The work of a childbirth educator is such a tightrope walk. We must speak to a crowd about an emotionally charged subject that's often contained within a challenging institution, that crowd ranging from folks who are natural birth enthusiasts to the "I think I may want to plan a Cesarean because birth is gross and I'm terrified" type. We must do this in a way that informs and soothes everyone in the class, not interjecting any personal agenda. We have to speak about childbirth as being normal, powerful, and awesome, but not push it too much for those who have no romantic or flowery notions about the process and may feel excluded from an elite club for not thinking birth is beautiful.
We must give students a heads up about some of the things to realistically expect in hospital birth, but to ensure they feel powerful about their choice to be there (if they plan on staying there)so they relax and don't impede their labours feeling like they have to go into their hospital fighting (remembering that ill-timed adrenaline kills oxytocin). If a student comes into your class feeling great about their hospital and caregiver of choice then leaves feeling like you think they're going on a suicide mission by walking through those hospital doors in labour, you have erred. A couple who felt like everything they wanted to happen would just automatically happen in their hospital but now knows that negotiation skills might be necessary, sensation coping skills a must, BUT that they have the wisdom to know when and how to calmly use them (IF they must use them...sometimes it's all just easy as pie) AND they have power to do so with ease, trust, and confidence, THEN you often have success.
Communicating that feeling trusting is important in labour yet knowing from your years of experience that some non-emergency procedures can be applied without adequate information (or sometimes even consent) is unbelievably challenging. While trying to foster confidence in themselves and their choices, we also give students tools to be able to question suggested procedures to check if they're truly necessary for their situation (which suggests that hospital birth DOES take awareness and negotiation, and is not a place to just go in and expect everything you hope for will materialize). To do all of this without creating a sense of fear is HUGE. To be able to talk about natural birth or the benefits and risks of procedures in a way that is informative, neutral, and non-threatening, even though some of the information is inherently scary to those who may be afraid of either natural or procedure-full birth is quite a feat, let me tell you!
When our students come out of our Birth Essentials Classes, we want them to feel excited about their upcoming births, and curious about the sensations. And if not, at least solid in their information about how to have a great epidural or Cesarean birth, knowing that ALL birth is sacred and powerful, no matter what. We want them to feel that they were honoured throughout their educational process. It can be really easy, when finding yourself in a roomful of birth enthusiasts who are eating up your words, to let down your hair and speak your opinions about some of the hospital procedures and when they're applied. But if you do that you may be missing the cues from those one or two couples who are sitting there quietly in horror who feel that everyone in the room thinks they're stupid because they LOVE their doctor and are keen on in no way emulating the moaning swaying ladies who look like they're having orgasms in the birth videos you show. Now, you SHOULD show these types of videos to foster positive images of birthing. But be prepared to address those who may not feel inspired by them. I try to tell my classes that many find the videos to stir feelings of power and excitement in them, and others may feel fear or ambivalence. I tell them that it's all good, and that we do not prescribe one way to feel about childbirth. I show images of totally undisturbed birth, and images of a more technocratic experience in order to let students decide for themselves what feels right for them. I used to assume everyone would look at the technocratic birth videos compared to the orgasm-y ones and automatically prefer the latter...but it's not always true. Never assume.
For some, no matter how great you may try to make birth seem, it will always just be a terrifying, yucky means to an end. But at least in a great class they know their thoughts are supported and that they're not alone in their feelings, and the work you've done has prepared them enough to mitigate some of the risks of the fears of the unknown. You may also be so amazed when you get the birth announcement and a grateful note from that couple who turned green every time a woman in a birthing video vocalized stating that in the end, while they felt birth to be hard and sweaty with not even one orgasm involved, it was not as bad as they thought. In fact,in the end they felt they didn't need the interventions they thought they had wanted, were able to stop a doctor from performing a routine episiotomy because it didn't feel right (and yay, didn't tear at all) and are pretty darn proud of themselves. You may also receive notes from that couple who had to transfer from their planned home water birth to let you know that your work in defusing fear around hospital procedures helped them to experience a Cesarean with trust and gratitude for skilled caregivers, calm presence, keeping connected to the sacredness of ALL birth, not just the way it was planned.
Big hugs to my MotherWit colleagues in Montreal and New Brunswick who teach my Birth Essentials Prenatal Class with the love and care they do. You have touched many lives and planted seeds of gentler birth legacies. If you're a parent who felt well supported in a great prenatal class, hug a childbirth educator today!
Thursday, April 19, 2012
Thursday, March 22, 2012
Where the Magic of Doula Care Lies
When people ask me "How does this doula thing work? Why is it doulas are able to bring such comfort to the women/couples in their care and reduce rates of unnecessary medical interventions?" I have an easy answer. The magic of doula care lies in the relationship between the doula and her clients.
It is incredibly valuable for all people who work with birth to have basic doula skills. A nurse or resident with basic doula skills can have a tremendously positive effect on a woman's labour. Even if these medical professionals don't have continuous time to spend with the couple, bringing in a fresh bit of energy into the room when they come in for an exam, perhaps some soft, gentle words of encouragement, a demonstration of how Dad can rub Mom's back, or a suggestion of how to use a yoga ball can be a soothing balm to couples who feel up the creek without a paddle.
I often get the opportunity to teach hands-on skills to student nurses and occasionally medical residents too, and the positive feedback I get lets me know that learning about birth through the eyes of a doula can bring a fresh perspective. This means viewing birth from a larger framework than just clinical, having a solid trust in the normalcy of the process for most women, and having a desire to protect the flow of oxytocin, which contributes to optimal bonding for Mother/s, Father, and Baby/ies. Focus on numbers, dilation, and time are de-emphasized in the couple's presence (unless necessary), while the parents' comfort and emotional state are taken into consideration. Small things, like being aware that while this is just a day on the job for a medical caregiver, it is the most special day in the life of these patients, are remembered. Remembering that moms are not intellectual beings during labour and that more than the necessary questions and explanations can disrupt her labour, or that talking with others in the room may disturb her during a contraction are small things, yet go a very long way in protecting the moment to moment experience for the labouring parents.
For those couples, however, who do not have support from loving friends/family who are knowledgeable of how to support their unique experience, free from their own personal agendas of how their birth "should" be, there is no substitute for a doula. Continuous labour support from someone with whom the couple has spent some time prenatally and forged a strong relationship with, or at least with someone who is well aware of their unique needs before they enter the birthing room (as in a situation requiring backup doula care) brings about a deeper sense of emotional safety. With emotional safety comes more relaxation, and with more relaxation ideally comes a smoother release of all those great labour hormones. Doulas strive to build a relationship of trust with their clients. We ask questions like: "What is your relationship to stress and pain?" "What are your most pressing concerns about birth and parenting?" "How do you envision your birth?" "Can you show me how you breathe deeply?" "Is there anything in your life you've experienced you would consider traumatic?" All of this information gathering facilitates discussions that help us tailor our approach specifically for our clients.
There have been many times in a woman's labour where the specific knowledge a doula has of her client can really save the day. The more respectful doulas are of the hospital environment they work in, the more trust caregivers can put into the relationship doulas have with their clients, and we can be turned to as tremendously valuable resources. In my years working as a doula, I've come to understand that sometimes it can look to an unsuspecting nurse or doctor that we don't know our doula skills because we're not doing the general things they've learned about to support their patient. For example, sometimes, even though moms "should" be upright a lot through labour and "should" use the bath or shower in active labour to relax and reduce pain, it's important for caregivers not to assume we're ignorant of the application of these comfort measures simply because we're not suggesting them. My way of being a doula is to NOT be over-solicitous, meaning I don't with every contraction ask Mom to get up, change positions, haul out a ball or massage oil, or suggest things. Why? Because after a while it becomes a pain to hear the mosquito buzz of questions in your ear in labour. Sometimes we like to just let our clients BE. It's also important for caregivers to realize that our client has already probably pretty strongly let us know what she needs. Perhaps she's lying on her side because this is her "happy place" and is indeed progressing just great as she is. We can be trusted to ensure she's getting up to pee once in a while and in the process shaking her pelvis around a little. Unless a mom is clearly trying to avoid the hard work of active labour and needs a little energy reversal to shake things up, leaving her to it is often a wise choice.
I've heard doulas have encounters with nurses who thought the doula was acting very strangely, even ignorantly, by fully supporting the mother's insistence upon a seemingly early epidural, and were chided by the nurse who wanted to give them a crash course in comfort techniques. When (with the clients' knowledge and permission of course) the doula took the nurse outside the room and explained the mother was a survivor of sexual abuse and that they had in advance of the labour come up with a plan to demand an epidural when the pain started triggering feelings of emotional instability, the nurses immediately did what was asked, recognizing the value of the doula/client relationship. I remember walking the hall of a hospital and the mom stopped for a contraction, leaned over, and I rubbed her back in the way we had discussed, due to an issue with her sacrum. A nursing student ran up, and said, "Let me," and proudly "showed" me how to do a sacral press because I guess she had learned it was better, even though it was wildly inappropriate for this particular mom. I've had a couple of students chewed out by hospital staff for looking like they weren't doing anything for a mom who had just clearly told them she wanted to rest quietly for a while.
Doulas craft their relationships with their clients painstakingly and lovingly. We find out what coping skills they have to weather the sensations of labour, find out whether or not they prefer fancier breathing techniques, what kind of essential oils they like, and what scares them. If we have had the good fortune to attend their previous births, this relationship becomes MORE powerful. A particular sound or body posture that may be easily missed by others can alert the doula to when this unique mom is about to quickly deliver the baby and ensure the staff is aware and prepared. A midwife I've worked with a few times recently totally put her trust in me to recognize when the silent mom was pushing. She said, "You've been with her before. Come get me when you think she's close if she gets there before the next heart tone check." I sent her sister running for the midwife just before heart tone check time. The husband looked confused and said, "How did you know?" and for me it was just the way she started walking that drew me vividly back to how it was with her previous birth before the baby squirted out.
It's important to remember that as doulas, we don't pay as much attention to times of contractions or numbers of cervical dilation. These are not tools we use to determine where a mother might be in her labour. That is a clinical perspective we leave to the clinicians. Instead, we are in deep observance of Mom's behaviour and subtle shifts in breathing and movement. We talk to the fears that might come up, address areas we knew well in advance she had been concerned about, and use not a whole myriad of techniques and every tool in our doula bag, but the simple things that we know work for THIS lady, because we know her well. We sit quietly, feeling, watching, sensing, sometimes even smelling.
Smelling? Did she just say SMELLING? Yes she did. To end the topic of relationships but to let you know what kind of secret spidey senses many doulas and midwives have, let me leave you on an interesting note: doulas use their sense of smell a lot. It's pretty clear if the mom's just peed herself or if her waters have broken given the ocean water smell of amniotic fluid. Subtle changes in Mom's body smells can let us know she's challenged with something like dehydration or hunger or too much fatigue. I recently told a couple that I smelled their baby coming. They thought this was funny. Baby was out within fifteen minutes or so. Seriously, I have gotten doctors in the room because of that smell (without telling them that). There is sometimes a scent mothers emanate just prior to birthing, a kind of fruity hormonal smell. It smells like fresh baby, ripe apples, and the earth after rain. To me, it's the loveliest scent in the world. Free from any need to worry about clinical things, doulas get to develop more grassroots way to figure out a labour. It may surprise some to know that our magic may run just a little deeper than double hip squeezes and lavender spritz.
It is incredibly valuable for all people who work with birth to have basic doula skills. A nurse or resident with basic doula skills can have a tremendously positive effect on a woman's labour. Even if these medical professionals don't have continuous time to spend with the couple, bringing in a fresh bit of energy into the room when they come in for an exam, perhaps some soft, gentle words of encouragement, a demonstration of how Dad can rub Mom's back, or a suggestion of how to use a yoga ball can be a soothing balm to couples who feel up the creek without a paddle.
I often get the opportunity to teach hands-on skills to student nurses and occasionally medical residents too, and the positive feedback I get lets me know that learning about birth through the eyes of a doula can bring a fresh perspective. This means viewing birth from a larger framework than just clinical, having a solid trust in the normalcy of the process for most women, and having a desire to protect the flow of oxytocin, which contributes to optimal bonding for Mother/s, Father, and Baby/ies. Focus on numbers, dilation, and time are de-emphasized in the couple's presence (unless necessary), while the parents' comfort and emotional state are taken into consideration. Small things, like being aware that while this is just a day on the job for a medical caregiver, it is the most special day in the life of these patients, are remembered. Remembering that moms are not intellectual beings during labour and that more than the necessary questions and explanations can disrupt her labour, or that talking with others in the room may disturb her during a contraction are small things, yet go a very long way in protecting the moment to moment experience for the labouring parents.
For those couples, however, who do not have support from loving friends/family who are knowledgeable of how to support their unique experience, free from their own personal agendas of how their birth "should" be, there is no substitute for a doula. Continuous labour support from someone with whom the couple has spent some time prenatally and forged a strong relationship with, or at least with someone who is well aware of their unique needs before they enter the birthing room (as in a situation requiring backup doula care) brings about a deeper sense of emotional safety. With emotional safety comes more relaxation, and with more relaxation ideally comes a smoother release of all those great labour hormones. Doulas strive to build a relationship of trust with their clients. We ask questions like: "What is your relationship to stress and pain?" "What are your most pressing concerns about birth and parenting?" "How do you envision your birth?" "Can you show me how you breathe deeply?" "Is there anything in your life you've experienced you would consider traumatic?" All of this information gathering facilitates discussions that help us tailor our approach specifically for our clients.
There have been many times in a woman's labour where the specific knowledge a doula has of her client can really save the day. The more respectful doulas are of the hospital environment they work in, the more trust caregivers can put into the relationship doulas have with their clients, and we can be turned to as tremendously valuable resources. In my years working as a doula, I've come to understand that sometimes it can look to an unsuspecting nurse or doctor that we don't know our doula skills because we're not doing the general things they've learned about to support their patient. For example, sometimes, even though moms "should" be upright a lot through labour and "should" use the bath or shower in active labour to relax and reduce pain, it's important for caregivers not to assume we're ignorant of the application of these comfort measures simply because we're not suggesting them. My way of being a doula is to NOT be over-solicitous, meaning I don't with every contraction ask Mom to get up, change positions, haul out a ball or massage oil, or suggest things. Why? Because after a while it becomes a pain to hear the mosquito buzz of questions in your ear in labour. Sometimes we like to just let our clients BE. It's also important for caregivers to realize that our client has already probably pretty strongly let us know what she needs. Perhaps she's lying on her side because this is her "happy place" and is indeed progressing just great as she is. We can be trusted to ensure she's getting up to pee once in a while and in the process shaking her pelvis around a little. Unless a mom is clearly trying to avoid the hard work of active labour and needs a little energy reversal to shake things up, leaving her to it is often a wise choice.
