#66

Laurie from FiLiA in conversation with the Greater Manchester Doulas: birthing during Covid-19

Laurie: So we are Greater Manchester Doulas. We are a women-centred organisation who support women primarily during pregnancy and birth. And we're going to have a chat about Covid-19 and how it is having a huge and damaging impact on women, especially birthing women right now. Some introductions. I'm Lauren, I've been a doula for the last four years I'm working as part of this organisation since it started with Ellie.

Ellie: I'm Ellie, I've been a doula for eight years. 

Amy: I'm Amy, I've been a doula for two and a half years, maybe three. I was initially working alone. And in the last year I joined forces with Ellie and Lauren with Greater Manchester Doulas and now I am working with them and it’s ace.

Laurie: So in the last few weeks, but even more so in the last couple, there have been huge changes for women and the maternity care that they've been receiving. We're seeing huge breaches of women's human rights when it comes to birth. So maybe let's start with what the problem is, what's been happening?

Amy: The changes are so widespread and different over the UK, but I'm sure in the world as well. At the moment we're hearing that birth partners are being limited to one and it's only during active labour. They can't stay afterwards. They can't come to scans. Some hospitals are saying no to video calls for strange reasons. Home birth services are being cancelled across the country. I mean, the information that women are getting is very varied. Obviously it's a changing situation, but it's not very clear and it's quite difficult to navigate. 

A lot of the basic human rights that women have during pregnancy and birth, place of birth, who they want to be with them are just being completely ignored, and with the excuse of Covid-19.

Ellie: And you were saying earlier about how it's all in the name of risk aversion and lowering the risk, but actually the way that it's being applied doesn't actually put anybody at lower risk and also who gets to define that risk as well. I mean there's a physical risk to getting the virus, but there's an emotional risk as well. Our mental health is important, so important. As important as physical health. 

Laurie: Yeah, I think a lot of the advice that women are getting, or what they're being told they can and can't do by medical professionals is with a focus on their physical safety and the physical safety of others. But as you said, our emotional safety is just as, if not more important.

The women who are having their choices taken away from them are at risk, huge risk of trauma and longer term mental health issues. Which have a long-term damaging impact that goes far into the future and doesn't just impact them, but also future generations.

Before all of this, depression, anxiety, suicide is so common among new mothers and in the first year after a baby is born and adding this on top, increasing the chance that they're going to have a necessary intervention that causes birth trauma is not to be downplayed.

Amy: And it's like who's deciding the risks and how are they working it out? Because hospitals at one end of the country are encouraging women to come to hospital even though everyone else in the country is being told not to. They're cancelling home birth services, so encouraging healthy women to come into hospital despite the risk to the woman and despite the fact that she may not want to do that.

And then at the other end of the country, the risk is they're coming into the hospital. So they've said anyone who can and wants to, should birth at home. So who's deciding the risk? And they're not factoring in the risks of interfering with birth, like you were saying, Laurie, that's so important.

Ellie: Maybe a quick word on mammalian birth and why this is so important because humans are obviously mammals and all mammals need the same thing for birth to go smoothly, which is a sense of privacy and a sense of safeness and a sense of being warm. Anybody who's had a pet cat and they've given birth in a cupboard under the bed will know that anybody who's a zookeeper will know that the second female starts showing signs of labour you leave well alone. 

It's an intricate cocktail of hormones that are responsible for the birth process. And to disrupt it is when things get unpredictable and dangerous. So we are already expecting women to come into a hospital where none of those needs are easily if at all are met.

There are bright lights, there are unfamiliar sounds and smells. There are strangers. Often women are forced onto their backs like a stranded beetle with their most vulnerable parts open and on display.

So already it's difficult for women to birth in hospital and it is a valid choice not to do that at the best of times.

 Many of the women who work with us and who contact us have been traumatised by their previous birth. When I say that, I mean traumatised by the so-called care that they received, not from the visible processes of their own body and going through childbirth.

How they were not listened to, not respected, how their dignity was removed, how their options were removed. They've been lied to, manipulated, coerced, and bullied so much of the time. And we see that, especially in Manchester where we are, that treatment is rife and these women are not wanting to go into hospital. They don't want a repeat of that. They don't want to be in the same building. They don't want to see any of that staff. They want to completely change their environment and to be able to control it more. And these are the women who've been told you can't give birth at home now and you can't have anybody for support.

So you might have built up a relationship with your doula for months and she might know your previous birth intimately. She might know certain triggers and how certain things make you feel. She might have learned all of the things that make you comfortable. She might have learned how to help you if your panic starts to rise, she might know your partner really, really well and know that at night they get really grumpy or really hungry. There's that relationship there. 

And the hospital is now saying, at best, you have to choose now between your partner and your doula, and that's so much to put on a partner to remember the hypno-birthing techniques, or remember all the comfort techniques and the breathing that the woman might want to do, to advocate for her to keep people at arm's length if that's what the woman wants to. To make sure that everybody reads the birth plan, to make sure that everyone is fed and not thirsty and also to enjoy it. I mean, it's so much to put on one person anyway, even without all of this.

