Category: hospital birth

Healing from incontinence

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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. 

Own your birth: Why you need a birth plan

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The birth plan: a tool pioneered by childbirth activist and midwife, Sheila Kitzinger in the 1970s, who believed that women and not their caregivers, should be the focus of childbirth and be able to advocate for themselves with this document, which detailed their wishes for the delivery. In the wake of birth plans, the Better Births Initiative was formulated as a way of educating caregivers on the general care of women in labour. The initiative was also rolled out in South Africa and expected to be adopted by all hospitals by 2015. Amongst the guidelines, it encourages respect, privacy and companionship for women in labour, pointing out that women should be able to labour and birth in whatever position they feel most comfortable, with as many birth companions as they choose to have. By Charlene Yared West. 

Birth plans inform and educate 

“Birth plans have become common practice now, as expectant mothers are more informed about their birth choices,” says Marié van Heerden, midwife and hospital manager at Genesis Maternity Clinic. “It is a good exercise for each expectant parent to inform themselves of their options through compiling a birth plan, so that they understand what they can expect, as well as benefit and risk of procedures and medication – and know where they can make certain choices. This applies to any type of birth, whether it is for a natural or planned caesarean section.” Laura Sayce, doula and lactation consultant at Genesis agrees; “I help my clients to compile their birth plans as a way of helping them make informed decisions. It also encourages them to do their own research into each element of the birth and then to make choices based on this information.” 

What should a birth plan include? 

According to a research paper Birth Plans, the good, the bad and the future by J.Lothian (2006), the focus of birth plans should be to answer three patient-focused questions: What will I do to stay confident and feel safe? What will I do to find comfort in response to my contractions? Who will support me through labour, and what will I need from them? “I encourage all my patients to write out their birth preferences and to make copies of it, one of which is placed into their file at the hospital and extra copies for the hospital midwife on duty for the day they go into labour,” says Dr Sean Drew, gynaecologist-obstetrician at Life Hilton Hospital. “It helps everyone onto the same page about what the parent’s intentions are for the birth, but it must also leave room for what happens in the event of having to resort to ‘plan b’ option, which is often not detailed in the plan, but should be.” Dr Drew explains that as medical professionals, their first obligation is to the safe and healthy delivery of baby and mother. “First we want to ensure life, then we can look at incorporating all the ‘quality of life’ elements from the birth plan. This is not to say we don’t observe what is written in the document. It is quite the opposite. We do try to fulfil the mother’s wishes to the best of our ability, within our scope of practice.”

Most important birth plan elements

Life Hospitals aim to work in an evidence-based way. Sister van Heerden points out that it is helpful to speak to your care provider and to do a hospital tour, so that you have a clearer insight into how the births are conducted at the hospital you have selected to birth at. “Once you have done that, you are ready to write your birth plan. There are so many templates on the internet, but here are some important factors to include,”: 

  • Labour and birth: freedom to eat and drink in labour, play music, dance, make labour sounds without inhibition, use aromatherapy oils (safe for labour and birth), have freedom to move into any position and birth in any position on the floor, or the bath or the bed. A mother should be allowed access to a doula or birth companion of her choice, who will provide non-medical pain relief options, including hypnobirthing, massage and general encouragement. Delayed cord clamping after the baby has emerged to allow for all the baby’s blood to be drained from the placenta to the baby. 
  • First hour: Uninterrupted, immediate skin-to-skin contact with the mother or the father (if the mom is unable to). Assistance with the first latch if requested, otherwise the baby should be allowed time to attempt a breast crawl. Weighing and measuring to be done after the first hour of bonding for the family. No separation of mother and baby unless absolutely medically necessary. 
  • Postnatal: Rooming in with your baby, no formula unless there is informed consent of the mother, provision of pain relief if medically necessary and assistance with breastfeeding. 
  • Plan B: In the event of an unexpected caesarean, there are still choices. The mother can request immediate skin-to-skin with the baby in the theatre after the initial checks by the paediatrician and no separation unless medically necessary. Early initiation and assistance with the first latch. If the baby has to go to the neonatal ICU, then the father may accompany the baby. 

What are the roles of each of the professionals present at a birth? 

