Weekend babies on the NHS

 

I woke up this morning and as is my habit, tuned into LBC.  I like to keep up with what the great British public are thinking about and medicate my homesickness for London.  This mornings birth news story was repeated over and over again. A discussion began about what can make birth safer. I asked a non-birth world friend (already a parent three times over) how they would feel if they were having a baby now and they came across this article “……frightened….like I would want to do the impossible and try and keep the baby in if it was coming on the weekend……” of course – this is a reasonable response to hearing that one in six baby deaths during birth at the weekend in England could be avoided.  Tuesday is the safest day.  So what will happen now with parents?

Tuesdays will be over run and I can imagine many women deciding not to turn up at the weekend if they can avoid it and maybe if they can’t too.  Not turning up when they are worried about their baby, not wanting to have an induction on a Friday, if they burst their amniotic sac of fluid, if they would ordinarily be ready but staying home that extra night in fear.  Fear we know is an adrenalin producer. Adrenalin we know is a direct inhibitor of oxytocin which is our love hormone.  Physiologically we need oxytocin to make our cells contract to open the womb for our baby to get out.  We are designed so well – this means if something frightening happens we can stop giving birth and deal with it.  It’s troublesome to not be able to produce it in abundance because you are freaking out your baby is coming on a Saturday night.

This was no small study – it can be found in its entirety here.  Imperial college London analysed 1.3 million births and found that babies were 7% more likely to die during birth or in the first week of life if born on a Saturday or Sunday. Infections after birth were 6% higher and the chance of the baby suffering an injury was also 6% higher.  Researchers found clear evidence of poor care and this was not due to a lack of senior doctors either.

So what can we do as mothers and fathers to counterbalance this?  Carefully considering your place of birth is a really good place to start.  What will be safest for you? Where will you feel safest? What is their reputation? You can often find feedback sections for maternity units on their websites and we are also in the fortunate position that we have an independent organisation that collates figures and facts called Which? You can find them here. The Birthplace Study has found that home and birth centres are generally safest for most women – even high risk – you can read more about that here.  My experience supporting at births over the years reflects this.  At home you have two midwives dedicated to caring for you and your baby and they can go nowhere else – they are with you constantly once you call.  We imagine that labour wards with doctors, equipment, theatres and medication will solve all manner of ills and there is no doubt at all that they can be very useful when needed but with all of those technologies come a further degree of risk – seemingly we are frequently introducing this risk to women and babies without having the staff to monitor as closely as needed or indeed the capacity for surgery that is needed once those higher risks manifest.

Also thinking about who you may choose to have with you can make a real difference. Having another woman with you who has given birth before has been known to greatly reduce risk. It significantly reduces the chance of c-section, instrumental delivery, induction, epidural and ups the chances of breastfeeding – this all lowers risk considerably.  Have a look at this piece of research here. I had my sister with me for my babies but this may also be your yoga teacher or someone who does this professionally like a doula. You can read more about doulas and find one near you here.  Doulas are fantastic at lowering risk. Why? They are on constant watch to make sure you have all that you need and sometimes its the doula who spots the clinical risk when the professionals haven’t. This is a very controversial issue as it is most definitely out of their scope of practice but what are you supposed to do when you can see blood pooling under an increasingly pale woman and the midwife is tapping away on the computer in the corner? When you see your maternity notes being handed to another woman who’s going in for her antenatal appointment? When a woman is convinced she is having a stroke and no one is listening to her? (I spoke with three midwives before a doctor arrived about 45 minutes later to check out the patient) When a baby is actually coming out and both mum and dad are saying this and the midwife is still asking who the GP is whilst again tapping information into a computer while dad is shocked and trying to catch? (in this case mum was a doctor). When syntocinon (a hard-hitting synthetic version of the  hormone associated with greater risk) is clearly going into a womans tissues rather than her blood supply and her hand is swelling and swelling? These are all real life situations I have personally witnessed and I could go on before I even begin to add in all the others I have heard of as a mentor.  This isn’t an attack on midwives and doctors – I’ve seen and know many who do a fabulous job at doing their absolute best to keep everyone safe and loved.  It seems to me that these over sights are often the result of a HUGE amount of bureaucracy and policies and procedures and machinery to read and attend to before you can fully concentrate on the mother.  We know that their is a problem with listening – this article here helps you to understand that. We are currently spending millions in the NHS on the Compassionate Listening programme. Alongside serious staffing issues which are clearly much more to do with not funding enough midwifery posts to deliver the standard of care that keeps everyone safe and supported including the midwives and much less to do with a shortage of midwives.

