30 May

Book Review: Birth Work as Care Work, by Alana Apfel

Birth Work as Care Work is an important introduction to the subject of intersectionality in the birth movement, drawing out themes of oppression and inequality through the stories of women.

Alana Apfel and her contributors identify the challenges of a profit-driven healthcare system dominating birth, and a society where “white volunteerism” overlooks the real lived diverse experience of birthing women in communities that are not their own. Apfel creates a space for birth workers to be heard on both a personal and a political level, including four beautiful birth stories.

I found this book challenging to read as a white middle class straight cis woman, because although I am steeped in a culture of empowerment, of being “with woman,” and of respect and awe of the birthing body, the contributors are quite deliberately not talking to me. Reading it has been a good lesson in making myself aware of the water I swim in, and not trying to “fix” others’ experience from within my own frame of reference.

This is a recommended read for anyone interested in the broad political and social context of birth, and wiling to feel like our work is radical, valuable, and important.

[Disclaimer: The author sent me a free copy of her book]. We will be chatting with Alana in Sprogcast Episode 27.

25 Oct

Book Review: Why Doulas Matter, by Maddie McMahon

I love that near the beginning of Why Doulas Matter, MM points out that “on one level, doulas do not matter.” The invisible but steadfast presence of a doula, and how much difference she can make to the experience of birth, is the most important lesson this book can teach you.

This is a book about what doulas do and how they do it, and it also tells you what they are thinking about while they’re doing it. Maddie’s voice comes through very clearly, and unlike other books in the Why It Matters series, this one is far more personal than political. One exception to this is her mini-rant about the politics of breastfeeding, where the most passionate passion of a very passionate woman is clearly revealed.

Why Doulas Matter contains much useful information about birth and breastfeeding, woven into chapters about labour, meeting your baby, breastfeeding, and the postnatal period. One thing I felt was missing was a little more history of women supporting women during childbirth, setting the question of why doulas matter in the context of the 21st Century western world.

This book would be particularly useful for people thinking about what sort of support they might need during and after birth, whether or not that support comes from a doula. It would also be useful for both new and experienced doulas who want to reflect on their role. It answers all the questions you might have about doulas, and much more.

[Disclaimer: I was sent a free review copy of Why Doulas Matter by the publishers Pinter & Martin. You can get a copy here, with 10% discount using the offer code SPROGCAST at the checkout].

01 Jun

Book review: The Secrets of Birth, by Kicki Hansard

The Secrets of Birth is a book born out of Kicki Hansard‘s extensive experience of supporting birthing women. This book is intended for pregnant women, and aims to reveal five secrets that will help them during birth and the transition to motherhood.

The five secrets can be sorted into two main themes: the first three tell us that childbirth is a normal physiological process, and the last two that becoming a mother is a major personal transformation. This is useful and interesting information, and Hansard covers important topics including straightforward birth, hormones, skin to skin, and the benefits of a calm, safe environment, very effectively.

She goes on to discuss the transformational process of birth, a time when women have “nowhere to hide,” (p72) and a great opportunity for growth. I would have liked to read about this in greater detail, as few books (Naomi Stadlen excepted) seem to focus on this except in the most superficial way.

Hansard obviously has a wealth of experience with women in the birthplace, however this comes across as being a fairly small section of society, since the first chapter discusses at some length the pros and cons of engaging a private obstetrician; and of course the majority of her experience refers to her own clientele, a self-selecting group of people who hired a doula. There are several parts of the book which read like a manifesto about the state of birth in the UK, which may not be generally useful for expectant parents. The language and concepts discussed are more appropriate for birth professionals. One could argue that this subject matter needs to be more widely talked about (but one cannot then argue, for example, that the NCT is “too academic” (p16) in their approach).

I am always wary of birth professionals who appear to set themselves up in opposition to other birth professionals, and some of Hansard’s secrets seem to imply distrust of obstetricians (p12), midwives (p15), hypnobirthing (p38), and even the father as birth partner (p32). While much of the book is based in the author’s experience and personal opinion, there are some well-referenced and useful points, and good signposting to a range of sources. The short section on natural caesarean is one of the book’s highlights. The final chapters consist mostly of birth stories, supporting the various points made earlier in the book.

While The Secrets of Birth is probably not the first book I would offer a pregnant woman, I think it would be a very interesting read for doulas in training, or anyone supporting a birth or a new mother.

[Disclosure: Kicki sent me a review copy of her book – thanks!]

07 Aug

One Week

Recently a father-to-be in an antenatal session asked about my work and commented on how varied it is. On a busy week I sometimes feel it might be a bit too varied! Now it’s the summer holidays and I’m not doing much at all, which is another big advantage of being self-employed. I thought I’d share a typical week:

MONDAY
In the morning I drive down to Hampshire to help at a breastfeeding drop-in running alongside a Health Visitors’ weighing clinic. It can be quite quiet but today there are a few mums and babies, and it’s a nice place to work because there’s another Breastfeeding Counsellor working alongside me. As you will see, while almost all my work is with people, it’s not very often that I work with a colleague.

