Wednesday, 4 September 2013

Keep Calm and use your BRAIN!

This little acronym - BRAIN - is a powerful tool to increase your chances of getting evidence based care. So here goes - your care provider suggests a procedure, such as a stretch and sweep, or an induction, or even an internal exam at 38 weeks, or an episiotomy, or even a Cesarean birth - what do you do?

Sometimes medical decisions are based on outdated policy, financial or convenience factors rather than on what is best for mom and baby. Many parents are not sure how to question their care providers in a way that opens doors of communication rather than slamming them shut. The BRAIN acronym facilitates discussion in a non-threatening way.

What this really all boils down to is making sure that you are making informed choices and giving informed consent. This is a tricky field legally, and particularly in the area of labour and birth where there is a huge emotional component involved and families feel particularly vulnerable. 

Just remember, no one is allowed to do an internal exam or 'adjust' your cervix without your consent - if your care provider asks to do an internal exam and you give permission, and are informed afterwards that your cervix was manipulated or your membranes stripped - that is not informed consent and that is a violation of your patient autonomy. 

Furthermore, no one can inject you with anything or put anything in your drip, or cut into your flesh at any point without your informed consent - and if someone is busy doing something, an internal exam for example, and you say - STOP - you have withdrawn your consent and that person is required to stop what they are doing and withdraw their hand. 

You may be asked to sign a blanket consent when you are admitted to hospital (if you are birthing in hospital) - please read through it and discuss whatever you are concerned about. Perhaps you could get a copy before the time. It really is worth it! I have heard too many stories of women lying in bed for the duration of their labour because they believed that was just how it's done and didn't know they could request otherwise. Or women coerced into unnecessary inductions because of the doctor's leave schedule. For a first time mom, inducing labour drastically increases chances of having a Cesarean birth. If women truly knew the risks of the procedures they are apparently consenting to I think our phenomenally high Cesarean birth rate in our private hospitals would be a thing of the past.

There is much more I could say about this, but you get the idea. When in doubt, use your BRAIN!

Just so you know, I actually have a website dedicated to helping parents make informed choices along their birthing journey. Click here:

When have you used the BRAIN acronym before? Please tell us!

Alternatively, was there a time you would have used the BRAIN acronym had you known about it? Tell us your story!

Wednesday, 28 August 2013

Private Birthing Venue!

Give birth in personalized privacy! 

Fully customized birthing suites available!

Entrust your birth experience to our highly skilled, passionate staff who have an excellent record of care. We aim to ensure that mothers and babies get the best birth possible, with no compromise on safety.

You will have a midwife and her assistant devoted to your care for the duration of your labour and birth. All essential equipment is provided. 

Immediate postpartum care and follow-up home visits 

are conducted by these same attendants,

available by phone 24 hours a day. 

Birthing suites come complete with double or queen size beds,

including free accommodation for partners and siblings.

You can even bring your pets!

  • No set menus or meal times - you decide when and what you eat.
  • You decide who may visit, and when they may visit.
  • You will be able to sleep while your baby sleeps. No one will wake you at 5am to check your pulse, and your sleep will not be disturbed by the sounds of babies not your own. 

Get all of this for less than half the cost of a natural birth at a private hospital!

Yes, you guessed it, 


So yes, while I know that not every can or wants to give birth at home, I just thought it was funny that we pay so much to get a home-like birthing environment.

Sunday, 3 February 2013

Belly Cast Tutorial

In it's curing spot, before refining and reinforcing.
Such a beautiful belly!
One of my kind doula moms, Candace, agreed to be my crash test dummy guinea pig in my attempts to make a belly cast. I'm considering the possibility of including belly casting as a service for my doula moms or anyone else who wants one for that matter, so I thought some practice would be a good idea!

I'm not a complete newbie when it comes to the art of working with Plaster of Paris; I majored in sculpture at varsity so PoP did feature at some point! I just don't remember it being quite that messy... I digress.

The basic idea behind belly casting is that you put Plaster of Paris bandages all over mom's belly and whatever else she wants casted  (breasts / thighs etc). Once the plaster sets it pops off and once it has cured you can reinforce, sand and paint it and hang it in your baby's nursery or anywhere you want to show off you beautiful belly! You'll need at least one person other than the mom, but having two people working seemed to work well for us. What we didn't take into account was trying to take pictures with plastery hands, so you'll need another helper if you want pics.

So here is how we did the belly casting:

What you need before you start:

From the left: Plastic wrap / Gloves / Vaseline /
Baby Wipes for mom afterwards /
6 rolls of PoP bandage in 2 widths.
  • A belly attached to a willing volunteer
  • A drop sheet (we cut up some rubbish bags - it's messier than you think!)
  • A chair (we used a sturdy coffee table so mom could lean back on one arm)
  • Something to smear on said belly to prevent plaster from sticking and causing unwanted nipple waxing Petroleum Jelly is what we used.
  • Plaster of Paris Rolls - We used 10cm wide by 4.6m long. 4-6 rolls should be enough. You can get different widths if you like.
  • Plaster of Paris Powder - for smoothing and reinforcing
  • Flat container with water - warm water sets quicker, cold water sets slower - we just stuck with room temperature! Warm water not recommended!
  • Large sharp scissors - I used kitchen scissors
  • Hole Puncher - For punching holes in the cast so you can hang it
  • Plastic or Latex Gloves - Check for latex allergies  Non-sterile is fine. You could use those gloves like the ones you get in hair dye kits, but I find them a bit clumsy for fine work.
  • Mom's Throne =
    Sturdy Coffee Table
    + Cushion + Plastic
  • Plastic wrap if mom doesn't want her nipples to show or if she wants the cast to go over the pubic area. Alternatively you could get those handy disposable paper undies from the discount chemist.
  • A bottle of red wine and some jazz on the go - And perhaps some smelly candles depending on the time of day.

