Author: Sophie Messager

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:

“We 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 – UKOSS – 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 guidance  (published 21st March) states that:

• Pregnant women do not appear more likely to contract the infection than the general population. 
• 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 “fetal distress was monitored in two cases” 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 “intra-uterine distress” without expanding on how this was determined. Two women out of the ten had vaginal births, with both these fetuses being classified as having “distress”. 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  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 Children’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/visits  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-19 

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

• Nationally: Independent midwifes UK
• Nationally:  Private midwives 
• London and Southampton : Neighbourhood midwives

Antenatal and postnatal support and education

• The positive birth movement  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 baby’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 breastfeeding”

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

• National Breastfeeding Helpline
• The Association of Breastfeeding Mothers (ABM)
• The Breastfeeding Network (BfN), which includes the Drugs in Breastmilk Information Service.
• La Leche League 
• NCT
• Lactation Consultants of Great Britain. The professional association for qualified lactation consultants. Members of the association provide advice, support and consultations on breastfeeding in the UK.

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

If you follow my blog you might have felt surprised that I haven’t posted anything since last July, when I typically wrote a monthly or twice monthly post before.

This is because, early in the summer, I experienced a personal and professional crisis of devastating proportions.

A midwife made a complaint against me, a handful of people from my local doula collective made the decision to suspend me, removing me from the local website and online forum. I was also suspended from teaching doula courses.

The severity of my ‘crime’? I, together with another doula, helped a client replace a clamp by a cord tie. In doing so, I used hospital scissors which had just been use to cut the cord by the father, to cut the plastic clamp off.

I would have expected the doulas in the local community who received the complaint to show me support, to listen to my side of the story, and to involve me in any decision made on my behalf. Instead, I was notified of my suspension by email. I had no idea this was coming. To say I was shocked would be an understatement. I was numb with disbelief. I don’t think In have never felt so ostracised and betrayed in my whole life. I was also dumbfounded that the other doula I had worked with, ns who has suggested the cord replacement, suffered no consequences.

Disbelief was the overwhelming emotion, as I really struggled to process how a group of people which I had been an active member of for 7 years,  a collective which was supposed to be based on values of support, compassion and non judgement, could cut me off like this, and how someone I thought was a life-long friend could do the same, whilst she knew I would suffer the double blow of being rejected by the community and by her.

I had thought that this community would rally round to support and protect a member in the face of the vulnerability that a complaint entails. I was wrong.

I felt like I was a rotten apple in a cart, and, at the time I needed it most, I was kicked out of the cart and told to deal with it by myself.  The emails I was sent made it clear that I was on my own in this process, so I didn’t reach out to anyone. Because of this, I also mistakenly spent several days believing that the whole community knew, and didn’t care.

Because the email suspending me told me that I might not be welcome in the hospital, I cancelled clients who had just hired me to support them through a birth.

I embarked on the process of trying to resolve the complaint with the support of the national doula association, doula UK. This process was long-winded, as it happened during the holiday season. It took 3 weeks for doula UK to receive the complaint, and another 3 for a meeting with the midwife to take place. The meeting was an anti-climax. I had worked myself into a state of extreme anxiety about it, expecting to be told I could no longer work inside this hospital. Instead, the midwife accepted my apology and the meeting was over in 20 minutes.

This left me reeling. Everything around the way the complaint had been handled by my community felt so out of proportion.

In the meantime I had to cope with the fact that my whole professional life had crumbled, that I no longer knew who I could trust, and that everything I believed to be true about my local doula community has been destroyed.

I felt that most of what I had build professionally had been reduced to rubble. I lost my sense of identity. I felt like I had been kicked out of the castle, and was alone with the wilderness, surrounded by scary beasts. And, from where I stood, all I could see what my whole life crumbled down to a ruin.

It was a very dark time. I had very serious suicidal thoughts for many weeks.

A few weeks later, I got diagnosed, for the first time in my life, with severe anxiety and depression. Getting the diagnostic felt like a relief and an embarrassment at the same time. There is still so much stigma around mental health in our culture.

I shared about my depression on social media to help others, because I thought that if I, who many considered a strong person, could be diagnosed with mental health issues and feel some level of embarrassment about it, what chances would more fragile or reserved people stand to get help?

Once upon a time, I used to believe depression was for losers. Then a whole bunch of people I loved and admired, including my own husband, got diagnosed with it. This shook my narrow minded beliefs and for this, I am grateful. I hope I might have helped others in the same way by disclosing my situation.

The summer passed in a blur of emotional pain. I have never cried so much in my life. I would drive to a client’s house, cry all the way there, put on a brave face and function whilst with the client, then, as soon as I left, the enormity of what had happened fell back onto my shoulders like a ton of bricks, and I would start crying again.

They say that crises show who you can really count on, and my, was that a harsh truth. I soon realised that very few people were truly available for me, beyond a few bland words of initial support.

