My Gentle Caesarian Birth Story

Assalamualaikum & Greetings Dear Mummies,

Below is my Gentle Caesarian Birth Story. Hope it benefits all InshaAllah.

This was my 4th Birth, Alhamdulillah.

1st & 2nd Birth: Medicated SVD (normal birth). I was on Pitocin to augment labour & also Pethidine for pain relief (2008 & 2011)

3rd Birth: Drug Free All Natural Waterbirth (2014)

It was an uneventful pregnancy this time around, Alhamdulillah. Well, uneventful until the last minute😬

At 35 weeks appointment, doctor said my baby was already engaged🤗 orang kita sebut "baby dah turun". And also in cephalic position (head down). so just waiting for time.

At 37 weeks appointment, blood pressure not so pretty. Advised for diet control (less salt) & home BP monitoring. Fyi, I had a history of Pregnancy Induced Hypertension with my 2nd pregnancy, which ended up in spontaneous preterm labour at 36weeks😅 With home monitoring, BP still wasnt so pretty but wasnt that bad..especially in the evenings. Probably due to dehydration/tired since its the fasting month & I am fasting? We continued to patiently monitor..

Another issue I had this time around was premature contractions. It started eversince I entered 3rd trimester (around 28 weeks) so I had to be on tocolytics (to reduce the contractions). Most of the nights, I could not sleep at all because of the intense contractions & back pain.

Time to time, I did belly dancing to reduce the discomfort. It really helped especially for the backache & pelvic pressure.


Anyways, back to the birth story. At 38 weeks on dot, I couldnt stand the contractions & noticed some leaking. It wasnt all that painful until you feel like dying😅 but it was pretty unbearable until I couldnt do much anymore. And I had some liquor leaking & show which started around 1pm 13.06.17.

Rested at home, tried walking around until around midnight. Pestered hubby to take me to hospital then..brought all the essentials (gym ball, essential oils, bunga akar fatimah, dates, air zam-zam etc).

Checked in into the same labour suite as my previous birth, had a sense of familiarity already😊

On assessment, contractions 1 in 5, moderate intensity, cervix not favourable, os not open.
Ok...so decided to wait until tomorrow morning..
A bit frustrated that os wasnt open yet😔
However, doctor asked to be admitted in view of leaking liquor & regular contractions.

14.06.17 (Wednesday)

11am: Doctor came to review. Contractions getting intense but still no os opening. I was so exhausted from the surges..in view of leaking liquor for almost 24hours & me being exhausted of surges, we decided to augment the labour using prostin..

6pm: Still no progress😓 contractions more intense. 2nd prostin inserted. Rested, walked, ate, showered, squats using gym ball, hip rotations using gymball etc..


15.06.17 (Thursday)

11am: Os only 1cm. Contractions intensifying. I didnt take any painkillers just yet..hoping labor would progress soon.. 3rd prostin in..
Cried to myself feeling so demotivated & exhausted at that point.. felt that I did my best to keep the pregnancy as healthy as possible.. ate well, exercised etc.. wondering why it was sooo difficult this time around.. back pain unberable.. still continued to walk, exercise, stretch, eat etc

6pm: Os 2 cm. Surges 1 in 3. Doctor came to review. It was these options

1st: take a "home leave". Go out or back home for a while and come back later to monitor progress.

2nd: induce labour. Start pitocin & rupture waterbag.

3rd: have a caesarian section.

8pm: Me & hubby did lots of thinking. And prayed. After considering many factors like..

Why we didnt opt for induction of labour? Doctor warned us of the dangers & risks..hyperstimulation, risk of fetal bradycardia (low heart beat)..& considering the fact that, if vaginal birth were to happened, we strongly felt that it would have already happened naturally or with just prostin augmentation.. how come was so prolonged this time around? And our intuition felt something wasnt right.. plus my BP was on the rising trend.. and prolong leaking liquor wasnt so good as well, risks for infection..hence, we opted for a caesarian.. it was a tough decision to make, but Alhamdulillah we finally came to a conclusion..

So we called the doctor and agreed for a caesarian that night itself.. i expressed some breastmilk before going into the operation theatre..and requested for hubby to have the honour of skin to skin with baby right after birth..

11pm: At the OT, it was time for epidural. MashaAllah, only God knows I am sooo scared of needles puncturing me, what more an epidural!!! Its like my worse nightmare. But Dr Idora was the sweetest, she hugged me tight when the anaesthetic doctor gave me an epidural knowing I was super scared of it.. she was really a gem, I cannot forget that moment, I was so touched..

11.40pm: Surgery started. Hubby witnessed it together with me, he was just beside me the whole way, comforting me, Alhamdulillah.

