Debra Pascali-Bonaro in Montreal

Winter Birth Intensive

January 2014 

with Debra Pascali-Bonaro

Have a look at details here.

This training brings together Debra Pascali-Bonaro, one of the most experienced doula trainers in the world, famous for her dedication to joy in birth, and Rivka Cymbalist, author of The Birth Conspiracy.

WHO?

Those who take the workshop do not need a professional background, but should have the following: fascination with pregnancy, childbirth, and newborn babies; a desire to work with women or couples during this most meaningful and demanding time in their lives; emotional maturity; stamina; and reliability.

WHERE?

Montreal, Canada. 

WHEN?

The course will take place during four days (this includes the Introduction to Childbirth). 

Dates: January 25 to January 28, 2014.

Introduction to Childbirth will start at 8:45am on the morning of the 25^th, so it will be advisable to reach Montreal on the 24^th.

WHAT?

The DONA International Birth Doula Training covers all the basics of doula care before, during and immediately after childbirth.  This workshop has been approved by DONA International and counts for two steps toward certification. Please contact DONA for information about membership and requirements for certification as a birth doula.

WHAT IS THE COST?

Registration including accommodation US$875.00.

Montreal residents $700.00.

Women who want to be Doulas

Mamas, please let your babies grow up to be doulas.....

We started Level Two again two weeks ago - time is already flying - there's so much to teach and learn at every level! Two of the Level Two students are accompanying a birthing woman today, so they won't make it to class tonight.

I am so pleased to have met my new students. The group of women this year is very diverse, in age, background, experience... and yet we are all drawn by the desire to accompany women through the journey of childbirth.

I believe that all midwifery students should have to accompany at least fifty women through the birthing process (but even better one hundred or more), and that most of these should be in the hospital environment. Why is this?

Doulas learn to sit on their hands and let the birthing process unfold.
Doulas learn to keep their mouths zipped while they maintain a safe space for the woman.
Doulas learn respect.
They learn that the birthing process is unexpected. That it proceeds better when it is undisturbed, but that nature is pretty flexible with its rules.
They learn what NOT to do.
They learn humility, kindness, diplomacy, and they learn when to speak out and when not to.

We may all have our different ways of practice, just like we were all born slightly differently, just like we will birth differently. But we all practice companionship, which is the most important aspect of our care.

Learn to be a doula here.

Serendipity

“Our work in this area began when one of our medical students failed to follow the instructions for another study. She was only supposed to obtain the approval of primiparous, healthy mothers in early labor. They were then to go through the usual hospital routine, and the study was to begin at their babies' birth. She obtained the approval for the study early in labor, but stayed with each of 10 study mothers giving emotional and physical support until they delivered (family support was not permitted in this hospital). When we first heard about this error, we were upset, because all of these mothers and babies had to be removed from the ongoing study. However, when we looked more closely at the charts of these mothers, we found that they had unusually short labors. Surprisingly, three of these mothers delivered in the bed. This was unheard of in this hospital, because the focus of the delivery unit was sterility, and the rules of the hospital were that every mother was to deliver in a "sterile" delivery room. It is this serendipitous observation of altered labor with emotional support that has been the focus of our research for the last 10 years.”

Klaus, Marshall H. Touching during and after childbirth. In Field, TM (Ed), Touch in early development (pp19-33). Mahwah, NJ, Lawrence Erlbaum. 

Birth and Beyond 2013

Why do I love this conference and the women who work so hard to make it a success every year?

Because it's fun! We get to play!

And for so many other reasons. We get to stretch our boundaries: just like the perineum stretches so nicely when a baby's head moves past it, so we have to stretch our ideas and preconceptions when we meet the motley crew of professionals, activists, birthing women, and others, who make this conference the best of the year.

We also have to think. The speakers and movers and shakers at this conference are really good at pushing us to look outside the box: Jodi Hall has a superb intellect, and her grasp of complicated ideas is truly stunning. She manages to light up those ideas for us lesser mortals, and challenge us to use our brain power while we take pleasure in the exercises she prepares for us.  James McKenna and Diane Weissinger speak science: let's start thinking about "what would mammals do?" Gloria Lemay does not suffer complacency lightly - she will always challenge you to a duel. Robbie Davis-Floyd can always be relied upon to: 1. present complicated papers on birth from an anthropologists viewpoint; 2. tell hilarious stories about the rock stars in the birth world and 3. be the amazing woman who starts everyone singing.

