Positive Birth News

birth stories, news and articles to encourage and inspire


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A Positive Caesarean Birth

If you wish to emerge from your baby’s caesarean birth feeling positive then it is wise to take ownership over your baby’s birth. This means speaking up for what you want and do not want and placing yourself in the hands of people you trust and feel safe with.

Consider what your wishes would be for a caesarean birth when you are doing your birth preparation and planning. Then you will have the opportunity to communicate your most important desires for a caesarean birth with your place of birth and carers ahead of time. This doesn’t mean dwelling on the possibility of a caesarean, it just means considering and documenting what would make this type of birth as positive as possible for you, your partner and your baby.

Most of us like to avoid conflict. We are used to being told what we should or shouldn’t do by health professionals and we are in the habit of giving over our power and ownership to others in medical situations. Although it may be very challenging for you (it is for me!), your baby’s birth is an opportunity to begin advocating for yourself and for your unborn child. Through your experience of birth you can set the scene for future interactions with doctors, dentists, health nurses and teachers where you are a strong advocate and an expert in your needs and the needs of your children.

There are options for a caesarean birth that may not be offered to you as they are not standard care in most hospitals. Although a caesarean is surgery, it is also the birth of a baby, a mother and a father. Even in an emergency, this surgery can be performed with gentle and respectful intentions, with consciousness that this is a birth and it is a special day.

Based on many women’s stories and the work of retired US obstetrician, Robert Oliver, MD, board of directors of APPPAH, the Association for Pre and Perinatal Psychology and Health, these are my suggestions for turning a necessary caesarean into a positive and beautiful birth.

Not all of these are going to be possible for a mid-labour emergency caesarean or in every individual situation, but they are possible and achievable. Reading positive caesarean stories and asking questions of other women will help you to discover that the smallest things can make all the difference to your baby’s birth.

Robert Oliver MD writes about his experience with positive caesarean births: “It is our intention to maintain the mother’s control of the events. She must at all times feel she is important to and guiding the birthing, regardless of the emergency and the operative procedure.This also goes for the baby in a spiritual and metaphysical sense. Ideally the obstetrician and labor room personnel will honor these two people most strongly.”

Preparing for Caesarean Birth
It is OK to feel disappointed, sad, or angry before and after your baby’s birth. Seek an empathetic listener (eg, your doula or midwife) who will not dismiss your feelings, ‘jolly’ you along, or diagnose you with depression before you even have time to grieve the birth and meeting with your baby that you had hoped to experience.

If you feel ready and you have time to prepare for your caesarean birth, read positive caesarean birth stories so that you are familiar with what will happen and what the birth may feel like. These stories will also give you confidence to ask for what you want. Talking to other women will also help you to find out what products there are that may make your recovery easier. (There are three positive caesarean stories in the Birth Journeys book.)

Meet the surgeon and anaesthetist beforehand with your midwife and/or doula to discuss your birth plans and hopes.

Ask that your baby be placed on your chest before weighing, cleaning and paediatric assessment, unless absolutely necessary. Weighing and cleaning are not emergency procedures that have to happen the moment your baby is born – they can wait – but we tend to accept that they take place immediately after birth. There are many possibilities like this that are not widely discussed or offered.

Ask for delayed cord clamping so that your baby receives all the cord blood and oxygen from the placenta while they adapt to life outside the womb. A recent review of studies showed that delayed cord clamping provides longer term health benefits for your baby as well as supporting them as they begin to breathe. A lotus birth is possible with a caesarean birth and it ensures that your baby is not taken away (although baby may be held rather than placed on your chest) before the placenta is birthed.

Ask for the lights to be dimmed and the surgery to be a little warmer than usual for your baby’s birth. This is achievable and it will make your baby’s first moments in the world easier and the birth environment more pleasant for you too.

Ask for talking to be quiet and gentle with attention focused on you, your baby, your partner and this birth. One common complaint couples have after experiencing a caesarean birth is that medical staff carried on with their own conversations ignoring the presence and the feelings of the key people in this important event. Perhaps some surgeons and theatre staff have this habit because other ‘patients’ would not be listening in and they may not be aware of how it makes many couples feel.