I've heard doulas have encounters with nurses who thought the doula was acting very strangely, even ignorantly, by fully supporting the mother's insistence upon a seemingly early epidural, and were chided by the nurse who wanted to give them a crash course in comfort techniques. When (with the clients' knowledge and permission of course) the doula took the nurse outside the room and explained the mother was a survivor of sexual abuse and that they had in advance of the labour come up with a plan to demand an epidural when the pain started triggering feelings of emotional instability, the nurses immediately did what was asked, recognizing the value of the doula/client relationship. I remember walking the hall of a hospital and the mom stopped for a contraction, leaned over, and I rubbed her back in the way we had discussed, due to an issue with her sacrum. A nursing student ran up, and said, "Let me," and proudly "showed" me how to do a sacral press because I guess she had learned it was better, even though it was wildly inappropriate for this particular mom. I've had a couple of students chewed out by hospital staff for looking like they weren't doing anything for a mom who had just clearly told them she wanted to rest quietly for a while.
Doulas craft their relationships with their clients painstakingly and lovingly. We find out what coping skills they have to weather the sensations of labour, find out whether or not they prefer fancier breathing techniques, what kind of essential oils they like, and what scares them. If we have had the good fortune to attend their previous births, this relationship becomes MORE powerful. A particular sound or body posture that may be easily missed by others can alert the doula to when this unique mom is about to quickly deliver the baby and ensure the staff is aware and prepared. A midwife I've worked with a few times recently totally put her trust in me to recognize when the silent mom was pushing. She said, "You've been with her before. Come get me when you think she's close if she gets there before the next heart tone check." I sent her sister running for the midwife just before heart tone check time. The husband looked confused and said, "How did you know?" and for me it was just the way she started walking that drew me vividly back to how it was with her previous birth before the baby squirted out.
It's important to remember that as doulas, we don't pay as much attention to times of contractions or numbers of cervical dilation. These are not tools we use to determine where a mother might be in her labour. That is a clinical perspective we leave to the clinicians. Instead, we are in deep observance of Mom's behaviour and subtle shifts in breathing and movement. We talk to the fears that might come up, address areas we knew well in advance she had been concerned about, and use not a whole myriad of techniques and every tool in our doula bag, but the simple things that we know work for THIS lady, because we know her well. We sit quietly, feeling, watching, sensing, sometimes even smelling.
Smelling? Did she just say SMELLING? Yes she did. To end the topic of relationships but to let you know what kind of secret spidey senses many doulas and midwives have, let me leave you on an interesting note: doulas use their sense of smell a lot. It's pretty clear if the mom's just peed herself or if her waters have broken given the ocean water smell of amniotic fluid. Subtle changes in Mom's body smells can let us know she's challenged with something like dehydration or hunger or too much fatigue. I recently told a couple that I smelled their baby coming. They thought this was funny. Baby was out within fifteen minutes or so. Seriously, I have gotten doctors in the room because of that smell (without telling them that). There is sometimes a scent mothers emanate just prior to birthing, a kind of fruity hormonal smell. It smells like fresh baby, ripe apples, and the earth after rain. To me, it's the loveliest scent in the world. Free from any need to worry about clinical things, doulas get to develop more grassroots way to figure out a labour. It may surprise some to know that our magic may run just a little deeper than double hip squeezes and lavender spritz.
Thursday, March 8, 2012
Happy Women's Day!
I spent a wonderful day honouring Women's Day by doing the work I love to do.
At noon I met with a pregnant couple and had the pleasure of being accompanied by one of my lovely apprentices. One of my tasks in being a doula, I feel, is to connect women with the internal resources they have to bring to their birth/parenting experiences. It was wonderful to learn how how this lady had done some serious work in her life to actively heal issues and create healthy boundaries. This type of emotional inventory and process work does wonders in releasing energy bound up by our past, thus creating more available resources with which to birth. I was so glad to see what a natural my apprentice was, taking the opportunity to really honour this woman's work, connecting her to the value of what she had done for herself, and her future child. I could also feel a strong desire from the woman's partner to be a great birth supporter. We nurtured that desire, emphasizing how valuable it is to have a partner lovingly committed to doing his best to help his child into the world.
There are so many ways in which our culture builds up the image of men being real dufuses during labour, and it's simply not fair. Sure, some couples prefer, for whatever reason, Partner be less hands on, and that is fine if both parties are in agreement and honour each others' expectations. But from my personal experience, I find when a man is really invested in being there for his woman and child, willing to embrace the experience as her expression of power, allowing himself be vulnerable, open, and a rock all at the same time, the experience is all the more special. It is an amazing bonding opportunity to have together, starting new parenthood off on powerful footing as a dedicated team.
Next appointment was with another lovely apprentice's company. We did a first prenatal meeting with a couple we had not met in person before, so we were both on the same footing. I just love getting to know folks and getting a sense of what may help them have the best experience possible. I learned that this couple have great resources in terms of being able to relax into and cope with stress. What I felt was most called for in this meeting was to create excitement about the normal process of birth. We are enculturated to tell each other horror stories, projecting our fear onto innocent pregnant ladies who become too scared to even dream of anything normal the more they are infused with that fear. So to neutralize it, I tell good stories, and recommend books not full of alarmist advice, but wonderful, triumphant stories. It doesn't dumb women down to have them feel positive about their upcoming birth experiences. Feeling confident doesn't put rose coloured glasses on them. This seems to be what we want women to believe: if they feel positively about birth, they'll be all the more hurt if things don't go as expected. So we seem to take it upon ourselves to save them from what we assume will be their feelings of failure or disappointment by "reminding" them of harsh realities with all the tales of birthing woe we can muster. Telling good stories and discussing birth as a wonderful thing reduces fear, fear itself being responsible for many of the challenges in labour and birth; not on an airy fairy plane, but a real, physiological, hormonal level. Confidence and hope are resources, not foolish fantasies of the uninitiated and ignorant, as we tend to imply with our our obsession with telling stories filled with awful drama to pregnant ladies. So much can be healed simply by changing the tune of our stories. Our telling of the good stories is narrative medicine at its finest.
My third meeting was with a new mother and father. Again, I had the pleasure of being accompanied, this time by a seasoned MotherWit apprentice. We've gotten to work together a couple of times, and I just love her strong, loving presence. She exudes safety and capability. Our couple's baby had had some feeding problems, but it was great to see this greedy little munchkin gobbling back milk like there was no tomorrow, getting fat and pooping up a storm. Mama was entirely exhausted, though, and while putting on a brave face, was clearly feeling quite challenged by the demands of growth spurt nursing, fatigue, and a baby who won't sleep without being in constant contact with a parent. And Dad, well, he's just anchoring it all, doing all the countless unseen beautiful things new daddies do to support their partners and babies as best they know how, all the while feeling as overwhelmed as she.
It does something to my heart to see grownup professionals, people who have lived out in the world gaining tons of life experience, masters at what they do, to be reduced to rank amateurs when they hold their baby in their arms the first time. I am filled with the most maternal feelings, not for the newborn baby, but for the newborn parents. It doesn't matter who we are or how many degrees we have or places we've traveled. When we have our own first babies, we are brand new and experience the joys, triumphs, discouragement, and frustration of those trying to master something we've never done before. But we're doing it with the hearts of those invested like never before, feeling love and responsibility so great, it renders us speechless in the spaces we have between diaper changes to think. We also try to manage all the endless tasks of new baby care running sometimes on empty. Not living tribally anymore, it is difficult to get the rest, food, and support we need to do this sacred work with as many resources as we could have if we were cared for just a little more. A doula's visit can cut to the chase of what's needed in terms of resources,while acknowledging all the positive things going on (but not in an annoying, "count your blessings" preachy kind of way).
As is typical on postpartum visits, we saw tired parents who needed more sleep, and tips on how to get Baby (or at least to try) to sleep. Baby was not at all happy with lying on the back sleeping by herself. Not that it caused intense distress, but she just woke up every time she was put down and cried for company. It's easy to say, "Well, just hold her all the time then," when we are avid about attachment parenting ourselves, but for those not used to such intense physical contact all the time, that advice can exacerbate feelings of helplessness. We gently talk about how many babies do indeed prefer being held most of the time as they're getting used to life outside of the cozy womb, but we also like to give some tools parents can try so they can decide for themselves how to sooth their fussy baby. We showed some swaddling tips (keeping in mind, this Baby nurses skin to skin and is gaining like a champ) and Baby holds to reduce gas in the tummy.
The parental tears came flowing at the admittance of overwhelm, as well as the guilt that always seems to come up with feeling overwhelmed. Though personally, I think feeling overwhelmed by having a baby is pretty appropriate. It's not easy! Sometimes when I show someone a way to hold their baby that calms them and then lie them down and they stay asleep, it makes them feel like they've been missing something crucial and reinforces feelings of their imagined inadequacy. I am sensitive to this, and have to remind them that I have twenty years and four babies worth of mothering experience (not to mention having showed colic holds and laying-down techniques to countless hundreds of parents), but at one time I was in the exact same position with the world's most colicky baby. By a couple months in though, I was an expert, and I assured them they will be too. There's nothing like learning in the field. I got great advice from my mother, my grandmother, my midwife, my doula, and La Leche League friends to help me along the way. Parenting is part instinct, but part learned as well. We learn how to be skilled parents not just from books and intuition, but by being lovingly taught skills by other parents or people with a lot of experience with babies. How we "experts" relay these skills is very important, as there's a fine balance between building resources and giving unsolicited advice to stoke our own egos. So it's always so important to let new parents know that we all have felt like overwhelmed newbies at some point, that their feelings are absolutely normal, and that in fact, I'm still overwhelmed a lot because I've never had a teenage boy before, or a daughter about to leave the nest. I have to consult with my friends who have grown kids all the time to learn ways to cope with new challenges. We're always newbies at any given stage of parenting. But nobody is quite as sensitive, tired, and hormonal as the parent of a newborn, so our resource building must be gentle and empowering, filled with reassurance that they are doing beautifully. They need to know that just their desire to try, their willingness to show up for those late night feeds and massive, up the back poop-alanches, their heartfelt desire to be good for this teeny little scrap of human, makes them BRILLIANT.
I left these parents with a few ideas on how to get more sleep, dates of our MotherWit Mom's Group to reduce feelings of isolation and have a space where mother to mother support can be exchanged by those in the same boat, and the number of an osteopath I trust to tend to some of the issues of tension and difficulty in settling this wee one has. It is often as simple as a little cranial/sacral alignment to aid digestion and relaxation in a newborn. We left them with big hugs and promises that it would get easier and that they would soon feel more mastery over their situation.
It was a great day, and now I get to hang out with my younger teen daughter and her friend to wrap up a lovely Women's Day. Blessings to all of you precious women out there.
At noon I met with a pregnant couple and had the pleasure of being accompanied by one of my lovely apprentices. One of my tasks in being a doula, I feel, is to connect women with the internal resources they have to bring to their birth/parenting experiences. It was wonderful to learn how how this lady had done some serious work in her life to actively heal issues and create healthy boundaries. This type of emotional inventory and process work does wonders in releasing energy bound up by our past, thus creating more available resources with which to birth. I was so glad to see what a natural my apprentice was, taking the opportunity to really honour this woman's work, connecting her to the value of what she had done for herself, and her future child. I could also feel a strong desire from the woman's partner to be a great birth supporter. We nurtured that desire, emphasizing how valuable it is to have a partner lovingly committed to doing his best to help his child into the world.
There are so many ways in which our culture builds up the image of men being real dufuses during labour, and it's simply not fair. Sure, some couples prefer, for whatever reason, Partner be less hands on, and that is fine if both parties are in agreement and honour each others' expectations. But from my personal experience, I find when a man is really invested in being there for his woman and child, willing to embrace the experience as her expression of power, allowing himself be vulnerable, open, and a rock all at the same time, the experience is all the more special. It is an amazing bonding opportunity to have together, starting new parenthood off on powerful footing as a dedicated team.
Next appointment was with another lovely apprentice's company. We did a first prenatal meeting with a couple we had not met in person before, so we were both on the same footing. I just love getting to know folks and getting a sense of what may help them have the best experience possible. I learned that this couple have great resources in terms of being able to relax into and cope with stress. What I felt was most called for in this meeting was to create excitement about the normal process of birth. We are enculturated to tell each other horror stories, projecting our fear onto innocent pregnant ladies who become too scared to even dream of anything normal the more they are infused with that fear. So to neutralize it, I tell good stories, and recommend books not full of alarmist advice, but wonderful, triumphant stories. It doesn't dumb women down to have them feel positive about their upcoming birth experiences. Feeling confident doesn't put rose coloured glasses on them. This seems to be what we want women to believe: if they feel positively about birth, they'll be all the more hurt if things don't go as expected. So we seem to take it upon ourselves to save them from what we assume will be their feelings of failure or disappointment by "reminding" them of harsh realities with all the tales of birthing woe we can muster. Telling good stories and discussing birth as a wonderful thing reduces fear, fear itself being responsible for many of the challenges in labour and birth; not on an airy fairy plane, but a real, physiological, hormonal level. Confidence and hope are resources, not foolish fantasies of the uninitiated and ignorant, as we tend to imply with our our obsession with telling stories filled with awful drama to pregnant ladies. So much can be healed simply by changing the tune of our stories. Our telling of the good stories is narrative medicine at its finest.
My third meeting was with a new mother and father. Again, I had the pleasure of being accompanied, this time by a seasoned MotherWit apprentice. We've gotten to work together a couple of times, and I just love her strong, loving presence. She exudes safety and capability. Our couple's baby had had some feeding problems, but it was great to see this greedy little munchkin gobbling back milk like there was no tomorrow, getting fat and pooping up a storm. Mama was entirely exhausted, though, and while putting on a brave face, was clearly feeling quite challenged by the demands of growth spurt nursing, fatigue, and a baby who won't sleep without being in constant contact with a parent. And Dad, well, he's just anchoring it all, doing all the countless unseen beautiful things new daddies do to support their partners and babies as best they know how, all the while feeling as overwhelmed as she.
It does something to my heart to see grownup professionals, people who have lived out in the world gaining tons of life experience, masters at what they do, to be reduced to rank amateurs when they hold their baby in their arms the first time. I am filled with the most maternal feelings, not for the newborn baby, but for the newborn parents. It doesn't matter who we are or how many degrees we have or places we've traveled. When we have our own first babies, we are brand new and experience the joys, triumphs, discouragement, and frustration of those trying to master something we've never done before. But we're doing it with the hearts of those invested like never before, feeling love and responsibility so great, it renders us speechless in the spaces we have between diaper changes to think. We also try to manage all the endless tasks of new baby care running sometimes on empty. Not living tribally anymore, it is difficult to get the rest, food, and support we need to do this sacred work with as many resources as we could have if we were cared for just a little more. A doula's visit can cut to the chase of what's needed in terms of resources,while acknowledging all the positive things going on (but not in an annoying, "count your blessings" preachy kind of way).
