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Nurturing Birth Book Review: Dynamic Positions in Birth

Book Review by Sally Carter

Front cover of the book "Dynamic Positions in Birth". The book has a bright purple colour, with the title across the top in white. Underneath is a graphic of a woman on her back, replicated 8 times with a slight turn so that it becomes a woman on all fours.

Dynamic Positions in Birth (2nd edition) by Margaret Jowitt is published by Pinter and Martin and costs £12.99

Dynamic Positions in Birth was an informative and at times compelling read.

As a doula, I understand the physiology of childbirth and the relevance of active, upright positions during labour and birth. This book has helped me to have a better, far deeper knowledge and understanding of the biomechanical and scientific theories behind why birth might unfold in the way it does and how the development of mankind and the medical profession has influenced and birth practices, & not always for the better.

I enjoyed the chapter on “Birth Furniture through the ages” which gives a timeline of the use and development of birthing stools, chairs, and other furniture for birth which then lead to the modern obstetric bed.  “Research Evidence” was also fascinating. This chapter discussed the pros and cons of observational study and clinical trials. The section on the Cochrane reviews of these studies was particularly interesting.

“Cochrane proposed that treatment based purely on medical opinion (or preference) should be replaced by treatment based on clinical research evidence obtained through randomised clinical trials (RCT’s).”

This led me to consider the amount of seemingly opinion based recommendations that are reported being given to women/birthing people nowadays, even though healthcare professionals should be using evidence based research to support their recommendations, ensuring women/birthing people are making informed choices. A lack of time and willingness to fully support informed decision making leaves us back in a place where medical preference often supersedes the individuals’ preferences.  

Jowitt’s visual models of the balloon and trampoline are also helpful in considering the actions of the uterus.

I found the later four chapters more easily accessible and informative when it comes to describing the passage of the baby through the pelvis and what Jowitt sees as how we can “make birth better”. For instance, she recommends that Midwives not only suggest changes of position, to the woman/birthing person, so that they can tick the box that they’ve done so, but that they actively encourage and support them to adopt upright positions. This is also when she revisits the importance of changing the emphasis in birthing rooms from the bed to other pieces of furniture or equipment that would support upright birth, and also to support midwives to be more physically comfortable and able to facilitate upright birth.

This book could be viewed as a feminist text (after all, isn’t birth a feminist issue?) with its references to the history and development of mankind and the birthing process. How once the patriarchy became involved and birth was seen as a way to profit and build stature within society for men, the voice of the woman/birthing person became supressed, and they were coerced to ignore and go against their natural instincts. For this, I applaud Jowitt.

However, I am a little disappointed in the hetro-normative narrative of the book – especially when the topic itself would lend so beautifully to a more gender-neutral and inclusive use of language. If you are going to “update” a work for the 2020 population, then surely you have a responsibility to make it as inclusive as possible?

I also found it quite hard going at times. I would say this is a book for birth workers rather than for the expectant parent audience, although anyone who is pregnant and has a more academic background might also find it informative. It certainly contains some very important messages about the power of position in labour and birth, and how reclaiming physiological birth would be empowering and beneficial to not just parents and babies, but also to our midwives and the maternity system as a whole.

Overall, I found this book to be very informative. It raises important issues, especially around upright birth being the physiological norm, and how understanding how different positions in labour can significantly affect birth. These are facts which are acknowledged by lay birth workers and midwives who wish to “be with” women/birthing people and that the medical maternity world needs to wake up to.

Sally Carter is a Nurturing Birth Doula. Click here for the link to Sally’s Nurturing Birth Directory entry.

I care: You Matter

Photo of Sophie Brigstocke. Sophie is a white woman with long, light brown hair and she's wearing a blue top.

By Sophie Brigstocke

Those following the March With Midwives group and galvanising themselves to join vigils on Sunday 21stNovember will already be aware of the desperate stories of midwives who are struggling to keep themselves afloat, let alone provide the level of care needed by those using perinatal services.  I read another story this morning from a midwife which just broke my heart – these are people who have a deep desire to support people and the necessary skills to help them birth safely and they are being taken to a dangerous edge.  So many are giving up and in deep grief at not being able to continue and/or at seeing maternity services in such a dire state.  

