The Irish Maternity System - Birth Trauma (Joe Duffy stories)

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DoulaCare Ireland have (like many others in Ireland) been listening to the stories that have been shared by families in Ireland on the Joe Duffy show over the last week. They have made very emotional listening at times. Unfortunately as doulas and childbirth educators we have been privy to similar stories over the years from women who have reached out to us, looking for someone to talk to. To know that women finally have a public platform to share their stories and to truly be heard is one of the positives to come out of the show. 



At DoulaCare Ireland we support clients nationwide, and of course some will have had past birth trauma. These women and their families often feel they cannot speak about their experiences or they will be treated badly on subsequent pregnancies. Those who do speak out often feel they are brushed aside or their trauma is belittled by hospital staff. 

woman calling about birth trauma


There is very little support within our maternity service for those who have had challenging birth experiences and need someone to talk to. Many of these women often apologise for feeling upset about their experience. After all, they have a healthy baby. Shouldn’t they be OK with how things went? Everyone else seems to think they should be grateful that all is well with baby and move on. But just because you are thrilled to have a healthy baby doesn’t mean you don’t get to grieve for the birth you had hoped to have. It is OK to be upset at how you were treated during your pregnancy and labour. It is such a vulnerable time in a woman’s life and while we may be nervous about the unknown, most of us don’t think that this will be compounded by being spoken to harshly or mistreated by the people we are supposed to trust. 


At DoulaCare Ireland we work closely with other supportive organisations and refer our clients to available services. 



If you have an experience (negative or positive) within the HSE care you can leave your feedback on their site called Your Service Your Say. This information does get reviewed and will be brought to the person in question. 

https://www2.hse.ie/services/your-service-your-say/your-service-your-say.html




We feel it is important to highlight the fantastic work that AIMS Ireland have done since 2007. They are campaigners for safe and respectful maternity care for the women of Ireland and they work tirelessly on a voluntary basis to do so. If you need advice or supports please do contact them on www.aimsireland.ie




We are also proud partners with Nurture Health, who are a national counselling service. They specialise in the care of women and their families during pregnancy and the postnatal period. They have counsellors nationwide who offer space and time to women who have traumatic experiences or have postpartum mood disorders. Irene, the CEO, always ensures their clients are seen quickly and matches them with the best counsellor for their needs www.nurturehealth.ie (and some of your hours may be covered by health insurance - Irish Life Health for example, offer hours with Nurture Health through their Parenting Path packages for new families.)



Some women find it helpful to get their notes from the hospital. They can be requested by writing into the Freedom of Information Officer in the hospital attended, with Name, Date of Birth and any other relevant details. The applicant must mention that they are requesting their notes under the Freedom Of Information Act in order to receive them free of charge. They will write back  with a standard letter saying they will give a response within 28 days, before sending on the notes on. If desired and the Mum feels able to do so they can then request to meet with the Head of Midwifery or with your Obstetrician to have a review of your notes (AIMS Ireland also offer this option). 



Many of the stories shared over the last week have mentioned women being alone and frightened or not understanding what was happening. With DoulaCare Ireland these situations never arise. With our agency model, each client has their chosen doula but also a back up doula. They also have the support of our full team of 35 doulas - all fully Garda Vetted. This means no matter how long a labour and birth lasts (4 day induction for example) our clients will have constant support from a known doula. They also have the knowledge and experience of 35 doulas to tap into at any point. We have women with diverse backgrounds in our team, from women health physiotherapist, midwives, nurses, yoga instructors, antenatal educators and much more. While our role is not to speak for you during labour we are there to help facilitate conversations between client and their health care provider, encouraging the Mum to ask questions if it looks like there is a lack of understanding on their part. 




