Bronwyn Holmes -Childbirth Educator & Doula

26/03/2026

Guess what we are covering tonight?

26/03/2026

Great Dr with a great approach!

When fear shapes birth: the quiet rise of defensive caesarean sections

There is a narrative that caesarean sections are often done for convenience. And while that may happen in isolated cases, it is not the full story.

In modern obstetrics, one of the most powerful and often unspoken drivers of decision-making is medicolegal risk.

We practise in an environment where, when something goes wrong, the question is often not what was reasonable but rather, who is to blame?

And more often than not, that responsibility falls on the doctor.

A vaginal delivery, even in the safest hands, carries an element of unpredictability. A baby can deteriorate quickly. Labour can change course in minutes.

A caesarean section, on the other hand, can feel from a legal perspective like a more “controlled” option.
And so, in grey areas, the decision is not always purely clinical. It is sometimes influenced by the quiet question: “Will I be criticised for not intervening sooner?”

This is where defensive medicine begins.
Not because doctors don’t believe in vaginal birth.
But because the cost of being wrong can be devastating, both professionally and personally.

At the same time, there is another extreme.
A growing narrative that “natural birth at all costs” is the ideal even when clinical concerns arise.

But birth is not ideology. It is medicine.
And while vaginal delivery is often the safest and most appropriate route, there are moments where intervention is not failure, it is necessary.

The safest obstetric care lives in the middle ground.
Not rushing to surgery out of fear.
Not avoiding it out of principle.

But making individualised, evidence-based decisions
with experience, judgement, and respect for both mother and baby.

As obstetricians, many of us deeply value vaginal birth. We advocate for it. We support it. We work hard to create the conditions where it can happen safely.
But we also carry the responsibility of knowing when to step in.

And sometimes, those decisions are made in seconds; in rooms where there is no room for ideology, only accountability.

What patients should know....
If a caesarean is offered, it is not always because it is the easiest option.
Often, it is because the margin for risk has narrowed.
The most important question is not: “Was this natural?”
But rather: “Was this safe, appropriate, and in my best interest?”

And what the system must recognise: If we want to reduce unnecessary caesareans, we need to create environments where clinicians can support vaginal birth without fear. Where good clinical judgement is protected. Where outcomes are understood in context, not just in hindsight.
Because birth should not be driven by fear.

Not fear of litigation.
Not fear of ideology.
But guided by balance, trust, and sound clinical care.

22/03/2026

This is the WOMBS Commitee of 2026.

20/03/2026

Where the APGAR score comes from.

On December 12, 1952, in the delivery room of a New York hospital, a baby was born blue, limp, and silent. The room froze. For a terrifying moment, it looked as though the medical team might simply accept the outcome.

Then a calm, steady voice cut through the panic.

“Let’s score the baby.”

That voice belonged to Dr. Virginia Apgar. In that single sentence, she did more than save one infant—she gave the world a tool that would save millions.

Virginia Apgar was born in 1909 in Westfield, New Jersey, the youngest of three children. Her father died when she was young, leaving her mother to raise the family alone. Money was tight, but education was non-negotiable. Virginia excelled in school, graduated from Mount Holyoke College in 1929 with a degree in zoology, chemistry, and physiology, and entered Columbia University’s College of Physicians and Surgeons—the same year the stock market crashed and the Great Depression began.

She graduated fourth in her class in 1933 and was determined to become a surgeon. But in the 1930s and 1940s, surgical residencies were almost exclusively reserved for men. One professor told her plainly: no hospital would hire a female surgeon. Many would have walked away. Virginia pivoted. She chose anesthesiology—a new field, less prestigious at the time, and one where women were slightly less unwelcome.

She trained at Columbia-Presbyterian Medical Center, became the director of the division of anesthesia in 1938, and turned it into one of the country’s strongest programs. She mastered the science of putting patients to sleep and waking them safely. She also saw something no one else was paying attention to: newborns.

In the maternity ward, she watched too many babies die in the first minutes or hours of life. Doctors had no standardized way to assess whether a newborn was in distress. Breathing, heart rate, color, reflexes, muscle tone—each physician judged these differently, often subjectively. There was no shared language, no protocol, no urgency tied to measurable signs. Babies who might have been saved were sometimes left to deteriorate because no one had a clear signal to act.

