musings of a montreal doula

Don't be a "Do-la"

2012-02-08T09:46:00.004-05:00

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 shit 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.

The Nourishing Perk

2012-01-06T22:07:00.003-05:00

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.

2011 Births: A Doula's Year in Review

2011-12-31T19:29:00.007-05:00

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!

Between Fear and Dreams: Birth Wants her Soul Back

2011-12-13T14:27:00.005-05:00

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

A Doula's Blessing for a Beautiful Birth

2011-12-09T18:18:00.002-05:00

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.

When Pregnancy Blows

2011-11-23T20:12:00.002-05:00

A lovely client of mine recently made an important observation about the tone of many natural, holistic books on pregnancy and birth. She said, "The statement 'You're pregnant! Congratulations! You are now a sacred vessel of life.' makes me angry. Why is it that the act of carrying a baby is what makes me sacred? Am I not already sacred without the need of a pregnancy to create or justify my sacredness?" Indeed.

I believe the intent of the sacred vessel statement is to help women embrace how great it is to be gestating a kid, affirming that they are special, worthy of extra self-nurturing. It's not malicious. However, this belief that pregnancy renders us sacred vessels puts an awful lot of pressure on women to match this projected beatific state with beatific behaviour...even when they're just not feeling it.

For the most part, most of the women I work with enjoy their pregnancies very much. Sure, they experience some of the uncomfortable symptoms like troopers, but are ultimately quite enthralled with their ripe states. And others absolutely can't stand being pregnant.

I have sometimes heard incredibly judgemental statements from the "You are now a sacred vessel" crowd regarding the women who experience their pregnancies negatively. I have heard people, many whom have never even experienced pregnancy before say things like, "Other women have been trying for years to have children and can't. You should be grateful to be pregnant at all." Or, "Your negative feelings are bad for the baby. You should work through why you are being so negative for your baby's sake." Way to blame! This is the same thinking which blocks a woman's grief over a disappointing birth experience, encouraging her to basically "get over it" because she and her baby are healthy, and that's the most important thing. Well, duh, it's the most important thing. No woman would prefer the alternative of a fabulous birth but an unhealthy baby. But can't we just take a woman's gratitude for granted and give her the space to authentically express her emotions in spite of a good clinical outcome?

Most books on birth don't have a chapter called "When Pregnancy Blows" (though I'm writing one). And I assure you, having worked with hundreds of pregnant women, I know sometimes it really does. Sure, there are some people in the world who are whiners by nature and turn a normal experience into one of abject misery by focusing entirely on the negative. Upon examination, you would see that this is the way they are in their everyday lives, not just in pregnancy. But in my experience, most women do their best to downplay the more negative aspects of their pregnancies for fear of being perceived as ungrateful.

The truth is that sometimes pregnancy is beyond challenging. Sometimes it's downright awful. I have known some women to be so floored by pregnancy that they spend an entire nine months either hospitalized on IVs or lying on their couches wrapped around a barf bowl containing upchucked Diclectin pills. I have seen women literally crippled by their pregnancies, suffering the excruciating pain of pelvic girdle dysfunction. Others develop complications, either minor or otherwise, which turn them from the vital, active women they are into what they feel are bedridden, vulnerable shadows of their former selves, wreaking incredible emotional havoc. To some, the act of expanding in girth is not just a vanity issue, but a deep seated terror rooted in past trauma. Very few women admit this to the general public, but sometimes those whose pregnancies put them into an unusual state of suffering have feelings of "I don't know if this is really worth it," and have literally considered terminating. Sometimes they get resentful of the presence of the baby inside who makes them feel utterly miserable, and begrudge their bodies for "failing" them when their friends are bopping around taking spinning classes until their due dates. Does this make them unworthy of being sacred vessels? Absolutely not.

Many women are shocked when they discover their pregnancies are less than they were cracked up to be because we are so adverse as a culture to talking about it. Letting women know in advance that pregnancy can be really rough on some is not going to make it happen or "give permission" to women to "whine" more about minor complaints. This is the same logic as saying, "If we talk about labour as being painful, then this will make labour painful. Labour is natural, natural shouldn't hurt, and the perception of pain is simply enculturated."

Do these women who suffer greatly feel guilty for these feelings? You bet they do. It is unsafe in proper company to speak so negatively of one's pregnancy without evoking judgement from others who don't understand. I heard one woman on Facebook say that she had had some itchy skin condition while pregnant and SHE never complained, so she couldn't understand why so many women complained so much about THEIR pregnancies, and that pregnancy was a time to be grateful and NOT complain. I'm sure this lady meant no harm and simply has not been exposed to some moms of twins who don't feel as stoic when they cannot lie down at all in the final weeks without throwing up, losing weight rapidly due to an inability to keep down food, or to ladies who are in wheelchairs because of severe pelvic and back pain.

Women who are not feeling great about being pregnant often also feel guilty that their negative perceptions are somehow harming their babies. But I think forcing positivity when it doesn't always exist or not giving vent to some of the authentic feelings that come up, such as extreme vulnerability, anger, resentment, and depression, can create worse problems. Stuffing back real feelings causes stress within the body, and stress has definitely been shown to have an impact upon the pregnancy and Baby's in-utero development. Instead of putting on a brave face when inside she's crying, it's probably healthier overall for a mother struggling with difficult feelings to be able to unburden herself in the presence of someone who will listen with empathy and compassion. Simply being able to have an emotionally safe space held for the acknowledging and accepting of not feeling at all like a sacred vessel can be deeply healing. After all, if you look at it up close, most of the time these feelings are appropriate reactions to crappy situations. If the mom weren't pregnant, the expression of feelings such as these in relation to a challenging life situation would be encouraged. But because she's a "sacred vessel", our culture seeks to look askance at her expression, and it is unfair.

When women repress their real emotions for fear of judgement, they tend to creep up uncontrollably, blossoming into the more socially appropriate condition of postpartum depression. While more well known and accepted than pregnancy negativity, make no mistake; postpartum depression is a serious state and has a far higher impact on the baby at that point. The longer a mother remains depressed postpartum, the larger the impact upon her baby, who very much needs to be emotionally attached to her for optimal development.

As a culture it is important for us to accept and honour the fact that while YES, pregnancy is mostly beautiful, amazing, transformative, and fun, there are lots of pregnancies that just blow. It is usually entirely beyond the mom's control, and she is often sitting on the sidelines wishing she were one of those shiny happy mommies-to-be. If we can meet those furtive admissions of suffering with understanding and compassion, perhaps the experience can be made just a little bit easier. We need to embrace all experiences of pregnancy and be inclusive of all women's feelings, not just the "sacred vessel" ones.

Doulas: Women of Story

2011-11-19T12:22:00.002-05:00

I often tell my students at the end of my doula training program that one of the most poignant aspects of being a doula is about becoming rich with story. Stories of people bringing new life into their families are juicy. They can be mellow or wrought with drama, but they are always meaningful, always interesting. It never fails to fill my heart at the honour it is to be present for the unfolding of each unique and special story. Doing the regular doula stuff, like holding hands, soothing, wiping tears and breathing with are only a small part of the role. It is the BE-ing a witness and participant at the beginning of a family's story, and following up to process it with them, watching them revel in their own reaction to it, that is for me the most meaningful part of my work.

I have held the space for so many stories; triumphs, tragedies, healings, and growth. Most of the stories are wonderful, full of the amazement of women owning their own power as they roar their babies ecstatically into the world. These stories lend the entire world a little grace and our culture a little healing in that moment the mother/s, father/s and child/ren discover each other in an oxytocin haze, a new family member and citizen born. Some stories are of trauma, either due to an unexpected emergency or at the hands of others, these traumas being worked through partly by the doula's gentle whisper, "You have the right to grieve. I take it for granted you are grateful for a healthy baby and will never remind you of the fact to block your tears." A few end in disappointment. "It just wasn't what I wanted." It is what it is and we breathe that in as a reality and work on happy mothering anyway. Rarely, some end before they have even begun. There are angel babies I hold in my heart, having witnessed first hand their passing. I have seen caregivers shaking in shock while I shake in my own and we have sometimes held each other in tears, human and powerless in the face of another's overwhelming sorrow. It is true what Ina May says: your heart will get broken. But I have learned to love better because it, and savour the joys more deeply. A few end in utter surprise with me catching a baby just before the ambulance arrives or before a resident, without backup in an overcrowded hospital, gets her gloves on. Many are first babies, one was even a 12th baby (though it came before I got there, "the fastest yet", the mother said). Some are journeys of deep healing, a reclamation of wholeness to restore faith in one's body that was previously thought to be defunct until the emergence of a precious child. And some are the bitter sweetness of hello and goodbye as the surrogate gives the child she's lovingly carried to his mother, or he goes with the social worker to be given to another family, me left tearful in the wake of some grief, but at the incredible spirit of wisdom and generosity of some birthers too.

It is the stories I have been privileged to have been invited to be part of that make me a woman of story, and which grace me with the honour of being an "experienced doula". It is one thing to start out bright eyed and bushy tailed at the thought of going to births and seeing new babies come out, ensuring a safe, natural passage with your presence. Then it is another to learn the crazy ropes of hospital politics and how to play the game (resentfully at first), as many seem to hate you even before you open your mouth, as well as see that sometimes you can pull out every single one of your cool doula tricks and not have anything go better birthwise for the mother as she goes off for the Cesarean. These are the days of, "What did I get myself into?" when after 40 hours of labour support, your mommy deprived kids at home, and an overburdened partner, you are unsure of your place in this unpredictable world of birth. Then, as you gather up enough story to you and your face becomes more familiar within the places you work, you feel lighter, more in your element, having found your endurance and your stride. You don't feel hated really...maybe just a little misunderstood sometimes, but more appreciated too. And you are able to let go of the fact that you truly don't have any control over how a birth goes. You glean comfort from knowing your support meant that a hard situation will be remembered better, or that the hours, sweat, and tears you put into rubbing someones back through each contraction contributed to that unmedicated birth the family wanted. Finally, even when it seems everyone in the hospital is nuts that day and it feels like nothing you're doing for the family is working at all, you can stand back, breathe, and love. Just love. All of them. Sometimes it's all we can do. And it is good. Good for you, good for them. It is Presence in action, and it is more powerful than you can imagine.

As a teacher I get to witness others as they witness their first births, those first stories being the true initiation into the world of doula-dom. I see the the tears of their joy at seeing new life emerge, the frustration of long hours of pulling out all stops then the birth ending in surgery anyway, the shock of hearing unconscious words or seeing disrespectful treatment sometimes, to them or to the parents, and the bleakness of some family situations. As much as it is an honour to witness birth stories, ALL birth stories, it is an honour to witness others on the path to becoming experienced doulas, to see the shifts that occur as they grow from newbies to women of story. It takes a lot of time and effort to become an experienced doula and to have snippets of story from most situations imaginable, but it is well worth the effort. The more experienced I see my former students and present colleagues become, the more in love with the work they seem to fall. I know I do. Each experience inspires me to recommit. If you're in the beginning phases and feel a little isolated, drop us a line. Sisterhood is far reaching. Here's to you becoming rich in story too.

More Business of Being Born: Bridging the Divide in the Montreal Birthing Community

2011-11-18T14:03:00.003-05:00

It is with great excitement Betsy Thomas (of Bummis fame, whom I have had the pleasure of knowing for many years) and I (founder and director of MotherWit Doula Care) are joining forces to bring the first screening of Ricki Lake's and Abby Epstein's More Business of Being Born to Montreal.

There are a variety of reasons we wanted to do this. One is that it is always fun to inform parents-to-be or those considering parenthood about their options for birthing. The film we have chosen to show is one of a series of four, and it is entitled Doulas, Birth Centres, and C-Sections. It is an exploration of the options families have to choose from when making decisions about their birth experiences. Now granted, this film is American, so it will be important for us to put the options into Quebecois context. For example, many women have no idea that giving birth in a Birthing Centre or at home with a midwife is an option that is covered by Medicare here. And others may know this, but may not be aware that by the time their nausea has passed and they begin to think about their birth options, it will be way too late for them to acquire the services of a midwife as the demand for midwifery care FAR outweighs the supply here in Montreal. The vast majority of women who want the option of an out of hospital birth experience with a midwife will not have it. In and of it itself, this is a huge issue we as a community need to address and strive to remedy.

Another reason Betsy and I were excited about screening More Business of Being Born was that a gathering of "birthies" is always a lively, passionate affair. Bringing together the community of parents-to-be, new parents, birth activists, and birth attendants always creates the opportunity for rich discussion. It is through gatherings such as these that positive change can be made towards improving birth experiences for all families, no matter what they choose. It is for this reason I have organized a panel of birth attendants together for an after-screening discussion. I am so pleased to have on board my own beloved midwife for my fourth kid and author of Naissance Heureuse, Isabelle Brabant. Representing the crucial role of obstetric nurses in maternity care is Luisa Ciofani. Luisa has been practicing as a nurse for many many years at the Royal Victoria Hospital and is also a teacher of women's reproductive health as well as a certified lactation consultant. When a woman gives birth in a hospital, it is the nurse from whom she receives the most attention and care. We are also pleased to have Dre. Stephanie Morel from St. Mary's Hospital who is a family doctor specializing in maternal and newborn care. For women wanting a hospital birth but one that is typically lower in interventions and more open to maternal comfort (support for natural birth, support for birthing in mother chosen positions, support for delayed cord cutting and immediate skin to skin contact with Baby), the care of a family doctor is a wonderful option. The obstetrician on the panel is still to be confirmed. This is an important voice to have in a discussion among various birth attendants and consumers of medical care. Many couples feel most comfortable with the presence of a highly skilled surgeon at their births for "just in case" scenarios, and many must have the presence of an obstetrician at their births because of the high risk nature of their pregnancies. It is also important to remember that what contributes to the safety of our midwife and family doctor attended births is the available safety net of excellent back up obstetric care.

I will be representing the role of the doula in maternity care on the panel. I feel very fortunate in my work as a doula, which spans nearly two decades, in that I walk among the different "worlds". I may rush from a water birth with a midwife at Maison de Naissance to an elective Cesarean for a breech baby with an obstetrician. I may be at an induced labour of twins with the presence of a family doctor, an obstetrician, and two feisty nurses and then the next day witness a home birth in which the midwife skillfully catches a fast baby over the toilet. I may transfer with a labouring mom from Maison de Naissance to the hospital for a minor concern, and then continue supporting her while the family doctor eventually catches her baby (a VBAC) while she is on her hands and knees and the nurse turns off the light to facilitate a gentle bonding time for Parents and Baby. In all of these scenarios, my mandate is this: to support a family in having the best possible birth experience within whatever setting and with whatever caregivers are present. In my work as a doula, I have come to deeply value each and every role of the key players in birth attending, and it is with great honour I get to sit with some of them on a panel. Unlike everyone else on the panel, my role is entirely supportive, and entirely NON clinnical. My two cents has mostly to do with my having a deep understanding, given the closeness, hours of contact, and rapport I build with the families in my care, how they feel about their birth experiences; how it was impacted for the better or for the worse by the environment they birthed within.

The theme of this gathering, as well as to watch a highly anticipated new birth movie, is about bridging the divides in the birth community. Many members active in the birth community, from birth attendants to passionate birth activists, have criticisms about other members: their approaches, their choices, their methods, and their beliefs. This is the nature of having strong beliefs and opinions. However, I have personally witnessed midwives bash obstetricians, obstetricians bash midwives, nurses bash family doctors, doulas bash nurses, natural birthers bash those who loved their epidurals, pro Cesarean advocates bash those who want natural birth, breastfeeders bash bottle feeders, formula feeders bash intactivists, and so on and so on and so on. Personally, I'm tired of the bashing. There doesn't seem to be healing in that. What I want to see is a truthful but respectful discussion about what women want for their births, what collectively they have found to be most wonderful or hurtful to their experiences, what safe really means and what a family's responsibility is in making safe choices, and how everyone can work towards making the experience of childbearing as good, as joyful, and as pleasurable as possible NO MATTER where and with whom a baby ends up being born. It is important for people to know where birth practitioners are coming from, what motivates their decisions, what changes can be made to support what families want (and what perhaps cannot), and ultimately how to serve birthing families not only clinically, but supportively as well.

Our evening will be MCed by the lovely Shari Okeke, a reporter who has been with CBC Montreal for over 10 years. She will mediate the panel discussion and keep our evening running smoothly. Essentially, she will be our "event doula"!

Another important intent behind the screening of More Business of Being Born is to raise funds for Maison Bleue, and organization staffed by a midwife (Isabelle Brabant), family doctors, a social worker, nurse, and special educator (www.maisonbleue.info ). These dedicated members work together to create a safe, nurturing, and empowering environment for families living under precarious conditions to birth and parent their babies within, thus preventing many of the associated risks. All profits from this screening will go to Maison Bleue. Representatives from Maison Bleue will be present at our event to take donations as well.

In order to create an opportunity for even more fundraising, small community businesses who serve the Montreal community will donate some of their products/services for a silent auction to be held in the theatre.

The Bummis and MotherWit teams really hope to see you there! A great night for a great cause!

Time
30 November · 19:00 - 22:00
Doors will open at 18:30

Location
La Maison Theatre
245 Rue Ontario Est
Montreal, QC

Please note that space for this one of a kind event is very limited!
Tickets are $15 and must be purchased in advance at:http://www.boutiquebummis.com/fr/billet-more-business-of-being-born.php?adr=1or in person at Boutique Bummis:
4302, Boulevard St- Laurent
Montreal, QC H2W 1Z3
(514) 289-9415
*tickets will not be shipped but have to be picked-up at the door on the day of the screening*

Illustrating the Need for Change

2011-11-03T08:44:00.001-04:00

More Business of Being Born, four more films by Ricki Lake and Abby Epstein, is about to be released on November 8th. I wanted to take a minute to reflect upon how Business of Being Born has impacted my work as a doula.

While I was in the middle of watching the original Business of Being Born at a screening here in Montreal, I was called out to a birth. It was a first time mom, who had begun having contractions at about 37 weeks gestation. Right from the get go, things were speeding along, so I had to leave during the scene where the Woodstock hippies are dancing around. I was disappointed that I had to leave what was going to be a great night complete with a long awaited birth movie and a panel discussion, but hey, a baby was on the way. The knowledge that I was going to see a new being into the world quickly soothed my disappointment. I arrived at the hospital and Baby Danica was born smoothly and naturally very soon afterwards to her lioness of a mom.

A friend of mine had bought a dvd of BOBB, so I had the opportunity to catch up on what I had missed.

BOBB has impacted my work significantly. As a birth doula, my concern is with contributing to the necessary healing of our birth culture, which, in my humble opinion, is extremely challenged. Natural birth is seen as radical, and even crazy to the average person. More and more healthy babies are being delivered of healthy mothers via major abdominal surgery, grossly overreaching the 15% Cesarean rate the WHO recommends. The epidural rate for first time mothers in many Montreal hospitals is 98%. The vast majority of women receive some kind of hormonal stimulation to increase the "efficacy" of their contractions. Woman are delivering in positions that are antithetical to the natural mechanics of their birthing bodies. The way labouring mothers are engaged with intellectually, the room often filled with idle chatter or conversations which should be taken outside, when what they need is support for their primal brains to come to the forefront, impinges upon the natural flow of oxytocin, thus impacting a birth experience for the negative much of the time. Birth is essentially contained within an environment which places far more trust in the technology and medications than in the process itself. Ultimately, though, what frightens me the most is how the average woman views even the idea of normal birth as something actually unnatural, really having no idea of what the physical/emotional/and psychological benefits of normal birth are. When normal, physiological birth is held in contempt even by the women themselves, it is clear we have lost our way.

Business of Being Born serves as a critical and necessary change agent, illuminating the problems with modern North American birth practices. It teaches us how despite our oodles of technological obstetric know how, medications, and hospital beds, our birth outcomes are inferior to countries such as Holland and Norway which use midwives to support normal birth, and obstetricians mostly for treating pathologies in birth. The film shows evidence of the iatrogenic problems that can arise in birth when there is simply too much medical interference with a process that goes normally the vast majority of the time. We also get a necessary wake up call by witnessing American women being interviewed at random in New York City, being asked if they'd ever have a midwife. Not only do most say "no", but many look startled and begin extolling the virtues of planned Cesareans because they eliminate the big messy unpredictability of childbirth. I know many women AND obstetricians who watched this film with eyes wide open, the glimmering of an understanding of how essential change is if we want to protect the act of straight up, garden variety, unmedicated vaginal birth from becoming obsolete. Because honestly, in North America, we are almost there.

Not only does Business of Being Born depict the problems and illustrate the need for change, narrated by midwives AND obstetricians, it also lets us know how deeply moving, empowering, and incredible natural birth can be. Yeah, it hurts. Fair enough. But how that wonderful dance of hormones and baby love transforms women into powerful mothers when the journey is over is at the heart of this film.

What I found most important about Business of Being Born was that it isn't just a film which preaches to the choir. Sure, every "birthie" in town saw it, but so did many pregnant women and mothers who were not yet "converted" to regarding the possibility of natural birth as a desired thing. This film reached out to everyone, and many heard the message loud and clear. Personally, my clientele increased because more women were now savvy of what to expect for a hospital birth and wanted to come in with a presence who supported their desires for their experience, as well as honoured the safety net obstetrics and hospitals are seen to provide. BOBB emphasises how critical the support of a doula is for birthing, especially in hospital birth. The presence of a doula helps to increase one's chances of a more positive birth experience. Many of my initial contacts from my clients begin with their saying, "I watched this film called Business of Being Born, and I need your help to give birth within the hospital system".

One of the greatest gifts of this film, I felt, was the sharing of the personal birth stories of the creators, Ricki Lake and Abby Epstein. Ricki Lake is a well known public figure. She's been in films and has her own talk show. She discussed the birth of her first child, which was a hospital birth and not something she felt went the way she wanted. So she chose to have her second baby at home with a midwife. She honestly describes the struggle and pain of her natural birth, and her desire to quit a few times, as most of us do in labour, yet keeps on going with the encouragement of her partner and midwife. Ricki generously shares with us the image of her naked self in the bathtub of her home, birthing her baby, as something natural, beautiful, and absolutely triumphant, as an experience that helped her reclaim the power she felt she didn't have during her first birth. Hers is a story of healing and inspiration. Using her inspiration and her status as a public figure to illuminate the challenges of our birth culture, giving us a glimpse of how amazing birth can be by showing us her own story, has inspired thousands upon thousands of women to examine their own desires for their births. I wanted to stand up and applaud that someone whom, as a celebrity, celebrities being mostly viewed at the "too posh to push" types, was willing to share something so intimate for the purpose of illumination.

Abby's birth story happens near the end of BOBB. She goes into premature, very fast active labour with a breech baby. We follow her from her home where her midwife lets her know it's time to get to the hospital, to the lobby of her apartment where she is on her knees of the floor vocalizing with her friend Ricki doula-ing her, to the cab in which her waters break. She makes it to the hospital in time to have the Cesarean she and her obstetrician have agreed upon, and delivers a baby who is very underweight and with major breastfeeding challenges who has to spend time in the NICU. While she is sad that her experience was not the birth she was hoping for, this part of the film does clearly embrace the fact that problems DO occur in labour, and that our safety net of hospitals and obstetricians are clearly a good thing that we can celebrate, even as we move as a culture towards the idea of exploring more natural options for birth.

Business of Being Born presents two distinctly different worlds: midwife attended natural births, mostly at home, and highly medicated hospital births with obstetricians. One of the criticisms of the film I encoutered was that it gave Medicine a bad rap. Some of my doctor and nurse friends felt hurt. While they know there definitely major problems with the hospital system, their intent is never to do "bad" to mothers. As a developed nation, we do have the luxury of embracing home birth as a great option because of the safety net obstetrics provides if complications occur. They felt there was a suggestion in the film that midwife attented home birth is mostly good, and OB attended hospital birth is mostly bad. I would like to see a world in which both choices can be consistently fantastic and meet every mother's personal needs/desires.

As a doula, my challenge is to strike a balance between the two worlds and embrace the possibilities in both. While I do get to work with midwives outside of the hospital, the vast majority of my clients are hospital birthers. Many of these women wish to have, or must have due to health risks or lack of midwifery resources, their babies in the hospital. There are no pools to birth in, no opportunities to birth on the floor or a bathtub or by the side of the bed, and a lot of interruption from strangers. My goal is to bridge this gap, to facilitate the best, most natural birth process we can within this challenging hospital environment. A lot of the time, while women still receive the benefits of my tlc, they don't have the birth they wanted because they simply didn't have the control over the environment they wished to. I can do my best, but it takes two to tango. For the best hospital birth possible, medical caregivers need to be on board and respectful of the mother's wishes. There must be more openness to the mother's desire for more control over her environment, such as remaining quiet and observant whenever possible, following the mother instead of insisting she do what is easiest for the caregiver, and encouraging unmedicated birth if the mother wishes as well as unrestricted bonding with the newborn. The wonderful thing is that an openness is just beginning within the hospital system, as evidenced by many of the happy births I have been witnessing of late.

This is the exciting thing: several doctors I work with have seen BOBB as well. While it is never easy and can make one initially feel prickly to be lumped into the collective "problem" and negatively scrutinized when all you're trying to do is your work of keeping everyone safe and actually doing some great life saving work, I have certainly seen the acknowledgement of the need for change, and some changes in action. I have seen a general shift of more consciousness towards protecting the experiences of the family, more openness to women birthing naturally and in different positions, and more compassionate treatment. Many of the physicians I work with agree that the medical system is extremely challenged. While they are going to continue doing what they do, there are more who are trying to do it in a way that honours the importance of the experience of birth, not only focusing on a good clinical outcome. Obviously, as a mainly hospital birth doula, this shift in consciousness impacts my life immensely for the positive. While challenges are still rampant and there is much work to be done, I do feel the tides turning slowly.

In my lifetime, I doubt I will see a mass exodus from the hospital back to a homebirth majority. But hopefully I will see an environment where women can have what they feel is the best of both worlds: mostly uninterfered with, undirected births, but with quick access to the medicine and technology they want close by. If Dr. Michel Odent could create this environment within his clinic in France and enjoy both fabulous clinical outcomes and triumphant new families, maybe, just maybe, we can dream this hope into reality in North America for those who want and/or need a hospital birth. I am myself a home birther. This is where I feel safest and most confident. I am an avid supporter of the midwifery model of care, and hope there will soon be enough midwives in and out of hospital births to meet women's demands for them. But most women don't feel this way in North America. These ladies who prefer the hospital make up the majority of the beloved clients I provide support for. For the sense of security they get from being in the hospital, which is essential to their personal sense of safety, it is my wish they should never have to pay the exhorbitant physical and emotional price of having their decent birth experiences potentially put at risk with an often overuse of medical interventions without proper informed consent, an impersonal environment, and caregivers who are sometimes unaware of good birth etiquette. So instead of dividing the two worlds, for the sake of most women and not just the ones who are on either end of the majority, I strive to work on healing the divide so that everyone can have the best chance at a beautiful birth.

It is my greatest hope that this impetus towards a healing of our birth culture continues. The more awareness we bring to issues in and potential of birth, the greater the healing will be. I offer many thanks to all the creators and participants of Business of Being Born for having generated this necessary awareness on a huge scale, and am very much looking forward to More Business of Being Born to keep the momentum going.

Lesley Everest

MotherWit Doula Training Toronto

2011-10-20T10:34:00.004-04:00

I am so pleased to have been invited to teach the MotherWit Birth Doula Training Intensive in downtown Toronto!

It has been a passion of mine to bring my training to different cities in intensive format. I believe it is extremely difficult to learn the basics of how to be a doula in a weekend workshop. Ideally, a training of a couple of years would be more ideal. However, this is often not a format that works for busy mothers of younger children. Mothers and babies need to be together as much as possible, so I believe that it makes sense to be in a room full of women and babies as we learn how to tend to women and babies. So we do this more grassroots and oldschool...we sit around in the beautiful chaos of nurslings for six days and three evenings (meaning 3 eight hour and 3 twelve hour days), burning the midnight oil so to speak, as women do, as we learn the ins and outs of the role of the doula as being not just the lady who rubs a woman's back and spritzes her with lavender thoughout labour, but how to be an agent of real change when it comes to healing what is clearly a very challenged birth culture. We learn how to navigate a challenging, regulated, protocol/policy based hospital system to help a woman have the best chance of achieving her goal of having a natural birth (if this is indeed her goal). We learn about what healing means for each individual woman, how a great birth experience is not one which reflects a perfection of extremes, but one which makes the mother herself feel amazing and powerful on her terms.

Our goal? Happy mummies and daddies. Why? Because they tend to have happier children. And happier children tend to grow into adulthood more smoothly. When parents are left aching and depressed over an unsatisfying or even traumatic pregnancy, birth process or postpartpartum period, this has an impact upon the family structure. A doula's presence is known to create birth environments which parents find more satisfying. That satisfying experience is how we hope our humble role creates that ripple effect into the child's adulthood, perhaps even creating new legacies of happy births for generations to come. A good clinical outcome is obviously paramount, but the experience of birth for parents is incredibly important as they transition into being a family. Our work is about protecting and nurturing this experience, about working with the family to discover what they need for the best experience possible. And when things don't go as planned or hoped for, a doula is there for them to lean on to help process the experience and draw upon the parent's strengths and triumphs for speedier healing. Our kind, conscious, loving attention can buffer a lot of the pain involved in challenging birth experiences, again creating a better chance of parents and babies beginning their lives together from a place the feels whole to them.

Doulas are essential to helping not only healthy families have normal births, but to be an anchor of emotional support and comfort to women who come from very challenging places, having suffered abuse, violence, and abandonment, and/or experience very high risk pregnancies. We are steadfast in creating a space of emotional safety within which a woman can birth on her own terms according to her own needs. We can buffer fear, generate love, nourish health, and provide comfort to women who are suffering. We do this without judgement, honouring each woman's unique path.

Doulas, despite popular views, don't eschew modern medicine and technology when it comes to birth. Most of us have been there ourselves. Yes, we do believe the vast majority of time birth goes normally and needs little to no intervention, and we respect what is important for our clients to feel safe and supported. Most of our clients prefer to give birth within the hospital system with quick access to technology "just in case", so in support of them, we ensure they have knowledge of the procedures and protocols ahead of time, we encourage them to research benefits and risks of each procedure, let them know what is realistic to hope for, and encourage them, with the help of their caregivers, to research their options. This gives them the best chance of giving their informed consent or refusal, and increases their sense of empowerment. We never tell our clients what to do. And we don't fill them with fear of the hospital system either, as creating fear for the environment within which a client will birth is not condusive to that wonderful oxytocin flow they need for their labour to go as smoothly as possible. We outline the reality of the system, and this may sometimes seem scary to some, but we help clients to rally their resources to work through their fear, suggest ways to make them as comfortable as possible, and clarify their desires with their caregivers. We do this instead of adding fuel to the fire by suggesting hospital routines are a "bad" for those wanting a natural birth. I have seen many exquisitely beautiful, triumphant, amazing natural births in hospitals, so I know good support can transcend some of the challenge these routines create. I have also seen sacred Cesareans and epidurals being nothing less than a blessing, either by advance choice or surprise. The doula's support of a woman's sense of emotional safety is essential for her birth to be perceived as a good one for her.

