The positive caesarean

When I was training as a perinatal yoga teacher, the question was brought up: Should we discuss caesarean birth in a prenatal yoga class? Some teachers, predominantly those who come from a background of conventional yoga without being involved with birth otherwise, don't talk about birth at all in their classes. Their focus is solely on the yoga practice, for them this is no dilemma. Among those of us from a birth background, who do discuss the wider issues of pregnancy and birth in our classes, the response was mixed.

I've spoken to many mothers who have attended antenatal classes that had no coverage of what to expect if you have a caesarean. Apparently this isn't just a yoga teachers' problem.

Do I think caesarean preparation should be a part of birth preparation. Absolutely yes. Let me tell you why.

When the topic of caesarean birth is avoided, deliberately or not, it becomes a dirty word. A looming enemy that we don't talk about in the hope that it will go away.

Often, it is talked about it purely as something to be avoided. A ceasarean is a serious intervention, the side effects are far reaching and range from barely perceptible disadvantages, to serious and debilitating health problems. Avoiding an unnecessary caesarean is a worthy goal indeed, and certainly something we should be talking about more.

It is not uncommon currently, for a hospital to have a 25-35% caesarean rate. We need to work towards reducing this, without a doubt, as this figure reflects a large number of avoidable surgeries. Individual mothers can take measures to improve their chances of avoiding surgery, this should be encouraged too.

Regardless, the figures stand. As antenatal supporters and educators, we cannot assume that none of our students will birth surgically. The figures speak for themselves. So what happens to the women we support who do go on to have caesareans?

In short, they feel alienated. That thing that we are not supposed to talk about, it happened to them. They may feel disappointed or even guilty. All this on top of dealing with the extra challenges presented by recovering from major surgery whist caring for a newborn.

There is evidence that disappointment in birth outcome is a contributing factor to postnatal depression. Does this mean we should not be encouraging women to strive for good birth experiences? I don't think so, but as birth workers, with a duty of care to the women we support, we can help them to prepare for a positive birth experience, regardless of the method of delivery.

In fact, a major factor in the way a woman sees her birth experience, is not the level of intervention, or the difficulties she faced, but how much she felt in control of the situation. It should be said that in this case "control" does not mean strict control over the outcome, but to be a part of the decision making process within the boundaries of the available options. Women with "textbook" birth experiences can feel traumatised by the process, when their needs, preferences, decisions and consent are perceived to be disregarded.

If women approach birth fully informed about all of the available options, they can add contingencies to their birth plan. If the situation changes, they can make an informed decision quickly, whether it be a confident choice to accept an intervention, or an informed choice to refuse it.

As birth workers we can help by talking frankly about caesarean birth and the options that come with it. We can talk about avoiding unnecessary surgery by looking at alternatives (such as breech delivery, OFP and VBAC), by avoiding interventions that are known to increase caesarean rates (such as continuous monitoring, epidurals and induction) and birthing options to promote natural birth (such as active birth and natural pain management).

We can also find ways to improve the experience of caesarean birth, for mother and baby. This video shows some excellent ideas for small changes that can be made to improve the experience of caesarean birth for mothers and babies. It's important to remember that positive birth experiences aren't just an airy ideal for crunchy hippies, these measures are improving physical and psychological wellbeing of both mother and baby in numerous ways.

[there are graphic scenes of surgery in the video]

In my prenatal yoga classes, I use this handout, to break down some of the options parents may wish to add to their birth preferences in case of ceasarean birth.

Although the video above discusses elective sections, it is possible to implement some of these measures in an emergency situation too.

My second child was born by category 1/crash section. My notes report that the time from making the decision to operate to birth was 31 minutes, though to me, it felt much less. My husband spoke to the midwife while they were getting his scrubs, and highlighted the c-section part of my birth plan. My OB was brilliantly helpful. I had a spinal block (although a general had been discussed), he was shown to me as soon as he was born, then laid on my legs, skin to skin, for 2 minutes before his cord was clamped. After that he was placed straight on my chest where he nursed while they stitched me back up.  They even kept my placenta aside for encapsulation later.

Despite the frightening frame within which it happened, I came away feeling very positive about my son's birth.

If we allow caesarean birth to be "the elephant in the room". If we do not take opportunities to talk about it, then we are preventing women from having this kind of positive experience, and what does that leave them with?

