How we are groomed in healthcare.

This post may be quite a difficult read for both professionals and parents.

If you feel you need some support then please call you GP, a mental health charity or call a trusted friend.

When we think about maternity care  we envisage wonderful people who just want to make a persons life better. We think of caring humans who are doing what they can to keep people alive. 

Yet within this grooming is happening. And yes, the same tactics that the typical vision of a groomer of young girls does also happen in maternity care. 

How? Many ways. 

Coercion is the big one. Coercion is actually usually done very subtly and in many forms.

Power imbalances play a part. The NHS and maternity system is seen as some amazing institution (it is) and the people within it often seen as untouchable. Yes, maternity staff are very knowledgeable, they are also human, with emotions and biases. This is OK. They do, however,  hold a lot of power and with this means that those who aren’t as knowledgeable, appear to  have less power. With every power difference those that hold higher perceived power can very easily coerce. Simply because we are taught to believe what the professionals, those with authority, tell us.

We learn this at a very young age through our parents and teachers. Learning to listen to our parents isn’t a bad thing as it keeps us safe. Believing everything anyone with some authority tells us does not necessarily keep up safe (look up Milgram studies in authority for anyone interested in the deeper psychology.) 

A typical abuser will assert authority in order to control an manipulate/coerce. 

Language used in maternity and health care is often coercive. Think about conversations that are had around deciding a plan of care. “I’m not allowed”, “you’ll be against medical advice” etc. If you feel you cannot say no then it’s not consent and is legally assault. 

One for professionals who say “my ladies”, perhaps we should be using alternatives such as “women I work with… women I support”. Using the word “my” implies ownership. It implies control. 

Then we have gaslighting and guilt tripping involved. Gaslighting is a series of techniques that make the person its being done to feel confused and like they are wrong. Done to assert control and power. 

I would say, controversially, that birth debriefs (especially by the same person in the same unit) are a form of gaslighting the parents. (But debriefs are a whole other topic for another day) 

So, how does gaslighting exist in maternity? Usually if you’ve had one thoight and then come away with a different thought and not really sure how it happened. A lack of informed choice is likely happening which is coercive as the full information hasn’t been given therefore gaslit and manipulated into one way.

Again, this is not saying maternity workers are just abusing women. They’re not. There’s a systematic and societal problem teaching people that authority and power is good. 

As a birth worker and mental health worker it can be easy to assert authority to get someone to react favourably to your needs and often many do not even know they are doing it.

I believe if everyone has their power then no one needs to take any. 

I’ve worked in healthcare for around 18years now and we are STILL having the same conversations around power, control, coercion. This is NOT acceptable. It’s time to change this.

When a family asks questions we don’t like, let’s not scoff, let’s not talk about them in the staff room and definitely not in network meetings!  Take it to supervision! 

Let’s give workers decent supervision. Let’s give them decent breaks and pay. Let’s not burnout our care workers. Don’t accept toxic workplace environments. 

Parents, ask the questions, you have a right to know, you have a right to say no. Healthcare workers are there to care for you, but they are not the authority of you or your baby, you are. 

In short, society grooms is all to listen to authority. We’re therefore groomed to do whatever we’re told by healthcare staff. Healthcare staff do want to help and support. We need a huge societal shift but we also need to challenge behaviours that don’t allow for choices to be respected. 

Treating trauma -CPD isn’t enough

I’m just going to say it. You can’t treat trauma on a few days class.

This may be somewhat controversial and is short and rambly. I may write deeper later.

Trauma is a complex psychological and physiological situation that even the highly experienced and trained academics and mental health workers continue to discuss. 

There’s quite the influx in people doing a 1-3 day course and then selling themselves as “trauma specialists” and that they can “treat trauma”. A lot of these courses require little to no previous experience or training. (I wouldn’t count most Doula training courses  in being adequate enough and would even question whether some degrees are). 

With something such as trauma, a person seeking help could actually have worse outcomes from someone inadequately trained than they would without. I’ve seen it, I’ve had health workers contact me to ask if it’s our doulas providing this “treatment for trauma” as women have reported horrendous outcomes. It isn’t. I know our Doulas aren’t able to do that. That’s why we have Counsellors with trauma training and experience. Yes, therapy can make things feel worse before it gets better but it seems there’s a lack of this with such training. It’s really not possible to learn how to hold the space within trauma within a few days. 

