Friday, March 30, 2012

Ask the Doula - the "too-big baby"

A week has gone by already, so quickly. I am involved in many interesting projects, more about them in a few days...
It's Ask the Doula time again!
Please keep sending in your questions. You can add them as comments below, or send your questions to our facebook page, or twitter @montrealdoula.

Today I am going to be looking at the question of cephalo-pelvic disproportion, or the "too-big baby". This mother generously agreed for me to print her question and the response.


Question Number Three 


"I had my first baby three years ago. I am expecting again and I would like to have a doula to accompany me. I am not sure how it will go. My doctor told me that my pelvis is too small to give birth. My first baby was born by cesarean after I was in labor for two days. I had contractions all day on the first day, then by the next morning they were so painful I couldn't even talk. We went to the hospital, where they broke my waters, and then I took an epidural. My baby didn't come out after two hours and they said she was too big. She ended up weighing seven pounds thirteen ounces, and had an Apgar score of 9 and 10. I have a very small pelvis and a narrow pubic arch. Do you think this is a good reason for a cesarean?"

First of all, let's understand how birth stories work. A woman will tell me her story, and it will be just that - her story about what happened to her. It is a story in the first person, about a primal experience she had. I will listen to the details but I will also listen to the tenor, the resonance, of the story.

This story is about a normal labor that somehow went wrong. The first hint is that she labored all day and after 24 hours had contractions "so painful I couldn't even talk." This is normal labor. Mothers will have contractions for a few hours, or a few days, and they will be uncomfortable and even painful. Then the body gets down to work and contractions become so intense that she cannot speak through them. Then she gets to the point where she doesn't even want to speak in between contractions, and this is when the doula knows that the laboring woman is definitely in good labor.

But in this story, the woman was not prepared for the intensity, and she went to the hospital soon after she entered the beginning of active labor. She doesn't say why they broke her waters, but usually it is done because there is a perception that labor isn't moving quickly enough.

In this case, it appears that the breaking of the waters did stimulate labor, and this stimulation increased the intensity of the contractions to the point where the laboring woman decided to take an epidural for pain relief. She was probably quite tired by now, as well, as no one had told her to rest during the night in between the contractions.

The epidural probably helped in terms of her energy, and her body obviously did the work of opening so that she reached the pushing phase. Then what happened? She pushed for two hours. The staff told her the baby was too big and she went to surgery. I cannot extrapolate too much, but here is a possible scenario:

The pelvis is narrow and small. The body made a baby that, in fact, was a perfect size for this pelvis. Her labor was progressing normally and the baby was doing the appropriate moves to navigate through the bones of her mother's body. At a certain point, she had moved her head to a sideways plane so that she could get some leverage to push it down further.

Imagine one of those wooden toys, where the child has to push blocks through different-shaped holes. The child will turn, and turn, and turn the block until it finally pops through. He learned this at birth.

But suddenly, the amniotic fluid drained, and she found her head stuck upon the bone in a awkward position. She still instinctively pushes her head to the other side, to straighten it in order to descend further. As she is doing this difficult work, she feels her mother's helpful body go limp. She has no more help from the outside, just uterine contractions that are pushing her more and more into a position that will be very difficult for her to move from.

The cervix becomes fully dilated, because the body is doing what it should. But the combination of the narrow pelvis, the crooked head, the epidural, and the impatient staff adds up to an unfortunate turn of events.

If she had decided to stay at home longer, until labor was more active, she may have avoided getting her membranes ruptured. If she had a wider pelvis, the baby may not have gotten stuck. If she had a doula by her side, she may have managed to avoid or at least postpone the epidural. If she had not taken the epidural, vertical or forward-leaning positions could have helped the baby come down. If the staff had patiently waited another hour, she may have pushed the baby out.

But we do not know. We really can never know what could have happened, had things been otherwise. But if we agree that we could never know what might have happened, then we have to also admit that we do not know if another baby, perhaps with a slightly smaller head, in a better position, without an epidural, with a doula assisting the mother, could successfully navigate through the birth tunnel and be born vaginally.

