The Mule

The Blood and The Beauty: Placenta Prints

2013-05-21T05:54:00.000-07:00

The first time I gave birth, they took the placenta away. They didn't ask. They just took it, and of course, I didn't notice. I was busy, waking up from the dream of birth, and falling in love with the first creature I laid eyes on.

Weeks later, in the darkness of night, I remembered. Where was it? I had wanted to keep it. What had they done with it? Could I get it back? No. It was gone, and strange as it sounds, I cried.

Not so much for the piece of my flesh - lost. I cried for the bigger loss it somehow stood for - the birth I wanted, but didn't get.

Somehow, the birth I wanted got replaced with the birth they wanted. And, in the birth they wanted, nobody keeps their placenta. Why would they want to do that?

So I cried, for the flesh lost, and the dreams disregarded.

The second time I gave birth, they took the placenta away. They didn't ask. They just took it, and of course, I didn't notice. I was busy, waking up from the dream of birth, and falling in love with the first creature I laid eyes on.

In the kitchen, I heard rustling, the giggles of my toddler, the quickening breaths of creativity. Moments later, with some pride, a procession appeared, midwives-toddler-all, carrying three large pieces of paper, on which they had made pictures - the imprints of the placenta.

Strange! Why would they want to do that? And yet I treasure them, these bloodied pages, even now they transport me straight to that moment, to the blood and the beauty, to the love and the care and the oxytocin, and the transformation, of something base and animal into something of meaning, and deeply deeply human.

Everything leaves its mark.

Cut Me Open or Send Me Home: The Lottery of Maternity Care

2013-05-08T01:23:00.000-07:00

Pregnant women are offered medical interventions so often that it's almost hard to imagine getting through an entire pregnancy and birth without having one. Whether it's injections, induction, or an intravenous drip, there are so many choices for women to make, and often they feel, quite understandably, that the best choice is to place their trust in the experts, who are, after all, offering them 'evidence based care'.

But if midwives and obstetricians are offering 'evidence based care' - that is to say, they are making their recommendations based on good quality research - why then does the advice that individual clinicians offer, and the policies that individual hospitals and trusts implement, vary so greatly?

A new report from the Royal College of Obstetricians and Gynaecologists (RCOG) suggests that the disparity between hospital statistics has finally come to their attention, although I'm not clear why it has taken them so long to notice information that has been available on sites like BirthChoiceUK for years?

RCOG points out, for example, that in one hospital the induction rate is 38%, in another, 17%. Emergency caesarean rates vary from 20 to 40%, and forceps from 16% in one unit to 38% in another. Of course, the evidence here is clear and hard to ignore: not all interventions are necessary, and a whole lot of women are having traumatic and unpleasant birth experiences that could have been avoided.

It's great to see a giant like RCOG admit that there are failings. One would hope that this is a big step towards positive change, with a promise that in the future doctors will have their individual stats compared to national averages, and be asked to explain any great deviations.

But - for now at least - it doesn't necessarily help the pregnant woman on the front line. It's all very well to number crunch and compare stats. But when you are carrying a precious child within you, or are even perhaps in the middle of birthing them, and the professionals in whom you are placing your trust start talking about 'increased risk', it's difficult to ignore them. You might be one of the thousands of women who are being offered intervention that isn't really necessary, but what if you're not? Do you really want to be the woman who takes a stand, only to discover - too late - that, this time, the doctors were right?

Let's say, for example, you are over forty years old. In one hospital you might be told you 'need' to have your labour induced on your due date, because of an increased risk of stillbirth. However, in a different hospital, induction on the grounds of your age would not even be mentioned and you would be treated the same as any other woman.

If you're under the care of the hospital who routinely induce older women at 40 weeks, you face a dilemma. Who do you believe? Who do you trust? Stillbirth is a powerful word. Can you ignore this advice? Whatsmore, do you even realise that there are women just like you only a few miles down the road who are not even being told they need induction and who are not even having to consider this horrible dilemma?

Induction advice in general seems to vary greatly from hospital to hospital, with some women reporting 'prodding', 'harrassment' and 'shroud waving', from around 38 weeks, while others sail past their due dates and even past 42 weeks without too much concern. Women under pressure feel they should perhaps listen to the experts - but how can such widely differing policies be 'evidence based practice'?

Last week I went to meet the Ob myself. Due to my second baby being over ten pounds at birth, there were concerns raised at my booking in appointment for baby number 3. I was told I would need consultant led care, regular growth scans, and induction at 38 weeks. Since that booking appointment I've switched to an Independent Midwife, but kept my Ob appointment, mainly out of curiosity. I wanted to hear what he had to say, for myself, and for all the other women who presumably get similar referrals after 'big babies'.

I took the morning off from looking after my two year old, and, along with Tara my midwife, went to the hospital, armed with a bundle of papers including scribbled stats about dating scans and induction for 'suspected macrosomia' (big babies), many of which I gleaned from this wonderful blog post. Me and Tara had about an hour to wait, and, quite frankly, by the time I was face to face with the man in the suit, I was a little bit hungry, and spoiling for a fight.

Imagine my disappointment when the utterly charming Ob said, "There is nothing wrong with you, you are perfectly healthy, and you pushed out a ten pound baby no problem. Why are you here?!"

Across the hall, the Ob we didn't get to meet was holding his clinic. Insider info told me that he 'didn't believe in vaginal birth', and had insisted his own wife had an elective section. I couldn't help feeling slightly cheated that I hadn't got to read my stats to him, or tell him in detail about my five minute drug free second stage, maybe whilst Tara sat on his chest.

We drove home for soup and an antenatal check up on the sofa, half giggling, half wondering - what happened? Why was he so laid back, when we both personally knew women who had been put under tremendous pressure to be induced for 'big babies'? Conspiracy theories were offered - had he been reading my blog?! I asked on my facebook page - what were other women's experiences in a similar situation, and I've been flooded with responses.

Looking at the stories I've been sent, one thing is clear. There is no uniformity. There is no evidence based care. Some women encountered no negativity at all, some were induced at 38 weeks, some were made to get out of the birth pool to push, others were given the OK for a home water birth, some were not 'allowed' to birth at home, some were advised to have an early epidural.

Like all of these women, my maternity care was not evidence based, it was pot luck. I'm told my Ob was 'one of the good guys'. I could have had the man across the hall. I might not have had a confident midwife to back me up. I might have felt scared of birthing a big baby. I might have agreed to regular scans and early induction. I might not have realised that what I was getting was 'personal opinion' dressed up as 'evidence based medical advice'.

This might seem like a desperate situation, but actually, I think it's largely positive. Things are changing. If RCOG themselves are noticing and publicly admitting that, "We cannot be sure that every woman is getting the best possible care," this has got to be a step in the right direction.

What's needed now is for more women to take the power back into their own hands. Realise that even the professionals themselves are acknowledging failings. Ask more questions. Get second opinions. Use the internet, forums, facebook groups and Positive Birth groups to talk to other women and hear their stories. Take responsibility, take time to think; get informed, and do not place blind faith in professionals. Above all, abandon any expectations of evidence based care. Because it simply does not exist.

Dan Poulter MP: Hear Women's Voices, Respect Women's Choices, Meet with IMUK!

2013-04-24T13:59:00.000-07:00

UPDATE: 26th April - IMUK have received word from Dan Poulter's office that he will meet with them on 7th May. IMUK are grateful to everyone who helped them campaign for this.

OK, before we start, well Dan Poulter, he's the Health Minister for Women's Health. There are several different Health Ministers, all of whom report to Jeremy Hunt, the Secretary of State for Health. You knew all that, right? Yup, me too, me too, just checking.

So - Independent Midwives, who as we know, face becoming illegal and extinct from October 2013, have been trying to get a meeting with Dan Poulter for several months to discuss their demise and gain his help and support.

Meeting with Dan Poulter is key to the IM's campaign. And yet, not only is he refusing to meet with them, he seems to be actively avoiding them.

For example, IM's and their supporters have sent Christmas cards, Valentines cards, and hundreds of letters explaining their situation and the barriers they face in careful detail. Dan Poulter did not acknowledge the contents of a single letter in a personal way and instead sent out standard replies.

About 600 supporters demonstrated outside parliament on 25th March and several MP's came outside to meet with them. Dan Poulter did not meet with any of his constituents.

Nicky Garret, Independent Midwife and one of Dan Poulter's constituents has asked to meet with him at his MP surgery. Dan Poulter has tried to discourage this meeting saying that he can only talk in his surgery about constituency issues. Nicky Garret intends to attend the appointment anyway, later this week.

There are several possible reasons why Dan Poulter is behaving in this way.

Firstly, it's possible that he feels that a solution has been found for IM's in the form of social enterprise companies - the suggestion is basically that they band together to form one formally constituted legal entity - however, IM's feel (and they have told Dan Poulter such), that this is not a solution they are happy with, as, above all, their work would then cease to be 'independent midwifery'. They also point out that a similar project, Neighbourhood Midwives, has had £260k of public money invested in it and yet has not so far been able to secure a contract from NHS commissioners.

Secondly, Dan Poulter seems reluctant to acknowledge and respond to Recommendation 20 in the Finlay Scott Review (an independent report on the requirement to have insurance as a condition of registration for health professionals):

"In respect of independent midwifery, the review recommended that for groups for whom the market does not provide affordable insurance or indemnity, the four health departments should consider whether it is necessary to enable the continued availability of the services provided by those groups; and, if so, the health departments should seek to facilitate a solution.”

And thirdly, we could speculate that Dan Poulter's own life experience is getting in the way of his judgement. He's a medical doctor who specialises in Obstetrics, and as a Senior Health Officer, he would have spent six months working in the area of complicated birth. It's unlikely he would have ever seen a normal birth, and certainly almost out of the question that he would have attended the sort of blissful home birth that IM's specialise in.

Perhaps someone who has such a tainted view of birth is the wrong person to be appealing to for help in this instance? However, Dan is the man, IM's need him to meet, listen and help, and they are now calling on him in an Open Letter (see below), which has also been sent to senior Ministers, the Cabinet, and the national press.

IMUK requests an urgent meeting with Dan Poulter, Jeremy Hunt and David Cameron before the 10th May. A Department of Health consultation on this matter ends on 17th May. Time is running out.

It seems extraordinary that the plight of Independent Midwives is being ignored by the government - effectively they seem willing to stand by and watch them disappear, in spite of their offering a standard of midwifery which currently meets the Governments own targets, as set out in documents like Maternity Matters, for example:

choice in maternity care
continuity of care
increased home birth rates
increased normal birth rates
increased breastfeeding rates
increased satisfaction

And they say money talks, especially when you are trying to get a politician's attention, so how's this: Independent Midwives care for approximately 3000 women a year, an estimated saving of £12 million for the NHS. This figure could increase as thousands more midwives would work self-employed if insurance was available. At a time of a rising birth rate of 22% and a deficit of 5000 midwives, the Government are ignoring part of the solution to the plight of childbearing women and the national midwifery shortage.

As some of you know, this issue is personal for me. I was attended by IM's Chrissy Hustler and Caroline Baddiley for my second daughter's birth nearly three years ago, and together they gave me the most priceless gifts - confidence, courage, fortitude, strength, and a completely incredible birth experience that I will never forget. Pregnant again at the moment I'm working with Tara Windmill Robson, who comes to see me every two or three weeks, usually with her armfuls of books, fun craft ideas for my girls, love and inspiration. I can't wait to give birth in her inspiring presence.

However, due in September, I deeply fear that I may become one of the last UK women to give birth with an IM and experience this amazing standard of care. Losing IM's will be a great loss to the entire midwifery profession, leaving no alternative choice to the NHS in this country.

So finally Dan Poulter, a personal plea from me: do these wonderful women the respect and courtesy of meeting with them, and help to keep birth choice, and normal unmedicalised birth, alive in the UK. For whilst you might be an expert in obstetrics, I doubt you've ever been present at a birth moment like this one, and if you don't help save IM's, it might become even rarer and harder to come by than it is already.

A copy of the Open Letter to Dan Poulter from IMUK is pasted below.

Please sign the petition to support Independent Midwives, click here.

Please write to your MP, join the facebook page Choose Your Midwife, Choose Your Birth, get tweeting, blogging and sharing.

Contact Dan Poulter himself and DEMAND that he meets with IMUK before 10th May.

Thank you.

To Dan Poulter, Health Minister

Cc Jeremy Hunt, David Cameron, Stephen Dorrell, Margaret Hodges, Members of the Cabinet, National Press

Open letter to Dan Poulter and the Government from Independent Midwives UK

Further to your standard issue letter dated 16th April 2013, in response to Independent Midwives UK (IM UK) correspondence, public campaigning, petitioning and public rallying regarding the issue of finding workable, affordable insurance for Independent Midwives to comply with EU Directive (2011/24/EU). We publicly state how extremely frustrated and concerned IM UK are by both your complete refusal to meet with board members of the organisation, and the obscene inertia in firing off standard responses to letters, Christmas cards and Valentine cards sent by members of the public over the last few months.

IM UK represents the only health professionals who will be outlawed in October as a result of the linking insurance to registration; it is not only short sighted to refuse to meet with us, but is insulting and unprofessional to do so in such a manner. You have agreed meetings with The Royal College of Midwives and Neighbourhood Midwives – organisations who support IM UK, but whom are not directly affected by the legislation and have their own campaigns to fight. We believe that you are unwilling to meet with IM UK, because acknowledging support for Independent Midwives from the public and maternity stake holder organisations in the UK would entail you having to recognise and respond to Recommendation 20 in the Finley Scott review:

"In respect of independent midwifery, the review recommended that for groups for whom the market does not provide affordable insurance or indemnity, the four health departments should consider whether it is necessary to enable the continued availability of the services provided by those groups; and, if so, the health departments should seek to facilitate a solution.”

