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Author: Sophie Messager

Why we have calluses on our hearts
You know when you do some gardening; you get calluses on your hands? I believe our society causes us to have calluses on our hearts.
It starts with birth, with families being bullied through a system that treats them like machines and disregards their emotional needs.
It starts with separating mothers and babies. By disrupting the release of the love hormone, Oxytocin, and the bonding process.
It starts with a culture that encourages parents to ignore their instincts, and disregard their baby’s needs for closeness and nurture, lest they will never become “independent”.
It starts with a society that sees punishing a small sign as a sign of strength and good parenting. A society that tells parents to “ignore bad behaviours”.
It continues at school, where beautiful unique souls are pushed and formatted, and expected to “be good”, sit still and do as they are told. TA place where there is control in the form of rewards and punishment, mostly punishment.
Later, it carries on within employment, where there is no trust, and where the carrot and stick culture continues. Where you get punished the moment you make a mistake. Where a culture of bullying pervades. Where whistleblowers are removed instead of addressing the issues they pointed at.
It’s no wonder perhaps that we develop calluses on our hearts. These calluses do not just disconnect us from ourselves; they disconnect us from each other. They remove the ability to experience compassion, and the sense of interconnectedness that is so essential to our wellbeing.
How to we change this?
We change this by listening to our instincts, whether it is during the journey to become parents, during birth, by parenting from a place of gentle nurturance and respect.
We change this by reconnecting to our hearts. By acknowledging the presence of the calluses and treating them with tenderness. By acknowledging them in ourselves, and by acknowledging them in others.
Above all, we change this by starting to listen to our hearts (rather than our heads).
We change this by reconnecting to our hearts. And by reconnecting to the knowing in our hearts.
It is my belief that humanity is at the cusp of a major transformation. That we are leaving the era of head based knowledge, and that the way forward is heart based.
How do you start to reconnect with your heart?
It’s easy.
You know about connecting with your breath? Next time you connect to your breath, imagine that you are breathing through your heart.
Next time you face a dilemma, or need the answer to a question, or need to ask yourself whether something feels right or not, drop into your body, and feel what the options feel like, in your heart.
Teach yourself to recognise your heart’s yes or no response to situations or questions. Drop in. Does it feel open, soft, warm? Does it feel closed, heart, cold? Your body knows. Your heart knows.
The Heartmath institute has many resources on how to connect to one’s heart, including this short animated meditation video.

November 12, 2021
Do you confuse productivity with effort?
Do only feel that you are “working” when it feels like hard work?
At the end of each week I do a “ta-da” list. Often as I reflect on my week, I notice that I often forget to include one to one session with clients as part of my “work” .
I believe that the reason I forget to count these sessions is because sessions with clients (in this case, several pregnant or new families I supported), do not feel like an effort. These sessions do not feel like an effort because I love supporting families. These sessions feel like a magical time out of time, where I’m at my best, holding space for someone whilst their own journey unfolds. During these sessions, I’m in a state of flow. It feels effortless and joyful.
I had an epiphany as I realized this : we live in a culture that equates success with hard work, with effort. The underlying idea is that there has to be some level of strenuousness to the effort for it to be counted as “work”. That we have to flog ourselves to push through unpleasantness for it to count. It is part of the system of education we have grown up in, and of the system that our children are in. A system that equals demanding effort= praiseworthy, and also behind it that whatever is easy has less value.
When I did my antenatal education diploma, I was amazed to discover that I had unconsciously internalized the idea that learning had to be “serious”. As I discovered the science of learning, I realized that mainstream education had it all wrong, and that we learnt much better when having fun. The internalized aspect is so strong that I felt the need to start every single one of my antenatal courses with a disclaimer explaining why I’d make the group do all the work in an interactive, fun way, instead of lecturing them.
The same is true of undoing the misconception that hard work is the only valuable way to achieve something. There is much to say about working within a state of joy, flow and ease. Since I started applying this principle, I have found that not only is my work more joyful, but opportunities seem to flow towards me more easily as well.
I have come to think of it this way: we exist in two extreme states, much like the fight or flight versus rest and relaxation state. We are either closed, rigid and hard, or open, playful and soft.
Magic happens from the second state. There is no room for anything in the closed, hard, rigid state.
Next time you catch yourself in this state, sink into your body and ask yourself how your body feels when you are in that state. Try to soften and open your heart and see what your work feels like from there.

November 12, 2021
Stressed? Overwhelmed? Try grounding.
If you are finding what’s happening in your life or the world overwhelming, I’m sure you know about breathing and meditation as tools for wellbeing (and you might have tried them and found that they do not work for you) but have you heard about grounding?
Grounding is simply using techniques to come back into your body, where you can process things better rather than when stuck in the thoughts in your head. You can ground yourself literally, by connecting yourself to the earth, literally, or by visualization or movement. It works because it brings you back to your body, and out of the stressed thoughts in your mind.
How can you do it?
- Literal grounding means putting your body in contact with the earth. Grounding is the earthing of our own energy to the energy field of the Earth. There is some really cool science behind it. We know that earthing helps people heal faster, having measurable effects on inflammation, the immune response, wound healing, and prevention and treatment of chronic inflammatory and autoimmune diseases. See this paper for example. There is also evidence that it reduces stress.
