Friday, 18 October 2013

The Positive Birth Movement at the Birthrights Dignity in Childbirth Forum

Yesterday I was honoured to be a part of the Birthrights Dignity in Childbirth Forum, held at the Royal College of Physicians in London.

I gave a short presentation about my organisation The Positive Birth Movement, which I'm reproducing here for those who were unable to attend and might be interested to read it.

Below the presentation I'm also sharing the 'submission' that was made to Birthrights about the Positive Birth Movement, which gives more detailed information about the organisation, including some fantastic feedback from those who facilitate and attend our groups.

Please come and join the PBM on Facebook, Twitter, or get in touch with me if you would like more information or want to be involved in any way. You can find your nearest Positive Birth group on our website:


My name is Milli Hill, and a year ago this month I set up the Positive Birth Movement.

It all started with a very little idea – the thought that, as a newly trained doula, I might run a monthly birth discussion group in my area – a place for women to gather and share thoughts and feelings about birth, to challenge fear and negativity, and to empower each other with support and shared information.

When I had been pregnant with my first daughter five years previously, I had longed for this kind of antenatal group. I didn’t much want to look at plastic pelvises or learn about epidurals. I was more interested in what birth was really like, and I was very very afraid.

In the time since my own first birth experience, I had also noticed – and begun to write and blog about – what I saw as some pretty serious flaws in the current birth system – an imbalance of power, over-medicalisation, and a whole lot of fear. And I watched friend after friend finding their plans for a normal birth end with their feet in stirrups or on the operating table.

So I thought that maybe women needed to come together and talk about all this – just a small group – round my gaff – maybe with cake.

In late September 2012 I went to a screening of Freedom for Birth, the film about imprisoned midwife Agnes Gereb, and the wider issues of rights in childbirth. It called on women to ‘take back childbirth’. I very much heard this call, but felt at a loss – how could we do this?

I saw a world in which women were afraid, and were faced with difficult choices in childbirth – a world in which real ‘evidence’ was hard to come by, and medical opinion was often presented as fact. I felt that women’s freedom was truly being compromised by this situation – for how can a choice be truly free as long as it is based in fear or a lack of accurate information?

I started to wonder if my ‘little idea’ – to set up a local birth discussion group, could spread? If I were willing to give my time to this cause for free, perhaps others might do the same? And what if we could use the power of social media to connect all these little groups to one enormous ‘Mother Ship’?

There has never been a better time to have a ‘little idea’ than the 21st century.

Through my personal blog, and through facebook, I dropped my little idea out into the ocean of cyberspace – and the response was overwhelming – a tidal wave of offers, ideas and positivity.

In a year, we now have over a hundred Positive Birth groups in the UK

26 in the USA and Canada

5 in Australia and New Zealand

3 in Turkey

2 in Brazil

and 1 each in France, Germany, Malta and Qatar.

All of our groups are free to attend, and our Facilitators are not paid to run their groups.

Most groups are facilitated by doulas, midwives, or other birth workers, but one or two are run by women who are ‘just passionate’ about positive birth.

Most of them meet on a monthly basis, some more often.

Anyone can attend a Positive Birth group – they are open to all but aimed primarily at pregnant women. 

We welcome all backgrounds and ALL birth choices - we are not the 'natural birth movement', and very much believe that any birth can be positive, so long as a woman is free to make informed choices, and is treated with respect and dignity.

The groups are structured as peer to peer discussion – ‘teaching’ is discouraged, shared ideas and conversation are encouraged in its place.

All groups are connected via social media, and we have a very active facebook page with nearly 4000 ‘likes’. Our Facilitators have their own extremely active discussion group on facebook, and I also send out a monthly newsletter to keep people connected and announce the monthly discussion theme.

