Healing from incontinence

November 1, 2020November 2, 2020Leave a comment

Urinary incontinence is common in pregnancy and is reported by about 60 percent of women. For these women, the severity of their condition can increase during the course of their pregnancy, especially peaking in the second and third trimesters. Of these women who experience incontinence in pregnancy, 70 percent go on to resolve the condition postpartum – and within the first year, the prevalence of incontinence drops down to 11 to 23 percent. Dr Bongi Makhubo, obstetrician gynaecologist from Life Anncron in Klerksdorp sheds more light on the topic.

Early incontinence is normal

Pregnancy can affect the normal way your urethra relaxes and contracts and many women, particularly those who had a vaginal birth, can experience incontinence after childbirth. “The pubic and pelvic muscles and the anal sphincter can be injured in up to 40-80% of births and so, leaking a little bit after birthing your baby vaginally is quite within the normal range, but it is not normal if it lasts for months afterwards,” says Dr Makhubo. “Directly after birth, using a thick maternity pad helps to absorb the leaks, but once you have stopped bleeding and incontinence persists, you might need a specialist appointment to discuss the problem further.”

Stress incontinence is also quite common in new mothers and affects roughly a third of women in the first year after birth. Stress incontinence leaks happen when the mother laughs, coughs, sneezes or goes for a run. Lifting heavy things can also cause these leaks, which are due to increased intra-abdominal pressure and a defective urethral support or closure.

<FACT BOX>What causes incontinence after birth? Dr Makhubo shares the facts:

Weakening of the pelvic floor muscles or injury to the nerves supplying the structures of the pelvic floor, due to a prolonged or difficult labour.
Carrying a bigger than normal baby in utero, leading to difficulty in delivering or stretching and compression of the pelvic floor.
High levels of elastin, a hormone which allows for more stretching of the skin and connective tissue, can cause prolapse and in turn, incontinence (as opposed to collagen, which is decreased during pregnancy).
Assisted delivery, especially with the use of forceps. Research shows that there is less injury and urinary incontinence noted with the use of ventouse in comparison.
Maternal age; the higher the age the higher the association with urinary incontinence.
Parity; incontinence is more common with parous women, however of note is that the highest risk of incontinence is with the first delivery, then 10% risk increase with each subsequent birth.
Vaginal delivery definitely predisposes women to a higher risk of incontinence and most women will be incontinent for a few weeks; however most will be normal within a year.

What can help?

“Pelvic floor muscle training or kegels exercise are by far the best way to combat the problem postpartum, although the research differs as to how much of the exercises should be done. However, these can be done anywhere, and one way to remember to do them is to pick an anchor which will remind you to do them. For example, when stopping at a robot or boiling the kettle: each time you do one of these activities, do some pelvic floor exercises too,” says Dr Makhubo.

She suggests that physiotherapy can also help in some cases. “A physiotherapist will give you cones or a pessary that can be used to squeeze and strengthen the pelvic floor muscle.” Dr Makhubo also encourages lifestyle modifications, such as drinking less coffee and alcolhol and stopping smoking. Decreasing BMI can also help improve incontinence issues. “If lifestyle modifications have been made and incontinence persists, then medical treatments can be offered,” she says. “The last resort is surgery.”

Medical treatment and surgical options

Medication:
- Estrogen creams, duloxetene and even botox can help to alleviate incontinence.
Medical devices:
- A vaginal pessary, which can be used for prolapses. It is a ring-like device and acts as a support for the bladder. A disposable urethral insert may also be prescribed and serves as a leakage barrier.
Bulking agents:
- Bulking agents are injected into the urethra to help plump up the tissues where urine is released from the bladder and help to hold it in.
Surgery: The underlying principle of surgery is to support the urethra, so that the bladder can work effectively.
- “Retropubic urethropexy ( Burch’s Colposuspension ) is used most common surgery for this condition. It is an abdominal procedure, where the pubocervical fascia is attached to a copper ligament or to the pubic symphysis (pelvic bone),” explains Dr Makhubo. “This helps lift the anterior vaginal wall and tissues surrounding the urethra and bladder, which helps to alleviate incontinence.
- Slings: There are various kinds of slings and they are all made of mesh. The use of mesh has been approved by the FDA and the South African Urogynaecology Society endorses and supports the use of this method for incontinence. A ‘hammock’ is created using mesh and tissue to support your urethra and can be done under local anaethesia.
  - Pubovaginal slings, mid-urethral slings, mini-slings and micro-slings are used as a means to help incontinence, but implanting mesh where it is needed, in and around the urethra. These range from being quite invasive to non-invasive. Your care provider will help you decide on the best approach for you.