Discuss your intentions for breastfeeding and how you will be supported after the caesarean birth. Identify how will you be helped to breastfeed, especially if there is a reason why you are unable to breastfeed your baby for the first few hours. Remember that skin to skin contact and allowing your baby to explore and find your nipple by themselves is a wonderful way to initiate breastfeeding and reconnect with your baby after a separation.

Caesarean births are sometimes linked to difficulties in establishing breastfeeding so consider finding the supportive friends and professionals now before your baby is born. It is easier to reach for support if you have already made contact before the birth.

You may wish to discover your baby’s sex for yourselves. You may like the doctors to welcome your baby by name. Ensure you make your wishes clear so that this special moment meets your wishes.

Use honey not vinegar to get what you want. If you are worried about dealing with potential conflict, try words like these: “It is important to us that… How can we work together to…” Eg, if you are concerned about your baby being taken away immediately after birth you could try words similar to “It is important to us that our baby is not separated from us. How can we do things so we have our baby in our arms straight after the birth?”

This may seem to be giving the power to find a solution to the doctors, but you are actually telling them what your concern is and what outcome you want. I’ve not had to use this method in maternity care, but I have used it in the operating theatre and recovery ward with my children to get what I knew they needed and it really works! Honest and respectful communication with the right person goes a long way.

On The Day
Have your partner place their hands on your belly or speak to your baby in the time before the caesarean birth begins. Your baby knows their daddy’s voice and this can help your partner to feel involved and connected with your baby and the birth.

Before the birth begins, ask to take a moment to welcome your baby and give thanks for their life and the wonderful care and the gentle hands of everyone in the room that will receive your baby into the world. If you would normally pray or say a few words before something momentous takes place then surely the caesarean birth of a baby fits this category. I believe your wish will be respected if you frame it as a need to give thanks, say a prayer or a blessing before your baby’s birth.

If saying something aloud is all too much, then ask for a everyone to share a moment’s silence to give thanks. Taking this small but very personal action will send a very clear message about the way you want this birth to be – respectful, gentle and calm. I have not read of this in any birth stories so you may be pioneers if you try this – be sure to let me know what happens!

Focus on your baby and visualise sending them reassurance and love. Let your baby know that it is safe for them to be born this way and that you are in control of what is happening. Talk or sing to your baby in your head or quietly – keep focused on them and their wellbeing and imagine them coming out into the light and the air. This will help you to feel involved and in control of the birth of your baby. By keeping calm, you support the wellbeing of both yourself and your baby. If this is not for you, use other methods such as counting backwards to help you keep calm.

Have a doula or familiar midwife in the theatre focused on your care and wellbeing. You’ll benefit from having someone there for you and your partner.

If you prepared for birth with hypnosis or meditation methods you may find these are still very useful during the birth. If you have prepared using breathing techniques or counting methods these amy also be helpful for you. (See the links below for hypnobirthing specifically for caesarean birth.)

If you are unable to hold your baby post-birth, your partner can hold your baby against his bare chest with a blanket over them both, or even inside his shirt. Your baby will be kept warm and will love this close contact with daddy.

Remember it is your birth and your baby’s birth not just an operation. Every aspect of this birth may be performed with an intention to help, to care and to show respect for you, your baby and your partner. You deserve this.

Some links you may find helpful before and after a caesarean birth:
Caesarean birth plan: http://www.birthtalk.org/PlanaPosCS.hhtml
Hypnobirthing for caesarean birth: http://www.hypnobirthingaustralia.com.au/preparation-for-caesarean-birth-cesarean-c-section/
What a caesarean is like: http://www.birthingfromwithin.com/cesarean
Birth Rites on positive caesareans: http://www.birthrites.org/caesarean.html
Love letter to mothers who have birthed by caesarean: http://thestir.cafemom.com/baby/131563/a_love_letter_to_csection
Words that heal – why language matters: http://www.huffingtonpost.com/brandy-ferner/words-that-heal-cesarean-birth_b_3722185.html

20130826-213350.jpg No matter how you birth or how your baby needs to be born, you deserve this treatment.

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Breastfeeding in Pregnancy, Labour and Beyond

This is an information piece in published in Birth Journeys,  by Leonie MacDonald

Often mothers who become pregnant wonder whether they can continue to breastfeed their baby or toddler throughout pregnancy. In most cases, it is perfectly safe and even beneficial.

