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AJ Silver Birth & Postnatal Doula: Essex, Kent, London & Hertfordshire

Ami Silver - Doula in essex

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Birth Beyond The Binary

 

Before we start, we must be clear that this is not trauma top trumps. It isn’t who is the most at risk, or who is the most deserving of our time, effort and inclusion. Inclusion isn’t pie, there is always enough to go around if we make the choice to be inclusive.


What is non binary?

Non binary is not always the lack of gender. It doesn’t necessarily look like assigned female at birth (AFAB) people who are wearing a suit from the men’s section. It’s more complicated than that. Non binary in general, although not always, is the absence of associating fully with the world’s assumptions of your personality, likes and dislikes, abilities, strengths and weaknesses based on your assigned at birth gender. Assigned at birth gender refers to whether your genitals look like they are male or female, or perhaps not one or the other. It is also expected that our genital appearance will match our chromosomes, but this is not the case for many people.

Some non binary people will go by gender queer, demi gender, agender, bigender and more. Some will identify as trans. The most basic explanation of trans is that your assigned at birth gender doesn’t fit who you are, who you present as. Other non binary people will identify as femme (feminine), others masc (masculine). The standing theme is that we do not fit into the world’s cis-heteronormative expectations.

Non binary can be an AFAB person in dresses with long hair, it can be AMAB (assigned male at birth) people with a beard, suits and eyeliner. There is no one “look” or dress code. They may change their clothing style from day to day, or like me, they have found clothes that feel comfortable and they wear the same clothes day in day out to avoid dysphoria. Non binary people don’t always present as androgynous people, although they might.


What is Dysphoria?

Dysphoria is when a person experiences distress or discomfort with the skin they are in, as this does not reflect their gender identity. This may be a non binary person wishing their chest or breasts were bigger or smaller, or a trans woman wanting to have a more “feminine” frame, walk or voice. These experiences vary dramatically from person to person. Not all trans and non binary people feel dysphoria at all, and many have no desire to change the body they were born in with surgery, hormones or anything else. Others feel that it is imperative to their life that they change their body’s appearance. There is no wrong or right way to be trans or non binary. For many people, being referred to by the wrong pronouns can also be very upsetting and trigger dysphoria.

Something that triggers one person’s dysphoria may not trigger another’s. It’s important to remember that gender euphoria also exists! “Follow the euphoria” can be a valid and safe way to explore gender expression in order to find an expression that fits, or more closely resembles your identity.

Some argue that gender roles in society have a lot of sway in a person’s dysphoria and identification. In other words, boys can wear dresses, and like makeup and unicorns, and girls can be scientists, roll around in the mud and be physically stronger than boys. But by removing or dismantling the world’s perceptions of femininity and masculinity will we remove dysphoria and remove the need for people to “change” or “transition” from one gender to another? Unfortunately not. Being a “tom boy” or a “butch woman” doesn’t mean you want to transition to being a boy or a man, want to have any surgeries or want to use male pronouns. Similarly, being a feminine boy, loving dollies and dressing up as princesses doesn’t mean that all of these “girly girl boys” want to, or will grow up to be trans.

It is interesting to consider what the situation would be if in society we HAD equality. If every opportunity and availability that is afforded to AMAB persons were available and given to AFAB people (and vice versa) would we still have “tomboys” and “girly girls”? Would people still transition? Would non binary still be a “thing”? Maybe – but for the time being, like it or not, we live in a hugely gendered society that constantly insists we are pigeon holed into abilities, likes, dress, jobs, interests and personality traits based purely on our genitals.


Being non binary in the “maternity” system

There are very few studies of any queer people birthing, and there is no research into gender queer or trans peoples’ birthing experiences that pre-dates 2013. The research that there is focuses more on lesbians experiencing pregnancy and the evidence does show that queer people may be at greater risk of perinatal mental health difficulties1.

However, there has been no follow up to these findings in the UK. Given that the percentage of lesbian couples registering birth has been rising by around 15-20% (these stats also do not include single parents2) year on year over the last decade, we can make an educated assumption that other queer people are also registering more babies year on year.

The birthing and parenting world is difficult for non binary people in a number of ways. The obvious and most prevalent are the ways the world constantly pushes us into boxes: Male or Female. Mum or Dad. Non binary people may choose to go by a different name, just as some grandparents are Nanny or Grandma, Pops or Granddad. Bubba seems to be fairly popular choice in the non binary world, as it’s gender neutral, and super cute! The needs and wants of the non binary community aren’t far removed from the wants and needs of the trans community who birth and feed their babies. AIMS has already covered a lot of this in their “He’s not the mother” article3, but I will discuss some additional issues below.


Feedback from parents is encouraging health care providers and birth workers to move away from calling new parents “mum and dad.” The fear is that it’s dehumanising to anyone – straight, cis, trans, non binary people - to lose their identity as soon as they’ve brought a baby into the world, to stop being who they are and to simply be referred to by their relationship to their child. This is a fantastic example of how inclusive language doesn’t just serve trans or non binary people - it can be viewed positively for everyone who births in society. It ensures recognition for the overwhelming majority, so let’s take another half step to include even more people.

