Author: Sophie Messager

The most important thing in everything I do is to support informed decision making and empowered choice.

And yet it probably is the toughest balancing act.

In a maternity system that isn’t fit for purpose, how do you prepare parents for what is waiting for them without scaring the shit out of them?

I find this dilemma, this balancing act especially difficult, because one of the first things I tell parents in antenatal meetings, is how much I hate that everybody is telling them horror stories about birth, and how wrong this is.

I have just supported a mum through a very empowering second birth. During her first birth she was treated in the most callous way, which left her and her husband traumatised. She told me she’d had so many friends who had bad birth experiences, and that she didn’t understand why people were putting up with it.

I think that people put up with it because, whilst they know the experience wasn’t good, they buy into the crappy narrative that it was for the best, for the sake of a healthy baby, and do not always realise that what happened to them was unacceptable.

It is not OK if the way you were treated made you feel like shit. Your experience matters, and whilst everybody wants a healthy baby and of course that matters, it isn’t all that matters either.

I have no doubts that interventions are sometimes necessary and that they do save lives.

I am talking about the fact that it isn’t necessarily how the birth unfolded that makes a good or a bad birth experience, rather how people were made to feel throughout their labour and birth.

Obstetric violence is real, and there is no excuse for unkind behaviour, ever, even in an emergency. Birthrights has excellent info on it, and I have written about it here.

What I often observe,  sadly, is that the empowered decisions of second time parents often come through a shitty first birth experience.

So what about those first time expectant parents? How do we prepare them for navigating the maternity system? How do we support them in preparing for a positive birth whilst also equipping them with managing whatever curve balls the maternity system might throw at them?

Again, whilst acknowledging the important of a positive mindset (we will come back to that), we cannot ignore the fact that within our maternity system as it stand, only a minority of first time parents experience a positive birth.

According to the Birthrights dignity in childbirth survey, only half of women had the birth they wanted, and

• 31% of women said that they did not feel in control of their birth experience
  •23% of women were unhappy about being not given a choice of position during labour
  •20% of women said healthcare professionals did not always introduce themselves
  •18% of women did not feel that health professionals listened to them
  •24% of women who had an instrumental birth said they had not consented to procedures.

I had a curious experience this week. I went to the local hospital for a routine eye check test. I am almost never a patient, and my interactions with the NHS are usually limited to my work as a doula. It was fascinating to experience the system through the patient point of view. In many respects, my experience was similar to what women experience in maternity care. I saw some lovely (and some not so lovely) nurses and doctors, some of which had excellent bedside manners, and some absolutely terrible. I got wheeled around through tests I had no idea where going to happen or why. I kind of knew some of the tests, having seen an optometrist before, but nobody sat me down and explained what was going to happen. I was not asked for consent before procedures, some of the staff didn’t introduce themselves or muttered an unintelligible introduction under their breath, and one was so tense I felt like asking her what was wrong. Being the curious scientist that I am, I asked a lot of questions and also pointed at flaws in the testing process (like testing eye function with the same line of letters you can learn by heart). People’s reactions to my questioning, where met by either dismissal or a “yes we know it isn’t ideal but there is nothing we can do about it”. Whilst my doula experience made it somewhat easy to navigate, it was still (pardon the pun), an eye opening experience.

It wasn’t an upsetting experience for me, just mildly annoying, but it gave me much insight about how it must feel like, when, in labour for the first time of your life, you turn up in labour at the hospital, especially if you’ve had no antenatal education whatsoever. It must be scary as hell!

Antenatal education is an absolutely paramount part of having a positive experience. I have already written about that here.

But this post isn’t just about antenatal education.

This post is about the difficult of educating first time parents about navigating what they are up against, without creating fear, causing anxiety, lowering their confidence, and generating mistrust towards the maternity system.

It’s hard, and although I have been doing this for over 6 years now, I am not sure I always get it right.

But I try. I try very hard.

