This year has been a real rollercoaster! I think it has been for everyone during this time where the world has lost its mind (hopefully temporarily). For the women we support it has been really fucking tough, women who have been pregnant and given birth during these last two years have had to deal with a whole lot of extra shit. You’re amazing.
For us there have been lots of changes and developments in the way we work. It’s been hectic, difficult, exhausting, fabulous and is definitely ending on a high.
We needed lots of hot chocolate, tea and coffee!!
This year we stopped attending births, we found out what Zoom was, we were able to reach women outside of Manchester, we adjusted to working from home and online, we ran a brand new project with young girls which was an absolute game-changer, one of our directors Lauren resigned and we adjusted to GMD being a two-woman operation! We felt like we were drowning at times, and then we got shit done. We also met some amazing women along the way (you know who you are!).
We have exciting times ahead of us and we’re glad you’re along for the ride. We decided to start attending births again, but exclusively freebirths – this is something we’ve wanted to do for a long time. Find out what led us to that decision here. We were worried that by becoming freebirth doulas we would end up with very few clients, but it has had the opposite effect (we knew you were all out there somewhere…) and we are so excited to be going on-call for some truly wild women in the New Year!
We are in the process of applying for Reaching Communities funding from The National Lottery which would make it possible for us to support women in so many ways for three years. This is something we’ve been working on behind the scenes and we’re getting closer. Fingers crossed!!
In 2022 we hope to start facilitating more of our existing community groups in-person and also introducing a new Consciousness-Raising Circle. More on this when we come back in January.
Oh, we also went to the tip lots of times (Elle’s favourite place), had a stall at the Platt Fields Winter Market and met a tiny dog which was super fun!!
All in all, 2021 was full of twists and turns for GMD but we are in a great place right now and really looking forward to next year! We are officially off from today, so it’s time for us to enjoy the cosiness of Christmas and the rest of December. We can’t wait to soak in the excitement and freshness of a brand new year!
It’s been such a long time since we were regularly meeting with women in real life – we’ve missed you! How are you doing?
We have good news – it’s about time we got back out there. We are making way for lots of in-person opportunities for us to get together and talk about all things birth. Starting with our community groups – we have reinstated real-life groups (finally)!! So from now on, we will be alternating between in-person and Zoom so that the groups remain accessible to everyone because we know that sometimes it takes way too many spoons to get up, dressed and leave the house. For anyone who hasn’t attended any of our groups whilst they have been on Zoom, pyjamas are 100% welcome! Come to think of it, they are welcome at our in-person groups too!
We have also started working from the community room in Eastlands Asda nearly every Tuesday where women can either book an appointment to come and see us or they can just drop in if we have availability. We’d love to see you there!
Eastlands Asda Community Room
ASDA Sportcity Ashton New Road Manchester M11 4BD
Our in-person groups are currently being held here! You’ll find the community room at the back of the Asda, to the left of the pizza counter – just knock on the door when you arrive and we’ll let you in. There is plenty of space, kitchen facilities and a toilet. The carpark is massive and free for a few hours.
You will also find us here almost every Tuesday between 09:30 – 14:30 – if you would like to book a chat with us, please send us an email so we can block out some time specifically for you.
Homebirth Group – Sunday 14th November – 10:30 – 12:00 via Zoom
Freebirth Group – Thursday 18th November – 13:00 – 14:30 via Zoom
Women Reclaiming Birth – Thursday 2nd December – 13:00 – 14:30 – Eastlands Asda community room (more details below)
Homebirth Group – Sunday 12th December – 10:30 – 12:00 – via Zoom
Freebirth Group – Tuesday 14th December – 13:00 – 14:30 – Eastlands Asda community room
Here we are, working from home on one of our more organised days (we’re both dressed and have a hot drink within arms reach!!). There have definitely been a few perks of working from home but we have really missed being out in the community and hanging out with other wise women.
We’re really looking forward to getting back out there and meeting you in real life again. Follow our Facebook page to stay up to date with any changes by clicking on the button below.
I have a few issues with this phrase and the way it is presented to women both in pregnancy and in the moments after birth. Language is incredibly important when it comes to pregnancy and birth, and for too long the negative impacts of the language used in maternity care has been ignored. I believe that “chemically induced third stage” is a more accurate term for what is currently known as an “actively managed third stage”.
The phrase “Active Management” and what it implies
Firstly, the phrase “active management” comes with some serious implications. It suggests that this is the safe, controlled way of birthing your placenta and that waiting for your body to do what it is designed to do is “unmanaged” and therefore dangerous. I went to a birth recently where the midwife described the cervix as a “vice” and told the woman that “sometimes nature just doesn’t do enough to get it out” – this kind of attitude towards women’s bodies is a huge problem in my eyes.
The importance that is put on the length of time passed since the baby was born is immense, but with very little evidence. By calling it a “chemically induced third stage” it is making it clear that this is an intervention that involves medication and is the act of forcing the placenta to be born before the body is ready to do so on its own. It seems appropriate given that it is essentially the same as chemically inducing labour – injecting a woman with an artificial “hormone” to force the uterus to contract.
What the body needs for a smooth birth of the placenta
The birth of the placenta needs the same basic things as the birth of the baby. A woman in labour needs to feel safe, unobserved and undisturbed – the same applies to the birth of the placenta given that it uses the same hormones.
If you ever witness an undisturbed birth, and the environment stays the same after the baby is born, you will see a smooth birth of the placenta too. It may not happen fast, but it will happen. If you witness a birth with midwives present, or people around who are looking for danger, on high alert and full of adrenaline, you will see the environment change entirely. The voices that were soft (or better still, silent) for the many hours prior are suddenly at a normal volume, asking questions and stating observations, the lights might even come on and suddenly the birth space is no longer the safe cacoon that it was before.