- If you want to learn more, the earthing movie is fantastic and covers much of the research, some of which really blew my mind. They also have a bunch of articles on the topic.
- The easiest (and cheapest) way to to earth your body is to put your bare feet on the grass or soil. My favourite way to do it is to do some year round wild swimming, because it provides a deeper, whole body experience.
- My favourite way to do a full body grounding is wild swimming. I do it year round (about to do my fourth winter) and you can read about that here.
- If bare feet on the ground or swimming in cold water doesn’t appeal or if you live somewhere where this might be difficult, there are companies selling grounding mats that plug into the earthing part of electric sockets, for example Grounding Mats and Groundology. Some of the published research that demonstrates faster wound healing for example, was done using such mats in a hospital setting.
Less literal grounding, as in coming back into your body can be achieved in several ways.
- Using visualization. A simple visualization to achieve it is the tree meditation. It goes like this: Stand up, close your eyes, give your body and mind a quick scan (how do you feel etc). Then imagine that you are a tree. Visualise the tree in as many details as you can. Then, with each out breath, imagine that you are growing your roots deep into the earth. That’s it! do this for a couple of minutes, then scan yourself again. Be prepared to be amazed at the difference!
- Using mindful movement. For example going for a walk and paying attention to what you see and feel (bonus if it’s in nature, especially somewhere with trees, because forest bathing also has cool published health benefits behind it).
- Another sure way of bringing yourself back to your body is to put some lively music on and dance for a few minutes. I love 5rhythms dancing and this track, which is only 7 min long, gives you a mini wave like a very short version of a movement meditation class.
- Do a quick rebozo or scarf self massage! This only takes 2 to 5 min. This really moves the energy in your body and refresh and enliven you!
Try it! It only takes about 5 minutes to make a difference. If you do try some of these techniques, I’d love to hear about your experience!
November 5, 2021
What is postpartum bodywork and why we need it back.
All around the world there are (or used to be) traditional practices to help a new mother’s body heal after birth.
Regardless of the continent, these traditions usually include some massage and wrapping rituals, as well as binding the belly and pelvis, and keeping the mother warm.
When you think about the tremendous changes a mother’s body undergoes, it makes so much sense! During pregnancy, the uterus grows from the size of a pear to that of a watermelon, the pelvis tilts forward and becomes wider, the ribs open, the spine curves increase, the abdominal organs get pushed up etc. To give birth, the mother’s body opens up on a physical and energetic level. After birth, these changes need to happen in reverse, whilst the body also undergoes the beginning of lactation.
It seems crazy that we no longer have processes in place to support these changes, or at the very least, some kind of physical examination to make sure everything has returned to a healthy place. At the 6 weeks doctor “check” in the UK, there is no overall physical examination of the mother.
With no checkup, and no sense of what is normal, we have a perfect storm of issues not being treated. The statistics are very telling: 1 in 3 new mothers experience urinary incontinence at 3 months postpartum and nearly one in 2 still has diastasis recti at 6 months postpartum. Research shows that it takes on average 8-10 years post birth for women to seek help for such issues.
Yet, during the first 4-6 weeks postpartum, when the body is still plastic and resetting itself post birth, there is a unique opportunity for healing.
Traditional massages and rituals, such as closing the bones, understand this need and the window of opportunity, and are designed to “close” a new mother physically, emotionally and energetically, after the widening and opening of pregnancy and birth. Because the needs of new mothers are the same regardless of where they are from, it makes sense all cultures have similar processes to support postpartum healing. This article from Innate traditions provides a beautiful overview of the topic.
As no such treatment is available as standard within the health system, it makes sense to seek bodywork and healing from people who can provide it.
What kind of postnatal bodywork can you have?
- Closing the bones massage
- Postnatal recovery massage
- Specialist therapists such as massage therapists, osteopaths, chiropractors, and pelvic physiotherapists (ask for local recommendations)
- Wrapping your belly and hips
When can you have postnatal bodywork?
As soon as possible during the first 6-8 weeks postpartum or as soon as you are ready. In traditional wisdom, there is a window of healing opportunity and plasticity during this time when the body is designed to heal faster. The strange “don’t do anything before you’ve had your 6 weeks check” isn’t based on any evidence. Moreover, it makes no sense because the 6 weeks check doesn’t include a physical examination. Having massaged many new mothers, some as soon as 24h post birth, I can attest that this is when the bodywork is the most effective to speed up healing.
What can you do for yourself?
- Use the 4 pillars of postnatal recovery (Social support, rest, food and bodywork) to write a postnatal recovery plan (you can download a free template here) to include bodywork. You can ask for gifts vouchers towards postnatal bodywork.
- Wrap your belly and hips. I wrote a blog about it which includes tutorials.
- Keep warm (like a convalescent person would: wrap up, and consume warming foods and drinks)
What can you do for new mothers?
- If you know someone who is pregnant or recently had a baby, it would be a wonderful gift to give them a voucher towards such a treatment.
November 3, 2021
Do you struggle to describe everything that you do professionally under one title?
I used to struggle to define myself professionally because I thought that I needed a title that covered ALL of my hats.
