Tag Archive | "natural birth"

A good birth

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A good birth

Posted on 15 October 2014 by Kristrun

Epidural during labour can give good pain relief but requires monitoring throughoutEver since I came to Hong Kong, now 14 years ago, I have been helping women to go through the journey of pregnancy and birth in such a way that they, their partner and their baby may have the potential of the best possible outcome, physically and emotionally.  What has become obvious to me is that somehow the whole birth event – when preparing – is often something that people look at in a black-and-white way, so when it comes to actually going through the process, most are surprised and are not well prepared at all.

So what is a good birth?
My opinion is that a good birth is a birth where you and your partner feel you have had your baby safely, where your wishes were treated genuinely well and you feel that you were supported to enjoy the experience in a respectful way.   This is usually achieved when you are in charge of your own birth i.e. allowed to do what you want while you go through labour, whilst professional staff also ensure that you and your baby are safe.  When I was at the very first birth in my midwifery training, my mentor at the time told me that my role in that room was to make sure that the woman and her baby were safe and they needed to be monitored and helped to continue to be so, but I was not allowed to order that woman to do anything.  If she wanted to crawl on the floor, sit in the corner, leave the room, take a bath etc., she was allowed all that, but I just had to chase her with my equipment, should I need to do any medical tests or checks on her.  I was not allowed to tell her to change whatever she was doing to make herself comfortable.

The reason for this is that when women go through labour, they gradually find ways to cope with it in a manageable way, as long as they are left to it and perhaps helped a little bit every now and again.  Similar to animals, if disturbed, they will often feel scared and anxious and lose the focus to cope and help themselves to have an easier birth.  Adrenaline takes over and the birth feels more painful and also is often described as “out of control” by the women.

Factors that may contribute to  making the birth easier for women are  things like:  moving about, eating and drinking, changing the environment in any way that feels best (lights, the setup of furniture is very important and you can learn more on Reclinercize about how to make it idea with cushions, birth balls etc), using toilet and shower, having the people around you that you want, having privacy (believe it or not but in many hospitals, staff just wander in and out of the labour room as they wish, without even knocking -  and often there is a half naked labouring woman in there).  Many women also complain that they are treated as if they are expected to just “do as they are told”  and “behave”  -  for example not to make any noise, or to lie down when it does not feel comfortable but the staff feels they should and so on, and this puts stress on them.

A good birth = natural birth?  
Perhaps, but it depends on how you define natural.  There is a common belief amongst women that a good birth is a natural birth only.  Anything not natural means that the birth has gone wrong.  Other women define a good birth as a pain-free one, and many define it as a birth where they feel in control.  I would say that if your expectations for a good birth are as rigid as this, it may be hard to meet them.

A birth where you are mostly in control is usually the birth that is remembered afterwards as a good one.  Control can mean so many different things,  but in labour if it means that at all times, explanations are given to you, you are supported to make decisions on your own, within safe limits, and regardless of the TIME the labour and birth takes and the INTENSITIY of the labour,  there is support available to you.  Much effort has been put into researching this and it is generally the view of labouring mothers that non-support in labour equals non-control AND a less positive birth experience. Similarly, good support through labour and birth, equals control and a good birth experience.  Take note that this is more or less regardless of pain, length of labour, or medical interventions.

Different types of labour
Many mothers are unaware of some factors in our modern world greatly affect the outcome of the birth.  In Hong Kong, one of the biggest factors is how labour starts.  A labour that starts at home, on its own, with contractions gradually building up, membranes intact and a normal, full length pregnancy and the woman can stay at home for most of her early labour, has a very good chance of a normal vaginal birth, with almost no medical intervention or unexpected surprises.  It is likely to be similar to most of the births that preparation books and classes have portrayed.  Where the onset of labour is more complicated, the rest of the labour is likely to be more complicated.  So you are to conclude that this will mean that you will not be able to have a good birth, you are in trouble!  Thinking out of the box is very necessary here and it is very important to focus on making the birth a good one – given the circumstances you are in.  So you have to ask yourself, what is REALLY important to you, apart from a healthy baby?

Birth is a journey that can be long, rough and totally different to what you expected it to be.  Still, it can be a very good one, as long as you have solutions and help available when you meet your challenges.  And fewer challenges do not always mean a better trip.

