Low Lying Placenta

Worried about your ultrasound? Told you have a low lying placenta?

So many women are told this at their early ultrasounds and then asked to check back at about 32 weeks.

They spend the next 10 weeks of pregnancy worrying and panicking, thinking they may need a caesarean or that there is something “wrong”. Only to be told at the next ultrasounds that “its okay” , “its moved up”.

Congratulations on finding and reading this blog! You will be able to understand the situation now and see that the chances of your placenta being any problem for birth is extremely low – it is most likely that all is very normal and very well 🙂

What IS happening?

Following conception, the placenta implants itself somewhere in your uterus, in no specific position. It may implant low, high, posterior (back) or anterior (front).

In your first and second trimesters, the uterus still has much growing to do, so an ultrasound late in your third trimester (after the uterus has finished growing) will give you and your doctor or midwife a better picture of what’s really going on.

An ultrasound may show that a placenta is near the cervix in early pregnancy. But, only a few women will develop true placenta previa. It is common for the placenta to move away from the cervix as the uterus grows. Only two to five percent of placentas that are “low lying” end up grade three or grade four previas by full term.

If the placenta does remain near or over the bottom of the uterus neck at the cervix, then there can be signs or symptoms to look out for:

Sudden, painless, bright red vaginal loss, usually in the later half of the pregnancy
Painless vaginal bleeding after sex
Uterine cramping with bleeding
Bleeding during labour

How Close To The Cervix Can My Placenta Be?

Doctors have different limits for how low they are happy for the placenta to be before they will tell you that you shouldn’t have a vaginal birth. It can be useful to get second/third opinions on a low placenta if you would like to avoid a caesarean section. Some doctors will be happy with the placenta to be above 2cms (20mm) from the os (cervix) and some prefer 3cms (30mm).

Get informed, find out what distance the placenta is from the cervix and ask your doctor or midwife if they would be willing to support your wishes for a vaginal birth (should it not move, as well as what measurement they want it to be).

What else you can do?

Insist on a tansvaginal scan to get a thoroughly accurate picture of what’s happening.

Transvaginal ultrasound scan is more accurate to assess placenta previa, trans abdominal scan usually over diagnosis it in up to one-fourth of the cases.

MRI: Can clearly outline the location of a placenta previa, but it is much more expensive and less readily available.

Birth Story PND Mental Health

‘My birth story, speaking the truth’ – Shared by a local Newcastle Mum

(Although this mother wishes to remain anonymous for now, she is choosing to share to help normalise and speak out about Post natal depression and mental health struggles for women).

“My husband and I had been talking about starting a family for some time but struggled to find the ‘right’ time. I had started a new job and was throwing everything into my work. We had also just moved into a rental property and were looking to buy a house. With everything in flux, I was determined to get settled into work and a new house. But my body had been aching for a baby. Everyone seemed to be pregnant or holding small children.

When we found out we were expecting a baby we were in shock as it was our first month of trying. We expected, especially after my complications with Hypothalamic Amenorrhea, to have to wait a long time to fall pregnant. We felt so lucky and relieved and nervous. It was the hardest secret to keep. I was very, very lucky to experience a wonderful pregnancy with little sickness or pain.

We decided to make a decision to change our birthing plan at about 22 weeks. Before then I had been seeing an obstetrician through the private hospital but I had been thinking about other options. Another woman I knew had a midwife and a natural birth and I had been reading into Hypnobirthing. I decided one day, just when I was about to book into the private hospital prenatal classes, that I would call a local Hypnobirthing specialist, and ask some questions. Our conversation was everything I was after. Natalie also pointed me in the direction of the Belmont Midwifery Group Practice, where natural, drug-free births take place at their birthing suites or at home. I called them and had a midwife arranged. Within a week or so, we had completely changed our plans and we couldn’t be happier.

I began devouring information on the birthing experience. I read and re-read ‘Hypnobirthing: The Mongan Method’ (my husband read this one too, which was helpful). I fell in love with books by Ina May Gaskin and learnt about acupressure for birth (which we completely forgot to use). I watched Ted Talks and read blogs. I learnt all of the hypnobirthing terminology and knew about each phase of labour. I had become a complete birth nerd.

When I got to 38 weeks, I was sure labour would start soon. My mother had wonderful pregnancies and delivered three times at 38 weeks and I am just like her. But for two long weeks I bounced up and down on my yoga ball eating pineapple and curry.

At 40 weeks and 1 day, I started experiencing contractions (or surges, for the hypnobirthing folk out there) at around 10:30pm that came every ten minutes or so. I was able to get a couple of hours of sleep but woke up at about 4am. I drew a bath, diffused Clary Sage and told my sleeping husband that today would be the day.