Doulas are amazing and can help massively in subsequent births but they do not “treat traumatic birth” nor provide “healing birth services”.  Midwives also can’t treat trauma. What we can do is help to inform and aid a peaceful birth space. As birthworkers we really need to look at where our competencies lie. 

If you’ve done a few days training in trauma awareness or “birth trauma treatment” then it’s really not likely you can “treat trauma”. Even if your clients don’t return it doesn’t mean you’ve done the job well and they are cured. It’s likely your training taught you how to respond to trauma and that is great and fantastic knowledge that’s needed and more of it. 

As I said at the beginning, trauma is complex. There are whole degree modules and postgraduate qualifications in the area. In working  in counselling and psychotherapy I know that just because a person doesn’t return, it doesn’t mean they feel better. 

The emotions and feelings associated with trauma do not tend to fit a neat little package. Being trauma informed is great to help with understanding and how to not further impact upon trauma as professionals. This and other cpd type training can not possibly be adequate. 

If you do want to learn about trauma then please check the qualifications and background of the person doing the training. 

If you are in need of some support with your own trauma then please check what the training of the person is and how long they trained for. 

Spoon theory in new parents

Spoon theory is usually spoken about in relation to those with Chronic illness, such as fibromyalgia, ME, migraines. 

It is the theory that a person has so many “spoons” to use in a day and that some tasks take more spoons than others. So, getting dressed may take one spoon whereas the school run may take three. 

And that once spoons are used then fatigue and other symptoms take over and the person is “down” for a period. 

I think this can also be transferred to new parenting. It’s well known that a lack of sleep impacts upon physical and mental functioning and new parents are lacking in sleep. However, new parents can become quite resilient to the lack of sleep. 

Lots of new parents report feeling guilty for not being able to do everything they feel they should be able to. But everyone has an amount of spoons. Maybe you have 10 spoons a day, take a couple off for a bad nights sleep, and you can see how everyone has limits. This is ok and healthy. 

Some days you may have more spoons so can do more and other days are depleted. Parenting isn’t always easy and takes energy. 

If we think about everyone having a level of spoons then we can begin to understand why some days seem better than others and how we can accept a day where things aren’t happeningZ 

Some days have more spoons, some days have more stressors, some people have more spoons. 

What takes your spoons? 

What gives you spoons? 

Postnatal depression reflections (part one)

Over the lockdown I have been watching some old DVDs of family moments.

I’ve gone back to being pregnant with my eldest (age 19, 15 years ago) and through his baby days and beyond.

Looking back at the times when he was a baby/toddler I felt a pang of sadness. I wanted to scoop me up and tell me it would all be OK! 

It took about 6 months to fully hit but I suffered from deep depression and anxiety for a good while after. Even watching  his first Christmas video I feel the anxiety coursing through as if I was back there. She’s still me, the 20yr old new mum is still part of me and she always will be. She has shaped who I am today, I doubt Snowdrop would exist had I not gone through those times. 

These old memories have been very much present in my mind and body when watching those times. Those memories shape things I do today too, I can  feel anxious in certain situations and will react in ways I remember doing then, the feeling of dread making me want to run. Sometimes I do, and that’s ok.. I’ve had a lot of therapy over the years and continue with these feelings coming up (even therapists have their own stuff to deal with). 

Watching these films have shown me that I have come along way and also acknowledge just how ill I was. 

I say I want to scoop her up but then what would I actually say? 

I know “it’ll all be ok” wouldn’t mean much to 20yr old me. She’d scoff. 

What would I say? 

I had zero confidence or self worth then. So maybe id need to hear, “you’ve got this.”

What would you say to a younger you if you could? Hard isn’t it. 

I think holding or simply a hand on shoulder would be enough. Knowing it’s ok to cry, be angry etc.

Those old feelings have definitely risen during lockdown. I think because I’m those times 15years ago my illness made me lockdown. Walking out the front door would give me an actual panic attack and now I’m forced in to some extent.  

