Episode 214 - Spicy Question Time with Mel
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host Dr Melanie Jackson. I'm a clinical and research midwife with my PhD and each episode I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth and postpartum journey.
[0:24] Hello, and welcome to today's episode of the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson, and today's episode is a different kind of episode than what you're used to. It's not focused on one topic, it's focused on many topics. Hello, Rebels. If you'll just give me 40 seconds of your time, I would like to personally thank the sponsor of this podcast, because that means that you get to listen for free. Poppy Child from Pop That Mama is a doula and hypnobirth practitioner, and she's a sponsor for today's podcast. Poppy has an online course, hypnobirthing course. It's called the Birth Box and it's already helped thousands of women five-star reviews across the board. And you know me, I am very picky about what I will endorse, but I get behind the work that Poppy is doing in the Birth Box. It's practical strategies to help you get ready for labor and birth, but also the challenges of parenting. And with my code, if you type Melanie in at the cart, you'll get 25% off. So if you're preparing for birth, go check it out. You will be so glad you did. The link is in the show notes. Type Melanie at the cart and get 25% off. Thank you Poppy for sponsoring this podcast so that everybody else gets to listen completely free. Let's get started on today's episode. And the motivation for this particular episode was on, well, let me give you the backstory.
[1:54] Every Friday on my social media account on Instagram, which is at Melanie the Midwife, I do a segment called Spicy Friday. And on that segment, anybody is welcome to ask a question and I answer as many of them as I possibly can on every Friday. I usually just write them on a tile and I can only put, you know, three or four sentences on a particular topic. But today I want to do live spicy Friday, which means answering questions from my Instagram and Facebook followers. That they want to know. Now the thing about Spicy Friday, it's not kind of curated and scripted and very carefully worded like the Great Birth Rebellion podcast episodes are. And so I may or may not, I can't promise anything, this is really going to be, absolutely off the cuff, just digging into whatever's in my brain, answering your questions. So there's no resource folder today, but all the links that I'm going to talk about, if I talk about any links in this episode, they will be in the show notes, below this podcast episode. Now, a few other things I want to share with you.
[3:05] Today is Monday that we release. And yesterday, Sunday, Saturday, and the Friday before, this weekend, this last weekend, I've just hosted the Convergence of Rebellious Midwives Conference. If you've never heard of that, this Convergence is something of my own creation. And it's been going for three years. We're up to year four because today we just started selling tickets for the Convergence 2027. Now this is the midwifery event of the year here in Australia. People come from all over the world to come to the Convergence of Rebellious Midwives but I'm here to tell you as part of this particular episode because 2026 just ended yesterday. It's epic. It's.
[3:54] But it's gone. But if you want to join us for 2027, it'll be happening August 13th to August 15th. It's a three-day conference, Friday, Saturday, Sunday. We're having it in Darling Harbour in Sydney, Australia at the International Convention Centre, which is where we had it last year. The venue is epic. You can see all of Sydney. It's a beautiful holiday location if you want to make a thing of it with your other colleagues. Now, the Convergence of Rebellious Midwives is called Rebellious Midwives Conference, mostly because it reminds me all the time to be pitching and aiming to serve midwives, maternity care providers. But it is open to anyone who wants to attend. If you want to come to this event, you are absolutely welcome. And in the past, we've had physiotherapists, fans, just birth nerds, acupuncturists, nurses, lactation consultants, doulas, midwives, of course, obstetricians, GPs.
[4:55] Policy writers come to this conference. It's not just for midwives. But no, if you are booking a ticket to the Convergence of Rebellious Midwives, it's pitched at midwives and it is the highest quality conference I've ever been to. Well, I mean, it must be because I made it. And the reason I made it is because I got sick of going to conferences that had low quality speakers, poor quality food, uncomfortable venues and frankly some of them I went to were hostile.
[5:25] And just dry. That is not the convergence. The convergence is the anti-conference conference. At the convergence, every time I build something and every time I think, what could I do next for the convergence? I'm always thinking, how can I love the people who have spent their time and money to come to the conference? And it bleeds through the whole conference, the love, the connectivity, the oxytocin, it's high quality and it's high value. And the tickets are on sale now. And for if you book through the first two weeks of August, 2026, you get $200 off your ticket. So the link to buy your conference tickets for 2027 are in the show notes below. There's payment plans. You can do a 10 month payment plan. You can pay it off straight off if you want to but this is the time to get your ticket if you want it as cheap as cheap as possible every year I get people emailing me going oh my gosh do you have payment plans I can't really afford the whole thing right now this is your opportunity.
[6:30] The whole year before the conference to start paying off your conference ticket. If you want to come and in the past finances have been an issue, now's the time because they're $200 cheaper and the payment plans, the long payment plans are in place. I'll put the link to the show notes for the Convergence of the Rebellious Midwives in the show notes. Click the link, have a look at the page. You'll see what we get up to. I've already arranged five epic speakers and I don't allow people to submit abstracts to the Convergence of Rebellious Midwives, I handpick every single presenter. I just want to make sure everything is bang on. Anyway, that's enough about the Convergence. Let's kick off our time of Spicy Friday. Now here's how it happens. I put a little tile up on social media, on Instagram, on my at Melanie the Midwife Instagram account, and people ask questions. So today I'm literally going to scroll through these questions, pick the ones I can answer straight off the cuff and go for it. All right. Strap in. It's spicy Friday, but on the great birth rebellion podcast on a Monday. All right. I'm going to pick these live. There's just so many questions. Honestly, as I scroll, I scroll through all of these. This is only, it's only 11 o'clock at the moment and all these questions have come through. So I need to choose which one to answer.
[7:55] I'm also aware that because I'm going off the cuff, I need to be very careful about what I say because it's no secret that there are enemies of the Great Birth Rebellion podcast that would very much like to report me to my registration body. So we're going to be careful, but we are also unscripted, which is not anything I ever do. I'm always heavily scripted on the Great Birth Rebellion podcast. That's why when I say things, I'm like, I stand by it 100% because I wrote it. All right, let's go. Let's have a look. First one. Okay.
[8:32] The first question is to protect the peri or not to protect the peri when pushing? How to know when to do it and when not to do it? Okay. Bit of context here. Midwives or healthcare maternity care providers.
