Birth - Greater Manchester Doulas CIC

Bum-first babies are not being difficult or awkward, they are simply comfortable. This doesn't need to be "fixed".

Bum-first babies are wonderful!

23 January, 202323 January, 2023 GMD Admin

Key points:

Breech is normal and not something that needs to be fixed
Birth works best, and is most predictable, when left well alone
The statistics women are told about breech birth are all based on the hospital environment

Babies in breech positions are not being difficult or problematic - they are comfortable. This doesn't need fixing.

Women engaging in NHS care are sometimes being told the position of their baby every time they have a scan, and focus is regularly being put on the position from as early as 33 weeks. Despite the fact that the entire function of labour is to move your baby down and into the best position for them, this information is being sought way before labour without any thought to how it might impact a woman’s confidence – or have they actually put a LOT of thought into that and that’s WHY they do it? The same seems to be true for “low-lying placentas”. Women are being told at their very first ultrasound that their placenta is “low-lying”, which means it is within 2cm of your cervix, but this isn’t the same as placenta praevia which can be one of the very few true birth emergencies. According to the NHS, placenta praevia affects 1 in 200 pregnancies, which is 0.5%. But who knows what they actually include in that statistic if they’re also scaring women with “low-lying” placentas that are not and will not become an issue.

I got off on a bit of a tangent there (that didn’t take long, did it?) but there are so many similarities between the “concerns” that come up towards the end of pregnancy that it’s hard to talk about one without referencing others. Anyway, back to breech. Let’s just think for a moment about the space your baby has to occupy when they are still inside your body. They are pretty snug in there, and they are likely to move around a lot in order to stretch out different parts of their body in different ways. Apparently, most people change positions in their sleep 10 to 40 times each night, and for 50-70% of people their instinctive posture is flat on their back, but that leaves a significant number of people (up to half in some studies) who feel more comfortable, instinctively, in a different position. There is no normal, or right, or “optimal”. Breech has been used as a tool to scare women, break down their confidence and ultimately medicalise their birth.

Birth needs very basic things for it to go smoothly. The woman, like any other mammal, needs to feel safe, warm, undisturbed and unobserved. She doesn’t need to understand the mechanisms that are taking place within her body, much like she does not need to know the technicalities of an orgasm for her to experience one, and she doesn’t need to know what position her baby is in. Birth is safest when these basic needs are met, in any situation, so when we remove these basic needs (by going into a hospital for example) we are making birth less predictable. Why would it make sense to ignore these basic needs when there is a concern about the baby or the mother? The basic needs are not a cherry-on-top, if all else is well kind of thing, they are the very foundation of birth going smoothly.

There are lots of statistics about breech births, and they are often used to scare women into a scheduled caesarean (major abdominal surgery) purely because healthcare providers are scared. The studies that produced these statistics were carried out in hospitals, where women’s basic needs were not being met and they were surrounded by fearful care providers. So what does that actually tell us? Not much, except that interfering with birth is dangerous. I would be much more convinced by the data if it was comparing outcomes of mothers and babies (not just physical but emotional) who gave birth in hospital or at home with medical staff present, versus those who had freebirths. That would give a true picture of the impact of pathologising a baby’s position.

Okay, so let’s just talk about the way women are treated in the system when they have a baby who is bum-down. Firstly, she is told that this is a problem that needs to be fixed, either by attempting to forcibly move her baby the “right way up” by applying immense pressure to her bump, or by “admitting defeat” and booking a caesarean section at 38 weeks (before her body has chance to go into labour naturally).

External cephalic version (ECV) is a procedure that is designed to “fix” a breech presentation. This procedure can take up to 2 hours including monitoring and carries a risk of premature rupture of the membranes, placental abruption, preterm labour, foetal distress and vaginal bleeding, all of which would lead to more interventions. But don’t worry, one clinic reassures us by stating; “ECV is typically performed near an operating room in case an emergency c-section is needed.”, so if they cause an emergency at least they can solve it quickly. Women often endure this ECV procedure in the hope that they will then be supported to give birth vaginally, but the truth is that the fear of care providers will have a huge impact on the way they treat a woman during labour, and you can bet that her basic needs will not be met.