I suppose it’s a reality of life that we are all busy with our own lives and problems, but in the face of this situation, it made me feel extremely alone, and added to my feelings of worthlessness.

The local doula collective counted nearly 40 members.  I got a few messages of sympathy when the news of my suspension was made public (again I had no say in this), but only a handful actually reached out and gave me support (and I am truly grateful to those who gave me their time and support especially when they were facing crises of their own). I now know that many had no idea what had happened, nor were aware of the severity of the impact it had on me. In the very negative mindset I was in for many months, I imagined that they knew and did not care. It lead me to develop a very negative view of the community.

The whole situation left me quite paranoid, and with very few people I could trust, but I realised that these people were really solid. My husband in particular, who had just finished his training as a counsellor, was a rock. My parents were amazing too and so were a handful of friends, who made the time to listen to me again and again as I struggled to process my feelings.

There is evidence that being ostracised is one of the most painful emotions that a human can experience, and that it causes physical pain. This was true for me. Something about belonging has to do with surviving, so being ostracised threatens this.

There is also evidence around the stages one goes through when grieving, denial, pain, anger and bargaining, depression, acceptance and hope. And god did I grieve. I grieved the loss of a community I had grown to love and that I thought to be amazingly supportive. I grieved the loss of a long term friendship which I never expected to end. I grieved the loss of my sense of identity. I grieved the loss of my professional success.

For the first few weeks I could barely function. I was forced to drop my work to a bare minimum, only working with clients I had already booked, and my income suffered and took a extreme dive. Being self employed, this added to my anxiety and my feelings of not being good enough. I had spent 7 years building my self employed business and it felt that it had been destroyed.

I knew I could only survive during this time, and use my limited energy to resolve the complaint.

I started seeing a counsellor and also had my first experience of the mind-blowing transformative process that is a family constellation workshop.

Whilst this happened, and whilst I was in the middle of that really dark place, I also knew that this happened to me for a reason.

In 2007 I was marched out of the biotech company I had been working for 7 years, under false pretences of redundancy. This really accelerated my professional reconversion from scientist to birthworker. I could feel that the current crisis had the same energetic signature (except this time it was much, much worse, because this was being removed from a place I loved, whereas I was relieved to be removed from the toxic biotech company I used to work for).

I fought very hard against where this process wanted to take me. I even conned myself into believing that I ought to forgive the people who had broken my trust. I was trying to claw the ground I had lost back. I am very grateful for the friend who called me up on it by saying “be careful, because what you are saying is basically : you shat on me, but it doesn’t matter”.

One of the book I read at the time was called “Broken open, how difficult times can help us grow” by Elizabeth Lesser. The book is full inspiring stories about the good that can come from tragic events. In this book I have found a new metaphor. Elizabeth refers to the process of going through tough experiences as the phoenix process.

” I have my own name for the quest. I call it the Phoenix Process—in honor of the mythic bird with golden plumage whose story has been told throughout the ages. Knowing that a new way could only be found with the death of his worn-out habits, defenses and beliefs, the Phoenix built a pyre of cinnamon and myrrh, sat in the flames and burned to death. Then he rose from the ashes as a new being—a strange amalgam of who he had been before and who he had become. A new bird, yet ever more himself; changed, and at the same time, the eternal Phoenix.”

This metaphor appealed to me a lot. A lot more than the lobster growth analogy I used to use.

I loved it so much I had a phoenix tattooed on my shoulder.

Despite a series of powerful insights with the various therapists I was working with, by the time I was getting ready to go on my annual holidays in France, I was falling apart. The 2 weeks away from my normal life, did me a world of good. During the last 2 days of my holiday I started feeling the dread, the weight, the enormity of the fallout from the complaint I had faced, fall back onto my shoulders. I was really scared that I was going to go back into the abyss.

Except that’s not what happened. When I returned I noticed that I felt a lot stronger.

I realised that the time away had given me one thing: clarity about how I felt about the way the complaint had been handled. I stopped doubting my feelings. I stopped letting other people trying to gaslight me.

In July, I felt like I had been kicked out of the castle, and that I was alone in the wilderness. I felt unlovable, lonely and scared. I stood in a barren land, and everything I had built was broken. Now, oddly, I felt OK, alone in the wilderness. I was no longer as scared and then, I started to notice new shoots starting to grow on the ground. I had been booted out of the cart, now I realised I didn’t want back in. Since then, I have kept on feeling a lot stronger.

Don’t get me wrong, I’m still recovering from the crisis, and from time to time, I get triggered and forced to revisit the crisis and when I look at the wreckage, it still hurts. Those times are hard, as I catch myself, despite knowing this is neither possible nor desirable, hoping that things could go back to the way they were.

There is this beautiful analogy about grief, where someone describe it like a shipwreck: when it just happens, you are floating amidst the debris and 100 foot waves hit you relentlessly, and all you can do is float. With times, the waves become less high and less frequent. But they never really stop. Stuff in your life happens that reminds you of the event, and suddenly the grief hits you again.  You can read the whole thing here

Another aspect of grief is the permanent change this it brings. Some parts of me died in this process. But they made room for new things. And there have been good things too, that have come from this process. I’m clear that certain people no longer belong in my life, and I’m mostly at peace with it.

