A response to Barbara Ellen’s “Meghan Markle’s home birth should not blind us to the risks for most women” published on The Guardian, 13th April 2019.

A response to Barbara Ellen’s “Meghan Markle’s home birth should not blind us to the risks for most women” published on The Guardian, 13th April 2019.

I am deeply disappointed in The Guardian for publishing Barbara Ellen’s ill-informed, fear-mongering article on the dangers of Meghan Markle’s decision for a home birth in influencing us, common plebeian women, who couldn’t possibly have a safe home birth without the royal treatment she will receive.

Based on research and reliable medical evidence, the World Health Organization (WHO) states “It has never been scientifically proven that the hospital is a safer place than the home for a woman who has had an uncomplicated pregnancy to have her baby.” No evidence that the hospital is safer for uncomplicated, low-risk pregnancies. You can also find, on the NHS website, information regarding revised guidelines issued by NICE (National Institute for Health and Care Excellence) which “recommended that women with low risk of complications in childbirth should be encouraged to either give birth at home or at a midwife-led unit.” The HSE, here in Ireland, also states that “research shows that a planned home birth is an acceptable and safe alternative to a planned hospital birth,” again, for healthy women with uncomplicated pregnancies. The HSE itself offers a homebirth scheme as one of its maternity care options, as does the NHS.

I could stop here. But I won’t.

I’m offended personally by the assumption that we, common women, wouldn’t carefully plan a home birth, or any kind of birth for that matter, as we have learned to do so from horrific hospital experiences. Anyone who has been listening to Joe Duffy lately would know all about that.

Among the inaccurate information contained in the article, I’d like to clarify a few:

• Homebirths are not attended by one midwife, but two. That’s how it works under HSE guidelines. Besides, with a midwife, at home, you get continuity of care, which hospitals fail to provide due to the way they are structured. This continuous care, provided by one person who you have come to know and trust, is associated with shorter labors and lower rates of intervention; hence the ever-growing popularity of birth doulas (in all birth settings; hospital, birth center, home, etc).

• When women who are giving birth at home need to transfer to the hospital, they don’t get there by “any means possible”; they use an ambulance service which has already been notified of the start of their labor and has coordinates to their home.

• The article mentions the “risks to most women”, which is also untrue as high-risk complications occur in less than 15% of all pregnancies, as stated by UC San Francisco Health.

Furthermore, if Barbara knew anything about the physiology of childbirth (because yes, newsflash: it’s a physiological process, not necessarily a “serious, bloody business”, as she hauntingly states), she would understand that in fact “splashing about in a birthing pool […] surrounded by Jo Malone candles […] and Enya on Spotify” makes an enormous difference to the progress of labor and can be the crucial difference between a straight-forward, uncomplicated delivery and a cesarean.

Our Co-owner Mary Tighe seen supporting her doula client during a home birth

That is because the physiology of childbirth is dependent on intricate, sophisticated hormonal dynamics. The driver’s seat is taken by oxytocin. They give you a synthetic version of said hormone in the hospital to start or augment labor. They also give it to you to facilitate the delivery of the placenta and to prevent hemorrhage. Oxytocin also aids in bonding with baby and the start of breastfeeding, both of which the synthetic version can’t do, by the way. But how is oxytocin brought about naturally then? Well, it’s the hormone of love and intimacy. So it’s raised through touch, massage, kissing, being in a safe, quiet, intimate place, with dimmed lights and privacy, with freedom to move around, have some water, eat something if you so wish; with no strangers walking in and out, asking a million questions, poking and probing at you. And for some people that might very well be a warm tub of water or shower, surrounded by candles, with Enya on Spotify. Delivering a baby is much more like making a baby than we seem to want to recognize. So, the answer is: whatever floats your boat, as long as it’s a safe option for you. Feel safer in a hospital? Then by all means, have a hospital birth! Have a complication that may require medical attention? Again, the hospital is probably a safer option for you. But this commonplace, ignorant discourse demonizing something you obviously know very little about is unacceptable. As a woman, I find that adding even more fear to this process, which can be a beautifully empowering one, is unacceptable. It’s like bullying women, more than they already are in this “serious, bloody business”.

There are various, researched techniques, or methods, that can attest to the efficacy of supporting this hormonal interplay, as they usually translate into calmer, quicker labors, with less unnecessary intervention (which means less risks for mother and baby), and better memories to cherish forever, because you will. forever. remember. that day. They are the likes of Lamaze, HypnoBirthing, and Ireland’s very own GentleBirth techniques, devising an informed birth plan, or hiring a birth companion, such as a doula, all of which work to empower and support the laboring woman and her baby, her feelings and desires, and in turn, this miraculous hormonal process.