The independent review by Finlay Scott states that it is through no fault of our own that indemnity insurance is not available - lack of availability is due to commercial reasons and not for clinical risk. We see no evidence of you honouring the recommendation Mr Poulter; indeed there is mounting evidence that you are actively trying to avoid it! Independent Midwives will no longer be able to register, simply because insurance is not available, and women will lose the choice of a safe alternative to the NHS.

The DoH continually claims that a solution has been found in social enterprise companies; £260,000 of public money was invested in the Neighbourhood Midwives project, which whilst a potential alternative to the NHS, it is not independent midwifery and to date it has not been able to secure a contract from NHS commissioners.

Independent Midwives are fully qualified and regulated; they are the midwives who provide the maternity care you promised your voters in Maternity Matters and other documents. This includes:

· Choice in maternity care
· continuity of carer
· increased home birth rates
· increased normal birth rates
· increased breastfeeding rates
· increased satisfaction

The Government are making illegal the only midwifery service which fully meets these criteria. Independent Midwives save the NHS an estimated £12 million a year by providing a high standard of care for women outside the system. There is a rising birth rate in the UK of 22% and a deficit of 5000 midwives; losing Independent Midwives will only compound the problem. Does the government that supposedly supports choice want to be responsible for women losing this choice and for increasing further burden on the NHS?

In summary, IM UK and its supporters have informed you of the barriers facing Independent Midwives in accessing insurance many times. Our requests for meetings have been refused; you are avoiding the voice of the thousands of voters who have pledged support and engaged in this campaign; it is disrespectful that you ignore these concerns and respond with ill thought -out standard replies - replies which ignore specific questions and only waste more taxpayers’ money.

IM UK again requests an urgent meeting with you, Jeremy Hunt and David Cameron to discuss this issue before 10th May.

Jacqui Tomkins (Chair IMUK)

How Men Can Play Their Part in the Birth Revolution

2013-04-24T11:23:00.002-07:00

I was extremely delighted to have my second article published by the Telegraph on the 18th April. It looked at the recent research that has made the news, suggesting that fathers are getting post traumatic stress disorder after witnessing their partners giving birth. Reading some of the coverage, I couldn't help but notice how readily the world seemed to accept that birth is a traumatic event, and wondered, as well as supporting fathers during and after difficult births, shouldn't we also be trying to make birth less traumatising for everyone - fathers, mothers and babies too?

Read the full article here.

Writing for the Telegraph, running The Positive Birth Movement, editing my book about water birth, trying to help in the campaign to Save Independent Midwifery, and gestating baby number three whilst looking out for one and two - well, I'm spread pretty thin, so apologies to all for my lack of blog posts at the moment.

Somehow in between now and Christmas I've got to finish Water Birth: Stories to Inspire and Inform, take The Positive Birth Movement to the next level, write some more articles worth reading, and bring another human being into the world. Oh, and we might move house too.

All this and I can't drink. Wish me luck.

Overdue? Desperate to Avoid Induction? This Method Really WORKS!

2013-04-10T14:45:00.000-07:00

On average around 20% of UK women have their labours induced, some for medical reasons, others because they are 'post dates', that is, they have gone a certain number of days past their EDD (Estimated Due Date). How many days your care providers will 'let you' go past your EDD before pressuring for induction varies from trust to trust, but often women find that conversations about induction start on or even before their EDD, with 'sweeps' being routinely offered to encourage labour to start, and difficult to navigate meetings arranged with Obstetricians in which women are talked to about 'increasing risk'.

Getting to the bottom of the actual reality of the risk of going past 41 or 42 weeks is tricky, mostly because so many women don't actually get this far. Midwife Thinking has a great article here about the balance of risks a woman contemplating agreeing to induction must consider. Many women feel under enormous pressure once the conversations about risk have begun, and not surprisingly, many agree to induction even before they reach 42 weeks (considered by the W.H.O and others to be 'term').

In between getting to their due date and accepting that induction is their fate, women often engage in a frantic catalogue of activities in an attempt to avoid a medical start to their labours. I was one such woman, and have already written an account of this fortnight of utter lunacy in the post 'They Let Me' Go Overdue. Read it and weep, as I did, on an hourly basis. Thanks to google, the list of ideas for 'overdue' women to send themselves bonkers with is endless, from eating pineapple (utter nonsense by the way), to drinking castor oil (cheaper than a colonic, and twice as effective).

The methods are all described as 'natural', although many of them may not feel this way at the time. Take for example this suggestion from Sheila Kitzinger, not normally partial to encouraging women to lie in the lithotomy position and allow men to save them with their magic wands, but in the race to avoid induction, she makes an exception:

"Lie on your back, head and shoulders well supported by as many pillows as you like for comfort, your partner facing you and kneeling between your parted legs. Lift one leg so that your foot is over his shoulder. Then the other. Though this position is not comfortable, it allows the deepest penetration so that the tip of the penis can touch the cervix...When he has ejaculated he should stay inside you for five minutes or so while you stay in the same position, with legs raised for 10 to 15 minutes, so that the cervix is bathed in semen."

Then there's the 'sweeps'. They seem friendly enough - no sinister drugs - just a midwife and her finger, and many of us accept them without question. Do they work? How could we ever really know? Most women who have them are due to start labouring any day, so anyone who does begin after being 'swept' surely can't be sure that it was this that actually got things moving. Nor are they without risk - your midwife may accidentally rupture your membranes meaning you face induction anyway - see here for some research on this.

Whether it works and whatever the risks may be, what really concerns me about not just the sweeps, but every other mad method on the post-dates bucket list, is that they smack of desperation, and betray a complete lack of confidence in a woman's body. As innocent and natural as they may seem, they are nevertheless the tiny tiny tip of a bloody big iceberg of mistrust in the process of birth, which many many women find themselves running aground on at some point between 38 weeks and the moment they first hold their baby.

We have to ask ourselves, do we trust our bodies to do this thing or not? If we do, if we really believe that we were made to birth normally and naturally and hopefully joyfully, then why are we engaging with any of this stuff? Why would we need our membranes swept or our cervix's bathed in semem or fifty quids worth of reflexology? Surely, we will just go into labour when our bodies and our babies are ready? And if we don't believe this, if we really feel we need 'intervention' to even get started, why then, let's book ourselves in for every medical procedure on offer and welcome this modern salvation of our frail and dysfunctional female bodies with open arms!

The stress caused by the desperation of trying to induce yourself to a deadline will probably do more harm than good, making it less likely that you can relax and get in the zone required to start spontaneously anyway. So here's my method, and damn I hope it makes me rich. If you are getting near your due date, or just past it, and are coming under any pressure, either from yourself or others, to begin your 'attempts to avoid induction', try this: Do nothing. Yes. You heard me. Do absolutely nothing. Try it. It's harder than you think. It takes a cool resolve, a mindfulness, and a deep and strong belief in yourself and your baby and mother nature herself. Exactly the mindset you need when you go into labour, funnily enough.

Don't let your confidence be undermined. You were made to birth. Just believe. Wait.
And do nothing.

Nothing.

Fighting for Independent Midwifery, Birth Freedom and Human Rights

2013-03-27T15:44:00.002-07:00

This week, the fight to save Independent Midwifery intensified, as five hundred people congregated in London in silent protest.

I wasn't able to be there, but I was thrilled to play my part in the day by writing this article, Why Independent Midwives are key to the fight for birth freedom, which appeared in the Telegraph online on Monday morning.

Of course, this was very exciting for me on a personal level too, as this is the first time I have had an article published at this level. It's amazing what can happen when you "Switch Off Your Television Set and Go and Do Something Less Boring Instead" - two years ago I started out writing tentative little numbers about fish fingers and my daily struggle to leave the house, and today I found myself sat at a table in a London studio, with cans on my ears and a fuzzy mike in my face, being asked to make sense of some of the issues around the current state of birth freedom in the UK.

I was joined my the absolutely vibrant and wonderful Virginia Howes, the Independent Midwife many of you saw recently on ITV's Home Delivery, and human rights Barrister Barbara Hewson. Over the phone came the voices of two wonderfully passionate and articulate mothers, Amy Scott and Alexis Brooking.

It was an absolute honour to be a part of such a rich and important discussion. You can listen to it by visiting this link: http://ruvr.co.uk/2013_03_27/women-right-choose-give-birth-home-midwife/ and clicking 'download'.

The story of Independent Midwifery is unfolding day by day. I feel very optimistic that with so many people working so hard, a solution must surely be found. The very latest news from the campaign today is that David Cameron has written to the Health Minister saying that women need this choice and that he must arrange a meeting with IMUK. So - this seems very hopeful.

This is an issue, not just about birth, but about human rights. We are all fighting, not just to save Independent Midwifery, but to preserve a model of care that is woman-centred, holistic, and intuitive, and that is not highly focused on risk management. This issue matters greatly for the future of midwifery itself, and for the birth experiences of all women, now and in the future.

If you haven't already, please sign the petition.

Save Independent Midwifery: Keep Birth Choice Alive!

2013-03-22T13:56:00.000-07:00

The following article appeared in the Huffington Post today.

Independent Midwives, the only alternative to NHS maternity care available in the UK, are currently under threat. This Monday – 25^th March – they are taking to the streets of London in protest at a E.U.Directive that requires all registered health professionals to have mandatory insurance. Independent Midwives (I.M’s) won’t be able to get this insurance – due to their low numbers and the potentially high cost of claims the premiums would be prohibitively expensive – and unless the Government answers their call to help them find a workable solution, they face becoming illegal and extinct from October 2013.

I first came across I.M’s during my second pregnancy in 2010. Having had a hospital forceps delivery with my first baby that, both physically and emotionally, took a long time to recover from, I knew the impact that a birth experience could have, and planned to have a home water birth with baby number two. For me, home was the place where I would feel safest, and where I felt this secure feeling would maximise my chances of birthing without unpleasant intervention.

However, my local maternity system changed during my second pregnancy. ‘Community Midwives’ became obsolete, and were replaced by a ‘bank’ system in which you were seen for antenatals by one of a large number of midwives from the area. I never met the same person twice. For a home birth, I was told, there might not be a midwife available to come to me, and even if there were, it was very likely that she would be a complete stranger. Even the midwives themselves were dissatisfied, and warned me that it also meant that the midwife sent to me in labour might have little or no experience of home or water birth.

All of this added a new layer of anxiety on top of my existing fears about a repeat ‘feet in stirrups’ experience. There were so many unanswered questions about who would be sent to attend me at this pivotal moment in my life. I felt this really mattered, and was intrigued when a friend suggested I look into the option of an Independent Midwife. After a few phonecalls, local I.M, ChrissyHustler, came to our house and spent a whole evening talking things through with myself and my partner as our daughter slept upstairs. When she left, we turned to each other and said, ‘Right, that’s decided then!’. There just seemed no question of making other choice now that we had seen what Chrissy could offer.

This turned out to be one of the best decisions of our lives. Chrissy, and her colleague Caroline Baddiley, made the birth of our second daughter a day that we will never forget – for all the right reasons. In spite of my fears they gave me the confidence to trust my body, and helped me to see birth as something safe and normal. They encouraged me to allow my then two year old daughter to be a part of the experience, and having her dip in and out of the room as I laboured, at one point with a bunch of hedgerow flowers for me, was simply magical. It seemed the room was filled with love that day, and I birthed my second daughter powerfully and joyfully and without difficulty.

This wonderful service comes at a cost: an I.M charges around £3000, which for some people would be out of the question. However, in cases of hardship, I.M’s often lower their fees, offer barter arrangements or allow spread payments. For others, it is perhaps a question of priorities – a small sum in comparison to the amount many spend on weddings, cars or holidays. In our case, although our income is relatively low, we felt that this was an investment we were happy to make. A birth that empowered me as a woman and as a mother, and that gave our baby the gentlest possible introduction to our family and to the world – this was what we paid for, and this was what we got.

Independent Midwifery is a birth option that needs saving. For starters, without it there will be no alternative to the NHS, leaving a system that is already struggling and overstretched with a monopoly on UK childbirth. With I.M’s currently the only place for women to turn if they have ‘higher risk’ pregnancies, and, for example, they want to deliver a breech baby or twins at home or naturally, the loss of I.M’s will mean that birth options narrow and even risk disappearing completely. Whatsmore, linking insurance to registration has worrying implications for women birthing in the NHS too – for who knows what might happen once insurance companies have a say in our childbirth choices?

If a solution can’t be found, and I.M’s become illegal, this Autumn I’ll be one of the last UK women who are lucky enough to enjoy what David Cameron has described as the ‘gold standard’ of midwifery care. I’ll know my midwife, Tara Windmill Robson, isn’t insured, but, having got to know her, I am certain that she is unlikely to be ‘negligent’ in her care of me – I trust her. She is passionate about birth, and gives me devoted, continuous care – which I think makes you a lot less likely to make a mistake than an insurance policy ever could. Let’s hope that the powers that be can understand this and find a way to keep Independent Midwifery – and birth choice - alive for the women of the future.

Take Action:

Petition the UK Government: click here

March and Protest in London on 25th March: Choose Your Midwife, Choose Your Birth

Facebook campaign group: Independent Midwives UK

More info on how the legislation will affect NHS midwives and women birthing in the NHS.

Stop Googling Your Birth Options, And Hop Up On The Bed, Dear

2013-02-28T13:33:00.001-08:00

Here's something every pregnant woman might like to know: during labour, you will be given a routine vaginal exam every four hours, and this will be used to check your cervical dilation, and to chart your progress. Your midwife might mention this at your antenatal appointments, but here's what she probably won't tell you - the exams are optional, you can refuse them, and unless there seems to be a problem or you actually want to know how dilated you are, it's probably better that you do, since this invasion of your privacy can actually bring you out of your Labourland trance, making your 'mammalian self' feel threatened and slowing or halting the very progress they are trying to check.

