When 'Mummy Tummies' aren't okay. My postnatal body: Guest Blog

The following is a guest blog on Post-pregnancy Body Image, written by my old running pal Amanda.  I'm so grateful to her for sharing this extremely powerful, personal, and brave story with us.  I for one had never heard of, or read, anything like this before.

Stories like this are such an important part of the dialogue of what it means to be women, and what it means to be mothers.  It is yet another poignant reminder of how different every woman is, every woman's body is, and how every woman's experience of pregnancy is so unique.

This is not meant to be a horror story. Quite the opposite.  It's an empowered story of the very personal physical and psychological transformations inherent in pregnancy and birth. And being able to confidently choose what's best for you, based on your personal circumstances.

Sharing these experiences is incredibly brave.  And I'm sure will be powerful in helping other mums negotiate their postnatal bodies, however they chose to do this...

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Images from left: "Ernie the Hernie!,"  3 months Postnatal, Post Surgery

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Until pregnancy I never had an issue with my body.

I was once an athlete, surrounded by tiny girls running in circles for fun. I had the occasional person at school saying I was too skinny but I never thought to judge or comment on someone else’s size. People certainly wouldn’t come up to me on the street to comment on how slim I was, or stroke my washboard abs. That was until I fell pregnant!!

I can fully appreciate the pregnant body on another woman and I initially quite liked what I thought was a cute bump, until people started commenting, “Oh My God, your bump is huge, are you having twins? Why is your belly button still sticking out?” et cetera et cetera …

I am quite the joker so I hid it well, but every time someone made a comment about my bump I felt like I must have looked like Mr Blobby. Going from a size 8-10, to being pregnant (measuring 49inches around the day I gave birth) made me feel like a beast. And if I was to say anything about not liking the size, I was frowned upon as though I hated the miracle that was growing inside me.

I suffered pre-eclampsia during pregnancy, which added to my already blooming size. But knowing I had a medical condition didn’t soften the thought of being huge.

I went into labour remembering my mum’s story that she came out of hospital wearing her size 6 pre-pregnancy jeans, hoping that I would be lucky enough to give birth and everything would go back to normal with my body. I was so wrong.

I came out of hospital, after giving birth to my gorgeous daughter Megan, with a bump that looked like I could be harbouring another child; only to realise it was empty when I laughed and it jiggled like a massive bowl of jelly. My belly button was black and I had stretch marks galore, but I was told that my body would go back to how it was (“Just use bio oil!”) so I initially felt okay …

A few weeks, then months passed and I lost the weight I had put on (with the help of breast feeding!) but I was left with so much excess skin. Once again people told me I could exercise it off…

I started resenting going to mother and baby groups because I felt like my body wasn’t normal compared to the other mums (I was tucking my saggy belly into my knickers whilst their vest tops were tight enough to show they had flat stomachs).

Whilst pregnant with my second baby I once again bloomed, but this time I was more confident to comment back with arsey comments like “Yeah the baby is huge but at least I have an excuse being pregnant.” Or just simply “I hate that people think they can comment on your size whilst pregnant” (a subtle Fuck Off!). After giving birth I had the stretch marks again that were purple/red and really deep, the brown belly button, the extra skin… but this time I also had a huge lump that wouldn’t go down.

Post-babies! Excess skin tucked into my leggings. My belly button resembled a Cat's Bum! 

I eventually saw a Physio who wrote on my notes that I had a 'diastasis recti' of the abdominal muscles, but no hernia, and he advised me to continue with the exercises.

One month after giving birth.  The hernia makes it look like I still have a baby in there!

I continued laboriously for over 6months but the lump wouldn’t go so I finally went to a plastic surgeon hoping he could just get rid of what I thought was stubborn fat. I paid for one of the best plastic surgeons in the UK and as soon as I laid down he diagnosed an abdominal hernia saying “no exercise will improve it and surgery is a must”. I also asked to have the excess skin removed whilst under the anaesthetic.  I just had to wait until my son was no longer breastfeeding (I had planned for 13months so he had the same as my daughter). My husband was forever telling me that I was beautiful and he didn’t care if I had a flat stomach or a saggy one.  I truly believe he meant it, but I needed the excess skin gone for my own self esteem.

Whilst not being diagnosed with a hernia and assuming it was just stubborn fat I found a picture on Pinterest of a mummy tummy that helped me deal a little with what I thought would be my body for life:

"A mark for every breath you took,

every blink , every sleepy yawn.

One for every time you sucked your thumb,

waved hello, closed your eyes and slept

in the most perfect darkness.

One for every dream you dreamed inside me.

It isn’t very pretty anymore. Some may even say it’s ugly.

That’s ok.

It was your home. It was where I grew you to love you,

where I laid my hand.

As I dreamed about who you were and who you would be.

It held you until my arms could,

and for that I will always find something beautiful in it."

Post-surgery: The hernia was caused by pregnancy causing the stomach muscles to part.  The physio's advice had made the hernia worse, to the point that the surgeon said it was one of the worst abdominal hernias he has worked on (the size of a mans's first).

I may have removed my badge of honour – the excess skin by taking the wimps option of paying for surgery whilst repairing a hernia. But I proudly still carry my stretch marks and read this confidently knowing my body did something amazing.

My advice to everyone: Next time you see a pregnant woman please don’t think it’s your god given right to comment about her size. I have also heard from friends that they were offended when people say “Oh you don’t have much of a bump, the baby is going to be tiny”! And then worrying about the baby the whole pregnancy and finally giving birth to a baby with a ‘normal’ weight.

My advice to new mums: For some people their bodies improve, for others they learn to embrace their new amazing body and for some, like me, intervention was the only way. Do what makes you happy but never let anyone else’s opinion change yours. Don’t put pressure on yourself by expecting to walk out after labour with your pre-pregnancy body, understand what your body has been through – it’s a bloody miracle.

The Mother Image: myths, misrepresentations and censure.

The visual image as catalyst for social change?

Last week, I attended the incredible event that is the annual Birthlight ‘Womb to World’ conference, along with some Midwife friends of mine.  It was a brilliant day, and a gathering of incredibly passionate and inspiring women.  I love these events, where women come together, and discuss, debate, and support one another… The enthusiasm and energy drives me to go on working hard and adds to my conviction that all kinds of positive change are possible, and indeed inevitable.

The theme of the conference ‘Maternal images and representations; before, during and after birth,’ covered a broad expanse of speakers and topics, each presenting and exploring motherhood and birth in innovative ways.

The rare fusion of different disciplines: anthropology, physiology alternative medicine, psychology, art, popular culture, is what makes Birthlight conferences so particular and unique. Such a synthesis speaks of a whole woman, the complex and special nature of motherhood: exploring the many threads, the many fibres that both differentiate and unite us. 

The focus on the visual image, in this particular conference, was important. Visual images hold the possibility to evoke something acutely embedded in our sub-conscious: something that goes beyond the limitations of language and the spoken world. Something that when unearthed, can lead to extraordinary revelations.

The Image, as its etymology suggests, is deeply woven with the imagination. In this way The Image represents creative opportunities, to explore, re-discover and re-define aspects of our modern realities.

Visual images represent, at once, that which we are, that which we have come to be, and that which we long for in our postmodern experience.   

Cross-cultural reflections and comparisons, in particular, can challenge our understandings of birth. Psychologist Antonella Sansone presented us with stunning images of motherhood amongst the Himba women of northern Namibia. These images of ‘integrated’, ‘connected’ and ‘shared’ motherhood can provoke primal urges, leading us to important questions: how connected is our society to motherhood? Do young women have an opportunity to practice motherhood? What does this mean for how we visualise, how we see, ourselves as mothers?

Bringing together academics and artists, we explored many strands of popular representations of Motherhood. Where are the mothers in popular TV? Who are those mothers and what do they represent? And indeed why does such an important aspect our experience as humans - as women - continue to escape public view?

