The day after I finished my Doula training
I went for a swim.
I was tired, so I swam lazily up and down for a few laps
then sat in the Jacuzzi,
feeling the warm jets of water soothe my back, and my legs, and my shoulders.
The training had tired me, more than I expected, but yet I also felt strangely elated, as though I’d given birth to something in myself-
something that was worthwhile, something valuable.
I lay back and closed my eyes for a while
then went in to the changing room
and showered.

There were probably ten women in the room,
dressing or undressing.
Naked, our bodies on display,
we stood or sat,
rubbed cream into our skin,
combed our hair,
applied deodorant and makeup,
or changed from everyday clothes
into swimsuits.

Some of this little band of chance-met strangers
were very young, blossoming into womanhood,
full of hope and promise and joy to come.
No lines marked their faces, no stretch marks marred their sculpted bellies
and their breasts were firm and tilted upwards.

One was pregnant, her heavy belly resting on her thighs,
as she sat toweling her long, dark hair.
Her breasts were veined, engorged, ready for their purpose,
her nipples darkened.
She looked proud and happy
as she reached for her shoes,
smiling ruefully as she clumsily pulled her socks on.
“I’ll be glad when this is over,”
she said.
We wished her luck,
and a safe delivery.

Two were very old,
maybe in their late eighties, maybe even ninety.
They were friends, it was easy to see,
as they laughed and joked as the pulled on voluminous underpants
and shapeless vests.
The skin in their legs sagged and wrinkled
like old stockings
and their hair was thin.

And I was there,
Not young, far more than middle aged,
but not yet too old, I hope,
although my hair is white
and my body not what it used to be,
but still not too bad
I think to myself
maybe just wishfully.

And so we stand around,
then go our separate ways.
Sometimes with a smile,
and a cheerful goodbye,
sometimes too wrapped in our own world
to pay much attention to the others.

But maybe a goddess sees us,
and smiles,
bestowing a blessing on us,
we who are all sisters under the skin,
all mysteriously, marvelously female,
with wombs and breasts
to nurture.
And hearts to love.

Birthkeeping and the Refugee Crisis

‘Doing what we can’

Megan Stuart

Red Tent Doulas

Final Project

“The Hummingbird”

One day a terrible fire broke out in a forest – a huge woodland was suddenly engulfed by a raging wild fire. Frightened, all the animals fled their homes and ran out of the forest. As they came to the edge of a stream they stopped to watch the fire and they were feeling very discouraged and powerless. They were all bemoaning the destruction of their homes. Every one of them thought there was nothing they could do about the fire, except for one little hummingbird.

This particular hummingbird decided it would do something. It swooped into the stream and picked up a few drops of water and went into the forest and put them on the fire. Then it went back to the stream and did it again, and it kept going back, again and again and again. All the other animals watched in disbelief; some tried to discourage the hummingbird with comments like, “Don’t bother, it is too much, you are too little, your wings will burn, your beak is too tiny, it’s only a drop, you can’t put out this fire.”

And as the animals stood around disparaging the little bird’s efforts, the bird noticed how hopeless and forlorn they looked. Then one of the animals shouted out and challenged the hummingbird in a mocking voice, “What do you think you are doing?”

And the hummingbird, without wasting time or losing a beat, looked back and said, “I am doing what I can.”

In the last 3 years I have worked continuously with grassroots charities involved in the refugee crisis, initially with those working in Calais and Northern France and more recently those local to the South-East of England. As my youngest child (now 3) is getting older I am also returning more to my work as a pregnancy shiatsu practitioner and last year I started my doula training – a path which has called me for many years.

As these threads of my work come together, it felt appropriate to write about what pregnant women face as refugees both during their travels and upon their arrival in (in this instance) the UK. There are many practical ways that we as birthkeepers can be part of meeting the needs of this particularly vulnerable community and I’d like to share information I have gathered along the way. I hope it is both interesting and a useful resource.

What keeps arising as I observe others and myself is the need to be acutely aware of our limits as individuals. Even if we worked tirelessly every day for years, the effects of what we do would feel like – and probably are – a drop in the ocean. This can be in the very least disheartening and in my opinion is definitely a contributing factor to the high levels of burn-out experienced in both jobs. The key learning I’ve seen amongst colleagues (and an ongoing practice for me personally) is remembering that our small actions do make a difference. This and the power of working together is something I am continually reminded of and inspired by. I work alongside a wonderful group in Brighton called the Hummingbird Project. They named their organisation after the fable above and its message is one I hold through my daily work.

