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Birth

International Cat Day & International Female Orgasm Day

Monday 8th August 2022 is both

International Cat Day AND International Female Orgasm Day!

Now you might be thinking… Okay, but why are you lumping them together and what is the connection to birth? And I can see where you’re coming from, but hear me out.

Cats

Cats are wonderful creatures, and they are also mammals, like us. When a cat is pregnant we can often tell purely by her behaviour before she starts growing noticeably. When that lovely bulging belly is getting bigger we often try to guess how many kittens she might have in there! We don’t take her to the vet to check though, unless we think there is something wrong, right? We don’t poke and prod her to try to make our estimations, we just know that there is a range of normal and that whatever number of kittens she is growing is going to be the right number, and we’re excited to find out. Do you think she is worrying about it? Nope. We often give her some extra love and attention, and vice versa, as she reaches the end of her pregnancy or more privacy if that is what she is indicating. We follow her lead. The human female however is often exposed to even more fear and more poking and prodding the closer she gets to the end of her pregnancy. Why?

When the mama cat goes into labour we use hushed voices and we keep our distance. We keep the lights low and we absolutely do not interfere with the perfect process. We trust her and her instincts. When her kittens are born, she does all the instinctual checks herself and she separates her kitten from its placenta using her own natural tools, in her own time. All is well. We do not touch her kittens because it is well known that this can disrupt the bonding of a mother and her baby and that this can be detrimental to the survival of the kitten. Both her and her kittens know exactly what to do, and we don’t doubt it for a second. Why do we doubt women? Why do we interfere? Why do we separate the mother and baby, or feel entitled to even touch the baby?

Women need the same basic things that cats need in pregnancy and labour. To feel safe, warm, undisturbed and unobserved. We know this for other mammals and we usually respect it, trusting in the process and not interfering. So why do we interfere so much with human birth?

Female orgasms

Did you know that the complete anatomy of the human clitoris wasn’t accurately described until the late 1990’s by a urologist Helen O’Connell? That’s really recent!! The female orgasm has long been a mystery that isn’t deemed important enough to talk about. The truth is that we don’t need research or diagrams, or any understanding of the process to be able to orgasm, but some recognition of our amazing bodies would be nice. We instinctively know what feels good, and the more time we spend alone, communicating with our own body, the more we understand ourselves. The more external influences we get, from partners, friends, the media or porn, the less we understand and trust ourselves. The same can be said for birth.

Orgasms are also wonderful. And guess what? They need the same basic things to go smoothly. Orgasms and birth are not two separate things, they are the same event separated by time. For a woman to orgasm she needs to feel safe, warm, unobserved and undisturbed. Have you ever tried to orgasm when one or more of these basic needs are not being met? Would you be able to if someone knocked on the bedroom door? Would you be able to if you were cold and uncomfortable? Would you be able to if you didn’t feel safe? Or if someone was taking your blood pressure or sitting in the corner taking notes? Probably not.

A release of oxytocin and dopamine. Uterine contractions. Increased blood pressure, respiration rate and heart rate. Involuntary groaning. Sound familiar? 

Something else that is similar between orgasms and birth – you can do it completely by yourself. In fact, in most cases it is less complicated when you do! In both orgasms and birth, they go most smoothly when you are not thinking about how the people around you are perceiving you or your movements or your noises or thinking about someone else’s thoughts or feelings. They both also work much better without the idea of time in your head, whether that is “is this taking too long?” or “this will have to be quick because I’ve got to leave for work in 20 minutes”, it’s much simpler without that pressure. 

Birth CAN be orgasmic. It’s not weird and it’s not impossible. It’s actually pretty normal when you think about how similar the processes are and the hormones involved. The thing that makes this kind of birth so illusive is the fact that for the most part the basic needs are neglected in birth, particularly within a medical setting. If you couldn’t orgasm in a hospital, why choose to give birth there? If you couldn’t orgasm at home with a member of the medical profession sitting in the corner taking notes, or worse – touching you, why would you choose to give birth in that scenario? Plan for birth as if you are planning for the best orgasm of your life. Set the scene so that you can do whatever the fuck feels good for you in that moment without judgement or observation. That includes when deciding whether you want your partner, or your mum, or a doula or a midwife present. 

