How doulas can help you navigate your birth journey

Posted by: on Sep 17, 2018 | No Comments

I’ve been staying in wildest Dartmoor, in a beautiful yurt for a few days.

Today I made my winding way up to Bel Tor and I had some realisations and thoughts about birth as I walked along the twisting path, up to the Tor and back again.

At first the Tor seemed really far away and that I had bit off more than I could chew. Sometimes it can feel like that when you go into labour and think birth itself will be too big, too much, too far in the distance and too hard! “What have I signed up to?” I thought! As the wind blew in my face, I wrapped a shawl around my ears (I get terrible earache) and followed the rugged path, trusting I must be going the right way, since there weren’t really any signposts. A little like early labour, I just put one foot in front of the other in what I assumed must be the right general direction.

Soon enough I found myself walking down a very bumpy and stony path. The parallels with the birth journey were really jumping out at me!

In good weather, with the right footwear, with clear sight, you can avoid tripping over big stones, or even stumbling on the smaller ones, skirting around them skillfully and with great care. What the stones or obstacles to smooth birth might be, will look slightly different to everyone, and some cannot be seen until you are up very close. If the path is particularly bumpy you will need to be looking very closely where you are putting your feet so anyone distracting and chatting to you will mean you have to stop in your tracks. If you meet someone coming back down from their own journey to the Tor who smashed their nose on a rock, you would know that not everyone does that, but it would be a wake up call to take more care where you put your feet!

As I walked further on I thought to myself “There’s hardly a soul about, and it seems such a private and even lonely pathway but how many humans have walked this exact route over the millenia?” and how many women across the ages have walked the birth labyrinth? You might feel alone in your journey as your contractions grow wilder and stronger, but although you are the only one giving birth in the room at that moment, you are part of a chain of mothers going back down the ages, and many many others are walking their own roads simultaneously elsewhere around the world as you give birth!

Back to my story… well after all those potenrially trippy-uppy rocks in my pathway, I now found myself at the foot of the grassy, gorsy sheep poo covered hill with the Tor, cragged and ancient, nestled on top. I wasn’t sure which way to walk, with paths this way and that, wherever there were breaks in the gorse, with curly horned sheep grazing, a little wary of humans. I followed my nose, trusting there must be ‘no singular or right way’ to go up. If it were dark I suppose I could have easily found myself tangled on gorse bushes – what are the gorse bushes in your own maternity care or birthing set up I wonder? You might not have any at all, or go a route that bypasses them.

Nearing the top, I found a burst of energy (bit like the bit during birth when you suddenly have a burst of adrenaline for the final push) How had I gotten from that carpark to all the way up here? It had seemed so hard but now, up close, I could only marvel at the magnitude of these beautiful stones, and after touching them in awe, decided to scale them to the highest one.

My feet found steps out of the natural curves of the stones, past little clusters of wild flowers, and a tiny holly bush. As if I had been there many times before, my feet just knew how to climb and it almost felt like the stones were helping me. After this magnificent stomp, I was on top! It had seemed so far away and impossible just 20 minutes before (birth can feel like this as contractions intensify!)

I stood a while, and looked at the hills all around. And then I noticed the wind, and how strong it was whistling around, behind my back. I thought in that moment how it feels to give birth, as if you’ve just scaled Everest, with the wind that was in your face, now firmly behind you.

The differences in the weather can completely change the experience. You can wear the right boots, and the right clothes for climbing a Tor, or to keep with my analogy, to give birth, but you have zero control over the weather. You could climb the same Tor a hundred times and the experience might be very different each time, even though you might follow a similar path each time. You might get to the top and be able to see for miles around, with gentle sunshine illuminating the trip or have an insufferable fierce heat or biting cold, bitter winds making it difficult.

As every person experience of climbing a Tor will be different, even on the same day… every woman’s experience of birth, is different. If you wear flip-flops, forget your jacket or sunglasses or water or layers or it’s hailing, the experience is going to feel much more challenging for you than if you are really prepared for the journey on the day. And some days the weather can be unpredictable and changeable!

A doula is someone who passes you your water bottle when you say you feel thirsty, or pulls some sunglasses out of her bag if you forgot your own. She will point out the boulder in front of you that you and so many others nearly tripped on, or shout “mind the poo” and she knows this journey is the same but totally different for everyone. She will pack her own bag with snacks and make sure her camera batteries are fully charged to capture that view or might just stop and help you catch your breath. She might have zero control of the weather on the day, but she will point out that flip-flops won’t cut it for a hike like this or pack a hairband so the wild winds dont blow your hair in your face so you can’t see! She knows she can’t climb the Tor for you. She also knows how much easier it is to climb to the top when you have a gently encouraging companion, it makes the journey a little easier!

She knows that at the top of that hill, the views are amazing… and that if a woman just can’t climb up, she must have some pretty good reason why.  You can’t climb to the top if you’ve twisted your knee, broken your foot or tripped and got concussed on a rock. Sometimes a woman’s backpack is just too heavy. Sometimes the weather is just so so ridiculous as to be laughable. And sometimes if we need someone carrying a sedan chair to lift us up those last few steps, and it’s the only way up, so be it!

We all face different challenges and have our own labyrinth birth journey to go on. Some of us travel on a clear day with a light breeze, and others go up in a hurricane.

One thing is for sure – next time may be completely different. And having a companion who knows the terrain can make it a better journey – in any weather!

How to have a positive birth when the maternity system is on its knees

Posted by: on Jul 30, 2018 | No Comments

In 2018 you would think we would have it sussed when it comes to how we treat and educate birthing women. We’ve had a long time to figure this stuff out – millennia in fact. So why are some women still having a really hard time giving birth?

We are going to go on a little journey. It will all seem like doom and gloom for the first half of the blogpost but trust me – by the end of the journey, you’ll realise it’s anything but. Bear with me and you’ll find out why. Now back to the subject in hand….

It’s not like we don’t have information available – I mean, we live in the age of information – information about how to give birth most easily has literally never been so freely available as right now. We have the means to be connected to all kinds of people across the globe.

 

Unlike women in previous centuries, we have vast online virtual libraries we can access at our fingertips – written by midwives, doctors and all kinds of really knowledgeable experts and lay people. It’s all out there. For those who don’t do the online thing, we have enough books, midwifery journals, research papers and magazines to fill whole football fields that have been written on the subject of giving birth. Many books we can borrow from our local library, books we can pick up for pennies second hand, at shops or online, or brand spanking new, from across the globe. We could not have any more access to information about birth if we tried. Women can buy old (or not so old) copies of  midwifery journals on ebay – that’s how accessible information is to us now. So why are so many mothers still in the dark?

Even this modern maternity system with its all-singing all-dancing technology and all the millions of quid thrown at it still aren’t preventing babies born distressed, birth trauma to mothers, PTSD, postnatal depression or women feeling dehumanised or butchered.

We should be crying out “Why are such large numbers of women coming out of birth feeling broken, traumatised and even violated!” The statistics are unacceptable in such a supposedly developed country. Where are we going wrong? And why aren’t we more angry about it?

The answer to this is because birth has become another industry – run on a system of conveyor belt standardisation. Robotic. Machines and monitors and litigation and targets are slowly taking the place of the personal judgement of a highly skilled, personal midwife. We’ve taken our distrust and fear of birth and women’s knowledge to new heights, and so much of it is based on untruths. Untruths which suit people who stand to make thousands if not millions from keeping everything just the way it is. And many many good people are working within that system. Kind-hearted people, making a difference to some lucky women. The rest however, are just processing us all like cattle – on automatic mode and no longer caring like they might have once done about individual women any more – because caring hurts too much, or simply takes up too much energy and headspace in a busy day of targets when they don’t even have time to so much as go for a piss for 9 hours straight, and they just want to get their head down and do their job without getting noticed too much, or bullied for standing up for individual women wanting anything outside of protocols. I have a lot of love for these tired and good people. But I’m just saying it like it is.

Midwives are over-stretched, and undervalued. They are expected to do magic with little support from above but are harangued with threats and consequences if they make even a tiny mistake. It’s not their fault the system’s shit. It’s a system built on the principles of a masculine model of industrialisation and profit-driven interests that are driving this maternity machine.

If this all sounds doomy and gloomy, take heart. There is plenty to feel good about. There is a thriving and active counter culture working hard to help women have positive and personalised, fully human experiences – trying to change the system from within and without. I know some really good people working within the system who are dedicated and passionate and somehow surviving in the rather toxic culture that they are expected to work in. They are the rebels, the movers and shakers who refuse to let women be just another number on the conveyor belt. They are the advocates, quietly working in the background, people you’ve probably never heard of, passionately working to bring love and common sense to women’s birthing experiences. Midwifing. Facilitating gentle Caesareans. Advocating. Campaigning. Writing. Making documentaries. Speaking at conferences. Doulaing. Educating. Giving the finger to the ‘computer says no’ culture. Or just tirelessly shouting the message: “We need to treat women and their babies better than this”. Up and down the country and around the world they are meeting up in hospital meeting rooms, conference rooms, in living rooms, in online forums, at events and gatherings of all kinds, trying to do better, to find solutions for women to push back against the mass and impersonal industrialisation model. You’ve most likely never heard of many of them but they number in the thousands. I know this, because I move in these circles!

So what can you personally do to improve your own birth experience?

 

Learn how your body works and which interventions are evidence-based… or not….