One way I try and do this is by discussing the following topics, which all fall under the birth preferences hat : The physiology of birth, the place of birth and the best conditions for birth to unfold, and medical interventions.

When we discuss the physiology of birth I make parents aware of the needs of a labouring woman for darkness, privacy, and quiet. I tell parents that you need the same atmosphere to get the baby out that you needed to make the baby. This is because the hormone that drives labour contractions, oxytocin, is a shy hormone, and is inhibited by adrenalin inducing conditions, like bright lights and noises. This video comparing birth to sex illustrates this concept very well.

We talk about the importance of choosing to birth in the place where you feel the safest. When discussing place of birth options with parents, we also debunk the myth that birth is always safer in the obstetrics unit of a hospital. Recent research like the birth place study actually shows it is safer for uncomplicated pregnancies to be in a birth centre or at home.  I’m not saying that birth centre or homebirth is for everyone. I just want to make sure that, whichever choice the parents end up making about where to have their baby, their decision is based on evidence AND that they also know that it’s OK to change their minds one way or another at any point, including during labour.

We discuss all major medical interventions, such as induction, augmentation, monitoring, instrumental and caesarean births, so if any of this presents itself, they have heard about it, know what it entails and have thought about what they would prefer, beforehand.

And of course all these topics are part of encouraging the parents to write their birth preferences. The process of doing this is an important part of the preparation. I encourage the parents to write 3 documents: one with their ideal birth, one for if interventions are needed, and one for a caesarean birth. I have written about the caesarean birth plan here.

Throughout the discussion of all these topics, I try to be as balanced as possible, and I certainly want to avoid coming across as negative towards the maternity system, even though I know its failings, so I tell stories to illustrate many possible scenarios. Mostly, I talk about a continuum. Everything is a continuum. A Gauss curve. We talk about how we can’t predict how we will get on with the caregiver assigned to support us (This is one of the number one failings of our current system- the lack of continuity of care – HOW ON EARTH are you supposed to feel safe in such a vulnerable moment as birth with someone you’ve never met before?) and how to handle it if you don’t like who is looking after you : you just ask for somebody else. I have heard so many stories of parents who didn’t like their caregiver but either had no idea they could ask for someone else, or didn’t want to offend them. You only get one shot at this, so this isn’t the time to worry about somebody else’s feelings. By the way, you can just go to the ward desk to state your wishes, you don’t have to confront the person you don’t like. Remember: you will most likely will be doing them a favour as well,  because if you don’t like them, chance is they don’t like you either. They cannot say that, but you can.

We talk about the grey areas in interventions, how sometimes what is suggested it really necessary, and sometimes it’s just because guidelines are being applied mindlessly. If the baby is well, and the mother is well, why not ask for more time?

To navigate these situations, we talk about question asking skills and the BRAIN acronym. If you’re only going to do one thing, the BRAIN acronym equips parents with the right question asking skills to handle anything that’s being thrown at them

BRAIN. Each letter is a reminder for a specific question whenever something you aren’t sure about is suggested to you :

B-what are the Benefits?

R-What are the Risks?

A-what are the Alternatives?

I-What does your Instinct tell you?

N-what if we do Nothing (i.e. can we wait, decline the intervention?)

Remember that informed consent is part of the code of conduct of every health professional. They cannot do anything to you without your consent. Sometimes saying “I haven’t given consent” or “I haven’t got enough information to make an informed decision” , or even “I’ve made an informed decision” may act as a magic word.

That is a lot already but I’m not sure it is always enough, because, even when I’ve been present supporting a birth as a doula, I haven’t always been able to prevent unkindly behaviour, or to avoid caregivers using coercive tactics to obtain consent (“You don’t want to put your baby at risk-do you?” which is a ridiculous question because no parents will ever put their baby at risk unnecessarily), but I have always been able to remind parents that they could ask more questions before making their decision, or to help get a few minutes on their own to reach a decision.

