Episode 2

#2 Birth Choices: Why the choices we make matter The Matrescence Podcast

As Bree announces she is pregnant with her second child we talk about processing her first birth and the options she are looking at for this birth. We touch on midwife led care, versus OBGYN and how to choose a care provider to meet your needs. There are key decisions to be made early in this pregnancy to ensure she gets the birth she wants.Key themes: midwife versus obstetrician, hospital versus home birth, brain technique, intimate birthing, antenatal testing, tests during pregnancy, gestational diabetes, birth stories, cutting the cord, choosing a care provider, positive birth experience, birth plan, 

Transcript

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[00:00:00] Kelly: [00:00:00] The birth of a baby is a defining moment in a woman’s life. 

[00:00:15] Bree: [00:00:15] But what about the birth of the mother?

[00:00:17]Kelly: [00:00:17] That’s right. When a baby is born so too is a mother.

[00:00:21]Bree: [00:00:21] This transition from woman to mother has a name it’s called Matrescence.

[00:00:25] Kelly: [00:00:25] This developmental stage is as powerful and irreversible as adolescence, and yet few women have ever heard of it.

[00:00:33] Bree: [00:00:33] So let’s talk about it. 

[00:00:34] Kelly: [00:00:34] Let’s talk about it. Each episode, we will bring you honest and thought-provoking conversations, evidence-based research and knowledgeable guests in order to help you emerge a more powerful and aligned version of yourself. 

[00:00:47] Bree: [00:00:47] So join us, your hosts, Kelly and Bree. As we attempt to make sense of our Matrescence journey and to help you make sense of yours

[00:01:03] [00:01:00] So today’s topic. We want to talk about birth choices. Bree and I have had this discussion a number of times, but what it really comes back to is what is a birth choice? What choices do you need to make? And at what point, along the way, because I know that having had my first child 12 years ago, and now what those different things are. But actually, when we really talk about it and break it down, the birth choices, aren’t that different in terms of the concept. But my level of information to make the right choices has gone up dramatically. And one of the things that I find myself doing now is, you know, the older woman in the room sitting down with the newly pregnant mum is saying to them, listen, this might not make sense to you right now, but here’s some things that you need to think about and please be informed and you know, go and do your research and it feels really unstructured in a way to bring that to light. So [00:02:00] now, today, being able to have that conversation in a structured way with someone who’s about to embark on this wonderful journey about making these choices again, I really want to throw that conversation to you Bree and say, what does birth choice mean? And what’s the journey that you’re going to embark on soon. 

[00:02:18] Yeah. So, to your point, I do remember you giving me the secret society talk when I was pregnant with my first baby, like grabbing me by the shoulders and being like, listen up. And I was like, okay, this lady is crazy, but it makes perfect sense to me now.

[00:02:35] So I think for me, I am, as you said, embarking on this journey again, I’m pregnant with baby number two, which hopefully by the time we release that will be this, it will be common knowledge. I’m also in my first year of my midwifery studies. So this has. I guess professional relevance to me, but at its core, it’s a personal conversation. It’s about my journey in learning [00:03:00] and researching and reflecting and I’m learning and unpacking my beliefs around birth. And I’ve done so much growing from my first pregnancy to now. And I think that that will lead me to make very different choices. So being that I’m only six weeks pregnant. It’s a very relevant conversation in that I’m having to make some really early decisions in particular surrounding my choice of care provider. What model of care I link in with? Yeah, so they’re the main ones. Excellent. 

[00:03:36] And so I think it’s a good place to start with the roles that you have going at the moment. So, you are in a situation where you already have one child. So, you’ve been through a birth process. You are in a very early stage of the pregnancy, and you’re also in the very early stages of trying to be a midwife. But this conversation is coming from a position of assuming that you are not a medical [00:04:00] professional, because actually even early subjects that you’ve done. I mean, there. Things like biology and research. I mean, you could become a lab assistant and do those things.

[00:04:08] I am in no way qualified to deliver babies at this point.

[00:04:11] No, but I think that’s a really important context because right now in society, medical professionals own, birth. 

[00:04:19] They’ve got the monopoly, they’ve got information,

[00:04:22] Absolutely, they’ve got monopoly and what we really want to do is encourage everybody to say. Birth choices is actually about the individual person understanding and knowing that they have access to the research to make enough choices and to ask questions of the medical fraternity, because it is there as a support and a enabler.