Firstly, it’s important to acknowledge that most people’s education on birth is shockingly lacking or based on media dramatisation or disproportionately blown up fears inherited from a crappy narrative about birth and what women’s bodies are capable of. Our education system is a bit rubbish when it comes to teaching us about our bodies so it’s up to you to learn about birth physiology if you want to stack the odds in your favour for a natural birth. If you don’t understand how your body works, and if your midwife is working on outdated or non-evidence based ways of supporting you or ‘managing’ your birth because that’s what her bosses insist on, you are more likely to be nudged along the conveyor belt and end up with interventions you might not need – including a caesarean. I’d like to say I’m kidding but I’m being deadly serious.  Many caesareans that are happening today are just not medically necessary at the onset of birth but become necessary after a string of other interventions stresses the baby and makes it unsafe for them to stay in the womb and endure the process of labouring in that particular way any longer. I wish I was making this up. But I know too many birth experts who are speaking, touring, writing, documentary-making, frustrated, sad, angry, broken and passionately verbal about this very phenomenon. Taking the time to study and familiarise yourself with some midwifery slang and understanding the variations of normal gives you a better chance of being able to ask confidently and assertively when you feel you actually DO need an intervention.

Find the birth books that midwives are inspired by

Instead of reading whatever is in your local bookshop by celebrities and authors such as Gina Ford (never had babies or been a midwife so her advice is actually pretty dangerous), try reading any one of these amazing authors – Milli Hill… Natalie Meddings… Ina May Gaskin… Dr Sara Wickham… Sheila Kitzinger… Michel Odent… Mark Harris… AIMS publications… Prof. Sheena Byrom OBE… Janet Balaskas… Dr Sarah Buckley…. Penny Simkin… Kerstin Uvnas-Moberg… Becky Reed… Frederick Leboyer… Rebecca Schiller… Dr Amali Lokugamage… Prof. Soo Downe OBE… Maddie McMahon… Kicki Hansard… Pam England…. Margaret Jowitt… Mia Scotland…. Adela Stockton… Katrina Berry…  look them up – they’re all, without exception brilliant and knowledgeable authors with a absolute wealth of birth experience. Whatever you do, don’t rely on NHS information alone!

Hypnobirth your baby

It’s not a fad, and in other parts of the world they have understood the power of the mind for millennia. It works, and when taught properly, can help you even if birth takes a turn in a different direction than you hoped for, giving you coping tools for life beyond the birthroom, and beyond  plan A.

Consider an Independent Midwife

I know it’s a lot of money, but consider hiring a private midwife – it will possibly be the most important couple of grand you ever spend in your entire life. More important than fancy nursery furniture, buggies or the latest car, expensive holiday or a big wedding. The positive ripple effect on the rest of your life will far outweigh the inconvenience of paying out. Continuity of care from the same person is proven to help birthgiving women on multiple levels – it’s the gold standard which all midwives wish they could give but so often can’t because of the institutional shite they have to wade through. The one’s who stay on after their shift has ended or will come and visit you even though they’re not being paid for it are like hens teeth.

Think about hiring a doula

Doulas mother the mother. We offer continuity of care by getting to know you before you give birth, are a solid, calm, reassuring presence during labour, and stick around for the days and weeks after in a way that is so much harder for midwives to do (Not their fault). We signpost you towards evidence-based information, but equally help you to cultivate a sense of trust in following your own gut feelings – that famous mother’s intuition. Doulas offer non-judgmental and loving support to you and your partner and being independent of your usual friendship or family circle can be an advantage as it means we don’t bring any of the baggage to the birth which can sometimes happen when having other family members or friends come to your birth. We offer positivity and perspective based on what is evidence-based rather than feed you negative stories because of aunty Doris’s neighbour’s sisters awful birth story or what your sister in law saw on One Born Every Minute!

Create a circle of positivity

Pregnancy is a time to immerse yourself in positivity and listen to and read stories of women gave birth in a positive way, even if things didn’t go to plan. Sharing positive stories instead of trading horror stories will help you much more. Check out Natalie Meddings website and facebook page for her TellMeAGoodBirthStory movement. And if you want a real dose of positivity check out all things Milli Hill. She has written a great book that has just come out, sparked a movement by the same name.

Hang out with people who uphold your dreams and visions without laughing at you or putting you down.

Birthplace Matters

Have you weighed up the risks of giving birth in hospital? Or only looked at the risks of homebirth? Setting foot in a hospital building opens you up to protocols and interventions which may otherwise be avoided at home. People often look at the benefits of hospital without considering the benefits of home too. It’s important to dig deep and look at actual benefits vs perceived benefits and actual risks vs. perceived risks. Sometimes we can be swayed away from hospital by such tiny statistics that we overlook other larger statistics which may be undesirable or compromise us and our babies if we go into a technical environment which may be offering us a false sense of safety.

Know your rights

If you don’t know what your rights are, how can you stand up for yourself with any conviction? Of course, it’s better not to have to use your voice or put your foot down, to have to refuse or rebel. It’s so much nicer and easier to be able to just let go and trust – but this needs to be in the right context. It’s certainly an easier life in the moment just going along with what you’re told to do. But, if we don’t have a basic sense of what’s what and how birth works best and easiest or the tenacity to follow our instincts even against medical advice then sometimes we can be soft-talked and tricked into things that aren’t in our (or our babies) best interests. (Many of us have been there, so if you’re reading this and nodding – you’re not alone). I strongly advise all mothers-to-be to read a copy of the AIMS book ‘Am I allowed?’. It’s a book which clearly sets out your birthing rights. I also recommend you read Rebecca Schiller’s online articles and book. She works for Birthrights, and is very knowledgeable about all things relating to this area. Sometimes it helps you have more resolve if you understand a gentler way to do a procedure which is being done elsewhere and it doesn’t hurt to ask or assert yourself to ask others to do something a new or different way.

What does this all mean?

It’s not possible to know exactly how birth will unfold, but you can be prepared and supported in ways that you might not otherwise be if you just go along with someone else’s (well-meaning) flow and you can still have an amazingly positive birth which puts you firmly in charge of all decisions even if your plan A doesn’t work out. It’s scary and it’s adulting to take on that full level of parenting responsibility and decision making but your parenting doesnt begin once the baby is born – we have to do what feels best for us and our babies even if others don’t agree. You have all the tools and knowledge you need at your fingertips and with the right team, you can have a truly beautiful and positive birth even in these strange, modern times!

How you can help women avoid birth trauma and PTSD

Posted by: on Jul 1, 2018 | No Comments

What causes birth trauma?

According to the Birth Trauma Association, it’s caused by a number of things:

  • Lengthy labour or short and very painful labour
  • Induction
  • Poor pain relief
  • Feelings of loss of control
  • High levels of medical intervention
  • Traumatic or emergency deliveries, e.g. emergency caesarean section
  • Impersonal treatment or problems with the staff attitudes
  • Not being listened to
  • Lack of information or explanation
  • Lack of privacy and dignity
  • Fear for baby’s safety
  • Stillbirth
  • Birth of a damaged baby (a disability resulting from birth trauma)
  • Baby’s stay in SCBU/NICU
  • Poor postnatal care
  • Previous trauma (for example, in childhood, with a previous birth or domestic violence)

There are some things we really can’t do much about, that as we say, are in the lap of the gods.

But whenever and wherever we can make things even a little nicer, easier, and less traumatic we really should be collectively striving for that. No matter how tired, exhausted, overworked a health professional might be, some things should be a reflex, inbuilt into our behaviour. No-one’s perfect, and we can learn from mistakes – it’s never too late to do better for our next client or service user!

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10 ways to help avoid / minimise birth trauma

1)  Point out what the protocols of your hospital are, but do not use coercive or bullying language EVER.

Make it clear what they are but always make sure women are aware that

- mothers-to-be are not legally bound to follow protocols

- there are sometimes several schools of thought around an area and that it would be wise for them to do their own research beyond the NHS leaflets to make an informed decision

- that protocols are designed for the general public, not each woman specifically or idiosyncratically

- she will often have several pathways available, some of which are not recommended but she is free to choose if she wishes, presented without emotion or persuasion – not just one you want to push on her because of your own preference.

2)  Acknowledge when you don’t know enough about a subject rather than pretending you do.

Signpost to robust, evidence-based sources and up-to-date information. Ask the mother how she is feeling and what her intuition is telling her to explore and research more closely. Instead of trying to look infallible, just admit ‘ this is outside of my knowledge’ and then point them towards someone more expert than you. Make a point of being open to learning things that are new and out of your current knowledge, so you can give women only what you know to be truly accurate information.

3)  Never dismiss a mother’s intuition.

If a woman has a strong feeling about something – trust her. While collecting birth stories for Birthplace Matters, I heard from so many women who had very accurate knowledge or intuition about how their baby was doing, either that everything was fine or that something was wrong, or how close they were to pushing their babies out, which was ignored. One example I hear a lot are stories from women in relation to dilation and pushing. I recently talked with a doula friend who had supported a woman who went from 6cm to having a baby in her arms in just 15 minutes. It can honestly happen.  So don’t shout at a woman not to push because she isn’t dilating according to the Friedman curve.

4)  Support women’s informed decisions

If she chooses a pathway that is outside of guidelines, try and find it in your heart to support it, without badgering her and bullying her over and over to get her to co-operate in an ‘our way or the highway’ campaign. Acknowledge she is going outside of recommendations and give her your care and loving support anyway. She is a fully grown adult not a silly child – don’t treat her like one. Her parenting right to make decisions for her baby doesn’t begin once she leaves the hospital and sets foot across the threshold of her own front door – that responsibility is hers NOW already. Make it clear to her that you understand that, without tutting, frowning, and making snide remarks please.