Multiples: A dream come true through IVF

November 1, 2020November 2, 2020Leave a comment

If you have been trying for a baby for more than a year, but have been unsuccessful, you are one of at least 50-million couples who experience infertility worldwide. The number of children being born in South Africa is also on the decline and according to the Recorded Live Births 2013 to 2015 report, the number of birth registrations decreased by 6.8% from 1.6-million in 2013 to 1.08-million in 2015. As a result, many couples are turning to infertility treatment to fulfil their hopes of having a baby. If you’re a good candidate for In Vitro Fertilisation, it may be the only way to help you grow your family unit from husband and wife to three… or even four… or more!

Multiples and IVF

“IVF treatment can result in multiple births because, often, more than one embryo is transferred into the uterus of the mother,” says Dr Henk Burger, gynaecologist and obstetrician at Life Carstenhof in Gauteng. “The chance of having multiple births can be reduced considerably by only putting one embryo back into the womb.” The cost of IVF ranges from R30k to R50k per attempt, which explains why many couples opt for implanting more than one embryo to increase their chances of a successful pregnancy the first time around, explains Dr Burger. He notes that sometimes a termination of one of the embryos is requested after implantation, but this is very difficult and dangerous for the embryo that stays behind.

Multiples and risk

We all know how adorable twins are – and they make for an instant family unit, but they also come with a certain level of high risk in pregnancy. “Around 30% of multiples are prone to prematurity – and born before their due date. There is also the risk of intrauterine growth retardation, birth defects and miscarriage. The mother is also five times more likely to get pre-eclampsia and six times more likely to have polyhydramnios and antepartum haemorrhage,” says Dr Burger. “Mothers carrying multiples must ensure they attend each and every antenatal consult; every four weeks up to 20 weeks, every two weeks up to 28 weeks and every week up to birth thereafter. The aim is to get the mother to carry her baby to at least 36 weeks, but this is often not the case.” He also advises mothers to eat a balanced diet, not to smoke and to take antenatal supplements. “Simple things like positioning of the safety belt in the car when driving are also important to remember to reduce risk,” he adds.

Natural or Caesarean birth for multiples

According to Dr Burger, birth by caesarean section is the safest for multiples, because of the risk, especially for the babies born after the first one. “There is positional risk such as breech or transverse positioning, especially for the second baby. There is also the risk of premature labour, placental abruptia, fetal distress and even early closure of the cervix,” he says. “There was a case reported where the cervix closed after the mother had naturally birthed the first of her twin babies. Her cervix remained closed for 56 days before she birthed the second one! It is the longest reported period between delivery of the two babies.”

Breastfeeding your babies

Dr Rebecca Makate is a paediatrician at Life Carstenhof and is experienced in helping parents adjust to life with their new babies. “Breastfeeding for any baby offers major health advantages such as less infections and better neurodevelopment. The breast can make enough breastmilk for two or more babies as breastfeeding is based on supply and demand,” she says. “In other words, the more you breastfeed the more milk your breast produces. It is also possible to breastfeed twins at the same time on different breasts. Having said that, having more than two babies can come with huge challenges during feeding time.Even if you breastfeed, occasional supplementing your babies formula will give you some much needed freedom and sleep.”

<Sidebar> So what is life like with multiples?Despite some challenges and drawbacks, having multiples is a great joy, says Dr Makate. “There is a level of convenience and efficiency in parenting children simultaneously; some of the unpleasant aspects are sleepless nights, feeding times, potty training and teenage troubles which all have to be endured at once. Mostly though, there is a great pleasure and enjoyment in parenting multiples, every moment is multiplied and every simple joy is magnified,” she says. Dr Makate lists the following challenges couples should consider before IVF:-Pregnancy and birth risks when carrying multiples.-Fetal complications and time in the NNICU.-Lack of sleep.-Difficulty bonding.-Economic impact on the family unit.-Relationship with your spouse is put under pressure.-The need for extra help with caring for the babies.

<Sidebar> What are Monozygotic and Dizygotic multiplesMonozygotic multiples: In monozygotic multiples, the embryo splits and the babies are born identical. In utero, they share one placenta and one amniotic sac. Dizygotic multiples: In dizygotic multiples, there are two separate embryos, each with their own placenta. Monozygotic multiples are higher risk for a few reasons: Placenta abruptia: where the placenta tears away from the uterus during birth and deprives one or more of the babies from it’s life source of oxygen and blood. Cord prolapse: where the umbilical cord of the second baby born prolapses out of the mother’s vagina. Twin-to-twin transfusion syndrome: where the babies share a joint blood circulation through the placenta, which contains abnormal blood vessels, where blood is transfused disproportionately from one twin (the donor) to the other twin (the recipient).

