Tag: pregnancy

Birth, Freebirth, Homebirth, Women

What are you inviting a midwife for?

GMD Admin

Okay, I’ve got some questions. When a woman is planning a birth that is the complete opposite of the standard all-intervention hospital birth, she is asked a million questions. “Why would you want to give birth at home? Who will cut the cord? Who will catch the baby? How will you know if there is something wrong? What if something terrible happens?”. Having a homebirth is already seen as a crazy choice, so freebirth is clearly bonkers. So when a woman plans a homebirth she often plans to call a midwife because that is the done thing and it answers lots of the common question (seen above), but I have some different questions.

Giving birth at home IS the biological norm. Women in the UK only started giving birth in hospitals in the 1950’s – that’s only 70 years ago, and despite its popularity it has not made birth safer. For the millions of years before that women gave birth at home, or wherever they found themselves at the time. We are mammals and, just like other mammals, humans need to feel safe, warm, undisturbed and unobserved. The very nature of the medical profession is to observe, looking for problems, and to observe is to disturb.

The societal norm these days is to see your GP when you discover you are pregnant and then attend a series of medical appointments for various measurements and tests. Nobody really asks questions of the women who are engaging with the maternity system fully and planning to give birth in hospital. Does anyone tell women that this is optional? No. Pregnancy is not an illness, so why is the standard path a medical one? The majority of women will follow this path, either because they haven’t been told that it’s optional, or because society says that is what she SHOULD be doing, so to please everyone around her she goes. She smiles and nods and agrees to all of the measurements and tests so that she doesn’t come across as being awkward. But what is she gaining from this path? Nobody asks.

Some women will question the number of appointments or decline the “extra” things (it’s all extra really,  because doing nothing would be the baseline). Even these women are challenged on their decisions, either by medical staff or family, friends or partners. They feel they have to justify declining unnecessary things that don’t bring them any benefits, and each time they try to justify it they are met with coercion. Nobody asks her what she actually wants from her pregnancy, what she needs or how she would like to honour her own milestones. Even when they are being selective about which parts of the system they want to engage in, they hesitate to push for what they truly want in case it gets someone’s back up. These are the women who, when asked if they think they might call a midwife, say that they will wait until “the very last minute” or, better yet, hope that the midwife doesn’t make it in time. So my question to you, wonderful women, is this: if your hope is that they miss the birth, what are you inviting a midwife for?

If this is something you have thought about, you’ve likely kept it to yourself. Well I’m here to tell you that you are among MANY women who have told us the very same thing (usually in a one-to-one session when their partner isn’t there and nobody else can hear them). When women say this we rejoice because we know that she is beginning to voice her ideal birth and she’s starting to question the societal pressures that encouraged her to medicalise her pregnancy from the start. Starting from your ideal birth is key. Think about it. Voice it. Plan for it. Hoping that your midwife will get stuck in traffic is not the same as planning to be undisturbed during labour.

 

So lets dig deep into the question: 

We often ask women to picture their ideal birth and use this as a baseline, adding things in only if it feels right. Doing it this way round, instead of looking at the standard medical pathway and trying to fit your wants and needs into that template, is much more likely to produce a genuine plan that reflects how you want to give birth. For many in society a midwife is a pillar of birth, so it’s automatically assumed that there will be one present wherever a woman gives birth. I encourage you to challenge this idea and pick it apart until it makes sense. A midwife is a medically trained individual. Birth is not a medical event, so it doesn’t make perfect sense despite the association in our heads. There are things that a midwife can bring that someone else couldn’t, like gas and air for example, or other medication that you don’t have at home. Here are some of the answers we hear when we ask women this question, and things to consider when weighing up the risks and benefits.

“To make sure everything is okay”

You are getting continuous information from your baby and you would be the first to know if something was wrong. If you are able to listen to and act upon your intuition, you will know if something is wrong and you’ll know what you want to do about it. How do you want her to check if everything is okay? There are lots of standard measurements midwives tend to want to take when they are present at a birth, including your blood pressure, your baby’s heart rate, your temperature, cervical dilation etc. (it’s a long list!). Lots of the women who give this answer have also said that they don’t want any intervention, so they would decline these checks anyway. So it’s worth thinking about whether you would accept or decline any/all of the checks a midwife would want to do, how much stock you put in those measurements, and what you would do if they contradicted what your intuition was telling you.

“In case something goes wrong”

What does “something going wrong” mean to you? This is different for each woman. There are lots of things that are labelled as “things going wrong” that are actually just a normal part of labour and birth that, given enough time, would resolve themselves. Meeting your basic needs is necessary for birth to go smoothly, being undisturbed is one of those needs. If you’re worried about things going wrong, it’s worth figuring out what that looks like for you and how to avoid it.

