šŸ„ New Course Alert šŸ„ Join me on ‘The Women Drum Keepers Collective’ Learn More

Sophie Messager

Author: Sophie Messager

  • Period Pain: if you’ve been told there is nothing you can do about it, read on.

    Period Pain: if you’ve been told there is nothing you can do about it, read on.

    If you suffer from period pain, or someone you know does, and if you have been told that there is nothing you can do: you have been lied to. There is plenty you can do, it is just that the knowledge isn’t part of what is taught within Western medical training.

    I got my period pain fixed, and it makes me so angry that women are told this lie over and over again, are told that it is normal, because it stops them from seeking the help that is available. I’m on a mission to change this.

    This is my story:

    I suffered from severe period pain from the moment I started my period. The pain was so severe that in my teenage years I used to be sent to the nurse’s room at school each month. I curled up in pain on the bed there and waited for my mother to come and collect me. I would spent the first day or two of each period curled up in bed with a hot water bottle. Sometimes the pain was so bad I vomited.

    I tried everything from mainstream drugs to homeopathy, but nothing worked. Around age 15 I was put on hormonal therapy for it. At age 16 I started taking the pill. As I no longer had “periods” (the bleeding caused by stopping the pill for a week is different from that of a period) I was free of pain. I stayed on the pill from the age of 16 to until I was 33, when I decided to stop taking the pill because I was diagnosed with precancerous cells on my cervix (I read some research showing a link between long term pill taking and these- If you want to read about it, the book “The Pill, Are you sure it’s for you” By Alexandra Pope, is fantastic).

    My period pain came back with a revenge. My husband, who had never seen me with this pain, was shocked at how bad it was. I remember once we were drivingĀ  when it started and I had to get him to park on the side of the road as I writhed in pain on the car seat, white as a sheet and covered in cold sweat, until I waited for the painkillers to kick in.

    I went to the GP for help. I remember being stunned when all I was offered was to take pain killers. I said to the GP : Ā “Really, in 15 years the medicine still hasn’t moved on?”. At the time I was working in a biotech company, and told my boss about this, and he said “if men had pain in their dick once a month you can be sure there would be a drug for it”!

    I resigned myself to taking ibuprofen every month. Then I became pregnant and the pregnancy and birth seemed to temporarily fix the problem. My periods became more regular and I was pain free for a few years after having my children. Then, a few years after my second child was born, the pain came back. I resigned myself to taking the pain killers again.

    In 2014 I met an osteopath in Cambridge called Teddy Brookes. I mentioned this to him and he said he could help. I was surprised and slightly disbelieving, but it was so bad I was willing to try anything. Teddy is trained in visceral osteopathy, something not all osteopaths are trained in. He felt the ligaments around the front of my uterus (the round ligaments), told me they were very tight, and worked on releasing them. It was not comfortable and I had to do some deep birth breathing during the treatment.

    That evening and night I had a lot of cramps in my uterus, but the next morning I woke up feeling absolutely amazing, both physically and emotionally. I felt like nothing could touch me. The next cycle the pain was less but still there. I got in touch with Teddy and he talked me through how to release the ligaments myself. I had to get my husband to do it as I couldn’t get my fingers in the right direction but it helped. Within 2 or 3 cycles I was completely pain free and I have been for 6 years.

    I was baffled by this because as a scientist I knew that from a scientific point of view, the cramps of period pain were caused by hormones called prostaglandins and I couldn’t see why releasing ligaments would affect this. Teddy explained that there cramps were still there, only that they were comfortable. I was delighted to be cured of the pain.

    As I told women about my experience, some asked me to teach them how to release their ligaments. But I didn’t feel comfortable doing that because everybody is unique and I thought maybe other ligaments would be tight and therefore need a different technique. Teddy told me that it is almost always the round ligaments that are too tight (more on that later).

    Other things happened along the way that helped my have a different relationship to my menstrual cycle. In 2016 I attended a workshop by Alexandra Pope of Red School, that helped me understand the changing energies throughout my cycle and how to tap into them. This led me to make sure I rested as much as possible during the first couple of days of my period. I blogged it about here.

    With my own practise, working closely with Teddy (we created a postnatal massage course together), massaging new mothers with closing the bones, with supporting women with healing as a Reiki practitioner, and with training such as spinning babies and biomechanics for birth, I general became more aware of my body and of the importance of good balance for uterine health.

    In 2019 I attended a workshop on womb health by Arvigo massage therapist Hilary Lewin. She brought a life size womb suit and proceeded to demonstrate in a very visual manner how the ligaments of the uterus affect period comfort.

    The uterus is attached to the pelvis by several sets of ligaments. You can see a 3D illustration of how the uterus ligaments attach to the pelvis in this video. The round ligaments in particular attach from the top of the uterus and to the front of the pelvis. A healthy uterus is normally slightly bend over the bladder. If the round ligaments are too tight, the uterus will be bent forward a lot more, making expelling menstrual blood a lot harder, and therefore more painful (as the uterus will need to cramp harder to get the blood out).

    In this video I explain in a very visual way what happens when the uterus is not optimally positioned.

    Part of the problem is that we live sedentary and unbalanced lifestyle so many of us have tight ligaments (sitting down a lot tends to do that) and don’t even know it. Because everything in your body is linked, having tight or unbalanced ligaments and/or pelvis may affect many other things too, such as causing back pain or bowel issues. Abdominal massage therapist Barbara Loomis explains some of this with great illustrations here.

    Sadly many women suffer needlessly suffer from horrendous pain, and because most of us believe the narrative that there is nothing we can do, we don’t seek help.

    Here are some stories to illustrate the pain of what some go through, and in some case what helped them:

    When I was younger, before kids I had some months were I would be crying & in excruciating agony, where I’d lay fetal style for hours in so much pain. Pain killers wouldn’t touch it. It wasn’t like that every month, but definitely had it a lot! I always had heavy periods with less pain or light with more pain! Doctors would always say : ‘it can’t be that bad’ and would basically ignore me. They wouldn’t believe me that paracetamol or ibuprofen didn’t work for me (I have a condition where I metabolise drugs really fast) I remember once (this is awful but) taking the strongest pain killers my Nan had prescribed to her for chronic pain, they still only barely took the edge off! My husband found me in a ball crying once & tried to take me to hospital but I knew there was no point. Once I started having kids I found they got so much better. I now have fairly ok period pain but I do now wrap my hips, use reiki, have a bath & rest (especially on my first day as much as I can)! Carly Lokrheim

    From the onset of my periods I had severe pain. Every month I used to be floored in agony. I went yellow in skin tone and was physically sick and sometimes past out. I used fear it every month. My bleed was so heavy and clotted I used to leak right through my school uniform. I was taken to the doctors many many times and was fobbed off and treated as a silly girl. I felt (and it was said) that I had a low pain threshold and I would not be able to handle birth. This put me off ever having children (right up until I was in my mid 30ā€™s) As I got older PMT got more and more intense till it started to affect my marriage. At this point I started Ayurvedic treatment which included massage, life style changes and diet changes. This really really helped with my periods and PMT. When we tried to get pregnant I found there was unexplained infertility, I started acupuncture and found it really helpful and also had a laparoscopy and found I had endometriosis scaring and fibroids. I think a combination of all three treatments/practices helped us to conceive and go on to have two babies. I now follow my cycles and adapt my life (as much as possible) to follow my inner seasons or at least be aware of them. I now also use a moon cup and relish my bleed as a time to retreat and surrender. Clare Wilson Hasted

    I had awful period pain from the age of 11 when it started, I would vomit and faint/ pass out with the pain. I was put on the pill at 13 it didn’t really help what did help was paracetamol, hot water bottles and rest. Then in my late teens I read a book called Who dies? and starting using the meditations in there to cope with the pain, I used the same meditations to cope with my contractions. I also took cramp bark. Staci Sylvan

    I tend to bleed for 17 – 20 days and I have excruciating period pains. This started at the age of 13 and has followed my entire life. I had hoped pregnancy might help but 6 weeks after giving birth sure enough agonising pains. I have tried so many therapies, pillsĀ  implant etc. And the pain each month is still so severe I missed time off school as a teenager and miss work as an adult. Every job I have had I keep a hot water bottle at my desk and painkillers in a drawer. I have had a mirena since the age of 21 and since then have not missed work due to period pains. My cycle became regular and bleeding only for 5 days. After having my son I had a 4 year break from the mirena. I realised I just couldn’t cope without it, my body hurt so much, I was exhausted and honestly just not a nice person as I was in agony so often, couldn’t sleep, didn’t want my husband touching me. I had the mirena inserted last November and I remember about 7 days later feeling like I had woken up. My foggy head cleared and I felt in control of my body again. I do get pain but it’s manageable with a hot water bottle and rest. I am happier, calmer, more patient and I feel like I have my life back. I can’t over state how much the Mirena has changed my life. It’s spectacular and I will always be grateful to the GP who initially recommended it after about 7 years of begging for help and being dismissed as “you’re female you just have to deal with it”. In terms of the painĀ  for me it’s thighs, bum, lower back and lower abdomen. It can been so painful I vomit from it. I feel like my whole body is stiff, exercise makes it worse. Rocking my hips on a gym ball cam help or gentle bouncing. When it’s at its worse there is no way I can work, I can barely talk and usually just end up crying. Jay

    As a teenager my period pain was severe. If my daughter experienced pain like that, I would take her to the doctor, or emergency in some cases I had. However, I was too afraid/embarrassed/shamed/whatever to tell my mom or anyone. I remember having to go into work while vomiting and hunched over in pain because my boss wouldn’t take no for an answer because I didn’t sound sick. Sharon Bales

    I’m aware that period pain can be caused by other issues than biomechanics. I know that some have PCOS or endometriosis or other conditions…but it is the same: you are sadly unlikely to get answers from mainstream medical professionals because they simply lack the training, knowledge and the tools to help you. It’s not their fault, rather it is the very narrow view of how Western culture sees the body that is to blame. As Katie Bowman explains in this article:

    “Dysmenorrhea is a pain, literally. Itā€™s a painful period, ranging from light to severe, that can also include vomiting, diarrhoea, headache and fainting. The ā€œprimaryā€ means that the dysmenorrhoea is not occurring simultaneously with another known pelvic pathology. (Secondary dysmenorrhoea can be created or affected by issues like endometriosis and fibroids that can cause extremely painful periods, and I know that people suffering from those conditions have likely heard a million ā€œjust do thisā€ solutions, and Iā€™m not trying to offer that here, although I hope that movement might relieve some part of your pain.”