Supporting new mothers going through similar situations I am aware of similarities and also the vast differences we can experience. I suppose I’d want to be more kind to myself as many mothers I support find helps. Just being there and riding the waves. 

I can now see those black moments do not last. There may be fleeting moments but they do not last and the black days can become fewer and manageable.

Watching these DVDs has shown me (reminded me), that people can go through some tough times and grow amazingly and that hindsight is a wonderful thing. 

Reminds me of this quote,

“Forgive yourself for not having the foresight to know now what seems so obvious in hindsight.”

How we shame women. (Part one)

I can see this maybe developing into a series of posts.

Having watched and participated in a few twitter discussions recently between mums and professionals I’ve been thinking. 

Can we ever really not be coercive in language? 

With health professionals (I’ll include doulas and Counsellors within that label) we strive to give information that’s the best for the individual. As Doulas we are not bound by the stricter policies that are within the NHS but we do have to be careful that we provide evidence based information. 

I think there’s a problem in that in itself. “Evidence”, by its very nature, is biased. There’s always an element of researcher bias in studies. A good researcher will eliminate that as much as possible but it still exists. 

When giving information out there’s also an element of bias. I’ve witnessed it far too many times a health professional giving one side of evidence and this is not enough for informed choice. Informed choice being when a person makes a decision for themselves (autonomy) with all the benefits and risks for every option available. I know myself that I have my own views on what’s best for myself, yet that is not the same for everyone. 

For instance, one particular Twitter conversation/topic  I’ve been following recently is around breastfeeding. Some suggesting that the benefits of breastfeeding are negligible in a country such as the UK. I have read the research around this and it seems fairly solid, however, over the last 15 years I’ve read a lot more telling me the benefits of breastfeeding far outweigh benefits of formula. I’ve always questioned that this doesn’t take into account the individuals. The benefits for one family  is not the same for all. However, the health benefits of breastfeeding, without other factors, do outweigh those of formula. For instance formula does not have living immunoglobulins (the part of the immune system that helps fight diseases and infection). 

An example I often remember is when I supported, as a Doula, two families who worked in NICU. One wanted all the drugs possible and to be in an obstetric unit. The other wanted a possible home birth. Both said they were choosing this because of their experiences in work. To me, I thought that was a fairly stark example as to what’s best for one is not always what another will choose for themselves. Medicine and health care should never be a one size fits all approach. 

Back to the twitter topics around breastfeeding and I am reminded that maternal mental health is majorly important, not only to the mother but also to the baby and wider family. Successful breastfeeding may be important to mental health to one but being told “it’s ok to formula feed” could be of huge importance to another and, actually, for that family the benefits of formula could outweigh the benefits of breastfeeding. As a big advocate for breastfeeding and also mental health of new parents, it is definitely important to remember this. 

There should still be better support around breastfeeding but I do feel that there should be more around mental wellbeing of new families. I think there’s better support for breastfeeding than there is for mental health currently in the UK, although this could vary in different areas. If we support better mental health care then this should include infant feeding and the relationships within this. It’s widely known that oxytocin if a hormone that helps with bonding and mental health (amongst other things, such as orgasm) and this is needed for breastfeeding. So simply biology would conclude that breastfeeding increases oxytocin and therefore is good for mental health. However, some have a negative feeling around oxytocin. There are theories about the “dark side” of oxytocin in particular in relation to trauma survivors and how the brain learns that oxytocin feeling can also be linked to not so pleasant experiences. In those who haven’t really experienced oxytocic feelings (there is some research that many women have not ever experienced an orgasm) then it’s also said that the feeling could be a little bit scary as any new thing is. So, it definitely isn’t a once size fits all. 

Perhaps, currently in the UK, the risks to the whole family of current levels of mental health support outweigh the risks for the current level of breastfeeding support. It may be safe to say that the level of breastfeeding support for families is better that the level of mental health support. I’d suggest that is actually the case local to me where we’ve Gold standard BFI

Giving a bottle of formula or expressed milk is not a fix to mental health for many but I do acknowledge that for some, to be told it’s ok to not breastfeed may be of huge importance. The pressure put on new mums is huge and detrimental in many ways. Society really should change this. (This is a whole other post!) 

