Sunday, September 29, 2013

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


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.

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


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.

Wednesday, September 25, 2013

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.




Monday, September 16, 2013

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.












Tuesday, September 3, 2013

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, 6thedition, 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.

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. 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, 6thedition, 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."
(http://www.who.int/patientsafety/implementation/checklists/background_document.pdf p. 6 Retrieved Sept 3, 2012).

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.
(see http://www.whiteribbonalliance.org/WRA/assets/File/Final_RMC_Charter.pdf).

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.