Lindy and Michael’s* story
We fell pregnant after many, many years of trying to conceive – almost ten years. Initially we tried naturally, then Artificial Insemination and then only In vitro Fertilisation. As I am an older mom it was necessary to go this route. It’s a very drawn out process with lots of steps and checks and balances. One needs to eliminate the options that are not viable first and the doctors are all very cautious and considered in how they approach IVF in South Africa. It is a very expensive process, but we were committed to being parents, and I was not willing to give up, so we just kept on trying until we had a positive outcome. We first attended the Cape Fertility Clinic but after no luck there, we moved to Aevitas which is based at Life Vincent Pallotti. Prof Kruger and Prof Siebert from Aevitas were absolutely amazing, as were all the sisters that worked with them in their team. A number of eggs were fertilised and the best quality eggs were implanted and we were very lucky that two fertilised eggs resulted in our gorgeous twins, Jacques and Stella. It was a very long and stressful process. We lost a baby at full term, Ruby Mae, who was stillborn at 41 weeks. Soon after this loss, we tried again to conceive and with the help of Aevitas got pregnant with the twins who were born on 1 May 2015. It was amazing and unbelievable to find out we were pregnant with twins after losing our previous baby. We were elated and also scared as twins are a major change in one’s life. On the 13th of January we felt our first big kick after steak strips with Szechuan pepper and salad for dinner, it was wonderful! We made it through to 38 weeks and delivered them with the help of Dr Marie Pienaar and her team and Panorama Mediclinic. We love them to bits and they entertain, inspire and motivate us each day to be better, kinder parents. Its tough with two but the highlights are by far in excess. It is stressful and one learns how to cope. Support makes all the difference, whether it is grandparents, siblings, night nurses, nannies or friends. Also each baby is so unique and has their own personality and it’s such a joy to experience the gift of twins.*Names have been changed.

Vanessa and Philipp’s storyWe had been trying to conceive for a long time, but I knew that with my pre-existing conditions of Polycystic ovarian syndrome and Hashimoto’s Thyroiditis, it would not be without some challenges. In 2015 I had a molar pregnancy – very rare – where a non-viable fertilised egg implants in the uterus and grows as abnormal tissue.In that time, we had been in touch with an adoption agency to come ‘kangaroo parents’, which are like safety parents for babies under 3 months old, where we would care for them for up to 90 days until they were transferred to their forever homes. When we started the paperwork, I found out I was pregnant and we felt it might be too much to go through with the adoption agency, but then later that year, I miscarried and this broke me on so many levels. After that I left for Europe and shortly after we received a call from the adoption agency to know if we were perhaps keen to foster twins who were 6.5 months old. We slept on it and the next morning we decided that we would do it and eight days later they arrived. We lost our hearts completely to the babies and decided to start the process of legally adopting them. We still kept our sights on having our own biological child one day, so we kept on trying naturally at first and then decided on IVF at the Aevitas Clinic at Life Vincent Pallotti. On the day of the transfer they implanted two eggs and at the 9 week scan we heard three heartbeats! The two boys shared one placenta, but each had their own sac and the girl had her own placenta and sac. I honestly felt as though I lost the ground under my feet and the world was spinning… we would be parents to five children now, the twins included! My pregnancy was easy until 26 weeks when I started having contractions and had to have bedrest at Life Vincent Pallotti until my caesarean birth on the 24th of April at 30 weeks pregnant with Dr Jacky Searle at Life Vincent Pallotti. My precious babies weighed 1290g, 1220g and 1540g at birth and now we are a beautiful family of seven. I am thankful for blessings in abundance and the good health of all my children.

Petra’s Birth Story

August 30, 2020September 3, 2020Leave a comment

Petra is a very strong mama who I met when she was pregnant with her first baby. Firm and determined, she never gave up all through her two birth experiences. It was lovely getting to know her as a mama also living in the Valley and this is the story of her second birth, where she attempted a VBAC. Thank you Petra for sharing your story!

I met Charlene in 2015 while pregnant with our first. My husband and I attended her hypnobirthing antenatal course. We were very keen on a natural birth and even changed service providers from a doctor to a midwife after doing a lot of research and weighing up all our options.

Unfortunately, our baby had other plans and presented in Frank breech, which is a breech position with the legs extended straight up towards the head. We were told by our supporting gynae that there was no chance of a natural delivery, and so we ended up scheduling a c-section. Our baby had other plans again: I went into labour the night before the c-section date, and our daughter was born by emergency caesarean at 03:30 in the morning.

3 ½ years later we found out that we were expecting again and to our delight our gynae suggested a vbac without us even asking. We agreed that this would be our preferred birth option, provided that everything was favourable.

I have a deep desire inside of me to birth my babies, and not just be delivered of them, which is why I felt somewhat “left out” with the c-section birth of our first child. And this time around I was determined to make sure that this baby would not be positioned in breech!

The pregnancy progressed well, without any complications and our baby turned head down and stayed head down – I was so thrilled!

We decided to make contact with Charlene for a refresher course, and chose her as our doula, to ensure that we have someone by our side who knows her way around natural birth.

