Happy New Year

So, 2011 is coming a close.

This time last year I was documenting the changes that I wanted in the New Year.  This year, well I'm still hopeful of change in the birthing world and in the world of breastfeeding.  Another year has merely increased my love and passion for the work that I do.

I have seen some incredible births this year and I've seen some that have made me cry, and not tears of joy.  Life!  What a funny cycle it is.  

So, my plan for 2012?  To continue to grow in knowledge about this miracle of birth.  To continue to help new families come together.  The first half of the year is mostly booked up and I am grateful for that.  I pray that the births I witness in 2012 are beautiful ones, trauma free ones, joyful ones and that the only tears are ones of joy.  That's what I pray for and what I expect.  Should some of the births not quite all that I hope they are, well I pray for the grace to come through them and to fully support my ladies and their partners.

In 2012 I will meet some first time parents, some established parents and I will have the joy of attending the birth of babies whose siblings I saw into the world.

So, thank you 2011 for all that you taught me.  We won't meet again, but I look forward to meeting your successor 2012.  Here's to knowledge, here's to the new families.  Let's change things, one birth at a time.

Happy Christmas!

Happy Christmas to you and yours.  May 2012 bring you all that you hoped for and more.  With love from me and mine!

What's the cost of a Doula?

Recently a client told me that I didn't charge nearly enough.  I laughed.  I'm not cheap.  And then I got thinking about the cost of a Doula and that made me think about the Sister Doulas who have given up and the reasons why.


Some have quite simply burnt out.  Now, I always wondered how and why that happened, especially as I can't imagine it happening to me.  Well that was until I had done several not so great births in a row.  Then I appreciated the 'burn out'.  Hospital births can really take it out of you.  Let us assume that we all appreciate that the mother does all of the work and that any trauma, shock, adulation and joy belongs to the parents.  Now... let's think about the Doula.


She meets, she greets, she shares excitement.  She talks through hopes and fears.  She de-briefs previous experiences, she helps explore alternatives.  She is there to support, to hold, to gently be.  She signposts, she reminds, she encourages, she breathes.  She sits back, she comes forward, she sits back again.  She is respectful to the midwives and doctors and does not try to influence them (well except when she replies in quiet voices in an attempt to bring the volume back down for her birthing mum).  She hands over water, food, wet flannels and heat packs.  She does not go off duty, she remains in her place.  She exults in the power of woman as each baby is born and she weeps inside for the births that become traumatic.  She holds all of this and smiles and says words of congratulation.  She watches the new families bond and come together.  She encourages mum to feed the baby/ies.  She take pictures, she remembers weights and times.  She kisses and congratulates and takes her leave.  She remains at the end of the phone.


672 hours of on call
calls day and night
an unquantified amount of hours for labour and birth
another couple of hours post birth at a minimum

A tale of two births

I adore twin births.  I admit to bias as a twin mum myself.  My own twins were a transverse lie so the vaginal option was out for me and I take joy when I see other twin mums get the birth that I didn't.  Now, I'm not putting my birth preferences on these mums, I am supporting them in their decisions.  It still, however, fills me with great joy to see twins born naturally.


Today I am going to share the birth story of one of my mums.  First we have to go back to our meeting and her subsequent antenatal visits to the hospital.

It was a late booking.  I was finally off call for the first time in months.  I planned many theatre trips, a weekend away, parties and visits to friends out of town.  I made the mistake of popping my off call status on my facebook page.  Within a few hours I had spoken to this expectant mother and like that I was her birth and postnatal Doula.  I felt bad as I explained that I would do my best to be at the birth but that I had theatre plans and I really didn't want to miss any plays.  She said that she understood.  Her initial enquiry, after all, was for a postnatal doula.  And so I prayed, for once, that the birth would entirely suit my schedule.


We arranged to meet at the hospital where she had an appointment with the consultant.  It is highly unusual for my initial meetings to be like this.  Normally we chat on the telephone and then arrange for me to go round so that we could meet each other.  I suppose it helped that I had been recommended to her by a past client.  We had talked through how she wanted her birth to go and what she wanted to discuss with her doctor.  Her partner had been with her earlier in the day for the scan but work commitments meant he couldn't stay for the consultant appointment.  As usual it was running late.  When she was called, I went in with her.  I said nothing throughout but listened as her reasonable consultant tried to reason her into an induction.  She didn't want to be induced and she was sure of her reasoning.  Mr Reasonable told her that it was dangerous to let twins go beyond 38 weeks and that in his experience the best thing was for her to be induced.  She refused again.  He explained that if she didn't book a slot for induction it would be too difficult for her to get another one.  He then said that of course he would respect her decision not to be induced and book her in for induction at 39 weeks instead.  When she refused again he told her that he would like to see her again at 39 weeks to talk things through once more.  In the meantime he suggested that she got a sweep from either a midwife or me.  I explained that Doulas don't do anything medical or clinical and therefore I would not be performing any sweeps.  I still remain confused on the whole sweep issue.  He said that she could have a first sweep and if it didn't work some days later she could have a second and a third sweep.  My confusion, I suppose, is that if they are so good.. why do women need more than one?  


My lady went in for regular monitoring, which kept everyone happy but the pressure was still on to accept induction.  Finally she agreed to a 40 week induction, but her mindset was that she probably wouldn't go in for it.  Of course once she'd agreed, everyone was happy with her again and there was no more mention of sweeps and inductions.

