postnatal Archives - Nurtured Birth

Sore Nipples and Breastfeeding: What You Need To Know

Sore nipples are one of the more common concerns new mamas face when beginning their breastfeeding journey.

Breastfeeding is a wonderful, natural way for a mother to bond with her baby, and breast milk is recommended as the only source of food for a baby’s first six months of life.

Whilst the production of breast milk occurs naturally, the art of breastfeeding doesn’t always go smoothly.

For many mothers the experience is simple and straightforward, but for some it can become a painful ordeal.

Breastfeeding is a learned skill for both mother and baby, and there are bound to be some hiccups at the beginning. Sore nipples are often dismissed as part of the process but pain definitely isn’t something new mamas should ‘put up with’. Sore nipples can be so painful that a mother gives up breastfeeding altogether.

Find out what you need to know about sore nipples and breastfeeding, and what we recommend for prevention and support.

Pre-pregnancy breast soreness

Breasts, areolas and nipples come in all shapes and sizes and will change throughout a woman’s life cycle, from adolescence through to menopause. We need to have an awareness of what is normal for our breasts by doing regular breast checks so we can spot any unusual changes quickly.

Breast soreness is very common. It affects most women at some time in their lives, usually in the form of swelling, lumps, bumps, general aches and soreness. Commonly felt at varying times of the menstrual cycle, breast soreness is usually regarded as normal. The soreness will vary from woman to woman, so it is important to be aware of what is normal for you.

If there is any unusual pain, extreme pain, or changes in the breast tissues (with or without pain) it needs to be explored further. This could be due to other factors such as cysts, tumours or mastitis. Seek advice from a medical professional for further investigation into the source of pain and treatment.

Pregnancy breast soreness

During pregnancy, your breasts undergo many changes, influenced by hormonal fluctuations.

During the first trimester your breasts may feel generally sore and tender. The breasts often increase in size and as the pregnancy moves forward the areola and nipples will usually darken and become larger.

It is important to make sure to be fitted with the right style and size of bra during pregnancy, to prevent not just soreness but long-term damage to the breast tissue.

During the third trimester the breasts will begin to make colostrum in preparation for milk supply for the soon to be born baby. This can be seen as a shiny, clear discharge from the nipples.

Some women may hand express this colostrum after consultation with their midwife, obstetrician or doctor. In certain situations babies need supplementation after birth and a supply of colostrum in the freezer can be used instead of formula.

Breastfeeding soreness

Breastfeeding is biologically the normal way to feed mammal babies and the production of milk (lactation) occurs naturally after giving birth. Breast milk contains everything your baby needs for nutrition for the first six months of life.

Breastfeeding begins soon after birth, often with mum bringing the baby to her breast within minutes after birth. Babies left on their mothers bellies after birth have an innate instinct to seek out the breast, and will crawl up to the nipple.

In the first few days, your breasts will produce colostrum and this provides everything your baby needs. Within a few days, your milk ‘comes in’ and changes in volume and composition. This can cause some discomfort as breasts become full and engorged, and your baby is increasingly hungry and more demanding.

Breastfeeding shouldn’t be painful. But in the initial few weeks, at the beginning of a feed, there may be some discomfort when the baby first attaches to the breast. The sensation should subside within a short time and as the feed continues it should not be painful.

There can also be other issues such as engorgement, mastitis, nipple vasospasm, thrush and other infections. Nipples may appear bright pink or red in colour, bleeding, dry, flaky, or have a white rash (thrush).

Causes of sore nipples when breastfeeding

Sore nipples most often occur if the baby doesn’t have the proper attachment or ‘latch’ to the breast.This can cause cracking, splitting and bleeding of the nipple. Sometimes these sores are obvious, but small cracks can be hard to see, even if very painful.

There can be other issues such as a baby with tongue tie, incorrect use of breast pumps, or medical conditions such as dermatitis or an infection. In these cases it is important to seek help from a qualified professional to properly diagnose the problem and offer the right course of treatment.

Even if breastfeeding is going well problems can still arise. Nipple soreness can occur if mum or baby become complacent about latch, the baby has a growth spurt causing a sudden increase in feeds, or baby begins teething.

What can be done to help breastfeeding and sore nipples?

Even if you have breastfed before, breastfeeding each baby is new and can take some adjusting to. Being prepared for breastfeeding before you have your baby is a good foundation to understanding what can go wrong and what to do about it.

Nurtured Birth recommends Born To Breastfeed, a comprehensive and accessible breastfeeding guide for mothers, answering all your questions and providing support for challenges. You can purchase this through Nurtured Birth’s shop here.