If midwives are present, the clock is started – they are counting down the seconds until the placenta is born, perhaps not once considering that by asking the woman questions and observing her so closely they are hindering the process. The fear is contagious, even if it is not justified. Despite there being no known “normal” length of time for the placenta to come, the 60-minute limit is applied and so the pressure begins, even though there is no evidence (nor common sense reason) that a woman’s cervix would close itself naturally before birthing the placenta. It does however make sense that this might happen if the woman has induced artificial uterine stimulation due to the use of Syntometrin.
The risk and varying definitions of post-partum haemorrhage
The common British definition of a haemorrhage is 500mls, whereas in Holland the definition is 1000mls. Whenever there is a big difference (in this instance a HUGE difference) in policies and guidance, it makes me question where they are getting their numbers from. What are they basing these thresholds on if they are so vastly different?
We know that when a woman is pregnant her blood volume increases dramatically, so whether this extra blood comes out immediately after birth, or in the weeks or months following, it is likely the same amount in total. The measurement of blood loss also doesn’t tell us much – one woman could lose a lot of blood and feel perfectly fine, another could lose a small amount and feel awful – surely the way the woman feels should determine whether medical attention is needed, not an estimated measurement.
The supposed benefits are based on very low-quality data, all of the studies were undertaken in hospital settings and according to the Cochrane Review; “Although the data appeared to show that active management reduced the risk of severe primary PPH greater than 1000 mL at the time of birth, we are uncertain of this finding because of the very low-quality evidence. Active management may reduce the incidence of maternal anaemia (Hb less than 9 g/dL) following birth, but harms such as postnatal hypertension, pain and return to hospital due to bleeding were identified.”.
We know that the risk of having a PPH is significantly lower for women who plan a home birth, even if they transfer into hospital for the birth itself. So why is the same low-quality data that only applies to hospital births being implemented into standard practice at home births too?
Also, as a side note, the maternity system can’t be massively concerned about preventing PPH when they are inducing women at alarming rates, which also increases the risk of having a PPH.
The risk and definition of “retained placenta”
incomplete separation of the placenta and its failure to be expelled at the usual time after delivery of the child.
So what is the “usual time”? The National Institute for Health and Care Excellence (NICE) recommends that; “the third stage is diagnosed as delayed if it takes longer than 30 minutes to deliver the placenta with active management or 60 minutes if allowedto deliver the placenta physiologically with maternal effort.”
* Notice the use of the word “allowed” – this is what I’m talking about with the use of language *
However, this doesn’t even begin to encompass the wide range of normal. From listening to women’s stories who birthed with no medical staff present, their third stages lasted varying amounts of time with no ill effects. In one freebirth study published in a midwifery journal, they varied from 30 minutes to 5 hours, and some women anecdotally report going to sleep for several hours before birthing their placenta.
According to an article in ‘Best Practice & Research Clinical Obstetrics & Gynaecology’, in less developed countries, retained placenta affects about 0.1% of deliveries, whereas, in more developed countries, it happens in around 3% of vaginal deliveries. Considering the intervention rates are higher in developed countries, this leaves a lot of questions about what is causing the increase in cases of retained placenta, how they are defining “retained placenta” and whether these stats are referring to women who do not have the injection or include those who do.
There are very clear symptoms of a retained placenta that is causing an issue, but in the standard practice of midwives, they do not wait for any of these symptoms. Instead, like many of the standard practices in maternity care, they simply assume that the body is incapable of performing its natural functions and intervene too soon.
These are the symptoms of a retained placenta;
Passing large pieces of placental tissue
Heavier than expected bleeding
Foul-smelling vaginal discharge
* Note that having an extended period of rest between the birth of your baby and your placenta isn’t listed as a symptom, so decisions to intervene should not be based on that without any actual indications of a problem.
The risks of Syntometrin
Syntometrin is the injection given for an induced third stage. It is made up of oxytocin and ergometrine maleate. Women are quite often told all of the risks of doing nothing, and only the so-called benefits of having the injection and getting it “all over and done with”. From my experience, the only reason women have accepted the injection (even when they had previously declined), is due to fear and/or to stop the constant pestering. The coercion that I have witnessed during that golden time between the birth of the baby and the placenta is truly awful and eventually takes its toll.
We know that with the injection the placenta tends to come fairly quickly, but at the cost of added discomfort due to fundal pressure and cord traction (having a midwife push on your bump and pull on the cord). But there is rarely any mention of the risks and side-effects of having the injection.
In reading the information provided on Syntometrin, here is what I found on the risks:
Ergometrine is known to cross the placenta and its clearance from the foetus is slow. Concentrations of ergometrine achieved in foetus are not known.
Ergometrine derivatives are excreted in breast milk but in unknown amounts. It can also suppress lactation.
Ergometrine can cause vasoconstriction
Caution is required in patients with mild or moderate hypertension, cardiac disorder, or hepatic or renal impairment
Oxytocin should be considered as potentially arrhythmogenic
Patients should be warned of the possibility of dizziness and hypotension
Some of the reported adverse drug reactions:
Anaphylactic/anaphylactoid reactions associated with dyspnoea, hypotension, collapse or shock
Myocardial infarction (heart attack)
“It might just be sitting there”… So what?!
We often hear this from midwives; “It’s likely that your placenta has detached from the uterine wall and is just sitting there on your cervix”. Okay, that makes sense… so what? What is the issue?
In our work as doulas, we trust in birth, we trust in women and their intuitive wisdom. We trust that if a woman feels well, she is well, and if something isn’t right she will know what to do. Women who have had undisturbed births describe feeling contractions and then a sudden urge to move positions due to feeling uncomfortable sitting or lying down, and with this movement, they birth their placenta. These women weren’t timing their third stage or being told when and how to move – just as in their labour, they were listening to the most up-to-date information their body was giving them and acting or waiting, accordingly.
