Nurturing Birth

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Pregnancy

When a baby dies

Photo of Michelle Every, Michelle smiling. She is standing with moorland behind her. her long hair down to her shoulders. She's wearing a teal padded jacket.

By Michelle Every

What do you say when someone – a doula client, a friend, a relative – tells you that they have experienced a miscarriage or stillbirth? Michelle Every offers some support, information and signposts.

When I trained to be a doula in 2007 I was astonished and saddened that supporting baby loss was not mentioned on my course. Then as I gained experience and connected deeper into the doula community I noticed that loss was not something that I saw being discussed. 

In 2014 I felt a strong conviction to change this so I created the Supporting Every Birth workshop. I wanted to create a safe space to explore loss with a focus on self-reflection and group participation and give time to consider where we are with our own grief being curious and honest with ourselves around our own views and opinions on loss

When talking to doulas about baby loss the two phrases I most often hear are “But what will I say?” or “I worry I will say the wrong thing.”

There is fear around the power of language.

What we do or do not say is not just relevant to supporting loss or supporting clients. It is relevant in every exchange we make in our everyday life. How we respond to what we hear can have a significant impact on the person sharing. Have we heard them or are we focusing too much on our own answers or our own story? How can we offer space, actively listen and resist the need to fix?

When I am considering my choice of words I keep the Nurturing Birth values of respect and compassion at the forefront of my mind. These values lay a great foundation when considering language, can shape my conversations and prevent me from saying something in anger or frustration.

Is what I am about to say respectful and compassionate?

Coming back to supporting loss, what do you say to someone who has discovered their baby has died during pregnancy? Or what can you say at a labour when the baby is born not breathing and has died?

I volunteered for the Miscarriage Association for fifteen years. When I answered the phone and listened to people share their own stories of loss I would hear how the countless times their family, colleagues and friends had said unhelpful things such as “Everything happens for a reason” or “Just move on.”

From my experience of facilitating loss support groups I am aware how a spoken phrase can bring much comfort to one person only to upset another. No one way works for all. It is good to remember that grief is a natural, unique and personal response to losing something important to us. As doulas we want to validate this uniqueness while acknowledging the challenge that this can bring to us personally. We are required to offer support in the moment and respond to what we see and hear rather than having a pre-planned and prepared response. 

Maybe we are beginning from the wrong place. Instead of starting at what we will or will not say it might be helpful to start with what can we be. How can we be our most authentic self and respond to the needs of the family we support? 

On the Nurturing Birth doula courses and within mentoring we talk about being rather than doing. Our skills are listening, holding space, being client led, responding to needs in the moment. We go to births with no guarantees or certainty and yet we go with confidence that our presence and commitment to the family will make a significant difference 

Is this any different when the baby does not survive?

We can create the same environment, listen with the same focus and respond in the same way. 

To be honest, and to give a little away from my workshop, not much changes in the support we offer in loss compared to supporting clients with live babies.

We simply doula.

The Miscarriage Association has created some excellent resources which come from supporting loss for many years, including this video -when you do not know what to say, simply say “I am sorry.”

How do you feel about supporting families through baby loss? Do you have concerns on what to say? I would love to welcome you on to the Supporting Every Birth workshop to explore the topic more. My desire is that every doula feels able to step into this role and offer support.

If you would like to talk to me more about the Supporting Every Birth workshop please get in touch – michelle@nurturingbirth.co.uk

Nurturing Birth Book Review: The AIMS Guide to Resolution After Birth

By Natalie Stringer

Image of the book "The AIMS Guide to Resolution After Birth"

The AIMS Guide to Resolution After Birth by Shane Ridley is available from the AIMS shop as a printed book or on Kindle, for £8: https://www.aims.org.uk/shop

“An absolute must-have resource.”

This book from the Association for Improvements in the Maternity Services (AIMS) is an absolute must have resource guide. It will point you in the right direction to find answers and peace following a challenging birth where you have experienced traumatic events.

All information provided in this book is completely up to date being published in 2020, therefore all signposting to relevant websites are accurate and still in practice.

There are so many different, confusing avenues you may need to explore when wanting to raise a concern or make a formal complaint after birthing a baby. This book very easily allows you to recognise and guide you towards the best route for your individual circumstance. It is UK specific and highlights the different organisations in England, Scotland, Northern Ireland and Wales, so you can contact the relevant people in your country. There are some time limits when making a formal complaint within the NHS Maternity system, and these are highlighted in the book. Therefore having this guide to hand to dip in and out of when you feel comfortable, will help you piece together what you need in a time frame that suits you, but does not exceed the cut off point.

