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Sophie Messager

Author: Sophie Messager

  • Induction of labour- do you know what you’re letting yourself in for?

    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.

    maze

    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?

    right way

    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.

  • A time in between-Waiting for a birth as a doula

    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.

     

  • New NICE induction of labour guidelines. Have we taken leave of our senses?

    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

     

  • You already know what is right for you (how to access your own wisdom)

    You already know what is right for you (how to access your own wisdom)

    What if I told you that you always know what is right for you?

    What if I told you that you do not need to outsource your wisdom, defer to other people, seek answers from outside sources, and that the answers, the real, true, optimal ones for you as a unique being, are already inside of you?

    In my previous blog, I explained that you are the expert is what is right for you and I want to expand on the topic and go further, as well as present ways you can access your inner wisdom.

    I believe that we are all born with inner wisdom and knowing and that we can originally access it easily. Babies and small children know what feels good and what doesn’t. They trust their inner compass. They express their bliss and displeasure loudly. It is very plain for all to see: when they are happy, their whole body is happy. When they are sad you can see it too.

    But then, because we live in a society that expects us to obey and do as we are told, and because this is present at every level, whether it is parenting, education, or the corporate world, we slowly learn to ignore our inner knowing and trusts that authority figures know best what’s right for us. To be seen as lovable, acceptable, we slowly learn to fit within the constraints of what is seen as acceptable in our society. We learn to ignore what feels right, in favour of what is seen as right.

    It can be hard to unlayer the learning of distrust of one’s instinct and to start accessing the inner voice inside. This is especially true when we enter an experience that is outside of our field of knowledge. And this is particularly true of the experience of pregnancy, birth and parenting. I see it a lot in my work as a doula. I see highly educated, intelligent individuals, who find it really hard to trust their instincts in the face of pressure from coercive maternity care policies.

    The same is true when we become parents, and it can be tempting to choose to believe the opinion of so-called “experts” in parenting, rather than following one’s inner guidance. I wrote about this in my blog Why baby books and “experts” can really harm you after you have a baby . It is true for most new experiences in life, most choices, and most life transitions.

    I see this being highlighted more than ever since the 2020 pandemic. There are so many conflicting pieces of information. Experts disagreeing with each other. Public health policies that treat people as a single entity and fail to take into account unique individual circumstances. Forever changing goalposts. Not knowing who and what to believe.

    I am not saying that it isn’t worth consulting people who know more than you do about an area. But as I explained in my previous blog, they cannot make the decision for you, because they aren’t the ones who are going to live with the consequences of your decisions.

    In navigating the perinatal period, and life changes, and for most of us in the current climate, learning to listen to our inner knowing can be a game changer, and bring out a sense of confidence and peace.

    But how do you start to unlayer the belief that the answers always lie outside of yourself? How do you start listening to your inner voice if you have always let the opinion of others guide you?

    There are many different ways to start accessing your inner wisdom. None of them is necessarily “right” or more powerful than the other. They are simply tools. The most important aspect is that you use one that works for you.

    I have been on a massive journey myself to debunk what I thought I had to do. For example I use to believe I was shit at meditation because I thought you had to sit on a cushion in the lotus position, stare at a candle, and think of nothing. This cool little animated video went a long way in helping to undo this.  It is surprising simple. All you need to do is have the intention to do so, and then start applying ways of accessing your own wisdom that work for you.

    Here are some ideas to try to get you started. Remember, that, as with any new skills, the more you practice the better you become. After all, if you were going to run a marathon you wouldn’t expect to do it without training. Start small. Start with the method you feel most excited about.

    Set an intention

    • The simplest way to access your inner wisdom is simply to set an intention to receive the guidance and see what happens.

    Meditation

    • If trying meditation appeals to you, there are many apps, such as headspace (and plenty of others, some of which are free) around to guide you through the process in tiny, incremental steps. It doesn’t have to be a commitment to have 20 min a day, it could be as little as 5 min and still make a difference.
    • Checkout the one moment meditation video. https://www.youtube.com/watch?v=F6eFFCi12v8

    Mouvement

    • Meditation does not even have to be a still process. One can meditate whilst walking, dancing, or other movement activities too. I am a fan of 5rhythms dancing (https://www.5rhythms.com/) and other conscious movement practices,These practises work much better for me than sitting still. I include my wild river swimming in my meditative practices.
    • When you feel stuck, try moving gently, or going for a walk. Bonus if you can get in nature, as it is extra grounding.