    So what can you do to help with period pain? Here are some of the therapies I have personally used or heard that some had success with:

    See a bodyworker that can work on your uterus alignment. This could be an osteopath or a chiropractor or a physiotherapist who is trained in visceral osteopathy. Or you could see someone who is trained in womb massage such as an Arvigo massage or a Mizan Therapy,Ā or a Fertility Massage practitioner. Having a closing the bones massage may help too. Make sure to get recommendation from good local practitioners.

    For the past year or so I had been suffering with debilitating period pains: I would faint, hang from my husband’s neck as if I was in labour, I’d only find relief in the bathtub where I’d be playing mermaid for at least half a day on my first day of bleeding. It got so bad I was checked for endometriosis and cervical cancer (as I also got 1 cycle with constant intermittent bleeding between 2 periods). Nothing wrong physically. After Sophie Messager mentioned her osteopath helping her with period pains to the point she is now pain free, I spoke to my chiropractor, where I’m currently going for regular sessions on another issue. For the past 2 cycles, she’s worked on my pelvis and the round ligaments holding my womb, and – touch wood – I’ve only had the slightest dull sensation on my previous cycle, not even worth calling pain, and am TOTALLY pain free in my current cycle. The difference is totally unbelievable. Ladies, if you suffer from period pain, this might be THE thing that changes everything. I already used rebozos, aromatherapy, herbal teas for myself, but nothing was even touching the edge of it. Until I got the tension in the ligaments released. I don’t even notice now, physically, that I’m on my period. (Emotionally and energy-wise I still do, and aromatherapy, herbs and rebozos still have a role to play there — but now it’s just become a week of gorgeous self-care, not a week of intense pain that makes that self-care so focused on the pain). Japjeet Rajbir Kaur Khalsa

    I personally found osteopathy and Ayurveda completely resolves my painful periods. Also reframing my understanding after reading Wild Power has been beyond powerful. Emma Hayward

    Work on your alignment (either face to face with a specialist such a physiotherapist, Pilates or yoga teacher or with an online course-see a list of courses at the end of this blog). Rosie Dhoopun is an alignment specialist. She shows you a movement routine to ease period pain here.

    Alignment and movement worked for me. Plus surprisingly using cloth pads. I even get mild cramps using a mooncup so use that infrequently. I used to suffer terribly as a child and eat a whole packet of feminax to get through. These last years I use to have such bad knee pain but all stopped since releasing tension. Isn’t it such a shame we are told it’s normal and medication is the best thing. Rosie Dhoopun

    My periods were once every 6 months. And Iā€™d be on strong painkillers for a week to get even near function. I saw a chiropractor, switched to barefoot shoes and started stretching my calves in my 30ā€™s which took me to regular and pain free. Philippa Wilmot

    See an acupuncturist. I have personally had great results treating infertility and recurrent miscarriages with one and I found that it helped make my period more comfortable too. Here is a review of the evidence behind the effectiveness of acupuncture for period pain by the Acupuncture council.

    See a herbalist. I saw Natasha at Forage Botanicals to help with the symptoms of the perimenopause who specialises in treating painful periods.

    See a homeopath. Here is an article with some suggestions on homeopathic remedies that might help.

    See a nutrition specialist with experience in this area. Since painful periods can be caused by too much inflammation in the body, changing your diet may help your pain.

    Nutritional therapy helped me. Period pain was crippling as a teen and rectified by the pill, which I took for ten years but it caused depression. Period pains got quite bad again slowly over the course of a few years and then stopped when I stopped smoking and did a sugar detox! My friend is a nutritional therapist, I was having bad mood swings all the time and awful cramps during my period. I wanted to try anything that would stop me needing SSRIs. She told me it was because the body can take a certain amount of stress but it has limits, so when I stopped smoking, it had better circulation and that helps with pain management and when I stopped eating sugar, less stress on my organs and hormones. Barely a cramp since. Abbi Leibert

    I found my period pain (not severe but present and very uncomfortable) almost disappeared after going vegan. Pippa Moss

    I had breakthrough bleeding in between my periods every month for nearly 3 years, I had all sorts of investigations scans biopsies nothing came back as a problem. Even had 4 miscarriages but still nothing has been found as a problem despite all the blood tests and so on. I discovered something called hair tissue mineral analysis and arrange the sample sent off I also did some additional blood tests privately. I found extensive mineral deficiencies and results consistent with hypothyroid despite normal blood results. I had a specially adapted list of supplements and dietary changes given to me by nutritional list and Six months on no breakthrough bleeding my period is so much more manageable, even more so since I discovered magnesium spray, and I have been wrapping my hips for quite some time. Still not entirely sure what our future holds in terms of pregnancies but at the moment Iā€™m just happy with how far Iā€™ve come in the six months. Nicola Witcombe

    Other more unusual things to try:

    Year round wild swimming (I’m not suggesting you swim in cold water during the actual bleeding when keeping warm is important), but there is mounting evidence that it does wonders to you wellbeing. It earthes you as well, see my blog on the subject.

    Try grounding yourself. Since period pain is at least in part caused by inflammation, and earthing/grounding has been shown to decrease inflammation, it may help. It can be as simple as walking or standing barefoot on the ground/grass. See a review of the evidence behind earthing in this paper.

    Try dancing. Movement has been shown to ease period pain, and boost blood flow. Conscious dance practises, such as 5rhythms, allows you to get deep into a movement that is unique to you.

    Nicky Smith, Ecstatic dance facilitator, says:

    “One thing which really helped me was movement. Our usual & natural inclination is to move away from pain & discomfort, of course! If we can move towards it, even a little, then allow the movement & expression to come from that place in our body it can give the intensity an expression which can support a release. Breathing into that place & moving on the exhale, helping our system to relax into rather than away from. The more I practise this approach the more I can move towards the pinnacle of the pain/discomfort and when I reach that edge my body will naturally start shaking. We can of course induce shaking ourselves. Another sweet release can be with our voice, giving that pain a sound, sometimes alongside movement can be a powerful medicine.”

    Ideally you would be able to see someone who is holistic in their approach and will take a case history and who can suggest an approach that covers all bases. But trying even one therapy is well worth it as it may be your first step on the road towards of a pain free period.

    As a teenager I never looked for help, because period and its pain is/was a taboo; I also lied down in a foetus position crying from pain. No pain anymore after having kids; what helped me was to accept my female body, as well as solving female ancestral karma (Closing the bones, constellation therapy, cranio-sacral therapy). So not one particular method, but rather awareness that menstrual taboos are so deep in our consciousness and that unhealed ancestral female traumas feel so painful in the body because the one/generation who becomes aware of that releases a lot of that ancestral shit with the energy of menstruation. Laura Linde

    What can you do for yourself (without seeing a therapist)

    Wrap your hips! I show you how to do this in this video. Because it supports the pelvis, the uterus and its ligaments, and because it provides warmth, wrapping your pelvis during your period may provide relief. I show a simple way of doing it in this video (there are others on my YouTube channel, and I have a blog on postnatal wrapping that is full of examples of ways to do it). Here is a blog post from Mizan Therapy explaining why it might help.

    Try switching to using reusable menstrual products. Some women report a decrease in period pain when they switched to using washable pads, period pants or a menstrual cup (There is a great YouTube channel about reusable sanitary products and menstrual cups here).

    My extremely heavy flow (so much so I couldnā€™t go to work 2 days at start of period, leaked through clothes etc) was helped hugely by moving to cloth sanitary protection. They say the chemicals in disposable pads increase flow. There was never a mention of the sanitary wear I used as a cause, rather the potential need for gynae reviews and long term medication. Thankfully not needed thanks to cloth sanitary products. Claire Pitchford

    My biggest healer has been switching to cloth and organic, un bleached sanitary ware and a series of womb massage sessions with Tania Meacher-Payne. She knocked my period down from 10-6 days. Life changing. I call her the womb fairy. Vikki Young

    Work on your alignment yourself.Ā  Alignment specialist Rosie Dhoopun runs an online courses on the topic. In this video she explains a set of techniques you can do yourself.

    There is a list of things to try to decrease period pain in this blog by Katy Bowman :

    • “1.Ā  Two days before the expected time for the flow to begin, reduce the amount of work done and increase the amount of rest.Ā  Take a warm tub bath each evening for thirty minutes.
    • 2.Ā  When the flow starts, go to bed and keep hot-water bottles to the feet and lower abdomen.
    • 6.Ā  To help prevent future attacks of dysmenorrhea give attention to the following:
    • a.Ā  Regular habits of eating, sleeping, and exercise.
    • b.Ā  A wholesome diet, free from spices, condiments, greasy or fried food, tea and coffee, with little or no fresh food.
    • c.Ā  Avoid tight clothing, and see that the limbs, neck, and chest are prevented from chilling.
    • d.Ā  Correct constipation, if present.”

    Take an online course:

    Checkout some websites

    Read some books:

    Here are the ones I have read and loved.

    • Wild Power by Alexandra Pope
    • Period Power by Maisie Hill
    • The wise wound by Penelope Shuttle and Peter Redgrove
    • Women’s bodies Women Wisdom by Dr Christiane Northrup
    • Moon Time by Lucy Pearce

    For supporting puberty:

    • Reaching for the moon by Lucy Pearce
    • How to support your daughter through puberty by Melonie Syrett

    And here is a collection of 28 books on the topic

    I’d love to hear about any other resources or therapies you have found useful!

  • Inducing labour with Castor oil : is it safe?

    Inducing labour with Castor oil : is it safe?

    Castor oil induction has bad press in the UK. Negative stories abound, claiming severe negative effects on mother and baby. For years, I too believed this to be true. I took it for granted that it was dangerous.

