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Why I’m hanging up my doula bag.

Doula
Baby Layla

This year, 2014, I’m hanging up my doula bag. After February, when my last client is due, I’ll be taking no new clients, not until my children are in secondary school.  I’ve seen 14 babies  born and experienced the joy of working with some of the most courageous, determined and powerful women I have ever met.  I’ve had the honour of being invited into their homes and hospital rooms at the most important time in their lives and able to share in the moment that their babies are welcomed into the world.  I’ll treasure those moments forever and can remember each and every one in detail.

The births for me were easy to be at; I live a very hectic life and being at a birth is the most exquisite exercise in mindfulness.  I love the birth space, of being in that moment, and of being present for that mother and partner without distraction. I would discard my watch, turn off my phone, the lights, shut the door. Tuning into the mother, I learned things about our connection to others in that pause, that island of time that I have read about but not experienced before being a doula. Through the work I discovered a much deeper part of my own femininity.  I felt connected to a collective female unconscious that went further than my own mother, grandmother. It has personally been a very healing and enriching experience.

What I found `challenging about being a doula was the on-call period.  I live in a rural area. Simple things I took for granted, like travelling to my favourite supermarket or going to the cinema with my boys would sometimes take me too far away from a client. Since many of my clients were over 40 minutes away in the nearest city I was not able to travel very far in the opposite direction. This is much how I imagine it is the US where bigger distances are covered by doula’s.

A couple of prospective clients tried to beat me down on price, and commented on it being expensive.  But Doula’s are actually cheap, we have overheads like tax, training, marketing as any normal business does. Being on call doesn’t mean I’m not working either; when I’m on call I have my client in my mind, and am always at the end of the phone.  I couldn’t commit to things when on call, like tennis matches for my team (I play competitively), or events like weddings or visiting friends at the weekend. I can’t have a drink either, sometimes for weeks on end.  Connections in my own life began to suffer as I let these people down and didn’t see my own friends as much.

I’m not just a doula,  but I’m also a hypnotherapist and I run classes, so occasionally I would have to cancel clients at the last minute or ask someone else to run my class.  I always swallowed that financial loss because I loved what I did. My husband started to call it a hobby.

I would have been awake for anything between 24 and 40 hours (births usually mean going without sleep for at least a night) and would have to drive home. There is no option to sleep over if you have been at a hospital. In rural areas we don’t have the luxury of city transport systems, affordable taxis, buses, trains or tubes that run on a regular basis.  Once I think I fell asleep at the wheel -I jerked and found myself heading towards an embankment at the side of the road. My husband recently did some work at the BMA to highlight working hours for doctors pointed out to me that studies show if you haven’t had sleep for around 24 hours you are functioning in the same way as someone over the limit.

But the final decision came, after my husband told me that my 9 year old son was like one of the Zombies out of ‘Walking Dead’ when he was roused from his slumbers at 7am, ‘sleep eating’ his breakfast, so that my friend Katie could pick him up while I was a birth.  I knew that enough was enough.  I had to spend more time with my children, and when I was on call I wasn’t ‘with them’.

I’m not 100% sure that I’ll ever take down my doula bag again. I’ll wait until my children are at secondary school and more independent, then think again.

I am totally in awe of the women who have been doula’s or independent midwives for many years, and who are constantly on call.  It takes a certain type of dedication and strength, both physically and emotionally, to be able to hold a space for a woman over weeks, sometimes months, whilst keeping your own life in tact outside of that space.

I hope that doula work becomes recognised and valued for what it really is other than by doula’s, birth workers and the people they care for. These are women who have little more motive than to give other women the continued care that a doula or independent midwife can offer and who believe very strongly in women’s right of choice and dignity in childbirth.  They embrace the mother and her partner with the undistracted support, trust and love that a woman needs in order to make informed choices and experience birth positively whatever path their birth takes.  A doula can help a woman feel valued, listened to and most of all make sure that she is treated with compassion and love.

