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

Sophie Messager

Category: choice

  • The Power of Persistence: Changing Illogical Rules within maternity care

    The Power of Persistence: Changing Illogical Rules within maternity care

    Twenty years or so ago, when I was swimming daily at my local public swimming pool, I managed to change the rules to allow the use of training fins.

    Prior to this, the pool had a blanket ban on the grounds of “safety”, whilst also allowing the use of hand paddles. Hand paddles are often made of hard plastic, and people use them ahead of them as they thrust forward, therefore they are, in my opinion, much more likely to cause a potential injury to another swimmer,Ā  than short training fins, which are made ofĀ  soft silicone rubber, and trail behind a swimmer.

    Keen to start improving my swim training drills by using fins, I discussed it with one of the managers by the pool side and he agreed to change the rules. Thatā€™s all it took, and I guess that not many people who use fins to train in this pool know how it got changed.

    Fast forward to today: about a month ago I joined a new gym/pool place nearer to my home. I went in as a guest of a friend who is a member and used my fins without issues. I decided to join because the pool, though not as nice as the private gym I had been a member of for year, was nice enough, much closer to my home, and much cheaper.Ā  It was only after I joined as a member that another lifeguard told me it wasn’t allowed, citing once again the safety risk. I challenged the ruleā€™s logic as someone was swimming in the same lane using very large hand paddles. I explained the lack of logic in terms of risks. But this lifeguard was insistent that rules are rules, and was not interested in engaging in logical debate, even inventing reasons on the spot to justify the decision (something Iā€™ve seen happen a lot in my work as a doula-more on that later).

    So I accepted that I would need to train without my beloved fins for now, since I had already joined this gym. However I also remembered my experience as the previous pool and knew that it was worth approaching the centre’s management. After all, I had nothing to lose by asking. I emailed the centreā€™s manager. Contrary to my 20 years ago self, I had grown in knowing that kindness often works better than bluntly pointing out the lack of logic in the rule. Instead, I expressed my surprise, explaining that I have been swimming for over 25 years in 6 different pools in Cambridge and that they all allow short fins. I also pointed out that I fully understood that not allowing the longer scuba style fins made sense in terms of safety (giving people a chance to see that Iā€™m reasonable), but that I could not see the danger of the type of fins I used. I also made sure not to mention the hand paddles as the last thing I wanted was for them to ban them too.

    Amazingly, the manager replied to me within a couple of days, agreeing with me and telling me that theyā€™dĀ  changed the rules. This morning I took great delight in bringing my fins to the pool. The delight went further than the fins themselves. I felt proud that Iā€™d managed to change a rule that made no sense. This also felt doubly important because the gym in question is part of my local hospital, the one in which I attended births and MVP meetings during my 10 years as a doula. I knew from experience that hospitals tend to be sticklers for rules.

    Beyond the fin story, what I feel proud about and why I am sharing this, is that it take not take much to change the rules, and it has benefitted many people. It only takes one person to change silly rules that would otherwise remain. I’m allergic to rules that do not serve humanity and have no joined-up logic behind them. Iā€™d like to encourage you to do the same.

    During my ten years as a doula, I also learnt that there are techniques that work better than other when trying to change rules, in order to avoid being met by the typical responde of “I’m obligated to operate within the boundaries set by the existing rules”. Here’s what Iā€™ve learnt from trying to change rules in my local maternity hospital:

    • Find a champion

    Itā€™s much easier to change things if you can find someone who works within the system, and who shares your vision for change. This is how I got to train the NICU nurses in learning to use baby carriers, after banging my head against the system for years. The same happened when an NHS trust hired me to train their midwives in using rebozo techniques for labour.

    • Use competitive pressure

    What helped me convince my local hospital to allow partners to stay overnight in the induction and postnatal wards, after banging my head against it without success, was mentioning the number of other hospitals nearby who were already doing it.

    • Stretch their minds

    When the subject of cord ties was brought up in an patient advocacy meeting, because doula clients were often meet with plain refusal (by people misunderstanding that guidelines are not the law, and always choosing to abide by ā€œthe rulesā€),Ā  most of the staff looked like we were crazy. I realised that they needed to stretch their minds a bit more, so I said ā€œand have you heard of cord burningā€ then spent a few minutes explaining what it was. After that they seem to think that the cord wasnā€™t so crazy after all. In the same way I have sometimes encouraged clients to ask for something outrageous that they had no intention of actually doing in their birth plan, in order to appear to be negotiating down. Iā€™ll never forget the expression on the face of the consultant when my VBAC client, pregnant with twins, told him she was thinking of having them at home.

    • Call their bluff

    I have helped several doula clients get offered something they were told was not possible this way. I was granted access inside the hospital with a repeat birth client despite lockdown restrictions only allowing one birth partner, by my client writing to them that sheā€™d stay at home instead of going to the birth centre if I wasnā€™t allowed in. I also had a client 43 weeks pregnant gain access to the birth centre by using the same strategy.

    • Pretend to follow the rules

    Iā€™ve found that if a pregnant woman says something like ā€œIf I havenā€™t had the baby by x date Iā€™ll have a caesareanā€ instantly removed the pressure of induction of labour. It doesnā€™t mean that you cannot change your mind again should said date comes and goesā€¦.

    I havenā€™t always been successful. On one occasion my attempt at changing the rules backfired. I was trying to encourage the hospital to change the illogical rule that only allows one partner inside the theatre. No doula was ever allowed in with her client and their partner (this rule was only bent once by a couple who were so assertive that they told staff they wouldnā€™t go in without me), and they used ridiculous claims of ā€œlack of spaceā€ (whilst allowing in students and private phlebotomists from cord banking companies), or ā€œsafety of mother and babyā€ (how exactly would a doula compromise this?). When I look back I could have gone about it in a more clever way (citing other hospitals doing it, and asking staff for the best person to talk to), and my discussions with the head of the delivery unit and the consultant anaesthetist resulted in not only no change to the rules, but a memo being circulated reminding everyone of the rule.

    It always baffles me when people follow rules without questioning them, or wondering if they are based on solid evidence, and simply do as they are told. I guess questioning things and tenacity are my blood. I also have a very strong sense of justice and deep aversion to rules that do not serve humanity or make no sense.Ā  I really like to support others in doing the same.

    With persistence, kindness and strategic approaches, we can all be change agents – questioning unreasonable rules and advocating for what makes sense and serves humanity.

    Does this resonate? Have you successfully changed rules, or banged your head against systems that refuse to change? Please comment below.

  • Why I created a podcast called The Wisdom Messenger

    Why I created a podcast called The Wisdom Messenger

    I just launched a new podcast. It took me a while to decide on the name because I wanted the name to reflect the eclectic range of topics that I intend to cover. I didnā€™t want to niche myself. Iā€™m a multi-passionate person with a multilayered, forever evolving business (the official name is a polymath but I find that term too dry), and therefore the podcast needs to reflect this.

    Iā€™m a sharer. I always have been. Itā€™s in my name after all, Sophie is the French version of the Greek name Sophia means wisdom, and Messager means messenger in French. If you know me you know I can talk the hind leg off a donkey. I share because I want to help make the world a better place. I started blogging in 2015 and Iā€™ve written about 200 posts, with an acceleration at a rate of a post every week or every other week since 2021. I published my first book, Why Postnatal Recovery Matters in 2020. The book has now been translated into 2 other languages, and soon will be available in a third. Iā€™m writing my second book about how drumming can support the birth journey and life transitions.Ā 

    For every person or family who reads my writing and feels heard, supported and helped by it, I feel Iā€™m achieving my soul purpose.