Learning about the various procedures, such as 'V.E's', that are likely to take place during your labour and birth can help you to make truly informed decisions about whether to accept or refuse them. It can allow you to think about the kind of labour you really want, and empower you to know your rights and take control of the experience, giving you a feeling of ownership and satisfaction, regardless of the way you ultimately birth your baby. There is a wealth of information available now to pregnant women, in particular thanks to the internet, and at the touch of a button you can inform yourself, and discuss your plans and concerns with other women who have 'been there, done that'.

Brilliant, right? What's not to like about this? Surely those concerned with the care of birthing women must be thrilled that some of them are actually taking an interest in what happens to them, and - often literally - getting off their backs and taking an active role in their labours? You would hope so, and yet Terri Coates, a practicing midwife, lecturer in Midwifery, and clinical editor to Call the Midwife, doesn't seem to be in favour of it in this interview from Tuesday's Mail:

"A lot of young women in the 1950s didn’t even know where babies came from. They were happy to have someone lead them and were more deferential. Now women are far more savvy, have apps on their phones, mum-and-baby books, better education. They know what they want and how to get it. Managing their expectations is like walking a tightrope. They expect the perfect birth, the kind they see in magazine pictures. Some feel that if they have anything but a drug-free birth, they’ve failed. But if they end up with a healthy baby, they’ve done extremely well."

So - the modern and informed woman is making life difficult for the professionals who have to 'manage her expectations'. Terri Coates seems to suggest that our access to information is encouraging us to set our sights too high, and she trots out the patronising and tired old idea that we should all be happy with a healthy baby. This attitude completely dismisses the mother's birth experience, and is often most painful to those of us who experience birth trauma, making us feel that we should stop complaining and be grateful that everyone simply survived.

As Elizabeth Prochaska, founder of Birthrights, the new UK organisation dedicated to promoting human rights in childbirth, puts it:

"What's worrying is an increasing tendency for healthcare practitioners to view the mother as simply a vessel for the production of her foetus, and to say “as long as you get a healthy baby and a live mother out of it that's all that matters". But it's not all that matters. Look at the cost to the healthcare system of women with serious disorders post-childbirth...The rise of post-traumatic stress disorder and post-natal depression are problems, too."

Women who have been traumatised are finding their voice, as in this recent article, in which several women, including Toni Harman from One World Birth, speak about the terrible treatment they suffered during labour and birth, including being shouted at, having their wishes ignored or belittled, and feeling as if they were being raped.

However, commenting on their stories, Dr Gedis Grudzinskas, a former professor of obstetrics and gynaecology at St Barts Hospital, London, seems unmoved. It seems he agrees with Terri Coates - we women are getting our hopes up too high:

"There's a world of diminishing resources but increasing expectations from mothers-to-be. Labour is an all-consuming process, and discussion can be very difficult because you might only have one-and-a-half minutes between contractions. So there may be a perception of doctors and midwives being too assertive - therefore bullying - but they have the patients' best interests at heart."

Our hopes are too high - we expect silly things like a decent shot at the birth we really want, and if that turns out not to be possible, for professionals to talk to us and touch our bodies kindly and with respect.

Grudzinskas also echoes Terri Coates yearning for the good old days, when women - apparently - just did what they were told without question, and the dangerous technology of the internet was not at their disposal:

"In the old days, women referred to doctors as experts. Now, many women think they're well-read because they've done research on the internet. But much of that information isn't correct."

Birth guru Sheila Kitzinger takes on this attitude in her excellent new book, Birth and Sex:

"An obstetrician once snapped at me that he couldn't stand 'back seat drivers'. He meant women who had ideas about what they wanted in childbirth."

And, with the usual twinkle in her eye, she tells this story:

"One obstetrician in a major teaching hospital where one in four women had a Caesarean was pleased that there is 'increasing maternal input into childbirth'. It is not clear what he means by this. Women have always had a lot of 'maternal input'. Doctors could not produce babies without them."

Women - with the help of the internet and all of the information and communication that it brings, are taking back childbirth. Slowly, ever so slowly, the balance of power is shifting, and it is this that is causing some professionals to feel uneasy and long for a time when women would defer to their expertise, not ask so many questions, and comply.

If a woman declines vaginal exams in labour, this is likely to make things a lot easier and more enjoyable for her, but have the opposite effect for her carers. They will have to rely on other methods (and skills that they may not have) to make their assessments. They will not be able to chart her dilation on a partogram. If they can't do this, they won't be able to fully assess her 'progress' or lack of it, and follow their usual procedures and protocols according to the clock. They might even have to behave like the midwifes 'in the old days' as Dr Grudzinskas would put it, and, putting down their clipboards, turn their eyes to the woman as the most powerful and knowing figure in the room.

Water birth, pronounced risky by some doctors, has a similar effect of restoring power to the woman at the expense of those who attend her. As Marsden Wagner, director of Maternal and Child Health for the World Health Organisation for fifteen years, puts it in Water Birth Unplugged:

"Water birth like home birth is controversial. Why? Because the obstetricians are out of control. It's that simple. The water helps the woman, but it sure doesn't help the birth attendant. It's the opposite of the lithotomy position (on the back with feet in stirrups), which helps the birth attendant, but doesn't help the woman. With water birth, the birth attendant has many dilemmas, do I roll up my sleeves, do I get in the pool, do I take my clothes off, what do I do here? You can't really attend a water birth and keep your sophisticated control and dignity."

If you are faced with a choice about procedures and interventions in childbirth - ask yourself - who is this most likely to benefit, reassure, or make comfortable - me, or my carers? We must not be deterred from learning as much as we can about our rights and our options in childbirth, no matter how much it may inconvenience midwives or doctors. We do not have to comply with their suggestions, unless we wish to. We are allowed to be powerful in childbirth. Whatsmore, birth is not simply a means to an end - our birth experience matters, and is of primary importance, not just to us, but to our babies, our families, and the whole human race.

My Search for Birth Freedom in a Climate of Fear and Mistrust

2013-02-16T05:51:00.001-08:00

Every generation likes to think they're free, and often only the clarity of hindsight reveals just how restricted they actually were. My mother, for example, thought, like many women in the 1970's, that it was the very pinnacle of freedom to have her labour induced, to be able to choose on which day of the week her baby came, and to be in a hospital which offered 'state-of-the-art' care for her and her baby. Looking back on it now, she can see just how far from freedom she truly was: shaved, enema'd and pethidined, with no formal talk of consent, and later, ushered sternly back to bed by Matron as she wandered the hospital corridors, drug-hazy and looking for the baby they had taken from her.

Nearly forty years later, that baby - me - is pregnant for the third time, and wondering - am I free? Do I have full freedom of choice to have the birth I really want and need? Can I feel assured that anything that is 'done to me' in the name of medical science will be absolutely necessary and helpful? And are there restrictions that none of us are even able to see, and that will only become apparent when the baby inside me is fully grown and making their choices against a new and different backdrop?

Already I have met resistance to my plans to birth at home. At my first appointment with the midwife, the flag was automatically raised because my last baby was born weighing ten pounds four. This is me just after I birthed her. You can see just from my face what a life or death struggle it was:

She was born in the water after a second stage that lasted about ten minutes, without a whiff of gas and air, without a single vaginal exam, without any instructions on when or how to push, without a hand laid on me except in love, and without a stitch.

But because she was 'so big', 'they' want me to do things differently this time. They want me to have consultant led care, a hospital birth, and an induction at 38 weeks. (That's a whole month before either of my other babies have been born - I'm a ten month mama!)

The size of my baby might have been a 'flag' for them, but let me tell you, I have 'flags' too, and I know how to wave them. They might not trust my body - but I don't really trust them - there are things that make ME lose faith in THEIR abilities. I don't want to list in detail all of my reasons here - I never want this blog to single people out or publicly criticise individuals - but let's just say that a few incidents and some inside information has led me to feel a lack of confidence in my local maternity unit, and a strong suspicion that they don't trust birth and don't have much faith or understanding of it as a completely natural process.

This local feeling would seem to reflect a national and international picture. In her latest book, 'Birth and Sex', Sheila Kitzinger describes a climate in which 'choice' is a buzz-word that is meaningless when applied to women's actual realities: "The rhetoric of 'choice' ignores the pressure exerted on women to have a particular birth place - hospital - and kind of care - obstetric management, and the power of the medical system, so that discussions about choice often amount to emotional blackmail."

Worse still, it seems that even those midwives who wish to support real choices have their hands tied. Kitzinger writes, "Midwives who support women in their own free choices are more at risk of being reported to the Nursing and Midwifery Council and losing their registration."

The prosecution and persecution of midwives who refuse to, as Kitzinger puts it, "guide women to 'correct' choices", is epitomised currently by the case of Becky Reed, held in the highest regard by leading members of her profession, a member of the legendary Albany midwives, and up before the NMC on the 11th March. Her campaigners state, "For Becky, one of the UK’s most respected midwives, to be treated in this way constitutes an attack on midwifery autonomy. If she is ultimately sanctioned, it will make it more difficult in the future for midwives to confidently support women’s birth choices."

They might well have written, 'make it EVEN MORE difficult' for it seems like this is already very much the case. As a trainee midwife recently said to me, "I'm already learning that it's best to keep any strong views or opinions to myself, otherwise I'll risk not getting the job at the end of training.", and a qualified midwife confirmed, "At the end of the day, it's a job and you have to feed your family. If you make too many waves you put yourself at risk."

In this climate of fear and mistrust, how can any of us be truly free?

For me, too many flags and a search for true freedom have led me, as I did in my second pregnancy, to book an Independent Midwife. I just don't want to give birth in a system that has no trust in me or my body, that sees birth as medical not emotional or spiritual, and that is so intent on following protocol that it can't see the woman behind the clipboard.

We had our first visit from Tara on Valentine's Day, and she brought red paper and silver string for my daughters to make heart decorations. And this summed up her visit. It was all about hearts. She wanted to get to the heart of my previous birth experiences, she wanted to understand the fears and hopes in my heart for this new baby and birth, she wanted to share the joy in the hearts of my whole family, and she wanted to connect with me, the birthing woman, at heart level. Instead of being left, as I was by the NHS, with worries and fears about my possible malfunctions, Tara stayed for six hours, and left us all with a feeling of great excitement about the months ahead and the wonderful birth experience we will all share.

I've exercised my freedom, I've raided my savings, and I've made my free choice - to have a midwife at my birth who I already know, who truly believes in the wonder of my body and who understands how to behave in order to make birth a beautiful and empowering experience for me and my family. But it's lucky I didn't wait any longer to get pregnant, because from September 2013, Independent Midwives are likely to be unable to practice as they currently do, due to an EU Directive that requires all health care practitioners to have indemnity. If nothing is done to save IM's, it seems likely that the free choice I just made to opt out of the NHS system for birth will no longer be one that is available to pregnant women in the UK.

I'll be writing more about Tara, Independent Midwifery and the campaign to save it, as my pregnancy progresses. In the meantime, please sign this petition to help their campaign:
Finding a workable and affordable solution for Independent Self Employed Midwives
We need to take action now to help preserve, improve and extend freedom of choice for all birthing women. Every woman should have the right to be attended by a midwife who is able to practice safely whilst remaining in touch with her heart. Every midwife should have the right to think, feel and work openly without her hands being tied by protocol and fear.

~ o ~

To find out more about Becky Reed, please visit the Facebook page: Justice for Midwife Becky Reed
To find your nearest Independent Midwife, please visit www.independentmidwives.org.uk
To find out more about our midwife Tara, please visit www.mindfulmidwifery.co.uk

How do YOU 'Self-Soothe'?

2013-01-30T14:22:00.000-08:00

The question of whether or not babies can learn to 'self-soothe' continues to divide parenting writers and experts. Does a baby left to cry alone in their cot eventually find ways to comfort themselves, to make themselves feel better? Or do they simply stop crying after a while because they realise that nobody will come and that there is nothing they can do about it - they learn that they are helpless?

Let's look at this from a fresh angle. Regardless of where you stand on this issue, let me ask you a question: How do YOU 'self-soothe'?

Think for a moment.

The shit is hitting the fan. You are distressed. You have lost your job. Your relationship flounders. Someone close to you is sick. The usual suspects. You feel 'emotional'; you are upset, jangled, stirred.

What do you do?

How do you try to regulate yourself, to bring yourself back into balance?

You might sit with your difficult feelings for a while, aware that they are part of life's pattern and will pass. You might cry, alone or in the arms of someone who cares. You might go for a run, or distract yourself with a project. Perhaps you stare into space. Maybe you pretend it's not happening. Maybe you eat. You might pour a drink. But do you stop at just one? And do you stop at just a drink?

Do you find 'comfort'? Are you ever fully 'soothed'? For some, this place is never reached, and attempts to find it become increasingly desperate - perhaps using drugs, self harm or other destructive behaviours. If this is you, you might not describe them as destructive, because you truly believe that they are helpful to you and that you will eventually find the inner peace that you seek in them.

The choices we make when our world is in turmoil are not simply genetic or the luck of the draw. They are a direct result of how we were treated as children.

If the adults around us could tolerate our distress, respond to it consistently, and bring us comfort, then we will now, as adults, be able to do this for ourselves. We will still feel distress, but we will not be afraid that it will overwhelm us or kill us or swallow us up. If the adults in our childhood were inconsistent, unresponsive, or worse still, abusive, we may well have difficulty in responding healthily to difficult feelings or situations. We will be more likely to be overwhelmed by life, seek comfort in unhealthy places, and take longer to recover from hard times, if we are able to recover at all.

In fact, the debate over whether babies learn to 'self-soothe' should become obsolete. Because the fact of the matter is - they do. We all learned to 'self-soothe' when we were babies, all of us. Every time we felt distress, we learnt a little bit more about comfort. Every time we were held, shooshed, rocked, nursed, sung to, kissed or hugged, we learned something. Every time we were ignored, left alone, told to stop crying, shouted at, shamed or threatened, we learned something. We learned to stay with our feelings and let them slowly shift, or to find ways to bury them, deny them or disown them.