Rebecca Feasley’s analysis of the representation of motherhood in popular media was particularly revelatory and charismatic. Inviting us to reflect on what has been the effect of the ‘idealised’ or ‘perfect’ mother portrayed to us in the media. We explored the extent to which the ‘motherhood myth’ has profoundly altered, and wounded, our understanding of ourselves as women and as mothers.

 Artist Hermione Wiltshire equally showcased a fantastic array of images from modern art. Here we reflected on how women, across the ages, have attempted to express their lived realities through the medium of the visual arts. What is still silenced in our experience of motherhood and birth? And how can we make these experiences felt, understood and heard through the various mediums of the visual arts?

These events are imperative in evoking reflection and debate, for us both as birth workers and as women.

Creative, historical, cross-cultural, images of motherhood and birth evoke something profound: they are a visible call to arms, a reminder that in visualising birth we need to start speaking of something more special and more sacred. Something that is deeply embedded in our consciousness as women, and that when unearthed, and acted upon could lead to something extraordinary, unparalleled, and dare I say it – revolutionary. “

You can read more about Birthlight and the Womb-to-world conference here

The Babymoon & the Postnatal Doula: A Love Story

Falling in love

Imagine that feeling when you first get together with someone you are madly, head over heals with: you dissolve into a magical bubble of love, compelled to devour every second of it.  You don’t want to lose a moment to wash, to sleep…you can barely be bothered to eat.  Ordering take-away Pizzas and spending hours simply gazing into one another’s eyes, wrapped in the snoozy bliss of each others arms. It’s the best sight you ever saw, the best music you every heard, the best food you ever ate. …Your senses are heightened, and a fuzzy feeling occupies your entire body.

This, my friends, is Oxytocin, and this is what it often feels like when you first meet your baby, in the inital few weeks of falling in love... In fact, your brain is hardwired to make this happen.  These ‘Overpowering hormonal tides,’ as psychologist Sue Gerhardt calls them, are what makes mums want to constantly touch, look at, and nurture their babies.

Evolution gave us winey, dependent, little miniature-humans that require their entire needs to be catered for, constantly. And so, mother nature also gave us the necessary hormones to engage in the otherwise unlikely inclination to burden ourselves with this needy little parasite!

Theses are the origins of a baby's emotional, as well as physical life

The first few weeks, and indeed first few years, are a pivotal time for the baby’s physiological, psychological, and neurological development: in seeding bonds, and in regulating their early social experiences.  

As well as physically nourishing the baby with her milk, the mother’s touch regulates the baby’s temperature, his muscle activity, his growth hormones and at the same time, disperses his stress hormones. 

Just like us, babies produce stress hormones such as adrenaline and cortisol, when they feel alone and fearful and ‘happy chemicals’ such as endorphins and dopamine, which are triggered when they feel safe secure and loved. Such processes have a powerful impact on the early shaping of a baby’s brain.

In fact, many psychologist have argued that the simple act of being held, has the most powerful impact of all, on baby’s early development.

The development of the infant brain is a hefty and complex topic, but Gerhardt’s book ‘Why Love Matters,’ describes the neuroscience of this in great detail, and is a book that I highly recommend.

It is as a result of these intimate processes and mix of hormones that mother’s feel compelled to stay enveloped in this bubble of love with their baby.  She needs to be physically present for her baby almost non-stop, especially in the initial few weeks.  This can be utterly exhausting: physically, emotionally, and mentally…and like in any period of great change and unfamiliarity we need support, assistance and reassurance in order to thrive and to flourish.

This is where a postnatal Doula can help: She assists the mum to make space, time, and room, for this love story to take place, uninhibited by other mundane daily tasks and worries….

 Imagining Another Reality

 One of my Doula clients who I am caring for at the moment had her first baby in the Netherlands (A homebirth of course!).  The Dutch are often upheld as demonstrating a ‘gold standard’ of maternity care.  For a start, they totally rock the homebirth statistics.   And they invest FIERCELY in women’s postnatal support: each new mum is allocated a maternity nurse who visits her house for the first few weeks following birth.  This specialist nurse is called a ‘Kraamzorg.’   They provide early advice and assistance relating to physical health, such as breastfeeding and nappy changing.  They also clean your house.  They make your meals for you. And it’s all included as part of state-funded health.

No people, this isn’t Nirvana, this is the Netherlands….

As usual, the Dutch are leaps and bounds ahead, in terms of their long-term foresight into what constitutes building a healthy society.  The Kraamzorg service is rooted in an understanding of the importance, and effectiveness, of investing in motherhood and the early postnatal period.

Many other societies and cultures replicate a similar period of rest, repose and support, for new mothers.  Some cultures even insist upon a ‘lying in period’ where a new mother is entirely exempt from usual daily household duties.  They are waited on hand and foot, by other female members of the their communities, and this period can last up to one month! (Read Sheila kitzinger for more info on these cross-cultural/ anthropological perspectives of motherhood – she explores them in depth!)

What does a postnatal Doula actually DO?

 The name ‘Doula,’ in general terms, refers to someone who supports, and assists a woman during their journey through pregnancy and new motherhood.  In the words of a good friend of my “She's a bit like your best pal for pregnancy.”

 ‘Postnatal’ or ‘Postpartum’ simply means after your baby is born.  A bit like ‘ante’ natal means before…

The purpose of the Postnatal Doula, as I see it, is both functional and practical.  More crucially, she is an experienced expert in facilitating the whole range of needs of mums and babies, at this very important time…

Personally, I worked part-time as a nanny before I became a Midwife and a Doula so I get mums and I get babies, in their full array of unique emotional & physical requirements. 

Having a Postnatal Doula, is just like having your mum, or another experienced friend/relative around the house to help you out. 

It takes the pressure off and allows you to regain some sanity and a sense of a world outside of your bed & your baby.  Or, it allows you the ability to have 100% love-time with your newborn, while somebody else takes care of the practical stuff.

Different women have entirely different needs…it’s all fairly flexible.  We offer help and support – whatever that means for you.

The expert functions

Postnatal Doulas understand mums and they understand babies.  They can help you navigate your way around adjusting to the the needs of this brand new tiny human.  This might include:

 - Breastfeeding support

 - Advice/help with postnatal exercise

 - Helping you to express milk

 - Reassurance and guidance on all sorts of mini-human functions:

settling the baby, bathing the baby, changing nappies and understanding sublime things such as poo textures, colours etc. 

 The practical functions

Covers, quite literally, anything and everything else: anything you need, that you would normally do for yourself, if you were not so busy being madly in love with your baby and catering for their 24/7 needs.  Think of it like having a Postnatal PA.

- food shopping

- assisting with making meals

-  washing, tidying…

-   sterilising bottles and/or breastpumps

- looking after the baby while you shower, etc

‘Devon Clement,’ the blogger behind ‘mama’s best friend,’ has written a brilliant blog, which describes the day to day task of a Postpartum doula beautifully: http://mamasbestfriend.com/day-home-postpartum-doula/

The chicken noodle soup scenario

When I describe postnatal Doulas to my friends I often use the chicken noodle soup scenario. 

When I am sick, recovering from an illness, or feeling otherwise out of sorts I always want a certain type of homemade chicken soup.

Ideally, my mum or one of my female relatives would be the maker of this broth: she’d have roasted a chicken the day before and made a stock with the carcass.  She would follow the traditional family recipe that we call ‘Panackalty,’ perfected by my grandparents, and quite probably their great-grandparents….This is the exactly the Stuff that my body and soul longs for.

It’s the culinary embodiment of home, health, and ultimate wellbeing.  And this stuff, in times of hardship, is like liquid gold for me. 

The amount of women I have looked after in hospitals, where their (most often) mum or female family member arrives, shortly after their baby has emerged into the world, with some kind of traditional broth or hot meal or equivalent, has cemented this idea for me.  I equally have beautiful memories of being at Homebirths in estates in Brixton, where we’d all sit round after the birth and Eat Saltfish&Acky with Rice&Peas, concocted by the woman’s Jamaican grandmother.

The Postnatal Doula also does this: she’s the Jamaican grandmother, the maker of the broth.  When you tell her it has to be THAT soup, made exactly THAT way, or bought from THAT particular shop.  She doesn’t think you are demanding or spoilt or totally outrageous.  She completely understands…She helps you with anything that your body or soul needs at this important and crucial time.  And she doesn’t judge.  