    Over the last couple of years Iā€™ve discovered that consuming knowledge via audio works better for me than reading, because I can listen whilst doing other tasks such as driving, or cooking. It has changed long boring drives into transformative moments. Iā€™ve got a Bluetooth speaker in my kitchen and it has transformed prepping meals from something tedious into something Iā€™m looking forward to. Iā€™ve listened to countless books and podcasts episodes, and itā€™s a great way to feed my ADHD hyper focus when it drives me to explore new topics in extreme depth.

    So it makes sense that I chose to share my stuff via audio too. I didnā€™t do it sooner because I didnā€™t know how and I thought it would be really complicated. Mastering new tech is my nemesis, and I often procrastinate for ages when an element of this is involved. I am very grateful for authentic business coach George Kao, because last week I started his new course called Interview Mastery, and it gave me the impetus to start the podcast.

    Once I started, I realised (this has been true pretty much every time Iā€™ve procrastinated over tech stuff) that the process was actually a lot easier and faster than I had expected. I like to compare processes to giving birth, with conception, gestation, birth and the postpartum (read my post about this here). I had a long conception and gestation, then the birth had some stop starts (mastering adding music to the beginning and end of the episodes took a lot of trials and errors, it felt like a stop start labour!), but in the end it was a fairly speedy, smooth and joyful birth. Iā€™m now basking in the afterglow of high oxytocin and dopamine.

    My signature approach, what I feel I am really gifted at, beyond sharing stuff, is bridging the scientific and the spiritual. I feel humanity is at a crossroad and unless we re-learn to become connected to each other, our inner wisdom, and the planet, we are headed for extinction.Ā 

    In this podcast I am going to share conversations with pioneers in womenā€™s health and personal development to reclaim lost knowledge and restore inner wisdom. I want to help bridge insights from ancient traditions and modern research, question stale cultural narratives and midwife a new paradigm around birth, life transitions, and womenā€™s autonomy. Expect stories and studies that empower women to reconnect with their inner voice and live their truths, to fully trust ourselves and shape our collective future.

    With this in mind, what better first guest could I have asked for than Jane Hardwicke Collings. Jane is a grandmother, former homebirth midwife for 30 years, a teacher, writer and menstrual educator and the founder of the school of Shamanic WomanCraft. Join us as we discuss how drumming can support the birth journey. Highlights of this episode include how making a drum can provide the medicine a woman needs during pregnancy birth and life; Janeā€™s own birth story and how drumming helped her experience an ecstatic birth; how drumming can help us communicate with our babies during pregnancy, and can effectively reduce pain during birth, and how it can help us connect with our great great grandchildren to know what do to now change the world to become a better place.

    My podcast is called The Wisdom Messenger, a literal translation of my name. You can find it on Spotify, Apple Podcast and YouTube.Ā 

    I would love to hear what you think of the first episode, and also please get in touch if you fit the description of my ideal guest and would like me to interview you.

     

     

    Play

     

  • Push back: challenging the alarming rise of non-medically indicated inductions

    Push back: challenging the alarming rise of non-medically indicated inductions

    A couple of days ago, I got a call from a woman in early labour. Her waters had broken a few hours before, and she was having mild contractions. She wanted to give birth at home, and was reluctant to let her midwife know about her waters breaking, because she knew that after 24h, there would be pressure to go to the hospital to induce labour. I reminded that it was her right to choose to stay at home, even if induction was offered. I also explained that she could either tell the truth (and be prepared to stand her ground), or chose not to, if having to argue during labour felt like too much.Ā 

    She went into established labour shortly after our call. When her midwife arrived, she told her that her waters had broken 3h prior. The midwife said that she needed to transfer her to the hospital immediately for induction because, she said ā€œyour waters are GONE and there is a high risk of infectionā€.Ā 

    This woman was a second time mum, and was having strong contractions every ā…” minutes at this stage. She refused to transfer, insisting she wanted to give birth at home. The midwife left shortly afterwards, saying that she wasnā€™t in established labour. Five minutes after the midwife left, the woman started to push. She gave birth at home in the end, and the midwife came back, but what should have been a beautiful and joyful experience left her feeling angry and stressed instead.

    The induction coercion

    Over the last few weeks, I supported several births even though Iā€™m not officially working as a doula anymore. People find me and I just canā€™t leave them without support in such a damaged system. Everytime I find myself supporting people, it is because they are being coerced by the system. In some cases I do home visits, officially to offer techniques for labour, but in reality I spend most of my time reminding people of their human rights.

    The women I supported recently were either ā€œlateā€ to give birth, having a long prodromal labour, or had their waters break before contractions started.

    What was the answer to all of these situations? You guessed it, induction of labour.

    What prompted me to write this was the extreme unusual circumstance of the birth in the intro paragraph. The midwife who turned up at her homebirth was adamant that she needed to go to hospital to be induced, but there was no clinical rationale to do so, even within the very tight hospital guidelines.

    In my nearly 15 years in birth work, I had never heard something as ludicrous. I suspect the midwife was a delivery unit midwife sent to cover for community midwives, and that she was not feeling safe supporting a homebirth. When this had happened in the past, and I saw spurious reasons used to suggest hospital transfer, at least there was some tiny something that was outside of guidelines, like an increased temperature 0.5 degrees over the upper limit. But here there was none, zero, nada.

    The rise of induction of labour

    When you have been around this field for as long as I have, you can see trends in plain sights.

    Birth centre rates are dropping. In my local hospital, when the birth centre opened in 2012, the goal was that 30 to 40% of all births would take place there. In 2014, the rate of labour started in the birth centre was over 30%, and 25% of births taking place there. Based on the last 3 years of infographics, the current birth centre rate is only 13%.

    Homebirth rates are also at an all time low. Before my local birth centre opened, the local homebirth rate was 6%. It is now below 1%. This is despite plenty of evidence showing that homebirth, for healthy pregnancies, is as safe as hospital birth, and with a much lower rate of intervention than in the hospital (90% chance of vaginal birth at home versus 58% in an obstetric unit, for the same category of low risk women). When the birth place study was published in 2012, I rejoiced thinking that we would see homebirths and birth centre births skyrocket. Instead, the exact opposite has happened.

    This means that 85% of births are taking place inside an obstetric unit, an environment completely ill-suited to supporting the physiology of birth. Bright lights, no curtains, noise, tiny cramped rooms with no ensuite bathrooms, and staffed by people who have become deskilled at supporting physiological birth.

    This also means that the percentage of women going into labour naturally is only 47%, the rate of vaginal birth is only 47%, and the rate of caesarean birth is 41%.

    We are in the midst of an epidemy of unjustified induction of labour. With the recently updated NICE induction of labour guidelines, it is only going to get worse. My local hospital had an induction rate of 38% in their last infographic, and with the new guidelines making induction happen earlier in pregnancy, because induction doubles the change of having a caesarean, it is likely to be over 50% within the next few years.

    Logically, it makes no sense.Ā  It is not biologically possible that less than half of women are able to start labour by themselves or give birth vaginally.