We have to compromise: the intactivists breathed the same air as those participants who choose circumcision. The registered midwives discussed their work with the not-so-registered.

And, best of all, the participants at Birth and Beyond are truly lovely: from different walks of life and different places, with stories and paths that sometimes converge and sometimes not. And, somehow, we  all manage to get along just fine. Well, most of us. And that's because, at Birth and Beyond, everyone doesn't necessarily share the exact same viewpoint.

We get to talk about interesting concepts like LOVE, like VOLUNTEERING, like CO-SLEEPING,  like ENTITLEMENT, like FEAR IN BIRTH, like WHAT TO DO, like LOSS?

We learn and go on learning, we open our minds and our hearts, we meet people we would not expect to meet.

This is above all a conference that is dynamic and alive. It is not political, it doesn't seem to subscribe to a certain political line, and that is the beauty of it. Melanie and Shawn have managed to get all of the ingredients together for an event that is going to keep on moving, year after year …. don't you want to be part of it?

Get involved! Birth and Beyond 2014

Salut Pauline! Loving my adopted province!

Last week, Montreal Birth Companions assisted a woman to give birth. Her hospital stay was very long and she finally left with a bill of over $20,000.

She was one of the many women MBC assists who do not have medical coverage here, who give birth in our hospitals at great cost. Some of these women are domestics who have been fired by their employers. Some are women who are here on the wrong kind of visa to be pregnant (hey, Harper! I thought you were against abortion!). Some are here illegally because they are afraid of harm or death in their home countries, but they do not qualify as refugees.

This woman was the kind of Muslim that Madame Marois wants: modern, educated, no head scarf. Her reasons for fleeing her country were valid and I will not explain more. She was taken in by an elderly Anglophone woman until the baby was born.

She needed a place to live, so we finally found her somewhere to stay until she gets on her feet. She is employable and will be fine.

But - her birth and postpartum search for housing was such a typical Quebecois event! The new mother was a Muslim. She wears western clothing and no head scarf. She was taken in by a Quebecois Anglophone, who is very old and appeared to wear a dressing gown. Her doula was a Quebecois Francophone who is a political activist. She rides her bicycle most days and has a couple of piercings. Her second doula was also Quebecois, who is a member of the Canadian army. The mentor doula is a Jewish woman whose politics veer from left to anarchist. She wears a headscarf. The shelter where she finally found refuge is run by a Muslim woman from Malaysia who regularly provides food for one hundred people at a nearby church. She wears a hijab and a floor length gown. The journalist who was interested in the story is a member of a visible minority. We all spoke different languages: French, English, Arabic, Bahasa Malaysia, Italian... and probably more...

We are united by love and goodwill, and by the urge to change this world for the better. Some of us wear head coverings, some of us don't. Some of us believe in God, some might not. But this Quebec is the place I like living - where we all get by and get along, sometimes speaking in broken this or that, trying to get along because we believe that getting along is a good thing. It's the place I brought my kids so they would get an education, and they are getting an education, and they speak several languages, including the language of tolerance.

So, Pauline, even though you have a bunch of liberal feminists on your side, and some aging would-be politicians, I would like you to come and visit our Quebec: the Quebec where we help people who don't necessarily believe in the same things we believe in, or speak the same language as we do, or wear the same clothes as we do. And I would like to remind you that while you are doing your politics, babies are being born and friends are being made and bonds are being formed across all of your artificially constructed boundaries.

A Student Doula's Story

Here is a post from another blog by one of my Level One students … giving you an inside view of what it's like to be a student doula, volunteering for Montreal Birth Companions.

DEAR BIRTHING, WITH LOVE (thank you http://highalert.net/news/dear-birthing-love)

I am ready to stop typing and run to my phone if it rings. It may be a call from the doula I’m shadowing. There is a woman who will give birth any day now, and when this woman (the client/patient/mother-to-be*) needs birth support, I will go (with the doula) to be with her at her home, or maybe straight to the hospital.

Besides my own, the only birth I’ve attended was that of my little sister, and I was a 5 year-old, and it was late at night. This makes me a minority among the 16 women in my Level 1 doula training course with the Montreal Birth Companions, because I am not a mother.