For now, I’m going to shift my focus to private classes in The Midlands and London as well as building Mindful Mamma into a great online resource on the tails of the ‘Mindful Hypnobirthing‘ book launch in March.  I couldn’t possibly give it up completely……

Find out more about why women enjoy working as doulas, and birth workers at this ongoing project by Maddie McMahon #feministbirth

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Letter to a midwife from a doula

Letter to a midwife from a doula
Letter to a midwife

Dear Midwife,

What you do is amazing. You are a multi skilled, compassionate person who does an incredible job under sometimes frustrating conditions. I’m constantly in awe of the work you do, and humbled by how you can fight to support a woman’s wishes and protect her space during a birth.

I’m often asked if I want to train to be a midwife, but I don’t. I actively made a choice to be a doula as I wanted to support women in an emotional sense. My training over the last 8 years has taught me more about how the unconscious works at a birth than how a uterus functions and that’s just how I like it to be.

Some doulas just attend home births, but I feel that it’s hospital where a mother needs a doula more, when you are busy and have paperwork and maybe have more than one couple to attend to, I can be there constantly. I also attend a surprisingly large percentage of births that are considered higher risk, not just because the mum wants a normal birth, but because we have prepared in a way that reduces her anxiety and helps her create a familiar, loving environment for the birth. All the high-risk births I’ve attended have been normal births, in spite of the odds being stacked against the mum.

I know you may sometimes see what I do as part of your role, the part of your job you perhaps enjoy the most, but I also know contact time with a midwife can vary, some women will be lucky enough to see you throughout their pregnancy others not so lucky. For those that are not so fortunate I have the luxury of time to get to really get to know that woman and her partner, unhurried, to know them as a couple and for them to get to know me. We both know that good continuity of care leads to better birth outcomes.

Letter to a midwife from a doula
Continuous support can make a difference to birth outcomes.

The mums I attend have great affinity with some midwives, not so much with others, that’s how it is with life. Some people you get on with others you don’t. Believe me, my heart leaps when the mum’s eyes light up because a community midwife she really likes steps through the door at her home birth. I know that if those mothers could choose their midwife and have continuous care throughout their pregnancy and birth my job would be redundant, and I would rejoice!

I’m not just a doula that is on shift that night, the mother will have interviewed me alongside other doulas, and she will have chosen me because I ‘feel’ right. This doesn’t happen with everyone, there are women I just know I’m not the right doula for and who I don’t feel that connection with.

Sometimes at a birth, I do feel like a spare part, I may sit and read, I may make you a cup of tea and have a chat with you. You may think I’m doing nothing, but in fact I know that this is what the mother needs. Sometimes I’ll be helping her breathe through each contraction, quietly (always quietly) encouraging her. Whatever happens I will be there from when she needs me until the end, the longest I’ve been away from my family is 24 hours.

Sometimes, the mother will want you to tell me first before if you want to do an observation, so I can gently prepare her. There is an unconscious interaction going on with this that makes the mother feel familiar and safe, not me being a guard at her door. Although sometimes I feel that this is what you think! If I sense that a mum has really bonded with a midwife, I will fall into the background, and allow this relationship to develop.

One thing that I want to be very clear about is that a woman’s birth plan is not my birth plan. I have not advised her or told her how she should birth her baby. This is not my job. A woman will often come to me, or hire a doula, because she has already done her research, she’s well educated about birth and she knows what her choices are. She may know that they are unconventional and she wants someone to support her that she absolutely trusts to help her navigate her birth, to help her through and keep her as close as possible to her plan. She knows that care fluctuates dependent on policies, which hospital she is attached to whether she is as home, at hospital, midwife led or consultant led.

I don’t make medical decisions or give medical advice. If you feel an intervention is necessary for medical reasons I can help you explain it to the mum in way that I know she will understand based on how I’ve got to know her and her partner and their wishes for the birth. Importantly, this also means that I can help her sensitively reflect on this, I’m trained specifically in this. But, I have to do this with integrity; she wants me to help her stay as close to her choices as possible, and I  have to do this while not obstructing you in your job. I recognise you have responsibility for the safety and care of that mother and baby. Sometimes this is difficult for me, and the hardest part of being a doula.  Sometimes I worry I step over the line, and that I have done more than I should. This is not my intention.