In conclusion

All mammals need the same basic things for both orgasms and birth (yes, other female mammals have orgasms too!). So why is it that in the last few generations we have created an environment for birth that does the complete opposite of meeting those needs? The truth is that in the way the maternity system is set up, we’ve almost completely removed the possibility of having an orgasmic birth whilst at the same time making it incredibly likely that the bonding between a mother and her baby will be interrupted. This is diabolical, and seems pretty intentional when you look at it from this angle. If a woman comes out of birth on a post-orgasmic high, feeling totally connected to her body and her baby, there is much less chance of her being controlled by, compliant or complacent in the patriarchy in any other area of her life. I can’t think of any other reason why our society would have created a system that oppresses women and goes against our nature in such an obvious, yet accepted, way. Can you?

Birth

The difference between pre-labour and true labour

Our interpretation of Natalie Meddings’ “Room 1, Room 2” description of labour

Natalie Meddings is the author of ‘How to Have a Baby’ and ‘Why Home Birth Matters’ and during lockdowns created a series of videos with Jenna Rutherford on YouTube. The series was called ‘How to have a baby in a hospital during the coronavirus’ and was a reaction to many of the homebirth services and birth centres being closed during that time. We have shared the links to this video series so many times and lots of women have found them incredibly helpful so thank you to Natalie and Jenna for creating this content!

The main aims of these videos, we think, was to explain how to recognise these different rooms so that women can use this to decide if and when to transfer into hospital. As they quite rightly said, hospitals are not set up to accommodate women who are in room 1, so in order to be as undisturbed as possible when planning a hospital birth, wait until you are in room 2 to transfer in. We would argue that hospitals are not set up for women to give birth in at all because they do not meet any of the basic needs, but if you are choosing a hospital birth it’s important to consider these factors when deciding when to go. You can also use this description to decide if/when to call a midwife to your homebirth – many women choose to call the midwife “at the last minute” to avoid unnecessary interruption and intervention. It’s worth remembering that you don’t have to call a midwife at all if you don’t want. We believe that this description is incredibly useful for all women because it can really help with the mindset of labour, whether you’re in hospital, at home with a midwife or freebirthing. We decided to try to condense what Natalie and Jenna talked about in their informative videos into a short written summary in the hope that it will be helpful to women and their birth partners.

We often hear about labour lasting days or even weeks, and this is often something that women worry about – particularly first time mums. Understanding the distinction between what pre-labour feels like in comparison to true labour can be the difference between your labour feeling like days/weeks long and it only feeling like a few hours. The essence of this description is based on what it feels like from the woman’s perspective, not what it looks like from the outside or what can be measured, which is often what is used by the maternity system as a gauge of “early labour” and “active labour”. The only true measurement of which room a woman is in is based on how she feels, so there is no place for timing contractions or measuring the dilation of her cervix. The early signs that something is starting to happen (you’re entering into room 1) can often come with a sense of expectation, anticipation and sometimes fear and tension. Recognising that you are in room 1 can alleviate that sense of expectation and thus release the tension, which is using up a lot of your energy! I believe this is often why women who are having their second or subsequent baby tend to describe having shorter labours, because they are not giving much (if any) focus to room 1 either because there is a familiarity there or simply because they have other children that need their attention. The key here is giving room 1 as little attention as possible.

In our interpretation we have included what these rooms might look like from the outside for the benefit of birth partners/doulas so that you too can recognise which room a woman is in and how to best support her where she is at.

 

Pre-labour

Room 1

Room 1 is pre-labour. This is the part that is most unpredictable in length and can vary quite a lot from woman to woman. The length of pre-labour can depend on lots of different factors including how emotionally ready you are for birth and parenthood, and who you are as a person. During pre-labour, your body is preparing for labour. Your baby is moving into a good position, possibly rotating and descending slightly. The cervix at this point is still firm and closed, but everything the body is doing at this point is working on softening the cervix and positioning the baby to help with that. It does all of this on its own and needs none of your attention or energy. The idea of labelling this part “pre-labour” is not to diminish the intensity of what come up during this time, we know that this time is often when the emotional stuff comes up along with sometimes very intense physical sensations and these are by no means irrelevant, but rather to lessen that sense of expectation and pressure.

