Birthing a Marathon?

mile 22

The way I see it, running a marathon and birthing a baby are very similar. I have attended well over 500 births (but under 1000 for those who are into numbers), and these three answers are the most common ones to the prenatal question I ask: "What is your greatest fear?"

• Dying
• Pooping in public
• Not being able to do it

I am a ravenous running nerd, and I read everything and anything to do with running, and I believe these are the three main fears of the marathon runner too: no one wants to die (hence the plethora of articles about people dying at races; no one wants to have to poop suddenly while running (more articles; EVERYONE worries about not finishing a race, for whatever reason.

When I am accompanying a pregnant woman, I may speak with her about her fears for the coming event. The number one fear is that her or the baby will die. Number two, fittingly, is that she will poop during the pushing phase. And number three, as in a marathon, is that she will have a DNF which actually is impossible in birth but, unfortunately, a definite possibility in every runner's mind.

Birthing and Running are the Same?

No, they're not the same, obviously, you can't compare a baby to a piece of bling!

You can compare some of the feelings, though. The hours, days, weeks and months of preparation. Finding a program or a method that matches your philosophy, or hiring a running coach (or a doula - we used to be called "birth coaches"); learning about nutrition; getting excited, then nervous, then depressed, then excited again; talking to other people who have done it ... of course, if this is your first baby or your first big race, all these feelings and choices will be felt and made in technicolor. If you're more experienced, you will still feel the same range of emotions, and you'll be "in the club".

That's where the similarities end, unfortunately.

Running the Drugs?

Runners, imagine this: You're at mile ten, almost half way through your marathon. You're keeping a good pace, maybe you started a little too fast, because this is your first. Your training went well, and you're feeling good. Mile eleven, you have to pee. You take a quick pee stop. At the next station you have a sip of Gatorade and you start to feel a little queasy, the way you ALWAYS DO when you have some carbs around miles ten to fifteen. You know this about yourself. It's a thing.

Suddenly, a car drives up and a bunch of people jump out, looking at their watches. "Your pace has slowed down too much! You're not gonna make your BQ! You might die!". In your head you know they're wrong, and you try to shut them out and run faster, anyway. But their worried expressions start to seep through your endorphin rush. "Oh, shit, does my heart feel weird?"

You let them know you're feeling a little tired, and you had that queasy feeling. All of a sudden, the car speeds up and they make you an offer: "Take some drugs, get in the back of the car, we'll drive you to the finish line, you'll get the bling anyway, all good, no shame, no worries." You protest - you're okay! But a voice in the back of your head says that actually, you're not okay. You need the drugs and you need the car ride. By this time, you're at mile 20 and you hit the wall. Take the drugs, get in the car.

Real Emergencies

Of course real emergencies exist, both during marathons and during birth. In those cases, there's no question that you need the damn car, preferably an ambulance, and you need drugs, and speedy medical intervention, and everything you could possibly grab for a life-saving conclusion to the RARE instance when you are actually in danger of losing your life (or if you're birthing, your baby's life).

Your Choice?

I'm not one of those airy-fairy militants who advocates a natural, candlelit birth for every woman. I've seen babies die, and I've seen women close to dying (Thank God for modern medicine!!). But I  do advocate CHOICE. I was just speaking to a fellow runner this morning. She's been running for twenty years and she's never gone further than 15k. She never races. She runs slow. Me, I've been running seriously for just over five years and I love to race. I push myself ... not too much ... but just enough.

I was at a race about a month ago - it was kind of tough: it was pretty cold and at one point the course turned into a muddy, icy puddle for about a kilometer, and it was a loop, so we had to do the puddle twice, once about the middle of the 21 k and once closer to the end. As I was coming up to the first mud puddle, I saw a runner with a weird gait... I got closer and I saw one of the yellow-jacketed medical people going over to him with a concerned air. The runner told him to go away. As I got closer, I heard him groaning with every step. He sounded like a woman in the deepest labor, feeling that baby's head right down low. A second medical person ran up to him: "Non, non, ça va, merci." ("No, no, it's okay, thank you!") I ran past him and didn't look back.

Here's the thing: I knew that if he was in that much pain already, there were two possibilities: either he would not finish the race, and spend months if not years fixing the damage he had wrought on his body; or he would finish the race and ditto. But, for whatever reason, he MADE THAT CHOICE and it was his to make. Obviously, if he was in cardiac arrest, or lying on the ground unable to move, the paramedics would be in there in a microsecond, doing what they need to do. But he was birthing a marathon HIS WAY.