Something needs to change. My first thoughts when I heard this headline this morning were that this would generate a whole lot of unhelpful fear and stress. With some reflection I think what it also does is open up the discussion that when we are overworked and over stressed we cannot work safely and we need to be having that discussion over and over until something changes. It’s just the human condition. Now this is out in the open we can begin walking towards change one step at a time keeping mothers, babies and staff loved, safe and happy.

nicola mahdiyyah goodall is a revert muslim who grew up with hip hop based in edinburgh, scotland and london, england. she works with women trying and mainly succeeding to build circles of knowledge and community primarily with birth. read more about her and find out how to access her services here. she is now also part of a new doula collective in london called birth in the city launching 2016 – watch this space!

she is also the director of wysewomen publishing and facilitates wysewomen workshops and red tent doula courses.

 

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Birthing with Sisters

Birthing with sisters

 

“When someone else speaks of a similar experience, it can evoke the memory and bring back the feelings, which restores the experience. Only if we speak from personal experience does this happen. This is why we need words for women‘s mysteries, which, like everything else that is of women, seems to require that one woman at a time birth what she knows. We serve as midwives to each other‘s consciousness“.

Jean Shinoda Bolen  

“Crossing to Avalon”

 

On a quite afternoon, as Scotland’s weather seems to show it’s magic with mist and rain. We were drinking tea in Nicola’s kitchen and talking about womanhood, sisterhood, birthing and life.

 

Me: Nicola, tell me, about your doula journey, how did you get to this point where you are now? How did you become a doula? I know you may have talked a hundred times about it, but maybe some new angle…

Nicola: Well It‘s really good to think about it every time. I have a very fortunate set of circumstances. I came to have my children in this community where everybody seems to have babies at the same age as me. My sister was there with me and had already started her family, and my family. Nobody was really bothered, they had their babies easily. I was really fortunate, because I had never thought how frightening it could be.

Me: So you were not damaged?

Nicola: Yes, I think I wasn’t  (laughing). I was protected. All the bad things that I was told, It just didn’t sink in. I don’t know why, maybe that’s the way I am. I never expect things to go wrong. I am upset with people when things go wrong, but I get more upset about the brutality of bad treatment. When the midwife comes sometimes it is just the government health program, it’s not midwifery. It becomes a tick box exercise, like  OK “I had you in the hospital”, “Ok, I am filling out my notes”, “Ok, I am going”. No words like “Hurray, you have a baby, it’s great” or “how you guys doing?”, “how do you feel about it”.

Me: Working through all these years, do you think this attitude changes?

Nicola: I think they don’t have time and resources to practise true holistic midwifery. I think it is getting worse, because they are under more pressure now. When I had my first baby twenty years ago and I had named midwife, I really connected with her. I will never forget her. She caught my baby and  I was told to go to the postnatal ward at 1 o’clock in the morning, and my husband is going home. I was in my early twenties. She obviously saw my face and she told me “I am going to take you there”. She took me upstairs and she sat at my bed for about 2 hours drinking tea with me. This is extraordinary in our health service. This is never happening in our local hospital today. No midwife is coming and sitting with you. It’s just not going to happen, because they are so overstretched. It would be like disappearing from their job for two hours.

Me: This is the thing, that amazes me all the time, how birth is related to initiation. This is such an intense experience and you are very vulnerable at that moment. If you get stuck in there, it can be so damaging and painful, and you will have to walk a long way to heal these wounds. It seems like a lot of women are carrying birth traumas in our time.

Nicola: It’s shedding. You have to shed. My last daughter is in puberty and she is in this hormonal “I am angry”, “I am crying”, “I don’t know what’s wrong”.  I gave her a cuddle and said “we are really lucky that we have this shedding, that you can shake all the things that you have to shake off to become a woman”. We have this before every cycle. In our bodies we have to shake off, to prepare for a possible new baby. It’s  happening in the menopause, in your wise age. A lot of women are really angry having premenstrual stress, or they don’t know why they are so angry when they are pregnant. Its very important to go through it, not to be medicated, to have somebody with you who knows about this. It’s sad, that most people don’t have that.  