A sense of community is extremely important for a doula to thrive and grow given the intense nature of this work. As we spend six days together, a sense of community and sisterhood grows, ensuring students have other new doulas to conect with after the training so they don't feel alone. My mentorship extends to after the training as well. Clearly I cannot take on apprentices when I train outside of Montreal, but I can still play a role in being a support person for new doulas, and encourage them to find experienced doulas whom they can shadow for a few births to learn the ropes. Mentorship and support are at the heart of the MotherWit Doula Training, as being a doula from a place of isolation is extremely difficult, and not condusive to growing into the practice as happily.

We also have a LOT of fun at our trainings, which are full of laughter, herbal infusion tasting, massage oil making, essential oil sniffing, massage giving, and most importantly, story telling. Women are story tellers. We learn and grow through a tradition of narrating our lives, our triumphs and woes. As doulas witness the birth of families, we become story keepers, which is a role I take on with great honour. At the end of my days as a doula, my greatest accomplishment is being rich with story. I wish this for you, that you are rich to bursting with stories of triumph and healing through birth that will be passed to the next generations.

If you are interested in becoming a doula, come check us out in Toronto from January 3rd to January 8th, 2012. Specifics about our training can be found at this link

https://www.facebook.com/event.php?eid=113164405449886

http://www.motherwit.ca/Doula-Training.htm

I'm looking forward to hearing from you!

"You Have to be One Tough Bitch to be a Doula"

2011-10-13T20:09:00.013-04:00

...This is the learning my recent students took most to heart....

I had the privilege of being invited to teach the MotherWit Birth Doula Training Intensive in Edmonton at Birth Source Inc, hosted by Tracey Stolarchuk. With great excitement, I packed my bags and flew on over from Montreal. At the airport, I met up with my friend, former student, and doula sister Sue Appleton Elliot, who is a birth doula at Apple of Your Eye Doula Services in St. John, New Brunswick. I was overwhelmingly grateful to have Sue's grounding presence, because I was nervous. Very nervous. Not because I was about to teach a 60 hour doula preparation class in six days, but because I was minutes away from seeing my father for the first time in over 15 years. I was so glad not to have to do that alone. Not that I was dreading the meeting, it was just so surreal.

Meeting up with my dad and his wife was lovely. It did my heart good to see my father doing well and living a life that satisfies him, having existed in the throes of terrible addiction for most of his life. I'm pretty proud of him for having climbed over a huge mountain of struggle to choose a healing path, and am amazed he made it out alive. He was proud to hear of a new grandchild (my sister's) and her marriage last year. We spent that evening having a lovely supper with them, and my father made plans with me to meet for dinner later that week. I had put Sue in charge of teaching that evening's topic so I could spend some time with my father.

It is always so exciting to meet in person the women who have, out of all the doula trainings available in North America, chosen mine to put them on the path to this crazy work. It makes me feel extremely humbled, and extremely responsible. You certainly can't teach someone how to be a doula in 60 short hours, but you can give them the overview of how to proceed, and set the tone for the beliefs they may bring to the birthing rooms they visit in the future. I was happy to see a feisty, dynamic bunch with lots of stories to tell. I knew we were going to have some fun.

My message is always very clear, that a "holistic" birth doula is not someone who believes an undisturbed environment and a healthy spritz of lavender will create the perfect birth outcome all the time. The fact is, most women in Canada give birth in hospital, and the fact is, most women want to, even though it reduces the normalcy of the process. So our work has to be tailored in support of each individual woman, in support of each environment she chooses to birth in. A good, healthy birth honours not only the precious biological blueprint of the birth process, but the resources, inner and outer, a woman brings to birth. An all natural birth can be an incredibly healing journey for many. Yet for others it is potentially an endeavour in terror, flashback, and trauma. We meet women exactly where they are, in love and support, and provide the most comfort and encouragement we can as she brings her baby into the world, on her terms, in her way, from her place of empowerment. If she comes through feeling amazing and powerful, even if it doesn't match our vision of "perfect", then this is healing and trans-formative for her. We rejoice. And if she doesn't feel that way, we are there to lean on to help her sort things out. A holistic doula nourishes the whole woman; her strength, her fears, her challenges, her choices.

After the first day of the training, I read a blog our hostess Tracey had written. It talked about her retirement from doula work, and that her parting gift to the new generation of doulas was the MotherWit Intensive she had invited me to bring to her home town. I felt an even stronger commitment to bring my absolute best to the women who wanted to learn, to live up to that faith someone I admire very much had in me to enrich the knowledge of aspiring doulas. I took that challenge and opened up, way up, and gave from a more spiritual, more emotional place than I have in the past, committing myself to my own authenticity, as I challenge my students to connect with and commit to theirs.

I looked around my group and it was clear what the theme of this training was going to be: "strength". Every training I have takes on a unique flavour. My first intensive expressed the impetus for building a strong community within which to learn and thrive, so the flavour was "sisterhood" in my mind. My second intensive was mostly full of strong, young, childless women who were inspired through their work and studies to help women birth on their own terms in a challenging environment. "Empowerment" was the flavour of that training.

I don't mean this Edmonton group was strong the way women are generally strong. These were women grounded in some serious ferocity. This was not a room full of hippie dippie patchouli doulas. These were women who have been around the block more than a few times and have held the space for some serious things in their lives. One lady had been in the Canadian Reserves and lives on Edmonton's military base, raising her three babies while her man is away in Afghanistan. There were a couple of nurses who are no strangers to pain, struggle, and every hard emotion under the sun. There was a drug and alcohol counsellor who compassionately sits with people when they have to detox from things like Listerine, as well as support them emotionally to get their lives back on track. We had a newly pregnant child and youth worker who flew all the way from a tiny island on the Bay of Fundy to meet with us in Edmonton. She and her husband were caring for a nephew at home whose mother was very sick. Sadly, the kid's mom died during the training, and my student will be going back home to support a child's grief. There was a woman who has worked in forestry for a decade. These are just some examples of the women who made up this incredible group.

What I loved about these women the most was that even though their strength was palpable, it wasn't harsh. They had the most loving hearts, and I know they will make any woman in their care feel totally safe, but really nurtured as well. And, wow, such amazing mothers these ladies were. I loved watching them all with their babies and toddlers.

The last day of our class is always a challenging one, as we spend time discussing the hardest aspects of birth attending; witnessing trauma, death, dealing with anger at a system that often isn't even conscious of some of the deep wounds it perpetrates sometimes, as well as how the intense enery of birth can launch us right into countertransference, opening up old wounds we didn't even know we had. I was already coming from a pretty raw place. The evening before, I was ready to meet my dad to spend some time with him, after 15 years of our not seeing each other or communicating much. I called him to see if he would be picking me up from the store after he finished working as we planned, his place of work being 5 minutes away. Apparently he had forgotten our plan. I pretended there hadn't been a plan so he wouldn't feel bad. I had to take some time to process that. For a while as Sue drove me in respectful silence back to our hotel, I felt like a kid who found out for certain that Santa Claus wasn't real. It's not that I had any expectations of my father suddenly being like a father...but maybe a little young part of me secretly hoped for it. I don't blame my dad. He is ageing and forgetful. But the truth is that we are just not part of each others' lives. This is not out of malice, but because even though we're related, we don't know each other. He was too sick while I was a child to ever be able to safely relate to him. I breathe that truth in. It is what it is. So a little time alone and a good cry of letting go with my husband over the phone, and I was able to come to a place of a better understanding: that I truly am a girl with no daddy, but that I do have a father who is doing his best in the world as a person and has done some mind blowing work to heal. He is kind, generous, and he is with a great partner. I like that. It is my responsibility alone to do with my feelings what I may, and blame certainly isn't going to be my choice.

As I was preparing the class a little later, it occurred to me how doulas often have a community of other doulas to process hard stuff with each other, because women naturally gravitate towards each other for emotional support. It made me wonder what doctors do. So I messaged by OB resident buddy for a chat about that. Yes, it is true, doulas and OBs probably do seem like strange friends in theory, but I have found this relationship to be quite healing, as well as inspiring. We swapped some really sad birth stories, and I learned that his greatest emotional support when birth gets tough comes from the nurses in labour and delivery, who are truly like moms to residents. I was happy to know that, and truly, not surprised. Nurses are pretty amazing, after all. I think it must be hard for doctors, who, given all their clinical responsibility, can't really hold a woman's hand in the face of emergency and cry with her afterward because they have to keep such a strong clinical perspective, yet their pain at what happens to their patients is just as acute as mine is for the sadness my clients experience. I feel doubly blessed for my community of doulas, and open our circle up to any doctor who needs a hug and a good cry when the dust of clinical trauma settles and the emotions begin to rise.

After a hard afternoon of painful topics on our last day of training, we talked about the qualities of a doula, and this is when it occurred to me how the hippie image of the doula is so incredibly whack. Media has it all wrong. We joke about it because while it's true we might be a little weird, most doulas I know aren't hippie-ish at all. I looked into the eyes of every one of these fierce women in front of me, and told them: "It takes one tough bitch to be a doula. When you have done this work long enough, you WILL see trauma you can barely contain, you WILL get your heart ripped open with grief, you WILL feel anger so strong at the sight of mistreatment, you will want to hurt someone. I WILL commit to continuing my work. I HAVE had my heart broken, yet I do it anyway. I HAVE experienced rage I've had to struggle to transform into love for those hands that will catch a new life, yet I commit to staying present, knowing it will probably happen again. This is my path, this is my choice, and this is how we can help to heal this culture, by choosing again and again to open ourselves up to love even when it hurts." Not one person flinched. Nobody turned around and tried to get out of Dodge as quickly as possible. Every set of eyes looked back at me with determination and even inspiration, and the words of a very wise mother in the room resonated from a guided imagery exercise we had done earlier in the day: "Love transcends all need for understanding." When the father is in pieces, if the baby has died, when a woman feels raped by an experience we couldn't control, when everything hits the fan at once, our role isn't to flesh out the reasons why. That's for the caregivers to do if it's even possible. Healing comes for and from us in the form of love; from the act of giving and receiving it, and from the sense of feeling worthy of it, even at our lowest. It reaffirmed to me the greatest compliment I have ever received after attending a hard birth: "You made me feel loved. When others couldn't meet my eyes, you loved me."

One thing I try to do in my trainings is introduce the concept of ritual or ceremony. Women, who used to cycle together and celebrate days of harvest and full moons together with ceremony, are particularly hungry for it. If we burn a little sage in class, eyes tear up at what seems to be an ancestral memory. My Edmonton ladies have already found ritual, as evidenced by the many awesome tattoos I saw (and I'm sure there were a few I didn't see). Many people judge people with tattoos, especially when the tattoos are sported by women. But really, with the world out of balance, commerciall-y baby showers taking the place of Blessingways and birth being something to schedule for convenience instead being seen as a woman's rite of passage into motherhood, it makes perfect sense to me why women would feel a deep desire to transform much of their emotional pain and personal experiences into body art through the process of enduring physical pain. This is a more ancient, less cerebral impetus towards healing. It doesn't have to make sense.

I wanted to take a moment to honour and celebrate the tattoos of my students. They all have stories, even if you may not understand their meaning by looking at them. Some tell stories of commitment, others of survival. A couple of them move me incredibly. One woman connected to our group lost a child years ago. Yet colourful butterflies of hope and transformation fly on her skin forever. How healing is that?! And beautiful. The one photo you see at the end may seem like the funniest, silliest tattoo ever, but make no mistake. If you knew this woman and her life, it is a profound message of surrender, serenity, and the gift of humour.

So, my inked up little Albertan badasses, love to you all. You are all tough bitches, and I mean that in the most loving way you can imagine. Go out and doula. It was an honour to meet each and every one of you. Merry meet, merry part, and merry meet again.

Tools for Change in Birth: Grace, Love, and Healing

2011-08-20T10:12:00.004-04:00

"...{Grace} is energy infused with a force greater than our own, a divine intention. When it arrives-usually unannounced or unrequested 'out of the blue' - it fills you with a luminous awareness that is different from everyday consciousness; it makes you come alive with vision and determination and the strength to act." -Caroline Myss

If there is anything I love about attending births, it is being witness to an act of Grace. If we regularly looked at life in more symbolic terms, birth would be honoured as the sacred rite of passage it is. Rarely is there an event in life where someone has the opportunity to dance with a massive force which, if you choose to dance, will raise you incrementally into an altered state, make you lose your inhibitions as you surrender your regular self to its pull, swaying and chanting, beguiling your body and mind to lose your everyday control, opening your body in extreme vulnerability but at the same time coaxing your fullest strength, and lifting you ecstatic and triumphant, with a new life in your arms , your identity changed forever.

I think the main reason I love attending births so much is because of the hits of Grace I receive, which are healing for me as well as for the one who births. I get to connect with another human being in the deepest possible way, witnessing a sacred act of creation work through her. She doesn't need me to control anything at all about her experience, but I can help her to feel safe and good about what she's doing when she questions what it's all for. She usually has a safety net of a primary caregiver to keep her and her baby physically safe, and my role is tend to her emotional safety and comfort. Through my connection to her, I help her to forge connections with the presence of everything that's there, not just nursing the pain, exhaustion, and challenge that are inherent parts of the experience and the ones our culture focus on the most. I try to guide a connection to the pleasure, confidence, reassurance, sensuality, and ultimately, Love, as connection these qualities bring beauty and strength to the experience.

There is nothing easier to me than loving a lady in labour. Even if she and I have nothing at all in common in our everyday lives, when Birth comes calling her to dance, regardless of how she dances with it, be it openly, resistantly, loudly, grouchily, or meditatively, she is in the presence of something incredible, and is worthy of unconditional love and support. I want her to feel entirely safe about doing what she needs to do to get through the journey, and know that she can look into my eyes to check in to find grounding and validation for how wonderfully she's dancing. My intention is for her to learn the lessons about herself presented in her unique dance with Grace, apply them to her life as a mother, and hopefully, to have her enjoy her ride as much as possible.

Everyone who is on the path of being a birth attendant has a unique Medicine they bring to the experience. Some have the ability to use their hands to calm, reassure, and create relaxation. Others are really connected to plants and know intuitively how to apply that medicine most effectively. Others generate the most healing with word medicine, sensing the right words and tone to bring peace and guidance. Some are particularly talented with surgery or other physical manipulations to manage and heal challenges in birth. I truly believe that these medicines are at their most effective when they are inspired by and applied with love. We can read about the correct words to say (or not say) or learn about why homeopathic remedy A is best for symptom B, or practice delivery techniques until they can be done in one's sleep, but it is love, based on a profound understanding of the woman and her experience, which empowers and enlivens the medicines we apply. When the woman feels loved and that her supporters are working from a place of compassion, whatever the outcome, her experience of Grace,and the healing Grace bestows when everyone is aligned with it, is increased. We all become part of this very special experience, and we imprint upon it for life, as we ourselves are imprinted. We all get to carry home a little bit of that Grace with us too. Empathy, compassion, kindness, and giving of ourselves for another is probably really healthy for us physically and emotionally. I know that my work makes me thrive and touches every aspect of my life, making me stronger, smarter, and more loving.

When students of doula work choose to use me as a resource in the hopes of furthering their learning, I let them know I'm not as concerned about how much they know or how "perfectly" they may execute a double hip squeeze...it's the quality of their touch, the quality of their presence for another person that is more important...their willingness to open their hearts vulnerably in love. It's about their willingness to explore their own unique "medicines", and discover not only how they can bring healing to birth, but how attending births heals them. The more we commit to healing ourselves, the more clarity we bring to our work, and the more profoundly we open to birth's Grace, which in turn generates even more healing on many levels for everyone present for it...whether those present are aware of it or not.

Maybe, just maybe, love can be part of the momentum that generates enough power to shift the pendulum of our culture so that the experience of birth is owned again by the birthing woman herself, and those that care for her are there to honour and trust her power, intervening only when warranted. This in no way means we have to give birth in huts again (unless we want) or eschew all technology if that's what's wanted or necessary...that's a perfectionist sense of owning one's power in birth. It simply means making the woman and her physical/emotional/spiritual experience the focal centre of birth again. Because right now, our cultural idea of supporting birth seems to be much more about Machine (paperwork, insurance companies, fear based protocols, iatrogenic patterns that give us as a developed nation comparatively unimpressive birth outcome stats, intimate procedures done without bothering to inform or ask for consent, contempt for "demanding" or non complicit patients/clients who want to "endanger" their babies by having "natural" or "medicalized" births, supporters who believe their way is the best or only way and push personal agendas and behave combatively) than Medicine (healing, support, compassionately applied technology, understanding of the deeper aspects of the birth experience, honour for the importance of the birth experience to be as good as possible for the greater health of the new family, supporting what is present right now, love). There is much change to accomplish. I'm game. "There but for the grace of god, go I."

De-Granola-izing the Doula Image

2011-08-07T00:23:00.003-04:00

When the average person thinks of a doula, images of earthy crunchy new-agey women with braids come to mind. We are teased in the media and in medical circles, our nurturing, supportive, natural earthy birthy vibe creating depictions of us lighting lavender scented candles and incense, chanting Goddess songs, eschewing all things "intervention".

I like to laugh at myself. There is obviously truth in humour. It is TRUE we do things like "hold space", spritz essential oil laden waters to liven up the energy in the birthing room, "point our toes" towards the place a doula sister may be attending a birth to add our positive vibes to the experience, and get really excited about babies coming out naturally. You're not going to see a doula running around the birthing room in an power suit and heels. You're more likely to see us with wet spots on our t-shirts indicating we have a nursling somewhere, a comfy flowy skirt (who can squat in dress pants?), and perhaps a chunky sweater to keep us warm in the hospital. So sue us. I do assure everyone that I don't eat granola, I don't dig tofu, and I want to smack people who break out into spontaneous sisters-in-the-light-of-Goddess songs during quiet, profound moments in groups. In situations like this you will usually see my MotherWit team and I giving each other sidelong eye rolls and subtle finger-down-throat gestures. As a crew, while we do the normal flaky stuff, we shy from the embarrassing. Our image is already hippie dippie enough without having to add fuel to the fire (around which everyone's arms are linked and are singing Kumbaya).

Given we are already teased to the hilt about our image, I think it's a good idea to keep the rest of our secret flakiness to ourselves. I have seen many doula businesses advertised with names that will never get a doula taken remotely seriously by any average mainstream client (who needs doula support as much as one of the "converted") and will alienate mainstream medical/midwifery professionals. You may not care about this now, preferring to maintain your own personal integrity about your beliefs, and so be it. But if you really want to work at your trade, it will be an important future consideration.

I'm not going to pick out any real names I've seen, but there have been some doula service titles that have made me cringe. I mean, I'm a "do what you will" kind of gal and far be it for me to criticize, but because I sometimes do talks with medical people and hold open houses for strangers to get to know my team and what we do, I'm hyper aware of not coming off as uber flaky so as to fulfill my intent, which is to serve whomever wants doula care. Preaching to the converted who may flock to the wafting lavender mist is easy. I prefer challenges.

So names that sound something like "Gypsy Moon Goddess Red Tent Doulas" or "Sacred Star Dust Doula Care" just don't fly, in my part of town anyway. What else? Join me in the fun! "Little Angel Spirits Manifesting Doula Care"? How about "Blessed Womb Fruit"? "Patchouli Breath and Unicorn Farts" or "Vaginal Way Doula Collective" really sum us right up!

I think we should have some bad ass names just to balance out the granola image. How about "Jesus Built My Hotrod Doula Services"? I like "All Liquored up Roadside Doula Services....and Waffles!" Ah, we could get so creative!

In any case, revel in your granola-tude ladies, but be aware that as an important and growing presence in maternity care, our image is definitely something to consider. Find balance and be accessible...but don't sell out!

Peace, Babies!

How Medical Professionals Can Improve Birth Experiences

2011-06-25T09:22:00.005-04:00

While we have many benefits to our maternity care system, even medical practitioners will tell you that there are also many flaws.

As a doula, while I work within this system helping women have the best births they can, I am not of it. It is my job to do my best for my clients, using the more grassroots skills of birth supporting to facilitate their normal labours, while respecting the parameters of the hospital protocols and policies. As most who have birthed within this system know, the hospital routines do much to disrupt the flow of normal birth, making the job of the mother (and doula), extremely difficult at times.

I believe in being realistic. Obviously, we cannot at this moment in time recreate the environment of Ina May's Farm, with its amazing birth stories and outcomes. As a doula I cannot make the system suspend their routines. Even if the doctors and nurses wanted to, they themselves are bound to work within the rules of the environment. So for now, it is what it is. I believe in improving what exists right now before projecting into my future vision of the perfect hospital birthing centre. It is by grounding ourselves fully in the now and keeping our feet planted on the earth that we can reach for the sky. My mandate is to work with what exists in our immediate situation.

Right now, even within the limits, there are ways to improve maternity care, contributing to the safety and enjoyment of a family's birthing experience. It is my hope that by witnessing the evidence resulting from these changes, the new generation of medical maternity professionals will begin to create change to the infrastructure of the hospital system in conjunction with the powers that be that make a hospital run. Big dreams, huh? But why not? I believe in ripple effects and morphic resonance. I believe that our birthing functions are highly influenced by our culture. Culture is something that can be created. These are my humble suggestions of what medical professionals can do to contribute to the healing of the hospital birthing culture and improve birth outcomes.

1) Understand Normal Birth

Normal doesn't refer to how about 98% of babies born to first time mothers come out, which is with the mother epidural-ed and on Syntocinon (Pit for you Americans). This type of birth is marked down on records as "normal vaginal delivery", but it is not. It may be considered normal because that's what usually occurs, but given how the body works and the dance of amazing hormones and mechanics that must align to get a baby born naturally, this scenario is anything but normal. In order to change hospital birth culture, we must get back to the original definition of normal birth. "Natural" birth does NOT mean "vaginal" birth. A natural birth is one that is for the most part ummedicated. I won't get into variances much here, but personally, I believe if a woman receives some Synto at some point in labour, as the environment impedes her own natural flow of oxytocin, and she births with no epidural, that goes down as a natural birth in my book. Purists would argue, but remember, I'm talking hospital birth.

I feel that student doctors and nurses should shadow a midwife or doula, someone who's cultural view of what normal birth entails is different from theirs, in order to witness how labour really works.

Though obstetricians are absolute experts in dealing with our birth emergencies (and God love 'em for it), the vast majority of them have never hung out with a woman from near the beginning of her labour to its end. They have not sat with her prenatally, discussing some of the factors in her life she brings to her birth experience, understanding her fears, concerns, and hopes and listened to her at length. They are not aware of some of the emotional issues she has that could potentially impact her labour. They know labour from walking into a hospital room, asking questions, reading monitors, checking dilation and fetal position, and "delivering her" when the time comes. They don't come to her home afterwards and hear what she has to say about it, how she feels, how the experience changed her life (for better or for worse). Medically, labour is something that exists within a given set of guidelines, and when birth doesn't fall into those guidelines, a woman is treated with drugs or instruments. Rarely have I seen an obstetrician turn to the very simple things that midwives and doulas know could effectively put a birth back on track. To really be an expert in something, I believe witnessing what its true normal is is crucial to our greater understanding of it. Facilitating a new doctor's witnessing of a normal birth or two without the distractions of being the clinically responsible one in the room is something we CAN implement now. Yes, I know the students and residents are really busy and that they are needed for emergencies. But I have this sneaking suspicion that if they could truly see what birth is in its essence as opposed to its symptoms and pathologies, we may see some radical changes to the hospital birthing culture, leading hopefully to less emergencies.

2) Acknowledge How Sensitive Birth is to the Environment in Which it's Contained.
Most doctors acknowledge that stress plays a huge part in the etiology of many of the prevalent ailments we have in the modern world today. They prescribe reducing stress, some even recommending the benefits of yoga and meditation. They know that exercise releases endorphins and contributes to mental health and well being. Blood pressure often goes down when stress factors are reduced. These are common sense givens.

It is widely accepted that tension can contribute to our digestive dysfunctions, resulting in constipation, diarrhea, ulcers, etc. Stress contributes to sexual dysfunction too, leaving folks with little desire or ability to "perform".

Birth is a physiological function that is both about elimination and sexuality, both functions highly affected by a person's emotional state. Something has to come out, and the woman needs to get into a certain state for it happen normally, surrendering to wavy sensations that make her dreamy and uninhibited enough to move a baby through her vagina without a memory of trauma anchored into her experience.

The hospital environment is inherently stressful. Visible machinery is around to remind a woman that complications may happen. It smells like antiseptic, which is associated with illness. Studies have been done which suggest that changing the smell reduces the rate of intervention. Women are constantly told that they have to be monitored and measured to ensure everything is okay. It is well known in midwifery and doula circles that a dark, quiet, comfortable, private space is one most birthing women respond to well. Birth tends to happen more normally, meaning her oxytocin and endorphins work optimally and she can move around as she pleases to facilitate the mechanical process, when a mother is disturbed as little as possible.

Of course, we cannot ask doctors and nurses to not do what they need to do to monitor a mother and baby the way their hospital dictates, but there can definitely be improvements within the given parameters. There are simple ways to protect the environment for a mother to contribute to her nice hormonal flow, even when there are protocols to be followed. For instance, knocking gently at the door and closing it softly would be a huge improvement over barging in and leaving it open, exposing a woman to all the distracting hospital noises in the hall. Instead of flipping the light on to read machine outputs, carrying a pocket flashlight is an incredibly sensitive way of keeping the environment dark and undistracting. Obviously, nobody is suggesting this if there is a real concern, but for routine checks, why not? Not engaging in idle chatter is also a kind way to leave a mother and her partner the focus they need to get that baby out normally. Doctors and nurses are often very friendly and really enjoy getting to know their patients and making conversation, but interestingly, I find the ones who create a lot of idle chatter and bustle, or who explain every single thing along the way, like "Okay, now I'm going to change your chux pad to keep everything clean...we don't want you to end up with an infection. I just had a patient the other day who had such a bad infection...." have patients who end up needing more interventions.

If you're in the bathroom trying to poop after it's been a couple of days, the last thing you'd want or need is a friendly chatty person on the other side of the door, or worse, opening the door and looking at you, talking to you about the weather. If you were trying to get it on with your partner, having someone barge in with the door hitting the wall as an extra oomph to indicate their efficiency, leaving it open for people in the hallway to look in while strolling by, saying, "Don't mind me, I'm just going to restock a few things...may as well as it's not a busy night tonight," you just mind find your mojo fizzle a bit.

Conversely, making no contact with your patient isn't good either. A nice sit down little visit in which you ask a woman what you can do for her is an amazing morale boost she will appreciate. When someone takes time to check in gently then leave the couple to it, they always say, "Wow, that person is really nice!" Feeling like someone cares about what they may want builds trust, so that if you need to intervene in some way, they know you have their best interest at heart. Doing vaginal exams while on your hospital phone or not introducing yourself before doing some kind of assessment is NOT going to get you in the good books. So if we go back to the poop scenario (and I apologize for that), if someone is having trouble in the bathroom, having someone outside the door who's taken a little time to get to know them saying, "if you need anything, I'm here, but I'm going away now to leave you to it" can be much more security building than feeling like they'd have to call on a total stranger for help.

As a medical practitioner, you must honour that labour is sensitive to these distractions. It's not women being demanding divas...it's the fact that like pooping and making love, the process is easily disturbed. Except that once labour is disturbed, the ensuing problems get treated and the birth itself is blamed for having gone abnormally. No fair. This leaves women feeling like they didn't work. So yes, do the job you need to do, but do it with consciousness towards the environment. Saying you have no time is not a good excuse, because in the end, normal birth is a lot less work for you to deal with than having to set up an IV, do a catheter because of an epidural, worry about having to do forceps, etc. And don't worry...if a true concern is bothering you, rarely is anyone going to mind you turning on a light or having a discussion at that point. That is, after all, your job, and the reason most people choose to have their babies in a hospital...to have the benefit of your skills and expertise. Nobody believes that a good environment alone guarantees a great birth...but you'd be surprised at how simple adjustments to it can put a labour that seems stalled onto a better track and how respect for it can prevent some problems all together.

3) Watch Your Words!

There are some things medical practitioners say that are most likely meant to be funny or inspiring, but often just create doubt and fear in a mother. And what do doubt and fear do? Dampen the hormonal flow. It's very simple. Keeping those hormones flowing happily and easily contributes to better birth outcomes much of the time. You want to PREVENT having to use the tools available, not unwittingly contribute to their necessity once the birth vibe has been disturbed to the point of no return.

Harsh, critical words are rarely appropriate in birth. Okay, if there is a true need, sometimes saying, "Okay, Honey, now it's time to give a REALLY big push!!!" is helpful. But for the most part, sensitive labouring ladies can interpret common comments as criticisms. Again with the sex, but we ladies know there's nothing like the buzz kill of someone saying something like, "oh, Baby, you are so sexy...I totally want you. Oh, look, your boobs are saggy!" It's hard to proceed after that. Or, again with the poop, but what if you had a room full of people staring at your naked butt, you with your knees up to your ears, while they shouted at you to PUSH, and then they told you you weren't doing it correctly, that you weren't pushing WELL. I wonder how much longer it might take than normal for that defecation to finally happen?

Here are some of the phrases that need to be kept to oneself while making a clinical assessment that is perhaps for you a red flag, but has not shown itself yet to be causing a real problem in labour:

"Wow, that's not a small baby, is it?" Women are understandably terrified of birthing a huge baby. The fact that something on average of 7 pounds or so has to come out their vaginae is a concern enough for most. Adding fuel to that fire by that comment will, in Ina May speak, clench up the sphincters. We want those sphincters to OPEN, not shrivel in fear. These words will prevent opening in many women. Poking about inside a woman's pelvis with a doubtful look upon your face, saying, "hmmm, it's not so roomy in there, is it?" is also not so helpful.

I know doulas who have been told by medical practitioners, upon having been taken aside to give them a heads up that their patient has been sexually abused as a child and that certain phrases most people can handle are terribly triggering to a woman who is about to give birth, such as, "open your legs, I'm going to put my finger inside you," or, "you're so tense...if you just relax this won't hurt you so much.", that all that is just hocus pocus. I have had clients told, "If you're bothered that much by my finger, how on earth do you plan on getting a baby out of there?" I heard once in response to someones simple request to be upright in labour, "This is obstetrics. You don't always get what you want. When it goes well, you're lucky." Well, the last time I checked, birthing women aren't practicing obstetrics, they're trying to have their babies. That statement implies, "I'm the one in charge here, not you. You can have all the good intentions you want, but it will probably be dangerous, and I'm the one who is here to save you, so do what I say." How much do you want to bet that created a self-fulfilling prophesy?