Birth

I've witnessed a tiny number of births that ended up to be medical emergencies, where mother or baby could have died. But most of them are normal, scary, joyful, life-changing, painful, pleasurable, primal events. Unfortunately, the people who work in the maternity care field are usually unwilling to adopt the "marathon runner" model, and instead use the "air crash" model. In the latter, birth is simply an accident waiting to happen. In the "marathon runner" model, the birthing woman could be treated like a marathon runner: during the nine months before the event make sure you are healthy (I got a cardiac ultrasound done last year before starting my marathon training because of a risk of familial cardiomyopathy); create your team; and start preparing.

Let's skip ahead to the "event": the runner has been trainings for months. She followed a training program, or had a coach guide her through the realities of training to run 26 miles. The birthing woman has been preparing for this day for months as well, and she has been working with her team to make the upcoming event as pleasurable as possible.  Both the runner and the birthing woman have possibly been reading everything they can about their upcoming event, and both may have suffered setbacks along the way.

Running

And, now, what happens when you're running a marathon? You join a big, happy crowd of people, and you start. As you run the miles, you are handed water, energy drinks, yummy gels, bananas. All along the route there are smiling people, holding funny signs, cheering you on, giving you high fives ... letting you know you're doing great!

No one looks at you with a worried look, even if you're the oldest person in the race and the slowest (happened to me on my 60th birthday), they just keep on smiling and cheering, unless, like I said, you're on the ground.

Then why, oh why, did my lovely, young, strong, healthy, well-fed, happy labouring clients get the hairy eyeball from the staff when all they were doing was, basically, the marathon of the day. No smiles, no happy people handing you cute cups of water, no cute cups of energy drinks, no gels, no bananas, no funny signs, no high fives.

The epidural rate for first time mothers in Montreal hospitals is over 90% (don't look at the published statistics, they include second-timers who know better, and pull that statistic down to around 60%). Why? Because we focus on the fear aspect (YOU COULD DIE!!), instead of the fun aspect (YOU GO GIRL!!).

Fun Stuff

Yes, the truth is that running a marathon is just plain more fun, and more pleasurable, and better appreciated, than bringing another human into the world. Weird.

So, I guess that's why I don't attend births in the hospital too much anymore. It just kind of tickles me when I imagine birthing mamas being treated like runners - and how different it is from the reality:

"hey, I know you're planning on running the Barkely, but it looks really dangerous. I think you should run it attached to an IV pole."

Or, "hey, I know you're 60 and you're planning on competing in the World Marathon Challenge. This is super dangerous, why don't you just get really stoned and we will drive you around - you deserve it!"

Or, "you know you could die doing that? Running a marathon/birth/solo travel/sailing/(fill in the blank) is just too dangerous."

Yes, I know I'm gonna die one day, and I'll let you in on a secret - so are you. And so is everybody. But I really wanna have fun while I'm doing this crazy little thing called life. Spread the Love!

Safe Birth?

These days, we have all become experts at reading articles in medical journals, or studies, and we casually use words like "exponentially" and "virus shedding" and "evidence-based". So, I am not going to go that route again, and quote this or that Cochrane review that will further convince you that I'm right. I don't even want to think in terms of who's right and who's wrong. I want to go deeper than that. Way deeper. I want to explore what makes birth sacred, and what keeps it sacred, and therefore safe.

I have witnessed three newborn deaths in my doula practice. Two in particular stand out for me. One took place in a birthing centre, and the birth was attended by midwives. I was the doula. When it was clear that the baby was in serious trouble, the midwives, in their fear and panic, became insensitive to the mother's emotional needs. They told me, the doula, to leave. Mother felt isolated, abandoned, and traumatized even more than she had to be. These midwives, don't get me wrong, did everything they should have done medically, to try to save baby's life. But they completely ignored the spiritual, emotional, transcendent nature of birth. Conversely, I was present when another baby died soon after birth in the hospital. The medical staff provided a space where the parents could hold their child and say goodbye. The parents wanted me there, so I hovered, as a good doula does. The fact that they even had spiritual needs was fully honoured by the doctor, the nurses, and the orderly. 

Both mamas lost their babies. Both mamas grieved. But both mamas were not traumatized for years. Because one mother felt safe during her birth experience, and the other did not.

So, what can we do to keep birth sacred? I believe if the sacred nature of birth is remembered at all times, then the attendants will be naturally drawn to keeping the mother safe at all times. Sacred. Just play with the letters a little bit. Scared. Being scared during childbirth is something that has a physiologic root. When our bodies release the stress hormones that initiate the "ejection reflex", our busy brains interpret those feelings as "scared". I have attended the most natural, undisturbed, physiologic births where I have seen the mother become afraid at that moment. It passes, it's transient because it's just a reaction to a physiologic event.

But I've also attended too many births where the birthing mother was actually afraid. She was actually made to feel afraid by the words or actions of her attendants. I often found my job as a doula to be one of shielding, holding the sacred space, creating a human sound barrier between the abusive staff and the birthing mama. Scared destroys sacred. It degrades sacred, pulls it down, tears it apart. Scared does not belong anywhere a mother is giving birth. Even if you're the primary attendant, and you are scared because of something that's happening, your priority is to keep that fear from entering the space.

