When it comes to pregnancy, the choice between a natural and a caesarean (c- section) birth often comes up as a heated topic of interest.
As each woman and pregnancy is so unique, there is a multitude of reasons why a woman would eventually have a natural or caesarean birth — and this could be either planned by choice or due to medical reasons.
In an interview with theAsianparent, we speak to mum of two boys and DONA Birth & Postpartum Doula and Lamaze Childbirth Educator, Leila Ng Caceres, who not only struggled to get pregnant but also fought for the birth that she wanted (read:natural breech birth) despite the odds stacked against her.
As a doula, Leila provides physical, emotional and informational support to parents and directs them to evidence-based resources if needed. | Image source: Instagram/mamacoachleila
Struggled With Getting Pregnant
According to Leila who “never really had regular periods” as a teenager, her condition did not affect her until she met the man who would become her husband. She decided to get herself checked.
That’s when she found out she has Polycystic ovary syndrome (PCOS)—a condition whereby a woman’s hormone levels are imbalanced, causing her to skip menstrual periods and making it harder for her to get pregnant.
“For someone who really loves kids, it was really tough for me to hear,” says Leila.
Subsequently, Leila was placed on medication and the couple successfully conceived a month into their marriage. “We were really blessed,” she says.
The Eunice Kennedy Shriver National Institute of Child Health and Human Development says that women with PCOS are three times as likely to miscarry during the early months of pregnancy as compared to women without PCOS. Leila’s cousin lost three babies due to PCOS, one of them at week 34.
“The entire time from the moment I found out I was pregnant till week 34, I was really freaking out. When week 34 came, I heaved a sigh of relief,” the 32-year-old Singaporean recounted.
Baby in Breech Position: Does That Automatically Mean Having to Go Through C-Section?
However, that relief did not last long. A prenatal check at week 34 of her pregnancy revealed that Leila’s baby was in a ‘breech’ position.
“Babies are supposed to be head down, but my baby’s bum was down instead!” she says. Leila’s doctor advised her to wait until week 36 before discussing the options available if her baby had still not turned head down.
Leila spent the next two weeks trying to turn her breech baby. “I tried everything. I attended spinning baby classes, more antenatal classes. I was googling everything that I can try to flip my baby. I think I probably watched like 300 to 400 birth videos on how to flip a breech.”
As a first-time mum to be, Leila recalled that everything she could to turn her baby, from going for moxibustion treatments to mopping the floor on all fours and sleeping on the ironing board upside down. She even placed a bag of frozen peas on her belly where the baby’s head was, but to no avail.
When week 36 came, instead of discussing their options as previously mentioned, Leila said her doctor simply told her to pick a date for a C-section, which “caught [her] completely off guard.”
“He sounded like we’re going to grab coffee together, just, let’s pick a date and cut the baby out. But it is a major abdominal surgery!”
Moreover, the doctor did not suggest or do anything to help turn the baby, Leila adds.
“Somehow I just really just didn’t want a C-Section”
Leila’s OBGYN said that opting for a natural birth with a breech baby could result in the baby getting stuck in the birth canal and that she might lose him.
“It was really planting the seed of fear into both of us. But somehow I just really didn’t want a C-section. I don’t know what was driving me, maybe my maternal instinct.
“For me, it’s not that I’m against a C-section but I’m very against not being able to even try. As a woman, it’s like the doctor has written my ability to birth my baby off, I felt like I had failed,” she adds. Leila says she wanted to know what options were available, especially when there was still a considerable window before the baby was due.
“At week 37, the baby has so much more to grow while in the belly. The brain and lungs are getting ready for the outside world in general,” she explains. Not giving up on getting the natural birth that she wanted, or at least be given the option to try for it, Leila told her husband that she wanted to get a second opinion. She eventually did so with another doctor, while at week 37 and a half.
While Leila shares that she has a deeper attachment to her first doctor because he helped her to conceive, he was not going to give her the birth that she wanted.
Why Knowing Your Options Is Important
The second doctor explained all the risks that accompanied a breech delivery and shared some options that Leila could consider. It enabled Leila and the doctor to agree that they could safely attempt a natural birth first rather than proceeding immediately to a caesarean.
Recounting her experience at week 39 after her water bag broke, Leila says her contractions were mild then. But because they were dealing with a breech baby, her second doctor advised her to make her way to the hospital.
From there, the pain from the contractions grew. Fighting the contractions, Leila tensed up which caused the initial 7cm dilation of the cervix to retract to 5cm.
The doctor gave Leila some more time as both mother and baby were still coping well with labour. However, “If [the doctor] comes back in the morning and it’s still the same or if my cervix closes further, it was likely the doctor was going to suggest a C-section for prolonged labour,” says Leila.
“In that instance, I told my husband I want an epidural, remembering reading that epidural sometimes allows the mother to relax and hopefully avoid a Caesarean.”
About six hours or so after administering the epidural, and Leila managing to get a nap after 32 hours of labour, she gave “three or four pushes”, and her son was born, “bum first into the world!”
“I saw him for a split second before he was whisked away to the neonatal intensive care unit (NICU). Because apparently, he wasn’t breathing okay,” says Leila. She recalls being very insistent in wanting to see her baby, to the extent that she would have dragged herself to see him if the nurses did not let her.
“If you really want something, it’s all up to you.”
“My whole birth made me realise that if you really want something, it’s all up to you. Your nurses and doctors will not harm you, they will still protect you and keep you safe, but within the boundaries of what you set.”