Yes, babies learn to self-soothe. A baby who cries in the night and is quickly enveloped in loving arms learns to soothe themselves quickly and with love. A distressed baby who is left alone learns to soothe themselves by switching off their feelings, minimising them, disassociating. The more such lessons are repeated the better they will be learnt.

Perhaps those 'experts' who advocate leaving babies to cry it out have a difficult relationship with their own distress - a childhood lacking in comfort which they now wish to play out through their books in the homes of strangers. It might be interesting to ask them the same question, "How do YOU self-soothe?"

Dear Daughters - I'm Sick Of You Waking Me Up!

2013-01-06T14:27:00.000-08:00

Dear Daughters

Brace yourselves, I have a confession to make. It may or may not surprise you. Here goes...

I don't like being woken up in the night! I REALLY don't like it! I can't stand it!

Maybe you thought it just washed over me - all part of the service - like chopping cheese into chunks or sitting through Waybaloo - well you're wrong. Being woken up and dragged from the delicious depths of sleep two, three, four, five times a night is WAY more irritating than that! WAY MORE! And, quite frankly, I'm bloody well sick of it!

It's not just the nights - which are bad enough - it's the evenings too. For five years now I have had my enjoyment of every single evening compromised in some way, either because I've been trapped in a bedroom breastfeeding, singing, storytelling or simply begging you to go to sleep, or because I've had to abandon my delicious food / fascinating film / other grown-up activity, and go back upstairs to soothe you back to slumber.

And then there's the days. I used to be bright eyed, sparky, witty even. I used to have a 'To Do List', and do the stuff on it. Now my face is as grey and puffy as my brain and I cry when I can't find a matching pair of socks. You might think that all I need is a good night's sleep, but deep down I know that this state of insane confusion is becoming The Way I Roll and that I'm slowly morphing into a Mad Middle Aged Woman. This is how it happens.

Yes, dear girls, the days, the evenings, the nights - all a chaotic blend of mind-numbing sleep deprivation, dreams that are never finished, and constantly, completely fucking irritating interruption. But do you know what? All of it is just a teeny tiny tip of the most enormous iceberg of what I would do for you.

For as long as I am alive, if you need me, I will come, no matter how much it inconveniences or even irritates me. Call me in the middle of the night from a train station four hundred miles away, and I will jump in my car without question. Get sick and I will camp on the cold hospital floor for as long as it takes. Without hesitation I will empty the bank, I will cut off limbs, I will turn my back on friends, I will serve time, I will move to a new country, I will lay down my life. No matter how old you are, or what the situation, I will be there.

Which kind of makes missing the end of the film while I pop upstairs to soothe you back to sleep seem like nothing much really.

For some reason I can't quite fathom, not everyone sees it this way. Being a 'parenting blogger' who speaks out against sleep training makes me a sort of 'High Profile Softie', and sometimes a target for people who think I should be treating you differently. Their arguments, often put forward angrily in blog comments, all seem to boil down to two essential points:

1. Letting you continue to disturb my sleep means I am ignoring my own needs.
2. Responding to your cries round the clock is 'spoiling' you and teaching you that the world revolves around you. You will grow into a selfish person with no boundaries and probably end up in prison.

Let's quickly deal with these points, firstly -

1. Ignoring my needs? My 'need' is to respond to you, to be there for you, to comfort you, to mother you. While you are small, and vulnerable, and dependent, I actually want to provide you with all the reassurance I can that you are 100% safe and loved. Doing so brings me great fulfilment. I absolutely know that this solid start will stand you in good stead as you grow and move away from me into the world, which brings me to -

2. Responding to a small child's needs day and night does NOT create a fragile adult destined for a difficult life, rather it provides a secure foundation, a strong sense of self-worth, and an ability to find comfort in healthy places - essential for long term mental well-being. If you actually talk to people who are finding life hard - prisoners, addicts, the mentally unwell - you will struggle to find any of them who say, "If only my parents hadn't been so responsive, so loving, so consistently warm and kind to me, 24/7".

And so, dear daughters, I will continue to be there for you at night as well as in the day, and ignore the critics, the baby trainers, the journalists and the researchers who say 'Shut the door and let them learn to sleep alone'.

I confess, I don't like having my sleep interrupted, not one bit, but I know that - for now - you need me, and I need to be there for you.

By the way, I really can't stand the Soft Play Area, either.

It's amazing what you'll suffer for someone you really love.

- - -

You know you're in love when you can't fall asleep because reality is finally better than your dreams.
Dr. Seuss

'Childism' - As Utterly Unacceptable as Sexism and Racism

2012-12-15T10:57:00.000-08:00

In the past few decades, mankind has had to shake up their attitudes about a number of things. It is no longer considered to be 'ok' to degrade, humiliate, taunt or insult another human being on the grounds of their sex, race or sexuality. It still happens of course, but it is not considered acceptable. Make a sexist or racist joke down your local pub and you might get away with it. But post an image on Facebook that derides another human being, and you're likely to be reported or even prosecuted. That is, unless that image is of a child. Then it's ok.

These images have been doing the rounds this week. Most commenters seem to agree that they are 'hilarious':

"Comedy Gold'

"Gave me a smile - thanks"

"A bit of humour"

"I just love this!"

I beg to differ. The children in these pictures look sad, and humiliated. At a time when they clearly need help to sort out their sibling rivalries and calm their emotional storm, the grown ups responsible for their care have instead chosen to ridicule them. They are powerless to refuse this treatment, nor can they consent or otherwise to the photo being taken and shared on Facebook for the world to see.

It's hard to imagine any other group in society being treated in this way. But if we were to take a similarly degrading image of a woman, for example, there would be an outcry!

A few months ago I was inspired to write a post about tantrums when I saw this image on Facebook, and read the comments beneath it:

"Who needs a mop when you have a pre-schooler?!"

"PMSL!"

"I laughed so hard at this photo!"

"Good on the mum for carrying on!"

But is it really funny to see another human being in complete distress, and whatsmore, to take a picture of them and post it online?

These images are considered acceptable because they belong to a world in which we are prejudiced against children, seeing behaviour such as fighting with siblings or throwing tantrums in a shop as clear signs of their inability to control themselves, the burden they place on their carers, and their 'badness' or 'naughtiness'.

This is a world in which it is considered perfectly normal and justified to turn our backs on the distress of another human being, so long as they are a child. So normal, in fact, that you can learn exactly how to do it on prime time television. Note in this clip from Supernanny that the mother is twice offered comfort, whilst the emotional needs of the child are completely disregarded:

This attitude has been described as 'Childist' by Elizabeth Young-Bruehl, psychoanalyst and a leading expert on the nature of prejudice. Her book on the subject - Childism: Confronting Prejudice Against Children - is excellent, describing in complex detail how our childist attitudes - in just the same way as racism or sexism - create a world in which it becomes acceptable to dislike children or even harm and abuse them.

"CHILDIST beliefts - that children are burdensome and absorb more than their share of resources, that they should serve adults, that they are property, that they lack reason, that they are rebellious and must be broken through harsh discipline - do not reflect current scientific knowledge about children's development, capabilities, and needs. It is CHILDISM when adults interpret children's dependence as inferiority, and thus deny children's rights. We are CHILDIST when we transform the adult responsibility to to care for children into an excuse to exercise unchecked power."
(Childism - extract from the Press Release)

It is time for us to stop finding it acceptable or even funny when we see evidence of childism, in real life or online. We need to take this prejudice seriously, and to stand up for children, who are often not given a voice in our current society and therefore unable to stand up for themselves. Once we recognise and acknowledge our childist attitudes, we take the first step towards much needed change.

Related Post: Let's Challenge Our Anti-Child Attitudes

Should We Be So Very Scared of Giving Birth?

2012-12-07T05:56:00.000-08:00

This article has now been published in the Huffington Post.

Tapping into the twenty first century zeitgeist is easy, and a bit fun - you just have to tap into Google. For example, enter ‘very scared of’ … and you’ll see the top four things that people are very scared of, right now, like this:

Many women are scared, afraid, terrified of giving birth. Some – as many as one in ten – suffer from Tocophobia, a morbid fear of giving birth that leads them to seek elective caesarians if they can. Others, while they may not have a diagnosable psychological disorder, are still extremely anxious and fearful about the task of bringing their baby into the world.

It’s not really surprising that so many women feel this way. The media portrayal of birth ranges from the rather ridiculous soap opera version – 'woman looking terrified and sweaty delivers baby in pub drama' – to programs like One Born Every Minute – 'woman looking terrified and sweaty begs for drugs in hospital drama'. Birth education in schools is woefully lacking and standard ante-natal input is often focused on what your options are if you cannot cope. Is it any wonder we’re all 'very scared'?

Ironically, going into labour feeling extremely afraid can actually increase your chances of having a difficult or even traumatic experience. Not only can fear increase tension which in turn makes birth more painful, but approaching birth with negative expectations can lead to a more ready acceptance of medical interventions, which usually serve to increase rather than remove any discomfort or trauma. All these frightened women (and I was one of them once) end up getting the experience they both expected and dreaded – the prophecy is fulfilled, fear becomes fact:

Is there any real justification for fear of giving birth? As well as the current negative media portrayal, there is an accompanying widely held belief that childbirth is dangerous, and that we should all be grateful for modern obstetrics, because, before it was invented, ‘women used to die’. But this is an oversimplification of a complex historical issue – many women used to (and in many parts of the world, still do) die in childbirth, not because of their bodies are poorly designed for birthing, but due to poor maternal health, poor diet and most of all poor hygiene. In the 19th century, over half of all deaths in childbirth were caused by Child-Bed Fever, a direct result of doctors simply not washing their hands.

The statistics we have on Western maternal mortality show a sharp increase in the early 1900’s, peaking in the 1930’s, in direct correlation to increased medical intervention such as botched caesarians and badly administered drugs. But the largest killer was always infection, often caused by doctors going from woman to woman and even from mortuary to birthing room, and this only subsided with the invention of drugs to fight it. Turning to the modern day, the country with the most medicalised model of childbirth, the USA, has seen rates of maternal morbidity double in the past 25 years.

In some cases, modern obstetrics saves lives, there is no doubt about that. The difficulty, for Western birthing women and no doubt their doctors too, is achieving some clarity about which cases are in actual need of medical help, and which would be best left alone. This, along with the conundrum of whether fear itself, and birthing in an environment not suited to our mammalian selves, is actually causing some of the hold-ups and struggles in modern labours, is a difficult and confusing tangle for us all to unpick, especially when you are nine months pregnant, or worse still, nine centimetres dilated.

In this complex environment, women are coming together to try to improve and inform their birth choices, and maximise their chances of a positive birth experience. In many ways, there has never been a better time to be pregnant - antenatal education has moved on from panting and plastic pelvises, and there now exists a whole host of vibrant groups offering everything from the latest information about evidence based care, to campaigns for birthing rights, for example The Birth I Want, One World Birth, One Born Every Minute - The Truth, and Tell Me A Good Birth Story.

I recently founded The Positive Birth Movement, a grass roots organisation aiming to spread positivity about childbirth via a network of free to access antenatal groups, linked up by social media. Within six weeks of launching we have over 30 UK groups and another 15 as far afield as New Zealand, Turkey, Germany, South Africa and the States. We believe that every woman deserves a positive birth – and that this doesn’t always have to be 'natural', but rather that:

The enemy of fear has always been information and communication. If you are worried about giving birth, you are not alone. Join The Positive Birth Movement on Facebook or visit our website for more information.

Childbirth Without Fear by Grantly Dick-Read and Birth: A History by Tina Cassidy were helpful to me as I wrote this article.

Mule Yule - A Great Big Motherhood Giveaway!

2012-11-21T16:21:00.002-08:00

This giveaway is now closed. Well done to the winners, announced below.

I've put together this wonderful prize package as a little festive thank you to all of you who read and follow my blog. To the winner, FIVE lovely books on parenting and motherhood, a fantastic FILM about early parenting, a BabyCalm white noise CD, and a bundle of Creatures Natural Baby Toiletries (toiletries UK only).

To five lucky runners-up, a copy of the ebook, Memoirs of a Singing Birth, by Elena Skoko.

The top prize is just perfect for anyone interested in birth, babies, motherhood and parenting. You might be an expectant or new mother yourself, or perhaps a birth worker or early childhood specialist. The prize could easily be divided up as Christmas presents to those you know and love, or you could just hog the lot yourself, whatever you prefer!

To enter, just leave your name in the comments at the bottom of this post. The winners will be picked randomly using the random number generator at random.org, and announced at 8.30pm on 1st December. If you want to enter, but have difficulties leaving a comment, get in touch with me via my Facebook page or by email, and I will be able to help.

Here is more detail about the prizes. If you don't win, they may give you some gift ideas!

BabyCalm: A Guide for Calmer Babies and Happier Parents by Sarah Ockwell-Smith was published in October 2012 and has since received rave reviews, beating some of the old stalwarts like Gina Ford and Supernanny in the Amazon charts. In fact, it doesn't even seem right to mention the names of the 'baby-trainers' of yesteryear in the same paragraph as this fresh, informative and compassionate guide for new mothers. The book is entirely and unashamedly baby-centred and grounded in the facts about early child development: rather than trying to sell you any lies about the restoration of normality, it encourages you to slowly adapt to parenthood by trusting your instinct and informing yourself about the true value of your input and the difference your actions will make to your baby's developing brain. Packed with information and advice for new mothers, I cannot recommend this book highly enough.

Available from Amazon and the BabyCalm website.

Also from BabyCalm, this White Noise CD is designed to replicate the constant reassuring sound heard by baby in utero, to calm babies, and help them sleep for longer.

Available from the BabyCalm website.

