Saturday, 26 May 2012

I Got The Power

The wonderful World Midwives shared a lovely Biblical quote the other day: 'Be careful what you say today. “The power of life and death are in the tongue.” (Proverbs 18:21)'

There are so many ways in which this is relevant in the birthing world.  Today I was thinking about it in connection with the way that I practise as a Doula.  I had lunch with a lovely couple who are expecting twins in the summer.  They are so excited about their future with these children.  They've listened to so many high risk talks and refused to be scared and are looking into more information and research.  At the moment they are collecting bits and pieces from friends and family.  They asked me what they should do about a buggy for the babies and my mind instantly reminded me 'don't make their decisions for them'.  I know it was as simple as a buggy, but think about it.  I recommend Buggy A, it's fantastic in my opinion, it does what I would want it to do etc etc.  They buy Buggy A and discover that Buggy B is actually better suited to them.  Much better for me to talk to them about what they might want in a buggy.  Too simplistic... hmmm... let me think!

Couple A are expecting a second baby.  Their plan is to have a VBAC.  Mum was induced at 42 weeks as there was no sign of her baby or labour.  A hyperstimulated womb means an emergency caesarean section.  They ask me 'What do we do? Do we have an elective section? Do we push beyond the 42 weeks in case this baby needs 43 weeks to come?'.  It would be so easy for me to give them my opinion, but my role is not to give my opinion, but to support theirs.  So instead I might point them towards Ten Month Mamas or  Perhaps I'd lend them my VBAC handbook.  Whatever I did, the aim would be for them to make their own decisions about how they would like the birth to go.

Couple B have no clue about birth at all.  They have done no preparation, read no books and are happy to go with the flow.  I've attended a lot of births.  I know that going with the flow is a risky choice.  So much comes down to your midwife and/or doctor.  They look to me to give them information and to 'tell them what to do'.  If they want to read books, I'm more likely to point them in the direction of Ina May Gaskin and Michel Odent.  I would direct them to Pinter and Martin so that they could see what was available to them.

Couple C are expecting twins and have been told that they will be induced at 37 weeks or they will have a planned caesarean.  Everything within me would rise up in a scream, but I would need to take a deep breath and start to ask them questions to find out what they want. They might want an elective caesarean.  That would be their choice.  Again, my role is to signpost information and get to the heart of what it is that they want and/or fear.  

It would be so easy to have my blueprint for birth for each of my couples.  You may be surprised to learn that I have a lot of opinions.  If you know me at all, you'll know that I love to talk.  There are so many times when I've recognised that all I need to do is to say something and my clients take it as gospel.  There's a lot of power that I hold in my hands.  Being a Doula is not something that I take lightly.  

Monday, 14 May 2012

How I got through the Moonwalk

On Saturday 12th May, 2012 I set off on a marathon walk from Hyde Park, round London streets, along the river and back to Hyde Park.

'Are you insane?' I hear you cry.

No, well maybe... 

I was one of 15,000 people who took part in The Moonwalk 2012 to raise funds for Breakthrough Against Cancer.  Some 14,000 women and 1,000 men walked a marathon through the night.  Some, perhaps many, had lost friends, family, mothers, lovers, sisters etc to breast cancer.  Some were in the midst of battling it themselves.  I walked in memory of the friends that I have buried in the last few years and in celebration of the friends who are fighting or have successfully fought breast cancer.  I walked with two friends, the lovely Yvonne and Julia.  It was not easy.  It required perseverance and determination and the way that I got through the course, was to liken it to labour as I walked.

We all gathered at Moonwalk City (big, big, pink tent in Hyde Park) where a live band played and words of encouragement were spoken to us.  There was a huge warm up session before the start.  This was the 'antenatal class' full of positive birth stories.  We were nervous but very excited about it.  We knew it would be hard, we were pretty positive that we could complete it but we were just a little worried that it wouldn't go the way that we wanted it to.