“Be faithful in small things because it is in them that your strength lies” Mother Teresa

The current situation of human migration is unprecedented (1). Across the world there are incredible grassroots organisations which have grown in response to the current refugee crisis. Everyone involved in this work is passionate and driven to do their utmost to help. Almost no-one I have met has had previous experience of working with a humanitarian charity. They are just ordinary people now doing extraordinary things. I’ve met baristas turned political campaigners, film-makers, chefs, CEOs, actors, knitters, engineers, builders, dentists, pensioners, students – all using whatever skills they have to support some of the world’s most vulnerable people. Through my  work with refugee organisations (2) and as a mama who works with expectant mamas, my attention kept returning to the experiences of pregnant and newly-birthed refugee women. I am not alone in this, there are dozens of wonderful midwives, doulas, breastfeeding supporters and doctors in many countries doing what they can to create safe conditions for women to birth and nurture their babies. There is a section of links at the end should you be interested in reading more or getting involved (3).

The extent of trauma these women experience is unspeakable. Not just the trauma of living in war-torn countries but, in some ways more gut-wrenching and depressing, the trauma of their journeys away from these countries – their journey to a ‘place of safety’.  I am involved in co-ordinating practical and emotional support for women newly arrived in the UK, many of whom arrive heavily pregnant. They have endured a lot. Not only the dangerous journey many of you will have seen glimpses of on TV (4)– overfull boats, smugglers, freezing treks across Southern Europe, police brutality, trafficking as only part of the story – but their arrival in an entirely new country, a new culture whilst hormonal and full with baby. They arrive at their goal, the place where everything would be ok, a new life – only to find that it is still hard. As well as the mothers, I keep seeing these babies, born in to a traumatised generation and it is difficult not to be disillusioned and grief-wracked at what humanity is doing to itself. Through our work as doulas we have seen and felt, intimately and deeply, the importance of how a mama is able to birth: both the impact on her and her baby and the ripples into her surrounding circle. Creating environments of choice and peace for these families as they bring the next generation into the world is crucially important.

“By the way – Angels of Peace – Please don’t give up!” Robin Lim

The story of support for pregnant and newly-birthed women changes along their journeys. Many spend time in Greece – a financially poor country, but one which seems to have a particularly proactive and nurturing approach to all aspects of the crisis including its treatment of pregnant mums. There are established organisations such as Amurtel who support exclusively women, children and families and the UK branch of LLL has been supporting LLL Greece for a long time. Some places are more aware importance of safe infant feeding than others. Despite initial resistance, a 100% breastfeeding rate was successfully re-established at camps in Moria with the support of specialist infant feeding groups, while closer to home unfortunately there are different stories. British doula and breastfeeding counsellor Maddie McMahon wrote about the challenges in working in the camp in Dunkirk, Northern France (5), a place where refugees arrive from many backgrounds. Despite international guidelines from UNHCR and Save the Children there was a significant absence of safe infant feeding protocol and a lot of antipathy towards the incoming breastfeeding team. As there was a clean water supply, there was some complacency regarding sterilising despite incredibly unsanitary conditions. I was involved in co-ordinating support for the Women’s Centre at this time and it was extremely difficult knowing that babies’ lives were being put at risk on a daily basis. It’s tough work, and while we can be happy that one mum feels supported and informed that breastfeeding is safer for her baby or sterile conditions for formula preparation are temporarily available, for me this is only part of the story. Another aspect is also about knowing which battles to fight and where to let go and place your energies elsewhere, a place where your skills can be received and optimised. In my opinion when working with such a large-scale crisis this is vital in keeping the work sustainable, mentally and physically.

The culture of doula work in this country is primarily that of working one to one with women with occasional group gatherings – what I have perceived in refugee work is the absolute necessity of community collaboration, both for the women and birthworkers. For doulas having a network of fellows workers would provide emotional and practical support. For female refugees, enabling the connections within their community is vital in combatting the primary issue of isolation. Many women in camps are too afraid to leave their tents, ever. Even to go to the toilet. Projects such as exclusive Women and Children’s centres are vital in providing safe spaces. We are in the unique position of being able meet different needs to the medical organisations and this facilitation of safe space can certainly be another aspect of our work as doulas.