    Scientifically it makes no sense, because the main reason to induce labour is to avoid stillbirth, yet rates have remained the same over the last ten years, despite rates of induction in the UK going up from around 21% to 34% on average (the latest UK maternity statistic available are from 2021, I suspect itā€™s already higher than this now).

    The trauma induction causes

    Induction of labour is not a benign intervention.

    Recent research shows that induction can cause harm to both women and children

    • “Women with uncomplicated pregnancies who had their labour induced had higher rates of epidural/spinal analgesia, CS (except for multiparous women induced at between 37 and 40 weeks gestation), instrumental birth, episiotomy and PPH than women with a similar risk profile who went into labour spontaneously.
    • “Between birth and 16 years of age, and controlled for year of birth, their children had higher odds of birth asphyxia, birth trauma, respiratory disorders, major resuscitation at birth and hospitalisation for infection.”
    • “IOL for non-medical reasons was associated with higher birth interventions, particularly in primiparous women, and more adverse maternal, neonatal and child outcomes for most variables assessed.”

    Induction of labour can also be long, painful and traumatising. This isnā€™t explained to family when this option is ā€œofferedā€. Nobody explains that it might take 5 days and you have about 50% chance to end up with a caesarean at the end. Nobody explains the process in detail, and the fact that the hospital is so busy, that they often stop the process half way through because there is no space in the obstetrics unit, leaving women in the ward, in limbo, sometimes for as long as 3 days. I wrote about this in my article, Induction of labour, do you know what youā€™re letting yourself in for?

    Families Iā€™ve supported have sometimes gone home for 24h in the middle of an induction, so they could rest, because nothing was happening. They were told off for this, told this was dangerous. Yet they were just being parked there, to quote a local midwife, ā€œlittle cattleā€.

    How to push back

    The system is so unfit for purpose, and the level of coercion is so rife within it (itā€™s gotten much worse since 2020 and this was one of the reason I stopped working as a birth doula) that whenever families call me for support, I have to tell them how to counter coercion with extremely assertive statements, lies, or legal threats. This is so wrong.

    Educating yourself or people you support about your human rights, and reading or listening to people who look at the research and challenge medical guidelines, especially when they are harmful, can really help you feel stronger in sticking to what’s right for you.

    My blog is full of articles on the subject. I also love both Dr Rachel Reed, her midwife thinking blog, her book about induction, and her podcast the Midwives’ Cauldron (there is an episode where I talk about the postpartum), and also Dr Sara Wickham, her blog, newsletter and many books, including What’s right for me.

    A new model

    Change will not come from within the system. Reading the book Closure really cemented this. I am no longer willing to waste my precious time and energy trying to make change happen from within. I have given 10 years of my life to maternity patient committees. It was an incredibly frustrating experience. I used to feel bad because I mistakenly believed that things didnā€™t change because I didnā€™t work hard enough.

    I recently listened to podcasts from Australian midwife Jane Hardwick Collings. What is happening to women during birth, she said, is ā€œinstitutionalised acts of abuse and violence on women and babies masquerading as safety.ā€

    This really hit me hard. I had to pause and rewind and re-listen this sentence as I let it land. Because it felt so hard, and yet so true.

    In my work I have heard and seen it so many times. The coercion, the abuse, so many horror birth stories. I hold trauma from witnessing these. Itā€™s so ingrained that people inside the system do not even see it.

    Over ten years ago, traumatised by the second birth I supported as a doula, I read Marsden Wagnerā€™s paper, Fish canā€™t see water: The need to humanize birth in Australia. The paper was published in 2000, and yet everything he wrote is still true:

    Ā ā€œHumanizing birth means understanding that the woman giving birth is a human being, not a machine and not just a container for making babies. Showing women ā€“ half of all people ā€“ that they are inferior and inadequate by taking away their power to give birth is a tragedy for all society. On the other hand, respecting the woman as an important and valuable human being and making certain that the womanā€™s experience while giving birth is fulfilling and empowering is not just a nice extra, it is absolutely essential as it makes the woman strong and therefore makes society strongā€

    Tricia Anderson wrote her article, Out of the Laboratory: Back to the Darkened Room

    Ā in 2002, and her conclusion is also more apt than ever:

    ā€œSadly most midwives and doctors working today have trained and worked for most of their lives in that laboratory: and in that laboratory ā€“ which is of course, a modern consultant maternity unit ā€“ childbirth is a mess. In this day and age of evidence-based practice, we talk so much of the importance of evaluating every intervention. Yet, no one is saying that we desperately need to evaluate the biggest intervention of them all ā€“ asking women in labour to get into their cars and drive to a large hospital where a stranger takes care of them.ā€

    I used to try and make change happen from the inside, now my perspective has changed, I want to use my precious time and energy to facilitate change from outside the system. To help people stand up to institutionalised abuse. This is why I still support families, this is why I share rebozo techniques.

    When I receive quotes like these, I know I am making a difference:

    ā€œMy daughter is a week old and my wifeā€™s labour went like this: contractions started at 6am one morning and at 9pm our midwife came to see us and my wife was only 1cm dilated. She said baby wasn’t in a great position and that we would wait until morning to see how things were going. Before she left she mentioned about ‘rebozo’ which we had both never heard of.

    This led to us searching for the technique where we stumbled upon your website. A quick look at one video and a bit of information I attempted this on my wife. The next contraction she had we heard an audible clunk and her water broke. Contractions instantly got longer and stronger. This was about 10pm and 2 hours later we were holding our baby girl. Dan

    This is why I write articles like this one, or like The Myth of the aging placenta. This is why I am currently teaching about using shamanic drumming to support pregnancy and birth. Because once a woman has, through the change of consciousness that drumming helps facilitate, communicated with her baby repeatedly, she has access to her intuitive knowledge and power. She knows she doesnā€™t need a machine to connect with her baby, and is therefore not likely to let an ā€œexpertā€ stranger dictate what she should do.

    There is change brewing, and people are starting to take matters into their own hands. As my Chinese husband says, when you push the pendulum too far one way, it always swings back the other way.

    I invite you to look at things from a birdā€™s eye perspective, and ask yourself: what can I do to facilitate a shift. I would love to hear your ideas.

  • How to choose and buy a shamanic drum

    How to choose and buy a shamanic drum

    In this article I want to share the options available if you’d like to get your own frame/shamanic drum. There are many options to choose from and I hope I’ll make nagivating that decision easier for you!

    As I created the content for my Drumming for Birth course, I had one of those beautiful “aha” moments while explaining how to choose a drum. You know those times when you suddenly realise just how much expertise you’ve accumulated, but you did not know until you stopped to reflect on it ? As someone with ADHD, one of my superpowers is the ability to hyperfocus on subjects that fascinate me – and drums have certainly been one of those subjects! 

    At the time of writing this, I own over 30 drums. I’m going to tell you about the categories, the pros and cons of each, and how much a drum cost to buy, including some real unexpected bargains. I’m also going to tell you about what to avoid.

    The type of drums I use are frame drums. One of the oldest known musical instruments, frame drums are found in various forms across many cultures worldwide and play significant roles in spiritual or ceremonial contexts. They are sometimes referred to as shamanic drums. A frame drum is a simple percussion instrument, typically circular in shape, consisting of a round wooden frame 2-4 inches deep, with a single drumhead stretched over one side. They can be played with the hand, or with a beater. The drumhead is traditionally made from animal skin, but synthetic materials are also used. The skin is usually secured to the frame with lacing. Frame drums produce a warm, resonant tone and are capable of a wide range of sounds, from deep booms to crisp, high-pitched tones.