Given this, I would suggest, before the birth to ask yourself the following:

1.    What kind of birth do you want and WHY?
2.    What are the circumstances that have been proven to maximize the chances of that kind of a birth?
3.    What is your view of pregnancy and birth in general?
4.    Why did you pick your doctor/midwife/hospital?  Have they been supportive during the pregnancy?
5.    Have you realized the difference between the labouring stage and birthing stage?
6.    What about the subject of pain?   Should it be there or not?  How to avoid it?  What are your opinions based on?
7.    Control.  How would you define this?
8.    Your partner & support people.  Will they be supportive?  How do you know?  Have you discussed your ideas?
9.    If you want a totally natural, non-intervention birth, have you prepared this way? How?

Safety and Comfort
Birth is an event that happens very differently to different people.  If you are going to have a good one, it is important to remember that doctors and midwives care very much about safety.  If you have picked your doctor and hospital, trust that they will genuinely do the best for you in this regard.  You are the one to take care of your comfort – and to make the birth a good one.  This you do by self exploring, preparing realistically and looking at all the different options you have regarding the birth, not only before, but also during the labour.  This means that despite the length or strength of labour and the hard work, at all times you keep matters in your own hands, get help when needed and make sure that the team around you is one to be genuinely devoted to what you want.

Hulda

(Slightly edited from first publication in the Parents Journal, Hong Kong)

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Testimonial from Regina

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Testimonial from Regina

Posted on 18 September 2013 by Kristrun

I just wanted to let you know how supportive the staff at Annerley have been during my pregnancy & now in caring for my daughter. When I moved to Hong Kong, I was 12 weeks pregnant. It was a bit daunting to be pregnant in a foreign country where I wasn’t familiar with the medical system and had limited social support. From the start, through Belly to Belly Workshops and antenatal classes, the staff at Annerley provided me with opportunities to learn about the maternity system in Hong Kong, gave me the tools hlep me to advocate for myself within the system, and provided me with all the information I needed for a healthy pregnancy and delivery. In working with Sofie during Belly to Belly workshops, one to one meetings, and the positioning class, I had a very fast labor and was able to have the non medicalized, drug-free birth I wanted. Given my history as brain tumor survivor, it would have been easy for the highly medicalized physicians in Hong Kong to convince me that I needed a scheduled c-section. However, the staff at Annerley taught me what questions to ask the physicians, how to express my wishes, and how I would know if and when medical interventions would be necessary. It was very useful when Sofie taught me about the importance of posture during pregnancy to help with the baby’s position. I was thrilled with my labor and birth, being able to labor in the different positions Sofie taught and even deliver standing up.
The midwife visits after returning home from the hospital with my daughter helped my husband and me feel more comfortable caring for our daughter and more confident in our parenting. The night we arrived home, my daughter was having some difficulty eating and it was very comforting to know that Rowena would be visiting the next morning to help sort us out. During those early weeks, having Rowena and Conchita visit helped us get through difficult days and nights. Breastfeeding was difficult for me due to my medical history and without the support of Annerley and the visiting midwives, I would not have been able to breastfeed at all. With proper planning before my daughter’s birth and support afterwards, I was able to provide breast milk to my daughter for 10 weeks. While that might seem like a short time for many mothers, for me, it was a major accomplishment. During those 10 weeks, when things got difficult & I wasn’t sure I could continue, support from Conchita helped very much. Her family centered and strengths based approach helped me to think through what the goal was for me, my baby and my family and what was going to make for a happy mom and happy baby, without any pressure to continue breastfeeding. Since giving birth, I have come to clinic, had home visits, and one to one meetings with Conchita. I appreciate that I can ask any parenting, childcare or medical question, no matter how big or small. And unlike visits with pediatricians, Conchita focuses on our entire family’s wellness and happiness, not just our baby’s. It is very comforting to know that Conchita and the staff at Annerley are available through all the stages of my daughters development. I am looking forward to discussing the next milestone with Conchita, starting solids. Conchita has been able to provide the medical support and emotional support that all new parents need.
My helper took Conchita’s course, “Caring for 0-12 month old babies” in the spring. My helper has over 20 years raising Western children but my husband and I felt strongly that she take a course from the same professionals who were teaching our antenatal and childcare classes. When my helper came home from the course each day, she was energized and shared with me the different things that she learned. It was fantastic that Conchita taught her new things and sent her home with “homework assignments”. It encouraged her to have conversations with me about what she was learning. Some of the highlights for both of us included baby proofing the house, how to encourage language development, and starting solids. It was wonderful that Conchita could make this information exciting to such a seasoned child care provider. Additionally, Conchita stressed to helpers in the class the importance of communication with employers. This ended up being a helpful reinforcement for both my helper and myself when after the baby arrived we realized we needed to communicate differently than we had before. I would highly recommend the course to all helpers who will be working with infants regardless of how much experience they have.
The services at Annerley fill the gap many of us feel without local family and give new parents the opportunity to get support on childcare and parenting, which is something the medical system does not routinely provide.
Thank you for all that you do,

