Why I didn't LOVE the book everyone's talking about

Why I didn't LOVE the book everyone's talking about

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I’ve spent the past 24 hours chatting when I can on the The Gram about This is Going to Hurt, by Adam Kay. I thought carefully about sharing my opinion and to my relief, it seems I’m not alone in not loving it.

So let’s start with the positives. A few pages in and I was chuckling out loud. Adam Kay is funny and there’s no doubt that he is (was) a very dedicated and hard-working Doctor. I’m so happy he’s now a TV Comedy writer, he’s definitely got a talent for it. This leads me to praising Junior Doctors everywhere for the undeniable sacrifices they make for their jobs and their patients. The NHS is a beautiful institution and we need to look after it. It makes me so proud of the UK and (*for now) couples should thank their lucky stars that they don’t get lumbered with a huge bill for having a baby in hospital, like people in many other parts of the world.

Throughout the book Adam references his suffering partner, who he calls H to preserve her privacy, the dozens of times he’s missed weddings, parties and other special occasions because there’s just nobody else who can work the shift and even, the number of times he’s slept in his car because the drive home to bed before the next shift isn’t worth it. Clearly, nobody becomes a doctor for the money, even if he does mention money, going private and his future ferrari-driving house in France aspirations on a few occasions.

Now for the not-so positives. Ready?

I don’t know about you, but as a woman reading this book, about a man working with the female body, I felt pretty sick for three quarters of it. And it seems I’m not alone. After sharing some stories with exerts from the book, I’ve had about a hundred DMs from women saying #metoo.

So Adam Kay is a Junior Doctor (unless you hadn’t gathered) who specialises in Obstetrics and Gynaecology, or ‘brats and twats’ as he says his medical school refers to it. Charming. His reasons for doing so aren’t for the admiration of women’s incredible life-giving bodies, nor for the privilege of witnessing new life being born multiple times a day. Instead he says: ‘I liked that in Obstetrics you end up with twice the number of patients you started with, which is an unusually good batting average compared to other specialities (I’m looking at you, geriatrics.)’ Fine. But then he says: “I also remembered being told by one of the registrars during my student placement that he’d chosen obs and gynae because it was easy. ‘Labour ward is literally four things: caesareans, forceps, ventouse and sewing up the mess you’ve made.”

So you see how I’m not convinced his heart was truly in this from the start. At least not for the reasons I’d hope for as a woman.

Mr Kay goes on to ridicule the birth wishes (I’m careful not to say ‘plans’ - we all know birth can go its own way, despite being depicted as very dumb in this particular part of the book) of his patients and completely undermines them in a way no woman would consider funny. He mocks hypnobirthing and women who practice it, calling us a ‘certain denomination of floaty-dressed mother’ and thinks it’s hilarious for women to outline which aromatherapy oils she might like to use during her labour. He even chooses to mention this mother’s ‘whale music’ and that the ‘whole thing was doomed from the start.’ This was where I got to when my mouth dropped to the floor. There’s a sort of ‘god-like’ status that society puts on doctors. They’re medical, experts, they have the facts, they know best and they ought to be obeyed. Except, this man seems to have swallowed only what he’s been told and closed his mind off to any school of thought that existed before his textbooks, and disregarded absolutely any alternative thinking whatsoever, even if backed up by evidence.

There is evidence that Hypnobirthing works - it’s not rocket science. Surely he sees the fear in women on that labour ward every day? Surely he must know about the delicate balance of birth hormones required for the whole thing to work smoothly, i.e less fear = less adrenaline? Surely he might be able to agree, if trying really really hard to put himself in the shoes of just one of the women in one of the beds on that ward, that by relaxing their minds, their bodies will be able to work more efficiently? All of the midwives I have worked with in hospitals across South London have supported a woman’s right to choose aromatherapy, homeopathy or Hypnobirthing in her birth room as tools to help her cope. In fact, three midwives in one particular hospital are trained Hypnobirthing Teachers and run aromatherapy in pregnancy and childbirth workshops.

Sadly, Mr Kay has seen too many medicalised hospital births to see birth as in any way glorious and beautiful - to him it seems to be something women need him to manage for them. The facts are, when a woman steps into a labour ward her chances of medical intervention goes up there and then by 50% - the cascade of intervention is hard to stem. Especially when faced with doctors like Adam Kay who will roll his eyes if a mother asks questions or exercises her human rights.

There’s just so much about the language in the book that I can’t stomach either, nor can I accept as accurate information - yet I know from my experience as a Doula that this is the ‘line’ OBs often take. For example, the footnote next to Syntocinon, reads: ‘You’re meant to progress by a centimetre of dilation every hour or two, and if that’s not happening despite Syntocinon then it’s caeserean time.” LIke there’s absolutely, categorically no other avenues to try from here then? None at all? What do we know about a dilating cervix and baby positioning? Nothing else we can consider here…off to surgery then, why not.

We know women dilate in childbirth at different speeds with or without Synto. The word ‘progress’ and the phrase ‘failure to progress’ makes me cringe every single time I read it, like a timeframe on birth is realistic and using the word failure anywhere near a woman in labour is kind.