    A couple of years ago a doula told me that several of her clients had successfully induced their labour with it, and that the stories didnā€™t match their experience. She also said that, faced with the prospect of a long induction in an antenatal ward, some women felt that it was a lesser evil. This conversation spurred me to look for the research. I was very surprised to find that it was actually quite safe, and that the stories didnā€™t match what the published research said.

    Birthworkers often talk about strongly held beliefs within maternity care, that turn out to be myths. You know, the kind of belief that everybody seems to have, without question, that gets perpetuated through stories, yet when you analyse the research you find that there is very little evidence to back it up (theĀ placenta ā€œfailingā€ at the end of pregnancyĀ being one of the most common ones). After reading the research on induction with Castor oil, I was embarrassed to admit that Iā€™d fallen prey to this myth believing myself.

    I cannot help but wonder how Castor oil came to have such bad press in the UK. For some reason it has fallen out of fashion here (Midwife Becky Reed told me that it used to be used in the UK in the past), and yet it is still more commonly used in the USA.Ā A survey of 500 US midwifesĀ in 1999 showed that it was the most commonly used natural substance used to induce labour.Ā  American Midwife Ina May Gaskin mentions it in her Guide to Childbirth. When Ina May came to a the Doula UK conference in 2017, doulaĀ Sue BoughtonĀ asked her what she thought of it and she said that it was perfectly safe and that they used it all the time.

    This is what Ina May says in her book, Ina Mayā€™s guide to Childbirth:

    ā€œIndigenous peoples all over the globe have used castor oil to induce labor for centuries. Taken orally, castor oil acts as a laxative, and the stimulation of the digestive tract often starts labor at term. No one knows why castor oil works to start labor. When there is little or no money to be made as a result of research, generally little or no research is done. Nobody has figured out how to make an appreciable amount of money from castor oil, so this subject has received virtually no research attention. Nevertheless, castor oil seems to be quite safe. Nearly nine percent of nearly eleven thousand pregnant women in a large birth center study used it to start labor, with no adverse outcomes. At The Farm Midwifery Center, we recommend beginning a castor-oil induction at breakfast after a full night of sleep. One tablespoon of castor oil is added to scrambled eggs or is mixed with fruit juice to make it more palatable for the women. If necessary, she takes one more tablespoon one hour after ingesting the first.ā€

    I want to share what the research says, to help you decide whether you think that castor oil induction is a good idea or not, and also so that there is an up to date review of the evidence to signpost women to, if they feel that it is an option that they would like to explore.

    Before I do this I need to give an important disclaimer: I believe that our cultureā€™s obsession with inducing labour as soon as a certain date has reachedĀ  is not only unhealthy, it is also not based on solid scientific evidence. I wrote about this beforeĀ in this blog. Therefore I want to be clear that I havenā€™t written this blog to encourage women to induce labour with castor oil. It is designed to provide a review of the evidence so that people can make truly informed decisions.

    what is Castor oil?

    Castor oil is an oil extracted from castor beans, which are produced by the castor plant, Ricinus communis. It has laxative properties. (It is often used toĀ empty the bowel in a medical setting prior to examinationsĀ )

    How does Castor oil work?

    The way Castor oil stimulates labour was only elucidated in 2012. Contrary to popular belief, castor oil doesnā€™t only work by only stimulating the gut (though this might play a role in the process as well). After being ingested, castor oil is broken down in the intestine, releasing ricinoleic acid, the main fatty acid in castor oil. Ricinoleic acid attaches directly onto receptors which are present in both the bowel and the uterus. As well as stimulating contractions of the smooth muscles in the bowel, research has shown thatĀ it causes uterus tissue to contract, and that in mice that lack its target receptor (prostaglandin receptor EP3) it does not produces uterine contractions.

    How is it taken?

    Castor oil is taken orally. Although Ina May Gaskin suggest a tablespoon or two (A tablespoon is about 15ml), most of the research studies used a dose of about 60 millilitres (so 4 tablespoons). It is usually suggested to mix it with fruit juice to make it more palatable. Interestingly, in one paper the authors used sunflower oil as a placebo and said that women couldnā€™t taste the difference between Castor oil and sunflower oil once it had been mixed in orange juice. One publication refers to a cocktail or smoothie as follow:

    • 2 ounces castor oil
    • 1 cup champagne
    • 1 cup apricot nectar
    • 4 tablespoons of almond butter.

    How effective is it?

    There is aĀ Cochrane reviewĀ of the literature from 2013, which includes 3 studies: . The three trials included in the review contain small numbers of women. All three studies used single doses of castor oil. The results from these studies should be interpreted with caution due to the risk of bias introduced due to poor methodological quality. Further research is needed to attempt to quantify the efficacy of castor oil as an induction agent.

    • InĀ one study of 47 women, there was a significant increase in labour initiation in the castor oil group compared with the control group (54.2% compared with 4.3%)
    • InĀ one study of 100 womenĀ , 52 women received castor oil and 48 no treatment. Following administration of castor oil, 30 of 52 women (57.7%) began active labour compared to 2 of 48 (4.2%) receiving no treatment. When castor oil was successful, 83.3% of the women had a vaginal birth.
    • InĀ one study of 80 womenĀ (37 in the treatment group and 43 to the control group) the odds of entering the active phase of labour within 12 hours of administration was 3 times higher among women receiving castor oil compared to women receiving a placebo.

    Two other papers not included in the review, were published in 2018. InĀ one of these papers, 323 women (who birthed in a birth centre) used castor oil to induce labour showed that 81% of the women gave birth vaginally, and the authors stated that this was significantly higher than the national average. They concluded that ā€Ā Our results show women who consumed a castor oil cocktail to induce labor experienced adverse fetal and maternal outcomes at very low rates. Further research, including a clinical trial, should be conducted to test the safety and efficacy of castor oil as a natural alternative to labor induction.ā€

    InĀ the other paper, 82 women were divided in 2 groups of 38 and 44 , and respectively received castor oil and a placebo (sunflower oil). Of the women who received castor oil, 42.1% entered labour within 24 h, 50.0% within 36 h and 52.6% within 48 h compared with 34.9%, 37.2% and 39.5% in the control group. The authors also found that castor oil was effective in stimulating labour in multiparous women (women who had already had at least one baby) but not in first time mothers. No differences in rate of obstetric complications or adverse neonatal outcomes were noted.

    I tried to find some research to compare the effectiveness of Castor oil versus the most common form of drug used to start the induction process in the UK : Prostaglandins, which are usually administered vaginally. This proved complex because theĀ Cochrane reviewĀ cites many different studies, all with different populations and different outcomes. For example one study with women of mixed parity (first time mothers and multiple pregnancies mothers mixed together), found that, in a study of 343 women with a favourable cervix (this means their cervix was already in a condition close to labour) and a 3mg dose of prostaglandins, found that 12% of women were still pregnant after 24h versus 100% of women who didnā€™t have the induction. In a smaller study of 39 first time mothers with an unfavourable cervix and a smaller dose of prostaglandins (2mg) compared with a placebo, 79% of the prostaglandin group and 90% of the placebo group were still pregnant after 24 hours. When combining the data the reviewers could not reach statistical significance.Ā The reviewers conclude after looking at all the studies that ā€Ā Overall therefore, although not certain, it is likely that vaginal prostaglandin E2 compared with placebo or no treatment reduces the likelihood of vaginal delivery not being achieved within 24 hours.ā€

    This gave me pause for thought, because on one hand, our culture can be quick to dismiss natural remedies as quackery and non evidence based. Yet I was surprised to discover that the research doesnā€™t show prostaglandin pessaries as being a very effective drug when it comes to labour induction, but because this is part of the normal maternity care, this doesnā€™t get questioned. You might be surprised to hear thatĀ only 9-12% of the royal college of obstetrician guidelines are based on high quality evidence. I also couldnā€™t help but wonder how many of the women who get offered an induction of labour get given the statistics about how successful the process is likely to be.

    What are the side effects of Castor oil?

    The most common side effects are diarrhoea (which is to be expected as Castor oil is a laxative) and nausea.

    • In the study of 47 women, 45.8% experienced nausea versus 0% in the control group.
    • In the study of 100 women , 100% of women who took the castor oil reported nausea compared to 0% of the women in the control group.
    • Contrary to the high level of nausea and diarrhoea described in the studies above, in the first 2018 study, out of 323 women, only 7 (2.2%) experienced nausea. The authors concluded that ā€Ā In the current study, the low incidence of maternal and fetal adverse effects suggest castor oil may be a safe and agreeable way to stimulate labor and avoid unnecessary caesarean birth. Although previous studies cited adverse maternal effects (e.g. nausea, vomiting, diarrhea) as a barrier to castor oil use, participants in this study who received the castor oil cocktail reported a low rate of these effects. In fact, less than 4% of the sample experienced nausea, vomiting, or extreme diarrhea.ā€
    • In the other 2018 study, 32 out of 81 women (40%) experienced an increase in bowel movement, 4ā€“6 h after ingestion of the oil (42.1% in the intervention group and 37.2% in the control group (who received sunflower oil). The authors did not observe any serious adverse events, and concluded that ā€œCastor oil is an effective substance for induction of labor, in post-date multiparous women in an outpatient settingā€œ.

    Castor oil does not appear to cause severe side effects on the mother or baby. The Cochrane review authors concluded that ā€œThere was no evidence of a difference between castor oil and placebo/no treatment for the rate of instrumental delivery, meconiumā€stained liquor, or Apgar score less than seven at five minutes.ā€

    What else matters when it comes to decision making?

    Beside the science showing that Castor oil appears to be pretty safe and effective, there are other aspects to consider. As I explain inĀ this blogĀ , induction of labour is an intervention that has many pros and cons, and you have to weigh the balance of pros and cons for you as a unique individual, with your own unique circumstances. And it is also important to remember that Castor oil IS a form of induction, regardless of the fact that it is a natural substance.

    What are the possible advantages of using castor oil to induce labour?

    • It can allow women to remain in control of the start of the birth process, and to choose where they give birth. When labour is induced in a hospital ward, you are committed to a process, which restricts your birth options. In most hospitals, being induced means the only option is to labour in the antenatal ward (though some hospital offer outpatient induction), then give birth in the labour ward. If you induce labour at home then you remain in control of the choice of place of birth, whether at home, in a birth centre, or in a labour ward.