Suddenly it was time to be off.  Our 'contractions started'.  We began the long walk out of the park.  It was so exciting.  We set off with high hopes and lots of energy.  After a while we passed the first mile marker.  It seemed a long first mile.  That, I likened to the shortening of the neck of the womb.  As we walked the first few miles we talked about how unexciting it seemed.  That was because it was a very 'same-y' route.  There wasn't much interesting to look at and we knew it was only the beginning of a long road.  Still, we were positive and the energy around us was great.  We were all eager for the walk to really get going.  There were a few bottlenecks en route and crossings that needed a policeman/steward to guide us over (imagine 15,000 people crossing major roads... it took some guiding).  These were the stops and starts of early labour, our 0-3cms.

As we walked past the 8 mile marker I thought about what is called 'established' labour.  This was the 4-7cms.  It was steady going and we knew it was going to get harder, but we were doing okay and we were walking.  As it picked up we passed the 13 mile barrier.

Then it started to get hard.  Really hard.  We were pushing through the 18 mile barrier.  We were hitting transition.  Would we make it to 20 miles?  It seemed so far away.  26 miles seemed like a lifetime away.  Our legs were aching, our backs were beginning to twinge (to be fair I think my back started that much earlier).  The encouragement of the stewards en route was invaluable.  'You can do this.  Well done, you are doing it.  Not far to go.  I'm so proud of you'.  The words that would often leave my lips when supporting my ladies in labour as they seemed to tire and/or lose hope, were the very words that helped my teammates and me to press on.  Suddenly it was 20 miles and then 21 and 22.  As we walked past the 24 mile marker we entered the second stage.  It was time to push.  It wasn't far to go, but still it was an effort.  Our legs just kept walking forwards, even as our minds and bodies felt like giving in.  Finally, finally, we were through the 26 mile marker.  Just the placenta to be born.  .2 miles.  It doesn't seem much, but when you've already walked 26, that .2 miles seemed a bit too much, and yet at the same time it was almost over and so that final tiny push took us through the finish line.  

What elation, what pride.  We'd done it!  We'd walked a marathon through the night.  We hadn't given in to our doubts, we'd heeded the encouragement and birthed a real sense of accomplishment.

Sunday, 6 May 2012

The doyenne of Midwifery

Ina May Gaskin the doyenne of Midwifery.  This woman is, without doubt, amazing.  I love hearing her speak.  I love reading her books, reading her site and watching videos of her.  Yes I'm completely in love with Michel Odent, closely followed by Denis Walsh but my first birthing hero is this woman here.  Ina May Gaskin.

I first met Ina May at a Biological Nurturing conference a few years back.  She was so lovely to just chat to.  There we all were, ever so slightly in awe, and she seemed to have no idea of the effect she had on us.  Ina May was one of the main reasons that I booked to attend the MAMA Conference.  There was no way that I was missing an opportunity to hear her.

Ina May was inspirational.  She took us through the history of some amazing women in the world of birth. and shared a couple of animal births as well.  She talked about the things that they discovered through the course of supporting women.  I loved the way their lives paralleled hers.  None of them were medically trained, at least not in the usual sense.  They learnt on the job, through observation, with the occasional helping hand from doctors of the day.  They talked about their findings and were ignored and yet the birthing women did well under their care.

Ina May and The Farm have amazing statistics with a caesarean rate of 1.7%.

  • 1.7% ended in a Caesarean (compared to US 32.3%)
  • 0.37% were forceps deliveries and 0.04% were vacuum extractions
  • 3.5% were breech and of those 8.6% required a Caesarean
  • 1.7% had a post partum haemorrhage
  • 5.4% were induced, but this was by castor oil or by stretch and sweep
  • 19 sets of twins were born. All vaginal births
  • 1.5% epidural (compared to US 80+%)
  • 99% Breastfeeding Initiation (compared to US 50%)
  • 0.39% Pre-eclampsia (compared to US 7%)

  • Over here it is becoming more and more unusual to hear about first time mothers having vaginal births, but there are good birth stories out there.  Our caesarean rate, as a nation, is pretty appalling - 28%. Someone's doing something right!  