You might wonder how you may benefit from having a doula, a hired birth companion, at a home birth, like Meghan is said to be doing. Doula support might indeed look a bit differently at home, because they can focus on you and your partner completely, and not have to deal with the hospital environment. They arrive before your midwife and are by your side the entire time. It gets to a point sometimes where midwives actually need to rest, to make sure they are well able to identify your medical needs, while a doula, in quite a different mindset, will still stand by you. Additionally, should you transfer to the hospital, they will accompany you and provide invaluable continuity of care. 

General areas in which doulas focus their support include: emotional and psychological preparation, guidance, and ease; physical comfort, positioning, and nurturing touch; supporting you in your confidence, decision-making, learning, gathering information and understanding your preferences. Although doulas and midwives both value those components as part of a satisfying birth, doulas get to focus on them entirely, while midwives are tending to clinical tasks. So together, at home, they are a wonderfully powerful team.

Of all the fashionable trends out there, I think this would be an absolutely lovely one to get informed about—and yes, if it’s a suitable option for you and your specific circumstances, maybe even follow.

Anita Petry

Birth and Postpartum Doula with DoulaCare Ireland

Member of the Doula Association of Ireland

Originally from Brazil, Anita now lives in Dublin with her husband David.

So Meghan Markle hired a Doula? What is that? Part 2

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So Meghan Markle has hired a doula and everyone is buzzing “what is a doula anyway?” Part 2.

There are two main types of doula. A Birth Doula and a Postpartum Doula. There are also Doulas who specialise in supporting families through loss and other niche areas

In this blog we will focus on Postpartum Doula support.

In times past (and indeed today in many cultures around the world) parents were not sent home from hospital with a new baby and expected to know what to do and manage on their own. We would have had the support of families, neighbours, friends - minding us, feeding us, helping us adjust to the changes in our lives and allowing the new Mum to rest and recover from birth and support her during the first few weeks of life with a small baby. Today we are often lacking this support and just expected to cope. People do call in to visit but don’t think to bring a cooked meal for the Mum, let her rest, load the dishwasher or ask how she is doing. The focus is often on the baby and the Mum is just expected to get on with it. However, we are not hardwired to manage in this way. We need the support of others in those first few weeks and months and in lieu of support from our community the postpartum doula can step in and offer this support.

A Postpartum Doula begins work with their client as soon as they book in. For some, this is during pregnancy (the forward planners!) and for others this is after baby is born. If it is during pregnancy, your doula will help you to prepare for your new arrival and the huge shift your life will take. If it is after birth, your doula will slot right in to your new routine (even if you don’t think there is any form of routine) As with Birth Doula support, your Postpartum Doula comes with many layers of support. We help you to debrief and process your birth experience. We nurture you while you recover from birth and find your new normal. We help your older children adjust to having a new dynamic in the family. We support your partner, adjusting to their new role and debriefing their own experiences. We offer knowledge, encouragement, information and support every step of the way - as each new day brings new challenges. Above all, we help you to savour the good moments between the chaos :)

Knowledge: Doulas are information junkies. We love reading, attending study days and growing our knowledge base. In DoulaCare Ireland all our Doulas must attend at least three CPD days per year. - which ensures the building of knowledge as evidence changes and new research is undertaken. We also learn from every interaction, with each individual client. We bring that knowledge base to you when you come home with your new baby. No matter what comes up, with your recovery after birth or your babies needs - chances are we have seen it before (or we know who to call if not).

Encouragement: Anyone who has had a baby, knows that surreal feeling of being left in charge of this new tiny human. Many parents feel “they are not seriously letting me home alone with this baby? I don’t even know how to bath him or tell if he is hungry” Don’t fear. It is normal to feel that way. The truth is no parent has the answers. Babies don’t come out with an instruction manual. We all learn on the job! The great thing is, with your Postpartum Doula by your side - you have a calm presence helping you every step of the way. So nothing feels overwhelming. You and your baby learn together, with a helping hand from your Doula.

Information: To new parents this is invaluable. The number one question we get asked… “Is this normal?” Rest assured, your Doula will have all the latest evidence and research at hand to help you make informed decisions when the fog of parenting clouds your brain. It can be hard to process information when you are recovering from birth and haven’t slept more than an hour in 2 weeks. Your Doula will give you the information you need in bite sized chunks so you can fully process it as required. She would also be delighted to tuck you up in bed, with clean sheets, after a hot shower and home cooked meal - and after a nice nap it is easier to think more clearly and have perspective on the changes in your life!

