Saturday, 4 February 2017

We need to act now to save Independent Midwives - and birth freedom!

Independent Midwives...where do I start with what I owe to them? Without Independent Midwives, I don't know what kind of birth I would have had with my second baby. Traumatised and scared after my first birth (induction, forceps etc), I discovered, right at the last minute, that you could 'opt out' of the NHS. I contacted Independent Midwives Caroline Baddiley and Chrissy Hustler, and as soon as they walked into my living room for our first meeting, I knew that everything was going to be different from that moment on.

It's awkward to 'big up' IM's because doing so contains the implication that there is something wrong with NHS midwives. And of course, this is not the case. There are many many fantastic midwives in the NHS and many women have fantastic positive births under their care. The problem that I had, and that drove me to seek an alternative, was that I could not guarantee that I would know the midwife who attended me. In my local area at the time, midwives came from a large 'bank', and I was told I probably would not know the person who turned up to my home birth, and she may not have any experience of water birth.

I wanted to know my midwife, and I wanted a water birth, but also, and perhaps more than both of these things, I wanted someone who 'believed' in birth (mainly because at that point, I didn't!). I wanted someone who would not feel the need to clock watch, or offer unsolicited pain relief, or give routine examinations that I didn't want, or box tick on a clip-board. I wanted someone who would have the confidence in my birthing abilities that I lacked, and who would bring a special positive energy to my birth space. Basically, I wanted the UK's answer to Ina May Gaskin. And that's exactly what I got.

After that beautiful birth, that changed the way I felt about my body, and was one of the many factors that triggered me to launch the Positive Birth Movement, I learnt that IM's were under threat. By this time (around Spring 2013) I was pregnant with my third baby, and was writing this blog really regularly (remember that?!), and so I used my blog, and then my new role as a writer for Telegraph Women, as a platform to voice support for them. They were being told that, due to an E.U directive, they would need to get insurance, or face becoming illegal.

Now, if you're not familiar with IM's this part might shock you: At this point in time they did not actually have any insurance, and had never had it or been required to have it.

For some reason we've become so familiar with insurance and litigation that the idea of someone being uninsured can make us feel quite uncomfortable. It's as if the very act of being uninsured might make a person less responsible or more likely to do something dangerous.

Of course, this is not the case. When Caroline and Chrissy came to that meeting in my living room, and explained to me that they were not insured, I couldn't have cared less. Ultimately, even if they had been insured, I would only have got a payout if something had gone wrong due to their negligence. If something had gone wrong due to mother nature, or bad luck, I probably would not have got a penny. Listening to these two fantastic women at what was effectively their 'job interview', I knew I had absolute confidence in them and that they would be the polar opposite of negligent. They would give me one to one care, be by side throughout, and they would know me and be emotionally invested in my welfare. I trusted them completely.

In some ways this is irrelevant, because the law, rightly or wrongly, did continue to demand that IM's found insurance, and they did go on to find cover. A different and completely wonderful IM, Tara Windmill Robson, attended my third birth, and she and I celebrated in relief when this solution was found. Since then I've promoted IM's wherever I can, as I believe (as I wrote in this article for the Telegraph), that IM's hold the key to birth freedom. Without them, we risk birth becoming more medicalised, more institutionalised, and depersonalised. Without them, women's choices narrow overnight.

It seemed like IM's had been saved, but behind the scenes, all was not well. I learned in the first week of January this year (2017), that they had received the news from the NMC (Nursing and Midwifery Council) that they could no longer practice.

This seemed unbelievable! Why had this happened?! Wasn't everything all sorted?!

I'm still not 100% sure I understand the situation fully. In this blog post I'm just going to tell you what I do know...

First of all, the NMC...

I've had a brief encounter with the NMC recently after I wrote this article for the Guardian which referenced the situation with IM's. They took issue with the paragraph about IM's as it originally appeared, and boy-oh-boy was there was a lot of to-ing and fro-ing with the Guardian Reader's Editor and myself as we tried to amend it. (not much fun when you don't have any childcare and you have to navigate the situation with Bing Bunny in your left ear and a 3 year old sitting on your arms).

One big problem is that the NMC seems to lack understanding of what an IM actually IS. They took issue with my statement in the Guardian that the option of an IM had been removed for women, saying that their ruling only affected a 'small group of IM's' who are members of IMUK, and that all of the other IM's in the country do have the right insurance and can therefore still practice. They seemed keen to diminish the impact of their decision, consistently stressing the tiny number affected, for example, in their original statement on the issue, they say:

‘The decision today only applies to around 80 members of IMUK who rely on their indemnity scheme. In contrast, more than 41,000 midwives in the UK operate with adequate indemnity cover.’

Anyone reading this who knows nothing about the issue could easily take away that there were tens of thousands of IM's! In fact, that figure of 41k includes every midwife on their register, including all of the midwives in the NHS. However, putting those two figures next door to each other certainly does make the number affected seem utterly insignificant! Well done, NMC PR department!

"Anyway", the NMC seem to be saying gaily, "there are lots more Independent Midwives who can still practice!" It's not a problem, they say, because all of the IMUK IM's can just get a job somewhere else! No worries!

Um, well, that's not quite the full picture. IMUK midwives are different. They are SELF EMPLOYED. The other UK 'independent midwives' (by this the NMC means private midwives working outside the NHS) are part of private companies. Anyone who has ever tried being self employed will tell you that this is a very different experience to working for a company, in particular in terms of autonomy, than being employed by a company, however small. 

So the Independent Midwives that the NMC has got rid of are basically unique. A woman who wants an IM - and by that I mean a SELF EMPLOYED and therefore FULLY INDEPENDENT MIDWIFE, not a 'Private Midwife' - in the UK at the moment, can no longer hire one to be at her birth. 

Her only option, if she wants to birth outside of the NHS, is to use a private midwifery company. If she is in London or the south east, she can try Neighbourhood Midwives. If she is in Essex or the Midlands, she might get lucky with One to One Midwives.  But if she's anywhere else in the country, she would have to try a company called Private Midwives, also known as UKBC (UK Birth Centres). 

Let me tell you a couple of interesting things about Private Midwives. 

First of all, they are the only private midwifery company that claims to cover the whole of the UK and Ireland. 

Second of all, they are the people who raised a complaint about IMUK Independent Midwives insurance provision with the NMC. 

