Sunday, February 21, 2021

Impostor?

"Coming out" is one of those phrases that is specific to the 20th and 21st century. It means disclosing a personal, private part of oneself to others. Some keep it private and let just their family know about their sexual orientation or their gender identity. Others have a big party, either in real life (pre pandemic of course) or on the social media.

But I've realized it can come to mean other kinds of disclosures: telling people about parts of yourself that you're afraid they won't like, or that will change their image of you, or that will actually put you in real danger. In the work I'm doing now, accompanying women during their reproductive journeys, I spend months having weekly check-ins with them, and one of the themes is always that they don't feel honoured, or even ready, in their task of making choices about their reproductive life. Whether to have a child, or to have a child without a partner, or to have a baby in the hospital, at home, in a birthing center, with midwives or a doctor or completely on their own; whether to have an ultrasound, or not; whether to keep the placenta, eat it, burn the cord; to breastfeed or not: all of these valid choices that should simply be informed choices, are bound up in fear. Fear because this person or the other person will not like you any more, or won't be your friend, or that you'll lose a community. Fear of being "cancelled". Fear of never, ever being good enough. Fear of being judged.

Impostor Syndrome is a phenomenon that has been recognized in the world of psychology since the late 1970's, but it isn't yet a classified disease in the DSM. This term describes a phenomenon that is increasingly common in "high-achieving" individuals. It is when you feel like you've only gotten where you are because you are basically a wily impostor. And by "getting ahead", I'm not just describing the traditional late-capitalist machine where women and men scramble and scratch their way to the top. No, none of us are off the hook here. It can happen to the most radical, kindest, authentic and all-around wonderful person as well.

Studies show that this syndrome is more prevalent amongst certain groups. My interest is and always has been and will be women, so I'm just going to talk about how it possibly evolves for us. Let's begin with what women are taught. We're taught that we should "get ahead". We can have a career, good looks, a doting partner, children: we can have everything! Especially if we're white! We are also taught, however, that it's not nice to make a scene. That assertiveness can be named "bitchiness" in the blink of an eye. And who wants to be thought of as a bitch? Or, in the case of a Jewish woman I know who was a successful professional, who wants to be thought of as a money-grabber? Or, for a Black friend of mine who is very successful at her job and managed to also create a beautiful family, who wants to be thought of an exotic sexy bird that somehow got lucky? Or that Asian woman who worked hard to get into her field, and does well at it, but everyone "knows" that her family just bought her into it. You get the picture. 

Ok, so it seems to me that this syndrome has a lot to do with WHAT OTHER PEOPLE THINK about you. Or what you imagine they imagine about you. It's the same, really, as the concept of Coming Out. A person's sexual orientation or gender shouldn't actually be anyone else's business. You're a boy? A girl? You like women? Or men? Great, good, and wonderful. Just don't hurt anyone, and we are good to go. Wear what you want, do what you want in the bedroom and in the world beyond, but care for others and be kind. Or at least that's how it would be in MY ideal world. But, of course, we are living in an aquarium-oriented world, where everything we do or say (and even anything we might believe for five minutes and post on the social media) can be and usually is held against us. Or used as a building block to create that persona that someone else creates about you.

Instagram bios are short: cute, to the point, often using interesting words that may or may not describe the person. What do we actually do on Instagram? We share information, we tell tiny stories, but most of all, we persuade other people to like us. Everyone knows that we create personas; avatars; versions of ourselves that we want to present to the world. We do it in real life, and we do it online. We want people to like us so badly that we create images of ourselves that aren't true at all. "Well, maybe you do that, but I don't" I'm sure will be a common response to this statement. And indeed, it's awful to think that you would actually lie, or falsify who you really are, or create a nicer version of yourself - especially if you work in a caring profession, as I do, as a birth companion who is expected to be honest and upfront.

But here's the thing, even if you have all the best intentions, people will always create a picture of you based on what they imagine they see, rather than looking at the "you" who really exists in front of them. In fact, one of the most important lessons I teach my students is to never form judgements of the woman you are accompanying on her reproductive journey.  You will hear the most surprising things if you keep your ears and your heart open.

