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Sophie Messager

Category: Birth

  • Inducing labour with Castor oil : is it safe?

    Inducing labour with Castor oil : is it safe?

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

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

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

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

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

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

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

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

    what is Castor oil?

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

    How does Castor oil work?

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

    How is it taken?

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

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

    How effective is it?

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

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

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

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

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

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

    What are the side effects of Castor oil?

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

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

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

    What else matters when it comes to decision making?

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

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

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

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

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

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

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

    • Impact on support after the birth

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

    What are the possible disadvantages of using castor oil ?

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

    In conclusion:

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

     

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • How to have a positive birth in unpredictable times

    How to have a positive birth in unpredictable times

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    What if your labour is being induced:

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

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

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

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

    I will leave you with this quote from Sara Wickham:

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

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

  • Rebozo techniques for relaxation during uncertain times

    Rebozo techniques for relaxation during uncertain times

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

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

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

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

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

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

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

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

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

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

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

    Self-care technique

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

    Play

    Wrapping the shoulders

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

    Play

     

    Rocking the pelvis

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

    Play

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

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

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

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

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

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

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

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

    I get that.

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

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

    I get it. I am having doubts too.

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

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

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

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

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

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

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

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

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

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

    Independent midwives

    Antenatal and postnatal education

    Babywearing support:

    Pregnancy/postnatal exercise classes

    Mental health

    Free meditations/relaxation tracks/relaxation techniques

    Mental health professionas/organisations

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

    Breastfeeding support organisations

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

  • How a doula can support you if you are having a planned cesarean birth

    How a doula can support you if you are having a planned cesarean birth

    It’s a commonly held belief that there is no point having a doula if you are having a planned cesarean, and I want to debunk this myth.

    I too, once believed that I couldn’t justify charging to support a woman who was having a planned caesarean.

    There would be no on call period, no phone call in the middle of the night, no unpredictable length of birth care.

    Or would there?

    Last year I got called unexpectedly (as I was busy packing the car for a week end away) by a client, pregnant with twins, who was only in the 32nd week of her pregnancy. She said “they are taking them out now”. I abandoned my week end plans and made it to the hospital with 15 min to spare.

    I was also called by a woman who unexpectedly found that they were moving her cesarean a week earlier. She asked if I could come to the hospital immediately.

    I have also been hired just to cover the on call period for a mother planning a cesarean, just in case she would go into labour before the scheduled date.

    I have worked as a doula for 7 years, and having supported several planned cesareans births, I’ve learnt that there isn’t such a thing as predictability, and also that doula support can be just as needed, just as useful as it is for a planned vaginal birth.

    I’ve learnt that, as every woman who births vaginally has her own set of individual needs, so do women who are having a planned cesarean birth.

    So, if you are having a planned cesarean birth, you can benefit from the exact same support you get from your doula as you would if you were hiring her for a planned vaginal birth.

    Doula support is a three legged stool of support, emotional, practical and informational support.

    This support applies regardless of the way your baby is born.

    So what can a doula do to help you before, during and after a planned cesarean?

    Pregnancy-the preparation

    When you are having a planned cesarean ,there are still many aspects of what will happen before, during and after the birth to think about.

    Having someone at your side who knows the hospital system in and out and how to navigate it, and help you push for what’s important for you, is very valuable.

    It is very much like going to a restaurant : you need know everything that’s on the menu to make your choice. If you’re a vegetarian and I only offer you meat stew this isn’t a great option for you isn’t it?

    I once supported a friend who was very keen on having what is known as a gentle cesarean. Her local hospital completely refused to support her choices, so I suggested she might want to try another more supportive hospital. I pointed out that, as she was having a planned cesarean birth, she could go where she wanted. She ended up finding the perfect hospital and obstetrician and having a beautiful and empowering birth.

    Sometimes, women who prefer to have a planned cesarean for all sorts of very valid reasons, can find themselves having a battle on their hands to get this choice respected. Having a doula on your side to help you navigate your rights can be invaluable in this situation too.

    So knowing all the options and having help navigating them and knowing how to get what you want is what having a doula is all about.

    A doula can also help prepare you emotionally for what is going to happen which can help you feel more in control.

    She can help you plan for your recovery after the surgery and how best to manage life with a new baby post cesarean.

    She can help you access a whole network of medical and complementary practitioners too.