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Doula support is scientifically proven to reduce traumatic experiences and postnatal mood disorders. A Cochrane Review 2017 showed:


Women who had doula support were:

  • more likely to have spontaneous birth

  • more likely to have shorter labour

  • less likely to use pain medication

  • less likely to have Caesarean birth

  • baby less likely to have low Agpars

  • Lower levels of Postpartum Mood Disorders


Women who had doula support had:

  • 31% decrease in use of Pitocin

  • 28% decrease in Caesarean

  • 12% increase in Spontaneous Vaginal Delivery

  • 9% decrease in use of pain relief med.

  • 14% decrease in baby going to SCBU

  • 34% decrease in risk of being dissatisfied after birth




We welcome the discussions on Joe Duffy show and thank the team in RTE for opening up the space for these women to share their story and finally be heard. It is shocking how many women have experienced trauma and remain silent. We hope that women will be able to find their voice, to speak up for their rights and to get the support they deserve. We also hope that those working in the maternity system listen and work to implement change. It must be hard for anyone who works in this area who actively supports and cares for women in kind and compassionate ways to hear these stories, as this is not how they would ever treat anyone in labour themselves. However, the myriad of stories from all over the country show that there is a systemic approach to treating women that needs to be addressed and changed for things to improve. 

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Sharing these stories is the first big step. Well done to every single woman/partner/supporter who has spoken out. Your strength will be a part in driving change for all the women and their families who will be entering into the Irish maternity system. 


We are here to support all women and their families. Get in touch if you need compassionate care postnatally to help you recover from a traumatic experience, or if you are embarking on a subsequent pregnancy. Your voice will be heard.

info@doulacare.ie



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So Meghan Markle hired a Doula? What is that? Part 2

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So Meghan Markle has hired a doula and everyone is buzzing “what is a doula anyway?” Part 2.

There are two main types of doula. A Birth Doula and a Postpartum Doula. There are also Doulas who specialise in supporting families through loss and other niche areas

In this blog we will focus on Postpartum Doula support.

In times past (and indeed today in many cultures around the world) parents were not sent home from hospital with a new baby and expected to know what to do and manage on their own. We would have had the support of families, neighbours, friends - minding us, feeding us, helping us adjust to the changes in our lives and allowing the new Mum to rest and recover from birth and support her during the first few weeks of life with a small baby. Today we are often lacking this support and just expected to cope. People do call in to visit but don’t think to bring a cooked meal for the Mum, let her rest, load the dishwasher or ask how she is doing. The focus is often on the baby and the Mum is just expected to get on with it. However, we are not hardwired to manage in this way. We need the support of others in those first few weeks and months and in lieu of support from our community the postpartum doula can step in and offer this support.

A Postpartum Doula begins work with their client as soon as they book in. For some, this is during pregnancy (the forward planners!) and for others this is after baby is born. If it is during pregnancy, your doula will help you to prepare for your new arrival and the huge shift your life will take. If it is after birth, your doula will slot right in to your new routine (even if you don’t think there is any form of routine) As with Birth Doula support, your Postpartum Doula comes with many layers of support. We help you to debrief and process your birth experience. We nurture you while you recover from birth and find your new normal. We help your older children adjust to having a new dynamic in the family. We support your partner, adjusting to their new role and debriefing their own experiences. We offer knowledge, encouragement, information and support every step of the way - as each new day brings new challenges. Above all, we help you to savour the good moments between the chaos :)

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Knowledge: Doulas are information junkies. We love reading, attending study days and growing our knowledge base. In DoulaCare Ireland all our Doulas must attend at least three CPD days per year. - which ensures the building of knowledge as evidence changes and new research is undertaken. We also learn from every interaction, with each individual client. We bring that knowledge base to you when you come home with your new baby. No matter what comes up, with your recovery after birth or your babies needs - chances are we have seen it before (or we know who to call if not).