During pregnancy, your milk supply may remain unchanged, diminish, or change to colostrum, especially towards the end of pregnancy. Colostrum is the first milk a newborn baby drinks. It is a clear yellowish liquid, very rich in vitamins and antibodies. It will do no harm to your breastfeeding child, although it may have a laxative effect and they may dislike the saltier flavour. Your supply of colostrum will not be used up by breastfeeding during pregnancy.

Your baby or toddler may wish to continue breastfeeding for comfort regardless of your milk supply. There are also immunological benefits of breastfeeding that continue even if your breastfeeder is not feeding very often or receiving much milk.

You may, however, experience sore nipples ranging from tolerable to very painful. Limiting the length of feeds or spacing feeds out can make this pain more manageable for some mothers. Heat or cool packs held to the breast before feeding can reduce the discomfort. Heat packs can also encourage the flow of milk. Sometimes the pain is only present at the start of the feed and then disappears.

Breastfeeding during labour is also possible and safe. Stimulating the nipples (through breastfeeding or through manual stimulation) can increase oxytocin and strengthen your contractions. It can be used to move your labour along in a natural way.

Some mothers will decide to tandem feed after birth. This means breastfeeding a baby and their sibling. The two do not have to be at the breast at the same time – any combination can work.


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Guess what? You’re a Mammal!

Are you ready to admit you’re an animal? A mammal like a chimpanzee, a dolphin, a giraffe, an elephant or a cat?

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We have become so civilised and socialised that we go through the day forgetting we are mammals. Birth is a great leveller, because labour asks us to let go of self-consciousness and tap into our inner mammal.

I was confronted, horrified and mortified by the birth video shown in the antenatal classes at our local hospital. I don’t know why this video was considered appropriate to show a group of nervous and inexperienced adults who had never seen a real birth before – only dramas on TV. The only birth that looked like something I could handle was the one where the woman had an epidural and I had already decided I didn’t want to have a needle in my spine or risk the effects of an epidural on my labour.

Even the birth described as a ‘nice, gentle water birth’ was way too much for me. Labouring women looked sweaty and messy, their bodies were heaving, their sounds were animalistic and almost sexual. I felt like I was prying on some very private moment that I wasn’t meant to see. I certainly didn’t like the idea of behaving like this myself! It was terrifying to think of losing control like that in front of other people (this should have been a clue that I needed privacy!).

No matter how much I prepared for my first birth with reading and learning, I was still uncomfortable with the raw, animalistic nature of birth and I couldn’t imagine myself in this state. I needed to feel completely safe and unembarrassed before I could really immerse myself in labour.

During my second birth I was able to trust, relax and let go completely. The experience was powerful and pain free for me and a straightforward, safe and much faster birth for my son. I didn’t need to rehearse or learn how to give birth. It was instinctive. This is how it is for other mammals – most of the time. And this is how it may be for humans – most – but sadly not all of the time.

If you want your baby’s birth to be natural, normal and safe, then it is wise to understand and accept the nature of birth. Birth is raw, physical, animalistic and instinctive. Your mammalian body does know what to do but it needs the right conditions. You need to make sure your human self-consciousness doesn’t get in the way. To birth your baby, you need to feel safe enough and comfortable enough to let yourself move instinctively, to feel able to tear off your clothes, to moan and groan, to be loud, or to be inward, withdrawn and private, and to do whatever feels right for you. The hormones that drive labour have evolved to work when you feel safe, unobserved and willing to give yourself over to birth. The bottom line is you need to feel comfortable with being a mammal!

If you are uncomfortable watching a DVD of a woman in labour then don’t avoid them. Watch a whole lot more, but do choose your viewing wisely. Gentle natural births that show women moving around, making labour sounds, or entering into deep states of relaxation, and being supported and nurtured by carers and partners can give you a positive and realistic image of what labour can be like. Water births are probably the least confronting to begin with. Animal births may be a good way to ease yourself into watching births too.

In contrast, viewing frightening, stressful births and emergency scenarios do more harm to you than good. Don’t imagine that reality birth shows will help you prepare for an emergency, just in case one happens. The only thing that will help you in an emergency is knowing that you can trust your carers and that you will be treated with love and respect as well as medical expertise. Focus on ensuring you have that relationship of trust, respect and nurturing with your carers and supporters instead. This will serve you well, no matter how your baby is born.


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Failure to Progress or Failure to Wait?