[8:49] Often taught to protect the perineum, the woman's perineum, and a perineum is the space between your anus and your vaginal opening. It's the space that stretches when you're pushing out your baby and you're at full stretch. Your perineum is at full stretch and it kind of looks like putting a beanie on a baby, but there's a hole in the top. It's like it really stretches over the baby's head. Now, midwives and maternity care providers are often taught to protect the peri, by either pinching the perineum together towards itself over the emerging head of the baby, or just putting their hands on it or hands on the baby to slow down the birth of the baby's head. What are my thoughts on protecting the peri? I have so many thoughts on this. This needed way more than one single tile on social media. So I'm glad I'm doing this live. Firstly, the research shows that, whether you put hands on a baby or hands off a baby or hands on the perineum or off the perineum, it doesn't make any difference to the woman's chance of tearing. This is why people want to protect the peri. I think it will reduce the chance that the woman will tear during birth.
[10:11] The thing that really irks me about this though is that protecting the peri really can only be done effectively in the technique that they show you when women are lying on their back with their legs up. Now the irony is this position is going to increase the risk of you tearing versus for example a hands and knees position where the pressure of the baby is less on your perineum.
[10:38] This could also be done in a side-lying position, I guess, but it's quite awkward for the practitioner to do that. But I feel like the protecting the peri thing is just kind of this obsessive thought that we somehow.
[10:54] Can do something to prevent a tear with our hands or like by putting hands on something. It's not true. The research has discredited that and it's a real shame. There's things that some hospitals institute that require midwives to put their hands on the baby and on the perineum. It's not evidence-based and I don't do it. I'm hands off unless there's a clinical need to put hands on. If you want to prevent tears, we've got a whole podcast episode on how to prevent tearing, how to prevent the perineum from tearing during childbirth. I'll link that in the show notes below but putting your hands on is not one of them, the only single time that I've ever put my hands on intentionally and it was in a lot of consultation with the woman is I had a client a long time ago, it's probably nine years ago now because I was heavily pregnant I remember it quite quite well she'd had a previous third degree tear that hadn't healed well and she wanted to have a home birth. And so we went on this big journey of what we could do for her to help prevent a repeat tear given that the previous one hadn't healed perfectly.
[12:15] So for her baby, one of our strategies was a slow, gradual birth of the baby's head. So she was going to do her very best with her breath and not to push with a contraction. And my job was to put my hand over the top of the baby's head. I was, it wasn't on the perineum, to put my hand over the top of the baby's head as counter pressure, so that if she got into a situation where she felt like she needed to push, harder than she wanted, there was a little bit of resistance there that would have made the birth of the head more gradual because we wanted to prevent any sudden movements of the baby's head through her perineum.
[12:55] We did that and she was in a side-lying position and we worked together and there was an agreement made prior to the birth to do this kind of thing. This was our strategy that we'd agreed on and that she wanted, especially because she was giving birth at home. She really wanted to prevent a repeat third degree tear. We did prevent a repeat third degree tear. She didn't need to go to hospital afterwards. Everything was beautifully fine. That was the most memorable time that I actually put my hand on the top of a baby's head and did anything hands-on to kind of prevent a tear but we've got to remember guys, our hands are not going to prevent the tearing of a perineum the things that are going to prevent tearing the perineum are done all the way through the labor we're talking positioning.
[13:43] Not barking at the woman to push push push push push the baby out and then stop stop stop stop stop breathe breathe breathe I mean, go back and listen to the episode about tearing and preventing tears. It's linked in the show notes. All right. That is my spicy Friday answer, spicy Monday answer to that question. Let's have a look. What's the next one?
[14:03] All right. This is a pretty good question. It's actually applicable. It's about a home birth transfer, but it's applicable to anybody who's moving, from their home to go into hospital to have their baby. So the question is, how can we protect our oxytocin if things go pear-shaped in a home birth slash transfer? All right, and this is applicable, again, anyone who's laboring at home and then needs to get in the car and go to hospital, this will be applicable to you. So the question is, how can we protect our oxytocin in the transfer process?
[14:38] Firstly, if you're new to the game, oxytocin is the all-important hormone that your body, your brain excretes as you're in labor. It's the one that gives you contractions and keeps your labor going and progressing on to have a baby.
[14:53] It increases, increases through the labor and then peaks after the birth of your baby to help with the birth of the placenta. So you can see oxytocin is a super important hormone required for your labor to actually progress physiologically. What we also know is oxytocin is a shy hormone. And so if you feel frightened, interrupted, if you have to engage your brain and actually start thinking and you get distracted in the labor and birth process.
[15:23] Cold, like temperature changes, sudden lights, strangers, these kinds of things can frighten oxytocin and reduce the amount of oxytocin that you release. So this woman's asking, how can you protect your oxytocin if you need to transfer from home to hospital? This was in a home birth scenario. There might be a little bit of fear involved also if you're moving from home to hospital and you weren't planning on it and a little bit of disappointment. So that's one thing. But if we're thinking about the strategies that we know for sure will help maintain your oxytocin, what you want to do is reduce the amount of stimulus that's getting into your body so you can try and stay in a sort of subliminal state. And this is what happens during labor and birth is as your oxytocin increases and your endorphins increase there's this hormonal cocktail, that puts you into a little bit of a labor trance especially if your care providers are gentle and unobtrusive and you've been allowed to completely sink into that it does require a limited amount of stimulation so an ideal environment for that kind of scenario to unfold is a, warm dark and quiet place where you have known people around you and you're not required to think and no one's trying to talk to you. You can just completely submit to that hormonal soup of labor and birth.
[16:51] But if something's going wrong or you need to transfer into hospital from home, this does represent an interruption. So what you need to do is do your absolute best to preserve the environment that's going to protect oxytocin. So reducing stimulation. I would say some big headphones, maybe if they're sound cancelling and you can put some kind of music or whatever you've been listening to at home, something familiar, something it makes you feel safe. Maybe if you've been doing hypnobirthing or something like that, you can play that through your headphones. That will cut out the audible interruptions.
