positive birthing

An open letter to women giving birth during lockdown

I never did get around to writing about birth on this blog; it never felt like the right time. Now, it feels not just like the right time, but the necessary time. I believe that a woman’s experience giving birth is incredibly important, largely because of the enormous difference my own experience made to me. I have lived with depression for many years now, and one of my biggest fears around becoming a mother was that I would suffer from post-partum depression and have difficulty bonding with my baby. Thus far, though I have enjoyed a few skirmishes with garden-variety, chronic depression, PPD has thankfully not formed part of my story, and I credit two things for this. One, that a compassionate consultant encouraged me to go onto medication halfway through my pregnancy, during the first 20 weeks of which my depression had peaked, bringing with it fun friends like panic attacks and suicidal thoughts. Two, that I had an immensely empowering, positive birth experience, and so started my time as a new mother on a high. I truly believe that a negative experience would have greatly increased my likelihood of developing further mental health problems in the aftermath. Positive birth matters.

And yet, right now, in the middle of a global pandemic, the context in which women can expect to give birth is changing, as the NHS responds to the double challenge of stretched resources and the need to reduce rates of infection. Standalone midwife-led units are closing and (in some trusts) homebirths are being stopped. Some women are being told they can only have one birth partner, or none at all. The priority – as it rightly should be – is on safety, and on responding to this unprecedented situation. But positive birth still matters. So, if you are expecting to give birth in the next few weeks, or even months, the below message is for you.

Firstly, I cannot imagine how you must be feeling right now. I would find it enormously stressful to be pregnant, effectively in quarantine, and facing so much uncertainty around birth. It is ok to be feeling worried, or panicked, and to feel sad and angry about this pandemic changing so much for you. At the same time, you’re going to have to do something really hard, which is to acknowledge those feelings… and put them aside. All I can do from behind my screen is wish you the strength to do that.

That said, you do not have to accept everything. Yes, we are in the middle of a global crisis, and yes, as a society we all have to comply with lockdown procedures in our day-to-day life to keep everybody safe. But that doesn’t mean you need to unquestioningly accept every new policy surrounding birth. You matter. Your birth experience matters. The charity Birthrights have released a position statement calling for better support and guidance for care in birth during this crisis. If you don’t feel up to reading the whole document, these are some of the key points: you have a right to a birth partner of your choice, provided they are not showing symptoms of COVID-19 (and if your first-choice birth partner is symptomatic, you can choose a ‘back up’). You have the right to a range of pain relief measures, including a birth pool. You have the right to ask your hospital to explain measures to the contrary, and to consider varying their measures based on your unique circumstances. For example, if – as I did – you had planned to have a second birth partner (I had a doula), you can ask whether this is possible, taking into account your specific circumstances (such as, in my case, vulnerable mental health). Or if you are having a planned ceasarean, and the hospital says partners are not allowed in theatre right now – it is your right to ask them to explain clearly why this is a proportionate measure (your baby’s other parent, of course, has a right to a family life and to be present at your baby’s birth if they wish to be). They might say ‘no’, but you do have the right to ask, and you can also seek support from charities like Birthrights if you feel the response is not reasonable.

There is also a great deal that you can control, even if you find yourself giving birth in a labour ward room instead of at home, or with fewer birth partners than you’d planned. You can – and should – ask midwives to empower you to remain mobile during labour and birth if that is something that you want. You can ask them to move the bed so you can labour on a birthing ball, or leaning against it. You can ask them to dim the lights. You can take with you items that make the hospital space feel more comfortable: I took my own pillow, my husband’s dressing gown, and half a dozen electric tealights. You can refuse routine vaginal examinations if you do not want to have them performed on you. If you want to go home after giving birth but before you are ‘allowed’ to, you can self-discharge. All of these things were true before COVID-19 and they are still true now. You have choices. Just because you are giving birth during a pandemic does not mean you have to do everything ‘by the book’. Do not worry about asking for things that you need to make your experience a positive one. It is ok to prioritise your physical and emotional needs when giving birth.

If you are expecting to give birth during lockdown, I want to wish you a few things. First, I wish you the strength to accept the things about this situation that you cannot change, but also the confidence to advocate for the things you can change. I wish you a birth experience in which you feel empowered to make the choices that are right for you. I wish for you to come out of the other side of giving birth feeling strong and proud of yourself – as you should do! I wish for you to be able to remember the kindness and flexibility of the individuals who care for you, even within the scary-seeming walls of protective, pandemic policies. I wish for you to never forget that you matter, your birth matters.

I wish you a positive birth.

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