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Sophie Messager

Tag: birth

  • Inducing labour with Castor oil : is it safe?

    Inducing labour with Castor oil : is it safe?

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

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

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

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

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

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

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

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

    what is Castor oil?

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

    How does Castor oil work?

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

    How is it taken?

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

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

    How effective is it?

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

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

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

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

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

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

    What are the side effects of Castor oil?

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

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

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

    What else matters when it comes to decision making?

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

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

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

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

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

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

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

    • Impact on support after the birth

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

    What are the possible disadvantages of using castor oil ?

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

    In conclusion:

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

     

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Online services-why should you pay for them?

    Online services-why should you pay for them?

    It’s a very strange and stressful time we are living right now, especially if you are pregnant.

    There is, understandably, a lot of anxiety about the unpredictable and fast changing nature of maternity services.

    I am seeing a lot of comments on social media about people wanting free antenatal classes (because their hospital ones got cancelled), and also questioning why people should still charge for online work, as well as accusing people who charge for online services of taking advantage of vulnerable people

    So I wrote this blog to explain, and debunk myths.

    I have written in the past about why doulas charge for what they do , and also the amazing lengths they go through to help their clients . The same rules apply here.

    Those “free” NHS classes were not actually free. The people delivering those classes were paid to teach them. Whilst the NHS is free at the point of contact, it isn’t “free” (because you pay for it with your taxes) and the people who staff it aren’t volunteers.

    Whilst I understand that many people might be struggling financially, many are also still employed and earning a salary, or at least 80% of it.

    Most of the people who provide perinatal education and support are self employed and run micro-businesses. I’m talking about doulas, independent midwifes, antenatal teachers, antenatal and postnatal exercise instructors, manual therapists etc. These people are it, i.e. their whole business is composed of one person. If they do not teach or do what they normally provide paid services for face to face, they don’t earn any money.Ā  Zip, nada. Right now, most of them are also trying to juggle doing this whilst having kids at home full time.

    I am one of those people. My income has almost entirely disappeared. I still feel grateful, because my husband is working part time in an employed position and working from home. Still, this crisis means that my little, successful-ish, micro business, which took me 7 years to build up, has been reduced to nearly nothing. But at least I know I don’t have to worry about having food on the table. Many of my birthworker and perinatal educator friends aren’t so lucky, because they are single mothers, or their partner also runs a self employed micro business.

    Yet I am also seeing that most of these people (myself included) are still giving a lot of their time for free right now, running free Facebook groups forĀ  pregnant women (believe me these are busy right now), answering worried messages, speaking to anxious women on the phone, running free zoom drop ins etc .

    It is the same as in real life: people should run free/charity stuff if they can and want to, but it shouldn’t be a obligatory or expected thing. If people cannot earn a living, they simply will not be able to carrying providing these services.

    So why should you pay for antenatal education, birth support, or postnatal education/support, if it’s moved online? For the same reason as when would when you pay for support : you pay for the time and money the person supporting you has spent training, the time they have spent prepping the class or one to one, and the years of knowledge and expertise they have built.

    Right now the people delivering these online classes are spending a lot of time thinking and prepping for these to make sure they work online (because making it work online isn’t the same as making it work IRL).

    They are also spending a lot of time self teaching themselves how to use online delivery systems they had never used before (like Zoom), without any support through it.

    Many are also spending money buying extra equipment (like video cameras and microphones or even laptop computers etc) to allow them to run their online services.

    They are all having to manage this whilst having to deal with their own anxieties about the unusual situation we are all in, their own families’ needs, and worrying about their client’s well being.

    I’m an experienced doula, and since I have been working in the birth and postnatal education for ten years, I feel confident and competent in delivering this to families. Yet, at the moment providing Skype or Zoom support to my clients is taking A LOT more time than when I’m doing it face to face.

    This is because when I’m face to face I no longer need to prepare much ahead. I have enough knowledge to deliver at the drop of a hat, I have a small bag of props than I can use to deliver almost every aspect of birth and postnatal education, and I can react to my clients feelings and adapt accordingly.

    This isn’t the case with the Skype or the Zoom stuff, because not only do I have to think and prep in advance how to deliver stuff that is easy face to face but much more complex online (for example teaching someone how to use a sling), but I also have to constantly keep up with the forever changing medical guidelines (the Royal College of Obstetrician has published 8 updates to their guidelines since they published the first one on the 9th of March, that’s 2 to 3 updates a week!). I am also having to keep up with local trust changing guidelines, as well as rake my brain to think about how my clients can support themselves after the birth in the hospital when I know I won’t be able to be there with them physically. Believe me this takes a lot of head space.