Failure to Progress and Preparing for a VBAC

For most mammals birth seems to be fairly straightforward. They seek a safe and private place to birth in the middle of the night. Some choose to birth alone and others have ‘midwife mammals’ by their side. If there is danger they either have a speedy birth or stall labour until there is another safe opportunity.

For humans, it seems far more challenging. We have to feel safe in our environment, safe with the people around us, and safe with the physical and emotional process that is taking us over. We have learnt to fear birth with our minds and hearts, yet nature requires us to feel safe in order to give birth. Sometimes ‘failure to progress’ is the result of this struggle.

‘Failure to progress’ is one of the common reasons given for a caesarean during labour. This label is a blanket term for times where contractions have slowed or paused, dilation has gone backwards, or contractions are continuing but the baby is making no further progress towards birth. Women’s stories suggest that the label ‘failure to progress’ is often used when their labour has taken several days, or simply longer than expected or allowed by policy.

There are many variations in labour and doctors and midwives face the task of judging when medical assistance is needed and when all that is needed is patience. No one wants an adverse outcome, however in the rush to keep birth safe, some mothers and babies are hurried into treatment for an emergency that just does not exist. Some caesarean births due to failure to progress are actually caesareans due to impatience and failure to wait.

“After 50 hours of intense labour, I had a caesarean.

I haemorrhaged and my uterus collapsed requiring manual internal manipulation to contract it back down again. I had to have the caesarean under general anaesthetic because of my previous spinal surgery – I was unconscious for the birth of my baby.

My husband was allowed into surgery to be with our baby. I’m glad of that, because I wasn’t ‘there’.

The last thing I remember was being pregnant. Next thing I knew, at least a couple of hours later, I was being wheeled up a corridor past a baby in a clear plastic crib and someone was saying, “That’s your daughter.”

It was a very surreal and disjointed experience. To this day, I still feel a gap. I don’t feel like I birthed my daughter, yet she’s gorgeous and I love her like I’ve never loved anyone or anything before.

It should not have happened this way. It was an unnecessary caesarean performed due to medical impatience with my long posterior labour. Neither my precious daughter nor myself were at risk during labour except when they intervened.”

From Jo’s VBAC story “Triumphant Birth”, in Birth Journeys – positive birth stories to encourage and inspire

The alternative response to a labour that seems to be failing to progress is to ask what obstacles are there to this birth. If a mother feels frightened, threatened, nervous, embarrassed, angry, unsupported, alone, disempowered, violated, exposed, worried, overwhelmed or any other negative feeling then this can slow her labour down and even stop her labour from progressing.

Women’s birth stories show that there are many ways to help a birthing mother to move through or let go of thoughts or influences that have made her feel unsafe or threatened if this is the cause of a slowed or stalled labour:
– a change in environment (can she leave the room, open or close the curtains, change the atmosphere if not location)
– a change in activity and pace (get moving if she has been still, be still if she has been moving)
– a challenging question (eg, what is it you are frightened of? What are you avoiding? Is she intentionally avoiding the intensity of labour mentally or physically by avoiding certain movements or positions that make her contractions more intense and more effective?)
– the removal of an unwelcome person in the room (is there an uninvited or irritating presence in the room? If it is a midwife or nurse, can you ask for a different one or buffer her from this person’s impact)
– or the inclusion of a loved and longed for person (is she missing someone special?)
a few simple encouraging words (you are made to do this, you are bringing your baby into the world, positive affirmations)
– a description of what her body is doing or needs to do (open up and let your baby come down)
– a cry (release the built up stress so she can feel ready to birth her baby)
– a reminder of the skills she has learnt and the strength she has to give birth and to be a mother (has she forgotten the birth skills she has learnt? Or is she worried that she doesn’t have the ability to be a mother to this baby?)
– some time alone (maybe she needs some quiet space to reflect and gather herself. A trip to the toilet seems to work well according to women’s experiences!)

Preparing for your next birth

It is important to understand the factors that contributed to the path of your last birth and to consider the possible impact your feelings (whether you felt safe or unsafe) had on your labour. It is wise to discuss your previous birth in detail with your chosen doctor/midwife for a birth after caesarean. Pay attention to the way your chosen carers talk about your past birth as this will tell you what you can expect from them.