Back from Hampshire in time to record an episode of Sprogcast with Mark Harris. This is a newish project, and great fun to do, but it’s pretty time consuming with the preparatory reading, interviews, and editing. It’s getting easier, though.

My son has a playdate after school so I don’t have to worry about doing his tea, but I do have to feed myself and my partner before I go out to facilitate session two of an NCT Essentials Antenatal Course. Session two is the one about labour and birth, so quite an intense evening for me, as this is not my specialist area.

I usually have to wind down in front of the television for an hour or so after an evening class; it’s nice to have some time with my partner, too.

TUESDAY
This morning I’m running an Introducing Solids workshop in Reading. These are quite a challenge because the clients have such differing needs, and because I’m not used to working in a room full of babies. You would think that I’d be more confident, having done them for years now, but I have to take a deep breath before every one of these workshops.

I get home in time for a swim, before picking my son up from school and taking him for his own swimming lesson. No evening class tonight so I can chill with my partner.

WEDNESDAY
On Wednesdays I run the local NCT Bumps & Babies group in a church in a town centre. I usually cycle in, then go for a swim afterwards. Bumps & Babies is fun, usually a good age range (the babies, that is!), and lots of chat. It’s a great place to come to meet other new mums and find out about what’s going on locally. We talk a lot about sleep, and nurseries.

In the afternoon I do a couple of hours on the NCT Breastfeeding Line, talking to (mainly) mums all over the country. Sometimes when the line is quiet I use that as my admin time, but sometimes a two-hour shift features back to back calls and a load of voicemail messages too.

The evening is tricky because my son has a karate lesson, and I have an antenatal group reunion, now that everyone in the group has had their baby and had a few weeks to get used to the idea. The group wanted it to be early evening, in a pub local to where I ran the course. This involves driving my son to my partner’s office, where he eats a picnic tea before getting the train home and walking up to karate; then going on to the pub and leaving in time to get back and pick him up at the end. And after that I had my tea!

THURSDAY
A quiet day! So I might go for a run or a swim in the morning, and the only work I’m doing during the day is an hour on the Breastfeeding Line and a call with one of my BFC supervisees. Any spare time will be spent editing the podcast.

In the evening I drive to Windsor where I’m facilitating an antenatal breastfeeding session for NCT. This always feels like my “core” work, the thing I joined NCT to do. Most of the time it’s the best, easiest and most rewarding of my many roles. Even the challenging groups are usually fun, and if you like the inside of church halls, then oh my goodness this is exciting work. That’s not the main thing for me, though…

FRIDAY
I’m in Didcot training a group of dedicated and enthusiastic mums to be Breastfeeding Peer Supporters. This is new work for me, and I’m learning a lot as I go along, as – I hope – are they! With the driving time, it takes up the full day and I’m usually home about five minutes before my son gets in from school. We usually spend Friday afternoon after school over at Ailsa’s house where the boys play together and we get to drink tea and debrief.

WEEKEND
Over the last year I’ve tried to cut out weekend work altogether, although I do sometimes offer my time on NCT’s Crisis Support line for other practitioners. Sometimes I do a class on a Saturday morning, but particularly in the summer I try to avoid this. I used to do two a day on a Saturday which was exhausting but paid well enough to justify giving up half my weekend.

This was a typical week, with about 18.5 hours of paid work and I can only hazard a guess at how much unpaid work I do on top of that, with things like volunteering for my NCT branch, taking local breastfeeding support calls, and all the admin that my roles entail. And this is a week with no doula client, and possibly the reason why there’s no doula client is that I just can’t spare enough regular hours to support someone properly. I love my work, I love supporting new parents and being part of this massively varied and positive profession. And I love having the flexibility to drop it all in the summer holidays so that I don’t have to worry about childcare – and I love my partner (not only) because without his support I’d never be able to do any of this.

Views expressed here are my own, and do not represent the views of NCT.

13 Nov

Birth Plan Prompt Sheet

Birth planning is a vague science; some birth workers now refer to “birth preferences” instead, and some prefer to avoid this sort of planning altogether. I’ve found a few resources online including this comprehensive tool from the NHS, and cobbled together a list of prompts so that my clients and I can go through it together and make something that is completely tailored to their needs. I’ll be taking several copies with me to the birth!

Birth Plan

Early labour – where?

Where to give birth – MLU/delivery suite/pool etc

Who do I want to be with me?