  • Obstetrician-Gynaecologist: A medical doctor who is the primary caregiver for your birth and there to deliver the baby when it is time to push the baby out. He/She may also conduct vaginal examinations during labour, but this is more often performed by the hospital midwife on duty. It is also the role of the doctor to perform the caesarean sections either scheduled or emergency. 
  • Hospital Midwife: The hospital midwife performs nursing duties during labour and ensures the medical needs of mother and baby are taken care of by checking foetal heart rate, mother’s well being,blood pressure and other medical checks. She/he may also conduct the vaginal examinations, under the instruction of the primary caregiver, the doctor. In private hospitals in South Africa, the baby is delivered by the doctor and not by the midwife, unless the baby is born before the doctor’s arrival at the birth. The midwives at Life Healthcare hospitals are however trained to conduct normal deliveries. In government hospitals, the hospital midwives are permitted to conduct deliveries. 
  • Independent Midwife: She/he fulfils the same role as the hospital midwife, but may also deliver the baby and call on the obstetrician-gynaecologist in the event of an emergency. Independent midwives may also conduct homebirths, hospital births on low risk pregnant women, with confirmation and back up of a supporting gynaecologist-obstetricians. 
  • Doula: A doula is employed privately by the parents themselves and works independently of the hospital. She is non-medical and is there for the mother’s physical and emotional support throughout the labour process. She may not advocate on the mother’s behalf to her caregivers. Research supports the use of a doula for a more empowered and positive birth experience, no matter what turn the birth takes, whether the baby is born vaginally or abdominally.   
  • Anaesthetist: The anaesthetist is called in if the mother requests an epidural during labour and is also there for caesarean births to administer the spinal block and for ensuring adequate pain relief after the caesarean. 
  • Paediatrician: The paediatrician is called in after natural births to check on the wellbeing of the baby. They are also present during caesarean sections to ensure the health of the baby. 
  • Lactation consultant: Although the mother receives breastfeeding advice and assistance from the midwives in the maternity unit of the hospital, a lactation consultant is extremely helpful to ensure long-term breastfeeding success. 

Prenatal Surgery: Saving a baby’s life in utero

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In July 2015, Eunice and Nathi Motha finally became pregnant via in-vitro fertilisation and their joy at the news turned to pure elation when they found out they were pregnant with twins; a boy and a girl. After an uncomplicated pregnancy until 18 weeks, the couple readied themselves for the arrival of their babies. Sadly, however, the amniotic sac of the boy foetus ruptured and his leg protruded through the cervix. This made life in the womb for the boy unviable and the pregnancy needed to be terminated – or did it? According to gynaecologist obstetrician, Dr Deon Van der Merwe at Life Midmed Hospital, the girl foetus could be saved and the pregnancy for one of the twins could continue, the boy however, had to be removed from the uterus either vaginally or via caesarean birth.  

Not just another day at the hospital

It was the second time in 15 years that Dr van der Merwe performed an operation of this nature and he consulted with colleagues to gauge their informed opinions. “It is not an operation that is taken lightly as the dangers are immense; there is the risk of uterine rupture to carry the second twin to term after a caesarean at 19 weeks, there is also the risk of bleeding and sepsis and lastly, miscarriage, as the cervix was already dilated to 3 cm,” said Dr van der Merwe. “Even with all these risks, I had to help Eunice, as she had conceived under trying circumstances through IVF and she wouldn’t entertain me terminating the pregnancy.” 

Eunice relates how Dr van der Merwe explained the termination procedure and how she refused to listen to his words. She believes that after seeing their desperation and sadness in addition to her husband Nathi’s pleas to save one of the babies, he decided to do the work. “Even before Dr van der Merwe saw that my son’s leg was protruding through my cervix, I just knew something was wrong. For me his little leg kicking felt like a wriggling worm – a feeling I would never wish on anyone. It broke my heart to know that he would not make it,” says Eunice. “When they did the scan, I could still hear his heartbeat and I was so worried about if he would be hurt when the procedure was done; either vaginally or via caesarean. There was also no time for me to process all of these thoughts and we had to make the decision to save one baby or risk losing both babies… We chose to save our daughter.” The membranes were already ruptured for one week and the decision could not be delayed any longer. 

Emphasising that the operation was not an everyday procedure, Dr van der Merwe set to work, trying to remove the male foetus vaginally, but it was not possible and so a caesarean was performed. “We put the patient under general anaesthetic and after trying to remove the foetus through the cervix, which would not open enough, we knew the only way to save the second foetus’s life was to remove the first one via caesarean.” he said. 

