Are we unwittingly perpetuating fear of C-sections; and contributing to birth trauma outcomes by doing so???

Are we unwittingly perpetuating fear of C-sections; and contributing to birth trauma outcomes by doing so???

You’ve all read the headlines, the sensationalist introduction to link to new studies on the latest medical research, the byline underneath the headline:

“Moms beware! C-section may harm your baby’s ‘concentration’ “

“Mother’s agony as anaesthetic wore off during C-section”

“Are women losing ability to give birth naturally? They’re relying too much on C-sections and drugs, says expert”

“The mothers made to feel guilty about their C-sections by OTHER MOTHERS”

“A study revealing the prolongation of labour, thanks to epidurals, has been useful in identifying the iatrogenesis – doctor induced harm – at the root of the cesarean problem”

“BIRTH IS THE KEY in breastfeeding: a natural birth unlocks breastfeeding potential and so much more”

“Induced labor may double the odds of C-section”

“Cesarean birth without labor associated with breastfeeding problems say two new studies”

“C-section babies more likely to become overweight”

Then we have the commonly rolled out “statistics” on how having a doula attend your birth means a “40% decrease in the risk of having a cesarean” or how “One-to-one midwifery care reduces C-sections and improves health care”, and the ever so helpful article entitled: “How to reduce your risk of having a Cesarean”, followed by a provocative article asking “Once a Csection, always a Csection???”….I saw that one and thought of the brave, courageous ladies who come to share their hopes and fears in the VBAC Support Group and thought “oh dear – how would you be feeling about your planned VBAC after reading that tagline?”

There I was, scrolling away on my Facebook page the other day – and the newest well intended article about how Csection babies seem to have a higher chance of having Autism, ADHD, obesity related illness, a bad temper*, longer eyelashes*, multiple nipples*, a recurrent ingrowing toenail* and a tendency to smile later* than babies born via the vaginal canal popped up in my news feed. Following my own positive experience of a C-section and subsequently well documented break up with the Natural Birth Movement these articles do intrigue me and I almost always click in to read them, review the science, consider the message and absorb what I can to support my son’s health. I read the article and noticed my mood had worsened. So I observed the feelings, felt them. Fear, worry, dismay, guilt….and then the thought struck me:

“Are these articles doing more harm than good – are we perpetuating fear of Cesarean birth and contributing to birth trauma by doing so ???”

First of all it is important to say: I don’t know the answer. I don’t believe that there is a binary answer to the question. I’m questioning whether or not I should even pose the question publically or just ponder this further alone?! As a disclaimer I will also point out that I have no science to back up this question or subsequent questions.

The criteria for experiencing birth trauma are well clarified by the Birth Trauma Association with a very clear list of potential contributary topics which contribute to birth trauma.

  • High levels of medical intervention
  • Traumatic or emergency deliveries, e.g. emergency caesarean section

These are two very clear very distinct definitions from a list of sixteen identified contributary factors. How do these events lead to trauma in some mothers but not others? They are not unusual birth outcomes. Is it the physical trauma of the body within these birth circumstances leading to a psychological trauma, or these birth circumstances having been feared/dreaded/denied as a possibility by the mother/never considered as an option meaning that when these circumstances unfold in this manner; the subsequent experience is therefore psychologically traumatic? It’s a bit of a chicken vs egg anomaly. How could we ever really study the impact of having read articles denouncing the perils of Csections on any women, let alone a wide ranging statistically meaningful group of women? Perhaps the only thing we can really do is to be conscious of the question as we encounter another article with a shocking headline?

When it comes to the notion of birth trauma and headlines like these contributing to birth trauma; the more comprehensive question would be

“By repeatedly using sensationalist and confrontational headlines when we publish these studies and their findings regarding birth by Cesarean are we:

a) setting women up with irrational fear of a procedure that sometimes becomes inevitable in an emergency?

b) paving the way for great disappointment in not “achieving” the optimal spontaneous vaginal birth?

c) laying the foundations for trauma by inherently invalidating and dismissing many women’s experience of birth by cesarean as suboptimal? ”

I certainly don’t believe that if we are perpetuating the fear of Cesarean birth in this way that we are doing so consciously – although unfortunately I have seen well meaning birth workers commenting on how “graphically violent” an image of a baby being born by Csection was (which seems a little counter productive to the notion of unconditional birth support).