What it might feel like:

  • Cramps, sensations or even surges can come and go
  • They can feel strong
  • They can feel regular and intense
  • You might feel the need to sway or moan or breath in a certain way
  • Things might start and then stop again – this is okay! If you find yourself feeling frustrated by the slowing down or stopping, a mental reset might be needed because it is likely that you’re feeling pressure to keep things going (either from yourself or someone external) and that is only going to exhaust you
  • The biggest identifier of room 1 is that between surges, no matter how regular or intense they feel, you are coming back out of it and continuing as normal
  • Between surges you can talk normally, ask for things, walk about and do your normal stuff
  • Waters can break before or during room 1 or room 2 or not at all, so try to get rid of any expectations that this is an indicator of whether you’re in labour or not

What it might look like from the outside:

  • She may be making noises through her surges and perhaps moving in a certain way that feels good
  • She will come out of that once the sensations pass and will be able to engage in conversation and/or normal activities like eating and drinking
  • She is consciously making decisions about where she wants to be with her thinking brain
  • She may want distractions – this is a good thing in room 1 because her body does not need her attention, in fact the less attention she can pay it the better

 

The reset button

 

What is the reset button and how do I hit it?

A reset might be needed when you recognise that you are still in room 1 but your expectations have taken over and you are putting too much of your energy into what your body is doing. Sometimes this looks like being in a dark room for hours on end listening to your birth playlist, but feeling disappointed that “nothing is happening”. So hitting the reset button could simply be opening the curtains and changing your clothes, or having a shower and getting some fresh air. It could also be just sitting on the sofa and watching a movie, but the point is that it is something that feels normal to you. Something that relieves you of all the expectation and tension that has built up from having sensations. If you have called your partner home from work or asked your doula or birth partner to come over, it’s okay to rethink this and send them away again if they are adding to the sense of expectation. What would you be doing if you were just on your period? You don’t need to be doing anything to “encourage” or “establish” labour, because it will be a futile use of your energy.

There is no downside to hitting the reset button because if your body is ready to go into room 2 and you’ve just got dressed, your body will soon let you know that she would prefer to be naked. You’re not going to delay or miss going into room 2 because it is inevitable and uncontrollable, so when your body is ready for it to happen you’ll know about it – you won’t miss it.

Don’t fear the reset button, it can be a really powerful tool.

 

True labour

Room 2

Room 2 is true labour. This is where it actually begins. At this point there is a shift and your baby is really descending – you can’t miss this sensation. In room 2 you will be reacting to your mammalian brain, not your thinking brain. Pre-labour has moved your baby so that their head is playing its part in pressing on the cervix which signals the release of hormones that cause contractions and the release of endorphins (your natural pain killers) to match the sensations. This is where your baby is moving down through your pelvis and coming earthside – and your body is leading the way.

What it might feel like:

  • Surges become predictable and you respond rhythmically, ritually and instinctively
  • You no longer have any desire to engage with the outside world during or between your surges
  • You might intuitively move to a quieter or darker room in the house to meet your basic needs (feeling safe, warm, unobserved & undisturbed)
  • You may prefer to be alone
  • All of your focus and energy is turned inward, listening and responding to the sensations in your body
  • The noises you make might become deeper and more chesty than they were before
  • You will be hyper-aware of any danger – this is instinctual
  • You are moving into positions that feel good without thinking about it
  • You’ll likely be drawn to being close to the ground
  • Your body is taking over, and it feels good
  • You may feel a sense of surrender – it is safe to go with this because you have chosen a safe environment and only invited safe people into your space

What it might look like from the outside:

  • If she needs something, she will no longer be polite about it (if she uses words at all)
  • She may take clothing or sheets off as she feels increasingly hot
  • She no longer comes up between contractions, she will likely stay deeply within herself with her eyes closed or her head buried because she is focusing intently on the sensations
  • She is also hyper-alert so any disturbance in the room is going to have an impact, it’s really important during this time to not make noise or distract her
  • She may appear to be fearful if she is moving through transition, she may say things that sound scary but she is waiting for her own reassurance. You don’t need to say anything, she will find it within herself.
  • If she needs something she will let you know either verbally or non-verbally. Be aware of those cues but you don’t need to ask her questions – just have things on hand to pass to her if she indicates that she wants it

 

We hope that this description helps to relieve some of the expectations women feel about “getting labour going”, “keeping labour going” or “speeding things up” that come from themselves, society, the maternity system and sometimes partners. We would love to hear your experiences of room 1, room 2 and whether or not you used that reset button!

If you’d like to share your experiences or chat about any of them, we’re here to listen.

 

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The NHS leaflet on unassisted birth and why it was a complete waste of time

Two years ago, back in 2020 when homebirth services had been taken away from women, birth centres closed, many women were faced with choosing to either give birth on an obstetric unit where the risk of PPH, tears, episiotomies and instrumental birth is much higher, or at home unassisted. The NHS decided to create a leaflet to give women information on unassisted birth. The NHS asked the MVP (Maternity Voices Partnership) to ask women what content was important to them.


The MVP representative posts on a freebirth group: “Hi all, the NHS are producing a leaflet for freebirthers to give them information about notifying and registering their baby’s birth. I’m helping review this tomorrow morning. Is there anything you feel particularly needs to be included? What about the language? We want it to be supportive but also make sure people are aware that it is a legal duty to do these things. Your ideas would be most welcome.”“​​I’ve been asked to talk to freebirthing women about what should be included so we can co-produce something with the NHS. I’m hoping when we get a draft together I’ll be able to share it for further input. It’s a blank slate at this stage to request whatever info we think is needed to get it included in the leaflet.”

There were over 60 responses to this one post in a group for the North West of England, but I’m sure there were many others in other areas. Responses included things like:
“clear information of how to notify of a birth yourself”
“Would it cover health visitation/gp registration/vaccines too? They were all things we had issues with” she goes on to say this was a struggle because her doctor refused to register her baby without having newborn checks (which is coercion because the checks are completely optional!)
“There needs to be a clear statement that the RCM / NMC / NHS recognise that freebirth is a right. All treatment / care / tests offered are optional.” – Okay, they did state this is a legal right at the beginning, but then proceeded to ONLY talk about the services they offer
“Definitely how to notify of birth. I’m still struggling to find information in my area, no one seems to know anything?” “I’ve asked the head of midwifery for the information but she just told me how dangerous freebirthing was and how my husband could be prosecuted if he acted as midwife.” – so despite them saying in this leaflet that self-notifying is a legal requirement and that your midwife can help you with this, women’s lived experience is that they actually won’t.
“It was a big worry for us not knowing how/who to inform and felt like i couldn’t bring the freebirth option up in front of any healthcare provider.”
“a note about there being freebirth groups that may offer support can’t imagine NHS would suggest you could have support as they do not want women to have freebirths.” – You’re not wrong, they definitely don’t mention any support outside of the NHS, and what they have mentioned is not support.
“Include that trying to get women to give reasons why for their decisions or change their minds is harassment and a violation of human rights for privacy (the 1998 human rights act) and human right to not be subjected to mental distress and degrading treatment.” – YES! But instead they have said that if you’re considering a freebirth you should talk to a consultant midwife… and we all know where that leads.


So here is my take of the NHS leaflet ‘for those considering giving birth unassisted by a midwife’. It’s taken me a while to write this because when I first read it I felt like I had wasted 4 minutes of my life. I’m writing this now because I have been supporting women in GM to freebirth for a few years now and have attempted to find information for them multiple times which is proving almost impossible to find. I re-read the above post and the comments of suggested content for the leaflet, then re-read the leaflet and felt compelled to write something about the clear lack of interest in what women actually want.


