Category: Birth

  • Drumming for Birth: Reclaiming Our Ancestral Wisdom

    Drumming for Birth: Reclaiming Our Ancestral Wisdom

    I have been deeply immersed in research on the history of drumming, and how it was used for the pregnancy, birth and postpartum journey. I’ve not been able to find much, apart from Layne Redmond’s book, When The Women Were Drummers, and a couple of blog posts and scholarly articles. So little has been written on the topic that the blog post I wrote two weeks ago about the science of drumming and how it helps support the birth process, is now coming up first when I search for the topic online!

    We have no recollection of our shamanic and wise women roots, because Western women’s wisdom and authority have been systematically suppressed, devalued and marginalised AND shamanism has also been actively destroyed.

    I’m going to cover the 2 separate topics: the erasure of women’s wisdom, and the erasure of shamanism, then finish by joining them.

    The erasure of women’s wisdom

    This happened in 3 separate waves.

    First, around 5000 years BC, the beginning of the patriarchy saw the removal of the spiritual roles and power of women. Layne Redmond in her book, When the Women Were Drummers, explains that:

    “The rituals of the earliest known religions evolved around the beat of frame drums. These regions were founded on the worship of female deities
Women became the first technicians of the sacred, performing religious functions we would today associate with the clergy
.Sacred drumming was one of their primary skills.”

    “Priestesses of the Goddess were skilled technicians in its (the frame drum) uses. They knew which rhythms quickened the life in freshly planted seeds; which facilitated childbirth; and which induced the ecstatic trance of spiritual transcendence. Guided by drumbeats, these sacred drummers could alter their consciousness at will, travelling through the three worlds of the Goddess: the heavens, the earth and the underworld”

    With the transition from nomadic hunter-gatherer lifestyles to settled farming communities, property ownership and inheritance became important, leading to the consolidation of power within male lineages, instead of the previous matrilineal system. This shift marked a turning point in societal organisation, as men gained control over land, resources, and social structures, while women’s roles were increasingly confined to domestic and reproductive spheres.

    Secondly, during the witch hunts that took place in Europe (and America) from around 1400 to 1800, countless women were accused of practicing witchcraft and subsequently persecuted, leading to their torture and execution. Many of these women were healers, midwives, or possessed knowledge about herbal remedies and folk medicine. I assume that they may have been drummers amongst them too. The persecution of witches was, in part, an attempt to undermine women’s traditional roles as spiritual leaders, as well as to exert control over their bodies and reproductive capacities. The witch hunts resulted in the murder of between tens of thousands and hundreds of thousand women in Europe alone, creating a void in that knowledge.

    Thirdly, from around the 18th and 19th century, the rise of the scientific and medical fields further contributed to the side-lining of women’s wisdom. As these disciplines became professionalised, women were excluded from formal education and professional opportunities. This exclusion limited their ability to participate in scientific and medical advancements and denied society the benefit of their unique perspectives and expertise.

    The systematic exclusion of women from the medical field and science, and in particular childbirth, was done deliberately, with the portraying of wise women such as midwives and healers as unsafe, and dirty, and ignorant (so that male doctors could keep the lucrative business of birth for themselves alone-see the books Birth, A History By Tina Cassidy, and The Birth house by Ami MacKay).

    The erasure of shamanism in Europe

    The history of shamanic drumming in Europe is rich and varied, spanning back thousands of years. Various European cultures, such as the Celtic, Viking, Germanic, and SĂĄmi people, practised shamanism, which involved connecting with the spiritual realms through drumming, chanting, and other rituals. Shamans, known by different names in different cultures (e.g., druids, seidhr practitioners), used drums as a tool for trance induction and journeying to commune with spirits, seek guidance, and perform healing ceremonies to accompany life and death.

    With the spread of Christianity across Europe, shamanic traditions and practices were suppressed and demonised as pagan or heretical. Shamanic drumming, along with other shamanic rituals, faced persecution and was actively discouraged by religious authorities. Many indigenous cultures had their spiritual practices suppressed, and knowledge of shamanic drumming was lost or went underground.

    In her book, Les Esprits de la Steppe, Shaman and researcher Corinne Sombrun (the founder of the Trance Science Research institute), explains that Russia made practising shamanism illegal in Mongolia as little back in time as the late 1960s. Shaman’s drums were destroyed and the shamans sent to prison. Some, however, carried on practising in secret.

    In Europe too, remnants of shamanic traditions persisted in some regions, particularly in remote areas. In the northern parts of Europe, such as Lapland and Siberia, the SĂĄmi people continued their shamanic practices, including drumming..

    In the late 20th century, there was a resurgence of interest in shamanic practices and spirituality in Europe. Influenced by a growing recognition of the value of indigenous knowledge, shamanic drumming began to experience a revival. Today, shamanic drumming circles and workshops can be found in various European countries, providing individuals with a means to explore altered states of consciousness, connect with their inner selves, and tap into spiritual dimensions. This revival often draws inspiration from both indigenous European traditions and broader shamanic practices worldwide.

    “Women often feel that, along with a portion of their history, they’re missing a part of their psyche. They have lost access to important regions of their minds. Until they can reclaim those parts of themselves, they are not whole” Layne Redmond

    Joining back the two threads

    There is a part of these two threads that is still going on today in the Western world, in the attempt at destroying anything seen as “not scientific” or “not evidence based”. For instance, when something hasn’t been published about, it is assumed not to be effective (which is ridiculous because lack of evidence is not the same as proof of a lack of effectiveness). Our culture reveres science like a religion, and in some aspects our scientific or medical world behaves like a mediaeval church. Rupert Sheldrake explains this in his banned TED talk.

    If this seems far-fetched to you, did you know that today in the UK, there are charitable organisations (which I won’t name because I don’t want to give them traffic), whose sole purpose is to destroy all forms of healing and traditional medicine that they consider to be pseudoscience. They target osteopathy, homeopathy, aromatherapy, reiki, the list goes on and on. Such an organisation successfully prevented osteopaths from saying that they can treat any condition for which the published evidence isn’t solid enough (for example, they are no longer allowed to say that they can treat colic). One such organisation managed to get a job offer post for a Reiki healer inside an NHS clinic removed.

    Similarly, modern maternity care behaves in accordance with patriarchy, where the “experts” hold the power, and the pregnant woman is seen as ignorant (and potentially dangerous), and where when a conflict arises between rigid maternity guidelines (not themselves based on any solid evidence ironically) and women’s wishes, this usually results in coercive behaviour on the part of health professionals. As a doula I have witnessed this often, in particular with the rise of induction of labour, and women being coerced to consent to induction (without being counselled on any of the risks of the intervention) by using the threat of their baby dying. 

    As Dr Rachel Reed explains in her book, Reclaiming Childbirth As A Rite of Passage,  where ancestral knowledge aimed at protecting pregnant women against the environment, the current system aims to protect the baby against its mother. 

    The reason I feel so strongly that drumming needs to be re-introduced to women and birth is because it can help us tune back into our intuitive wisdom. Bringing back drumming as a support tool during pregnancy and birth is not only an important part of bringing back our lost knowledge, but a powerful way for women to be able to be able reclaim their power and stand up to the “experts”.

    “So often women feel disconnected from their babies and their own bodies and this process helps work toward healing or dealing with whatever it is that blocks that connection.  Shamanic journeying during pregnancy offers great preparation for labour and birth as both are best approached from a similar altered state of consciousness.” Jane Hardwicke Collings

                                                                                                                                                     

     

  • Drumming for Birth: The Wisdom and Science of How Drum Beats Support the Brain and Body to Empower the Birth Journey

    Drumming for Birth: The Wisdom and Science of How Drum Beats Support the Brain and Body to Empower the Birth Journey

    Pregnancy, birth and the postpartum constitute a profound rite of passage. Expectant families are often guided to seek holistic approaches to enhance their birth experience. One such approach, which is gaining recognition, is the ancient practice of drumming. Rhythm is innate, and every culture around the world has (or has had) drumming traditions. 

