Monday, February 27, 2017

Pyrrhic Victory

Last night I attended my last birth for a long time, unless one of my special people asks me over to attend her birth - and you know who you are my loves!

I was working in my capacity as a doula - to my utmost capacity - I calmly stood by while the staff dickered around about whether the meconium was thick or light. I kept a grin off my face when the young medical student estimated that the birthing woman, who was clearly very close to pushing, was "progressing nicely" at six centimeters, and I kept calm when five minutes later she started pushing in earnest. I kept the worried look off my face when it appeared that there might be an abruption, and I supported the nurse while she tried to do her job.

I supported the woman, I supported her husband and her mother. I kept my face devoid of grumpy callouts when staff acted unprofessionally. I pandered to the two young doctors, and praised the Big Doctor Man when my client asked me, in front of him, if he was "good". In short, I brown-nosed the way doulas learn to do in our maternity care system.

The doula's job is to support the birthing family, to bring love into the birthing room, to create a safe space.

So imagine my conundrum when the nurse asked my client if she agreed to erythromycin ointment for the baby's eyes. My client didn't know what to say, so she turned to me for support.
I had to think quickly. I could site the most recent statement by the Canadian Pediatric Society, (, which suggests eliminating the practice of universal antibiotic prophylaxis for neonatal eye infections (most dangerously caused by gonorrhea or chlamydia), or I could avoid looking like a know-it-all and making the doctor feel like a fool, and simply use a tactic that I had seen him use a few years ago (something about his wife, can't remember the details).

What to do? Think fast! It's three am and your client wants an answer. She then asked me "Did you give it to your kids?".  An honest answer - yes, I did.

Pipes up the honourable physician, to the effect that my client shouldn't be so stupid as to agree to an intervention just because "someone" had it done to her kids, but rather should have it done because "doctors advise it". Um. We were all rendered rather voiceless. Then, again, Dr. A. pipes up: "Will you vaccinate your child?" My client answers that, yes, of course she will.

Intimation being that I wouldn't vaccinate my kids, and would advise my clients not to. So rude! So judgemental! So many unfounded assumptions! So disrespectful of the birth room!

It makes me sad that people that are supposed to be practicing good medicine, and good science, are practicing mediocre medicine, not reading the literature, and showing off their skills at making an older woman feel like shit at three in the morning. Bravo! Physician, heal thyself!


Saturday, February 4, 2017

Brutal Births for Asylum Seekers

Yes, as if it wasn't bad enough leaving Mosul, Aleppo, Damascus or any other not so well-known  place where war killed thousands and maimed more (have a peek here to get a sense of the immensity of the crisis), yes if that wasn't bad enough, if it wasn't bad enough to flee - to have to flee, leaving a normal life - the kind of life you and I lead - with phones and laptops and going out to eat and new clothes and a job and a house and cool stuff and a country you love or you love to complain about -if it wasn't bad enough to run through a country you didn't recognize, and maybe get caught by the police, or maybe your brother gets caught and he throws you his child - and you keep running - and then if it wasn't bad enough to have to live in a tent, when you're pregnant and having to pee all the time, and your sister is in Turkey and you are worried about her, and its your first baby and you don't know anything about having a baby because you were studying finance in University before all this shit started - and if it wasn't bad enough to get a call at midnight from the UNHCR telling you to pack your stuff because you're being relocated tomorrow, so any friends you had you can only communicate by Whats App because no one can get around much - and if it wasn't bad enough that you packed all your stuff in one nylon bag, and your belly is hurting and you don't know why, and you are moved to a hotel past the airport, and there is an abusive helper man there but you can't tell anyone, and if it wasn't bad enough to be living in a hotel, with no chance to cook so you want to be back living in a tent in a warehouse ....

Then you may be in labor but you don't really know - and who has ever been pregnant for the first time knows how this feels - and of course we get calls all the time when people think they're in labor and they just need some love and reassurance and they usually go back to sleep, unless they really are in labor in which case we go to be with them.

But in any case, there's no one to call, and you're frightened for the baby, so you call an ambulance. And indeed you're not in labor, but its kind of around your due date, and your baby's big according to the ultrasound, so you have a c-section. Alone, because husbands aren't allowed in, and because you don't have a doula, and because just because. Your life just gets more and more painful, and the blood is awful, and the people speaking Greek to you, loudly so you understand, but you don’t understand anything – not why you had to leave, why you are running, why you can’t just go to Switzerland where your brother is, why you are having your baby cut out of you instead of how normal people have their babies … it is awful, and you think about your friend a few years ago, she had a baby. She had it in the hospital, back home in Syria, she said it was painful but nothing you couldn’t do with just a little encouragement. Her older sister went with her, and she had a nice doctor.

Cesarean section rates are ridiculously high in Greece, much higher than the recommended 15% that the WHO suggests is a rate that both protects mothers and babies, and higher than the rate was in Syria before the war (see Syrian c-section rates here). Our average in Canada is around 25%. That’s one in four babies born – but those figures vary widely across the country and across socio-economic lines. More wealthy and educated people in Canada are now working hard to have a vaginal birth, and of course the possibility of midwifery care greatly increases your chance of having your baby vaginally. My private doula clients have generally had rates of c-section varying from 6 to 15 %. The volunteer doula program I led for many years served marginalized families in Montreal, and our c-section rates were high – up to 35%. I am extrapolating from my figures and from what I heard from the mothers I met, and I suggest that from a Greek 60% it may go up to closer to 90% for asylum seekers, in a rural hospital next to a refugee camp.

If you are an asylum seeker in Greece, you are at the mercy of spotty health care, and that care is embedded in a system that doesn’t work! The medical NGOs are doing their best - Medecins du Monde, Medecins Sans Frontiers, SAM, Rowing Together ... but prenatal care is patchy. And there isn't the kind of continuity that always makes a difference. Frequent ultrasounds are the norm, instead of quality week-by-week prenatal care. Logistically, it’s easier to plan an induction or a c-section than to have a laboring woman transferred by … by what? Taxi? Ambulance? Someone’s private car?  … at 3 in the morning if she goes into labor and has been relocated to the back of beyond? So she gets the call from her doctor, or a doctor who comes to the hotel or the camp, and off she goes.

The word is, that doulas aren’t allowed in the hospitals, but I don’t believe it. I believe a friendly, smiling face accompanying a laboring mother will be welcomed by the hospital, especially if that mother starts screaming the doula’s name when she is separated (sorry, yes, I have done this). I want to change things around for these mothers, and provide them with caring companions who will be with them through thick and thin. Even if they don’t get to go into the labor room, even if a mother does end up having a surgical birth, a smiling face at the end of that tunnel is a life-changer.

I’m not big on bureaucracy, protocols, rules. I believe kindness, unconditional love, and a little who-gives-a-shit attitude can go a long way. I am determined to change some peoples’ lives for the better, starting with their birth day.

Who’s with me? Please let me know if you would like to be part of my dream: leave me a comment and I will reply as soon as I can, or join my group on Facebook: Birth Companions International.