A bundle of Creatures new baby goodies, including a 300ml Creatures Baby Shampoo, a 420ml Creatures Baby Wash and a 220ml Creatures Baby Balm Butter. (This part of the prize is only available if the winner is UK based.)

Available from the BabyCalm website.

Musings on Mothering edited by Teika Bellamy reminds me of mothers everywhere, in that it has an understated cover and a tendency to play itself down and sell itself short. Look within, however, and it is filled with richness; an explosion of beautiful art, touching words and poems, warmth, humour, pathos and sorrow. An absolutely perfect book for all mums, a wonderful gift for Christmas, a completely lovely book. If you do not win it, please buy it and give it the ego boost it deserves. All royalties from the book go to La Leche League GB. Buy via Mothers Milk Books, priced £13.99.

A copy of Babyhood - The Film - an absolutely fantastic explanation and defence of child-centred, responsive parenting (which ought not to need explaining or defending of course, but...!) A stellar cast of leading experts - Camila Batmanghelidjh (Director of Kids Company), Lesley Page (Former Head of Midwifery and women's health at Guy's and St Thomas' NHS Foundation Trust), Sue Palmer (Writer, presenter and consultant on modern childhood, author of Toxic Childhood & 21st Century Boys.) Helena Kennedy QC (Member of House of Lords. For her work for women she received the Times Newspaper's Lifetime Achievement award in 1999.), Sue Gerhardt (Psychoanalytic Psychotherapist and author of Why Love Matters), Carrie Longton (Co-Founder of Mumsnet), Dr. Suzanne Zeedyk (Senior Lecturer in Developmental Psychology, University of Dundee) - tell us in clear terms the vital importance of the first months and years of life, and there is the occasional poem by Holly McNish, which lifts an already excellent documentary into the realms of creative art. A great educational film for all new parents, go to the website to buy copies, watch using Distrify, or organise screenings. Watch the trailer here:

Catching Babies by Sheena Byrom is the memoir of a midwife from her first day as a student nurse through her thirty five year career in the NHS. Those who have heard of Sheena Byrom will know that she is a passionate campaigner and advocate of positive birth and woman centred care, and this shines through in her story - from the moment she drops into the conversation that she spearheaded a move away from midwives wearing such formal uniform as nurses, since pregnant women are not sick and uniforms create an imbalance in the power dynamic, you know that you are reading the work of a subtle revolutionary! The book is gentle and readable - Call the Midwife meets the late 20th century - with a sprinkle of midwifery politics thrown in.
Available from Amazon.

Home Births: Stories to Inspire and Inform is one of a great series of books published by Lonely Scribe. I've already reviewed the lovely Breastfeeding: Stories to Inspire and Inform; Twin Birth is coming out soon, and as some of you know, I am thrilled and a bit anxious to find myself editing their forthcoming book on Water Birth. The Home Birth book is an excellent read for anyone interested in home or 'natural' birth, filled with beautiful birth stories written by both mothers and their partners. Highly recommended for both pregnant women, dads to be and birth workers everywhere.

Available from Amazon.

Baby Shiatsu by Karin Kalbantner-Wernicke and Tina Haase is another great book for new and expectant mothers. The book explains some of the basic principles of Shiatsu and then offers well explained exercises for parent and baby, illustrated with hundreds of clear and attractive photographs. There are some workouts just for mum or dad as well and lots of encouraging tips and info on the emotional and physical world of both baby and grown up. Anything that encourages parents to spend time connecting with their baby gets my vote, so this book gets my vote.

Available from Amazon

So...leave a comment to be in with a chance of winning this fantastic haul of prizes, and if you are not the lucky winner, you might still win one of five copies of the ebook Memoirs of a Singing Birth, for the runners up.

This truly is a beautiful book for anyone with a passion for childbirth, and would make a particularly lovely gift for a pregnant woman. Elena Skoko writes with insight, wisdom and wit about her journey into motherhood, weaving into her birth story a wealth of information about birthing practices, the politics and history of childbirth, and the actual reality of her own birth experience, giving birth in Bali with guerrilla midwife Ibu Robin Lim.

Part of the proceeds from the sale of the book will be donated to Yayasan Bumi Sehat, a non-profit natural birth center in Bali.

Available in paperback at Lulu and Amazon US &UK, and also published as ebook on Smashwords.

Good luck!

The giveaway has now been drawn, the lucky winner is:

SAMMY GREER

And the 5 runners up are
AMANDA PASTORIA
DENISE RICHTER
EMMA CAVILL
LIANNE MONSOON
LIENE BLUMA

Well done and thanks to all for entering and making it fun. Please get in touch with me if you have won a prize, and have a wonderful Yule, from the Mule! x

Sometimes I Pass the Place Where We Once Lived - A Sonnet

2012-11-13T14:36:00.000-08:00

Sometimes I pass the place where we once lived
And glimpse three ghosts arriving at the door
A woman - me, a man, a newborn child,
Alighting, in the darkness, shocked and sore.
I watch them cross the threshold, disappear,
They don't exist now - all of them are gone,
For brand new parents barely last a day,
And babies only live 'til they are one.
In twenty years I'll show you our old haunts:
"We used to come here once when you were small"
You'll shrug, but I'll see flashes everywhere -
Each gate you climbed, each park, each village hall.
Our lives move on, we change, evolve, adjust,
Leaving our trace, our imprints in the dust.

If you are partial to sonnets about parenting you might also like:
I Lie With You Until You Are Asleep

The Positive Birth Movement: What It Is and How to Get Involved

2012-10-25T15:17:00.000-07:00

Too many women are not having a positive birth experience. A positive birth experience does not always have to be a natural, blissful, drug free birth. But it does have to be a birth in which a woman feels she has had freedom of choice, access to accurate information, and that she is in control, powerful and respected. And it should also be a birth that she approaches with some trepidation, yes, but without fear or dread, and a birth that she then goes on to enjoy, and later remember with warmth and pride.

Currently, we are stuck in a loop that is hard to break. It goes something like this:

The 'Fear Becomes Fact' Cycle of Negativity

Often, when as birth activists we try to address this loop, we focus, quite rightly, on what happens in the hospital. We wish there was less intervention, we question how much of it is necessary, and we shake our fists at the doctors who anaesthetise, yank and cut away women's hopes of a natural or positive experience. But what if we let that be, and tried to break the cycle at a different point? What if we challenged the information, feelings and negative expectations that are held in women's minds and hearts as they feel the first tightenings of labour? What if women walked towards the hospital reception with an entirely different mind-set?

This week I launched The Positive Birth Movement. The Movement aims to break the Fear Becomes Fact Cycle by spreading positive messages about childbirth. We aim to tackle the current negativity about labour and birth in the following ways:

1. By building a network of peer to peer Positive Birth discussion groups, which will be free for all women to access.
2. By ensuring that all pregnant women are made aware of this network and can gain easy access to a local group.
3. By using social media to build an umbrella Positive Birth group, to which all smaller groups can feed back.
4. By encouraging the sharing of expertise, information and positivity in the umbrella group.
5. By sharing and challenging 'human rights in childbirth' issues via the umbrella group.
6. By promoting positive messages about childbirth.

This is a movement in its very first days of life! So it will certainly change, evolve and grow with time. But for now, our main focus is the building of a network of groups to Meet Up, Link Up and Shake Up Birth! Here's how:

Meet Up - organise a regular gathering, discussion group or meeting to talk about themes related to Positive Birth.

Link Up - use social media to link up these groups to build a global network of support and positivity. Take advantage of the expertise, solidarity, power and clout of the network. Gain advice and support on anything from niggling birth questions to human rights issues. Or just spread some positivity!

Shake Up - Challenge the culture of fear and negativity that surrounds birth, and the negative messages that women and girls receive. Support and empower pregnant women and help them to approach birth with a completely different mind-set.

Want to set up a Positive Birth group?

If you would like to set up a Positive Birth group, here's how to get started:

Who can Facilitate?

Anyone can create a Positive Birth group. You might be a doula, midwife or birth worker, or just have a passion for positive birth. You are not required to be an 'expert', the idea is simply to 'facilitate' (the definition of which is 'to make easy'). You can 'make it easy' for women to gather, communicate, support each other and share information quite easily. All you need to do is set a date for a meeting, either in your house, or a local cafe, hall or other venue, as you prefer. Let The Positive Birth Movement know about your group and we will add you to the network.

Who should attend?

Pregnant women, birth workers, and anyone interested in positive birth. However, if your group is entirely made up of birth workers, you might use the opportunity to brainstorm how you can reach more pregnant women, or other ways you could make a difference.

How often should we meet?

This is up to you, but it would be helpful if it could be at least monthly, and regular, for example, the first Monday of each month. This would make it easier for pregnant women to access.

How should we structure our meetings?

This is up to you. If we are going to 'trust birth', we need to trust women to follow their intuition when it comes to running these groups! You might like to start by introducing a topic for discussion and stating the purpose of the group. You might also like to decide whether the group will be confidential. At the end of the group you might like to summarise what you have discussed and make sure that any questions or issues that are outstanding have been noted so that they can be fed back to the online umbrella group.

Can I charge for a group?

No. All Positive Birth groups must be free and not for profit. However, if you are hiring a hall for your meeting you may like to share the cost between you.

Any other Do's or Don'ts?

Not really. I don't really want The Positive Birth Movement to become just another bureaucratic and controlling establishment! All I would say is to remember that the main aim is positivity and that this should mean respect for women and their choices. Remember to listen and facilitate, rather than try to teach or preach. This is not about evangelising home birth or drug free birth. This is about empowering women to approach birth differently and to expect and enjoy a positive birth - whatever that means to them.

If you would like to facilitate a group, please get in touch with me with the details.

A suggested topic for November is 'Planning a Positive Birth' - more info and suggestions to follow, and to be found on the Facebook group.

Even if you cannot facilitate or attend a group, please join us on Facebook and Twitter and help us to grow this idea, and transform the Fear Becomes Fact cycle into... Positivity Becomes Fact!

www.facebook.com/positivebirthmovement

www.twitter.com/birthpositive

If you have any thoughts, ideas, questions or suggestions please email me milli@birthinsight.co.uk

The Positive Birth Movement: Meet Up, Link Up and Shake Up Birth!

2012-10-21T15:25:00.000-07:00

In September I had two wonderful and life enhancing experiences, firstly I began my Doula training, and attended an excellent week-long course with Kate Woods of Conscious Birthing, and secondly, I took a rare evening off nursing my daughter to sleep and went to a screening of Freedom for Birth. Both - coincidentally - took place in Glastonbury, a Somerset town dominated by the mystical Tor and filled with a sense of creativity and transformation that never fails to inspire.

For a long time on this blog I have tried to cover the subject of a woman's right to a positive birth. One of my first ever posts was an attempt to address the politics of power in the birth room: "They Let Me" Go Overdue. Later, I wrote about how Every Woman Deserves a Positive Birth, the impact of what I called The Wallpaper of Fear on the birthing woman, the importance of giving our daughters positive messages about birth, and most recently, the global Birth Revolution and the Freedom for Birth screenings.

The thread between all of these posts has been, I think, the desire to question the status quo, to spread a message of positivity about childbirth, and to empower women to reclaim birth and make truly informed decisions. One of the many subjects we were asked to consider in our Doula training was our own personal 'blueprint' for birth - something that particularly interests me given my background in the world of therapy. What messages have we been given throughout our lives about childbirth? What images have we seen, what sentences have we heard that have stuck in our minds? For many of us, the messages have been mostly negative. Our expectations of birth are pretty low, and we approach it with fear.

Thinking about my own personal blueprint, I was reminded initially of how my mother always told me that, "when you give birth, you lose all your dignity", and get used to, "everybody and their uncle," looking at you, "down there". Of course, I now realise that although this was her experience, it didn't have to be mine, but so often, especially when we are given this information from a young age, we simply do not think to challenge it. However, if we don't challenge it, it becomes increasingly likely that it will happen to us, and that we will be telling the same story to our own daughters. Self-fulfilling prophecy becomes self-perpetuating myth: misinformation becomes reality, rumour evolves into fact.

Even if we are well-armed and determined to read a few books and break a few cycles, the negative messages can still drip into our mind and take hold when we are least expecting it. When planning a home birth, I so clearly remember the Health Visitor's comment, who had come to visit and look around our narrow three-story house. When I told her I was planning to give birth in the top floor bedroom, she said, "I'm sure it will be fine, the only concern they sometimes have is whether they can get a stretcher down the stairs." Immediately I got an image of myself, strapped to a white board like a casualty from the trenches, moaning and blood-stained, whilst two paramedics strained in a staircase corner under my full-term weight.

How does a birthing woman wriggle free from such imagery and a life-time of negative input? In many cases, including my own, she doesn't - it's an almost impossible task. She might have a well informed neo-cortex, but there are so many layers of crappy misinformation in between this and the ancient mammalian limbic system she needs to engage to give birth easily, that she simply doesn't stand a chance. Add to this the fact that she's giving birth in a system that has it's own hugely negative 'blueprint' and is often stretched to it's limits, and it's even clearer to see why so many natural birth plans end up on the cutting room floor.

I don't think that women can expect 'the system' to change - I think that we need to change how we are when we enter the system and that in this way the system will have no option but to change to accommodate us. Reading and informing ourselves in an intellectual way is an excellent start, but I think we also need to go deeper, and explore and challenge the very roots of our feelings and fears about childbirth. We need to 'redecorate': to gleefully tear down the wallpaper of fear and replace it with much more positive surroundings. And to do all this, we need to communicate.

To this end, I've decided to play my own small part by setting up a The Positive Birth Movement, and I've organised our first discussion group with an open invitation to pregnant women, fellow Doula's, birth workers and anyone with an interest in positive birth. Our first meeting is on November 6th - HERE is the Facebook event page for it - and what I've been wondering is - would you like to join us?! If you are local to me in Somerset UK you would be most welcome, but of course, many of you are further afield, and anyway, my house is not quite big enough all of you! But could we possibly set up a system whereby women all came together in small groups on a regular basis to share information, ideas, experiences, thoughts and feelings about birth, and then fed back to each other on a larger scale using social media?