I'm getting to the Impostor Syndrome, in a slow sideways manner. 

"Mr. Drake Puddle-Duck advanced in a slow sideways manner, and picked up the various articles. But he put them on himself! They fitted him even worse than Tom Kitten. "It's a very fine morning!" said Mr Drake Puddle-Duck." (Beatrix Potter "The Tale of Tom Kitten")

An outfit drops from the sky. It looks okay. You pick it up, put it on, and figure it fits. You walk around in it for years, until one day it gets too tight and you realize it's just not you. We feel like impostors not because we haven't done the work, but in spite of it. The Impostor feels like she has ended up in the wrong (successful) place, just because of her looks, or her lies, or the fact that she can spin a good yarn. She feels like people imagine she knows more than she really does (even though she actually does know a lot). 

She keeps these doubts inside though, of course, and continues to put her best impression forward. She is the woman with the great career, or the mother-earth type, or the one who has children AND a career, or the one who does everything singlehanded. Whatever role or persona she has chosen for herself, she has to hide her doubts and flaws in the outside world, or in the virtual world, because those doubts and flaws would PROVE that she's an impostor! Does our culture insist upon everyone feeling like a badly reflected image of who they "really" are? Because we crave authenticity and the "real experience"? And we aren't interested in the kind of life that is thrust upon us, one where everyone has their roles clearly mapped out for them. 

I spent some time in a cult (yep. I've been along so many roads in my life; it's one of the reasons why I a: can meet people where they are and b: never expect people to be who I imagine they are). Anyway, the beauty of belonging to a cult is that you never have to question what you're supposed to do. You just do it, because that's what you do. That's what you're told to do: what GOD told you to do! You never have to decide anything for yourself, and you certainly don't tell anyone about your real dreams, desires or inner self. That's an extreme example, but I think that in the past people lived much narrower lives, where certain aspects of yourself were never exposed (hence the modern ceremony of "coming out"). 

Well, I suffer every day feeling like an Impostor - in so many spheres of my life - as a runner, a wife, a midwife, a woman, a cook, an Italian speaker ... you name it, I'm a fake. But the way that I have chosen NOT to wriggle out of that uncomfortable feeling is to tell everyone all about my stuff. 

I've decided that the best way for me to travel through this life will be to keep myself to myself; learn from my experiences; and, above all, be open to others. And if that's the life of an Impostor, so be it. 



Sunday, February 14, 2021

The Elusive VBAC

 

I love to listen to birth stories. Many of the stories that I hear are a testimony to the pregnant woman’s great ability to “animal out” on her attendants. One of my favourites is the story of a young woman who had her first daughter by cesarean section. She became pregnant again the same month (yes, I know … but true), and it turned out she was carrying twins. Her doctor was very alarmed and booked her for a cesarean at 38 weeks. She went into labor at 36 weeks and delivered two lovely girls, vaginally.

 

Two remarks have stayed with me over the years, and these were both delivered by obstetricians to a labouring woman: “Childbirth is like war, and I am on the front line” is one. “This is Monday morning in a busy hospital. There are road accidents, emergencies…” is the other. This was said to a woman who wanted to labor a little more before going to surgery, implying that the birth of a child had to be scheduled in somehow between a messy car accident and some other horrific case.

 

Why did the first man want to become an obstetrician? How did he feel about his “patients”? How had he been born? What was it about birth that gave him images of war? The second remark came from a woman. What was it about birth that frightened her so much? How could the birth of a child be imagined in the same breath as a car accident?

 

What is it about childbirth that makes people think in terms of war, accidents, and death? Is it just fear? And if it is, what exactly is everyone afraid of? And, more importantly, where does the midwife fit into this mosaic of fear, or does she fit in at all?

 

The doctors and midwives who are afraid of childbirth are partly afraid because of their training. Allopathic medicine teaches about pathology rather than about the whole healthy being. In obstetrics, pregnancy is often seen as a pathologic condition that can throw the whole system out of sync.

 

If we look deeper, however, we can see that there is another, more complex root of this fear, and it has to do with the fact that Western medical training teaches health workers to rely only upon their own knowledge. How can this lead to fear?