[00:04:43] But often what happens is, is that we actually get onto this pathway and all of a sudden, it’s follow the path that’s set and assigned for us. And that’s really one of the things that I want to talk about today and unpack is that who’s in [00:05:00] control of that journey around choices and knowing that you don’t, you know, you don’t make a choice at the beginning of the pregnancy.

[00:05:07] Well, that’s it, I’m on the path now. I just have to follow the bouncing ball. You’re constantly refining and adjusting and that we can as a non-medical professional access information, ask questions and to make those journeys. So I think that’s an important context because later in years to come, when you are a medical professional, your lens will change.

[00:05:27] But right now it’s the lens of, I’m a new mother. Who’s struggling with all of the excitement and opportunity of the future, but all of a sudden there’s a lot of decisions to make. 

[00:05:36] Yeah, and I think that when we talked about having this conversation, I was worried that I was not qualified to be talking about these topics being that I don’t have the degree yet, but I, we agreed that it provides a really accessible lens because the majority of people giving birth, aren’t going to be midwives.

[00:05:56] They’re just going to be mums who want the best thing for [00:06:00] their baby. So it’s definitely from a personal experience. And I think that we do live in an era where we have more access to information than ever before. I think in terms of credible quality research articles that we can access on the internet.

[00:06:16] That’s how I do a lot of my research, but also the opportunity to hear other’s birth stories, such as through podcasts to link in and chat to other women on specific birth groups, such as natural birthing groups or home birth groups on Facebook. So we have more access than ever before, and I think that that can both be helpful and a real hindrance to your journey, you know, depending where you’re getting your information and how that’s affecting you.

[00:06:50] So I think that there’s something there in terms of. Making informed choices around the information you digest. But you’re right. I think that it’s [00:07:00] a time where we can have these conversations. It’s not reserved for medical professionals and where just the bystander. 

[00:07:07] Kelly: [00:07:07] Yeah. And, and so let’s start. Right at the beginning, because for context, we had a lovely morning this morning watching birth videos of our birth, talking about our birth stories and sharing those moments.

[00:07:19] Bree: [00:07:19] Isn’t that how most people start their Saturday morning. 

[00:07:23]Kelly: [00:07:23] So there’s a lot going on but one of the things I realized with my first birth having been 12 years ago is there were many parts of that journey that I went on very actively and took an active role on. And there’s other parts that are a mystery to me.

[00:07:37] And I don’t even know if I thought about them. One of those questions I have is let’s start with a baseline of obstetrician and midwife. What are the two concepts loosely around those two parts and the decision for what sort of care, because I can say I went into the midwife, led care with both of my children.

[00:07:58] However, my eldest [00:08:00] son was born in the UK 12 years ago. And for example, we do know that the stats in the UK have the ratio of midwife led care to obstetrician is very, very high midwife led care. So. I would have had to very specifically request obstetrician letter. We had to pay for it. I wasn’t in a financial position to do that.

[00:08:17] So I went into the system and the system was midwife led care, but in some ways that was almost a lottery that I won because it worked for me. And now I’m so much more informed, but to be honest, even all this time, two babies later, I don’t necessarily clearly understand why would you like – what’s obstetrician versus midwife.

[00:08:36] Bree: [00:08:36] So tell me a little bit about that again, from a personal. Point of view. I don’t understand the training behind obstetricians professionally, if I’m completely honest, but my understanding of our role as midwives is that we’re trained as medical professionals that support and facilitate natural birth.

[00:08:54] So we are very equipped to handle birth from start to finish prenatal and [00:09:00] postnatal care. When the situation escalates to being more high risk. That is essentially where obstetricians thrive. So they are medically trained surgeons. They are the ones that it would step in in the case of a Syrian or complication.

[00:09:18] And there is absolutely a role for both of them. I think. That’s undebatable, it’s undeniable. So, or something we do know though, is that when you look globally areas with higher rates of. Midwife to obstetrician ratios – so with more midwives than obstetricians in general have better outcomes, and that’s true of Australia as well.

[00:09:41] We do have many qualified midwives both in the public system and private practice. I think where we run into a little bit of trouble is using obstetricians as the default for low-risk birth. And that often comes from a place of. I’m paying for my private health. [00:10:00] I want to utilize it, and the desire to pick your obstetrician.

[00:10:06] So if you know, a friend who had a good birth with them, and you can then pick that obstetrician compared to going through the public system and getting assigned a care provider, I think that that is quite appealing to people. You can do that. In terms of private midwifery, we do have privately practicing midwives.