Language is incredibly powerful. A doula's magic is often about creating "word medicine" to counteract well meaning but insensitive comments..like the "Gate Theory of Pain Mechanisms," but in emotional terms. Nobody is asking a medical practitioner not to be honest with their patients about their situation, but paying attention to the wording is crucial. I recently saw an amazing example of how a challenging situation was given much hope by a sensitive resident. A client of mine had been labouring for an incredibly long time with very little progress. She was becoming exhausted and frightened that labour would never progress. Being in the hospital, she was now in a situation where medical suggestions were going to be given. The resident said, "you're doing great! You're doing everything you can and coping really well. It's true there hasn't been a lot of change in your cervix for 24 hours, and there is a potential for concern. But in obstetrics, we don't even consider you having a problematic labour until you're having strong contractions at least every three minutes lasting for a good minute. You haven't even gotten there yet, so here are the things we suggest to get you to that point before we even think about diagnosing a problem...." Worded this way, the woman had hope that there was still a lot of room to try some different medical things to get labour moving. Her struggle was honoured, she was praised, and was told not to worry, that there were still options before anyone started announcing the dreaded C-section. This powerful choice of words I feel contributed to those medical tools working well for her and her coming away with a really positive feeling about her birth. It could have been said like this, "You have been here for 24 hours with hardly any change to your cervix. We're looking at a risk of dystocic labour which can lead to (insert horrors here). Clearly you need help as your body isn't doing it on your own, and if you don't choose these things right now you are endangering your baby." Sadly, I see that wording more often that not.

4) Trust the Woman

The body that has forged this baby and that is working hard to get it out probably has valuable insight into what's going on inside her. Even if she happens to be incorrect, it is still worth investigating for her, making her feel respected and heard. A student of mine went into labour at 34 weeks. Because she was very quiet, a nurse kept telling her she wasn't in labour and that she should just go home. The monitor wasn't picking up contractions, so she wasn't believed. The nurse left the room and the baby was born unassisted. I as a doula have actually caught a couple of babies in the hospital because nobody believed the grunting first time mother standing by the bed could be fully dilated when she was just 4 cm 20 minutes before.

It saddens me that many women get eyeballs rolled at them (behind their backs) and get treated like bothers as opposed to the honourable life givers they are in that moment. After a long birth I have had nurses come up to me and say, "how did you deal with her? She was SO demanding!" when I never really interpreted her as anything more than that natural birthing woman she was. Birth is hard. It's even harder having a natural birth in a hospital environment. Many women need to be touched and encouraged a lot. I just find that normal, not demanding. I do that because I love to. When medical staff interpret natural birth as cumbersome, we are lost. I trust women know what they need intuitively much of the time to get the job done. If she wants to stand on a chair because the floor feels cold on her feet, fine. If she wants to sing or howl or moan, great. If she wants to cry a lot to release pain and tension as her cervix blossoms, beautiful. If she wants me to press into the small of her back for eight hours, great! This is my trusting her. Sure, there are times suggestions are warranted because she's caught in the "rock and hard place" space, but even then I think the baby will most likely come out given enough space and time.

When women are forced into a certain position and told how to push, this shows a lack of trust. They are told, "You're baby WON'T come out if you don't push HARD!" They're told if they don't have the episiotomy they will end up torn from stem to stern (which strangely enough, I have almost never seen happen when a woman refuses a non emergency episiotomy...in fact, often they don't tear at all). It is assumed they will lose all control and just squat in a corner and birth there if there aren't some ground rules (really, would that be so bad?). Sometimes it is even assumed that because a woman claims to want a natural birth, she is stating that this is her intention at all costs. This is a very damaging assumption. There is not trust in it at all.

Obstetrics focuses so hard on the pathologies than can potentially occur in the birthing process (and that has many benefits, obviously), that a lack of trust in the normalcy of it develops. There is a terrible lack of trust that everything will be okay if the woman just does what she wants in labour. Really, though, if all hospitals were equipped with Dr. Michel Odent's "salle sauvage" with a comfy platform of cushions, a birthing pool, perhaps a rope to hang on, and the constant presence of a patient woman (a doula or midwife), intermittent auscultation, almost no vaginal exams, and freedom to do what she wants to cope, how much LESS would we actually need obstetricians? If a woman received more trust in her birthing process, I do feel the rate of needed interventions in birth would go down. Isn't that what we ultimately want? It should be. If an obstetrician loves natural birth and wants to be involved in it and not just the complcated cases, that's awesome! Then they are probably part midwife at heart. Maintaining quiet clinical vigilance while having good faith in the woman's body lends well to maintaining the physical and emotional environment women need to give birth within as normally as possible...and hey, if shit happens, they have all the skills and tools available to do what they need to do.

5) Remember that Birth is Sacred

Okay, pour granola over that and add a drop of patchouli if you want. Have your giggle. But it's true. This is the birth of a child, a human being's very beginning. It is the most monumental event in a family's life. Their experience shapes how they parent, how they feel about themselves as birth givers. It affects their lives. It is for a reason that a woman's state is usually one of ecstatic trance when she delivers her child happily and normally. It is so she can fall madly in love with her baby. Be part of that love fest. It's good for your health.

Connect with your patient in a way that will make them remember you fondly. Every day you step into the case room, you have the opportunity to create a positive experience. It doesn't take much more effort than you would normally have to expend. Make eye contact. Smile and say hello. Ask her what she needs. Don't be afraid to offer touch that's not clinical if this feels appropriate. Kind, loving, encouraging words from a medical person are particularly powerful. You will be remembered for the rest of that family's life, as this is a sacred day. If there is one thing I ask you to remember, it is that.

At the end of the day, what interventions a woman may have had during birth will probably not have as much impact on her as how she was treated and how she feels about her overall experience.

I leave you with a personal story to show you what I mean. I'm an old natural birth promotor. I am not into most hospital protocols. I like the squat in the corner approach. When I was pregnant with my first chid I walked into the hospital I planned to give birth in to check it out, walked out and knew I simply couldn't do it there. I felt profoundly unsafe. I knew home birth was my best option. So imagine me during my second labour, after having had a beautiful, empowering, amazing home birth to my daughter, ending up having to transfer from midwifery care to a hospital to receive medical care. I cried a lot standing in the parking lot of the midwives' birth house waiting to get my non progressing butt to the dreaded hospital. I was scared. And lo and behold, I had actually had a really nice experience. I am one of those really lucky ones, yet it would be so easy for everyone's experience to be similar to mine.

I was only there a few hours before my son was born naturally (all be it facing upwards), but in those few hours I encountered a couple of doctors who made the experience good for me. Of course, I arrived at the hospital at shift change. I saw a doctor I recognized from having attended births several times at that hospital. I started sobbing saying I was having a hard time. Instead of freaking out and worrying about ending my suffering and getting on my case that I should have been in a hospital in the first place, she diffused my drama in a wise, motherly way, put her arms around me and actually slow danced me through a contraction! I cannot say how good that felt to be vocalizing into her secure, substantial bosom! She broke my waters for me, which actually did the trick, and I remember her saying, "There, Mamaleh, you were around 4, not you're 7."

She left soon after, and I was so nervous someone not as understanding would come on shift, but I was blessed yet again by a lovely older male doctor. I only remember snippets, but his positive, gentle presence meant so much to me, and I remember it almost 17 years later. I was yelling like a banshee, yelling for an epidural, but refusing one at the same time. Sure, perhaps there was some serious eyeball rolling out at the nurse's station, but the doctor never projected any annoyance of me at all. I was a mess, screaming between contractions with back pain. He wasn't afraid of me in my rawest state. When he needed to communicate something to me, instead of roughly trying to get my attention or telling me i wasn't helping myself all out of control like that, he stood near me quietly and calmly. When the pain took a small break, I'd look at him and say, "I'm so sorry, I'm so sorry, I don't mean to be screaming in your face." He would touch my arm, look me in the eye and say, "it's your second baby, you're nine centimetres, you're almost there. It's hard." He would tell me not to apologize, that he knew it hurt. When my baby finally came out posteriorly, the resident, also very kind, didn't need to hand him to me as I grabbed him by his shoulders and took him myself. I looked at both these respectful, gentle men and told them, "Thank you." They told me I was a champion. Not that I need my ego stoked, but for some reason those simple words validated everything I had gone through to birth that baby naturally (which I don't regret one bit) and the fact that they took a second of their lives to honour my experience remains with me. Frankly, I don't at all remember the several vaginal exams I received. I don't remember being tethered to the machine for the few minutes I pushed. I don't really worry about the fact that my baby needed to be examined because of grunty breathing and was taken away from me for a minute, and I don't remember much of a managed third stage and an iv inserted because I was bleeding.. and remember, I am one of the "routines disturb birth" preachers! All those things I planned to avoid and worried a lot about prenatally when I envisioned my unexpected hospital birth experience pale in comparisson to the very positive emotional feedback I received from the doctors who tended to me. That's oxytocin for you...it makes you trusting. When you reach out and find someone kind on the other side of your pain, the effects are amplified by the presense of that lovey dovey hormone. I wished I could have had my baby at home, but I have no complaints about my hospital birth.

I hope this story illustrates how easy it is to honour a woman's birth experience and how easy it can be to infuse her experience with something positive she will take away with her and remember almost 2 decades later..and probably will forever. It's no matter that the doctors likely don't remember me at all. It means a lot to me that the first hands that touched my son were kind and gentle ones. I feel he probably had a very nice imprint in those first few moment of his life...patient hands and a mother who was made to feel like a champion. Not a bad way to come into the world. You hold the power to create a happy beginning like this too. Whenever you feel impatient or harried, take a second before you walk into a birthing room to take a breath, and focus on the now. This woman in front of you is bringing forth a new life. This is sacred. Please, please don't forget that.

Considering Doula Training? Come Join me in Nova Scotia!

2011-06-06T15:32:00.005-04:00

There are times you come home from a birth and are filled with the feeling, "I understand many of the things I saw happen in the hospital were done by good people, performed with well educated as well as loving intention in the hopes of sparing a labouring mother and baby from unwanted birth complications.... yet despite that, I cannot help but feel I have witnessed something brutal." What do you DO with these feelings?

Sometimes you can come home with all of the beauty and struggle you've witnessed and feel like there's no way to ground it all, and to process everything you've seen and learned. How do you build a community to gain strength from?

Birth is an amazing thing, and you may feel like you want to participate in the process, helping a couple feel emotionally safe and supported while they work hard to bring their baby into the world. How do you go about doing so?

Perhaps you've always wanted to be involved in childbirth, but didn't feel like you wanted the clinical responsibility that being a doctor or midwife entails. Where do you go to learn how to provide empowerment and comfort to women birthing in all kinds of different settings?

You may see the childbearing year as an opportunity in a woman's life for immense healing and personal growth, and wonder how you can learn to nourish her health and build up her resources to birth the way she wants. How do you learn how to move beyond "timing contractions" and applying techniques, to truly embracing the whole woman and guiding her to finding her strength to give birth happily, whatever that means to her?

Are you interested in not just witnessing and helping with birth and mothering, but in participating in creating healing for our challenging birth culture one mother, father, and baby at a time?

Are you interested in getting off the divide between "us" and "them" when it comes to a holistic vs. medical approach to childbirth and learn to build bridges to create healing on a global level, serving what women want and where they are at right now?

Would you like to learn how to be a doula in a beautiful environment, learning not only about the art of doula care but discovering more about yourself, your strengths and your fears, and finding opportunities for your own personal growth and healing?

Would you like to learn how to be a doula in a supportive community, receiving feedback and followup as you transition into your important role?

Would you like to feel that mothering and learning are not mutually exclusive, and feel that your nursing child is welcome within a circle of women learning the same things?

Would you like your learning process to be a powerful, nurturing, transformative experience for you?

Do you want to immerse yourself in the learning of all things birth-y over a period of six days and evenings in a workshop that goes beyond what you ever thought you knew about being a doula?

Would you like to let go of the pettiness of politics and mandatory qualifications and fear based impositions to flourish as the doula YOU are meant to be, embracing your work as the grassroots but deeply socially responsible role it is?

Would you like to learn the art of doula care from someone who has been doing this work for nearly two decades?

Did you know that a doula is not a liscensed professional, and that papers and organizations are not necessary to bring your very best work to a birth? Certifying papers show you have met the requirements of any given body who provides doula training and an outline of agreed upon doula behaviour. While this is a great way to feel you've accomplished what you set out to do and a good way to know you are on the right track by being evaluated by an experienced person/organization, you are technically allowed to do doula work anytime in your life, with or without papers. Would you like to feel confident about your abilities to provide excellent doula care even if you are called on to be at a birth before being or without being certified?

Then come and join me! I am giving a training in beautiful New Germany, Nova Scotia, at Windhorse Farm www.windhorsefarm.org from July 24th to July 29th.

The deadline for applications is June 18th. No applications will be taken beyond this point. For more information, go to: http://www.motherwit.ca/MotherWit.ca_Birth-Doula-Training-Intensive.pdf

I would love to see you there! Send me and email and we can chat about it if you have questions. Payment plans are an option. info@motherwit.ca

This course is neither the beginning nor your end of your journey. Never at any point will you learn all the tricks to being a doula and then you're done. It is a life long process. It is my hope this training will serve as the garden where you will push down your roots deeply and find nourishment, so that one day your branches reach far into the sky as you contribute in your own loving, unique way to the path of healing.

How to Prepare for Birth

2011-05-19T09:10:00.005-04:00

The sensations of labour vary for every woman. Not only from woman to woman, but from labour to labour. I have had births that felt virtually painless for most of the labour, to having sensations that kicked my ass leaving me breathless and begging for mercy.

I honour whatever approach people take for their births. We all have different personalities and make-ups, and everyone has a different relationship to strong sensation. For me, while labour pain can be extreme, I can handle it. Unless there were a really good reason to do so, my choice is to not take epidurals or other forms of pain relief to manage the sensations. It hurts a lot, yeah, but having been through it, the endorphin and oxytocin reward at the end of the journey is so worth it. It is the most intense high I have ever had. I can draw the memory of that high into my being far more easily than I can the body memory of the pain. But the sensation of nausea? Youch. If I had the kind of nauseated labour I see some women have, or if labour felt anything like my first trimesters, I would seriously question whether or not I would want to have natural births. The sensation of nausea is so odious to me, that given the choice between a 36 hour posterior labour and a 12 hour stomach flu, I would absolutely, without any misgiving, choose the 36 hour labour. Because of my intensely difficult relationship with the sensation of nausea, I have compassion for women who have a feeling the sensation of labour might be something they absolutely abhor. Some people can handle achy pain but not sharp pain, or some breeze through a terrible bout of food poisoning cramps, while a migraine may traumatize them. It is such a subjective thing that it is important not to pile women all into one group, give them one method to prepare for labour, then send them off promising if they do it correctly they'll "be just fine". One may argue, "But labour pain is normal and natural, something good is happening in our bodies, therefore it can be done...it's not like the stomach flu or migraine, which are pathologies and trigger a stress response, thus exacerbating pain." True. But nausea and vomiting in labour are totally normal and natural as the body makes room and purges what it doesn't need..it doesn't mean I'd like it or be okay with it. Despite its normalness, it would trigger great anxiety in me. Luckily, I don't have pukey labours.

The challenge with birthing is that, if you've never done it before, you're not aware of how intense it's going to feel or how you're going to cope....whether the sensation is one of those types that's "safe" for you or challenging on a deeper level. This creates anxiety in women. When I work prenatally with my ladies and they invariably tell me they are nervous about their upcoming births, I say, "Great!" This is an opportunity to explore where she's coming from. I reassure the lady in front of me that it is perfectly appropriate to be anxious when teetering upon the precipice of the complete unknown. Using that energy usefully aids women in gathering to them what they need: resources, both external (support, primary care, knowledge of ways to help them cope) and internal (emotional exploration, cultivating an ability to relax and breathe deeply, maintaining presence with challenging sensations or emotions). A doula's job is to help a woman build up her resources.

Part of my prenatal care is to ask a woman what kind of approach she'd like to take with her birth. This helps me to figure out whether or not she's interested in having a natural birth. Contrary to popular belief, it is not only the flowery skirted ladies with a stockpile of incense to last through the Age of Aquarius, or whatever age we happen to be in, who hire doulas. In fact, those who procure the services of doulas in my neck of the woods are usually urban professionals in their mid to late thirties who are highly educated and well read about the birth process, with a lot of concrete ideas as to how they'd like to approach their birthing sensations. They've found whom their friends and relatives have told them are the best obstetricians in town. Their belief is that the combination of good obstetric care and the nurturing supportive care of a doula creates the best of both worlds for them. While many of them really do want to "go natural", there are those who are not that interested, and want their doula there to help assuage their fears and hold their hands through the epidural and just be a friendly face to hang out and make them and their partners comfortable. Fair enough. I serve whomever wants me at their birth, and my mandate is for them to feel like rock stars no matter what their approach. But I do have a few guidelines I feel are important for all of them to consider.

1) Prepare for anything and know you're great no matter what. Just about the only thing I can guarantee about birth is that it is unpredictable. I guide my clients into getting their heads around all contingencies. While I absolutely believe that the VAST majority of healthy women with good heads on their shoulders, if well surrounded but undisturbed in a cozy environment they felt safe and supported in, could have their babies with little to no intervention, birth, especially hospital birth, takes some preparation and knowledge. The whole, "Do nothing, have no fear, and you'll just open like a flower" approach is not useful or realistic in an environment that tends to make sphincters shrink rather than blossom. Neither is the, "I'm going to have an epidural the second I have pain, and my doctor will 'get the baby out' at some point and then it will be done" approach. Both extremes have the potential to leave one feeling disappointed at best, to downright traumatized at worst.

Imagine this: What if you are planning to have an epidural as soon as you feel pain and it doesn't work out that way? For instance, what if you have one of those types of labours in which you're having a huge amount of pain at 1cm? Some women just have a lot of pain in early labour. This doesn't mean they're wimpy...we have to get out of the mind set that a number of dilation equals an expected sensation. This isn't true. So what if you're having 2 minute apart contractions that you consider rate an 8 on the pain scale, you're planning an epidural, and lo and behold, nobody wants to give you one because doctors don't really like to give epidurals to people at 1cm (for good reasons)? You would be offered other kinds of medications like narcotics, but anyone who's taken those during labour knows they don't really do the job that well if you're truly hurting.

What if you were planning an epidural, you get to the hospital and the pain starts, you ask for the Epidural Man, and lo and behold, there are 3 Cesareans in a row he must be present for? I have seen women have to wait 4 hours for an epidural. Sometimes they give birth before it comes. It is not the norm, certainly. But it can happen. Or, what if you have the epidural, and you are one of those ladies it doesn't work for, or it's all weird and makes you feel numb everywhere except for a two inch patch of excruciating pain in one little area on one side of your belly? What if you planned and epidural and you give birth too fast to get one? You can begin to see where having skipped the chapters on pain coping techniques in your books or caught up with text messaging during that part of your childbirth education class might not have been the smartest of ideas.

If you are going to plan an epidural, that's fine. But always prepare for natural birth too, because you never know. The last thing you want is to be faced with pain you never expected or prepared for because you decided to give all your power and jurisdiction over your sensations to an external source. Give over all your power, and the potential for birth trauma here is enormous. Do yourself a favour and get some tools to help you cope.

Conversely, what if you're planning a natural birth, you've done all the preparing and totally believe in yourself, that you can do it and everything feels like it's going to be great...but it doesn't end up this way? This is not a bad approach at all, and I believe very much in the power of positive thinking and visualization, trusting that the bodies who made these babies know how, without a lot of instruction, to birth them normally. Childbirth preparation truly comes more from the work we do on the inside than reading a bunch of intellectual information. However, having an understanding of what might happen IF something comes up and you find yourself in a position needing to make some hard choices about things like pain relief or you end up having that Cesarean you NEVER expected would ever happen to you, is important.

I don't think it's a bad thing to at least skim the info on what goes on when things don't go the way you'd hoped. I know this sounds silly, but it bears keeping in mind: reading or talking about a Cesarean will not make it happen. As logical and rational as a culture we are, superstitions linger. One day I was talking to a group of OB residents about birth plans. You know what their number one reason for not liking them was (for this group, anyway)? They believed they "jinxed" labour, that if a woman commits her deepest wishes on paper, it basically evokes the wrath of the evil eye.

Deep down, I think a lot of people believe that if they read the chapter of their favourite birth book on Cesarean and invite that knowledge into their minds, it might "make" it happen, and it is better to be blissfully ignorant. Saying all the magic words and doing everything right goes a long way to co creating a wonderful experience, sure, but again, there are no guarantees. Having a basic understanding of what it might be like to switch plans is a resource, not a hex, and will lend well to the situation if it ever comes up. For example, "I'm lying on the operating table shaking as if I'm having convulsions..oh, phew, that's normal, I remember reading that...it seems hard to breathe, am I dying? No, wait, it's just the muscles that are a little numb, I actually can move air into my lungs...breathe, breathe, breathe, I will be meeting my baby soon." You can see how not having a little knowledge here about the Cesarean process could make this a more terrifying experience than it already is.

So PREPARE! The process of birth IS important to a woman's experience of motherhood, sexuality, feminine empowerment, all of that. This is what I'm all about. AND, it is unpredictable. It is so important, especially if birthing in a hospital, which, frankly, does tend to generate more need for intervention than you would expect, to prepare at least a little. AND, it is important to remember that the gold medal is the BABY, not the birth. All women get this somewhat patronizing message when faced with an intervention they didn't want, but there is truth to it. It is not uttered just to placate you into accepting something you never thought you'd want or need. It is the truth...absorb it, own it, breathe it...that you are amazing no matter what. You are noble and fierce for all the work you have done. This is not to say grief and disappointment are not warranted in a birth that didn't go the way you wanted. There is nothing selfish or unrealistic or stupid at all for having hoped and believed you could move mountains in labour. Normally you can. But sometimes it just doesn't work that way. We are not the only ones on the journey...sometimes the baby has his own ideas. It is vital to healing to emotionally process our births and it is important to recognize and deal with situations in which you felt less than empowered or honoured. But YOU are amazing. Dude, you had a BABY! No matter what, you are a hero

2) Manage your expectations. Preparing for natural birth is all about stretching...stretching your body, stretching your mind, stretching your heart to open to the magnificent love of and for a new being, and stretching your limitations. Expect it to be a challenge. Don't be cocky. Everything about you will open wide. When I get to the part of my prenatal meetings with my ladies where we talk about whether or not they're interested in birthing naturally, I often get the answer from well read, well informed women who are choosing to birth in a hospital, "I would like to do it as naturally as I can...but if it gets to be TOO much, then I'm open to taking an epidural." What this says to me is, "I have a secret wish to have a natural birth and reap all the amazing benefits for me and my baby as well as be like those tranced out women in the film Orgasmic Birth....but because this is unknown territory, I don't want to feel like I wimped out if they have to scrape me up off the floor in a quivering mess of pain induced insanity. I give myself permission to call time out to spare myself from entering into what I fear could be my worst nightmare."

There is also fear of judgement. "What if I share my precious dream of natural birth to the world, then I don't have it and everyone will say, 'ha ha, told you so!'?" We always feel like we need to qualify. Personally, if I stated I was intending to have a natural birth and resisted the temptation to give the pat disclaimer of "if everything goes well", but if it didn't happen and I got judged for it by certain people, well, I'd tell them to go jump in a lake and not associate with them anymore. A woman who's birth reality ends up not matching her expectations doesn't need judgement and messages like, "poor little woman, it was really cute for you to think you could do it...know now you're just like all those other people who yelled for their epidurals when the going got tough"..she needs SUPPORT.

Anyway, back to that "I want a natural birth but am open to an epidural if it gets to be too much" statement. I like to take this opportunity to ask women what "too much" means to them. Because quite honestly, there WILL be points where it is "too much". People rarely have natural births when they have a well padded "escape plan". If I were to say, "oh, sweetie, you'll be just fine. The pain isn't much. In fact, if you breath into point A while chanting phrase B, you shouldn't feel anything at all," I would be a liar and deceiver of the worst kind. Women may say, "why are you telling me it's going to be so hard? Won't that make me nervous and make it so, given that stress makes birth hurt more?" Ah, again with the superstition. I'm not personally so powerful that my words prenatally can make you hurt or not. If I tell you it's going to be hard, two things can happen..it ends up being hard and you are prepared with resources to cope with it, or you've expected it to be so long and hard that it sneaks up on you and we arrive at the hospital to find you're in way more advanced labour than you thought..woohoo (this happens frequently with my clients)! Don't ever think that if I DON'T tell you about the challenge it won't exist. Better to know.

Even those who never knew they were even pregnant and give birth birth after having thought they were just REALLY constipated feel a lot of pain. I don't buy that ignorance of pain is bliss in the case of birthing. But I do like to discuss how the pain can be transformed into power, and that it can be a total thrill ride.

When I ask ladies what "too much" means, they often don't know what to answer. I'm so curious to know what they think is going to happen to them. I ask them, "what are you afraid the sensations of birth are going to DO to you?" I get all kinds of interesting answers. Some say, "I'm afraid the pain is going to make me really mean to my husband or the staff, and they'll get mad at me." Interestingly, media paints the picture of women turning into these impossible hellions during labour, scratching their husbands' eyes out. My experience shows me that in normal birth, oxytocin tends to make women quite loving, trusting, and snuggly. Yeah, they're fierce too, but the ferocity is directed towards managing the energy of their sensations, not emotionally castrating their partners. There can be some irritation, but I rarely see a woman go rabid like Old Yellow. This is reassuring news for those who define themselves by their polite and good behaviour.

Others say, "I'm afraid I will lose control of myself." "What does that mean?" I ask. "What does being out of control look like to you?" What they usually mean is that they will be in such a state that they will lose all semblance of who they are. I tell them that they will change, yes, but they will still be themselves within that pain/endorphin haze, able to take in, process, and communicate what is needed in the moment. Yes, they may lose their modesty in front of strangers, find themselves nude with blood, amniotic fluid and mucus running down their legs, little rivulets of barf drooling from the corners of their mouths from time to time, and that they will be making uncontrollable noises they never thought they'd make. To some, this animalistic image is deeply disconcerting. But really, if you're willing even a little bit to go there, what you will find is freedom and even possibly a level of intimacy you never knew could exist with your partner and those in attendance. There is nothing more liberating than being in that space of pain and mess, looking up in your misery and finding eyes that meet yours in total acceptance of your experience, eyes that mirror back absolute approval and praise for what holy work you are doing, giving you energy, and even having those messes tended to with love and honour. You are safe, and everything is okay. You have "hit bottom" in terms of what our culture deems ladylike behaviour, but having gotten there and found strength in yourself and awe from your attendants, you have found your rawest nature, the one that gets you through to the end of the journey. You have found ultimate surrender in pushing away all cultural expectations of your femininity which believes having it all together is the sign of an accomplished woman; now you learn that where you find your truest power is not in keeping your shit together, but in letting it all go. Sometimes literally. What you have been afraid of all this time is becoming the birthing animal you actually are and have been programmed to be since your DNA decided to light up as "girl". You will come back...I promise. But you will come back having witnessed and activated a deep part of your Self that we are meant to bring to motherhood. You will come back feeling like you've been through a very important rite of passage. And so you have. It is a biological blueprint we fail to honour as a whole, and we must begin to work to reclaim it rather than do dumb things like have women birth in machines while a gaggle of pimply students oggles them with clip boards clutched in their hands, trying to figure out why women can't give birth properly anymore (duh).

We all read the birth books with the secret hope we will make it unscathed and maybe avoid that scary animal place. There is no chant or prayer to spare you from that. It is meant to be. Whether it is painful or not for you, you will go to that growly, trance-y place whether your expression of it is outward or more internalized. You will temporarily lose that intellect we cling so fiercely to and go into an incredibly dreamy place inside you...Labourland. It's the best place to fall in love from.

I dare you to make a commitment to natural birth without a disclaimer. We already know it. You will not have to go around wearing some scarlet letter if you don't reach your goal. Be willing. Be willing to get down and dirty, to open up your THANG, in every sense of the word. If you can't figure out how to "do" a hard contraction, yell your head off if you can't breathe through it. It's okay. What you can always choose to do is use the spaces between. Choose not to waste your in between times negotiating with yourself how much longer you're going to do it for, or how much more you can take. Sink down into what you will find is a deep, beautiful, profound space of rest and quiet. Trust that as the pain cranks up, so will your ability to cope. You will say "I CANNOT do it anymore" only to find three hours later you still are and are just fine. As I mentioned, you stretch in every way...your resources too. Be willing to ride the sensation even when it hurts, be willing to have those huge waves crash down over you, knocking you down. Be willing to get up again tearing at your clothing with your nails, bearing year chest and yelling, MORE! I CAN! Trust that strong contractions are GOOD contractions, and that each one brings you one step closer to meeting your baby...and in between, soften, soften...soften.

I will never candy coat labour pain to a woman. That is not love. That is disempowerment. I just talked to someone who used a method of pain "control" in labour. When I asked her if it worked, she said, "well, I DID feel pain at some points, so I guess we just can't get away from those cultural expectations...the idea of birthing pain is so imbedded in us that we'll always believe it's there even if it's not meant to hurt because it's natural." This broke my heart, because what these methods teach us is that if we do hurt, it's our fault, that the stain and stigma of normal pain must be attributed to the woman's failing the method, not the method failing the woman. I like to see the strong sensations as conducting the hormonal flow. It's a good thing. And perhaps the more we dive in, embrace it, open to it, accept it, work WITH it instead of against it and trust it, the less it may actually "hurt" us.

I remember with my first kid believing with all my heart birth would be the worst pain ever, that I'd probably go crazy, that it would be horrible, but that I just would do it. I'm a paddy ass, so I planned a homebirth to keep myself away from the drugs. I just went with it, saying, "one foot in front of the other, one contraction at a time". And when my midwife came into my room asking me if I felt pushy because I was making some convincing sounds and she found me fully dilated, I said, "What? I did it? Already?" Because even though the sensations were the fiercest, craziest, most mind blowing sensations that made me yell so loudly I thought I was gonna bust, it was never actually bad...if that makes sense. All I'm saying is, if I can do it, wimp that I am who cries when my tummy is upset, you can too.

