A book that I absolutely loved from the Abuela Doula reading list was The First Forty Days by Heng Ou with Amely Greeven and Marisa Belger.
I adored reading this book as it provided an insight into how other cultures regarded the postpartum period and the traditions surrounding recovery. It was a book that I wished I had read when pregnant, as I was guilty of being up and about far too soon trying to get back to ‘normal’ which in turn prolonged my recovery.
It’s very much a book that has informed my postnatal work; not only the theory but some of the beautiful recipes.
The Abuela Doula course along with this book also awakened my curiosity in the history surrounding the postpartum period in my culture (English and Polish). Over the years many of the traditions and beliefs have fallen by the wayside in Western society, and it’s easy to discount them all together.
But actually Europe did have a tradition similar to the Chinese zuo yue zi (“sitting in month”). We had a “lying in” period (between 10 days and 2 months), and during that time the birthing woman was expected to stay in bed with care given by female relatives or paid caregivers. During the 1740s, ‘lying-in hospitals’ were set up in London, which provided not only support through labour by midwives, but also for maternity care postnatally for a month. It wasn’t just rich women who had the lying-in period, it seems that poor women were supported to have lying-in periods through donations of the parish, so established was the practice. It was normal for new mothers to stay in hospital for 10 days following birth right up until the 1970s, allowing them to sleep at night and ensuring they ate healthy food.
There was also tradition surround food and drink. The new mother might eat ‘Kimbly cake’ which she had prepared during the early stage of labour ( I love the idea of making a cake during early labour, there is something so homely and comforting about baking so will help oxytocin flourish, plus you are upright and moving). Or her husband may provide groaning cake and cheese, both of which have been specially kept for the occasion. In the postpartum period a traditional drink (a caudle) was prepared, made of ingredients including eggs and alcohol. It was thought to be beneficial and restorative to anyone who had given birth or was otherwise sick.
Although the woman who had given birth was not ill it was believed that it was all too easy for her to become ill, and that could be a serious issue without medication such as antibiotics. So the aim was very much to prevent such illness.
Obviously we know much more medically now, but even so reading books and information from the time which talk about these practices show that actually much of what was practiced was common sense, and is relevant still today.
Nature has designed us to take it easy after we have given birth. Breastfeeding and bonding are so much easier when we are in bed, naked, doing skin to skin. Our bleeding postpartum (lochia) often becomes heavier if we are too active. Pressure on our perineum (and stitches if we have had them) is much worse in a full sitting position rather than when we are semi-recumbent. Too often we become caught in a cycle of eating snacks and junk food in the postpartum period, feeling chained to the sofa but in turn this lowers our energy levels and fails to restore our nutrient store which was depleted during labour. It can also make make constipation worse (already common after having a baby) and that can lead to or aggravate piles.
When I talk to clients about their recovery during the postpartum period, so many are so reluctant to slow down. “I’m not used to it”, they tell me. “I don’t think I would be happy lying down, I like being up and about”. I try to stress to them that those first few weeks are precious. Not only will you never get them back, but the way you treat yourself and are treated by others will have a huge impact on your physical and mental recovery. It really isn’t worth rushing the recovery and pushing through the pain in order to feel ‘normal’. You need time to ease into the new normal of family life including your baby. Take the time, it really will be worth it.
http://www.gutenberg.org/cache/epub/7129/pg7129-images.html - The Prospective Mother, by J. Morris Slemons
Ritual and Conflict: The Social Relations of Childbirth in Early Modern England, by Adrian Wilson
Observations on the Popular Antiquities of Great Britain: Chiefly Illustrating the Origin of Our Vulgar and Provincial Customs, Ceremonies, and Superstitions, by John Brand
https://pubmed.ncbi.nlm.nih.gov/3511335/ - Deaths in Childbed From the Eighteenth Century to 1935
So yesterday I shared an article about traumatic births, and the role that antenatal classes can play in the conversation about birth trauma
(link here https://www.facebook.com/glowbirths/posts/817194178797500).
I wrote on the post that I had had two difficult births. I didn’t think what I wrote was that controversial but someone has messaged me to say that they think if I am sharing that I had two traumatic births then I can’t be very good at hypnobirthing, or it can’t be any help, and it’s a really bad advert for my business and they wouldn’t book with me.
Ok, let’s unpick a few points around this....
Having read yet a few stories recently where people giving birth are being told they must lie down for monitoring, and are ‘not allowed’ to change position I am feeling so full of rage that some antenatal education cares so little about informing women of their rights in labour, when this should be something they are told through their pregnancy to hammer home their autonomy. I am so angry that as a society we have convinced women in labour (women in life generally) that they should do as they’re told without question, don’t rock the boat. That women are being treated like prisoners (and I don’t think women in prison giving birth should be treated like this either!) and being told they are not allowed to move from the bed but must lie there hooked up to monitors, despite all evidence showing that those who are able to move in birth, who use gravity and open positions, having easier and shorter labours. It makes me so angry and it makes me want to cry.
