Monday, March 28, 2011

Doulas Cannot Re-Create The Farm

I re-read Ina May's Guide to Childbirth, and have read Spiritual Midwifery at least 10 times over the last couple of decades. The message that always resonates most with me is that culture helps to shape birth. It is true to a large degree how something is observed influences how that thing functions or "behaves".
Ina May lives in a culture she has contributed to forming in which birth is a normal, natural, exciting, joyful, transition into motherhood...that women are powerful both in their birthing prowess and in the strength of the support they provide to the birthing women in their community. Her amazing stats bear this out, showing evidence for the efficacy of this woman centred rather than technological approach to birth. There is very little in the birth stories Ina May features in her books that cannot be remedied by the loving and strong support of the spiritual midwives and other women close to the couple. Of COURSE the unexpected and even the dangerous can and does happen on occasion, even on the Farm. But for the most part her statistics tell a much different story than standard North American birth stories, that many issues that come up in labour can be resolved with more emotional support and spiritual excavation rather than medical intervention (not eschewing, of course, good medical care when necessary). Again, bear in mind those phenomenal outcome stats before pooh poohing.

The birthing culture I live in now is way different. My "culture" when I was having my babies consisted of a community which favoured home birth, home schooling, natural approaches to health, bed sharing, etc.. The far reaching majority of us had pretty straightforward home births, easy breastfeeding, and good postpartum support from friends. I don't think any of us had Cesareans, whereas now you can't throw a stick without hitting someone who's given birth surgically. What used to be considered a major thing is now becoming a norm. We held Blessingway ceremonies for each other during pregnancy and hung out a lot telling good birth stories and providing each other with emotional support. It was a beautiful time. Now these children we birthed and nourished are growing fast, many of them already grown. I pray our practices stick with them as they make their way through the ups and downs of today's North American birth culture.

It has been said that form follows function and function follows form. As above, so below. When our culture has such an overwhelming fear of the birth process, it makes sense this seems to be reflected in our birth outcome statistics. For all our shiny technology, our outcomes are pretty poor compared to Ina May's at the Farm. So many births seem to need epidurals and Cesareans despite the woman's best intentions. Women are told they couldn't have had a safe birth without their interventions. The poor old female pelvis is not the all powerful thing we seem to pay lip service to after viewing all those great birth documentaries, but apparently, according to our North American stats, an unpredictable lemon. When it works naturally, it's an awe and triumph, not really the norm. A natural birth is a rarity. In fact, in our present birth culture, natural birth is often seen as radical, sometimes even held in contempt not just by some of the medical community, but by many of the women themselves. This breaks my heart as it demonstrates a terrible collective misguidedness.

The way we prepare women for birth is so intellectual. Breathing techniques often consist of counting. Women seek to hypnotize themselves out of a fear response to the normal sensations of birth! I see women reading all the right books and wanting the image of that dream birth yet still buying the cultural fear so much that they will almost always in the end go for that 41 week induction for terror of sudden fetal death, or go to that hospital with 24 hour on call anesthesia just in case they can't handle it, but without exploring what "can't handle it" means. They get mad at their doctors sometimes for delivering the information and treatment outlines to them (and I don't blame them much of the time, as this information can sometimes be delivered in ways that make them feel like bad, neglectful parents if they don't do what they're told). In the end though, nobody goes to their houses, holds their faith in their bodies hostage, and takes them at gunpoint off to their intervention filled births. We must recognize that there is some choice here, and that we must own for the most part that which we make informed choices about. These choices shape our culture.

It is a hard thing for women in this culture to bear, and one that I believe to very much affect the mechanics and juicy hormones of birth: on the one hand you want a great natural birth inspired by the good stories and films out there, but on the other you ultimately feel you must trust Medicine as the last word and a very fear based aggressive approach, feeling backed into a corner and possibly resentful, yet unwilling (or in many cases unable due to lack of resources) to make different choices because guessed it...the very fear that makes Medicine outline those choices. We are terrified of the unknown and for being responsible for choosing something that may ultimately make us suffer the horror of having hurt our babies. Medicine is afraid of the repercussion of uncontrolled choice as much as we are....thus everyone feeds off the fear and it continues to spiral out of control, to the extent that in some North American hospitals the Cesarean rate is over 50%. We keep choosing the more medical approach DESPITE the rather grim statistics (ie.: definitely not like Ina May's)which seem to illustrate that the more we mess with normal birth the more problems we seem to cause. YES, Medicine saves lives, and God bless it! YES, sometimes things happen out of the blue that necessitate quick and immediate medical care. And for that reason, though those quick emergencies are pretty rare (I sound like a broken record, but I again defer to Ina May's gorgeous stats), we continue to take calculated, controlled risks to our normal births, very likely causing more problems than would need to be treated if we didn't interfere so much with this process.

It is very hard to bring the Ina May approach into the hospital. Her approach is about trusting ourselves, the process, and the support. Her brand of midwifery is certainly wise and vigilant (again, check out the great birth outcomes), but it is dynamic and views the woman as a whole, not a check mark on the all mighty progress chart or an alarm bell going off when anything is not "average". Not that doctors are uncompassionate and uncaring...on the contrary, their choices are usually motivated by a lot of care. Ultimately, though, clinical responsibility and covering all contingencies is the absolute priority. That's the way it is. The Farm midwives know the relationship of the couple, know who's visiting whose hut, know the diet well....our doctors are not aware of these factors and cannot offer support that way. They are busy preventing and treating the many emergencies, which is not a bad thing.

