headshot copy
About me

I qualified as a midwife in 2001 after completing a BSc (Hons) in Midwifery in the UK. I have practised midwifery in a range of settings in the United Kingdom and Australia.

I am a Senior Lecturer in Midwifery and Midwifery Discipline Lead at the University of the Sunshine Coast. My research focus is on the physiology of birth; women’s experience of birth; care provider practice during birth; and women’s rights in maternity care.

I have published in numerous formats including journal articles and books. I have also presented at many events nationally and internationally. You can find out more in my resume.

About this blog

The aim of this blog to stimulate thinking and share knowledge, evidence and views on birth and midwifery. The posts reflect my own perspective and opinions… not necessarily everyone, or anyone else’s including my employer. I welcome debate and I’m happy to be wrong – so feel free to comment and put me right if required (preferably politely). My posts are not intended to provide advice or recommendations for individuals.

I update key posts with new research and resources regularly rather than writing lots of new posts.

This site is marketing-free. I don’t accept advertising offers, and will not promote or endorse products for companies or individuals.

Email: midwifethinking@wordwitch.press

The Sunshine Coast, QLD, Australia

236 Responses to About

  1. Rosemary Weckert says:

    Hi Rachel
    It’s nice to read about Australian midwifery. Many sites are international which can be stimulating but it is good to see some Australian content. I work as a midwife in Alice Springs. Goodluck with you studies and I will be ‘listening in’ on your blog from time-to-time.
    Rosemary Weckert

  2. I absolutely love your blog. πŸ™‚ So cool. I’m going to add it to my blog roll.


  3. Katrina says:

    Hi there…are you able to practice as a homebirth midwife in Qld? I live in Brisbane, as I understand it there is some kind of legal issue (which is terrible) with attending homebirths…are women in Qld able to have midwife attended homebirths?

    I understand if you can’t comment explicitly about your own scope of practice. Thanks :).

    • Hi Katrina
      Yes I can still practise as a homebirth midwife in Qld. The only change for me so far is that I have to purchase insurance for antenatal and postnatal care (mws are exempt from insurance for homebirth for 2 years because it is unavailable). However, midwives who want to be eligible to access medicare provider numbers (which I don’t) need to have a ‘collaborative arrangement’ with an obstetrician. It’s all a bit long winded and complicated but basically the AMA and RANZCOG have been very influential in determining what ‘collaboration’ is and the resulting legislation means eligible midwives will be regulated by obs. So it will be impossible for women to access the care of a homebirth midwife and claim medicare rebates for the care. However, women can still have a midwife attend their birth legally… for now.

      • kay hardie says:

        hello rachel, I practice an independent midwife in the UK and was interested reading your comments above as midwifery here is facing a crisis. Currently it is not mandatory to have indemnity insurance, but from October 2013 because of an EU directive it will be compulsory and likely to be a requirement to be on the register. But as an independent my union RCM doesnt cover me and its impossible to purchase any on the open market because of the perception of ‘risk’. So independents are facing extinction here. Shocking for women’s right to have choice of care provider and that of midwives to deliver woman centred care.

        • It is terrible what is happening in the UK. It is similar here i.e. insurance requirements have been implemented and it will probably result in many midwives being unable to practice in the way they want… and the way women want them to. 😦

      • Love your strength of character Rachel and the recognition that we are a profession in our own right. Collegiate relationships and arrangements when required have been effective for the last 42 years that I know of. This has been without all the issues associated with “collaboration”, inappropriate “legislation” and “insurance”, all designed to create professional midwifery fear. Provider Numbers for Midwives are not new, Private Health Funds have been functional in this area for at least 20 years. Medicare Provider Numbers are new however the process to achieve this is long, excessive and controlling to the point that midwife autonomy is difficult. Thank you again Rachel.

        • Ashleigh says:

          Hi Dr. Thompson,
          My husband and i are trying to get pregnant. I came across an article about amniotic fluid embolism. It states that uterine abnormalities is possibly a risk factor. I know AFE is not fully understood but I do have a 1.3 cm uterine polyp. My first saline ultrasound that confirmed the polyp says it was vascular but second ultrasound I just had says it avascular. What are the chances of amniotic fluid embolism if my polyp is vascular and tears during labor or delivery? Has anyone been documented with AFE and had a uterine polyp(s) ?

  4. Lara says:

    Hello Rachel,

    I’m a doula practicing in the UK and I want to thank you for your excellent and well-presented information. I particularly appreciate your links to research and have just printed some of the induction material to take with us tomorrow, for the dreaded post-term induction conversation at the hospital. My client really wants to avoid intervention and it’s good to have the research to hand when advocating for normal birth. I feel prepped, as does my client, but I’m still secretly hoping for baby’s arrival tonight, on the 42 week mark πŸ™‚ Cross fingers X

    • Hi Lara
      Good luck with the hospital appointment. I would love to know how it goes… Or the birth went. It is good to hear that the UK has doula services (there were practically none when I lived there). Women need doulas to help them negotiate the system.

  5. It is saddening that our society (I am in the USA) does not trust nature to take care of us. I thought about using a midwife 18 years ago with my first, but was really pressured into believing that it wasn’t safe (being a registered nurse, I had more exposure to friends that were hospital staff, not midwives) and that I was “odd” for even thinking of using one.
    Thanks for allowing women to see that the birth process is one that is not complicated unless you make it that way, and how much sense using a midwife makes to both mother and child.
    While my 2 birthing experiences were uneventful, I would have definitely opted for a midwife if I had a bit more moxie.
    I only wish I could turn back the clock!

    • There are lots of us who would love to turn back the clock and birth with our current knowledge (me included). However, our experiences good and bad make us who we are. All we can do is spread the word and help future mothers make changes.

  6. JMT says:

    I stumbled onto your blog and read the whole thing … at work at my desk job … woops. Thanks for the wonderful posts, pictures, and videos. Please keep writing. I’ve subscribed on my reader and will look forward to future posts. I’m a student in public health in Massachusetts and love reading about midwifery care around the globe.

  7. Elizabeth says:

    I just found your blog–I forget how–but I am enjoying it and had to write and tell you how much I love the header picture! Wonderful! I am a midwifery student in Portland, Oregon, USA, which is a great place to practice midwifery. I look forward to reading more about your experiences!

  8. Helena says:

    May I copy some of your posts to share with my students? I see you are licensed under creative commons and I will most definitely attribute your work to you. You explain things very clearly! Would love to collaborate with you and Gloria Lemay and others on a new guide to birth.

    • Of course you can share the information with your students! The whole purpose of the blog is to get information out there and generate thought and discussion. The more of us reinforcing women’s birthing ability and power the better πŸ™‚

  9. Nik says:

    Thanks for your awesome, informative blog. I’ve been following it for months and am starting midwifery studies this year (in SE Qld).
    I’m wondering, are there any books that you’d recommend for people who are aspiring to be a homebirth midwife? Books that promote a non-medicalised understanding of pregnancy and birth…to supplement what’s studied at university which I imagine *may* be fairly medicalised?
    Cheers and thanks πŸ™‚

    • Congratulations on starting your midwifery studies!
      Textbooks are improving (slowly) and I would guess you will have an anatomy and physiology book on your list along with ‘Midwifery’ by Pairman et al. The books I like and use for teacher are:
      – ‘Normal Childbirth’ Downe (ed)
      – ‘Childbirth, Midwifery and Concepts of Time’ McCourt (ed)
      – ‘Birth Territory and Midwifery Guardianship’ Fahy et al.
      The best way to learn is to get involved in the birth community and if you aspire to being a homebirth midwife connect with others involved in this scene. We can learn so much through sharing experiences and wisdom, and listening to birth stories. Ultimately women are our greatest teachers. Enjoy your studies πŸ™‚

    • Linda Stegeman says:

      Sarah Buckley – Gentle Birth Gentle Mothering, Anne Frye’s series of holistic midwifery books – antenatal, birth and postnatal are good. There is Ina May Gaskin and her birth books including spiritual midwifery. Dennis Walsh, Soo Downe, Sarah Wickham have are British midwives who have written really good stuff and will lead you on to other midwives such as Mavis Kirkham.

  10. thank you for your blog – it is just wonderful. i’m not a midwife, but i did have an amazing midwife-assisted birth just about 3 years ago and have since felt the need to soak up as much information as i can to pass along to my peers. sadly, i am so far the only one amongst my acquaintance to have had a remotely positive birth experience, and to me it seems no coincidence that i am also the only one who had midwives to cheer me on. it’s so hard to explain to other women that birth is mostly done by your body – even the closest friends dismiss my experience as “lucky” or “flaky”, rather than my own characterizations of “natural”, or even “incredibly well-researched” (especially that last one, as i was someone who initially had NO idea how birth could even physically work, and it was actually all the outcomes literature that made me check out midwives in the first place.)

    i basically feel like i need to be armed to the teeth with technical knowledge whenever i engage in even the most casual conversation about birthing. hence, the brilliance of your blog for me. plus, it’ll prepare me in case i ever want to change careers – yours seems like the way to go.

  11. Bobbi says:

    I dont know how I found your blog either, but have also had to sit down and read the whole thing. I am a doula in Vancouver, BC and I felt like a sponge just soaking up all the info that you have provided. It echos so much of what I feel about birth but had never seen supported or substantiated before. I will definitely be recommending your blog as a great resource to my clients if that is ok?
    Thank you so much for sending all this great information out there into the birthing world!! Please keep it coming! You are an inspiration!

  12. Thanks Bobbi
    This is exactly what I want to achieve with this blog. Many of us ‘feel’ and ‘know’ that physiological uninterrupted birth is usually the safest way to birth. However, we live in a world where intuition, gut feelings, experiential knowledge etc. are dismissed. Knowledge must be rational (whatever that is) and scientific to gain respect – although of science is far from rational or non-biased in reality. Anyhow, my aim is to try and support and substantiate what we ‘know’ with science and rationale. Not because I think we should have to, but because it helps us get heard. If I’m in hospital talking to an obstetrician it helps to speak their language. If you can provide good evidence for wanting something or not wanting something it makes life easier in the ‘rational’ world.

  13. Johanna says:

    Hi Rachel,

    I just wanted to thank you for writing this blog. I really enjoy reading it, since I am a mother, too and on my way to become a midwife.

    Thanks for investing so much time and thought πŸ™‚

  14. Emily says:


    I have just sat and read your blog from start to finish. It is so great to have all of this information here. I am 34 weeks and preparing my birth plan and it just feels great to be armed with information so I can ask my midwife lots of questions before birth and really discuss with my husband what our options are. Just having the knowledge of pro’s and con’s for so many elements of birth is empowering. I just want to be calm going into labour and confident as well, and so much of what you have written has really helped me. Thank you so much for taking the time to write this blog, I’m sure many people will find it really useful, I know I have.