My answer? I do not know the reason for your first cesarean. But I do know that you do not have any conditions that definitely preclude your giving birth vaginally. There is a saying: "labour is the best pelvimeter". In layperson's terms, this means that the best way to measure your pelvis is with a baby's head, when you are in labor.

My advice? Hire a doula. Make sure you have a good relationship with your doctor or midwife.Stay positive and open. I wish you the best of luck!


Ask the Doula - the "too-big baby"

A week has gone by already, so quickly. I am involved in many interesting projects, more about them in a few days...
It's Ask the Doula time again!
Please keep sending in your questions. You can add them as comments below, or send your questions to our facebook page, or twitter @montrealdoula.

Today I am going to be looking at the question of cephalo-pelvic disproportion, or the "too-big baby". This mother generously agreed for me to print her question and the response.


Question Number Three 


"I had my first baby three years ago. I am expecting again and I would like to have a doula to accompany me. I am not sure how it will go. My doctor told me that my pelvis is too small to give birth. My first baby was born by cesarean after I was in labor for two days. I had contractions all day on the first day, then by the next morning they were so painful I couldn't even talk. We went to the hospital, where they broke my waters, and then I took an epidural. My baby didn't come out after two hours and they said she was too big. She ended up weighing seven pounds thirteen ounces, and had an Apgar score of 9 and 10. I have a very small pelvis and a narrow pubic arch. Do you think this is a good reason for a cesarean?"

First of all, let's understand how birth stories work. A woman will tell me her story, and it will be just that - her story about what happened to her. It is a story in the first person, about a primal experience she had. I will listen to the details but I will also listen to the tenor, the resonance, of the story.

This story is about a normal labor that somehow went wrong. The first hint is that she labored all day and after 24 hours had contractions "so painful I couldn't even talk." This is normal labor. Mothers will have contractions for a few hours, or a few days, and they will be uncomfortable and even painful. Then the body gets down to work and contractions become so intense that she cannot speak through them. Then she gets to the point where she doesn't even want to speak in between contractions, and this is when the doula knows that the laboring woman is definitely in good labor.

But in this story, the woman was not prepared for the intensity, and she went to the hospital soon after she entered the beginning of active labor. She doesn't say why they broke her waters, but usually it is done because there is a perception that labor isn't moving quickly enough.

In this case, it appears that the breaking of the waters did stimulate labor, and this stimulation increased the intensity of the contractions to the point where the laboring woman decided to take an epidural for pain relief. She was probably quite tired by now, as well, as no one had told her to rest during the night in between the contractions.

The epidural probably helped in terms of her energy, and her body obviously did the work of opening so that she reached the pushing phase. Then what happened? She pushed for two hours. The staff told her the baby was too big and she went to surgery. I cannot extrapolate too much, but here is a possible scenario:

The pelvis is narrow and small. The body made a baby that, in fact, was a perfect size for this pelvis. Her labor was progressing normally and the baby was doing the appropriate moves to navigate through the bones of her mother's body. At a certain point, she had moved her head to a sideways plane so that she could get some leverage to push it down further.

Imagine one of those wooden toys, where the child has to push blocks through different-shaped holes. The child will turn, and turn, and turn the block until it finally pops through. He learned this at birth.

But suddenly, the amniotic fluid drained, and she found her head stuck upon the bone in a awkward position. She still instinctively pushes her head to the other side, to straighten it in order to descend further. As she is doing this difficult work, she feels her mother's helpful body go limp. She has no more help from the outside, just uterine contractions that are pushing her more and more into a position that will be very difficult for her to move from.

The cervix becomes fully dilated, because the body is doing what it should. But the combination of the narrow pelvis, the crooked head, the epidural, and the impatient staff adds up to an unfortunate turn of events.

If she had decided to stay at home longer, until labor was more active, she may have avoided getting her membranes ruptured. If she had a wider pelvis, the baby may not have gotten stuck. If she had a doula by her side, she may have managed to avoid or at least postpone the epidural. If she had not taken the epidural, vertical or forward-leaning positions could have helped the baby come down. If the staff had patiently waited another hour, she may have pushed the baby out.

