The way in which your primary caregiver views birth, their management style and their degree of commitment to the normal birth process will determine how they care for you during labour and the services they will perform.

Thinking about your goals for the birth can help you to identify which type of care arrangement is going to support you to achieve the kind of birth you are dreaming of. It’s a good idea to shop around for your caregiver in order to give yourself the best chance of fulfilling your goals.

Choosing a Birthplace

The environment in which a woman labours and gives birth has a major effect on the birth. A woman’s physiological responses will be affected by her surroundings and the result can either speed or delay the process. Her main need is to feel safe and protected from danger or harm, since during the hours of labour she will feel particularly vulnerable.

Many expectant parents assume that their baby will need to be born in a hospital. The World Health Organisation states that normal, healthy pregnant women may wish to consider a number of options, and that for these women, giving birth in their own home is a safe option.

The availability of suitable caregivers will also influence where a woman chooses to give birth. And some women choose to arrange several alternatives so that they can make their final decision during labour. For example, a woman may make a booking at the hospital, but choose an independent midwife who can assist her in either her home or at the hospital, depending on how the labour develops and how she feels at the time.

General Statistics for Birth Outcomes in Victoria

References:
- Births in Victoria 2003-04. (2005) Perinatal Data Collection Unit. Department of Human Services
- WHO (1985) Appropriate technology for birth. Lancet ii, August 24, 436 - 437

These statistics show that a healthy woman’s chances of experiencing a normal birth are greatest if she chooses to have her baby in a birth centre or in her own home. It also shows that public hospitals support higher rates of normal birth than do private hospitals.

The World Health Organisation recommends that normal birth should be around 80% as it is this percentage of the population who are able to give birth without the need for obstetric intervention. WHO research also shows that countries which have caesarean birth rates of between 10 and 15% also have greater levels of maternal and newborn health.

For more detailed informaion, you can find out how your hospital performed in 2005 - 06 in this online Victorian Government publication Victoria Maternity Service Performance Indicators - Complete set for 2005 - 06 Listed here are statistics for each hospital in regard to Induction of Labour; Caesarean Section; Tearing and VBAC.

Your options for Birth Venue:

Birth Centres

Some hospitals have additional facilities, called Birth Centres, which are designed to be as home-like as possible. These units are usually set up as a separate unit, and have their own staff of midwives to oversee the pre-natal care and the birth. They aim to enable women to give birth with as little intervention as possible.

Benefits
• Care provide by a team of midwives.
• Increased likelihood of achieving a normal birth than in a hospital labour ward.
• If a woman requires medical assistance or the use of pain relieving drugs, transfer to the nearby labour ward is easy.

Risks
• These programs are very popular and often have waiting lists.
• Tension between the philosophy of the birth centre and the Medical institution it sits within, may impact on the facility’s ability to offer true midwifery care.

Melbourne’s Birth Centres
• Monash Family Birth Centre, Clayton. Ph: 9928 8780
• Mercy Family Birth Centre, Heidelberg. Ph: 9270 2222
• Angliss Family Birth Centre, Upper Fern Tree Gully. Ph: 9764 6226

Home Birth

The availability of home birth depends largely on the availability of midwives who provide this service. Details of independent midwives can be found at www.maternitycoalition.org.au

Though doctors rarely provide home birth services, there is one GP, Dr. Peter Lucas who will support a woman to birth in her home. He is based at Wattle Park House, 1138 Riversdale Rd, Box Hill South, ph: 9808 0533

Benefits
• Freedom to labour in your own way, in the privacy of your own home.
• No need to make special arrangements for other children.
• Reduced risks of medical technology or drugs being used routinely – you will be asked to consent to every procedure.
• Reduced risk of infection.
• The baby will be welcomed into its own home and family with little chance of separation or disruption.
• No need for special visits to the hospital with your new baby - your midwife provides post-natal care in your home.

Risks
• Your home must have basic equipment – telephone, hot water, ready access and be within 20 minutes of the nearest hospital.
• If there is a complication with the labour, you will need to transfer to hospital, which can be traumatic. Most independent midwives make a back up booking for you with the closest Level 3 maternity hospital.
• Although midwives will carry basic medical equipment for most situations, if there is a problem with the baby, emergency transfer to the nearest hospital may be necessary.

Hospital Labour ward

The majority of women give birth in a standard hospital labour ward.

Benefits
• Care in public maternity hospitals is free
• Some public hospitals provide midwifery led one-to-one care (Birralee Maternity Service, Box Hill, Sunshine Hospital, Casey Hospital)

Risks
• Facilities vary and may not be conducive to undisturbed birthing. A visit during pregnancy will help you to decide if this is where you want to be for the birth. Prepare for this visit and feel free to ask questions of hospital staff whilst you are there. The hospital tour questionnaire attached might help.
• Though care during pregnancy and labour is provided by midwives, hospital routines are informed by policies based on the medical model of birth, intervention rates in Australia are relatively high.

