Monday, November 30, 2009

In Praise of Spaces

Birth is so much about swelling, surging, growing, stretching to maximum capacity, riding the waves, and being full to bursting.

I want to take a minute to remember the importance of the spaces. The pauses. The rests. We spend so much time as doulas and birthing mothers supporting/coping with dizzying heights of contractions. And this is important, because these waves require a lot of our attention and a commitment to working through their challenge. These waves create gifts. The endorphins which make us stoned and the oxytocin which makes us loving and sexy in good labour, are the gifts we can bring to the spaces. These gifts allow us to sink into the ocean of Resource available to us, if we so choose.

But many of us do not choose. We are products of big, over-thinky minds. Our minds are like impatient children, demanding "why". "Why is labour taking so long?" "Why does it hurt so much?" "Why isn't it ending soon?" "Why is this happening to me?" I have seen so many labours deteriorate with our cultural obsession with the question "why". The truth is that there often are no real answers. There are thoughts, and hypotheses, but not always something concrete, which insults our minds, which feel entitled to answers for their demands. We then take awareness away from our bodies, which would benefit far more by resting between the great big swells of active labour. By wallowing in the "why", we deny ourselves the potent Medicine which exists in the spaces.

Unfortunately, many supporters of birth are far too willing to engage in theories
in order to help the woman to "understand" her situation. This often does not help. Information itself is not usually what heals. Many "bring to hospital" lists include magazines and movies in order to fill the space. Medical students are asked to do questionnaires and workups in the spaces. Nurses chat between contractions to get to know their patients. It is hard to find the space in this environment, the space to regroup and re-source. We need to work on this, as natural birth should not have to be next to impossible in a hospital.

We can help to create more space through many means, depending upon what's going on. Breath is an important way to make room inside. As we breathe deep into our bellies, into the space around and below our settling babies, we make room for everything to open, allowing our babies to settle more deeply. If we make the conscious choice to put down our minds, sink down into the spaces of our wombs with our breath and our quiet, aided to do so more deeply with the gifts of endorphins and oxytocin created by the waves of contractions, we find where our Medicine lives. Our most womanly power exists in these spaces, the power to nourish and restore before bringing forth life on a wave. Our Medicine is Grace. It is Courage. It is Faith. It is Love. It is Endurance. It is Acceptance.

Space can be created by assuming positions which encourage our babies to follow the path of least resistance. Vomiting, peeing, and shitting during labour are valueable too, because they create space. They relieve tension. The image I get when I think of vocalizing during labour (ie: yelling our heads off), is of making our personal containers bigger with the sheer force of sound in order to hold the crazy, overwhelming birth energy. Space is created by processing the emotions that come up in labour. A good cry can create renewal. Letting go of what we hoped for and accepting what is present in our labours creates the space to flow with what is here and now.

Sometimes space needs to be created in more hardcore ways. And let's make sure to honour those too, as they can provide immense value. Manually stretching a cervix when appropriate can make more space for the baby to be born. Occasionally an epidural is the way to create the space to find our internal Medicine. For whatever reason, sometimes the mother needs to get perspective from the experience and the only way to do so is by putting the pain on "pause" in order for the body to do it's thing within the space of rest.

If supporting a woman in active labour, do not engage her with chatter. Don't probe her for information. Don't fill her spaces. You are denying her access to her resources. When she questions "why", unless there is a real answer, don't go there. Encourage her instead to figure out how to deal with what is, which is usually to pause and go inside. Add to her endorphins and oxytocin by making her feel really good, if that's what's called for, by massaging her or soothing her with whatever comfort helps her. If you're birthing soon, practice relaxation. Know how to let your body go instead of shlepping around the tension of the last contraction with you to the next one, compounding the stress and reducing efficiency.

How do you help to create space?

Sunday, November 29, 2009

control

I think it is so important to know how little control we have over the birth process, as birthing women and as doulas. It hurts a little every time to have this lesson driven home. I think there is a secret belief that if we do everything right, like provide the correct support, use the correct remedies, say the magic words, we will be granted with our clients' births going wonderfully. We go around wondering "why?" when an outcome is not as we'd wanted, and fall into the pattern of wondering if there was anything else we could have done. And while we may come up with hypotheses, ultimately, we don't know much of the time. Who knows what lessons any particular woman needs to come away with, what the baby needed, etc? The "why" is the great mystery, and hanging around there too long is not conducive to healing. Figuring out what to do right now and extricating the important lessons are far more important than believing you actually had that much control anyway.

Being a doula means being able with presence, love, and peace, knowing you pulled out all the stops you could to help the birth run as smoothly as you knew how, look your lady in the eye as she is about to be wheeled off to the surgery she never wanted, and say "Well, here we are." You must be a vessel of compassion for what is present right now, instead of caught up in despair over what wasn't "achieved". We want our moms to be at peace when their babies are being born, as these babies need to be received in an environment of love, not rage or terror, no matter what is going on.