So, back to coercive language. Any policy, procedure, guideline, I would argue is coercive. They tend to require an outcome with certain ways to achieve. With little flexibility it can make it difficult for health care professionals to support, or inform, all choices. I’ve heard many say “I’m not allowed to tell you this but…” and actually that information/advice has been highly beneficial to the recipient. 

I, myself, have been in trouble many times when I’ve worked in the NHS and other care services, from doing things “out of policy”, even though those professionals agreed that what I was doing was of benefit to the person. (Usually simply sitting and listening with a person who just wanted something simple.) The phrase, “against medical advice” is always a really manipulative one, I feel. “Against medical advice”, usually means against a policy, or even a personal belief. I have supported many women who choose to do things “against medical advice” and each one of those decisions has been from a place of being fully informed of all the angles, usually having only been given one side by those medical professionals and once the other evidence is presented the response is simply “well this is against medical advice.” There is a culture of power and authority seeming to come from medical professionals and that is very coercive in itself.

Let’s remember the authority should be with the woman and the family. 

Coronavirus reflections

As the coronavirus pandemic hits everyone in the world, we, at Snowdrop Doula Community Interest Company, reflect on some on the things we are experiencing in supporting women and families as they navigate their pregnancy, birth and life with a newborn. 

I support women and families through the perinatal period as a Psychotherapist and Doula. I also manage a team of paid Doulas and volunteers, working with all complexities and families that one can think of. 

With the current global pandemic, the same concerns are being expressed by all who make contact. Women are concerned about their pregnancy and how safe it is to be going anywhere. New parents are concerned around going out of the house as, they feel, the baby could pick up the virus and become seriously ill. There appears to be a lot of confusion about the rules and each day this seems to change and cause further confusion. Women want reassurances and this does not seem to be available which heightens anxiety. As a Doula and psychotherapist, I am acutely aware of the impact of stress in pregnancy and the impact this can have on the family and the baby and supporting families through a stressful time where some stresses are currently unavoidable gives a new challenge for all. Many are finding that knowing they are not alone, and things cannot be changed, gives them a sense of acceptance and calmness. Which reminds me of the process of grief. It appears society is going through a period of collective grief. Perhaps mourning patterns of life and adapting to new patterns

Accepting things that you would not usually accept is an interesting concept, I find. Usually we would look at challenging policy that may not fit with own beliefs for birth and parenting. There seems to be a shift in that at the moment and families are accepting many things they would not normally. A concern here is that there seems to be a collective coercion. Which leads to an ethical question around is coercion ok in some instances? 

With homebirths no longer being supported in many trusts, many families are either having to birth in hospital or opt for an unassisted birth. Neither of which are the preference of the family. Again, this is putting additional stress onto the family as they rethink the best for them. A professional reflection on this leads me to think about how much autonomy and choice families have in pregnancy, birth and parenting at any other time. Choices are always based upon the information we have at that time. If some options are removed how can a person choose that and therefore is full choice and autonomy ever, in reality, an option? 

Locking down pregnant women for 12 weeks, as per government guidance as I write this, would normally seem hugely immoral and unethical. Yet society has now accepted this. Families have had autonomy removed in most things within the global pandemic and we accept that as “the greater good”. In conversations with families this felling of lack of control and autonomy is a common theme, they feel they cannot control their lives. Conversations, mostly, are around finding the little things they can remain in control of. Such as what they do in their own home. Goal settings and routine are things that families would like at this moment as it seems usual routines are stopped right now. Adjusting to the new normal. 

In speaking with our Doula staff, we are having conversations around what is “essential support”. We can no longer support in hospital at birth. Staff are concerned how long this will last. Working with those who have requested Doula support for various reasons, they deem our service as essential. Both our own outcomes and research shows the huge difference a Doula can make to families. I would argue that Doulas and Counsellors/ psychotherapists are essential for many families and our families tell us we are. It seems we are temporarily essential to promote wellbeing in normal situations and even more so in unprecedented situations. To support in empowerment and resilience, or whatever word fits. 