I read the research, studies and their findings keenly (despite the way the headlines are worded) as a birth professional too; as I stand for informed choice. Informed choice in childbirth should be fundamental, always – whether the choice comes in an emergency situation, a semi emergency situation or even as a choice earlier in pregnancy. I can see and have seen that risks, benefits and options are not always explored fully with expectant or labouring families by medical professionals; and so I can see that by using sensationalist headlines information comes to parents through other channels which otherwise they may not encounter. New research which is consistently being conducted means that sometimes people who made a certain set of choices a few years ago, may well discover something that would affect their decision were they given the opportunity to make the same choice again now; sometimes those people are deeply effected by these articles too. I hope their concerns can be somewhat allayed by reminding them that we do our best with the knowledge that we have at the time.

Above and beyond being crucial in women having all the information they need to make informed choices for their families, the publication and sharing of the research is important and meaningful in the evolution of how we collectively approach birth as mothers, fathers, birth workers, health care providers and policy makers; how medicine and medical protocol advances; and how we can best support our babies’ health post partum, throughout childhood and onwards into adulthood; catering to the specific needs which are unquestionably sometimes a little different to babies who are born via the vaginal canal. This is wonderful as we are actually able to develop practices like seeding the microbiome of the mother’s vaginal canal into the newborn baby’s body post Csection, in order to best replicate some of the benefits of vaginal birth. For more information on this practice head over here. It means that the procedure of the C-section itself can be adapted to offer the mother and baby some of the psychological and physical benefits of spontaneous vaginal birth by performing “Natural C-sections” or at the very least “Gentle C-sections”. For a personal account of a Natural C-sectionby a mother who took part in a study currently being conducted by UCLH in the UK please head over here.

It does seems clear to me though, that some of the aforementioned headlines could be perceived to be perpetuating fear of Csections; intentionally or not.

The question does then broach the bigger picture of the presentation of birth within mainstream media, and the notion of birth as a feminist issue (although birth as a feminist issue deserves it’s own book – let alone a blog post!). I was reminded of the visual presentation of health crisis in the media recently when my beloved grandfather had a heart attack and said a number of times to the emergency healthcare providers; “I can’t believe I’ve had a heart attack – I wasn’t rolling around on the floor groaning in agony with a puce face at any point”. Women’s impressions of birth from mainstream media are often equally misguided, and can range anywhere from “I gave birth on the toilet – I didn’t even know I was pregnant” to “my waters broke as I left the expensive department store, I gave birth in the taxi on the way to the hospital into the taxi drivers hands” to “I fainted in the street and was rushed into hospital via blue light straight into theatre to be put under general anaesthetic and my baby was delivered by emergency C-section”. Certainly any of these situations are possible: but all fairly unlikely. The reality is that there are many opportunities for you as parents to ask questions, discuss your desires for your birth plan, discuss and negotiate the “What Ifs?” or grey areas of birth preferences, and to sometimes even say “I hear that the protocol states we ought to do something to further the progression of my labour right now; but I do not want to and am not ready to agree to any intervention”. Indeed when looking at the reality of pregnancy and planning birth preferences; there is usually very little ‘high drama’ to attract big audiences or a large readership(!)

What can we do with this question? I’m not even sure: doula it? Hold space around it? Consider that client we know who is currently going through the fog of PND or PTSD after having experienced a birth outcome she wasnt anticipating? Consider the heightened intuition of the client who is 39 weeks pregnant and who we know who is digging deep for faith in her body as she prepares to VBAC after having stalled last time she laboured at 3cm? Consider holding space for those clients and others like them before we repost the article unthinkingly and unquestioningly?

It feels important to me to ask the question of myself and the communication I contribute to the discussion around birth; specifically via Caesarean birth.