Seek advice straight away! The best person to help is a lactation consultant. They will have specialist training and knowledge on breastfeeding issues. Your midwife, maternal & child health nurse, postnatal doula or paediatrician can also provide some support.
Consider attending breastfeeding classes during pregnancy to prepare yourself and your partner. You can also make contact with a lactation consultant so they will already be on hand to assist once the baby is born.
Try to feed on the baby’s first cues of being hungry, not waiting until they are crying. You can try putting the baby to the breast more often, expressing some milk prior to feed and offering the less sore side first.
Finding the proper positioning while feeding. Getting the right set up of chair, pillows, baby’s position to allow for correct attachment to the breast.
Keep nipples dry between feeds. Make sure to change nursing pads frequently and use 100% cotton for best airflow, not plastic lined ones.
After a feed leave some fresh breast milk on your sore nipples and keep them open to air for a few minutes. Pat dry gently.
Products like the BodyICE Breast Pads provide relief for sore nipples. You can purchase these cleverly designed pads that fit into your bra through Nurtured Birth’s website here.
Soothing products to assist with the pain and healing: after a feed apply a saltwater rinse to the nipple or try a warm cloth compress. A lanolin ointment that is 100% medical-grade is also safe to use on your nipples after a feed.
Check your expressing technique – some electric pumps can be too harsh and may need to be adjusted. Sometimes a manual pump or hand expressing can be gentler on sore nipples.
Nipple shields can be used for short periods of time to ease sore nipples. They often lead to future issues with poor attachment so need to be used with advice and careful consideration.
Some causes of sore nipples need medical intervention. Thrush can be treated with an ointment that is safe for baby, mastitis may need antibiotics so it does not become serious and lead to hospitalisation. Always seek out advice from a medical professional.

Where do I find help?

You can contact the following organisations for more information:

Lactation Consultants of Australia and New Zealand (LCANZ)

Australian Breastfeeding Association runs the National Breastfeeding Helpline 1800 686 268

Maternal and Child Health Line (24 hours) – 13 22 29

Nurtured Birth postnatal doula available for home visits in Melbourne, even during Covid-19 times.

Written by Sharon Clarke, Remedial Therapist at Nurtured Birth

Essential Oils in Pregnancy, Birth and Beyond

The use of essential oils in pregnancy has a range of therapeutic effects, from easing tension, anxiety and aching muscles to generating a positive mood, calming or energising.

Essential oils in pregnancy can be wonderful to support the changing body through each trimester, into labour and postnatally, but must be used safely and sparingly.

Jo Harris, founder of Soularoma shares her tips and guidelines for using essential oils in pregnancy.

What are the benefits of essential oils in pregnancy?

I obviously love and deeply believe in the benefits of essential oils during pregnancy, it is a very special time and usually happens only once or twice in most women’s lives.

A pregnant woman’s wellbeing (physical & emotional) is of utmost importance and thus it is a time to use essential oils for that extra boost if it is needed.

It is important for women to have complementary approaches available during their pregnancy to cope with the physiological and emotional issues that can appear. It is empowering for a woman to treat issues which don’t require medical intervention by herself with natural essential oils.

What are the considerations you apply when choosing essential oils for pregnant women?

Safety is always number one, but then also what the individual client likes and needs (emotionally, physically & spiritually) at that moment.

Unfortunately there is a lot of contradicting information with essential oils in pregnancy. With pregnancy it is best to be on the safer side and act with caution.

Why is it important to seek the advice of a trained aromatherapist?

To be sure what you are using is safe for you and your baby. This is of utmost importance at all times with essential oils but especially so when during pregnancy.

It is also important to use very little during pregnancy. So the dilution should always be half of a normal adult dose- a maximum of 1.5% dilution.

What do you include in your Birth Surges oil and why?

For establishment of labour – clary sage, a great uterotonic, helps relax (like a euphoria), and decreases anxiety, fear and panic. Clary sage also works to decrease irritability and strengthen the central nervous system. It also helps gain clarity.

For active labour – rose oil, it is a great uterotonic, rose is calming, decreases anxiety, fear and panic and works to promote love (opening the heart), concentration, patience and decreasing irritability. It also protects from negativity.

Birthing the placenta – jasmine helps promote confidence, helps to decrease anxiety and fear. Jasmine is also a great oil for gratitude & opening the heart. Jasmine also helps to reach a meditative state and to feel peace.

None of these oils should be used before 38 weeks of pregnancy.

Essential oils in trimester one

During the first 13 weeks of pregnancy a woman will undergo a variety of changes as her body begins to support her growing baby. These changes occur physically, emotionally and physiologically.

Although not all pregnant women will experience all symptoms, there are many common changes and complaints that can be experienced, such as nausea, fatigue, headaches, emotional vulnerability, hormonal swings. There is also a mixture of excitement and anxiety about pregnancy and birth.