This two-page leaflet is dreadful. None of the things that women want to know are included! It states that freebirth is a “a legal choice in England.” and that their “commitment is to listen and respect your informed choices.” but then goes on to only talk abo​​ut the services that the NHS offer… nothing to do with freebirth at all and it’s clear that they have not listened to women in the slightest when creating this leaflet. Nobody said in the comments that what they would like from this leaflet is more information on what maternity services can do for them – because they already know this. This information is really easy to find, and is the default for most women. The maternity service is something that we are expected to engage in and use, so we already know what they offer. But here they lay out a handy list of all of the things you’ll be “offered” despite the fact that you have already declined them:

Extract from the leaflet


Of course, they have promised to give unbiased and evidence-based information, but then only list the “benefits” of having a midwife present. It doesn’t list any of the risks of having a midwife present at your birth, but that’s unsurprising given the source. This is not unbiased or evidence-based information, nor is the information often given to women in her appointments.


They are not respecting women’s choices. In fact, they specifically say that if your choice to freebirth is based on fear of bad treatment from maternity services (which is a very valid fear), that you should engage with them MORE, and medicalise your pregnancy further by speaking to a consultant midwife. That does not say “respecting your informed choice” to me. To me it sounds like “you clearly don’t know what you want so come and talk to us and we’ll tell you what you need”.

Extract from the leaflet


The most common thing women said in the comment here was that they wanted information on how to self-notify the birth of their baby without involving medical professionals. Women are still struggling to find the right information on self-notifying, which is just ridiculous. I have tried to contact the relevant services to ask the question for clients and nobody seems to know the answer.


So, after they’ve given women absolutely no information about freebirth, they have rounded it off by reminding them that the NHS will continue to pester women throughout their pregnancy and postpartum:

Extract from the leaflet


This is not reassuring.

They have at least touched on the legal requirements in this section, but alas no useful information but instead just redirect women back to maternity services. From experience, and from hearing many women’s stories, it is not as simple as asking your local midwifery team who you should contact to self-notify, because they don’t want to give that information away.


It’s really clear from this leaflet that NHS maternity services do not support a woman’s choice to freebirth. If they did, they would have actually given us useful information. The information that women actually asked for, and have been asking for for a long time to no end. Information that is needed to fulfil our legal duty to notify of a birth within a ridiculous time window. How can something be a legal requirement and yet is made so difficult to actually do? Why is it that, despite the fact that it is our legal right to decline all medical care, there is a nifty requirement in law that can seemingly only be fulfilled by engaging in the very service that we have the right to opt-out of? Why is the NHS the gatekeeper of this information? Women want to be able to notify of their birth without engaging with midwives or health visitors or doctors. Why? Because women know that intervention leads to more intervention. Women know that social services are often used as a weapon. Women know that birth is a normal bodily function and not a medical event, and therefore should not need the presence of a medical professional at any stage. Women want to be in control of their own body and take care of their baby, and they know how to do that.


We are attempting to put together a list of contact details for the different areas in Greater Manchester and further afield, so if anyone who is reading this managed to find the right info for your area, even if you’re outside of GM, please message us!

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“What else can I do?” – Isabela Madrigal

Okay so it’s about time we talked about Encanto! Firstly, love it and can’t get the songs out of my head. Secondly, yes yes yes to all these strong female characters!!

I love all of the characters and each one probably deserves their own blog post but I’ll start with Isabela’s story because it did get me thinking and I wanted to share those thoughts with you.

Isabela has spent her life until this point doing what everybody expects of her, maintaining the “perfect” exterior and never colouring outside the lines. She is a classic people-pleaser and of course on the surface seems to have it all, until she falls apart and reveals how shit it is to live like that. The line “so much hides behind my smile” rings loud and clear for a lot of us. Within her song she realises that if she does create something that is imperfect or not what is expected of her, it actually feels amazing! This one revelation spirals quickly and she realises that there is no limit to what she CAN do and that she no longer needs to please everybody, just herself. This is HUGE! We could all do with a dose of not giving a fuck about what others want from us.