The advantages to this would be both the solidarity and extended expertise provided by a wider group than it would be possible to gather in 'real life'. For example, one group may have a question that they are unable to answer that they could put to a wider audience, or they may even encounter a human rights issue that they feel should be raised and discussed amongst a larger group. There would be power and 'clout' in our numbers. I would hope that it would also simply create a 'buzz', a feeling of warmth and shared purpose, and a sense that, in the face of dark times for birthing women, we are 'doing something'.

If you would like to join up with the meeting on November 6th, here's what to do:

Organise a discussion group yourself, or hold a meeting of an existing group, on or as near to November 6th as possible.
Let me know about it, by email, or my Facebook page for The Mule, or twitter.
Join up with The Positive Birth Movement on Facebook.
Follow loosely this month's theme: Planning a Positive Birth
Tweet about it with the hashtag #positivebirth
Share your stories, questions, issues or positivity with me via email, Facebook or twitter.
Blog about it and let me know.
Watch this space for news!

You don't have to be a midwife, doula or birth professional to take part. The Positive Birth Movement is about ALL women coming together to share their experiences and help each other. For example, three pregnant women could all get together and brain storm their birth plans. Think how much they might learn from each other's choices! This is a chance, not to teach each other, not to judge each other, but just to listen to each other.

If the first Positive Birth link up is successful, I will try to arrange another meeting in the first week of December.

As always, let me know your thoughts!

For more information on Doula Training with Conscious Birthing please visit www.doulatraining.co.uk

For more information about my own work as a Dramatherapist and trainee Doula please visit www.birthinsight.co.uk

Responsive Parenting: Moving Towards Parenting Without Punishment

2012-10-16T15:22:00.000-07:00

Responsive Parenting begins in utero, as we start, however tentatively, to recognise a life at once within and beyond ourselves, and to consider their needs alongside our own. It is this deep and strengthening connection with another person, and the resulting desire to respond to their needs rapidly and with love, that forms the bedrock of Responsive Parenting. Responsive Parenting is not about how we feed our babies, how we transport them from a to b, or where we lay them to sleep. It is deeper, and much much more important than that.

Maternal responsiveness - the way mother (or other main caregiver) watches, understands and meets their child's needs - has been shown in study after study to be fundamentally important to everything from language acquisition, to social competence, to long term emotional well being. Here is my definition of Responsive Parenting:

Responsive Parents:

Observe their children, notice and interpret their cues, and take prompt action.
Respond to their child with love, consistency, empathy, kindness and humanity.
Question and seek to understand their own responses to their children and the familial and cultural background that informs them.
Help their children to learn more about their responses to their own emotions, and to other people.
Acknowledge that all children are individual unique human beings who need to be responded to in individual unique ways.

It is difficult to see any way in which Punitive Parenting could sit happily alongside Responsive Parenting. By Punitive Parenting, I mean using some, or all, of the following techniques, as part of your parenting approach:

Shouting, shaming, name calling, intimidating or humiliating.
Withdrawal, or threatened withdrawal, of objects, privileges or love.
Isolating, eg 'naughty step', 'time out'.
Smacking or threatening to smack.

They sound pretty awful in a list like that, but many of us use some or all of them from time to time, often because it's the only way we know, and we get a bit lost, especially when the heat is on. Notice I called this post 'Moving Towards Parenting Without Punishment' - as I really want to stress that making this change and parenting in a more child-centred and gentle way is something that all of us, both as individuals, and as a society, are still learning about. And as my eldest daughter, then three, so brilliantly put it: "Learning is Falling".

Here are ten techniques and tips that I find helpful in my own personal move towards parenting without punishment. Please do add your own in the comments section below.

1. Keep the Physical Tank Topped Up

Children's behaviour almost always takes a nose dive with tiredness or their blood sugar. It's of course not fair to then punish them for their actions which are caused simply by needing to eat or sleep. Avoid feeding or sleeping routines if these come at the expense of your child's behaviour and your subsequent sanity. Offer regular healthy snacks and let your child off the hook if they lose their grip at the end of a busy day.

2. Keep the Emotional Tank Topped Up

Make sure you are giving your child bags of love and attention before they have to ask for it. Children don't always ask for you to notice them directly - sometimes they just draw on the coffee table or throw a spoon at their sister. Our lives are busy, but try this: set aside two or three minutes before you begin packing the car / cleaning the house / leaving for work or whatever it is you have to do. Take just those few minutes, and before you start anything else - hug, kiss, cuddle, dance, laugh, talk, listen, notice. Tell your child how utterly brilliant you think they are, and then, and only then, get on with the boring grown-up stuff.

3. Shift Your Thinking

We all need to change not just our expectations of children, but the whole way we view them. The punitive model of parenting that most of us grew up with assumes the worst of children, and pits offspring against parent in a never ending battle that can last an entire childhood. Once we start down this road of:

despairing of our children, rolling our eyes, complaining about them
telling them off for not behaving like fully formed adults
getting cross, frustrated, and shouting at them

we can get trapped in a battle situation that is not enjoyable for either party and, if left unchecked, can spiral quickly downwards to become a miserable habit. We need to soften, to try to see things from their perspective, and assume the absolute best of them at all times. Hopefully then we will begin to feel as a family that we are all on the same side, supporting each other.

4. Model Kindness and Empathy

Children learn quickly about how to behave from what they observe, not from what we tell them. If we always try to be kind, forgiving and gentle with them, they cannot fail to become kind, forgiving and gentle with themselves and others as they grow. Likewise, if our child behaves unkindly to another person, this is a chance to show them a better way - by focusing our energy on saying sorry and showing concern to the upset person, in full view of our child. Some parents prefer never to tell their child to apologise - my personal view is that this is age dependent, and that once a child reaches around two, it is ok to gently explain how and why we say sorry, although fairly pointless to enforce it. Again, if we assume the best of our children, we would conclude that they do regret their actions, but are too overwhelmed / upset / developmentally unready to express this in a formal way.

5. Hold Realistic Expectations for your Child's Age

This can be difficult, as we are not all developmental psychologists, and even they don't completely understand the developing brain or have all the answers. Suffice to say that many of the behaviours that children, particularly younger children and toddlers, get punished for, are actually just normal phases of their development - in other words, things that they simply don't understand or cannot help. For example, my two year old drew with a biro across our vinyl tablecloth, and it won't come off. I don't punish her though, because I know she doesn't understand how much tablecloths cost, what money is, what sentimental value is, what the past is, or what the future is. She just wanted to make her mark.

There are lots of online resources on child development, for example, The Encyclopedia on Early Childhood Development, and Zero to Three.

6. Reframe Negative Behaviours as Positives

If we truly try to see the best in our children, then we might even find ourselves admiring some of the behaviours that in another light, we might be tempted to punish. Perhaps they are not 'bad' or 'naughty' after all, but just strong-willed, determined, feisty, passionate, creative, exciting, or humorous? Picture them in twenty years time, once the natural refinement of adulthood has smoothed the rough edges off their current rather crude approach. With a bit of work, these could be just the qualities to take them to the top of their field! Reframing their behaviours in this way allows us to soften towards them, and even feel proud of their stubborn or wilful ways.

7. Set Clear Boundaries with a Clear Head

Parenting without punishment is NOT parenting without guidance. Children need strong boundaries to enable them to feel safe and loved. Set boundaries for your children and discuss them at times when everything is going well, rather than when it's all hitting the fan. Allow your children to have some input into limit setting and consider having some 'rules' that apply to the grown ups too. For example, 'in our family, we do not hit, we respect each other, we are kind etc'. There is no reason why this should all just apply to the children! If a child crosses one of your decided boundaries, don't 'do nothing' - as a Responsive Parent, you need to respond, without resorting to punishment.

8. 'Time In'

Many parents use 'Time Out' - getting their child to sit alone in an allocated place for an allocated time - as a standard punishment. But often, this is simply isolating a child right at the moment they need you the most, when their emotions are raging out of control, and they need your help as the adult to help them calm down, regulate, and make sense of what just happened. A much better response is 'Time In' - bringing a child in close, holding them on your lap, listening to them, talking calmly with them about what is happening. As soon as you see difficult behaviour approaching or escalating, give your child some 'time in'. The sooner the better. An early time in will often also 'fill the emotional tank' (see 2) and prevent challenging behaviour from happening. (More on time outs / time ins here from psychologists Laura Markham, and David Coleman.)

9. Try for 'Oxytocin Led' Responses!

Oxytocin, dubbed the 'Love Hormone' by birth pioneer Michel Odent, is the hormone that helps us to give birth, breastfeed, orgasm, fall in love, bond with others and empathise, to name just a few. Oxytocin is secreted by the pituitary gland when we look at or hold in our arms the person we love, and produces a feeling of warmth, relaxation, gentleness and well-being, a feeling of being in love! But often, in difficult parenting situations, when we are on the cusp of resorting to punishment, we are flooded, not with the hormone of love, but with the hormone of fight or flight - adrenaline. We are upset, angry, our buttons are being pushed, our pulse is rising. Adrenaline is a hormone of action - it makes us want to 'do something' - hence something like the naughty step might seem a good idea. Stop. Breathe out. Take some time out for yourself if needs be. Better still, have some 'time in' with your child, hold them, kiss them, remember how much you admire and adore them, and raise your oxytocin levels! Then respond from that place of love.

10. Always Approve of Feelings, Don't Always Approve of Behaviours

It's really important to help our children to understand their emotional life and to give them words to describe what is happening inside of them. It's also important to give our approval of all their emotions, even anger or other so called 'negative' emotions. This can be difficult as so many of us were told as children not to have certain feelings or were disapproved of when we displayed them. But approving of and accepting our children unconditionally can be a powerful gift and can help them to grow into adults who are able to cope emotionally. The misunderstanding about peaceful or non-punitive parenting is that if we don't punish, we therefore have to approve of our child's every action, and this is simply not the case. For example, if, at a parent and child group, our child hits another child, we might say, quite simply: "It seems like you are feeling very angry. It's ok to be angry, but it is absolutely not ok to hit someone." Use 'time in' or take your child out of the situation and help them to understand their feelings. Reiterate often your approval of the feelings, but not the behaviour. (It's ok to feel x, but not ok to do y). A great book about this is Raising an Emotionally Intelligent Child by John Gottman.

Other posts on Responsive Parenting:

Babies Don't Need Attachment Parenting, But They Do Need Responsive Parenting

Responsive Parenting: Why Tantrums Matter

Please do leave your own suggestions and thoughts in the comments below.

On Jimmy Savile, and Why We Should Listen To Our Hunches About Child Abuse

2012-10-14T07:09:00.001-07:00

The UK news this week has been dominated by the story of Jimmy Savile, the television presenter and media personality currently under investigation for a string of sex offences. It's emerging that Savile, who died in October 2011, abused a series of young people - the exact number is yet to be established - over a showbiz career that spanned several decades. Our reaction: shock, horror, sadness even, but surprise? Not really, because, we sort of knew, didn't we?

We sort of know. We have uneasy feelings, gut reactions, hunches, intuitions, sixth senses. The hairs stand up, very slightly, on the backs of our necks. We don't know how we know. But we do. No one could capture this better than poet Simon Armitage, a former social worker, in his poem, The Guilty:

They look us dead in the eye
and deny it. They turn out their pockets -
nothing but biscuits and shreds of a tissue.
They will undress their children this very minute.

Suggest their names, they are astonished.
Push them further, they remember date and places. Push them
further, they come up with blood groups, postcodes,
distinguishing features. Their curtains twitch

when we call round in the car, or we hear them
leaving like rabbits through the back door.

They take on habits, the guilty; throw us
from the scent. Analogue watches worn to the inside,
the buttering of bread before the slicing.
They let out their belts, one notch,

before eating; salt their supper before they taste it
and flush it twice if they flush the toilet.
Shake their hands, their hands are like putty.
Their children agree with them, absolutely.

So when shall we birch these people?
And how do we know these things?

When I worked as a therapist with adults and children who had experienced abuse, often feelings of anger would be directed, not so much towards the abusers themselves, but to to those around them who seemed not to notice what was happening. Right now, this is being acted out in the UK on a national scale, as the Press and others try to point the finger of blame at everyone from the BBC to hospitals to individuals. How could nobody have noticed? Worse still, did somebody notice, and turn a blind eye?

This calling into question the actions of everyone but the abuser himself is partly a symptom of our individual, or in this case, collective denial. It diverts attention away from the real horror of the situation, and allows us to express our feelings in a more manageable and safe area. It's easier for us to discuss the role that Newsnight played in all of this, than to contemplate the full extent of Savile's actions. All of us - whether we have personally been abused or not - wishes that child sexual abuse didn't happen, and that we did not have to think about it.

But it's also quite a genuine question: how could we not have noticed? Why did we not look more carefully at the situation and protect those who were most vulnerable? Often, for a survivor of child abuse, these questions are directed to one person in particular: the mother. Did she really have no idea what was going on? Or was it so hard for her to confront - and in doing so, break every aspect of her life into pieces - that she kept it a secret, even from herself?

Of course, child abusers themselves play a big part in the cover up. They make it their business not to be discovered, and often go to great lengths to make sure that they are liked and respected in their community. They do not just 'groom' their victims, they groom everyone around them, so that, should a hunch or a doubt or suspicion flash briefly across someones mind, it is quickly dismissed. "Oh no, not him - only last week he put away all the chairs after the parents evening / gave me a lift to the doctors / donated money to our charity" etc. Savile's case was somewhat unusual in that he was quite openly 'weird', and seems to have created a sort of elaborate double bluff, as if his strangeness was all 'just showbiz', and he was really just a charitable eccentric. Many many other abusers present themselves as quite 'normal', and even as pillars of their community. But still, we sort of know.