With these changes in mind we need to find essential oils that are soothing and relaxing but also uplifting and revitalising. It is really important to use essential oils only if really needed during the first trimester – less is more. Safety is really important in this trimester especially.

For nausea – cardamom, mandarin, lemon, orange, ginger; and for headaches lavender or lemon.
For emotional health – lavender, patchouli, orange, vetiver, mandarin, bergamot, grapefruit, palmarosa, petitgrain, lime. These oils have soothing, refreshing, uplifting, tranquil qualities.
To counteract anxiety – petitgrain, bergamot, lavender, neroli, orange, grapefruit, mandarin., lemongrass (in low dosages), rosalina, vetiver, chamomile.

Essential oils in trimester two

As the pregnant woman enters into the middle of her pregnancy, weeks 14 to 27, she may find pregnancy symptoms begin to ease. She will begin to feel her baby move and often embrace the joy of her pregnant body and her baby growing inside her.

Common conditions that may arise in the second trimester include increased energy, sinus aggravation, less stable joints/muscles causing pain, spider/varicose veins, heartburn and constipation.

The oils that will offer the most benefit during this time will target the digestive system, balance and focus, easing pain.

For digestion or indigestion – ginger and lavender, sweet orange, coriander, mandarin, cardamom
Aching muscles – lemon, ginger, rosalina, myrtle, cardamom
Sinus – Rosalina, myrtle, lemon
Overall balancing – lavender, geranium (not for use in early pregnancy), mandarin, petitgrain, neroli.

Essential oils in trimester three

The last 13 weeks of pregnancy are known as trimester three. During this time the baby has grown so much it is having a significant impact on the pregnant woman’s physicality.

The common changes and complaints that occur include a decrease in energy, anxiety for impending birth, oedema, leg cramps.

For inspiration and to invigorate – geranium, lemon, ginger, lemongrass
To promote sleep – a citrus base such as orange, tangerine or bergamot blended with lavender
To unwind, destress, relax – a citrus base of orange, bergamot or lime blended with geranium, patchouli, ylang ylang, or petitgrain, lemongrass, lavender, chamomile, rose geranium.

Essential oils during labour and birth

Essential oils can offer support and calmness to the birthing woman, assisting her through each stage of labour, providing nurture, strength and positivity.

Inner power – mandarin, frankincense, ginger, rose, patchouli
Meditation – a citrus base or tangerine or bergamot, with lavender, frankincense, vetiver
Feminine – orange, ylang ylang, lavender, geranium, jasmine
Promoting contractions – clary sage, sweet marjoram, ginger, rose.

The baby can be greeted at birth by a mild pleasant aroma. The use of essential oils should be stopped close to birth to provide a more aromatically neutral environment as babies are very sensitive to smells. It is best for the baby to smell mum’s own scent to help with bonding.

Essential oils for the postnatal period

Common changes and complaints that occur after pregnancy and birth include exhaustion, physical tiredness and pain, emotional adjustments, hormonal changes, healing, breastfeeding issues.

Breast engorgement – geranium
Healing emotions – lavender, patchouli, mandarin
Emotional tension – neroli, palmarosa, mandarin, chamomile.

Postnatal application of essential oils to the skin:

To help reduce stretch marks, help the skin keep its suppleness and elasticity by deeply moisturising using rosehip oil, helichrysum, lavender.
To assist with healing the perineum (tears, fissures, etc.) a lavender compress or lavender in water in a spray bottle can be applied to the perineum after going to the toilet.
Soothe the skin for calming and relaxing – lavender, rose, roman chamomile.

Oils should be blended with a base oil or cream, diluted.

Always remember:

No ingestion of essential oils
Essential oils should always be packaged in dark glass and be 100% pure
Discontinue use immediately on an allergic reaction and seek professional advice
Do not ingest oils or apply undiluted on the skin
Keep essential oils out of reach of children
Oils contraindicated in pregnancy are: angelica, basil, bay, clary sage, cedarwood, cypress, eucalyptus, fennel, jasmine, juniper berry, myrrh, marjoram, peppermint, rose, rosemary, spearmint, Spanish sage, sandalwood, thyme, yarrow.

If you would like to get in touch with Jo Harris and find out more about her products and journey as an aromatherapist, please contact her at:

web: soularoma.com.au

email: hello@soularoma.com.au

Phone: 0457 698 480

Osteopathic Treatment During Pregnancy

Women may seek osteopathic treatment during pregnancy for a variety of different reasons.

From helping the body adjust and adapt with ease to the changes of pregnancy, managing pre-existing conditions, treatment of new aches and pains, to preparing the body to encourage positive labour and birth outcomes.

Osteopathy is a manual treatment that embraces the link between body structure and wellness.

What to expect from your osteopathic appointment?