    I am not complaining, mind you, because I love learning new skills and this sure is keeping my brain on its toes!

    But if I wanted to be totally fair, I should actually be charging MORE money for all of my time, to reflect all the extra time spent preparing. Instead because most of us want to support women regardless of their circumstances, many of us are offering discounts, payment plans, pay what you can, or indeed free services.

    I am worried that some of these valuable micro businesses, run by passionate people who do it because they care rather than wanting to make a quick buck, will simply disappear.

    Yes, many celebrities are offering free online classes, but these celebrities are likely to have plenty of money. They are also likely to receive revenue through advertisement, so, again, these free classes may not be actually “free”. Whilst their offer is laudable, is it also sadly contributing to the idea that all online stuff should be free. You simply cannot extrapolate what celebrities are doing to micro businesses which are only known to their local community.

    Another thing I have seen is that people say you don’t need the paid services, because you can teach yourself, with these free/cheap resources. Whilst this is true : you can indeed learn from a book, free courses etc, this isn’t the same as getting into a live course or one to one work with an expert in the field. The main ways you can educate yourself about anything fall into 3 categories: DIY, group courses, and one to one tuition. Each one of them has pros and cons, but it isn’t necessarily fair to compare the DIY approach to what you’ll get if you hire someone to work with you one to one. I have explained the pros and cons of this in a previous blog called three ways to educate yourself about birth.

    So if you still have a salary, please consider paying for support rather than just doing free classes. If you are doing free classes with a micro business person and enjoying it, consider giving them a donation, or hiring them for their paid services.

    I promise you that you will still get value for money and incredible support. You will also contribute to keeping someone’s only way of earning a living afloat. And if you worry that online support doesn’t work, I have addressed it in this blog (along with plenty of free classes links). My blog is also full of free recently added resources for pregnancy birth and beyond, including a recent post on how to have a positive birth in unpredictable times.

    I wrote this blog to explain, and debunk the myth, please feel free to share it widely.

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

  • How to have a positive birth in unpredictable times

    How to have a positive birth in unpredictable times

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    What if your labour is being induced:

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

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

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

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

    I will leave you with this quote from Sara Wickham:

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

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

  • Rebozo techniques for relaxation during uncertain times

    Rebozo techniques for relaxation during uncertain times

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

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

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

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

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

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

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

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

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

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

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

    Self-care technique

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

    Play

    Wrapping the shoulders

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

    Play

     

    Rocking the pelvis

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

    Play

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

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

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

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

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

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

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

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

    I get that.

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

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

    I get it. I am having doubts too.

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

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

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

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

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

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

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

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

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

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

    Independent midwives

    Antenatal and postnatal education

    Babywearing support:

    Pregnancy/postnatal exercise classes

    Mental health

    Free meditations/relaxation tracks/relaxation techniques

    Mental health professionas/organisations

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

    Breastfeeding support organisations

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

  • The incredible things doulas do to support their clients

    The incredible things doulas do to support their clients

    A criticism that is commonly heard in the doula world is that doulas are expensive.

    In the UK, healthcare is free at the point of contact. This can lead some people to believe that they shouldn’t pay for services when it comes to supporting people around anything linked to health and well-being.

    Last week, I was saddened to hear that a friend who runs a pregnancy and new mothers centre, complete with free drop-in groups for new mums, was questioned not too kindly by medical professionals who accused her of preying on vulnerable women. They said that support should be free.

    This is a commonly held view sadly. I gave a talk about doulas to a group of student midwifes, and this was brought up too.

    I agree that, in an ideal world, support should be available for free to all that need it. But, interestingly, people who mention this seem to be unable to realise that they, themselves, aren’t working for free, and that the NHS isn’t free, it is paid for by our taxes.

    I am yet to meet a doula who does this for the sole goal of making money. As I’ve written about before, when we break it down, most of us earn an hourly rate that is way below the minimum wage.

    Recently, I spoke to a doula who was waiting for a client to birth, way beyond her due date, and was facing the quandary of cancelling important plans, because she wants to be available for her client’s birth. This reminded me that, through the years, I’ve heard incredible stories about the lengths doulas go through, not just to be available to their clients for a whole month or more, being available at the drop of a hat, juggling incredibly complex childcare arrangements etc.  The things that doulas do in the background, rearranging really important personal stuff, unbeknown to their clients, so that they can be available for the birth, are usually only known to those who belong in the doula world.