Regina Karchner September 2013

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Blooming Bellies – A Natural Birth – Event photos and Review

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Blooming Bellies – A Natural Birth – Event photos and Review

Posted on 20 June 2013 by hulda

Thank you all – guests, speakers, sponsors – for helping us create yet another wonderful Blooming Bellies evening on the 18th June.

Annerley_Blooming-Bellies-audience

Thank you to the guests

Thank you for coming to the evening and we hope that you took much information of value away with you. We are passionate about empowering women to make informed decisions about birth and we hope we have achieved that in the evening. Please take advantage of your free $500 voucher for a consultation with our midwives; we’re sure it will be of value.

Thank you to the speakers

Gianna Buonocore – thank you for sharing your own experience of birth and your parenting challenges. Traditional Chinese Medicine and its application for birth and labour is an area that is not so accessible for non-Chinese speakers and it is fascinating to learn more about the medicine of the area we live in.

Annerley-Blooming-Bellies-Arden-Wong-Michell-HuangArden Wong and Michell Huang – we were honored that you shared your preparation and experience of a homebirth in such an honest, humourous and humble way. Thank you for your suggestions:

  • How practising yoga, exercising and using visualisations techniques helped you to prepare for the birth.
  • To acknowledge the inevitable fear and to face it rather than try to stifle it.
  • Prepare using physical tools, such drawings of labour positions, to support you through labour
  • How the role of the father, especially in a hospital environment, is to support his wife’s decisions and help keep her willpower strong, and to challenge the automated suggestions for medical interventions.
  • Do not feel pressured to have family and friends as guests in the first few days after birth, make this a time of peace and quiet for the new family.

Annerley_Blooming-Bellies-Hulda-ThoreyHulda Thorey – It’s a rare occasion when we get to learn how one of Hong Kong’s most experienced midwives went through the birth of her own four children. Hulda’s recommendations include:

  • Before birth you need to know what you want and why you want it so that it is easier to stick to your plan when alternatives are offered to you.
  • Equip yourself for labour with support tools that will work whatever environment.
  • While you may not be able to control the hospital environment, make your home environment as comfortable as possible to support your body in the early stages of labour.
  • If using the private system, be clear that you are the paying customer and that, within reason, your will should be respected.

Hulda also shared a breathtaking video celebrating a natural birth.

 

Thank you to the sponsors and partners

GeoBaby
who helped spread the word. Have you seen their new site?
TIny Footprints
Tiny Footsteps – who donated the amazing door prizes of the Mima Moon Highchair, cushion set & footrest (valued at $4,135) and an Il Tutto Nico Baby Bag (valued at $2,495). Visit their website for more great baby products.
Yoga Privates
Monica Proctor – Yoga Privates

 

Jenny Smith - Gecko Yoga
      Mandarin Spa The Mandarin Spa team – for glorious mini manicures and pedicures, the generous door prizes and the wonderful array of goodies that helped stuff the goody bags. Remember that you are in good hands with the Mandarin Spa team

And congratulations to the winners of the Mima Moon Highchair, the Il Tutto Nico Baby Bag, the 4D-Scanning Experience by Annerley, The Annerley Helper Training course.

If only the odds of winning the Mark6 were the same!

 

View the gallery below from our Blooming Bellies – A Natural Birth event

 

Make sure that you don’t miss the next Blooming Bellies  - sign up to receive our newsletters to learn more about all aspects of pregnancy, birth and childcare.

