Blog

Welcome to our blog

Welcome to our written blog. If you click the Doula Place heading or clock here you will also find our podcast. 

Here you will find rumblings, musings and thoughts on all things pregnancy, labour, birth, postnatal and parenting. We will blog about things of interest that we come across. You can even ask us to write a post on a specific thing, as long as it’s connected to pregnancy, birth or parenting. We hope you find things of an interest. 🙂

Blessingway beads

Are home births safe?

There’s been quite the reporting about home birth in the last few months in relation to a couple of court cases. The conversation around whether they are safe has become a forefront again. In short, they can be safe. 

What is safety? What is danger?

A number of Research studies do suggest that home births does not increase the risk of mortality (death) or morbidity (medical problems) in comparison to hospital births. Further to this rates of interventions is lower in planned home births. The latter is partly to do with these not being available at home. However, it does suggest that there may be a lower need. 

The NHS website says this,

“But if you’re having your first baby, home birth slightly increases the risk of serious problems for the baby – including death or issues that might affect the baby’s quality of life – from 5 in 1,000 for a hospital birth to 9 in 1,000 for a home birth.

If you’re having your second baby, a planned home birth is as safe as having your baby in hospital or a midwife-led unit.”

Putting those figures into perspective chances are 0.5% chance of a problem for the baby in a hospital birth and a 0.9% chance at a home birth. Still relatively low, statistically. However, these numbers seem to be in contradiction with other research studies that suggest there’s no difference and possibly even safer to birth at home in low risk and some situations with a perceived added risk.

Within the NHS, families often find they are told of many reasons why a home birth may be dangerous and risky. This reasons may be “big baby”, small baby, bleeding, and even death. We’ve previously discussed the risk of death and that this does not appear to be as big as suggested but what about the other situations. The evidence on the risk of birth on many of those situations commonly mentioned is lacking. 

There are certain situations where home birth isn’t safe, such as a transverse presenting baby (lying across the womb) or placenta previa (placenta lying across the cervix/ opening to the womb). These situations require caesarean birth. 

To say home birth is not safe as a general statement is not based in any evidence. The risks and benefits in each situation is unique and for each woman and family to decide themselves. If a decision is deemed “against medical advice” then that is OK and within legal rights. As discussed above, the evidence around some of the “against medical advice” can be lacking in quantity and quality. Regardless of that, legally, a birthing woman can choose do to whatever she wants with her own body. She can decline whatever she wants too. No one should feel coerced into a decision

Final note.

Whilst debates around the safety of home births are happening there is a lack of discussion around the safety of hospital births. There are risks associated in those situations that are very rarely discussed. Perhaps, for the purpose of informed choice, these conversations are also happening. If you’re a professional and you’re questioning someone’s ability to make the right choice due to a home birth, perhaps ask if the same person was requesting various interventions would you be asking the same. If not, then maybe the person is absolutely fine to be making the decisions. 

Danger and safety are subjective. Blanket statements do to help anyone. 

Home birth is safe.

Hospital birth is safe.

Both can also cause problems. 

The decision always lies with whoever is birthing.

Are we offering the right treatment for postnatal depression?

I have been doing a small bit of research into the use of antidepressants for postnatal depression and anxiety. In this I have struggled to find any statistics as to how often antidepressants are prescribed for postnatal women. 

In practice I know this is quite high. Most, if not all, new mothers who I see in practice that have seen their GP say they have been offered antidepressants as a first response to their depression or anxiety. The treatment pathway, according to the NHS guidance, should include the offer of psychological therapy. This means talking therapies such as seeing a counsellor or psychotherapist. In the perinatal period (pregnancy to 12 months postnatal) an appointment should be offered within 2 weeks of referral. This does seem to be hit and miss and some are told they cannot be seen by the service once they have had an assessment.

In addition to this, the ability to access this seems to depend on the offer. It remains the case that new mothers are expected to find childcare for therapy sessions that are between 9am and 5 pm. Evening and weekend appointments remain, somewhat, non-existent. This means the ability to access talking therapies for new mothers is extremely difficult. 

With all this, the offer of antidepressants seems logical. Research shows they do help the symptoms so using them will help in the immediate term. However, the withdrawal from this medication can be quite difficult and many do not wish to take them. Looking at what to expect in this is important. Antidepressants can be great for some people, there is the concern around what else is offered. Those of us who believe that the symptoms are more than a “chemical imbalance” (there’s a lack of evidence behind this but that’s another blog post) would suggest that antidepressants won’t work as a long time solution unless one continues to take them. There are those who do take them for a short period that do find they help to get through a particularly stressful moment in life and they can be wonderful for that. For some this could be the case with postnatal depression, however, for those whom I see in practice this does not tend to be the case. 

In my research I have become particularly interested in those who have been prescribed antidepressants years ago and report that they can not seem to stop taking them, they feel worse again when they stop and the dosage keeps being upped. There seems to be a lot of women who are 10, 20, 30 years on medication for what began as postnatal depression. I really struggle to find where this is ethical. What are we, as professionals, missing? Are we not looking for a “cure” for the depression/ anxiety? 

Years ago, the way society looked at mental illness was different. 20 something years ago Electric shock treatment (electro convulsive therapy) was still used commonly for post-natal depression and so some of this long-term use could be a bit of a hangover from that. Yet it does appear that the use of medication is a first offer for perinatal mental illness with a real lack of ability to access talking therapies. Working in this area for around 15 years now (as a parent and now professional) I am becoming very aware that little has changed in this time. I sit in meetings now where questions around “how do we engage the hard to reach communities?” are still being asked and yet no one seems to actually go do this. We must stop this. 

So, why am I writing this? To hope to trigger some thoughts, some discussions and some change. This is happening, I know I am not the only psychotherapist seeing this. 

Are you a professional working with new mothers? Let’s talk and see what could be different.

Are you a mother and this feels relevant to you? There are people willing to listen. I am here to listen. If you feel you can share your experience, then please do. 

A last note: medication has its place. 

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”.