The Complete Australian Guide to Pregnancy and Birth by Sophie Walker and Jodi Wilson

‘It’s wonderful to find such a warm and friendly guidebook for Australian families. I love the value Jodi and Sophie place on planning for postpartum, not only birth, emphasising the need for rest, simplicity and support during the profound emotional, physical and mental changes.’ — Julia Jones, Postpartum Doula

‘This book is full of helpful information for pregnant people, written with clarity and compassion. What a gift! I wish I had a copy when I was pregnant.’ — Heidi Sze, Nutritionist and Dietitian

‘This book draws on the wisdom of birth stories. It is packed with valuable information for all pregnant women who want to prioritise their wellbeing and prepare for an informed and empowered birth.’ — Rhea Dempsey, Doula and

Birth Educator

‘Comprehensive and tailored to the Australian maternity system, taking you from pre-conception right through to postpartum, this guide is a must-read for any parents-to-be.’ — Claire Eden, Naturopath and Doula

‘This is THE informative, supportive and empowering book I have been waiting for to recommend to my clients and friends who are on their fertility, pregnancy and birthing journeys. Sophie and Jodi expertly offer pages full of wisdom to navigate the tender journey of pregnancy and birth in all its stages and facets. Knowledge is empowering! An empowered pregnant and birthing person is a mighty thing, flowing down the line to the next generation of mightiness.’ — Erin Lovell

Verinder, Herbalist, Nutritionist and Author

‘Indispensable and comprehensive. I can already see this guide dog-eared, well-loved, passed from one reader to the next as they embark on the profound journey of pregnancy and birth. Full of practical information, expert tips and intuitive wisdom . . . I will be buying this book for all of my expectant friends.’ — Laura Brading, Founder of WellRead

‘Finally, a comprehensive, holistic, empowering, educational and thoroughly researched guide to the pregnancy, birth and motherhood journey . . . This kind of support and education helps more women have positive and empowered birth experiences, which has a profoundly positive impact on women, babies and society at large.’ — Sheree Rubinstein, Founder

and CEO of

One Roof

The Complete Australian Guide to Pregnancy and Birth

Sophie Walker and Jodi Wilson

INTRODUCTION

‘I wish I had known’ is a phrase uttered by countless women after they give birth for the first time. It’s often closely followed by, ‘I wish someone had told me’. We hope this book gives you everything you need to know about pregnancy, labour, birth and early postpartum so you’re not left wondering what could have been.

This is an honest conversation about just how significant the changes of pregnancy are to your life. The growth of your baby is definitely important and we’ve covered it in each trimester, but this book is about you – how your body is changing, how your emotions are faring, the importance of essential care and the acknowledgement that your pregnancy, birth and motherhood experience is precious and unique to you; there’s no need to compare it with anyone else’s or aim for perfection. Ask any mother, obstetrician, midwife or birth worker and they will agree: perfection doesn’t exist in pregnancy and it most definitely doesn’t exist in parenthood.

In Australia a baby is born every one minute and forty-five seconds. There is one train of thought that speaks of only wanting a healthy baby, and we hear it often. Of course we want a healthy baby and it goes without saying that we want a healthy mum. But when we focus on the outcome, we dismiss the life-altering experience the mother goes through to bring her baby into the world – regardless of where she is birthing, how she is birthing and who is caring for her along the way.

We know that positive birth experiences are transformative. This doesn’t only mean intervention-free vaginal births – it’s any birth experience where the birthing woman and her support people feel safe, cared for, understood, heard and empowered to make decisions that they feel best suit them. Throughout the following chapters we encourage you – again and again – to inform yourself, acquire birth skills and actively prepare for your birth and postpartum. We do this because the research is clear; a positive birth experience is dependent on two things: the birthing woman’s ability to make informed decisions, and those decisions being supported and respected by her care provider. We wholeheartedly encourage you to get educated and empowered. In one of the most privileged countries in the world, we should all have the opportunity to step into postpartum without carrying the weight of birth trauma. Your pregnancy matters. Your labour matters. Your birth matters. You matter.

Sometimes we can’t help but be consumed by our birth stories and, as the podcast has revealed over the past few years, storytelling is cathartic. And for

those listening, it’s a pure and potent education. When a woman shares the small, precious details of her birth story, she opens up her most vulnerable self. Threaded throughout these pages are the birth stories of a diverse group of Australian women who have shared, without reservation, the messy, challenging, beautiful experience of pregnancy and birth; the elation and heartache; the tears and blood; and the glorious reality of growing, birthing and unfurling into motherhood.

We have also gathered a range of specialists and professionals in perinatal health to share their experience and offer advice, and we’ve uncovered the facts and stats about birth in Australia and the hospital system. But amidst all of the numbers there’s a lot of gentle, kind advice because we want this book to be your faithful friend and companion, regardless of how much you already know or in spite of the fact that you know nothing. If you want to familiarise yourself with common birth terms before you start reading, you’ll find a comprehensive glossary on pages 396 to 401.