    I want to clarify that I am not sharing these stories to make clients feel guilty or that we resent the commitments.

    Being a doula is a calling, and whilst we find this job demanding at times, it’s worth it otherwise we wouldn’t keep doing it!

    Doulas tend to keep these stories secrets in order to avoid burdening their clients, hence they don’t usually get shared from outside the doula community.

    I hope that these stories will help demonstrate the incredible level of dedication that doulas show for their clients.

    A couple of my own stories that stick out include attending a 4 day long birth. My husband’s birthday was in the middle of these 4 days, so not only I wasn’t there but he was alone with the kids for that time.

    Another time, my family and I were all packed and ready to go away for the week end. My husband is from Hong Kong and this was Chinese new year and we were due to visit his family. This is like missing Christmas. I had a client expecting twins, someone who I had already supported through the birth of her first child. She was 32 weeks pregnant. As I was walking over to our neighbours to let them know we were going to go away, the phone rang, and my client told me that they were taking her to theatre, right now! I walked back inside my house, my husband saw my face and asked me what had happened. I told him, and he said to just go to be with her and that we could go join his family the next day. I made it to my client with 10 min to spare prior to her transfer to theatre. When I returned a few hours later, overcome with gratitude, I asked my husband why he’d agreed to change our plans, he said “I could see how torn you were”.

    My client wrote me this testimonial:

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

    Here is a collection of stories from doulas about the amazing things they’ve have done and sacrificed in order to be there for their clients :

    I shadow doulaed for a client, I finished 9hrs in my day job, picked my girls up from childcare and got home for 1730, got the call my client was in labour at 2000 so raced over to her, stayed all night until 0530 the next morning, popped home to take the girls to childcare and then back to another 9hr shift at my day job! I worked out I went without sleep for 40hrs! But I love what I do. It is annoying when people say I charge too much but when you workout out how long you’re on call for, the extra childcare, travelling and everything else I come out the other side with very little. Working in the birthing world is definitely a ‘labour’ of love! Rachael Ruddock

    Iā€™ve worked 3 days straight with one hours sleep. I finally got home at midnight on Christmas Eve. I then had to wrap all the gifts for my 5 and 3 year old. I also missed all the festivities leading up to Christmas including the show we had tickets for. I do still love my job. Melanie Butcher

    I had to sleep in the car off a lay-by on the A1 once at 4am as I wasn’t safe to drive, I have to travel long distances as I’m rural. I keep a blanket and pillow in the car. I have slept in hospital car parks too in the middle of the night, so safety an issue. I’ve had to leave cinema showings with my kids, give up work commitments, like cancelling clinic and moving classes. Sophie Fletcher

    Iā€™ve missed Christmas Day with my kids to be with a solo mama in labour, went early so she wasnā€™t alone – the kids still bring it up. Beccy Hands

    I’ve stayed awake for 70h. Hayet Hb

    I have missed my daughters 16th birthday party, my brother in laws 30th party and my uncle’s funeral. My auntie and cousins couldnā€™t understand how I could miss a funeral but this client had many baby loss experiences and I would rather sacrifice the funeral and have my family upset with me than let down a woman giving birth. Supporting Birth and the beginning of a family is more important to me than almost anything! Beverley Hinton

    I’ve missed invitations to weddings, christenings and birthday parties. I’ve said no to informal gatherings to see friends or have dinner with grandparents. I’ve missed education sessions for the kids. I’ve skipped dental appointments, hospital appointments and other personal appointments. I have stayed awake for over 60 hours. I have dumped the kids and ran on many occasion to disappear, sometimes for a day, sometimes for several. I have not eaten or drank water for long periods. I’ve not seen my own family who are in hospital. I’ve taken 3 days to recover from a long birth. Nikki Mather

    I have been on call over Christmas and my sons birthday. This shows my commitment and the willingness to miss these special events to support another family. Bev Samways

    Iā€™ve just had my first birth and missed 2 hospital appointments, my babyā€™s 2nd birthday party, hairdressers, I did nothing on my 40th birthday just in case I was called. My mother in law changed her holiday so that she could be on call for my childcare. Iā€™m also a pregnancy yoga teacher and had to cancel 2 classes to be with my clients, losing money for both.  I didnā€™t go to a college friends reunion. Kirstie Broughton