Virginia decided to fix it.

In 1952 she sat down with a pen and paper and created a simple, five-point scoring system. One point each for:

- Heart rate (absent, slow, over 100)
- Respiration (absent, slow/irregular, good cry)
- Muscle tone (flaccid, some flexion, active movement)
- Reflex irritability (no response, grimace, cry/pull away)
- Color (blue/pale, body pink/extremities blue, completely pink)

A score of 0–2 meant immediate intervention. 3–7 meant monitoring and possible support. 8–10 meant the baby was vigorous and healthy. The test took sixty seconds to perform, at one minute after birth (and later also at five minutes).

She called it simply the Apgar Score.

The medical community did not resist. They adopted it. Within a decade it was standard in nearly every hospital in the United States. Because doctors finally had a universal, objective language to assess newborns, they knew exactly when—and how urgently—to intervene. Resuscitation rates rose. Neonatal mortality dropped significantly. Studies later estimated that standardized neonatal assessment contributed to declines of 40–50 percent in high-risk infant mortality in many regions.

Virginia did not stop there. In 1959 she earned a Master of Public Health from Johns Hopkins and joined the March of Dimes, where she became vice president for medical affairs. She spent the rest of her career advocating for maternal and child health, researching birth defects, and pushing for prevention and early intervention. She lectured worldwide, wrote extensively, and mentored generations of physicians.

When people asked how she thrived in a field that did not want women, she would offer a small, knowing smile. “Women are like tea bags,” she said. “You never know how strong they are until they’re in hot water.”

Virginia Apgar died on August 7, 1974, at age 65, from liver cancer. She never married, never had children of her own. But every two seconds, somewhere in the world, a newborn takes its first breath, and a doctor or midwife silently calculates a score.

That number is her monument.

It is quiet, invisible, essential. It does not bear her name in bronze or marble. It simply works—saving lives one minute at a time.

She did not invent breathing. She invented the certainty that a baby who needed help would receive it. She did not ask for recognition. She asked for a system that noticed suffering and acted.

Because she refused to accept guesswork where lives were at stake, millions of children have grown up who otherwise might not have.

Virginia Apgar proved that one person with a pen, a clear eye, and the refusal to accept “that’s just how it is” can rewrite the future.

Most people will never know the woman behind the score they receive at birth. But every life she helped save is living proof that you do not need fame to be a hero. You just need to leave the world better than you found it.

20/03/2026

Ready and set for another jam packed class!
Don’t miss out.
My next course starts in May!

26/02/2026

25/02/2026

Delayed cord clamping (DCC) for one minute is said to transfer about 80 mL of blood from the placenta to the fetus.

New study finds that on average given DCC weigh about 24g more than those who did not have a delay.

Wonder where the extra grams went? 🤔

https://pubmed.ncbi.nlm.nih.gov/41720473/

12/02/2026

The power of contractions.

💪Wow look at this powerful contraction!
Labor contractions are a consistent and strong rhythmic tightening or internal squeezing of the belly that is coupled with a cramping sensation followed by A relaxing of the muscles of the uterus. Here's what happens during a contraction: You can visualize it like you are starting to climb a mountain. There is a starting point, climbing up, peak (the most intense part), let down and then a break.

* The Start: The uterus muscles begin to tighten, causing a sensation of pressure coupled with cramping in the lower abdomen, back, or pelvis.
* The Build-up: The contraction gradually increases in intensity and duration.
* The Peak: The contraction reaches its maximum intensity. This only lasts for about 10- 15 seconds and is when the muscles are working hardest to dilate the cervix and push the baby down.
* The Let Down : After reaching the peak, the contraction begins to decrease in intensity and duration as the muscles relax.
* The Break: Belly is relaxed and you can recharge and rest as you gear up
* For the next wave.
# 📸

30/01/2026

I love seeing men show up for class.

Childbirth education isn't just for you, it's for your support team too!

It helps partners have a deeper understanding of what's happening, recognize how to provide support, and feel more confident during intense or unfamiliar moments.

An informed and educated partner often feels less helpless and more connected to the birth experience as a whole!

Birth is a team effort, and education supports the entire team!