As is typical on postpartum visits, we saw tired parents who needed more sleep, and tips on how to get Baby (or at least to try) to sleep. Baby was not at all happy with lying on the back sleeping by herself. Not that it caused intense distress, but she just woke up every time she was put down and cried for company. It's easy to say, "Well, just hold her all the time then," when we are avid about attachment parenting ourselves, but for those not used to such intense physical contact all the time, that advice can exacerbate feelings of helplessness. We gently talk about how many babies do indeed prefer being held most of the time as they're getting used to life outside of the cozy womb, but we also like to give some tools parents can try so they can decide for themselves how to sooth their fussy baby. We showed some swaddling tips (keeping in mind, this Baby nurses skin to skin and is gaining like a champ) and Baby holds to reduce gas in the tummy.
The parental tears came flowing at the admittance of overwhelm, as well as the guilt that always seems to come up with feeling overwhelmed. Though personally, I think feeling overwhelmed by having a baby is pretty appropriate. It's not easy! Sometimes when I show someone a way to hold their baby that calms them and then lie them down and they stay asleep, it makes them feel like they've been missing something crucial and reinforces feelings of their imagined inadequacy. I am sensitive to this, and have to remind them that I have twenty years and four babies worth of mothering experience (not to mention having showed colic holds and laying-down techniques to countless hundreds of parents), but at one time I was in the exact same position with the world's most colicky baby. By a couple months in though, I was an expert, and I assured them they will be too. There's nothing like learning in the field. I got great advice from my mother, my grandmother, my midwife, my doula, and La Leche League friends to help me along the way. Parenting is part instinct, but part learned as well. We learn how to be skilled parents not just from books and intuition, but by being lovingly taught skills by other parents or people with a lot of experience with babies. How we "experts" relay these skills is very important, as there's a fine balance between building resources and giving unsolicited advice to stoke our own egos. So it's always so important to let new parents know that we all have felt like overwhelmed newbies at some point, that their feelings are absolutely normal, and that in fact, I'm still overwhelmed a lot because I've never had a teenage boy before, or a daughter about to leave the nest. I have to consult with my friends who have grown kids all the time to learn ways to cope with new challenges. We're always newbies at any given stage of parenting. But nobody is quite as sensitive, tired, and hormonal as the parent of a newborn, so our resource building must be gentle and empowering, filled with reassurance that they are doing beautifully. They need to know that just their desire to try, their willingness to show up for those late night feeds and massive, up the back poop-alanches, their heartfelt desire to be good for this teeny little scrap of human, makes them BRILLIANT.
I left these parents with a few ideas on how to get more sleep, dates of our MotherWit Mom's Group to reduce feelings of isolation and have a space where mother to mother support can be exchanged by those in the same boat, and the number of an osteopath I trust to tend to some of the issues of tension and difficulty in settling this wee one has. It is often as simple as a little cranial/sacral alignment to aid digestion and relaxation in a newborn. We left them with big hugs and promises that it would get easier and that they would soon feel more mastery over their situation.
It was a great day, and now I get to hang out with my younger teen daughter and her friend to wrap up a lovely Women's Day. Blessings to all of you precious women out there.
Monday, February 27, 2012
After Training High
Those who know me know one of my greatest passions is to guide women on their journeys to becoming doulas themselves. It's not just because I love to chat about birth and see eyes open big and mouths open in wide "Os" of wonder (though that's a large part of it), but because I feel that having more women aligned with what birth in our culture needs for healing MUST reach critical mass. I feel a desperation to see the pendulum begin to swing the other way, ensuring within the context of the great access to modern maternity care we have, ALL families experience birth in ways which nourish them.
There are too many stories of emotional trauma, too many choking sobs at the telling of birth stories, too much shame surrounding the experiences of mothers and fathers, stories which, had the tellers been honoured in the spirit of "bringers forth of life" instead of "ignorant inconveniences", could have ended in triumph. Sadly, many end in the frustrated, guilty tears of those who feel they don't have a right to grieve while healthy babies lie in their arms.
Before I begin a doula training, I take time to connect as deeply as I can with my intent. What do I want for these women? I am humbled by the amazing women who decide to come to me to help them further and focus their aspirations to embark upon this work, and I have an overwhelming desire to serve them well. I believe my students all come with a deep yearning in their hearts to be of use, to do what they can to serve families as they contribute to the healing of Birth. They usually come for three reasons: either they've had that sip from the Holy Grail of "Transformative Birth" and want that for everyone, they have been deeply wounded and want to prevent that sadness for others by buffering and supporting, or they have experienced neither but intuitively know the stories they're hearing need to change, and want to be a part of that good change. Not only do I want to give them skills and knowledge to do so(learning myself from the amazing depth of skills and knowledge they already have), but I want to connect them more profoundly to their own feminine wisdom. I want to nourish that deep soul yearning they bring to our learning circle. I want them to feel in their cells how their inspiration to work as doulas is the prayer of their great great Grandmothers. So we work with that part too, exploring ceremony and energy work as we honour the inspiration that sets us on the path of Love and Spirit.
I love the way women gather. I observe how they interact. Before names are even exchanged, a woman will take another's baby so she can take off her carrier and coat, both of them happily chatting about early motherhood. Offers of holding babies are freely given so mothers can eat hands free (a rare treat). Coffees are poured for each other, resources are shared, tears dried, hugs exchanged, and acknowledgements of the great feeling in the room uttered. The talk is earthy, laughter filled, and bawdy as we let down our hair away from the presence of older kids and gentlemen. Women are capable of generating a lot of amazing energy in their gathering, an energy born of the simple being in community with a shared dream. And when that energy is focused with a collective intention, great shapeshiftings of heaing occur. I know many of these women will go home and experience some amazing synchronicities and come back to our next gathering with stories of more deeply honed intuition.
Today, after teaching half of our eight day birth doula training (the rest happens next month), I am physically and mentally exhausted, but I am on an emotional high as if I've just worked long and hard for an amazing birth. Thank you all, Ladies, for bringing your beauty to our humble gathering space within which to hone your own motherwit. Merry meet, merry part, and merry meet again.
Note: For anyone who finds themselves all freaked out at the sight of doulas feeling bellies and listening with a fetal heart finding device, have no fear and relax. We are not out to do midwives' jobs (otherwise we'd go out and be midwives), nor are we trying to assume any clinical care of our clients. My students are literally under contractual obligation to perform NO diagnostic skills on their clients. We nourish the whole and provide information and support. We like to promote optimal fetal positioning.
There is a lot of controversy as to whether or not there is value to this, as many babies turn posterior during birth..but because of the fact we see a large percentage of natural births, we also see (as anecdotal as it may be) that many of these malpositions during labour occur after mothers receive an epidural. We know that for moms who have healthy, normal pregnancies and their babies are determined by their caregivers to be head down and stable, the principles of OFP may potentially contribute to a smoother birth. Can we tell where babies are lying in their mom's tummies? No, of course not, that takes years of midwifery/medicine experience. We ask Moms when we are asked if we know where their babies might be upon our discussions of OFP, "Where do YOU think your baby is?" We ask where the mom feels kicks and a bum, and if she wishes, we feel along with her. It is in the spirit of bonding, exploration, and empowerment,and helps moms get accustomed to our touch, establishing a deeper rapport that we bring to her birth experience. To validate to Mom that her instincts were right on, or to perhaps explore further if she is unsure, we invite her to listen to her baby's heart, having her place the device over where she thinks Baby's heart would be heard. Parents love to listen to this, and their eyes light up when they realize they figured out the mystery. Never is anyone listening to the heart rate for any diagnostic reasons, nor are doulas ever trying to diagnose position or lie. If nobody hears a heartrate, we know it's because none of us know enough to find the right spot, no big deal. When parents ask about their baby's positions, most doctors tend to consult the ultrasound papers and say, "it's head down" and that's that. So discussions about fetal positions and their being proactive about it piques their curiosity to know more about their bodies.
This is for fun, information, and for parents to feel more involved in the understanding of their pregnancies and how they can potentially help themselves have a smoother birth. If they find Baby be in a position that may be less favourable for a smooth birth, we discuss and demonstrate exercises for moms to do.
Doulas are very intimate with their clients' bodies, massaging them throughout labour, drying them off when they're getting out the shower and are too busy with their labours to do so, dangling them on our laps to help bring Baby down, suddenly seeing a baby's head in her vaginal opening and yelling for a doctor, positioning their bodies to facilitate changes in position, drying tears, wiping blood off their legs, changing soiled bedding, holding vomit bowls, touching breasts, showing how to diaper and swaddle their babies, holding their babies when necessary....to put a taboo around a belly with a baby in it is a silly silly thing if this is our client's desire. There is often the assumption that if you give a woman some knowledge she'll go off and do dangerous things with it. Feeling bellies is not a "Gateway Touch" which shoots doulas over the line into playing midwife. The Spanish Inquisition ended a long time ago.
There are too many stories of emotional trauma, too many choking sobs at the telling of birth stories, too much shame surrounding the experiences of mothers and fathers, stories which, had the tellers been honoured in the spirit of "bringers forth of life" instead of "ignorant inconveniences", could have ended in triumph. Sadly, many end in the frustrated, guilty tears of those who feel they don't have a right to grieve while healthy babies lie in their arms.
Before I begin a doula training, I take time to connect as deeply as I can with my intent. What do I want for these women? I am humbled by the amazing women who decide to come to me to help them further and focus their aspirations to embark upon this work, and I have an overwhelming desire to serve them well. I believe my students all come with a deep yearning in their hearts to be of use, to do what they can to serve families as they contribute to the healing of Birth. They usually come for three reasons: either they've had that sip from the Holy Grail of "Transformative Birth" and want that for everyone, they have been deeply wounded and want to prevent that sadness for others by buffering and supporting, or they have experienced neither but intuitively know the stories they're hearing need to change, and want to be a part of that good change. Not only do I want to give them skills and knowledge to do so(learning myself from the amazing depth of skills and knowledge they already have), but I want to connect them more profoundly to their own feminine wisdom. I want to nourish that deep soul yearning they bring to our learning circle. I want them to feel in their cells how their inspiration to work as doulas is the prayer of their great great Grandmothers. So we work with that part too, exploring ceremony and energy work as we honour the inspiration that sets us on the path of Love and Spirit.
I love the way women gather. I observe how they interact. Before names are even exchanged, a woman will take another's baby so she can take off her carrier and coat, both of them happily chatting about early motherhood. Offers of holding babies are freely given so mothers can eat hands free (a rare treat). Coffees are poured for each other, resources are shared, tears dried, hugs exchanged, and acknowledgements of the great feeling in the room uttered. The talk is earthy, laughter filled, and bawdy as we let down our hair away from the presence of older kids and gentlemen. Women are capable of generating a lot of amazing energy in their gathering, an energy born of the simple being in community with a shared dream. And when that energy is focused with a collective intention, great shapeshiftings of heaing occur. I know many of these women will go home and experience some amazing synchronicities and come back to our next gathering with stories of more deeply honed intuition.
Today, after teaching half of our eight day birth doula training (the rest happens next month), I am physically and mentally exhausted, but I am on an emotional high as if I've just worked long and hard for an amazing birth. Thank you all, Ladies, for bringing your beauty to our humble gathering space within which to hone your own motherwit. Merry meet, merry part, and merry meet again.
Note: For anyone who finds themselves all freaked out at the sight of doulas feeling bellies and listening with a fetal heart finding device, have no fear and relax. We are not out to do midwives' jobs (otherwise we'd go out and be midwives), nor are we trying to assume any clinical care of our clients. My students are literally under contractual obligation to perform NO diagnostic skills on their clients. We nourish the whole and provide information and support. We like to promote optimal fetal positioning.
There is a lot of controversy as to whether or not there is value to this, as many babies turn posterior during birth..but because of the fact we see a large percentage of natural births, we also see (as anecdotal as it may be) that many of these malpositions during labour occur after mothers receive an epidural. We know that for moms who have healthy, normal pregnancies and their babies are determined by their caregivers to be head down and stable, the principles of OFP may potentially contribute to a smoother birth. Can we tell where babies are lying in their mom's tummies? No, of course not, that takes years of midwifery/medicine experience. We ask Moms when we are asked if we know where their babies might be upon our discussions of OFP, "Where do YOU think your baby is?" We ask where the mom feels kicks and a bum, and if she wishes, we feel along with her. It is in the spirit of bonding, exploration, and empowerment,and helps moms get accustomed to our touch, establishing a deeper rapport that we bring to her birth experience. To validate to Mom that her instincts were right on, or to perhaps explore further if she is unsure, we invite her to listen to her baby's heart, having her place the device over where she thinks Baby's heart would be heard. Parents love to listen to this, and their eyes light up when they realize they figured out the mystery. Never is anyone listening to the heart rate for any diagnostic reasons, nor are doulas ever trying to diagnose position or lie. If nobody hears a heartrate, we know it's because none of us know enough to find the right spot, no big deal. When parents ask about their baby's positions, most doctors tend to consult the ultrasound papers and say, "it's head down" and that's that. So discussions about fetal positions and their being proactive about it piques their curiosity to know more about their bodies.
This is for fun, information, and for parents to feel more involved in the understanding of their pregnancies and how they can potentially help themselves have a smoother birth. If they find Baby be in a position that may be less favourable for a smooth birth, we discuss and demonstrate exercises for moms to do.
Doulas are very intimate with their clients' bodies, massaging them throughout labour, drying them off when they're getting out the shower and are too busy with their labours to do so, dangling them on our laps to help bring Baby down, suddenly seeing a baby's head in her vaginal opening and yelling for a doctor, positioning their bodies to facilitate changes in position, drying tears, wiping blood off their legs, changing soiled bedding, holding vomit bowls, touching breasts, showing how to diaper and swaddle their babies, holding their babies when necessary....to put a taboo around a belly with a baby in it is a silly silly thing if this is our client's desire. There is often the assumption that if you give a woman some knowledge she'll go off and do dangerous things with it. Feeling bellies is not a "Gateway Touch" which shoots doulas over the line into playing midwife. The Spanish Inquisition ended a long time ago.
Thursday, February 16, 2012
A Doula Mentor's Dilemma
I recently attended a birth with an apprentice I chose specifically for a certain couple. Why did I choose this particular student to accompany me? All I can tell you is that I had a feeling. I have many students who enjoy attending births with me, but this one lady came very strongly to mind when I envisioned who would be a good fit for this couple.
