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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

Let’s get started…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 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 Birth Toolbox• 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

FEELINGS ABOUT THIS PREGNANCYHow 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.

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

W H A T M A K E S A ”G O O D B I R T H” ?• 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.• Doulas do not give advice – we do not have a preference for how your birth progresses. We are here to support your informed choices.

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 birth 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 effectively, we have a more efficient, more comfortable, shorter labour with fewer surges

• Involuntary process (coma)• 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 (Restitution)• 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 an 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 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 pregnancyFitness and strength.• Perennial massage Practice from 37 weeks onwards. Learn to relax during perineal stretching. • Kegels (Pelvic Floor) - It is more important to learn to relax your pelvic floor than to build its strength• Cat cow and Miles Circuit to prepare baby’s position. Studies show both help.• Sitting on a birthing/exercise ball regularly. UFO• Biomechanics• Diet – building strength and health.• Partner to exercise and learn to relax too –endurance in birth.

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. London Marathon• 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? Practice whenever you can.• Look at who you spend time with prenatally - affirming your choices and beliefs.• But also preparing for what happens if birth takes another path. - BRAIN

H Y P N O B I R T H I N G 1 0 1 Quiet mind = relaxed bodyPractice mindfulness and relaxation in pregnancyTools• Sounds – Playlist, relaxation scripts, trigger words (Breath/Relax)Pick your playlist around 20 weeks. Use it to relax. • Smells – Lavender, Mandarin, Neom blend• On a cloth, muslin wrist or neck.• Breathing – learn to control your breathing. Long slow breaths, in through the nose and out through an open soft mouth.Use these tools during pregnancy. In the bath, laying down in bed, sitting in the garden, also on the tube, at the GP/Midwife app.Your subconscious brain remembers these triggers for relaxation and then you use them in labour to help you remain relaxed and calm.

P R E P A R I N G L O G I S T I C S• 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• Preparing for birth can be viewed as preparation for parenting.• You will both need to make decisions together about how, where and when you would like your birth to take place.• The process helps you to find your own voice, for you and your child. Agency and advocacy.• Your doula is there to support you as parents. We aim to empower you to advocate for yourselves.• 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.

B I R T H 1 0 1: L E T I T G O •Ensure you have controlled all your controllables; your bag is packed, your birth preferences are done, you have all the things you need for birth and the immediate postnatal period, the isofix base is in the car, not in the baby’s room!!•Once you have all these things prepared, then, ‘Let it go’, get distraction and concerns out of your head, and relax.•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.

T H E B I R T H 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• The miles circuit• Movement and position changes• Hydrotherapy – bath or shower• Birth pool• Pouting water (waterbirth massage)• Still hands and gentle pressure• Finding a pattern that brings relief• Tonal grounding (vagus relaxation)• Vaginal examinations• Intermittent monitoring• Continuous monitoring• Electronic foetal monitoring• Sweep (see next slide)• Early induction (more on this in later)• Induction by AROM (breaking of waters)• Induction with Syntocin• 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 arisePhysiological supportMedical support

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

Looking for reassurance?• In the last few days/hours of your pregnancy your physiology will make your focus on finding a place that feels safe for your labour to begin. • For many women safety looks like reassurance from medical professionals due to our culture and society viewing birth as dangerous. • This can often lead to birthing people thinking that intervention is going to decrease risk of poor outcomes and increase safety for baby and child, unfortunately that is not what the evidence says for low-risk women

THE INTERVENTION CHAT• Spontaneous labour figures for NHS Trusts in London & South East are on average between 35-55%. • Towards the end of your pregnancy it is now almost guaranteed that you will be offered various interventions for various reasons to help the onset of labour• It is very important to plan for these conversations as early as 36 weeks. • Make sure your partner is with you for all appointments• We will take you through risks & benefits of any intervention mentioned as they are suggested to you on additional zooms • There are very few cases where intervention is backed by published evidence

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 1stDo No Harm – full published article We will cover medical intervention in the second session in more detail

REASONS FOR INTERVENTIONReasons behind the type of intervention recommended depend on several factors:• Every trust has different ‘guidelines’• Every medical professional interprets data and protocol differently, it very much depends who is on duty that day• Logistical factors have a huge impact on what is suggested by the trust. How busy are they? It is more important than ever to you listen to your body and remember that BIRTH IS SAFE and you are the best judge on how your baby is doing. A big focus on all birth preparation needs to be on developing trust in your body. Women's’ bodies are incredible and connecting with what your instinct is telling you is vital.

INFORMED DECISION MAKINGNICE Guidelines ‘recognise that women can decide to proceed with, delay, decline or stop an induction. Respect the woman's decision, even if healthcare professionals disagree with it, and do not allow personal views to influence the care they are given. Record the woman's decision in her notes. [2008, amended 2021]’

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.

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

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.

