TAKE CARE OF YOU

If you’re a suitable candidate, a home birth can be a wonderfully fulfilling way to bring your baby into the world. If you’re thinking of this as a birth plan, here’s what you need to know, writes Tracey Hawthorne

THERE ARE MULTIPLE reasons why a home birth tops the list for many women looking for a rewarding birth experience. “It gives you a sense of autonomy,” says midwife Ruth Ehrhardt, who’s been attending to women in labour from her base in Muizenberg for six years. She is the co-founder of Home Birth South Africa (homebirth.org.za). “Having control over your environment and procedures, and who’s present, and being able to call the shots, as well as the feeling of safety your own home gives you, are all extremely beneficial.” And, adds Ruth, you can take your time, and not have to labour according to a clock or graph. “There’s also no change in staff during your labour, and you can choose the position you want to birth in.”

After the delivery, your baby isn’t taken away from you, and you can snuggle in bed as a family while the midwives clean up and bring you tea and do all the necessary checks.

ARE YOU A CANDIDATE FOR A HOME BIRTH?

A carefully planned home birth for “a healthy woman having a low-risk singleton pregnancy” is a safe and natural choice, and can be a calm and joyous experience, says midwife Heather Pieterse, whose Pretoria-based practice has been assisting with home births for almost 20 years.

WHO WILL YOUR CAREGIVER BE?

Midwives are trained healthcare professionals, usually nurses, and doulas are specially trained women who provide non-medical support before, during and after the birth.

“A midwife brings to a birth what you would find in most labour wards in a birthing clinic or hospital,” says Ruth. Among other things, they carry the tools and the skills to monitor the foetal heart rate in labour, perform vaginal exams and measure blood pressure, and are trained in neonatal resuscitation (helping a baby to breathe) and postpartum haemorrhage (heavy bleeding after the birth).

If your caregiver is a nurse, check she or he has full South African Nursing Council registration and also good medical indemnity cover, adds Heather.

WHERE WILL YOU FIND YOUR CAREGIVER?

“Word of mouth from a friend or family member, or a healthcare professional, is a great start,” Heather says. She adds that while it’s fine to use the internet and/or social media, you should bear in mind that it’s not the best or safest way to find a midwife. “Listen to your gut too,” she notes.

Don’t be afraid to shop around and interview a few midwives before making your choice. Most midwives invite you to meet with them prior to booking, as the match goes both ways, and the midwife would also want to assess your suitability for a home birth. For medical-aid coverage, your midwife should be registered with the Board of Healthcare Funders and have a practice number for medical-aid coverage. “She should be affiliated with a backup hospital and doctors in case of an emergency transfer becoming necessary,” Heather adds, noting that you must also book a place at a hospital in case something goes wrong at home.

HOW MUCH WILL IT COST?

Midwives all charge different rates, so do your homework. The home birth itself can cost anything between R10 000 and R15 000, while the initial booking visit, prenatal visits and postnatal visits may be charged separately. Heather adds that it’s crucial that you’re aware of the full costs of a hospital admission for Mom and Baby if there’s an emergency. If you don’t have medical aid, a private hospital will demand a large deposit. “In an emergency there’s no time to phone a family member to borrow money,” she points out.

WILL MEDICAL AID COVER IT?

It depends on the medical aid – many do cover 100 percent of the cost of a home birth, and some hospital plans cover part or all of the cost. Some will cover the cost of a doula out of the savings portion of a medical aid. Speak to your medical aid.

WHAT ARE YOUR PAIN-RELIEF OPTIONS?

“The general consensus is not to use synthetic pain relief at home births as analgesia has side effects that can affect the baby’s breathing at birth as well as impact on breastfeeding,” Heather says. “Usually in a homebirth environment, natural means of pain relief are very effective, and these start with adequate preparation, both physically and mentally.” Natural coping techniques include water, heat, massage, pressure points, reflexology, verbal encouragement, visualisation, emotional support, a supportive aesthetic environment, and supportive people around you.

WHAT HAPPENS IF THERE’S AN EMERGENCY?

A good emergency-care plan is an essential part of a safe home birth, and you will discuss this and draw one up with your midwife during your pregnancy. Some of the reasons a transfer to hospital might become necessary include slow progress in labour that requires further intervention, foetal distress (if the baby’s heart rate is “non-reassuring”), if you’re battling to actually birth the baby, if the placenta gets retained, if the baby is struggling to recover after the birth, or if there’s heavy bleeding after birth.

“The careful monitoring of the mother in pregnancy usually eliminates emergencies in the labour, because the reasons for them cropping up in the labour are dealt with in the pregnancy,” says Ruth. “Most healthy pregnancies do labour smoothly. Birth isn’t an illness or an emergency, it’s a normal physiological process.”

ATTACHMENT BEGINS IN the womb, and there’s so much you can do to prepare for your face-to-face meeting with your baby.