    Beyond its musical and cultural significance, drumming offers a unique potential to support and empower and heal during pregnancy, birth, and the postpartum period. In this post, I explain some of the ways in which drumming can positively influence the birth process.

    Creating Sacred Space

    Drumming can be part of bringing more sacredness to the pregnancy and birth journey. Pregnancy and birth are sacred processes which deserve reverence and a sense of ritual. In today’s modern healthcare system, where many births take place in hospital settings, it is essential to find ways to re-infuse the birthing process with a sense of sacredness. Drumming is a powerful way to create a sacred atmosphere, adding a ritualistic element that can positively impact the birth experience.

    “At home I felt in my own space, but in the hospital I felt at the mercy of the system, with a lot of vulnerability. The drumming stirred up my sense of empowerment and of standing up for myself” Leigh

    Tuning in

    Drumming taps into the innate rhythms within us, synchronising the body, mind, and spirit. When expectant parents listen or engage in drumming, it helps them connect with their own internal rhythm and intuitive knowledge, promoting a sense of calm, focus, and empowerment. By embracing these qualities, individuals can navigate the various stages of the pregnancy and birth journey with greater ease and confidence. During labour, drumming can also support the mother into entering an altered state of consciousness that facilitates the birth process.

    In the book “When the drummers were women” Layne Redmond explains:

    “Priestesses of the Goddess were skilled technicians in its (the frame drum) uses. They knew which rhythms quickened the life in freshly planted seeds; which facilitated childbirth; and which induced the ecstatic trance of spiritual transcendence. Guided by drumbeats, these sacred drummers could alter their consciousness at will, travelling through the three worlds of the Goddess: the heavens, the earth and the underworld”

    “I had some gentle drumming at beginning of pregnancy. I found it very calming and healing. The effect lasted a couple of weeks.” Leigh

    “The main thing I remember was my consciousness ascending with the drumbeat and connecting with my baby’s consciousness and bringing him into this reality before I did it physically.” Ailsa

    Relaxation and Alleviating Anxiety

    The repetitive beats of a drum have a soothing effect on the nervous system, inducing a trance-like state of deep relaxation. Drumming can help reduce stress, and ease the anxiety commonly experienced during pregnancy and birth. This relaxation response not only promotes a more peaceful birth environment but also allows the mother to surrender to the flow of the process. Heartbeat-like drumming reminds us of our time in the womb, and promotes a sense of safety.

    “I wanted a doula who could drum to help me remain calm (I had massive anxiety going into my second birth, for lots of reasons). “ Ailsa

    Increasing Endorphin Release

    Drumming stimulates the release of endorphins, which are natural pain-relieving and mood-enhancing hormones. During labour, the intensity of contractions can be accompanied by discomfort and pain. Drumming can help activate the body’s own pain management system, creating a more positive birth experience.

    “During my birth, the drumming felt a bit like when you are jogging and you have power music on, it gave me a power boost. It felt like it was saying “open up, relax, trust your body, have faith in the journey”. It made me feel more confident in my abilities.”  Leigh

    Facilitating a Sense of Community and Support

    Drumming can be a communal activity, bringing together partners, doulas, midwives, and other birth supporters. Creating a drumming circle during pregnancy or birth fosters a sense of community and support, allowing individuals to feel held and encouraged throughout the birthing journey. 

    I came to the drum circle on my due date, to ground myself, to feel the vibrations from the drums, and because I felt that it would call my baby into going into our world, to feel welcomed. Kamila

    Connecting with Spirituality

    Throughout history, drumming has been used as a spiritual practice, connecting individuals to their ancestral roots and the wisdom of past generations. By incorporating drumming into the birth process, expectant parents can tap into this ancient wisdom, accessing a deep sense of spirituality and connection. Drumming can serve as a bridge between the physical and the spiritual realms and can also help parents connect more easily with their unborn baby. Drumming helps create a sense of sacredness and people help turn inwards. 

    “I wanted a doula who could drum for me during birth for many reasons, to mark a huge initiation, welcome my baby into the world to the sound of the universe’s heartbeat, to have something of me present in a medical situation, a reminder of the vast context of the process I was going through” Ailsa

    Nurturing the postpartum transition:

    Drumming continues to be a valuable practice beyond the birth itself, offering support and nurturing during the postpartum period. The beats of the drum can provide a soothing and grounding presence, helping new parents navigate the emotional and physical changes that accompany the postpartum transition. Drumming can serve as a form of self-care, allowing individuals to release tension, process emotions, and find inner peace during this transformative phase.

    “A week after giving birth, during the closing the bones ceremony, the drumming helped me release something and really opened up the gates to my connection as a mother. The realisation that I’d arrived as a mother really landed. It was beautiful, I cried tears of joy.” Leigh

    Conclusion

    Drumming offers a unique and multifaceted approach to supporting the birthing process. By listening or practising drumming, expectant parents can tap into their inner strength, find deep relaxation, alleviate anxiety, enhance endorphin release, foster a sense of community, and connect with their baby and spiritual dimensions. 

    Incorporating drumming into the birth journey holds potential for supporting transformative and empowering experiences. 

    If you have drummed during the pregnancy, birth or postpartum journey, or have had drumming during these times, please comment below, I’d love to hear your stories.

    Note:

    I am in the process of collating a lot of drumming research, experience and stories related to the birthing process and women life transitions. If you have stories to share, I’d love to hear them, as I am writing a book about women and drumming.

    Read more: I have published an article about drumming for pregnancy and birth for the International Journal of Birth and Parent Education, which you can download for free here. I wrote another article about it in the Green Parent Magazine, which can be downloaded for free here. I offer an online course called drumming for birth. I gave a talk about the science of shamanic drumming at the convention of women’s drummers in Colchester in November 2023 and will do the same again in 2024. I run monthly drum circles near Cambridge which everyone is welcome to attend. No experience necessary.

  • Drum healing, bullshit?

    Drum healing, bullshit?

    I have been on a journey from dismissal to powerful experience, and I want to tell my story with the hope that it may encourage others to explore this modality too. The first time I heard about drum healing from a friend my reaction was: drum healing? bullshit! It didn’t occur to me to be curious and ask my friend questions about what he did. All I felt was judgement and dismissal. It’s a funny thing isn’t it? We all accept that sounds can do medical stuff (how does a doppler work?), but because shamanic drumming has been mostly erased from our culture, we dismiss it as hippy, non evidence based woo.

    My journey into drumming as a practise came from first hand experience. In 2013 when I attended a doula retreat, and there was a drum workshop called Shamanic Work for Doulas. Amongst other things that day, the teacher led a drum journey. I was very sceptical, thinking “this isn’t going to work”. And yet, as I relaxed into the journey, I had the most vivid visions of what felt like past lives to me. The experience blew my mind and unlocked a part of me that I didn’t know about. It left me yearning for more, and I left the retreat with a desire to own a drum. I told my mother, about it, and she gifted me a Bodhran she has bought on a trip to Ireland.