I have received messages from many other services (including those within the NHS) working with families that are disappointed in our service being limited at births and in the community at the moment and they feel this is an oversight as the stretched services struggle to cope usually anyway. We have made contact to offer ourselves under the volunteer scheme so families can remain supported. In the meantime, we have had interest in video support at births and have launched a national Doula Helpline to help with this. This is proving popular. 

In my experiences in having daily conversations with families and staff working with families, there are common concerns. Concerns around autonomy and choice, own health, partners in the hospital. With choices and options now removed under policy and law there is a huge restriction on human autonomy under the thought of public health. Some conversations have been around removing he rights of some to protect others in a public health pandemic. There are no answers right now. 

In usual circumstances it would be wise to seek to change things we are uncomfortable with. Some would argue that we should not simply accept anything we are uncomfortable with, ever. Right now, it seems that acceptance of the situation is bringing comfort to many and that is key. Informed choice can continue to be explored within the realms of current guidance, policy and law and families, and birth workers, can strive to find something within that that suits the induvial. 

These are not usual times and we can continue to watch, challenge, reflect and choose what is best. We are all navigating new ways of working and new ways of being. 

Michelle Bromley-Hesketh 

Self Care

Importance of Self Care

As parents, as women, we seem to have a lot of pressure placed on us.

We’ve to be the mother raising the children and we’ve also to go and work.

Nothing ever seems good enough.

Stay home mum – lazy, not teaching work ethic

Working mum – not interested in child.

Men don’t seem to have this same pressure. They have different pressures.

This pressure can cause a range of emotions and feelings. Anxiety, worry, stress, sadness, depression, anger, frustration

All these feelings can leave you, tired, irritable, teary, fidgety. Even effecting your immune system, meaning you are ill often.
This can affect your menstrual cycle too, meaning your periods become irregular.

So if we do not take care of ourselves then we can struggle with taking care of other things in life as our health can begin to suffer too.

Taking care of yourself helps you to manage the pressures easier. Not feeling guilty in doing so too. (I know it’s taken me a long time to learn it’s ok to take some time for me, I still struggle with actually doing this)

What to do for self care?
Watch TV.
Listen to music.
Spend a day in dressing gown.
Go for a walk/run.
Exercise.
Yoga/ Meditation.
Spend time with friends/loved ones.
Be on own for a short while.
Turn off phone.
Counselling.
Massage.

All of these can be therapeutic and good for short periods. If they become a lot of the time this may be an issue too.

Like a pan on the hob, if you keep the heat there eventually it’ll boil over or even longer all the water will boil away completely. Sometimes the pan just needs taking off the heat.

Give yourself a break. It’s deserved.

Pick something to do for YOU right now! Even reading this is something for you! Well done. What else can you do for Self Care this week?

“Have you told You lately that You love You?”

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Accredited Doulas in the UK

Due to the success of our trailblazing projects and demand, we are launching three new streams to our Doula project.

We have an evidence based model of supporting families. Gaining recognition nationally for our work. We are trailblazers and continue to support women and families.

With all these streams you will become part of a nationally recognised, (BACP and ICO and NHS Information governance registration), not for profit Community Interest Company organisation supporting families. With endorsed training, policies and procedures, debriefing by qualified counsellor and birthworker, comprehensive staff and volunteer support, giving both worker and family piece of mind. We are the only Doula organisation in the country (possibly the world) to have this in place.

Doula support workers.

Firstly we are looking to train and recruit “Doula support workers” across the country.

These workers will be volunteers (with the potential for paid positions in the future) that commit to so many hours support women and families in group and one to one settings. You will support women and families alongside Doulas. You will not be required to be on call.

You will work within our Ethical Code and policies.

You will be trained with our CACHE Endorsed training.

There is a cost to the training, sliding scale due to household income and whether funding is available.

This is currently free for those living within BB postcodes.

Volunteer nanny worker

We are looking for volunteers to provide care for children whilst the mother is birthing in the hospital.

You will work with a Doula to provide holistic support to parents.

You will ideally have a childcare qualification or willing to train in Core Skills.

Hours will be as and when needed.

Potential for paid positions in the future.