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Drugs or No Drugs – That is the Question!

Posted on 26 June 2012 by Annerley

OK here’s a fun question for you. Which is considered to be more beneficial – a drug-assisted labour that keeps Mum pain-free but may have a negative effect on the baby or a non-drug-assisted (aka natural) that is great for baby but may be extreeemely painful for Mum? It’s a question running through my brain as I head towards the birth of my first child!

Hulda responds:

Yes this is a fun question and if you asked 20 people this question you would get 20 different answers.  The most important aspect of planning for any birth is remembering that it is your birth, no-one else’s and that you do not need to live up to anyone’s expectations.

Take an active part in the birth, find out information beforehand, communicate with your caregivers as to how you would like the birth to go, and then be open to whatever happens.  As with anything we do in this world, for instance driving a car or getting onto a plane, we assess the benefits and risks and decide which ones we are happy to accept, and which we would prefer to avoid where possible.

The cascade of intervention is fairly well known meaning that the more intervention you have within the birthing process, the more you are likely to have.  Therefore if you want to avoid an assisted birth, either vaginal or caesarean, then the better option is to avoid interventions/ medications where possible.  There are side effects and associated outcomes with the various forms of analgesia, which generally are treatable or manageable, and you need to consider whether you are happy for your baby and yourself to be exposed to these risks.

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Low-lying placenta

Posted on 19 April 2012 by Annerley

My obgyn has told me that I have a low-lying placenta so I may need a c-section. Why is this? Do I have any hope of a natural birth with this condition?

Hulda responds:

With regard to low lying placentas (as with one of the later questions) there are degrees of this.  Often women are told early in the pregnancy that they have a low lying placenta, only to find that as the pregnancy progresses, the lower segment develops and the placenta moves further away from the opening.   So yes you have every hope of a natural birth.

As many as 15% to 20% (one in 5-6) of pregnancies have a low lying placenta. Fortunately, only 5% (one in 20) of these remain low lying at 32 weeks and only one third of those are low lying at term (37 weeks). After 28 weeks, a low lying placenta is known as placenta praevia.

The degrees are often called grades and the most severe is when the placenta sits completely over the cervix.  In terms of having a vaginal birth, this causes problems in that the baby cannot be born through the placenta and the placenta cannot be born before the baby, so in this instance the baby must be born by CS.  There are then lesser grades where the placenta either touches, or sits close to the edge of the cervix.

At approximately 32-36 weeks you should have a repeat ultrasound,  if at this stage the placenta is covering the internal cervical opening then that is an indication for a CS, however as stated earlier, by this stage most are clear and the baby is able to be born vaginally.  Indications that the placenta is still low could be bleeding or the baby failing to move into a position optimal for birth.  If the baby’s head is moving into the pelvis then this is a good sign that the placenta is not causing it any problems.

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A Natural Birth Story

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A Natural Birth Story

Posted on 20 March 2012 by hulda

Do you have any natural birth stories to share? We’d love to hear your stories. Email your story to us at hulda@annerley.com.hk.

Heather from Pangea shares her story:

My name is Heather Cogan and three months ago I gave birth to my first son, Noah. I choose to deliver naturally (so no drugs) and after 14 hours of labour gave birth to our baby … all 4.5 kg of him and left the hospital the same day. On the way to the hospital my husband John and I felt calm, excited and prepared for what was to come and I put it all down to the help we received from the Annerley team and the daily Pilates routine I followed at Pangea.

I have been teaching Pilates for 8 years and started my own training 12 years ago. So Pilates and I go way back. Having taught over 62 pregnant women in the past, I knew a lot about what to expect and how to prevent many of those nasty pains related to changes the body goes through whilst being pregnant. To name a few, sciatica, lower back pain, upper back pain, shoulder and neck tension, hip displacements and so on. So I was looking forward to practicing what I preached.

I practiced pilates anywhere between 15-60 minutes daily. The aim was to keep my spine as mobile as possible and strengthen certain areas in my body to cope with all those changes. I also regularly practiced a few of my chosen birth positions recommended to me at the natural birthing course at the Annerley.