And one of the things that has upset me most recently is that the woman does get to choose who's at her birth, and most hospitals have always said two people to support people. And now we're seeing this reassuring advice that says, it's okay. You're still allowed one birth partner in this hospital. And it's just like, no, that's not good enough. 

Laurie: In some areas women are being told they can't have a birth partner at all, even in their own homes. We know that a woman's birth partners, especially doulas or if she has chosen to have an independent midwife are not just nice to have extras. They're a crucial member of her care team, of the multidisciplinary team that are caring for her. 

As far as I know, the Royal College of Obstetricians and Gynaecology, all of their recommendations say that women have a right to have this support. And actually it's important, but that advice isn't trickling down to the actual maternity units as you said with the excuse that it's to keep the people safe. It's to keep midwives safe and the women and the babies, but actually it's not really keeping women safe at all. 

When we're talking about home births. A woman has human rights.

Often I think one of the arguments that I've seen for not supporting home birth is that it takes two midwives out of the system, away from the wards, just for that one woman and her baby. but I read that there's no NMC requirement for two midwives to attend a home birth, that actually it's okay for it to just be one.

So there are ways that maternity units can shift the way that they're working in order to best meet women's needs, but they're not doing it and that I think, is something that we all need to shout about because it's women that are going to suffer the most at the end of this. 

Ellie: What effect is it having on the community firstly, the uncertainty and secondly, the restrictions?

How is it affecting women and their plans and families in our community? 

Laurie: I think it's become really divisive among women. On one hand you have women saying we should just do as we're told, we should just fall in line. It's for the greater good, women are policing other women. I've seen so many posts online of women telling other women that they're selfish, that they don't care about their community because they want to have a positive birth experience because they don't want to be traumatised and then on the other hand we've seen women who are stepping back and realising, actually, I don't need the system, I'm a woman and I've grown this baby by myself and I can birth this baby by myself, or certainly not necessarily by myself, but without being part of this industrial model. 

So I think in that sense it's been amazing to see real grassroots support from woman to woman, passing on of wisdom and information so that women aren't relying on what is a huge patriarchal system of power.

Ellie: So in general terms, it's making women who would never consider giving birth without medical professionals. It's giving those women pause and making them consider other options. So women who will plan to go to hospital are now going, why go to hospital? That's where the sick people are. I'm just going to stay home and if they can't provide a midwife, then I'll just go and sit on the toilet and have my baby.

 So that's a positive if women are finding their power that way. But then there's also women who are doing that who don't feel they have any other options. And we don't advocate for any kind of birth over another. What we advocate for is women's choice, and we don't want women to feel forced into giving birth in a way that they don't want to. Whether that's giving birth at home without medical assistance when they don't want to, or being forced into a caesarean section that they don't want to do. 

And lots of women, again, who are planning home births, are now planning to go to hospital to have either an induction or a caesarean, because that they feel it would be the least traumatic thing for them.

Whereas making a choice out of necessity like that leads to feelings of powerlessness, which is the very foundation of trauma. 

So I think we're going to see a huge spike in postnatal depression and birth trauma and other postnatal complications after this more than we've possibly ever seen before. 

Laurie: I think when everybody is operating under really high levels of stress, both women and maternity services, what we're seeing is a lot more non-evidence based care, fear-based clinical decisions that aren't based on a medical need or from any level of medical evidence, but just a place of fear and that's going to result in much higher levels of depression among new mums and pregnant women. Much, much higher levels of trauma, which are already shockingly high because women expect to be able to go into maternity services and to ask for care and believe that everybody who they come into contact with has the best intentions for them and is only going to make suggestions that are in their best interest. But that isn't what we see happen when there isn't a global pandemic going on and I think what we're going to see is that women become even less of a priority. 

Amy: I think as an example of that, like non-evidence based practice, just from fear is that some hospitals said, you know, yeah, of course you can FaceTime during a scan or during the birth and some hospitals have said, no. There's no risk of infection via FaceTime. That is the system making decisions for themselves, not for women.

Laurie: Yeah. Making an argument that, oh, it might interfere with equipment when there is no evidence to suggest that it would. 

In many ways it's deliberate, so it's an opportunity for The industrial model of birth for that system to take advantage of the fact that women don't have as much access to support and that they can use this power that they now have to strip women of the support that they have. Because a woman who has her doula with her, has her independent midwife, has her birth partner that she's chosen is much less likely to fall in line and to be a good girl and to do what she's told, she's much more likely to be an advocate for herself or to have those around her being that advocate that she needs.

I guess that's why we're doing what we're doing. 

Ellie: Yeah, I mean, that's what we do as doulas. The support that we offer is emotional, practical, and it's informational, and we get to know that woman really, really well, and over the weeks or months or sometimes just days that we have to get to know her. It's about preparing her for that so that we're advocating with her rather than for her, so that she knows what all of her options are and that she's making informed decisions, and that she is actively choosing as much as she can about her birth so that she can look back on it with warmth and pride. And so that bond between her and her baby is absolutely solid. 