W H A T I S Y O U R D U E D A T E ?Excellent link to find out more on EDD hereo Around 85% of first babies arrive after 40 weeks, average length is 41 – 41.5 and a half weeks o Other countries have different ideas about how to work out a due date, France says 41 weeks, U.K says 40. o Women and babies are all different o The WHO guidelines says that average length of pregnancy 37 and 43 weeks o 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. 38o Due dates cause stress – from yourself, from family, and from medical care giverso Tell people a date 2 weeks later o Baby knows best – babies have a growth spurt, including development in their brains in the period before birth o Those few extra days are a bonus – time for you Make plans for post 40 weeksBorn on due date4%Born before due date11%Born after due date85%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…. Causes Stress An estimate

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

Amy Smith – Birth Preferences – HospitalThank you for taking the time to read our birth preferences. About meLabour & BirthMonitoring of BabyPartner – Joseph (Joe) Smith (0785225567)Doula- Louise Oliver (07973496092)Hoping for – physiological birthMother’s DOB – 01/05/1986Gender of baby – femaleEDD – 5/9/23Place of birth – George's birth centreExisting Health Conditions of Mother to be aware of for birth:•Hypermobility•Pelvic Girdle Pain•Tendency to anxiety/panic attacks relating to past trauma if things feel out of control in a medical settingI would like my partner and doula to be present and questions directed to them when appropriateI wish to use a birth pool for comfort during labour.I wish to be able to move around and change position at will throughout labour.I would like to be able to eat and drink as I wish.I would prefer vaginal exams kept to a minimum unless medically necessary. Please do not direct my pushing unless I ask for help.I am happy for baby to be regularly monitored but would prefer the use of handheld Doppler.I would prefer continuous electronic monitoring kept to a minimum.We would prefer not to use foetal scalp electrode but will discuss this if it is deemed medically necessary.Pain Management & EnvironmentAccelerationThird StageI would like the environment to be kept as quiet and dark as possible.We are planning to use the following forms of pain management and relaxation:● Massage, aromatherapy, music● Gas and air● Tens machineIf I feel the need for additional pain management, I will ask for it, please do not offer it.I do not want to discuss induction until 42 weeks' gestation. Please do not schedule any Consultant appointments prior to this, unless there is a medical condition that has reputable evidence to suggest intervention is required in my personal circumstances.Do not give me a sweep without asking my consent.Please do not encourage me to ‘push’ or ‘bear down’ unless there is a medical reason to accelerate labour.We would prefer that the umbilical cord stops pulsating and has gone white before it is cut.Joe wouldlike to cut the cord.I am planning a physiological third stage unless a managed third stage is deemed medically necessary. Please do not offer medical intervention for third stage unless it is.After the birthCaesarean birthOtherIwould like to catch the baby.I would like my baby to be delivered onto my tummy and to have skin to skin.We would ideally like a quiet and dimly lit 60-90 minutes after the birth for bonding, breast crawl and for Joe to have time for skin to skin.Please don’t clean baby, and delay weighing and measuring until we request it.We would like the baby to have the Vitamin K injection.I am planning to breastfeed; we would like at least 90 minutes for baby to find their way around breastfeeding before we help with a latch. We do not plan to force the baby to feed in the first hour so please don’t mention it.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.We would like our doula to accompany us at all time, but at the least until after the epidural is administeredWe would like to be kept fully informed of all developments and to share in any discussions and decisions. We are happy for one student to be present.E X A M P L E B I R T H P R E F E R E N C E S– Physiological Birth

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 shnuggleis 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.

· Your maternity notes & a copy of your birth plan.· Birth pool if you are hoping to use one. You can rent or buy one here. · Shower curtain to use as birth pool lid to keep water warm· You might need to purchase an additional adapter to the one that comes with the pool to fit your tap properly. When the pool arrives its always important to check the connection to the tap works.· Lots and lots of towels (and some blankets) to keep you and the baby warm and dry after you give birth. Extra if you're using a pool and may get in and out. You go through them so quickly and then when it’s time for baby to arrive they are all soggy and cold from you having used them during labour. You can just get cheap ones and wash them ahead of time. Dark colours preferable. Example· A small reading light. Useful to plug in near where the midwives set up their note taking area. This is especially relevant if you want the lights kept low so that they don’t have to turn all the lights on to see what they are reading/writing.· Easy access to a kettle for a cup of tea. A selection of teas would be good not only for yourself but midwifes love tea & biscuits (as do Doulas )· Something to protect the area you want to give birth in as you move around, like plastic sheets, shower curtains /tarpaulin / dust sheets are all great. These are also useful to cover soft furnishings you are planning to use if/when you are wet, as well as all those towels ;-)· Large bin bags for rubbish and dirty wet laundry.· Plastic bowl or bucket for if you're sick – which is a common experience in labour.· Food and drink for you and your birth partner. Stuff you like, not just a whole load of ‘healthy’ things and any celebratory food or drink post birth that you are really missing out on.· Items that aid atmosphere, comfort and relaxation, like battery powered candles, fairy lights, hot water bottle, massage aids and oil, lots flannels for hot or cold compresses.· Something to listen to or watch for relaxation or distraction. Prepare a couple of playlists – a relaxation one and a more upbeat one.· Birth ball· Non-medical cord tie, if you plan to use one.· Whatever you want to wear in labour, which might include a big t-shirt, a bikini top, hair ties, or nothing at all (pack a spare in the hospital bag). Something as a back-up in case whatever you’re wearing gets wet.· Maternity pads (also in hospital bag) and pants· TENS machine, if you want one. · Something to dress or wrap the baby in, and a nappy (also in hospital bag)· Fully packed hospital bag – we will give you the packing list for that separately.· Lots and lots of absorbent bed pads like these, just get the best priced onesA waterproof mattress protector - even if not having a home birth its useful to relax so you are not worried about your waters going and wetting the bedTotal blackout window film if the curtains in the room you plan to birth in aren’t effective at blocking light. Birth home useful stuff