If your doctor seems to blame you and your body for a failure to progress, then be wary of both the doctor and the truth of what they are saying. Keep in mind that a very, very tiny percentage of women actually have a physical reason why they cannot labour and birth vaginally and statistically you are unlikely to be this woman.

If you hear words like “Your pelvis is too small and your baby got stuck. Luckily we saved your baby’s life just in time. You’ll never be able to have a vaginal birth of course” then you can thank this carer and start looking for another! They have just revealed that they are unaware of or insensitive to the emotional issues around birth and they already believe you and your body ‘failed’. You could enquire about the evidence for their verdict or you could simply put this energy into finding a more supportive and respectful doctor first. There are ways to discuss a ‘failure to progress’ that would be more supportive, caring and respectful.

One doctor or midwife’s ‘failure to progress’ will be another’s call to action: how can I help you to feel safe enough to give birth?


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Doulas and Partners

Why would women have a doula when their partner will be there to support them?

Men attending their baby’s birth is a relatively modern phenomenon. My father was not present at either my birth or my brother’s birth and in the 1970s this was the norm in Australia. Fathers are now expected to be present and to shoulder a large part of the birth support role. Now many men want to be there. They want to support their woman and they want to see their child into the world. But how prepared are today’s men for this new role when their own fathers were at work or down at the pub when they were born?

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Consider that first time partners have (most likely) never seen a birth. If it is your first birth, then the chances are you haven’t either. Your partner (most likely) hasn’t read positive birth stories, watched gentle birth DVDs and has consumed less information than you.

They have (most likely) been told sensationalised and frightening birth stories including stories from men about seeing their partner in pain, seeing blood, poo, vomit, fluids and very intense and stressful situations.

Your partner is also carrying the legacy of their own birth story and they have (most likely) not reflected on their entrance to the world and what this has taught them about birth.

They may be frightened – but they’re probably not about to let you know because they want to be a rock for you. Your partner may not have gone through the same journey of learning and transformation as you in preparation for this birth and the transition into parenthood.

If this is not your first birth, then your partner may be distressed by the memory of your last birth. Even a straightforward and uncomplicated birth may have been a shock. They will have had less opportunity and less support than you to debrief and integrate their experience.

Men don’t get to meet up with other men post-birth and swap experiences the way women do. Men don’t usually get to go to birth circles or have heart to heart discussions about their experiences and feelings. They don’t get to do prenatal yoga and meditation where they can bond with their baby and visualise the birth they want and how they want to feel. They will have had less opportunity to do the healing and growing needed to go into another birth feeling ready, open and strong.

Your partner has a huge emotional investment in this birth. It must feel like the lives of the two most precious people in the world are in a boat out at sea and your partner is waiting, hoping, and willing that they will see both you and your baby safe in the harbour at the end of birth.

A doula won’t take away from your partner’s role, nor destroy the intimacy of experiencing this rite of passage as a couple. However a doula can support and reassure your partner so he can support you throughout the birth. Your partner deserves this support as much as you do!

Some ideas and resources to help your partner feel positive, supported and ready for birth too!

Becoming Dad is a blog, a facebook page and a movement created by Darren Mattock: Connect your partner up with Darren’s community for support in the transition into fatherhood. http://becomingdad.com.au/how-can-dads-make-a-difference/

Men at Birth is a collection of men’s birth stories edited by David Vernon (also a contributor to Birth Journeys) (Scroll down the linked page to find this book)

Beer and Bubs is a childbirth class for men held in an informal, friendly pub environment. Men have the chance to talk with a father who has done Beer and Bubs before and since experienced the birth of their baby, as well as learn from childbirth educators. Available around Australia.

Cheers to Childbirth is the book that grew out of the Beer and Bubs program, written by Lucy Perry with birth stories from celebrity dads.

Birth Journeys – positive birth stories to encourage and inspire contains three stories which share men’s experiences of birth (so do pass these stories over to your partner if you have the book!). These are Lachlan and Bree’s story of their first birth, Christian’s story of his second daughter’s birth in the water (she was born in the caul!), and Chris tells the story of his second baby’s home birth. There is also a piece by David Vernon on how men can prepare themselves to support their partner during labour.


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Ten Great Reasons to Choose a Doula

  1. A doula can help you have a better experience of your baby’s birth. A 2012 review of studies showed that women with continuous non-medical support throughout labour have better birth outcomes in every way.