So is a placenta truly retained if it just hasn’t had enough time to come out yet? If it isn’t causing any of the obvious physical symptoms of a genuine issue, does it just need time and patience? Does the presence of someone who is timing this pause have a negative impact on the process? Why are we treating every woman as if a PPH is incredibly likely when that isn’t the case? In the same way that the “failure to progress” label is put on women whose labours aren’t following an arbitrary timeline, intervening can lead to a whole host of other issues, not least that woman feeling like her body failed when the reality is that the maternity system failed to wait.
We often speak to women who don’t know where to start with their birth plan and have even been told more than once not to bother, but if you’re choosing to birth within the maternity system then we have a few tips for you!
Writing your birth plan isn’t just an opportunity to put clear instructions in writing for whoever attends your birth, but the process of writing it will bring up questions for you that you may not have considered before.
If you’re not sure where to start, or you have written your plan but want to make it solid, here are a few things that might help;
1. Plan for your ideal birth
If you’re not planning for your ideal birth, then what are you planning for and why? If you start at the end, you can work your way back, figuring out along the way what will make your ideal birth more likely, and what might become a barrier. When you figure out those barriers, you’ll notice that most of them are within your control. By doing this, you will work out what your hard lines are and under what circumstances you might move to plan B (if you have one).
2. Remove the barriers at the earliest opportunity
Knowing what barriers might come up in pregnancy (especially around 36 weeks) and during labour is a really good starting point. If you are seeing a midwife and/or intend to have one at your birth, you can ask them what THEY would consider a reason to transfer to hospital. You can then look at that list and decide for yourself what your reasons would be. Growth scans, for example, are a big one towards the end of pregnancy so deciding for yourself how reliable you think they are, and whether that information is useful for you and would have a bearing on where you want to give birth – if it wouldn’t, then remove the barrier by declining the scan. Use the BRAIN acronym to decide what is working for you and what isn’t; BRAINsign
3. If you say no, you can always say yes later
Lots of women find that when it comes to vaginal examinations and monitoring, it’s much easier to say a firm no to all of it in your plan and at your appointments, knowing that if at any point you do change your mind the option is always still open to you. If you say yes to something you don’t feel comfortable with, you can’t undo that vaginal examination or doppler reading and it becomes much harder to then change your mind and find the strength to say no. It’s also always okay to take more time to think about something before you make a decision. The same goes for saying no to birthing in hospital, if you plan for a home birth then all of your options are still open to you, you can decide to go to hospital any time you like. It’s much harder, however, to decide last minute that you’re having a homebirth if you are inviting midwives to attend.
4. It’s good to be specific
If there were ever a time to be really clear about your needs, it’s during pregnancy. You might have really specific wants and needs – you’re not being fussy or awkward – express them! If it is important to you then it should be important to the people you are inviting into your birth space. For example, if you want a silent birth space, don’t say “please keep the noise to a minimum” because that isn’t actually stating what you need, and a midwife’s ‘minimum’ might be very different to yours. Phrases like “if possible”, “kept to a minimum” and “only if necessary” are incredibly open to interpretation, and makes it an almost pointless sentence because you’re then leaving it up to someone else to decide.
5. Write your plan for the worst midwife you’ve ever heard of
We hope that your interactions with midwives have been positive ones, but we also know that some do not respect birth as a bodily function that needs patience and privacy to go smoothly. Aim your birth plan at that midwife who is tired, twitchy and looking for any excuse to transfer you to the hospital. That way, if the midwife you’ve met a few times who is supportive and respectful turns up, she’ll totally get why you’ve written it that way. It’s a set of clear instructions on how you expect to be treated. You don’t need to ask permission (“please” and “if possible” are hinting at seeking permission) and you don’t need to be polite.
These are just a few ways you can write an effective, assertive birth plan. If you would like any support in writing or implementing your birth plan, or book in a holding space session to chat about your plans, please don’t hesitate to get in touch: firstname.lastname@example.org
You can find our birth planning templates and examples here;
This one is pretty simple so I’ll keep it short. You have the right to birth your baby wherever you like, with whomever you like. You have the right to decline maternity care altogether if it isn’t serving you. You have the right to give birth without a midwife present. It is not illegal. We often hear from women; “I was told it was illegal and that my partner could be arrested!” – this is complete rubbish. It’s a scare tactic to make us think that we HAVE to engage with maternity services and that we HAVE to have a midwife present. Can you imagine the ruckus it would cause if women realised that they didn’t need to put up with being told what to do, how to move (or not move), when to push, or being poked and prodded whilst they’re trying to listen to their body? … it might just topple the system.
2. Birth is a normal bodily function that needs very basic things to go smoothly
Birth is made out to be this really mysterious thing that, if you’ve never done it before you couldn’t possibly know how to do it without being told. But that’s just not the case. If we treated all bodily functions in that way, intervening before giving the person enough space and time to follow their own body, it would cause all sorts of issues. If we decided that it was too risky to poo on your own because you might brew a poo that’s too big to come out, so it’s much safer to cut you open and get the poo out that way instead… we’d be in a pretty big mess. And you would probably question it because… we’ve been pooing by ourselves for millions of years. But surely birth is different… oh wait. No, it isn’t. Human women have been giving birth without being told how since the beginning of humans, and before humans, the rest of the females of all species did it too. You might hear the argument “yeah but… loads of women and babies used to die from childbirth!”, and that’s not incorrect, but the technology didn’t fix that problem. We are much healthier as a species nowadays and we learnt that washing our hands can help to prevent infections, that’s all. If anything, technology has made birth more dangerous – just take a quick look at America, a very technologically advanced country – while the global maternity mortality rate has dropped by 44% worldwide between 1990 and 2015, and by 48% in developed countries, the US is one of only 13 nations who has seen its maternal death rate rise. Birth is safest when the birthing woman feels safe, supported, unobserved and undisturbed. The maternity system is based on being risk-focused and avoiding being sued. These two things do not work together.