Of course the soup is merely an example, a metaphor. but you know exactly what I mean right? You just need the soup. – The Doula will bring you the Soup.

Mothering the mother

For some people, the idea of being a Doula might not sound that appealing: it probably sounds a bit like being a maid. And in some respects it is; the term Doula actually derives from the ancient Greek word for ‘female slave.’  However, we do this job not through an obsessive love of grocery shopping or tidying-up… we do it from a genuine love of supporting other women.

The support we give stems from a deep appreciation, and an empathy, for women’s needs, desires and vulnerabilities, around new motherhood.

What I refer to as a Postnatal Doula here, does not necessarily have to be someone you pay or hire.  The term covers a broad concept and/or role.  Many women are lucky enough to have one of their own relatives or friend who fullfils this role exquisitely.

However, due to the nature of our ultra modern lifestyles – frequently migrating to cities far from our homelands and families - many of us find ourselves out of reach of such traditional support networks.

And as with the ‘labour doula,’ many fathers have now begun, to some extent, to take on this role.

As a community midwife working in London, I frequently would see grandmothers travelling from afar, quite literally from all over the planet, to camp up for a few weeks around the birth of their grandchild.  However I also saw many new mothers and fathers struggling alone, in the early days, to navigate and interpret the needs and desires of their new baby, exhausted, frustrated and confused…It can be a challenging as well as joyous time. 

Since we don’t yet have the system that they do in the Netherlands, many mothers have found that hiring a professional Postnatal Doula is a really good investment in their own and their baby’s wellbeing, and quite frequently their partners too!

Just like in other aspects of our health, when the state-funded care doesn’t quite cut it, and we want a more personalised, specialised and holistic service, we decide it’s worth splashing the extra cash.  To me, it’s not that dissimilar to when you pay for a massage, or acupuncture, or a yoga retreat…you know its good for you, so you don’t mind the investment.  And arguably it’s a more fruitful investment that a designer handbag…  

Birth Art: visual representations of womanhood and birth

http://callthemidwife.tumblr.com

I recently came across a wonderful tumbler blog through my twitter friend @edinbirth.

The 'Call the Midwife' Tumblog has an incredible range of images on pregnancy, birth and womanhood which I'm sure many of you will enjoy!

My 2 personal favourites are the images of a baby swimming (below) and the anatomical pants (above)!  My mum has always loved to swim and took me swimming from being a very tiny tot; I have been a 100% water baby ever since!   And the anatomical pants are just, well, hysterical...

http://callthemidwife.tumblr.com

I'm really happy to be able to share  images like this as I believe they are really important in shaping our understanding of birth: modern, historical, and cross cultural.

This weekend I am attending the Birthlight annual conference which explores Maternal images and maternal representations before, during and after birth, which I am very excited about!  Birthlight is an incredible organisation run by Cambridge-based anthropologist Francoise Freedman: you can read more about Birthlight here

Why do visual representations matter?

The way we view, and represent birth, and the female body has a powerful affect on our understanding of pregnancy and womanhood.  Seeing is believing: what we see informs our brain, most notably our unconscious mind, and we subconsciously decode this 'visual information,' which goes on to contribute to our understanding of the world...

Before I became a Midwife/Doula/Antenatal teacher I did an arts degree at Durham University and I loved reading books such as John Berger's "Ways of Seeing" which explore the way in which visual images penetrate our understanding, and have a lasting impact on our interpretation of certain spheres.

"Birthing from within" is one of my all-time favourite birth preparation books, which explores some wonderful ways in which art techniques can be used in birth preparation, as visual images are used to inform our understanding about the processes of birth.  This book includes many beautiful illustrations, and was initially lent to me by my inspirational friend and super-hero Midwife (aka Neighbourhood Midwife) Annie Francis, just before I became a Midwife.  It has had a profound, and lasting, effect on my understanding of pregnancy, and alternative birth preparation methods and techniques.

Sheila Kitzinger's classic book "Rediscovering birth" is another favourite, which showcases many wonderful cross-cultural representations of women during childbirth, as well as a range of traditional birth art, sculptures, and other images from around the world.  **Recommend!**

You can also see the REAL DEAL of some amazing sculptures and statuettes relating to womanhood and fertility IN REAL LIFE at the British Museum. These include ancient figurines (below left), which date back to several centuries BC! The Wellcome collection, on Euston Road, equally displays some incredible anatomical drawings and sculptures relating to pregnancy and childbirth (below right).

Visit the Wellcome collection image gallery on birth here

If you have any interesting birth art of your own or you have seen interesting related blogs elsewhere please do get in touch! I would love to showcase more here! Thanks : )

What makes Midwifery/Doula work the best Job in the world?

Last night I was getting ready for a nightshift at the hospital when I received this beautiful and wonderfully heartfelt email from Jonathan, one of the fathers whose wife I supported at the Homerton Birth Centre/Alongside Midwifery Unit, last month.

I'm sure that many of you - Midwives, Doulas, Mothers and Fathers - can relate to how much it means to us Healthcare Professionals, when we hear just how deeply our care is appreciated by the families that we support.

We all work incredibly hard to make parent's experience as caring and personalised as possible - so it's great to hear when it's appreciated!

SO, I wanted to share this story with you all as I feel it so wonderfully expresses the difference it makes when we (Midwives, and other health professionals) go beyond the call of duty.

It is stories like this, and knowing that we can make such a huge impact on the people that we care for, that keeps us going even when we are on our last legs! (lord knows - it definitely isn't the money!)

I can also attest to what Jonathan describes here as the unique spirit of the Homerton hospital.  It really is such a positive and friendly place to work, and a fantastic team to be part of. I too have felt so nurtured by many of the senior Midwives and Doctors there, who have always been  willing to support me, since I started working as a Midwife at the Homerton (Patricia, Nettie, Modupe... - you know who you are!)  Staff encouraging, supporting, and being kind to each other really does make a huge difference to the overall positive atmosphere of the place - and this relays to patients too, which is clear from Jonathan and Emma's experience here! Go Team!

Thank you Jonathan for sharing your beautiful words with us:

"My wife Emma and I had our baby at the Homerton just over three weeks ago.

We started in the Birth Centre with Jodi, but Emma was bleeding so we went to the delivery suite to be monitored, and eventually to theatre for an emergency c section due to placental abruption.

We then stayed for 3 nights on the Templar Ward.
During our time we probably encountered over 50 different staff members, from consultants to cleaners, and we felt so often that not only are people really in command of their field (even at the end of a gruelling nightshift) but theygenuinely care, and will so often go that little bit further than the call of duty.
Jodi and the other midwives were wonderful and really supported us, and gave us time to try natural methods when we could, and explained to us when and why we needed to try other things.

The consultant who made the call to take Emma to theatre and performed the op was extraordinary. I have a vivid image of her holding Emma, stoking her hair, soothing her as she sat on the operating table while the anaesthetist had some difficulty finding the spot for the needle in her spine. She understood that we wanted things to be as natural as possible, and even asked me to bring in music, and I had skin to skin with our son almost immediately.

I could go on for pages: a midwife called Mica who spent 45 minutes tenderly helping Emma to breastfeed on day 1, Josceline the breast feeding specialist who took us even further on that journey with patience and humour and spotted the tongue tie (that had been missed earlier), countless little moments talking and getting advice: in SCBU, NICO, and Precious who shared our last morning with us and discharged us feeling like we were really special.

And having seen the relentless turnaround on that ward, I know that feeling comes from the fact that so many of the staff are doing it from the heart.

And that really means a lot given the very trying climate that you’re all working in.

I was really bloody scared when we were whisked into theatre, and after both Emma and Nico emerged healthy, we were very very grateful for the efficiency and skill of the team, and the fact that we live in a country where such cases routinely result in happy outcomes…and not least that there was no financial aspect to the story as there would have been in other countries.

So we’d like to salute you all, and thank you enormously.