It is really important to understand, in fact not just understand, but to believe, know even, that a good birth does not have to fit specific methodological criteria. A good birth can be a home birth, it can be a hospital birth, it can even be a surgical birth. A good birth does not have to fit the original birth plan. Most importantly of all, hope for a good birth is never lost, simply because it is necessary to make a decision we hoped we wouldn't have to.

Some more of my writing

I have been writing a bit for Yahoo UK Lifestyle recently, here are some articles of mine relevant to this blog:

How I fell in love with babywearing

Hypnobirthing and fear of giving birth

Baby sign language

Choosing your baby carrier

A while back I promised a blog about different types of carriers for babywearing, this is going to be a big one, so lets get straight in...

Structured carriers

For the expectant parent, the world of babywearing can look big and complicated, structured carriers with harnesses and buckles are quite approachable.
Check that the carrier has a wide seat, your baby should be supported from knee to knee, to protect their developing hips as they sit in their natural carried position, upright with their legs tucked up and wrapped around your body.
A good example of these is the Ergo, or Connecta.
Be aware that a carrier with pre-positioned buckles will need to be adjusted every time you wear it, to ensure the baby is seated above your waist, secure within the carrier and against your body. A change of clothes will change how the carrier fits, you need to check the adjustment every time.

Stretchy wraps

Newborns love a stretchy wrap, they tend to be lightweight, jersey type fabric; they are wonderfully supportive and snug. You can nurse your baby in a stretchy wrap quite comfortably. You need to practice putting them on, but it's really not that hard once you have done it a couple of times (pro-tip, practice before the baby arrives), and because they stretch, you just need to fit the wrap to your body, it will stretch to accommodate the baby. This is also very handy for the beginner wrapper, as you can get your wrap right without having to juggle the baby.
The Moby and Boba wrap are good examples of this style. They tend to be fairly easy on the budget too, but be aware that your baby will outgrow this wrap, probably at around 6 months, when they get too heavy and stretch it too far! You cannot safely use a stretchy wrap to carry your baby on your back.

Woven wraps

These are the top end of the wrap world. If you wear your baby a lot, they are a sound investment. Woven from blends of cotton, linen, silk, hemp and bamboo, these wraps have very limited stretch and are very supportive, even for large toddlers. They come in a range of sizes, dependent on how you plan to wear them and your body size. It takes a bit of practice to use these, as you wrap the baby onto your body, and there is an art to getting the right tension and a snug fit. Some fabrics are easier to handle than others, and new wraps need to be broken in by washing and using - as a beginner it is often worth buying second hand for this reason, as well as budget.
These wraps last a long while, and hold their resale value well, many babywearers buy a special wrap (often a limited edition design) to keep as a legacy for their child to wear their grandchildren in.
Brands to seek out are Didymos, Natibaby and Girasol.

Ring slings

A ring sling is a handy tool to have around. They are quick to put on and adjust, they pack down small into your bag and they are great for nursing in. You can wear a newborn up high on your chest/shoulder (never be tempted to use a cradle carry), a bigger baby on your chest or hip, and a toddler on your back. Use one around the house for when you need both hands, keep one in your car for those short errands, carry one in your bag for when your toddler's legs get tired.
Some are padded, on the shoulder, and/or the rails (the hemmed edges, top and bottom) but if you have a padded sling, make sure the padding sits in the right place when you are wearing it, different sized wearers will need the padding in different places.
They do take a bit of a knack to adjust right (make sure the fabric is spread across your back to spread the weight, and your baby is sitting deep in a hammock of fabric with their knees up). They are also asymmetrical, which can be a strain with a heavy baby, and ideally you should alternate the shoulder you wear it on.
One last warning, there are some cheap ring slings available on ebay and the like, which are of inferior quality, usually in terms of the rings being too weak and deforming during use. Go through a trusted brand and supplier, who use good, strong rings.

Pouch slings

These work on a similar principle to the ring sling, but they are pre-sized. You have to buy a pouch sling to your measurements, so no sharing between carers (unless you are identical in size). They are small and light, very cheap (you can make them yourself from a strong cotton fabric) and great for keeping a baby held on your hip comfortably. They are less supportive than other slings, I tend to naturally wrap my arm around the baby's back unless I am using that hand, but they are very handy for short errands and they take the strain off your arm.