But we do not know. We really can never know what could have happened, had things been otherwise. But if we agree that we could never know what might have happened, then we have to also admit that we do not know if another baby, perhaps with a slightly smaller head, in a better position, without an epidural, with a doula assisting the mother, could successfully navigate through the birth tunnel and be born vaginally.

My answer? I do not know the reason for your first cesarean. But I do know that you do not have any conditions that definitely preclude your giving birth vaginally. There is a saying: "labour is the best pelvimeter". In layperson's terms, this means that the best way to measure your pelvis is with a baby's head, when you are in labor.

My advice? Hire a doula. Make sure you have a good relationship with your doctor or midwife.Stay positive and open. I wish you the best of luck!


Tuesday, March 27, 2012

Radical Birth Film?

Montreal Birth Companions has been providing volunteer doula services for almost ten years, and we are beginning a fundraising campaign so that we can keep our doors open for the rest of 2012.

One of our plans is to have a film screening. We have chosen one film already, and we are looking for a RADICAL film that shows life and birth as it is.

Can anyone suggest a film that is possibly about doulas working with the type of clientele MBC serves? Refugees, immigrants, young mothers, ... women in prisons...

Please leave your comments here. The screening will take place in September, so if you are in the final stages of film creation ... let us know!
 




Thursday, March 22, 2012

Ask the Doula - doula training

It's Ask the Doula time again!
Please keep sending in your questions. You can add them as comments below, or send your questions to our facebook page, or twitter @montrealdoula.

This week I want to tackle another interesting question. I am always getting calls from women who feel a calling to midwifery. They often ask if they can take my doula courses, or if I would allow them to observe me at work or take them on as apprentices. This week, I am going to explore a question from an aspiring midwife.


Question Number Two

"I am 24 years old, single, without children (yet!). I have been interested in birth from a very young age - I was born at home but my older brother was a c-section baby, and my mother always told me about my wonderful birth day. I am applying to several midwifery schools and I am hoping to start my studies in the fall. Do you have any suggestions for me? How can  I increase my chances of getting accepted? Should I train to be a doula first?"

This is a lovely question. It's so interesting that many of the younger women I see moving into the birth "scene" are women whose mothers had wonderful birth experiences. In my generation, many of us went into birth work because of less-than optimum experiences.
First, I would like to wish this young woman all the luck in the world. It is very challenging to send in applications, to receive rejection letters, and to wonder what went wrong. Remember, there are many more women who want to become midwives than places in midwifery programs, and this is especially true in Canada.

I think the most important thing to remember, as an aspiring midwife, is that the road is long, and that the main goal is not just the diploma, the job, or the number of births you end up attending. The journey to becoming a midwife is full of twists and turns, and may take you to some unexpected places.

Of course, you do need to understand some basic principles, and you need a lot of theoretical and clinical 
preparation, and this is why you have to go to school. And here in Canada you cannot become a registered midwife just by apprenticing with an experienced midwife. So, what to do?

There are several important tasks you can take on that will not only increase your chances of getting accepted, but will also give you a good background for the important work of being a midwife.

First - go to births! You will learn from every single birth you attend. Take a doula training, and start volunteering with your local volunteer doula organization. If there isn't one, start one. Do not expect practicing doulas or midwives to welcome your presence at births. Their priority is the care of the women they are attending. So you need to get out there, get some doula education, find a partner, and volunteer. Some people suggest you go to the births of friends and family, but I think it is easier and "cleaner" if you do not.

Second - Read and keep reading. Read books for pregnant women; read scholarly journals; read blogs and e-zines. Make notes. Try to discover what you really believe about birth. You have an opinion, and it is valid. Don't go along with the crowd without really thinking about what the crowd is saying.

Third - Learn from others. If a doula or midwife allows you to observe a prenatal, birth, or a postpartum visit or group, by all means go and observe. But observe. Don't participate actively unless you are invited to. Take notes. Ask questions, afterwards when you feel it is appropriate. Learn from the medical staff when you are attending a hospital birth. You may ask questions, again, if it is appropriate. Do not try to be their equal. You are not. Be humble.