Countrywide branches

Due to our success and the amount of requests we have received we now have the opportunity for Snowdrop branches to open across the country. This will give the option for funding support with access to our policies, software, research and knowledge and name. Due to different demographics within areas each area may work slightly differently. We have a procedure to follow for set up with regular audits. These audits help to ensure consistency across, protecting the families and workers.

There is a cost to this.

Funding can be accessed for this.

If you would like to be involved then please get in contact at michelle@snowdropdoula.co.uk with subject matter “Doula support work”, “Nanny” and/or “new branch”.

Should we be grateful for a bad outcome?

So many times, I am hearing and witnessing new parents being grateful to the “professionals” for saving them and their baby. Where this is true, the healthcare staff do save lives. What appears to be worrying trend to thank the interventions that may not have actually been necessary and actually caused the need to be “saved” in the first place.

Statistics show that on average in the UK 70% of births have some form of intervention happen. Do we really think that we have evolved so only 30% of humans can birth the next generation without help? Yes, epigenetics may be having an effect on this (watch for new blog post) but to such an extent? I’m really not convinced this should be so low.

Therefore, these interventions will, mostly, be unnecessary.

In practice as a Doula and trainee Counsellor working in this area, I am seeing that when women realise that what happened to them may not have needed to happen, they have a whole range of emotion. Anger, distress, sadness, anxiety, distrust, the list goes on. I also see women coming and saying, “They saved mine and my babies life, so why do I feel this way.”  “It was done to me, not with me” Then they do not wish to approach what happened in any detail and piece things together. Mothers, and fathers seem to enter a dissociated state, a trauma state.

Acknowledging that those who “saved” a mother and baby may actually be the one who caused the need to be saved is a really difficult journey and should not be ignored. Many parents come to us quite angry at what happened. “It was done to me. I didn’t know I could say no, I trusted them.”. This is NOT consent.

Gaslighting is a term used to describe what abusers do to their victims in order to manipulate them to be grateful to the abuser. Even manipulating the victims version of really that they doubt their reality. It appears this may be happening on a societal level.

All this is not saying that maternity professionals are deliberately causing harm to then save women and babies. This appears to be more a societal/ cultural issue. “Well at least you have a live baby”. “At least we have a free health service” “they do what they can with limited funding”. Should we be grateful for limited care? The worry within the medical professionals to act before a major incident could be contributing. The worry of litigation. The lack of education around birth expectations. The overworking of staff. The lack of funding within the health care system. Many factors can be contributing to this.

So, what can birth workers do? Listen, even if a mother comes to us reporting these things, listen. Do not dismiss.

What can we do to prevent this? This can be a difficult balance. Sometimes intervention needs to happen to save lives. Consider if the intervention is too soon and a bit panicky. For example, is this induction truly clinically indicated if she is 40+10? Does the mother and father have the full range of information to make the decision? Time can be limited to do this, I know. So, let’s think how this can be done. The lack of funding in the NHS is a real problem. Staff and the public all feel it. I’m not sure how that can change anytime soon without a real shake up of government policy. (a whole other blog/debate) I do believe that we can all ease the burden of this with compassion and acknowledging where we may get it wrong.

Antenatal education is important! Find an antenatal class or Doula who can give all the information for all eventualities so you, as parents, can have all the information available before you could be in the moment needing to make a quick decision. In our classes we talk about the BRAIN.

Benefits – what are the benefits of doing or not doing this?

Risks – What are the risks associated?

Alternatives – What alternatives are they? True alternatives. Not just carefully selected alternatives to coerce into something.

Instinct – what is your instinct saying? Listen to it, it is important.

Nothing –  what happens if you do nothing? Can you just wait? With any decision there is always the option of doing nothing.

Second opinion or Smile – Can you have a second opinion? Or just smile and ask for some time to think. Even if 1 minute.

Everything pregnancy and birth related is the choice of the parents. More than that it is the choice of the mother.

If you are afraid to say no, then it is not informed consent.

If you are reading this and are feeling some distress or that something like this has happened to you then please call us, we have trained staff to talk to. Or contact your local mental health team, Birth Trauma Association, Samaritans.

You can also feedback to your local maternity and health service as they do want to learn how to make care better.

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