    I found your blog via someone linking to it on a discussion on Bubhub, and I am so grateful to have been able to read your stuff. I love that women are so keen to share positive information woth each other via forums/websites/blogs etc.


  15. Hi Emily
    I am pleased you are finding the information on the blog useful. I also think it is great that there is so much positive information online – women sharing their experiences and knowledge. I hope that these ripples turn into a wave of women who know and trust in their ability to birth. Happy Birthing! πŸ™‚

  16. Sara says:

    I didn’t know where to ask this, and I don’t *think* that it is anywhere on your blog, but I was wondering about your thoughts on the RhoGam shot for RH- mothers during pregnancy. I’ve read a lot of conflicting information about it, and it seems that even very “crunchy” and non-interventionist midwives are pretty supportive of it. I really respect everything that you post, though, so I’d love to see your take on it. I am glad that I don’t have to worry about it, since I am not RH-, but I am one of Jehovah’s Witnesses, so I am interested in the shot, knowing that it is a blood fraction product and it is generally considered a conscience matter as to whether a mom would accept the shot.
    I guess I just really believe that the Creator would not design a system that didn’t work really well, so what is the chance in a birth that is not intervened in that the mom’s and babies’ blood would mix?
    I am hoping to train to be a midwife in the very near future, and I really love love love your blog! I shared it with my doula class earlier this month.

    • I haven’t written about routine Anti-D (RhoGam) administration. I might in the future. Sara Wickham has written a book on the subjects: http://www.amazon.com/Anti-D-Midwifery-Sara-Wickham-Hons/dp/0750652322 and I have been lucky enough to hear her speak on the subject. There are a number of concerns with antenatal administration.
      – it is a blood product and often women are not told this (which is particularly important for JW women)
      – there has been no research to examine if it is safe for a Rh+ fetus to be exposed to Anti-D
      – it is the only drug administered prophylactically to 2 people (mother and fetus) for the possible benefits of a possible future person
      I’m not sure why in the last decade we have moved from only giving it after birth (or for AN bleed) IF needed to routinely giving women doses in pregnancy…. money?
      The blood between mother and baby very rarely mix.

  17. Sara says:

    Thanks for the recommendation and your insights. I hadn’t thought of it like you put it-
    “- it is the only drug administered prophylactically to 2 people (mother and fetus) for the possible benefits of a possible future person”

    Interesting thought!

  18. Pia says:

    Thank you for at very inspirering blog. I found you because I was searching for info on how the cervix works as a sphincter. I am familiar with Ina May Gaskin but since you are more aproachable i would like to ask to your experience as a midwife.
    I am a midwife myself but havn’t practice in a few years. I live in Scandinavia by the way.
    I am curious to know if the cervix in your experience is more soft and eager to open than we usually think. I have read that the cervix migth get tigth and rigid if the woman is affraid. But i have not had the opportunity to examin this myself. So to claryfy – is the cervix by nature able to let go easy and with no pain?

    I have also stumbled upon websites – american and european – that states that a totally painfree birth is possible if you use the breath (different kinds for the differnt sites!) and the change your beliefs about birth. What is you oppinion on that?
    best wishes from
    midwife Pia

  19. Hi Rachel, just wondered…would you fancy speaking about any of these topics, or anything else for that matter, on the Virtual International Day of the Midwife on May 5th? http://internationaldayofthemidwife.wikispaces.com ? cheers Sarah

  20. Jane E says:

    As someone who is obsessed with birth and babies, and still debating whether to retrain as a midwife, I really enjoy reading your blog!

    Have you had any experience of silent labours?
    Let me briefly share my story. I had my first baby in December 10, and went into the hospital after a bleed at 38weeks to be told to my surprise that I was 5cm dilated! I didn’t believe them at first until the monitor showed I was indeed having contractions. 30hrs later I was 7cm and still not even being able to tell when I was contracting. I was completely comfortable! However my blood pressure was high, and I was exhausted after a sleepless night on the wards, so I had an ARM and my son arrived 3hrs later.

    I’d never heard of a silent labour before and didn’t know it was possible. I have struggled to find any information about it since too. I don’t know the implications for a future birth and if I could get to fully dilated without knowing it or how much warning I might get. I don’t know how common a silent labour is, and for someone who likes to know how things work I don’t know how I could have not been able to feel contractions and to not know that I was labouring. If I hadn’t gone to hospital after that bleed, who knows when/where I would have realised I was in labour.
    Can you shed any light on this please?


    • Hi Jane
      I wish I could shed some light on this for you. I have never personally cared for a woman who experience this, although I have heard other midwives talk about it – so you are not alone. Did you feel any sensations at all as the baby moved through your vagina ie. pressure, stretching etc?
      For future births it might be an idea to stay home and have a midwife come to you. It is unlikely that you would labour without a ‘show’ of mucous, waters releasing, or blood at some point (as you experienced). This might have to be your cue to call the midwife rather than waiting for contractions. If you did feel pressure and stretching at the end with your first, then this could also be a cue. Otherwise be prepared mentally and physically to catch your own baby if you are alone and your midwife doesn’t make it. Lots of women actually plan to be alone during birth.

      • Jane E says:

        Thank you for your reply!

        Hopefully my blood pressure won’t be as high next time so the home birth will be an option. I did feel the pressure and cramps once baby started to descend, and I did get the spontaneous pushing reflex too.

        I’ve never heard of women planning to be alone during birth before, but I know that this could really happen to me next time. Hopefully I will be able to be provided with a kit to keep near me just in case.

        Would there be any monitoring that I could have to give a little prior warning?

        Best wishes,

        • Jane E says:

          Oh, and I live in the UK!

        • Hi Jane
          There is probably no monitoring that could predict when/if you were in labour. If you got pressure then that may be your only warning unless your waters release or you have a bloody show. Do a search for ‘freebirth’ and check out this site: http://www.unassistedchildbirth.com/
          At least if you get comfortable and confident about birthing on your own you will feel better about the possibility of not getting your midwife there in time. If your baby arrives before the midwife you can relax and enjoy him/her and the midwife can help clean up when she gets there πŸ™‚

  21. Pingback: proper prenatal care | Dharma Talks

  22. Jen says:

    Hi Rachel,

    do you have a private email addy you can send to me? I’d like to pick your brain if you happen to have a few spare moments in your life.



  23. Fidelle Luciano says:


    My name is Fidelle Rosa Del Rosario Luciano, a practicing midwife in the Rizal Province, Philippines. I am very interested in migrating to Australia and would like to take the Migration Skills Assessment for Midwives. I would like to request for learning resources in preparation for this.

    I got interested in migration thru relatives who are Australian citizens and residing in Sydney.

    The focus of my Midwifery studies in Unciano Colleges, Antipolo was Public Health Care. I have two years experience in home and clinical maternal and child care, mostly in the rural areas. Since I have studied Midwifery and Public Health Care in the Philippine setting, I find my knowledge of Midwifery in the Australian perspective very limited.

    I have been researching on how midwifery is practiced in your country and would like to request for more learning resources. Where can I get books, pdfs, or websites dedicated to Australian Midwifery?

    I am very happy and excited to learn more about your country and your medical practices.

    Thank you for your kindness.
    Fidelle Rosa D. Luciano, R.M.

    Cainta, Rizal, Philippines 1900

  24. hi,i’m puspita, i,m midwife …i’m from indonesia…..nice to meet u…n please share with me all about mother n baby…..thank u so much…..sorry my english in not good…..

  25. Evelyn says:

    This is a really great blog. Thx to the auther

  26. Lili says:


    My name is Lili. I am a miudwife about 3 years of experience from Iran. I will move to Australia in about 6 month time . Could someone please advise me if i can work as a midwife in Australia as i am not an Austuralian registered midwife .
    I undrestand that 5 years of experience is required for midwifes from other country in order to get registered in Austuralia.
    Could someone please advise me How and Where i should start .


  27. Melissa says:

    I have a question. I recently had my first child, (at home! Woot!). After my son came out my contractions completely stopped. Concerned, my midwife gave me an injection, (I can’t remember anymore what it was), to jump start contractions again. When my placenta was coming out it didn’t initially detach completely, and my uterus was pulled down with it. The long and short of it is that my uterus is now where it ought to be, and my midwife tells me that I’m fine physically to have more children. I’m wondering if you have any opinions on whether or not this prolapse could have been caused be the medication I as given to “jump start” my contractions again. I’ve researched and am unable to find ANYTHING on this subject. Thoughts?

  28. Melissa says:

    Rereading what I wrote I don’t know if I made it clear — my uterus almost came out, but through the skill of my midwives they were able to keep it in my body where it belongs…

    • Hi Melissa. It is impossible for me to say what caused your uterine prolapse. If the placenta is still attached pulling on the cord can pull the uterus down. However, many women experience a prolapse without any pulling. The injection is unlikely to be linked except that once it is given you are then supposed to pull on the cord to get the placenta out.

  29. Simone says:

    This blog is incredible-your work, your research, your voice is an asset to any pregnant woman or birthworker. Thank you so much for this! if it was a book-I’d buy it!

  30. Daniela de Oliveira Figueiredo says:

    Hello Katrina,
    I’m from Brazil, have been doing midwifery course with Michel Odin and Brazilian nurse Heloisa Lessa, and currently I am on my 3rd year of nursing school. I’ve been assessing the possibilities to study obstetrics because here the situation is really getting out of hand, as far as unnecessary caesarians. Also thinking about doing my masters in a year and a half somewhere else.
    I’d just like to let you know doula and midwives here in Rio have been recommending your site.

  31. di diddle says:

    hi rachel,

    great website & great info. i will definitely be adding you as a link to my www & look forward to reading more of your posts…..

  32. US/Mexico border in El Paso Texas. the link to the trailer is here if you and your contacts are interested!

  33. I’m sorry, the last post didn’t work!

    We have just finished working on a documentary about midwives living and working on the US/Mexico border. I included the trailer for you and your contacts to check out!

    Thank you for all your awesome work helping women and babies !

  34. Thanks for replying! The documentary is in the screening phase of production. We are looking for dedicated people to help us organize screenings all over the country and hopefully in Mexico as soon as the translations are done. Do you have any suggestions to who I can contact about setting up screenings? I’m trying to reach out to as many women as I can about this.

    It will be out on DVD Fall of 2012 we hope.

  35. Please keep on writing, Rachel. I have been checking this blog almost every second day for about 9 month now – which no blog ever made me do without constant input being posted.

    You are an amazing woman and I would love to read more from you.