[17:34] Then you want to reduce your sight. So eye masks or red light, sorry, blue light blocking glasses. They're the red ones with the red glass in them. That'll reduce your exposure to artificial light. Which will help keep the oxytocin level high and the melatonin level low because melatonin potentiates the activity of oxytocin. So if you've been in the dark and your melatonin starts to increase, that's going to increase your oxytocin activity too. So try and do that.
[18:09] The other thing is, is if you're feeling frightened, be sure to take people with you in the transition who you feel safe with, okay? And also, they're going to have to control their own fear. The whole idea will be to reduce the stimulation coming into you. So, nice warm clothing, so you feel cozy. You might want to take heat packs, take a huge big blanket if you want, pillows. Anything that keeps you feeling calm and safe is going to help maintain the oxytocin. The other thing that's going to be really important here is that your support people advocate for you. In the transition to hospital, you want to try and maintain that completely closed off scenario where you still get to stay in labor land. And so everyone around you, your husband, doula, partner, support people, midwife, whoever you have with you can talk on your behalf and share the story. I'm sure when you arrive at hospital, they'll want to talk to you too. And then when you get into the room, make sure the lights are all off, that you maybe only speak to one clinician and not an audience of clinicians. And perhaps they can pop you straight in the bath when you get there, depending on the scenario. But we do have a podcast episode specifically related to.
[19:28] Managing the transition from home to hospital. Again, I will put that in the show notes for you to have a big, long listen. That's just my spicy Friday version to answer that question. Great question.
[19:40] Okay, what's next? That one. Oh, yeah. Okay, next question is, do you think that posterior labour that's not supported properly leads to unnecessary intervention and caesareans? I do have some spicy thoughts on this. Yes is the short answer. I do think that a poorly supported posterior labour will be more likely to lead to unnecessary interventions and cesarean sections. And here is why. So again, new players to the game. Posterior labour means that instead of your baby coming down where the head and the back are facing outward, so the back and the head would be laying along the front of your belly.
[20:30] That's the ideal position for your baby to come down through your pelvis and be born. But some babies, I think it's around 20%, I haven't checked the stats recently, but about 20%, don't quote me on that, of babies will actually be posterior during labour, which means that they're rotated to the back and their back is on your back. So if you imagine that they're actually looking out towards your pubic head. And this means that a bigger part of the baby's head is actually trying to be the leading part to come through your pelvis and it's, it's uncomfortable and an awkward position for the woman and for the baby ideally the baby would rotate and come out in an anterior position where its head is tucked in deeply, sorry just yelled into the microphone there, and it's better able to traverse your pelvis.
[21:26] The thing with posterior labors is that that's a longer rotation for the baby to get around and so it takes longer. And also women experience some different pain sensations because of the rotation of the baby. It can create some different pelvic pain and sometimes back and hip pain.
[21:44] Now, because it takes longer and the woman has usually a more painful labor and birth with a posterior baby, it can be done. It absolutely can be done. It just takes time and support. And the really big thing with a lot of hospital births is they don't have extra or they don't allow extra time necessarily. The other thing that happens with posterior babies, and this has freaked me out once or twice in a home situation because I'm a home birth midwife, is as the baby rotates, their heart rate can do some wacky things. I'll never forget, I was probably three or four years into private practice, maybe less, and I was with a woman and the heart rate was just doing some wacky stuff. I couldn't convince myself that there was anything wrong, but I was like, what is happening? And then when my colleague arrived at the time I was working with Hannah Darlin, Professor Hannah Darlin, some of you might know her as now, and we worked together clinically for about eight years during home births together, and she arrived and I was like I'm not sure what this wacky heart rate is and she's like oh that's just a classic heart rate for a baby that's doing a rotation.
[23:03] That was the first time I learned about that so maybe this is the first time you're learning about it. If you think the baby's posterior or maybe in a sort of less ideal position, it might do some wacky heart rate things as it's rotating, which seems to be a normal situation for babies who are doing a rotation like that. But I think there is a low tolerance for abnormal heart rate readings on things like CTGs. And now, you know, we're watching so, so closely what baby's heart rates doing that maybe that.
[23:38] A more trigger-happy clinician might not wait to see if it resolves and just act. But also because it's a bit more painful, I wonder if women are more likely to have pharmaceutical pain relief. And then because the progress is slower, maybe they'll also be more likely to have augmentations with artificial oxytocin. And then if it's taking too long or if the woman is kind of done or, you know, the clinician has looked at the picture and decided no time to pull the plug, then women might be offered a cesarean section but the other thing that can happen is something called like a deep transverse arrest where they do come down in an awkward position and actually get wedged and stuck in there there are things that can be done I have seen oh my gosh I have seen the most, beautiful it was poetic it was like watching ballet.
[24:32] A an obstetrician do a manual rotation of a baby that was completely posterior that you know it was a client of mine and we were at home she was fully dilated, and the baby had come down posterior and just got wedged and wouldn't and couldn't rotate we tried a lot of things at home and it just wasn't working, so we arrived at hospital and I didn't know exactly what the obstetrician was going to do, I thought it could lead to the cesarean section. A skilled clinician potentially could have rotated the baby with a vacuum and done a vacuum extraction or potentially forceps. I think it could have gone anyway. But we were presented with this incredibly skilled obstetrician who said, I'll do a manual rotation and then she will push out her baby. And I thought this is the most ideal situation possible. And for those of you who don't know, a manual rotation, they will numb the area, the vulva area and vagina. If a woman's already got an epidural, great. But otherwise, this woman got what was called a pudendal block, which is an injection of Linda Kane, which is a local anesthetic, but into the pudendal nerves inside the vagina. And it numbs the whole area because the clinician puts their hand onto the baby's head, which is in the woman's vagina.
[25:59] And literally with a contraction, rotates the baby into the ideal position. Now, I hadn't seen this done well in my career. But this one, oh, man, it was beautiful. She did, through three contractions, this obstetrician rotated the baby to an anterior position. And then she said to the woman, okay, go ahead. You're up. You know push your baby out and the woman did in like 10 minutes the baby came out after hours at home trying to rotate this posterior baby.
[26:41] And I remember as we were having conversations about the options and she said, well, I'll do a manual rotation and the baby will come out. And I asked, okay, well, I mean, that's great. But what if the baby doesn't come out?