We know, in any profession, that information presented depends on a person or a practitioner’s own experience and training, not always what might be best for that mother or that baby in those unique circumstances. I may point you in the direction of her birth plan if something is suggested that goes against her wishes. I may ask for your help in suggesting things that help her keep close to her birth preferences. I can help her and her partner reflect and explore questions that give them ownership of their baby’s birth, I certainly don’t have all the answers. I apologise if this makes your job harder, and takes your further from the guidelines that you feel comfortable with, but I know that this will help the woman have a better experience emotionally.

Although I’ve done training in positioning and massage, I will nearly always follow your lead on this when you are encouraging a woman to move about or use certain massage techniques for specific points in labour. I’ve learned some incredible things from midwives over the years including some great aromatherapy mixes!

If I’ve helped them prepare using mindfulness, relaxation or hypnosis, I’ve tailored it to them, so I may give them confidence to let go and make as much noise as they wish or internalize and work with their breath.  They may be very quiet and focussed. This means that they might not want to talk to you, that’s ok. Sometimes they don’t talk to me either.

Being a doula, is not an easy job, but I love it. It’s a job of balance, diplomacy, of compassion and of love. If you find yourself with me at a birth, remember I am just her second birth partner, one who may know a bit more about birth than other birth partners, but she still needs a loving, compassionate and skilled midwife like you to support her in the birth of her baby.

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Trust your birth intuition

Trust Your Birth Intuition
Your intuition knows how to birth.

Trusting your birth intuition can make all the difference.

by Sophie Fletcher

I wanted to talk to you about birth intuition today, as it is so important with birth.  One of my mantras is ‘trust your intuition’, but it’s a bit of a floppy suggestion, what does that actually mean?  What is your birth intuition and how do you listen to it when it’s trying to tell you something?

I was at a birth recently, a super fast, second birth with no drugs at all, a baby girl who was a little over 8.5 lbs with a physiological third stage and no nicks or tears.  The look on the mothers face afterwards – it was awesome.  For her it was a completely different experience to her first birth when labour was hurried along by breaking her waters, which lead to an epidural, episiotomy and forceps delivery.  After her first birth, she was so shaky she couldn’t hold her baby.

What a difference!  But it wasn’t just because she was a second mum, true, she prepared well with hypnosis for birth but she also listened to her birth intuition this time and didn’t try and tick the labour checklist off with every little niggle or set of Braxton Hicks, falling into the trap of thinking labour had started while her body was still just warming up.   She didn’t go to the hospital too early and she listened to what her body was telling her to do.

It was an interesting birth, my head told me that she would be early, for certain reasons, but I didn’t feel it. I was in no hurry to pack my back, and the birth somehow felt distant to me.  I didn’t get many texts from the mum, as she was so busy with other things.  Then the Thursday before the birth, at 40+3 I packed my bag. I didn’t even think about it, I suddenly stopped myself and thought “Hmmm why have I done that?” This commonly happens, somehow I know when to pack a bag.

Then on Friday I cancelled a tennis match that I really wanted to play in. It would have taken me 1.5 hours  away from my client, and although I’d played a match on the Thursday, this time is was different; it didn’t feel right, like a hint of pressure in my chest when I thought about going.  I even had a vivid dream that night, that her labour was so quick they wouldn’t have time to fill the pool!

Sure enough Saturday afternoon I got a text saying that she was going to call her mother in law, for ‘a bit of security’ to look after her other child. I knew then that this baby was coming, even though she wasn’t in labour.   She wrote, “nothing is happening, thought it was the start in the morning, but they must have been Braxton hicks contractions as they stopped”.   She reflected afterwards that if this were her first birth, she would have probably gone to the hospital at that point.