It is advisable to arrive a little early for your first appointment, as you will need to fill out some paperwork. You will also be asked to sign a general consent form, but you will have the opportunity to consider and consent (or not) to specific treatment in the consultation.

Your osteopath will initially take a comprehensive case history. This will b e followed by a full osteopathic assessment where motion tests are performed in addition to any necessary neurological or orthopedic testing.

Osteopathy takes a holistic approach to treatment, so your practitioner may look at other parts of your body, as well as the area that is troubling you during this assessment. We are also interested in what has worked for you previously, and whether you have any treatment preferences.

Following this an osteopathic diagnosis will be made and discussed with you, allowing you to ask any questions you may have. We will explain how we would like to approach the treatment, as well as gain your consent before treatment.

You should let us know immediately, even during the treatment, if you would like to change or stop and discuss the treatment we are giving you.

Every treatment is different and tailored to the individual’s needs and comfort levels. Osteopaths have a wide variety of manual techniques which they use to treat various complaints. Osteopathic treatment in pregnancy may include:

Soft tissue releases and/or massage
Gentle stretching
Gentle joint movements
Muscle energy techniques (used to lengthen tight, contracted muscles)
Counterstain (releases tight muscles by positioning the affected muscle in a shortened position to stretch the opposing muscles)
Joint manipulation where appropriate and only when the patient is comfortable with the technique
Taping where necessary
At home exercise and/or stretching advice.

Your position during treatment will vary with the technique being used as well as your stage of pregnancy.

Early in pregnancy you may be still comfortable lying on your abdomen. However as you progress through your pregnancy, most treatment is performed lying on your side, seated, or occasionally laying on your back with your right hip lifted slightly by a pillow.

At the end of the treatment, your osteopath will reassess the initial movements you performed so we can see how effective the treatment has been.

Your osteopath may organise a return consultation and may give you some stretches and exercises to do at home to help speed up your recovery or improve your body’s function.

How many treatments will I need?

The number of treatments needed depends on how long you have had the presenting problem, how severe it is, and how your body responds to treatment.

Through years of experience helping women through their pregnancy we have found women will often gain greater benefit from regular osteopathic treatment rather than seeking treatment with the sudden onset of pain.

This is usually every 4-6weeks during the early stages of the pregnancy and may be more frequent towards the end as your baby grows and as you start preparing your body for labour and birth.

Is osteopathic treatment safe in pregnancy?

Our osteopath has a passion for treating and supporting women through their pregnancy.

She combines her osteopathic skills with her knowledge and experience as a registered midwife, allowing her to compassionately and safely treat and support you through all the stages of pregnancy and the postnatal period.

The techniques used during pregnancy are carefully selected to minimise risk. These techniques are gentle and the comfort of the mother is always taken into consideration and may be adapted to suit each patient.

Please note, although osteopathic care is generally consider safe during pregnancy, if your pregnancy is considered high risk, we advise you check with your general practitioner, midwife or obstetrician before seeking care from any manual therapy modality.

What do I need to bring to my appointment?

Comfortable clothes. Depending on the area of your body requiring examination some disrobing may be required, but at all times you will be draped with towels.

It is essential you feel comfortable, so you may want to bring or wear a pair of leggings or stretching gym shorts to the session.

Medicare referral if applicable, private health insurance and any relevant imaging results (x-rays etc).

Should I have a postnatal osteopathic treatment after the birth of my baby?

The weeks after birth can be challenging as you embrace your new normal and connect with the amazing changes pregnancy and birth have gifted you.

Osteopathic treatment can also help with pain and discomfort associated with breastfeeding posture, lifting car capsules and prams, carrying and settling your baby, and bending over the bassinet or cot.

Osteopathy helps restore balance, posture and release tension, improving your health, recovery and mindset as you look after your new baby. A happy and healthy mother is the centre of a functioning family.

This is the perfect time to seek treatment to restore alignment and prevent ongoing issues, such as back problems, stress incontinence, constipation and menstruation issues. Abdominal muscle separation and pelvic floor weakness are also common problems after pregnancy and birth.

Many women are unsure if they are able to have treatment before their six week postnatal check up with their doctor.

Unless you have any significant postnatal complications we consider treatment before this time safe, even after a caesarean section, and will tailor all treatments to suit the women and the presenting condition.

Written by Katie Wood, Osteopath at Nurtured Birth

Home Birth During Covid-19

Home birth during Covid-19 is a choice many women are considering as they search for safe and alternative birth options.

Pregnancy is an amazing time as your baby grows inside your body and you prepare to welcome a new person into this world and into your family.

As your due date draws nearer there can naturally be some apprehension and uncertainty of what is to come during the birth.

This is even more so in 2020 as women seek support and care during pregnancy and birth during the Covid-19 pandemic.

