A letter to my head of midwifery

Hi HOM, 

As mentioned, I am writing to you regarding my birth choices and preferences. I want to ensure these are addressed prior to my estimated due date so we can work together effectively from a place of understanding.

Human rights law gives individuals the right to enjoy a private and family life. This means I have the right to choose who supports me during pregnancy and birth, and in the days following birth and my chosen birth place.

Firstly my perceived risk is due to having a caesarean birth previously. Due to PROM I was induced which resulted in a caesarean. Prior to the cascade of interventions my waters were clear and I was fit and well showing no signs of infection or concerns for babies welfare. Had I been presented with the research at the time to make an informed choice I would have chosen to stay at home and wait, unless concerns arose.

For this pregnancy, all is currently well with the pregnancy and no other perceived risks other than the previous caesarean and a perceived risk of scar rupture. It was a lower transverse incision, the evidence suggests the risk of this is 0.22% and so I am willing to take the 99.78% chance that this won’t happen to me. My background in tissue viability assures me that I have a healed well and allowed enough recovery minimise the risk further again. I discussed this with the obstetrician and I understood him to respect my choices and has hopefully emailed you with the outcome of our discussion. I have asked that unless something comes up in the pregnancy that this is not revisited as I feel there is nothing more to say. 

As a Trust I feel you need to consider the harm the restrictions of the home birth policy may cause as I appreciate restrictions can be put in place, especially around winter pressures. Research in this area has repeatedly demonstrated the benefits of being supported by loved ones and companions of choice during pregnancy and birth. I appreciate staffing may not facilitate a home birth however should no one be available I will be remaining at home with the support of my husband, family and Doula unless I feel the need to come into hospital due to any concerns that I may encounter.

I know questions will be raised around my preferences to not be monitored in labour and declining Vaginal examinations. I would like to make it clear I am informed in my choices and that to achieve the birth that I need to heal from my previous experience these choices need to be respected.

There is no research to date examining whether the practice of fetal heart rate auscultation improves outcomes, or the optimal frequency of auscultation and therefore unless I request it, I do not want to be pressured into monitoring of any kind.

Also to add, the idea that the cervix can tell a midwife about my progress in labour is underpinned by an incorrect understanding of birth physiology. Childbirth physiology is complex and I strongly believe that being left undisturbed optimises my birth experience, mentally, physically and spiritually. I've done a lot of Dr Rachel Reeds lessons in reclaiming childbirth and witnessed firsthand birth unfold beautifully without interruption so the belief that my instinct will prevail is strong and this is what we should be guided by.

I understand that I may need to make alternative decisions during my birth. I want us to work together to make sure I fully understand my options so I can make an informed decision however understanding my above preferences will make this easier and as a result I am confident that my birth will progress without complication.

A lot of self discovery and research has gone into creating my birth preferences which is why I know this is the best chance for me having a birth without trauma or complication.

It is also important to note that once baby has arrived, I do not want the immediate time to be disturbed unless I request it. The only hands touching the baby will be that of my own, my husband and possibly my daughter if she is awake. I do not require active management of the placenta and it is through my own experience that I wish for patience with its arrival as it often seems to come at approximately 90minutes after birth of baby, of course each individual is different. I would also like to keep my placenta. We will be using a cord tie and cutting the cord as a family once the cord is white and non pulsating.

I appreciate their is a lot here that your policy’s may not be supportive of however I am hoping that any midwives involved will be excited about the prospect of a true physiological birth and supporting me by hopefully having to do nothing but sit, listen and wait. I will have refreshments readily available. I also hope that having all of this documented on my health care record can facilitate this further again and reduce any anxieties around protecting NMC registration. I want the midwives to feel relaxed in supporting these choices that do not fall within their usual practice. 

I look forward to your response and chatting through this with you.

Yours sincerely,

Leanne

I’m having another baby

So with a heart that's about fit to burst with love we are so excited to share that baby number 2 is in the way and expected January 2024.

I have my last client due in the fall AKA pumpkin baby and I will then be on wind down with self care and family time. I will also still be running baby massage until Christmas.

I am also facilitating Alex of the @the_original_birth_connection wonderful Doula training for the North West & Scotland so I won't be quiet on here and if you sign up to OBC training I will see you in the new year, possibly with a little babe in arms.

I know the question will be asked "is the doula hiring a doula?' And the answer is Yes! I'm classed as birthing outside of guidance due to having my first born via caesarean and planning for a HBAC and although I am happy to advocate for myself I feel my husband will benefit from an impartial expert to execute my birth preferences should they need to. It takes the pressure off him massively and those good hormones will just flow better.

I won't be sharing everything but I will be sharing a lot via my social media so expect doula content, personal journey updates, community, baby massage content and just general stuff that alligns with who I am and what I believe in.

Lots of love

Leanne x

A Safe Space

It is important to know Doula Diary is a safe and non judgemental space!

This comes from me, being a human being and learning everyday about challenges we all face. This is a very open, wearing my heart on my sleeve kind of post. One I feel some of you will relate to and understand, and why I want to share.

I love my life, everything I have dreamed of has come true…is true. I’m living my dream. It’s not perfect but it’s what makes me happy. It’s a balancing act to juggle happiness, finance, home, work, family, life and as I grow and learn more about myself I understand more.

I have a roof over my head, a healthy body (granted I could do with more sleep and my body aches from time to time) a healthy family, supportive friends, an understanding husband, 2 wonderful dogs and the best clients who really make my work fulfilling.

So when it comes to that time of the month where as a women I bleed. Things get a little foggy. I get irritable, lack motivation and need space and time away from my family. The balancing act becomes overwhelming.