Over the years we have witnessed many doulas reaching a point of burnout – of not being able to continue.  Many of us in the Nurturing Birth team have sailed close to that point ourselves, and over the past few months I have certainly recognised those tell-tale feelings of exhaustion.  Stopping and recognising when the time has come to take care is essential.  As doulas we often prioritise others – we are the carers, the providers, the nurturers.  But, when our own energy is depleted we are no good to anyone else.  

Last Monday Michelle and I hosted the first of what we hope will be many retreat days across the UK and beyond.  I’m not sure I have the words to explain how special the day was, but I will certainly try! 

Our retreat day focused on simple principles – relaxation, nourishment and letting go.  So many of the wonderful doulas who joined us shared that they were holding on to stuff that they wanted to put down – in holding space for others we sometimes absorb their energy and overly carry responsibility.  Making space and time to put some of it down is important so that we can continue to offer that essential role.

Nourishment comes in many forms – we were really fortunate to be joined by a wonderful yoga teacher, who guided us through a really restorative, simple practice which helped us to ground ourselves.  Our fantastic mentor, Charlotte, who is passionate about nutrition and especially postnatal recovery, created such a delicious lunch, rich in colours, flavours and nutrients.  Being in the beautiful Hampshire countryside we were able to go out and walk, enjoying the rich autumnal colours.  And then we went into a guided breathwork session, a really powerful practice which supports the body to let go, release old emotions and stories, detoxify and re-energise.  Witnessing those in the room was a privilege.  

At the start of the day I read a simple oracle card on which the words “I care; You matter” were printed.  The reminder was to be fully present and it echoes for me the power of holding space.  As doulas we care and I hope we make clients and those we support feel like they matter.  On our retreat days, and in the other offerings we have for doulas I hope we are able to offer that same sentiment – doulas matter and we, at Nurturing Birth, care.  We are there to listen, to be fully present, to hold space.  It is becoming ever more important as we navigate this complex time in the maternity field.  

We are in the process of confirming dates for our retreat days next year – I would love to host many, so if you would like one in your area and you know 6-8 people who would love to join you then please let me know.  The days are not exclusively for doulas, but open to anyone who works with or around those in the perinatal period.  

We care … You matter.  Take care of yourself this week – listen to your body and do what you can to nourish yourself.  

Journey to being a doula: Leslie Altic

Headshot of Leslie Altic. Leslie is a white woman with short, curly hair and glasses with a black rim. She's wearing a grey polo top and a grey fleece. She's standing outside with trees in the background.

By Leslie Altic

Leslie is a birth and postnatal doula, although she’s drawn more to the antenatal and birth aspect of doulaing.

When did you first hear about doulas?

I had vaguely heard about doulas when I was pregnant for the first time, but didn’t really know much about what they did until after I had my second baby, 11 years ago. A couple of women I became friends with worked as doulas, and I kind of thought ‘who would want to do that?’ Doulas were, and still are, relatively unknown in Northern Ireland, though thankfully the word is now slowly spreading! Then after I had my youngest, I was meeting and connecting with more women who were involved in all different aspects of the birth world, whether that was through antenatal teaching, doula work or campaigning for improved services, and that sparked my interest and passion in pregnancy and birth. I now know exactly why someone would do that!

Through my own pregnancies I knew how beneficial it was for me to have Continuity of Carer and that is exactly what a doula provides: A continuous source of much needed support, particularly now that maternity care can be extremely disjointed.

What were you doing before training as a doula?

Before becoming a doula, I did many and varied qualifications and jobs over the years. I entered my 40s still not knowing what I wanted to be when I grew up! I moved to Northern Ireland from Virginia 23 years ago to volunteer with a cross-community family centre, met my now husband (who has been my absolute rock through everything!) and never went back.

Since then I have trained and worked as a pastry chef and baker, completed a Nutrition Research Masters, worked part-time in Lush as well as a local theatre and arts centre and most recently worked full-time in the civil service. I still love baking and am more than happy to provide lovely treats and baked goods for clients, but I have well and truly become obsessed with all things birth-y. For a while I considered training as a midwife, but with a young family it wasn’t possible at the time. However, I did want to follow my passion for supporting families through pregnancy and birth, so first began training as an antenatal practitioner, then as a doula. I’ve since left the civil service and alongside my doula work I now work part-time as a Maternity Support Worker with a local Sure Start.  

Had you been at any births before training to be a doula?