There are template letters provided in the book that you can work with to raise a concern or make a formal complaint. Numerous support organisations and charities are listed throughout the book, enabling you to seek out who can help guide you through this process, if necessary.

The book also provides a great insight into how to prepare for a subsequent birth and who to liaise with, as this will help ensure certain traumatic events do not reoccur again. Guidance on how to write your ‘birthing decisions’ is a great resource and will give you the foundations to make this birth better and more in-line with your own personal needs. It provides different options for you to choose the best support for you throughout your next pregnancy, labour and birth. This will help ensure you can feel more emotionally and physically in control of your decisions and your autonomy.

Exploring how you feel about your difficult birth experience and/or the care you received is discussed in Chapter 3 of this book. I know this will be so comforting for many mothers and birthing people who decide to put pen to paper and allow their experience to be validated. This may just be a starting point that encourages you to recognise that you do indeed wish to raise a concern or make a complaint. For others it may provide enough emotional release and your resolution may end there.

The language used in the book can be a little difficult to digest in some places. Although written thoroughly and very clearly, some areas can be a little heavy on abbreviations and putting a sentence together in places may need re-reading a few times to help it sink in or understand which organisation or charity has been written about.

Ultimately, many readers will be looking to find much needed answers and therefore it can be used as a reference book. So it may be a case of finding the relevant chapter(s) for their individual needs rather than reading the book from cover to cover. The contents pages at the beginning make it easy to navigate through whilst missing out sections that are not relevant to you. However, I believe every birth worker should read every page of this book and refer to it often, not only to recommend to their clients who need to seek resolution after birth but also to locate relevant information very quickly.

As part of ‘The AIMS Guide To’ series of books I believe this one will help many, many birthing people find their inner strength and courage to explore not only what happened during and following the birth of their babies, but also find the light to indeed seek resolution.

The main success of this book is giving parents the permission to find a way to raise their concerns or make formal complaints about their birth experiences. Together, if more people feel listened to, respected and supported when choosing to revisit their difficult experiences in order to find answers, they will be paving the way for a better maternity system for birthing people now and for the next generation.

Book review writted by Nurturing Birth Doula Natalie Stringer.

Natalie can be found at www.equilibrium-birthing.com

Mindful Breastfeeding – doulas supporting breastfeeding

By Anna Le Grange, of Mindful Breastfeeding.

I always get excited when I find myself working with doulas (I have a not-so secret ambition to become one myself one day!) There’s something so beautiful about the gift a doula gives to new and expectant families. What a wonderful time to be supporting families whilst they enter into parenthood for the first, second or even tenth time! All of that time you get to spend with them, getting to know them and supporting them with whatever it is they need, I know it is a gift for you too – it really does warm my heart. I know that you get asked a lot about breastfeeding both before and after the birth and this can certainly get complicated at times! I wanted to share with you that although nothing beats referring breastfeeding problems to a specialist, I have a whole host of simple tools that you can use to support families whilst they prepare and learn to breastfeed. These mindfulness and positivity-based tools are simple, yet very effective in supporting families at this time.

About 4 years ago, after becoming a lactation consultant, I wrote an online breastfeeding preparation course for expectant parents and included principles of relaxation, neuroscience, self-care and mindset into the course. It soon became popular, especially with other birth workers and health professionals, supporting stressed and worried families. Since May 2018 I have been teaching others to provide these techniques themselves in their own practice. One thing that is fed back to me time and time again is that they are bowled over at just what a difference such simple techniques can make, not just to the mental wellbeing of their clients but to how well breastfeeding goes too – even in the most challenging of circumstances. These are some of the things we focus on at The Mindful Breastfeeding School.