“You are actually the spear-header, the driver of everything. At the end of the day, you decide what happens to you, your own body, your own baby,” says Leila.
“Find the people [who] support that, be it your OBGYN, hospital, husband, mother or confinement nanny.”
She also advises: “Don’t be afraid to switch doctors. There is no obligation that you have to stick with the doctor that’s been with you for 10 years.”
The former freight trader explains how she would have been in a very different place right now if she simply agreed to a C-section out of fear, instead of a place of power or choice.
“So that’s my biggest learning, and it is the thing everyone hears me say over and over. That’s the reason why I do what I do because I want everybody to make informed choices from a place of knowing all their options and not from a place of fear,” says the US-certified DONA Birth, Postpartum Doula and Lamaze Childbirth Educator.
Image source: Website/Leila & Co.
“If you can find your “why” to do certain things and you choose to do it, you walk in with your eyes wide open, planning for it.” And that carries on to breastfeeding and parenting, apart from the kind of birth parents want, Leila adds.
“Birth shouldn’t be like this”
Leila shares that her son was about three and a half months old when she was trained by the founder of The Oregon Doula Association in the United States.
Shadowing the doulas in the hospital, it made Leila realise this was what she really wanted to do.
Her family later returned back to Singapore and Leila went on to support hundreds of births and parents.
“But what I teach in my class is not how to go against your doctor but how to clarify,” says Leila on founding her company, Leila and Co., that helps parents and babies create their best possible pregnancy, birth and postpartum experiences.
Taking all of her learnings with her during her second pregnancy, Leila gave birth to her second child after four hours of labour, standing up, over the bathtub in the hospital. A stark difference to her firstborn which took 42 hours.
“There must be something that I did right. Like my whole pregnancy, the way I am, and of course during labour.” Unlike her first birthing experience, Leila was also able to have immediate skin-to-skin contact with her second son—something that she wasn’t able to do previously with her first son who was immediately taken into the NICU after he was born. Leila was also up and about on her feet hours after the second birth, playing with her firstborn.
Leila attributes the skin-to-skin contact to the difference she sees between her sons in terms of successful breastfeeding, temperament, and how secure and grounded they are.
Image source: Instagram/mamacoachleila
Empowering Women To Give Birth Confidently
As to why Leila decided to also venture into childbirth education after becoming a doula, she says she wants to reach more people.
In her experience of having attended a hospital birth class in Singapore while pregnant with her second child, Leila notes that the classes are less likely to help inform parents of their possible options, unlike private classes that are charged at exorbitant fees.
“That’s where I realised something was missing. I want to help make private childbirth and parent craft classes that share more about the parents’ options more widely available and affordable.”
Lamaze is a method of childbirth preparation that has existed for a long time based on educating parents on what to expect during the labour and birth process and Ivan Pavlov’s theory of conditional response; applying distraction and comfort techniques to help lower the woman’s perceptions of discomfort during contractions.
Less of a method and more of an approach to childbirth, Lamaze has evolved into evidence-based maternal and fetal care over the decades. It helps to empower women to feel confident in their ability to give birth as well as teaching coping mechanisms such as touch, breathwork, movement, etc for labour.
“Your Doctor is Your Go-to Person”
Rather than coming out of the antenatal classes and then turning to Google, family or friends, Leila highlights the importance of clarifying doubts with the doctor, which is what she teaches in her classes.
“Clarify and ask them for options or alternatives before it hits crunch time. And then you can decide what it is that you want,” says Leila. “All these things affect how much risk you want to take.”
According to Leila, unlike other classes which involve multiple sessions, her class is a full-day crash course (eight and a half hours), which she says parents really like, especially the dads.
“During my class, I help the birth partner figure out what the various birth terms and stages are, what to expect and how to help their wives. My classes involve a lot of hands-on practices, a lot of what I would do as a doula if I were supporting their births but now I’m entrusting it to you [the birth partner] and you can do it yourself!”
“After they have attended the class, they have full access to me. I am available for them to ask me questions,” says Leila.
For parents who are looking to hire a doula, Leila recommends them to attend an antenatal class before hiring one.
As a doula, Leila shares that she is there for the parents providing physical, emotional and informational support from the moment parents engage her during pregnancy. She jokes that she is the “combination of Google, Siri and a concierge.”
Image source: Instagram/mamacoachleila
“Doulas are the only ones other than the husbands allowed into the delivery room,” they support both the birth partners and the labouring mothers. This support carries through even after birth: Leila does house visits, helping with setting up mummy’s breastfeeding station, latching and holding the baby, revisit the breastfeeding process, how to help bath/care for the baby, check-in with the birth mother emotionally and physically, how does she feel about her birth and look out for any signs of postpartum depression, among others. “Sometimes my postnatal visits just include rocking and holding the baby while the mother takes a much-needed shower or nap,” Leila chirped.
Noting that there is “no real community”, apart from virtual ones, and that many parents lack the knowledge surrounding pregnancy, labour, birth and postpartum, Leila wanted to provide parents and parents-to-be the access to educational materials and to help break them down in easy to understand terms. “When you relate birth and how birth partners can help in a way that people connect or laugh to, it makes the whole journey less scary and more welcomed.”
“To me, community is so important. It really helped me prevent postpartum depression. To be honest, breastfeeding in the middle of the night, or just breastfeeding being a stay-at-home mum can be very lonely. You’re often in the middle of the night breastfeeding and you’re all by yourself.
“Having that connection of education, small groups and like-minded people can make all the difference. That’s what I want Leila & Co. to be.”
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