My gut feeling registered funny in my head though, because really, the student and the couple were very different personality wise. My student is very quiet, gentle, and kind of shy in a sweet way. The couple is straight up, have no qualms about dropping f-bombs, and are expressive and raunchy (all in a great way).
I also encountered a bit of an ethical conundrum. My head kept saying that I should be very careful about taking a calculated risk with my apprentice's heart because of her own life stories. On the one hand, I knew our client's GREAT birth experience would bring some healing and inspiration. On the other, a challenging, disappointing birth experience could potentially bring up a lot of painful and discouraging feelings. As we can never predict birth, especially one of this particular nature, it was not "low risk" for my apprentice. All I knew was that it felt really important for this student to be there. Whenever I would think of bringing on someone else whose own personal history rendered them "safer" emotionally if this birth didn't go well, I kept thinking of this student. I outlined the situation to her, and she agreed, admitting that it could be a challenge, but that she was willing.
The couple really liked her presence, and were generous with their inclusion of her in their prenatal/birth experience. She is a quiet observer, but still waters run deep. I feel like she provided a sense of deep listening and compassionate grounding for this couple. There was something in having a commiseration about past birth experiences that I think made my clients feel secure with her. Not that my student talked about her stories in detail at all, but the general gist was something I knew the couple appreciated. When labour was getting stronger they asked when she would be there, so I was very pleased with the connection.
Sad to say, the birth, while everyone came out healthy and sound, was not even close to the experience I had hoped for either as a doula or a mentor. To make a very long story short, we all ended up witnessing (and our clients being the victim of) one of the worst abuses of medical authority I have ever seen. Of many of the things I specifically didn't want them to have to have to bear witness to, they did, in extreme and almost unbelievable ways.
As a doula, I felt devastated for this couple. As a mentor, I felt terrible. I wanted so much to have everything be good. I didn't feel as responsible for what happened to the couple, as things were entirely out of our control. We know as doulas that we can't wave our magic wands, turn back time, and make the staff be nice. We can only deal gracefully and help the couple stay focused on birth rather than anger in the moment. But I certainly do feel responsible for my student, as I took a risk in asking her along, knowing it might be hard on her emotionally. Well, this birth would have been hard on ANY student emotionally, especially if were your introduction to birth attending. But I had really really wanted it to be good for her in particular.
From what I can tell, my apprentice's presence added extra support to a difficult situation, which was great for the clients. And I think she's doing okay. I remain available to students who need to process their experiences. Sometimes it takes a while because they are all busy with their lives as I am with mine, or sometimes it just doesn't feel right yet, but at some point these things come up when they're ripe and ready, and we can go over them. Sometimes it takes a while to process things before we wish to talk them out. I did feel I had to very quickly address the violence that we were exposed to.
I know this is going to sound deeply weird, but I had a dream recently in which I was on this bright, clear rocky mountain, very high up. A man dressed in dark furs leather coverings of a culture I can't identify said to me, "This is for you," and handed me a reddish brown stone with black stripes through it. He talked to me about how the masculine principle in birth is really important, that the practice of modern medicine (the gender of the practitioner doesn't matter...the energy of diagnosing and applying strong interventions being "masculine"), has in many ways improved lives for families over time. It is as "inspired" as any other healing modality. But the problem is that this masculine principle often ends up being the last word, usurping more feminine, intuitive, experiential wisdom instead of supporting and working in cooperation with it. It has made things out of balance and now many are harmed. The unpredictability of birth doesn't lend well to the sensibilities of Medicine, and there are often a lot of attempts to control the process. In order to gain control because of this trepidation towards the unknown, coercion can be used to manipulate certain situations. I was told to remember that it wasn't out of cruelty as it would outwardly seem, but out of extreme fear and vulnerability. This dream wasn't spoken in so many words, but this was the "message" I received loud and clear.
I had to write it down quickly after it happened to make sure I got it all, as these kinds of dreams, for those of you who dream this way know, are precious and often feel like they resonate with an incontrovertible truth that is not to be forgotten.
I had the image of the stone placed in my hand really strongly, so as soon as I could, I looked for images of it on the Internet and found it was red tiger eye. When looking at the symbolism behind this stone, I found it is used to "protect against abuses of power". I told my husband about my dream, and bless him, he goes along with me. He found some red tiger eye and gave it to me.
I took one of my stones (Hi, my name is Lesley, and yes, I keep stones meaningful to me in my birth bag...wanna make something of it? ;p) and gave it to my apprentice the next time I saw her. I explained it was a kind of amulet to protect her from the abuses of power she may witness in birth. When we had a moment alone, I briefly explained my dream (risking being gaped at as if I were insane). I also feel (yeah, laugh away) that something in that stone, or perhaps more accurately in the energy created by the connection to it through the dreaming and the giving of it, could begin to create a subtle shift towards healing. Sometimes less words are better and a gesture from the heart says much more.
It IS a risk to the hearts of students to bring them to births that might be hard. In the end, it's probably better that this incident happened while I was there... because it certainly won't be the last time she sees something like that. She saw a senior doula NOT lose her shit and go postal on the staff member (as much as it might have felt good to do so in the moment). She learned how to calm herself and take measures for herself so SHE didn't lose her shit and go postal. She learned how to shift gears fast, help clients rechannel their strong feelings to focus on love for their baby, and how to recognize the healing in subtle acts of compassion by other staff members who were also hurt by the witnessing. She learned how one is NEVER truly helpless, and that when all else seems hopeless, we have our ability to energetically broadcast peace. When we can't make peace, we can be it. This act holds more power than you may think.
When we sign up to be doulas, we take on the role knowing we will, at some point, get hurt. Yet even upon the hurting, we come back and risk again. It is a risk to me (my credibility, perception of my sanity, etc.)to share dreams and beliefs of such a personal nature with others. Nobody likes being judged. But like our ladies who risk their hearts by opening to the unpredictability of birth, the VAST majority of the time, the reward is immeasurable, and the healing intention is accomplished by getting down dirty real.
My apprentice accepted her tiger's eye with a genuine smile. I'm still not sure why I felt so strongly about bringing her to this birth, and maybe I'll never know. Sometimes it's just a mystery and we have to trust it's all getting worked out somewhere. I get a strong sense she's going to be just fine, though. Not because of the stone, obviously, or my kooky dream (though I hope it it helps), but because she's a strong, resiliant woman. She seems eager to go to more births, and that's a great thing. She's going to be a fine doula. Love and honour, Sister.
My gut feeling registered funny in my head though, because really, the student and the couple were very different personality wise. My student is very quiet, gentle, and kind of shy in a sweet way. The couple is straight up, have no qualms about dropping f-bombs, and are expressive and raunchy (all in a great way).
I also encountered a bit of an ethical conundrum. My head kept saying that I should be very careful about taking a calculated risk with my apprentice's heart because of her own life stories. On the one hand, I knew our client's GREAT birth experience would bring some healing and inspiration. On the other, a challenging, disappointing birth experience could potentially bring up a lot of painful and discouraging feelings. As we can never predict birth, especially one of this particular nature, it was not "low risk" for my apprentice. All I knew was that it felt really important for this student to be there. Whenever I would think of bringing on someone else whose own personal history rendered them "safer" emotionally if this birth didn't go well, I kept thinking of this student. I outlined the situation to her, and she agreed, admitting that it could be a challenge, but that she was willing.
The couple really liked her presence, and were generous with their inclusion of her in their prenatal/birth experience. She is a quiet observer, but still waters run deep. I feel like she provided a sense of deep listening and compassionate grounding for this couple. There was something in having a commiseration about past birth experiences that I think made my clients feel secure with her. Not that my student talked about her stories in detail at all, but the general gist was something I knew the couple appreciated. When labour was getting stronger they asked when she would be there, so I was very pleased with the connection.
Sad to say, the birth, while everyone came out healthy and sound, was not even close to the experience I had hoped for either as a doula or a mentor. To make a very long story short, we all ended up witnessing (and our clients being the victim of) one of the worst abuses of medical authority I have ever seen. Of many of the things I specifically didn't want them to have to have to bear witness to, they did, in extreme and almost unbelievable ways.
As a doula, I felt devastated for this couple. As a mentor, I felt terrible. I wanted so much to have everything be good. I didn't feel as responsible for what happened to the couple, as things were entirely out of our control. We know as doulas that we can't wave our magic wands, turn back time, and make the staff be nice. We can only deal gracefully and help the couple stay focused on birth rather than anger in the moment. But I certainly do feel responsible for my student, as I took a risk in asking her along, knowing it might be hard on her emotionally. Well, this birth would have been hard on ANY student emotionally, especially if were your introduction to birth attending. But I had really really wanted it to be good for her in particular.
From what I can tell, my apprentice's presence added extra support to a difficult situation, which was great for the clients. And I think she's doing okay. I remain available to students who need to process their experiences. Sometimes it takes a while because they are all busy with their lives as I am with mine, or sometimes it just doesn't feel right yet, but at some point these things come up when they're ripe and ready, and we can go over them. Sometimes it takes a while to process things before we wish to talk them out. I did feel I had to very quickly address the violence that we were exposed to.
I know this is going to sound deeply weird, but I had a dream recently in which I was on this bright, clear rocky mountain, very high up. A man dressed in dark furs leather coverings of a culture I can't identify said to me, "This is for you," and handed me a reddish brown stone with black stripes through it. He talked to me about how the masculine principle in birth is really important, that the practice of modern medicine (the gender of the practitioner doesn't matter...the energy of diagnosing and applying strong interventions being "masculine"), has in many ways improved lives for families over time. It is as "inspired" as any other healing modality. But the problem is that this masculine principle often ends up being the last word, usurping more feminine, intuitive, experiential wisdom instead of supporting and working in cooperation with it. It has made things out of balance and now many are harmed. The unpredictability of birth doesn't lend well to the sensibilities of Medicine, and there are often a lot of attempts to control the process. In order to gain control because of this trepidation towards the unknown, coercion can be used to manipulate certain situations. I was told to remember that it wasn't out of cruelty as it would outwardly seem, but out of extreme fear and vulnerability. This dream wasn't spoken in so many words, but this was the "message" I received loud and clear.
I had to write it down quickly after it happened to make sure I got it all, as these kinds of dreams, for those of you who dream this way know, are precious and often feel like they resonate with an incontrovertible truth that is not to be forgotten.
I had the image of the stone placed in my hand really strongly, so as soon as I could, I looked for images of it on the Internet and found it was red tiger eye. When looking at the symbolism behind this stone, I found it is used to "protect against abuses of power". I told my husband about my dream, and bless him, he goes along with me. He found some red tiger eye and gave it to me.
I took one of my stones (Hi, my name is Lesley, and yes, I keep stones meaningful to me in my birth bag...wanna make something of it? ;p) and gave it to my apprentice the next time I saw her. I explained it was a kind of amulet to protect her from the abuses of power she may witness in birth. When we had a moment alone, I briefly explained my dream (risking being gaped at as if I were insane). I also feel (yeah, laugh away) that something in that stone, or perhaps more accurately in the energy created by the connection to it through the dreaming and the giving of it, could begin to create a subtle shift towards healing. Sometimes less words are better and a gesture from the heart says much more.
It IS a risk to the hearts of students to bring them to births that might be hard. In the end, it's probably better that this incident happened while I was there... because it certainly won't be the last time she sees something like that. She saw a senior doula NOT lose her shit and go postal on the staff member (as much as it might have felt good to do so in the moment). She learned how to calm herself and take measures for herself so SHE didn't lose her shit and go postal. She learned how to shift gears fast, help clients rechannel their strong feelings to focus on love for their baby, and how to recognize the healing in subtle acts of compassion by other staff members who were also hurt by the witnessing. She learned how one is NEVER truly helpless, and that when all else seems hopeless, we have our ability to energetically broadcast peace. When we can't make peace, we can be it. This act holds more power than you may think.
When we sign up to be doulas, we take on the role knowing we will, at some point, get hurt. Yet even upon the hurting, we come back and risk again. It is a risk to me (my credibility, perception of my sanity, etc.)to share dreams and beliefs of such a personal nature with others. Nobody likes being judged. But like our ladies who risk their hearts by opening to the unpredictability of birth, the VAST majority of the time, the reward is immeasurable, and the healing intention is accomplished by getting down dirty real.
My apprentice accepted her tiger's eye with a genuine smile. I'm still not sure why I felt so strongly about bringing her to this birth, and maybe I'll never know. Sometimes it's just a mystery and we have to trust it's all getting worked out somewhere. I get a strong sense she's going to be just fine, though. Not because of the stone, obviously, or my kooky dream (though I hope it it helps), but because she's a strong, resiliant woman. She seems eager to go to more births, and that's a great thing. She's going to be a fine doula. Love and honour, Sister.
Wednesday, February 8, 2012
Don't be a "Do-la"
One of my teachers on my path of studying body/mind integration therapies had this great saying: "The more you do, the more you doo doo." Translation: the more you mess around with techniques "just because" instead of listening to the recipient of the work, making gentle suggestions with your hands, voice, tools, or energetic intention (IF warranted), the more you interfere with the body's impetus to self-healing. Obviously, there are times when big guns need to be called upon in our work as doulas, like hip presses and frequent positional changes, bodywork or remedies, even sometimes a little tough love. But as the intense birth energy works through the mother to open her up and bring forth her child, our job is ultimately to support, not meddle in what is normally an already pretty perfect process.
Many doulas these days introduce themselves to me or others with their catalogue of credentials, CEUs, certifications, and qualifications. The "with whoms" and "how many hours" and "advanced studies" all seem very important, and are listed in CV style on personal websites. Now there is NOTHING wrong with constant learning. I do it myself. But at some point, clients really don't care what you studied. Their eyes will glaze over after you've listed the third workshop or so. They are not concerned with a piece of paper (at least the hundreds of couples I've worked with aren't...rarely have I been even asked about my certifications, CEUs, advanced training, or association memberships). They want you to make them feel safe and can usually tell by meeting you if you "click" with them or not. Their feelings towards you will usually matter more than your impressive CV.
Many apprentices I work with and very new doulas I know, still years away from getting to tons of the great educational opportunities out there, are able to exude an energy of safety and calm that is palpable in the birthing room. Many a time I have seen doctors and nurses walk in and literally say, "It FEELS really good in here. I'm just going to sit down for a while." And they do, vibing out with the doulas for a spell. While the tools we learn from more experienced birth practitioners ARE immensely valuable, these are not necessarily the keys to becoming better doulas. More knowledgeable, and more skilled, yes. But not necessarily better. For you doulas out there who maybe see all of these opportunities online to attend amazing workshops and conferences but are unable to attend due to having young children or a lack of financial wherewithal, please don't despair. Being a doula is about a life time of learning. Until you are able to enrich your hands on skills through continuing education, if you are able to doula with presence,awareness, and most of all love, this is absolutely good enough. As far as I'm concerned, this is a grassroots, ancient, woman to woman role (not a "profession")which, if you are called from a deep place within to do, you will know very intuitively how to do it without a lot of bells and whistles. Women have been providing this support for each other from the beginning of time, so I figure the ancestral memories of how to do it are easily activated for those who feel that inexorable pull.