And so in the name of desensationalising Caesarean birth, in the name of anecdotal evidence to allay your fears about the shocking headlines telling you the dangers and suboptimal outcomes of Caesarean birth: let me finish by telling you the last chapter of a beautiful birth story of a mummy and baby boy I know very well (ahem ahem blush blush) who ended up meeting eachother in the bright, blue, loving and gentle theatre of the OLVG through a stargate wound as opposed to having met in their living room after the full journey through the vaginal canal.

It wasn’t what they had planned.

It was exactly what the mother had feared the most.

But it was beautiful, truly beautiful.

It was deeply healing.

It was what she needed, despite having had a doula, an independent midwife and a best friend as birth attendants to try to  avoid it.

It was a whole host of things underpinned by a whole host of emotions; but it was their unique, wonderful birth story.

She experienced that heart burstingly ecstatic moment right there in the theatre.

The wonder.

The bonding.

The magical miracle of birth, albeit a different kind of magic to the magic she’d been hoping for but magical all the same.

Breast feeding worked out.

The wound healed perfectly and quickly with no infection or complications.

And to date there are no health issues to report in her son, partly because she reads all the articles she can on the health impact of Caesarean birth, and makes the choices that feel right for her and her family in order to best mitigate any “potential long term health impact”.

Words can’t always express the emotion of birth; but I believe these photos capture some of them – a big big thanks to Claudia Van Dijk (midwife from vive: vroedvrouwen in verbinding who took them.

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*Please note* no studies currently prove any link between babies who are born via csection to having a higher chance of having: a bad temper, longer eyelashes, multiple nipples, a recurrent ingrowing toenail, or a tendency to smile later (you’ll be glad to read).

I wish I had…

I wish I had…

I wish I’d been more prepared…

I wish I had read more about what to expect…

I wish I’d known that I could say no…

I wish I had known that I could question their decisions…

I wish I’d made a birth plan…

I wish I’d asked them to follow the birth plan…

I wish I had known I didn’t have to lie on the bed…

I wish I’d learnt how to breathe…

I wish I had waited before agreeing to induction…

I wish I’d known about the other choices…

I wish I had known I didn’t have to have constant monitoring…

I wish I’d been more assertive…

I wish I had been given a clearer picture of the consequences…

I wish I had really understood what a doula does…

I wish I’d had a doula!

I hear so many different mothers and fathers saying these things or variation on these themes.

Even long before I became a coach and doula, people have told me their stories and secrets. I often joke that I have a sign on my forehead that says “Tell me the things you would normally never tell a stranger”. I love hearing these details, despite them often being difficult or painful to hear. I believe passionately in people telling their stories, owning their stories, giving their stories space and time to heal, to evolve and to transform. Ultimately it is these eclectic stories I’ve heard that led me to become a coach.

It is a strange thing now as a doula though (perhaps it’s also that I’m a mother) that I catch myself so often wishing that I could have met them sooner, told them about the myriad of wonderful birth workers in Amsterdam that they could choose from – that their regrets over how their birth unfolded or how their trauma occured could somehow have been less painful, less rueful. It’s a nonsensical line of thinking though of course – because these experiences of birth; be they ecstatic, traumatic, blissful or agonising – have the power to reshape our lives and experiences and propel us into a new direction or simply propel us forward to begin to question the paradigms we had previously accepted without a second thought. And that is beautiful.

I’ve been privileged to have supported many second time mothers and fathers, and after having experienced a very different type of birth the second time round they say things laughing like “I wish every family could have a doula” or “I wish we had had a doula the first time” or “I wish every family could have the chance to prepare like we did this time around”

I previously wrote an article on “what a doula does” which goes into a little more comparative detail about what a doula can support you with compared to other people in the birth team, but I didn’t speak of how doulas can offer so many different support options and how affordable a doula can be.