    Grounding

    • Walking barefoot on the grass/ground is a super fast way to discharge stress and ground yourself. From a place of grounding it’s easier to access one’s inner voice.
    • Being in nature is generally grounding. I swim in the local river all year round and it is one of my favourite ways to de-stress and meditate.

    Breathing

    1. As with meditation, simply paying attention to your breath can help your mind quieten enough to hear the inner voice inside. Again there are many techniques available, but you already know how to breathe (after all you’ve been doing it all your life), and simply paying attention to your outbreath, and slowing it down slightly is all you need. Some meditation apps include breathing relaxation.

    Heart centering

    • This is a quick and simple way to gain a more heart centered state. Breathe gently for a couple of minutes, then imagine that you are breathing in and out through the centre of your chest.
    • You can also try the HeartMath institute heart coherence technique .

    Journaling

    • Some people find their inner voice communicate best with them via writing. Again it doesn’t have to be complicated. All you need is a notebook and a pen, and a commitment to start with free writing 5 min a day. One thing that can help is simply to state in your mind before you write “what does my inner voice/soul (or whatever other word resonates most with you) want to tell me today”.

    Learning to recognise your body’s response

    • Did you know that you can use your body as a pendulum to get an answer to a question? Start by asking a very easy question, for example, do I like (favourite food or drink). Close your eyes and really feel inside your body. Feel your unique body’s response to the yes inside. Mine is a feeling of energy circulating in a circle around my heart, but yours might be completely different. Then ask yourself the same question for a food or drink you really dislike. Feel the response inside your body. Once you have familiarized yourself with your own response, you can start practicing with every day questions. The more you practice the easier it becomes.

    Drumming

    • I cannot resist mentioning drumming because I love it. It is one of my preferred forms of meditation. You do not need to be musically trained. Research shows that drumming to a simple, repetitive, heartbeat like rhythms, causes the brain waves to slow down, which helps to get the mind chatter out of the way. I wrote a blog called Drum healing, bullshit? about my self-taught drumming journey. Over the last year I have drummed twice weekly in the local nature reserve first thing in the morning. It is the most nourishing spiritual practice for me.

     

     

  • You are the expert in what is right for you

    You are the expert in what is right for you

    You are the expert when it comes to making decisions in your life.

    This is one of the most important points I share with my clients. I think it applies to many things outside of pregnancy and birth too!

    It can be tempting to defer decisions to experts such as doctors and scientists, or anyone you perceive as an expert in the field, especially if you are trying to make a decision in a area of knowledge that is new to you.

    But the role of the experts is advisory.

    They cannot make the decision for you.

    This doesn’t mean that the role of the experts isn’t valuable, because they can curate options that suit you when trying to oversee the whole picture might feel overwhelming.

    I liken it to choosing dishes in a buffet. The role of the experts is to curate the buffet to your needs (for instance making sure there is no animal products if you are a vegetarian), but they cannot choose the dishes for you. You do.

    Not the scientists, not the doctors, not the experts. You are unique with your own unique needs and you get to live with the decisions you make, not the experts. The role of the experts is to lay options in front of you. It doesn’t mean that the a coach isn’t valuable, because they can curate through a lot of options for you, but their job is to lay options in front of you and your job is to choose what’s right for you.

    Because they aren’t the ones who are going to live with the consequences of the decision.

    You are.

    Play

     

  • Postpartum support and butterflies: what do they have in common?

    Postpartum support and butterflies: what do they have in common?

    In my book, Why postnatal recovery matters, I explain that postnatal recovery boils down to 4 pillars: social support, rest, food and bodywork.

    Social support is the foundation on which everything else is built. If you are going to rest, have some great nourishing, food and some bodywork after birth, it’s kind of impossible to do this alone. You need other adults around to be supporting you in order to do this.

    But postpartum support goes beyond the simple practical aspect of having other pairs of hands to hold the baby, cook you food or give you a massage.

    Yes, having another adult in the house means that there is someone to help with house stuff, but most importantly, it means that we aren’t alone. It means that there is someone else to keep us company, listens, and reassure us when we doubt ourselves.

    It means, most importantly, that there is someone to hold the space for us.

    Holding the space looks like someone is doing nothing, but it might be the most important aspect of all. Heather Plett explains this concept beautifully in her article.

