Monday, November 26, 2012

Breathe Together



I have had some feedback about the title of my book. Several reviewers have given it "five stars", but have had doubts about reading it because they thought it would be an angry, polemical work about the horror of hospitals and the saintliness of doulas.

And it isn't.

I have a holistic world view, which means that I believe that there is a place for most types of activities and interventions, within very strict limitations. A 90% epidural rate for first-time mothers is just plain wrong. 90% of all first time mothers do not want an epidural, although certainly some do. And very few first-time mothers actually need pain medication. If and when they do, an epidural is a very effective tool that can provide exactly what the doctor ordered.

Cesarean sections are also very, very useful tools. Surgery can save a baby's or a mother's life. But one quarter of mothers and babies in North America are not in danger of dying during childbirth, adn so we see that this tool as well is overused.

We have come to believe that the overuse of these tools is necessary. Women are afraid of pain, men are afraid of birth, and children are being born into bright lights, machines, masked humans, and a mother nowhere in sight.

Here is a little explanation of my use of the word "conspiracy":

The root of “conspiracy” comes from the Latin conspirare, from con- “together with” and -spirare “breathe.” My hope is that just as women instinctively know how to breathe through their contractions, we will realize that we all know how to breathe together. Whether we are in a hospital, a birthing center, or at home, when all of us: physicians, nurses, midwives, obstetricians, doulas, birthing women, partners and, of course, the baby, are working as one in the birthing room, then the birth experience will provide a better start for the new family. When the birthing woman and her child, and not a machine or a chart, or a schedule or an agenda, are the center of our attention, then no matter what the outcome, the new mother will feel better about her experience and will be better able to care for her child. When we simplify our approach to birth, we will see that birth is simple.

Wednesday, November 21, 2012

War on Women

My heart is with the women of Goma.

Rebel soldiers captured the town of Goma yesterday morning, while the UN and the world stood and watched.The country's army can do little against the rebels, and the UN soldiers do not have a mandate to strike against them, so they are now in control of the airport and much of the town, according to news from the area. They are moving towards Bukavu today.

Why do we care?

Here are some statistics from the website of the Panzi Hospital, which opened in 1999 in Bukavu, 100 km south of Goma. Dr Denis Mukwege founded the hospital, as a response to a growing number of sexual violence victims in the area. He is still the medical director, and the hospital specializes in gynecological surgery for fistula and for vaginal reconstruction following violent rape. They also provide treatment and support for women suffering the effects of these attacks.
  • It is estimated that there are over 200,000 surviving rape victims living in the Democratic Republic of the Congo today.
  • From 2006 to 2007, an estimated 1,100 women were raped EVERY DAY.
  • Today, it is estimated that 36 women and children are raped daily.
On October 25, 2012, four gunmen attacked Mukwege's home, killing his guard. They fired bullets at Mukwege as well, who avoided them by dropping to the floor.[2] After the assassination attempt, Mukwege fled to Brussels and the Panzi unit reported that [his] absence has had an “overwhelming effect” on daily operations at the unit.[3]

Four women are raped every five minutes in the Democratic Republic of Congo, according to a study done in May 2011 by three researchers, including SUNY’s Tia Palermo. “These nationwide estimates of the incidence of rape are 26 times higher than the 15,000 conflict-related cases confirmed by the United Nations for the DRC in 2010,” says Palermo. The level of sexualized violence has received an intense amount of international focus, which has revealed the varied kinds of horrors soldiers have perpetrated against women, even while the country maintains the highest number of U.N. peacekeeping forces in the world. (see here)

As the fighting escalates, families are fleeing from Goma, but they have nowhere to run. There are five DP camps in the surrounding areas and these are full. Families are being separated. Pregnant women are still giving birth, and if a woman survives a gang rape there is a good chance she will have conceived and will give birth. Where are these women to birth and who will attend them?

Montreal Birth Companions doulas have accompanied women from Congo and other countries who have suffered rape and violence at the hands of "freedom fighters" who use rape and sexual coercion as part of their arsenal. These women are strong, and we are honored to accompany them as they give birth. But these are the lucky ones, who have made it to a more peaceful home. Thousands, if not millions, if not billions (One Billion Rising) of women are being raped, beaten and murdered, even as I sit in my comfortable warm living room and write these words.

Please help in any way that you can. Spread the word about this conflict. Donate money to charities that are working on the ground to assist women and children:

Pennies for Panzi is a campaign that is raising money to create a daycare where children of rape survivors can be cared for while their mothers are healing.

Heal Africa provides assistance for women and children in Congo.

Medica Mondiale "supports traumatized women and girls in war and crisis zones."

Safe World for Women is a UK based charity.

This winter season, have a party, do some dancing, and ask your guests to donate money to a worthy cause. If you are a medical professional, consider going to a war-torn country to donate your skills. If you own a company, perhaps you can make a larger donation or donate materials.


Remember how lucky you are.



War on Women

My heart is with the women of Goma.