Juliana Brennan is a private midwife, director of Mamatoto Midwives and a mother of three. She shares with us an amazing insight into the world of private midwifery and home birth during Covid-19.

How are you at this time?

Well, a bit more settled now, but like everyone else there was so much upheaval and concern over the health of all our community, my family and especially my elderly parents.

My biggest fear was not knowing much about the virus, the panic buying, children being taken out of school, social isolation and my son is in year 12…what is this going to mean for him?

I am glad we have had some restrictions lifted but I am still very much practicing social distancing to keep myself, my family and my clients safe.

What is it like for you as a midwife at the moment?

I’ve always been very busy and my practice is consistently booked out every month, however now I have been inundated with enquiries from women wanting home birth – even from women with very serious risk factors which normally excludes them from homebirth.

These women have reached out because they were only allowed one support person in labour at the hospital and they really wanted that extra support person as well as their partner.

Also they are fearful of contracting Covid-19 from the hospital setting…after all that’s where the really sick people will be…in hospital! So I have referred many women on to other midwives as I am already booked out until the end of October.

Many of my hospital shared care/hospital support clients who are experiencing an uncomplicated pregnancy have changed over to a homebirth. This is because they couldn’t have the support they wanted in the current hospital setting, but also they didn’t want themselves and their families possibly being exposed to Covid-19.

It’s a tricky situation as you really have to want to have a homebirth, and feel safe at home to be safe for a homebirth. Merely wanting to avoid a hospital for birth isn’t a good enough reason to have a homebirth.

I will still be careful in choosing my clients who are suitable for homebirth, both physically and emotionally.

What’s it like for prenatal clients who want to home birth during Covid-19?

We have moved most of our education and appointments to an online format via Zoom. Women we are meeting for the first time we would only see online. Our clients needing a check up we would see first online, then they would come into the clinic for a 10 minute visit for a check of blood pressure, baby’s growth and heartbeat.

My clinic in Clifton Hill, where I work alongside natural therapists on the first floor, was closed down. Below us is a hairdresser that also closed down.

My sister came to the rescue and allowed me to use her clinic in Kew. She stopped seeing her clients face to face, so her offices were free for me to use. I must say, I really like the space. My colleague Danielle works out of one office and I work out of the other…so we are both doubly lucky to be able to say hello to one another’s clients and of course catch up in between clients!

My new clinic room in Elwood at This is Life also closed down, so the lovely midwives from Mama allowed me to use their rooms…but now the Elwood clinic has reopened, so I am back there seeing my Bayside clients on a Saturday morning.

My clinic room in Chirnside Park at Koru Natural Therapies has remained open, so I have still been able to see my clients there too.

Of course adhering to the strictest hygiene, washing down beds, tables and changing linen in between clients and of course lots of handwashing!

Overall my prenatal clients all decided to self isolate as much as possible. Especially from 37 weeks…this was my recommendation. Many women were anxious I may have to change their birth plans if they were planning a homebirth, but I reassured them if they were willing to self isolate and so was I, then we were at very low risk of contracting Covid-19.

What changed significantly for the hospital system was the decision to allow only one support person in hospital. This meant one of my clients wanting a vaginal birth after two c-sections (VBAC2C) chose me to support her in hospital instead of her husband! What a responsibility!

For others it meant dropping women off at the emergency department and staying in close contact via phone or Zoom. Not ideal, but I completely understand the issues surrounding social distancing and protecting clients in hospitals and also hospital staff.

I do think two support people should be allowed in birth suites from now on…as Australia seems to have the infection under control much more so than other countries.

Have you adjusted your postnatal care?

Postnatally I am still happy to do face to face appointments, as long as clients and their families don’t have a cough, fever, or sore throat.

If they do, I arrange testing for them and wouldn’t visit if they had symptoms. This actually hasn’t happened…probably largely because my families all isolated fairly strictly prior to their births.

What is home birth during Covid-19 like?

For my clients it is self isolation from 37 weeks of pregnancy then the birth at home is the same.

My recommendation for women that have a fever in labour be transferred to hospital. Usually we would transfer anyway, after eliminating other reasons for fever such as dehydration.

This guideline has been debated amongst my colleagues; some feel we should still keep women home if they have Covid-19 symptoms if they don’t seem too unwell. My concern is leaving four hours after the birth and not being able to supervise all the time as well as the unknown effects of the virus on the unborn baby. In hospital the woman and baby would have constant supervision and care.

It is definitely an issue for me if hospital transfer is required. I did have one first-time mother needing a hospital transfer in labour…and of course I had to hand her over to the hospital staff. I kept in very close contact with her partner and he called me regularly to ask for my advice. It still isn’t the same as being ‘with woman’ and it saddened me deeply…as I am her main care provider and I develop a strong bond with my clients.