Eunice remembers how she felt after the first operation. “I did not expect to have the burning sensation in my belly, as I assumed they would be able to remove him vaginally. I was denied pain medication so that they could do a scan after the operation was done to make sure my daughter was ok,” she says. “I knew I could endure anything for her well being, so that when I heard her heartbeat on the scan I was so happy, but it was also mixed with a deep sadness for the loss of my son, who I had never met, but who I had only felt – in my cervix. I still wish I had had the opportunity to see him with my own eyes, just to say goodbye – and that I was sorry.” 

A challenging caesarean section

Dr van der Merwe explained how the incision was made only after carefully ascertaining where the girl foetus’s placenta was. It was imperative not to accidentally rupture the amniotic sac of the second baby, as that would mean a complete termination of the pregnancy. “There would be no way to save the female baby if the membranes ruptured, so we had to be extremely careful. The incision was followed by removing the male infant with the ruptured sac and then putting the undamaged sac back into the the mother’s uterus to enable her to continue with the pregnancy,” he added. A stitch was also made around the cervix, as the pregnancy needed to continue – and because she had already dilated to 3 cm. “The risk of preterm labour of the other baby increased, as well as the chances of infection and so we had to be very cautious after the operation too. The longer the foetus could stay in the mother’s womb the better for it’s overall health and development,” said Dr van der Merwe. 

D-day for the girl twin to be born

Eunice’s pregnancy progressed to 35 weeks when she went into natural labour. She proceeded to go to the hospital immediately and underwent a second caesarean in the space of 17 weeks after her first caesarean. “The second caesarean was far less complicated; as the baby was ready to be born, although five weeks premature,” said Dr van der Merwe. “There was absolutely no way we could allow for an attempt at natural birth either, because of the danger of uterine rupture as a result of the very recent previous caesarean earlier in her pregnancy.” Eunice remembers meeting her daughter a day after she was born, as she was admitted to the neonatal unit for what became 13 long days after the birth. 

“After the caesarean, I was so confused and exhausted, so I slept a little while. On that same evening, I got up, had a shower and felt better. After getting dressed, I took a wheelchair up to see my baby girl… and I could not stop staring at her beautiful face,” says Eunice. “She was so amazing and just so beautiful and I will always be grateful to Dr van der Merwe who saved my baby’s life. My husband and I cannot be more thankful than we will always be to him. We named her Thembelihle, which means Good Hope; as she gave us hope when we almost lost everything.”

Ruwarashe’s Birth Story

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Ruwa was nervous at our first meeting. Soft-spoken, she asked about my role as a doula for her birth. I walked with her in pregnancy and birth and when she went into labour, I met her at the hospital. Her birth changed everything. She was shown how powerful her birthing body was and that she could do anything. Here is her story of the birth of her son…

My name is Ruwarashe and I am 21-years-old and I come from Zimbabwe. I’m currently studying at UCT. I became pregnant in September 2018. Pregnancy was going to be a hard journey for me, as I didn’t understand anything about birth and even worse, I was a long way from home where I had friends and family to guide and support me. In Cape Town, I have little support. So many people recommended I get a doula, especially since I felt quite isolated in Cape Town without my family near. 

Choosing a doula for me was so important, because I needed someone compassionate and soft and when I went onto Charlene’s website, I knew she was the doula who would understand my fear and confusion of becoming a mother. ( I hadn’t even met her in person yet, but I just knew.) 

I remember I wasn’t sure if I was going to have anyone close to me at my birth, because my family and fiancé stayed so far away… And I had so many fears of becoming a new Student  mom. Charlene reminded me that she was going to be there for me – and that I would be ok, no matter what turn it took. She said this at our first meeting.

Charlene engaged with me every week reminding me to trust the process of the journey I was on, offering me her kind support along the way. I was at school from 8am to 5pm everyday and I was at school until I was 9 months pregnant.

She also made sure we were able to meet close by to where I lived, as I did not have a car. She did this without hesitation – and it was so kind of her. When I felt low, I would message her and we would chat and she would encourage me to keep my faith and to be strong. 
I think what especially helped were the Relax Into Birth visualisation tracks. Listening to them regularly helped me realise that birth wasn’t just an event, it was a process – a beautiful process… Finally I was learning to trust the process – and trusting myself to do it! I felt strong enough to birth my baby boy. The strength seemed to come from within me. A deep knowing. 