3) Own your choices. . When it comes to normal labour, I think it's really important for women to own their choices. "I had the epidural because I just couldn't do it anymore" (at 4cm five hours in) is not the truest of statements. This is not to be mean, but I have a hard time with that. We're not victims of our normal labours. Culturally and mentally unprepared maybe. Our physiologies profoundly effected by our modern psychological and emotional landscape perhaps. But what does that mean, "I couldn't do it?" Well, yah, technically, you probably couldda. If you had been walking around in the middle of nowhere and labour came upon you and there was nowhere else to go, you'd just do it....with nobody telling you how. There would be no opportunity to say "I can't do it", you would have to. If this same labour comes upon you in modern civilization, "I can't do it" is what many women say when the crunch is on. Actually, when given the choice and available epidural, and admittedly the much more challenging birthing environment to labour in, the truer statement is "I don't want to do it." And you know what? That's perfectly okay. You are in no way, shape, or form expected to have a natural birth you don't want just because you think you should. If you didn't in the end want a natural birth when you got to active labour, it's important for the sake of your friends and daughters and women everywhere not to blame your labour for your personal choice. This desacrates the brilliance of your body, of the brilliance of the bodies of your Grandmothers. I'm not talking about situations such as inductions, or you're at 9cm for years, or you have a permacontraction that doesn't let up,or hideous back labour, or you have a PTSD reaction to a trigger, or the staff is so challenged by your coping methods that they simply drive you to distraction so you lose your mojo, or it's really long and you're truly exhausted, or there's some kind of problem, or your in laws refuse to stop wandering in and out of the room causing a case of family dystocia...these scenarios are more about survival than personal choice. I'm just talking about regular labour you decided wasn't your thing.

I feel so sad that many women think they need to apologize for their choices for pain relief and perhaps even cover up unneccessary shame by trying to convince themselves and others that their bodies were lemons for not birthing "properly" when in fact there was no problem. Maybe it means they felt they failed themselves and didn't feel as strong as their friends who had natural births. It's not a competition. Or maybe, they just really don't know what normal labour means, which is kind of a societal failure. Shouldn't girls be taught this in detail from a young age instead of know more about what celebrity was "too posh to push"? Though this choice may often be made without the correct information on benefits vs. risks of elective Cesarean and is not one I'll ever feel good about as a doula, claiming to be too posh to push is at least really honest, and the choice is totally owned with emphasis on the woman's desires for her Cesarean rather than blame on the probable birthing excellence of her body. There are very sad and misguided aspects to this choice, for sure, and it does create collective harm definitely, but at least there is no blaming or creating victimization to justify a choice.

You know, there are other ways women can experience surrender and raw power. It doesn't HAVE to be in the realm of childbirth. It's not "for" everyone. I have seen a few incredibly beautiful births, which were intensely empowering, with women whose mandate it was, for personal reasons, to feel NO pain in labour. I learned a lot from these births, and came to an honest place of honour for these women, not just paid them a lip service because I have to be diplomatic as a doula. While I may not personally agree with some choices, meaning I wouldn't choose them myself, I can totally appreciate an informed choice and ownership for that choice. Personally, if my labours felt like intense nausea instead of the way they did, I'd probably be strutting around saying, "Yeah, I had them knock me unconscious the minute I felt sick. I was simply not interested in going there. There are no benefits to my feeling that way in any circumstance in or for anybody in my life. Wanna make something of it?" Well, no, I'd probably just deal with it anyway because I believe so strongly in the benefits of natural birth. I would do my very best to heal my issues surrounding nausea. But if I did in the end make the choice to end the discomfort, I wouldn't make any apologies for myself. It is what it is.

Happy International Day of the Midwife!

2011-05-05T09:15:00.009-04:00

When a woman becomes pregnant, she is already beginning to grow. It's not her belly that starts to poke out immediately, but her mind and heart that begin to stretch. To integrate the first glimmer of knowledge that she is pregnant requires a huge shift in consciousness. "Oh my God. I am pregnant. I am one of those pregnant women. I'm going to have a baby. My body is amazing. But will I get very sick? Will I be able to give birth? How will my life change? I am PREGNANT! I am so amazed...and confused...and terrified...and joyful...and ambivalent...and profoundly moved." Some or all of these thoughts and emotions will surge through a woman and she will already be making the necessary opening of all channels that motherhood requires.

Dealing with all these new thoughts and feelings, it is pretty normal for arrangements for labour and delivery to not be first and foremost on the mother's mind for at least the first few weeks in as she battled with issues like what to eat without throwing up, and how to get in a nap. Everyone is different, but just integrating the knowledge of being pregnant is a large adjustment in and of itself. Most women, if they have never gotten pregnant with the intent of having a baby before, don't really know what options are available to them in terms of prenatal/postnatal care and birthing.

In Montreal, you have three options. Well, there are more, but here are the main ones: You can have an obstetrician care for you (which is the norm), a family doctor who specializes in maternity care (both types of doctors tend to births in hospitals), or a midwife. Midwifery care is covered by Medicare here in Quebec, as is medical care. Midwives tend to healthy pregnant women and normal births primarily in free standing Birth Houses in which there are no medical practitioners present, though women can be shipped to the nearest hospital easily enough if a problem arises. Midwives also attend births at the woman's home if the woman wants and the situation is deemed appropriate. They also occasionally do so at the hospital, though it doesn't seem to be the norm unless there is a reason for the mom to be there, like a minor pregnancy concern or a transport. If a woman has a complicated pregnancy, or she knows she wants to have an epidural for pain relief in labour, she normally won't be having a midwife tend to her. There are not really enough resources to pull midwives away from their traditional role of helping women have their babies naturally outside the hospital, so those who know they want a medicalized birth (births with epidurals being medicalized births) or those who are found to have complications or higher risk situations will need to seek out doctor care.

In many other places where midwifery is practiced, midwives are often part of the hospital staff. While this has its benefits in many ways for the consumer (access to the hospital environment and drugs/technology etc. they may want) and the midwife (shift hours, responsibility easily shifted to an obstetrician, etc.), it definitely does change the essence of midwifery a lot, which could be seen as a disadvantage.

Midwives here from my observations tend to keep it more traditional, and work with those families who have their hearts set on natural births outside of a medicalized setting. Yes, some of you may be thinking that women should always be able to have their cake and eat it too: the lovely hour long prenatal sessions with a midwife, the one on one care during labour, gentle hands receiving a baby in whatever position the mom wants or in a big tub, hushed tones, uninterrupted skin to skin...AND perhaps pain relief to take the edge off with all the equipment and MDs waiting on the sidelines. And fair enough, it's certainly not wrong to want what looks like the very best of both worlds. But it's rarely done like that here. Rare and precious midwifery resources tend to be given for the most part to those committed to the intention of birthing naturally. For those women who want that well deserved nurturing attention as well as have enough concern about the challenges that could come up in labour to warrant wanting to give birth in a hospital with access to doctors and epidurals, doulas normally fulfill the nurturing role while doctors and nurses maintain a clinical role.

So back to our freshly pregnant woman. With the pregnancy test showing a big old plus sign, the first thought on her mind is not usually who she's going to have receive her baby at the time of birth. It's not really until she starts reading or talking to friends and allowing ideas to gel in her mind as to how she wants her birth to be that she starts to think midwifery care might be thing for her. Yet, despite the huge consumer desire for midwifery care in Quebec, unless she calls with that damp pee stick still in hand, chances are, unless she has already birthed with a midwife previously, she will be put on a waiting list for care at the Birth House. A LONG waiting list. Women are often shocked, when the time finally rolls around for them to start making arrangements for their prenatal care (or, after having received the typical 3 minute prenatal examination from her doctor and trying to ask questions to the OBs back, which can be seen flying out the door as they are completely overworked and need to move on to the next patient, a woman realizes she rightfully wants some more time and attention) to find that their option to experience midwifery care has long since gone.

We know statistically that midwife attended out-of-hospital-births for low risk women are generally safe. They are as safe as(and some would definitely argue even safer) than doctor attended hospital births. And we know women WANT midwifery care. Oh, do they want it. As a doula such a large percentage of my clients receive default care in a hospital with a doctor they may like but chances are will never see at their births. They had wanted so much to get into the Birth House and give birth naturally, yet, like the VAST majority of women who want this care, just couldn't get in. Sure, I can provide the warm fuzzy and individualized emotional care women usually need to feel confident about their birthing selves, but as I have said in past blogs, I don't have control over the environment. While my presence definitely helps to reduce unwanted and often unnecessary interventions, it's not the same for those who didn't really want to be in the hospital anyway. In fact, from having vast amounts of hospital birth attending experience, I can say that those women who just don't feel right in a hospital but feel they have to be there anyway without any other choice, there is definitely a huge emotional, and thus often physical impact upon the birth. If a woman walks into a hospital holding my hand tightly and bursts into tears when she gets there because it's simply not where she feels safe and right (I so know that feeling...when I was a 22 year old pregnant girl I walked into the hospital I had planned to give birth at and walked out with all my sphincters in "PROTECT" mode, with the vow, "NO NO NO" on my lips), I don't expect an easy birthing. Challenging births can definitely be a direct result of a woman not being where she feels safest, and I don't care who tells me that's just hocus pokus. So if a woman's birth can be made longer and more painful and perhaps more complicated by not being in an environment that supports her psychological and emotional needs as well as the basic clinical stuff, we are creating problems, not just succeeding in preventing them by having most women birth in a hospital.

So where does that leave women? Well, if they're really determined to birth outside of a hospital and cannot find any licensed midwives around, some will look for traditional birth attendants, usually midwives who are trained in other areas of the world (and some have extensive training...more than they would even get here through the university training route) but not practicing within the Quebec system, to tend to them in birth. This service is extremely difficult to find, there are extremely few resources, and in the end most women don't want to do make this choice as they are afraid of being on the "down low". The resources for this service, which a client would have to pay out of pocket for, are terribly few because honestly, if something went wrong during the birth and you were caught out as the birth attendant "practicing medicine without a licence", well, you could into huge trouble. This is to protect women from bad and dangerous care (and bad care unfortunately does sometimes happen in these situations, though usually most of the women assuming this role know well what they're doing). Understandably, many legal midwives don't much like unregulated birth attendants either, as any blips on the radar can reflect badly on their profession and hurt what they have been fighting for for years. So it is the extremely rare and dedicated bird with a passion to tend to women where they want to be tended to in their place of choice as opposed to standing back and accepting that women should be happy with the shabby "default" route our government forces us into, who will attend home births illegally. Her belief in the rights of men, women, and babies to start their lives together in the environment of their choice usually overrides her fear of getting caught out by "the establishment" who has deemed to dictate where this very private affair must happen. These are women who are taking a huge personal risk of potential fines and/or jail time if found out, especially if something goes wrong during or after birth. In spite of the concerns, backlash, criticism, and arguments the powers that be have against the role of the underground midwife, I must say I fiercely admire the spirit and bravery of one who stands up for family and choice in this way at great personal risk. If not for some of my midwives working "underground" at the time they tended to me, I would not be the empowered birther I was, nor would I be doing what I do today. So a "Happy Midwives Day" goes out to ALL of you, the ones in the shadows as well as the ones in the light.

Another choice some women pursue is to give birth unassisted. The very rare couple will feel okay with this choice, but some people feel so strongly about not being in a hospital to have a baby, and simply cannot accept that they have to go there because the government refuses to meet the desperate consumer need for more midwives, that they will do so. Some even feel that the midwifery care they are receiving is too limited by governmental and medical dictates. There is also the choice to birth somewhere else other than Quebec if possible...perhaps even drive to The Farm to have your homebirth of a breech or twins with one of the Farm midwives if that's what you want to do. Most would not know about or fathom these as reasonable options, thus leaving them with the "default". Please realize I'm not saying default in terms of all hospital birthing being default. If this is where you feel safe and want to be you should be there, and I will follow you happily. It's the default for the women who don't want to be there because they cannot get a midwife or aren't happy with the midwifery care they may be receiving.

We simply cannot be okay in a society which says to around 70% of women who want the care of a sage femme, "No, Madame, we don't have a midwife for you. They are all booked up. Live with it. Yes, statistics say their care is safer. Yes, they are incredibly cost effective for our overburdened medical system. Yes, we know how you feel about having to birth in a hospital with a doctor when you are healthy and wanting things a certain way. And by the way, if you choose any other alternative to what we say, you put people at risk of going to jail for your selfish desires. We don't really make changes in the interest of birthing women and their partners and babies without massive and constant pressure on us exerted by the likes of you, and even then, change is gonna be slow, because quite frankly, you're not really a primary concern. And neither are midwives." On this Day of the Midwife, I want you all to really think about how medieval this is, and explore how it makes you feel to know that birthing choices, birth being such an important, profound, and personal event in a family's life, are being dictated and limited. The Witch Hunts have not really ended. There is still not enough healing here for all those terrible past transgressions against women and their midwives, and these transgressions that continue today. Whatever your opinion of midwifery care in Quebec is, the fact that choice for women is so drastically limited in the realm of something sacred that belongs to us should pique your concern.

So let's get to the good stuff. I have been blessed in my life to have my four babies born with midwives (okay, one came out before the midwife got there, but not without her sheer great effort to rush). My first midwife was a teeny, gentle lady, but tough as nails. She would hug me before and after appointments, and was so mellow and reassuring about my health, ensuring I was eating well. She was a rock during my challenging posterior birth (my wee one was born face up after around 3 hours of pushing while squatting and moving around). The labour was pretty easy as far as labours go, but the pushing was quite a challenge. She had me get up and belly dance. She helped me stay focused. She never made me venture into fear. And she was tough with me when she needed to be. When, like many first time birthers I called her to my home because I was SURE the sensations I was having indicated the baby was not far off, she checked me, told the heinous news I was 4cm, and stood back as I moaned and groaned about it. For Pete's sake, I was 3cm when I saw her last 18 hours ago (granted, I had only just started labour then). She simply did not enable my fear that I couldn't do this. She looked me in the eye and said, "THAT was latent labour. Now things are changing. This is good." She refused to entertain my "whens" and "whys" and casually went off to take a nap so she could be fresh for the birth, which she looked jauntily confident would happen reasonably soon, leaving me to think that at least one of us thought things were going okay. And sure enough, I was fully dilated about 2 hours later.

My first midwife was not just a midwife to the birth of my first daughter, but to me as a mother, silly little girl that I was. And she honoured me as "Mother", so I owned up to her expectations. Without her presence, strength, and trust in me, I would not have been transformed by birth the same way. She assured me that had I been at the hospital I had originally planned to birth in, I would have had a Cesarean. Not for any fetal distress, but because my kid would have been deemed as "stuck". But out she came. And no tearing to show for it, either. To you, my first midwife, je t'aime. You put me on this path. Bless you.

With my second baby I had a very strong intuition right from the get to that he was a boy, and that he was not going to be a birth that worked out at home. I can't tell you why I felt that, but it was true. Even though the Maison de Naissance was not officially up and running yet with its pilot project to see if midwifery should be legal, I was one of their early customers. I had met my midwife before, who had been a back up to my first midwife. I was pretty confident about giving birth, but I had this niggling feeling. Things were pretty rough in my life at the time. I didn't feel like home was home. There were many concerns about my date. I was given a due date of December 27th by an ultrasound done at what we thought might have been 20 weeks (to also rule out suspected twins). Given my growth, my health, and the fact there were no twins, all the midwives at the centre totally disagreed with this date and pushed up edd by a month. I had never had a period between pregnancies, so I was truly at a loss about when I conceived. And we just didn't trust the ultrasound at that point because it was probably done later in the pregnancy than we thought.

My midwife was stellar. More than anything, she was a huge source of emotional support. She provided me with a lot of counseling prenatally, as I was a bit of an emotional mess at the time. I started having contractions on Hallowe'en, having huge bouts of them that would then periodically stop, making me forget I was close to birth. We were in a bit of a pickle, because I was in the mid 36 week range. Once contractions stuck around and didn't stop anymore, I went to the Maison de Naissance to labour before we were to transport to the hospital, and it was rough. This baby was clearly also posterior, but he was wreaking a lot more havoc than my first star gazer. I was experiencing more pain at 5 cm than I had in transition with my first child, and I stayed there for a long time. My midwife took me to the hospital in her car after a night and day of no visible progress. I cried a little because I had not wanted a hospital birth, but I didn't fuss because that was the way it seemed to have to go down. And I received such a lovely reception. I had just attended a birth with the doctor who was on call 3 weeks before and she took me in her arms and danced with me through some contractions while I cried on her shoulder that I was having a rough time. She took me to a room and suggested she break my waters. I looked to my midwife and she nodded. When it came to any interventions, I had decided just to let her approve or not because I was in too much pain to think about anything else. I made my poor midwife's life difficult with this birth. I was refusing being on the monitor (not because I was not into having my baby heard, I was just in too much pain to sit still)and, though she totally buffered the harshness of the environment from me, nurses blamed her for my labouring my way and my friend told me later they made her cry. Don't get the impression she was not a fierce and badass woman, she was, but because of the grand opening of the Maison de Naissance, I think she was super exhausted and overworked. Yet in spite of that her labour support when I was in the hospital was absolutely present, tireless, and necessary. Whenever I was about to give up, she'd suggest something. I'd balk, but then it would turn out she was right and I felt better. The doctor and the resident were absolutely angelic men I will never forget, and when my face up baby was finally born on November 3rd, they called me a champion. They treated me with the utmost respect. Darn tootin'! These gentlemen, and they truly were gentlemen, made all the difference in how I could have felt about myself and my birth had they chosen to treat me with contempt for being a pain in the ass.

The midwife of my second birth helped me to let go of expectations in labour, how to go with the flow, how to release, how to shift my mind, how to relinquish control. She taught me how strong I can be when things are harder than you expect. She fiercely protected my experience within the place I never thought I'd end up, but did it with such non combattiveness I noticed nothing, and because of that, I can honestly say I had a great hospital birth, despite the talk in the nurse's station of what a jerk I was for howling the case room down and not taking the epidural. Sticks and stones. To the midwife of my first son, who taught me how sweet and beautiful the experience of mothering a boy could be when I was a bit scared of having a boy, thank you, thank you, thank you! That birth could have ended up waaaayyyy differently had you allowed me to entertain the looming despair. Much love to you!

My third midwife was very special because she was willing to attend my home birth. This was illegal for her to do especially because she was on staff at Maison de Naissance, so for that dedication to homebirthing women, refusing to have her skills limited by location, she was a saint. She helped me navigate my way through some blood sugar fluctuations I was having, and helped me gain back some of the faith I had lost in the greatness of my birthing body because of my challenging previous birth. We had both pursued the same training in emotional process work, so we had tons to talk about, and I learned so much about how our minds affect our births. We sorted out some of the reasons my last birth may have been hard and helped me to truly open up to the experience and be present for it, no matter what. I believe she created a self fullfilling prophesy letting me know how much easier this birth could go, how I had processed and healed, how I had learned, and how receptive my body could be with that shift to surrender.

Our last visit before my second daughter's birth she looked me in the eye and said, "I have a feeling this will go fast." I held that lightly, as I didn't want to be disappointed if the birth went the same way it had gone before. Well, it did go fast. In fact, it was 43 minutes from the first contraction to the birth, and she didn't make it to catch the baby. But she made it for the placenta. Having had a birth in which I received NO vaginal exams and my water bag remained intact until my daughter's emerging shoulder broke it, nobody received her except my husband and me, and I had no tearing, opened my eyes to clincially hands off birth. To you, my third midwife, thank you and je t'aime. You faciliated such healing and such a reclaimation of power in a way I never imagined. You risked your practice because of your belief in women's choices, and bestowed your gift upon me. You are amazing.

My fourth pregnancy was smooth and easy, a great gift gleaned from all of my experiences. I knew i could weather any kind of birth, older 36 year old mama that I was going to me now, and knew I was powerful no matter what. My fourth midwife could not have been a better match. The agreement was, "I'm there as vigilance and experience, but I will not interfere unless I need to." And I fully trusted that if she was doing something, it was necessary. This helped me to relax fully, knowing there was a strong, competent safety net, a strong, comforting, loving presence, but that my birth was my very own and that I owned it. Having her trust me so deeply was one of the most empowering gifts a birthing woman could ever have. So our prenatals were really about just building up excitement and being thrilled with the normal, and getting really excited about the fact that finally, homebirth was going to be legal. My fouth baby, my sweet little second boy, was among the first handful of babies to be born legally at home in Quebec. My birth was pretty much perfect in every way, and I caught my own baby after 1.5 hours of very gentle labour and maybe 30 minutes of active labour and pushing. Almost six years later, I am still high about it. To you, my fourth midwife, je t'aime. The quality of your presence make my birth sheer and utter joy. How you regarded me helped to make it so. You were there not to help me grow up, but to witness how I had already grown, and to revel in how deeply gorgeous, how spiritually profound birth can truly be, how it can be a woman's greatest expression of ecstasy.

Every one of my midwives was exactly the right one for that phase of my life, and today seems like the right day to express my deepest gratitude for your presences in my childbearing and transformations. You will never just be to me the women who midwifed my births, but the midwives of different phases of growth who have helped me to become the person I am today. Truly, my life may have been very different without each and every one of you. God bless you, ladies.

To midwives everywhere, today I honour you. To Vickie in New Jersey, to Alexis in New Mexico, to Julie in England, to Ina May in Tennessee, to Stephanie in Oregon, to Barb in Cali, to Kersten in Nova Scotia, to Ratine in Madagascar, to the near and dear (Celine, Francoise, ZaZa, Trista, Lise, Fabienne, Marie, Sinclaire, France, my motorcycle Goddess, and,of course, Isabelle) here and everywhere...Love to ya, girls, and to the all male midwives too.

"Why Don't You Just Take the Epidural?"

2011-04-29T10:26:00.007-04:00

Firstly, before anyone decides this is a rant against epidurals, let me explain. I am emphatically NOT anti-epidural. You cannot work in birth for nearly two decades and be anti-epidural. Just because I'm a doula, the very word conjuring up images of bowls of organic granola lovingly moistened by the milk of the goat who lives in my back yard, do not assume I am all about all natural birth all the time. Ultimately, I am about whatever works and women's choices. Just to be clear.

Before exploring some of the questions I've heard people ask in response to the shocking idea of natural birth, let me defend the poor old epidural for a moment. Everyone who has worked in a hospital birthing culture for a reasonable amount of time has seen how an epidural can potentially and sometimes even miraculously restore morale and labour efficiency to a woman who has been labouring hard for a long time with the discouraging news that she is not opening. We all have stories of women who stayed at home for a couple of days with contractions strong enough to make them vocalize loudly. You know, the kind that look like the baby should be coming soon but just isn't, so they decide at their limit to accept an epidural when they find out that the three centimetres dilated cervix their doctors told them they had 2 days before they even went into labour has not budged in the 72 hours of minute long contractions every few minutes they've been having. And then boom, she goes to 10cm in 30 minutes after a break in pain. Could it be there was a real physiological need for the epidural and its benefits of relaxation? Maybe. Could it have been a psychological thing? Perhaps. Could this be a product of our enculturation? Sure, why not? Regardless, it worked, and the baby came vaginally, an epidural being less of a risk and less of an invasive intervention than abdmonial surgery. So let us give credit where it is due and a round of applause to this brilliant invention that can and does help some mothers' births proceed a little more normally sometimes. Sure, most babies would come out given enough time. But in cases like that you might start to ask "at what cost?" Sometimes, one might need to admit that in the the odd case the benefit of an epidural outweighs the risks of a labour continuing the way it is. Sometimes no matter what stops the support team pulls out to help labour progress more normally, from emotional support to comfort measures, to maternal positioning, to bodywork, to homeopathy, to down and dirty emotional/spiritual excavation, our efforts do not magically produce a baby. Nobody is to blame. And you can look for the "whys" and "wherefores" all you want, but in that moment that's not necessarily the healing thing to do. In these cases, sometimes the epidural is the most compassionate and effective healing tool.

It is also important to emphasize that doulas are not anti-intervention, they are pro choice. If a woman is truly and fully informed of the risks and the benefits of routine epidural (those risks can be found within seconds on the internet for those not in the know) yet in spite of that knowledge still claims she will want an epidural because she knows herself and her relationship to pain, then it is not our business to judge her. Sometimes getting to the bottom of what is often fear helps her to move through that desire and she ends up birthing perfectly normally. Sometimes not. It is our job to support her with as much love and enthusiasm as someone going for those natural births we tend to like. It is simply not true that a woman will only choose a routine epidural out of ignorance and an unwillingness to let go of a sense of control and propriety. You still grunt, cry, bleed, and poop with an epidural...sometimes for longer than you would without it. Yet even when this is explained, some still want it. I tell women it is totally normal to bellow up a storm while in good labour, that of COURSE it's fine and even desireable to make some noise, as how would you and a baby, if you found yourself accidentally birthing in the forest, keep those blood thirsty carnivores away without your yells scaring the crap out of them? Even with that doula-logic instilled, some still want that epidural. Fair enough. Everyone has their reasons, and everyone deserves to have their decisions understood and respected when it comes to pain relief in labour. I do my best to educate, and if we want to remain in the spirit of true empowerment, we stand by the choices our clients make for their coping methods. Period.

So I just want to take a moment to explore the question, "Why don't you just take the epidural?"

Here are some of the thoughts I've heard people express on the subject.

1) "If there is all this pain relieving technology out there, why wouldn't you just take the epidural?" It is understandable that most people in our western birthing culture cannot understand why on earth a woman would want to go through that pain when they didn't have to. The spirit of this question is usually meant with compassion, an expression of curiosity around the idea of why one would choose to take the pain filled jourey of childbirth as opposed to the much more comfortable one.

This speaks to a fundamental lack of understanding of the benefits of natural childbirth. The pain is not just some inconvenient by-product of the process, it is what helps to conduct the flow of hormones. You contract, you hurt, you get more oxytocin, you hurt even more, and so on. If you're feeling okay and nobody is bugging you, this flow is usually not interrupted and the baby is born. If it is constantly interrupted by routines and a demand on the intellectual as opposed to mammalian part of your brain (like timing contractions, grrr, and strident heart monitoring protocols), things may feel more painful and be less effective. And the opposite can be true in some cases as well. Birth can be fickle and it can not give a crap about what's going on externally. It is too unpredictable to pin down. Contrary to popular belief, I have not seen this pain phenomenon make women automatically turn into crazed evil banshees, lashing out at their partners for ever having impregnated them. That's media education for you. For the most part, if the mother feels safe and well supported, I usually see the oxytocin make them behave very lovinginly and trustingly, and sweetly spoken. Even at 9cm of dilation, the vast majority of women are grasping me tightly, apologizing for possibly having hurt me, murmuring how glad they are I'm there, and I kid you not, I have even been told "I love you" on more numerous occasions than you would believe in such an intensely painful situation.

My neighbour has the mouth of truck driver, God love 'er. Her husband was terrified she would totally alienate the hospital staff when the pain of labour hit and made her start swearing a blue streak. Well, wouldn't you know, labour came, she did it naturally, and all her words were sweet and grateful. Not that labouring women don't let out a few choice curse words here and there...sure they do and that is fantastic. It's good to vent now and then. They get pissed off that the baby's not coming quickly enough or bummed out when someone is not doing what they need them to even though she has told them five times. But that brief annoyance is usually not directed at anybody in the anger you might expect of someone in a lot of pain. Put it this way, I have been hugged 99% more times than smacked while helping someone in labour, so, given the intensity of the sensation (been there, so I know what I'm talking about), you've got to figure the hormones must have some effect on that.

This oxytocin, when the baby and then placenta comes out, is as it's peak. The whole room seems jacked up to the hilt on the stuff. It's beautiful. When the baby arrives, usually most of the pain is gone immediately, relief sets in, and in a couple of days when the body memory fades, women say, "Oh my God, that was AMAZING! I would do that again." It is discombubulating if you're not aware of the beauty and power of natural birth, even when it looks INTENSE. You might think the mother is some kind of masochist given what you've just see her go through. But regardless, they usually do go on and do it naturally again if they've done it before. I have. Four times. In spite of the yelling and feeling like you'll never make it. In spite of sensation that makes you think you will never be able to contain it in one little body. In spite of the exhaustion, shaking, and nausea. In spite of the nine months of pregnancy challenges and discomforts. You most likely choose to do it that way again if it worked out for you before. And hey, even women who have had really tough, intervention filled experiences usually give birth again, many, even though they may have been those ones stuck for days at 3 cm with howler contractions and no progress, go into it the next time with the intent of doing it naturally.

So why do some women choose to do it naturally, whether they are first timers, have had a natural birth before, or have had terrible experiences before? It's not just because of the known health benefits of not messing with this particular blue print Nature has given to us if it's not warranted, but I guess because at the end of a good birthing journey, there's a body knowing, a deep soul intuition, a flash of motherwit if you will, that occurs when a birth has gone normally. It bestows upon your being a sense of rightness. In spite of all the judgements of "you're crazy." It just feels...right. It is what glory feels like. Labour is not something you love while you're doing it most of the time. You love it when it's done. It is at the same time the hardest and the best day of your life. Up and down, ebb and flow, effort and rest, give and take, scream and love.

2) "You wouldn't have root canal without anesthesia, would you? Why on earth would you have a baby without drugs if it hurts that much?"

This analogy bugs me to no end. It's stupid, even though it's asked if YOU'RE stupid. Sorry to those who like to use it. Root canal is a procedure dealing with a pathology. In your mouth. Someone is doing it to you to help you with something in you that is sick, impacted, and potentially rotten. If you want to put the intended nature of that question into its proper context, you should ask, "You wouldn't have a Cesarean without anesthesia, would you? So why would you have a vaginal birth naturally if it hurts so much?" But then you'd sound like a total tool, as the intention of Cesarean is to quickly remove a baby from a mother if one or both of them is in mortal danger (well, that's what it used to be for, anyway); normal vaginal birth is...well, normal, even with the level of pain usually involved.

Women have been birthing for a scabillion years. In fact, you, yes you, would not be here today if you did not come from ancestors who, from the beginning of time, birthed vaginally without epidurals. Even if your great grandmother and mother had a little help, or you were conceived in a petrie dish, it still means that (at least up 'til a couple of generations or so ago) you come from a line that can be drawn back to the dawn of birthing humanity in which they rocked birth old school. Yeah, we may have lost a mom here and there along the way. The benefit of living in the now is that maternal death happens less frequently in developed countries (though with all the stats on the impact of all this surgical birth on maternal health, even that is seeming sketchy). You may have lost a lot of great great great uncles and aunts over time. But you are here. How many births have occured in your ancestral line to get YOU here? Millions? Is this not a testament to the birth giving brilliance of your Grandmothers' bodies? And if you want to use the evolution/big fetal head argument on me, you're barking up the wrong tree. The poor old decrepit female pelvis is probably not to blame for what seems to be more difficult births and all these interventions to save us from the pain and death invading us from all sides. It's probably a combo of fear, enculturation, detachment from our bodies, sitting on our butts all the time, pain management messing with our hormones and muscles, birthing positions that are antithetical to simple mechanics, lack of real emotional support as everyone pays more attention to drama and danger, and a bunch of numerous other things I'll just get too mad about if I start writing about them now. The point of the whole "root canal/childbirth" analogy is that it needs to be put to rest because it is just an insult to one's intelligence and a spitting on the honour of our Grandmothers.