11.46pm: Saw the amniotic fluid being sucked out! Big smile on my face. I knew baby was coming!!! Soon, I heard a cry & saw my baby. MashaAllah tears of joy & relief rolling down my cheeks. I was given the chance to hold his little hands & did some cheek to cheek skin touch with him. Soon, hubby got the honour to clamp the cord. And off the two of them went to have some father & baby skin to skin time for two hours while I finished with surgery & was transferred to ward.

Baby was in occiput transverse position & had short cord. Probably that was the cause of prolonged labour🤔

Post op, I was paranoid for a while. I couldnt feel my legs! Yeah that was expected of an epidural but it was the worse feeling ever. My legs were as heavy as it can be & At that moment I realized.. how ungrateful I had been to God's blessings..
Honestly, this was an unexpected pregnancy, and I am not ashamed to admit that I was tired of raising my 3 kids, let alone thinking of raising a newborn..I was in denial most parts of the pregnancy even though I tried my best to eat well , exercise & stay positive..
All that was running through my mind NOW AFTER NOT BEING ABLE TO FEEL MY LEGS was how lucky I was to have been given good health all this while.. and I shouldnt be complaining at all of how tired I am raising kids..instead I should be thankful of this wonderful opportunity! My paranoia with my legs continues up until the ward, i kept asking when would I be able to feel my legs? The nurses were sweet comforting me, saying soon it will be ok.. and true enough, in a few hours time, I could already feel them, Alhamdulillah..

At the nursery, hubby did skin to skin & the nurses fed my son my expressed milk. MashaAllah, I was so happy he got skin to skin time with daddy! And we delayed bathing him until the next day, let all that beautiful vernix (whitish substance on the skin) stay & do it's magic.

When I was back in the ward, about 2 hours post birth, I got some skin to skin time & also started breastfeeding baby.

Alhamdulillah, it was a new amazing, humbling & eye opening experience for me😊 I have no regrets or remorse that I opted for a caesarian because I knew I tried my best to have a healthy pregnancy & natural birth.. & I understood the need for caesarian in this situation. And it was done so gently & respectful of our requests & consent.

I hope sharing this birth story benefits other families InshaAllah❤️I am finally a lucky mother of four beautiful children❤️

Does Mode of Birthing Have Any Effect on Breastfeeding?

Assalamualaikum/Greetings.
It's been quite a long hiatus since I wrote. Truly I love writing and I find it a source of therapy for myself while I share whatever little knowledge I gained during studying and consultation sessions with my clients.

As a Childbirth Educator and also a Lactation Counselor, this is a topic close to my heart. Does MODE OF BIRTHING actually has any impact on breastfeeding success? Let's have a little insight on this topic.

Firstly, I will briefly enlighten on the lactation physiology for a better understanding.

Very briefly focusing on lactogenesis, it is divided into 3 stages.

Stage 1: Begins during the second trimester of pregnancy & continues until about day 2-3 postpartum. During this period, the breast undergoes changes to prepare for lactation while the constituents of milk are already being manufactured and ready to be released under stimulation of prolactin after childbirth.

Stage 2: Begins during postpartum day 2 or 3. This is when a mother might feel a sensation of breast fullness or also known as "milk coming in".

Stage 3: This is the phase of maintainence of breastmilk secretion. This occurs during days 14 to day 30 of post partum. This is when mature milk is established. Prolactin and Oxytocin is essential for effective maintainence of milk supply, therefore frequent nursing and milk expression (if necessary) is essential during this period of time to ensure sufficient supply.

Note the changes in breastmilk with time

Onset of secretory activation (lactogenesis II) is an endocrine@hormonal function, while maintenance of lactation, lactogenesis III, is an autocrine@local function with the control located in each breast. 

With this in mind you will understand that mode of delivery will not affect the physiological onset of lactation. 

Type of Birth	Delayed Milk Onset
Spontaneous vaginal	16%
Assisted vaginal	42%
Scheduled cesarean	27%
Emergency cesarean	56%

                                         (Adapted from Dewey, 2003)1 



Note that the mode of delivery (vaginal vs cesarean) was not the cause of delayed lactogenesis. Only something that interferes with the proper functioning of the endocrine system will delay or inhibit secretory activation such as accidents at birthing for example, retention of a functional portion of the placenta that continues to secrete progesterone, or a hemorrhage severe enough to cause Sheehan's syndrome (pituitary gland necrosis). And so might stress.

   Below are some studies associating stress & delayed milk onset. 

High stress levels are correlated with high cortisol levels. Cortisol, in normal concentrations, is also necessary to initiate secretory activation (lactogenesis II) successfully, though what its role is isn't fully understood yet.