If a birth attendant doesn't believe that birth itself is sacred, then we run into problems. If you think it's just another medical procedure, then it makes it more complicated. But every doctor knows that a happy patient heals quicker and better than an angry or lonely one. So even if we're not talking "sacred" because some people are scared by the word, we can still try to keep the birthing mother happy, right? And a happy mother feels safe.

Our maternity care system is broken. Too many women go into the experience with no understanding, and they trust their medical caregivers of course, because why not? And they are sadly betrayed. They're told all sorts of scary things: your baby is too big, you're too old, you have a something percent of this or that horrible thing happening, you won't be able to stand the pain, your baby is too small, you live too far for a home birth, there are no midwives, you have to pay $10,000 before you can even think of birthing here, and on and on. Many, many women give birth just fine within the medical system, often with the loving attendance of a doula. These women are a testament to the strength of the birthing mother. But too many do not give birth just fine. They leave the hospital or the birthing centre traumatized and confused. Some traumatic birthing experiences literally take years to recover from. Other women live their whole lives with feelings of inferiority and a damaged sense of worth. Still others spend their whole lives to make the birth experience sacred and safe for other women (Yours truly!). 

There is a growing number of women who are taking the situation into their own hands, and their own homes. They are saying "no" to maternity care that is based on fear, and they're giving birth on their own terms, in their own homes, with people around them who they trust. Keeping birth sacred. 

I don't believe a normal pregnancy and birth belongs in a hospital. Hospitals are places where you go when your health is at risk, or you need surgery. Normal birth is sacred and belongs at home. The undisturbed mother feels safe, and everyone around her participates in the sacredness of the event. This has become clear during the current crisis, where the role of the hospital has been clarified by the event. 

But if we bring birth home, where it belongs, then are we sacrificing another kind of safety? If we don't have midwives who are trained in the art and science of attending Sacred Birth, then every home birth will be a "freebirth". Which is fine for those mothers who want that. But many birthing women want to have someone present, who knows about the things that can and do happen during birth, when it is important to have someone attending who knows how to respond.  

I'm asking questions. I don't have practical answers yet. I am grateful for you doulas out there who are still attending births in the hospitals, and I strive to support you as much as I can. I am grateful to the birthing women I attended throughout my practice, who taught and continue to teach me so much about Sacred Birth. 

Let's talk this out! Let's strive for answers! Let's change birth and keep it Sacred!

Cesarean Awareness Month

It's funny they would have a month for a surgical operation. I have the same feeling about Black History Month. Like, if it's important, shouldn't we learn about black history every day we learn about history? Like, shouldn't the history books be rewritten? They're certainly biased....

I digress. Let's deconstruct history another way:

Pithiviers, France, is remembered by some French Jews as the place where their relatives or friends of the family were sent after the Nazis occupied France. There was an internment camp there where families were separated and the adults were sent to Auschwitz to be killed.

We also remember Pithiviers as the place where Michel Odent was head of the maternity ward from 1962 to 1985. Here, he fashioned his notions of natural birth, by creating an environment where women could give birth in an undisturbed way. He provided singing sessions during the prenatal period, birthing pools, and skin-to-skin contact after birth.

Years ago, I was part of a group of birth workers who brought Dr Odent to Montreal to speak. I remember being so shocked when he suggested that there was a causal relationship between the murder and violent crimes rates in some cities in the world, and the cesarean rates. Effectively, he was suggesting that if you have your baby by cesarean, then they are more likely to become a violent criminal. I immediately took a dislike to him and his silly ideas, and, more importantly, I asked myself why there was a whole room of healthy, young women absolutely worshipping his words? There he was, a shrunken old white guy, talking about how babies needed to go through the vagina and arrogantly proclaiming that women who have cesareans are going down the path to hell, and dragging their newborns along with them.

Fast forward a few years and I was up on the stage. We were doing a little panel about VBACs. A woman stood up from the audience and said that she was newly pregnant with her second, hoping for a vaginal birth after a brutal c-section with her first. She wanted advice from a midwife on the panel. This is what she got: "If you want to give birth vaginally, you have to put your big girl panties on and fight for what you want."

And I remember teaching a class to a group of doula students, and the woman teaching with me said that, generally, women who have repeat cesareans have a lot of unprocessed resentment to deal with, and if they dealt with it their chances of VBAC increases. 

So, in a nutshell, three birth professionals said: women who birth their babies by c-section are driving up the crime rates because their children are more likely to be criminals (also, in an article he wrote in 2008, Odent suggested that cesarean birth may produce more male homosexuals); that women who want a vaginal birth after a previous c-section should somehow grow up so that they can achieve this; and that women who have c-sections may be dealing with repressed feelings, and that repression or other negative feelings such as resentment could be the reason for the surgeries.