“Empathy is the starting point of creating a community and taking action. It is the impetus for creating change” Max Carver

As women arrive in the UK there are council-run services targeted to support pregnant asylum seekers, however many of these struggle to truly provide the support needed due to a combination of factors which broadly fall into two categories: a lack of funds for crucial aspects (eg translators) and a lack of knowledge of the significant cultural differences. The impact on the women is to compound the isolation she feels – they will arrive in the UK, be placed in a detention centre, have a visit from a midwife (either with or without a translator – this is also stressful for the service providers) and until two years ago they may have been relocated multiple times across the country during the last few weeks of pregnancy (6).  We all know mums who move house at nine months pregnant, then laugh at themselves about how stressful it was. The key difference in this situation, obviously, is that of choice. Whilst there may be (sadly not always) compassion in individual interactions the refugee mother receives, there is never any choice. In where they live, where they birth, the clothes they wear, often even the food they eat. What I have observed is a lot of (well-intentioned) ‘giving’ from charitable groups. Whilst this is gratefully received, I believe the most powerful action you can take if you are working with a newly-arrived pregnant lady is to offer situations where she has choice. This can be really, really simple: ‘Shall we take the stairs or the lift?’ ‘Shall we have tea inside or outside?’  I was recently face-painting at an event and was struck by the  subtle but powerful shift in the energy of a woman shrugging ‘I don’t mind what I have’ to quietly saying ‘I like red’. There is often initially a deep sense of disempowerment and resignation, but dig a little and you’ll soon find the remarkable resilience and desire to fight for the wellbeing of her baby. Don’t underestimate the power a few simple, positive experiences can have on a woman’s confidence to assert her choices when it comes to birthing her baby.

An Eritrean mum who now has a delightful  5 month old baby gave this feedback about having informal weekly meetings with a female volunteer up to (and after) her birth: ‘Meeting J made my day happy. I was sad and scared on my own. I worry about my baby. To start I am shy and not talking but J is very kind. We go out from the centre to drink tea and eat cake. I like it! J tell me how the hospital is here in UK. My husband not want to be in my birth, in my country father is not coming into the birth. J tells me it is ok that my (female) friend can come to hospital. When I having my baby I miss my mum… I scared but my friend tell me it is ok and when my baby comes I so so happy he is safe now. J visit me and (baby) M and bring me cake. Everything is very good now.’

My observation is that many official services would benefit hugely from the opportunity to liaise with volunteers who have on the ground experience of what the refugees’ journeys and lives have been like up to this point. This would enable them to offer more appropriate and effective support, in particular through having information about the specific needs which arise from trauma. Feedback from local groups (LGBTQ and youth support) who have actively welcomed refugees and asylum seekers shows that both current users and service providers often feel overwhelmed by the scale of trauma they are presented with and have requested more training in this area.

“The paradox of trauma is that is has both the power to destroy and the power to transform and resurrect” Peter A. Levine

City of Sanctuary (7) is an organisation which supports groups across the UK which actively promotes and provides welcome and support to the refugee and asylum-seeking community. There are various streams which link across the country; education and health being two. Leeds was the first pioneer project of the Maternity Stream. In each of the cities involved (most based in the Yorkshire/Humber area) projects have been initiated with a core of peer befrienders from the refugee community. Once the service has been established and proven to show good practice and progress in three core principles (8) these projects receive a Sanctuary Award.

I work alongside the Brighton branch (Sanctuary on Sea) and am in the early stages of establishing a Birthkeeping Project in Brighton which will lead to the development of a Sussex Maternity Stream. The services planned for the early phase of the project stem from the experiences and feedback of women who have experienced arriving pregnant and subsequently given birth in the UK. The main themes which arose were isolation from their own community (compounded if their English was limited) and not understanding the medical processes (eg of induction) they experienced. It is important to take into consideration that many of these women have experienced violence and/or sexual violence either in their home country or during their travels and provide appropriate support. There is a huge need for volunteers in this area.

The Birthkeeping Project has a volunteer bank of peer befrienders, a health visitor, a breastfeeding counsellor, midwives and doulas. The aim is to provide the opportunity to access ante-natal information and social connection, birth support, early post-natal and breast-feeding support and longer term social support. I am liaising with other teams from Maternity Streams – The Refugee Council, local BME orgs, HVs, community midwives and doula groups are also good points of contact if you are interested in initiating a group such as this.

The initial phase of the project will start with a regular series of pre-natal groups with the aim of giving space for women to connect with each other.  I have observed that a simple approach is often most effective: allowing the connections to naturally develop from our shared experience, in this case our shared experiences as women. Encouraging women who have been settled in the UK for some time to support newer arrivals as informal doulas (health befrienders) and to affirm the women’s rights to express what is natural in their culture as well as offering information to enable them to go forward and make informed choices within this healthcare system. By creating the conditions – written translations and translators; an informal and women-only setting; moving our bodies (through yoga (9), dancing, hand massage); drinking tea – these things allow the thawing of isolation and the space for emergence into connection and expression, all of which will have a positive impact on the well-being of mum and baby.