Your options for caregiver in Australia:

The Midwife:

The World Health Organisation recommends that midwives be seen as the best caregivers for healthy women with normal pregnancies. Midwives are trained in the management of normal pregnancy, birth & newborn care. If problems arise, the midwife is able to recognise them and refer to specialists as necessary. She offers a range of non-medical techniques for promoting safe outcomes for you and your baby and for managing the pain of labour. Public hospital midwifery services are usually free. Different hospitals offer different models of care. The case management model gives you a named midwife who will care for you throughout your pregnancy, labour and birth. In the team midwifery model you are cared for by a team of midwives throughout your pregnancy, labour and birth. Some hospitals offer special midwife run clinics and birth centres.

Controlled trials have been conducted to look at the effects of continuity of care during pregnancy and labour. These trials compared the experiences of women who were cared for by a small team of midwives and women who were cared for by a variety of midwives, obstetricians and GPs. Women who were cared for by a small team of midwives were less likely to be admitted to hospital during their pregnancies; were more able to discuss their worries and feel well prepared for labour; needed less pain relief and experienced fewer interventions during labour. They had fewer babies who required resuscitation at birth.

Independent Midwife:

Independent midwives work on a private basis and so have a range of charges for services. They are sometimes available through outreach programs at local hospitals. Independent midwives may work on their own or with a partner and usually offer homebirth. An independent midwife can also attend you in hospital providing you with continuity of care throughout your pregnancy and labour. Unless they have negotiated visiting rights with the hospital they will not be seen as your primary caregiver by hospital staff. If complications arise in a pregnancy they can refer to an obstetrician. If you are a healthy woman with a normal pregnancy, hiring an independent midwife is one way to ensure that you have a caregiver you know and trust to care for you throughout labour and birth.

Independent midwives do not currently have professional indemnity insurance. If you are considering making a booking with an independent midwife, it is a good idea to discus the implications of this with her before you confirm care arrangements.

Details of independent midwives can be found at www.maternitycoalition.org.au

General Practitioner:

In some communities, GPs offer maternity services. These GPs have additional training in obstetrics and often undertake c-sections. It may be possible to ‘share care’ with a midwife. GPs may provide prenatal care to women planning to birth in hospital, assisted by themselves or by a midwife, and may offer post-natal care – providing continuity of care through pregnancy and birth into the initial postnatal period. Some GPs only provide pregnancy care and will not be present at the birth. GP services are usually available on Medicare.

Obstetricians:

Obstetricians are specially trained in the management of complicated pregnancies and births. Midwives will refer ‘high risk’ clients to obstetricians. Other specialists may be consulted if a woman has an existing condition e.g. diabetes, this will incur additional fees. A private obstetrician provides prenatal care at private rooms. They will be closely involved in your care during labour although they may not be present for all of it. They will plan to be at the birth and will provide care after the birth. Choosing an obstetrician when a normal pregnancy and birth is anticipated does not appear to improve outcomes compared with involving obstetricians when complications arise. It can lead to higher rates of intervention such as Caesarian Sections or forceps. A likely cause of this is that obstetricians follow the Medical Model of birth, which anticipates problems, rather than managing birth as a natural process.

The Active Birthing Workshop can further develop your skills and build your knowledge around:

• The advantages and disadvantages of each choice of birth attendant;
• The advantages and disadvantages of your birth venue options;
• Your rights as a pregnant woman;
• And how to use a birth plan to communicate with your caregiver.

References

• Enkin. M, Keirse. MJNC, Neilson. J, Crowther. C, Hodnett. E, & Hofmeyr.J. (2002) A guide to effective care in pregnancy and childbirth. 3rd Edition. Oxford: Oxford University Press.
• Robertson, A (2002) Preparing for Birth: Mothers – Background notes for Pre-natal Classes. Camperdown: ACE Graphics.

A healthy pregnancy and great birth have their foundations in your health and diet during pregnancy. Nutrition has a great impact on the health of your baby from its life as it grows inside you through to adulthood. ANY improvement you can make to your diet during pregnancy will benefit both you and your baby.

Even if you are far into your pregnancy, there is still much to be gained from reviewing and improving your diet as the nutrient requirements of your pregnancy increase significantly during the second and third trimesters with the baby’s rapid growth. Nutrient deficiencies could still be avoided or their impact on the birth and the post-partum period lessened even at this late point.

A well balanced diet during pregnancy is also good preparation for successful breastfeeding. Changes made to eating patterns late in pregnancy will place you in an even stronger position to meet the physical demands of breastfeeding and life with your newborn baby.