How are you navigating any possible Covid-19 pregnant or birthing woman?

The first thing to do is arrange testing and to self isolate until the results come back. If the woman presents with symptoms in labour I do have full PPE available.

So far none of my clients have had respiratory symptoms, so I haven’t had to worry about it. I think self isolating since 37 weeks has made all the difference.

What are the pros of a home birth during Covid-19?

Well staying out of hospital is definitely a positive!

If hospital is needed, not being able to take your primary care provider with you due to the one person support policy is a real issue. Continuity of care leads to good outcomes in birth, but Covid-19 is a real threat and hospitals have to enforce the rules!

What is birth like for healthy and well women at this time?

They are being exposed to hospital environments, then discharged home very early, with NO follow up except phone calls from maternal and child health nurses (MCHN). Some MCHN refused to visit, some GP’s wouldn’t do contact appointments.

Thankfully one of my colleagues was able to offer postnatal face to face care to many of these women which meant breastfeeding could be fully supported and of course she could weigh babies and make sure they were thriving. My own clients had the same care as they would have had before Covid-19.

What are the main challenges birthing women are facing with these new protocols?

Women who wanted two or more support people have had major issues adapting…many women choose to have private midwives at a hospital birth to advocate for them, and then facing this loss often meant changing to a home birth.

What are the main challenges for Independent Midwives in during this pandemic?

Making sure we don’t contract the virus! Keeping our clients safe! Hospital protocols around one support person.

Nurtured Birth would like to thank Juliana for her contribution to our blog.

If you are considering an independent private midwife for your pregnancy and birth, Juliana Brennan is very experienced and deeply caring.

Juliana can be contacted at Mamatoto Midwives for a comprehensive choice of maternity care options.

Juliana Brennan

Mamatoto Midwives

juliana@mamatotomidwives.com.au

0419 253 778

At Nurtured Birth we love supporting independent midwives and working alongside them to enrich the continuity of care we know through research it results in better birth outcomes, improving mothers experience antenatally and postnatally.

We love it when our clients thrive therefore we have developed our practice to compliment maternity care by offering a range of pregnancy care options with pregnancy massage, osteopathy, doula support, childbirth education, naturopathy, pre & postnatal yoga, mothers groups too.

All this is our heartfelt vision to enrich, nurture, nourish and support a mama’s pregnancy, birth and beyond.

Written by Sharon Clarke, massage therapist at Nurtured Birth

Spectacular capture at the top by Bree Downes

Giving Birth During Covid-19

Many women in our community are worried about how their maternity care will be affected by practices put in place when giving birth during Covid-19.

These protocols and procedures are due to hospitals and medical centres preparing for potentially large numbers of infected patients. Fortunately cases of Covid-19 have remained manageable in Australia.

For the pregnant, birthing and postnatal women in our community, Covid-19 has thrown them a curve ball. Even a straightforward and healthy pregnancy and birth comes with some apprehension. Now, women are concerned about how the new protocols and procedures will affect them and their connection within the health system.

So what does maternity care and birth during Covid-19 look like?

We asked Dr Danielle Wilkins, obstetrician and Director of Maternity Services at Cabrini Health, to give us an insight into what it is like for the women in her care during this pandemic.

Dr Wilkins answers all of our questions with an open and honest frankness relaying the message that pregnancy, birthing and the postnatal period can still be a beautiful and calm experience amidst Covid-19.

For women who are concerned about how their maternity care and birth during Covid-19 will look, this information can be a starting point to research options and make an informed decision about maternity care providers.

How are you coping during Covid-19?

What a roller coaster this year has been! The highs are seeing how optimistic, adaptable and focused pregnant women are when their lives are turned upside down.

The challenges are working with those who are finding these changes overwhelming and the lows are not knowing what is around the corner.

What’s it like for you as a doctor in the current situation?

This is such an emotional time. I found myself, like so many Australians, watching the international news in abject horror, unable to look away as my colleagues around the world try to fight this virus without protection, without rest and without success. I was losing sleep thinking about them day after day and night after night. So I had to listen to the same advice I have been handing out and I had to stop watching.

What’s it like for your prenatal clients in this time?

I have approximately 90 women who I am actively caring for at the moment. Since the restrictions in Australia started I have been keeping in touch with them much more closely than usual via a fortnightly email update. Through this I have kept them abreast of all the work that Cabrini has done to keep them safe and to keep them informed, negating any surprises.

I have introduced telehealth into Obstetrics which previously we thought would be of little or no benefit, and this has been pleasantly well received by those that have chosen to use it. I have encouraged all of my clients to make the informed choice themselves and to use the telehealth system as the safest option but if they prefer they can still come in for a face to face appointment.

I believe that providing them with relevant local information and also giving them options is helping them to navigate the situation.