What can you do to avoid the position of your baby being a barrier to the birth you want? Don’t give that information away. When asked if you would like to have your belly palpated or measured, consider what information they are looking for and if it would be helpful for you (and them) to have it. When going for a scan recognise that they WILL see which way up your baby is and that regardless of how many weeks pregnant you are, this information might be used to scare you. What is the purpose of that scan? What are you getting from it? Could you get what you want in a different way? If you’ve already been told that your baby is in a “difficult position”, what are you doing to protect yourself from further fear mongering? How can you reground yourself and build your confidence back up?

A few ideas:

1. Surround yourself with women who believe that birth is normal, whatever way round your baby is, and have complete trust in you and your intuition

2. Practice saying no to things that do not serve you – the more you shut out the external voices, the easier it will be to listen to your intuition which will keep you and your baby safe

3. Come along to one of our groups and speak to other women who might have been in a similar position to you, or might have birthed a baby in a breech position completely unassisted

4. Speak to us about how you can navigate the system, or step away from it

Useful resources:

Hands off that breech! | AIMS

Coalition for Breech Birth | Facebook

Breech Without Borders | Facebook

Breech Birth UK

Birth, Homebirth, Pool Hire

Why is the deadline 30 weeks?

22 August, 202222 August, 2022 GMD Admin

We recently made some changes to our pool hire service, and you might be wondering why. So here is a brief explanation of why we have decided to enforce a 30 week booking deadline. We know that not everyone will agree with our approach, and we’re okay with that – these changes have been based on our observations and what we have learnt from women over the past few years of running the service. We will continue to learn as time goes on and things may change again in the future, but for now here is our stance and why:

We started running this pool hire service back in 2020 and during that time we have learnt a lot. We included free support sessions within our hire because we recognised that so many of the pools were coming back unused because women were being coerced out of their home birth by the maternity system, and those women weren’t getting emotional support or accurate information from their midwives. We continued to book women in who were approaching us late on in their pregnancy, but we learnt quickly that women who are waiting until a certain point in their pregnancy to be ‘signed off’ or ‘given permission’ by a medical professional were also the ones who would accept that ‘permission’ being taken away again.

Sometimes women would take us up on the support session near the end of their pregnancy, around 34 weeks when suddenly “risks” started cropping up (like growth scans), and we were the first people to tell her that she gets to choose, that all of the appointments, measurements, examinations and procedures are optional, that she doesn’t need permission to give birth at home. It is heartbreaking to see that realisation dawn on her face when she is so far down the line that it feel impossible for her to do anything about it now.

Women who were looking for external reassurance from appointments, inaccurate measurements and scans, and permission were not wholeheartedly planning a home birth. They were hoping for one, but that hope was balancing on a jenga tower that could be knocked over at any moment by a medical professional. A medical professional who works within a system that doesn’t understand normal birth or the basic needs of a woman in labour. A system that builds its policies on fear of litigation rather than what women actually want or need. What we found was that women who were hoping for a home birth very rarely had one.

We understand why this is the current norm – we are brought up to believe that others know our body better than we do, and that we need “experts” to be able to give birth safely because it is a dangerous and unpredictable medical event. That’s why so many women do turn to midwives or doctors for external reassurance. We understand how hard it is to question that cycle or and it’s even harder to break it. It can be scary to take radical responsibility for our decisions, particularly when something is presented as a health issue/medical event. The truth is that birth is a normal bodily function, just like sex or having a poo, birth is incredibly predictable when left alone and we ARE the experts on our own bodies.