Yes, you heard correct. IMUK, a group of individuals that are basically the only competition to Private Midwives / UKBC, has effectively been put out of business by the NMC decision, the wheels of which were set in motion by a complaint (which I have personally seen and read) from their main competitor...UKBC.

But that's OK, say the NMC, because all the IMUK midwives who have been put out of business by the decision can just go and sign up with Private Midwives / UKBC!!

Well there's a few reasons, apart from the obvious, why they may not want to do that. 

First of all, being employed as a midwife even if it is outside the NHS is not the same as being an Independent Midwife. You are not autonomous. You are not self employed. You are working for the Man (even if the Man is a twinkly eyed midwifery company manager). 

Secondly, Private Midwives / UKBC don't seem to have the same values as the IMUK midwives. Take for example their website. Under 'Birth Choices', they list as an option, 'Cord Blood Banking' in collaboration with a company called Future Health Biobank. Now, an IM would support you if you really wanted to do cord blood banking, because they support ALL choices. But they would never actively promote it, or take a financial cut from it as presumably UKBC are doing, because, as every IM will tell you, cord blood banking is almost impossible to do effectively without interfering with Optimal Cord Clamping. 

Did you know there's a brilliant new birth book coming out next month by a little known birth writer called Milli Hill?! She's given me her permission to share an exclusive extract from her book about Cord Blood Banking, in exchange for this shameless plug:

This extract from the Positive Birth Book is taken from a larger section on everything you need to know about Optimal Clamping:

What about cord blood banking?
Cord blood banking is big business. While there are some options to donate your baby’s cord blood, for example in the NHS, there are many more private companies who charge around £2,000 or more to collect and bank your baby’s cord blood, which they often describe as, ‘a waste product with life-saving potential’. However, you can’t do ‘optimal clamping’ and ‘cord blood banking’. So it’s worth considering whether you want to donate around a third of your baby’s blood volume, by having it banked for their own or anyone else’s possible future use. Although we can’t predict every scientific advance of the future, it’s thought that the chance that your own baby will need their banked cord blood before the age of 20 could be as little as 1 in 20,000. Also, should your child develop leukaemia, it’s extremely unlikely that his or her own cord blood will be appropriate for transplant. Essentially, so-called ‘cord blood’ is actually ‘your baby’s blood’. Perhaps the health benefits might be highest for your child if this blood goes straight into their body at birth?

I called Future Health Biobank and asked them what would happen if I wanted OCC but also wanted to bank my baby's cord blood. They said I would be able to wait 2 minutes before collecting, and whilst Private Midwives say they advise a wait is built in, they also admit that the longer you wait, the higher the risk of the sample failing. Let's just say this, if you had had cord blood banking promoted to you by the midwives you had trusted to hire, AND had paid around £2k for it, would you want to risk it not working out, or would you ditch the OCC and get that blood harvested PDQ?!

It's all a bit murky. This rival company, who complained about IMUK's insurance, and promote the utterly daft practice of cord blood banking, are also alleged to have a voluntary excess of £50k on their policy and to have been, until recent investment from a company on the Isle of Man, substantially in debt. How much of this is true, or who the new investors are, I'm yet to find out, but boy would I love to know.

I've asked the NMC if they plan to investigate the insurance arrangements of UKBC and they have told me that they, "do not currently have concerns about the indemnity arrangements of any other group of midwives."

In the meantime IMUK members cannot attend women in labour. There are pregnant women who are directly affected by this decision, and Birthrights have said that their actions, “appear designed to cause maximum disruption and damage to independent midwives and the women they care for,” adding that, “we do not believe that these are the actions of a responsible regulator.”

I would add that I feel this decision directly threatens the future birth experiences of every woman currently pregnant or yet to be pregnant in the UK today. Independent Midwives represent an alternative model of birth to anything else currently on offer. They believe in the power of women's bodies to birth without interference. They care for women in a completely different way to the service most get under the NHS, offering the kind of individualised care that has been shown by research to have better outcomes for safety and satisfaction across the board, and promoted by the recent maternity review as the gold standard to which the NHS should be aspiring.

And for now - they are...gone.

Please help save this option for UK women by taking the following action:

There is a comprehensive list of ways to get involved listed here on this site

They include...

Write to the NMC at (example letters here)

Sign a petition

or this one to the UK parliament

or this one on 38 degrees

Or all three!

Join this Facebook group

If you're tweeting, use the hashtag #savethemidwife

Here's a few pics from my two births with Independent Midwives.

Monday, 28 November 2016

Sometimes I sits and thinks, and sometimes, I just sits.

Oh, how long it has been since I have written this blog! Actually, I've really missed it, and it feels good to be back. has really moved on in so many ways from the days when I used to sit at my desk, one evening a week, and sip wine, and think, and write.

It's can I put this...hectic. We moved house, not to any house, but to a kind of derelict place, one half of which used to be the village hairdressers and the other half of which had been lived in by a lovely little old lady for about fifty years. Walls needed knocking down. Floors dug up. A staircase ripped out and another rebuilt in it's place, the other way round. For the past three years I have lived under a layer of brick dust, with the sound of an angle grinder haunting even my dreams. My partner - who was born to live on the road in a van and admits it himself - reminds me that many people the world over would be so glad to live in a building site and wouldn't mind the powdered concrete clouds or the lack of central heating or think that not having a kitchen to speak of was anything out of the ordinary. In turn I remind him of the droves of people who would consider the property to be 'uninhabitable' and would stay in a hotel for the duration of the building project, or just never ever touch a house like this with a ten foot barge pole for the sake of their own sanity. There have been disputes. Tear-sodden, brick-dust-coated disputes, in which we've debated the haves versus the have-nots and their respective merits and I've wanted to whack him with the greasy frying pan that could have been so much more easily washed up in the dishwasher I so superficially longed to possess.

Then there was the baby. When we moved into said building site, I was about 6 months pregnant with baby number 3. I've heard that having a third baby is a bit like - you're drowning, and then somebody throws you a baby - and I'm here to tell you that it's not like that at all, it's much much worse. Or maybe it just feels like that if you're living in a pile of rubble disguised as a house, and then the baby gets sick (see here for the story of his horrendous eczema), and then your dad gets lung cancer and dies.

OK so I must sound like I'm crying the blues here but this really is the story of the past few years of my life, or at least the story of the events that led to my feeling like a great big boot had swung back, hoofed itself into my status quo, and knocked the whole shebang firmly into orbit. My absolute low point must have been the day after my dad's funeral, when my son had his first asthma attack. I took him to A&E and a nurse took one look at him, picked him up and ran with him down the corridor, buttons were pressed, a team came running, it was surreal. I was terrified. He was OK.