3) "Isn't wanting to give birth naturally just a display of feminine machismo?"

I have sat outside rooms beside a couple of male doctors, with the woman inside the room yelling and keening with her birthing pains, ask me that very question. I am not picking on male doctors, as I have known women to say this too...about other women. This feels even worse to me. Anyway, in these cases, I could sense the doctor was having a hard time not wanting to save the woman from what clearly sounded like abject suffering. The tension from hearing these sounds when there is a perfectly good Epidural Man walking around the hallways administering sweet pain relief can be a lot for many people, medical or otherwise, and they start to wonder as their stress builds, "well, if it really hurts that much, isn't kind of stupid to suffer like that? She can't give birth with all that tension. She's hurting herself and the baby. This is all ego based posturing so everyone can tell her what a hero she is afterwards." I invite those with this belief to reclaim their projections. Part of them is saying, "I want you to end your pain because I can't handle it." Trust me from many years of working with natural birth when I say that the most hard core natural birther will call for help when she has reached her limit. No thoughts of heroism intrude upon a woman who is in truly dysfunctional labour. It is obvious in one's deepest core that something isn't working that great. She stops being all trance-y and stoned with the contractions and the bad kind of adrenaline starts working, and she starts getting more intellectual about things. I myself have been in that space wondering, "hmmmm...I may need to think about plan B". We don't push ourselves to the limit or go about trying to prove a point at all cost. Nobody wants to put their babies or themselves at true risk. We push ourselves to the limit because we're handling it and we're strong, thank you very much.

Let us be clear about one thing. We as a culture use the phrase, "you don't have to be a hero" to women who state their intentions to have a natural birth. What we really mean is "don't be a martyr". A hero shines in beneficence and helps heal our world on various levels. Is it wrong to be a hero, for ourselves, for our babies? Is it wrong to want to create new legacies for our future birthing daughters and to embody the magnificence of normal birth to caregivers who rarely see it? Is it wrong to want to be a pioneer again? Is it wrong to want to reclaim a little faith in our bodies our culture views as defunct? Does that warrant this judgement of intended machoism? Is this how resentful people are of women who want to have natural births, that they will think them as megalomaniacs for going through the pain involved? If we were quiet about the pain would they feel differently? A martyr is someone who dies for her cause. I have never ever known a woman who would not throw herself on the floor and subject herself to unanesthetized surgery if there was evidence her baby was in immediate danger. This is not to say people don't sometimes make bad choices. It happens. But if we're talking about owning the sensations of labour, if a woman is paining, it doesn't mean she's dying, it means she is expressing a tremendous amount of raw, natural power. She is WORKING it. And if you can't stand the heat, you should get the hell out of the kitchen. When she's labouring she needs support and encouragement like the marathon runner who is at mile nineteen and all systems look to be shutting down. She doesn't need jugement about her intentions. Trust that if she can't take it or if there's danger, she'll do what she needs to do. That whole "feminist machismo" assumption is one of the most disempowering things I have ever heard, and it speaks of how little we regard the process that gets us here and those who have laboured to do so in heroic, miraculous grace. It speaks of a woman's intentions to experience birthing pain as misguided, and of not being smart enough and too stubborn to seek help when needed. Shame on us.

To be honest, there IS a tremendous ego boost to having birthed naturally. Huge. But it's a healthy one, not the macho kind. After that baby has come out naturally and you realize you did it all on your own steam you usually feel like a consummate badass. And is that so wrong? You haven't done it at anyone's expense, in fact, it has contributed to your and your baby's health. Shouldn't it be okay to feel great about that? In my doula logic I believe the confidence boost a woman receives from either having a great normal birth, or a difficult birth in which she may have needed interventions for but gave what she felt was her all, is one of the best springboards from which to leap into motherhood. Motherhood is joyful and amazing, but it's hard. And it's forever. To start out that relationship feeling like you can do anything, gives you RESOURCES. There is no Epidural Fairy who comes in the middle of the night to save your ass when your nipples hurt and the baby is waking up for the fifth time in a row. You are struggling, but you remember: you have given birth. You can do anything.

I ran into another neighbour of mine walking with her toddler and her new baby. Her first birth had been very long and she had had an epidural. She felt like she did great, but was a bit disappointed how it turned out. She wasn't sure she wanted to try it naturally again, but ended up doing so.

Lesley: "Jen, you had your baby! That's so great! How did it go?"

Jen (beaming): "I did it NATURALLY!"

Lesley: "Yay, that's fantastic, good for you! Do you feel like a rock star?"

Jen: "I AM a rock star. I feel like I could fly".

Enough said. "In glory and awe I have given birth, and found therein, my Self, my Child, and my God." -Kim Miller

Doula Work Hours : Finding Balance

2011-04-22T11:26:00.005-04:00

Doulas are known to be extremely accommodating. We commit ourselves to staying at births no matter how long they are. That means slipping from our beds at 3am, without knowing as doctors, nurses, and many midwives do, when we will be home. If the birth is 3 hours, 30 hours, or 3 days, so be it. We are there. We quietly dip outside the birthing room with our cell phones when the sun rises and there is a lull in labour to reschedule our day packed with pre/post natals and re-arrange our childcare that becomes necessary after a couple of days away. Ah, there goes the day off planned for the week, and if the birth is really long, there goes the day off next week too in order to catch up on meetings. If the birth is super long and someone else went into labour early despite your attempts at good scheduling and you have to send a backup, well, there goes that income you had planned on too. It is crazy work, and it takes a very strong and giving spirit to do it happily without burnout. Thankfully, the rewards of birth attending are HUGE. I come home after a great birth or prenatal meeting high on good feelings of connection and the knowledge that I am doing something meaningful with my life.

The nature of a doula is usually one of givingness. To everyone. This can leave us sometimes feeling like we're failing everyone, our clients and our families, because we cannot clone ourselves and be fully present for all those people in our lives. It is extremely important, and you will see this as you grow into the work, that boundaries surrounding your pre/post natal meeting hours are essential.

I have kids in school. To see them off to school is important. To be there when they get home or soon after is important to me and to them. This is because usually at least once per week they miss me for a good chunk of time. Sometimes, like this week, there were three evenings in which I was there for neither after school nor bed time. This is hard on kids. It is crucial to find balance.

I schedule my meetings during school hours, from 10 to 3. This is not necessarily convenient for many clients who work, but as they usually take periods of time off once in a while to see their doctors or midwives, I usually suggest booking me in when they have that time off. I do not work (unless it's a birth or an event like a "Meet the Doula" night or apprentice gathering) evenings or weekends unless it is absolutely urgent. Sometimes I cave and meet with people at 9am or at 4pm. This is often NOT good for my family. I have to police myself firmly to not make that a habit. I arrived home at 3am one day this week, with a meeting scheduled at 9am. Constitutionally, I can stay up for 2 nights, down a coffee, and teach a 9 hour long doula training workshop without much issue. But it's not about me and keeping my schedule at this point. I realized if I made my 9am, which I should not have scheduled anyway, which I did out of guilt for not seeming accommodating enough to my beloved clients who work hard to schedule with me, that would be a LONG time away from my family. The after school, the dinner, the night time, AND the morning before school....for the second day in a row with many other births coming up, was getting a bit much. Those precious couple of hours to snuggle and catch up with our children, from toddlers to teens, are what nourish us all. We can go back to our work knowing everyone feels somewhat tended to if there is that reconnection to the home and hearth.

Another thing that makes not keeping schedules a total drag for my family is how hard my husband has to work to hold down the fort. He has his own stressful job. It's nine to five most of the time, but when you start feeling like a single dad of four, doing all the cooking, cleaning and child minding instead of his regular share so I can work, this can be a tremendous strain. He is the best doula husband ever. It is no easy feat being a doula's partner. His patience for my crazy birth attending hours has widened a lot over the years as he honours the importance of my job. But when it comes to sneaking in those little extra meeting hours in? No. Patience goes out the window, and I don't blame him. It's not only the days I'm not there, but if I arrive from a long birth at 8am, I usually need to sleep a bit, which means more time he is "on". He takes it in stride gracefully, and I am really grateful for that, but I totally understand why sneaking in those 4pm meetings, leaving supper to him AGAIN is a starting to ask a lot.

When we're starting out as doulas we're just so thrilled we get to go to births, and tend to bend over backwards to run any time and any place our clients want us to be so they are happy with us. As your practice grows, you will need to keep that in check and figure out what will work for your family and what will not. Yes, it is true, some clients may not hire you because they simply cannot make those day time meetings, but that's okay. I have a large enough practice that when one one client cannot take me, there are usually several more willing to take their place, and that will eventually happen for you to. There is a strength and grace and professionalism about someone who keeps strong boundaries. As doulas, we model mothering to our clients. To model the importance of family and boundaries is all part of the work.

And don't forget, there is not just work and family, there is you too. I always try to schedule a day off for my self during the week. I catch up on sleep, take long walks with the dog, go shopping, go for a long run along the lake shore, etc. It often doesn't work out because of births necessitating rescheduling of appointments, but when it does, I have to FIGHT the urge to sit down and work on administrative stuff or tend to all those little work-y things I "should" be doing. If I am going to model to my new mothers that self care is essential to harmonious parenting, and that they must "sleep when the baby sleeps" and not worry about messes and loose ends at work when there is a moment to chill out, I have to walk that walk too, otherwise my message is empty. I can only find true balance when my own self feels nourished enough to have plenty to give away.

As hard as it is finding balance as a doula, while I have my moments of stress and overwhelm, I do feel satisfied with most aspects of my life. I love my family and I love my work. And oh, I love my time to myself. If I don't get to be alone with my self or with my husband sometimes nothing runs as well. When guilt entered our culture for self-nourishment I'm not sure, but it is the ugly demon we need to keep fighting off in order live peaceful lives. Sitting in front of the tv in jammies on Sunday night is healing. Lying in bed reading a trashy novel when the house is a mess is a spiritual practice. Spontaneous kitchen messes with the kids are godly. Mother and work your heart out, sure, but have fun too.

A Rose by Any Other Name...Birth Speak

2011-04-07T22:48:00.006-04:00

I have been noticing in the doula world some stuggles over words. We have so much to do, so many balances to create, so many environments to improve. Some of these struggles are completely spot on and need addressing. Some verge on what seem to be an attempt to be more unique or less mainstream than the average bear. Words most definitely have the power to make us distinct. Language is very important, no doubt. If I'm standing up strongly for myself and creating a stink over injustice, I don't like to be called a bitch. Calling someone "sweetheart" in a way that's clearly condescening and sexist, instead of in a loving, nurturing way is awful.

There is tremendous power in words and we do need to be careful. But sometimes quibbles can be much ado about nothing. Yes, apparently I am waxing Shakespearean this evening. I don't love the quibble over the word "contraction". Yes, while the endorphin suffused state of birth in no way feels emotionally like a contraction but an expansion of consciousness, in reality the uterus most certainly contracts. Hard. Calling it a wave or an energy rush is not a bad thing, but really, it doesn't change the fact that a uterine contraction is occuring. Calling it another name might make it seem less "hard" (I consider it to be a word referring more to simple mechanics than to Medicine) and perhaps more spiritual, (and in our culture this desire for a shift of balance in birth perception is certainly helpful for many), but I am perfectly comfortable with "contraction". The uterine contraction causes a heck of a lot of sensation, and while I understand this phenomenon is perhaps not what some people want to focus on in their birth experience, really, that big sensation which goes hand in hand with the mechanical uterine contractions seems to take center stage in most labours regardless of what we plan or hope for.

I have noticed that many people don't like to use the "p" word with regards to labour...you know what I'm talking about.....pain. There have been several terms generated to shift perception surrounding the birthing sensations, but in my humble experience both personal and in birth attending, I tend to believe birth hurts, no matter how you try to pretty up the word. But the pain isn't a bad thing. That strong, strong sensation creates the flow of endorphins, and our experience of it raises oxytocin levels so the next contraction is even STRONGER. We birth hopped up on that beautiful " 'ormone of luve", which is guided and driven by...you guessed it, pain. Whether they plan to or not, the vast majority of women feel some level of pain in labour. Instead of quibbling about the word, perhaps shifting the focus from the pain as being some nasty by-product of the childbearing process that we "shouldn't" have to suffer through to being a noble, healthy challenge we are absolutely capable of moving through would be more helpful. Call it an interesting sensation, call it a wave, sure...that doesn't hurt. But the sensation still does. And that's okay.

I see more and more doulas not seeming to like the word "training" for the process by which doulas learn their skills. The definition of training is: "organized activity aimed at imparting information and/or instructions to improve the recipient's performance or to help him or her attain a required level of knowledge or skill." I believe in training. Where I veer from most doula training organizations is that while I believe in good training including apprenticeship with an experienced doula, I don't care much about certification one way or another. In the doula world that piece of paper, while it is great because it means you did what was asked according to someone's made up standards, it in NO way means you're "done" learning. It in no way defines the greatness of a doula. Frankly, it means little to me. I have doulas on my team who are certified and who are not. What attracts me to them is their integrity, reliableness, passion, compassion, and a sense of knowledge I get from them just by speaking to them casually about birth. We develop through constant learning and continuing experience. So while the piece of paper stating "qualifications"is not so important to me, the fact they took the time to invest and immerse themselves into the preparation or "training" of how to be a doula is. There is a basic level of skill being a doula needs. I don't want to say "required" because that's too rigid. While the learning is life long, there are basics to know. You might want to know what a cervix is, for example. You need to know how to listen actively. You need to understand the process of labour and how women experience it. You need to know some tools to help. It's not all hearts and flowers and broadcasting love. So doula courses DO train doulas. Whether we want to claim that word "train"or not as what we do to prepare doulas is up to us, but I am happy with the word. I do not consider it too mainstream. I don't think it necessarily leads to an assumption of a means to an "end" of learning and major standard of pratice focus over skills. I don't believe it's about a check list of qualifications so you can call yourself a doula. It's about basic skills, information, and personal growth so that all participants can find their unique path and expression of the work. I'm sticking to the term "training" with impunity because I think it's a good word for the process of learning basic doula skills.

I'm not so down with the term "delivery" for the receiving of babies. What I don't like about it is that it implies the attendant "delivers" the baby. While they may be actively helping in some cases (whether it's needed in that situation or not), I've always kind of felt that mothers deliver their babies into the world. But I won't argue with or correct someone who uses this term.

You know what word I really don't like? "Doula"! It rubs me in all kinds of wrong ways. It comes from the Ancient Greek word "slave", for crying out loud! And a bonded slave at that. While the ancient lady of the house was birthing and mothering, her maidservant hung out with her and carried out a very noble role, but maybe not necessarily with the love and passion we modern doulas bring to our work because we do it from a place of free will and choice. To tend to women in their childbearing year is an honour. But the ancient maidservant was probably bought into the family and would have been stoned to death if she didn't carry out her role, like it or not. I can't think of one great other word describing what I do, but I must say it has never fell comfortably out of my mouth. Dooooouuuullllaaaaaa. It sounds kinda flakey to me..even a little romantic. Plus, half the people you mention it to say, "say what?" But hey, it is very deeply entrenched in our modern language, so instead of quibbling about it, I just go with it. It doesn't really change my life so much. Whether I'm called a doula or a birth attendant or an accompagnante, I love the role I play. A doula, the essence of the work being summed up by this popular word, is what I choose to call myself, whether I dig the acutal term or not. It's what people know and respond to. Really, "a rose by any other name would smell as sweet."

Lesley

Doulas Cannot Re-Create The Farm

2011-03-28T15:34:00.010-04:00

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 of...you 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

www.MotherWit.ca

Doula Training in Nova Scotia

2011-03-12T16:36:00.005-05:00

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 (windhorsefarm.org), 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 http://www.motherwit.ca/ soon.

For you ladies farther out West, you are not forgotten! The amazing Tracey from Birth Source Inc. (http://www.birthsource.ca/) 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 (http://www.durhamdoulas.com/) 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.

Positions in Labour

2011-02-11T10:04:00.002-05:00

When I meet people who are interested in working with me as a doula or childbirth educator, one of their burning questions is: "Are you going to teach me about positions to use in labour to make me more comfortable?"

While I may do the briefest of overviews to show what many women enjoy doing positionally with their contractions, asking them and their partners to try them out so they can feel comfortable knowing what they are doing is totally normal once they're in labour, positions for comfort is actually something I don't focus on a lot. I tend to find most women know what to do in normal, ummedicated, physiological labour to make their contractions more efficient and comfortable. If we provide fancy charts of positions that are helpful to birthing women, it assumes they will be using their intellect during labour to mentally bring up the image of the "menu" of positions (or check their notes while actually in labour), and select which might work for their particular scenario. While this may help in early labour (or not, as I tend to recommend the "don't focus on early labour and find something to distract yourself with" approach rather than the "focus on the early sensations with all kinds of positioning and massage so you're at a loss as to what to use to help when things really get cooking" approach), the kinds of contractions that have you drifting away on an endorphin cloud to lala land are simply not conducive to the mental gymnastics of cross referencing.

I have actually not seen a labouring woman with back pain NOT lean over or go on her hands and knees to take that desperate pressure off her sacrum. I often see women who are being monitored while lying on a bed rip off the transducers and stand up because they simply cannot lie there any longer. They can't tell you why, they just know they cannot bear that position anymore. Their bodies are guiding them intuitively, their babies whispering from the inside, "Mama, I need some more space...move this way."

I have had women yell in transition, "Tell me what to do! What do I do?!" and I'll make a suggestion, but inevitably they do what they want. I remember a woman asking her midwife what to do and the midwife suggested she sit on the toilet. It's a great suggestion...the opening of the legs, the safety of the toilet, the squatting position putting pressure of the baby's head on the stretchy cervix, helping it to open perhaps more quickly. There's no need to explain all of that to the labouring mom , as it's too much information for her to process. All she wants is some direction on which to anchor her hopes that this will all be over soon. Despite the midwife's simple suggestion, the mom just stood over the toilet. All she wanted to do was stand, so finally after being asked several times what she should do, the midwife validated that clearly what this woman wanted to do was stand, and to trust that. When she started grasping and pulling down on the shower rod, we guided her out of the bath (where she was standing) so she could grab onto the trapeze bar provided for that purpose. She birthed beautifully hanging from the bar. That would have happened whether she had been educated about positions in advance or not.

Labouring mothers often do some strange things to comfort themselves in labour, and it's all good. I've seen women lie down on the bare hospital floor because it felt cool, stand up on a chair because the floor felt too hard, or walk like an elephant on all fours swaying to and fro with their heads. All a mom needs to know is that if it feels good, she can go for it.

Where positioning education comes in very handy is when the mother has an epidural. Because many of her body instincts are numbed by the medications and positioning of the baby can become misaligned with the pelvic structure, suggestions of position changes help a lot. And because the mother is capable with the reduction or absense of pain and endorphins to draw upon her intellectual capacities, a check list she's learned in advance of positions to increase labour's efficacy can be extremely useful if she doesn't have anyone around to guide her with this.

When labour is NOT going normally and clearly the baby needs to do some shifting to create a better fit with Mom's pelvis, positioning can be extremely helpful. I had a mom once whose back was so sore and stiff from a long hard labour that she couldn't sit down. She wanted to, but the aching prevented her from acting out her intuition. Her husband and I tried to guide her to sit on the toilet, but she just couldn't bend her knees. Her poor back was raw from all our rubbing. Her poor bum muscles were so tight from all the pain, so my instinct was to grab them and shake them out. I did this for a good minute, just jiggling those bum cheeks. We were all giggling a little. Finally the mom sat down, and things got moving immediately. She ran to the bed, got on all fours, and was found to be fully dilated. Again, we could teach all that in childbirth ed, but really, when in the throes of labour, without some skilled direction, she and her stressed out partner probably won't think about all the possibilities or receive support. This is why good childbirth education AND good doula support create better outcomes than just education.

Positions for rest are something I like to talk about. Sometimes moms get really tired, but cannot stay in a position during contractions that they really like between them. So knowing how to rest and contract in one position for a bit while she regains her energy is useful. I like using a yoga ball and edge of a bed or counter to lean over on for resting and contracting, or hanging out in the bath. It's important that the skill of how to rest and chill out in labour is as important as riding the waves of contractions.

Another area in which discussiong positions is useful is when it comes to the second stage of labour. I love to watch people's faces as I demonstrate what a normal labouring woman often loves to do when that fetal ejection reflex kicks in...butt juts outward, arms reach up to grasp, torso leans way forward. I gently and slowly tip myself backwards without moving any limbs, just letting my hands grasp my knees, and it really hits home how, when you adopt the stranded beetle position, a woman is asked to do the EXACT opposite in most OB assisted births of what Nature asks, effectively mobilizing the sacrum (which dearly wants to be able to stretch and yield to the babe's extending head), perhaps necessitating circus style pushing to compensate for the smaller space created in the pelvis, and potentially wreaking all kinds of nasty havoc. Telling women that there is a good possibility of their not feeling great being on their backs while pushing (as many don't know this is not the real "way" the body likes to deliver babies), and that their instincts to do otherwise are spot on regardless of what they're directed, helps them to know they're not "bad" patients or somehow abnormal. And it's also helpful for them to know that there is no black and white, and that if they do happen to feel good on their backs, then this is absolutely fine too. Just because it may not be an ideal position for some, it may certainly be for others. I have seen women whose babies are exiting with great speed (myself included) throw themselves spontaneously on their backs. Perhaps this is how we are intuively guided to slow things down a little.

It is important to remember that birth is not intellectual from the birthing woman's point of view. The more charts and diagrams a woman has to look at and follow, the more she gets caught in wondering, "okay at what point do I do this, what sensation necessitates this position, etc." This is exactly where we do NOT want labouring ladies to be...in their heads worrying about what is "right". If they seem as happy as they can be in super active labour and things are going well, then it's right. The most useful tools in childbirth education are not the fancy tricks that are learned involving balls and positions, but the practice of relaxation, release of tension through whatever means the mother prefers, and the ability to stay with the sensations confidently as opposed to reacting to them with fear.

A Guide to Holding Birth Trauma

2011-02-08T09:52:00.003-05:00

Scary things can happen in birth sometimes. It's not something we like to think about, but the fear of emergencies in birth is something that lurks in the corners of the minds of pregnant women and their caregivers alike.

As doulas, occasionally we are front row centre witnesses for someones trauma. It can feel powerless watching those scary things unfold. We are often grasping at straws in our minds wondering, "What do I do? How can I help fix this?" Well, sometimes we can't. As much as we try to prevent birth trauma by guiding people to empowered choices and as much as we hate for bad things to happen to the couples in our care, the unexpected can occur. We can end up feeling very powerless when an emergency takes place, and it's crucial to know how to anchor ourselves in the eye of the hurricane so as to create the optimal space for healing to begin as soon as possible.

While trauma is occurring:

1) Acknowledge it. We need to look those parents deeply in the eyes, take a breath, and in our own gentle, loving way say, "Yeah. Here we are. That scary place nobody ever wants to go. Breathe, and hold on.". Trying to "make it pretty" when the proverbial poop is hitting the fan, minimizies the experience and only leads to dissociation.

2) Stay present. Breaking down emotionally, getting caught up in those bubbles of fear and drama, and freezing up is not an option. You cannot "check out". You need to open your heart up, waaaayyy up, stay anchored within the chaos, and stay there strongly with your clients. Be totally present, surrounding them with as much love and calm coming out of that open heart space as possible. It may sound flaky, but the emotional tone we set can have the power to keep others calm. As doulas are very much "space holders", what we energetically broadcast into the room can influence how the parents and caregivers respond to the trauma.

3) Reassure when possible. If a woman has to go through a tough obstetric procedure, while we can't make it rosy, we can definitely let her and her partner know all the positive aspects of what is happening, like "You are doing GREAT!", "We can see your baby now, hang on!", "This is the hardest part and it's almost finished." If Baby is an issue, repeating the positive things you hear the caregivers saying can be helpful to parents, such as, "They say your baby's heart rate sounds great." or "Her breathing has improved a lot in the last minute." A blue floppy baby is all a parent will see, and if it is appropriate, letting them know the good stuff that is going on with their newborn while the caregivers are busy focusing on their tiny patient can help promote calm. Often, parents will not receive this information, and their terror of the unknown could otherwise exacerbate their sense of trauma surrounding the memory of their child's first moments of life. Being informed and reassured whenever possible is comforting to parents. The look on the faces of new parents when nobody is actually telling them the baby is breathing with a good heart rate is enough to ensure you as a doula are on top of this.

4) Be loving. Touch the mom, speak to her lovingly, stroke her hair, coo to her. Be loving to her partner. This helps to promote oxytocin and reduce too much adrenaline response. Doing whatever you can to keep that mother/baby hormonal connection intact, even when the baby needs to make a fast birth exit or has just had a difficult passage and is not able to be in the room with her, may help improve her future memory of her birth experience.

5) Trust. Give caregivers ample room and support in their important job of dealing with a medical emergency. Trusting doesn't create the outcome we want, but staying connected to the trust whenever possible that everyone is doing their best, promotes calm, often helping the best care come about. As doulas, our spiritual beliefs are definitely something to draw from at this time, if we are so inclined. The idea of trusting that as we hold the space for our clients and everyone else in the room, all of us are also being held by a loving source, even if what's happening is something we can't make sense of, is something many doulas and caregivers seek comfort in. Knowing deeply we have no ultimate control and that our power lies simply in doing the tasks required, being present, and living this moment as fully as possible, no matter what, is often what helps us all to heal more completely when the emergency is over.

Once trauma has occurred and everyone is left picking up the pieces:

6) Beware of magical thinking. I had a sweet, lovely student end up attending several dramatic C-sections for her first mentored births. After the third, she broke down in sobs, asking, "Is it ME?" The doctor present was loving but firm and gave her a great reality check: "Ah, Sweetheart, you feel like you've earned the black crow award because all you've been present for so far is emergencies. We can all feel like this. Really, though, you're not THAT powerful that you can bring on bad outcomes just by your presence." This is a wise and straight to the point wake up call on those days we are stuck in the past traumatic experience, trying to envision what a different outcome might have been had we heroically jumped in to do the impossible to spare a woman from turmoil. Know what to own, know what to let go of as magical thinking. Help your client avoid falling into this trap too.

7) Don't entertain the "why" and "what if" too much beyond getting to the basic physical reasons something may have happened. Spending hours conjecturing "why" is not healthy, and with doulas/caregivers sometimes even arrogant as we try to throw out many hypotheses that will usually only ever remain hypotheses. It soothes our egos to have a tangible reason for those unexplained traumas, but healing isn't about soothing our egos. Sometimes things are just mysteries, and what's done is done. Sure, when there is evidence for something, it can feel good to know actions were completely justified. However, often there are many pieces of the puzzle missing, and will always be missing. An amazingly wise Abenaki Grandmother told me once, "Every time you ask why, Spirit takes a step back. Who says you get to be privy to why something happens the way it does? Instead, ask, 'What is it I can learn from this experience? Spirit will take a step forward.'"

Many clients after trauma will ask if you think the outcome could have been different had they done something else, for example, let's say, birthed vaginally had they avoided the epidural. You cannot possibly answer this question. Gently point out that wallowing in the whys and what ifs are fodder for self flagellation, and not healing. Embracing the experience for whatever it was, good or bad, making meaning of it, and living fully is usually a better choice for healing. This may only come about after a long period of grieving.

8) Debrief with your clients about their experience. Let them pour out their pain without trying to pretty the experience up for them. Don't join the ranks who say, "Well, at least you have a healthy baby." (if the baby is indeed healthy). Women need to feel "allowed" to grieve the loss of the experience they wanted. It's not selfish to have hoped for a lovely birth. It is heartbreaking to have suffered trauma. Grief is totally appropriate. My dear friend says when something has gone badly, "Dude, that sucks." She says it with absolute compassion, and there is comfort in knowing that someone acknowledges that something plainly sucked as opposed to having someone be chirpy and sunshiny when the real emotional landscape is so obviously grey. We want people we care about so much to feel better, but it's not always possible for a while. Sparing someone from authentic feelings and creating dissociation by interjecting niceties is more about our being uncomfortable with their feelings, and it's the same pattern that contributes to such high epidural rates, "Oh, poor dear, you're suffering. I can't stand to see you in pain. Let's just make it go away."

When the whole thing is talked out and there is more emotional space for perspective, connect them to where they were amazing and graceful in dealing with such challenging circumstances. It's not the same as trying to make it pretty. It's honouring the person's role in authentic and powerful living. They may have felt totally "weak" because they cried and couldn't "get on top" of things. Crying and feeling scared is emphatically NOT weakness. Just as the icon of the Zen woman breathing easily and painlessly through her contractions is not an appropriate image of birthing, neither is the stoic stiff upper lip image for someone who is softer and more sensitive.
Deeply honour how a couple moves through the unique emotional terrain of their unique births.

9) Provide resources. If couples need to seek more counseling about birth trauma or reactions of anxiety and/or depression, knowing which professional avenues to send them down is important. Be very aware of your limitations. Doulas are not therapists, and owning all of your client's emotional process is not appropriate, potentially blocking their healing by not sending them to the proper resources. You can always be available for support, but support doesn't mean owning their healing.

10) Doula heal your Self. When you have been traumatized, it is your mandate to deal with it. You cannot bring past trauma to the next birth and be fully present for the clients in your care. Doulas can and most certainly do experience Post Tramatic Stress Syndrome, whether it be from a true birth emergency to witnessing violently harmful and disrespectful behaviour towards a client. Whatever the reason, it is our responsibility to take the time we need to heal. Write it out. Connect with your own spiritual practices. CALL YOUR SISTERS! A community of doulas is the best way to help each other heal. I'm all about doula-ing the doula and without the support I receive from my community, I would most likely be a gibbering mess today. Reach out, talk it out, and embrace the incredible richness of this life of birth attending. Connect, ultimately, with your Love, as this is what grows when we remain present and seek to heal our own wounds. This Love can serve as a light to those healing their own traumas.

MotherWit Birth Doula Training Begins Soon!

2011-02-07T09:49:00.002-05:00

I am so excited to be welcoming the new wave of doula students who will be embarking upon this journey with me on February 17th, 18th, 19th, and 20th, and March 17th, 18th, 19th, and 20th.

This is a bit of a new format. Our last training was in the beautiful hills of Morin Heights where we connected to Nature and lived/breathed/ate/slept Birth for six incredibly intense days and nights. This format suits those who cannot leave the city for that long, and who like to take things a little slower, having a month's break to process learnings before moving on to studying how to hold the more challenging aspects of birth and hospital environment. I will still do intensives for any group of doulas who wish anywhere in the world, but the Montreal training will be a more leisurely format this year.