Dinner time rolled around and I was still experiencing contractions every ten minutes. That night I got very little sleep as I was awoken every ten minutes- just as I’d start to doze off. I also reheated the wheat bag about twenty times! I made sure my husband slept through all of this because I knew I would need him when labour began.

By Sunday I was sick of being housebound and certain that I was never going to have a baby, so we decided to take our mind off things and keep me active with a little Christmas decoration shopping. I rested on seats at the shops and held on to reindeer or Christmas trees when the contractions were too strong. We decorated the tree when we got home and I took another bath.

That night, we went to a family birthday party as it was close to home and I was feeling up to it. When I was at the party, I noticed the contractions were getting closer together and I was struggling to hold conversations. I struggled to get through my lemon meringue pie (a sure indication that something was happening) and we decided to head home early.

Before bed, I had another bath to soothe my aching back. The moment I got into bed my waters broke, which I never expected to happen! My husband called the midwife and told her what had happened. There was no rush at this point- I was to wait until I had four contractions in ten minutes. But contractions started coming hard and fast so we were to head straight into the birthing suite.

When we reached the birthing suite, I got straight under a hot shower and then spent several hours in the bathtub. I found at this point that I could not focus on the meditation tracks but preferred soothing music. The midwives checked me routinely and wiped my forehead with a washer soaked in icy water. It was bliss! They left us to be on our own for most of my labour, which was exactly what we wanted. I was using the hypnobirthing balloon meditation through each contraction, focusing on a variety of colours which ended up following a particular pattern. This technique helped me to focus on my breath and an awareness of expansion rather than contraction.

belmont midwifery group practise

After several hours and position changes, I got out of the bath. My midwives recommended sitting on the toilet. I took whiffs of Clary Sage and held my husband tightly. I was finding labour incredible intense at this point and was losing energy.

I looked at the bed and knew in my gut that I had to lie down and rest. My contractions had slowed and lost intensity but my baby’s heart rate was strong. My midwives observed that I was dehydrated and would need to drink water or have a saline drip. I tried drinking a fair amount of water followed by a sip of my husband’s orange juice but ended up vomiting. I had the drip and focused on relaxing my body, which wouldn’t stop shaking.

I fell into this strange yet blissful state that lasted hours. I felt contractions coming and going, but also drifted in and out of consciousness. My husband, too, doesn’t know what happened between about 2:30 and 4:30am!

My contractions strengthened and a wave of energy came over me. After about 54 hours of regular contractions, I was on my last legs. I moved to the birthing seat and found the handles to be life savers. One of the midwives took some incredible, raw photos at this point, which I look back on sometimes to remind myself of my strength.

I definitely didn’t employ the gentle birth breathing I’d prepared for – I was pushing with all my might! The midwives were great at helping me channel my remaining energy into birthing. At 6:43am, our darling little boy made his way into the world and into the hands of his father. He was put up on my chest and made his first cries. I truly couldn’t believe what was happening and joined him in the crying!

He stayed on my chest for some time after that. I had learnt that newborns go searching for the nipple when they’re born and I wanted to see if he would too. He did, and with a little help we were breastfeeding.

After our first breastfeed, we phoned our parents and our midwives did all of their measuring and weighing. I also needed to have a few stitches. We were going to have our parents visit us at the birthing suite, but after a quick shower and another breastfeed we were ready to head off and decided to meet them at our house. They brought around morning tea and we settled in for a cuppa.

Belmont birth

My mum stayed for the whole day (and came over on many days after that!), allowing my husband and I to catch up on some sleep in the afternoon. Our midwives visited daily for a week or so to check in on all of us. And from then on, we were parents!

While I was very fortunate to experience such positive pregnancy and birthing experiences, I was one of the many women who struggled with mental illness following the birth of their first child.

I had always assumed that if I had a wonderful pregnancy and birth, the postpartum period would be wonderful too. If only life were that clear-cut!

What I haven’t included in my birth story is my mental health struggle with Obsessive Compulsive Disorder (OCD) and anxiety that re-emerged a week before my baby was born.

OCD is an anxiety condition that affects about 3% of people. A common, well-known form is contamination OCD, such as the fear of germs or diseases, but OCD encapsulates any obsession that causes thoughts, images or doubts to loop in your mind, along with the resulting physical or mental compulsions (such as hand-washing or rumination).

I had previously dealt with what I believe now was OCD a few years prior. I had been travelling overseas on holidays with my husband during a frantic time in my career. A doubt that I would never sleep again came into my head somewhere between the jetlag and the work stress and I couldn’t let it go. I spent much of my ‘holiday’ awake, crying to my exhausted husband in bed, or on the phone to my mother, or avoiding caffeine and late nights and alcohol and anything that could interfere with sleep, fearing it from morning until night.

belmont birth mental health

It ebbed and flowed for months after out return home. I didn’t seek treatment other than the standard sleeping pills and vitamins. Eventually, life came back into the picture and the fear was buried.