Often times, the more tools one has at one's disposal, the more one is apt to want to bust them out willy nilly if one's powers of discernment are still developing. I hear great explanations of the chosen tools/methods that are being applied to any given scenario, because it is exciting to speak of what we've learned...but perhaps not while the mom is busy trying to work her baby down and couldn't possibly be paying much attention.
My rule of thumb as a doula is to take the birthing mom's lead. It is easy to read someone's needs during labour. For example, some are chatty, and feel more grounded when you respond with a matched energy. You can see the labour progress and watch her fade away eventually into labour land. It is fun to have a conversation, then a conversation where concentration to keep talking through the contractions is necessary, then having the conversation between contractions, then having the train of thought forgotten entirely as the mother shifts into dream time. This is not talking randomly, it is actively using words appropriately as a method of relaxation. In fact, this woman left in what we think should be silence might actually feel more frightened or abandoned. Other women, however, would be in labour for days if you kept talking, so they would require near silence and perhaps a lot of touch communication. Some want you outside the room keeping unwanted visitors out of the space (cue lock and load sound), their need for your presence as great, just more with a focus on you containing their experience instead of mingling with it. Understanding how and when to apply the tools you have is far more important than having a ton of tools and not having appropriate discernment.
When a student or another doula I may be working with comes in with a massive amount of tools in her doula bag, claps her hands together and says, "Okay, let's get this baby out!" identifying where the squatting bars and birth balls are (before even really tuning in), I groan inwardly. It is an almost clinical approach, and I know we'll be in for a long haul much of the time. If, in being so excited about all the stuff you know that you start engaging the labouring mother's intellect and lecturing about why the double hip squeeze you're doing works, or say more than a sentence about why you're tucking a rebozo under her tummy and shaking her around, you may be impeding the labour process for that particular woman. Honestly, the mother doesn't give a whit about why if things are really active, she just wants sweet relief and is open to ideas you think may help her if she feels scared or flagging. That's what she hired you for, not to give her a crash course on labour support tools.
A doula should never be dependent upon her doula bag of tricks to help her during a birth. There are times you'll have to dash from somewhere that's not home without your stuff, and it shouldn't worry you at all. Your most important tools are your hands, your voice, your insight, your communication skills, and ultimately, your heart. The rest is just icing on the cake.
While accumulating a lot of knowledge and tools is a great and worthy endeavour , as you never know what could potentially help a birth that is experiencing a situation where a piece of knowledge or obscure skill could become invaluable, that list of creds isn't what makes the doula. It isn't what you DO a lot of the time, it is who you are. What you are DO-ing may be the simplest thing ever on a physical level, such as holding a hand or wiping away post vomit tears. But the energy you exude and the quality of space you hold is paramount. If you are distracted, inappropriately chatty, digging around for this and that in your bag "just because", flipping though your doula manuals to review procedures, shifting around and bustling, you are probably doing too much. If you sit, stand, or hold with awareness, with presence, "listening" to the environment and working with the feel (energy) of the room actively but quietly, this may some of your most effective doula-ing. And this will be confirmed to you. I recently had a lady having her third baby. She had had epidurals for her first two and wanted to have a natural birth this time. I sat in a chair by her bed. Yup, that's what I did. The whole labour. That is what felt right. I sat and beheld, quietly synching my breathing with hers, relaxing my shoulders when I saw her raising hers, loosening my jaw when I saw hers clench. She told me afterwards she couldn't have done it without me, and I reassured her that I did absolutely nothing, that she did all the work and was blessed to have had a nearly pain free birth. She said, "But you weren't just sitting there. I could feel waves of absolute calm and trust coming from you. I felt your connection to me unwavering, and it made me unafraid." Remember, labouring ladies are deeply attuned. A touch that has no heart in it will often be noticed and not appreciated. Zoning out because "there's nothing to do" makes some feel abandoned. Keep checking in.
In the doula training I provide, we certainly go over a whole bunch of nifty tools gleaned from almost two decades on the job, but those are only stepping stones. I prefer to focus on the quality of presence a doula holds for her clients. How do you listen? How do you tune in? How do you hold the space? How do you channel calm into a stressful environment? What may you need to work on within yourself to have more access to insight and intuition? What can you broadcast energetically to bring a positive change to a situation? This is doula-ing in the deepest sense of the word "holistic".
There is a BEAUTIFUL scene in the British series "Call the Midwife" which illustrates the essence of what I'm talking about. A clumsy new midwife named "Chummy" who has barely passed her qualifying exams experiences her first professional clinic day. An obstetrician has been called to this clinic (run by nuns) in London's East End (circa 1950's) to assess a case of a woman whose pelvis has been deformed by rickets. She has lost four previous babies at term due to severely obstructed labours. Now with the National Health Services, she gets the opportunity to have a Cesarean this time, and the only shot at having a live baby. The doctor is explaining the woman's rickety pelvis to Chummy, going over all this technical stuff, looking at his x-rays, not tuned in at all to the fact that this mother is looking terrified and grieving. He is very excited about the opportunity this poverty stricken woman gets to birth by Cesarean at a hospital and is kind of carried away with the details. He's a lovely man, he is just doing his clinical job and is not at the moment "tuned in". Chummy very clearly is, and has her eyes on the lady the entire time. You can just feel the solid, grounded compassion she starts exuding as she keeps eye contact. The mother bursts into tears over her lost babies, apologizing for her emotional state. The doctor looks uncomfortable and sheepish about the tears. Chummy takes her hand and gets close, and weaves a web of calm and safety around her, honouring her experience and her emotions. She explains how wonderfully safe this mother is in this excellent doctor's hands, that this is a new baby and new experience, and that everything is going to be okay. For all her lumbering ways and technical shortcomings, there is authority in her emotional presence. The doctor takes her aside and tells her that she is a WONDERFUL nurse midwife, because she has provided one of the most valuable things to her patient, which is a sense of safety and trust.
In my humble opinion, THAT type of doula skill is the most important to develop...excellent touch, verbal, and energetic communication and environment monitoring. And you don't even have to write it on your CV!
Doctors, nurses, and midwives are often reminding themselves to "sit on their hands" to allow the birth process to unfold optimally without unnecessary intervention. Doulas must be careful of this too. Remember, we are not "Do-las", which entails bustling around all efficiently, spouting our street creds, getting the job done with an agenda, and owning "successes", but "Doulas", who inform, nurture, honour,and support in the unique way each situation calls for...with presence, insight, grace, and love.
Many doulas these days introduce themselves to me or others with their catalogue of credentials, CEUs, certifications, and qualifications. The "with whoms" and "how many hours" and "advanced studies" all seem very important, and are listed in CV style on personal websites. Now there is NOTHING wrong with constant learning. I do it myself. But at some point, clients really don't care what you studied. Their eyes will glaze over after you've listed the third workshop or so. They are not concerned with a piece of paper (at least the hundreds of couples I've worked with aren't...rarely have I been even asked about my certifications, CEUs, advanced training, or association memberships). They want you to make them feel safe and can usually tell by meeting you if you "click" with them or not. Their feelings towards you will usually matter more than your impressive CV.
Many apprentices I work with and very new doulas I know, still years away from getting to tons of the great educational opportunities out there, are able to exude an energy of safety and calm that is palpable in the birthing room. Many a time I have seen doctors and nurses walk in and literally say, "It FEELS really good in here. I'm just going to sit down for a while." And they do, vibing out with the doulas for a spell. While the tools we learn from more experienced birth practitioners ARE immensely valuable, these are not necessarily the keys to becoming better doulas. More knowledgeable, and more skilled, yes. But not necessarily better. For you doulas out there who maybe see all of these opportunities online to attend amazing workshops and conferences but are unable to attend due to having young children or a lack of financial wherewithal, please don't despair. Being a doula is about a life time of learning. Until you are able to enrich your hands on skills through continuing education, if you are able to doula with presence,awareness, and most of all love, this is absolutely good enough. As far as I'm concerned, this is a grassroots, ancient, woman to woman role (not a "profession")which, if you are called from a deep place within to do, you will know very intuitively how to do it without a lot of bells and whistles. Women have been providing this support for each other from the beginning of time, so I figure the ancestral memories of how to do it are easily activated for those who feel that inexorable pull.
Often times, the more tools one has at one's disposal, the more one is apt to want to bust them out willy nilly if one's powers of discernment are still developing. I hear great explanations of the chosen tools/methods that are being applied to any given scenario, because it is exciting to speak of what we've learned...but perhaps not while the mom is busy trying to work her baby down and couldn't possibly be paying much attention.
My rule of thumb as a doula is to take the birthing mom's lead. It is easy to read someone's needs during labour. For example, some are chatty, and feel more grounded when you respond with a matched energy. You can see the labour progress and watch her fade away eventually into labour land. It is fun to have a conversation, then a conversation where concentration to keep talking through the contractions is necessary, then having the conversation between contractions, then having the train of thought forgotten entirely as the mother shifts into dream time. This is not talking randomly, it is actively using words appropriately as a method of relaxation. In fact, this woman left in what we think should be silence might actually feel more frightened or abandoned. Other women, however, would be in labour for days if you kept talking, so they would require near silence and perhaps a lot of touch communication. Some want you outside the room keeping unwanted visitors out of the space (cue lock and load sound), their need for your presence as great, just more with a focus on you containing their experience instead of mingling with it. Understanding how and when to apply the tools you have is far more important than having a ton of tools and not having appropriate discernment.
When a student or another doula I may be working with comes in with a massive amount of tools in her doula bag, claps her hands together and says, "Okay, let's get this baby out!" identifying where the squatting bars and birth balls are (before even really tuning in), I groan inwardly. It is an almost clinical approach, and I know we'll be in for a long haul much of the time. If, in being so excited about all the stuff you know that you start engaging the labouring mother's intellect and lecturing about why the double hip squeeze you're doing works, or say more than a sentence about why you're tucking a rebozo under her tummy and shaking her around, you may be impeding the labour process for that particular woman. Honestly, the mother doesn't give a whit about why if things are really active, she just wants sweet relief and is open to ideas you think may help her if she feels scared or flagging. That's what she hired you for, not to give her a crash course on labour support tools.
A doula should never be dependent upon her doula bag of tricks to help her during a birth. There are times you'll have to dash from somewhere that's not home without your stuff, and it shouldn't worry you at all. Your most important tools are your hands, your voice, your insight, your communication skills, and ultimately, your heart. The rest is just icing on the cake.
While accumulating a lot of knowledge and tools is a great and worthy endeavour , as you never know what could potentially help a birth that is experiencing a situation where a piece of knowledge or obscure skill could become invaluable, that list of creds isn't what makes the doula. It isn't what you DO a lot of the time, it is who you are. What you are DO-ing may be the simplest thing ever on a physical level, such as holding a hand or wiping away post vomit tears. But the energy you exude and the quality of space you hold is paramount. If you are distracted, inappropriately chatty, digging around for this and that in your bag "just because", flipping though your doula manuals to review procedures, shifting around and bustling, you are probably doing too much. If you sit, stand, or hold with awareness, with presence, "listening" to the environment and working with the feel (energy) of the room actively but quietly, this may some of your most effective doula-ing. And this will be confirmed to you. I recently had a lady having her third baby. She had had epidurals for her first two and wanted to have a natural birth this time. I sat in a chair by her bed. Yup, that's what I did. The whole labour. That is what felt right. I sat and beheld, quietly synching my breathing with hers, relaxing my shoulders when I saw her raising hers, loosening my jaw when I saw hers clench. She told me afterwards she couldn't have done it without me, and I reassured her that I did absolutely nothing, that she did all the work and was blessed to have had a nearly pain free birth. She said, "But you weren't just sitting there. I could feel waves of absolute calm and trust coming from you. I felt your connection to me unwavering, and it made me unafraid." Remember, labouring ladies are deeply attuned. A touch that has no heart in it will often be noticed and not appreciated. Zoning out because "there's nothing to do" makes some feel abandoned. Keep checking in.
In the doula training I provide, we certainly go over a whole bunch of nifty tools gleaned from almost two decades on the job, but those are only stepping stones. I prefer to focus on the quality of presence a doula holds for her clients. How do you listen? How do you tune in? How do you hold the space? How do you channel calm into a stressful environment? What may you need to work on within yourself to have more access to insight and intuition? What can you broadcast energetically to bring a positive change to a situation? This is doula-ing in the deepest sense of the word "holistic".
There is a BEAUTIFUL scene in the British series "Call the Midwife" which illustrates the essence of what I'm talking about. A clumsy new midwife named "Chummy" who has barely passed her qualifying exams experiences her first professional clinic day. An obstetrician has been called to this clinic (run by nuns) in London's East End (circa 1950's) to assess a case of a woman whose pelvis has been deformed by rickets. She has lost four previous babies at term due to severely obstructed labours. Now with the National Health Services, she gets the opportunity to have a Cesarean this time, and the only shot at having a live baby. The doctor is explaining the woman's rickety pelvis to Chummy, going over all this technical stuff, looking at his x-rays, not tuned in at all to the fact that this mother is looking terrified and grieving. He is very excited about the opportunity this poverty stricken woman gets to birth by Cesarean at a hospital and is kind of carried away with the details. He's a lovely man, he is just doing his clinical job and is not at the moment "tuned in". Chummy very clearly is, and has her eyes on the lady the entire time. You can just feel the solid, grounded compassion she starts exuding as she keeps eye contact. The mother bursts into tears over her lost babies, apologizing for her emotional state. The doctor looks uncomfortable and sheepish about the tears. Chummy takes her hand and gets close, and weaves a web of calm and safety around her, honouring her experience and her emotions. She explains how wonderfully safe this mother is in this excellent doctor's hands, that this is a new baby and new experience, and that everything is going to be okay. For all her lumbering ways and technical shortcomings, there is authority in her emotional presence. The doctor takes her aside and tells her that she is a WONDERFUL nurse midwife, because she has provided one of the most valuable things to her patient, which is a sense of safety and trust.
In my humble opinion, THAT type of doula skill is the most important to develop...excellent touch, verbal, and energetic communication and environment monitoring. And you don't even have to write it on your CV!
Doctors, nurses, and midwives are often reminding themselves to "sit on their hands" to allow the birth process to unfold optimally without unnecessary intervention. Doulas must be careful of this too. Remember, we are not "Do-las", which entails bustling around all efficiently, spouting our street creds, getting the job done with an agenda, and owning "successes", but "Doulas", who inform, nurture, honour,and support in the unique way each situation calls for...with presence, insight, grace, and love.
