Tuesday, December 22, 2020

Midwifery and Bullshit


These are not midwifery tools, but they could be. 

I have started offering prenatal support and consultation to women who are looking to give birth in an autonomous way. Several of these women are being followed, or have been followed, by registered midwives here in Canada. I've also spoken to a few practising midwives in this country, and I believe our midwifery establishment is in crisis.

We were an unusual country. Midwifery was illegal in all of our provinces and territories until the 1990's, when provinces started to recognize that it would be useful to register and educate midwives in the medical model. During the twenty years from the 1970's until midwifery was legitimized and regulated, midwives worked illegally to assist mothers at home, and there were a few midwives who were charged with practising medicine without a license. 

During the 1990's, midwifery became regulated and legitimized in several provinces. Midwifery education programs were developed and offered in universities across the country. These programs were very hard to get accepted into, and required a formal academic background over life experience. Most of the original lay midwives who had been practising illegally before legislation were "grandmothered" in to the Colleges of Midwives, but the applicants who were accepted into the programs were generally younger and obviously less experienced. 

Midwives were and are in great demand. The supply is very limited, partly because of the restrictions that competitive educational options and limited employment options mean for anyone who is drawn to the practice. Provincial governments in Canada have succeeded in effectively reducing the number of potential practising midwives, either with restrictive educational possibilities, or by limiting the ways that midwives can practice.

Because of the lack of registered midwives, and because the available midwives were practising in the medical model, several women over the years in various provinces in Canada chose to give birth either unassisted or with Traditional Birth Companions. As well, midwives trained in the US or elsewhere started offering their services as midwives and attended women at home. This was risky, because with the creation of a College of Midwives, anyone offering restricted practices under the provincial midwifery acts could be (and were!) prosecuted by the provincial College of Midwives. So far, this has happened in B.C., Saskatchewan, and Quebec. 

The pandemic of 2020 changed the face of birth. Women who were hiring doulas to accompany them to their hospital births found that the hospital authorities had full power to limit the number of people present, and doulas were left at home in front of their phones, providing encouragement, support and continuity of care from afar (Hats off, shout out, Kudos to all you doulas out there!!!). Home birth was restricted or banned in some areas, and midwives were given even more rules and regulations they had to practice under. 

Hospitals were seen, rightly so, as places for sick people (hmmmm, isn't that what they always were?). A few women, certainly a larger number than in 2019, decided that they would give birth on their own. Others decided that they would continue with midwifery care and fill in the gaps with the council and support of other practitioners.

Here is a little account of what is wrong with midwifery today, gleaned from conversations I have had with women seeking answers, and why I believe it has gone wrong:

  • Newborn mothers and babies do not need immediate testing. They need skin-to-skin togetherness, if the immediate indications of their health is good.
  • Newborns do not have to latch on the breast like a champion within the first half hour of life. Again, they need skin-to-skin togetherness. Mother will need to eat and drink. Attendants should stick around with gentle attention.
  • If you say that you will offer a woman attendance at her home, and you visit her home and bring equipment and preparations ... she is not going to hear your quid pro quos and fine fine print at the bottom of your conversations. She will be deeply disappointed when you tell her that (for whatever reason, that has to do with YOUR infrastructure and organization of lack thereof) she cannot after all birth in the comfort of her own home.
  • Women over 40 are not inherently dangerous. They can carry a baby to term and do not need extra testing or worrying conversations about how risky their pregnancy is. That's why she chose you, a midwife, so they wouldn't have to be bullied.
  • Midwives have to learn to keep their faces pleasant. So many women have let me know that they got really scared when they saw a young midwife look at their lady parts with horror/fear on their face. A vulva or a newborn's head can look wildly psychedelic, but usually is no reason for alarm.
  • The word "should" doesn't belong in your vocabulary if you are attending a birthing woman. 
Women now, a small percentage but nevertheless a percentage, are choosing to give birth at home autonomously instead of seeking the attendance of a midwife or a physician. This fact makes me sad. Why? Because I believe that every woman deserves a safe and sacred place in which to birth her child. Some women want to birth in the hospital. That birth should be as respected and loved as a birth that takes place at home surrounded by a circle of women. Some women want to birth at home, and these women deserve respectful, kind, reliable, and legal midwifery care. 

There is work to be done!!!

Sunday, December 6, 2020

Meconium Happens

The more I live this life, the more I am convinced that the deal is, it is not what happens to you that matters so much, it's how you accept it (or not). I have been to births that have been really challenging and tough, where the woman accepts the labor and is thrilled with the whole experience. I have seen other women fight against labor and birth, one contraction at a time.

Today is December 6, 2020. A day like any other. Except not: it's the anniversary of the day when 14 women were killed by an armed killer.

It's a day when my friend had to go back into hospital. It's a day when thousands of people died from Covid-19.

It's a day when we have to, as always, take the joy from every moment and cherish it. And even when we are full of joy, and all comfy in our enlightenment and entitlement, shit will happen. Meconium does happen. A baby can suffer some small slight and poop. Or a baby can get their cord squeezed so much they poop a lot. Things break down, things break. People break. 