It was easy when I started after my professional reconversion from scientist to birthworker, I just called myself a doula. Then I grew, I learnt a lot of new things, and started teaching them. After a few years, I gave up some activities to make room for new things I had learnt and felt more drawn to. Soon I found myself struggling to describe what I do. It bothered me because I thought I had to find a title that covered it all.
I discovered a new word in a French book. The word is slasheuse. A slasheuse is a multitalented professional who has carries out several activities/wear several hats in their work. The term makes reference to the slash sign being used between the different areas of their work. I like this expression because it describes me to a tee. I wear many professional hats:
I am a scientist/doula/healer/teacher/author/facilitator. Under each of these categories are many sub categories. Too many to put in a title.
I’m grateful for having discovered authentic marketing coach George Kao who taught me that I don’t need to describe all of myself under one title (here is one of his articles about it ) and it is incredibly liberating.
It’s OK to talk about each of your many work and personal life interests in turn and without a particular logic or order.
It’s OK for people to know you only for the aspects of your work that resonate with them.
It’s OK not to have a title that covers them all.
If my work as a doula has taught me one thing, it is that everyone of us is unique. That we are beautiful and messy and full of paradoxes. And we are more than the sum of our work, the sum of our interests and hobbies. We are also always evolving, growing and learning new things and dropping some off. We aren’t static.
If, you, like me, are a “slasheuse” (or a slasheur), I invite you to discover the ease and joy that comes when you stop trying to fit your beautiful unique self into tight neat little boxes.
October 29, 2021
The last days of pregnancy, a place in between
This article was written by midwife Jana Studelska, and originally published on the Mothering website. The original text is no longer available on the mothering website, so I have copied it here, as I like to share this text to my clients when they have reached their due date as it can help put soothing words on the complex feelings associated with waiting for birth.
“The last days of pregnancy are a distinct time of in between. It’s a tricky time for mothers, and these last few days are a biologic and psychological event.
She’s curled up on the couch, waiting, a ball of baby and emotions. A scrambled pile of books on pregnancy, labor, baby names, breastfeeding … not one more word can be absorbed. The birth supplies are loaded in a laundry basket, ready for action. The freezer is filled with meals, the car seat installed, the camera charged. It’s time to hurry up and wait. Not a comfortable place to be, but wholly necessary.
The last days of pregnancy — sometimes stretching to agonizing weeks — are a distinct place, time, event, stage. It is a time of in between. Neither here nor there. Your old self and your new self, balanced on the edge of a pregnancy. One foot in your old world, one foot in a new world.
Shouldn’t there be a word for this state of being, describing the time and place where mothers linger, waiting to be called forward?
Germans have a word, zwischen, which means between. I’ve co-opted that word for my own obstetrical uses. When I sense the discomfort and tension of late pregnancy in my clients, I suggest that they are now in The Time of Zwischen. The time of in between, where the opening begins. Giving it a name gives it dimension, an experience closer to wonder than endurance.
I tell these beautiful, round, swollen, weepy women to go with it and be okay there. Feel it, think it, don’t push it away. Write it down, sing really loudly when no one else is home, go commune with nature, or crawl into your own mama’s lap so she can rub your head until you feel better. I tell their men to let go of their worry; this is an early sign of labor. I encourage them to sequester themselves if they need space, to go out if they need distraction, to enjoy the last hours of this life-as-they-now-know-it. I try to give them permission to follow the instinctual gravitational pulls that are at work within them, just as real and necessary as labor.
The discomforts of late pregnancy are easy to Google: painful pelvis, squished bladder, swollen ankles, leaky nipples, weight unevenly distributed in a girth that makes scratching an itch at ankle level a feat of flexibility. “You might find yourself teary and exhausted,” says one website, “but your baby is coming soon!” Cheer up, sweetie, you’re having a baby. More messaging that what is going on is incidental and insignificant.
What we don’t have is reverence or relevance — or even a working understanding of the vulnerability and openness a woman experiences at this time. Our language and culture fails us. This surely explains why many women find this time so complicated and tricky. But whether we recognize it or not, these last days of pregnancy are a distinct biologic and psychological event, essential to the birth of a mother.
We don’t scientifically understand the complex hormones at play that loosen both her hips and her awareness. In fact, this uncomfortable time of aching is an early form of labor in which a woman begins opening her cervix and her soul. Someday, maybe we will be able to quantify this hormonal advance — the prolactin, oxytocin, cortisol, relaxin. But for now, it is still shrouded in mystery, and we know only how to measure thinning and dilation.
“You know that place between sleep and awake, the place where you can still remember dreaming? That’s where I’ll always love you, Peter Pan. That’s where I’ll be waiting.” -Tinkerbell
I believe that this is more than biological. It is spiritual. To give birth, whether at home in a birth tub with candles and family or in a surgical suite with machines and a neonatal team, a woman must go to the place between this world and the next, to that thin membrane between here and there. To the place where life comes from, to the mystery, in order to reach over to bring forth the child that is hers. The heroic tales of Odysseus are with us, each ordinary day. This round woman is not going into battle, but she is going to the edge of her being where every resource she has will be called on to assist in this journey.
