My top 10 FAQ | Real Life Midwife

my top 10 most frequently asked questions

Midwives are the front line of maternity care - we're often the first face (or voice!) you'll encounter every time you have an episode of care, even if you have a private obstetrician. So it goes without saying, I've been asked many questions in my time. Now that I have a social media and online presence, I'm also receiving these questions both publicly and privately. So for those of you who are time poor (let's face it, who's not time poor these days?), I've compiled the 10 most frequently asked questions I have with my answers...because you are bound to have wondered about these questions too!

  1. I’m pregnant! What’s next?! And when should I tell people?
    Congratulations, first up! Don’t stress if you aren’t feeling the sort of feelings you thought you would. Even if you have dreamed of this moment for a long while, being pregnant can be a big adjustment, so now is a good time to release alllll the expectations you might have for the journey ahead, and just feel what you feel.
    Secondly – if you haven’t already, soon you’ll need to make some choices about your pregnancy care. A trip to your GP is in order, where you will be offered the routine early pregnancy tests (such as your immunity to certain diseases, your blood group and so on), receive more information about future tests and screening, and be referred onwards to your chosen model of maternity care. If you’re not sure of your choices, your GP can go over them with you, and I have also written a blog post about the type of maternity care associated with the best outcomes for you and bub, here.
    In regards to telling people, I totally get the excitement that comes with that step. Many of us are (quite literally) busting to tell everyone the news, but then there's something about the magical 12 week mark you've heard about, so you should wait? Basically, my advice for telling people is this: whilst the chance of miscarriage decreases with each passing day, there's absolutely no "safe zone" of pregnancy. Women sadly lose their babies at all stages of pregnancy, and in most of these cases there isn't anything that can prevent this. So with this in mind, you can tell anyone you want, whenever you want - but you have to be comfortable with also potentially informing them about a miscarriage or pregnancy loss (it is a very hard experience having to contact people after a miscarriage). So if you're not comfortable telling Uncle Bob about a miscarriage, then it's not time to tell him. On the other hand, if you know that you would be leaning on your mum/sister/friend for support after a miscarriage, then definitely tell them you're pregnant asap! Also - ignore the supposed rule about the 12 week mark (or any other stage of pregnancy where people tell you you're safe). This just doesn't exist - pregnancy loss unfortunately does happen after 12 weeks, so follow my guidance above on who you should tell and when.

  2. Is the epidural the best type of pain relief? Should I get the epidural?
    There is no black or white answer to this question. The answer is going to depend on each individual woman and her labour and birth. Some mums plan on having the epidural, but labour too quickly to get one, or it takes too long for the anaesthetist to arrive, or it takes a while to get the epidural inserted and working well. Some mums really don’t want one, but the circumstances of their birth might mean an epidural is a good choice for them. So it’s a great idea to be fully aware of all your pain relief options. The epidural involves local anaesthetic and strong pain relief medication being administered around your spinal nerves in your back. Because of this, it is very effective at blocking the pain associated with contractions. However, there are many other effective options for pain relief as well, and they don’t have to involve medication (bonus as there will be minimal side effects and many have instant effect at reducing pain).
    Warm water (bath or shower) is fabulous for labour, will help relax you and can help your bub move into an ideal position for birth. Heat packs or a TENS machine are also incredibly effective for labour pain. Many women also find changing positions, using a birth ball, aromatherapy, acupressure/massage, music and/or sterile water injections beneficial during their labours.
    Nitrous oxide (commonly known as laughing gas) is one medication used for pain relief in labour. It is inhaled through a mouthpiece, with the effects only lasting as long as you keep inhaling. It really helps you to breathe through contractions and is great at taking the edge off. You’ll still be able to be active in your birth. Another medication is an injection of an opioid pain reliever such as morphine or pethidine. These drugs work well for strong pain, but can have a sedating effect or make you feel nauseous. There is also the slight chance of an impact on the baby’s breathing if given too close to the birth, so we need to be cautious around the timing of this injection.

    The epidural is the next up from all of these. It requires a sterile procedure by an anaesthetist, to find the tiny space to administer the drugs. Hence, it is certainly not a ‘quick fix’. Because it is working on spinal nerves of the lower half of your body, your legs become fairly incapacitated – so most women with an epidural are confined to the bed. You’ll also have continuous monitoring of the baby’s heartbeat due to possible side effects, and a catheter as you won’t be able to empty your bladder.I always recommend to my patients who are considering an epidural to have a ‘back up plan’. That means – don’t just count on having the epidural. Even if your anaesthetist arrives quickly to do the procedure, it might take 20 minutes to set up, 20 minutes to place it and administer the drugs, and 20 minutes for those drugs to have a good effect. So you need to have strategies for coping with your contractions through that time. Also, it’s worth considering the epidural’s risks and side effects. It will commonly cause a blood pressure drop (which can cause more complications, but can also be reversed), and for around 1 in 8 women it doesn’t work well or at all (and will require another procedure or extra medication to try and get it to work). Then there are the rarer but more serious side effects such as headache and nerve damage[1],[2].