[26:54] And she said, well, no, it will come out. And I said, well, yeah, but what if it doesn't? And she's like, no, it will. It will rotate and it will come out. She was so certain and it did. I mean, that was beautiful obstetric practice. I've gone off track now, but that's what happens when you give me the mic and a long form platform. But yes, to answer the question in short, yes, I do think posterior labors, end up with unnecessary interventions and cesareans, partly because they take longer and time is not really like extra time is not really always appreciated in labor and birth. Sometimes the baby's heart rate can go a bit wacky, but sometimes it can actually cause an obstruction, which does require some kind of intervention. Again, that's not a full answer, but it's an answer. All right. Oh, this isn't a question, but I really like it and I'm going to read it out anyway. This woman says, just thanks. You remind me that midwives make a difference despite the challenges of the medicalized system. Great. Amazing. You're welcome. Thank you for that. By the way, I always love, I love compliments. I love a good G up. So if you ever want to like give me a pat on the back, I'll allow it. Just message me, email me, you know, whatever. It keeps me going. All right. What's next? All right.
[28:24] Oh, this question is, how often is breech missed? I'm asking as I recently had a physiological surprise breech birth. All right, that's a good question. How often are breech babies in a breech position? So that means that the bum's down and head's up. Usually babies are born head down. How often is this missed? Okay. It's more often than you think. I reckon every midwife has a story of a missed, breached birth. I don't know if there's ever actually a bit of statistical check on how many are missed, but 3% of babies will be breached at full term.
[29:03] I've personally been at two surprise breached births at home. And the one that I remember most vividly was my client. And she was having her fifth baby. I'd seen her the day before and everything was fine and normal no dramas felt the baby felt as it always has felt as all the other babies felt you know we knew each other so well because she had five babies with me, and then she has also very quick births so she went into labor that night she called me, and when I got there she was clearly in established really established strong labor but it appeared as though she was about to start pushing anyway, which is what I expected. And I never do routine vaginal examinations during labour and birth. I just don't find them to be helpful to me or the woman. There's so many other skills that I have to work out where a woman's up to and if she's fully dilated, I don't actually need to put my fingers on there. It's just very occasionally if we're trying to do some diagnostic work of if there's something wrong. Anyway, so she started pushing and I, you know, it's always dark at home birth. So I had this, my little torch having a little look and I looked at the other midwife and I said, are those, are those toes?
[30:24] And she went, she looked and she went, yeah. And so off she went to go and get the oxygen tank and get ready for a breech birth because there was no, but going back now we could see toes. The baby was coming, breech.
[30:36] And what we know about breech babies is that they're far more likely to need resuscitation after birth. We can manage that kind of thing, but that's what we were getting ready for. And in that moment.
[30:49] I decided not to tell the woman that her baby was coming out breech for a few reasons. Firstly, it was her fifth baby. I knew she knew how to push babies out. I didn't have to give her any instruction and I'd always just kind of left her to it. Secondly, I didn't know how she felt about a breech birth because we'd not had to talk about it because her baby was never in a breech position as far as I could feel and tell. And I mean I'm very experienced at palpating women's bellies I do full continuity of care and you know I fill women's bellies all the time the position of baby so I didn't think I'd sort of messed it up.
[31:30] But I thought if I tell her now that her baby's coming out breech in the moment that it's coming and I spook her, if she's got some hang-ups about breech or you know she's worried about it and I spook her this could really interrupt how the baby emerges so I made it a decision. I'm not going to tell her. I just said to her, hey, for this birth, when you feel an urge to push, you just go right ahead and you give it a good big push. And we're just going to get the whole baby out. Now, the thing with breech birth is it is different to head down birth in terms of the management. So I was trying to give her some information that she could use without spooking her, without kind of alerting her to the fact, hey, your baby is breech. There was nothing we could do we couldn't transfer I didn't want to spook her we had to get the baby out, so anyway she did and the baby came out in one single contraction, and as I handed her her baby I said hey your baby came out bum first and she said oh I thought it felt different.
[32:35] And then afterwards, I quizzed her and I said, look, yesterday I did not feel your baby was breached. Do you think it was? She said, no. She said, I don't think it was breached either. She said, I think I felt it turn during labor. She had this big experience before she called me. A huge, she said the baby did this huge movement and she didn't really know what it was, but it finished. She thinks, and I think too, because I definitely did not feel a breech baby, think that the baby turned in labor. So that was a super, super surprise. Others can just be, you know, some baby's head and bum feel firm, but I don't think it's all that uncommon actually. Although with sort of more mainstream care, if you're with a clinician who regularly puts an ultrasound on you, it's much less likely that that would be missed. And potentially, if you're in hospital and having vaginal examinations and your labor wasn't going fast, the breech baby would be identified during labor. But because I don't do regular vaginal exams, it was a surprise. I don't know how many it would be, though. But how cool that you got to push the baby out of your vagina because so often...
[33:53] If you get diagnosed with a surprise breech birth in labor, they'll recommend that you have a cesarean section unless there's a clinician there who's skilled in breech birth. But this is getting rarer and rarer, unfortunately, to have a clinician who's actually willing to plan a breech vaginal birth. But amazing for you. That's my spicy Friday answer to that question. Oh, my gosh, there's three questions here that I want to answer because they're all awesome.
[34:20] Firstly, well, the first isn't
[34:21] a question. It's just like another huge pat on the back, which I love. This woman says, I'm convinced your work is having a massive impact on women and birth outcomes. Is it possible to somehow quantify it? I mean, wouldn't that be amazing if we could do a study on the impact of the Great Birth Rebellion podcast on women and birth outcomes? I don't know that we can quantify it, but how cool would it be?