    Alex Heath, doula

    “Doulas definitely help clients to negotiate an elective cesarean in the first place. Using knowledge of hospital pathways, language and mindset to support them in asking for an elective cesarean if that’s what they want…”

    Pippa Moss, doula

    “Helping with any preferences/alternative birth plan. Letting their clients know there are “gentle” cesarean options they may not know about, optimal cord clamping, gown on back to front to facilitate skin to skin etc. Calming nerves before surgery”

    Kristina McKeown, doula

    “Being aware that as a doula you may be one of few people fully supporting them in their choice. There still a lot of judgement in choosing a cesarean birth and just having someone to talk that through can be really helpful.”

    Ceci Goldaracena, doula

    “My client was booked for a elective cesarean. ā€œPast Due dateā€ and with a preview cesarean. She could not have an induction. We worked a lot in the birth plan for a gentle cesarean. Went together to hospital that morning and started to work in keeping oxytocin and happiness in high levels. Turns out that after a couple of hours when the medical team was ready they did a last monitor and she was having labour contractions. We asked to stop the A plan. Lots of walks , stairs,dancing and laugh…baby was born that night naturally.”

    On the day-waiting for the cesarean

    When you get scheduled for a cesarean birth, you get told to come to the hospital at a certain time, without having eaten any food. It is not uncommon for the wait to be longer than expected-because emergency cesareans can take priority, so having a doula at your side whilst you wait can help you stay as calm and relaxed as possible whilst you wait.

    Sarah Budden, doula

    “My role was all about the before. I spent 5 hours pre surgery distracting – playing cards, talking about Homes under the hammer, looking at pictures of their first born, getting dad involved in some foot massaging. She was scared. I was there to make the wait less intense, to stop her legs from shaking and discharge some adrenalin.”

    During the cesarean

    Having a doula there means that there is a familiar, friendly face to keep you calm in theatre. Your doula can hold you whilst they place the spinal anesthesia. She can hold your hand during the surgery. The birth itself is usually quite quick, but the longest part is the stitching afterwards. Is you are having your baby skin to skin in theatre she can help facilitate this too, and even help you to feed your baby then if you wish to do so.

    Most hospitals have a one partner policy only, however hospital policies are only guidelines and should be adapted to the need of the birthing family.

    I have been present in theatre with a couple.

    I have also been present with the mother when there was no partner, and I have been present with the mother when it felt like the right choice for a couple (for example when the father felt uncomfortable being in theatre, or when the father needed to stay at home to look after other children).

    Nicola Collins, doula

    “I supported an elective as one of my first births and it was so calm and beautiful. I helped with putting birth preferences together and going to appointments. Worked through any worries and concerns she had before the birth. On the day she was fourth down and we just chatted and laughed and I reassured her and reminded her of the golden thread breath when she was a little anxious. She had a bit of a tricky start as couldnā€™t get the spinal working properly for 40mins and all I could be was a voice of reassurance and give her my support. Finally got going and section went great and I just kept talking to her and keeping her informed about what was happening. Then I got to take photos of the baby being lifted out which was amazing and then mama got skin to skin straight away and even baby had latched on just before we left theatre. Back in ward, I helped with anything that mum needed. Breastfeeding support, got her food and drink. Called her parents and kept them updated. Let her have a little rest and just sat with her while she slept”

    Claire Walker, mother

    “When I got pregnant with my twins I knew I would have a planned c-section due to an emergency c-section with my first daughter. I had no hesitation in hiring a doula as the emotional support on the day was what kept me calm and relaxed as I could be. Having someone that is just there to support you before and after who will listen and comfort you is priceless.

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

    Nuria Pozas, doula, from her client

    “Nuria who accompanied me was very helpful, caring and professional. Even though I had a cesarean she helped me all the way through specially with my fear and later on with my emotion. She was also a great support after the birth and gave me useful advice regarding to breastfeeding and newborn baby.”

    Beau, mother

    “I had planned a home birth but knew if my labour was anything less than ‘perfect’, I would need another c-section, so the presence of a doula was necessary (no other support was possible as both our families are far away). There was meconium in my trickling waters so I was sent to the hospital. There was no question about it – my doula, who had been with me since 2h after labour started, came with me (my husband stayed at home to be with our first daughter) and it was the most amazing experience because, unlike my husband, my doula wasn’t squeamish (obviously!) so I asked for the drape to be lowered and saw my baby come out. I didn’t have to keep chatting to my doula to prevent her from fainting, as I had done with my husband with our first daughter. She took pictures and films. Having a doula was a no-brainer in pregnancy, and it was the best decision ever considering how my birth panned outĀ šŸ™‚