Rebel soldiers captured the town of Goma yesterday morning, while the UN and the world stood and watched.The country's army can do little against the rebels, and the UN soldiers do not have a mandate to strike against them, so they are now in control of the airport and much of the town, according to news from the area. They are moving towards Bukavu today.

Why do we care?

Here are some statistics from the website of the Panzi Hospital, which opened in 1999 in Bukavu, 100 km south of Goma. Dr Denis Mukwege founded the hospital, as a response to a growing number of sexual violence victims in the area. He is still the medical director, and the hospital specializes in gynecological surgery for fistula and for vaginal reconstruction following violent rape. They also provide treatment and support for women suffering the effects of these attacks.
  • It is estimated that there are over 200,000 surviving rape victims living in the Democratic Republic of the Congo today.
  • From 2006 to 2007, an estimated 1,100 women were raped EVERY DAY.
  • Today, it is estimated that 36 women and children are raped daily.
On October 25, 2012, four gunmen attacked Mukwege's home, killing his guard. They fired bullets at Mukwege as well, who avoided them by dropping to the floor.[2] After the assassination attempt, Mukwege fled to Brussels and the Panzi unit reported that [his] absence has had an “overwhelming effect” on daily operations at the unit.[3]

Four women are raped every five minutes in the Democratic Republic of Congo, according to a study done in May 2011 by three researchers, including SUNY’s Tia Palermo. “These nationwide estimates of the incidence of rape are 26 times higher than the 15,000 conflict-related cases confirmed by the United Nations for the DRC in 2010,” says Palermo. The level of sexualized violence has received an intense amount of international focus, which has revealed the varied kinds of horrors soldiers have perpetrated against women, even while the country maintains the highest number of U.N. peacekeeping forces in the world. (see here)

As the fighting escalates, families are fleeing from Goma, but they have nowhere to run. There are five DP camps in the surrounding areas and these are full. Families are being separated. Pregnant women are still giving birth, and if a woman survives a gang rape there is a good chance she will have conceived and will give birth. Where are these women to birth and who will attend them?

Montreal Birth Companions doulas have accompanied women from Congo and other countries who have suffered rape and violence at the hands of "freedom fighters" who use rape and sexual coercion as part of their arsenal. These women are strong, and we are honored to accompany them as they give birth. But these are the lucky ones, who have made it to a more peaceful home. Thousands, if not millions, if not billions (One Billion Rising) of women are being raped, beaten and murdered, even as I sit in my comfortable warm living room and write these words.

Please help in any way that you can. Spread the word about this conflict. Donate money to charities that are working on the ground to assist women and children:

Pennies for Panzi is a campaign that is raising money to create a daycare where children of rape survivors can be cared for while their mothers are healing.

Heal Africa provides assistance for women and children in Congo.

Medica Mondiale "supports traumatized women and girls in war and crisis zones."

Safe World for Women is a UK based charity.

This winter season, have a party, do some dancing, and ask your guests to donate money to a worthy cause. If you are a medical professional, consider going to a war-torn country to donate your skills. If you own a company, perhaps you can make a larger donation or donate materials.


Remember how lucky you are.



Friday, November 16, 2012

Bad Science, Bad Medicine, Bad Luck

I am actually enraged this morning, and I have been since last night. It's just no good any more to pretend to be kind old Mrs Tiggy Winkle, and watch women being abused over, and over, and over again in our worn out medical system.

A few weeks ago, I witnessed a natural, speedy delivery. The woman was effectively pushing in a supported squat. Enter the doctor, who cannot catch a baby from underneath and pressures the woman to lie down. A small shoulder dystocia develops. Doc pulls on the head like there's no tomorrow and breaks the baby's collar bone.

That same week, a foreign lady let me know that an OB at the same hospital has been charging her $100 cash for each prenatal. Here in Canada, that is ILLEGAL.

She labors beautifully, and is almost delivering, when the doc suggests an episiotomy. This was the one thing, the ONE THING, that my client was terrified of. Luckily, she pushed the baby out with the next contraction.

Move forward, random thoughts: A client was in the hospital for twelve hours. During that time, she saw about ten medical professionals. What do you think the most-asked question was: How are you feeling? Nope. "Do you have any questions?" Nope. "Is there anything you need?" Nope. It was "Have you had any miscarriages or abortions. Well, it's not rocket science to figure out that that may not be the best question to ask a laboring woman for two reason: One, she may not want everyone in the room, including her partner, to know. And, Two, these are painful memories that she may not want to think about.

But yesterday takes the cake.

Lady is being induced, medically necessary induction. Gets put on the pit. She's 2 cm. Then in five hours, she's seven cm! And then two hours later, still seven cm! They are talking AROM, so my client wants me to come to the hospital. Fine.

She's laboring so well, not feeling her contractions at all. I have seen this, infrequently, but I've seen it. The doc wants to AROM, but since she's seven cm, she decides to wait it out.

Finally, in the evening, another physician comes in and checks her. She's two.

Discussion. Justification "your vagina is a funny shape". "She's a good resident so we don't check her results". Even when those results are difficult to believe? Really? Then, a peace offering. You stay here and sleep, we'll start the induction again tomorrow.