5)  Give statistics responsibly and talk about benefits as well as risks

Simply saying, for example that your baby’s risk of abc doubles if xyz happens is a terrifying prospect to any mother. However, if you tell her her babies risk of something doubles from 0.05 percent to 0.1 it gives woman a more realistic sense and is more helpful in making them make truly aware so they can arrive at their own carefully weighed up decisions – if there are risks to something, women need to know using maths not misleading language designed to scare them. Let them weigh up the benefits and risks of a particular pathway – NEVER make decisions for them by omission – if you are only presenting them with one option when you know damn well there might be 2, 3 or 4 options then you are forcing a pathway that isn’t chosen freely.

6)  Advocate for them even if you don’t agree with their choices and defend their human and maternal rights regardless.

Refer women to others with specialisations in supporting whatever the woman herself wants to choose, and don’t take her non-compliance as a reason to take it personally or be nasty. It’s not about you.

7)  CONSENT!

You should not be doing anything to a woman without her consent, and in order to make sure you have gained her consent, you must explain fully what you are doing or what a recommendation is. And remember it is just that – a recommendation, or suggestion.  You can’t put your gloved hand inside a woman and get consent as it is going in. You cannot break her waters without her consent. You cannot do anything at all to her or her baby, unless she gives her consent. Even if you think it’s in the best interests of the mother and/or baby. This is not your baby, your birth, or your body. She will live with the consequences of your actions so make sure she said yes and understood first!

8)  Read the birthplan

It’s completely reasonable for women to express their wishes and when something is written in black and white it should be read by staff. You are public servants to her, not vice versa. She is not there to grease the wheels and make your shift easier. Her taxes pay for you to be there assisting her and she may only give birth once or twice in her lifetime. This may be everyday work for you, but for her, this is one of the most important days of her life

9)  Gentleness costs nothing

No matter how many times you’ve stitched a vulva today, or put in an IV drip or cannula, or catheter, no matter how busy, rushed or tired you are – please remind yourself of the human in front of you who may walk away with PTSD because of your actions – this woman is not a piece of meat but a living, breathing, feeling, person with dreams, future memories, and rights.

10)  Remember why you joined this profession

If you think you can’t offer gentle care anymore, consider moving on to another career path. It doesn’t make you a bad person to admit that. It makes you a caring one who won’t let women suffer because of traumatic practices which are ingrained into the people working around you which have become so normalised they’re not even seen clearly for what they are any more..

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The links below are from the Birth Trauma Association website:   http://www.birthtraumaassociation.org.uk/about-the-bta/research

Allen, S (1998). A Qualitative Analysis of the Process, Mediating Variables and Impact of Traumatic ChildbirthJournal of Reproductive and Infact Psychology, 16: 107 – 131.

Allen S North N and Elliott P (2005) An investigation of the relationship between PTSD and PND symptoms and factors mediating the development of PTSD following traumatic labour experiences ( Paper available from Sarah Sllen Department of Psychology Southampton University SP17 1 BJ)

Andreucci CB1,2, Bussadori JC3, Pacagnella RC4, Chou D5, Filippi V6, Say L7, Cecatti JG8;Sexual life and dysfunction after maternal morbidity: a systematic review. Brazilian COMMAG Study Group; WHO Maternal Morbidity Working Group.

Ayers S Eagle A Waring H (2006) The effects of childbirth related PTSD on women and their relationship : a qualitative study. Psychol Health Med 2006 Nov 11 (4) 389-98

Ayers, S, Bond, R, Bertullies, S and Wijma, K (2016) The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework. Psychological Medicine, 46 (6). pp. 1121-34. ISSN 1469-8978

Ayers, S. & Ford, E. (2012). PTSD following childbirth. In: C. R. Martin (Ed.), Perinatal mental health: a clinical guide. (pp. 155-164). M&k Update. ISBN 1905539495

Alvarado R Perucca E Rojas M Monades J Olea E Neves E Vera A (1993) Gyneco obstetric aspects in women developing postpartum depression. Obstet Ginecol 1993;58 (3) 239-4

Ayers, S and Pickering A.D. (2001) Do Women Get Posttraumatic Stress Disorder as a Result of Childbirth? A Prospective Study of Incidence. Birth. 28 (2): 111 – 118

Ayers S Thoughts and emotions during childbirth: a qualitative study. Birth 2007 Sep 34 (3) 253-63

Ballard, C. G. et al (1995) Post-Traumatic Stress Disorder (PTSD) after Childbirth. British Journal of Psychiatry. 166: 525 – 528

Beck, C. T. (2004) Birth Trauma – In the Eye of The Beholder. Nursing Research. 53(1): 28 – 35

Beck, C.T. (2004) Post-Traumatic Stress Disorder Due To Childbirth – The Aftermath. Nursing Research. 53 (4): 216 – 224

Beck CT (2006) The anniversary of birth trauma; failure to rescue Nurs Res 2006 Nov-Dec 55(6) 381-90

Born L , Soares (2006) CN, Phillips SD, Jung M, Steiner M Women and reproductive related trauma Annexe NY Acad Sci 2006 Jul 1071:491-4

Boudou M Sejourne N Chabrol H Childbirth pain, perinatal dissociation and perinatal distress as predictors of PTS symptoms Gynec Obstet Fertili 2007 Nov 7

Callahan JL, Hynan MT Identifying mothers at risk for postnatal emotional distress: further evidence for the validity of the perinatal post traumatic stress disorder questionnaire J Pernatol 2002 Sept 22 (6) 448-54

Church, S and Scanlan, M (2002) Post-traumatic Stress Disorder After Childbirth. The Practising Midwife. 5 (6): 10 -13

Cohen et al (2004) Posttraumatic Stress Disorder after Pregnancy, Labor and Delivery, Journal of Women’s Health, 13(3): 315 – 324

Creedy, D. K (2000) Childbirth and the Development of Acute Trauma Symptoms: Incidence and Contributing Factors. Birth. 27(2): 104 – 111

Crompton, J (1996) Post-traumatic Stress Disorder and Childbirth. British Journal of Midwifery. 4 (6): 290 – 294

Crompton, J (1996) Post-traumatic Stress Disorder and Childbirth: 2, British Journal of Midwifery, 4 (7): 354 – 373

Czarnocka, J and Slade, P (2000) Prevalence and predictors of post-traumatic stress symptoms following childbirth. British Journal of Clinical Psychology. 39: 35-51.

DeMier R.L. (1996) Perinatal Stressors as Predictors of Symptoms of Posttraumatic Stress in Mothers of Infants at High Risk Journal of Perinatology. 16 (4): 276 – 280

Emerson, W. R. (1998) Birth Trauma: The Psychological Effects of Obstetrical Interventions, Journal of Prenatal and Perinatal Psychology & Health”, 13 (1): 11 – 44

N. Goutaudier , N. Séjourné , C. Rousset , C. Lami  & H. Chabrol Octogone Negative emotions, childbirth pain, perinatal dissociation and self-efficacy as predictors of postpartum posttraumatic stress symptoms

Gamble, J.A. et al (2002) A Review of the Literature on Debriefing or Non-Directive Counselling to Prevent Postpartum Emotional Distress. Midwifery. 18: 72-79

Holditch-Davis, D et al (2003) Posttraumatic Stress Symptoms in Mothers of Premature Infants. Journal of Obstetric, Gynecologic, and Neonatal Nursing (JOGNN), 32 (2): 161 – 171

Hynan, M. T. (1998). The Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ). In R. W. Wood and C. P. Zalaquette (eds.) Evaluating stress: A handbook of resources, 2: 193-199. Lanham, MD: Scarecrow Press.

Joseph S Bailham D (2006) Traumatic childbirth: what we know and what we can do. RCM Midwives 2004 Jun 7 (6) 258-61

Kennedy, H.P. (2002) Altered Consciousness During Childbirth: Potential Clues to Post Traumatic Stress Disorder? Journal of Midwifery & Women’s Health. 47 (5): 380 – 382.

Menage, J. (1993) Post-Traumatic Stress Disorder in Women Who Have Undergone Obstetric and/or Gynaecological Procedures. Journal of Reproductive and Infant Psychology. 11: 221-228

Nicholls K Ayers S (2007) Chilbirth related post traumatic stress disorder in couples; a qualitative study. Br J Health Psychology Nov 2007 12 Pt 4 491-509

Parfitt, Y. & Ayers, S. (2009). The effect of postnatal symptoms of post-traumatic stress and depression on the couple’s relationship and parent-baby bond. Journal of Reproductive and Infant Psychology,stress and depression on the couple’s relationship and parent-baby bond. Journal of Reproductive and Infant Psychology, 27(2), pp. 127-142. doi: 10.1080/02646830802350831

Priest SR Henderson J Evans SF Hagan R (2003) Stress debriefing after childbirth: a randomised controlled trial. Med J Aust 2003 Jun 2 178(11) 542-5

Reynolds, J.L. (1997) Post-Traumatic Stress Disorder After Childbirth: the Phenomenon of Traumatic Birth. Canadian Medical Association Journal. 156 (6): 831 – 834

Rowan, C. Bick, D. Basots, M.H. Postnatal debriefing interventions to prevent maternal mental health problems after birth; exploring the gap between the evidence and UK policy and practice. World views Evid Based Nurs 2007 3 (2) 97-195

Sandstrom M, Wiberg B, Wikman M, Willman AK, Hogbierg U. A pilot study of EMDR for PTSD after childbirth Midwifery 2007 Jan 12 th

Soderquist J Wijma K Wijma B Traumatic stress in late pregnancy J Anxiety Disorders 2004 18(2) 127-42

Soderquist J Wijma K Wijma B Traumatic stress after childbirth; the role of obstetric variables. J Psychom Obstet Gynaecol 2002 Mar:23 (1) 31-9

Soet, J. E et al (2003) Prevalence and Predictors of Women’s Experience of Psychological Trauma During Childbirth. Birth.30 (1) 36 -46

Turton, P. et al (2001) Incidence, Correlates and Predictors of Post-Traumatic Stress Disorder in the Pregnancy After StillbirthThe British Journal of Psychiatry. 178: 556-560

Vaiva et al (2003) Immediate Treatment with Propranolol Decreases Posttraumatic Stress Disorder Two Months after Trauma, Biological Psychiatry, 54: 947 – 949

Van Pampas MG, Wolf H, Weijmar Schultz WC, Neeleman J, Aarnoudse JG

Post traumatic stress disorder following pre eclampsia and HELLP syndrome J Psychosom Obstet Gynaecol 2004 Sept – Dec 25 (3-4) 183-7

Wijma, K. et al (1997) Posttraumatic Stress Disorder After Childbirth: A Cross Sectional Study. Journal of Anxiety Disorders. 11 (6): 587 – 597

 

The 12 Ancient Midwives

Posted by: on Mar 15, 2018 | No Comments

Have you ever wondered how women give birth without assistance? The ones who have their baby rather dramatically and unexpectedly in such places like the back of a taxi, in a lift, or alone in the toilets at high-school? How do they manage it without pain relieving drugs, since there are none available?  And is a woman ever truly alone, and unassisted, when she births?