    Emilia, mother

    “My decision to seek the support of a doula was driven by the fact that I wanted a vbac in the face of a number of ā€œrisk factorsā€ and to help me navigate and to support me through a medically complex pregnancy. The anomaly scan revealed that my son would be born with a complex health condition. After the diagnosis, my pregnancy became enormously stressful, requiring regular monitoring and checks, and involving the healthcare professionals who would be involved in my sonā€™s postnatal care strongly advocating a range of birth interventions that I had always intended to avoid. In the final month leading up to the birth, we came across more complications, which led to me reluctantly deciding that an elective cesarean birth was the safest mode of arrival for both me and my baby. My birth doula was incredible. She helped me research my ā€œrisk factorsā€ and the options open to me, knowing how important to me it was that my birth choices were well informed. I felt empowered and heard out, and although I was sad to abandon my vbac plans, with her help I felt at peace with my decision.”

    Immediately after the cesarean

    In the recovery room, your doula can help support you to to feel comfortable, look after you and help you to feed your baby. You will be having cannula in your hand still, and be hooked to equipment like fluid delivery, blood pressure monitors etc which can make handling a newborn a little trickier.

    If your baby has to go to the NICU (which can be more common with elective cesareans as they often occur earlier in pregnancy), then your partner can go with the baby, and this means that you aren’t alone in recovery. In this situation, your doula can also help support you to express colostrum to feed your baby.

    Recovery nurses will look after your vitals etc, but they won’t stay with you every minute of the few hours post surgery, and they won’t be a familiar face, someone you know and feel safe with. Your doula’s presence can help you feel more comfortable and safer. I have had women hiring me for this reason alone.

    Bryony Vickers, doula

    “Calming nerves after surgery. Having someone to sit with you in a dedicated way after you have had surgery is invaluable. I think women forget that they can feel not great after surgery. We can help to hold the baby, get skin to skin, help other parent with learning baby care – dressing, nappies, holding etc. Helping with getting food, drinks, with knowing what is normal, what will happen next.”

    Jo McCracken, doula

    “I was touched once when a client of mine had to have a section and, once she was in recovery, she did nothing but moan for me to be there. Finally a midwife came to get me and said, ‘We need you in recovery. She won’t listen to any of us’. When I arrived, she burst into tears and said, ‘thank goodness you are here now’. So, maybe, calming nerves after surgery too.”

    Emilia, mother

    On the day, we knew that only one birth partner would be able to accompany me into the theatre. Nonetheless, my doula was waiting for us in the lobby at the crack of dawn. Her presence helped to diffuse and lighten the atmosphere. I was nervously anticipating and looking forward to the birth rather than dreading it. Knowing what was really important to me, she was able to prompt discussions on the day. It had previously been agreed that my newborn would be taken away to nicu. We agreed that my partner would accompany him. The team agreed that my doula could enter once my partner left to take his place and to keep me company. She remained with me in recovery when I otherwise would have been left alone. She maintained contact with my partner and gave me regular updates on how my baby was getting on. She advocated for me with the midwives in recovery, passed me drink and food, talked to me, made me laugh. Having my birth doula made my pregnancy and my caesarean birth a very positive experience, despite it being complex, stressful, and not what I had wanted it to be, and I am completely convinced that it would not have been so positive if it wasnā€™t for her wonderful support and friendship.

    In the postnatal ward

    A few hours after the birth, once your vitals have stabilised, you will be transferred to the postnatal ward, where you will stay usually a minimum of 24h or so.

    Postnatal wards are often understaffed, especially at night, and it can feel very frustrating if your baby is crying and you can’t pick her up (you’re still immobile due to the spinal or epidural anaesthesia for a few hours), and if you ring the bell, it can take a while for someone to come.

    Having a doula supporting you there means that someone can help you with simple tasks like getting you a drink or a snack, passing your baby to you, changing your baby’s nappy, helping with feeding, and generally making sure you are comfortable.

    Sometimes the partner can do this, but sometimes the woman has no partner, or the partner may need a rest, or need to go home to look after other children etc, so having a doula there means that you won’t be alone whilst you cannot move whilst the spinal or epidural wears off. It also means that someone can be there to support you whilst you take your first wobbly steps or have your first shower.

    If you end up staying in the postnatal ward for a few days, then having a doula can also mean that someone can give your partner a much needed break, that your doula can hold your baby whilst you have a nap, or even bring you some much needed home cooked food.

    After the cesarean-at home

    When you get home, your doula can help you with settling in at home with your new baby (or babies!), helping you with feeding, with finding positions that feel comfortable to do so (feeding lying down can be a godsend for some post cesarean mums), and generally being a much needed extra pair of hands around the house,Ā  so you can rest, get to know your baby, and recover from the surgery.

