stay. The choice of hospital is usually determined by the doctor, who may have consulting rooms at that hospital. This is a traditional hospital setting.
• A homebirth : is usually attended by a pair of private midwives who will give you a lot of  guidance about what you need to prepare for the birth and what to expect on the day. You would attend regular antenatal checkups with these midwives. The midwives will arrange a back up doctor and hospital facilities in case of emergencies.

 2. Caregiver

• Private midwives are qualified, registered (with the SA Nursing Council) midwives who work independently in a self employed capacity. Midwives view pregnancy and birth as normal biological events and have a back up doctor should the need for intervention or a caesarean birth arise.
• The doctor who looks after women in pregnancy is usually an obstetrician who has particularly specialised in the care of women who have a high risk in pregnancy.
• Besides the midwife or doctor, many women are choosing to have a doula / birth companion present with them during labour and birth. A doula is a lay woman who has trained as a companion who supports women and their families during labour and birth. The doula can also provide care and support at home after birth too.
   

Choosing the right hospital for me 

The hospital where you birth plays an important part in your first step to parenting. The staff and the philosophy of the maternity ward can make your start to family life either blissfully wonderful or an absolute nightmare - so important issues need to be considered when making the decision of which hospital it is to be. Many people just go along with where their doctor suggests delivery, but few look into what is really available out there.

 Take your time and look around before making the final decision - look early on in your pregnancy so it doesn’t become a last minute panic. In making this decision, you need to consider the following and decide what issues are important to you and look for those features in the hospitals under choice.

·         Are you encouraged to have a tour of the maternity unit as a couple

·         Is there ample time to ask questions of the maternity unit staff

·         Are they open to you bringing in your own birthing plan

·         Can you be mobile during labour

·         What is the environment like where you will be labouring

·         Is the ward environment cold and clinical or home-like

·         Do they offer an alternative to a regular labour ward

·         Do they allow you to create your own birthing environment and bring in your own music and pillows

·         Is there a birthing pool or bath for relief of pain during labour

·         Do they encourage breastfeeding

·         Is there a breastfeeding consultant as part of the team

·         Do they encourage or allow your baby to room-in with you

·         Do they make you feel at home and part of a family in the ward

·         What are the rules for visiting

·         Do they allow partner access at any time

·         Do they promote partner participation in looking after the baby

·        Do they charge medical aid rates

·        What are the costs if not on a medical aid

·        What education is carried out in the ward

Remember the right choice can give you a memorable birthing experience as well as the best start to parenting
 

How to choose a Paediatrician

By Dr Nicoletta Hay – Paediatrician Morningside Clinic 

Ones first pregnancy is an extremely exciting time – but also a time when so many decisions need to be made. One of these is about the doctors that will be taking care of you and your baby. 

What some people are unaware of, is that your obstetrician, who follows your pregnancy until birth, is not the person who will be looking after your baby – his or her responsibility to your baby ends when your baby is born. 

A paediatrician, a doctor who has specialised in paediatric care, will have this honour – and his or her job begins at birth. Because a normal vaginal birth is considered a low-risk time if uneventful, paediatricians are not present at the birth unless the obstetrician or midwife are concerned – and the paed is usually called to check the baby soon afterwards in order to perform the first neonatal check.

However, because caesareans sections are usually performed because of a problem with either mother or child, a paed is always present at a caesarean birth. What most mothers are not aware of though, is that they are able to elect the paediatrician of their choice to attend the birth. If they have no preferences, the obstetrician will then call one to the birth. There are, however, various things to consider when choosing a paed. 

All my colleagues and I have been asked to attend caesareans births in hospitals where we are not primarily based. Whilst this seems easy enough, what one must remember, is that all is well if the baby is healthy – if there are problems however, a doctor must always be in close proximity and it isn’t always in the best interest of the baby to have a doctor who is not on the premises should there be an emergency, and thus the first important thing to consider in choosing a paed, is proximity to where the baby will be born. 

Other factors influencing your choice of paed will depend on whether any problems were picked up with your baby during the pregnancy. If there is something that will need immediate intervention after birth, (for example a tracheo-oesophageal fistula, exompholos, pulmonary problems, cardiac abnormalities etc) your choice of paediatrician must take into account what additional services are available at the hospital where he/she is based. These include the quality of the ICU, presence of neonatologists or paediatric surgeons etc and the proximity of the hospital to your home, as you may need to be visiting the hospital for extended periods. 

And lastly, your choice of paediatrician will depend on personal factors – would you prefer a male, female, older, younger etc – and this is also important as you will probably have a long relationship with this person. Remember too that you are not bound to the paediatrician that was at your child’s birth for life – if you do not feel comfortable, change!
 

Choosing your Obstetrician

By Dr. Alan Adno - Gynaecologist and Obstetrician - Parklane Clinic

The Obstetrician together with other maternity professionals, i.e. midwives, childbirth educators, paediatricians, anaesthetists and general practitioners form part of a team that cares for pregnant women and their families.

Modern maternity care is more “patient friendly” with the pregnant woman assuming a central role in making choices that affect her. 

Gone, or going are the days of the autocratic and paternalistic (or maternalistic) doctor and today’s obstetrician needs to be more sensitive to the changing needs of pregnant women and the way they feel about their pregnancy and birth. 

Two way communication between the obstetrician and yourself is essential. All your questions and anxieties regarding any aspect of your pregnancy and delivery must be open for discussion. 

Information should be provided in a clear and unbiased, non prescriptive way but the obstetrician should still be able to guide you in making appropriate choices. However the freedom of choice will rest with you, the patient, who will be able to make informed choices after having all the available options explained to you and having all procedures and interventions carefully discussed and explained. 

Many patients today draw up a carefully thought out birth plan. Be sure that the obstetrician is part of this process and that he / she and other members of the team know exactly what you want, e.g. Let the obstetrician know what your views are as far as routine enemas and shaving, what interventions you would allow and how these should be carried out. 

However be prepared for alternative actions and discuss these options with the obstetrician as unfortunately sometimes things don’t go according to plan and you will need to trust the obstetrician to help you make the correct and the safest choice. 

Although your doctor may be extremely busy, when it is your turn to be seen, he must have the time to listen and explain. 

Once your choice is made, you should feel confident with his / her expertise and advice. If you are not satisfied, then it remains your prerogative to seek another opinion and even to change obstetricians. Patients have different needs and this will determine which obstetrician they eventually choose. 

Practical considerations may also affect your choice, i.e.

·        Location of consulting rooms and maternity hospitals.

·        Costs - whether you are on a medical aid or not and what portion of the bill they will cover.

·        Locums -if your doctor happens to be away at the time of your delivery, will you be introduced to his or her locum. 

Pregnancy and childbirth should be a rewarding and happy experience. Confidence in your choice of obstetrician will create a climate of security and trust, and enable you and your family to experience this special time to its full.