How would you cope?

Well for starters, birth is not a solo sport. It is a partnership, a dance of two – mother AND baby. When the birth is not disturbed or directed by others, a baby and mother are perhaps freer than being directed by assisting strangers. By moving and twisting and turning their bodies in collaboration entirely on instinct, as happens in the wild, women can usually expell a baby from their body by a series of involuntary muscular reflexes – much like going for a poo. If the woman can let her body take over from her mind and just do what it knows how to do, she removes one of the biggest obstacles to birthing easily – fear.  Animals all over the world do it every day, without having been to a single hypnobirthing class or reading a Sheila Kitzinger book!

Deep in our bones, we have primally imprinted birthing reflexes buried under all the layers of our education and civilisation.  I doubt there would be so many people or animals on this planet if that wasn’t true. And if a woman can give birth in a coma, then the human body, undirected in any way from external instruction, surely must be considered expert at expelling babies?

But who delivers a human baby in the spiritual sense, when no midwives are present? Who honours and witnesses the arrival of a little soul?

I was pondering this during the last dreamy days of pregnancy with my daughter Poppy in a state of dreamy meditation. And then I saw them clearly.

Introducing…. The 12 Ancient Midwives…

     

 

These ancient helpers give us the power to be able to birth our babies even when there are no other humans around. Their names are….

Love – is the reason this baby was made in the first place. Love swirled and worked its magic inside your body to receive your partners sperm and usher it towards the egg so your baby could begin its life inside you. It was a guiding force all along. Why not now? Why shouldn’t love, that helped the baby get in, also help the baby to get out! When a woman births with love from her heart, with loving thoughts, body, and soul, the baby will come with more spirit than if she feels hateful, angry or purely scared. For this reason, Love is the first midwife.

Patience – as every good midwife knows, patience is the ultimate tool in her kit. Generally speaking, the more she can respect the natural momentum of the birthing mother and baby dyad,
and not interfere, the less complicated will be the birth. A mother who is patient with herself and her baby as she gives birth will birth more easily and smoothly. Patience is the second midwife.

Trust – When we trust in our bodies, in the will of the universe, in our baby, it takes the tension out of our bodies and relaxes them. We can do things we thought previously impossible when we replace fear with trust. When we trust, we give permission for life to unfold in the moment, feeling it will all work out as it is meant to. For this reason, Trust is a great midwife, and she is the third of our twelve.

Laughter – has a magic effect on us. It transforms pain into something other. It makes difficult things more manageable. Laughter opens up our chest and rolls through our body, releasing tight muscles and making them relax. Laughter is a free form of medicine, and requires no outside persons. When laughter is a midwife at birth, she makes things smoother, happier and easier. She is the fourth midwife.

Ancestors – do you ever wonder if your ancestors are guiding and keeping protection over you? Sometimes they might leave a sign they are around, holding the space for you. Perhaps you can
smell a faint trace of them. Or a song plays on the radio suddenly that was your song. Perhaps a bird leaves you a feather or some other token, that only you understand. Our ancestors can carry on giving us the gift of their strength even after they have gone from the earthly realm, through their memory and example if nothing else. They are the fifth midwife.

Prayers of the living – every good thought others have towards you, your baby and your birthing has an energy that draws a line between you and them across the miles, in the ether. I really
believe this. For this reason, I believe prayers have power. When a woman is birthing and reminds herself of the well wishes and support of others, she can draw on it as a source of strength. This collective body of positive, confidence-boosting energy is the sixth midwife.

Cosmic forces – are the mysterious energies which govern all life. Some call it God, others nature. Whatever you believe, our place in the universe is a blessing, and the universe swells and swirls and pulses according to its own order, its own rules. We are but a humble speck in it all. It is good to remember this. The cosmos is an endless series of cycles of creation. We are not in charge of everything, we cannot control everything. When we give birth it is good to remember we are here but for the grace of god and so are our babes. The seventh midwife is there whether we choose to believe in her or not!

Strength – until a woman gives birth, she usually has no idea of her full powers and strengths. Birth reveals hidden depths and strengths she never knew she had – especially more so when she births alone and is not overpowered by others. When a woman births without limitations or boundaries, her strength is a force to behold. Strength is the eighth midwife who digs deep into a woman’s inner treasure chest and delivers a baby into the world with pure, raw, trembling, earth shaking primal force.

Intuition – will be the mothers companion for the rest of her mothering years, as with the other midwives. Like the others, intuition will stick around. She is the watchful midwife with the third eye. She feels the answers to things others can only partially understand. This midwife is supremely ancient. She is the midwife who never truly sleeps but always keeps half an ear or an eye open. The ninth midwife will help a woman to know things that her rational brain could never know on its own.

Connection – Even whilst alone, a woman is not truly alone. Her baby is there with her. She is part of the interconnected web of consciousness to which we all belong. It is comforting to remember this during a birth. A woman is connected, cradled, and held by others at the mere thought of them. She can draw strength from the love she shares with her baby’s father, and from her friends and family – anyone she feels safe and happy with. When a woman gives birth she also straddles the worlds of ancestors and descendants and stands at a crossroads between past, present and future. The connections she has through her bloodline, umbilically link her like a matryioshka doll to them all. She can also draw strength by connecting in spirit to all the other birthing women in the world labouring their babies in that same moment as her. Connection is the tenth midwife.

Surrender – is a powerful teacher. She is the midwife who leads us down the rabbit hole and tells us it will all work out fine, that our bodies are made to cope. She whispers to us to have faith in the wild and crazy process. She tells us it will all be ok at the other end of it all. Without her, we cannot let go. Without her, we cling to the safety of all that we know. But we cannot bring forth our baby if we don’t go down the rabbit hole. We must walk a labyrinth journey of sorts, going deep into our own strength and body to bring out a baby. Surrender is the the eleventh midwife who says it is safe to let go, let go… let go… .let go…..

and finally…

Nature – The midwife in every cell of your body. She knows what to do. She is the great conductor that leads the orchestra of hormones in our bodies that birth the baby. She does what she needs to do, with her own utter efficiency and logic, and her own timing. Sometimes she leads the orchestra in a waltz, sometimes a birthing is more of an opera – but she knows what she’s doing. She is wiser than any human and has secrets we will never understand. If you listen closely to her she has great wisdom to teach. Make friends with her and learn ways to harness her gifts. She is abundant, generous and nurturing as well as feisty, wild and untamed. And she is the twelfth ancient midwife. Is she the most important?

I hope you enjoyed meeting the twelve ancient midwives. Chances are, you know them already. If you know a mama having her first baby, maybe you could show her these friends who can guide her on her journey, helping her to draw on her incredible strength to birth and raise her baby with peace, love and confidence – no matter where, when or how she gives birth.

***************************************************************************

A slightly longer version of this post used to sit on Rebecca Wright’s (no longer active) blog. She gave her permission for me to reclaim it and share it here.

Extortionate fees or extreme value for money?

Posted by: on Feb 8, 2018 | No Comments

If you think doulas are expensive, trust me, you are about to find out just what good value we actually are.

This as an open letter to Dr Ahmed Rashid, an NHS doctor, in response to his comments about doulas in the British Journal of General Practise, February 2018….

” I first came across a doula as a junior doctor working in obstetrics and the idea has fascinated me since. In case you haven’t heard of them, they are trained or experienced lay women who provide social, emotional, and practical support during pregnancy and birth, but do not provide any clinical care. Although the practice has ancient origins, the modern doula movement began in the US in the 1970s and private doulas, hired by mothers (often for extortionate prices), have been popular in certain parts of the UK for some time. A recent Oxford study focused instead on volunteer doulas, trained by third-sector organisations. After interviewing 19 doulas and 16 mothers who had received their support, the authors concluded that they can play an important role in improving women’s birth experiences by offering continuous, empowering, female-focused support that complements the role of midwives, particularly where the mothers are disadvantaged. Perhaps it’s not such a bad idea after all.”

Dear Dr. Rashid,

I’m not sure you appreciate quite how much work goes into doulaing, and the costs we incur in the act of doing this valued work, so please allow me to enlighten you.

