Category: csections commentary

Who are Lazy Daisy and why are they different

I recently came across a relatively new antenatal organisation – Lazy Daisy. They offer movement based pregnancy wellbeing and birth preparation classes.  While they do not talk about interventions and more traditional modes of pain relief as I would advocate what is fantastic is that they focus on

“helping mum eliminate worry or fear before the birth…encouraging her to look forward to her birthing day, however the journey pans out”.

Of course a caesarean may be the outcome but in viewing birth as a positive journey and focusing on the end goal Lazy Daisy’s founder Julie Long reports that

“even when birth has taken a different path to what they hoped, [women] continue to feel in control and so feel 100% positive about the journey. Many of our mums forget to even mention how the journey finishes [vaginal or caesarean] because they are so enthusiastic about describing how they were riding their waves.”

These classes do not claim to be a one stop shop for antenatal preparation but they do seem to encourage women to have more realistic expectations of birth. The classes provide a safe, open and honest environment in which to discuss all aspects of birth. No topic is out of bounds. Lazy Daisy recognise that while natural birth and breastfeeding are desirable goals they also acknowledge that for some women bottle feeding and medical forms of pain relief may be preferrable. They point out that there should be no shame attached to this and they encourage discussion on all topics.

Anja a mother who recently attended Lazy Daisy classes before her home based VBAC said

“We practised techniques to help keep us calm and once in labour I went into a kind of automatic, I could hear the teachers voice from the relaxation sessions and it really worked, my homebirth was a wonderful, calm experience.”

The organisation is growing fast and there are now classes all over the country.

Thinking about a VBAC?

What should you consider if you have previously had a c-section and are now expecting another baby?

“Decision-making following a caesarean is naturally coloured by previous experience, but if possible the key thing to focus on when making your decision for your next birth is a balanced assessment of risk in your specific circumstances, this time round. It should not simply be a question of ‘This is nature, I am made to do it this way’ or ‘This is my right’. It is the specific circumstances of your previous births, your current condition and the progress of your pregnancy this time that should carry most weight.” More

Media reports on NICE caesarean debate quite balanced

Media debate over one of the key changes to the NICE caesarean guideline has been very thorough throughout the day. Focus has primarily been on the recommendation that women should have the right to request a caesarean even when they do not have a medical indication for one, (assuming that request follows detailed discussion about the benefits and risks of both modes of birth).

What is particularly impressive about the media coverage is the balance and accuracy achieved in so many of the interviews and reports.

NICE guidelines published

Today NICE released the 2011 version of their guidelines for Caesarean Section.

There are a number of significant updates. In particular:

  • women wanting to request a caesarean on the grounds of fear should be offered perinatal mental health support and if, following this, they continue to want a caesarean, this should be granted
  • women wanting to request a caesarean where there is no medical need should engage in a detailed discussion with their practitioners. All the risks and benefits of both vaginal and caesarean birth should be fully discuss but if, after this, the woman still prefers a caesarean this should be granted
  • not all women with HIV should be automatically offered a caesarean, they should be informed that “the risk of HIV transmission is the same for a CS and a vaginal birth” in specific circumstances – read the guideline (page 6) to get a summary of the specific circumstances where this is the case

There are also new recommendations regarding: timing of antibiotic administration, the use of colour-flow Doppler ultrasound scans etc.

The important thing to note is that this is a guideline, not a directive and some hospitals may still choose to ignore some of the recommendations.

The ‘Good Patient’ phenomenon

The idea of the ‘Good Patient’ phenomenon may ring a few bells when you hear Birthwares’ description of how we sometimes interact with our health-carers:

“It presents with the need for the pregnant mama to please her caregivers. Often she will undertake medical tests and procedures without understanding the need for or the value of the information provided by the tests. She will attend prenatal appointments promptly and regularly, but will leave her list of burning questions, unasked, in her pocket, for fear of taking up the time of her busy caregiver. She will accept any intervention or treatment offered to her, with the implicit understanding that her caregivers know best.”

I know I have certainly done this time and again despite knowing that I have burning questions about things that are concerning me. Even with a list in my hand I have felt compelled to keep quiet because someone is frantically trying to keep on top of their own schedule. 

However it is crucial that we ask questions and do so even when we feel pressured to move on.  Each pregnancy is different and new questions will arise even if you have already had a baby. As Birthwares suggests “bring your list of questions. Lose the niceties about the weather and how hot it is. Rattle off your questions instead.” So whether you are planning a vaginal birth or a caesarean stand your ground and ask those questions. It can help to take someone with you to every antenatal appointment, even if you think you are just there to wee in a bottle, you never know what you are going to be told or what you might want to ask and a second pair of ears can mean less gets missed.