At this point I need to mention that I turned 43 about 5 weeks before the birth of this baby and, whilst I feel much younger than this, my gynae would not allow me to go over 40 weeks for possible age-related complications. This means we have a scheduled c-section booking in case I don’t go into labour by that time. He also tells us that I cannot be induced, because it is a vbac, but he can rupture membranes for me the day before the booking, which might induce labour. If that doesn’t work, then I will have to stay in hospital overnight and have the c-section the next morning.

Week 38 has me seeing a midwife for a stretch and sweep. She tells me that my cervix is 1-2cm dilated and my body is definitely preparing to go into labour. Yay!

Week 39 and my gynae does another stretch and sweep, telling my husband that our weekend plans might just be in jeopardy. Great! Monday comes without any signs of labour and the booked section day is Wednesday. Oh no! We have a final check-up with the gynae, and he tells me to check into hospital at 3pm the following day so he can attempt to start my labour by rupturing the membranes. This being a vbac, we also agree that if there is foetal distress at any stage or if I start bleeding (which can be a sign of uterine scar rupture) then we will change plan and do an emergency caesarean.

Tuesday 21 May – the day before our c-section booking
I wake up feeling calm. Too calm! Not a surge in sight. I chat to Charlene and she suggests that I ask the gynae if we can check in earlier, so that I have a better chance of not labouring through the night.

So there I am at 13h00 hooked up to the CTG, listening to Charlene’s birth affirmations and waiting to have my membranes ruptured.

The procedure is successful, my water breaks and an hour later labour has started, and I am having regular surges roughly 5 minutes apart.

My birth photographer is there and Charlene has also arrived, and worked her magic in the room, transforming it into a much friendlier place.

The surges quickly become more intense and very soon they are 2 minutes apart. Charlene and my husband take turns massaging my lower back through the surges, which is where I am feeling the most pressure.

I need to be hooked up to the CTG a lot and for this I have to lie down on the bed, which is much more uncomfortable that sitting on the birth ball or standing and swaying my hips through a surge.

At some stage I have to go to the toilet, which is outside of the labour room. It takes a lot of courage to venture out of the room and when I finally do, I take Charlene with me. I simply cannot bear to face a surge without someone by my side. (Which not-so-clever person designed these labour rooms and didn’t include a toilet..?!)

There is quite a bit of blood and we think it is a good show. As labour progresses, I can however feel that there is fluid leaking out at the end of every surge, and I assume that this is amniotic fluid.

At 17h00 my gynae comes to check up on me again, and notices that I am haemorrhaging. “Why is there so much blood?” I hear him asking the midwife. So that is the fluid that I feel at the end of every surge! He also checks the foetal monitor printout, and then comes to tell me that I am 7 cm dilated at this stage, but I am also bleeding, the foetal heart rate is declining, and he is not happy about either of this. Those are the 2 things that we agreed would mean a change in our birth plan.

A decision is made quickly and calmly that we will proceed with an emergency c-section. Both baby and I are fine at this stage and there is no panic. I keep breathing through my surges, still lying on the bed and connected to the CTG, while Charlene and my husband keep massaging my back.

At 17h40 my gynae comes back to take me into theatre and I am pleased to discover that the assisting doctor also assisted with my previous c-section, and the anaesthetist is the one we requested for our booking the following day – this helps to put me at ease even more.

Charlene once again works her magic and soon there is beautiful music playing in the theatre, which helps to create a light and calm atmosphere.

15 minutes later we’re ready to start the c-section and at 18h00 our baby is born! Because we didn’t want to find out the gender during the pregnancy, the gynae lifts the baby up for a gender reveal: it’s a girl!! My husband has tears in his eyes when he turns to me and says, “we have another girl!”.

I really try to be more present to all that is happening than I was with my previous c-section. The gynae tells me that my scar is fine and wasn’t the cause of the bleeding, and that he cannot see where the blood was coming from. We assume that it could have been from the placenta starting to detach and this confirms that a c-section was the right decision. The baby was also facing forward and that was causing my back labour.

Once the paed finishes his check-up, she is placed on my chest skin to skin and we get to cuddle a bit while we wait for the surgery to end. There is a happy atmosphere in the theatre with lots of smiles, we have a healthy baby girl and all is well!

Charlene accompanies us to our room and helps to get us all settled in before leaving hubby and me to bond with our little girl, who is breastfeeding like a pro and soon falls asleep right there on my chest.

The next day starts off well, I am up and able to take a shower. I feel fantastic, with hardly any pain at all thanks to the pain meds, and I am looking forward to our “big sister meets little sister” visit that afternoon.

It is truly one of the best moments of my life, watching my older daughter meet her younger sister, and our lovely birth photographer captures some amazing pictures for us. I love every moment of it, and in the excitement of it all, I get up far too often and move around far too much… by the time my husband leaves with our daughter, I am in a lot of pain and can hardly stand up straight. I am now very annoyed with myself, as this is not my first c-section and I should really know better than behaving like I have just done! I also need to empty my bladder but try as I may, I can’t go. It is just too painful!