Of course, this is not the only story of the past couple of years. All of this time my three wonderful children have been delighting me and simultaneously driving me nuts and keeping me sane. I've been writing writing writing away, first for Bestdaily, where I wrote week after week about birth, breastfeeding and motherhood, notching up over 100 articles in just over 2 years. Sadly their website didn't make it, and my column died along with it, but since then I've written regularly for Telegraph Women, and a few bits and bobs elsewhere, too.

And all of this time, I've been running the Positive Birth Movement (PBM) - launched as a small idea here on this very blog in 2012, and quickly snowballing into a huge organisation with over 400 PBM groups worldwide and an ever-growing presence on social media. I'm so proud of what the Positive Birth Movement has become, and I love hearing the wonderful feedback from women who have - either through social media or the 'real life' groups - found a new narrative of childbirth that has changed their own story. Women who had (like so many of us) a terrifying mental image of birth, but began to believe that it could be different - powerful, beautiful, or even enjoyable - when their own turn came.

Because of this success, I've now written a book - The Positive Birth Book - which will be published by Pinter and Martin in March 2017. It draws on the real appetite that women have for new, positive messages about childbirth, that the PBM has revealed to me over the past few years! But it's actually much, much more than that. I really feel that the book is quietly revolutionary, because, as well as giving the inside track on what birth is really like and how brilliant it can be, it's also packed with information about choices and rights in the birth room, and brings the same PBM philosophy - that it's up to women to decide what makes birth positive for them as individuals - rather than raising up one kind of birth above another. I hope I'll get time to share more about the book here on this blog over the next few months leading up to the launch, but for now, let's just say that, although it's not littered with the F word, I think it's about as feminist a book about birth as you're likely to find.

So I feel like I'm at a turning point, although as always I'm slightly afraid to say that in case the Fates overhear me and start randomly slinging crap at me again. At home there is no more brick dust. There are radiators and a dishwasher. There are no longer large holes in the walls. It's beginning to look quite lovely in places. The baby is now 3 and we haven't had an overnight stay in the Children's Ward for about a year now. The PBM is flying. Whilst I love birth, there are to be no more babies and their associated chaos. And the book is with the 2017 could be very exciting indeed. Who knows I may even find myself sat at my desk, sipping wine and blogging once a week. Although that reminds me of one of the very funny little truisms my dad used to say:

"Sometimes I sits and thinks...and sometimes...I just sits." 

_________________________________________________________________________________You can pre-order The Positive Birth Book on Amazon or Wordery and it's out in March!

Friday, 7 March 2014

Baby eczema took over our life: have we found the answer?

"How come you have stopped blogging?", someone asked me recently. Short answer: I had a baby. Slightly longer answer: I had my third baby, my life is chaos, I got a job as a columnist and it's all I can do to get that done every week, I'm a perfectionist and it takes me ages to write anything, oh, and my baby got eczema and it's pretty much taken over our life.

Eczema? Isn't that just like, a rash? A bit of dry skin, the odd bit of redness behind the knees. That's what I thought, and almost laughed when the community nurse suggested I apply for disability allowance shortly after the eczema started. Four months on, it has nearly broken me.

I can't describe to you how awful it is just to see your baby not looking right. This might sound awfully superficial, but I'm sure it's much deeper than that. There must be something hard-wired into the deeper, older parts of a mother's brain, to feel ill-at-ease if her baby looks sick.

The skin of a baby ought to be creamy. Babies are bloody hard work, but the pay-off is you get to put your face and nose all over them and shower them with love and kisses and raspberries. With my baby, we went from this:

to this:

In the space of just three or four weeks, what started as the usual 'milk spots' seemed to evolve into something horrendous.

At first the doctor said it was a skin infection and prescribed a cream called Fucidin H, followed by antibiotics, which I gave without question - looking at the photos, wouldn't you? But all this did was upset his stomach, and as my doctor seemed at a loss, I took him to A&E.

There we saw a paediatrician who said it was Seborrhoeic Dermatitis, to stop the antibiotics and to get a cream called Double Base (an emolient).

When this didn't help either I turned to the facebook community and many suggested I gave up various foods in my diet (as he is breastfed) and see a homeopath. I've never thought much of homeopathy so it shows my level of desperation. To be fair, the homeopath was the only person at that point who really took a thorough history and actually seemed to be determined to help.

Meanwhile the rash spread to cover his whole body.

Over the next few weeks, I gave up dairy, egg, wheat and gluten in the hopes of helping what seemed to be an allergic reaction. There was not much feasting for me over the Christmas season!

We also saw another paediatrician in mid December who diagnosed eczema and gave us some help and sympathy. We were told to use steroid creams twice daily and in between put on a thick, greasy, paraffin based ointment called Hydromol.

There were mixed messages about the steroid creams, summed up by this, "They are harmless, but don't use them too much!"

Sometimes he would look a bit better, and I would think, I've cracked it! I tried keeping food diaries and sometimes I would think I had spotted a pattern. I tried various natural creams, all of which, especially Hope's Relief, were lovely. But none provided what I wanted - cure.

And moments of hopefulness were always swiftly followed by total despair, as my beautiful baby's face and body were taken hostage again.

He did not seem to be as affected by it as you might think, looking at these photos. He has a very sunny disposition, and seems to be able to smile no matter what. Sometimes I think he 'gets it' and I feel a sense of irony coming from him. We are very connected, and the eczema has only made me love him more.

But my god, it has been a trial. For starters, a lot of the time his face has been oozing pus. Not an infected kind of pus, just a sort of watery, pale yellow liquid. This has meant that (yes, poor me again, here we go) I have been unable to wear any normal clothes for several months - I've been living in supermarket hoodies, which can get chucked in the wash at the end of each day.

We have had to change his sheet every day, as this would become soaked in pus and Hydromol during the night. He sleeps beside me in the bed and sometimes I have felt disgusted by this soggy, pus-y little guy attached to my breast, I admit it. But only in very dark moments.

The nights overall have been the toughest. Because of his terrible itching, he has been unable to really 'settle' into a deep sleep, in spite of seeming to be a fairly happy sleeper for the first couple of months of his life.

I have been sleeping holding his arms to stop him scratching. Not very restful for me, but the alternative is impossible - I cannot just lie there and listen to him cry and rub his face with his mittened hands.

