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24.01.2022 INDUCTION SERIES - Gestational Diabetes Pregnancy changes the way the body responds to insulin. The placenta produces hormones that support the baby’s growth an...d development. From 20 weeks gestation these hormones cause insulin resistance in the mother’s cells. Cells that are resistant to insulin are less able to convert glucose into energy. . However the pancreas increases production of insulin during pregnancy to compensate for insulin resistance. This additional insulin keeps blood glucose levels within a normal range. In gestational diabetes the pancreas is unable to secrete enough additional insulin to maintain normal blood glucose. . There is disagreement about the best approach to gestational diabetes testing. In Australia we offer routine testing and in recent years the range of ‘normal’ has been lowered and therefore more women are being diagnosed. . In the UK, NICE (National institute for Health and Care Excellence) warns that routine testing can lead to over diagnosis, which can lead to increased antenatal monitoring and increased interventions particularly induction without significantly improving outcomes, so they now only test women who have significant risk factors. . Determining risk in gestational diabetes is complicated. The research into gestational diabetes does not distinguish between women with pre existing diabetes and those of pregnancy induced diabetes. The treatment of gestational diabetes aims to see blood glucose within normal limits, either by diet and lifestyle changes or by medication. . Complications for women with abnormally high blood glucose levels in pregnancy include, pre-eclampsia, excess amniotic fluid, postpartum haemorrhage, infection and is more likely to develop type 2 diabetes after pregnancy. High levels of insulin in the baby’s body stimulates the growth of organs and results in excess fat around the abdomen and shoulders. Larger shoulders can increase the chance of baby having difficulty getting through the pelvis. After birth babies need to readjust their insulin production and are often given formula to increase their blood glucose levels which can disrupt their gut microbiome and interfere with establishing breastfeeding. . Another way to manage this Is for women to express colostrum from 36 weeks, freeze and store so they have additional milk supply for baby the first few days. In relation to induction, a recent Cochrane review concluded that there is insufficient evidence to demonstrate differences in outcomes for women with gestational diabetes and their babies if they have labour induced or wait for spontaneous labour. The World Health Organisation (WHO) and Australian guidelines both state that if blood glucose is well managed there is no indication for induction for gestational diabetes. If a woman with gestational diabetes keeps her glucose within normal limits, her chance of complications is the same as a woman who does not have diabetes. . ( Information sourced from Evidence Based Birth and Rachel Reeds book - Why Induction Matters. We also encourage all women to have open discussions with their care providers and make a decision that feels right for them ) . #aboutbirth #aboutbirthonline #onlinebirtheducation #positivebirth #midwife #homebirth #laelandjules #empoweredbirth #labour #obstetrician #hospitalbirth #callthemidwife #vbac #duedates #skinonskin #birthplans #drugsinlabour #breathingtechniques #partnersupport #prelabour #watersbreaking #membranesrupture

18.01.2022 A new Australian study comparing perinatal and maternal outcomes of low - risk women across different planned places of birth has just been released! The study... by Homer and others reported that the odds of a 'normal labour and birth' (I.e. No augmentation, epidural/spinal/general anaesthesia, episiotomy, ventouse/forceps extraction or caesarean section) were twice as high in a planned birth centre birth, and almost 6 times as high in planned home births, compared to planned hospital births. Additionally, there were statistically no significant differences in stillbirths, early or late neonatal deaths between the three places of birth. The ICU admission and readmission to hospital statistics listed here are for the women, but the study also looked at neonatal ICU/SCN admission and readmission to hospital in the following 28 days, and they are consistently lower for planned homebirths vs. birth centre or hospital births. This study really exemplifies why your choice of birth place (and typically, the consequent/subsequent choice of care provider) is so important! My biggest tip is to choose a birth place and care provider that aligns with your desires for birth If you desire a 'normal labour and birth' (I.e, minimal intervention) then birthing in a birth centre or at home is going to give you the best chance of achieving that #birth #birthaims #birtheducation #birthcentrebirth #birthcentre #hospitalbirth #homebirth #research #birthdoula #bluemountainsdoula #lithgowdoula #nepeandoula #hawkesburydoula #BRAIN #pregnancy #birthplan #birthplace