We need time and space to prepare for that journey. And somewhere, deep inside us, at a primal level, our cells and hormones and mind and soul know this, and begin the work with or without our awareness.
I call out Zwischen in prenatals as a way of offering comfort and, also, as a way of offering protection. I see how simple it is to exploit and abuse this time. A scheduled induction is seductive, promising a sense of control. Fearful and confused family can trigger a crisis of confidence. We are not a culture that waits for anything, nor are we believers in normal birth; waiting for a baby can feel like insanity. Giving this a name points her toward listening and developing her own intuition. That, in turn, is a powerful training ground for motherhood.
Today, I am waiting for a lovely new mother named Allison to call me, to announce that her Zwischen is ended and labor has begun. I am in my own in between place, waiting. My opportunity to grow and open is a lovely gift she gives me, in choosing me to attend her birth.”

October 26, 2021
Maslow’s Hierarchy of needs for the postpartum
You have probably heard of Abraham Maslow’s hierarchy of needs pyramid ( if you haven’t here is a good introduction article)
Maslow was a psychologist who introduced the concept of the hierarchy of human needs as something that underpins motivation. This hierarchy suggests that people are motivated to fulfill basic needs before moving on to other, more advanced needs.
I’d like to introduce you to a version of Maslow’s hierarchy of needs adapted to the postpartum.
Maslow’s theory dates back from 1943 and since it has been criticized to say that the needs depicted don’t necessarily come into an order as simple as this pyramid, and that they can be in any order. I personally feel that the needs described here are basic needs for any human to thrive, and even more important for a new mother during the first weeks post birth, whilst she learns to mother her infant and find her feet as a new mother.
I like this model because it is well known within the Western world, and because it can be helpful to help supporters visualise what the needs of a new mothers are, and see how these needs aren’t usually met in the modern world. With this model in mind it’s easy to see why a new mother needs to be at the centre of a circle of support to be able to thrive.
Survive
The most basic needs, the surviving needs of a new mother are the physiological needs for sleep, food, water, and warmth. I’ve also added bodywork because for me it is fundamental to help a new mother recover and heal faster. Postpartum bodywork used to be (or still is in many parts of the world) given as standard in every culture around the world. When you imagine trying to meet all these needs whilst caring for a new baby, it is easy to see it is almost impossible without support from others. This is why social support is so essential during the postpartum. Another adult in the house to cook, clean, tidy up, and hold the baby whilst the new mother sleep is a basic need, and not a luxury.
Live
Feeling safe as a new mother only comes when there are enough resources, and enough support around so that her wellbeing and health doesn’t suffer. The need for safety is also met by community support, because it helps the new mother to regulate her emotions. Experienced mothers around her make a huge difference in terms of meeting the challenges of new motherhood.
Love
The sense of belonging that comes from having loving relationships is much easier to meet when it is provided by friends, family and the community rather than just the partner as it tends to be in the Western world. Showering a new mother with loving attention and nurture goes a long way into helping her to recover after the pregnancy and birth.
Esteem
Nurturing supporters make sure that they point out all the things that the new mother is doing right, rather than showering her with conflicting advice that undermines her flailing sense of competence
Sense of self
With all the bottom layers needs being met, the new mother can develop a healthy and strong sense of self in her new identity as a mother.
When you look at this pyramid, it is easy to see that, in our modern culture, the most basic survival needs aren’t usually met, let alone the more complex needs in the upper part of the pyramid.
If you know someone who is pregnant or who has recently given birth, I invite you to use this hierarchy of needs for the postpartum as a blueprint to offer them nurturing support.
October 8, 2021
Induction of labour- do you know what you’re letting yourself in for?
(updated September 2021)
Induction of labour is the bane of many birthworkers lives (and of many pregnant women’s too). In the area I live in, it is reaching epidemic proportions (about 35% of first time mothers)
Deciding to consent to induction is a complex decision, one that should be fully supported, without pressure or coercion, so that women and their supporters make a truly informed decision. Only it doesn’t happen. Most of the time, women just get taken for a ride.
I need to give a disclaimer : I have no doubt that induction of labour is the right option when a medical situation (say, high blood pressure, or reduced fetal movements) means that doing something is probably more sensible than waiting. Because things are likely to only get worse if we wait. I get it. This isn’t what this post is about. I also have to warn you, if you are pregnant, before you read any further, that this might not feel like a pleasant post to read. I’m going to talk about what induction entails and depict it in a light that I know could be anxiety inducing.
Now that this is out of the way, let’s look at the situations when induction might not always be the most sensible thing to do.
1) Your baby is “late”. Being overdue is probably the top reason for unnecessary induction – and I have already written an extensive post about that.
2) Your baby is “too big” is another very debatable reason. Women tend to grow babies who fit their pelvises. Pelvises aren’t hard, inflexible bony things, in fact they have lots of joints and ligaments (which are made extra flexible by the pregnancy hormone relaxin) and can open to let your baby out. Babies heads mold to fit inside the pelvis. So we can’t predict that the fit, short of doing a constant MRI scan during labour. There simply is no evidence to support the idea that a big baby won’t fit. Similarly, estimated baby’ size towards the end of pregnancy via scan or palpation is notoriously inaccurate. Evidence based birth has reviewed the evidence on big babies, and states that ” Research has consistently shown that the care provider’s perception that a baby is big can be more harmful than an actual big baby by itself“. You can read the full article here.
