Below is a list of all my blog posts in alphabetical order (excluding ‘the’, ‘a’, etc). The posts are updated regularly with new research and resources:
An actively managed placental birth might be the best option for most women
The Anterior Cervical Lip: how to ruin a perfectly good birth
Amniotic Fluid Volume: too much, too little, or who knows?
Asynclitism: a well aligned baby or a tilted head?
Big babies: the risk of care provider fear
Birth from the Baby’s Perspective
Birthing the Placenta: women’s decisions and experiences
Childbirth Trauma: care provider actions and interactions
Cord Blood Collection: confessions of a vampire-midwife
The Curse of Meconium Stained Liquor
In Defence of the Amniotic Sac
Early Labour and Mixed Messages
The Effective Labour Contraction
Feel the Fear and Birth Anyway
The Future of Midwifery and Homebirth in Australia
Gestational Diabetes: beyond the label
Guest post: when birth is trauma
The Human Microbiome: considerations for pregnancy, birth and early mothering
Induction: a step by step guide
Information Giving and the Law
Listening to Baby During Labour
Midwifery Practice During Birth: rites of passage and rites of protection
No Woman’s Land: a student midwife’s call (guest post)
Nuchal Cords: the perfect scapegoat
The Perineal ‘Bundle’ and Midwifery
The Placenta: essential resuscitation equipment
Postdates Induction of Labour: balancing the risks
Pre-labour Rupture of Membranes: impatience and risk
Pushing: leave it to the experts
Research (Bias) and Maternity Care
Responsibilities in the Mother-Midwife Relationship
Shoulder Dystocia: the real story
Stages of Labour and Collusion
Supporting women’s instinctive behaviour during birth
Understanding and assessing labour progress
Vaginal Examinations: a symptom of a cervical-centric birth culture
I have enjoyed my first blog and look forward to reading more. X
Hello Dr Reed. Thank you for such an exhaustive website of info. My wife ( and I ) are considering a vba6c and in my researching came across your website. We have a midwife friend who is walking with us on this very uncertain road. My wife is 37 weeks. Do you have more info that I can read up on re vba6c? Kind regards, Gus
Hi Gus – There are so few women having a VBAC after multiple c-sections that there is no research. I think your best bet is searching Facebook for community VBAC groups. You will probably find women in them with experience and resources they can share. Good luck! 🙂
Hi Rachel
I am considering a vbac with twins. I read your vbac article and found it really interesting – especially the part about benefits of going into labour even if ultimately planning a c section. My biggest fear is cord prolapse of second baby. Can you please recommend research I could read about this ? And also about uterine rupture with twins, is the risk greater with multiples?
Birthing in new Zealand.
Twin VBACs are rare therefore there is no research in this area. Theoretically there possibly would be an increased risk of uterine rupture with twins because the uterus is more stretched out. In terms of cord prolapse – this is a concern for twin 2. I am not aware of any specific research – only clinician experiences and consensus that it is something to look out for. However, the chance of this happening will depend on many individual factors that you and your care provider can assess as the birth becomes closer and during labour eg. position of the babies. It would be great if you could come back and update us after your birth. 🙂
Thanks, Rachel. I guess I’m wary of discussing cord prolapse only with obstetricians as I’m assuming they’ll focus on this risk and not risks of c section as they tend to be more medicalised than midwives. Do you know why twin vbacs are so rare? Because of fear? I guess it’s catch 22 and the research can’t be collated if women aren’t doing it. But are women not doing it because of misinformed fear? Hmmm. Could you please be more specific about how cord prolapse could be preempted and therefore prevented? I’ve been told so far position of second twin is fairly meaningless until first twin has been delivered. Could you also elaborate a little on benefits of labour even if planning a section? Can the hormones help with milk coming on earlier? I had a five day wait with my last one and i had experienced a very long labour before it. …so hormones didn’t seem to help with that side of things. ..
Yes it is a catch 22. Women are probably not doing it because care providers recommend a c-section and may not have the skills (beliefs) required to support a physiological twin birth. They are rare events. I have only seen a handful myself. A cord prolapse cannot be pre-empted or prevented (if it is going to happen) but some factors make it more likely eg. ‘high’ unfixed fetal head, amount of amniotic fluid, how/when the membranes break… if there are more than one amniotic sac, the position the second twin gets into after twin one is out… and on and on. This is why you need to discuss these risks and management with your care providers. And position of 2nd twin is not ‘meaningless’ before birth of first… a head down twin who is not ‘locked’ has less chance of suddenly turning transverse of breech than an already transverse baby. To be honest cord prolapse is not a huge concern for twins… there are others such as placental abruption that are more common.
The benefits of labour are complex too. The baby initiates labour, there are a cocktail of hormones released during labour that facilitate not only birth but the early bonding and initiation of breastfeeding. Immediate and prolonged contact (skin to skin) with the baby/ies after birth also facilitate the release of these hormones (oxytocin and prolactin). Sarah Buckley has some great resources re. hormones if you want to search for her online.
Thanks so much for taking the time to respond. Much appreciated. Will check Sarah Buckley out. Will try to post back after birth but depends entirely on how much time I have. Which I’m assuming won’t be much 😉
Thank you for your work. Ive only seen 2 true shoulder dystocias in my 15 years ptactice. The movie link at the end of your article appears to be broken. Try this https://m.youtube.com/watch?sts=17170&v=CRUypStm2pE&oref=https%3A%2F%2Faccounts.google.com%2FAccountLoginInfo&has_verified=1&client=mv-google&layout=mobile
Thanks Joy – I’ve fixed it 🙂
Hello Dr Reed. Thank you for such an exhaustive website of info. I’ve found your articles translated in french. They’re still available ?.