What is a balanced diet?
A balanced diet includes a variety of foods from all 5 food groups described in the Food Pyramid, which also describes the recommended number of daily servings. It should provide enough calories to ensure a desirable weight and should include all the necessary daily nutrients.

On a balanced diet, supplements are not required. However increasing your intake of folate a month prior to conception and for the first 2 months after conception can reduce the risk of your baby developing neural tube defects.

The neural tube is that part of the developing fetus from which the skull, brain and spine develop. Neural tube defects include spina bifida, anenchephally and encephalocoele. A daily folic acid supplement of 400mcg for the first two months of pregnancy (or the first month only if the date of conception is known) is recommended.

Dietary supplements may also be required if you have a pre-existing dietary deficiency, are expecting more than one baby, are a heavy smoker, or regularly use drugs or alcohol. You should consult your medical practitioner for advice.

How to get the nutrients your body needs during pregnancy

The table below gives the Recommended Dietary Intakes for energy, protein, calcium, iron and folate during pregnancy.

Energy: Additional energy is required in pregnancy to allow for the increased needs of the growing baby and the changes to your body. Energy is the major nutrient determining the baby’s weight gain. Energy requirements are greatest between 10 and 30 weeks gestation, when your body is depositing larger quantities of fat. Sufficient energy is a primary dietary requirement of pregnancy. If energy needs are not met, available protein, vitamins and minerals cannot be used effectively for various metabolic functions.

After the first 3 months of pregnancy, your additional energy required can be met by eating an extra two slices of wholemeal toast and a banana, or one cup of rice or pasta and an apple each day.

Protein:Additional protein is required during pregnancy because your body is making new body tissues. Protein provides for the growth and development of the baby, the placenta, the uterus, breast tissue and increased blood supply.

After the first 3 months of pregnancy, your additional need for protein required can be met by drinking an extra glass of milk or calcium enriched soy milk (200ml) daily or eating an extra half a peanut butter or cheese sandwich.

Calcium: Additional calcium is required by your baby for the formation of bones and teeth; the functioning of nerves and muscles; and the development of heart rhythm and normal blood clotting. The majority of extra calcium is required in the last three months of pregnancy. Calcium is also required for the production of breastmilk. Dairy foods, such as milk, cheese and yoghurt are excellent sources of calcium.

The additional calcium required during pregnancy can be obtained by eating or drinking:

• an extra glass of milk or calcium fortified soy milk (250ml);
• a wedge of cheese (40g);
• 1 carton of yoghurt (200g);
• or 1 cup of mashed pumpkin (240g) and ¾ cup of cooked spinach (115g).

Iron: Additional iron is required to meet the needs of your growing baby and placenta and for the increase in your blood supply. Iron also builds bones and teeth. It is particularly important in the 3rd trimester when there is a large shift of iron to the baby for its development. Iron deficiency can lead to anaemia as your iron stores depleted in favour of the baby. Blood loss during the birth also needs to be compensated for by increased iron intake.Iron found in animal foods (haem) is more readily absorbed by the body than the iron found in plant foods (non-haem). Ideally the diet should combine haem and non-haem sources of iron.

*Liver products should be avoided during pregnancy since they may contain excessive Vitamin A.

Foods rich in vitamin C (citrus fruit, strawberries, green capsicum, kiwi), when eaten alongside iron-containing foods, increase the body’s absorption of iron. Milk, tea, coffee and antacids inhibit the absorption of iron and should not be taken with meals.

Folate: The main function of folates is to preserve the integrity of genetic material while it is being transferred from one cell to another.It is possible to increase your consumption of folate by taking a low dose folate tablet, normally called ‘folic acid’, 0.5mg or 500mcg, by eating foods rich in folate every day and by choosing foods that have added folate. By eating several serves of folate rich foods every day it is possible to reach the RDI of 500mcg. The 1999 Victorian Folate Campaign recommended that women do all three of the above.

Attention to food preparation is important as folate is very sensitive to high temperatures so fresh green vegetables should only be cooked for a short time in as little water as possible. Folate is also destroyed by cooking food in bicarbonate of soda. Best cooking methods include steaming, microwaving and stir frying.

The additional folate required pre-conception and during pregnancy can be obtained by eating an extra ½ cup of cooked spinach (100g); or an extra vegemite sandwich each day.

Women are at increased risk of experiencing a neural tube defect affected pregnancy if:

• They have had a baby with spina bifida, anencephaly or other neural tube defect;
• They themselves have, or have had, a neural tube defect;
• They have a close relative who has, or has had, a neural tube defect.

Women taking medicines for epilepsy or seizures are also at increased risk as these drugs can interfere with the body’s ability to absorb folate.