    We have a lot to learn from the Ina May's of this world.  People who spend time with birthing women, allowing them the space to birth their babies.  There is a far more holistic approach that needs to be taken around birth.  My hope is that we actually learn from history.  We are promised so much choice in where and how we birth our babies, when in reality it's more a case of 'my way or the highway'.  I hear too many stories of women who are pacified at hospital appointments and arrive to a completely different story.  Perhaps Birth Matters should be required reading for all who aim to work within the world of birth.

    Wednesday, 2 May 2012

    In the words of another - My new crush

    Denis Walsh!  How have I come so far in my Doula career and not come across Denis Walsh before attending the MAMA Conference?  What a rookie error.  The man is amazing.  Oh, you're sensing a theme aren't you?  You think I'm going to go into divine raptures about this man don't you?  As if I.... yeah!  You're right!

    The Rhythms of Labour was a fascinating presentation.  A lovely Doula friend said that she used to believe 'no uterus, no opinion' until she heard Denis.  I have met 3 male midwives who made an impact on me.  The first was in a South London hospital, Queen Mary's, the second at UCLH, based in central London, and Denis Walsh.  The first is my favourite ever midwife.  He had such a gentle manner, he clearly believed in a woman's ability to birth her baby and he talked with such calm authority.  I loved hearing his stories of his wife and sons.  The second is, I confess, the worse thing to ever happen to midwifery.  Obviously that is my opinion, but when you break a woman's spirit in labour, shout at her for not pushing according to your dictates whilst you watch a screen and then leave promptly at shift change with barely a word of goodbye, well... I know how I feel.  So you can imagine how fabulous it was to meet Denis, who single handedly restored my faith in male midwives.

    Enough of me, this is about Denis.  Here was another speaker who placed importance and emphasis on collaboration amongst the birthing world.  He started out by talking to us about the different paradigms of labour.  He told us about Friedman's Curve and gave other examples of how doctors etc have tried to quantify labour.  Denis talked about how birth is a dance.  Instantly the words 'birth is a dance, not a goosestep' came to mind.  Dance is so (or can be) so fluid and it changes according to the lead.  The dance of birth is led by mother and baby.  They find their rhythm and they dance.  There is no rigid marching and saluting the linear graphs.  This partnership is one of stops and starts, a piacere and adagio.  Denis spoke about the experiential way that labour feels.  I don't know how your dance will go, any more than you could have predicted how mine went.  We heard about the 'unique normality' of birth (Downe & McCourt 2008) and 'orderly chaos' Winter & Duff (2010).  Denis pointed us towards 'Holistic Midwifery Volume 2' (Frye 2004) and talked about us 'doing nothing, well'.  To be clear, he was talking about us waiting as women birthed, learning the art of 'doing' nothing and doing it well.  Another lovely phrase that lives in my consciousness now is 'some things that really count, cannot be counted'.  He talked to us about fearing the unusual.

    It is our fears that impact the women we support and in turn increases their fears (or even create fear within them).  We find it hard to sit still and do nothing.  And yet, what does the birthing woman need us to do?  Denis repeated the phrase I use so so often.  Pizzas are delivered.  Babies are born.

    Meeting the catcher of babies and the lovely Joy

    What  a joy it was to meet the lovely Sheena Byrom OBE.  I have a friend who has known Sheena for a long time (small world).  They are neighbours.  She said that it doesn't surprise her that we got along, we are alike.  So clearly that means that Sheena speaks nineteen to the dozen about everything and in my mother's words "has a lot of knowledge and likes to share it".