In fact I don't know how anyone could survive this situation without having their baby in their bed.

I'm completely knackered. This has been one of those periods in your life where you feel you are aging by about a year a day. My hair full of hydromol and pus, my horrible clothes, my haggard, exhausted face...oh there I go feeling sorry for myself again.

So I've been trawling the internet through my tired tired eyes. You know how it is - breastfeeding and peering at your smartphone. Just over a week ago I overheard a conversation in a facebook eczema group. Some women were talking about a guy called Dr Aron. Their tone was reverent. It had a sort of 'cult' feel to it, as if this Aron guy was the new Messiah.

Expecting to find a whacky website, I followed the link, to discover a South African Consultant Dermatologist, based in London, who specialises in child eczema. It all sounded good, too good to be true perhaps. I trawled google. I could not find a single person with one bad word to say about him.

Apparently (and this is anecdotal) he is so fed up with the needless suffering of children with eczema who are often given the wrong treatment that he wants to make his treatment more accessible and 'give something back'. To this end he has set up an online consultancy service, offering a low cost alternative to private face to face appointments.

His treatment method is based on a mix of creams. If you want to know more, watch this short film or read his website:

As we were thinking about travelling to London to see a specialist anyway, this seemed worth trying.

We are now on day three of his treatment. It's early days, and I'm loathe to get too excited, but so far the results speak for themselves:

Words cannot describe the delicious relief gained from pressing my face up to that taut smooth dry skin and kissing away like mad!

Even if it all becomes a nightmare again, I will be grateful for these few days of seeing a glimpse of a 'normal' baby.

Obviously I will be blogging about this again, as if Dr Aron's treatment works (as SO many of his former patients say it does), then the world needs to know about this.

Please keep your fingers crossed for my beautiful boy, for my patient little girls who miss their pre-baby mummy, for my long suffering partner who has born the brunt, and of course, greasy, pus-y, haggard old me...and watch this space.

UPDATE: 14th August 2014
We are still working with Dr Aron and my son's skin remains mostly clear. A blog post with more info coming soon but meanwhile, do join the Facebook group to see Before / After pics of others who have been treated by Dr Aron and talk to a supportive community of eczema mums, here:

And here is the gorgeous boy!

UPDATE: 19th November 2015
We remain eczema free and have not used Dr Aron's cream or any steroid for over a year. After a bath we usually apply Lush Dream Cream but other than that, we don't do anything to his skin. He is peachy and beautiful and adorable, just as he was always meant to be! We remain eternally grateful to Dr Aron, and frustrated that this approach continues to be largely ignored by the NHS.

Friday, 18 October 2013

The Positive Birth Movement at the Birthrights Dignity in Childbirth Forum

Yesterday I was honoured to be a part of the Birthrights Dignity in Childbirth Forum, held at the Royal College of Physicians in London.

I gave a short presentation about my organisation The Positive Birth Movement, which I'm reproducing here for those who were unable to attend and might be interested to read it.

Below the presentation I'm also sharing the 'submission' that was made to Birthrights about the Positive Birth Movement, which gives more detailed information about the organisation, including some fantastic feedback from those who facilitate and attend our groups.

Please come and join the PBM on Facebook, Twitter, or get in touch with me if you would like more information or want to be involved in any way. You can find your nearest Positive Birth group on our website:


My name is Milli Hill, and a year ago this month I set up the Positive Birth Movement.

It all started with a very little idea – the thought that, as a newly trained doula, I might run a monthly birth discussion group in my area – a place for women to gather and share thoughts and feelings about birth, to challenge fear and negativity, and to empower each other with support and shared information.

When I had been pregnant with my first daughter five years previously, I had longed for this kind of antenatal group. I didn’t much want to look at plastic pelvises or learn about epidurals. I was more interested in what birth was really like, and I was very very afraid.

In the time since my own first birth experience, I had also noticed – and begun to write and blog about – what I saw as some pretty serious flaws in the current birth system – an imbalance of power, over-medicalisation, and a whole lot of fear. And I watched friend after friend finding their plans for a normal birth end with their feet in stirrups or on the operating table.

So I thought that maybe women needed to come together and talk about all this – just a small group – round my gaff – maybe with cake.

In late September 2012 I went to a screening of Freedom for Birth, the film about imprisoned midwife Agnes Gereb, and the wider issues of rights in childbirth. It called on women to ‘take back childbirth’. I very much heard this call, but felt at a loss – how could we do this?

I saw a world in which women were afraid, and were faced with difficult choices in childbirth – a world in which real ‘evidence’ was hard to come by, and medical opinion was often presented as fact. I felt that women’s freedom was truly being compromised by this situation – for how can a choice be truly free as long as it is based in fear or a lack of accurate information?

I started to wonder if my ‘little idea’ – to set up a local birth discussion group, could spread? If I were willing to give my time to this cause for free, perhaps others might do the same? And what if we could use the power of social media to connect all these little groups to one enormous ‘Mother Ship’?

There has never been a better time to have a ‘little idea’ than the 21st century.

Through my personal blog, and through facebook, I dropped my little idea out into the ocean of cyberspace – and the response was overwhelming – a tidal wave of offers, ideas and positivity.

In a year, we now have over a hundred Positive Birth groups in the UK

26 in the USA and Canada

5 in Australia and New Zealand

3 in Turkey

2 in Brazil

and 1 each in France, Germany, Malta and Qatar.

All of our groups are free to attend, and our Facilitators are not paid to run their groups.

Most groups are facilitated by doulas, midwives, or other birth workers, but one or two are run by women who are ‘just passionate’ about positive birth.

Most of them meet on a monthly basis, some more often.

Anyone can attend a Positive Birth group – they are open to all but aimed primarily at pregnant women. 

We welcome all backgrounds and ALL birth choices - we are not the 'natural birth movement', and very much believe that any birth can be positive, so long as a woman is free to make informed choices, and is treated with respect and dignity.

The groups are structured as peer to peer discussion – ‘teaching’ is discouraged, shared ideas and conversation are encouraged in its place.

All groups are connected via social media, and we have a very active facebook page with nearly 4000 ‘likes’. Our Facilitators have their own extremely active discussion group on facebook, and I also send out a monthly newsletter to keep people connected and announce the monthly discussion theme.

