Hackney Birth Doula

Just in case you stumble across this site while I'm winding it down, let me direct you to my shiny new website www.hackneydoula.co.uk.

It's quite a lot like this one except it actually works. Enjoy!

I'm having a few website issues. Hopefully I'll be up and running again shortly. In the meantime do email me at rebecca@hackneydoula.co.uk if you need any information that you can't find on the site.

Right I'm off to route my server via the mainframe. Or something.

Apparently, according to the UK media, doulas are becoming 'fashionable'. A recent article referred to us as 'the latest fashion accessory' and I've actually tracked down one piece with the rather nifty title: 'Mothers with Moola Must Have a Doula'.

There is a part of me that does a little dance of joy, clicks my heels together and shouts 'wahey!' when I hear this. I mean, if there's a choice of having a really unpopular job or one that's fashionable who wouldn't choose the in vogue one?

Yet something about the word keeps irking me. 'Fashionable', I keep asking myself, 'what's wrong with the word when applied to what I do?'. Aside from my penchant for 90's indie music and legs that run screaming from skinny jeans, I think the irk-factor lies in what springs to mind when someone uses the word 'fashion'. Apologies Ms Wintour but it does tend to give off as sense of transience, luxury, here today gone tomorrow-ness and whimsy. It's generally applied to bags or shoes or a fad for cake decorating/cross-stitch/knitting amongst trendy twenty-somethings living in Dalston and making jam whilst hungover.

I, however, am NOT a fashion item! I can't make jam and my DVF dress has a small porridgey handprint on it. As a doula I'm prepared to climb on the roof of Vogue House and declaim that I am actually highly unfashionable. My role has been around, in one form or another, since early civilisation and it isn't going anywhere. I'm not a passing trend or something the middle-classes are trying on for size soon to be discarded.

Though I have previously claimed otherwise (particularly at Christmas), objects of fashion are rarely necessary. They don't often dramatically change your life and they aren't proven to be tangibly beneficial. Indeed some items are actually rather damaging (spandex? jumpsuits? cropped tops?).*

However every study that has looked at the work of birth doulas has recorded concrete benefits of their support. Take this latest Cochrane review of 21 separate studies of women who had continuous support during their labour. The data collected from over 15,000 trial participants demonstrated the following:

• Women allocated to continuous support were more likely to have a spontaneous vaginal birth and less likely to have intrapartum analgesia [pain relief during labour]  or to report dissatisfaction.
  
• In addition their labours were shorter, they were less likely to have a caesarean or instrumental vaginal birth, regional analgesia, or a baby with a low 5-minute Apgar score.
• Subgroup analyses suggested that continuous support was most effective when provided by a woman who was neither part of the hospital staff nor the woman's social network, and in settings in which epidural analgesia was not routinely available. 
• AUTHORS' CONCLUSIONS: Continuous support during labour has clinically meaningful benefits for women and infants and no known harm. All women should have support throughout labour and birth.

I'm yet to meet a handbag (even a Marc Jacobs one) that can claim it statistically improves both the outcomes of birth for mother and baby and crucially the mother's postnatal satisfaction with this momentous experience. If someone can invent one I'll have my name down first on the list in Selfridges. Until then we are all going to have to accept that doulas just aren't fashionable. You can't make us in to an overnight sensation because we've been around for aeons.

With the weight of evidential proof behind what women have known for centuries we aren't going the way of crimping** any time soon.

* if my husband is reading this please ignore this sentence in the context of future spending justification
** apologies if crimping is actually fashionable again

It may sound like a contradiction or even (should you have recently dusted off your GCSE English textbook, an oxymoron) but, if you are planning a caesarean for any reason, you may want to think about ways you can make it a more gentle entry in to the world for your baby.

Smith, Plaat and Fisk (when not busy being characters in Dicken's undiscovered masterpiece A Tale of Three Obstetricians) have been pioneering what they call a 'woman-centred' approach to caesareans at London's Queen Charlotte's hospital. You can read more about their technique in the Royal College of Obstetrician and Gynaecologists journal or in a more user-friendly Times article.