Equipment I plan to take with me

Intermittent/continual monitoring of baby during labour

Keeping active during labour

Positions to adopt

Trainee midwives/doctors in the room

Immediate skin to skin

Pain relief preferences

Episiotomy

Third stage – active/managed

Breastfeeding

Vitamin K

Any special requirements

16 Oct

Book Review: The Birth Partner, by Penny Simkin

Penny Simkin is an author, doula, childbirth educator, and birth counsellor.

I was advised to read this book prior to my first job as a birth doula, and having now read it through, I will probably take it with me when I get the call. Aimed at dads, doulas and other birth companions, and packed with details of what happens before, during and after labour, it is not a small book, but its chapters are easily accessible and logically arranged.

The long section on normal labour is particularly useful. Each stage is broken down into a description, followed by what the mother feels, what a birth partner might feel, what a caregiver would be doing, and what a doula would be doing. There are suggestions for self-care and coping strategies appropriate to the challenges of each stage; it’s a real step-by-step manual.

There is a medical level of detail on pain relief, and this would need to be read and absorbed beforehand rather than at the time, but it remains a book to dip into during the process for an idea of what is happening and how to deal with it.

For when things don’t go to plan, the book covers instrumental and caesarean birth as well as other interventions. Helpfully value-free, Simkin sets out the things to take into consideration, and strategies for decision-making.

A comparatively short section at the end covers the baby’s first few days, and post-partum recovery; again with a what to expect/how to support the mother focus.

My one criticism of the book is its US-centric language, which makes me suspect that some of the procedures described may differ in the UK. But women’s bodies are the same all over the world, and ways of supporting a birthing mother are universal.

This book is a must-read for anyone working in birth, and for birth partners who prefer a lot of detailed information in a format they can refer to both before and during labour.

30 Jun

Holly’s birth story

I started losing plug Wed morning and then getting cramps late afternoon and evening. I felt really agitated and hyper all day so I just knew it was starting. We set up the birthing pool and went to bed at 1am. The pains were much worse when I lay down so I left hubby to sleep and paced around the spare room.
At 3am I eventually tried to lay down again to get some rest but just as I drifted off my pelvis audibly popped and my waters broke. I went to the toilet expecting a cascade but it stopped only for me to sit back on the bed and loads pour out. I woke OH who started filing the pool whilst I contacted my doula. My waters were very green in colour so I knew baby had pooed at some point but not recently as there were no meconium chunks. I called triage and they said the homebirth MW was out at another birth but would come over soon. I had a bath and OH poured water over my belly to soothe me.

My contractions got very intense very quickly and soon no amount of pacing or swaying helped. I kept spilling out more waters as I moved about much to my amusement/horror. I was so desperate to get into my pool but it wasn’t hot enough for ages it was like torture sitting looking at the full pool, having serious contractions and not able to get in. My doula was amazing and helped me through each contraction.

1st MW turned up at 5ish and was very worried about meconium and wanted me straight into hospital. My doula and husband talked through the risks and it was agreed I could continue to labour at home and they’d keep monitoring baby. I knew she was a big strong girl so I wasn’t too worried.

I got into the pool finally at around 6 and the contractions went mad, at times overlapping into one another and so intense they were making me convulse. New MW took over at 7 and I agreed to my first VE and I was 9cm! She was pleased but also a bit shocked and so an ambulance was called to take me the whole 2 min ride to hospital as I had agreed that for baby’s sake I would birth her there. By this time I was delirious; I could hardly take a step without contracting and I was at the animal noise stage by now. What a sight for my neighbours haha!

In the ambulance it was like having an out of body experience, I felt like I was asleep and watching myself as I lay there making these insane noises. We arrived at roughly 8:30/9.

The next 2 hrs are a blur with random periods of lucidity between contractions. I tried so many positions: squatting, standing, on toilet, kneeling over back of bed, holding legs open….. But in hindsight I was allowing too much of the power to go into the noises I was making and not into the pushing. So we got her to the point where her head was visible but it keep slipping back inside. Although she had constant monitoring via the little pin on her head she didn’t get distressed but the meconium was still a concern so they didn’t want her stuck down there for too long. Around 10:30 the doctor said she would need to use a suction cup to stop baby sliding back and asked if she could cut me rather than allow me to tear. She was calm and explained all my options and I felt sure that she was only doing what was best for me and baby so I agreed. So after little local anaesthetic and a cut and some serous suctioning, my baby came into the world at 11:05.

I am so pleased with the actions of the hospital. I was tired and getting a little worried and couldn’t have pushed this little chunk out on my own. In the end, her meconium has caused her no problems but we have stayed in overnight for 4 hr obs.

I have vaginal stitches but they are to the side so no damage to perineum. So far no pain from them either.