3) Your placenta is “failing”- again there is no evidence to back this up. In this article, Prof Harold Fox states that ” A review of the available evidence indicates that the placenta does not undergo a true aging change during pregnancy…..The persisting belief in placental aging has been based on a confusion between morphological maturation and differentiation and aging, a failure to appreciate the functional resources of the organ, and an uncritical acceptance of the overly facile concept of “placental insufficiency” as a cause of increased perinatal mortality“. You can read this article here.
4) You are “too old”. First time mothers over 40 get “offered” an early induction of labour. This is mostly due to the risk of stillbirth increases in older mothers. To quote the RCOG scientific impact paper “The incidence of stillbirth at term in women is low. It is higher in women of advanced maternal age. This at 39–40 weeks of gestation equates to 2 in 1000 for women ≥ 40 years of age compared to 1 in 1000 for women < 35 years old.15 Women ≥ 40 years of age having a similar stillbirth risk at 39 weeks of gestation to women in their mid 20s at 41 weeks of gestation, at which stage the consensus is that induction of labour should be offered to prevent late stillbirth.” This means that the risk is stillbirth is still very small. It might not be an acceptable risk for you. But it still makes sense to balance those risks against those of the induction process, so you can make a truly informed decision (you can read a great review of the research on the evidence based birth blog)
The thing that really gets my goat, though, is the lack of discussion on the risks of induction, and on what induction actually entails.
What I see happen on a regular basis, are expectant parents being “booked in” for an induction at whatever random date (it varies between NHS trusts) their local health system has decided is the “right” time. They don’t realise this isn’t compulsory, they don’t realise they have a choice, and more worryingly, they don’t really understand what they are letting themselves in for. What bugs me most is that the lack of open, honest discussions itself goes against clinical guidelines.
NICE states that
“Healthcare professionals should explain the following points to women being offered induction of labour:
- the reasons for induction being offered
- when, where and how induction could be carried out
- the arrangements for support and pain relief (recognising that women are likely to find induced labour more painful than spontaneous labour) (see also 1.6.2.1 and 1.6.2.2)
- the alternative options if the woman chooses not to have induction of labour
- the risks and benefits of induction of labour in specific circumstances and the proposed induction methods
- that induction may not be successful and what the woman’s options would be.”
In practice, yes, perfunctory discussions take place and leaflets are given, and health professionals rarely explain the realities of what induction of labour entails.
Therefore parents consent to go in for induction thinking they’ll have the baby that day. They also do not have a real concept of the risks involving induction of labour (because usually the only discussion that took place covered the risks of not inducing only). Some of the risks are that induction either doesn’t work, or that the baby doesn’t cope with the drug induced contractions-in either case, a caesarean is then the only option.
In my area, the rate of caesarean for first time mothers being induced is 45%. That’s nearly one in two. This stat isn’t usually given during induction discussions. I believe that if this was explained in a more balanced way (the way NICE recommends it above), more parents would probably choose to wait. What happens in practise is that people are told that induction doesn’t increase the chance of having a cesarean. Whilst some debatable publications from the past says so, in practise (I’ve been in this field since 2010), this doesn’t fit with the statistics produced by most UK hospitals. More recent published research like this paper, show what I’ve witnessed time and time again since I’ve worked in the birth field, which is that, for first time mothers, induction of labour roughly puts the chances of having a caesarean at 50% instead of the 30% for the average population).
Induction of labour also carries other risks which are rarely explained such as explained below:
“Although induction at term could prevent rare cases of fetal death,” write Seijmonsbergen‐Schermers in the BJOG, “all induced women will be exposed to potential disadvantages. Women whose labours are induced have a higher risk of postpartum haemorrhage, uterine rupture, hyperstimulation resulting in fetal distress, and perineal injuries (Miller et al. Lancet 2016). Furthermore, more women need pain medication and have limited freedom of movement, a longer labour, and a negative birth experience. There is increasing evidence that suggests negative consequences of synthetic oxytocin administration. This may influence maternal–fetal bonding, the maternal psyche, and neonatal preparation on being born. A large cohort study found higher rates of jaundice, feeding problems, infections, metabolic disorders, and eczema up to 5 years of age among children born after induced labour (Peters et al. 2018).”
After all, when it comes to postdates induction, even the Cochrane database states that ” the absolute risk of perinatal death is small. Women should be appropriately counselled in order to make an informed choice between scheduled induction for a post-term pregnancy or monitoring without induction (or delayed induction).”
One thing that isn’t explained in the NICE bullet points above, is how long induction can take. Yes, parents are told it can take days, but the discussion isn’t complete enough in my opinion.
I often talk about continuums, or gauss curves, to explain how different we all are, and how variable our individual responses to certain situations can be. When asked about induction, I explain that for the majority of people it usually take 2 to 3 days, but that some people respond incredibly fast to induction, and that some may take up to 5 days (or more!).