How can we be more inclusive in the Maternity system?


So, the first and arguably the easiest step is language. Can we be inclusive without language?

Misgendering someone is using the wrong pronouns (using the person’s assigned at birth gender’s pronouns: calling a trans woman he / him for example), or using their “dead name” (the name they were given at birth, if they have decided to no longer use it, rather than their chosen name, if they have one). The easiest way to explain how this feels, or what it does for the relationships that health care providers and service users are trying to forge, is that it destroys all confidence that the non binary person has in the person providing the care for them. If your health care provider kept getting your name or date of birth wrong, or calling you “Mr So and So” if you identify as a woman, would you feel confident that they understood you, your medical history or that they had prepared for the meeting?

The journal of adolescent health in 2018 published its findings that using a person’s chosen name and pronouns may cut the risk of suicide by a massive 65%4. Given that the Stonewall research has uncovered that a staggering 89% of trans people have considered suicide, and that 27% have attempted suicide, using their chosen names and pronouns isn’t just polite, it could be a matter of life and death.

Removing the word “Woman” is not an option.


Pleas for inclusion are often met with the objection that it is erasing the overwhelming majority of those who birth, the mothers, the women. This thought process needs some examining here.

The example I always fall back on is that ramps on public buildings take nothing away from the able bodied people that want to access them, but it makes it possible for disabled persons to access them. Cis-heteronormativity will not disappear overnight because we include language, tick boxes and space in our hearts and minds to accept that not all who birth are women or mothers.

The wider LGBT+ community accepts and acknowledges that removing any and all references to women is in no one’s interest. If we remove language that protects any person that births their baby we risk the principle of bodily autonomy being diluted. If we give equal rights to the non- birthing parent, we could risk giving the right to make decisions about our own bodies to other people such as fathers, known and unknown sperm donors and partners of the women and birthing people, rather than, as it should be, entirely the choice and decision of the pregnant woman or person. This needs further collective work, thought and time to ensure that no one is left out, no one’s rights are diluted, and that we are all included in being able to access these basic human rights surrounding birth and pregnancy.


Issues that trans and non binary people experience around maternity care

One of the issues faced by Trans and non binary parents is their legal right to be known as the father (for trans men) and the mother (for trans women). The current law of the Human Fertilisation and Embryology Act 20085 states that whoever gives birth to the baby is legally the mother. However, if the birthing parent is a trans man he may want to be known as the baby’s father. If the child is adopted by a lesbian couple, they can amend the birth certificate, and both be listed as parents (parent 1 and parent 2), and gay men can apply for a court order to then adopt their child. This leaves a hole for trans and non binary people who, in a legal document, are unable to be referred to as, or to be recognised for, their true relationship to the child. Even if the person birthing is legally male (have obtained a Gender Recognition Certificate, or GRC), they are currently recorded as being the mother.

There is currently an ongoing legal battle in the UK6 for a trans man who birthed his baby to be listed as the father rather than the mother. The case could be a landmark victory for the LGBT+ community and open the doors for gender queer people to be recorded on official documents in accordance to their identities. If it is rejected by the court, the rights of LGBT+ persons, especially when it comes to gender and identity, will be rejected by officials once more. This is yet another blow to our freedom and rights to be who we are born to be.

The baby of a trans man has no legal protection to be breastfed in public. The Equality Act 20107 says that it is discrimination to treat a woman unfavourably because she is breastfeeding. Limiting the protection to just women, means trans men - who are legally men – are excluded from the protection that the Act offers. This therefore risks the baby’s right to being given breastmilk, and, of course, risks the person breast or chest feeding that baby to be discriminated against.


Similarly, a trans man is not clearly protected by the Equality Act 2010 for aspects of the Act which only refer to women. A trans man therefore may have no protection, for example, against dismissal or unfair treatment based on pregnancy, nor rights regarding maternity pay, nor maternity leave. This situation has not yet been tested in court.

This goes some way to explain why many gender queer people will default to their assigned at birth gender, or remain closeted (or not “out”) when birthing and parenting as there is often no other option for them. They are better protected as a woman, in a legal sense, despite the psychological distress that this may cause

There is no universal legal proof in the UK, or any document that a non-binary person can acquire to “prove” their gender, or lack thereof. Some countries (such as Canada, Portugal, and certain states in America) are emerging with a “third option” on driving licence, passports and birth certificates and so on, but the UK is lagging behind.

Documents have been issued in these countries as early as 2003 with an “X” or a “U” to indicate the bearer is neither “F” (female) or “M” (male)8.

There are small leaps being made across the world for the right for people to be legally neither male nor female, however, we are often forgotten or erased in the battle for these small victories.

Having health care providers and birth workers that acknowledge our gender is an essential link in the chain to improving the outcomes for parents who do not fit into the world’s cis-heteronormative expectations.