Infant Feeding Mindset
Everyone comes to parenthood with their own infant feeding story and their own expectations on babies and themselves. I help expectant and brand-new parents to uncover their feelings and beliefs. It’s often something that they haven’t discussed or even thought about. Journaling prompts can be a great way to get the conversation going. Once they have an awareness of their expectations and fears, we break them down into any negative thought patterns that they may be experiencing or even hiding away deep in their subconscious mind. Research shows that negative beliefs can have a big impact on how breastfeeding and early parenting goes. These negative thoughts that we all have tend to be on repeat, often without us knowing it. For expectant or new parents it might be:

“I don’t believe I’ll make enough milk for my baby”

“I’m terrified of feeding in public”

The good news is that we can use what is known about mindset and neuroplasticity to rewrite those negative thoughts into positive ones. Through writing personalised affirmations and then showing parents how to use them, infant feeding and early parenting mindset can soon become more positive, having a more positive effect on their experience.

Calming the Nervous System
Stress is normal and part of everyday life. In small amounts it’s part of our normal physiology to go in and out of stress – early humans needed this part of their nervous system to keep them safe from predators and other life-threatening events. And of course, we still come across threats and dangers ourselves, just different ones. The problem is that our brain doesn’t really know the difference between a real threat and the stresses that we feel in modern day life. Our body still kicks into emergency mode. The issue with being in this mode too much is that our bodies don’t function optimally. It’s called the sympathetic nervous system and when we are running this system energy and oxygen are pumped to our heart, lungs, arm and leg muscles. Our body gets ready to fight, flee or freeze. At the same time areas of the body not needed in an emergency are slowed down. This includes our digestive system and the hormones that we need for birth and breastfeeding such as oxytocin.

In Mindful Breastfeeding we teach parents how to calm their own nervous system to keep themselves out of the sympathetic nervous system when it is not required. This is such a useful thing for any of us to be able to do and it’s a relatively simple once you know how. Tools such as breathing exercises and guided relaxations or visualisations are what we teach parents to help bring themselves out of moments of stress so that they can enjoy the feelings that come with calmness and relaxation and connect more deeply with their baby and themselves.  This leads to improved breastfeeding outcomes and a more fulfilling parenting experience.    

Breastfeeding Support & Education
Support comes in many forms and as doulas you know how vital it is. When I work with expectant families we talk about 3 types of support:

– Partner/co-parent support
– Community support
– Breastfeeding support

I encourage parents to be to talk about and plan how the breastfeeding parent will be supported in the early weeks and months and to put a plan together for what this might look like over the first 6 weeks.  

When it comes to breastfeeding education, before the birth is best. So many people believe that after their baby arrives breastfeeding will just happen naturally and if it doesn’t it can feel like a real shock or like they are failing at this first step in parenthood. Truthfully, breastfeeding, like all other developmental stages in life, is a learned skill. And in a society where most of us see very little breastfeeding in our lives, most expectant parents don’t have a realistic idea of what it will be like.
Good breastfeeding education includes understanding normal infant behaviour and development, as well as how breastfeeding works and when and where to get breastfeeding help. Breastfeeding support telephone numbers or group contacts are hospital bag/home birth kit essentials. If any problems arise at all, families should know who to go to and not to wait until things get worse. Finding breastfeeding-friendly solutions to feeding problems is, sadly, not always forthcoming in our society, so having the details of a local, trusted breastfeeding specialist to be able to share with parents is vital.

It’s such a privilege to work alongside brand-new families at this time in their lives. The road for them doesn’t always feel easy and breastfeeding is often named as a particular challenge. I hope I have inspired you to consider a more mindful approach to breastfeeding support. I truly believe that if we help prioritise calm and connection, so often the breastfeeding follows – it’s certainly a good place to start.

Anna Le Grange is a Mum to 3, IBCLC, Paediatric Nurse and meditation teacher. She is the author of the Mindful Breastfeeding Book and runs breastfeeding education courses at The Mindful Breastfeeding School.

The man who birthed his babies

Nurturing Birth doula and writer Emma Ashworth interviews Yuval Topper, trans man from Yorkshire and birth father of three to find out more about his experiences, and how doulas can better support trans men during pregnancy and birth.

Emma: Tell me about yourself, where you’re from.

Yuval: I am married to Matan, I’m from Israel but I live in the UK and I’m a trans man with three children who I gave birth to.

I had my oldest son (Lyrie) and my daughter (Aria) in Israel – my son in hospital and my daughter at home, although I had planned a home birth for them both. It’s not easy to have a home birth in Israel, and most midwives will not come once you reach 42 weeks, so at just over 41 weeks I was getting quite nervous. I decided to take castor oil which did seem to trigger labour – but also may have been why my Lyrie passed thick meconium when my waters broke, so we transferred to hospital.