In my experience, parents are rarely told, for example, that because the ward might be busy, they might get admitted in the induction ward, only to get bumped off due to other more urgent cases jumping the queue. The record I have seen is 5 days. Yes you read that right. 5 days of restless hospital nights before the process even gets started. Exhausted before labour even begins. Nice.
I have seen instances of women’s inductions being stopped half way through because the delivery unit was suddenly full.
At the other end of the spectrum, I’ve also heard parents who responded to the induction faster than expectant, having the scary experience of birthing they baby on the ward with nobody supporting them.
Don’t get me started on the Bishop’s score (an assessment based on how low, soft and open her cervix is), which is done prior to induction, in order to assess readiness for labour, and also to choose the best drug option for cervical ripening. Only the results of the assessment aren’t unusually shared with the woman. Yet, in order for the woman to make an informed decision about her care (and even if the caregivers have little flexibility about options based on the results of the assessment, because an unfavourable cervix is usually followed by induction taking place anyway), surely some discussion should take place between the caregiver and the woman about the result of this assessment?
I just don’t get it.
Admitting that induction is started straight away, very few parents realise that the first line of induction, artificial prostaglandin, is usually something (especially if the woman is a first time mother and her cervix is “unfavourable”) that can take a loooooong time. 24h of propess (a kind of tampon like prostaglandin pessary), followed by up to 3 times application of prostin (a prostaglandin gel) 6h apart. We’re already 42h in the process and labour may not even have started yet. Assuming this has worked enough to soften and slightly open the cervix, then waters are artificially broken, and a drip of synthetic oxytocin drip is used to start contractions. It isn’t unusual after that for it to take another full 24h to reach full dilation of the cervix.
During this time, again this is my personal experience, many first time mothers find the contractions caused by syntocinon (the synthetic oxytocin) more painful to cope with. Natural oxytocin comes in peaks and throughs with breaks in between whilst your own natural painkillers (endorphins) rise accordingly. With syntocinon you get a constant high hormone level in your bloodstream and often no break in pain between the contractions. And there is no build up of natural endorphins because the artificial oxytocin doesn’t cross the blood brain barrier.
Because induced labour is more painful, more induced women end up with an epidural. This means that they are lying on their back, with no gravity, and a slack pelvic floor (no sensation means no muscle tone), which makes it harder for their baby to be in a good position for birth. Having an epidural double the chances of needing instruments or a caesarean to help the baby being born.
So we are often looking at process that can take up to 3 whole days. Or more. And which in half of the time ends up with a caesarean anyway.
So sometimes, I wish women where really given the option to opt for a caesarean instead of induction, or at least be told that they can say “enough” at any point and choose a caesarean instead.
So when faced with the prospect of induction, how to do navigate the maze of options to decide whether to say yes or wait?
Here are a few things you might want to think about before consenting to induction of labour.
- Whether the risks involved continuing the pregnancy are greater than the risks involved in induction (risk is a very personal concept and you need to be fully informed to make such a decision).
- That you are committing to getting this baby out once you start the induction process. Once you start you cannot back out, and a caesarean is recommended if the induction does not succeed or if the baby becomes distressed
- That the induction itself creates risks that require further monitoring and interventions (in particular, the use of constant fetal heart monitoring is recommended rather than using a hand held ultrasound for intermittent monitoring).
- That induction reduces your birth place options (no home or birth centre) and your ability to move around in labour.
- That induction, as an intervention, significantly reduces your chances of having a straightforward vaginal birth.
If you want to read more, Dr Rachel Reed has written an extensive article on the topic of the risks of induction, which includes all literature links
Sara Wickham has written an excellent article about induction too, called ten things I wish every woman knew about induction of labour.
Above all, remember that medical guidelines are based on an average of the population, so the same blanket policies are applied across the board, regardless of individual circumstances. You aren’t the population. You are an individual with your own personal individual history and risks, and your own personal preferences and risk perception.
You deserve individualised care and true open discussions to make the right decision for you.
Update September 2021.
Two new aspects that one now needs to take into consideration:
Since March 2020, partner’s access has been restricted. So I have supported women who went through several days of induction alone, without their partner or my support, and their partner was only allowed to join then when the last past of labour when they transferred to the delivery unit.
Staffing issues which where already a problem prior to March 2020 have gotten worse, and therefore women get admitted to the induction ward, but often left there to wait for some days before the induction starts, or the induction process gets stopped half way through due to lack of space in the delivery unit. This has become such an issue that someone just published a paper about it.
You might want to factor in these aspects in your decision making about whether to consent to induction of labour or not.
Some families have choosen to take matters into their own hands and induce the labour themselves using castor oil. If this is something you would like to explore, I wrote a blog post that reviews the evidence about castor oil as a method of inducing labour.
September 14, 2021
A time in between-Waiting for a birth as a doula
I love the article ” The Last Days of Pregnancy: A Place of In-Between” by Jana Studelska,. I send it to my clients when they are fed up waiting for the baby to arrive. Jana uses a German word: ‘Zwischen’, which means ‘between’, to describe the unusual but necessary waiting time between the end of the pregnancy and the beginning of labour.