    I have supported many mothers post cesarean, both as a birth and as a postnatal doula. This has taught me that, similarly to a vaginal birth, everybody’s experience of recovery is very widely varied. I have seen mums bounce around 3 days for cesarean looking pink and healthy, and also at the other end of the spectrum, mums having issues with retained placentas and/or scar infections which meant that their recovery journey was long and protracted.

    Partners usually only get a couple of week’s parental leave, and post cesarean mums are more likely to need antibiotics and have a longer stay in the hospital. On many occasions I have seen mums stay in the hospital for 3 to 5 days, so by the time they got home their partner only had about a week’s leave left. It can feel very scary indeed to be alone at home with a new baby when you are not only recovering from surgery, learning to look after a new baby, but also are more limited in your ability to get around (I’ve seen mums who lived in a remote areas getting very lonely as they couldn’t drive their cars for several weeks).

    Ultimately no new mum should ever be alone coping by herself in the first few weeks post birth, she needs aĀ  community around her to support her, and this is even more true for post cesarean mums.

    Kate wilson, mother

    Our doula, Candie, provided us with a huge amount of support both before and after the birth. She was with us in recovery and helped us to initiate breast feeding – which was so important after a traumatic experience with our first child. She then visited us at home and provided lots of support in helping us to adjust to life as a family of four. She supported me with breast feeding as Charlie had a tongue tie, she played with my older children and made sure I rested.”

    Georgia Wakins, doula

    “I supported a third time mum after a cesearean recently and there were lots of practical things I could help with for all three kids, but the most satisfying thing was the blissed out expression she had after I gave her a back and shoulder massage. The oxytocin and endorphins released with physical touch can be amazing for post-op discomfort, just like for labour.”

    If this resonates with you and you would like to work with me, head over here if you’re an expectant or new mum, or here if you are a birthworker

    Also feel free to signup to my mailing list to receive my newsletters by using the signup form at the bottom of this page

  • Rebozos, shawls and scarves : the lost art of supporting women through the childbearing years

    Rebozos, shawls and scarves : the lost art of supporting women through the childbearing years

    RebozosI was introduced to the art of using a traditional Mexican shawl called a rebozo to comfort birthing women at my doula course by Maddie McMahon in 2008.

    Whilst I developed my antenatal and doula career, in my usual, knowledge junkie style, whislst I learn to use the tool for myself, I decided to learn as much as I could about this magic tool by attending training.

    Over the my first few years as a doula, I pursued my knowledge further by learning from several doula colleagues (I am especially grateful to doula Bridget Baker who showed me how to properly wrap a rebozo around a pregnant woman’s belly during a doula UK AGM).

    I attended my first formal workshop with Stacia Smales Hill on rebozo use for labour and birth in 2013. In the same year I also attended a workshop by Rocio Alarcon called closing the bones, a postnatal massage techniqueĀ  which included rocking and binding with a rebozo.

    Frustration over long and difficult labours, and especially malpositioned babies led me to seek more specialist training,Ā  such as the rebozo for labour progress and malposition with Selina Wallis, micromovements with Francoise Freedman, and 2 iterations of different levels of spinning babies with Jennifer Walker and Gail Tully.

    As my experienced developed I also brought more focus towards postpartum support, and recently attended a workshop on healing diastasis recti with Birthlight which included many rebozo techniques.

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

    I started facilitating workshops around this topic because people asked me to. Repeatedly.Ā  At first, I refused, as I didn’t feel qualified or experienced enough. But after a few years of constantly using this amazing tool in my birth work and my antenatal and babywearing classes, and seeing howĀ the incredibly versatile such a simple piece cloth could be, and the miraculous experiences that ensued, I finally felt ready to start teaching workshops around this topic, because I had so many positive experiences I felt I needed to share this skill with others.

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

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

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

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

    I spent a few years believing that the rebozo use for labour was uniquely South American but I have since met a Somalian midwife who told me how they use their traditional shawl, called a Garbasar, in a similar way during labour.

    I trained a Moroccan birth worker in doing closing the bones, and she was surprised when she started offering the massage that women came forward and told her they’d had a similar treatment in the local hammam after birth (using the traditional Moroccan cloth called a Mendil).Ā  Tunisia offers a similar practise called a fouta massage (the fouta is a hammam towel, which is very similar in nature to the Turkish towel).

