Just a day after International Women’s Day, an article appeared in The Age today with the alarmist headline; “‘The figures are appalling’: Rising number of Victorian women haemorrhaging after childbirth.”
You want to know what’s appalling?
→ The fact that only 40% of Australian women experience a spontaneous labour. About 35% are induced and around 25% experience no labour at all and will just go straight to Caesarean section.
→ The fact that around 80% of women whose labours are induced will have their labours augmented (sped up artificially) with synthetic oxytocin – also known as Syntocinon.
→ The fact that almost 40% of Australian women are giving birth via major abdominal surgery.
(Source: Australian Institute of Health & Welfare – https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies/data)
What on earth is happening in this country and why isn’t anyone ringing the alarm bells?
If our current maternity care system was a bushfire, we’d have fire trucks, police vans and ambulances en masse blaring their sirens as they rushed to the emergency.
But it’s just women and babies. No need to sound the alarm. Nothing to see here. Just move along people.
“Rising numbers of Victorian women are losing dangerous amounts of blood after childbirth, with almost one in three women haemorrhaging post-delivery.
Experts are struggling to pinpoint what is fuelling the rise but believe increasing rates of caesarean and inductions, women having babies when they are older and obesity are contributing to the surge”.
Here we go again. Let’s divert the real root of the problem and just point the blame at “older, fatter women”. Seriously folks, that old trope is getting a bit tired, don’t you think?
You don’t need to be a rocket scientist to understand why so many women are experiencing postpartum haemorrhages – a loss of 500mls or more following birth.
Labour and birth at its core is an intricate dance of hormones – initially prostaglandins and Oxytocin working together to kickstart and subsequently progress labour by helping the uterus to contract efficiently and the cervix to stretch and thin. As labour intensifies, endorphins are released, providing natural pain relief to help the mother transcend the most intense peak of her contractions.
Adrenaline, at the right time in labour, gives the mother an important burst of energy to help her to push her baby out. That same hormone also protects the baby’s neurological function during the most challenging part of the labour – the pushing phase, also known as the second stage of labour.
Oxytocin once again plays a key role in labour and birth immediately following the birth of the baby, when mother and baby experience uninterrupted skin-to-skin contact, causing the mother to produce the highest levels of oxytocin in her entire lifetime. This serves a critical dual role of helping the uterus to efficiently clamp down, slowing the flow of blood loss, while helping the mother-baby dyad to bond.
All of that – literally all of that – is disrupted when we induce and/or augment labour. A woman’s body simply does not know how to function throughout the labour process because her brain is not sending the critical messages to the rest of her body, which is why we see so much labour dystocia (slowed/stalled labour) and why women struggle to cope without major intervention – synthetic hormones and the use of medical pain relief.
It’s not just the mother who is impacted. A new study by Buckley et al (2023) highlights the potential hazards of synthetic oxytocin for the fetus/newborn. “Newborns whose mothers receive synthetic oxytocin infusions in labour, compared to newborns of women without synthetic oxytocin, have increased risks of acidaemia (abnormally high blood acidity); NICU admission; hypoxic-ischaemic encephalopathy, a marker of brain compromise; convulsions and other indications of neurological morbidity; and in some settings, increased risks of neonatal death. These risks are highlighted by the Institute for Safe Medication Practices, who nominated synthetic oxytocin as a high-alert medication that carries “a heightened risk of harm” and requires “special safeguards to reduce the risk of error”. According to Clark (2009), allegations of synthetic oxytocin misuse may be involved in half of all paid obstetric litigation claims. For these reasons, monitoring of fetal wellbeing, including fetal heart rate monitoring, is essential when synthetic oxytocin is administered in labour”.
So what can women do to reduce their risk of experiencing a potentially life-threatening postpartum haemorrhage?
Well, in a nutshell they can follow the Lamaze 6 Healthy Birth Practices – all evidence-based and shown to significantly reduce the risk of complications and improve outcomes for mothers and babies.
- Let labour begin on its own.
Bottom line: avoid an induction unless it is truly medically indicated. (Hint: Going past your due date, being told your baby is big, you had IVF to conceive, you’re over 35 years old, or because you have gestational diabetes (that is well controlled with diet alone) are NOT reasons to induce labour.
- Walk, move around and change position frequently throughout labour.
Bottom line: Stay off the bed and keep moving! Use tools like birth balls, mats, showers and baths to help you find comfort during labour.
- Bring a loved one, friend or doula for continuous support.
Bottom line: Evidence clearly shows that when women are supported throughout labour by someone who is NOT their medical care provider, they will experience shorter, easier, less painful labours.
- Avoid interventions unless medically necessary.
Bottom line: Unless your life or your baby’s life is at risk – avoid unnecessary, routine intervention. If someone says they want to speed your labour up, ask WHY. Because the labour is taking longer than expected is NOT a reason to speed it up.
- Avoid giving birth on your back and follow your body’s urge to push.
Bottom line: Give birth in an upright, forward leaning position, or in water if that is an option, and only push when your body tell you to.
- Keep mother and baby together. It’s best for mother, baby and breastfeeding.
Bottom line: Not only is uninterrupted skin-to-skin beneficial from a bonding and breastfeeding perspective, but it will also significantly reduce the risk of a postpartum haemorrhage.
What else can you do?
Take the time to seriously consider your chosen model of care and where you are planning to give birth. Continuity of care by a known midwife is globally accepted to be the gold standard of maternity care, even when you are considered to be “high risk”. Birthing in a private hospital with a private obstetrician is associated with significantly higher rates of intervention.
Invest in some really good independent, evidence-based childbirth education. Sure, I am biased, but Lamaze education will provide you and your partner with the information, skills and tools to make great, informed decisions about your care, and to be able to advocate for yourself with confidence.
Finally – trust your body, your baby and the process. It’s time we turned this bloody ship (no pun intended) around and took control of our births back.