[00:10:24] But they rarely covered by private health. So, you do have quite a few options. I also went through midwifery led care through the public hospital for my first birth through something called MGP. So, I had a primary midwife and then about four secondary midwives who I got to know all of them. So that when it came time to birth, someone familiar to me would be delivering my baby. So that’s a great option through the public system, if you want to go down that route. But yeah, I think there’s a place for both of them. If you’re a low-risk woman, [00:11:00] potentially midwifery care is going to be a great option to start with and then escalate to obstetricians should it become necessary? 

[00:11:07] Kelly: [00:11:07] It’s such an interesting point because I do think there is a generalization, which is if you’re in the public system, then you would, you know, there’s midwife led care if you’re private, its obstetrician led, but in actual fact, that distinction, which is having a private practice doesn’t have to be obstetrician. Like there are options around midwife led care in the private system. 

[00:11:27] Bree: [00:11:27] There is, but interestingly so obviously very relevant to me at the moment I had a doctor’s appointment just this week to get a referral to a private practicing midwife. And my doctor wasn’t familiar with the concept of a private practicing midwife. She clarified whether I meant an obstetrician and I said, no, no, a private midwife and here are her details. They didn’t have them on file. So, I think that it is an option that not many people know about. 

[00:11:56] Kelly: [00:11:56] That is super interesting and that [00:12:00] default positioning on it which touches on an issue around, you know, private versus public around the financial viability of birth, which is a whole other area that we’re probably not going to go into this time, but certainly you know, realizing.

[00:12:15] That there were certain things in the birth process. I went through that I was really clear about choices I wanted to make, but there were other things that never occurred to me because I went into a public system. I turned out to have a baby having never met anyone who was in that room with me that day.

[00:12:29] And then you walk away, and someone just helped you give birth to a human being. 

[00:12:34] Bree: [00:12:34] Yeah. And it’s a very intimate experience. So to be sharing that with a stranger. Is it, it’s an interesting concept, isn’t it? You wouldn’t have sex in front of a stranger. I don’t know, but we do the same thing, the same intimate process in that situation.

[00:12:50] Kelly: [00:12:50] Yes. And I think that’s one of the major triggers in choice for people to want to go into private practice is that they know that they’re going to have that same person all the way [00:13:00] through and why that default for private same person with me the whole way through is obstetrician. It often feels like you’re stepping outside the normal and, and anytime we step outside the normal and we challenged something, it feels quite uncomfortable.

[00:13:13] So even that process of listening to that conversation about explaining, having you as a I’m a mother giving birth, explaining to a general practitioner. What is a private midwife, and this is how, and here’s her name and address, and I’ve already done the research myself. I just need you to give me the letter you really needing to do, take a front step in, in tha t, which is ultimately what we’re talking about today is birth choices.

[00:13:38] First one being, how do we even know what are the choices we need to make and when, so that we’re not so far down the track that we can’t change those choices. Because from the moment you realize that you are pregnant, the journey begins in terms of choices, and I think that choice of who’s helping and supporting on that care thecare provider or [00:14:00] the care system seems to be one of the really key decisions that it’s not that you can’t change it later, but there are always implications and so the earlier you think about that, the better. 

[00:14:11] Bree: [00:14:11] I think that there are a multitude of options. You have public hospital midwives, private midwives, obstetricians, shared care between your GP and midwife. There are plenty of options and there that information is pretty publicly available. So it’s not something that I feel the need to go through.

[00:14:28] You can Google your local hospital and they’ll provide that information or the GP will provide it to you. You could also listen to for example, the Australian birth stories podcast is a great one where people share their birth stories, and they of course go through different models of care.

[00:14:46] So you get to hear that experience, but I think that it is an important conversation around choices because. All care providers are not created equal. They have different strengths and [00:15:00] weaknesses. They’ve got different training, they had different perspective surrounding birth. So, while you can hope for and strive for, and work for a vaginal non-instrumental birth, that’s going to be easier to achieve with certain care providers or in certain settings.

[00:15:22] So, if you are aiming for that potentially enlisting the help of an obstetrician who, as we talked about has a very important role, but more towards the high-risk pregnancy territory. Potentially, they’re not going to be as supportive of your choices and you will have to advocate for yourself more.

[00:15:43] Whereas if you maybe contract a private midwife that might more align with their philosophy. So I think that it’s a really important thing to choose a care provider who you were aligned with. Not just based on a recommendation of a friend or the fact that you have [00:16:00] private health and it is a privileged decision.

[00:16:02] Not everyone can afford to make the decision that they would want, but it’s worth thinking about. And you can do that by, I mean, good care providers will allow you to interview them in a no cost situation where you can get to know them and ask questions about their philosophies. So that’s a great way to do it.