3. You can still opt-out of things, even if they’re seen as “the norm”
It might seem obvious, given what I’ve already said in the previous points, but it’s never presented as an option. You can decline any part of what is considered the “normal” path through the maternity system. That includes booking in. The only thing you legally have to do is register your baby within 42 days of the birth with the Registrar of Births and Deaths in the area in which your baby was born. Women give birth at a wide range of gestations too, and the scope of “normal” gestation (between 37 – 42 weeks) would be a lot wider if the medical model didn’t feel the need to rush the process for no good reason. There are plenty of women who ignore their due date altogether, and they are the women who have a peaceful pregnancy because they know that their EDD is just a number, that is only 4% accurate, and will likely result in the pressure being piled on by professionals, friends and family. There’s another thing you can decline or reject.
4. Pregnancy doesn’t change the fact that you are the only person
who gets to make decisions about your body
When you conceive a child, there is suddenly a whole load of things you are expected to do, whether you like it or not. There are lists upon lists of things you can’t do or eat when you’re pregnant, things you should definitely do because you’re pregnant, things you need to buy for your baby and appointments you have to attend. But is there any other time in life where you would just accept all of these things that people are telling you, even if they didn’t sit right with you? Is there any other time in life where you would be expected to let someone touch, measure, press on your belly even if it was uncomfortable? Or let them put their fingers inside you without asking or sometimes without even warning you? No. What do we want our daughters to know? That it’s okay to say no. That our bodies are our own and nobody gets to touch it without our consent. Right? But for some reason, when we’re pregnant we’re expected to just grit our teeth and get through it because it’s “standard procedure”. That’s not okay.
5. Your human rights don’t go away just because you’re growing another human
In the UK, unborn children do not have separate legal recognition from their mothers. This means that nobody can override your human rights for the sake of your baby, unlike in some other countries. This means that there is no limit to which you are the sole decision-maker when it comes to your care, or opting out of it altogether. This actually makes things a lot simpler than in countries where the unborn baby has rights too. You and your baby are one. What you decide is right for you, is right for your baby by extension. You absolutely matter.
6. You get to decide whether or not you want to go for a scan or appointment
Although scans and appointments are considered the norm nowadays, with women booking in around 12 weeks and having a few scans along the way, this is always a choice. These appointments and scans are not without risk. The information discovered during these appointments is something that can be used to coerce you, no matter how inaccurate the information is. The language used in these appointments plants the seed of doubt, giving the message that at some point your body will fail and you’ll need help. It very rarely gives the impression that birth is normal, and something that when uninterrupted is very unlikely to end up in an emergency. The maternity service is not designed to be woman-centred, it’s designed to manage birth, which just isn’t something that you can do with a bodily function. Treating women like a big, mysterious ticking time-bomb creates fear and will ultimately create emergencies in the process.
7. Birth is not inherently dangerous, but the way women are treated in labour is
As stated in the previous point, birth is not inherently dangerous. It becomes dangerous when we interfere with it. When a woman comes to the end of her pregnancy, there is a whole dance that her body is doing that involves a delicate balance of hormones. Labour begins when the baby is ready, and it will take as long as it takes. Sometimes it starts and then stops again. Sometimes it slows down for a long while then picks back up. Sometimes there are no signs at all and then comes on hard and fast. Labour, even though it can stop and start in different places, is actually very predictable when it is left alone. When people talk about birth being unpredictable, what they have seen or heard of is birth that is interrupted and disturbed by interventions. The evidence is out there – Marjorie Tew who set out to prove that hospitals had made birth safer ended up proving the complete opposite. Michael Odent explains that there are maybe 5 types of true emergency in birth and they are very rare. The intervention and caesarean rates do not reflect that number, which means that we are making birth dangerous by treating it as an emergency and interfering with a bodily function.
8. You don’t have to compromise, in fact, you don’t HAVE TO do anything
As stated in nearly all of the other points, there is no point at which you HAVE TO do anything. This phrase, however, is used in almost every conversation I hear about birth. Women are told by friends, family, strangers and midwives that they “have to” book in by a certain date and that they “have to” go for that growth scan because “it’s for the best” (despite the fact that they’re notoriously inaccurate), without knowing the risks associated with engaging in maternity services. This language is powerful, but you don’t have to listen to it. Anyone who tells you that you “have to” do something (e.g. wait to get in the pool or push now or be monitored in some way) or they use the phrase “we just need to do this” (e.g. a vaginal examination or listening in), should be kept far away from your pregnancy and birth.
9. Nobody gets to tell you what you are or are not “allowed”, or what is safe,
and you don’t need anyone’s permission
If you drive to a doctors appointment and the doctor says; “You didn’t drive here did you?! You’ll have to walk home because driving is too dangerous!” you would probably be outraged because you are a grown-ass woman who has weighed up the risks and benefits of getting in your car today and someone is deciding for you that it is too dangerous. So why is it that, during pregnancy, when we hear the words ‘risky’ and ‘safe’ used, we accept it? Because of the emotive language used around it – this is a tactic that is used frequently and is very effective. But population-level advice and statistics are not the only things that factor in risk and safety. You are a whole woman who has emotional, physical, practical, spiritual and mammalian needs, and nobody else will have the same priorities as you. Your risks and benefits would look very different from someone else’s, so it’s impossible for someone else to judge what is safe for you. In terms of being told what you “have to” do and what you’re “not allowed” to do… you are an individual with capacity and rights, which means that you get to decide where you have your baby, who you invite into your birth space, whether or not you want to engage with maternity services and to what extent. You get to decide when to get in and out of the pool, and if and when you cut your baby’s cord, and who gets to touch your baby. Nobody has the right to allow or not allow when it comes to your body, your baby and your birth.
