Let's talk fertility.........

A topic that needs no introduction, and yet has such a huge impact either for us as individuals, as couples, as families or for our friends and colleagues around us. If not ourselves, then we will know of someone who has had/who is having difficulty conceiving (primary infertility), trouble conceiving another child after already having given birth (secondary infertility) or unexplained infertility. Let’s pause a moment to consider that no matter what ‘category’ someone may fall under, how terribly heartbreaking it must be to try to accept that you may never have a child or may never have another child & the depths of sadness they must be feeling. Can we really imagine?

At 42, I have completed my family long ago. 3 children and we felt we were complete. I write this as we are in lockdown due to COVID-19 in April 2020, and I often think how hard it must be for families home with babies and little ones. I see Facebook posts about the daily grind, the daily wine to make it through and the comments about groundhog day. I laugh. I laugh because I understand how much hard work it can be to raise little ones - and empathise - especially when they can’t even go to the playground. I do wonder however, how many women are reading these posts while scrolling through their daily social media and would still take it all. They would take the lot, just to have their own precious children.

So, let’s talk fertility…….

Fertility Definition:

• The ability to conceive children or young, The quality of being fertile

Infertility Definition:

By definition, Infertility is defined as having tried to conceive for 12 months or more OR having sought medical help to conceive. By the age of 38 years of age, infertility was experienced by 26% of women and 22% of men (https://www.fertilityassociates.co.nz/understanding-your-fertility/infertility-explained/).

What are the causes of infertility in females?

• Ovulation - Issues with ovulation or lack of ovulation (annovulation) or irregular ovulation, but not completely absent, is called oligo-ovulation.

• Endometriosis - A common inflammatory condition where the tissue similar to the lining of the uterus (endometrium) is found outside the uterus. This tissue can form lesions, nodules and cysts which are mostly found in the pelvis, ovaries, bowel, ligaments and the bladder.

• PCOS (Polycystic Ovary Syndrome) - This is a condition which affects a woman's hormone levels. Women with PCOS produce higher-than-normal amounts of male hormones. This hormone imbalance causes irregular menstrual periods, making it harder for them to get pregnant.

• Tubal Problems - Partially or completely blocked or scarring which narrows the tubes

• Recurrent Miscarriage - Recurrent pregnancy loss refers to the occurrence of three or more consecutive losses of clinically recognised pregnancies prior to the 20th week of gestation. 

• Autoimmune Antibody Disorders - e.g. Diabetes, Autoimmune thyroiditis, Systemic lupus erythematosis

What are the causes of infertility in males?

• Retrograde ejaculation - This is when the semen enters the bladder instead of emerging through the penis during orgasm, and there is no or very little semen during ejaculation.

• Blocked ducts - Blockages of tubes can be due to repeated infections, swelling or developmental defects, injury or vasectomy. With a blockage, sperm from the testicles can’t leave the body during ejaculation.

• Absence of Vas deferens (Congenital) - Congenital absence of the Vas deferens (CAVD) is a condition in which the Vas deferentia reproductive organs fail to form properly prior to birth. Can be unilateral (CUAVD) or bilateral (CBAVD).

• Failed vasectomy reversal - A vasectomy reversal is considered a ‘failure’ when there is no sperm present in the semen 12 months following the procedure.

• Autoimmune antibody disorder - Antisperm antibodies (ASA) in the male cause an autoimmune disease 'immune infertility'.

• Undescended testes in childhood - Undescended testes (Cryptorchidism) occur when one or both testicles do not reach the scrotum and remain inside the abdomen or groin (inguinal canal). Testes need to be in an environment that is a few degrees cooler than the rest of the body. If a testicle does not descend into the scrotum, the warmer environment inside the abdomen or groin can cause it to develop abnormally. The testicle may fail to grow (atrophy), sperm production may be affected - possibly contributing to a reduction in fertilityhttps://www.southerncross.co.nz/group/medical-library/undescended-testes-cryptorchidism)

• As for females, in males some causes/reasons for infertility are unknown

Understanding fertility language read here

Learn about hormones, ovulation and your menstrual cycle…..it’s fascinating! Click here

Discover how you can: learn, understand and apply the signs of your fertility on a chart with Sympto-Thermal method here and read the facts here

Advice on your journey with infertility:

• Make sure you have plenty of emotional support (and for your partner too) - seek counselling

• Really pay attention to the advice you are given - nutrition, lifestyle suggestions e.g. (supplements), work/life balance, regular exercise, restorative sleep, regular therapeutic massage

• Investigate holistic options and see if this is something you might like to explore (Naturopaths, Medical Herbalists, Acupuncture, Homeopathy) - what works for some may not work for others

• Incorporate Mindfulness. It doesn’t have to be ‘fluffy’. Pay attention to your thoughts - notice your feelings, the thoughts came first!!