Fourth - Learn different skills. Take a yoga class. Take a knitting class. Start practicing staying up all night and remaining alert. Do a CPR class. Learn about your own body and how it works under stress and without sleep. Test your patience. Sometimes babies take a long, long time to come. If you have learned the art of sitting on your hands, you won't be imagining non-existent dangers that will lead to to wrong decisions.

I have been on this road for ... since I was thirteen. It is long, interesting, sometimes painful. Open your heart, and know that wherever it takes you, there you should be.



Ask the Doula - doula training

It's Ask the Doula time again!
Please keep sending in your questions. You can add them as comments below, or send your questions to our facebook page, or twitter @montrealdoula.

This week I want to tackle another interesting question. I am always getting calls from women who feel a calling to midwifery. They often ask if they can take my doula courses, or if I would allow them to observe me at work or take them on as apprentices. This week, I am going to explore a question from an aspiring midwife.


Question Number Two

"I am 24 years old, single, without children (yet!). I have been interested in birth from a very young age - I was born at home but my older brother was a c-section baby, and my mother always told me about my wonderful birth day. I am applying to several midwifery schools and I am hoping to start my studies in the fall. Do you have any suggestions for me? How can  I increase my chances of getting accepted? Should I train to be a doula first?"

This is a lovely question. It's so interesting that many of the younger women I see moving into the birth "scene" are women whose mothers had wonderful birth experiences. In my generation, many of us went into birth work because of less-than optimum experiences.
First, I would like to wish this young woman all the luck in the world. It is very challenging to send in applications, to receive rejection letters, and to wonder what went wrong. Remember, there are many more women who want to become midwives than places in midwifery programs, and this is especially true in Canada.

I think the most important thing to remember, as an aspiring midwife, is that the road is long, and that the main goal is not just the diploma, the job, or the number of births you end up attending. The journey to becoming a midwife is full of twists and turns, and may take you to some unexpected places.

Of course, you do need to understand some basic principles, and you need a lot of theoretical and clinical 
preparation, and this is why you have to go to school. And here in Canada you cannot become a registered midwife just by apprenticing with an experienced midwife. So, what to do?

There are several important tasks you can take on that will not only increase your chances of getting accepted, but will also give you a good background for the important work of being a midwife.

First - go to births! You will learn from every single birth you attend. Take a doula training, and start volunteering with your local volunteer doula organization. If there isn't one, start one. Do not expect practicing doulas or midwives to welcome your presence at births. Their priority is the care of the women they are attending. So you need to get out there, get some doula education, find a partner, and volunteer. Some people suggest you go to the births of friends and family, but I think it is easier and "cleaner" if you do not.

Second - Read and keep reading. Read books for pregnant women; read scholarly journals; read blogs and e-zines. Make notes. Try to discover what you really believe about birth. You have an opinion, and it is valid. Don't go along with the crowd without really thinking about what the crowd is saying.

Third - Learn from others. If a doula or midwife allows you to observe a prenatal, birth, or a postpartum visit or group, by all means go and observe. But observe. Don't participate actively unless you are invited to. Take notes. Ask questions, afterwards when you feel it is appropriate. Learn from the medical staff when you are attending a hospital birth. You may ask questions, again, if it is appropriate. Do not try to be their equal. You are not. Be humble.

Fourth - Learn different skills. Take a yoga class. Take a knitting class. Start practicing staying up all night and remaining alert. Do a CPR class. Learn about your own body and how it works under stress and without sleep. Test your patience. Sometimes babies take a long, long time to come. If you have learned the art of sitting on your hands, you won't be imagining non-existent dangers that will lead to to wrong decisions.

I have been on this road for ... since I was thirteen. It is long, interesting, sometimes painful. Open your heart, and know that wherever it takes you, there you should be.



Wednesday, March 21, 2012

Montreal Doula Training revised schedule

I have been getting lots of positive response about the course, so I have decided to give you all some more details - here below is an outline ... remembering that the best class plans are never followed to the letter!