Firstly, training to become a doula is not an undertaking which is funded by an employer but is paid for by the woman herself. During her initial training a doula will likely spend hundreds on the training course, and hundreds more on books to better understand the many complex needs of the women they serve. Some clients will have experienced earlier birth trauma, others may be survivors of childhood abuse or domestic violence. Even straightforward births can be greatly assisted by a doula who is skilled in certain things – which in themselves may also cost money for her to learn or do. Aromatherapy oils are not provided for free to doulas, nor are such things as a rebozo scarf (extremely useful tool which I invite you to google), or the many other items doulas might carry in their bag to aid women to give birth. The NHS budget doesn’t always stretch to some things which are proven to help women and which doulas invest in as part of their toolkit.

Furthermore, doulas take pride in continuing to learn after their initial training, and supporting women may take on many forms – providing assistance with all manner of skills which don’t happen by magic but are gained through training courses, which also cost money to attend – when you consider course fees, travel costs, accommodation costs are all out of the pocket of the doula herself, this adds up.

Then there are yearly insurance fees, membership to Doula UK, taxes, fuel costs, hospital car park fees, website/ promotional / advertisement costs, mail system fees, payment fees (paypal costs for example). We don’t get new clients by pure magic. And even word of mouth can only go so far.

Consider this – a doula is potentially putting aside a whole month of her life during every ‘on call period’ with a caveat on all commitments or social arrangements that she makes to ensure that she can reliably attend the birth of her client who has invested a lot in her emotionally besides the financial cost of hiring her. If a doula charged £1,000 per birth and booked 12 clients a year, forgoing a holiday, that is a maximum yearly income of £12k, before taxes. This is hardly extortion, when viewed in this light.

I conducted a poll this very evening on a Doula UK forum to see what the average doula charges for doing all this work. There were 30 respondants, with the mean average fee for births, including London pricing, coming in at £787.

Does this in all honesty strike you as moneygrabbing, or extortionate, Dr Rashid? Could you or would you, do this kind of work for that sum? Would you put your whole life on hold for that? Even those women who charged at the upper end of the scale gave detailed descriptions of the numerous antenatal and postnatal visits included in their package with a broad range of services to assist mothers in recovery from childbirth – none of which are even remotely available on the NHS.

Going to births can be gruelling. It is a sweaty, bloody, pooey, pissing, puking, very much hands-on kind of job. I have come away after 27 hours solidly supporting a woman and her partner absolutely drained to my core. Unable to drive myself home safely. Emotional. Aching all over. Bruised. I have known doulas to stay with women for five days straight. This job is not for the faint-hearted! Plus, who do imagine looks after our children while we do this work? And at what cost?

Please do not underestimate how much this job takes out of us. You may think we just massage our clients back a little for a few short hours and squeeze their hand whispering encouraging things but you do not see the hours of invisible work, research and worryinwe do for our clients. This is more than hand-holding – we support women’s journeys with our whole being.

You may not know of the meetings or email exchanges for the months before, providing information and signposting towards services and resources, or the messaging at 1am trying to resolve breastfeeding issues as a mother struggles and needs someone to talk to who has been there and can help…. but we do. It’s a normal part of our work.

The Cochrane review has already demonstrated our influence in the birth room as a force for good, and I can vouch for this in my own experience. The mothers I support talk about how transformational the process of becoming a mother has been for them, and have often told me how integral my support has been in facilitating the family’s bonding, healing, recovery, and initiation into parenthood. I have had fathers message me, thanking me and saying how much my influence has shaped their partners identity as a new mother or helped shape their parenting journey per se. I also know, from my work as founder of the Birthplace Matters campaign, that relying solely on the care of the NHS alone can leave some women utterly high and dry – the stories I have been told are freely available on http://www.birthplacematters.org.uk if you care to see what standardised care without doula support looked like for some women. The NHS is severely stretched and midwives cannot always offer the care they would wish to – this is where doula support is especially valuable.

Would you really have us all offer this dedicated extended support spanning many months either for free (which doulas do sometimes offer for a valued friend or for access fund clients (where a few basic expenses are funded through a charity but they receive no other payment at all for the birth or on call period) or for a measly couple of hundred pounds?

I respectfully ask you to reconsider your comments about our true value in the light of the many ways that doulas help women and their families. We do this work for love, not to get rich.

 

I hope you perhaps appreciate now how much we doulas are in fact excellent value for money!
Regards,
Paula Cleary
Doula and Founder of Birthplace Matters

Keeping Birth Normal: Why Aren’t Women Being Taught Birth Basics?

Posted by: on Mar 19, 2017 | No Comments
Guest Blog Post by Spoken Word Artist & Doula, Kati Edwards

Thank you so much Paula for inviting me to write a guest blog. It is such an honour. I’ve chosen to tell a little of my background for those who don’t yet know me and tell a story highlighting one of the things I just don’t get about our maternity system.

Keeping Birth Normal: Why Aren’t Women Being Taught Birth Basics?

My journey into the birth world has been a little unconventional perhaps. In 2015, my home water birth was televised on the landmark BBC1 documentary ‘Childbirth All Or Nothing’. I say a landmark show because it was an undisturbed home birth which is so rare to see on mainstream TV. Anecdotally, the show was fairly seminal too. Partly, because I ingested a piece of my baby’s placenta on national TV. Anecdotally, I’d heard it might benefit and starve off the baby blues. The show apparently set off a wave of women wanting to do the same and keep their baby’s placentas to add into fruit smoothies!

But aside from the placenta smoothie sensation, the show did a great job of presenting some of the issues and diverse choices available to women and their partners when contemplating how and where to give birth.

The programme makers ‘Landmark Films’ were recruiting women who were making conscious choices in childbirth that were outside the norm and who could articulate their reasons for doing so. I think they did a really good job and still, to this day, sometimes people come up to me to say the show changed the course of their birthing experience.

As a result of being on the show, I’ve been subsequently invited to speak at birth conferences both in the UK and internationally either with storytelling or with my poetry.

This article focuses on something that happened at one of my first midwifery society conferences in 2015. The audience was mostly second and third year midwifery students although there were a handful of doulas and other birth workers. My chosen title at the conference was ‘Confidence, Positivity and Empowerment’ in childbirth.

At the time, I was working for the NHS in a Neuropsychology team in Physical Health so my job was all about how the ‘mind affects the body and the body affects the mind’. Since having my first baby in 2011, it always occurred to me that the mind/ body connection is SO important when it comes to childbirth and yet is given so little credence. There are few psychologists working within the field.

Antenatal appointments are mainly, in my experience, focused on the physical. There’s the taking of blood samples, measuring tummies, collecting samples of urine and collecting data on blood pressure. Data is collected and presented as though it’s an exact science and may be presented in a way that steers a path for those families involved, limits options and promotes fear.

How we are feeling about ourselves or our babies or the impending birth rarely appears to be on the agenda in my experience. And psychological strategies to help women and their partners help themselves are rarely presented as options. If one of the aims is to maximise comfort and minimise distress, I believe we must look further into how our minds can positively affect our bodies to give birth.

At the conference I alluded to above, one of the talks was on ‘Hypnobirthing’. It was this talk more than any other that stuck with me. But not for the reasons you might imagine. You see, I’d studied ‘Hypnobirthing’ for my own baby’s births and I knew the material well.

During the talk, the basic principles of ‘hypnobirthing’ were delivered. We learnt about how

  • the practice of relaxing deeply in pregnancy and women receiving a positive understanding of how the body works to help the baby exit the womb can be really helpful
  • when the woman is able to go into herself without being disturbed, she increases the chances of giving birth naturally
  •  the hormones affecting birth especially about the role of oxytocin sometimes called the hormone of love that makes labour progress most effectively
  • steps must be taken to keep fear out of the birth room because fear can increase adrenaline levels which in turn hamper the progression of labour

We were shown a sign given to hypnobirthing women to put on hospital doors that said something along the lines of ‘Quiet please. Hypnobirthing in Progress’.

And the audience had a discussion about how having this sign really makes a difference. We heard how staff frequently act differently around ‘Hypnobirthing women’. For example, staff are often much more sensitive to knowing these women want quiet. People knock quietly on the door to enter and speak in low tones with minimal distraction or interference.

All this support for the woman and protection of her birthing space clearly gives that woman a greater chance of her baby’s birth unfolding naturally.

As the lecture went on, I became more and more dumbfounded. To me, the lecturer was describing how birth worked. Things I already knew despite at the time not being a doula or a qualified antenatal educator or a midwife.

These were things I already knew, but the audience was mostly 2nd and 3rd year students. Surely they knew already this stuff? What had these student midwives been learning in the first years of their course?

If this is how birth works, why aren’t all women being given this knowledge and therefore the best chance to give birth naturally? (should they wish to of course).

Surely, you shouldn’t have to ‘hypnobirth’ or take natural birth classes to be given this chance?

After the lecture ended, I went and sat next to the speaker and said, “Excuse me. Can I ask you a question?”

She nodded. I asked, “Can I ask, is what you’ve just said ‘news’ to these midwives?’

She looked at me slightly puzzled and said, ‘Yes. I think so.’

We later chatted about what I meant by this and for me, the following questions came up;

  • How come these midwives don’t know this stuff?
  • Shouldn’t we be starting off with ‘normal’ before we present the abnormal?

I want to shout from the rooftops, why is this ‘hypnobirthing’ and not just birthing?

Ultimately, what I just don’t get about maternity services is this:

Women should surely be supported to have the very best chance to work with their hormones to birth their babies?

I believe women who want to avoid intervention should be given the very best chance of doing so.

Shouldn’t ALL women and their partners know their baby’s births can be influenced by not only their own thoughts and feelings about the birth process but also the environment in which they choose to birth in and the trust of those supporting their birth space?

In my opinion and experience, there is not enough focus within the NHS on the things you can do to support yourself to have a better birth experience if you would rather avoid medical intervention. There is plenty of information about pain relief options but relatively little about what people can do to really help themselves have a better experience.