  3. I’m approaching/past my due date and can’t wait to meet my baby! How can I bring on my labour?
    If I’ve learnt one thing from this job, it’s that you can’t make a baby do what a baby doesn’t want to do! They come on their own time, when they are good and ready. In fact, there are many things that contribute to when a baby is born: genetics, the gender of the baby, the number of babies the mother has had and what gestation her other babies were born at, to name a few. For example, male babies and first babies tend to have longer gestations – only 50% of first babies are born by 40 weeks and 5 days (so if it’s your first baby and a boy, be prepared to cook a little longer!)[3],[4]. That said, there are still things you can do which have been proven to increase your chances of going into labour. Here's a post that covers this in much greater detail, but in short – my favourite options that are safe and effective for stimulating labour are:

 

This image shows the use of essential oil clary sage during labour. A support person is applying the oil to the mother's food (a known pressure point). Here's a link to a clary sage rollerball (or clary sage and lavender rollerball, for the added pain management effects of lavender) for easy roll-on use in late pregnancy and during birth!

4. How much weight should I gain in pregnancy? I’m worried I’ve put on too much/not enough…
I’m asked this question (or related questions) A LOT…because, this is the topic I’m researching for my PhD. So I feel like I know a little bit about it…The full article is here, but I've summarised it for this FAQ post.
First up – ignore anyone that tells you to eat for two – it’s a myth! Secondly, too much or too little weight gain in pregnancy is associated with increased risk of complications, which is why it’s important to know how much weight you should be gaining.
Anyway, what you need to know is that there are international recommendations for weight gain in pregnancy, but your individual target weight gain will depend on your BMI when you got pregnant (so you will need to know you BMI or height + weight). Once you know your BMI, you can use the table below to find out how much weight you should aim to gain during your pregnancy[5].

Whilst this may seem a lot/not a lot depending on your circumstances, bear in mind that many things can impact weight changes in pregnancy. For example, in the first 20 weeks of pregnancy, the uterus is growing, there is a big increase in blood volume in your body, the baby is growing, and the placenta is developing as is the amniotic fluid around the baby. That said, many women suffer from morning sickness in the first half of pregnancy (if not longer!) which can affect appetite and weight gain. Whilst eating a healthy, balanced diet and exercising in moderation will go a long way to achieving healthy weight gain, it isn’t enough for many women, as most women gain the target ranges above! So please speak with your midwife or obstetrician about any concerns you have in this area, and follow me on Instagram to see updates on my research as they come through!

5. What products/resources do you recommend to your patients to prepare them for what's ahead?
I am definitely a visual person - I like to read and see in order to get new information and knowledge. My absolute favourite resources for birth preparation are books (and unsurprisingly, they are super popular in the midwife/mama world) but they are just so darn useful and comprehensive. The first one is Juju Sundin's "Birth Skills", a really practical guide with heaps of 'how-to' pics for different positions and pain relief for labour. This is so easy to flick through and pick up some ideas, and pass on to your birth support people so they know about these strategies too. Then you pack it in your birth bag, to pull out when you need some ideas in labour. You can find this book here.
The second book is Rhea Dempsey's "Birth With Confidence: Savvy Choices for Normal Birth". Rhea is world-renowned for her birth education classes and birth support, and luckily she put all of her wisdom into a book for us all (if you can't get to one of her classes). She explains in great detail the complexities of the maternity care system and how to navigate/advocate for yourself and your bub to optimise your chances of a normal birth. You can find this book here. The final resource I love is one that prepares you, gently but realistically for a baby (the first 12 months!). It's called "Baby on Board" by Sydney paediatrician Dr Howard Chiltern, so you know you are getting qualified advice. You can get this book here.

