Pregnancy, birth and parenting blog

Cord clamping and cutting. What are the options?

3rd stage of birth. Delayed cord clamping, lotus birth, psychological 3rd stage. Placenta.

After the birth of your baby the umbilical cord will come away and form the belly button for the baby. The umbilical cord is attached to the placenta and all needs to come away in some form as it is no longer needed to provide nutrients to the baby. Most are clamped and cut at birth more often this is delayed cord clamping. It is not thought cutting the cord causes any pain or distress to the baby, there’s no evidence to suggest this. Here are some options.

Immediately clamped and cut – Managed 3rd stage.

There is an injection offered post birth to help with the birth of the placenta and also to manage any heavy bleeding. The umbilical cord needs to be clamped (and cut ideally) for this to be given. With a managed 3rd stage the placenta is usual born within around 30 minutes, usually much quicker.

Leave until placenta is born – Physiological 3rd stage.

There has been research to suggest that immediately cutting the umbilical cord meant that babies could be losing up to 1/3 of the blood volume that the could get if left. With this includes stem cells. So there has been campaigns to ”Wait for white”.

A physiological 3rd stage of birth means you are opting to let nature take its course. A full physiological 3rd stage would wait until the placenta is born to cut the cord. As most opt for the injection there is some debate on how long it is normal and safe to leave the placenta in situ. There is some suggestion that if the placenta has not come away an hour after birth then perhaps some help is needed.

Delayed cord clamping

Delayed cord clamping can mean somewhere in the middle of the previous two options. There’s theory that the umbilical cord (and placenta) has passed all its’ nutrients, blood and stem cells, by the time the cord has turned white. This can happen within 5-20 minutes post birth. Some may choose to do this and then clamp and have the injection to help the placenta. Others may cut at this point and not have the injection.

Lotus birth

Lotus birth image
photo credit from The Independent

This option may seem a bit ”woo” to many but is a valid choice. This is where the cord and placenta is left attached until it all dries and falls off together in a few days. The placenta is kept in a bag whilst attached with fragrant herbs etc on the placenta. There are numerous reasons why families may choose this option.

There are always various options for all aspects of pregnancy, birth and parenting. What suits one family may not suit another.

Self help tips for postnatal anxiety

Postnatal anxiety is specific anxiety that happens post birth. Having a baby can be a worrying time for anyone and feeling anxious can actually be a usual response to becoming a parent, especially with a lack of sleep and changing hormones in the body. Self help tips for postnatal anxiety can help you in the here and now.
Here’s a few tips to help if you’re feeling anxious.

Challenge the thought.

Is the thought real? Anxiety can often come with intrusive thoughts that worry you. Is there any evidence that that thought or belief is true? A common one is the thought of collapsing. So how true is that? How many times has that happened?
Question it, it removes its power slowly.

Distraction techniques.

This can be useful shorter term. The physical response your body feels in anxiety/panic cannot last more than a few minute. The thoughts can keep the cycle going. Using distraction techniques can help stop it in it’s tracks.
Try these, or find your own;
Talk to your baby. Can be anything, playful voices also has a hormonal change to help reduce the anxious feeling.
Read number plates. Simply distracts the brain.
Feel your feet on the ground.(removing footwear can help, if appropriate)
Look for 5 things you can see, 4 things you can feel, 3 things you can hear, 2 things you can smell and 1 thing you can taste.
From head to toe focus on each muscle, on each out breath relax another muscle.

Sit with it, breathe it away.

Seems like the opposite of distracting but sometimes the feelings need to be heard and valued to be able to feel better. Allowing the emotional release, if safe, can help it to move on. Imagine it like a friend telling you they felt something, you may wish to listen to it and help find a way to make it better.

Look at diet and hydration.

A diet that’s lacking in some vitamins can cause the symptoms of anxiety/panic. It can be worth looking to see if there could be any changes here. Particularly things like iron, vitamin D, B vitamins and dehydration. If you feel you may be lacking it may be worth chatting to your GP.

Consider therapy.

Counselling really can help you to find out why you may feel like this and how things could be better. There are many different counsellors and many different counselling ways. It can be a case of finding a counsellor that fits. We offer counselling but you can have a search and see which service fits.

Remember that the feeling always passes! These self help tips for postnatal anxiety are just a few, you may find your own ways.

Hierarchy of birth needs.

