Thursday, June 30, 2011

Witch Doctors?

I had to go to the hospital yesterday with my son for a small but annoying problem. While I was sitting waiting I thought about the hocus-pocus of medicine and about why we need ritual and ceremony during a healing experience.

We went to the Emergency Ward and my son was poked and prodded for an hour or so until the nurse said we had to go to the clinic in the next town. We drove down and, after doing some paperwork, we sat in a small, hot waiting room for three hours until we were admitted to see the doctor. The waiting room was uncomfortable, the chairs were hard, the other patients were anxious. Once we got into the room, the doctor was wearing a green outfit, and a young woman assisting him was wearing white. Strange-looking instruments were produced. When the young woman hit my son on the head with the metal basin, nobody laughed. Only when the doctor's cell phone started singing a White Stripes song from his pocket did my son finally crack. The doctor asked "Why do you laugh"?

The last time I went was for a series of tests a few months ago (all good!). That time, the mystique was much more serious. I had an ultrasound first. I went to the clinic, paid my money, and sat for a while in the obligatory waiting room. My name was called and I was led into a small cubicle where I had to remove all my clothes and put on a little paper gown. I was allowed to bring my purse into the examination room, where a technician smeared me with a cold blue substance and then pushed a magic wand onto my abdomen. This went on for about twenty minutes until she handed me a small tissue, told me I could leave, and left the room. I ineffectually wiped some of the blue gel off and then stickily tried to find my room. My bladder was bursting as I had not been allowed to pee since the morning. I found my room, my clothes, and the bathroom and left the clinic.

A week later I was in a similar room but this was a co-ed changing room in a public hospital. The gowns were cloth but didn't fit around the back. I was tilted on a hard table and a heavy object was placed over my pelvis. Everyone left the room. A few minutes later they came back in and said I could leave.

A few weeks later I went to my doctor and she said everything was okay. Yea! The blue goo, the isolation room, the magic wand, and the heavy object cured me!

Not so far from reality, really. Maybe all I needed was some ritual, some magic, someone knowing more than I about the mystery of my own body. Perhaps I just needed someone to say "Everything is fine - your body works". Maybe I needed to feel vulnerable in a paper gown so that I could fully comprehend how scared I was of something being really wrong.

We can't know in the end what heals and what doesn't - and why some cures work for some people and not for others. Or who will not be cured in the end, and who will walk away. For this reason, it is important to have an open mind, to accept the rituals, no matter how annoying they may seem. And to remember to do no harm.

Wednesday, June 22, 2011

Birth (and life) after Cesarean

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 attendant. My favorite is the story of a young woman who had her first daughter by cesarean section She became pregnant again the same month 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.

Of course, women who are trying for vaginal birth after cesarean don't always have such fine stories to tell. Two remarks have stayed with me over the years, and these were both delivered by obstetricians to a laboring woman. The first was: “Childbirth is like war, and I am on the front line.” The second: “This is Monday morning in a busy hospital. There are road accidents, emergencies …” This was said to a woman who wanted to labor a little more before the decision was made to go 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 this man want to become an obstetrician? How did he feel about his "patients"? How had he been born? What was it about birth that suggested to him images of war?
What is it about childbirth that makes these people think in terms of war, car accidents, death? Is it just fear? And if it is, what exactly are they afraid of? And , more importantly, where does the midwife fit into this mosaic of fear, or does she fit in it all?

Doctors and midwives who are afraid of childbirth are partly afraid because of their training. Allopathic medicine teaches about pathology rather than the whole healthy being, and pregnancy is often seen as a pathologic condition. But there is another more profound reason for 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 does this lead to fear?
Let me explain. During childbirth there is something present that is outside of us as individuals, out­ side our knowledge, even outside our experience or our skill. 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, cut it out another way. But another thing happens as well. Strangely, your faith (most of us have faith in something) gets turned inwards. As an obstetrician, you have faith only in your own skill. And that is what is frightening-- that an event which cries out for the presence of God gets reduced to the simply human.

I'm sure that there are obstetricians who works 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 are religious, how many live in sight of that something which many people call God. But what happens to the sympathetic midwife working within the medical system? What happens to her sensitivity to that Other which touches us when we give birth?
I have met many diverse people over the years of working with birth.I have encountered some women who probably disliked their work, who were overtired, overworked, who had little faith in any­thing. I have also encountered mid­wives who have accepted modern medicine's vision of birth. And I have met many brave and gentle souls doctors, nurses, midwives, and doulas, who are working within the medical sys­tem and trying to maintain their faith at the same time.

What do we see in a hospi­tal? We see, first of all, an exagger­ated reliance upon technology. We know that the use of technology has a snowballing effect, creating the need for more and more complicated interventions. Secondly, we see 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 the hospital in labor with my first child, the nurse, who was actually a mid­wife trained in Scotland, touched by 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 they let me eat and drink less and less, my cervix grew smaller, I was touched less and I began to feel more and more isolated. I was touched only when necessary. The baby's heart­ beat was checked less often. I began to feel abandoned.

Can I offer some advice to birth attendants working with women who are hoping to give birth vaginally after a cesarean section? 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 as much as possible. Remember "failure to progress" can be linked to fear and stress.
Keep things easy even when they get hard. Remember that a woman work­ing for a VBAC needs 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. Re­member as well, if it turns out to be another cesarean, don't abandon her. Give her the support through the birth and afterwards that you give any birthing woman. If a lady has another cesarean, she may feel very low; it may help her to talk to another mother who has been through the same thing. Avoid the mistake of "You're lucky the baby's okay.That's the important thing." Yes it is, obviously, but ... she may still need to grieve.

I am lucky - I have been blessed to have attended many successful VBACs during my years as a birth attendant. Thank you, again, to all the women who have shown me how fearless and strong birthing women are - not least, the woman who have said "Yes, I am ready for surgery, of course, if my baby's life is in danger."
Here's to a happy marriage of modern medicine and safe midwifery, with lower cesarean section rates and happier and healthy mothers and babies. L'Chaim! To Life!

Sunday, June 5, 2011

Winter Blues, Spring Fever

As I write this I can hear a bird from the back yard, through my open window. I suddenly came alive again about two weeks ago, when the sun came out and my blood started moving. I realized that I'd been in hibernation for most of the past six months, my body was sleeping and that affected my mind. Oh, yes, I know I was at those meetings, I attended births, I wrote stuff. But I was moving through a sludge of hormones that were not letting me wake up.

How much of what we do and feel is just about chemicals? We are synapses, elements, neurons, electrons, and those little neutrinos and prions are part of us as well. Where's the "me" that feels happy when the sun finally shines?

I watched the hockey game last night. Oh, what testosterone! What violent ballet! What ballerina skill those large men have, and how I love to watch them jostle and spin their way across the frozen water. I am happy when my team wins, sad when they lose.

When I am accompanying a woman giving birth, I remember that we are all part of a net of atoms, molecules and love and I enter into that shimmering net with an open heart. Her hormones pass to me and we make the journey together. Even if it is in the dead of winter, when I take my son to school and pick him up from school in the cold and dark, the hormones of birth are warm and bright. Small punches of light in a darkened window. Just like the cardinal in my back yard in the winter whiteness, when the snow covers everything and he is a patch of crimson and a sharp song in the darkening day.

Thursday, June 2, 2011

Book!

My book is actually in print!
Only review copies are available now, so if you are a journalist and would like to review please contact me.
It looks good, and reads beautifully...the culmination of many months of work.