You don’t have to be a mother to be a doula. You just have to be there. In the last few months of this course, I’ve learned a lot about birth: anatomy, pain-alleviation techniques, how it progresses and why it might stall, affirmations, visualizations, and what to pack in my birth bag. This is all important, but the most important role that a doula plays is of being present, and being loving.

Montreal Birth Companions, then, love hundreds of women a year. They provide free doula services to women in need. They are most often refugees, immigrants, women without family in Canada, and women who don’t have health care. They are women who just need a little bit of love at a vulnerable time.

With each ‘birth story’ that I hear from a fellow Montreal Birth Companion, I am filled with admiration at the important role they play at these births. They are advocates and peace-makers, negotiators and videographers, a friend and calm presence. I am also filled with a certain amount of frustration or anger at a medical system that seems, often, to desecrate such a powerful moment—perhaps the most powerful of all. Birth also has two sides: pleasure and pain. But, I’ve learned that pain in birth serves a function—it releases oxytocin which makes the contractions stronger and more effective, and stress hormones increase blood flow, which brings much-needed oxygen to the baby. I’m not confident, though, that the ‘pain’ of the medical system serves a purpose.

I’ll remain on high alert for calls to explore birth and love in the hospital. In the meantime, I encourage you to VOTE daily for Montreal Birth Companion’s campaign to provide more free pre-natal classes to women. You can like the MBC’s facebook page and select 'get notifications' for daily reminders.

*Serving as a doula is new to me and I am not sure what language I feel comfortable with, yet. As my teacher writes in her book The Birth Conspiracy, 'client' seems impersonal and business-like, while 'patient' may disempower the woman giving birth.

Level Two Doula Course

I am very pleased and a little taken aback that my doula course has been so well received. So, happily, I will be offering Level Two starting on November 25, 2013. 

Classes will start on November 25, 2013, and will go through to February 17, 2014, with a break in December. Classes will run every Monday night from 6:30 to 9:30, at 6767 Cote des Neiges, in Montreal.

I have tweaked this course a little, and added two extra classes, as there is always too much to learn! So it will be a total of thirty hours of class time. Shadowing and attending births will of course be part of the learning experience.

Please let me know as soon as possible if you are interested in Level Two. As always, the cost is $400, payable in instalments if need be.

We will be adding several other courses this year: Level Three will definitely be offered, also an in-depth Fun with Herbs Workshop and a doula retreat.

Here's a taste of Fun with Herbs:

Herb Day 2013

Healing Balm

Herbs and Poetry, Birth and Death

In the midst of our world turning as it does - MBC doesn't have enough doulas for our needy clients; refugees are streaming from war-torn countries to other, less war-torn countries, Kofi Awoonor killed in that horrific bombing in Nairobi - Kofi Awoonor! - may he rest in peace...

"Across a New Dawn"

Sometimes, we read the

lines in the green leaf

run our fingers over the

smooth of the precious wood

from our ancient trees;

Sometimes, even the sunset

puzzles, as we look

for the lines that propel the clouds,

the colour scheme

with the multiple designs

that the first artist put together

There is dancing in the streets again

the laughter of children rings

through the house

On the seaside, the ruins recent

from the latest storms

remind of ancestral wealth

pillaged purloined pawned

by an unthinking grandfather

who lived the life of a lord

and drove coming generations to

despair and ruin

But who says our time is up

that the box maker and the digger

are in conference

or that the preachers have aired their robes

and the choir and the drummers

are in rehearsal?

No; where the worm eats

a grain grows.

the consultant deities

have measured the time

with long winded

arguments of eternity

And death, when he comes

to the door with his own

inimitable calling card

shall find a homestead

resurrected with laughter and dance

and the festival of the meat

of the young lamb and the red porridge

of the new corn

We are the celebrants

whose fields were

overrun by rogues

and other bad men who

interrupted our dance

with obscene songs and bad gestures

Someone said an ailing fish

swam up our lagoon

seeking a place to lay its load

in consonance with the Original Plan

Master, if you can be the oarsman

for our boat

please do it, do it.