    I brought the Bodhran back home, but I felt out of my comfort zone playing it. because I didn’t know how. My brother,  a professional musician, showed me how to play it with the traditional stick. I I couldn’t play it well with the stick and felt disheartened. When I returned to Cambridge with my drum, I visited my friend Peter, a scientist, shaman and drum maker. I explained my quandary to him. Peter asked me what I wanted to do with this drum. “Do you want to play in an Irish band?” he asked. I said “no, I want to do some shamanic drumming”. Then he explained I didn’t need to use the stick and showed me how to make a felt beater, and how to use it. This was a very empowering moment, because Peter gave me the confidence to experiment and start drumming. It also helped shape who I am, and how to help others learn and explore in non prescriptive ways. I like to encourage people to develop skills in a way that works for them.

    I started playing my Bodhran and experimenting with it. I did this by myself and with no guidance, a way of exploring things which I now realise is quite natural for me, as a kinaesthetic learner. I have found that, whilst getting tuition from more experienced people is valuable, there is also value in exploring what a new modality feels like for you, without another person’s views affecting your experience.

    The following year, at the doula retreat there was a drumming workshop with Carolyn Hillyer, where we all drummed as a group. I absolutely loved it and wowed to make drumming a regular practise.

    That year I also ended up giving someone a closing the bones massage at the retreat. My friend Rebecca drummed in the background whilst we rocked and massaged and held the women receiving the ceremony. This felt very powerful and I asked questions to Rebecca about it and she suggested I buy a particular drum a maker on Etsy. I bought this drum shortly afterwards.

    Drumming soon became something I added to the ceremony at the end of my closing the bones workshops. I also started offering it to clients who received the ritual and who liked the idea. I loved introducing women to the powerful mind altering state that drumming provides. I had a bit of a drumming hiatus after that. Growth paths aren’t linear. I struggled with some lack of belief in my abilities to drum for a while

    In 2016 I attended another doula retreat, there was more drumming involved with a workshop that included a journey to meet our power animal. It rekindled my love of drumming big time and I felt drawn to birth my own drum. A few weeks later in July 2016, I attend a drumming making workshop with Jo Gray in Essex,  It was a wonderful day. I made a drum, and the most gorgeous drum beater, complete with wood burning decorations and crystals embedded in the beater’s handle. Slowly, drumming became more of a normal practise for me, thought I still had a small element of impostor syndrome about it.

    I birthed another drum at the 2017 doula retreat, where we spent 2 days making a drum with Carolyn Hillyer.  13 of us doulas made this drum together. The following year we brought back our drums and drummed together which was magical. This drum became my favourite and I have used it for healing ever since. In 2017 I also felt drawn to get more learning behind my drum healing practise. I attended the Reiki Drum technique training with Sarah Gregg , during which I experienced some deep healing. The Reiki Drum techniques uses the drum to channel Reiki healing onto the person receiving the treatment.

    Joining the Reiki Drum family meant that I also got to attend Sarah’s Spring Equinox Gathering the following year. Drumming together with 60 other reiki drum practitioners was a powerful experience I will never forget. Sarah made a video of the day and if you watch carefully you can spot me in it.

    After that, drumming became something I do, and no longer felt weird. I started offering it as standard as part of my closing the bone treatments and rituals. I also used it as part of women circles, and mother blessings and group closing the bone ceremonies. I love drumming alone, but but group drumming is even more special.

    In 2019 I was lucky to become the owner of a handcarved wolf drum (my spirit animal) from the incredible talented finish drum maker Juha Jarvinen.

    In 2019 I also ticked one of my bucket list wishes:  to drum at a birth. I actually got to drum during a two births that year. The first one was a home birth, which felt quite natural to do. The second time, I was specifically hired by a woman who wanted me to drum at her birth. I got to drum in the hospital for the first time. There were two of us drumming during this birth. It was in the birth centre, which is staffed by midwifes who are generally more on board with natural birth than in the obstetric unit.  I was still aware that it could raise some eyebrows, in a “what’s that weird hippy shit they are doing over there?”. It felt very helpful for the mothers to have drumming whilst they laboured, and I was delighted with the experience.

    In November 2019 I felt a pull to take my drum work further and I decided to train to become a Reiki Drum teacher. I did 24 reiki drum sessions in the space of a couple of months as part of my case studies. Some of my case studies had mind blowing healing experiences through it, way beyond my expectations. It only strengthened my desire to carry on. I attended the training in February 2020 and loved it. I haven’t had the opportunity to teach this modality yet due to the lockdowns, but I have found that it has had tremendous effects on my personal growth.

    Early in 2020 I also started attending a gong bath in Cambridge, which has 12 enormous gongs and some giant chimes. I had amazing experiences of relaxation from it, including feeling the ground move under my body, and I could still feel the benefits the next day. If you have never had a drum journey or healing session, I truly recommend it. It is incredibly relaxing, I liken it to having a massage in your brain. It frees your way of thinking and allows you to look at problems and issues sideways and find your own creative solutions.

    In 2020 I also started running monthly drum circles in Cambridge. It went better than I could have imagined. 14 people turned up to the first 2 live sessions, many of which had never done any drumming before. It worked extremely well and all where delighted by the experience. During the first lockdown I ran it on zoom, and then outdoors in the woods over the summer. I am still running these circles 3 years on, and this has included running them online (during lockdowns) as well as in person.

    In May 2020 I turned 50. I started the day drumming in the woods with two other women, and we have been drumming twice a week together ever since. It has been utterly supportive and transformative. It ticks all three boxes of wellbeing for me : me connection to myself, to nature, and to people I love. I link a lot of my personal growth and development to this practise. I’ve also reached the point where drumming feels like a completely normal activity for me.

    If after reading this you still think that drum healing is bullshit, it might help you to know that there is some cool published research on the effect of drumming on the brain, completed with EEG measurement showing an altered state of consciousness. You can find a review of some of these papers here .

    French shaman and researcher Corinne Sombrun has co-created an institute of research called the Science Trance research institute , and works with neurobiologists to understand the effect of drumming sound on trance like states. One of their published papers states that:

    We present the first neurophysiological study of a normal subject and our co-author, who had received extensive training in the Mongolian shamanic tradition and is capable of inducing a shamanic trance state at will. We integrate original research with literature review and suggest a unified psychobiological model for ‘altered’ modes of consciousness. This model incorporates objective, subjective and intersubjective science within a broad evolutionary framework to provide a non-reductionist account of psychological, biological and social determinants of self experience that helps to bridge Western and traditional healing techniques.”

     

  • Closure book review: How the ending of the Albany Midwifery Practice was about control, not safety

    Closure book review: How the ending of the Albany Midwifery Practice was about control, not safety

    I just finished the book “Closure: How the flagship Albany Midwifery Practice, at the heart of its South London community, was demonised and dismantled” by Becky Reed and Nadine Edwards.

    I found Closure a gripping and soul-stirring book. It peels back the layers surrounding the downfall of the Albany Midwifery Practice, a ground-breaking continuity of care model, which ran from 1997 to 2009 in Peckham, South London. 

    Defying the official narrative that safety concerns were the reasons for closing the practice, Closure exposes and challenges motives rooted in control and suppression. Meticulous research, first-hand accounts, and interviews with key figures paint a vivid picture, demonstrating that the model provided safe and effective care with positive outcomes well above those achieved by local hospitals. They also leave little doubt that the closure was not a mere unfortunate occurrence but a deliberate ploy orchestrated by influential forces.

    Using powerful storytelling, Closure unveils the profound connections and trust that existed between the Albany midwives and the community they served. It portrays the impact of the practice’s nurturing approach on expectant mothers, birth and postpartum experiences, families, and the wider community. The Albany Practice did not just provide exemplary maternity care, it provided a space to build and nurture communities that lasted beyond the childbearing years.