Encouragement: Anyone who has had a baby, knows that surreal feeling of being left in charge of this new tiny human. Many parents feel “they are not seriously letting me home alone with this baby? I don’t even know how to bath him or tell if he is hungry” Don’t fear. It is normal to feel that way. The truth is no parent has the answers. Babies don’t come out with an instruction manual. We all learn on the job! The great thing is, with your Postpartum Doula by your side - you have a calm presence helping you every step of the way. So nothing feels overwhelming. You and your baby learn together, with a helping hand from your Doula.

Information: To new parents this is invaluable. The number one question we get asked… “Is this normal?” Rest assured, your Doula will have all the latest evidence and research at hand to help you make informed decisions when the fog of parenting clouds your brain. It can be hard to process information when you are recovering from birth and haven’t slept more than an hour in 2 weeks. Your Doula will give you the information you need in bite sized chunks so you can fully process it as required. She would also be delighted to tuck you up in bed, with clean sheets, after a hot shower and home cooked meal - and after a nice nap it is easier to think more clearly and have perspective on the changes in your life!

Hands-on tips and tricks: A Postpartum Doula passes on all the parenting tips and tricks they have picked up through their training and working experience. They help you to simplify your daily life. Sometimes it’s a gentle suggestion on where to keep the changing table, that you hadn’t thought of (like having a second one in that corner downstairs to save you running up and down the stairs 20 times a day) Sometimes it is demonstrating different methods of helping baby to get wind up - which can be a tricky skill to master.

Partners: Partners are often Doulas biggest champions! We help them to feel involved every step of the way. In parenting, it can be helping them to figure out how to put a baby grow on baby (which way is up? Are these the arms? We all know how hard it can be to get a new baby dressed!) It can be explaining the hormonal rollercoaster women ride after giving birth and to expect highs and lows. It can be a listening ear for them to debrief or to gush about their beautiful new son or daughter. Sometimes it is offering gentle suggestions to help them adjust to their new role and see what part they can play in supporting their partner and adjusting to their own new role.

With DoulaCare Ireland you have a full team of support. Each client is matched with the perfect doula for their needs. In the bigger contracts (100+ hours) you will usually have two doulas offering support. You have the opportunity to meet both beforehand. Both doulas will know your parenting style and wishes. This means that if for any reason your doula needs to change your scheduled hours you have the option of your second doula covering so you are never alone! Our co-owners Jen and Mary are always on hand too. We offer phone and email support to our clients and our doulas so no question is ever left unanswered.

We know from neuroscience that our brains are not hardwired to manage on our own in those first few weeks of adjusting to life with a new baby. All so often when we arrive at a new Mums house, they disclose that they feel they are doing something wrong as they struggle to cope. So few of us talk about how hard it is, that many are left feeling not good enough. The postpartum doula steps in to fill the gap. We are there to build confidence and make those first few weeks a positive memory for years to come - in other words to help a family thrive and not just survive the early days of parenting


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Meghan Markle has hired a doula, what is that? Part 1

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So Meghan Markle has hired a doula and everyone is buzzing “what is a doula anyway?” Part 1.

There are two main types of doula. A Birth Doula and a Postpartum Doula. There are also Doulas who specialise in supporting families through loss and other niche areas


In this blog we will focus on Birth Doula support. 


A Birth Doula begins work with their client during pregnancy. Supporting them throughout pregnancy, labour and birth. We don’t clock out at 8pm. We are there by our clients side every step of the way. Offering continuity of care throughout pregnancy, labour, birth and postpartum. We then visit our clients at home, offering support with all those early parenting questions.. We offer knowledge, encouragement, information and hands on tips and tricks of the trade. 


Knowledge: We help our clients to understand their chosen place of birth (most commonly a hospital) policies.We compare the different hospitals policies, statistics and what the National Clinical Guidelines say. We also chat about International Guidelines and help our clients to make informed decisions about their care. We also cover the physical process of labour and birth and common things that come up. We can assist our clients to create their birth preferences for their unique journey. After baby arrives we share all the latest evidence on infant care, recovery after birth and anything else you’re wondering about too!

doula pregnancy support




Encouragement: We build up our clients. A huge part of our role is to help our clients (the birthing mother and her partner) to feel confident. We are like their coach or cheerleader from the sidelines, reminding them of all the skills they have gained throughout their pregnancy and the strength they have within. This does not stop once baby arrives. We build you up again after birth and remind you of that strength and knowledge.