    The authors of the first 2018 paper stated that ā€Ā By stimulating labor and decreasing the necessity for intervention via cesarean section, castor oil as a method of labor induction may enable women to adhere to their birth plans (e.g., at a birth center, vaginally, etc.), benefitingĀ from these positive outcomesā€

    • It can allow women to remain in their own environment, with their support partners of choice.Ā Induction of labour can take days, and it is sometimes stopped or delayed half way through if the induction or labour ward becomes full. Because of this, in the recent past IĀ  saw many women undergoing induction lasting up to 5 days. Now in 2020, the new visitor restrictions due to Covid19 mean that partners arenā€™t allowed in the hospital until women are in established labour. For the mother this may mean days of early labour without any support from anyone she knows and trusts, as well as having no one to help advocate for her.

    I have supported such births recently and they felt very frustrating for the mother, her partner and myself. I provided remote support over the phone, but in my experience the induction felt more upsetting than usual with the lack of face to face support from the partner and myself. I know this frustration is shared by others, and aĀ recent publicationĀ has highlighted how womenā€™s rights in childbirths are not being respected since the beginning of pandemic:

    ā€œThe position of the rights of women in childbirth is in this context a precarious one. Stories have emerged in mainstream media ā€“ supported by personal accounts received by global and European birthrights organizations ā€“ of women having their labor induced, being forced to have cesarean sections, giving birth alone, and being separated from their babies immediately after birth.ā€

    • Impact on support after the birth

    Women whose labour is induced are more likely to end up with medical interventions such as caesarean or an instrumental birth, which may mean a longer stay in the hospital post birth. With Covid restrictions in place, partners are only allowed in postnatal wards for a 1 to 2h visit daily. If a new mother is recovering from a caesarean, or if she is very tired after a long labour and birth, this simply isnā€™t enough support for a her to get some rest and recover after the birth. Nobody is there to comfort her, or to hold the baby whilst she sleeps. I have listened to many harrowing such stories from new mothers to know that this is a very difficult situation to be in.

    What are the possible disadvantages of using castor oil ?

    • The side effects mentioned above might not be acceptable to some women or their partner.
    • Some women may feel safer being induced in a medical setting.

    In conclusion:

    Using Castor oil to induce labour can cause side effects such as diarrhoea and nausea but it appears to safe for mother and baby. It is also a fairly effective, especially when women have already had one or more babies. Some families may perceive that it is important for them to retain control over the induction process, and may decide that having the diarrhoea and nausea might be an acceptable side effect, compared to the reality of being being induced in a hospital setting.

     

  • Why I wrote my book, Why Postnatal Recovery Matters

    Why I wrote my book, Why Postnatal Recovery Matters

    Ā 

    Play

    Ā 
    Ā 
    Ā 

     

    Ā 
  • A little bit of background about rebozos and their use to support women

    A little bit of background about rebozos and their use to support women

    I was introduced to the art of using the traditional Mexican shawl called the rebozo back in 2013 when I attended a workshop by doula Stacia Smales Hill on rebozo use for labour and birth. During the same year I also attended a workshop by Dr Rocio Alarcon, who taught a postnatal massage technique called closing the bones, some elements of which included rocking and binding with a rebozo.

    Over the course of the following years I pursued my knowledge further by doing several more workshops with Rocio, and several other rebozo workshops with different focuses, such as the rebozo for labour progress and malposition with Selina Wallis, micromovements with Francoise Freedman, 2 different spinning babies with Jennifer Walker and Gail Tully, and a workshop on healing diastasis rectiĀ  with Birthlight which included many rebozo techniques.

    I am also a babywearing instructor, and as such use rebozos and wraps to carry babies too.

    As I started teaching workshops around closing the bones and rebozo work as well as babywearing, the incredibly versatile use of the cloth really blew my mind.

    As I met people through teaching, I constantly questioned people I met about their culture’s practises, I started to build a picture in my mind of something much more universal than the rebozo.

    It seems that every culture had a piece of cloth of some kind, call it a shawl, a sarong, a scarf, or a wrap.

    Whilst the rebozo is a traditional shawl from Mexico and some South American countries, I found that other cultures used different pieces of cloths in the same fashion.

    Cold countries often us thick, woollen fabrics (think Welsh Shawl or Scottish plaid), and warmer countries, cooler, thin, cotton fabric (think African Kanga or Indonesian Sarong).

    There are almost too many fabrics to count, but one thing is for sure, women have used all sorts of cloths in incredibly versatile ways, and what I’m going to say below about the rebozo is true for many other cultures too. It’s a truly universal practise.

    I spent a few years believing that the use of the rebozo during labour was uniquely South American but I have since met a Somalian midwife who told me how they use their traditional shawl, called a Garbasar, in a similar way during labour. Supporting a pregnant woman from the same country confirmed this, and in fact her mother even showed me how it is used to bind the abdomen post birth.

    I trained a Moroccan birth worker in doing closing the bones, and she was surprised when she started offering the massage that women came forward and told her they’d had a similar treatment in the local hammam (Steam bath/wet room) after birth (using a traditional Moroccan cloth called a Mendil).Ā  Tunisia offers a similar practise called a fouta massage (the fouta is a hammam towel, which is very similar in nature to the Turkish towel-it has become a very popular alternative to beach towels in France recently).

    I am lucky to be part of a multicultural family, being French and married to a man from Hong Kong. In Hong Kong I’ve been told they use a long piece of muslin cloth to bind the woman’s hips and abdomen after birth, and my mother in law showed me how the midwifes taught her to wrap her belly with a towel post birth.

    It’s also quite fascinating to see how contact with foreign cultures can influence each other. For example I recently acquired a Dutch postpartum girdle called a Sluitlaken. I couldn’t help but notice how similar to Indonesian postpartum binding it looks, then a friend pointed out than Holland used to have Indonesian colonies!

    So, what can you do with a rebozo (or a scarf of shawl)?

    Pretty much all cultures on the planet, some kind of cloth is used to cradle and carry a baby. In some cultures is used to rock and soothe the baby too. Rocking is such a primal rhythm we all experienced it in our mother’s womb, that we find it soothing all through our lives. Ā Even in Europe there are pictures of women wearing their babies in Welsh shawls which dateĀ from the 1940s.

    Later, when the baby grew into a toddler and child, she would use the cloth to dress up, pretend play (including carrying toys and/or animals, pretending to carry a baby), make a den etc.

    As the child grew into a young woman she would use the cloth as a shawl to keep warm, as a clothing accessory, a blanket, to carry siblings ( in traditional cultures women learn baby care from a very young age as they tend to live with extended families), and to carry loads on her back or head.

    Later still when she became a woman, she might have been given her own shawl as part of a menarche ceremony. She might have worn a special cloth on her wedding day.

    When she became pregnant, she would have used the shawl to support her belly, and her midwives would have used it to alleviate the aches and pains of pregnancy, and maybe to help the baby move into the best position for birth.

    During labour she would have used the shawl to hang from, to pull on, and her birth attendants would have used it to provide comfort measures, such as sifting, rocking, shaking, and wrapping.

    After the birth she would have had a “baby moon”. Again this is something pretty much universal in the world-women the world around have been alleviated from household tasks and cared for by family members for the first 30 to 40 days postpartum. During this time they would rest so they could recover from growing and birthing their baby and get to know their baby and learn to care for them. Her birth attendants and the community of women would have come to feed her nourishing food, and help her body heal from the pregnancy and birth by using Ā a combination of their hands, massage techniques and using the cloth to help move and bind her hips and abdomen to help them back into place. In the West we used to have this practise called “churching” whereby the new mother was expected to rest for a month before rejoining the community and be welcome back during a special blessing at the church (you can read about it here). The research I have done for my upcoming book “Why postnatal recovery matters” has also shown me that the rest AND the binding still used to be part of the UK culture, less than 70 years ago.

    She then would have start to use the cloth to carry her baby and start the cycle all over again.

    Later as she grew old, her family members would have used the cloth to rock and soothe aches and pain.

    Women would have been buried with their shawl using it as a shroud.

    So you see, a traditional cloth, rebozo, shawl or cloth can be used to support a woman throughout her whole life. It is a universal phenomenon on our planet.

    As the shawl came out of fashion and modern practises like using pushchairs became seen as more fashionable and desirable, this skill was soon lost, and because like most traditional women-only practises, it was just passed on orally rather than written about, the knowledge was lost very quickly, in one or two generations. We also tend to embrace “modern” practises mindlessly, seeing traditional ones as backwards and old fashioned.

    Mexican and Chinese friends tell me that nobody wants to use the traditional shawl or carrier these days as only remote farmers or beggars still use them.

    This is Ā something that we need to reclaim and teach all women, as it is part of the essence of women circles and supporting women through life transitions.

    This is why I am so passionate about passing this skills to both expectant and new mothers, and to anybody who works with expectant and new mothers. It is our birthright!

    You can learn more about the Rebozo and its many wonderful uses to support pregnancy, birth and the postpartum in my online rebozo course.

    (This is an updateĀ  from a blog I published originally in 2018)

    If you have found this blog helpful and would like to support my work and help me continue provide valuable free information to birthworkers and expectant and newborn families, you can donate to my paypal account paypal.me/SophieMessager.

  • Online services-why should you pay for them?

    Online services-why should you pay for them?

    It’s a very strange and stressful time we are living right now, especially if you are pregnant.

    There is, understandably, a lot of anxiety about the unpredictable and fast changing nature of maternity services.

    I am seeing a lot of comments on social media about people wanting free antenatal classes (because their hospital ones got cancelled), and also questioning why people should still charge for online work, as well as accusing people who charge for online services of taking advantage of vulnerable people

    So I wrote this blog to explain, and debunk myths.

    I have written in the past about why doulas charge for what they do , and also the amazing lengths they go through to help their clients . The same rules apply here.

    Those “free” NHS classes were not actually free. The people delivering those classes were paid to teach them. Whilst the NHS is free at the point of contact, it isn’t “free” (because you pay for it with your taxes) and the people who staff it aren’t volunteers.

    Whilst I understand that many people might be struggling financially, many are also still employed and earning a salary, or at least 80% of it.