The Relax Into Birth classes made me realise I wasn’t just doing a duty a woman is required to do; no! My body was giving life to a soul, another human being. Although it was about birth, it also somehow helped me establish what type of mom I was going to be to my little boy. 

When I finally went into labour, the emotional support for me and my fiancé was tremendous! She always made sure I was as comfortable as I could be in those circumstances. When it was time for me to deliver, I remember I was very tired – and our doula Charlene never once wavered, always trying ways to help energise me and encourage me to bring my son down to earth.

During my visits to the doctor, I was told we had to schedule an induction, because they didn’t want me going over my due date, which was the 26th of May. I wasn’t so sure I wanted an induction considering the potential complications. It was really not what I wanted.

In my 39th week, I went for cervix check to prepare for my induction. I was notified that soon I was going to be in labour – and that it was likely I would not need an induction. On Thursday 23 May, my waters broke as I was going to bed. I remember I kept my calm. I took an Uber with my fiance who had arrived from Zimbabwe, even though my contractions hadn’t kicked in properly yet. I didn’t want to stay at home after that because I didn’t want to be under pressure to rush to the hospital when it became necessary. I didn’t want something dramatic! Charlene did join us at the hospital when my contractions got regular and intense. She was there the whole time and I held onto her. She created such a calming environment in such a tense situation. I remember I had moved 1 cm in 4 hours and all I wanted was an epidural. I asked the nurses for an epidural, but was refused by them, saying it was too early to administer. In the face of that, my doula encouraged me to keep going and to stay strong as I was birthing my angel.

We used other forms of natural pain relief. We used the shower and we counted together and breathed together and finally at 7 am they decided to insert a dose of prostaglandin gel to help my cervix open. Once that was given to me, five minutes later I was standing to go poo in the toilet and another five minutes later I was walking myself to the tub in the delivery room. During that walk I definitely felt my baby was coming! I got into the tub for a few minutes and notified both my fiancé and Charlene that the baby was indeed coming.

The delivery room not prepared by the hospital staff (as they didn’t expect me to push so soon), they quickly put me on the bed, and there was my baby crowning! They quickly set up the room as I involuntarily pushed him out. A few pushes and I had birthed my baby.

My birth taught me to trust my body and trust my baby. I have never felt as strong or as empowered as I did in those first days. I was blessed to have such a positive, empowered birthing.

Pip’s Birth Story

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Hailing from New Zealand, I had never met Pip in person, but she was referred to the Relax Into Birth Hypnobirthing course by a dear South African friend of hers, who had also completed the course a few years earlier. She was so excited to share her story with me after she had given birth, because the techniques had been so helpful. Here is her letter to me after her birth.

Dear Charlene,
I just wanted to give you an update on how I have been doing and let you know our little baby girl “Niamh” arrived safely with us in hospital at 10.07am on the 8th May 2020 at 6 Ib 15 oz and we are all doing great! I am sorry I haven’t been in contact sooner – I just wanted to sit down when I had some time to fill you in properly. I have emailed you because if I sent you a voice over on whats app I would be in tears!

Just to give you some background on myself, I had extreme anxiety about labour for as long as I can remember and this soon got worse when I became pregnant. To give you an example I had previously passed out from getting cervical smears done and I am just not good with that kind of stuff! – ironic really considering I am a horse vet! 

You couldn’t have come at a better time for me as the anxiety was getting the better of me as time progressed. I remember around 26 weeks in tears at my midwife appointment feeling completely overwhelmed and not knowing what to expect.  I spoke to my dear friend Felicity Meek who put me in touch with you. As soon as I started listening to your affirmations and then doing your course from around 33 weeks my mind set started to change and I began to relax ! Your course allowed me to understand the process but in a way that wasn’t scary but beautiful, something to look forward and that my body was going to do it! I had no idea how powerful hypnobirthing could be but it was the best thing I could have done to prepare myself ! I can not thank you enough Charlene – you are incredible and what an amazing birthing experience you and your course have given me.


Now for the gorey details………… well there aren’t any! Haha! I went into latent labour on the 4th May ( my due date) with mild contractions every 10-20 mins for about 20 seconds in length on / off through to the 7th May when the contractions gradually got stronger and longer. I had a “Show” over this time too which I admit did freak me out a bit but I had your voice saying “Show time!” in my head which helped to ground me and stop me panicking. 
I laboured at home for as long as possible and made a wonderful area in my sitting room with candles, diffuser with lavender oil, exercise ball, cushions, fairy lights etc …. with my husband, 2 dogs and my favourite movies on.