That first hour after birth, the amount of hormones and the play between them that happens. I mean, it, it will never be repeated in the rest of that woman's life and in fact, never in the life of that baby either the mother and baby are primed to fall in love with one another. And it's, it's said that your reserves of oxytocin, the hormone of love is set for the rest of that baby's life is that first hour of interaction with the mother. It's not something that you can just put to one side and think, I'll work on this later. Yeah, you can in lots and lots of ways, but actually priming the brain to give and receive love for the rest of the life. I mean, that's huge. That's not something that you can mess with, not without having a huge long-term. negative 

And for all the, the women who are policing all the women and for all of the healthcare professionals that are just trying to get through this crisis, it's so short-sighted to go ‘Birth is just one day in a woman's life’. It's so much more than that.

Laurie: Absolutely. And I think if you are a professional working in maternity services, whether you're a doula or a midwife or an obstetrician, if you are not standing for a woman's reproductive freedom, you are not standing for women. You are not offering women-centred care, and that means that a woman needs to have all of those options available to her, and she needs to know what those options are.

So what are we doing? Making sure that women know about their options. That, that those haven't changed and how you go about accessing all of those options is different now and I think you said earlier that unfortunately it's probably going to come down to which woman shouts the loudest, they're the women that are going to get what they want and deserve.

So, we need women to shout for themselves, but to shout for other women and to demand better care because I agree that the NHS and certainly maternity services are stretched beyond belief, but they have access to, if they want to, to resources that can help them meet the needs of women.

So, for example, making use of the huge numbers of independent midwives that are out there who want and are willing to serve women in that role but it's up to Trusts to take that on and to make that happen.

Amy: Absolutely. Can you imagine the pressure that would be taken off the maternity service in general not just right now, if midwives would support free birth and give the information that women want for free birth? Can you imagine how much pressure that would take off?

Laurie: Absolutely. Because birth is not a medical event. It is biological, it's a biological function. As far as what happens in our bodies, we're made to do this.

It's when we start messing with it that birth goes wrong. And actually there are very, very few situations where birth becomes a true medical emergency. So for all those women for whom birth can happen in a normal, straightforward way. If that was taken out of the hospital and that was in the home where the woman could feel safe and supported, it would save the pressure on obstetric units for true obstetric emergencies for women who really do need that lifesaving medical intervention when they're having the babies.

But that isn't unfortunately going to happen unless women demand that that's what they need and that that's what they're going to do, so that they want to stay at home or they want to be in low risk units, birth centres, midwife led units, and demanding that care.

So for any woman who does want that, who wants support to figure out how they get woman-centred care in a Patriarchal system, we are obviously happy to talk to any woman. 

We're going to be putting together some template letters for anybody who's been told that they can't have a birth partner, but they can only have one birth partner, that they are suddenly finding that where they wanted to have their baby is no longer an option being presented to them, so that women can put that out there and say, this is what I need. 

Ellie: Yeah, you can contact us through Facebook. Just look for Greater Manchester Doulas CIC. 

We've obviously got our website. You're very welcome to message us for support. We are doing a lot of Zoom chats at the moment, and, and we'll continue to do that. No matter what the guidance might be we're always going to advocate for women's choice. That's not going to change. 

And for every woman who is policing another woman's opinions or choices or decisions, there are so many other women who are absolutely championing women's choices and will absolutely be behind you and say, yeah, it's absolutely right that you are still choosing what's best for you and what feels safest. This is what I did. I came up against this and this is how I got through it. And it's just about surrounding yourself with the people who will have your back. And we are a part of that. And we are going to be here all the way through this pandemic. And we're going to still be here after, and our focus is not going to change from informing women of their choices and their rights, providing accessible and holistic education and connecting women with one another and building that sisterhood. 

I think this pandemic has got the potential to revolutionise maternity care, but it's going to take women realising their power and that's brilliant. That's exactly what we want. 

It's our birth-right to give birth in power and to be able to draw on that for the rest of our lives when we're parenting, when we go: ‘wow, I can't believe that I did that’ and we want women to come out of birth and go: ‘I want to do that again’ Like when you get off a rollercoaster, like that's what we want. That is what's possible. 

Hormonally, giving birth, uses all of the same processes as having an orgasm and there's actually no physiological reason why you can't orgasm from having a baby. That's how it's supposed to be. It's supposed to feel amazing. And that's been taken from us and turned into some kind of weird, crazy myth. But it's real. It's really, really real. And the women that we've supported have that experience, they are changed women. It's transformational.

And that's why we do what we do, because we know full well what it does to a woman to have that transformational experience. That woman responds to her baby differently. She responds to her partner differently. She responds to society differently because she's a woman running under her own power and the way that she views herself is different.

The changes that I've witnessed in a woman after having a, a powerful birth experience and the positive changes to her self-esteem, to her self-worth and how she sees her importance and her role in the world, and then that extends to other women as well. I mean, that's how you build sisterhood and solidarity. 

Laure: So we are Greater Manchester Doulas. We are Women's Centred and if you would like our support, if you would like to work with us, if you want to just chat more about what we're doing and what's going on in the maternity services for women right now, you can contact us through our website.

Go to greatermanchesterdoulas.com