Saturday, 31 December 2011

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.

Sunday, 25 December 2011

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!

Friday, 23 December 2011

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

Wednesday, 21 December 2011

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".  

Sunday, 11 December 2011

Pregnancy. A time to relax and enjoy.


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."