It was really beautiful and my husband was absolutely amazing using some of your massage techniques on my lower back and making sure I was eating/drinking. I used a water colour painting of a lotus flower to remember your affirmations and a colour card to look at to help me focus on the rainbow breathing technique. During contractions I would also think about your lovely knitted uterus which helped me visualise and understand what mine was doing!

 By the 7th May from 6pm the contractions got stronger and lasted longer until  I was getting contractions every 3-4 minutes lasting a minute by midnight –  I was in/out of the bath at this point which helped a lot. 

We made our way to the hospital at this point and got screened at the entrance for COVID-19. We entered the maternity ward and the corridors were lined with pastel balloons and fairy lights which was wonderful! I was examined (I was apprehensive about the examination) and found to be 8 cm dilated. My waters broke at this point – I was delighted thinking ” not long to go now!”

I went into a bath  and my husband and midwife set up some led candles and my affirmation cards. I stayed in the bath from about 2 am to 6 am . I was examined a few times and found to be 10 cm by 4 am but my contractions started to get weaker and further apart. I got out of the bath and tried sitting on a squatting stool but that didn’t really bring things on.

Up to this point everything was 100 % perfect but I started to feel anxious and willing for more intense contractions! I was examined by an Obstetrician  at 6.30 am – he was astounded that I had no pain relief and I remember the midwife saying proudly “she’s using hypnobirthing!” The obstetrician confirmed with the midwife that all was well with baby and there was no reason why she shouldn’t come through my pelvis.

It was discussed with me to go on a Pitocin drip to get contractions going. My platelets were low so it was not recommended to have an epidural, but I remember feeling so exhausted and the thought of pain relief sounded good! Your affirmations grounded me through this process and helped me focus and I just continued to breath, eyes closed and I just went into myself. Once the drip was in and monitor put on baby head I was allowed go on 4’s on the bed. The contractions came – I took gas as I found them heaps stronger than my own ones but I could tell we were making great progress.  I remember feeling my baby head turn and pop through my cervix. An incredibly visceral and alive feeling I had – I think I shouted out “Fecking hell!!!” and “How close are we now?”

Then I felt the wee burn feeling and I remember thinking “We are nearly there!” My midwife got me on my back at this point, one of my legs was wrapped around her neck. I couldn’t believe how much pushing I had to do along with the contractions. She got me to really push with my breath. At this point I remember taps going on and her telling me try not to push at the moment. She was putting hot flannels on me. Then the last contraction came and she warned me she may give me an episiotomy (I didn’t care at that point !) but she didn’t  have to  in the end and Niamh’s head came out followed shortly by the rest of her and up she went onto my chest – total magic!!!

My husband Josh cut the cord and she stayed on my chest for an hour.  I got a small superficial tear that was stitched (about an inch or so long), but that was it. I passed the afterbirth and I remember the umbilical cord some how slid up between my bum cheeks and I said “Guys – the cord is giving me a wedgey!” , then I proceeded to wiggle around on the bed trying to pull it out. 

I walked out of the delivery room an hour later feeling completely elated and so proud of myself. I had a beautiful and empowering birth experience and when one of my fears of having interventions occurred I was able to process and deal with it thanks to you and your course. 

So Charlene, I can not thank you enough. Every first time mum should be doing this as it has honestly helped me beyond belief. I really think it should be offered to all expectant mums at their first midwife/doctors appointment. A huge thank you from the bottom of my heart.
Love from Pip.

Want to find out more about Relax Into Birth Hypnobirthing? Enjoy a more comfortable, empowered birth and click below to enroll and find out more. Relax Into Birth is an Online Birth Preparation Course, of international standard, teaching women and their partners Hypnobirthing techniques and deep relaxation methods for a more comfortable and manageable birth experience at home or at hospital, for natural or caeasarean birth.

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Petra’s Birth Story

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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

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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!

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

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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 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 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

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.

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!

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:-)

Emma Nummanoglu, Lindsay Donnachie and me

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

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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.

😊🤗😊

Birth Options Midwifery Team Statistics 2017

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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 )

So there you have it. In a world where unnecessareans are on the rise, it helps to know your options and who will support you in your preferences.

And remember, no matter what turn your birth takes, there are no unnatural births. ❤️