    Sheena and the lovely Joy Horner IM (Independent Midwife) were called in to replace the wonderful Mary Cronk who had suffered a bereavement.  Joy started with a wonderful homage to Mary and talked about the breech births that they attended.  Joy was such a lovely speaker and there were moments when I wasn't sure she'd be able to continue as the tears welled to the surface and never really vanished.  This is a woman with a deep, abiding respect for Mary Cronk, a respect that was shared by most, if not all, of the room.  She showed us pictures of breech presentations and talked about how they were dealt with.  An IT man was at the side, watching to ensure the videos worked and the projections on the wall were the ones we were meant to see.  Oh but he had an education.  There was a beautiful moment when Joy asked us which part of the baby we saw birthing first.  It was the baby's scrotum!  Mr IT's face was priceless.  Sadly I don't have a picture of it.  It's one of those 'you had to be there' moments.  The entire room laughed, but he took it well.  Joy Horner is one lucky woman.  To have worked alongside Mary Cronk and to have seen the amazing births she's seen.  It was a wonderful tribute to Mary and whilst I would have loved to have heard Mary again (A Day At The Breech), it was lovely to hear the high esteem in which she was held. As she talked, Joy grew more and more confident and I really enjoyed listening to her.

    Joy Horner IM

    Sheena then stood and began to speak to us.  The title of their presentation was 'Unusual but Normal Births'.  So naturally they spoke a lot about breech births and the best way to deal with them.  Hands off the Breech people, unless it is contra-indicated. I think that it's such a shame the midwives and doctors are so de-skilled now in dealing with vaginal breech birth.  Sheena talked about the many people in the room and spoke about how good it was that we were all working together with a real spirit of collaboration.  She was warm and infectious.  It was so difficult to take notes because I just wanted to enjoy her words.  The way she spoke to her Sister Midwives about the ways in which they practice was inspiring.  I'm not surprised Sheena got an OBE for services to nursing.  Her bedside manner must be amazing.  She had a way of holding your attention and a fabulous smile.  She spent each session (except the one she spoke in) tweeting away like mad.  She even hosted a tweeting session, which she asked me to help with :proud: as she has only been tweeting for a few months, where she taught tweeting to those who wanted to learn.  In a moment of pure, unadulterated pride... I taught the legendary Ina May Gaskin how to use her hash tag to attract medical students to her tweets.

    Both Sheena and Joy exhorted us to join Breech Birth Network so I do hope that you sign up.  Now if you'll excuse me, I have a book to read.  There's a man climbing out of a bedroom window.

    Sheena Byrom OBE

    Tuesday, 1 May 2012

    It's birth but not as we know it!

    Michel Odent!  :swoon:

    To be fair, that's all I have to write for this blog post to be a loved blog post.  I mean c'mon people... Michel Odent.  

    Okay, clearly that's not enough for a blog post.  I won't tell you about wanting to drown in the sound of his voice.  The man is 82 and I've never seen so many women swooning in one room.   When I decided to become a Doula, I trained with Michel.  The man made me so excited about birth that I went home thinking that I wanted another baby.  I had five at home.  I didn't need another one. I still have five children.  There are no more.

    So, Michel was speaking at the MAMA Conference (yes this is next in the MAMA Conference series) about Womb Ecology and what he said put a chill into my heart.  In his words we are at the bottom of the abyss and it is time to smash the politically correct nature of childbirth.  It is the cultural conditioning that we live with.  He told us some stunning truths (stop me if you miss the dripping sarcasm... not about Michel.  Never about Michel) including how over the last 50 years we have learned that babies need their mothers.  Seriously.  Stop the press!  Michel said "in the 21st Century, it is not about acquiring knowledge, it's about digesting the knowledge we have".  It's time to rediscover common sense.  Think about it.  Babies need their mothers.  Our babies are incredibly vulnerable beings.  They are born without the ability to stand, speak or fend for themselves.  They need their mothers.  Kangaroo careskin to skin is now promoted throughout hospitals.  It does rather beg the question... why on earth was the practice allowed to be forgotten?

    Caesareans have become such common practice that Michel told us that he thinks it will impact on future generations and the whole "women cannot birth without assistance" argument will be a self fulfilling prophecy.  Can you imagine that?  Our daughters will be unable to birth our grandchildren without a surgical operation.  And if our daughters manage, then their daughters may not.  How much do we play with when we create a climate of fear around birth?  Personally, I'm tired of hearing stories of Consultants that hand over boxes of tissues to women before telling them the only way they can birth live babies are to do it the doctor's way.  How does that inform women?  Where is the unbiased risk information?  And where pray tell is the space for oxytocin?