Did you know this is perfectly normal and valid for so many. Now my husband always worries as I naturally become distant. I’m reserving my energy. It’s hard work raising a spirited toddler who’s navigating her own emotions. To support my daughter with this it all starts and ends with me. Now I find it so so difficult to maintain this patience at this time of the month. I have to breathe and collect myself. Easier to do if I’ve had some headspace and filled my cup.

My husband asked me what he can do to help as he isn’t ‘Intuitive’ when it comes to stuff like this. I could have cried. I try to explain that it’s not him , our daughter or our life together. It’s my hormones, it’s my emotions, it’s who I am and always have been. Once upon a time it would have manifested so differently but now I have people who depend on me. But I still need space, and that is what he can do to help. Take our daughter and give me some space.

I may seem like a little bit of an ‘expert’ around birth. I’m not, I’m always learning, same with parenting. It’s a learning journey which we do better when we do it together and share. We have highs, we have lows.

Each Parent, baby and child is different and so is the journey. It will never be the same. So I want you to know that my inbox is always open if you need to splurge into a message how you are feeling. Do not worry about any typos, auto corrections (these can be quite funny and humour is powerful) or grammar. I don’t, it doesn’t matter in the grand scheme of things.

Pop me a little heart in the comments if you ever feel the same, or have anything to add. I would like to show my husband it’s not just me. I appreciate those of you who are pregnant won’t have a cycle right now but that feeling of being overwhelmed may still speak to you.

Lots of love

Leanne x

And Doula Diary was born…

Dear Doula Diary,

It all begins with an idea. Doula Diary was born following the birth of my daughter Olivia on the 13th August 2021 at Stoke Mandeville Hospital. On Wednesday 11th August1pm (ish)I had a trickle down my leg. Did my waters just break or had I peed myself? I genuinely wasn’t sure so I Googled it which wasn’t really helpful. I decided to see if labour would follow and carried on about my day. Nothing else happened. Thursday 12th August me and my husband decided I should speak with the midwife. My midwife told me to go to the hospital to get checked, without even questioning this I did as I was told and was checked. Little did I know at the time that this could be damaging to the natural progression of my labour and also would introduce infection. Without much thought, as I was hoping that The hospital staff would confirm that I would be welcoming my baby, they confirmed my waters had broken but they hadn’t “popped” completely. This is where the cascade of intervention began, I did not know it at the time and I would have done things so different if I had prepared myself differently. Due to the hospital protocol they wanted me to start on 4 hourly IV antibiotics as precaution (infection risk) and I was to be induced the following day. I thought this was over the top but I complied as I thought that they would know best, I put my trust in the service provider and not myself. Working for the NHS for the last 10 years I did not think this trust was misplaced. As I was working through a mixture of emotions I had to fight for my husband to be able to remain with me as they would not let me go home. We offered to pay for a hotel near by so we were close to the hospital, anything to not be separated. Eventually once the night staff had come on and the day staff had gone home they allowed my husband to stay and for us to finally get some rest. It was a very unsettled night and I was praying that labour would start spontaneously.

Friday 13th August cervix closed so to help things along I requested a pessary as the reading I had done had said this may help speed things along. I know better now but in the moment for my first birth I thought this would help my situation. 1st pessary inserted 01:30 and I tried to get some rest. Nothing happened (Surprise!). Later that morning at 12:15 I was checked and my cervix remained closed, I was very disheartened. Certainly know good hormones floating round my body at this stage. Before I was to be induced I took the opportunity to have a bath and then I was induced at 12:45 which was ticking along, I had a lot of nausea and vomiting throughout my pregnancy and I vomited again the morning of the induction. When the induction started I used a tens machine initially to manage any pain. I thought this worked well, I know that induced labours could be more painful and wanted to try and manage the pain as best as I could with limited drugs. When the induced contractions stepped up a level I had a practice with the gas and air. The consultant then came in to do a stretch and sweep and a hook to properly break my waters at 15:25 (this was brutal!) Crazy contractions minute apart minute in length started not long after this with babies heart rate raised! The consultant checked my Cervix and I was only 1.5cm. It was described to us that it was like trying to push a baby out of a keyhole on a closed door. I do not really recall much more other then some paper being placed in front of me and the health care staff “informing me” of the risks to a caesarean. It was too late, I had no choice, I was in pain, something was not right and my baby was in distress. I scribbled something that looked like my signature. With baby distressed, heart rate over 200 and everything a blur, it all happened so quickly and Jack (my husband) held my hand every step of the way. We were rushed to theatre, I had a Spinal block, urinary catheter inserted and a Cat 2 Caesarian Birth. The spinal block was very surreal and made me feel even more vulnerable when I already felt helpless.

Jack got to cut the cord and have a cuddle whilst they played some relaxing music and put me back together. The theatre staff were very lovely and tried to involve me and honour my wishes as much as possible. Olivia was born. Time: 18:41 on Friday 13th August weighing 7lbs 3oz. She was here and she was safe! I however, was broken. All I remember repeating whilst I was in theatre was that “this is everything I did not want!’ This is where the journey began to understand my own birth story, heal from it and find myself wanting to ensure your birth is in alignment with your vision and that you are prepared. Part of my recovery has been facilitated by becoming a Doula and finding a village of women and birthing people who have either a passion for birth rights and birth or have had their own birth trauma to deal with and found themselves wanting to make birth and postpartum the empowering and transformative experience that it should and can be, if we understand the physiological process of birth and have the confidence to trust our instincts. I can 100% support any birth providing that the mother understands their options and can make informed choices that is right for them. I am particularly passionate about first time Mum’s achieving ANY birth as long as it’s what they have chosen without coercion. I am also very passionate for second time Mum’s achieving vaginal birth after caesarean (VBAC) or home birth after caesarean (HBAC) as this is what I am aspiring for my next birth and I know with the right support around us we can achieve it!