    Most of the people who provide perinatal education and support are self employed and run micro-businesses. I’m talking about doulas, independent midwifes, antenatal teachers, antenatal and postnatal exercise instructors, manual therapists etc. These people are it, i.e. their whole business is composed of one person. If they do not teach or do what they normally provide paid services for face to face, they don’t earn any money.Ā  Zip, nada. Right now, most of them are also trying to juggle doing this whilst having kids at home full time.

    I am one of those people. My income has almost entirely disappeared. I still feel grateful, because my husband is working part time in an employed position and working from home. Still, this crisis means that my little, successful-ish, micro business, which took me 7 years to build up, has been reduced to nearly nothing. But at least I know I don’t have to worry about having food on the table. Many of my birthworker and perinatal educator friends aren’t so lucky, because they are single mothers, or their partner also runs a self employed micro business.

    Yet I am also seeing that most of these people (myself included) are still giving a lot of their time for free right now, running free Facebook groups forĀ  pregnant women (believe me these are busy right now), answering worried messages, speaking to anxious women on the phone, running free zoom drop ins etc .

    It is the same as in real life: people should run free/charity stuff if they can and want to, but it shouldn’t be a obligatory or expected thing. If people cannot earn a living, they simply will not be able to carrying providing these services.

    So why should you pay for antenatal education, birth support, or postnatal education/support, if it’s moved online? For the same reason as when would when you pay for support : you pay for the time and money the person supporting you has spent training, the time they have spent prepping the class or one to one, and the years of knowledge and expertise they have built.

    Right now the people delivering these online classes are spending a lot of time thinking and prepping for these to make sure they work online (because making it work online isn’t the same as making it work IRL).

    They are also spending a lot of time self teaching themselves how to use online delivery systems they had never used before (like Zoom), without any support through it.

    Many are also spending money buying extra equipment (like video cameras and microphones or even laptop computers etc) to allow them to run their online services.

    They are all having to manage this whilst having to deal with their own anxieties about the unusual situation we are all in, their own families’ needs, and worrying about their client’s well being.

    I’m an experienced doula, and since I have been working in the birth and postnatal education for ten years, I feel confident and competent in delivering this to families. Yet, at the moment providing Skype or Zoom support to my clients is taking A LOT more time than when I’m doing it face to face.

    This is because when I’m face to face I no longer need to prepare much ahead. I have enough knowledge to deliver at the drop of a hat, I have a small bag of props than I can use to deliver almost every aspect of birth and postnatal education, and I can react to my clients feelings and adapt accordingly.

    This isn’t the case with the Skype or the Zoom stuff, because not only do I have to think and prep in advance how to deliver stuff that is easy face to face but much more complex online (for example teaching someone how to use a sling), but I also have to constantly keep up with the forever changing medical guidelines (the Royal College of Obstetrician has published 8 updates to their guidelines since they published the first one on the 9th of March, that’s 2 to 3 updates a week!). I am also having to keep up with local trust changing guidelines, as well as rake my brain to think about how my clients can support themselves after the birth in the hospital when I know I won’t be able to be there with them physically. Believe me this takes a lot of head space.

    I am not complaining, mind you, because I love learning new skills and this sure is keeping my brain on its toes!

    But if I wanted to be totally fair, I should actually be charging MORE money for all of my time, to reflect all the extra time spent preparing. Instead because most of us want to support women regardless of their circumstances, many of us are offering discounts, payment plans, pay what you can, or indeed free services.

    I am worried that some of these valuable micro businesses, run by passionate people who do it because they care rather than wanting to make a quick buck, will simply disappear.

    Yes, many celebrities are offering free online classes, but these celebrities are likely to have plenty of money. They are also likely to receive revenue through advertisement, so, again, these free classes may not be actually “free”. Whilst their offer is laudable, is it also sadly contributing to the idea that all online stuff should be free. You simply cannot extrapolate what celebrities are doing to micro businesses which are only known to their local community.

    Another thing I have seen is that people say you don’t need the paid services, because you can teach yourself, with these free/cheap resources. Whilst this is true : you can indeed learn from a book, free courses etc, this isn’t the same as getting into a live course or one to one work with an expert in the field. The main ways you can educate yourself about anything fall into 3 categories: DIY, group courses, and one to one tuition. Each one of them has pros and cons, but it isn’t necessarily fair to compare the DIY approach to what you’ll get if you hire someone to work with you one to one. I have explained the pros and cons of this in a previous blog called three ways to educate yourself about birth.

    So if you still have a salary, please consider paying for support rather than just doing free classes. If you are doing free classes with a micro business person and enjoying it, consider giving them a donation, or hiring them for their paid services.

    I promise you that you will still get value for money and incredible support. You will also contribute to keeping someone’s only way of earning a living afloat. And if you worry that online support doesn’t work, I have addressed it in this blog (along with plenty of free classes links). My blog is also full of free recently added resources for pregnancy birth and beyond, including a recent post on how to have a positive birth in unpredictable times.

    I wrote this blog to explain, and debunk the myth, please feel free to share it widely.

    If you have found this blog helpful and would like to support my work and help me continue provide valuable free information to birthworkers and expectant and newborn families, you can donate to my paypal account paypal.me/SophieMessager.

  • How to have a positive birth in unpredictable times

    How to have a positive birth in unpredictable times

    I am writing this because I know that if you are pregnant right now, the lack of information combined with the unpredictability what maternity care might look like when you give birth might be making you anxious.

    I am seeing a lot of worried pregnant women and new mothers asking worried questions on social media at the moment.

    So I am going to try and give you some ways to prepare.

    I have already collated all the information produced by the royal college of obstetricians in this blog.

    Here is a summary of what restrictions are in place right now (I will aim to update it as it changes):

    • No partners or visitors are allowed to accompany women at antenatal appointments (such as blood tests, scans etc).
    • No partners or visitors in antenatal or postnatal wards.
    • Only one partner during labour. This only includes established labour, so if you start labour at home you’ll be able to go with your birth partner of choice to the hospital (as long as you are both symptom free), if your labour is induced, because this is taking place in the antenatal ward, your partner will only be able to join you once you are in established labour and you transfer to the labour ward.
    • Your birth partner can only accompany you if they are well, i.e. free of COVID-19 symptoms (so it might be a good idea to plan for a backup person if you can).
    • Several trusts have suspended homebirth services due to ambulance services being stretches.
    • Because staffing levels are stretched, some trusts have also closed their birth centres.

    Because of the above, it is likely that the only option available for the majority of mothers will be giving birth inside an obstetric unit, or to give birth at home unassisted (something known as freebirth-which is legal in the UK- see Birthright’s fact sheet on unassisted birth , and AIMS’s articles. If this is something you are considering, educating yourself deeply on the topic is paramount).

    I’m aware that this may feel like a rock and hard place situation for many women.

    Whilst I am seeing a lot of anxious mothers on social media groups, I am also reading a lot of positive birth stories, with women relating stories of incredibly supportive midwifes in the face of stretches circumstances, as well as being apologetic about the current restrictions.

    As someone who has been supporting pregnant, birthing and new families for over 10 years, I am accustomed to the fact that birth in unpredictable, and that what makes a good birth experience isn’t what the birth looks like on paper, but rather how the parents were made to feel during the birth.

    I encourage all the families I support antenatally to write 3 birth plans: Plan A which is your ideal scenario, plan B for curve balls such as when induction of labour is needed, and plan C for a caesarean. I wrote a blog about this here .

    I have supported plenty of women who told me that they didn’t like the idea of writing a caesarean birth plan just in case, but that when it came to it made all the difference because it meant they still got some aspects of what was important to them (such as skin to skin in theatre). The situation we are facing now is similar.

    I also encourage women to think about what is really important to them, i.e. I know that there will be plenty of things in their birth plans that they aren’t particularly bothered about, but to highlight in bold or red the stuff that really matters.

    This doesn’t mean that losing your preferred birth options doesn’t matter. It does, and so does grieving the loss of said options. Your feelings matter, and I know this is a very unusual and stressful time.

    Just like I encourage expectant parents to cover all possible scenarios ahead of the birth (because deciding whether you are happy for a major medical intervention to happen during birth is easier to ponder whilst you aren’t in the middle of labour), I know that by getting prepared as much as you can for all possible scenarios, you are more likely to have a positive experience, and to have put things in place that will allow you to retain some elements of control and decision making, regardless of how your birth circumstances unfold.

    Since it is likely you might give birth in an hospital labour ward/obstetric unit, think about how you can make the space as private and homely as possible.

    Here are some example of things you could bring to make the room as cosy as possible:

    • Dim the Lights/use fairy lights/LED candles. A great tip to darken a room without curtains is to bring a couple of rolls of foil: moisten the widows and you can stick the foil to them, making instant black out (make sure to have a torch in case staff doesn’t have one). Another option is to use a sleep mask.
    • Bring some pillows from home/some blankets (they’ll smell like home and be softer/nicer than hospital ones)
    • Bring something nice to smell, such as pregnancy safe essential oils, which you can put on a tissue.
    • Your own music/noise cancelling headphones, some people like to make a playlist.
    • Create a playlist of your favourite music, whether itā€™s calm or upbeat. Music can help reduce stress and the perception of pain during labour. Start working on that playlist while you are in birth preparations by finding what genres or artists are soothing/relaxing to you. Listen to those tracks or stations throughout your pregnancy; itā€™ll be familiar during labour and help promote relaxation.
    • Some pictures. I’ve seen couples putting up pictures and/or affirmations on the wall. Some included pictures of the scan, pictures of a favourite holiday place etc. You could make a collage to take with you and blue tack on the wall.
    • Move the furniture around! Here is a video showing how you can move things around inside a typical labour ward room and make use of the furniture to have an active birth

    What if your labour is being induced:

    • First know your rights and options, and that being induced for “postdates” can be a bit of a grey area. I wrote a blog about this here .
    • All of the above, plus stuff to keep you entertained, like books and downloaded movies. Induction can take some time (sometimes several days) especially for first time mothers. Since you will be on your own in a ward, with several other women in the same bay, privacy can be an issue, so sleep mask, earplugs and noise cancelling headphones can be really helpful.