We won’t tell you what to do during pregnancy, nor how to plan your birth. We don’t know you and we know nothing of your medical history, your knowledge, your birth priorities or your fears. But we do know what pregnancy feels like and we understand the mental and emotional journey of growing and preparing to welcome a new baby.

We remember with such clarity the anticipation of labour as we wandered all heavy and soft through the final days of pregnancy, leaking fluid, spilling tears, inconsolable on the precipice of change. We have laboured and been induced, we have cried to our midwives and growled at our partners, we have breathed and moaned through contractions and interventions, we have fought fear with faith and reminded ourselves in the depths of labour that millions of women have birthed before us; we can do it, we are doing it. One breath at a time, you will, too.

CHAPTER

1

THE FIRST TRIMESTER

Pregnancy is one of life’s most significant experiences and has the power to narrow your focus and simultaneously change the way you see the world.

For some, pregnancy brings a gleeful kind of happiness that is largely indescribable, and for others it creates an overwhelming sense of awe: Is this really happening? Is there actually a baby growing inside me? As you navigate profound and incredible change, you’re probably feeling lots of things and they’re all valid. While we’ve been conditioned to think of a positive pregnancy test as cause for elation, it’s not always like that. You may be grappling with all the other emotions that accompany this early stage – fear, overwhelm, grief, doubt, regret and confusion. It’s quite normal to take weeks, sometimes months, to truly accept the pregnancy you’re carrying and adjust to the inevitable changes ahead of you.

Pregnancy may be a common choice for many families but that doesn’t mean it’s an easy one. Indeed, the path to a positive pregnancy test is different for all of us. You may have carefully planned the baby that now grows within you or perhaps your missed period came as the biggest shock of your life. After years of challenging fertility treatment or a previous miscarriage, you may have finally received the news you’ve dreamed of and yet you’re carrying the heartache of loss so you’re stepping anxiously through each day of this first trimester, mustering all the hope and positive affirmations that you can. Perhaps when you saw those two positive lines you reacted with elation and basked in the thrill of anticipation, or maybe it’s taken you weeks to get to this point of acceptance where you feel you can now consider what the next few months will look like. Everyone’s circumstances differ although we all share a common thread: we’re navigating a major life change and learning to cultivate trust in the unknown. We all have our stories of early pregnancy and they are as varied as the birth stories we share years later.

Regardless of how you conceived, now that you’re here, it’s a good idea to stop for a few moments and honour the fact that you’ve arrived. It’s big, isn’t  it? Early pregnancy can be a tender time where you feel particularly vulnerable, unsure of so much that lies ahead, overwhelmed by the enormity of it but also quite charmed by the magic happening within you. It’s a time of profound contradiction. Perhaps you’re too nauseous to consider anything but your proximity to the bathroom or you’re too scared to think too much about birth because what you’ve heard isn’t exactly comforting. While there is a lot to plan and learn, you don’t have to do it all at once. We encourage you to take things one step at a time – day by day, you’ll get through.

MENTAL PREPARATION: MANAGING OVERWHELM

Sometimes you may find yourself questioning your ability to grow and birth your baby and then a few hours later, you may be overwhelmed with excitement and the thrill of anticipation. For some women these mixed feelings linger throughout the whole pregnancy. This sense of ambivalence is actually a very expected and healthy sign; it means you’re intellectually processing what this major life change will look like for you, hence you’re starting to adjust. Your doubt is normal, too, and it can creep in at the most inconvenient times (hello, 2 am insomnia!), prompting you to worry and fret about what’s to come. It’s important to acknowledge your fears and insecurities and to recognise them as a very real and expected part of pregnancy. But remember, there is no such thing as the perfect pregnancy or the perfect mum. We encourage you to make space for imperfection; in fact, welcome it. Becoming a mother is an experience with many twists and turns that requires you to release the need to control and to accept yourself as you are. Remember: you are enough just as you are. And if you feel like you’re flailing or you need support, now is the time to rally friends and family or reach out for professional help. You may be growing your baby by yourself but you don’t need to do pregnancy alone.

MINDFULNESS PRACTICE

You may like to start by closing your eyes and taking a few deep breaths. Let out a gentle sigh with your exhalation and let go of any obvious tension. Now, bring your left hand to your heart and your right hand to your belly. Feel the connection between your breath, your body and your baby. For now, you are one; your baby is comforted by the rise and fall of your breath and the rhythm of your heart. Repeat these words as many times as you like: I trust my body to grow my baby. I inhale faith and exhale fear.

Is It Normal to Feel Overwhelmed?