The Department of Human Services recommends that women at higher risk need to have a folate intake about 10 times higher than the average recommended daily dose, at 5mg per day (Department of Human Services 1999).

Early Pregnancy Sessions can further develop your skills and build your knowledge around:

• Reducing pregnancy discomforts through nutrition;
• The advantages and disadvantages of vitamin supplementation;
• Managing special diets during pregnancy e.g. vegetarian and vegan;
• Recipe and menu ideas for healthy eating.

References
- Australian Nutrition Foundation Inc.(1994). Nutrition for Pregnancy – Stepping up your nutrition. Adelaide: Finsbury Press

- Bennett, VR & Brown, LK (1999). Myles Textbook for Midwives. London: Churchill Livingston.

- Department of Human Services & Family Planning Victoria (1999). Folate – A guide for primary health care professionals.

- Institute of Medicine (1990). Nutrition During Pregnancy: Part 1 – Weight Gain. Part 2: Nutrient Supplements. Available at http://books.nap.edu/books/0309041384/html/index.html [Accessed 24.3.03]

- Sanitarium Nutrition Education Service. Leaflet: Give your baby the best start in life. Wahroonga: Australia.

- Sears (2003) Eating right for two. Available at http://www.askdrsears.com/html/1/t011400.asp [Accessed on 16.3.03]

- Story, M. & Stang, J. (eds) (2000). Nutrition and the pregnant adolescent – A practical reference guide. Available at http://www.epi.umn.edu/let/nmpabook.html [Accessed 27.3.03]

- US Department of Agriculture 2003 Food Pyramid. Available at http://www.nal.usda.gov:8001/py/pveg.htm [Accessed on 19.3.03]

During pregnancy it should be possible for you to maintain any pre-pregnancy exercise program to some degree. Research has shown that exercise during pregnancy can reduce your perception of pain during labour.

If you have not done any regular exercise before becoming pregnant, pregnancy can be a good time to start, but it is important to take it slowly and listen to your body. Regular low impact exercise (that is exercising 3 times a week) is better than exercising in intense spurts.

Breathing and stretching during pregnancy can also bring you many benefits, as you become familiar with the groups of muscles used in birthing. You will be more able to recognise, isolate and activate these muscles for a more efficient labour. Toned muscles are better able to perform their functions. By performing pelvic floor exercises these muscles will be better able to play their two very important roles during birth. They guide your baby’s movements through the birth canal; and they relax and allow your baby to exit from the pelvis. Good pelvic muscle tone can make your pushing efforts during the second stage of labour more effective, resulting in a shorter labour for you and an easier birth for your baby.

The benefits of exercise during pregnancy don’t stop here though! Maintaining or improving your muscle tone can also make for a more comfortable pregnancy. Exercise is effective in reducing backache, as your body is better able to maintain the natural tilt of your pelvis; muscle cramps through improved circulation; and episodes of constipation.

A good level of physical fitness during pregnancy may reduce your overall stress and anxiety and will leave you in better shape to enjoy your new baby.

Guidelines for exercise during pregnancy

1. Always listen to your body, don’t overt exert yourself. If you experience
   dizziness, nausea, blurred vision, fatigue or shortness of breath during
   exercise, STOP, these can be signs of heat stroke. Never exercise to point of
   exhaustion or breathlessness.
2. Warming up your muscles before exercising and cooling your muscles
   down after exercising is very important.
3. Wear comfortable footwear giving strong ankle and arch support.
4. Take frequent breaks and maintain your fluids levels.
5. Avoid exercising in extremely hot weather.
6. Avoid rocky terrain or unstable ground when running or cycling ? during
   pregnancy your joints are more lax and therefore more easily sprained or
   injured.
7. Contact sports or any sport where you run a risk of falling should be avoided during pregnancy.
8. Weight training should emphasise improving muscle tone especially in
   the upper body and abdominal areas. Avoid using weights that put a strain on your lower
   back.
9. During your 2nd & 3rd trimesters, avoid exercise that involves laying
   stationary on your back as this decreases blood flow to uterus. There
   is also a danger of supine hypotension. Instead try half-lying position with your back
   raised to angle of 35 degrees.

Birthready Stretch and Relax classes can further develop your skills and build your knowledge around:

• Warm ups and basic stretches.
• Stretching to demonstrate how mental relaxation can be used in labour.
• Pelvic floor exercises.