Groups are free to use our monthly discussion theme as a starting point, if they so wish. Some of our themes have included:

  • Planning a Positive Birth (thoughts, feelings and experiences of ‘birth planning’)
  • What is a Positive Birth?
  • Choices in Birth (the many and various choices pregnant women face)
  • The Language of Birth (the language we use about birth and why this matters)
  • Images of Birth (what images we have seen of birth in our lives and how these have affected our expectations and experiences)
  • Place of Birth (how can we have a positive birth in the various locations, what our options are etc)
  • The Hour after Birth...and Beyond (what we can choose to do to make this important time positive, too)
  • Oxytocin
  • Improving Birth (what needs to change about birth and what can we do about it?)

The Positive Birth Movement has grown far beyond my first imaginings.

If I’m honest, the organisation is entirely built on good will, passion, and trust – which I sometime worry might be its weakness as well as its strength! We don’t have much formal structure underpinning all this fantastic positive energy – and this is something I plan to work on over our second year – as this seems to be a way that we might grow stronger, and also gain funding.

However, I very much want us to keep the passion to change and improve childbirth at our core – this very ‘little idea’ of women talking to women. By coming together to ‘just talk’ – as women have done for millennia - challenging fears and sharing wisdom and positivity - I very much hope that we can ‘take back birth’.

I would really welcome all of your ideas and input – so please do get in touch with me if there is any way that you can help me or would like to be involved.

Thank you very much!


We are a grass roots movement, spreading positivity about childbirth via a global network of free Positive Birth groups, linked up by social media. We aim to challenge the current epidemic of negativity around childbirth by bringing women together to -

Meet Up, Link Up, and Shake Up Birth.

Since our ‘birth’ in October 2012, Positive Birth groups have spread to all corners of the globe. We now have over 100 groups in the UK, nearly 30 in the USA and Canada, and a further 20 in the rest of the world, including Australia, New Zealand, Turkey, Brazil, France, Germany, Malta and Qatar.

Our core beliefs: 

The Positive Birth Movement believes that every woman deserves a positive birth. 

By positive birth we mean a birth in which a woman feels she has freedom of choice, access to accurate information, and that she is in control, powerful and respected. A birth that she approaches, perhaps with some trepidation, but without fear or dread, and that she then goes on to enjoy, and later remember with warmth and pride.

A positive birth does not have to be ‘natural’ or ‘drug free’ – it simply has to be informed from a place of positivity as opposed to fear. The Positive Birth Movement is woman-centred and as such respects a woman’s human right to choose where and how she has her baby.

You can birth with positivity in hospital or at home, with or without medical intervention. You can have a positive caesarean, or a positive home water birth. Positive Birth is about approaching birth realistically, having genuine choice, and feeling empowered by your experience.

The Positive Birth Movement believes that communication is the key to shaking up birth. By coming together, in real life and online, and sharing experiences, feelings, knowledge and wisdom, women can take back childbirth.

What we are and what we do:

All of our groups are completely free to attend, and most run at least once a month. They are mostly facilitated by doulas, midwives, and birth workers, and some are led by women who are ‘just’ passionate about positive birth. They are mainly aimed at pregnant women, but are open to anyone who would like to either gain or share some information and wisdom about birth.

Our groups are not ‘antenatal classes’ – nobody present is an ‘expert’ or ‘teacher’. They are discussion groups, a place where everyone is equal and where all views and approaches are valid. Each month the Positive Birth Movement sets a discussion topic, which the groups are free to use as a starting point for their meetings. Groups can then feed back thoughts or issues that arise to the main Positive Birth Movement facebook page, which also takes that discussion topic as its monthly theme. Past discussion topics have included:

  • Planning a Positive Birth (thoughts, feelings and experiences of ‘birth planning’ 
  • What is a Positive Birth? 
  • Choices in Birth (the many and various choices pregnant women face) 
  • The Language of Birth (the language we use about birth and why this matters) 
  • Images of Birth (what images we have seen of birth in our lives and how these have affected our expectations and experiences) 
  • Place of Birth (how can we have a positive birth in the various locations, what our options are etc) 
  • The Hour after Birth...and Beyond (what we can choose to do to make this important time positive, too) 
  • Oxytocin 
  • Improving Birth (what needs to change about birth and what can we do about it?) 