I went to the theatre.  I saw the amazing Comedy of Errors and the RSC's production of Matilda amongst other things and I waited.  Finally, with no plays to see for several days, her waters went 4 days before Induction Day.  We were so happy, she didn't want to be induced and now she wouldn't have to.  She went into hospital in the early hours of the morning and had the loveliest, quietest midwife she could hope for.  I arrived at 6am and watched in awe as she laboured with a TENS machine, support from her partner and a smile.  The shift changed at 8.30am and another beautifully supportive midwife came to take over.  She was totally respectful of my lady's birth wishes.  


Baby one waited for no one.  My lady's breathing changed and her gentle "this hurts" became slightly more guttural utterances.  The midwife turned to open her birthing pack and said "Don't push yet" but baby one was not to be held back.  Suddenly a beautiful wee head emerged and the midwife turned to catch his body.  His speed meant that there was no second midwife in the room and so the emergency button was pushed (this because the midwife couldn't reach the simple help button).  Suddenly the room was filled with doctors and the atmosphere changed.  From calm and tranquility to a sense of panic. It was as though no one knew what they needed or wanted to do.  Lovely midwife tried to explain that she simply pushed the button to get a second midwife, but no one seemed to listen.  It was all about canulas and misoprostol.  The doctor said "Right, we need this second baby out in 10 minutes.  Are you having any contractions mum?  No, let's get the misoprostol up".  Within moments of the drug being sited and running baby two's heart rate dropped.  The doctor decided to attempt a forceps delivery.  Mum's legs were up in stirrups, people were busy doing many different things and there was no time to wait, listen and discover.  A beautiful birth had suddenly become an emergency.  Baby two was high up and so the forceps delivery was neither gentle nor nice.  Mum had extra internal tearing due to the forceps and the baby arrived battered and bruised.  


Two births, two very different experiences in the same bed.  Don't get me wrong, the fact that the baby's heart rate dropped meant that all bets were off, but did it have to go that way?  I suppose we'll never really know.  The frustration of not knowing what might have happened if they had let mum take a breath and allowed her contractions to come back up... well in doctor speak "at least she has a healthy baby".  In my lady's words "it's as though they let me have the first birth the way I wanted it but then it was their turn to show me how it ought to be done".  

Pregnancy. A time to relax and enjoy.

Except!!!!!! 

It has been puzzling me for the longest time.  Yes, I know I probably do know some of the answers, but you know when something keeps going around and around in your head?  Well this is on permanent rotation.

Mums to be (parents to be) fighting with Health Care Professionals (HCPs).  Why is it necessary?

An example. One of my ladies (who will eventually blog her journey and I'm hoping to persuade her to pop it here as well) went into hospital for the birth of her first child.  For her and her partner, it was a simple decision.  The hospital would be the safest place for this baby because they had never had one before and just wanted to be sure that everything turned out okay before, possibly, thinking about homebirth for any subsequent children.

So, they enter hospital.  They decide that the HCPs know what they are doing and they trust them completely.  There will be no rocking of THIS boat.  Labour moved fairly quickly, but whenever she wanted to move, change positions or simply listen to her body, she was made to feel stupid and uninformed.  Then they were left alone for what felt like hours.  She begged the midwife to check, despite having been checked recently, because she could feel the baby gearing up for entrance.  Long story short… the midwife and the doctor were unhappy with the baby's position and so she was wheeled into theatre and the baby was pushed back UP the birth canal and she was given a caesarean.  Both my lady and her partner were completely traumatised by the whole experience and horrified at the way that they had been treated.  

Fast forward a couple of years, and they were getting ready to welcome their second child.  Enter me!  They spoke to several lovely doulas and I was the one privileged to support them.  They spoke at length about their fear, about the lack of listening and the sense of abandonment.  A labouring woman needs a sense of privacy and security when she is birthing her baby and they felt that they would only get this at home.  And so the battle began.  They were refusing to go into hospital for the birth of this baby despite the many many conversations about the risk of uterine rupture.  Eventually my lady told them that she understood the risks and didn't need them reiterated every time she spoke to someone or had a check up.

She spoke to the Head of Midwifery and the Head of the Homebirth team.  It was agreed that she would be supported at home, but they had strict protocols.  My lady listened to them and said that the ones that were supported by medical reasoning and evidence based research were the ones that she would happily follow.  Don't get me wrong, both my lady and her partner were prepared to go into hospital should it be deemed medically necessary.  She had been offered the opportunity to make use of the birthing centre, but she felt that that would not help her feel safe, rather she might feel pressure to transfer over to the labour ward.  Finally it seemed that everyone was happy with the decisions made.

The day before her baby finally made an entrance she was told that the senior consultant had been furious to discover that she would be birthing at home.  The midwife was told to tell her that she HAD to go in to meet with him to 'discuss the risks properly'.  They then proceeded to take her blood pressure.  It was high!  So, they disregarded that reading and after 20 minutes, when they reiterated their support of her decision, the midwives took it again.  Back to normal.