Women and their partners have to look elsewhere to supplement their knowledge, hire a doula and/ or do an independent antenatal preparation course.

And often, no-one tells them that this whole other world of birthing ‘enlightenment’ exists. Maybe it’s just something they have to find out for themselves. Through books. Through word of mouth. And even then, they’re only going to hear it, if they’re ready to.

For me, birthing ‘enlightenment’ in the modern age means: knowing your options, feeling comfortable with trusting your instincts, working through any fears and doubts so you can trust the process of birth and give yourself the best chance of a positive experience, having birth attendants around you can trust to understand your wishes and having mental tools to help you relax in all situations.

In my idealistic world, all women would have these opportunities and not just the lucky few.

 

Kati

Kati Edwards is a doula and antenatal educator based in Manchester, She is the creator of “The Birth You In Love Project”, a FREE mini-vid series to help women understand the basics of birth.

 

Dear Healthcare provider….

Posted by: on Jul 20, 2015 | No Comments

Dear healthcare provider,

Please think very carefully before you say the words you are about to speak. Before you laugh at my birth plan, snigger at my choices, try to bully or trick me (for the safety of my baby), before you insist upon that procedure, before you force yourself on my body with your ‘helpful’ instruments, and before you say even one word more, STOP.

STOP and think what you are about to do or say.

Let me tell you why.

We don’t know each other very well, and there are many many things you could not possibly know about my journey in life so far. You cannot know if I was shamed or bullied about my body, by my parents, siblings, other family members, friends or acquaintances at school, at the vulnerable time of my blossoming. You cannot have any idea the effect this had on me, you cannot know what ideas or teachings I inherited, or how traumatic my entry to womanhood was.

You cannot know if I was touched up by pervy old uncles, a teacher at school, my childhood dentist, or even a closer member of my own family. You cannot know if I had a boyfriend throughout my vulnerable teens, twenties or thirties, who undermined me, cheated on me, criticized, or even beat me.

You cannot possibly know if I was raped or abused, and how utterly utterly horrible it feels having people like you ‘just taking a little look’, and putting things into my vagina, however gently, as if I were a piece of meat. Maybe, just maybe I have had enough of that in my lifetime and I just want my body back. Perhaps I haven’t told you because I have not even been able to tell some of my close friends yet. Perhaps I haven’t told you because I barely know you, and I don’t feel safe to. Perhaps I haven’t told you because I have a toddler in tow at all my appointments, and really do not want to discuss that kind of thing around her. Perhaps I don’t want to tell you because I only just met you five minutes ago. Perhaps you, with your white coat, and air of authority and respectability,  with your letters after your name that are supposed to mean that you are a professional who would never hurt anyone, look a little like the dentist who used to do horrible things when I was five and noone was looking.

And perhaps someone just like you, who meant well, who had the right credentials, the right training, the doctorate, and the confident assured words, gave me some terrible advice last time, which led to a cascade of horrible interventions resulting in a birth that felt like I was being butchered. You will possibly not find out that the full impact of things that might have happened to me because maybe I don’t really want to tell you. Or maybe I don’t have time. You might be just another one of possibly many healthcare providers I might meet in the course of my pregnancy or birth. Do you think I really want to tell every last one of you everything that might possibly have happened to me to date? What do I know about you, really? Apart from your job title? Can you understand my perspective?

Right now, I am carrying a baby inside me, and I want to enjoy this time, in the present moment and not revisit my past. I do not want to invite stress upon my unborn baby. I am an adult now, and I don’t need to be told what to do any more by kindly, paternalistic know-it-alls.

As an adult, I am free to make choices about my body, and my baby. I am going to live with this body for the rest of my life, and whilst my birth is just another out of many you will witness today, or this week, or this year, I will live with that birth for the rest of my life. I will wake up and relive it over and over, for better or worse, and it will still be with me, when I lie on my deathbed.

So please believe me when I say that I do not make my choices flippantly or lightly.

I am planning to carry and give birth to my child the same way I intend to raise them – by listening to others advice and then doing whatever the hell feels like the sensible, intelligent thing to do, according to my own principles and preferences. As the parent of my child, I am responsible for making decisions on their behalf from the word go. Not when you decide. It starts now already. If I say no to something, it is because I have carefully considered and weighed up all the pros and cons, and decided that no is the best choice for us. If I say yes and give my consent, it is also because I have weighed things up and made an educated choice.

I may not have your degree or doctorate. But you know something? The age we live in is making your knowledge less exclusive. We are not in the 1200′s any more. I am part of a savvy, educated movement of women who are curious, who debate, who watch, discuss, and share knowledge. I can read, so have quite possibly, read quite a good many different books about birth. I have the internet, where I can read blogs and websites by midwives, discussing the ins and outs and pros and cons of every minute aspect of birth. I have possibly taken part in discussion threads involving scores, if not hundreds of intelligent commenters, some of whom are healthcare professionals, so are more than qualified to comment, give advice, share information, insights and so on. The beauty of such forums is that women can try on different ideas and hold them up to be examined in the light of others experiences, before making any informed decision about things that will affect their baby or themself.

You don’t have a monopoly on understanding different aspects of birth. You are the expert in the information that you know, and an expert in doing things a particular way, but that does not mean it is the only way, the best way or that I absolutely have to agree to your way. You are entitled to your opinion, but you are not entitled to force me to agree with it. You are a service provider, and your job is to serve me. Not the other way round. If what you are offering doesn’t sit right with me, I have every right to say No, and for that to be respected. If you do not like this, and I understand that this can be hard for you to swallow. But it’s the truth.

Every decision I make about my body and my baby has been carefully considered. I love the child that is growing inside me, I will love them their whole life long. I will never stop loving them. My child, my partner and I will also have to live with the consequences of whatever decisions we make on our babies behalf, so believe me when I say that we never make these decisions lightly.

So please don’t you dare wave the ‘dead baby’ card and use this as an excuse to trample over my decisions. If I choose to do something against your advice it can only be because I don’t entirely trust it, based on my own independent enquiries, study, reflection, earlier experiences and discussions around this particular issue, and as I said, this may involve a blow-by-blow dissection of the subject with other midwives, obstetricians, and possibly other mothers who have been in the same position as me and have been able to share their own take on things. Whilst it may smart that I have chosen to disagree with you, and take a different course of action, know it is my right to make that choice and that I am doing it in what I believe to be the highest interests of my baby and myself.

If you assume that I am choosing homebirth simply to have some kind of hippy ‘experience’, without thinking deeply about all the implications of what birth at home means, or that I haven’t weighed up the risks and cons sufficiently, please think again. I am choosing my homebirth because I genuinely, absolutely, believe it is where my body will be relaxed enough to give birth without inviting stress and interventions that I know are so common in hospital. I may well gush about my birth afterwards, I may tell my friends or write online about how it was beautiful, that I enjoyed it and felt ecstatic even. You might mistake this for dangerous wrecklessness and dreamy hippy nonsense. I assure you, it is a happy side-effect of taking an educated choice, after weighing everything up in all seriousness. If I report that I had a healing birth, it may be that an earlier one left me feeling so traumatized that I did not believe birth could be so gentle, and was taken by surprise at how calm being at home felt in comparison. I don’t tell my birth story to spread hippy-schmippy propaganda, but to give hope to others who may also have suffered a brutal, institutional birth, which opened up wounds, caused new ones, or left them bewildered and confused about the role of such ‘helpful’ institutions such as the one you work in.

I know your hours are long. I know your training took many years. I know you believe you are valliantly saving women every day, and in some cases, you do this, and I am grateful that you do. You might even save my baby or my life. If you do, I will be eternally grateful. I do not mean to say that I do not appreciate your work or your role. I am just reminding you of a few things in case you have forgotten along the way who has the ultimate say over my body and my baby.

So, are we clear now? Before you open your mouth and speak to me…. I want you to remember this conversation we will probably never have…. but perhaps you read it online and it made you stop and think before you make assumptions or rude comments about my choices….

Tread softly….. dear healthcare providers.. …tread very softly please.

How society tells women to be aspirational… just not in their birth choices

Posted by: on Jul 10, 2015 | No Comments

I’ve been thinking today about the mixed messages we receive about how and when we women are encouraged to be aspirational, and by contrast, when we’re told to stop whining and suck up our lot.

We are bombarded by aspirational messages every day in the form of advertising, where autonomy, breaking out of the box, being discerning and fearless are positively encouraged. We are almost being dared to push the very limits of what is possible, to not settle for anything less than our best. The Women’s Tennis Association tells us ‘Strong is beautiful’. EA games tell us to ‘challenge everything’. Adidas tell us ‘Impossible is nothing’. Nike tell us to ‘Just do it’. IMAX tells us to ‘Think Big’. Vodaphone say ‘Power to you’. L’oreal tells us we are ‘worth it’. Apple tells us to ‘Think Different’. Sky says ‘Believe in better’. Tag Heuer tells us ‘Success. It’s a mind game’. M&S says ‘The customer is always and completely right’. The Red Cross tell us ‘the biggest tragedy is indifference’. Porsche say ‘There’s no substitute. Ferarri tell us that ‘Only those who dare, truly win’. Audi say ‘Never follow’. We are even encouraged to have full soverienty over our  burger-choices, and told, proudly to ‘Have it your way’.

Choice seems to be the shiny, glittering prize of our consumerist age. Choice to have it on our own terms, choice to shop around, choice to assert our own personality and feelings. Choice, choice, choice, choice, choice. Choice is literally poured at our feet at every turn. And so long as we are CONSUMING, as long as we are buying into their version of freedom, of carefully branded (pseudo) empowerment, we are treated as captains of our own ship, we reign supreme. Price comparison sites are falling over themselves to help us, the discerning and intelligent public, to enable us to match up our exact requirements, with tickboxes and forms to ensure we are filtering things correctly and end up with exactly what we asked for.