References

• Bennett, VR & Brown, LK (1999). Myles Textbook for Midwives. London: Churchill Livingston.
• Enkin. M, Keirse. MJNC, Neilson. J, Crowther. C, Hodnett. E, & Hofmeyr.J. (2002) A guide to effective care in pregnancy and childbirth. 3rd Edition. Oxford: Oxford University Press.
• Goldberg, E. (2001). Exercise and Pregnancy. Available at http://www.med.umich.edu/1libr/womens/pg08.htm [Accessed on 16.5.03]
• Reeder, SJ., Martin, LL., Koniak, D. (1992) Maternity Nursing – Family, Newborn and Women’s Health Care. 17th Edition. New York, London, Hagerstown: Lippincott Co.
• Varrassi, G., Bassano, C. & Edwards, WT. (1989). Effects of physical activity on maternal plasma beta-endorphin levels and perception of labor pain. Am J Obstet Gynecol, March 1989;160(3).

Ever heard a birth story where the woman goes into hospital after getting some really good contractions going at home — only to have them stop once they get through the hospital doors? What is often happening here is a very normal and important response by the woman’s body to her feelings of anxiety about her labour, and its all down to hormones. The good news is that you can increase your chances of avoiding this becoming part of your birth story by finding ways to increase your feelings of safety and security during labour.

You may have heard about oxytocin, as it is the major hormone responsible for creating contractions during labour. Did you know that in response to these contractions your body releases endorphins? These are your natural pain relievers, and they are very similar to opiates like pethidine. Endorphins are those powerful chemicals, which give you a high after a strenuous workout at the gym or after a really hot curry! In fact, your body will start to produce these endorphins well before labour, in preparation for the big event. As your labour intensifies, your endorphin levels rise in response, to get you and your baby through labour and birth.

But if you become scared or anxious during labour, your body may release another hormone into your system, which works against oxytocin and endorphin. This hormone is adrenaline, and its release is part of your body’s primitive survival behaviours, because its job is to slow down or stop your labour until the perceived danger has passed and you feel safe again, so protecting you and your baby.

This effect occurs because adrenaline reduces the levels of oxytocin in your body, slowing contractions. Adrenaline will also work upon your cervix to stop it from dilating and in some cases it will reverse the work you have already done and begin to close it.

A woman’s body might release adrenaline in response to anxiety about an increase in the level of pain she is experiencing, or the feeling that she has a lack of privacy, or perhaps in response to a worrying comment she has heard from a caregiver. But sometimes the source of the anxiety is less obvious because it is an emotional issue, such as the concern that the baby may have a disability or a fear of pushing the baby out. In these cases too, adrenaline can be released, slowing and sometimes stopping the labour.

So how can you avoid this becoming part of your labour? Well, one of the most important things you can do is to try to increase your potential for automatic relaxation in your chosen birthplace. If you are planning a homebirth, you will already be in your own environment. If you are planning to birth in a hospital this can mean doing a bit of preparation before labour begins, as you will want to try to create a ‘home from home’ in your hospital birthing room.

Firstly make sure that you visit your hospital birthing suite or labour ward during pregnancy, so that you are familiar with the place before you arrive there in active labour. Most hospitals run tours regularly. You will also be able to find out about the available facilities and meet more members of the hospital staff team.

Whilst you are there find out if:
You will have access to a bath/ birthing pool during labour?
There is a CD player in every room for any music you may bring from home?
You can have access to an electric oil burner for aromatherapy?
Every room has a small lamp or dimmer switch to create dim lighting?
Can you have access to a birth ball; bean bag; floor mats; extra pillows?

If you are a healthy woman with a normal pregnancy, it might be worth checking to see if your hospital has a birth centre attached to it. Births centres are usually run by midwives and their rooms are generally much more ‘homely’ than those in the main hospital birthing suite or labour ward.

Once you have done a ‘recky’ of the birthing suite, think about the kind of atmosphere you would like to give birth to your child in and how you might achieve this in the birthplace you have chosen.

Pack your hospital bag to increase your comfort and privacy!

Take your own bedding with you. Seeing and smelling your own linen can be very comforting. Pack your own shirts (or clothes) for labouring in. Take anything else with you which might remind you of your home for example photographs of family, scarves or sarongs to cover up unused hospital equipment, favourite ornaments etc.

Pack some CDs. Even if you do not listen to music regularly, music can help to create atmosphere whether that be peaceful or upbeat (both might be needed at some point during your labour) and can block out noises from the rest of the labour ward. Music has also been shown to relax the medical staff too. Make sure you take a good variety to avoid monotony.

Packing your favourite perfume to spray in the room can mask any unhomely hospital smells. Or if you find that aromatherapy helps to relax you, take some well chosen oils with you.

Once you have arrived at your birthplace:

Dim the lights – Close the curtains if it is daytime. If it is dark outside, turn off the main light and put on a small lamp or the bathroom light instead.