Information: Apart from the mentioned topics, doulas also answer any questions that happen to arise with each client. It may be they read an article online and wonder does that happen in Ireland? Or they are told they have a condition (such as gestational diabetes GD) and would like information to help them feel informed and confident on how best to manage it.



Hands on tips and tricks: Doulas are not afraid to get in there and help out. During pregnancy we show our clients different massages, counter pressure and comfort measure to help during labour. We teach these skills to the birth partner so they feel fully involved in the process. On the day of labour often doulas and partners work really well together - tagging in and out (counter pressure can be really tiring after a few hours!) This support continues on into parenting. From showing you how to change and dress a newborn (which is surprisingly tricky at first) to helping you find a comfortable position to feed in - your doula will be right there. 

doula birth support



Partners: Partners are often Doulas biggest champions! We help them to feel involved every step of the way. Partners often say things like “I didn’t know what to do to help my wife” or “I felt like a spare tool in a scary unknown setting” but with a Doula supporting them - they have a full tool kit to draw from. They also get encouragement and a helping hand along the way. After they become a Dad/Mam we are still there. Helping them to adjust to their new role and offering guidance on how best to support you.



With DoulaCare Ireland you have a full team of support. Each client is matched with two doulas. You have your primary doula and your back up doula. You have the opportunity to meet both. Both doulas will know your birth preferences and wishes. This means that if for any reason your doula needs to take a break (such as a long birth, where your doula may need to grab some sleep), you have the option of your back up doula joining you so you are never alone! Our co-owners Jen and Mary are always on hand too. We offer phone and email support to our clients and our doulas so no question is ever left unanswered.

In next weeks blog we will discuss Postpartum Doula support.

Until then… Doula Jen x

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VBAC Mothers are real!



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Hi I am here…a real life, breathing VBAC mum :) 

So many of our DoulaCare Ireland clients do not believe that VBAC’s actually happen in Ireland. Well as a doula I have supported them, as an antenatal educator I have taught parents about them and earlier this year I experienced a VBAC personally.

My beautiful baby daughter Kayla Rose (a bit of a social media celebrity now) arrived in a whirlwind on 25th March 2018. I had an intervention free VBAC, supported by my husband, doula and midwife (an obstetrician was there also but I have very vague memories of her as she was not my focus) 

As Kayla’s birthday starts to draw closer, I have started to write my birth story. I will upload it in two parts (its a long story even though the birth itself was fast) That will give you all a full run through of my VBAC.

Before labour began I was admitted to hospital at 38 weeks for polyhydraminos (too much amniotic fluid) and baby in an unstable lie. Kayla was lying diagonally across my tummy. This meant there was a high risk of cord prolapse if my waters released. So after weighing up all my options, the pros & cons I decided to stay in hospital. (see my pregnancy blogs and our social media posts during March 2018 for videos/updates etc) You can also look back through my weekly pregnancy blogs ;)

There was lots of talk about elective caesarean but I held firm that I would like to try for a VBAC. I was confident in my body’s ability to birth my baby. There was a lot of negotiation and I found being informed about my options really helped in these situations. I knew the benefits and risks and studies that were done around vaginal birth after caesarean and also repeat caesareans. I was never against caesarean. I knew it was one option and if that ended up being the case I was ok with it, once I was listened to. My main priority was always to have a safe birth BUT I also wanted to have a positive experience. I found having doula support a great advantage as I had someone that I could bounce my thoughts and feelings off, who was non-judgemental and impartial and made a great sounding board for me. They supported me as I mourned the birth I wanted (to labour at home before going into hospital), and help prepare me for my change in circumstances. The brain training techniques in the GentleBirth app also helped me keep my focus and stay calm as things changed for me.