Warm regards,
Jonathan."

You can also read Jonathan's kind testimonial that he wrote about the care I gave to Emma&himself here

Licence to (KG) Hypnobirth!

Look what arrived through the post this morning! : )

Contrary to what you some of you might think, the assessment for KG Hypnobirthing teacher training is actually extremely thorough and comprehensive.  

It is rooted in solid scientific knowledge and an in-depth understanding of the physiology of birth.  To read more about the science behind hypnobirthing you can read my Blogpost here

Since I now have personal experience of going through this particular KG Hypnobirthing training programme and assessment, I can verify it's high quality, and the  criteria that teachers must go through in order to qualify as a KG Hypnonbirthing teachers.  

Even as a qualified Midwife there were plenty of topics I had to refresh on and research in order to complete my assessment!

Next stop : Perinatal Yoga teacher training in December!

As part of my ongoing journey to support women in pregnancy&birth I will also be undertaking the full Perinatal pregnancy Yoga training with the wonderful Birthlight, so I look forward to sharing lots of interesting stuff re: Pregnancy and Yoga with you all soon! (I LOVE Learning : ))

Thanks to all of the lovely staff down at KG hypnobirthing for their positivity and support!

Here are the lovely comments/feedback I got from my assessment: 

The Beauty of normal birth

What’s the Science behind Hypnobirthing?

3 Simple Scientific Facts

During a long weekend away in Toulouse recently, I encountered a little…erm… scepticism about Hypnobirthing from some of the men-folk! (The phrase ‘Hypno-bullsh*t’ may have been thrown around once or twice!)

For starters, the name ‘Hypno’ gets some people going at the offset, as it conjures up all kinds of images of tie-die and whale sounds and airy-fairy la-la-land stuff like that.

However, when you explain that much of Hypnobirthing is actually rooted in solid science, the subject appears to become more palatable…. (particularly, but not exclusively, to those who have Y chromosomes!)

So for the cynics, or potential cynics, amongst you…here are some of the rational facts that might convince you little Einsteins that it’s not all Ommmm sounds and ‘energy’ talk down at Hypnobirthing school….

1. Biology/Physiology

   Firstly, Hypnobirthing starts from a biological understanding of the anatomy and physiological processes involved in birth.  

   We look at the anatomy of the Uterus, and how the various uterine muscles work together, to facilitate the mechanics of birth.

   We then teach various breathing exercises and relaxation techniques that facilitate theses muscles to work efficiently and comfortably. (BREATHING and RELAXATION?! I can hear alarm bells ringing! but wait.…there’s more science to come!)  

2. Neuroscience

   The focus on relaxation is based around a well-researched understanding of the Autonomic nervous system.

   The Autonomic nervous system is composed of 2 parts:

   i) The Sympathetic nervous system

   ii) The Parasympathetic nervous system.

   When the body encounters a stressful situation, this information is perceived by a part of the brain called the ‘Amygdala,’ which then sends a stress signal to the Hypothalamus.

   The Hypothalamus is the ‘control centre’ of the brain; it disseminates this stress signal to the rest of the body through the Autonomic Nervous System (ANS).  The particular branch of the ANS that is activated during the fear or stress response, is the Sympathetic Nervous System, which prompts the Adrenal glands to release the hormone Adrenaline into the bloodstream.  You’ll probably all be familiar with this process as it is commonly referred to - as the “fight or flight response.”

   The release of adrenaline also leads to a series of physiological changes that you will have all experienced at some point: our hearts beat faster, muscles tense, breathing quickens, and our senses sharpen.

   There is also a second mechanism that kicks in (after the initial release of adrenaline diminishes - if the brain still perceives something as dangerous), known as the HPA, which leads to the release of cortisol, another powerful horomone.  You can read about this all in much greater detail here.

   Indeed, this is a pretty hefty topic, but the essence of our understanding here is that the hormones released during the stress response, specifically adrenaline, are not conducive to the physiological processes needed for a smooth and comfortable birth (I will talk more about this in section 3)

   Cumulative low-level stress over a long period of time can actually lead to long term physiological and psychological harm, such as anxiety and depression - but that's another story for another day.

   SO how do we counter the stress response? RELAX!! If we can train the brain to relax around certain events during pregnancy and childbirth, we can reduce the fear/stress response and activate instead the second part of the ANS which is called the PARAsympathetic nervous system or the calm response.

   Therefore the Hypnobirthing scripts which you practise as part of a hypnobirthing programme, are not, in fact, pseudo-spiritual brain-washing that's going to make you or your other half want to grow dreadlocks and join a commune. They are simply a series of relaxation exercises which train your brain to think about your birth positively and calmly, and thus keep the stress response at bay. Et Voila!

   Medics such as Dr Herbert Benson (and yes he’s a real Doctor, like actually a professor of medicine) at the Harvard Health school have already made headway into a deeper understanding of how we can elicit the ‘relaxation response,’ as an antidote to the stress response.  Such approaches include breathing techniques, focussing on certain calming words or language, and visualisation of tranquil scenes. Funnily enough - all of which feature in Hypnobirthing practise! 

   You can read more about this work here.

   “The relaxation response is a physical state of deep rest that changes the physical and emotional responses to stress... and the opposite of the fight or flight response"

3.  And more Endocrinology

   What is key about the relaxed response, or when the PARAsympathetic nervous system is in operation, is that a number of other hormones and natural opiates, which are incredibly useful for birth, are also freely released:

   These amazing and wonderful little molecules are:

   Oxytocin - the lurv horomone.  It’s what makes us all loved up when we get sexy, but it’s also the absolute MOTHER of the birth hormones.  Oxytocin is what makes our uterus’s contract (or ‘surge’ as some hypnobirthers like to call it), as discussed in section 1 above.  It is also the hormone which promotes breastfeeding and bonding once the baby is born.

   Endorphins - literally endogenous morphine - the body’s own, magnificent natural pain killer, said to be several times stronger than the synthetic morphine you might be prescribed by your doctor. This is what makes natural birth more comfortable; when the body is operating in the calm response it is able to freely emit this magic opiod stuff.

   In brief, the hormones produced during the relaxed response are absolutely FUNDAMENTAL to a calm, natural and comfortable birth as they make the mechanisms of birth more functional and more efficient.

   SO we know which part of the ANS we’d prefer to be operating in during birth now don’t we? Exactly….  

   Conversely, Oxytocin and Endorphins are not freely emitted when the Sympathetic Nervous system is in operation, which takes us nicely full circle back to point 2 above,  why the stress response is not helpful during birth.  Oxytocin is often referred to as the ‘shy hormone’ as it comes out to play only when we are in a safe, quiet, place.  (Think about the environment you’re most likely to be in to make love, and then apply the same principles to birth).  You can read the main man Michel Odent for more info on this one!

   So there we have it, just some of the science behind why hypnobirthing works. If you are preparing yourselves for a calm, comfortable and smooth labour then the science seems to say that this would be a good start!

   There is obviously much more to Hypnobirthing than simply this, and what I’ve given here is only a brief outline of the physiology of birth and the neuroscience and hormones involved...but I hope that for now I’ve gone at least part of the way in convincing some of you that it’s not all hippy-dippy Hypno-Bullsh*t!

The Birth Queen!

Birth centres arrive in Paris! Les maisons de naissance arrivent enfin en France!

 The first of August was a very exciting day for French Women - and babies!

A law permitting birth centres to open across France was officially enacted last week.

‘Les maisons de naissance’ which are expected to appear over the coming months, mark a revolutionary change for birth in France, which has traditionally been seen as an extremely medicalised and interventionist culture.

The large majority of women in France currently give birth with an epidural, in an Obstetric Unit, and options for those who want a more natural or physiological experience has been very limited, up until now. 

Not only does the opening of maisons de naissance herald increased choice for women, who wish to give birth outside of an Obstetric Unit, but it equally signals a change in the way the French think about labour and childbirth.  

The philosophy of a birth centre stems around supporting and enabling physiological birth. A calmer, more gentle experience, which respects and harnesses the natural rhythms and wisdom of the body.