Following on from this, we are building a beautiful network of birth-workers who are able to offer ongoing support nearer to and through labour and the immediate post-natal period and another group of volunteers who will continue to maintain this support by facilitating further post-natal groups. There is an already an established art group, cooking group, writing and birth-story projects all for mums (and babies). All of these groups can be tailored to the specific needs of the refugee community.

“Caring for myself is not self-indulgence it is self-preservation, and that is an act of political warfare” Audre Lorde

This work can easily becoming overwhelming. Many wonderful volunteers burn out, badly. They can’t do everything, they can’t save everyone – often these are sensitive people who get little if no training and end up experiencing a lot of vicarious trauma. I can see the same with many birthworkers. What can we do to make our work sustainable? And nourishing? And joyful?  How to balance the energy of fire and drive and a desire to change the world with keeping it real? I currently get on average 3 nights of unbroken sleep per month (reality of having young kids) – self-care has to be up there as a priority. In the bigger picture, the NHS is in crisis, meaning that maternity services are stretched (an understatement) and care is not always optimal despite best efforts. And all this is before we even scratch the surface of the toxic culture of birthing that we currently live in – doctors, midwives and women themselves are often so far away from their instincts of being able to tune into and trust the natural process of labour that the results are sometimes horrendous birthing scenarios which can be traumatic for all those involved.  Whilst of course this isn’t always the case, it certainly isn’t all clary sage, oms and orgasmic homebirths – in fact, I am in wonder when it is, given everything that is needed to create those conditions! As humans we need to be mindful of the challenges of reality and, amidst the work we do, look after ourselves. Get enough sleep, regularly nurture our souls and find the joy and nourishment in the essence of doula work: the service and the love. Whilst serving and love ourselves at the same time. For me this is a daily practice and a work in progress, as I imagine it is for many of us ☺(10)

So –  we do what we can! We connect deeply with our own truth and knowledge in whatever way has integrity for us – an ancestral connection from our own family lineage, a spiritual practice, practical techniques and learning from courses attended, being deeply and fully with nature and the earth while we work to optimise any situation we work in. We use our wisdom to allow the space at transition times, whether it is birth, death or any time in between. There are some things we ‘don’t do’ as doulas. I feel strongly that one thing we can do is gently create the conditions that provide the woman with as much choice as possible to birth HER birth, whatever her environment or backstory. I am extremely fortunate to be in a position where I am able to advocate for my rights and choices. I am fortunate that I have had access to therapies when I have most needed them. But every woman has a right to a safe, fear-mongering-free and undisturbed birth which, however it then unfolds, she will know belonged to her and her precious baby. As birthkeepers we are privileged to have the opportunity to help protect this space. This work is needed. Globally and vitally, needed.

Beyond a wholesome discipline, be gentle with yourself.
You are a child of the universe no less than the trees and the stars;
you have a right to be here. And whether or not it is clear to you,
no doubt the universe is unfolding as it should.

1)‘Human Flow’ is a fantastic film by Ai WeiWei documenting the current state of human migration across the globe https://www.humanflow.com/

2) https://helprefugees.org/  http://refugeecommunitykitchen.com/

3) Links to organisations supporting women and babies abroad:

https://www.dunkirkrefugeewomenscentre.com/

http://greece.amurtel.org/  http://www.amurtel.org/refugees-in-greece-update/

https://www.laleche.org.uk/supportingrefugeemothers/

A blog about one doula’s experience of volunteering with Amurtel: http://www.youniquepostnatal.co.uk/blog/4594069694/Supporting-Refugees-in-Greece-as-a-Postnatal-Doula-Jan-2018—Naomi-Kemeny/11276475

http://www.midwifepilgrim.org/

4) ‘Exodus’ (first shown on iPlayer) is a documentary filmed by refugees as they make their journey into and across Europe https://www.imdb.com/title/tt5808940/

5) This is the account of her first visit. The Birthhub site has the other blog entries on infant feeding as well. https://thebirthhub.co.uk/2016/11/15/not-animals-day-dunkirk-refugee-camp/