That people have to educate themselves really thoroughly about their rights (it should just be a given that when you’re in labour you have the same free rights as you do the rest of the time) and that they then have to blinking fight for those rights, at a time when we need the ocytocin flowing, not the adrenalin. And then we wonder why our intervention rates are rising year on year, and why so many women have ‘failure to progress’. It’s not the women failing to progress, it’s the institution not allowing them to progress by making them fight at every turn, by scaring them out of their wits, and by constantly telling them they need help to labour.
These points are taken from the RCM Midwifery Blue Top Guidance Midwifery care in labour guidance for all women in all settings:
“Recommendations for practice…
And yet despite this being in the guidelines for practice, this is still not considered the norm, and is ignored by some midwives (and consultants) who very often choose to make things easier for themselves rather than the person in labour.
I know hospitals where women are discouraged from using the birth pools, because the midwives don’t like filling them up. This despite the evidence showing that hydrotherapy is a very effective method of managing comfort levels in labour, and women using birth pools are less likely to need stronger pain relief such as epidurals, less likely to need intervention and less likely to tear:
“Labouring in water – there is good evidence of benefit from water immersion during the first stage of labour. Results indicate that it can reduce the likelihood of requiring an epidural and qualitative studies have illustrated that women who choose to labour in water feel a high sense of control and satisfaction…
Giving birth in water – there is some evidence that associated maternal satisfaction with maternal pushing experience in water and no added risk of sustaining obstetric anal sphincter injury, no increase in maternal or neonatal infection or requirement for resuscitation or admission to NICU...”
[RCM Midwifery Blue Top Guidance Midwifery care in labour guidance for all women in all settings]
I fully understand that midwives are under a huge amount of pressure, and that filling a birth pool takes time, but if you have a birthing person who labours quickly needing less intervention that saves time in the long run, but who needs to look at the bigger picture eh. Some seem to forget that labour should ultimately be about the person giving birth, that they should be the centre of the experience and consideration.
In the summer I supported a woman who was having a tricky pregnancy and for various reasons, we suspected would have a difficult birth. She did. It was fairly traumatic and despite us both being aware of her rights, what she was entitled to ask for and decline, when it came to giving birth she and her partner felt unable to advocate for themselves, as the power balance was too inequal. She was persuaded passively aggressively, then coerced and finally threatened. And so she gave in. After hearing her story I felt traumatised because she knew all of the stuff, she’d educated herself, she did all the right things and it still wasn’t enough. She just wasn’t allowed to use the knowledge, and when you are in a hospital with people ordering you around, the default is to fall in line. It takes a very strong person to stand up for themselves in that position, and when you are being told your baby will die if you don’t do as you’re told, most of us will do as we’re told. This is an abuse of power, it is not informed consent, and it is against our human rights.
A reminder of a couple of the key human rights applicable in childbirth:
Article 3 – No torture, inhuman or degrading treatment
This can include physical or verbal abuse, non-consented care, non-confidential care, discrimination and denial of care (including withholding pain relief).
Article 8 - Right to Private and Family Life
Which includes the right to personal autonomy and physical and psychological integrity (this right means you must not be physically or psychologically interfered with). Unconsented vaginal examinations, unagreed rupturing of membranes, or any other procedures done without full informed consent (ie you know what you are agreeing to and the benefits and risks of having or not having ‘x’ done) all breach this right. This right also includes a birthing person’s choice over where they give birth.
Not only do we have a two-tier antenatal system, with many unable to access good quality and unbiased information, but even for those that do educate themselves there is often a fight to get what they want. I hear countless tales of parents not being able to choose their own place of birth, put on to a high risk care pathway with little medical evidence to support that pathway, denied options around the type of birth they'd like or persuaded to choose a method of pain relief that the caregivers feel most suitable, whether or not the person giving birth would choose it autonomously.
And so I’m angry. I’m angry for me, and the way that I was treated. I’m angry for all the women who’ve been treated like children, like prisoners, denied their human rights . And I’m even angrier that, against the growing body of evidence showing that undisturbed births where those giving birth are able to move freely result in easier labours, healthier mums and babies and more positive experiences, interventions are on the rise and there are more and more cases of traumatic birth experiences.
This isn’t a rant against midwives in general, this is a rant against those individuals who have lost their compassion, or their understanding of who they are there to support, and against a system which is feeling so incredibly broken and is leaving a swathe of broken women in its wake.
If you’re interested in reading more about human rights in birth, Why Human Rights in Childbirth Matter by Rebecca Schiller is a great starting point. Birthrights is a UK organisation providing advice and support regarding rights in birth, and the Birth Trauma Association is helpful for those who have experienced a traumatic birth.
There are lots of reasons, but I’ll start with the one that to me is the most important.