Before training as a doula, the only births I had been to were my own, but I had started to chat more with local doulas about their work and I realised I had finally found what I wanted to do. I attended my first birth 6 months after completing my training, and when I got the phone call to come and join them at home I was beside myself with excitement! I spent 16 hours with them, and although I was nervous about how things would go and if I would be able to provide the support they needed, after a while it just felt ‘right’. When I got home, I thought ‘That was amazing! I want to go back and do that all over again’ and I knew I was on the right path.

What made you decide to train as a doula?

The road to motherhood was a difficult journey for me, but ultimately it started me on the path to becoming a doula. My first baby, Joshua, was stillborn at 41 weeks and it turned my whole world upside down. I had 2 very anxious rainbow pregnancies (now healthy and happy girls), and I wouldn’t have gotten through them without the support of friends, family and other bereaved parents.

My experience made me realise how precious this time is and how, with the right information and support, pregnancy and birth can and should be a positive and empowering life-changing experience. I am a befriender for Sands, the Stillbirth and Neonatal Death charity, and a few years after I had my youngest I joined the local Maternity Services Liaison Committee working towards improving maternity care for bereaved families.

Through this work I started to connect with others involved in the birth world, and these friendships inspired and encouraged me to follow that work myself. That’s when it really took off – my absolute passion for supporting parents to be empowered to have the most positive birth experience and to get evidence-based information to make the decisions that are right for them. I really enjoyed my antenatal practitioner training, and love working with parents antenatally to prepare for their birth. Training as a doula is an extension of that and felt like the right path for me, being able to provide that individualised supportive relationship, as I learned from personal experience that it is vital for feeling safe, confident and supported.

What do you love most about being a doula?

I absolutely love being a doula, so it would be hard to say what I love most. All of it! Although the schedule is unpredictable and the hours can be long, it doesn’t actually feel like work. I love the excitement of being called to a birth. I love getting to know the parents as individuals, developing that relationship, creating that connection. Each family is so individual and this connection means that I can support them in the way that they need. And when a woman has just birthed her baby and says ‘I just did that. I am amazing!’ or enters motherhood feeling really positive about her birth experience, it is such a fabulous, oxytocin-filled feeling!

What do you find challenging about being a doula?

There are times when doula work can be challenging. Being on-call while still being present for my family and other commitments can be tiring, both physically and emotionally. Luckily, my husband and girls are amazing and completely support and understand (sometimes!) my work and why I do it! With clients, the nature of the relationship is so close that it can come with a sense of responsibility for ensuring that their birth goes ‘to plan’, that they have their birth, their way. When asked ‘what would you do if you were me?’ it’s understandable to want reassurance that they are making the right choice and it can be tricky not to share my personal thoughts or my own experience. But what’s right for one family is different to what’s right for another, or me, so it’s about supporting them to follow their instincts. My role is to walk beside them, and not advise or make decisions for them, and when a birth experience is different than planned, trying not to feel as if there was something that I could have done differently. This is all part of reflecting and learning from each birth so that I can grow and develop as a doula.

What do you want from the future/where do you see doulaing taking you?

I am a bit of a perpetual student, and love learning and training, so am continually doing courses or workshops to help develop my skills and expand the support that I can offer to clients. I have trained as a hypnobirthing teacher, a Relax, Stretch and Breathe practitioner and I also do 3-Step Rewind to support those who have experienced a traumatic or difficult birth. In future I am looking forward to Spinning Babies training, and would really love to do aromatherapy for pregnancy and birth, and baby massage, baby yoga.

I own and run Belfast Baby Company with my doula partner, Emma, and we really want to be able to provide an all-round birth support service to parents. But doulaing will be at the heart of it because that is what I always come back to. I’ve been working as a doula now for 3 years, so I still feel like I’m relatively new to the doula world. But who knows where it will take me!

I’m so excited about the journey! It is an absolute privilege to play a small role in someone’s journey to parenthood.

Leslie Altic, trained with Nurturing Birth in March 2018

You can contact Leslie here:

https://belfastbabycompany.co.uk/

https://www.instagram.com/belfastbabycompany/

https://www.facebook.com/belfastbabyco

[email protected]

Nurturing Birth Directory: https://nurturingbirthdirectory.com/doulas/united-kingdom/county-down/purdysburn/leslie-altic/

Nurturing Doulas – The Virtual Cuppa

Photo of a cup of tea with the text "Time for a Virtual Cuppa" and the Nurturing Birth logo

Community has always been really important at Nurturing Birth and pre-pandemic we often arranged opportunities to gather doulas together. 

