Choices Women Make in Childbirth

This is a short blog about a few conversations with several women regarding the choices they made for the birth of their babies....I was  in a shopping center promoting midwifery and chatted to some pregnant women.....  I’m sharing some of these conversations for two reasons; because the choices these women made blew me away and in light of the vigorous homebirth debates after the release of the SA coroner’s report where he suggested that women who have a high risk factors should possibly consider a caesarean section rather than a homebirth or words to that effect...... (which will be my next blog).

I have to note that the women concerned all had private health insurance and wanted to birth in a private hospital. First two women were 35 and 36 weeks respectively, they were having repeat caesarean sections. When I asked how they felt about their impending c/section Mary said “look I have accepted that is my reality”, I asked was she happy to discuss her decision and she said she was happy to share and talk about it.... she went on to say “my first section was an emergency.... when I was pregnant again we saw the same obstetrician and we were told the risk of the scar tearing was high and its best to have another section. I then said I would get another opinion..... You know, I could not find another obstetrician that serviced the private hospital that would do a VBAC.....and besides my husband did not want to take the risk and I have to consider his wishes,” I asked “did she know the risk was really low...as in 0.04%” and she said “yes, but my husband did not want to take that chance, I wanted to have my baby in a private hospital and did not want to go to a public hospital, so I accepted the second section, now its baby number 3 and that’s the choice I’ve made, it would of been nice to birth normally, but that’s the choice I made, I wanted to have my baby in a private hospital”.

Janie who was her friend had a similar story.... except this was her second section...she also knew about the risks involved regarding a VBAC but really did not mind having a section, again her main reason was she wanted to birth in a private hospital as opposed to a public one....

Sally was an older professional woman, 39yrs old first baby and elected to have a caesarean section, currently she was 34 weeks and was not interested in a vaginal birth, she said ‘I never wanted to give birth naturally, I want to protect my pelvic floor and besides it took me longer to get pregnant than I thought, don’t think I could deal with all that unexpected stuff, now I know the date my baby will be born.....’ her mind was made up – we did go to talk about breast-feeding to which she was not interested in, however we did manage to talk about skin to skin at birth for bonding and the possibility of expressing for the first few weeks and bottle feeding with  breast milk as an option.... I asked had she ever spoken with a midwife, her response was ‘I have private health insurance therefore I have a very good obstetrician.... and he does have a midwife I see from time to time....but he makes all the decisions....”

The last woman was 35 weeks booked for her repeat section at a private hospital – first section was an emergency, no VBAC offered and she elected for a section because her husband is a fly –in-fly-out and she wanted to plan his time off for the birth and this was the easiest way....she also did not want to birth in a public hospital....”on no I only go to private hospitals, that’s why I pay for private health insurance...”

Out of the 10 women I spoke to 5 were having elective sections, 3 were booked in secondary hospitals and another two for private hospitals and hoped for a vaginal birth but all knew about the chance of a caesarean section.... “if all goes well, I will have a vaginal birth..... we have discussed if the need arises we might have a section”.....

I must say the aspect that surprised me most was the desire to birth in a private hospital even if it meant having a c/section as opposed to birthing in a public hospital.....that puts a different perspective on some of the issues.....what is it that the majority of women want and is this the expected norm of place of birth?

Again I come back to the point of education and informed choice..... these women wanted to birth in a private hospital and how that happened did not matter, their main issue was the place of birth.....food for thought.

A vaginal Birth with an epidural. It is all about informed choice!

Birth of Logan Mark

This birth story has been written with the permission of Nikki & Scott. Thank you.