“In case of emergencies”

There are only a handful of true birth emergencies and they are very rare. It would be easy to think otherwise if you look at the homebirth transfer rates, but remember that the majority of transfers are due to things that are not emergencies, such as length of labour, labour stalling, “baby getting stuck”, getting tired… all of which are either the normal rhythm of labour or would just require more time and the woman’s basic needs being met. If a midwife is at a birth and a true birth emergency occurs, she would call an ambulance. You have this power too, and as stated above you would know if you needed emergency care.

“To do the paperwork afterwards”

This is a less frequent answer because if a woman is saying this she has already ruled out all of the ‘just in case’ reasons and this is purely a practical thing. You can call a midwife after you’ve given birth to your baby and your placenta and ask them to come and do the paperwork. The paperwork is often presented as a complicated thing that can only be done by a midwife, but that’s untrue. You can notify of the birth yourself if you’d prefer by filling in a form and emailing it to the relevant place (we have some info on this if you’d like it).

“To do some/all newborn checks on my baby”

Again, this is an afterwards situation. You can ask them to come over just for this reason and it’s all optional. You will be observing your baby closer than anyone else on the planet, you know them better than anyone else too, so again, you would know if you needed to get them checked over and you always have access to A&E should they need emergency care.

“To bring pain relief”

Very practical. Often when this is the answer it’s because the woman has experienced a painful birth in the past (usually in hospital) and is expecting to need pain relief again. The sensations of labour feel very different when your basic needs are met, and women who give birth undisturbed don’t need medication as their body is producing endorphins at the right rate. Being free to move and make noise and be however you feel is pain relief in itself. There are also lots of natural pain relievers that you can access without having to compromise on who you have in your birth space. Questions to think about: How can you minimise the need for medical pain relief? How can you make sure your basic needs are being met? What are your alternative methods of pain relief? Can you source it from elsewhere? If you need her to bring it, what can you do to protect your birth space once she has arrived?

“I want her to be in a different room and only come in if I need her”

Okay. This answer is the one that is the most telling. What you’re really saying is that you don’t want her there, but you don’t want to say that out loud. Or there is something you want her to bring or do before/after she stays in another room. Firstly, figure out which one of those it is for you. If it’s the former, that’s something to dig deeper into – Who are you trying to appease? What are you scared of if you plan a freebirth? What would you gain from her being in another room? What would be different if she wasn’t there at all?

If it is the latter, then go through the reasons that you DO want her there and make sure that it’s you that is benefitting from it, not someone else. In what situation would you want her to come in? What would you want her to do in the “if I need her” situations? Again, this will be different for each woman. This will help you to write an assertive and clear birth plan for the midwife who does attend.

 “So that they don’t refer me to social services”

We hear this one quite often from women who have engaged with the system as little as they feel is possible. They are scared that if they say no to the care they are offered they will get bad care, but the truth is that if you’re scared of that then you’re already receiving bad care. Referrals to social services for declining optional services do happen in Manchester, we’re not going to lie to you and say that they don’t. These referrals are used as a threat, and often they work. Agreeing to something under the threat of a referral means that your consent was not freely given and is therefore not valid. There is no magic formula to avoid being referred to social services for your birth choices, despite the fact that your birth choices are not grounds for a referral. But you could do everything that is asked of you, and then decline one thing and have the same thing happen. So it’s about knowing your rights, doing what you think is best for you, and recognising that you are doing nothing wrong when you decline elements or all of what the (completely optional) maternity system has to offer.

 

Take what you want from the system, leave the rest

Now that you’ve pictured your ideal birth, and questioned the societal norms of inviting the hospital into your birth space, you might have some answers. Here is the thing – whatever your answer is is the right one for you. The maternity system is an opt-in system. Scrutinising it doesn’t have to be an outright rejection. The way that it is presented is as a system that you must engage in as a standard and then only say no to things that you really, really don’t want (but even then you might be pushed into it anyway). If you start with a baseline of not engaging, doing nothing and enjoying your pregnancy as a normal part of life, then you can see the system clearly and engage if and when you wish to. This is how we treat all other medical systems. We go when we feel unwell, or when we have toothache. We don’t go every few weeks looking for problems. We also don’t live our lives with a paramedic in the next room, just in case we choke on our food, because if we did we probably would choke just because we’re thinking about choking.