10. Your intuition can be trusted – it won’t lead you wrong
We often hear women saying “but what if something is wrong and I don’t know about it”. The monitors that we’ve invented are trying to mimic what our body already does, so that it can be plotted on a chart, but those machines can never replicate the instinctual responses that our bodies have. You will be the first to know if something is wrong because nobody else can feel what you’re feeling or even attempt to interpret it from the outside. We all know that when a pregnant woman is stressed, her baby will feel it because of the increased cortisol in the body, and the same is true the other way around. If you are able to listen to your intuition and follow what your body needs, it will not lead you wrong. We hear women saying “I knew that I needed to push but they kept telling me not to”, or the other way around “I knew that I didn’t need to push yet but they kept telling me to” and it’s those women who come away from birth feeling traumatised, it’s those moments where the people around her were speaking louder than her intuition that she feels out of control and it’s in those moments where birth becomes dangerous. Our intuition is what has kept the human race alive and thriving for such a long time, so don’t doubt it.
There is an abundance of misinformation given to women about the infamous ‘stretch and sweep’. This misinformation leads women to believe that a sweep is completely harmless, and in some cases necessary! The feeling that comes from these kinds of ideas is that labour needs help to start and that it would be dangerous to do nothing, undermining the fact that labour is a perfect system that involves lots of hormonal changes before any obvious signs of labour can be detected.
Misinformation Exhibit A:
A poster that was displayed in the waiting room of a maternity clinic
Where do I begin?
Maybe from the top and work our way down.
1.Let’s start with due dates. Due dates are calculated on the assumption that all women have the same length menstrual cycle. This is simply not the case, they can differ hugely from woman to woman, month to month. The “normal” range of being full term is between 37 – 42 weeks, so that is already a wide window but it doesn’t take into account how many women are induced due to the fear of going “overdue” (like a library book). So in reality, if we were all left to our own devices this window of normality would probably stretch much further. Whilst we’re on the topic of being left to our own devices – have you ever heard of a woman being pregnant forever? I haven’t. I have heard so many times “I’ve never gone into labour before so I don’t even know if I can” or “I wasn’t going into labour so I had to be induced”. There is no reason to think that your body wouldn’t go into labour naturally given enough time and patience, it is the healthcare system’s incessant need to interfere that undermines women’s confidence in this.
2. The next point of focus on this awful poster is the second line; “want to start labour naturally?” … WHAT?! The only natural way for labour to start is to leave well alone because anything that you try to bring labour on before it naturally would, isn’t labour ‘starting naturally’. The other important thing to ask here is why would we want to start labour early? The only reason women feel pressure to “kick things off” is because of the information they are being given about due dates and going past them. That pressure is coming from the maternity service, so they are offering a “solution”. Sweeps are often offered as a way to “avoid induction” but a sweep IS part of induction.
3. So you’ve so far been told that approaching your due date means that you must want to get labour going, and that having someone put their fingers inside you to “sweep” around your cervix is a “natural way to induce labour”, and that you should talk to your community midwife about it. I’m not sure about you but the information they’ve given so far isn’t exactly filling me with confidence that talking to them about it would benefit anybody. It is easy to tell from this poster that birth is not seen as a normal bodily function because there is a continuous want to DO something or measure something or fix it. Midwives have to follow the policies of their hospital, and clearly, this hospital (like many others) see birth as something to be managed, which includes inducing labour at all costs. Offering a more “natural method” of a sweep (rather than a chemical method) seems like a compromise, and women are expected to take this compromise to avoid being pressured into further induction techniques. The idea that you can only avoid a formal induction by having a sweep suggests that saying no isn’t enough and won’t be respected. But here’s the thing… you don’t have to compromise. If you don’t want an induction, you don’t have to have one. You can tell your midwife that you will not have an induction and therefore don’t want to discuss it any further, and if they do bring it up against your wishes then you can tell them that they are harassing you. There are many, many ways to avoid the pressure to be induced, but having a sweep isn’t one of them because it is a form of induction, and once you have said yes to one form of induction, it becomes much harder to say no to the rest.
4. ‘Available at your local clinic from 40 weeks pregnant’ despite the fact that most women who are 40 weeks pregnant have already been offered multiple sweeps. The main purpose of a sweep is to avoid going post-term (two weeks past your only 5% accurate due date), and the reason for that is based on the increased still-birth rate associated with post-term pregnancy. The research for this is varied, but there are 10 years worth of CEMACH, CMACE and MBRRACE reports that actually show a lower percentage of stillbirths in women who gestate for 42+ weeks, compared to women who gestate for between 37 – 41 weeks.
5. ‘Successful for 8 out of 10 women’… I’m not sure where they have found this stat or what they consider to be “successful”. The most recent Cochrane review on the topic, done in February 2020, states “Membrane sweeping appears to be effective in promoting labour but current evidence suggests this did not, overall, follow on to unassisted vaginal births.” So it might be the case that a sweep can trick the body into contracting, but is that really a success if it just leads to a longer, more exhausting labour with more interventions?
A stretch and sweep can only be performed if the cervix is “favourable”, meaning your body is already preparing for labour (so it’s probably imminent anyway), which means that for women who do go into labour following a sweep it might be that their body was already ready to go into labour and would have done so regardless of whether they had the intervention or not. There is no way to know this, but if you ask around I’m sure the majority of women who went into labour after a sweep has had more than one sweep previous to that one and did not go into labour, so it could have just been a coincidence.