It got me thinking about a lot of women we meet who are engaging in the maternity system not because they want to, but because they think it’s what they should be doing and it will make everyone else around them more comfortable. They may not have even considered whether this IS something they want to do or not. Sometimes these women take a stand on one thing, maybe it’s a growth scan they know they don’t need or a test for something that wouldn’t actually change any of their plans. It feels good to say “NO” to something that isn’t serving you! For a lot of women though, it feels like they are pushing it each time they say no, and that maybe they should say yes to some things just to keep everyone happy. But here is the thing, women who continue to only say yes to things that serve them and say no to everything else come out of birth feeling powerful and thinking… “what else can I do?”. They often go on to do other things their own way! They no longer do things just to please other people, but do things because they know it is right for them. 

The maternity system can often feel like an opt-out system that you have to go through, but that you have some degree of choice along the way. Often these choices are presented as ‘intervention A’ vs ‘intervention B’ which gives the illusion of choice without actually presenting all of the options. However, the maternity system is actually the opposite. It is an opt-in system which means that every interaction you have with them is on your terms. You have no obligation to engage AT ALL if you don’t want to. So there is no limit to how much you can say no. You are not pushing your luck, you are not being awkward or difficult, you are not asking for the world, you are simply deciding which parts, if any, you want to opt-in to. Once you start making those decisions for yourself instead of feeling funnelled down a certain path, you will start to wonder “where is the limit here?” (there isn’t one!) and “can I just do what feels right for me in every other situation in life?” (yes and you absolutely should!).

We know that the patriarchy can’t handle women who know and trust themselves and make their voices heard, women who are not reliant on the systems built by and for men, so when women come out of birth feeling fucking amazing and invincible, it threatens the patriarchy. The women we know who have given birth outside of the system, or on their own terms, have gone on to question all of the other bullshit we are told in life and this is where real freedom happens. It can feel overwhelming for sure to question everything, but this is where our power lies.

Figure out what YOU need, what YOU want and make it happen. Then ask yourself, “what else can I do?”.

Testimonial

What do we mean when we say ‘with woman’?

Through our work we recognise how much past experiences or current struggles have an impact on other areas of a woman’s life. Not long ago, we began exploring ways in which we could support women in other times in their life, not just during pregnancy and birth. As full-spectrum doulas we see the importance of supporting each woman holistically, because she is a whole and complex person. We began offering a longer-term version of holding space, which we named ‘with woman’. This support plan could be used for recovering from a traumatic experience, going through big life changes or when you simply an urge to connect with yourself.

This support can look different for every woman, but here is a beautifully written account of one amazing woman’s journey with us. Thank you Charlene for sharing your experience and allowing us to share it with others (and your amazing photos too!).

“Where do I even start with sharing some kind words about the GMD With Woman sessions? I honestly found such a simple idea of theirs life changing.

Back in 2015 I became a mother but it took 2 years or so to realise my feelings and emotions weren’t just struggles with the new motherhood balance but linked to birth trauma from my hospital experience. Trauma so ingrained I was in an internal battle over whether I could consider having more children because I couldn’t face the idea of years of upset after again.

After a couple of sessions they helped open my eyes to how the trauma was inevitable in a system not made to support women but more importantly, that I had other options. It wasn’t my fault and I didn’t have to go through that again. Options were shared that I was never aware of during my first pregnancy. That light bulb moment helped me feel confident and supported in the journey that followed.

I’m now cuddling my 4 month old typing this review after an incredibly empowering and healing birth in November. The Mum who said no to more kids because I couldn’t face the idea of a traumatic hospital birth and years of therapy again…it shocked a lot of people close to us as I’d been so vocal about not wanting more children! 

Thanks to the doulas I started my journey feeling supported and empowered to choose a wild pregnancy and freebirth at home with my husband and 6 year old daughter. Having then there to help explore my feelings and support my journey was the start of a transformation I’m proud of. Thank you GMD ?? “

– Charlene

To find out more about our ‘with woman’ support plan, click here, or send us an email to hello@greatermanchesterdoulas.com if you have questions!