Apprenticeships are wrapping up from the last training...we have established regular case study/doula support nights, the students are well connected, providing support and guidance for each other, creating and nourishing the community of birth healers I have been wishing to see for years. Many are almost finished their training requirements and soon we will have more well prepared doulas out in the world who have been guided and mentored. This is the core of doula work: woman to woman support, birth attendants healing themselves, an ability for doulas to not only know how to help on a factual level, but to intuit, guide, and offer wisdom. I am so deeply proud of my trainees, as they slowly make their transition from apprentices to colleagues, adding their voices, their stories, and their skills to those of the many visionaries we need to bring this birth culture, which has spiraled outwards in its insanity, back to where it belongs...into the hands of the family....at its very root a transitional journey ripe with potential for healing. It is an honour to embrace these women as sisters.

I open my arms to all of you, new MotherWittie novices, and am so glad to have the opportunity to teach you some of the things I know. We are going to have fun, you are going to experience challenge, and you will find healing and growth. Thanks so much for joining us, and I'll see you in a few days!

Lesley

A Doula's Path

2011-01-12T14:08:00.021-05:00

"Doula" is not yet a common household word, though the importance of the role of a doula in modern maternity care is well documented in many studies. For those of you new to the concept, a doula is a woman who supports pregnant, birthing, and postpartum women and their families. The word is derived from the ancient Greek word for "slave" (I know, strange, right?), but has come to mean "in the service of women" in modern times. A doula supports women in their childbearing year by providing information about what she's going through and the choices she will face as pregnancy, birth, and mothering unfolds, offers comfort measures to ease the bumps along the journey, as well as reassures with constant emotional support.

If the mother has a partner, he or she also benefits from a doula's care, as the doula's support extends to them as well, ensuring they are well informed, prepared, and relieved of the stressful feelings many duties required of birth partners evoke. Many things concern the birth partner, such as knowing whether what the mother is experiencing is normal or not (if someone has never seen birth before, it may not be obvious that shaking, vomiting, and loud vocalizations are all very typical things labouring ladies do), having to press hospital staff for clarification surrounding medical interventions in birth, knowing what best techniques and methods to use to help the mother cope with the strong sensations and emotions that come up in birth, knowing how to deal with sore nipples during breastfeeding, etc....the list is vast. By being free of the burden of anxiety of having to know all the details of birth and how to advocate for the mother and help her deal with the challenging task of birth, not to mention at the same time being an emotionally invested, possibly nervous partner and co-parent, the partner can be fully present for the mother, holding her, encouraging her, and providing the intimate connection which gives so many women the strength they need to get the hard job of birthing done.

A question that commonly comes up is, "Is a doula the same as a midwife?" The answer to that is "no". Midwives, while also usually extremely supportive to the couple in their childbearing year, also usually have the responsibility of the mother's clinical care, meaning the midwife is the one who assesses and monitors the mother and baby's health throughout pregnancy and birth as well as the weeks following birth. She is usually a primary caregiver, and depending upon the laws of the country, province,state or county the midwife lives in, she "delivers" babies in a home, hospital, or birthing centre setting.

A doula's care is not clinical. Some doulas have midwifery skills, and if this is the case, they often, if where they live allows, work as "monitrices", meaning they provide the support of a doula, but monitor the mother's and baby's health at home until she feels it is time to move to the hospital for a doctor or midwife to take over clinical responsibility of the birth while she stays to support the couple. Because a doula is not responsible for a woman's or baby's health status, she is free to provide that information, comfort, and support the couple wants. That nuance was really brought home to me during the birth of my first child. My midwife arrived at my home when I felt like labour was good and strong. She listened to the baby's heart through my belly and examined my cervix. She said, "Everything is good. I'm going to go take my sleeping bag and have a nap in the other room so I can be fresh when the baby is born. My assistant will stay with you." I didn't know the assistant well, though she was very nice. She was not, however, particularly skilled at providing comfort or emotional support, and didn't really address my inexperienced anxiety at having dilated from 3 to only 4 centimetres in 18 hours of labour. It was my doula and my husband who kept me grounded and provided me with immense comfort, like massage for my sore back, whispered sweet nothings, and a real sense of emotional safety. Not that a midwife can't or doesn't do that very same thing, it's just that in my case, she was tired from having attended a lot of births, and was doing the responsible thing by ensuring she was fresh and awake when I gave birth so she could better use her clinical skills if they became necessary. When primary caregivers and doulas work together, the couple often feel they are getting the best of care, meaning a good clinical safety net should it become necessary, as well as continual supportive care.

I have been a doula in Montreal for over 17 years now. I have often been asked why I don't go on to become a midwife or a doctor. For one, I enjoy being "just" a doula. I am personally not interested in being responsible for important health decisions should they arise. I have much respect for those who are, and I prefer to let them do their thing while I remain continually emotionally present for pregnant, birthing, and postpartum women. If things go unexpectedly in birth, then clinical care is the priority of the primary caregiver, whereas the doula takes those scared parents-to-be by the hand, looks deeply into their eyes, weaves a web of calm around them and says, "Okay. Here we are..yes, in that very place you were scared to be. Breathe and stay." If things go normally, as they usually do, we simply remain available for what the parents need for comfort.

My favourite thing about being a doula is being a keeper of precious memories for parents, of moments of their love and brilliance told to them later on in our postpartum follow up visits. To witness a new father moments after birth as he anoints his baby with his tears of awe, or to hear those quiet, holy words of love whispered to a newborn by his enraptured mother is to hold the most beautiful and subtle threads of the tapestry of the story of this family's beginning, threads that are lovingly handed to them in the moments the parents are swept away on the roller coaster ride of the postpartum period. These bits of story connect them to their strength, serving as reminders that all of this experience, even the hard parts, is about love. The healing potential in these juicy bits of story could be so easily missed if we as doulas had to put our attention to the clinical details. We walk the halls with our couples while they labour, sit by them while they rest in the bathtub, just listening...with our ears, with our hearts, always striving to find the balance between being and doing.

As we are story keepers, so are we keepers of the gate between fear and confidence, distress and courage, panic and calm, empowerment and victimization. While we do not own the birth our clients experience, nor attempt to control birth or birth's caregivers, our belief in birth as a sacred journey, no matter how it unfolds, very much holds the potential to influence the process. Doulas strive at births to be our most grounded in the knowledge we have as well as open to the realms of intuition, which we look to when we need to know the best way to buffer a harsh environment, or to sooth away the ripples caused by an unconscious yet hurtful remark, so things that could otherwise potentially be perceived as trauma do not get a chance to anchor into the labouring woman's perception and be carried into motherhood with her. It is not always possible, but we try our best.

As a young doula I wanted to help women have natural births, no matter what. I felt like the epidural and I were in competition. I was easily wounded by the often shocking hospital environment, and felt like if a woman received an intervention, I had failed. It took time and experience to know on a cellular level that my job was not to rue every little intervention. I don't own another woman's birth. She is responsible for her choices. If she decides she must give birth in a hospital to feel safe, she will be subject to the environment. I do my best to buffer the harshness of the hospital environment and empower her as best I can so she is able to make choices suitable to her. If she chooses induction because she and her doctor feel this is best, it is not my business or my right to dissuade her. I ensure she has the best information I can give her at her fingertips with which to make an informed choice, and when she chooses, I support. Yeah, that ride may potentially prove to be really bumpy as all those risks she was hoping to avoid with induction become reality in her experience. And so it is. This is her story, her learning, and her own grappling with the tension that lies between trust in her body and fear of not doing the right thing for her baby. I have learned that my job is to support not always what I wish would be for someone, but what exists in the now.

I know many have contempt for doulas...the Medical Establishment (and I refer to an entity, not to individuals, whom I find are most often caring and have the best interest of the mother and baby at heart) for our illuminating the often gross shortcomings in the sometimes unconscious and unkind policies that are not at all supportive of a labouring woman, her baby, and her partner. There are as well those who think doulas are sell outs by trying to help women have more humane birth experiences within the hospital system, standing idly by as we meekly "allow" our clients to be brutalized. Again, I support what is, not just what I wish would be. Sure, I'd love us all to claim responsibility for our own births, birth at home humanely and lovingly, our experiences undisturbed, our babies born into optimal bonding environments with bodies, minds, and spirits intact. I am blessed to have had that experience three out of four times, and I want that as much for everyone as the next guy does. But if about 98% of women in North America are giving birth in the hospital, most with medical care, because they feel safe there or they feel it's the only option they have, this sense of safety and lack of options a product of a culture that is terrified of birth and death, do these women not need an incredible amount of support to have birth experiences they can look back on with a sense of power? I do not believe my trying to help a lady have a decent birth in spite of the hospital environment will make women go, "Oh, okay, it's all good, then," and lessen the minuscule percentages of those who choose home birth. I alone am not going to get those 98% to change their minds, regardless of all the stats which tend to support the idea that home birth is as safe or in many cases even safer than hospital birth. Many people may understand that their fears are overblown on an intellectual level. But the collective fear is so big, people still pack their bags and birth in the hospital with obstetricians anyway. And if that's where they feel safe, and that's where they want to be, that's where you'll find me. I'm not there to judge what makes someone feel safe. I'm just there to help when I can. And believe me, when things go awry, I'm very grateful for obstetricians and technology. I am not against hospital births or doctors or nurses at all. What I am challenged by are many of the policies and protocols which detract from the normalcy of most births. This is where change must happen, and I'm hoping it will grow from more positive hospital birth outcomes, which the presence of a doula is shown to increase.

Isn't every birth a woman looks upon with love and good memories a triumph, even if it isn't filled with the potential for "perfection" (meaning perfectly undisturbed, perfect environment, perfect bonding, etc.)? Isn't it good to have a few more women come out of the hospital feeling like strong and powerful mothers? Of course it happens that sometimes when a woman looks at her birth with fondness I am knotted up inside at the things she maybe didn't know looked heinous to me. But who am I to tear apart her birth experience because my vision of great birth isn't the same as hers? I WANT her happiness, and am thrilled for her triumph, and I have learned not to be attached to my version of "perfection" in birth. If something was really awful and she was unconscious of it at the time because she was all hopped up on her love and ecstasy hormones, adoring the nurse who was maybe actually quite impatient with her, and feeling bonded with the doctor who brought up emergency cases with the resident in front her of while she birthed, it will come up. It will sit in the back of her memory until it is ready to burble up to the surface for illumination. And when it does, I usually get a call, and then we process it. Often there are delayed reactions. If it never happens, fine...it is not for me to say what "should" traumatize someone.. but if it does, many of these women go on to choose different routes for their next birth experiences. There are many roads to empowerment.

My path as a doula has morphed from just wanting to see nice births to really trying to help improve maternity care in hospitals. Midwives are doing a great job tending to those families who feel happy birthing outside of the hospital, and God love 'em. There is a big movement right now that is shedding light on the some of the potential pitfalls of hospital birth and illuminating the beauty of homebirth and potential for the amazing strength women possess. Women are taking their experiences and using them for others to learn and gain courage from. One of my favourite examples is the scene in the The Business of Being Born where Ricki Lake gives birth in her bathtub. She is naked, hurting, and vulnerable, yet at the same time in her fullest power. She allows us to witness her bringing her child joyfully into the world, a generous and precious gift to our lost birth culture, an invitation to those who have maybe never thought about birth beyond how soon they can get an epidural, or had perhaps not even had an idea that homebirth was an option they could pursue for themselves. This is potent medicine.

We have had grassroots homebirth movements for some time, but to now reach out to the mainstream, to not just preach to the converted but to begin little by little to shift the collective consciousness from overwhelming fear and contempt of anything that questions what Medicine tells us to, to "I'm still afraid but somewhat curious...maybe some change is needed" is crucial. While the rising Cesarean rate and crazy induction and routine epidural epidemic continue to wreak havoc in North American hospital birth, this slight shift gives us a glimmer of hope that we have to nurture and help grow...hope that our birth wounds can begin to heal...slowly, little by little, decade by decade. Along with the work people do to raise awareness, consumers of medical care must also become aware of their responsibility in birth. As long as we put all the power in a doctor's hands to get our babies out, the pressure on them is enormous, and their fear of not doing everything possible to meet these expectations and maybe even the fear of litigation makes medical maternity care often very aggressive indeed. We cannot simply lay blame on Medicine...we have to look at areas where we may have abdicated our own responsibilities as well.

Doulas, with their belief that birth is usually normal and healthy, go into the hospital with a couple and try to keep them, within that environment of "what if" and "risk" and "danger", connected to their intuitive knowledge, their practical wisdom: their motherwit. I choose to do this as my part. This is my small contribution to what I hope is healing. One mother, father, and baby at a time.

The doula training I provide reflects this impetus to create healing within the system that often perpetrates great wounds (while honouring the many blessings it can also provide). Many doulas have contacted me over the years, feeling woefully unprepared for doing this crazy job within an environment that can be resistant and sometimes cruel. While I feel that my work as a doula has changed its shape over the years, I feel that training needs have changed too. I think we need a paradigm shift in what a good doula training constitutes. I do not believe a woman can take a 2 or 3 day training and do this job with enough skill and enough tools with which to protect herself emotionally. This approach doesn't gel well with this profession. This is why I believe wholeheartedly in the apprenticeship model of learning, and strive to promote it as a new standard of doula training. While many trainings are excellent given the time they're done in in terms of learning hands on labour support techniques and how to deal with challenges, a lot of the students are very focused on papers and credentials and sometimes arbitrary limitations that are as fear based as hospitals are, and I have not found those things to confer good doula skills. Yes, it is up to the doula to continue her education and be self motivated to study, but this kind of learning does not necessarily help develop wisdom.

I believe strongly in the value of having an experienced birth attendant doula the doula (yes, I am using "doula" as a verb) as she embarks upon this journey of birth healing, helping her build her skills, recognizing her vulnerabilities, being involved in her education and development. I like to bring her into the hospital with me so she can observe, without pressure, as birth unfolds, no matter how it is. It is good for my students to have to shift gears and prepare for the planned C-section they were hoping our client could avoid and bounce creative ideas of how to give the best support off someone experienced. It is good for them to call me in a shaky voice telling me they're not doing well emotionally because the birth they are at is really hard, the woman is losing it, barfing uncontrollably, and the novice doesn't know what to do to make her feel better, learning the lesson that sometimes you can't and you just have to keep trying and be present. It is good to get a call in the wee hours from a new doula who has witnessed something traumatic saying, "I am so angry and I don't know how to go back in there and do a good job" and have someone who has been through it talk her off the ledge and bring her back to her centre. It is good for them to miss a birth because it was so fast near the end and know clients were so happy because it went well and are grateful to her because they used all that good prenatal guidance they were given, and good to be able to call and ask, "they're not just trying to make me feel better, right?" It is good to have gatherings so the apprentices can build community with each other as well, and can vent and cry, laugh and muse, ask questions and come up with their own answers with encouragement. And it is good for me to learn from them too.

As I continue to support women in birth, and hopefully will continue to do for decades to come, I continually develop my approach to training new doulas. This is important work. We are striving to shift the pendulum, adding our voices and skills to those who are also working hard to illuminate, educate, and empower people about what birth has the potential to be. I am excited that my birth and postpartum doula trainings, as well as MotherWit doula mentor training workshop is sparking interest in student and experienced doulas around the globe who are realizing the potential they have to be a wealth of resource and support for parents to be and new doulas. Though I don't know if I'll see radical changes for the better in hospital maternity care in my life time (though being asked to give doula workshops to nurses and even medical residents has been a really pleasant surprise), I will remain steadfastly hopeful that doulas are making a difference not just to the individual families they serve, but to our culture as a whole.

This is my path, and I'm sticking to it.

Doulas in the News!

2011-01-03T20:09:00.002-05:00

CBC News came to the MotherWit Doula Centre a few weeks ago to an interview with some doulas and clients. It's a very short, but very nice overview of how doulas are becoming more visible in the public eye.

If you go to 23 minutes and 40 seconds into the broadcast, you can see some of what we're up to here in Montreal. Enjoy!

http://www.cbc.ca/video/#/News/Local_News/Montreal/1317903731/ID=1719989702

Birth Stats: A Doula's Year in Review

2010-12-28T15:03:00.003-05:00

I just got home from an absolutely gorgeous birth of a nice big boy. This is most likely my last birth before the new year, though anything is possible. As I have time to do so now, I'll share how things went this year.

Before getting to the birth stats, let me just say this has been a HUGE year for me, full of growth. Though I have been a doula for quite some time, MotherWit is just over a year old. In this year I created and we launched our very successful Birth Essentials: A Course in Childbirth Empowerment prenatal classes. I taught my birth doula training in intensive format for the first time with great success. I also taught for the first time a four day postpartum doula training course. Both trainings required many hours of creation and hundreds of pages of doula training manual writing. The work was well worth all the effort, and I am very very pleased with my amazing apprentices and students.

The MotherWit team opened a physical space, something we had been hoping to do for quite some time. In this space we teach our classes, see our clients, do trainings, have mom/baby groups, apprentice meetings, "Meet the Doula" soirees, and will soon be doing infant massage teaching for parents. We have parties, too. I am thrilled with our cozy space.

MotherWit was asked to do 2 informal, in- hospital doula-led workshops...one 8 hour workshop for new nurses, and one 1 hour workshop for family medicine residents. Oh, what fun! This was a very eye opening endeavour, and we learned a lot about where many medical people's hearts are at...it was all good news. We also learned about how restrictive protocols and policies can be and how they inhibit some of the ways some of these people really wish they could work. There is lots of exciting work to do in these areas to create more satisfactory birth experiences for families who want/need to birth in a hospital. Working together, I truly believe good changes can be made. People often think I'm a PollyAnna and a dimwit for holding onto that hope. But I stand by it. Yes, I am myself a home birther. Yes, I point women who want to take that route to all the resources available whenever it seems they want this option. Yes, I sometimes feel I am being asked to witness train wrecks. Yes, sometimes what happens in hospitals is terribly hurtful and frustrating. But as MOST women are still wanting to birth in the hospital because this is where they feel safest, I feel focusing my energies on ensuring these potentially overly managed births, often the price for this sense of safety, have a lot of input from well informed, well prepared parents. I also feel it is crucial for these women and men to have emotional buffering when necessary. Everyone deserves support in labour, to have their choices honoured, and to feel heard and loved. This is the essence of doula work.

I also went to Madagascar this year! Yes, I am still intending to blog about this experience, but as you can see, work has been crazy! I will get there. It was incredible! The preparation to get this trip underway was no easy feat, and it took a lot of time and energy, again, well worth the effort.

On a personal note, my eldest baby turned 18 and my youngest baby started Kindergarten this year. My sisters came from the UK to visit because one of them got married here in Quebec...a truly lovely wedding. My mom and stepfather had some health challenges that are now, thank Goodness, behind them (ptu ptu ptu). It felt like a real blessing to have Christmas together with everyone in good health. I lost my friend Lhasa to breast cancer early this year. If it taught me anything, it was to seize opportunities and to be very grateful for every day.

I attended 42 births this year and saw 47 babies enter into this world. This is, thank Goodness, 21 births less than I attended last year. My goal had been to attend much less births. While 42 births is still a ton given everything else I've been doing, it was technically still a bit of an easier year in terms of birth attending. I am so glad for the MotherWit team who are slowly beginning to take over the volume of births I'm trying to let go of little by little. My goal is to do significantly less this year so I can focus on teaching, as I have been receiving requests from different places to train doulas. I also REALLY want to finish my book. I had hoped it would have been done this year, but not yet.

Many people think doulas have good stats because we attract couples who want natural births. This is so not always the case. As doula work becomes more mainstream, it is not necessarily those who are hoping for a natural birth who seek out our services. Often it's couples who are savvy of how lost they may become within the hospital system, and just really want an anchor, or to ensure there will be someone there to trust them and give them support when they feel afraid. As I said, everyone deserves support in childbirth, not just those who have the goal of natural childbirth in mind.

The main demographic of my clients are educated middle to upper class couples. They are of varying races, religions, and sexual orientation. While having a large percentage of educated, prosperous couples as clients may sound easy, I assure you this is not often the case. Many of these couples come to birth having been very focused on careers up 'til this point, and are educated about birth via friends (who love to share horror stories), media, and their doctors. The connection they forge with their bodies and their emotional needs as soon to be parents (with our guidance) is often very new. Our way of helping couples prepare for birth is less intellectual and more about encouraging them NOT to trust a clock or a number, but to tune into themselves. It is not easy encouraging women who have spent all their lives in control of things to let go and allow this primal process to unfold organically. They often refer to "those other ladies" who can squat in the fields, not realizing that they are capable of that too. Their doctors also often assume that because they are educated and career oriented that they will be thrilled with the "civilized" way of birth (induction and epidural), so it's often promoted as a good thing for them. One of my clients was offered a planned Cesarean (not often done in Quebec at all), probably simply because she comes from a very wealthy family, and it was assumed (wrongly) that she would feel too posh to push. Believe me, we have our work cut out for us to help women connect to those fledgling, barely whispered of hopes they hold that maybe they could have births like the women in those documentaries, even if they're not planning to give birth at home in a kiddie pool but with a high risk obstetrician at a tertiery care hospital because they're on the long toothed side of 35, and in spite of the fact they are getting most of their childbirth education from a culture who looks to A Baby Story for inspiration. To those of you who really know birth, I know this sounds like an impossible dream. But I am telling you, even though they're not birthing in pools, they are getting to places they never thought they'd go, and these ladies who are often told by their friends and doctors that they WILL be begging for "their" epidurals (as if there's one just waiting to scoop up every birthing woman) as soon as the going gets really tough, ARE BIRTHING NATURALLY! With doulas, anyway. Yes, we still see way more epidurals and Cesareans than we otherwise would if most of these women planned to give birth at home, but substantially more than half of my mamas birthed naturally this year.

Out of these 42 births, only 2 this year were planned outside of a hospital (both were planned at a Maison de Naissance, or Birth House for those of you who don't speak French or Frenglish, which is a free standing birthing clinic run by midwives...no doctors on staff). One lady was transferred from there to the hospital to give birth, and another gave birth so quickly her midwife barely had time to run to her house to catch her baby. All of the rest happened in hospitals. In the downtown Montreal area, hospital birthing women have up to 98% epidural rates, meaning about 2% of first time mothers here birth without epidural. According to nurses, most of those women wanted an epidural, but didn't get it on time. Midwives do not make up hospital staff here. All of these births were attended by doctors.

I had a higher percentage than usual of Cesarean births this year. So, in total, 7 surgical births: 1 planned for twins because both were breech (the doctor on call said he would attempt to assist with a vaginal birth, but the mother chose otherwise), 1 planned for twins because one twin was definitely showing signs of distress before labour had even begun, 1 mom induced with 41 week twins (after 36 hours of labour, things didn't progress), 1 singleton birth planned at 37 weeks for vasa previa, 1 attempted singleton VBAC attempting lady had a repeat C-section for fetal distress due to an abrupted placenta (they thought maybe the uterus had ruptured), 1 planned for twins with a pre-ecclamptic mom with a breech first baby, and one long singleton labour that ended with fetal distress and an emergency Cesarean. All babies were born healthy, or became healthy quickly after birth. This is just shy of a 17 per cent Csection rate, which is the WORST I've ever had. As you can see, the majority of these surgical births involved twins. There is SO much work to be done to support twin moms, who are subject to a crazy amount of intervention.

8 of my ladies had epidurals (the ladies who had Csections only had epidurals at the very end of labour because they knew they were going to have surgery, or were planned, so I don't count them in this stat). 3 were for long, hard posterior labours, 2 were for Cervidil/Pit induced labours, one lady got one at 8cm after her Cervix hadn't changed after 1.5 hours with transition contractions...wasn't attached to natural birth, , and two wanted them when labour started getting really tough because they had both had traumatic birth experiences before and were terrified of experiencing that level of pain for a long time again. They felt it was what they needed to feel safe. Epidural rate, 19%

27 of my clients experienced natural birth. Some were "augmented" because of waters being broken for a long time before labour starting, but they gave birth without epidural or IV narcotics.

Out of these natural births 11 were first time moms (one mom of twins in there), 3 were VBACS, and the rest (13) were subsequent vaginal births, most second and a couple of third babies. 64% natural births.

So, folks, that's this doula's year in review. I cannot thank those enough who had me at their births, and to all those who have helped and supported MotherWit get off the ground. You are all appreciated.

I will leave you with a nice story. I encountered a lovely resident at the hospital today who told me she had been one of the residents to attend the workshop I gave earlier this year. She told me this workshop had really touched her, and that it had been exciting and eye opening. After my client gave birth with her usual beautiful grace, on her hands and knees with her husband helping, and she and her husband and baby had had some time to bond and bask in the glory of their experience for a while, the resident came up to them and said with her eyes shining, "Thank you so much for the honour of sharing in such a special time in your life." The message I really tried to give to the residents was to remember this...that no matter how many births they attend, no matter how interesting of a "case" it may be, these patients of theirs are bringing life into the world, and that it is sacred and special. I emphasized that if those patients will remember anything about the people who were involved with their births, it will be how honouring their caregivers were of them. It was really moving to see this resident not only act as if were not just an ordinary part of her day, but to express the sacredness of their experience with her gratitude. May this trend continue....

Happy New Year!

Doula Boundaries re: Finances

2010-12-14T18:49:00.010-05:00

Occasionally I will have a client who finds out that when she must have a planned Cesarean, she feels she no longer wants doula services, or wants extra postpartum care instead. If this is planned in advance and all are on board, this is fine. Doulas are flexible, and usually don't mind doing some extra postpartum visits instead, or a friendly termination of services if this is appropriate.

I have heard a few doulas tell me, however, that their clients decided at the last minute they felt a doula at their Cesarean birth was pointless, and demanded other services that were not really within the scope of the birth doula's work, like night nanny-ing or older child care, in order for the doula to earn the fee. If this is something the doula is really happy with, whatever a client and doula want to do is their business. I feel, however, as a reasonably experienced doula, that contracts are essential to establishing clear boundares. I know they can feel uncomfortable to a doula who is so willing to give everything and bend over backwards to serve all the desires of her client. Doulas serve. This is our essential definition. And because birth is so incredibly unpredictable and changeable, flexibility is part of our natures. But boundaries are important. Doulas need to honour their worth and refrain from feeling badly for taking pay because, for example, a birth went very quickly, or from allowing their family income to take a huge financial hit because they weren't comfortable standing up for themselves. This can cause resentfulness and burnout. Contracts make things clear. They are important for doulas, especially for newer doulas who are scared of making a client uncomfortable.

If a client signs on for a birth and has agreed to the listed things in the contract such as "if you choose not to have your doula after your prenatal meetings, you are still responsible for the remainder of the fee", this fee is still owed. Period. Doulas meet with their clients before any official prenatal work is done in order to ensure both parties like the chemistry. That can usually be sensed immediately. If the client decides at the last minute she'd prefer her best friend to you after the work you've done together and fails to contact you for the birth, your contract protects you. It is certainly her right to not have you come at the last minute, but your fee is still due. If a baby comes too fast, for example, we still must be paid. A planned Cesarean is still a birth. It is wrong to assume that a doula's presence is not very valuable for a Cesarean birth. While she cannot go into the operating room with a client much of the time, especially if the mother's partner is going in to support her, there is much we can do after the surgery.

A doula's work is so unpredictable, and outcomes are beyond her control. She should not be penalized for her client's last minute choices. She will not have had time to book another client with such short notice, and this can severely affect her livelihood.

Sometimes clients will expect special services because they decided a doula at their C-section was not necessary, and this is not fair. A doula lovingly and thoroughly prepares her clients for the birth of their baby, however that unfolds. We cannot guarantee a vaginal birth. We can't guarantee anything. To expect that we'll just do something convenient for the parents in place of birth attending is like their asking for a free dessert from a restaurant because despite the effort of our crafting a wonderful and elabourate meal that was requested by them, for whatever reason it turned out they didn't want to eat it, or pay the balance. As it was the customers who came to the restaurant in the first place and placed a request that you have refused other requests for in order to accommodate this one, it is only fair there is financial accountability for the original order instead of having to delve into the chocolate mousse resources to "make up" for the balance they owe. It's not the restaurant's fault the client now doesn't want the caviar and truffle souffle. Now, granted, if the meal were terribly prepared and served, this would be another issue, and should be something the parents can dispute. But generally, signing on for all the prenatal preparation, postpartum follow up, and a birth means that regardless of how the birth has to go, the doula has been asked to provide a service and must be paid according to her contract and not get ripped off because she didn't replace her service with another coveted one. Birth doulas are not babysitters or night nannies. We attend births. Cesarean is birth. The vast majority of clients who want these other services don't even ask whether or not this would require a different payment structure or a different service provider...it is apparent to most. But occasionally some don't, and when this happens, the doula must be firm in standing up for herself, even if this means taking action to get the pay her contract states is owed to her.

I had a client recently who knew before our first face to face meeting she would have to birth via C-section. We decided to do less prenatal visits, decided I would be at the hospital for her and her partner while she birthed, and that I would do extra postpartum work. We were all very happy with this arrangement. I have had other couples ask me, "If I end up having to have a planned Cesarean, I don't feel I'll need you there as I've been through Cesarean before. Can we have something in the contract which states I can refrain from paying the birth attending fee?" And I will agree to that if they know a few weeks ahead of time. This gives me the opportunity to book someone else in their spot. Requested flexibility is not an issue. However, if a client signs her contract in advance knowing she is bound to pay for birth services, whether she asks her doula to be there or not, then that's what she needs to do.

Birth attending is an amazing joy. Sometimes births are short and we make quite a great wage if you add it up hourly. And sometimes with loooonggg births, especially if we missed another birth because someone's birth was very early and loooonngg and another person went very late (this can happen even if you only book one lady per month), you can end up in the hole financially. We have to plan for these occasional contingencies, and take those rare but sad hits. But if our flexible natures which love to serve and to please our clients make us pushovers, we will inevitably get taken advantage of at some point. And yes, it IS true that if we speak up for ourselves and claim our right to decent pay, we can get the reputation of being hard assed. But it also shows we respect ourselves and value our work. Being firm has in fact only helped my business as opposed to send clients running to someone else. When YOU know your value, it is apparent to potential clients as well.