In the two weeks prior to the baby's birth I had received texts and calls that suggested the baby might be getting ready to be born, but nothing happened.  I remember thinking, one evening, that I ought to get an early night.  I wound things down slowly at home and just before I headed up to bed my phone rang.  She was in early labour.  She'd called the midwives and wasn't sure what they needed to do as the hospital had told them to come in because they'd seen some blood.  Their midwife called them back and explained to dad that it was a show and that all was well, she would see them shortly.  Within an hour I was on my way to their home.  I arrived to find grandma on toddler duty, two midwives, my lady on all fours and dad beaming.  Things were moving quickly, but the two midwives were glorious.  They left her to it and waited peacefully.  My lady would lean back into her partner as the urge to push intensified and rock forward with me as the surges faded.  I remember re-arranging lamps so the the midwives could see and using my mobile phone as a torch.  One of the midwives popped a mirror on the floor.  Dad couldn't find a small one, so mum (as she explained afterwards) was able to watch her baby enter the world.  It was all the encouragement that she needed.  Less than an hour after I arrived she was holding her second child.  The placenta came easily after she went to sit on the toilet.  The checks were carried out and the midwives tidied away their things and left.  

My point?  Ah yes, there is one somewhere in this mind of mine.    Why is it  not possible to lay out the risks, accept that the parents have understood them and listen to their reasonings for why they choose to birth the way that they do?  Why is it not possible to support without the scare tactics.  Why do we move prophylactically?  

I'm sure there will be those that say, 'well she was lucky this time', but was she really so lucky the first time, when she was in a 'safe hospital environment'?  Her experience begs to differ.

I received this message from my lady a couple of days later:

"…just in case I didn't make this clear in my tired state - I thought the birth was amazing & one of if not the most positive experiences of my life so thank you."

A sad day for birth

I have had two Caesarean Sections and, particularly with the second, I am glad that that operation is there.  However, today I feel is a sad day for birth.  Women are now to be told that they have the right to a Caesarean Section, whether medically indicated or not.


Why does this make me sad?  Well it's simple really.  We were made to birth.  We carry our babies throughout their gestation and then we birth them.  More and more we are being told that women aren't able to birth their own babies.  Our bodies aren't strong enough, clever enough, intuitive enough, big enough, small enough, perfect enough for us to give birth.  Who can help save us, the helpless woman, to do the thing that we have done for millennia, since the dawn of time?  Doctors.  Doctors who train to save our lives and to spot and stop problems.  They don't always succeed, but they give it a good go and on the whole are mighty successful.  Our lovely midwives that know and recognise normal birth are being sidelined.  Why have a midwife when you can have an Obstetric Nurse? 


Birth has been slowly, slowly drawn into the medical sphere.  Out of the home and into the hospital.  We all know or have heard someone say "if I hadn't have been in hospital, my baby would have died!", and there are some of us who wonder, why it got to that point and what happened in the run up to the lifesaving situation.  I know that I'm not the only one wondering how the caesarean rate has climbed to 25%.  Surely it can't be true that 25% of women are unable to birth their babies vaginally.


My firstborn was born via Caesarean section.  He was due mid December and it had never occurred to me that being so close to the Christmas season this would make his birth date inconvenient.  I was told that I would be induced on 15th December.  Four days past his EDD (Estimated Due Date).  I was young and uninformed.  So when I woke on the morning of 15th December at 7.15am and felt the beginnings of labour, I high-tailed it into hospital.  One brutal VE (Vaginal Exam) later and the Midwife pronounced that I was only half a centimetre and that I had no reason to say I was in pain.  She read through my notes and said, "Oh, I see we're inducing you today.  I will get the pessary."  My young, foolish, 'uneducated in the ways of birth' self simply waited for her to do what needed to be done.  I didn't know that I had gone to the hospital far too soon.  I didn't know that I was within my rights to refuse an induction.  I didn't know the risks or how it might not benefit me and my baby.  Another brutal insertion and the pessary was in.  I was told to stop making a noise and abandoned in the antenatal ward.  Now this isn't about how my first birth experience scarred me etc, but this is about how lack of information led me towards a major, surgical operation.  When I finally hit active labour I was told that I would need an epidural.  So I agreed, but my baby didn't like it.  His heart rate dropped and suddenly I was being wheeled into theatre to have an operation.  I lost 2L of blood during that operation.  How does that happen?  This is a safe operation.  I never lost that amount of blood with my vaginal births.  I had a blood transfusion and now, almost 20 years later, I am unable to donate blood.


Was I unable to birth my baby vaginally, or had mitigating factors prevented me?


The Wee Weapons (my twins) were born by Caesarean Section.  They were a transverse lie which meant that a vaginal birth was off the table.


So I'm grateful that there was the option to birth my babies safely. I truly am, but this doesn't stop this feeling of dread and sadness I have in learning that women can routinely choose a Caesarean Section.  My mind can't help but skip back to the doctor who told me that he was going to America to learn how to do a tummy tuck at the same time as a Caesarean.  Nor can I forget the risk factor and I hope that these women are being told the risks and making decisions with informed consent.


Ultimately, however we decide to birth our babies, there is no right or wrong way.  We make decisions, we forgive ourselves if it doesn't turn out the way that we had hoped, or if we were led 'the wrong way'.

4:4:1 (part 2)

Birth three came out of nowhere.  Having barely recovered from births one and two, I was looking foward to a bit of down time before the next of my ladies laboured.


I was on my way home at about 9pm on Thursday.  I was tired and hungry, and looking forward to communing with my bed.  It was not to be.


Lady Three had attended my antenatal classes for multiples three years ago.  That birth had ended as a caesarean section, so for this next baby she had a caesarean booked.  She had had talks with her consultant who advised her that whilst it was 50/50 having a VBAC, as an older mum (41), a section would be safer.  It also helped her and her husband to plan, as he travelled a lot and they were able to ensure that his work commitments left him free for the birth. 