One of the blessings of the pandemic was having to think outside the box.  Along with the rest of the world we became friends with Zoom, and, craving connection, we decided to create The Virtual Cuppa.  Hosted once a week, this was an opportunity for any Nurturing Birth-trained doula to come and join us for an hour to just be with other doulas and chat through anything that was affecting them as a doula in the current time. 

It’s been 18 months since The Virtual Cuppa launched and it has grown and developed beyond recognition.  It is now a fixture of many doulas’ weeks.  We have a lovely group of doulas who regularly attend as well as people who drop in for the occasional session, depending on the topic up for discussion or their availability. Doulas join us from across the globe and deep friendships have formed that wouldn’t otherwise have existed.  One of the fun things we do is ask people to add their location to their name on their Zoom account. It’s a joy when you see doulas realising that they are locals, be that in London, Northern Ireland or even further afield, like Abu Dhabi!

The Virtual Cuppa is a space for the doulas to decide what they want to discuss. The range of topics has been fascinating – from freebirth to business marketing.  And, the expertise comes from the group.  Most weeks we give people the opportunity to go in to smaller breakout rooms to chat through questions on a topic before returning to the larger group.  It gives all doulas, whether they are brand-new or hugely experienced, whether they are super-confident or shy and reserved a chance to share, be heard and speak if they want. 

For some doulas The Virtual Cuppa has been described as the highlight of their week and we are so thrilled that this is now a permanent fixture.  Both Michelle Every, Mentoring Co-ordinator, and I love it.  It feeds our souls to have so much time with Nurturing Birth doulas, to hear their stories, to hold space and provide somewhere for connection.  It is truly inspirational for us as we develop and grow. We were forced into meeting online because of Covid, but we’ve realised that it’s the only way that so many doulas can easily access this amazing resource, with no travel costs and wasted travel time. While we will undoubtedly want to start in-person meet ups at some point in the future, The Virtual Cuppa will be a staple of Nurturing Birth’s doula support, Covid or not!

Access to The Virtual Cuppa is available for all doulas who have completed the Nurturing Birth doula training. If you’d like to join us, please see the Nurturing Birth Doulas Facebook page for the access code.

Nurturing Birth Book Review: Labour of Love: The Ultimate Guide to being a Birth Partner

Book Review by Rahima Ahmed

Front cover of Labour of Love: The Ultimate Guide to being a Birth Partner shows a photo of a white woman's chest and bump. She has long brown hair and is wearing a white strappy top, and blue jeans. The background is light blue with the book's title printed on the background.

The Labour of Love: The ultimate guide to being a birth partner by Sallyann Beresford is published by Dandelion Publishing and is available from good book outlets.

With over twenty years’ worth of experience supporting pregnancies in a variety of capacities including working as Doula, Antenatal Yoga Teacher, Sleep Consultant and a Hypnobirthing teacher; Sallyann Beresford has created an ultimate guide essentially written by an experienced birth partner for birth partners to be. Whether you’re supporting a birth for the very first time or you’re an experienced Doula you will benefit from taking some time out to read this book.

From my experience, I’ve found that electronic libraries and bookshop shelves seem to be flooded with resources dedicated to expectant mothers, but there is limited material in comparison for birth partners. Sallyann’s aim behind this guide was to create a resource that supported couples in the labour room.

By providing birth partners with the right preparation and knowledge, Sallyann noticed that the support she offered resulted in more positive pregnancy, birth and post natal experiences. Sallyann effortlessly breaks down the journey of birth, covering topics such as birth locations, hormones, safety words, dilations, positions, birth plans, birth management and preparing for the postnatal period. The book provides expectant parents and partners with the confidence and up to date knowledge needed to achieve a positive birth, not only for the mother or birth parent but for everyone involved.

Sallyann manages to inform her readers of all the options available to them, whilst covering multiple scenarios and how to handle changes that may arise. Her ability to pair each chapter with real-life personal experiences and stories bring the chapters to life, as well as supplying very useful bite sized recap points which are great for birth partners to easily access.