    When I go on call my life dynamics completely change. As I have small children I have to allocate time to drop them off safely to someone before I can head-out. So I go no further the 30min out of my house range. Have all bags packed and prepared. Miss play dates, days out, constantly being alert and it can be exhausting waiting for that call. When Iā€™m there Iā€™m 100% in and the outside world doesnā€™t exist. Iā€™m as involved as the couple need me to be. I have massaged a woman once for 6 hours because she wanted me to and there wasnā€™t a partner to take over. I missed my in laws 60th wedding anniversary, turned down invitations. Doulas sacrifice a lot on day to day basis but itā€™s so worth it seeing that mother being supported and getting the best start on her long journey through motherhood. Eva Kralova

    I once had my husband pick me and my friend up from the airport after a weekend away and drive me ( in the opposite direction) straight to the hospital so that I could meet my client who had gone there in labour. My friend had to just roll with it. My husband and children hadn’t seen me for 3 nights and we had no plan for how I’d get home after. But right then she needed me and I went. It’s what we do. Amber Strong

    For two of my son’s birthdays I wasn’t there to wake up with him- because i was with clients at their babies birthday. Bitter sweet. The first time my son was young, I was a single mum and the babysitter was there. He was very upset. I got home after 48hrs and drove him to go bowling with a couple of friends. Trying to keep the wheels on. 2nd time he was older and very gracious- when speaking to me on the phone he said “It’s ok mum – I can wait for my presents until you get home – it’s important you stay with your lady until her baby comes. Gosh I blubbed.  Katie Olliffe

    Iā€™ve missed Christmas Day, my middle sonā€™s birthday morning, my partnerā€™s birthday. I go home early from rare nights out, my social life has suffered. I seldom drink. My family have left on a holiday without me & I followed them the next day. My kids complain about my job & say itā€™s the ā€˜worst job in the worldā€™. I tell them the opposite is true! Roma Hearsey

    I just made it to my best friend and my cousinā€™s weddings – leaving the birth the morning of my best friendā€™s. I have been absent for entire weekends and was called to a birth on Christmas morning – and missed my kids opening their presents. Over January I attended 4 births despite going through one of the most stressful periods of my life (divorce). One of these births was 5 days long. Itā€™s hard to explain the impact this work can have on a person’s life. Laura Scarlett

    It also affects my husband’s work – he also works from home but in an employed capacity and occasionally needs to travel around the country – when I’m on call – he has to not travel. Melanie English

    I rushed across the country on New Year eve to get a super fast birth of the first baby in the county. Our job is multidimensional and money exchange really represent partial contribution towards its value. In the old days the village would support the wise women who helped at birth through barter of services and goods and we are just monetising the same principle. Vera Dubrovina

    Iā€™ve missed birthdays, anniversaries, parties. The one time I DID set a boundary around a planned event, having missed so much throughout one year- I wasnā€™t there for my clients birth. A back up was- but it felt really hard for me- difficult feelings I had to unpack. Tortie Rye

    I missed my daughterā€™s prom to rush to a client after our birth contract had finished to support with a serious health issue. Caroline Zwierzchowska-Dod

    I went directly from an early pregnancy scan where I was told my baby had died and took a cab directly to my labouring client to attend her birth. Lauren Mishcon

    I did a birth on my birthday once 20 hours, wet through from supporting the mama in a tiny en suite on the DU. She wasn’t even my client – I was a backup doula! Jo Rogers

    I missed my daughter’s birthday one year and another year was so tired after being awake for 38 hours I picked her up from school and fell asleep before she had finished opening her presents. Missed first three days of my summer holiday when my client went pass 43 weeks . Aimee Sri Laxmi Hamblyn

    These are all true stories. I hope this helps give a measure of how passionate we are about supporting our clients.

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

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

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

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

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

    Or would there?

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

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

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

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

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

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

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

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

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

    Pregnancy-the preparation

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

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

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

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

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

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

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

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

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

    Alex Heath, doula

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

    Pippa Moss, doula

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

    Kristina McKeown, doula

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

    Ceci Goldaracena, doula

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

    On the day-waiting for the cesarean

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

    Sarah Budden, doula

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

    During the cesarean

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

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

    I have been present in theatre with a couple.