If we travel to a hotel for a couple of nights, a relatively inconsequential event perhaps in contrast to many other life events, we can go and look on a website like trip advisor and get the lowdown on what the place is really like by reading hundreds of reviews and look at photos of the rooms from different angles, then fish around for the best deal we can possibly get before we go.

You might think that in this age when we are encouraged to be so go-getting, to be discerning, to strive for the best, to aim high and take no nonsense from anyone along the way, that women have never had it so good.

But when it comes to REAL choices, are women ‘worth it’ as L’oreal tell us? Or are we only worth trivial choices? Does our autonomy and thinking power only stretch to choosing what car to buy, what lipstick to wear and which brand of clothes wash really does get whites whiter than white?

When it comes to the really big stuff, to life and death, it’s amazing how our choices suddenly shrink. And when no-one stands to make a buck out of us, we are no longer savvy, cool and intelligent women who know their own minds, who are encouraged to ‘Never follow’ or ‘Think different’ or that success is a ‘mind game’.  Strong is no longer beautiful, but instead, if we assert ourselves on those issues that matter, those details  in our lives which really mean something, we are treated like a royal pain in the arse. This is where it all starts to break apart and we see a very different attitude to women… and this attitude is most prevalent when we speaks out about our birth choices. Suddenly, we are now seen in a different light – wanting things our way is a problem.

We might have been a tiger in the gym, or the boardroom, but when it comes to asserting our fundamentally personal birth choices we can suddenly face resistance in different guises:  gentle discouragement, being laughed at, told not to be unrealistic or unreasonable, selfish, or even reckless. It is a rare thing for a woman to state all her birth wishes and for every person along her journey to say – ok, let’s make this happen! It’s even sadder when female staff undermine the woman’s sovereignty and, perhaps worn down by working in an anti-feminist, patriarchal culture, can actually take the mockery of women to a new level – reinforcing a disempowering model.

And of course, those female staff are under enormous pressures and strains to pressure women to conform, comply, fit in with the hospital’s way of doing things so they don’t get into any trouble, and partly perhaps also because of their own trauma and not wanting women to suffer something they believe must be an inevitable consequence of a woman’s ‘unwise’ choice.

This has never been more true than when a woman chooses to give birth in her own home. You might be able to have your sodding burger any way you like it, but having birth your way? Do you know how hard that can be to achieve? The fight so many women have, the obstacles they need to jump through, the ignorance, the comments, the judgement, the warnings, the finger wagging and tutting. And even, outright lies.

If you are in any doubt about this, all I can say is that these are the exact reactions so many women are telling me in real life, and reporting in homebirth discussion forums, where others pipe up with ‘me too’s’. I have heard of midwives say ‘we’ll see about that’ or obstetricians tear up women’s birth plans in their face and laugh. This is how little autonomy women really have, in the so called civilised, developed world, of the free and the upwardly mobile.

I wonder if men gave birth whether there would be such a hoo-ha about their choices? Or would they be having Burger King style births, where every request was respected and met with a “Yes sir, no problem!”

The Red Cross is right, the greatest tragedy IS indifference. This is why it’s up to every woman to stand up for her rights, stand up for her choices and as Nike say, Just do it. Strong truly IS beautiful. On our terms. We really ARE worth it. But we don’t need some advertising brands to sell us that strength or that beauty, or that freedom. It is ours to hold onto and fight for.

We don’t have to tolerate the intolerable. Being pregnant does not invalidate our right to say ‘This is what feels right for me and my baby now can you please respect that and stop bullying me!’

If you want to refuse a certain procedure, like vaginal examinations or induction, you have every right. Find that midwife or doula or advocacy group to give you the courage to stand up for what is really important to you, those who will be your ally. But remember, ultimately it’s YOUR voice that matters most in the birthroom.

YOUR BODY. YOUR BABY. YOUR CHOUCE.

Homebirth – is it really that dangerous in 2015?

Posted by: on May 11, 2015 | No Comments

There’s a gameshow here in the UK called QI (which stands for Quite Interesting). When a contestant says a wrong answer, gigantic screens behind the contestant flash on and off whilst very loud alarm bells scream around the studio and the contestant is mocked for being such a dilly and saying the wrong thing. Sound familiar? Has that happened to you when you told people you wanted a homebirth? Of course I’m not suggesting ACTUAL alarm bells have gone off (That would be a bit weird) but…. when you encounter that attitude, you’ll know it’s there. It might be a veiled comment at the school gate, an exclamation of disbelief over dinner with friends, or an outright NO WAY! when suggesting the idea to your partner. What? You want a homebirth? You do know that women and babies used to die during birth at home, right? Are you mad? What if something goes wrong?

It’s a true enough fact. Women used to die in childbirth far more frequently. And so did babies. But is it really the act of being in hospital that has brought these incidents down to such a very tiny number? Can hospitals and modern machinery and advances really scoop up ALL the credit for birth being safer in 2015? Those entrenched in the system will tell you hell yeah! But I think not. And here’s why.

Giving birth at home in 2015 is not even remotely like giving birth in 1215, 1615 or even as recently as 1915. And here are 10 reasons that prove it.

1) Germs

We now understand that germs can cause infections. But, for hundreds of years, no one realised that inserting dirty hands or instruments into the birth canal could be fatal for the mother. It is estimated that over a million women died from ‘childbed fever’ in Europe alone in the years before the link was made. Ordinary household germs are fine when they are just knocking around in the home and it is actually beneficial for baby to be born in their own home where they will be immune to those normal germs – providing of course you don’t live in actually squalid conditions. But things like MRSA and other superbugs in a hospital environment are alien to a woman’s immunity. And the very act of being in hospital increases the likelihood of the use of instruments like forceps for example, or use of needles, or Caesarean surgery which could cause infections to happen. Staying away from hospital in the first place means these kinds of things are less likely to be needed. Giving birth in a modern day not-too-dirty but not-too-bleachy home which is clean and warm is a safer environment germ-wise than most hospitals. 

2) Water

….. Clean, fresh, running water. In the home. Coming out of a tap. Not only do most modern homes have their own bathroom with flushing toilet but they also have access to heated water, (Not just that but central heating – big trump card for homebirthers in 2015) and washing machines for instant cleaning of linens, bedding and clothes, which has greatly improved overall sanitation in the home – making modern day homebirth a much safer option than in earlier centuries. We take it for granted that water comes out of a tap on demand but getting clean water used to take up a lot of time and effort. Even better than just having water on tap – we can now have birth pools in our very own living room, offering drug-free pain relief and a more ‘active-birth friendly’ environment to replace the bed and to lying in the stranded turtle position. What’s not to love?

3) Diet

Women overall are well nourished in 2015. Ok some like myself are a tad erm too well nourished and we do have issues in the west with obesity. But overall? Women in 2015 have access to a wider variety of grains, meats, fish, fruits, vegetables, minerals and supplements than any other generation of women before them. There is greater understanding of women’s dietary needs, and even such conditions as diabetes or anaemia can be managed and improved with proper care, treatment and planning – by conventional means and also by a wide range of complementary medicines/practitioners. Both of these conditions can be extremely dangerous when unchecked and untreated, but we are better at addressing this today than ever before, and can even rule out homebirth if medically necessary – not an option in 1615. Dr. Amali Lokugamage talks in her book ‘The Heart in the Womb’ about the ways in which she reversed her gestational diabetes and was able to safely give birth at home, partly through modifying her diet. It is possible.

Malnourishment was once a frequent cause of death for mothers, whose bodies were depleted and not strong enough to support them through a long or difficult labour. We now have better access to foods to fortify mothers and most women here in the UK can afford to feed themselves quite well. A very different story to the poorest Victorian working class mother, perhaps having her eighth child on an empty stomach in cold and maybe even squalid, conditions. This particularly grinding poverty is not likely to be the case for most home birthing mothers in 2015.

4) Improved gynaecological health

Speaking of women having many children…. since the introduction of contraception, women are no longer having so many children as they once did. Gone are the days when it was entirely normal for a woman to have a brood of ten, and for the placenta to keep having to implant itself in a new spot each time that gets harder and harder when we are getting into such high numbers – causing increased risk of fatal post-partum haemmorrage. Women (or indeed very young girls) may also have had no choice but to give birth to a child following rape. Or incest. Such things were not discussed or written about and there were no self help groups or counselling services from folks trained in how to cope with such enormously emotionally damaging scenarios.Women giving birth to a disabled child could not know with certainty if the child would be well received by her husband and family and some may have been reported as having died during the birth but were in fact sent away. Having a baby out of wedlock was considered to be an absolute disgrace, so women were forced to give birth in secret, sometimes far away from home, where no one could find out. It must’ve been very difficult for some women (or young girls, let’s be honest) to bond with their unborn babies and lovingly carry them to full term. There was also the problem of dodgy abortions which were very dangerous for women and if performed badly, could leave their wombs scarred and damaged for any subsequent pregnancies. Let’s also remember that it was quite common for women to have STD’s in earlier centuries which sometimes went untreated. Syphilis in particular was rampant in earlier centuries and could have terrible consequences for mother and babe if left untreated.