    • Thank you… I will write more. I am having a very busy period with births, teaching, preparing for conferences/workshops, writing articles and a book chapter and finishing my phd. You can subscribe to save yourself checking – then you will get an email when I post πŸ™‚

  36. Hi Rachael, Are you still blogging? No pressure, just thirsty for more πŸ˜€ Also, do you have any support against routine active management of placental delivery? (looking for info for a birth prep client) Many thanks and please keep ’em coming.

  37. Hi Rachel what a joy it is to find your blog. Thank you for making such valuable information available in such a succinct way . It will become a treasured resource for our Dial a Doula students.
    I look forward to being a regular visitor.

  38. Raquel Oliva says:

    One of the best blogs I’ve ever read! Thank you for sharing!

  39. Pingback: Induction of Labour: balancing risks « Mommy Baby Spot

  40. Ella says:


    I just stumbled across your blog, thanks to “my ob said what.” I’m impressed by your commitment to evidence based medicine, your extensive citations, and your excellent writing. Especially your excellent writing. I’ve seen a lot of dry, formulaic, convoluted, and downright boring writing by PhDs/PhD candidates, even when they’re trying not to sound academic. Your blogs are a pleasure to read.

    One thing that I’ve been wondering about is plancental expulsion in a physiological birth. I’m in the US, and hear lots of stories of docs/midwives yanking on cords to pull out the placenta. Most people say that hurts. A quick google search only mentions ‘normal’ expulsion time and a decreased risk of hemorrhage if expulsion is helped along.

    What is your experience and knowledge of placental expulsion? Is this another place where docs see ‘normal’ and think ‘necessary’? Or is there actually a reason for them to yank it out? Any chance you could write up a post about it at some point?



    • Hi Ella – Thanks.
      When attending a physiological placental birth ie. no medication it is best to leave everything well alone. The woman will birth her own placenta when it is ready. The usual hospital approach is to give an oxytocic drug and then pull the placenta out. The theory being that pulling reduces the chance of haemorrhage (and you have already interfered by giving a drug). However, this recently hit the news: http://www.nytimes.com/2012/03/13/health/study-says-umbilical-cord-shouldnt-be-pulled-during-labor.html?_r=2&src=tp
      Even when an oxytocic has been given women can push their own placentas out… or even pull them out. A woman is not likely to rip an unseparated placenta out of her uterus. I might address this in a post in the future. I have a hectic month ahead then some space to write πŸ™‚

  41. Hi,
    I love your blog, and I’d love it if you would write about placenta delivery! I’m a transgender guy and I had a home birth, but there were still many unnecessary interventions that continue to bother me. My midwife convinced me to let her rupture my membranes (I regret this so very much!), she directed pushing (I tore, grrrr), and since the placenta was very slow coming out I was given oxytocin and the cord was pulled to get it out of me. I write my own blog about my breastfeeding journey as a transgender man – please check it out if you have time: http://www.milkjunkies.net Perhaps you could write a guest post some day for me!!

    • Thanks Trevor. I checked out your blog – very interesting. I will pop back when I have more time to read more. Yes I will most likely do a placental birth post sometime soonish… just need to get through these busy months and find some space πŸ™‚

    • Melissa says:

      This same thing happened to me! Horrible! In the end I had a prolapsed uterus that had to be held in place manually until my body would accept it again. My midwife then wrote in my records that my placenta came out spontaneously! What in the world! Still a little emotional about it all even though it’s been over a year now.

  42. Dear Mid Wife Thinking,
    Your blog is wonderful!
    I wanted to introduce my work to you, I am an underwater portrait photographer who specializes in mommy’s to be.
    I would love to submit my photographs for consideration to your blog!
    Thank you so much for your time,
    Sincerely yours,
    Erena Shimoda

  43. Thank you for your informative posts. Have you written anything about hte evidence surrounding increased risks in pregancies of mothers over 40? Are the risks statisically real? Pre-eclampsia, hypertension, IUGR and still birth. Even in my unit there is conflict between obstetricians. Thought you may be able to make it all clear! Thank you

    • I have some future posts lined up. Statistically there are increased risks for mothers over 40. However stats are only general. They don’t fit an individual woman. An individual 45 year old may be healthier and have less risk than a 20 year old. Personally I ignore age and look at the whole woman/picture.

  44. Olicha says:

    What a great blog!
    So informative and inspiring!
    I am currently living on Gold Coast, preparing for a home birth after cesarean (not even pregnant yet hehe). I hope you don’t mind if I translate and share your articles on one of russsian parenting blogs. The information you give needs to be heard!

  45. Linda Stegeman says:

    Hi Rachael,
    I attended one of your weekends at Daylesford recently which I really enjoyed. I read your info about placental birth and would like to make a couple of comments. Having come from a practice where I had many physiological births I have found that it is very difficult to support this in Australia within the hospital system. A long list of issues seem to preclude the safe support of this starting from a lack of time within antenatal visits to discuss pretty much anything (if you want to spend time “with” the woman just asking her how she is), multiple care-givers while birthing, constant interruptions by everyone on the floor, the huge amount of medicalisation or should i say the paucity of physiological birth. I keep thinking about “the first do no harm” theory and grieve fairly strongly at times. I know you know all this but I am worried at how many people caring for women consider the culture normal and safe. I strive at each working day to make a difference and it is exhausting. I have just read the latest Essentially MIDIRS and Lorna Davies suggests in her time wise survival guide to “not take work too seriously”……seriously!! Most of us wouldn’t be here if we didn’t take women and birth seriously. Just wanted to say. Also – I have a BMid and was wondering what you would consider I would need to look at joining a faculty for teaching mid. I gather that many tutors here also provide care as private midwives.
    Linda Stegeman

    • Hi Linda
      The maternity system is broken and far from woman-centred which is what we as midwives are hopefully striving to be. I can’t offer a survival guide because I could not survive long term in the system and I think the ‘cycle of grief’ adequately illustrates what I and probably many others experience. I also find it impossible to not take work too seriously.
      If you want to teach midwifery then there are a few things you can do… send your resume to universities and offer sessional tutoring; continue your own studies (Masters, PhD); Study ‘adult education’ ie. course/cert/diploma.
      Good luck and don’t ever become complacent about women and birth πŸ™‚

  46. sara says:

    Hi Rachel,
    What a great Blog. Well done. I am a Midwife and an Osteopath in the UK (www.perfectbalanceclinic.com), I work privately as an osteopath and NHS for midwifery but there are not many of us. Do you have any osteopaths that are midwives also in Australia? Do you have any experience with Osteopaths and their techniques that have a more structural approach in labour instead of just utilising the subtle cranial techniques commonly seen?

    • Hi Sara
      I don’t know of any osteopath midwives in Australia. I also don’t have much experience with osteopaths. I have cared for a few women who see an osteopath. Do you bring your osteopath knowledge/skills into your midwifery practice? I’d be interested to know more about how osteopathy can enhance midwifery practice πŸ™‚

      • ivana arena says:

        hi I’m an italian midwife I’ve quickly red some of your posts and I agree on everything. I became a midwife after a CS and had a VBAC after graduating as a midwife in year 2000. now, after 8 years in hospital, I finally do what I became a midwife for, only home births! thanks for your posts i’d like to keep in touch

  47. irene says:

    Hello Rachel, I am a student midwife and came across your web page here, which I must say I am liking alot. I have a question regarding your site here, how often do you post/update/access your site?
    Thank you, Irene

    • Hi Irene
      This year I have been lecturing full time, travelling with workshops/presentations. attending births and writing my phd thesis… so my postings have taken a back seat. I update posts with new links/research about once per month and access the site regularly to respond to comments. I will be posting a new post within the next 2 weeks – so watch this space… or better still subscribe so you get to know about new posts as I put them up.

  48. Shanti says:

    I just want to thank you, whoever you are, for your intelligent communication and for making this information accessible to all – it must take a considerable amount of your time, and I am grateful to have it.

    Your articles are fascinating, stimulating and inspiring and written with clarity and honesty. You make no secret of your own private beliefs, yet you do not allow them to cloud the issue you are discussing nor prevent you from delivering factual information transparently.

    This lack of highly emotional bias makes for very interesting reading that one can feel more confident in, as you quite fairly bring both sides if an opinion to the readers attention. In doing so, the reader gains a greater understanding of the processes you describe, and give the issue deeper and more critical thought.

    This is of particular assistance to the layman, birther

  49. Shanti says:

    I accidentally pressed submit before I’d finished!

    I just wanted to say, after all I’d said earlier, “thanks” for supporting & encouraging women who have the faith in themselves and their babies and bodies; who prepare and inform themselves well when choosing their birth path; who are willing to take responsibility for their pregnancies, births, babies and choices; and who wish to see other women as empowered and able to stand up to the systems that have eroded our rights and silenced our voices.

    It’s time to take it all back, one healthy, happy, blissful, free or midwife attended home birth at a time…

    Thank you for reigniting my desire to empower and support more women to do this.

    I am an exoerienced birther – one C-section @ 35 weeks, first hospital VBAC at 37wks, natural & drug free, 2nd hospital VBAC (couldnt find a home birth midwife) at 41.4 weeks, natural & drug free, one midwife assisted home birth at 36 weeks, on planned free birth at 40 weeks.

    I started training as a birth educator following my first VBAC, wishing to help others to birth naturally amd safely afrer caesareans, but the Org I trained with deconstructed due to lack of funding.

    I started training as a breastfeeding counsellor, with ABA (then Nursing Mothers), but gave it up when family structure changed and I again became a sole parent.

    After deciding I didn’t wish to train as a midwife because the system and I would clash too constantly, I decided to train as a doula, so that I might help others to be confident in their ability to birth.

    After my final “free birth”, this desire to educate women as to the benefits of birthing alone made me rethink that position, but I came back to the idea that a doula can be instrumental in a free birth!

    However, I also considered that HAD I trained as a midwife, the experience and knowledge gleened from working within the system could have been very useful in educating women towards considering home birthing, and I could have used that in practice as an independent. Too much thinking, not enough doing, and suddenly it felt like it was too late!

    So back to Doula training!! BUT…

    My confidence to work as a doula took a beating following the highly intervened birth experience of my daughter’s first birthing in a Sydney hospital.

    She birthed identical twins, hitherto identified as fraternal, at 33 weeks, with every intervention and constant, and I mean constant, harassment – over 24 hours of labour, she was not permitted to sleep until I became less doula and more hysterical mother – and in the end a horrific Caesar with the epidural almost completely worn off, ensued.

    I felt I’d let her down, and failed to navigate her safely through the system. I think I had given up a bit.

    Reading your latest post led me back to re-reading previous posts in your blog, and while I now feel it may be too late to train in midwifery (I’m 43) I might still serve as a voice and support to women (especially young and single women) if I am a qualified doula.

