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.