To find out more about Charlene’s fantastic photography, you can find her here:

Charlene’s Website

Charlene’s Instagram

Charlene’s Facebook Page

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A Beautiful Rebirth Story

Have you had a birth experience that you wish had gone a little (or a lot) differently? You are not alone.
We know that many women experience trauma during their pregnancy and birth due to the way they are treated by those around them. One way to process some of the things that may have happened during birth is to have a ‘rebirth ceremony‘. This can look however you wish, below is an example from one woman’s experience – she would like to remain anonymous but we are incredibly grateful for her allowing us to share her story and wise words with you.

“I heard about rebirthing being a thing, possibly in one of GMD online groups, after I had my second baby and it appealed to me.

My births had been one traumatic hospital birth and one much better, transformative home birth supported by the GMDs. Even though the second one was so great in so many ways, I still actually had regrets that haunted me about both births. They were all basically about letting health staff interfere and impose and talk me into things that weren’t right and that had caused damage, stress or other  negative effects. 

Talking these regrets  through with the doulas and having rewind therapy helped, but when I heard about rebirthing and saw a description of someone else’s I knew I wanted to do it. 

There is no fixed way to do it, so I really just had to take inspiration from whatever I found online, think about what I wanted and create my own ceremony. It was during lockdown when restrictions were high so having the doulas over didn’t seem like an option but I did manage to have them involved online and I hired a birth pool from them for the ceremony too.

I reflected in the lead up on what was good and bad about the birth and how I would change it if I could. I planned to set that scene as best I could and have a fun and meaningful ceremony based around that.

 Basically, on reflection, I felt that I should not have involved health staff in my births and if I had my time again I would have given birth at home without them but with doula support. I would have made it more beautiful downstairs and with a bit of luck, because my husband wouldnt have been busy dealing with the midwives, he would have had the time and focus to fill the pool in time.

 It was a quick labour during my second birth at home and it didnt take long before I didn’t want to move. So between that and my husband being distracted by the midwives, I missed the birth pool window. I had set up a nice nest for early labour in an  upstairs bedroom so that was fine, but part of the reason I did that was because I wanted to feel safe and private and have somewhere to hide.  This wouldn’t have been as much of a concern without the midwives there. So I reasoned that I would make it to the pool in my ideal scenario. 

Being in the pool would have been a nice experience but it would also have helped relieve pain and minimise tearing, as would not having midwives there telling me to change position and coaching me to push the second time or inducing me before baby and I were ready the first time. 

 On the day I got into what I would have worn if I was giving birth and sat quietly where I probably would have been in early labour and where I was the second time. I reflected and listened to music and relaxed alone like I would have done in early labour, like I did the second time. I think I listened to my hypnobirthing CD too. 

I had an online holding space session with the GMDs then, which helped to make it feel more important and momentous and gave me a bit of TLC and support. I talked through with them what I regretted and what I would do differently and  how my ideal births would have been, and also the positives of the births and becoming a Mum. 

Then eventually I made my way down. My husband and eldest had filled up the pool and things were set up how I’d have wanted them for both my births with pool, music, lights, floaty things in water, food, drinks, towels, etc.

After spending some time alone in the pool imagining what labour would have been like in there, the baby was handed to me who was dying to get in! She was 1 by then, just about to have her birthday, so not a baby in arms. I had read about trying to simulate birth (without risking drowning baby obvs) – holding them safely to float around gently in the water near you and then bringing baby up to your chest and cuddling and feeding as if you had just birthed – so I did that as best I could. 

Baby didn’t want to feed yet and was quite wriggly as she was so excited to be in the water. So I let her play around in the water. Eventually she calmed and wanted to feed and I  was able to bring her up for a feed and that felt like the rounding off of the main rebirthing ceremony of my youngest.

My eldest got in then and we talked about how I’d have done this with both of them if I knew then what I knew now and why I thought it was the best way. We had a nice cuddle too. 

Some things I’ve read talk about talking through what happened at the birth and what went wrong and apologising to the baby if you feel bad. I may have quietly done that a bit with baby I can’t remember but I kept it mainly positive with my eldest who was 6, emphasising what a good memory it was of them both coming into the world and our lives. 

Then husband got in and It was a family celebration then and we had food like it would have been in my ideal births. No midwives! And my placenta would have come out of its own accord at some point of course during that time. And there would be no unnecessary transferring to hospital, just staying home.