I am just back from a birth in which I supported a woman for 48 full hours, she and I keeping absolute faith in her profoundly amazing body, giving everything we could, doing everything "right". And she ended up having a C-section. Of course I think, "what could I have done?", "was there any other thing she could have done?", "was it the hospital's fault?" And the truth is, I don't know, and never will. What I need to focus on is a mother who will need to heal emotionally from having her baby surgically. I will do so by not denying her full right to grieve, and protect her from those who tell her she has nothing to be upset about because she has a healthy baby and the process wasn't important.

As far as I am concerned, this woman made one of the most heroic attempts at natural birth I have ever witnessed, and the staff at the normally extremely intervention happy hospital we were at were nothing but full of praise, support, and encouragement for her process. The nursing station was buzzing with excitement, even while she was still 8 to 9cm for over 24 hours...with no pain relief at all. There were no snide comments that she was crazy or egotistical for doing this. Just well wishes. The chief of obstetrics came in on a wave of love and support, saying how much he admired her, and since her baby was doing well, he would support her wishes. He would occasionally come into the room, like a doula, to buffer any statements made by well meaning residents or students that were less than helpful. The environment was as nourishing as possible. In the OR, the energy was positively tender..everyone from the anaesthetist to the nurses were telling her how heroic she was and that they applauded her. And they were not just words, the hearts behind the words were palpable. It was amazing how much heartfelt support this woman drew to her. This will lend well to her healing. But even so, healing will need to be done.

It is a huge shock to live in a body you have trusted all your life, and you have done all you could to prepare it for the natural birth you expect, have gathered up a support team to keep the environment safe, and in spite of all that still don't birth vaginally! Ouch! As a doula, I don't even have the comfort of being able to grumble about how the hospital environment discouraged free flowing labour, because they DID, possibly more than any time I've ever seen. I can't use their routines and fears as a scapegoat, because they suspended all of that to allow her to birth freely. And in a way, that leaves me wondering how many times I have conveniently blamed some of the Csections I've attended on the hospital environment. Okay, probably the environment DOES account for an awful lot of Cesareans. I would say most, even. I am convinced that the risks involved in the routines and interventions applied based upon fears of potential horrors are higher than the risk of leaving things alone as much as possible. Yes, there should be vigilance, and yes, there should be skills and technology available. But the "in your face" aspect of the hospital brand of vigilance is so often birth mojo killing. In any case, I admit there very well may be the occasional time I try to blame the environment, in an attempt to grasp at straws for reasons "why", when truly, I can't really always know that. Who am I to judge anything? When we have no blame, we are left with a terrible sense of how Birth really and truly is the great mystery we've always secretly hoped we could have control over by our right actions. How easily we crazy humans get caught up in magical thinking! Yes, we have influence, it's true. There are times I know a woman would have ended up with a Cesarean without my help. So we can as birth supporters do some magic. But the belief in magic becomes insanity when we think we actually created rather than facilitated an outcome that was already probably meant to be, if you believe in that kind of thing, which sometimes I think I do.

There is a saying...Trust Birth! Well, I do trust that the vast majority of time birth unfolds normally and women have healthy babies if we leave women space to do it. If it didn't, I couldn't do this job with the faith I have. But that's more trusting women and their bodies to function normally given the support they need (or by leaving them alone if they don't need it). By reducing fear, I can help the function flow more normally, but only if that was what was meant to be given the sort of harmonic convergence a particular body/baby/energy/alchemy and circumstance any given birthing event creates. The body does know well how to overcome many less than ideal situations, and sometimes my support can get a rough journey on track. Not always, though, no matter what I or the primary caregivers do.

So back to the Trust Birth statement; do I "trust" an ancient, unfettered energy that has the power to give as much as it has the power to destroy without that much notice, and think my puny little hopes and intuitive magical musings actually bring about an outcome She has other ideas about? That would be imprudent. Just because we feel all safe and warm and faithful about birth doesn't mean that makes birth all okay. Yes, I do trust it goes fine the VAST majority of time. But not always, and when it doesn't can be so painfully unpredictable. Put it this way: I don't "trust" Birth enough that I believe every healthy woman should go and birth unassisted. But I do trust that Birth is usually a lot safer than the medical system makes it out to be most of the time. A good balance between a decent supportive safety net and freedom for women to do what they want and need in birth without being disturbed seems to be where safety is at its highest. Sadly, in our birthing culture, this balance is so out of whack, I don't know how or when the pendulum is going to shift to a place of sanity. However, I digress. This birth I'm speaking of may not be a product of this imbalance I so often think is the cause of many less than ideal outcomes. It just is what it is. I was so grateful for Hospital Medicine and what it was able to provide for a safe outcome. This Medicine truly is a gift and I am glad it's so readily available when we need it. I am also over the moon grateful for the tender hearted people who were so skilled and so compassionate in the way they applied their Medicine. A bow of honour towards them.