One of the most effective methods to reducing aches in my body was correct standing, something so simple yet so many pregnant women fall into terrible posture which leads to real discomfort and pain. However, its easier than I had imagined to let gravity have its way and draw you into bad posture whilst pregnant so brining your awareness to standing correctly is essential. I thought about it as much as I could, in the shower, standing in line and at the beginning and end my exercise and it made such an amazing difference. It kept my awareness deep inside my body so that I could cope with the huge weight spread round my center, rather than giving into gravity waddling like a duck.

No one can really describe to you what your pregnancy, and birth experience will be like, because like our children, they are all so different but once you meet the baby that has been kicking your ribs, keeping you up at night, pushing down on your bladder and caused you embarrassing episodes of flatulence, it all seems worth it.

Three months down the track Noah is already wearing 6-9month old baby clothes. I have enrolled him in a baby massage course with the Annerly team which I know he is looking forward to. I have upped the intensity of my own pilates training and I am feeling fit and mobile once again, and can fit back into my skinny jeans. Hurrah!

Heather Cogan
Head Pilates Teacher
Pangea – Align Fitness
www.pangea.com.hk 

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Natural births in Hong Kong

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Natural births in Hong Kong

Posted on 20 March 2012 by hulda

Every pregnant woman wants a healthy baby and a good birth experience and many women also say they want a ‘natural’ birth.  The term ‘natural’ can mean anything from a vaginal birth to an undisturbed home birth and for women in Hong Kong – depending on various factors such as budget and where you live – there are several different options available:

Natural birth

If we are to assume a natural birth means a birth where there is no intervention, most midwives will agree that preparing well for the birth is important. Also, the location and those selected to be present will strongly influence the outcome. Choosing a doctor and midwives that have good statistics for normal birth (for example, a C-section rate below 25 percent), and also a hospital that not only has staff but also facilities to support a natural birth is obviously important too.

Other factors that will contribute to a the likelihood of a natural birth are, for example, whether you can stay at home during the early stages of labour, being mobile and active at this time, eating and drinking regularly and choosing a position that feels good when you are actually giving birth.

Many women are quite vulnerable when they are in labour and as a result they fall into a role of a patient rather than following their own instincts – which in returns makes all of the above hard for them.  Furthermore, even though it has been long proven by research, some hospitals and doctors have a policy that all women must be in hospital right from the earliest signs of labour, lie in bed during the whole labour and birth, have continuous monitoring of the baby’s heartbeat, give birth in a hospital bed (and sometimes in stirrups) and have a routine episiotomy.

Many women don’t even dare to question this as they may have been told that this is the safest way to give birth. One only needs to look for evidence-based guidelines about maternity care, such as the NICE guidelines that are used in the NHS in the UK, to see that this practice is no longer recommended for women who are not classified as high-risk patients.  So if you are truly seeking a natural birth, it is useful to look at the birth places available in Hong Kong and what they have to offer.

Where to give birth in Hong Kong

In Hong Kong, people have the option of private or public health care.  The public hospitals here offer excellent maternity care and are both professional and have good statistics when it comes to natural birth and interventions.

Their main disadvantage is probably the fact that they are busy and the staff cannot provide continuous care which means that it is not as personal as some would like. Also, there are quite a few “rules” and protocols that are followed more strictly than in private hospitals.

One of the main advantages of public hospitals is that they are very well equipped with staff and tools for serious conditions, and for babies that are premature or ill — although luckily most babies are born healthy and well.

Also, in the recent years the public hospitals have started to offer more support for natural birth, providing birth balls, yoga mats, and the option for hypnobirthing methods and being mobile. The routine use of episiotomy has now finally been discontinued, which is great news to all childbearing women.

Private hospitals tend to be good here too. Care is usually given by a doctor you have chosen yourself and consulted with throughout pregnancy.  This means that you know who will deliver the baby, although the doctor is only there at the final part. Those who are considering private care will need to look at the budget, since private health care here is expensive and insurance does not always cover the cost.

In addition, although often very good, being at a private hospital does not necessarily mean you have more chance of a natural. In fact, the statistics for most private hospitals show us that C-section rates, epidural use, induction, and forceps and vacuum deliveries are much more common there, with C-section between 50 to 85 percent.