I bought a special fancy two piece swimming costume that would have been good to birth in and flowery head dresses to make it more special and fancy costumes for the kids, though baby was naked for the ceremony. I had pretend leaves and floaty lotus flower lights to decorate the water and waterproof fairy lights around it. There were candles and fairy lights elsewhere. I just tried to play music I would have played for the different stages.

It was pretty chilled. Photos were taken but I didn’t want it to just be a photo shoot. I wanted it to feel like a meaningful experience and ritual and a celebration too. So I did what I could to achieve that. 

It was really nice and special. I think it did help me to set things right in my head, heart and body and symbolically reclaim my births.

There seems to be good evidence that re-enacting and rewriting traumatic experiences can help healing, even if it is just done in your imagination. People feel that replaying birth physically with babies, sometimes just in the bath, helps mother and baby get over trauma and reset. I don’t know about evidence for that but I’ve read that it can help to establish feeding better in early days. As oxytocin helps with all that it makes sense on that level alone if you set things up nicely and have a nice cuddly time. 

For me it was a year later for one birth and six for the other but it still felt healing and empowering and I hope it may even have been healing and resolving on some level for my husband and the kids too. Another year on, I don’t tend to feel haunted by painful regrets much now. I’ve done various things to process it all including talking, writing and the rewind therapy for my first birth, but I’m sure the rebirthing was a significant part of my healing and recovery.

The Greater Manchester Doulas really helped to make it feel special and important and helped me to have the courage and make the effort to do it. If it wasn’t for them I might have felt too silly or shy or decided that it was probably too much of a self-indulgent palaver and thought better of it. Their validation and encouragement helped me to hold on to the value of it, not lose my nerve and see it through. I’d recommend considering a rebirthing ceremony to anyone with niggling regrets and I’d recommend the support of the GMD if you do it.”

News

Thank fuck that’s over!

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!

Thanks for your ongoing support, wisdom and love.

Merry Christmas and Happy New Year!

Elle & Amy

 

News

Let’s get together (in real life!)

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.
 

 

November Groups:

Homebirth Group – Sunday 14th November – 10:30 – 12:00 via Zoom

Freebirth Group – Thursday 18th November – 13:00 – 14:30 via Zoom

 

December Groups:

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

Zoom Groups:

We will use the below link every time

https://us05web.zoom.us/j/4109702305?pwd=Zi9BQk9SdG5yVUFoOHR0bEZlTWFJQT09

Meeting ID: 410 970 2305

Password: biaM0F

Here is a preview of the room itself on the first day we used it… please forgive our overflowing excitement! > https://fb.watch/9fCc1U53Pk/
 
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.

Amy & Elle
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Birth

The issues with “active management” of the third stage

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”

re·tained pla·cen·ta

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 allowed to 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;

  • Constant pain
  • Fever/high temperature
  • 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
  • Headaches
  • Dizziness
  • Myocardial infarction (heart attack)
  • Chest pain
  • Vomiting
  • Nausea
  • Abdominal pain
  • Hypertension

 

“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.

 

 

Resources:

https://sarahbuckley.com/leaving-well-alone-a-natural-approach-to-the-third-stage-of-labour/

https://www.medicines.org.uk/emc/product/865/smpc

https://www.evidentlycochrane.net/third-stage-of-labour/

https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-12-130

https://www.bellybelly.com.au/birth/how-inductions-increase-the-risk-of-haemorrhage/

https://www.sciencedirect.com/science/article/abs/pii/S1521693408000965

Birth, Resources

Writing Your Assertive Birth Plan

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: hello@greatermanchesterdoulas.com
 
 
 
You can find our birth planning templates and examples here;
 
These assertiveness phrases may come in handy either in writing your birth plan, or implementing it if you come up against resistance; https://www.youtube.com/watch?v=kxGBEwFAGho
 
 
If you are struggling with having your wishes heard and respected, AIMS has a really good helpline and have some template letters that might come in handy; https://www.aims.org.uk/campaigning/item/template-letters