The bond between you and your baby starts the moment you know you’re pregnant. And when you feel the first stirrings of life inside you, and you realise there’s something wonderful going on in there, you may start to comprehend that this is a person, separate from you and with all their own special qualities. Research is showing that rest, relaxation and being positive during your pregnancy are good ways to ensure you have a healthy baby and a healthy pregnancy. The opportunities for parents to form a relationship with the baby in the womb are significant and remarkable. This contrasts sharply with the previous view that prenates did not have the capacity to interact, remember, learn, or put meaning to their experiences. Only a decade ago, doctors typically told pregnant mothers and fathers that talking to a baby in the womb was useless and unrealistic. Now there’s mounting evidence for memory and learning in utero and for communication before the stage of language. Mothers and unborn babies who shared touch and massage during pregnancy develop a special emotional and physical bond that continues for life.

BELLY BABY LOVE PROGRAMME

This programme stimulates the senses of touch and hearing. This is something that you and your partner can do actively. Try to establish some time at least three times a week, where you will actively focus on stimulating your child’s sense of touch and hearing. While in the first half of the pregnancy and not fully aware of your baby’s movements, take time out, after you have eaten, for stimulation. Once you can feel your baby’s movements, you will be more aware of the cycles of sleep that your baby has and can take advantage of the alert stages more often. Touching your unborn baby through abdominal massage releases feel-good hormones in your body, and baby gets bathed in tender loving feelings. Your unborn knows that he is valued and wanted and loved. This is the start of building good self-esteem.

BE CONSISTENT

Find a time in the day when you will not be disturbed, and where you will have privacy, peace and quiet. Try not to have any unnecessary noise around you, and play your music selections in the car, when working, or when relaxing. Don’t start something like this and then let it fizzle out. Make contact with your baby in some way every day.

Get comfortable and relax

✓ Try and find time to tune out from the rest of the world and focus only on your baby for at least 15 minutes twice a day or 30 minutes in one go.

✓ Soften your tight muscles. Whatever is happening to you physically, emotionally and spiritually is happening to your baby as well. Create the right kind of environment, and cultivate a natural, unhurried lifestyle by both parents in order for the unborn to flourish and learn in the womb.

Play music Choose something that you find soothing. You should relax when you hear it. Some days you may wish to simply talk to your baby while you massage your belly or read Baby a story. Enjoy really being in the moment as you verbalise your feelings, and talk to your baby about the time ahead. Studies have shown that newborns are soothed by hearing the same stories and songs they were used to listening to in the womb.

Breathe for two Calm, slow abdominal breathing will settle you and your baby very quickly, especially if you have been dealing with normal everyday stress. Tune out of the harsh world, and tune in to your body and your baby.

Loving touch Touch your belly from early on, so that it becomes a habit, and continue to do this throughout pregnancy, especially after the sixth month. Learn to massage your unborn because your loving, intentional touch is helping your baby to wire his brain to be alert but relaxed in the future. Most importantly, your unborn baby can feel your love through many of your senses, and when you feel loved, valued and precious, so does he.

✓ Use a small amount of simple baby oil, tissue oil or a cold-pressed oil, so as to reduce the friction on the skin, and enable your hands to glide around the abdomen.

✓ If using aromatherapy oils, be sure to use those that are safe in pregnancy.

✓ There are various ways to massage your belly during pregnancy and birth, including effleurage, petrissage, tapotement and feathering – these refer to different strokes used during the massage session. You can do it yourself, or get your partner involved.

EFFLEURAGE This is a good form of massage for the early part of labour. Don’t press too hard. Keep one hand in contact with the skin at all times. Place one hand below your ribs and the other hand beneath the navel. Stroke the abdomen in one circular direction. Do this three times, and then change direction. Keep the movements slow.

PETRISSAGE Using two hands, place the upper part of the fingers against the skin, and press firmly at different places on the abdomen. Using both hands, gently roll the skin inwards between your thumb and fingers in a kneading movement.

TAPOTEMENT Open hands over the abdomen, palms facing downward. Tap with quick percussive movements. Do this at different positions on the abdomen, alternating between them. FEATHERING Stroking with the fingertips only, applying slight pressure.

You can also gently shake the abdomen, squeeze at different poles of the uterus and play tapping or kicking games. Rub your abdomen in circles, or stroke in different directions.

Partners should be encouraged to experiment with different ways of massage on mom’s belly. Their touch will feel very different to the unborn. Scientists have found that fathers and mothers touch their babies differently – mothers stroke, and fathers poke, and the unborn baby will expect the difference.

A partner’s touch will make you feel loved and special, and these feelings will pass on to your baby.

For an external voice to reach the womb, the person needs to be fairly close to the mother, if speaking at a normal level.

If your partner or other children wish to talk to the unborn, one cheek may be rested on the mother’s belly, so that the sounds travel directly through the touching bodies.

MORE IDEAS

In order to develop your unborn baby’s memory and recognition, read something aloud and repeat it often throughout your pregnancy (a nursery rhyme or a children’s book with interesting language construction like Dr Seuss is a good choice).