Either way, in my experience, both models are good for different reasons; in a private hospital the most important part is to choose a doctor who will truly support you, and regardless of where you give birth, you should prepare yourself since no one else will do the actual work for you AND – not less important, that you prepare yourself really well.

Home births

In some countries, home births are becoming increasingly popular and have been proven to be a safe option for healthy mothers in low-risk pregnancies. Those that fall into this category can expect to have an undisturbed birth in a private and quiet environment; and they should not expect to be induced, use medication or have any other intervention, since should these be needed, they would be transferred to hospitals.

Women who want a truly natural birth often opt for this and prepare accordingly. Outcomes are generally good, with only 5 – 10 percent of cases requiring a hospital transfer because of medical complications.

Many believe that home births are illegal in Hong Kong. This is not the case, although they are not supported here, nor is it easy to find staff that is willing or trained to assist.  As a result, home births are probably not as safe an option in Hong Kong as they would be in many other countries. This does not mean that it is impossible and with the help of skilled midwives and the correct preparation, a homebirth can be an option for those women who are low risk.

Doula care

To have appropriate support while in labour is so important and that person can be a husband, family member, friend, midwife, or doctor – but whoever it is, good support is invaluable.  And by good support I mean support that is on your terms. This is why it is important for those that are with you during labour and birth know you and understand what you want.

Doulas have existed for centuries and their role is to be exactly this; to provide support on your terms. They provide everything from psychological support, to physically massaging and coaching you through the birthing journey. Doulas help women to stay at home as long as they feel comfortable and then continue to help them while in hospital.

I have been a registered midwife here in Hong Kong for many years now but since midwives do not have admission rights in private hospitals and have to speak Cantonese to work in the public wards, I have not been able to provide a one-stop pregnancy and birth care service.  I have however, found myself in the role of a Doula, or birth support many times. The experience of doing this has been invaluable and given me insight into all the different birthing options that Hong Kong has – including all those that I have explained above.  It has also frequently reminded me of the fact that we professionals so often forget; that each family is unique and each birth is too. It is not just an event that results in a safe birth, but a family event that has an everlasting imprint on everyone involved and it should be treated with such respect.

More doulas are now available in Hong Kong which is a fantastic thing.  Donna Watts, our excellent early childhood nurse has just done her doula training and within Annerley. Donna, Eugenie, Rovena (and Tamara on South Lantau) and myself can offer women continuous support through labour at home, and sometimes even in the hospital. We also work with other very good doulas to provide excellent care.

Prepare well

To all pregnant women I would suggest:

  • Before the birth, ask the doctor/midwives about their statistics and how they routinely work.
  • Ask how much they will be there during the labour.
  • Tell them in advance what your thoughts are.
  • If you do a birth plan, make sure that it is short and only contains the things that are very important to you, but not the details of medical care.
  • Be firm, but polite.

If medical intervention is offered ask:  Why?  Can we wait?  Is the baby in danger?  Are there any other options? Remember that the staff takes usually extremely good care of safety but they pay less attention to comfort – this is something you must do.

Hulda Thorey, 2012

 

Points to remember regarding hospitals:

Public hospitals: 

Possible challenges:

  • You can only have your husband / one support person with you when you are in established labour, i.e. after around 3 cm of dilation.
  • Sometimes mobility is a bit restricted.
  • Drinking and eating is no encouraged, but you can do it anyway.
  • You cannot take showers or baths during the labour, there is no access to toilet or bath.
  • Episiotomy is very common in some hospitals, but you can usually say no to this.
  • There is less privacy and sometimes staff will come and go.
  • When your baby arrives, it is usually taken away for a check-up. Again, you can suggest otherwise.
  • Breastfeeding is supported but sometimes the staff do not have much time to assist.

On the positive side:

  • The staff are very professional and practical, and being teaching hospitals, the staff follow protocols; things are not done for personal convenience or financial gain.
  • Most public hospitals do have private rooms and allow “props” to be taken in, once you are in established labour.
  • Most wards have TENS machines and the midwives are trained to give massages and support natural births.
  • You can usually get your way if you are polite and resourceful.
  • Major medical interventions are much lower than in private hospitals.
  • Epidural rates are much lower than in private hospitals, but they are available.

C-section rates much lower than in private hospitals.

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