    Thank you for the inspiration and motivation. You are doing such a marvelous job – women have been conditioned for so long to believe they do not have the right to take responsibility for their bodies and their babies, yet it is not only our right but our DUTY as parents to do so.

    Education is the best means for re-empowering women, and you are really fulfilling this need in many ways.

    You deserve formal, narional recognition for this most valuable and selfless work, and I hope one day you will receive it. In the meantime, I give you my thanks!

  50. Annie Frogley says:

    Love your work. Always fabulously thought provoking. Thank you πŸ™‚

  51. Emily says:

    Thankyou so much for your blog, it’s so inspiring! I am about to embark on my third year of nursing with goals to do midwifery when i am finished. I am so passionate about home birthing and i know in my rural area there is a huge demand, but unfortunately there are not many around and i am finding it had to get in contact with someone local to ask my many questions. I don’t really want to train in a clinical setting and have thought about doing midwifery through correspondance, but is it better to learn in a clinical setting first? Is there any course is Australia that teaches natural births? I have so many questions!

    • There are lots of pathways into midwifery. If you want to be a registered midwife then you need to complete an accredited program. This will involve placements in clinical areas. Generally in university you will learn about physiological births but you are unlikely to see any in a hospital setting. This is the struggle that student midwives have – access to experience of genuine midwifery and physiological birth.
      Personally I find my clinical experience (years in the system) helpful in understanding how the system works and assisting women to navigate through if they end up there. It was not helpful to my understanding of physiological birth or midwifery – except ‘how not to’. I had to relearn lots when I left the system for homebirth. Having said that I am currently working with a newish graduate midwife doing homebirth. She feels more confident having spent some time in ‘the system’ and is a wonderful homebirth midwife. Good luck with your future πŸ™‚

  52. Laura says:

    Hi I have just found your blog as it was passed onto me by my doula here in the UK. I am currently in the process of starting visa applications etc for a move to Brisbane and am delighted to have found you! Your blog is amazing and so informative. A breath of fresh air.
    I have one son at the moment born at home in a water pool through hypnobirthing. I am planning to have more and wondered if you have the time to explain a little about Australian maternity system as well as whether you could either yourself or recommend a doula/midwife for future births. I would greatly appreciate any information and support.

    Thank you.

    • Hi Laura
      The maternity system here is in a state of great change. I am reluctant to outline the complicated goings on as they may be very different when you are here and looking at your options. Perhaps once you get here connect with local mothers/birth groups and find out what is available in your local area. At them moment there are midwives and doulas working in Brisbane and I could recommend some. However, as I have said – things change a lot and the future is unknown. I may not be practising myself in a couple of years due to the changes. πŸ™‚

  53. Quest says:

    I wanted to ask you a question but didnt see no where to email but ill just write here lol So i have a question about cerival swelling. My son was op and my water was broken early because I was laboring fast enough then came pitocin epi and swelling anyhoot i ended up with a c-section. I did have the urge to push at 5 cm but i fought it made it to 8 cm and felt like i was in transition but i started to swell and kept fighting the urge to push because the nurse on the last shift told me not to.
    Is there a way to tell what can cause cervical swelling?
    And for my personal notes what are techniques that can be used during labor to help reduce swelling?

    Im such a parnoid that my baby will be OP again or ill have cervical swelling… I know its slim that it can happen again but i want to be prepared. Im already making the decision to go through a hospital cnm b/c dh isnt comfortable with homebirth but thats for the near future he could change his mind.

    Thanks for reading…

  54. Leslie says:

    A wonderful blog…..and an amazing resource that is not funded by large corporation. namaste

  55. Isis says:

    I love your blog. I am a Spanish midwife and I would love to dedicate to home births but it is difficult because very few women (though growing) are willing to give birth at home. Typically the society call you “crazy” or tells you that you are risking their lives.
    Congratulations on your work.
    Sorry if my English is not good πŸ™‚

    • Your English is much better than my Spanish πŸ™‚
      Women are considered ‘crazy’ in Australia too. Whenever women are empowered enough to think their bodies can work without medical intervention they are considered crazy. Society is crazy in my opinion!

  56. Laima says:


    I’m a student Doula from Lithuania and I have one request i’d like to ask you personally.
    Can i contact you in any way?

  57. Liz Fletcher says:

    Modern midwifery is a very demanding job, which is why it requires the skills and knowledge of a university graduate. The BMid midwifery degree lasts three years and gives you everything you need to begin your career as a midwife. If you are interested in studying a BMid Midwifery University Degree then look no further than The University of Southampton, Hampshire where students will acquire work experience across a range of settings, including hospitals, birth centres and the wider community.

  58. Myrna says:

    Thank you for your blog, I started this pregnancy hunting for an Independent midwife, found that they had all been ousted ( obs all very anti HB here), got kicked out of midwife program for having GDM and am now in “shared care” but don’t see any midwives. This is my fourth child, and my fascination with birth process started with NO.1. I’m also lucky to have had very uneventful straight forward births. This one I’m stressing about being able to advocate for myself with the “scary GDM” ( Induction has already been proposed prior to growth scan- but one look at my face and the doc backed down to lets see how the growth scan goes), as well as the trip to hospital ( half an hour drive on dangerous roads- normally) with a prior labour only taking half an hour from start to finish. think classic Hollywood drive and entrance to hospital. Your blog is giving me the confidence that things will be ok, no matter what, and my instincts will help pick up if something goes wrong on the way.
    Still disgusted with the reduction in birth options for mothers, but not sure how to promote my disgust to government legislators.

  59. Jeanne Lane says:

    Just wanted to say thank you for sharing your research and opinions. I’m a student midwife, pursuing my CPM in Texas, USA. Your posts are always thought provoking!

  60. Jaclyn says:

    Hi Rachel,

    I was wondering if you had any research or an opinion about vitamin k after birth?! Would love to hear your thoughts! πŸ™‚

    P.s. love love love your blog! My new bible!

  61. Valerie says:

    I am just loving your blog! I have had two medicated, unnatural vaginal births πŸ˜‰ and then, more recently, an all natural unmedicated birth (also at the hospital because of low platelets) and I am now completely interested in all things birth!
    I appreciate all your articles and I am learning so much.

    I would like to know if I can quote you (and give a link to your blog, of course) for an article I am writing about birth in the caul. You said, “During a contraction the pressure is equalised throughout the fluid rather than directly squeezing the baby, placenta and umbilical cord. This protects the baby and his/her oxygen supply from the effects of the powerful uterine contractions. When the membranes have ruptured the placenta and baby get compressed during a contraction. Most babies can cope well with this, but the experience of birth for the baby is probably not as pleasant. When the placenta is compressed blood circulation is interrupted reducing the oxygen supply to baby. In addition, the umbilical cord may be in a position where it gets squashed between baby and uterus with contractions. When this happens the baby’s heart rate will dip during a contraction in response to the reduced blood flow. A healthy baby can cope with this intermittent reduction in oxygen supply for hours (it’s a bit like holding your breath for 30 seconds every few minutes). However, this is probably not so great for an extended period of time, or if the baby is already compromised through prematurity or a poorly functioning placenta.

    Eventually the force of the contraction and the movement of the baby will rupture the sac as the baby’s body is born. You don’t need to worry about the sac holding the baby back. A baby and uterus are stronger than the membranes.”

    I just don’t think it could be said any better, and the information would be a great addition to my article. Would that be alright with you? πŸ™‚

  62. Hi Rachel,
    I’ve been reading your blog for a little while now, and really loving it. I appreciate the way you provide the physiology, the pathophysiology and then both a medical and midwifery approach. As a nurse-midwife in training, you address some of the very topics I’m interested in, and I always enjoy reading your posts!

  63. michelle Salem says:

    hi Rachel. I am a midwife, I work with Kerry Ruston. (I have left this message on your facebook account too ) I follow your blog, and I am involved in the international promotion of delayed (or optimal ) cord clamping.
    In England at the moment, some DCC friends are trying to put together a petition to stop cord blood banking, which is in the process of being pushed forward.
    don’t know if you are already involved, but I was just chatting to Kerry about it, and maybe your promotion of the petition via your blog? when finished would be of some use. and your British routes, and your connections with across the pond, can only help spread the word
    If you are interested I can have you added to a discussion that is going on at the moment in the face book world

    Michellle x

  64. Jessica alexander says:

    I love this blog of yours! So informative and easy to comprehend. If I have a question for you, how would I contact you?
    Thank you for your time!

  65. I can’t believe this is you. I’ve read this blog so many times. I just knew you’d make a difference there without the need to lock doctors out of the room.
    I moved to Harrogate in 2006 and have two children now, Frankie (5) & Ru (3). Out of sheer madness, in january 2013 I started a masters in clinical research methods, wrote a book and set up my private antenatal education business. Hope you’re well, keep on touch

    (RVI 2003-2006) xxx

  66. Rebecca says:

    Hi Rachel,

    You really have a brilliant blog, it has certainly opened my eyes I can tell you!

    I have been looking for someone to tell me from a Midwife’s perspective if our social media network for families, 23snaps would be a beneficial asset to documenting a child’s birth and growth?

    We really want new parents to be able to share their experiences in a secure and private way with the rest of their families. Please tell me what you think.

    Here is a link to our page:

    Thank you,


  67. Pingback: Guest Post on Balancing the Risks of Induction of Labour - Gillian Sims | Tauranga Midwife

  68. Michaela K. says:

    Hi Rachel,

    I loove your articles and often use it as a source of information. I am desperately looking for some articles or studies talking about placenta aging. I heard it is a myth but cannot find anything up to date to talk about it in detail. It is very often used to scare women into an induction. Tx. M.

  69. Maria Paxton says:

    Dear Rachel,

    I’m writing to you from London College of Osteopathy, one of the few schools to offer an Online Master’s Certificate in Osteopathy to wellness professionals. A growing number of practitioners worldwide are seeking training in this holistic medicine as it shares similarities with many complementary therapies.

    Osteopathy determine health by one’s physical balance and emotional well being
    Postural alignment, joint mobility, and diaphragmatic flexibility are essential components of good health
    The human body, given the right support, has an inherent capacity to heal itself

    The Master’s Certificate Program builds a solid body of knowledge in the osteopathic approach allowing health practitioners to enhance their scope of practice.

    We are very interested in your site and the possibility of presenting our program(s) to your readership.

    Please contact Gabriel at marketing@lcocanada.com to discuss a future collaboration.

    Maria Paxton

  70. germaine says:

    Dear Rachel

    Thank you for your sharing your passion and work here. I am preparing myself for what is routinely a very medicalised birth in Singapore. There are no midwifery led units here and home birth is practically unheard of (“Are you nuts?” and “what’s wrong with you?” or the worst, “how can you be so irresponsible?”). My previous two deliveries in the UK were natural, with no intervention, no drugs and both mid-wife led. My husband remembers the senior mid-wife exchanging glances with the junior mid-wife and both of them nodding before dropping their paperwork, just when i was ready to push. They just knew from the change in my voice (apparently, i began braying like a donkey) and my body that the baby was imminent.