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

    Nicola Collins, doula

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

    Claire Walker, mother

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

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

    Nuria Pozas, doula, from her client

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

    Beau, mother

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

    Emilia, mother

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

    Immediately after the cesarean

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

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

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

    Bryony Vickers, doula

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

    Jo McCracken, doula

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

    Emilia, mother

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

    In the postnatal ward

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

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

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

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

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

    After the cesarean-at home

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

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

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

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

    Kate wilson, mother

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

    Georgia Wakins, doula

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

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

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

  • Confessions of a hippy scientist : 3 years on.

    Confessions of a hippy scientist : 3 years on.

    Three years ago today, I published a blog call “confessions of a hippy scientist“.

    In this blog, I came out as a science meets woo person, something I had shied away from for a couple of years.

    You see I’ve got a PhD in biology and spend 20 years working as a research scientist.

    When I left my scientific career to become a doula (back in 2012), being at births and feeling the incredible powerful energy in the room, combined with hanging out with a lot of spiritual birthworkers, led me to want to develop my energy healing abilities further.

    Back in 2003 I had undergone Reiki Level 1 training. In 2015 I took it to level 2 then master teacher level.

    After training and starting to offer healing to people on a regular basis, I agonised over showing this side of myself to the world.

    Doula clients told me they’d picked me because of my scientific background, which wasn’t surprising as Cambridge is full of medics and scientists. They felt reassured by it and I understood that.

    I worried a lot about putting people off if I chose to show my woo underbelly.

    I even went as far as considering a separate website for my Reiki work!

    Luckily someone challenged me to “come out”, and I wrote the blog I mention above.

    It felt very vulnerable to publish it, yet the post only got amazing responses, mostly from people who felt the same as me and thanked for it. It helped others on their way to embracing their full selves.

    Something magical happened in my work too, as I started getting clients who were more aligned with my true self.

    Because you see, when you show your true self, it puts some people off, but these aren’t the people you want to work with.

    Instead, you start attracting people who are much more aligned with who you are.

    For instance, a birth client who had told me she didn’t want any hippy stuff, asked for several Reiki treatments after birth. When I asked her what had made her change her mind, she said “before the birth I didn’t get it, but now I do”, which was a complete reflection of my own journey.

    So where am I now 3 years after this “coming out” blog?

    First of all, I have now embraced who I am so much that I cannot believe that I used to feel the need to hide this side of myself.

    I still work with a lot of scientists and medics (I’m still in Cambridge after all), but somehow my alternative side is never an issue.

    I’m getting a lot more woo clients too, which I love. This year I have finally ticked my bucket list wish of drumming during a birth, and I have also been hired specifically by someone who wants me to drum at their birth. It feels very good and exciting.

    I’m also being hired to organise mother blessings and group closing the bones ceremonies, as opposed to just doing them for friends.

    I’m still a scientist, and always will be be. I love nothing more than providing clients with evidence based links, especially when those help them make truly informed decisions about their care, and challenge population based hospital policies.

    Last year, I spent several months reviewing the research on the aging of the placenta and wrote this blogĀ  mostly because I got fed up of seeing non scientific birthworkers friends being bamboozled by jargon, and to show that things aren’t quite a simple as the “experts” say.

    To write it I had to put my old scientist hat firmly back on and spend many hours reading the research. I realised I found doing this, that I found it tedious and dry. This is no longer who I am, and I’m really glad I’m not working in academia anymore. Today I’m able to unapologetically embrace who I am, and no longer feel that I need to know everything.

    As I write this, I realise that I already felt this way when I was a budding scientist, early during my PhD. I remember my supervisor implying that I had to know everything and that I was incompetent if I didn’t. What a load of tosh! Something in me already knew this wasn’t true. I also remember questioning the way scientific papers were written under the same rigid rules and not liking it. I found reading papers for the sake it really tedious even then. I guess I always was a bit of a maverick, and someone who questions everything.

    Between 2008 and 2012, as I trained for my diploma in antenatal education, I learnt about the way we learn, and it makes so much more sense to me. You simply cannot force knowledge into people, by pouring it into their heads.

    Interestingly, I feel that my scientific knowledge is now kept fresh and alive by the multitude of clients I supports and all their wide and varied needs. Because I love nothing more than finding scientific evidence for clients, I find myself reading avidly on their behalf, and the knowledge sticks because there is a positive and emotionally investment behind my looking for it.