I arrived at hospital three to find my lady contracting nicely and using gas n air.  She was in a state of semi-panic, understandable really.  Baby Three was just over five weeks early.  Suddenly, all their plans had gone out of the window.  They had gotten off of a long flight from New Zealand and on arriving home her waters had gone.  Here she was contracting and yet she didn't know whether she wanted to proceed with the caesarean or go for a VBAC.  It's not my role to advise, but she badly wanted me to advise her.  So I simply said, "You are doing beautifully, darling.  What do you want to do?" A lovely registrar came in and asked what she wanted to do.  The midwife (lovely as she was) assumed she would proceed with the section and was prepared to get things moving.  The registrar explained how she positively encouraged VBACs and because my lady was doing so well, she said that she was happy to support her whatever her decision.  The registrar and midwife left.  Lady Three asked me what I thought.  I said that the registrar was right and that she could stop it at any time and request a section.  Mum looked to Dad, they both took on a look of excitement.  "We're doing this.  We're really doing this!"  


The gas n air was a godsend.  Mum was 2cm dilated.  The midwife was keen for Mum to take on some Diamorphine but neither Mum nor Dad wanted anything that would cross the placenta to the baby.  The registrar was keen that she didn't get an epidural too early and the decision was taken to give another internal exam in four hours and review.  Dad and I worked hard distracting Mum from the slow turn of the clock. She was convinced that we were lying to her and told us in no uncertain terms that she wouldn't be able to cope for eighteen hours with this level of pain.  She wanted her epidural and the midwife had better not be late with the exam.  


As the fourth hour ended the midwife came back and gave my lady a second vaginal exam.  She was 6cm but, for a moment, the midwife thought that she was fully dilated.  My lady was filled with joy, she could have her epidural.  The midwife left the room and my lady said, "I'm pushing!"  I looked and she was.  I pressed the call button and the midwife came back.  She saw no evidence of pushing, but called for another midwife and a birthing pack.  As she left the room I saw gaping and the first signs on a head beginning to emerge.  Mum was in shock. She couldn't believe that she was pushing out a baby.  Dad was over the moon with joy.  "She's doing it!  My girl is doing it!"


A beautiful baby girl was breathed into the world.  Mum's first words.. "I knew you wouldn't let me have an epidural" and then she kissed her daughter and the joy that filled the labour room was amazing.  A planned section that ended as a surprise VBAC!


Lady Four had been showing signs of going into labour for a few days.  Things went off and she waited for me to be less busy.  Got to love a client like that.


On Saturday night, I fell into bed, late.  I had meant to sleep earlier but the previous three births had messed with my sleep patterns somewhat.  As I slipped into deep sleep the phone rang. I had had texts from her over the days running up to her labour so I was expecting the call. I spoke to her husband who told me that her contractions were coming every three minutes.  I got into a cab and headed over. It was 1.00am.  She was contracting nicely but there was no need to move to hospital.  I left her and her husband together and I went to bed in the spare room.  Eventually her contractions built and I stood with her whilst she laboured.  She found it hard to have her husband beside her and so he busied himself with other things and I waited with her.  Soon it was time to go.  When the taxi arrived the driver told him that he didn't take labouring women and that an ambulance needed to be called.  I stepped forward and put on my mother of five voice. "This lady is fine.  She will NOT give birth in your cab.  I travel with women to hospital all the time.  An ambulance will NOT come." I turned to Dad and asked him to put their stuff in the cab, collected Mum and we set off.


We arrived in the birthing centre.  It was a quiet night and so my lady got the pool room.  She had been assessed in triage and found to be 6-7cm dilated.  Wonderful progress.  She didn't get on with the TENs machine and so had progressed nicely alone.  Unfortunately the Midwife hadn't had any training with waterbirths and went off to find someone who had.  Meanwhile my Lady was contracting continually and eventually put herself into the pool.  When the midwife came back she tried to hint that it would be better if she were out of the pool.  After a while the triage midwife came in to take over.  She had a lot of experience.  She was a calm and quietly spoken midwife who told the initial midwife that talking wasn't necessary and that sometimes the best thing was to remain silent.


By the time the shift changed at 8.30am my lady was making involuntary pushes.  Two calm and confident midwives took over and all was well.  Sadly my lady was too tired and after an hour and a half pushing, the baby was really low and sitting in the mouth of the vagina, but despite her best efforts, my lady couldn't push hard enough to get her baby out.  The baby's heart rate began dropping and we were moved across the hall to the labour ward.  There, a lovely doctor came in and after speaking calmly to my lady told her about ventouse and forceps.  The doctor decided to go for a ventouse delivery and gave my lady an episiotomy.  In less than three minutes, her daughter was out.  My poor lady was convinced that she was a failure, something that the doctor and I were at pains to refute.


She found it hard to have her husband there, though she wanted and needed him there.  She found the experience too intense whilst looking at him, but he was everything that she wanted.  A strong, silent support.


Four births, four hospitals, two boys, two girls, four very different birthing experiences and one very tired but supremely happy doula.

4:4:1 (part 1)

No, it's not a football formation!  It is the interesting week that I have just had.  4 births, 4 hospitals and all in 1 week. 4:4:1.


Now, I know that I'm a busy doula, but this wasn't the kind of busy I had envisaged!  What the week has reminded me of is the very different birthing experiences women have.