This experience set the stage for what occurred before my son’s birth. A week or so before my son was born I woke up at 2am. I was used to waking up throughout pregnancy and my sleep had been overall excellent. But this time the doubt struck again. What if I can’t sleep when my baby arrives? This then spiralled into many other doubts- what if I can’t sleep well enough before the birth and I’m too exhausted to deliver? What if this causes postnatal depression? What if I can’t take care of my baby? What if I blame my baby for this? What if I then don’t love him/her?

I struggled with these doubts and with sleep for several months. Even when I’d have a good night of sleep (carefully added up first thing the following morning), I’d still spend the day gripped by anxiety and fear. Unfortunately you can’t rationalise with OCD! I sought therapy at this point, which helped a great deal. My anxiety decreased and sleep improved, but I still hadn’t addressed it to the extent I needed to and as such, a new obsession emerged. It was at this point that I was diagnosed with OCD.

My obsessions have changed several times in the past year and I am still tackling this condition one day at a time. Therapy, medication, exercise, meditation, yoga and supplementation have helped a great deal, as has sharing my struggles with friends and family and letting go of my perfectionist tendencies. 

For baby number two, I’ll make use of the techniques I’ve learnt through Natalie and her private Birth Education and hypnobirthing. I’ll also apply Acceptance and Commitment Therapy (ACT) strategies that I’ve developed in my mental health journey this year. While two differing practices, I believe they both have wonderful insights to offer and that it’s important to personalise your approach to birth, just as you do to your life.

If there’s anything I’ve learnt through my pregnancy, birthing and postpartum experience, it’s that life – just like birth – is often that bit messier than we expect it to be.

Although this author wishes to remain anonymous, she shares her very personal story to help normalise and speak out about mental illness struggles for mums.

Click here for more information about Belmont Midwifery Group Practise

Click here for more information about Natalie and her Birth Education Services

NOTE: If you are experiencing mental and/or emotional struggles, call PANDA, free phone counselling for pregnancy and beyond: PANDA National Helpline (Mon to Fri, 9am – 7.30pm AEST) Call 1300 726 306 https://www.panda.org.au/info-support/support/calling-panda-national-helpline

and read more here: https://www.panda.org.au/info-support/postnatal-psychosis

Birth mortality rates – let’s get real

A sad, frustrating article was published to the public two days ago. Myself and fellow birth educators and birth experts were appalled at the inaccuracies and the fear mongering.

It is so upsetting, as we know that fear negatively affects birth.

Is journalism so sensationalist that it would propagate fear?

Wait, don’t answer that 🙁

IF you believed what you read in that paper? Claire Harvey is claiming to her audience that “half of all women and half of all babies used to die in childbirth”.

I was so glad to see Tanya Strusberg from BirthWell Birthright quickly write and publish an excellent response to Claires’ article.

Except, I was enjoying Tanyas’ article and then THAT sentence jumped out at me AGAIN! With Tanya stating: “However, in 1900, childbirth was to be legitimately feared. Almost half of all women would not survive birth“.

Okay, that myth has got to be debunked. That myth has become so deeply ingrained in society that even the most educated and passionate about birth can pass over it.

My investigation into the myth:

For perspective lets first acknowledge that Australias’ current mortality rate is extremely low at 7.1 deaths per 100,000. If we’re to believe that ‘half of women used to die in childbirth’ then that literally means that, at some time in history, childbirth was so dangerous it killed 50,000 per 100,000 women ?!??!

If you take the time to reflect on that (if you have the time – like me sitting at home with a newborn)- it makes NO sense at all. If half the women died, then the next year when most fertile women fell pregnant again, half of THEM would then also die. And the next year when again most fertile women fell pregnant again, then half of THEM would die. It would be very quick before there were no fertile women left! The young girls maturing to a fertile age would not be able to get there quick enough to continue the population onwards.

So, being a bit obsessive with birth matters, I set to researching.

In Barbara Hanawalts’ book “Growing up in Medieval London” On pages 43 and 234, the author cites 1,440 maternal deaths for every 100,000 births in 15th century Florence.

I found a very well referenced and researched article discussing rates around the early 1900’s. It looked at records from England and Wales from about the 1850s to 1937 and described mortality as “high” and staying at a steady rate in those years. They described the mortality at that time as much as “50 times higher than now”. Developed countries currently have 12 per 100,000 so I multiplied this by 50, and got a rate of 600 per 100,000.

The work by Wrigley and Schofield, who wrote a “population history of England” [Cambridge: Cambridge University Press, 1981] found maternal mortality rates were at ≈400–500 per 100,000 births throughout the 19th century. They state “it was a bit higher at the beginning of the 19th century and was up to perhaps 1,000 per 100,000 births in the early part of the 18th century”.