Me: I think we are coming to this question, how would you explain, what you do as a doula?

Nicola: I had to think for a long time about this. I decided, that a doula should be the ultimate faith bearer. She always believes everything will be ok – in an almost worshipping way. Even if something happens, it’s still going to be ok. You believe, that woman will walk through whatever she will have to walk through. It can be hard, but eventually it will be all right. You have to be the person with your feet on the ground. You have to give them love. You have to really give them love.

Me: It seems, that doula work is so related to the shamanistic way. You go through something, that seems like chaos. The shaman tells you, that’s the principle of life, that’s how it works. Suddenly everything clears out. It’s like Jung would say, in every chaos, there is a cosmos.

Nicola: I think, that midwives were shamans. You still find midwives around the world creating ritual and ceremonies. I was talking to one Native American guy, who used to be in a difficult place, but now he is helping the young people when they are in the same situation as he was. He is using traditional ceremonies and rituals. When I asked him what he does for a living, his answer was: “I am healing the next seven generations and the previous seven generations”. He is saying, that the good birth, and a good birhkeeper is also doing the same thing. If you have a good birth, you are healing seven generations back and seven generations in front. So the good birth keepers are shamans, and these are authentic ones.

Me: It reminds me that when I was pregnant, everybody was expecting that I will give birth the same way as my mum and grandmother did. It’s such a powerful feeling, when you go the different way, when you have the opportunity to experience, to relate to these powerful events in a different way. It’s something like healing in your mother line and you can pass something different to your daughter.  

Nicola: Oh yes, it’s such a powerful healing, that you can change that pattern, you can break it, you can almost break the spell. I had a talk with one woman. She was expecting her second baby. Her first baby was stuck in some way, when she was pushing. It was the same when her mum was giving birth, and her grandmother too. So yes, it might be something physiological, but it might also be some psychological pattern. She has to think about it and discuss it with her daughter. To work something out.

Me: Do you see any changes in relation to birth in the women that you are helping?

Nicola: No…Well it’s more popular now. They are and will always be women, who are giving birth. There are more people, who realise that the national health service is broken and that there is a lot of things missing, and there is some danger in that struggling system. I had one woman, and she was so badly mismanaged, from the medical point of view, they created so much more risk for her, she may have been better birthing in her room on her own.

Sometimes I think, that you have to hit the wall, to jump back. Something like that is happening in our hospitals.

Me: In my country Lithuania, we saw, how dads came to the birthing room. Now it seems normal and is encouraged even by staff. But doulas are something new and a lot of rejection is going on. I hear a question – why do you need other person? If you have the father at the birth.

Nicola: Women were having other woman come and be around them when they had babies. When they started to go to the hospital eventually somebody said, you can’t bring your mother anymore, because they are getting in the way. So it’s natural for women to be with other women during birth.

I have seen much research, that showed, when a doula is present, the father is more relaxed and active during birth.

It’s really important to remember the history, how fathers get into birthing room. We campaigned  for men to come to the birthing room to protect their woman, because they were so violated and brutalized. Now this is the cultural interpretation, that you are there as a man, and this is bonding, watching your child being born and supporting your woman. But it’s not how it started. In hospital everybody is listening all the time to see if something will go wrong – they listen to the babies heart beats, they check her blood pressure, everything around is geared for something going wrong. Usually when something goes wrong or risky, dad will listen to midwife, of course. The subtext is that you have to listen, otherwise your wife and baby will be in danger. So they always act to keep their child and mother alive and well. This is natural and very healthy. For dad to go what his wife would say and not what implied risk from health care provider would be radical.. So that’s why doula should be there in the first place. She is someone different, saying like me, everything will be all right. You have choice – this is your decision.

Me: I think women bring different things to birth. It brings a lot of things in our life too. I want to ask you about sisterhood. I have this impression that more and more women are gathering, sharing their experiences, talking and appreciating their womanhood. How do you see those things?,

Nicola: Well, I think this is a natural part of society and the problem is, that we destroyed our society. We’ve gone from the village to the town, to the city and we lost the community. This is an unnatural way and a lot of problems come from there, like the epidemic we have of depressed women, who are basically drug addicts with prozac and the like. I saw my mum taking everything from the doctor, pharmacy and everything she could get her hands on to deal with her difficult unsupported  situation. What we do with our older ladies here? We treat them so badly and make them so lonely that we have another epidemic of mentally ill older women and then we put them in the care home. Its awful. I need these women – my children need these women – this should be the easiest and most appreciated stage of our life. The natural and healing way for women is to go together.

