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This isn’t just our profession, but our true passion - so you can rest assured that you’ll be in the best of hands.A Birth Story You Are Proud OfA Protective, Nurturing, Calm Environment For BirthHelp And Support As Your Family Grows

BEFORE WE RELAX…It is important to note that:• Everything contained in The Doula Hub pre-birth sessions is a starting point for discussion and further research.• These topics are designed to give you seeds of thought to help you grow your knowledge of birth, build your own preferences and desires, and create your unique approach to birth and newborn care.• We will discuss all of the areas and we will take note of any areas that we can help you further explore with evidence reading and research after we finish.• Nothing herein or that we will discuss should be taken as advice or recommendation – and nothing we will discuss refers specifically to you or your pregnancy.• Please ask anything you like, read and research yourself, and talk to your medical providers with any questions or concerns.• This birth is yours alone, and anyone else there is attending as your guest. It’s your party.

SESSION 1 - RIGHT BRAIN EMOTIONAL💓• This session can be quite tiring – let me know whenever you need a break.• The role of a doula.• Hopes and fears, myths or rumours • Your knowledge of birth• Birth physiology and hormones• Your due date• Birth preparation – mind, body and logistics.• The Doula Toolbox• Areas of concern or questions – reading list.• Questionnaire for birth preferences.This session will put your mind to rest and help you look forward to the birth together.

SESSION 2 – LEFT BRAIN PHYSICAL RECAP SESSION 1 – ANY QUESTIONS• Discuss your birth preferences.• Practical techniques for comfort in labour - massage, acupressure and aromatherapy tips. • Stages of labour. What to expect and actions to take as labour begins, Positions and places to relax as labour progresses. • The importance of the Golden Hours.• Postnatal period – reality and planning. Building the Baby Bunker. You will feel prepared and excited for the birth and to welcome your baby!

S E S S I O N O N E

“A doula is like a tour guide for birth. You could get from A to B by yourself with a map but being with someone who knows the landscape and speaks the language can make the experience easier and more enjoyable.”• Support in pregnancy – information and birth preparation• Continuity of care in labour – advocacy and practical help• Safeguarding of the golden hours and early postpartum period• Evidence of a better birth – shorter labour, fewer unwanted interventions, fewer caesareans, and greater birth satisfaction.Evidencebasedbirth.com/Doulashttps://www.cochrane.org

Y O U R H O P E S & F E A R S

Y O U R K N O W L E D G E O F B I R T H• Have you given birth before – what was your experience?• Do you have any religious or cultural beliefs about birth?• What was your mother’s birth like when she had you?• Have you attended any courses or read anything that influences your perception of birth?• Do you have an friends or family members who have told you about their birth?• Have any strangers, well-meaning or otherwise, told you about their births?

FEELINGS ABOUT THIS PREGNANCYWe might consider about how this pregnancy fits within your own story.How long had you been trying to conceive? What was that journey like for you? How do you feel about the pregnancy now? Are there any feelings that you didn’t expect or that are more complex than you expected?The journey you walked to get here is an important starting point for the pregnancy, but also for the birth itself and the postnatal period.

W H A T M A K E S A ”G O O D B I R T H” ?• Doulas do not give advice – we do not have a preference for how your birth progresses.• Term used by many birthworkers is physiological birth – no birth is “unnatural”• Largest survey of birth satisfaction found that women are no more or less satisfied because or the place or way that they birthed.• What does influence birth satisfaction is how informed the parents are about what birth will entail, and how involved they are in decision making during birth.• Education and advocacy are far more important than vaginal vs abdominal, physiological vs assisted, medicated vs non-medicated.

B I R T H P H Y S I O L O G Y To have a calm and straightforward physiological birth, the brain needs to produce oxytocin and endorphins. Their production is inhibited by adrenaline, so it’s important that during labour:• The birth space is protected as a sacred area – no unwanted intrusions.• Keep lights low and voices hushed.• Negative language is avoided.• As few people as possible in the birth space – minimal distractions.• The birthing person can move freely to birth comfortably.• Food and drink can be taken as needed.Labour is not a thinking process. We do our preferences and planning before, so your primitive brain can be allowed to take over from your human brain during birth.Increased anxiety = increased pain levelsNocebo effect - perception and expectation of pain causes pain.What do other mammals’ stop-start labours teach us?

H O R M O N E S T H A T D R I V E L A B O U RFor full animation click here

3 S T A G E S O F P H Y S I O L O G I C A L B I R T HFor full animation click here

W H Y T H E C E R V I X D I L A T E S I N L A B O U R• Bag of powerful muscles to maintain the pregnancy• Most of birth is the process of the cervix , thinning and opening• Upper vertical fibres work to draw up/lower deeper horizontal hoops release• Conflict between the muscles leads to an inefficient , uncomfortable and longer labour • When the muscles work normally we have a more efficient, more comfortable, shorter labour with fewer surges

• Involuntary process (coma)• Horizontal muscles like squeezing toothpaste or moving a tennis ball down a sleeve, while the vertical muscles are like pulling a turtleneck over your head.• Movement can only happen during a contraction• The whole second stage can last quite some time, look at how much baby must do. • Hormones present - Oxytocin causes contractions of the active segment, prostaglandin helps relax the passive segment muscles• Two steps forward one step back• Once the head is out the body must move and rotate to for the shoulders through• Foetal ejection reflex – backwards vomiting 😉• Conflict between the muscles leads to an inefficient, uncomfortable and longer labour – stay relaxed and breathe• When the muscles work normally, we have a more efficient, more comfortable, shorter labour with fewer surges.V A G I N A L C H I L D B I R T H