    Anyway, I am now in Singapore and the system, sadly is not yet ready for mid-wife led births. In fact, a natural birth is considered “alternative”. Whilst I am confident in my body’s ability to progress in labour and deliver the baby (and the placenta), i find i battle my own Obstetrician in justifying my choices – which she challenges. E.g why i do not want to be induced, or why I don’t want syntocin and duratocin (for the afterbirth) and why i am insisting not to be hooked up to a CTG, or why i insist on skin-to-skin. I find your blog a good resource to explain that I understand my choices and I want to have the choice and not be frightened into having an injection.

    I don’t know how many more women there are like me here but I really wish there was a mid-wife here who would deliver my baby at home!!

    Kind regards,

    • It is so difficult when you are limited by the options available to you. Will you be able to take a doula or friend into hospital with you to advocate for you whilst you are in labour? This is your third baby and you will likely labour well regardless of where you are – you are the birthing expert here. It will be a case of finding strategies to be left to do your thing. Let us know how it goes.

  71. Danielle says:

    Shalom from the US!
    We are seeing an increase of mothers- some of them multigravda w no prior history of nursing problems- having trouble w milk quality. Their babies are not gaining weight!!! These are loving mothers who have resources to be and eat healthy and have nurtured and cared for multiple beautiful children. We suspect gut issues arising out of problems w stress (environmental, some have had big life changes but not all, etc) and in particular GMO grains. Many of them eat healthy (GF, organic veggies, etc) although not all of them. All of them to date that we know of have made sure they are drinking plenty of water, red raspberry and other good teas, plenty of coc oil, calories, etc. They have healthy relationships w their spouses.

    What do you know about this? What is the role of choline (possibly depleted during times of stress) and gut issues in nutrition absorption ? Is there a connection between GMO grains– even possibly altered organic GF and gluten grains and nutrient absorption by mother…. Then obviously effecting quality of milk (not quantity) and baby’s nutrition?

    Love your posts!! Hoping you might have additional thoughts on this!

    • Hi Danielle – not sure… Even very poorly nourished women produce breastmilk. I’d be questioning what the ‘nursing problems’ are and how the quality of the milk is being assessed. Are the babies being fed on demand and growing?

    • Ahlam Najjar says:

      Shalom! If its not a inconvenience would you be willing to participate in this survey.

      I, Ahlam Najjar am currently a Year 12 studying Community and Family Studies (CAFS) . As apart of the course I am required to do a major task, an Independent Research Project (IRP) which involves me gathering primary and secondary data in relation to my focus question the method I have chosen to use to gather data is a questionnaire and an interview.

      The focus question in which my IRP is centred around is:
      Pregnancy and Wellbeing which falls under the syllabus point as Parenting and Caring and Resource Management .The question that I have decided to do is β€œHow significant is the role of the midwife during child birth?”.The reason why I have chosen this topic is because I have always wondered how important the role of the midwife is during. What I hope to find from this research project is how does the role of the midwife contribute during childbirth to the wellbeing of the mother, baby and the families.

      Pregnancy is an important time for most people and so this makes it an available topic that I feel will be accessible to interview people about and of interest to many other people who have undergone this process, involved with this process on a daily basis working in that field or have no knowledge at all but are willing to partake and provide a personal opinion on this focus question in my interview or questionnaire.

      You are reading this letter as I wish to seek your approval to voluntarily partake in my primary data collection. All data collected will remain confidential if results of this study are published or presented, individual names and other personally identifiable information will not be used. All results found will only be used for the Independent Research Project. If you agree to participate in my research, I will conduct a questionnaire with you at a time and location of your choice. It should take no longer then (5-10min) along with your personal and honest view on the questions relating to my focus question. Your time and cooperation is greatly appreciated by myself as it will help assist with the primary data collection.


  72. Ahlam Najjar says:

    Hello Rachel, I was wondering if you are willing to particpate in my Questionnaire?

    Dear Participant,

    I, Ahlam Najjar am currently a Year 12 student at Mount Carmel Catholic High School studying Community and Family Studies (CAFS) . As apart of the course I am required to do a major task, an Independent Research Project (IRP) which involves me gathering primary and secondary data in relation to my focus question the method I have chosen to use to gather data is a questionnaire and an interview.

    The focus question in which my IRP is centred around is:
    Pregnancy and Wellbeing which falls under the syllabus point as Parenting and Caring and Resource Management .The question that I have decided to do is β€œHow significant is the role of the midwife during child birth?”.The reason why I have chosen this topic is because I have always wondered how important the role of the midwife is during. What I hope to find from this research project is how does the role of the midwife contribute during childbirth to the wellbeing of the mother, baby and the families.

    Pregnancy is an important time for most people and so this makes it an available topic that I feel will be accessible to interview people about and of interest to many other people who have undergone this process, involved with this process on a daily basis working in that field or have no knowledge at all but are willing to partake and provide a personal opinion on this focus question in my interview or questionnaire.

    You are reading this letter as I wish to seek your approval to voluntarily partake in my primary data collection. All data collected will remain confidential if results of this study are published or presented, individual names and other personally identifiable information will not be used. All results found will only be used for the Independent Research Project. If you agree to participate in my research, I will conduct a questionnaire with you at a time and location of your choice. It should take no longer then (5-10min) along with your personal and honest view on the questions relating to my focus question. Your time and cooperation is greatly appreciated by myself as it will help assist with the primary data collection.


  73. Hi Rachel! I really love your blog and refer to it ALL the time. I am an Australian currently living in Bosnia-Herzegovina where maternity care is incredibly poor quality. Home birth or birth centres do not exist and in hospitals it seems like they are using an actively managed approach to labour and birth including routine shave and enema, frequent augmentation and artificial rupture of membranes, restriction of movement through drips and continuous fetal monitoring and restrictions to eat or drink. When it comes time for pushing, women are taken to a special delivery room where they must lie flat on their back attached to a CTG and are instructed to push. If they don’t push the baby out in two pushes, there is a lot of panic and the doctor or nurse applies strong fundal pressure to increase the force of maternal effort. Routine episiotomy for almost all mothers is then carried out. Doctors seem to believe that these interventions are really what is best for mums and babies. Women in general accept that this is normal and don’t seem to question it, though a small natural birth movement is only starting to emerge. I am trying to help this movement by setting up a website in the local language. Right now, I am trying to write an article about why they seem to be so concerned about having a short labor and delivery (especially short 2nd stage) and am looking for evidence that a long labour and a slow birthing of the baby does not necessarily put the baby at risk. Can you refer me to any literature about this? Many thanks! Melissa, a wanabee birth activist and future midwife (maybe) xxoo

    • You already are a birth activist!
      The risks associated with the ‘2nd stage’ of labour are for directed pushing. When directed pushing is taken out of the equation there is no evidence regarding ‘safe’ timeframes. I worked in a hospital in the UK with a policy of ‘no prescribed limits if wellbeing and progress were happening’. As midwives we informed the OBs if we got to the 2 hour mark with primips but then they stayed away unless we really did need them. Most babies were out within 2 hours but occasionally 4 hours. Of course this is spontaneous pushing – not directed. As for research – you will find supporting research re. length of 2nd stage in the literature review in my thesis which you can download from the link in the post. Good luck πŸ™‚

  74. Joy Jones says:

    Hi Rachel,
    Do you have any articles about blood tests for the newborn?
    What is a normal BG for newborns?
    Which birthing interventions affect the BG of newborns?
    (I have heard that IVs given to mothers during labor can make the newborn BG appear to be too low)
    How can mothers avoid unnecessary interventions regarding the BG of newborns?
    (ie unnecessary treatments if a certain range of “low BG” is normal)
    How frequently do mothers need to nurse in order to keep the newborn BG at normal levels?
    Joy Jones (US)

    • There is intense debate about what is a ‘normal’ BG for a newborn. Hospital guidelines usually state less that 2.6 = hypoglycaemic but many LCs would argue that lower BG levels are normal. This is not my area of expertise…
      Fetal distress significantly effects BG and most babies who require resuscitation will have low BG due to burning all of their glycogen stores. I haven’t heard of IVs effecting newborn BG. If the baby is not symptomatic at birth and there are no ‘risk factors’ then a BG should not be taken. Generally an ‘at risk’ baby or a baby with known low BG should be encouraged to drink colostrum regularly – permanent skin-to-skin to encourage this, syringe/finger feeding if baby is not interested. Every hour initially and then every 3 hours. Colostrum is very nutrient dense and a few drops can make a significant change to BG levels.

  75. Liisi says:

    Hi Rachel,
    Greetings from Finland. Thank you for your excellent articles, which make me more confident when expecting my second child.

    In Finland, we deliver in hospitals, but the doctor gets involved only in the case of real problems. Otherwise it’s mom, support person and the midwife. My life was saved because of that practice. With my first child, I experienced heavy bleeding from the placenta and to save my life even in the hospital required very quick actions.

    We don’t need to be educated about healthy and natural practices. They are part of the normal hospital protocols. For example, we must refuse if we don’t wan’t to put the baby to the skin contact, start breast feeding directly after giving birth etc. One of the most baby friendly units is our biggest one, where 8000 babies are born each year. I would never option for home birth instead of going there. When you deliver your first baby, you may even get an own room where dad is taking care of the new family after the delivery. Midwifes help you with breast feeding and you can quickly go home if everything goes well. We have one of the world lowest mortality rates of new borns and mothers.

    Here the baby delivery does not consist of 2 stages, but 3. The extra stage is “transition period”, which is before the active pushing phase. Transition period start when the cervix is fully open, but you don’t feel urge to push and ends when you feel urge to push. First time moms get training from midwifes about the delivery. The transition period was discussed very carefully, because it is supposed to be the most difficult period. We were told that it is natural to feel despair, just before you will feel urge to push. Dads are educated too, to accept the moms suffering related to this period.

    We don’t need to have all natural delivery. You can have pain relieving if you ask (beg) for it, but sometimes they refuse to give you any strong medication if the delivery is considered to be safer without it. Babys well being is monitored, but most of the time you are encouraged to find varying positions to ease the pain. Such practice makes many moms nervous, because you don’t necessarily get any pain relieving and you feel you are left “alone”. I also was very eager to find some excuse to get induced delivery. My first baby was 4,3 kg and the one I’m expecting could be even bigger. I’m nervous that it will get stuck. I’m told that it’s not good reason for induced delivery. Doctor says it’s better wait for the delivery to start naturally for 4,5 kg baby than to have few hundred grams smaller baby with induced delivery. Even cesarians are most often done only after mother has tried to deliver the baby, even in cases when they know that natural birth is most likely impossible. In that case it is believed to ease breast feeding, and it is supposed to be healthy for the baby.