So where do we find balance? While a doula certainly provides the loving, guiding aspect of support the Farm midwives do, we usually do so in the hospital. This is not the lovely home environment of Ina May's birth stories our clients read about and are inspired by. Instead, their births unfold in an environment that is saturated with the fear of all the bad things that can happen, the fear of not making all the right choices to save a baby's life, and an endless sea of strange faces coming and going and commenting. Having a doula present doesn't magically erase the heaviness of this environment. Surely we help. It is true our clients have less Cesareans and epidurals, but to believe their births will be like the ones on the Farm with the support of a doula within the hospital environment is simply not true. Doula or not, the pervading institutional-ness of the hospital will have a profound effect upon more sensitive physiologies, potentially creating in the end what will be a real need for interventions.

A doula's emotional support is powerful, it is true, and can reduce anxiety thus a need for many interventions, but our support can easily be undone by many different things....a shift change, another bit of information about the labour that requires a mom to be on a monitor more and frightened, an insensitive vaginal exam... A sensitive woman will definitely be thrown by a well meaning but misplaced comment or harsh word no matter the buffering power of her doula's word medicine.

I have seen the environment shut down a great labour despite my attempts, and this can make us feel really powerless sometimes. Sure, sometimes you are very grateful as a doula you were at the hospital because of a truly unforseen emergency. But often you have a sneaking suspicion that a little privacy and a little time off the monitor would have turned a "stalled" labour around instead of the epidural that was sold so hard you're all left reeling. And even though the labouring woman knows this on one level, fear of not doing what's suggested often bears out and influences her choices...which influences her labour....which co creates the bigger picture of our birth culture.

Luckily, we doulas have FAR more great stories than not, but let's face it....the books we write will never be like the stories they have on the Farm unless we live in a homebirthing culture. Yet we keep on slogging, praying that each great birth we attend contributes to a healing of this culture and the slow, slow swinging of the pendulum. For now, I seek to make hospital birth, which is the norm no matter what I have to say about it, as humane and as beautiful as I possibly can. If I didn't see great success with that much of the time, I couldn't continue doing this work. I would be walking around permanently wounded. So doulas, especially newer doulas who have been having their eyes opened to the reality of hospital birth despite their hopes and best intentions, though it sometimes seems overwhelming and impossible, don't give up. We are making a difference.
Lesley Everest

Saturday, March 12, 2011

Doula Training in Nova Scotia

It is official! MotherWit is hitting the East Coast of Canada this summer. Join the Doula Ceilidh from July 24th to July 29th as we get down to the nitty gritty, the earthy crunchy, and even the airy fairy of the science and art of being a doula.

This full six day/3 evening birth doula training intensive will take place at the beautiful WindHorse Farm in New Germany, Nova Scotia (, which is about a 90 minute drive from Halifax and 30 minute drive from Lunenburg (home of the Bluenose). We are renting the Sunshine/Carriage House which will hold our hostess (Katrina of Cape Breton) and 15 live-in students (though our training will not be limited to 15 for those who wish not to stay in the house).

Our unique intensive approach is geared to eating, breathing, and sleeping birth. Our training last summer in Morin Heights, Quebec among the beautiful scenery of the Laurentian hills and living in close quarters for nearly a week created a life changing experience for many of the women who attended. In this tradition, we bring our training to you doula sisters and doula wanna be's out east.

This course in holistic birth doula work is great for those who desire to serve their community as doulas, for those wanting to go on to study midwifery or nursing, for those wishing to expand their knowledge of tending to women in their childbearing year, or for more experienced doulas who wish to deepen their knowledge and wisdom. There are no prerequisites except a desire to nurture, educate, and support families during this special time in their lives. A doula has the potential to bring profound healing to a wounded birth culture with each family she serves. Evidence supports the fact that the presence of a doula in the birthing room reduces the risk of unnecessary interventions (as well as potentially mitigating the risks of those that could become necessary), and this training will show you how to do it.

We will talk about the tools women have used to help promote balance and healing since women have been birthing, as well as explore in detail how to create and hold the space conducive to normal, triumphant childbirth in different settings, as well learn how to support those having more challenging or even traumatic births. Learning how to deal with difficult situations and how to tend to ourselves as doulas is also emphasised in this course. Nestled within the shelter of Windhorse Farm and supported by the magical beauty of Nova Scotia, join us on this journey.

Women from Prince Edward Island, New Brunswick, and Newfoundland, it would be such an honour to have you. We realize doula training may be difficult to find in your areas, so this would be a perfect opportunity to learn to start generating crucial change to the birth culture in your town. It really doesn't matter where you're from. If you've always wanted to visit Nova Scotia, here's a great reason to do it.

Join me and my teaching assistant Sesch Wren for a week you'll never forget!

Details will be put up on soon.

For you ladies farther out West, you are not forgotten! The amazing Tracey from Birth Source Inc. ( and I have been having some very interesting chats about bringing this new approach to doula training to Edmonton. We are also discussing bringing the MotherWit Doula Mentor Training to Edmonton as well, which is intended for experienced doulas (certification not necessary) who have a strong desire to reignite the ancient approach of taking apprentices, which is ultimately the very best way to learn how to be a doula: from other experienced doulas. No dates have been set yet and we're still in the planning phase, but just so you know we're thinking of you.

And for you ladies across the pond, the sweet Rebecca Wright ( and I have been doing some planning of a birth doula training intensive for UK doula sisters, as well as the mentorship workshop for experienced doulas. Irish, Scottish, Welsh and English doulas/doula wanna be's, keep checking back for more information as our plans develop.

If you're from anywhere else and are wishing so much you could join us but just can't because of distance, consider hosting us. We LOVE to travel.