[34:45] If we could look back and watch the growth of the Great Birth Rebellion and the improvement of birth outcomes and the reduction in interventions, that could be cool. I could never claim that it was me though. I mean, you'd have to do a study on women who didn't listen to the podcast and women who did, and then you'd have to match them. Here I am designing a study to work out how we could measure the impact of the Great Birth Rebellion podcast and the work of Melody the Midwife on women and birth outcomes. It's possible. It's happening. I don't know. I don't know. But if we were going to study it, you'd have to get women who are matched in as many ways as possible. If you're going to design a study, if someone wants to do this, matched in as many ways as possible. So you were comparing two similar women and then one would have to listen to the podcast and then we have to decide how many episodes do they have to listen to in order for it to be kind of like a therapeutic dose of podcasting. And then the others would have to not at all engage with any of the work. They just kind of get standard, standard care. And this would be like the Great Birth Rebellion Care or like the Melanie and the Midwife group. That's, you could do it. It's possible to quantify it that way to say, hey, the people who listened, the women who listened, and you can do this with courses and things, right? So like if you wrote a course or a program, like they recently did it with the hypnobirthing program, and they compared the outcomes for the women who did hypnobirthing to the women who didn't and then they matched them.
[36:14] We spoke about it recently in an episode not long ago.
[36:17] And they found that the women who use the hypnobirthing technique reduce their cesarean section rate by 30% and reduce their epidural rate by 50%. So I mean, it's doable. Yeah, it's totally doable. That's how you would quantify it. But I can't do that work. I'm really too busy doing the actual work. But if somebody wants to study the impact of the Great Birth Rebellion podcast, that would be, I have a study designed for you. All right, that's that one. Now, this next question, I love it and I'm just so sympathetic.
[36:49] What is your advice for the graduate midwife starting out their career in midwifery? Oh, do I have so much advice. One of my passions is to mentor midwives because I was mentored. The reason I'm here where I am today is because there are midwives who came around me, who believed in my capacity, who saw something in me and decided to commit themselves to mentoring me to make me the midwife that I am today. Honestly, you have to do this with a crew. So I guess that would be my first thing is find some people, find your people. It would be midwives who you really value, whose work you're watching and you think, oh, one day I want to be like that midwife. You want to pursue the people who are doing the things that you want to do.
[37:36] And my advice would be, is to be mentored by them. That can look any way you want. I've mentored people before that said, I just want to sit with you and ask you questions. And so I've done that. I've mentored private midwives, 200 private midwives who went through, I have an online mentorship program that is done with private midwives, midwives who want to be private midwives in Australia. And 200 midwives have been through that program. That is not running this year. You've missed out on that if you're listening. I apologize. But I am mentoring in a whole other way, in a way that can be truly scaled. And it's called the Assembly of Rebellious Midwives. And I'm taking enrollments in October this year, 2027. And I'll open it up for more enrollments each time. But at first, I can take 200 midwives to mentor you through your careers. I'm going to be offering lifetime membership and lifetime mentorship for as long as I am alive, not as long as you are alive. You might outlive me.
[38:45] But my advice would be mentorship. Seek out somebody who's doing the things that you want to be doing in your career and get people around you. So you've got to find like a work buddy. You're on the same page. This can really go nicely for programs like midwifery group practice programs where you're regularly working with other like minded midwives it's all about that one's all about sustaining your career is that you need mentorship and you need a crew and this is why it's why I built the assembly of rebellious midwives because a lot of midwives find they can't find a midwife or they don't have people around them they just always feel like the black sheep in their workplace and they need a place a soft place to land and people to ask questions to that aren't going to roll their eyes and go oh my gosh this again. So, you know, find a mentor. If you can't do that and you want me to mentor you, oh my gosh, in the Assembly of Rebellious Midwives, that's where I do it. I'll put the link to register your interest in that in the show notes. That's the first thing. Second thing, I would read the book so good they can't ignore you. It's by Cal Newport. Now, caveat, he's a man and writes a bit for men, but just take the principle.
[40:02] As you can, so good they can't ignore you. The idea is that you stop looking at all the limitations all around you and the things that you can't change and the things that you don't like and the hard things, which are many in the system, in the maternity care system. It's quite a challenging place to work because there's a lot of, I guess, hostility toward midwifery practice.
[40:24] I would read that book, So Good They Can't Ignore You, and focus purely on your mindset, the craftsman's or the craftwoman's mindset, which basically asks, how can I get better today? What can I learn today? What can I do today? How can I help today to make you a better midwife? So 1% better every day is what we're aiming for. And then you're going to have this exponential improvement in your maternity care. The more interest you have in improving your own self as a midwife, the better and better you'll get. Now in this book, he supposes that the better that you get, that means the more autonomy that you will get in your role, people will trust you more. They know you're capable. You won't be so heavily supervised and watched. And it gives you some autonomy to be the midwife that you want to be if you've become a skilled and trustworthy clinician. But you can't assume that right from the bat.
[41:24] You have to start somewhere. So for example, if you've gone ahead and taken initiative to learn suturing, for example, as a midwife, and you can suture perineums, and then everybody comes to know that when you're in the room, we don't have to wait for a doctor to arrive or do the assessment, that you are fully skilled to be able to do that. You can suture the women who are under your care, they may never need to see a doctor. If they come in and everything's well and they push their baby out and you can see they've got a tear, a second degree tear, you might choose, you know, to offer them the opportunity that you could suture that and you could do it. That, you know, focus on making gradual and everyday improvements because when you graduate, you're not truly, I know they say we are, we're not truly ready. There's a lot of skills and extra things to learn and consolidate. Okay. So just commit to that. So good, they can't ignore you. And you know what happens when you become so, so good? The minute you see a job or a position or an opportunity that you want, you are first in line because you've committed yourself to being so good that when you apply for that position or if you want to take up an opportunity or you want to petition for something in your hospital, you can't be ignored because people have been already watching at how amazing you are so these are my two recommendations is mentorship.
[42:50] So good they can't ignore you and I'm offering my and this I was not intending on advertising the assembly rebellious midwives but this is kind of perfect this is exactly why the assembly of rebellious midwives exists and why I want to, mentor midwives is I think I want to be able to multiply midwives who understand physiological birth, who are highly skilled, who are great at collaborative relationships, all those things, who understand research, who can do evidence-based care, and who give women respectful care. I want to multiply them. And so that's why I opened the Assembly of Rebellious Midwives. So you could join that. The wait list is in the show notes. It opens in October. Or you go ahead, read the book, So Good They Can't Ignore You, find yourself a mentor and go gentle with yourself just remember, you can't change the whole system you're one person, don't expect yourself to be able to make epic and huge changes in your workplace you might make some small incremental ones and all when we work together we make small incremental changes, but you can absolutely work on making yourself the best midwife you could possibly be. So just dive into that. Honestly, block the rest out. That's my answer to that question.