During my pregnancy I did all I could to empower myself. I worked on my physical and mental health. Over the 9 months I worked on building a positive mindset. preparing my husband to be my advocate. I armed myself with great support, in the shape of my informed husband and my wonderful Doula. I took time for self care. I had regular reflexology, used aromatherapy, had shiatsu, realigned my pelvis with chiropractic treatments, listened to daily affirmations, GentleBirth tracks and had a vision board. I knew my VBAC wasn’t going to just land in my lap. I had to take ownership and prepare for it.

I stayed really positive and used my time on the antenatal ward to focus my mind and prepare my body. I went into spontaneous labour just as I was going to bed on the 24th of March. I did consent to having the CTG, even though I had originally felt I did not want it (more detail to come in my birth story) However I was clear that I chose my own position and moved with my body.

Kayla Rose entered the world at 4.17am, the night the clocks went forward. So my labour lasted less than 3 hours. She was 8lbs 2oz, at 38+6 gestation. 

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I escaped with only a small 1st degree tear and no abnormal blood loss. 

I did it!




Jen with baby kayla enjoying skin to skin,surrounded by love with (hubby paul taking the photo), midwife jo (rotunda) and doula mim.

Jen with baby kayla enjoying skin to skin,surrounded by love with (hubby paul taking the photo), midwife jo (rotunda) and doula mim.

It was such a high and I was so proud of myself. I haven’t really spoken about that high much. There was complications after, as Kayla was born with an undiagnosed cleft palate and Pierre Robin Sequence but that was not connected to our VBAC. My moment of euphoria only lasted a second before we realised something was wrong with our baby.

So after a bit of my story…. I experienced a VBAC in an Irish maternity hospital. Yes at times during my pregnancy I felt like there was a huge spotlight over my head. Yes I had to negotiate and be firm at times. Yes I had a wobble myself during labour, when I had a burning sensation across my scar but I did it. The evidence says many more woman can safely do it too. 

Preparing for a VBAC can definitely be a rollercoaster and support is crucial. Most people (including health care providers) just assumed I would be having a repeat Caesarean. I knew VBAC was safe, I was aware of the evidence and for me it was the option I hoped for.

There is a lot of misinformation out there about VBAC birth. You will hear care providers tell people that they can have a VBAC but only labour for so many hours as it is dangerous for the scar (not evidence based), or they cannot go over 40 weeks in case the scar ruptures (not evidence based), or because it has only been 2 years since their last baby their scar may be too weak (not evidence based)…you get the picture!!! So in order to have a successful VBAC you do need to prepare yourself. Below I have listed some of my top tips for anyone hoping for a VBAC.


What are my top tips?

Empower yourself with knowledge and the latest evidence.

Educate yourself and your partner so they are also aware and can advocate for you if needed.

Get yourself a Doula!

Take an independent childbirth class - a Cuidiu antenatal class or a GentleBirth workshop, or a VBAC specific workshop (also given by an independent provider).

Try to be under midwifery led care if possible.

Peer support is hugely helpful. The VBAC in Ireland Facebook group is a great support network of Mums who have tried for a VBAC, or are trying (LINK)

Don’t be afraid to ask questions at appointments (bring a notebook if it helps)

Know you have the right to decline any option of care once you understand the benefits and risks (a caesarean, a CTG trace, an induction and so on)

Remember to use BRAIN as a tool when discussing your options (both for you and your baby)

Example:

What are the BENEFITS of a repeat caesarean?

What are the RISKS of a repeat caesarean?

What are the ALTERNATIVES?

What does my gut INSTINCT say? Need more INFORMATION?

What happens if I do NOTHING for now and wait to make a decision?

Remember DoulaCare Ireland are here to support you through your VBAC. Ask us questions, gain information & support but above all, gain the skills to make informed decisions for your individual situation. 