    Closure delves into themes of community, power dynamics, and the complex web of interests that shapes the fate of medical services. It empowers readers to question the narratives imposed by those in authority and to champion the preservation of institutions that nurture the health and well-being of communities. Closure is a catalyst for change, inspiring us to fight for the rights of families to birth where and with whom they choose, and for a maternity care system where connection and compassion prevails.

    Closure stands as a testament to the indomitable spirit of the Albany Midwifery Practice. The time and effort the midwives and their supporters spent trying to prevent the closure of the practise and to raise awareness about the amazing results the practice achieved, is truly inspiring. Sadly their efforts were not successful in preventing the practice’s closure. I couldn’t help but wonder, if the situation had happened ten years later, whether the impact of a powerful social media campaign might have led to a different outcome.

    Reading Closure left me reeling with a mix of intense emotions. I felt a deep sense of outrage as the book exposed the web of deception and incompetence surrounding the closure of the practice. My blood boiled at the realisation that the supposed safety concerns were nothing more than a smokescreen masking a hidden agenda. I also felt familiar rage towards the belittling attitude of medical management professionals towards the midwives and the families who tried to challenge the closure. 

    I kept asking myself: how did a medical institution lose sight of its fundamental purpose—to serve patients and the community? Sadly, this scenario has become all too familiar. For let’s be clear: it wasn’t safety concerns that caused the demise of the Albany, but the fact that it challenged the status quo so deeply. Whenever a ground-breaking and successful model emerges, challenging the very foundation of an existing institution, the response is often one of silencing and destroying the individual or practice behind it, rather than engaging in introspection and self-improvement.

    I also felt a deep sense of empathy and sadness as I read the poignant stories of mothers, families, the dedicated Albany midwives, and the witch hunt against midwife Becky Reed. The testimonies laid bare the devastating impact of losing this wonderful midwifery practice—a sanctuary of care, support and empowerment. My heart ached for the mothers robbed of a trusted support system during their pregnancy journey, and for the midwives whose passion and expertise were trampled and discarded. 

    The rollercoaster of emotions continued, weaving indignation and compassion. Alongside the anger, I felt deep admiration for the unwavering resilience displayed by those affected. They highlighted the strength that can arise when a community unites to fight against injustice.

    Reading Closure made me revisit and confront the realities of power imbalances within maternity care and the impact they can have on individuals and communities, echoing my own experience supporting families as a doula. It stirred a renewed commitment to raising my voice to advocate for change in support of models of care that prioritise connection, informed decision making and evidence based transparency. The book also highlighted how deeply embedded the belief that birth is inherently dangerous is within our culture, and how most of the professionals within healthcare have no understanding of the concept of informed choice.

    Upon finishing the book, it became clearer than ever to me that the current maternity care system is beyond redemption, incapable of self-transformation from its dehumanising model of care. 

    But I also felt hope, as if a turning point had been reached. I have been seeing the signs of transformation everywhere, especially since the pandemic has led to soaring rates of medical interventions such as induction of labour, that simply cannot be justified by logic or evidence. Families and birth professionals are reclaiming their rights to birth as they wish, stepping outside of a system that inflicts harm.  Change is brewing, fuelled by a collective refusal to accept the disempowering and controlling attitude of the current maternity system, and to reclaim the autonomy and sacred nature of the birthing experience.

    The pendulum, when pushed too far in one direction, inevitably swings back the other way. 

    PS:  Closure has also inspired me to write a future blog called The Myth of Birth Safety in Hospital.

  • The “untried penis”

    The “untried penis”

    Women sometimes get told that they cannot give birth at home with their first baby because they have an “untried pelvis”.

    What if we told men they couldn’t have sex at home the first time because they have an “untried penis”

    Just imagine a young couple going to see a health professional, to discuss their plan to have sex for the first time.

    Doctor: Hello please  come in, what can I help you with?

    Couple: Hello, we have been together for a while now, and we feel ready to start having sex.

    Doctor: That sounds about right, I will arrange for you to go to your local hospital.

    Couple: Actually we were hoping to have sex at home

    Doctor: At home!! For your first time?? This isn’t safe.

    Couple : Why? It’s quite a natural thing isn’t it?

    Doctor: Yes it’s a natural thing, but lots of things can go wrong, because you have an untried penis. When you’ve had sex at least once in hospital, and we know you can do it effectively and safely then we’re happy for you to have sex at home. But for your first time, it’s much safer to do it in the hospital

    Couple: What can go wrong?

    Doctor: Well we don’t know how long it will last, whether you’ll be able to get a strong enough erection, maintain it for long enough, that’s one thing. It can also be very strenuous for the two of you, so we will need to monitor your heart rate, temperature and blood pressure. People have heart attacks whilst having sex you know? And you are both nearly 25, the risk of heart attack doubles after 25. At least if you’re in the hospital there are doctors available to intervene quickly should anything bad happen.

    Couple: This sounds very worrying, but we really don’t like hospitals, the environment is cold and clinical, it smells of disinfectant, whereas at home we have the right atmosphere, smells, and all the comfort that we need.

    Doctor: Well you won’t need be there the whole time, you’ll get started at home anyway, we don’t really want you to come in until you’re past the established arousal stage. Plus it can be quite a messy affair, you don’t want to ruin your furniture, do you?

    Couple: So we will have to travel to the hospital, like, in the middle of it? Won’t this disrupt things?

    Doctor: A bit, especially if you come to the hospital too soon, before you have reached the established arousal stage. When you come in, an intimacy midwife will assess your arousal and the strength of your erection. If your erection isn’t big enough and you aren’t yet in the established arousal stage, we will send you home and tell you to come back later. But once you’re settled in the hospital, you should be able back into the swing of things quite quickly, especially as our staff is highly trained to support the intimacy process, and help you if you struggle. Also you need to know that nearly half of first time couples who are planning for home sex end up transferring to the Intimacy Unit anyway.

    Couple: We’ve had a tour of the hospital and we really don’t like the Intimacy Unit. The rooms are tiny, the beds are high and narrow, there are only bright lights and thin paper curtains, and no en-suite bathrooms.

    Doctor: well yes for your safety is paramount that we can see what you are doing, and access the bed quickly and easily, in case something goes wrong, you see. It’s also safer for you to be in the missionary position for that reason.

    Couple: This really puts us off,  and we’re worried we won’t be able to do it in there.

    Doctor : Don’t worry if you fail to progress, we have a lot of technology at hand to help complete the process, like Viagra and penis substitutes.

    I tell you what, since you’re both still kind of low risk, as long as you’re still under 25 by the time you have sex, we could let you go to our Natural Climax Centre, instead of the Intimacy Unit. It’s a home from home centre, with large rooms, double beds and mood lighting, and even one hot tub per room so you can get in the mood and relax. It looks more like a fancy B&B than a hospital! It’s staffed by experienced intimacy midwives, who are skilled in supporting physiological sex. So it will be just yourselves, a midwife, and a couple of reproductive students. They only use intermittent monitoring every 5 min during the established arousal phase. Of course if anything goes outside of the guidelines, we would suggest you transfer to the Intimacy Unit where we can monitor your heart rate continuously, as well as intervene with a penis substitute if you cannot finish by yourself. As I said before, as you have an untried penis, we don’t know which way it will go.

    Couple: Regardless of the hospital location, we feel that having lots of people we don’t know watching us will be inhibiting. And we don’t want students!

    Doctor: Oh don’t worry about that, all the staff are trained and completed used to it! They see it all the time, and you once you get back into the swing of things, you won’t be paying attention to what’s going on around you. Plus we are a teaching hospital, so we need to train our students.