 Birth Companions Doula Course
a knowledge-based, hands-off approach
Introduction
This course is the first of three levels of the Birth Companions doula program. It includes 24 hours of class time.
When you have completed this level, you will be eligible to accompany clients from the Montreal Birth Companions volunteer doula program, under my mentorship and with a partner doula. Once you have completed three volunteer births, you will be able to proceed to Level Two, after which you will be able to work as a private practice doula.
The course will integrate theory and practice. Shadowing and mentoring may take place throughout.
The only prerequisite is enthusiasm and availability.
Materials
Bring your own experiences, a notebook, your hands and an open heart. We will utilize The Birth Conspiracyas our main reference. The book will be available on or before the first class. The cost is $24.95.
Requirements
To fulfill requirements for Level One, you need to attend all of the classes, if possible. I may ask you to present or prepare assignments, but these will be done within class time. If you are interested in doing an independent project, please speak to me and I will be available for mentorship.
Cost
We are pricing this course to be accessible for as many women as possible. The cost for Level One is $400.00.

Please see the outline below, for the class program. This course will take place at Studio Vie, 5175C, Sherbrooke West, Montreal, H4A 1T5



Class One April 15, 2012, 10am to 1pm

Introductions

“What is a Doula?”

Class Project

Nutrition assignment

Class Two April 22, 2012, 1pm to 4pm

Bare Bones – anatomy

The birth process, cardinal movements

Class Three April 29, 2012, 1pm to 4pm

Questions and Review

The Childbearing Year

Centering Exercise

Class Four May 6, 2012, 10am to 1pm

Nutrition

Breastfeeding

Role playing

Class Five May 13, 2012, 1pm to 5pm*** note this class is a four hour class

Doula Care A to Z, the process, the doula bag

Doula Techniques – alternative ways for coping with the pain of childbirth

Role playing

Class Six May 20, 2012, 1pm to 5pm *** note this class is a four hour class

Common Interventions – Induction, Epidural, C-Section, Episiotomy, Instruments, Exams

Role playing

No class May 27

Class Seven June 3, 2012, 1pm to 5pm *** note this class is a four hour class

Presentations – Nutrition Guides

Review

Montreal Doula Training revised schedule

I have been getting lots of positive response about the course, so I have decided to give you all some more details - here below is an outline ... remembering that the best class plans are never followed to the letter!


 Birth Companions Doula Course
a knowledge-based, hands-off approach
Introduction
This course is the first of three levels of the Birth Companions doula program. It includes 24 hours of class time.
When you have completed this level, you will be eligible to accompany clients from the Montreal Birth Companions volunteer doula program, under my mentorship and with a partner doula. Once you have completed three volunteer births, you will be able to proceed to Level Two, after which you will be able to work as a private practice doula.
The course will integrate theory and practice. Shadowing and mentoring may take place throughout.
The only prerequisite is enthusiasm and availability.
Materials
Bring your own experiences, a notebook, your hands and an open heart. We will utilize The Birth Conspiracyas our main reference. The book will be available on or before the first class. The cost is $24.95.
Requirements
To fulfill requirements for Level One, you need to attend all of the classes, if possible. I may ask you to present or prepare assignments, but these will be done within class time. If you are interested in doing an independent project, please speak to me and I will be available for mentorship.
Cost
We are pricing this course to be accessible for as many women as possible. The cost for Level One is $400.00.

Please see the outline below, for the class program. This course will take place at Studio Vie, 5175C, Sherbrooke West, Montreal, H4A 1T5



Class One April 15, 2012, 10am to 1pm

Introductions

“What is a Doula?”

Class Project

Nutrition assignment

Class Two April 22, 2012, 1pm to 4pm

Bare Bones – anatomy

The birth process, cardinal movements

Class Three April 29, 2012, 1pm to 4pm

Questions and Review

The Childbearing Year

Centering Exercise

Class Four May 6, 2012, 10am to 1pm

Nutrition

Breastfeeding

Role playing

Class Five May 13, 2012, 1pm to 5pm*** note this class is a four hour class

Doula Care A to Z, the process, the doula bag

Doula Techniques – alternative ways for coping with the pain of childbirth

Role playing

Class Six May 20, 2012, 1pm to 5pm *** note this class is a four hour class

Common Interventions – Induction, Epidural, C-Section, Episiotomy, Instruments, Exams

Role playing

No class May 27

Class Seven June 3, 2012, 1pm to 5pm *** note this class is a four hour class

Presentations – Nutrition Guides

Review

Monday, March 19, 2012

Montreal Doula Training April 15, 2012

I am happy to announce that I have teamed up with Jana from Studio Vie to organize a doula course that will be starting on April 15, 2012.