Try to make sure you really have everything ready before you start! Otherwise you will end up with white hand prints all over your kitchen. True story...

Before you start: Some considerations

  • Decide how big / extensive you want the cast to be. Just belly? Belly and boobs? Belly, boobs and thighs? One shoulder? One or two or no hands on the belly? Just remember that you can't take the cast too far around the body - you want to be able to get out once it's set!
  • Pick a position. Most of the time women choose sitting positions - if mom is at all prone to feeling faint or dizzy then standing is not recommended! Changing positions while casting is also not recommended. Make sure her spot is comfortable!
  • Cut the rolls of plaster into 30cm lengths, with a couple of shorter ones for more detailed areas - especially if you are including a hand. Square pieces are great for nipples and belly buttons.
  • Have a shallow bowl of water ready. Tap water should be fine. Cold water will cause the plaster to set slower, while warm water will speed setting.
  • Lay your drop sheets down - and make sure there is space for your water tray quite close to the mom.
  • A spot for the cast to cure once you're done.
    What? It looks like you just rolled up some
    newspaper and piled it up on a  chair cushion!
    Um, er, yeah, that's exactly what I did.
  • Prepare a spot to put the cast to cure once you're done. We used a chair cushion with a stack of bunched newspaper to help maintain the shape while it cured. 

Ready to start?

Double Triple check that mama has had a pee in the last two minutes. You'll need her to sit still for a good half hour so make sure she's been fed and watered too.

My volunteers were Candace and her partner, Mat. I was going to be their doula at their upcoming birth so doing the belly cast was quite a good icebreaker in terms of being in each other's space.

About to pop... Candace and the Cast!
Ok, so once you're ready to start it's time for mom to get undressed. Make sure the room is warm enough / cool enough and that she doesn't feel too exposed. If you're doing a belly cast at a baby shower, just make sure there isn't a chance of Great Uncle Ned walking in on the process.

First you need a lubricant of some kind so that the plaster doesn't stick to the skin and give an unwanted nipple wax. If you're using latex gloves, don't put them on yet! The Vaseline will eat them up. I think you need something pretty sticky i.e. not olive oil. You are not trying to rub it into the skin, but make sure it forms a layer on the skin - like those chaps who do ice water swimming covered in a layer of Vaseline. I'd really like to find a natural alternative to petroleum jelly though, I just didn't have a chance this time. You could also wrap mom in some cling wrap, although you do lose detail that way.

Once the smearing is done the smearer can make sure his/her hands are wiped clean of the lubricant and put gloves on. I guess gloves are not absolutely necessary if you don't want to use them - the plaster will eventually come off your hands. But that's entirely up to you.

So being the good doula, I got Mat to smear the Vaseline all over the casting area and once Candace was sufficiently greased, we took one last sip of red wine and got working. You'll need to work quite quickly from here! 

 Take your strips of plaster bandage one by one, zip them through the water (i.e. don't soak them) and lay them down on mom's belly.
  • As you lay the strips and smooth them you will see how the plaster fills in the gaps in the bandage.
  • Use the square pieces for the nipples and belly button so you can get reasonably good detail. Again, Mat was happy to oblige. Try not to put too many layers over these areas to keep as much detail as possible.
  • Lay the strips in different directions for greatest strength. and ensure everything is covered in at least two layers. 
  • Keep going until everything is well covered. Make sure to reinforce the edges and corners and try to make the edges even, but it's not a train smash if they aren't - you can sort that out later.
  • From the other side
  • At the end we smoothed the whole cast over with some plaster paste made with 2 parts PoP powder to 1 part water.
  • Mom will feel the cast get warm - Don't Panic! That is what the plaster does as it sets... She will start to feel it popping off as it hardens anyway so it should come off pretty easily after about 20-30 minutes after you lay the first strip. 
Put the cast down in its curing spot and give mom some wipes to take care of the worst of the vaseline, then help her get to a bath or shower to clean the rest off. She may need a loo break. 

Then you clean up...

24-48 hours later

The cast needs 24-48 hours to cure completely so make sure it is well supported. Now you can smooth some of those edges and do some finishing off. 

With this cast I trimmed any rough edges with kitchen scissors and took strips of plaster and reinforced all the edges i.e. laying the strip along the edge and folding it over. I also reinforced the internal points of weakness - the crease under the bust and the space between the breasts. 

Top of the cast with rough edges
Trimmed with kitchen scissors and reinforced with plaster strips.
If you hold the cast up the the light you will see if there are any weak spots. You can also fill in with a little bit of plaster paste where necessary. 

Hopefully you can see the reinforcing here! This is looking from the inside.
 It is reinforced all along the edge,  in the crease of the bust and in the space between the breasts. 
I then used a hole punch to make holes to hang the cast - once I had reinforced the spots where the holes would be. 
Hole punch...
You can sand the cast quite smooth if you like.
Once it is as you want it you can seal it with something called gesso; you can get it at most art shops. You can also paint it with acrylic paints, or write on it with permanent marker - it really is up to you!

I'll add a pic of Candace and her belly cast when they are reunited...

So tell us, what would you do with your belly cast?