Friday, January 6, 2012
The Nourishing Perk
One of the sweetest things about being a doula is seeing how much love is generated by the birth of a new baby. It doesn't have to be the all natural picture perfect birth either. It is the parents' connection with the baby, the connection of family and caregivers which creates a powerful vortex of love. As the new wee one lies naked upon his naked mother, quietly taking in the world from his safe harbour, a magical hush settles.
As doulas, we are often included within this inner sanctum of crazy, mushy love. I recently had the joy of spending about eight hours in a tiny little curtained cubicle of a post Cesarean recovery area with a beatific mother and father, their precious baby, and my apprentice who was witnessing it all for the first time. What was so joyful was seeing this new family love grow bigger bigger every moment, seeing them process these feelings, and seeing how with this love came such responsibility and an eagerness to meet it. Whomever kindly holds that space and supports it with any nurturing energy at all tends to get love bombed, as we most surely did. What a blessing!
It is very important for doulas to remember that this love being given so freely to you is not really because of anything you've done. You've done the human thing, which is to be caring and supportive, comforting and emotionally nurturing. You've done your job, and are probably, in fact, being paid for your service. I am often heaped with praise, told the experience couldn't have been done without my presence, and am called "Auntie" in relation to the baby. I know this isn't because I've done anything particularly special. It is because hormones are high and I've helped to facilitate their flow, encouraging the emotions associated with them to flourish. It's not like I've stepped off the street and done a saintly act. I've just done my job to the best of my ability, and done it with great honour.
It is crucial to not let this pure, precious new-parent love inflate our egos. Smile graciously at the praise, and allow that love that's projected onto you into your heart, nourishing your soul. See it as Transpersonal love rather than feeling you are truly an object of it. If you do, you can become too attached, as who doesn't crave in their core to be loved and praised in such an unadulterated way? But be mindful. Take that love so generously and tenderly given, and use it properly: use it to continue stoking the fires of good birth experiences, no matter how they unfold, passing it on to the families you serve. Hold every birthing space drawing upon this love, paying it forward, the love being coloured by the beautiful energy that already exists in your own heart to make your care unique.
Enjoy this nourishing perk of the doula experience. This very high energy exchange is incredibly healthy IF you can see it for what it is and flow with it, work with it, and ground it. Don't just hold it all in and keep it for yourself. It is not that kind of gift.
As doulas, we are often included within this inner sanctum of crazy, mushy love. I recently had the joy of spending about eight hours in a tiny little curtained cubicle of a post Cesarean recovery area with a beatific mother and father, their precious baby, and my apprentice who was witnessing it all for the first time. What was so joyful was seeing this new family love grow bigger bigger every moment, seeing them process these feelings, and seeing how with this love came such responsibility and an eagerness to meet it. Whomever kindly holds that space and supports it with any nurturing energy at all tends to get love bombed, as we most surely did. What a blessing!
It is very important for doulas to remember that this love being given so freely to you is not really because of anything you've done. You've done the human thing, which is to be caring and supportive, comforting and emotionally nurturing. You've done your job, and are probably, in fact, being paid for your service. I am often heaped with praise, told the experience couldn't have been done without my presence, and am called "Auntie" in relation to the baby. I know this isn't because I've done anything particularly special. It is because hormones are high and I've helped to facilitate their flow, encouraging the emotions associated with them to flourish. It's not like I've stepped off the street and done a saintly act. I've just done my job to the best of my ability, and done it with great honour.
It is crucial to not let this pure, precious new-parent love inflate our egos. Smile graciously at the praise, and allow that love that's projected onto you into your heart, nourishing your soul. See it as Transpersonal love rather than feeling you are truly an object of it. If you do, you can become too attached, as who doesn't crave in their core to be loved and praised in such an unadulterated way? But be mindful. Take that love so generously and tenderly given, and use it properly: use it to continue stoking the fires of good birth experiences, no matter how they unfold, passing it on to the families you serve. Hold every birthing space drawing upon this love, paying it forward, the love being coloured by the beautiful energy that already exists in your own heart to make your care unique.
Enjoy this nourishing perk of the doula experience. This very high energy exchange is incredibly healthy IF you can see it for what it is and flow with it, work with it, and ground it. Don't just hold it all in and keep it for yourself. It is not that kind of gift.
Saturday, December 31, 2011
2011 Births: A Doula's Year in Review
I seriously doubt a new baby will eke its way into the world out of one of my clients within the next few hours (though anything is possible), so I thought I'd look through my birth notes of this year to see what's cooking in terms of the efficacy of the work of doulas.
This year I attended quite a few births less than I do on average. The grand total was 37 births. My goal was to cut it down to 30, but it's SO hard for me to say "no" to my repeat clients. I took off most of April, all of July, half of October, and only took on one birth for December. So given I was actually off call for a good 10 weeks to teach or go on vacation, it still was a decent amount of births.
I had a higher than usual amount of "out of hospital" births with midwives (six). Out of the nine planned, two transferred to the hospital in late labour for medical intervention (one a first time mom, and one a second, both for vacuum extraction after prolonged second stage), and one was risked out of her desired midwife attended birth and medically induced because of pre-eclampsia (all gave birth without epidural).
Four of my clients gave birth by Cesarean. One was planned due to a breech baby and large uterine fibroids. One was an emergency with the baby during second stage (all worked out fine in the end). One was a mom who had wanted a VBAC, but developed an infection just prior to labour, and another was a long Cervidil/Synto induction for post dates which ended up simply not progressing after a very long and heroic attempt. All moms and babies are doing just great.
Nine of my total number of 37 clients received epidurals, for all reasons ranging from personal preference (yes, doulas DO take clients who know from the get go they WILL take an epidural no matter what...we are all for informed choice) to very long, difficult labours in which the choice to take an epidural greatly helped the mom's experience.
11 of the ladies who did not receive epidurals were first time birthers, and three out of these were medically induced (one with Cervidil, which produced a baby super fast, and 2 with Synto). One induced with castor oil at 2 weeks post dates. (Nine of these un-epiduraled births took place in a hospital setting ).
13 of the ladies who birthed without epidural were having second or third babies. One was induced simply by having her waters broken.
Out of the ladies who did receive an epidural, (one first time and one second time birther), two were long, exhausting inductions.
Two of the 37 births were VBACs (which is a low amount for my usual total). A third was an attempted VBAC, but the mom birthed by Cesarean again.
So in terms of percentages:
Cesareans: 10.8% This is less than half of our provincial average.
Epidurals: 24% In Montreal, overall epidural use is about 80% (this is not including my mothers who had Cesareans...they only took epidurals very close to their surgeries.
Because "natural" birth can mean many things, to clarify, because I work with a mainly hospital birth population, I call a "natural" birth one in which there was no epidural or Cesarean. This can include induction, episiotomy, vacuum extraction, whatever. Yes, I know, purists would take great issue with this, but if a woman is able to go into a hospital and have an induction and perhaps vaccuum extraction and can pull this off without an epidural, darn right we'll let her claim natural birth. What are you gonna say to a lady who has a 48 hour labour and ends up with a vacuum extraction as her only intervention? Sorry, Dude, no natural birth for you? Nope. Everything is relative. I hesitate to use the term "normal" birth for all these births, though, as most births I see in hospital settings are not normal by virtue of the hoops women are asked to jump through even when they might not want to, hoops that can be antithetical to the physiological process of birth (lying on back, being tethered to an external fetal monitor, being engaged intellectually during contractions, directed during pushing, her environment outside of her control, etc.) But this does not mean women don't have GREAT births in the hospital much of the time and are very happy with their experience, even if they were not "normal" or "natural". So, yeah, I say natural when there's no epidural. Period.
And the rate of moms having a natural birth:
64.9%
The most hands off birth I saw this year, meaning the baby was literally only caught once in mid-air because she insisted upon not being touched, the room was nearly silent, the mom was left to pick up her own baby instead of her thrown into her arms (the mom was on her hands and knees and the baby was scootched between her legs up to where mom could look at and take her when she was ready), the cord was left for a good 15 minutes, no perineal checks, "massage" of the uterus, or management (besides quiet, respectful vigilance)until after the placenta was born, and no routine Synto, was not where you would expect. This birth took place in a hospital with a nurse and an obstetrician who were both SO happy to serve the woman in this way. I wanted to weep with the hope of possibility.
My stats also consistently illustrate that epidurals don't necessarily always go hand in hand with inductions, depending on the type of induction.
While many of my clients came to me wanting a natural birth, many of those who were not sure what they would choose in the moment DID end up having a natural birth. And several who KNEW they wanted a natural birth, did NOT have one for varying reasons.
The shortest labours this year were about 1.5 hours from the time contractions were noticeable. (one was a first time mom)
The longest was about 50 hours (first time mom), about 36 of those hours having contractions strong enough to make her vocalize.
The biggest baby was 10.5 pounds, born at the Maison de Naissance to a first time mom in about four or five hours of labour with a WONDERFUL, skilled midwife who knew to keep the oxytocin flowing by keeping Mom calm and focused when the shoulders proved to be quite jammed. She never screamed (PUSH, THIS IS SERIOUS!), because fear and arenaline tend to have the opposite effect on what needs to be done by the mom. It was a brilliant and enlightened approach.
Thank you, all my wonderful clients and babies, for allowing me the honour of attending your births! You are all rock stars of the highest degree. And thanks to all the caregivers who did great jobs in keeping the birthings safe and the environment pleasant. Blessings to all for a wonderful New Year!
This year I attended quite a few births less than I do on average. The grand total was 37 births. My goal was to cut it down to 30, but it's SO hard for me to say "no" to my repeat clients. I took off most of April, all of July, half of October, and only took on one birth for December. So given I was actually off call for a good 10 weeks to teach or go on vacation, it still was a decent amount of births.
I had a higher than usual amount of "out of hospital" births with midwives (six). Out of the nine planned, two transferred to the hospital in late labour for medical intervention (one a first time mom, and one a second, both for vacuum extraction after prolonged second stage), and one was risked out of her desired midwife attended birth and medically induced because of pre-eclampsia (all gave birth without epidural).
Four of my clients gave birth by Cesarean. One was planned due to a breech baby and large uterine fibroids. One was an emergency with the baby during second stage (all worked out fine in the end). One was a mom who had wanted a VBAC, but developed an infection just prior to labour, and another was a long Cervidil/Synto induction for post dates which ended up simply not progressing after a very long and heroic attempt. All moms and babies are doing just great.
Nine of my total number of 37 clients received epidurals, for all reasons ranging from personal preference (yes, doulas DO take clients who know from the get go they WILL take an epidural no matter what...we are all for informed choice) to very long, difficult labours in which the choice to take an epidural greatly helped the mom's experience.
11 of the ladies who did not receive epidurals were first time birthers, and three out of these were medically induced (one with Cervidil, which produced a baby super fast, and 2 with Synto). One induced with castor oil at 2 weeks post dates. (Nine of these un-epiduraled births took place in a hospital setting ).
13 of the ladies who birthed without epidural were having second or third babies. One was induced simply by having her waters broken.
Out of the ladies who did receive an epidural, (one first time and one second time birther), two were long, exhausting inductions.
Two of the 37 births were VBACs (which is a low amount for my usual total). A third was an attempted VBAC, but the mom birthed by Cesarean again.
So in terms of percentages:
Cesareans: 10.8% This is less than half of our provincial average.
Epidurals: 24% In Montreal, overall epidural use is about 80% (this is not including my mothers who had Cesareans...they only took epidurals very close to their surgeries.
Because "natural" birth can mean many things, to clarify, because I work with a mainly hospital birth population, I call a "natural" birth one in which there was no epidural or Cesarean. This can include induction, episiotomy, vacuum extraction, whatever. Yes, I know, purists would take great issue with this, but if a woman is able to go into a hospital and have an induction and perhaps vaccuum extraction and can pull this off without an epidural, darn right we'll let her claim natural birth. What are you gonna say to a lady who has a 48 hour labour and ends up with a vacuum extraction as her only intervention? Sorry, Dude, no natural birth for you? Nope. Everything is relative. I hesitate to use the term "normal" birth for all these births, though, as most births I see in hospital settings are not normal by virtue of the hoops women are asked to jump through even when they might not want to, hoops that can be antithetical to the physiological process of birth (lying on back, being tethered to an external fetal monitor, being engaged intellectually during contractions, directed during pushing, her environment outside of her control, etc.) But this does not mean women don't have GREAT births in the hospital much of the time and are very happy with their experience, even if they were not "normal" or "natural". So, yeah, I say natural when there's no epidural. Period.
And the rate of moms having a natural birth:
64.9%
The most hands off birth I saw this year, meaning the baby was literally only caught once in mid-air because she insisted upon not being touched, the room was nearly silent, the mom was left to pick up her own baby instead of her thrown into her arms (the mom was on her hands and knees and the baby was scootched between her legs up to where mom could look at and take her when she was ready), the cord was left for a good 15 minutes, no perineal checks, "massage" of the uterus, or management (besides quiet, respectful vigilance)until after the placenta was born, and no routine Synto, was not where you would expect. This birth took place in a hospital with a nurse and an obstetrician who were both SO happy to serve the woman in this way. I wanted to weep with the hope of possibility.
My stats also consistently illustrate that epidurals don't necessarily always go hand in hand with inductions, depending on the type of induction.
While many of my clients came to me wanting a natural birth, many of those who were not sure what they would choose in the moment DID end up having a natural birth. And several who KNEW they wanted a natural birth, did NOT have one for varying reasons.
The shortest labours this year were about 1.5 hours from the time contractions were noticeable. (one was a first time mom)
The longest was about 50 hours (first time mom), about 36 of those hours having contractions strong enough to make her vocalize.
The biggest baby was 10.5 pounds, born at the Maison de Naissance to a first time mom in about four or five hours of labour with a WONDERFUL, skilled midwife who knew to keep the oxytocin flowing by keeping Mom calm and focused when the shoulders proved to be quite jammed. She never screamed (PUSH, THIS IS SERIOUS!), because fear and arenaline tend to have the opposite effect on what needs to be done by the mom. It was a brilliant and enlightened approach.
Thank you, all my wonderful clients and babies, for allowing me the honour of attending your births! You are all rock stars of the highest degree. And thanks to all the caregivers who did great jobs in keeping the birthings safe and the environment pleasant. Blessings to all for a wonderful New Year!