Positive Birth Groups aim to be a helpful part of pregnancy; a warm and welcoming place for women to hear stories and ideas, to consider what they really want from their childbirth experience, and to challenge any fears or negative expectations they might have.

We believe that if women are empowered to approach birth differently, birth will be different.

How I got to thinking about Positive Birth… 
As a creative arts psychotherapist, trainee doula, writer and blogger about birth, and most importantly, mum – a few things slowly collided for me, and led to the setting up of the Positive Birth Movement in October 2012. Not only do I sometimes feel angry when I hear a ‘typical’ UK birth story, I also feel that the importance of the experience of birth is often completely underestimated – for the mother, and of course for the baby too, and the family unit which is just beginning.

In western society, there is evidence of disordered and disrupted attachment everywhere – and I saw a lot of this in my working life before motherhood - in drug and alcohol rehabs, with children in foster care, and with people experiencing all kinds of mental health issues.

In the search to heal this, or even prevent it, we often look to parenting, and to the way that the parents were parented. However, birth itself is often completely ignored.

Experiencing a positive birth is not ‘just’ a ‘feminist issue’, or even ‘just’ a ‘human rights issue’ – it is an issue for all humanity. Birth as a gentle experience, in which all concerned are treated with dignity and respect, maximises the chances of a great start to the mother infant bond, and a confident beginning to parenting. The power of this cannot be underestimated!

Gentler and more positive births could lead to stronger attachments, to better mental health, to better relationships – both personal and societal. To gentler and more positive people – and a gentler and more positive world.

So – looking at the current situation for birthing women in the UK, I felt that change was needed, but felt pretty overwhelmed at the prospect of trying to change ‘the system’. I wondered if, instead of focusing on the system and what was ‘wrong’ with it, we could instead change the way that women entered the system.

In psychotherapy, you learn that you can’t change the way other people behave, and that you can only change yourself. However, if you change yourself, other people are usually forced to change to accommodate the ‘new you’. For example, a bully can’t be a bully without a victim.

So my hope is that by becoming more empowered, informed and knowing their rights, women will enter the system differently, and that the system will be forced to change to accommodate them.

The birth of a Movement…!

At first, I was thinking about these ideas on a small scale. I had the idea of setting up my own birth discussion group, in which people could share ideas and information. Once I had begun to set this up, I wondered – if a birth enthusiast like me is willing to do this once a month for free, maybe others out there would be willing to do the same. Very quickly, I had the idea of a ‘Positive Birth Movement’, the plus sign logo popped into my head, and I set up a facebook page and blogged about it, never anticipating the scale of the response! Perhaps if I had known how big it was going to get, I might have thought more carefully about starting it in the first place!

The response was immediate, and I began to be flooded with emails from people who wished to set up a group. The Facebook page was also popular, and in a year has gained over 3000 ‘likes’.

And with nearly 150 groups worldwide, clearly the idea has caught on!

It seems there are many many people who are equally passionate about changing childbirth for the better, and who are willing to give up their time for free to do so.

How it is run
Quite ‘loosely’, would be the short answer to that!

Because it was set up on the spur of the moment without much planning, the Positive Birth Movement has developed quite organically as it has gone along, and has evolved in its own way according to the input of all those involved.

I try to hold some cohesion by running a Facilitators group on Facebook and sending out monthly newsletters to all our groups. Everyone involved is ‘linked up’ by social media and often Facilitators will support and advise each other independently of me.

There is a lot of trust involved. Our ‘logo’ and ‘brand’ is out there in the world, and there is no heavy ‘vetting’ procedure for anyone who wishes to be involved. To some, this might seem risky, but it actually works wonderfully well. Our organisation is all about empowering women and giving them back their autonomy – and this requires trust and respect.

Everyone involved has a great enthusiasm for improving birth, and together we have created what feels like a very non-judgemental and positive space, which I very much hope is reflected in our groups.