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

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

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

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

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

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

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

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

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

    After the birth she would have had a “baby moon”. Again this is something pretty much universal in the world-women the world around have been alleviated from household tasks and cared for by family members for the first 30 to 40 days postpartum. During this time they would rest so they could recover from growing and birthing their baby and get to know their baby and learn to care for them. Her birth attendants and the community of women would have come to feed her nourishing food, and close her bones and help her body heal from the pregnancy and birth by usingĀ  a combination of their hands, massage techniques and using the cloth to help move and bind her hips and abdomen to help them back into place. In the UK we used to have this practise called “churching” you can read about it hereĀ 

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

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

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

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

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

    Mexican and Chinese friends tell me that nobody wants to use the traditional shawl or carrier these days as only remote farmers or beggars still use them. And certainly my recent trip to Hong Kong showed me that it took less than 15 years for the traditional baby carriers to have been almost forgotten andĀ  superseded by more modern, yet less ergonomical, models.

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

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

    How fitting is it that my friend Awen Clement just wrote this poem, for me it sums up everything the use of the rebozo is about.

    “We are all weavers

    Life is a cloth
    our stories the threads
    carried across the warp by breathĀ 
    and memory
    Every soul
    unique in its tapestry
    with tangles unpickedĀ 
    and rewoven anew
    A rainbow of colour
    where our threads meet others
    and when we take our last breath
    love will weave the ends”

    (C) Awen Clement 2018

    You can learn more about rebozo and its many wonderful uses in my online course

  • The mother blessing -a mother centered alternative to the baby shower

    The mother blessing -a mother centered alternative to the baby shower

     

    Recently I had the privilege to organise a mother blessings for one of our local doulas who was pregnant.

    A mother blessing is an alternative to the “baby shower” were friends of the pregnant mother gather to give her presents.

    The big difference is that in the baby shower, all the presents are for the baby.

    In the mother blessing, it is the mother who is the center of attention, and the gifts are for her, not for her baby.

    It feels very important to me to facilitate such gatherings, because our culture focuses on the mother only has a vessel for the baby, and usually once the baby has been born, nobody focuses on the mother anymore.

    Therefore with the mother blessing we can help start a cultural shift towards a more mother centered culture.

     

    I have written before about what new mothers really need, and how much of a raw deal we get, once our baby has been born, our partner has returned to work, and we’re alone at home all day, trying to make sense of this new experience, whilst trying to understand the needs of this new life helpless being we have given birth to, whose needs come before ours, always. We’re not meant to be doing this without a support network.

    Organising a mother blessing does not have to be complicated. It can be simple yet beautiful and powerful.

    This is what we did for our doula sister:

    We sat in a circle with her.

    We sang to her

    We gave her a bead each to have during her birth and the postnatal period, and we said good wishes as we gave her our bead.

    We threaded the beads into a necklace, to remind her of her circle of sisters being there with her in spirit, holding her, through the birth of her baby and the early postpartum weeks.

     

     

    We boundĀ our wrists, in a circle, with some wool, then cut the thread, tied the individual bits around our wrists, and all agreed to keep our little wool bracelet until her baby was born.

     

    We readĀ poems about motherhood.

     

     

     

     

    We massaged her hands and feet with gorgeous scented oils.

    We gave her a candle and all took away little tealights to light when we would hear the news that her baby was soon to be born.

    We gave her a goody bag of nurturing gifts.

    And of course we shared some yummy food.

     

     

    It was simple, yet magical and powerful. It was, like birth, an everyday extraordinary event.

    She knew this was meaningful, and it was touching and special for her and all those involved.

    We reminded her she could call upon us after the birth of her baby for support and companionship, and we also offered to gather around her to give her a closing the bones ceremony after the birth of her baby.

    This is what Ceci wrote about her mother blessing

     

    ” Today my doula friends gave me a “mother blessing”, which is a day to share before the baby is born, like a baby shower but more focused on Ā mum, with food toĀ share, poems, songs, made me a necklace with beads and a wish of each one.Ā  They gave me a candle and they also got one each also for when I start labour. We also sat in cicrle, each one told me a few words and we were passing a thread that we all tied up on the wrist and that we will have until my daughter is born. They gave me massages and we laughed a lot! I am super grateful to have them and to have had this day for me”

     

     

    I would like to see the tradition of mother blessings to replace that of baby showers, I sincerely hope that it will help place mothers back were they should never have left, at the centre of the circle of support, with the reverence they deserve for bringing new life into the world.

     

     

  • Reflections on what I did in 2017

    Reflections on what I did in 2017

    In my last blog, I suggested you spent some time reflecting on what you achieved in 2017.

    Inspired by my favourite doula, Maddie Mc Mahon, review of the year (you can read hers here), I decided to blog about reviewing my year too.