Take 4 hospitals.  The way that the individual hospitals treat women play quite a role in the way these women birth.  Of course within the hospitals are the individual doctors and midwives.  There will always be the ones that give you pause and the ones you want to praise to the heavens. 


So, a quick look back at the week I didn't see coming.


Birth one.  Considered an older mum and therefore high risk.  A history of surgery, including back surgery.  High risk.   A fuller figured woman.  High risk.  The birth centre said that they couldn't take her, but they did promise to bring the birthing centre to the labour ward.  They were happy to move beds, balls and equipment.  A lovely compromise.


This was a woman who made sure that she was informed.  She did her research, changed her mind about a few things that she thought she wanted and went into her birth prepared.  Having an epidural wasn't a preferred option because of her back surgeries and so she opted to use remifentanil which is something that I had never seen in action before.  She was able to self-medicate as there was a timed, limited dose release.  This came in handy when baby boy decided that he wanted to stay inside a little longer than most.  This birth was an induced birth, something that my first lady hadn't wanted, but she felt that it was the right thing to do.  


It was a long long labour.  Baby boy was clearly content where he was.  The pessary gel worked up until a point, but the contractions failed to build and remain steady.  So the next step was syntocinon.  This was hard for my lady.  So she stepped up the pain management and began using the remifentanil.  In the end, baby boy wasn't in the best position for birth and both he and mum were getting tired.  So birth one ended as a caesarean section.  


Birth two came along two days after birth one.  Another baby that decided to ignore all mention of estimated due dates.  Mum asked me if I would visit her in the circus.  She would be the 'Woman pregnant forever'. I promised to take the children and to feed her popcorn.  


She refused sweeps, though as she approached 42 weeks she began to become tempted.  Perhaps the stint in the circus wasn't what it was cracked up to be.  She was in a different hospital to Lady One.  This second hospital didn't have the best of reputations, but there had been a change in staff and things were turning around.  Lady Two was grateful to hear this and no longer worried about the care that she would get.  This was a second baby for her.  The first was an induction that spiralled down the intervention path.  She was desperate to avoid this for the second birth. 


We made a plan to meet for coffee and sinfully good cake on the Wednesday to talk through her options.  She would be 42 weeks on the Friday.  I think it was a conspiracy to keep me from cake.  She went into labour on the Tuesday.  Her contractions started but they were spaced out.  After hours of labour she called the hospital who advised her to go in as she was post dates.  She went in and called me to join her and her husband.  She apologised for probably calling me in too soon.  She laboured beautifully and her husband was great support. We ate chocolate and waited.  She didn't progress beyond 4cm.  Things were moving slowly.  The decision was taken to break her waters.  She knew from past experience that it would make her contractions stronger and she wanted to be sure that she had her pain management on board.  She agreed to an epidural, but she wasn't happy that she'd made that decision.  She had been managing well with a TENs machine, until she dropped it, twice.  It gave up the ghost and so she, together with her husband, spent the next half an hour calling all the local department stores to see if she could get another one.  


We talked through the pros and cons of the epidural.  The biggest pro was that she would get some sleep.  She had not slept for at least 20 hours and she was seriously flagging.  A tired mum doesn't tend to labour well.  As she slept, the contractions built and did their work.  She made steady progress until finally she was fully dilated.  She was told that the Midwife would wait an hour before getting her to push.  Fortunately the epidural was just beginning to wear off as she got to the pushing stage and so she was able to feel her body enough to send her baby down.  A very very gentle Midwife encouraged her pushing.  Suddenly it was 8am and there was about to be a shift change.  The incoming Midwife caused Lady Two some panic because she began shouting "hold your breath, put your chin on your chest and PUSSSSSSSSSSSSSSSSH!"  "No!" replied my lady and continued to breathe her baby down.  I was so proud of her.  Her son was born shortly afterwards.  She was so proud of herself for not having the same birth that she had with her first.

Nip and tuck

I'm not really sure how to write this blog post today.  I'm a little tired from doing 3 births in less than 1 week with another gently brewing in the background, but I have to share my conversation with a doctor who was stitching up my client (lovely birth, small tear).  Or maybe it would be easier to bullet point his comments and leave you to stare in shock or scream at the screen.

• Women should only have one or two babies, especially if they are planning to have caesareans
• Women shouldn't get pregnant.  It is an awful thing to be pregnant.
• My wife and I have one child.  I don't think that she should have any more babies.
• Midwives don't know how to stitch up vaginal tears very well.  It should be left to doctors.
• Women's bodies aren't very good at giving birth.  They need our interventions. 
• That said, one intervention leads to another so don't pretend to do it naturally if you want to let us break your waters.
• I don't understand why any woman would have more than one child.
• I'm planning on studying in America for a year so that I can learn to do a tummy tuck at the same time as a caesarean.

My lady, her husband and I all stood open mouthed as he spoke.  I told him that I couldn't wait to see him in a few years and hoped that when I did, he had four children.  We don't think he likes daughters.  Is it wicked to hope he has girl triplets? (The answer to that by the way is, YES, wicked to the daughters)

With my mum and my children (of which I appear to have too many eh Doc?)

Breastfeeding Twins Pt2

On becoming pregnant with twins, women are told of the dangers of the babies coming early. This is one of the fears that is put upon them from the start of their pregnancies. Now, don't get me wrong, I'm not saying it is always untrue, because babies are born early the world over, especially twins. I am, however, saying that it is a fear that is often put into the minds of parents-to-be. My response to this, as usual, is to get informed. If you are expecting twins (or indeed any set of multiples), it is a good idea to get some good information. Another good idea is to talk to your care provider about how they treat women expecting more than one baby. This is also the time to ask the 'what if' questions. Women often find themselves working from a position of ignorance when it comes to birth and breastfeeding and it is easier to sit back and let the 'experts' take over. So, I will assume that you've done the necessary research about your birth and talked to your care providers. Now, let's move on to breastfeeding premature babies.