Home is safe. It’s where we perform all of our other bodily functions. It is where the only bacteria around is the stuff we’re in contact with every day and are therefore used to. It is where we get to choose who comes through the door, and where we are free to move around and be ourselves. It’s also proven to be safe for birth through studies (and the existence of so many generations before us). Biologically it makes perfect sense – we are mammals, and other mammals find a safe, dark spot where they will not be disturbed or observed. Women need these basic things too, and none of these needs are met within a medical setting. Giving birth at home is the biological norm and is always an option.

You do not need someone’s permission, or for someone to write it in your notes, or to be ‘signed off’ to plan a home birth. It is your human right, and your birthright.

Our organisation is rooted in women’s rights and bodily autonomy. The maternity system does not respect these things. We will no longer nod along and stay quiet when a woman is walking through or into a system that is set up to fail her. The reason we no longer take bookings after 30 weeks is because we want to make it clear that women do not need to wait until after this point to start planning something that they know feels right for them. We want women to recognise that they can do whatever works for them, without checking with a midwife or asking for permission. This autonomy and critical thinking is necessary for having a good birth, because if a woman is deciding to engage with the maternity system (which is also something we assume is necessary but isn’t) then she is likely to have to assert herself at many points in her pregnancy, labour and birth. She is likely to be told that she “needs to” or “has to” do things that she’s not comfortable with (which is a lie, she never has to). She is likely to be coerced with emotive language instead of genuine evidence. She is likely to be told that she is “not allowed” a home birth because she is too “high risk” based on inaccurate information.

We don’t write this lightly, and it is no way an attempt to scare you or place any blame on you. The dependence on the maternity system is something that is deeply ingrained and socially accepted, it’s not the fault of the woman who engages in it, the fault lies with the system itself. We feel it is our responsibility to be honest about the system and the way it treats women. We know that this doesn’t make us very popular (particularly with midwives) and can often feel confronting or upsetting for women who are still in that relationship with the system. But we hope that our reminder that women are completely capable, incredibly wise and are their own experts will plant a seed. We hope that women hear that they deserve to be treated with respect, rather than as a faulty piece of birthing equipment, that they deserve to feel strong and wise, rather than unsure and deflated, and that they absolutely don’t need anyones permission to give birth wherever they damn well want to.

I’m sorry that we are unable to offer you a birth pool after 30 weeks, but we hope that you are able to find one.

We are hopeful that this deadline will encourage women to question the care that they are and have been receiving that made her feel like she was “high risk” and had to wait for permission. Questioning this as early as possible (before or) during pregnancy is what will lead women to navigate or step out of the system in a way that works for them.

Birth, General health, Resources

Let’s talk about herpes

10 August, 202210 August, 2022 GMD Admin

Hi, I’m Amy and I have herpes. As do 70% of people by the time they are 25 years old in one form or another. There is a lot of shame around this topic and many of us don’t feel able to talk about it for fear of being seen in a certain way. I had my first outbreak of herpes many years ago, and I could have caught it long before that without knowing. I don’t know who I caught it from and I don’t really need to know, they may not even know. What I do know is that the word ‘herpes’ bring with it a whole host of fear, embarrassment and unknowns.

My first outbreak was agonising. I was working as a support worker on a 13 hours shift and I could barely walk for the pain. I made excuses for my frequent visit to the toilet just so I could stop my knickers from touching my sores for a few minutes of relief. Eventually I couldn’t hack it any longer and told my boss that my sister was unwell and needed me – this was a lie but I was too ashamed to tell her the truth (even though I worked in a medical profession). I went to a sexual health clinic and they were able to take a swab and gave me a treatment to speed up the healing. When they called me to tell me the diagnosis I felt utterly broken. I cried in silence. I worried in silence. I thought of all the worst case scenarios in silence.