Emma: How did Lyrie’s birth go?

Yuval: I really hadn’t wanted to go to hospital. I had gone to a different hospital at about 26 weeks with reduced movements. The experience in the hospital wasn’t too bad, and my baby was looking healthy, but then shortly afterwards a national newspaper contacted me, wanting to write about my ‘story’.  Matan and I decided that we really didn’t want to talk to them – and they ran the story anyway – the first trans man to be pregnant in Israel. It was not positive coverage. The hospital denied that it came from them of course, but it really made me wary of contact with unknown medical staff.

Lyrie’s birth was quite traumatic. As is common in Israel I was made to have interventions that I didn’t want, such as an episiotomy and ventouse. I was also mis-gendered a lot. In Hebrew everything has a gender. In English I might be mis-gendered when someone talks about me, ie using she/her rather than he/him, but in the Hebrew language this can happen when someone speaks to you directly, and this happened a lot during his birth.

I really wanted to be completely naked while I was in labour, but the staff kept covering me which felt really irritating and against my body’s instincts. I did wonder whether they felt uncomfortable seeing my non-conforming body which is why they kept trying to cover me.

After Lyrie was born and I was moved to the postnatal ward, I had a frustrating conversation with a midwife or nurse who kept telling me how unusual the situation was, and she’d never come across it before, but she was fine with it. She was clearly out of her comfort zone and continuing to repeat that she was “fine with it” showed that she maybe wasn’t! Next day another staff member came round to see me and asked whether I was going to “stay a woman” now!

Emma: That sounds really exhausting

Yuval: Yes, I was feeling that I had to justify my existence rather than focus on my baby. But it didn’t end there. Although they gave Lyrie a registration number in the hospital, I had lots of problems when it came to register his birth. They would not allow registration from a man, and that forced me to re-register myself as a woman, register Lyrie and then register as a man again. The process is complex and for a while it was unclear whether they would re-register me as a man, which would have left me with unmatched identification such as my passport and driving licence.

Emma: What happened with Aria’s birth?

I again planned a home birth with Aria, and this time had a very positive birth at home. However when it came to registering her I had even more problems! The Registrar refused point blank to register her and actually told me that Lyrie’s was a “one time offer”! We did manage to register her in the end but it took so much time and effort, and for no benefit to anyone at all. It was transphobia, pure and simple.

Emma: So then you moved to the UK?

Yuval: Yes, and I became pregnant with our third child, Liam. At around 12 weeks of pregnancy I was phoned by the hospital and asked to come in for a scan – they had found a problem on my blood tests. My husband was away and my friend was unable to come with me – I was really nervous about attending an unknown hospital in a new country. Did they even know I am trans? How would they treat me?

In the end I went with a midwife that I had met once before, who I knew was trans friendly, and that she would support me to advocate for whatever I needed – but as it turned out I could not have been better cared for.

When I went to the appointment I received the devastating news that Liam had died at around 10 weeks of pregnancy. Despite the shock of the news I felt extremely well cared for by the obstetrician at the hospital. She made sure to ask me my pronouns, not assuming that I would prefer he/him (which I do) as some trans people prefer they/them or something else. I was otherwise treated just like anyone else – no one tried to ask me whether I was now going to stay as a woman! They were kind and supportive and recognised that I had just lost my baby, and my gender changed nothing about that.

Emma: When you were pregnant with your fourth baby, how did this influence your care decisions?

Yuval: When I was pregnant with Teagan – or Tig as we call him – a medical condition meant that I needed to have frequent scans and tests. My body had become Kell+ sensitised. This is a very rare condition which is very similar to being RhD Positive, but there is no equivalent with Kell+ to the anti-D treatment. I am Kell- and my husband is Kell+, so each baby has a 50/50 chance of being one or the other. As with RhD, this doesn’t matter for the first baby, but if any baby has a different blood type to the birth parent, and if this blood mixes, this can cause problems for subsequent babies. It seems likely that Aria’s blood, which is Kell+, mixed with mine during her birth. This means that my body became sensitised to it and my immune system is then able to attack the blood cells of any Kell+ baby.