When we talk about birth, we talk a lot about the immediate postnatal experience. Skin-to-skin contact with babies is promoted more and more by midwives and doctors, which is good news because it benefits both Mum and baby greatly. It helps the baby maintain body temperature – something that is vital in premature babies – it helps to stabilise and maintain the heart rate, respiratory rate and it generally settles the baby. It promotes bonding between mother and babies and encourages breastfeeding as the babies are more likely to root for and attach to the breast. 

Kangaroo Care has been shown to have improved outcomes in premature babies. What better place to have your babies than on your skin, held close against you?

Once the babies are born, it is important to establish your milk supply, and this can be done as soon as your babies are born, no matter what stage of your pregnancy they arrive. The lovely Kellymom has some good information about establishing your milk supply and expressing. She also has a handy guide for expressing and storing milk for premature babies. 

Now, why is it so important that you get your milk supply sorted for twins? After all, there are a fair number of people who will tell you that you “have to” supplement twins anyway and that “only martyrs” exclusively breastfeed. Now, let me quickly set my cards out on the table. I would LOVE for you to breastfeed your twins exclusively and my personal opinion is that the vast majority of twin mums (premature or full term) CAN exclusively breastfeed their babies. However, this is not about my personal opinion and I know that many other factors may come into play.

So, first let's see about reasons for sorting out your milk supply and remember every breastfeed counts. The milk a mother produces for her early born babies is different to the milk produced for term babies. Our milk is very clever stuff. It provides all that our babies need to protect them from infections and these can have very severe consequences in pre-term babies. NEC (necrotising enterocolitis) is one such gut infection that can be life threatening in preemies. Get shown how to hand express colostrum. This is liquid gold. Your babies need as much of it as your body produces. If, for whatever reason, you do not or are unable to produce enough milk for your babies then donor milk is an option. Ask your hospital about this or see if there is a way you can access some donor milk for your babies. 

NICUs commonly have feeding schedules for premature babies. I know I sound like THE biggest fan, but Kellymom really does have great links and resources (and the lazy in me says "why re-invent the wheel"). Here are a couple of articles to read about demand feeding preemies and how it gets them home sooner. (KellyMom articles). The feeding schedules can sometimes lull parents into a false pattern. Yes, I know and recognise the importance of sleep, but did you know that your prolactin levels tend to be higher at night? This will help with expressing and your milk yield. One of the downsides of scheduling feeding is what may happen when you bring your babies home. Suddenly it feels a lot more full on and overwhelming. You no longer have those long, deep sleeps. It is one of the things that most new mums find when they bring their babies home. There are no midwives and doctors to peer around the curtain to check that all is all right. You have sole care of these babies and suddenly you have to deal with the feeding and settling at night. It may feel scary and you may begin to doubt your ability to feed them sufficiently. 

The fear of hospital re-admittance, having just gotten them home, looms large. It is this fear that often leads parents of preemies to reach for formula. Coming home from a regime where everything is timed and measured may cause doubt and mums forget to listen to their instincts about their babies. They do wonderful work in the NICU and they are there to help you get your babies home, so don't be afraid to ask about breastfeeding, kangaroo care and feeding to your babies’ cues. Be informed, it will help you to manage your concerns. 

Let me leave you with some reasons to be proud as you care for your premature babies and some resources for breastfeeding them.

A quick tale about expressing for premature twins.

And on one more note, should you have the privilege of meeting parents of premature babies, here are a few things NOT to say.

You can also read this and other blogs I've written on the wonderful new resource for Mums: Acorn Pack

Letter to my firstborn

The evening that you were born was strange to me.  They took you from my body and told that it was because of my failure.  My body had failed to progress beyond 4cm and your heart rate was falling.  No one told me that that was a risk I had taken when I accepted the epidural the insistence of the Midwife.  I hadn't prepared myself for your arrival.  I was pretty clueless.  I told myself that I would be a good enough mother.  Not for me the dizzying heights of perfection.  

Looking back, I think I did okay.  That first failure wasn't my last.  I failed to see that my instincts steered me right when it came to you, the baby.  I put you to my breast and pulled you into my bed.  It was a happy relationship that everyone told me was wrong.  They laughed at me when you cried and wouldn't settle in a cot.  They made me question my ability when they saw that you preferred my arms to prams and when I wore you round the house instead of letting you cry on the floor.  I was pushed into weaning you from my breast and filled you with artificial milk so that I could be like everyone else.  It wasn't their fault.  They knew no better than me when it came to babies and how to nurture them.

Some of my failures held you and I in great stead.  I failed to keep you within the pre-school that people said was good enough for you.  I wanted better and best.  I failed to get you into the school I felt was best, but the school you went to was good and I met lifelong friends.  I moved you the next year when a place opened up in the preferred school.  I failed to remain within the low expectations people had of me when I grasped this new school by the horns and took on the PTA by throwing my 'I know nobody' self into the heart of school life.  I failed to accept that boys like you weren't supposed to achieve when you sat the entrance tests a two schools.  The first rejected you by a matter of a few marks, but the second welcomed you in.  I failed to hear the criticisms of the choices I made that took you through that school.  I failed to agree with the statistics that said parenting you alone would cause you to fail and push you into a broken life.