The pain gets worse and eventually I am in complete agony with what feels like one large abdominal spasm, almost like a labour surge that peaks and never ends! A nurse comes to measure my blood pressure and temperature, telling me that both are raised – I get annoyed with her, because it doesn’t take a genius to figure out that all this pain is causing the raised measurements. At this stage the spasm pulls up on the right-hand side from my abdomen into my shoulder and I am desperately trying to find a comfortable position to lie in. I’m clinging on to the bed rail and moaning through the pain! Finally, after what seems like an eternity, my gynae comes to check on me. I am in tears and tell him that I think I might have torn something with all my movement earlier. I feel completely responsible and am so disappointed with myself, and I am in so much pain. He gives me a voltaren injection, the nurse reinserts a catheter and eventually the pain fades. I am able to have a fairly restful night.

The next morning my gynae pops in on his rounds and tells me, that he thinks my bladder might be punctured, and that I will need to go for a scan. Baby stays with the nurses while I head off to the radiologist. Not much later we have confirmation: my bladder is leaking and will need to be fixed.

At lunch time my gynae returns with the urologist, and together they assure me that this is not my fault and that nothing I did could have caused the bladder puncture. It must have happened during the c-section and gone unnoticed. Surgery is scheduled for 19h00 that evening. Until then I am not allowed to eat or drink anything… not great, as I trying to establish breastfeeding.

Later that afternoon I have another abdominal spasm with pain as bad as the day before, and this leaves me exhausted and more than willing to go back into theatre just 49hrs after having a c-section. My baby does an hour long feed and then falls asleep just before her daddy arrives to look after her, while I go in for surgery.

The urologist checks on me outside theatre, and once again assures me that it was not my fault and that he will fix my bladder for me shortly. I am tearful and sore, feeling very sorry for myself and heartbroken for being away from my 2 day old baby. A theatre nurse walks past and sees me lying there looking miserable. She stops to come and console me, stroking my hair and telling me not to worry, that all will be fine. Sometimes angels don’t have wings and wear scrubs instead.

Surgery takes an hour and much to my relief I really do wake up without any pain. After recovery I return to my room to find hubby sitting peacefully in the easy chair with a sleeping baby girl skin to skin on his chest. She slept through the entire thing!

I spend 6 days in hospital with 2 catheters and went home with the suprapubic catheter strapped to my leg with a “pee-pee bag” as my daughter called it. Not the most comfortable thing to have but at least I was mostly pain free. Charlene also came to visit me at home for a doula check and a long heavenly foot massage, where we talked and talked, and I had an opportunity to debrief.
The suprapubic catheter was removed after 11 days and I was mighty glad to be rid of it.

So in the end my deeply desired vbac turned into another emergency c-section. Not what I had hoped for but this whole birth experience taught me one thing: “Surrender, it is what it is.”

I kept on repeating that phrase to myself, and I also kept looking for the blessing in each situation:

I look at the photos of our daughter’s birth, I see myself during those few hours of labour, actively participating in the birthing process, and in the end, we had a calm and joy-filled c-section birth with lots of smiling faces.
I would never want to go through the pain of the abdominal spasms again, but I treasure the fact that my husband got to spend those hours bonding with his little girl, while I had to have another surgery. Precious time that he would probably not have had otherwise.

Hospitals are by no means a restful place, but I had 6 days alone with my baby, before we went home to a very excited 4-year-old sister.

I am at peace with the turn my birth took and Charlene sums this up beautifully in one of her poems:

Even when things go in the opposite way of what was intended.
It’s that most sacred of moments.
When she locks eyes with her babe for the first time…
Skin to skin now on her chest she lies.
“You must be mother. You are, this place – is my home.”
She holds her closer and adjusts her position to bring her closer to her breast.
The noise and voices and bustle of the hospital dim all around her…
Yet, she suckles… and the circle is complete.

Aimee’s Birth Story

August 30, 2020August 30, 2020Leave a comment

It was my honour to walk beside Aimee and Ryan for the birth of their baby girl Kenzy. Here is their story…

When I think back on my “Birth Day” it was nowhere near what I expected, despite all my reading and “scenario-planning.” And to be honest, I wasn’t convinced I needed a doula in the beginning. I went to the Relax into Birth workshop which was incredible and empowering. Then I listened to the tracks every single day, and after a month I’d realized something. Not only did I now want a doula, but I only wanted Charlene. I couldn’t actually imagine giving birth without her there. I didn’t know my water had broken on Saturday. It just felt like I’d wet my pants. On Monday a confirmation call for Tuesday’s gynae appointment became the green light to come into hospital *with my bags*… There was some urgency as it had been almost 40 hours since the water breaking and I hadn’t experienced any contractions. But the phone call was pleasant and relaxed; and when I hung up I had a little joyful cry and some reflective me-time while I waited for Ryan to come home.At the hospital, a litmus test for amniotic fluid was positive and the gynae started a Propess induction immediately. (According to my Birth Plan, I hadn’t wanted to be induced, but by then it had been 45 hours since my waters had broken, and I was completely at peace with it). I was told it would take a while, and we could just relax! Great! The baby would be coming that night or in the early hours of the morning (it was only 2pm at that point). We were excited, joyful, “floating”! So we started sending some messages to the family and we told Charlene that she could come in after the traffic died down.