References:

1. https://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780199778072.001.0001/oxfordhb-9780199778072-e-003
2. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/families/bulletins/familiesandhouseholds/2017
3. “He’s not the mother”, AIMS Journal 2017, Vol 29, No 2 https://www.aims.org.uk/journal/item/hes-not-the-mother
4. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/85008/business-quickstart.pdf
5. Human Fertilisation and Embryology Act 2008 https://www.legislation.gov.uk/ukpga/2008/22/section/33
6. Legal case of a trans man who gave birth applying to be listed as the baby’s father: https://www.pinknews.co.uk/2018/06/09/transgender-man-starts-legal-battle-to-be-recognised-as-the-father-of-baby-he-gave-birth-to
7. Equality Act on breastfeeding: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/85008/business-quickstart.pdf
8. Non binary gender registration models in Europe: https://www.ilga-europe.org/sites/default/files/non-binary_gender_registration_models_in_europe_0.pdf

Aims Website

Link to the Aims website - direct to this article.

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Birthing Whilst Fat.

Why do we need to talk about fat birth?


1 in 5 people birthing in the UK today is obese – or fat. 20% of all the people that birth their babies are treated differently, ushered down corridors of intervention, all of which may not be truly necessary. This is risking the physical and mental health not only of those who birth, but their babies too. 

98% of mothers with a BMI over 35 gave birth in an obstetric unit, A third undergo induction of labours and 20% had a cesarean birth prior to labour (1).


BMI is BULLSHIT. 


Many, many articles have done a better job than I have ever, or could ever do at quantifying the nitty gritty of why BMI is bullshit. A weigh lifter with 5% body fat could weigh more than a person who never does any physical exercise. But the BMI would suggest that this uber healthy person, who is physically fit and able, is more at risk than someone who leads a sedentary life style.


Weight and height are smooshed together and out pops a number, which, apparently can indicate health, and ability to carry and birth ones baby effectively. 


If the number is over 25 you may be offered, key word, offered, to go on a consultant lead pathway. What this means effectively that as well as seeing a midwife, as standard, you will also see a consultant to oversee your “abnormal” circumstance.

If the number is over 30, you will likely be told that you must be induced, you must birth your baby in hospital, you cannot have a water birth, you must have continual fetal monitoring. That you are too fat to have your baby.

The concerning aspect is that intervention introduces risk. 


“The first intervention in birth that a healthy woman takes is when she walks out the front door of her home in labour.”

~Michael Rosenthal. 


We know that continual fetal monitoring doesn’t make labour safer, in fact its increases the risk of cesarean birth by 63% (2), we know that home birth for second time parents is safer, we know that being induced increases the risk of tearing (4), the likely hood you will have a cesarean birth (5) – again brings another load of risks with it (infection, future cesarean births, higher rates of NICU admissions, to name a few (6), Likely hood of needing an epidural (7). So, we see this cascade of intervention, each step leads to more risk, which could lead to more risk and so on. 


We must look at cases on an individual basis. Rather than lumping everyone over a certain magic number together on a conveyor belt that could lead them and their baby to further risks.


Dealing with the Patriarchy.  


We all know that (as the vast majority of people birthing are women and identify as such) that women are hysterical, and that the world views fat women lazy, stupid, undesirable and would rather stay home and eat cheese cake then listen to the doctors. If you don’t believe me, go and read “happy fat” by Sofie Hagen and come back. 

We’re the butt of the joke, from the clips of us waddling around, with pasta sauce over our face, to the idea of anyone wanting to have sex with us the ripe and easy subject to defile men with at the pub. It’s all too easy to once again put fat bodies lower down in our thoughts, minds and hearts when considering risk, inclusion and wholesome decent humanity.


When we then consider than many other oppressed groups are also at higher risks of gestational Diabetes, for example, Black, Asian and indigenous persons are at an increased risk of developing gestational diabetes (8). We know that Queer parents birthing at a higher risk of Postpartum depression than their straight, Cis cohort (9), We must acknowledge that it may be doubling down the risk for these parents and babies. Those are the cross section of two or more oppressed or at risk groups at what point do the benefits or reductions of risk out weight the risk of the intervention being offered.

Parents are, capable, smart, biologically hard wired to protect themselves and their babies, and the current system of conveyor belt care maybe, putting people birthing, their babies, their wider families at further risk. 


Greater education for parents in their rights (I recommend “am I allowed” by aims buy it here: 

https://www.aims.org.uk/shop/item/am-i-allowed) and greater funding for health care professions so they can do the job they want and need to do; provide personalised, tailored care for each family that needs or wants their support. 