En savoir plus:

Links in the French press:

http://www.la-croix.com/Actualite/France/Les-maisons-de-naissance-voient-le-jour-en-France-2015-08-02-134065

http://lci.tf1.fr/france/societe/des-maisons-de-naissance-verront-bientot-le-jour-en-france-8641412.html

Are we forcing fathers into the birthing room?

Do men bring drama to the birth room?

The ubiquitous Michel Odent famously, in his characteristically provocative fashion, once said that father’s should not be allowed into the birthing room.

The radical, french obstetrician, well known for his discourse on the medicalisation, ‘modernisation,’  and masculinisation of childbirth, is no stranger to causing a stir in the boho-maman-bébé circles.  However, unlike some of his other revolutionary ideas, this particular little nugget of wisdom didn’t quite seem to catch on.

Perhaps this was due to the fact that the childbirth Guru is, himself, a man and there was a subtle sense of irony in this implication that he was the only male fit to be present in the birth environment [At times we would be forgiven for thinking that Odent is actually a women, or some kind of born-again misandrist that woke up one day and found himself with a penis]. 

None-the-less, I am in fact a big fan of many of Odent's ideas, and his argument about men bringing unnecessary noise, drama, anxiety and adrenaline to the birthing room was rooted in, and cohesive with, his ideas about stress hormones, and the overstimulation of the ‘thinking’ brain, fundamentally inhibiting and disturbing the birth process.

We only have to look at the clip of Robbie Williams serenading his unimpressed wife, as she attempts to give birth to their baby, or watch a clip of One Born Every Minute, to see that the male presence in the birth room is not always helpful.

And whilst it doesn't necessarily follow that all men bring drama to the birth room, I can’t help but think that there is at least some element of truth, in Odent’s claims here.

The blurring of gender roles

Part of living in this, our post-modern times is the perpetual definition and re-definition of our gender roles. The current ‘trans’ debate, for instance is blurring the boundaries of what we see and think of as distinctively ‘male’ and ‘female’ roles.

Thus, this new-found fluidity, between what we once saw as typically male or female characteristics or tendencies; the mothering female: empathiser, carer, nurturer, Versus the He-man hunter gatherer figure: scientific, rational, material provider, perhaps goes part of the way to explain the wake of men busting into the birth room.

Historically, and anthropologically, we know that birth has been a traditionally female domain.  And the fact that most father’s in the UK now attend the birth should, rightly, be situated within it’s own historical and cultural context.

Whilst we have come to see this model as the norm here in the UK (93% of men are involved to some extent), it is in fact a relatively new, and culturally specific phenomenon.    

Dr Laura King, is a social historian at the University of Leeds, who completed her PhD in fatherhood in early modern Britain. She situates the rise of fathers accompanying their wives, from the 1950’s onwards, within the context of the movement of birth from the home to the hospital.                    

 « Away from the familiar surroundings of the home, women looked to a birthing partner for more moral support and men started to play an increasing role. »

The emergence of the 'modern man'

The ‘rise’ of the modern man presents us with a new, and curious creature, who frequently sees his ‘mate’ quite literally as his best pal, and decides to embark upon all that she does, and experiences, in a kind of symbiotic, mutual journey.

I have witnessed many a specimen of this new modern man: in touch with his emotions, embodying and embracing everything from hypnobirthing visualisations, “think of the lotus flower baby; open like a lotus flower,” to furrowing through the Bach flower remedies manual to find the best potion for his Missus’ present ailment.

But whilst many men are all too willing to get down and dirty with birth, there are still those who prefer to stay well away, maintaining that birth is a female domain. Some feel simply too squeemish about the whole gory process, whilst others are concerned about the impact that getting up-close and personal during birth will have on their future romantic relationship.

On both sides of the channel we have seen prominent male figures declare their distain for the male presence at birth.  The ever-outspoken Gordon Ramsey, cooked up a fuss when he publically, and unapologetically, announced that he did not attend the births of any of his four children.  Expressing particular concern over the repercussions this would have on his sex life he commented: 

“Seeing a woman in distress, screaming at the top of her voice, pushing, pushing, pushing, and sweat, sweat, sweat? I'd rather be stark bollock naked in a steam room with 50 vegans."

Across the channel, the prominent French Sailor Olivier de Kersauson was equally unapologetic when he declared: « birth is women’s business ; it is not men’s business.»  Being a french man, he chose to elaborate this belief by using the analogy of a roman temple, in which males and females are like columns: a certain amount of distance and separation must be maintained, for the continued stability and equilibrium of the whole....  

La maternité est une affaire de femme. Pas une affaire d'homme.  Dans les Ecritures, on présente l'enfant au père une semaine après l'accouchement. Les colonnes du temple, quand elles sont trop rapprochées, ne soutiennent rien. Un homme et une femme doivent être suffisamment séparés pour pouvoir soutenir quelque chose, une construction. [...] 

Whereas the above may well represent extreme examples, the British pregnancy advisory service estimates that one in 20 fathers still avoids being present when their partner gives birth.

Often chastised for being unsupportive, or selfish, should men who feel truly uncomfortable with the process, or that it is not their domain, be given a bit of slack?

Is birth still a female space?

There is also the bigger question of how useful Men actually are at what we traditionally consider female roles.  A Telegraph article last week highlighted the increasing number of women who are now choosing to have their Mother in Laws (‘MIL’s’) present at their birth.  This idea of an experienced female figure, who has had their own children, being well equipped to provide emotional support, is also the premise behind the rise of the Doulas.

Experienced doulas have often undergone several training courses and attended hundreds of births, and many have also had children of their own.  Such experience means that they can anticipate the needs of the labouring woman and provide reassurance and guidance. Can we really expect men, who have no previous experience, to do a crash course in birth support and meet these needs equally well?

And are we putting too much pressure on men to fulfil this role, which does not always come naturally to them?  Un-practised, and un-experienced, subject to their own anxieties about their own transition into parenthood, men now experience the additional social pressures of becoming birth and breastfeeding wizards in the space of 9 months.

Of course there will be some men who are very excited to embark upon this journey, and extremely dexterous at it.  But for those who aren’t so keen, should we be more lenient, and willing, to let them duck out? 

On several occasions I have heard of women being disappointed with the support they received from their partners during birth, wishing instead that they had chosen to have a more experienced and calming female figure supporting them during this emotionally and physically taxing time.  I cannot speculate on the impact this has on their relationships, but one would assume that that these feelings of dissatisfaction and inadequacy, feelings of letting-down or being let down by your loved one, during this important time,  pose potential negative consequences. 

Rad-dads, such as Dean Beaumont, author of the Expectant Dad’s handbook, equally adds that for those fathers that are keen to participate, health professionals need to do more to welcome and involve fathers, in order to enable Dads to feel more comfortable and willing, about their role in the birth room.

As with everything to do with childbirth, the matter ultimately boils down to personal choice. However, given that what we now assume as ‘the norm,’ is in fact only 60 years young, perhaps we should be more open and reflective upon the potential disadvantages, as well as advantages, of having fathers in the birthing room.  It cannot be assumed that the father attending the birth, is, necessarily, the best outcome for all couples.                                                                           Given that this is such a recent phenomenon in human history, we cannot yet say, with any conviction, what effect the presence of the father at birth will have on a whole range of social phenomena, including romantic and intimate relationships.

Meditating Midwife

The alternative beauty blog

#altbeautyblog

In an attempt to meditate daily for a whole month I will be posting a picture of myself meditating in a different place every day.

Since I am still recovering from a broken foot, I am doing a lot of sitting at the moment, so I figured I might as well make good use of it! 

The philosophy behind the #altbeautyblog (as you can probably guess from the title!) is to offer a different kind of beauty blog to the dominant fashion/lifestyle/beauty blog that focus on outer beauty and buying stuff to make yourself feel beautiful.  

#altbeautyblog is about cultivating inner beauty and wellbeing.  It's radical because it is free! And it shifts the focus inwards...

As I go to Paris this Saturday, and then on to Canada, this project could include some interesting locations!