The program is based on the approach that I have explored in my book, and we will be using the book as our text.

This program is comprised of three levels. Completion of the Level One course will allow the participants to volunteer as doulas for Montreal Birth Companions volunteer doula organization.

Level Two is a continuation and an exploration of themes introduced in Level One. This level will provide doulas with the necessary skills to run a private doula practice.



 Level Three courses are specialized, and they take place in all sorts of interesting places.

We will be going to Cuba together next spring, and this summer we will be exploring storytelling and healing with Lewis Mehl-Madrona, in Italy.

To be accepted into Level Three you need to have attended births as a doula or lay midwife, and you need a strong foundation in self-directed learning.

If you are interested in accompanying me on any or all of these journeys, please let me know. Our courses are filling up fast!

Montreal Doula Training April 15, 2012

I am happy to announce that I have teamed up with Jana from Studio Vie to organize a doula course that will be starting on April 15, 2012.



The program is based on the approach that I have explored in my book, and we will be using the book as our text.

This program is comprised of three levels. Completion of the Level One course will allow the participants to volunteer as doulas for Montreal Birth Companions volunteer doula organization.

Level Two is a continuation and an exploration of themes introduced in Level One. This level will provide doulas with the necessary skills to run a private doula practice.



 Level Three courses are specialized, and they take place in all sorts of interesting places.

We will be going to Cuba together next spring, and this summer we will be exploring storytelling and healing with Lewis Mehl-Madrona, in Italy.

To be accepted into Level Three you need to have attended births as a doula or lay midwife, and you need a strong foundation in self-directed learning.

If you are interested in accompanying me on any or all of these journeys, please let me know. Our courses are filling up fast!

Thursday, March 15, 2012

Ask the Doula - epidurals


I am always getting letters, phone calls, or face-to-face questions about birth, doulas, and such.

Every week, I am going to  try to answer and explore a different question that is presented to me, and, in doing so, perhaps answer some of your questions, and perhaps learn a thing or two myself.

Please send me your questions as comments, and I will select one question each week to answer.



Question Number One

"I was at a birth the other day, and the doctor said to my client that there was a recent study done that proves that an early epidural [that is, administered before 4cm] does not lead to a rise in c-sections. What is your opinion on this?"

I think more doulas and women will start to hear about this study, and I think it reflects a dangerous trend. The doctor who quotes recent research seems very with-it and up-to-date - she's done her homework. But let's have a little look at the research in questions:

The study is a systematic review of six studies that included over 15,000 women. Please click here to retrieve it. As you can see, it is a nice little study, I suppose, with one serious flaw that jumps out on first reading.
It states that the ..."review showed no increased risk of caesarean delivery or instrumental vaginal delivery for women receiving early epidural analgesia at cervical dilatation of 3 [c]m or less in comparison with late epidural analgesia." Early epidural analgesia was defined as that administered at 3 cm or less. Late epidural analgesia was not defined, so it could have been administered anywhere from 4 cm well into the pushing phase. Well, when was it? Was it at 4.5? Or was it after an hour and a half of pushing?

The danger is that, the media being the creature it is, someone could simply snip this conclusion, as I have done, and weave a generalization from it. An unsuspecting woman reads the two-sentence generalization and thinks "ahhh, well, that's a relief, I don't have to wait to take my epidural."

Let's look at the reality:
What do we see, as doulas? As I suggest in my book, IF a baby is not optimally positioned (and, by the way, this is also something that we have studied and studied, and we still can't ever really tell when and if a baby is well-positioned, except by watching her  weave successfully down the birth tunnel), and IF a woman takes an epidural early in her labor, and IF the baby's descent could have been helped by a resistant pelvic floor, then this mother and baby could end up with a surgical delivery.