Weaved in and out of this topic, as you have already gathered, is the concept of dignity and respect. If at any point parents feel uncared for, not listened to, not treated with kindness, or if their caregiver’s style simply isn’t to their liking, then they should express their concerns about this.

Sometimes it’s very simple things. Sometimes well meaning behaviour is wrong too. I have heard so many stories of couples being put off by a quiet, silent midwife sitting in the corner in the birth centre. I knew she meant well by being unobtrusive, but many couples told me that they would have liked more active support. So I started telling couples to ask for more verbal reassurance or active support if they needed it. It worked, because recently, a couple told me this is exactly what happened to them. When they told the midwife they needed more support, she really rose to the challenge and became more verbal and openly supportive and they loved it. It completely transformed their birth experience.

I often feel that when someone is unkind, we are all responsible if we say nothing, because how is that person going to know what impact they have on people if nobody tells them?

So to summarise, how to prepare parents for a positive birth experience? A common analogy in the birth world is to compare giving birth to climbing a mountain: you’ll need preparation and a positive mindset, and certainly starting the climb with the intention to stand at the top to admire the awesome view with the most glorious “we did it” feeling is a great way to start. And you know that listening to the people who are worried and trying to discourage you with horror stories of people had accidents whilst climbing the mountain won’t help, whereas listening to those of people who had a great time will. But you also know that preparing yourself for whatever unpredictable event might happen : bad weather, having the right equipment and support, knowing the easiest route, etc is also a very  important part of the preparation.

If you are a birthworker and would like to work with me, look here. If you are a parent, head over here.

After “I don’t need a doula because I have my partner” this is the second biggest myth about doulas

I have lost count of how many times I’ve been asked “can I have a doula if I am planning to birth in the hospital”, so this myth is very real indeed.

Let me set the record straight.

Doulas aren’t crunchy, lentil knitting yogurt weaving tie dye wearing hippies who want you to freebirth in a yurt in the woods surrounded by unicorns (though if this what you want we’d be more than happy to support you-more on that later).

Yes we are advocates of physiological births, but first and foremost we are advocates of informed choices and of women feeling supported in those choices.

That’s the essence of it, really.

We doulas are there to support you in your choices, the ones that make you feel strong and empowered, whatever those choices might be.

To give you an idea about how varied doula birth support can be, this year (and this is pretty much reflective of all my years as a doula), I have supported women having an elective caesarean, giving birth in the obstetric unit (and that included transfer from home and from the birth centre during labour), having birth centre births and homebirths.

I was as fiercely passionate defending the rights of a woman wanting to give birth at home as those of a woman wanting an elective caesarean birth, because, and this is the key message here, this was the right choice for her.

One of the things I love most about being a doula is how much it has opened my mind. When I worked as a scientist, I mostly hung out with scientists, and whilst they were all different people, there was a certain mindset similarity between them. Since becoming a doula I have met lots of fascinating people with so many different personalities and so many unique quirks and paradoxical ways of thinking. It’s never boring. It never stop stretching my mind, I never stop learning. I love it.

But what I have learnt above all is that there is no one size fits all (I wrote another post about it here).

So as a doula I always try to approach my clients with a completely open mind. Without a preconceived idea of what is right for them. They know what is right for them. I don’t. My job is to help them find out, amongst the sea of options available, what options make them feel safe, strong and empowered.

Some women feel safer giving birth at home, some in the birth centre, some in the obstetric unit.

Some women need a lot of physical support during labour (like massage and touch), some labour best if left to their own devices, and some cannot bear to be touched. Some women like music, or aromatherapy oils in the background, some don’t.  Some like to labour in water, some prefer to be on dry land. etc.

And things can change to, during labour, sometimes women change their mind (like deciding to stay at home after planning a hospital birth, or the opposite). And this is totally ok with us too. We have no set ways, no preconceived ideas. We want to get to know you and find out how best we can support you.