The unborn can also hear everyday sounds such as the phone ringing, water splashing against your body, or any loud noises, especially those that are close. You can “ting” a glass with a light tap of a spoon, or tap your abdomen, click your fingers, pour water over your belly, stand close to a wind chime.

Very often when you touch your baby, he will acknowledge this by responding and making a movement of his own. He will begin to associate your quiet time with music and touch, with love and pleasure, and this will continue once he is outside in the world. Babies who are touched frequently know they are valuable and precious. This goes a long way in building selfconfidence and a high self-esteem. Children show more tolerance and patience to others if their own needs are met. A baby can’t be spoilt by attention and touch. You can never spoil a child with love.

Touching your unborn baby through abdominal massage releases feel-good hormones in your body – and baby gets bathed in tender loving feelings

I felt mold pressure

Once the doctor started making the incision, I could feel the area that he was busy in, but I didn’t feel any pain. My baby was quite high up, and a nurse started pushing down at the top of my belly with some force. I felt some mild pressure from my baby moving down inside of me. It wasn’t painful, but I was definitely aware of where they were working and tugging at my body. Seconds later, I suddenly felt lighter in my mid-section, and my husband and I heard the most beautiful sound – our baby’s first cry, letting us know she was here and all was okay.

SHANNON COETZEE, 28, Springs

NAUSEA MADE MY EXPERIENCE UNCOMFORTABLE

I had to have a c-section, as I had placenta praevia. I remember feeling very nauseous in the theatre. When my baby was pulled out of me, I felt an immense tugging sensation. This exacerbated my nausea so much that when my baby was delivered, I didn’t want her to be put on my chest. She was instead given to my partner. I didn’t expect to feel so disconnected from my baby, but I put it down to feeling “off” in my body. I think many women forget that a c-section is major abdominal surgery, and it can be daunting for some.

DINEO MOLETE, 27, Knysna

A neat little package

When my baby boy was born by c-section, my husband and I were so surprised to see that he came out in exactly the foetal position. With our first baby, born naturally, she came out arms and legs sprawled! But our baby boy was neatly tucked up.

MONIQUE LAWRENSON 37, Bryanston

I FELT DISEMBODIED

What really surprised me was how much tugging was involved and how I “felt” that. It didn’t hurt, but I could feel the doctor moving things around in my lower body, pushing down on my abdomen. It felt quite forceful, although disembodying as well. KERRYN MASSYN, 35, Randburg

Lasering the previous scar

With my second c-section, my husband told me that when the doctor lasered into my previous c-section scar, the actual scar tissue was removed and looked like a piece of biltong!

CHERISE BOTHA, 29, Hout Bay

I WAS SURPRISED AT HOW CALM I WAS

I had planned to have a natural birth at 36 years old. I was 41 weeks pregnant when I was induced. Labour just wasn’t progressing, and then I was told my baby’s umbilical cord was prolapsed, so she couldn’t move through the birth canal properly and was in distress.

I had to have an emergency c-section. I actually felt very calm during the procedure and was elated when my baby was born. I thought I would be in absolute distress, but I wasn’t. I think if you keep your calm and just know that as long as you and your baby are healthy and strong, it doesn’t matter what kind of birth you land up having, planned or not.

TRACY MURRAY, 36, Umhlanga

It felt impersonal

With my first baby, I had a vaginal birth with epidural. The epidural only “took” on one side of my body, so the experience I thought I would have – of a pain-free birth – was not what I got in the end! I struggled for many hours through the labour, but eventually my baby was born, and everything was fine. With my second pregnancy, I opted for a c-section because I didn’t want to have a repeat experience of the labour I struggled through. I was surprised at how impersonal the c-section felt. I was whisked away for my spinal, and it felt like within 20 minutes my baby boy was born. My husband and I both felt as if we were in a birthing factory and they were getting as many women in and out as fast as possible. I had no complications, but it made me feel slightly despondent, as it wasn’t what I had envisioned it to be. JENNIFER FERREIRA, 34, Lonehill

GET MOVING!

I had four major surgeries before I had my c-section, three of which had serious complications. I was taken aback by the recovery of the c-section. It was a lot less pain than I expected, and the feeling in my legs came back after a few hours. I had a shower that night and was up and moving every day. Remember, the quicker you get moving after an operation like this, the better your recovery. TASNEEM MOONSAMY 32, Table View

An intense headache

Because I had spinal fluid leaking from the area where my doctor administered the spinal block, I experienced an intense spinal headache. The pain was unreal. MOTSHELANOKA MOLEBATSI 23, Free State

I HAD AN AMAZING EXPERIENCE

I expected it to be scary and painful, but it was amazing! The anaesthetist even lifted my head so I could watch my baby being pulled out. He used compression balloons on my legs after, and I also lay flat with baby until the next morning, so the pain was manageable. I was off pain killers in a few days. It is possible to have an amazing experience when you have a c-section.

CHANTELLE SWANEPOEL, 26, Underberg