I asked you before

once upon a shore

at home, where the

seafront has narrowed

to the brief space of childhood

We welcome the travelers

come home on the new boat

fresh from the upright tree

From "Promises of Hope: New and Selected Poems", selected by Kofi Anyidoho, University of Nebraska Press and the African Poetry Book Fund, 2014

I bring to you a recipe for St John's Wort oil in the hopes that you will be able to use it to heal each other and yourselves.

This can be used for muscle strain, sunburn, muscle cramps, bruises, labor pains. Do not apply it to open skin, and remember that it may increase photosensitivity so don't use it as a suntan oil.

Have fun with herbs, read poetry, make love not war!

Call for Volunteers

Montreal Birth Companions provides free doula services, prenatal and postpartum support, and resources for refugee, non-status, and other marginalized women in Montreal.

We are in need of birth companions ... please contact me if you are willing and able to devote some time to our worthy cause.
If you are a doula and you can donate one birth every six months to MBC, we would be happy to have you on board!
We are looking especially for birth companions who are fluent in different languages. We would love to have more doulas from our diverse Montreal communities. We welcome everyone who has an open heart and is willing to donate their time and energy.

The women we serve appreciate the companionship, support and kindness that her doula provides. Women come from many backgrounds, walks of life, stories and histories. But the birthing year is the same: we want to give birth to a healthy baby, and we would like to have that experience to be filled with joy. This is not always possible if it is a sad time in the mother's life, but the presence of a birth companion can help spread the love.

We have clients from all around the world. Right now we are serving women from: Algeria, Haiti, St. Vincent, Germany, India, Nigeria, Philippines, Mali, Senegal, Guinee, and Quebec. Next month, we could receive requests from China, Cameroon, Mexico, the US, or Russia ... we never know where our clients will come from or when they will find us. We have had calls from women in their first trimester, and from women in labor!

Many midwifery students try to gain experience as interns in other countries. Volunteering for MBC is a way that doulas and aspiring midwives can gain experience working with women whose cultural attitudes and lives are very different from their own. It is a way that these doulas and aspiring midwives can really understand that the birth experience is universal, and that accompanying a woman in labor transcends language and reaches across boundaries.

Please consider volunteering for MBC.

Vote for Montreal Birth Companions!

As you all know by now, if you are regular readers of my blog (speaking of which, please follow me!), Montreal Birth Companions is a volunteer-led organization that provides free doula services and resources to marginalized women in and around Montreal.

The women we serve are at risk because of youth, poverty, isolation, or refugee/immigration status, or because of all of these factors. MBC doulas work to provide non-judgmental and unconditional support to all of our pregnant women and new parents.

Montreal Birth Companions have been providing support for birthing families since 2003, with no funding. Our volunteers work from the heart; our coordinators and administrators spend unpaid hours devoted to this worthy cause. Please help us help women by voting for Birth Companions on the AVIVA FUND. You can vote every day, from individual email addresses!

HOW TO VOTE:

1) Create an account on the Aviva Community

Fund website: https://www.avivacommunityfund.org/users/registration/register

2) Go to your email inbox and click on the link that Aviva sent you.

3) Go to the Montreal Birth Companions Aviva idea:

http://www.avivacommunityfund.org/ideas/acf16929 and VOTE for Montreal Birth Companions!

4) Do this every day starting September 30th. Help us win funds to provide prenatal classes for the women we serve.

Ethical Birth Work

I was an intern at a maternity clinic a quite few years ago and I had some interesting experiences there. One young woman came to get some experience as a midwife, so that she could decide if she wanted to make the jump from being a doula, or if she was going to move to physiotherapy instead. On her first afternoon, the clinic was very busy, and she was led to a room where found she was the only midwife (not even!). She became depressed over the six weeks I knew her, and she left miserable and feeling violated.

I was very interested in what was happening. I have had a dream all my life of returning to Uganda where I spent my first three years, and working alongside the TBAs there to provide maternity care. I am fascinated by how organizations work, and I love to see how particularly women's organizations unfold, and how we keep (or not) bullying and aggression out of the ring.
I have travelled to many places. I have so many memories of different places and different people. I remember being led up a rocky path in the mountains of Morocco when I was seventeen, by two young women. We found a stream and drank, and spoke with our eyes and hands. We laughed. I gave them my earrings.

In Africa, a few years later, a young woman ran to me carrying her baby. I knew he was dying. She thought I may be able to help because of the color of my skin. I couldn't.