• Pain in labour is a side effect of a normal process• There are lots of examples of pain that we are not fearful of, like physical exertion. We accept those, labour is the same. Look at the word labour ‘make great effort’• Pain doesn’t have to rule the labour – when medical providers take away the pain there is interference with the hormones and the labouring woman’s body in getting ready for the baby. • Pain is a unpleasant physical sensation, can be damage or physical exertion.• Suffering is a feeling of being overwhelmed, out of control or helpless. You can have suffering without any pain e.g. emotional suffering.Some women suffer in childbirth because of the way they are treated, respected and due to feelings of being alone. This can turn the pain into suffering. Pain is present but should be manageable. If it’s not then there are several tools available to you, including pain medication to help. If a woman crosses from pain into suffering then we have failed her. Having a code word is a great way for the woman in labour to communicate when the pain has changed to suffering so that her support team can intervene and get her the help she needs. P A I N V S U F F E R I N G

B I R T H P R E P A R A T I O N

P R E P A R I N G T H E B O D Y • How has this pregnancy been? (Are you expected to go to term, means of delivery, any complications.)• What were your previous pregnancies and births like – these leave a lasting imprint.• Fitness and strength.• Perennial massage (Athletes, dancers, horse riders, runners, yoga and Pilates) those with strong core muscle - most important. Practice from 37 weeks onwards.• Kegels (Pelvic Floor) - add flexibility and teach you to relax it. Not as necessary for athletes to strengthen, but must learn to relax (let go).• Cat cow and Miles Circuit to prepare baby’s position. Studies show both help.• Counting kicks.• Diet – building strength and health.• Partner to exercise and learn to relax too – endurance in birth.• Sitting on a birthing/exercise ball regularly. UFO

P R E P A R I N G T H E B O D Y

P R E P A R I N G T H E M I N D• Mental strength as important as body, preparing for the birth you want.• But also preparing for what happens if birth takes another path.• What kind of birth are you hoping for and what childbirth classes (hypno, NCT etc) have you done.• How much do we want to help you achieve your plan – we will prepare a word to use if you want to change your mind.• What are your stress triggers and how do you behave under stress? • What is your defence mechanism and what helps you in stressful situations?• Look at who you spend time with prenatally - affirming your choices and beliefs.• Think carefully about who attends the birth and who is around you in the immediate postnatal period. Oxytocin people vs adrenaline people. Who keeps you calm?

P R E P A R I N G L O G I S T I C S• To have a calm, relaxed birth it’s crucial to think about who will be there - sacred and intimate space.• Also consider who is in the waiting room and the pressure it adds – would you want your whole family in living room waiting for you to have sex?• Having too many people around – especially people you know - can slow or delay labour.• Constant texts and questions from the first contraction asking, “Any news?” – the pressure is unreal.• Logistically you also want to prepare for what you want – things to eat during, any equipment you need.• Any fears or worries here – ironing out logistics before you go can help to relax you ahead of birth.• We will create preferences, so all of your wishes are clear and communicated to your care team.• We will cover this in more detail in session 2.

P R E P A R I N G T H E P A R T N E R S H I P• Birth can be viewed as preparation for parenting.• In the same way that you will begin waking up in the night as your body prepares for sleepless nights feeding, the birth itself helps prepare you for parenthood.• Your doula will not speak for you, the birth is an opportunity for you two to work together and find a way to have the birth you want. • The process helps you to find your own voice, for you and your child. Agency and advocacy.

B I R T H 1 0 1: L L E T I T G O •The best advice that anyone ever gave or received about birth is as simple and as complicated as this.•Many conversations about pregnancy centre around sacrifice: the changes you’ve made to your life, your wardrobe, your diet, your body. But if pregnancy is about sacrifice, birth is about surrender. The more you fight it and the more interference you allow, the more difficult it will generally be. •Find a word or phrase that you can repeat to yourself, surround yourself with positive thoughts, and follow your body and your baby’s lead.•The best things you can do in this time are: ignore the contractions as much as possible, eat normally, do things that make you relaxed and happy, drink lots and go to the toilet often.READ – How To Have A BabyBy Natalie Meddings

T H E D O U L A T O O L B O X

T O O L S F O R L A B O U R• Light touch massage• Music• Low lighting• Peace and quiet• Food and drink as needed• Childbirth massage• Aromatherapy• Acupressure• Pouting water (waterbirth massage)• The miles circuit• Movement and position changes• Hydrotherapy – bath or shower• Birth pool• Still hands and gentle pressure• Finding a pattern that brings relief• Vaginal examinations• Intermittent monitoring• Continuous monitoring• Electronic foetal monitoring• Sweep• Early induction• Induction by AROM (breaking of waters)• Induction with Pitocin• IV fluids• Epidural and anaesthesia• Directed pushing• Episiotomy• Assisted birth (ventose/forceps)• Caesarean/Abdominal birthWe will put everything we might need into a toolbox, whether we want to use it or not. Knowing what interventions are, and when they might be needed puts you in a position of confidence and control, should the need to use them ariseLow impact supportMedical support

DRUGS IN LABOUR –PROS & CONSDRUG POSITIVE NEGATIVE USEFUL WHEN…Gas & Air (Entonox) Helps control breathing, most experience relief during contractions. Leaves body and baby quickly. Some experience nausea or lightheadedness. Can cause dreamy feeling or hallucinations. Can cause a dry mouth.Active labour begins.Pethidine Designed to relieve pain and about 50% of birthing people report relief. Some explain it as blurring or rounding off contractions. Can help you sleep.High incidence of nausea, can make you drowsy or forgetful, less able to push effectively. Baby is often drowsy and reluctant to feed. Can delay lactation. Can’t use pool.No evidence of effectiveness in studies when compared to a placebo.Diamorphine Used in the same way as pethidine but less common. Slightly less vomiting reported. As above and other opioids but associated with longer labours. Both cross the placenta.As above.Epidural Total pain relief for most, doesn’t cross the placenta. Can be used as a lower dose so you’re more mobile.Takes 40 mins to work so ineffective if close to baby’s arrival. Contractions can slow resulting in a need for syntocinon. Longer second stage and no vegus nerve for pushing.You want to sleep.Pitocin/Syntocinon Causes the uterus to contract during labour or after birth to stop bleeding.Studies show a negative effect on breastfeeding. Contractions thought to be more painful.You agree to induction or speeding the birth of the placenta.- Like any tool, every drug offered in birth has an appropriate purpose and time to use it – you don’t hammer a nail with a screwdriver. - Knowing the pros and cons helps you make informed decisions about what to take if anything.