    Regardless of how and where you hope/plan to give birth:

    • Write a multipart birth plan, the process of finding out about options is as important as ever. Remember that nothing should be done to you without your full and explicit consent, even simple medical procedures such as vaginal examinations.
    • The positive birth book has a great set of free icons to download if you’d like to make a visual birth plan-they are also great as a prompt if you aren’t sure about what topics to cover
    • Use the BRAINĀ  (Benefits, Risks, Alternatives, Instinct, Nothing) acronym to help you through decision making and asking the right questions.
    • In your birth plan, you might want to start with a paragraph introducing yourself to your caregivers, highlighting any really important aspects. The quicker they can get to know you and what you prefer, the easiest it will be for them to establish rapport and support you as best they can.
    • Practise ahead of time techniques to help you stay as relaxed as possible, such as meditation, breathing and relaxation techniques, or movement.
    • Consider hiring a doula. Whilst it’s unlikely a doula will be able to come with you due to the one partner only rule, most now offer remote services. Not only your doula will be invaluable in helping you prepare, she will provide a much needed friendly voice at the end of the phone or video call. I know it sounds odd that we can provide help remotely, but I have personally supported several couples through birth over the phone and I know how much of a difference it can make.

    Ultimately whilst we can control certain things, I think what this extremely unusual circumstances have shown us is the we have the illusion of control of scenarios, when really we don’t have control over it.

    I will leave you with this quote from Sara Wickham:

    “I am so heartened to hear about the generous and creative ways in which many people have responded to this crisis. I’m taking two thoughts into the weekend with me. The first is that there are still plenty of things that are within our control. And the second is that creativity and connection are key to getting us through this.”

    If you have found this blog helpful and would like to support my work and help me continue provide valuable free information to birthworkers and expectant and newborn families, you can donate to my paypal account paypal.me/SophieMessager.

  • Rebozo techniques for relaxation during uncertain times

    Rebozo techniques for relaxation during uncertain times

    I’m seeing a lot of understandably anxious pregnant women since the beginning of the Covid-19 crisis. What will happen to my appointments and when I go into labour? Will I have to give birth alone? What will happen after the birth?

    I’ve tried to address as many of these questions in this blog about pregnancy and the pandemic, this one about postnatal recovery, and this one about online support.

    But I’d also like to offer a simple practical way to relax that you may not know about.

    A rebozo is a traditional Mexican shawl, which, besides being used as an item of clothing, is use to provide great comfort by rocking, jiggling and wrapping a woman’s body, especially during pregnancy, birth and the postpartum.

    I’ve been using rebozos for 7 years, as well as teaching the techniques to parents and birthworkers.

    I have had so many mind blowing experience using rebozos shawls and scarves in my work to support women through pregnancy, birth, the postpartum and beyond, Iā€™m on a mission to pass on this skill to ask many people as possible.

    What the rebozo does, by gently rocking and wrapping you, is calm you right down and bring you back to you body.

    As a species we exist in two extreme opposite states: the fight or flight, and the rest and relaxation stage.

    Right now, understandably, many of you are stuck in the fight or flight state. It’s made worse by the fact that you literally cannot “flight” because we are all stuck at home.

    The simple techniques I describe in this blog are incredibly effective, yet super simple to do, and anybody can do them. You don’t even need a rebozo to do them, something simple like a scarf or a pashmina will do.

    Here are 3 simple relaxation techniques you can use during pregnancy, birth, and the postpartum period (or at any other time! These aren’t limited to pregnancy-anybody regardless of gender or age can benefit from their relaxing effect).

    Self-care technique

    • A quick 5 min “reboot” to get you out of your head and into a more relaxed state
    • This is an easy routine to warm and loosen your muscles. It is especially helpful if your energy could do with a boost or if you feel stiff from having sat down for too long (especially after working at a computer), or if you feel anxious or stressed. The technique starts with some shoulder stretches, followed by a shoulder, back and buttocks rub, and finishes with a foot rub. After doing this quick and easy routine you may find that you feel happier, warmer, more relaxed, and more energised šŸ™‚

    Play

    Wrapping the shoulders

    • Wrap the rebozo or scarf around the shoulders, cross the ends, then gently tighten and hold. This can be done standing up, sitting down, or lying down. It is a very calming and grounding technique, because the gentle tightening around the ribcage encourages you to breathe deeper into your belly.

    Play

     

    Rocking the pelvis

    • This consists in wrapping the rebozo or scarf around the pelvis, then Ā gently rocking the pelvis. This can also be done with the woman resting her back or arms against a wall for support, as well as lying down on the floor, or sitting on a couch.

    Play

    This is a taster version of the full version of my self-study rebozo ebook, or in my rebozo online course. If you would like to buy a rebozo, I have them in my online shop.

    If you have found this blog helpful and would like to support my work and help me continue provide valuable free information to birthworkers and expectant and newborn families, you can donate to my paypal account paypal.me/SophieMessager.

  • Online learning and support for pregnancy, birth and beyond-how does it work?

    Online learning and support for pregnancy, birth and beyond-how does it work?

    Online learning and support for pregnancy, birth and beyond-how does it work?

    As we navigate the unexpected and unstable changes happening in our world right now, a lot of peoples are moving from offering them face to face to online.

    Some of these things that may feel normal and already be part of your life for example you might already be doing some exercise using online programmes or youtube videos.

    They are things that you may never have experienced online and cannot quite get how they are going to work.

    I get that.

    Years ago I was made redundant from a biotech company I worked for. As part of my redundancy I got a package to support me in finding another job. I choose to hire Suzanne Doyle Morris, a female coach I had met through a women in science network I belonged to, and who specialised in supporting women in male dominated fields. I was unpleasantly surprised when she explained that we would be working over the phone, because I didn’t believe it would work as well as face to face. Boy was I wrong! The sessions with Suzanne were extremely powerful and helped me not only see what I wanted to do, but also helped me shift out of the frozen feeling I had, and develop a way of being that had positive impact way beyond the job finding process.

    Fast forward to today-I can imagine if you were looking forward to face to face group classes such as antenatal classes, or had hired a doula, how too may believe that it is not going to work and that there is no point in continuing.

    I get it. I am having doubts too.

    On a normal week I sing in a choir, and I go to a 5rhythms dancing group. These are moving online and I haven’t experienced them yet so I’m feeling a mix doubtfulness but also some of curiosity about how they are going to work online. I have already heard really positive stories from people who have taken part in such groups.

    What I am also seeing however is that pregnant women are really worried about what is going to happen when they give birth, and that the support is needed more than ever.

    As a doula I am used to support people with a mix of face to face and remotely via email, texts, whatsApp and phone calls. I have even supported people through several births over the phone.

    What I can tell you is this: whilst some things cannot be done remotely (such as massage), and face to face support offers something unique, many aspect of support can be provided remotely (for example, I am able to teach techniques to help turn a breech baby or carry a baby in a sling, online), , remote support is still extremely helpful.

    At a time of uncertainly, when things are changing daily, having someone who understands and knows the system, can find information for you, and simply be a listening ear and help you navigate your worries and concerns is invaluable.

    So if you are pregnant or a new mother right, and you are worried or scared, please consider hiring someone who can support you through it.

    Here is a list of people and organisations that can offer remote support:

    One advantage is that you are no longer constrained by distance, so you can lookup antenatal and postnatal classes nationally and pick the ones that suit you best.

    Here is a list of organisations you can get support from:

    Find a doula at Doula UK, the non profit associations for doulas in the UK. Having a doula will help you navigate your birth and postnatal options whilst things change in the maternity services right now, and also guarantee that you have someone to talk to when you need to. I have blogged several times about what doulas do, both to support birth and the postnatal period, feel free to scroll through my previous blog posts to read these.

    Independent midwives

    Antenatal and postnatal education

    Babywearing support:

    Pregnancy/postnatal exercise classes

    Mental health

    Free meditations/relaxation tracks/relaxation techniques

    Mental health professionas/organisations

    • ZoĆ« Tolman Ā counsellor & psychotherapist specialising in perinatal mental health.
    • Alex Kremer fertility support, birth trauma, hypnobirthing and parenting support.
    • Traumatic birth recovery : practitioners trained in a fast birth trauma release technique called the Rewind technique
    • Make birth better: A collective of parents and professionals working together to end suffering from birth trauma.
    • Mind is a mental health charity, they have a section on postnatal depression
    • Mia Scotland is a perinatal psychologist
    • Saveria EFT birth trauma and birth anxiety sessions
    • Spiritual Health Programme (free)
    • Jo Rogers doula and spiritual companion
    • The Pandas foundation for perinatal mental health
    • SHaRON is a peer support based ehealth system, available via a mobile phone app and associated website.

    Breastfeeding support organisations

    So you see there are a lot of options available, from one to one to group classes, to charities. Do give a try to at least some of the free resources, you might be surprised by how helpful you find them!

  • Pregnancy, birth and the postnatal period during the pandemic -what do you need to know?

    Pregnancy, birth and the postnatal period during the pandemic -what do you need to know?

    Updated 24/03/20 in line with new RCOG guidelines

    If you are pregnant right now, I can imagine that the unpredictability of the pandemic situation might make you feel anxious.

    I am writing this to try and help allay fears, as well as suggest of list of ways you can get support for yourself.

    We haven’t got a lot of data as Covid-19 is a new virus, which was identified for the first time in China in November 2019. We’re mid March 2020 as I write this which means that we only have about 4 month’s worth of data. But there is some data, and it has been evaluated thoroughly to issue guidelines. These guidelines are likely to change as we get more data.

    You might be worried about the recent government report on the news saying that all pregnant women need to self-isolate. I’d like to reassure you that this was just a precaution blanket statement, in fact the Royal College of Obstetricians and Gynaecologists (RCOG), the Royal College of Midwives and the Royal College of Paediatrics and Child Health issued a joint statement to reassure women after the government announced these measures:

    ā€œWe welcome this precautionary approach as COVID-19 is a new virus, but would like to reassure pregnant women that, as things stand, no new evidence has come to light suggesting they are at higher risk of becoming seriously unwell compared with other healthy individuals. Research and data are key to monitoring the ongoing situation and the UK Obstetric Surveillance System ā€“ UKOSS ā€“ will monitor all cases of pregnant women who have a diagnosis of coronavirus.”