[44:10] All right, this question now, what are your thoughts on the 5,000 hours for private practice? All right, a bit of context. Here in Australia, if you want to be a private midwife, you have to be a midwife. You have to do postgraduate qualification in pharmacology and diagnostics. You have to have 5,000 hours of clinical experience already before you can qualify for the insurance product that we need to take out in order to be private midwives. The only reason that 5,000 hours existed is because that is what our endorsement for the insurance hinders on. So in order to be an endorsed midwife, you have to have 5,000 hours in the pharmacology training. And then you can access the insurance product.
[44:58] However, our registration body is looking to take away those 5,000 hours. And this is what the question is. what's your view on the removal of the 5,000 hours? Straight up, I am in support of removing the 5,000 hour requirement and here is why. Hear me out. No other profession, not a single other profession is not allowed to work to their full scope without further training. Every other profession can work to the scope to which they were trained without doing additional hours and the full scope of a midwife is that they can work in a home birth, community-based birth, hospitals, theatres, anywhere. That is within the scope of a midwife. Why do we have to get 5,000 more clinical hours just to unlock our capacity to work privately in a home setting? This is what it's attached to. Also, I am the product of zero. I did not have 5,000 hours when I started because I started way back before that rule even existed. That rule came in in like 2010.
[46:07] When I qualified, you just needed to be registered, have a kit, know how to open a website so people can find you and start providing midwifery care. Because I'm a qualified midwife, of course I can provide midwifery care. Obviously, I also had a mentor. That's something that I pursued because I knew, that our hospital-based training and our university training does not get midwives ready for home births. It really doesn't. it's not enough. You need a different level of confidence and a different level of skill to be able to attend women at home. But guess where you don't get that skill? You don't get it by doing more hours in a hospital because we don't learn physiological birth skills in a hospital. We learn physiological birth skills by working with women who are having physiological births. And that's so unlikely in a hospital. So, and I'm sorry, I'm being super spicy about that, but the physiological birth rates are pitiful they're minimal, we don't have many of those anymore so midwives don't actually have the opportunity to properly watch and learn physiological birth the only way you can learn how to be a private home birth midwife, is if you become a private home birth midwife and have midwives around you who can support you to in that practice, you won't get the skills that you need for home birth or private practice by doing 5,000 hours.
[47:35] And, you know, the registration body, the Australian College of Midwives, actually all of the bodies involved in putting these rules in place are actually in support of removing them. So the bulk of the argument, even from our registration body, is that it should be removed because it's an unusual requirement. None of the other registered healthcare professionals are required to have any level of additional, work applied to their capacity to work in their jobs, so I think they should go and I think any midwife who's, recommending that they stay is either scared of an influx of other private midwives who are about to come in and flood the market with private midwives and they're worried that it's going to impact on their business earnings.
[48:25] And also maybe there's ones that have done the 5,000 hours and are a little bit bitter that other people don't have to which I think is also a bit rubbish but, I am the product of no 5,000 hours and so I'm in support of it being removed I think midwives should be trusted to be able to work to our scope, also I'd say to midwives who want to go into private practice that you need to make sure that you're fully skilled and your scope is, as such that you can be working in private practice especially in a home setting and the way to do that is to have a mentor and to have midwives around you who are going to keep an eye on your activities, and help you expand your scope so that you are ready to be fully confident in private practice okay there's way more that I would like to say about that but that's what I'm going to say right now okay.
[49:16] Um, oh, this is a good one. All right.
[49:21] Why do midwives push on your uterus after birth with no warning or cause? Can I say no? Ouch. I know. Okay. Can I just say, I don't do this. I do not. It's called fundal massage. I don't fundal massage any woman unless it's involved in the treatment of a postpartum hemorrhage or if she's sort of like reporting some unusual sensations and pain we might do a little check but hear me out here's, what happens and you haven't had your baby yet after you have your baby one of the more common practices after your placenta is born is that a midwife may, more likely than not come and rub your fundus or check your fundus now the fundus is the top of your uterus and once you have your baby your uterus is empty of baby and placenta but it's still, it's still pretty big you'd feel it around the site of your belly button that's around where the top of it will be.
[50:24] And it's become part of midwifery practice that once the placenta is born, the midwife pushes on your fundus and kind of pushes it down to, see if there's any blood clots still in there to be expelled. Because if there's blood clots still in there that don't come out, sometimes that can cause your uterus not to fully clamp down and stop bleeding.
[50:48] The other thing they do sometimes it creates a contraction which will stop bleeding if you are actually bleeding but it sounds like this question was just the woman's like why did they do that I was everything was fine but for some midwives it's routine part of the placental birth process so like it's not finished until we rub the fundus, but it's really painful and I've found it to be unnecessary so I don't have it as part of my usual practice however the majority of my clients have physiological placental birth. So their placentas are born without me pulling them out. Usually if you're in hospital, they do active management where they give you the oxytocin injection and then they put traction on the cord to bring it out. And often midwives will rub the top of the fundus as a result. But, and even to midwives might not realize this, but it's actually not necessary. Like you don't have to do it, but if you are going to do it, at least you have to warn the woman or, I mean not even just warning ask permission to put your hands on their body, and do a procedure that's actually quite painful pretty soon after the birth so, it's kind of routine practice, it's around making sure your fundus is your uterus is fully contracted so that they can predict whether or not you're going to have a bleed or, they might do it in response to a bleed this is a time when I would do it if the woman's bleeding or you know there's even just like a trickle and it's not quite stopping, there could be blood clots stuck in there that need to be expelled, in which case you can kind of push them out from the top of the fundus.
[52:18] Or if she's actually bleeding, rubbing the fundus will create a contraction to help prevent further blood loss. So it can be done for a variety of reasons. But if there was nothing going wrong and everything was completely normal, they're usually doing it to make sure it's firm so that they can predict whether or not you may or may not have a bleed a little bit later. Make sure it's not filling with blood, but you would feel that too. That's painful to have blood clots and blood in your uterus. Yeah, sorry about that. but they should ask for permission and you can say no, yes, that would be fine. And they'll only just re-feel it again, but it shouldn't hurt. I mean, I do feel women's funduses just to feel if it's firm, but that doesn't hurt. It's the fundal massage that hurts. Okay, that's what I'm going to say about that.