    As you will see, one should really do what they preach because I had a very interesting experience doing this.

    I have many hats so I’ll break it down in sections: my doula year, my teacher/facilitator year, my personal development and self care.

    My doula year.

    This year I supported 8 families through birth and 4 through the postnatal period.

    As usual in the doula world, it was a rollercoaster of variations and unexpected twist and turns. There was a woman who had had a very traumatic first birth, and who ended up with such a speedy birth this time that I only made it 30 min after the birth. The birth was a beautiful healing experience for her.

    Then another woman went beyond 42 weeks of pregnancy and decided to have an elective caesarean, instead of the homebirth she had planned, because she said that with the lack of support and “risk” pressure from the hospital she didn’t feel she could go into labour naturally. This is one of my pet hates, the arbitrary induction for “postdates” and the pressure women are under when they reach 42 weeks of pregnancy. As a mother who birthed my first baby 16 days past 40 weeks, I feel very strongly about it. I have written about it before here , and in the light of new scientific evidence about the supposed “failing” of the placenta post term, I shall be writing about this topic again in 2018.

    I provided backup support for a doula supporting a refugee mother, who didn’t speak any English. This was a new experience for me, somewhat reminiscing of my visit to a refugee camp in the North of France a few months before. Gone was the softly-softly, gentle approach I normally favour. here is no room for that, when all you’ve got is to communicate is an translating app that mostly spouts gobbledegook, and pictorial birth plans. Yet I know we made a massive difference to this mother, providing her with the information that allowed her to birth her twin babies vaginally with no interventions, and also with much needed donated baby equipment, and contacts with other local mothers who spoke her language. It felt really good to do this.

    I found myself supporting a repeat client through a miscarriage, which whilst different from a full term birth, needed the same kind, and even more gentle and loving support, than for a full time birth. I accompanied her to hospital appointments, and provided much needed emotional support in a system that only went through the motions and never acknowledged her loss. As someone who experienced recurrent miscarriages myself, this is another area that I feel very strongly passionate about supporting. After the miscarriage had happened, I went to close her bones, and it felt really good to be able to offer her something that acknowledged and honoured her loss. I wrote a blog about how closing the bones can help with loss shortly after that.

    I supported a first time mother through a long labour which ended with an instrumental birth in theatre. As in many occasions before, the couple requested my presence in theatre. In this particular case both the midwife and the obstetrician thought this was a good idea, but the anaesthetist said no. This had happened to me before, and had always felt so wrong, because when a couple ends up with a theatre birth and it wasn’t what they wished for, they are often very distraught, and for their doula to not be allowed to carry on supporting them through this difficult moment is very upsetting for them (and for the doula). I had tried to raise this with our local head of midwifery in the past, without success. This particular birth spurred me to finally try to do something about it again. A few months later I met with the head of my local delivery unit to discuss it. The meeting was very positive, and he promised to discuss it with the consultant anaesthetist. I was hopeful. Sadly, the consultant anaesthetist said no. I have been present in theatre in this very hospital with a couple myself in the past, and I know other doulas who have, so I know it can be done. I wrote to the consultant anaesthetist asking for a meeting, but didn’t get a reply. In, 2018, along with Doula UK, I will take part in a campaign to try and make this change happen.

    Doulas often say that births come like buses, and this year I had my most unexpected experience yet, as I attended 2 births within 12h of each other. The odds of this happened were very small indeed. I am grateful to my doula buddies Ceci and Maddie, with whom we provided an awesome shared care doula team for the second birth, and I was safe in the knowledge that this client would be in good hands should I not be able to attend. As it turned out, both births were swift and straightforward, so I was able to attend both. It left me so high on oxytocin, that I only managed 4h sleep the following night before waking up for the day, and had the most amazing glow going for a few days. There is never a dull moment in doula life.

    This was a year of firsts for me, as I also started supporting a repeat client through a twin pregnancy (she hasn’t had her babies yet), this is a foray in a new territory for me, with a lot of heavy handed medical approach and many appointments. There have been quite a few scares during this pregnancy, and I am grateful for the fact that I am supporting this client together with my doula colleague Ellie. Having another doula to share support, especially when faced with a complex situation makes the work lighter and easier, and means that there is always someone at the end of the phone who “gets” it, someone to share ideas and concerns with. I’ve also been able to reach out to the wider doula community to access knowledge. It makes a world of difference. Doulas need the support of other doulas too.