T H E M E M B R A N E S W E E P Most commonly offered intervention – and often not described as an intervention by caregivers. So what is the evidence?Massage of cervix using 2 fingers. Releases prostaglandin. Hoping to soften & ripen the cervix and produce contractions.PROSDecreases the length of pregnancy by an average of four daysMay contribute to spontaneous labourCan reduce the need for induction for medical reasons CONSCan cause pain and bleeding.Can begin strong irregular contractions that can be painful – “uterine irritability”.Waters can be accidentally broken (9% of sweeps)Can result in stop-start contractions and long labourNo scientific evidence to support having a sweep CONCLUSION We should think carefully about having it done without clear medical necessity. For more information please follow this link

REASONS FOR INDUCTION OF LABOURTop 5 reasons for having an attempted medical inductions according to a US study were:• Baby full term• Baby needing to be born because of a a health concern e.g. Gestational Diabetes, small baby, twins, maternal age etc• Baby ‘overdue’ (40, 41 or 42 weeks). Full evidence here• Water broken and worried about infection. Full evidence here• Big Baby. Full evidence hereNational Institute for clinical excellence (NICE)“Induction of labour has a large impact on the birth experience of women and their babies and soneeds to be clinically justified. It may be less efficient and is usually more painful thanspontaneous labour. Epidural and assisted delivery are more likely to be needed if labour hasbeen induced”From 42 weeks, women who decline induction should be offered increased antenatal monitoringconsisting of twice weekly scans/ check ups

19% End in C-section31% end in C-sectionFirst-time mothers with term babies (37-41 weeks’ gestation) who experienced labour5% End in C-section20% end in C-section47% of women agreed to induction53% of women declined inductionT H E C A S C A D E O F I N T E R V E N T I O N S 1st Do No Harm – full published article

U S I N G Y O U R B. R. A. I. N.Unless there is an obstetric emergency, we can ask for a little time to consider any treatments or interventions that are offered. B – What are the benefits?R – What are the risks?A – What are the alternatives?I – What does my instinct tell me?N – What if we do nothing? This moment to consider the options, however short, can be the difference between feeling involved and consulted in the birth process and feeling that birth took a path you didn’t want it to.

P L A C E O F B I R T H Home – with or without water, home gives flexibility about where you birth. Two midwives attending. Get into your own bed after baby is born.Midwife Led Unit - staffed by midwives and can be free standing or a separate department within a hospitalObstetrics unit/Labour ward - Obstetricians work in an obstetric unit in a hospital, although most of the time midwives will be caring for a womanWeigh risks and benefits of each birth setting Women in well integrated settings who intended to give birth at home compared with those planning a hospital birth were;• 40% less likely to give birth by caesarean section• 50% less likely to have an operative vaginal birth • 70% less likely to use epidural analgesia• 55% less likely to have an episiotomy• 40% less likely to experience a 3rd or 4th degree perineal tear• 60% less likely to receive oxytocin augmentation of labour (Induction)Adverse maternal outcomes were also less frequent among those intending to give birth at home with;• 75% fewer reporting maternal infection• 30% fewer reporting postpartum haemorrhageResearch published by LancetWhere should we have our baby??HomeMidwife Led UnitObstetric UnitGas & Air (N2))YesYesYesTens MachineYesTake from homeTake from homePethidineYesYesYesDiamorphine?YesYesEpiduralNoYes (some)YesBirth PoolYesYes (limited)Some Bag & MaskYesYesYes1 to 1 careYes (2 to 1)(Yes)(Yes)Consistency of careYesSomeSomePrivacyYes(Yes)(yes)Birth Partner presentYesYes(Yes)FoodYes(Yes)(Yes)Stitching (if required)(Yes)(Yes)YesInjection for haemorrhageYesYesYesWhere should we have our baby??This is information for just you to consider – you need to decide to have your baby in the setting that is most comfortable for you, whether that be home, midwifery unit or labour ward

W H A T I S Y O U R D U E D A T E ?HOW IS IT WORKED OUT? • Your EDD can be worked out in several ways.• At first, it’s calculated according to the date of your last menstrual period using a theory called Naegele’s Rule. • This dates back to 1744 and is based on Biblical teaching that human gestation lasts approximately 10 lunar months. CAN THE CALCULATIONS BE WRONG? • Because of variations in many women’s cycles, the estimation of the date of ovulation can be out by a week or more. • Later in the pregnancy, your baby will be measured at the 12-week scan and the EDD estimated again, often altering your first EDD, but this is not able to consider whether the baby may be bigger or smaller than average. Make plans for the week following your EDDWHAT IS IT GOOD FOR? • Research suggests that the risk of negative outcomes for the baby are increased the further beyond EDD the baby goes. • The increase is small, and with carefully monitoring of mother and baby most issues can be avoided, but your care team wants to be aware of this so they can offer you appropriate support.WHAT ISSUES MIGHT IT CAUSE? • Recent studies found that up to 80% of mothers gestate to beyond 40 weeks, with the average first time mother birthing her baby at 40 + 5, which makes for an awful lot of women being termed ”overdue”. • For some care providers, this can lead to pressure to “get things moving” which can be difficult if you’ve decided not to have any interventions. WHAT IS IT FOR? The EDD is an estimation of when your baby is due to be full term, but all is not as it seems…. Born on due date4%Born before due date…Born after due date80%Excellent link to find out more on EDD here