    I’m still a hippy, in fact more than ever! I’ve carried on developing my more spiritual skills since I wrote the original blog. In 2017, made a shamanic drum at a very spiritual workshop, for the purpose of healing around pregnancy and birth. I then took a Reiki Drum training course shortly after that, and using my drum for healing and holding groups etc has become completely normal and natural to me. I’ve had two Reiki training upgrades. I have even stopped shying away from using my drum as standard in my closing the bones treatments (I used to give people the option to have it or not, now I just tell them it’s part of the treatment). Using Reiki treatment is part of my everyday life.

    What I’ve found has happened is my energy work offering, which started being a neat Reiki thing, has morphed into my own style of blended healing, which is completely intuitive, and doesn’t actually have a proper name or fit in a box, but it’s mine and I love it.

    Rather than offering energy work as a standalone I now weave it in and out of my birth and postnatal practise as and when feels appropriate.

    The call to embrace and develop my inner healer is extremely strong. It feels without a shadow of a doubt that this is where I’m headed.

    To make room for this I ended up dropping hats that no longer fitted me, that I felt I had outgrown. For instance I left my role as an NCT teacher.

    I’m also slowly letting go of my teaching of babywearing. I still love supporting parents using slings, but I dropped running a sling clinic and I’m also letting go to actively teaching babywearing peer supporter courses-because whilst I still enjoy it, it doesn’t fill my soul with joy the way facilitating more spiritual work like closing the bones does.

    The thing I love above all is blending my own cocktail of science and woo.

    I trained with Spinning babies since I wrote the blog, twice, and I use a combination of their techniques which I apply in a very scientific way, together with tuning in to what I feel and see happens energetically to the mother during labour. I have experienced true miracles in using this unusual mix.

    Perhaps the one thing that exemplifies this above all, is that I just finished developing an entirely new massage technique inspired by closing the bones, together with Teddy Brookes the osteopath. We called it the postnatal recovery massage. It combines massage, energy work and osteopathy. We teach it together, and the feedback we have received reflects exactly that. To quote Charlotte, a doula who attended our first training :

    ” Sophie and Teddy have taken all that is special about it and fused her energy-work approach with his osteopathic technique to create something extraordinary.”

    Openly embracing who I am with all my paradoxes and quirks has been the most liberating journey ever.

    I am a scientist but I am also an energy healer. I am proud of it. It’s what makes me unique.

    If being a doula has taught me one thing, itā€™s that we are ALL full of paradoxes and quirks and uniqueness.

    Nobody fits nicely into a neat little box.

    I want to support others in this journey of embracing themselves, and this is a massive reason being my recently becoming a doula course leader.

    When we celebrate rather than shame our uniqueness, this has tremendous power, both for ourselves and everybody around us.

  • A four day long HBAC

    A four day long HBAC

    Caro and Santi (both from Argentina) had hired me and my co-doula Becky as their doulas.Ā  They were planning a HBAC (home birth after cesarean) after having had what they knew to be an unnecessary elective caesarean with their first child.

    We met several times during Caro’s pregnancy, and built a lovely rapport together, getting to know them and their toddler son Max. They were both delightful and warm and friendly, and very well informed and researched. As Santi stayed at home to look after Max, I accompanied Caro to her hypnobirthing classes. This is the story of their birth, shared with their permission. It lasted 4 days, the longest birth I have ever attended in my 6 years as a doula.

    Day 1

    Caro texted us on Saturday morning (40 weeks and 5 days) to let us know that her waters had just broken. We kept in touch throughout the day.

    She lost some mucus around 10am, and started having mild, period cramp like contractions, soon after. She napped and ate, and rested throughout the day, keeping us updated.

    On their request I provided Caro and Santiago with evidence based papers to read about the risks of induction versus caesarean should they go beyond the 48h deadline after her waters had broken. Caro called the hospital around 10pm. They asked her to go in, which she declined. The hospitals send midwives to her home to listen to the baby’s heart instead.

    Caro declined a vaginal examination at this stage. The midwives booked an appointment for her on Monday afternoon at the hospital.

    Day 2

    Sunday morning around 2:30 am Caro texted us a screen shot of her contraction timer showing 40 sec to 1 min long contractions about 3 to 6 min apart. I called her. We agreed I should come and support her. I arrived at her house around 3am.

    She was having quite regular contractions but she was very “with it” and alert and I could tell this was early labour still. We filled the pool. Caro got in but things slowed down so she got out.