I personally don't quibble about my prices. I don't give people money off here or money off there because they feel my price is high. Every doula knows the feeling of walking into the home of someone who owns a BMW or you see a $1000 stroller in the corner, or the couple just came back from a big vacation to Jamaica, and then the clients want to negotiate a "better deal". I have never had a problem lowering my price for people who clearly are struggling with finances and who seem very committed to investing in their birth experience. A colleague of mine was recently approached by a pregnant teenager who said, "I need a doula, but I have no money. I can bake, and I can knit." This honest, upfront approach impressed her, she agreed, and they both had an incredibly rewarding experience. If women are genuinely disadvantaged, I send them to a doula organization which specifically helps women in need. But for the vast majority of my clients, my price is my price. Those who initially found it quite high change their minds after the birth is done. The 24 hour on call committment, doing our best and pulling out all stops in terms of support in the throes of extreme sleep deprivation, helping clients gather enough information to make choices that in the end spare them from a potential C-section and the recovery time and breastfeeding challenges ensuing from a high tech birth, having to reschedule sometimes 2 days of appointments, missing our 2 year old's birthday party, etc.....this kind of service is incredibly valuable, and the far reaching effects of a satisfying birth and postpartum experience are global. When the birth is done, clients are very aware of all you have done.

Doulas out there, you are amazing. Within a scattered, unpredictable, crazy making job, a firm backbone of boundaries in the area of finances is crucial for your mental and emotional health, as well as that of your family. Never doubt your worth.

Missing the Forest for the Trees: Birthing in an MRI Machine

2010-12-12T13:32:00.010-05:00

http://www.foxnews.com/health/2010/12/07/woman-gives-birth-mri-machine/

I came across the above article from a Facebook friend, and have to say it left me with a dizzying sense of sadness. A woman gave birth in an MRI machine in Germany. The stated intention behind this crazy endeavour was to set up a study which seeks to examine why doctors "have" to deliver so many babies by C-section. They want to unlock the mystery as to why some women can birth 10 pounders and others have 7 pounders which get stuck. They want to understand why so many babies' craniums are disproportionately large for their mothers' pelvises. When the article went on to state the researchers were trying to get a better understanding of the mechanics of birth, I didn't know whether to laugh my head off, barf, or hit someone.

Firstly, even open MRI machines, which is what this woman birthed in, are not in any way conducive to normal labour. I highly doubt she could have been any way but lying on her back. I could be wrong, but from images I've seen it doesn't appear to be possible in another position. So if you are trying to study the mechanics of labour yet put a woman under a machine on her back, can you be seriously believing you are studying something that even remotely approaches normal labour mechanics? The vast majority of women in this world who have given birth normally, meaning unmedicated and largely undirected, would not even conceive of lying on their backs to birth. If the baby is trying to push that nice flexible sacrum away with his face as he begins to extend his wee head, the joints of that sacrum being suffused with lovely, bone-opening Relaxin, what kind of slap in the face is it to find that the sacrum won't move because it's sandwiched between his head and the bed his mother is lying upon...on her back? Mom is directed to resort to purple pushing with people yelling at her that she HAS to create intra-uterine pressure by holding her breath and popping her eyeballs, effectively turning herself into a human pop-gun. The rush and stress of all that direction and being yelled at not to yell when it is all you want to do, makes MY pelvic floor contract at the the thought of it. Purple pushing is NOT NORMAL!!!! But close off the space, and Mom may have to resort to it.

I doubt this nifty MRI machine, closed or not, accommodates the positions most women adopt during physiological labour, which are more hands and knees or crouching stances. And they will probably want to YELL as they push their babies down, and move around a lot, which is probably not great when you're trying to get an MRI image. She will not actually be "wasting" her contractions, or "lessening the efficiency" or "be doing it wrong" if she doesn't surrender to the needs of the MRI machine and the desires of the doctors who "deliver her". But she will likely be made to feel like she is in the wrong, the negative emotions created by this circus contributing to some of the mess I as a doula have to help a woman process after her birth to heal from her experience so she doesn't remain unconfident, traumatized, and subject to depression..and this is without even having birthed in a machine. Women don't birth "wrong". Yeah, sometimes the unexpected happens, and thank goodness for science then, but the way women adjust and adapt their bodies to the process is instinctive, and to change them is usually inappropriate and problem CAUSING. Just check out the powerful, gorgeous, loud birther of Jason Shawn in this YouTube clip. I dare you to tell this woman to shut up and get on her back because that's the "best way"! I in no way see in this clip a woman suffering or out of control...I see a woman expressing her most authentic power, and it is pretty much the opposite of a medicated woman in a machine lying on her back. I don't see why this kind of birth can only happen either with midwives or unassisted. Why can't OBs hold the space for this kind of birth too? It's obviously not like they have to do much.

http://http//www.youtube.com/watch?v=9jYp_Vh6yjM

If you observe a woman birthing and you have the attitude there is something inherently wrong with our birthing design, and you're creating a study to determine her potential biological flaws so the people in white coats can "fix" us, I assure you, you will not be watching a normal birth, mechanics aside. Your doubt filled observations will affect the process. If you are trying to have an orgasm and you sense you're being observed and judged, you're going to lose your mojo a little. If you're trying to have a crap, you have a time limit in which to achieve it, people are observing you and perhaps even commentating, would the efficacy of your bowels not be affected just a smidge? Is it not considered a common thing for gentlemen to have pee shyness when another guy stands beside his urinal? How on earth can we expect a woman experiencing an event as challenging and dare I say as sacred as childbirth be remotely normal in this INSANE context? We're not even scratching the surface here, as there are other reasons many of the cases of shoulder dystocia and "CPD" could be occurring, such as the over use of labour stimulants, epidural anaesthesia, etc, which are all known to have a potential effect upon normal hormonal flow AND mechanics.

As a woman, a woman who knows the triumph of having birthed normally 4 times, and as a doula who has witnessed so many potentially unnecessary hospital horrors my tears could fill an ocean, this whole article did not make me execute jumpy claps at the marvels of science. It made me feel terrified for the future of birthing women, because I really think much of what this study will find is blame for the woman and her brilliant design to justify the expense and effort put into it, as opposed to illuminating the sheer arrogance and danger of trying to determine how birth fails by breaking it down and examining it right down to its smallest particle. What if we were to focus more upon the preventative benefits of nourishing the whole process, perhaps even doing a little humble bowing in the face of such Mystery...woman's mystery...now and again? You know, even Joe Public understands that many Cesareans are iatrogenically generated. Don't these researchers know this?! There is no motherwit here.

New MotherWit Birth Doula Training

2010-11-29T00:30:00.002-05:00

The MotherWit team and I are excited to officially announce the new MotherWit Holistic Birth Doula Training, which will be taking place in Montreal, Canada. It will be 2 four day intensives, the dates being: February 17th, 18th, 19th, and 20th 2011, and March 17th, 18th, 19th, and 20th.

Having been a doula for going on 2 decades and having been training doulas since 2003, I feel very confident students will find this the most thorough training on how to begin to make a real change in our modern birth culture. By providing accurate information, supporting a woman through the emotional ups and downs of the childbearing year, lovingly and without judgement advocating a couple's choices, and helping to create a cocoon of safety within which a couple can confidently put their feet to the path of birth and parenthood are ways in which doulas contribute to better birth experiences. We help women reclaim their innate knowing, their intuitive wisdom...their motherwit....trusting they are the experts in what they need to give themselves the best chance at birthing triumphantly.

Birth doulas contribute to the healing of a struggling birth culture, and this potential lies in remaining grass roots, true to our natures, while everything else grows rapidly more clinical and structured around us. While we learn the often challenging essentials of birth, as women we learn through story, through sharing, by paying attention to our own emotional landscapes and the feelings of others. As we build scientific knowledge, we build emotional intelligence, learning skills such as diplomacy towards those who hold different views from ours, non judgement, and active listening. Babies and nursing toddlers are welcome within our circle, as mothers should never be excluded from learning skills that support other women. If we have trouble learning women's work in the presence of noisy babies, we have lost our way. MotherWit is about reclaiming our ways.

While we are grassroots at heart, we work within a highly structured system when attending hospital birth. It is essential to understand thoroughly what a client may expect while birthing there, and how to skillfully bridge the gap between a highly technical and grassroots approach. While we maintain a holistic approach, we strive to be non-flakey, as our real job of healing is not about preaching to the converted...it's helping everyone feel safe within our presence by being knowledgable and compassionate about where people are coming from. No true healing will come from an antagonistic approach to birth support. Respect for all is essential. And when things make you feel powerless, which they sometimes will, we have ways to help you cope with that too.

We believe firmly in the apprenticeship of new doulas as they embark upon their new work with their hands held for awhile. It is simply not enough to say, "Here, take this information," and expect you to have enough knowledge and wisdom to support a birthing couple, especially in the hospital system, without having seen a big sister doula in action a few times. To truly understand the scope of our practice and the strength of the space of safety we hold for our ladies to birth within, it takes time. It takes observation without pressure, and a safe space in which to process witnessed birth experiences, and ask many questions. MotherWit provides the opportunity for apprenticeship.

What some former students have said about the MotherWit Birth Doula Training:

" I could not have picked a better guide to lead my journey into finally claiming my life's work: empowering women in their birth choices." MT

"You are enriching so many women's experiences and opening the doors which enable women to find their truths." KdeJ

"Thank you so much for encouraging me to come and helping to facilitate what I needed to do for my own healing. It's more bearable when there's someone willing to stop justifying and just agree that sometimes 'that just sucks, dude.' Absolute heart felt gratitude for your teaching and support." KO

"Thank you for being our teachers, our mentors, and our healers."LT

We are very much looking forward to seeing you in the new year.

If doula wannabes in the Toronto area are looking for some doula training, let us know, as this summer we're hoping to travel to your fair city.

For doula organizations or experienced solo doulas (30 plus births) who are interested in providing excellent mentorship to future doulas, MotherWit also provides a weekend workshop in being a MotherWit Birth Doula Mentor. Embrace the art of teaching apprentices, and share the wisdom of your experience, woman to woman. We will travel for a group of 10 or more.

Have a wonderful week!

In the Wake of SuperMom

2010-11-23T13:35:00.003-05:00

Phew!

This has been an intense past three weeks. I attended six births, several of which were extremely challenging. I opened up the MotherWit Doula Care Centre, which meant a lot of shopping, building, painting, decorating, and all those little things it takes to make a space for parents and babies as warm and welcoming as can be. Obviously, I had a lot of help with that, and owe endless gratitude to Lewina and Sesch for sewing, Millie for painting and cleaning, and Steph for cleaning and furniture building. Most of all, I thank my husband Mitchell, who does every single little thing I don't have time to do, can't figure out how to do, or don't anticipate is necessary. It takes a village to support a doula. Also, I began a new series of MotherWit Birth Essentials Prenatal Classes, and prepared for the MotherWit Postpartum Doula Training, which entailed creating a 100 page training manual in 2.5 days (my apologies for wonky editing to all my students who are now discovering it). Lastly I taught, with the assistance of Millie Tresierra(MotherWit Postpartum Doula extraordinaire), the training itself. Any of you who have ever given 4 full days of training know how much energy it takes to hold that space and give what is needed in the time you have. There was the added emotional stress of having a mother who has been having serious health challenges (though all seems to be fine now, thank goodness).

So again, Phew.

Sometimes as trainers, it takes our own trainings to make us see up close and personal how we don't always walk our own talk. While all of these things I had to do were necessary at the time, it was only during and after the training I realized a few things. One thing in particular I noticed was the overwhelming amount of praise I received for working at such a manic pace. I was being congratulated for all the energy I had, and there were encouragements to keep on going. And to be honest, my ego sucked all that praise up to fuel the fires of insanity. All those who bestowed praise upon me had nothing but the best intentions in mind and at heart, and I do thank them for their appreciation of my efforts. But next time anyone sees my running around like a manic chicken with a newly missing head, sit me down, make me some tea, and tell me what I'm doing is crazy.

As those who have trained with me know, I am not just about giving information on how to help women have and mother babies. I craft the trainings within a framework of acknowledgement of how our culture is severely wounded with regards to the fundamental feminine experiences of birth and mothering. I see doulas as healers of this culture, bringing about balance as we illuminate other potential paths to our ladies, helping them to reclaim their motherwit, their intuitive, innate knowledge about their bodies and ways to tend to their babies. It is nothing new or magical, simply a reminder of what they, in their heart of hearts, already know. We seek to bring choice back into the hands of the woman and her family, empowering her through providing information and offering her emotional support as she finds the confidence within to make choices about birth and mothering appropriate for her and her baby. We trust the mothers in our care deeply, when others may try to erode their confidence about their instincts or attempt to lead them away from their most personal beliefs.

In order for the doulas I teach to be able to facilitate this empowered choice making and hold hearts full of non-judgemental support for those choices, I strongly emphasise doulas take their own emotional healing into their own hands, making regular personal time for reflection/meditation/journaling/etc. a requirement.

Our postpartum doula training introduced the coiffed, perfectly made-up, uber-Pilated, jauntily caped and leotarded vixen we referred to as SuperMom. She's quite a character, is SuperMom. She can, as the 70's commercial for some perfume used to brag, "bring home the bacon, fry it up in a pan, and never ever let you forget you're a man". We may laugh. We may swear we are not like her at all. Oh, dear ones, but we are. Her June Cleaver facade may make her pretty, but her intention is to enslave us all.

SuperMom is the energy which spurs us to take up crazy feats. She is the energy which says, "you have just given birth. Your baby is sleeping. Excellent, that gives you time to clean the house, send thank you notes, do your exercises so you can fit into your prepregnant jeans in record time to make your friends jealous, and meal plan." Our inner wise Grandmothers, who have always known the key to postpartum healing is rest and nourishment, may give us a little extra bleeding or plugged ducts as a sign it is time to slow down and be present for ourselves and our babies. "Nonesense!" cries SuperMom, eshewing the wisdom of Grandmother. "What's a little plugged duct? Suck it up and keep going!" So new mothers put these signs aside and slog through the fatigue and discomforts, slaves to the ideal of "woman who is the highest achiever after birth is the best."

We know intellectually this pushing ourselves isn't healthy. We know in the deep wisdom of our bodies this hyper productivity is damaging. Yet there is guilt when we don't live up to the SuperMom ideal. Our mothers tell us, "When I had you, I was alone all day and managed to get everything done. Your father always had dinner on the table waiting for him and a clean house. We didn't go running to you every time you cried like all you new mothers do today." When we are running on fumes alone, our plugged ducts threatening to blossom into mastitis, our bleeding giving way to hemmorhage, SuperMom spurs us on, hidden in the voices that tell us how AMAZING we are for all we are achieving, how ENVIOUS everyone is of our energy and accomplishments. And wow, you just gave birth! I wish I could be just like you!

It's of no matter to SuperMom you have feelings of deep sadness about your birth experience if it didn't go how you'd hoped. The voices of Supermom assure you there is nothing to feel angry about or grieve over because, after all, you have a perfectly healthy baby and that's all that matters. The blues Grandmother sends your way to dampen your spirit so you will stop and look inward for answers are ignored, and your feelings go farther and farther underground, your truth depressed.

I want postpartum doulas to bring wisdom into a culture of insanity, embodying the voice of Grandmother so her words are louder than those of SuperMom, who, underneath all that makeup and washboard abdominal muscle is a newborn mommy needing someone to validate her strength and power as well as nourish her vulnerability.

As the training went along, I realized how active SuperMom has been in my life these past few weeks, and how much pride I took in her using and battering my body and mind for her own single-minded purpose of total control over everything, perfectly executed. My plan after the training was to jump right back into work and see all those clients ASAP who couldn't POSSIBLY do without me for one more day, thinking how much better a person I was for believing rest is a luxury, or simply for the lazy. Silly. Thank goodness my wise students were strong channelers of Grandmother, and in that spirit I took to my bed all day yesterday, dozing for hours, doing fun things like reading and taking my kids out to see Harry Potter. And nobody perished or fell apart without my presence. Duh. And now that I've refueled, I have so much more to bring to the world anyway.

One doesn't need to be a mother to have an overactive SuperMom flitting about in her tights (with no runs in them, of course). It's just an energy of overachievment and the pride our ego takes in response. But for a mother, it takes on a whole new tone because there is just SO much to tend to, so many emotions at stake, and so many expectations and criticisms to endure. For new mothers, this energy is particularly dangerous, and to encourage one to value her rest and honour her need to take life slowly sets the tone for a saner motherhood as the role develops and grows. As every new mother gives herself the permission to rest, eat, and stare lovingly at her baby with a full, present heart and leaky, drippy boobs, we heal.

My advice to those stuck in the wake of SuperMom: make a little sign, post it on the ceiling over your bed so it's one of the first things you see when you wake up in the morning, that says, "Dear One,I can take care of the world just fine by myself today. Love, God". (or whatever word you may want to interject there).

Doulas Teaching Doctors

2010-10-21T22:30:00.003-04:00

I am so grateful to have had the opportunity to do a little workshop yesterday with medical residents on the role of the doula in childbirth, and how to help a woman deal with the strong sensations of the second stage of labour.

Just to give a bit of a background: I work at all the hospitals in Montreal pretty much, and have always tended to favour the birth experiences in which family doctors are the primary caregivers. For one, I see a lot more consistency in their practices. If the woman's doctor can't be there, the one who is on call tends to have a very similar approach, and she isn't shocked by a radically different philosophy that sometimes exists between one obstetrician and another. I am of course generalizing, however I do see a strong tendency towards consistency. Consistency builds security, and security contributes to better birth experiences.

Another reason I enjoy births in which family doctors are present, is that they tend to have a much more relaxed approach. In Montreal, I see more babies caught in the hands and knees position by family docs than I do with their moms in the stranded beetle posture. Family doctors tend to hang out in the labour room more, building rapport. I also generally find they encourage questions, respect concerns, do their best to answer questions, and are invested not just in a good clinical outcome, but in the emotional well being of their patients too. Plus the continuity of care is attractive to many couples. Often the same family doctor who took care of them prenatally will take the baby on as a patient too...perhaps even all the family members. In a city where finding a family doctor is nearly impossible, this is an appealing option for medical care if indeed a hospital birth is desired, but with as little interruption/routine procedures/sledgehammer obstetrics as possible. Not to knock sledgehammer obstetrics...it certainly has its time and place, and thank goodness for that. But many women want a low tech birth even though they are not comfortable birthing at home or at a free standing birthing centre. For these women, the care of family doctors provides them with what they're looking for.

A nice thing about the family doctors I've worked with over the years, is that they are generally very supportive of doula care. Because of this mutual appreciation and respect, the birthing environment is usually really nice for Mom and her partner. No, it's not home birth for all you readers who don't feel safe or like birthing in a hospital, yes, there are still strangers, shift changes, and not total control over your environment (in my town you won't get to birth in a bathtub or squatting over the toilet even if it's what you really want when it's time for the baby to emerge) and yes, there are rules and restrictions that are hospital policy no matter who the caregiver is... but as I said, for those who WANT a decent experience AND embrace the benefits of medical care even if it means following a few rules, the phrase "nice hospital birth" does not have to be an oxymoron. If I didn't often have lovely hospital birth experiences, I couldn't do my job. I'd be a depressed wreck.

What I'm basically saying is that my highest ratio of truly lovely hospital birth experiences takes place under the care of family physicians. In fact, my second child was born into the hands of a gentle, loving, encouraging family doctor after my midwife felt it was necessary to transport me to the hospital, and my one hospital birth experience was just fine. True, an impatient nurse literally made my exhausted midwife cry by blaming her because I was choosing not to stay on a monitor (I was not trying to be a "bad" patient, I had just been in way too much pain for too long to be able to stand still long enough to get more than a 30 second trace), but the doctors themselves were godsends. One of them actually slow danced with me through a few contractions. Her comfort with touch and willingness to use her body to support a woman in nutso labour is not something you see every day.

At the MotherWit Doula Training Intensive I gave this summer in Morin Heights, Quebec, I was graced by the presence of a lovely student who happens to do administrative work for the group of baby catching family doctors I like best. She had a lot of ideas about how cool it would be to do some doula-led info sessions to residents to help them learn how to appropriately and effectively be with a labouring lady.

At first I thought this was a great idea. A couple of doctor friends of mine, though, didn't. Both thought that time is so tight for residents, that learning now to hang out with birthing women and rub their backs wasn't going to be time well spent, that improving basic skills was much more productive...not to dis my profession, or anything. And truly, I heard that, and figured, "oh, true...good point". After all, that kind of "fluffy" stuff (that's how it's perceived, anyway) is my job, not a doctor's. I agree that a new doctor's focus is going to be on medical care, not doula work. However, after having now done the workshop and having reflected upon some experiences I've had with residents in the past, I am absolutely glad I did it and my suspicion that imparting a few simple doula tricks to medical residents would prove to be valuable was true.

To be an excellent clinician in no way means you automatically know how to approach birthing women with wisdom. Wisdom grows, and planting a few seeds is not time wasted. Yes, doctors needing to improve their clinical skills is crucial. But to be a doctor means to interact with patients, in this case vulnerable, open, life giving women who are having peak experiences of pain and physical/emotional catharses. Some manners to keep that experience sacred, if you will, are important to learn.

I have known of and seen residents do the following (please don't judge them harshly...they are learning, and most of them are young and sweet...they make me want to feed them soup): talk about the baby in the next room who just suffered from major shoulder dystocia while they are standing between the legs of a woman whose baby is crowning...answer and talk on a cell phone WHILE doing a vaginal exam...allow a discussion to unfold, inspired by the fact that the woman in front of them has been pushing for a long while, about the baby earlier in the day who died from a complication and that that mom had been pushing for a long time too....tell a woman that she CANNOT deliver unless she BLOCKS her air and GETS MAD at the baby and PUSHES it out HARD....examine a woman because she has had some mild bleeding and cramping and given what's going on with her cervix tells her in no uncertain terms that she will NOT go into labour on her own, will have to be induced, and that a natural birth will be impossible, and not to set herself up for disappointment (the lady birthed completely normally 6 hours later, by the way...I have known of this resident to say this to a couple of my clients, only to be wrong each time). This is but a small sample of many anecdotes.

So instead of us getting mad at them and irate about their insensitive treatment (and many of them are born with an acute awareness of others' emotional needs...we're just discussing a few who need to develop this awareness), why not get more pro active and guide them towards a bit more awareness of the quality of their presence? I believe in people's hearts, and I truly do not think any of these residents held bad intent in theirs. They are simply so busy learning how to be fantastic clinical care providers that it can be easy to forget that behind the pelvis is a woman and her partner...who are extremely vulnerable. The fact that doctors are entering into their practices NOT necessarily having been taught Ina May's words to live by: "If a woman doesn't look like a goddess in birth, someone isn't treating her right," means there are major gaps in medical training. Because as midwives and doulas, we are acutely aware that labour can malfunction when a mother becomes physically and emotionally distressed. Labour can stall. The sensations become more painful and make it much harder for a woman to embrace them. They can panic. It is not a wonder that lots of doctors don't view birth as beautiful and transformational, but as an act of suffering. Most doctors I know claim they will probably want an epidural when they themselves give birth. Most of the births they have seen have not been normal.

If the quantum physics theory (and obviously I'm being very general here) states that the observed "object" changes given how it is observed and by whom, Ina May may has hit the nail on the head. Be calm, present, aware, and respectful of the sacredness of the birthing woman's work, and maybe, just maybe, the quality of one's presence can influence the mother's sense of well being, thus creating a greater potential for smoother physiological functioning. It sure doesn't hurt, does it? Midwives and doulas believe and embody this belief, and act accordingly. Doulas do not just rub backs, suggest positions, and have our clients just talk about their feelings with us the live long day. We actually hold an energetic space...a strong, loving space within which a mother can birth confidently and hopefully as normally as possible. And if it doesn't work out that way, the benefit of our support is just as important, if not more, to keep her feeling strong and centred. I think this is the magic inherent in our better than average outcomes. Given the much studied and well documented fact that a doula's presence in the birthing room can, quite simply, make birth go better, I believe we have a lot to teach.

A few weeks ago, I was asked to show up on a particular date, but didn't have any information about what I was supposed to talk about until 2 days before the scheduled workshop. Then two days ago I received an email. The email basically said, "talk for 5 minutes about what a doula is and what she does, then for 25 minutes provide some concrete techniques for pain control in the second stage of labour. A doctor will talk more about pain control for about 10 minutes, and then there will be a question and answer period."

Give me a birth related topic and I can talk about it for hours, so I just jotted down a few notes. As I got closer to the building the workshop was being held in, I began to get a bit nervous. I don't normally get nervous anymore before teaching or public speaking, but I was feeling antsy. I walked into the room, feeling more confident because some of my MotherWit colleagues joined up with me, and was pretty surprised to see how many residents were actually there. More nerves. The family doctor who was facilitating this workshop was finishing up teaching about communicating with women they suspected were in abusive situations. Finally, it was our turn to speak. A few of the residents there had never heard of a doula, so we talked about who doulas are and what we do, and why what we do works.

To make a long story short, as I've been blathering on for long enough, we discussed the fact that though I was asked to talk about "pain control", I couldn't do that, as doulas don't do pain control, that in fact if a mom wants to birth normally, trying to control her pain could actually affect her progress. So that led to a discussion about the benefits of labour pain, which are probably not extolled as a virtue in medical school. We help moms embrace their sensations, work through their pain and provide the comfort measures and emotional support to help them with that task. Of course if they need or want pain control, we stand back and embrace anaesthesia too. We talked about how doulas don't really have an agenda about how a woman gives birth, but that we are invested in her feeling as powerful about her experience as possible.

Then I talked about oxytocin. A simple thing that residents can do to make birth more comfortable for Mom is to respect that the oxytocin/ endorphin interplay is fickle, and that things don't function as well when people are not respectful of the birthing environment. I asked them to imagine what it would be like if they themselves were trying to have a major poop, and people kept knocking on the door, asking how things were going and telling them the clock was ticking. Keeping that in mind, I asked them how it may feel to be a labouring mom who is experiencing some crazy sensations, feeling like a watermelon is in her rectum, is put on her back so strangers can see and touch her privates, and yelled at to PUSH! What might the mojo feel like to her? We talked about being wary of talking about other cases while in the presence of a birthing woman, or making her feel negatively judged, etc. We talked about oxytocin as being "zee 'ormone of looove", and that the more oxytocin, usually the more endorphins, which will contribute to helping a mom deal with her pain without us having to do much.

We talked about respecting physiology...why birthing on the back is, for most woman, probably a lot more painful than doing what feels natural, which is using gravity and utilizing the mobility
of the sacrum instead of sandwiching it between the baby's head and a bed. We talked about purple pushing...y'all know my views about that. Sesch and Lewina (my sister MotherWitties) and I demonstrated different pushing positions women seem to like. I passed around pictures of a woman giving birth on hands and knees and showing how a sacrum allowed its full range of motion will sometimes result in the baby's posterior shoulder coming out first. We showed a video clip of a woman birthing unassisted making the most powerful, loudest, beautiful-est, guttural noises you have ever heard, showing that no, purple pushing in normal birth is usually not necessary.

Sesch, Lewina, and I demonstrated how the residents could help to facilitate relaxation by centering themselves, speaking calmly, using reassuring touch and gentle guidance to help talk a really frightened, freaking out woman off a ledge. Sesch is fantastic at playing a stressed out birthing lady, and she yelled out while crossing her legs and drawing up her bum, "I HAVE to POO. AAARRRGHHH!" while I did the doula thing and calmed her down between her "contractions" and provided reassurance. We actually got a big round of applause for our role playing.

The doctor who was facilitating gave great feed back. She reminded us to talk about how to support women who were on epidurals, and also asked us to discuss how they might support a mother who has been sexually abused in her past. Interestingly, she also asked us how on earth we managed to have private lives given all the doula work we do. That's a whole 'nother blog. The best answer I can give to that one is to have a partner as supportive of my work as mine is. I couldn't be me if I didn't have him.

It seems there was some miscommunication, as it had been this doctor's belief that we were going to talk about the first stage of labour instead of the second. But it didn't really matter. Hopefully we got some messages across as well as provided some entertainment. I like things to be fun. We did focus heavily on physiological, unmedicated birth. This was not because we don't believe in pain relief in labour when a mom needs or wants it, but because we live in a culture in which natural birth is considered radical. In their worlds it's a rarity to see normal birth. I hope that talking about it as if it is an every day occurance might create balance and an inspiration to support more women to have normal births. If these residents understand that natural birth is the norm for most of our clients, perhaps it might make them say to a woman asking them for an epidural.."you're doing a great job...I know you can do it." If medical people understood how much their patients look to them, and realized that those few words could actually help many moms get through birth normally, that moms just might think, "if my doctor thinks I can, then I guess I really can!", they would realize how much power they have to make a woman's birth experience feel really positive to her, even if it doesn't go the way she had hoped or expected. Someone having faith in you is always a nice thing. A dear client of mine told her doctor that what she needed from her (as well her medical care) was to know that she believed in her. These fledgling maternal hopes should be nourished with great tenderness. Doctors aren't just clinicians who take case histories, scout for complications and treat them with their skills and tools, but witnesses to a birth experience! How special is that? May they never forget the honour.

Thank you, residents, for listening. Thank you, Doctor H, for your support, and thanks, Gen, for getting it off the ground. Let's do more.

I promise I'm still around

2010-10-12T16:17:00.003-04:00

I have in no way abandonned my poor neglected blog. I am busy putting together my postpartum doula training manual, and am soon holding a grand opening for the new MotherWit Doula Care Headquarters.

I will soon get cracking on writing the Madagascar story, and add pictures to what I've already posted.

Love to you all,
Lesley

Shopping Nightmare

2010-09-21T16:13:00.004-04:00

Yes, I am working on a blog about Madagascar, but in the meantime, life still happens.

I had very little scheduled today besides checking out a space for the potential future MotherWit Headquarters (which, by the way, looks like it just might work out great), so decided to do the dreaded dress shopping excursion I have been putting off. It has been knawing at me like a toothache that won't go away, so I figured I'd get it over with. My sister Jennifer is getting married to her lovely man Jon in a couple of weeks. They are coming here all the way from England with my delicious little nephew Antony so we can share in their special event. I'm thinking this occasion warrants some fancier duds than I usually wear. Usually, I'll buy a little stretchy wrap from H&M, those being just about the only things that fit me from that store, but my sister's wedding is worthy of something a little more special.

I have to say that I abhor clothes shopping. I am not the type of person things fit easily. I am 5 foot and half an inch soaking wet, with a very wide rib cage, a postpartum tummy (nobody has to know that I haven't had a baby in over 5 years), barely any hips or bum, and boobs that are over DD. I refuse to even know how much higher in the letter scale they go, but let's just say that for my frame, they are big. Shopping for clothing is a freakin' nightmare. Especially when I'm looking for dresses, as my waist is size 6 to 8, my hips size 2 to 4, and my top at least size 10 for tailored shirts, even though it's not even possible for me to wear buttoned things. If it buttons in front, it will be laughably huge in the shoulders, back, and sides. Shopping makes me feel misshapen, and feeling misshapen makes me feel angry. Not at my shape, which I'm happy enough with, but with the people who make dresses.