• The relationship between the birth experience and lactation performance of 40 women was explored. Stress hormones were measured in serum or plasma during pregnancy, parturition (cord and maternal blood), and lactation. The researchers found that markers of both fetal and maternal stress during labor and delivery were associated with delayed breast fullness.2


• Salivary cortisol levels were studied in women intrapartum and postpartum, to ascertain any link between them and the onset of lactation. Onset of lactation occurred later in women who had higher cortisol levels. Primiparous women had higher levels than multiparous women. They concluded that stress during labor and/or delivery is likely to be a significant risk factor for delayed onset of lactation.3


• Two mechanisms have been suggested to explain the link between delayed lactation and stress. Firstly, maternal stress seems to interfere with the release of oxytocin causing poor milk removal. Although milk removal is not necessary to trigger secretory activation, it may be related to the timing of onset of full milk production or the volume of milk produced. And secondly, a newborn who experienced stress during labor and delivery may be too weak or too sleepy to latch on and suckle effectively at the breast.4


• Cortisol levels were measured in the fetus and correlated with birthing circumstances. Umbilical vein cortisol was significantly elevated in association with spontaneous normal birthing, but highest for infants experiencing an instrumental delivery and lowest in infants delivered by elective cesarean section.5


• Cortisol levels fell significantly during the breastfeeding sessions on Day 2 postpartum and correlated with the duration of skin-to-skin contact before the onset of sucking. However, between mothers having received epidural analgesia, with and without oxytocin, cortisol levels differed significantly. The researchers noted that medical interventions in connection with birth influence the activity of the hypothalamic-pituitary-adrenal axis 2 days after birth.6

What about Caesarian Sections & Instrumental Vaginal Deliveries?

Women who have a cesarean section experience a significant delay in initiating breastfeeding compared with women giving birth vaginally, with or without instrumental assistance.7,8 One study showed that breastfeeding rates at 8 months weren't significantly different7 while another8 showed that cesarean delivery was associated with a lower breastfeeding rate at discharge and at follow-up at 7 days, 3 and 6 months of life. In a further population that has a high breastfeeding initiation and duration rate, cesarean section delivery was significantly related to earlier cessation of breastfeeding.9

A Hong Kong study followed a very large cohort and identified cesarean delivery as a risk factor for:10

• not initiating breastfeeding
• for breastfeeding for less than 1 month, and
• a significant hazard against breastfeeding duration.
• Assisted delivery with forceps or vacuum, although not associated with breastfeeding initiation, was a significant risk for reduced breastfeeding duration.

An interesting study investigated differences in the hormonal patterns of oxytocin, prolactin and cortisol between women delivered by emergency cesarean section or vaginally, and their relationship to the duration of breastfeeding. The researchers found that the mothers birthing vaginally had significantly more oxytocin pulses on Day 2 than the cesarean section mothers. Furthermore, the cesarean section women lacked a significant rise in prolactin levels at 20-30 min after the onset of breastfeeding. They were able to link the oxytocin pulsatility on Day 2 to the duration of exclusive breastfeeding.11

I have not touched on the intrapartum factors like ability to eat, drink, IV fluids commencement, mobility, analgesia with regards to breastfeeding; which I will do so in future posts, hopefully :-)

Maternal Commitment? In the end, this is the most important key to breastfeeding success!

Several authors(7,9,12) have demonstrated that maternal commitment and support by health care professionals are significant factors in the mother reaching her breastfeeding goal when obstetric factors are against it. Intervention is sometimes lifesaving, and sometimes we are in no position to prevent unnecessary intervention. Giving the neonate and mother as much skin-to-skin contact as possible, being patient and continuing to support the mother for as long as it takes are all important to assisting her to follow through with her commitment to breastfeeding. 

Of course, early preparation like attending breastfeeding and birthing classes during the antenatal period would help mothers be well prepared on birthing and breastfeeding, empower themselves with knowledge and ensure that they understand what is happening during the time of labour to avoid stress on themselves should anything unplanned happen along they way.

So, moral of the story, be it spontaneous vaginal delivery or caesarian section..empower yourselves with knowledge, understand what is going on with your body and should you need necessary interventions, understand the situation, think rationally, avoid grudge or holding on to emotional baggage..please avoid stress...and believe that you can breastfeed your baby!