Then in the evening I got a message saying things had started and that she was fine, then later in the evening, I got a very laid back text saying things were moving along they were 5 minutes apart and lasting 1min30 seconds. I just knew, rang and asked if she wanted me there, so she said “I think you should come over but don’t hurry” (when a very laid back second time mum says this, in a spaced out way, I hurry!).

Sure enough she was at home with her music on, just rocking with the contractions and quietly breathing through them.   The dad wanted to go in, but I reassured him that she’d know when to go in. If she’s asking “is it time to go in” or it’s your suggestion as a birth partner, it’s too early.  After the next contraction had passed she said, “no I’ll wait a bit”, then the next contraction came  and she said “now it’s time”;  in the space of 10 minutes it was time to go.  Afterwards she said they were just different, and she just felt it was time to go, her birth intuition had kicked in.

Once we arrived in labour suite they were down to 3 minutes apart, after a quick exam she was 6/7 cms dilated, shortly after that her waters broke.  Her baby was born just 30minutes later, after she quietly gave one little push to little to bring babies head into the world.   No guided pushing or straining, her little girl slid her head and shoulders out, had a good look around and then the rest of her followed very quickly.  Within 10 mins baby was latched on, followed by the placenta.

For me this birth was all about ‘just knowing’ when things were starting, “just knowing’ the right time to go into hospital or call the midwives. This mum had listening to her Mindful Mamma mp3s every day, but had also been busy with a toddler and many other happy distractions in her life, so she hadn’t pounced on those early warm up contractions, instead trusting her that birth intuition.   It also interested me how more and more, I just ‘know’ too. My bag is always packed at the right time, I always have childcare in place, and well, you know, whatever you believe, that dream was true!

Just the difference between two contractions was enough to make the choice to go the hospital. Prepare so you are relaxed and trusting in birth, let go of your fear using hypnosis if you can.  When you get near to your date see those niggles and on off contractions as warm ups, stop starting maybe until your body just clicks into the rhythm of labour.  Stop thinking about it, switch your focus to something else that can absorb you, don’t intellectualise. Trust you will know, here is a checklist:

Listening to your birth intuition:

  • Trust hunches, don’t ‘think’.
  • If it doesn’t feel right or you are asking someone else’s opinion, consider not doing it.
  • If you have to question if it’s the right time to go to hospital, it is probably far too early. (Don’t let other people push you into going, research shows that women often end up in hospital too early as their partner wants to hand over responsibility). If you recognize these, “shall we go? Maybe yes – just to be on the safe side, “Why don’t we go in just to get checked”, “You can get settled in. oh, okay” it’s not the right time.  It should be a “Let’s go, now!” from the mum.
  • If you are able to make a cup of tea, have nap either in bed or the bath it’s too early to go in.

Signs to go in hospital or call the midwife in a normal birth;

  •  It just ‘feels’ different.
  • Your contractions are 3-4 minutes apart and lasting longer than a minute – this really does mean a minute or more – early contractions may get regular, but may still be shorter than a minute, maybe lasting 40 seconds or so, then may drop off for a while before starting up again, then they may be more spaced apart but lasting longer. Some antenatal teachers may say strong and long.
  • You have pressure in your bottom, not your back  – you feel as if you need to have a poo.
  • You really don’t want to get in the car (this is unfortunate if you are off to hospital).
  • You don’t really want to hold a conversation with everyone around you.
  • Something tells you that you absolutely have to go to hospital now, or call the midwife.

 

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Why the Amish Birth So Well.

I’ve been really interested in how Amish women birth recently as they nearly all birth at home, unless there is a medical risk. This is partly cultural but also because of expense of going into hospital or antenatal care, many Amish don’t have insurance.  Interestingly, research shows that despite a higher prevalence of several risk factors for perinatal and infant death among the Amish, neonatal and infant death rates for Geauga Settlement Amish in Ohio have been very similar to the corresponding rates of white children in Ohio State.