Groups are free to use our monthly discussion theme as a starting point, if they so wish. Some of our themes have included:

  • Planning a Positive Birth (thoughts, feelings and experiences of ‘birth planning’)
  • What is a Positive Birth?
  • Choices in Birth (the many and various choices pregnant women face)
  • The Language of Birth (the language we use about birth and why this matters)
  • Images of Birth (what images we have seen of birth in our lives and how these have affected our expectations and experiences)
  • Place of Birth (how can we have a positive birth in the various locations, what our options are etc)
  • The Hour after Birth...and Beyond (what we can choose to do to make this important time positive, too)
  • Oxytocin
  • Improving Birth (what needs to change about birth and what can we do about it?)

The Positive Birth Movement has grown far beyond my first imaginings.

If I’m honest, the organisation is entirely built on good will, passion, and trust – which I sometime worry might be its weakness as well as its strength! We don’t have much formal structure underpinning all this fantastic positive energy – and this is something I plan to work on over our second year – as this seems to be a way that we might grow stronger, and also gain funding.

However, I very much want us to keep the passion to change and improve childbirth at our core – this very ‘little idea’ of women talking to women. By coming together to ‘just talk’ – as women have done for millennia - challenging fears and sharing wisdom and positivity - I very much hope that we can ‘take back birth’.

I would really welcome all of your ideas and input – so please do get in touch with me if there is any way that you can help me or would like to be involved.

Thank you very much!


We are a grass roots movement, spreading positivity about childbirth via a global network of free Positive Birth groups, linked up by social media. We aim to challenge the current epidemic of negativity around childbirth by bringing women together to -

Meet Up, Link Up, and Shake Up Birth.

Since our ‘birth’ in October 2012, Positive Birth groups have spread to all corners of the globe. We now have over 100 groups in the UK, nearly 30 in the USA and Canada, and a further 20 in the rest of the world, including Australia, New Zealand, Turkey, Brazil, France, Germany, Malta and Qatar.

Our core beliefs: 

The Positive Birth Movement believes that every woman deserves a positive birth. 

By positive birth we mean a birth in which a woman feels she has freedom of choice, access to accurate information, and that she is in control, powerful and respected. A birth that she approaches, perhaps with some trepidation, but without fear or dread, and that she then goes on to enjoy, and later remember with warmth and pride.

A positive birth does not have to be ‘natural’ or ‘drug free’ – it simply has to be informed from a place of positivity as opposed to fear. The Positive Birth Movement is woman-centred and as such respects a woman’s human right to choose where and how she has her baby.

You can birth with positivity in hospital or at home, with or without medical intervention. You can have a positive caesarean, or a positive home water birth. Positive Birth is about approaching birth realistically, having genuine choice, and feeling empowered by your experience.

The Positive Birth Movement believes that communication is the key to shaking up birth. By coming together, in real life and online, and sharing experiences, feelings, knowledge and wisdom, women can take back childbirth.

What we are and what we do:

All of our groups are completely free to attend, and most run at least once a month. They are mostly facilitated by doulas, midwives, and birth workers, and some are led by women who are ‘just’ passionate about positive birth. They are mainly aimed at pregnant women, but are open to anyone who would like to either gain or share some information and wisdom about birth.

Our groups are not ‘antenatal classes’ – nobody present is an ‘expert’ or ‘teacher’. They are discussion groups, a place where everyone is equal and where all views and approaches are valid. Each month the Positive Birth Movement sets a discussion topic, which the groups are free to use as a starting point for their meetings. Groups can then feed back thoughts or issues that arise to the main Positive Birth Movement facebook page, which also takes that discussion topic as its monthly theme. Past discussion topics have included:

  • Planning a Positive Birth (thoughts, feelings and experiences of ‘birth planning’ 
  • What is a Positive Birth? 
  • Choices in Birth (the many and various choices pregnant women face) 
  • The Language of Birth (the language we use about birth and why this matters) 
  • Images of Birth (what images we have seen of birth in our lives and how these have affected our expectations and experiences) 
  • Place of Birth (how can we have a positive birth in the various locations, what our options are etc) 
  • The Hour after Birth...and Beyond (what we can choose to do to make this important time positive, too) 
  • Oxytocin 
  • Improving Birth (what needs to change about birth and what can we do about it?) 

Positive Birth Groups aim to be a helpful part of pregnancy; a warm and welcoming place for women to hear stories and ideas, to consider what they really want from their childbirth experience, and to challenge any fears or negative expectations they might have.

We believe that if women are empowered to approach birth differently, birth will be different.

How I got to thinking about Positive Birth… 
As a creative arts psychotherapist, trainee doula, writer and blogger about birth, and most importantly, mum – a few things slowly collided for me, and led to the setting up of the Positive Birth Movement in October 2012. Not only do I sometimes feel angry when I hear a ‘typical’ UK birth story, I also feel that the importance of the experience of birth is often completely underestimated – for the mother, and of course for the baby too, and the family unit which is just beginning.

In western society, there is evidence of disordered and disrupted attachment everywhere – and I saw a lot of this in my working life before motherhood - in drug and alcohol rehabs, with children in foster care, and with people experiencing all kinds of mental health issues.

In the search to heal this, or even prevent it, we often look to parenting, and to the way that the parents were parented. However, birth itself is often completely ignored.

Experiencing a positive birth is not ‘just’ a ‘feminist issue’, or even ‘just’ a ‘human rights issue’ – it is an issue for all humanity. Birth as a gentle experience, in which all concerned are treated with dignity and respect, maximises the chances of a great start to the mother infant bond, and a confident beginning to parenting. The power of this cannot be underestimated!

Gentler and more positive births could lead to stronger attachments, to better mental health, to better relationships – both personal and societal. To gentler and more positive people – and a gentler and more positive world.

So – looking at the current situation for birthing women in the UK, I felt that change was needed, but felt pretty overwhelmed at the prospect of trying to change ‘the system’. I wondered if, instead of focusing on the system and what was ‘wrong’ with it, we could instead change the way that women entered the system.

In psychotherapy, you learn that you can’t change the way other people behave, and that you can only change yourself. However, if you change yourself, other people are usually forced to change to accommodate the ‘new you’. For example, a bully can’t be a bully without a victim.

So my hope is that by becoming more empowered, informed and knowing their rights, women will enter the system differently, and that the system will be forced to change to accommodate them.

The birth of a Movement…!