[53:09] Okay, this is a good one. It's pretty loaded. The question is, does birth impact breastfeeding? The short answer is yes. We know babies born by cesarean section, for example, have more trouble breastfeeding for various reasons, especially if it's what we call like a cold cesarean where you haven't had any contractions and then the baby's born. That can make it a lot harder for you to establish your milk supply and for the baby to latch. But and then also we do say, you know, my clients often ask, oh, my gosh, breastfeeding, well, what's going to happen? And my usual response is, and my response is this, based on my experiences, my experience as a private midwife, 18 years. Very few of my clients have actual genuine trouble breastfeeding. Occasionally there's a fundamental issue with supply or, you know, anatomy issue. But very rarely does this ever happen.
[54:12] Your breastfeeding journey is a direct result of the birth process. So pregnancy, birth, postpartum are all along the same continuum. Your pregnancy impacts your birth. Your birth impacts your breastfeeding and postpartum experience. And there's so many papers that I want to refer to for this. And I know that that's like a sentence that somebody would like write to APRA and go, Mel said the birth impacts the breastfeeding journey. And, of course, this is probably a whole podcast episode because there's a stack of papers that reflect this. But I want to give more. But, yes, in short, yes.
[54:58] An uneventful physiological birth where everything just flows generally, in my experience, leads to an uneventful breastfeeding experience where everything just flows. That's what I'll say about that.
[55:12] Okay, this is another good question. What are your thoughts on whether a physiological third stage has to be a lotus birth? So no cutting and clamping the cord. Okay, I think this is a misconception. So the majority of my clients will have physiological placental births, which just means that they're not having the octetocin injection and having the cord traction to bring the placenta out. What it means with a physiological third stage is that you're just, the woman is pushing out her placenta in a physiological way in the same way she pushed out at her own baby. It's a continuum of the process.
[55:50] If you want to detach the baby, you can. We wait for the cord to be white. That means the baby's finished with the placenta. And then you can cut the cord and clack the cord and then you just give birth to the placenta in a physiological way. You don't have to have a lotus birth. And a lotus birth is where you keep the placenta attached to the baby until the cord falls off along with the placenta. So as it sounds, you carry the placenta around with the baby. It's prepared in salt and things like that and wrapped in a parcel. You carry it around with the baby until it falls off all on its own. It can happen anywhere from like two to ten days. That's a lotus birth. But you can have a physiological placental birth after cutting the baby from the cord. You absolutely don't have to keep it attached to the baby. But you should keep, in a physiological placental birth, you should keep the baby with the mother. And the placenta can stay attached to the baby and then the woman pushes out the placenta and it's still attached to the baby but then we just cut it off afterwards when when the mom's ready to cut the cord so no it's not a prerequisite you have a physiological placental birth whether the baby is attached to it or not.
[57:04] All right we've got a time for a few more questions and I like this one because it's going to reveal it's going to reveal a few things The question is, despite being a midwife for three and a half years, I still can't determine flexion on an abdominal palp. Any tips? Okay, so what this midwife is asking, basically we do abdominal palpation for the baby and we feel their position where they're lying. Technically we can feel where their head is if it's deflexed or flex facing down or if it's immediately up, And I want to say, I palpate women's babies all the time. And little secret, even I'm not certain most of the time. And I think, and this is the controversial part.
[58:04] I don't think anyone's certain. I reckon we could all just be making things up with what we're feeling with the head. I would love to hear from you as a midwife if you're like, no, 100%, I'm confident every single time I palpate, I know the position of the baby's head. I.
[58:23] Don't know that we can tell. Is that sacrilege? Am I like sharing some big secret? But anyway, that's what I want to say about that. Even I struggle. and actually I don't think it even really matters because if women are moving around in labor and birth and doing what they feel is intuitively going to happen and they haven't got an epidural and you know you're supporting them with all different positioning, the baby should theoretically get itself into appropriate birthing position in theory gosh I'm rambling now okay let's find another question, Okay, this is a good one. If a baby was born with an APGAR score of two at home, so, anything above seven is considered like a pretty good APGAR score,
[59:11] and an APGAR score is what we use to kind of grade the condition of the baby when it's born. Does this baby need resuscitation and help transitioning, or is it doing okay? If the baby was born with an APGAR score of two at home and was floppy, what would happen? So, you know, if you're receiving a baby as a midwife and the baby comes out and kind of flops into your arms and just has no tone and is not crying and we call them floppy babies. This is kind of a bit of a midwifery terminology.
[59:42] Okay, what would we do? This has happened to me many times, multiple times. It happens in occasions with if you've had to help manage shoulder dystocia, sometimes just all of a sudden. So if a baby comes out floppy, we do exactly the same thing as what would be done at a hospital. We prepare for resuscitation. We have all the resuscitation equipment that we need, including newborn airways. If we need to place an airway, we've got bag and mask, oxygen, oxygen saturation monitors. We can listen to the baby's heartbeat. So we can do everything that would be done for an early resuscitation for a baby. at home. Otherwise, we wouldn't be there. If we didn't know how to manage a baby that came out with a low APGAR, you should not be doing midwifery at home, just putting it out there. The other thing that happens is it doesn't happen very often at home because there's no pain medications that we're using. Theoretically, the women are well and healthy enough to be, you know, I guess, eligible in inverted commas for a home birth.
[1:00:56] And the birth's been physiological. It's just potentially something that's happened at the end that's caused the baby to be like that. In which case, babies are really resilient and they come good. So we know how to resuscitate, basically. We may need to do chest compressions. Obviously, for babies born with an APGAR of two, we would be immediately calling an ambulance as well to transfer in. But babies are incredibly resilient. And they very, they don't, not very often do they end up unwell as a result of a physiological birth. And it's usually because of shoulder dystocia or a cord prolapse or something like that. But again, not very often, but we're completely equipped. So that's what we would do. Okay.