Me: I am reading this extraordinary book about “Dreaming sisters” by Diane Bell where she studies Aboriginal women’s lives from a woman’s perspective. A women has this big house, where old women, widows, lonely women live there. The wise women are in charge. You can go there, just to sit with other women, to spend time, to get help, support, to live there. They have their rituals, celebrations. It made me feel, that this is the way how women become strong and secure. You have all the time this sisters, where you can find help, support and peace.

Nicola: Yes, it’s so true. That’s natural human behaviour. This is Fitra, the Arabic word and it’s so true. Fitra is our inner nature or our code that we are born with. Like a baby knows where to find a breast.  You feel this in your body. You respond to those kind of things, because that’s how we are supposed to live.

Me: There was a lot of devaluation in women’s relationship. It felt like it’s ok to be in the family and the relationship are important and respected there. But when women go out with their friends, society sees it like shallow time – gossiping, shopping and pink fluffy stuff.

Nicola: Yes, I think we really have to stand up for that and say “what’s wrong with women getting together?”. We have to be that person that stand’s up and says “grey hair is beautiful, old age is not ugly, that’s the sign that I went too far”. Every other culture in the world appreciates it as wisdom, beauty, knowledge. You have to be the renegade. One of my teacher says, that you can tell the renegade by the arrows in his back. I am looking forward to being a grandmother and having grandchildren, everybody is running away from this among my peers. But I am getting shot on that, because it’s not an easily understandable thing in our culture right now. So we need more people standing up and saying “shoot me down, I don’t care, but I believe…”

Me: I’ve noticed, that men started to appreciate those women gatherings too.

Nicola: Definitely. It’s really good for a man to have a strong woman with a good circle of friends. This is the problem with the common structure, if we don’t have it, we put everything on the men – they have to be the mum, the aunty, friend, lover, husband and so on. It’s impossible for one man to carry all these roles.

Me: I think womens circles are very important when you have your baby. Those Australian aborigines can’t understand how woman in our society with a little baby is living alone in those flats-cages and sometimes spends all day long alone.

Nicola: Yes, and I think it breaks a lot of them.

Me: I want to ask you about postnatal support. It seems, that a lot of things are happening to prepare women for birth, but the postnatal period seems a little bit more left out. What do you think?

Nicola: I think postnatal support should be just as important. We have to undo a lot of miseducation, for example about breastfeeding, it used to be understood that the bottle is safer, easier. We have to get the basics. We have to talk more about the rest period after birth. We have to spread the news, to talk, that this is going to be better for you, you will be happier, you will have calmer baby, you all will get together as a family.

Me: In old cultures they have this ceremony after birth. In Lithuania the women went to sauna, and after that it was the celebration to welcome her to the society. How do you think, what’s the meaning of that?

Nicola: It’s very important to honour your transitions as human beings. We do really badly in this area. We are not honouring toddler’s, teenagers, we do nothing for menopausal women, we do very little for parents. We have some baby showers but little of any depth.

Me: But sometimes it seems like more for present, then for spirit.

Nicola: Exactly, empty. I think it is really important for women, after doing such a big job, to be acknowledged, to celebrate this with close ones, to hear, that “we are here for you”, “you are fantastic”, “here is food”, “we are here to help you”, listening to her grandmothers stories with their babies is really important, this is giving everything that they need.

Me: What do you think the most important thing for taking care of women postnatal?

Nicola: I like to cook. Because I believe, that with cooking you can really nourish people.

Me: Yes, one of the most vivid memories most people have are their mums cooking, all these tastes, smells, warmth. It nourishes not only your body, but the soul too.

Nicola: Yes, the food is really important. It makes a good environment to hang out, to talk. This is very natural way.

Me: I’ve noticed, when you are doing some kinds of work like cooking, grass picking, sewing, the talk goes very smoothly and very deep. It’s like healing.

Nicola: This is relative, I think, to different brain activity. It’s like meditation, knitting and something like that. You busy your hands and it’s related to your brain. We need that more.