I traipsed all along St. Catherine Street, popping into this place and that, marvelling at how slim the pickings were for appropriate dresses. They either looked like they were made for prom queens, club chicks, or dowagers. There was nothing in between for a 40 something, reasonably concerned with style person. Nothing I liked, anyway. I usually depend on Winners to get me through difficult shopping sprees, but trips to 3 different Winners yielded nothing. BCBGs clothes all looked like sparkly candy. Betsy Johnson had cute stuff, but holy high price tags, Bat Man! Mexx and Tristan all looked business casual. Everything else was in shades of black and gray or were ridiculously strapless. I just don't have enough interesting accessories to spruce up these colours, which don't generally look so hot on me anyway unless I'm striving for Jaundice Chic.

Even Mango had nothing to offer. Then I found Olam. Right away 3 cute, interesting, well cut, reasonably priced little dresses popped into my vision to say "hello". A nice young sales lady took my finds to the changing room. Finally, feeling confident I would find something wonderful, I went to the changing room....only to find they did not have mirrors inside! On PRINCIPLE I will NOT buy clothing from places that don't have mirrors hidden privately away inside the changing cubicles. I will NOT emerge from these tiny caves of furtive clothing tranformation to bare my unchecked, lumpy underwear-ed and dingy bra strapped self to a store full of onlookers. It is not that I'm that vain. It's just that I think this is the sneakiest, most underhanded way of insisting you are "cared for" (sales pitched) by a sales person probably hustling for commission. And I strongly object! I do not WANT the store to assign me an "ooher" and "aaher" (despite what's really going through her mind), or an accessory draper whose favourite colour is puce. If I have my own private shopping doula with me, like my friend Nat, she fulfills that role for me, but with honesty. I refuse to have some stranger oggling my body and making suggestions without my express consent. When you have no mirror to look into privately and must come out to be viewed by the awaiting sales person and any other stragglers who are dragged along with other dress seekers to "shopping doula", you don't have much of a choice about the matter without sounding like a bitch.

I asked the lithe, perfectly decked out girl who was young enough to be my daughter if there was a changing room with a mirror. She said, "No, but I can hold the mirror up in front of the cubicle if you want so you don't have to come out." Yeah, like that wouldn't look to everyone observing like some person too unconfident to come out of her hidey hole! That just makes people want to oggle even more. Besides, given that she was tiny and the mirror was about 7 feet tall, I felt doubtful. And pissed off. Nothing against the girl, as she didn't design the store or make the rules and is, after all, just trying to make a living. So I kindly said, "No thanks," and left. Too bad for them. I would have shelled out some cash. Alas.

I wandered along the street feeling glum. Surely there must was an affordable, not too ugly dress that fit me SOMEWHERE in Montreal? Though I kept meaning to grab the Metro and head for home, something kept pulling me to the final Winners on the strip. I didn't want to go. I resisted, knowing another attempt to find something there was futile...yet why did I feel compelled?

I dragged my feet into the Alexis Nihon Mall Winners for one last look. I went to the dress rack that in the other Winners yielded absolutely nothing cute or interesting. And lo and behold, several sweet little numbers looked somewhat appealing. I had not seen in them in the other stores. I took 4 different dresses in varying sizes. I always have to try a few. I took them to the changing room (WITH mirrors...bite ME, Olam) and became very discouraged when everything made me look heinous. Then I tried on the very last one...a black and white Calvin Klein dress with wide shoulder straps, a high waist, and pencil-y skirt...all things Stacey and Clinton say are good for people with my shape. And wouldn't you know...BAM! Except for a teeny little adjustment that will need to be made in the strap to make it smaller, it fit my monster boobs, it fit my rib cage, it camoflauged my post baby belly (I will claim that until Finn is 40), and came just below my knees. And it was less than I thought I was going to have to pay for a dress appropriate for my sister's wedding.

I could have cried with relief! I called my husband right then and there in the changing room, jumping up and down saying, "I found it, I found it!" He wasn't sure what I was talking about at first, but when I clued him in, I knew he was extremely glad to hear I had found something, thus eliminating a wasteland of weeknights of him having to trek through stores with forced cheer, me trailing in an absolute funk of dejection, listening to my arguments to convince him that I am simply not made to wear nice clothes. I felt like we had just bought hours of time and spared us nights of heartache.

So that was my day. Ladies, if we all refuse to shop in stores that don't allow us the right to look at ourselves in the mirror privately, thus allowing us to choose whether or not we want to reveal ourselves, practices would change.

Lesley

Madagascar Diary: On our Way

2010-09-18T10:20:00.023-04:00

I woke up on the morning of September 2nd with a feeling I usually get in my gut before I travel anywhere. It's a slight feeling of unease, like maybe I shouldn't have planned this trip in the first place. Maybe I'm not made for this. Maybe I should cancel. Maybe I should continue to live my white bread life in the suburbs of Montreal. I was leaving for Madagascar. How the heck did that happen? Who thought I was cut out for this?

I was already all packed, so I burned off the pre-flight jitters by writing a bunch of receipts for my clients that were long overdue. Finally, it was time to go.

My husband and little son drove me to the airport and dropped me off at the Air France departure area. As we approached the Dorval Airport, an amazing feeling overtook me. Instead of anxiety, I felt an overwhelming sense of happy anticipation. This is unsual for me, as I'm usually a wreck before flying off somewhere. I admit I am a neurotic traveller. So leaving for a country like Madagascar should have had me in paroxyms of panic. But I wasn't. Instead, I just felt really excited.

I met with my companions Dr. Deborah Goldberg, Sarah Hunter, a friend who usually lives here in Montreal and practices midwifery when she lives in the US, and her baby daughter Keelia. Everyone was in good spirits as we navigated our way around. We had a lot of baggage. We had our own clothes and gear like sleeping bags, as well as a fair bit of midwifery equipment, rain gear for the Malagasy midwives, 400 bottles of donated children's vitamins, and every nook and cranny crammed with women's and children's clothing we had purchased at the Salvation Army. Some of our bags were slightly over the allowed limit, so we had to do some creative redistributing. One of our bins was extremely heavy, and we had to pay $300 to check it.

I was a little worried when we had to take out all our liquid objects and put them in a clear plastic baggie for examination, because I had lots of herbal tinctures and essential oils with me. But nobody cared, as nothing added up to over a litre. Phew. I would not like to have flown without my Motherwort tincture or dealt with stomach issues without oregano oil.

Finally, we waited to board. Every once in awhile one of us would say, "Oh my God...we are actually going to MADAGASCAR!" After all the dreaming, planning, organizing, fundraising, meeting, packing, and arranging, we were finally about to accomplish what we had set out to do: fulfill the wishes of the members of Taratra Reny sy Zaza, an organization of women and children in the area of Mahatsinjo, Madagascar. The facilitator of this project, Karen Samonds, asked these women if they would be interested in having any friends she knew from Canada to come out there and do some workshops discussing nutrition, health and environment, family planning, general health, goals for their future, as well as provide training for the local traditional midwives to increase their skill level. They seemed excited by the prospect, as their community definitely experiences a lot of health issues. That put the wheels in motion. So there we were with bells on, ready to board the plane. not knowing exactly what we were in for, but so grateful to have the opportunity to do whatever we could. We didn't really know what to expect, but we were willing to share whatever information and skills we had to help improve the lives of these people Karen and her husband Mitch have alway spoke of with great fondness.

None of us could stay for very long. Deborah is a family doctor who focuses on maternal/newborn care. She has been catching babies for about 7 years. Sarah is part of a co op that sells soap and natural products, and spends much of her life helping to run the store and tending to a new child. I have my own children at home and many clients counting on my presence at their birth. Our trip would be 10 days, though with the immense amount of travel time required, we would only really have about 5 days and six nights in the forest doing workshops. A crazy whirlwind endeavour, for sure, but what is life if not for a little adventur

Right away it was apparent that as travelling companions, we were all going to get along well. Sarah and I have been friends for years, so I knew that wasn't an issue, but it was clear immediately that Deborah was really open, willing, positive, and supportive. We all clicked, and am happy to say that the vibe remained that way throughout the trip, with each of us lending support to each other whenever we could. Sarah and I have our schtick after years of adventures together. We normally speak together with every second word being four lettered. We bitch about stuff a lot. We laugh at radom things other people wouldn't understand and have inside jokes. We've experienced things in our work as birth attendants and general lives that would make the average person faint and doctors cringe. And Deborah took it all in stride. She comes from a very different background altogether. She is a medical professional. She is stable and contained. Not that Sarah and I are unstable, but neither of us have exactly led the white picket fence existence nor had our young lives shaped at the bosom of a Clever like family . Deb has, and as a result is a naturally easy going, confident, grounded, practical, focused person. An upstanding citizen, even. And good on her for that. For whatever reason, our co-existence worked. We respected each others' values and differences, and came out of our time together with an even higher regard for each other than when we went in. This is a rare and precious thing. Nobody chose to get caught in any conflict of ideals or of judgements, and as a result our combined respect, efforts and resources made our work together far more powerful.

Because Sarah had Keelia and a cane (her hip gets messed up sometimes, so she brought it in case she needed help walking), she was always moved up to the front of the line. Deborah and I figured we would take turns pretending they were our wife and child. We got a little cocky, thinking we'd get some special treatment along the way. HA! Did I tell you we were traveling Air France? If you would like to sit back and watch some of the weirdest, rudest, snottiest service ever, just grab a flight with Air France. This in no way reflects upon the one or two lovely individuals throughout our entire trip who were actually kind and considerate, but as a whole, the experience was so shocking I had to laugh. I don't meant to be ungrateful, as they did get us to our destinations safely and in once piece, but not without us being horribly treated, dehydrated, and half starved. I am not one to complain much about things like service, as I tend to be pretty easy going...but wow. It was something else.

We kept to ourselves mostly through the first leg of the trip, which ended in landing at Charles de Gaulle Airport in Paris. You kind of have to prounounce the name of this airport fast,as if it were all one word, the "s" on "Charles" being silent, the "Ch" said as "Sh", the "e" at the end of Gaulle being pronounced as if you had just been tapped in the gut, all the while with your lips pursed as if you had just laid eyes on someone behaving rudely. I watched a couple of supremely bad movies, listened to some music, and was constantly aware of being very thirsty with no offers of water coming our way. The flight attendants all wore a nauseating amount of perfume. This should not be allowed, a flying tin can full of smelly neurotoxins. They also had this thing where they would act totally pissed off at you because you were too stupid to intuit their protocols. For example, at one point I wanted some coffee. The woman held out a tray that contained milk and sugar. I tried to take some milk and sugar and practically had my hand smacked off. "NON!" I got scared. What was I doing wrong? Was I breaking some sort of ancient French custom? I was being looked at with loathing and contempt that should only be reserved for someone who has done something really awful, like farted loudly in church. My heart started palpitating. Beads of sweat broke out. Then I realized I was supposed to place my cup upon the tray for the flight attendant to fill it. I complied, but in my nervous state flubbed up and put my hand on the whole tray as if to take it, not just the cup on it. "MADAME!" was shot at me like a freakin' bullet. I forgot that I could speak French and had enough word skill to verbally eviscerate her 'til Tuesday if I so chose. But I was just so surprised at the level of vehemence over something so small, I was silent. Meek, even. She left in a cloud of indignation at being affronted by our North American idiocy, and I drank my coffee, feeling like I wore a mark of shame tatooed on my forehad. Sarah looked at me with her eyes and mouth wide open in disbelief. Ah, this is but one example.

We arrived at Charles de Gaulle at about 4am Paris time and had to wait about 6 hours to board the 10 hour flight to Madagascar. Keelia was awake and running around. We found a little playground area and hung out there. As shops in the airport opened, we popped our heads in. We washed and brushed our teeth in the bathroom, and had some tea in a cafe. Keelia ran around, flirting shamelessly with other travellers.

After awhile, it was time to hang out at the boarding area. We thought the plane would be mostly full of Madagascar natives, but mostly, the travellers seemed to be white tourists from different parts of Europe. There were a couple of interesting characters: A Malagasy nun carrying a colourful statue of Jesus with its hands all bandaged up....a very churchy looking family with several little girls with braided blonde pigtails....an extremely grumpy man who looked at all the children waiting to board as if they were loathesome, even though he had about three of his own in tow. Finally, we boarded, ready to endure another onslaught of Air France brand hospitality.

Deb had sneezed at least 100 times at the airport...possibly the result of too many perfume fumes....and decided to take some decongestant before boarding. As a result, she practically fell asleep in her food when it came. Because it was very early morning in my stomach's time, there was no way I was going to be able to eat the heavy meal they wanted to give me, so I refused it. Sarah and Deb kindly grabbed a couple of pieces of bread and cheese off my tray to save for me for later. We tried to sleep, but all Sarah and I really did was shift consciousness a little. Keelia remained a great sport, and finally slept a bit. I had headphones in my ears while she apparently had a small freakout.

Every once in awhile we would check where we were. It was amazing to know when we were flying over the Nile, or directly over Kilamanjaro. It was all very strange to us that we were actually over the continent of Africa. As the time came closer to land, we got more and more excited. Like SUPER excited! As we landed we were all practically holding hands with giddiness, bouncing on our heels the way children do. When you get out of the plane in Madagascar, you go down a bunch of stairs and land directly on the tarmac. The first thing I noticed when I stood in the doorway of the plane was the sweet scent of woodsmoke, a smell I had always loved. That smell would permeate our lives for the next week. The feeling of the air was cool and still. We had arrived. I took a couple of photos, but the airport people clearly objected for some reason, so I put my camera away.

We had been told before we left that a guy named Shady would tend to us when we got there. Yes, Shady. Of course, when we saw him and he turned out to be a pretty skinny dude, we called him Slim Shady, and in our sleep deprived state sung a lot of "Na na na NA na na." Before Shady came on the scene, though, we had to get visas. Again, because Keelia was in our presence, we were forwarded to the front of the line. We were a little nervous that the guy who led us there grabbed our passports and took them away from us for inspection, but that seemed to be the protocol. We received our passports with the visas completed, then went off to wait for our bags, which took forever. Even Slim Shady was getting impatient.

As we got out of the arrivals area, we met up with Karen, who looked fabulous in her purple Lilla P wrap. Finally, with all our many bags in tow, we went through customs, and thanks to Shady, nobody even questioned what we had with us. For all they knew we could have been smuggling heroin. But when we said the bin was full of children's vitamins, they didn't question. Yay, Shady! We could have been held up there for an awfully long time given all our stuff.

Jean Luc, a founding member of Sadabe, (Karen and Mitch's organization), who was born and lives in Madagascar, was in the parking lot to meet us with a truck. We packed our stuff in, then Deb and I went back inside the airport to change some our money into Malagasy Ariary. 2000 Ariary equals about $1. Given the amount of mosquitos flying around, I was very happy I had chosen to take Malarone.

Finally, we were off to the house just outside of Antananarivo Karen, Mitch, and their girls Anne and Evelyn rent for when they are not living in the forest. We were all completely exhausted. It was interesting seeing bits of the capital at night with everything closed. Karen's house is right beside a cell tower. It is nestled beside a larger home. In the parking lot were broken down tourist buses. In the house was Jean Luc's wife, who is due to have her first baby in December. We greeted her and learned that the Malagasy do 3 cheek kisses, as opposed to our Montreal 2 kisses. There was a child sleeping on the couch, and when she woke up she looked excited to see us. "Salama!" she greeted with enthusiam.

In Karen's house there is a living/dining room. There is a sink for washing up, and in a teeny little room a stovetop to cook on. There is no fridge. There is a bathroom with a sink, toilet, and porcelein square with a drain to bucket shower over. There is no hot water, and the running water stops frequently, necessitating a bucket of water dumped into the toilet to flush it. There is electricity, but it apparently goes off a lot. Upstairs, there are two rooms to sleep in. Karen led us to a room with a double mattress, and a little sleeping nest set up on the floor. We eyed them gratefully. As Karen was explaining that we would get to sleep for about 4 or 5 hours before heading off to the forest early in the morning, her elder daughter Ann woke up.

Ann exudes pure love. She has big blue eyes like her daddy's and a face that expresses joy with ease. She ran into the room practically wriggling with glee to see us. I took her into my arms giving her a big snuggle. Evelyn toddled into the room soon after and it was so good to hug children. I felt pangs of missing my own. I realized that all three children in the room were babies I had seen born. I never forget what an honour that is, and what a bond that creates. We all settled down to grab some sleep, the happy sound of nursing, cosleeping toddlers filling the air, anticipating a long, busy day tomorrow.

Stay tuned!

Happy Addendum

2010-09-14T11:40:00.002-04:00

I just heard that Kandy and Vince had their baby this morning...natural birth, perfect latch. Thanks to MotherWit Doula Steph Bouris and MotherWit apprentice Andrea Legg for their superb, reliable support. All unfolded as it should have.

I'm Baaaaack!

2010-09-14T09:07:00.002-04:00

Salama!

I thought I'd let y'all know that I am back from Madagascar, safe and sound. I am firmly out of commission until tomorrow evening, but thought I'd send out a little update.

I am experiencing a level of jet lag that is making me want to crawl out of my own skin. I have already had a couple of lessons thrown my way since I got back, too. Yesterday I found out that, as is typical when I go away for any length of time,a couple of people were either in or threatening labour. My first reaction is always to say, "Oh, well, forget about that day off for recovery, I'll just go to those births." But when my beloved neighbour drove up beside me yesterday while I was talking to another neighbour on my street and said, "You're back! I'm in labour," I just knew I couldn't do it. To agree would have been stupid. In fact, given that she will be in fantastic hands with any of the MotherWitties who back me up, it would have been an ego based-workaholic-prove to the world I can do anything-extreme endeavour. And who would that serve? Not my beloved neighbour. So I let it go and told her to call upon my backup. I also learned an expecting mother of twins, my third in 2 months who have gone way over their due dates, was being induced yesterday. My backup for that birth asked if I would be going in. Oh, man.

Let me explain. Sleeping in a tent in a surrounding far from any "civilization", where all energy of the people of that area goes towards surviving with limited resources, you learn by observing that there is just no time to wallow in distractions. In Mahatsinjo, Madagascar, tending to the basics of one's life in a focused manner is not just about creating a state of balance, which we First Worlders have the luxury of indulging in or not (if you don't have groceries for supper one day, you can order out, if you don't balance your cheque book, you have overdraft, if you run yourself ragged and become ill, you can get medical care and sick leave), but a matter of staying alive. If I learned anything, it is to tend carefully to my life. Birth attending is a huge part of my life...I adore it and feel it is a calling and a path. But if I were to attend a birth wasted by jet lag, with digestion that, while not exactly "runny", is rather delicate at this moment, worried because one of my travelling companions called me with the report of having rapidly proliferating fleas, and 3 children and a husband who are feverish and coughing and desperately in need of my maternal nourishment, would this be tending to my life? Not really. And truly, it wouldn't be heroically attending the woman either, as what good would I be to her with all this in my presence right now?

I find that whenever I come to an important decision about things, in this case a resolve to make a concerted effort to tend more deeply to what I have in my life rather than allowing work to justify the constant state of distraction and harriedness which has been impinging terribly upon my life, I am tested to put my money where my mouth is. Whatever that means. But there you go. Back to the neighbour pulling up beside me in the car. I had a choice. I know what Pre-Madagascar Lesley would have done. But this time, I took a deep breath, and I let it go. With love and best wishes. With the knowledge she will be better served by another. That she can, indeed, do this without me. With the knowledge that I can be here to help when she's back home. That to allow myself to take proper time to rest and recuperate from an adventure I cannot even begin to describe at this point, is not the self-indulgence of a weakling who can't heroically do whatever is asked of her without boundary, but a necessity....for myself and my family. Today I will tend to my home and my health. I WILL tread gently, depsite the pull, which I accept will always be there, to choose the more harried path which, while making me feel "accomplished" and even "heroic" in the moment, often has extremely depleting repercussions, leaving me in situations of such ungroundedness, that I do things like walk around without an updated Medicare card for literally years, or forget to get my son's birth certificate in time for him to start school, or get shockingly behind in administrative duties, despite the tons of help I have. It is time to tend to my foundation with more focused attention, letting go of the shame over the cracks in it, that shame making the pull to harried distraction more magnetic, thus exacerbating the severity of the cracks. It is all a matter of choice, and this trip, along with the crazy Malaria pill dreams I had (I know Malarone is not supposed to have this side effect as much as Lariam, but I had CRAZY illuminating dreams all the same), showed me that "I just can't manage it," in reference to tending to the basics of my life is a huge freakin' cop out.

I know you're all dying for stories, and I have so many. Every night before I went to bed I jotted down notes so I would remember details. I will take a little time whenever I can to have this adventure unfold, photos included. I have decided this is not just another distraction, as blogging is wont to be on occasion, but an important way for me to process my experience as well as bring attention to the beauty, the ravages, the energy, and the spirit that is Madagascar.

Karen Samonds, the lady responsible for bringing me there, told me when I arrived in the capital city, before heading off to the forest, that this place changes you indelibly...that you don't come back the same. And the tears brimming in my eyes writing that statement speaks to me of its truth. While I am still me, I feel a subtle shift of awareness, a greater capacity to be present without being drawn into the alluring buzz of the constant "business" which I now see clearly to be more about preferring distraction than tending to matters at hand. I have the power to make better choices.

My neighbour Kandy, the very lady who drove up to me in early labour, presented me the day before I left for Madagascar with a quilt she made for me during her many days on bed rest. It is the most beautiful thing you have ever seen, and she made it to thank me for guiding her towards a network of support during a time she and her husband Vince felt like they didn't know how to manage navigating their birth experience through the challenging waters of our hospital system. They knew it would possibly be someone else attending their birth given I was going away, but their gratitude lay in my providing them with solid education and support, with or without me. On the back of the quilt, Kandy stitched a square which quotes Mahatma Gandhi, "If I have the belief that I can do it, I shall surely acquire the capacity to do it, even if I may not have it in the beginning." So thanks to Kandy not only for the inspiration, but for the opportunity to exercise my power of wiser choice.

I am off to experience the sheer luxury of a hot shower. Then, I am going to tend to my home, grateful that I have one to tend to. Then, I am going to make a nice after school snack for my convalescing children, grateful to have the ability to do so, and grateful for well fed, strong immune systems which give them the ability to convalesce. We take these things for granted, yet where I have been lack of nourishment and ability to heal is a reality. I digress. One story at a time.

Veloma,
Lesley

MotherWit Postpartum Doula Training in Montreal November 18-21 2010

2010-08-22T21:51:00.002-04:00

MotherWit Postpartum Doula Training
MotherWit Doula Care is pleased to present a comprehensive training in holistic postpartum doula care.
In a culture that puts a lot of pressure on new mothers to live up to the mythical image of SuperMom, a MotherWit Postpartum Doula has the power to bring a sane, calm perspective. We believe in nurturing the new mother so all she has to do in the precious few weeks after birth is focus on her new baby/babies and her loved ones.
Full healing of everything a woman has gone through during the childbearing year requires some space and reflection. By providing opportunities for rest and proper physical and emotional nourishment, the MotherWit Postpartum Doula creates a special space within which a woman who has just given birth and her partner can heal and come into their own power as a mother and father.
We like to call this space the BabyMoon.
As a MotherWit Postpartum Doula Trainee, you will learn the following:
􀁺 good listening skills: new mothers need to share their birth stories and discuss the intense
emotions that becoming a mother brings up
􀁺 proper physical and emotional care of the postpartum mother, with focus on nutrition and safe,
natural remedies to soothe a variety of common complaints, such as breast engorgement,perineal discomfort, fatigue, etc.
􀁺 how to provide education about attachment style parenting, and give non judgmental support
for new parents' choices
􀁺 basic baby care such as bathing, diapering, baby-wearing, swaddling, etc.
􀁺 how to provide basic breastfeeding support, and how to know when to call in a lactation consultant
􀁺 how to recognize signs of postpartum depression
􀁺 how to help with basic organization of a home with a new baby
􀁺 how to support a mother with multiples, and how to engage older children
....and much much more!
This training will either be a 4 day intensive.

Cost:
$850.00 total -this is $700 for the 4 day training, plus $150 for your apprenticeship...all costs include
taxes.
MotherWit Doula Care looks forward to offering this training in Spring

For more info please contact info@MotherWit.ca

MotherWit vous propose des cours prénataux en français dès le mois de septembre 2010, à Montréal.

2010-08-18T20:52:00.002-04:00

Cours Prénataux MotherWit

Les Essentiels de la Naissance

Les cours prénataux Les Essentiels de la Naissance, offerts par

MotherWit Doula Care, visent à vous préparer à la naissance de

votre bébé, ou bébés, et à votre nouveau rôle de parents. Pour

obtenir de l’information sur l’accouchement, la majorité de futurs

parents participeront à des cours prénataux traditionnels donnés un

hôpital ou une clinique.

Ces cours ont tendance à présenter le travail comme un événement

qui suit un rythme prédéterminé, et décrivent la façon dont

l’hôpital prend en charge la mère et le bébé. L’emphase est mis sur

les chiffres (les contractions, la dilatation…) qui servent à

déterminer le progrès du travail ; la mère et l’expérience qu’elle est

en train de vivre sont des éléments secondaires. Il y a peu

d’instruction pratique pour doter les parents d’outils leur

permettant de faire face aux sensations du travail.

Les accompagnantes à la naissance sont de véritables mines d'or

d'informations à partager au sujet du travail et de l’accouchement.

Nous demeurons aux cotés de la mère pendant toute la durée de

son expérience, jusqu’à la naissance de son bébé. N’ayant aucune

responsabilité médicale vis à vis de nos clients, nous sommes

libres d’observer et de soutenir. Lors de nos observations, nous

avons appris beaucoup de choses à propos de l'accouchement que

vous ignorez peut-être, et nous observons même des choses avec

lesquelles le personnel médical a peu d’expérience. Par exemple,

comment soutenir effectivement une femme en travail sans la

péridurale. Chez les mères qui accouchent pour la première fois, le

taux de recours à la péridurale est de 98%. Ces chiffres ne sont pas

forcément représentatifs des désirs des couples par rapport à la

naissance de leur bébé. Souvent, une femme choisira la péridurale

car elle et son partenaire se sont sentis démunis face aux sensations

qui accompagnent le travail et n’étaient pas suffisamment pas

préparés à l’événement de par la simple lecture de livres sur le

sujet.

Il est de notre avis que les cours prénataux Les Essentiels de la

Naissance vous donneront les outils qui vous permettront de faire

des choix éclairés par rapport à cet événement si important. Plutôt

que de nous concentrer sur les “plans” de naissance, nous

encourageons une attitude ouverte et équilibrée afin de faire face

aux inattendus qui font partie de l’accouchement. Nous mettons

l’emphase sur la pertinence de l’observation et le besoin de

regarder la femme en travail versus la montre.

Les accompagnantes de MotherWit sont convaincues que la

plupart des femmes sont capables de mettre au monde leurs bébés

avec un minimum d’intervention à moins qu’une situation

particulière n’exige autrement. Nous souhaitons vous aider à

trouver votre sagesse intérieure, une sagesse qui a permis à des

milliers de générations de femmes d’accoucher. Nous prenons le

temps de discuter de vos soucis par rapport à la naissance, et de les

valider. Selon nous, la meilleure éducation consiste à présenter les

différents choix et à respecter les décisions que vous prenez avec

votre professionnel de la santé (médecin ou sage-femme). Bien

que notre objectif soit de vous donner la confiance d’accoucher

naturellement si vous le souhaitez, et si les circonstances en sont

favorables, nous soutenons pleinement vos propres choix.

Les cours prénataux MotherWit Les Essentiels de la Naissance

sont une série de cinq cours de deux heures et demie chacun qui

ont lieu le soir, une fois par semaine durant cinq semaines. Les

cours sont donnés par des accompagnantes à la naissance et aux

relevailles expérimentées. Les cours sont destinés aux femmes et

aux couples, peu importe leur situation. Une mère qui accouchera

sans la présence d’un partenaire peut venir avec une personne de

soutien si elle le désire. Le meilleur moment pour participer aux

cours prénataux est autour de la 25ième semaine de grossesse. Des

cours privés à domicile sont aussi disponibles (cours en format

condensé).

Coût pour les cours de groupe: 250$ par couple – 12.5 heures de

formation en groupe

Coût pour les cours privés (format condensé): 400$ par couple -

environs 8 heures de formation individuelle en trois séances (ou

deux séances intensives).

Tous les participants des cours prénataux MotherWit Les

Essentiels de la Naissance sont les bienvenus dans nos soirées de

rencontre MotherWit. Venez partager vos histoires de naissance,

rencontrer d’autres parents et découvrir les ressources de votre

communauté.

Descriptif des cours:

1er Cours: Votre Corps et l’Accouchement Normal

 la naissance aujourd’hui, le reflet de notre culture

 nourrir le corps et l’esprit pendant la grossesse

 anatomie et physiologie de l’accouchement

 les signes annonciateurs du travail

 le travail – à quoi ça ressemble, qu'est-ce qu'on ressent ?

 mettre au monde votre bébé

 le rôle du partenaire

2ème Cours: Faire des Choix

 quoi apporter au lieu de naissance prévu ?

 quand partir pour le lieu de naissance prévu ?

 une fois arrivée, que se passe-t-il ?

 procédures médicales de routine et interventions pendant

l’accouchement: les avantages, les risques, les alternatives

 défis rencontrés lors du travail et de l'accouchement

3ème Cours: Comment Agir Face à Votre Travail

 ne pas vous préparer à la réalité de la douleur, une piège à

éviter

 la valeur inestimable de la douleur normale du travail

 comment gérer vos attentes

 comment déterminer le moyen par lequel vous arrivez à passer

à travers la douleur

 affrontez la douleur du travail avec la respiration, la

visualisation, le mouvement, l’alimentation, le repos et les

changements de position

 encourager un positionnement optimal du foetus

4ème Cours: La Douleur (suite), Préparation Émotionnelle au

Travail, Fondements de l’Allaitement Maternel

 la théorie du portillon (Gate Theory of Pain Inhibition) mis en

pratique – massage de la mère

 encourager la détente

 les femmes enceintes: exploration de vos craintes par rapport

à l’accouchement avec la visualisation guidée et l’art

 partenaires: quelles sont vos craintes ?

 jeux de rôle

 l’allaitement mené par la demande du bébé

5ème Cours: L’Allaitement (suite), la Période Postpartum, le

Rôle de Parent

 défis fréquents de l’allaitement et comment dépister un

problème

 la famille pendant le période postpartum

 questions fréquentes sur les nouveau-nés

 prendre soin du couplePublish Post

 un entourage qui prend soin de vous

Les cours débuteront le lundi 13 septembre à 19h00 chez Materni-T, 3289 Saint-Jacques O, Montréal de 19h00 à 21h30. Pour plus d'informations, appelez-nous au 514-569-5878

info@MotherWit.ca