What is the experience of women giving birth during Covid-19?

Fortunately we have yet to have a Covid-19 positive pregnancy in Victoria, nor have we had a positive partner or support person. Our women are able to have their one support person with them throughout their labour and their postnatal stay.

We are continuing to provide them with one-on-one midwifery support. The big changes have been for those women planning to have more than one support person with them, and for some women this was a very sudden change. But women are resilient!

We have received feedback about how comfortable it was just having the 4 people present for the birth. They are reassured they still have all the pain relief options available as needed.

Many of my clients were emotional about the postnatal stay, when relatives and friends would normally come to the hospital to meet the newborn. What has been striking is how rested the mums are, how connected they become with their midwife who has less juggling to do around visitors and how much easier they are finding it to breastfeed on demand.

What are the procedures in place for Covid-19 positive cases?

We have a statewide guideline for any Covid-19 positive pregnancy cases which we have adapted for Cabrini.

We have modified our largest room in the birth suite to accommodate anyone who is positive or suspected to be positive during labour and we have a guideline for partners and support people as well. These guidelines ensure the full support of the couple as well as the safety of all of our staff.

The trickier situation is the symptomatic Covid-19 positive partner or support person – this person will not be able to enter the hospital if they are symptomatic. This is a huge incentive for self isolation close to term.

Would the new mother stay together with her baby to breastfeed?

There was a wonderful success story out of Brisbane last week relating to this. The couple would need to wear gloves and a surgical mask when handling their newborn whilst they were considered to be infectious, but as long as they are well their baby will stay with them and they will be assisted with breastfeeding and encouraged to do so if that is their desire. We will encourage these families to return home as soon as it is safe to do so and provide them with telephone support once home.

What could a birthing woman expect during her time in hospital?

Women can expect one-on-one midwifery care, a large room to mobilise with an ensuite with shower. They will not be able to use nitrous and air for pain relief as it may increase the viral load in the room and put other staff at an increased risk.

The staff who provide their care will all be wearing full PPE (personal protection equipment). Whenever the woman and her support person move through a public part of the hospital they will be escorted by staff, will be required to wear a surgical mask, and asked not to touch anything along the journey.

We will discuss their wishes for pain relief and explain that there may be benefits to an epidural if they are considering one. This is because all procedures will take a little more time to be performed as safely as possible, and in the event of any emergency in obstetrics we like to be as prepared as possible.

A paediatrician will be present at the birth, as overseas data has suggested that the babies to Covid-19 positive women sometimes need some initial support to transition from inside to outside the uterus. This is only for a brief period in the vast majority of cases.

What is giving birth during Covid-19 like for women who are healthy and well?

Unchanged! We are wearing a little more PPE for births but that is not affecting our communication or support for women, nor our ability to provide one-on-one midwifery care. You can expect us to be wearing a clear visor, a surgical mask and a gown during the pushing stage of labour.

What are the main challenges women face with these new protocols? How are you finding their adaptation?

Women are finding their strengths, they are finding their way. Those that had different plans for support through their birth are spending prenatal time telehealthing with their support team and working together to develop strategies and plans for the different stages of labour and birth.

There is so much support for them already online and I have included a lot of this information in my newsletters to help support them. I am constantly impressed but not surprised by their determination and ability to adapt.

What is it like for women after they give birth during Covid-19?

This is a challenging time for first-time mums who are very nervous about not having the support of maternal and child health nurses, mother’s groups and in many cases their parents and families.

I am encouraging them prior to their labour and birth to make plans for accessing support, to be prepared and to know they can continue to link in via the phone and via telehealth. We may soon see an easing in restrictions which will put our first-time mums at ease I think.

Your final thoughts on what you believe it is important for people to know…?

Keep doing the right thing. Read what is relevant and don’t get overwhelmed by what isn’t. It is really important to remember that we are all in this together and we are all getting through it together because we are doing what is best. And remember to look up.

About Dr Danielle Wilkins

Dr Danielle is an obstetrician and the Director of Maternity Services at Cabrini Health. Her practice rooms are located at Cabrini Mother and Baby Centre. She offers individualised care to the twelve women she sees each month through her boutique obstetric practice.

Danielle graduated with honours from Monash University, trained at Monash Health and gained twelve months of obstetrics and gynaecology experience working in a busy unit in Ireland.

She spent nine years as the Director of Women’s Health training at Monash Medical Centre, and six years as the Discipline Coordinator for Women’s Health for Monash University. She was the Head of the Multiple Pregnancy Unit at Monash Health before moving to her current role at Cabrini.

Danielle has extensive experience caring for twin pregnancies and supporting women wishing to have a normal birth after a caesarean birth.