Anyhoo, I’m getting drawn into the nitty gritty now. And I’ve not even touched upon the delightful anecdote where he was bleeped mid-wank to assist a woman (or in his terms, deliver her baby) and he smugly closed one entry with: “Mother and baby both fine, good old me. I can now write my own bucket list and tick off ‘Delivered a baby while still erect.’ Speaking of buckets, anyone else want to take a moment here to calm yourself, take a deep breath and/or vomit into one?

What I would like to end on is, the book makes me really sad that it’s received so much praise and nobody (that I’ve heard of) has highlighted that this isn’t an ok attitude to have about birthing women. This Doctor is highlighting the systemic patriarchy in medicine and it needs to be changed.

Human Rights in childbirth matter. Being listened to and respected matters. Having options matters.

And finally, it’s never entertaining to me to hear about someone else’s trauma. I don’t care how many hours unpaid work you’ve done that week, or how you dress it up as a comedy sketch. It’s not funny.

If you’ve suffered trauma or are experiencing PTSD from childbirth, here are some places you can go for the right connections and support.

Birth Trauma Support Family

Dr Rebecca Moore and Birth Better

Birth Talk

How to Heal a Bad Birth

Tranquil Birth

Also - never not going to signpost to these:

Positive Birth Movement

Birth Rights

You might also enjoy

Debunking Doula Myths

Debunking Doula Myths

There are a LOT of myths out there about Doulas and while they do make me smile on the whole, some are preventing women from accessing the support they need to have a positive birth. SO a while back I did some much-needed de-bunking with a Doula sister of mine named Leata and I’m really passionate about spreading this far and wide. I feel it’s something I will always reference, always keep coming back to and I hope hope hope it means that someone out there will have a better experience as a result. Here we go.

A little doula history

Contrary to popular assumption, doulas have always existed for as long as women have been giving birth. There is often a woman of the community who just knows when your birth date is close and will be there with food, love and capable arms. She might leave a nourishing meal on your doorstep without a sound knowing that your privacy is sacred in those Golden Hours with your newborn. When we birthed in caves a doula might guard the door. She might be your neighbour, your sister, your friend. She might have only met you during your pregnancy and you just know you want her close when you are birthing. She might call the midwife, blow up the pool, strategically lay out snacks or just hold the mother while she works towards meeting her baby. 
There are many myths about Doulas, and sadly they often come between a woman and the support she wants and needs when birthing. So we decided to bust them…

All photography in this post is by the talented Christina Benton, who gave permission for me to use them for this content.

1) “The only person you need at your birth is your mother.” 

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Evidence suggests that a loving, female presence in the room has a tangible impact on the outcome for mother and baby. But a mother does not replace the role of a doula. A doula is a woman who is experienced in childbirth, who is neither a member of the hospital staff nor a part of the woman’s social circle (relative or friend). Because while a doula cares deeply about the emotional needs of the mother, she won’t bring any personal agenda or opinions about the birth. A doula simply informs and supports, always based on evidence-based practice and will walk the path with the mother in her choices, unconditionally.  It should also be said that for many women, having their mother at their birth is simply not an option. Not everyone’s mother is a calm, tranquil and relaxing presence in the room, and that’s ok! Nor do their mothers live nearby or are able to take time off work to attend the birth. 


Current evidence (doulas love evidence)

In the 70s and 80s two paediatricians named Klaus and Kennell’s conducted studies of doula support which led to the founding of DONA (Doulas of North America) in the 1990s. Later, a Cochrane review found that there are such beneficial effects of doula support that it actually recommended all women have access to one regardless of the rest of her chosen birth team, including her own mother.

It’s always ALWAYS about choice

Doulas exist to illuminate all of the birthing mother’s choices for her, to help her to make her own decisions and feel empowered at every single stage. Ultimately, each person present at your birth serves a role for you and only you can decide that. Whoever you choose to do whatever in your birthing environment or at home with your new baby afterwards is yours and yours alone.

2) “Doulas are only for first births.”

Every pregnancy is different, every birth is different regardless if this is your 2nd, 5th or 10th. No birth is exactly the same so you may need information and support in a very different way for each pregnancy.  Many women who give birth without a doula present for their first birth, come to know about doula support for their following pregnancies. A mother may need a doula’s support to help work through some of her past experiences before birthing again, particularly if they had a difficult or traumatic first birth. Your other care providers i.e your doctor or midwife, may not have met you before or have the time to sit with you and unpick your fears, give emotional support and detailed information during your pregnancy.  And this isn’t even mentioning the immense impact that Postnatal doulas can have with helping the mother and father when they have more than one child at home. Navigating these transitions can sometimes be an ‘all hands on deck’ sort of task, especially with washing, cooking for and feeding multiple mouths.

3) “Doulas take over the partner’s role.”