6. Should I express milk during pregnancy for my baby?
This is a really great idea, and has become popular over the past few years as mums are keen to build a stash of breastmilk for use in the early days (or other reasons). Two things you should know about breastfeeding: 1) low milk supply is frequently wrongly blamed for many issues after birth and 2) it’s surprising how often formula/additional feeds are used in the early days after birth. However, formula use in the first few days is well known to impact on your supply and breastfeeding success[8]. Hand expressing at the end of pregnancy to build a freezer stash is a great way to avoid formula use and encourage success with lactation. If you take a few frozen syringes into hospital with you, and keep some at home, you can use them as you need without wastage.
To illustrate my point - I knew my bub would be having a NICU stay. I began expressing (with my OB's clearance) 2 weeks before she was born. I had 60mls frozen by the time she was born, and she never needed to have formula. The nurses were amazed! You may run into some negative attitudes regarding the safety of this practice, however this large randomised controlled trial showed that expressing breastmilk from 36 weeks of pregnancy is not associated with any increased risk[9]. However, if you have questions about your own individual circumstances however, definitely chat with your midwife or OB.


7. What are the best options for birth classes, and when should I do them?

In my experience, birth classes are essential for several reasons: they expose you (and your birth partners) to things you need to know about birth, such as the signs of labour, stages of labour, birth preferences, birth positions and options for pain relief (plus skills to support you – for your partner!). You’ll also meet some other parents expecting babies around the same time as you, which is a great opportunity to build your ‘village’. Many hospitals offer birth classes, and these are a great introduction, however they are limited by hospital budgets and often only cover the essentials (including hospital policies and so on). Doing community-based or external classes is a great way to achieve a comprehensive understanding and preparation for labour and birth. Hypnobirthing or Calmbirth are two common and fantastic birth class options. If you prefer to read, I outlined my favourite books in question 5 (I highly recommend Rhea Dempsey’s Birth with Confidence book or Juju Sundin’s Birth Skills book as great preparation for labour and birth) - you can get them both here, and you can start reading them anytime. Once you’ve had your 20 week anatomy scan, you can book your birth classes for any time that suit you. However, I recommend booking them earlier rather than later so that you have time to practice your breathing and relaxation techniques for many weeks before you actually need them!
One final option is to do an online class. This can be great as you can do the videos at your own pace, in the comfort of your own environment, however you don’t get the face to face benefits of a class.

 

8. What can I do to reduce the chance of having a C-Section?
Globally, we are dealing with rates of C-Sections that are way above the World Health Organisation’s recommended rate of 10-15%. Many women wish to avoid caesarean sections because of the increased risks of a C-Section compared with a vaginal birth. There are many things you can do to improve your chances of having a natural birth. Firstly – the maternity care and birth place you choose will have a huge impact. Especially for low-risk pregnancies, continuity of care with a midwife consistently shows the best outcomes, including for natural births, for mums and babies[10, 12]. Birthing at a public hospital, birth centre or at home versus a private hospital is also associated with higher rates of normal birth[11]. The type of support you have in labour is also crucial – continuous support from a partner, midwife and/or doula is linked with less caesarean sections[12]. Finally, the more you can avoid medical interventions during your labour and birth, especially if they are unnecessary (e.g. synthetic hormones to ‘speed up’ labour when it is progressing at a normal rate), the more likely it is that a caesarean birth can be avoided[11]. For more about this – I recommend reading up on the ‘cascade of intervention’ in labour and birth.
 

9. How will I know if labour has started?
This is a question I’m asked by many first-time mums, but rarely mums who’ve given birth before, unless they were induced (they will overwhelmingly tell you “oh, YOU’LL KNOW” with a raised eyebrow and a wry smile). But reality is, sometimes we get mixed signals from our body! And every so often on the news you’ll see a baby has been born en route to hospital, and we wonder whether the mother didn’t realise she was in labour in time to make it to hospital (FYI, these babies tend to be the typical 2nd baby, very quick births! They take their mums by surprise after the first birth was a much longer labour). Labour is made up of several stages. The first stage involves your cervix dilating from closed to fully open; the second stage involves the birth of the baby and the third stage involves the birth of the placenta. The first stage is usually the longest stage, and can be split into two parts: latent first stage and active first stage. Latent first stage is characterised by irregular, unpredictable tightenings or contractions (usually lasting less than a minute), and they may start and stop over days or even weeks. They are actually doing a very important job (softening and thinning out your cervix up until around 4cm dilation), and generally this stage is best spent at home. You might feel excited, apprehensive and uncomfortable, but you should still be able to talk through your contractions and rest a bit. Somewhere between 4cm and 6cm (generally speaking) is when you’ll hit active labour – and those irregular cramps will be characteristically regular, and occurring 3 or 4 times in a 10 minute period, and lasting around a minute. This is when labour lives up to its name and becomes hard work – you mightn’t be able to speak during contractions as you need to focus on breathing through each one. You should be in contact with your midwife or obstetrician through this time so they can continue guiding your care appropriately.
 