Wherever you are planning to have your baby you may want to talk to your consultant and midwife about:
- playing music you like in theatre
- dimming the lights for the moment of birth
- lowering the screen for you to see your baby emerge
- delaying the clamping of the cord
- your partner cutting or trimming the cord
- discovering the sex of your baby for yourselves
- immediate skin to skin between you and your baby (putting your gown on backwards and asking for the SATs monitor to be placed on your foot will help with this)
- no wrapping or washing of your baby
- help with breastfeeding in theatre

It may not be the way things are normally done at your hospital, but armed with the knowledge that all of the above are possible and have happened, you may feel confident to explore this more natural approach with your team.

I'm feeling rather pleased with myself today having officially become a 'recognised' doula. This means that I've completed an intense period as a trainee doula (which rather confusingly was after I completed my actual training) and have worked with an experienced mentor and assessor for a period of time. All of my clients have given her feedback and following a final interview I am now officially admitted in to the ranks of recognised Doula UK doulas. Hurrah!

Though I completed my required number of births last year, it's taken me a little while longer to get all the paperwork sorted out, but I'm very pleased to be official at last.

I'm also now a Nurturing Birth certified doula as this rather nifty stamp testifies.

A big thanks to everyone I've worked with so far and to all the wonderful doulas who've supported me as a trainee.

My artistic skills have always been fairly limited. Limited, that is, to slightly squiffy looking stick men and the odd collage of a long-forgotten boy band on my school 'rough book'. I distinctly remember my art teacher sniggering gently when I, in a moment of madness, suggested that I might take GCSE art.

Nevertheless, I've finally forgiven the artistic establishment for tossing me aside like a broken pencil and spent the past few weeks enjoying a course in birth art process, given (via the wonders of modern technology) by the legendary American birth educator Pam England.

Her book, Birthing from Within, is a very different and inspiring take on how to prepare for childbirth and I use some of the exercises with couples I'm working with if it feels right. Almost by accident, as is always the way with brilliant ideas, she discovered that making art as part of birth preparation classes gave people a freedom to find something different, raised new questions, offered deeper insights and always gave something meaningful to the couples she was working with.

As part of the course I'm going to be working with a few clients over the coming weeks to work on leading them into the birth art process. I'll keep you posted as to how it goes and what we're all learning.

In the meantime I'm off to practice my stick men - how do you make them look pregnant?!

So I'm finally getting round to putting some testimonials on my website. More will be coming over the next few weeks, but this is a start!

After a bit of a break from the blog (a flurry of births, a gaggle of builders, a sprinkling of illness and a partridge in a pear tree) I'm back and bursting with doula enthusiasm for 2011.

I've started the year by investing in a professional grade birth pool, which I'll be hiring out to couples I'm working with who are planning a homebirth.

You can find out more about why people might be planning a waterbirth here, and some rather lovely waterbirth photos here.

Oh and if you want to invest in your own pool as you quite fancy using it as a giant paddling pool/non-bubbling jacuzzi in future, I can arrange for couples I'm working with to get a cheeky discount on Birth Pool in a Box and La Bassine pools.

Coming soon in 2011:
- testimonials from some previous couples I've worked with
- birth stories
- suggested reading lists
- ideas for your birth bag
- and of course more regular birth/pregnancy/baby stuff on the blog

Wishing you all a very happy and belated new year!

Ok, I'm just going to come out and say it. I HATE the contraction master website and iphone app (there is deliberately no link here). Every time I hear of someone using it I have an almost uncontrollable urge to go on a worldwide rampage destroying each and every iphone and grinding every single one down till they are nothing but dust.

And breathe...

Why does the idea of these meticulously accurate contraction timers drive me to a rage blackout? Well, it's not because I'm a technophobe (I've got a blog AND I twit, twitter, tweet, hoot, whatever) but more because everything about these devices strikes me as standing in direct opposition to the best way to facilitate labour.  This does also apply to timing with digital watches, watches with a second hand, or even a fob watch if I'm honest.

Let's take it step by step.

1. Observation
So timing of each of your contractions millisecond by millisecond is observation in extremis. Your birth partner is desperately searching your face for signs of a contraction (and probably saying 'are you having one? has it started yet?' every minute or so) so they can be sure to push the button at the exact moment your contraction commences. You are also engaged in a frantic self study to be sure you say 'go' exactly as your contraction begins. And then, between contractions, you both get to pour over the data (be it on a spreadsheet or scrap of paper) analysing whether your last contraction was longer/shorter/closer or further away than the last.