I travelled on my own, avoiding danger or fleeing when necessary. I used my polite manner and my eyes and hands to communicate friendliness, and I was never hurt too badly.

Years and many experiences and chapters later, I decided to finally get my certification as a professional midwife. My visit to the maternity clinic was one step along the road. One night, at around three in the morning, I was in a birthing room at the clinic. I was not supposed to be "primary", but the woman who was on for that night was exhausted from a hard birth, so the head midwife told me to assist. The birth was difficult, and the head midwife told me to enter the woman and manipulate the baby's head so that he could be born. I had my hands in the woman, when the boss midwife entered the room, tapped me on the shoulder, indicated that I should leave, and she had another intern take my place.

She was having a power struggle with the head midwife. Her ego was too big to fit through her pelvis, that's for sure!

But what about the woman giving birth? How did she feel when my hands left her, there was a tense emotional moment, and a new person's hands went in? Did she feel violated?

I have no interest in manipulating baby's heads, actually, I believe they get born better if they're left alone. But I also believe that the epicentre of the birthing room HAS to be the mother who is birthing her baby. A birthing room is no place for politics to unfold. Aggression and rudeness do not belong there. Love belongs. Peace belongs. Honor and respect belong.

There is a wider discussion going on right now in the midwifery world, about how this plays out in the bigger world picture of midwifery today. Student midwives from North America are traveling to poorer countries to earn their qualifying numbers so that they can become certified as professional midwives. Is this right or wrong? How can we accept a student midwife's desire to do good, and screen out the "number whores" (these are the students who travel to other countries simply to get their qualifying numbers, giving little thought to the women they are working with or for).

There are many small clinics all over the world where courageous, passionate, dedicated and professional midwives work every hour of every day to improve maternity care for the women they serve. Let's not throw the baby out with the bath water! For many of these clinics, paying volunteers from rich countries are one of the few ways they manage to stay solvent. But we do not need students to travel to other places so that they can experience a woman dying...birth is not reality television.

I believe the answer is within. If you go into every birthing room with love in your heart, respecting the other people in that room and honoring the birthing mother, then you will find yourself unable to use a birthing mother as a number, a statistic, or an educational tool. Women who give birth are worthy of the greatest respect. Let our politics play out elsewhere, away from the new baby, away from the birthing mother, away from the birth room.

Refugee Babies

You decide to move to Canada, because in your country, you are hearing stories from neighbouring countries about chemical attacks, schools closing, medical care non-existent. Your friend's cousin's aunt married a man from a country where, ten years after she moved there, she is leaving everything and running to live as a refugee in a country she only visited once before, on holiday.

Your sister can legally sponsor you, and you move to Canada. You and your husband can find work legally, and the children can stay with your sister. You live together in a small apartment, smaller than the one at home but... the future looks good

Even the birth control pill doesn't work 100% of the time. The best way to not get pregnant is to not have heterosexual sex. But, you're in love, you're on an adventure...the sperm meets the egg, and you are pregnant.

You know you don't have medical coverage, but you don't care. You're young and healthy.

Then you find a doctor, who tells you that the birth will cost you at least $5000. If you have a cesarian section, or your baby needs care, it could go up to $10,000 or even $15,000.


I know some people think that the lady in question should "go home". But sometimes that just isn't possible. MBC has assisted women who have been living in Montreal as domestics, for years, and when they find themselves pregnant, they find themselves out of work and out of a home, and without medical care. Other women do not qualify as refugees, but they know if they go home they will be killed, or raped, or they will have to work as prostitutes. It's always easy for you to say, if you're a hard-working person with the good luck to be born into a place where hard work pays, and food is on the table, that "these people" need to act differently. But everyone makes love, and babies are conceived all the time. And sometimes a baby is conceived out of love - and when a woman keeps a baby in her body who is the result of violence and violation, doesn't that woman at least deserve our care?

Babies are being born every minute, and I believe we are ALL responsible for them. If we can assist a mother to have a birth experience that is full of love, and she can leave the birthing room knowing that she is capable of providing unconditional love for her baby, and knowing that she will be supported in this task, then we are paving the way for a better world for all of us: our children, and everyone's children.

Montreal Birth Companions doulas accompany women like these to the hospital to labor and give birth. Many of our clients are single, or apart from their families. Some have other children "back at home". Some have love babies, others have babies conceived during violence. Some have medical coverage, many do not.