6) Maternity Action campaign hard politically to make these changes –  in 2016 Home Office guidance on dispersal (relocation) of pregnant asylum seekers was rewritten due to their work: “Working in partnership with the Refugee Council, we ran a three year campaign resulting in a comprehensive rewriting of the Home Office guidance on dispersal of asylum seeking women during pregnancy. Women are now much less likely to be moved in the late stages of pregnancy and to experience multiple moves in the lead up to the birth.” https://www.maternityaction.org.uk/

7) City of Sanctuary website, you can search the Maternity Stream for more information: https://cityofsanctuary.org/

8) Maternity Stream’s three core principles to demonstrate good practice:

LEARN, EMBED and SHARE: Learn about pregnant asylum seeking and refugee women, their experiences of asylum, the challenges of living in the UK and their subsequent health and social care needs. Ensure women are aware of the service or support group and how and why to access it.

Examples:

• Invite an asylum seeker or refugee along to your team meeting to share her story of pregnancy, birth and motherhood in the UK.
• View the Maternity Stream film at your work/group (the film is available to view on our website here)
• Encourage the women you support to speak to others in their situation about why and how to access maternity care
• Undertake a group session with the women you support to explore their experiences and correct any misunderstandings about how maternity care works in the UK

Embed positive action

Examples:

• Produce resources that are not reliant on the ability to read and write in English
• Hold regular group meetings with the women you support to continue the learning process for all involved
• Develop guidelines or care pathways to inform your work.
• Create new volunteer roles for asylum seeking and refugee women
• Monitor and evaluate best practice in your work

Share best practice with maternity services and local voluntary sector organisations

9) This is a great example of a local yoga project set up specifically for female refugees and asylum seekers: http://www.bnhc.co.uk/images/stories/pdfs/yogafinalfeb2016.pdf

10) Stephanie Dawn puts it brilliantly:

‘We must ask ourselves: “What do I need in this moment?” Then we must reach out! ..We must become excellent at calibrating our own needs. No-one can do this for us. Practicing excellent self-care for ourselves is where it’s at!..Are we truly caring for ourself? Are we being loving to ourself? Are we offering ourselves as much love as we are willing to give to another? I invite you to cultivate your selfcare/self love muscle. Give to yourself in unprecedented ways.’

‘On  Becoming a Birth Angel’ from ‘Eat Pray Doula’ by Robin Lim

My role as a doula in birth and beyond, reflects all of the female life cycles; the archetypes of Maiden, Mother, Crone.

I embody the Maiden with my need for more knowledge and experience of birth and breastfeeding. Here, my creative juices flow; I am vibrant and energetic..As Maiden, I hope to inspire women to know their own power, strength, and endless beauty.

I am hopeful, joyful, and playful..dancing through birth, singing to uplift.

I embody the Mother with warm, loving care this nurturing care facilitates women and families to learn and to know themselves. As they find their footing, my gentle encouragement offers them a hand when needed.

I mother the Mother so that she feels safe, and held, and seen for who she is, as she rises up and becomes a new self day-by-day, moment-by-moment, breath-by-breath.

I stoke the hearth of the home (loving the mother); with nourishment and love, I hold her hand encouraging and remaining by her side as she births her baby and her new self.

As Mother, I am protector, gatekeeper of this woman’s precious space, ensuring that in that moment when she has to journey inside, that she need not concern with anything but turning inwards as she opens to birth her baby. And after, I guard that space all the same, so that she can rest and heal.

I have known the great depths of suffering, in which I have sat, and waited for the difficulties to pass. And in waiting for the passing, I have known my breath through fear, and sadness, and grief but most of all..being with not knowing.

Through making friends with Being with Not Knowing, the Crone was born.

She often sits silent, listening to everything; listening out to hear the true words of people’s hearts.

When I am the Crone, I am a medicine woman, with the wisdom to know when the great medicine of silence is needed.

Here, I am patient, and know that birth is sacred, and it knows no time, the body knows no stages..it just seamlessly breaths in and breaths out, contracts and releases.

In this moment, I am mindful and aware; I recognise the turning of the tide and sit strong by her side.

As the Crone I am always listening deeply, throughout the great journey of pregnancy, birth, and the early postnatal days. I listen with my ears and my heart, so that I know when I am needed and when I am not. I also have the wisdom to know my and other’s boundaries, and I respect them deeply.

How Holy a privilege it is to be invited into these sacred moments; moments to be revered and respected.. So I pack my songs, my joy, my playfulness, my encouragement and loving warmth, my patience and my medicine of quiet, and I set off to be Companion (not Guide) on a magical journey….Where will we go?