Why is observation bad? Well, it comes down to oxytocin - the hormone that our bodies release to get contractions going: the more oxytocin, the more effective the contractions. Oxytocin is a shy little wallflower though and is inhibited by things like bright lights, talking and observation. It's the same stuff you release when you make love and chances are that if someone had popped in with a timer to give a moment by moment account of the er, time you conceived, you might well not be reading this blog. Just as most people can't envisage successful lovemaking while someone times their every move, labour isn't best facilitated by constant, intense observation.

2. Intelligent brain
I'm afraid this isn't a compliment or a suggestion that you sign up with MENSA. The neocortex is the bit of our brain that sets us apart from other mammals. It's the intelligent bit - the one that makes decisions (or endlessly procrastinates), debates, worries and weighs up options. It is pretty brilliant in almost all aspects of our human lives apart from labour, when it is the ENEMY. Oxytocin is much more friendly with the primitive bit of our brain (ever wonder why animals give birth so easily?) but gets a bit shy when we start using our neocortex. So, if you are sitting there thinking 'is this a contraction, oh hang on no it's wind. Oh but this is definitely one. Bert, press the timer thingy. Has he pressed it? Yes he has. I wonder how long this one will be. Will I have time to catch the headlines before the next one comes? I really want to hear MORE about the royal wedding.' Etc etc etc, you are keeping that intelligent bit of your brain super active and thus repressing the hormone your body needs to produce to make your labour efficient.

3. Fear and anxiety
Most people are fearful and anxious at some point in advance of their impending labour. Part of what I do is to help couples understand and deal with their anxieties in advance of labour so they don't jump out at us unexpected on B-Day. Why is anxiety of particular concern during labour? You guessed it: oxytocin. Fear makes our bodies produce adrenalin. Handy if you need to fight or flee, but a right pain in the **** if you are in labour. Oxytocin and adrenalin are the two popular girls who turn up to the school disco in the same spangly dress: when adrenalin walks in to the room, Oxytocin legs it as fast as it possibly can. So if you are sitting there thinking, 'Oh god, my contractions aren't getting any closer together. They aren't ever going to. I'm going to be in labour forever. In fact they are slowing down. Oh god.' your contractions probably are slowing down, as you've scared the bejasus out of your oxytocin and your labour has stalled.

4. Not going to' that place'
There's a place, a place for us labouring women. It's a place where no one else can join us, where nothing else matters, where the world disappears. In all the labours I've been present at, there's a point where the women gives herself over to what she's feeling. It might be in a quiet, accepting way it might be in a 'come and get me labour, I'll take you on' kind of way, but however she does it, she sort of disappears. Everything else recedes and she's focused on herself, her baby, what she's feeling. She often doesn't hear you unless you speak right in to her ear, she doesn't like noise or distraction. It's at this point that I think 'this baby isn't too far away'. Now, if you've got a data sheet in front of you, responsibility for shouting 'go'  and 'stop' to your partner so they can time your contractions you aren't going to be able to disappear off to that place.

So, I beg you, don't slavishly time your contractions. What do I suggest? Well, go with the flow. Sure, your partner may want to look at the clock from time to time to reassure you that things are progressing and answer the midwife's questions when they ring. But there's no need to have a blow by blow account on your iphone. Listen to your instincts and back them up with your partner glancing at their watch occasionally (I tend to look at my digital watch every 20 minutes or so when I'm with a labouring woman, but I don't mention the timings unless she asks or I need to give information to a midwife).

Let the oxytocin flow!

Over and out.

You've bought your little dear the latest travel system, maxed out your cards on a luxurious bed nest and invested in a beautiful woven wrap to carry him in. How does he thank you? By deciding to turn the 'wrong way round' towards the end of your pregnancy. Brilliant!

Never fear, all is far from lost. Take a deep breath and read on to find out more about what you can do to encourage your little one to perform a flip and your options should he really been keen to enter the world bottom first.

This is a bit long and factual, but hopefully useful...