I’ve become aware of toxicity in spaces that I thought to be only good. And I also know that this potential exists everywhere. I’ve become unblinded to the fear and darkness that exists in many communities that claim to be based on ‘love and light’, and who are quick to criticise others but slow to appraise their own failings. In fact, as I’ve discovered by talking to a lot of people, such communities are often the worst when the shit hits the fan.

Edited to add: when this blog was published in January 2021, someone from the local doula community made a formal complaint against me to the national doula association, doula UK, claiming that my blog post was not reflecting the truth and could be damaging to the local doula collective. Doula UK upheld the complaint, and told me that unless I removed the blog, my membership would be terminated. My mental health at this time was still fragile that I didn’t have the energy to fight it. I made the decision to unpublish this blog post at the time. Having left the organisation, I chose to republish it.

I also went through a cathartic, and still on-going, process of decluttering my home, and letting go of stuff I no longer need, literally, as well as emotionally.

One thing I noticed is that I am less affected by people’s opinions of me. You know that phrase “other people’s opinions of me is none of my business?”. Well, I knew this on a mental level, but now, because I’ve survived being rejected and ostracised, including by people I lived, I feel able to embody it. I catch myself thinking about people whose opinion mattered to me, people who were part of this exclusion process, and I realise that I no longer care about what they might think of me.

I no longer feel as responsible for other people’s feelings in the way I was in the past. At a birth I attended recently, the midwife was rather frosty. Rather than wondering what I’d done wrong, I realised she was feeling threatened, and that it had nothing to do with me.

I feel a lot clearer about of who I am, and what my values are. My two top values are authenticity and integrity. I’m not prepared to pretend these don’t matter to me, even if this means the end of some relationships. It’s difficult to explain fully, because it’s mostly that I keep catching myself not reacting like I used to.

I no longer feel that I need to justify myself, or that it’s my job to explain my opinions to people who don’t want to listen. I no longer feel the need to enter every fight I’m invited to.

I stay silent in situations where I would have spoken up in the past, and speak up in situations where I would have remained silent. I feel a restored sense of sovereignty. It’s very liberating.

To create space and time for this, as well as time to process and reflect, I decided to take a break from working as a doula. My last doula client was in October, and I will wait until the universe gives me a sign that it is time to return.

And, with that space and with the slow lightening of the darkness, new projects have arisen.

I have started writing a book on postnatal recovery, which was accepted by publisher Pinter and Martin. My goal is, beyond the book, to create training around supporting the postpartum.

I have created a new product, a smokeless smudge using Palo Santo essential oil, called the Sacred Sprace Spray.

I have started training to become a Reiki Drum teacher.

I have planned to learn the Arvigo Mayan Abdominal massage training in 2020. I signed up for one of the most transformative business mentoring programme I have ever come across, Become your own business advisor, with Hiro Boga.

I started doing new things in my personal life too, doing healing with horses, learning to crochet, and discovering the practise of TRE (tension release exercise) and of the 5rhythms dance, which I love. This also led me to meet a lot of new people.

Why did I write this blog? Now that I’m mostly on the other side of the crisis, I wanted to tell my story in the hope that it inspires and helps others.

I’m not yet at the stage where I can forgive nor feel grateful towards the individuals who caused me so much pain, I feel grateful for the personal growth this crisis has given me.

So, if you’re in the middle of your own phoenix process, I want you to know that you are not alone. I also want you to know that it’s OK to take your time. I want to encourage you to reach for help, often people how now idea how bad you feel, because most people who feel terrible tend to keep to themselves.

I also know that, when you’re in the darkest place, it’s kind of impossible to see what will come from the other side when you finally get out.

And yes when you go through a phoenix process, some part of you will die. It is important to acknowledge that loss, because it is a very significant one. It is also important to take the time to process the hurt, and not rush through the processing. Each of us has their own timing and way to process it, there is no right and wrong. Don’t beat yourself up for the time it takes, and do not listen to people who are telling you to hurry up and be somewhere you are not ready to get to yet.

I also want to give you a message of hope. Because, at the bottom of the abyss, you will find the diamond that has been carved by the darkness and the pressure, and you will rise from your ashes with a renewed sense of self.

Not quite the same, but whole.

There is a poem from Rumi which describes this process so perfectly.

“This being human is a guest house.
Every morning a new arrival.

A joy, a depression, a meanness,
some momentary awareness comes
as an unexpected visitor.

Welcome and entertain them all!
Even if they’re a crowd of sorrows,
who violently sweep your house
empty of its furniture,
still, treat each guest honourably.
He may be clearing you out
for some new delight.

The dark thought, the shame, the malice,
meet them at the door laughing,
and invite them in.

Be grateful for whoever comes,
because each has been sent
as a guide from beyond.”