Great Expectations Birthkeeping

12/07/2025

“It doesn't matter how many pinging machines we bring into the room, how many research studies we do or how many specially-trained people are standing around.

They will never be able to prevent every problem.

What they will do, however, is to continue to undermine women's knowledge, prevent the flow of the hormones that make birth happen (and generally happen pretty well) and perhaps cause problems that wouldn't have happened if we had left well alone.”

That’s a quote from my book, ‘What’s Right For Me? Making decisions in pregnancy and childbirth.’

It also summarises my experience after studying birth-related research for more than three decades.

Sure, some people will come along and tell you otherwise.

Some will try and tell you that your body is faulty.

They might try and make it about your age, weight, and/or the colour of your skin.

Some will use long words and the fact that they have qualifications or have written books to try to persuade you.

Some will try and tell you that I and others like me are mad, bad, or dangerous charlatans.

(If you want to check me out, see my 'about' page).

Others will use their sparkly insta skills and the fact that they are NOT trained to try and convince you that their way is better and that things can never go wrong.

That's not true either.

(One thing I’ve learned about genuine experts over the years is that they don’t tell you they’re an expert. Or, worse, tell you in false humility that, “others say I’m an expert.” They just quietly get on with it, offer balanced information and evidence and let you decide for yourself whether to listen or not.)

If you’ve made it this far, I think we can be confident that you’re fairly good at making decisions, and more than capable of deciding what’s right for you.

If you’d like another source of birth-related information to ponder as you make those decisions, you’ll find loads more info at https://www.sarawickham.com/me

19/02/2025

A retrospective comparative cohort study looked at the outcomes of 100 Australian women who gave birth at home during the study period.

"They were more likely to have a physiological birth (p < 0.001), intact perineum (p < 0.0001), and less likely to have a postpartum haemorrhage (p < 0.0001) compared to the matched cohort of women who birthed in hospital.

There were less assisted births and caesarean section births for women who transferred from home to hospital (p < 0.0001).

No statistical differences were seen between groups for postpartum haemorrhage, and Apgar score of < 7 at 5 minutes."

"This study demonstrated favourable outcomes for women receiving MGP who planned to birth at home compared to those women who chose a hospital birth.

This is consistent with the existing literature that place of birth makes a difference."

you can see the study at https://www.womenandbirth.org/article/S1871-5192(24)00324-X/fulltext

This is just one of the studies that we will be sharing in this month's Birth Information Update, which we send to followers of Sara's emails.

If you're not on our list and would like to be, you can sign up at https://www.sarawickham.com/news

We have added this study to our home birth information hub, which you can see at https://www.sarawickham.com/research-updates/is_home_birth_safe/

10/12/2024

Many studies have challenged the idea of a fixed due date, with one researcher noting that this idea “stretches credulity.”

Gerald Wightman Lawson searched and analysed the medical literature relating to "variables on the length of pregnancy, the expected date of confinement, and prolonged pregnancy."

His research (like many other studies before) confirmed that:

"a number of factors were found to significantly influence the length of a pregnancy, including ethnicity, height, variations in the menstrual cycle, the timing of ovulation, parity and maternal weight." (Lawson 2020)

And for those who would like a bit more detail...

"The proposition that a pregnancy is 40 weeks or 280 days in duration is attributed to the German obstetrician Franz Naegele (1778–1851).

His rule adds nine months and seven days to the first day of the last menstrual period.

The expected date of confinement from this formula is approximately right in the majority of cases.

However, the idea that this rule can apply to every pregnant female – young or old, nulliparous or multigravida, Caucasian, Asian, African, or Indigenous – stretches credulity.

In addition, many women regard the 40‐week date as a deadline, which if crossed, may then place the baby under stress.

Forty weeks is such a simple, round, convenient figure that it has proved difficult to challenge, despite criticism.

Nonetheless, what might have been an appropriate formula in Germany in the 19th century deserves to be revisited in the 21st."

You can see the paper at https://obgyn.onlinelibrary.wiley.com/doi/10.1111/ajo.13253

For loads more information about "due dates", other approaches and the options available towards the end of pregnancy, see my books on induction, or visit https://www.sarawickham.com/iol

10/10/2024

Some doctors may try to push you into agreeing to an induction or cesarean. This post will discuss how to prevent being talked into one you don’t really need.