We sort of know, but often, we still look away, preferring to think of child sexual abuse as something that happens to other people, not us. Here are some denial busting statistics from the NSPCC commissioned research:

Experience of some form of sexual abuse:

Nearly a quarter of young adults (24.1%) experienced sexual abuse (including contact and non-contact), by an adult or by a peer during childhood.
One in six children aged 11-17 (16.5%) have experienced sexual abuse.
Almost one in 10 children aged 11-17 (9.4%) have experienced sexual abuse in the past year. Teenage girls aged between 15 and 17 years reported the highest past year rates of sexual abuse.

Experience of contact sexual abuse:

One in nine young adults (11.3%) experienced contact sexual abuse during childhood.
One in 20 children aged 11-17 (4.8%) have experienced contact sexual abuse.
Two thirds (65.9%) of contact sexual abuse experienced by children aged 0-17 was perpetrated by someone aged under 18.

We often have concerns about 'stranger danger', but unfortunately, it is those we know and trust and who have daily access to our children, who we most need to 'listen to our hunches' about. According to the NSPCC, seven out of ten cases of child sexual abuse involve a relative, friend, or someone else close to the child.

As parents, we need to wake up to reality now, even if we have chosen to remain ignorant in the past. This is not to suggest that we should live in paranoia and fear, or indeed, pass these concerns on to our children and taint the wonderful innocence of their childhood. We should, however, be realistic, and be vigilant. We should make it our business to protect our children, even if this means an uncomfortable loss of denial. And we should follow our hunches, our intuitions, our uneasy feelings, that tell us - something is not quite right. Because sometimes, you just sort of know.

If you are concerned about the safety or welfare of a child, please contact the police or, in the UK, you can speak to an NSPCC counsellor - more details on their website.

Creating a Ritual for Weaning at Four

2012-10-04T15:11:00.000-07:00

I'm aware that the title of this post makes me sound a bit whacky, and, to be honest, I quite like that. I'm hoping you've already got a mental picture of me, hair matted, eyes rolling, dancing naked around a ceremonial fire with my tits swinging in the breeze. Or perhaps, worse still, you've got me eyeing the camera sexily as my daughter stands on a chair for a bit of 'extreme nursing'. Of course, none of it was really like that.

Let me tell you the actual story.

Like most mothers who breastfeed beyond one, or two, or three, I didn't set out with that plan, it just happened. My daughter loved nursing, and so did I, well, most of the time, and when I didn't, I loved her, and could see that she loved it, so kept going anyway. In many ways, nursing a child who no longer needs you as their main source of nutrition is easy, compared to the frantic dependency of babyhood. It becomes more flexible, more negotiable: a mutual loving experience that is almost entirely about comfort, which can only be a good thing.

And so we went on. Through her first year, her second, through my next pregnancy, and then 'tandem' nursing with her baby sister for another year and a half. Like many other aspects of motherhood, nursing two children together contained some of the most exquisitely lovely and darkly terrible moments imaginable. At times, I wished I had weaned her before she even knew of her sister's existence. Having two such dependent creatures felt stressful, fraught, tearful, claustrophobic, irritating, draining. And then they would nurse together, and silently lock eyes, finding each others hands and holding them across my body without breaking for a second their deep sisterly gaze.

In the year she was three the nursing sessions began to diminish and just one feed a day became a comforting part of the bedtime routine. Some days it would feel like a chore for me, already tired from nursing her sister to sleep, and I would be secretly glad on the nights she fell asleep with her dad and we skipped our 'boobie'. As we moved towards her fourth birthday, we were only nursing about three times a week. And then something funny happened, that I hadn't anticipated. She stopped being able to do it. She told me, 'Mummy, I can't - I can't get the milk to come out!'.

Unusually, I couldn't seem to find any information online, so I posted in a forum. 'Yes! This happens', came the response. Apparently (and this is anecdotal evidence so I can't give you a reference!), a combination of a growing jaw and less frequent nursing sessions can mean that a child loses their ability to latch on, and can no longer get you to 'let down'. I was surprised to hear this, and also slightly relieved, as I felt ready to stop, and this seemed like a bit of a 'deus ex machina', an intervention by fate that took the onus off either of us to decide it was time to wean.

My daughter, of course, was less impressed by the news, but we had already talked a lot about weaning, so she was not completely unprepared. In her sadness, she suddenly had an idea. She remembered that 'babies who can't have boobie have a bottle instead', and asked if I would get some of my milk out and give it to her in a bottle instead! I agreed to try, if only to give her the message that I cared about how sad she was feeling. We sat by the fire with an old breast pump I had lurking in the cupboard, and I gave it my best shot, but I was just as useless at expressing as I had been when she was a baby, and only got out about half a teaspoon. At this point it was my turn to cry, holding her and repeating how sorry I was that we couldn't nurse any more.

Typically, my partner read the situation at a more practical level, and got busy in the kitchen with a baby bottle, which he filled with cows milk, sugar and horlicks, telling her it was 'formula'. She was thrilled to bits with this, and still asks for it now sometimes. I, on the other hand, wasn't so easily comforted, and suddenly felt nostalgic for her lost babyhood and reluctant to move forward into the next phase of life. It was then that I remembered Ritual.

Across cultures and throughout recorded time, humans have created and participated in ritual to mark and celebrate pivotal moments in life. In today's world, many of us are no longer religious, taking part in hardly any rituals apart from the odd wedding or funeral, and I think we feel it's absence, a sort of 'ritual shaped hole' existing deep in our psyches. Ritual brings meaning to times of transition and change, it is a way of pausing to decorate the threshold between one phase of life and the next, rather than simply rushing forwards and paying no attention or respect to past, present or future. Like roses around a doorway, ritual is at once utterly pointless and fundamentally significant, a beautiful and life enhancing waste of time.

So I made one for our daughter. We set off on a wintry day to a field where we had planted a tree when she was born. I carried a little bag containing two beautiful bracelets, sent to me along with a candle and a little sachet of dried herbs by a wonderful blogger and artist in America called Susan Betke. My partner carried a bluebell and a big spade. We invited my daughter's best friend and her parents to what became known as a 'Weaning Party'. Oh, and there were chocolate eggs.

In the cold field we planted the bluebell under her tree and I noted that it had four flowers, one for each year of her nursing. I gave her a bracelet and put on a matching one myself. We stood around the tree and the children ate chocolate. After the planting, I gave them some ribbons to decorate the tree and the children spontaneously declared this a 'May Pole', twisting the ribbons in patterns as they danced around. We lit a little camp fire and my daughter thoughtfully went back to her tree alone and sprinkled it with herbs. The whole affair was understated but everyone in their own way seemed to enjoy filling their 'ritual shaped hole'. Then we went to the pub.

That was over six months ago. In the past few weeks my little nurseling has started school, and it's not insignificant that I've chosen this particular moment to finally take the time to write about our weaning. As she disappears each day into her new world, I find myself on another threshold, and am often consumed with the usual human reluctance to cross over to the next phase of life. In purely selfish moments, I want my baby back, and long to run into the school and scoop her up and take her home. But of course, she is not 'my' baby; she does not, and never has, 'belonged' to me, and my task now is to make the transition with grace and celebration; to decorate the doorway rather than keep banging my head on it. Perhaps a return visit to our tree is needed, or at very least, a trip to the pub.

Reflections on Freedom for Birth

2012-09-23T15:09:00.000-07:00

Freedom for Birth, a new documentary film about human rights in childbirth, was screened in over a thousand locations across the world last Thursday, and I was there, keen to take part in a 'Mother's Revolution' supported by leading lights from the field - Ina May Gaskin, Sheila Kitzinger, Michel Odent - all calling for women to 'take back birth'.

The film took as its focus the plight of Agnes Gereb, the Hungarian midwife currently under house arrest for attending women in illegal home births, and the related case of Ternovszky vs. Hungary, in which the European Court of Human Rights ruled that every woman has the right to choose where and how she gives birth.

Quite clearly, there are some circumstances in which the compromise of freedom and the violation of human rights are tangible, for example when imprisonment is involved, or, as in another case touched on in the film, a woman's baby was taken away on the grounds of negligence because she has refused medical intervention at birth. In such instances, outrage and revolution are needed.

In the USA, the film clearly highlights, soaring rates of intervention and poor rates of maternal morbidity are a wake-up call for change. In a land where most birthing women have very little choice about where and how they give birth, and where the majority of obstetricians have never seen an unmedicalised delivery, I felt quite excited by the prospect of an American Ternovszky, taking her case all the way to the Supreme Court, explained in the film by Hermine Hayes -Klein, a Lawyer & Research Director of Bynkershoek Institute's Centre for Reproductive Rights:

With any case, you only have to go to the next court if the lower court doesn't honour the right. Anna Ternovzsky turned to Hungary and said: "Hey, don't I have the right to choose the circumstances in which I give birth?" And they said: "No you don't!" If they had said "Yes" that would have been the end of it. She wouldn't have had to go to the European Court of Human Rights. She only had to go to Strasbourg because Hungary was failing her. Similarly, within the United States, if a birthing woman turned to the state of Indiana and said: "I have a problem with the fact that my midwife might go to jail if she supports me giving birth at home" and Indiana said, "Well sorry, the doctors of Indiana think that home birth is child endangering you and you don't have the right to endanger your child's life" then she could bring an action all the way to the Supreme Court of the United States.

Then the Supreme Court would have this question before it, a first question, just like the European Court of Human Rights faced this for the first time. This question of "Well geez, what are the rights of birthing women?"... Does a woman have the choice of how she brings a baby into the world?" And I would like to think that the United States Supreme Court would acknowledge, as Strasbourg did, that American women have the right to choose the circumstances in which they give birth.

But if it didn't, then that too I think would spark a revolution in American women because it would really bring home for them the problem with birthing in the United States. So either way, the holding has the capacity to generate a revolution whether from the top or from the bottom.

So - America is on the cusp of much needed change. But what about women in the UK, like me? The general feeling in the after film discussion was that we are 'lucky' in the UK that we do not have midwives being imprisoned, nor do we have the hugely medicalised, obstetrician led system of the US. Perhaps, then, we are alright as we are, and don't really need, or even want, a birth revolution? As a hospital midwife sitting next to me put it, "This is great, but it's preaching to the converted. The majority of women I meet aren't interested in changing the system. They're quite happy to just have their epidural and get it over with as soon as possible."

Whether or not this is true or simply patronising to women is up for debate, but certainly, it does raise the question of whether it is equally a human right to choose to be numb for birth or even bypass it altogether with an elective section. But if a woman makes such choices simply because she's terrified and lacking accurate information - is she truly free?

At the other end of the spectrum, some women choose to 'free birth' without any midwives to attend them, because they have felt violated by a previous hospital birth experience, or decide, in spite of being higher risk, to have a home birth because they feel that in hospital they are likely to be victims of unnecessary intervention. I repeat - if a woman makes choices simply because she is terrified and lacking accurate information - is she truly free?

What all of these women have in common is that they are birthing in a climate of fear - be it fear of childbirth or fear of intervention. Freedom for Birth calls on women themselves to take responsibility for the birth revolution, to 'take back birth'. But in reality, this is not as simple as it sounds. For as much as a woman may understand the politics of birth, her human rights, and that she is giving birth in a world in which far too much unnecessary intervention is taking place, how can she be sure that the intervention she is being offered is unnecessary?

Nine months pregnant, or even nine centimetres dilated, and told that she or her baby are at risk, she is faced with an impossible choice: to stick with the books she has read telling her to trust her body, or to accept intervention being offered by experts into whose hands she has placed her safety and that of her unborn baby. You are too far past your due date, she is told, you have been in labour for too long, you are getting tired, you are not progressing, your baby is too big, your baby is too small, your waters have been broken for too long, you are too old: the risk is increasing.

"Increased risk" is a term pregnant and birthing women hear all the time, and it is often almost impossible to get to the bottom of. Research, if you can find it, is limited, or old, or contradictory. You may feel you want to challenge the powers-that-be, but struggle to find any concrete evidence that contradicts their view. Rightly or wrongly, the impression is given that lives could be in danger, and, rightly or wrongly, most women unsurprisingly choose to forgo their hopes of a natural birth, and accept intervention.

Again, I repeat: if a woman makes choices simply because she's terrified and lacking accurate information - is she truly free? Across the board, it seems, birth choices are being made for negative instead of positive reasons, a sure sign of oppression. Birth freedom is being eroded throughout the Western world, sometimes in ways that are glaringly obvious, at other times in ways that are complex and hard to unpick. One thing seems certain: this may be a 'Mother's Revolution', but if women, midwives and obstetricians do not work together to address the climate of fear and the unavailability of truly accurate information, then there will never be true freedom for birth.

Take Action:
Free Agnes Gereb
Petition Amnesty to Support Persecuted Midwives in Europe
Petition the European Parliament to investigate human rights in childbirth
Support threatened UK Independent Midwives
The Birth I Want - campaign for continuity of care and birth choice in the UK
AIMS - write to Jeremy Hunt, Secretary of State for Health
Freedom for Birth
Human Rights in Childbirth (HRiC)

Please let me know of other resources to add to this list.

I Lie With You Until You Are Asleep: A Sonnet

2012-09-18T14:49:00.000-07:00

I lie with you until you are asleep,
Ten minutes, twenty, thirty, often more,
Clocks tick, frustration builds, yet still I keep,
And stay with you on your side of the door.
Out there, my old life tempts, a voice cries, "Fail!",
And tells me there are better things to do,
Release: the world shrinks down, we both exhale,
And drift together, touching souls, we two.
In age, perhaps, you'll do the same for me,
And hold my papery hand, and stroke my hair,
You'll know the worth of love's proximity,
The gift we give by simply being there.
A final kiss, a sigh, a comfort deep:
I lie with you until you are asleep.