And what did you do in return for those failures?  You grew tall.  You grew kind.  You grew and continue to grow as the best big brother ever.  You surpassed expectations and took hold of your life and began to make choices as a man.  You rejected my dream of an Oxbridge son because it wasn't the path you wanted to take.  In doing so you made me proud because you stood for what you wanted and began carving your OWN dream.

I look back over those almost 19 years of your life and I'm proud of my failures.  I'm so proud of you.  The first in the family to go to University.  The loving son and brother, who cares so deeply for his family.  I'm proud of your loyalty to your friends and your going for your dreams.

A self-indulgent letter no doubt, but when I see you… I see my firstborn baby in my arms and at my breast.  I know that I did something right.  My failure is my success.

Ask Me About Breastfeeding Twins (part 1)

Ask me about breastfeeding twins

That's one of the profile pictures on my Facebook page this week.  It is World Breastfeeding Awareness week (or World Normal Feeding Awareness Week as they say on Mothering Mutiples:Breastfeeding and Caring for Twins or More page )

So, I suppose I ought to respond as though I had been asked.

On a parenting forum I was called smug when a woman asked about breastfeeding twins because she'd heard nothing but horror stories.  I replied that it was much like feeding a singleton except that there were two babies, but fortunately we have two breasts.  A non twin mum jumped quickly up to call me smug and tell me that I had NO concept as to how hard breastfeeding twins was.  Sadly tone doesn't carry through the printed word and no one could 'hear' me smiling as I responded.  I have, of course, helped many women with breastfeeding their twin babies and nursed my own until they were 18 months old.  And I still believe that it is as simple as having two breasts.  Now fret not, I am not some kind of narrow-minded freak who doesn't recognise that there are sometimes difficulties in breastfeeding, be it twin or singleton.  I just believe that we should start with the premise that it is as simple as having two breasts and work from there.

So, let's start with healthy, term babies, the ones with no health issues.  Actually, I think we need to start some months prior to this.  I think (and remember these are my opinions) that breastfeeding twins starts with preparing ourselves to nurse them.  Almost from the moment people find out that they are pregnant with twins the naysayers appear.  "You'll never manage to feed twins, it's too much", "You won't have enough milk to breastfeed twins", "I never managed to exclusively breastfeed twins, don't feel bad that you need to use bottles", "No one can breastfeed twins".  This is the time to get yourself informed.  There are many places where you can get good information.   The National Breastfeeding organisations, like The Association of Breastfeeding Mothers, The NCT, The Breastfeeding Network, La Leche League all have helplines, websites and literature.  There are of course the various twin and multiple birth networks as well eg TAMBA and The Multiple Birth Foundation.  There are some wonderful websites full of information about breastfeeding like Dr Jack Newman, How Breastfeeding Works and Kelly Mom.  Of course the growth of social media has simply opened us up to more information (though do be careful about your sources as there are some out there who are simply in it to make a quick buck and their information can be downright dangerous).  I shall quickly name a few favourites, but this could take all day, so I really will just post a few. Dispelling Breastfeeding Myths, Mothering Multiples:Breastfeeding and Caring for Twins or More, Breastfeeding Basics, The Leaky B@@b, Best for Babes Foundation and Lakeshore Medical Breastfeeding Medicine Clinic.

A lack of understanding about breastfeeding and breastmilk tends to be the common denominator for discouraging twin mums when it comes to nursing.  I remember sitting with one of my clients after she had given birth to twins.  The first had fed beautifully and she was feeding the second.  A lady from the MBF (Multiple Births Foundation) came to see her and her opening words were not what either of us were expecting.  "Don't worry if you can't breastfeed twins, not many can.  I, myself, gave bottles.  It's good to get them started".  Fortunately my lady knew that she wanted to breastfeed and she had done her research and knew the key to producing enough milk for her daughters.  Feed, feed, feed according to their cues.

It may well be incredibly tiring, but that doesn't mean that you can't do it.  Get your support put into place.  Some twin mums swear by maternity nurses.  If this is a route you decide to take, make sure your MN knows how breastfeeding works.  I recently had a client who was relaxed and breastfeeding beautifully when I left her.  I went back a few weeks later after she had had a MN in.  She had been told that in order to have things 'work well' she needed to put the babies on a feeding schedule and breastfeeding was only encouraged 6 times a day.  Believe me, when you are a twin mum, some form of order is more than tempting.  Fortunately my lady knew that a lot of what she had been told to do wasn't helping.  Her milk supply didn't seem as good and her daughters were hungrier than they had been.  She recognised that it was the feeding schedule and went back to cue feeding.  

The same things that apply for nursing a singleton apply for nursing multiples, a few tweaks here and there perhaps, but the basic information about breastfeeding remains the same.

So, for now, assuming that your babies are/will be healthy newborns, put them to your skin and inhale the wonder of them.  Let them feed on cue and should there be any difficulties at all, get help immediately.  Often it's a simple issue, with an easy solution.  Use your helplines, call an IBCLC, call a Breastfeeding Counsellor, talk to experienced breastfeeding twin mums. Let your information be good and something that helps and not hinders you.

There is more to come, but for now let's start with two babies, two breasts.  You can do it!