    In my work I use frame drums with a handle, the kind that is played by hitting it with a soft beater.

    Frame drum categories:

    Frame drums come into 2 main categories: the ones that are made of animal skin (known as hide), and ones that are made of synthetic skin (plastic material, or sometimes canvas type fabric). 

    Size matters: the bigger the drum, the deeper the sound. As a rule of thumb, I would suggest you start with something no smaller than 14 or 16 inches for a good sound. Tiny drums do not usually sound great. Really big drums  (20 inches and above) have a beautiful deep sound by they can be unwieldy to carry and hold.

    Synthetic drums

    I have 2 main synthetic drums: A 16 inches Remo Buffalo drum (A misnomer as the drum is made of a synthetic skin) and a 16 inches Remo Bahia Bass Buffalo drum (it has a deeper sound than the normal Remo Buffalo). I also have a couple of synthetic Kanjiras (a small Indian drum with a jingle), and a small 8 inches hand held synthetic Remo which I mostly use for travel.

    Synthetic drum Advantages

    • Good, reliable sound (this applies only to reputable brands, see below on what to avoid)
    • Sounds remains the same regardless of weather/water/temperature
    • If you play outdoors like I do, and live in a cold and wet country, youā€™ll be grateful to have a synthetic drum. You can play it in all weathers, even in the pouring rain, without the sound being affected. I’ve even taken mine inside sweat lodges and saunas.
    • These drums are typically cheaper than a skin drum, a Remo Buffalo Drum costs about Ā£115 for a 16 inches drum

    Synthetic drum disadvantages

    German company Thomann has sound samples of Remo drums (and many other drums) on their website. 

    Drums made from animal hide

    I own 24 different skin drums, 7 of which I made myself in drum birthing workshops or on my own, and the others I bought or received as gifts.

    Skin drums advantages

    • Unique, beautiful, individual drums
    • Handmade by cottage industry businesses or with your own hands
    • Unique spirit and energy (and different hides from different animals, each with their own unique energy)
    • You can buy them ready made, have them custom made, or make them yourself to your own preference and style (including adding symbols, crystals, painting them etc)

    Skin drums disadvantages

    • The quality can vary a lot & there are fakes (more on that below)
    • They are sensitive to weather, moisture & temperature. In winter you need a fire to warm them up if outdoors or in cold weather
    • They can get damaged by heat or moisture (you cannot play them in the rain and you have to the careful not to leave them somewhere hot, for example in the car)
    • Because they are handmade, they tend to be pricey (from Ā£150 to Ā£300 or more)

     

    I have skin drums from the following makers, and I trust and recommend their work:

    There are many other makers of drums both in the UK and around the world. Ask for recommendations and see whose work you resonate with.

     

     

    One affordable skin drum option I often recommend is the Irish Bodhran. Whilst it is not officially designed as a shamanic drum it works perfectly for that purpose (read my article where I share how I overcame the misguided idea that there was only one right way to play this drum). A bodhran usually comes with a wooden stick called a tipper, and youā€™ll need a soft beater instead but these are very easy to make (a foraged stick and a stuffed sock or piece of felt attached to the stick with a string or elastic, or watch this video). Or you could buy a beater to go with your drum. Drum beaters come in factory or handmade versions. There are plenty of handmade ones on Etsy.

    My first drum was a Bodhran, bought by my parents in Ireland from the oldest bodhran maker in Ireland, Malachy Kearns, and gifted to me. Malachy Kearns bodhrans start at 130 euros, however I have found such bodhrans available second hand on Ebay or Facebook marketplace for as little as Ā£30 to 40. Another well known bodhran brand is Waltons. Just make sure to buy one that is a decent size, at least 12 to 14 inches.

    When it comes to acquiring a skin drum, you can either buy one ready made, have something make a custom drum for you, or (the ultimate experience in my opinion), attend a workshop with a skilled drum making teacher, and make your own. When someone makes a drum for you, or you make your own drum, this drum carries the medicine that you need.

    Size matters

    With any drum, the bigger the drum, the deeper the sounds ( though I have sometimes seen smallish drums with surprisingly deep sound). For a starter drum I recommend something between 12 and 16 inches diameter. Really big drums (20 to 22 inches diameter) have beautiful, deep, resonant sound, but they can be tricky to hold and carry.

    A few other people I have either seen drums made by (some run drum birthing workshops and also sell kits to make your own drum)

    General instruments shops that sell drums and other musical instruments in the UK:

    A list of makers recommended by knowledgeable friends (but I haven’t seen these drums myself)

    What to avoid when buying a drum

    Quality matters. If at all possible try to listen to the sound of the drum before you buy. There are many cheap drums on Amazon for example, which are poor quality. They would be ok for a small child to play with. I was surprised when visiting Djoliba, a big percussion shop in Toulouse, France, to see a tiny drum cost more than some much bigger ones. The shop keeper explained that the tiny one I was looking at was handmade by a very well known drum company called Cooperman in the US, whereas the shelf of bigger drums I was looking at where factory made in India.

    Sadly there are also fake drums. A lot of whatā€™s sold on Facebook ads, Ebay or Amazon are often fakes/copies of real drum, made in China. People simply copy the artistā€™s pictures, and print and glue them on a plastic drum the size of my hand. Because they use the real artist pictures in the listing, what you think you’re getting and the reality are completely different, The drums made by Velenslav Voron for example, are so distinctive in style that I  instantly recognised one of his designs on a Facebook ad for Ā£30 on Facebook. I knew something wasnā€™t right, so I contacted him and he told me about the stealing of pictures, and the cheap copies, and about not being able to do anything about it because if he reports a shop, another shop pops up the next day. A friend bought such a drum and she sent me pictures of a crappy plastic drum not even good  enough for a child, with the picture and surrounding tape peeling off. Currently you can buy drums that look like the Shaman Drums from Ukraine for under Ā£10 on Aliexpress.  Remember: if itā€™s too good to be true, it probably is.  Get recommendations, and if possible, get to see and try before you buy.

    I hope this is helpful, and if you end up buying a drum with the help of this post Iā€™d love it if you posted a picture of your drum in the comments

    Happy drumming!

    If this speaks to you and you’d like to find out more about the work I offer with the drum, from one to one work, to healing, drum circles, workshops, and courses, you can find out more on this page.

    Or you find out more about how drumming supports your wellbeing in my new book, The Beat of Your Own Drum (the link includes a free sample chapter).

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

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

    I just finished the book ā€œClosure: How the flagship Albany Midwifery Practice, at the heart of its South London community, was demonised and dismantledā€ by Becky Reed and Nadine Edwards.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Riding the phoenix: Navigating Perimenopause, ADHD, and Emotional Rollercoasters.

    Riding the phoenix: Navigating Perimenopause, ADHD, and Emotional Rollercoasters.

    If you follow me youā€™ll know that Iā€™ve navigated more than my fair share of challenges over the last couple of years.