This is coming about from another Twitter discussion.

Donna Ockenden (of the Ockenden report, of which I am still making my way through) made a comment that the 1 thing every mother and family wanted was safety in birth. To feel and be safe in a maternity setting when having a baby.


My first thought is that surely this is basic level for anyone entering a hospital and with any medical professional. If a woman does not feel safe and, what’s more, is not safe in such a setting then surely the system is failing at basic care and something urgent needs to be done? Heck, if a car fails at basic safety in an MOT, then it’s illegal to drive it. There are inspections and systems in place to check things but, as with all these things, lots gets missed. The Ockenden report is of one trust after a series of deaths and many more “near misses” and is, rightly, looking at these basic needs.

This idea of safety being the 1 thing that mothers want is far too basic a notion. Women need and want more. Anyone who has done any course in psychology will have likely heard of Maslow’s hierarchy of need. This suggests the needs of a human of optimum wellbeing, or self actualisation as Maslow terms. At the bottom of the pyramid, we have shelter. Then it goes up to things such as love. Each step needs the one below it to be in place before it can be reached. Within the covid pandemic it’s said that optimum wellbeing could not be reached. We could not socialise meaning some of the top levels were limited as we were locked down

Hierarchy of birth needs

When we look at birth in this context, I think, a similar idea can be written.
At the bottom would be being alive and well at the end with safety being a next step. These being two different elements as a person could be alive and well and yet not feel or be safe. What feeling safe looks like will be different for every individual, some will want home comforts and others will want the top medical interventions. All are valid to feel safe.

Birth hierachy of needs

Then we go up with love and care (also to optimise oxytocin for birth), which helps the feeling of safety but goes a few steps further to feeling the best possible. The theory being when all the steps are fulfilled can a person reach full wellbeing. Again, this is subjective/ individual. What makes you feel loved and cared for? This may be different for others and also worth noting that those who may have experienced abuse, or a toxic relationship may struggle with what this actually looks like.

Next step may seem a bit ‘fluffier’ and can become harder to achieve. I write this as “empowerment”. So, what does this really mean? It’s about power dynamics, who holds their power in a situation. For birth, I think, this is when the mother feels she has the power in the room, she is the focus, her needs are met and, beyond that, she is in control. This is no matter what is happening. A woman may have a birth plan to say x and then in the course of birth y and even z happens that is completely different to her ideals, but if she feels empowered then she will still feel she ‘holds the cards’ and knows and understands what is happening. This is important to positive wellbeing.

Full wellbeing can be achieved in birth if numerous things are considered on an individual basis.

Within maternity care it seems very important to consider every individuals needs, wishes and experiences and listen, just listen. Preparing for all situations and respecting decisions.

Safety is a basic requirement for every woman and family, and is what the Ockenden report looks at. More is needed for wellbeing.

If a woman does not feel safe in her pregnancy or birth then something is major failing her.

The history of Snowdrop Doula – a snaphot

So, my name is Michelle Bromley-Hesketh. Here’s, some of, the history of Snowdrop Doula CIC. Some of my recovery from postnatal depression.

I founded Snowdrop Doula in 2011. 

Being prepared for parenting

My eldest son was born in 2005, when I had not long since turned 20. His birth was a very “normal” (whatever normal is) hospital birth. I turned up in early labour, got sent home, came back an hour later. Straight on the gas and air. Birthed about 12hours later to a healthy boy, 7lb 7oz.

I’d attended the antenatal classes by the midwife and felt prepared for the birth, but I don’t think it was enough now. I remember, as many mums do, left in the hospital bay at 11pm with a new baby who I was sole carer of and panicked. 

“Oh gosh, what do I do if he cries?”

“Is he hungry?”

“Do I just stick my nipple in his mouth?”

“Does he want a nappy change? How do I change his nappy?”

“Should I ask the Midwives? No, don’t ask the Midwives, you’ll be judged as a young, stupid mum who doesn’t know what she’s doing”

“Why don’t I know what to do?”

“Oh shit, my whole underneath hurts. Will it ever be the same again?”

Waking up in the night (because newborns don’t sleep long, was not prepared for that often) thinking, “oh gosh, why is my shirt so wet.” It was milk but I wasn’t aware that may happen.

I also remember the drive home (in my ex step father in laws car) feeling VERY surreal. I remember seeing danger everywhere yet feeling quite floaty. 