    You can find the RCOG new updates here , and there is also a Q&A for pregnant women and their families here

    The RCOG guidanceĀ  (published 21st March) states that:

    • Pregnant women do not appear more likely to contract the infection than the general population.Ā 
    • There is also no evidence that the virus can pass to your baby while you are pregnant or during birth.
    • As a precautionary approach, pregnant women with suspected or confirmed coronavirus when they go into labour are being advised to attend an obstetric unit for birth but their birth plan should be followed as closely as possible.
    • At the moment there is no evidence that the virus can be carried in breastmilk, so it is felt the benefits of breastfeeding outweigh any potential risks of transmission of coronavirus through breastmilk.

    The RCOG has also published a Q&A section for pregnant women and their families.

    Two papers (Chen et al; Zhu et al)and have been published from retrospectively studying 2 sets of 9 and 10 women in China who tested positive for Covid-19 in pregnancy. The authors found no evidence of the virus being transmitted to the baby during pregnancy, found no trace of the virus in amniotic fluid, cord blood, placenta, and also importantly none in breastmilk, which is very reassuring.

    There has been however, a couple of cases reported of babies born from COVID-19 positive mothers who tested positive for the virus soon after birth. We do not yet know whether transmission occurred during the pregnancy or after the birth.

    In the RCOG guidance to pregnant women, it is suggested all women positive for COVID should be admitted to an obstetric unit rather than giving birth at home or in a birth centre, so that their baby’s heart rate could be monitored continuously during labour.

    “If birth at home or in a midwifery-led unit is planned, a discussion should be initiated with the woman regarding the potentially increased risk of fetal compromise in women infected with COVID-19 (as was noted in the Chinese case series of nine women). The woman should be advised to attend an obstetric unit for birth, where the baby can be monitored using continuous electronic fetal monitoring.”

    The guideline is based on the fact that two Chinese publications showed some level of fetal distress in women who were positive for the virus. However, when you review the evidence on this, this suggestion is open to interpretation. Obstetrician Dr Kirsten Small’s blog explains that the evidence is based on the only 2 papers published so far (papers about pregnant women positive for COVID-19 who gave birth in China):

    The first paper (Chen, et al., 2020) included 9 women, 8 of whom had viral pneumonia, and the remaining woman had fever and a cough, having experienced prelabour membrane rupture at 36 weeks of gestation. The abstract stated that ā€œfetal distress was monitored in two casesā€ but provided no further information about how this was determined. All infants had normal Apgar scores.

    It is difficult to ascertain whether the 10 women whose outcomes were reported in the second paper (Zhu, et al., 2020) include some of the women reported in the previous paper. All ten women were symptomatic with signs of viral pneumonia. The findings stated that six fetuses exhibited ā€œintra-uterine distressā€ without expanding on how this was determined. Two women out of the ten had vaginal births, with both these fetuses being classified as having ā€œdistressā€. All infants had normal Apgar scores.

    The small number of women (19) used to generate a recommendation which might be carried out on thousands of women worldwide is concerning. The Cochrane review on CTG monitoring included over 37,000 women and it is often argued that the research still has not included enough women to generate reliable answers. These papers do not offer any useful information about the risk of intrapartum fetal hypoxia in women who have tested positive, but who have no, or mild symptoms secondary to CoVid19, as all the women in the papers were hospitalised with significant symptoms. Therefore using these findings as the basis of a recommendation for CTG monitoring is not consistent with how evidence-based care is conducted.

    Dr Small goes on to explain the pros and cons of continuous fetal monitoring, which is something that is known to increase obstetrics interventions such as cesarean. To date, continous fetal monitoring has not been shown to improve outcomes for babies. Dr Sara Wickham has written several blogs reviewing the evidence for CTG monitoring.

    How to protect yourself

    The WHO has issued a set of guidelines for the public, which includes basis protective measures.

    Be especially mindful to wash your hands after you touch objects such as door handles or petrol station’s pump handles etc.

    What are your rights regarding maternity care?

    The charity birthrights has published a useful guidance on your rights to maternity care during the pandemic. You still have the same rights to maternity care during the pandemic, however availability of services (for example homebirth or birth centre availability) might change as the level of available staff.

    Labour and birth

    This is my local trust’s guidelines. Check your local trust, as Ā it is possible that there may be slight differences from one trust to another (I have seen divergence in the number of birth partners allowed, ie some hospitals still say two, some only one), in doubt call the hospital to ask what the current rules are (as they are likely to change)

    Guidance for women during labour:

    • If you are in early labour you should call the maternity unit for advice.
    • If your intended birth partner has symptoms, or has been in contact with a confirmed case, they will not be able to visit in any area of the maternity unit.
    • If you have mild coronavirus/ COVID-19 symptoms you should remain at home in early labour as per standard practice but call the maternity unit first for advice.
    • You should come to the hospital in private transport (your own car or someone else giving you a lift) where possible or call 111/999 for advice as appropriate. If an ambulance is required, the call handler should be informed that you are currently in self-isolation for possible coronavirus/COVID-19.
    • You should alert a member of maternity staff that you have arrived at the hospital, remain in your car and phone the labour ward for instructions before you enter the hospital. You can do this by phoning the labour ward.

    Guidance for women who are pregnant for antenatal appointments:

    • If you have no symptoms of coronavirus please attend your antenatal appointments as usual unless you are contacted directly by your community midwife.
    • Please contact your community midwives directly for all queries regarding appointments and where they are taking place as circumstances will be changing daily
    • Please note that GP surgeries and Childrenā€™s Centres are likely to be reviewing access to them over the coming weeks and months so location of appointments may change over this period
    • Please note If your partner has symptoms they should self-isolate and not attend any appointments/visitsĀ  with you.

    One thing you may want to think about ahead of time would be to have a backup birth partner in case your partner develops symptoms.

    The RCOG guideline also says that if you have suspected or confirmed COVID-19 you will not be able to use a birthing pool.

    Bliss, the charity for premature and sick babies, has published guidance on neonatal care and COVID-19Ā 

    Where to get information and support?

    NHS If you have any concerns (Covid or otherwise) about your health during pregnancy, your midwife and your GP should be your first port of call. As I write this as far as I’m aware pregnant women are still receiving normal antenatal care from midwifes. The majority of GP surgeries have switched to screening people via phone appointments. My understanding at the moment is that pregnant women who have symptoms are being told to self isolate. It can take some time to get through the phone to your doctor, or to get through 111 for advice but you should still get support.

    If you are (understandably) worried or concerned, consider enlisting the support of people who are used to supporting pregnant women navigate the maternity services, such as antenatal teachers and doulas.

    Many antenatal educators and birth professionals have moved to offering their services online. All around the UK, doulas, antenatal teachers, pregnancy and postnatal exercise classes (yoga, pilates, babywearing exercises classes etc), are offering online instead of face to face support.

    One major advantage is that you are no longer constrained by distance, so you can lookup antenatal and postnatal classes nationally and pick the ones that suit you best.

    Here is a list of organisations you can get support from:

    Find a doula at Doula UK, the non profit associations for doulas in the UK. Having a doula will help you navigate your birth and postnatal options whilst things change in the maternity services right now, and also guarantee that you have someone to talk to when you need to. I have blogged several times about what doulas do, both to support birth and the postnatal period, feel free to scroll through my previous blog posts to read these.

    Independent midwives

    Antenatal and postnatal support and education

    • The positive birth movementĀ  is a network of pregnancy and birth support groups, linked up by social media, therefore a way to connect with other mums during pregnancy
    • Find someone to help you carry your baby in a sling at Slingpages .
    • The NCT charity runs antenatal and postnatal classes
    • The motherside provides a support networks and a g global community and support network for all mums and mums-to-be
    • Calmfamily is an education CIC that provides consultations and classes to educate and support parents
    • The daisy foundation offer antenatal and postnatal classes
    • Netmums
    • Gingerbread is a charity that support single parent families

    Mental health support

    • Traumatic birth recovery offers a listing of practitioners trained in a fast birth trauma release technique called the Rewind technique
    • Make birth better is a collective of parents and professionals working together to end suffering from birth trauma.
    • Mind is a mental health charity, they have a section on postnatal depression
    • Mia Scotland is a perinatal psychologist
    • The Pandas foundation for perinatal mental health
    • SHaRON is a peer support based ehealth system, available via a mobile phone app and associated website.

    Breastfeeding support

    The current RCOG guidelines state that :

    ” It is reassuring that in six Chinese cases tested, breastmilk was negative for COVID-19;2 however, given the small number of cases, this evidence should be interpreted with caution. The main risk for infants of breastfeeding is the close contact with the mother, who is likely to share infective airborne droplets. In the light of the current evidence, we advise that the benefits of breastfeeding outweigh any potential risks of transmission of the virus through breastmilk. The risks and benefits of breastfeeding, including the risk of holding the baby in close proximity to the mother, should be discussed with her.”

    This is a welcome recommendation. Despite this, it is possible that if a COVID-19 positive mother might be encouraged to be separated from her baby and formula feed. This needs to be balanced against the possible distress for both mother and baby, and the fact that breastmilk has antiviral properties, and that it allows the transfer of antibodies to the baby, as well as supporting the development of the immune system (Prameela 2011, Newman 2018).

    The Unicef baby friendly initiative also states that:

    “There is a wealth of evidence that breastfeeding reduces the risk of babies developing infectious diseases. There are numerous live constituents in human milk, including immunoglobulins, antiviral factors, cytokines and leucocytes, that help to destroy harmful pathogens and boost the babyā€™s immune system. Considering the protection that human milk and breastfeeding offers the baby and the minimal role it plays in the transmission of other respiratory viruses, it seems sensible to do all we can to continue to promote, protect and support breastfeedingā€

    La Leche League has published some guidance on breastfeeding during the pandemic and so has Baby milk action.

    Should you require breastfeeding support, it is now possible to access the support from breastfeeding clinics, breastfeeding counsellors and lactation consultants online.