    Iā€™ve supported one of my children through severe mental health issues, Iā€™ve navigated the ups and downs of perimenopause, and I discovered that I have ADHD (I got formally diagnosed a couple of weeks ago and I plan to write another post about this). Itā€™s not been an easy time to say the least. When I look back I can see that Iā€™ve experienced chronic stress for 2 years.

    And yet, I also want to know that these challenges are somewhat linked and have all the hallmarks of a rite of passage. And that, despite the challenges, I already know that when I fully come out the other side, I will be happier than I was before. In my case, the growth has been commensurate with the level of pain.

    A couple of weeks ago I attended a talk about ADHD and women. One graph in particular drew my attention. It showed the peaks and troughs of hormones during perimenopause. It lookedĀ  like this:

    The messy ups and downs of hormones in the middle made me think: no wonder my world is in chaos. The chaos isn’t just outside of me, itā€™s inside as well! It reminded me of my experience of puberty, and also of the first few weeks of postpartum (where I also had big emotional ups and downs, and terrible night sweats).Ā  The messy hormone curve has all the hallmarks of a rite of passage,Ā  where there is no solid ground beneath your feet, where you no longer know who you are, where you have to face the scariest monsters, and where who you were, literally, has to die, to give birth to the new you.Ā 

    Added to that, over the last year, my ADHD symptoms increased to a level that has made daily life very difficult. I felt constantly overwhelmed, because within 5 min of getting up I would see ALL THE THINGS that needed doing, and be unable to prioritise them. For example Iā€™d start making coffee, then see that the dishwasher needed emptying, and on the way to that, that the dogā€™s water bowl needed refilling, that the recycling bin needs emptying, and I would start each task without finishing it, moving to the next and so on. This video illustrates the issue so well! I was aware that I was doing this, but unable to stop myself. I also got woken up several times a night, with night sweats and a racing heart. This would trigger anxiety, as I worried about all the things I wasn’t doing, this would often keep me awake for an hour or more.Ā  I would then wake at 5am with the anxiety mindset, and would not be able to go back to sleep So on top of the low mood, anxiety and overwhelm, I also felt exhausted. How Iā€™ve managed to keep the wheels on my small one woman self-employed business is unbelievable.

    I truly believe that everything is linked. There is evidence that the hormonal changes of perimenopause exacerbates the symptoms of ADHD. It certainly was the case for me, as my symptoms didnā€™t become unmanageable until last year. However, since I started reading about neurodivergence and discovered I have ADHD,Ā  when I look back, these symptoms had been rising steadily since I started my perimenopause journey in 2012.

    Hindsight is a wonderful thing, but I feel that one of the big issues is that we no longer have rites of passages accompanying huge life changes. Just like puberty or becoming a mother, perimenopause is completely unsupported from a community and spiritual point of view, and seen only through a pathological lens.

    Over the last year, on many occasions, I have felt such empathy for what I describe happens to new mothers, in my book, Why Postnatal Recovery Matters. The need for community support, for rest, for good food (provided by others), and for nourishing bodywork have felt so relevant. I have felt such longing for this myself, and often fantasised about what my life would be if I lived in a close knit community of women. I believe the same needs apply during the perimenopause, as well as during any other big life transition times. We simply cannot do it alone.

    When we no longer have the support of our community to help us navigate big life transitions, we suffer. When our culture is blind to the need for support during these times, unable to see it for the transformation that it is AND when our culture also depicts the transition in negative terms only, then we are completely lost at sea.

    To ride those big transitions, we need to be supported by groups of people who have experienced them, and who can support us through it from a place of gentle understanding and holding. Sadly, the generations before us have also lost this knowledge too, and there is therefore very little holding available. Nobody even remembers that it is a thing!

    Even deep into the depth of the challenges, I felt that the discomfort, the stripping, were all clearing me for something new.Ā  times for the last year or so, as Iā€™ve had to undergo more growth, at a faster rate than Iā€™ve ever had in my life. I already feel how much spaciousness, openness and tolerance this growth has given me. Itā€™s made me aware of unhelpful patterns in my brain, and as I am aware of them, I am no longer run by them. Starting microdosing was instrumental in this, and so did working with a neurodivergent coach.

    This doesnā€™t mean that there hasnā€™t been deep pain and a desire to escape it all. As I write this I am aware that a lot of the pain, as it was in those first few weeks of motherhood, stems from wanting my life to be like it was before. The pain is caused by resistance, and by a desire to run away from the pain. When I sink into it, when I stop fighting it, itā€™s never as bad as I feared.

    But, similarly to the fact that I, and many of the new mothers I have supported as a doula, struggle to adjust to the slower pace of new motherhood and often run themselves ragged by trying to do all the things they did before had a baby (Iā€™ve heard some many new mothers say ā€œIā€™m not doing anythingā€), so too does my pain stems from refusing my bodyā€™s demand for slowness and rest (which I know is easier said than done as a busy mother of special needs children, but still: the deepest pressure was the one I created myself)

    In the book Second Spring, Kate Codrington talks about the possibility of a menopause gap year. Since the beginning of my perimenopause 10 years ago, I have longed on many occasions to run away from the demands of family life, and entertained dreams of living in a commune of midlife women, tending the land and doing simple crafts. I have longed for peace, and for a slower pace of life, connected to the land and to a community of like minded people.

    I think thatā€™s where the lack of support from society has been the hardest. How on earth are we supposed to pause, to find space for peace and rest, in the midst of the demands of family life in the Western world? I also cannot help but wonder if motherhood later in life (my children were born when I was 35 and 39 and I’m 53 as I write this), means that I have teenagers, when ideally by now they would have already flown the nest and I wouldnā€™t need to provide so much care?

    If we lived in tribal society, or at least in medium sized communities of people who knew each other, then I imagine that 1) there would be elders who would understand, help understand, and support the process 2) the chores and demands of family life would be shared, this would lighten the load AND meet the needs for human connection, making this time feel easier on so many levels.

    Instead of the support, not only have I had to undergo the transition with neither map nor support, but the added mental health challenges of my child have made an already difficult time unbearable. Itā€™s perhaps no wonder that, now that I am finally out of a deep crisis and survival, my body has collapsed.

    The thing is, you cannot ā€œcureā€ the rite of passage. You just have to go through it, whether you like it or not. My tunnel has been long and dark and every time I thought I was finally due a break, something worse happened instead.Ā 

    In March we got the news that the funding for my youngest child to attend the small nurturing specialist school I spent 2 years fighting for, was successful. Instead of feeling better, my system crashed. I spent a night in A&E in the worst pain I had ever experienced, and a CT scan showed a kidney stone. I then concussed myself because I fainted due to the pain and hit my head,Ā  and had to spend a week in bed instead of going on the beautiful, much overdue holiday I had booked for my family to celebrate. Then for most of April, I felt the worst mood swings, tearfulness and exhaustion I had ever felt. I would go to bed at 8h30 and still waking up tired. I felt joyless. I became so tired and fed up with feeling like this. I desperately needed space to breathe, and feel like my normal self again. I longed for peace and calm.

    I recently got diagnosed with ADHD, but even with the right to choose route, I am now on a 6 month waiting list before I can start titration (and Iā€™m not sure ADHD drugs are something I want to take for the rest of my life either, having tried some already, read about this here). My GP ordered a bunch of blood tests, and suggested I try HRT. My first response to this was a complete no, because I feel that using drugs that put a lid on symptoms doesnā€™t resolve the underlying issue. My instinct also told me that they may prevent the spiritual development that goes with the drop in hormones.