Half an hour later, I was in agony and I couldn’t bear to lie down on my back. The baby’s heart rate was high. She was in distress – fetal tachycardia. The Propess was removed and I needed to have an emergency caesarean. My gynae was so kind, gentle and professional. She knew I had wanted to have a vaginal delivery, but we talked through the situation and I felt like we were always on the same page. Physically, it was agony, but emotionally I felt cared for and respected. I even felt quite content about going in for the surgery, knowing that my baby needed it. (We learned later, during the surgery, that it was all because her umbilical cord was wrapped around her neck twice. I am so glad I trusted my doctor.)

Then it was a whirlwind to get prepped for surgery. Even though our time schedule had changed drastically, I was mostly just feeling excited to meet my baby. Charlene arrived just in time! I was relieved to hear her voice: the same calming voice I’d been listening to every day. She put on some beautiful music and came to massage my shoulders, which was just what I needed then because I started to really feel a lot of pain. It felt like I was being bullied internally, my organs being pushed and pulled. Tears were rolling down my face and I could hear myself groaning with every surgical touch. The pain was too much and I agreed to a general anesthetic. I know I was hyperventilating, but I felt Charlene’s firm grip around my shoulders and chest guiding me to breathe slowly while the gas was administered. Despite the intensity of it all, I felt safe. I closed my eyes and woke up to see my beautiful healthy baby 45 minutes later.

Five months later I filled in that missing 45 minutes. Charlene had captured the whole birth on video on my husband’s phone! It was such a gift.

Ryan and I hadn’t spoken through the “sedated-scenario” and by that stage he was quite traumatised by my pain. He was so worried about me that he didn’t even watch the birth; he just held my hand and kept watch over me. When Kenzy was born, he didn’t know what to do or expect. (And that was exactly why I had wanted a doula: Someone to be a guide for us both, to be on our “new parents” team, our coach.) Ryan was particularly grateful to Charlene for talking him through those first moments of our daughter’s life. A funny moment comes up in the video where we hear Charlene saying “take off your shirt” and Ryan looks so surpised! He thinks she’s joking. But because he listens, the nurse brings Kenzy to put on Dad’s chest right away for skin-to-skin. I bet she didn’t expect to get a mouth full of hair while looking for her first drink! He really cherishes that time he got to share with his daughter.

Ryan bonding with his baby girl for the first time

It was an unexpected arrival in most ways, but I am so grateful I was prepared for every surprise step. I praise the Lord for modern medicine and how swiftly and professionally the whole team worked!

It’s your ONE BIRTH. Choose your birth team wisely!

March 26, 2018April 6, 2018Leave a comment

It’s essential you choose your birth team with utmost care, empowering yourself with information, educating yourself on the birth landscape you find yourself in.

You don’t get to do it all over again. You don’t get a retake… You only get to do this birth once, so that even if it ends up in a caesarean section, you will have peace in your heart, because you know you tried and exhausted all avenues.

I wish you joy and a sense of empowerment and confidence as you prepare to meet your baby!

Check out http://www.relaxintobirth.com for more info on doula care, pre and postnatal pampering, products and the Relax Into Birth course, which includes Hypnobirthing techniques for labour and birth and caesarean section.

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Surrender

March 9, 2018Leave a comment

The power of each surge
Flows through me
Like water.
Washing off my skin,
Taking my breath away,
Bringing forth life… And
Opening me up.
Stripping away the layers and layers
Of holding back
I leave my body
Surrendering and merging with my baby’s soul
Hovering around me.
Come my love I say…
It’s time. Let’s emerge together…

As a baby is born
A mother is born also.

Words and photo by Charlene Yared West.

Pregnancy Awareness Week at one of the best hospitals in town, Life Vincent Pallotti!

February 25, 2018February 26, 2018Leave a comment

Pregnancy Awareness Week takes place annually and this year’s theme was about empowering parents for their journey to birth. I was there representing Relax Into Birth, talking about doula care and relaxation techniques. Many thanks to Sister Lindsay Donnachie, Carline and Vaughanine for arranging such an inspiring event.

Sister Lindsay Donnachie opening the day’s Pregnancy Event.

Sister Donnachie reminded women about their invisible bejeweled crowns on their heads and that no matter how their births turned out – or what turn they took, natural or caesarean, that they would still, no matter what, be the queen of their own births. She emphasised that what really mattered was how the mother viewed her birth and that in order to have a positive experience, she needed to empower herself with information and to know her options. She welcomed all attendees and speakers to the event.