As I have said, all of our groups are free, and Facilitators are careful not to use their real life or virtual groups for self promotion or money making activities. So far, the PBM has raised a small amount of money from holding screenings of Face of Birth, but otherwise, no money has changed hands.

Feedback from our Facilitators

Samantha Waldron – Positive Birth Hillingdon, London

When women come together to explore positively new ideas, stories and information, the room becomes fuelled with oxytocin and power. There truly is a feeling of love and connection between us all and we all go away feeling “high” on the possibilities that can be achieved.

Guinevere Webster – Positive Birth Oxford, UK 

We were really excited to add our existing home birth discussion group to the Positive Birth network. Although we felt it was important to keep the focus on home birth because there is no other local forum for this kind of support, being part of the PBM allows us to make it clearer that we are about positive birth wherever it takes place, and people don't have to be considering a home birth to come along or gain from the group.

Ann Charles - Positive Birth Central London 

We started in August 2013. I deliberately wanted a venue that wasn't traditionally 'mothery' and would attract people after work. I plumped for the Fifth View bar at the top of Waterstone's Piccadilly. It does nice food and mocktails, you can bring books up from the pregnancy section of the bookshop for discussion and is the sort of place people can drop in and out without feeling like they've entered a parallel universe of church halls, squash and biscuits. So far we've only had two meetings. The first one - only one person came. Second meeting - a different pregnant lady came. Both were planning a homebirth. The struggle at the moment is getting people to come.

Melissa Thomas – Positive Birth Derby, UK 

I think that the Positive Birth Movement Derby was the right place at the right time. In an area lacking any resources for supporting mums and pregnant women it is a refreshing and new outlook. The group really has gone from strength to strength slowly but surely. I truly believe it could become a great network, challenging the fear and outdated attitudes that still pervade most maternity services and practices.

Our biggest success has been gaining the interest of two academics from the University of Derby. Jenny Hallam and Chris Howard approached myself about developing a collaborative research project, investigating the birth experiences of women who use the Positive Birth Movement meetings. I view the study as being a genuine opportunity to open doors with the NHS, taking women’s experiences to the fore and getting policy makers and support services to really listen. Time will tell what the outcome may be but I’m thrilled to have been invited on board as a research assistant and thoroughly look forward to growing and nurturing the PBM Derby.

Mathilde Mazau – Positive Birth Glasgow

I co-facilitate Positive Birth Glasgow which my friend and I launched last November. We started our monthly meetings in January this year and our group has since gone from strength to strength. We have over 150 members of our facebook group including mothers, pregnant women, doulas, midwives, an obstetrician, a shiatsu practitioner, trainee midwives and other birth workers. The ‘real life’ group is a wonderful and safe space for women to share, listen and learn during this amazing time that is pregnancy and birth. The Positive Birth Movement as a whole is an amazing and much needed grass roots movement and we are very proud to be an active part of it.

Feedback from women who have attended our groups

Michelle Levy, Positive Birth Larchmont, New York 

I was thrilled to find a positive birth group near my home during my second pregnancy. Our hostess, Joyce Havinga in Larchmont, chose focus topics such as Postpartum Care, Addressing Fears, or The Role of Oxytocin. This helped steer the group but free conversation and questions were also welcome. Nothing beats a sense of sisterhood when you need it most. Sometimes we received literature. This group is invaluable because more free services need to be available to new mothers. We were all motivated by the good intention to give and receive support.

Sarah Dauncey, Positive Birth Portsmouth, UK

What I love about the Positive Birth Movement meetings is that they are about mums / parents / families empowering themselves and encouraging each other, the ‘professionals’ who support the group provide information but the emphasis is on each family taking the information and making their own decisions to have what makes a positive birth for them, no one tells anyone else what they should want or do.

Susan Last, Positive Birth Derby, UK

I became involved with the Positive Birth Movement primarily because, having had three amazing home water births myself, I wanted to spread the word about what might be possible for others. My birth stories are definitely an antidote to the horror stories so many women hear, even if my choices aren't for everyone! I'm also deeply committed to the sharing of accurate information and know that the research I do can be helpful for others, if only to point them down research paths of their own.