    “Bottom line: Continuous support in labour increased the chance of a spontaneous vaginal birth, reduced intrapartum analgesia, caused no known harm, and women were more satisfied. In addition, labours were shorter, and women were less likely to have a caesarean section or instrumental vaginal birth, regional analgesia, or a baby with a low 5-minute Apgar score. There was no apparent impact on other intrapartum interventions, maternal or neonatal complications, or on breastfeeding… continuous support was most effective when provided by a woman who was neither part of the hospital staff nor the woman’s social network, and in settings in which epidural analgesia was not routinely available.From Continuous support for women during childbirth, Hodnett ED, Gates S, Hofmeyr GJ, Sakala C, October 17, 2012 http://summaries.cochrane.org/CD003766/continuous-support-for-women-during-childbirth#sthash.VsvNUnvh.dpuf

     

  2. A doula is an independent, educated professional who will give plenty of time to hearing you, sharing information and helping you to identify what you need and want for your journey into parenthood. A doula has usually studied pregnancy, birth, labour, how to support couples and how to be at births. An experienced doula will have knowledge and intuition.
  3. A doula can help you and your partner to understand and communicate with health professionals. A doula can offer you suggestions for how to bring up issues or ask questions. She can support and assist you and your partner to explain what you need, want and are concerned about.This is particularly helpful if you are seeking non-standard care (eg for a VBAC) or you are planning and preparing for a natural and unhindered birth. Some might even say if you are seeking a natural birth then you are automatically seeking “non-standard” care in many hospitals in Australia and the US! If the policies and practices of your place of birth are not aligned with your birth wishes then a doula will be a very good ally.
  4. A doula can give your partner a break, work with your partner as a team, or support your partner in a practical role. A doula won’t take away from your partner’s role, nor destroy the intimacy of experiencing this rite of passage as a couple. However a doula can support and reassure your partner so he (or she) can support you throughout the birth.
  5. A doula is someone to ask you questions and help you reflect on your pregnancy, birth and motherhood. She may ask questions you wouldn’t think to ask or may avoid asking yourself. This process helps you to know yourself better and helps her to support you.
  6. A doula knows how to be around women in labour, to set the tone and protect the birth space you want. A doula is trained and practised in being with birthing couples without allowing her personal circumstances, history or other factors to affect her or you. A friend or relative may not be able to give unconditionally like this especially if they have not experienced positive births before or are bringing their own fears or negative experiences into the room.
  7. A doula is someone who knows your needs, wishes and your history in a personal and emotional way – as long as you let her in and trust her. Your partner also needs to be comfortable with her and trust her. Someone who knows you well is better able to read your needs and support you than a midwife who has only just met you and you are one of several women in her care at that time. A doula who you feel comfortable with will help you to labour well because her presence makes you feel safer, unobserved and more relaxed. This supports the hormonal processes that drive labour.
  8. A doula is someone to stay with you if your partner needs to go with your baby to the nursery, or you need some medical attention post-birth. This is not a scenario you would wish to focus on, but it is reassuring to know that in this situation you would have support.
  9. A doula is someone to visit you in the post birth days to help with breastfeeding, mothering, and your wellbeing. This may be as simple as making you a cuppa, bringing you one-handed healthy food, or holding your baby while you shower. These things are really helpful post birth especially if you do not have other people who will be there for you in this gentle, reassuring and ‘no strings attached’ way.
  10. A doula becomes someone special who has witnessed your baby’s birth in a non-medical, personal way. She will be able to share in your story, hear and understand your feelings, and affirm your memories of what happened. She will hold a special place in your heart and your family.
    Not convinced? Are there blocks to you considering a doula for birth support? Making Good Decisions for a Positive Birth examines some of the common reasons shared with me for not choosing or not needing a doula and asks you to dig deeper and examine what is behind the reasoning. Only you can know whether your reasons are based on evidence, a deep consideration of your needs and an understanding of your fears.

https://www.facebook.com/notes/birthtalkorg/do-i-need-a-doula/238875327307

This article by Birthtalk shares the benefits of choosing a doula and talks with mums who have had doulas to find out how their doula helped them.

Melissa and Debby of Birthtalk were professional contributors to Birth Journeys and they support women and couples to help them heal from previous births and prepare for a positive birth. You can read more about Birthtalk and the services Melissa and Debby provide on the Birthtalk website.