But where there's rupture, there's repair. A body's urge is to health, just as a plant moves towards the light. In the same way, the knowledge of women has always been towards healing. 

We can't do anything to bring those women back to life. But we can speak out against violence every single day. And, unfortunately, in my field (haha no, not in my cafe...in my real field which is maternity care), violence against women is rampant, ugly, and expected. 

What can be done? Well, one thing that's happening is that pregnant women are rising up and saying "No more violence! No more treating me like I'm a child, that I don't have feelings, that I don't know my own body. No more speaking about me as though I'm not present. No more making decisions about my body without my consent. No more doing things to my body without my consent. No more lying to me!" And how are these women doing that? By withdrawing from the hospital system. They are giving birth on their own or with Traditional Birth Companions. 

Another thing that is happening is that doulas are continuing to support women who choose to give birth in the hospital. Or, more importantly, those women who don't actually have the choice and have to give birth in the hospital. Especially these days, it's hard to be a doula. Many hospitals have taken away the birthing woman's right to support by insisting that she choose between her partner and her doula. So doulas are providing companionship and support virtually. 

Medical staff in hospitals in today's world are stressed. They're overworked, tired, and they have all the same concerns on their minds as you or I. Suicide rates are higher for physicians than for the general population, and higher for female doctors than males. The medical system isn't working for anyone.

What can a doula do to relieve everyone's symptoms? Let me be clear: when a doula works to facilitate a mother feeling empowered in a situation where her power can be taken away from her at any minute, we are not talking about getting at the root of the problem. If a birth is an undisturbed birth in a place where the birthing woman is comfortable, safe, and respected, then the doula can do the work of being a doula: easing labour, providing encouragement, seeing to the birthing woman and her family's needs. But if a birth is taking place in an environment where the go-to routine is medication, management and directives then the doula can only provide bandaid measures within a strict and abusive system.

And these bandaid measures can work! Any number of women leave the hospital with their babies feeling joyful, even ecstatic, and satisfied with their care. But a huge number of women leave the hospital hurting.

Is it time to finally step away from an abusive system? What happens to a woman when she has a vision of a natural, normal birth and she arrives at the hospital and things start to go haywire? Is it possible to convince women to stay at home, at least until they are in active labor? What about the woman who feels every contraction, from the very beginning, like torture; the woman who can't separate her labor contractions from an abuse she experienced years ago? What is the role of the doula through this seismic change? What about midwives? Why are midwives still using the words "should" and "allow" when they speak about birth? 

Is it time to Rise Up?

Tuesday, December 1, 2020

Birth and Scars

As we grow, we absorb big and small shocks to our bodies and souls. We all know where our physical scars are, and we often assign stories to them. I remember when I was skipping school and the knife chose that day to slice my finger, so I had to get myself stitched up without (I dreamed) my mother finding out. I have a little white line on my finger that tells that story.

Some women have bigger scars, on their skin and their muscles, from birthing their babies. I hear these stories often when I am speaking to women about their birth experiences.

Other women have emotional scars that last for years. These scars have a way of aching and burning during pregnancy and birth. The doula can gently assist the woman when she is feeling these aches and pains. Doulas are not therapists so they do not have to probe, suggest, or hypnotize. What they do is provide a non-judgmental ear, if the woman wants to talk. They let her know that she is not alone, that she has support. They also remind her that there are other women who have traveled the same road and survived.

One of my students is accompanying a woman as I write. The woman has been in labor for most of last night and today. She does have emotional scars, and they are hurting. My student has been with her the whole time, supporting and comforting. And even though my student is a very inexperienced doula, she is still providing the essence of what a birthing woman needs. The expertise, medical know-how and scientific facts is not the realm of the doula. She is there with other skills: the skill of touch, listening, compassion, and presence.

With our world changing every day; with our experiences and our innate wisdom challenged every single day; with our routines and habits changing minute to minute, we are starting to see between the lines of our lives. We are starting to look between the cracks; to probe between the layers of darkness that we have been hiding behind. We, as women, are starting to see what has been hidden: that birth is a unique act, unique to women; that women's bodies are exquisitely designed for this task; that a woman births best when she is surrounded by a loving circle of care.

It is wonderful if that circle of care can include someone, an elder perhaps. who know about the vagaries of Mother Nature and her cruel jokes. But if not, chances are that everything will work out fine. And that is better than being treated like a child, when you are bringing forth new life.

So I see women and their partners and their communities going about their lives, far from hospitals and Covid regulations. And it makes me sad that with this huge machinery of health care that we as a society couldn't have created a safe and sacred space for women to birth in; but I understand why that isn't possible. Can you imagine what would happen if the power of womanhood was actually unleashed? 

Think about the biggest wave you've ever seen. Think about the most love you've ever felt. And the most beautiful place you've ever been. Imagine what it would be like if women grew babies in their wombs and birthed them with respect, honour, and love. 

Scars have a way of healing. With healing comes change, and growth. Womanhood has been injured and scarred for too long. There's a new era coming, so watch out!