Archive | January, 2016

When to go to the hospital to give birth?

When to go to the hospital to give birth?

Posted on 28 January 2016 by Kristrun

Midwife with woman during labour

Midwife with woman during labour

It is usually best to wait until you are in active labour before going to the hospital, or around 3cm dilated or if the membranes have ruptured (breaking waters).

This is for a number of reasons. Firstly, some hospitals have a policy where until you are at least 3 cm dilated, you do not go to a birthing (delivery) room. Whilst the policy is good, the implementation is not always optimal.

Labouring women tend to be more comfortable in their own environment. Remember how the hormones work – this will promote the endorphins and oxytocin, which will result in a shorter, less painful labour.

Added to this, until you are in active labour we have no idea of how fast your cervix will open. Getting to 3cm could take 2 hours or 22 hours and once you are in hospital there will be an expectation that you will progress and if you do not, someone will want to help you. This is where the cascade of intervention plays a role. Research has shown that whenever a form of intervention is utilized in your labour, there will be an increased chance of further interventions. Once you are in active or established labour, it is likely that your labour will continue to progress and there will be less likelihood of further intervention or a cascading scale of intervention.

A possible (but not inevitable) example would be that you are at the hospital in early labour and your cervix is open about 1 cm. After 4 hours the cervix has thinned out but is only open 2cm now. You are advised that your membranes should be ruptured to speed up labour, by approximately 30-60 minutes for a first time mum. Evidence tells us that having your membranes ruptured increases pain for the mother, so you choose to have an epidural. Evidence also tells us that the baby has an increased chance of demonstrating a concerning fetal heart rate pattern (CTG) – you are then advised that the baby is distressed and needs to be born imminently. Assuming the cervix is completely open and the baby is in a good position, a vacuum birth is safely attended, with an episiotomy. The baby is born in good condition, but subsequently develops jaundice, which requires photo-therapy and an artificial milk formula to clear the jaundice and you then develop problems with breastfeeding!

Other reasons to go to hospital would be:

  • Amniotic fluid is leaking
  • Concerns about baby’s movements
  • Bleeding, not mixed with mucous
  • Contractions 3-5 min apart, regular in length, strength and frequency
  • You do not feel comfortable at home

You are not trying to avoid the hospital, but trying to identify when there is a real need to go.  If labour comes on very quickly, sometimes there is also a need to move swiftly as you do not want to be on your way to the hospital with very strong contractions – better to have settled into the labour ward nicely.   Any woman with a high risk pregnancy, or if it is a second or third baby, needs to go into hospital as soon as the labour starts.

Please let us know if we can help!

The midwives

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Breastfeeding was hard for me too

Breastfeeding was hard for me too

Posted on 09 January 2016 by hulda

Sometimes I think back about why I managed to breastfeed my babies, despite the fact that I had nipple pain for weeks with each one of them, little milk overall and always went to work reasonably early after giving birth.  I have come to the conclusion that it was because of a few things that I was lucky to have – mainly the environment that I was in and the mindset of the people around me.

Everyone just does it, in Iceland.  In my home country, 79% of women still breastfeed at 5 months, although this number is today even higher, 35% of them exclusively do so.  Two thirds of women exclusively breastfeed for the first two months and pretty much everywhere you go, it would not be considered inappropriate to breastfeed. In hospitals, no-one ever asks you if you are going to breastfeed, it is just assumed that you will.

 

Breastfeeding in Iceland 2004 to 2008

 

It is done reasonably discretely, boobs are not just visible to everyone, but even in a meeting or a coffee break at work, a breastfeeding mother would not be inappropriate, as long as she otherwise is doing her job.  Pumping milk is not that common, women just breastfeed.  When they want to go somewhere, the milk travels with them, so planning is not all that important.  “The baby should not feed for at least another hour” – is not a sentence you would hear often in Iceland.  You just feed when the baby needs feeding.  Who wants a baby to cry when it is easy to stop it?  It is true that the maternity leave is longer there, so it is easier for that reason.  But the great emphasis on “is the baby getting enough?” is definitely not as common in Scandinavia as it is in Hong Kong.

When I started to work in Hong Kong after having my 3rd and 4th babies, I had so little breastmilk, i.e. there was exactly as much milk as they needed but not really a drop more, I could have easily have been totally discouraged by it.  I never was able to pump more than 60 ml of milk when I was trying to store milk for them in advance of working.  But I just decided to try it out.  It turned out that they adjusted to it just fine.  And then came solid food and on weekends there was catching up that was lovely for us all.  But the health clinics were certainly not very helpful in supporting this system, I must say.

The other thing that helped me, was the fact that I did in fact have very good knowledge and some skills in breastfeeding, through my work.  In Iceland, the midwives’ training includes academic study and then weeks of breastfeeding assistance on the postnatal wards and during homevisits, to be able to sit your midwife exams.  This has of course greatly contributed to the support that the mothers in Iceland are getting and the statistics reflect that.  However, it is of course different when it is your own body and baby, and we all need some form of support.  So I was lucky, that I had this, offered by the government.

Yet another part was the general mindset of not bothering with the details.

When you read about that you must cover the whole areola and that you must fully empty a breast, feed for certain amount of time etc.  -  although all of these are valid advise, you can easily get a bit hooked on this and worry that you are not doing it right.  Especially if the baby is unhappy and crying, other family members have other opinions or generally the feeling when feeding, is not good.  Areolas are greatly different between women and some women have a fast letdown reflex and plenty of milk, so their feeds take a very short time, whereas others take much longer to drain breasts to the baby’s needs.

So when you can -  take the advice and educate yourself, but then use it appropriately. For example in my case, I really had to swap between the breasts often to keep one of my babies happy.  Otherwise she would simply fall asleep and then be hungry shortly after.  But when I swapped, she was much happier.  I made sure to try and empty one of the breast at least, each time, but this again, is sometimes hard to evaluate, when you are a first time mother.  ‘Empty’ to me, was a rather difficult concept – are the breasts ever empty?  My other kids would feed more “typically” i.e. all of the standard breastfeeding advice was very appropriate and useful. But flexibility was needed.

The same goes for foremilk and hindmilk - often it seemed hard to know when it was long enough a feed to be considered to be giving hindmilk.  But when I stopped agonizing over these details, and rather focus on the baby and how she responded, gained weight and slept – then it was all a bit easier.  The information was useful, but I needed to step away from it and be able to just try and test what worked.

And one last thing – the position to feed from.  Basically, especially when I once almost had mastitis after being with another woman in labour for 20 hours, what really did the trick was to feed the baby in ALL sorts of positions.  I mean, almost nothing short of a headstand.  In the bathtub, on the sofa, in a chair, leaning over her completely, upside down on the bed – the whole lot, many times over.

Being able to extend the night by feeding lying down in bed with the baby – what a glorious thing! If someone had come and told me off for co-sleeping, I am not sure what I would have done.  But luckily, no one would have even dared to so so!

A good midwife or a lactation consultant will tell you all of this.  You can read about it too.

To actually do it, though, and release the ‘strictness’ and let go of how you ‘should’ do things, is something you must do yourself.

This is just my story, I hope it helps you.  Let’s try and make Hong Kong more like Iceland and Scandinavia, where breastfeeding is just simply no big deal, women can do it their own way, whenever and wherever they want to, based on the baby’s needs.

Hulda x

 

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