Sources:

1: https://www.publichealth.hscni.net/sites/default/files/Maternal%20Obesity%20in%20the%20UK%20executive%20summary.pdf

2: https://evidencebasedbirth.com/fetal-monitoring/

3: https://www.nhs.uk/news/pregnancy-and-child/births-at-home-or-in-hospital-risks-explained/

4: https://www.acog.org/Patients/FAQs/Labor-Induction?IsMobileSet=false

5: https://www.acog.org/Patients/FAQs/Labor-Induction?IsMobileSet=false

6: https://www.nice.org.uk/guidance/cg132/chapter/appendix-planned-cs-compared-with-planned-vaginal-birth#appendix-planned-cs-compared-with-planned-vaginal-birth

7: https://www.nice.org.uk/advice/esnm38/chapter/Introduction

8: https://www.cdc.gov/pcd/issues/2012/11_0249.htm

9: https://www.researchgate.net/publication/271625750_Postpartum_Depression_in_an_Online_Community_of_Lesbian_Mothers_Implications_for_Clinical_Practice

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Secret - it's drawn from a real picture of me! 

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Why tongue tie, really, fucking, matters.

The reason I have put off writing about this for so long is because I knew it would be difficult.


I knew that it would cause me to once again blame myself and question everything I was ever told. 


My story isn’t a single voice in the night, all too often throughout my career of working with new parents I hear the same story. So I am sharing mine, to show the extent of damage not having adequate support for new parents does.


Izzy was 10 days old when she was readmitted into hospital due to a 14% weight loss.  I was told a number of things. 


1. I was too fat.

2. Its because I had gestational diabetes

3. Its because I was young (24 isn’t that young in the grand scheme?)

4. Its because I am a first time parent

5. Its because I am not producing enough milk

6. The milk I was making wasn’t fatty enough

7. She was lactose intolerant

8. I wasn’t eating the right foods

9. I was feeding her too much so  my milk was too watery and a plethora of other bullshit.


The real reason that Izzy lost 14% of her birth weight? She was spectacularly, visibly from the other side of the room, unquestionably tongue tied.

So now I am watching my 10 day out being laid out on this huge bed in the ward, her tiny baby grow was cut from her body (still don’t know why they couldn’t let me remove it!) and nurses busied themselves, one with a cannula for her tiny hand, another putting that sensor on her tiny foot, another dripping sugar solution into her mouth because she was understandably screaming her tiny little lungs out.

My legs buckled under the weight of the moment, after all, what kind of parent can’t make enough milk for their own baby? 


After trying for ages they couldn’t place the cannula so they fitted a feeding tube and immediately gave her 40 odd ml of formula. 

We were sent to a side room and a breast pump was requested, which came the next day. 

The few ml I was getting was given through the tube and the full amount of designated formula was given after.

After a few days, they said if I agreed to formula feed then we could go home, because clearly, my milk wasn’t good enough, clearly I was making enough, clearly she was a hungry baby, clearly I couldn’t feed my baby.


So, 2 and a half years later, Emma came into our world, calmly, into the water at home, herself and I untouched, uncoached and undisturbed. Into the water, bliss.

Immediately, now I knew the signs, I saw it. That flap of skin, the tugging on her tongue as she poked it out at me when rooting for the breast.

The midwife there and then indeed the specialist NIPE check midwife who came the next day, said, ah no, just a small one, that’s not too bad, she will be fine, plus she’s a BIG baby (9lbs 2oz) so just feed her lots and lots and you’ll be fine. Well at the end of day 2, with Emma having barely left my skin, my breast, amongst this sea of hormones, still bleeding and longing to get to my cave and be with my baby alone, safe, alone. I started to call IBCLC's (International board of certified lactation consultants) that I could get to. I needed to get this ball rolling.


The only one who would see me this side of the weekend was in east London, not too far I said hopefully, 40 minutes in the car, hour and a bit by train, we’ll go in the car.


Emma had over plans, you see there were two options with Emma, on the breast, or screaming. Due to the restriction on her tongue, and, what we now know is her feisty, I ain’t taking no ones shit attitude, before we even got the car seat in the car, I snatched her from the grip of its buckles and ran as fast as my 3 day old raw birthing body would carry me back into the house.

We called the IBCLC she agreed to move out appointment back an hour so we could get the train.


When we arrived, Petra, was so calm, motherly, warm and safe. After some time watching us feed, watching how we moved together and listening for my baby drinking she noticed that unfortunately, Emma was not strong enough to get my breasts to “let down” there were no big gulps, there was no pause, just frantic, furious suckling until, exhausted she would sleep. 


Too hungry to sleep, too exhausted to feed. The cycle we were stuck in.


So she examined Emma’s tongue, and her ability to move it, up and down, side to side, Emma sucked away at her finger a few times before realising no milk was coming from here either! Petra confirmed what I already knew, she had a posterior tongue tie.

Petra sorted some forms and told us to go home and ring Kings Collage London tomorrow morning and ask for an urgent appointment and she would fax our forms over so they are ready and waiting


On the train on the way home, I blubbed to my friends. It was happening again. They hadn’t been in my life when Izzy was born, and they were about to show me the difference it can make having informed, passionate other breast / chest feeding parents in your world.

When I got home there was a cool box on my door step, inside were a box of lactation cookies, and 4 small bags of breastmilk. 


Petra had showed us how to make a make shift SNS (Supplemental nursing system), its effectively a tiny tube, in this case a veterinary catheter, attached to a milk receptacle, we were using 20ml syringes.