Having postnatal depression

Fast forward, 6months I was diagnosed with, and I quote, “severe depressive episode”. I’d put “a brave face” on for too long. My dad rang the health visitors who sent someone round that day (or the next). Within the week I had support from the Sure start family support worker, her name I think was Liz, who then had occupational therapy and a CBT therapist come to me. Intensive support from that led me to recover, although I’d never be who I was before. (That’s not a bad thing) 

I wanted to help others who are experiencing what I did. I also wanted to help stop it happening in the first place. What needs to happen? How could I have stopped this? 

The struggle to do peer support

So, I started researching, the internet back then was chat forums and websites, and I had found an online chat group. I found that there was a link to breastfeeding and reducing chance of Postnatal depression. I had stopped breastfeeding at 2 weeks as I thought he should be sleeping through (!) and everyone gives formula in the end anyway. I thought that only weirdos don’t (!)

I looked to train in breastfeeding support. All those organisations I contacted wouldn’t let me train as I hadn’t breastfed for 3- 6months. I did get very frustrated and gave up a little. I went back to working in care homes. Then I fell pregnant and was told I could actually do some breastfeeding peer support training now I was pregnant. I did the BFI training, age 22, 36 weeks pregnant and had a sudden clarity as to why we didn’t manage to breastfeeding didn’t work. In the hospital I was told baby should be feeding 5 minutes a time. (They possibly said “at least 5 minutes”.) So when he was attached for half an hour, at least, a time I believed I didn’t make enough. I also thought babies should be sleeping 4 hours at a time at a week old. This is not true for most.

Recovering from postnatal depression

My second child was born at 42 weeks, almost in the car park of the hospital, Labour was about 2 hours, 20 mins in hospital with a possible shoulder dystocia in the mix. 8lb2oz.

Physical recovery was much quicker and was more determined to breastfeed to keep away the depression and anxiety. I stayed in hospital 3 nights to make sure, the Midwives were a little desperate to get me out as no medical need but I was determined to make breastfeeding work this time and so stood my ground a bit. Having post natal depression and anxiety again was NOT an option!

I volunteered as a breastfeeding peer support worker in community and in the hospital. 3 months later I was modelling for the Be a Star campaign. 

A few months  later and I felt the same feelings returning. Turns out breastfeeding isn’t the cure I thought it would be. I recognised and spoke to health visitors immediately, I was referred for talking therapies. When I went to an assessment appointment, that was a nightmare as I couldn’t take children and it was in a windowless room, down a long windowless corridor. Not good when part of the illness is claustrophobia.

I requested home appointments as I’d had before, or later appointments so I could get childcare. The service had to have a meeting about this. Apparently my case went to a committee and they declared I couldn’t have that as , and I quote, “you are not depressed enough”. That line is the stupidest thing. If we think about how prevention and early intervention is key how does waiting until crisis point make the difference? Clearly I was depressed and having issues with my mental health and yet on a number scale it wasn’t enough to warrant home or later appointments. This meant I couldn’t access talking therapies and they couldn’t offer anything else.

I had to sort myself out. What I did was to shut off. I ignored the emotions, it did not feel I had a choice.(That’s never a good thing)  I did have some alternative therapies such as hypnosis. 

The relationship with the father of the children broke down. (Not suprising) and I shut off even more. I had to be strong now. Utter nonsense. 

In 2008 I was 23 and a single mum to a toddler and a newborn. I felt a huge pressure to be strong, to carry on. I joined every playgroup I could (CBT told me distraction was good) I opened a dressmaking business. I volunteered with Little Angels, NCT, school. I started studying NCT breastfeeding counsellor diploma, stopped that as couldn’t afford it, started an Open University degree in psychology.

So, the distraction worked, the being involved in voluntary groups helped. I began feeling happier.

There’s an analogy I often talk about of cupboards, imagine a kitchen cupboard, start filling it, the spices get pushed to the back, you can’t see them, you can’t remember what the spice even is, but it’s there for years, not even usuable anymore, more stuff gets piled in, pasta, some organic spelt flour you think will make things healthy, eventually the cupboard is full but you need to cram more in, so you do, for some reason that seems easier than clearing it. then you daren’t open it as something falls out when you do. Eventually you’ll open that cupboard in an attempt to put in the 5th jar of mixed spice. And the whole lots falls out!

