The landscape of labour and birth in 2020 is vastly different to how it was 20 years ago (not just because of COVID!). Statistics show that the number of women with complications during pregnancy is significantly higher that it has historically been. The two main contributing factors to this are maternal age and obesity.
Improved opportunities for women in terms of education, travel and career, improved fertility treatments such as IVF and social and cultural factors such as isolation from extended family and financial cost have influenced many women to choose to start a family later in life. The percentage of women having babies when they are over the age of 30, has risen from 23% in 1991 to 48% in 2016.* Pregnancy over the age of 35 is associated with an increased risk of many complications including preterm birth and diabetes
The prevalence of obesity is increasing worldwide. In 2016, 39% of adults aged 18 years and over were overweight (BMI from 25 to 29.9), and 13% were obese (BMI >30) – that’s almost half of all adults! Matching this, nearly half of all mothers in NSW were overweight or obese in 2018.*
Obesity is associated with an increased risk of almost all pregnancy complications, such as: diabetes, preeclampsia, post partum haemorrhage, large baby and more. In 2018, over 13% of women had diabetes in pregnancy and one in three mothers gave birth via Caesarean Section.
So that’s a lot of bad news for expectant mothers! What can they do about it?
Planning for pregnancy
If you are planning a pregnancy and you are overweight, the single most important thing you can do to improve your chances of a healthy pregnancy and birth is to get your BMI back to between 18.5 and 24.5. If you are already pregnant, then maintaining a healthy weight gain is key.
If I develop complications, how will they impact labour and birth?
Should you have complications in pregnancy, there are lots of things you can do that can improve the likelihood of having a healthy baby, normal birth and a positive experience of labour.
The most important thing to understand is that your labour will be managed differently from women who have no complications.
How will it be different?
1. You are more likely to be recommended Continuous Electronic Monitoring during labour. This is involves two monitors being strapped to your belly: one measuring the baby’s heart rate, and one measuring the frequency of contractions.
2. There will be more frequent interruptions in the form of conversations, observations and examinations of you and your baby.
3. You will most likely be offered a different set of choices than someone who doesn’t have complications in pregnancy. For example an induction of labour or additional ultrasound scans. You many also have less choice when it comes to labour and birth. For example, you may be discouraged from having a water birth or labouring at home for as long as possible in the early stages of labour.
Preparing for birth
Because of the above, women with complications in pregnancy are less likely to have long periods of quiet time during labour. Traditional birth classes teach women the importance of a birth space that is quiet and dark that will allow the hormones of labour to work their best, but it is more difficult to achieve this when you are being frequently interrupted. These interruptions take women out of the lovely “birth zone”. Many women have an expectation that they will manage labour using popular relaxation methods, and are disappointed when things don’t go to plan.
Not only do the women become annoyed because the techniques they are trying to use don’t seem to be ‘working’, but the frustration and disappointment also interrupts the flow of labour hormones. This slows the progress of labour, leads to an increase in the experience of pain and the need for more pain relief, in some cases the baby can become distressed and there is an increase in interventions overall.
No wonder some women feel their bodies failed them or that their birth was traumatic.
BUT, it is possible to achieve the birth you want, it starts with a different kind of preparation.
What can you do?
1. The most important step is to be informed. Learn all you can about your specific circumstances. Don’t rely on google or other people’s experiences (from chat groups), find out from your Health Care Provider or other reputable sources such as Diabetes Australia or NSW Health.
2. Develop a good collaborative relationship with your Health Care Provider. Ask them how they propose to care for you during labour and birth. For example, do they recommend monitoring, an induction, or anything else specific to your situation?
3. If you have had a previous difficult birth, or even an experience that didn’t match your hopes, it can be helpful find out what happened. You can ask to look at your old notes with your Health Care Provider and/or debrief the birth.
4. Prepare, prepare, prepare. If you are planning a vaginal birth, it is important to understand the reality of what the day will actually look like and not to expect the ‘wished for’ quiet dark room with no interruptions.
5. Being active during labour and birth is still really important and achievable, even with interruptions. It will be slightly different when you’re connected to a monitor, but you can still adopt positions that are helpful for birth and comfortable. The midwives can help you with this – you don’t need to labour in bed just because you are on a monitor!
6. Relaxation techniques are also really important for helping women have an optimal level of good labour hormones. The key is preparation and practice of not only the technique itself but also how to come in and out of the relaxation smoothly.
7. Have realistic expectations. Understanding what your carers will be doing, how often and why will also help labour hormones flow, because you will feel safe and calm.
Women are much more likely to have a positive birth experience when their expectations match the reality of their situation, they have a collaborative relationship with their Health Care Providers, are well informed and supported in their choices.
Despite the challenges faced by women giving birth in 2020, there is still a lot within their control. Preparation is instrumental in achieving the best possible outcomes.
*Sources:
NSW Health Mothers and Babies Report: https://www.health.nsw.gov.au/hsnsw/Pages/mothers-and-babies-2018.aspx
WHO International:
https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
Prepared for Birth is an online business providing antenatal courses for women who have more complicated pregnancies. In particular they focus on women planning a VBAC (Vaginal Birth after a Caesarean Section) and women with Gestational Diabetes.
Our expert Jodie is a Clinical Midwifery Consultant who has worked with hundreds of women with complications in pregnancy preparing for labour and birth. She was constantly frustrated by the lack of information in traditional birth classes for these women, and how they weren’t prepared for the reality of what they were going to experience during labour, what their choices were and how they could navigate it differently. Years of working with women with higher risk pregnancies who desperately wanted a normal birth was the inspiration for starting the Prepared for Birth business.