I would put the donor milk into the syringe, attach the tube to be level with my nipple then latch Emma on, She would get the milk from the syringe and whatever I was able to produce for her and it would encourage her to nurse. Rather than her tummy be suddenly full like Izzy’s was, when they put the formula down her tube. Funny I’ve just recalled laughed with my spouse when they did this and Izzy would make sucking motions. Now I know she did that as it was her inbuilt instinct to suckle to get milk. Ouch.


So we got the appointment for kings, on day 12 of Emma’s little life. Two trips to the city in just 12 days of life. Big city kid. 


These 8 days were a blur of well wishers, all wanting to hold the baby, fat fucking chance, you would have to surgically remove her from the breast first. Pumping, oh the pumping. Erg. The teas, the lactation cookies, people coming to drop me donor milk, 7 women in total gave me, well Emma their milk. Still get choked up thinking about what people did for us, did for her, did for me. 


But we made it and they divided that sucker there and then, Emma went first, because she was the youngest, and we had to stick about so they could check for bleeding etc. after, so I made myself busy adjusting everyone’s slings in the waiting room, I had a line at one point! As I skillfully fed Emma in the ring sling and everyone gushed and marvelled. I was going to OWN THIS SHIT now, she’s got her tongue snipped I said to myself as my smug ass waddled back to the train and she slept, nestled, between my breasts, ALL THE WAY HOME.


Miracle cure I said to Adam, my spouse. 

UNFUCKING LIKELY.


After a few days It was clear that Emma slept out of exhaustion and shock rather than being full. We returned to the SNS, pumping, donor milk, teas, supplements and I started taking domperidone. On the 1st of October, we had finally saved enough to visit Doctor Levinkind. Emma was now nearly 4 months old. She had fallen from the 96th to the 2nd centile, but all HCP, including the dietitian and pedestrian at the hospital said she was perfectly healthy, just small, which seemed unlikely looking at her sibling, and her parents but we shrugged, happy in the fact that the doctor said its fine, and carried on.


Doctor Levinkind noted several buccal ties as well as a lip tie, and of course, the rest of the tongue tie that kings, either missed or didn’t divide in the first place. Emma had chiropractic and Cranial Osteopathy in the hope that she would in Adam’s words, calm the fuck down.

Again we forked over hundreds of pounds and again Emma’s tongue tie was sorted. 


Doctor Levinkind is marmite, you either love him or hate him, and I loved him. He was funny, warn and knowledgeable, more than that he gave me HOPE.

Emma was lasered, and had a mouth like the Dartford tunnel and we cracked on. 

A few weeks later we went to a weigh clinic and I hugged the HV and did a, in hindsight, much to aggressive air punch when they said Emma had gained an entire pound.


Once Emma could have food a couple months after we stopped the donor milk, and now, sitting beside me grabbing at the laptop is a nearly 4 year old, healthy, happy, still with the not taking any of your shit attitude that I’ve grown to love. She hasn’t asked for the breast in a few month, I offer every now and again, and she places her head on my lap looks up at me and laughs, lets the breast touch her face, sniffs, and says MILK ALL GONE and runs off to do her ever so urgent and important preschooler shit and doesn’t look back.


Once Emma has sorted we turned out attentions back to Izzy, who at this time was starting through the system of speech and language therapy and alike. We were told repeatedly that she is tied yes, but it doesn’t affect speech. 


Cant lift her tongue well enough to latch onto the breast, cant lift her tongue well enough to make a TH sound, cant make a S sound, cannot not dribble or spill when eating or drinking, but sure, it doesn’t affect speech.


Unknown to us at this time Izzy is Autistic, she has autism. So her speech and language delay could be explained away but as time went on and some words did come, they were mispronounced to the point no one, but me and my spouse could understand the few words she did have.


She made her own language up, she wasn’t waiting around for us to figure her out so she sorted it. Love that. At 3 we had, chuckt chuckt, Tockatocka tocka, Dadadad, and Ahhhhhhhhh. We figured it out most of the time. One glorious day as I said with nursery rhymes playing, boobing Emma, standard, the most unexpected, glorious sound came. “Un, ooh, eeh, Or, ive” (once I caught a fish alive) Ick, ‘eaven, eit, ine, en, (then I let it go again) I SCREAMED. Awaking a very pissed off and letting me know about Emma. Izzy repeated this for hours and hours as I cried and cried, and I knew, I fucking knew it, I could see her tongue, anchored to the floor of her mouth, I could see the triangle it was making at the front and the divot in the middle like someone putting a nail gun trough an open parachute.


 I FUCKING TOLD YOU SO MOTHER FUCKERS.


So we turned, like most parents in the 21st century, to Facebook. We found a group, we found a provider that would see an older child, we sat our arses down in the GP’s office, lied through our teeth (that she had already been diagnosed with tongue tie) and got our referral to Norfolk and Norwich hospital to see Mr Minocha *queue the choir of angels*

We dragged everyone up to Norwich and we hadn’t been in the door 2 minutes before all the doctors and nurses, were cooing over Emma, and fascinated by Izzy. “how couldn’t they see it” “ you poor things” “oh how did you manage” “oh you are a trooper” “this is ridiculous, they couldn’t see THAT!” 