I have had a brilliant experience and only truly now appreciate how a plan is only a plan and that the medics really do know their stuff. I would definitely labour at home again but would probably birth in hospital or midwife led clinic in the future.

I have a cuddly little lady in my life now, she was worth the wait and we are learning from each other already. She’s latching well but not taking very much each time, she is sleeping a good 3hrs straight each time too so I’m a happy and contented for the moment.

23 Jun

Baby Shock

I meet a lot of new parents, and have come to recognise the glazed stare of someone at the height of sleep deprivation, and anxiety, coming to terms with the reality of life with a newborn baby.

Of course my sample is skewed by the fact that my job entails being there to help when there are difficulties. Many new parents have strong support networks, realistic expectations, and enough confidence in their own instincts, to enjoy these first weeks and sail off into the parenthood sunset.

Feedback from antenatal sessions tells me that parents-to-be sometimes feel they would like more preparation for parenthood. They request practical things: nappy changing always evaluates well but clients would like antenatal teachers to tell them how to get their babies to sleep. Everyone tells you about the sleepless nights to come, usually with a wry smile; but nobody tells you what it feels like. It isn’t like working shifts or travelling across timezones, because of the emotional and hormonal whirlwind going on around you, the physical recovery from birth, and the realisation of immense, relentless responsibility. You can’t sleep this off, and anyway, opportunities to do so are rare.

New parenthood is such an unpredictable and chaotic time, but gradually instincts emerge and you start building knowledge and confidence in yourself. You get to know your baby, and perhaps start to see why we can’t tell you, in advance, how to manage this little person. Your family and your baby are unique, and things are going to shape up in their own way. Only a tiny percentage of babies are “in a routine” by six months of age, but more than half are sleeping through the night. At a recent Introducing Solids session, mothers of four and five month old babies talked about how their babies had slipped into natural rhythms, whether they as parents had tried to manage this, or not.

Life with a new baby might be a big unknown, but you can prepare for it by gathering around you the people you trust to give you care and support, by not expecting too much in terms of “normal” life, and preparing mentally for meeting and getting to know your unique little one when he or she arrives.

20 Jun

Book Review: The Hormone of Closeness, by Kerstin Uvnas Moberg

The Hormone of Closeness: The role of oxytocin in relationships, is the second book I’ve read by Kerstin Uvnas Moberg on the subject of oxytocin, the hormone involved in childbirth, bonding and so much more.

Moberg posits an explanation of attachment theory wherein oxytocin underpins the child’s sense of security through enhanced wellbeing, increased calm, and a sense of satisfaction. She terms the innate and evolutionarily necessary need for closeness and contact with others as “skin hunger,” to equate it with hunger for food. This casts touch and its effects in a useful new light, showing how breastfeeding is about so much more than the transfer of milk, for the mother and the baby.

While much of the evidence in the book is drawn from lab studies on rats, her arguments are logical and compelling. Lay readers might skip the scientific stuff about what goes on in the brain, and read instead the fascinating description of the mother-baby relationship in the first place, which is then drawn into the wider context of our social interactions, stress levels, and the way we live.

Looking forward to the implications of the development of synthetic oxytocin, Moberg acknowledges that artificially increasing oxytocin levels, thereby increasing the tendency to trust, might not always be a good thing, particularly in a setting where we would not naturally be trusting. Evidently it would be better for the individual, and for society as a whole, to find natural ways to increase the world’s oxytocin levels. To illustrate this, she looks at the doula phenomenon, where a trusted woman present at birth can have a positive outcome, by allowing the birthing mother to tune into her body and allow levels of oxytocin to rise, facilitating labour and bonding with the new baby.

She finishes by looking at the possible consequences of our increasingly separate lives, and with a call on behalf of future generations to consider how to bring back social closeness, that “all of us on earth could live in peace and harmony with one another.” [p157]. This is an enlightening and affirming read.

***

To order The Hormone of Closeness with a 25% discount, just follow the link and use the discount code KH25 at the checkout.

[Disclosure: review copy provided by publisher]

13 Mar

Announcement!

Today I met with my mentor Maddie McMahon, and after an interview which took place over a pleasant lunch, I am now a Recognised Doula. Here’s an explanation of Mentored and Recognised Doulas from the Doula UK website:

Mentored doulas
A Mentored Doula has completed a Doula UK approved Preparation Course and is involved in Doula UK’s Recognition Process. This means that she has a Mentor providing support and supervision within a framework for reflective practice until she has gained sufficient experience to become a Recognised Doula. A Mentored Doula’s fees reflect her previous and current experience, her expenses and the going rate in her area.

Recognised doulas
A Recognised Doula has been evaluated by a Doula UK Doula Mentor at the end of the Recognition Process, as having sufficient experience to practise without on-going mentoring. Doula UK nevertheless continues to provide support for all its members.