No matter how many babies you’ve had, a new pregnancy can feel incredibly overwhelming, especially in the early weeks when you’re expected to continue life as normal because you haven’t shared your news and your pregnancy isn’t obvious. No matter how mellow or intense your pregnancy symptoms are, it’s easy to be overwhelmed by all the unpredictable change that lies ahead. It can be a lonely time, too, as you process how life is about to change and what the next few months and years will look like, while you’re also surrendering to the sometimes bumpy experience of the first trimester. Your overwhelm may be accompanied by a range of emotions and you may be feeling them all at once –nerves, fear, elation, worry, awe and curiosity. Your pregnancy is a pivotal life transformation, so of course it’s going to take time for you to adjust to the inevitable changes to your body, your lifestyle, your relationships and your family dynamics. This is all exacerbated if you are challenged by the physical symptoms of early pregnancy, so please go easy on yourself.

It’s also normal for your partner, if you have one, to experience their own sense of overwhelm, which may manifest as stress and anxiety over big things one day and seemingly trivial matters the next. We all adjust to the news of a new baby in our own way. While you may be worrying about your ability to grow and birth your baby, your partner may be more concerned about earning money, creating stability and providing you with adequate emotional support.

When you feel yourself becoming overwhelmed by how much your life is about to change and all the choices you have to make, just come back to your body and your breath. We’ll encourage you to do this throughout the book in the hope that it will be a little practice you embrace regardless of where you are and what you’re doing. By purposefully focusing on your breath, lengthening your exhalations and connecting with your baby, you’re shifting your awareness from your mind to your body and taking a practical step towards calming your whole self.

For now, you might like to repeat to yourself: All I need to do right now is breathe. I’m breathing in, I’m breathing out.

‘People would say to me, “Just take it one day at a time,” but I had to take it five minutes at a time. All of my first trimesters were awful for me. My mental health plummeted, I felt sick every minute of the day and in my last pregnancy I lost 10 kilograms, couldn’t even keep water down and was put on an IV drip in hospital. I begged my husband to remind me that it was like this before and that it would pass. He would put his hands on

Breeana’s Birth Story

ANTENATAL DEPRESSION, ELECTIVE CAESAREAN

Breeana’s pregnancy was unplanned but, despite her initial hesitancy, she decided to keep her baby. unfortunately her persistent nausea and vomiting didn’t subside in the second trimester and it was a contributing factor to her low mood. Having studied psychology, she knew she had classic symptoms of depression so she sought help from the mental health unit at the Royal Women’s Hospital in Melbourne. For the remainder of her pregnancy she worked closely with her psychiatrist as she navigated severe depression. At 30 weeks she elected to have a caesarean birth because labour was an unknown that completely overwhelmed her.

Just prior to falling pregnant, I started questioning whether I wanted children at all and then one morning I was sitting having my breakfast and realised that my period was late. The pregnancy test came up positive straight away. I did consider having a termination but we had been talking about having a child and we were in our early thirties. I felt like if I was going to have a baby, now was the best time. I called the pregnancy helpline, which is such a great resource, and I told them I was having doubts about keeping the pregnancy. The counsellor encouraged me to go on the holiday my partner and I had planned and explained that if I still had doubts when I returned home, it wasn’t too late to terminate.

I was six weeks when I started feeling nauseous and before long I was throwing up multiple times a day. I think the effect of serious morning sickness on a woman’s mental health isn’t considered nearly enough; you’re just expected to get on with it when, in actual fact, it’s torture.

A lot of women who are diagnosed with antenatal or postnatal depression do have a family history of depression or anxiety, or they’re familiar with it from past experience. up until 12 weeks I just put my low mood down to the fact that my pregnancy was a surprise; unplanned pregnancies are another trigger for antenatal depression. I just felt like it would pass after the first trimester, when I started to feel better and have more energy. I was waiting for that point so I could start getting excited but it never came.

At 14 weeks I said to my partner, ‘I’m really struggling, I’m feeling like I don’t want to be pregnant, I just can’t cope.’ I don’t think I’d ever seen him cry up until that point. In Victoria, it’s relatively easy to obtain a termination and at that point it was still on my mind, but obviously the further along you are, the more difficult it is.

At my 16-week appointment with my doctor I told her that I was feeling depressed. She referred me straight to the hospital’s mental health unit and I got an appointment within a few days. I shudder to think what would have happened to me if I didn’t have access to the amazing psychiatric team there. I was assigned to a psychiatrist and I saw her throughout my pregnancy (four years on and I still see her). She was my rock during the lowest part of my life and I couldn’t imagine my life without her now. From that point on, at 16 weeks, I slid down a very deep hole of depression. Therapy kept me afloat but it didn’t stop the severity of my depression.

until you have experienced antenatal depression, you just don’t know what it’s like. It’s a very common issue in pregnancy and the women who have it really need support because it is just so isolating. I’ve never felt as lonely as I did then. At the time it felt uncontrollable; I was completely overwhelmed. And I’m a middle-class woman with a supportive partner; I was being seen by a world-class psychiatrist at a world-class hospital and I could not dig myself out of the hole. It wasn’t a matter of changing my mindset or embracing positive affirmations or adding a quick meditation session into my day. It was a persistent overwhelm, every hour of every day. I would see my psychiatrist once a week and I lived for those sessions; towards the end of my pregnancy I saw her twice a week and she reminded me if I was ever completely overwhelmed, I could just go to emergency and they would admit me.