As doula trainer Maddie McMahon says, doulas are the chameleons of the birth world. We are constantly adapting and responding to the circumstances and the environment.

So yes, some women prefer to give birth in a low key environment, but doulas aren’t just for women giving birth at home.

If you are a birthworker and this resonates with you- look here.

If you are pregnant and feel drawn to work with me, head over here

I’ve been using Reiki to support my work as a doula every since I started attending births 7 years ago , and I have been meaning to write down my thoughts about this for a while.

I think Reiki is the ultimate tool for birthworkers, one that gives you the ability to support yourself, your clients, and everybody present in the birth room.

I remember a couple of years ago, a friend asked if I used Reiki at births. I first said no, because I thought I had never actively channelled it into the mum’s body, but when I thought about it I realised I used it all the time to hold the space, and hold myself and the atmosphere in the room energetically.

The only thing is that I didn’t do it so consciously at the time so didn’t realise I was doing it. It took me by surprise when clients said things referring to it in their feedback, like

” She created a positive, calm feeling in the room which I almost didn’t appreciate until it was all over and Sophie had gone home and it suddenly just felt like a hospital room again.  ”

or

” Sophie’s warmth could be felt in the house even after she left.”

In fact during the first ever birth I attending I actively channelled energy into the mum’s shoulders at her request, with amazing effects (the baby, who wasn’t engaged, immediately dropped down into the pelvis-the change of shape in the mum’s bump was immediate and very noticeable). And then I also realised that, because Reiki tended to flow out of my hands anyway regardless of whether I intended it to or not, I had mostly likely channelled healing into labouring mothers whist massaging their back or holding them as well.

I think that when you are present at births, it’s impossible not to develop your own spirituality, because there is a real, amazing sense of energetic shift during the labour and immediately after a baby has been born. It is a huge wave of energy in the room . It is so palpable, you can almost touch it.

To quote Grantley Dick Read:

” It is not only that we want to bring about an easy labor, without risking injury to the mother or the child; we must go further. We must understand that childbirth is fundamentally a spiritual, as well as a physical, achievement. The birth of a child is the ultimate perfection of human love.”

So how can you use Reiki for as a birthworker?

First you can use it for yourself, second you can use it to help your clients, third you can use it to help everybody else in the room.

For yourself

Reiki is first and foremost a self healing and self development technique. So when you learn to use Reiki, you are the first one to reap the benefits! Being a birthworker is a very demanding job on a physical, emotional and spiritual level, so being able to treat yourself with Reiki is a very good self care tool indeed.

Reiki will help you grow and heal your own personal wounds. It is a very important thing as a healer, or any giving profession, because we tend to naturally want to heal other people’s wounds before attending to our own (This is a very good article with a great analogy on this topic).

You can use Reiki at any time you need it to treat yourself, to give yourself a much needed energy boost. Self treatment with Reiki is like having a lovely, nurturing and warming meditation. It is the ultimate self care tool!

If anything stressful happens (be it related to your birthwork or not!), sitting down for a few moments, doing Reiki on your heart is the fastest way to get yourself back to a calm state (it works wonders when my children push my buttons!).

It is also a brilliant way of sending yourself to sleep at anytime when you find sleep a little more challenging (phantom texts, anyone?).

What I love the most about it, is that it is always with me! No need to worry about having forgotten a tool (like say a massage tool), because it’s always on you!

When on call waiting for a birth, and the wait gets the better of you, a Reiki session can get you back in the stress free zone. I find that after a treatment I once again trust that everything will be all right. Again during the on call if you feel a cold coming on and you’re thinking “Oh I can’t be ill right now”, a Reiki self treatment at bedtime might mean that you wake up refreshed and well.

If you are trained at level 2, you can use the Reiki symbols to empower wishes and goals in both space and time. For example when I go on call I like to write positive wishes for the birth on a piece of paper, and also ask for Reiki to be sent to myself at the time of the birth, so that I can receive it automatically when I need it.