 

Let me explain. During childbirth there is something present that is outside of us as individuals; outside our knowledge; even outside our experience or our skills. That “something” has to do with faith. It is only with a leap of faith that you can appreciate or even accept that a new human being comes out of a woman’s vagina. Without that leap of faith, what happens? Two things: more obviously, you have to interfere: pull it out, or cut it out another way.


Another thing happens as well. Strangely, your faith (most of us have faith in something) gets turned inwards. As an obstetrician, or as a midwife, you begin to have faith only in your own skill. And that is what is frightening – that an event that cries out for the presence of the Divine (or whatever it is that you would name that) gets reduced to the simply human.

 

I know that there are obstetricians who work differently, but I think that it is easier for a midwife to accept that there is something else, something larger than herself, working through a birthing woman. It is quite noticeable how many midwives do live in sight of that something which many of us name God.

 

But what happens to a sympathetic midwife or physician who is working within the medical system? What happens to her sensitivity to that Other that touches us when we give birth?

 

What do we see in a hospital? We see, first of all, an exaggerated reliance upon technology. The use of technology has a snowballing effect, creating the need for more and more complicated interventions. Secondly, the hospital maintains a rigid hierarchical structure in which usually one person is calling the shots. Finally, we see the “spiritual” infrastructure, upon which this hierarchy is based, to be inward-looking and grounded only in human knowledge.

 

What happens in the hospital when things start to “go wrong”, when things don’t follow the prescribed path? When I went into hospital in labor with my first child, the nurse, who was actually a Scottish midwife, touched my belly and said cheerfully: “This baby will be born by noon!” As time went on, she touched me less and less. By the next morning at the start of her shift, she didn’t even greet me. As the nurses let me eat and drink less and less, my cervix closed tighter and tighter. I was touched less and I began to feel more and more isolated. Finally, I was only touched when absolutely necessary. The baby’s heartbeat was checked less often. I began to feel abandoned.

 

Our national cesarean section rate is quite a bit higher than the rate suggested by the WHO, which is 10-15%. In Canada overall, the rate is closer to 25%. I’m not interested in exploring why the rate has shot up so precipitously in the past 30 years, leave that to others who love statistics and platitudes. What I am interested in, is threefold:

To create an environment in which every woman has access to a safe and sacred birth.

To provide access to first-time mothers to be able to experience a vaginal birth BEFORE cesarean.

To facilitate VBAC (vaginal birth after cesarean) for women who are seeking that route: to provide information, support, informed choices and LOVE.

 

Here is some advice to midwives, doulas, and physicians who are working with women who want to give birth vaginally after a cesarean:

Remember that the previous cesarean(s) have left scars not so much on the uterus as on the woman’s sense that she is capable of giving birth. Accept that having a cesarean can hurt.

Please don’t describe to her how a ruptured uterus may feel. Watch for danger signs yourself; keep your concerns to yourself and your co-attendants.

Remember that “failure to progress” means that a woman was probably afraid and stressed. She does not need to be reminded of her failure.

Keep things easy when they get tough. Remember that a woman working for a VBAC will do well in the comfort and security of her own home.

Remember that she may need to work on building confidence, on throwing away fear, on finding her “animal” self.

Tell her you love her. Give her and her partner some time to be alone together during labor.

 

Remember as well, that if she ends up giving birth by cesarean another time, don’t abandon her. Give her the support through the birth and afterwards that you would give to any birthing woman.

 



Thursday, January 28, 2021

Placenta Magic


"I knew a placenta once. She was a big gal. Knew how to hold her space. I considered inviting her home but others said "oh no - no, no, no.," and then she was gone, just like that."


Most women these days who give birth surrounded by doctors or midwives don't learn anything about the placenta before they give birth, and then afterwards it disappears just like the one Sarah described above. She birthed in the hospital, was followed by midwives, and had no idea that her baby's magical organ would simply disappear into the bowels of the hospital.