So, in fact, when I see a nice easy birth and:
a mother who has always taken an epidural (and this is her sixth baby and hey! who am I to argue?)
or a mother who always maintained she would ask for pain meds
or a mother who needs meds for another, outstanding reason (sexual abuse being one - we'll get to that another week)
then I have a better feeling about outcome when she decides to take an epidural (even if I know she doesn't really need it).

But when I see a labor that is not going well, for whatever reason: for example, if a woman is having the particular kind of pain that may indicate a poor position, or a woman is undergoing an induction (more about induction coming up too) that looks like it may fail, then I worry about an early epidural, and its effects on labor.

So what can we do about it? "No, little missy, you cannot take the drugs. I as your doula know best"?
Of course not. Maybe there is not really much we can do in the moment. Maybe prenatal education is absolutely paramount. We need to sit with our clients and talk with them about what they are reading, what they understand, what they believe. We need to work with them and open up to them about our own experiences as doulas, and let them know that although a natural birth is definitely simple, it is not usually easy, and that even during labor they will probably have to make choices. And that her choices WILL affect the way her birth unfolds. If she wants a natural birth in a hospital, she will have to work for it. Part of that work will be not accepting pain medication too early in labor.
I know it goes against the review.
But I have evidence that early epidural administration DOES interfere with the normal progress of labor. That evidence comes from my own observation. No studies, no funding, no university degrees. Just women birthing.


Ask the Doula - epidurals


I am always getting letters, phone calls, or face-to-face questions about birth, doulas, and such.

Every week, I am going to  try to answer and explore a different question that is presented to me, and, in doing so, perhaps answer some of your questions, and perhaps learn a thing or two myself.

Please send me your questions as comments, and I will select one question each week to answer.



Question Number One

"I was at a birth the other day, and the doctor said to my client that there was a recent study done that proves that an early epidural [that is, administered before 4cm] does not lead to a rise in c-sections. What is your opinion on this?"

I think more doulas and women will start to hear about this study, and I think it reflects a dangerous trend. The doctor who quotes recent research seems very with-it and up-to-date - she's done her homework. But let's have a little look at the research in questions:

The study is a systematic review of six studies that included over 15,000 women. Please click here to retrieve it. As you can see, it is a nice little study, I suppose, with one serious flaw that jumps out on first reading.
It states that the ..."review showed no increased risk of caesarean delivery or instrumental vaginal delivery for women receiving early epidural analgesia at cervical dilatation of 3 [c]m or less in comparison with late epidural analgesia." Early epidural analgesia was defined as that administered at 3 cm or less. Late epidural analgesia was not defined, so it could have been administered anywhere from 4 cm well into the pushing phase. Well, when was it? Was it at 4.5? Or was it after an hour and a half of pushing?

The danger is that, the media being the creature it is, someone could simply snip this conclusion, as I have done, and weave a generalization from it. An unsuspecting woman reads the two-sentence generalization and thinks "ahhh, well, that's a relief, I don't have to wait to take my epidural."

Let's look at the reality:
What do we see, as doulas? As I suggest in my book, IF a baby is not optimally positioned (and, by the way, this is also something that we have studied and studied, and we still can't ever really tell when and if a baby is well-positioned, except by watching her  weave successfully down the birth tunnel), and IF a woman takes an epidural early in her labor, and IF the baby's descent could have been helped by a resistant pelvic floor, then this mother and baby could end up with a surgical delivery.

So, in fact, when I see a nice easy birth and:
a mother who has always taken an epidural (and this is her sixth baby and hey! who am I to argue?)
or a mother who always maintained she would ask for pain meds
or a mother who needs meds for another, outstanding reason (sexual abuse being one - we'll get to that another week)
then I have a better feeling about outcome when she decides to take an epidural (even if I know she doesn't really need it).

But when I see a labor that is not going well, for whatever reason: for example, if a woman is having the particular kind of pain that may indicate a poor position, or a woman is undergoing an induction (more about induction coming up too) that looks like it may fail, then I worry about an early epidural, and its effects on labor.