Surgery was set for 4 weeks later.


On the 27th June 2016, just before Emma’s first birthday we once again travelled the 2 hours there, 2 hours back to Norfolk and Norwich and I held my 3 and a half year old as she went under general. 

As any parent who’s done this, they will tell you its fucking rough. 


She will be back in 20 minutes and you can come into recovery they told me. 

Half hour later.

40 minutes later.

50 minutes later.

I ‘am doing my best to remain calm, and I finally ask in my nicest, politest, scared shitless parents voice. WHERE THE FUCK IS MY KID.


68 minutes later, I am told she is in recovery and I can go down. She is out of it, doesn’t know what’s up and what’s down and she whispers something, what’s that darling, Esssie, essie? Essie, ple(ase) Essie. Im about ready to tear this hospital apart to look fro essie. What the fuck, or who the fuck is Essie. 

Essie she musters a final time, essie bowboy. The fucking penny dropped, she wanted her Jessie cowboy. We had promised and promised, she would wake up to a brand new Jessie from toy story. She doesn’t miss a beat this kid. At which point I remember I am holding the bloody doll and hand it over.

Few hours later everyone is happy she’s had some yogurt, she’s getting back to herself, read, trying to launch herself across the recovery bay to get to the toys, so we get back into the car for the return leg.

They both slept the entire way home. Bliss.


Over the next few days Izzy made sounds I’ve never heard. She never once cried, or said it hurt, well she did cry actually but only because she couldn’t have any crisps!

One, two, three, four five (once I caught a fish alive) Six, Seven, Eight, Nine, TEN! (then I let it go again)

It was earth shattering the first 20 times.

Remarkable the next 50.

The following 1000 could not have been better.

The screaming it in Lidl at 8 in the basterd morning was still music to my ears.


Now before you ask, no there is no research on kiddie winks, tongue tie and speech, but I know what I heard. I know what I saw. 

Don’t rush out and get snipping on this rather long and sweary blog, its not backed by evidence, its not peer reviewed. 


Its our story.


Our messy, expensive, long, heartbreaking, elating, devastating, victorious story.


The point? Tongue tie is fucking important.


I was handed this picture today by my mother in law, it shows little Izzy and her smack you in the face obvious tongue tie. It took all I had not to cry, as they are all gushing and cooing over baby Izzy, as her 6 (and a half she will hasten to add) self, sits embarrassed on the other side of the room.


The other point, is the failure I felt, Izzy is failing to thrive, she is failure to thrive. The only people that failed were the specialists and the people who should have seen this tongue tie. 


I didn’t fail. Izzy didn’t fail.


It took me nearly 4 years to get to the point of accepting this.


The wonderful people in our NHS are under paid, under staffed, under appreciated and people will fall through the cracks, I know, its an imperfect system.


But its lucky, isn’t it, that we had the means to go private, its lucky isn’t it that we had the connections, the wildly dedicated friends to share their information, love, cookies, and fucking breastmilk with us. 


Lucky.


Black Maternity Health Week 2019

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LGBT BAME rights in maternity. 


As a Doula (like a non medical midwife that supports families emotionally through pregnancy and birth) I spend a lot of my time going over facts and figures with clients, so that they can make their own informed decision about their care.


As an out and proud Doula, when LGBT* people come to me in need of support there isn’t one single study that focuses specifically in the birthing outcomes (how happy people were with their experiences, as well as their physical outcomes, i.e: rates of birth by caesarean section, induction of labour, maternal and infant mortality) of LGBT* parents.


There is limited research into the birth outcomes of BAME people, namely the MBRRACE study(1) that showed us that black women are 5x more likely to die in child birth in the United Kingdom. Not globally, in the UK. Where white women die at the rate of 8 in every 100,000, Asian women die at 15 out of every 100,000, over twice as likely as white women, and black women a shocking 40 out of 100,000, 5 times the risk.


The immediate  reaction from most is to blame black bodies. That they are some how less able to birth, or blame is placed on socioeconomic factors, that black women don’t educate themselves, or cant afford to attend clinics etc. 


However, on the African continent and in the Caribbean when you remove the socioeconomic issue they are not at more risk than white women, so the BAME people birthing in the country they were born and raised in have similar outcomes to white women. When they are born and raised in the UK that is where the disparity starts. So it is the microagrresions and the systemic and structural racism that they live and birth in that puts them at increased risk. (2)

So what does this mean for those who fall into both of these groups?


We already know that LGBT persons are more likely to struggle to get the help that they need, in health care providers and that many health care professionals feel that they lack the understanding, experiences and training to support or offer their services inclusively. 


We already know that LGBT* people are at increased risk of suicide, unemployment, homelessness, certain cancers and other health conditions (3), especially Trans people, with Trans Women of Colour being the most at risk of physical and emotional abuse and of murder (4).