So lot’s of talking.  The feedback that I get, the good doula does a lot of listening. I always say to doulas, that you have to go in like the best mother that she could have. So you are not judgmental, you are encouraging her. Of course you can be firm if you feel that. But loving and caring is the most important thing. “Go take the bath, I will be with the baby”, “I will wash your hair”, “I will make soup for you”…

​Me: It’s so good to listen to that.

Nicola: Yes, I know. I would like to have that. We all need that and we all should have that.

​Me: What are the happiest moments for you as a doula?

Nicola: Well …seeing parents happy in their bed with a baby, having had the birth that they wanted, appreciating the impact that made on their lives. That’s the happiest moments. It’s such a good start. My best moments are after VBAC birth. When a woman had a caesarean the first time, and she is told that her body doesn’t work properly, you are broken, you are useless. When you love her, prepare her, give hope and trust her and being there, when she gives birth vaginally and saying “I am not broken at all, I can give birth” This is so empowering and a healing experience, to have a normal birth after caesarean trauma. You can transfer it to your life. In a broader sense.

It helps us believe, that we can do a lot of things, if we want. It‘s really powerful. Birth does that, for growing women in society.

one muslim woman thinks out loud

this morning i woke up in so much turmoil over the broken heart of our planet. i found an email from one of my colleagues in my inbox asking me to explain what is happening. i became a muslim almost 25 years ago and spent many years delving deep into my religion to understand it and also break apart the illogical things i was seeing and hearing amongst some of my community.  i wrote the following response and i want to share it with more than one woman.  i need to do something positive every day right now alongside my prayers for humanitys healing. i believe the birthkeeper has always been and will always be also the earthkeeper – we have to be involved in peace keeping.

“…..my heart is also bleeding – i came out of my bed this morning and dressed to go and walk in the woods for healing – i cried last night – there is so much pain in this world and the media are highlighting it right now – the injustice of who we choose to mourn for is particularly pulling on my heart strings – a life is a life – i think of the mothers and the pain they hold….the mothers of the victims…. the mothers of the bombers…. the mothers of the politicians….
you know muslims are just human beings like all other human beings – those who describe themselves as religious and those who do not…those who call themselves muslims or christians or buddhist or hindu or jewish or atheist….this we must always remember and those who commit abhorrent acts will often find some justification somewhere …when i was continually harassed and attacked in my headscarf when i moved to scotland (i was pregnant with two babies) i didn’t once think this is a christian problem …. we mustn’t forget the transatlantic slave trade was built on the bible – the africans (and many europeans including many of my irish ancestors) were seen as animals of burden – how does this sit in the human mind?  i do not understand it – captured, shipped, beaten, raped and worked to death under the guise of the teachings of jesus – the awful apartheid situation in palestine is built on the torah – the terrible atrocities in myanmar are built on the teachings of buddha …these are all peaceful texts with love at their centre. men will twist and alter even the purest word and intention to suit their own ends….there will be men amongst them that go against the peaceful words of these holy people and use them to cut others out of their gang – out of heaven – out of humanity because they don’t abide by the same code as they do even though all these codes tell you to be kind to others outside of your understanding of faith and be good to them….my benchmark for muslims is what God tells me should be my benchmark – only judge a man or woman by their taqwa – by their piety ….when i meet a muslim i want to see them acting in the muhammadi way (the bad behaviour you have experienced is not the muhammadi way) when i meet a christian i want to see the way of jesus – i want to see the light of mary – i loved the “what would jesus do” bracelets – i think like that all the time – is the light of God present?….noone can tell you you are not a human being because you are not a muslim, because you are african, because you are european, because you are a woman, because you have a disability, even controversially because you are a terrorist – we are all creation – we all come from Her…what you must remember is that people misinterpret verses of the holy texts as well to support their own ends…when we look at the word jihad for example jihad means struggle for God – we find that we are taught that the greatest jihad is the jihad of the ego – we also have the very robust teaching that we can only wage defensive war and not offensive – we have verses of the quran telling us that to take one human life is like killing all of humanity – it is very clear but in order to move towards gaining their own ends half the verse will be left out – the context will be left out ….do we think ANY of the holy texts condone violence against women? no of course God would not condone this but they have ALL been used to justify it
i really hope this has been of some use – lets keep doing the work we do to spread love and increase the capacity to love in this world ……”
we must not despair. we must not give up. we must not join in the hate and match it. we must match it with love. love is the only way.