    Our doctors and midwifes daily job is to explain to mothers how they should go for as natural delivery as possible. They will not give us induction, cesarian or any very intensive intervention unless you or your babys life is severely endangered. Here it’s so common to complain about that. After reading your blog. I’m not complaining anymore. I’m very proud of the system that we have here.


    P.S. Finland is the country where each expecting mother gets a free gift from the state:
    The gift is a big cardboard box full of baby clothes and accessories, and of course, reading about breast feeding benefits. It contains enough baby gear for having a nap outdoors in our icy cold winter.

    • Hi Liilsi
      Thanks so much for sharing this. It is really important that people realise that practice surrounding birth is cultural. Finland seems to be a lot more ‘woman-centred’ than Australia!

      • Liisi says:

        Hi Rachel,
        This may sound strange, but most often this system does not seem woman-centered to us. It looks more like we are forced to have as natural birth as possible, despite of consequences. We have life after the delivery. We are afraid of tearing and long lasting damages to the body. Moms are not medical professionals, so we can’t estimate how well we are taken care of. The only thing we see is that we just have to fight against the system to get any “help” (=medical interventions). Doctors and midwifes are the ones who are for natural birth, but most mothers are not.

        I haven’t delivered yet. I’m now at 40 weeks + some days, which makes me think as everyone else: how could I trick the system to get them to induce this birth? My friend, who is a doctor, really recommend me to do anything I can to get an
        induction. The first baby was 4,3 kg, with 37 cm head and this is about to be the same size. The only positive thing is that now the head was measured to be only 35cm at 40 weeks. However, it was ultrasound check which can have some error. I’m starting to freak out. I can’t decide who to believe. If I just follow the system, they’ll induce the birth at the end of 41 weeks of gestation. At that point, this baby could be more than 4,5 kg. I haven’t decided if I should try to get induction or not.

        So, what ever the system is, many women are unhappy anyway. With more natural practices, we complain about not getting the help we need.

        • I’m not sure which country you are from… in my experience and from the vast majority of comments on this blog women are finding it difficult NOT to end up with unnecessary intervention (help).
          You might find this post informative re. induction: https://midwifethinking.com/2010/09/16/induction-of-labour-balancing-risks/
          “We are afraid of tearing and long lasting damages to the body” – induction of labour increases your chance of tearing if you are a multip (have previously given birth). It is also the biggest risk factor for fetal hypoxia due to hyperstimulation… also more common if you have previously given birth (you have more oxytocin receptors on your uterus). Generally, when it comes to birth a physiological birth without intervention is the safest for mother and baby. Medical intervention is most effective when it is actually required due to pathology and complications. This is why midwives and doctors avoid unnecessary intervention – it causes more harm for women and babies.

          • Liisi says:

            Hi Rachel,
            Thank you for your reply. Sorry, I forgot to add my name to the reply. The previous post was from the same Liisi from Finland as the first post. We surely don’t have a problem of getting unnecessary medical interventions we didn’t ask for.

            I was trying to say that in Finnish hospitals most doctors and midwifes support as natural approach as possible. The only problem is that many mothers don’t understand the reasoning behind it. We have many beautiful practices, but moms can’t appreciate them since we tend to see them “not providing help” approach. My belly is huge and I get constantly questions why don’t they induce this birth. I’ve got so many comments, that even I started to freak out. Thank you so much for explaining everything so well. I feel so much better to give birth after reading all your posts. It really helps to balance all silly comments I get.

            Thank you for your support. Most likely this delivery will start naturally. If I’m stupid, luckily midwifes and doctors are not. They will not induce this, or any other labor because of no reason. Here you don’t get stupid interventions, even if you ask for them. Different culture, as you say.


          • Hi Liisi
            It is not a case of being ‘stupid’… it is not knowing and not being given the information by care providers. They should be explaining how birth works and why it is usually best to leave it alone. πŸ™‚

  76. May I share your article about the microbiome on my blog? I was going to write a similar article but when I came across yours, I saw you’d already done lots of the work for me! So… if you don’t mind, that would be great!


  77. Amy says:

    Love your blog. Thank you.

  78. Susan Constable says:

    I am interested in reading more about the background to this statement, if there is background… “β– If the baby is compromised at birth encourage the parents to talk to their baby and touch him whilst the placental circulation re-establishes the normal blood volume and oxygen for the baby. If the baby requires resuscitation do it with the cord intact.”

    • This post may provide some further background: https://midwifethinking.com/2010/08/26/the-placenta-essential-resuscitation-equipment/
      If a nuchal cord has been compressed resulting in hypovolemia then once the vessels are not longer compressed – after birth – the blood in the placenta will be able to move through the vessels into the baby and increase circulating blood volume, oxygen and stem cells. This will resuscitate the baby. Parents interacting with their baby will also stimulate the baby – further assisting. Of course if the baby is extremely compromised and not transitioning – active resuscitation is required.

  79. Roma shehzadi says:

    As a midwife i realized a great need to communicate the woman during labour according to her wish.Dont share any personal ideas and professional conflicts in front of woman.

  80. I was so happy to discover your blog! I had this weird feeling while reading the ‘Judging Birth’ blog and the ‘Feel the Fear and Birth Anyway’ blog that I knew what you were gonna say, like I could have written the same words… So I’m guessing that means we must think alike, and that made me feel really good! It’s nice to see my thoughts in print! I am a CNM in south Florida (transplanted from the mountains of Colorado) with extensive experience with hospital birth who now (gratefully) has a homebirth/hospital birth practice. I am looking forward to reading more and also to blogging on my own website http://www.midwife360.com. I would love to have a conversation with you someday! Thank-you for having the courage to speak out and to be such a wonderful testament to the naturalness of birth – we owe it to the babies!

  81. Sophie says:

    Hello Rachel
    Just wanted to say how fantastic I think your blog is and how it resonates how I hope my practice will be. I’m a student midwife in UK currently in 2nd year but already thinking about electives- I read somewhere you originally traveled to Austrailia for elective/ioanthe trust and I’m thinking of the same as Im interested in independent midwifery and the difference in practice globally.
    If you have any tips about planning elective abroad would be very grateful though appreciate you very busy!
    Look forward to future blog entries!
    Sophie x

    • Hi Sophie
      Tips = make contacts and a clear plan of what you will be doing, visiting, experiencing and why. Australia is in a bit of a turbulent situation re. independent midwifery and would make an interesting comparison to UK. Also, Australia is a big country and there a lots of differences in contexts of practice from city to rural and remote. Do some research and decide what you are interest in… and how long you will be here, as you could experience a few different contexts. πŸ™‚

  82. Christina says:

    Great blog, very informative!

    I was wondering if you’ve had the experience of helping women who, for medically necessary reasons, are induced at early term. My specific case is (likely) going to be ICP (intrahepatic cholestasis of pregnancy), where delivery at 37 weeks is considered to be the only surefire way to prevent stillbirth (together with Ursodeoxycholic acid as a medication). Are there ways to birth kinda sorta naturally and help prevent a C-section in such cases? One of the scarier things about ICP is that it seems to change extremely rapidly, and that incidences of stillbirth are reported in “mild cases” (i.e., low bile acid levels), with frequent fetal monitoring, etc. Moreover, everybody admits that it’s something that is not well understood, so the plan seems to be, “get the baby out by 37 weeks” as the safest course of action.

    I’m not looking for specific advice to supplant the advice of my midwives and doctors, but rather to get another perspective in terms of what it means to try to birth naturally in such a situation.

    Thanks again for such an informative blog. (Learned a lot about how labour could’ve gone differently for my OP, big-baby, meconium-stained amniotic fluid first-born son! Ah well. He was born by C-section, and while I would’ve liked a different delivery, I don’t believe in dwelling. Life is too short! We must simply learn and move on.)

    • Hi Christina
      This is a difficult one because ICP is one of those situations when early induction is indicated for all the reasons you mention.
      If you have laboured before (I’m guessing your previous c-section was during labour) then you are likely to respond well to the induction process. You may find that your body responds to just the prostin gel and you can avoid the syntocinon (pitocin) which is where the real risks kick in especially with a previous c-section scar. Perhaps spend some time encouraging your body to prepare for birth eg. some relaxing acupuncture or whatever works for you in relaxing your body and releasing oxytocin.
      During labour you can increase the chance of a vaginal birth by staying mobile… which you can do with continuous monitoring – you may even be able to use the shower or pool if the hospital has a waterproof/telemetry CTG. Perhaps have a discussion with your care provider/s and let them know you are keen to birth as ‘naturally’ as possible despite being induced. Ask them what they can offer you in terms of supporting this. Good luck – it would be great if you come back and let us know how it went πŸ™‚

      • Christina says:

        Thank you for your reply!

        Yes, my previous c-section was during labour, not planned (failure to progress with the meconium-clock ticking and a big baby in OP position). It’s reassuring that I’m likely to respond well to induction. I have an appointment with my care providers (now both midwives and their backup physicians) this week, so I’ll talk to them about trying to use just the prostin gel you mention.

        Thank you again, both for the reply and for the excellent information here. I’ll be certain to report back!

        • Not sure if you found this article https://midwifethinking.com/2011/07/17/induction-a-step-by-step-guide/ it explains the steps and prostin. Prostin is likely to be the first step in your induction anyway… unless they suggest a catheter balloon because of previous c-section. Anyhow – discuss things with your midwives and let them know your wishes about keeping birth as normal as possible. πŸ™‚

          • Christina says:

            Thanks! That was really informative. Yes, because of the previous c-section, I could only have the catheter balloon (ick.).

            I met with the consulting doctor today, and I was pleasantly surprised. I suppose it’s not fair, but when I first saw him (an old white dude), I was worried that I’d have to really press him on the fact that I want as natural a pregnancy as possible. On the contrary! First off, he was quite honest and told me that my chances of a successful VBAC with induction at 37 weeks is low — there are just too many things working against me, including the fact that too many doctors are too impatient and will be working to get the labour to happen faster, not better (he wouldn’t necessarily be the doctor on call). He also said that I’m right to be concerned about a failed induction leading to a c-section baby at 37 weeks. (I should add that for many women with ICP, induction does not carry an associated higher risk of failure and subsequent c-section, because an ICP uterus is already “irritated” and susceptible to labour anyway, hence the high spontaneous preterm labour rates associated with it. However, my case so far seems to be borderline, and if I do have it, likely mild, so it’s not clear how irritated my uterus really is.)