[00:16:22] And yeah, just, just being aware that. Any outcome is possible. But you’re more likely to have certain outcomes.

[00:16:28] Kelly: [00:16:28] And, realizing that it’s a very much a trust relationship. So even if you are in a situation where the option is only public because of financial or other constraints, or, you know, one of my children was born in a country hospital.

[00:16:42] So whether you are private or public patient, it was the same hospital and the same nurses and the same midwives. There was no difference. So sometimes it’s, it is a financial thing, but sometimes it’s a location-based issue as well. It’s really about having that confidence to ask [00:17:00] questions and expect that you’re doing something that is both – yes, it is a medicalized in our society because we have the ability to understand risks and mitigate risks through birthing process. But it’s also it’s actually a very much an emotional and very personal experience, you know, having a baby and that you’re within your rights to ask, how does someone you know, ask those questions, build a relationship, build a trust relationship, really get to the heart of here’s what’s important to me. How would you handle these situations in different times if I make this choice, what are some of the second order consequences of those that I might not know about now because how choice has presented to us in terms of choice architecture is really influences what we do. And although this sounds quite broad, I mean, some examples that might be around, you know, if we’re presented with the choice of saying things like, you know, right now is a good time for you to, you know, [00:18:00] engage in X, Y, Z procedure.

[00:18:02] Okay. What were the triggers that brought us to that decision? And what are the consequences of those? I can tell you where that when you are in the middle of birthing a baby, it’s not the time to do the research because your kind of busy right then. So at least having done some preparation and that’s where today’s conversation really starts with, I’ve just found out I’m pregnant. What are the choices that I might want them to start making now? And what are the second order consequences of those? 

[00:18:29] Bree: [00:18:29] Yeah. So I think that you’re right. It’s sometimes it’s easier to make choices. If you, for example are presented with the choice of an induction and you’re not currently in labor. You’re more going to have the time, the mental space to step away and reflect on that. If you have had an epidural and you’re quite relaxed, it might be easier to make a decision, but if you’re in transition and your body is in voluntarily pushing, it’s probably not the time to be really asking questions and [00:19:00] advocating.

[00:19:00] And so, I mean, you can mitigate that by having a doula or having an informed birth partner, but something that I like to use is the BRAIN acronym. So this kind of comes in when you have to make decisions around your birth and I’ve heard of people printing it off, laminating it, providing it to their partner, which I think is fantastic.

[00:19:23] So what brains stands for is B what are the benefits are, what are the risks? Are there any alternatives. I, what does my intuition say? And, what happens if we do nothing? And what that brings the conversation back to is the essence of informed consent. So, if you’re being told, for example such as in the case of my birth, my first birth, you’ve had an epidural, let’s just give you some Pitocin to speed things up, no need for this to take all day. 

[00:19:58] Kelly: [00:19:58] So for clarity, Pitocin is [00:20:00] something that is an induction. It’s a form of speeding up the birth process. 

[00:20:03] Bree: [00:20:03] Yes. So it’s the same drug that would have been used in your induction. So it speeds up birth and stimulates contractions and mimics the body’s oxytocin.

[00:20:14] So what I didn’t understand at the time was how that is linked to fetal distress and C-section and intervention. I had no concept of that. And it didn’t occur to me to even ask the questions. So where an acronym like this can come in here handy is really not putting your care provider on the spot, but asking them to justify it to you out loud.

[00:20:38] And I think that that’s a powerful concept is, you know, what does the research says, say, and are there any other options or is this, is this my only choice? 

[00:20:49] Kelly: [00:20:49] So let’s walk through that example because I think it’s really relevant. So you’re at a point where you’re being offered for all intents and purposes, a drug during the birthing process.

[00:20:57] So the question would be what are the [00:21:00] benefits? The benefits is it will. Speed things up.

[00:21:04] Bree: [00:21:04] Yes. And in this case, my midwife was on her last day of work before she had long service leave. So for her, there’s probably lots of benefits. 

[00:21:13] Kelly: [00:21:13] The question is what’s the benefit for me as the birthing mother? 

[00:21:15] Bree: [00:21:15] To me as the birthing mother, again, from my personal opinion, I can’t see many benefits of stimulating labor at that point.

[00:21:22] He wasn’t in distress. I wasn’t fatigued. I was very comfortable. So in that situation, it probably would have highlighted that there wasn’t a lot of benefits for me, 

[00:21:32] Kelly: [00:21:32] And really interesting that the benefits of the other person comes to light. When you ask that question. 