The review also found that women who had a sweep were “less likely to have a formal induction”, but this only perpetuates the notion that a formal induction is inevitable and non-negotiable. What actually makes any form of induction less likely is giving women all of the information and breaking the cycle of thinking that women’s bodies are incapable of going into labour on their own.
6. ‘No known side effects’ … this is a blatant and dangerous lie.
Stretch and sweeps can cause;
Pain during and after the procedure
Painful contractions for the following 24 hours without leading to labour
An increased risk of infection
An increased risk of rupturing the membranes
And for what purpose?
The Cochrane review found that it did not generally lead to labour within 24 hours, and it did not reduce the incidences of further intervention such as the use of synthetic oxytocin and instrumental births. The very fact that a sweep can cause contractions that aren’t effective will lengthen labour, and there is often a lot of pressure put of women who have been contracting for 24 hours, makes you wonder whether there are actually any knownbenefits.
7. ‘Unlike curry!!’
This is clearly meant to mock the more “natural methods” of induction, but as I said at the beginning, anything that you do to try to bring on labour is a form of induction, whether it is chemical or otherwise so they fall under the same umbrella, except eating a curry doesn’t involve someone putting their fingers inside your vagina. The theory behind the curry method is the irritation spicy food can cause to your bowel, which could potentially trick the body into contracting. But, unlike sweeps, eating curry (if you like curry) has many benefits and not just to pregnant women! These include;
Spicy foods tend to release endorphins which can give you a bit of a buzz
Cooking curry can be really fun
It tastes great
If you don’t like it or it is causing you discomfort/pain, you can stop eating it instantly without having to tell anyone (unlike having a sweep where, if you wanted it to stop, you would have to rely on the midwife performing the procedure to listen to and respect your decision, which isn’t always the case)
In conclusion, this poster is a load of shit and is a perfect representation of how frequently women are misinformed in pregnancy and how flippantly this is done. It shows how easily things become routine without really being based on any solid evidence. It also says a lot about thesystemic mistrust in women’s bodies and the belief that they need help to perform the most natural of bodily functions.
If you find yourself being offered or pressured into a “quick sweep to get things started” or any other kind of induction, take whatever time you need to go through the BRAIN acronym and consider the benefits, risks and alternatives to what is being offered, check in with your intuition and ask yourself (and your midwife if you want) what happens next if you accept the intervention and what happens if you decide to do nothing. All of this information will help you to make the decision that is right for you.
If you want to chat about any of these decisions or navigating the maternity system, feel free to get in touch with us and book a ‘holding space’ session by emailing email@example.com
As we hear more and more about doulas, it’s easy to get the impression that having a doula will somehow magically lead to having a better birth experience. It often feels like one of the things on the ‘positive birth’ checklist; hire a doula, do a hypnobirthing class, read a birth book etc. and it’s true that having a doula can significantly reduce the risk of interventions and birth trauma, but that is largely due to the work that a woman does with her doula, and by herself, during pregnancy.
What we have learnt from women
Through our years of working as doulas in Greater Manchester, we have come to realise that birthing within the maternity system can and often will come with complications, barriers and difficulties. One of the best ways to combat these hurdles is to know what’s coming. Knowing how the maternity service works and knowing their policies gives you a head-start and also shows you that there are other options, such as birthing outside of the system. Knowing your rights and your options are the first steps to having a positive birth. A doula can support you in learning all of this, provide you with information and books on the subject, they can give you information about how the system works and how you can navigate it, and tell you all about the birth process, but it takes you to make the difference.
Women who have had a traumatic birth in the past often come to us believing that their body failed them and that they need to do something different this time. Hiring a doula is a great start because it gives them the space to talk openly about what happened last time, a place to wonder whether those things were necessary or completely unacceptable, a place to cry and ask questions. Once women learn and start to believe that the process of birth is not inherently dangerous, and is not a medical event, it leads to an awakening that is incomparable. Getting to this point though takes a whole load of courage and openness from that woman, and when that woman is heard, she can find the answers she’s been looking for. So many of the women we listen to were having a perfectly normal, healthy pregnancy and labour until it was interfered with by medical staff, and realising that sometimes complications in birth are caused by the interference is key to protecting themselves against it. Their body did not fail them, the system did.
We have been programmed to think that authority means safety, but in so many instances we have been proven that in fact, the opposite is the case. When we trust someone else’s word over our own feelings of discomfort, we are left feeling violated. When we look to someone else for the answers, especially in birth, we are handing over our control and ignoring our intuition. We often hear in women’s stories that the parts that felt the most traumatic are when they went against what their body was telling them, and just did what they were told – so far I haven’t met a woman who regretted following her body. Our intuition is what has kept us alive and safe for so long, and birth is such a private and personal event that it makes very little sense to look for external approval or guidance. When we trust women, birth is safe. A doula is often the only person in the birth room who is solely focused on you, as the birthing woman, and having someone who completely believes and trusts in your body at that moment can make a huge difference to the energy. Questioning the authority of medical staff is necessary to get the birth you want, because going with someone else’s flow will inevitably lead you down a path that makes you uncomfortable or feels wrong. You ARE the authority, and you DO know best, even if you have never birthed before. Birth is a hormonal event and a normal bodily function – if you were monitored, observed and examined whilst trying to have an orgasm it probably wouldn’t go very well, would it?