Firstly I will congratulate my son Scott and his fiancé Nikki on the birth of their son on the 19th October at 0115, weighing in at 3420gm. Nikki has always wanted an epidural, with the birth of Jessica (8hr labour) their first child, she also had an epidural which was not very effective and Nikki ended up with an episiotomy and Neville Barnes forceps – not very nice. Why do some women want an epidural? – Well that is simple, as Nikki would say “I don’t do pain” and “I am the biggest sook”. Now I don’t agree with Nikki’s choice of terminology, because pain is whatever the woman/client says it is and epidurals have a place in childbirth, because it is all about informed choice. The aim is to achieve a safe spontaneous vaginal delivery (SVD) or birth. As midwives our role is to inform women of their options and assist them to achieve the birth they choose. Nikki wanted a normal birth without an episiotomy and that was pain free. The only way to have a pain free birth is by having an epidural, all other forms of pain relief do not take the pain away completely they just knock the top off the mountain. In saying all this, epidurals are not completely foolproof; sometimes they do not work or only partially work as Nikki found out. Full credit to the excellent midwife who was looking after Nikki, who did everything possible to make sure that Nikki’s epidural was working effectively, finally after all possible top-ups etc Nikki was comfortable, now we could concentrate on getting more effective contractions.

Nikki called me at about 3pm not sure if her waters had broken, I was on my way to see my friend and decided to call in a see how Nikki was going – sure enough there was a wet patch on the bed, and most women hate the thought that they may have wet the bed, heaven knows why, you have a baby constantly pushing on your bladder, it would not be surprising at 38+5 days. Anyway after resting on the bed with a pad on for 20 minutes the pad was wet, had a sweet odour and was clear. The baby was moving nicely, the head was engaged, and there was a good fetal heart. There were no apparent contractions and Nikki described having a cramping feeling, so we decided to keep her walking around the house. I decided to go home, which is only 10 minutes away, and finish cooking my dinner and we would share it. Scott’s sister Faye and Brendon & their children would come over and we would pass some time – Nikki reminded me that she still wanted an epidural and not to leave it too late, I also said to Nikki that it would be beneficial if she was in established labour before she had the epidural to ensure an vaginal birth and she was agreeable.

About 6:30 Nikki’s pad changed colour, it was meconium stained (the baby has done a poo in-utero), lightly stained meconium. Nikki was still not contracting regularly or strongly, we rang the hospital, and were advised to make our way in. There was mild disappointment in the air, meconium stained liquor, and this changes things now.

We arrived at the Labour and Birth suite at about 1945hrs – Scott was dropping off Jess and would meet us there shortly. Nikki was great, we had a good talk in the car about expectations, epidurals and how to push effectively when you have an epidural in place so as to avoid having an episiotomy. Nikki laughed at my analogy – as you can’t feel anything, close your eyes and imagine that you are totally constipated and you have to push the biggest shit out – that’s what you have to do.
No sooner were we there when Nikki was assessed, hooked up to the CTG, examined – it was good to see that she was 4cm dilated, however the head was -3. IV inserted and bloods taken. Nikki was happy to stand next to the bed whilst being monitored; it was now meconium 2, which meant continuous fetal monitoring. Her contractions were still not strong, getting more uncomfortable for Nikki, so the epidural was arranged. The CTG had good variability however a couple of late decelerations – the decision about using an oxytocics was made, to increase the strength and frequency of the contractions, due to the meconium and late decelerations. Nikki was happy to get things going, anything to make it work rather than having a caesarean section. Nikki was coping really well, now comfortable with her epidural almost working effectively – it was denser block on one side, her left leg was numb and difficult to move.

Scott was like a cat on a hot tin roof – he had his own expectations, and did not share them. He is 6’+ and seems like a gentle giant and he felt out of place in the delivery suite, although he very much wanted to be there. Like most men he was busy comparing the CTG machine to the equipment he used when working out in the bush with the geologist comparing it to the seismograph. This did make me smile; he was constantly eating, lollies, biscuits, fruit and pacing the floor.


