What to discuss with your obstetrician or midwife before birth
You are in charge of birth experience – that’s the message Midwife Tylah wishes more mums knew.
Speaking to Tell Me Baby for our new TMB TV series, Pregnancy, Birth & Beyond, Tylah, who is a midwife based in Sydney, says: “I wish women knew the amount of control that they have over their care.
“If you put in the research and you look at your options, you really can help control the outcomes.”
While every woman’s birth experience is different, the time for speaking up is before birth. Don’t be afraid to air any concerns you have, or to express your wishes for your delivery. (You can also read our article about online resources to help you prepare for birth.)
Watch our interview with Midwife Tylah (article continues below).
Conversations to consider having before birth
On tearing
If you’re afraid of tearing, you’re not alone. Tylah says this is common.
“This is one of the most common concerns in childbirth, and I completely understand why,” says Tylah.
Thankfully, there are a few things you can do to reduce your chances of tearing. “The number one thing I recommend is perineal massage. Essentially, it’s using massage on the perineum – the skin between the vagina and the anus. Start to lubricate it and stretch it out,” she says.
In fact, according to the Mater Mothers’ Hospital, research shows women who practice perineal massage (from 35 weeks), have a lower risk of severe tearing.
You can also ask about using a warm compress. And if the pain is something you’re worried about, “you’ve got the option of the epidural. But your care providers are also able to put local anaesthetic into your perineum,” says Tylah.
“I would be having these conversations early and putting a plan in place, so that you can feel at ease when you get in that birthing room.”
Pain relief
If having an epidural is something you’re unsure about, it’s important to air those concerns before giving birth. The good news is that you don’t have to make a decision right away.
“Why not just step up as you go,” says Tylah. “Start with a heat pack and with massage, then work your way up to using the shower or bath. Then consider morphine, and there’s also gas. You do have all these options if you’re hesitant to consider the epidural.”
It’s about planning your pain-relief wishes and saying, “I would like to try this.” That way, you can keep your options open.
Skin-to-skin
If you’re having a c-section or have been diagnosed with gestational diabetes, you might be wondering if you can still have skin-to-skin time after birth.
“If you’re on insulin and they recommend your baby go to nursery, say an hour after birth, you can still have that skin-to-skin time,” says Tylah. “You are still well within your right to have that.”
“This is such an important discussion to have in that antenatal period to make sure there’s a plan in place. Say ‘I would like the baby with me as long as possible.’ And, ‘I would like to know exactly what’s going to happen.'”
The same can be said for women who are having a caesarean. “Most hospitals are adopting what we call skin-to-skin during caesarean sections. That is when a midwife will stay with you, and you can have baby on you straight from the caesarian section. So you don’t have to be separated from your baby at all. But again, it is really important to see what your hospital does specifically.”
Vaginal birth after caesarean
“If you have this preference for attempting vaginal birth after caesarean, you need to start having those discussions early and not be discouraged,” says Tylah.
“They are going to present you with a series of risks to help you weigh up your decision.”
So be prepared for this.
“If you can premeditate that and start to research and start to consider what you might like to do, and go in strong and informed and aware of your choices – that’s really important,” says Tylah.
Formula feeding
If you want to formula feed your baby from birth, Tylah says, “Public hospitals do have a no-formula policy, unless it’s for medical intervention. However, you’re completely within your right to bring your own formula and use that.”
Have that conversation with your care provider but also call your hospital to find out their policies.
“Nowadays, most midwives are pretty open-minded to what you want to do. And we do practice women-centred care,” says Tylah. “However, I can’t promise that that’s going to happen in every postnatal ward around the world. Look at your hospital policies, call the postnatal ward and have these questions answered before giving birth.”
As hard as it can be to air your concerns when being rushed in and out of appointments, Tylah wants to reiterate that “you’re completely in control and if you feel in control, you feel comfortable.”
“Start building that confidence in yourself,” she says. “Trust your mother’s instinct and the decisions you make for yourself because that’s something you’re going to need to build and carry out throughout the whole of parenting.”
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