T H I N G S T O C O N S I D E R W H E N C R E A T I N G B I R T H P R E F E R E N C E S • Where do you want to give birth?• Who do you want to have in the room?• How do you feel about vaginal examinations or monitoring for you and baby?• How are you feeling about the birth?• How present do you want the care provider to be?• How did your previous births go if relevant?• What do you want the atmosphere in the room to be – light, conversation, music, medical students or limited personnel. • Do you have preferences about the comfort measures you’d like to use?• Are there any additional requirements or considerations that the medical team should know?• How do you feel about guided pushing?• Who would you like to catch or discover the sex of the baby?• Who should cut the cord and when? **• Do you have plans for your cord or placenta? • How would you like to deliver the placenta?• Do you have any considerations in the case of caesarean birth?• Do you have plans for the first moments and hours with your baby – feeding, skin to skin, wiping baby, weighing, newborn checks? The Golden Hours• What have you decided about Vitamin K?** Delaying umbilical cord clamping (DCC) for 1 min or longer following a neonate's birth has now been recommended for preterm and term newborns by multiple professional organizations. DCC has been shown to decrease rates of iron deficiency anaemia, intraventricular haemorrhage (IVH), necrotizing enterocolitis (NEC), and blood transfusion – link to full publication here

B I R T H P R E F E R E N C E SNAME: Joanne SmithNHS NO: 551-820-2345DOB:20/06/1984BIRTH PARTNER: John Smith (Father) & Lauren Milligan (doula)EDD: 22/04/2021PLANNED PLACE OF BIRTH: St John’s MLUMIDWIFERY TEAM: JadeThank you for your help and support at the birth of my baby. This is my first baby, a little boy, and I have chosen a low-intervention, physiological birth in the midwife-led unit. I have been working with my doula to practice slow breathing and natural comfort measures and would like as far as possible to create a calm, quiet environment to help me birth my baby. Once he arrives, I would like to have skin to skin and breastfeed as soon as possible, and would really appreciate delaying all checks for a few hours. I understand that sometimes birth takes its own path, but these are my wishes all being well. I really appreciate your support and care at the birth of my baby. DURING THE BIRTHI would like to have a calm physiological birth, so would ask that birth be allowed to take its own course providing it is deemed safe by my care team. I would like a quiet, dimly lit environment for birth with as few people as possible in the birth space. I would like to be able to eat, move freely, and use any other comfort measures I need supported by my doula, Lauren. I have practiced natural comfort measures including slow breathing, massage and positions and also intend to use gas and air. I do not wish to be offered other pain relief - and if I want any interventions, including an epidural, I will ask. I will have vaginal examinations and heart tone monitoring as necessary, but would ask that interruptions are kept to a minimum. WHEN BABY IS BORN I would like to have skin to skin contact with my baby as soon as possible and initiate breastfeeding. If my baby needs to leave the room for any reason, I would like Lauren to accompany him. I would like to delay weighing, measuring and other checks for a few hours to allow me to spend the first few hours getting to know him and practising feeding. I am happy for Vitamin K to be administered by injection and will take my care team’s advice about the delivery of the placenta. I would like to catch the baby and cut the cord myself, if possible, and for the clamping to be delayed as long as possible.

E X A M P L E B I R T H P R E F E R E N C E S– Physiological BirthThank you for taking the time to read our birth plan. Partner – Bill 07496029683Doula – Leti 07973496092About me Labour & Birth Monitoring of BabyName – Ameillia SmithHospital # - Husband/Partner - BillDoula- Mary-Anne1st birth – unplanned c-sectionI suffer from anxiety attacks, but have this under control with Citalopram 0.5mg per dayI have an aversion to needles so please use ‘magic’ cream if neededI would like to be free to walk around during labour.I wish to be able to move around and change position at will throughout labour.I would prefer to keep the number of vaginal exams to a minimum.I would like to be able to eat and drink as I wish.We would like the Mother/Father to discover the sex of baby.I would prefer Electronic Foetal Monitoring kept to a minimum.I would prefer the use of hand held Doppler.Pain Management & Environment Acceleration Unplanned Caesarean birthIf I feel the need for pain management other than what is listed below, I will ask for it. Please do not offer it to me.MassageTENS MachineMusic and aromatherapyWaterGas & AirI would like the environment to be kept as quiet as possible.I would like the lights in the room to be kept low during my labour.I’m using HypnotherapyI would like the amniotic membranes to release spontaneously.I would like labour to be allowed to take its natural cause.We would like our baby skin-to-skin immediately.We would like delayed cord clamping as per latest NICE guidelines.We would like the room kept quiet and the lights dimmed.We would like a family centred caesarean.I would like heart monitor pads put on my back.Cannula placed in less dominant hand and arm left out of gown.After the birth Third Stage OtherI would like my baby to be delivered onto my tummy and have skin to skin.I intend to breastfeed/formula feedI would like the Paediatrician to examine my baby in our presence.We would like to be left alone after birth for bonding.We would prefer our baby to have Vitamin K orally/injectedI would prefer that the umbilical cord stops pulsating before it is cut.I am planning a physiological third stage.I would like to see my placenta.I’m keeping my placenta and have a cool box for it.Father/mother would like to cut the cord.We would like to be kept fully informed of all developments and share in any discussions and decisions.We do/do not mind students being present.

I N T H E H O S P I T A L B A G Mum - BirthMum – PostnatalPartnerBabyHospital notesBirth preferencesNightdress / pyjamasComfy Birth ClothesFlip flopsDressing gownSocksSnacks, e.g. bananas, cereal bars, honey, sweets, etc.Bottle of water with spoutTabletPhone and chargerTissues/wipesYour pillowBirth ball (check with hospital if they have them)Face clothsFairy lights or electric candlesTENS Machine2 or 3 nursing brasMaternity pads/pantsFront opening night shirt, shirt or pyjamasToiletriesToothbrush and pasteTowelsHairbrushPlenty of big cotton pantsMaternity clothes for going homePhoneChargerCameraToiletriesBookTablet for any downtimeSwimwearSnacksWaterNappies (allow 6 a day)2 or 3 sleepsuits2 or 3 vestsMuslin squares1 pair socks or bootiesA suit for going homeBlanket or shawlJacket or warm suit for winter babiesHat (usually supplied by hospital)Car seat (can easily be collected later if you have a substantial amount of luggage or a visitor can bring it to the hospital)** For homebirth you still need to pack a bagHighlighted = put on a post-it note on the fridge to pack last

A N Y Q U E S T I O N S O R C O N C E R N S ?