The placenta is a unique organ that provides nourishment for the fetus during their time in the womb. It is attached to the mother's body; it works as a filter between the mother's blood and the fetus'; it provides the fetus with oxygen-rich blood from the mother's body, and allows for the transportation of oxygen-depleted blood to leave the fetus' circulation and get transported back to the mother's circulatory system.

After the baby is born, the uterus works to expel the placenta, and if the umbilical cord has not been cut, then the attached placenta separates from the baby's body within a few days to a week after birth. However, it is very common practice now to cut the umbilical cord even before the placenta is born, thus depriving the newborn of some of the oxygen that it could have had access to without the separation.

Many women do not know about the placenta. I've created a Mini Series about this magical organ on my Baby Magic Podcast. Listen up on the 9, 16 and 23 of February, 2021 for a look at the placenta: 
On February 9 we will be guided by Patricia Edmonds, midwife of over 40 years, who will answer the question: What is the placenta? 
On February 16 I will be chatting with two women who decided on Lotus Birth for their babies. One of these women gave birth in a hospital, and the other at home.
And on February 23 two business partners from Australia will enlighten us on placental encapsulation and the benefits of ingesting placenta.

Listen up! I hope our meanderings through the world of women's bodies, justice, and love are pleasing to you. 


Saturday, January 9, 2021

Gratitude Alphabet (2021)

I am starting another gratitude alphabet because I had some pandemic blues last week and started a good old Pity Party. 
So here is what I am thankful for:


A is for Avraham.

Weirdly, my husband tells me that when we first met, when he was only 20 and I was 25, I told him I wanted five children!!! To his credit, he didn't run or try to hide like many men (and women) would have done back then. We were leftists! Revolutionaries! We didn't do such things as plan families or have babies; we were destined for bigger things...

Anyway, we had four sons and lived an idyllic life on a small farm in Italy until reality struck and we moved back to Canada. In 2000, I thought I was done reproducing but I wasn't! I gave birth to my fifth son in 2001.

Avraham is the most laid back person I have ever met. He's the tallest of everyone in the whole family. He loves to ski. He makes films. He helps me with my podcast. 

I'm so grateful that he is in my life. This year has taught me a great deal about being content with what we have, and about how things can change on a dime, and about how we aren't really in control at all. Avraham always taught me about love, patience, slowing down, living to your own beat.



Tuesday, December 22, 2020

Midwifery and Bullshit

 

These are not midwifery tools, but they could be. 

I have started offering prenatal support and consultation to women who are looking to give birth in an autonomous way. Several of these women are being followed, or have been followed, by registered midwives here in Canada. I've also spoken to a few practising midwives in this country, and I believe our midwifery establishment is in crisis.

We were an unusual country. Midwifery was illegal in all of our provinces and territories until the 1990's, when provinces started to recognize that it would be useful to register and educate midwives in the medical model. During the twenty years from the 1970's until midwifery was legitimized and regulated, midwives worked illegally to assist mothers at home, and there were a few midwives who were charged with practising medicine without a license. 

During the 1990's, midwifery became regulated and legitimized in several provinces. Midwifery education programs were developed and offered in universities across the country. These programs were very hard to get accepted into, and required a formal academic background over life experience. Most of the original lay midwives who had been practising illegally before legislation were "grandmothered" in to the Colleges of Midwives, but the applicants who were accepted into the programs were generally younger and obviously less experienced. 

Midwives were and are in great demand. The supply is very limited, partly because of the restrictions that competitive educational options and limited employment options mean for anyone who is drawn to the practice. Provincial governments in Canada have succeeded in effectively reducing the number of potential practising midwives, either with restrictive educational possibilities, or by limiting the ways that midwives can practice.

Because of the lack of registered midwives, and because the available midwives were practising in the medical model, several women over the years in various provinces in Canada chose to give birth either unassisted or with Traditional Birth Companions. As well, midwives trained in the US or elsewhere started offering their services as midwives and attended women at home. This was risky, because with the creation of a College of Midwives, anyone offering restricted practices under the provincial midwifery acts could be (and were!) prosecuted by the provincial College of Midwives. So far, this has happened in B.C., Saskatchewan, and Quebec. 