If you would like more information about our program, please visit Montreal Birth Companions.

A Response to Dr Gawande

Dr. Atul Gawande's article in the New Yorker, "Slow Ideas"  has been spreading like wildfire on Facebook and elsewhere in the birth world.These are important ideas about change in maternity care and care for women and children overall. Everyone likes his ideas about woman-to-woman communicating and grassroots movements and bringing change one woman and baby at a time.

I read the article and I had serious problems with the language, first of all, but also with the overall set of assumptions about how "we" care for women and their unborn or newborn babies.

Here are my thoughts:

Why did Ibu Robin Lim win the CNN Hero of the Year award in 2011?

Ibu Robin has been working for nearly twenty years in Indonesia, offering free maternity care to women who would otherwise be giving birth at home, in unsanitary conditions, and possibly without attendance. She is on excellent terms with the hospitals in her area, and has single-handedly changed the face of childbirth in Indonesia.

While the goals of the Better-Birth Project are laudable, the inconsistencies in Dr. Gawande’s approach to better childbirth practices need to be addressed. First, there are several simple facts that are misrepresented in his article (“Slow Ideas”, July 29, 2013). For example, it is simply not true that “many babies cannot take their first breath without assistance”.  About 10% of newborns need assistance with their first breath, and around 1 to 2 percent need resuscitation ("Most newly born babies are vigorous. Only about 10% require some kind of assistance and only 1% need major resuscitative measures (intubation, chest compressions, and/or medications) to survive". (Textbook of Neonatal Resuscitation, 6^thedition, American Academy of Pediatrics, p. 39).

Secondly, serious obstetric emergencies, such as shoulder dystocia (rare and potentially fatal, and often unpredictable), are lumped together with common phenomena such as a cord around the neck (around 30% of neonates are born through a nuchal cord). This speaks of an approach to childbirth that is steeped in the western belief that childbirth is an emergency that must be prevented.

It is this approach that will not bode well for underdeveloped countries and their attempts to save mothers’ and babies’ lives. Dr. Gawande describes an effective program: women on the ground, moving from village to village, teaching simple practices that will help to save thousands, if not millions, of lives. But why stop there? Perhaps we can reduce the “twenty-nine basic recommended practices” to just ten. Actually, these 29 practices are only part of an initiative sponsored by the World Health Organization, that is studying the efficacy of a checklist in reducing infant/maternal mortality. It is not yet recommended practice, or even yet proven to be effective . "The formal trial began in 2012 to measure the impact of the Checklist on severe maternal and newborn harm ... Data collection is expected to begin in 2013 and will continue for a period of three years. It is estimated that the study will be completed by 2016."

At the end of his article, Dr Gawande suggests that what made a difference, in one particular woman's life (she was a nurse), was that the expert who was making suggestions about how she could change her approach was friendly. "She was nice." A vision of maternity care that works is a vision that certainly reduces maternal/newborn mortality and morbidity. But it must also be a vision that includes respect for women and their babies, their families, and their culture and history.

I believe that Dr. Gawande’s vision must be taken one step further, and that with just a little more courage and the kind of round-the-clock dedication that I have seen at Yayasan Bumi Sehat in Indonesia, we will start to see dramatic changes in maternity care around the world. We have to reduce the fear of childbirth, and the institutionalized fear of "untrained birth attendants". We can, instead, work with what we have - integrate ten or so better practices into the TBAs practice. Create better and more efficient, low-tech tools for TBAs to carry. Integrate the technology we DO have - mobile phones are used extensively all over the African continent, for example, and find creative ways to save lives. Reduce high-tech interventions. They don't work unless the infrastructure can support them.

Turn your held beliefs on their head: It is certainly a triumph of modern medicine that we can be vaccinated against tetanus. I always keep my vaccine up to date: the old lady who lived at our house in Italy years ago died from tetanus after being pricked by a rose! It is a horrible way to die, and once a wound has become infected, it is incurable.
Newborn tetanus kills babies, every day, in many countries in the world. The tetanus bacteria enters through the umbilical cord, either from unsterile equipment or unhygienic after care.

What if we didn't cut the cord? No wound! No tetanus!!!

Let's work together to find answers to this daily tragedy: mothers and babies deserve better.