Follow me on instagram:  meditatingmidwife #altbeautyblog

I will be also be posting daily meditations and pics on my website here

Anyone who wants to join in you are very welcome! Please hashtag #altbeautyblog or #meditatingmidwife on Facebook/Instagram! (alternatively if you don't have either of those just email me your pic!)

Thanks!  ENJOY!  

Morning meditations

I try to do some mindfulness meditation at least once a week, usually on a morning. 

I always feel more positive and energised afterwards, and it sets a good intention for the day.

It's generally easier to do on a morning as my mind is usual clear and quiet, and there is sense of starting over:  moving forward from whatever came the day before, and preparing the mind for whatever might come today. 

Sometimes it's a bit of wrestle getting out of bed, and moving towards my mat;  I think of things I'd rather be doing, convince myself I am too busy or don't have time.  But then I remember how good I will feel afterwards.  

SO I set my pink yoga mat and my cushions down on my patio, and away we go…. 

Since I live in a council/ex-council block in the middle of Hackney, theres always plenty of noises, and sensations to focus on so.   It's a total myth that you need to be in some kind of tranquil oasis in the middle of nature to meditate.  Obviously it's wonderful to be on a peaceful beach where you can focus on the sounds of the waves.  

But even in the middle of the concrete jungle there are sensations to focus on; the feeling of the gentle breeze on your skin, the sun on your face (sometimes!) and the bird singing (why the birds don't ditch Hackney and fly somewhere nicer I really dont know)….

And there is always Breath; the gentle rise and fall of the breath.  Thats the great thing about meditation, you can carry it with you and do it wherever you go. 

I would also really recommend Mindfullness practice for Pregnancy and even after the baby is born.  Apparently you can use many of the same techniques for the early days with a baby or toddler, although I've never tried it myself.

Mindful birthing, by Nancy Bardack, is a great book that was recommended to me by my wonderful Yoga and Mindfulness teacher Ayala Gill. 

Apparently you can also get books about mindful hypnobirthing but I haven't got my head round that yet!  They are undoubtedly very complementary practises but I am yet to fully suss out how you merge the two: I'll keep you posted!

If it all sounds a bit whack for you right now then I'd recommend to simply start by downloading a mindfulness app and listen to it whilst you are lying in bed at night.  Pop in your earphones and have a go; nobody has to know that you're not actually listening to Radiohead.

And it's probably much better for you that listening to Radiohead anyway...

How to have the Midwifery X-factor: My 5 tips for Wannabe Midwives

I’ve had rather a lot of messages from newbie Midwife hopefuls over the past few years, asking for tips on applications and interviews. So I’ve hashed together some of the things I personally think are important when preparing to WOW the interview panels.

I read somewhere a few months ago that it’s now (statistically?) harder to get onto a UK Midwifery course than it is to get into Oxford or Cambridge? Is this actually true?

I remember my own lightbulb moment when I eventually decided to become a Midwife.  I was re-reading the book The Red Tent in my flat in Brixton, absorbed in the beautiful tales of Dinah (the protagonist who becomes a Midwife), thinking, “WOW, being a Midwife really is such a magical job, if only I had done Science A-levels…surely you must need science A-levels to do this right?”

By this point in my life I’d flirted with about 400 different career paths and actually, or nearly, enrolled on degree courses for approximately 1 in 10 of them…but the more I thought about it and the more I read, this one REALLY did feel like my calling (although some friends and family definitely thought it was just another pipe dream or 'phase').

I’d always been interested in, and involved with women’s issues, and done countless women's- related voluntary and paid work.  Looking back, they all followed a certain trajectory that lead towards Birth, but I’d never really joined the dots.

Then came the agonising bit.  By the time I had done a summer work-experience with the Brierley caseload Midwives I was totally and utterly obsessed with becoming a Midwife.   I’d heard it was going to be tough getting a place at Kings, so I spent rather a lot of time constructing spider diagrams of every possible question they could ask me and what my potential responses might be.  I was like MASSIVELY over-prepared, but I wasn’t going to take the risk of having to re-apply and waiting another year to start.

I had read (seemingly) every maternity document ever published, collected old copies of  ‘The Practising Midwife’ dating back to the time of TakeThat, and barely came up for breath from Ina May’s ‘Spiritual Midwifery’ throughout my entire summer holiday in Turkey.  I also quizzed pretty much any Midwife, Doula, antenatal educator or pregnant women who would talk to me.

I can honestly say, hand on heart, that I watched One Born Every Minute, once, and came to the conclusion that it was horrific, and have avoided it like the plague ever since.  I do, however, have a wonderful memory of my good friend Lea Morpurgo coming to my flat and us watching the film ‘Birth into Being,’ where Russian women birth their babies in the Black Sea.  Now THAT is something worth watching.

I recognise, however, that I was incredibly lucky in my gentle and hugely inspiring introduction to the world of Birth; the first dozen ‘real life’ births I saw were all beautiful, uncomplicated homebirths with the Brierley.  My spiritual mum (as I call her), Ingrid Lewis kindly said that this was the universe’s way of welcoming me into the world of birth, but it may well have just been fluke….

In the end I only applied for places at Two Universities: Kings and City.  And I got unconditional offers from both of them. SO I must have done something right…

But enough about ME ME ME.  Here’s a few tips to get you started.  I’m sure some other wise and wonderful Midwives, mothers, and Doulas will add to them for you along the way…

1. Firstly, know how to articulate WHY you want to be a Midwife

You can probably think of a million different reasons, but try to focus, and come up with a few coherent and succinct points.  

Practising this one in front of a mirror is actually worth its weight in gold, not only for the application form/interview, but because once you eventually become a bonafide Midwife you can absolutely guarantee that every party you go to, every friend, friend of a friend, man, woman, beast, vegetable/mineral, that you encounter, is going to ask you this question.  Even other Midwives will ask you!  

So you may as well invest in getting your patter down on this one now.

Be honest, lucid, and most of all be passionate.  There’s nothing more convincing than someone who lights up and beams when they talk about Midwifery.  You might be anxious or nervous, but dig deep and think what truly inspires you to be a Midwife.  Chances are, you have something really wonderful to say, because it’s something truly wonderful that’s inspired you to want to care for, and support other women.

Just don’t say it’s because you LOVE babies.  

2. Show that you genuinely CARE  

This is the one thing that we all know really counts, unwaveringly. It’s the one midwifery skill that will stand the test of time: When it’s 4am and the A&E vending machine is out of diet coke and mars bars, you’ll want to climb into the nearest and birth pool and hide from the world.  But you won’t, because you are totally wedded to the woman you are caring for and you’ll do anything to help her to achieve a positive birth.

This, ultimately, is the most important part of being a Midwife and what shines through in all of the great Midwives I know.  They will run themselves ragged, and put their own needs on the backburner for the women they care for.

All the technical stuff they can teach you; the biology, the practical skills, the clinical research… but true empathy, compassion, and dedication? Well you’ve either got it or you haven’t. 

3. Know your stuff; the big issues

You’re not meant to know everything about Midwifery before you’ve even started the course.  But it’s important to have a basic understanding of the hot topics and key issues in maternity care.

Pivotal guidelines and key publications such as Maternity Matters  and Midwifery 2020 are a good place to start.

It’s also useful to have read one or two things by some of the main movers and shakers in the Midwifery world such as Sheena Byrom, Michele Odent, or Ina May.  You can read more about these recommended books in my blogpost here.

You don't need to be an expert, but having a few of these golden nuggets in your repertoire will make you feel more confident that you’re down with the key debates and have something interesting to say about what’s relevant in maternity now.

Social media sights such as Twitter and Facebook are especially great for keeping up to the minute with the latests Midwifery chat, so find some bloggers/tweeters/facebook group/pages and ride on the back of their links/debates. Job done.

4. Transferable skills/topics: You know more than you think 

Chances are you will have tonnes of life experiences and interests that might not appear to be explicitly linked to Midwifery at first, but they in fact are.