My favourite part of the article is this:
“I believe that this is more than biological. It is spiritual. To give birth, whether at home in a birth tub with candles and family or in a surgical suite with machines and a neonatal team, a woman must go to the place between this world and the next, to that thin membrane between here and there. To the place where life comes from, to the mystery, in order to reach over to bring forth the child that is hers. The heroic tales of Odysseus are with us, each ordinary day. This round woman is not going into battle, but she is going to the edge of her being where every resource she has will be called on to assist in this journey. We need time and space to prepare for that journey. And somewhere, deep inside us, at a primal level, our cells and hormones and mind and soul know this, and begin the work with or without our awareness.”
As I sent it to a friend (who is fed up waiting for her baby to arrive) and suddenly it struck me: doulas experience Zwischen too. The on-call period; the waiting time for the mama to go into labour, is an ‘in between’ time for the doula too. A weird period where she tries to carry on her life as normal but always has her client at the back of her mind and isn’t fully present to her family and friends. A doula always has to make sure she can go to her client whenever needed. When I wait for a mama to go into labour, every night I go to bed thinking tonight might be the night. When I am waiting for a while, I often feel the same disappointment/frustration I experienced when I was waiting for my son’s birth, 9 years ago (he was born 16 days after his ‘due date’). I remember waking up every morning, and thinking “still pregnant!” and feeling annoyed.
Waiting for a labour to start, as a doula, can be a challenging experience. Sometimes, and I found this be especially true for mums who already have babies, the labour starts and stops for a while. I believe it is nature’s wise way of making sure the mother isn’t away for too long from her other child(/ren), because labour is usually swift after this. However it can be frustrating and draining for the mother and her supporters! I oscillate between moments of quiet acceptance and moments of impatient frustration (It would be so great if she birthed tonight!). This waiting involves an element of tension in both mind and body.
It is a strange time indeed, the Zwischen-time of being on call; like suspended in time, in limbo, where everything is on hold. We do it because we love our clients and our job, but it can take its toll on our minds and bodies.
I was reminded of this recently. I was on call for a repeat client of mine for 3 weeks, and feeling very invested emotionally in her birth. The birth happened, and it was beautiful. After she had birthed, I noticed how much more relaxed I felt and how tense I had been waiting for her birth. Later on, as it is often the case when we work hard on something for weeks, only to fall ill when the task is over, my back started hurting. I knew this wasn’t physical because the birth had been quick and easy and I hadn’t had to provide a lot of demanding physical support. My osteopath found my back to be “emotionally and energetically empty”. I hadn’t realised how much tension I had been carrying waiting for my client to birth.
When I first wrote this blog I was just coming out of being on call for nearly 6 weeks, having had 3 births in as many weeks (not usual – I normally only take a client or two a month, but a client was late and another client birthed early due to medical condition). For the first time in weeks I felt very peaceful and relaxed, and I was enjoying the odd glass of wine, and looking forward to a much needed holiday.
We doulas really need to excel at self care, lest we suffer from both emotional, physical and spiritual burnout. The “oxygen mask” analogy comes to mind, when in airplanes you are advised to put on your own oxygen mask before attending to your children’s. Self care in that context isn’t selfish, it is survival. If we do not look after ourselves and fill our own tanks, we have nothing left to give.
My mum recently told me: “Tu n’as pas vole ton salaire” (you haven’t stolen your salary – a French expression, meaning that you are doing more work than is expected of your salary level) and it was good to have someone reminding me of this. It felt very validating. We doulas really give every bit of our being to our clients.

July 22, 2021
New NICE induction of labour guidelines. Have we taken leave of our senses?
The National institute for clinical excellence (NICE) has published new draft guidelines for induction of labour. They are open for consultation until the 6th of July 2021.
The part that is most concerning is this:
Consider induction of labour from 39+0 weeks in women with otherwise uncomplicated singleton pregnancies who are at a higher risk of complications associated with continued pregnancy (for example, BMI 30 kg/m2 23 or above, age 35 years or above, with a black, Asian or minority ethnic family background, or after assisted conception).
You read that right. The new guidelines propose that everyone whose body mass index is over 30, above 35 years old, who is black, brown or any non white background, who have conceived through IVF, should all be induced at 39 weeks of pregnancy. I couldn’t help but wonder: how many people does this leave, who do not fall in these categories?
I had a look at the office of national statistics, to check what percentage of the population these groups represent together. I haven’t been able to find detailed enough data to remove overlaps between the groups. However, I have found the following:
- About 50% of pregnant women are classified as overweight or obese in the UK
- Black, brown and ethnic minorities represent about 10% of the UK population
- About 25% of babies born in the UK were conceived by IVF
- About 25% of babies born in the UK are from mothers over 35
I know that some of these categories overlap, but I’m guessing that not many people will still fall within the “low-risk” people being “allowed” to go into labour naturally if this guideline passes at it is. Especially as, in my experience, few people question the “guidelines” and apply them as if they were the law.
Worryingly the rate of induction has already just gone through a major rise. Since March 2020 many trusts have seen steep rise in induction (and cesarean) rates. (this is easy to find in the infographics shared from various trust pages on social media). In my local trust, the induction rate has gone from being between 25 and 30% prior to March 2020 to 39% in May 2021. Doesn’t it feel extremely odd to you that nearly 40% of the population already needs to have their labour artificially started? Isn’t it possible that this rise wasn’t justified by evidence, but rather by a knee jerk reaction to the covid crisis?