The baby was difficult to monitor, and I really could not understand why, as Nikki is tall and fairly slim – certainly not obese – therefore theoretically should be easy to monitor, however the “little fella” was playing possum with us. The CTG baseline rate was about 145bpm, variability was good however we were getting complicated variable decelerations. The pressure was on; “I don’t want a caesarean section” was Nikki’s lament. It was time to reassess due to the complicated variables, at approximately 1130pm Nikki was still 4cm, head 2-, so the head had come down, it was really no surprise that the cervix was still 4cm as the contractions really were not yet effective or strong enough. The decision was made to continue and reassess in 30 minutes. We changed positions, left lateral, right lateral, then upright to try and improve the trace. Another top-up as well as self administered top-ups were given, Nikki still has an uneven block, however she was more comfortable now. The syntocinon was titrated upwards as per the protocol and Nikki’s contractions finally kicked in, 4:10 strongly, however with this came more complicated variable decelerations, the registrar decided to tickle the baby’s head, to ascertain if the baby’s heart rate would accelerate which would be equivalent to a 7.25 pH and therefore the baby is not hypoxic. Hooray! The little fella’s heart rate went up to 165bpm, which bought us some more time.

At 0100hrs the midwife decided to put a scalp electrode on the baby’s head, so it would be easier to monitor him – and to her/our surprise Nikki was fully dilated – fantastic – that is an efficient uterus - she did a test push, Nikki was fantastic, she visualised and pushed well. It was time to birth, Nikki, Scott and the midwife were happy for me to catch – as was discussed earlier.




It was a wonderful vaginal birth, intacted perineum – little Logan Mark was born at 0115hrs weighting 3420gms.



On reflection talking to Nikki and Scott a few days later – Nikki found the birth easier than Jessica’s birth and was grateful to have the midwife and myself present, “everything was easy, casual and relaxed – it was awesome!” Nikki said that she had back pain for at 5 days post the epidural.
Scott reflected that he thought that there would be more blood and gore! He cut the cord which gave him a sense of fatherhood. However, Scott did say that he felt superfluous through the whole process. I wonder when women have an epidural does it change the focus for men, as the level of support may change due to the level of pain being different. I did notice that both Nikki and Scott watched TV and debated which movies to watch.

As for me...............This was as always a memorable experience. It is a privilege to help birth your grandchildren, to support the women of your family and share your knowledge, expertise, love, warmth, caring, just being there. It is truly a magnificent moment – a true reminder of the miracle of birth and the power of a woman’s body, truly spectacular.



It’s all about what the woman wants!

Interesting comments by Louise Sliverton

I was browsing the net, as you do on a Sunday night after a very busy weekend (withdraws from the Internet) I came across this story from the guardian.co.uk 'Fear of pain' causes big rise in cesareans, written by Denise Cambell.
I thought what a "surprise" there's nothing new! the difference is that a Midwife has made the comments - and who is the midwife - Louise Silverton.

Now one of Britain's leading midwives has reignited the debate about cesareans. In an interview with The Observer, Louise Silverton, deputy general-secretary of the Royal College of Midwives, has controversially claimed that an increasing number of women under 40 are less prepared to undergo the physical trauma of childbirth than their predecessors, a trend that is pushing up the rate of surgical deliveries.

I have had the pleasure of meeting Louise on several occasions. It is always nice to meet the author of books you have read. I also think it is time that midwives became more vocal, it does raise our profile.
The article goes on to talk about current trends in the perception of pain in today's society, which is very interesting. I do tend to agree with Louise when she argues that people today do not want to deal with any sort of pain, the answer is take a pill, however I am not sure that is is contributing to the increase in the cesarean section rate. These comments have created debate from all angles, to the point of blaming the shortage of midwives to the raising cesarean rate. I also found it interesting that the cesarean section rate is lower in the UK than in WA which is currently at 30%. I think that people forget that a cesarean is major abdominal surgery, as it is never portrayed in this way.

'Currently, the Cesarean rate [in England] is 24.3 per cent. Therefore one has to question whether the women of this country are physiologically incapable of having normal births, and I don't think they are,' said Silverton, a midwife for 30 years. She wants Britain's rate brought closer to the 15 per cent recommended by the World Health Organisation and fears cesareans 'have been normalised in the minds not just of women but also midwives and obstetricians'.