    Couple: We were also hoping to do it at a spontaneous time…

    Doctor: Well yes, for low risk couples it’s ok to wait for sex to start spontaneously, but since you’re both nearly 25 your risk of heart attack is higher, so if we haven’t had sex by the time you are 25, we think it’s safer for you to come in at an agreed time so we can monitor your heart rate from the beginning, and intervene if needed. We start the process in the pre-intimacy ward, by giving you some Viagra orally, and if that doesn’t work we can give it to you via a drip which is more effective.

    Couple: OK, doctor, we want to do what’s safest and not put ourselves in danger, so we will go for what you suggest.

     

    Why did I write this?

    Comparing childbirth to sex isn’t new.

    The hormone that drives labour, Oxytocin, the hormone of love, is the same hormone that floods our system when we have fall in love or have sex, and because this hormone flows best in dark, private, unobserved conditions (think romantic diner atmosphere), it is generally understood that one needs a similar atmosphere to birth a baby that they needed to make the baby.

    Sadly modern obstetric units rarely provide the environment for birth to unfold easily. This has been explained extremely well both in Tricia Anderson’s Out of the laboratory: back to the darkened room and in Marsden Wagner’s Fish can’t see water articles

    In the book “the function of the orgasms” Michel Odent wrote a “Dear John” wedding night preparation letter from a woman to her fiancĂ©, where she talks about the wedding night educator she has been working with and the wedding night plan she has been writing.

    There is a particularly clever satire video which depicts an Italian couple trying to conceive in an hospital, it’s called “The performance“. There is another one in English called “Push”.

    I have this wonderful role play that was written by Jill Alderton & Jill Oliver, for a home Birth Conference. It depicts a couple going to see their GP because wanting to have sex at home. I have adapted and rewritten it with the untried penis scenario.

    Reading an article in the press today triggered me to write this new analogy.

    There was the following quote

    ” Why could Meghan not have a home birth?

    Meghan’s reported decision to abandon her home birth could have been down to an number of factors, an expert claimed.

    Consultant obstetrician and gynaecologist Peter Bowen-Simpkins, told the Mail: “When you have your first baby you essentially have an ‘untried pelvis’.

    “You don’t know what’s going to happen when the body prepares for labour and birth.

    “If a woman is on her second or subsequent baby and has had a normal delivery before then it’s likely there wouldn’t be any problem at all.

    “But you don’t know that’s going to be the case until you have your first baby.”

    I got very annoyed reading this, for several reasons.

    First, because it’s yet another example of what is wrong with the current maternity care culture in this country. It’s a fear based culture, one that treats birth like an accident waiting to happen.

    Second, because it’s a symbol of the patriarchal culture within the maternity system. Birth is a natural physiological function for women. For a male doctor to state “she has an untried pelvis” is implying that women cannot give birth well by default.

    It’s a bit like saying to a man who is getting ready for his wedding night “Here’s a dildo, just in case you can’t get it up-no pressure”

    Reading about the untried pelvis made me wonder what would happen if we told men who hadn’t yet had sex that they have an “untried penis”.

    So I decided to write about this, just to illustrate how supportive it would feel for men if they were told this.

    Now I need to give a disclaimer. I know birth and sex are different processes. I know that bad sex doesn’t have the same possible consequences as a birth that goes wrong.

    I’ve also been a doula and birth educator for long enough (I started working in this field over 10 years ago) and seen enough births to know that nothing is ever black and white, and that things can go wrong. I’m not naive. And I’m not suggesting everybody should birth at home.

    I am also a paid up member of the informed choices society so I am NEVER going to push homebirth on anybody,  and I’m as likely to fiercely help a woman to have an elective cesarean if it is what’s right for her that I am to support a woman to birth at home despite “high risk” factors.

    Also, language is important. The words we use can either inspire confidence (your labour is progressing really well) or cause anxiety and distress (you’re ONLY 3cm dilated).

    This is why I dislike the expression “untried pelvis” so much. Because it implies that it won’t work. That we will let you “TRY”. It’s not very encouraging is it?

    That’s why I wanted to make the analogy with the untried penis.

     

  • The maternity machine

    The maternity machine

    Today I went from a house
    Where a woman swayed as her body opened
    Gently vocalising, in tune with herself
    Warm water ready to embrace her
    With candles as the only light
    And two women sitting quietly
    Watching and waiting
    Whispering words of encouragement
    Holding her and her space
    Today I went from this sacred space
    Where time slowed down
    And all that mattered was this moment
    And this woman
    I went from this sacred space
    Into the belly of the machine
    With its bright lights
    Its beeping tech
    Its dry, cold, clinical rooms
    And its dry, cold, clinical staff
    In this space where everything is timed
    Measured
    Counted
    Calculated
    Where numbers are more important
    Than the person they are supposed to be caring for
    Today I went into the belly of the machine
    That ‘saves’ lives
    But destroys spirits
    Where the sense of the sacred is lost
    Where it’s just another day at the office
    Where kind people are a rare find
    And the mother is just a vessel
    Where the machines take over
    Where babies are born distressed
    And nobody comforts them
    The machine eats birthing women
    Like an unsatisfiable beast
    And spits them out, emptied of life
    And emptied of spirit
    Because as long as the baby is alive,
    Who cares if the mother is broken?
    Today I watched in a theatre
    Medical staff milling around
    Like a swarm of busy bees
    Doing the tasks they have been trained to do
    Told to do, programmed to do
    Where nobody saw her
    As she lied on the table
    Reduced to her body parts
    I heard them say “congratulations”
    Like repeating a script, without meaning it
    And as I sat there, I wondered:
    How did they become so dehumanised?
    And as I watched them, I wondered
    How did they forget?
    How to connect and how to be kind?
    And as I watched, I told myself
    I never want to be there again.
    It is too late
    They are too far gone
    Blind to their own conditioning
    In the maternity machine.

    Play

  • Three rebozo techniques for pregnancy and birth

    Three rebozo techniques for pregnancy and birth

    I’ve had so many positive experiences using rebozo techniques as a doula to support pregnancy, birth, the postpartum and beyond, I’m on a mission to pass on this skill to ask many people as possible.

    Every technique is extremely simple to do, anybody can do it. Yet this humble tool provides an unparalleled a level of comfort and relaxation.

    There are hundred of different things you can do with a rebozo (and it works with other shawls and scarves too). The techniques usually fall within a rocking or a wrapping technique.

    Here I share 3 simple techniques you can use during pregnancy, birth, and the postpartum period

    Pregnancy technique: Hip wrapping

    During pregnancy the rebozo can be wrapped tightly around the hips to provide support to the pelvic girdle. The rebozo can be twisted and tucked at the front or at the back of the pelvis. Whether you are tying at the front or the back will have slightly different effects on the sacro-iliac joints. Try both version and be guided by the feedback fon what feels best.
    Remember whilst this will provide support and comfort, this technique won’t ‘fix’ the underlying cause of the pain/discomfort and therefore won’t replace being treated by a skilled bodyworker (like an osteopath). In situations where pain is present, such as pelvic girdle pain (the Pelvic Partnership is an awesome resource), however it can provide support and comfort whilst awaiting treatment. It should be used mindfully, as a treatment, and not 24/7. You can also use the rebozo to hold an ice pack or a hot pack in place.

    Play

    Teddy the osteopath‘s view of the technique

    Wrapping the hips-supports and stretches the pelvic ligaments (the broad and the round ligament) and helps support weight from the bump on the abdominal muscles and fascia. Many women experience lower pelvic tension and discomfort and band like pain around the front of the pelvis during pregnancy. This technique may also help the ache or soreness in the genitals that can happen during to pregnancy. Wrapping from the back instead of the front provides a similar effect but might be better later on in pregnancy as it provides a broader contact, less pressure at the front and more opening at the back. Both techniques have an impact on the sacro-iliac joints by opening them in slightly different ways. The front tying opens the joints more posteriorally versus anteriorally for the back tying technique.