Bad Science: why the induction? check your results, and especially check a student's results. Have a look at how you're playing with the insulin and oxytocin.
Bad Bedside manner:  Is it necessary that a woman not eat for days? Is it possible to at least make eye contact with the doula, so that she doesn't feel like shit when she leaves the hospital? Are you going to apologize for your mistakes?
Bad Luck:  How often do iatrogenic errors lead to major consequences?

Where is this all leading? It's not leading to a rise in home births, at least not in Quebec. I was speaking to a midwife yesterday from another country who has witnessed over a thousand births, and she is not certified here and therefore is not practicing. There is no bridging program that effectively allows for CPMs to become certified here in Canada, so we are left with a lack of midwives and an overburdened hospital system where errors frequently can and do happen.

Comments? What are YOU doing to change obstetrical care in your community?


Wednesday, November 7, 2012

She's Too Radical

When I look in the mirror these days I see a caricature of Mrs. Tiggywinkle. My body changed over the past ten years. Even though I still run four kilometers three or four times a week, and I feel quite fit, more or less, my shoulders have changed shape, my waist has thickened, my grey hair is down to my bum but no one ever sees it because I wrap it in a scarf, and...well, I feel different.

Mrs Tiggywinkle, however, is a laundress. She is an independent female: round in shape, granted, and she is a little perhaps neurotic, but she takes care of herself, of her small house, does other people's laundry AND makes friend with a little girl in distress.

And she's got fearsome prickles.

Is she radical?

I met a prospective client the other day. Lovely woman, nice partner. She had heard about me through one of the long grapevines that eventually lead my way. I'm not big on advertising, publicity, I never wanted to be on Oprah, and I don't have a fan club. So people usually hear about me from other women in a round about way.

But this lady had gone through a list of doulas in Montreal, found them wanting, and came to me. And she expressed one doubt, which was that I may be "too radical".

Radical has its root from root: from Late Latin "radicalis" ("of or pertaining to the root, having roots, radical"), and from Latin radix (root).
And the definition is: Favouring fundamental change, or change at the root cause of a matter. 

What is the root cause of the birth matter? I believe the root cause of abusive maternity care shares its root with woman abuse in every aspect of our lives. So, in "favouring fundamental change", I am going to go to the root of the matter. I am not going to spout empty slogans and run other women's lives according to my agenda.

The root of birth abuse is a culturally useful and familiar disrespect for women in general, and for birthing women in particular. If I am going to practice as a radical doula, then my priority will be respecting the birthing woman. To this end, I will not persuade her to make choices that conform to me agenda. Ever.




The woman I met may have been imagining a furie, a Roman goddess of vengeance, guarding the door of the birth room with an eye to exacting payment for past wrongs.

The furie would insist that the woman follow her rules: no interventions, under any circumstances; upright positions throughout; lots of vocalizing required; partner hands-on at all times.







But radical doulas are not furies. We respect the desires of the women we accompany. We melt our egos and support the woman's choices. Our agendas stay at home. We are just and fair, possibly to a fault. It is a fine line between supporting a woman during childbirth and feeling like you are witnessing, indeed apologizing for, an abusive act that should be named. But in the naming, the birth process is damaged. Our role is to bear witness, to take notes, and to love the one you're with.


Tuesday, November 6, 2012

Thoughts on Solitude


We are all alone. We are born alone, and we die alone. This little albino lizard blends in so well with her surroundings, we can hardly even see her against the whiteness of the sand. But she is alone, just like you and me.

The most wonderful and valuable service a doula can offer another woman during her childbearing year is companionship.

The newborn is the most beautiful, alluring little creature. But he needs attention, breastmilk, love, concern...he is alone too, but he knows what he wants. He wants to be held, nuzzled, nursed, touched, loved.


Please be mindful when you are accompanying a woman on the journey of giving birth to a new life. Be mindful if you are accompanying her on a more difficult journey, when she is not having a perfect experience. Please be mindful when you are feeling alone, and remember that the air you breathe in has just been breathed out by another person. Please be mindful when you speak to a woman in labor. Be mindful when you stand next to an old woman on the bus. Be aware that your presence can mean a universe to a woman who is feeling alone.



Thoughts on Solitude


We are all alone. We are born alone, and we die alone. This little albino lizard blends in so well with her surroundings, we can hardly even see her against the whiteness of the sand. But she is alone, just like you and me.

The most wonderful and valuable service a doula can offer another woman during her childbearing year is companionship.

The newborn is the most beautiful, alluring little creature. But he needs attention, breastmilk, love, concern...he is alone too, but he knows what he wants. He wants to be held, nuzzled, nursed, touched, loved.


Please be mindful when you are accompanying a woman on the journey of giving birth to a new life. Be mindful if you are accompanying her on a more difficult journey, when she is not having a perfect experience. Please be mindful when you are feeling alone, and remember that the air you breathe in has just been breathed out by another person. Please be mindful when you speak to a woman in labor. Be mindful when you stand next to an old woman on the bus. Be aware that your presence can mean a universe to a woman who is feeling alone.