Birth is led by the hormone oxytocin – as are orgasms – and for oxytocin to be released it needs the right environment. For women to release oxytocin they need to feel safe, warm, unobserved and undisturbed, so when you put a labouring woman in a brightly lit hospital with a bunch of strangers, unfamiliar loud noises and smells, and continue disturbing her with monitoring and examinations, it’s no surprise that birth takes longer or is more difficult. When birth is undisturbed, endorphins are released to match the intensity of labour as it builds – this is what makes labour pain manageable. When we interfere with the body’s natural pain killers, we cause more harm than good. Understanding what birth needs is a great foundation for planning where you want to give birth, and who you want to be there. Doulas can be really helpful in supporting you to navigate the maternity system when you are “going against medical advice” or just declining what you are being told is “how they do things”.
What we wish women knew before giving birth
We wish that all women knew that they were in charge of their body and their birth, that they didn’t have to agree to anything that feels uncomfortable or compromise with medical staff. We wish that women knew that birth doesn’t need to be fixed or monitored or sped-up and that they have the right to say no or to seek the care they are not being offered. We wish that women who have had traumatic experiences knew that they were not alone and that what happened to them was not okay. We wish that women weren’t expected to be “good girls” and do what they are told even when it feels wrong and that it’s okay to be “difficult” or “bossy” – in fact, that shows a belief in yourself, and the ability to assert your boundaries!
The work we do is to create the space for women to ask questions, to speak up and use their voice, to take what they need and to take back their power. We listen to women’s traumatic birth stories, we help them to write birth plans, we share information and experiences, we are behind them when they are navigating the system, or choosing to birth outside of it, and we have that unwavering trust in the birth process and in the woman in front of us.
We support their choices, we hear their voices and we are privileged enough to witness their power.
But ultimately, what makes a positive birth is a woman who is ready to go deeper, to question what she is being told, and is fully supported in her decisions.
This post is sparked by my personal experience (it’s Amy here, in case my hilarious t-shirt below didn’t give that away) and also from listening to women talk about their journeys with contraception.
Grab yourself a brew (and maybe some biscuits) because this is a long, winding road to a very broad but important point – bare with me.
Let’s talk about contraception (and information and consent and bodily autonomy… because it’s all part of the same point)
Being doulas, you might think that the topic of contraception is a little out of our remit but (as I have so succinctly concluded in the subtitle) that is not the case.
As doulas and feminists, we respect every woman’s right to choose what is right for her body, so naturally, the topic of being informed and choices being respected is at the very core of what we believe in. Also, being full-spectrum doulas we support women before they are pregnant and long after they give birth so it does come up a fair bit.
Let’s start with sex education
Way back in school (Elle would like to point out that it wasn’t that long ago for me), we were only ever told about two or three methods of contraception. We learnt a bit about the pill, maybe a bit on the injection and of course, everyone remembers the demonstration of how to put a condom on a cucumber or banana or any other object that doesn’t look like a real penis so that the teacher doesn’t get embarrassed. I’m guessing it wasn’t all that different for you? But this isn’t enough. If you’re going to teach young people about sex and contraception, you have to tell them all of their options and what each one entails. For example, I don’t remember anyone telling us in school that the longer you are on the pill, the longer it could take to get pregnant once you stop taking it. This might seem like a very way-in-the-future conversation to have with children, but who else is going to tell us that? Especially considering lots of women go on the pill from a very young age. “Wouldn’t that be the healthcare professionals job?” I hear you ask… the answer is yes, it definitely is, but that doesn’t mean that they will fulfil that expectation. The other HUGE gap (or if talked about at all, misrepresentation) in sex education is birth, but that’s a whole other rant.
My personal experience with contraception
Over a period of about four years, I tried two different types of the pill and the injection before deciding to have a detox because the hormones were having a very negative effect on my mental health. The side-effects are different for everyone but the general consensus of women I have spoken to is that there is at least one pretty rough down-side to every hormonal contraception option.
Condoms were the only other option (that I knew of) – our readily available, non-hormonal, trusty, 98% effective friend. However, it took one of these trusty little guys to split for me to end up seeking emergency contraception. For me (and many women have a much worse time of it), that meant I had to wait about 4 hours at a walk-in clinic (feeling alone and nervous), complete an incredibly personal face-to-face questionnaire and brush off several judgemental ‘I don’t believe you’ looks, for someone to finally tell me about the copper coil! I listened intently as they told me how it was hormone-free, had very few side-effects, could stay in for 5 years (some stay in for 10!) but can be removed any time I want, it doesn’t stall fertility after removal, and it is more than 99% effective…
…SHUT THE FRIDGE!!
Why in the hell had nobody taught me about this option before?! I had suffered through years of hormones messing with my brain, my skin, my personality. I got it fitted that day and four years later have not regretted it once. Now, it sounds like I’m just trying to sell you all on the copper coil, that is not my intention. It works for me and I love that, but the point of my rant is…
Why did it take so long for someone to tell me all of my options? Who decides which methods of contraception are offered to us first? If we are born into a religion that believes abstinence is the only way – where do we get the information to decide for ourselves? If our parents decide that sex is too difficult a topic and tick the opt-out box on the sex education form, where do we learn about our body and the changes we are going to go through? Why should other people get to decide what information we get about puberty, sex and contraception? It’s the first step towards bodily autonomy and nobody wants to talk about it! Maybe because bodily autonomy isn’t something that society wants us to have. Working as a doula has taught me that.
This power play continues throughout our lives, with anything to do with women’s bodies from contraception, boundaries, birth and beyond.
(Sorry, it took me a while to get to the point! Have another biscuit…)
From a friends experience
A few years ago, before I was no longer shocked by the controls put on women and their bodies, my friend was seeking the morning after pill at a pharmacy. She had gone to the only pharmacy open that Sunday morning, she steeled herself, walked up to the desk in the not-so-private supermarket aisle where the pharmacy is located and told the pharmacist what she wanted to purchase. There was no medical reason for her to be unable to access the morning-after pill, but the pharmacist said no. He said that he could not dispense the pill because of his personal beliefs.