[1:01:41] All right. I'm going to need two more questions, this one. All right. This is a statement, I guess, but I have something to say about it.
[1:01:49] Sonographers giving results that scare you only for your midwife to say that everything's fine. I have a massive bugbear about sonographers who do a scan, find a thing, and then go ahead and start giving women advice, recommendations, or opinions. So things like, whoa, that's a big baby. Looks like you'll be having a cesarean section. Or like, whoa, there's not much fluid in there, best to be preparing for an induction or whatever it is they say. It's happened so often that the sonographers go ahead and give you actual advice. Let me tell you, the only job a sonographer has, and they're excellent at it and I love them and they're brilliant. The only job a sonographer has is to do the ultrasound, Get the pictures and report back to your care provider of what the pictures found. That's all. It's almost like the person who's taking your blood...
[1:02:58] Imagine if they got the results in front of them and they went, oh, look at that, your iron's low. That means you need this, this, this, this, and this. No, their only job is to collect the information and deliver that information to your care provider who's supposed to be the one to give you the next advice. What are we going to do now that we've found this thing? They're just supposed to find the thing. So can I suggest if your sonographer says something, do not take it as professional advice. They're actually not trained in healthcare. They're trained to do ultrasounds. They're not trained to look after you with what happens to you that they found in the ultrasound, if you know what I mean. You know, when I tore my calf playing netball and I had an ultrasound and the sonographer said, you've torn your calf. But they didn't tell me what to do next except your doctor will get the report and you'll plan a rehabilitation with them or with the physio as it turns out, so that's that's bugbear with that don't take sonographer's advice as medical advice because they don't actually know they're not trying to know that they're just trying to take the pictures and interpret the pictures and then report those back.
[1:04:12] Unless you've got a sonographer who also happens to be an obstetrician all right let's do this one.
[1:04:18] This woman says, I requested a copy of the water birth policy. The midwife states she's not allowed to. Is that correct?
[1:04:29] Either she's lying. She might have said she's not allowed to because the hospital won't allow it. Maybe. I've never heard of a woman being declined a policy. I would have just responded with, yes, you're allowed. I need to see the policy. Or can you please, I need to speak to somebody else then. You can request any of that information. No, not correct. So the question is, is this correct? No, not correct. Go back. You can ask again. In fact, some water birth policies are publicly available online for certain hospitals. All right, let's do one more question. Let's do one. Oh, I've got to pick a goodie. There's so many. Look, look at this. Oh, there's so many. They just keep they just keep going and going and going and going so oh gosh how do i choose okay, And a lot of them already have podcast episodes available for them. So my first suggestion is, if you didn't get your answer, have a little scroll through the Great Birth Rebellion podcast episode, see if they've got something there. But top tip, actually, if you go to melanethemidwife.com, I've got a free button question there.
[1:05:41] I've got a free stuff button there on the front page. And there's a catalogue of all the podcast episodes that are available for the Great Birth Rebelling podcast and then you can scroll through just the list and see which ones you want to look at. It's a bit easier than scrolling through on your device. Oh I'm going to do this one. Okay I'm going to do this one.
[1:06:04] Tips on how to support neurodiverse women in labour with sensory issues in hospital. This is a good question and I've been thinking about this because I've had clients who've specifically chosen to have home births because they just absolutely, cannot tolerate the environment in hospital. There's quite strong smells in hospitals. They use cleaning products that can be offensive to people who are neurodivergent.
[1:06:33] Confronted with strangers, sounds, lights, all kinds of things can be really, disruptive to the process of the labor process for a neurodivergent person. In fact, any woman would have trouble. So it's all about the feeling of being overwhelmed. I'm not neurodivergent, so I don't have a personal experience with this, but I have family members who are, and obviously I've cared for women who are, so I can only give you my opinion based on that.
[1:07:08] But the real element for women who are neurodivergent is the overstimulation and overwhelm. So the focus should just be on reducing stimulation.
[1:07:26] I would go for low lights, as few visitors in the room as possible, no new people, no random intrusions in the room of anybody who wants to introduce themselves to this woman, I would turn the sound if there's a CTG on, if you can turn that sound off, uh the you know often things beep and make noises all the time in birth rooms turn off anything that's beeping close off the lights, ask the woman if she has particular music or something that would help her feel settled. And just reduce the amount of interaction. Often if the woman's overwhelmed, she's overstimulated, don't add to it. So yeah, low lights, as limited stimulus as possible. You could also try a smaller room. Sometimes having less space could help. Offer calming things like maybe the bath or the shower, but also they could be overstimulating too. Sometimes just a feeling of water could be enough. But with any woman who has particular needs.
[1:08:39] Ask her specifically, what do you need from me in order to feel safe and not overwhelmed? Ask her. She's probably got some strategies. She's lived in her mind with her body and with her situation for her whole life. Ask her, what do you need from me in order to feel safe and not overwhelmed? And then you'll get the answer directly from her. but at the very least.
[1:09:10] Reduce stimulation to avoid overwhelm that's what i'll say for that one, all right that is a little taste of spicy friday if you liked that, i do spicy friday every friday this is i know it's spicy monday but it's podcast but i do spicy friday on my instagram stories at melanie the midwife. You can join me there. Better yet, if you loved Spicy Friday, but on a Monday on the Great Birth Rebellion podcast, send me an email or a message. Let me know. I'd be keen. If you love it, I can keep doing it. I've appreciated doing Spicy Friday on a Monday for the Great Birth Rebellion podcast. Now, don't forget, I mentioned the convergence of rebellious midwives as we were getting started, tickets are on sale now and two for two weeks. They are $200 cheaper. And you can go to my website, melaniethemidwife.com to have a look. And anything that I've referenced today, any podcast episodes, all the links, all the information is in the show notes. That's been today's episode of the Great Birth Rebellion podcast, and I will see you next week.
[1:10:24] To get access to the resources for each podcast episode join the mailing list at melaniethemidwife.com and to support the work of this podcast wear the rebellion in the form of clothing and other merch at thegreatbirthrebellion.com follow me, mel @melaniethemidwife on socials and the show @thegreatbirthrebellion, all the details are in the show notes.
This transcript was produced by ai technology and may contain errors.
©2026 Melanie The Midwife
