Physiological Birth 

Supporting physiological birth: how can a doula support towards this outcome ?

Aims Editor Alex Smith calls birth the ‘final day or two of a physiological process that has been unfolding since conception.’ During a prenatal session, I begin by highlighting this concept, emphasizing that we usually trust our bodies to do everything right during gestation, only to fear its potential fallibility when nearing the end of pregnancy. To emphasise how beautifully well-orchestrated our bodies work* to aid us in birthing, I then discuss the different stages of physiological labour and the perfect interaction of hormones. Explaining how the same dance of hormones present at labour brought on the pregnancy (through sexual intercourse), I ask the parents to visualise their ideal safe space for intimacy. A hospital wouldn’t likely be anyone’s first choice. However, it may be the only place where even a healthy birthing person thinks they’d feel safe during labour. It is essential to make a distinction here: the difference between what makes us feel safe and what we consider safe on a rational and cultural level. During pregnancy, the rational part of our brain might tell us that labour isn’t safe at home, but, once in the hospital, our body could still not appreciate the environment as safe (due to stark lights, noises, unfamiliar surroundings, and the presence of strangers). This is down to our human evolution. Our bodies are designed to stall labour through the influx of adrenaline and the ensuing onset of the fight-or-flight mode. Fight-or-Flight mode would have helped our ancestors find a safe location before bearing down. Unfortunately, what served our ancestors doesn’t aid our ability to relax during a (heavily) managed birth. Therefore, I stress the importance of preparation to the expecting parents, talking them through their medical and alternative options. The ideal outcome of this part of the preparation is that parents can identify what they need to feel safe and can act on it.
Empowerment in birth doesn't mean everyone having a home birth. Empowerment in birth means you get to choose at every turn.  ...

*I am aware that my statement here is not true for everyone. Also, when writing our bodies, I simply chose the wording for simplicity of reading, rather than to say that I am speaking of all human bodies or female bodies only.

Also related to the body, I discuss the birthing person’s previous experience of pain. I ask if they already have coping strategies for pain, and we look at options for natural pain relief. I mention that the large quantities of oxytocin released during labour double as pain relief. As part of a prenatal session, we also look into pain relief via drugs.  And finally, I appeal to their intuition, gut feeling, and body wisdom. How do they feel about their body and within their body? How well do they know their body and its needs? From this, we launch into nutrition, hydration, birth snacks, and how their partner can best support them in physical ways. If they wish to give birth in a hospital/birth unit, we discuss what to pack in their birth bags (I advise the partner to bring one too) and what they are likely to expect from a medical environment. If they choose a home birth, we also discuss things like who they want to be there, the birth pool, immediate postnatal support, down to little details like fairy lights. Either way, we speak about the birth plan. 
When talking birth plans, I use Millie Hill’s icons to illustrate the possibilities and options, and ask the parent(s) to put together three birth plans: one for their ideal birth, one for a more ‘realistic’ version, and a final one that combines both (I remind them that their signed birth plan is a legal document). All throughout their journey of pregnancy and birth (including postnatal), I keep reminding them of their options, rights, and the B.R.A.I.N. tool. The BRAIN acronym (Benefits, Risks, Alternatives, Intuition, Nothing) is a method to help individuals make informed healthcare choices, especially during pregnancy and childbirth, by prompting them to consider all angles of a decision. 
I agree with Elms when she says, ‘Only when we truly know our options, and fully understand them, do we really have them.’ 

End of the Third Trimester 

The importance of the last days of pregnancy... 

Aims Editor Alex Smith once wrote, "Birth is the final day or two of a physiological process that has been unfolding since conception". 
I knew this to be true when I carried my daughter in 2016, and yet, I, too, was getting twitchy when her estimated due date came and went.
At 41 weeks, the pressure became almost unbearable. Her father's family told me to "be responsible and do what's right for the child". My gynaecologist kept offering induction whilst also pointing out that I really shouldn't opt for a home birth with my first baby. 
During my final scan, a consultant urged me to reconsider my choices because "that is no small baby." 
I also faced other challenges at the time. My husband and I had separated when I was two months pregnant, and after time spent in Spain, Austria, and the UK, I had just moved back to Germany two months before my due date. Although I chose a beautiful space for my daughter and me, I lacked a local support circle, and fears about our future began to creep in. I doubted myself and felt daunted by single-parenthood. 
Knowing these feelings weren't ideal for a positive birth, I sought solace in nature. My mum, visiting to help with the birth, mentioned an old oak tree nearby...

The outside pressure was still very much real, however. So when I was offered a membrane sweep on the morning of 41+2, I accepted. 
I felt very strange for the rest of that day, and it is the only part of my birth-journey that I have regretted for a long time. Casually called 'a stretch and sweep', it is still a form of induction, but I only fully understood this after having had one. 
My waters broke at 4 am the next morning. The contractions were relentless from start to finish, and extremely painful. Having spoken to many mums over the years, who also had membrane sweeps, I now understand that this intervention was likely one of  the main causes for my intense labour.  
After nine hours, my daughter Maylea was born at home, weighing 10lb 7oz (no small baby, indeed). Her birth was a powerful  and beautiful  journey. And those final days leading up to it were invaluable to that outcome, even though I had also opted for a form of induction. 

Faye 

These days, I make it my aim to provide my doula clients with as much information as possible, so they can make the right decision for themselves and have an empowering and self-determined birth. Please scroll down for more information on induction.