    In the episode of the Midwives’s Cauldron podcast I did about postnatal recovery, I tell a story that illustrates this beautifully (you can listen to it here). When my daughter was a baby, she suffered from painful gas at night which left her inconsolable. I became aware that she reacted to certain foods I ate and had to eliminate these from my diet. On a holiday to France when she was 3 months old, I unknowingly ate some food she reacted really badly to, and she woke up in the middle of the night and cried for over an hour. As I got out of her bed to rock and soothe her, my mother heard her cry, and she came to keep me company. She didn’t do much; she just sat with me whilst I rocked my baby. But having another adult there, just being present for me, meant that I felt much stronger and able to support my daughter.

    Recently a new mother I supported as a doula told me something similar: she said you have help during the day, but at night, you’re alone and it’s so hard. I helped her find a night doula, and it made a world of difference to her wellbeing.

    As humans we are a social species, and we kind of intuitively know that we need community support through life transitions. This is why every culture used to have (and many still have) a set of rituals around big life transitions life becoming a parent.

    The polyvagal nervous system theory tells her that we need each other to regulate our stress levels, especially at times when we are vulnerable.

    Postpartum rituals around the world all have in common a period of about a month during which the new mother is nurtured and looked after, almost like a child, because there is an innate understanding that she needs to be surrounded and supported by experienced adults as she navigates her new role and identity.

    Western societies are so focused on productivity that we tend to only plan for practical things. I see a parallel with what people ask me about my doula role. They ask what does a doula do, yet most of my role isn’t easily quantified, because it is more about being than doing.

    An analogy often used for the transition to motherhood is that the change from a caterpillar to a butterfly.

    If you have ever seen a butterfly emerge from its cocoon, you’ll know that as the butterfly first comes out, its wings are crumpled and soft. The butterfly needs to hang upside down from its cocoon or a nearby branch, whilst it waits for the wings to unfold, dry and strengthen. Only then can it take its first flight. If you’ve ever witnessed this you may also know that if the butterfly falls before the wings are dried, the wings are usually damaged.

    Postpartum support is the same. It is about providing stable ground. One cannot help or speed up the wings unfolding and drying process, but they can be the strong cocoon on which the butterfly hangs whilst they unfurl.

    We need to introduce this concept in the postpartum too: that what new mothers need, most of all, are people to hold the space for them, and who trust that they can find their own path, and unfold and spread their wings by themselves, in their own time, once there have become strong enough.

    (PS: if you’re a birth geek like me you’ll be fascinated like I was to learn that there is a substance called meconium, which sounds quite similar to the human version, which the butterfly pushes through its wings to unfurl them.)

  • How to normalise rest and support after birth

    How to normalise rest and support after birth

    One of the reasons I wrote my book, Why postnatal recovery matters, is because I got fed up of witnessing new mothers struggle and blame themselves for it.

    As a society we are blind to the needs of new mothers. When they struggle to adapt and adjust to the intense demands of new motherhood, new mothers tend to think that something is wrong with them, rather than placing the blame where it belongs, which is in a culture that totally fails to support them.

    We also place an abnormal value on independence, which means that new mothers often hide their struggle as feel shame and guilt, mistakenly believing that they are the only ones who struggle. It’s a vicious circle.

    Since I published my book, I have been heartened by positive stories about it. One second time mother in particular, said that because of the book she didn’t feel guilty letting other people look after her after the birth this time around. But there is still SO MUCH we need to do to change things. In my doula work I still witness new mothers blaming themselves for their struggles, and who feel guilty asking for help, who feel guilty at having me to supporting them even!

    We need to normalize rest and support after birth. I believe than when as little as 15% of new families get given the support they need, this will become. I need your help in doing this.

    Please share the message that resting and being looked after the birth isn’t selfish but that it is the norm for our species.

    Encourage expectant families to plan for the postpartum as well as the birth. It’s easier to have support when you put plans in place in advance.

    Play your part in the revolution by giving gifts that actually support the new family, like food delivery, vouchers for a postnatal doula or mother’s help, or voucher for a postnatal massage.

    The more people experience true nurturing postpartum, the closer we will get to the goal of transforming our culture.

     

    If you’d like to read more, I started blogging about this topic in 2016, and you can read more posts below:

    What new mothers really need

    Motherhood is fucking hard and you aren’t meant to be doing this on your own

    Have you heard of a postnatal plan?