Hands-on tips and tricks: A Postpartum Doula passes on all the parenting tips and tricks they have picked up through their training and working experience. They help you to simplify your daily life. Sometimes it’s a gentle suggestion on where to keep the changing table, that you hadn’t thought of (like having a second one in that corner downstairs to save you running up and down the stairs 20 times a day) Sometimes it is demonstrating different methods of helping baby to get wind up - which can be a tricky skill to master.

Partners: Partners are often Doulas biggest champions! We help them to feel involved every step of the way. In parenting, it can be helping them to figure out how to put a baby grow on baby (which way is up? Are these the arms? We all know how hard it can be to get a new baby dressed!) It can be explaining the hormonal rollercoaster women ride after giving birth and to expect highs and lows. It can be a listening ear for them to debrief or to gush about their beautiful new son or daughter. Sometimes it is offering gentle suggestions to help them adjust to their new role and see what part they can play in supporting their partner and adjusting to their own new role.

With DoulaCare Ireland you have a full team of support. Each client is matched with the perfect doula for their needs. In the bigger contracts (100+ hours) you will usually have two doulas offering support. You have the opportunity to meet both beforehand. Both doulas will know your parenting style and wishes. This means that if for any reason your doula needs to change your scheduled hours you have the option of your second doula covering so you are never alone! Our co-owners Jen and Mary are always on hand too. We offer phone and email support to our clients and our doulas so no question is ever left unanswered.

We know from neuroscience that our brains are not hardwired to manage on our own in those first few weeks of adjusting to life with a new baby. All so often when we arrive at a new Mums house, they disclose that they feel they are doing something wrong as they struggle to cope. So few of us talk about how hard it is, that many are left feeling not good enough. The postpartum doula steps in to fill the gap. We are there to build confidence and make those first few weeks a positive memory for years to come - in other words to help a family thrive and not just survive the early days of parenting

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Meghan Markle has hired a doula, what is that? Part 1

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So Meghan Markle has hired a doula and everyone is buzzing “what is a doula anyway?” Part 1.

There are two main types of doula. A Birth Doula and a Postpartum Doula. There are also Doulas who specialise in supporting families through loss and other niche areas

In this blog we will focus on Birth Doula support. 

A Birth Doula begins work with their client during pregnancy. Supporting them throughout pregnancy, labour and birth. We don’t clock out at 8pm. We are there by our clients side every step of the way. Offering continuity of care throughout pregnancy, labour, birth and postpartum. We then visit our clients at home, offering support with all those early parenting questions.. We offer knowledge, encouragement, information and hands on tips and tricks of the trade. 

Knowledge: We help our clients to understand their chosen place of birth (most commonly a hospital) policies.We compare the different hospitals policies, statistics and what the National Clinical Guidelines say. We also chat about International Guidelines and help our clients to make informed decisions about their care. We also cover the physical process of labour and birth and common things that come up. We can assist our clients to create their birth preferences for their unique journey. After baby arrives we share all the latest evidence on infant care, recovery after birth and anything else you’re wondering about too!

Encouragement: We build up our clients. A huge part of our role is to help our clients (the birthing mother and her partner) to feel confident. We are like their coach or cheerleader from the sidelines, reminding them of all the skills they have gained throughout their pregnancy and the strength they have within. This does not stop once baby arrives. We build you up again after birth and remind you of that strength and knowledge.

Information: Apart from the mentioned topics, doulas also answer any questions that happen to arise with each client. It may be they read an article online and wonder does that happen in Ireland? Or they are told they have a condition (such as gestational diabetes GD) and would like information to help them feel informed and confident on how best to manage it.

Hands on tips and tricks: Doulas are not afraid to get in there and help out. During pregnancy we show our clients different massages, counter pressure and comfort measure to help during labour. We teach these skills to the birth partner so they feel fully involved in the process. On the day of labour often doulas and partners work really well together - tagging in and out (counter pressure can be really tiring after a few hours!) This support continues on into parenting. From showing you how to change and dress a newborn (which is surprisingly tricky at first) to helping you find a comfortable position to feed in - your doula will be right there. 

Partners: Partners are often Doulas biggest champions! We help them to feel involved every step of the way. Partners often say things like “I didn’t know what to do to help my wife” or “I felt like a spare tool in a scary unknown setting” but with a Doula supporting them - they have a full tool kit to draw from. They also get encouragement and a helping hand along the way. After they become a Dad/Mam we are still there. Helping them to adjust to their new role and offering guidance on how best to support you.