14.01.2022 INDUCTION SERIES - Vaginal Birth after Caesarean . In Australia, 34.6% of women are giving birth by Caesarean section and for many women who choose to have ano...ther child, they need to consider whether to have a repeat caesarean or plan for a VBAC (Vaginal Birth after caesarean). . The main risk of trying for a VBAC is Uterine rupture, which is a rare complication and occurs in less than 0.5% of VBAC trials and is 0.9% for women who have had more than one caesarean. In most cases of uterine rupture, the complication is identified and a repeat caesarean is performed. The chance of stillbirth and infant death during a VBAC labour is extremely low and comparable to the risk of a woman having her first baby who hasn’t had a previous caesarean. . The alternative is having a repeat caesarean which also has risks. Caesarean complications include bleeding resulting in a hysterectomy 0.7%, bladder or bowel injury 0.1%, infection 6%, readmission to hospital 5%, and persistent pain in early months 9%. Babies who do not experience labour are more likely to have respiratory difficulties and miss out on being exposed to vaginal bacteria affecting the gut microbiome. . Planning for a VBAC requires commitment from the birthing woman, research and planning to find a module of care/care givers that support her choice for a VBAC. . ( Information sourced from Evidence Based Birth and Rachel Reeds book - Why Induction Matters. We also encourage all women to have open discussions with their care providers and make a decision that feels right for them ) . #aboutbirth #aboutbirthonline #onlinebirtheducation #positivebirth #midwife #homebirth #laelandjules #empoweredbirth #labour #obstetrician #hospitalbirth #callthemidwife #vbac #duedates #skinonskin #birthplans #drugsinlabour #breathingtechniques #partnersupport See more

10.01.2022 Homebirth Newborn Resuscitation ~Potential trigger- newborn resuscitation~ One of people’s greatest concerns about homebirth is-... What if my baby isn’t doing great at birth? These photos give an insight into homebirth resuscitation. The differences with hospital resus? The baby stays attached to the mother. In most hospitals in Australia the first thing that happens is the umbilical cord is cut and the baby is taken to a resuscitare on the other side of the room. At home, the cord is left in tact so the blood flow from the placenta continues to go to the baby, giving them essential red blood cells to oxygenate their blood until their breathing is established. The baby is moved and massaged, blown on and talked to to stimulate their reflexes. If this doesn’t work, room air is bagged into them through a mask (or mouth) to help trigger their lungs to breathe. In a lot of cases, this is enough. If it isn’t, there is a tank of oxygen close by, ready to administer. You’ll see in these photos, the baby stays attached to her mother, everyone keeps their calm and the midwives methodically step their way through these processes. You will also notice the mother holding on to the cord to check it is still pulsating, giving reassurance her baby is receiving what it needs. You will also see the midwives assessing the baby’s heart rate throughout with both touch and stethoscope. Everyone is informed every step of the way, and everyone is involved. I am all too aware that a resus is not always this straightforward, and that babies can need a lot more help. What happens when, for example, the baby needs chest compressions (which are necessary when the fetal heart rate is below 60 bpm or if ventilation doesn’t increase the heart rate to above 100 bpm)- in that case the woman is asked to get out of the pool and CPR is still commenced with an intact cord. As the first line of action- doesn’t leaving the cord in tact make a whole lot more sense? . A recent study found it does. Intact cord resuscitation versus early cord clamping in the treatment of depressed newborn infants during the first 10 minutes of birth (Nepcord III) a randomized clinical trial- found that the newborn’s oxygen saturation (Sp02) and APGAR scores were higher at several measured points after birth along with other benefits such as both initiation of breathing and respiration rate when a necessary resuscitation was done bedside with the cord intact on an infant who was not breathing at birth. Midwives- Midwife Jo and Jacqui Wood Mama- Birth Aims - Doula Aimee Sing Aimee Sing . Thank you all involved for your willingness to share this moment. . #homebirth #birth #waterbirth #midwife #midwives #birthphotography #sydneybirthphotographer

01.01.2022 Confirmation the full beneficial hormonal effects of natural oxytocin release in the body and maternal brain are not replicated through infusions of artificial oxytocin during labour. Wherever possible physiological labour must be supported. https://rdcu.be/bOg4v