• Replace ‘remain hopeful’ with ‘remain positive’

• Remember to enjoy the current while you are planning for the future

When do you seek help?

Heard the phrase ‘my clock is ticking?’ Yes, it is true, fertility does decline with age and is a very important factor to consider. Fertility Associates have a great graph which is very helpful in determining when you should seek help

Fertility/Infertility Support -

• Fertility Associates: https://www.fertilityassociates.co.nz/

• Fertility New Zealand: https://www.fertilitynz.org.nz/

• Repromed: https://www.repromed.co.nz/

• Your GP

• Ministry of Health: https://www.health.govt.nz/your-health/certified-providers/fertility

Other Support Services -

• National Women’s Health: https://nationalwomenshealth.adhb.govt.nz/our-services/fertility/support

• Natural Fertility NZ: https://www.naturalfertility.co.nz/

References:

Information retrieved for this blog (with thanks):

https://www.fertilityassociates.co.nz/

https://www.southerncross.co.nz/

** Please note I am not a medical doctor, or claim to be one (nor do I play one on TV)… The purpose of my blog is to share information, a little bit of support and share resources with those who read all the way to this disclaimer. PLEASE seek a professional opinion at all times when it comes to your own personal health and wellbeing or the health and wellbeing of others.

My Birth Doula Contract - What it is, Why we have it & What to expect

You may have had a friend recommend you invest in a Birth Doula, you may have read about what a Birth Doula can offer while browsing online, you may have even come across the role of a Birth Doula in a pregnancy or parenting magazine. Do you jump on google to find out more?

Perhaps the next step for you is to browse and see who is available in your area, or maybe you just have lingering questions and you are not quite ready to reach out just yet. One of these questions I am sure you keep tucked away while you ponder is ‘How do I know they are the right fit for me?”. I encourage you to pick up the phone and call the Birth Doula, or to email them if you prefer. Part of my service (and most other Birth Doula’s too) is to chat first and then arrange a ‘meet and greet’.

A meet and greet is offered at no charge (for myself & again most other Birth Doula’s) and is usually around an hour’s duration. We meet at a cafe or it can be in your own home, depending on what makes you feel the most comfortable. This is the opportunity to ask your Birth Doula all your questions, their philosophy around birth, where they trained, how many births they have attended, do they have a back up person they work with and if so, will you get to meet them?, what is their scope of practice? do they offer you a copy?, how many births they will attend per month, if they will attend births in hospitals, birthing centres or home births, or all of these options?

You may like to obtain references or testimonials. At the initial meet up, the Birth Doula is also considering herself whether she feels that she will be the right fit for you too - it is a mutual decision, and often both parties come to the same conclusion at the end of the meeting.

At the meeting my potential client/s receives a folder with a copy of my Birth Doula service contracts (I offer two), information about my other support services, a copy of my scope of practice and a handout on The Benefits of Birth Doula’s. Couples or individuals will then take this information away which gives them the time to talk over their thoughts and feelings before making a final decision.

Depending on the Birth Doula (and like a Midwife) you will need to make your decision fairly quickly as they may no longer be available if you leave it too long. Some of my Birth Doula friends will only attend one birth a month and another will attend up to 5 - so it does vary.

Once you have made the decision to go ahead - great. You will be asked to pay a deposit (that varies from Doula to Doula), read, sign and date the contract and then begins the wonderful journey of having them work with you for the duration of your pregnancy, birth and for some of your post-partum period.

What is in a Service Contract?