5) Overall health

Women in earlier centuries would not have understood such underlying medical conditions as pre-eclampsia, or gestational diabetes or had any means of screening for them. Their bodies carried the scars of every illness that they ever had. Some illnesses could leave a woman weakened permanently. She may also have had treatments or operations that were dangerous or botched in some way. It stands to reason that women used to also give birth whilst suffering from cancers, tumours, rickets, poxes, viruses… all kinds of physical conditions that could make pregnancy and birth more difficult or even life threatening than it would be for today’s average woman. Nowadays women are cared for throughout pregnancy and can have their blood and urine tested, choose screening by ultrasound, receive effective, immediate, or ongoing treatment if needed for any underlying conditions and have an idea of how baby is doing. We now have so many ways to detect and identify if there are any obvious reasons why birth might be difficult or dangerous in advance of the event and anticipate how to manage those risks, and whether to absolutely avoid homebirth altogether. A woman in 1715 could not choose between the two -it was home or nothing.

6) No more corsets

In 2015 women are not contorting their bodies into corsets or other physique-altering clothing. Imagine what having such a pinched waist would do to a woman’s insides! It literally altered the shape of a woman’s womb and moved her internal organs into positions they were not meant to be in. Is it any wonder some women could not give birth to their children with such contorted bodies?

7) Women are more informed than ever

The age of information and the explosion of material on pregnancy and birth means that modern day women understand the mechanics and physiology of their own bodies and the birth process better than any other time in history. Information has gotten into the mainstream and women can read books, blogs and websites by midwives and other birth professionals,  attend courses, join support groups, compare graphic details, watch youtube videos of women giving birth, or talking about birth, and learn things like hypnobirthing to help them to feel informed and in control. Women in 1215, 1615, and let’s face it even as recently as 1915, might not have received any sex education at all, or at best be relying only on the bible, or a church person to tell them about birth. If they were lucky their mothers might tell them in advance but it’s not uncommon for women to literally be given no indication at all as to where their babies would even come out of them. Prudishness and modesty prevented some people (and some entire cmmunities in fact) from talking frankly and honestly about the female body and it’s functions. Any birth attendants might have chuckled knowingly amongst themselves or spoken in coded language that betrayed very little of what the woman in labour should expect. Imagine how terrifying birth must have seemed for women who didn’t have a clue what was happening to their bodies and if they would survive – how tense they would’ve been! This alone may have caused long difficult labours in the past.

8) Skilled equipped birth attendants are the norm

Those who attend homebirths nowadays tend to be trained midwives who have studied, witnessed, attended and analysed a variety of births and they attend with a whole kit of clean equipment (some life saving) – but not every woman was so lucky throughout the ages. Before the NHS and free midwifery care, not everyone could afford to pay a midwife to attend to them. They may have been particularly unlucky and lived at a time when a new breed of midwife came to the fore – cocky doctor men with instruments to wield – whether a woman needed them or not. Such doctors thought they knew best and became zealous advocates of forceps and told all their women patients to lie down to give birth. By inserting things into their vaginas so they could be seen to be doing things and justify their fee, many actually made childbirth more dangerous for women.

But by the same token, not every midwife had enough skill or knowledge to assist mothers well either. Some were living under very close watch and approval (or disapproval) of the church and had to be very, very careful about what they prescribed, did or suggested to mothers. There was a very real fear that midwives with their hooked nails ( for piercing the amniotic sac) and faith and knowledge in healing herbs might be at odds with the churches way of thinking and could end up on trial, or worse, on the scaffold. In the 1600′s in particular, witchcraft was something that terrified people and accusations of this were most often levelled at midwives. It stands to reason that a certain number of women and babies died because some midwives were actively prevented or at least, deterred, from performing some potentially life-saving action, or from prescribing a particular thing that would assist a mother or baby in difficulty. Women could be accused of witchcraft if they gave birth to a disabled child. Thank goodness we have a more compassionate outlook in 2015.

9) We no longer rely on horses for transport

Look at our infrastructures for transport in 2015. We have smooth roads, A-roads, motorways, cars, ambulances – heck we even have helicopers! Most midwives will tell you that any problems a woman has in labour tend to unfold slowly, and with proper observation and action can be managed at home, and even if transfer is needed, it might not always be a 999 drama. But even if, in the extremely rare circumstances that you DID need to get to hospital fairly quickly, this is not 1715 when you might be relying on a horse and cart to take you to the midwife woman in the next village (Who you would hope to god would be at home but you couldn’t be absolutely sure). No, in 2015, we have house phones, mobile smartphones to call for extra assistance and (and a team who will come in a flash), cars and fully equipped ambulances to help take you to one of perhaps several hospitals. All of which no woman ever had in earlier centuries.

10) We have our men by our sides

Women in 2015 have something many others did not have in the centuries before – the love and comforting support of their men in the birth room. Women supporting other women has always been the norm, and fine it is too. But there is some thing particularly reassuring for a woman to have the father of her child there to lean on, to rock with, to hold and kiss, and to love. Having that strong masculine presence and energy has made me feel bolder, more confident and more calm during my homebirths than I imagine I might have felt as a woman giving birth in 1615 with a group of gossipy old women surrounding me and making me feel like a silly little girl who doesn’t know diddly squat. Michel Odent says men in the birth room are a wimpy nuisance as they are too needy and nervous. I say pish to that. Sometimes, yes, men can be like this. But I have found in my own birthings the opposite to be true.
So there you have it. I’m sure I probably missed a whole bunch of reasons why homebirth is safer today than any other time in history. What I can tell you is this: electric foetal monitoring in hospital hasn’t been proven to save even one life. A quarter to a third of babies being born by caesarean is not normal. Women being routinely induced as frequently as they are (which often triggers what is known as the cascade of interventions) is also not normal. Women getting infections in hospital from c-section operations – not normal or desired.

Next time all those alarm bells seem to be going off when you tell someone you want to have your baby at home, and they tell you how dangerous homebirth is…. Take a step back. Remember hospital births with all their routine interventions are not always so very safe. Clinical yes. Sterile, perhaps. A little soulless. Possibly.

Is hospital birth necessary for some mothers who have very particular needs and risks?Absolutely. Should we have hospitals as a back up? Absolutely. But is it really necessary for 99% of women to have their baby in a hospital with all the increased risks of interventions and surgery and infections that that brings….. in these modern times when we’ve never had it so safe?

Well, I’ll leave that up to you to decide…..

Breastfeeding needs time, loving care and support

Posted by: on Aug 17, 2013 | No Comments

Breasfeeding is an activity which seems to be harder for some women to do these days.

I have been one such mama. After experiencing no problems breastfeeding my older three children, at the time I was having my fourth, I felt really stressed. I didn’t have the right kind of support to help me to breastfeed every day and every night, I was full-time home educating my other kids who needed me, and my husband was working crazy hours. I struggled to get a good latch with my son, and felt a failure for suddenly becoming so faffy and awkward and cack-handed at feeding.  I couldn’t believe that I was in this predicament fourth time round and it really rocked my confidence in myself to be in this position. Exhausted, I counted down the weeks and days till my son was three months old so I could say that at least I lasted three months. Looking back, I pressured myself to much to be a perfect mother, and could have relaxed a little. You live and learn.

The thing with breastfeeding is that you need to slow your life down to be able to do it – something which has hidden gifts and rewards for those who do it, but many women are unwilling or unable to slow down quite so much. Breastfeeding is a peaceful, not frenetic action. Sitting still is required. You can’t be multi-tasking very easily whilst you’re feeding, and if you’re used to go-go-go living, it’s hard for a woman to just.stop. The reason I gave up was because I could never sit still long enough – it felt like I was constantly having to tend to some minor emergency with my other children – the toddler who was hysterical because they spilt juice on the floor – or because the phone rang and I felt I must answer it, or the doorbell went. It’s only now that I realize how unimportant the phone or doorbell were. That they, not my baby, should have to wait, and come second. Had I just slowed down and planned my other children’s activities during feedtimes, I would have been more relaxed – I would have flowed more easily in every sense of the word. It’s easy to be wise after the event though.

In any case, in order to have a good flow – a mother needs rest. She needs nurture. Her milk just won’t flow nicely when she’s feeling rushed, or stressed. She needs to drink plenty of fluids. She needs good wholesome food that truly nurtures her and boosts her milk supply and energy levels, not junky crap. (Incidentally I received this book by La Leche League for review from Pinter and Martin last year and it was awesome – I will be using it a lot.)

She needs time to love and heal her post-birth body and be gentle with it. A feeding mother needs to be mothered herself in some respects – this is perhaps why women in communal or tribal groups simply don’t experience the issues of milk ‘drying up’ – a myth that seems to perpetuate whererever powdered milk is heavily advertised and promoted. Women in extended family/community groups help one another out with cleaning and caring for children and feeding one another’s families. They take things in turns. They nurture and value nursing mothers and venerate them.

With love, they help keep things lighter and more carefree. Western women are generally expected to do it all themselves, to ‘get on with it’ – often struggling alone, and isolated from that kind of daily help. It’s no wonder the milky powder that offers them a route out of exhaustion seems so alluring.

And now I find myself pregnant again, I am in a different place altogether – my hubby is sharing the care and education of our children with me, since he quit his business to do so – seeing how important those first few years are and that they cannot be reclaimed later. I’m enjoying a gentler paced pregnancy. The other children are all older – my youngest will be five and a half by the time this little one arrives – a whole two years older than my third child had been when I gave birth to my fourth. This time, I will feed my baby slowly. I will take the time to look lovingly at them whilst I’m feeding rather than at the clock, or nervously wondering what a curious and accident-prone toddler might be up to. I will have time to eat good food. To drink. To go for a pee in peace. It sounds silly but these things matter.

I’m a different mama this time round.

I really sympathize with mamas who turn to the bottle – but this time, it’s boobies all the way for me. I’m looking forward so much to nurturing my little one, holding him or her close to my skin….. and saying fuck it to the doorbell!!!