At first, I was thinking about these ideas on a small scale. I had the idea of setting up my own birth discussion group, in which people could share ideas and information. Once I had begun to set this up, I wondered – if a birth enthusiast like me is willing to do this once a month for free, maybe others out there would be willing to do the same. Very quickly, I had the idea of a ‘Positive Birth Movement’, the plus sign logo popped into my head, and I set up a facebook page and blogged about it, never anticipating the scale of the response! Perhaps if I had known how big it was going to get, I might have thought more carefully about starting it in the first place!

The response was immediate, and I began to be flooded with emails from people who wished to set up a group. The Facebook page was also popular, and in a year has gained over 3000 ‘likes’.

And with nearly 150 groups worldwide, clearly the idea has caught on!

It seems there are many many people who are equally passionate about changing childbirth for the better, and who are willing to give up their time for free to do so.

How it is run
Quite ‘loosely’, would be the short answer to that!

Because it was set up on the spur of the moment without much planning, the Positive Birth Movement has developed quite organically as it has gone along, and has evolved in its own way according to the input of all those involved.

I try to hold some cohesion by running a Facilitators group on Facebook and sending out monthly newsletters to all our groups. Everyone involved is ‘linked up’ by social media and often Facilitators will support and advise each other independently of me.

There is a lot of trust involved. Our ‘logo’ and ‘brand’ is out there in the world, and there is no heavy ‘vetting’ procedure for anyone who wishes to be involved. To some, this might seem risky, but it actually works wonderfully well. Our organisation is all about empowering women and giving them back their autonomy – and this requires trust and respect.

Everyone involved has a great enthusiasm for improving birth, and together we have created what feels like a very non-judgemental and positive space, which I very much hope is reflected in our groups.

As I have said, all of our groups are free, and Facilitators are careful not to use their real life or virtual groups for self promotion or money making activities. So far, the PBM has raised a small amount of money from holding screenings of Face of Birth, but otherwise, no money has changed hands.

Feedback from our Facilitators

Samantha Waldron – Positive Birth Hillingdon, London

When women come together to explore positively new ideas, stories and information, the room becomes fuelled with oxytocin and power. There truly is a feeling of love and connection between us all and we all go away feeling “high” on the possibilities that can be achieved.

Guinevere Webster – Positive Birth Oxford, UK 

We were really excited to add our existing home birth discussion group to the Positive Birth network. Although we felt it was important to keep the focus on home birth because there is no other local forum for this kind of support, being part of the PBM allows us to make it clearer that we are about positive birth wherever it takes place, and people don't have to be considering a home birth to come along or gain from the group.

Ann Charles - Positive Birth Central London 

We started in August 2013. I deliberately wanted a venue that wasn't traditionally 'mothery' and would attract people after work. I plumped for the Fifth View bar at the top of Waterstone's Piccadilly. It does nice food and mocktails, you can bring books up from the pregnancy section of the bookshop for discussion and is the sort of place people can drop in and out without feeling like they've entered a parallel universe of church halls, squash and biscuits. So far we've only had two meetings. The first one - only one person came. Second meeting - a different pregnant lady came. Both were planning a homebirth. The struggle at the moment is getting people to come.

Melissa Thomas – Positive Birth Derby, UK 

I think that the Positive Birth Movement Derby was the right place at the right time. In an area lacking any resources for supporting mums and pregnant women it is a refreshing and new outlook. The group really has gone from strength to strength slowly but surely. I truly believe it could become a great network, challenging the fear and outdated attitudes that still pervade most maternity services and practices.

Our biggest success has been gaining the interest of two academics from the University of Derby. Jenny Hallam and Chris Howard approached myself about developing a collaborative research project, investigating the birth experiences of women who use the Positive Birth Movement meetings. I view the study as being a genuine opportunity to open doors with the NHS, taking women’s experiences to the fore and getting policy makers and support services to really listen. Time will tell what the outcome may be but I’m thrilled to have been invited on board as a research assistant and thoroughly look forward to growing and nurturing the PBM Derby.

Mathilde Mazau – Positive Birth Glasgow

I co-facilitate Positive Birth Glasgow which my friend and I launched last November. We started our monthly meetings in January this year and our group has since gone from strength to strength. We have over 150 members of our facebook group including mothers, pregnant women, doulas, midwives, an obstetrician, a shiatsu practitioner, trainee midwives and other birth workers. The ‘real life’ group is a wonderful and safe space for women to share, listen and learn during this amazing time that is pregnancy and birth. The Positive Birth Movement as a whole is an amazing and much needed grass roots movement and we are very proud to be an active part of it.

Feedback from women who have attended our groups

Michelle Levy, Positive Birth Larchmont, New York 

I was thrilled to find a positive birth group near my home during my second pregnancy. Our hostess, Joyce Havinga in Larchmont, chose focus topics such as Postpartum Care, Addressing Fears, or The Role of Oxytocin. This helped steer the group but free conversation and questions were also welcome. Nothing beats a sense of sisterhood when you need it most. Sometimes we received literature. This group is invaluable because more free services need to be available to new mothers. We were all motivated by the good intention to give and receive support.

Sarah Dauncey, Positive Birth Portsmouth, UK

What I love about the Positive Birth Movement meetings is that they are about mums / parents / families empowering themselves and encouraging each other, the ‘professionals’ who support the group provide information but the emphasis is on each family taking the information and making their own decisions to have what makes a positive birth for them, no one tells anyone else what they should want or do.

Susan Last, Positive Birth Derby, UK

I became involved with the Positive Birth Movement primarily because, having had three amazing home water births myself, I wanted to spread the word about what might be possible for others. My birth stories are definitely an antidote to the horror stories so many women hear, even if my choices aren't for everyone! I'm also deeply committed to the sharing of accurate information and know that the research I do can be helpful for others, if only to point them down research paths of their own.

Kristina McGuinness, Positive Birth Glasgow 

It's amazing to have positive support and encouragement in an area often shrouded not only by negativity but also mystery. It has been an amazing support for me and helped me realise I'm not crazy for wanting a natural home birth.

Veronica Hunter, Positive Birth Larchmont, New York 

I recently had a wonderful home birth (VBAC after twin c-section two years ago) of a lovely 9lb 4oz baby girl at exactly 41 weeks. Had I not attended the birth group I would probably have stayed with the Ob I saw up until 30 weeks who would probably not have permitted VBAC of a 9lb 41 week baby. Not having another c-section was very important to me because I truly believe the c-section I had previously got my twins and I off to a difficult start. The ease of breastfeeding this baby girl and her calm nature (perhaps in part due to her smooth entry into the world) have been wonderful and very different from the twins. So many thanks for making me aware of the choices out there and the beautiful way nature designed the process to work.