    Rocking technique (for pregnancy and labour)

    Jiggling the hips or abdomen (or any other part of the body) can relax tight ligaments and may help a baby rotate in pregnancy or labour more easily, as well as provide relaxation and comfort. Being rocked elicits a very primal feeling  (reminding us of being in the womb) and it is very calming and soothing for anyone. It can help a pregnant or a birthing woman relax when she is tense or anxious. Generally, these techniques relax the body so that the baby is more likely to take a better position.

    Here I show you how to rock the pelvis whilst standing up. This can also be done with the woman resting her back against a wall for support.

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    Teddy the osteopath‘s view of the technique

    This provides movement between the lower thoracic spine and the lumbar spine, and helps with the compression forces caused by postural changes during pregnancy. It provides a passive articulation, completely removes the pressure, especially in the thoraco-lumbar joint. This can have a positive impact on breathing too as it also releases the diaphragm. Using a faster movement makes it more of a fluid technique/viscera (which can direct movement into the uterus and its ligaments) towards the front rather than the back. On the bump, faster movement again move the uterus rather than slower articulations.

    Fluid health is about transition of fluids. Movement in the body causes pressure changes resulting in fluid pumping in and out of tissues and right down to the cellular level, increased fluid movement leads to more healthy body tissues. Fascial tightness or looseness (connective tissue) can govern the ability of fluid to move in and out.

    Bump rocking on hand and knees

    The woman is on her hands and knees, kneeling over a sofa or birth ball or chair, and the rebozo is wrapped around the bump and lifted gently prior to sifting. When lifting, ask for feedback from the woman so you can lift enough to take all of the weight of her bump from her spine. As well as providing relaxation and comfort, this technique can  help restore balance to the uterus and with the positioning of the baby during pregnancy or labour.

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    Teddy the osteopath‘s view of the technique

    This loosens all the fascial tension from the front to the back: abdominal fascia and muscles, viscera (organ) ligaments, lumbar muscles and fascia. The vibration provides more movement into the uterus and uterine ligaments and helps to take the tension off it.

    All the techniques in this article are a taster version of my Rebozo for an easier birth course. The course contains over 25 techniques for pregnancy, birth and the postpartum.

    I have also made this set of techniques available to download as a handy PDF, you can get it by scrolling to the bottom of the Rebozo for an easier birth course page.

    Watch the video below, where I show examples of more techniques included in the course.

    Play

     

  • Preparing for the postpartum : it works!

    Preparing for the postpartum : it works!

    In the West, after a new mother has her baby, the focus shifts entirely on the baby, and the mother receives very little support. This is not normal for our species to be in this situation, and everywhere around the world, there is, or used to be, a period of about a month post birth when new mothers were treated like goddesses, supported, fed, and nurtured by the community and didn’t lift a finger!

    I wrote my book, why postnatal recovery matters, to raise awareness about the lack of support new mothers get during the postpartum in the UK, and to offer practical solutions to change this.

    I suggested in the book that we prepare for the postpartum like we do for birth: by writing a postnatal recovery plan, using the four pillars of the postpartum (social support, rest, food and bodywork) as a blueprint.

    Since the book was published, and the feedback I have received, I can report that preparing for the postpartum is not only worthwhile, but it works!

    The message in the book is doing exactly what I hope it would do, which is help families prepare for the postpartum, get more support, and have a better experience all round. In fact it has gone further than my wildest expectations in how it has positively impacted families.

    It has also helped many families who didn’t have a great experience the first time have a much better one for their next one.

    It has not only transformed the lives of many new mothers, but it has also transformed how I support the postpartum myself, because I now talk about it antenatally. I have also run a lot more mother blessings (a mother centred version of the baby showers), during which I have asked people to pledge support for the new mother in the 4 pillars above).

    Here are some of the things that have been shared with me:

    • Several people have told me that, rather than buying gifts for the baby, they have decided to organise food deliveries for the new parents instead.
    • A new mother I’m supporting as a doula, and for whom I organized a mother blessing, shared that food parcels keep turning up on her doorstep.
    • “After reading the book, I felt much less guilty about letting other people look after me this time around”
    • “I am so grateful for someone finally voicing how I felt as a new mother, but couldn’t put into words myself. We are living in very different times from when (even) our parents gave birth, and the recommendations of this book could not be more relevant to new families now – and especially those struggling with loneliness and isolation due to COVID related restrictions.”
    • “I bought your book, read it and passed it on to my daughter. Wow! It has made such an impact on her as she plans ahead. As she suffers with OCD and anxiety, your book gives her the tools so she knows how she can plan ahead and manage others‘ expectations. For example she has made a list of ways in which supporters (as oppose to visitors) can help during the postpartum.”
    • “Reading it has made my recovery after having my 4th baby so much easier and relaxed. Without the guilt that I should be doing more. I also feel that my bond with my baby was better, I suffered with depression and anxiety which came on during pregnancy.”
    • “It helped me see what I could have done differently after my first child was born and made me feel so much more confident in preparing for number two. I had never even considered some of the ideas she presents for post-natal recovery, but after reading about them I realized that they sound like just what I need.“
    • “I ordered this book 3 weeks before my due date hoping this would help. I read it in 2 days and was able to action some of the advice straight away. I love that is it so readable and go to the point, and above all that is written in such a kind, gentle, non-judgemental way. It really helped me to reframe my expectations for these first few weeks/months after birth”
    • “Sophie Messager writes with such empathy for new mothers that I found her words hit me in a very raw place. She has put her finger on a particular type of pain that (in my experience) has gone unrecognised. Her simple validation that for weeks after giving birth, a mother needs and deserves rest, attentive care, reverence, good food, emotional and physical holding and nurturing by others and by society, is profoundly moving and not rocket science”

    If you want to learn more about this topic, I have a whole host of resources available:

    Free resources like my postnatal recovery plan template, and many blogs on the topics.

    My book, why postnatal recovery matters, which costs ÂŁ10 including UK postage.

    The book is also available in French (MĂšres nouvelles, traditions ancestrales : Restaurer les rituels de soin du post-partum), in Italian (Il Postparto,Cosa serve a una neomamma), and German (Was im Wochenbett wichtig ist).

    You can read why I wrote the book in this blog post. This page has all the clickable links from the book available for free

    My online course, How to prepare for a nurturing postpartum, is for birthworkers and families who want to take a more in depth journey in how to prepare, or help others prepare, for a nurturing postpartum. Read about what’s special about it in this blog post.

    And, because bodywork seems to be the most neglected aspect of the postpartum, I have created an online course on postnatal rebozo massage and closing ritual. You can read why I created this course in this blog post.

  • The last days of pregnancy, a place in between

    The last days of pregnancy, a place in between

    This article was written by midwife Jana Studelska, and originally published on the Mothering website. The original text is no longer available on the mothering website, so I have copied it here, as I like to share this text to my clients when they have reached their due date as it can help put soothing words on the complex feelings associated with waiting for birth.

    “The last days of pregnancy are a distinct time of in between. It’s a tricky time for mothers, and these last few days are a biologic and psychological event.

    She’s curled up on the couch, waiting, a ball of baby and emotions. A scrambled pile of books on pregnancy, labor, baby names, breastfeeding 
 not one more word can be absorbed. The birth supplies are loaded in a laundry basket, ready for action. The freezer is filled with meals, the car seat installed, the camera charged. It’s time to hurry up and wait. Not a comfortable place to be, but wholly necessary.