    Becky joined us around 7am. At day break things slowed right down. Max and Caro’s mother got up and join us . We shared a lovely breakfast of scones and jam.

    We hung out in the house/garden throughout the morning. It was a gorgeous, warm and sunny spring day.

    Caro was still having regular contractions but there were only 5/10 min apart. Santi and I went to get a takeaway lunch from a local South American restaurant.

    I went home around 3pm to get some sleep and spend some time with my family (it was my husband’s birthday that day). Becky spent some time lying in the garden with Caro, and rubbing her back during contractions.

    Caro messaged me around 9pm, contractions still irregular, and about one min long. I went to sleep after that. Becky had gone back home by then to rest too.

    Caro texted us around 10pm as her contractions were about 1 min long and 5/7 min apart. She found them harder to cope with. She messaged again around 11pm,by then her contractions were 4/6 min apart and 1 min long.

    Day 3

    Becky and I came back to her house around midnight. We spent another night of supporting her, both in and out of the pool. At some point in the night Caro experienced a lot of pressure in her bottom, and we got quite excited believing that baby was on his way, but it wasn’t time yet.

    I was amazed that Caro wasn’t exhausted at this stage, but somehow she managed to sleep between contractions and recover enough to cope. In the morning Becky went to sleep upstairs and I had a nap on the sofa.

    A midwife came in the morning to assess things. Caro agreed to a vaginal examination (she had been in labour for nearly 48h by now) and was found to be only 2/3cm dilated. I had a big wobble at this point. I also believed her baby to be back to back, hence the pressure in her bottom. The midwife also said that her baby was only 3/5 engaged.

    I suggested to Caro that she does some engagement spinning babies techniques, namely a technique called the bump lift, consisting in flattening her back against the wall and lifting her bump, and we also did some rebozo sifting on her belly. It seemed to help a bit, and her contractions got stronger. Becky and I had a chat and agree we should tag team and she sent me home to rest. At home I had some food then a nap, then came back at 2pm.

    I brought some loo roll with me as I’d noticed they’d run out, and I knew they wouldn’t find the time to go out shopping for some!

    Caro and Santi were snoozing upstairs when I got back. Becky told me they have agreed to a visit from the midwives, but that they only wanted to check the baby’s heart rate and mum’s vitals but not have any vaginal examinations, nor hear any talk about risks.

    Becky left and the midwives arrived. I met them downstairs and explained Caro’s wishes. They weren’t pleased by my request, and one of them said sharply that she had to tell her (about the risks) as she had a duty to protect the baby. I explained that after the previous talk of risks, Caro’s contractions stopped for over 2h, and therefore it really wasn’t a good idea. The midwives came upstairs. I crouched on the floor feeling like a mama bear, ready to pounce if the talk of risks rears its ugly head. Surprisingly, they did the checks and only mentioned to Caro and Santi that they needed to know that they are going against medical advice.

    At this stage, Caro and Santi agreed that they would go for a caesarean early the next morning (Tuesday) should she not have given birth yet. The midwives left.

    I carried on supporting Caro through the afternoon. Her contractions were still spaced out. Santi had a good long nap with Max Late afternoon I spoke to Becky and she told me to go home. We agreed we could have another night and day, possibly in hospital with a caesarean, after today.

    When I relayed our plan to Caro and Santi, Caro got upset and told me that I had lost faith in her, and she was right. I was by this point extremely weary and tired, and this affected my emotions a lot. I apologised profusely. Santi was also worried about doing bedtime without our support. I explained that we were happy to help but really need some sleep ourselves and Caro’s mum could support her during that time. I went home to sleep around 8pm.

    Day 4

    Becky called me around 1h30 am saying Caro was pushing. I got dressed and drove very quickly as I was worried I might miss the birth! When I got there I could tell Caro was nowhere near birthing yet. Her contractions were still not quite strong enough.

    Two midwives arrived at around 2am, both really lovely community midwives, calm and compassionate. One of them examined Caro and she was 5/6 cm dilated. This was hard for me to hear as I was really hoping she was ready to push her baby out! Caro carried on labouring through the night.

    When shift change was due to happen I explained to the midwives how important it was to have a supportive, confident midwife just like them replacing them. I asked for a particular community midwife whom I knew, and who Caro liked a lot. They organised for her to come :-). She was incredibly calm and supportive.