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 spoutPhone and chargerTissues/wipesYour pillowFace clothsFairy lights or electric candlesTENS MachineMaternity pads/pantsFront opening night shirt, shirt or pyjamasToiletriesToothbrush and pasteTowelsHairbrushPlenty of big cotton pantsMaternity clothes for going homeDark TowelPhoneChargerToiletriesTablet for any downtime*SwimwearSnacksWaterNappies (allow 6 a day)Muslin squaresA suit for going homeBlanket or shawlJacket or warm suit for winter babiesHat (For going home)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

Q U E S T I O N S & 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: • 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.• Period type cramps/Contractions• Tightening's like Braxton Hicks.• Rupture of membranes.• Loss of appetite/nausea.• Unsettled or restless feeling.• Urge to be on all fours.• Looking for reassurance and safety – Now more important than ever to you listen to your body and remember that BIRTH IS SAFE & you are the best judge on how your baby is doing. Really important to trust your body and be its N1 fan, don’t lose faith now

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 must be tuned. • Some people compare it to a marathon being run in stages • 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. • 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. 3 stages walk & talk, talk between, full concentration• 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.• Don’t focus on finding a pattern or feel disappointed when they are not “organised” –labour just isn’t in full swing yet.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. Or look at the following links 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.

PRE LABOUREarly body changesSATURDAY VIBES• Stay local• Keep moving & stay active when if feels right• Keep up your energy with food & drinks• Do NOT focus on contractions• Stay away from anxious people • This stage can last for hrs, day or even weeks – your body is getting ready, its all normal physiologyEARLY LABOUR1st StageSUNDAY VIBES• Continue pre-labour life but at a slower pace• Make comfort food, watch a boxset, cuddle on the couch, take a nap• Rest & refuel are key as this stage could take hrs• Look after and protect the shy oxytocin • Contractions will ramp up making it difficult to walk or talk through them• Communicate with your midwife if you feel the need toACTIVE LABOUR1st to 2ndStageMONDAY WORK DAY• This stage is shorter than the others and more intense.• Its hard work but brining you very close to meeting your baby• The urge to push & bear down will increase • Your breathing can change, remember to breath deeply and calmly• Letting go, and making noise can feel really helpful• Your team will be there to encourage you!CROWNING AND BIRTH2ndStageLAST FEW MOMENTS • This stage will probably last a few minutes, probably not more than 20• Breathing and bearing down slowly and gently will give your skin time to stretch• You can watch in a mirror or feel the baby’s head with your hand if you wish• As soon as the baby is fully out you can grab your baby and bring them to your chest for immediate skin to skinSTAGES OF LABOUR

PARTNER’S FRIDGE LIST• 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 • 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• Tell her funny stories/make her laughThings to do in early labour before your doula arrives

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• If labour starts and you’re less than 37 weeks pregnantIf you are ever worried or unsure always call your midwife

H O W T O B R E A T H EYou can’t control your trigger’s, but you can control your responseInstinct 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. 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. 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.

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.62Lying 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 ITS ALL ABOUT SKIN TO SKIN 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 helps 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• We will look at a ‘breast crawl’ later

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):• Recouperation • 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• 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 To ensure quicker recovery from birth • First week, Mum and baby in bed• Second week on the sofa• Visitors kept to a minimum (45 mins max)• Eat 3 healthy melas a day• Ensure water and snacks are always close to Mum• Partner cares for baby while mum sleeps in another room

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 always.• 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• Someone to walk the dog• Invest in a couple of pairs of nice pyjamas• Minimum visitors (45 mins)• Postnatal doula!

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

W H Y B A B I E S C R Y• SURVIVAL – “I need food, I’m cold, I feel unsafe.”• SIGNALLING – “I’m here, did you see me? I need you.”• SEPARATION – “Where are you? I feel alone or forgotten.”• SENSORY DISCOMFORT – “My nappy feels wet, I hate this stupid hat, what are these socks even for?”Only around 10% of babies exhibit what’s described as “excessive crying” – sometimes called “colic”.

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.• WORK AS A TEAM – For the first few weeks you will need to put your ‘normal schedule’ on hold.

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

Breast Crawl• https://www.youtubetrimmer.com/view/?v=hs7ai466toE&start=74&end=253&loop=0• Full video

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 cuesClenched fistsStarting to stir Turning head/rooting Mouth opening Mid cuesStretching Increased movementsPutting hand to mouthLate cuesAgitated movementsTurning red in the faceCryingCrying 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 for all 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

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 - 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 282688Mail – leti@letiziatufari.co.ukWeb - https://www.miraclebirth.co.uk/

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