    The last “first” of the year was supporting my first home VBAC. The birth itself was straightforward and the mother coped beautifully and got the birth she wanted.I hadn’t anticipated how anxious the midwifes attending her birth would be, and how keen they would be to try and transfer her to the hospital. Reflection is a very important skill for a birthworker, and it took me a few hours after the birth to understand what had felt so odd and uneasy about the atmosphere during the birth: the midwives were outside of their comfort zone, and it is amazing that the mother managed to labour so well within such a distrusting atmosphere. I feel that I was the only one there (apart from the mother and her partner) who trusted the process. Never in my 5 years as a doula have had ever had to do so much space holding and protecting, and been so utterly convinced that if I hadn’t been there, the outcome would have been completely different. Whilst on paper, the birth was straightforward, the protecting and managing the space left me completely wrung out, so much self care was needed afterwards.

    Early in the year, I became a doula UK mentor. I loved every minute of my own mentored doula journey and wanted to be able to give this back to the doula community. This year I had the honour to support 7 mentored doulas. I had expected to enjoy supporting them, but not how much more depth of knowledge of my own doulaing it would give me, and how much I would learn from my mentees. It has brought me much joy, and I have loved this new experience of reflection and self-development.

    I wrote 24 blog posts on topics ranging from birth to motherhood and I hope what I wrote helped women and birthworkers feeling empowered in making informed decisions. I also wrote blogs for other people and 2 articles for The Doula magazine.

    My teaching/workshop facilitator year.

    In 2017 I got to do a lot of something I love, facilitating workshops for birthworkers. I facilitated 34 workshops in total (Closing the bones, rebozo, babywearing peer supporter (one was with the local hospital NICU staff and one with my local nursery), and reiki workshops). I trained around 230 people. I travelled up and down the country (from Cambridge, to Peterborough, Bristol, Manchester , Sheffield, Liverpool, Brighton, Canterbury, and London (several times)). I meet some awesome people, and shared some incredible moments of connection. I also braved my ultimate nemesis which was driving through central London. I feel blessed to be able to do this.

    I also delivered a couple of conference presentations about using rebozos at a babywearing conference.

    I did several one to one babywearing consultations through the year, either as part of my doulaing or for a single one to one consult. It’s always a joy to witness the expression of joy on a new mother’s face when she realises she can meet her baby’s need for closeness effortlessly and get her hands back. I was particularly touched by a mother whose baby had a flat head, I suggested she visits my osteopath and I got a delighted thank you email later when the baby’s skull roundness had been fully restored.

    2017 also saw me develop the beta version of my online rebozo course to a group of early adopters. I thought I’d get about 10/15 people but 115 signed up, and I was totally blown away by the response I got (and to be honest, a little overwhelmed!). I will launch the live version of the course in the first quarter of 2018.

    I celebrated having trained 300 people in offering the closing the bones massage, and also launched a website dedicated to closing the bones, to spread the word further and help people find practitioners. https://www.closingthebonesmassage.com/. I hope this will help play a role in changing our culture’s attitude towards supporting women during the postpartum.

    I developed and launched the second level of the closing the bones workshop, called Deeper into closing the bones. I also started developing the massage table version of the technique, which I will launch sometimes in 2018.

    I also started an online rebozo shop at the end of 2017, something I’d sworn I would never do, as I’m more about services than products, but I had reached the stage where, having started selling rebozos at my live workshops only, there were enough people who knew I had them, and therefore I receive requests for them on a weekly basis, which was a time consuming process. My shop is a work of love, as I went to great length talking to suppliers to make sure the process is ethical. Have a look, there are some lovely stories (including videos) about the suppliers in there.

    My healer year

    Healing, with Closing the bones and/or Reiki is something I love to do, and this year there was plenty of this in my life too. I heard many harrowing stories and it felt good to be able to listen deeply and offer this powerful ritual to honour them. I got to treat a range of people, closing the bones in particular to women having experienced trauma or loss. I loved doing the massage 4 times on a new postpartum mum within 2 weeks of the birth. I taught closing the bones to a male doula (who had a fantastic healing experience from it). I usually incorporate Reiki into my closing the bones treatments, and I treated several people with alone Reiki too, and got to experiment with my new skills using the drum to channel Reiki.

    My personal development year

    Earlier in the year I set out that I’d like to attend a minimum of one day of personal self development/learning new skills per month. It’s interesting because until I wrote this post I didn’t think I had quite achieved that, but in reality I attended well over 15 days of training in 2017, which means that I beat my goal (I had no idea I had until I started writing this post!)