We discovered through the NIPT test that Tig was almost certainly Kell-, which was a huge relief, but we could not know for sure. This did lead to a very stressful pregnancy, and I decided that I needed the support of a midwife that I knew, so we hired Hannah, the independent midwife who had been with me when I learned that I was miscarrying Liam. Having Hannah was a huge help, although I was also receiving excellent support from the NHS as well. In the end I birthed Tig at home together with Hannah and my friend Mari, and these photographs are the ones that Matan and I decided to share, and which have gone viral!

Even though the care in the UK was far more trans-friendly than I experienced in Israel there were still serious issues. For instance, the lab rejected my blood tests a number of times as my medical record has me recorded as male, and the lab tests were for pregnancy related conditions. This caused delays and could have impacted on mine or Tig’s health. I was also frustrated that, like in Israel, I had to have my name recorded on Tig’s birth certificate as “mother” – but here I also had to add in my occupation. So Tig’s birth certificate says “Mother… occupation – Full time dad”!

Emma: I love that! I do hope that the NHS will be able to update its systems to better support trans and non-binary people with all aspects of health care. It’s great that that you got the support from the staff. I’m wondering what, as doulas, we could do to better support trans or non binary clients?

Yuval: I think my biggest request would be to not make assumptions! For instance, many people assume that trans people don’t like their bodies. This is really not the case for many people! Many of us are very happy with our bodies. Different people do have different feelings about their body parts though – especially the genitals and the chest. Some people really struggle with the names of genitals and prefer to use different names. Others are happy to use the regular names. Where appropriate and relevant, just ask. However, consider whether you need to know – don’t just ask just because you’re curious. Also listen carefully for the words that the person you are supporting uses, and use the same words. For instance, if they mention chestfeeding, use the word “chestfeeding” rather than “breastfeeding”.

Please don’t assume what our pronouns will be, but ask what we prefer to use.

It can be really helpful to have the discussion about what kind of advocacy would be useful to us when we are in labour, or in hospital if we’re planning a caesarean. Please check whether, for instance, we’d want you to correct people using the wrong pronouns or words to describe the body that we have already said we would prefer to not use.

Ask if there are any other aspects of care that the doula should know and ensure that the medical staff know, if relevant. For instance, some trans men may be even more likely than women to object to having their breast/chest exposed or touched – especially those trans men who have not had top surgery (breast removal surgery).

Otherwise, trans people have the same needs in pregnancy and birth as anyone else, so once the differences have been discussed, please just support us as you would everyone else. Like birthing women, we want to have births which are right for us and personalised support where we are each asked what we need as an individual.

Yuval lives with his husband Matan and three children in Yorkshire, UK. To follow him on Facebook, click here: https://www.facebook.com/yuvaltopperez

If you are looking for doula support, please visit the Nurturing Birth Doula Directory.

Three photos of Yuval - 1, Yuval in the birth pool leaning over the pool with Matan behind him. 2, Yuval holding a newborn Tig in his arms and smiling at him while still in the pool. 3, Yuval cuddling Tig who is wearing a rainbow hat.

Nurturing Birth would like to thank Tara Leach for permitting us to use her birth photography images in this article.
‘Your Child’s First Adventure’. ‘Tara Leach is a Manchester-based birth photographer.  She is interested in documenting all births and all adventures. To get in touch either see her on Facebook or email taraleachphotography@yahoo.com

Video interview with Polly Hand, chiropractor

Sophie chats to chiropractor and doula, Polly Hand, about her work with pregnant women, babies and families, especially when it comes to breech or malpositioned babies. She discusses how she uses the Webster Technique amongst others to help babies move into an optimal position.

For more information about Polly visit her website or follow on Instagram

Click here to watch Sophie’s interview with Aine Homer about baby reflux or click here to watch Sophie chatting with Hannah Wallace of Wear My Baby about baby wearing and the benefits for families.

If you are looking for a respected, quality doula then do visit the Nurturing Birth Directory

Video interview with Liz Stanford, The Calm Birth School

Sophie caught up with Liz Stanford who recently took over The Calm Birth School from Suzy Ashworth. They chat about Hypnobirthing, the science behind it, the mind body connection and how empowering it is for women approaching birth. They also talk about how the term hypnobirthing can be off-putting for some and dispel some of the myths around it. Liz shares her experiences of using hypnobirthing for the birth of her three children.

To find out more about Liz and the Calm Birth School visit their website, Facebook Page, Instagram

Click here to watch Sophie’s interview with Alex Heath, Hypnotherapist about Birth Trauma recovery.