    The list of organisations include

     

    I will aim to regularly update this blog as new information becomes available

  • The incredible things doulas do to support their clients

    The incredible things doulas do to support their clients

    A criticism that is commonly heard in the doula world is that doulas are expensive.

    In the UK, healthcare is free at the point of contact. This can lead some people to believe that they shouldn’t pay for services when it comes to supporting people around anything linked to health and well-being.

    Last week, I was saddened to hear that a friend who runs a pregnancy and new mothers centre, complete with free drop-in groups for new mums, was questioned not too kindly by medical professionals who accused her of preying on vulnerable women. They said that support should be free.

    This is a commonly held view sadly. I gave a talk about doulas to a group of student midwifes, and this was brought up too.

    I agree that, in an ideal world, support should be available for free to all that need it. But, interestingly, people who mention this seem to be unable to realise that they, themselves, aren’t working for free, and that the NHS isn’t free, it is paid for by our taxes.

    I am yet to meet a doula who does this for the sole goal of making money. As I’ve written about before, when we break it down, most of us earn an hourly rate that is way below the minimum wage.

    Recently, I spoke to a doula who was waiting for a client to birth, way beyond her due date, and was facing the quandary of cancelling important plans, because she wants to be available for her client’s birth. This reminded me that, through the years, I’ve heard incredible stories about the lengths doulas go through, not just to be available to their clients for a whole month or more, being available at the drop of a hat, juggling incredibly complex childcare arrangements etc.  The things that doulas do in the background, rearranging really important personal stuff, unbeknown to their clients, so that they can be available for the birth, are usually only known to those who belong in the doula world.

    I want to clarify that I am not sharing these stories to make clients feel guilty or that we resent the commitments.

    Being a doula is a calling, and whilst we find this job demanding at times, it’s worth it otherwise we wouldn’t keep doing it!

    Doulas tend to keep these stories secrets in order to avoid burdening their clients, hence they don’t usually get shared from outside the doula community.

    I hope that these stories will help demonstrate the incredible level of dedication that doulas show for their clients.

    A couple of my own stories that stick out include attending a 4 day long birth. My husband’s birthday was in the middle of these 4 days, so not only I wasn’t there but he was alone with the kids for that time.

    Another time, my family and I were all packed and ready to go away for the week end. My husband is from Hong Kong and this was Chinese new year and we were due to visit his family. This is like missing Christmas. I had a client expecting twins, someone who I had already supported through the birth of her first child. She was 32 weeks pregnant. As I was walking over to our neighbours to let them know we were going to go away, the phone rang, and my client told me that they were taking her to theatre, right now! I walked back inside my house, my husband saw my face and asked me what had happened. I told him, and he said to just go to be with her and that we could go join his family the next day. I made it to my client with 10 min to spare prior to her transfer to theatre. When I returned a few hours later, overcome with gratitude, I asked my husband why he’d agreed to change our plans, he said “I could see how torn you were”.

    My client wrote me this testimonial:

    My twins were born 8 weeks early so had to go straight to NICU. I wanted my partner to go with them as I didnā€™t want them to be alone and also to make sure our wishes for them where kept. I also didnā€™t want to be left alone in the theatre so asked for my doula to be around in when my partner left. This really helped me to stay calm as I knew my babies had dad with them and I also had someone to support me as it can be very lonely even in a theatre full of doctors and nurses. Having someone to talk to and hold my hand stopped me panicking. It also meant that when I was taken to recovery I wasnā€™t by myself. It was very hard being wheeled past other mothers with their babies, I donā€™t think I would of have coped if I didnā€™t have my doula with me. She also helped me hand express my colostrum into syringes. Just having someone with my while my partner was with the babies was amazing, she kept me calm just by being by my side and holding my hand.”

    Here is a collection of stories from doulas about the amazing things they’ve have done and sacrificed in order to be there for their clients :

    I shadow doulaed for a client, I finished 9hrs in my day job, picked my girls up from childcare and got home for 1730, got the call my client was in labour at 2000 so raced over to her, stayed all night until 0530 the next morning, popped home to take the girls to childcare and then back to another 9hr shift at my day job! I worked out I went without sleep for 40hrs! But I love what I do. It is annoying when people say I charge too much but when you workout out how long you’re on call for, the extra childcare, travelling and everything else I come out the other side with very little. Working in the birthing world is definitely a ‘labour’ of love! Rachael Ruddock

    Iā€™ve worked 3 days straight with one hours sleep. I finally got home at midnight on Christmas Eve. I then had to wrap all the gifts for my 5 and 3 year old. I also missed all the festivities leading up to Christmas including the show we had tickets for. I do still love my job. Melanie Butcher

    I had to sleep in the car off a lay-by on the A1 once at 4am as I wasn’t safe to drive, I have to travel long distances as I’m rural. I keep a blanket and pillow in the car. I have slept in hospital car parks too in the middle of the night, so safety an issue. I’ve had to leave cinema showings with my kids, give up work commitments, like cancelling clinic and moving classes. Sophie Fletcher

    Iā€™ve missed Christmas Day with my kids to be with a solo mama in labour, went early so she wasnā€™t alone – the kids still bring it up. Beccy Hands

    I’ve stayed awake for 70h. Hayet Hb

    I have missed my daughters 16th birthday party, my brother in laws 30th party and my uncle’s funeral. My auntie and cousins couldnā€™t understand how I could miss a funeral but this client had many baby loss experiences and I would rather sacrifice the funeral and have my family upset with me than let down a woman giving birth. Supporting Birth and the beginning of a family is more important to me than almost anything! Beverley Hinton

    I’ve missed invitations to weddings, christenings and birthday parties. I’ve said no to informal gatherings to see friends or have dinner with grandparents. I’ve missed education sessions for the kids. I’ve skipped dental appointments, hospital appointments and other personal appointments. I have stayed awake for over 60 hours. I have dumped the kids and ran on many occasion to disappear, sometimes for a day, sometimes for several. I have not eaten or drank water for long periods. I’ve not seen my own family who are in hospital. I’ve taken 3 days to recover from a long birth. Nikki Mather

    I have been on call over Christmas and my sons birthday. This shows my commitment and the willingness to miss these special events to support another family. Bev Samways

    Iā€™ve just had my first birth and missed 2 hospital appointments, my babyā€™s 2nd birthday party, hairdressers, I did nothing on my 40th birthday just in case I was called. My mother in law changed her holiday so that she could be on call for my childcare. Iā€™m also a pregnancy yoga teacher and had to cancel 2 classes to be with my clients, losing money for both.  I didnā€™t go to a college friends reunion. Kirstie Broughton

    When I go on call my life dynamics completely change. As I have small children I have to allocate time to drop them off safely to someone before I can head-out. So I go no further the 30min out of my house range. Have all bags packed and prepared. Miss play dates, days out, constantly being alert and it can be exhausting waiting for that call. When Iā€™m there Iā€™m 100% in and the outside world doesnā€™t exist. Iā€™m as involved as the couple need me to be. I have massaged a woman once for 6 hours because she wanted me to and there wasnā€™t a partner to take over. I missed my in laws 60th wedding anniversary, turned down invitations. Doulas sacrifice a lot on day to day basis but itā€™s so worth it seeing that mother being supported and getting the best start on her long journey through motherhood. Eva Kralova

    I once had my husband pick me and my friend up from the airport after a weekend away and drive me ( in the opposite direction) straight to the hospital so that I could meet my client who had gone there in labour. My friend had to just roll with it. My husband and children hadn’t seen me for 3 nights and we had no plan for how I’d get home after. But right then she needed me and I went. It’s what we do. Amber Strong

    For two of my son’s birthdays I wasn’t there to wake up with him- because i was with clients at their babies birthday. Bitter sweet. The first time my son was young, I was a single mum and the babysitter was there. He was very upset. I got home after 48hrs and drove him to go bowling with a couple of friends. Trying to keep the wheels on. 2nd time he was older and very gracious- when speaking to me on the phone he said “It’s ok mum – I can wait for my presents until you get home – it’s important you stay with your lady until her baby comes. Gosh I blubbed.  Katie Olliffe

    Iā€™ve missed Christmas Day, my middle sonā€™s birthday morning, my partnerā€™s birthday. I go home early from rare nights out, my social life has suffered. I seldom drink. My family have left on a holiday without me & I followed them the next day. My kids complain about my job & say itā€™s the ā€˜worst job in the worldā€™. I tell them the opposite is true! Roma Hearsey

    I just made it to my best friend and my cousinā€™s weddings – leaving the birth the morning of my best friendā€™s. I have been absent for entire weekends and was called to a birth on Christmas morning – and missed my kids opening their presents. Over January I attended 4 births despite going through one of the most stressful periods of my life (divorce). One of these births was 5 days long. Itā€™s hard to explain the impact this work can have on a person’s life. Laura Scarlett

    It also affects my husband’s work – he also works from home but in an employed capacity and occasionally needs to travel around the country – when I’m on call – he has to not travel. Melanie English

    I rushed across the country on New Year eve to get a super fast birth of the first baby in the county. Our job is multidimensional and money exchange really represent partial contribution towards its value. In the old days the village would support the wise women who helped at birth through barter of services and goods and we are just monetising the same principle. Vera Dubrovina

    Iā€™ve missed birthdays, anniversaries, parties. The one time I DID set a boundary around a planned event, having missed so much throughout one year- I wasnā€™t there for my clients birth. A back up was- but it felt really hard for me- difficult feelings I had to unpack. Tortie Rye

    I missed my daughterā€™s prom to rush to a client after our birth contract had finished to support with a serious health issue. Caroline Zwierzchowska-Dod

    I went directly from an early pregnancy scan where I was told my baby had died and took a cab directly to my labouring client to attend her birth. Lauren Mishcon

    I did a birth on my birthday once 20 hours, wet through from supporting the mama in a tiny en suite on the DU. She wasn’t even my client – I was a backup doula! Jo Rogers

    I missed my daughter’s birthday one year and another year was so tired after being awake for 38 hours I picked her up from school and fell asleep before she had finished opening her presents. Missed first three days of my summer holiday when my client went pass 43 weeks . Aimee Sri Laxmi Hamblyn

    These are all true stories. I hope this helps give a measure of how passionate we are about supporting our clients.