Obviously I can’t speak for all other birth workers but I can speak for what I am able to offer aside from my doula support packages as stated here:

  • Birth Planning Session: 2 hours discussing birth, labour, post partum and induction/interventions in detail. I leave you with a few birth planning templates and review the document with you a week or two later over the phone/email. 175 per couple.
  • Best Birth Support Companion Ever: 2.5 hours teaching your birth partner “how to doula you” 175 per couple.
  • Birth Story/ Birth Trauma Healing: 2 hours speaking, counselling and coaching through your previous birth experience and ending with body or energy work to finish the session. 150

And two last points:

  • It is never too late to hire a doula! Don’t be the one that says “I wish I’d gone for it and hired a doula”! I offer a last minute package (if I have availability) which is priced at €695 for one two hour prenatal appointment, being on call for you 24/7 from the moment of hiring, and one post natal appointment. I am even open to you keeping my phone number in your phone and if you end up in hospital thinking “right about now I would appreciate having someone here to support us” then try me – whatever the hour!
  • To put the cost of full doula support into context, the Principal Doula Package will cost you less than 20 per week of pregnancy…doesnt it seem much more affordable when put like that?! Please see the testimonials page for more insight into how others have valued my services.

And the very last point(!) – my teachers Jennifer, Jacky and Joyce at JJ Doula Training have details of many student doulas who have completed the education with them but who are looking for experience – and a student doula support will cost between 200 – 350 in Amsterdam (level and experience dependent) for two or three prenatal appointments, birth support and post natal support. I’m happy to facilitate contact or you can reach out to them directly.

Doulas are for Dads too!!! A father shares…

Doulas are for Dads too!!! A father shares…

And then all the pursuing, the hustling, the meditation, the love, the fear, the struggle and the efforts to make your dream a reality is worth it….when you receive jaw droppingly lovely feedback from a dad you supported; a man of few words.

“I would like to have on record that I was initially sceptical about having a Doula present during my partners pregnancy and birth. After my first meeting with Ilena I was immediately put at ease and I am convinced that Ilena has had a hugely positive impact on the happiness and well being of my child. The whole experienced was very humbling for me and has improved my own relationship with my partner and children.”

“Outstanding. Ilena was a calming influence in the room and was available at anytime for both my partner and myself. I was very appreciative to Ilena personally for helping me during the experience when required. All of the techniques used during the birth were familiar to us as we had gone through them in our appointments. Ilena gave us the support and confidence to ensure the birth was handle in the way we wanted.”

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To put it into context further; this man stood by his partner’s side as her sole source of support at the birth of their first child. After what culminated in a traumatic assisted birth of their first, he was understandably a little apprehensive about the second upcoming birth due to having some residual feelings about witnessing that trauma that were not quite resolved.

He confessed that he was a little squeamish(!) too about certain things,  and was uncertain whether or not he could cope with the unfolding of birth and its mess at home, which is what his partner wanted in her heart. For this squeamishness we agreed upon a “safe” word between us; which he could say to me quietly during labour if he needed me to step in to support so he could take some distance and regroup.

This dad was incredible throughout the labour and birth***. He was his partner’s rock. He organised the birth pool between contractions, he pressed acupressure points, he massaged and rubbed at varying pressures, he had his hands and arms squeezed and squeezed, and he remained calm throughout; reassuring his love and ready with hugs, kisses and little jokes to keep the oxytocin flowing. He even cut the cord! Then managed to not succumb to nausea whilst I prepared a placenta smoothie(!) AND he never once needed the “safe” word!!! *** needless to say his partner; the labouring mummy, was an absolute goddess too! ***

Witnessing his experience of the birth story of his second child was already an absolute honour – but to then receive this feedback in black and white is indeed the cherry on the cake for me.

  • choose a doula who you both have a good click with; often our gut instincts when we first meet with someone will tell us whether or not we will get along. There are lots of doulas and birth workers out there; choose the best fit for you AND your partner so that you BOTH feel safe and comfortable.
  • birth trauma is real for men and partners too; let us acknowledge and honour it
  • processing those difficult experiences and emotions, making a comprehensive plan for every eventuality are invaluable steps in supporting a father in being calm and present during the unfolding of labour
  • a doula’s support can benefit a happy beginning for the whole family
  • never underestimate the depth of feeling from a man of few words
  • this quote is what guides my beliefs about my role as a doula:
“Our doula really helped bring me together with my wife as she gave birth. My wife remembers my constant support and never failing love or knowledge. She remembers the doula as a nice person who did some stuff in the background. We won’t give birth without a doula.”
I’m able to take a last minute booking for October, and have space for one more booking in November and December….and roll on 2016 – the booking pages and my heart are wide open!!!!
Please make contact using the contact form, email or directly on 0648688308 to arrange an acquaintance meeting.
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Feeling “connected” to baby during pregnancy