Tuesday, December 13, 2011
Between Fear and Dreams: Birth Wants her Soul Back
I was recently sent a beautiful video of how nurses process their own grief when they've supported families through perinatal loss. The quality of a medical caregiver's presence can be pivotal in helping families who are dealing with grief, and my hats off to those who, with exquisite sensitivity and compassion, make a seemingly impossible path just a little smoother and more light filled. While for the most part the video was a guide to how nurses can move through their own emotions surrounding difficult experiences, it brought up important observations for me. They came up when one of the nurses was discussing her own personal experience of pregnancy from the perspective of one who sees stillbirth and tragedy on a pretty regular basis. She describes being a student in her childbirth education class, and how couples would discuss things they wanted for their birth experience. This nurse admits, "I don't care about episiotomies or anything. I just want to be alive, and my baby to be alive."
My heart just broke for this nurse. I witnessed someone so steeped in the experience of being a relatively frequent witness to tragedy that she dared not invest her heart in any desires towards her own birth process. It was almost as if wanting more than simple life was an audacity. I have seen this with clients who have experienced previous perinatal loss and are expecting a subsequent baby. Where once they were innocent, concerned with cloth vs disposable diapers or about the risks of epidural, or prefering to refuse a routine IV during labour, their innocence is shattered by grief and the fact that life can seem cruel. Once bitten, twice shy.
Herein lies a very important issue at the heart of some of the problems we face as consumers of medical maternity care: our doctors and nurses, given the high volume of births they see ranging from the mundane to the highest risk possible, fairly frequently witness death as a result of pregnancy and birth. It's clearly not something they can avoid, as this is the occupation they signed up for. Remember, this exposure doesn't mean there IS generally a lot of death as a result of birth if you look at overall outcomes. The exposure comes comes from witnessing high volumes...hundreds of births per year, many of them, depending upon the hospital centre, extremely high risk. As they say in the labour and delivery wards, most of the births are regular to the point of boring. It's the small percentage of drama that keeps everyone on high alert. It is all part of the job of being one who assists women on this journey to motherhood. But if the experiences of trauma and loss go improperly processed, there are aspects of this frequent exposure to heartache that have can have a negative impact upon us as birthing women.
To see death in the labour and delivery ward is not the same as being in geriatrics or ICU, as many patients in those wards are expected to pass because they are old and/or sick. But when a couple is expecting a happy start to family life and that dream is tragically extinguished, not only do caregivers mourn the death of a sweet, innocent baby, but bear the burden of parents' acute shock and grief. To witness a mother holding her lifeless baby, those months of hopes and dreams just gone, or to see a father simply shut down, his shock rendering him broken spirited, is emotional suffering I cannot even describe to you if you haven't seen it yourself.
We are blessed in developed nations to have access to these caregivers who can save us and our babies when emergencies occur, we truly are. More tragedies than we could imagine are prevented with this incredibly skilled care. But sometimes Nature overrules and no matter what is done, no matter how many years of studying someone has undergone in surgery and pathology, no matter how much experience they have, no matter how careful they were, no matter how safe the situation might have appeared minutes before all hell broke loose, someone dies. Sometimes it can't even be identified why. And in our culture, this is perceived unacceptable.
In order to truly understand where medical caregivers are coming from, and to glean an essential insight into one of the reasons why our birth culture may appear as wounded as it is, it's important to look at a few thing. Take the personal grief the caregivers most likely feel in reaction to their experiences of tragedy into account (nobody goes looking for that feeling, and in fact tries to avoid it all cost). Mix it up with the weight of responsibility doctors and nurses carry for us (we go to THEM for care, expecting THEY will keep US safe). Now throw in the fact that in the midst of overwhelming grief, sometime parents might feel they need someone to blame (which will usually be the caregiver who, being the responsible expert we entrusted our lives to, "should" have been able to do SOMETHING, or something different from what was done, to avoid the devastation they are now suffering). This cocktail of pressure can potentially create a powerful fear of future emergencies, disasters waiting to happen, and ultimately, the unpredictable mysterious nature of uncontrolled, unfettered physiological birth...which, on occasion, leads to grief. And it is this fear which surrounds and permeates the hallways of the hospitals these medical professionals practice in, as well as the rooms in which many of us attempt to birth normally.
In some schools of psychological theory, it's believed that when we experience a trauma, there is a disassociation of a portion of our presence from the experience. It is a protective function of our minds, serving to spare the psyche from unmanageable pain during a time attention is needed for survival. But at some point, that trauma and the emotions involved (that were neatly tucked away to help us function in the world) need to be revisited and processed in order for us to heal and move on, to re-associate essentially. Shamans of old believed that a piece of one's soul actually fractured away during trauma, and got left behind in that traumatic experience, existing in a different dimension indefinitely, longing to come home. One of the ways they would seek to heal their tribes people would be to conduct a ritual of soul retrieval. The shaman would go into a state of trance, and supposedly travel in different worlds of non ordinary reality to seek those pieces of soul, bring them back to his patient, helping to reintegrate the lost piece so it felt welcome. The patient would experience a cathartic release of the emotional energy caught up in the lost piece, and then they would live a more whole and balanced life with that blessed reclamation, being able to maintain a normal instead of wounded perspective of the world.
If a person does not eventually process the disassociation that served at the time of the trauma, a person can be easily triggered into post traumatic-like reactions in situations that resemble the original trauma. Even the thought of a repeat of the traumatic occurrence can trigger rushes of adrenaline and fear. This is a very painful way to live, as access to many of one's internal resources are limited.
All this is to say, I believe our birth culture functions around massive chunks of missing soul pieces, if you will. I make no personal accusations here, as many of the caregivers I know and love are very well integrated and can weather the occasional loss of life inevitable in childbearing without becoming traumatized. But I believe collectively, Medicine just may be learning, working, treating, and intervening from a place of post traumatic stress. And no wonder! Imagine this (and I am not making up this scenario): you're a nurse, and you've just helped with the delivery of a stillborn baby who died right at that 41 week and three day line, the non-stress test you set her up for and ultrasound having seemed perfect the day before. You're still wiping tears away after having wrapped up the little body for the parents to hold, inside wondering if you could have had any power to change this outcome if you had just a little more forcefully encouraged the mom to induce a few days earlier when you put her on the monitor. Part of you is worrying about how the parents might react if they somehow wonder the same thing, and this will haunt you for a long time. Then suddenly there are premature twins down the hall who need delivering fast to a pre-eclamptic mom and all hands are needed on deck! On the way to that family in crisis, you run into a patient you know from care you've given her prenatally in the hospital, who is just admitted in labour. She is wanting to birth naturally and has this list of mundane f$#*&#g requests she's flapping in your face, requests you've heard a million times from a million people! You are holding so much in your heart and mind right now and this woman wants things that you might, with the perspective you've gained from your job, have discovered are luxuries and trivialities apart from a living baby.
I stop here to take a deep, long, breath of understanding, of compassion, and of true honour for all you are capable of and willing to do to keep us and our babies alive. I invite everyone here to do the same..take a second to breathe and put yourself in that place. Empathy is crucial to truly understanding, gratitude amplifies our loving energy far more than angry blame, and this opens our hearts to the beginnings of healing. Let us start by seeing the big picture behind what we perceive as the fear based medical practice that we feel puts our birth experiences at risk.
The average person who is effectively attempting to retrieve missing soul pieces can usually get away from their triggers to gain perspective. The woman who is constantly traumatized by an abusive partner can generally begin to heal when he is out of the picture. It takes a lot of psychological work for her to come to a place where she doesn't perhaps perceive all other men as threats or go into shock when she sees someone wearing something he used to wear, but with support it can be done. A recovering addict must remove himself from people, places, and things for a while that he associated with using his drug of choice in order to heal. While still raw and processing his emotional pain, the associations with the drug of choice can be a powerful trigger back into addictive behaviour.
So what about the medical care giver who, after having experienced the trauma of a baby dying on their watch, has to go back into the trenches and keep going, knowing they will inevitably see tragedy again at any random time? Well, chances are they're going to up their game in the vigilance department. And given that they're pretty vigilant to begin with, this is saying a lot. If they've seen uterine rupture during an attempted VBAC, VBACs may be something they're deeply reluctant to do in the future, for a while anyway, until the event is sufficiently behind them and they feel open to trying again. If they tried a breech birth and the baby died, chances are, they're going to be unwilling to revisit that scenario again any time soon and prefer to perform Cesareans on their patients with breech babies. Because of a seemingly large infant, many caregivers will not be willing to allow a vaginal birth given the higher risk of shoulder dystocia and the devastation that can potentially entail. Why? Because they've seen it! It's normal human behaviour. If your house gets broken into, you'll probably get a better lock or alarm system and never leave that one window open again at night, regardless of the lovely breeze that used to come through. If you've been mugged, you're going to be on higher alert when you're walking down the street alone at night, or skip that route altogether, even though you may have walked it happily and safely every night for ten years. It is human to try to avoid pain and recurrence of trauma, and a health care provider is psychologically no different. In fact, it's deeper than that, as they are not trying to spare their feelings necessarily, but someone else's. They are also at the mercy of many rules, no matter what their personal beliefs, rules created by that collective deep seated fear of unpredictable old birth and death.
The build up of post traumatic stress in Medicine doesn't help birthing families in many aspects. One could argue that aggressively applied obstetric care has reduced death all around, and sure, there are truths to that, such as the fact that experience gained in dealing with trauma provides practice with how to work with complications more effectively. I'd sure like the guy dealing with my stuck baby to have oodles of experience in doing so. But consider how fear-based care may not be so great for us. For example, in North America the Cesarean rate has risen crazily in the last decade or so, while outcomes have not really changed in response to this impetus to get babies out surgically. This is testament to the fact that women and babies aren't actually generating any more emergencies than before, but that Medicine is scared. Scared of messing up, scared of allowing the unknown to emerge, and scared of not pulling out all the stops to get a baby out in decent shape. Women are scared too, as seen in some North American hospitals where more Cesareans are planned and preferred over vaginal birth. As a result of fear begetting fear begetting fear begetting even more fear, we have become a bundle of simmering panic threatening to erupt.
The belief of health care providers and many parents that technology and medications are always being logically and judiciously applied, or the fact that arcane practices are being imposed upon birthing women routinely regardless of their good health or what they may want, (lithotomy, continual fetal monitoring, etc) illustrates that we as a culture are servants of Terror when it comes to normal birth. We say it's all about safety for Mom and Baby, that the hyper-vigilant, agressive "just in case" approach is for the best. But our North American statistics don't always prove the safety of our methods of trauma prevention the way we may hope. Yes, overall we do a great job! But we can do better. When we compare our maternal/newborn outcome statistics with those of some other developed nations in which there is generally a lot less fear surrounding the birth process, a different story emerges. In these countries, trained, skilled midwives are attending the majority of normal births in birthing centres or at home, and obstetricians are usually reserved for complicated pregnancies and births. We see that they are enjoying better and happier outcomes. Our fear centred, overly managed practices are not serving mothers and babies as well as the mother/baby/wholistically centred practices they have in Holland and Norway. A mother's positive experience of birth and postpartum is very important to these cultures. In Holland, a woman whose role is similar to that of a postpartum doula comes to the mom's house daily to tend to her for weeks after she's given birth. And this is at no cost to the family, the government pays for it. Our focus is single minded in that a live baby/live mother is all that's really important; well-being is simply icing on the cake, which is an attitude very harmful to women in general.
I in no way want it to be thought that I don't believe we should have OBs deal with normal births anymore. I will address this more in Part 2, but I want it out there for the record.
Normal, physiological birth has come to be considered a radical act in many circles. Many caregivers AND many women HOLD NORMAL BIRTH IN CONTEMPT, even though many have never even seen what that looks like. The fact that birth is SO out of balance, meaning that regular old labour and birth is rarely seen in modern hospitals, reflects a physical manifestation of massive collective terror. Aspects of that are profoundly unhealthy to women, their partners, and babies; physically, emotionally, and spiritually. Surrounding this truth are some groups of people who are yelling that natural birth is the ONLY way and that medical care providers are essentially butchering and assaulting most women in their care. This is unfair and it doesn't help! There is so much fighting and hatred and gnashing of teeth in the name of change that small, easy steps to heal aren't actually being taken as much as pot shots. I have heard midwives called "witches" by doctors, doctors called "butchers" by midwives, and women called "irresponsible" by anyone who feels threatened (essentially frightened)by their desire to birth on their terms. It feels very heavy, almost desperate, and sometimes I lay my head in my hands with sorrow and don't quite know what to do. We have to move through this in a way that makes everyone, birthers and caregivers alike, feel as safe as possible, leaving us all with feelings of integrity.
If how we make choices about birth and how we react to birth is a reflection of our reverence for this mysterious energy that is Nature's design for bringing forth life, we are in trouble. I am being asked more and more to hold support groups for women who feel deeply disturbed by their birth experiences at the hands of well meaning, but disconnected caregivers who seemed terrified of letting them do what they wanted, like birth on their hands and knees or not take pain medication. And if our culture's disassociated, fear-triggered approach to birthing can be seen as a metaphor for the "as above, so below" principle I'd have to say I think Birth is demanding her soul back.
The divide that exists between medical caregivers and consumers who want normal births is this: we birthing customers usually don't see babies die in our every day lives. Our perspective of birth comes from somewhere..well, more normal. Most people don't see volumes and volumes of babies born and witness worst case scenarios, or even the occasional time a normal birth simply ends badly for no foreseeable reason. We are aware that it happens, and we are scared of it happening to us, but it's still all just concept. We are not usually coming to hospitals triggered by tragic experiences of birth loss. Though we are not ignorant (we know bad stuff happens), we do come to birth with a certain innocence. And I think this is okay. It doesn't help us to be armed with terror. Terror interferes with that important oxytocin flow. We come to birth with dreams. Here is where we get to the crux of the matter: regardless of what caregivers have experienced of trauma, resulting in personal wishes and/or sets of hospital rules prescribed to over manage our potentially trauma-filled births, as compassionate as we may feel for the place they're coming from, we still want the right to dream of our good births. And we want to have our good normal births encouraged. Not just in word, but in deed. We want those dreams to flourish without "being put in our place" by the fear projections of the sadly wisened. We do not want our wishes of empowerment and joy to be trivialized by those who have seen it all and would prefer us to not have high expectations for fear of "being disappointed". We want partners in our intent to have whole, happy births, and only saviours if that becomes necessary.
It is somewhere here, between fear and dreams, where something must give and release the pent up emotional energy we're held hostage by and a new way, one rich in safety AND meaning, can emerge. We emphatically DO have the power and the resources to accomplish this. Real healing is essential...and entirely possible.
Stay tuned for part two: How Do We Have Our Cake and Eat it Too?: Retrieving Birth's Soul
My heart just broke for this nurse. I witnessed someone so steeped in the experience of being a relatively frequent witness to tragedy that she dared not invest her heart in any desires towards her own birth process. It was almost as if wanting more than simple life was an audacity. I have seen this with clients who have experienced previous perinatal loss and are expecting a subsequent baby. Where once they were innocent, concerned with cloth vs disposable diapers or about the risks of epidural, or prefering to refuse a routine IV during labour, their innocence is shattered by grief and the fact that life can seem cruel. Once bitten, twice shy.