Sister Donnachie reminding mothers to wear their invisible crowns.

Sister Emma Numanoglu of Breastfeeding Matters was first up and is a lactation consultant extraordinairre. Her talk focused on debunking myths around the subject of breastfeeding. Emma’s heart and soul is in her teaching and consulting and those who have been touched by her kindness can attest to that. Nothing is too big or too small – Emma will help you! Did you know that you don’t have to cut out any major food groups while breastfeeding? You don’t have to go gluten free or dairy free (unless medically indicated)! And, did you know there is science behind the use of cabbage leaves for sore, engorged breasts? Also that Jungle Juice is not helpful for anything except a sugar overload and does not help with supply issues… only a good latch can ensure that baby is getting milk… and milk being extracted from the breast helps to increase milk supply. Emma shared these titbits with us and more…

Emma Nummanoglu presenting a breastfeeding talk

Sister Emma Numanoglu presenting a breastfeeding talk.

Next up was Dr Jacky Searle. One of the most gentle, aware and intuitive doctors in Cape Town, her talk focused on choice and birth. She made attendees aware of the choices available in pregnancy and birth and how to navigate the landscape of those choices in Cape Town and within the limitations of medical aids. Practical and always so encouraging, Dr Searle empowers women daily in her work life and beyond. Births with this fine doctor are always Beautiful.

Dr Jacky Searle presenting a talk on choices in the birthing landscape.

I was next in line and my talk was entitled “Empowering women through doula care and relaxation techniques”. Doula care is often misunderstood and so my talk opened with an explanation of the doula role through pregnancy and birth and how it differs from that of a midwife. I also shared some tools for relaxation, excerpted from the Relax Into Birth course.

Attendees trying out some Relax into Birth breathing techniques.

Next up was Liesl Hansen from Johnson and Johnson, who spoke about the benefits of massage in pregnancy, labour and the postnatal period in her talk; “The first touch of love.” When it came to baby massage, she handed out dolls for the parents to practice on, which was just so much fun and so informative! Who doesn’t love a good massage and these parents left feeling equipped to give their babies some extra tlc through massage. She was assisted by Lisa Townend of Holistic Baby – Baby Massage Classes, a certified infant massage instructor.

Liesl Hansen and Lisa Townsend share their learnings around baby massage techniques.

Liesl Hansen and Lisa Townend share their learnings around baby massage techniques.

Last but not least, Jenny Spiro of Nurture One delivered a very interesting talk entitled “Start out right… And sleep tight.” She emphasised the importance of catching the sleep wave to assist your baby to sleep as best as possible. She also showed parents a very clever way of using the amazing Nurture One nesting pillow to put baby to sleep. The pillow cleverly mimics a womb-like environment and gives newborns much comfort.

Jenny Spiro shares info around baby sleep methods to help new parents also get more sleep!

Here are some other pics from Saturday’s fun event:-)

And here’s one of my son and I; my inspiration to do this work in the first place… Dearest Leonardo… Funny face selfie 😍:

See you at the next pregnancy event! Wishing you a wonderful birthing day, no matter what turn it takes ❤️❤️

Celebrating my doula sister, Gayle Friedman

February 25, 2018Leave a comment

As birthworkers, we just cannot do this work without someone just there for us, waiting in the wings. Gayle is my mentor and friend and I have learnt so much from her. Here’s ten reasons why I am thankful to Gayle (I’m sure there are more than 10!):

1. JUST BEING THERE: I know that no matter what we have going on in our respective lives, I can count on Gayle to be there for me if I call her.

2. DEBRIEFING: In the caring profession we forget that we as birthworkers also need to debrief… And we talk and walk each other through birth stories, tough times and good times. My husband was grateful as he no longer needed to listen to my birth stories… Now he says; “just call Gayle!”

3. NOURISHMENT: I know that she would just show up with a flask of tea and something healthy to eat if I find myself at a long birth 😁

4. BACKUP: If two births take place simultaneously, which happens, but very rarely, we know we have reliable back up in each other and we match each other in skillsets and tricks!

5. LEARNING: They say you can’t teach and old dog new tricks… I disagree! We learn from each other constantly and live through each birth the other takes on and support each other through each birth too with tips or a fresh perspective.

6. LAUGHING: Let’s face it, as rewarding as this work can be, it is also a little stressful… Ok a lot (LOL😂) and I must admit sometimes after long birth, we are the only people (besides other birthworkers) who understand just what we’ve been through… And that’s where the 3am hysterical laughter comes in… 😁

7. SPACE-HOLDING: Just as we are highly skilled at holding the space for mothers, fathers and babies, we also hold the space for one another. Sometimes the doula also needs doulaing!

8. TIME IS JUST A NUMBER: No matter the time, we chat just about at any time, anywhere when we need to or want to. It helps to know that no time is off limits. We do know how important sleep is though!