Asian carriers 

There is a whole range of carriers that fit under this umbrella, the most common being the mei tai. At their most basic these are a square of fabric, with straps that are arranged, usually around the waist and shoulders. Some have 2 sets of straps, some have one which passes through D rings to meet the carrier at 2 points.
These carriers are often marketed from birth, but usually are not really supportive enough for a baby that cannot yet hold their head up, or preferably sit with support. They are light, cool to wear in the summer, and easy to convert for carrying on the back.
The Connecta is a structured carrier that uses a mei tai design, but fastens with buckles rather than being tied.

Mei tai in action.

The unmentionables

Some baby carriers on the market fail my "Safe and Secure" checklist, by principle of their design, so I would not recommend these at all. To be clear, these are:

The crotch danglers

Mentioning no brand names, these aren't hard to spot. The crotch dangler is a structured carrier in a style that is quite popular and very commercially available. The problem, as the nickname suggests, is that the "seat" is too narrow, and instead of supporting the baby's bottom and thigh, holds the baby up by a narrow strap under the crotch; the developing hip is not supported, the baby's centre of gravity is forward as they cannot wrap their legs around the wearer (moreso if they have an outward facing option) making them tough on your back; I have met so many parents who say they found babywearing too much of a strain, when I find out they used these carriers, I get them to try a wrap, suddenly they are comfortable. They are not recommended for more than 20 minutes wear at a time.

Bag slings

The biggest no-no of the baby carriers. The bag sling looks like a shoulder bag, the baby is worn across the chest in a cradle position with an elastic or drawstring around the upper edge of the "bag" section - they were quite fashionable for a time. These carriers are responsible for several deaths by positional asphyxiation (the chin dropping to the chest and restricting the airway) and overheating. Never put your baby in one.

Framed carriers

These are the heavy duty rucksack style carriers with a solid frame, they are often used for toddlers. The baby is not secured snugly in the carrier, they rattle around rather than swaying with your gait. The weight of the baby and the carrier is not close to your own centre of gravity, putting unnecessary strain on the wearer.


The carrier you choose depends on your baby's age, how often you intend to wear them, for how long, and what you intend to be doing while you wear them. Hopefully this has given you some ideas. From here I would recommend seeking out your local sling library or babywearing specialist. It is also well worth visiting the Natural Mamas forum, for advice and preloved sling sales.

A warning about babywearing.

So babywearing, it's an obsession. When you start out, you don't realise, or you see others in the grip of the addiction and you think "no, that would never be me". Then it creeps up, and one day you find yourself thinking "you know, I really do need another wrap". It keeps happening, and happening, then one day, you realise you have a wrap collection (or "stash" as we call it on the streets) like this.

Of course the actual wearing of the baby is important, we all love that bit, but the appropriation of new "fluff" has a drive all of its own.

My husband has a solution for this. It goes "How many wraps can you wear at once? Well that is how many you need!" Oh but was he ever wrong.

You see I need a short wrap, for quick back carries, like rucks and tibetans. it has to be small so it is light and easy to transport, I even made it a little  tidy from scraps of other wraps, like some weird cannibalistic armour (don't worry, no wraps were harmed, the scraps came from the Lenny Lamb factory as part of a craft competition).

Then I have my mid length wrap that is for solid front carries as well as back carries, I use that one the most.

Finally I have my maxi length wrap. 5.45 metres of gorgeous woven teal and purple dragons. Long enough to securely wrap a wriggly toddler in a double hammock, with tails to spare.

If it is going to be cold out, then it's worth investing in a wool-mix wrap, so really, I need a wool version of at least 2 of the above, right? It has been ever so chilly lately. When it gets warm however, I need linen wraps, so that's another couple (in reality both my shorty and maxi are linen blends, but you get the idea).

That's before we even start to consider aesthetics. Clearly I need to co-ordinate with my outfits, I need classy designs for serious occasions, fun designs for everyday. Colour co-ordination has to be considered....

I NEED ALL THE WRAPS!

Then there is the wants. If you are uninitiated, then take a look at some of the beautiful designs the big wrap manufacturers create every single season. See how beautiful they all are? It's not just a tool to carry your baby in, it's a work of art.

This is what has brought me to my current dilemma. I need a replacement/alternative for my mid length wrap, it's a size 6, so maybe a 5 to bridge the gap between that and my shortie would be good. I'd like a linen or silk mix. Easy! I know the size, I know the fabric, no problem!