I have closed the midwifethinking French blogsite because I was unable to keep the articles updated. I regularly update articles with new research and information to ensure they are current. It is a big job and I don’t have (or expect to have) a French translator to consistently work on the French versions. However, some of the article are available on other people’s French blogs (with permission). If you search for a post in French you may find a version. 🙂
I realize this is a personal question, but maybe you have come across it before and could post on the topic. I had my first baby at home; a magical and sacred experience. I had a leep in June 2017, and became pregnant with my second 2.5 weeks later. My ob has concerns with how my cervix will hold up, saying in the majority of her experience, the scar tissue seals the cervix shut and needs to be manually stretched. Can I still have an unmedicated birth? She said the cervix may also not hold up and could put me at high risk for miscarriage/and early birth. I’m a little lost trying to navegate all of this and wanting the holistic birth I had with my first.
I’m a bit confused by the information you have been given by your OB. I’ve never come across a cervix that has healed shut. How would you menstruate or get pregnant if this was the case? Also – how can the cervix be so tightly closed that it causes problems in labour and needs to ‘manually dilated’ but does not ‘hold up’ in pregnancy and causes miscarriage – it can’t do both.
The research into leep outcomes =
An increased rate of miscarriage if leep procedure was done less than 12 months before pregnancy http://www.sciencedirect.com/science/article/pii/S0015028214025436
An increased rate of pre-term birth: https://www.ncbi.nlm.nih.gov/pubmed/23635744
No difference in c-section rates: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3547644/
In my experience during labour, sometimes the scar alters the cervical dilatation progression… it can appear to stop dilating for a while as the scar tissue is pulled and ‘worked on’ by the contracting uterus. Once the scar tissue ‘gives’ dilatation is often very quick and the birth can take everyone by surprise. Another very good reason for not doing vaginal examinations – particularly in this situation. https://midwifethinking.com/2015/05/02/vaginal-examinations-a-symptom-of-a-cervix-centric-birth-culture/
I have never encountered problems in labour due to a previous leep procedure.
Perhaps you could get a second opinion about your birth? Is your OB the right person to support a holistic birth if this is their belief system?
Dear Dr.Rachel Reed, I’m Lucia, from Spain. I work as a homebirth midwife in Barcelona. First of all, thanks for your blog, it’s light in front of many shadows. Secondly, I’d like to know your opinion about this paper. Thank you.
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002425
Best regards
My opinion is that quantitative research = a very narrow view of a very complex issue. When it comes to induction we are arguing about extremely small numbers (less than 1%) of perinatal death i.e. one outcome. This research does not look at the experience of birth, or the impact of birth on short-term and long term health outcomes for mother and baby. It does not look at the woman’s sense of self and the transformational potential of the birth experience. It does not address the problems that syntocinon can cause for initial bonding and breastfeeding. For some women these things are more important than a less than 1% chance of perinatal death.
Life is full of risks. Every option we face has risks attached. We need to decide what risks we are willing to take.
I’m writing a book about induction at the moment – it should be published later next year 🙂
Dear Rachel
I am so pleased to have found your site and read many of your blogs today. I have found them really refreshing and thought provoking, especially as you have captured many of the thoughts and feelings I have about the medicalisation and technocratic approach to childbearing.
I am a registered nurse and health visitor who started a shortened midwifery course in February, and to be honest I’m struggling to understand the rationale for some of the practice I’m seeing and hearing about, and feel powerless to really challenge it – given my student status and all that implies…
I am a naturally curious person who enjoys learning and gaining new knowledge/insights, but my learning at the moment feels uncomfortable as on one hand I learning about promoting normality and providing women-centred care – which I am really excited about – whilst on the other hand working within a system that, in my opinion, promotes ritualistic and defensive practice. For example, when asking a community midwife about discussing birth place and the options (MLU, CLU or home) she said I don’t discuss home as an option unless the women asks about it. Their reason being, they didn’t want to ‘sow the idea’ of a home birth to a women who hadn’t already considered it, in case they decided to have one, something went wrong and they were blamed. I found this very sad, but l was unsure how to respond so said nothing.
Anyway, on a positive note, I am about to start a placement on the birthing unit, and am ever opportunistic that I will witness the magically power women have to naturally birth their offspring.
Thank you, again, for sharing your thoughts and wisdom. I look forward to receiving notifications of new posts.
Kind regards,
Lisa
Thanks Lisa – you are not alone in struggling to work out your place in a system that is not aligned with your knowledge and beliefs re. midwifery. There is no rationale for much of the common practices and approach. However, it is important that midwives who question and challenge enter the maternity system… otherwise it will never change. So keep going!
Hi Rachel, via the article about PRoM I came on another article by you, which is about research bias and the lot. Unfortunately I don’t see it in this list of articles, which is a shame because I think fewer people will read it via the already mentioned article than via this list of so many great great articles. Maybe you could add a link to it on this page?
Thanks for letting me know about this over-sight. I’ll add it to the list 🙂
Hi Rachel,
What do you know of ‘placental lakes’?
Thank you!
My understanding is that the term ‘placental lakes’ just refers to the normal anatomy and physiology of how the placenta works as seen on ultrasound.