S E S S I O N T W O

T H E F I N A L L A P!Last few weeks and days! Changes in your body to look out for: • Contractions or tightenings like Braxton Hicks.• The mucus plug (entrance to your uterus) coming away from your cervix.• Backache.• An urge to go to the toilet, caused by baby's head pressing on your bowel.• Rupture of membranes.• Loss of appetite/nausea.• Unsettled or restless feeling.• Urge to be on all fours.• Period type cramps

W H A T I S ”F A L S E L A B O U R” ?• The most important thing to understand is that it’s not false, it’s very real, and it is doing something very useful and productive.• Like the orchestra tuning up before the main performance, these contractions are versions of the real thing but are not the real show – but to play properly, those instruments have to be tuned. • Some people compare it to a marathon being run in stages – and often women with a long prodromal stage find that when labour does begin, they are already several centimetres dilated.• There can be a temptation to “get things moving” or keep things moving, but the truth is that this isn’t necessary. If your body and baby are ready for birth, you won’t need to kickstart it and certainly won’t be able to stop it. Resisting the urge to ”get things moving” will help avoid frustration as well as unwanted interventions. • Often early contractions are manageable, and you can talk and move through them, which means you still have time to get some rest and snacks.• Three levels of contractions – talk and walk through, talk and walk between, very little communication during or between. • You have no need to be timing the contractions until you are focusing on nothing but labour – usually when contractions are around 3 in 10 minutes and lasting for 30 seconds to a minute.• Try to avoid fixating on contractions or surges. Timing them, counting them, becoming frustrated between them can result in a loss of faith in your own body. This is part of the process.• Don’t focus on finding a pattern or feel disappointed when they are not “organised” – labour just isn’t in full swing yet.• Try to find positive associations with each contraction – every one, even when irregular – are bringing you closer to baby.• Early labour can last a week – it’s a marathon not a sprint

• Historically women carried out more physical work during pregnancy, walking, scrubbing floors etc, we need to make up for this new sedentary lifestyle in the last weeks of pregnancy• Birth ball, car seat, walking more, more upright on sofa. UFO position.• Visit The Doula Hub Client Area for video to help with optimising your baby’s position and much more. Ot take a look at the following link for more info.Miles circuitForward leaning inversionCat / CowSpinning babiesB I O M A C H A N I C SIn the last few weeks of pregnancy, from 32 weeks, it is good to do exercises daily that help baby move into the optimal position for them to be born more easily.Link to videoLink to video80% of babies are born in the cephalic position, but a few start labour in other positions and want to rotate prior to dropping right down into the pelvis.

MAKE A FRIDGE LIST WITH STATIONS• Tell her funny stories/make her laugh• Remind her to breathe deeply - counting backwards from 20 during contractions if it’s helpful• Do the counter pressure moves on her lower back during contractions• Remind her to relax her face jaw and shoulders• Try using still hands, just gentle pressure without moving hands on her shoulder or back• Help her take a shower or bath• Give her a cloth for the shower with some lavender oil or just a tissue with some on to sniff and help her breathe deeply• Help her keep moving and swaying on the birth ball or standing with her arms resting on something high - hips in a circle or figure of eight• Tell her she’s amazing 😊Things to do in early labour before the your doula arrives• Remind Her to drink• Tell her she’s amazing• Remind her to pee• Tell her she’s amazing• Feed her snacks/meals whenever you are having one if she can still manage to eat (keeping her energy up is really important• Tell her she’s amazing (you get the picture)• Help her visualise somewhere calm and happy that you’ve been to while she closes her eyes and breathes deeply• Remind her to rest between contractions• Stroke her arms and shoulders gently• Suggest some of the positions she liked like from the sheet• Help her do the Miles Circuit moves in early labour• Take her for a gentle walk

W H E N T O G O T O T H E B I R T H S P A C E Go To The Birth Space When Contractions Are:• Recurring 3 in 10 mins (beginning to beginning)• Consistent for an hour • Each lasting 45 to 60 secs (The “3-1-1”)• Taking all your focusCall Your Midwife (home or hospital) if:• You experience bleeding• Your waters break• You have severe abdominal pain, vomiting or headache• Baby’s movements reduce or slow• You’re less than 37 weeks pregnantIf you are ever worried or unsure always call your midwifes

H O W T O B R E A T H E• Can’t control your triggers but you can control your response• Natural instinct when concerned or excited is to breathe faster, this causes the production of adrenaline because your body believes it is entering fight or flight mode.• We can trick the body to instead remain calm and relaxed by slow breathing. This is used in the first stage of labour and in hypnobirthing is called “up breathing”. You aim to breathe using your diaphragm, so your stomach will inflate instead of your chest when practicing. • Take a deep breath in through your nose, and let it go through your mouth. Some people find it helpful to count, some not. It’s up to you. Aim to make both breaths slow and long – oxytocin is produced on the out breath.• Breathing can be used alongside visualisations – imagining a place where you feel happy and safe, or with other calm images that produce an “up and open” feeling: a flower opening, a hot air balloon rising, a sunrise, blowing bubbles. • In hypnobirthing, the second stage of labour sees a switch to a different kind of breathing – “down breathing” or “J breathing”. With a soft mouth, take a short breath in and then breathe with your focus downwards. You can practice while doing the toilet in the last 6 weeks of pregnancy.

C H I L D B I R T H M A S S A G E • Use any comfortable position – lying, sitting or standing.• Use following the breath – encourage a long, slow out breath.• Use both hands at the same time – or one after the other in a wax-on, wax-off way.• Check pressure, comfort, heat and cold between surges. During just use hands. Don’t distract with other conversation. • Also long strokes on arms and legs moving towards the heart.