This week more than ever we need voices of LGBT* people of colour amplified and more awareness of these shocking rates of disparities.

So by understanding that those at this “double risk cross section” need more support then ever, I want to make and hold space for your voice in my LGBT* competency course I am writing.


There are many people leading the way in trying to unpick the reasons and find solutions of how to fix the system that causes the disparities for people of colour who birth. Namely Mars Lord from Abuela doulas (www.abueladoulas.co.uk) who will be editing and ensuring that the LGBT* competence course I am writing is not only LGBT* competent but culturally competent too.


This course will reach all manner of birth workers and your story could be the key to gaining more momentum and visibility of those who birth outside of the worlds hetero-white-normality.


I am particularly interested in hearing from any Trans men of colour who may have or want to birth or feed their babies. Your successes and your struggles.


Please get in touch if you want to discuss it any further. 


Sources:

1.  Source - https://www.npeu.ox.ac.uk/mbrrace-uk/reports

2. Source: https://blogs.bmj.com/bmj/2019/04/08/amali-lokugamage-maternal-mortality-undoing-systemic-biases-and-privileges/

3. Source: https://www.gov.uk/government/publications/national-lgbt-survey-summary-report/national-lgbt-survey-summary-report

4. Source: http://www.thetaskforce.org/new-analysis-shows-startling-levels-of-discrimination-against-black-transgender-people/


Language and why it is important.

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Birth-workers all over the world, by which I include: Doulas, Midwifes, Consultants, Health Visitors etc, all recognise how important language is.


As I am often mainly, speaking with Midwifes, I was really pleased to hear the roll out of recommendations to stop using the terminology focused around the “Delivery” of babies. A student midwife attending a birth in East London recently told me they use “catching” now. 


So the discussion of language is always rolling around in birthing world. We also talk about language in hypnobirthing, surges in lieu of contractions, power in place of pain and very commonly in the wider world partner rather than husband or wife. 


When it comes to the language of pregnancy and birth in the LGBT* world its often dismissed or minimised. 


Why is language important. 


For the same reasons its important that midwifes or doctors don’t  “deliver” a parents baby not all who birth are mothers, or women. 


We know that Trans and non binary people have often developed a distrust in health care professionals due to Transphobia, source: NHS PHE Screening booklet 2018. This booklet states that “trans people may be at higher risk of cancer due to risk factors, such as higher rates of smoking and alcohol consumption” and that “many healthcare professionals report they lack the knowledge required to meet the needs of these patients”


Unfortunately we lack the studies and the understanding of Non Binary people and Trans Men surrounding birth. We know that almost half, 48%, of trans people have attempted suicide at least once, and 84% have thought about it. (source: Stonewall, www.stonewall.org.uk/sites/default/files/trans_states.pdf) 


We absolutely must make change to ensure the inclusion, visibility and well being of trans and non binary people in the world, especially as all birth workers accept that the most vulnerable time during a birthing persons life, is their pregnancy, birth and postnatal period.


So what can we do? As parents, as birth workers, as members of society?


Smallest acts can effect huge change, so if you offer a product or service is it inclusive? Not just “queer friendly” but competent. 

In the same way we need to invest in cultural competency and cultural safety (for more see here www.abueladoula.co.uk) we need to invest  in our knowledge to help the vulnerable people in our world.


Passing laws to ensure that same sex couples can marry and adopt doesn’t take anything away from heteronormatily our society places on marriage and parenting.


Language is a free, easy and visible first step. 

Language isn’t the end, the final hurdle, to then sit back and declare ourselves woke, educated, fair, open, equal or any other lip servicing expression to tick a box on our CPD or to make ourselves look good and feel better.


Does your website, social media or business plan include language for your potential customers to identify with your products or services?


Are they able to recognise themselves within the sea of language?


Including LGBT* language doesn’t have to come at the exclusion of the huge majority. The mothers, the women, the hetero, the cis. 

Just as race orbits whiteness as its epicentre, sexuality identity orbits Cis – Hetero-normality. 


In the same way that ensuring our business or public premises is wheelchair accessible we take nothing away from the able bodied people visiting.


We understand that we are the minority, but the fulfilment of seeing yourself represented in the thoughts and goals of others can’t be underestimated. 


Simple ideas as including a smattering of mothers and birthing parents,  they and them as well as He or She, parents instead of Mother and Father, or even their names. Which reminds me of another request to use first names rather than “mum” or “dad”  with midwifes, HV etc. as it could be dehumanising for new parents to loose their identity before or immediately after birth. 


So can we afford the ink, time and space to ensure that as many people as possible are represented, visible and loved?


Its not fucking pie.  


Birth Traditions

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Birth traditions sadly in my family are non existent.


Unless you count my fierce as fuck Northern Irish Nanny birthing all of her 8 live babies at home, including twins.

 

But traditions surrounding birth and pregnancy not so much.


I was born 6 weeks prem and my mother clearly found that hugely traumatic as whenever I’ve asked about it previously she cannot discuss it. Only that my dad walked in in time to catch me!