30/05/2024

When Chantel* arrived for her prenatal appointment, she hadn’t eaten in three days. As the midwives seated her at the table and offered her a meal, she laid her head on her arms and sobbed.

Through her tears, Chantel shared her heartbreaking story. Eleven days ago, her husband passed away, leaving her five months pregnant with their third child. Without a job and unsure of what to do next, she faces the daily struggle of finding food for her children and a safe place for them to sleep. Her despair is overwhelming.

Stories like Chantel’s are all too common for the midwives here. They hear tales of pain, hopelessness, and desperation every day, especially now, with the worsening situation in Haiti.

When the midwives reach out to us for help with a specific mother, we listen and take action.

We Need Your Help

The situation in Haiti is dire. We are seeking donations to help Chantel start a micro-business, which will provide her with a sustainable source of income. Your support will also enable us to continue offering free prenatal care and safe birthing services to women in dire need.

How You Can Make a Difference

Please donate and write “mom of three” in the notes section. Every contribution, no matter the size, will make a significant impact on Chantel’s life and the lives of many other women and children we support.

Donate Now - mamababyhaiti.org/donate

Thank you for your generosity and support.

(*name changed for privacy)

16/04/2024

Hansard record of the item : 'Cass Review' on Monday 15 April 2024.

24/11/2023

Think my page may have been hacked. Don't accept any friend requests.

25/10/2023

Changes to birth practices happen overnight when they align with the dominant discourse. Five years after the perineal (OASI) bundles were introduced we have research confirming the harm caused by these interventions.
https://midwifethinking.com/2018/05/09/the-perineal-bundle-and-midwifery/

26/09/2023

Please sign - women being erased.

525 signatures are needed, let’s get there by the end of the day?

06/09/2023

Amazing book from a fabulous author and expert.

15/08/2023

The 'diagnosis' of gestational diabetes is used to control and coerce women and prevent their choices.

About one in six pregnant women in Australia are now diagnosed with gestational diabetes. Rates have more than doubled since the thresholds for diagnosis were changed.

25/06/2023

The virtually indiscriminate use of induction has now reached an almost industrial scale. And the consequences for women are serious.

Analysis of data from 184,422 healthy women’s birth records has further confirmed some of the current issues that we face around growing rates of induction of labour.

The results of this analysis show that induction isn’t associated with improved perinatal outcomes. However, areas which have lower induction rates also have lower unplanned caesarean section rates.

Researchers “…focused on practice variation in induction of labor between maternity care networks in the Netherlands. These collaborations of hospitals and midwifery practices are jointly responsible for providing high-quality maternity care. We explored the association between induction rates and maternal and perinatal outcomes.” (Offerhaus et al 2023).

Offerhaus et al (2023) focused on healthy women who were giving birth to a single baby at term. This is one of the groups that those who are questioning the current high induction rate are most worried about.

That’s because these women’s chance of a problem if they await spontaneous labour is low, especially when compared to the downsides of induction.

There are also significant benefits to awaiting spontaneous labour, as I discuss in “In Your Own Time.”

The researchers divided areas into those with lower (18%), moderate (23.8%) and high (30.8%) induction rates.

The women in the areas with the lowest induction rate, “…had fewer unplanned caesarean sections (Q1: 10.2%, Q2-3: 12.1%; Q4: 12.8%), less unfavorable maternal outcomes (Q1: 33.8%; Q2-3: 35.7%; Q4: 36.3%) and less adverse perinatal outcomes (Q1: 1.0%; Q2-3: 1.1%; Q4: 1.3%).” (Offerhaus et al 2023).

These data show us what happens on a population basis with different rates of induction. They show how just a small percentage change in the induction rate can lead to small but important differences in outcomes.

As ever, this is a complex topic and I cannot possibly say everything there is to say about this study in a social media post. You can get more depth on this topic by reading the study at bit.ly/43PeAPt

You can also learn more about induction research and the wider issues in In Your Own Time: www.sarawickham.com/time