So I have spent an afternoon scouring the preloved wrap boards. I have found the design I want, and the perfect colour I want it in - my unicorn, but no one is selling it. I know that now anything else I find will seem second rate. I have found an adequate alternative, the right design in a colour I like, but it's too long. Another in a gorgeous pattern, and a colour I don't have anything akin to, but it's expensive. I have found another that would be great, but it is so similar to my middle wrap that I could only justify it by selling that wrap and outright replacing it. I put out a request for options and was flooded with offers, all of which I would love, but none of which are quite "it".

I'm just going to have to buy a couple more wraps ;)

*Disclaimer. It is perfectly possible to wear your baby with only one wrap. A quality mid-sized cotton wrap is a great workhorse that will see you through from birth to toddler and still be good to sell on or keep for your next child. Just don't tell my husband.

Tips for safe babywearing.

I've just come back from meeting a lovely group of mamas and talking to them about babywearing, so I thought today I would share my checklist for a safe and secure carrier.

There are lots of different types of carrier out there, some are very versatile, some are best in particular situations, and some just need to be avoided. I will write more on types of carriers at some point in the future, but today I am going to tell you the rules to follow to check any carrier, or to check a wrap after you have tied it.

Tight and upright.

Your carrier should be firmly secured, your baby should be close to your body, not rattling around inside the carrier. If your carrier has harnesses, make sure that they are correctly adjusted every time you wear it, as even a change of clothing and make the carrier less secure.

Babies who are not able to sit with support are best in a carrier that supports their whole body, like a stretchy wrap, once they can sit up, they are ready for  a more open carrier, like a mei tai, if you prefer.

Some carriers, and some wrap methods, allow you to carry your baby in a cradled position. I would not advise this. Even new babies are very comfortable being carried upright, as long as the carrier supports their neck appropriately. In the cradle position there is a risk that your baby will drop their chin onto their chest, which compromises their breathing. In an upright position your baby will also be able to react to your movement, rather than being jostled around, they will learn to balance into the sway of your walk, this aids the development of their balance and muscle tone. They will also be able to peep out and observe your surroundings, other people and your conversations. Worn babies get a great social life!

Chin off chest

I cannot push this point enough, it is absolutely vital. A newborn does not have the head control to prevent their chin dropping down  into a head position that could potentially obstruct the airway. This is more a problem associated with bag slings (if you have one, bin it, now, no, burn it ceremonially, whatever you do, do not carry a baby in it) and cradle positions in wraps. When your baby is upright on your chest they rest their face against you and can't drop their chin. Just to be safe though, check, you should be able to fit 2 fingers between the chin and chest.

If your baby is less than 4 months old, or is not yet able to support their own head, make sure you always have line of sight to be able to check this, so no back carrying before that point.

Parent facing.

Whether your baby is on your back or front, they should be facing into your body with their legs wrapped around you. This is the position they naturally go into when you pick them up. Facing outward does not complement the developing curvature of their spine, and it shifts their weight away from your body, putting more of a strain on you. There are also arguments that psychologically, the outward facing view, with no option to "escape" by snuggling their face into you, is overwhelming for small babies.

Close to your centre of gravity

Your baby's centre of gravity should be as close to yours as you can manage, the babywearing adage "close enough to kiss" covers more than just this rule. Firstly they should be fairly high on your body, higher than most assume, their bottom should be above your belly button - any lower and you will be straining your lower back. Tiny newborns can be carries higher on your chest, or shoulder in a ring sling, but as they get heavier, and taller, the belly button rule is a good guide. When back carrying however, be careful of going to far the other way, you will feel uncomfortable if your baby is too high, and they will not be as secure in the wrap.

With their legs wrapped around you their centre of gravity is closer to yours, and when they are held tightly to your body the strain on you is greatly reduced. It is worth considering here the structured rucksack type carriers (the ones with a stiff frame), these hold your baby loosely and quite far from your body, so are much harder to carry than a baby tightly wrapped on your back.

Allows natural movement

For comfort, and muscle development, your baby should have some freedom of movement in the carrier, they need to be able to bounce a little to absorb the shock of your footsteps, whilst still being secure. There should be no pressure from straps or folds of the wrap to impair their circulation. Swaddling a baby before carrying them is not a good idea, both for the sake of their movement, and to avoid overheating.

Froggy legs

Babies have a natural leg position, much like a frog. With the knees bent the hips are below the knees and the lower leg is loose. Your carrier should honour this natural position.