References:

1. # Dewey KG et al. (2003) Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss
2. # Chen DC et al. (1998) Stress during labor and delivery and early lactation performance
3. # Grajeda R et al. (2002) Stress during labor and delivery is associated with delayed onset of lactation among urban Guatemalan women
4. # Dewey KG (2001) Maternal and fetal stress are associated with impaired lactogenesis in humans
5. # Mears K et al. (2004) Fetal cortisol in relation to labour, intrapartum events and mode of delivery
6. # Handlin L et al. (2009) Effects of sucking and skin-to-skin contact on maternal ACTH and cortisol levels during the second day postpartum-influence of epidural analgesia and oxytocin in the perinatal period.
7. # Rowe-Murray HJ et al. (2002) Baby Friendly Hospital Practices: Cesarean Section is a Persistent Barrier to Early Initiation of Breastfeeding
8. # Zanardo V et al. (2010) Elective cesarean delivery: does it have a negative effect on breastfeeding?
9. # Shawky S et al. (2003) Maternal factors associated with the duration of breast feeding in Jeddah, Saudi Arabia
10. # Leung GM et al. (2002) Breast-feeding and its relation to smoking and mode of delivery
11. # Nissen E et al. (1996) Different patterns of oxytocin, prolactin but not cortisol release during breastfeeding in women delivered by caesarean section or by the vaginal route
12. # Janke JR (1988) Breastfeeding duration following cesarean and vaginal births

Birth Plan

Assalamualaikum/Greetings Lovelies!

It's my pleasure to be writing this entry.

What is a Birth Plan?

A birth plan is a document that tells your health-care provider, your birth team/companion (eg husband, spouse, doula etc) and the hospital staff what kind of childbirth you would like and how you would like your baby cared for after he/she is born. 

Imagine going for labour like going for a marathon. Oh yes, it is indeed hard work preparing for labour. BUT you have approximately 40 weeks or so to prepare for it. And what happens if you don't prepare for it? Just imagine going for a marathon without preparation. What are the worst scenarios that could happen? Fatigue, Muscle Crapms, Injuries, Giving Up Halfway etc...

Same goes to birthing.

When should you start drafting a Birth Plan?

If you ask me, personally my answer would be as soon as you plan to conceive @ at pre-conception stage itself. No such term as "too early" to prepare for birthing! It’s also a good idea to discuss the plan with your partner and your family if they are going to be involved in some way. However, it is your body, and your family needs to understand that you are the only one who can make some of the more personal decisions.

What should be included in a Birth Plan?

When writing a birth plan, consider the list of things you want during:

• Labour (Consider things like pain relief methods, freedom of movement, allowing labour to progress naturally, how you want the room to be set eg music, aromatherapy, how many companions you want & who are they, do you consent to any invasive or surgical procedures, and if yes; under what circumstances)
• After Childbirth (Consider Natural Placental Expulsion, Delayed Cord Clamping, Skin to Skin, Immediate Initiation of Breastfeeding etc)
• Method of Care to the Newborn (Consinder whether or not you want vaccination for the baby, consider delayed bathing etc)
• 
  

Below is an example of my birth plan. As you can see, after prior discussion with my healthcare provider, and after mutual agreement of what I request and what she agrees to carry out for me, we put all in writing and signed the birth plan. Two copies, one for me to keep and another for the hospital record.

NOTE: THIS IS MY PERSONAL BIRTH PLAN. EACH BIRTH PLAN SHOULD BE CUSTOMIZED TO SUIT EACH INDIVIDUAL'S NEEDS.

Tips for writing a birth plan:

1. Keep it short & focused in point forms.

2. Do not cut and paste from someone's else's birth plan. This should be unique to you. But that doesn't mean you can't look at other people's birth plans  to get some ideas.

3. Avoid a list of "don't wants". Instead, mention what you want. This would not only make the birth plan a positive note to read, it may sound a bit more friendlier to the health care provider.

4. Be precise on what you want and avoid vague words like "minimal" or "only if necessarry". Your definition of "only if necessary" or "minimal" might defer from others.

5. Know what you want and be assertive about it. Use wordings like "It's really important that..." or "I humbly request your support ...." INSTEAD OF "I prefer..." .

What if my health-care provider refuses to co-operate with my Birth Plan?

Use your birth plan as a catalyst for your own research. Attend birth classes (trusted resources) & read up as much information as you can from evidence-based articles & journals.

 When you present your birth plan to your healthcare provider, pay attention to his or her reactions and listen to their feedback and consider their suggestions. Every individual & each case is not similar, hence your healthcare providers suggestions do play an important role in ensuring your well-being & safety. However, the point is for your healthcare provider to respectfully look into your birth plan, then discuss with you if there are any issues regarding it & educate you with all the necessary knowledge so that both parties can come to a mutual decision. Vice versa, if you find your healthcare provider acting in a demeaning manner to your birth plan & rejecting it without prior justification, hence my take is you should shop for other healthcare providers!

The White Ribbon Alliance has advocated for Respectful Maternity Care, so you have the rights to plan your birth & be attended respectfully by Healthcare Proffesionals!

Certainly, to write up your own birth plan, you have to be sure what you want first!!

Therefore, knowledge is important to be able for you to know what you want in the first place.
Learn, unlearn & relearn! For the best of you & baby!