Dr Danielle Wilkins can be found at Cabrini Mother and Baby Centre, Cabrini Hospital Malvern, Level 2, 183 Wattletree Rd, Malvern

Massage In Times Of Coronavirus (Covid-19)

We at Nurtured Birth are happy to announce that after six weeks of no massage in the time of coronavirus (Covid-19) we’re reopening for limited massage sessions.

As Covid-19 became a new reality within our community, we made the difficult decision to close our doors temporarily. This move was to keep our clients, staff and families safe.

It has been over six weeks of self-isolation and social distancing and no massaging.

All of us at Nurtured Birth miss our clients, especially our pregnant and postnatal mums. We know how daunting pregnancy and early motherhood can be, with the physical and emotional changes both bring.

Massage therapy provides support for the physical and emotional aspects of pregnancy and to provide the best care possible for a safe and healthy pregnancy.

Massage In Times Of Coronavirus (Covid-19)

We are sure all our pregnant and postnatal clients are in need of a massage treatment, with the special care, support and expertise that only Nurtured Birth can provide.

Nurtured Birth will reopen for limited massage sessions at the Windsor rooms, beginning Thursday 7th May 2020.

Reopening our clinic for massage therapy is exciting news, but massage during Covid-19 times means extra protocols and precautions to keep us all safe and healthy.

Protocols For Massage & Covid-19

Nurtured Birth will reopen as per the Victorian Government legislation and following the advice of our association, Massage and Myotherapy Australia (MMA).

In Victoria, as of 17th April 2020, MMA confirmed remedial massage and myotherapy members are permitted to provide professional services at this time.

We have enlisted the following protocols for our clinic:

Appointment times are spread out to provide time for thorough cleaning and disinfecting between clients.
Only one client in the clinic at a time.
Clients must wait in their car until the therapist contacts them to enter the clinic for their treatment.
Hand sanitizer provided on entry and exit of clinic.
All clients asked screening questions prior to their treatment.

Precautions for Massage During Covid-19

Dr Norman Swan, Australian physician, journalist and broadcaster has provided guidelines for massage therapists through MMA.

The following precautions are important for massage therapists to use as a guide to massage during Covid-19, to protect clients and keep themselves and their families safe.

Screening questions need to be asked at the time of booking and/or at presentation to the clinic at the beginning of the appointment.

Do you feel well? Do you have any symptoms of cough or cold, fever, difficulty breathing?
Have you travelled overseas in the last 14 days?
Have you had contact with anybody who has tested positive for Covid-19?

Any positive results from this screening process would be reason to postpone the appointment.

Washing hands with soap and water thoroughly for 20 seconds.

Covid-19 is a virus with a fatty outer layer. Soap dissolves this layer of fat and makes the virus inactive. This stops the spread of the covid-19 virus.

Alcohol-based hand sanitizer works the same way but you need to use more liquid to cover all areas of your hands. Gloves are optional but generally do not provide protection from infection unless in a sterile environment.

Masks for the therapist are not essential but make sense as a precaution due to massage putting the client and therapist in close personal proximity.
Waiting area – limit and organise appointments to only one person at a time and/or allow for 1.5m distance in waiting areas; remove all reading material; clean regularly with alcohol wipes/disinfectant.
Creams and oils used in massage are for single use only. Washing hands with soap and water after treatment is important to remove all products from the skin.

General Facts About Covid-19

Every day we’re learning more about Covid-19 and how it is spreading around the world. There is also much research going into treatment for those who are infected and also prevention of the virus.

Covid-19 has some things in common with influenza but they’re caused by different viruses. We do know Covid-19 is mutating slowly. Influenza has a shorter incubation rate but Covid-19 is more contagious and has a higher mortality rate. Covid-19 has a more devastating effect on older people and those with chronic health issues.

The common symptoms of Covid-19 can be similar to a cold or flu:

Fever
Tiredness
Cough
Sore throat
Breathlessness.

Other symptoms have emerged that not everyone experiences but may indicate cover-19 infection:

Aches and chills
Nasal congestion
Loss of taste and smell.

The major risk factors are contact with an infected person and overseas travel.

Self isolation and social distancing are important to reduce the spread of contact transmission. Australia is doing well in preventing the spread of Covid-19 and the health system is prepared well to deal with any patients.

For more information, news, advice and support about Covid-19:

Coronavirus health information line 1800 020 080
Download the Coronavirus Australia App
Download the Covid Safe app

Massage Appointments During Covid-19

We are happy to be able to massage again and would love to see you in Nurtured Birth’s clinic space as soon as possible. Our healing hands are ready and waiting for you to arrive.

Please make a booking for a well deserved massage at Nurtured Birth:

Phone Bookings and enquiries: 0401083778
Online Bookings: www.nurturedbirth.com.au

Author: Sharon Clarke, Remedial Massage Therapist at Nurtured Birth