A lot of Midwifery issues are linked to broader feminist and social/political debates, which you may well already have some knowledge or experience of.  For instance, a huge part of midwifery care is the public health aspect of the role: working with, and supporting women with complex social circumstance such as Asylum seeker/refugees, homeless, drug&alcohol dependent women, as well as women who suffer domestic abuse.

If you have any experience of working/volunteering with vulnerable groups such as those with special needs or any of the ‘hard to reach,’ groups mentioned above, this will all be hugely relevant.

‘Soft’ skills and communication skills are equally incredibly important to a Midwive's crucial role in building strong and trusting relationships with women. So too is a propensity for self-awareness and self-reflection; being conscious of the language you use, and the impact you have in your interaction with women and their families is what enables excellent partnerships, and improves birth outcomes and birth experiences for women. 

5. Relax, Breath, and be Confident

The Midwives who will interview you are nice people! They’re not going to be scary or mean because they want to see, and get, the best from you.

They will rightly recognise that everyone has different strengths and weaknesses to bring to the table: There might be some candidates who are incredibly articulate and outspoken, but someone who listens to others is equally, if not more, important.  Knowing when to be silent is a crucial midwifery skills (Im still fine-tuning this one; being naturally one of the articulate but gobby ones!)

If you’ve done your preparation (see steps 1-4!) then you have nothing to be worried about.  Being Calm and Confident now will allow your passion and your motivation to beam through.

The last thing I did on the morning of my interview, before I left the house was some relaxation and meditation excercises.  The memory of this little baby midwife buddah is still vivid! I can literally picture myself sat on my cushions in the corner of my room channelling all of the wonderful people I knew were rooting for me.

After that I actually felt quite excited! Because I knew how well prepared I was and how right this felt for me.  Chanel lots of positivity and you will shine too.

Then come to the Homerton and be my student : )

Midwives and Mothers: Let's get angry, but not at each other.

The war between Midwives and women detracts from the real demon: the system itself.  

Before I became a Midwife, I heard a lot of Midwife bashing; negative attitudes towards Midwives that largely came from Doulas and Mums who were angry at the maternity system, and therefore angry at Midwives who were part of it.

Now I am both a Midwife and a Doula (and at some point in the next few years hoping to be a mum!) I can empathise fully with both sides of the argument.

However, women turning against one another serves no positive purpose.  We need to understand that the same system that quashes women also quashes Midwives.  In-fighting merely detracts from the real, and urgent, debate: maternity care needs to be a public priority and higher up on the government agenda.

We are all aware of the profound, far-reaching, long-term benefits of investing in maternal and child health, and yet it continues to be put on the backburner of government agenda.

We know that when women suffer poor care this impacts upon, and filters into, all aspects of the health and wellbeing of both them and their families.  

Primal health research also increasingly points to the importance of the ‘primal period’ (fetal life, perinatal period, and the first year of an infant’s life) in shaping the future health, wellbeing and character of future generations.

The issue is thus not WHAT will make things better for women and Midwives, we already know this.  The question is HOW to make those changes a reality.

In politicising this campaign we will be stronger if we stand as a united voice; Midwives, Mothers, Doulas…

For anyone who talks about birth as part of the feminist agenda: Remember, Midwives are women too.  The fact that Midwives still work in a system that devalues the work that we do, and provides substandard working conditions, is symptomatic of the same culture that devalues and underfunds women’s maternity care.

All of this in a profession which employs almost exclusively women, in a service destined entirely to serve women...seem surprising? No, and arguably men would not put up with it.

Midwives across the UK regularly work 12-hour shifts without a break to even eat. They work those same 12 hour shifts days, nights and weekends.  They have families, partners and dreams of their own and yet they put other women’s need constantly before their own, day in, day out…

Staff shortages, and the proliferating fear culture within maternity care means that increasing demands are being put on Midwives, resulting in them being unable to spend as much time ‘with women,’ as they might wish.

Or, as Mavis Kirkham puts it “Midwives cannot empower women until they themselves are empowered.”

We are losing some of our most experienced and best Midwives due to expanding pressures, and difficult working conditions.   We increasingly hear in the press, of Midwives who say they have chosen to leave the profession not because they don’t care about women, but because they care too much, to continue to struggle within the existing maternity framework.

 I am not saying the standard of care we give in Britain is not good, quite the contrary.  The majority of Midwives are doing the best possible job they can for women under the current system.  What I am saying that things could be better.

However, women turning against one other will not further the cause.

We ALL want to make birth better, but when Midwives and women fight each other we lose track of the common cause: we all want to see maternity services improved, both for women, and for Midwives.

We do not lack the evidence, or the skills to make birth better.  What we lack are the resources and strategic backing to make these changes a reality.

A good example of this is the resistance to expanding the caseloading/continuity of care model (where a woman see’s the same midwife/small group of midwives throughout her pregnancy), throughout the UK.  All of the evidence we have about the caseloading model points to women being more satisfied with their care and better outcomes for women and babies.  This is the model of care which most Midwives want to give and most women want to receive, and yet the RCM still face barriers to making this the predominant maternity care framework throughout the UK.  (See the RCM better births website for more details on the benefits of this model)

Incidentally, this gold standard of caseload care does actually exist all over the UK: it’s called an Independent Midwife. But you have to pay for it. 

Here in the UK we can be grateful for the fact that we have a strong and autonomous midwifery profession.   In many respects we are still leaps and bounds ahead of many countries across the world, where women do not receive one-to-one care from a Midwife in labour, homebirth is still illegal and intervention rates are much higher than in the UK.

I was speaking with a Colombian Doctor friend of mine a few weeks ago who didn’t understand what a Midwife was; they do not exist in Columbia.  Like in many other countries a General physician will ‘deliver’ all women, in lithotomy position, whilst a general nurse assists the Doctor.

However, despite our comparative advantage in the UK, there is still plenty of work to be done to continue to improve maternity care.

As Louise Silverton, director of Midwifery at the RCM commented yesterday:

"We remain around 2600 full-time midwives short in England. Midwives cannot deliver high quality care if there are not enough of them."

So Yes we should be angry.   But the current climate of Midwifery and Obstetrics is bigger than any one individual.   What women are really angry at is the status quo, and its inability to provide them with the quality of care that they know they deserve.  

We need to continue to campaign and make our voices heard.  But lets not waste those voices shouting at each other.

Doula or don’t I?

5 reasons why you (might!) need a Doula for you birth and why. 

1.     Continuity

A Doula provides continuity for expectant mothers all the way through to the postnatal period. She is a friendly and familiar face who is there to support you throughout your pregnancy.

Unless you are one of the fortunate few who have a local caseload midwifery team in your area, you will see a different midwife for your antenatal, intrapartum (during the labour and birth) and postnatal care. 

N.B. This kind of model does not exist in Paris at all as maternity care is entirely fragmented in France.

Unfortunately this kind of Midwifery continuity of care is still not available in most areas of the UK, despite its benefits having been recognised in several research studies.  The RCM persistently campaigns for a wider expansion of the Midwifery-led continuity of carer models across the UK.  However, until this becomes a reality a Doula can go some of the way in providing this continuity for a woman.

See Sandall et al.’s Cochrane review for more info on the benefits of Continuity of Care. 

You can read more about the RCM's Better Birth Campaign on continuity of care here

2.     Personalised Care

A doula is there for YOUR needs. This is her entire purpose. 

Since you have spent time together before the birth your Doula knows you and your preferences well, and thus knows how to best support you during the birth. 

Knowing that there is someone there to safeguard your wishes can relive stress and anxiety and allow you to focus on (dare I say it – enjoying?) your labour and birth.

A woman’s partner/family member can also provide continuity and act as a protector of her space and wishes, but they may lack the comprehensive knowledge of birth processes and support techniques, which is the Doula’s realm.

3.     Experience

Doulas like myself have seen hundreds of normal labours and births.   They will have developed effective techniques in supporting you to have an intervention-free and active birth (if that’s what you want!) wherever possible.

An experienced Doula will quite literally have a BAG of tricks with her, and can assist you in preparing for a comfortable birth.