Nicola Zoumidou, Positive Birth Glasgow

Fantastically supportive group of amazing women. I came away from the Glasgow meeting feeling empowered.

The Positive Birth Movement - Where Next? 

Over the next year I would very much like to strengthen and further promote the Positive Birth Movement, whilst maintaining the integrity and spirit which seems to be so appreciated by all involved.

I have taken some advice on gaining charitable status and hope to look into this further in 2014.

Our main aim for the coming year is to increase awareness of our groups among pregnant women – this is a free resource and although some groups are over-subscribed, there are others which are struggling to fill places. I would love any offers of help to connect pregnant women and the midwives who work with them to our groups.

Funding would certainly help us to raise our profile, too, with good quality printed material and a better website at the top of our wish list.

However, even without financial help, I feel sure that the Positive Birth Movement will continue to grow and spread, simply because there are so many women out there who are so passionate about improving birth that they are willing to run our groups at their own expense. Whatsmore, there seems to a be a growing sense among ‘mothers-to-be’ that the current ‘average’ birth experience, is not really good enough, and a desire amongst them to explore their options and choices. The Positive Birth Movement meets this need perfectly.

Dignity in Childbirth – Respect, Autonomy, Choice

We very much hope to contribute to dignity in childbirth, by encouraging women to become informed decision makers in their birth experience, by spreading more awareness of birth choices, and by encouraging both self-respect and the demand for respectful treatment from all pregnant and birthing women, and all those who work with them.

Monday, 3 June 2013

"Positive, Empowering Birth? Sounds Like Bullsh*t To Me!"

I once read somewhere that the goal of psychotherapy is to reveal the secrets we are keeping, even from ourselves. We all do this. We all keep a few bits of reality out of sight, sometimes because they are painful, but more often, perhaps, simply because to acknowledge them would be a difficult admission of a lifetime of misguided beliefs, misdirected energy, and mistakes.

We see this a lot with the birth issue. Sometimes it's as if simply talking about birth in a positive way is too much for people to tolerate. The cultural attitude that birth is dangerous and downright unpleasant has become so engrained that many people seem to no longer see it as an attitude at all - they see it as a solid FACT. To challenge this would involve accessing ways of thinking that, whilst they may exist, are completely beyond everyday awareness, like rooms in a mansion that have been put under dust sheets and long forgotten.

In the media, journalists with the power and influence for positive change often reveal their own beliefs about birth, beliefs so deeply held they can only be perceived, by the holder, as facts. In this recent article in the Guardian, for example, the interviewer met Caroline Flint, one of the UK's most highly regarded midwives. Flint was clearly overflowing with wisdom and wonderful positive messages about birth, so much so that the interviewer herself was, "almost swayed" - almost. Ultimately, for reasons the interviewer probably keeps secret, even from herself, she felt compelled to dismiss Flint's ideas - with all their power to be transformative for women - as 'transcendental gubbins', accusing her of 'piling guilt onto mothers', and wheeling out an Obstetrician to remind us yet again not to pin our hopes too high when it comes to labour, because, after all, yup, you guessed it, all that matters is a healthy baby.

You don't have to look very far to find similar examples of the media pouring scorn on the notion that birth can be pleasant, delightful, or even orgasmic. In fact, it's much harder to find an article that doesn't. Even articles that are about women who do actually manage to have positive births seem to carry the addendum, 'Birth is not like this for most women. For most women it is painful and frightening. We just thought you might be entertained for a moment by this lunatic fringe who think otherwise.'

Sometimes in life we start with the evidence and build up our beliefs, other times we start with our beliefs and make damn sure we find some evidence. Nothing illustrates this better than a story told to me in my first pregnancy by a midwife friend, which I'm pretty sure taught me more about birth than a lot of the books I have subsequently read:

A field mouse is snuggled in a little nest of hay, quietly beginning to give birth to her litter of babies. Some walkers pass by, see the mouse, and feel worried. What should they do? Knowing there is a vet nearby, they scoop up the mouse, and gently take her to the vets surgery. The vet assures them there is no need to panic, puts the mouse on the examination table, and shines bright lights on her. The mouse is frightened, and her labour stops. The vet tries to restart it with drugs, to no avail, and eventually performs a caesarean. The mother and all of her mouse babies survive. "Well", say the people who found her in her field nest, "Thank goodness we were passing by and saw the mouse in time, otherwise, who knows what might have happened?"

In the stories we hear, and the events that take place in our lives, we often see what we most want to see, and filter out or dismiss the stuff that doesn't conform to our belief system or world view. When we apply this to birth, it means that often the stories of women who relish and enjoy it do not sit comfortably with us, and that we prefer and even find more reassuring the stories of horror and trauma, which reinforce the attitudes we have come to believe are facts.

There may be many reasons for this collective denial, which often keeps women a prisoner of their own self-fulfilling prophecy, believing that birth cannot be positive let alone 'transcendental', and therefore not even trying to make it so. For some women, perhaps, having had their own babies in unpleasant circumstances, it's too painful to admit that things could have been different. Maybe this is what is meant when, as it often is, the notion of 'piling on guilt' is raised.

To move forwards, perhaps this pain needs to be acknowledged; a few generations of women who have missed their chance for an empowering experience and instead had a birth they would rather forget. Maybe they need a collective apology, for the shaving, the cutting, the stirrups, the steel, the brutal experiences they suffered, and continue to suffer, in the name of progress? Perhaps this would be a way of pulling off the dust sheets in the long forgotten room, of laying bare the secrets we are collectively keeping from ourselves - and of clearing the way for women to make a new start and have the positive births they deserve.

Tuesday, 21 May 2013

The Blood and The Beauty: Placenta Prints

The first time I gave birth, they took the placenta away. They didn't ask. They just took it, and of course, I didn't notice. I was busy, waking up from the dream of birth, and falling in love with the first creature I laid eyes on.

Weeks later, in the darkness of night, I remembered. Where was it? I had wanted to keep it. What had they done with it? Could I get it back? No. It was gone, and strange as it sounds, I cried.

Not so much for the piece of my flesh - lost. I cried for the bigger loss it somehow stood for - the birth I wanted, but didn't get.

Somehow, the birth I wanted got replaced with the birth they wanted. And, in the birth they wanted, nobody keeps their placenta. Why would they want to do that?