    I attended Sara Wickham’s post term pregnancy course, Gena Kirby’s cultured doula programme, an advanced spinning babies workshop with Gail Tully, Diane Garland’s waterbirth workshop, a Birthlight course on healing Diastasis Recti (which to my delight, included a lot of work using a rebozo), and a 2 day workshop on Closing the Bones with Rocio Alarcon. I also went to the doula UK conference, to a babywearing CPD on inclusivity, and to the annual doula retreat, were I made the most powerful and magical drum. I have using this drum for healing since, and even more so after training in the Reiki drum technique in September.

    My self care year

    I kept to my promise to myself of having a body work treatment after every birth, often within days of the birth, mostly with my osteopath and friend Teddy Brookes. I tried something new too: I had two floatation tank sessions, which I loved. I did several healing/massage skill swaps with my brilliant massage therapist friend Emma Kenny, who gave me some of the best aromatherapy massages I have ever had. I did some kind of meditation/Reiki self treatment most days too. I was lucky to be invited to a one day mini retreat called “nurturing the mama” run by two wonderful women, Jo Gray and Suzanne Morgan, who are both Reiki masters, therapists, healers and general awesome women. I had met them when they attended a closing the bones workshop. I feel very grateful for the people that my work puts on my path. And of course the 4 days doula retreat in North Wales in May, away from the hustle and bustle of the “normal” world, was the highlight of my self care year. Huge thanks to doulaĀ Selina Wallis for organising it!

    Another very important part of my looking after my soul, is that in 2017 I re-joined a community choir. I had spent 10 years in a Cambridge community choir before, but I hadn’t taken part regularly since my daughter had been born in 2009, so this was a big deal. Coming back to singing made me take stock and measure how much I’ve changed since my scientific career days, how much more in tune with my body am I. I also found the singing is such an important medicine for the soul, in a job as emotionally and spiritually demanding as doulaing.

    Sports wise, I kept to my normal regime of 3 swims a week. In April I joined an online fitness club called Rebelfit and started learning lots of new fitness techniques I had never done before, including playing around with kettlebells. I can now squat and do proper situps and press-ups, something I couldn’t do before. I also started experimenting with eating a paleo type of diet and mostly eliminated grains and dairy. I’m make exceptions to this regularly, but I notice I have much more energy when avoiding these foods.

     

    Writing all this, which I would probably not have done in so many details for myself if I hadn’t been writing this blog post, I’m oscillating between feeling very proud and feeling a little worried it comes up as boasty. I’m quite surprised that I have done so much because it really didn’t feel like it until I looked back. I’m getting a taste of my own medicine when I tell people to focus on their achievements. I’m quick to dismiss my own because I mostly focus on what I’m not yet doing, not yet achieving, against my own impossible standards. And yet, looking at it all written like this, this is rather a lot.

    Because I wrote this blog, I spent a lot more time than I normally do reflecting on how I work. It has allowed me to see pattern and things I want to do differently, and plan differently. It’s been a real eye opener. Who knew?

    I just took part in a live seminar on goal setting with my friend Charlie Ashley Roberts, from “your time to grow”. During the seminar, Charlie explained that only 3% of people write goals, 13% think about goals but don’t write them, and 84% of people don’t do any goals at all, yet research shows that people who set goals are much more likely to achieve them than people who don’t. I oscillate between the 13 and the 3%. My struggle is to find a good balance as I have such high standards, that I often use the goal tool to berate myself, to feel that I’m notĀ  good enough.

    I just received an email newsletter from Lissa Rankin, a brilliant American doctor/healer, and her it said this:

    “ Studies show that approximately 40% of people make New Years Resolutions, but only between 8ā€“19% of people actually follow through on fulfilling those promises two years later which means that 81ā€“92% of people who make New Years Resolutions wind up feeling like undisciplined losersā€¦”

    This year I’m planning to work more creatively around the goal setting thing, rather than making it a chore/or a stick to beat myself up with (I’m not finding bullet points type lists very exciting). I’m going to apply the principle that it’s best to do little and often, rather than setting unrealistic goals (for instance, committing to meditating 10 min a day is much easier than 30 min which I know I’m unlikely to do). I’m going to be playing around with a law of attraction diary and also meeting up regularly with a couple of friends to set goals together, starting with making a vision board.

    Mostly, I’m making the promise to myself to spend more time having fun with my work, than trying to stick to a rigid working schedule.

    I’d love to hear how you balance celebrating your achievements and finding the right balance in goal setting and work planning.

     

     

  • A tale of two VBACS

    A tale of two VBACS

    I wrote this blog with Sarala’s permission, and it is now featured on the Cambridge vbac friends blog

     

    Saralaā€™s two VBACs in the Rosie Delivery Unit and the Rosie Birth Centre as told by her doula