    The last days of pregnancy — sometimes stretching to agonizing weeks — are a distinct place, time, event, stage. It is a time of in between. Neither here nor there. Your old self and your new self, balanced on the edge of a pregnancy. One foot in your old world, one foot in a new world.

    Shouldn’t there be a word for this state of being, describing the time and place where mothers linger, waiting to be called forward?

    Germans have a word, zwischen, which means between. I’ve co-opted that word for my own obstetrical uses. When I sense the discomfort and tension of late pregnancy in my clients, I suggest that they are now in The Time of Zwischen. The time of in between, where the opening begins. Giving it a name gives it dimension, an experience closer to wonder than endurance.

    I tell these beautiful, round, swollen, weepy women to go with it and be okay there. Feel it, think it, don’t push it away. Write it down, sing really loudly when no one else is home, go commune with nature, or crawl into your own mama’s lap so she can rub your head until you feel better. I tell their men to let go of their worry; this is an early sign of labor. I encourage them to sequester themselves if they need space, to go out if they need distraction, to enjoy the last hours of this life-as-they-now-know-it. I try to give them permission to follow the instinctual gravitational pulls that are at work within them, just as real and necessary as labor.

    The discomforts of late pregnancy are easy to Google: painful pelvis, squished bladder, swollen ankles, leaky nipples, weight unevenly distributed in a girth that makes scratching an itch at ankle level a feat of flexibility. “You might find yourself teary and exhausted,” says one website, “but your baby is coming soon!” Cheer up, sweetie, you’re having a baby. More messaging that what is going on is incidental and insignificant.

    What we don’t have is reverence or relevance — or even a working understanding of the vulnerability and openness a woman experiences at this time. Our language and culture fails us. This surely explains why many women find this time so complicated and tricky. But whether we recognize it or not, these last days of pregnancy are a distinct biologic and psychological event, essential to the birth of a mother.

    We don’t scientifically understand the complex hormones at play that loosen both her hips and her awareness. In fact, this uncomfortable time of aching is an early form of labor in which a woman begins opening her cervix and her soul. Someday, maybe we will be able to quantify this hormonal advance — the prolactin, oxytocin, cortisol, relaxin. But for now, it is still shrouded in mystery, and we know only how to measure thinning and dilation.

    “You know that place between sleep and awake, the place where you can still remember dreaming? That’s where I’ll always love you, Peter Pan. That’s where I’ll be waiting.” -Tinkerbell

    I believe that this is more than biological. It is spiritual. To give birth, whether at home in a birth tub with candles and family or in a surgical suite with machines and a neonatal team, a woman must go to the place between this world and the next, to that thin membrane between here and there. To the place where life comes from, to the mystery, in order to reach over to bring forth the child that is hers. The heroic tales of Odysseus are with us, each ordinary day. This round woman is not going into battle, but she is going to the edge of her being where every resource she has will be called on to assist in this journey.

    We need time and space to prepare for that journey. And somewhere, deep inside us, at a primal level, our cells and hormones and mind and soul know this, and begin the work with or without our awareness.

    I call out Zwischen in prenatals as a way of offering comfort and, also, as a way of offering protection. I see how simple it is to exploit and abuse this time. A scheduled induction is seductive, promising a sense of control. Fearful and confused family can trigger a crisis of confidence. We are not a culture that waits for anything, nor are we believers in normal birth; waiting for a baby can feel like insanity. Giving this a name points her toward listening and developing her own intuition. That, in turn, is a powerful training ground for motherhood.

    Today, I am waiting for a lovely new mother named Allison to call me, to announce that her Zwischen is ended and labor has begun. I am in my own in between place, waiting. My opportunity to grow and open is a lovely gift she gives me, in choosing me to attend her birth.”

     

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

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

    (updated September 2021)

    Induction of labour is the bane of many birthworkers lives (and of many pregnant women’s too). In the area I live in, it is reaching epidemic proportions (about 35% of first time mothers)

    Deciding to consent to induction is a complex decision, one that should be fully supported, without pressure or coercion, so that  women and their supporters make a truly informed decision. Only it doesn’t happen. Most of the time, women just get taken for a ride.

    I need to give a disclaimer : I have no doubt that induction of labour is the right option when a medical situation (say, high blood pressure, or reduced fetal movements) means that doing something is probably more sensible than waiting. Because things are likely to only get worse if we wait. I get it. This isn’t what this post is about. I also have to warn you, if you are pregnant, before you read any further, that this might not feel like a pleasant post to read. I’m going to talk about what induction entails and depict it in a light that I know could be anxiety inducing.

    Now that this is out of the way, let’s look at the situations when induction might not always be the most sensible thing to do.

    1) Your baby is “late”. Being overdue is probably the top reason for unnecessary induction – and I have already written an extensive post about that.

    2) Your baby is “too big” is another very debatable reason. Women tend to grow babies who fit their pelvises. Pelvises aren’t hard, inflexible bony things, in fact they have lots of joints and ligaments (which are made extra flexible by the pregnancy hormone relaxin) and can open to let your baby out. Babies heads mold to fit inside the pelvis. So we can’t predict that the fit, short of doing a constant MRI scan during labour. There simply is no evidence to support the idea that a big baby won’t fit. Similarly, estimated baby’ size towards the end of pregnancy via scan or palpation is notoriously inaccurate. Evidence based birth has reviewed the evidence on big babies, and states that ” Research has consistently shown that the care provider’s perception that a baby is big can be more harmful than an actual big baby by itself“. You can read the full article here.

    3) Your placenta is “failing”- again there is no evidence to back this up. In this article, Prof Harold Fox states that ” A review of the available evidence indicates that the placenta does not undergo a true aging change during pregnancy…..The persisting belief in placental aging has been based on a confusion between morphological maturation and differentiation and aging, a failure to appreciate the functional resources of the organ, and an uncritical acceptance of the overly facile concept of “placental insufficiency” as a cause of increased perinatal mortality“. You can read this article here.

    4) You are “too old”. First time mothers over 40 get “offered” an early induction of labour. This is mostly due to the risk of stillbirth increases in older mothers. To quote the RCOG  scientific impact paper “The incidence of stillbirth at term in women is low. It is higher in women of advanced maternal age. This at 39–40 weeks of gestation equates to 2 in 1000 for women ≄ 40 years of age compared to 1 in 1000 for women < 35 years old.15 Women ≄ 40 years of age having a similar stillbirth risk at 39 weeks of gestation to women in their mid 20s at 41 weeks of gestation, at which stage the consensus is that induction of labour should be offered to prevent late stillbirth.” This means that the risk is stillbirth is still very small. It might not be an acceptable risk for you. But it still makes sense to balance those risks against those of the induction process, so you can make a truly informed decision (you can read a great review of the research on the evidence based birth blog)

    The thing that really gets my goat, though, is the lack of discussion on the risks of induction, and on what induction actually entails.

    maze

    What I see happen on a regular basis, are expectant parents being “booked in” for an induction at whatever random date (it varies between NHS trusts) their local health system has decided is the “right” time. They don’t realise this isn’t compulsory, they don’t realise they have a choice, and more worryingly, they don’t really understand what they are letting themselves in for. What bugs me most is that the lack of open, honest discussions itself goes against clinical guidelines.

    NICE states that

    “Healthcare professionals should explain the following points to women being offered induction of labour:

    • the reasons for induction being offered
    • when, where and how induction could be carried out
    • the arrangements for support and pain relief (recognising that women are likely to find induced labour more painful than spontaneous labour) (see also 1.6.2.1 and 1.6.2.2)
    • the alternative options if the woman chooses not to have induction of labour
    • the risks and benefits of induction of labour in specific circumstances and the proposed induction methods
    • that induction may not be successful and what the woman’s options would be.”