If sonnets about parenting peel your potato, see here for another: Sometimes I Pass the Place Where We Once Lived.

Crying It Out: What Feels Wrong, IS Wrong

2012-09-11T17:12:00.011-07:00

Sleep training, controlled crying, and crying it out: is it ok, or isn’t it? New research has just been published in the American Journal of Pediatrics suggesting that:

“Behavioral sleep techniques did not cause long-lasting harms or benefits to child, child-parent, or maternal outcomes. Parents and health professionals can feel comfortable about using these techniques to reduce the population burden of infant sleep problems and maternal depression.”

The research is already being hailed as a victory by those who claim that sleep training is an essential parenting rite of passage and completely harmless to the child involved. The Daily Telegraph headlined: ‘Leave your baby to cry, scientists say’, whilst the good old Daily Mail claimed, ‘Letting babies cry rather than rushing to comfort them is secret to longer sleep (for infants AND parents)’.

This is not a new debate. The fight over whether or not sleep training is harmful rages constantly amidst parents, facebook groups and experts, and there have been many and various studies and scholarly articles claiming that it is damaging, and that it isn’t, before this latest one. So how do we, as parents, decide what to believe, and who is right?

The whole thing rather reminds me of a very different debate: Is smoking bad for you? It might surprise you, but if you google this question, you will find a whole raft of people who are looking for evidence that cigarettes cause harm, and doubting the evidence that exists. There are even articles that claim that cigarettes do not cause any damage, and that there is research to show that there is no link between smoking and lung cancer.

To all of these folk who are swimming along in a big fat Egyptian river known as Denial, I’ve just got one thing to say: do you remember your first ever puff on a cigarette? I do, let me tell you what happened. I lit it up, I inhaled, for a brief moment I looked and felt pretty cool, and then…I coughed like a dog, the room spun, and I felt flippin awful. Don’t worry, I persevered, and went on to be a committed smoker for a decade - nobody likes a quitter. But do you know what, from that very first moment, I knew that smoking was bad for me, really bad for me, and that it could probably kill me. And I didn’t need an expert to tell me that.

If it feels wrong, it's probably wrong. All mothers know in their heart of hearts that they should never ignore the cries of their own flesh and blood, and yet, in our culture, it’s considered pretty normal to do so. Perhaps, then, the question that should be being explored is not, ‘Should they do it?’, but ‘Why do they do it?’. Because they’re tired! I hear you cry, but is it really that simple?

‘Tiredness’ as a new mother is very real – and I’m writing as someone who hasn’t had an unbroken night’s sleep for four and a half years, so trust me, I’ve got the T-shirt (and, my partner would probably add, the personalized bullet belt). But – and if you haven’t slept in a while, please don’t shoot me – I think the tiredness can also be a metaphor for a whole host of other feelings that are much more difficult to pin down or name. As a new mother, you often have no idea what you are doing or what you are supposed to be doing; your old body, career and life have disappeared pretty much over night, and you can be isolated too.

It can feel overwhelming, like chaos unleashed. Amidst it all, you struggle to find words to describe your feelings. ‘How are you?’, they ask, ‘Oh – tired’, you reply. And suddenly, not getting enough sleep becomes like a bucket you can fill with a whole multitude of other things; all the chaotic, overwhelming, crazy struggle with your endlessly heavy responsibility, your loss of identity, your sudden and stark awareness of mortality, your fears and all the lonely darkness of this massive life changing event. You long to take back the control you have lost, and you start to believe, if only I wasn’t so tired, if only my baby would sleep through the night, then everything would go back to normal again, I would get my life back, my old life in which I was never this tired.

You feel tired, but actually this is just a metaphor for lost / lonely / overwhelmed / adrift / struggling. You say you want a good night's sleep, but what you really mean is you want to get a grip on things, you want the chaos to subside, you want normality, order, predictability, control. Sleep training, then, might seem tempting, offering the promise of the restoration of the status quo at seemingly very little cost. But as new mothers, there are some simple truths that we need to face:

Life is never going to be the same again, even if we get more sleep.
If we feel in our absolute hearts and our deepest instincts that leaving our babies to cry alone is wrong, then it is wrong, no matter what the experts say.

Oh, and one more - smoking really is bad for you!

What feels harmful and damaging, is harmful and damaging. What feels wrong, is wrong. You know.

You might also like:
Crying It Out: The Damage We Can Measure, The Damage We Can't

Get Off Your Backs for a Birth Revolution!

2012-09-02T16:17:00.001-07:00

If you gave birth recently, did you feel you had real freedom? Freedom to choose where you gave birth, who was present, what interventions took place and how you delivered your baby? Were you given access to all of the facts needed to make your choices truly informed? Who was the most powerful person in the room at the moment of birth? And did the experience leave you feeling exhilarated, disappointed, or downright traumatised?

These questions are currently being considered on behalf of all mothers as part of a global movement to ‘take back birth’ and reclaim women’s power in the birth place. ‘The freedom in a country can be measured by the freedom of birth’, states Agnes Gereb, the midwife currently imprisoned in Hungary and held up as ‘the epitome of the very worst of what’s happening in birth today’ by the makers of Freedom for Birth, a UK based film about human rights in childbirth to be globally screened on September 20th.

Over in the US, where caesarian rates are more than twice the WHO recommended 15%, and maternal mortality rates have doubled in the past 25 years, another organization - Improving Birth - are spearheading a ‘full scale birth revolution’ on Labor Day, leading ‘rallies for change’ in 100 major cities over 50 states, and demanding evidence-based care for all and the education and empowerment of birthing women.

For some, such protests might seem unnecessary. Surely, giving birth in a hospital with access to all the pain relief you might need is something women should be grateful for? No, say campaigners such as Alex Wakeford, co-founder of One World Birth, who describes how, “…birth has been stolen, by a powerful institutionalized system, that is born of fear, a system that inherently believes that birth is dangerous, and must be managed and controlled by modern technology”

Whilst a UK mother might assume that she is free, in fact, much of what happens to her in childbirth is determined, not by the limitations or otherwise of her body, but by the geographical place and historical time she gives birth. A woman delivering her baby in England in the 1950’s could expect a very different experience to a Scottish birther in the 1980’s, as the following graphs illustrate:

In the UK today as few as 20% of women are aware of the options for their place of birth, and in some geographical areas, options such as midwife led units are non-existent due to lack of funds. This in spite of the 2010 case of Ternovsky vs Hungary, in which the European Court of Human Rights ruled that every woman within Europe has the legal right to be supported in her choice of where and how she gives birth.

UK women are told that they are free to choose a home birth and that this is often the safest option, but in reality, the idea is less appealing when warned that they may have to transfer to hospital at the last minute due to a shortage of midwives. Continuity of care is also an issue: around one in three pregnant women never sees the same midwife twice in spite of government promises and nearly a fifth of women say they feel unsupported during labour and birth.

At the moment UK mothers can opt for an Independent Midwife: around £2500 buys you continuity of care, a guaranteed midwife if you want to birth at home, and – almost non-existent in the NHS - the reassurance that you will have met and made a relationship with the person who attends you at one of the most pivotal moments in your life. But you’d better be quick, because as of September 2013, Independent Midwives become illegal in the UK.

Birth rights campaigners see this as yet another example of diminishing choices in childbirth and symptomatic of a global witch hunt against midwifery. In America, obstetricians lead the care of most pregnant women, only 1% of women get midwife led care outside of a hospital setting, and direct-entry midwives are illegal in several states: all of this in spite of sound evidence to show that midwife-led care produces better outcomes for mothers and babies.

In the UK care in birth is still largely midwife-led, but numbers are low, and the Royal College of Midwives is pressuring the government to recruit 5000 more midwives. This would undoubtedly inprove choice and help a system straining under rising birth rates. But some, including Toni Harman, Producer of Freedom for Birth, feel that this does not go far enough. “More midwives would help, but would not solve the problem of the routine Human Rights violations happening within the UK maternity system. There needs to be a complete culture shift within the obstetric community to make women the true informed decision-makers in their births.”

This ‘culture shift’ is at the core of what is demanded by those calling for a ‘birth revolution’. Campaigner Holly Lyne told me, “The way maternity services are commissioned is fundamentally flawed and the emphasis on risk assessment and fear of litigation are leading to massive amounts of costly, ineffective and traumatising intervention.” Independent Midwife Nicky Garrett added, “ I was trained to provide holistic woman-centred care and found that it was impossible to give that service within the NHS. The care for women was fragmented, paternalistic and pared to the bone, and the job satisfaction was zero.”

The importance of a positive, normal, low intervention or no intervention birth extends far beyond the individual. Women who demand better births can sometimes be accused of selfsishness, and organisations suggesting less epidurals have this week been declared anti-women. But how we birth has a huge impact on early bonding and attachment, breastfeeding, PND rates and more…which in turn has long term impact on the mental and physical health of both mother and child…which in turn affects the human race. There are plenty of ways to join the birth revolution, and it matters: true freedom in birth really could change the world.

You might also like Reflections on Freedom for Birth

Responsive Parenting: Why Tantrums Matter

2012-08-26T04:37:00.008-07:00

People make different parenting choices, and that's fine. We don't all want to sleep with our baby in our bed, carry them in a sling, or nurse them until they're three. We might not like the idea of routines, we might despise the thought of spoon feeding a baby purees. But whilst these issues are often a source of interesting and sometimes heated debate, none of them really matter, or at least, they pale into insignificance compared to the bottom line, which is this: Parents need to be Responsive. No matter what other choices you make, as long as you try your best to be consistently and lovingly responsive to your child, you are 'getting it right'.

Tantrums - which mostly happen at the toddler age - are a difficult area for all parents and it's sometimes hard to know what to do. But how we respond to our children in these testing moments is very important. I've written a detailed post about responding to distress in general here: Everybody Hurts: Ten Ways to Help Children Grow Into Adults Who Cope. But let's look specifically at why tantrums matter - by which I mean, not foot stamps or pouts, but full blown, out of control, toys out of the pram, lie on the floor and beat your fists stuff. You know the one.

Tantrums are not 'Bad' behaviour
When a child is having a tantrum, they are not being 'naughty' or 'spoilt' or behaving badly, although it can seem that way to us as the parent, particularly if we were repeatedly told as children that we were being bad or naughty when we behaved in this way. But what we now know, thanks to advances in neuroscience, is that tantrums are not deliberate, manipulative or naughty - a small child's brain just isn't yet developed enough to make any other choice.

As the Adult, we need to Look Beyond the Tantrum

Often tantrums are triggered by something as simple as hunger or tiredness. Small children usually prefer to eat little and often and tantrums can be prevented by offering plenty of healthy snacks throughout the day. It's also worth looking beyond the tantrum to the surroundings (boring? over-stimulating? frightening? strange?) or to what is going on in the child's - or indeed the grown-up's - world. Have you just moved house, started something new, or been separated for the first time for longer than normal? Has there been a big change, loss or transition, for either the child or the parent? Just like grown-ups, sometimes a small thing like a broken toy or a spilt drink can be the 'straw that breaks the camel's back' and tips us over the edge. Understanding the bigger picture in this way can help us to feel more compassionate to our child and offer comfort.

A Tantrum says 'I Need You' - and you CAN help!
Faced with a child in full blown tantrum, particularly in a public place, we can often feel overwhelmed and helpless. We might feel that we just want to throw up our arms, turn our back, and despair of them. But actually, a child in the midst of a tantrum is really crying out for the input of an adult who has a more developed brain and can help steer them through and beyond these awful feelings. By responding consistently and lovingly instead of walking away, you will actually help your child to develop neural pathways in the brain, which, over time, will help them to calm themselves without help.

How you respond - MATTERS!
It really is time that the world dropped the outdated idea that children turn out pretty much the same no matter what you do. It might seem like a heavy load to bear as a parent, but this simply isn't the case. How we respond and relate to our babies and children, particularly in their first four years when so much brain development is going on, is absolutely critical to their future mental health. Genes play a part, but scientists are increasingly learning that much of who we are is epigenetic rather than genetic - that is to say, that our environment and our experience influence the way our genes behave.

Tantrums are Golden!
It might not seem this way sometimes, but it's the moments when our children are most 'difficult' that they really need us the most. When we manage to respond to them in a way that is warm, loving, soothing and helpful, we are helping them to build within themselves the resources to be warm, loving, soothing and helpful to themselves - to 'internalise' the role of 'Soother' or 'Mother', so that it exists within them and can be accessed always. People who have not internalised this experience often feel a lack of it their whole lives, and can try to fill the emptiness with addictions or other destructive behaviour. In other words, if they can't find comfort on the inside, they will look for it in places outside of themselves. As a parent, you can help them build their Inner Comforter.

Responding to Tantrums is not 'Giving In'
Some parents are concerned that responding to tantrums will result in so called 'permissive parenting' and that their child will be 'spoiled' as a result. But being kind and loving to our child when they are in the midst of a tantrum does not mean that we have to give in to their demands. We can offer them comfort, without feeling we have to give up and buy them the lollipop they wanted. We can acknowledge their disappointment at not getting what they wanted, we can help them understand and find words for their emotions, and we can teach them that love and hugs are actually much nicer than lollipops anyway!

'Tantrum it Out' is just as bad as 'Cry it Out'
Turning our backs on our small children at the very moments they need us the most is not acceptable, regardless of how frustrated, embarrassed or over-whelmed we might be feeling. We absolutely owe it to our children, regardless of the fine details of our other parenting choices, to respond to them lovingly and consistently as much as we possibly can. This means taking their emotions seriously, and not dismissing them as naughty or manipulative. It means seeing the good in them, and taking seriously our role as their grown-up helper. 'Being there' doesn't mean 'censoring' children's emotions or putting a lid on them. We can't always prevent our babies from crying or our toddlers from having tantrums, but we must not leave our babies to cry alone, and we must not leave our toddlers to tantrum alone.