With DoulaCare Ireland you have a full team of support. Each client is matched with two doulas. You have your primary doula and your back up doula. You have the opportunity to meet both. Both doulas will know your birth preferences and wishes. This means that if for any reason your doula needs to take a break (such as a long birth, where your doula may need to grab some sleep), you have the option of your back up doula joining you so you are never alone! Our co-owners Jen and Mary are always on hand too. We offer phone and email support to our clients and our doulas so no question is ever left unanswered.

In next weeks blog we will discuss Postpartum Doula support.

Until then… Doula Jen x

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Postnatal Depression, when love doesn’t come as a thunderbolt.

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Postnatal Depression, when love doesn’t come as a thunderbolt.

I was 21, and diagnosed with Poly Cystic Ovarian Syndrome (PCOS), on a hot June day, in the consultants room, in a Cork hospital. One minute I was worrying about my parent's car being clamped, and the next minute I was being told,  if I was ever going to have kids, do it now in my early 20s. He closed the folder and stood up, as I sank into the chair. Fast forward to 23, going out with my husband, and about four weeks into the relationship, the clock now ticking so loudly, I sit him down and tell him. In September 2011, my daughter was born. Five years after my PCOS diagnosis. A greyness descended, initial happiness replaced with fears, thoughts, overwhelming feelings. My brain telling me that I’m not good enough for her. My husband was beaming, but my heart was breaking, because, after five years of hoping, wishing, endless sticks to wee on, I didn’t get that thunderbolt. I was in shock. 

I stayed in the hospital for four days, because I didn’t want to go home until I felt ‘right’ . That thunderbolt didn’t come. Over the following days and weeks, I lied to friends and family who were enamoured by her. I was staying awake all night, afraid, and dreading the moment she would need me again. Would she be better with someone else as her mammy? I envied my husband's love for her. I envied how happy he was. I loved her, but felt that I wasn’t enough for her. What if she didn’t like me? Friends kept telling me how lucky we were to have a happy, healthy baby. I didn’t feel lucky, I felt guilty, ashamed that I wasn’t enjoying the baby I had longed for. I was lucky to find a breastfeeding support group,  that allowed me to cry, talk openly, and not be judged. It became my lifeline. I found Kathy Kendall-Tackett's book, The Hidden Feelings of Motherhood, and it was eye opening, and reassuring. Dr Andrew Mayers from Bournemouth University, has done some interesting research about partners developing postpartum depression too.

I had heard some myths about PND , and medication, and I had fears about asking for help. What if they take her off me? What if, what if, what if? I became numb, and comfortable in my numbness. I hit rock bottom in 2016, when my neighbour passed away suddenly. A few days later, at my doctor's for something else, I broke down. He gave me some options, and I chose a referral for counselling. It was amazing. A weight lifted. The shame and guilt could be put down. I could breathe. 

I now work as a postpartum Doula, with Doula Care Ireland. One client described me as “a wonderful calm presence amidst the chaos" .I am not a health care professional. I am not there to tell you what to do. I give you the information,  and allow you to make an informed choice that works for you and your family. There is no one magic cure for PND, but , with calm, clear, informative support you can begin your journey out of the greyness. I am continuously working on being the best version of myself, and it is a continuous process. Sometimes I see glimpses of how I felt, in my clients, and it reminds me that the process of being mentally well, is something we need to keep working on.

Written by one of our doulas Dee Burke. You can fins out more about Dee and the support she offers here https://www.doulacare.ie/dee-burke-1/

If you or someone you know is suffering with a postpartum mood disorder these resources may help

https://www.nurturecharity.org

http://www.pnd.ie

https://www.cuidiu.ie/httpwwwcuidiucomsupports_parenthood_postnatal

https://www.hse.ie/eng/services/list/4/mentalhealth/mother-and-infant-health/#Finally,%20support%20services%20for%20those%20with%20Poatnatal%20Depression

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Moved over to main website blog:Adjusting to life with a toddler and a newborn

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Adjusting to life in the early days and weeks.

It is important to acknowledge that it will be hard at times, but it won't be impossible. It is all an adjustment but the love you will feel will make everything worthwhile. Of course as your Postpartum Doula I will assist you with adjustment and daily tasks. Here are my top tips on how to set yourself up for success and make each day easier.

• Cook extra portions of freezer friendly meals (like bolognaise/shepherds pie/fish bake etc) while you are pregnant or if baby is here then at the weekends so you've a good supply of nutritious food to see your family through week ahead. This is also something family and friends could do to help out.

• Shop online for now if a grocery shop seems unimaginable. 

• Buy preprepared fruit and veg as handy snacks to grab on the go.

• Don't be too proud to accept offers of help and don't be afraid to suggest chores (unload the dishwasher, hoover the stairs, clean the bathroom etc)

• Lower your expectations of how the house will look during the first few months. You've got a lot on your plate, and it doesn't really matter if the dusting doesn't get done or you have to wear un-ironed clothes for a few days, or years even.