[00:21:38] Bree: [00:21:38] Of course. And I think that I believe I had a really great midwife, but we are all humans.

[00:21:43] Like this is still her job. She’s still at work. She’s. Keen to have a quick day, if she can, like we’re all human beings. So I think that that’s important to keep in mind. Yes, absolutely. The risks. So 

[00:21:55] Kelly: [00:21:55] the risks that would have been presented at that time?

[00:21:58] At the time, no risks [00:22:00] were presented to me. Which for me, made it an easy choice.

[00:22:05] Why would I not choose that option when no risks were mentioned? I think often it’s linked from my understanding to things like distress because they’re putting an unnatural amount of stress on the baby which can then lead to things like episiotomies and instrumental deliveries. But none of those risks were presented to me at the time

[00:22:26] Alternatives again, none presented at the time? What are the logical alternatives to this? 

[00:22:32] Bree: [00:22:32] Just wait, just wait, let it take its time. Enjoy it. Yeah.

[00:22:38] Kelly: [00:22:38] What do you remember at the time, what your intuition was telling you, or do you feel you were disconnected from that? 

[00:22:43] Bree: [00:22:43] At the time I was totally disconnected and that’s something that I reflect on now, a big a driving force in my decision making throughout labor was not wanting to bother anyone not wanting to be dramatic or too opinionated or too [00:23:00] difficult. And so it was very much like, well, if you think that that’s best, no problem. 

[00:23:08] Kelly: [00:23:08] That’s so interesting because we’ve had this conversation before that both of us grew up very much with being, I guess, the good child and trying to do things that was not people pleasing, not rock the boat, et cetera.

[00:23:18] And interestingly, when we played back. The birth videos that we did earlier because I’d forgotten all the things. 12 years is a long time, but when I watched the video and there was one particular spot where My son is born, and I turned around and they’re clamping the cord. And I say, no, he’s still getting oxygenated blood.

[00:23:35] Bree: [00:23:35] So for context that he, they felt that he was in distress and wanted to take him away for resus. And Kel in all her wisdom suggested to keep him attached to the cord because he was still receiving oxygenated blood, which is a fantastic recommendation. 

[00:23:51] Kelly: [00:23:51] Yes. And I, I do remember. Straight away. I wanted him bought to me. I wanted to hold him. And once I then actually had a good look and [00:24:00] I thought, I actually remember thinking, Oh, he does look in distress and at that point they did decide to cut the cord, take him away and resuscitate and all went well. But that was probably one of the very few times in my life where I really spoke up and was like, no, no, don’t clamp the cord, he’s still getting the oxygenated blood. But, but realizing that, that was probably because that was, they were things that I had done the reading beforehand and had made some decisions that I wanted to keep the court attached as long as I could in the right situation. 

[00:24:28] Bree: [00:24:28] I think importantly, in that situation, you were flexible, you were open to their recommendations, but you did also have that knowledge to draw on and it’s not a great moment to be making hard choices, but sometimes we do have to make hard choices in the heat of the moment with big consequences. And I think that that’s where the education is really important that we can fall back on that.

[00:24:53] So the last one in our acronym is what happens if we do nothing. And sometimes there are really big [00:25:00] risks. For example, if they hadn’t taken him away to recess that could have had implications, but in my situation, if they did nothing, if they didn’t offer Pitocin, I probably would have just waited a bit longer.

[00:25:12] So I think that this acronym can really help in terms of asking for time and space to make a decision when that is an option. And also the conclusion you come to you don’t actually have to justify. To your care provider? No. Is a full sentence. You can just say no, thank you. 

[00:25:31] Kelly: [00:25:31] No is a full sentence. I’ve never heard that before, but I really like it.

[00:25:34] Bree: [00:25:34] It’s a Goodie isn’t it? Yes, it is. You don’t need to justify anything to anyone at the end of the day without informed consent, they can’t proceed. So, 

[00:25:44] Kelly: [00:25:44] Oh, absolutely. So in terms of that relationship that we have with the care choices. Sometimes that is a small group, one or more that you will go through the entire process with sometimes [00:26:00] if you are in a system, which is you’re turning up and getting whoever there’s still, each time, you just need to advocate enough to be able to go in there and say, these are the things that are important to me. How do we find a middle ground in terms of me getting what I need out of this interaction, whether that is a scan, whether that’s choices in which tests, we get done because that’s a whole other, huge area, by the time you are, between six and 12 weeks pregnant, you’re already in this program of let’s find out more information, let’s get a dating scan, let’s get some testing done. The question is, if I get this test, what information will I get? And what decisions can I make from that rather than just assuming that we’re getting all of the tests.