Kristina McGuinness, Positive Birth Glasgow 

It's amazing to have positive support and encouragement in an area often shrouded not only by negativity but also mystery. It has been an amazing support for me and helped me realise I'm not crazy for wanting a natural home birth.

Veronica Hunter, Positive Birth Larchmont, New York 

I recently had a wonderful home birth (VBAC after twin c-section two years ago) of a lovely 9lb 4oz baby girl at exactly 41 weeks. Had I not attended the birth group I would probably have stayed with the Ob I saw up until 30 weeks who would probably not have permitted VBAC of a 9lb 41 week baby. Not having another c-section was very important to me because I truly believe the c-section I had previously got my twins and I off to a difficult start. The ease of breastfeeding this baby girl and her calm nature (perhaps in part due to her smooth entry into the world) have been wonderful and very different from the twins. So many thanks for making me aware of the choices out there and the beautiful way nature designed the process to work.

Nicola Zoumidou, Positive Birth Glasgow

Fantastically supportive group of amazing women. I came away from the Glasgow meeting feeling empowered.

The Positive Birth Movement - Where Next? 

Over the next year I would very much like to strengthen and further promote the Positive Birth Movement, whilst maintaining the integrity and spirit which seems to be so appreciated by all involved.

I have taken some advice on gaining charitable status and hope to look into this further in 2014.

Our main aim for the coming year is to increase awareness of our groups among pregnant women – this is a free resource and although some groups are over-subscribed, there are others which are struggling to fill places. I would love any offers of help to connect pregnant women and the midwives who work with them to our groups.

Funding would certainly help us to raise our profile, too, with good quality printed material and a better website at the top of our wish list.

However, even without financial help, I feel sure that the Positive Birth Movement will continue to grow and spread, simply because there are so many women out there who are so passionate about improving birth that they are willing to run our groups at their own expense. Whatsmore, there seems to a be a growing sense among ‘mothers-to-be’ that the current ‘average’ birth experience, is not really good enough, and a desire amongst them to explore their options and choices. The Positive Birth Movement meets this need perfectly.

Dignity in Childbirth – Respect, Autonomy, Choice

We very much hope to contribute to dignity in childbirth, by encouraging women to become informed decision makers in their birth experience, by spreading more awareness of birth choices, and by encouraging both self-respect and the demand for respectful treatment from all pregnant and birthing women, and all those who work with them.

Monday, 3 June 2013

"Positive, Empowering Birth? Sounds Like Bullsh*t To Me!"

I once read somewhere that the goal of psychotherapy is to reveal the secrets we are keeping, even from ourselves. We all do this. We all keep a few bits of reality out of sight, sometimes because they are painful, but more often, perhaps, simply because to acknowledge them would be a difficult admission of a lifetime of misguided beliefs, misdirected energy, and mistakes.

We see this a lot with the birth issue. Sometimes it's as if simply talking about birth in a positive way is too much for people to tolerate. The cultural attitude that birth is dangerous and downright unpleasant has become so engrained that many people seem to no longer see it as an attitude at all - they see it as a solid FACT. To challenge this would involve accessing ways of thinking that, whilst they may exist, are completely beyond everyday awareness, like rooms in a mansion that have been put under dust sheets and long forgotten.

In the media, journalists with the power and influence for positive change often reveal their own beliefs about birth, beliefs so deeply held they can only be perceived, by the holder, as facts. In this recent article in the Guardian, for example, the interviewer met Caroline Flint, one of the UK's most highly regarded midwives. Flint was clearly overflowing with wisdom and wonderful positive messages about birth, so much so that the interviewer herself was, "almost swayed" - almost. Ultimately, for reasons the interviewer probably keeps secret, even from herself, she felt compelled to dismiss Flint's ideas - with all their power to be transformative for women - as 'transcendental gubbins', accusing her of 'piling guilt onto mothers', and wheeling out an Obstetrician to remind us yet again not to pin our hopes too high when it comes to labour, because, after all, yup, you guessed it, all that matters is a healthy baby.