HIP SQUEEZES• Counterpressure technique that works to help open the pelvis and counteract the pressure of the baby’s head moving into the pelvis. • It works like a clothes peg, applying pressure to the top to help open the bottom.• Apply pressure to both hips simultaneously • Check how it feels – lower or upper pelvis can be better depending on where baby’s head is.• Check pressure too – can feel good with more pressure than the giver might expect.• Can also be done by two people or using a scarf or muslin tied around the hipsPractice from 36 weeks will help find a technique that works for the birth

2015 Care Quality Commission survey of Women’s experiences of maternity care found:• Around 83% women still give birth on a bed. - Bed can be useful – can be adjusted, useful tool.• 35% of those were in stirrups (lithotomy position), still very common position.• NICE guidance CG190: women should be as active as possible during labour.• Just because bed is there – don’t need to assume role of patient.55Lying on backUFOUpwards open forwardP O S I T I O N S F O R C O M F O R T Evidence on upright birth● Available space in the pelvis can be increased by 28-30%● Contractions can be more effective● 23% less likely to need medical intervention● Baby is 54% less likely to become distressed● Shorter labour● 29% reduction in possibility of C-section required● 21% reduction in episiotomy rates● Reduced need for epidural analgesiahttps://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003934.pub4/full

B I R T H V I D E O ‘ SHomebirth waterPlease say if you would rather watch this alone after our session

T H E G O L D E N H O U R S • You can hold off on weight and measurements if there is no urgent medical issue. No confrontation needed just “no thanks”.• Take your time and look for baby’s feeding signs. Enjoy those first few hours connecting.• They know your voices and want to see your faces for the first time - baby will lift their head to see you when they hear your voice• Eye contact and voice makes them get to know you - both parents. Perfect vision at distance between breast and baby• Dark areola that the baby can see.• Heartbeat familiar and makes them feel safe• Breasts warm up 2 degrees hotter than the rest of your body to prepare for baby to feed• Montgomery glands secrete microscopic fluid that smells exactly like amniotic fluid• The breast crawl after 30-40 mins YouTube

P O S T N A T A L P L A N N I N G

L E T ’S T A L K P O S T N A T A L E X P E C T A T I O N S…Areas for discussion (what you expect of yourselves and those supporting you):• Feeding • Visitors• Food• Household management• Older children• Pets and other responsibilities • Mental health and emotional support• How to press the reset button

W H A T I S M A T R E S C E N C E?Concept coined by Dana Raphael to explain that changes we go through as we become parents. It is like adolescence in several ways: • Hormonal changes• Different body• Shift in identity• Altered relationshipsCast your mind back to those teenage years as you went from child to adult – except this time it happens in a moment!TED Talk

• ASIA – Confinement is a cultural norm across much of Asia where new families remain in their home, or in Japan at their parents home, for ‘ansei’ – peace and pampering. In Vietnam, parents wait 6 weeks before introducing their baby to anyone outside of the family unit. Food and care in China and Korea is geared towards rebalancing the hot-cold dynamic of the body so warm clothes and hot soups are recommended. • SOUTH EAST ASIA – In Indonesia and Malaysia, a tradition of bodywork, herbal baths, belly wrapping and massage is observed to help the mother to welcome her new body with love. • AFRICA – Importance is placed on the group that supports the new parents. In the Ivory Coast, female relatives cook and care for the parents and help with household chores and the baby’s needs until the new family have recovered their strength. While in Zambia, housework is banned until the baby’s umbilical cord falls off. • SOUTH AMERICA – In many parts of South America, la cuarentena decrees that female relatives take on all domestic duties for 40 days to help guard against the new parents suffering from exhaustion related illnesses. P O S T N A T A L P R A C T I C E S

B U I L D I N G T H E B A B Y B U N K E R• Food and water in front of you at all times. Bottles and snack stations in key rooms.• One handed food• Warm food - pre make soups and one pot reheats• Cooking ahead - freezing meals.• First day meal plan what you really want• Cleaner for 4 weeks• Shopping delivered • Someone to walk the dog• Invest in a couple of pairs of nice pyjamas• Minimum visitors• Sitz bath - herbs and hot as possible water• Padsicle - alcohol free witch hazel and herbs (lavender camomile calendula) put in the freezer.• Postnatal doula!• Press reset

Y O U R B A B Y ‘ S J O U R N E YW O M B• Dark• Muffled sounds• Warm temperature• Constant food• Confined space• Water• No smells• Constant contact with mother• Constantly held• Naked• Surroundings soft and warm• Constantly movingW O R L D• Light• Loud• Fluctuating temperature• Hunger and thirst• Lots of space• Air• Lots of smells• Much less contact• Held much less• Clothed• Surroundings hard and cold• Still much of the time

T H E T R U T H A B O U T S L E E P • RHYTHM - Your baby’s circadian rhythms are not established until 4 months so the notion of making them sleep through the night in the early weeks and months is just not possible or logical. • INTERVALS – Newborn babies wake every 2-3 hours to feed because their stomach’s can only hold a small amount of milk so they need to feed little and often.• KNOWLEDGE - The most powerful starting point in sleep coaching (rather than sleep training) is the understanding of normal infant sleep patterns and how you can work with them to make sure you all get what you need.

T H E M A G I C O F S K I N T O S K I N• Skin to skin regulates body temp• Increases oxytocin, which improves milk supply• Prevents active amygdala, which produces adrenaline • Give access to pheromones – faster bonding, better feeding • Releases endorphins – relaxing/pleasure hormones• Endorphins stop nervous system kicking in – leads to increased crying• Regulates the autonomous nervous system – preventing the baby from becoming over vigilantSKIN TO SKIN means your bare skin and baby just in a nappy.Not just for Mum, but just for same household !!

BREASTFEEDING: The Truth & The Myth• The UK has the lowest breastfeeding rates in the developed world (1% at 6 months) – so why do countries with a similar system to us have much higher rates?• Low-income developing countries fare much better – with most of the top 20 list featuring developing countries.• Studies have shown that when isolated from other breastfeeding mothers, primates are unable to breastfeed. • Anthropologist Sarah Blaffer Hardy found that the more intelligent the primate species, the more difficult breastfeeding was. • One crucial evolutionary reason for intelligent primates struggling to breastfeed when isolated would be to encourage them to stay with a group of other females – so your village is not just helpful it’s essential!