    However, over the last 10 years Iā€™ve tried many different holistic approaches (and one less holistic): I’ve worked with 2 herbalists, I’ve tried CDB oil and many other supplements, meditation, acupuncture, homeopathy, family constellations, counselling, coaching, EFT, MAP, microdosing, antidepressants, emotion doodling, and more forms of bodywork and healing that I care to count (somatic massage, thai massage, reflexology, osteopathy, lomi-lomi, bowen, Rolfing, TRE, sound healing, Reiki, and more). They all provided some healing and some respite, but I was now in a place where none of these holistic approaches seemed to be enough anymore.

    I also developed regular weekly nurturing practices (all of which I can now see are dopamine raising activities), such as wild swimming, drumming in nature, and 5thythms dancing. When I started doing these, and a for a few years, they had a deep transformative effect on my wellbeing, and brought me calm and joy. Today, they still sustain me, and are an important part of my wellbeing, but somehow arenā€™t enough to keep me in a place of trust and peace.

    I had a chat with my neurodivergent coach, and she said that I wasn’t just coping with the menopause but with a lot of other challenges at the same time. She said that I could try HRT and see if it worked for me, and this was useful as I think I felt that it was all or nothing. In 2022 I tried antidepressants and hated it, and I thought this might be worth a try, at least to know if it helped or not.

    In my typical fashion (thank you ADHD hyperfocus!) I researched HRT deeply prior to the appointment with my GP to discuss it. I joined groups, I read books and articles, I spoke to a lot of people. One of my fears was that it would stop me from undergoing the spiritual development that comes with the menopause. I reached out to menopause mentor Kate Codgrinton, as Iā€™m reading her book, Second Spring. When I mentioned my concerns, she said that some women found that the HRT sometimes helped their spiritual growth, giving them more time and space to put helpful practices in place in their lives. In Second Spring there is a section about HRT, and it fits with what I believe. Menopause, Kate says, is a caterpillar to butterfly process. The hormones support can help you stay a strong caterpillar but not support you to become a butterfly. Reading this, I realised that I needed to be a strong caterpillar for my family at the moment.

    My fears alleviated, I decided to give HRT a try.Ā  I started taking it last week after researching the different forms (I choose to have the estrogen gel and micronised progesterone. I particularly like Dr Newsonā€™s prescription guide to HRT). I could feel a difference within 3 days of starting the estrogen gel, with improved mood, sleep, and energy.

    Just as Iā€™d hoped, a week on, not only do I feel calmer and happier and have more energy, I also have enough spaciousness inside of me to start looking at my life and putting things into place to feel better. I spoke to my coach about things I could do to improve my mental health and she suggested I make a jar with activities I can do when I feel low. She said when you feel stressed you cannot think. I made the jar there and then (when before the idea of having another task filled me with dread), and I was surprised by the list of ideas I wrote (once I got going I realised that I had a lot more ideas than I thought. You can find my list below.

    The re-regulating / grounding jar list

    • Go for a walk (with the dog)
    • Cuddle/play with the dog
    • 5 min dancing (Use Tankwa Town track which is like a a short 5rhythms wave Danielā€™s joik track, or the Double Touch trackĀ  depending on mood and need)
    • Craft something (even if only for 5 min)
    • Doodle how Iā€™m feeling (draw a person with thought bubbles)
    • Go to the river (swim or just contemplate)
    • Sensate break (10 min)
    • Self Reiki (10 min)
    • Drum (10 min)
    • Rebozo self massage (5 min)
    • Meditate (5 min)
    • Breathe slowly (5 min)
    • Smudge myself and/or my space
    • Sway hips (5 min)
    • Breathe against a wrapped rebozo
    • Notice things I can see, smell, hear
    • 5 min gratitude (think, write, or speak)
    • Take some rescue remedy sweets (easier to consume mindfully)
    • Diffuse or sniff uplifting or calming essential oil blend
    • Walk bare feet on the earth
    • Touch trees/plants

    If you want to create one for yourself, feel free to be inspired by my ideas, but make sure you add stuff that works for your unique self too. And remember that, if you pick a paper in the jar and you don’t like it, you can put it back and choose something else!

    Time will tell if it works, but writing the list uplifted me, as I realised I have more options/knowledge than I thought, and I also noticed that these activities are more likely to work for me than a list written by a stranger.Ā  Youā€™ll notice that a lot of the activities are short. This is because when I feel low, I have resistance to doing anything, and Iā€™m more likely to want to do something that takes 5 min than 20. Incorporating micro habits like this in my life feels do-able. And more importantly, it also feels like something that can bring restoration to my life in real ways, rather than waiting for something that takes a couple of hours like a massage.Ā 

    I hope you find this useful and helpful if you are experiencing similar challenges. I would love to hear about your experience.

     

  • The importance of switching off when you work for yourself

    The importance of switching off when you work for yourself

    I’ve been working as a solopreneur for 10 years.

    The first year I went away on holiday, as a newly self-employed birth worker, I noticed that I was still responding to work emails, something I never did when I was an employee. I didn’t resent it but I was very conscious of the difference. As an employee, I used to truly switch off when I was away, and I rarely worked outside of my contracted hours.

    Sure, in my pre-parent years whilst working a postdoc and then for a biotech start up I worked very long hours, including weekends and evenings, but chose to do so myself and didn’t resent it. After becoming a parent, I did the odd bit of work in the evenings and at the week end, but mostly I went home and did not work, and certainly never worked whilst on holidays.

    Since I left science and started working for myself, my business has kept growing. There is always stuff to do, and at the beginning I was rarely switching off in the evenings or during the week-end.Ā  I also interact with a lot more people than I did at the beginning, so there are messages coming from many different sources and apps, messages on my business page, comments and questions, and so on, which need replying to.

    In the digital age with live in, where the boundaries between work and home are somewhat blurred, I might have ended up there anyway if I’d remained a scientist. I read Cal Newport’s book, A world without email, and his description of the corporate world of today certainly seems fitting with a constant barrage of messages.

    As I’ve grown older and a more experienced self employed person, I have become more conscious than ever of the need to establish firmer boundaries in my life between work and play, to be more present to myself and my family, and to resist the desire to answer yet one more email or message. The downside of being self employed (the upsides far than make up for it however!) Ā is that I used to have an underlying feeling of guilt when I was not working.Ā  I found myself thinking that I ought to work 9 to 5 and be productive all the time, something that I now see as a hangover of our education and workplace system.

    About 4 years ago I embarked on a journey to get out of this productive overwhelm, and I blogged about it here. I ended up writing a whole collection of posts on the topic, which you can find listed in this post. It has been so utterly transformative that I am think I may end up creating a course to help others do the same.

    The other important aspect to consider is, when you have chosen a path that involves giving and caring for others, you need to spend time away from that, refilling your own tank and giving to myself, before I am ready to give again to others (I wrote a post about that too).

    During my first summer break as a self employed doula/birth educator, I was quite shocked to notice how tired I was, because for the first for the first 3 or 4 nights of my holidays I slept for nearly 12h each night (a normal night for me is usually between 6 and 7h of sleep).