When you get “the call” you can give yourself a brief treatment before joining your client, to ensure that you are in a centered,  grounded state.

During a birth, you can call on Reiki to provide you with a boost of energy or lift your mood during a long labour. I find it especially helpful during those “dark night of the soul” moments at 3am.

Reiki can help you stay grounded and in a state of love towards all involved (I have written a blog about it called “choosing love over fear as a birthworker”), so that you are more able to deal with whatever curveballs are thrown at you , including managing your own energy, and that of the other people in the room (more on that in the “for everybody who enters the room”  paragraph). It is very simple, if you feel unsure about anything, just tune into the Reiki energy, and ask for help!

After the birth, using Reiki is also a lovely and easy way to get yourself back to a clear, grounded, calm space and can help you process the birth and the emotions associated with it. Even when I am exhausted after a long birth, it only takes 5 min whilst lying in bed to clear myself of the birth energies. It also helps me wind down when I am too wired to sleep.

For your clients

The first advantage for your client is that you are more likely to be in a centered, grounded state. This really is the essence of being a present birthworker, and the most important point in my opinion. Offering the treatment to your client comes second.

You can offer Reiki to your clients during pregnancy, labour and birth, and during the postpartum period.

During pregnancy it can be a wonderful way for a pregnant woman to relax, to connect with her baby, and to help process any fears or worries she may have about the birth. It is also a wonderful way for you to connect at a deeper level with your client ,which also makes for a better labour support experience. I find it especially helpful in situations of stress such as when a women is postdates and anxious for labour to begin.

During labour you can use Reiki to help your client stay calm and help her cope better with the contractions. There isn’t much written about the topic, but American Doctor Jeri Mills have a lovely except of her book which illustrates how successfully Reiki can be used during labour.

I have used it many times at births and clients have commented on the lovely warm energy that came out of my hands, and how it made them feel good and helped them cope better with the contractions.

During the postpartum period, a Reiki treatment is a truly lovely way of nurturing and honouring the new mama and making her feel truly cared for (as she should be- I have written about this here). I once treated a new mum only about a week postpartum, I had been her doula at her birth, and had given her Reiki during the birth as well. She really wasn’t into this kind of things before the birth, but to my surprise, she asked for a full treatment, and it was one of the most lovely and life affirming experiences I had. She cried during the treatment, but these were tears of joy not sadness. She said she felt the treatment acknowledged the hard physical work her body had been through to birth her baby. She said it felt like I was saying thank you to her muscles, thank you to her uterus. It was beautiful and magical for us both.

It can also be a symbolic way to close the circle of support, after the birth, as a way to get closure and say goodbye to your client in a way that is positive and meaningful for both of you.

For everybody who enters the birth room

Again, first and foremost by staying in a grounded, loving state, we can positively influence what is happening in the birth room.

We cannot control who enters the space, but I believe that by sending loving, positive intentions (and you can do this ahead of labour starting), we can positively influence what is happening, and who is entering the space.

Our job is to stay in a state of love over fear, at all times. Sometimes it is easy and you and the medical staff present really enter a true teamwork and it is lovely and rewarding.

Sometimes, it isn’t easy, especially when unkind people enter the space. I wrote a post about this called “choosing love over fear as a birthworker“. We cannot control who enters the space, and we cannot control the behaviour of the people who enter the space. But we are in charge of our own reactions.

I also find it helpful to remind myself that even if it isn’t clear to me at the time, things are usually unfolding the way they are meant to.

Tuning into Reiki can really help you shift back to a state of love in this type of situation. We cannot fight fear with fear, but by actively tuning into a loving, connected, and benevolent state of being, I believe we can positively influence the behaviour of less than gentle people, by making them feel safe. I choose to see the people who display this kind of behaviour as victims of a system which encourages disconnection.

I run Reiki for birthworkers workshops-have a look if this resonates with you and you feel drawn to working with me.