If you answer the above questions and have a long list of reasons why you want a midwife to attend your birth, that’s wonderful – you can now write a really clear birth plan for her so she knows what you need. If you answer the questions and decide that having a midwife present wouldn’t benefit you, also great – you can plan your ideal birth knowing what you actually want, and remember that you don’t have to tell people that’s your plan if you’re worried about their reaction. It’s your information to share or not.

If you’ve got more questions, or you want to talk through any of the things that have come up for you whilst reading this (even if those feelings are anger or defensiveness) you’re welcome to come along to our monthly freebirth group or book in a one-to-one holding space session to chat with us.

You get to choose how much to engage in the maternity system. There is no right or wrong answer if it feels right to you. This is not midwife-hating, or telling women what to do, the point of this post is to encourage you to question the standard path and to make sure that the path you are currently on is bringing you joy and confidence. If it isn’t, it’s okay (and never too late) to change it.

Birth, Homebirth

How to plan your birth during a midwife shortage

GMD Admin

 During covid times it became standard practice to cancel homebirth services due to staffing levels. There wasn’t much logic behind this at the time given that this funnelled many healthy women into hospital, but it was accepted by many. This seems to have continued, with women being told weeks before their due date that there are staff shortages and there might not be a midwife available when she goes into labour. Or that she can only have a home birth during the day time Monday to Friday. This is simply unacceptable and has the desired effect of putting women off planning a homebirth for fear of the unknown. For women choosing homebirth because it is the only place they can meet all of their basic needs for birth, it is a HUGE compromise to leave your home during labour, so don’t be persuaded to do so by staffing levels or uncertainty.

 

  1. Stop hoping, start planning.

    Hoping for a homebirth is pointless. It means that you are not putting anything in place to make it happen, but you’re relying on external factors to make it happen, but those external factors want you to give birth in hospital because logistically it’s easier for them. So hoping will not be enough. If giving birth at home is important to you for any reason, then plan it.

  2. Don’t wait for permission.

    Lots of women are told by midwives that they can discuss their birth place at 36 or even 38 weeks. Don’t wait for them to bring it up – just tell them. This gives them plenty of time to put staff in place for around your guess date.

  3. Get really comfortable with the reasons you are choosing to give birth at home

    Those reasons don’t change based on staffing levels. You don’t have to explain these reasons to anyone else, but it’s important to remind yourself of these reasons often, particularly at times where your options seem to be being limited. Does the fact that there is no midwife available change the reasons you want to give birth at home? It’s also worth considering what giving birth in hospital would be like with a shortage of staff – where would you rather be?

  4. Learn and practise the broken record trick.

    If you decide that you do want a midwife present at your homebirth, you call them when the time comes and they tell you that nobody is available, you can repeat a basic script: “I’m in labour and I’d like a midwife to come out to me. I won’t be coming into the hospital.”

  5. Plan for a freebirth.

    Plan for there not being a midwife available when you go into labour. What does that look like for you? What support can you put in place? Does this actually change anything for you? What did you actually want a midwife for and how can you fill that gap in other ways? What are your fears? For many, the idea of having a midwife at their birth is just a given (as in, without any thought) because it’s just the done thing, so they have no idea what they actually want from a midwife. For others, they want a midwife present “just in case”, presumably just in case a true medical emergency arises which is very unlikely, and in such a scenario a midwife would call an ambulance. You also have the power to call an ambulance. If you remember that birth is a normal bodily function, just like your other bodily functions, then the idea of doing it in your private space, without any strangers makes a lot of sense. Once you’re okay with this as an option then your birth plans are no longer at the mercy of medical professionals – the uncertainty suddenly disappears.

 

How can we support you?

If you want to talk to us about planning your homebirth with or without a midwife, or air out any fears that come up for you at the thought of freebirthing, you can book a holding space session online with us here.

If you’d like to connect with other women who have given birth without a midwife, either intentionally or because there wasn’t one available, feel free to come along to our community groups which you can find here.

Don’t wait for permission to book a birth pool if you’re thinking of a home water birth, our booking deadline is 30 weeks. Find out more here.

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

Bum-first babies are wonderful!

GMD Admin

Key points:

  1. Breech is normal and not something that needs to be fixed
  2. Birth works best, and is most predictable, when left well alone
  3. 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, Resources

Writing Your Assertive Birth Plan

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;
 
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

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.

 

Related Links:

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

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

https://www.bellybelly.com.au/birth/fetal-ejection-reflex-what-is-it-and-how-does-it-happen/

Birth, Uncategorized

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

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

 

Related Sources:

https://billieharrigan.com/blog/2019/5/6/birth-hijacked-the-ritual-membrane-sweep

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

Uncategorized

Why it takes so much more than just hiring a doula to have a good birth

Amy

 

As we hear more and more about doulas, it’s easy to get the impression that having a doula will somehow magically lead to having a better birth experience. It often feels like one of the things on the ‘positive birth’ checklist; hire a doula, do a hypnobirthing class, read a birth book etc. and it’s true that having a doula can significantly reduce the risk of interventions and birth trauma, but that is largely due to the work that a woman does with her doula, and by herself, during pregnancy.