The pandemic of 2020 changed the face of birth. Women who were hiring doulas to accompany them to their hospital births found that the hospital authorities had full power to limit the number of people present, and doulas were left at home in front of their phones, providing encouragement, support and continuity of care from afar (Hats off, shout out, Kudos to all you doulas out there!!!). Home birth was restricted or banned in some areas, and midwives were given even more rules and regulations they had to practice under. 

Hospitals were seen, rightly so, as places for sick people (hmmmm, isn't that what they always were?). A few women, certainly a larger number than in 2019, decided that they would give birth on their own. Others decided that they would continue with midwifery care and fill in the gaps with the council and support of other practitioners.

Here is a little account of what is wrong with midwifery today, gleaned from conversations I have had with women seeking answers, and why I believe it has gone wrong:

  • Newborn mothers and babies do not need immediate testing. They need skin-to-skin togetherness, if the immediate indications of their health is good.
  • Newborns do not have to latch on the breast like a champion within the first half hour of life. Again, they need skin-to-skin togetherness. Mother will need to eat and drink. Attendants should stick around with gentle attention.
  • If you say that you will offer a woman attendance at her home, and you visit her home and bring equipment and preparations ... she is not going to hear your quid pro quos and fine fine print at the bottom of your conversations. She will be deeply disappointed when you tell her that (for whatever reason, that has to do with YOUR infrastructure and organization of lack thereof) she cannot after all birth in the comfort of her own home.
  • Women over 40 are not inherently dangerous. They can carry a baby to term and do not need extra testing or worrying conversations about how risky their pregnancy is. That's why she chose you, a midwife, so they wouldn't have to be bullied.
  • Midwives have to learn to keep their faces pleasant. So many women have let me know that they got really scared when they saw a young midwife look at their lady parts with horror/fear on their face. A vulva or a newborn's head can look wildly psychedelic, but usually is no reason for alarm.
  • The word "should" doesn't belong in your vocabulary if you are attending a birthing woman. 
Women now, a small percentage but nevertheless a percentage, are choosing to give birth at home autonomously instead of seeking the attendance of a midwife or a physician. This fact makes me sad. Why? Because I believe that every woman deserves a safe and sacred place in which to birth her child. Some women want to birth in the hospital. That birth should be as respected and loved as a birth that takes place at home surrounded by a circle of women. Some women want to birth at home, and these women deserve respectful, kind, reliable, and legal midwifery care. 

There is work to be done!!!

Sunday, December 6, 2020

Meconium Happens

The more I live this life, the more I am convinced that the deal is, it is not what happens to you that matters so much, it's how you accept it (or not). I have been to births that have been really challenging and tough, where the woman accepts the labor and is thrilled with the whole experience. I have seen other women fight against labor and birth, one contraction at a time.

Today is December 6, 2020. A day like any other. Except not: it's the anniversary of the day when 14 women were killed by an armed killer.


It's a day when my friend had to go back into hospital. It's a day when thousands of people died from Covid-19.

It's a day when we have to, as always, take the joy from every moment and cherish it. And even when we are full of joy, and all comfy in our enlightenment and entitlement, shit will happen. Meconium does happen. A baby can suffer some small slight and poop. Or a baby can get their cord squeezed so much they poop a lot. Things break down, things break. People break. 

But where there's rupture, there's repair. A body's urge is to health, just as a plant moves towards the light. In the same way, the knowledge of women has always been towards healing. 

We can't do anything to bring those women back to life. But we can speak out against violence every single day. And, unfortunately, in my field (haha no, not in my cafe...in my real field which is maternity care), violence against women is rampant, ugly, and expected. 

What can be done? Well, one thing that's happening is that pregnant women are rising up and saying "No more violence! No more treating me like I'm a child, that I don't have feelings, that I don't know my own body. No more speaking about me as though I'm not present. No more making decisions about my body without my consent. No more doing things to my body without my consent. No more lying to me!" And how are these women doing that? By withdrawing from the hospital system. They are giving birth on their own or with Traditional Birth Companions. 