     

  • Getting out of overwhelm

    Getting out of overwhelm

    A few years ago I started my journey out of overwhelm. I was overworked and stressed and I didn’t know how to get out of the cycle. I was trying to work harder out of it. It was so bad that I remember stopping to pick some berries on a week day on my way home and feeling guilty because I felt I ought to be working.

    I was stuck into a mindset where my productivity and my worth were mixed up, and I wasn’t even aware of it.

    Luckily I embarked on a coaching programme with Bonny Williams. As part of the programme, Bonny challenged me to spend one hour a week doing something called soft play. The idea of soft play was to spend an hour doing something nourishing and fun, alone.

    At first I struggled to find what to do. Bonny suggested I think about what I enjoyed as a child. I remembered I loved being in nature, build dens, that kind of stuff. I can vividly remember my first soft play: I went for a walk to the local nature reserve, alone, on a week day, when I “should” have been working. I had a lot of stuff to do that and I very nearly didn’t go. But I did, and it felt great and oddly rebellious. And, oddly enough, that day I managed to do everything on my to do list and I felt great.

    Fast forward 3 years, this has become part of my new routine, and had spread new fantastic new habits like year round river swimming, and drumming in the woods and 5 rhythms dancing. I’ve realised this is so important that  days I put the time in nature as the first task on my weekly to do list. And you know what? Magic has happened! I feel a more relaxed, creative and productive than ever. I also have a lot more fun. In fact I’m so elated with the results I’m planning to create a course sharing my experience.

    The bottom line is this: You can cannot get out of the overwhelm created by working hard by working harder. Let me say this again: you cannot get out of overwhelm by working harder.

    Instead, to create spaciousness in your life and more balance with play, you need to let yourself experience that play and spaciousness inside. Once you start experiencing this, all sorts of magic will unfold by itself and you will not look back.

  • Why postnatal recovery matters online course: what’s so special about it?

    Why postnatal recovery matters online course: what’s so special about it?

    My name is Sophie Messager and I am on a mission to revolutionise the postpartum.

    Everywhere around the world, there used to be a period of about a month after birth during which the new mother was taken care of completely. Family members, or members of the community, used to take charge of the household (chores, older kids etc), make sure the mother rested, provided specific nourishing foods, and well as give or organise some bodywork, such as postpartum binding or massage. It was a ubiquitous practice in every continent (and still is in many parts of the world today). In the Western world, we used to have this too in living memory.

    I do not know why we forgot, but I know that what we have isn’t adequate, and that our lack of understanding of this fundamental need puts new mothers under intense stress. As a doula I have been witnessing new mothers struggle alone, trying to meet their own needs and the intense needs of their newborn babies. Not only this, but there is also intense pressure for new mothers to “go back to normal” as fast as possible, which contributes to feelings of inadequacy and suffering. Because we have lost sight of the needs of new mothers, mothers often blame themselves for their suffering, wondering what is wrong with them, instead of seeing that their struggle is caused by a culture that fails to understand and support them.

    Having witnessed this struggle over 10 years, I have wanted to do something to change it.

    In 2020 I published a book called Why postnatal recovery matters, which is a call to action for a change towards a more nurturing postpartum. I wrote it because I wanted to provide knowledge and practical ideas for both new families and the people who support them.

    I decided to create an online course based on the principles highlighted in the book. The course provides more of a held experience, as it is divided into bite sized modules and lessons, and because in each module there is a video where I introduce the topic. I have also expanded on the knowledge I gathered over many years as a doula and perinatal educator, and expanded to write the book and which I have carried on acquiring since. As well as all the videos and text to read, one of the entirely new aspects that the course provides are questionnaires in each of the modules, which you can download and print. These questionnaires encourage you to explore your beliefs and your hopes and fears on each particular topic. You can then revisit the questionnaire after each module, to see if anything has changed. This provides a deep enquiry process which can be transformative.

    After completing this course you will have:

    • Learnt about traditional postpartum wisdom, and why we need it back
    • Gained a solid understanding of why preparing for the postpartum is essential
    • Learnt about your own beliefs and needs for the postpartum.
    • Learnt about the 4 pillars of the postpartum: Social support, rest, food and bodywork, and how to make them work for you
    • Learnt why hiring help, in particular a doula, can be a game changer
    • Learnt how to write a postnatal recovery plan
    • Learnt about preparing for every eventuality, including the unexpected

    By the end of this course, you will feel confident and armed with the tools your need to have a supportive the postpartum recovery, one that places the new mother firmly at the centre.