    In recent years, I’ve learnt to plan for time off work by putting in in my diary so I know what my availability is and I also know not to over commit myself. I’ve also become much better at feeling my body’s energy and wellbeing, that when I need to slow down I feel the need before I reach crashing point. February to April this year were an intense time for me, supporting my last doula clients, and having a new puppy to care for, and launching 3 online courses (the postnatal rebozo closing ritual course, updated rebozo for pregnancy and birth course, and my new How to run a mother blessing course). I really feel the need to slow down and recharge deep in my bones.

    Ahead of my holidays, I plan my work so that I can truly switch off. I am going to have long leisurely days with a lot of time outdoors, some long, social family diners, I’m going to read more books and swim in as many bodies of water as I can. Bliss.

    And when I’m back at my desk, I am going to continue refining my work-life balance, so that I am in a state that works for me, keeps me purposeful and happy, to keep putting the things that keep me fuelled like drumming, wild swimming and dancing as the most important things in my to-do list,Ā  and spend as much time as possible being joyfully present.

     

     

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

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

    (updated September 2021)

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

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

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

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

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

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

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

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

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

    maze

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

    NICE states that

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    I just don’t get it.

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

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

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

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

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

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

    right way

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

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

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

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

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

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

    Update September 2021.

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

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

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

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

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

  • New NICE induction of labour guidelines. Have we taken leave of our senses?

    New NICE induction of labour guidelines. Have we taken leave of our senses?

    The National institute for clinical excellence (NICE) has published new draft guidelines for induction of labour. They are open for consultation until the 6th of July 2021.

    The part that is most concerning is this:

    Consider induction of labour from 39+0 weeks in women with otherwise uncomplicated singleton pregnancies who are at a higher risk of complications associated with continued pregnancy (for example, BMI 30 kg/m2 23 or above, age 35 years or above, with a black, Asian or minority ethnic family background, or after assisted conception).

    You read that right. The new guidelines propose that everyone whose body mass index is over 30, above 35 years old, who is black, brown or any non white background, who have conceived through IVF, should all be induced at 39 weeks of pregnancy. I couldn’t help but wonder: how many people does this leave, who do not fall in these categories?

    I had a look at the office of national statistics, to check what percentage of the population these groups represent together. I havenā€™t been able to find detailed enough data to remove overlaps between the groups. However, I have found the following:

    • About 50% of pregnant women are classified as overweight or obese in the UK
    • Black, brown and ethnic minorities represent about 10% of the UK population
    • About 25% of babies born in the UK were conceived by IVF
    • About 25% of babies born in the UK are from mothers over 35

    I know that some of these categories overlap, but Iā€™m guessing that not many people will still fall within the ā€œlow-riskā€ people being ā€œallowedā€ to go into labour naturally if this guideline passes at it is. Especially as, in my experience, few people question the “guidelines” and apply them as if they were the law.

    Worryingly the rate of induction has already just gone through a major rise. Since March 2020 many trusts have seen steep rise in induction (and cesarean) rates. (this is easy to find in the infographics shared from various trust pages on social media). In my local trust, the induction rate has gone from being between 25 and 30% prior to March 2020 to 39% in May 2021. Doesnā€™t it feel extremely odd to you that nearly 40% of the population already needs to have their labour artificially started? Isnā€™t it possible that this rise wasnā€™t justified by evidence, but rather by a knee jerk reaction to the covid crisis?

    If the above guideline goes ahead as it is, what rates of induction are we going to see? Are we headed towards in a situation where everyone has their labour induced? How is this logical? How is this balanced? Have we taken leave of our senses?

    The draft guidelinesĀ  are open for consultation until the 6th of July 2021. If you wish to comment, you are welcome to copy and paste some of my comments to issue your own reply to the NICE consultation. Just email InducingLabourUpdate@nice.org.uk

    Dr Sara Wickham has published an extensive blog about it too.

    Dear Nice labour induction team

    My name is Dr Sophie Messager. I am an ex biology research scientist turned doula and perinatal educator.

    Over the last ten years in this role I have seen theĀ rate of induction of labour in my local trust rise from 24% to 39% without an improvement in maternal or fetal outcomes.

    What I have witnessed however, is that induction of labour often causes trauma for mothers and their partners. I have also witnessed time and time again that true informed decision rarely takes place because the majority of parents rarely get told what induction of labour entails (in primips often a 3 to 5 days process which ends up in a caesarean). They rarely get told that it is a choice (most get told ā€œweā€™ll book you in for an inductionā€), and they also rarely get told of the risks that are involved in inducing labour (increased risk of caesarean birth and fetal distress amongst other things). I also see a lot of coercion in making sure people consent to having their labour induced, and in particular implying that the baby might die if they do not agree. I wrote in more details about it in this blog post.

    Since March 2020, most hospitals trusts banned the access of partners to antenatal wards, only allowing them during established labour, I have witnessed women being induced for 5 days, alone in antenatal wards with no support from myself or their partners. This is dehumanising and traumatising for women and their partners.

    Since March 2020, I have also seen rates of induction and caesarean rise by about 10% in many hospital trusts, with no evidence behind the change. In my local trust, the induction rates was 40% in May 2021, when it was between 25% and 30% prior to March 2020. Carrying out a survey of the rise of induction rates since 2020 across UK hospital trusts since March 2020, and the reasons behind them, and whether this rise improved outcomes or not would probably prove very informative. Surely the percentage of women who go into labour spontaneously has not decreased by 10% in less than a year?

    I am worried that the people who are making the recommendation in the guidelines have no experience of supporting women and their partners in labour, and in particular, induced labour, or that if they do, they have no experience of what happens in the aftermath. Most health professionals only get to see people for a few days after birth, until they leave the hospital. Doulas and other private perinatal practitioners often support new families for weeks after birth, and they may be the only ones who truly understand how traumatising induction of labour can be, especially when the process hasnā€™t been communicated adequately ahead of time.

    The draft guidelines state the following:

    Consider induction of labour from 39+0 weeks in women with otherwise uncomplicated singleton pregnancies who are at a higher risk of complications associated with continued pregnancy (for example, BMI 30 kg/m2 23 or above, age 35 years or above, with a black, Asian or minority ethnic family background, or after assisted conception).

    Yet the guidelines also state that ā€œAs there was no evidence to identify the optimal timing of induction in these groups, the committee made a research recommendationā€.

    I had a look at the office of national statistics, to check what percentage of the population these groups represent together. I havenā€™t been able to find detailed enough data to remove overlaps between the groups. However, I have found the following:

    • About 50% of pregnant women are classified as overweight or obese in the UK
    • Black, brown and ethnic minorities represent about 10% of the UK population
    • About 25% of babies born in the UK were conceived by IVF
    • About a quarter of all babies born in the UK are from mothers over 35

    Which percentage of the population does this leaves that still falls within a low risk group? Has this been assessed as part of the drafting of the guideline?

    If the draft guideline gets published as it is we are very likely to see a further rise in an already alarmingly high induction rate, and a concomitant rise in caesarean rate, as despite some flawed research claiming that induction of labour doesnā€™t increase caesarean rates, in practise (and according to some recent research), induction of labour usually leads to doubling of the rate of caesarean. See https://www.sciencedirect.com/science/article/abs/pii/S0301211521002463.

    I am worried that we are headed for the same rates of caesarean as countries like Brazil or China (which are around 50%), without improvement in birth outcomes.