[00:26:42] Bree: [00:26:42] Exactly. And I think that the thing is that there’s no right or wrong answer. There’s only a right answer for you. And the important thing to remember is that everything is optional. There is nothing throughout your pregnancy, aside from probably giving birth, that isn’t optional. So [00:27:00] you can choose to have a dating scan or not.

[00:27:02] You can choose whether to do the glucose tolerance test or not. Again, when it comes back to choices is information and being provided the whole picture. So if I get this test, what are the implications? If it comes back positive for gestational diabetes, what does that mean for my birth choices? And how is that going to limit them again, that brain acronym – what happens if we do nothing? What happens if we don’t test? And often medical professionals are time limited in being able to have these conversations, but if you can, I think they’re very important conversations. 

[00:27:40] Kelly: [00:27:40] Mm, absolutely. And you know, it was a big thing when I was pregnant the first time round about this concept of having a birth plan, but that was really from the moment you went into labor and actually it’s from the moment you find out you’re pregnant, there’s this journey like a giant, it’s almost like a snakes and ladders board where there’s [00:28:00] decisions you make and sometimes you will end up somewhere that you didn’t expect because of a decision that you’ve made and we would talking earlier about the dating scan. I didn’t really understand what happens at the dating scan is we get a date. But what does that actually mean? Especially if you already know, and both of us have had the bizarre situation of actually knowing the point when we conceived for various reasons. 

[00:28:25] Down to the minute, 

[00:28:27] Which is a whole other story. But if you already know when you conceived, then you’ve already got a timeline. So if you get a dating scan and that date is different because the dating scan is an imprecise baseline created in the absence of other information. 

[00:28:46] Bree: [00:28:46] And I think that the problem with that is, again, we are trusting something other than ourselves. We know when we conceived, and this is a conversation I had with my doctor the other day, she suggested [00:29:00] that I get a dating scan and I was like, I don’t really feel it’s necessary. I can tell you the day I conceived and when my last period started and ended, I can show you a year of data on periods. Like. There’s no ambiguity there. And she’s like, Oh, well, just to be sure. But for example, say you’re birthing your second time round, and you know, you tend to carry babies quite long for some women, 42 weeks as a normal gestation. If you get a dating scan that puts your due date earlier. That is going to increase your risk of being induced.

[00:29:34] Because while you may only be 40 weeks, if the dating scan is telling the medical professionals that you are 41 weeks, that’s going to change your care. So again, it’s just having that knowledge to make an empowered decision about whether you want to or not. And for me, the dating scan, wasn’t presented as a choice it’s this is what you need to do. So yeah, just for men remembering that it’s optional. 

[00:29:57] Kelly: [00:29:57] Yes, absolutely. And you know, [00:30:00] not a lot of people know when they conceived. I actually have a friend who got to nearly five months and was wondering why she was really overtired and found out that she was pregnant, so in that case, it was. Genuinely, well, I have no idea how long have I been like this, and it sounds like a crazy amount of time, but actually because many of us have irregular hormonal systems that is entirely possible, that can happen also. 

[00:30:24] Bree: [00:30:24] And I think that it kind of sets the precedence and sets the tone. Like, am I going to trust my innate knowledge and wisdom? Or am I going to outsource that to something else, to someone else, to a machine. And for some people dating scans can be very reassuring. If you hear a heartbeat and can rule out multiples so there’s pros of having a dating scan. For others, if you have an early scan, you might not hear a heartbeat and that can be very distressing so it’s not a case of yes or no. It’s a make a choice that’s best for you. 

[00:30:56] Kelly: [00:30:56] I think that’s an important distinction for this conversation is that [00:31:00] we’re actually not advocating for any one choice. We’re actually advocating for the concept of choice, for the concept of informed choice, of informed consent.

[00:31:09] And hopefully through sharing some of these real life experiences, we can bring to light some of the choices that we might not otherwise consciously make. With my first child. I went through all of the usual tests and I distinctly remember one test in particular, which I’m going to call the test where they tell you your risks associated with having a child with down syndrome, which the Nuchal Translucency and PT.

[00:31:33] Bree: [00:31:33] I think it’s usually abbreviated too. It’s usually around 12 weeks and is commonly a blood test. Combined with an ultrasound, and then they look at those results together to give you a prediction on your likelihood of having a child with I guess chromosomal abnormality. 