Set up a labour nest ON THE FLOOR on the opposite side of the bed from the door – Staying off the bed can be a good start if you wish to achieve an active labour. Placing yourself on the opposite side of the bed from the door, will minimise your disturbance from caregivers coming in and out of the room. In early labour, you may find it useful to simply lean over the bed during contractions. During active labour you could try kneeling on the floor and leaning over a beanbag and extra pillows during contractions and for relaxing in between them. Use matting and pillows to cushion your knees.

Check the temperature – Use fans or heaters to make sure that you are comfortable.

Your partner as ‘Guardian of the birthplace’ – This is one of the most important roles your birth partner can play whilst you labour. Seek your caregiver’s help in reducing disturbances to you whilst in labour, some suggestions include:

Ask that only essential personnel be present in the room. If you are labouring normally, you may only be attended by a midwife, but it is not necessary for her to be present all the time if you find this to be a distraction. Your caregiver might also ask if a student midwife can attend, this is your choice. In a hospital, you may be assessed by a doctor at 4 hourly intervals. Again your doctor might ask if medical students be allowed to attend, this is your choice. If you have a private doctor, they will expect to be there for the birth and possibly at other times during your labour. If the room is filling up with people even though all is going well, your partner can gently ask non-essential staff to leave.

Ask staff to knock and wait to be answered before entering the room.

Keep vaginal exams to a minimum. An observant caregiver should be able to assess your progress in labour just by noting your behaviour. If a vaginal exam becomes necessary, ask to have it performed in your current position if possible.

Escape to the toilet! If it is proving difficult to achieve a quiet and calm atmosphere in the room, and everything is going well, escaping to the toilet or bathroom can be effective. We are conditioned into giving people their privacy when they are in the toilet and the limited space will reduce the numbers of people in attendance. Using water during labour, either a shower or bath has also been shown to increase a woman’s sense of privacy during labour.

o Childbirth. New York: Bantum.

The Stretch & Relax Class is so much more than just a prenatal exercise class! The class features a gentle stretching program which

is designed to strengthen and tone the muscle groups which support your body during pregnancy and enable you to give birth. The program also aims to enhance your body confidence, familiarising you with the
parts of the body used during childbirth, and better equipping you to work with your body during labour. Each class also provides you with an opportunity to share you experiences with other pregnant women and
establish friendships for the journey into motherhood and beyond.

The Stretch & Relax Class incorporates a birth preparation program comprising individual and group activities and discussions, written materials and video presentations. There are also regular nights which can be attended with your support person, enabling them to develop their skills and knowledge around their role during labour and birth.

-> Read what women are saying about these classes

Box Hill Class

Costs

Introductory session - $13
4 session membership card - $68
8 session membership card - $128

“I learnt so much during my short time in the group and I only wish that I had found your classes earlier in my pregnancy. I loved the combination of activities from the stretching to the relaxation, the birth education and just being with a group of supportive women all experiencing the highs and lows of pregnancy together. I also loved listening to other women’s birth stories. Every time I left one of your classes I felt more relaxed, more confident and more knowledgable about birth. So thank you very much for the fantastic support that you provided me.” Second-time mother, Mount Waverley, VIC

How to book your place

Complete and submit the Registration Form featured on the website. We will then confirm a start date with you by email, within 2 working days. NB: please ensure that your junk mail settings will allow you to receive email from Birthready.

If you have indicated that you have medical issues on your registration form, we will contact you by telephone to discus the appropriateness of the class for you.

What is a Professional Birth Attendant / Doula?

A professional labour supporter or doula is a non-medical labour assistant, who provides continuous physical and emotional support to the birthing woman and her partner throughout labour and birth. Victoria Marshall-Cerins is a qualified and experienced doula, who has been attending birthing women through the passage into motherhood for the past three years.

A doula offers the one-to-one continuous care that the hospital staff team may be unable to provide. Victoria offers support and comfort to the mother and her partner during labour and birth; she works to facilitate effective communication between the birthing couple and their midwife/doctor; and aims to preserve a peaceful and respectful birthing space within which the woman can respond instinctively to the needs of her body and birth her baby with dignity and profound satisfaction.

“Your wisdom, guidance, patience and sense of calm led us through a beautiful pregnancy and eventually a rewarding birth. You will always hold a special place in our lives and memories. Thank you so much for all you’ve given.”
Sue, Mont Albert North

Victoria is able to offer a wide range of self-help ideas and partner support techniques for improving comfort and managing pain during labour and to increase the efficiency and safety of the birth process.

A doula also offers unconditional emotional support during labour and birth. Victoria can support you to get complete and unbiased information about recommended interventions from your midwife/doctor, in order to make an informed decisions about your care. Victoria will fully support your informed choices. It is a doula’s role to support you to achieve YOUR goals for birth, and to experience the best birth possible for YOU and your baby.