So I cried, for the flesh lost, and the dreams disregarded.

The second time I gave birth, they took the placenta away. They didn't ask. They just took it, and of course, I didn't notice. I was busy, waking up from the dream of birth, and falling in love with the first creature I laid eyes on.

In the kitchen, I heard rustling, the giggles of my toddler, the quickening breaths of creativity. Moments later, with some pride, a procession appeared, midwives-toddler-all, carrying three large pieces of paper, on which they had made pictures - the imprints of the placenta.

Strange! Why would they want to do that? And yet I treasure them, these bloodied pages, even now they transport me straight to that moment, to the blood and the beauty, to the love and the care and the oxytocin, and the transformation, of something base and animal into something of meaning, and deeply deeply human.

Everything leaves its mark.

Wednesday, 8 May 2013

Cut Me Open or Send Me Home: The Lottery of Maternity Care

Pregnant women are offered medical interventions so often that it's almost hard to imagine getting through an entire pregnancy and birth without having one. Whether it's injections, induction, or an intravenous drip, there are so many choices for women to make, and often they feel, quite understandably, that the best choice is to place their trust in the experts, who are, after all, offering them 'evidence based care'.

But if midwives and obstetricians are offering 'evidence based care' - that is to say, they are making their recommendations based on good quality research - why then does the advice that individual clinicians offer, and the policies that individual hospitals and trusts implement, vary so greatly?

A new report from the Royal College of Obstetricians and Gynaecologists (RCOG) suggests that the disparity between hospital statistics has finally come to their attention, although I'm not clear why it has taken them so long to notice information that has been available on sites like BirthChoiceUK for years?

RCOG points out, for example, that in one hospital the induction rate is 38%, in another, 17%. Emergency caesarean rates vary from 20 to 40%, and forceps from 16% in one unit to 38% in another. Of course, the evidence here is clear and hard to ignore: not all interventions are necessary, and a whole lot of women are having traumatic and unpleasant birth experiences that could have been avoided.

It's great to see a giant like RCOG admit that there are failings. One would hope that this is a big step towards positive change, with a promise that in the future doctors will have their individual stats compared to national averages, and be asked to explain any great deviations.

But - for now at least - it doesn't necessarily help the pregnant woman on the front line. It's all very well to number crunch and compare stats. But when you are carrying a precious child within you, or are even perhaps in the middle of birthing them, and the professionals in whom you are placing your trust start talking about 'increased risk', it's difficult to ignore them. You might be one of the thousands of women who are being offered intervention that isn't really necessary, but what if you're not? Do you really want to be the woman who takes a stand, only to discover - too late - that, this time, the doctors were right?

Let's say, for example, you are over forty years old. In one hospital you might be told you 'need' to have your labour induced on your due date, because of an increased risk of stillbirth. However, in a different hospital, induction on the grounds of your age would not even be mentioned and you would be treated the same as any other woman.

If you're under the care of the hospital who routinely induce older women at 40 weeks, you face a dilemma. Who do you believe? Who do you trust? Stillbirth is a powerful word. Can you ignore this advice? Whatsmore, do you even realise that there are women just like you only a few miles down the road who are not even being told they need induction and who are not even having to consider this horrible dilemma?

Induction advice in general seems to vary greatly from hospital to hospital, with some women reporting 'prodding', 'harrassment' and 'shroud waving', from around 38 weeks, while others sail past their due dates and even past 42 weeks without too much concern. Women under pressure feel they should perhaps listen to the experts - but how can such widely differing policies be 'evidence based practice'?

Last week I went to meet the Ob myself. Due to my second baby being over ten pounds at birth, there were concerns raised at my booking in appointment for baby number 3. I was told I would need consultant led care, regular growth scans, and induction at 38 weeks. Since that booking appointment I've switched to an Independent Midwife, but kept my Ob appointment, mainly out of curiosity. I wanted to hear what he had to say, for myself, and for all the other women who presumably get similar referrals after 'big babies'.

I took the morning off from looking after my two year old, and, along with Tara my midwife, went to the hospital, armed with a bundle of papers including scribbled stats about dating scans and induction for 'suspected macrosomia' (big babies), many of which I gleaned from this wonderful blog post. Me and Tara had about an hour to wait, and, quite frankly, by the time I was face to face with the man in the suit, I was a little bit hungry, and spoiling for a fight.

Imagine my disappointment when the utterly charming Ob said, "There is nothing wrong with you, you are perfectly healthy, and you pushed out a ten pound baby no problem. Why are you here?!"

Across the hall, the Ob we didn't get to meet was holding his clinic. Insider info told me that he 'didn't believe in vaginal birth', and had insisted his own wife had an elective section. I couldn't help feeling slightly cheated that I hadn't got to read my stats to him, or tell him in detail about my five minute drug free second stage, maybe whilst Tara sat on his chest.

We drove home for soup and an antenatal check up on the sofa, half giggling, half wondering - what happened? Why was he so laid back, when we both personally knew women who had been put under tremendous pressure to be induced for 'big babies'? Conspiracy theories were offered - had he been reading my blog?! I asked on my facebook page - what were other women's experiences in a similar situation, and I've been flooded with responses.

Looking at the stories I've been sent, one thing is clear. There is no uniformity. There is no evidence based care. Some women encountered no negativity at all, some were induced at 38 weeks, some were made to get out of the birth pool to push, others were given the OK for a home water birth, some were not 'allowed' to birth at home, some were advised to have an early epidural.

Like all of these women, my maternity care was not evidence based, it was pot luck. I'm told my Ob was 'one of the good guys'. I could have had the man across the hall. I might not have had a confident midwife to back me up. I might have felt scared of birthing a big baby. I might have agreed to regular scans and early induction. I might not have realised that what I was getting was 'personal opinion' dressed up as 'evidence based medical advice'.

This might seem like a desperate situation, but actually, I think it's largely positive. Things are changing. If RCOG themselves are noticing and publicly admitting that, "We cannot be sure that every woman is getting the best possible care," this has got to be a step in the right direction.

What's needed now is for more women to take the power back into their own hands. Realise that even the professionals themselves are acknowledging failings. Ask more questions. Get second opinions. Use the internet, forums, facebook groups and Positive Birth groups to talk to other women and hear their stories. Take responsibility, take time to think; get informed, and do not place blind faith in professionals. Above all, abandon any expectations of evidence based care. Because it simply does not exist.