My cupboards burst open again after birth of my youngest child in 2013. This time I looked at what’s there. I’m still throwing out the spices from the 90’s. And that’s ok.

So, what did I do?

I always thought that there’s something major lacking in services. Society is missing something.

Then I read about Doulas.

Sounded like the answer. Or at least part of it. So in 2011 I went and did a training course and set up Snowdrop Doula as a sole business. 

I very quickly found out that charging for the service in East Lancashire wasn’t viable. And that by charging a huge amount of families miss out. East Lancashire is not the same as Chelsea. It was then I made the decision to look for funding. Finally setting up in 2014 as a Community Interest Company. (after baby number 3 was born at home in 2013, 8lb9)

I’d been supporting women through breastfeeding peer support and as a Doula for free and found that there was a lot more needed. Somehow services couldn’t meet full the needs of families. 

In 2014 I began to apply for funding. Gaining Awards for all funding for free Doula support in 2015. 

Alongside some NHS Clinical Commissiong Group (CCG) funding for antenatal journaling classes. Running these projects showed a greater need for support for women and families in the perinatal period. So many local families were asking for additional support. 

We had CCG funding for pregnancy dance classes too. 

Then the big funding came in 2017 to train and employ 5 Doulas to be able to support more families.

We now have 2 hubs we work from. One in Burnley and one in Accrington and also have a café in Accrington. With Doulas, we now have volunteer Doula support workers, Counsellors, baby goods and food bank, second hand and ethical goods shops, hypnobirthing classes and workshops, support groups, play groups, branches growing across Lancashire and beyond. 

If I could tell the pregnant 19 year old and the new mum me where we’d be now…

Sometimes it is scary to go out.

Perinatal mental health

I’ve been there, perinatal agoraphobia and claustrophobia, anxiety, depression and I now think maternal OCD. i seemed to just tick lots of boxes. My experience is a reason Snowdrop exists.

Agoraphobia is a fear of unknown places or situations in which you feel you can’t escape.

Claustrophobia is a fear of confined or crowded places.

If you put both these things together, it can be a very scary place to be.  The world becomes a place where going out is full of worry, concern and staying in can feel overwhelming. Everybody can react in different ways to this, some stay in one place and neglect everything else. Whilst others can develop an OCD, in which in order to go out or do anything requires certain things to be in place before it can happen. Having these after the birth of a baby can be related to the change in life and priorities, suddenly everything seems dangerous and theres a need to protect and control the world around where we can. Perinatal agoraphobia, claustrophobia, can be really scary but it does get better.

It does get better.

In the depths of my own illness I would have numerous things I would do in order to feel “safe”. I would need a bottle of water, some food, medication in my bag, I would need to know the route, the timings and to know where the door is, sometimes I’d need a blood pressure machine and to be checking regularly (!). If I didn’t have any of these I simply could not do it. Now, I am 17 years in and still do some of these things (ensuring I’ve always got some food and drink, but I justify this now as I get migraines with lack of food or water). I am now able to continue in a place and feel calmer, it does get better. 

Sometimes there could be a reason why a place may be scary. Could be a rational reason as it’s a situation that causes worry for most? Perhaps a previous bad experience? If this is the case there are some techniques that suggest confronting the situation again to change thoughts to that it’s OK now. If the situation is genuinely unsafe then it’s ok to remain scared and not go. 

What is unsafe to one may not be to another. 

Places and situations can be scary.

It is OK to acknowledge these feelings. To listen to them and what they need and look to provide the comfort. 

If you are struggling please talk to a trusted friend/family member and get in contact with a therapist and/ or GP.

Is Breast best?

Breast is best v fed is best.

There are a few phrases used in infant feeding that, I feel, are not helpful to anyone and are problematic and even traumatising.  “ Breast is best”, “Fed is best” are two such phrases and here’s some reasons why I say this.

Neither are best and yet both are.

(C)Snowdrop Doula CIC

Whilst the evidence suggests that breastmilk is superior to formula milk in all it contains and what the act of feeding offers, it is arguable that in a middle class home in the UK these benefits are negligible. The effects on mental health of the mother and the baby due to the way an baby is fed can also be argued in various ways. I’d err on the side that, in general, breastfeeding has physiological benefits on mental health. 

Breast is best. Really?