If we look at these criticisms from a feminist perspective, they seem very similar to the rape dilemma - don't wear provocative clothing, don't go out at night alone, don't drink, or you will become a victim.

There's a feeling amongst the "natural" birth movement that a woman can have a "natural" birth if she wants it hard enough. We can read of powerful, transcendent, wild, free births where a woman moves through portals to meet her child. These are lovely, indeed, but not everyone can have or would want to have that experience.

In my opinion, giving birth is a very private act. It is so varied, the ways in which we birth, almost as varied as, for example, the shapes of our noses, or the leafiness of our labia. Some women want to birth alone, or just with their partner present. Others want their children there too. Some want a doula or two, and a midwife. Other women prefer a physician, and they want to be in a hospital. Some want to have a midwife follow them, and they want a water birth in the birthing centre.

All of these possibilities should be respected as valid, informed choices. So why are they not? Because, often, if a woman chooses to be followed by a medically trained midwife or a doctor, she ends up giving up her right to informed choice and she gets put on a conveyor belt where she is no longer the central person in this sacred, primal event, and she gets things done to her. The birth process gets put on a schedule; the body is examined time and time again; this or that intervention is done until finally all the options have been exhausted and she is wheeled into the operating room.

Yes, having a doula present will decrease your chances of c-section by a decent percentage, especially if you are a mid- to high-income woman living in an affluent country (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003766.pub6/full) 

Women choose to go the hospital to have their babies for many different reasons, and none of these reasons are an excuse for an unwanted and unnecessary c-section. What could these reasons be? 

• they want the security of being in a hospital
• they wanted to have a midwife follow them but couldn't find one
• they don't have health insurance and/or can't afford a midwife
• they don't have a home that is suitable for a home birth (think abuse, living with a lot of other people who aren't supportive, and those kinds of things)
• they don't know their options
• they are forced to because no one will attend them at home because they're carrying twins, or have had several c-sections, or they're obese, or are substance abusers
• they are followed by a midwife but get transferred to the hospital because of government regulations (labour too long, pregnancy too long, suspected this or that)
• covid-related issues reduce their choices

Any number of these women could end up being part of the 25-30% of women who give birth in the hospital who end up with a c-section. The WHO suggests that 15% is a reasonable rate. I insist that here in our affluent country, a c-section rate of 5% would adequately save the lives that have to be saved by obstetric surgery.

How can you avoid an unwanted c-section? Ask questions. Hire a doula, or find one for free. Contact me and I will do my very best to connect you to the people you need. Find a midwife. Get a doctor who hears what you're saying. Say no. Don't do anything that seems wrong. 

Let's work together to put the Cesarean section back where it belongs - in the realm of emergency surgery!

Birth and Pleasure!

Here are some highlights from the Birth Companions/DONA workshop with Debra Pascali-Bonaro last weekend. We started out sitting around in a circle, with notebooks at hand, listening intently to what Debra had to say...

Day One, Hour One

The room started to get a little messier and we all moved in closer to Debra, and to each other, as we started to get into her words and the concepts we were exploring together.

Moving Closer

Group Work

Debra explaining about positioning. As I was saying - Birth is Simple! An introduction to the concept of pleasure during the childbearing year.

As the days progressed, we got to know each other better through working in groups of two, three or more. Women came from Nova Scotia, Quebec, and Ontario to participate in this gathering, and from such different backgrounds! But we found common ground and really connected.

And That's It! Debra brought her birth cards out - a wonderfully innovative tool that really helps the new parents to imagine and understand what their options may be, and how one choice will have consequences on how the birth will unfold. The students played with these cards to learn how a doula can help the new parents to make choices prenatally.

Working with the birth cards

I Love You  Taking the time to treasure each other and ourselves.

WomanPower!  We learned important techniques to use during labor and birth: the rebozo was a favorite! And of course the messiness of the room was no longer a consideration. We were getting down to the ground and having a good time! Shimmying with a rebozo Through active role play the students learned how they might act with a real woman in real labor. They used props such as birth balls, rebozos, and learned about positions in labor, prenatal positioning, and some massage work.

Shake and Lunge!

 This useful tool hangs on a door (make sure it's locked!!) and a laboring woman can pull on it as she squats.

Deep Squat

 Finally, on Day Four, our babies were ready to be born. Our doulas comforted each other through active labor and used all the techniques they had learned during the final role play. They used birth balls, rebozos, positions, physical comfort measures, and a lot of vocalization! The room was alive with woman sounds: moaning, yelling, sighing, and laughter!

Thank you to everyone who made this workshop happen!