    We had a chat with Santi explaining that Caro’s mother needed to take Max out of the house for the day because Caro really needs some peace and quiet to get on with her labour. She left for the day soon after that. I went shopping for some food as we hadn’t got much left in the house.

    Sometimes in the morning, the midwife did another vaginal examination (in the pool!) and Caro was still only 6cm dilated and hadn’t progressed. This was a down point. I asked specific questions to the midwife, especially if baby was back to back and asynclitic, and she confirmed this. Her baby seemed to have completely more than one turn around the pelvis several times already, from being OP, then OA then OP again.

    I took my spinning babies handbook out of my bag again, and with Becky’s help (and Caro’s consent!) we helped Caro into an inversion. During about 3 contractions, I used my rebozo to do vigorously do shaking the apples on her bottom. It took all of us to support her through it, as you can imagine this wasn’t the comfiest thing to do at this stage. Then I did a sacro-tuberous ligament release and also a standing sacral release. Caro immediately said that she has felt the baby turn and that her back pain was gone. Her contractions cranked up big time and I knew we had changed things for the better.

    A vaginal examination around 3pm showed that she was 7cm dilated. Caro got back into the pool and carried on labouring. Contractions were really powerful at this stage, and I was feeling very hopeful.

    Becky supported Caro by saying ” longgg deeep slowwww breaths” as she had a few wobbles. Eventually Caro started to show signs of pushing šŸ™‚

    Around 5 pm there was another shift change, I am worried because one of the midwives is the one who talked about risks the day before. I was worried that the change of midwives at such a crucial time could upset Caro’s labour. The midwife in question hadn’t given me a good vibe the day before. By then Caro has been pushing for a while.

    I suggested to Santi that he supports her pushing by standing on the edge of the pool with a rebozo around his shoulders for her to pull on. Becky tried to make sure that the other midwife, not the one we had a bad gut feeling about, came into the room instead but that didn’t work.

    So I worked hard on changing my feelings towards her to positive ones. Luckily she turned out to be much more relaxed than I thought. Caro carried on pushing.

    At some point she shouted “I’m fucking doing it”, and she sure was! She soon started feeling some stinging.

    Caro’s baby son Leo was born in the pool in her living room around 6h30 pm, after 4 days of labour. When he was born, the emotion in the room was incredible. There wasn’t a dry eye in the room, even the midwives were crying.

    I cried and laughed at the same time for the first time in my life, with the cheer joy and relief. It was the most incredible feeling. Becky and I hugged each other like loonies. I sobbed some more. I literally shook with it. This was one of the most emotional births I have ever been at.

    After the birth I suggested to Becky that she goes home to sleep straight away as she was still on call for someone else. I stayed to support Caro and make sure she and baby were comfy

    I help her take a shower, and she was elated by the fact that she could walk around straight after the birth- a stark contrast to her previous caesarean.

    Caro was soon tucked up in bed with her new son Leo, and a nice chunk of groaning cake.

    I left around 9pm with a huge smile on my face.

    Reflection

    When I reflect on this birth several months later, I am still amazed at Caro’s resilience, at her belief in herself, and at the unwavering support of her husband.

    I also can’t believe I managed to support them for that long, with so little sleep, if I had been told that the birth would have been this long in advance I’m not sure I could have coped with it. But in the middle of it you just dig deep and get on with it.

    This is also the first birth where I experienced my first true miracle with the spinning babies and rebozo techniques.

    I teach rebozo techniques workshops, and Caro’s birth completely changed my outlook and the way I teach. It really anchored in my heart that this simple tool can really work miracles.

    I went on to have several similar miracles with such techniques at other births (though not quite at long!) since. This birth also illustrates to the extreme the commitment doulas make to their clients, and how much emotional investment be put in this job.

    I asked Caro to share her incredible birth story because I hope it will give other women the belief that they too can have an incredibly empowering birth after caesarean. For doulas, this birth illustrates how awesome shared care doula support can be. I canā€™t imagine how I would have survived without Becky, both in the fact that we supported each other, and the ability to tag team and get some rest!

    The day after the birth, Becky went to a study day at the hospital, and she lost count of how many midwives approached her and asked “what did you do?” about the amazing effect of the inversion with the rebozo. I am hoping to train the midwives in my local hospital to do this too. Caro is now a life long friend and is planning to become a doula. When I think back about her birth, all I feel is tremendous gratitude and joy.

    Becky and I shortly after the birth