You don't have to look very far to find similar examples of the media pouring scorn on the notion that birth can be pleasant, delightful, or even orgasmic. In fact, it's much harder to find an article that doesn't. Even articles that are about women who do actually manage to have positive births seem to carry the addendum, 'Birth is not like this for most women. For most women it is painful and frightening. We just thought you might be entertained for a moment by this lunatic fringe who think otherwise.'

Sometimes in life we start with the evidence and build up our beliefs, other times we start with our beliefs and make damn sure we find some evidence. Nothing illustrates this better than a story told to me in my first pregnancy by a midwife friend, which I'm pretty sure taught me more about birth than a lot of the books I have subsequently read:

A field mouse is snuggled in a little nest of hay, quietly beginning to give birth to her litter of babies. Some walkers pass by, see the mouse, and feel worried. What should they do? Knowing there is a vet nearby, they scoop up the mouse, and gently take her to the vets surgery. The vet assures them there is no need to panic, puts the mouse on the examination table, and shines bright lights on her. The mouse is frightened, and her labour stops. The vet tries to restart it with drugs, to no avail, and eventually performs a caesarean. The mother and all of her mouse babies survive. "Well", say the people who found her in her field nest, "Thank goodness we were passing by and saw the mouse in time, otherwise, who knows what might have happened?"

In the stories we hear, and the events that take place in our lives, we often see what we most want to see, and filter out or dismiss the stuff that doesn't conform to our belief system or world view. When we apply this to birth, it means that often the stories of women who relish and enjoy it do not sit comfortably with us, and that we prefer and even find more reassuring the stories of horror and trauma, which reinforce the attitudes we have come to believe are facts.

There may be many reasons for this collective denial, which often keeps women a prisoner of their own self-fulfilling prophecy, believing that birth cannot be positive let alone 'transcendental', and therefore not even trying to make it so. For some women, perhaps, having had their own babies in unpleasant circumstances, it's too painful to admit that things could have been different. Maybe this is what is meant when, as it often is, the notion of 'piling on guilt' is raised.

To move forwards, perhaps this pain needs to be acknowledged; a few generations of women who have missed their chance for an empowering experience and instead had a birth they would rather forget. Maybe they need a collective apology, for the shaving, the cutting, the stirrups, the steel, the brutal experiences they suffered, and continue to suffer, in the name of progress? Perhaps this would be a way of pulling off the dust sheets in the long forgotten room, of laying bare the secrets we are collectively keeping from ourselves - and of clearing the way for women to make a new start and have the positive births they deserve.

Tuesday, 21 May 2013

The Blood and The Beauty: Placenta Prints

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

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

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

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

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

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

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

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

Everything leaves its mark.

Wednesday, 8 May 2013

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Wednesday, 24 April 2013

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It seems extraordinary that the plight of Independent Midwives is being ignored by the government - effectively they seem willing to stand by and watch them disappear, in spite of their offering a standard of midwifery which currently meets the Governments own targets, as set out in documents like Maternity Matters, for example:
  • choice in maternity care 
  • continuity of care 
  • increased home birth rates 
  • increased normal birth rates
  • increased breastfeeding rates
  • increased satisfaction 
And they say money talks, especially when you are trying to get a politician's attention, so how's this: Independent Midwives care for approximately 3000 women a year, an estimated saving of £12 million for the NHS. This figure could increase as thousands more midwives would work self-employed if insurance was available. At a time of a rising birth rate of 22% and a deficit of 5000 midwives, the Government are ignoring part of the solution to the plight of childbearing women and the national midwifery shortage.

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

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

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

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

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

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

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

Thank you.

To Dan Poulter, Health Minister 

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

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

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

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

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

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

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

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

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

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

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

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

Jacqui Tomkins (Chair IMUK)

How Men Can Play Their Part in the Birth Revolution

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

Read the full article here.

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

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

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

Wednesday, 10 April 2013

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

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

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

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

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

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

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

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

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

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

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