Don't let them tell you birth's not beautiful

I recent read a story about the unassisted birth of undiagnosed twins.  Now this lady wasn't looking for an unassisted birth.  The babies were BBA (born before arrival) of the Midwife.  It was a planned homebirth and the mum simply trusted her body and her baby was born.

This reminded me of the two babies that I 'caught' in their homes.  Both mothers had planned hospital births.  These were first babies and both mothers wanted the 'safety' of hospital.  The first was insistent that her low pain level meant she would require an epidural, the second wanted to do everything to avoid an epidural as she had done her research and believed that she could do it.  The first laboured silently and had a slight change in demeanour and stance, the second roared throughout with an increase in roar and intensity moments before the baby was born.  What they both had in common was a faith and belief in their own bodies.

I find it sad that whenever there is an article, blog or news report of an unassisted birth, the first comments are instant 'doomsayers'.  "Ooh you are so lucky that there were no complications", "My baby would have died if that had happened to us".  There is no denying that there are times when life saving measures NEED to be taken, the clue being in LIFE SAVING.  Why is it wrong to glory in the beauty of birth?  Why can't women, mothers, pat themselves on the back and say "look at me.  I did it!"?  Mothering can be a thankless task at the best of times, so why can't we start our mothering careers with a quick "didn't I do well"?  None of this is about downplaying some one else's birth experience.  This is that moment of congratulation when Mum can look at herself and say "Wow but I was wondrously made, and look at what I was blessed enough to do".

There are many many horror stories about birth out there.  Many!  The oft trumpeted hospital birth having quite a few.  For those that have horror stories there is the birth trauma support group.  A healthy baby isn't the only outcome that we should look for at a birth.  We also need a happy, healthy mother.    What messages do we send to our daughters if we hold back the 'good' birth stories?  And when I say 'good birth stories', I don't just mean the unassisted births or the 'I just breathed and the baby came', I mean ALL the good birth stories.  The 'I laboured for hours and just when I thought I couldn't go on, I was holding my baby', the 'I had my baby in hospital and the MW was so hands off'.  I even mean the 'I knew the pros and cons, I chose to have an epidural and had a lovely birth',  and the 'I was induced and it happened quickly and easily'.  Funny how women are allowed to have THOSE birth stories and no one accuses them of passing judgement on others.  

One of my ladies (remote support) went to 43 weeks with her pregnancy.  It's not as uncommon as you might think, given the levels of inductions at 41+ weeks.  There are the horror stories of the doubling of the still birth rate.  Well who wouldn't run into hospital to be induced if they knew the risk of still birth was doubled!  But what do they mean by doubled? 0.3% to 0.6%.  Statistics. (Here's a quick look at some hospital statistics for birth and maternal health.)  We need to know what they are and what they mean in relation to us and our bodies and babies.  My lovely lady, S, wanted a homebirth.  Her pregnancy was normal.  There were no high risk indicators, both S and baby were doing fine.  As she passed her EDD (Estimated Due Date) the talk turned to induction. The risks began to be talked about.  The homebirth midwives began to say that they would not be able to come out to her if she went over 42 weeks.  Week 40 and her friends were beginning to become impatient.  "Haven't you had that baby yet?", "I can't wait to see that baby.  Why isn't it here yet?".  They began to suggest induction and ask if she was going to be induced.  Week 41 rolled up.  The homebirth midwives were crossing their fingers, but bound by hospital protocol, reminded S that she would have to go to hospital to give birth.  Week 42 appeared.  Mum and Dad were trusting her body and knew that their baby wasn't ready to be born.  The hospital told her that she would no longer be allowed to have a homebirth and that she would have to go in and have a hospital birth.  S asked simply to be monitored and, politely but firmly, told the hospital that her intention was to give birth at home.  With each monitoring appointment, all was clear that mum and baby were healthy and happy.  S, herself, was beginning to get impatient.  "What can I do to hurry this up?" she asked me.  "Wait!" I said.  "Okay, I'll continue with the monitoring and I'll wait".  Week 42 was coming to an end.  The external voices were getting louder "This is taking a really long time.  Are you allowed to be pregnant for so long?".  "Is this baby ever coming?".  S trusted her body.  The baby was moving nicely.  The monitoring still showed a healthy baby and mum.  Good, steady heartbeat.  Dad trusted Mum.  The hospital again told her that hospital protocol didn't allow for her to give birth at home.  When she, again politely and firmly, told that that she was staying home, they told her that they had a duty of care to provide a midwife, but that she had to come in to hospital.

Labour started slowly and moved slowly.  36 hours in and Dad called me for a chat.  What could they do to get things moving?  I replied "Lots of sex and laughter".   More waiting.  He told me that she was having difficulty using the bathroom.  I mentioned that perhaps the head was moving down and getting ready.  He replied "No, the contractions aren't regular enough and she only feels uncomfortable". And then suddenly she was in the birth pool, and then 8-9cm dilated.  Within a couple of hours she was holding her baby and Dad text to tell me that it was a beautiful birth, he remembered his role in encouraging her when it got harder for her at the end. When their daughter was born, the midwives agreed that there was no way this baby was overdue, but had come exactly when she was meant to.  

How different all of that might have been with the interventions.  36 hours of labour and not much seeming to happen?  Surely that's cause for syntocinon?  Surely she needs to have her waters broken?  Surely speed is needed to 'get the baby out'?  

It's time to begin loving women again.  Loving BEING a woman again.  Trusting in women's bodies again.  Celebrating the wonder that is a birthing mother.