Feeling “connected” to baby during pregnancy

“Every orchestra has specific instruments and musicians, but you, the mother, are the conductor. You are writing your own symphony, you choose the music and the notes. If something is out of tune, you can change the music. You create the harmony. You are the maestro.”

excerpt from The Greatest Pregnancy Ever: The Keys to the MotherBaby Bond Tracy Wilson Peters, CCCE, CLD, and Laurel Wilson, IBCLC, CCCE

Baby heart headphones

As a doula in Amsterdam, I hear many confessions from pregnant women or women who have recently given birth. I say confessions because often it’s as if they hear the word “Doula” and then decide to offload the thoughts they haven’t dared to share with anyone else about pregnancy, or childbirth or the postpartum period. This isnt a new experience for me – I often wonder if I have a sign on my forehead that reads “Please share your most taboo thinking/intense life experiences/painful loss/heartfelt desire/dirty secrets with me”?!?!?! It’s all good – I love hearing these untold pregnancy and birth stories!

A very common pregnancy confession (that sometimes women feel so guilty about that they don’t dare to vocalise it) is that they don’t or didn’t feel very connected to baby.

Fortunately we are now very mindful of the fact that babies’ consiousness does indeed develop in the uterus. Annie Murphy Paul gave an excellent TEDTalk on the matter, and the documentary What Babies Want explores this in a very convincing and heartfelt way – both great watches if you find you do want to explore the subject of babies’ inutero consciousness (see also the links at the end of this blog).

As with much of our developing awareness though – this knowledge can be a double edged sword. Many pregnant mothers upon hearing that indeed baby’s consciousness is there from almost the moment you see the extra line on the stick or hear the words “You’re pregnant” become very concerned with making sure their unborn baby has only positive experiences within the uterus, and that she experiences as much love, connection and nurturing as possible before birth. Great! As long as it doesn’t become a means to tell yourself that you are anything less than absolutely incredible for carrying a baby inside your womb.

“People keep asking if I’m enjoying the mother-baby connection and honestly I just don’t know what that is supposed to feel like?”

or

“How do I connect with a baby that I can’t see?”

or

“It’s hard for me to feel loved up and connected to baby when I just feel like crap 82% of the time due to pregnancy tiredness!”

Other confessions along the same lines go

“I felt so sad so often during my first pregnancy – I was worried that when she was born she would be depressed”,

or

“I just don’t have time for this pregnancy – I’m running around after an eighteen month old who has just started running – I can’t keep up with him let alone focus on this unborn baby”

You get the picture. Why are parents so hard on themselves?!?!

Here are six suggestions as a quick “How To Connect With Baby During Pregnancy”