[00:31:49] Kelly: [00:31:49] Right, and so I do remember the anxiety leading up to the test. I remember getting the results and looking at the results and thinking. But you didn’t tell me the results would look like this and the [00:32:00] results were something to the effect of, do you have a one in 375,000 baby chance of having something. 

[00:32:06] Bree: [00:32:06] Yes, and ours was in the millions from memory. So what does that translate to in real life?

[00:32:12] Kelly: [00:32:12] And saying to the, or what, what decision can I make from this and them saying, well, it’s your decision? What to decision to make? And I’m thinking. This has this helps me not at all, like zero in fact, it’s actually affected me negatively because now I’m thinking to myself, is that good or bad? Like now I have to do the re et cetera. So with my second child, I actually just chose not to do it. And I chose not to do it because the question I had to ask myself is if I get the results, how would the results have to look for me to take an active decision versus doing nothing?

[00:32:42] And the answer was, I just actually didn’t know, like, if it was one in two or one in a hundred or one in a thousand, what would be the trigger point for me to take action from those results? And when I was like, I don’t know, there is no reason for me to have that test and I made that choice, but I just [00:33:00] was not informed to make that decision beforehand because it never even occurred to me 

[00:33:04] Bree: [00:33:04] I think again, that’s the best choice for you. So for some people that might provide reassurance for me, I had already had the conversation with my husband and said, you know, if this shows up bad, how are we going to feel about that? How’s it going to affect our decision making? And I mean, it’s an inherently tough subject because it’s, it’s loaded.

[00:33:23] And as we talked about before, you know, it shows you maybe one, one thing is your child likely going to have downs syndrome? They can’t tell you yes or no. And as Kel and I talked about before, like it can’t tell you if your child is going to be an asshole, like it does not show up many things, and there are many worse things in the world.

[00:33:46] You know, while being sensitive to the issue, down syndrome, children are beautiful and incredible and worthy of life. And so for us, we knew that that wouldn’t impact on our decision. And so in that situation, probably what was right for [00:34:00] us would have been to refuse it. But again, it didn’t occur to me that I could.

[00:34:04] And so that might change whether we do or not. Next pregnancy and this pregnancy. But I just don’t recall at any point, knowing that these things were optional at all. 

[00:34:15] Kelly: [00:34:15] Yeah. And I think that’s the point that we’re both raising as, you know, having gone into a second birth, much more informed from my experience of the first and now with you going into a second birth. It’s like, how do we package up the things that we learned from the first birth and share that with others so that they don’t also have that feeling because, you know, ultimately and this is going to come across very broadly. It doesn’t matter what we say today.

[00:34:42] This will be triggering for people because we are, as humans, we are triggered by things and the process of you know, being pregnant of, of birthing is so connected to our identities, our emotions, our relationships, our relationships with our own parents, how we were raised [00:35:00] our siblings and our partners.

[00:35:02] And so this process of going through and making choices is actually often a simple choice that we may need to make around our pregnancy is actually reflective of a much broader life view, attachment to identity, whether we are the type of person who inherently questions, whether we are the person who just wants to be small and quiet.

[00:35:24] You know, whether we are someone who has, 

[00:35:26] Bree: [00:35:26] Are we  a rule breaker, are we…. Yeah, absolutely. And I think that for me, this is much like with teenagers, and I guess this is very, very relevant to us with the age that your boys are. But I’m also only 24, so it’s not a distant memory being a teenager. And I think that no matter how much our parents told us we had to live the experience ourselves, and that is one tricky thing about birth is that it doesn’t matter how much knowledge we acquire or what people tell us, it’s hard to know how you’re going to respond until you’re in that situation. [00:36:00] But recently I’ve been sharing I guess, birth related content on my Instagram, which is just a humble, personal Instagram of 400 people. But it is something I feel passionate about. So I’ve been sharing it. And in response, a lot of women have shared with me their birth stories, which is fantastic because I spend all my spare time watching birth videos, listening to podcasts on birth stories. So I love that they feel comfortable sharing that with me, but I definitely see a pattern of. This is how my first birth went and it was okay, or it was actually quite traumatic. And as a result, second time around, I did things very differently. I was more empowered. I questioned why decisions were being made. I said, no, I maybe enlisted the help of a doula. And I guess something that I’m grappling with personally, but more professionally knowing that I will be working in this space. It’s like, how do we capture that? How do we harness that and give it to first time [00:37:00] moms so that we don’t have to move through trauma to get to a place of knowing and trusting ourselves?  