In spite of the compassionate and skilled treatment my lady received, in spite of some of the given suggestions of why this birth ended the way it did, it is EXTREMELY hard not to have an answer to why things simply go crappily sometimes. What gets on my nerves is everyone sitting around in the recaps of challenging births spouting, "Oh, I KNEW that was going to happen!", or "I THOUGHT that red flag I sensed would amount to something like this!" That's just so easy to say, and unless you're quite psychic, it's all just speculation without some pretty decent evidence (and I DO feel anecdotal evidence and evidence that is beyond the clinical is totally valid a lot of the time...evidence doesn't all boil down to RCTs and clinical suspicion either, otherwise I'd be rich, for example, if I got a dollar for every time I heard a birth ended in Cesarean because the baby was just too big for the mom.). It IS important to recap and to rehash and to delve into the story to learn, but it's also important to hold our hypotheses lightly.

So here I sit in this place of not knowing, trying not to be angry with it, but also being grateful for mystery and for teachings and for stretching my capacity to accept rather than blame. I'm going to choose to allow my heart to be open more to the pain of the fact I don't know anything rather than stick around in the 'why' game, which is the distracted musing of a wounded ego.

Thursday, November 26, 2009

Wednesday, November 25, 2009

Royally Miffed

I am one annoyed doula tonight. H1N1 continues to plague our practices. Yves Bolduc, Quebec's Health Minister, said that he felt making a birthing woman choose between her husband or her doula in Montreal hospitals was, in short, paranoid. So despite the fact that I subjected myself to a vaccination I am not particularly comfortable with in order to be as responsible as I can be to my more vulnerable clients, St. Luc hospital is STILL clinging to this rule. My poor clients are distraught. They were told that St. Luc's is a higher risk hospital for the flu, though I'm not sure if I understand why, given St. Justine, which DOES allow doulas and husbands in the birthing room, is a hospital strong in pediatrics. The benefits of labour support outweigh the risk of becoming extremely ill from the flu, especially considering my clients and I are vaccinated. Why vaccinate at all if this is not even considered?

To continue on my rant, I just have to mention that an OB/GYN who attended my lovely client's birth, WALKED OUT OF THE ROOM when she refused to get on her back, despite 4 people trying to physically force her into this position. He threatened her with abandonnment of care. Personally, I didn't see the big deal about his not being there, as the baby was practically out anyway and there was a resident and a veritable herd of experienced nurses in the room. What made me sad was how scared the nurses seemed, as if they were going to get blamed for failing to control their patient. The birthing lady decided to go on her side, and I suppose someone went out to kiss the doctor's butt so he'd come back in and catch the baby.

I have no problem with an accoucheur feeling uncomfortable and inexperienced with a particular birthing position. Most of the docs I know would be respectful and explain why they weren't comfortable and comprimise with a position both doc and lady were okay with. But to stomp out of the room shrouded in a cloud of self righteous indignance to sulk in the hallway is extremely lame. Midwives are down with all kinds of positions, as are some OBs and many family docs, and know how to protect the perineum in just about all of them. Perhaps some skills sharing for the resistant is in order so that women's choices are better supported.

Tuesday, November 24, 2009

Montreal Doula Training Intensive Retreat 2010

When: July 18th to 23rd, 2010 Where: Montreal (Morin Heights) Who: This training is for women who want to pursue a career in supporting women in birth. This can either serve as a complete professional for a career as a doula or as a stepping stone to a career in midwifery, nursing or medicine or as a continuing education for women already working with birthing women and want to enrich their practices. Lodging is available on-site. Please contact us at info@motherwit.ca or visit us at www.motherwit.ca

Monday, November 23, 2009

musings from a very tired doula

Oh, so tired! What a busy week ahead...days packed with pre and post natals, and goodness knows when babies will come and all will have to be rescheduled. But this is the gift of doula work...I never know what the day will bring. Life is never boring.

I am full of gratitude this evening. I live in a world of women, but tonight I am grateful for the boys...a huge thank you to my web guys who make such far reaching communication possible. In my Great Great Grandmother Charlotte's day, midwives and fathers-to-be would knock on her high bedroom window with a broom handle in order to request her help at birthings. How far we have come! Charlotte, who could not read or write, would be blown away by this technology. I vow to use it for the greatest good. Much love to Mitchell and Daeman. I thank you from the bottom of my heart.