Simply saying “Breast is best” can cause a lot of stress for many. Whilst also not seem helpful at all for many reasons. After 16 years of supporting families most have said to me that this phrase does put pressure on mums because it suggests that if they aren’t breastfeeding then they aren’t doing the best for their child. No parent wants to think that. There are instances where breastfeeding may not be the best for that baby and/or that mum. A whole picture needs to be looked at. It’s also worth noting here that formula companies are those who brought this phrase into the dominance. Simple psychology theory here is to make themselves look like the saviour of struggling mums and we buy their product.

Fed is best. Is it?

“Fed is best” is also hugely problematic. Of course a baby should be fed , I’ve not met anyone who suggests otherwise. This message usually ends up becoming that formula milk is just as good as breastmilk and that just holds no evidence. There are sometimes cases where breastmilk isn’t as good as formula but this is very rare (I’ve never come across a case). The transfer of the milk and other socio/psychological factors tends to be the main issue.

In practice, I’ve come across many women who have come across such messages who then feel pressure to not breastfeed. Others feedback that they have found themselves thrown out of “support” groups for saying they don’t want to give formula. This isn’t a one off, it’s happened too many times to count. These women then feel very let down. They have sought midwifery support and received little. Then sought online and been thrown out and this can have a huge negative impact upon a new mum. 

“Fed is best” as a phrase can undermine those who are breastfeeding and wish to continue and can actually play into capitalist and patriarchal roles.   Capitalism requires people in work, making money, and mums at home, breastfeeding are not doing that. So if formula feeding is just as good as breastfeeding then a woman can surely go to work after birth and baby can be in childcare. Childcare also makes money. I’m potentially going off on a tangent here and a post for another day there in the role of mothers (that may yet form my thesis). 

So, what can we use as alternatives?

How about we do nothing! Let’s just stop talking about what’s best for anything parenting. It’s not helpful or true and causes a whole load of undue stress. 

Sure, let’s talk about what current research shows as safe, such as bedsharing safety. Whilst remembering that things change and any research is always an opinion on the data they have. 

But, the only thing that is “best” is what a mum feels confident in doing.

Will I poo in labour?

It’s very likely you’ll poo during birth and someone will clear it up.

Will I poo in birth? Yes, you’ll likely poo in labour and childbirth.

As baby moves down the contents of your bowels can get squeezed out in the process.
You may find that in early labour you’ll have a bit of diarrhoea, again this is quite normal as your body prepares to birth. If diarrhoea persists you may find yourself becoming dehydrated which can have an impact on the effectiveness of contractions. It’s advisable to keep hydrated, sipping water or electrolyte drinks (such as Lucozade, other drinks are available, search for one that may be suitable for you).

Although pooing in birth can be normal many women worry about it, it’s not something that’s anyone wants to do. No amount of midwives saying “don’t worry we see it all the time” can ease the worry as they haven’t seen you poo, and you haven’t been to the toilet in front of them before. However they do just see it as part of the process and chances are you won’t actually realise it’s happened, the midwives are quite skilled in disposing quickly and you’re busy birthing your baby.

How can you stop this? There’s isn’t really any way. You could make sure you go to the toilet in labour when you need and you can also have discussions in pregnancy about this with the midwives and/or family. You can also ask people to not tell you if it does happen. Be aware that it is a usual part of birth and a sign things are working as they should.

Did you poo in labour? Join us on social media to chat with others.

What is a Doula?

Blessingway beads

What is a doula?

The word doula comes from an Ancient Greek word (doule) which means female companion. A Doula can provide both emotional and physical support to women and parents during pregnancy, birth and postnatal, the time the are bringing a child into the world. A doula will support the parents through there choices in this period and provide them with information on which to make these decisions. A doula is not a midwife and our roles are different. Parenthood can be a daunting task for many and a doula’s role is to ease this transition.

Some figures.

Our service feedback and data shows a better chance of health and wellbeing in pregnancy and beyond, whilst improving birth outcomes. See some of our results here:

  • 82% of the women supported had vaginal births.
  • 18% had caesarean sections(most of those planned) as opposed to the 25% national average.
  • 44% reduction in chance of assisted birth (such as forceps, episiotomy.)
  • Triple your chance of successful breastfeeding
  • 5% induction rate (in comparison to 20%)
  • 10% had a home birth (2% UK average)

Check out our website for what our doulas do and the blog post here.