Amish women do not tell people apart from their midwife or husband that they are pregnant, it’s said that when they go “they go quick”, probably because they are not tied to due dates. Neither do they have pain relief during labour. They don’t believe in birth control so they often have huge families, sometimes around 10 -12 children. As a result pregnancy and childbirth is a normal part of everyday life, someone is pregnant or in labour all the time and they don’t fear it. Children see this natural process and, as they grow up, girls are not exposed to the international culture of fear and uncertainty around childbirth. Amish children don’t grow up  fearing that there is something wrong with their bodies or that they are incapable of a normal birth.

Amish women birth quietly, often just with their husband a birthing mother, and older woman from the community, who often plays a similar role to a Doula. When in labour, very often they continue doing their daily chores around the home until they are unable to any longer. They certainly aren’t preoccupied with imminent birth or early labour itself!   Research also shows a link between their psychosocial state, which is typically secure and unstressed, and positive birth outcomes.

Ina May Gaskin works closely with the Amish communities, which are close to her birthing centre, in fact it was from the Amish that she first learned breech birth was possible. Nowadays we know that the Amish have a c-section rate of around 2% similar to the Farm, Ina May Gaskins Community.

What is also interesting is the absence of autism in Amish communities. Amish women are very rarely induced as they don’t have ‘due dates”. Recent research shows that some forms of autism are associated with oxytocin deficiency, and questions are currently being raised about the links to this and the use of artificial oxytocin, syntocinon (Pitocin) or other drugs routinely used in labour. There have been very few studies done, but there are calls to investigate this link further. This article explores that link further.

Here is an extract dictated by a midwife with experience of working in Amish Communities.

Taken from http://www.citypages.com/1999-05-01/feature/the-culture-of-childbirth/

Sarah* is a direct-entry midwife in New York state. She practices in rural dairy country near the Canadian border among the many Amish and Mennonite families living there. Currently, Sarah attends more than three-fourths of the births that take place within these close-knit, insular groups of highly-religious families. In Sarah’s own words, here is what is like to attend an Amish or Mennonite childbirth at the beginning of the new millenium:

“The women I work with give birth at home, almost exclusively. This is a matter of finances, for these folks mostly milk cows, which isn’t a big money maker if you have a small herd and milk without machines, as they do. They do not carry health insurance because of their religious beliefs. Additionally, they feel very suspicious of the medical establishment not honoring their beliefs and treating them with respect. They prefer to remain at home, where they have control over such things as allowing nature to take its course rather than, for instance, trying to save a very premature baby.

When the time comes time for an Amish woman to give birth, there is always an older woman from the church community with [the birthing mother]. The mothers have their husbands present as well, but the whole thing is a big secret to their other kids. The Mennonites usually do tell their other kids. Many of the Mennonites prefer to birth with only their husband present. When a young woman in either of these communities gives birth for the first time, she has never really heard much about what the birth experience is going to be like. I usually tell first-time mothers what to expect and that’s all the education they get, except for what their mothers tell them. The pregnancy is absolutely hidden until the baby is born.

I have never seen one of these women ask for medication for the pain of childbirth. I don’t know why they don’t use pain relief. The one time I asked, the woman acted as if she had never heard of the idea. They just don’t seem to have terrible pain.

These women have between ten and twenty children each. They give birth well into their forties. The Amish seem to have as many babies as a human can, spaced according to how long they can go without having another child, usually one per year or year and a half. I have personally delivered the sixteenth baby of a forty-six-year-old. The Mennonites–some of them–use birth control.

The women almost always give birth in a semi-sitting position.They wait until the baby is about to crown to even lie down. They stay clothed the entire time, but the women have special dresses that they wear at birth where the belly can be exposed so that the baby can be immediately placed on the mother’s belly after birth.