            That would have all been very depressing if he hadn’t said that he believes that the stillbirth risks have been over-emphasised, and that the risk level quoted by all the literature refers to an old and flawed study. Doing some research on my own, I came across a study that recommends a more conservative approach to what they classify as low-risk ICP cases (http://www.ncbi.nlm.nih.gov/pubmed/15368452). Based on this, the doctor doesn’t feel that the risks to an early-term induction outweigh the risks of stillbirth. So provided my bile acid results don’t come back off the charts, we’re taking the wait and see approach.

            Sorry for the long post. I thought that maybe as a birth nerd you might appreciate a non-standard, but scientifically founded take on the ICP/induction issue. (BTW, I’m a linguistics nerd, but my nerd-ism transfers readily, and so I kind of went crazy researching this… πŸ˜‰

            Thanks again for your blog. I was talking to my husband last night, and I told him that, reflecting on my previous labour, I was so “young” (at 30… heh) and just expected the midwives to do everything right. But this time all the “reasonable” interventions I had last time — rupturing of the membranes, membrane sweeps, worrying about the meconium-clock — are things that I’m prepared to have a voice about this time. So thank you. I feel much more empowered going into this labour, despite the added uncertainties.

          • Women with ICP do tend to labour quickly. RCOG have a good guideline about ICP which discusses the research and recommendations: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg43/ πŸ™‚

  83. Christina says:

    Thank you!

    • Christina says:

      Just a quick update, because you asked: I had a borderline case of ICP, so we decided to simply monitor it and let me go into spontaneous labour, which I did at 40w 5d. I had my VBAC (no meds!) and gave birth to an 8lb 13oz baby girl. πŸ™‚

      I want to thank you again for your blog. Thanks to the reading I did here, I decided my first midwife was a twit (for many reasons), but in particular for telling me not to scream, so I ignored her. I screamed through every contraction until it was time to push, when I found it unnecessary to scream anymore. I think that if I hadn’t read your blog, I would have felt like I was failing at handling the pain. Of course, since I found out afterwards that the L&D rooms at the hospital are not in fact sound proof, I may have been an unwitting advertisement for epidurals… πŸ˜‰

  84. Cassie Holdsworth says:

    Please sign me up to your blog posts I’ve tried before but don’t seem to get notified. Thanks.

  85. divine grace e. reyes says:

    I am a Filipino midwife, and in the future I’m going to live in USA coz my husband is a American citizen. I would like to ask, can I do my practice of being a midwife in the USA, since I have my own clinic also here in the Philippines for 3 years, I’m also thinking if I can build also my own birthing clinic in USA. Thank you and I,will wait for your response. Godbless.

  86. j says:

    Ive stumbled upon your wonderful blog tonight and have really enjoyed what ive found. Your approach to labour and risk/ benefit of induction is what stands out to me as being thoroughly sensible in a very risk averse culture. Just what I needed to read tonight as I sit and ponder whether waiting for my little girl to arrive is the right thing. I understand everyone has to make their own decisions but I just wish our medical teams (nhs in the UK) were more supportive of us parents who dont want every intervention under the sun. Thank you for recentering me and for reminding me of the different options we have the right to make as parents. Keep up the fab blog xx

  87. Karin says:

    Thank you for this incredible website! I’m so grateful for all the information and wisdom you share and I’m convinced that it helped me have the natural birth I wished for, after my previous emergency c-section. If it would be any help to you I would be happy to share my story. Thanks a million!

    • Thanks Karin – it would be great if you could share your birth story in the comments of the VBAC post… I am sure it will inspire other women planning birth after c-section πŸ™‚

  88. Jodi Garrod says:

    Hi Rachel
    I am a UK midwife and I have really found your blog useful and inspiring.
    I have just put a link to it on my own blog to recommend it to others who might be interested in reading it also.
    I hope you don’t mind! Thanks again for sharing your wisdom and experience.
    Jodi Garrod

  89. Jen Chilton says:

    Rachel, I just wanted to say what a fantastic interview you gave on meconium was absolutely fascinating and incredibly empowering. I just wanted to thank you. I am due to give birth in the next week or so and I would have been in a much poorer place had I not listened to your interview

  90. Lucy Series says:

    Hello! I am pregnant with my first baby. I am really excited but also a bit nervous and really curious. Your blog is amazing, it’s exactly what I was looking for. I’ve been reading around the hypnobirthing etc stuff, and whilst I’m up for a bit of deep breathing, relaxation and active birth, I felt it had these woman-blaming and woman-controlling overtones (when I told a hypnobirthing friend of mine I wanted to have my baby in a birthing centre, so I had access to gas and air, she said “why are you planning to be in pain?”!). But at the same time, I’m keen to avoid an overly medicalised birth. So your blog was just perfect – informative, balanced, well researched and down to earth. Thank you!

  91. Manon says:

    Hello! Thanks for you great blog: very insightful. I was wondering if the french versions are uptated like some of the english versions are (for example: anterior cervical lip). Thanks! From, QuΓ©bec, Canada

  92. Jackie Teasdale says:

    Hi😊My name is Jackie.I live in Cairns Qld.I am 35yrs old & have 6 awesome children & 1amazingly gorgeous grandson.My passion is to become a Midwife.I’ve looked into doing a Bachelor in Midwifery but unfortunately no University,Tafe or College in Cairns seems to offer midwifery courses😒A beautiful midwife who delivered 3 of my kids & has become a good friend of mine advised me that a Uni in another state offered midwifery degrees via online studies (then u go to the uni for exams) I contacted the uni but unfortunately that’s not possible.My friends sister lives on Thursday Island & she’s doing her midwifery degree online?I know u can do nursing then go into midwifery but I’d much rather do my direct entry.I don’t want to give up my dream,everyday I contact a hospital,uni,college anywhere to try to find a way to study my degree.I’m so frustrated though because I never thought that this problem would occur!Who would’ve known how hard it would be to study midwifery in Cairns when the Cairns Hospital is looking for qualified midwives?

  93. Rachel Lacey says:

    Oh! So so happy to find u! I’m an assie mum with thirteen live births some unassisted some midwife home and others hospital….urk…. Love love all ur writing of real birth and how our bodies and babies do as They are meant to…..I find the medical system v difficult.

  94. Ashleigh Eason says:

    Hi Rachel

    I want to get pregnant soon but afraid of amniotic fluid embolism. I know it is rare but can not help but think it will happen to me.I just read on en caul births, is it possible if I have no interventions and I do a water birth that I could have this kind of birth? I’m just thinking cause if water do not break then it won’t go into my blood stream there for no AFE.

    Or could I go for a c section at 30 something weeks and get the same outcome? I heard of somewhere purposely doing that for mothers because it’s “good luck” or something to be born en Caul.


    • AFE is extremely rate – 1 in 20646 births. They can also occur during a c-section. You have little control over when your membranes rupture during labour. A waterbirth will increase the chance of an en caul birth. I am not sure why you are focusing on this very rare risk. I suggest you get some support to work through your fears.

  95. Geetanjali says:

    HI Rachel,
    Your blog was really helpful.I am currently 33 weeks pregnant is it possible to meet you and discuss about my concerns.

  96. Ashleigh Eason says:

    Hi, I have tokophobia. Mainly I think because I have googled to much but I still can’t get the idea of dying in labor or delivery out of my head. My main fear is Amniotic fluid embolism. Everyone says it’s rare but I can’t help but feel it may happen to me. I do want to have a midwife when I become pregnant.

    My question is if i have a water birth and I don’t get my water broken and I deliver my baby en caul. Wouldn’t that lessen chance of AFE even more?

    I am also terrified because I was born severely premature myself and I worry I have a brain AVM and I won’t know until I’m pregnant and it bursts. Does anyone know if babies born in the late 80’s got head scans to check for brain malformations?


    • Hi Ashleigh
      I have already answered a similar question from you (see above). Your worries and concerns are not healthy and are out of proportion, I really think you need to seek some psychological/emotional support. I don’t think any amount of reassurance will assist you without first addressing the source of the issue.

  97. Virasha says:

    From miss anonymous
    Goodmorning/ Afternoon (not from Australia)
    Sorry to disturb you, how are you? Query, is it an issue if a nuchal cord got a tear before cutting and clamping after delivery of baby in cesarean section, is the midwife to be blamed when Dr tried pulling the very tight cord around the neck over the head after delivery.
    Baby, was vigorous, crying well, no RD and cord had minimum bleed.

    • One of the risks of pulling on a cord is that it can tear. In the case of a c-section, the cord will be clamped very quickly anyway… so as long as the cord was clamped before the torn cord bled to much it will not have made a difference to the baby’s outcome. Not sure why the midwife would be blamed for anything a doctor does during surgery. Surgery is the doctors responsibility.

  98. Amy says:

    Hey there Rachel,

    Im loving your points of view on midwifery, mine are very similar in ways. I was wondering what your thoughts are about when women are told their ‘pelvis is too small to birth their baby’, as I am under the impression that the womens body wouldn’t create a little human inside of them that wouldn’t fit through the pelvis? Am I being too sceptical or is this an actual common occurrence?

    Sorry if you’ve already written a post on this, haven’t been able to find it…

    • Physiological birth is complex. The baby’s skull moulds and adjusts to the shape of the ‘exit’, and the baby actively moves and rotates to help. The mother’s pelvis can increase by up to 30%+ as the posterior part ‘opens up’ – the sacrum moves out and up and the coccyx uncurls. The mother also instinctively moves to assist baby through. Of course many women and babies are medicated dulling their instinctive movements, and women are placed on their backs = reducing the potential size of the pelvis. Then we tell them their pelvis is too small ie. blame them. The WHO state that ‘obstructed labour’ = 3% of births worldwide… so yes, there are some rare occasions when babies do not fit – usually due to malnourished and/or un-developed mothers ie. very young. In the industrialised world, with industrialised birth it tends to be that babies and women fail to fit the institutional timeframes for birth rather than that they don’t fit each other.

  99. Joy Jones says:

    Also, during the prenatal care in many industrialized countries, during the pregnancy the main focus tends to be on preventing the mother from gaining too much weight, rather than on assisting her in eating enough of the kinds of foods that the pregnant body needs. The pelvis is not actually one solid bone, but rather 3 bones connected by ligaments. When mothers do eat enough of certain foods during pregnancy, the ligaments which join the 3 parts of the pelvis become much looser and stretchier, so that they will actually stretch during the pushing part of labor. This stretching process is increased as the mother moves around, and squats, or goes on hands & knees.