“I wanted to particularly thank you for your company and for staying after my baby and husband had to go to the nursery. I appreciate it had been a long and exhausting day for you, so thank you for extending yourself in this way. I can’t express in words what a fantastic birth experience I had and how much a part of that you contributed to. You provide a wonderful service.”
Alison, Blackburn South

These sessions are designed especially for pregnant women and their
partners in their first and early second trimesters. They provide
wonderful opportunities to spend a couple of hours together focusing
upon your pregnancy and to meet other couples at a similar life stage.
The evening combines group activities, discussion and video and audio
presentations to enable you to:

• learn how your baby grows and develops within you
• find out how to nurture your body and baby throughout pregnancy
• explore some of the changes that are part of pregnancy
• practice basic exercises and stretches to enhance your comfort
• access information about prenatal testing and options for care during pregnancy

Details:

• Sat 26 April 08, 1pm - 4pm - Box Hill Library, Whitehorse Road, Box Hill. Ph: 9890 1002
• Sat 21 June 08, 1pm - 4pm - Oakleigh Library, 148 Drummond St, Oakleigh. Ph: 9563 4138
• Sat 9 August 08, 1pm - 4pm - Vermont South Library, Pavey Place, Vermont South. Ph: 9887 9646

Costs: These sessions are FREE!

How to book your place

Pease contact the relevant library for the session you are interested in and ask to register for the Positively Pregnant - Early Pregnancy Workshop. We look forward to meeting you there!

Introduction

This workshop is delivered over two Saturday or Sunday mornings using interactive and innovative teaching strategies. It will increase your confidence in your ability to birth your baby; and equip you and your partner with labour self-help techniques and partner support strategies that really work and can dramatically enhance your experience of birth. You will also learn how to use decision making tools which enable you to birth your way.

We will combine group activities, games, discussion, practical exercises, role play, videos and written materials to bring you an inspiring and enjoyable learning experience. You will come away from the workshop feeling prepared and confident to meet the challenge of labour and being able to apply your new knowledge and skills to give yourself the best possible birth experience.

The information and skill development provided by these sessions is rarely included in hospital prenatal classes.

We will explore:

Labour and Birth…
• What normal labour is really like and how you might respond to it.
• Feelings about birth, their impact on labour and how to remove fear.
• The benefits and principles of active birth:
• wonderful self-help techniques which enhance the experience of birth and shorten the length of labour including, breathing, positioning, movement, vocalisation and more.
• How to achieve deep and focused relaxation throughout the birth process, resulting in a shorter, more comfortable labour.
• Powerful partner support strategies which bring you closer together as a couple, increasing feelings of safety and trust and enable you to better work with the pain. including: observation, massage and touch, breathing, heat/cold therapy and more.
• Decision making tools which enable you to partner with your midwife or doctor to better achieve your goals for birth.
• How to reduce the risk of unnecessary interventions during labour and birth including episiotomy.
• How to remain active if interventions and drugs for pain relief become necessary.

Early Parenting…from Oct 08

• The first hour after birth - the euphoria, the significance and your options.
• Birth self-attachment and successful breastfeeding
• What life after birth is really like - including physical, social and lifestyle changes
• Babycare and baby nurturing - settling, sleep and communication
• Looking after YOU - strengthening your relationship, postnatal support plans

“The first couple of weeks as a parent are WAY more difficult than the Labour… it is GREAT you are planning to introduce it to the course.” Alessandra, First-time Mum, Sept 07 workshop

This is what participants from previous workshops had to say about their experience:

“Fabulous! We’d done the hospital one so had a bit of knowledge in theory, but this was far more practical.” K & G, First-time parents-to-be

“I loved the relaxed atmosphere and open discussion.”

“I love being part of a group discussing birth. There are things other people offer that do not occur to me. I wish I’d attended before our first birth.” Katie Woods

‘The russian waterbirth video was amazing, she was majestic - it is very inspiring for me to see these possibilities and the reality of it.”

“I found the workshop incredibly informative and empowering. I feel much less anxiety about the birth and have more confidence in my body’s ability to birth naturally and with minimal, if any, intervention.” First-time mum-to-be

“Your wealth of knowledge and positive attitude were fabulous. Very glad we did this!!” Ann-Marie Horsley”

“I certainly feel more confident and I really enjoyed the format of the workshop. I think you did well to facilitate discussion of all approaches not just non-interventionist. Thank you.” First-time dad-to-be

These take place in your own home and may enable you to:

• Identify your options for care based on your preferences and goals.
• Develop a birth plan and other strategies for communicating with your caregiver.
• Focus upon a particular aspect of labour and birth, for example the role of your partner/ support person; how to avoid an episiotomy; non-medical strategies for pain relief during labour; VBAC preparation; or preparation for an elective caesarean birth.
• Condense the class series into a 5-6 hour private workshop.
• Refresh previously gained skills and knowledge around birth.
• Debrief / discus previous birth experiences.
• Create a space just for you and your existing children to prepare for the arrival of your new baby.