BREASTFEEDING – The First Hours• Baby will be very alert and looking at you – skin to skin will help them get to know you. • They will use their reflexes (arms circling, legs walking, head lifting) and may look like they are flailing around, but they know just what they are doing.• Baby will take some time to find the breast and practice latching.• No one should touch you or interfere with this process.• Your baby has been born with its own “packed lunch” - a layer of brown fat that will sustain it for up to 36 hours.• Skin to skin and practicing latching are the focus not “feeding” in the way we think of it. • The focus is getting you know your baby and both of you transitioning – from womb/pregnant to outside world/breastfeeding.• Think of colostrum as a small amount of perfectly balanced medicine for your baby – preparing its gut, balancing blood sugar, laxative removing meconium, providing antibodies.• Baby doesn’t need liquid – it is full of amniotic fluid that its kidneys need to process – it needs the delicate balance of nutrition that colostrum provides.• Babies digestive track is not ready to receive milk/formula as soon as they are born. Colostrum is needed to prepare the gut for digestion. They have a very delicate digestive tract that can be easily disrupted by the premature introduction of infant formula

BREASTFEEDING - The Game-Changing Feeding Position• British midwife Suzanne Colson examined the effect of gravity on breastfeeding for her PHD thesis and found that a laid-back position had by far the most positive impact on feeding.• Baby’s body in constant contact with the mother meaning feeding trigger points -chin, torso, hips, legs, and feet – are constantly stimulated.• Good breastfeeding dynamics – baby’s body in line, head free, nose to nipple, close to mother – happen without effort.• Mother is comfortable and has a free hand to touch or cuddle her baby - or eat and drink. • Especially important in the early weeks as baby and mother both learn to feed –establishing good habits for both. Laid-Back Feeding

BREASTFEEDING R E C O G N I S I N G Y O U R B A B Y ‘ S C U E SEarly cues💕Clenched fists💕Starting to stir 💕Turning head/rooting 💕Mouth opening Mid cues💓Stretching 💓Increased movements💓Putting hand to mouthLate cues💗Agitated movements💗Turning red in the face💗CryingCrying is the very last sign of hunger, so if you manage to pick up your baby’s messages before then they will be used to you anticipating their needs and won’t feel the need to cry for them. The cues can be split into early, mid and late and usually the baby will work their way through until you get the hint. 😂

BREASTFEEDING – The Next Few Weeks• Colostrum becomes milk on day 3-5 and comes with a surge of hormones.• You will be hungrier and thirstier than usual – so needs to focus on eating and sleeping only.• Feeding has a greater chance of success if you feed on demand and avoid bottles/pumps/dummies for the first 6 weeks.• Beyond that, you are statistically likely to continue feeding as long as you want to if you reach the 6-week mark.It can be useful to think of the first few months as three distinct periods: • first two weeks (emergency measures – food and sleep are the priority); • next four weeks (no rhythm yet but more sleep and normality); • post-six weeks (some daily patterns emerging led by baby, and a glimpse of the return of normality).Your guiding light should be the fact that the second reason for feeding is nutrition – the first is to respond to and reassure your baby, creating a secure attachment. (UNICEF doc)• We will look at other positions to try once latch is mastered.

C H I N S B R E A S T F E E D I N G C H E C K L I S TC – Close to you – with baby’s body touching yours at all pointsH – Head free – sounds counter-intuitive but hold baby’s shoulders insteadI – In-line – baby’s nose and navel should be in a line not twistedN – Nose to nipple – with the nipple pointing up the noseS – Sustainable – if baby begins feeding are you comfortable?

Other Breastfeeding Positions -Ideally Post Six-Weeks

How We Know That Feeding Is Going Well• Feeding is pain free.• Baby is peeing/pooing.- THAT’S IT –Contrary to what anyone may tell you, these are non-negotiable. Pain or lack of output should trigger a call to an expert (IBCLC, cranial osteopath, tongue-tie practitioner, or some combination of all three).

BREASTFEEDING - Resources Videos on doula hub• World Vision Video with latch• Lotus Midwife Latch Video• Newman videos• Robyn Thomson• UNICEF doc• Suzanne Colson BN siteLINK

All pics have links to amazonShopping list✓Sling! Most important thing is a fabric sling you can put baby in to keep them close and let you be hands free✓Nipple cream✓Maybe a perineal spray - there’s one on Amazon by Nana & Dee that’s less expensive but just as good ✓Babygros and vests Nappies - disposable size 1 or reusable ✓Breast pads - we found some amazing washable ones on Amazon that never leak. ✓Nursing bras - maybe 4 is plenty✓A couple of big muslins to use as blankets/lay baby on/mop up spills✓Small muslin squares - use to wipe baby’s face when feeding wash them in the bath✓Reusable wipes - you just wet them with water and chuck them in the wash. You can get a few packets of wipes as well for ease when you’re out and about. ✓Baby bath (not essential but makes life easier - the shnuggle is the one lots of our clients have right now)✓Cosy suit if you want to take baby out in the early weeks ✓Moses basket✓Separate towel for babyThen obviously in terms of big equipment, the car seat, pram and crib for beside your bed are the ones you need first. All the big nursery furniture including the cot you can buy later since baby will usually be in your room at least the first 3-4 months and even longer if you’re breastfeeding.