Help, my baby is breech - what can I do?!

At term (37-42 weeks) only 3% of babies are breech. Take heart, if you are waiting for your baby to turn before 37 weeks it is most likely he will! You might want to start thinking about how you can encourage him to shift if you are approaching term though. However close to delivery you are Spinning Babies is always worth a look to see what you can do to optimise your little one's presentation.

If you are 35 weeks plus, you may want to step things up a bit. A qualified acupuncturist, particularly one who practices the Chinese art of moxibustion, can have dramatic results in persuading a breech baby to turn. Your doula should be able to recommend someone with a good track record and many hospitals and birth centres do have relationships with moxibustion practitioners, so it's worth asking for a recommendation.

There's a good summary of some safe ways to try and flip your little one at home here. With everything from frozen peas to shining a torch on the bump it can sound a little like interrogation techniques, so just do what you are comfortable with!

If you have a friendly homeopath it's worth asking about remedies such as pulsatilla.

What might my midwife or doctor suggest?
Hopefully they will talk you through some of the above options in the first instance (and if they don't you may want to ask them for some time to try these). At around 36 weeks if junior is still upside down they will suggest you come in for a scan. This allows them to confirm if your baby is breech and check for any reasons why he might be that way round (a placenta in a slightly funny place for example).

If the breech is confirmed you will most likely be offered External Cephalic Version (ECV). This is when a doctor manipulates your bump from the outside to try and manually turn the baby. You'll want to find out the success rate of your particular doctor as they can vary wildly from 30-80% and it's worth making sure you have the most experienced practitioner possible. You can ask for someone else if you aren't happy with the first suggestion. Do also ask about whether they will give you any medication to relax your uterus and make the procedure less painful. There's evidence that this improves the success rate.

Of course, you don't have to accept the ECV - some people are worried about risks, others not keen on the pain, some don't think it's worth it as the success rate isn't high at their hospital and others think if their baby is breech he is so for a reason! Take a look at this for more information on ECV.

What are my options if my baby stays breech?
I like the Royal College of Midwives campaign for normal births very balanced view on this:
"A breech presentation is normal, it is just not typical. This is really important to remember: breech is not an abnormality. And a normal labour and a spontaneous birth are not excluded just because the presenting part is breech (although not all breeches can or should be born vaginally)." More of this here.

The options you are presented with will depend on the type of breech presentation, your specific history, the attitude of your doctor and your hospital's policy. It's worth therefore being well versed in the facts, options and opinions yourself so you can make an informed choice.

You'll almost certainly be offered an elective caesarean and you will be strongly encouraged to accept this for more challenging breech presentations or if you have other complications. Most breeches are now born by caesarean and midwives skilled in vaginal breech delivery are becoming more scarce. Requesting a vaginal delivery is therefore sometimes a bit of a fight.

But, a vaginal delivery is still possible and if you are interested in this, it is worth reading this article by the highly experienced midwife Mary Cronk, this by the Royal College of Midwives and as ever the homebirth resource site is a great repository of information on breech delivery, include breech births at home. Also useful is the Royal College of Obstetrician and Gynaecologists position on breech birth options.

Broadly speaking the accepted medical view is that caesarean delivery is statistically a bit safer for the baby, though carries more risks for the mother. This is largely based on a study called the 'Term Breech Trial'. There are however many practitioners who believe that when additional complications, inexperienced practitioners and other important factors are excluded from that study, the relative safety of vaginal and caesarean delivery for a breech baby is comparable. Caesarean delivery does have implications for future pregnancies, which is another aspect to consider. Mary Cronk's article is a great summary of safe and unsafe breech delivery practices and when it is safe to attempt a vaginal breech delivery.

If you decide a vaginal delivery is for you, you'll want to ensure you can be attended by midwives with a good deal of breech experience. In some cases this may necessitate hiring an independent midwife for which some couples have successfully billed their local NHS trust! AIMS will be able to discuss how to go about demanding an experienced breech midwife from your NHS trust.

Whatever you decide, be sure to do your research so that you are 100% sure of your chosen option and have negotiated the care you need.

I'll end with this video of a frank breech homebirth, to show that you still have lots of options open to you, even with a breech birth