So what can we do about it? "No, little missy, you cannot take the drugs. I as your doula know best"?
Of course not. Maybe there is not really much we can do in the moment. Maybe prenatal education is absolutely paramount. We need to sit with our clients and talk with them about what they are reading, what they understand, what they believe. We need to work with them and open up to them about our own experiences as doulas, and let them know that although a natural birth is definitely simple, it is not usually easy, and that even during labor they will probably have to make choices. And that her choices WILL affect the way her birth unfolds. If she wants a natural birth in a hospital, she will have to work for it. Part of that work will be not accepting pain medication too early in labor.
I know it goes against the review.
But I have evidence that early epidural administration DOES interfere with the normal progress of labor. That evidence comes from my own observation. No studies, no funding, no university degrees. Just women birthing.


Tuesday, March 13, 2012

More Storytelling - in Lunigiana


The second installation of our storytelling adventure will be in Lunigiana, a hidden corner of Italy where ancient peoples worshipped the moon and carved moon statues, or "menhir".

Lunigiana Storytelling will take place from July 28 to August 4, 2012. We are inviting anyone who is interested in stories, birth, healing, or just plain relaxing and having fun under the Tuscan moon.

More Storytelling - in Lunigiana


The second installation of our storytelling adventure will be in Lunigiana, a hidden corner of Italy where ancient peoples worshipped the moon and carved moon statues, or "menhir".

Lunigiana Storytelling will take place from July 28 to August 4, 2012. We are inviting anyone who is interested in stories, birth, healing, or just plain relaxing and having fun under the Tuscan moon.

Sunday, March 11, 2012

Montreal Birth Companions Volunteer Doula Program

It is with a heavy heart that I have had to put our volunteer efforts on hold for a while. We made an application for funding in January and we are awaiting good news, but in the meantime I have decided I can no longer put in the hours of work I was devoting to the organization.

I was surprised by the lack of response by some of the agencies who have been accepting our volunteer services for many years. Maybe I was kind of imagining people to write back and say that we will all pull together and let's do this thing! But no, the announcement passed without much of a ripple.


Just like the earth, everything needs to be left for a time in order to grow healthy and strong. I am having my fallow time now. I was offered a very good opportunity that meant leaving my family for two months, and I decided to leave that go as well. I need to stay at home, write my book, and let myself be nourished by my surroundings (inside my house, let it be known , not the grey urban landscape outside).

And since I made that decision, all sorts of new sprouts have been poking their green heads up from the ground. To continue my metaphor, even the manure I received from some of the crummier experiences I've had over the years has proven useful. Difficult times and difficult people have taught me to bend when necessary, and to stand firm when possible.

So, please send your best wishes our way, that the powers that be in the funding world smile upon us, so that MBC can continue to provide doulas for the neediest women in our society.

A reader just pointed out - if you wish to donate, please visit the MBC website here and you can donate directly. Thanking you in advance!



Montreal Birth Companions Volunteer Doula Program

It is with a heavy heart that I have had to put our volunteer efforts on hold for a while. We made an application for funding in January and we are awaiting good news, but in the meantime I have decided I can no longer put in the hours of work I was devoting to the organization.

I was surprised by the lack of response by some of the agencies who have been accepting our volunteer services for many years. Maybe I was kind of imagining people to write back and say that we will all pull together and let's do this thing! But no, the announcement passed without much of a ripple.


Just like the earth, everything needs to be left for a time in order to grow healthy and strong. I am having my fallow time now. I was offered a very good opportunity that meant leaving my family for two months, and I decided to leave that go as well. I need to stay at home, write my book, and let myself be nourished by my surroundings (inside my house, let it be known , not the grey urban landscape outside).

And since I made that decision, all sorts of new sprouts have been poking their green heads up from the ground. To continue my metaphor, even the manure I received from some of the crummier experiences I've had over the years has proven useful. Difficult times and difficult people have taught me to bend when necessary, and to stand firm when possible.

So, please send your best wishes our way, that the powers that be in the funding world smile upon us, so that MBC can continue to provide doulas for the neediest women in our society.

A reader just pointed out - if you wish to donate, please visit the MBC website here and you can donate directly. Thanking you in advance!