• As soon as you can, try to get out for at least a short walk every day it's amazing what a boost it is to get out of doors. If that seems too epic right now, sit in the garden and play with your toddler.

• Take all offers of taking your toddler out for a while (once your toddler is happy of course!) Granny wants to take her out to the playground? Great, don’t feel guilty and try to go too - grab a nap with baby while you can :)

• Make your toddler aware from the very start that the baby is interested in her, is watching her and loves her. Say things like, "She's following your game with her eyes" and "She's very interested in what you're doing".

• Involve your toddler in games with the baby from the earliest days, and always tell your toddler how much you value her help with tasks such as handing you a nappy for the baby.

• Have a ‘special feeding box’ Fill the box with little toys and books, colours or activities for your toddler. This box only comes out while you are feeding the baby and is your toddlers special treat.

• Babywear. Using a sling gives you the ability to meet your newborns needs (to be warm, safe and close to you) while still playing, reading with or just spending quality time with your toddler. I would recommend attending a sling meet or get a sling consultant to your home to find the right sling for you.

• Take photos, because while the days seem endless right now, the weeks and months will fly past and you will appreciate the memories ☺

• Be gentle with yourself. No one is perfect. This is all learning on the job, take each day as it comes and remember you are doing your best and that is all anyone can do!

Enjoy the madness! Doula Jen x

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Moved to New Blog They never told me about the Second Night!

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They never told me about the Second Night!

Why is it that when we are pregnant everyone has an opinion. They want to share their experiences and what items we should or shouldn’t buy to be prepared for our babies arrival. So why is it then, while we are being bombarded with information and stories of woh – that not one person mentions the horror that is night 2 of our babies lives?

Let me explain.

So the first 24 hours are bliss. We are on an oxytocin high. We have given birth, become a new family and have our new tiny baby/babies. We can count their toes, smell their gorgeous baby smell and kiss their cute button noses. All the while our beautiful baby is content to cuddle in and sleep, only really waking to eat. We are led into a false sense of smugness...that yes I have the perfect baby. This parenting lark is amazing.

Then, as the sun sets on day 2 our beautiful sleepy baby disappears and seems possessed with a different baby spirit, who does not sleep, cuddles/rocking and singing don’t help and they never seem to be full.

This is where it can so easily go wrong. Doubt creeps in. Do I not have enough milk? Is my baby starving? Why won’t he stop crying? He keeps fussing at the breast, does he not want me?

The answer is, your baby is doing EXACTLY what he should be doing! Don’t worry – it is nature driving him to behave like this and it will be over soon.

So what is going on? Well on day one your baby was sleeping off the birth. Remember you and your baby were a team, going through labour and birth together. They are tired too. Not only that but it can be a shock to their system, entering our crazy world from the cosy and safe surroundings of your tummy.

Your baby has to breathe for the first time. Regulate their own body temperature, feel hunger & eat. They are hearing, seeing and smelling so much more. Your babys senses are on overload. However, on night two they have had time to settle in, get used to their surroundings. They have slept off their birth and now nature is telling them they have an important job to do – get your milk supply in so they have a food source. So how can a new baby do that? They can feed like crazy, signalling to your body they have mastered suck, swallow & breathe and are ready to take on bigger volumes.

This does not mean your baby is starving and needs bottles. It does not mean your baby wants someone else. Your baby is being driven by instinct to help your milk come in. Plus lets not forget – you are their home! You have been their whole world since the second they were created, you are where they want to be.

“Nothing an infant can or cannot do makes sense, except in the light of mothers body”

Dr Nils Bergman

Help your baby by keeping them close. Your body will keep them warm. Your heartbeat is the most familiar sound in the world. Your breasts will make the perfect amount of milk for them as they grow. Follow your babys signals, don’t watch the clock. You both know what to do if you can switch off your thinking brain ;)

So batten down the hatches. Prepare for it. Stock up on food and snacks that can be eaten with one hand and have them at easy reach. Charge up your phone or tablet to have something to keep you sane at 3am. Take a few naps when you can with baby (yes the old tale of sleep when baby sleeps is turu, but also important for survival!) But above all, enjoy it. No I am not insane. Your baby is only this size once. You only have this moment in time once. While it may not be picture perfect, it is your new normal and it is amazing. Be in awe of your body for creating this little human being. Be proud of yourself for getting through your first 24 hours as a parent. Watch in amazement as your baby feeds from your breasts. You are a goddess right now.

So hold your baby. Feed your baby. Feed yourself! And (yes I am going to say it)

This too shall pass.

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