I wish you luck on your journey. Whatever the outcome, what is important is that you have a positive experience - at the centre of that is making informed decisions and feeling supported. 



Doula Jen x



Some Further reading :

http://aimsireland.ie/vaginal-birth-after-caesarean-vbac/

https://www.hse.ie/eng/services/list/3/acutehospitals/hospitals/cavanmonaghan/maternity-services/consultant-led-care/maternityvaginalbirth%20aftercaesarean.pdf

https://www.rcm.org.uk/tags/vbac

https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_45.pdf

https://evidencebasedbirth.com/topfive/

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They never told me about the Second Night!

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They never told me about the Second Night!

 

 

Why is it that when we are pregnant everyone has an opinion. They want to share their experiences and what items we should or shouldn’t buy to be prepared for our babies arrival. So why is it then, while we are being bombarded with information and stories of woh – that not one person mentions the horror that is night 2 of our babies lives?

 

Let me explain.

 

So the first 24 hours are bliss. We are on an oxytocin high. We have given birth, become a new family and have our new tiny baby/babies. We can count their toes, smell their gorgeous baby smell and kiss their cute button noses. All the while our beautiful baby is content to cuddle in and sleep, only really waking to eat. We are led into a false sense of smugness...that yes I have the perfect baby. This parenting lark is amazing.

 

Then, as the sun sets on day 2 our beautiful sleepy baby disappears and seems possessed with a different baby spirit, who does not sleep, cuddles/rocking and singing don’t help and they never seem to be full.

 

This is where it can so easily go wrong. Doubt creeps in. Do I not have enough milk? Is my baby starving? Why won’t he stop crying? He keeps fussing at the breast, does he not want me?

 

The answer is, your baby is doing EXACTLY what he should be doing! Don’t worry – it is nature driving him to behave like this and it will be over soon.

 

So what is going on? Well on day one your baby was sleeping off the birth. Remember you and your baby were a team, going through labour and birth together. They are tired too. Not only that but it can be a shock to their system, entering our crazy world from the cosy and safe surroundings of your tummy.

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Your baby has to breathe for the first time. Regulate their own body temperature, feel hunger & eat. They are hearing, seeing and smelling so much more. Your babys senses are on overload. However, on night two they have had time to settle in, get used to their surroundings. They have slept off their birth and now nature is telling them they have an important job to do – get your milk supply in so they have a food source. So how can a new baby do that? They can feed like crazy, signalling to your body they have mastered suck, swallow & breathe and are ready to take on bigger volumes.

 

This does not mean your baby is starving and needs bottles. It does not mean your baby wants someone else. Your baby is being driven by instinct to help your milk come in. Plus lets not forget – you are their home! You have been their whole world since the second they were created, you are where they want to be.

 

Nothing an infant can or cannot do makes sense, except in the light of mothers body”

Dr Nils Bergman

 

Help your baby by keeping them close. Your body will keep them warm. Your heartbeat is the most familiar sound in the world. Your breasts will make the perfect amount of milk for them as they grow. Follow your babys signals, don’t watch the clock. You both know what to do if you can switch off your thinking brain ;)

 

So batten down the hatches. Prepare for it. Stock up on food and snacks that can be eaten with one hand and have them at easy reach. Charge up your phone or tablet to have something to keep you sane at 3am. Take a few naps when you can with baby (yes the old tale of sleep when baby sleeps is turu, but also important for survival!) But above all, enjoy it. No I am not insane. Your baby is only this size once. You only have this moment in time once. While it may not be picture perfect, it is your new normal and it is amazing. Be in awe of your body for creating this little human being. Be proud of yourself for getting through your first 24 hours as a parent. Watch in amazement as your baby feeds from your breasts. You are a goddess right now.

 

So hold your baby. Feed your baby. Feed yourself! And (yes I am going to say it)

This too shall pass.

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