Tuesday, August 23, 2011

Illegal Midwives?

"Illegal" is a word that brings to mind outlaws, bandits, drug runners, hoaxters and jails. I prefer to use the word "underground" when I am talking about the midwives I know who are working outside the (extremely limited) system of registration, colleges,and paperwork that is in place in most of Canada. I joke that they are underground - they'll only assist a woman in an underground parking lot or a basement. Ha ha.

In fact, the women working outside the system are not allowed to assume the title of midwife or sage-femme, which is why many of them describe themselves as birth attendants or even as birth activists. The Montreal Gazette's story about this phenomenon presents some bare facts and portrays a sympathetic, sensible woman who has chosen to assist women who would otherwise be giving birth in a hospital with a doula, or alone at home. Not so say that giving birth with a doula isn't the choice that most women ultimately make. The doula's job is often a difficult one, because of this. She has to straddle compromises that are often unbearable to watch.

"Brave" and "courage" are often words I hear about the women who choose to give birth at home with a qualified, if "illegal", attendant (or "stupid" and "selfish"). But I think a woman is much braver who knows exactly the kind of treatment she may receive in a hospital, after she has already had an unnecessary cesarean section, and chooses to go back into that environment with a doula at her side, in the hopes that she will be able to give birth with dignity and autonomy.

The sad thing is, birth shouldn't have to be about bravery, about ego, about choices, the law, surgery, or drugs.Here is an excerpt from my upcoming book:

The other day I was at a birth. My client was a third-time mother and she didn’t want to be in the hospital for too long, but her previous two births had not been that short. So as she kept in touch during the day I agreed that she didn’t have to rush to the hospital. It was mid-morning when she decided to go, after having a bath and making sure her kids were settled. When the doctor examined her, she was almost ready to give birth. The birth proceeded very quickly, and afterwards, the obstetrician said “Oh, ladies like you will put me out of business!”

I would like to be put out of business. I would like the system to change so much that the privately hired doula is a thing of the past. Certainly, there will always be women who do not have anyone to accompany them at their birth, and for these situations we will have the volunteer doula associations that already exist today. My vision is one of most women giving birth at home, with full medical back-up available to them if needed. Midwives would provide prenatal care and accompany the laboring women through labor and birth. They would assist with the postpartum period and help the new mother adjust to life with a new baby. If there were problems, the midwives would refer the woman to a doctor, who may in turn refer her to a specialist, an obstetrician. Full emergency support would be in place for the rare occasion that it is needed, so that the midwife would know that she is covered in the case of an emergency.

The women who chose to give birth in the hospital, in my dream world, would be there because of clear medical or social need. The hospital birthing centers would provide specialized medical care for the few women who need it. Occasionally, there would be a woman who needs the extra emotional support of a doula, but the doula would be well-integrated into the hospital system and would be on call in these situations. Sometimes a woman would want to give birth away from home, and she could go to an independent birthing center which, again, would be fully supported in case of a medical emergency.

I do not believe that this vision is so far off in the future, or that it is out of our reach. For now, however, our reality is that most women in the developed world are giving birth in hospitals, and many of these hospitals have different philosophies about birth than many of the patients they are there to serve. In Canada, the philosophy of any hospital must be to provide the best care for the greatest number of people. This may translate into an epidural for every woman, especially if there are not enough nurses to support women individually. In the USA, hospitals are run as profit-making enterprises, so the word philosophy may not apply. We do know, however, that cesarean section rates are skyrocketing, and that the general consensus is that a national rate of about 15% may be optimum. Personally, I believe that the rate for emergency cesarean sections can be held to 5% without putting the mothers or babies at risk.

The doula is the interface between the birthing community and the medical establishment. This puts us in a difficult position. I have spoken to  women who thought that I would leave them to give birth alone if they decided to take an epidural (this is beyond cruel). I have been yelled at by a physician who thought I had removed an intravenous drip (the nurse hadn’t had time to put it in). I have been looked upon as a knight in shining armor (I don’t even like horseback riding) by women who had not yet understood that the birth work is done by the birthing woman.
I have also been thanked and cherished by hundreds of women who have been happy to have me by their side as they go through the experience of giving birth. My task, our task as doulas, and in a bigger sense, our task as human beings in the 21st century, is to “humanize” birth. To me, that means affirming that all of us are different, and that we all have needs, desires, and histories, that cannot and should not be judged. 