I couldn’t believe this was legal, especially with something as time-sensitive as the morning-after pill. I furiously googled it and found that yep, apparently, pharmacists have an opt-out clause which gives them the power to inflict their personal views onto others, potentially causing an unwanted pregnancy. Technically, if a pharmacist exercises this ridiculous clause, they are supposed to offer an alternative, but what good is that on a Sunday when nowhere nearby is open and the customer can’t drive? That’s a pretty risky clause to have, don’t you think?
So I have a few questions; would a doctor who is a Jehovah’s witness have a clause to opt-out of giving a life-saving blood transfusion because of her/his personal beliefs? Does a doctor who is Jewish have an opt-in clause to enforce circumcision on all babies because of his/her own beliefs? Is the opt-out clause used for anything other than emergency contraception, or is it a clause solely to deny women the right to decide whether or not to have a baby?
Now I am wiser I know that actually, professionals impose their personal opinions on women all the time, it’s just usually less obvious. For example, during pregnancy when something is offered to you (because it is just an offer, even if it doesn’t come across that way), that midwife or doctor should be giving you ALL of the information, the risks, benefits and alternatives, for you to make an informed decision about your care. This very rarely happens, and what we can assume from this is that the person giving you the partial information is deciding, based on their personal views, which information is more important for you to know, and what can be left out. This does NOT equal informed consent.
The patriarchal society that we live in has assumed that women’s bodies, and the decisions women make about those bodies, are to be monitored and controlled. Constant protesting of abortion, the hoops we have to jump through to access all types of contraception, the scare-tactics used in pregnancy and the birth room – it is all about controlling women. Strong, independent women who are able to make informed decisions and stand their ground are a threat to that control. Information is power, and withholding information (or more directly, actual medical care such as the morning-after pill), is to take away a woman’s power.
If we take away a woman’s control of her own body, we are telling her that she is not important and that her body is not hers to be in control of.
What does this teach young girls and women about consent? What does it teach us about boundaries? What does it teach us about our power?
(and yours too, if you want us to!)
Resources related to this post:
– The most recent changes I found on the opt-out clause (2017):
So we know it’s been a while since you’ve heard from us! It’s been too long and we’ve missed you! As more restrictions were brought in, we found ourselves inundated which meant we were working in survival mode – just trying to meet the needs of our incredible community. We’re finally starting to find our feet again and are looking forward to keeping you updated once again.
What we’ve been working on
What haven’t we been working on?! As you may remember, in May we received funding from The National Lottery Community Fund to support our COVID-19 response. This has looked like: lots of powerful holding space sessions, supporting wise women through our birth doula support, creating a new offering of virtual birth doula support, birth trauma recovery sessions, and lots (and LOTS) of community groups – all over zoom (for the time being).
What we’ve been up to
Lori: I’ve been channeling my stress into rearranging our flat – a coping mechanism that started in my teens that’s never left! Creating a “me only” space where I can work, read, meditate, play my piano, hide from the children… Theo and Felix are loving our new family bedroom but single handedly taking down and rebuilding their bunk bed left me very sore for a few days. Oh and we got kittens!!
Elle: I’ve been playing Watch Dogs 2 on PS4, specifically to beat Az from the Ice Shack to get all the trophies first. But the writing is very small, and I don’t make a good criminal so I may concede this win.
Amy: I moved into a new flat with my sister, Katy, and drove my van on the real roads in the process which was sooo much fun! I’ve been adjusting to life with a very energetic kitten (the kitten came free with the sister) – I’m not adjusted yet.
If you’re local and missing Ice Shack as much as we are, you can still get deliveries by messaging through their facebook page! Berry vanilla cake anyone?
Quickfire questions for the doulas
What has been your favourite thing about lockdown? L: Being able to work in my pjs! A: The quiet roads! I’ve still been driving to work at the studio the whole time so I got to enjoy the peaceful traffic-free roads for a while. E: Finding my health and strength
Describe yourself as a teenager in 3 words. A: Angry but quiet (you wouldn’t have known I was angry, which is definitely not a good thing – this is why I’m enjoying Rage Becomes Her so much!) E: Emo. Masculine. Insular. L: Vulnerable, sensitive and shy.
What are you most looking forward to doing as restrictions ease? E: Going on holiday. L: Celebrating my birthday 🎉 I normally shy away from anything where I’m the focus. But I’ve been through hell over the last few years and I’m turning 30 so I’m hoping to do something special for a change. A: Getting the materials I need for my van conversion so I can go on some trips. And getting to hang out with you two again!
What’s coming up?
Have you heard about our Wild Women Rising Circle with Dance Like a Mother? We’ll be gathering this Friday at 7.45pm so be sure to get your tickets.
We’ll be gathering together to share experiences and hold space for one another. There will be the opportunity to ask us, and each other, any questions you may have surrounding birth and motherhood, and the option of joining us for a relaxing meditation to close the circle. Come as you are, there’s no expectation from us for you to share if you don’t want to, you’re more than welcome to just be present.
We hope you are hanging in there and we can’t wait to start seeing you all in person again soon.
We are so excited to announce that we have received funding from Magic Little Grants for Virtual Walks and Talks.
We know exercise is important for good mental health, so we want to combine an emotional support service with walking, for even more benefits to women. We want to offer our unique support via ‘Virtual Walk and Talks’, where you can explore their hopes and fears about childbirth, or debrief a previous experience, with experienced staff who will listen and understand without judgement.
These will be very much like our Holding Space sessions, with the added benefit of being able to walk and connect with nature at the same time. All you need is a phone that can access zoom, headphones and perhaps a warm drink!
If you would like to book in one of these sessions please get in touch. We can’t wait to hear from you.