Herein lies a very important issue at the heart of some of the problems we face as consumers of medical maternity care: our doctors and nurses, given the high volume of births they see ranging from the mundane to the highest risk possible, fairly frequently witness death as a result of pregnancy and birth. It's clearly not something they can avoid, as this is the occupation they signed up for. Remember, this exposure doesn't mean there IS generally a lot of death as a result of birth if you look at overall outcomes. The exposure comes comes from witnessing high volumes...hundreds of births per year, many of them, depending upon the hospital centre, extremely high risk. As they say in the labour and delivery wards, most of the births are regular to the point of boring. It's the small percentage of drama that keeps everyone on high alert. It is all part of the job of being one who assists women on this journey to motherhood. But if the experiences of trauma and loss go improperly processed, there are aspects of this frequent exposure to heartache that have can have a negative impact upon us as birthing women.
To see death in the labour and delivery ward is not the same as being in geriatrics or ICU, as many patients in those wards are expected to pass because they are old and/or sick. But when a couple is expecting a happy start to family life and that dream is tragically extinguished, not only do caregivers mourn the death of a sweet, innocent baby, but bear the burden of parents' acute shock and grief. To witness a mother holding her lifeless baby, those months of hopes and dreams just gone, or to see a father simply shut down, his shock rendering him broken spirited, is emotional suffering I cannot even describe to you if you haven't seen it yourself.
We are blessed in developed nations to have access to these caregivers who can save us and our babies when emergencies occur, we truly are. More tragedies than we could imagine are prevented with this incredibly skilled care. But sometimes Nature overrules and no matter what is done, no matter how many years of studying someone has undergone in surgery and pathology, no matter how much experience they have, no matter how careful they were, no matter how safe the situation might have appeared minutes before all hell broke loose, someone dies. Sometimes it can't even be identified why. And in our culture, this is perceived unacceptable.
In order to truly understand where medical caregivers are coming from, and to glean an essential insight into one of the reasons why our birth culture may appear as wounded as it is, it's important to look at a few thing. Take the personal grief the caregivers most likely feel in reaction to their experiences of tragedy into account (nobody goes looking for that feeling, and in fact tries to avoid it all cost). Mix it up with the weight of responsibility doctors and nurses carry for us (we go to THEM for care, expecting THEY will keep US safe). Now throw in the fact that in the midst of overwhelming grief, sometime parents might feel they need someone to blame (which will usually be the caregiver who, being the responsible expert we entrusted our lives to, "should" have been able to do SOMETHING, or something different from what was done, to avoid the devastation they are now suffering). This cocktail of pressure can potentially create a powerful fear of future emergencies, disasters waiting to happen, and ultimately, the unpredictable mysterious nature of uncontrolled, unfettered physiological birth...which, on occasion, leads to grief. And it is this fear which surrounds and permeates the hallways of the hospitals these medical professionals practice in, as well as the rooms in which many of us attempt to birth normally.
In some schools of psychological theory, it's believed that when we experience a trauma, there is a disassociation of a portion of our presence from the experience. It is a protective function of our minds, serving to spare the psyche from unmanageable pain during a time attention is needed for survival. But at some point, that trauma and the emotions involved (that were neatly tucked away to help us function in the world) need to be revisited and processed in order for us to heal and move on, to re-associate essentially. Shamans of old believed that a piece of one's soul actually fractured away during trauma, and got left behind in that traumatic experience, existing in a different dimension indefinitely, longing to come home. One of the ways they would seek to heal their tribes people would be to conduct a ritual of soul retrieval. The shaman would go into a state of trance, and supposedly travel in different worlds of non ordinary reality to seek those pieces of soul, bring them back to his patient, helping to reintegrate the lost piece so it felt welcome. The patient would experience a cathartic release of the emotional energy caught up in the lost piece, and then they would live a more whole and balanced life with that blessed reclamation, being able to maintain a normal instead of wounded perspective of the world.
If a person does not eventually process the disassociation that served at the time of the trauma, a person can be easily triggered into post traumatic-like reactions in situations that resemble the original trauma. Even the thought of a repeat of the traumatic occurrence can trigger rushes of adrenaline and fear. This is a very painful way to live, as access to many of one's internal resources are limited.
All this is to say, I believe our birth culture functions around massive chunks of missing soul pieces, if you will. I make no personal accusations here, as many of the caregivers I know and love are very well integrated and can weather the occasional loss of life inevitable in childbearing without becoming traumatized. But I believe collectively, Medicine just may be learning, working, treating, and intervening from a place of post traumatic stress. And no wonder! Imagine this (and I am not making up this scenario): you're a nurse, and you've just helped with the delivery of a stillborn baby who died right at that 41 week and three day line, the non-stress test you set her up for and ultrasound having seemed perfect the day before. You're still wiping tears away after having wrapped up the little body for the parents to hold, inside wondering if you could have had any power to change this outcome if you had just a little more forcefully encouraged the mom to induce a few days earlier when you put her on the monitor. Part of you is worrying about how the parents might react if they somehow wonder the same thing, and this will haunt you for a long time. Then suddenly there are premature twins down the hall who need delivering fast to a pre-eclamptic mom and all hands are needed on deck! On the way to that family in crisis, you run into a patient you know from care you've given her prenatally in the hospital, who is just admitted in labour. She is wanting to birth naturally and has this list of mundane f$#*&#g requests she's flapping in your face, requests you've heard a million times from a million people! You are holding so much in your heart and mind right now and this woman wants things that you might, with the perspective you've gained from your job, have discovered are luxuries and trivialities apart from a living baby.
I stop here to take a deep, long, breath of understanding, of compassion, and of true honour for all you are capable of and willing to do to keep us and our babies alive. I invite everyone here to do the same..take a second to breathe and put yourself in that place. Empathy is crucial to truly understanding, gratitude amplifies our loving energy far more than angry blame, and this opens our hearts to the beginnings of healing. Let us start by seeing the big picture behind what we perceive as the fear based medical practice that we feel puts our birth experiences at risk.
The average person who is effectively attempting to retrieve missing soul pieces can usually get away from their triggers to gain perspective. The woman who is constantly traumatized by an abusive partner can generally begin to heal when he is out of the picture. It takes a lot of psychological work for her to come to a place where she doesn't perhaps perceive all other men as threats or go into shock when she sees someone wearing something he used to wear, but with support it can be done. A recovering addict must remove himself from people, places, and things for a while that he associated with using his drug of choice in order to heal. While still raw and processing his emotional pain, the associations with the drug of choice can be a powerful trigger back into addictive behaviour.
So what about the medical care giver who, after having experienced the trauma of a baby dying on their watch, has to go back into the trenches and keep going, knowing they will inevitably see tragedy again at any random time? Well, chances are they're going to up their game in the vigilance department. And given that they're pretty vigilant to begin with, this is saying a lot. If they've seen uterine rupture during an attempted VBAC, VBACs may be something they're deeply reluctant to do in the future, for a while anyway, until the event is sufficiently behind them and they feel open to trying again. If they tried a breech birth and the baby died, chances are, they're going to be unwilling to revisit that scenario again any time soon and prefer to perform Cesareans on their patients with breech babies. Because of a seemingly large infant, many caregivers will not be willing to allow a vaginal birth given the higher risk of shoulder dystocia and the devastation that can potentially entail. Why? Because they've seen it! It's normal human behaviour. If your house gets broken into, you'll probably get a better lock or alarm system and never leave that one window open again at night, regardless of the lovely breeze that used to come through. If you've been mugged, you're going to be on higher alert when you're walking down the street alone at night, or skip that route altogether, even though you may have walked it happily and safely every night for ten years. It is human to try to avoid pain and recurrence of trauma, and a health care provider is psychologically no different. In fact, it's deeper than that, as they are not trying to spare their feelings necessarily, but someone else's. They are also at the mercy of many rules, no matter what their personal beliefs, rules created by that collective deep seated fear of unpredictable old birth and death.
The build up of post traumatic stress in Medicine doesn't help birthing families in many aspects. One could argue that aggressively applied obstetric care has reduced death all around, and sure, there are truths to that, such as the fact that experience gained in dealing with trauma provides practice with how to work with complications more effectively. I'd sure like the guy dealing with my stuck baby to have oodles of experience in doing so. But consider how fear-based care may not be so great for us. For example, in North America the Cesarean rate has risen crazily in the last decade or so, while outcomes have not really changed in response to this impetus to get babies out surgically. This is testament to the fact that women and babies aren't actually generating any more emergencies than before, but that Medicine is scared. Scared of messing up, scared of allowing the unknown to emerge, and scared of not pulling out all the stops to get a baby out in decent shape. Women are scared too, as seen in some North American hospitals where more Cesareans are planned and preferred over vaginal birth. As a result of fear begetting fear begetting fear begetting even more fear, we have become a bundle of simmering panic threatening to erupt.
The belief of health care providers and many parents that technology and medications are always being logically and judiciously applied, or the fact that arcane practices are being imposed upon birthing women routinely regardless of their good health or what they may want, (lithotomy, continual fetal monitoring, etc) illustrates that we as a culture are servants of Terror when it comes to normal birth. We say it's all about safety for Mom and Baby, that the hyper-vigilant, agressive "just in case" approach is for the best. But our North American statistics don't always prove the safety of our methods of trauma prevention the way we may hope. Yes, overall we do a great job! But we can do better. When we compare our maternal/newborn outcome statistics with those of some other developed nations in which there is generally a lot less fear surrounding the birth process, a different story emerges. In these countries, trained, skilled midwives are attending the majority of normal births in birthing centres or at home, and obstetricians are usually reserved for complicated pregnancies and births. We see that they are enjoying better and happier outcomes. Our fear centred, overly managed practices are not serving mothers and babies as well as the mother/baby/wholistically centred practices they have in Holland and Norway. A mother's positive experience of birth and postpartum is very important to these cultures. In Holland, a woman whose role is similar to that of a postpartum doula comes to the mom's house daily to tend to her for weeks after she's given birth. And this is at no cost to the family, the government pays for it. Our focus is single minded in that a live baby/live mother is all that's really important; well-being is simply icing on the cake, which is an attitude very harmful to women in general.
I in no way want it to be thought that I don't believe we should have OBs deal with normal births anymore. I will address this more in Part 2, but I want it out there for the record.
Normal, physiological birth has come to be considered a radical act in many circles. Many caregivers AND many women HOLD NORMAL BIRTH IN CONTEMPT, even though many have never even seen what that looks like. The fact that birth is SO out of balance, meaning that regular old labour and birth is rarely seen in modern hospitals, reflects a physical manifestation of massive collective terror. Aspects of that are profoundly unhealthy to women, their partners, and babies; physically, emotionally, and spiritually. Surrounding this truth are some groups of people who are yelling that natural birth is the ONLY way and that medical care providers are essentially butchering and assaulting most women in their care. This is unfair and it doesn't help! There is so much fighting and hatred and gnashing of teeth in the name of change that small, easy steps to heal aren't actually being taken as much as pot shots. I have heard midwives called "witches" by doctors, doctors called "butchers" by midwives, and women called "irresponsible" by anyone who feels threatened (essentially frightened)by their desire to birth on their terms. It feels very heavy, almost desperate, and sometimes I lay my head in my hands with sorrow and don't quite know what to do. We have to move through this in a way that makes everyone, birthers and caregivers alike, feel as safe as possible, leaving us all with feelings of integrity.
If how we make choices about birth and how we react to birth is a reflection of our reverence for this mysterious energy that is Nature's design for bringing forth life, we are in trouble. I am being asked more and more to hold support groups for women who feel deeply disturbed by their birth experiences at the hands of well meaning, but disconnected caregivers who seemed terrified of letting them do what they wanted, like birth on their hands and knees or not take pain medication. And if our culture's disassociated, fear-triggered approach to birthing can be seen as a metaphor for the "as above, so below" principle I'd have to say I think Birth is demanding her soul back.
The divide that exists between medical caregivers and consumers who want normal births is this: we birthing customers usually don't see babies die in our every day lives. Our perspective of birth comes from somewhere..well, more normal. Most people don't see volumes and volumes of babies born and witness worst case scenarios, or even the occasional time a normal birth simply ends badly for no foreseeable reason. We are aware that it happens, and we are scared of it happening to us, but it's still all just concept. We are not usually coming to hospitals triggered by tragic experiences of birth loss. Though we are not ignorant (we know bad stuff happens), we do come to birth with a certain innocence. And I think this is okay. It doesn't help us to be armed with terror. Terror interferes with that important oxytocin flow. We come to birth with dreams. Here is where we get to the crux of the matter: regardless of what caregivers have experienced of trauma, resulting in personal wishes and/or sets of hospital rules prescribed to over manage our potentially trauma-filled births, as compassionate as we may feel for the place they're coming from, we still want the right to dream of our good births. And we want to have our good normal births encouraged. Not just in word, but in deed. We want those dreams to flourish without "being put in our place" by the fear projections of the sadly wisened. We do not want our wishes of empowerment and joy to be trivialized by those who have seen it all and would prefer us to not have high expectations for fear of "being disappointed". We want partners in our intent to have whole, happy births, and only saviours if that becomes necessary.
It is somewhere here, between fear and dreams, where something must give and release the pent up emotional energy we're held hostage by and a new way, one rich in safety AND meaning, can emerge. We emphatically DO have the power and the resources to accomplish this. Real healing is essential...and entirely possible.
Stay tuned for part two: How Do We Have Our Cake and Eat it Too?: Retrieving Birth's Soul
Friday, December 9, 2011
A Doula's Blessing for a Beautiful Birth
May your birthing space be prepared in sacredness by those who attend you,
as the Grandmothers do.
May you climb and surf the mounting peaks with a spirit of adventure,
as the Wanderers do.
May you surrender to the Dreamtime and gather wisdom from its messages,
as the Shamans do.
May you roar your fullest Power into being, guided by blessed challenge,
as the Warriors do.
May you open courageously to the earthbound surge of inexorable manifestation,
as the wolves, whales, and bears do.
May you reach, transformed, for the living grail of your fruitful journey
as the Mothers do.
as the Grandmothers do.
May you climb and surf the mounting peaks with a spirit of adventure,
as the Wanderers do.
May you surrender to the Dreamtime and gather wisdom from its messages,
as the Shamans do.
May you roar your fullest Power into being, guided by blessed challenge,
as the Warriors do.
May you open courageously to the earthbound surge of inexorable manifestation,
as the wolves, whales, and bears do.
May you reach, transformed, for the living grail of your fruitful journey
as the Mothers do.
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