As I got bigger, I was reminded of what was happening and I felt like my life was out of control because I was headed in a direction that was just so unknown. Even when you’ve got stable mental health, being hurtled towards life with a newborn baby is difficult. There’s a point where you question whether you’ll be a good mother and when you’re not mentally well, you know that every day you’re getting closer to the inevitable – a challenging time of sleep deprivation and relationship pressure – and that contributed to an even further decline in my mental health.

At 28 weeks I started thinking about labour and birth. I felt like if I was left to go into spontaneous labour, there were any number of possible things that could go wrong with that, and I felt that if labour and birth were traumatic or difficult in any way, my resilience was so low that the newborn stage would

PREGNANCY AND YOUR FINANCES

Worrying about money in pregnancy is common despite the fact that it’s not something we generally discuss. We know that money dictates many of our decisions (financial concerns may even have delayed your plans to start a family) and for those navigating an unplanned pregnancy, the strain can be even more significant.

Life is expensive and one quick google search will reveal that babies cost a lot of money, with those costs growing year by year. Considering inevitable changes to your income, the cost of childcare and escalating living expenses, it makes sense that most pregnant women (and their partner, if they have one), find themselves worrying about the accumulated costs of welcoming a new baby, regardless of their income and specific concerns. Research agrees, with one study citing that there’s a link between financial stress and low birth weight. The same study suggests that anxiety isn’t linked to how much money a woman and her partner make. Women across all income levels are stressed about money; the perception of stress was the significant factor.

Before you spend another night wondering how you’re going to make it all work, let’s break things down. There are a few simple steps you can take to make things more manageable and minimise stress:

Speak to a financial counsellor

If you’re feeling overwhelmed by your financial situation, you’re experiencing financial hardship or you just can’t make sense of the numbers, chatting to a financial counsellor can be a really positive and practical step. You can access free financial counselling in Australia by calling the National Debt Helpline on 1800 007 007; it’s a not-for-profit community service that offers confidential and personalised advice and guidance that’s based on your circumstances.

Break the worry cycle by voicing your concerns

Chatting about your finances with your partner or your support person can make them seem less overwhelming; a different perspective really can halt the perpetual worry cycle and offer practical solutions.

Investigate the Parenting Payment through Centrelink

If you are a single parent, an Australian citizen and you meet Centrelink’s criteria, you will be eligible for Parenting Payment, which you can access if you are the principal carer of a child younger than eight. This is paid alongside

Family Tax Benefit (which includes rent assistance). If you do return to work, Parenting Payment will cease but you will still receive Family Tax Benefit (the amount paid will be determined by your annual income). It’s a good idea to find out exactly what you’ll be entitled to once your baby is born so you can budget accordingly. You can do this via the Centrelink website, which is accessible via my.gov.au.

Check your maternity leave entitlements

If you are employed, chat to your employer or human resources (HR) team about your maternity leave entitlements. You can call your HR representative anonymously if you’re not quite ready to share your news. (See page 208 for a guide to accessing paid leave from both your employer and the government, as well as guidance for reviewing maternity leave policies if your HR department hasn’t updated them in the past five years.)

Check your paid leave eligibility

If you have been working in your current role for at least 12 months, you are eligible for 18 weeks paid leave from the government. You must meet the Centrelink work test, be your child’s primary caregiver and have individually earned less than $150,000 in the past financial year. You can get this on top of any provisions from your employer if you meet the requirements. This payment also applies to sole traders, as long as you have been working under your current ABN for a minimum of 12 months. Self-employment can definitely have its own challenges, so creating a plan regarding when you’re going to go on maternity leave and how long your leave will last is a practical method for getting organised and easing your concerns.

Consider what is really necessary for your baby

There are lots of products out there, most of which are touted as ‘must-haves’, but ask any mum of multiple kids and she’ll tell you that all you need are the essentials; stockpiling baby products during pregnancy is unnecessary. Now is a great time to step off the frantic consumerist path and consider a more relaxed and mindful (and more affordable!) route. Birth and motherhood preparation is not reliant on spending money and accruing ‘must-haves’, although we understand that this can be a thrilling experience that makes it all seem a little more real. Reach out to your community via Facebook Marketplace, your local community centre or op-shops close to you. Babies grow very quickly and often preloved clothing in sizes 0000 to 00 is in perfect condition.