Independent businesses are run by independent thinkers. There is no party lie to toe, no worrying that you need to convey a certain message or fit in with a company or institution ethos, or follow guidelines. I spend a huge amount of time looking at research and staying abreast with current modes of thinking to do with birth and parenting. And I am passionate about sharing that information honestly, giving you both the pros and cons, and guiding you to know how to gain more information yourself. I don’t believe in teaching birthing people to be patients but in helping them to have control and options even when clients don’t think they have any as the guidelines say they don’t. I don’t have any bias towards ‘natural’ births (and I hate that term) or medicalised births; I give you all the information I have and let you go off to decide what you want to do with that information.
I know that if you book a class with me, my class sizes are likely to be smaller or one on one, with more in depth training; this means there is more time to ask questions, to do practices and activities plus receive a personalised service after. Independent teachers tend to work really hard for their money. We don’t have the luxury of being a nationally known name, or having people book automatically thinking they are compulsory (I have genuinely had people say they thought they had to book a national company’s classes).
When you book my courses you can do so already knowing who I am, and having spoken to me. I am not an anonymous teacher booked through a central reservation service. I have a photo and a bit about me on my website and facebook page, I offer taster sessions where you can get to know me, I offer free breastfeeding and birth debrief sessions, and I am always happy to have a chat or go for a coffee for those who feel they need more info or the personal touch. I know that the relationship between the teacher and a pregnant person (and their partner) can be a very intimate one; I hear fears, hopes, medical information, previous birth stories, disagreements between partners. To my mind it is really important that you like the person teaching you and that you feel comfortable talking to them and the benefits are so much more when the relationship becomes a close one.
One of the questions that often comes up is about whether a class taught by midwives will be better. Honestly it is always teacher dependent. Midwives who teach (unless you have employed them as an independent midwife) are not allowed to answer medical questions related to your health, as answers will be specific to your full medical history. So it really is a level playing field.
In my classes I talk not only generally about the processes of birth, but specifically about the services and facilities available at our local hospitals. I know the different options in our area, pain relief on offer, different services if you need further support, and so on. They are tailored if you have a particular need, for example if you know you will be having an induction or a Caesarean birth so that we spend more time on the techniques that will help you in your particular situation.
And finally, you know, it’s good to challenge the status quo. For years there was very little choice when it came to antenatal classes. You either booked the NHS, the NCT or you didn’t do classes. Now you can book active birth, hypnobirthing, calm birth, yoga, aqua natal, etc. Having a range of competition raises the game for everyone. It means that hopefully antenatal education improves, that people are more informed, that they have the option to find a class that suits them and their hopes for their birth. It means that if you don’t feel comfortable going to one type of class because you think you look different to the usual attendees, there will hopefully be a class where you do feel you fit in.
Antenatal classes should not be for one type of person but should be available to all, and everyone should find a class where their hopes for birth are not mocked, downplayed or disregarded.
A doula is a non - medical companion who supports a birthing person and their family through labour, or who supports a new family in the early weeks as they grow
There is a doula for every birthing person, no matter where they have planned to give birth and what type of birth they are hoping for. As doulas don't get involved in the medical side of birth they can support parents through every birth, whether a homebirth or a caesarean.
The role of a doula is not just to support the birthing person but to ensure any birth partners also feel calm, confident and secure in their role.
Birthing a baby is a life changing event but so is witnessing one being born. It's completely normal that birth partners may feel nervous, excited, or even scared but this means that they will be full of adrenalin which stops the lovely calm atmosphere of oxytocin vibes needed for birth. A doula can be there to calm and reassure, reducing tension in the room and allowing oxytocin to flourish.
I know that having a baby is an expensive time with a seemingly huge list of things to buy. If someone really wants a doula but is worrying about the list of baby things they need to buy, I would always recommend that they sit down and list their priorities to bring clarity to whether paying for a doula is worth it to to them.
There is evidence to show that having a doula can mean:
- A reduced risk of interventions such as induction, instrumental births and Caesarean birth.
- Less likelihood of needing an epidural and other forms of pain relief
- A shorter labour
- A more positive experience of birth
- An increased likelihood of achieving desired breastfeeding goals.
- A reduced risk of experiencing PND
If you're interested in hiring me as your doula the level of support you have is entirely up to you, and every package is tailored to the family's requirements. Want me antenatally and postnatally but not at the birth, no problem. Want me at the birth but already got your antenatal sessions covered, that's fine too.
As with all relationships some people will be more your cup of tea than others. If you're looking for a gentle, all natural earth mother then I might not be the doula for you.
I like to think I'm calm and relaxed but I'm also honest, pragmatic and down to earth; I don't lie about labour and birth or parenting, if you've got pregnant then you're grown up enough to know what to expect. I feel that my job is to inform you of the process of birth and all of your options surrounding labour and birth, and then help you feel confident to make those decisions yourself.
I have no bias about your birth or parenting choices, and I work hard to be culturally aware and safe. If there is a cultural tradition you wish to follow that I am not aware of then I will go and research to allow me to work in a way that is appropriate.
I'm always happy to have a chat with no obligations or expectations. If we get on then we can meet for a coffee and a more in depth chat. If I'm not the one for you then that's fine as well, it won't offend me.