    In practice, yes, perfunctory discussions take place and leaflets are given, and health professionals rarely explain the realities of what induction of labour entails.

    Therefore parents consent to go in for induction thinking they’ll have the baby that day. They also do not have a real concept of the risks involving induction of labour (because usually the only discussion that took place covered the risks of not inducing only). Some of the risks are that induction either doesn’t work, or that the baby doesn’t cope with the drug induced contractions-in either case, a caesarean is then the only option.

    In my area, the rate of caesarean for first time mothers being induced is 45%. That’s nearly one in two. This stat isn’t usually given during induction discussions. I believe that if this was explained in a more balanced way (the way NICE recommends it above), more parents would probably choose to wait. What happens in practise is that people are told that induction doesn’t increase the chance of having a cesarean. Whilst some debatable publications from the past says so, in practise (I’ve been in this field since 2010), this doesn’t fit with the statistics produced by most UK hospitals. More recent published research like this paper, show what I’ve witnessed time and time again since I’ve worked in the birth field, which is that, for first time mothers, induction of labour roughly puts the chances of having a caesarean at 50% instead of the 30% for the average population).

    Induction of labour also carries other risks which are rarely explained such as explained below:

    Although induction at term could prevent rare cases of fetal death,” write Seijmonsbergen‐Schermers in the BJOG, “all induced women will be exposed to potential disadvantages. Women whose labours are induced have a higher risk of postpartum haemorrhage, uterine rupture, hyperstimulation resulting in fetal distress, and perineal injuries (Miller et al. Lancet 2016). Furthermore, more women need pain medication and have limited freedom of movement, a longer labour, and a negative birth experience. There is increasing evidence that suggests negative consequences of synthetic oxytocin administration. This may influence maternal–fetal bonding, the maternal psyche, and neonatal preparation on being born. A large cohort study found higher rates of jaundice, feeding problems, infections, metabolic disorders, and eczema up to 5 years of age among children born after induced labour (Peters et al. 2018).”

    After all, when it comes to postdates induction, even the Cochrane database states that  ” the absolute risk of perinatal death is small. Women should be appropriately counselled in order to make an informed choice between scheduled induction for a post-term pregnancy or monitoring without induction (or delayed induction).”

    One thing that isn’t explained in the NICE bullet points above, is how long induction can take. Yes, parents are told it can take days, but the discussion isn’t complete enough in my opinion.

    I often talk about continuums, or gauss curves, to explain how different we all are, and how variable our individual responses to certain situations can be. When asked about induction, I explain that for the majority of people it usually take 2 to 3 days, but that some people respond incredibly fast to induction, and that some may take up to 5 days (or more!).

    In my experience, parents are rarely told, for example, that because the ward might be busy, they might get admitted in the induction ward, only to get bumped off due to other more urgent cases jumping the queue. The record I have seen is 5 days. Yes you read that right. 5 days of restless hospital nights before the process even gets started. Exhausted before labour even begins. Nice.

    I have seen instances of women’s inductions being stopped half way through because the delivery unit was suddenly full.

    At the other end of the spectrum, I’ve also heard parents who responded to the induction faster than expectant, having the scary experience of birthing they baby on the ward with nobody supporting them.

    Don’t get me started on the Bishop’s score (an assessment based on how low, soft and open her cervix is), which is done prior to induction, in order to assess readiness for labour, and also to choose the best drug option for cervical ripening. Only the results of the assessment aren’t unusually shared with the woman. Yet, in order for the woman to make  an informed decision about her care (and even if the caregivers have little flexibility about options based on the results of the assessment, because an unfavourable cervix is usually followed by induction taking place anyway), surely some discussion should take place between the caregiver and the woman about the result of this assessment?

    I just don’t get it.

    Admitting that induction is started straight away, very few parents realise that the first line of induction, artificial prostaglandin, is usually something (especially if the woman is a first time mother and her cervix is “unfavourable”) that can take a loooooong time. 24h of propess (a kind of tampon like prostaglandin pessary), followed by up to 3 times application of prostin (a prostaglandin gel) 6h apart. We’re already 42h in the process and labour may not even have started yet. Assuming this has worked enough to soften and slightly open the cervix, then waters are artificially broken, and a drip of synthetic oxytocin drip is used to start contractions. It isn’t unusual after that for it to take another full 24h to reach full dilation of the cervix.

    During this time, again this is my personal experience, many first time mothers find the contractions caused by syntocinon (the synthetic oxytocin) more painful to cope with. Natural oxytocin comes in peaks and throughs with breaks in between whilst your own natural painkillers (endorphins) rise accordingly. With syntocinon you get a constant high hormone level in your bloodstream and often no break in pain between the contractions. And there is no build up of natural endorphins because the artificial oxytocin doesn’t cross the blood brain barrier.

    Because induced labour is more painful, more induced women end up with an epidural. This means that they are lying on their back, with no gravity, and a slack pelvic floor (no sensation means no muscle tone), which makes it harder for their baby to be in a good position for birth. Having an epidural double the chances of needing instruments or a caesarean to help the baby being born.

    So we are often looking at process that can take up to 3 whole days. Or more. And which in half of the time ends up with a caesarean anyway.

    So sometimes, I wish women where really given the option to opt for a caesarean instead of induction, or at least be told that they can say “enough” at any point and choose a caesarean instead.

    So when faced with the prospect of induction, how to do navigate the maze of options to decide whether to say yes or wait?

    right way

    Here are a few things you might want to think about before consenting to induction of labour.

    • Whether the risks involved continuing the pregnancy are greater than the risks involved in induction (risk is a very personal concept and you need to be fully informed to make such a decision).
    • That you are committing to getting this baby out once you start the induction process. Once you start you cannot back out, and a caesarean is recommended if the induction does not succeed or if the baby becomes distressed
    • That the induction itself creates risks that require further monitoring and interventions (in particular, the use of constant fetal heart monitoring is recommended rather than using a hand held ultrasound for intermittent monitoring).
    • That induction reduces your birth place options (no home or birth centre) and your ability to move around in labour.
    • That induction, as an intervention, significantly reduces your chances of having a straightforward vaginal birth.

    If you want to read more, Dr Rachel Reed has written an extensive article on the topic of the risks of induction, which includes all literature links

    Sara Wickham has written an excellent article about induction too, called ten things I wish every woman knew about induction of labour.

    Above all, remember that medical guidelines are based on an average of the population, so the same blanket policies are applied across the board, regardless of individual circumstances. You aren’t the population. You are an individual with your own personal individual history and risks, and your own personal preferences and risk perception.

    You deserve individualised care and true open discussions to make the right decision for you.

    Update September 2021.

    Two new aspects that one now needs to take into consideration:

    Since March 2020, partner’s access has been restricted. So I have supported women who went through several days of induction alone, without their partner or my support, and their partner was only allowed to join then when the last past of labour when they transferred to the delivery unit.

    Staffing issues which where already a problem prior to March 2020 have gotten worse, and therefore women get admitted to the induction ward, but often left there to wait for some days before the induction starts, or the induction process gets stopped half way through due to lack of space in the delivery unit. This has become such an issue that someone just published a paper about it.

    You might want to factor in these aspects in your decision making about whether to consent to induction of labour or not.

    Some families have choosen to take matters into their own hands and induce the labour themselves using castor oil. If this is something you would like to explore, I wrote a blog post that reviews the evidence about castor oil as a method of inducing labour.