10. I really want to breastfeed but I’ve heard it can be really hard – is there anything I can do to make breastfeeding easier or more successful?
Breastfeeding has a wealth of benefits for both mum and bub, but unfortunately many mums (for a variety of reasons) aren’t able to continue their breastfeeding journey as long as they’d like. One of the most common reasons mums give up breastfeeding is a (often incorrect) perception that they’re not making enough milk. See, low milk supply is an easy scapegoat for many things early on: Not enough weight gain? Mustn't be enough milk. Constipated? Not enough milk. Mum's tired? Trying too hard to make not enough milk. Baby fed 15 minutes ago and hungry again? Not enough milk. Baby only slept 20 minutes? Not enough milk. Baby has jaundice? Not enough milk. Baby is cold? Not enough milk. Mum's boobs are soft and comfortable? Oh - must be empty! Baby is unsettled at the breast? It's because there's not enough milk. But all of these things can occur even if the milk supply is plentiful! I highly recommend reading up on what will impact on the establishing of lactation and your milk supply in the early days, so you are well prepared for success before your bub arrives!
Another thing that contributes to breastfeeding problems is the technique (or positioning and attachment). This is crucial for ensuring that the milk you are producing is transferred to the baby. And, breastfeeding is a learned behaviour, which unfortunately in our society is often done behind closed doors – meaning by the time we come to breastfeed our first baby, we have not acquired this learned skill.
So, my tips for success (in addition to question 6 – expressing colostrum in late pregnancy!) are two-fold: equip yourself with knowledge about establishing breastfeeding and your milk supply, and try to avoid things (or people!) that might lower your supply (but don’t automatically blame your supply if you have any issues!). Secondly, observe as much breastfeeding as you can – whether that’s friends or relatives that are happy for you to be present as they feed their babes, YouTube videos, breastfeeding classes and so on. My "Breastfeeding 101" article is really detailed and has  a tonne of images that show good versus bad positioning and attachment, plus a lot of other helpful breastfeeding stuff (click here to read). Another helpful tip - find a lactation consultant (someone who’s done extra qualifications to be a breastfeeding specialist) near you, so that you have a contact to assist you at the first sign of an issue in your breastfeeding journey. Finally, lactation cookies are a healthy, delicious snack option proven to increase your milk supply. I kept a tin of these ones in my pantry after birth, and used them anytime I  felt my supply needed a boost (or if I just wanted a really yummy snack!).

 

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[1] Arendt, K.; & Segal, S. (2008). Why epidurals do not always work. Reviews in Obstetrics & Gynecology 1(2): 49-55

[2] Hermanides, J.; Hollman, M.W.; Stevens, M.F.; & Lirk, P. (2012). Failed epidural: causes and management. British Journal of Anaesthesia 109(2): 144- 154

[3] Jukic, A.M.; Baird, D.D.; Weinberg, C.R.; McConnaughey, D.R.; & Wilcox, A.J. (2013). Length of human pregnancy and contributors to its natural variation. Human Reproduction 28(10): 2848 – 2855

[4] Dekker, R. (2015). The evidence on: due dates. Retrieved from https://evidencebasedbirth.com/evidence-on-inducing-labor-for-going-past-your-due-date/

[5] Institute of Medicine (2009). Weight gain during pregnancy: re-examining the guidelines. Washington, D.C.: National Academy Press

[6] https://rednose.org.au/section/safe-sleeping

[7] https://www.reallifemidwife.com/safesleep 

[8] Chantry, C.J.; et al (2014). In-hospital formula use increases early breastfeeding cessation among first-time mothers intending to exclusively breastfeed. Journal of Pediatrics 164(6): 1339 – 1345 

[9] Forster, D.A et al (2017). Advising women with diabetes in pregnancy to express breastmilk in late pregnancy (Diabetes and Antenatal Milk Expressing [DAME]): a multicentre, unblinded, randomised controlled trial. The Lancet 389(10085): P2204-2213

[10] Sandall J, Soltani H, Gates S,Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub5

[11] Dahlen HG, Tracy S, Tracy M, et al. Rates of obstetric intervention and associated perinatal mortality and morbidity among low-risk women giving birth in private and public hospitals in NSW (2000–2008): a linked data population-based cohort study. BMJ Open 2014;4:e004551. doi:10.113

[12] Bohren MA, Hofmeyr G, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub6

[13] Lothian J. A. (2014). Healthy birth practice #4: avoid interventions unless they are medically necessary. The Journal of perinatal education, 23(4), 198–206. doi:10.1891/1058-1243.23.4.198

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