A Doula can also provide you with support and advice negotiating various parts of pregnancy and birth.   Most antenatal clinic appointments in UK and France are allocated approximately a 15-minute time slot, so you inevitably will not have time to explore all of the issues you want to with your Midwife.  A Doula can help you to explore theses decisions in detail, taking into account your personal beliefs, values and preferences. Personally, I would also point you to up-to-date research and evidence that supports your choices.

4.     Bonus stuff

Many Doulas have other areas of expertise, such as Hypnobirthing training, Aromatherapy training, Yoga/Mediation skills…etc.

Many doulas will have had tonnes of other life experience and/or children (and even grandchildren!) of their own.  They can therefore assist you with additional, tried and tested techniques to encourage a positive birth experience.

     5.   The Doula has a distinct role.  She does not replace a Midwife

Quite the contrary.  A midwife is the technical, clinical, expert on pregnancy and birth.  Her primary job during antenatal and postnatal appointments, as well as labour, is to carry out a series of clinical examinations that assess the continued health and wellbeing of the mother and baby. 

Of course the Midwife also provides some emotional support.  However, she is occupied with carrying out, and documenting, important clinical investigations and assessments and therefore many people find it helpful to have another, skilled professional, present to be solely dedicated to the emotional support of the woman.

A good Midwife will welcome a positive and cooperative Doula to assist with the birth.  As an NHS midwife I frequently work with Doulas and birth partners and generally love having them around, finding them to be a great support.

Doulas and Midwives are not, and should not, be at odds with one another.  Essentially, we provide distinct and complementary roles, in our shared goal to support women to have positive, and safe, birth experiences.  

Midwife Thinking: How to ruin a perfectly good birth

Rachel Reed's blog 'Midwife Thinking' has been a great source of reflection and insight for me, since I qualified as a Midwife, and I would definitely recommend it to other Midwives/Doulas/Doctors.

Rachel is an independent Homebirth Midwife in Australia, or as she calls herself 'a birth nerd!'

Her blog examines and challenges current midwifery/obstetric practise and looks at the evidence (or lack of evidence!) behind what we do and why.

Rachel's blog on Early pushing "the anterior cervical lip; how to ruin a perfectly good birth" has been particularly influential in my development as a Midwife and I would encourage EVERYONE to read it.  

This under-researched topic of early pushing is such a great example of how we need to challenge our taken for granted assumptions and learned behaviour and look at the real evidence behind our attempts to 'manage' birth.

I am so grateful for blogs like this as in the current system of management of birth and denying women's own instincts it can sometimes feel like I am the only one who thinks we are unduly doubting women's bodies to birth perfectly.  Blogs like this remind me that I am not alone in putting women's bodily wisdom at the centre of my care and give me strength to carry on.

Keep fighting the good fight people! 

And visit Rachel Reed's blog here!

Homebirth in Paris, and across France: the Fight for Physiology

Sidonie Le Poul-Petit and other homebirth midwives, across france, are upholding the right for women to maintain access to a service, which truly values and respects the physiology of birth.

A friend of a friend told me about these homebirth midwives today and it has literally rocked my world.

The frenchies have got a bit of a bad rep when it comes to birthing ‘au naturel.’  So I was absolutely over the moon to see that there are still some incredibly strong and powerful French midwives who continue to fly the tricolour for women’s choice and freedom, to birth outside of the managed, obstetric environment.

It’s an incredibly brave move as it means that homebirth midwives like Sidonie, who work in the Paris region, are forced to work without insurance.  She is quick to share this information with parents as soon as she meets them, engaging them in partnership with her.  Sidonie is taking a personal and professional risk, every day, in order to to uphold true choice and autonomy for women. 

Jacqueline Lavillioniere, was a homebirth midwife for over 30 years in the Ardeche region of France, and now focuses on campaigning for a greater respect for the physiology of birth across France.  As Jacqueline explains; this campaign is not simply about a relentless quest for homebirth in and of itself (She herself says would have been happy to work in a maternity unit if there was any chance of birth physiology being respected there). It is about providing an alternative to the dominant obstetric system in France.  The fact that doctors dominate decision-making, that natural birth and pain are feared, the threat of litigation…this all prevents a calm and serene birth  being possible inside the current obstetric structures in France.

“L’objectif n’est pas l’accouchement domicile…l’objectif c’est ou que nous soyons, les sages femmes puissent permettre a la physiologie d’etre respectée”

“The objective is not just homebirth, the objective is that we, the midwives, can allow the physiology of birth to be respected, no matter where.”

You can read more about the amazing work of these midwives here: 

I’m afraid this webpage is only available in French but if you REEEEEALLLY want to read it and you are uni-lingual then please email me here and (if there are a few of you) I’ll translate the text into English. (Because everyone really deserves to read about their fantastic work).

BUT THIS IS THE BEST BIT OF ALL: these wonderful midwives have made a beautiful documentary film (with english subtitles!) about their work, which is currently being screened across France and will soon be available on DVD!

You can see the trailer with English subtitles here

It is also available with Dutch, Spanish, Italian, German and Portuguese subtitles so let’s get it shared around the world!

Just watching the trailer practically brought me to tears (nobody does films like the french do films!) and I absolutely cannot wait to see it.

If you would be interested in seeing the full film then please email me here and I can arrange a viewing in London and/or Paris once I get my hand on the goods!!!

You can read more about 'accouchement a domicile' on the ADD website here:

http://accoucheradomicile.chez-alice.fr\

and read more about the collectif de defense de l’accouchement domicile here:  http://cdaad.org

Why Birth Matters: The Journey from womb to world

I was recently sent a podcast with Midwife Anna Verwaal, from my childhood friend Lucy Beaumont.

(Lucy used to live in Hampstead and was a journalist at the Sunday Times before doing a runner from the City Life. She subsequently became a Forest school teacher and Yoga teacher and is currently living in what can only be described as a ‘Hippy Community’ in Spain!)

‘Our Lu’ has been known to recommend and engage in some fairly bonkers stuff so I was a bit reluctant when I initially heard the first few minutes of the podcast and the lady sounded a little bit experimental! But then it BECAME REALLY JUICY. 

The podcast is an incredible and mind-blowing conversation with Anna Verwaal, who has over 20 years experience working as a Maternal-Child Health Nurse, in high-risk labour and delivery, obstetric theatres, as well as postpartum and newborn nursing.

Anna’s revolutionary interpretation of the way in which our bodies remember the circumstances of our birth, and how that goes on to affect our behaviours as adults, will almost certainly make you rethink the importance of the way that we are conceived and born. 

Working in a similar vein to pre-and perinatal psychologist such as David Chamberlain, (check out his birth psychology website here) Anna suggests that we each have a seminal memory, shaped by the events surrounding our birth, which creates a blueprint for the rest of our lives.

This embodied or ‘cellular’ memory, of the way on which we came into being, can equally shape our own fears, belief systems and patterns about birth.

Anna’s therapeutic work thus lies in bringing us to an understanding of the events surrounding our birth, therefore helping us to unravel the patterns of behaviour that they came to shape.  Or, as she puts it, permitting people to “take off layers that don’t belong to them.”

I personally find all this stuff especially interesting in relation to my Hypnobirthing work.  Since hypnobirthing aims to address and change our underlying patterns of beliefs about birth, Anna’s work gives us greater insight into the origins of these potentially damaging and restricting beliefs.  Such an understanding definitely compliments our hypnobirthing work, and gives us further insight into individualising our hypnobirthing practise to each parent's specific fears or concerns.

In fact, it is an important insight for anyone working with women and families around birth; Doulas, Midwives and Doctors alike…..As Anna herself puts it:

"When everyone who deals with babies and childbirth, personally or professionally, realizes how much of an impact the conception, pregnancy and birth experience has on our physical, emotional, psychological and spiritual lives we can begin to create the necessary changes that will allow for more gentle and conscious births to take place."

It might all sound a bit crackers at first, and it certainly took me a moment to get my head around it, but why wouldn’t our very first contact with the world shape our perception of the world from then on?

Love it or totally refute it, but definitely have a listen….

Click here to listen to this podcast