I fully support those women who choose to give birth at home, who choose to assist others at home, and who choose to follow a different path. My only condition, however, is that birth attendants keep their egos, their pride, and their ambitions out of the birthing room, and indeed, out of the process. That way, knowledge of the craft can be the highest priority, assessments can be made honestly, and difficult decisions are not clouded by personal needs.

Two of the most famous midwives, Shifra and Puah, were "illegal"; they disobeyed the Pharoah of Egypt to assist women at home ... power to the women who follow in their footsteps! May we merit to be midwives to a better way of giving birth.




Illegal Midwives?

"Illegal" is a word that brings to mind outlaws, bandits, drug runners, hoaxters and jails. I prefer to use the word "underground" when I am talking about the midwives I know who are working outside the (extremely limited) system of registration, colleges,and paperwork that is in place in most of Canada. I joke that they are underground - they'll only assist a woman in an underground parking lot or a basement. Ha ha.

In fact, the women working outside the system are not allowed to assume the title of midwife or sage-femme, which is why many of them describe themselves as birth attendants or even as birth activists. The Montreal Gazette's story about this phenomenon presents some bare facts and portrays a sympathetic, sensible woman who has chosen to assist women who would otherwise be giving birth in a hospital with a doula, or alone at home. Not so say that giving birth with a doula isn't the choice that most women ultimately make. The doula's job is often a difficult one, because of this. She has to straddle compromises that are often unbearable to watch.

"Brave" and "courage" are often words I hear about the women who choose to give birth at home with a qualified, if "illegal", attendant (or "stupid" and "selfish"). But I think a woman is much braver who knows exactly the kind of treatment she may receive in a hospital, after she has already had an unnecessary cesarean section, and chooses to go back into that environment with a doula at her side, in the hopes that she will be able to give birth with dignity and autonomy.

The sad thing is, birth shouldn't have to be about bravery, about ego, about choices, the law, surgery, or drugs.Here is an excerpt from my upcoming book:

The other day I was at a birth. My client was a third-time mother and she didn’t want to be in the hospital for too long, but her previous two births had not been that short. So as she kept in touch during the day I agreed that she didn’t have to rush to the hospital. It was mid-morning when she decided to go, after having a bath and making sure her kids were settled. When the doctor examined her, she was almost ready to give birth. The birth proceeded very quickly, and afterwards, the obstetrician said “Oh, ladies like you will put me out of business!”

I would like to be put out of business. I would like the system to change so much that the privately hired doula is a thing of the past. Certainly, there will always be women who do not have anyone to accompany them at their birth, and for these situations we will have the volunteer doula associations that already exist today. My vision is one of most women giving birth at home, with full medical back-up available to them if needed. Midwives would provide prenatal care and accompany the laboring women through labor and birth. They would assist with the postpartum period and help the new mother adjust to life with a new baby. If there were problems, the midwives would refer the woman to a doctor, who may in turn refer her to a specialist, an obstetrician. Full emergency support would be in place for the rare occasion that it is needed, so that the midwife would know that she is covered in the case of an emergency.

The women who chose to give birth in the hospital, in my dream world, would be there because of clear medical or social need. The hospital birthing centers would provide specialized medical care for the few women who need it. Occasionally, there would be a woman who needs the extra emotional support of a doula, but the doula would be well-integrated into the hospital system and would be on call in these situations. Sometimes a woman would want to give birth away from home, and she could go to an independent birthing center which, again, would be fully supported in case of a medical emergency.

I do not believe that this vision is so far off in the future, or that it is out of our reach. For now, however, our reality is that most women in the developed world are giving birth in hospitals, and many of these hospitals have different philosophies about birth than many of the patients they are there to serve. In Canada, the philosophy of any hospital must be to provide the best care for the greatest number of people. This may translate into an epidural for every woman, especially if there are not enough nurses to support women individually. In the USA, hospitals are run as profit-making enterprises, so the word philosophy may not apply. We do know, however, that cesarean section rates are skyrocketing, and that the general consensus is that a national rate of about 15% may be optimum. Personally, I believe that the rate for emergency cesarean sections can be held to 5% without putting the mothers or babies at risk.