Costs

Consultation fees (minimum of 2 hrs): $180.00 for a two hour session
Private birth education: 2 sessions of 2 hours is recommended

How to book your private consultation

Call Victoria on 9808 7464 or email to enquiries@birthready.com.au

Birth information from Australia

http://www.health.vic.gov.au/maternity/- an information resource for women in Victoria, and the health care professionals who provide their maternity care.

http://www.pregnancy.com.au - an up-to-date and extensive source of information and support for pregnancy, birth and parenting.

http://www.maternitycoalition.org.au - is a national non-profit, non-political and non-sectarian consumer advocacy organisation. MC acts as an umbrella organisation to bring together support groups and individuals for effective lobbying, information sharing, networking and support in maternity services. Mothers and midwives working together for better maternity care in Australia. Please join!

http://www.bubhub.com.au - The bub hub website – a comprehensive resource directory for pregnancy, birth and beyond.

http://www.maternitycoalition.org.au/mippslist.html - a list of independent midwives.

Some independent midwives have their own websites, where you will find information about their services, birth stories and other useful links.

http://www.midwivesnaturally.com.au/ - Jennie Teskey, Clare Lane, Helen Brown, Nicola Dutton, Melbourne

www.aitex.com.au/joy.htm - Joy Johnson, Blackburn, Melbourne

http://www.birth-wise.com - Kim Stead, Maffra area, Victoria

www.melbmidwifery.com.au – Robyn Thompson, Alton, Melbourne

Informed Choice

What does evidence-based maternity care mean?
“Evidence-based maternity care” means using the best research about the safety and effectiveness of specific tests, treatments, and other interventions to help guide maternity care decisions.

http://www.childbirthconnection.org - website of the UK initiative from the Maternity Center Association to promote evidence-based maternity care. Also features an online copy of ‘A Guide to Effective Care in Pregnancy and Childbirth’, Enkin et al.(2000), which details the ‘gold standard’ in evidence based maternity care.

http://www.infochoice.org/ic/ic.nsf/welcome_consumer?openform - a comprehensive set of 21 leaflets providing information about key decisions facing parents during pregnancy, birth and afterwards.

http://www.aims.org.uk - Association for Improvements in Maternity Services website, though based in the UK, provides information about maternity choices, and current research on childbirth issues.

Caesarean Birth

http://www.radmid.demon.co.uk/csgood.htm - how to plan a good caesarean birth.

http://www.ican-online.org – resources and support for women planning a vaginal birth after a caesarean.

http://www.birthrites.edsite.com.au - aims to provide a support network for women who’ve had a previous c/section(s), and to increase the awareness of these women’s needs to their health-carers within the medical profession.

Home birthing

http://www.homebirthsydney.org.au - lots of information on homebirth and natural childbirth.

http://www.joyousbirth.info/forums - A group of Australian homebirthers, midwives, birth attendants and doulas, providing support, sharing knowledge, experience and the company of those who believe in gentle birth.

http://www.homebirth.org.uk - A UK based reference site. Research based evidence about the safety of homebirth, information and support.

Breastfeeding

http://www.breastfeeding.asn.au - Website of the Australian Breastfeeding Association.

http://www.naturalbreastfeedingsecrets.com - FREE “20 tips to painfree breastfeeding” ebook *FREE* and breastfeeding instructional video.

http://www.lalecheleague.org - Website of the La Leche League, who provide mother-to-mother support, encouragement, information, and education.

Parenting

http://www.pinky-mychild.com - Pinky McKay’s website, with information, resources and great links for new parents.

http://www.essentialbaby.com – Australia’s busiest online parenting community. Includes a forum for Australian home birthers.

http://www.naturalparenting.com.au/npm/ - Natural Parenting Melbourne is a new city-wide network of families and professionals aiming to support, educate and celebrate the diversity of natural choices available to families as they journey their way through pregnancy, birth and ongoing parenthood.

www.bbf.org.au - Bonnie Babies Foundation supports families who have experienced pregnancy loss. It undertakes medical research projects, counselling for bereaved families, a 24 hour, 7 day per week grief counselling helpline in Australia. The Foundation also assists in education to health professionals.

http://bellybelly.com.au/home/ - An Australian website providing real-life, gentle solutions for conception, pregnancy, birth and baby, all in the one place.

http://www.alternativebaby.net - Attachment, instinctive, conscious & informed
parenting information and support.