  • First thing in the morning or last thing at night. That lovely only half awake time when your eyes are probably closed, you feel way less self conscious and either the thought bubble (The Mind) is just about to switch on or off. As you’re adjusting your body to rest or wakefulness take a moment to place your hands on your beautiful bump and maybe just begin by saying “Morning Baby” (or Goodnight!) No need to say it aloud – though no harm in doing so. Once you feel comfortable doing this – you may even like to spoon in to your partner and invite them to say a few words.
  • Whilst doing something mundane or mind numbing. You’re washing the dishes or brushing your teeth, dare i say it – maybe you’re driving on a route you know like the back of your hand. This is also a great moment to decide to check in with how baby is feeling. Chances are you’re relaxed and just in the moment – baby may already respond to this energy and have a little wriggle around – focus your attention on your womb, perhaps this feels more comfortable if you touch your belly with one hand to make contact. Tell baby what you’re doing. Tell her it’s boring! Tell her it’s really not your favourite thing to do but that somehow it’s quite relaxing anyway. Tell her what you did today. Tell her what you’re doing later.
  • Guided visualisation or meditation. As a coach and doula in Amsterdam I often suggest to clients who are looking to build meditation into their practice but who find it difficult to switch off that they have a look on Youtube for guided meditations to listen to on headphones. That would be a great place to start, there are lots of guided meditations out there to try, and many women report finding a lot of peace and relaxation from the Natal Hypotherapy and Hypnobirthing CDs. It is also important to say that it is very very common for you to go “to sleep” whilst listening to a guided meditation, especially whilst pregnant(!) forgive yourself for this – and be reassured that it is all going in anyway! EDIT: I have also since recorded a few prenatal/pregnancy visualisations and meditations here and here!
  • Singing to baby. Something wonderful happens to us when we sing! We breathe differently, we breath deeper, our lungs expand more fully and our diaghpram needs to get to work to help us project our voices. If you are a power ballad singer in the car, if you are a musical star in the shower or if you’re an arena filling singing chef in the kitchen – keep on singing – and just set the intention that the song is for baby. Having a song or two that you sing repetitively for baby during pregnancy can be a wonderful calming and reassuring tool for helping baby to feel safe and calm in the fourth trimester – and beyond. There is a truly beautiful anecdote from Penny Simkin (doula and doula educator extraordinaire) to be found here – enjoy!
  • Going within: asking questions and listening. After having adopted a couple of the practices above – once you are able to recognise that you are connecting with baby in a deep and a meaningful way; then you may be ready to really take the contact with baby to the next level. Usually to really be able to pose questions and hear the answers it helps to be still and quiet. To be comfortable and feel safe. To know that time is stretching out ahead and you can really enjoy taking time to communicate with baby. Sitting down comfortably; if you are comfortable in the lotus position with your back straight and your spine aligned – great! Perhaps you’re more comfortable sat on a chair – a straight and well supported spine, both feet on the ground, perhaps you’ve been really using the birthing ball and are able to sit with a straight well aligned spine, knees wide and below hips, feet stable and supportive in full contact with the ground. Begin by placing your right hand on your belly to make contact with baby, and your left hand on your heart centre (on your chest).Take three deep breaths and focus on dropping your consciousness from your head into your heart. Take another three breaths and set the intention to connect with baby. Notice the warmth of each hand, notice baby; is she still, does she move? Invite the heart to ask baby how she is feeling. Notice. Breathe. Notice. Allow the feelings/instincts and thoughts to come up and take shape. Try not to judge. The ego will get busy telling you this is crazy, telling you that you’re imagining things. Just allow those thoughts; they too have their place. Ask again; ‘what can I do to help you feel better’? Notice. Breathe. Notice. Allow. Ask if there is anything else that baby needs to communicate to you. Notice. Breathe. Notice. Allow. And finally, what do you want to communicate to baby? Share. Notice. Feel. Breathe. Notice. Allow. Before you open your eyes, move around and get back to your day – take some time, take space together, feel the gratitude, feel the peace, feel the calm. Then >slowly< come back to your body, open your eyes, stretch and pick up your day.
  • You’re always connected anyway….Remember this. Go about your day. Just be reassured that baby is listening, baby is feeling, baby is sentient, baby is connected to you; you are connected to baby – baby is within you. Baby is coming to earth, and earthside there is a whole range of emotion, of feelings, of experiences, of connection, of disconnection. Baby will get to taste it all. You are unequivocally connected to baby every second – waking or sleeping. And maybe that is enough for you to remember; actually you dont have to make a conscious effort to “connect with baby” because baby is connected. Let me say it again: you. dont. have. to. “DO”. anything. Be aware of the connection. Don’t scaremonger yourself about any “negative” experiences being “bad” for baby. By all means – focus as much as you can on the positives – beautiful if you can mainly be in this state, but if there are things going on in your life that are stressful, that are out of your control – let it go, try not to get hung up on it.

Here are a couple of other links for you to look into on the notion of mother-baby connection and evidence for it’s positive impact on pregnancy, child bearing and the immeditate post partum period, if you have any to add or if you have any heart warming anecdotes to share on the topic: please comment below!

An interview with Bruce Lipton called “Happy Healthy Child: A Holistic Approach”

The inspiring Dr Christiane Northrup posted a wonderful blog about “Waiting for Baby” which covers some other beautiful visualisations.

Lastly: image credit unknown – I would love to attribute this beautiful image to it’s rightful creator so please make contact if you know the artist.