A photo post :-)

Some photos from my vbac:

Christmas day - 40 weeks pregnant exactly

In the birthing pool

My darling husband holding me up

Meeting our baby girl for the first time...

... and then suddenly realising what I had just done. Such a blurry photo, but I love the pure emotion captured here!

My beautiful vbac baby, 9 days old!

Happy family

To midwife or not to midwife... and the truth about interventions

So the default childbirth 'attendant' in South Africa, even for a low-risk pregnancy and birth is a gynae (technically an obstetrician, since they are there in an obstetric role, but we all call them gynaes anyway). Why would we need a doctor when we are pregnant? We treat pregnancy as some kind of disease, as a medical problem to be fixed, and yet we are often healthier pregnant than at any other time in our lives, barring those with true medical conditions.

In a low-risk normal delivery, a gynae is called by the hospital midwives when you arrive to give birth, and is then periodically updated until they decide a C-section is 'required' or you are ready to begin pushing and they arrive to catch the baby. A hospital midwife is usually allocated to you while you are in labour, but will leave when her shift ends and another midwife comes on duty. Before you go into labour, you see your gynae every so often for 10 - 15 minutes at a time for a quick scan, and to get your urine and blood pressure tested.

In contrast, you see your midwife for an hour at a time before giving birth, she meets you at the hospital when you arrive (assuming you're having a hospital delivery - but at least you have the option of giving birth at home with a midwife), spends as long as necessary with you and you will only see her during your labour. By then you know her and trust her, as you have spent so much time with her, and she is able to encourage you in a way that is meaningful to YOU!

The contrast between the amount of time spent and the amount of money you pay for each boggles my mind! My entire hospital vbac birth (hospital stay, midwife, paediatrician and lab tests to check if C had jaundice) cost almost as much as the gynae bill alone of a friend who gave birth a couple of months before me.

But what if something goes wrong?

Firstly, something is a lot less likely to go wrong if you leave your body to birth naturally. No induction, no augmentation (to strengthen contractions or speed up labour), no pain medication. Yes an epidural is a wonderful invention - but its also likely to slow your labour down at best and can possibly stall it altogether, especially if you get it too early. Gynaes generally have much less experience in natural, normal birth than a midwife, and so tend to not trust the birth process quite as much. They get nervous when a birth isn't happening quite fast enough, or when fetal heartrate decelerates (totally normal during a contraction).

Unfortunately, one intervention tends to lead to another. You get induced because at 39-odd weeks you think you've been pregnant long enough (because, of course, pregnancy only lasts 40 weeks at most. If you are pregnant longer than your due date there must be something wrong with your body). The Pitocin you are given comes continuously, unlike the bursts of oxytocin that your body naturally produces, which causes extra-strong and extra-long contractions and your baby may struggle to recover in between contractions (usually a C-section will be recommended). Pitocin may cause placental abruption, uterine rupture, laceration of the cervix and hemorrage after giving birth, and also causes more painful contractions, so you ask for an epidural.

The epidural inhibits the production of a number of key labour hormones, increases the length of your labour (by up to 7.8 hours), increases your risk of a C-section by 2.5 times and increases the risk of pelvic floor problems (urinary, anal and sexual) after birth. Women who have been given an epidural are often confined to bed, instead of allowed to labour in the position most comfortable to them. Since they are lying on their back, their baby is 4 times more likely to turn posterior, decreasing the chance of a natural birth. Epidurals also cause immune suppression and decreased  heart rate, blood and oxygen flow in babies, and can be present for up to 36 hours after birth (similar results are seen after a C-section, often leading to sleepy babies and breastfeeding problems). Babies who are exposed to anaesthesia may also be less alert and active for up to a month after birth.

All of this is much more likely if you are giving birth with a gynae.

Midwives have seen natural births so often - they know that you can do it! And because they know what a normal birth is supposed to look like, they also know what its not supposed to look like, and will be able to identify a (true) problem quicker and more accurately than a gynae. Gynaes spend much more time practicing their operating techniques than observing natural births, and are so adept at 'picking up problems' that they often anticipate them before they even occur, leading to the interventions that so often cause more problems than they solve.

And if something does go wrong, your midwife would call your back-up doctor (or the on-call doctor if its in the middle of the night). Just like the hospital midwives would call your gynae if something goes wrong during your gynae-assisted birth. My back-up doctor knew when I was in labour, and phoned my midwife every so often just to check on how things were going - if I had a problem, she would have been there just as fast as if I had been her own patient.

I understand that in higher-risk pregnancies, more specialised medical observation is required, but a normal run-of-the-mill pregnancy is best handled by the people who specialise in normal, natural births - a midwife! She's cheaper, spends more time with you and is more experienced - its a win-win situation all around!