[00:37:08] Kelly: [00:37:08] Yes, absolutely. I’ve just come up with an idea that I’m sort of putting on the spot here, but I feel like this might be something that we can address over the coming months where we might pick some certain choices along the way. And maybe just through you telling your own stories of the choices you make and why that might actually be helpful, because that is a theme where if we have had an experience where we feel that we would want to do it differently later, how do we share stories upfront and learn from those such that we have the ability to at least feel we have choice. And there’s this whole concept of you know, perceived control and perceived choice is better because in some situations there is a genuine requirement. That there are certain things have to go a certain way. There needs to be a medical intervention, but how we go on that journey in this comes all the way back to the first conversation about [00:38:00] picking a care provider that respects your choice, respects you as a human being and engages you in a conversation and explains, and is willing to work through the questions of – here’s some options. Here’s why we think they’re the right things. Even though this feels like it might not be great time or, a great decision to be making, but it is important because I’ve got information that you don’t, that I need to share with you. 

[00:38:23] Bree: [00:38:23] Yeah. And I think that this is a really important conversation because what we know about feelings about a positive birth experience is that it actually doesn’t matter a whole lot whether you had a home birth with candles and hypnobirthing and breathed the baby out, or if you had an emergency caesarean, one of the key predictors of feelings of a positive birth is feeling, I guess, perceived choice, not choice because sometimes we wouldn’t make those choices, but feeling as though you had some control in the process that your concerns and [00:39:00] opinions were heard and respected.

[00:39:02] And I think that that is actually really empowering because you can start with a birth plan of home birth and end up with a caesarean and still feel that it was a really positive, empowered choice. And I think that it takes some of that power back. So we’re not at the mercy of birth because birth is inherently unpredictable. We can’t control it. And the more you try to control it, the more dissatisfied you’re going to be with this experience. You know, if you cling tightly to your ideas we know that that leads to dissatisfaction and feelings of regret and disappointment. But that doesn’t mean that you shouldn’t have a birth plan or an idea about your birth. You just need to hold it loosely and be adaptable and yeah. 

[00:39:48] Kelly: [00:39:48] Yeah, absolutely, and I think that’s probably a great place for us to sort of close out today’s discussion as one, which is if we’re advocating for choice, some of that is knowing ahead of time, what the [00:40:00] choices you’re going to make. And some of them are knowing things which there is actually great research around. And one of the common things that we talk about all the time is the birth position. So you know, this came up when I was able to show you the birth video and, you know, straight up onto hands and knees to have the baby. I haven’t seen a video at a movie where they got up in their hands and knees it’s always goes legs in the air, et cetera.

[00:40:23] And it still fascinates me to this day that people are still giving birth on their back with their legs in the air, which is for the receiver’s benefit, not the birth benefit because it allows you to see better. 

[00:40:36] Bree: [00:40:36] Although that’s debatable. You have better access, better access. They have better access.

[00:40:41] Kelly: [00:40:41] Yeah. But there’s a reason we don’t birth on our backs.  

[00:40:44] Bree: [00:40:44] And what we know is that it decreases pelvic size, which is very important when you’re trying to push a baby out. Like it’s a very important factor. And it’s not supported by evidence, so the fact that it is so widely used, still is problematic, but I think this ties in really well to [00:41:00] what you were saying in that we’re not advocating for one choice over another, or shaming people based on their choices, because in this conversation, I’m the one that delivered on my back. That’s how I birthed my child at the time I didn’t know better. And I would do it differently next time, but it’s not presenting things as black and white. It’s just, it comes back to choices doesn’t it?. 

[00:41:21] Kelly: [00:41:21] Yeah, it certainly does. And I’m really looking forward to going on this journey with you as you explore these choices and hopefully, we can share some of those along the way to help people really understand what’s possible in having choice.

[00:41:34] Bree: [00:41:34] Yeah. Thank you. I’m excited.

[00:41:42] Kelly: [00:41:42] Thanks for joining us for today’s conversation. If you want to hear more like this, don’t forget to hit subscribe so you don’t miss an episode. If you’d like to know more about anything we talked about, or you heard on the podcast today, check out our website http://www.birthofamother.com.au. You can find us on [00:42:00] Instagram @matrescence.podcast , or send us an email to info@birthofamother.com.au.

[00:42:05] If you think others could benefit from this podcast, take a screenshot of you listening to this episode, to post on your social media and tag us. Alternatively, consider leaving a review with your favorite things about the Matrescence podcast. This really helps us to increase our visibility and ensure we are reaching as many women as possible. As always, thank you for spending your time with us. We hope you’ll tune in next time.

Kelly and Bree


kelly@birthofamother.com.au
brianna@birthofamother.com.au

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