For many years I didn’t tell anyone except my sister who was lovely and supportive, as always. I did tonnes of research to make sure I was doing what I could in my lifestyle to minimise the likelihood of further outbreaks, and made sure I wasn’t passing it on to others. I have had relatively few outbreaks so far, maybe one every two years, and they have definitely become less severe each time. I decided not to take any regular medication to prevent outbreaks because I didn’t feel it was necessary. One year I had an outbreak when I was on a family holiday and I decided to tell my Mum because I wanted her help to get a prescription from a local pharmacy. I soon realised that it was MUCH easier to cope with an outbreak when those around me knew what was going on for me and I wasn’t having to pretend that I was fine.

Not long ago I saw a post on Facebook from a woman who had concerns about herpes and birth – she had been told that she wouldn’t be able to give birth vaginally because she had herpes. I was so grateful that she had been brave enough to put that question out there into the world, and that she got some answers. It took me a long time to feel able to share my story but I’m hoping that in doing so, I will be able to share some information that I have found useful and remind people of how common and normal this is. We shouldn’t be suffering in silence, and we shouldn’t be given misinformation that we are too embarrassed to question.

If this topic is something that applies to you, I hope it has been helpful. If you know someone who is struggling with this, you now have more knowledge to support them. If you would like to talk to us about whatever journey you are on, you can book a ‘holding space’ support session with us here. If you would require access to our fund for this session, please contact us before booking.

The resources I found helpful:

Home – Helping You With Herpes

https://www.rcog.org.uk/for-the-public/browse-all-patient-information-leaflets/genital-herpes-in-pregnancy-patient-information-leaflet/

https://www.webmd.com/genital-herpes/guide/potential-herpes-triggers

https://www.facebook.com/groups/678841182501973

Birth

International Cat Day & International Female Orgasm Day

8 August, 20228 August, 2022 GMD Admin

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

30 May, 202230 May, 2022 GMD Admin

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.

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

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.

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.

Birth

The issues with “active management” of the third stage

23 June, 202117 December, 2022 Amy

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

23 April, 202123 April, 2021 Amy

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;

Birth Plan – Blank Template

Birth Plan – Prompts

Birth Plan – Home Birth Example

Birth Plan – Caesarean Example

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

Birth, Human Rights

10 Things We Wish All Women Knew

17 March, 202117 March, 2021 Amy

1. Freebirth is LEGAL

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.

Sweeps ARE induction (…and there is nothing natural about them)

26 November, 202026 November, 2020 Amy

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
Vaginal bleeding
Painful contractions for the following 24 hours without leading to labour
Longer labours
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 known benefits.

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;

Satisfying hunger
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 the systemic 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 hello@greatermanchesterdoulas.com

https://www.aims.org.uk/journal/item/induction-at-term

https://www.sarawickham.com/articles-2/unpacking-sweeping-policies/

https://www.aims.org.uk/journal/item/ten-things

https://www.cochrane.org/CD000451/PREG_membrane-sweeping-induction-labour

https://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=12011000682&LinkFrom=OAI&ID=12011000682

Birth, News

International Day of the Midwife 2020

5 May, 20205 May, 2020 GMD Admin

Today is the International Day of the Midwife 2020. Whilst we are not midwives, our roles often sit side by side and our missions closely aligned. We wanted to take this opportunity to celebrate midwives around the world whose life work is to truly be ‘with woman’.

In a world where women live and birth within patriarchal institutions and normal, physiological birth is unnecessarily pathologised, traditional midwives can play such an important role. Their knowledge and wisdom is a much needed reminder that industrial birth is not our only option. They are a wonderful support that women can look to on their journeys to powerful, ecstatic births.

Today we celebrate and hold space for midwives who are choosing to create new paradigms, rather than engage in futile fights with broken systems. Heart led midwives who serve the woman above all else. Protectors of physiological birth. Birth keepers who trust women all the way, and know in their hearts that we are the ultimate knowledge when it comes to our own bodies and babies. In particular we hold those midwives who have been persecuted for believing in women and providing women-centred care despite the risk to themselves. Thank you.

Sending you all so much love and respect!

Lori, Elle & Amy x