THE DOS AND DON’TS OF SIBLING BONDINGThe Hello Toy – two-way street. Explain Absences – to their level.The Busy Box – for feeding time and only then.Involvement – designated jobs.Praise and Older Sibling Plaudits – responsibilities they enjoy.No Major Changes – to environment or routine. Quiet Time – your bed or on couch doing familiar activities.Talk To Baby About Sibling – while they are there or listening. “Did you see what your clever big brother just did?”Room/Space Ready In Advance – no surprises and involvement.Sibling Baby Book – to show them their baby time.B E S T F R I E N D S F O R E V E R

Q U E S T I O N S & C O N C E R N S

Wishing you the very best birth experience you can imagine

T H E D O U L A H U BThree doulas supporting each other to support you.We will step in to support each other’s clients in case of injury or sickness – especially in these uncertain times – or in case of an unexpected date clash.We are all very similar in our approach: practical and non-judgmental with a mother-centred perspective to pregnancy, birth and postnatal care.With 10 children and countless births between us, we are ready to support you respectfully and sensitively.

"Our commitment is to ensure that at this very special time you can relax in the knowledge that you will be fully supported by a doula who knows what you need, understands your birth plan and is truly committed to helping you have the birth that is right for you."H O W W E W O R K

The Doula Hub - LaurenHi, I'm Lauren.I’m an adopted Londoner, originally from south west Scotland, but now firmly rooted in south west London. Over the past 10 years, I’ve had three very different boys in three very different ways - and the more time has passed the more I have realised how important the birth experience is to what kind of parents and family you become.I didn’t know what a doula was when I had my babies so my aim is to be the doula I wish I’d had: a practical doula, providing support and guidance for parents looking for straightforward tips and solutions throughout the pregnancy, birth, and postnatal period.I have completed training in aromatherapy, acupressure and massage for birth - as well as a course to help expectant parents work through previous trauma ahead of the birth - and will support, and help the birth partner to support, the birthing person using these techniques before and during labour.I firmly believe that the perfect birth is one that the parents feel informed about and involved in no matter how far it might deviate from their original plan. Your doula is there to help make that happen.ContactMobile – 07850132060Email – Lauren@thedoulahub.co.ukWebsite - https://www.thebarnesdoula.com/

The Doula Hub - LouiseThe Peaceful DoulaHi, I'm LouiseI love my job more than I can express in words. I've come to this vocation after spending 20 years in the corporate world and I have to say it's the best decision I ever made.Having had three very different births; from unplanned C-section at 29 weeks, to the calmest physiological birth you could imagine, I realised that being truly supported and fully informed is paramount. As your doula it is my job to ensure that during your birthing experience you feel, in control, knowledgeable, calm, confident and empowered.I did my doula training with the lovely Kicki Hansard at the BirthBliss Academy and subsequently enhanced my skillset at the Katherine Graves home of Hypnobirthing where I trained as a hypnobirthing instructor. I have also completed a course to help with previous birth trauma adjustment.You can find out lots more about me on my website, but in essence; I'm the most mature doula of our team!! I have a calming influence, I'm told by previous clients that I'm supportive, intuitive, nurturing, thoughtful and kind.I have 3 lovely boys who I'm very proud of; Cameron ('90), Charlie ('03) and Freddy ('05). I currently live with the youngest two in Sandhurst on the Surrey, Hampshire, Berkshire borders, but also cover south west LondonMobile - 07973 496092 Mail – louise@thedoulahub.co.ukWeb - www.thepeacefuldoula.co.uk

The Doula Hub - LetiMy name is Letizia Tufari, Leti for short! I am Italian and moved to the UK as a child back in 1990. I live in Wandsworth, South West London, with my English husband and three young children. I absolutely love to travel and like organising fun and different family holidays.Having three births in three years definitely led me to really wanting to help other women going through this very special time. I didn’t know anything about doulas until I had my third child and as soon as I came across them I knew it was just perfect for me. Supporting women and birthing people through this very special time is extremely rewarding and joyous and I feel lucky to have been able to do it as a profession for the last eight years.I truly believe it is 100% possible for all women to have a really positive birth experience. I learned a huge amount from my three births and all the amazing women and birthing people I have had the privilege to support. Every time I am with a woman during labour I see that being supported and nurtured at this very vulnerable time is what really makes a huge difference to the outcome.Our bodies have been wonderfully designed over thousands of years to birth beautifully and sometimes in our modern society it’s easy to lose sight of that. My role is to provide you with as much information as possible for you to be able to make informed decisions that you feel really happy with. To help you and your partner feel confident, safe and knowledgeable from the moment the first contractions start to the early postnatal period.I hear so many sad stories about births that have left mothers feeling like they were totally out of control and felt pressured by some of their caregivers, sometimes even feelings of having failed. Not knowing what is happening can be really scary and in labour even more so. I feel passionately that this should never happen. Whatever you choose for your birth, my job is to be your advocate and make sure your voice is heard. It's your party, everyone else is just an invited guest! Every time I witness a birth I am reminded what a miracle it really isMobile - 07973 282688 Mail – leti@letiziatufari.co.uk Web - https://www.miraclebirth.co.uk/

The Doula Hub - MaelleAntenatal & Postnatal DoulaHi, I am Maelle, an antenatal and postnatal doula, living in Fulham, London with my family.I became passionate about helping mothers and families when I realised how little emotional and guiding support was available for new parents-to-be through their pregnancy journey, birth and postnatal period. I believe in helping women feel empowered with all the information they need to make informed choices about birth and parenting.Your birth and parental experiences matter to me. I would be more than happy to nurture you, be that experienced and friendly go-to person that will take good care of you in this transition period, share knowledge and experience in a meaningful way, answer your many questions, help you settle in your new life and support you through all ups and downs that this new experience brings.I was lucky to train as a doula with Kicki Hansard, a very inspiring award-winning author and the founder of Birthbliss Academy. I have since continuously been learning to stay on top of the latest information and completed training in understanding newborns’ development, holistic sleep coaching, supporting twins and multiples, understanding and preventing reflux, postnatal planning, and helping with birth trauma, phobia and fear through the 3-step rewind NLP-based method.As a member of Doula UK and the Birthbliss Doula Directory, the 2 leading organisations in the UK, I follow their philosophy and professional code of conduct. I am Enhanced-DBS certified and have a paediatric first aid trainingMobile - 07444 418583 Mail – maelledoula@gmail.com Web - https://www.maelledoula.com/