    This course is for you if you are an expectant or new parent, or if you are someone who supports expectant and new parents.

    What makes this course, and my approach, unique?

    • I have a unique blend of scientific, theoretical and practical experience. I was a biology research scientist for 20 year prior to reconverting to being a doula. What I bring is my unique signature mix of scientific, traditional, and practical knowledge.
    • The course is full of scientific references, with clickable links you can follow, and also full of traditional wisdom.
    • I have extracted the fundamental principles of what constitues a good postpartum recovery, looking at what is common between cultures rather than specific in each individual culture, and divided them into 4 simple principles which are easy to apply. This means that you can make it work for you and your unique family and circumstances.
    • The course is full of stories from my clients and from mothers and birth professionals, which help illustrate the topic with real life examples, as well as give you ideas that you may want to try.
    • As well as being a scientist, I have gained practical experience in many traditional techniques, such as wrapping the hips and belly, which I share with you in the course.
    • Having gained a DiPhe in antenatal education, as well as facilitating hundred of courses and workshops for expectant parents and birth professionals over 10 years, I know how present information in a way that allows students to learn easily and enjoyably.
    • The course has also been co-developed with a group of 85 birth professionals, so you know that the content have been tried and tested by experts in the field.

     

     

     

     

    What’s in the course?

    • The course is divided in 11 bite size Modules
      • Introduction
      • History
      • What we are missing
      • Social support
      • Rest
      • Food
      • Bodywork
      • Hiring help
      • Postnatal recovery plan
      • Special circumstances
      • Conclusion
    • Each module is presented with an introduction video, and a mix of text, pictures, videos, and questionnaires for optimal learning, and to investigate your own beliefs and revisit them as your go through the course.
    • The course includes access to a private Facebook group for sharing knowledge and ongoing support.

    FAQ:

    How long do I have to do the course?

    As long as you need. You get to do the course in your own time.

    In which order do I do the modules?

    As you prefer. You can go through the course in a linear fashion, or go straight to a particular module you are interested in.

    How much does it cost?

    £119

    How do I access the course?

    Here 

  • The buffet curator: an analogy for doula work

    The buffet curator: an analogy for doula work

    Imagine you were going to a buffet restaurant in a foreign country, and that you had no idea what the foods on offer tasted like, or what the dishes contained.

    Imagine that you didn’t speak or read the language

    Imagine that you had your own dietary restrictions, such as being vegetarian, or being gluten free, or allergic to nuts.

    Imagine that the buffet restaurant was this enormous place, with more than a hundred dishes on offer.

    Imagine that, as you started queuing in front of the dishes, that people kept moving in front of the dishes, and that you knew people behind you would become impatient if you didn’t move.

    Wouldn’t you feel stressed? Wouldn’t you worry that you are going to pick the wrong dishes, some that you will not like, or that could cause you a major allergic reaction?

    Now imagine if you had a guide, someone who knew the restaurant and all the dishes in it.

    Imagine if, because you even entered the restaurant, your guide had taken the time to find out about your needs, made sure they understood what you wanted (and didn’t want), and then explained to you which dishes you would be able to choose from. Imagine that they had even gone and asked the chef which dishes were safe for you to eat. What if the guide could even ask the chef to prepare a different dish especially for you? How much safer and enjoyable would the experience be?

    This is what a doula can and will do for you, as you enter the maze of choices that pregnancy, birth and the postpartum bring. The many options, including ones you didn’t even know existed. The conflicting advice you find on every single topic.

    A doula is like your own buffet curator. As your doula gets to know you, your unique needs and preferences, she can sift through the many options available to you and present you with a curated list of options which you can pick from.

    You doula cannot pick the dishes for you, only you can do that, but having the list tailored to your needs might save you a lot of time and stress.

    A doula then walks the path with you, supporting you along the way and always being available to any questions as you choose, and get to decide what’s right for you. You even can change your mind at any point! Imagine how empowering this feels?

    If this resonates with you and you would like to work with me, you can find out more about the education and support I provide for families and birthworkers in the form of one to one support, and online courses.