What we have learnt from women

Through our years of working as doulas in Greater Manchester, we have come to realise that birthing within the maternity system can and often will come with complications, barriers and difficulties. One of the best ways to combat these hurdles is to know what’s coming. Knowing how the maternity service works and knowing their policies gives you a head-start and also shows you that there are other options, such as birthing outside of the system. Knowing your rights and your options are the first steps to having a positive birth. A doula can support you in learning all of this, provide you with information and books on the subject, they can give you information about how the system works and how you can navigate it, and tell you all about the birth process, but it takes you to make the difference. 

Women who have had a traumatic birth in the past often come to us believing that their body failed them and that they need to do something different this time. Hiring a doula is a great start because it gives them the space to talk openly about what happened last time, a place to wonder whether those things were necessary or completely unacceptable, a place to cry and ask questions. Once women learn and start to believe that the process of birth is not inherently dangerous, and is not a medical event, it leads to an awakening that is incomparable. Getting to this point though takes a whole load of courage and openness from that woman, and when that woman is heard, she can find the answers she’s been looking for. So many of the women we listen to were having a perfectly normal, healthy pregnancy and labour until it was interfered with by medical staff, and realising that sometimes complications in birth are caused by the interference is key to protecting themselves against it. Their body did not fail them, the system did.

We have been programmed to think that authority means safety, but in so many instances we have been proven that in fact, the opposite is the case. When we trust someone else’s word over our own feelings of discomfort, we are left feeling violated. When we look to someone else for the answers, especially in birth, we are handing over our control and ignoring our intuition. We often hear in women’s stories that the parts that felt the most traumatic are when they went against what their body was telling them, and just did what they were told – so far I haven’t met a woman who regretted following her body. Our intuition is what has kept us alive and safe for so long, and birth is such a private and personal event that it makes very little sense to look for external approval or guidance. When we trust women, birth is safe. A doula is often the only person in the birth room who is solely focused on you, as the birthing woman, and having someone who completely believes and trusts in your body at that moment can make a huge difference to the energy. Questioning the authority of medical staff is necessary to get the birth you want, because going with someone else’s flow will inevitably lead you down a path that makes you uncomfortable or feels wrong. You ARE the authority, and you DO know best, even if you have never birthed before. Birth is a hormonal event and a normal bodily function – if you were monitored, observed and examined whilst trying to have an orgasm it probably wouldn’t go very well, would it?

Birth is led by the hormone oxytocin – as are orgasms – and for oxytocin to be released it needs the right environment. For women to release oxytocin they need to feel safe, warm, unobserved and undisturbed, so when you put a labouring woman in a brightly lit hospital with a bunch of strangers, unfamiliar loud noises and smells, and continue disturbing her with monitoring and examinations, it’s no surprise that birth takes longer or is more difficult. When birth is undisturbed, endorphins are released to match the intensity of labour as it builds – this is what makes labour pain manageable. When we interfere with the body’s natural pain killers, we cause more harm than good. Understanding what birth needs is a great foundation for planning where you want to give birth, and who you want to be there. Doulas can be really helpful in supporting you to navigate the maternity system when you are “going against medical advice” or just declining what you are being told is “how they do things”.

What we wish women knew before giving birth

We wish that all women knew that they were in charge of their body and their birth, that they didn’t have to agree to anything that feels uncomfortable or compromise with medical staff. We wish that women knew that birth doesn’t need to be fixed or monitored or sped-up and that they have the right to say no or to seek the care they are not being offered. We wish that women who have had traumatic experiences knew that they were not alone and that what happened to them was not okay. We wish that women weren’t expected to be “good girls” and do what they are told even when it feels wrong and that it’s okay to be “difficult” or “bossy” – in fact, that shows a belief in yourself, and the ability to assert your boundaries!

The work we do is to create the space for women to ask questions, to speak up and use their voice, to take what they need and to take back their power. We listen to women’s traumatic birth stories, we help them to write birth plans, we share information and experiences, we are behind them when they are navigating the system, or choosing to birth outside of it, and we have that unwavering trust in the birth process and in the woman in front of us. 

We support their choices, we hear their voices and we are privileged enough to witness their power.

But ultimately, what makes a positive birth is a woman who is ready to go deeper, to question what she is being told, and is fully supported in her decisions.