9. SHARING OF IDEAS: Gayle and I are on the WOMBS committee and it helps to share ideas with each other and also apply them to our own partnership and businesses.

10. EARL GREY TEA: The sweet aroma of bergamot Earl Grey tea and chatting to my birth buddy.

😊🤗😊

Doula dads for the win!

February 1, 2018March 16, 2023Leave a comment

It really is the parents who make this course what it is… One dad at the January course held at Birth Options in Plumstead, shared that one of the exercises we did made him feel more empathy and compassion for what his wife was going to face in labour.

“It made me realise what she might experience and how I can perhaps help her – as best I can,” he said. Dads do not have to be helpless on labour day and that’s why Relax Into Birth provides birth companions aka dads and partners with a toolkit to become doula dads, who feel more at ease in the birth space.

I love seeing lightbulb moments for dads come to life when they suddenly feel more empowered to fully embrace what the experience holds in store.

#relaxintobirth #empoweringbirthsandnewparents #charleneyaredwest

Birth Options Midwifery Team Statistics 2017

January 20, 2018January 21, 20181 Comment

I’m about to share the the latest statistics from 2017 for the Birth Options Midwifery team – and they are unbelievably good!

The team is comprised of Glynnis Garrod, Susan Lees, Angela Wakeford and Bernice Jehring Down.

Birth Options Independent midwives can attend both home and hospital births at Vincent Pallotti and Melomed Tokai with gynae/ obstetrician backup at those allocated hospitals. Ayla Nowell of Birthing Naturally, another wonderful independent midwife, has back up support from Vincent Pallotti and Constantiaberg Mediclinic. So women have the option of birthing at home with the support of Independent Midwives (with gynae back up support in case of emergency) as well as to birth at these allocated hospitals under the care of an independent midwife (with gynae back up support in case of emergency). We also have traditional midwives in Cape Town, who use various government hospitals for back up support. It pays to know your options and that you have choices available to you!

It says a lot about these doctors at those hospitals (Vincent Pallotti and Melomed Tokai) and their view on promoting a natural approach to birth, where caesareans are only called for when necessary. This is a rare breed of doctor in South Africa and should be taken into account when choosing your care provider/back up gynae.

Independent midwives specialise in normal, low risk pregnancies and birth and will do all within their capacity to help you have the most positive birth experience, whether that is a natural, vaginal birth or a necessary Caesarean in the end.

Without an independent midwife, you will have hospital midwives attend to you in private hospitals. Hospital midwives change shift, so you might have multiple midwives for the duration of your labour and birth time. Hospital midwives are also not allowed to deliver babies, (but sometimes they do as a baby may come quickly!:-)) as that role falls to your obstetrician, who is called to come in when you are near being fully dilated. Many hospital midwives are underappreciated for their hard work and loving care of mothers in labour, and burn out can be a very real challenge facing all birth workers.

My wish is for women in South Africa to start seeing independent midwifery care and doula care for Pregnancy and birth to be the norm, so that we can also lower our exorbitant rate of 90% caesareans in the private sector… Of which most were likely not necessary… and, to choose their doctors and hospitals more carefully too. You only have your one birth, so make choices that will facilitate a good birth experience without regret in the end.

So, without much ado, here are the fabulous stats from Birth Options.

Birth Options Midwifery Team Statistics 01/01/17 – 31/12/17

Total number of clients: 147
Total no Caesarian Section 21/147 = 14%
Number of clients who labored with the Team = 136
Spontaneous Vaginal Birth 115/136 = 84.5%
Kiwi Ventuse Delivery 4/136 = 3%
Emergency Caesarian Section 16/136 = 12 %
VBAC 7/10 = 70 %
Primigravida (first birth) 55/136 = 40 %
Waterbirth 15/136 = 11% (many more labored in water)
Epidural12/136 = 9%
Episiotomy 14/136 = 10%
Induction of Labour 15/136 = 11 %
PPH 500-1000ml 9/136 = 6.5% (post partum haemorrhage)
PPH over 1000 ml 3/136 = 2 % (from a retained placenta)
Third degree Tear 1/136 = 0.7 %
Neonatal Unit Admission at Birth: 2/136 = 1.5 % (1x 34 weeks, 1x signs of sepsis)
Births @ Life Vincent Pallotti 73/136 = 53.5%
Births @ Melomed Tokai 29/136 = 21 %
Home Births 34/136 = 25 %
Transfer to hospital from home birth 3/34 = 9 %
7 births not with the team – care taken over by back up Obstetrician: X3 persistent Breech Position after 37 weeks for elective c/s, 1x 37week early labour with breech position, 1x 31week premature labour breech position, 1x previous Caesarian Section, Term, SROM with meconium, unfavorable cervix, baby weighed 4.6 kg, X1 transfer from homebirth in labour for c/s ( CPD) to Christian Barnard Hospital – care handed over to Gynae as we don’t have an SLA there ( prior arrangement )