As a Doula, reading this book made me reflect on the ways in which I currently support my clients and how I can improve on this to ensure that they feel as safe and as comfortable as can be. Sallyann developed an acronym ‘P.R.O.T.E.C.T.S’ which stands for Positions, Refreshments, Oxytocin, Timing, Environment, Calm, Touch and SIlence. Each word highlighted in this acronym is a quick way to somewhat checklist that you’ve covered every aspect of your role as a birth partner and it remains relevant in all types of birth.

Sally Ann dedicated an entire chapter to ‘The Birth Partner’. Whilst specifically reading through this chapter I was reminded of the power of just being present which can be so easily overlooked; sometimes words are not needed, just simply being present is enough. I find myself encouraging my clients to believe in themselves and believe in their bodies. As birth partners we need to remind them of this, whether that’s in the language that we use, or by confidently encouraging them to allow their bodies to naturally go with the flow.  Sallyann also reminded me of the importance of trusting a mother or pregnant person’s instinct as it’s very rarely wrong.

Overall, I would highly recommend The Labour of Love. It’s an easy read that I didn’t want to put down. The book itself has the perfect balance of antenatal education combined with birthing reality. The mixture of diagrams, acronyms and charts were very informative too.  By truly understanding the needs of a woman or birthing person, whether those needs are emotional or physical, we can all work together to create the most beautiful and positive birthing experience possible. By reading this book I believe this even more.

Book Review by Rahima Ahmed (Riri The Doula) www.ririthedoula.com

Why did I become a Doula?

By Michelle Every

Michelle's photo, Michelle is a whit woman with grey-brown hair. She's wearing a blue puffa jacket and standing in fields

The answer to this question is simple. I became a Doula because people who knew me asked me to be present and support them at the births of their children.

At this time I lived in Mid Wales and was privileged to have a job which was predominantly connecting and supporting the local community. I had space and time to spend with people and found myself being invited into their homes and lives. This led to being asked into their pregnancy, birth and post natal stories.

When I reflect back to this time there are four significant experiences that shaped my journey into becoming a Doula as a full time job.

When I was pregnant with my fifth child, a friend of mine at the parent and toddler group we attended shared with me that she was having a miscarriage. We connected and I offered her support. A couple of weeks later she found me and shared her news that she had a baby still growing in her womb. She had been expecting twins. We kept in close contact throughout her pregnancy and as the time for the birth drew closer she asked if I would be willing to drive her to the hospital for the birth as her partner worked away. The hospital was an hour away and on this journey we had such fun. This was her 5th child and she was confident in how she wanted to birth. Her challenge was trust. She found trusting strangers difficult, so I was invited to be present to help her to let go and to trust her body.

I was astonished to see what a difference my presence made to this woman. I sat in the birth room. She didn’t want me to talk, to touch her or do anything. Yet she said afterwards that just knowing I was there was all she needed. Wow. This impacted me deeply.

The second experience that impacted my journey into being a Doula was the birth of my 5th baby. I share about Arthur’s birth often as he was born when I was 20 weeks pregnant and his life and death has impacted who I am deeply. Giving birth to a baby who is not “viable” impacted my world in a way that is difficult to describe. When I became a Doula I knew I wanted to support others who experienced miscarriage, stillbirth and infant death. As the years passed I also became passionate in equipping other Doulas to offer the same service so I created and facilitate Supporting Every Birth – a workshop exploring supporting loss.

The third experience was supporting another lady in my local community just days after I had given birth to Arthur. This lady had experienced a miscarriage before her first son was born. I spent time with her son while she birthed her daughter in another room. I was not needed in the birth space this time. What she needed from me was to keep her son safe. Being part of this family’s story so close to my own loss was emotional for sure but one I am so glad I agreed to do. Their joy brought me joy.

The fourth experience happened once I moved to Greater Manchester. Again, I was asked to support a mum bringing her firstborn into the world. She had a long labour at home and my role was encouragement, laughter, service and companionship. The midwife attending the birth was the voice that changed my life – she asked me if I was a Doula. And if I was not that I should be as this was what I was doing.

“Doula? What is a Doula?” I asked.

Looking it up on Google I could not believe that what I had instinctively offered was, in actual fact, a job.

Two years later I was looking for a new job. I found Nurturing Birth and trained to be a Doula.

Reflecting back today on why I became a doula what I notice is how natural and easy the process was. I took each opportunity that came my way and trusted my instincts. I hope my story brings encouragement and confidence to others.