The doula is the interface between the birthing community and the medical establishment. This puts us in a difficult position. I have spoken to  women who thought that I would leave them to give birth alone if they decided to take an epidural (this is beyond cruel). I have been yelled at by a physician who thought I had removed an intravenous drip (the nurse hadn’t had time to put it in). I have been looked upon as a knight in shining armor (I don’t even like horseback riding) by women who had not yet understood that the birth work is done by the birthing woman.
I have also been thanked and cherished by hundreds of women who have been happy to have me by their side as they go through the experience of giving birth. My task, our task as doulas, and in a bigger sense, our task as human beings in the 21st century, is to “humanize” birth. To me, that means affirming that all of us are different, and that we all have needs, desires, and histories, that cannot and should not be judged. 

I fully support those women who choose to give birth at home, who choose to assist others at home, and who choose to follow a different path. My only condition, however, is that birth attendants keep their egos, their pride, and their ambitions out of the birthing room, and indeed, out of the process. That way, knowledge of the craft can be the highest priority, assessments can be made honestly, and difficult decisions are not clouded by personal needs.

Two of the most famous midwives, Shifra and Puah, were "illegal"; they disobeyed the Pharoah of Egypt to assist women at home ... power to the women who follow in their footsteps! May we merit to be midwives to a better way of giving birth.




Monday, August 22, 2011

WWOOF Italia

I got a call from Ninni the other day. She was the first Italian Wwoofer we had years ago on our farm. Her and her boyfriend drove up from Sicily, held hands while they picked stones from the wheat, which I then ground and made our bread and pasta, and were generally a lot of fun to have around. Even though I could hardly understand a word of what Ninni said when she got excited and slipped into full Sicilian.
Talking to Ninni got me reminiscing about WWOOF Italia, and thinking about volunteers and the difference they can make to people’s lives.
We bought a crumbling stone farmhouse and seven acres of land, part vineyard, part wooded, with a pond and a spring, when I was expecting my fourth child. What a time those boys had! When we were in the fields or up on top of the roof, they were fighting battles, rafting in the goose-ridden pond, and making wooden schooners next to the chicken coop.
We had many helpers over the years. Our youngest was a seventeen year-old from England who came, took one look, and asked to be taken back to the station. Our oldest was a lovely woman who had done with family and children, and wanted to explore the world. They helped weeding the garden, picking grapes, building stone walls, cutting hay, … in return for a place to stay and three good meals a day.
Wwoof has changed over the years. In 1991 there were two or three hosts, now there are hundreds. The typical host was like us: lots of children, a small mixed farm, no money, and lots of energy and determination. There are still many hosts like we were, but there are also large “agriturismos”, which use volunteers to change beds and set tables.
And the volunteers have changed too. Back in the day, they were mostly travelers, or people in search of a different lifestyle, or curious about farming, or wanting to get away from their city-based life. Now, especially in the summer, we are inundated with young tourists, who are looking for a cheap place to stay, and consider a little farm work to be a good way to get some exercise. Winter is generally better, when tourism is down.
Still, it is a good way to get experience, and a wonderful way to meet people, and learn or practice languages. The hosts still benefit from a helping hand, and tolerance and generosity are generally the order of the day.




Sunday, August 21, 2011

Rites of Passage

Today is my birthday - I am 55 years old. I am finally a grown up. It didn't happen when I was fifteen and I left home. It didn't happen when I was twenty-five and met my true love. Neither did it happen when I had my first child at twenty-seven. Nor when I had my fifth at forty-four. It just suddenly happened on the long stroll up to fifty-five. It feels good!

L'chaim! To life - I hope you all have a wonderful birthday day.

Rites of Passage

Today is my birthday - I am 55 years old. I am finally a grown up. It didn't happen when I was fifteen and I left home. It didn't happen when I was twenty-five and met my true love. Neither did it happen when I had my first child at twenty-seven. Nor when I had my fifth at forty-four. It just suddenly happened on the long stroll up to fifty-five. It feels good!

L'chaim! To life - I hope you all have a wonderful birthday day.

Tuesday, August 9, 2011

Feel the Love


Blackberries are my favorite fruit. I made four jars of blackberry jam this morning. I made a blackberry pie the other night. They are in season around my birthday, so they are a yearly treat for me. They taste of the end of summer, the sugary heat of June and July is stored in their black bubbly taste. They have a rich taste that lends itself well to jam. So I'm jamming.

Jamming and reading my emails. And I read a beautiful account of a birth attended by one of "our" volunteers doulas. She assisted a mother who labored for many hours, and finally the decision was made to go to surgery. The baby was born, and the mother is recovering well from surgery and is mothering, as we do, to the best of her ability. Her doula was fully present for mother and baby from the beginning of labor, in the labor room, in the operating room, and at home.