If you have time click on the link and read the comments by women relating to their experiences of birth.

We all know that 'fear' plays a big part in the birth experience, so if you feel as if this is stopping you or you want to debrief seek some counselling, talk it through.
The best way to deal with 'fear' as Susan Jeffery's would say is "feel the fear and do it anyway"

National Caesarean Awareness Day (NCAD)

"Getting clear about fear"

I attended the NCAD conference yesterday and what a sensational day it was. It never ceases to amaze me the endurance of women. I was fortunate to meet many amazing women but in particular a women who had dreamed of having a vaginal birth, but unfortunately had quite the opposite. Amber shared her journey of first the joy of being pregnant then the horrendous pain of being rail-roaded into a caesarean, not once but twice and why, for the perceived ‘risk’. Amber for her third pregnancy employed an independent midwife to achieve the dream she wanted. ‘
This begs me to ask the question?
Why is our medical system failing these women?
This has been the theme of a few of my recent blogs and I have come to the sad conclusion that Obstetricians have what they perceive as the women’s best interest in mind, historically this comes from the Hippocratic Oath, however, they fail to hear or listen to what women want. They hide behind the fear of litigation and work in a defensive manner (consent forms for vaginal birth, refusal of epidurals etc).This also is a result of a perceived loss of medical power, in times gone by it was always ‘doctor knows best’ however now with ready technology and ‘google’ the consumer, woman is armed with information and therefore asking more questions. We fear risks that are hard to understand: doctors find it hard to understand why women make the choices they do. This then leads to the power struggle and the ‘fear’ tactic to regain the power and so the cycle continues. If the medical model continues to not listen to women, instead of women caving in to the ‘fear’ or the doctors pressure, they will seek help from other sources, be it, independent midwives or freebirth, they will do it alone.


Approximately 77 people attended the conference, what was exciting to see was women breastfeeding their young babies. It was sad to see that there were no Obstetricians at the NCAD conference, last year there were several and it made for good conversation and debate. Why did the doctors not attend? They would benefit from hearing Ambers story!
The word ‘RISK’ is communicated in many different ways and changes the birth plan enormously if communication is not a two way street. Maybe a solution is that we need to start at medical school to change the mindset of doctors, have consumer groups talk to medical students, about listening and informed choice.
Doctors are forgetting that most women are well informed and make choices. Autonomy is the single most denied option given to women who are pregnant. Women have the right to choose the care that they desire, despite the doctor not agreeing with them, as long as the women are fully aware of the implications of their actions. It is important to let go of control, develop a trust relationship and do not manipulate. “Listen more & insist less”.
I have to acknowledge the great presenters of the conference, Amber her story, The VBAC Dilemma: What the Evidence Tells Us - Henci Goer; Risk and Fear: The Best of Friends - Heather Hancock, Birth Beyond Fear - Lorraine Hale, Next Birth after Caesarean - Tracy Martin, Moving on after a challenging Birth - Lynne Staff and Initiating Change in the Operating Theatre – Caroline Dufton & Sara Bayes.

NCAD have achieved many things over the last year, more awareness regarding the rising rate of caesarean sections, the enormous help they provide to traumatised women resulting in caesarean section. Government recognition of the caesarean rate and the need to reduce this rate (through lobbying), advice on the National Maternity Plan, also the assistance with NVBAC (Next Vaginal Birth After Caesarean) clinic at a major tertiary hospital, and too much more to mention here.



This is only the tip of the iceberg; Birthrites do a fantastic job and continue to do so. They are a group of dedicated people who work very hard, a job well done.
If you require any further information regarding Vaginal Birth after Caesarean section: visit Birthrites - Healing After Caesarean Section http://www.birthrites.org/

The planing committee: Congratulations an Excellent program and day.