    Experience and history (for example in the case of the Hannah breech birth trial) shows that when new guidelines like this one get published, they tend to get adopted widely without question within maternity care, and that, even when new evidence disproves the original results, it is very hard to get the system to change, because the belief about what is “normal” has become entrenched within maternity care.

    The long term impact of a rise induction of labour on the health of the general population is this happens is greatly concerning. As concluded by the author of this study explains:

    ā€œIOL for non-medical reasons was associated with higher birth interventions, particularly in primiparous women, and more adverse maternal, neonatal and child outcomes for most variables assessed.ā€œ

    More worryingly, there appears to have been no consultation of the interested party, i.e people having to undergo the actual induction of labour (women and their partners) in the drafting of this guideline.

    I urge you to reconsider these guidelines, and in particular, ensure that a consultation of the experience of induction of labour for mothers and their partners takes place prior to any new recommendations being made. I would also like to see the long term physical and mental health implications for families and babies taken into account to balance the recommendation.

    Regards

    Dr Sophie Messager

     

  • You already know what is right for you (how to access your own wisdom)

    You already know what is right for you (how to access your own wisdom)

    What if I told you that you always know what is right for you?

    What if I told you that you do not need to outsource your wisdom, defer to other people, seek answers from outside sources, and that the answers, the real, true, optimal ones for you as a unique being, are already inside of you?

    In my previous blog, I explained that you are the expert is what is right for you and I want to expand on the topic and go further, as well as present ways you can access your inner wisdom.

    I believe that we are all born with inner wisdom and knowing and that we can originally access it easily. Babies and small children know what feels good and what doesnā€™t. They trust their inner compass. They express their bliss and displeasure loudly. It is very plain for all to see: when they are happy, their whole body is happy. When they are sad you can see it too.

    But then, because we live in a society that expects us to obey and do as we are told, and because this is present at every level, whether it is parenting, education, or the corporate world, we slowly learn to ignore our inner knowing and trusts that authority figures know best whatā€™s right for us. To be seen as lovable, acceptable, we slowly learn to fit within the constraints of what is seen as acceptable in our society. We learn to ignore what feels right, in favour of what is seen as right.

    It can be hard to unlayer the learning of distrust of oneā€™s instinct and to start accessing the inner voice inside. This is especially true when we enter an experience that is outside of our field of knowledge. And this is particularly true of the experience of pregnancy, birth and parenting. I see it a lot in my work as a doula. I see highly educated, intelligent individuals, who find it really hard to trust their instincts in the face of pressure from coercive maternity care policies.

    The same is true when we become parents, and it can be tempting to choose to believe the opinion of so-called ā€œexpertsā€ in parenting, rather than following oneā€™s inner guidance. I wrote about this in my blog Why baby books and ā€œexpertsā€ can really harm you after you have a baby . It is true for most new experiences in life, most choices, and most life transitions.

    I see this being highlighted more than ever since the 2020 pandemic. There are so many conflicting pieces of information. Experts disagreeing with each other. Public health policies that treat people as a single entity and fail to take into account unique individual circumstances. Forever changing goalposts. Not knowing who and what to believe.

    I am not saying that it isnā€™t worth consulting people who know more than you do about an area. But as I explained in my previous blog, they cannot make the decision for you, because they arenā€™t the ones who are going to live with the consequences of your decisions.

    In navigating the perinatal period, and life changes, and for most of us in the current climate, learning to listen to our inner knowing can be a game changer, and bring out a sense of confidence and peace.

    But how do you start to unlayer the belief that the answers always lie outside of yourself? How do you start listening to your inner voice if you have always let the opinion of others guide you?

    There are many different ways to start accessing your inner wisdom. None of them is necessarily ā€œrightā€ or more powerful than the other. They are simply tools. The most important aspect is that you use one that works for you.

    I have been on a massive journey myself to debunk what I thought I had to do. For example I use to believe I was shit at meditation because I thought you had to sit on a cushion in the lotus position, stare at a candle, and think of nothing. This cool little animated video went a long way in helping to undo this.Ā  It is surprising simple. All you need to do is have the intention to do so, and then start applying ways of accessing your own wisdom that work for you.

    Here are some ideas to try to get you started. Remember, that, as with any new skills, the more you practice the better you become. After all, if you were going to run a marathon you wouldnā€™t expect to do it without training. Start small. Start with the method you feel most excited about.

    Set an intention

    • The simplest way to access your inner wisdom is simply to set an intention to receive the guidance and see what happens.

    Meditation

    • If trying meditation appeals to you, there are many apps, such as headspace (and plenty of others, some of which are free) around to guide you through the process in tiny, incremental steps. It doesnā€™t have to be a commitment to have 20 min a day, it could be as little as 5 min and still make a difference.
    • Checkout the one moment meditation video. https://www.youtube.com/watch?v=F6eFFCi12v8

    Mouvement

    • Meditation does not even have to be a still process. One can meditate whilst walking, dancing, or other movement activities too. I am a fan of 5rhythms dancing (https://www.5rhythms.com/) and other conscious movement practices,These practises work much better for me than sitting still. I include my wild river swimming in my meditative practices.
    • When you feel stuck, try moving gently, or going for a walk. Bonus if you can get in nature, as it is extra grounding.

    Grounding

    • Walking barefoot on the grass/ground is a super fast way to discharge stress and ground yourself. From a place of grounding it’s easier to access one’s inner voice.
    • Being in nature is generally grounding. I swim in the local river all year round and it is one of my favourite ways to de-stress and meditate.

    Breathing

    1. As with meditation, simply paying attention to your breath can help your mind quieten enough to hear the inner voice inside. Again there are many techniques available, but you already know how to breathe (after all youā€™ve been doing it all your life), and simply paying attention to your outbreath, and slowing it down slightly is all you need. Some meditation apps include breathing relaxation.

    Heart centering

    • This is a quick and simple way to gain a more heart centered state. Breathe gently for a couple of minutes, then imagine that you are breathing in and out through the centre of your chest.
    • You can also try the HeartMath institute heart coherence techniqueĀ .

    Journaling

    • Some people find their inner voice communicate best with them via writing. Again it doesnā€™t have to be complicated. All you need is a notebook and a pen, and a commitment to start with free writing 5 min a day. One thing that can help is simply to state in your mind before you write ā€œwhat does my inner voice/soul (or whatever other word resonates most with you) want to tell me todayā€.

    Learning to recognise your bodyā€™s response

    • Did you know that you can use your body as a pendulum to get an answer to a question? Start by asking a very easy question, for example, do I like (favourite food or drink). Close your eyes and really feel inside your body. Feel your unique bodyā€™s response to the yes inside. Mine is a feeling of energy circulating in a circle around my heart, but yours might be completely different. Then ask yourself the same question for a food or drink you really dislike. Feel the response inside your body. Once you have familiarized yourself with your own response, you can start practicing with every day questions. The more you practice the easier it becomes.

    Drumming

    • I cannot resist mentioning drumming because I love it. It is one of my preferred forms of meditation. You do not need to be musically trained. Research shows that drumming to a simple, repetitive, heartbeat like rhythms, causes the brain waves to slow down, which helps to get the mind chatter out of the way. I wrote a blog called Drum healing, bullshit? about my self-taught drumming journey. Over the last year I have drummed twice weekly in the local nature reserve first thing in the morning. It is the most nourishing spiritual practice for me.