If I look at the details of the story, I could probably find places where decisions were made that were not optimum, that may have led to further interventions, where this woman could have avoided surgery. But that's what I love about "my" volunteers and apprentice doulas. They are not working from information, experience, or an agenda. They are the best doulas I know, because they are working from a sense of companionship. They are loving the birthing woman.

I know several artists and musicians. A familiar refrain in the world of creativity is "Ah, if I could draw/see/play as a child does! If I could regain that way of looking at the world, where everything is new and interesting." In the birth world, as well, that sense of innocence, of wonder at birth, is something that we all strive to keep. I remember when I was looking forward to going to my first birth - I would have done anything just to be at that woman's side and accompany her through labor and birth. Not to say that I am not as dedicated to birthing women as I used to be. But I know them better - I've seen more - I don't have that freshness of vision that a "new" doula or a child has.

As doulas, we need to remember to forget ourselves and our knowledge when we are accompanying a woman in labor. Just as I greet the first wild blackberries with joy and appreciation, we should greet every birthing woman with respect and with a sense of her "newness" in the world.Forget about how much or what you know, and remember that it is her journey and you are a guest. Be happy.




Sunday, August 7, 2011

Birth Day

I posted a picture on Facebook the other day. The young man is my son’s good friend, and he is visiting us up on the mountain. His mother posted a comment about remembering when he was a baby – as we mothers do. I love watching my sons grow into men, and marvel at the fact that, for me, they retain that quality they always had, that I loved when they were babies and young children, and still love now.

One of my sons turned twenty-five this summer. I remember when I was in labor. We were living in a beautiful farmhouse in Tuscany that belonged to a famous yoga master (I only knew her as my landlord back then, not being initiated into the realms of yoga and the like). I labored and labored, and I remember the farmhand and his wife coming to visit, dressed in their Sunday best. The day before, I had watched him picking apricots in the field below. Their daughter had started labor at the same time as me, had delivered, and was cuddling her baby in bed, so they thought I would have a baby to show off as well. We told them we would let them know when the baby was finally born, which he was in due course.

When I got home with my newborn, the landlady’s daughter came to visit, bearing a huge bunch of blue cornflowers. I can never see cornflowers growing, or apricots being picked, without thinking of those few days of labor and birth. I remember the taste of the rice ice cream I ate while I was laboring.

Apricots, ice cream, flowers, babies, love ... summertime!

Monday, August 1, 2011

Put Up a Parking Lot

We were surprised to see yellow signs all over our mountain, even in the most hidden and isolated forest. The signs were reminding people that they have to pay for mushrooms or berries picked in the zone. There was a lot of effort, and a lot of money, put into the sign project, and it’s a joke to everyone I’ve spoken to.
Down by the river, as well, a new sign appeared the other day, also yellow, stating that the river is a spot only open to residents of the area.
I know it’s childish of me, but signs like this make me want to pick as many mushrooms and berries as I possibly can, and bring as many of my foreign friends and relatives to have loud parties at the river. We go to the river occasionally – it’s wonderful – there is a narrow waterfall, a cliff to climb, rocks to sunbathe upon, and the supply of skipping stones never seems to decrease.
There is another river, closer to our house, that you get to by going down the path to the left, following the trail past the abandoned villages, until you get to the old midwife’s house, then you keep going down until you hear the river, keep on going, past the fallen tree, until you are in the valley and there is the most beautiful little mountain river, wading size, but with pools you can bathe in if you can stand the cold.
Our guest picked cherries the other day: he found a cherry tree that was full of red cherries. I didn’t have time to make a pie or jam, and no one wanted to eat them so they turned mushy and went into the compost. He was upset at the waste but I showed him the trees all up and down the road, full of cherries. The myrtle berry bushes are full. The raspberries are finished, left to the worms. The blackberries are ripening, but there’s no way I can make jam with all the blackberries on the mountain.
We found some Chanterelles the other day and ate them fried in olive oil. But we haven’t found any Porcini yet, it’s a strange season this year. The old-timers don’t know why – even in their secret spots they are not finding the usual amount. But it’s not because of the signs. Nature has its mysteries that we can’t understand. It may be because of all the spring rain, or the lack of early summer rain, or the heat in June, the cold spell in July … we can put up signs, parking lots, and tollbooths, but no one can tell the mushrooms where to grow.