My in laws sadly, like my own family lack tradition, culture or history. 


Like most working - emerging - middle class, white people we all took the “best” option which was always billed to us as sit down, shut up and do what the people in the white coats tell you.

 

And so no one but me in my family that I have asked apart from my grandmother, who is no longer with us, has birthed anywhere but a hospital. 


During my time as a doula I have supported many BAME birthing parents and their families and have witnessed some ancient and religious traditions. 


I was not prepared for how moving this atheist would find it to watch a tearful, exhausted but elated first time Dad whisper the call to prayer in his 20 minute old sons ear. 

Or how much my heart would ache as another clients grandmother prepared her Golden milk as she nursed her 10 day old daughter.


So, traditions or culture surrounding birth or pregnancy for me, sadly is only fear and doing as you are told.


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Let’s talk about bias or defaults.

We all have biases, or defaults. We all do.


This doesn’t automatically make us bad people. Refusing to acknowledge or change might.


Being born and raised in an affluent area to a white, middle class family it’s no surprise I have racial bias. Being raised by a northern Irish family I have a bias for that accent. Bias’s can be “good” and “bad”.


Those biases cover sexuality and identification too, being queer, specifically Pansexual the misconception is that I am “gender blind”.


I’m not gender blind, I love gender, more specifically I love it when people express their gender how they want. I’ve always said the reason I find Trans people attractive is partly due to their fearlessness to express their gender in a way that completes them. 


So what has all this got to do with being a Doula?


Supporting families means just that. Families. In their ever changing, non conforming, deliciously different and fulfilling variants.


That’s what doulahood means, that’s what supporting families means.

It is essential to recognise that you will support people outside of your defaults, and the defaults that society has placed on us.


Most of the time the birthing parent will be a woman, most of the time their partner will be a single other person and it’s hugely likely that person will be a man. 


Does that mean it will ALWAYS be that way?


The defaults our society, upbringing and exposure has put on our interpretation and expectations.

Smash them love, throw the whole damn thing out.


I can afford the ink and the space to acknowledge that people exist out of the default, and that those people deserve support to.


Doulas for all.

Doulas for all: its more than just a tag line, its your words and actions.

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Having just read Doula UK’s autumn copy of “The Doula” magazine where they speak with Morgane Veronique Richardson. Morgane is the director of the NYC Doula Collective, they talk about their experience as a Doula of colour and a member of the LGBTTQIA* community.


What struck me first and what had me doing a little queer dance was not only did DUK acknowledge the need for such an article but that it took up 3 entire pages of this relatively short publication. Win.


Secondly, the tag line: “I really see the importance of LGBTQIA families having care providers who are active allies – not just ones who claim to be queer–friendly or queer-competent”

There is a huge difference between being “Queer Friendly” but being actively queer aware and inclusive.


We cannot take a one day course in equality and diversity, hang up our hats, give ourselves a pat on the back and declare ourselves woke, educated, fair, open, equal or any other lip servicing expression to tick a box on our CPD or to make ourselves look good and feel better.


It’s ALWAYS going to be forever changing, forever evolving journey to inclusion and equality.

Look at the changes to language (like and not exclusively with LGBTTQIA*) as a reason to celebrate.


Another oppressed group have finally got their recognition, they are finally represented in the language or name of their community, and the world. 

Their long, hard fought efforts have paid off in validating glory.


Yes it is hard to keep up, and yes we will get it wrong. Respectfully apologise, correct, and inform yourself. 


Doulas for all.


100% conversion rate

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 When I first started going on doula interviews, I was obsessed with the image I was displaying. 

Who was I? Don’t say fuck, don’t say fanny so much they might not like it! 

Now I try to say fuck and fanny within the first 2 minutes of meeting people, because I say fuck and fanny a lot.


I also try to let people know I’m queer, I make it clear I have racial bias, but I’m working on it. I make people aware I’m a carer to my father who is an amputee and a paraplegic, my grandmother who has Alzheimer’s and my daughter who is autistic amongst other diagnosis.

I make it known I’m a bit of a live wire, and I often speak before I think. I make it known I am too “lion hearted” for my own good. 


More importantly, I let them know that I want them to meet other doulas, meet all the doulas!

Interview everyone. Email them all! 

I used to want a 100% conversion rate from interview to booking. Now I want people to book me when they know me. They know how I can help them and most importantly, they know when they are in the most beautiful awe inspiring stages of labour and that I am standing behind them. 

Not just physically but emotionally and entirely. 


You have not only chosen me, I have chosen you (shocker, I have said no, as most doulas have)


So if I am the one holding your hand, or the one I am wrapping my sling around when that contraction hits, there is no doubt we both wanted to be there, in that moment. 


So to the families and women who haven’t hired me. I am grateful, I wasn’t your doula. I am so glad you found them. 


There are no perfect scores when it comes to advocating, supporting and loving families. 

 

Quote taken from Mars in Hyde Park Summer 2018. To find out more about Mars Lord, click below