Tiny babies will tuck their knees right up to their body. At this stage babies are happiest in a soft wrap or ring sling with their legs tucked in alongside their body, it will become clear when they are ready to stretch out.

The carrier should support the baby from knee to knee, with their bottom sitting down inside a hammock of fabric. Beware of structured carriers that have only a narrow band of support, known not-so-affectionately as "crotch danglers" by their critics, these do not support the developing hip, and bears the baby's weight uncomfortably on their crotch.

It takes 2 years for a baby's hip to stabilise, so during this time it is important that they are carried with their knees above their hips, their thighs supported and, once they are past the newborn phase, their lower leg free.

There is a wide range of baby carriers available, and their suitability for you depends on your needs, lifestyle, baby's weight and preferences. Whichever you choose, apply these rules, and you can carry your baby safely, securely and comfortably.

10 things to do with your baby 0-6 months

I keep coming across articles (usually on Pinterest) about things to do with tiny babies. They are usually quite intense in terms of structure, props etc, so I thought I would do my own version. These activities are all simple, and very almost free, but they all help nurture and entertain your baby, without being a strain on you:

1. Cuddle.

Babies love cuddling, up until at least 4 months you can happily make yourself a cuppa and deposit yourself on the sofa, baby in arms. Baby will lie there, gazing at you or snoozing as happy as a clam. Are clams actually happy? Who knows? (Does anyone care even? Poor clams). Your baby however, will be happy, small babies love the warmth of your body, your scent, your heartbeat. It is emotionally, developmentally and physiologically good for them. So enjoy those baby cuddles.

2. Nurse

Whatever your chosen feeding method. I am using the Sears definition here, where nursing is feeding in a loving and nurturing manner.
Breastfed babies love to suckle, they need to; as well as getting nutrition they are comforted and get the skin to skin contact that makes them feel really close to you. There is a myth that babies need to feed less often than they do (every couple of hours is really not unusual) and that suckling for comfort is a bad thing - it's not, it is normal and beneficial.
If you are bottlefeeding your baby, snuggle down with them, get them skin to skin if you can, make eye contact, talk to them softly, make feeding an emotional exchange.

3. Nap together

Babies sleep so much better when you are close. They even regulate their breathing and heartrate better by your example. Parents need rest. So make a safe sleeping space - firm, no pillows or heavy blankets, no risk of rolling off - and snuggle down for a nice nap, you will both benefit.

4. Go for a walk

Pop the baby into a sling, let them feel the closeness of your body and enjoy the sway of your movements. It's like being back in the womb. This is a really great way of settling a fussy or overtired baby. Walk somewhere that you get something out of. A favoured route, a social call, window shopping, whatever you find rewarding.

5. Chat

Babies start understanding our language long before they can speak themselves or even demonstrate their understanding. It's also excellent preparation for both of you to start conversing as early as possible. Talk to your baby about what you are doing, things of interest you come across, how you are feeling, ask them questions. Give them space to respond, even from before birth (preemies do it too) babies will converse in terms of responding to your speech and leaving a space for you to respond back.

6. Sing

It doesn't matter whether you are any good, your baby will love your singing voice. You can sing nursery rhymes, lullabies, pop songs, it doesn't really matter, but they love repetition. If you are still unsure about how to sing to your baby, you could attend a baby singing class. These rites of humiliation, where mothers sing nursery rhymes to confused babies, are a great way to make friends by mutual discomfort.

7. Bathe together

We are back to skin-to-skin again. Co-bathing helps new babies get used to the bath, and once they start to enjoy it they can share the fun with you. It also solves the issue of what to do with the baby while you wash.

8. Get on with your day

Many of the things we consider mundane are fascinating to children who find new things fascinating. My 2 1/2 year old still loves the supermarket, for the colours, new faces and naming everything I put in the trolley. A small baby will often enjoy watching you sort laundry from their bouncer, or making faces at cashiers from their carrier,

9. Baby massage/yoga

OK, this one is a bit fancy, but I am sneaking it in. You can attend a class (where you can meet people and get direct tuition) or there are books and videos on the market. It's a nice bonding exercise that you will both get a lot out of.

10. Look in the mirror.

Babies love mirrors, they don't recognise their reflection until they are much older, but they still find them fascinating and hilarious. If you are carrying your baby past a mirror, pause and take a moment to let them play.