If the above guideline goes ahead as it is, what rates of induction are we going to see? Are we headed towards in a situation where everyone has their labour induced? How is this logical? How is this balanced? Have we taken leave of our senses?
The draft guidelines are open for consultation until the 6th of July 2021. If you wish to comment, you are welcome to copy and paste some of my comments to issue your own reply to the NICE consultation. Just email InducingLabourUpdate@nice.org.uk
Dr Sara Wickham has published an extensive blog about it too.
Dear Nice labour induction team
My name is Dr Sophie Messager. I am an ex biology research scientist turned doula and perinatal educator.
Over the last ten years in this role I have seen the rate of induction of labour in my local trust rise from 24% to 39% without an improvement in maternal or fetal outcomes.
What I have witnessed however, is that induction of labour often causes trauma for mothers and their partners. I have also witnessed time and time again that true informed decision rarely takes place because the majority of parents rarely get told what induction of labour entails (in primips often a 3 to 5 days process which ends up in a caesarean). They rarely get told that it is a choice (most get told “we’ll book you in for an induction”), and they also rarely get told of the risks that are involved in inducing labour (increased risk of caesarean birth and fetal distress amongst other things). I also see a lot of coercion in making sure people consent to having their labour induced, and in particular implying that the baby might die if they do not agree. I wrote in more details about it in this blog post.
Since March 2020, most hospitals trusts banned the access of partners to antenatal wards, only allowing them during established labour, I have witnessed women being induced for 5 days, alone in antenatal wards with no support from myself or their partners. This is dehumanising and traumatising for women and their partners.
Since March 2020, I have also seen rates of induction and caesarean rise by about 10% in many hospital trusts, with no evidence behind the change. In my local trust, the induction rates was 40% in May 2021, when it was between 25% and 30% prior to March 2020. Carrying out a survey of the rise of induction rates since 2020 across UK hospital trusts since March 2020, and the reasons behind them, and whether this rise improved outcomes or not would probably prove very informative. Surely the percentage of women who go into labour spontaneously has not decreased by 10% in less than a year?
I am worried that the people who are making the recommendation in the guidelines have no experience of supporting women and their partners in labour, and in particular, induced labour, or that if they do, they have no experience of what happens in the aftermath. Most health professionals only get to see people for a few days after birth, until they leave the hospital. Doulas and other private perinatal practitioners often support new families for weeks after birth, and they may be the only ones who truly understand how traumatising induction of labour can be, especially when the process hasn’t been communicated adequately ahead of time.
The draft guidelines state the following:
Consider induction of labour from 39+0 weeks in women with otherwise uncomplicated singleton pregnancies who are at a higher risk of complications associated with continued pregnancy (for example, BMI 30 kg/m2 23 or above, age 35 years or above, with a black, Asian or minority ethnic family background, or after assisted conception).
Yet the guidelines also state that “As there was no evidence to identify the optimal timing of induction in these groups, the committee made a research recommendation”.
I had a look at the office of national statistics, to check what percentage of the population these groups represent together. I haven’t been able to find detailed enough data to remove overlaps between the groups. However, I have found the following:
- About 50% of pregnant women are classified as overweight or obese in the UK
- Black, brown and ethnic minorities represent about 10% of the UK population
- About 25% of babies born in the UK were conceived by IVF
- About a quarter of all babies born in the UK are from mothers over 35
Which percentage of the population does this leaves that still falls within a low risk group? Has this been assessed as part of the drafting of the guideline?
If the draft guideline gets published as it is we are very likely to see a further rise in an already alarmingly high induction rate, and a concomitant rise in caesarean rate, as despite some flawed research claiming that induction of labour doesn’t increase caesarean rates, in practise (and according to some recent research), induction of labour usually leads to doubling of the rate of caesarean. See https://www.sciencedirect.com/science/article/abs/pii/S0301211521002463.
I am worried that we are headed for the same rates of caesarean as countries like Brazil or China (which are around 50%), without improvement in birth outcomes.
Experience and history (for example in the case of the Hannah breech birth trial) shows that when new guidelines like this one get published, they tend to get adopted widely without question within maternity care, and that, even when new evidence disproves the original results, it is very hard to get the system to change, because the belief about what is “normal” has become entrenched within maternity care.
The long term impact of a rise induction of labour on the health of the general population is this happens is greatly concerning. As concluded by the author of this study explains:
“IOL for non-medical reasons was associated with higher birth interventions, particularly in primiparous women, and more adverse maternal, neonatal and child outcomes for most variables assessed.“
More worryingly, there appears to have been no consultation of the interested party, i.e people having to undergo the actual induction of labour (women and their partners) in the drafting of this guideline.
I urge you to reconsider these guidelines, and in particular, ensure that a consultation of the experience of induction of labour for mothers and their partners takes place prior to any new recommendations being made. I would also like to see the long term physical and mental health implications for families and babies taken into account to balance the recommendation.
Regards
Dr Sophie Messager
July 5, 2021

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