  100. Hi Rachel!
    We are a german couple blogging about parenting in Germany. Today we published an article about midwifery in Germany and how our healthcare system works when in comes to pregnancy, delivery, and childbed. Maybe you are interested: http://familylife.rocks/healthcare/2017/01/12/call-the-midwifes/

  101. Bea says:

    Dear Rachel, I’m an oboe player who play contemporary musics (multiphonics, loud sounds, etc.). I’m afraid those specifics vibrations (not harmonic at all) can affect my baby, I’m currently 14 weeks. It’s my job and I’m doing it everyday since years, it’s for me normal activity. I have many collegues who play in orchestra and the sound I produce is less or similar than this, I’m worry more about the nature of the sound than the decibels. Thank you in advance for your answer.

    • The sounds and vibrations will not effect your baby negatively. By the time your baby is born he/she will be used to the sounds and vibrations you create – it will be ‘normal’. You might find that after they are born, playing your oboe helps him/her to settle and sleep. When a baby is in the womb they adapt to what they are going to be born into via messages from their mother – hormones (emotions), nutrition, sounds, etc. Enjoy your music and your pregnancy!

  102. Hi there! Was wondering if you can give me any info on high blood pressure during pregnancy and or labor/delivery.

    • I can’t give you any specific information. Any info needs to be give in the context of the whole individual picture of the woman. For example, is it essential hypertension or a symptom of pre-eclampsia. Two very different scenarios.

  103. Hello Dr. Reed,
    I just wanted to thank you for such a wonderful, informative blog! I recently had an older friend who had a home water birth and I had several questions regarding this, but I was too shy to ask for fear of offending or upsetting her. As a current BSc student, and who is a long way from having children of my own, I was curious to know if the water washes bacteria off the baby and how that would affect the baby. After finding answers on your blog, I was thoroughly impressed by the amount of information that you have provided. I even learned what a caul birth is and that it was possible to rub vaginal bacteria on a baby born by C-section. I will definitely be following your posts πŸ™‚

  104. Rebecca says:

    Dear Rachel, I just wanted to say thank-you for writing your blog!

    I am halfway through my first pregnancy. I live in the Netherlands, where, yes they have a great care system based on continuous support, but the hospitals still have protocols with directives that are not always evidence-based. I suffer from PTSD in relation to previous medical treatments and as a consequence have developed extreme anxiety at the prospect of being transferred from a home birth to a hospital. Fortunately there is no indication at the moment that this is necessary, but I am preparing myself as best I can with the help of a psychologist.

    Every post that I have read on your blog (plus your thesis) has been informative so thank-you for sharing! It has helped me to write my birth plan and to ask for informed consent and evidence in decision-making. Thank-you and keep up the good work!

  105. Olaya says:

    Hi Rachel,
    i just discovered your blog and I found it very interesting. I particularly like that you base your opinions in data and research that it is not always presented to the mothers when they are asked to make a decision about their wellbeing and their babies wellbeing.
    Lately, I’ve been reading a lot about gestational diabetes and I,ve found a lot of research regarding how to treat it during the pregnancy but I couldn’t find much about evidence based intrapartum care (I only found hospital protocols that unfortunately are not based in objective research and they provide a routine care to all women, eg:”forcing” them into having inductions at 38-39weeks without individual evaluation).
    I would love to read a post about the intrapartum care for women with GDM and would be very interested in your opinion.
    Thanks for this blog

    • Thanks Olaya
      I might write a post on GDM in the future. At the moment I am in the middle of writing a book about induction which does include a section on induction for GDM. In summary. Induction before term is offered to women with GDM to reduce the chance of stillbirth. Abnormal blood sugars increase the rate of stillbirth, particularly at the end of pregnancy. However, if a woman diagnosed with GDM maintains normal blood sugars, her risk of stillbirth is the same as a woman who does not have a GDM diagnosis. Therefore, induction for an increased risk of stillbirth is only relevant if the woman has been unable to keep her blood sugars within a normal range.
      Induction for a suspected large baby is not the rationale for inducing GDM – this approach is not support by evidence. And anyway, if the blood sugars are in the normal range, the baby will not be bigger. My opinion = women need to be given this information and make their own decisions re. induction or not. No-one should be forcing them to do anything.

      • Olaya says:

        Thanks for your answer. I totally agree with your opinion. It makes me feel angry when I see doctors not giving the complete information to pregnant women for them to be able to make the best informed decision about their well being and their baby’s.
        I would like to know when your new book is ready as I find the subject very interesting.
        Thanks again for your answer, for your approach to midwifery and respect to women in their journey to become mothers and for the good articles posted in your blog.

  106. Oli says:

    Hello Rachel, do you know if there is any study about increased or decreased risk on rh negative woman and delayed cord clamping? As some say, and what makes sense to me aswell, is that dcc is better as the blood is not hold back in the placenta and then mix with the mothers blood. But I couldn’t find any studies…I would appreciate your information.

    • No I don’t know of any research studies in this area. The point in labour between the birth of the baby and the birth of the placenta is thought to increase the potential of fetal blood getting into the maternal circulation. And theoretically this would be more likely if there is a large quantity of blood trapped in the placenta due to premature cord clamping. So… based on an understanding of physiology, leaving the cord alone would reduce the chance of isoimmunisation. There is also debate about whether medications used to actively manage the birth of the placenta increase the risk. The theory is that the artificially strong contraction can squeeze the placental site and force fetal blood into the maternal circulation. Again, no research to support that idea yet.

  107. Danielle Sears says:

    Question! A friend suspected twins and a couple days ago (gestation 25weeks) had peaking of brown tinged amniotic fluid. A hospital visit confirmed the presence of twins, one they say stopped growing at 18 weeks, lots deformed. Baby B is gestationally on course and doing great. They are monozygotic twins and share a placenta. TTS is of course on the radar. Mama is boosting iron/blood support, immune system support, vit c for placenta , grain free diet with fermented cod liver oil and garlic, will start probiotics and gut healing diet once hospital round of antibiotics are through . Do you have any experience w something like this??? Would love to have her home birth still…would love to go to term…would love to hear anyone’s experience w losing one mono twin and carrying the other. She’s in the hospital to be monitored. Unless Baby B looks anemic or signs of infection the hospital is going to leave Baby B to continue to grow. Any thoughts would be welcome! We have sooo many questions!

    • Danielle Sears says:

      Looking back and seeing my fast typing and auto correction over sights! Leaking not leaking…deformities not deformed…

    • I don’t have any experience (as a midwife) with this scenario. The medical team caring for your friend should be able to provide information and answer questions – they will have access to all the information and test results etc. I wish your friend all the best.

  108. spturgon says:

    I just love your site and blog. I blog for a pregnancy and birth site (besteverbaby.com) and often come here to get clear and medically correct info from a midwifery perspective. I wish I were 20 years younger, lived in the UK, and could intern with you πŸ™‚ Thanks for the great info delivered so warmly and clearly.

  109. Eliane Labrosse says:

    Hi Rachel!
    I am reading your post on GD, and at some point you mention that a baby who’s has an incontrolled BGL will be more likely to be obese in adult life. Can you give me the studies supporting that?

    I am wondering if its only because a mom with GD is more likely to be obese, so the child too (genetic) or if it has something to do with the level of insuline and BGL in the baby who were abnormal and that would create difficulty regulating thoses parameters on the future child…

    Thank you so much for your blog, because of the so well done explanations I feel it makes me a better midwife, cuz i get to understand subjects better.


    • Hi Eliane
      The association between GD and obesity (for the child long term) has been found in a number of studies. Here is a recent one: https://www.nature.com/articles/ijo2017277
      As with most quantitative research – this tells us what but not necessarily why. Obesity is multifaceted – genetics, lifestyle, microbiome/gut heath, cortisol (stress), etc. all contribute. My guess is that a baby who has had to up-regulate their insulin during the important pre-birth phase of life (epigenetic programming) may alter their ability/parameters later. This will contribute to a compromised response to other factors as they emerge later in life. But that is theory πŸ˜‰

  110. leah jin says:

    Hi Rachel,

    I love your blog and would like to feature your posts on my curated blog aggregator site thebloggersdigest.com. I don’t know if I even technically need to ask for your permission to use link-backs and thumbnails to your posts but I would still like to!

    About the links:
    – Only the title, a possibly up to 150 character description (usually the first sentence or so from the post), author (which would link back to your blog home page) or blog name, and accompanying thumbnail image (if any) will be displayed. Most likely your original post title will be used unless this is objectionable to you. No other content aside from title, possible description, author or source, and thumbnail (if available) will be displayed on my site.

    – When the reader clicks the link it goes directly to the article on Midwife Thinking. I do not cache articles indefinitely or rebrand them under my site.

    – For each content category, I will credit the blogs that comprise that category. If there is a podcast associated with the blog I will display a headphones icon to link to the podcast.

    Also, once this project gets off the ground I would like to feature interviews with bloggers like you and create original content. If that is something that sounds interesting please let me know! And if you are ok with me using larger than thumbnail (150px or smaller) images for the links, let me know! This is helpful for laying out the main page to get a mix of different sized images to increase readability.


    • Hi Leah – yes that is fine. I am more than happy for my content to be shared if credit is given and a link to the original content included. Good luck with your project! πŸ™‚

      • Leah jin says:

        Thank you!! I will try to remember to send you a link when it goes live!

        One additional question: do you care if the image size is sometimes larger than thumbnail? I use a front page layout where the top stories in each category have a around 350px by 220px pic (usually first image in post or sometimes blog icon) and then 3 stories under that with 100px by 70px thumbnails. If you are ok, then your posts will sometimes be featured as the top post in the category.


        • that’s fine – just check re. copyright for images that are not mine ie. that the pics are attributed. Eg. I use a lot of Amanda Greavette’s art at include her name and link on the picture.

  111. Betty says:

    Hi Rachel , thank you very much for your blog! I don’t know if it is this the right place to ask you what do you think of using of Pethidine and Hydrocodeine in labour.I am experiencing a shocking number of midwife administer those two in a Birth Centre where I am worling now in UK as normal practice. I never used once in my 32 years of practice around the world, mostly as Independent midwife.The outcome sometimes is heart breaking. Any recent advice for evidence are welcome.

    • I know opiod medications are commonly used in hospital settings around the world. They are not particularly effective for pain relief. The baby also gets a dose via the placenta and these medications are associated with respiratory depression and problems establishing breastfeeding.

  112. Renata Pučnik says:

    Thank you for your blog. It’s lovely and super informative to read.
    When you feel up to it I would also love to read something about precipitate labour and it’s consequences on postpartum period, as I was hardly able to find any relevant information myself.

  113. Shoshana says:

    How do I subscribe to your blog?
    Please add me in. Fascinating and well written!!


  114. I am a Hypnobirthing Educator in Brisbane and ordered your book off Book Depository. Wondering if you would do a bulk of order? I would love to buy some as gifts for my clients.

    You cover everything in detail but in an easy to read format and just the right amount of statistics!

  115. Danielle says:

    Love your blog! It has been very helpful.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s