‘Asking your husband to be your sole guide through labour is like asking him to lead the way on a climb of Mt Everest. He may be smart and trustworthy, you may love him, but in the himalayas you’d both be a lot better off with a sherpa!’ (Pam England ) A doula certainly isn’t there to replace anyone, but add support to everyone involved – including the partner. Partners are really important people in the birthing room. The love they share and the oxytocin the couple produces when they look at each other, touch, kiss, cuddle, will fuel her labour – way more effective than any artificial hormone drip.  Having said that, some dads want to wait outside altogether, some feel big adrenaline rushes as soon as her labour starts and need a lot of support themselves. A doula is there to be that extra pair of hands. Practically she might let the partner sleep, run and get snacks and she will have a host of doula tricks to help ease the mother through her surges too, (or suggest ways the partner can help her.) We are practical, emotional and informational support for the couple *as a team* and ensure the best possible outcome for mother and baby.

4) “Doulas are either for rich people, white people, or both!”

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While it may appear that doulas are all middle class white women supporting….middle class white women, non-white doulas are here and growing. Diversity has long been an issue in the birth world with the majority of articles, videos, images and films all featuring exclusively white families, giving the impression that positive births and experiences are not for people of colour. This is something that is slowly changing with small collectives and birth justice movements growing and bringing variation, advocacy and awareness to birth work. Then there’s money – different doulas charge different fees and offer a range of extra services. So do your research, meet with many doulas to find one who will suit you and your family best. Be open with your doula about money early on and chances are she will have lots of ideas up her sleeve to ensure you can have her support if you want it. Such as; bartering, payment plans, payments in kind and vouchers. There is also the Doula Access Fund with Doula Uk which enables those on a very low income to have the support of a doula.

5) “Doulas are a new made up role”

While the word ‘doula’ may seem new, the role has been been around for a very long time, as long as women have been giving birth, there have been doulas.  A lot of time and energy is spent supporting each and every mother as a doula and offering continuous care and support isn’t always easy. Getting that call in the middle of the night, leaving the warmth of our bed, sometimes arranging complex childcare and leaving our family without knowing when we will be back is hard. There might be times where we lose out on food and sleep just so we can be there by her side. Of course we wouldn’t have it any other way but it takes a lot more than an ‘interest in birth’ to be a doula and we certainly wouldn’t categorise it as a hobby, aka a leisure-time activity. Some of us say we answer a calling to be a doula – so that all our past experience and passions come together and make sense. It’s been that way for centuries and long may it continue.

6) “Doulas are only for unmedicated home births.”

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Doulas can be found anywhere; hospitals, in birth centres, and at home, in large houses, small flats, boats, tents, prisons and even in the birth pool. Not all doulas are built the same, some of us use soft words and herbal remedies, some of us are straight talking, some of us have babies ourselves, some of us don’t but what we do all have in common is the desire to support mothers & their families, that all women have choices and are heard, and that we can give you the tools to empower yourself. A doula doesn’t care where you give birth what they care about is that you feel supported, respected and cared for. Your birth is exactly that, your birth! And a doula doesn’t hold preferences on what that could look like if it is not your choice. Whether you want to birth at home unmedicated or in a hospital using any pain relief method available, as long as you are making informed decisions that is what matters & having a doula will give you access to that information, giving you the chance of your most optimum birth outcome.

7) “Doulas and midwives do the same job.”

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This is a common one. Doulas complement the role of the midwife, who don’t always have the time or opportunity to get to know the mother over her entire duration of her pregnancy. 88% of women will only meet the midwife present when they birth their baby when they are in labour. Continuity of care is important to ensure the mother feels relaxed and really held.  Sometimes women seek the support of a doula once they realise they may not see a familiar face when they’re in labour. This always seems a bit sad because Doulas don’t replace midwives. Every woman should have the chance at a nurturing, caring and supportive relationship with her midwife. Doulas aren’t either/or when it comes to midwives and there’s no such thing as too much support in that room. We all have our roles and a doula’s is not medical. She won’t recommend treatment, take your blood pressure or do a fetal heart check. Nor will a midwife give you her personal mobile number, bring food, apply counter pressure for 20 hours or hold your weight while you sway right up until your baby is safely in your arms.  A doula can help you get the best out of your midwives and complement their excellent care.

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If you are pregnant and like the idea of having a Doula, get in touch with me and we can discuss you wishes. If i’m not the right Doula for you, I’ll put you in touch with some wonderful women who might be.

Lu x

Research


Cochrane review of the effects of continuous emotional support in labour.

Also included in this article is research on the effects of early and prolonged skin to skin contact after birth.

http://www.cochrane.org/CD003766/PREG_continuous-support-for-women-during-childbirth

Rosen, P. Supporting women in labor: analysis of different types of caregivers Journal of Midwifery & Women’s Health Jan-Feb 2004, Vol 49(1), pp.24-31 Paper available from:http://www.medscape.com/viewarticle/467128

https://evidencebasedbirth.com/the-evidence-for-doulas/
Interesting reading….

http://www.huffingtonpost.com/entry/new-evidence-that-we-just-need-to-give-women-more-time-to-labor_us_56ec4f66e4b084c672203418
http://www.telegraph.co.uk/news/health/news/11766317/crowd-birthing-mums-social-media.html
https://www.theguardian.com/commentisfree/2015/jul/30/birth-crowdbirthing