The Amish women in the community who attend births are called “catchers,” but since Amish religion prevents anyone from getting an education past the eighth grade, the catchers are not formally educated, carry no equipment or drugs, and generally do not know how to treat most serious complications, although they are very well-versed in herbal medicines and I have learned a lot from them. Their main role when I am there is taking the baby immediately after birth and wiping it from head to toe with baby oil, binding its belly, and dressing it in a special dress and bonnet. The young brides seem to take great pleasure in sewing the dark blue baby dresses and caps and quilting a baby blanket. They like to get the baby dressed as soon as possible, with his belly bound and feet wrapped, and covered with many blankets.

One thing the Amish believe is that there is no breastmilk at first, and some don’t feed the baby until the next day. Some give the baby things like jello water or watermelon seed tea, which is supposed to be good for preventing jaundice.

For postpartum women, they use sheperd’s purse tea for bleeding. For a month after birth, the new mother has a ‘hired girl’: an Amish neighbor who, for $15 per week, lives there and does all the household chores including cooking, child care, canning, and quilting. Occasionally another one will stop by to help with laundry.


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Birth Space, Quiet Place

Keeping the birth space a safe, quiet place

Birth Space
Silence before Humour

Noise. It’s like a belisha beacon, or a loud game show buzzer jumping out of the screen every time I watch a birth on One Born Every Minute or a birth on television, or even homebirths where people chatting away while mum’s in the pool, I even saw one when a telephone rang just as the mother was birthing her baby. The noise sets my teeth on edge. Instinctively it just feels wrong, I want to “shhhh!” them. Why do people feel the urge to fill that  birth space with chat?

Last weekend I finished my Doula training with Michel Odent and experienced Doula Liliana Hammers. I was mesmerized listening to Liliana’s accounts of how even when awoman shouts out or asks questions, she treats it as rhetorical, just quietly shrugs and smiles with a calm reassurance, not even necessarily answering the question. This does take skill and at one point I realized that Liliana would make a fantastic counsellor. Very often in counselling, clients ask a question as part of their own internal process. Entering into an internal space, with the unspoken support of someone nearby, allows them to connect safely with their emotions and to ask questions of themselves.  Asking a question out loud doesn’t always mean that they are asking you for the answer, but seeking that answer from within themselves or even expressing an observation. Silence is often used as a technique to allow someone to become still and to engage with the feelings that arise in that moment, free of judgment.

Why are people so uncomfortable with silence in a birth space? And why do they feel the need to talk all the time.  So often people feel compelled to speak when there is silence and to fill that birth space with the clutter of words and noise.  Very often this is what happens at births, people seem to find it difficult to just sit and to be.  Some midwives are chattering away, interrupting the mother, some fathers or birthing partners use humour to break that silence as it feels uncomfortable and humour is an instinctive way to ‘break the ice’. Sometimes there evens seems to be a bit of a social event going on around the mother.

Why not chat away, interrupt, engage the mother with conversation?  During the birth a mother goes into an internal birth space, it’s a different state of being than she is in every day life.  Naturally, she quietens down her chattering mind, her neo-cortex, the same part of the brain that shuts down as you drift off to sleep at night. Michel Odent told me he called it “falling into sleep and falling into labour”.   To allow the right birth space is to allow the mother the same space as she falls asleep in every night. Secure, dark, unobserved, protected and quiet.  If someone were chattering away to you, or standing over watching you while you were trying to get to sleep it would be difficult wouldn’t it!

Very often midwives used to knit so that they could just be in the birth space, occupied with something that allowed them to be present without making their presence felt.  This strong, calm, non-judgmental, quiet reassurance helped to hold the mother in that  birth space, without the need for interruption.

So when it’s silent be silent too. If the mother makes noise, or asks questions that seem irrational and unlike her,  don’t always feel like you have to reply or even give words of reassurance. Bite your tongue, be strong, present and calm.   Consider that nothing needs fixing, everything is fine and that by wading in with words you are disrupting something that needs to be uninterrupted and undisturbed .  Sometimes that quiet, calm presence, and that reassuring shrug and smile are all that’s needed for the birth space to be a perfect space for birth.