This can vary but typically you would expect to be offered:

• Up to two antenatal visits

• Devise and write up a birth plan (or two) together

• Comfort measures for birth and labour

• Support via phone or email for the duration of your pregnancy and birth (and some post-partum)

• On call 24/7 from 37-38weeks through to 42 weeks of your EDD (so this on-call period can be 5 weeks to a month)

• Stays with you from the moment you need their support when in labour, to approx. 2 hours post birth

• Can take photographs if requested and keep family/friends updated via text/email if requested

• Offer further services & this is individual to each Birth Doula (e.g pregnancy massage, aromatherapy oils)

• Visit once or twice in the post-partum period to see how you are managing and whether you made need any additional support (light housework, cooking, help with baby)

What about the cost factor?

Each Birth Doula’s service fees vary, the majority asking for a deposit up front (approx. 50%) of total service fee once the service contract has been signed, with the final payment made at 37-38 weeks - this is so your Birth Doula can be on call for you 24/7, from this time on. Again, this may vary, but the usual expectation is that the last payment is made at the time (mentioned above), and some Birth Doula’s will enforce that they will not be on call until this final payment has been received.

Antenatal visits vary, I offer two which are a few hours in duration each, and this is where we discuss their concerns, thoughts, doubts, fears and expectations. We discuss comfort measures for labour and birth, offer our resource/referral list, what it will look like for them as I attend their birth, the roles of all those attending your birth (medical staff included) to name a few. A part of my service with my holistic health background is to discuss the use of Bach Flower Essences or Homeopathic remedies if this is something that interests them and, more often than not, the additional services (add-ons to my service contract) are taken up as they can see the benefits of non-medical pain relief options once these have been explored. However, I do have clients that are very aware of my training and background and tell me from the day we meet that they are not interested in my potions and lotions - they will be having an epidural and that is that! That’s all good! So, is it my role to ‘try to change their mind?”. No it isn’t. I will of course want to explore what led them to their firm decision, offer research and a discussion (the same which I offer in a Childbirth Education class) and if they are still firm with their decision, great. As long as I know they have made a fully informed decision, I am going to honour that.

When not visiting face to face I like to check in every few weeks to see how they are getting on and if the need any assistance in their decision making. This is where it is crucial to be careful - we cannot give our personal opinions about what we think they should do or “what I would do if I were you” scenarios, rather, we offer evidence based information (with up to date research) and allow them to make their own decisions - IF of course this is something they wish to pursue. Which leads me to the Standards of Practice/Scope of practice, and why it is so vitally important. It is in place so that you, as my client, understand services rendered, limits to practice, advocacy, referral process, continuity of care, training and experience.

A Code of Ethics outlays our rules of conduct, ethical responsibility to clients, ethical responsibility to colleagues, ethical responsibility to the birth doula profession and ethical responsibility to society.

I like to send an email to the Lead Maternity Carer to introduce myself, and I am happy to meet with them at one of the client’s antenatal appointments if this is something the client and/or the LMC requests.

Birth Plans?! Yes, plans. One for a normal physiological vaginal birth and one for a caesarean birth - consider both carefully and document your wishes as you don’t know for sure how your birth experience will unfold. There are differing opinions on birth plans e.g. they never go to plan, it just goes out the window anyway… some of it can, for sure. But…. just because some things don’t go quite as you had hoped - doesn’t mean the whole entire experience has been ‘wasted’. And, this is just what we go through - different scenarios & what is likely to unfold.

Birth - The time has arrived for you to birth your baby. You may go into spontaneous labour or perhaps a decision has been made for an induction - either way your Birth Doula is there for you with a toolkit of support measures. She will see you through side by side, hour by hour, minute by minute to ensure you can have the best birthing experience possible. When you feel ready, you will want to be alone with your new baby and your birthing partner - this is the time your Birth Doula says farewell and makes her way home feeling exhilarated, but tired!

Post-Partum - A visit or two to see you and baby will include (if offered & varies between Birth Doula’s) - a home-cooked meal, baking, picking up any items you may need, light house-work, helping with baby (settling & soothing techniques) and offer a listening, supportive ear.

Please know your birth experience is an experience the Birth Doula will cherish also. The connection and bond created lasts long after the birth of your baby so much so, that not only do our clients keep our number on their phone (‘for just in case’) we feels so privileged that you’ve invested the trust in us to be a part of your next birth experience!