Here’s another quote from another writer discussing medieval history: “In fact, more than one of every three adult women died during their child-bearing years”. Notice how scary this sounds at first? If you break down this statement, it’s not so scary. If one woman in three will die “in her childbearing years” this could mean just anywhere between the ages of 14 and 45. It doesn’t mean that during birth a third of all women died.

It helped me see where the myth could come from.

Another article discussed that around 1620 “a woman’s chances of dying during childbirth were between one and two percent for each birth”. So mortality rates as high as 2,000 per 100,000.

None of these historians mention any mortality rate near 50,000 per 100,000. (thank goodness, otherwise birth really would be extremely dangerous and scary).

What about current mortality in developing countries? Where there is barely any obstetric or midwife support at all. Where water and nutrition are scarce. Where many populations are diseased or overcrowded. What is the mortality rate there?

In 2015 the maternal mortality ratio in developing countries was 239 per 100 000.

So next time you see the sentence: “half the women used to die childbirth”, be careful not to allow this to go unquestioned. If we don’t consciously question grossly inaccurate statistics – then we stand to accidently continue to perpetuate the negative myths and fears of childbirth.

My belief system is that if you go back in history far enough, you’ll find good survival rates. And its easy to prove my theory – just look at how well humans populated each corner of every continent many thousands of years ago.

Trust your body, it knows how to birth. Women have been doing it for millions of years.

pregnancy newcastle

FINAL NOTE: When childbirth was causing a lot of death it was due to two particularly large medical errors, including using metal instruments to interfere with birth and cause sever post partum haemorrhage and also, childbed fever, where doctors used dirty, infection exposed hands to then attend a woman in birth.

Birth Chances Flowchart

Answer a few simple “yes” and “no” questions to find out how your birth chances are looking with your current plans and actions.

Utilise the chart to then find ways to improve your birth.

pregnancy birth choices
Birth Chances Flowchart

Shoulder Dystocia

This article was reproduced from Midwifery Today. E NEWS 1:3

Let the Shoulders Birth Spontaneously
– from “A six-year retrospective analysis of shoulder dystocia and delivery of the shoulders” by Vivien R. Mortimore and Mary McNabb, Midwifery magazine, 1998

When birth takes place under water and when women choose to give birth on all fours, squatting, kneeling or standing, the shoulders are usually born spontaneously a few minutes after the birth of the head. This occurs despite the fact that a “hands off” approach to the birth of the shoulders is common practice at such births, as access is often restricted. In comparison, when women are delivered in a recumbent position, traction appears to be required more often, particularly when the mother has epidural analgesia.

Delivery techniques may actively influence the mechanisms of labor. If traction is applied to the shoulders before they have had time to rotate, it is possible that this interferes with the outlet mechanisms and hinders the spontaneous birth of the shoulders. It has been suggested that in cases of difficulty, the use of traction may only serve to increase the degree of impaction and the likelihood of neonatal injury. If such interventions run the risk of causing difficulties with the delivery of the shoulders and injury to the baby, the common practice of applying traction needs to be questioned. These problems may be reduced, if time is allowed for the shoulders to be born spontaneously, by waiting for a uterine contraction and for the mother to bear down.

Many birth attendants are anxious that, by waiting for shoulders to be born spontaneously, birth will be prolonged significantly and the baby will become asphyxiated. A study was carried out on 100 women and compared an active with an expectant approach to the delivery of the shoulders. The mean time for the birth of the head to expulsion of the body was 18 seconds (range 4-40 seconds) in the active group and 50 seconds (range 9-150 seconds) in the expectant group. In this small study prolongation of the expulsive process in order to achieve spontaneous birth of the shoulders did not compromise neonatal outcome. There was no neonatal birth injury in either group.

It would appear that when there is less interference and the shoulders are allowed time to rotate and are born spontaneously, the posterior shoulder is more likely to be born first. This was the case in the early part of the century when a less intrusive, expectant approach to the birth of the shoulders seems to have been the norm. It would appear that a technique that was initially reserved for cases of difficulty has been gradually adopted routinely for normal births The reason for this is unclear, but it is possible that it was used to hasten birth or possibly because obstetricians, accustomed to using this technique in more difficult cases, began to employ it before difficulties with the shoulders were encountered.

Research to date has associated the use of traction at delivery with injury to the baby. If women were allowed time to give birth to the shoulders spontaneously, there is no evidence to suggest that neonatal mortality or morbidity would be increased and the problems associated with the use of traction would be avoided. It may be more appropriate for women to give birth to the shoulders unaided, and for the midwife to adopt a hands off approach unless otherwise indicated.

– from “A six-year retrospective analysis of shoulder dystocia and delivery of the shoulders” by Vivien R. Mortimore and Mary McNabb, Midwifery magazine, 1998