Another thing that is happening is that doulas are continuing to support women who choose to give birth in the hospital. Or, more importantly, those women who don't actually have the choice and have to give birth in the hospital. Especially these days, it's hard to be a doula. Many hospitals have taken away the birthing woman's right to support by insisting that she choose between her partner and her doula. So doulas are providing companionship and support virtually. 

Medical staff in hospitals in today's world are stressed. They're overworked, tired, and they have all the same concerns on their minds as you or I. Suicide rates are higher for physicians than for the general population, and higher for female doctors than males. The medical system isn't working for anyone.

What can a doula do to relieve everyone's symptoms? Let me be clear: when a doula works to facilitate a mother feeling empowered in a situation where her power can be taken away from her at any minute, we are not talking about getting at the root of the problem. If a birth is an undisturbed birth in a place where the birthing woman is comfortable, safe, and respected, then the doula can do the work of being a doula: easing labour, providing encouragement, seeing to the birthing woman and her family's needs. But if a birth is taking place in an environment where the go-to routine is medication, management and directives then the doula can only provide bandaid measures within a strict and abusive system.

And these bandaid measures can work! Any number of women leave the hospital with their babies feeling joyful, even ecstatic, and satisfied with their care. But a huge number of women leave the hospital hurting.

Is it time to finally step away from an abusive system? What happens to a woman when she has a vision of a natural, normal birth and she arrives at the hospital and things start to go haywire? Is it possible to convince women to stay at home, at least until they are in active labor? What about the woman who feels every contraction, from the very beginning, like torture; the woman who can't separate her labor contractions from an abuse she experienced years ago? What is the role of the doula through this seismic change? What about midwives? Why are midwives still using the words "should" and "allow" when they speak about birth? 

Is it time to Rise Up?


Tuesday, December 1, 2020

Birth and Scars

As we grow, we absorb big and small shocks to our bodies and souls. We all know where our physical scars are, and we often assign stories to them. I remember when I was skipping school and the knife chose that day to slice my finger, so I had to get myself stitched up without (I dreamed) my mother finding out. I have a little white line on my finger that tells that story.

Some women have bigger scars, on their skin and their muscles, from birthing their babies. I hear these stories often when I am speaking to women about their birth experiences.

Other women have emotional scars that last for years. These scars have a way of aching and burning during pregnancy and birth. The doula can gently assist the woman when she is feeling these aches and pains. Doulas are not therapists so they do not have to probe, suggest, or hypnotize. What they do is provide a non-judgmental ear, if the woman wants to talk. They let her know that she is not alone, that she has support. They also remind her that there are other women who have traveled the same road and survived.

One of my students is accompanying a woman as I write. The woman has been in labor for most of last night and today. She does have emotional scars, and they are hurting. My student has been with her the whole time, supporting and comforting. And even though my student is a very inexperienced doula, she is still providing the essence of what a birthing woman needs. The expertise, medical know-how and scientific facts is not the realm of the doula. She is there with other skills: the skill of touch, listening, compassion, and presence.


With our world changing every day; with our experiences and our innate wisdom challenged every single day; with our routines and habits changing minute to minute, we are starting to see between the lines of our lives. We are starting to look between the cracks; to probe between the layers of darkness that we have been hiding behind. We, as women, are starting to see what has been hidden: that birth is a unique act, unique to women; that women's bodies are exquisitely designed for this task; that a woman births best when she is surrounded by a loving circle of care.

It is wonderful if that circle of care can include someone, an elder perhaps. who know about the vagaries of Mother Nature and her cruel jokes. But if not, chances are that everything will work out fine. And that is better than being treated like a child, when you are bringing forth new life.

So I see women and their partners and their communities going about their lives, far from hospitals and Covid regulations. And it makes me sad that with this huge machinery of health care that we as a society couldn't have created a safe and sacred space for women to birth in; but I understand why that isn't possible. Can you imagine what would happen if the power of womanhood was actually unleashed? 

Think about the biggest wave you've ever seen. Think about the most love you've ever felt. And the most beautiful place you've ever been. Imagine what it would be like if women grew babies in their wombs and birthed them with respect, honour, and love. 

Scars have a way of healing. With healing comes change, and growth. Womanhood has been injured and scarred for too long. There's a new era coming, so watch out!